Sunday, June 25

the Crossover Ep 112 - Are you a good hair boss or a bad hair boss?

The world's first and best Fire/EMS/Police Podcast keeps on keeping on with a show about hair.  And management.  In this episode, HM and MC discuss different leadership styles. From the Good Beat Partner to the Condescending Prick, leadership styles are as varied as the people that fill those roles.


What makes a supervisor good (besides the hair)? How can those of us being supervised offer constructive criticism/encouragement to a newer boss versus taking whatever is thrown at us from a supervisor that is “feeling his new stripes”?

Recently, EMScapades published a very telling cartoon (see below) that struck a chord with the guys and they spend this episode discussing it.

Here’s the cartoon from the fine folks over at EMScapades:


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Stop Responding for Overdoses? Sign Me Up!

Middletown, Ohio.  Population 48,000 and change.  About 1/3 the number of people who pass through my service area in a day, has an opiod problem.  As the noted thespian Robin Williams stated in the motion picture Good Morning Vietnam "There isn't a marijuana problem in Vietnam...it's everywhere."

Middletown Ohio Councilman Dan Picard (No relation to the Starfleet Captain) is frustrated according to this story where he asked if EMS can just stop responding to overdose calls.  He applied the ever so American baseball "Three Strikes" correlation and asked if EMS could just not respond after a third ODcall to the same address.

Sign me up dude!

There's nothing I hate more than going to the same address and dealing with the same people for the same conditions.  Trouble is, your hamlet has done an incredibly poor job at dealing with the opiod problem and this is the fallout.  OH, and how do we differentiate between a foul and a strike?  After all the first 2 count but if they keep hitting it back and into the bleachers what do we do?

In the story Mr Picard notes that most of the OD patients are transients and not even residents of Middletown.  Well, shoot, Dan.  There goes your entire argument.

You see, when the call comes in it rarely mentions an "OD" or "Overdose" and since you said most of the overdoses are transients there is no consistent address to apply to them and deny the services.

But you know who we CAN start scaling back on?

Diabetics.  They are usually at home and the medications we give them are on par cost wise with narcan.

Seizure patients.  Again, usually at home or wearing a medic alert bracelet, the medications we give these folks are actually narcotics.  Imagine the cost savings if we stopped responding to their home after the third time we have to stop their seizure and get them breathing again.

I get it.  You're frustrated that people come into your little corner of the world, do drugs in the open, then have to be revived by your EMS system.  Costs are skyrocketing and you may not be able to have fireworks at this year's 4th of July party.  I get it.

Here's what you need to get, Mr Picard:

An understanding of addiction and a plan to prevent it.

The story points out that a new addiction center just opened and is starting to make a dent, but just a quick search has Middletown as a hot bed of illegal drug trafficking.  Maybe you should hire some more cops to intercept all of the fentanyl laced heroin and crystal meth rolling through town before holding back on the narcan?  After all, does that double in OD cases reported include home prescription ODs?  You know, of the people who you might actually give 2 cents about?

Oh, and one last thing before I go...you are quoted as saying

“I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life,” Picard said. “We need to put a fear about overdosing in Middletown.”

If withholding care is how you handle things I don't think many people want to goto Middletown in the first place.  Except to get drugs, which appears to be remarkably easy.

Saturday, June 24

Yup. Still Barfing

Somewhere along the lines the term "Emergency" has morphed.  I have argued in this forum and others that it is the patient's definition of "Emergency" that drives the system these days, not ours.  After all, what do we know?

But there has been a third party lurking in the shadows of EMS that has only been empowered by technology.  I am speaking, of course, about the third party caller.

Walking past a man sleeping in a doorway?  Whip out that cell phone and tell 911 that no, you can't see if he's breathing and no, you aren't going to go wake him up. Eww.

Now we're rolling lights and sirens to a "Man down, unconscious, breathing status unknown" when all you had to do was either keep walking or gently shake them.

Cell phones now allow a person to call 911 from across a crowded room without even making contact and asking a person if the want, or need help.

Case # 14,338,265 in point:  Last night.

Code 3 for the man vomiting.

Seriously.

Crews arrive to find a man vomiting into a trash bag, embarrassed, and waving off rescuers. "I feel horrible, but I'm fine."

30 minutes later crews are dispatched again for the "recall for the man vomiting."  As a supervisor I always like to roll on "rekindles" just to make sure everything is on the up and up.  After all, if the man changes his mind and now wants an assessment I need to make sure everything on the first contact was on the up and up.  Part of the way to this call I heard my crew on the radio, "This is the same person who refused assessment earlier, a third party called this in again."

So a special thanks to the person in the area who called 911 for something that happens all the time without approaching the person to ask if they need help, seeing him refuse Paramedics, THEN CALLING AGAIN.

 

What should have happened was this:

"911 what's the location of the life or death emergency?"

"Hi, there's a guy puking into a bag. I think he needs help."

"OK, walk over and ask him...I'll wait."

 

That would be so much easier, cheaper and better for all involved.  Instead, my medics hit the doorway and muttered "Yup, still barfing."

Wednesday, June 21

I Heard You, She Heard You, the Baby Heard You

This post is a vent of frustration that this therapy experiment was created for.  We bring you into the action where a full ALS assignment is standing by for an international overseas flight requesting Paramedics for a woman in labor.

Most of the time this is no big deal since airlines won't allow you to fly if you appear to be so pregnant that you'll deliver enroute to your final destination.  As the door opened the look on the face of the crew told us this would be the rare exception.

"Did you have a live birth on board?" I ask, formally as possible.

"Yes, it's a girl!" says the excited Purser.  He clearly has a great story to tell and I'll hear it after I get some APGAR and vitals from mom and the baby.

As has been happening far longer than we know, mom and baby did this all on their own.  A quick thinking passenger with kids of his own inspected the placenta and put it in a bag.  Our observation matched his and we're quickly giving mom a wipe down so she and baby can leave the plane with dignity, not covered in afterbirth.

Baby is about 4 hours old and doing just fine, we fashion a quick diaper and swaddle, making sure the EMTs without kids at home watch and learn.

When we later discussed the call and what happened immediately afterwards, everyone of the responders expected applause for mom and baby as we left the plane.

Dead. Silence.

It was Mom's long, billowy black gown, headscarf and olive toned skin, we would soon learn, that was causing the passengers to begin to draw conclusions and assumptions about what has transpired.

Out of the plane into fresh air and mom and baby are still doing fine.  The ambulance crew arrives with a fresh, green intern and we set him loose on the patients and close the thin curtain between the customs inspection/patient care room and the jetway where the passengers are about to leave.  It's a small area and there are a lot of us.

"Do you have a name picked out?" I ask mom soon after asking Dad for their travel documents and Passports to hand over to the Customs agent just outside.

Her answer was not Sally or Jane or anything else I recognized so I offered my congratulations and handed the documents outside.

"Enjoy your anchor baby" is heard more than once through the thin curtain as passengers begin to disembark the plane. "Good planning, enjoy free everything" is also heard and I begin to tense up.  Other disparaging comments are heard through the curtain but we can't leave the little room just yet.

They would not have said those things if they had the facts.  Or maybe they would?

Mom has a USA Passport.  Born and raised in the midwest.  Studied overseas, fell in love, got married and is returning home to have her baby near her parents.  Baby is 4 weeks early.

Baby isn't a citizen because Mom and Dad cheated.  Baby is a citizen because Mom is a citizen.

 

Have we really let things get so ugly that grown ass men will raise their voices to speak out against a woman and her newborn child simply because of her dress and complexion?

Yes.

The new parents planned on renting a car and driving out to the parent's place anyways, but first a trip to the hospital for a full exam for both and care and supplies for the drive. "Where do we even get a Car Seat?" Dad is asking, clearly still in shock of his new status in life. "Don't worry, the hospital will give you a list of everything you need before you make the drive home."

The drive home.

Is there a Doctor on board?

Or should the more accurate question on board an aircraft with a passenger feeling ill be "Is there anyone who has assessed a patient in person in the last, say 3-5 years?"

THE EMERGENCY

Tower reports an aircraft returning to the gate due to an unknown medical emergency, man unconscious.

THE ACTION

Units are racing over since a plane returning to the gate means delays and considerable cost to the airline and a loss of possible connections for those onboard.  It also means that the rest of that day for that plane and crew are now delayed.  They don't make this decision lightly.

The cabin doors open to a nervous looking flight attendant pointing us towards the rear of the fully packed 737, all 150 people wondering why they aren't in the air.

On the floor near the rear galley is a few vacant seats and no less than half a dozen people blocking our access.

"Hi folks, Paramedics, can I have all but one of you step out please?"

The man closest to me and still not at the patient's side simply breathes over his shoulder "I'm a nurse, we're going to get an IV going."

"I'd really wish you didn't until we have a look see.  What happened?"

"I told you," he says turning around so I can see the silly quote on his T-shirt, "We'll give a report once he's stabilized."

"Nope" comes out of my mouth as I direct him to be seated along with 4 more onlookers who have opened the MD kit on board and are slapping the AC of a man lying supine, shirt off, covered in vomit.

"Airway?" I ask so that my crews behind me can hear.  I step over the patient and pull the tourniquet on the far forearm and wipe vomit from the patient's mouth.

"He's dehydrated!" the woman calls to me from over her reading glasses. "I see it all the time in the office."

"He's unconscious and his airway isn't clear.  Folks thank you but please let us work." I said to the patient, who was slowly beginning to open his eyes.

A few moments later we have him breathing nice and deep, his color improving and we extricate him quickly down the aisle only now seeing the mound of vomit on the floor in front of one of the seats as well as partially on a young woman, clearly concerned for his well being.

 

Off the plane we are able to make a full assessment and place a line for some fluid.  Part of me wanted to go back on the plane and ask them what they were thinking trying so hard to start an IV on a patient with a mouth full of vomit, but I knew I'd be dismissed as an EMT who probably doesn't understand what it's like to treat patients on the mean streets of General Practice USA.

These folks are the minority but not the exception to the rule.  Luckily we are met with "Thank goodness you're here and a brief puff of dust as the person who helped until we got there gets out of the way.

Friday, June 16

the Crossover Podcast - Ep 111 - Paramedic Perv

Not me, you freak.

In this episode, HM and MC discuss pervy paramedics. Well, technically, just one medic. 


Here’s the link to the article to which the guys refer in this episode.


Not interested in listening to the guys wax philosophic about the appropriate time/place to get you a handful of patient breast? Here’s the Cliff’s Notes version:

FRIGGIN’ DON’T.

This Cliff’s Notes version of the show is brought to you by the fine people over at Patreon.com/TCS where you can go to support this very show!

BOLO


Wool by Hugh Howey

Orphan Black (Amazon Prime)

The Leftovers (HBO)

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Thursday, June 15

Reporter Unclear of Aircraft EMS Operations

Our old pal the Social Medic, Dave Konig, has a new post up about a report from the Business Insider that inferred that EMTs were "under fire" for the way they removed a patient from an aircraft.

Dave's story is here.  Dave's story also has the link to the local news story of the event. I will not link to the Business Insider Article.  He doesn't deserve the traffic.

The author's name however, is Benjamin Zhang, and if he has a google search for his name running...Hi Ben, sit down and let's have a chat about patient care onboard an aircraft.

Just you and me.

You a transportation reporter and me a Rescue Paramedic Captain at one of the busiest airports in the world.  You know, expert to expert.

For those of you following along with Ben and I, one of the passengers on a flight had an issue with the manner in which an "EMT" removed a "dying woman" from the aircraft.  Mostly the issue was modesty, claiming the woman had no pants on as she was dragged off the plane.  She was found unconscious in the lavatory.  Happens quite often.

One passenger made comments about the situation.  Likely the same passenger who remained in their seat during the medical emergency onboard.  Likely the same passenger who sighs heavily when I board telling everyone that we'll be out of their way as soon as we can.

You see, Ben, the FAA requires that when a pilot requests medical assistance, that all passengers remain seated onboard the aircraft until the nature of the emergency can be determined and addressed.  This is most commonly Paramedics boarding the aircraft, assessing and treating the ill or injured and working closely with the cabin and flight crews to deboard as swiftly and as safely as possible.

In  my experience doing this exact thing we usually find someone low on sleep, food and water and high on exhaustion, booze and anxiety.  We walk them off or use a device called an aisle chair to remove them.  However, it sure is easier to wheel someone out of the upper deck of an Airbus A380 than it is a small commuter aircraft.  This being a 737 we can use the chair (props for getting the right aircraft in your thumbnail) but her being unconscious, the chair is not an option.

In those cases we use a drag or over seat board carry method.  If I have a patient in extremis and I can't intervene in the cramped quarters of the aircraft, we are extricating with all speed.  Ever stood in the rear galley of a 737 waiting for the restroom?  Exactly.

This may mean a slide board, blanket drag or a simple under arm carry/drag.  While we do try to retain modesty when possible, I'm sure you'll accept my condolences in the passing of your loved one because we took the extra time to put their pants back on before extricating them and doing our jobs.  I know you're simply rewording the local press version of events quoting 1 of the 150 some odd passengers on board which was disputed by multiple other passengers, the airline and the local EMS agency, but hey, headlines get clicks, right?

So do us all a favor, Ben, stick to writing about airplanes leaking fuel (which happens all the time you must know) or the newest mileage card offers but leave the commentary about Aircraft EMS to us, the experts.  Heck, I'll even offer to serve as a resource to you for your next headline about "Peanuts: Danger or Delicious."

 

-HM

The new rigs are here!

And we're wondering what happened to what we asked for.

In true municipal fashion we asked for a small, lightweight vehicle with a maximum height of 6'6" (this is a Paramedic first response unit, not an ambulance).  We needed some extra seats in the back and enough room for what we carry.

The folks who would have to work on it if it breaks down were in the loop and approved.  Everyone was onboard.

Then the bids came in and somewhere along the line the entire design had been changed.

The unit is too long, too tall and has none of the features needed to serve its primary goal.

In additional to all that is missing we have tons of space you can't access, features and extras we'll never use and the chassis and motor far exceed our needs.

Yet no one will step forward and explain what happened, where the disconnect was, where the requests of the line personnel who will use the unit were disregarded for this...this...THING.

But here it is.  It's ours now.  Brand new and that isn't nothing.

We'll rearrange the extra shelves someone thinks were a good idea and hopefully send them back for a credit.  We can use flashlights to light up a scene that isn't directly in front or to the side.  We can use the extra features to help out around town, towing forklifts or pulling cars out of ditches.

We're going to take these new rigs and love them because that's what we got.

It isn't anything close to what we need, but it's what we've got.

So we'll make it work.

No photos here, but watch the Facebook and Twitter feeds in the weeks to come as we put them in service.

-HM

Wednesday, June 14

the Crossover Show - Ep 110 - Do You Poop Where You Eat?

In this aptly titled episode, HM and MC  have a simple question for you: What would you do as a Paramedic, Cop or Fireman if your municipality offered you money to buy a home in your district?  What would HM do?  What would MC do?


Would you like to live where you work?  Work where you live?  MC brings up a difficult situation HM never considered as a fireman and both of your hosts get nostalgic about their Firefighter dads and having them both first due at home.


HM’s district offered just such a program and he doesn’t live anywhere near it.  Find out why.


BOLO is pushed aside this week for a long overdue edition of “Ask MC” where HM finds 3 stories from the disciplines and does his best to earn MC 1/8 of 1 Doubloon.


He actually doesn’t do as horribly as usual if you can believe it.


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Monday, June 12

What to do for an allergic reaction...or not

Below was a situation I overheard from one of those crews who's rig you pass half parked, half landed in the ED, doors still open, engine still running and the back looks like a tornado hit.  I put a spring in my step inside thinking I could help transfer the patient to the cot or perhaps at the very least help the EMT get the cot out of the way.

The crew offered the following order of events as to their need to get into the ED as swiftly and as safely as they did.

Imagine yourself in these shoes:  You are driving with a friend and they begin to experience a scratchy throat and a hoarse cough soon after leaving the Thai restaurant you've both been wanting to try.  Here's what this person did...

  1. Keep driving

  2. Pull over at the corner market and get them some allergy medicine

  3. Drive some more

  4. When the coughing is too much for them to handle, pull off at a coffee shop and get them some hot chocolate

  5. Pull them out of the car, barely breathing and call your son, the Doctor

  6. After your son, the Doctor, screams for you to call 911 try giving him some of your seasonal allergy prescription medicine

  7. Call 911

  8. Get upset when Paramedics appear to be concerned about the severity of the allergic reaction

  9. Push cell phone into face of Paramedics with your son, the Doctor, on the line for instructions

  10. Call everyone you know and tell them you'll be late to the meeting because the Paramedics won't let you go


Elapsed time from onset of symptoms to 911 call estimated at 25 minutes.

 

Yeesh is right.

 

Call us first, folks.  There's no harm in us getting there, finding nothing wrong and letting you go about your day.  This person was put at significant risk for no reason other than a desire to get to where they had to be.

 

 

 

 

Monday, June 5

The Last Shift of the Lost Cause

...and I missed it.

 

While taking a few arguably well deserved days off no one even thought to call or even send a text when they found out Lost Cause, a Medic I keep butting heads with on calls, is no longer answering them for his employer.

I want to stop by and ask if anyone knows what happened, if it was the constant calls from me and other Captains or maybe the stress of the job or maybe even something completely unrelated...

 

I'd like to picture Lost Cause performing a job he understands in a field he can appreciate and getting satisfaction from it because we sure as hell weren't getting that in the old spot.

 

So here's to you, Lost Cause, mostly sure you know about my little therapy experiment here.  May your days be long upon the earth and never again be burdened with patient care decisions.

 

-HM

Sunday, June 4

The Crossover Show - ep 109 - Is that Cocaine or Anthrax?

In this episode, MC and HM talk about an old saying in the Fire Service: Cops suck at HazMat calls.


HM shares a story from el airopuerto about a cop who broke out in a sweat after incorrectly identifying the unknown substance found near a gate.


We discuss the importance of cops letting firemen be firemen and how jumping to conclusions could get someone hurt.


The boys also discuss the Willamette Writers Conference and how they’re presenting August 5th about how to to podcast for fun and profit.



BOLO






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Thursday, June 1

How to respond when your spouse tells you to be safe at work

Each morning I roll out of bed, still mostly asleep, and get dressed in the dark and wife will wake up just enough to notice I'm leaving.  Somewhere in the back of her mind is the remote chance this is the last time we'll speak to one another, but in the front of her mind is the hope that I'll reset the coffee maker before I leave.

 

She has always offered some kind of goodbye usually including the natural "I love you" which was, is and always will be followed by an immediate reply, but I noticed a few years ago my response to her next sentence has changed.

"I love you. Be safe," is what her sleepy lips send my way and I used to respond "I love you, I will."

No more.

 

I can't remember when I stopped telling my wife I would be safe at work, but for the last few years I just haven't.  It has been replaced with "I'll do my best."

Maybe it was the few times I was nearly hit responding to a call, while wrestling a combative patient or arranging for quarantine for a known communicable disease from overseas, but it changed.

No one will come to my funeral and tell the wife "You know he told you he'd be safe, he lied!" but it just no longer feels right to tell her I'll be safe.  The best I can do is remind her that I'll be thinking of my family first as I go through my day of dealing with the unknown and should something happen, I did my best.

 

Do you have a ritual goodbye before your shift?  Has it changed over the years?