the Happy Medic

We've moved

2009-10-15T14:35:00.000-07:00

We've moved.

I told you update your address bars, right? Well, happymedic.com is up and running with thehappymedic.com on the way soon.

Same content, different look, new home.

happymedic.com

Hoseline Placement or How Not to Impress the Public

2009-10-14T07:38:00.000-07:00

Trying to keep up with the flood of industry news that is Statter911 can be daunting and I missed this story not once, but twice.

On October 7th DC Fire & EMS put on a demonstration of the effectiveness of fire sprinklers. It also ended up showing the ineffectiveness of modern firefighting.

One of our brothers was hurt in this exercise and I hope he makes a full recovery. I've been hurt at fires and I've been burned, neither experience do I wish to repeat. Our thoughts are with our injured brother.

This is not a Monday Morning Quarterbacking of the event, but instead some great video that will show you what happens when you are unfamiliar with how to use your equipment to its full potential.

This first video is from farther back than the second and is a better opportunity to read the smoke and see possible flashes. As you watch it, imagine you are in the hallway of a dorm approaching this room. Heavy smoke in the hallway, intense heat and that flame dancing out of the top of the prop will be spreading in all directions along the hallway ceiling. Now, as it flashes, imagine where you will place your team and where you will shoot first.

This is another video from head on that better shows the incipient, free burning and flash periods of this particular fire, as well as our brothers placing their line. I can't help but notice the fog nozzle.

A smooth bore at 60 psi could have knocked the seat of this fire from the imagined hallway in my earlier example, even banking it off the wall if the heat was too much. Many news outlets talk about the lack of a backup line. Huh? Don't need one. Smooth bore from 20 feet makes short work of this fire without even having to go on air.

Putting ourselves in a dangerous situation in public only makes me wonder what we're doing in the dark hallways at working fires. Let's use our equipment to our advantage. Take that fog nozzle and put it in your pocket, get smooth bore nozzles on your pre-connects so you can put the fires out. HMHQ is a firm believer in the power of water applied from a safe distance in order to make a safer environment for extinguishment.

Another quick word on the Culture of Extinguishment. Lt McCormack, in his "controversial" remarks before the FDIC in April 2009, fought for the idea that "If you put out the fire, safety is accomplished for everyone on the fireground." I agree with that 100%. Unfortunately, I don't think Lt McCormack's message is getting to firefighters as intended. The Lt wants you to safely put out the fire, not go running in without using your tools and training to your advantage.

I speak with many firefighters in my service who heard about the speech, but never read excerpts. They make it into a call for safety to be thrown out the window when there is a fire or a rescue. Not at all, friends, not at all.
WAKE UP! Pay less attention to which Chief or Union Leader blames who and look at what gets our people hurt and don't do that. Don't go somewhere your water can go instead.

Placing a hoseline is not a simple task and I, on the nozzle, have been dragged by my airpack to a different location by my officer who had a better view of the situation. Each and every time I have them walk me through where I was, where they moved me to and why. Then I apply that next time.

Are we all perfect first try? No. But this first try got someone hurt.

If you get stopped...

2009-10-13T19:54:00.000-07:00

The Po-po with the Mo-mo, the Po-po a Go-go is back on the streets after welcoming Baby MC and starts off in a car due to pouring rain. Poor guy didn't even get to fire up the Honda and bust some fools on his first day back? We at HMHQ think that is just a travesty.

Welcome back Motor Cop, we missed you and your matter of fact style. We always enjoy reading from our Law Enforcement friends, but you are after all our brother from another mother here in blogger land.

Stay Safe MC and see you in the report room for cocktails.

HM

(Oh yeah I did)

My 5 hour day

2009-10-13T17:44:00.000-07:00

I was confronted by a citizen recently about how I was paid to sit around and play pool and sleep and that I was robbing the City. She stopped me while we were out doing our weekly hydrant checks, which I explained to her, but she refused to listen.

It got me thinking though, that many of you not in the business may think us 24 hour guys have it pretty good. I'm the first to tell you we do, but not because of the reasons you may think. When I stopped to think about it, I really do have a weekend everyday I go home. But I also work 5 distinct "days" within my 24 hour shift. Since I try to arrive an hour early, this makes my day 25 hours. Allow me to explain.

Monday - 7 AM to noon
Back to work, just like you folks on your Mondays. Getting into the swing of things, seeing your work friends, and remembering what working is like. Check all the gear, clean the house and get the shopping done. It's all routine on Monday.

Tuesday - Noon to 5 PM
The week drags on, but the morning is finished. After lunch it's usually a drill and a class, then maybe a workout before getting ready to fix dinner. This is by far my favorite part of the day.

Wednesday - 5 PM to 10 PM
Hump day. Making dinner, eating dinner and the wind down following the meal can be good, but you're reminded that your shift is only half way finished. Sometimes you have time for a full movie, other times you're lucky if you get dinner on Wednesday.

Thursday - 10 PM to 3 AM
Isn't it Friday yet? On my Thursday I'm up in the dorm looking for a good place to sleep, wondering how many more times I will have to climb the three flights of stairs before Friday is over. When busy it goes fast, but when the calls are spaced about an hour apart and bells ring just as you enter REM sleep it can exhaust you just thinking about it. I HATE THURSDAYS.

Friday - 3 AM to 8 AM
But those who know my writings here know I'm a fan of my Friday. When I awake and see we're heading out and it's after three I relax and realize it is officially morning instead of night. then it's a downhill slide to the sunrise and end of shift at 8 AM, my Friday night.

So there you have it my 9-5 friends, my 5 day week within a day. Then I get a weekend, just like you, except mine can't start until I get home after the shift.

Attention all Companies

2009-10-12T09:53:00.001-07:00

The mandatory reading assignment for this week is waiting for you at Ambulance Driver's in response to another excellent post by Rogue Medic and the comments that followed.

Another example of the need to restart this trade as a Profession and lift ourselves out of this "patch and tan box" mentality so many of us are still stuck in. Reboot the entire system. EMS 2.0.

You Make the Call...Line Up...What Happened

2009-10-12T08:39:00.000-07:00

This was a giant Duh moment really. We later discovered the officer was doing his final day of FTO before getting out on his own and we were being used as a partial prank.
The Sergeant stuck his head in the back door a few moments later laughing, apologizing for the seriousness of the request, they expected him to smile and laugh instead of actually ask us about the line up. The superiors had intentionally waited until both men were on the boards before telling the rookie about the suspect in custody.

Seems they realized our clients were far to inebriated to make a reliable ID.

If you said "You're kidding right?" You made the right call.

Sunday Fun - If you build it...

2009-10-11T07:00:00.000-07:00

There is always talk around the dinner table at the firehouse that the house was clearly not designed by anyone who had ever even seen a firehouse before.
"The locker room is too small!"
"This kitchen sucks"
"Can't we have a toilet on the ground floor?"

The usual complaints.

So this Sunday we're heading out of HMHQ and over to the architect's office with a copy of Gerry Souder's book and the following demands.

#1 - Humidor Cabinet
The guys are having an occasional cigar, but why have the engine parked infront of the smoke shop every weekend? With this cabinet, each member can purchase and store quality cigars to enjoy 50 feet from the closest door, per policy. If your organization prohibits the use of tobacco products while on duty, install this in the basement. Cigars.com has a lovely selection.

#2 - Commercial Dishwasher
At a busy triple company house, feeding and cleaning up after 14 people can be a chore. But if you use a commercial strength dishwasher, you can wash an entire load of dishes in 90 seconds. That is not a typo. 90 seconds. I work at a big house that has one of these and it is awesome. Pile in the silverware, press on, wait a minute and a half and POW, clean forks.
It takes a few more cycles since there is only one tray, but the water heats up to 170 degrees and cleans those things like no one's business. The folks at ArchiExpo can tell you more.

#3 - 3 Burner Bunn-o-Matic Coffee Maker
Forget those fancy fru-fru drinks for $3 a pop at the local coffee shop. Save those for heading home. That's your reward for staying safe and going home again. Until then, we need 3 piping hot supplies of delicious coffee. Some may tell you the 4 burner is the way to go, maybe if you're having a lot of meetings at your house, but if you're all career, 3 should do fine. And while you're at it, stop buying the crappy coffee at the warehouse store and spend the extra $2 a pound for some quality coffee from a local vendor. Chances are he'll be glad to brag that you buy his coffee to drink in your house. No gifts, buy the coffee.

#4 - Wireless
Do I even need to include this in our dream house? What house these days doesn't have wireless yet? Get a private phone line installed and collect the $5 a month from the members and get a network set up. You'll likely want two routers, one on each side or end of the house so that the computer up front gets as strong of a signal as the dorms. We'll also need a communal computer for research and checking for updates on firegeezer. That brings up another thing, networking the network. That fancy TV you spent all the money on last year you currently use to watch Dancing With the Stars has a video input on the back. Run a cable from the computer to the TV and watch training videos, fireground close calls, and post important information. We recently had a boss do this to the giant TV to give a ventilation drill. he fired up the video on the communal computer and everyone actually wanted to try it and was involved. We watched, we learned, then we went and did it. And add in the free printer, make it wireless so all the laptop guys can use it too.

#5 Truck Turntable
Too many folks are getting hurt and some have even died while the apparatus is backing up. Why? Why are we even "spotting" these things, only putting ourselves in danger to protect someone's investment. Let's install a truck turntable. Pull in, press the button and just like Batman did, we're turned around and ready for the next attack from the Riddler. I can hear some of you groaning about how elaborate, expensive, problem prone this might be but it can never fail. It simply becomes a floor if it stops rotating. Not sure how the tillers will do with this, we'll look into something. And for those of you singing the praises of drive through bays...I don't want to hear your bragging anymore.

#6 Slidepole
No slide. Slide Pole.

You Make the Call...Line Up

2009-10-09T07:00:00.000-07:00

Nighttime is always good for a few fights and you've caught a decent one.

A couple of guys from out of town got mugged and attacked with a knife. Nothing major, but the report in your mind already has the phrase "copious ETOH odor" so both are getting full c-spine precautions with various bruises forming on their faces and some superficial lacerations to their faces, necks and torsos.

Nothing worth screaming towards the trauma center for, but certainly taking your time for a full secondary assessment.

As you're completing C-spine precautions on the man on the bench seat and indicate your driver to go, a police officer jumps in the back and begins asking the men questions. Completely understandable, so you get a head start on your charting in the few moments he takes to finish up getting different descriptions from your patients, who are clearly intoxicated beyond remembering.

You exchange your professional courtesies and the officer climbs out and closes the door. As you begin to pull away from the curb, he opens the door and asks you to divert over 4 blocks for a lineup, they think they have the suspect in custody.

Both men are in full C-spine precautions.

Divert oven and have your patients ID the suspect or not?

You make the call.

Oh No. Not Again

2009-10-08T10:05:00.000-07:00

In The Hitchhiker's Guide to the Galaxy by Douglas Adams, two missiles are improbably transformed into a suprised whale and a bowl of petunias. The whale embraces his new identity, while the bowl of petunias, while falling to the ground from space says, "Oh, no. Not again." Adams then tells us that had we understood what the bowl of petunias meant we may have a better understanding of the nature of the universe.

I recently discovered that just saying that phrase, "Oh no. Not again" means your night is about to get interesting.

THE FIRST EMERGENCY

Automatic fire alarm activation

THE FIRST ACTION

The engine arrives on the scene just before 3 AM to find no alarm bell ringing and no strobes flashing. The building is secure and we prepare to pack up as a small man dragging a shopping cart makes a mad dash across four lanes of decently busy road to reach us.
He waves and waves and I lean out the window to ask him his trouble.
"I am out of medication." he tells me, not even a hint of a wheeze or shortness of breath. There he is, no distress whatsoever, apparently he thinks we have a pharmacist behind the hydrant jumper lead in the hose bed.
"We don't have medication refills here, do you have an emergency Sir?" I ask wondering if I;m really having this conversation.
"I need more medicine, I need 911." He tells me, refusing to get onto the sidewalk, preferring to stand in the street.
"Do you want an ambulance, Sir, you seem OK."
"No ambulance, no hospital, I need medication from 911." He tells us, looking from my jump seat to the ladders on the side of the engine, still waiting for the pharmacist to pop out.
"We have no medicine refills on the fire engine, so if you don't have an emergency and don't want an ambulance, we're going to go, OK?"
"OK, but where is 911?" And he grabs the dirty cart and scurries (Yes, he altered route and speed at random) back across the street and around the corner.
"We're going to see him again, I can feel it" I said into the headset as we pulled away and back to the house.

Just as I got my turnout pants unbuttoned, the lights are on and the bells are ringing.

Oh no. Not again.

THE SECOND EMERGENCY

A cell phone caller reports a man short of breath at the doughnut shop.

THE SECOND ACTION

The doughnut shop in question is not the high quality place mentioned in other posts, but the 24 hour place on the other end of town.

Off the engine I can see only two customers in the shop. One on the phone and drinking coffee, the other remarkably familiar and scurrying again, this time out the door towards me, not away.
"No, no" He's waving, "I no need firemans, I need 911 for medications,"
"What medicine do you need Sir? I have medicines for sick people...are you...sick?" I ask trying to chase him through the parking lot.
"My brain pills are gone. GONE! I am needing more." he tells me over his shoulder, zig-zagging through the lot. There's no way I'm letting him get away just to call us back all night long, so I'm in pursuit.

The only thing that slows him down is the sound of the approaching ambulance from at least 5 blocks away.
"My medicine is coming!" He tells me.

Good Grief.

The ambulance crew gets my "Don't kill the messenger speech" to which they sigh and wave us off. I pay careful attention to the radio traffic when I hear the ambulance report that their patient has disappeared down an alley and they are going back in service.

Not ten minutes later, we're backing into the barn when the bells ring.

Oh no. Not again.

Boo!

2009-10-07T04:44:00.000-07:00

Halloween. All Hallow's Eve. Samhain. Whether you practice the ancient Celtic holiday or just dress up on October 31st, there are certain things you should not do when decorating your home for the fall holiday.

THE EMERGENCY

Cell phone caller reports flames in the window of a residential building.

THE ACTION

4:30 AM. We should have had 3-4 calls since I crawled into my sleeping bag and am rather well rested when the dorm came to life for a full box alarm. The Engine, Truck and Chief are all first due and only blocks away.

We're barely dressed when we pull up to the intersection and see flames in a window box outside a window on the fourth floor.

Airpacks go on as we see the truck get set to head for the roof and to the window in question when I see my boss do that head movement that can only be described as the RCA Dog tilt. His body language changed right then to a relaxed stance as he motioned for us to come to his side with one hand and began waving down the rising aerial ladder with the other.

As we looked, I mean really read the flames, we noticed...no smoke and the flames are neither growing nor receding, meaning the fire is not growing, moving or giving off gasses. Hmmm...

Then we looked closer at the window, noting not only no discoloration, but there are multiple paper Halloween decorations on the outside, slowly waving in the soft breeze of the early morning.

By this time the entire first alarm compliment had arrived and we can now see it is a small electric cauldron. A small fan is blowing fabric above a light, causing the appearance of fire.

Outside. In a planter box. At night. We get planter box fires often, what with discarded cigarettes and all. I just never expected someone so excited about modern Halloween celebration to put such an element outside a wooden frame building.

A reminder on uniforms...

2009-10-05T15:41:00.000-07:00

I like to think I am a Professional. When summoned to headquarters or even stopping by to see the clerks at payroll, I'm in a new uniform shirt, cap and tie because you never know when you'll bump into the Chief of Department.

So imagine my surprise when we responded to our Headquarters on a medical call and I found myself without my button-up shirt.

Not really listening to the guys calling out jokingly "Grab your shirts!" I donned my navy blue, collared job shirt, zipped it up and climbed into the fire engine to respond.

20 minutes later I was doing a walk of shame.

Lessons I've learned from this event:
1. Always have your shirt at the ready. Whether you are anywhere near HQ or not, if you're not wearing it, put it on the engine anyways.

2. If you find yourself without it and out in public, don your safety coat instead of wearing just your shirtsleeves. You shouldn't be wearing your shirtsleeves out anyways.

3. When you see your engine mates donning their safety coats OVER their uniform shirts, follow suite and do the same, even if the call is a possible cardiac.

4. While assessing the patient and the Chief walks in, focus on patient care, there is time for chit chat later.

5. When the Chief says "Nice Sweatshirt" in the same tone one might say "Hey you cut me off in traffic," do not say "Thank you, Sir" while taking the blood pressure.

6. And by all means, when important papers still have to pass through that Chief's office for certain blog related issues, avoid this situation entirely.

D'oH!

Yeah, you better run!

2009-10-05T09:12:00.000-07:00

Summoned for refresher training, I was into my own car and out and about the fair City one sunny morning. Still in my uniform, as required when still on duty, I happened to be passing the infamous coffee shop and had the urge to stop in for a cup of caffeinated goodness before the 3 hour protocol update lecture.

I parked my car in the first metered spot, fed it some coins and was walking to the corner when a man sleeping in a doorway peeked out from behind a number of dirty blankets to see who was passing.

I paused at the corner, empty mug in hand, and glanced back to the eyes in the doorway. He was visibly startled when he recognized my uniform and he began to gather his things.

"I don't want to go to the shelter! I don't want a hospital! Leave me alone! Leave me alone!" And he began to run down the street.

I was amazed. Every time I pull up in an ambulance, they never run. And now this man is fearful of my uniform, so much so he'll abandon a clean, warm doorway to get away from me.

That cup of coffee was extra delicious.

Sunday Fun - Kids + Fire Trucks = Blog?

2009-10-04T07:00:00.000-07:00

While wandering the interwebs for a completely unrelated post on robots (Just go with me here) I came across something fun.

Kids Firefighter Blog was started by a family who had trouble finding a single site as a resource for kid friendly toys, information and activities related to the fire service. They cover coloring books, regional activities, lego, you name it, if it relates to kids and fire trucks, chances are it's in there.
I especially enjoyed this photo series of classic fire apparatus built with Legos. So close to my 900 series, I had to post a pic.

With so much going on around the Project, I've been neglecting my traditional Sunday Fun stories of the tradition of our Profession. Until I get my piece on red lights finished, visit our new 2nd Alarm Company firedaily.com.

The power of the Blog

2009-10-03T14:47:00.000-07:00

Mark has chimed in about an update to the Project, the Trans-Atlantic Paramedic exchange I'm always reminding you of. Pop over and read his post, answer his question, then come back for my thoughts on whether blogs are bad.

It seems that the powers that be on both sides of the pond are still nervous about the reality of patient confidentiality laws, and rightly so. It is understandable to be worried about litigation if one of your people is blogging, facebooking/Myspacing or tweeting the address of a patient, a patient's name, history, likeness or scene photo, but what about those of us trying to make an impact on the Profession of EMS?

These same supervisors who are nervous about Mark's blog being perceived as NHS driven and my supervisors to even allow me to tell you my name, surely sit down with other professionals and share tales of "the big one" or "the call that went wrong." Are those violations of privacy rights?

What about ACLS scenarios? Each time we enter the classroom we are encouraged to share stories of patient outcomes and interventions. Are those violations of privacy rights?

Many of you may be shaking your heads and saying, "That's different, it's not in the public realm," I say sure it is. I go home, tell the wife about a rough call or scenario in class, she tells a friend, etc etc.

We share information all the time, and mostly even more details than have even been shared in this arena. Privacy is so private that people will scream for help on a busy sidewalk, then refuse to give their name because they don't want a bill. Will rail on and on about their medical history, in front of dozens of strangers, then I have to get a form signed saying I promise not to share their information with anyone outside of our billing system. That's makes sense, right?

I took this opportunity to re-read the Health Insurance Privacy and Portability Act (HIPPA) and find out once and for all if what I've been doing is allowed. Here's a shocker...yes.

From the text of HIPPA:

What Information is Protected

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."¹²

“Individually identifiable health information” is information, including demographic data, that relates to:

the individual’s past, present or future physical or mental health or condition,
the provision of health care to the individual, or
the past, present, or future payment for the provision of health care to the individual,

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.¹³ Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g.

De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.¹⁴ De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.¹⁵Take note of the "and" following the bullet points under Protected Health Information. If I post about someone who, even if I change all the information, can still be identified by someone not there at the time, it becomes questionable.

I understand the reason for privacy rights, believe me, but I also understand how sharing information of a non-sensitive manner can help move our understanding of this Profession forward by leaps and bounds.

I don't know what privacy laws are relevant in the UK, but I'm sure Mark is well aware of his limitations, as evidenced in his post.

Blogging can do harm Mark, when done recklessly and without respect to our patients, clients, employers and co-workers.
But when done following the intent AND letter of the law, it can only help.

I'll explain more when you pick me up from the airport in Newcastle during our blog born EMS exchange to advance patient care. But keep that private, OK?

You Make the Call...Brain Attack

2009-10-02T07:00:00.000-07:00

Brain Attack is the new stroke. Did you not get the memo? In an effort to expand on our similarities, not just our differences, I thought a straight forward medical scenario would do the trick.

You are assigned to your regular response unit and dispatched just after 10 am for a reported altered mental status. You response time is 6 minutes and you are the first care giver on scene.

Family states the late 60s male in the hospital bed in the family living room has an extensive cancer history and has been having difficulty getting up and walking around in recent weeks. This morning he awoke around 530 and had his linens changed, at which time he used a walker to move around the room.

Just a few minutes ago family returned to awake him from his nap and find him unresponsive, left extremeties in a state of contraction and a noted facial droop with drooling, also left sided.

You complete a full assessment finding him actually responding to painful stimuli with a grimace from the non drooping side, no voluntary movement from the contracted left extremeties and faint squeezing on command on the right. Blood sugar is in normal range, EKG and secondary exam all come back normal, previous notations excluded.

Pupils are equal and tracking together, no fixed gaze.
There is no past history of stroke or CVA.

The nearest hospital is 10 minutes away. Another 10 minutes is the regional trauma center, with scanner.

What is your agency's policy for this patient? Is he in the window for stroke center care in your jurisdiction? Does your system offer any in field treatments for this patient? You Make the Call.

Social Media in EMS - A Tip of the Helmet

2009-09-30T22:22:00.000-07:00

A Tip of the Helmet to online EMS educator Greg Friese and his extensive research into how EMS agencies need to embrace social media before it gets past them and starts to cause problems. In his September 2009 article, he mentions our efforts here at HMHQ to use this media for positive change in our profession.

Not sure what social networking can do for EMS? Have you ever used a tip you learned online, on twitter or even done a google search for something related to your role as an emergency care giver?

Then you are using social media to advance our Profession. Learn more in the article here,and at the EMS Expo in Atlanta Georgia, where it looks like Greg will be expanding on his article in person. I would attend, but will be recovering from my CO-Op Refresher in New Mexico and preparing for the Project, which starts in less than 6 weeks.

A Tip of the Helmet to Greg Friese. On twitter and facebook and everything. I'm sure he'd have it no other way.

Facebook updates now rolling

2009-09-30T06:06:00.000-07:00

Hey Facebook friends and followers, it's your cartoon fireman friend the Happy Medic here, now linking directly to Facebook. Used to be I'd have to log out, log back in as Steph Frolin, navigate over to HM's fan page, grab a link...you get the idea.

And since we have been auto piping posts into twitter, and getting a good response, we decided to follow Fire Critic's lead and use an application called Networked Blogs in Facebook to crawl the blog and feed you updates without me having to do it all he time. This means you can follow the blog from the comfort of your Facebook status and make comments, like it or share it.

If you click on the image in the Facebook post you will be magically transported to HMHQ here at thehappymedic.com and have a chance to scroll through the 2nd alarm and mutual aid boards for the best fire and EMS bloggers on the interwebs machine, not to mention click an ad or two.

All this is in anticipation of making it easier for you to follow the Project, my and Medicblog999's adventures trading places and riding along to experience patient care across the pond.

Now you can hear about it on twitter, facebook and the blog readers, since the BBC will likely not be making our adventures into a program. We'll just have to change the world from right here on our computers.

For those of you not on facebook, who still have something called "free time," I'll try not to mention it much more after this, but I make no guarantees.

EMS FAIL or Client FAIL?

2009-09-29T09:53:00.000-07:00

Our Pal CK had a rough night recently, not just with some hellish weather and unsound sleep, but encountered one of the glaring issues of modern Emergency Care, the frequent flier.

For those of you not in the industry, frequent flier refers to clients who activate 911 for non-emergent conditions or situations that the normal responsible person would simply take some tylenol or decongestant. These persons call 911 when they run out or lose their albuterol inhaler, have their seizure medication "stolen" or didn't listen when the pharmacist told them not to drink alcohol when ingesting these medications.

Another kind of frequent flier is the basic care seeker. These clients call 911 and use code words like "chest pain" and "seizure" and "difficulty breathing" to get their response bumped up to a priority dispatch. Then, when the crews arrive and find no life threat, they know the law and demand a transport to the ER, which they know we can not refuse.

You see, the laws were written back when companies would refuse to take those who could not pay, or, for whatever reason, the attendants didn't want to take in. That was back when we were a trade.

Now those laws tie the hands of professional care givers who care not only about the patient at the scene, but the next patient who may actually need that ambulance, instead of the client demanding care they do not need.

These folks are not responsible citizens. They demand others care for them, even when there is no care needed. It goes without saying that we treat those who need it, right? So why can't we be honest with those who don't need it? If she calls 911 3 times in 24 hours and got transported, seen, released and brought home twice, why the hell are we there a third time? This issue needs to be solved at EVERY level of the health care ladder, from the patient all the way up to the CEO of the insurance company she may or may not have. So let's break down where the system fails our friend CK, respecting that I don't know the specifics of his system model, so I'll try to be generic in my solutions.

The "patient," or client as I like to call them, is the single biggest share holder in their own health care decision making. The patient needs to seek out information about their medical history, health care options and basic interventions. This can be as simple as listening to the tylenol ads on TV in between episodes of Walker: Texas Ranger and as complex as making an appointment to see their doctor to discuss different interventions. Most folks can't take the time out of their busy schedule of sitting to be bothered with caring for themselves, besides, "Isn't that your job?" No, Ma'am, that's your job as a responsible citizen and proactive member of your community. Not every person can step back and see how their personal life effects their community, we are in the middle of the most selfish generation of people who don't care what happens to their neighbor, only to them.
In CK's example, the client was the first part of the system to fail. She refused to listen to the care takers already put in her path from the prior transports and thinks the ambulance is her personal taxi. PATIENT FAIL.

The family needs to be informed decision makers and understand the conditions which their family suffers from, if at all. Don't tell me she has seizures but you don't know how often, or why, or if she takes meds for them, or if it's just "DTs" (Which I am observing less and less, I think even the alcohol abusers are getting too lazy to fake seizures). If you care for your family, then CARE for them. If they fall and hurt their elbow, maybe take them to a clinic or their doctor's office. Don't call 911, demand a transport, then follow in your car. Tell you what, you get in with her and I'll drive your car, how's that? The family needs to also recognize abuse and nip it in the bud. Huh, third ambulance ride today? Maybe nothing is wrong if they keep sending her home. FAMILY FAIL

The General Practitioner who was called and defaulted to a 911 response is playing CYA with local resources. I am not your insurance policy Doctor, I am a Paramedic. My profession is not your car service and can not respond to cover you should you decide to actually see your patient. I know you are overbooked and understaffed, but that nice Audi I saw in the parking lot is coming from somewhere. Get off the phone and get in the Audi and tend to YOUR patients. House calls are a thing of the past? How about a thing of the future? If there was a component of your practice that allowed this patient to access you or your staff at all hours, she would not be calling 911 3 times in 24 hours and bothering you at all hours. If she is healthy she doesn't need to call you and you actually have more free time for cruising in the Audi. And if you think that simply activating us gets you off the hook and we can do a better job, then let's see you put your credentials where your mouth is and step up as a Medical Director and give your Paramedics authority to refuse care to folks who don't need it. DOCTOR FAIL

The 911 EMS system. You fall, they call, we haul is funny, yet true. Why can't our friend CK take in all the facts, do a professional assessment, determine no need for the ambulance transport and call the doctor back, informing them of the situation? Why? Lawsuits. Our services are afraid someone will actually be refused a transport because of their nationality, sexual orientation or ability to pay, but they ignore the fact that if I wanted to stick it to people I didn't like I would simply not treat them properly. Well, I think it's obvious we're past that part of EMS history, let's get up and actually move past it. Medical Directors need to be proactive in giving their systems tools to guide people out of the water slide that is defaulting to ALS to a hospital. Why was an entire town's EMS system activated 3 times for this client? EMS RESPONSE FAIL.

Does this woman have medical insurance? Is she on disability or perhaps in the VA system? If she is in a private system, has she called the nurse advice line and if we reached that far, did the dial-a-nurse default to telling her to call 911? In my experience with the dial-a-nurse lines, they should be replaced with a recording that says, "Hang up and call 911." In the rare instances where the information is valuable and followed, the clients calling are honest about their symptoms and are clearly responsible citizens, proactively trying to stay healthy. In this situation, again assuming she has some sort of policy, the company must now reimburse the ambulance service, the ER docs and whatever specialists may be activated, instead of spending $100 to get this person into the office sooner. INSURANCE FAIL

The emergency room is the most expensive form of preventative care. I once transported a woman who demanded a pregnancy test. When I offered her the $12 to buy one she refused and told me to do my job and take her in to get the test. "That's what my insurance is for." she told me. No, Ma'am, it's not. And even worse, I know for a fact that the Docs that night gave her that test and anything else she wanted simply to avoid the possibility of legal action should our client decide she didn't get what she wanted. We give these Physicians powers to save lives and end them but tie their hands when it comes to rationing (ooooh buzz word) treatments they know, from being doctors, clients do not require. Let Doctors practice medicine, not constantly defend themselves from what could, possibly, maybe, one day, be a law suit. ER FAIL

So there we have it, CK's situation broken down and the failure found. That's the easy part, unfortunately. The difficult part is finding the solution that fits to make sure our client, remember her, is healthy. That is what this whole giant medicine thing is about, healthy people.

So do we ditch the whole for profit thing and go single payer socialized medicine? It might change a few aspects fo the system, but it will not make our client responsible for her own care. It will give doctors and paramedics more options for diverting her away from the ER, but in he end, CK is still right there in the middle of the night for the third time.

Can we tweak the way insurance companies bill, maybe have everyone pay a little? Still not changing our client's desire to be proactive and there is CK, sleepy and at her home.

Tort reform will surely change the way physicians treat, right? Maybe, but how can solving the problems in the penthouse fix the problems in the foundations? Insurance for the Docs will cost less, but will they pass along the savings back into the system or will there be His and Hers Audis? Not to mention our client is still calling the first time, even if we can convince her no to call the second and third times.

Advanced Care Paramedics and ability to refuse transport could help, right HM? That's only part of the picture and we're still going out there for the initial call and, likely having to return multiple times if they don't get what they want. How many times have you had someone wave you down demand meds and when you refuse they call 911 thinking someone else will return for them. Refusing transport only works if there is a framework we can plug people into instead of the ER.

The solution has to be wide ranging, sweeping and take into account every single aspect of health care from inoculations and birth control to advanced surgery and experimental treatments for advanced conditions.
There is no solution that solves all our troubles, but there is one solution that goes the farthest towards helping to take the pressure off the rest of the system.

Personal Responsibility. Taking control of our own lives and inspiring others to do the same. Get in the faces of your clients and impress upon them how they impact the system. Follow your protocols, do what is right, but point out to your clients the truth about what they are doing and remind them of ways they can access healthcare that isn't running red lights, putting lives on the line for a hurt foot. Be honest about the cost of your response, that if someone nearby is actually sick or actually hurt, they will suffer as a result of this abuse of the system. Nothing in the laws says you can't tell the truth. When people say "Sorry to bother you with this, but I didn't know who to call" take the extra 5 minutes, grab a phone book and show them who to call, where to go and how to get help. Then do what the law requires. Be nice, be supportive, but be honest.

Next time, if we can get people proactive about their care and encourage them to do the same for their neighbors, maybe our call volume starts to go down.

Lofty dreams of an overly optimistic Paramedic, sure. Ramblings of an EMS blogger, certainly. A simple first step towards positive changes in our profession...if no one else will, then I will.

Will you?

Hope you have a better night CK, and if it gets to busy, I'll bring 99 over and we'll cover in. I'd love to have a little chat with your client.
This post started as a simple response...sorry I got long winded. And Medic999 and my UK friends, I'd love to get your responses to CK's situation.

Are you already intubating TRAUMA?

2009-09-28T14:06:00.000-07:00

The Crew of Medic 77 - Kevin Rankin as Tyler, Derek Luke as Boone in NBC's TRAUMA

The buzz is alive! NBC's "new hit" TRAUMA premieres tonight, as I'm sure anyone who visits these pages and others already knows.

Thing is I'm already hearing from my co-workers and others that the show is doomed to fail.
"Looks so fake." I was told by a fellow watching The Terminator.
"It isn't like that at all, that's not an accurate picture of what we do." Said the woman who adores CSI:Las Vegas.

My point here is that this is not a documentary about EMS, that Project got knocked down, this is TV. A TV show not unlike the one with the yellow family that hasn't aged in 20 years, or the genius doctor and his merry group of physicians treating the exotic, or perhaps my favorite show about spaceships and people that talk funny.

It's TV. This is not the Emergency! of our generation, we know that, so lower the bar of expectations a bit my friends.

TV Paramedics never seem to do well for two main reasons.
1. No one wants to watch a show about what we ACTUALLY do. There is no good TV value in watching me help a 45 year old man claiming to have an asthma attack scream about how much I abuse him every week, without a single wheeze. Boring. Funny in the moment, but boring. The magic we on occasion create, when a patient actually responds to a complex treatment is rare and over quickly, mainly because we tend to move quickly to definitive care.

2. They follow the characters home. In my exhaustive 10 minute research on the subject of TV Paramedics, I've found that each had a really good chance of succeeding until the story followed them home.

Case in point:
Paramedic Wyatt Cole from TNT's Saved was a great example of a Paramedic of the 21st Century. Apart from the whole "I graduated Medical School but I hate my father so I work on an ambulance" story line, he was a true caregiver who they showed actually caring. The show was clearly written by someone who worked in the field, since they had smelly regulars and a rival ambulance company pushing unwanted vagrants into their roll area. It was a fun medical show, but the home lives of the characters began to take up more of the show and before you knew it it was less of a Paramedic show and more of a show about a guy who happens to work in EMS.

Law & Order does so well because you know exactly what is going to happen every week. 30 minutes of Police doing amazing police things, a twist, an arrest, and then 30 minutes of lawyering. No homelife BS, no diversions, plain and simple. In the rare cases they do wander home, it's part of the case.

TV isn't meant to be real, guys and gals, it is meant to be entertaining. Tonight, when you're angry that someone did something WAY outside their scope of practice, or says something like, "Don't you die on me now!" take a deep breath and imagine Motorcop watching reruns of Chips, or Firegeezer watching Rescue Me, don't get upset if it's not an accurate portrayal of EMS in the US, heck from what I can tell it's not even an accurate portrayal of EMS in San Francisco.

TRAUMA is a TV show about Paramedics, not FOR Paramedics. If it was, it would be on the BBC or Discovery Channel and actually ride along with Paramedics. Wait a minute, I swear I've seen such a program...

I will be watching it here at the Angry Captain's place with an open mind and a hope for entertaining television. And even if it fails to make me cheer, I'll keep watching it because it has helicopters and explosions, which are never a bad thing.

112

2009-09-28T09:03:00.000-07:00

One Hundred and Twelve degrees farenheit. 112. Last I checked cell walls break down around 107, but our caller swears her son's temperature has broken the land heat record. At 1 AM, of course.

THE EMERGENCY

A mother states her son is lethargic with a temperature of 112.

THE ACTION

The bells are loud at this station and I seem to have chosen a bunk directly under the speaker. I wander into my turnout pants and down the slide pole before I completely comprehend the dispatch information.

"Did they say 112?" the Officer asks as we climb in the $450,000 fire engine staffed by 1 highly trained firefighter, 1 highly trained driver, 1 new Officer and yours truly.

"Impossible," I say clicking my seat belt, "107 is as high as you go while alive. Maybe she's reading it upside down?"

Enroute dispatch advises the child is unconscious and they add a Paramedic Supervisor to the run. This town panics when kids are involved. As we arrive at the address we see the standard teenage girl flailing her arms in the street as if the houses weren't numbered in ascending order. Off the engine and bags in hand we're led to the third floor, past a woman screaming a foreign language into the phone and into a back bedroom where I see our young fire child.

Awake. And dressed, shoes and all.

"Is this the boy with the fever?" I asked as the firefighter checked the boy's skin.
"His fever is 112, I had to call you, I don't know what else to do!" Mom is crying to us as young "Danny" is curled up at the edge of the bed asking why my pants look funny.
"These are my fire pants. We brought our fire engine, want to see it?" simply wanting to see if he comprehends the facts in front of him, kind of a level of consciousness test.

"YEAH!" He shouts and is off to the races and down the stairs nearly knocking down the ambulance crew running up the stairs, Pedi bags in hand.
"How much Tylenol have you given him?" was the last question I heard as the ambulance crew pushed us out the door and back in service.
"None" was mom's response.

Danny was excited to see the engine, lights flashing in the early morning hours, even though he should have been fast asleep, tylenol doing its thing on his mild fever.

You Make the Call...Smoke Showing...What Happened

2009-09-28T07:00:00.000-07:00

Seems every time we put a fresh pot of coffee on, something comes in.

In this scenario I was actually the eager young fellow out in front of the station reading the smoke in the early morning hours. I was beside myself when the boss looked over to me and told me we were out of service and there are other companies to cover it. But, the red stuff, it's...red and burning and hot and stuff. Huff.

My jaw was on the floor. I wanted to throw the radios back in our coats and head over there. I don't need my ALS kits at a working fire, that's what ambulances are for.

If you said hang back, you made his call.
However,
If I was in the seat that morning we'd be right back in service on the air and responding if we were due. I think most of us work in a place where if you can see the smoke, chances are you're due.

If you said get off your butt, there's a fire, you made my call.

A quick note on our You Make the Call series. There are often comments about not knowing my situation or my SOPs, etc, etc. The point of these situations is to get us thinking about what WE would do in our own districts with our own SOPs, staffing, equipment, etc. Don't wonder what I did, tell me what YOU would do. Hence the "YOU" Make the Call.

Sunday Fun - Smaquis the Frog

2009-09-27T07:00:00.000-07:00

Mitch Hedberg - February 24, 1968 – March 29, 2005

Shorties: Mitch Hedberg on Smaquis the Frog

Atom.com: Funny Videos | Animation | Shorties Watchin' Shorties

Rules for Covering-In

2009-09-26T13:42:00.000-07:00

Different places might call it different things, but here when one company is called to respond for another, it is called Covering-In. Our dispatch system already knows who will cover for who depending on the severity of the incident. Most commonly used when greater alarm fires are transmitted, this system puts companies into the effected area to maintain basic coverage.

We are dispatched as follows: "This is a directed cover for Engine 99 to the quarters of Engine 77, Engine 99 you are now first due in place of Engine 77." And we head over to Station 77.

There are rules you should follow when covering-in.

1. Get the map book from the office and put it on your rig, after looking it over. Maybe you're lucky enough to come from a nearby area and know the neighborhood you're covering, but if not, become best friends with that book if you're the driver.

2. Cover the food. If they were in the middle of a meal when the bells rang, cover their plates and tend to the food left out. Do not eat the food, they're expecting it to be there when they return, so go out and get your own food.

3. Make up a hose pack. If your department has a standard strapped hose load, make a new one so the company can go back in service faster when they return. Make it up or ensure there is enough line to restock their pre-connects and get it ready.

4. Don't sleep in their beds. If you're stuck there overnight, you get to sleep in a chair. Do you want some stranger sleeping in your bunk? Didn't think so.

5. Secure the house and the yard. Make sure all the doors are closed and locked (and that you can get back in) and cars in the lot are secure. Goodness only knows what they were doing when the call came in.

6. Make a fresh pot of coffee. Also check for bottled water and put some in the fridge.

7. Post a night watch. This person will be pre-selected to answer the phone, front door and monitor the radio to wake the crew when the home company is returning. That way they return to lights on, fresh coffee and extra hands to help get back in service.

8. Check the washing machine and dishwasher. Do basic chores to make less work for your co-workers when they return, likely exhausted.

9. Keep a log of any supplies you use while gone, from coffee to medical supplies.

10. Before leaving, make sure there is nothing else you can do for that company including chores, dishes, cooking, anything. Pay it forward. Do onto others, etc etc.

A Tip of the Helmet - HIPPA Mad Libs

2009-09-25T18:46:00.000-07:00

A tip of the helmet to Mack505 at Notes From Mosquito Hill.

The recent post joking about how a HIPPA approved EMS blog entry would look sparked a nifty idea over at his home blog.

Mack505 copied the [bracketed] items and sent them to friends as an actual EMS Mad Lib.

The first one came back and it is indeed funny. Give it a shot, here is the list of brackets.

[a location]
[medical condition]
[possible relative]
[partaking in a household task]
[he and/or she]
[mechanism of injury]
[an injury and/or illness]
[municipal service]
[a/an approved medical device]
[conveyance]
[patient care procedure]
[medical device]
[medical device]
[an approved setting]
[the appropriate button]
[a body part]
[patient care procedure]
[approved pharmacological interventions]
[Physician and/or Physician's Group]
[a secular receiving medical facility]
[an approved pharmacological intervention]

Replace your words into the text of the original post and send it to Mack505. Neat idea Mack, I like it and we might just do this again some time.

You Make the Call...Smoke Showing

2009-09-25T07:00:00.000-07:00

Congratulations on making it through your first shift as the Engine Boss. Yesterday went well and here you are at 6 AM stripping the radios and whatnot from the engine as she is due at the yard for an oil change.

Just as you finish removing the ALS bags, defib, radios and headsets, a call comes over the radio for a reported working fire in the next district over. You are out of service for the yard, made the call not 5 minutes ago.

Not thinking much of it at first you go back to your morning paper. The first engine to go enroute on the air reports heavy smoke showing as they pull out of quarters. One of your firefighters has come running back in as you take your first sip of coffee and tells you it looks to be on the border of your two jurisdictions, maybe even closer to you.

"Are we going on this or what?" He has his pants and coat on.

You make the call.

the Handover - 8th Edition

2009-09-24T19:05:00.000-07:00

The Handover is alive! And for the next 12 hours my link bar will likely have all links to this edition, hosted over at Life Under the Lights.

CK has put together the funniest. calls. ever. and did a fantastic job. Anything with a one armed fisherman joke, sign offering a free cat and stories about human urination can't go wrong. Right?

Attention all Companies

2009-09-24T13:35:00.000-07:00

In case you were unaware, you can also access the Happy Medic blog from thehappymedic.com, or happymedic.com.

If you currently access HMHQ from a bookmark in your browser, please take a moment to update the exhausting yourhappymedic.blogspot.com with a quick happymedic.com.

This will make it easy for you to follow along seamlessly should I finally decide to expand the blog into a full fledged site. Yes, that was a threat.

Also, keep watching for details on the England Paramedic Exchange "the Project" and dates for EMS and Fire Bloggers meetups both in the UK and the US. They will be in November, exact dates and locations TBD. Want to join us? Drop me an email at thehappymedic@gmail.com and I'll update you personally. Or at least my secretary will, if Mrs HM will let me hire Scarlett. *sigh*

In addition, HMHQ was linked by a publication for our advice on Disaster Planning recently, so that will continue early next week with tips on how to plan for an evacuation. Remember, this is all adding to our binder we started after agreeing to finally get that living will sorted out, so just keep adding to that binder and before long you'll be prepared for anything.

That is all.

A HIPPA Friendly Post

2009-09-23T21:30:00.000-07:00

I was joking with a friend that instead of changing facts in these posts to make them safe and legal and such, I could just omit the information. I joked it would look like a horrible MAD LIBS. Sounded like a challenge. So here is a HIPPA approved EMS Blogger Post:

THE EMERGENCY

[There is no way to confirm or deny the existence of a medical emergency]

THE ACTION

We arrived at [a location] for a reported [medical condition]. The reporting party said their [possible relative] was [partaking in a household task] when [he and/or she] lost their balance, resulting in a [mechanism of injury] that caused [an injury and/or illness].

The [municipal service] moved quickly to apply [a/an approved medical device] and extricated the patient to the awaiting [conveyance]. In the back I started a [patient care procedure] and rapidly shifted gears to the [medical device]. I charged the [medical device] to [an approved setting] and pressed [the appropriate button]. The smell was intense. [a body part] had caught fire, literally, as a result of the [patient care procedure] despite my use of [approved pharmacological interventions].

Needless to say the accepting [Physician and/or Physician's Group] at [a secular receiving medical facility] was not at all amused at our predicament and immediately started [an approved pharmacological intervention].

Two Houses

2009-09-23T01:12:00.000-07:00

Two households, both alike in dignity,
In fair Verona, where we lay our scene,
From ancient grudge break to new mutiny,
Where civil blood makes civil hands unclean.
From forth the fatal loins of these two foes
A pair of star-cross'd lovers take their life;
Whose misadventur'd piteous overthrows
Doth with their death bury their parents' strife.
The fearful passage of their death-mark'd love,
And the continuance of their parents' rage,
Which, but their children's end, naught could remove,
Is now the two hours' traffic of our stage;
The which if you with patient ears attend,
What here shall miss, our toil shall strive to mend.
Shakespeare's Romeo & Juliet, Prologue

Two Houses.
EpiJunky

Capt. Schmoe

I do believe an ancient grudge is boiling to a head.
A grudge born from a time when what we do was still a mystery, a trade, an idea whose time was overdue. The fact that this new idea took root in a large municipal agency has led to many today misunderstanding why it was put there. Some have seen the big red machine have little effect on their company's ability to provide excellent service to their community over decades.

There is a battle raging in some systems between these two houses that has no winner, no finish line and no perfect solution.

We are the children of a time of confusion and reaction. The machine struggled to defend their size and mission. In no way am I suggesting that the children of the two systems will unite and die to finally get the parents to stop quarreling, as Shakespeare tells, but I now believe that my current role may in fact be that relationship. A combination of the two houses that was not properly vetted or thought through and was doomed from the beginning.

The meeting of fire and EMS for me is a natural fit. I don't see things in the contrast of Montague and Capulet but shades of Verona Citizenry. Fire based EMS makes sense to a point, but I've seen it taken so far past that point in some places, we're starting to finally turn on one another.
To quote James Andrews from PCU - "It used to be the Administration's job to make the rules. It used to be us against them, now its us against us."

The cousins of both families are at war because we take the least of each and apply it as the rule.

We're better than that. Those we make example of may not be "us", but the folks that take the time to even type EMS in the google search bar are miles ahead of those bringing the meaning of what we do into the gutter.

Fire engine, ambulance, squad, pick-up truck, volunteer, whatever capacity you provide you service, we should all be striving towards the same goal of providing the best possible service to our clients and patients, leaving all the political BS, name calling and ancient grudges outside. It doesn't belong at the scene, it belongs here, in the channels of communication we have opened when others failed.

It is here, in this new medium, we can have an International discussion about what to do next, instead of raising our voices in front of the people who call for help, not caring what color uniform walks in the door, or who pays the salary, just that help comes.

So vent my friends, get it out. Write a post out of frustration, erase it and start over again. Each version calming your anger and settling your frustrations.

Share your experiences so that those new in the business can learn what a true caregiver looks like and those who may be slipping can catch themselves before they fall.

Losing Independence

2009-09-22T15:12:00.000-07:00

Not a political post, I assure you. This is about a section of the population that needs to come to terms with their limited abilities. And to remind PAs that I am in charge of patient care at a scene.

THE EMERGENCY

Caller states there has been a car accident and one person appears shaken up.

THE ACTION

Shaken up. OK. Out the doors and a few blocks down we see a large SUV into a light pole, newspaper machines and trash cans in the sidewalk, 2 parking meters down for the count and a little old lady seated behind the wheel of a little hatchback behind the SUV.

Blink. Blink.

The SUV was empty and parked, our little friend is alert and oriented, sitting behind the wheel, clearly upset at what has happened. I think she would likely get out of the car and be fine if it weren't for the half dozen samaritans encouraging her to go and get "checked out."

I introduce myself to the group and they all start to tell the story, each pointing different directions and saying different things. Quickly, I duck down and make contact, she is not injured and has no complaints. She describes not having parallel parked in years, let alone on a hill like this, and hit the gas a little to hard backing up (she points over her shoulder to the uphill parking meter). Then she gunned the gas a little too much instead of letting the car roll forward. (She points forward towards the mess down the hill). When she realized what was happening, she tried to hit the brakes, but her foot was still on the gas. She pushed that SUV right up off the street and onto what is usually a crowded sidewalk.

As I completed my assessment and she blushingly refuses an ambulance, a man approaches to ask me if she had a TIA.
"I don't think it appropriate to discuss her condition with strangers, do you know this man?" I asked her seeing her shaking her head.
"I'm a PA," he advises, removing his sun glasses, "Are you OK Dear?" He asked her as if talking to a three year old.
"Sir, I have this scene under control, and she has a name if you'd care to ask." Was my smart ass response that got his attention off of her and onto me, as planned.

"You guys sure have a lot of attitude," he observed looking me up and down, perhaps looking for my Registry Certificate, State and County Licenses, 48 hours of continuing education, Bachelor's Degree, instructor's certificate and years of assessments. I keep them in my other pants.

"I would have her checked out if I was you." And away he went, placing his sunglasses back on as if nothing was wrong.

"Who was that man?" my client asked looking up at me from the seat of the car, holding her insurance information and license.
It was then that all the BS around that man faded away and I saw what was going to happen to my friend. There is no way her insurance rates will stay affordable, likely resulting in her losing the car. The freedom she has known for close to 70 years of driving will be gone. Then she'll have to walk to the market, that is until her knees give out. Then she'll be stuck at home. And the PA so concerned for 80 seconds will never stop by to lend a hand.

Milk dripping from my nose

2009-09-21T19:13:00.000-07:00

We added a new CE source awhile back and they recently earned a permanent spot in the CE group.

Take a big sip of milk and click on this link to the most recent post at Ugly Things for Sale entitled, "There is nothing about this post I don't like"

I haven't laughed like that since they tried to convince me the King tube is better than the combitube.

This is good for 48 CEs for the author of that blog.

LATE EDIT -

Speaking of CEs, I've added Rogue Medic to the Mutual Aid Board, but will also give CEs for his insightful posts and unyielding desire to CITE HIS SOURCES when making an argument. I find people who make claims they can back up fun to read and great to learn from.

By the way, your CEs are only good for your Happy Medic refresher, so no more emails asking for the certificate provider number for your National Registry. Even though I'm sure they were a joke, I just wanted to set some ground rules for you new folks. Both of you.

Last call for the Handover

2009-09-21T11:00:00.000-07:00

CK at Life Under the Lights has sent out the last call for submissions to the Handover. This month's theme is "Funniest. Call. Ever." Grab a link to your funniest call and send it to him for inclusion, but hurry, today is the deadline.

You Make the Call...Advertising...What Happened

2009-09-21T07:00:00.000-07:00

Well, well, well, your flirting has finally caught up with you, eh? (Thrown in for Little Girl)

This situation called for either disregard and hiding or coming out into the open. Or blaming someone else... Where is MC when you need him?

I chose to come forward and tell the brass about the situation, in person. When I walked into headquarters and into the Chief's office I was met by a familiar coffee cup on the desk and knew everything was cool. We talked about how parking in front of the shops we frequent can send the wrong signal and that we were of course allowed to patronize appropriate businesses.

In the end it could have gone either way with the same result, I think there was some pressure from City Hall as to why one of "their" rigs was in an ad without their permission.

There was no such outcry when a local insurance group used a shot of one of our rigs in their ads proclaiming quality care by their services.

If you said be honest and get out in front of this thing, you made the right call.

Sunday Fun - Dinner, dinner, dinner

2009-09-20T07:00:00.000-07:00

Three of my favorite words in the firehouse are:

Jumped - You are relieved, I'll jump a call if you get one.
Box - A reported fire.
Dinner - No explanation needed.

Stuck for a recipe for tonight? Try this site, FireHouse Chef dot com. Each recipe gives the member who submitted it and there are a large number.

Even something for my bacon loving friends:

Border Bullets - For Those Who Like it "HOT"

12 large jalapenos or how ever many you want to make.
Cut the tip or small end off of the jalapenos leaving the stem on the other end.
hollow the jalapenos. ( we use a potato peeler )
Fill jalapenos with cream cheese.
wrap jalapenos with bacon holding bacon in place with toothpicks.
Broil in oven until bacon is to your liking.
remove, let cool and eat.

Recipe by Firefighter: Phil Burrow - Alva Fire Department, Alva Oklahoma

Do you have a favorite recipe? Post it in the comments and you'll have another place to look for recipes.
And don't forget to stop by our friend Mrs Fuzz over on Fuzz Food for other ideas.

Onstar?

2009-09-19T17:29:00.000-07:00

I was asked by a client recently if this Onstar really works. The idea is that the sensors in the car send signals to the company who calls 911 in the area and relays the information.

I was wondering if anyone out there has responded to one of these automated calls and how it came in. Was the information accurate? Did it make a difference?

You Make the Call...Advertising

2009-09-18T07:00:00.000-07:00

A couple weeks ago you were at one of your local coffee spots enjoying a fresh, brewed just for you, cup of caffeine when you commented to the clerk, whom you fancy, how much you love the coffee there.

"These keep me awake to save lives" you half joked, half hoped she was single.

The bells rang over the radio and away you went on a call, not giving it a second thought. You've been back every shift, so has half the fleet.

Yesterday morning the newspaper has a new ad running showing your ambulance parked in front of the coffee shop with your quote in large block letters. Medic 99 clearly visible on the side.

This morning a memo is out asking those responsible to come forward. Your Department's policy on endorsing products in uniform is clear: No.

After sipping the last of your coffee, your partner asks why you turned red. You make the call.

No one wins

2009-09-16T14:56:00.000-07:00

The dispatch is for an unknown medical aid.

I press the button for the rickety elevator, wondering how long the trip up to the fifth floor will be.

"Mid 40s female...overdose," the Fireman says.

I pause

"Early 60s male, respiratory issues," is my reply.

"Lunch and dinner?" He asks, hand outstretched.
"Lunch and dinner," and we shake hands as the elevator opens and we pile in.
The ride is shorter than we expected, and we made it all the way up.

As the door rumbles open there is a distinct odor of urine and an open door just down the hall.
"In here!" a tired male voice calls. I turn to enter the little room and see, on the bed, a man in his 60s having trouble breathing, holding onto a woman in her 40s with an altered mental status.

"Well that was anti-climactic" the boss says and we go to work.

Later that night we bought each other's meals just to keep the spirit of the game going.

Holy anhydrous ammonia Batman!

2009-09-15T23:10:00.001-07:00

You need to stop what you are doing right now and click over to Life Under the Lights.

This is not a drill.

Disaster Plan - Supplies

2009-09-15T17:09:00.000-07:00

I've gotten a couple of supportive emails about the Family Disaster Plan we've been slowly building, so I'll try to add a section or two every couple of weeks.

This new section is about supplies. Not necessarily MREs and climbing gear, but re-purposing some basic household items to be used in case of a disaster.

We'll need some bins. Buy your supplies first, stack the items together, then buy bins that will fit your stuff. Don't try to cram stuff into bins after the fact.

First, let's talk water. You will need one gallon of water per person, per day. That means at least 12 gallons for my family. When you get the water home look at howe much space it take up not only in the house, but in the parking lot at the store. Keep this space usage in mind since if you need to evacuate you'll need to bring it along. (Water does not go in the bins)

Next, let's talk food. I recommend one can of food per person, per meal. This means a family of four could share 2 cans of chili a vegetable and a fruit as an evening meal. Include canned foods, nothing that needs to be refrigerated, and things your family will actually eat. The side of the road in the middle of the night is a bad place to try to introduce spaghetti Os to a finicky 3 year old. Check the expiration date on the cans and make sure they'll make it to next year around Christmastime. When they near expiration, replace them and donate them to one of the many canned food drives. Instant karma.

In addition to the cans, we'll need some variety. Add in a box of unsalted crackers, a package of juice popsicles unfrozen (Like OtterPop Brand) and a handful of candies. This will keep the sugar level up and add some yummy flavor for the kiddos. At the store, find some 12oz V8 cans and add 3 per person. This is your breakfast and is also a great source of vitamins.

Avoid pasta, ramen, anything that requires water to cook. You need that water for drinking.

Now, onto the cooking of the food and the sheltering while away. We'll cover how and when to evacuate later, let's get our supplies together first.
Do you go camping? Do you have a tent, camp stove, flashlights, candles and a decent little stockpile of utensils and the like? Then great, you have a disaster kit almost ready to go. Move all you camping things together and into a place that can be easily accessed in a hurry. This will be your home if you need to evacuate. Especially if you are leaving with your pets since many shelters will not accept persons with animals, camping allows you to chose who you bunk with. Re-read the instructions and cautions on your cooking stove to ensure you always use it in an open area.

Just a few more things for our bins. Each bin now gets a can opener, 2 large trash bags, a small box of ziplock bags, a roll of duct tape, a package of baby wipes and an emergency radio/flashlight. You can find a variety of models to choose from, but I recommend one that can run on batteries, solar and dynamo power. It should include a flashlight and radio and some even offer adapters to charge a cell phone. Each bin gets one along with an old cell phone with charger cable. As long as you can transfer your card into the old phone, you're good to go.

If you have really little ones, add formula and a bottle set up to each bin and remember to update the food choices according to age.

There, the basic bins are ready to go. Whether it fits in 2 or 3 or 4 bins, be sure that the supply can be split if needed, one group taking enough for them while leaving enough for others. Store the bins so they are easily accessible, maybe with the camping gear and you'll have everything you need in the same place.

Write down what items are in each bin with their expiration dates and place it in the binder in the back. Update it every year before the holidays along with the photos on the front page.
Not sure what I'm talking about? See where this all started at our first adventure into Disaster Planning HERE, ans follow up HERE to learn even more.

Next time we'll talk about when and why to evacuate. Until then, be prepared.

It's a funny squeaky sound

2009-09-14T16:54:00.000-07:00

You need only watch the first 20-30 seconds of this for the following dispatch to make sense.

Aunt Bethany from National Lampoon's Christmas Vacation is a favorite at HMHQ. It isn't Christmas until Clark W. Griswald and family go through their annual disaster. I was temped to hold this post until the Christmas season approaches but I had to share this remarkably appropriate use of resources.

THE EMERGENCY

The caller states she hears a "Loud squeaking sound" from her basement.

THE ACTION

Did I mention that I am so creative I have imagined every single one of these posts? None of them is rooted in any reality whatsoever, I'm that good.
Oh I wish I made this up.

The engine and truck companies arrive on the scene, code 3 I might add, to the large apartment complex where we are led to the unit of the reporting party.
"It's a loud squeaking sound" she tells us, causing me to smile recalling Aunt Bethany.

We head to the basement where we find a hot water circulator pump with what sounds like fried bearings. We explain that we can turn it off, but folks up on the upper floors may have to wait a while for hot water.

"I can't sleep with that sound, turn it off." she tells us and turn it off we did.

It was back on the sidewalk out front as the ladder came down (why not have a quick drill?) when a passerby asked me what the trouble was. When I told him what we had found he stopped dead in his tracks.
"Are you [expletive, deleted] kidding me? They called 911 for a noise? Are they retarded?"
"Sir I can make no statements as to the mental well being of our clients, what with privacy concerns and all."

He smiled and went along his way. I, unfortunately, had 14 more calls to run before that shift was over.

Sunday Fun - For the Firegeezer

2009-09-13T07:00:00.000-07:00

When I got my phone I didn't care if it had a camera. When I bought my camera I didn't want it to have a phone. Now that I've found myself in a few places wishing I had my camera only to have my phone, I will pay more attention.

While sitting fire watch on a large industrial fire from a few days earlier, our engine company was doing the obligatory orientation to entrance, egress and safety issues when I peaked into one of the warehouses and saw a sad sight. The sight captured by my sad little camera phone.

In the middle of the picture is a kitchenette with a two pot Bunn-o-Matic which completely melted down the front of the cabinets. The unit itself survived, but the bottom pot seems to now be stuck to the lower cabinet. The excessive light is from a section of collapsed roof, hence my inability to get closer for a better shot.

But I saw this and thought of Firegeezer's nice clean 4 pot Bunn on his Facebook avatar and I shed a tiny tear for this coffee maker.

Poor thing never had a chance.

My Healing Hands

2009-09-12T17:19:00.000-07:00

I'm working a 48 at a decently busy house when, early on day two we start to notice something extraordinary. Everyone I've touched has been cured on the spot. Call them miracles, call it a practitioner's energy, what have you, but don't burst my bubble by saying they weren't sick in the first place. That's just cruel.

PATIENT 1

A middle aged man at the local gym. The staff heard him singing one minute, then passed out cold on the floor the next. We arrived and found him supine, the water off, his skin still warm. I reached down to check his pulse when his eyes opened and he came to life. "What happened?" he asked me, standing and covering himself with the towel nearby. "You tell me," I tell him and he does. He's been up for two days straight and just finished a basketball game with friends. He remembers the water being so warm and inviting...then found himself on the floor. He awoke to my touch. Miracle.

PATIENT 2

Activated to a street corner for the severe asthma attack. The address is well known for drug traffic and asthmatics who rarely refill THAT prescription. the Police officers at the corner are waving frantically as we turn the engine down the last block. They run to my door, not the lieutenant's door, but mine. This must be serious. "She's barely breathing, hurry!" I'm told so I grab the bag and hustle over to where they pointed. A woman is leaning over the bed of a pickup truck with her head down. I quickly reach for her chin to assess her breathing when she slaps my hand away. Effective motor control for someone in distress. "Can you breathe?" I ask. "No, I can't. I have asthma real bad." Is her response. the stethoscope is out and under her intentional grunting is clear air movement, even way down in the lower lobes.
I can hear a bit of the conversation in the background between my lieutenant and the police.
"She wants into the apartment, hubby won't let her in, she told us she needs her asthma machine and to call you."
"I don't think this is asthma," reaching down to check her pulse rate, "is there anything-"
"Fine, thank you." She interrupted standing, straightening her shirt and walking over to the officers. "Will you let me in now or not?"
As the ambulance crew arrived I told them the situation and they agreed I had the magic touch. For sure.

PATIENT 3

An elderly man was seen being escorted from the commuter train, pale and sweating, by two adult males. In this time of increased security, the guard decided to give 911 a ring. When I arrive in the bathroom, the man turns out to have been escorted to the train by his two adult sons, who were concerned he wouldn't make it to the toilet in time. They reluctantly open the stall door and there he is, pale, cool skin covered in sweat, and a look of embarrassed discomfort on his face. "I'll be fine as soon as I can go." I'm thinking the same thing you are so I reach for his pulse rate when he groans. Honestly, the moment I touched him, he pooped and instantly felt better. "My medication makes me constipated." He says. And my supernatural powers do the opposite my friend.

PATIENT 4

Sometimes you really can talk sense into your regulars, especially when they try playing your game. This time our friend in the lobby of the motel tells us of an elaborate cardiac procedure performed earlier that day that should have meant a scar and a few more days of observation, but hey, at least he's trying. I explain the details of the procedure and how long I spent in school to learn that as he fidgets with 3 of his 4 extremeties. As my EMT is taking vitals and holding one arm still, the other begins to fidget around. This man's nervous system is clearly in massive overdrive and the blisters on his lips give me a good idea what's happening. When I place my hand on his shoulder to get his attention he straightens up, looks at me and says, "If you think nothing is wrong then I don't care, I'm going back to sleep." And wandered back up the stairs.
The lieutenant walked up and asked if I'd be willing to touch his throat, he's had a cough as of late. I told him he should wait until I wash my hands. My miracle hands.

PATIENT 5

Anxiety impacts a large portion of our population and our friend called today because he refilled his prescription for anti-anxiety pills, but sold them for heroin instead. We've all been there, right? He walks out of the hallway alert, oriented and breathing fine, all the while telling me he can't breathe. I talk him through some breathing exercises, slowly calming him and he feels better. As the ambulance pulls up he waves them off. I haven't touched him yet and am wondering if it's a fluke. As the ambulance turns the corner he starts to breathe quickly again telling me he needs the pills or he won't get better.
"Look at me," I say taking his arm to focus him, "You don't need those. We didn't use them today, it's all about controlling your breathing." He smiled, turned around and walked away. I turned to the crew, each with a different variation of "WTF" on their face and thought to myself, "This is totally going in the blog."

What is that smell?

2009-09-12T06:14:00.000-07:00

Some folks, when given instructions by 911 dispatchers, follow those instructions. Others follow them to the extreme and have a negative impact.

THE EMERGENCY

Security is reporting an employee with burns from the fryer.

THE ACTION

Racing down the freeway towards the casino at the northernmost exit, ours is the ALS ambulance and my driver has decided he can't let the BLS unit responding behind us to beat us to the scene. To anyone coming the other way, it must have looked like an ambulance race instead of an emergency response. All I could think of was the scene from Mother, Juggs and Speed.

We arrive at the casino and are led into the tiny security office off the main lobby to a most peculiar smell. In the corner is the cook (They make nachos and chicken wings so Chef doesn't cut it) we always make a nod to when we pick up dinner on some nights. The look on his face is one I would later learn is true excruciating pain.

He was emptying the grease from the deep fryer when it spilled out and splashed on his lower leg, which is still smoking ever so slightly. As we made quick movements to do the first important thing when treating burns, removing the source of the burn, the security supervisor explained he was told by the dispatcher not to put anything on the burn.

Um...yeah...about that. That excludes removing the oil with a towel or perhaps cool water, right?

Soon after the 2% area was cleared and wrapped the Manager burst into the office asking why the kitchen (snack bar) was closed. She actually asked if he could finish the last 4 hours of his shift before getting treated. The guy could barely stand up the pain was so bad so there was not even a hint of a possibility of letting him stay.

Enroute to the hospital, a 40 minute haul, we talked about the Manager's plans to expand the kitchen (snack bar) into a real restaurant and hire him a staff. Then he could make one of them empty the fryer.

Battalion 1 to Manhattan

2009-09-11T05:46:00.000-07:00

Radioed by FDNY Battalion Chief Matthew Ryan at 8:46 AM local time:

"A plane has crashed into the trade center. Transmit a second alarm and start sending additional companies into the area."

Less than 20 minutes later, FDNY Chaplain Mychal Judge, bottle of holy water in hand, entered the debris to tend to firefighter Danny Suhr, who had been killed by a body falling from the tower. When Father Judge removed his helmet to administer to the fallen firefighter, he was struck and killed by falling debris.

He was found by five men who carried the fallen Father 2 city blocks, placing his body in front of the altar of St Peter's Church. He was covered with a white sheet and his priest's stole, then his helmet and badge were placed on his chest.

This is an image that will remain with me for the rest of my days. The respect shown by these 5 men who took a fallen brother home stops me in my tracks every time I imagine myself seeking solace in that church on Barclay street. The doors bursting open and these five men carrying a lifeless body to the alter, showing their respects, then returning to help others. I was not there, but I can imagine the raw emotion.

Father Judge was later moved to Engine 1, where his car was housed.

Hidden in all the "Never Forget" and "343" stickers and T-shirts are thousands of tales of heroism and bravery, brotherhood and citizenship. Learn one. Pass it along to others.

Father Mychal Judge was later declared official fatality #00001.

Mychal Judge

Chaplain, FDNY
May 11, 1933 - September 11, 2001

Video from NBC about 911 abusers

2009-09-10T17:02:00.000-07:00

I almost missed this thanks to the football game tonight, but was able to get it online. the previews for this story were completely different than the story they tell in the video.

Visit msnbc.com for Breaking News, World News, and News about the Economy

I think this is a foot in the door to address the abuses of the 911 system and possibly reach out to our communities about what an emergency is.

I think the most interesting part of this video was the dispatch in the beginning sending 2 engines and an ambulance to a trouble breathing call. 2 engines...10 people...1 patient...

"How can they do both?"

2009-09-10T08:58:00.001-07:00

Just saw an ad for the NBC Nightly news tonight that talked about how "Our nation's bravest" (Showing pictures of fires) are being taken out of the firehouse to care for the nation's poor.

And this is news now?

Seems to me the article mentioned all over from DC E10 has made it to the airwaves. The problem is the public still has no idea what the mission of the modern fire service is. Is it fires? Is it EMS? Is it code inspection?

I'm sure there are many an IAFF local that would like nothing more than to stop providing EMS services from their fire apparatus, but have they looked at the ink those calls bring? When I run the numbers in my department, there would be no way to justify half the resources we have deployed if they no longer responded to EMS runs. Plus, who will wait on scene 40 minutes for a private ambulance to arrive?

Are we at the crossroads where EMS can be lifted out of the fire service and if so where do we put it? Our pal CK mentions an EMS based EMS system, but my area doesn't have the resources to deploy EMS without the pre-existing resources staffed by the fire service.

Believe me friends when I say that if there is a more efficient way of providing our services, let's get to it. But to my readers who are "hardcore firemen" and dislike providing EMS in between your increasingly infrequent fires, just remember it's your job to provide that service. When that service is no longer part of the expectations of the community you will have serious trouble justifying all those big red trucks when the bells no longer ring.

Without EMS runs our 3 busiest engines and one of the nation's busiest ladder companies will drop off the list completely. But it's not all about how busy we are, but are we providing a valuable service to the community in the most efficient manner possible?

I'll be tuning into NBC News tonight to see the story, curious to see what they report. The timing of the story is also very interesting, considering tomorrow.

Politics

2009-09-09T22:12:00.000-07:00

Not in that sense, I steer clear of that here, you all know that.

I mean the politics of EMS. I mentioned a while back that I sought out and was appointed to a seat on the local EMS Committee in my community. At my first meeting I was a nervous wreck thinking I was way out of my league amongst industry reps and MDs with years and years of experience. I sat in the corner and said nothing.

This most recent meeting, I pitched the Project and they loved it. Everywhere I mention this opportunity, folks are interested in our differences and our similarities to our friends across the pond.

I had the opportunity to have a few words with the Medical Director who empowers the Paramedics who will treat my family and I had to smile. His thoughts on the Project were great and where he wants the system to go are progressive and treatment based. He showed interest in the Advanced Practice Paramedic concept as well as expanding the State's Paramedic training. Champion.

They also want to hear about what I learned from the Project when I return.

So now the pressure is on to gather as much information as I can on this exchange. I'm not looking to adopt a socialized response system, that won't work here. I'm looking for ideas that can reduce our requirements to default to transport to the emergency room. I'm looking to see if the rapid response model might work in my department to ease the burden on some of the nation's busiest ALS engines.

And on top of all that, I'm looking forward to finally meeting my friend Mark.

If you're also interested in meeting Mark and will be in the Northern California area around November 12th, let me know and we'll get together and talk shop.

And even though anyone paying attention knows exactly where I am I still need a bit longer to "come out" to you. It's a big deal, you know, but will be revealed as we promote the Project. Baby steps, hence the new banner.

Chasing the past - New Blog to follow

2009-09-08T09:44:00.000-07:00

I'm adding a unique blog to the Continuing Education Board here at Happy Medic Head Quarters.

The Engine 17 Project chimed in on a recent post and I'm intrigued. The author is finding the original Engine from his childhood neighborhood and restoring it to it's prior glory.

The updates are coming slowly, but that is understandable with such a project. Click over and catch up, won't take more than 20 minutes and counts as a full hour of CE's for your refresher.

Plus she's an ALF 900 series. Happy is in the market for this Engine's cousin, the ALF 100' tractor tiller.

They Make the Call...What Happened

2009-09-07T07:00:00.000-07:00

Well, what did happen when you told the family about this? As indestructible as we feel from time to time, planning for your death is the right thing to do.

Having the papers drawn up is not the end of your task, however, more must be done to make the tragedy easier to handle. That is where your Family Disaster Plan comes into play.

We all have 72 hours of supplies, right? Food, water, medications, flashlights and radios. Not just in hurricaine, tornado and earthquake country, but all of us should be ready to ride out 3 days on our own. We've all seen how help can take a few days to arrive in a disaster.

But just putting the food in a corner of the garage isn't enough either. The whole concept of surviving and recovering from a disaster should be at the forefront of your mind BEFORE you need it. Put the time in now and in an emergency you can simply follow your prepared plan. And, since the plan is written down, the family can follow the plan should it occur while you're stuck helping others.

So, for the first time ever I am assigning homework to all my readers. I know you understand computers, so click open a new word processing document and list the following things:
Members of your family with names, dates of birth, eye and hair color, you can add a photo later.
Next page lists contact numbers. Home, cells, work, doctor, pediatrician, local animal shelter, non emergency dispatch, family friend in walking distance.
You're doing great, now on another page, give simple instructions on where and how to shut off the electricity and gas in your home.

Now, print it out and place it in a large 3-ring binder and put it on the shelf. When you get all your living will documents together, place the originals here.

There. You're well on your way to completing a Family Disaster Plan.

If you're rolling your eyes or think I'm taking this thing way too far, there might be a Cop Rock rerun on that would be more worth your time.

More details to follow, including the Evacuation Ordered section and the previously mentioned LODD envelope. You can find that post under the label Disaster Plan under the Topics Tab.

Sunday Fun - Your first

2009-09-06T07:00:00.000-07:00

They say you always remember your first.

No matter how many came after, regardless of shape, size or ability, that first one will always have a special place in your heart.

My first was this 1976 International 10 speed double clutch 1000 gallon water tender. We shared some great experiences together and at times was my only friend out in the middle of nowhere on an abandoned car fire or running as fast as we could (mid 40s) to a freeway accident.

I learned from her that if you take care of your equipment, there is still no assurance it will work when you arrive on scene.
Aside from the water, she carried 8 pieces of assorted cribbing, 50 feet of supply line, two preconnects and a shovel. That was it.
Every time we went to the gas station on the other side of town she would backfire...loud enough to make folks duck. She had no primer motor and the light bar gave out from time to time, but it was experiences like that that taught me to expect the unexpected and adapt to ever changing situations.

Do you remember your first?

They Make the Call...You're dead

2009-09-04T07:00:00.000-07:00

I'm wondering how many of you were motivated by my post a little bit ago about living wills and talking with your family about what should happen if/when you die.

So, congratulations, you're dead.

If your loved one is near you right now, tell them the following scenario:

On the way to work this morning another driver ran a red light broadsiding you and you died. Your body has been taken to the medical examiner.

Does your loved one know what to do next? All the account numbers, access codes, insurance, who to call at your work, what kind of service you want, if at all. What to do about income, the bills etc etc.

Now let's take that a step further and imagine the following scenario:

You and your loved one are out for a movie when the same thing happens, only both of you are dead. Who cares for your children? Who can legally come and care for them? How will your family access your accounts, your matters and deal with your estate?

If you or your loved one said "I don't know" to any part of the above scenarios stop reading this and look into a living will. At least talk about what you want to have happen to you after you die. As soon as you have the aftermath figured out, now get into the details of your wishes should you be unable to make medical decisions for yourself. Who makes them? Do you trust your loved one more than your mother, brother or local legislature? Put it in writing and get it notarized because simply saying "He told me he wanted to die/live" is not legally binding. Terry Schiavo ring a bell?

Get your living will and all other important documents and make 3 copies. Put the originals in a binder in a common area of your home labeled Family Disaster Plan (Details on that soon). Send another copy to whoever you chose to care for your children should you die. Then send the third set to a trusted friend or family member away from you who is not likely to be involved in the same disaster should one occur. Seal it in an envelope labeled (FOR EMERGENCY ONLY) and ask them to file it away.

Now, tell each other person about the 3 copies and where you keep the binder. Should something happen to you someone need only open the binder and follow the instructions, having all the necessary legal documents in hand should any question arise.

This, my friends, is how you take care of your family when you are dead. We'll cover more about the Family Disaster Plan later, especially the sealed folder in the back labeled LODD.

Get things straightened out before the unthinkable happens.

Priceless

2009-09-03T14:21:00.000-07:00

Plane tickets to England: $1000

New laptop for trip to England: $399

Seeing the fast response model first hand with a new friend to show the way: Priceless.

Clear your blog calendars in November friends, Mark and I are on a mission.

the Project is a go.

The PD to FD Translation book

2009-09-02T17:19:00.000-07:00

No offense to my BIBs (Boys in Blue) but some of the CYA stuff we get called on is starting to wear thin. Every time you chuckle when we ask you to clear a scene evens out when you call me for a "red cheek" from a slap that "just needs to be cleared."

We all do it to ensure everything necessary has been done for our clients. That being said, let's see what we really mean when we communicate.

When the PD says:
"Send an ambulance code 3, this guy is out cold."

What they really mean:
"I have actual police work awaiting me, get someone here to get this drunk off the street before they call back."

When the PD Says:
"We need a psych hold."

What they really mean:
"I am not putting this bag of nuts and bolts in my car."

When the PD says(When I've barely started my assessment):
"Is this a transport?"

What they really mean:
"I'm not taking her to jail, so..."

When the PD says:
"We just need an eval, he says he got hit."

What they really mean:
"This guy can sue us and me if I don't offer to get him help for what is clearly a non emergent injury. Sorry."

And when the PD says:
"I'm releasing you so you can go to the hospital and get checked out, OK?"

What they really mean:
"Your hospital is nowhere my beat. Get out of my hair, there is way less paperwork. For me."

Before all my BIB readers get upset, the reverse is just as true, just as retarded, and will be posted soon.

Your sister is not my Medical Director

2009-09-01T11:41:00.000-07:00

Each time I sit down and try to share this tale, I sigh and tell myself to calm down and try again another time. Being able to calm myself down is truly a fantastic sanity maintenance device. The young lady I met this night needs to learn it. Fast.

THE EMERGENCY

Two vehicles have collided in an intersection, PD states one occupant seems to be "panicing."

THE ACTION

We're sent code 2, or no lights no sirens to the nearby intersection where PD has already been able to close the intersection, set flares and even one wrecker has already arrived.
The passenger of one of the cars is in full hysteria mode, not unlike my three year old when you ask her to go wash her hands. She is crying, mumbling about making it to work in 2 days with no car and reaching out grabbing onto anyone who walks by.
Noting no injury and little mechanism from the crash to indicate such a thing, I move into dealing with hysterical clients.
"Hi there, I'm Happy and I'm here to see if you need some help. Are you hurt in anyway?"
She breaks down and just screams and cries. The boyfriend, who was driving and is also uninjured, tells me she started crying when the first police car arrived. She has trouble calming down he tells me.

Really?

I pretended she was my daughter and coached her through taking some deep breaths and trying to get her to laugh. Laughter is kind of like the synchronized cardioversion of emotional responses. You can go from balling your guts out, have a giggle and go back to normal in seconds. Works almost every time.

She calms after my patented one armed fisherman joke and agrees to climb into my office for a quick once over, but mainly to remove her from the stressful situation and into more of a comfortable space.

Now calm and settled, she has only a vague discomfort to her sternum below where the seatbelt kept her safely in her seat. I explain that is not unusual and everything else looks just fine. We offer her a ride to the ER, which she declines, the boyfriend will keep an eye on her and call an MD should anything change. After the usual legal disclaimer and autograph, we're back in service and heading back to dinner.

Suddenly the radio blows up with tones.
"Engine 99, Medic 99, Captain 99 and Rescue Squad 1 for the chest pain following MVA, possibly trapped..." to the same intersection we were just at. We told dispatch to hold the cavalry and turn around.

We pull up to the same two cars, same police cars, same everything except one officer shaking his head and looking down.
"I tried to tell her, but she won't listen" he tells me as I get out and there, on the side of the road in full hysterics, is the woman I just left calm and collected.
I open the side door and motion for her to get in. "I know I told you you could call us back for any reason, what changed?"
"I...called..." and the water works continue.
I gave the "WTF" look to the boyfriend who told me, "Her sister wants her to get checked out."

"What do you think I just did? I did check her out, she's fine. Do you want a ride to the hospital?" I ask her and she nods.

No treatment is indicated so I simply modify the report I had yet to complete on the way to the hospital. I spoke by telephone to the patient's mother explaining that I had performed a complete physical examination finding nothing of concern.
"Does she have whiplash? Her sister thinks she has whiplash. She should get checked out." I just handed the phone back.
"Is your sister a doctor?" I ask her to which she shakes her head, "She doesn't have a job right now."

"When you get the bill for this," I tell my uninsured friend, "Send it to your sister. All of this was her idea, let her pay for it."

Happy Birthday Happy Medic

2009-08-31T16:45:00.000-07:00

One year ago, exactly, I published my first post.

Looking back, I was just hoping to blow off some steam and vent my frustrations with the way EMS and Fire were being used by the folks I encountered. I didn't want to get caught up in the day to day news, there are far better sites for that. I also didn't want to get caught up in training, techniques and instruction, there are far better sites for that.

But I found very few that addressed the situations that make us shake our heads and think, "You called 911...for this?"

The 365 days and almost 400 posts that followed have been an absolute blast. The format has changed repeatedly, as has the picture up there, but one thing remains. I still aim to put a smile on your face giving you a first person account of my encounters with the public at large.

Thank you for stopping by and having a look around, see you next year.

your Happy Medic

You Make the Call...Triathlon...What Happened

2009-08-31T07:00:00.000-07:00

This person was not the most popular in the house to begin with and when the "injury" occurred, we all rolled our eyes and did things by the book.

Going off on disability means you are unable to fill a role within the organization, even if that means sitting at a desk filing papers and making copies for 8 hours a day.

When we saw his picture in the paper it was like a slap in the face. Guys got vacation canceled because this guy went off and here he is running a triathlon?

I mentioned the person looked familiar and threw the paper back on the table. One look from the officer and she was like a flash of light to the phone. She called him and asked him to explain how he was on disability for a bad knee while running a triathlon, to which he told the officer it was none of her business.

Wrong move.

If I recall correctly he ended up quitting over this situation, instead of asking someone for trades, or arranging vacation to train for the sporting event.

I have absolutely no hard feelings, guilt or anything like that about the situation. He faked the injury, he ran the race, he got his picture taken. Had I pushed him down the stairs, then I'd feel bad.

If you said call him on it, you made my call.

...for the conspiracy...

2009-08-30T12:45:00.000-07:00

In honor of the upcoming one year Anniversary of the Happy Medic Blog I thought I'd throw in a call in the old format that asked "You called 911...for this?"

You Called 911...for the conspiracy?

My fascination with the things people will call 911 for will never end. But on this call I had to scratch my head and ask, "Really? You were forced to smoke crack against your will?"

THE EMERGENCY

A first party caller reports he is unconscious

THE ACTION

How he got across to the call taker his unconsciousness does not change the dispatch code 25A5 looking back at me, a psych issue. Great.

He rings us into the little unit groaning and moaning with each step, but doing all right. It is our first run of the day and our hopes are still high for a good shift. The gentleman who called explains to us that he is unable to make it to the methadone clinic today on account of his stomach pains and he would like a doctor to give him some. After my standard talk about how we don't do that kind of thing, he decides to switch gears and appeal to my inner conspiracy theorist.

Did you hear Mrs Happy Medic just roll her eyes? She doesn't even read this blog and yet she somehow knows when I'm talking about conspiracies. It's a consp...
...I digress.

I won't bore you with my theories here, only to tell you each one can not be proven false any more than I can prove it true. That is the hallmark of a good conspiracy theory. So I perk up and wonder what this man could have that I haven't heard before.

"I'm forced to smoke crack and take methadone so I'll never get a job." He tells me while rummaging for a half smoked cigarette on the couch.
"Who supplies you with these substances?" I ask still looking around the room.
"My brother buys for me." He finds the cigarette and tries to light it.
"Not so fast there, Speed Racer, no smoking allowed." I take the lighter and put it down for him. For whatever reason people freak when you take the cigarette, but taking the lighter is OK.
"I NEED my methadone or I'll die!" He's getting irate.
"Tell me more about the conspiracy," I distract him by handing him some pants for the drive we will likely be taking any time now.

"I saw it on TV. See, some [INSERT RACE] guys decided to kill all the [INSERT DIFFERENT RACE] people like me, but not right away, see, that would be obvious, so they gave us all crack and heroin and weed and they're just waiting to take over."
"And then they make you do the drugs against your will? Really? You were forced to smoke crack against your will?" He's pointing at me and nodding as if I was a fourth grader explaining a math problem to an adoring teacher.
"Exactly!" He celebrates, arms in the air and a smile on his face.

"Wow. Well, good news is, you look good enough to take the bus to your methadone clinic and an ambulance may not be best for you today." I said slowly turning.
"I have chest pains."

Cheater.

"OK, let's go, Saint Closest is 3 minutes away."
"I want to go to Saint Cleanest (Just past Saint Farthest)." He tells me, again with the point and the smile.
"No dice, you said chest pain, which gets you the closest facility. Or you can just go to the clinic. Up to you." He's looking at me, possibly even considering doing the right thing, but you all know how this run ends.

Clearing Saint Closest we see him out at the bus stop, giving us the "I'm watching you" fingers to the eyes, then at us. My driver nearly spit out his coffee. It's a conspiracy.

Sunday Fun - Take me out...

2009-08-30T07:00:00.000-07:00

I'm not a baseball fan, but when I hear Station 13 has a bet with the Station 13 of the other team in the game, it really makes it interesting. What is the bet you ask? T-shirts. Loser sends the winner one shirt for each guy signed up. On today's schedule:

AT
1:05 PM

AT
4:05 PM

Finding this info is challenging, I need your help gentle readers. If you know what house is first due at a local pro stadium, send me an email with a pic or a link to a pic and let's start a database. Football, Baseball, Hockey...just list the city, stadium, company and sport. Then I'll post it up and more folks can get into the T-shirt collecting business.

Play Ball!

You Make the Call...Triathlon

2009-08-28T07:00:00.000-07:00

2 weeks ago one of your co-workers fell down the stairs in the dorm. He's usually a fit guy, training and weight lifting, but somehow turning the corner at the landing took his knee out. You did the assessment, finding little if any sign of injury, but he was transported and placed off duty.

This morning's paper has extensive coverage of yesterday's big triathlon meet and guess who is on the front page, in full color, number attached to his shirt crossing the finish line? No one else at the table seems to notice your injured co-worker running.

Do you say something? If so, who and how? You Make the Call.

the Handover - Edition 7

2009-08-27T18:58:00.000-07:00

The Handover Blog Carnival is home this month, where MedicBlog999 asked for submissions describing your first emergency.

I have the honor of being included in the list of blogs I enjoy reading, which is pretty neat in my book.

So go have a look into what the authors of your favorite blogs submitted as their first ever emergency.

Next month CKEMTP over at Life Under the Lights will be hosting the Handover with the theme "Funniset.Call.Ever." Now I have 400 posts to go through. Thanks.

10 new first responders without the Fire Department

2009-08-27T05:43:00.000-07:00

Last week I covered what the Fire Department will be doing to pass the time between fires if not responding to EMS runs.

This week, instead of covering what EMS services will be doing, I thought I'd invite some people from the neighborhood to fill in the first response role. Without fire resources rolling, maybe these folks can arrive first and make a report or early intervention.

#10 Letter Carriers
They know every address as well as any medications a person may have delivered on a regular basis. The post office has an army of these folks on the streets and all they're doing is moving things from place to place.

Pre-deployed we can arm them with AEDs and basic airway kits, and dispatch them by zip code, which is nice.

And you know they're in shape to help you carry patients down the stairs or assist in extrication.

#9 Police Motor Officers
Our friends Two Wheel Terror and Motorcop may not be too jazzed about this reassignment, but they know they can get places your Chevy can't.
They can handle basic interventions and I know there is room on their tool belts for an IV bag and some angiocaths. And they can cite folks while waiting for the ambulance to arrive.

#8 Pizza Delivery Drivers
Synchronized cardioversion in 30 minutes, or it's free!

#7 the Ice Cream Man
One of our two pediatric specialists already in the community, they have a PA system for use in MCIs as well as refrigeration units for the upcoming therapeutic hypothermia treatments we'll be starting.

Treat...ments...No? Sorry.

#6 the Cable Guy
These dudes seem to be on every corner these days, fixing something, and since they say they can arrive anytime between 8AM and 6 PM, we can use them to augment the commute hours.

They understand electronics, so let's give them the 12-lead monitors and have them upgraded to transmit broadband wireless to any physician we need to, including the ER. And if we tip them $50, they'll add an anteriolateral STEMI printout to get us bumped up on arrival.

#5 Tow Truck Drivers
They're already responding, bump them up to code 3. Replace the yellow lightbar with a red and get them out there. Load up some spreaders and a few hydrolic jacks and we don't even need fire to respond at all.

An added bonus, they already know where all the hot spots are and will surely stick around until the scene is cleaned up properly and the cars taken away. There is no down side here.

#4 Meter Maids
Every time you turn around these folks can sneak up and write a full cite and disappear before you can dig for another quarter. They will respond as documentarians to gather and record all medications, family names, vehicle types, weather conditions and the like, download it to your ePCR and then *poof* they'll be gone and onto another call.

#3 Garbage Collectors
Want to know about someone? Go through their trash. Few people can play the detective game we must do in mere seconds when arriving at the scene of a medical emergency. Not dispatched for trauma so much, the refuse patrol will respond to all critical medical calls and evaluate the surroundings to give you insight into the patient's life, likes, dislikes and recent credit troubles. Then they can clean up all the medication and equipment trash we leave behind.

#2 School Bus Drivers
Pediatric specialists. The bus already has red lights and will respond bringing a child of like size for dosaging reference. That darn Braslow tape is so old and kids are fatter these days, it helps to be able to choose from a variety of children, weigh them and have an accurate dosing scale.

Not to mention they come in handy for MCIs.

#1 the Missionaries
No other group is seen in every community in the country more than our white shirted, bike riding, religious missionary friends. They have bikes, so they're mobile. They have a firm resolve in their work, so you know you can trust them and their packpacks could carry an AED and a med kit no problem.

Not to mention, they have a higher power on their side, which could make the difference on some runs.

So there you go. If you don't like the fire service resources currently deployed and responding on calls with you, take your choice from the above.

Happy is an uncle!

2009-08-26T09:57:00.000-07:00

Attention all companies and units in the field:

Just received via twitter:

@motorcop1 Baby MC has arrived! The Wife rocked it! Med free and all natural! She is my hero! I am now surrounded by estrogen with two beauty girls.

My self proclaimed brother from another mother reports via twitter that both Mrs MC and Baby MC are healthy and well.

Watch for updates at Motorcop's home base.

That is all.

2 Year old Tip of the Helmet to Orlando

2009-08-25T21:27:00.000-07:00

There is so much talking by politicians about how fire stations can be closed without effecting response time without anyone actually showing examples of how a well staffed, well deployed service can handle adversity in a time of need.

This tip of the helmet goes to the Orlando Fire Communications Staff, Orlando Engines 11,6,1 Tower 1,8 Rescue 1, Heavy Rescue 1 and other units at the scene of this large apartment fire recently seen by our friend Beemer and sent along to HMHQ. It is from September of 2007 but could be happening in your town tonight.

The next time a politician in your area thinks that brownouts aren't such a big deal, remind them that if any one of the first units to this scene had been closed that day, the woman and 4 children trapped inside would be dead. Send them this video, now.

This video is well put together and includes 911 tapes from the woman and the children trapped in a bathroom behind heavy fire.

A job well done.

You Make the Call...Pump Lever...What Happened

2009-08-24T07:00:00.000-07:00

This situation certainly falls under the WTF header in the fire service, butting keeping your wits about you will allow you to adjust your plan smoothly.

As an experienced engine operator you can anticipate problems like this and have a short list of quick options to go to. When your first line is not chargeable because of a valve failure, that valve, regardless of what you think the reason may be, should be deemed out of service.

I pulled the second line to the first coupling and did a quick make and break. Before they had time to wonder what was taking so long, I charged the second preconnect.

To ensure no one following in the response grabbed the bad line, I threw the last 50 feet back over the hose bed and out of the way.

Anytime a line is deployed you should have in mind anything that could go wrong, be it hose, water, or pump.

If you said attach to a new outlet and get water flowing ASAP, you made the right call.

Don't forget to come back every Friday for a different You Make the Call, with follow ups on Monday.

Sunday Fun - Ladders

2009-08-23T07:00:00.000-07:00

I was reading a book to one of the little ones the other night and had to answer some pretty tough operational questions from a 3 year old. The book was Richard Scarry's Busiest Firefighters Ever! and the cover is just hilarious. Aside from the engine operator wearing a cooking pot for a helmet (with Company number) and the Officer wearing a colander and playing trombone, one of the firefighters is clinging to a pompier ladder as they drive along.

My little one commented that he was not sitting safely and that the ladder looked funny. She will one day make a great Truck boss.

But it got me thinking about the wide variety of ladders both in our past and in our present.

Looking through the IFSTA manuals we see all manner of ladder raises and techniques. The 3 man 35'. The 4 man 35'. The 1 man 24' etc etc. So what are we running with?

Most engines are wandering town with the standard 10' attic, 12-14 foot straight and the go to 24'.

Ladder and Truck Companies, however, seem to produce odd ladders at odd times.

The pompier ladder was a center beam rung ladder with a 2-3 foot barbed arm on the end. This ladder allowed a firefighter to scale the exterior of the building without placing a ground ladder. In the days of having an escape route, it is impractical for sure. If you have one of these it needs to be adorning your wall, not your ladder tray.

In my opinion your fire escape ladder and your 6' A frame ladder are your most important ladders for quick deployment. The fire escape ladder for obvious reasons and the 6' A frame to get in quick and plug those pesky fire sprinklers.

San Francisco, California still operates wooden ground ladders on account of the numerous above ground electrical supplies still common in most neighborhoods. Each of their Trucks carry a 50' wooden extension ladder weighing in at 350 lbs and requiring 6 people to raise. Then they brace that with a 24' straight ladder. It looks VERY heavy.

At the 100th anniversary of the Great Earthquake and Fire, they brought out the last of the 65' wooden ladders, only used for demonstration.
From the SFFD Historical Society:
"The 65 foot ladder was the principal means of rescue before the advent of the aerial ladder and was also used in locations were the aerial ladder trucks could not operate. The ladder can, when fully extended, reach a five story roof or a sixth floor window."

The Mumbai Fire Brigade, when dealing with a stressful situation and heavy fire with hundreds trapped, tried a new way to raise a ladder with poles, pull them. Check out they guy in the bottom center of the photo. Apparently it worked and they made many a rescue.

And on a lighter note, who can tell me what is wrong with this ladder placement?

A Tale of 2 Poles

2009-08-22T16:54:00.000-07:00

Here in Happy's Department we, like many others, have stations of varying age. Some of the brand new houses are spacious, well lit and don't smell funny. Others are cramped, crowded and have a faint odor no one can find the source of.

Recently I was working one of our outlying engine companies that still uses part of the house built in the 1940s. When remodeled, the Department absorbed the neighboring parking lot and built another single bay garage right next door, attaching the two. This allowed for a larger kitchen in the new addition and added office space on the ground floor of the old one, where the kitchen used to be. The ceiling height difference made for an awkward middle floor for the officer's quarters.

This is where the tale of 2 poles title comes in. This house has it's old pole from the dorm to the apparatus floor in the old part of the building, and a newer, interesting concept, in the new house.

The old pole never moved in the remodel, never got a clam shell, it is still bolted to the wall in front of the building. It goes from top to bottom, these are old school 18 foot ceilings.

Pretty straight forward, right? And no, our station isn't fuzzy, that's just the entry level camera built into my rockin' phone. My work camera was liberated from the car in front of my house a few months back.

Over in the new wing of the house, is this fire pole:
This pole has a top, and a bottom, as so many do, but look again. You're standing on the mezzanine level, the restrooms are above you and the new apparatus floor below. That door to the left goes into the officer's bunk. Incase of alarm, a sleepy officer could encounter a firefighter sliding from above.

And yes, you can get from the top to the middle, but it is awkward to climb off halfway down.

The reason I bring this up is the recent conversation, apparently, about slides versus poles.

Slides? Really?

A simple pole in a corner seems to work just fine.

Firegeezer started it OVER HERE, then take a look over HERE at Fire Critic for details, but take the stairs, it's not an emergency.

20 years of drunkenness

2009-08-21T13:51:00.000-07:00

I'm not referring to myself in the title, but to two women I met hours apart who may actually be the same person in some strange time twisting episode of the Twilight Zone. At any moment Rod Serling could have popped out and I would have accepted his version of events as truth.

THE EMERGENCY Part TWO

A caller reports a woman unconscious on the street corner.

THE ACTION Part TWO

This call comes in hours after Part ONE, but we'll be going in age order, not chronological order. The engine is waved down in a nice part of town just after closing time at the bars and we see a well dressed young lady in the usual too drunk for consciousness pose. A quick assessment rules out the usual alcohol look alikes of stroke, hypoglycemia and trauma, so we get more back story.

Our callers, a middle aged couple out walking a restless new puppy, saw the woman staggering and having trouble walking from a half block away. As they followed her, mildly concerned, they saw a car pull up next to her and a young man try to help her. "How nice," they thought until they noticed her try to walk away ever so clumbsy-like. As they approached, calling out to the young man that they could help, he let her down and made a run for it, speeding off before they had their wits to get the license plate.

The ambulance has no choice but to take her sobbing vodka laden body to the local non-ER resource for observation.
The young woman will awake in the local sobering center amongst some of the most odorous persons in existence and hopefully understand how lucky she was and to control her drinking. Otherwise, she might end up like our patient in Part ONE.

THE EMERGENCY Part ONE

The front desk of a hotel is describing a woman who has fallen and hit her head.

THE ACTION Part ONE

This call came in a good 6-7 hours before our friend above.
One of our dynamically deployed ambulances was switching posts and happened to be nearby, beating us to the scene. As I approach the front door, the EMT comes running past me offering only a quick "Hey."

Ahead of us in the lobby, I see a pair of legs flailing from around a corner and a string of expletives that would get this blog an X rating for sure. I'm a fan of using quotations in my reports when folks get verbally abusive, not only to better recall the event, but to paint the picture accurately should the case go to court. I would have hesitated to use half this language.

The flailing legs belong to a woman in her late 40s who took a swing at a stranger exiting an elevator, fell and struck her head on the marble floor, leaving a puddle of blood and quite a large bloody mess in the general area. I found this out as I rounded the corner to see the Paramedic partner of the EMT wrestling with the woman who was throwing blood covered fists and arms in all directions.

As we jumped onto the legs to help our friend, the EMT returned with restraints, a board and a collar. It is truly laughable that we are required to C-spine these types of people. All the while we were restraining her limbs she would make eye contact with one of us and say something so remarkably vile that even the cast of the Jackass movies would ask her to tone it down a bit.

Finally bandaged, tied and boarded we carry her to the awaiting cot while the husband and a few friends try to tell us she is normally a perfectly nice person, but she has been drinking too much. I firmly believe that enough alcohol will let the real you out of your skin and we met the real her.

The excitement has left the little lobby and only the bloody mess remains. Then Rod Serling steps out, lit cigarette in hand.
"Picture a woman who has no control over her emotions and allows excessive intoxication to control her life. Had she only recognized the destructive forces of alcohol 20 years earlier, regardless of how legal it might be, she may not have fallen and been hurt. Then none of the emergency workers would have heard language that should be reserved...for the Twilight Zone."

You Make the Call...Pump Lever

2009-08-21T07:00:00.000-07:00

You are driving the engine today and have been rung out for a reported apartment fire. Blocks away you have heavy black smoke showing and as you pull up the third floor is fully involved. Your crew is gearing up and the officer is radioing in as you switch from road to pump, hearing that tell-tale change in the motor as the PTO kicks into pump. A hydrant is right out front and you parked right at the tires, so your pony supply line will reach perfectly.

The officer calls for the 200 foot pre-connect and he and the firefighter advance the line into the front door, leading it into the lobby and up the interior stairwell.

You secure the door open and return to connect to your hydrant when you hear the officer over the radio call for the line to be charged, they have encountered heavy fire on the stairwell from floor 2 to floor 3. As you pull the valve lever towards you and out of the panel, there is a sudden give and the lever comes out. The cotter pin is missing and your crew is calling for water.

What to do? You Make the Call.

God's Gift to Firefighting

2009-08-20T06:09:00.000-07:00

This is a letter to my associate the other day, God's gift to firefighting.

Hi.

It's me. The one sitting next to you in the back of the fire engine. We are part of a team, you and I, and we need to work together to get our job done. We each have our own responsibilities today and I take this job seriously. There are just a few things I wanted to point out that I learned in your glowing presence yesterday.

1. You must be one hell of a fireman, just look at your turnouts. Your pants are thick with grime and soot, completely dry and obscuring the reflective security features. Your coat is just as dirty, I noticed you wiping it earlier with those cow skin gloves from the warehouse store. I mentioned how easy it is to clean and care for your gear and you looked at me as if I asked to date your daughter. I'm sorry.

2. You don't have to race for the nozzle, great one, for it was your duty that day. My duty was to ensure you had water and room to do your job. I was discouraged when you were unable to advance the line due to smoke conditions. I could see your mask on the regulator, near your waste through my own mask.

3. When we hiked up the 7 floors on that report of smoke in the hallways, I wasn't just feeling the doors for heat, as I'm sure you knew. Even though you raced down the hallway to the next stairwell, the officer and I were checking doors by pushing slightly against the top of the door to break the weather stripping. That is how we found the unit that had the burnt popcorn. You were upstairs.

4. Your level of professionalism is, of course, without question, but your T-shirt said FDNY. We are not in New York, unless I am very confused.

5. I was not aware that I was the problem in the fire service today. You spoke at length about the wasted seat that could have a real firefighter in it, not just "some medic." I was discouraged by this and still do not understand what you meant.

6. After our busy night of 6 runs between midnight and 6 AM, you mentioned it was my fault we were so busy and that you didn't believe EMS belonged in your fire engine. I was reading the paper getting ready for another day of work so I may not have heard you clearly.

7. Throughout the day you mentioned large fires at which you contributed, sometimes mentioning work I did as your own. Suddenly my work, and the work of others, is fair to claim as your own at the dinner table.

Come to think of it, I'm not sure you are the deity you present yourself to be. In fact, I now question whether you understand the mission of the fire service in the 21st century. I may not completely understand it either, but I think I have a better way to find the solution to our troubles than blaming the other guy in the rig. Even though it seems as if I'm doing just that.

Trouble is there is more than one "God's gift to firefighting" and just as many "God's gift to EMS" out there, but what can we do to dial down the talk and dial up the action? We'll see.

Don't fill the boot this year

2009-08-19T09:29:00.000-07:00

It's that time of year again. When throngs of firefighters across the country will be standing in front of grocery stores and at street corners asking you to "Fill the boot!" This is the annual run up to the International Association of FireFighter's support of Muscular Dystrophy research and "Jerry's Kids."

Happy is not a fan.

It may have started when I was forced to stand in 101 degree heat for 5 hours in my uniform shoving a boot in people's faces at a grocery store because C-Shift had raised $500 the day before and we had to out do them.

I support research into debilitating conditions such as MD, but also support other causes. After treating my sunburns from that day and trying to get the sound of the toy machine nearby out of my head ("There's no telling what you could win!" every 30 seconds) I thought about it.

Filling the Boot for Jerry's Kids is not a good idea. Yes, you read that right.

Like with most organizations, there is overhead and administrative costs involved in organizing a nationwide campaign and telethon to raise money. This often hovers between 20 and 30 percent. That means for every 10 dollars I raise, $3 goes to pay some folks to collect my money, give it to Jerry's people, then maybe give some to those kids he brings on stage each year. Don't get me wrong, they have raised over $1.5 Billion, with a B, dollars to fight a host of muscular ailments and similar diseases since the inception of the Telethon.

That means that in that same time almost $400 Million has gone to organizers, producers, party consultants and other support staff. That money never made it to the kids.

I support keeping the money in the community it came from. Let people rally behind someone in their own community. Tell them to fill the boot for their neighbor, their mother, their friend. Fill the boot to help a family get a room while their child is treated at the hospital. Fill the boot to buy paint to redo the children's wing of the local hospital. Fill the boot to buy toys to give away at Christmas. The possibilities are endless.

I see no need to be a pawn in some corporation's fund collection machine, especially standing on a street corner near traffic or worse even, in the median, which I have seen in the past.

Stop sending your community's money away to a group far away and keep it local. We have a strong influence over people when it comes to respect and support. We may not get it when we're actually doing our job, but when we ask folks to help us, they almost always reach into their pockets and give something. Give them a face, a name, a local charity, something that will impact their lives directly to think about. When they give that $5 to help the local shopkeeper hire a helper while his back heals, they may just stop in and buy a little something extra to help out.

The local media will love it and you can get your message out to the community for free.

In these troubling economic times folks will be a little more hesitant to give, so give them a good example of neighbor helping neighbor.

If we all did that, that $400 million over the time of the telethon would have gone to help even more people in need. According to the IAFF, firefighters have raised almost $375 million in the 55 years they have supported it. We've almost covered the overhead.

But if filling the boot for Jerry's Kids is the only philanthropy your agency will agree to, then do what you can, safely.

The IAFF encourages their locals to raise money safely, find details HERE.

Top 10 new responsibilities of the Fire Department

2009-08-18T18:44:00.000-07:00

Since most of the readers commenting aren't so jazzed about ALS delivered by the Fire Department, I've devised a few new ways for the folks at the fire hall to keep busy and not get closed down.

Top 10 ways the Fire Department can look busy if not responding to EMS runs-

#10 Tree Trimming
Get those ladders out and close the bike lane, Truck 121 is going to work. With the versatility and man power offered by most truck companies these days, they should be able to make quick work of most of the trouble spots as well as whatever the Town Council needs done come the fall.

They are also for hire out to private citizens, provided you can clean up the trimmings when they're done. They used to tow a chipper behind the ladder, but there was an incident. You know Firemen.

So call 911 today to schedule your tree trimming, free of charge.

#9 Bungee Jumps from the bucket.

All the cool kids are doing it.

And since we're under the same expensive insurance as the unrestrained passengers on the municipal bus system, I can't imagine the underwriters having a problem with this. After the tree trimming is through, we set up in the parking lot of the community college and make a killing. I mean a lot of money, not...well...nevermind.

It can double as a high angle rope rescue drill should something go wrong.

3...2...1...BUNGEE!

#8 Birthday Parties

Every kid dreams of climbing in the fire truck and squirting water on a fire, so why not give them what they want? Bring your group of at least 20 sugar hyped children ages 2-15 by the firehouse and drop them off for a day of fun!
They'll learn to operate the aerial ladder platform, make and break various hose leads and how to don and doff gear in searing heat.

Each child will receive a roll of municipal toilet paper and a sticker that says "Junior Firefighter" in a gift bag. Reserve now!

#7 Fire Engine races
Nevermind.

#6 City Tours in the Engine
Load up the tourists and hit the streets. If your engines are going to cruise, might as well get some cash along the way. The crews can point out where all the best coffee is and where all the hidden alarm panels are.

For added realism, let them put on your coat and helmet. What a great photo op!

#5 Mobile Water Park
Hot day plus bored children plus 500 gallons equals fun! Combine that drafting drill with some good old fashioned water park fun! Kids can frolic in the droplets as your firefighters show what they can do with that $500,000 piece of equipment.

Your kids will be begging to go to the drill yard every day this summer, just don't forget your towel!

#4 Demolition
Sure we tear down fire damaged houses, but don't let us stop there. If you need concrete, wood, metal, stucco, any kind of construction torn down on site, call 911 and we'll send one of our teams right over. Not only will they respond quickly, but they will call more teams out if the job is a big one.

Saws, poles, hooks and axes will be put to use bringing your structure to the ground. Heck, it doesn't even have to be yours, you can place your order anonymously.

Just remember there is no haul away service included, we leave it all right where it falls.

#3 Code 3 Delivery Service
No longer assisting on that resuscitation down the block, our team is off to #4 Privet Drive to deliver a rather important letter to a rather important boy. That sounds like a great idea for a book.

Lights and sirens in a fire engine beats an Emo kid on a 10 speed everyday of the week.

When it absolutely, positively, has to get there delivered by 3 men in a shiny (not today, they need #2) red truck, call 911 and they'll come get your package, letter or person to be delivered and whisk them away.

#2 Mobile Car Wash and Detail
When not washing their own cars on company time, why not hire the Fire Department to wash your car?

Engines are deployed throughout the metropolitan area, carrying all the necessary tools to give your car or light truck a great wash and wax.

Call now and we'll add a burnt food air freshener with every third wash.

#1 Keep private ambulance parking spots filled

They sit at that corner all day, mainly because the coffee shop has clean bathrooms and free wi-fi, but if they receive an ALS run 25 minutes away, they need to return later to the same sweet spot.

Fire engines can be dispatched to "sit a spot" details at little charge to the ambulance agency. They will only be refused when all engines are out on fires, tours or car washes.

10% off if you mention coupon code "System Status Rules"

I'll get the flip side next week.

What do you mean Shock Advised?

2009-08-18T13:38:00.000-07:00

Not every rural community can afford to keep a Paramedic on full time shifts. Sometimes a couple of volunteers can help, but when the bigger FDs are hiring, these folks often move on. But what happens when a woman experiences cardiac arrest 40 minutes from the nearest Paramedic?

THE EMERGENCY

Community volunteers are calling for an ALS intercept.

THE ACTION

Back in the old ambulance we're rung out for an ALS intercept with a volunteer ambulance crew screaming towards us with a cardiac arrest. We're getting broken updates, they're still out of range of our County repeaters so we take our place at the top of the pre-determined freeway exit, lights flashing and prep the back of the rig. My intubation kit is out, I've decided to do everything in my rig on my terms, we'll do a "hot load" and take whoever is in charge with us.

The 25 year old chevy ambulance comes limping around the far bend in the highway, a single 4 reflector beacon slowly turning on top, smoke spitting from the muffler and being passed by the commute traffic. This rig hasn't been run like this in a long time.

They pull up and a younger fellow climbs out of the cab shouting, "She's conscious!"

We spring to the back door, now even with our back bumper and can hear that familiar AED voice stating "Shock Advised, stand clear."

"STOP!" I shout when I see the patient sitting up in the cot, pads placed one on top of the other on her partially exposed chest and a look of fear I have yet to see since.

"Are you OK, miss?" I ask as the 3 EMTs climb out of the back of the old chevy, stretching their legs and smiling at one another.

"I think I had a panic attack." She responds, catching her breath on the brink of crying.

"Report?" I ask the group, hoping someone will step forward.
"Chest pain. We applied the AED for monitoring, I've taken a few classes," the driver responds. The driver.

"We were told cardiac arrest. Was she ever unconscious?" They respond in the negative and point to the AED.

We got her to walk over to our rig and talk about what happened and she told quite the story.
The first EMT at her home, when she was experiencing what she defined as an anxiety attack, gave her oxygen and took her vital signs and radioed for an ambulance.
The ambulance arrived with 3 First Responders who applied the AED and transported, the EMT now standing outside our rig talking about how crazy "all this ALS stuff is."

In the end she was fine, if not frightened about the care available in her community. We ran her to the local ER for a quick once over and had quite the talk with the EMS supervisor from the rural area, who responded that he can only get a small amount of people to even respond, but he'd look into training on the AEDs.

We discovered later that the community had recently had their primary ambulance involved in an accident and the only Paramedic on staff, a volunteer, was on a family vacation.

I never did see that old chevy ever again and I have doubts as to whether it even made it home.

Mutual Aid Board Addition

2009-08-18T11:09:00.000-07:00

We're flush on available resources at the moment, but are bumping a blog up from the follow list onto the board.

9-Echo-1 has been hiding in my blogger reading list for a few months now, but this recent post about the current Health Care debate made me smile, laugh, and had an amazing calming effect as I read it. I think the author and I differ politically, but reading ideas that make perfect sense is something I'll always agree with.

9-Echo-1 Describes his writings this way:

"My rambling musings, opinions, and observations on all manner of things...life, work, EMS, politics...anything. Names will be changed (in accordance with HIPPA) to protect the innocent, guilty, and terminally stu...well, we'll leave it at innocent and guilty for now. Politicians are exempt from HIPPA. These are my opinions and mine only. They do not represent the official policy or opinions of any of my employers, past or present."

Welcome to the board 9 Echo 1, standby for a 26 Alpha 1.

Is that a fire engine or a fire truck?

2009-08-16T20:04:00.000-07:00

In response to my Sunday Fun about marking your gear, I received comments from across the pond asking the difference between our different units in the US, since I mentioned the need to tell us apart based on task.

So for my UK friends, and maybe my few readers not in the business, I give you the American Fire Department 101.

The Engine Company

The work horse of the American Fire Service is the Engine Company. Originally hand pulled pumps, then steam engines, these machines supply the water for the fire fight. The Engine Company carries three main elements that make it a stand alone team. A Pump, a tank and hose. The tank is often 500-1000 gallons, depending on the reliability of water supplies and can, if need be, draw water (draft) from a static source such as a pool or lake. The pump moves the water through the manifold and out one of many outlets to fight the fire. I can't imagine this being much different than the UK Brigade units.

In some municipalities, the engines also offer EMS response at the Basic and Paramedic level as well as extrication using multiple power tools.

At a fire the engine company will usually arrive first, do their best to secure a water supply, deploy lines, find the seat of the fire and knock it down. Even though their mission may include other tasks, this is their main purpose, water on the fire.

"God Bless the Engine"

The Truck or Ladder Company AKA the Hook and Ladder Company

The Truck Company has a completely separate set of tasks to accomplish at a fire or emergency scene. The truck, or ladder, carries, you guessed it, a variety of ladders and tools designed to gain access to the fire building for two main reasons, ventilation and search.

The truck company is often second or third to arrive at a fire and prefers to have access to the front in case the large ladder is needed. Although Happy prefers a 100 foot articulated ladder truck (with a driver in the rear to provide maximum maneuverability) ladders can also have buckets on the end, making them a different tool entirely.

Truck members will focus on ventilating the building of heat and poisonous gasses by opening windows and cutting holes in the roof they gained access to using their wide variety of ladders. These folks do not concern themselves with fighting the fire, that is not their job. If I am on an engine, shooting water on the fire, they are working above me cutting the roof, or behind me using thier hooks to pull the ceiling down to check for fire spread. Without them the fire could work it's way back over our heads and emerge behind us, cutting off our escape.

Very rarely does a ladder truck carry water, and even then it is a small amount compared to the engine companies. The mission of these firefighters is not to fight fire directly, but to aid in the containment and ability of firefighters to attack the fire effectively.

At non fire scenes truck companies often provide forcible entry, advanced extrication, rope rescues and similar tasks, not to mention they are my heroes when a fire sprinkler needs to be shut down and replaced.

"God Save the Truck"

The Medic Van

The Paramedic units can, of course, treat and transport the sick and injured, but in a fire or rescue scenario are trained and equipped to fit into most roles on the fire ground from the hose line from the engine, or the saw on the truck, or harnessed up to go over the edge with the rescue squad to execute a rescue. This is the most versatile crew in the service today, and my favorite spot I might add. You can go from transporting a skinned knee and hate your job one minute, to carrying a person down a flight of stairs at a fire the next. Ok not that fast, but you get the idea.
And intubating with an airpack on...not as hard as it looks, but no reason not to gear down first.

"God help the medics"

The Squad

A squad in the US can mean a number of things. It can range from a Paramedic pickup truck as in the Emergency! TV series. It has been known to identify any team of firefighters not assigned to a pumper engine or ladder truck. A squad in the FDNY is a specialized team that can perform duties above a regular engine company. But for the purposes of Happy Medic Headquarters, a squad refers to the big boys, the HEAVY RESCUE SQUAD, the heroes, the Gods of the Fire Service. No really, just ask them.

Although the training, equipment and abilities of each rescue squad is unique, they are most certainly armed to the teeth for their standard responses and whatever else might get thrown their way. This is who responds for building collapses, swift water rescue, dive emergencies, you name it, chances are they drilled on it this week. Some units carry ice rescue gear, while the heavy rescue squads in San Diego, California likely fill that spot with something surf related. They carry heavy lifting bags, SCUBA gear, confined space and haz-mat suits, high and low angle rope kits, etc, etc, etc. A giant rolling tool box. These are the men who will go where I will not and hand me a (most often) viable patient. Or completely disregard my presence.

"God is the Squad"

The Quint

This hybrid combination (bastard) of the service is a politician's dream and a firefighter's nightmare. On paper it combines a 4 man truck company and a 3 man engine company into a 4 man quint company. But now that we know the engine and truck have COMPLETELY different tasks on the fire ground, this is just silly. Besides, you had to shorten the ladder to fit it on my engine frame and all the ladder hardware, the jacks, hydrolics, extra beefy frame, leave less room for an adequate water tank to fight the fire.
I used to serve on one of these and my verdict is: You're fooling yourself. A 60 foot elevated master stream with a framed box ladder does not a truck company make you. Ahem...

The Ambulance

Not to be left out in describing the American Fire Service is the role of private ambulance companies. While not technically part of the service, they work hand in hand with responders to provide treatment and transport either as the sole carrier or to augment an existing, but not quite adequate municipal system. They are a needed piece of the puzzle in the American model. Some places they thrive, others they struggle, but where I am they do a great job picking up the slack from a devastated budget that cut EMS first.

So there you have it my UK friends, a brief introduction to that which is the American Fire Service. Perhaps when MedicBlog999 gets back from his engine ride along he can explain it in more detail. Graphs and charts perhaps.

Sunday Fun - What are you looking at?

2009-08-16T07:00:00.000-07:00

What do we see when we look at each other on the fire ground? We tend to all look alike. If you're not careful it can be easy to get confused, misdirected and find yourself working with the wrong team.

I keep coming across this photo and will now use it to illustrate some points about fire ground recognition.
Now, before we get started, get your chuckles out about the hood and the way the SCBA hose goes under the hood into the open coat. Done? Good.
Imagine you encounter this person in a half dark hallway in a fire.

Who is this? What is their company assignment? Are they from the truck? Squad? Engine? Have the medics wandered to the roof again?

Luckily the reflective markings are clean so we saw him(her?) coming, that is point number one. Clean your Gorram gear, especially your reflective. The last thing I want to do is be sent in to find you and you look just like all the debris. Dirty gear is not the sign of an experienced firefighter, only a lazy one.

As far as company marking go, it depends on the style of gear you are wearing, most notably your helmet.

There are 3 main types of helmets making the rounds these days with minor variations. Believe me when I say that just figuring out which type of shield to buy can be confusing enough. There is a good chance you are wearing a helmet like our friend up there.
Less common today are the "LA Style" and the "Old Fashioned." I'll try to avoid using manufacturer names.

The LA style is perfect for the application of proper markings to avoid confusion.
This photo shows a group of teams working in the "LA Style" helmets. Firefighters and Officers have different color helmets so they can be identified from any direction. The company number is visible from 3 sides and engines have white numbers, while trucks have red numbers. Done. Simple as that.

In addition, each member has their name clearly visible in 1" letters on the rear brim of the helmet. No more shouting "Hey you on the ladder, get down!" You can call the person by name, on the radio even, and know who you are talking to.

On the other coast the common helmet is an "Old Fashioned" style, similar to the helmet we use at HMHQ for our Tip of the Helmet series. It is simple enough, wide brim and longer tail to keep water out of your neck, but the design leaves little chance to mark it effectively. Most common the leather shield will tell you who and where the wearer is assigned, but that can help little if you are chasing them down a hallway. I believe Boston, MA marks the rear of their helmets with their company numbers. The shields can vary in color depending on rank, but most common the numbers will tell you about the company.

In the FDNY for example A black passport shield with white number is an engine company. Yellow passport or yellow number is a squad and a red passport belongs to the truck.

Most often, however, the members mark their helmets on the under side of the rear, so you can only see their name when they place chin to chest. And even then, it is upside down. But, they have their names on their coats.

What I'm getting at here is that we need to be not only visible, but recognizable on the fire ground. In Happy's perfect world helmets are color coded by rank, marked with your name on the back, company numbers on three sides and your level of medical training indicated by the color of reflective tape on the helmet. Yellow EMT, Orange EMT-I, Blue Paramedic, White MD. Your turnout coat will also have your name on the back, below the airpack. The airpack itself will have a large reflective number showing where it came from.
All this is simple enough to do from the onset, but a lot of guys here where I work have gone through a lot of trouble to make sure that helmet is as black as night and laugh when they see me cleaning mine after a fire.

If I can see you I can rescue you. Simple as that. Now go wash and mark your gear.

"It does nothing for the patient"

2009-08-15T07:30:00.000-07:00

Listening to the EMS Garage podcast (Episode 45) discussing the Los Angeles County cuts to service, the conversation turned to the reason to have Paramedics on the fire engines.
The panel spoke of various reasons for the cutbacks, then took an interesting turn when the commentators had this exchange:

"They (Los Angeles) have Paramedics on their engines."
"Why? Why would you do that? ...There is no benefit. Why is there tiered response to medical calls?"
"They do it to support their staffing"
"It does nothing for the patient."

This initially get me hot under the collar. I'm sure if asked to clarify their conversation there would be more explanation. At least I hope so.

Why is there a tiered response to medical calls? Why is there a tiered response to fire calls? Or to police emergencies? Why do we combine the abilities of different resources to aid as many as possible?

I am not for all ALS fire resources. Let me get that out now, before some of the single role folks start fuming. This debate has been going on for a long time, time to get it out here in the open and discuss it on it's merits.

If you support public access defibrillation then you recognize the need for early intervention in cardiac cases. Get a trained set of eyes with a med kit in there ASAP. If the system in place has Paramedics arriving with or before Fire ALS resources, then I call into question the need for Fire Based ALS in that community. Then again, what happens when all the ambulances are busy? Who will administer that epinephrine to the kid who got stung? Who will cardiovert the woman on the bus? There are so many ifs, that having an insurance policy is not a bad idea. Could these be handled by supervisors already in place by the EMS provider?

I believe in a scaled response model, be it tiered or provided by a single service, but I reject the idea that my responding and treating patients from the fire engine is doing "nothing for the patient."

Countless times I have initiated ALS care still waiting for an ambulance to arrive on scene.

Countless times I have been dispatched to BLS scenes miscoded by dispatch or exaggerated by the caller. As a trained Paramedic I can advise dispatch to slow down or reassign the ambulance to better the system's ability to respond to legitimate emergencies.

In many communities it seems the answer to keeping the fire department in business has been to throw a patch and a monitor on a truck and claim they "save lives." I've heard it said that the Fire Service is a budget looking for a mission and EMS is a mission looking for a budget. I like to think both are necessary, but no necessarily together in their missions. Some communities have strong private agencies who provide training and support for their crews, others not so much. In that case, it falls on the municipality to provide the ALS care. If that means putting competent Paramedics on a fire engine that is already responding, then so be it.

Too many cooks can spoil the soup. But when time can make a difference between an asthma attack and a resuscitation, I choose the early recognition and adequate treatment.

We're all on the same team here, folks. Sure I'm a Firefighter/Paramedic instead of a Paramedic, but I try hard to keep up on both skills. That doesn't make me any less of a care giver. I'm not slacking on my 12-lead skills because I had a tower ladder drill this morning, it just means that I can provide a service in a time of need as well as being available for a less common emergency (Fire.) I am very interested in learning more about breaking the Paramedic off of the fire crew for certain calls, whether that be in an APP model like Wakefield or a FRU model like the UK. Again, location specific based on community, topography and resources available.

I had to laugh when I listened to the next installment of the podcast, Episode 46, with the discussion of police officers with AEDs being a good idea because they can respond so quickly.

One or the other. Either an early intervention is good, or it is not. Why stop at AEDs? Why not encourage Paramedics to cross train as Police Officers? Because every police officer that responds to a medical call is taken off the streets from being a law enforcement resource.

Every bell I get to a medical takes my suppression unit out of it's pre-determined roll as well.

A perfect example of a tiered response happened at my suburban home last year. You can get the full story HERE, but the first responder on the scene was a police officer in a car who happened to be a licensed Paramedic, but not for his agency. Then the ALS engine arrived and began treatment, still no ambulance to be heard. When the major carrier rig did arrive, they were the professionals I expected and did a great job. Why not get a trained set of eyes on the scene as soon as possible?

The response mandates are backwards in my mind as well. We have to respond to BLS calls in 5 minutes, but ALS in 9? Think about that. We're required to be faster for the folks who don't need us as much? That is based on the BLS before ALS model which , unfortunately, is the cheapest way to provide EMS. Get an EMT on scene and hope a medic can respond. I hear on the radio all day long "Engine 99, do you need an ambulance code 2 or code 3? - Code 3" then the ambulance later clears on a refusal or a no merit.

I say dump that thinking right now. We need to break the mold of BLS first with an ALS chaser. Flip that model. Get ALS in the door first, then BLS can augment at ALS discretion.

There I go dreaming again, right? The privates think the FD is taking all the money and slacking on treatment and the FD thinks the privates are a bunch of folks who couldn't pass the firefighter test. Let's move past that. There are those on each side looking to go to the other side, always will be.

CK over at Life Under the Lights speaks of lifting the bar in EMS education so that the first person in the door in an emergency has the training and capabilities of modern day paramedics. Then CK would like to get the current Paramedic skills and training lifted towards the PA level. I was hesitant to get on board with that thinking at first, but if the only thing holding us from that reality is money, let's do it.

But that isn't our problem in EMS is it? Our problem is the folks passing through. Too often we are seen as a way point onto other careers. This was also a topic of discussion on the EMS Garage and I'm glad there are others that feel the way I do about it. So few reach the level of Paramedic and say "This is where I want to be" so they have no stake in making the system better. they're on the way to RN or PA or whatever and are looking to get an adrenaline fix.

The point of this rant is that I take personal offense to the comments on the podcast that I have no effect on patient care when arriving on the scene in a big red truck instead of a big red ambulance. The commentators meant no personal offense, I know that, but I would like to remind them they have a very large audience who is looking for role models and leaders for the next 20 years of EMS. All care givers need to work together to find what works best in their communities and strive to make it so.

Am I obsolete in the Firefighter/Paramedic role? Maybe. But currently, the model making the most difference is a tiered response from a public/private partnership.

One of our own...

2009-08-14T21:48:00.000-07:00

Our friend Bernice over at the I Call it as I See it blog has issued a challenge to help a friend.

Click over to Bernice's to learn more, then get over to Pink Warm and Dry for an amazing post.

Let's put this social network of ours to work for something good.

You Make the Call...Dedication

2009-08-14T07:00:00.000-07:00

I'm borrowing this from one of my readers, I hope he doesn't mind. We're also going out of our comfort zone this week, hold on tight.

A local politician has decided to do something special for a retired member of your service and has suggested dedicating the new firehouse to the retired firefighter. Being on the community committee, the vote is 3-3, and you have the swing vote on this decision.

When you suggest a plaque and a ceremony, the politician informs you that will not be enough. He hands you this rendering of the sign in front of the firehouse:
You make the call.

There will be no monday morning results, so get your comments in.

Last Day and a not so brief history

2009-08-12T14:31:00.000-07:00

My most likely last day on the transport unit was... a blast. My partner was a friend and we made the best of it. The entire day had the feeling we described as the last day of school. Even if the teacher told you to clean the entire place top to bottom, you would, because it was the last day.
But at the same time, there was a slight fear as to what would happen tomorrow. Much like a high school graduate still waiting to hear if he's been accepted to the fall semester at University.

The day started with a code 3 critical cardiac, allergic to nitro, who had a massive anteriolateral MI probably 3 days ago. We meandered through cardiac cases, a motorcycle accident with unique presentation (she had no right ulna so the arm looked horribly broken, but was fine) and even a decent mechanism fall down the stairs of an elderly woman in the middle of the night. We were awoken just after 4 AM for a difficulty breathing call and, wouldn't you know it, another massive MI. Every patient we encountered needed ALS intervention from the time the first person walked in the door. Nothing that would fit with the theme of my blog. That is, until the last call.

As if she knew the day was going splendidly a young mother vomited and wasn't sure what to do, so she called 911. Our perfect last day ended with convincing a young woman that throwing up is perfectly natural and doesn't always need an ambulance. Almost on cue her 1 month old spit up and I said, "See, happens all the time. Call your doctor and double check your diet."

We limped back to quarters skirting the 8 o'clock shift change by moments.

If only everyday could be like yesterday.

A BRIEF HISTORY
But things are changing here. As I promised a few readers, a quick general history of my system's troubles over the past 100 years.

The first fire companies were established soon after the City was founded and organized into a municipal force in the 19th century. The first Doctor to climb in a wagon with an attendant happened 20 years after that. The systems were uniquely separate with fire doing their thing and the ambulance corps doing theirs until the 1970s. The fire department began sending EMT equipped engines on medical responses, at first, augmenting the extra hands of the rescue squads at major emergencies.

In the late 1990s, the idea was floated to merge the 120 year old fire department and the 100 year old ambulance service into one. The "Merger" took persons who had been trained as Paramedics and put them onto fire engines as probies, some of them with upwards of 20 years of service to the community. Those displaced firefighter/EMTs became ambulance attendants. Ambulances were moved off the streets and into the fire houses, painted a different color and all was well. What could possibly go wrong?

The combination was fraught with complications from non acceptance of "F'ing Medics" in the firehouse, to complaint after complaint from firefighters who claimed they never signed up to drive an ambulance.

As the years went on there was improvement in the working relationships and some medics chose to return to a few scattered 12 hour cars downtown. As the need for more Paramedics became apparent in a plan to get every engine ALS, the Department looked for previously experienced "Lateral" hires who could hit the ground running in both the fire and EMS arenas.

Along comes your pal Happy, in the market for a good job in a struggling system. I see the articles about the difficulties the system is having, I do a ride along and learn about the hardships, but from what the medics are saying, this is the place to be in the next 5 years.

5 years after that we were fighting tooth and nail to get off of our probationary status in time for the Lieutenant's test. Seems there were folks who thought being a Paramedic gave you an unfair advantage at test taking and sought to postpone eligibility for a small class. Others fought harder than me and they got us through our probationary status (mine after 6 years, normally 8 months) and a number of my colleagues did very well and were promoted. I did not sit for the exam.

When the budget axe came swinging through in the last couple of years, the positions left vacant as Paramedics were promoted to fire officers were never filled. 2 classes of single role Paramedics and EMTs had been hired to take the heavy load off of our stressed 24 hour cars and the firefighters were transferred back to the fire engines, displacing remaining paramedics to dual medic 24 hour units. Nothing is more wasteful in my opinion than paying a Paramedic to drive another Paramedic to the hospital. It was during this time I clocked my busiest day at 24 jobs in 24 hours on an ambulance.

The thought was that more time on an ambulance would "keep our skills up" even though we have seen no real change in care. The slackers still slack and those who want to be there still do their best every day.

But there is a constant push by some organizations to eliminate Paramedics from the fire engines all together, returning to the system in place when they were hired or how they think it "should be."
Big problem is, I see merit in what they say, but not their logic in arriving at this conclusion. Sending 10 people to the scene of a reported emergency just to get 2 paramedics is overkill, but currently the only way to meet our response mandates. I am in the minority of Firefighter Paramedics interested in taking the Paramedic Supervisor exam and see myself in that role in the next 5-10 years. That will be the end of my suppression career, but hopefully the start of something far more interesting.

Whether I will still have the opportunity to serve in the capacity I hope remains to be seen.

There is no concrete plan as to how the system will evolve, let alone adapt to the budget woes so many other municipalities are suffering through. It is a bad time to be suggesting sweeping changes in the way we deliver our service, even if those ideas are cost saving in the long run.

In response to Medicblog999's post about the role of the Firefighter/Paramedic, it has to be all or none. You can't limp into the idea of ALS from a fire engine unless all resources are able to supply the same level of service. Otherwise you have, again, 10 people where 5 would do just fine.

And to make a point 999, It all depends on the base lego man is built on as to whether he will stand tall or fall.

Double Closing Time Drama

2009-08-12T07:23:00.000-07:00

I know one of the tricks some clinics use to clean out their waiting room is to exaggerate patient conditions and request ambulances, but this response got ridiculous. Fast.

THE EMERGENCY

Staff on the 8th floor of the hospital building report a man unconscious

THE ACTION

Come on now folks, we are not your office clearing taxi service. We arrive as the ALS engine backing up the BLS engine and a private ambulance arriving on the scene as we do. We are directed to the eighth floor by a security guard very intent on getting our names and badge numbers for his "report."

On the floor we're led over to the office exam room where a nice envelope is stuffed with a printout from the office computer which has the patient basics and a time noted of about 20 minutes ago.
"Not him, guys, over here," we're instructed by a different nurse.
"But mine needs to go too," the first nurse tells the second.
"But I have to leave first, so mine goes first." she replies, trying to physically move us down the hall.

"Do you have a 911 emergency here or are you looking to head home early?" we ask and drop the bags in the hallway.
"I need to see the MD. Right now." I tell them and open the door to the exam after a quick knock.
The man inside is not only awake, but alert with a chief complaint of diffuse groin discomfort.

The MD is now in the hallway asking where our gurney is and I inform him we received a 911 call for an unconscious.
He looks from one nurse to the other and sighs. "They both need evals across the street (at the ER) but neither is a 911 run. Did you really get this as 911?"
As I try to respond we are interrupted by the second wave of rescuers arriving for the second patient.

The MD apologized for the trouble and promised to keep a better eye on his staff and their use of the 911 system. The ambulance assigned to us receives a page on their system that they should transport both patients if they can.

As they discuss it between themselves the first man, sitting in front of us for the whole exchange, stands and says, "I can just walk across the street if that's all I need to do."

The ambulance medic beat me to it when he said, "Sir, that is up to you, I'm not going to chase you."

He grabbed his jacket and walked away. The smile on his and my face as the nurse stood slack jawed was quite comforting.
"Isn't that abandonment?" She asked.
"When you 911 the job, you are no longer in the loop unless the MD takes us over. And I'm pretty sure that isn't happening." the private car medic said and asked to be shown the other patient.

We cleared the scene and were glad the clinic was now closed and we wouldn't have to come back today.

My last day

2009-08-10T19:46:00.000-07:00

Being one of the low guys on the totem pole, I do not have a permanent assignment in my Department, but am assigned to a Vacation Relief status. This means what it sounds, that I float around covering open spots. That is how I get such a wide variety of odd 911 calls to tell you about.

I got word this afternoon that my assignment will be on the medic unit tomorrow.

One of the last 2 medic units. Based on the way they do the rotations this will be my last ambulance shift. Possibly ever.

In the past I was conflicted on how to feel, always assuming there would be one more day and deal with it then. Time to deal, I guess.

When I graduated from college I began testing in places that were building strong fire based EMS systems that I could become a part of and learn the ins and outs, the practical applications of all my schooling. I chose my current position carefully, choosing only systems who transported within the fire model.
This job was considered my brass ring. I really wanted it. The night before the physical exam I crashed on the floor in my sister in law's flat because we couldn't afford the plane and a hotel. I was proud to accept the offer and did my best in the academy.
We hit the streets and things went well for about a year.

Then the changes didn't happen. The ALS engine program began to stagnate and morale began to drop. What we had been told was not true. Those who told us quit and moved on to other Departments. Having come from a small Department by anyone's standards, I was just happy to have more than 2 people in a station and a nice steady pay check.

I began to doubt if I had made the right decision. The Department I worked for no longer had the system I was told it had and had researched prior to testing.

Skip ahead a few years and the transport element that was so important to me is gone. Tomorrow will possibly be my last day to ensure that what I saw when I first arrived on scene is relayed to the ER staff. Tomorrow I will be sad.

A dispatcher I met at a recent community event, upon finding out I was a Paramedic, asked me "Aren't you glad to finally get off that stupid ambulance?" She meant it well enough. Those rigs got pounded because the system forgot to adjust to their existence and adapt. I smiled at her and said, "That was part of the job when I took this job. I like it."
Just then a man and his toddler walked up to see the ALS engine I was assigned to for the day. The father saw my Paramedic patch and said to his son, "This man is a Paramedic, he rides in the ambulance." When I tried to explain the ALS/BLS tiers to him in the simplest way I could he asked if there was a "just firefighter" that could show them the engine.

This job is no longer what it was. If they were hiring today I'm not sure I would apply. But I'm not leaving now, that's just what they want. No, I'm staying because this is now my home and I want to make sure it can provide the best level of service, regardless of the administrative difficulties, budget cuts, or public perception issues.

I am a Firefighter/Paramedic and worked damn hard to get here and I'm going to keep working hard.

I just won't be working on that little red box with the big white stripe.

But hey, me being Happy and all, at least I'll still get to jump on to take in major traumas and cardiac arrests.

You Make the Call...Hanging...What Happened

2009-08-10T07:00:00.000-07:00

The guy who decided to wander to the shop window and peer in at THIS scene was more excited to see us force the door than he was upset at what he saw.

This situation shows the need for some practitioners to put every patient they find into "Annie's pose," supine on the floor. This is not always the best place for our patients and especially those that may need a closer look from folks who know more than we do about crime scenes. We are indeed the number one contaminators of crime scenes and I've only seen one TV show that showed it accurately. I can't find the episode, but on TNT's the Closer, the detectives arrive at the scene of a killing to a pool of blood and piles of wrappers and discarded equipment. The leader says something about how sloppy we are and I laughed.

This man does not need to be moved to confirm he is without life. A basic physical exam told us he had been there for hours (hence my mentioning he had been successful) and the EKG trace of asystole in 3 leads can be done in the position found. We unbottoned the shirt and carefully placed the electrodes, using the ladder that was in place.

The officers who responded with us were snapping pictures of the surroundings and the damage we had to do to the door to get in.

If you said let the Detectives do their job, leave him there, you made the right call.

Sunday Fun - What Makes a Chief?

2009-08-09T07:00:00.000-07:00

We dove into why we wear a bugle to signify rank a few weeks back, but some of our readers are wondering "How many bugles signify a Chief?" We get at least 5 hits a day from google with just that question, so here goes:

It depends.

Allow me to explain.

The Chief Officer of a Fire Company or Department is most often signified by five overlapping bugles pointing in all directions, signifying that that person is in charge of all aspects of the Company. From this rank down we remove bugles, but they always remain crossed, signifying that the person is a Chief Officer.

A Deputy Chief or Administrative Chief such as the EMS Section Chief or Deputy Chief of Operations will likely have 4 crossed Bugles, all pointing down. This signifies that the wearer is below only the Chief Officer and can serve in that capacity should it be necessary.

The highest rank in the field, responding to calls, should be your Division Chief. Division Chiefs cover a geographic area and supervise Battalion Chiefs. This rank is signified by 3 crossed bugles, again all pointing down. You can see that as you get more bugles you are in charge of more people.

A front line supervisor of multiple Companies is the Battalion Commander, or Battalion Chief. This person supervises multiple companies in multiple specializations. A Battalion Chief covers a geographic area and often serves as the Incident Commander at most incidents.

(All these insignia available at Chiefs Supply)

In most jurisdictions gold bugles signify a Chief Officer, but pay close attention to how many are present to see who you are addressing. When on duty, the Chief Officer should be addressed by rank, given full attention including you standing and facing them, a smart salute (when appropriate) and an offer of a hand shake introducing yourself. You should then stay in their presence until excused or given an order. It sounds overly formal, but when respect is given your workplace becomes a more respectful and professional place. And saluting the Chief in shorts and tennis shoes is just silly.

In addition to collar insignia, Chief Officers should be wearing a white helmet with a gold shield. This differentiates them from line personnel with a simple glance.

A white turnout coat should be reserved only for the Chief of Department. In a major emergency or MCI this Chief can be easily spotted in the sea of white helmets at the command post.

Next week we'll talk about the rest of the Department and how we should be dressed, marked and labeled.

Until then, *snaps to attention* "Thank you, Chief"

EMS 2.0 starts now

2009-08-08T05:00:00.000-07:00

All the comments here, on twitter and with our friend CK over at Life under the Lights have called our collective ideas to change how EMS is delivered EMS 2.0. Hospital radio reports via instant message, electronic patient care reports downloaded wirelessly on arrival, care back in the hands of the caregivers, not the bureauocrats. Alternates to automatically defaulting to transport in an ALS ambulance to an ER.

Ok, EMS 2.0 it is.

The movement is service based, focusing on what can be provided by EMS staff and giving those providers more access to services other than an ER in a hospital as the only option for patients.

EMS 2.0 combines advanced practice paramedic services as well as a number of options for transport, transfer and relocation.

This new service revolves around a seamless network of emergent, non-emergent, clinic and community resources working together, not each service struggling to deal with eachother's overload.
Imagine an emergency room that only deals with emergencies. Imagine a clinic that only handles acute, non-emergent cases and a physicians office where people aren't threatened by large co-pays and 40 day waits to get an appointment.
It won't be reached in my service time, but if we're going to get there, the foundation has to be built now.

We've figured out the patient care thing, let's move ahead.

Multiple colleges and universities now offer Bachelor's degrees in EMS and Paramedics are retiring from 30 and 40 years of patient care to teach others.

We have arrived as a profession, let's start to act like it.

I have taken the steps to begin the process of changing the system where I am, are you? Would you rather find a shady place to ride out the rest of your career? If so, I only ask that you offer solutions or keep out of our way.

No longer will the excuses of "That won't work" and "We tried that 15 years ago" be accepted.

I've submitted a test policy through my chain of command. A simple change to make a situation we encounter often easier to deal with. It does, however, include a simple change to put just a little more power in the hands for the folks doing the heavy lifting.
If they approve it, it will make our ability to provide medical care easier and serve as a launching point for the next 4 phases of the project.
If they reject it, their reasons will give me insight into how to better propose the other changes and I try again.

We can only change the world if we work together.

Here we go.

Language Barrier

2009-08-07T15:34:00.000-07:00

I do enjoy when a Saturday Night Live sketch comes to life on an emergency response. Sure the Massive Headwound Harry bit with Dana Carvey is hilarious, but sometimes the subtle misunderstandings between cultures can trigger a good Garrett Morris memory.

THE EMERGENCY

The local nursing home reports a woman unconscious.

THE ACTION

It's 4:30 in the morning. Most of the City is unconscious, but here we go anyway. I have been witnessed more than one time sliding down the pole crying out, "Where's my ambulance? I'm not alert, I need one too!"

The engine pulls up in front of the high end nursing home geared towards persons of Chinese heritage and we have to wait to get buzzed in. The staff usually speaks only Chinese and the decorations, food and activities are geared towards these folks in particular. Not unlike the Jewish Home we respond to often as well. Only completely different.

Up to the floor, again at 4:30 in the morning, we find a resident fully dressed, bag in hand and holding a hand over her stomach. As I introduce myself she clearly doesn't understand a word I am saying so I go into my standard fumbling Chinese assessment. Seeing a 6' 3" white guy in turnouts trying to speak Mandarin is apparently very funny to the staff who makes no attempts to help. Halfway through either asking where it hurt or ordering another round of rum and cokes, one of the staff members steps forward, I assume to help translate. Like I said, they all speak Chinese and have been chatting all the while I've been trying to communicate with my patient.

"Can you ask her what hurts or why she needs us?" was my question.

Instead of speaking the patient's native language, she leans in and begins to shout at the patient in broken english, "What wrong with you!"

I laugh and ask her to stop as the engine crew retreats into the hallway to let out the giggles. The caretaker looks at me and says, "I no speak her language."

"Who does, more importantly, what language does she speak?" The staffers look at each other shrugging their shoulders and decide they don't know. My white boy's ears hear an Asian dialect for sure, but can't tell. I break out the translation flip charts we carry, each page with basic questions in a number of languages. Maybe if she can at least point at one we'll have an idea.

She takes the chart, flips through it, hands it back and shakes her head in the negative.

The ambulance crew had no luck with a native Korean speaker either, so back to square one.

On the ride back to the firehouse we laughed about how we were reminded of the Saturday Night Live sketches with Garrett Morris. He would appear in a bubble over the shoulder of then anchor Chevy Chase and shout the news "For the Hard of Hearing."

HERE is a clip, you can watch the whole bit or skip ahead to 2:03 to see Morris. When you watch it, imagine a quiet dorm full of the elderly and a tiny 90 pound Chinese woman yelling.

You Make the Call...Hanging

2009-08-07T07:00:00.000-07:00

Dispatched to a report of a person hanging, you arrive to a local shop on main street which is closed up and the doors locked. A person waiting at the bus stop peered into the window, saw the man hanging and called 911.

After 10 minutes to break into the well secured shop you find a man who was successful in his last task in life, hanging from the rafters which he removed ceiling tiles to access. A note is found nearby and there is no sign of a struggle in the tiny shop.

The police are on scene and detectives are enroute when the ambulance crew asks you to help them cut him down to confirm he is lifeless, per protocols.

Should you cut him down before the detectives arrive? You make the call.

I had a dream

2009-08-06T10:06:00.000-07:00

I had a vision of Emergency Care in the Future. Then I awoke in a cold sweat, it was a nightmare.

The year is 2020.

EMS in the US is now strictly privatized. There is no governmental intervention in patient care whatsoever. All medical care was briefly socialized in the early 2010s but failed when over 75% of the population was obese or ill from chronic disease. A federally mandated national diet was enforced and followed, closing most of the fast food chains but the load was far too great for underfunded hospitals and clinics to bear and the system imploded. The private sector responded by reopening the hospitals and clinics to paying customers only.

After massive budget cuts, the Fire Service was unable to keep highly trained, highly paid Paramedics and EMTs on staff. Fire Companies were closed leaving only a framework in the event of an emergency.

When a medical complaint is called in, private ambulances submit instant online bids to the caller and the caller chooses the company to respond, being charged immediately, regardless of complaint or outcome.

Physicians have taken over patient care via hand held patient care devices which instruct a patient to speak their chief complaint into a microphone which allows the ambulance technician access to only the tools needed for that complaint based on protocols. Then the patient boards the ambulance, the technician applies the treatments indicated, and the patient is placed in a medically induced hypothermic coma.

The ambulance technician is not legally allowed to make verbal contact with the patient for the fear of violating the patient's privacy. The ambulance was GPS guided to the call and the driver is never even informed of the service address, again for fear of loss of privacy.

Once at the hospital, the patient is taken into a sound proof room and thawed, then tended to by a staff of nurses and medical students. Only students are allowed to work in the Emergency Rooms, all licensed physicians are in private practice.

When a patient's condition is stabilized they are immediately moved upstairs, into surgery or returned home with instructions to call their private doctor.

The ambulance will be randomly assigned to the next bid.

Nightmare indeed.

You can't pee?

2009-08-05T10:00:00.000-07:00

The universe has a strange way of evening things out. Every time I have a rough night on a busy engine or ambulance, I think about a time when I had a great day and I call it even. I smile and I'm a Happy Medic. This particular job came in at 3:30 AM on a busy engine company downtown.

THE EMERGENCY

Severe respiratory distress in a mid 40s male.

THE ACTION

The renovations to the low income housing are somewhere between a college dorm and a mid range hotel. Nice lobby, 24 hour security and a large bonus room on the ground floor. We were directed to the elevators and to the 7th floor, all the while discussing how nice the renovations were and wondering if the pricetag was where our budget went last year. In the back of my mind are my procedures for nasal intubation. It's been awhile.

As the doors chimed open a man is standing in the elevator lobby. "Are you rescue?" He asks, giving away he is not from these parts.
"Did you report a life or death emergency?"
"I can't pee." he says handing me a mess of hospital discharge forms.
Before I can speak the engine boss grabs him by the shirt and pulls him into he elevator.
"If I don't pee, I'll die. Did you know that?" He's asking me. I see no distress in his breathing and he is standing steady.
"Not untrue, but why do you think we can help you? Don't you think you should wait for your doctor instead of calling 911. Wait a minute. Have you tried to pee at all, are you...well...blocked?" I ask wondering what his proof might be that his plumbing is in order.

"I need a shot to pee." he stated as the elevator doors opened and the ambulance crew welcomes their new friend. He recounts the tale to them and they wave us back in service while trying to guide him back into the elevator and back upstairs.

I smiled and the firefighter asked me what could possibly be so funny about this kind of abuse of the 911 system. I told him this story, and the universe and I were equal once again. It lasted less than 3 minutes.

Where are we going with this?

2009-08-04T13:47:00.000-07:00

Life under the lights has taken up the EMS 2.0 cause as of late with another great post about how he would like to see EMS evolve in the future. Have a read and come back.

Fired up? Ready to do something about it? Good, because you're a part of this.

As CKEMTP mentioned, there are a lot of things he and I disagree about, but I love this field and how seemingly opposites can agree on the fundamentals of their profession.

Profession. I can't stress that enough. We are no longer a trade and need to stand up to those who try to treat us as such.

A community based model is a fantastic idea and can work. At my first paid position, we operated the ambulance out of the Community Health Office and had a list of folks we did home visits on each day. Every morning we went to 3-5 houses to visit folks at high risk. Diabetics, known asthmatics who were in poor health and similar situations. At the time I hated it. I was a Fireman "forced" to ride the bus. It was a few years later when I knew most of my clients before we arrived at the scene, knew their sugar ranges and just how much albuterol would make them better. It made me a better care giver.

That was around the time I began my Bachelor's in EMS program. Half way through it I envisioned expanding the EMS system to include a clinic based element for rural and suburban areas. An ambulance can respond from a clinic and transport appropriate patients to the clinic for minor procedures or along to the proper hospital. On their downtime they assist in the urgent care clinic.
I incorporated a fire based model to respond from the clinic and the system made little sense with dualing command structures and confusion in supervisory authority.
The basic plan still sits in my little notebook I used to keep my ideas in back when I thought we could change things.

I re-read it after reading CK's post.

EMS 2.0, for those of you not familiar, is a concept of changing the delivery and abilities of EMS to adapt to the changes in patient presentation and tools at our disposal. EMS 2.0 is named such because we need an overhaul and upgrade of the current system, not just a polishing and reshuffling of the same old ideas. Painting the ambulances red doesn't make the men inside them part of the fire service, no matter how shiny it gets.

Talking to the Angry Captain about some personal and blog issues the other day I commented about needing to get "less political" in the coming months. Since my command staff is aware of this place (Hi, Chief) I do need to watch what I say, but when it comes to improving the way we do our business, it is my responsibility to be a patient advocate and get things moving in the right direction.

I don't have a political axe to grind, represent any trade group or company, I'm just a practitioner seeking a better way of doing things. I'm currently in a fire based model that is undergoing a transition and can see a lot of room for change and improvement, but I am young in the business.

Let's fight the good fight.

The Will of the Living

2009-08-04T07:18:00.000-07:00

I was recently a witness to how a person's last few hours should be handled. Not because it was what I wanted, but because it was what HE wanted. This is in line with a current rift in politics at the federal level which encourages persons in this situation to put pen to paper about their end of life wishes.

Before I am dispatched to the report of CPR in progress, a bit of background.

Our new friend is a recipient of medicare and was, a few months ago, enrolled in a hospice program and was allotted around the clock care from 2 care takers, each on 12 hour shifts. Each of the care takers kept a log book which they kept and one large book which stayed at the gentleman's home. This included a very accurate meds list, recent complaints, menu and amounts of food eaten as well as his activities for the day. This was the most in depth record keeping I have ever seen.

Last night the care taker passed along that her client had been more short of breath than usual and was too tired to do his usual walking laps around the small house. The day time caretaker called the agency and requested a nurse come out to evaluate him in case he needed an adjustment in meds or oxygen. When an appointment was made in a few days time, the care taker fought and convinced the agency to send someone immediately because he, "Was so tired and sad."

The nurse who answered the call was equipped with a high tech laptop which held all the information for the large amount of persons currently under her supervision. When she arrived at the house, the caretakers had made their client comfortable in his favorite chair, facing a photo of him as a younger man, taken long before the painful cancer began to eat him alive.

The nurse evaluated him and determined there was no adjustments that could be made and offered to stay and help the caretaker deal with what would likely be happening soon. She made the caretaker breakfast and finished some paperwork on the computer when they both saw him lift his slumped head, look at them and close his eyes.

He was gone.

The nurse removed the original copy of the DNR from the wall over the bed and taped it to the front door while calling the non-emergency number for a Paramedic to pronounce death. The nurse then contacted her agency, the gentleman's primary care doctor and the funeral home, all before I arrived at the scene with a dispatch of:
"Man down resuscitation, CPR in progress, gathering further."

I rang the bell and noted the DNR on the door. The nurse meets us, giving us the details in the stairway, and leads us to the gentleman still in the chair. We do our assessment finding him clinically dead, moving to the next step, contacting the Medical Examiner for a notification. Often this involves a police officer to standby with the deceased and a 1-2 hour wait for an ME to arrive and perform their field assessment before releasing the body to a funeral home or gathering for an autopsy.

On the phone I mention the patient's nurse is at the house and has already notified the primary care when he says, "Really? Cool, let me talk to her."

They have a conversation that ends with, "Thank you Sir," and hands the phone back to me.
"Expected, witnessed and notified, you don't need us, the nurse says the funeral home is already enroute."
"That's it?" I ask, usually I have to give them a 10 minute report on meds, history, family etc etc.
"Yup, thanks." and the line goes quiet.

The nurse asks if we can place the gentleman back in the bed to help the caretaker's cope. The one on duty is slowly giving into her grief in the kitchen as the night girl arrives and they embrace.

No tubes, no drugs, no violent CPR to prolong what was clearly a painful and excruciating life. He made sure, months ago, to make out a living will which explained his wishes should his heart stop beating, which led to the DNR.

Not to mention freeing up the other resources to those who may need them.

When you finish reading this look into a living will. There are a number of websites that will guide you through it, I found THIS one just doing a quick search. The wife and I were lucky enough to get help from a lawyer group that helps Firefighters for free and sat down a few years back and did the whole thing. Then we took the copies, put them in a binder and told the family that if anything happens, trust the paper, not the person. End of life decisions, funeral arrangements, custody, everything needs to be addressed.

Make sure those around you know what your wishes are and you can move along to the next step on your terms, not those of the EMTs responding.

Our friend did it and not only did it make an impact on his life, but on mine. And, hopefully, yours.

You Make the Call...Traffic Stop...What Happened

2009-08-03T07:00:00.000-07:00

This was a kind of trick question. When this event took place I was working for a Public Safety Agency. Each vehicle was marked the same, ambulance, fire engine and law enforcement car. Per the policies, the officer was within his abilities to use the ambulance to stop the vehicle. Since I was driving I was uncomfortable with the idea of a pursuit, but agreed to at least slow them down and get the kids sitting properly and safely.

Just as I hit the lights we heard an off duty officer on the air asking our situation. He was in his unmarked cruiser and was now behind us, but was not in his uniform.

It was a combined effort with the unmarked car making the stop and the ambulance pulling in behind for the uniformed officer to approach the car and do his business.

I cleared the scene as another marked duty car pulled in and once again had to delay the fantasy of the high speed chase. Until this happened.

If you said do what you can for safety's sake, you made the right call.

Motor Cop and Happy Medic as one

2009-08-02T20:18:00.001-07:00

One of my readers sent me this motivational poster :
Wait a minute. Anyone else notice he's the only one getting ready to swing? Hilarious!

"Magic Wellness Stick" oh you kill me, you really do.

But MC and HM have met before...

And those videos only get better

Sunday Fun - Television

2009-08-02T07:00:00.000-07:00

There is a lot of buzz on the interwebs about a new TV show on NBC this fall. I have remained neutral as to what I think about the show, since I have not seen it, but judging from the previews, I don't think we'll see anything too new when it comes to the way our profession is viewed by the TV audience and those in the business.

Then I thought more about the impact TV medicine has had on my ability to treat patients in the field. I tried to get mad about folks calling for the new medicine they saw in commercials or that they have a condition seen on last night's episode of House or ER.

But I realized that the way EMS and EMS patients are portrayed actually plays into our favor. Follow me on this. There are a few conditions I classify with the prefix "TV" as in "TV-Seizures."

TV-Seizures have a person, often in their 20s to 30s, flopping around on the floor, holding their eyes shut tight while the friends panic and run around looking for something to put into their mouth. I often lean down into the patient's ear, introduce myself as a Paramedic and explain that I know what a seizure looks like and that they can stop faking it now.

TV-Overdose has a number of subsets but my favorite is the ice in the crotch for the heroin OD. Whether this is an old herbal remedy minus the herbs or what, it certainly is a perfect way to let me know he was using heroin. You can deny it all you want but when you try to explain the ice in the crotch and pits is where a drink spilled, now you look silly.

TV-Medics are always on their way to another career. "I'm going to medical school," is my favorite, but they rarely portray EMTs and Medics who want to be just that. The one exception I found was the short lived show "Saved" that featured a laid back medic who's family kept trying to get him into medical school, but he declined. His partner was, alas, studying to go back to school. I like the trendy T-shirt with "bus driver jacket" uniform he wore. So relaxed. I will one day put a Ferrari patch on my jacket ala Mother. I'll post a pic.

But in the end, they always have someone kicking in the door to the trauma room and shouting vitals to attentive ER staff. HA!....sorry....that always gives me a good belly laugh. More than once I've had to block the nurses station to get a spot. That's not good TV.

TV has a lot to offer our struggling profession, little of it can be good because when you get down to it, our job is boring. There are no smoke creatures on a tropical island, no bikini clad co-eds romping in strange stunts (not all the time anyway) and no cash prize at the end. The reason TV shows about EMS never do well is because they follow the characters home. Remember when Rescue Me was a cool firefighter show? Then they followed Tommy home, the family got weird and now it's a circus soap opera set in a firehouse.

Come on TV Producers, give us a show about EMS that show the public the truth! Show them the countless hours of training and recertification, standby, paper work, stocking and dealing with 911 abusers, finding a clean bathroom on post, not just the "You're not dying on my watch!" cliche. I've tried it, it doesn't work at all.
and...
ACTION!

The new guy

2009-08-01T15:06:00.000-07:00

We recently released new meat into the streets of the City, cleanly pressed uniforms and anxious to get some 911 action under their belts. Maybe they can start off with a low speed MVA or Erma on another of her Doctor's ideas of preventative care: An ambulance to St Farthest. No, Mr Black Cloud brings a full code, with some complications.

THE EMERGENCY

A man has reported difficulty breathing.

THE ACTION

This is a run from the busy house I spoke of on twitter. Both units assigned to this house are in the top 10 busiest in the nation, one of them top 3. When the Medic van used to be there, they were top 10 as well. Makes for little sleep, but a lot of blog fodder.

This call, however, was one that shows the importance of advanced intervention and assessment skills, and was only 1 of 2 legitimate emergencies we encountered, the other being a decent kitchen fire I'll share shortly.

But I digress. The new guy.

Into the living room converted to care facility and we meet the BLS engine who beat us in the door by mere seconds. The family states the patient was just talking to them, coughed and fell asleep right before she heard sirens. She states there is no DNR.
Pale, apneic, the faint remnants of life pulsing away at maybe 20 at the tiny carotid.
"Do we move him to the floor?" The BLS team asks.
"No, get a bag on high flow, I want to hear what is in his lungs and get it out, I need that suction unit." And the gears begin to churn as the ALS machine comes to life.

Pt now supine, pads are on and the BVM is making no difference in auscultated lung sounds, but I know what's coming so I instruct the engine EMT to pull the OPA and start suctioning.
"Suction what? OH MY GOD!" His voice raised as the fluid began to spill out of our patient's mouth and into the awaiting suction tip.
"When did you feed him last?" I asked the family, noting the J tube in place.
"We gave him his bottle and medicines maybe 5 minutes before we called you."

He was backed up. In the seated position, the fluid likely backed up his esophogus and began to trickle into his trachea and lungs, slowly drowning him.

"Now to the floor," I instruct and the airway is now clear and we can get to work. A reassessment shows the faint rate of 20 is now slowing to 10 and below when I instruct them to start CPR. These guys paid attention in the refresher and it showed. The 7.5 ETT passed easily after a bit more suctioning of the orange juice colored, milk consistency liquid and we were getting a decent capnography wave as the ambulance arrived.

The new EMT had just recently hit the "Available" button in his new ambulance when this job came in. First day, first bell. Lucky him.

Into the room, you can tell this is his first field code as he's not sure where to stand or where to go. Then his training kicks in. "Next CPR cycle, I'll step in. Do we need anything from outside until then?" Nice.

We're into the second round of the AHA's bible when I pull out the narcan. You never know. His list of medications was as long as my...well...it was long.

As I announced it was going in so the other medic could keep track and think of anything else to try, the new EMT, now on the BVM stopped, opened the patient's eyes and said, "But his pupils are fixed and dialated!" I grinned.

In the end our patient had a ticket wherever he was headed before we arrived, but helped the new guy get over the first day jitters.

The Handover - July

2009-07-31T10:15:00.000-07:00

The Handover Blog Carnival is now live at Trauma Queen. All the submissions are great reading, some from new blogs I intend to start reading.

Go by and see what Kal has put together.

You Make the Call...Traffic Stop

2009-07-31T07:00:00.000-07:00

You are returning from a rough transport, major trauma, and one of the local police officers came with you. An experienced EMT, he was at the scene before any other help arrived and assisted you into the hospital.

Returning to your jurisdiction, and his, in the ambulance he is in the passenger seat in his uniform with weapon.

A convertible speeds by with a number of teenagers clearly not restrained and traveling well above the posted speed limit.

The officer radios in the plates but receives a radio message that no officers are available at this time to pursue.

He looks to you and says, "Light it up and catch that guy! I'll take the heat from your boss, just get him to slow down and stop!"

Do you turn your ambulance into a police cruiser? You make the call.

You peed?

2009-07-30T14:36:00.000-07:00

The text says he is having trouble breathing. The dispatcher has added a Paramedic Supervisor to the call, usually reserved for major emergencies. What we found was not what we were told.

THE EMERGENCY

A man is having difficulty breathing.

THE ACTION

The middle aged man has called 911 reporting he can not breathe. We arrive at the house and are met by a girl in her late teens, telling us to hurry, her father can not breathe.
At the top of the stairs we hear him calling out to us, in full sentences and at quite a volume, that he can not reach his urinal.

"Hurry up already, I peed! I have to pee more!" He is shouting.

"Sir, do you have an emergency?" My partner asks as I take a moment to survey our surroundings. 50" HDTV with HD Satellite box, clean bedding, stacks and stacks of pirated DVDs, bed side commode and fridge (Not a combo unit).

"I need a ride to the doctor, I can't hold me pee!" He calls out as we hand him the urinal. "It's too late now. What took you so long?"

"..." I can't speak.
"..." Partner is at a loss for words as well.

The phone is placed back on the hook from where he called 911 and immediately rings. The son is calling asking what the problem is, he heard sirens. The son is 3 doors down. All this time the son is 3 doors down, alone, and can't come help dad pee. The girl is rubbing her forehead and taking notes of our assessment. When I ask why she tells me her mom will want to know exactly what happened and she wants to be accurate.

"You don't need an ambulance, Sir, but we'll call your Doctor's office to try to arrange a ride if you don't have one. I don't see a cane or walker, are you able to get around OK?" I ask, hoping he listens to reason.

"I want a ride and you are my ride. Let's go." He's up off the bed, slippers on and heading for the door, not even allowing a basic assessment until we're in the ambulance.

All the way downstairs and to the street without even a wince or groan, a wheeze or moan and he refuses to climb in, instead demanding we remove the cot and load him up. Realizing we are not in control, we've stopped trying to do the right thing. As soon as he sits down on the cot and I take the feet to load him up he cries out, "Hurry up I have to pee!"
"Can you hold your urine, I'll get you a urinal in..."
"I'm peeing!"

I love my job.

Attention all units in the field.

2009-07-29T17:00:00.000-07:00

You need to get over to Ben's place and read the Insomniac's Guide to the Ambulance for his inspiration. Now.

Mr Universe

2009-07-29T11:27:00.000-07:00

A neat feature built into cell phones is this concept that even if it has no carrier and no one paying the bill, it can still turn on and call 911. Great feature. I love it. Genius. Anyone who finds a phone in the street can turn it on and call for the FBI.

THE EMERGENCY

The call center has received a cell phone call requesting the FBI be sent immediately to a street corner.

THE ACTION

Reading the text, which I'm sure the dispatch center was laughing about the whole time, I think back to every time I've had to wait for an ambulance to respond because others were tied up on clients instead of patients. Yes, I consider people who activate 911 for non-emergent, non-urgent, non-medical/police/fire/assistance clients, not patients.

Mr Universe is often seen at this corner, half in traffic, waving us along as if without him we will slow to a stop and not be able to continue. Mr Universe is homeless by choice and often tells us, at length, about how much easier it is to score with the ladies when you don't have to waste your assistance check on housing.

He wears a number of layers of clothing, each eclectic in its own right. An open front helmet is covered with a variety of old CDs and flashy nick knacks he has collected over the years and a beard that matches his dreadlocks perfectly. And yet, despite his appearance, is entirely sane.

Today Mr Universe found a cell phone in the street and, by golly, it turned on. There was no service to it, someone likely threw it out instead of recycling it, but when Mr Universe saw it ask him if he needed 911, he decided to get some things taken care of.

As we arrived and saw him waving, as usual, and on the phone we could only wonder what he was up to.
"When did Universe get a phone?" the driver wondered aloud.
"Probably nicer than mine" the officer grumbled.

As I approach Mr Universe is still online with radio telling them that there is a conspiracy to destroy the earth and some other nonsense, and he wants the FBI, not the Fire Department.

Yes, dispatch assumed this man was mentally unstable and instead of sending a law enforcement officer, as per the caller's request, they sent Fire/EMS. The catch all, end all of the system.

We informed Mr Universe we had no phone number for the FBI and the boss asked to see his phone. Out came the battery and Mr Universe was reminded that to seek fire or medical assistance he need simply use the street pull box located 6 feet away, but that false alarms are not tolerated.

He waited 6 hours to pull the hook in the box and ask for the FBI again.

Smoke Eaters and Hall Crawlers

2009-07-28T10:11:00.000-07:00

This is another in a series of tales told by my probationary boss before his retirement. You can find them under the tag "Tales."

Smoke Eater is a title that gets thrown around easily these days. With the proper use of airpacks and application of physics, no modern firefighter need be a smoke eater.

New on the job and still catching frequent big fire, our probie is assigned to the low rent district on the engine. This neighborhood is well known for the resident hotels and single room occupancies, often 5-7 floors each with 20 or so rooms scattered on a floor that has been remodeled who knows how many times in the 100 years the building has stood.
A fire in these buildings will get out of control and jump floors fast, not to mention catch unsuspecting occupants in the interior stairwell.

The bells ring late in the evening for a full box assignment, reported fire in a building.

On the engine, doors open and siren screaming, from their vantage point in the open cab they see the flames from blocks away. The south half of the 4th floor is blowing fire and catching the fifth fast. Luckily this building was recently updated with a standpipe system and, lucky still, it is not on the side on fire.

Off the engine with both bundles of 100', the officer has the wye and they're up the stairwell, pushing past folks running downstairs, most naked or nearly so.

Smoke is heavy on the second floor and our engine crew has been forced to their knees halfway to the third. On the third floor the heat is intense and the smoke thick. No hoods, no airpacks, just your guts and your experience to get you in and working. They hook into the standpipe and are leading the line upstairs when they are forced down to their stomachs. The heat is described as a giant elephant sitting on your neck and face, unrelenting, inescapable. To charge the line and shoot water now means a steam burn for sure. The body can take more heat dry than wet, so they push forward, a lunging crawl at a time, both members of the nozzle team wishing they could find the fire and get the hell out.

In all the confusion, they must have crawled into a closet because the team has encountered a pair of boots in their path. The smoke is thick and the low levels of oxygen could be playing tricks on their eyes.

Nope.

The boots belong to the engine boss, crouching, but still walking, in a backwards duck like shuffle that outside of a burning building would indeed seem odd.
"Get off the floor you clowns, we're almost there!" He calls and the team rises and imitates the shuffle which, to their surprise, helps with the heat, but the smoke is more intense, piercing their eyes and making them burn as if on fire.

By the time they find the bulk of fire near the end of the fourth floor, they find the truck company passed them while crawling and has already ventilated and was pulling ceiling in anticipation of water.

After the fire, amidst all the coughing, snorting and wheezing, was a kid wondering if his boss went through the same learning experience he just did. It was there in the street he finally understood what they meant by "Trial by fire."