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Happy Birthday Happy Medic

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

Posted by happymedic on August 31, 2009 • Filed under: Administrative

You Make the Call…Triathlon…What Happened

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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.

Posted by happymedic on August 31, 2009 • Filed under: You Make the Call

…for the conspiracy…

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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.

Posted by happymedic on August 30, 2009 • Filed under: Medical Aid

Sunday Fun – Take me out…

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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!

Posted by happymedic on August 30, 2009 • Filed under: Sunday Fun

You Make the Call…Triathlon

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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.

Posted by happymedic on August 28, 2009 • Filed under: You Make the Call

the Handover – Edition 7

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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.

Posted by happymedic on August 28, 2009 • Filed under: The Handover

10 new first responders without the Fire Department

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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.

Posted by happymedic on August 27, 2009 • Filed under: Administrative

Happy is an uncle!

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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.

Posted by happymedic on August 26, 2009 • Filed under: Mutual Aid News

2 Year old Tip of the Helmet to Orlando

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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.

Posted by happymedic on August 26, 2009 • Filed under: A Tip of the Helmet

You Make the Call…Pump Lever…What Happened

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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.

Posted by happymedic on August 24, 2009 • Filed under: You Make the Call

Sunday Fun – Ladders

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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?

Posted by happymedic on August 23, 2009 • Filed under: Sunday Fun

A Tale of 2 Poles

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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.

Posted by happymedic on August 22, 2009 • Filed under: Administrative

20 years of drunkenness

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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.”

Posted by happymedic on August 21, 2009 • Filed under: Medical Aid

You Make the Call…Pump Lever

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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.

Posted by happymedic on August 21, 2009 • Filed under: You Make the Call

God’s Gift to Firefighting

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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.

Posted by happymedic on August 20, 2009 • Filed under: Administrative, EMS 2.0

Don't fill the boot this year

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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.

Posted by happymedic on August 19, 2009 • Filed under: PSA

Top 10 new responsibilities of the Fire Department

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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.

Posted by happymedic on August 19, 2009 • Filed under: Administration & Leadership, Administrative, EMS Topics, Fire Rescue Topics, Funding & Staffing, PSA, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus • Tagged: Administrative

What do you mean Shock Advised?

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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.

Posted by happymedic on August 18, 2009 • Filed under: Medical Aid

Mutual Aid Board Addition

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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.

Posted by happymedic on August 18, 2009 • Filed under: Mutual Aid News

Is that a fire engine or a fire truck?

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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.

Posted by happymedic on August 17, 2009 • Filed under: EMS Health & Safety, EMS Topics, Fire Prevention & Education, Funding & Staffing, Special Call, Technology & Communications, Training & Development

Sunday Fun – What are you looking at?

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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 markings 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.

Posted by happymedic on August 16, 2009 • Filed under: Sunday Fun

"It does nothing for the patient"

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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.

Posted by happymedic on August 15, 2009 • Filed under: Administrative, EMS 2.0

One of our own…

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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.

Posted by happymedic on August 15, 2009 • Filed under: Administrative

You Make the Call…Dedication

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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.

Posted by happymedic on August 14, 2009 • Filed under: You Make the Call

Last Day and a not so brief history

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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.