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One of those nights

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I’ve been busy preparing for the premiere of the Chronicles of EMS and haven’t been sleeping well.  When I do sleep, it is shallow, poor sleep, at least at work.  At home Mrs HM tells me I sleep like a baby rock log.

But a few days ago at the table after a long night at work I had to ask the firefighter on the engine, “Did I get in trouble last night?”

As I remember it, we were running back and forth on our usual compliment of folks unclear on the concept of an emergency.  The engine was dispatched to a reported motor vehicle versus pedestrian.  At 4 AM it could be bad, so we were ready to work when we arrived at the intersection to find a man laying on his back between 2 parked cars.

A quick approach shows no damage to the vehicles around him and no fluid on the ground.  As we approach we see his feet crossed and he wipes his chin with a dirty hand.

“Sir!” I call out as we arrive at his side.

“Ah, you made it.  Man, I need a place to sleep, this is killing me.” He replies as he rises looking past me to the engine. “Where’s the ambulance? I asked for an ambulance.”  No distress, no problems.

I assessed his clean clothes and unstained shoelaces, a clear sign he has not been on the streets long.  He told us all about how he was a local and grew up in the neighborhood, but couldn’t name the school he went to or what street he lived on.

We get a lot of folks coming to town thinking it’s all wine and roses on the streets of the big City.  Many other cities appear to be using us as their dropping point for folks they choose not to help.

This guy clearly expects an ambulance to take him in.  As we confirm he is not injured, I spot a $20 in his pocket.

“You have cab fare, just call a cab if you want shelter.” I tell him as the boss code 2s the ambulance.

“You can’t tell me what to do, now call me an ambulance and go away.” He said laying back down between the cars.

I lost control for the briefest of moments and threw the BP cuff at him from a short distance.  I was fuming, rage kept deep for so long bubbling up to the surface and I know I have to leave.  Across the street I walk and sit down.

“What the hell are you doing?” The boss calls out to me.

“I’m done with him.  Call the EMS Supervisor and the BC, I’m not coming back over there, I might do something more stupid than I just did.”

Hours later I’m sitting at the kitchen table, sipping coffee, still angry.  The firefighter is pondering my earlier question, clearly thinking about it.

“No, I don’t think so.  Did you kill someone while I wasn’t looking?” He answers, looking back to the metro section.

“Did I throw a BP cuff at that guy in the street?”

His head looks up and he smiles. “Threw a WHAT? Are you feeling alright?  Have you thrown anything, like, ever?  No you didn’t get in trouble last night.  We didn’t  run a guy in the street.”

The boss has heard the tail end of the conversation and chimes in, “Bad dreams huh?” and he offers to fill my coffee.

Bad dreams indeed.

the Handover turns 1

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The Handover, blog carnival roundup brain child of my UK alter ego Medic999 turns a year old this month.

Buckman at Gomerville.com asked for submissions around the theme of an EMS Portrait and the submissions did not disappoint.

Hard to believe it was a year ago Mark emailed me about this idea and I had no idea what he was talking about.  Now it’s a great way to find new blogs and share posts about a theme.

Be sure to read up on next month’s topic and host while there and drop a post in.

Two Important Lessons

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I’ve been saving this a little while so as not to give away too much.

Lesson #1

Don’t leave your iphone alarm set to a ringtone in the dorm of a double company house with a Battalion Chief.  If you do, make sure to either turn it off immediately or, should you get a job near alarm time, take it with you so it doesn’t disturb the others.

Lesson #2

Don’t take a picture of yourself with said phone if the owner has hundreds of hits a day on his blog.  He might just post the pic.

IMG_0196

Sorry about the alarm.

“RTB for a cuppa” I’m allocating in the UK

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chroniclesblogRTB means Return to Base.  A cuppa is slang for a cup of tea.  Allocating is something I very much wanted to see first hand.

On this morning in Newcastle, my second to last, Mark has arranged for me to meet with the executive staff of the NEAS at their headquarters.

Before meeting with them, however, I’m downstairs in the bullpens.  I’ve got 2 hours to sit in the dispatch center and do a “Sit-along.”

When you tell a guy who loves talking theory on systems allocation he gets to see the system work from the nerve center, he gets a touch giddy.

My first chair was at a call taker’s desk and I got plugged in.

BANG, less than 10 seconds, not even a chance to introduce myself to the call taker I’m with the first tone is in my right ear.

Before she can answer the call a timer has popped up on her screen 8:00, 7:59… the clock is running.

“Ambulance Service” she answers and begins reading from the screen the pre-ordained triage system called Pathways.  As I’ve mentioned before, this dispatch system makes no attempt to diagnose the problem, but the physician designed questions can dial up or down the response in real time as the call taker asks the questions.

While she is asking and answering, a small red circle has appeared on the screen, then, a bit away, a purple one.  Later I would learn that one is the location of the caller and the other the closest vehicle assigned to the call.  When that vehicle arrives on scene, the timer now passing 6:15 will stop.  This is their target and they take it very seriously.  As I’m listening to the call, it is a very straight forward sick call and the caller is honest about it.  It is then I see the benefits of the flexible front loaded system.  The rapid response car, the closest resource to the caller, has been stood down since there is not an emergency at the caller’s location.

The vehicle, or cot transport capable ambulance, is continuing, however, and the target is no longer 8 minutes, but now 16 from the time the call was answered.

As more questions are answered and the system confirms the lack of life threats, a simple screen gives instructions for the caller until the crew arrives.  The call taker then scrolls around her GPS monitor and finds the vehicle, then advises the caller about how far out they are.  The caller thanked her and the call was terminated.  Less than 3 minutes passed from the answering of the call to the triaging and confirmation of appropriate response.

At no time did a supervisor step in to augment the call taker’s classification, nor did the system err on the side of caution by upgrading the response, putting rescuers’ lives at risk, “Just in case.”

In the hour we were together I learned more about the desk I was at and the number of calls she answers in an average shift.  We took mostly non-emergent calls, details of which would obviously violate privacy, but I can share with you the CALLERS.

When I explained how folks abuse our service by calling from a cell phone miles away about a person they think might have been either unconscious or sleeping, she smiled.  Then, I went on, our criteria based dispatch system considers the caller’s inability to confirm consciousness to be unconscious and their inability to confirm breathing to be apnea, and 7 people are now responding code 3 for nothing.

It was just when the call taker was explaining some of the loop holes used that a care facility called to request an ambulance.

They were not with the patient so unable to observe their mental status, efficiency of breathing or if there was any bleeding.  The system took this information and kept the RRC responding.  Each time the call taker asked a question, the caller was already answering, knowing exactly which question comes next.

She later explained that folks have learned that if they take a cordless phone around the corner and call an ambulance, the crew arrives faster than if they honestly answer the triage questions.

“Same callers, different country.”

It was later in the morning across the room with the allocators that I saw the strength and weakness of the NEAS.

Mark and I spoke at great length about being honest but respectful when offering our observations and suggestions to improve each other’s systems.  Mark was an example of this when he met with SFFD Chief of EMS Pete Howes for a kind of exit interview before leaving.  I hope I can meet that example with the following paragraphs, but each time I write it it comes off preachy, so here goes.

Sitting between the allocators I watched them constantly on the radio with numerous vehicles and cars in various states of service.  Each color on their screens meant something different, from enroute, on scene, RRC, vehicle, on post etc, but it was the clipboard they were passing back and forth that caused them the most frustration and, more than once, delayed allocation.

Not by a definitive amount, we’re talking 3-5 seconds, but it was the constant flipping of pages and radio traffic related to the one thing that I think the NEAS needs to change for the betterment of the system.

No more breaks.

I can hear the UK medics now “Hell no.”

Let me elaborate for my work straight through the shift American friends.

The NEAS, as a portion of their labor agreement, provides their crews with certain breaks depending on their daily activities.  When they have been on post for an hour away from station, they get rotated back to the station.  This was commonly referred to on the radio as “Return for a cuppa.”  The basic premise is simple enough, really.  People need clean bathrooms and a chance to eat since eating is not allowed in the cars or vehicles, nor are they allowed to sit down and eat in an establishment while on duty.  This was evident when Mark was nervous enjoying some Pho in San Francisco.

In the car and vehicle this didn’t seem to be a big deal, we’d get a message to return to base, or that we were clear for meal break.  The meal break can be interrupted, should the allocators need the resources, but they avoid it since the crew interrupted gets paid quite a bit for it and the allocators, although they wouldn’t elaborate, appear to be held accountable.

Sitting between the two allocators on the desk that morning, 50%-75% of their time was arranging rotation station breaks or ensuring crews got their meal breaks.  These variables also added more color codes to the dispatch screen.  This car is on dinner, this vehicle is on base rotation…etc, etc.

When a call came in they shot a quick look to the clipboard showing who gets a break when and dispatch decisions are based off of that.  I did not witness it make a difference in response times, since that information is streaming in real time on giant monitors overhead, but these folks are scrambling to keep everything running smoothly.

With my limited dispatch experience it seemed like a simple change, since on the days I was on rotation in Newcastle we never had a point in the day where we were unable to reach a bathroom or food.

My head was trying to process all the information these women were basing their allocations on and one of them turned to ask me, inbetween moving a car back to base “for a cuppa,” “How do your dispatchers handle your breaks?”

When I explained we (listen to me, like I’m still in a rig), THEY are gone for 10 hours, no breaks, they froze.

It was passing the clipboard back and forth that I saw the only 2 seconds they both held still: glaring at me.  It was clear I was not to repeat that statement for the rest of my time with them.

“That would make, ‘Go ahead 405′ this so much ‘thanks and to base if you please’ easier.”

Yeah, 2 conversations at once.  I have trouble typing and listening to music or TV at the same time.

Mark had some family business to attend to while I was meeting the voice on the other end of the radio and he returned just before dinner time to collect me.  It was an eye and ear opening experience to see the chaos that a simple concept like breaks caused the folks moving units around.

Something I completely neglected to mention over lunch with the executive team.

Told you I couldn’t screw that up.  My conversation with the folks hopefully getting Mark cardioversion and CPAP, and where to put your coffee when the table is literally covered in signs that say “DO NOT PUT CUPS ON TABLE, USE SAUCER” soon.

Yeah I did.

Chronicles of EMS Caption Contest

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All right all you twitter folk, I heard your call for the contest and I’m stepping up.

We’re having ourselves a little caption contest.

Mr Setla, my producer, and ninja trainer, over at the Chronicles of EMS posted some teaser photos of a brand new series in the works called Chronicles of EMS: A Seat at the Table.  This new web series is an exciting project we’re working on to open up the dialogue in our profession in a way that’s never been done before.

As a result, we’ve been testing and experimenting with topics, light and film and this photo is a screen shot of one of those tests.frumpydumples

So you’re wondering what I’m saying?  Let’s hear it.  Caption this photo.

CONTEST RULES

  • You can comment as many times as you like and offer as many entries as you like.
  • All entries must be here at the Happy Medic blog in the comments of this post.
  • I am the judge and will choose the one that makes me the happiest.
  • Entries must be made before 10 PM pacific time February 11th
  • The winning caption will be announced immediately after the premiere of the Chronicles of EMS pilot episode which airs at 5 PM Pacific on February 12th.
  • The winner will receive a Chronicles of EMS T-shirt to be supplied by me.
  • You MUST be present at the premiere or in the chat room during the premiere to claim your prize.
  • This contest is void where prohibited by law or llama, whichever comes first.
  • Foul language will not get you eliminated, but may be difficult to explain to your mother when the shirt arrives in the mail.
  • There is no cost to enter, but if you must, donate to the CoEMS cause.
  • The winner will also be invited to be a special guest on the new Chronicles of EMS:A Seat at the Table series in Northern California.  I’ll invite you, you just have to get here.

Shapes and Colors

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I often joke with folks outside the Profession that things need to be made “Firefighter Proof.”  This denotes the fact that my mother was right, I ended up with a job where they put my name on my shirt.  Another variation is that this job is all about shapes and colors.  Why else are the drugs in different color boxes, catheters as well, and we color code hydrants based on flow in some places?

But buried in all the jokes about how simple things need to be are some basic shapes and colors that are out in plain sight in the community that help us do our jobs better.

We visited a local cell phone company’s transfer station to train on a new system shutdown procedure.  it seems that if there is a fire in the server and transfer room, the system will handle it but there will be a need to shut down sections of the system, not the entire system.

Inside we saw reflective taping on the floor leading us to the breaker panel.  The tape said “FIRE DEPT SHUTOFF – THIS WAY —>” and it continued all the way to the panel.  At the panel, each switch had a colored reflective tape.  Each area served by that breaker was marked on the floor in front of it by the corresponding tape.  no more wondering which breaker to hit, just remember the color.

Loved it.

Shapes and colors really does work.

If you’re not really concerned about the switching station in your response area, let’s start with the simple ones found in elevators.

SOL_elevator Here is a shot I took at a local shopping mall.  Many places I go have these markings and few rescuers know what it means when a Star of Life is in the elevator well.  And why does this one have it but the one next to it does not?

Think you know?  Do you know?  Formulate your answer, then CLICK HERE to find out what makes this elevator so special.

star floor

Now that we’re in the elevator, we need to know how to get out at the ground level.  In the City, many buildings are on hills so they have more than one exit to street level.  In this elevator, which floor is the ground floor? This panel is pretty straight forward, being in a smaller building, CLICK HERE for a neat collection of photos of panels from around the world. Be glad we have a uniform building and elevator code. That star will get you out on the street level of the marked address. If the building is 123 Main street, that star will get you out on Main street.

All right, how about this reflective sticker on the electric meter at the street level?

What about the house next door with this sticker?

Find out from an article on FFN from Christopher J Naum.

Keep your eyes open out there.

HM

Hey, Box Jockeys!

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This hose monkey has some questions for you.  Please answer honestly, anonymously if you like, but some things have been bothering Happy as of late.

Question #1

Does your employer discourage you from being honest with your patients when it comes to transport decisions?

Question #2

Has your employer asked you to omit information on your reports that would prevent billing a patient a certain way?

Question #3

If a patient asked your opinion, you told the truth and they refused care, would you be in fear for your job?

Question #4

Does your service encourage starting an IV or EKG monitoring for BLS patients to upgrade the billing?

Question #5

Are you aware that the above situations could constitute fraud?

If you are trying to decide whether to do what is right by your patient or keep your job, email me.  Your employer, municipal or private, paid or volunteer, is wrong and we need help changing their practices.

If you are comfortable and supported by your service when being honest with your patients about their conditions and transport options, please list your service in the comments section, they deserve praise.

ems2point0

HM

On the Ambo in the UK

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chroniclesblog

Subtitle for this post: Can you reach that for me?

Coming off a superb time on the Rapid Response Car, nappy time aside, we’re on the vehicle today.  The vehicle is what you and I would call an ambulance, but since anything that can take people to the hospital is an ambulance, it needs to be narrowed down a bit.

The car is certified as an ambulance since it can take people.

The vehicle can, as that is the main purpose of it.

But hiding around town, and just out of camera range as we drove by were swarms of non emergency ambulances, almost buses in their capacity.  When asked their function, Mark and our ECSW Becky (more on her later) informed me they take folks to their appointments, get tests and from one facility to another.

Collecting my jaw from the floor I explained to them and reminded Mark how many times we activated 6 people to do just that.  Becky shot me a look from the driver’s seat of the vehicle and asked a great question I still can’t answer.

“Why not just give them a ride in a van or bus?  Why send the ambulance?’

Why indeed Becky, why indeed.

I could try to explain to her how, in America, people have become so expectant of lights and sirens whenever they want them that they’re willing to sue if they don’t get them.  Regardless of the condition, reason or outcome, folks will threaten a lawsuit and managers will blink and change protocol. Why inconvenience the few when we can just take them and inconvenience the many, right?

That was the start of my shift on the vehicle.  I’d love to tell you that life on a UK ambulance is so much different than in the US.  But when it finally gets to comparing apples to apples in these systems, having someone in the back is it.

Previous posts have covered my impressions of the ambulance layout and ways I think they can be improved to benefit patient care and provider comfort and safety.

Mark had difficulty accessing most of his equipment from the cabinets.  Everything he needed he got to, but not without ducking around the patient, around the family member, then leaning over.  The trash was also oddly placed, lying directly behind the family member so that to dispose of bloody mess you have to ask them to lean aside.

But that being said, with the current layout based on “safety” there is no other place to put these things.

Mark described to me the regulations in place to protect the persons traveling in the back of the vehicles and it makes perfect sense.  Until we have to actually do patient care.

After my description of the ambulances in a previous post I was contacted by an ambulance manufacturer who wishes to remain anonymous, I’ll call them Box inc.  Box inc wanted my thoughts on what makes the perfect ambulance and I told them I have yet to see it.  But, Box inc had some new ideas about making your ambulance more versatile when on post, more on that another day.  But Box inc will still take a van or pickup truck, rip off the back, slap on a place for a cot and make it flash, there really isn’t another option at this point.

But back to Newcastle and the McDonald’s parking lot.

Yes, we’ve found our way to the parking lot at the McDonald’s, on post if you can believe that, so I snuck in for a coffee.  It’s an addiction, I know.  We had a chance to talk on camera about Becky’s role in the NHS and what an ECSW is.  But as we talk about it, a few points to look for first.

I am sitting on the cot and Mark in the chair for family members.  The pass through to the cab behind him has a small door on the top that leads to the trash bin behind that seat he’s in.

The cabinets behind us and between as as we talk contain all of Mark’s equipment.  Just from the layout you can see how challenging it could be to access them with a poorly patient in the back.

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When I said that Becky was above an EMT, the comments section at youtube went insane.  What I meant was that she can give pain relief without medical direction.  She can do something I can’t do, mainly because I’m told I need more education and training to deliver pain gas to those in need.  Becky is proof I do not.  So when I said she is above an EMT, I was referring to her ability to medicate them in that manner.  An EMT can transport, Becky can not.  Apples and Oranges folks.

Our jobs on the vehicle were similar to what Mark and I saw on Medic 99 in the City, moving folks with this complaint over there and that complaint over here.

It was on the vehicle that we encountered the only person, out of dozens, who demanded transport.

As you all plainly know, my clients demand transport 90% of the time and need it 5% of the time.  Newcastle respects their Paramedic’s opinions, likely because they can get in and get seen outside the A&E in a reasonable amount of time compared to here in the US.

This person activated 999 to report an assault and we entered the house cautiously.  It was quite a bit reassuring knowing that the occupant was most likely not carrying a weapon that could mow us down from 40 feet away.  I’m no ninja but I’ll take a clipboard to a knife fight over a knife to a gun fight any day.

The local police were close on our heels, again, without firearms (hard to get used to) and the scene was more than secure.  Very secure the police confirmed, poking holes in our patient’s story.  Then there was the recounting and description of the event given and none of that matched what we were looking at.

Clearly there were behavioral issues in play and the decision was made to transport based on the inability to confirm normal mental status.  We’ve all been there and trying to communicate with eye movements and physical gestures must have appeared as though Becky and I were flirting.

My eyes said “Look at the door, the things piled in front of it, it opens inward, no one broke in there.”

Her eyes said “What?”

My body, arms crossed, said ‘Over there, look, the door!”

Her body, arms raised to the side and shoulders up said, “Huh?”

Mark’s eyes said “Stop it!”

Mark does not ring down, or pre-alert, the hospital himself, but relays it through his control center.  When I saw what the control center did the next day, I decided that was unnecessary.  If your service relays patient reports trough a third person you are introducing another player in the telephone game and just another chance for pertinent information to get lost.  I would love to be able to forward my report to that point to the hospital and they can move that information to a bed and await our arrival.

Oh, did I nod off?

Right now my service gives audio radio reports to whichever nurse lost the coin toss that day and has to answer the radio.  I tell them what I have and why, vitals and hang up.

Many Americans may shudder at the idea of waiting 2 hours for an ambulance but I met a woman who disagrees.

Mary, I’ll call her, fell down on a friday afternoon and injured her hip. Being of a stoic generation, she didn’t want to bother anyone with her trouble, so she hobbles through the weekend until her doctor’s office opened monday morning. She called the office and spoke to her doctor who advised her to go into the A&E to be evaluated since his office had no x-ray capabilities.

The doctor called the ambulance and the call was classified as an “urgent” meaning there was no life threat, but still a need for a transport. This call is then put in hold in the system with a maximum wait time and an ambulance is assigned as soon as the system has the available resources.

Mary met us at the front door and walked us in with a slight limp, dressed and ready for her trip to the A&E like many of my lights and sirens patients. We took our time making sure her medications were gathered and the stove turned off, then into the chair and down to the ambulance.

Because this trip was arranged her medical records were waiting at the hospital, as was a bed reserved for her and she was seen as soon as she arrived. I asked her if the 2 hour wait was too long and she looked at me as if I asked her what color the sky was.

“I waited all weekend to call, another few hours wasn’t going to kill me, son.”

I wanted to hug Mary right then and there.

After a day of back and forths on the vehicle and torturing Becky with the American and the camera duties, we were close to finishing our shift when that dreaded job came in.

The late job.

We were planning on meeting some of the rank and file for a social evening and this job would put us over our shift and we’d be late.

We screamed through the streets of Newcastle, pushing old women off the road and opposing traffic wherever we could.  OK, not really, we were sent on a common case that would later bring out our common response “Same patient, different country.”

With the patient on board and her friend safely secured we made our way through the evening traffic to St Farthest, all the while talking and keeping our patient in good spirits.

The day went fast in retrospect.  Traffic still doesn’t get out of the way when you’re rolling lights and sirens, you still have to go hunting for the extra blanket at the hospital and the nursing staff is still often glad to see you when it counts.

The evening was a night out with some of Mark and Sandra’s co-workers, we were fashionably late after some creative dropping off and ride sharing.  I got to talk to them about Mark without him listening and their opinions were high and genuine.  Mark is a respected and admired Team Leader in his station and his system.

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Get it out now

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I have decided too many in this field use the phrase

“You call, we haul, that’s all.”

So I have declared that today, January 22, 2010 is the last day we are allowed to say that, unless you have a side job in the refuse industry or possibly driving a tow truck.

Your new slogan is

“You hurt, we flirt. You lyin’, someone might be dyin’.”

It is not against the law, nor outside of your responsibilities to inform persons when their injuries or illnesses are untreatable by you and your staff.  Nor is it against the law or outside your responsibilities to tell the truth when they ask if they should have called you.

I have been known to remind clients that a baby could be choking nearby but they will die because their paramedic resource is here putting your swollen wrist in a towel from your kitchen and frozen vegetables from your freezer while all your college buddies watch from the couch.

“I didn’t know what to do so I called you guys, is that wrong?”

“Yes.”  Odd look.  “An emergency and an injury are two remarkably different things.  Sometimes they overlap, but not as much as you might think.  Your ambulance will be here shortly, they’re coming from far away, busy night tonight.”

“A lot of sick people huh?”

“No.”

“Do you think I need an ambulance?”

“No.”

“What should I do?”

“Goto a doctor.  But as you can see I’ve taken the pain away and reduced the swelling in your wrist using common household items.  I learned this in the cub scouts.  This is as much pre-hospital care as we can give, so from this point on everything is else is just a ride. A very expensive ride.”

“Can my friends take me instead?  I mean I thought you guys could get me in quicker.”

“Sure your friends can take you, let me help you to the car.  Sign this release form first and assume liability for the bill.”

“What bill?’

“The bill from us coming here to help you.  As much as your politicians would like you not to know, this tax payer funded service is not fully funded to the point we can provide service for everyone calling 911, so we bill for our service.”

“Oh.”

OMG happy, what are you doing?  If he’s insured that’s an easy ALS billing transport, we need that money!

No, I just freed up one of your precious ambulances to run an actual emergency call and performed vital public education, something our profession fears among all other things.

A well informed and healthy populace generates few billable transports.

Stop lying to your patients by telling them they should always call you when they stub their toe or that there is no fee when there is one.  Lying to them IS against the law and outside your responsibilities.  Telling the truth and refusing transport are two completely different things.

Telling the truth can never get you in trouble.

Carry on.

What do you know?

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blog medicWell, Ma’am, a great deal more than you.  Especially when it comes to emergency response protocols, anatomy and physiology, the effects of alcohol on the clotting factor of blood and what my job is.

THE EMERGENCY

A woman in a wheel chair has rolled herself into a hotel lobby, bleeding from the nose, asking for an ambulance.

THE ACTION

The engine has advised us to slow to a code 2 response and we are happy to do so.  As we arrive on scene I see the engine crew on the sidewalk having an animated discussion with a very alert and oriented woman with cotton balls stuffed up her nose.

As the door to the ambulance opens I now have the audio to match the pointing and head shaking.

Engine Medic: “Have you called your doctor, any doctor, about your nose bleed?”

Hell on Wheels (Could have been Helen, I can’t recall): “I’m not saying anything to you.  You are not a doctor.”

HM: “He sure isn’t.  Anything remarkable?” Is my question and the head shake my answer.

HM: “Then thank you Sir, we can take it from here.”

I introduce myself to our client and ask her to define a chief complaint.  Most times the person who called us has a singular issue they wish our assistance with.  My dad can’t breathe, for example, or I cut off my foot.  But this client goes into a laundry list of complaints ranging from before I was alive finally ending with what got us involved today.

“My nose is bleedin’.”

And it was.  At least it had been.  Hard to tell with her constantly moving around telling me to get her to St Farthest before she dies from it.

HM: “How long has it been like this?’

HOW: “Since 1 AM, I haven’t slept! Why all the stupid questions, let’s just go.”

A quick glance at the time, 6 PM.

HM: “Have you made any attempt to seek an evaluation without calling 911?  A clinic or an urgent care?”

HOW: “Honey I just got here and don’t have time for all your 20 questions.  I need a doctor, I need my pills.”

As my partner is confirming the vitals we got from the engine, I begin my social worker intake interview.

HM: “You mean you need a pharmacy.  The doctors don’t dispense medicine, they write prescriptions.  Is your prescription empty?”

She shoots me a look I get often wen I bring reality into these conversations.  The head snaps around on the thick neck to me while leaning back slightly, eyes wide and a look of anger around the mouth.  Then it comes out.

HOW: “What do you know?  The paramedics where I’m from never disrespect me like this.”

HM: “What do you mean disrespect you?  I’m trying to establish if an ambulance ride to the hospital is the best option for you right now.”

I feel my tired arms leaning onto my knees as I stand bent over trying to stay in her line of sight as she realizes I’m not the pushover medics she left behind in whatever town she sailed in from.  A quick stretch and I ask her the magic question.

HM: “Do you want to do the right thing or would you like an ambulance ride to the hospital?”

HOW: “Do your job and take me to the hospital.  But somewhere where I can get seen fast, and get something to eat.”

My hands are back on my knees and I’m as in her face as I can be without losing my cheerful disposition.

HM: “Are you looking for a ride to food?  Because if you are we actually have that resource here.  You’ll have to wait a little while, but I can get you a free ride to a shelter and a warm meal.”

HOW: “I don’t have time for that, I need my pills now.  I have chest pain.”

Had I been a TV detective, this is the part where I bang on the interview table and go into a well prepared speech about the abuses of 911 and how the best thing she can do for everyone is go back where she came from.  Where she came from easily has a lower cost of living, but that has not entered into her equation.

But I am not a TV detective so she steered the power wheel chair over to the ambulance and told us how she has so many leg problems she is on disability.  Then she stands, climbs in the ambulance and sits on the cot with a familiarity some folks on the job don’t show.

We sigh.

HM: “Chest pain you say?”

HOW Now with arms and legs crossed: “Yup, let’s go.”

HM: “That means an IV, and I’m not all that good at them.”

HOW: “Oh no you don’t, you ain’t touchin’ me with no needles.” Her head is shaking almost to a point I think she’s going to hit it on the cabinet doors and then need an ambulance.

HM: “Yup, let’s go.”

On our short trip to St Closest she wanted to discuss the finer points of how I don’t know what I’m talking about and only Doctors understand what she is going through.  My lips were sealed, only asking my billing and pertinent negative questions and completing my report.  She refused a line, a trace and everything else except another BP.

When we made it inside she commented that the ER had an odd odor to it and she wanted to know the name of the hospital.

HM: “St Closest, why?”

HOW: “Tomorrow they’ll take me somewhere better.”

Report finished I left, smile on my face, almost wanting to work the next day just to see if she does it.

That’s twice

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blog engineI’m walking through a busy shopping center looking for someone, not sure who, and it’s stressing me out.  Panic, confusion, anticipation.  Then a loud tone strikes me from my sleep, the shopping center nothing but a dream.  The lights are bright in the dorm of the firehouse, the time is just before 2 AM and the tones finish just as I sit up to the corner of the bed awaiting the inevitable magic voice telling me where the sick people are.

“Units standby for the box!” the voice says with a tone of excitement.

A fire.

The dorm springs to life, sleepy firemen now scrambling into their turnouts and heading for the pole hole as the dispatcher rattles off the companies due.  Downstairs we dress, the doors are coming up and the rainy night awaits our response.  The dispatcher finishes reading the first alarm assignment by telling us this is a report of smoke in a building and we take that very seriously.

The engine beats the truck out the door, as we should, but not by much and I can see them following from my rear facing jump seat.  The green light on the front gives away they are a truck company, letting our driver know to let them take the block ahead of us if we’re second due.  The MDT tells me that we are first due and by the address, we’re less than 3 blocks away.  I might just be ready by the time we get there.

Hands still tingling from waking suddenly we are on scene to the large apartment building with nothing showing but an audible alarm sounding and young people milling about in the lobby.

My walk around the engine to my airpack gives me a chance to size up the building.  If we’re going above the ground floor, we’ll need a bundle to extend a pre-connect.  The first door on the first floor (first above the garage level) has a smoke detector alarm sounding and an odor of burnt food.  Deadbolt secured, we’ll need to force the door, damaging it completely, to make entry to investigate.

The truck is laddering the fire escape when they see a haze through the window of the unit in question and the decision is quickly made to enter through the window.

From our position in the hallway outside the door, the haligan tool is just being placed in the door jamb when we hear the truck make entry through the window.  The old thick windows break loudly and we now hear our brother pushing the mini blinds aside.  Boots thunder to the floor and footsteps get louder as the lock on the door clicks and the smoke wafts out as he opens the door.

“I gave at the office,” he says as I grab the pump can and go in search of the source of the smoke.  As we converge in the kitchen we hear shouting from the back room.  Shouting about waking up.  Shouting only from our people.  Being the Paramedic, I peel away from the burning pizza making all the smoke and meet the truck in the back room with a man curled up on the couch, completely passed out asleep.

They’re shaking his feet, being polite as can be in an effort to let him know we’re there and his apartment is filled with smoke.  It’s amazing that the breaking window didn’t wake him.  The tillerman and I exchange a look and the politeness is gone as he shakes the man’s shoulders shouting “Wake up! Fire! Fire! Wake up!”

Nothing.

Down in his face. “WAKE UP!”

“Whoa! What?” He sits up defensive, most of the first alarm compliment standing in his living room.  Escorted to the hallway, he is still confused about what is happening and I make my way back to the kitchen to help remove the source of the smoke.  The pick end of the haligan has a number of uses, one of them being removing small pizzas from ovens, so out it comes onto a baking tray and it is carried outside into the rain.

Back upstairs one of the firemen from another company looked around, saw the man we awoke and cried out,

“Let me guess, pizza in the oven?”  He went to the man and held up two fingers, “That’s twice!”

Dose That Kid! Results

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Some of you may have known the age of the child in this post from experience, others may have had no clue.

In the comments there was a wide range of values, and it is indeed difficult to guess the weight of a child if you aren’t with them.  But the point of the post was to get us thinking about why we base our peds doses on weight and how we arrive at that weight.  There were comments about carrying a backup broselow tape (I spelled it right this time), but is that really the answer?

I understand the usefulness of a field guide and having a broselow tape in my peds bag is one of the first things I look for in that kit.

But I am also confident in knowing that if it is lost, stolen, damaged or suddenly switched for a BeeGees Best of Compilation that I can take a deep breath and do my job without it.

I am not better than anyone else because I feel comfortable with peds calls.  I can’t handle dislocated fingers.  That’s my Achilles heel, or finger, if you prefer.

Again, the goal of this You Make the Call game was to get you to remember what you are trained to do when all the fancy tools, bells and whistles are gone.  Anyone claiming “BLS before ALS” needs to start with the simple deduction of size, age and weight of the patient.

We do it for Dopamine on adults, but don’t carry large cheat sheets to lay next to them.  Why do we rely on one for kids?


The young lady in the photo was 4 weeks old and weighed 9 pounds.

If you were way off, no big deal, keep that tape handy.  But next time you have a peds patient ASK the parents how much they weigh and remember it for reference.  We also learned a quick reference rhyme in P school, hopefully you did too.  It’s the 1-5-10, 10-20-30 ratio.  Meaning a 1 year old should weigh in around 10 kilos.  A 5 year old at 20, and a 10 year old at 30.  These are guidelines to establish if a suspected weight is within reason.  Don’t grab a one year old and start dosing at 10 kilos without a proper assessment.  Also keep in mind that a child’s diet, heredity and, believe it or not, race could be a factor as well.

A wonderfully designed system being adopted by hospitals can be found here, along with photos of children to represent their sizes and color coded dosages of medications.  But keep in mind your concentrations of those medications may be different and if you don’t know what the value should be, there is no way the guide can help you.

Take a few minutes to wander the Color Coding Kids site, a lot of common sense stuff there.

See you next week when our patients get bigger.  Much bigger.

Halfway Done in Newcastle

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chroniclesblogThe morning of Day 4 started much like the first morning, with me confused and disoriented up on the fifth floor looking at an alarm clock that said 5:15 AM and a body that said “No.”  I was dragging and the project induced exhaustion was starting to wear through.  Downstairs in the lobby waiting for Mark to pick me up, I sipped my coffee and wondered if I would make it all the way through the day.  When at work and I feel this tired, I can just zone out in a corner after chores and I feel better.

Being a guest and having to be on top of my game meant today was going to be rough.  And rough is just how I came across according to Mark.

At the Fire and Ambulance station I made another cup of coffee and settled into a green chair.  Mark would later tell me I looked Knackered.  If that meant anything like destroyed, he was right.  I was tired.

About an hour later, out on post, Mark must have seen me nod off in the back seat.  It was still dark, the light rain misting around the car, the bright green hills and warm brown houses passing by outside the tinted windows…zzz…roundabout…zzz…

It was embarrassing to say the least.  9000 miles from home and I fall asleep.  Mark steered the car back to my hotel in between postings and dropped me off for a proper nap.  We agreed on a time to collect me and I melted into that bed for a power nap unlike any I had had before.

And while I slept Mark did what I wanted to see him do – Refuse transport to someone who didn’t need it.  One of the 2 benefits to the front loaded model and I missed it.  My foot still makes contact with my back side for that.

Mark arrived at the hotel to collect a refreshed and appreciative American and we finished the shift with a few calls I have mentioned already.  This afternoon showed the flexibility of the RRC  and we transported more than 1 person in the car.  As I think back about that experience from here in the future, I get frustrated.  We just this morning were activated for a difficulty breathing that turned out to be someone looking for a ride across town.  6 people responded lights and sirens at 7 in the morning for that and the patient knew we could not tell them “No.”  They described all the insurance plans they were a part of and refused to understand just how badly they were abusing an emergency service, let alone the lives they put at risk by flat out deceiving the dispatchers.

From what I have seen to this point from Mark and the NEAS, Mark could stand down the ambulance and either re-direct the person to an appropriate clinic or GP, or, if he still insists or has something else bothering him, Mark can put him in the car.  1 man and a station wagon saving the day for an overloaded system.  In the end, Mark isn’t coming in that car, nor is he going to cancel me when it is realized this complaint is not worthy of a lights and sirens response.

At the end of our car shift I was a bit bummed it was over.  We still had a day on the vehicle ambulance coming up and I was indeed looking forward to that, but I’ve done ambulance work, I wanted more RRC time.  I wanted to jump in the car and drive it home to show my system that we don’t need a $50,000 4 wheel drive SUV to deliver care.  But alas, the wheel is on the wrong side and there is a touch of water between there and home.

As we pulled away from the station and back to the house I thanked Mark for letting me rest that morning and I apologized for my lack of professionalism.  He smiled and said something about he really wanted to go with me, but was able to rest on his rotations back to the station.  No nap, but a chance to sit still and recover.

The evening activities were to include a nice dinner in a town called Heddon-on-the-Wall at a wonderful restaurant called the Swan.  In attendance were some of the NEAS executives and my chance to ask about where the service has been and where they are going.  In between questions about response times and clinical interventions we enjoyed a wonderful evening meal.

Peter Stoddart, Operations Manager and the arranger of most of my experiences in Newcastle, was in attendance as was his lovely wife.  We spoke at length about event EMS at the Sunderland match the day before and I had to bend his ear about disaster and event related topics later as well.  What can I say, I’m a systems and resource allocation nerd.

Paul Liversidge, one of the executive team from the NEAS, was also there to talk to me and I took advantage.  I made sure to sit next to him and over a few drinks we got to talking about the future of the NEAS and the possible new role of the Fire and Rescue Services (Fire Brigade) in providing EMS.  He was curious to hear of the troubles many American services experienced, are experiencing, and will soon experience.  Only there it will be a blue shirt green shirt battle, instead of a blue shirt white shirt battle like in the states.

Mr Stoddart’s Left hand man, a lovely woman named Fiona in this case, was back with us after a wonderful night the night before and she is always all smiles.

Mark and Sandra somehow muscled their way into the arrangement, Mark trying to get a word in edgewise whenever I took a breath or a bite and Sandra was constantly checking to see if I was wearing white socks again.  And, not surprisingly, she is happy and in the only one in focus in this photo taken by Mark.

This must have been how Mark felt when we were treated to a wonderful dinner and frank conversation with SFFD EMS Section Chief Seb Wong.  He and Mark talked about ideas the SFFD had for the near future and Chief Wong listened.  It was amazing to see the way he trusted Mark’s opinions and suggestions.  I can only hope I made a similar impression on the NEAS team.  After all, in 2 days time I was to meet with the ENTIRE administrative staff to tell them about San Francisco and the fire based model.

And I couldn’t screw that up if I tried right?  Right?

And don’t worry fire buffs, that kick ass training center is coming up, here’s a photo to wet your whistle.

And those are just the appliances assigned to the training yard.  The first row.  Of the first yard.

Are you for Coco?

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Tell the chin he had his chance. He screwed it up and now he wants his old house back? I don’t think so Jay. Stay at 10 or retire.

NBC, I have a show in mind that could replace Jay at 10 and be of interest to millions of viewers you lost to the other networks.

My name is Justin Schorr and I’m with Coco.

Pass the candle.

the Angry Captain, Film Maker

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The popularity of the Fireman Mike video I linked to has spawned quite the collection of tributes.  Through that link I have found dozens of hospital and firefighter related videos that have me rolling.

Then I get a message from the Angry Captain to check my facebook page for an update.  I found this.

I can’t wait until retirement.
And I can’t wait until I can dance like that cartoon.

Posted with permission of the Blog Master of the Universe and is all in good fun.

Talk about Tactical Pants and they talk about you

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Those multi-pocket pants loving folks over at Tactical Pants have featured your favorite cartoon fireman (No not Fireman Mike, me silly) in a very well researched Q&A session.  And they finally reveal why cartoon Happy has such a prominent probiscus.

I enjoyed answering questions about my pants, as most guys do, but also about the Chronicles of EMS, my time on the Reservation and even a bit about how I got the name the Happy Medic.

And make sure you’re a follower of all things tactical on their blog, I have a feeling some of my favorite bloggers have also answered similar questions and I’m curious to learn what kind of pants RogueMedic and TOTWTYTR wear.  Wait, that came out wrong.

Wearing my wool 5 pockets,

HM

You Make the Call – Dose That Kid!

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Welcome back to every Paramedic’s worst nightmare-

DOSE THAT KID!

The wildly entertaining game show that makes you actually learn what kids weigh by looking at them without being given their specs on a written exam.

So there can be no cheating, despite your best efforts to find someone who knows the age/history of the child, none can be found.  Your Braslow tape was left on the bed in the ER last night.  Also, for you out there in the know, all of the clothing tags have been removed, so no excuses.  Now let’s play DOSE THAT KID!

elizaOur first contestant has been found in a child care center in a woman’s garage.  They state the girl is new to the group and they have no information on her whatsoever.  She was having a bottle when she choked,turned blue and is now unconscious, unresponsive and in vfib.  Your partner is managing the airway and has IV access. DOSE THAT KID!

Chronicles of EMS Episode leaked!

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Despite his best efforts, Producer/Director/Paramedic/Nice Guy Ted Setla was not minding the store when our friend Ms Paramedic hacked his iphone and downloaded the pilot episode of the Chronicles of EMS.

I don’t know how long I can keep this up before he knows it’s gone and demands I take it down.

But you all deserve to see the show before the big premiere next month on the 12th.

Sorry, Ted, I had to.  Here you go:

And for those who love Fireman Mike, no I did not make him, only embedded his video.  You can watch more of Fireman Mike HERE and leave comments for the creator.

These little movies are getting popular.  I tried making one and apparently have no knack for it.  Thanks for the laughs MsP.  See you at the real premiere on February 12th.

Questions in Haiti

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We’re all following the updates from the 7.0 earthquake that struck Haiti just 48 hours ago.  Our brothers and sisters have been mobilized to assist and there is a pouring out of support in the form of food drives and monetary donations all over the internets.  Before I get into my points to think about, please remember to donate to established organizations.  The American Red Cross is just such an organization that can use the money well, as opposed to your local corner Girl Scout Troop who may have to pay to have things sent over, and even then it may not arrive in time.

In time for what Happy?  Oh I think you know.

Our brothers and sisters mobilized for the search and rescue effort are facing a task they may not be ready for.  They are trained professionals in search, rescue, recovery, everything first response, but there is, by all accounts so far, no framework to support their efforts.  I don’t just mean a place to land, restock and camp, I’m talking about basic disaster concerns.  These folks can get in and get setup, do their thing like no other.

Let’s think this through for a moment.  Estimates show 9 million people in Haiti and at least 1/3 of the country may be injured.  3 million injuries.  From scratches and scrapes to fractures to crush syndrome and major systems trauma.  Many may not survive the night because of their injuries, but let’s look past that.

When the USAR teams use their tech, tools and smarts to rescue the injured, where will they go?  Who will come to transport them to the hospital?  Where are the hospitals?  In rubble.  Each and every resource that can assist in this event will need to be brought in from without.  How long will it take to set up triage and treatment centers to help the ambulatory?  Then the injured but invalid? And finally to the traumatic injuries.  The hospital does not just need electricity, or staff, or supplies, they need everything, including walls.

On all 4 networks I have seen different footage, all of one ambulance traveling the rubble strewn roads.

The honest answer is that definitive care for most of those injured will not arrive within 72 hours of their injury.

Do we remember what happens to internal injuries that go untreated?
I had an image of three survivors still trapped in the rubble set for this post, but have deleted it.  You can see it here, it’s photo number 2.  When these folks are rescued…then what?

What is the plan for when the almost 100,000 estimated dead are still in the streets in 96 hours?  Will they have an adverse effect on what little sanitation remains, what little clean water there may be?  What will happen to those sleeping in the open near the bodies?

I do not  envy the person who must choose how to deploy resources, but it makes me think about my own City when, not if, but when our big one hits.  We will have plans, resources from afar.  We have volunteers trained to help, we have disaster supplies ready to go.  We have folks with phones that can make calls without cell towers, buildings that can generate electricity when the sun shines.

Those things are not common in Haiti.  Cell phones, the ones that still have a signal, will have dead batteries soon.  Gasoline for generators will be running low.  People will become desperate for help.

What do we do then?

I don’t have an answer, nor am I posing these questions in a political framework, just trying to get us all thinking ahead.

If it looks bad now, just be ready for when decomp begins and things get worse.  And each person rescued is another that will need advanced care, food, water, medicine.  Each reporter that arrives needs water, food and shelter that could be used at a temporary hospital.

I challenge each and every news network to pull your crew out of the disaster area and donate what you would have used on your people to the relief effort.

If anyone has a link to updates directly from teams at the site, let me know.

HM

Breaking News

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Mark McGuire did steroids.  Also new tonight, the earth is round.  But for more about what is really on our minds, here is your Anchorman Fireman Mike:

YouTube Preview Image

I’m not sure what’s worse, that everything he said is true or that we would all get fired if we said it on camera.  Fireman Mike has a youtube channel and I’ll be watching for updates.  And now back to your regularly scheduled blog.

Check for updates about the premiere of the pilot episode of Chronicles of EMS, the new reality EMS series HERE.chroniclesblog

Small fire, small water. Big fire…

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Well, did you finish the statement?

Did you finish it the same way most do? “Big fire big water”?

Is that really the right answer?

I think it is the wrong answer.

Pumping high volumes of water into the 7th floor office complex isn’t going to help us if we haven’t trained with the tools used to knock that fire down. Yes having larger amounts of water on the fire floor will help us, but we must remember the layout of our commercial sites. They are commonly open with organized furnishings, and heavy on false walls and highly flammable file cabinets, records etc.

Training needs to include coordinating multiple lines, finding the seat of the fire, and knocking it down. Sounds simple and straight forward, but when all you hear is, big fire, big water, then train residential and not commercial, things can get tricky.  But even in a multi-residential situation, we need to get our water to the fire, otherwise it will ricochet off the ceiling, fall to the floor and run into the street.  All that big water right down the drain and the fire is still burning.

I prefer to say “Big fire, SMART water.”

Get in there with the large line but use it appropriately. Get your fog nozzle off and gain the distance from a smooth bore nozzle. That will give you a chance to get closer to the seat of the fire, find it and effect a knockdown to facilitate a search.  Defensive fires are no different.  Shooting a line from the street and aiming for the ridge line will direct all that water up and over the fire, not into it.  If you don’t have fire to hit, why are you training a line there?  Use that water to your advantage.  Collapse an issue?  Then get the lines up and out of the collapse zone with aerial pipes and platforms but don’t just “surround and drown.”  Aim for areas of heavy fire.  You won’t be “pushing it” somewhere else, it’s already going there, knock down the bulk of it’s heat and support and it will slow it’s advance.

When it is commercial and you’re trying your best to get as many large lines as you can into the office building, what are we doing?  Each of those lines needs 2 persons on the nozzle, an officer and then a member at each corner feeding line.  That exceeds even the best staffing models I’ve seen.  Take that first line and make a difference with it.  Keep it dry until you absolutely need water, then your layout person and other companies can help you stretch as you go.  Charge that 2 1/2″ line with 2 people at the door and all it will be good for is holding the front door open.You’ll need help getting it where it needs to be, but once there and trained on the seat of the fire, conditions will improve and smaller lines can chase the fire back as you advance, knocking down a lot of fire.  All because of SMART application of water.

Think I’m wrong?  Know I’m wrong?  Show me.

These are my observations and do not reflect the standards and practices of my employer.  Nor is the Department in the image used being singled out, nor were they the inspiration for this post, just a nice shot of an outside defensive line and an officer who appears to REALLY love that tree.

A Tip of the Helmet – Cleveland says “No”

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Social Media in EMS - A Tip of the HelmetIt was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:

“This is a huge step for Cleveland,” EMS Commissioner Ed Eckart said. “This is a step back from a long-standing culture in this city.”

And indeed a long standing culture in America on whole.  I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.

Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.

As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that “maybe” call, the actual crushing chest pain that IS an MI is waiting longer for a transport.  We need to stop worrying about what might be and focus on what is.

The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers.  We call it triage.  No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center?  If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.

For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything.  Cleveland says no more.  Cleveland.  No offense to the system there, I’m learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3.  Until now.

A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing.  I hope to learn more about their research and system savings in the near future.  I will most certainly pass that along if I can get it.  Do you have a question you’d like me to ask the Commissioner?  Post it below and I’ll ask him.

The Car, The Wall and The Game – Day 3

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chroniclesblogThe alarm seemed to be timed better this morning and I was bright eyed and bushy tailed for my second day on Mark Glencorse’s Rapid response Car in Newcastle.  The coffee was ready when I got out of the shower and I watched a bit of news while getting ready.  When I was in England a frightening wave of flooding was literally washing away parts of the western side of the country and numerous Fire and Rescue resources had been mobilized.   It was a topic of conversation in passing throughout the morning with the Vehicle (ambulance) crews we saw and hospital staff we talked to.

The check out on the car was much quicker since my first day orientation and away we went to our first post.  On the way Mark asked if I was hungry and I had to remind him I don’t often eat breakfast.  In the back of my mind was another McDonald’s run but in the front of Mark’s was taking my for a proper Geordie breakfast.  The term Geordie refers to the people or speech from the Tyneside region of England, which is where Mark is from and where we were.  Similar to referring to someone as a Lonestar or Southerner here in the US, a dialect of speech and set of stereotypes is set into your mind.

The car weaved through the light morning traffic to a take away trailer in a light industrial park.  The aroma from this man’s trailer was like heaven.  The odor of bacon, along with other smells, changed my long standing no breakfast clause and my mouth was watering.

As with many of our other adventures this day, Mark in the car had folks wondering where the emergency was.  No one thought he was the Police coming to get him…until they saw me in my navy blue.  When Mark ordered my meal and the fellows standing nearby read the back of my jacket, which said “Firefighter/Paramedic SFFD” they were curious to ask all the questions we’ve been asking each other for months.

“Is it true you have to pay to go to the Doctor?” “yes.”

“If you can’t pay do they send you away?” “No, you get a bill later.”

“What about an ambulance? Is it true you’ll leave me to die if I can’t pay?” “No, we’ll help you out no matter.”

It was a great conversation with locals about their neighborhood and town.  Keep in mind this town has been here more or less FOREVER.  It’s not like some guy wandered through 200 years ago and started a farm.  There are castles and churches still standing despite centuries of wars.

It was in the middle of a talk about a nearby castle that my breakfast was ready.  Mark’s smile widened as he handed me what can only be described as heaven with a side of LAD.

Bun, mushrooms, brown sauce, black pudding, eggs, sausage, bacon and it was glorious!  Along with a true cup of coffee and some good conversation it was a wonderful way to start the morning.

But like so many things on this job, wouldn’t you know it a motor vehicle accident has been reported just a few blocks away.  Chomp, gulp, a thanks and away we go to the 2 car accident.  There was an initial need for extrication so Mark called in the Brigade.

The ambulance arrived quickly, as did the brigade and everyone went to work doing their pre-determined roles.  It was refreshing to see firefighters not distracted by assisting with patient care, but simply having a task and seeing to it that it was done.  This scene was more what I was used to.  Ambulance, fire engines, police, a proper job.  Although the injuries minor and the damage to match, the resources in the community worked seamlessly together to get the job done.  After the patient was transported I had a quick talk with the firefighters about their roles and responsibilities on this assignment, since there was not the usual bickering or fighting for the glory of the jaws that I have seen all throughout my career.  The firefighter assigned to cribbing was working just as carefully and quickly as the two sets, yes I said two sets, of hydrolics that were being prepared.  We discussed my role as dual trained and they gave a polite smile.  I think just below that was two distinct thoughts.  First, “That’ll never happen here” and the competing, “Oh God, what if they do that here?”

My photographer for the day obliged for a photo of the brigade that responded drawing my caption, “One of these fireman is not like the other…”

After a couple more jobs we were released from our roll area and directed north to the Arsenal/Sunderland football match.  The trip started as a chance to show a lifelong soccer fan a proper football match in his adopted country, but it would turn out to be an EMS learning experience.

But first, Mark had something special planned for me.  We grabbed our sack dinner, lovingly prepared by Mrs999, and hit the road to see the proper section of the old Roman Wall I was so interested in.  The drive through the countryside was amazing.  Rolling green hills hiding in the fog, unchanged since ancient times, save for the occasional 200 year old farmhouse with it’s trailing smoke from the chimney proving someone still inside.  The park rangers (or the UK equivalent) came out of their warm office to meet us when the RRC pulled up and we got out.  They wondered if a hiker had been hurt on the wall, why else would the ambulance be there on a foggy, rainy afternoon?

After a climb and a brief hike I was able to take some video and one of my favorite pictures from this adventure.  smallerThen I got to do what my Grandmother never did, stand on Hadrian’s Wall, where her hero Arthur may once have stood.  There was a connection with that place I can’t really describe.  I have the book she was reading when she died, Stories of King Arthur, a book she received as a child from her grandmother and I display it proudly in my living room, bookmark still in place and soon a photo of this part of the wall will accompany it.

It was an experience I hope to share with my young girls when they are old enough to appreciate what the wall means to the family.  Folks have been known to walk the whole length, camping as they go, and I plan to do the same in good time.

And now for something completely different.  If you’ve made it this far, I thank you.  Like Mark has said, so much happened on this trip, so many interesting and exciting things we shared with each other and with all of you, these day by day accounts are long winded.  If you skipped this far to read about Event EMS you are truly a Fire and EMS nerd and I salute you for that.

The Sunderland stadium can hold, at capacity for a football match, 45,000 impassioned fans.  The perception of many of you in the US may be “Soccer Hooligan” and the stereotpye is fitting in many cases when it comes to premier league football.  I was treated to not only the game, but a tour of the medical facilities made available for players and fans alike.

The stadium has an impressive command center encompassing the EMS team co-ordinator, Fire safety specialist, CCTV team and the police commander, all in two large rooms.  From this unified command center a response can be co-ordinated and a plan followed by radio.  The CCTV cameras also allow the leader to call in extra security if it appears an EMS fly team has unrest around them.  Help can be on the way before they even notice what is happening.  There were 4 teams on staff, dispersed around the stadium with assigned seats and radios, ready to respond as well as 2 pitch or field teams ready to respond to an injured player or person on the ground level.

Behind the scenes are two levels of care.  The teams have physicians on staff to deal with injuries to their people and outside the stadium, tucked in with the snacks and beverages are a number of doors marked First Aid.  Behind these doors are the service I know little about from my travels there, St John Ambulance.  (Not St John’S ambulance, St John.  I learned that one real quick.)  In these almost clinic areas are basic care givers, EMT’s, Paramedics, RNs and an entire medical community, all volunteering to help out.  While Mark and I sought refuge there to eat our dinner before the game, a woman came in, was assessed, treated, medicated and released, all in the span of 10 minutes, all by the St John staff.  It all happened before I could finish my Dr Pepper.

Upstairs in the control center I had a chance to peek at the emergency response plan and these guys have it all figured out.  I learned later that a number of previous events led to a mandate that each stadium have an action plan and the resources in place to react to those emergencies.  We also talked about rotating the teams if more than 1 fly team was mobilized, the extent of the St John involvement, their ability to staff a team and a number of other things most laymen would have fallen asleep thinking about.

The match was brilliant.  We stood just outside the command center, which was near the visitor’s seats.  Arsenal fans are passionate fans.  When I applauded a good play, which is common in this sport, Mark grabbed my hands just as one of the visiting supporters turned to see who was clapping.  Just what I need 4,000 pissed off drunk football fans chasing the American who clapped because the home team goal keeper made a nice save.  Tragedy averted.  And good too, because we were heading out on the town later.

We’re meeting Mrs999 and Fiona for a night on the local scene to give me an idea what Geordies do when the sun goes down.  Well, a while after the sun goes down.  OK, late at night.  I was treated to some local color and had a chance to talk to Mrs999 and Fiona about the person I was shadowing this week.  We talked, danced, twittered and had a wonderful time.  Mark loved his new iphone, since the old one died in San Francisco and at one point he fell asleep updating all the Chronicles of EMS followers.  OK, not really, but it made for a fun twitter update.

As the evening continued on the famous Millennium bridge over the river Tyne, I had a chance to reflect on where I was and why.  It was a big deal to be where I was, with Mark and the NEAS, learning how to deliver care in the front loaded model.  We should have called it a night there, but we had one more stop.

Bachelor and bachelorette parties in Geordie country take themed dressing to the extreme.  In Las Vegas, the girls may dress in pink shirts with the bride to be in some kind of white head dress and veil, letting all the single guys know exactly what she is celebrating.  But here, the entire group dressed to match.  There was a group of guys dressed as 20’s gangsters, pinstriped suits and fedoras.  Why? Stag party.  Groups of girls wearing matching tight shirts all wishing their engaged friend luck in cleverly worded phrases on the front. Why? Bachelorette party.  In came a group of girls wearing black and their names on he back of their shirts.  One of them we know.  Steph Frolin is the name my co-workers use to alert me to a scene that is not what it seems.  Imagine we are investigating a person who says they just came in from a terrible car crash.  As I’m assessing them my partner discovers witnesses in the next room who can confirm no such thing ever happened.  They will refer to me by my BS name: Steph (Pronounced Steve) Frolin.  as in “hey Steph, can you have her describe the car again?” Now I know something has changed and that I need to speak to the partner ASAP.

So Mark turned on his ambulance charm and talked the poor girl into standing with the only guy wearing a jacket for some reason involving an American and a blog.  No doubt she has erased this moment from her own memory.

As I mentioned earlier, we should have cut the evening short at the bridge.  The jet lag, the drink, Mark’s dancing, a long day and an early alarm clock would spell disaster early the next morning for our last day on the car.

Taking it easy on the drink is a suggestion that carries through all situations and this one is no different.  Not that I went to excess this night, no where close, but the combination of the time change, new diet and excitement of the Project would lead Mark to getting me off the streets the next morning.  And I’m glad he did.  Details on my nap next time.

Mutual Aid Updates

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Attention all units in the field.

The Mutual Aid Bards are being updated with a couple of new blogs on the EMS radar.

Ambulance Amateur is a volunteer care giver in the UK who so far is quite opinionated by the clients he meets.  I’m adding them as a window into another version of what i saw with UKMedic999 on the Project.

Another new find is the Orange Taxi who I found wandering looking for other folks reactions to the discussion over at CK’s place about EMS pay.  He’s been in the business a bit and has something to say about it. I’ll be listening.

I wish our new blog family good luck with their endeavors.  have a read and if you like them, follow them.

HM

20 Keys to a Positive Exchange

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The 20 Keys to having a positive, productive exchange in Emergency Services.

1. Agree on your purposes upfront.  if you want to prove another system inferior, they may not be too cool with that.

2.  Observe, note, learn, apply, repeat.  Not everything will work in both places, politics will never allow it.

3.  Know why you’re choosing that place.  It needs to be a balance between person and system.  If neither is 100% it will never work.

4.  Get the third rail conversation out of the way early.  Talk religion, politics, family.  Find your differences and common ground early.  If you see another persons religion or values as an issue you may not honestly see the system they want to show you.

5.  Be honest with yourself and your partner.  If they ask your opinion, give it, but be prepared to back it up.

6.  4 days observation is a fair amount.  8 days away from home yields travel, 4 days on the streets and meetings.

7. Plan to be exhausted.

8.  Plan time between visits of at least 1 week for family time.  Mark and I did 23 days total, too much.

9. Get the support of the local media to showcase your work.  This should draw the attention of the politicians who can enact some of the changes you may want.

10.  Every system has one Chief or Administrator who wants to be involved.  Let them be.  Keep them in the loop, it is handy to have someone upstairs if you need it.

11.  Avoid the unusual or extreme.  Give them an honest average day in your life.

12.  Be respectful if things turn out differently than you thought.  Above all else be honest.

13.  Find alone time during your trip to reflect on why you are there.  Whether it be a meal, evening or part of a day, you’ll need a few hours to reflect on what you’re doing.

14.  Avoid heavy drink.  It can not only impact your next day, but reflect poorly on your partner, you and your service.

15.  Make sure you have permission from your Department to appear in your uniform and make public comments about your system.

16.  Avoid questions that start with “How come you don’t …” like “How come you don’t intubate kids?” The tone could be considered confrontational.  Try making it easier to answer. “What tools do you have to secure a pediatric airway?”

17. Eat the food.

18. Try to understand the culture, phrasing and customs.  Learn the local history.

19.  Remember not everyone has the same set of definitions you do. A rescue here may not be a rescue there.  When there, use their terms, not yours.

20.  Be Happy.  Smile.  Have fun.