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Gearing up for Tak Response

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Over the next few weeks you’ll be hearing from me about the Tak Response Conference in San Jose coming up September 14th-16th.

Chronicles of EMS was invited to be a part of this collaborative training opportunity that will bring the best of all fields together to network and learn from each other.

This conference combines nursing, Fire, Haz-Mat, law enforcement, SWAT, EMS, public works and a number of other disciplines together, since when we all arrive on scene we have to work together.

Let’s start to train together.

Tak Response is not only a chance to learn from other disciplines where you fit in at “their” scene, but to network socially with your fellow providers before the you know what hits you know where.

Imagine a scene where the Battalion Chief, Patrol Officer and EMT all already know each other and what each agency expects from the others.  That’s a smooth running scene.

Here’s the episode of Seat at the Table where we meet the organizers of the Tak Response Conference and run the concept by paramedics, firefighters and even a cop.

Criteria based on what?

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You all know I am not a fan of little boxes.

I dislike the little boxes we have to cram our patients into to treat them based on chief complaint.

Also on my list is the little boxes we take them to the hospital in.  Bolting a box onto a van isn’t enough.  More on that another time.

On the top of this list in big red letters are the little boxes our call takers are required to fit their callers into.

They must meet criteria in order to be coded, qualified, weighted, and then sent out to the trauma hungry troops on standby all over the City.

Problem is, it doesn’t work.

I do not know Dr Clawson, but I do know his system and that, if a system can correctly act on the information gathered and coded, it works most of the time.

What really gets me going these days is the purposeful miscategorization or non categorization used to move calls out of the call center faster than they need to be.  I am not alone in this experience, getting messages, tweets and emails from folks all over the USA asking me what they can do to improve dispatch.

You can’t improve dispatch.  Not until you improve the callers themselves.

One of my readers described it as GIGO (Garbage In, Garbage Out) meaning, in the most respectful of terms, that dispatch should not be changing anything the caller says and that if the caller is wrong, then I do hope my dispatcher is wrong as well.  If a person calls and tells the dispatcher that the space shuttle has crashed on main street and thousands are dead, maybe it did.  But the problem lies in sending that call out before it is coded.

The two most inexperienced people in the system are the ones guiding the system.  The caller and the call taker.

I have never been to a call that was reported, coded and turned out to be the same thing, mainly for the same reason my patients’ chief complaints never seem to jive with my treatment per protocol:

They don’t fit into your pre-determined boxes.

Many systems run a BLS tier, or perhaps a single paramedic resource to handle Omega, Alpha or even Bravo calls.  Here in mine, there seems to be no rhyme or reason to the assigning of resources on some calls.

A call coded by the system, based on information provided by the caller, to the call taker has been declared a 26A1, a sick call.  Yet in the call classification next to the code is the term BLEED-SEVERE.  And now the call becomes a code 3 and 6 or more lives are at risk.

“Better safe than sorry, right?”  Good thought.  Who is in more danger?  The person who bit their lip and called 911 or the 6 responders using red lights and sirens to respond to the call now thought to be more than it is.

“Then what’s the answer, smart guy?”

Ditch the codes.  Stop the tiny box requirement.

If they call and say “I bit my lip,” Dispatch it as such.  Let the responders apply calculated risk to the situation without being blinded by administrative tricks used to ring the bells faster, improving your call center stats.

If you can send a call out in 30 seconds without gathering all the information, that is not a success.

I am not blaming dispatchers.  That voices that tell me where the sick people are are not the ones in control of the dispatch system, but the ones required to work within it, not unlike me not liking aspects of my treatment protocols.

GIGO.

They relay what they are told and code the call.

It is the trick of changing the code or description that I don’t like.  That is how the cut fingers, bit lips and sleeping people send out a full ALS response and drain the system of resources at a time when we are getting stretched thin.

By changing from a criteria based system to a “plain text” system, two distinct things will happen.

Firstly, crews can use their judgment, ETA and experience to determine their response priority based on what the caller actually said, not what the system thinks they might be saying.

“My back hurts again” is not coded as “Non-Traumatic Pain-Code 3″ so the crews can apply their expert training to audit the dispatches in real time.  I worked in a system like this and it worked.

Secondly, it will become very complicated and difficult to classify and track types of calls for analysis after the fact.

“We don’t know how many CPR calls went out last quarter because we have to go back through each call instead of just pulling the codes.”

A recent study by UCSF and SFFD Medical Director Karl Sporer celebrates the finding that 1 out of 7 reports of a rescusitation in San Francisco turned out to be just that.  You can’t find stats like that celebrated outside of baseball.  1 in 7 was a success.  I see the 6/7 mis-reported or mis-coded calls as room for improvement indeed.

You Make the Call – Hired

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All the studying, testing and nervousness has paid off and you got that paid spot!  Only problem is the commute, 1.5 hours each way 3, towns over.  But, it’s with a good company and you hear great things about them.

Your first day comes along and you arrive at the ambulance yard, clean new uniform and gear, only to discover you were hired over many of the senior part time folks who also applied.  Needless to say they aren’t thrilled by your arrival.

During morning check out you are assigned to a brand new EMT-Basic, ink still wet on his card, who is not familiar with the roads, equipment or hospital locations.

Gulping your coffee, you decide to head into the supervisor’s office to see about a reassignment, at least until tomorrow.

“Nobody else wants the new guy, or gal, so make do.”  Is what you’re told.

Back to the rig and gear is checked but your narcotics are low.  Back into the office the supervisor tells you they don’t have a license for narcs, you’ll have to restock with the FD in the next town.

Something is off for sure.  Is this a test?  Some kind of cruel first day prank?  At the end of the first shift you feel like tossing in the towel but a friend reminds you that their are no other companies hiring anywhere nearby.  2 local ambulance companies recently went under and the remaining one isn’t hiring.

Keep the job and most likely the house and the car payments relying on it, or get out while you can?

You make the call.

There will be no Monday follow up to this week’s situation, it was sent as a request for advice to thehappymedic@gmail.com.  If you have a situation and you’d like to ask for a wide variety of insights, send it in, no name needed.

You Make the Call – The Bar – What Happened

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I was taken aback by this guy at the bar in a T-Shirt with a 8″ EMT on the back and giant star of life.  Add to that the stethoscope around his neck and I was just confused.

My fire and PD buddies were making jokes while I was trying to make the decision whether or not to approach him.

I could start the conversation by asking if he really was an EMT, which I’m sure he is hoping someone will ask, hence the shirt, but it was really the combination of the pants, shirt and especially stethoscope that had me thinking this person is clearly not “one of us,” US being the profession.

He managed to wander over to a table of ladies with his friend who said, “Make room for my EMT buddy,” at which point I had to cover a laugh.

No matter what I said or how I approached the situation, this was not the time or the place to address his lack of professionalism.

He was not in a uniform, but as far as the public knows, he was.  He was not doing anything “wrong,” just not the best thing at that moment.

Mark can tell you that when coming home from riding with him and purchasing an adult beverage at the store, I turned my jacket inside out.  I looked odd, but even in another country I didn’t want to let folks know about that association.

So in the end, I let it go, mainly because I am convinced he would not have understood.

My buddy then, after we left, asked why I didn’t give him a Happy Medic card, then blog about it.

Also not “wrong” but maybe not the best way to approach it.  So in the end, I only did one of the two.

If you said stay out of it, you made my call.

You Make the Call – The Bar

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Ah, a day off! You’ve decided to head out for a few quick drinks with friends and meet at a little restaurant/bar in a quiet suburb. As you try to describe to your fire and PD buddies about the culture at an event such as EMSExpo, they ask if folks wander into area bars in uniform.

Replying in the negative, they laugh and ask if folks wander into bars in uniform wearing stethoscopes.
When you glare at them they laugh and point over your shoulder to the other side of the bar.

Seated at a stool and drinking a beer is a fellow in EMS pants, a blue shirt with a large “EMT” on the back and, sure enough, a stethoscope around his neck.  The shirt shows no company or department name and he is wearing no ID you can see.

While you try to make sure you are seeing what you are seeing, your PD buddy says, “Well, are you going to say something?”

You make the call.

Chronicles Germany Style

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One of the Chronicles of EMS earliest followers Sascha Fehr, who I had the pleasure of meeting in San Francisco months ago, arranged for a Hungarian Paramedic to travel to his system in Germany.

He recently uploaded this video:


Find more videos like this on Chronicles of EMS

Tell me again how we’re not changing the world?

Beyond the Lights and Sirens

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Chronicles of EMS – The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

The new name for the reality series about EMS providers from around the world.

May I have the definition please?

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A funny video has been making the rounds on the interwebs machine, an ad for Mercedes Benz.

In this video a woman walks into a library and tries to order lunch:

It’s funny, right?

Now imagine she wanders into an ambulance station and asks to be transported for a toothache.  Is it still funny?  She’s still in the wrong place asking for what she wants.

I hear from many corners of the EMS industry that we need to lose our “above them all” attitude and just take people in that want to go in.  “It’s their definition of emergency, not yours” is something I am tired of hearing.

What if I told you it’s her definition of library, not yours?

We are not Jim’s Emergency Medical Services, or Sally’s or even Justin’s.

Responders have been trained to handle specific situations using specific tools, medications and techniques.  If you can not be aided by those things, then perhaps we need to find another resource for you. Most communities do not offer these services on demand, but arrangements need to be made ahead of time. They either wait or call 911 and get immediate service.  In still other communities EMTs and Paramedics are discouraged from or worse, disciplined, for accepting refusal of transport.

I’m not advocating leaving the sick and injured in the streets, but adding some realism in addressing our current problems.  We do not face a shortage of ambulances in America but an overpopulation of “emergencies.”

When you get on scene of the young woman who bit her lip and didn’t know what to do so called 911, no matter how you dice it, that injury is not worth placing responders lives at risk to respond to, not to mention who might be told “We have no ambulances available” while you’re trying to nicely tell your patient how minor the injury is.  Add to that that some private services do not allow refusals, now they’re generating a bill for the bit lip and taking up a spot at the ER.

Rogue Medic reminds us that our concern when at the scene with a patient is that patient and not the next one.  I completely agree that when on scene we need to focus on the needs of that person and not what might happen.  But when looking at the system as a whole, someone needs to be thinking about the next run.  Supervisors, managers, Chiefs, EMS Educators, SOMEONE needs to be looking out for who might need those supplies, skills and equipment your patient is asking about while getting that ride.  In the back of the ambulance is not the place to theorize about EMS.  That place is here in online forums, at conferences and when meeting with your Medical Director, System Managers and Chiefs.

There are things we can and can’t do for our patients.  If all you can offer is a ride, is it still an emergency?  Think about it for a minute.  If it’s just the speakers not working, do we really need to call a tow truck “just to be sure?”

Awhile back I had a good back and forth with David Konig about comparing McDonald’s, Starbucks and Dunkin’ Donuts to modern EMS.  He mentions the way Starbucks outdoes Dunkin not because of superior product, but because of superior customer service and a better customer experience.  It was in response to a series on Liability.

But those companies are still limited in the experience they can provide.  As I mentioned, when someone calls 911 for a reason I can not help with, nor any of my equipment, training or experience help with, do I still have to give them a positive experience?

Absolutely.

And that means not transporting those who do not need it.  The same way Starbucks will not make the girl in the video a hamburger, or arrange for one to be delivered.  They’ll likely smile, ask her if she meant a venti Americano, and remind her she is asking for a service Starbucks can not provide.  Then a good employee will make sure the customer can find what they are looking for, leaving them a positive impression of the company.

“This is a Starbucks.”

“This is a library.”

“This is an ambulance.”

We’ll just load her in the ambulance and take her in because after all, it’s not our definition of emergency, it’s hers.

Should the librarian stop her work and fire up the grill? After all it’s her definition of library, not yours.

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Psychokenisis in EMS a reality?

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On a recent job I was reminded not only of the ease with which people can put 6 rescuers lives at risk, but I learned the power of the human mind.

THE EMERGENCY

A caller reports a man unconscious and unresponsive in front of a local pharmacy.

THE ACTION

We get this call all the time and so far, in the I don’t even know how many times, it has been a new arrival sleeping.  When folks get off the bus that their home town put them on as a public service, they arrive broke, hungry and in need of a plethora of services their old location clearly didn’t offer.

Luckily we have a free van service in the City to help these folks get processed into the system here and to shelter, food, medical services, whatever they might need, and at no cost to them or the municipality that bussed them here.

Our client today has chosen to sleep curled up on the sidewalk, and since the police have no interest in wasting resources waking him and having him scoot along, callers often bring out what they know will work and work fast.

“I think he’s passed out or something.  He’s not moving.”

Bells. Engine 99, Medic 99 code 3 for the unconscious, possible recuscitation.

He wakes from the siren, no one has tried to wake him until now and he brushes the long dirty hair away from his face to peer at us confusingly.

He has no medical complaint.

He has no injury.

He simply wants to go back to sleep.

“You think MAP will take him?” Our Engine driver asks from the fresh air near the curb.

We stand him up and he’s a little uneasy on his feet, not unlike I am when rudely awakened when exhausted and I recall past encounters with our van service.

They are staffed by one person with no medical training and the client must be able to walk to the van unassisted.

“No,” I say, wishing he was more steady on his feet, “They’ll take 30 minutes anyway.”

“OK, It was a thought.” He says as I look over his shoulder and to the van pulling up in front of the engine just outside his line of sight.

The MAP van.

“I’ve been looking for him for 20 minutes” says the driver as she runs over to us. “I’m sorry you guys got called on this, he must have gotten up and moved or something.”

The look on our driver’s face was one of surprise and pride.

“Did you just summon her with your mind?” I asked.

“I can do it all,” He replied.

800 What?

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Words.  I want you to write 800 words.

In my recent travels through the dungeons here at HMHQ, many of my favorite posts average around 800-1000 words.  a fair amount to get you in, tell you a tale and let you go.

So I got to wondering if you could convince someone of something in the same amount of time.  An educational article could go on and on for pages, citing this study and that.  I’m not looking to be shown beyond a shadow of a doubt, just convince me social media is a good idea and good for our Profession.

But here’s the challenge:

Don’t use the term “Social Media.”

You can say blogs, twitter, RSS, facebook, any number of other terms, but no using the buzz words “Social Media.”

Think you’re up to the challenge?

Convince me.

email your submission to theHappyMedic@gmail.com by August 20th.

Enter as often as you like, but keep in mind if I read a second submission of yours I like better, the first one gets eliminated.  Open to everyone, not just bloggers.

Prizes to be announced shortly.

This is for you new people

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Since you all follow the Mutual Aid lists and Continuing Education tab on this site, I shouldn’t have to repost this, but watching this fail video from FAILBlog is a great learning tool for young EMSers, or anyone studying to advance in medicine.

First, watch the video, then some questions.  I don’t have answers, and was not there  to talk to this man, but I think since he is on TV he must be an actor, so let’s enjoy, shall we?

Now, without replaying the video, answer the following questions:

1. What happened?

2. What is this man’s GCS score?

3. Is he competent to refuse transport in your jurisdiction? Why or why not?

4. Could this be his normal mentation?

5. If not, what would you suspect a person who presents like this actor acted to be under the influence of?

If you replayed the video, you cheated.

Pop Quiz Answer Key

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Well darn it if that wasn’t a hell of a response.  I asked you to guess which of the 10 calls mentioned I was NOT sent to, and dozens of you chimed in with your thoughts.

Un_Ojo, a friend and fellow twitterer mentioned over there that I must have had one hell of a rough day.  No, luckily, the runs mentioned were over the month.  Had that been one day I would have taken off my coat and helmet and blended in with the crowd.

MrsHappy took one look at this list and almost slapped me on the back of the head.

You see, I have 2 little ones and one of their favorite snacks is grapes.  I have been told for almost 4 years now to be sure to cut the grapes in half for the little ones because of the choking hazard.

I’ve been to kids choking on a lot of stuff, both food related and not, but in 16 years of going on emergency calls I have yet to see a person, or a kid, choke on a grape.  Not that it isn’t a possible hazard, just not as common as the baby books would like you to believe.

However, on a lighter note, the rest of those calls are 100%* true and highlighted a stressful month for me.

Be safe,

HM

*Each one of those calls is fictional

Pop Quiz

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What a month it has been!

Your job, gentle reader, is to choose which one of the following calls I DID NOT get dispatched to.  Seriously.

1.  Motor vehicle versus pedestrian, driver of car in full bicycle riding regalia and parked up the block.

2.  Partial scalping.

3.  Stabbing.

4.  Building alarm set off by a BBQ 2 houses over.

5.  A fall down 2 floors of wooden stairs after an earthquake.

6.  A running toilet in a park restroom.

7. A person urinating on the sidewalk.

8.  A high speed police chase on the Golden Gate Bridge.

9.  Sprinklers spilling into the street.

10.  A child choking on a grape.

OK, have at it.  You know I left out all the boring full codes, hypoglycemics and basic MVAs just because that would be too easy.  So out of the 10 calls above, which one was I NOT dispatched to?

Click it or stay home

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We used to only die in fires.  Never thought I’d long for those days again.

WEAR YOUR GORRAM SEATBELT

If the events of this week have not inspired you to do it, then nothing will and it is too late for you.

On Scene with Happy and Steph

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Welcome back to our coverage of Engine 99, I’m Happy and with me as always is Steph Frolin.  How are you Steph?

Good, Happy, good, we’re reviewing the last call by Engine 99 when challenged by a client who was threatened with arrest for theft.

That’s right Steph, and since you’re here we know there is something else to this code 3 medic request for the hurt elbow, let’s go to the play by play.

Engine 99 and Medic 88 are dispatched for the code 3 medic request by a PD unit in a swanky shop.  No details are given to the dispatchers, so the call is off their roles in mere seconds.

Our teams don’t even have a code or description?

No, that would make it too simple, but here they are, on the scene with PD waving them in.  It appears to be  quite the PD event, I count 3 cars on the scene.

This could be serious, Steph, I see them bringing in ALL their gear.

They do that on every call, Happy, never can tell what’s really happening anymore.  Remember that code 2 fall that turned out to be a breach delivery?

I do Steph, but our team is being led to the back alley of the store and their patient, who is holding his elbow.

The crew is quick to slow the ambulance to code 2, possibly saving lives and money.

Steph they appear to be assessing an elbow injury, but from what I can tell the medic is using distracting assessment techniques to yield an honest assessment.

He sure is Happy, that allows the medic to assess the injury a number of times and compare responses.

OH! That looks bad Steph, the man has winced without being touched, but makes no facial changes on assessment.

A gutsy move, but the medic appears to know exactly what happened despite the story he is being told.

The officers describe walking him forcefully, holding his arm at the elbow, walking back to the alley to discuss the finer points of his arrest.  At that point he began to cry and ask for a medic to transport him.

Happy, this happens all the time.  Folks think calling for an ambulance will get them out of jail, not realizing they will be transported, assessed at their expense, then arrested.  He’s probably thinking the PD will just let him go, but since they are the reported assailants, this is going to get sticky.

Steph, that’s amazing.  I can’t imagine people trying to scam the system that way.

Your rosy outlook amazes me sometimes, Happy, but what is this?  The crew is being told he was thrown to the ground and beaten!  This is indeed a change of events!

And the crew is adjusting nicely, performing another secondary assessment to rule out any injury from the new description of injury.

I’m surprised the officers are holding their composure so well.  One of them burst out laughing on the beating comment and has left the alley and is now back in the store.

Steph, what is going to happen now with the report of being kicked in the head with steel toed boots?

With no evidence of such an injury, even in the slightest, I would be surprised if this crack squad goes the full route of C-spine precautions.  When-

Steph! Look at this! A store employee has emerged with a laptop computer and is showing something to the rescuers and the man holding his elbow!

If we’re lucky it’s security camera footage.

It is! It is the film, clearly showing the man attempting to leave the store without paying, then store security confronting him and a beat officer walking in soon after.  They walk him back to the alley, where another camera sits, and he stands there, on his feet the whole time, until our rescuers arrive.

Let’s see what happens now Happy.

I can only imagine the citizen will be embarrassed and submit to his punishment for thievery, Steph.

Sometimes I wonder if we really are the same person Happy, no way is he going to back down, he’s going all the way with this one, just watch.

Oh ye of little faith-

There it is! He just stated the video has been altered and demands transport!  Oh my!  This is as surprising as Jersey Shore being re-upped for a new season.  It shouldn’t happen, but it does.

My oh my, this does indeed seem like a waste of resources, Steph, why can’t these medics just declare this man a liar and be done with him?

They don’t have the authority to declare a person is completely without injury, even though we have visual proof that nothing indeed happened warranting a response, let alone a transport.

Amazing Steph, just amazing.

Until next time, I’m Steph Frolin and with me is the Happy Medic, and we’ll see you On Scene.

Can you see me now?

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Have we all gone Hi-Vis insane?

Forget about a nanny culture or statistics about it making us safer.  Last I heard it was the flashing lights that attracted sleepy and inebriated drivers so turning me and my crew into passive crappy driver attractant is not my idea of a good time.

I wear my vest most times, really I do.  Mainly on account of my uniform is all navy blue and at night I disappear.  Perhaps the slight chance I get seen at the last minute is the point, but I have a big coat with reflective that could do the same thing.

“What the heck, Hap?  What got you all fired up?”

This photo from Ray Kemp at 911Imaging.

You saw this series on the cover of JEMS magazine a little while back.  The first thing that will catch your eye is the sea of reflective vests, running about $100 a piece on the rescuers, covering the reflective on their turnouts.  The ambulance folks have them on as well, well done, folks.

But look IN THE STREET!

In the one place those vests can actually be useful and you’ll see two fellows wearing what I wear, all dark colors.

Well, I wasn’t there so I can’t blah, blah, blah.  No, I’m jumping in here and pointing out that perhaps we have our priorities a bit out of whack.  We go racing to jump on the Hi-Vis bandwagon without looking at what our people already have and using it to our advantage.  Hidden in all the stories of people getting hit and killed in the streets are the facts adding up that vests don’t stop cars, trucks and SUVs from killing you.

If you stand in the road covered in day glow paint carrying flares you will still die.  If we trained our drivers to block the road with the giant reflective rigs, perhaps the vests could go to those who have no giant truck to protect them.

Better yet, where is the increased driver’s education to stop the poor drivers from trying to kill us in the first place?  Rhetorical for sure, but I can see at least $1000 in this photo that could go a long way.

My own service is not immune to the allure of the shiny, reflective vests.  We have some that say Incident Commander, others say Triage.  Mine on the engine says SFFD in black on a field of bright yellow and silver.

Here’s a picture from one of our new engines under construction (Thanks Crimson-Fire):

That is where the reflective belongs!  And while we’re at it, can we get some more warning on the sides of these giant road blocks?  How nifty if we could get an arrow stick on the sides AND the back, since if we park to block the scene the rear mounted one is hard to spot.

Some Departments deploy street signs out ahead of the scene, cones, flares, all those kinds of nifty, expensive street decorations aren’t stopping the drivers who are going to hit us anyway.

Even on a simple vehicle fire on the highway, we need to focus on parking and awareness rather than throwing money into reflective to cover up reflective just to check a box on a state form.

If you have a vest wear it, but use common sense first.  Use that giant thing that drove you there to protect the scene and stay out of traffic.  Leaving the scene unprotected and going in and out of moving cars will get you killed, no matter how much shiny suit we plaster on you.

Be safe people,

HM

PD is on scene – The Crossover

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Our old pal Motorcop approached me asking if we could jump the fence from time to time and have a chance to share with the other crowd.  So today he launches “the Crossover” a chance for him to address fire and EMS folk, while I have a chance to talk directly to his law enforcement officer types.

Kind of a digital cross training experiment where we can air our differences and issues in a friendly way.

If you have something you want the law enforcement crowd to know, send the topic to MC and see if he’ll host with you too.

Here he is, the Po-Po a Go-Go, the guy you don’t want to see in your mirror, Mr Motorcop himself!

Greetings, fellow first responders!

I’m your local law enforcer, MotorCop (MC for short), and I’m happy to have the opportunity to chat with you briefly at the world famous HMHQ.  Thanks to my good friend, Happy, for agreeing to The Crossover!  It’s our aim to commandeer one another’s site on a monthly basis.

Prior to jumping into it, let me start by saying I grew up in the Fire Service (Dad retired as a Captain), so I’ve always had a soft spot for you all.  That being said, I’ve got a bone to pick with you…

Now, I’ll be the fist to say, no one likes the images a scene like the above bring to mind.  Unless those happen to be a pair of your kicks, it’s safe to say none of us knows what happened in the above photo; however, it probably wasn’t the aftermath of a good time.

So, what is our collective function when we arrive before the crime scene tape is strewn across the area?  I think we can agree the main job is first to treat the injured and prevent further injury.  After that, our respective jobs diverge and that’s the topic I want to address to you today.

I’m not a medic.  I’m not a doc or a nurse or even a f’n podiatrist.  Consequently, I only know the basics of first aid.  Ready?  Here it is, “Fire’s one the way, pal!  Hold on!”  That statement is quickly followed by, “Who did this?  What happened?”  Of course, I’m rehashing a long standing joke about PD and our ability to render aid, but inside the joke is the key to our differences.  My job is to find the bad guy.  Yours is to save the victim.

Often, our two jobs…jobs that one would think would dovetail nicely…butt heads like two big horn sheep.  We on the blue side of things (sometimes) affectionately refer to you on the red side of things as the Evidence Eradication Team.  Y’all pull up in your pretty red engine with your shiny reflective turnouts looking cool for all the swooning women.  The problem?  You parked the aforementioned engine right over my fuckin’ evidence (be it shell casings, skid marks, etc).  You swoop in, scoop up, and bounce…usually leaving God knows what kind of medical flotsam and jetsam strewn about.

I’ve always hated it when people just bitch for bitching sake.  So, let’s talk about solutions.  Let’s start by saying there is typically a communication breakdown at the scene.  For example, a couple weeks ago, I was first on scene at a fully-involved house fire.  Within a matter of minutes, a veritable army of firefighters arrived.  Instead of me milling about and possibly getting in the way, I found the firefighter with the shiniest helmet and cleanest gear and said, “Hey, Chief, what do you need from us?”  Then, I got the hell out of the way and let you kids do your thing.

Is there any harm in either of us doing that for the other?  If it’s an obvious fire call (medical, fire, etc.) and you just need traffic control, just ask (if I haven’t already).  If it’s an obvious PD call (crime, collision, etc.), before you cruise on up and park next to the wrecked vehicle or injured party, stop and think about where you’re about to park that big ass boat you’re driving.

I’m not asking you to compromise the care an injured party may need…but you guys get paid to work out for crying out loud, you can swing walking an extra couple hundred feet. All I ask is for a little scene integrity.  What if it were your wife, sister, mother, brother, friend that was hurt or worse?  If that person were beyond your help, you’d need us to solve the crime.  It’s hard to accomplish that with tainted and/or destroyed evidence.

All I’m looking for is a little mutual cooperation.  We’ve both got big egos and sometimes that gets in the way of seeing things a little more clearly.    We can keep up the jokes about us eating donuts (which is true…love me some donuts) and you folks getting comfy in your La-Z-Boys (also true…I’ve been in a House a time or two).  But, when it comes to the job, what say we both try to be more mindful about what the other may or may not need from us.

Thanks for your consideration.  It is well appreciated!  Drop me a line at motorcop1@gmail.com or head on over to the blog and say hello!

See you at the next crash…

Then who gets this rainbow one?

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Many moons ago an associate was part of a landmark study for a medication I guarantee is now on your rig.  You probably gave some today.

In the course of this study, Paramedic crews who encountered the specific condition that warranted the specific intervention were entered as candidates in the study with family consent.  Most times, I’ve learned, people want something new to be used if it will help.  After all, “…if it didn’t help, why would they be testing it?” I’ve heard a few times.

The way to keep it double blind was to give two doses from the same kit, only the researchers after the fact knowing which was medicine and which not.

However, to get permission to deviate from established protocols, we had to get Base Physician approval to administer the study kit.

When you called on the radio you would give the information that met criteria for the study.  If it seemed, in the MDs eyes, that your patient needed quicker interventions the study was put aside and normal actions taken.  In the kit are a number of colored packets with different concentrations, dosages, who knows, but each kit is to be chosen by a pre-determined list at the hospital.

The MD on the other end of the line will check the list and order you to give a certain colored kit to the patient, possibly based on information from the report, time of day, who knows.

Imagine this scenario:

You are dispatched to the home of an African-American family who’s mother is experiencing [Study specific medical condition].  The family is adamant that you help and you assure them everything is being done.  Your EMT is like lightening to the [BLS intervention for study specific medical condition] and you radio to Base for permission to enroll in the study.

After all the info is exchanged, the MD comes back over the radio on your lapel stating:

“Copy that Medic 99 your patient is a candidate.  Open and administer the…the…BLACK drug, copy?”

The family erupts!

“No!  Give her the white drug!  She wants the white drug!”

After an explanation of the situation and showing the multiple colored kits the family calms down and mom recovers from the [study specific medical condition].

Keep in mind that even though you think things you say or do are harmless, your patients and their families may misunderstand.  Be ready for a quick explanation.

But that led me to wonder…who gets this rainbow colored one?

Specialty Centers Text Discussion

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Seems the neato thing to do these days is get your hospital registered some kind of specialist center.  we have STEMI Centers, Stroke Centers, Trauma Centers, Burn Centers, Pediatric Centers and so on and so on.  Well, in my system we also have a microsurgery center.

So I got a text message on July 3rd from an old intern who had an interesting question:

John- “If I get a firework injury with fingers blown off, but there is burns, do I go to burn center, microsurg or trauma?”

HM- “You decide, because each of the decision matrix end with Paramedic Judgment. If the burns are considered extensive, go to the burn center, unless there is significant trauma, otherwise go to the trauma center.  BUT, if there is tissue that could be salvaged and repaired, immediate transport to the micro surg unit is warranted.”

John- “What about a peds?”

HM- “The system will implode.”

Sunday Fun – Staying Motivated

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I found more motivational posters to share:

Blogger down, 999medic signs off

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Writing about emergency medical services, most specifically the events that can shape a career, is a mine field.  That mine field has claimed a good friend and colleague today.

Due to pressures from people who do not understand what we do Mark Glencorse is making the decision to discontinue his world famous and award winning website 999medic.com.

In a release today Mark cites perfectly understandable reasons for stepping away and I still support him 100%.

It was reading his posts about how EMS was so different outside the US that got me inspired to change my own system.  Forget that he was the one who dreamed up what would become the Chronicles of EMS when he reached out to an anonymous blogger in the states who hid behind a cartoon character.  Mark is a trusted voice in the pre-hospital field and for reasons they can not explain, people around him want him shut down.

Patient privacy is a serious concern.  So serious agencies the world over are willing to take the risk of having uninformed rescuers so that a little old (he was really only 25) woman (no it was a guy) I ran last shift (it was 3 years ago) on that dark night (it was a rainy morning) with the unique EKG can be protected.

Medic999 was the voice of a nation, a system, a different way of doing things that made me a better Paramedic and hopefully, because of his inspiration, a good supervisor as well.

There is no bad guy here.  Please don’t blame Mark or his service, I’ve been there, they are good people looking out for their population.

No, the enemy here is fear.  Fear of the ability to share information in real time without a 3 month vetting process.  Social media, whether the establishment likes it or not, is here to stay.

We are not the ones they need to be worried about.  The ones who are irresponsible online are policed by us, the community, and when something seems too close to the truth we call them on it and we get results.

Gone are the days of posting pictures of patients, gone are the days of making inappropriate comments while on duty.  Use this event as a lesson that we are having an impact and as such share a responsibility to use it properly.

Mark will still be around on twitter and facebook, but his daily sharing of life saving tips and tricks will have to wait until this kind of forum is better understood.

I feel like a piece of the future of EMS has died today and that makes me sad.  It also makes me want to prove that people like Mark, the Ambulance Drivers, the Michael Morses, the countless authors of EMS books and articles who draw on experiences to teach us all are doing the right thing, not endangering the privacy of someone who screamed for an ambulance for a broken finger at the top of their lungs in a busy subway station.

Since I have no blogger flag to lower on this day, I will place a black band on the banner for a bit in memory of Mark’s contributions to making EMS blogging a legitimate way to gain information and insight for both new and old providers alike.

Be well, Mark.

The Handover – Call for Submissions

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Tactical Pants is the June 2010 host of the Handover Blog Carnival.

The theme is “Down Time,” something we all look forward to and want more of.  Click over to have a look at the details and submission deadline.

Tie one on

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Yup, I’m adding a new icon for a new class of response: Water Rescue

In my firehouse we staff an ALS Engine, Truck, a rescue boat and rescue water craft, meaning most of the folks here are certified rescue swimmers and take their roles very seriously.  Most of the dispatches for these highly specialized units are in the news and easily identifiable, so if a person is rescued, chances are you will not read about it here due to privacy concerns.

But what if there is no victim?  Then there is no privacy.

Been tied up all day?  So were we.  Then, when I read the screen on this call I had to scratch my head.  Not only had the caller actually called for this, but it made it through the system as a code 3 water rescue.

THE EMERGENCY

A caller has reported, “A neck tie can be seen in a pond and there could be a body attached to it.”

THE ACTION

I just completed my class so my role on this job would be dock side and assist the boat in…wait a sec…did they say…pond?

The engine officer wisely chooses to respond to the reported location in the fire engine instead of deploying the rescue boat and we arrive to a very large tourist crowd at a very popular tourist attraction.  Lights and sirens.

Because of some of the key words in the caller’s statement, we also have a heavy rescue unit, ambulance, Chiefs and a truck responding as well.  Lights and sirens.  To the pond.  For the neck tie.

As we arrive our swimmer is ready to deploy if necessary and I grab a ceiling hook because I always like to have a tool when I leave the engine.

In slightly dirty 2 foot deep water we can see the bottom of a neck tie floating and the remainder of it resting, very much without a neck, on the shallow bottom.

It was in easy reach with the hook so I grabbed it and pulled it in.

“Anything else down there?” The Chief asks.

“No, Sir,” I reply, “I can see the bottom and there’s nothing there.”

“Drag it around just to be sure.” He tells me and I oblige.

The caller is understandably embarrassed and tells us something we are starting to hear more and more, “Better safe than sorry, right?”

“Absolutely, Sir.  That’s why we’re here.”  In that moment I was part of the problem of mis-information of the public as to the purpose and abilities of the modern fire service and EMS resources.

But then again there is no other resource in my community that deals with dead bodies in shallow ponds.

Or is there?

You Make the Call – A fall or not a fall?

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When we hear a person has had a fall, there are a series of questions to be asked to find out more about the fall.  Most of these establish mechanism, or the likelihood an injury has resulted.  Most of the time there are factors in play that remove all of our normal indicators and put us back at square one.  Other times it is obvious what we need to be concerned about.

But what about when the story evolves into a grey area?

A cable TV installer was working on a rooftop when he stepped through a plastic skylight.  The opening is approx 3 foot by 3 foot and he was brought down to the street by residents of the apartment building.

As units arrive you hear he has fallen through a skylight 20 feet over a staircase and is bleeding from the legs, arms and face.  C-Spine precautions are taken as you learn he caught himself on the edges of the skylight and was raised back up through the opening by residents.

Is it a fall?  From how high?  Do we need to maintain C-spine precautions?

You make the call.

Meeting the NEAS Executive Team – My UK EMS Conclusion

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chroniclesblogIt all comes down to this meeting doesn’t it.  The entire project, everything I hoped to learn comes down to sitting with Mark’s supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.

But then again, we kind of are.

I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.

Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee.  The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.

So what do I do?

Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a “Hey stupid” look.  It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS.  Population, call volume, etc.

It was made clear to me ahead of time that Fiona, the Chief Executive’s aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.

Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.

A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting.  This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.

I went into a brief overview of my system in the SFFD and also explained other systems around the country.  Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.

Each member present asked a number of questions about billing and a person’s ability to pay and I had to remind them many a time that that doesn’t come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.

Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.

When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US.  Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.

In true executive fashion Mr Featherstone turned to his clinical care person and said, “How soon can we look into doing these things?”

Bang.

Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.

The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.

But I understand that.  England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.

Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways.  If Mark wrote a book about EMS I would buy it.  If he had a radio show I would listen to it, but until those things happen (If he had a TV show I’d watch it) I will follow the media he uses to become a better Paramedic.  Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook.  All media that is growing not only in popularity but usability and relevance to what we’re trying to do in the pre-hospital care fields.

I don’t expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.

One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient’s privacy while allowing those doing the care to share insight and best practices in real time.

A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.

After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.

In Conclusion-

The NEAS provides a high quality service in a straightforward manner to a well informed population.  Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system.  Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.

The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier’s preferred spot.

Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.

The food was great, the coffee we can work on in future visits.

Will the NEAS model work in San Francisco?  I won’t know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie.  Fire readers, this is the post you’ve been waiting for.  But like most of what we do, EMS comes first and accounts for 80-90% of what we do.  Why should my UK story be any different?