Let it go, this too shall pass
Archives for ems-health-safety
Words that can get you fired. Others include,
She said she was fine;
His lead II was unremarkable and has had heartburn in the past;
Your anxiety can come from nowhere and leave you tachy, lady of 55 who’s mother died of an MI recently;
Damage like this happens all the time, that bruise is normal;
A little smoke inhalation won’t kill you, look at me;
Asthma is not going to kill you, go find your inhaler;
The Doc signed off on the AMA so I’m golden;
Babies sleep all the time;
The snow was too heavy;
It was too hot;
I was tired;
I read in a blog that doing that was alright;
Have you seen this funny youtube cartoon?
Point being that there are a lot of rumors, stories and opinions flying about what happens in our business and it can be very hard to find the truth in a situation with 3 correct versions, one wrong version and 15,000 who have parts right.
I have been known to join the fray when it comes to EMS and Fire Departments who do something I like (Tip of the Helmet) and things I don’t (Letter in the File) but drawing conclusions from a single source is a bad idea.
Have an issue with a story you read part of on facebook? Before you lay it on thick you may want to finish reading the story, then seek out at least 2 more sources to confirm the facts. If you can not get the facts, use the google to find out who to call to get the facts.
If they call you back, great. If not, then you have to go with what you have, but the impulse to post something you may regret will have passed.
If you are the one facing termination for doing something you knew in the moment was wrong, see ya. If you find yourself on job 21 in 24 hours and know that not writing a chart will get you home sooner, keep in mind that not writing the chart could get you home a lot. As in unemployed.
If just yelling at the guy to wake up instead of checking his blood sugar and other vital signs to confirm it’s just Reuben again after another $3 bottle of wine, you yourself could be the one budgeting for the cheap stuff while on unemployment.
Backed the ambulance into another car near end of shift and drove away? Might as well keep driving into the sunset.
We all make mistakes. I make them all the time, but I make sure I’m doing what I’m supposed to be doing for my patients based on the information I have and how that information fits within the laws, protocols and policies I have sworn to uphold. Have I not charted patients? Of course, when it is not indicated. Have I omitted vital signs on my charts? Yes, it happens when you get back and can’t recall the BP, so instead of lying I write nothing.
Being able to defend your actions or inactions with cited policy and protocols in front of you goes a long way to easing stress and the impact on your employment status.
In the end we all need to take a deep breath and find the facts about stories we read, especially in the internet age, when opinion can be mistaken as fact on a regular basis.
“Mr Happy Medic is there a reason you did not awaken the man lying in the street who was later found to be in cardiac arrest?”
“He looked OK to me…”
I’d be fired for sure, and for good reason.
I have finally had the opportunity to become one of the folks I mentioned in the trailer of Chronicles of EMS. I am now one of the lucky ones who can travel across the country to visit other providers at a trade show.
As I’ve been reminding you, Zoll invited Mark and I out to EMSToday in Baltimore, Maryland.
And oh boy did we almost not make it on time.
When I was growing up we always got to the airport early. Always. Sometimes by hours. So that just became my normal plan. Get there early.
With two little ones and a just over one hour commute home from work, then turning around and racing to the airport I got there 1 hour ahead of the flight, a nail biter in my world.
Mr Setla was relaxing after a calm lunch and I was frazzled to find our flight not only delayed, but now not even arriving at our destination.
The airline, for whatever reason, saw fit to take the same plane we were on before and reroute it. Not through a different connection, since the same plane continued on to Baltimore, but to send us an hour out of the way to DC.
Despite multiple questions as to the reasoning we were no longer able to land at our purchased airport, we were assured the two airports were not far away from one another at all.
I should have known better.
6 hours later we gather our luggage in DC’s Reagan Airport and ask the locals the best route to Baltimore. Their suggested Super Shuttle was a moderately priced hassle, requiring us to sign in, buy a ticket and wait 20 minutes before getting in one of the half dozen waiting vans.
We were 2 hours later than expected and now an hour away from our hotel. It’s 1130 PM and we’re tired and hungry.
A taxi trip will run us almost $100, but get us there quickly.
Knowing a trip from Baltimore airport to the hotel runs about $40 (Thanks FireDaily for the heads up) our chosen method of transport made perfect sense.
Jay’s Sedan Service is a family run business in the NY/DC/VA/MD area operating just a handful of cars driven by the owners and the care and attention to detail shows. We’ve all been in a leased car vs an owned car and the difference was clear.
Our driver, Jay, made us a deal over the phone and was curbside in less than 5 minutes. En route we started with idle chit chat until we learned Jay is on Facebook and Twitter (@jayssedansvc) with his business and we had to have fun with it.
Next thing you know Ted is ustreaming live video from the back of the Lincoln Town Car while Jay is laughing along with us.
After a touch of traffic we finally arrived at my hotel just after 1 AM local time. I say mine because Ted had been booked by a different group at a different hotel nearby.
Thank goodness for free late night food delivery.
So skip ahead to what my body thinks is 430 AM when my alarm goes off and I open the window to the beautiful brownstone Baltimore clock tower.
I can’t wait to dive in to everything this weekend could create for me, my friends and EMS in general.
I had no idea that walking patients to the ambulance was such a risque thing to do.
Since the debut of Chronicles of EMS I have been seeing posts and getting emails about how folks are glad they saw me walking patients to the ambulance because it proves I’m willing to show the cameras what’s really happening.
Well, news flash – I walk patients to the ambulance all the time.
When their condition permits, of course.
But when Bubba Fishbiscuit calls because he is out of “brain pills” again, or sprains his wrist guess what folks, he walks if he wants to.
I have even been known to walk patients INTO the ER! AAAAAAAHHHHHHHHH!
My question to you is, why aren’t you?
If your patient doesn’t need the cot, or want it, why are you “required” to use it? And the stair chair too?
I dug through my County Guidelines, Department Protocols and even Department rules and regulations and found nothign about folks not being able to use their good legs when they want to.
Forcing people to make you carry them is insulting.
“No Ma’am, we have to for liability reasons” is the exact opposite of what you’re doing. By letting them walk they are responsible for their actions. When you carry and drop them, well, that was your call.
So why is it that so many Paramedics and EMTs were taken aback when I allowed people who were walking around when they called me and walking still when I arrived to walk into the ambulance?
Is it billing?
Is it?
Is the ability to be reimbursed for the transport more important than the patient? If you are required to carry or cot everyone no matter what, then yes.
Ask your Medical Director about walking patients to the rig who have non life threatening injuries or who are stable per their history and protocols and request to walk on their own, watch what they say.
Now go ask your billing department how hard it is to get Medicare to reimburse when you start your narrative with “Pt ambulated without assistance to Medic99.” Watch their eyes catch fire.
Your protocols should outweigh your policies because your policies cover you and your protocols your patients and we’ve covered more than once in this forum that this thing isn’t about us, it’s about them.
If Bubba’s had a few too many, he gets carried. If he’s going to reach out on the stairwell and twist in the chair causing my knee to go out, who’s fault is that? Bubba’s for reaching out or mine for not helping him down the stairs in the first place.
Have a serious talk with your system administrators if you are not permitted to let your patients walk to the ambulance. Show them the Chronicles episode and show them that I do it all the time and, gasp, no one dies.
But, and I hate that I have to add this, follow your established policies and protocols until otherwise advised by those who have the power to change things.
What a weekend indeed. As our regular readers are aware, it appears those 26 exhausting days back in November were worth it after all. Even though only the first half of our Project was turned into the Chronicles of EMS, the entire experience has changed the way I view my system.
This screen shot will take you where you can watch the show.
This past Friday saw the World Premiere of the Chronicles of EMS Reality Series in San Francisco. Mark and I arrived a bit early at the request of Producer/Director Thaddeus Setla and were quickly aware of the extensive set up on site. Multiple large TVs are linked to laptops and cameras, all relying on a tiny ethernet cable to stream it all live around the world.
The chat room got a bit colorful at times but we did notice those of you out there reminding visitors to keep things clean, even if they refused.
Before we knew what was happening, Mark and I were at a table talking with magazine reporters, investors, friends and readers, all excited to see the first episode.
Although we had a really nifty schedule of events, technical troubles and the wave of people in the Hotel Frank made that schedule difficult to keep.
Keep in mind this is all being put together by Paramedics, not professional live streaming folks. We can’t afford them yet.
But when the show went live, the room got quiet and I went to the back of the crowd to gauge reactions. And the were 100% positive.
Thank you all so much for taking your own time and money to help us show the world what we did and what we learned.
The following morning Ted loaded up the cameras, Mark and got a few folks from out of town we usually talk to over skype or email to sit down and talk with us. We fired up the cameras and filmed a sister show, A Seat at the Table.
It was more fun to film than I expected and we talked about a lot of issues. You can watch the show link for information on future table discussions and how you can join them live, each show has a laptop open to the chat room which has it’s own place at the table.
Whenever we travel with the Chronicles team, we hope to gather folks around the table and open the dialogue even more.
Thank you again for all your positive comments about the show, we hope to live up to your high standards in the future.
The pre-Chronicles retrospect of favorite posts continues with part 2 of the 3 part posts about a patient who didn’t exactly behave himself. My partner on this job recently went light duty and pulled strings to let me keep her spot warm while she’s gone.
Originally Published June 25th, 2009
Round 1 seemed normal enough, at least as normal as things get in the big scary City some nights.
Round 2 begins as I’m assisting Bubba down the stairs and he decides an elbow to my face would make his night better.
Luckily, I watch a lot of movies. Not fighting movies or martial arts movies, Happy is a lover, not a fighter, but I enjoy a good strategy and tactics film when I can.
I had 3 options as Bubba took his first of many swings.
Option 1 – Let him hit me. Um, no.
Option 2 – Try to duck or dodge out of the way. I’m not one for choosing the direction of an assault and I figured I had a 1 in 3 chance of moving the correct way.
Option 3 – Close the range to target.
What came to my mind in a flash was the Hunt for Red October. When he turns into the path of the torpedo before it can arm itself. My reasoning after the fact seems perfect, in the moment I just needed him to chill.
The bottom of the stairs had along it’s side a large wrought iron ornamental security gate, the kind we have to force open most days.
As Bubba moved with the elbow, I forced my shoulder into his, jamming him into the gate. My right leg got up under him to throw him off balance while my left hand dropped the computer and squeezed Bubba against that gate. I knew if he got me off balance and I went to the ground I was going to get hurt.
My partner was already on the radio screaming for police assistance. She had to scream to be heard over the screaming of, in ascending order of volume, Me, Bubba, the girlfriend…and mom, who’s voice had found new heights.
Bubba was my height and had at least 20 pounds on me. I was tired and sober, he was drunk and rested. My only hope was to keep him against that gate until the cavalry arrived. All I wanted to hear was the screaming of the police sirens.
I was able to get his right hand into mine and forced behind his back, now near my waist. His left arm, the one that swung the first time was pinned between him and the gate, not moving for now.
The scene from Pulp Fiction when Julius is telling Honey Bunny to be cool was playing over and over in my head and I’m sure lines from the scene were coming out of my mouth. All I remember is wanting to keep his 230 pound frame off balance and against the gate which was almost more than my one leg could do.
After what seemed like hours of holding him he began to calm and still no sirens filling the night air, only screaming. He promised he was “OK,” and I reminded him that I had no problem keeping him there all night if I had to, a thought my leg would most certainly disagree with.
I decided, possibly foolishly, to let him back down to the ground, partly for a rest and partly because he had indeed calmed. I kept his right hand behind him and made a reach for the left wrist, controlling both rather well considering the circumstances, I thought, and we slowly made the drunken, angry stumble towards the ambulance, feeling him squirming and trying to get free the whole time.
There in the middle of the street, mother still screaming and us now screaming at her to go back inside, Bubba sees an opportunity to try knocking me down again. He’s got one leg up on the rear step of the ambulance and one hand on the rail to climb in when, I’m told later by my partner, Bubba takes a swing. All I recall was seeing him shift his weight and losing my cheerful disposition.
He quickly found himself flat on the cot as I tackled him into the ambulance, landing one leg on his hip and one arm on his chest. I’m not entirely sure it was one maneuver but I would have loved to see the video.
As we’re struggling now in the ambulance, as if by stealth, a sea of blue rushes the back and there are no less than 3 boys in blue saying and doing things that I can not. They have him four pointed and are able to clearly shout over the rest of the commotion outside where I can make out at lest 2 more officers dealing with mom and the girlfriend.
I look at my partner and share a look of, “Holy s*it, did that just happen?”
I took off my duty jacket and took a deep breath throwing it to the bench seat in frustration, suddenly feeling the strain in my shoulders and legs from holding him for what turned out to be 4 minutes against that gate.
The officer looked to me and told me he was impressed I didn’t fight back. What I had taken as staggering towards the ambulance, they had seen from afar as him struggling and swinging elbows, all while I’m walking behind him.
The final part of our tale, Round 3, will be covered tomorrow morning, Friday as a perfect You Make the Call.
Another co-worker recently reminded me of when she and I met Bubba one night, leg wrapped in a towel, tied with twine and an attitude.
Originally published June 25th, 2009
The next 3 posts will cover 3 distinct parts of a rather interesting job.
Round 1 – The Dispatch
1:15 AM and the MDT tells me you’ve cut your hand. It also tells me you’re in your twenties. It doesn’t tell me if you’re seriously calling 911 for this. I assume you know more than I do about who needs an ambulance and away we go.
THE EMERGENCY
A man has accidentally cut his hand.
THE ACTION
This was a perfect storm of mystery, intrigue, alcohol and lies. The building is older and has a large partial S staircase leading from the street level to the first floor door. So when we start our trek up the dark staircase, the front door is out of our sight above us and to the right. I stood there at the bottom of the stairs, tired already from the first 16 hours of the shift, waving my arms at the motion sensor light that, apparently, has yet to be installed. Warning flag #1.
The door is open and I hear high pitched voices speaking, nay shouting, in a language I do not understand. As is habit I scanned the floor for blood. I see none. In the next room is Bubba. (See Glossary of Terms)
Bubba has his pants half way down and has a towel tied to his thigh with twine.
“Hi there.” I say, hesitant to put anything down quite yet.
He mumbles in response. Even just this slight mumble sends a waft of alcohol breath my way that would have caused me to fail the brethalyzer right then and there.
He’s telling a story about opening a can of oysters and missing, hitting his leg. Then, after a few questions he tells a different story about how he got cut. All the while I’m telling him I know he is lying. And all the while the mother and the girlfriend are shouting and won’t leave the room until my associate for the day finally convinces them to give us peace and quiet.
His leg is cut, not his hand…warning flag #2.
Using my Happy Medic skills we’ve convinced Bubba to come to the hospital to have the 5cm wide 2-3 cm deep wound from the chef’s knife examined.
Oh, did I skip that part? After arguing with the landlord Bubba thought it would be a good idea to get wasted drunk, grab a couple of knives from the kitchen and wave them around like a child demanding more dinner. Darn it if those things are sharp when you get a little too animated.
His mother and his girlfriend, who hovered over my discussion with Bubba in the room are still shrieking in their native tongue and Bubba is trying to shout back at them as I’m guiding him towards the front door and down the stairs.
Quick aside, the wound is wrapped, not bleeding and he flat out got angry when we tried the chair. Warning flag #3.
Halfway down the dark stairs I have my hand under his arm to help him balance, as I offer to everyone I treat. I have Bubba in my right hand, one step ahead of him and the electronic PCR in my left. I looked away to check the bottom steps. When I looked back up…warning flag #4, a swinging elbow coming my way.
Coming soon – Round 2 – the Struggle
Buried within all the excitement of the premiere of the Chronicles of EMS Reality Series is another premiere I’m proud to be a part of.
Over the years EMS has been serving their communities we seem to be finding ourselves out in the cold when budgets are doled out or reimbursement tables adjusted. The practitioners on the street, in the patient’s bathroom, bedroom, living room, deepest darkest days are largely ignored when industry heads meet to discuss where the trade may go.
They’ve talked of minimizing standards to maintain a constant flow of low paying jobs and EMTs eager to step on the gas and run the lights and sirens. Study after study showing one way is wrong so another can get a bigger market share. All the while our pagers are going off and alarm bells are ringing.
If we’re lucky enough to have a voice in the discussion, we are looked at as an afterthought. A nod and a smile greets our suggestions for improvement, often with a “we tried that before, it didn’t work” which is the EMS version of a pat on the head.
Various committees and organizations sprung up with a spot for us, among dozens of others, making sure we had no chance to be heard. EMTs and Paramedics were never given a seat at the table.
So we made our own.
Social media has us sharing ideas and concepts in a way they never saw coming. Research can be done from home instead of at a far off conference of owners and Chiefs all striving to prove themselves as having the best system. We can now call their bluffs, and they can call ours.
A Seat at the Table takes one element we discovered while filming the Chronicles of EMS Reality series and expands it into a format rare in our industry: Video. This element was the civil discussion of differences by street level EMS personnel who took the time to comment about what Mark and I were learning from one another.
There are plenty of EMS videos available for viewing online and by purchase, but never before has a filmmaker with a vision and a background in EMS taken up the challenge to document what we’re talking about.
Take a look at this snippet Ted Setla and I shot to explain to investors the power of Chronicles of EMS:
Chronicles of EMS – The purpose from Thaddeus Setla on Vimeo.
The Chronicles of EMS:A Seat at the Table is a table top discussion program filmed in the round and is scheduled to include as many people involved in the future of EMS as we can find.
Each time the Chronicles team travels, A Seat at the Table will be close behind to take advantage of the unique people we might meet and want to hear from.
Not only will we be sharing ideas, but getting answers to questions from those in charge of where we’re all going. Mark Glencorse and I will be there but you will be as well, following each episode as it is filmed HERE in the ustream chat room (scroll to the bottom). When you listen live to the filming, Mark and I will be monitoring your comments and questions for the panel and including them in where the show goes.
That chair you’re sitting in will now be at the table, a voice in where our young profession leads.
Watch the Chronicles page for updates about filming in your area and if you want to be in studio with us, let me know. thehappymedic@gmail.com.
Bookmark the link to the Seat at the Table page as upcoming episodes, topics and guest lists could change suddenly as we’re sent all over the world exploring how EMS systems operate.
See you there.
My EMS adventures in Newcastle upon Tyne had come to an end and I had but one full day left in England. Swalwell Station Manager Peter Mudie has arranged for me and Mark to take a bit of a tour of the capabilities of the Tyne and Wear Fire and Rescue Service, so we’re up early and he’s taken us for a road safety class.
Not for me, thank goodness, but for a group of young drivers to impress upon them the importance of not drinking and driving.
Many of us have been to these presentations before. A middle aged expert prepares what to them appears to be a hip multi-media presentation and the attendees seem less than interested. I was the same way at 16, we all were.
Enter the Happy Medic and UKMedic999 and the class is now wondering what just happened.
The presentation was actually one of the best I’ve seen including some racy videos that in the end have a message about driving safely. The kids were really paying attention then. Mark and I had a chance to impress upon the gathered youth the importance of seat belts and driving safely. I think my “accent” kept their attention more than my content.
Even the locals were cold. Mrs HM knit me two hats, so I shared.
Then it was off to the yard behind the station for an extrication drill to show the new drivers what happens when cars collide.
Set up down the hill were two cars and two students were chosen to be the victims.
To say it was “balls cold”, as one student put it, would be an understatement. I’m a 6th generation Californian, 50 is cold for me. This yard was cold. Wind blowing, snow falling and me with no gloves.
The kids watched as their friends shivered in the cold while the fire appliances pulled up and began their task. I mentioned in passing to the instructor that I would have let the kids go back inside and he suddenly had a point to make to the youth suddenly more interested in each other than the hydraulic tools freeing their friends.
“AYE!” He shouted to the huddled, hooded forms, “You’re here wearing your coats and gloves, hats and whatnot, but what if you were heading back from your mate’s place and were wearing only a shirt and crashed?” He was moving around in front of them, almost pacing like a drill sergeant, “Laying in the snow, cold, tired and hurt? You wouldn’t last very long would you?”
He had their attention the rest of the morning.
The extrication was straight forward with the only difference being the use of the smaller ladders to brace the car on it’s side.
After a lunch cooked by the station’s french chef (Yes, the chef is not a firefighter) it was off to Tyne and Wear Fire Headquarters.
What an impressive building and training ground they have!
A grand foyer greets the visitor and many small groups of men are sitting in plain clothes discussing this and that. One of them, the only one wearing a shirt and tie sees my SFFD Firefighter/Paramedic jacket and does a double take.
As I surveyed the enormous complex I would assume candidates are intimidated when they enter to get their employment packets. Peter led Mark and I on a brief tour of the lower level and the man in the tie wandered over and said hello. Just a casual greeting, he seemed like a regular guy in a sea of white embroidered uniforms and street clothes.
Chief Bathgate, Yours Truly, Peter Mudie
The man in the tie wandering the lobby is none other than Iain Bathgate – Chief Fire Officer for Tyne and Wear.
blink. blink.
He offered a hand and I shook it. There I was in my uniform shirt, but buried under a sweatshirt and a jacket. Had I known I was going to meet the Chief I would have at least donned my cap and tie to show respect.
Turns out he was more interested in the back of my jacket than what wasn’t around my neck.
“You do both then?” he asked me.
“Not often at once, but yes, I am proficient in both skills” I replied, wondering if I should go into further explanation. As we spoke the other men were taking interest in the fellow with two titles on his jacket their Chief was talking to. He immediately suggested a tour of the training grounds, something his face glowed about, he was proud of it.
Through the main lobby and out another set of large glass doors was their training facility, easily 5 acres and including a wide variety of props.
There was a standard training tower that, since once at the top one could peer over to the automobile manufacturer test track next door, was rotated and modified to keep wandering eyes away.
Next to that was a high voltage power line tower prop for high angle rope drills. Under construction nearby was a large two story collapse house that can be dropped and rebuilt quickly to simulate rescues.
A number of burn buildings stood ready for recruits and in service crews alike, one of which was in service when we visited.
But the piece of equipment that caught my eye as special was their train rig. Over behind the airplane prop and the piles of wood was a full size train car half in a man made tunnel. 
I wish we had one.
Half way through my tour, Mr Bathgate dismissed himself and went back to running what appeared to be a well funded and well respected organization.
Mark, Peter and I finished the tour and the Department had a photographer come down and snap a few pictures of us in front of some of the appliances. then a few minutes later she rushed out with a stack of nice photos for me and Mark to remember our visit.
The only comments Mr Bathgate made regarding the wording on my jacket was, “Oh, we’ll not be doing that here” which is something I’m not unused to hearing from the Big Red Machine.
Same System, Different Country.
I’ve got a few more posts worth of observations and anecdotes that I’ll be saving until after the Chronicles of EMS premiere on February 12th.
Thanks to the Chronicles of EMS, both Mark Glencorse and I will be attending the JEMS EMS Today Conference in Baltimore, Maryland, March 5th and 6th.
It’s a big deal for us to be able to spread our message to as many people as we can and there is no better way to share ideas than face to face. Even though we can communicate here in the internets machine, Mark and I didn’t really see what each other meant until we stood shoulder to shoulder in each other’s systems.
Since it will be a little while until we can get to everyone’s systems and learn from everyone how best to deliver EMS, heck even what EMS means anymore, we’ll travel as much as we can to meet you and keep the dialogue open.
That’s where our sponsor ZOLL Medical comes in.
SFFD Zoll Rep Roy Kniveton was kind enough to give the Chronicles of EMS team a run down of things coming from Zoll and let us put the new E Series through some quick tests. Not any of that scientific lab type stuff, but medics dragging it around a room type tests. Roy even offered to let the 100′ aerial ladder truck run over it to show it’s durability.
The truck officer declined the request.
But aside from coming in and letting us see what was new, Roy actually listened when we told him about our growing following. He was genuinely interested in the EMS 2.0 movement and did some quick searching to see what we were interested in getting from our equipment in the future.
We must have done something right because our near future included a generous sponsorship in our pilot episode and flying Mark and me to Baltimore for EMS Today. We will be Zoll’s guests at their booth and we’re looking forward to meeting all of you and answering questions about the Chronicles show, new concepts coming in social media TV and anything else you want to talk about.
I’ve never had anyone fly me anywhere before.
And to EMS Today no less. Check out the web page HERE and look for JEMS Editor in Chief AJ Heightman to wander in to give you the details on all the exciting things happening around me and Mark. Yes, there will be more than us ruggedly handsome frumpydumple fellows.
If you get a chance to make the premiere of the Chronicles of EMS in San Francisco on Feb 12th, we’d love to have you, sign up to let us know you’re coming HERE. And a special thanks to EMS1.com and AAM Consulting (Randy Africano) for sponsoring the premiere event at the Hotel Frank. More about them soon.
See you in SF.
See you in Baltimore.
My name is John and I am 63.
In just over 3 years time I’m going to be driving through your jurisdiction just as you are sitting down to your first meal in 12 hours. As your order hits the counter I will experience an odd tightness in my chest and dismiss it as gas.
When you take your first bite my wife of 35 years will watch me clutch my chest and stop the car on the side of the road.
Just as you begin to think your bad day is finally slowing down, the worst day of my life, and possibly the last, has just begun.
I’ve slumped over in the car, releasing the brake pedal and the car drifts into a signpost, discharging the airbags.
My wife is hit by the passenger side airbag as she is leaning over to help me, noticing my unconsciousness just prior to her own.
A passerby has stopped and is now describing a motor vehicle accident to your dispatcher.
Lunch is still warm in your hands when your radio alerts to the accident.
You are tired.
You are hungry.
The kids have been keeping you up late.
The rent is past due.
Big deal. I’m about to die. While you’re cursing me walking to your rig, my MI is moving and my wife’s head injury is complicating what is already going to be a difficult airway judging by the amount of teeth on the floorboards.
As your rig negotiates traffic, my respirations are rapid and shallow, my wife’s now non-existent.
When you pull up to the scene I need your A game. I need you trained to the point where what you are about to do comes as naturally as breathing, because we’re having a bit of trouble in that department.
This is not about you. It’s about me. It’s about us.
So back to your studies, we’ll meet again before you know it.
It 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?
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.
HM
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.
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.
The 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.
It 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 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. 
Then 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.
I left off soon after our first job on the car which had me wanting to see the versatility of Swalwell 405, our Rapid Response Car. I was beginning to wonder if I had built it up into more than it was when the universe stepped in and answered my questions, as always.
A school child was ill with a unique condition that was familiar to the child’s brother at the school as well as the mother who had arrived on the scene before us in the car. When Mark had determined the non-emergent condition of the 10-18 year old (not a little one is the point) the ambulance was canceled. There it was, the front loaded model in action. A trained set of eyes able to determine no need for a two person gurney transport, so the unit is canceled ASAP. Should transport be needed or requested (which it never was, save once over there) the patient was appropriate to sit in a car, seat belted, and driven to the A&E or clinic.
Through the course of the evaluation Mark and I both asked a variety of questions trying to get to the center of what the unique condition was doing to our patient. In the end, Mom decided she would follow up with their Doctor later that day and she will let the child rest at home, something that usually helps when the child feels this way. Mark offered to follow Mom back to their house just 5 minutes away just in case something happened. Not sure exactly what that might be I was even more excited when he said, “Or I can just take her in the car and follow you home. Would that make you feel better?”
The mother smiled, blushed and sighed. “Would you?” Mark smiled and assured her it was no problem at all and we escorted our patient to the car and drove her home. There was never a point where this patient needed a hospital, let alone an ambulance based on the mother’s description of the unique condition and other factors revealed at the scene. In San Francisco I would have had to transport the child or send them home with Mom. In my experience both parents are often working and unavailable to respond to the school, and that’s IF they even answer the phone number given on the emergency contact card.
5 minutes and a car made a huge difference for resources in the area. I was sold on it right there and then and a number of other calls re-enforced the benefits of the RRC. The old man with the hurt wrist who we gave a ride to the clinic, leaving the ambulance available. The baby with a cough who we gave a ride, strapped in her seat with Mom along for the ride. None of them needed an ambulance but had no other way of getting evaluated for their chief complaint. In San Francisco a 4 person ALS engine and 2 person ALS ambulance, 6 people and$600,000 worth of apparatus to do the job of 1 man and a ford station wagon. It was reading through the real estate section looking for a house to buy that a call came in that would change my mind about the current NEAS system. A certain resource issue that is.
This is the section Mark has been waiting for. All through our experiences he has been wondering what my real opinions were/are/will be and I kept telling him, “I already told you.” But I have to share with all of you or else this is all for nothing, right?
The ambulances currently used by the NEAS are inefficient when it comes to treating a patient enroute or dealing with more than 1 patient. I use the term carefully since when a rider is placed in Mark’s ambulance and a patient is in the cot, half of his kit is inaccessible. The large gurneys load into the open space in the rear of the ambulance and latch into a sliding platform that can move the gurney from the wall to the center of the floor for the simple reason of accessing the patient’s left side. This removes space for a bench seat and moves the patient a good deal away from a practitioner in the back. I had difficulty imagining Mark working a proper patient, rolling blues to the hospital and being able to access anything quickly and safely. This photo is from Swalwell Vehicle 214, which we worked on later in the week, but show the head of the cot and the fold down seat for a family member or rider. the cabinets slide out of the wall so when they are closed they are secure and not accessible. More on that when I discuss working in these Vehicles.
That being said, I did like being able to almost stand up completely and have all the light and vent controls in an overhead consul instead of buried back in the corner near the shelf near the captain’s chair like in many type IIIs here in the US.
Working a motor vehicle collision with more th
an one patient opened my eyes to the benefit of multiple hands on the scene. We arrived soon after the police and began assessment. An ambulance had already been dispatched and when they arrived I had my first glance into one. Whoa.
The crew opened the doors and a large lift was raised and the gurney loaded onto it. Then it was lowered to the ground and removed to our location. In all less than 2 minutes, but still seemed like a long time. I’m an immediate satisfaction type of guy.
When the first patient had been boarded and was being loaded I saw Mark reach to his radio and request another ambulance. I stopped, looked around the crew loading the first patient in and that is when I saw there is no bench. No place to put a second patient on a board. Neither of the patients needed critical care interventions, just C-spine precaution, routine medical care and assessment, something I’ve done to 2 LSB folks often.
It was an awkward wait in the middle of the highway for that second ambulance. During that wait, on the other side of the highway went a fire engine. In service, staffed, yet not dispatched to the motor vehicle accident on the highway. The first emotion was confusion as in, “Why can’t they respond to assist?” which gave way to frustration, “Lazy brigade won’t even hang a u-turn and check on us?” then reality sank in, “They couldn’t help right now if they wanted to.” No fluid leaks, no fire hazard, the road was already safely blocked by the highway department and all we needed was a place to put a patient on a backboard.
My plans to move over were put on hold. For all the benefits there were indeed drawbacks. Of course there would be. But so far, the only thing missing was that ability to take a second backboarded patient and have access to all the equipment in case of a proper patient. Especially since Mark spoke of having to do CPR and push drugs alone in some cases.
But what is the answer? The NEAS used a Chevy type III years ago and it didn’t work out. From what I’ve been told I think it was a combination of politics and underpowered motors, not necessarily the patient care compartment. That conclusion is drawn from a number of conversations with a number of NEAS folks.
It was made clear to me when I brought up my observations to Mark that the governing bodies mandate the secured nature of all the equipment in the ambulance and that repositioning it would not only take a completely new vehicle, but changes in rules and regulations country wide. So the work is cut out there. However, to be fair, Mark took one look into the back of medic 99 and nearly passed out. Nothing secured, supplies behind flimsy plastic doors, no cot lift, it was a recipe for injury in his mind and the mind of his regulators.
Is there a middle ground? Wheeled Coach, Medstar, there are so many different manufacturers just here in the US, what are they using as the basis for their designs? And what about Mark’s ambulance manufacturer? Are they deciding what is best for us or are we? I have yet to work in an ambulance where I thought to myself, “This is perfect!”
See Mark, all things I told you when I was there. We even discussed it in a video report later in the trip.
A few more jobs and we were back to the station for end of shift.
The spot on swooning British nurse impression Mark does was not actually spoken, but he was told repeatedly that I looked “nice” in my station uniform. Funniest thing was, I was cold and wearing my coat most of the time and he had me remove it before going in. I think he’s angling for a different style of uniform.
The end of my first day on the RRC brought smiles from me and from Mark and a look forward to another wonderful evening with my extended UK family. Tea with Margaret, Sandra and the Boys was my family time. Had I had the time to bring Mark the hour home with me each night here in SF, I think he would have had a much better experience and I now regret not being able to share that time with him.
Back to the hotel and a warm shower and inviting bed. Tomorrow would be another big day on the car and an afternoon of local heritage, discussing Event EMS and an explanation of this photo:
Steph? Steph Frolin is that you?
After following Mark’s day by day adventures, I’m dragging you right along on the second week, the one not covered by the Chronicles of EMS cameras.
But why is this going up at 11PM your time Happy? Because that is 7 AM Newcastle time. Wrap your head around that one and let’s get started.
Mark’s San Francisco adventure covered 10 days in total and he was clearly as exhausted as I and likely more. I last saw him at the BART station on the way back to the City and then to the airport.
I wouldn’t see him again for 48 hours.
In that time I let my girls crawl all over me, literally and figuratively, all the while packing and preparing for my England trip. When the time came to board the plane emotions were high. The littlest one giggled when I gave her a kiss, the older one asked me to say hi to Mark in England. She seemed to be taking this experiment remarkably well considering the enormity of it and her comparatively small understanding of the world. The Mrs was understandably emotional and supportive, something she does very well. I had already given 10 days to this project rarely seeing the girls awake, if at all, and was about to give 10 more.
Into the airport I saw the car drive away and took a deep breath. This was not going to be easy.
The plane was packed. I had one of the window seats, but they neglected to tell me the foot room is severely restricted thanks to the new video on demand units. I had been to Seat Guru, but it seemed every seat sad that. In exchange for a place to put my feet I had dozens of movies to watch to take my mind off the tingling in my lower extremeties.
The time difference was 8 hours ahead. To help deflect the impact of the time change I knew I would have to get on the plane, eat and get to sleep as soon as possible, then sleep most of the flight. The last time we flew across the Atlantic I fell asleep during the safety video, then not a wink the rest of the flight, I was exhausted 20 hours later.
Imagine my surprise and pride when I finished dinner, put on my headphones and fell asleep. Then again we medics have been known to fall asleep in odd places at odd times.
I was awoken an unknown time later (6 hours I discovered) to the following conversation:
(This was an Air France flight)
“Keep heir on ze oxee-jin and we can moove heir to zee floors.”
Oxygen? Moving someone to the floor? This sounds like a job for…
…the flight crew.
Watch this video from my layover in Paris to find out what happened next:
After a quick commuter flight from Paris, we landed in cloudy, rainy, windy Newcastle, met by a somewhat rested Mark Glencorse.
Newcastle International Airport
I was whisked away to mark’s home and welcomed as family. It was nice after a long flight to sit down on a couch surrounded by familiar names and voices. We enjoyed a wonderful dinner (Tea, I was told to call it, the evening meal if you prefer) and the perfect start to what would become an exhausting week.
Even though my family was far away, I had a new one just a few minutes down the road.
I had shared a family story that my late Grandmother was fascinated by the King Arthur legends and that recent research believes Arthur to have been a Roman General defending Hadrian’s Wall from Northern Invasions. I had mentioned this in passing on an episode of EMS Garage and Mark and Fiona had heard me. Fiona scheduled a dinner meeting at the Swan Inn in a town called Heddon-on-the-Wall who’s cathedral was built with stone from the wall.
I was hoping for a brief time during the trip to go out to see the wall my Grandmother spoke of, but didn’t expect much at all. Little did I know that, on the drive back to the hotel, we passed by part of the wall there in the middle of town. Mark made it a nice surprise and swung the car around, parked and said, “There’s your wall, Mate.”
I froze. I had trouble moving for a moment. It was kind of like meeting someone you admired. I climbed out of the car into the cold night air and took a deep breath. I could hear my Grandmother’s voice as if she was right there with me. “He stood here. He garrisoned here. This is history.”
It was a small section, only 6 feet wide, maybe 30 feet long and a few feet tall, in a protected grass area near homes, but it was the wall she spoke of.
I took a few photos and a quick one of me on the wall before heading back to the hotel to rest. As is now a Chronicles of EMS custom, the internet was pay as you go, so uploads were going to be difficult.
Mark dropped me at the hotel and I went straight past the pints in the lobby and straight to bed. The first day on the Rapid Response Car was waiting for us early the next morning and I wanted to be ready for it.
That story, and video of what I look like before coffee, next time.
I didn’t know such a call would cause such a commotion in the comments section both here and on facebook. THIS is a situation we encounter often in my jurisdiction. Almost 30 percent of the calls our call center handles require a translator of some kind.
The main thing I was looking for on this one was what options do you have as a caretaker to help this man aside from loading him up and driving away. Seeing Mark in the UK have access to other options is always in the front of my mind now when I encounter calls like this.
Our patient did not call, his family did. The family states they were not told what the discharge form said when they left the doctor’s office this morning following his endoscopy of the esophogus. The paper details a recent diagnosis of liver cancer and colitis and that he should expect the exact symptoms he is experiencing. We were able to use a 14 year old family member to confirm with the patient he did not want us there and by no means was he going with us or signing anything to make us leave.
They tried calling the doctor’s office but got no answer since it was after hours. Unsure what to do next, they called us. There were numerous family members worried about him and willing to bring water, broth, noodles or anything he needed to get back on a normal diet. He had not eaten all day due to nausea, from the meds most likely.
We were fine leaving him in his home to recover, as directed by his physician.
Whether they were not offered translators or the phone call went unmade or the family simply didn’t understand, it is clear that the ball was dropped long before I walked in the door. It can be hard to paint the picture accurately for you on these You Make the Call runs, but clearly I painted this man sicker than he was. Readers on Facebook spoke of MIs presenting as abd pain and wanting to run 12-leads and treat ACLS. I noted that his regular hospital was on saturation divert, meaning that even if we do transport, he likely wouldn’t be treated until they can confirm his history, which could take awhile on a good day.
The discussion ran into pushing pain meds, anti-nausea meds and transporting to remove the discomfort and remove any liability, but the best decision in this situation is to honor the patient’s wishes and do our best to clean up wherever the system has failed him.
But, that being said, without the translator, without the discharge papers or if he was alone, he’s on the hook and we’re on our way.
Because it all came together, he was welcome to stay home. If you said honor the patient’s wishes and let him stay home, you made my call.
This tale comes to me from another co-worker and his old department.
It turns out he chose to approach his own supervisor, one not involved, and mention what he believed to be an inappropriate situation. He brought up the use of the command vehicle and the possibility of an inappropriate on duty relationship.
And wouldn’t you know it, he was officially reprimanded for spreading rumors and falsehoods. Both parties involved denied the vehicle had been seen there, especially since one of them was married at the time. The write up was one of the inspirations for his leaving to another department.
A few years later, the two parties who denied their relationship were married.
Regardless of the end result here, bringing this to the attention of your front line supervisor is the right thing to do. Approaching the parties individually could get messy. The main point I drew from this situation is that the supervisor is using his duty car on duty to partake in a personal endeavor of questionable appropriateness.
Instead of command vehicle, replace it with Fire Engine or Police Car and see if you feel the same way.
If you said report it, you made his call.
There are many things I wanted Mark to see while visiting the SFFD EMS system. Not once during his trip did he experience the mad shuffle that is our resource allocation when we drop to level zero. What he did get to see was the rampant abuses in the SF 911 system and the paramedics helpless to do anything about it.
I don’t want to ruin the pilot episode of the Chronicles of EMS by telling you about specifics that Mark was able to witness (All with the patient’s full permissions of course), but I wanted to touch on something I didn’t see in the UK system in my short time there: 999 abuse.
Of all the calls we ran, I can think of only one that didn’t have a legitimate need for medical evaluation by someone higher trained than a Paramedic. Notice I didn’t say ambulance, because of the versatility of the NEAS Pathways system. This one person claimed to have a condition that he clearly did not, yet wanted the ambulance to take him in regardless. It was clear to everyone on the scene that it wasn’t necessary, but away we went anyway, just to be sure.
Most of the other persons who dialed 999 and got the tall American Fireman were simply looking for medical advice when they were scared or frightened. Does anyone remember the last time someone called 911, you responded and THEN they made their decision based on your assessment and advice? It sure as hell was more than 11 months ago, I’d wager even more than 11 years ago.
the Project has shown me how we in the EMS Profession have allowed our abilities and responsibilities to be hijacked. We are no longer help arriving in a time of need, but a means to get into the ER. Granted, the few instances when we have to say, “No, always call us if this happens” through gritted teeth to the old man who fell out of bed aside, I have been told to do my job and take someone to the hospital for the last time.
My job is not to take someone to the hospital, but to assess their complaint and devise an appropriate treatment, if necessary. Not drive someone to the hospital, especially in my new fire engine only capacity.
Imagine you drive a tow truck. Someone calls stating their car is broken down and they need a tow. When you arrive you find their stereo is broken, but they want the car towed to the shops, just to be sure. You’d hook that car and be glad you can bill them, right? But what if you ran a free towing service and other cars were actually broken down, needing you more? Another one of my bad analogies for sure, but one that always creeps into my mind when I meet folks who decide to go before I tell them otherwise.
No longer should we let our clients dictate their transport options without a complete assessment and history, condition permitting. In an emergency, we will obviously default to transport, but what about the other 95% of our business? The ones who decided to goto the hospital hours ago, but waited to call us for their stubbed toe, or cough, or fever of 101, or sprained wrist? They have grown accustomed to a level of service they do not need. They are entitled in their minds and it is not just a certain generation, this cuts across all economic and age levels.
ALS units flying through traffic to meet that magical response time, and for what? A sprained knee? Painful for sure, urgent certainly, an emergency…debatable.
Somewhere along the line lawyers wiggled their way into the medical care field, willing to pull the trigger and sue any paramedic who flinches and tries to tell their car accident victims that going to the ER when uninjured will not help them in court. I find myself practicing defensive EMS all the time, it was witnessed by Mark more than once, most notably on a minor scooter accident he can elaborate on.
But it’s easier to C-spine everybody than to learn how to clear, prove to your medical director you can be trusted, and then do it right?
Enough of what’s easy. Enough of playing to the lowest common denominator. Enough of listening to someone with ZERO training and education tell me about how the shoulder articulates, not even able to name a single bone, muscle, nerve or blood vessel in the area. Tell me what happened, what hurts and what doesn’t and let me do my job. Answer my questions honestly. At the end I’ll tell you what I think and discuss with you your options and what I believe is best.
“That will never work!” You shout at your computer. I saw it work. The problem is convincing the newly retired man that he can drive to the ER or clinic himself for the insect bite from 2 days ago, provided he stops scratching it to make it red every time I can’t find it on reassessment.
We are the reason our clients are so poorly informed. There is abuses of the 999 system, there have to be and reading Nee Naw, we know there are, but I didn’t see it in my 4 days with Mark and the NEAS.
So what can we do to make people understand we are more than a flashing lights taxi service?
That is what we need to focus on and something I hope to expand upon in the very near future.
The Chronicles of EMS Reality Series was filming Mark’s visit to the SFFD, in case you haven’t been reading this blog. Or twitter. Or Facebook. OK, I think everyone knew that, but did you know being filmed while doing patient care is tough?
Our pal Mark has had cameras along for the ride before. This was my first time having non co-workers and non-family members in the back of the ambulance with me. Having a preceptor in the back is hard enough, but having these guys back there can really make you sweat. In case you’re thinking it’s no big deal, keep in mind how many little things you do that might not be the exact prescribed method. Little short cuts and tricks that help you do your job better, but might need a little explanation can give the perception that you don’t care.
I hope I don’t come off that way on camera. Having Mark, a fully licensed Paramedic, watching was OK, but directly over Mark’s head was a large mounted camera capturing the entire patient compartment. Next to Mark, near the pass through was Producer/Director and also licensed Paramedic Ted Setla, camera moving to capture my movements as I treated. Then at the edge of the bench seat was Camera Stud (My term, not his) Chris Eldridge moving his camera around as well, making my wonder what they were capturing.
At a motor vehicle versus pedestrian accident, I made my scene survey and made patient contact, Mark close behind. As I got a report from the engine company I took another look at the car involved and there on the other side of it, looking at me, was the Dridge and his camera. Turning a quarter to my right, there was Ted, doing the same. I didn’t want to be that Medic we all hate to see, doing something stupid on camera. “Just do what’s right and nothing goes wrong,” was all I could hear in my head. Could they see me sweating hoping I don’t screw up the IV or make a wrong decision?
It turns out, on that run at least, I appeared calm and collected, even though I was screaming on the inside. Ever had one of those patients that just needs to calm down and relax but won’t stop crying? Mark stepped in, sexy accent (Her description, not mine) and all to calm her and hold her hand while I worked. Strong work, Mate.
No pressure. Just act natural.
It’s easy to say “just be yourself” here in my recliner, but saying that over and over again at the time made me even more self conscious of the cameras and what I was doing. It didn’t change any treatment, everyone got what they needed, but it really made me focus on the little details. Where normally I would leave a sharps down (our caths auto retract for safety but I like to get a sugar off of it later) on the chux until later in the run, I now swiftly secured it.
Times when I would tell patients, and especially clients, that they need to stop smoking, drinking and shooting heroin to get better, I made more of a broad speech about personal responsibility. My usual speech comes off a bit preachy I’m told, so I left it behind.
And it’s not just the emergency calls that makes having the film crew along rough, it’s the down time.
Let me choose a better phrase than downtime, “Interviews.”
After every run and most spare moments we talked on camera about our experiences to that point. If we had nothing to say, we were updating twitter and facebook with photos and thoughts, always trying to keep you guys up to date.
On the ambulance the cameras were pretty easy to get used to, but on the engine it was just the Dridge. He would go running to the engine when the first bells hit, climb in my side and across to the other side of the engine, staying as out of the way as you can with 4 people in a 4 person cab. After the Dridge, Mark would climb in, giving me room to turn out or in case of a medical, just climb in and take my jump seat. Getting dressed for a fire in a moving fire engine is a learned skill. Doing it with a camera rolling isn’t much different, but with all seats full and gear all over, it took a few runs to get the hang of it.
I hope the footage they got gives you the story of what we went through. There wasn’t a lot of helicopter action, no MCIs, and nobody fell in love. As far as I know. So it’s not the usual EMS show that has been thrown at us before we could duck. I’m excited to see how the Chronicles team puts it together and shows it to you. Although you already know what is going to happen, since you’ve been following along the whole time.
More updates on the Project and Chronicles of EMS to come, including my thoughts about the NEAS Administration, giant patient compartments with extra space and something I like to call a bad ass training facility.
One of the things that drives me nuts is the public constantly thinking I’m a police officer. While Motor Cop likely giggles at that idea, I commonly respond to these people by pointing to the fire engine and then at my hip. “No gun, fire engine.”
One thing I noticed both here and in the UK with Mr Glencorse was the unmistakable uniforms he and his fellow ambulance employees wear.
The green jumpsuit. They also have green pants and polo shirts, vests, fleece jackets and the high vis jackets, but everything revolves around that green color. It made it easy to figure out who was who at an accident scene for one thing.
We wear a navy pant, navy shirt and navy jackets and sweaters/sweatshirts, just like the police do. More than once in England, wearing my SFFD uniform, I was spoken to as if I was law enforcement. One woman, when I asked if she was OK after a minor accident, began to go into detail about where she was coming from and how fast she was going.
Mark would love it if I came out asking for the green jumpsuits over here, not going to happen. When Mark took me around to meet the nursing staffs at local hospitals in the UK, they all commented about my uniform and badge. Mark groaned and laughed, but kept introducing me. They just aren’t used to Paramedics that look like police officers, or firefighters for that matter.
But I am pretty sure Mark has never been mistaken for anything else other than what he is. Most of the garments are labeled simply “Ambulance.” I have always appreciated the professionalism that my current uniform reminds me of, especially as many departments are now wearing t-shirts and shorts and wondering why no one takes them seriously.
I also appreciate that my department still honors the cap and tie and the traditions they represent. When we are sent out of our regular stations to another house for the day, it is tradition to wear your cap and tie and make proper introductions first thing in the morning. Even though it is met with smiles and everyone saying, “Take that stuff off,” not wearing it gets you noticed even faster. It is a sign of respect to the regular members of the house and is a little bit of the past I like to have around.
That would be odd in a jump suit or polo shirt.
But Mark doesn’t have the same responsibilities I do in the fire house and a jumpsuit would actually make the transition from EMS to Fire quicker and safer. Imagine just zipping out of a jumpsuit and into your turnouts instead of unbuttoning a shirt, then pants. I doubt there is a happy medium there.
But what about colors? We wear different colored helmets and helmet shields, maybe different patches, why not a completely different uniform?
Because we’ve always worn these and they work just fine, we just need to figure out a way to convince the public that not everyone in navy blue outside a coffee shop is a police officer.
Does your service have a distinctive uniform?
