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Alphabet Soup

Justin Schorr, FF/NREMT-P, WhO.C-arES

Emergency Services seem to thrive on certificates.

I’ve got some paper on my wall, I’m very proud of it. At times I mention it behind my name when trying to gain credibility for what I am writing, saying or presenting. People pay more attention when they know you are trained in what you are about to tell them, right?

But looking through some old files a few days ago I came across my last college paper “Shortening the Chain of Survival” in which I studied and showed the importance of, wait for it, early ALS intervention.

What bothered me right off the bat was how hard I was trying to establish myself on the title page. I included my rank at the time, my NR status, my MICU cert and 3 more abbreviations I had earned at school.

I sure was trying hard to prove that paper legitimate, perhaps not relying enough on the paper itself.

Wandering through some recent issues of the leading EMS magazines and articles on leading EMS websites (blogs excluded) we can see folks doing the same thing. An article is submitted and, as if to make us believe they’re an expert right off the bat, the letters start to get added to the name. RN, NR (Which I just noticed mirror one another) MD, BSN etc etc.

As a struggling profession it is as if we are clinging to any semblance of formal education to catch up to the MD, RN, BSN, PA etc, sometimes without reading through the things we propose to let them stand on their own merits, just like that paper I found.

Talking with a father and son Firefighting family at FDIC, I saw a generational divide on the perception of the letters after the name. The father, near retirement, wanted to hear more about the letters I had earned, while the son seemed more interested in what can be learned on the job. Book smarts vs street smarts all over again.

There aren’t many high school kids writing policy these days, however, no matter how much it seems like it, so maybe a touch of credibility is warranted.

When we present something, an idea, a new protocol, procedure or concept, perhaps one set of letters is appropriate, but let’s call it good there, shall we?

Posted by Justin Schorr on September 2, 2010 • Filed under: Administration & Leadership, Administrative, Command & Leadership, EMS 2.0, EMS Topics, Fire Rescue Topics, Training & Development

UKMedic999 AIQ

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Break out your green and yellow backgrounds everyone!

“Welcome Back” doesn’t seem right since you were never really gone, just on a long job. Now you are back home.

Posted by Justin Schorr on August 28, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS 2.0, EMS Topics, Fire Rescue Topics, News, Technology & Communications

Gearing up for Tak Response

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

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

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

Let’s start to train together.

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

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

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

Posted by Justin Schorr on August 25, 2010 • Filed under: Administration & Leadership, Administrative, Command & Leadership, EMS 2.0, EMS Health & Safety, EMS Topics, Fire Prevention & Education, Fire Rescue Topics, Firefighter Safety & Health, Fires, HazMat, Mass Casualty Incident, News, Special Operations, Technology & Communications, Training & Development, Videos, training-fire-rescue-topics

Criteria based on what?

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

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

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

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

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

Problem is, it doesn’t work.

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

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

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

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

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

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

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

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

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

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

“Then what’s the answer, smart guy?”

Ditch the codes. Stop the tiny box requirement.

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

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

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

GIGO.

They relay what they are told and code the call.

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

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

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

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

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

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

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

Posted by Justin Schorr on August 24, 2010 • Filed under: Administration & Leadership, Administrative, Command & Leadership, EMS 2.0, EMS Health & Safety, EMS Topics, News, Patient Management

You Make the Call – Hired

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

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

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

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

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

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

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

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

You make the call.

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

Posted by Justin Schorr on August 20, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Patient Management

You Make the Call – The Bar – What Happened

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

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

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

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

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

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

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

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

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

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

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

Posted by Justin Schorr on August 16, 2010 • Filed under: Administrative, EMS 2.0, EMS Health & Safety, EMS Topics, Fire Rescue Topics

You Make the Call – The Bar

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

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

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

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

You make the call.

Posted by Justin Schorr on August 13, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, You Make the Call

Beyond the Lights and Sirens

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

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

Posted by Justin Schorr on August 11, 2010 • Filed under: EMS 2.0, EMS Health & Safety, EMS Topics, Fire Rescue Topics, News, Technology & Communications

May I have the definition please?

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

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

It’s funny, right?

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

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

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

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

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

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

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

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

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

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

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

Absolutely.

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

“This is a Starbucks.”

“This is a library.”

“This is an ambulance.”

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

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

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Posted by Justin Schorr on August 9, 2010 • Filed under: Administration & Leadership, Administrative, EMS 2.0, EMS Health & Safety, EMS Topics, Patient Management, Training & Development

Psychokenisis in EMS a reality?

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

THE EMERGENCY

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

THE ACTION

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

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

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

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

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

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

He has no medical complaint.

He has no injury.

He simply wants to go back to sleep.

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

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

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

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

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

The MAP van.

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

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

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

“I can do it all,” He replied.

Posted by Justin Schorr on August 8, 2010 • Filed under: Administrative, EMS 2.0, EMS Health & Safety, EMS Topics

800 What?

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Words. I want you to write 800 words.

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

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

But here’s the challenge:

Don’t use the term “Social Media.”

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

Think you’re up to the challenge?

Convince me.

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

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

Prizes to be announced shortly.

Posted by Justin Schorr on August 6, 2010 • Filed under: Administration & Leadership, EMS 2.0, EMS Health & Safety, EMS Topics, Fire Rescue Topics, News, Technology & Communications, Training & Development, technology-communications-ems-topics, training-fire-rescue-topics

This is for you new people

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

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

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

1. What happened?

2. What is this man’s GCS score?

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

4. Could this be his normal mentation?

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

If you replayed the video, you cheated.

Posted by Justin Schorr on August 3, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS 2.0, EMS Health & Safety, EMS Topics, Firefighter Safety & Health, Patient Management, Training & Development

Overheard in the Firehouse

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Fireman #1 -”What kind of cookies are you making?”

Fireman #2 -”They look like married cookies to me.”

Fireman Chef -”Why do you say that?”

Fireman #3 – “Because they looked really good when you started, but now after all the heat, not so much?”

Fireman #2 – “No, because they’re all touching each other.”

Posted by Justin Schorr on August 2, 2010 • Filed under: Administrative, EMS Topics, Fire Rescue Topics

Pop Quiz Answer Key

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

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

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

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

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

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

Be safe,

*Each one of those calls is fictional

Posted by Justin Schorr on August 1, 2010 • Filed under: EMS 2.0, EMS Health & Safety, EMS Topics

Pop Quiz

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What a month it has been!

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

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

2. Partial scalping.

3. Stabbing.

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

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

6. A running toilet in a park restroom.

7. A person urinating on the sidewalk.

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

9. Sprinklers spilling into the street.

10. A child choking on a grape.

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

Posted by Justin Schorr on July 30, 2010 • Filed under: EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, Firefighting Operations

Going to P School? We can help.

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Usually when Thaddeus Setla and I have one of our conversations, 2 things are for sure. We’re about to spend a lot of money and we’re going to change something.

One morning last week I got an email from a fellow EMSer in Texas who was wondering what he could do in the Chronicles Community to help him raise money to attend a Paramedic Program he had been accepted to.
Fresh in my mind was the outpouring of support a year ago to our friend EpiJunky, thanks to Bernice, which allowed her readers to donate money to help her attend Paramedic School. I chipped in.

Her class completed just this Monday.

So with these 2 topics fresh on our minds on our weekly conference call Ted blurts out, “What? Do you want to do a Scholarship Program or something?”

“Yup.” Was my reply.

And there was born the Chronicles of EMS Scholarship Program. From the site:

In true CoEMS fashion we wanted to bring the community together and help others who wanted to improve their career and were interested in sharing their experiences with the world.

We will be accepting applications in the form of videos where the applicant will explain not only who they are and why they want to be a Paramedic, but how they plan to implement aspects of EMS 2.0, our future vision for EMS. The winners will then chronicle their Paramedic School experience on our website as a weekly (v)blog, posting thoughts, feelings, and questions, allowing the entire EMS online community to become their tutors and mentors.

We are coming together as a community to help those in need of funding to complete their Paramedic education. Organizations interested in sponsoring all or part of a Scholarship will have a part in shaping the future of EMS nationwide, not just in their own communities.

Students interested in submitting a video application are advised to upload their video to Youtube, Vimeo, or any video sharing site and embed the video as a response to this blog.

Awards will range from $250 to $1500 depending on sponsorships and will have caveats such as:

1. The student must successfully complete the course or forfeit the award to another student

2. The student must keep the community informed as to their progress (in the form of a written blog or video blog)

3. The student must adhere to a code of ethics (Still being drafted)

The success of this program will depend upon the donations received from the members of this community. We will continue the program on a quarterly basis if we find that the donations support the Scholarship Program. 100% of the donations will be used for the program and as a member of this community we will keep you apprised of all donations coming in and the applications we receive. The winning student will be decided upon solely by the Chronicles of EMS Team so that this does not become a popularity contest, but a true recognition of the student’s desire and passion for EMS and the future of the industry!

Like the site says, this is no popularity contest. Whether you have 10,000 twitter followers or don’t know what a twitter is, all entries will be judged on their own merits. and since I’m one of the ones choosing the recipients, rest assured that a simple video recorded on a built in web cam will be given the same consideration as a high quality produced feature.

The Chronicles Team recognizes the power of the community, we’ve been inspired to help each other out before, here’s a chance to do it on a grander scale.

Would you like to be a part of ensuring a motivated, excited candidate has the opportunity to pay for Paramedic School? Then donate to the program. There are no administrative fees, no one here at CoEMS is making a profit on this and in the end it will likely cost us out of pocket, but not nearly in the amount some folks are having to dig to make their dreams of furthering their career in EMS a reality.

If you can spare 3,5,20, 100 dollars to help someone out you can do so publicly or anonymously and corporate/business sponsors can choose to sponsor an award of their own and be a part of the future of EMS.

Details as they develop at Chronicles Headquarters.

Posted by Justin Schorr on July 27, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS 2.0, EMS Topics, News, Training & Development, technology-communications-ems-topics, training-fire-rescue-topics

On Scene with Happy and Steph

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let’s see what happens now Happy.

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

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

Oh ye of little faith-

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

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

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

Amazing Steph, just amazing.

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

Posted by Justin Schorr on July 23, 2010 • Filed under: EMS 2.0, EMS Health & Safety, EMS Topics, Patient Management, Training & Development

Name that Show Competition Finalists!

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The crack team at Chronicles of EMS:The Reality Series have narrowed down the field of over 500 entries to rename their landmark new show.

As you recall, yours truly and that Brit Mark Glencorse took our desire to learn from each other in person and Thaddeus Setla’s desire to film a unique Paramedic experience and created the reality EMS series.

Chronicles of EMS – Reality Series (Teaser) from Thaddeus Setla on Vimeo.

In moving the show from web based to network television, there was a need to change the title. It turns out that “the Reality Series” isn’t very descriptive, so we turned the choice of names over to the audience.

Voting is now open, the finalists have been chosen by the producers and Chronicles Staff and the prize for the winner is amazing.

One of those five finalists will win a 3 night 4 day trip to any location we film at around the world. AND an ipad to follow along on the trip.

Newly announced is the prize for first runner up.

The finalists are:

Chronicles of EMS: Beyond the Lights & Sirens

Chronicles of EMS: Mobile Medicine

Chronicles of EMS: Frontline Medicine

Chronicles of EMS: Medicine in the Streets

Chronicles of EMS: Real Life, Real Emergencies

Head over and see what that prize pack includes and vote for your favorite.

Posted by Justin Schorr on July 22, 2010 • Filed under: Administration & Leadership, EMS Topics, Fire Rescue Topics, Technology & Communications, technology-communications-ems-topics

Can you see me now?

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Have we all gone Hi-Vis insane?

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

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

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

This photo from Ray Kemp at 911Imaging.

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

But look IN THE STREET!

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

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

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

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

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

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

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

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

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

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

Be safe people,

Posted by Justin Schorr on July 20, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, Line of Duty, News, Special Operations, Training & Development, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus, training-fire-rescue-topics

PD is on scene – The Crossover

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

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

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

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

Greetings, fellow first responders!

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

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

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

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

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

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

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

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

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

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

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

See you at the next crash…

Posted by Justin Schorr on July 18, 2010 • Filed under: Administration & Leadership, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health

Then who gets this rainbow one?

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

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

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

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

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

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

Imagine this scenario:

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

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

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

The family erupts!

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

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

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

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

Posted by Justin Schorr on July 16, 2010 • Filed under: EMS Health & Safety, EMS Topics

Specialty Centers Text Discussion

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

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

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

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

John- “What about a peds?”

HM- “The system will implode.”

Posted by Justin Schorr on July 13, 2010 • Filed under: EMS Health & Safety, EMS Topics, Fire Prevention & Education, Technology & Communications, Training & Development

Bernie, Erma’s Brother

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We all have those addresses that get our blood boiling. The one you know by heart. When the address comes over the radio we can recite the person’s name, social security number and even their first 4 medications.

For me the new address, since there are folks like this in every area, is causing me more headaches than it should.

The first time I met Bernie (Bernie is Erma Fishbiscuit’s brother. Yes, I’ve added to the Glossary of Terms! Found under the Who is HM tab) he was sitting in bed, unbathed for weeks, arguing with his home health care worker about how short of breath he was and that she can’t leave him yet. Bernie didn’t want his daily companion to leave.

Unfortunately Bernie didn’t let the care taker do anything much for him when she is there.

He won’t let her change the bedding.

He won’t let her cook him food, he’d rather snack all day.

He won’t let her clean up the room he is in for fear she will steal something.

The poor care taker sits and watches him slowly dying simply because he won’t let her help.

So here we are on a code 3 dispatch, ambulance trailing because Bernie won’t let anyone under the rank of MD help him. But what can we as Paramedics and EMTs do?

When Bernie and I start to have an honest discussion about quitting smoking, or at least agreeing to walk the length of the apartment to get his smokes each day, he demands transport, spinning yarns about how long they will keep him there.

We all know he’ll be home tonight, if not this afternoon, right back where he started.

The care giver knows she should be doing more, but is a frail thing and if she and Bernie got into a shoving match, we’ll be here for her instead of him.

Bernie refuses to listen to reason.

“I have asthma” he tells me.

“You smoke too much” I tell him noting the stench from the nearby overflowing ashtray sitting on the oxygen machine.

“You’re no doctor, what do you know?” I’m challenged.

“No, not a Doctor, but I don’t need to be one to see what you’re doing to yourself” he hears.

The private ambulance company is more than happy to take him in since he has private insurance and I am once again reminded why my premiums keep going up.

The health care practitioners at the scene, the ones most experienced to make a determination of most appropriate resources for this person, are powerless to effect change in this situation.

We could call his insurance company and ask them to send more people.

We could ask them to send a counselor to discuss with Bernie the importance of taking their advice.

Calling Adult Protective Services might bring a case worker out in a few weeks, but we’ll have been there dozens of times by then.

Bernie doesn’t want our help, just a ride.

On our most recent visit, I moved his pack of cigarettes to the other side of the room and reminded him of the real possibility that he will kill himself AND others while smoking on oxygen.

Then I helped him to the cot and along to the ambulance for yet another treat and release at a not so local ER.

What can we do unless the system adjusts to let us assess, refer and release Bernie? The insurance company, fire department and ambulance company could save 10s of thousands of dollars on one person each year. And that’s just one person.

They need savings, I can offer tons. So long as Bernie realizes that when the Paramedic arrives without an ambulance he isn’t getting an automatic taxi ride, then listens to what we have to say and becomes an active participant in his own health we all win, especially Bernie.

And Bernie is not one of the uneducated poor often blamed for EMS abuse, but one of the growing trouble spots in EMS.

Bernie is a baby boomer.

Posted by Justin Schorr on July 11, 2010 • Filed under: Administration & Leadership, EMS 2.0, EMS Topics, Funding & Staffing, Glossary of terms

Name That Show Competition

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The competition to rename the Chronicles of EMS reality series is coming to a close, but you still have time to enter! No purchase is necessary, just follow THIS LINK and register to be part of the Chronicles of EMS community and choose 2 names for the show.

And incase you forgot what the show is, here is the pilot episode of the Chronicles of EMS.

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

The winner will get full airfare and accommodations on a future episode of their choosing anywhere in the world! And get to bring along their brand new ipad AND be a part of the show.

The contest closes July 10th, Saturday, so get over to Chroniclesofems.com and enter the name you want to see on TV when we finally start to share what we do with an unknowing world.