Archives for technology-communications-ems-topics
See all posts in the network tagged with technology-communications-ems-topics
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.
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?
RTB means Return to Base. A cuppa is slang for a cup of tea. Allocating is something I very much wanted to see first hand.
On this morning in Newcastle, my second to last, Mark has arranged for me to meet with the executive staff of the NEAS at their headquarters.
Before meeting with them, however, I’m downstairs in the bullpens. I’ve got 2 hours to sit in the dispatch center and do a “Sit-along.”
When you tell a guy who loves talking theory on systems allocation he gets to see the system work from the nerve center, he gets a touch giddy.
My first chair was at a call taker’s desk and I got plugged in.
BANG, less than 10 seconds, not even a chance to introduce myself to the call taker I’m with the first tone is in my right ear.
Before she can answer the call a timer has popped up on her screen 8:00, 7:59… the clock is running.
“Ambulance Service” she answers and begins reading from the screen the pre-ordained triage system called Pathways. As I’ve mentioned before, this dispatch system makes no attempt to diagnose the problem, but the physician designed questions can dial up or down the response in real time as the call taker asks the questions.
While she is asking and answering, a small red circle has appeared on the screen, then, a bit away, a purple one. Later I would learn that one is the location of the caller and the other the closest vehicle assigned to the call. When that vehicle arrives on scene, the timer now passing 6:15 will stop. This is their target and they take it very seriously. As I’m listening to the call, it is a very straight forward sick call and the caller is honest about it. It is then I see the benefits of the flexible front loaded system. The rapid response car, the closest resource to the caller, has been stood down since there is not an emergency at the caller’s location.
The vehicle, or cot transport capable ambulance, is continuing, however, and the target is no longer 8 minutes, but now 16 from the time the call was answered.
As more questions are answered and the system confirms the lack of life threats, a simple screen gives instructions for the caller until the crew arrives. The call taker then scrolls around her GPS monitor and finds the vehicle, then advises the caller about how far out they are. The caller thanked her and the call was terminated. Less than 3 minutes passed from the answering of the call to the triaging and confirmation of appropriate response.
At no time did a supervisor step in to augment the call taker’s classification, nor did the system err on the side of caution by upgrading the response, putting rescuers’ lives at risk, “Just in case.”
In the hour we were together I learned more about the desk I was at and the number of calls she answers in an average shift. We took mostly non-emergent calls, details of which would obviously violate privacy, but I can share with you the CALLERS.
When I explained how folks abuse our service by calling from a cell phone miles away about a person they think might have been either unconscious or sleeping, she smiled. Then, I went on, our criteria based dispatch system considers the caller’s inability to confirm consciousness to be unconscious and their inability to confirm breathing to be apnea, and 7 people are now responding code 3 for nothing.
It was just when the call taker was explaining some of the loop holes used that a care facility called to request an ambulance.
They were not with the patient so unable to observe their mental status, efficiency of breathing or if there was any bleeding. The system took this information and kept the RRC responding. Each time the call taker asked a question, the caller was already answering, knowing exactly which question comes next.
She later explained that folks have learned that if they take a cordless phone around the corner and call an ambulance, the crew arrives faster than if they honestly answer the triage questions.
“Same callers, different country.”
It was later in the morning across the room with the allocators that I saw the strength and weakness of the NEAS.
Mark and I spoke at great length about being honest but respectful when offering our observations and suggestions to improve each other’s systems. Mark was an example of this when he met with SFFD Chief of EMS Pete Howes for a kind of exit interview before leaving. I hope I can meet that example with the following paragraphs, but each time I write it it comes off preachy, so here goes.
Sitting between the allocators I watched them constantly on the radio with numerous vehicles and cars in various states of service. Each color on their screens meant something different, from enroute, on scene, RRC, vehicle, on post etc, but it was the clipboard they were passing back and forth that caused them the most frustration and, more than once, delayed allocation.
Not by a definitive amount, we’re talking 3-5 seconds, but it was the constant flipping of pages and radio traffic related to the one thing that I think the NEAS needs to change for the betterment of the system.
No more breaks.
I can hear the UK medics now “Hell no.”
Let me elaborate for my work straight through the shift American friends.
The NEAS, as a portion of their labor agreement, provides their crews with certain breaks depending on their daily activities. When they have been on post for an hour away from station, they get rotated back to the station. This was commonly referred to on the radio as “Return for a cuppa.” The basic premise is simple enough, really. People need clean bathrooms and a chance to eat since eating is not allowed in the cars or vehicles, nor are they allowed to sit down and eat in an establishment while on duty. This was evident when Mark was nervous enjoying some Pho in San Francisco.
In the car and vehicle this didn’t seem to be a big deal, we’d get a message to return to base, or that we were clear for meal break. The meal break can be interrupted, should the allocators need the resources, but they avoid it since the crew interrupted gets paid quite a bit for it and the allocators, although they wouldn’t elaborate, appear to be held accountable.
Sitting between the two allocators on the desk that morning, 50%-75% of their time was arranging rotation station breaks or ensuring crews got their meal breaks. These variables also added more color codes to the dispatch screen. This car is on dinner, this vehicle is on base rotation…etc, etc.
When a call came in they shot a quick look to the clipboard showing who gets a break when and dispatch decisions are based off of that. I did not witness it make a difference in response times, since that information is streaming in real time on giant monitors overhead, but these folks are scrambling to keep everything running smoothly.
With my limited dispatch experience it seemed like a simple change, since on the days I was on rotation in Newcastle we never had a point in the day where we were unable to reach a bathroom or food.
My head was trying to process all the information these women were basing their allocations on and one of them turned to ask me, inbetween moving a car back to base “for a cuppa,” “How do your dispatchers handle your breaks?”
When I explained we (listen to me, like I’m still in a rig), THEY are gone for 10 hours, no breaks, they froze.
It was passing the clipboard back and forth that I saw the only 2 seconds they both held still: glaring at me. It was clear I was not to repeat that statement for the rest of my time with them.
“That would make, ‘Go ahead 405′ this so much ‘thanks and to base if you please’ easier.”
Yeah, 2 conversations at once. I have trouble typing and listening to music or TV at the same time.
Mark had some family business to attend to while I was meeting the voice on the other end of the radio and he returned just before dinner time to collect me. It was an eye and ear opening experience to see the chaos that a simple concept like breaks caused the folks moving units around.
Something I completely neglected to mention over lunch with the executive team.
Told you I couldn’t screw that up. My conversation with the folks hopefully getting Mark cardioversion and CPAP, and where to put your coffee when the table is literally covered in signs that say “DO NOT PUT CUPS ON TABLE, USE SAUCER” soon.
Yeah I did.
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.
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?
Surprise! These scenarios sneak up on you when you least expect it. Our normal Friday feature has been found on a relaxing Sunday night.
You are the first responder to a small apartment on a cool, but not cold evening, to a man complaining of severe abdominal pain. On arrival you are met by half a dozen family members of varying ages and levels of English recognition. As per usual for this particular culture, only the folks under the age of 30 speak clearly, and the closest to that is a 14 year old.
She describes to you that her uncle, who is lying on the bed rubbing his upper right abdominal quadrant, has been feeling sick for days. When you try to get something more specific she asks the uncle and the entire room erupts in conversation, loudly, and not a one of them talking to the patient, you or the translator. This is clearly a heated topic.
You are handed a telephone by one of the non-english speakers who simply says “Doctor?” On the other end of the line is an answering service for a Doctor’s office, so much for that.
Some discharge papers are handed to you which detail your patient’s last 48 hours. Diagnosis of liver cancer, colitis and an endoscope down the ol’ esophogus this morning. The papers tell him to expect nausea, vomiting, fatigue and discomfort and to begin eating slowly with clear liquids and broths.
The family demands he be transported, the patient looks miserable but says nothing, seeming almost embarrassed.
His hospital of choice is on saturation divert, so your nearest facility is now 15 minutes away.
What options do you have for this patient? You make the call.
Here is the long awaited trailer to the pilot episode of the EMS Series Chronicles of EMS.
Watch it full screen, Ted Setla did an amazing job.
http://www.vimeo.com/8235377Do you think Mark Glencorse and Justin Schorr should visit your system? Drop a line to the Chronicles of EMS and tell them where and why.
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?
I’m not sure how many parts this report will have. I’ve been writing pages and pages of observations, recollections of discussions, talks with patients, staff, Doctors, other Paramedics, all in the hopes of learning something from the 23 days that I so hoped would open my eyes. We can occasionally get caught up in the details of what we do without seeing the broader picture, the entire system, with all it’s players and pieces. I found that visiting other systems around the US helped, but the same obstacles presented themselves.
When blogger Mark Glencorse an I dreamed up the Project, it was initially partially for fun. Then we began to talk even more about what we did differently and I had to see it first hand. And I did, for the most part. Just as with Mark’s visit to San Francisco didn’t show him everything we do, I know I missed a lot of the problems with the NHS system. That being said, I was able to burst many of the myths of socialized medicine and an ambulance service run by bureaucrats.
My experiences with Mark here and also in England taught me that there are all the same people in EMS no matter where you go. There are the flirts, the nerds, the jerks, the dirty guy and the OCD fellow. Some want to be there, others are on the way somewhere else, but for the most part people were genuinely curious as to what we might learn from the Project.
What did I learn, you might be wondering? It boils down to this:
We are two countries separated by a common language.
Not sure who said it first, certainly not me, but it is true. For example, in the North East of England a Chips Buttie is a nice afternoon snack. Here it is called a french fry sandwich with butter. There things are made with sugar, here High Fructose Corn Syrup. There the EMS system is seamlessly joined to the hospital and clinic care, here it is a fight to get triaged in a timely manner. In both places family means family, I now have a new one 9,000 km away.
Looking over my notes from this Project, I have a boat load to tell you about and a lot I hesitate to tell you about since it may appear my mind was made up before I went about socialized care. I do have some suggestions how to make that system more efficient, but things there are so completely different when it comes to health care, it will never work here. Not because of the administration, or government, or labor unions, but because Americans have come to expect instant gratification from their EMS systems. They refuse to believe their sprained wrist can wait more than 4 minutes for a fire engine and ambulance. It is this basic understanding of what EMS is that is lacking in America and I know who is at fault.
We are. Anyone who has been in this business more than 2 years is responsible for the complete lack of understanding that grips the common American about their emergency medical systems. It is time we recognized this fact and did something about it. Exactly what that is will depend on those above us in this machine to recognize their part and help us educate our “customers” (I hate that term in this business).
For my short career I’ve been repeatedly discouraged by people using EMS as their free taxi service when more appropriate, far less expensive methods of treatment are available. I did see, in my short time there, EMS abuse in England, but not nearly at the rate I see it here at home. I believe it stems from the belief that people have a “right” to an ambulance whenever they want. And not just the entitlement generation, but those who have paid into the system and want something, anything, back from it. We need to show these people that they are entitled to help when they need it and an honest discussion about what is best for them.
I also learned from my experience that my system is not being as efficient as it could be, nor is Mark’s. Believe me when I say that each of those statements could have their own volume, and likely will, since most of the things I want changed there, labor will never allow and the same here.
Before I start boring you with the countless posts about what I did, saw, learned and learned to avoid, I want to take a moment to thank a few people that made this trip everything it turned out to be.
To Mrs HM – The woman who sat next to a burnt out EMT on the tailgate of the rescue truck in rural New Mexico and said, “You don’t belong here.” She is the reason I got off my ass and got serious about going back to school full time. I graduated 3 years later. She’s been right here with me this entire time and made this whole thing work.
To Mrs 999 – Who I’m sure had just as many headaches as my Mrs while mark was away, you welcomed me into your home each night for tea and made me feel at home.
To Firegeezer – For noticing a little blog about the joys of 911 abuse.
To Lt Talmadge and her UK counterpart Fiona – Meetings, dinners, etc, all went to plan.
To anyone and everyone who donated to help make the Pilot episode of Chronicles of EMS. Having the cameras along was unlike anything else I have ever done, I hope you all like it. And I hope that Ted mentions I hit every IV first try with three witnesses and three cameras rolling.
And finally to Mark – Thanks for being so easy to get along with, bad jokes aside. and sorry all the nurses liked my uniform and accent…wadda ya gonna do?
I’ll get more specific on my observations over the coming weeks, keep an eye out here and at Mark’s blog. Thanks for following along.
This month’s handover draws from our friends across the interwebs stories of close calls. Times when they or their patients, colleagues or family almost didn’t make it. I was inspired to make this the theme not just because of the holiday weekend here in America, but to remind us all that we are fragile and put ourselves out there sometimes. Hopefully one of these links rings back when you’re in an unsafe or curious situation.
Found with the Where did the angry guy go files-
“What do we do?” asked Eric, his eyes wide.
“I don’t know about you two,” I said, “but I’m about to jump through that window over there. I don’t know if that guy’s getting a gun or what.”
by Buckman who runs Gomerville
From the I don’t think you should be driving file-
“I was overwhelmed by the dreadful realization that I had just accepted a ride from a highly intoxicated snowmobile rider and we were hurtling through the dark northwoods at 70+ miles per hour.”
from Greg Friese of, among many, Every Day EMS Tips.
From the Thank God you’re driving category-
“This was a serious incident. This was no routine, boy, we almost had an accident. This was my death.
I don’t know if my partner would have stopped on his own if I hadn’t shouted. Maybe. Maybe he had it all under control and was already getting ready to hit the brakes.”
from Peter Canning, a new contributor to the FireEMSBlogs family, at StreetWatch:Notes of a Paramedic
In a section titled simply Gulp
“Jill and I found him lying on the floor, fully clothed and in a coat, eyes shut, but eyelids flickering. An almost certain sign of pseudo-unconsciousness. A fake. I took a step back and called out to him. Jill was still standing by the front door, uncertain how to proceed. Something still felt wrong, so I asked her to go and call for police back up. With hindsight, I should have gone with.”
writes Ben Yatzbaz, resident Insomniac Medic
Found in the Basement selection
“This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor.”
from our pal Chris Kaiser at Life Under the Lights
From the lost in the snow pile-
“Dear God, they’re working a search pattern. Please, not tonight. It’s not mutual aid to another fire department; they’re working a grid search with the police. I grab my boots, then pad to the garage to check the fluids in the IV warmer. Anyone caught in this weather without shelter will be near death, if not there already.”
by Mack505 at Notes from Mosquito Hill
From the trust your guts file-
“I give my partner the “time to leave pronto” hand gesture. “Code 3, hurry up”. I give a little oxygen and attempt the IV enroute with no success. I realize that something is not going well for this patient and I don’t have the means to diagnose or fix the problem.”
by Rescue Monkey of Paramedic:Life on the Streets
From the Old School section-
“The smoke level now was to the floor as I grasped the hose line to find my way out. The urge to rip off my mask was strong but my training had taught me this would be fatal for sure.”
by HMHQ Contributor the Angry Captain
and finally, from the Hmmm…that looks wrong category
“A back board was brought up and one of the other Paramedics on the engine teams attended to him pulling off his jacket. Justin asked us if the building was still on fire. We we told him that yes, it was still on fire, he asked us to put his jacket back on. Not completely out of it.”
from yours truly and the event that launched me into the blogosphere.
Next month’s handover will be hosted by Ambulance Driver, theme TBD, watch his space for details as they develop and, above all else, be safe.
HM Clear.
Today was my second day in Newcastle, UK but the first on the streets with Mark. It is indeed a different world here. the video from the end of today is linked at the end of this post.
We started early this morning and grabbed a coffee at the McDonald’s, then off to standby in a local neighborhood where we pulled out the laptops and discussed the day.
I was able to have a quick interaction with some of the Firefighters assigned to the station with Mark and the Ambulance crews, nothing more than a quick introduction between calls, but it was later in the morning when I learned I don’t have it nearly as good as I thought.
While heading out to the pouring rain, I bumped into the station cleaning crew mopping the floors. The fireman don’t do the big housework. No wonder mark was so surprised when I gloved up and cleaned toilets back home.
Later in the morning still, I met the Station’s French Chef. They don’t cook their own food either. These are two things I think identify the firehouse as a home. It seemed more like a school than a fire house.
But, I have yet to see it through the eyes of one of the firefighters, that comes next week.
As far as impressions on the ambulance, I can say that some of my expectations were met while others missed completely.
For example, Mark can honestly tell people when they don’t need to go, then leave them at home to recover. He can not only let them drink water, but take pain meds. He can cancel the ambulance and drive patients into the clinic.
He also has to wait in the middle of the highway for a second ambulance when he has 2 patients in C-spine precations. You see, the European style ambulance is abundant on space on the inside, but so much of it is unused. There are two chairs and a cot in the back of these rigs, no room for a second patient. When we had 2, almost 3 patients to board, we had to wait, when most US services have the bench seat that can be used for that second patient.
He also gets to watch the fire brigade going the other way on that highway just looking. They did not respond to the traffic collision. Had I not been there he would have been alone, but I’m sure done fine. The police and highway department arrived and had a cool hand with the traffic, no safety issues or requests to reopen the highway sooner. Infact, where some of the agencies I have worked with would open the lane next to the accident, these folks kept it closed since we were close to it.
It is hard to draw any conclusions from a 12 hour shift in one station, but at first glance I want to have Mark’s training and options when encountering patients who don’t need an ambulance and I think he needs my ambulances to offer a better service to his community.
Deploying rapid response cars within the SFFD may not work after all without the clinical routing options he has at his disposal, not to mantion an ENTIRELY different view of what it means to call an ambulance. Each and every person I encountered today listened to Mark explain their situation, condition and options wheras most of my clients demand transport regardless of their condition.
The internet here in my hotel is not included, like their website would like you to believe so I am using Mark’s mobile USB adapter which uploads a single photo in 8 minutes, so the updates from here will be mostly in text, but I’ll film my video and give it to mark to upload at home each night.
And for those of you who think I’m in the bag for socialized care, I favor it because it makes more sense but I will be honest about what I see here. Believe that.
I awoke this morning in the UK to news that NBC has ordered three more episodes of TRAUMA. Before you go groaning about how bad you thought the show was realize the opportunity we have as a Profession. Everyone talks about the show being up against better shows in their time slot. Mark and I even had a chance to visit the set of a filming while he was in San Francisco and even the folks there mentioned the tough time slot.
Does anyone watch TV when the shows are live anymore? I have weeks of my favorite shows backed up on the DVR, including TRAUMA and we only watch certain shows live. The rest we watch when we have a chance. So put away all those arguments about the time slot.
Also, realize that we’ve been heard by the writers and producers about the characters and call types, the show is getting better with each episode.
Enough about the unrealistic medicine. Of course it’s unrealistic, but how many of you demanded ER be cancelled for the same reasons?
TRAUMA is the first real vehicle for bringing our job into the light. I’ll be it it’s a dim light for right now, but we need to take anything we can get and change it when it gets here.
Besides, until Chronicles of EMS gets picked up, this is the closest thing to what we do on TV. Unless you want Baywatch back. Don’t make me get that one out.
So let’s get our patient loaded and transported. This might just be an epi rhythm, but stranger things have happened.
Mark’s last day in the firehouse in San Francisco flew by today and filming went great.
We were lucky to be assigned to the Fire Boat Guardian, since that is one of the responsibilities of Engine 13. A group of school children arrived for a tour and a cruise and we got to come along to staff the boat. Mark and I, and the Dridge, had a wonderful cruise along the embarcadero, off under the golden gate bridge, then around to Alcatraz Island.
It was a beautiful clear morning and, now that I think of it, it hasn’t been cold or foggy since Mark got here. I think he finished with 3 videos and 60 some odd pictures, all available on the flickr link.
It wasn’t really “Paramedic” related, but this was part of my regular day, so away we went.
It was a somber mood on the set of Chronicles of EMS today with the England filming still in the air with 72 hours until I depart. It was also a little difficult scheduling wise this week since the original schedule prepared months ago was thrown out do to a new policy here in the SFFD. Not a huge deal, we just had to call in each day to find out what the schedule was for the next day. But then again, that’s how I get my schedule on regular days.
I want to prep you guys for amazing news and bad news. I’m not sure which to tell you yet, because I don’t know myself, but I want to say something ahead of time. When Chief Hayes-White walked into the conference room a week ago, she had a 5 minute notice that Setla Productions would be filming. She walked in seeing me, Mark, Ted and Chris and rolled with it. So did Cheif Howes. That being said, since Ted got funding at the last minute, we were still unsure of whether it would be filmed until halfway into the meeting when we realized they hadn’t stopped the filming.
They could just have easily told us to turn off the cameras and tell Mark he wasn’t welcome, then keep me around to show me my pink slip. All these actions seem extreme, but not outside the realm of possibility.
You guys have been following along behind the scenes of the Pilot pisode of the Chronicles of EMS but have seen none of the actual show yet. I think Ted said they have 26 or so hours of film for the show and a number of Mark and I talking about the patients we saw and the differences, but I think tomorrow’s exit interview will be the real deal this is all about.
The Dridge, camera man and all ’round cool dude, will be there to capture it for the show and for all of you.
Now, about England. The Project is a go, Chronicles might not make it, this time. Think about the timing and the costs for flying international with all this camera gear with 3 days notice. If they can’t make it, don’t panic or get angry or try to blame someone. I don’t want to see any posts about somone who’s “fault” it is they don’t make it. The last thing we need is to fall apart now. If we start bickering and complaining those who control this machine we’re trying to fix will excuse us as a bunch of dreamers and complainers.
We are neither.
Mark and I are learning a great bit from each other and I get frustrated when he asks me, “Do you always have to…” and my answer starts, “To avoid litigation…”
Hang in there guys, I have Ted’s flip camera, the one he used to update all of you and I’ll be using it to send updates whenever I can. Just keep in mind I’ll just be one person if the crew can’t make it this time.
More tomorrow after I send Mark along.
HM
Have to get in a bit about the Handover before I pop along to England next week.
This month’s blog carnival the Handover will be hosted here at Happy Medic Head Quarters. For those of you not sure exactly what in the world we’re handing over, one of our good blog buddies, 999medic.com, founded a blog roundup of sorts called the Handover. It started as a collection of favorite posts collected by a volunteer host and is now the largest and widest read blog carnival for and by pre-hostipal EMS and ER staff.
Past hosts include
For November’s theme I have chosen “Close Calls.” The theme is inspired with my own close call, which I have mentioned as the driving force behind starting this therapy experiment we now call the Happy Medic. I want you to send me a blog post you authored or have read that made you say, “Wow, that was close.” Perhaps a time you caught a patient right before something happened, maybe a time when you almost got hurt or, perhaps when you did get hurt but it could have been worse. And as Mark introduced a bit back, feel free to send in anything EMS or ER/A&E related you wrote or enjoyed. Share.
A little different than other months, I’ll be busy with Mark for a few more days then off to the UK for my turn in the passenger seat, so get your submissions in early. The deadline for submissions will be Novmeber 25th, and i will save all submissions to my handy new laptop before boarding the plane home to the USA. I will arrive home on Thanksgiving, hopefully with a good group of posts to share and be thankful for. it will be published on the 27th of November.
I am finally at home after dinner with Mark, sipping a scotch and thinking about tomorrow’s first day on the ambulance. I am wondering if Mark will be able to contain himself the first time someone abuses the 911 system, or the second, or the third, when he sees we are required by law to take folks in.
My mind imagines Mark in awe when we apply our CPAP to the woman who would normally need to be nasally intubated and she not only stabilizes but improves.
What will he think if we get a chance to pace a symptomatic unstable bradycardia or convert an unstable SVT.
Will Mark search through my kit looking for pain medications when I have only morphine and oxygen for pain management.
I have so many things I want to show him about the fire based and private tier model we use that I almost forget about the ocean between us in capabilities for patient care. Fire engine and rapid response car aside we make differences in different ways, don’t we?
Tomorrow is Mark’s first day on an American dynamically deployed fire based ambulance and part of me is worried he’ll be angry we can’t do the right things for most of our patients and clients. Another part of me hopes he sees the benefits of some of the things we’re doing he is not. There is so much opportunity to learn from one another side by side I hope my clients don’t get in the way of our learning.
This will also be an opportunity, with the Chronicles of EMS filming along side us, to show he rampant abuse of the 911 system in San Francisco. How can we solve a problem that is not ours? That’s an entirely different show indeed.
So I’ll try not to sweat the small stuff and just do my job like I always do with that green jumpsuit close behind.
We’ll be in the yard at 830 for our shift at 9. See you on post,
the Happy Medic
OK, just one, but I will be calling this out in the airport later today.
If you are reading this it means that UK Medic Mark Glencorse is on a plane from London to San Francisco to begin the Project, our Trans-Atlantic Paramedic Exchange.
In case you were wondering how this all started, you can catch up by clicking on the tag “the Project” over in the right hand sidebar.
This is my last reminder to follow us on Twitter, @ukmedic999 and @thehappymedic, as well as the flickr feed and youtube channel. Mark’s first update will be tonight, so make sure you’re subscribed to the channel.
The action starts tomorrow morning with a meeting with Chief of Department Joanne Hayes-White, EMS Chief Pete Howes and PIO Lt Mindy Talmadge, who will no doubt be glad I’m not calling and emailing multiple times a day now that this has started.
When we finish at Headquarters, we’ll be off on a walking tour of some of the high points of the history of the SFFD. Many of these can be found in a variety of tour books and at the SFFD Museum, but when I took some of my early days in the City wandering around I found some specific things I find fascinating. I’m working on a book specifically for visiting Firefighters to enjoy these places, but as you’ve been reading on this blog, I’ve been a bit busy.
That should wear him out so he’ll sleep well and be ready for our first shift on the ambulance on Tuesday.
Like the Angry Captain used to say when the lights went down at the movies,
Here we go.
Happy was a guest on the EMS Garage Podcast, Episode 60, which is now up at EMS Garage.com.
http://emsgarage.com/archives/390
Come listen to me and Mark talk about the Project as well as the details to the Blogger Meet-up in San Francisco next Saturday!
The host’s volume is low and Mark’s accent might throw you for a loop, but it is also a great conversation about using social media to further our EMS missions.
Special thanks to Chris Montera, Carissa O’Brien, Gary Wingrave, Ted Setla and of course, Mark Glencorse.
It would certainly be a premium channel, right?
What got me thinking about this was my recent experience on the EMS Garage, hosted by Chris Montera. If you’re not listening to this forum, you need to be. The twitter blitz that was the 2009 EMSexpo mentioned podcasts and videos, but with my trip from the refresher and trying to catch up on work and the Project, I never clicked over.
<punishment=”bang head on desk”>Stupid, stupid, stupid</punishment>
Neat video. I say neat because it reminded me of one of m favorite shows, Attack of the Show. On AotS two hosts have a great time sharing news and product reviews geared towards a specific demographic, the 18-35 year old nerd. (myself included)
EMSexpo live produced clips from the show floor clearly designed for a specific demographic, people passionate about EMS. Each piece is interesting and fun to watch with both Carissa O’Brien and Chris Montera clearly having fun doing it.
Motoring in EMS the Segway Way! from Thaddeus Setla on Vimeo.
See what I mean? Click through and watch the series of videos from EMS expo 2009, Atlanta. Neat stuff.
Perhaps this can expand into a “channel” where podcasts become videocasts and learning videos become a learning series? I can has host bloopers show?
Well Captain Tom, you asked…
“OK HM, It’s November. When does 999 land in SF?”
…and I’ll answer. Sunday.
Paramedic Team Leader Mark Glencorse will be the guest of the San Francisco Fire Department beginning on Sunday November 8th, when he touches down at SFO. From that moment until he departs on the 16th we will be comparing our systems at the ground level, care giver to care giver. No “company line” no prepared statements, just two friends meeting and getting the low down on what is really happening in each other’s systems.
Later this week I’ll be adding links to the sidebar here at HMHQ to help you follow along on our experience. Follow us on twitter @thehappymedic and @ukmedic999. The new slideshow on the right hand side there is the Project Flickr slideshow. That will certainly be added to as we go along. Daily if not hourly.
Then there is the youtube channel we established that many of you are already following (subscribed to). We have decided that the visiting medic will do his best (nights of drinking aside) to do a nightly update as to the day’s activities, impressions and thoughts. Mark will of course be updating you mostly at first, then I’ll start when I arrive in Newcastle on the 19th.
We are both not only representing our Departments but, more importantly I think, the power of this new creature we all have come to embrace, social media. Twitter, Facebook, blogs, online news, flickr, IM, SMS, all these amazing on demand services at our fingertips and we’ve harnessed them for a good cause, making ourselves better care givers.
So not to make this another boring “the Project is coming” post, maybe something new?
Since the official SFFD press release went out today I guess it’s fair to tell you who I am.
the Happy Medic is, and always has been, Justin Schorr, a Firefighter/Paramedic currently employed with the San Francisco Fire Department.
That’s me with the patches-Photo Credit SF Chronicle.
I hold a Bachelor’s of Science in Emergency Medical Services from the University of New Mexico School of Medicine where I studied under Larry Cobb and Rick Lynn, to name a few. I was one of the first 10 graduates of the BS in EMS (no giggling) program there and was one of 4 to first stand within the School of Medicine group to graduate (God they hated that!)
My career started as a Fire Explorer, then as a volunteer firefighter getting hired at 18 with a small Indian Reservation outside Albuquerque, New Mexico. Talk about rural EMS.
I later moved on to a small suburban department struggling to find it’s identity with a strong Public Safety model that relied on fire trained police officers to assist when emergencies struck. It was there that I learned the best way to confirm a house has been ventilated prior to forcing the door is to do it yourself.
Now I find myself in beautiful San Francisco and raising my family.
So there you have it. The first official, documented privacy violation of the Happy Medic, my own.
See you at the big one,
HM
A Tip of the Helmet to online EMS educator Greg Friese and his extensive research into how EMS agencies need to embrace social media before it gets past them and starts to cause problems. In his September 2009 article, he mentions our efforts here at HMHQ to use this media for positive change in our profession.
Not sure what social networking can do for EMS? Have you ever used a tip you learned online, on twitter or even done a google search for something related to your role as an emergency care giver?
Then you are using social media to advance our Profession. Learn more in the article here,and at the EMS Expo in Atlanta Georgia, where it looks like Greg will be expanding on his article in person. I would attend, but will be recovering from my CO-Op Refresher in New Mexico and preparing for the Project, which starts in less than 6 weeks.
A Tip of the Helmet to Greg Friese. On twitter and facebook and everything. I’m sure he’d have it no other way.
