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Thanks to the Chronicles of EMS, both Mark Glencorse and I will be attending the JEMS EMS Today Conference in Baltimore, Maryland, March 5th and 6th.
It’s a big deal for us to be able to spread our message to as many people as we can and there is no better way to share ideas than face to face. Even though we can communicate here in the internets machine, Mark and I didn’t really see what each other meant until we stood shoulder to shoulder in each other’s systems.
Since it will be a little while until we can get to everyone’s systems and learn from everyone how best to deliver EMS, heck even what EMS means anymore, we’ll travel as much as we can to meet you and keep the dialogue open.
That’s where our sponsor ZOLL Medical comes in.
SFFD Zoll Rep Roy Kniveton was kind enough to give the Chronicles of EMS team a run down of things coming from Zoll and let us put the new E Series through some quick tests. Not any of that scientific lab type stuff, but medics dragging it around a room type tests. Roy even offered to let the 100′ aerial ladder truck run over it to show it’s durability.
The truck officer declined the request.
But aside from coming in and letting us see what was new, Roy actually listened when we told him about our growing following. He was genuinely interested in the EMS 2.0 movement and did some quick searching to see what we were interested in getting from our equipment in the future.
We must have done something right because our near future included a generous sponsorship in our pilot episode and flying Mark and me to Baltimore for EMS Today. We will be Zoll’s guests at their booth and we’re looking forward to meeting all of you and answering questions about the Chronicles show, new concepts coming in social media TV and anything else you want to talk about.
I’ve never had anyone fly me anywhere before.
And to EMS Today no less. Check out the web page HERE and look for JEMS Editor in Chief AJ Heightman to wander in to give you the details on all the exciting things happening around me and Mark. Yes, there will be more than us ruggedly handsome frumpydumple fellows.
If you get a chance to make the premiere of the Chronicles of EMS in San Francisco on Feb 12th, we’d love to have you, sign up to let us know you’re coming HERE. And a special thanks to EMS1.com and AAM Consulting (Randy Africano) for sponsoring the premiere event at the Hotel Frank. More about them soon.
See you in SF.
See you in Baltimore.
My name is John and I am 63.
In just over 3 years time I’m going to be driving through your jurisdiction just as you are sitting down to your first meal in 12 hours. As your order hits the counter I will experience an odd tightness in my chest and dismiss it as gas.
When you take your first bite my wife of 35 years will watch me clutch my chest and stop the car on the side of the road.
Just as you begin to think your bad day is finally slowing down, the worst day of my life, and possibly the last, has just begun.
I’ve slumped over in the car, releasing the brake pedal and the car drifts into a signpost, discharging the airbags.
My wife is hit by the passenger side airbag as she is leaning over to help me, noticing my unconsciousness just prior to her own.
A passerby has stopped and is now describing a motor vehicle accident to your dispatcher.
Lunch is still warm in your hands when your radio alerts to the accident.
You are tired.
You are hungry.
The kids have been keeping you up late.
The rent is past due.
Big deal. I’m about to die. While you’re cursing me walking to your rig, my MI is moving and my wife’s head injury is complicating what is already going to be a difficult airway judging by the amount of teeth on the floorboards.
As your rig negotiates traffic, my respirations are rapid and shallow, my wife’s now non-existent.
When you pull up to the scene I need your A game. I need you trained to the point where what you are about to do comes as naturally as breathing, because we’re having a bit of trouble in that department.
This is not about you. It’s about me. It’s about us.
So back to your studies, we’ll meet again before you know it.
It all comes down to this meeting doesn’t it. The entire project, everything I hoped to learn comes down to sitting with Mark’s supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.
But then again, we kind of are.
I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.
Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee. The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.
So what do I do?
Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a “Hey stupid” look. It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS. Population, call volume, etc.
It was made clear to me ahead of time that Fiona, the Chief Executive’s aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.
Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.
A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting. This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.
I went into a brief overview of my system in the SFFD and also explained other systems around the country. Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.
Each member present asked a number of questions about billing and a person’s ability to pay and I had to remind them many a time that that doesn’t come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.
Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.
When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US. Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.
In true executive fashion Mr Featherstone turned to his clinical care person and said, “How soon can we look into doing these things?”
Bang.
Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.
The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.
But I understand that. England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.
Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways. If Mark wrote a book about EMS I would buy it. If he had a radio show I would listen to it, but until those things happen (If he had a TV show I’d watch it) I will follow the media he uses to become a better Paramedic. Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook. All media that is growing not only in popularity but usability and relevance to what we’re trying to do in the pre-hospital care fields.
I don’t expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.
One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient’s privacy while allowing those doing the care to share insight and best practices in real time.
A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.
After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.
In Conclusion-
The NEAS provides a high quality service in a straightforward manner to a well informed population. Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system. Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.
The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier’s preferred spot.
Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.
The food was great, the coffee we can work on in future visits.
Will the NEAS model work in San Francisco? I won’t know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie. Fire readers, this is the post you’ve been waiting for. But like most of what we do, EMS comes first and accounts for 80-90% of what we do. Why should my UK story be any different?
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.
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.
Welcome back to every Paramedic’s worst nightmare-
DOSE THAT KID!
The wildly entertaining game show that makes you actually learn what kids weigh by looking at them without being given their specs on a written exam.
So there can be no cheating, despite your best efforts to find someone who knows the age/history of the child, none can be found. Your Braslow tape was left on the bed in the ER last night. Also, for you out there in the know, all of the clothing tags have been removed, so no excuses. Now let’s play DOSE THAT KID!
Our first contestant has been found in a child care center in a woman’s garage. They state the girl is new to the group and they have no information on her whatsoever. She was having a bottle when she choked,turned blue and is now unconscious, unresponsive and in vfib. Your partner is managing the airway and has IV access. DOSE THAT KID!
It was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:
“This is a huge step for Cleveland,” EMS Commissioner Ed Eckart said. “This is a step back from a long-standing culture in this city.”
And indeed a long standing culture in America on whole. I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.
Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.
As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that “maybe” call, the actual crushing chest pain that IS an MI is waiting longer for a transport. We need to stop worrying about what might be and focus on what is.
The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers. We call it triage. No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center? If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.
For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything. Cleveland says no more. Cleveland. No offense to the system there, I’m learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3. Until now.
A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing. I hope to learn more about their research and system savings in the near future. I will most certainly pass that along if I can get it. Do you have a question you’d like me to ask the Commissioner? Post it below and I’ll ask him.
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?
The iphone rang so early I thought I was still dreaming. Sure it said 5:15 AM and Mark would be along to pick me up in 30 minutes time, but I felt destroyed. My body still thought it was 10 PM and was gearing down for night.
NO! I yelled to myself and turned the lights on.
This was going to suck.
I got cleaned up and dressed, then went to make a cup of coffee. Coffee in England is different than in America. In America you get a nice drip brewed cup of joe from perhaps a Peet’s, or even a Starbucks or gas station. In room 501 of the hotel, my HMHQ for the week, there was a water kettle and a baggie of freeze dried coffee. A taste I choked down at first and then missed as soon as I was on the plane ride home. I had come prepared for the coffee situation, however, as you may recall from this video I posted later in the day:
Mark took me over to his station, the sun yet to rise. Inside I met a few of the night shift going off duty in the ambulance room of the Fire and Ambulance Station. It immediately took me back to microwaving 25 cent burritos and drinking tap water during my internships. There was a TV in the corner, 4 very nice green chairs (green is the color for EMS there) a couple of side tables, small kitchenette with sink and a microwave. We really are the same.
Craving more coffee I went to fire up the kettle and prepared another cup of the freeze dried goodness as Mark took me out to the floor and to Swalwell 405, our Rapid Response Car for the day.
It was exactly as I had imagined. A ford station wagon, appointed with safety markings, emergency lights and the ever important aspect to the RRC, the label “Ambulance.”
The RRC with the Appliances at Swalwell Station
Mark led me on a quick overview of the equipment kept inside and what I could carry on a job and what I should stay away from. We talked about interventions I could perform, such as assisting persons to stand or to walk, the basic stuff we all do, but at no time was I to use his giant Lifepack 12 to cardiovert someone in unstable SVT.
As soon as we were checked out we were sent on a system status post in a nearby neighborhood. Not to get Mark in trouble, but I needed more coffee (some have cocaine, others a hobby or “life”, I have coffee, let it go) and the only place that pours a cup is a place I hadn’t been in over two decades, the McDonald’s.
We were on post for an hour when we were called back to the station. You see, Mark and his co-workers are given a rotation back to the station each hour for bathroom trips, food and what not. When we left our area, another vehicle or car would fill in. This seemed simple enough at first, but a few days later, while watching the allocators try to juggle all the breaks and rotations, I wondered just how important that 1 hour mark was.
At the station Mark’s point to point radio came alive. I had trouble understanding the accents at first to decipher our assignment and there was no station alarm or alert system. Perhaps it would have awakened the firefighters upstairs? We climbed in the car and away we went, blue lights flashing to a reported fall victim. Specifics aside this was the perfect first call for me to see the NHS in action.
I in my station duty uniform with badge of office and Mark in his now famous green jumpsuit made our way in and found a run we EMT and Paramedics handle all the time, a minor muscular injury. Mark went into his comfort zone, patient care, and I handed him the BP cuff and placed the stethoscope across his shoulders to have it in reach. That got me a look I often saw as a small child when I would break something expensive. No one over there stores their stethoscope around their neck. I only do it on scene, mainly so I don’t lose it, but throughout my trip I never saw one ’scope around one neck.
As I recovered from that faux pas a walking Saturday Night Live memory came through the door. The patient’s neighbor was a Scotsman, a true Scotsman, and when he found out I was American he began to tell me a story about an American he knew back in the 60s. I know this because Mark translated for me later. I could only make out a few words here and there, no unlike watching TV in a foreign country.
The Scotsman was ignored when I heard Mark tell the woman she should take some Peracetamol and the ambulance will be along in a moment. He is allowed to let his patients medicate themselves for new conditions. Now, I can create a gray area and make it work, but imagine telling the receiving facility that you let your patient dose up on Tylenol (acetomeniphon/paracetamol) for a new injury. The ambulance crew arrived and away the patient went and we were back in service. Nothing extraordinary, a simple run of the mill job we both encounter all the time. The only difference was arriving at the scene in a car, and alone (without me) would be challenging at first, but some days, with some crews, I am kind of am responding alone.
In my next post I’ll describe the odd moment when we were waiting in the middle of the highway for a second ambulance as a fire engine drove by, not assigned to the accident and something I think the NEAS needs to change immediately to better serve their citizens.
After following Mark’s day by day adventures, I’m dragging you right along on the second week, the one not covered by the Chronicles of EMS cameras.
But why is this going up at 11PM your time Happy? Because that is 7 AM Newcastle time. Wrap your head around that one and let’s get started.
Mark’s San Francisco adventure covered 10 days in total and he was clearly as exhausted as I and likely more. I last saw him at the BART station on the way back to the City and then to the airport.
I wouldn’t see him again for 48 hours.
In that time I let my girls crawl all over me, literally and figuratively, all the while packing and preparing for my England trip. When the time came to board the plane emotions were high. The littlest one giggled when I gave her a kiss, the older one asked me to say hi to Mark in England. She seemed to be taking this experiment remarkably well considering the enormity of it and her comparatively small understanding of the world. The Mrs was understandably emotional and supportive, something she does very well. I had already given 10 days to this project rarely seeing the girls awake, if at all, and was about to give 10 more.
Into the airport I saw the car drive away and took a deep breath. This was not going to be easy.
The plane was packed. I had one of the window seats, but they neglected to tell me the foot room is severely restricted thanks to the new video on demand units. I had been to Seat Guru, but it seemed every seat sad that. In exchange for a place to put my feet I had dozens of movies to watch to take my mind off the tingling in my lower extremeties.
The time difference was 8 hours ahead. To help deflect the impact of the time change I knew I would have to get on the plane, eat and get to sleep as soon as possible, then sleep most of the flight. The last time we flew across the Atlantic I fell asleep during the safety video, then not a wink the rest of the flight, I was exhausted 20 hours later.
Imagine my surprise and pride when I finished dinner, put on my headphones and fell asleep. Then again we medics have been known to fall asleep in odd places at odd times.
I was awoken an unknown time later (6 hours I discovered) to the following conversation:
(This was an Air France flight)
“Keep heir on ze oxee-jin and we can moove heir to zee floors.”
Oxygen? Moving someone to the floor? This sounds like a job for…
…the flight crew.
Watch this video from my layover in Paris to find out what happened next:
After a quick commuter flight from Paris, we landed in cloudy, rainy, windy Newcastle, met by a somewhat rested Mark Glencorse.
Newcastle International Airport
I was whisked away to mark’s home and welcomed as family. It was nice after a long flight to sit down on a couch surrounded by familiar names and voices. We enjoyed a wonderful dinner (Tea, I was told to call it, the evening meal if you prefer) and the perfect start to what would become an exhausting week.
Even though my family was far away, I had a new one just a few minutes down the road.
I had shared a family story that my late Grandmother was fascinated by the King Arthur legends and that recent research believes Arthur to have been a Roman General defending Hadrian’s Wall from Northern Invasions. I had mentioned this in passing on an episode of EMS Garage and Mark and Fiona had heard me. Fiona scheduled a dinner meeting at the Swan Inn in a town called Heddon-on-the-Wall who’s cathedral was built with stone from the wall.
I was hoping for a brief time during the trip to go out to see the wall my Grandmother spoke of, but didn’t expect much at all. Little did I know that, on the drive back to the hotel, we passed by part of the wall there in the middle of town. Mark made it a nice surprise and swung the car around, parked and said, “There’s your wall, Mate.”
I froze. I had trouble moving for a moment. It was kind of like meeting someone you admired. I climbed out of the car into the cold night air and took a deep breath. I could hear my Grandmother’s voice as if she was right there with me. “He stood here. He garrisoned here. This is history.”
It was a small section, only 6 feet wide, maybe 30 feet long and a few feet tall, in a protected grass area near homes, but it was the wall she spoke of.
I took a few photos and a quick one of me on the wall before heading back to the hotel to rest. As is now a Chronicles of EMS custom, the internet was pay as you go, so uploads were going to be difficult.
Mark dropped me at the hotel and I went straight past the pints in the lobby and straight to bed. The first day on the Rapid Response Car was waiting for us early the next morning and I wanted to be ready for it.
That story, and video of what I look like before coffee, next time.
I get a fair number of emails at thehappymedic@gmail.com, most asking me to send them money in some elaborate purchase scheme. Nigerian Prince or not, I’m not even sure where to send a money gram anymore. But, every now and again someone will write asking my humble advice or just wanting to rant. I like reading those because I know how good it feels to get everything out, even if to a total stranger.
But when I got the following email from a person calling themselves “fireman88″ in “Buttasscold, Michigan” I was curious to read more.
Mr BAC asked me about a situation he found himself in a few years back and wondered since I do a feature about making decisions would I like to give his situation a try. Naturally I decided to ask all of you, so here you go:
We have a traditional chili cook-off every year for the department and it raises money for gear and rigs and training and stuff. We used to have only fire fighters cook chili but some local businesses got into it and they cook too now. One of them a B-B-Q place has won a lot of awards and always wins now. I had to do a preplan of their BBQ place soon after the cook off and it was nasty. I would never eat there anymore. Nothing was unsafe, OK, just dirty and smelly and nasty. When I told my Chief about it he told me not to upset the owner because he donates a lot to the neighborhood.
I read this and imagined myself back in the kitchen of a local fast food joint a few years back doing a similar thing. I won’t say the name of the place, but when the kid told me they never clean out the chili bin, just add more, I have yet to order the chili cheese tater tots again.
But, what should our cold friend fireman88 do in this situation? He never mentions if he is career or volunteer, but I think the situation is the same regardless.
I’ll give my response on Monday and, if you’re reading this fireman88, check your inbox I want to hear what you did. Email me or post it in the comments section here.
I didn’t know such a call would cause such a commotion in the comments section both here and on facebook. THIS is a situation we encounter often in my jurisdiction. Almost 30 percent of the calls our call center handles require a translator of some kind.
The main thing I was looking for on this one was what options do you have as a caretaker to help this man aside from loading him up and driving away. Seeing Mark in the UK have access to other options is always in the front of my mind now when I encounter calls like this.
Our patient did not call, his family did. The family states they were not told what the discharge form said when they left the doctor’s office this morning following his endoscopy of the esophogus. The paper details a recent diagnosis of liver cancer and colitis and that he should expect the exact symptoms he is experiencing. We were able to use a 14 year old family member to confirm with the patient he did not want us there and by no means was he going with us or signing anything to make us leave.
They tried calling the doctor’s office but got no answer since it was after hours. Unsure what to do next, they called us. There were numerous family members worried about him and willing to bring water, broth, noodles or anything he needed to get back on a normal diet. He had not eaten all day due to nausea, from the meds most likely.
We were fine leaving him in his home to recover, as directed by his physician.
Whether they were not offered translators or the phone call went unmade or the family simply didn’t understand, it is clear that the ball was dropped long before I walked in the door. It can be hard to paint the picture accurately for you on these You Make the Call runs, but clearly I painted this man sicker than he was. Readers on Facebook spoke of MIs presenting as abd pain and wanting to run 12-leads and treat ACLS. I noted that his regular hospital was on saturation divert, meaning that even if we do transport, he likely wouldn’t be treated until they can confirm his history, which could take awhile on a good day.
The discussion ran into pushing pain meds, anti-nausea meds and transporting to remove the discomfort and remove any liability, but the best decision in this situation is to honor the patient’s wishes and do our best to clean up wherever the system has failed him.
But, that being said, without the translator, without the discharge papers or if he was alone, he’s on the hook and we’re on our way.
Because it all came together, he was welcome to stay home. If you said honor the patient’s wishes and let him stay home, you made my call.
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.
When responding with Mark and his colleagues in and around Newcastle I noticed the seamless integration of their dispatch and GPS systems. From the person answering the phone, to the allocator, to the crew in the car or vehicle, everyone can pull up the location of the vehicles responding.
While the reliance on GPS has been ridiculed when crews go down a street that appears to go through but doesn’t, in my experience this happens with map books as well. More than once Medic 99 was delayed because the street ends at the bottom of a hill, even though the map shows it going through. Area familiarization can help, but when most of your day is running calls, these things seem to find us when we least want to meet them.
That being said, we were dispatched to an address that made me scratch my head. Up to day 3, each dispatch had a street and number. Much of the older parts of town had addresses facing different streets, since other streets did not exist when the house was built. For example, we had one where the address was on south street, but the door was on north avenue, always has been, but address is south street. Confusing? Imagine my head scratching when we were sent to a home with a name, not a number.
The patient’s details are not important, what is important is the fact that houses on this block we found had names. Names like “Watterson Cottage,” “Peterson Place” and “Fireman Hostel” all of which had doors facing different directions. It was clear that the road access to these buildings was long after they had been built and occupied.
But the GPS knew exactly which house we were to respond to because of the 6 digit postal code given by the caller. We were inside for a few minutes expecting the police to respond, it appears they had trouble finding it as well.
We are lucky in most parts of the City knowing that 851 5th avenue is mid block on one side of the street. These houses had small wooden signs with 2″ lettering on the side, not always facing our approach, which made finding which door was the one we needed a puzzle.
Without the GPS we would have needed to know the postal codes specifically to find the house. I can only imagine how difficult it would be to find it at night. Thank goodness it was daytime. Notice I didn’t say bright and sunny.
I was sent this video by a friend on facebook and had to make sure it spreads as far and as wide as we can get it. Maybe you’ve seen it before, maybe it’s been on other blogs or outlets, but this video from almost 80 years ago could be dubbed over modern video and be just as important. It is about 12 minutes long and comes to us thanks to the folks over at flashovertv.com, a site I will spend most of the day wandering through and suggest you do the same. But first, a company film.
Please to enjoy the Los Angeles Fire Department training film “Company Response”
It has been a rough shift in your rural department and you and your partner are returning from a long transport. Passing near his home, still in your area, he remembers forgetting a change of clothes for the following day so you swing into his neighborhood, monitoring the radio.
Parked in one of the driveways is the take home car of one of your supervisors. A quick inspection as you pass reveals it to be the on duty supervisor, and not at his home. Your partner says he sees it there from time to time, but only late at night. He was unaware it was not the supervisor’s home.
Later in the week you are invited to a female co-worker’s home for a social event and the address is familiar. It is the same home as where you saw the command vehicle earlier in the week.
Should you approach one or both of them or stay quiet? You make the call.
There are many things I wanted Mark to see while visiting the SFFD EMS system. Not once during his trip did he experience the mad shuffle that is our resource allocation when we drop to level zero. What he did get to see was the rampant abuses in the SF 911 system and the paramedics helpless to do anything about it.
I don’t want to ruin the pilot episode of the Chronicles of EMS by telling you about specifics that Mark was able to witness (All with the patient’s full permissions of course), but I wanted to touch on something I didn’t see in the UK system in my short time there: 999 abuse.
Of all the calls we ran, I can think of only one that didn’t have a legitimate need for medical evaluation by someone higher trained than a Paramedic. Notice I didn’t say ambulance, because of the versatility of the NEAS Pathways system. This one person claimed to have a condition that he clearly did not, yet wanted the ambulance to take him in regardless. It was clear to everyone on the scene that it wasn’t necessary, but away we went anyway, just to be sure.
Most of the other persons who dialed 999 and got the tall American Fireman were simply looking for medical advice when they were scared or frightened. Does anyone remember the last time someone called 911, you responded and THEN they made their decision based on your assessment and advice? It sure as hell was more than 11 months ago, I’d wager even more than 11 years ago.
the Project has shown me how we in the EMS Profession have allowed our abilities and responsibilities to be hijacked. We are no longer help arriving in a time of need, but a means to get into the ER. Granted, the few instances when we have to say, “No, always call us if this happens” through gritted teeth to the old man who fell out of bed aside, I have been told to do my job and take someone to the hospital for the last time.
My job is not to take someone to the hospital, but to assess their complaint and devise an appropriate treatment, if necessary. Not drive someone to the hospital, especially in my new fire engine only capacity.
Imagine you drive a tow truck. Someone calls stating their car is broken down and they need a tow. When you arrive you find their stereo is broken, but they want the car towed to the shops, just to be sure. You’d hook that car and be glad you can bill them, right? But what if you ran a free towing service and other cars were actually broken down, needing you more? Another one of my bad analogies for sure, but one that always creeps into my mind when I meet folks who decide to go before I tell them otherwise.
No longer should we let our clients dictate their transport options without a complete assessment and history, condition permitting. In an emergency, we will obviously default to transport, but what about the other 95% of our business? The ones who decided to goto the hospital hours ago, but waited to call us for their stubbed toe, or cough, or fever of 101, or sprained wrist? They have grown accustomed to a level of service they do not need. They are entitled in their minds and it is not just a certain generation, this cuts across all economic and age levels.
ALS units flying through traffic to meet that magical response time, and for what? A sprained knee? Painful for sure, urgent certainly, an emergency…debatable.
Somewhere along the line lawyers wiggled their way into the medical care field, willing to pull the trigger and sue any paramedic who flinches and tries to tell their car accident victims that going to the ER when uninjured will not help them in court. I find myself practicing defensive EMS all the time, it was witnessed by Mark more than once, most notably on a minor scooter accident he can elaborate on.
But it’s easier to C-spine everybody than to learn how to clear, prove to your medical director you can be trusted, and then do it right?
Enough of what’s easy. Enough of playing to the lowest common denominator. Enough of listening to someone with ZERO training and education tell me about how the shoulder articulates, not even able to name a single bone, muscle, nerve or blood vessel in the area. Tell me what happened, what hurts and what doesn’t and let me do my job. Answer my questions honestly. At the end I’ll tell you what I think and discuss with you your options and what I believe is best.
“That will never work!” You shout at your computer. I saw it work. The problem is convincing the newly retired man that he can drive to the ER or clinic himself for the insect bite from 2 days ago, provided he stops scratching it to make it red every time I can’t find it on reassessment.
We are the reason our clients are so poorly informed. There is abuses of the 999 system, there have to be and reading Nee Naw, we know there are, but I didn’t see it in my 4 days with Mark and the NEAS.
So what can we do to make people understand we are more than a flashing lights taxi service?
That is what we need to focus on and something I hope to expand upon in the very near future.
The Chronicles of EMS Reality Series was filming Mark’s visit to the SFFD, in case you haven’t been reading this blog. Or twitter. Or Facebook. OK, I think everyone knew that, but did you know being filmed while doing patient care is tough?
Our pal Mark has had cameras along for the ride before. This was my first time having non co-workers and non-family members in the back of the ambulance with me. Having a preceptor in the back is hard enough, but having these guys back there can really make you sweat. In case you’re thinking it’s no big deal, keep in mind how many little things you do that might not be the exact prescribed method. Little short cuts and tricks that help you do your job better, but might need a little explanation can give the perception that you don’t care.
I hope I don’t come off that way on camera. Having Mark, a fully licensed Paramedic, watching was OK, but directly over Mark’s head was a large mounted camera capturing the entire patient compartment. Next to Mark, near the pass through was Producer/Director and also licensed Paramedic Ted Setla, camera moving to capture my movements as I treated. Then at the edge of the bench seat was Camera Stud (My term, not his) Chris Eldridge moving his camera around as well, making my wonder what they were capturing.
At a motor vehicle versus pedestrian accident, I made my scene survey and made patient contact, Mark close behind. As I got a report from the engine company I took another look at the car involved and there on the other side of it, looking at me, was the Dridge and his camera. Turning a quarter to my right, there was Ted, doing the same. I didn’t want to be that Medic we all hate to see, doing something stupid on camera. “Just do what’s right and nothing goes wrong,” was all I could hear in my head. Could they see me sweating hoping I don’t screw up the IV or make a wrong decision?
It turns out, on that run at least, I appeared calm and collected, even though I was screaming on the inside. Ever had one of those patients that just needs to calm down and relax but won’t stop crying? Mark stepped in, sexy accent (Her description, not mine) and all to calm her and hold her hand while I worked. Strong work, Mate.
No pressure. Just act natural.
It’s easy to say “just be yourself” here in my recliner, but saying that over and over again at the time made me even more self conscious of the cameras and what I was doing. It didn’t change any treatment, everyone got what they needed, but it really made me focus on the little details. Where normally I would leave a sharps down (our caths auto retract for safety but I like to get a sugar off of it later) on the chux until later in the run, I now swiftly secured it.
Times when I would tell patients, and especially clients, that they need to stop smoking, drinking and shooting heroin to get better, I made more of a broad speech about personal responsibility. My usual speech comes off a bit preachy I’m told, so I left it behind.
And it’s not just the emergency calls that makes having the film crew along rough, it’s the down time.
Let me choose a better phrase than downtime, “Interviews.”
After every run and most spare moments we talked on camera about our experiences to that point. If we had nothing to say, we were updating twitter and facebook with photos and thoughts, always trying to keep you guys up to date.
On the ambulance the cameras were pretty easy to get used to, but on the engine it was just the Dridge. He would go running to the engine when the first bells hit, climb in my side and across to the other side of the engine, staying as out of the way as you can with 4 people in a 4 person cab. After the Dridge, Mark would climb in, giving me room to turn out or in case of a medical, just climb in and take my jump seat. Getting dressed for a fire in a moving fire engine is a learned skill. Doing it with a camera rolling isn’t much different, but with all seats full and gear all over, it took a few runs to get the hang of it.
I hope the footage they got gives you the story of what we went through. There wasn’t a lot of helicopter action, no MCIs, and nobody fell in love. As far as I know. So it’s not the usual EMS show that has been thrown at us before we could duck. I’m excited to see how the Chronicles team puts it together and shows it to you. Although you already know what is going to happen, since you’ve been following along the whole time.
More updates on the Project and Chronicles of EMS to come, including my thoughts about the NEAS Administration, giant patient compartments with extra space and something I like to call a bad ass training facility.
This was the situation I gave you on friday, standing at the top of the stairs, no smoke, no fire, only an odor of burning paper.
We had all our PPE, including air of course, and multiple companies arriving behind us, so we took our pump can and went in search of the odor. Back under the stairs in what likely passed for a store room 100 years ago, we found a small section of charred drywall at the floor level. Opening up the wall led us to a large section of brick which likely went all the way up the inside of the building, but all the drywall was clear. Oddly enough the other side of the brick wall had a large amount of trapped smoke so the Truck went to work opening it up.
In the end the conditions were such that having a charged line before going down there would have gotten us knotted up for sure. Turns out the source of the smoke may have been above us, at the street level in an alley where a man was seen smoking prior to our arrival.
If you said have a look, but be safe, you made the right call.
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.
In my confused and sleep deprived state I neglected to include an article in this month’s Handover from one of our favorites, Lt Morse from Rescuing Providence. An oversight I have come off of my break to rectify.
“It’s a three mile trip from the Rhode Island Hospital Emergency Room to the Allen’s Avenue Fire Station. ETA six minutes. I could probably make it. Everything was going great, light traffic, perfect weather conditions, no road construction in sight. I could see the promised land in the distance, a little more than a minute away. I started to relax.”
Only the hardcore providers among us have been in this situation and survived. I once ducked into a patient’s bathroom to puke, but I had been feeling bad all day and the timing was right. But never have I been a block from release only to be…well…read for yourself.
And then read all about the Lt’s movie situation, and follow along to see if I play the love interest, the cranky Captain or cross the street in the background.
This was almost a letter in my file. Phew.
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.
