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

Emergency Services seem to thrive on certificates.

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

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

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

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

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

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

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

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

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

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

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

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

Let’s start to train together.

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

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

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

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

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

It’s funny, right?

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

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

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

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

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

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

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

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

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

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

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

Absolutely.

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

“This is a Starbucks.”

“This is a library.”

“This is an ambulance.”

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

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

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Words.  I want you to write 800 words.

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

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

But here’s the challenge:

Don’t use the term “Social Media.”

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

Think you’re up to the challenge?

Convince me.

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

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

Prizes to be announced shortly.

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

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

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

1. What happened?

2. What is this man’s GCS score?

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

4. Could this be his normal mentation?

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

If you replayed the video, you cheated.

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

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

Her class completed just this Monday.

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

“Yup.” Was my reply.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Details as they develop at Chronicles Headquarters.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let’s see what happens now Happy.

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

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

Oh ye of little faith-

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

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

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

Amazing Steph, just amazing.

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

Have we all gone Hi-Vis insane?

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

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

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

This photo from Ray Kemp at 911Imaging.

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

But look IN THE STREET!

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

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

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

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

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

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

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

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

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

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

Be safe people,

HM

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

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

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

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

John- “What about a peds?”

HM- “The system will implode.”

A few weeks back I recieved a pair of structural firefighting boots from Black Diamond Boots who was a co-sponsor of the FireEMSBlogs.com meetup at FDIC in Indianapolis.  They are well know for their Boot Girls.  You can meet them and try on the boots for yourself in Baltimore July 22-24th at Firehouse EXPO.

Oh, sorry, the boots.

I’ve had a fair variety of different boots over my 16 years of pulling these things on, from basic rubber boots as an Explorer Scout, to heavy duty duty boots and all leather turnout boots.  These X-Boots look nice and have a few special features that I liked.  It also has one feature I did not like, but more on that later.

Let’s talk about the evaluation period.

I used these boots on a total of 11 shifts.

In those shifts they experienced 2 fires, dozens of medical jobs and a few MVAs.  Whenever partaking in a ladder drill, I made sure to volunteer to climb and lock in.  Whenever on a medical I carried the chair/patient and footed the gurney, used the boot to elevate the board for taping, you get the idea.  I tried to get them into every possible situation I could encounter during the trial period.

The X-Boot is a leather/kevlar/rubber combination boot that when worn is very comfortable.  Even as a new, stiffer soled boot, it was more comfortable than I expected.  The sizing is also great, with my 11.5 feet staying in the 11.5 boot.  We all know when walking down an alley at a fireground pace a loose fitting boot is annoying and you get that clop clop feeling as the boot slightly hangs on your foot, heel loose.

The X-Boot has a 3 point heel lock feature that may lend to this problem being eliminated, but I can’t feel anything “grabbing” or “holding” my heel in when I walk.  It just feels better than other boots I have worn.

• NFPA standards are met or exceeded by this product and they did just fine in the fire environment and were very easy to clean afterwards.

• Locking in on both straight and extension ladders was no different.

• Crawling and performing other fireground tasks was also very similar to other boots I have worn.

A feature I think I would like after a few years is the extra material on the top of the toe.  My current boots are torn up from crawling and footing gurneys, even this additional 1cm of rubber is huge in the long run.

Built in pull up loops replace the more common straps to pull the boots on, but I prefer the straps and have never lost one yet.  The reinforced material to accommodate the handles causes the one drawback I found with these boots.  When donning, the boots go on fast and slick.  When back in the dorms, the wide opening and reinforced profile make it difficult and time consuming to pull the pants back down around the boots.  To test this, I borrowed a larger pair of turnout pants to see if it was just my gear, but even a larger set was difficult to pull down.  When running multiple building alarm, MVA and fire calls it got frustrating, but I’m willing to put up with it for the better fitting boot.

In the end I would recommend this boot to anyone looking for a comfortable fitting turnout boot.  The list price of $249.99 is more than reasonable for this product.

If that is more than you are willing to spend, you can try a smaller version:

My rating for this product is 3 1/2 out of 4 helmets.