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Gearing up for Tak Response

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

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

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

Let’s start to train together.

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

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

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

800 What?

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Words.  I want you to write 800 words.

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

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

But here’s the challenge:

Don’t use the term “Social Media.”

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

Think you’re up to the challenge?

Convince me.

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

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

Prizes to be announced shortly.

Going to P School? We can help.

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

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

Her class completed just this Monday.

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

“Yup.” Was my reply.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Details as they develop at Chronicles Headquarters.

Can you see me now?

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Have we all gone Hi-Vis insane?

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

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

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

This photo from Ray Kemp at 911Imaging.

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

But look IN THE STREET!

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

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

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

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

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

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

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

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

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

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

Be safe people,

HM

Black Diamond X-Boot Review

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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:

Firefighter monopoly

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

The Car, The Wall and The Game – Day 3

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England recap, Day 3.

The alarm seemed to be timed better this morning and I was bright eyed and bushy tailed for my second day on Mark Glencorse’s Rapid response Car in Newcastle.  The coffee was ready when I got out of the shower and I watched a bit of news while getting ready.  When I was in England a frightening wave of flooding was literally washing away parts of the western side of the country and numerous Fire and Rescue resources had been mobilized.   It was a topic of conversation in passing throughout the morning with the Vehicle (ambulance) crews we saw and hospital staff we talked to.

The check out on the car was much quicker since my first day orientation and away we went to our first post.  On the way Mark asked if I was hungry and I had to remind him I don’t often eat breakfast.  In the back of my mind was another McDonald’s run but in the front of Mark’s was taking my for a proper Geordie breakfast.  The term Geordie refers to the people or speech from the Tyneside region of England, which is where Mark is from and where we were.  Similar to referring to someone as a Lonestar or Southerner here in the US, a dialect of speech and set of stereotypes is set into your mind.

The car weaved through the light morning traffic to a take away trailer in a light industrial park.  The aroma from this man’s trailer was like heaven.  The odor of bacon, along with other smells, changed my long standing no breakfast clause and my mouth was watering.

As with many of our other adventures this day, Mark in the car had folks wondering where the emergency was.  No one thought he was the Police coming to get him…until they saw me in my navy blue.  When Mark ordered my meal and the fellows standing nearby read the back of my jacket, which said “Firefighter/Paramedic SFFD” they were curious to ask all the questions we’ve been asking each other for months.

“Is it true you have to pay to go to the Doctor?” “yes.”

“If you can’t pay do they send you away?” “No, you get a bill later.”

“What about an ambulance? Is it true you’ll leave me to die if I can’t pay?” “No, we’ll help you out no matter.”

It was a great conversation with locals about their neighborhood and town.  Keep in mind this town has been here more or less FOREVER.  It’s not like some guy wandered through 200 years ago and started a farm.  There are castles and churches still standing despite centuries of wars.

It was in the middle of a talk about a nearby castle that my breakfast was ready.  Mark’s smile widened as he handed me what can only be described as heaven with a side of LAD.

Bun, mushrooms, brown sauce, black pudding, eggs, sausage, bacon and it was glorious!  Along with a true cup of coffee and some good conversation it was a wonderful way to start the morning.

But like so many things on this job, wouldn’t you know it a motor vehicle accident has been reported just a few blocks away.  Chomp, gulp, a thanks and away we go to the 2 car accident.  There was an initial need for extrication so Mark called in the Brigade.

The ambulance arrived quickly, as did the brigade and everyone went to work doing their pre-determined roles.  It was refreshing to see firefighters not distracted by assisting with patient care, but simply having a task and seeing to it that it was done.  This scene was more what I was used to.  Ambulance, fire engines, police, a proper job.  Although the injuries minor and the damage to match, the resources in the community worked seamlessly together to get the job done.  After the patient was transported I had a quick talk with the firefighters about their roles and responsibilities on this assignment, since there was not the usual bickering or fighting for the glory of the jaws that I have seen all throughout my career.  The firefighter assigned to cribbing was working just as carefully and quickly as the two sets, yes I said two sets, of hydrolics that were being prepared.  We discussed my role as dual trained and they gave a polite smile.  I think just below that was two distinct thoughts.  First, “That’ll never happen here” and the competing, “Oh God, what if they do that here?”

My photographer for the day obliged for a photo of the brigade that responded drawing my caption, “One of these fireman is not like the other…”

After a couple more jobs we were released from our roll area and directed north to the Arsenal/Sunderland football match.  The trip started as a chance to show a lifelong soccer fan a proper football match in his adopted country, but it would turn out to be an EMS learning experience.

But first, Mark had something special planned for me.  We grabbed our sack dinner, lovingly prepared by Mrs999, and hit the road to see the proper section of the old Roman Wall I was so interested in.  The drive through the countryside was amazing.  Rolling green hills hiding in the fog, unchanged since ancient times, save for the occasional 200 year old farmhouse with it’s trailing smoke from the chimney proving someone still inside.  The park rangers (or the UK equivalent) came out of their warm office to meet us when the RRC pulled up and we got out.  They wondered if a hiker had been hurt on the wall, why else would the ambulance be there on a foggy, rainy afternoon?

After a climb and a brief hike I was able to take some video and one of my favorite pictures from this adventure.  smallerThen I got to do what my Grandmother never did, stand on Hadrian’s Wall, where her hero Arthur may once have stood.  There was a connection with that place I can’t really describe.  I have the book she was reading when she died, Stories of King Arthur, a book she received as a child from her grandmother and I display it proudly in my living room, bookmark still in place and soon a photo of this part of the wall will accompany it.

It was an experience I hope to share with my young girls when they are old enough to appreciate what the wall means to the family.  Folks have been known to walk the whole length, camping as they go, and I plan to do the same in good time.

And now for something completely different.  If you’ve made it this far, I thank you.  Like Mark has said, so much happened on this trip, so many interesting and exciting things we shared with each other and with all of you, these day by day accounts are long winded.  If you skipped this far to read about Event EMS you are truly a Fire and EMS nerd and I salute you for that.

The Sunderland stadium can hold, at capacity for a football match, 45,000 impassioned fans.  The perception of many of you in the US may be “Soccer Hooligan” and the stereotpye is fitting in many cases when it comes to premier league football.  I was treated to not only the game, but a tour of the medical facilities made available for players and fans alike.

The stadium has an impressive command center encompassing the EMS team co-ordinator, Fire safety specialist, CCTV team and the police commander, all in two large rooms.  From this unified command center a response can be co-ordinated and a plan followed by radio.  The CCTV cameras also allow the leader to call in extra security if it appears an EMS fly team has unrest around them.  Help can be on the way before they even notice what is happening.  There were 4 teams on staff, dispersed around the stadium with assigned seats and radios, ready to respond as well as 2 pitch or field teams ready to respond to an injured player or person on the ground level.

Behind the scenes are two levels of care.  The teams have physicians on staff to deal with injuries to their people and outside the stadium, tucked in with the snacks and beverages are a number of doors marked First Aid.  Behind these doors are the service I know little about from my travels there, St John Ambulance.  (Not St John’S ambulance, St John.  I learned that one real quick.)  In these almost clinic areas are basic care givers, EMT’s, Paramedics, RNs and an entire medical community, all volunteering to help out.  While Mark and I sought refuge there to eat our dinner before the game, a woman came in, was assessed, treated, medicated and released, all in the span of 10 minutes, all by the St John staff.  It all happened before I could finish my Dr Pepper.

Upstairs in the control center I had a chance to peek at the emergency response plan and these guys have it all figured out.  I learned later that a number of previous events led to a mandate that each stadium have an action plan and the resources in place to react to those emergencies.  We also talked about rotating the teams if more than 1 fly team was mobilized, the extent of the St John involvement, their ability to staff a team and a number of other things most laymen would have fallen asleep thinking about.

The match was brilliant.  We stood just outside the command center, which was near the visitor’s seats.  Arsenal fans are passionate fans.  When I applauded a good play, which is common in this sport, Mark grabbed my hands just as one of the visiting supporters turned to see who was clapping.  Just what I need 4,000 pissed off drunk football fans chasing the American who clapped because the home team goal keeper made a nice save.  Tragedy averted.  And good too, because we were heading out on the town later.

We’re meeting Mrs999 and Fiona for a night on the local scene to give me an idea what Geordies do when the sun goes down.  Well, a while after the sun goes down.  OK, late at night.  I was treated to some local color and had a chance to talk to Mrs999 and Fiona about the person I was shadowing this week.  We talked, danced, twittered and had a wonderful time.  Mark loved his new iphone, since the old one died in San Francisco and at one point he fell asleep updating all the Chronicles of EMS followers.  OK, not really, but it made for a fun twitter update.

As the evening continued on the famous Millennium bridge over the river Tyne, I had a chance to reflect on where I was and why.  It was a big deal to be where I was, with Mark and the NEAS, learning how to deliver care in the front loaded model.  We should have called it a night there, but we had one more stop.

Bachelor and bachelorette parties in Geordie country take themed dressing to the extreme.  In Las Vegas, the girls may dress in pink shirts with the bride to be in some kind of white head dress and veil, letting all the single guys know exactly what she is celebrating.  But here, the entire group dressed to match.  There was a group of guys dressed as 20′s gangsters, pinstriped suits and fedoras.  Why? Stag party.  Groups of girls wearing matching tight shirts all wishing their engaged friend luck in cleverly worded phrases on the front. Why? Bachelorette party.  In came a group of girls wearing black and their names on he back of their shirts.  One of them we know.  Steph Frolin is the name my co-workers use to alert me to a scene that is not what it seems.  Imagine we are investigating a person who says they just came in from a terrible car crash.  As I’m assessing them my partner discovers witnesses in the next room who can confirm no such thing ever happened.  They will refer to me by my BS name: Steph (Pronounced Steve) Frolin.  as in “hey Steph, can you have her describe the car again?” Now I know something has changed and that I need to speak to the partner ASAP.

So Mark turned on his ambulance charm and talked the poor girl into standing with the only guy wearing a jacket for some reason involving an American and a blog.  No doubt she has erased this moment from her own memory.

As I mentioned earlier, we should have cut the evening short at the bridge.  The jet lag, the drink, Mark’s dancing, a long day and an early alarm clock would spell disaster early the next morning for our last day on the car.

Taking it easy on the drink is a suggestion that carries through all situations and this one is no different.  Not that I went to excess this night, no where close, but the combination of the time change, new diet and excitement of the Project would lead Mark to getting me off the streets the next morning.  And I’m glad he did.  Details on my nap next time.

Swalwell 405 – Day 2 in Newcastle

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This is a continued retelling of my adventures on Part 2 of the Chronicles of EMS, the one we weren’t allowed to film.

Day 2 in Newcastle, Day 1 on the car.

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:

YouTube Preview Image

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

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.

Where’d who go?

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blog medicBehold the car into the tree.  Behold the car full of teenaged girls saying something about a motorcycle.  Alas we found the bike.  Where’d the rider go?

THE EMERGENCY

Units are responding to a reported major MVA, entrapment, car vs tree.

THE ACTION

And as usual, the tree won.  But this isn’t a straight forward tale of a car accident, extrication and treatment.  No, no my friends, you all know this forum is about the unusual, so follow along as we piece together what happened.

Tonight the girls are out to have a good time, cruising towards the club district, jamming the tunes as the kids say, when they enter an intersection at a decent speed.

Something impacts the car causing it to veer onto the sidewalk and come to rest, rather violently, around a tree 40 yards down the road.

The responding engine approaches from the side the car was going to, not coming from and has radioed for assistance while they begin assessment.

Me and my ride are coming from the other direction, the same as the girls were traveling.  Not one to get tunnel vision I always make it a point to scan the road before an accident for skid marks, body parts, you name it, and that is how I spotted the motorcycle.

We stopped for a brief moment and looked for a rider to accompany the bike since there was a trail of fluid from the intersection to the bike it had not simply been knocked over.  I see no one and the buildings are so close to the street that had he hit one, we’d see him.

So we choose to approach slowly, looking with the spotlights for the mysterious rider, but have no luck so make contact with the crews at the car.  It is here where we hear multiple stories from the emotional passengers about the man on the hood of the car.

Hoping I had not missed something so obvious I take a quick peek and, thankfully, no one there.  But my brain starts to process the distance from the intersection and the likely speed of the car into the tree and it occurs to me.

He was ejected from the hood.

Sure enough, 30 yards back the way the engine had come, partially wrapped around a sign post is our bike rider, helmet now off, relaxing up on one arm.

“I was wondering if you guys saw me, I’m pretty sure me leg is busted.” he tells me as if mentioning my shoe was untied.

He had some significant trauma and we took full precautions, even so far as removing his now almost useless re-enforced riding jacket in one piece, per his request.

We landed the helicopter a few blocks down and got him out fast.

I found out later from the nurse who took him in that he was hit by the car and felt a searing pain in his leg, then found himself trapped on the hood of the car as the girls began to scream and the driver lost control.  Had he been even 1 foot in either direction he would have been pinned against the tree or ejected and likely run over.

In the end he was lucky to have been hit the way he had.  But it still makes me smile when I think about the police officer/EMT holding the collar who, when asked where the man on the hood went, responded,

“Where’d WHO go?”

The PD to FD Translation Book

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A little while ago I told you about the hidden meanings when PD talks to Fire. Now for the flip side.

When Fire says:
“We need this road closed!”

What they really mean:
“Would you mind blocking those cars with your body instead of mine?”

When Fire says:
“Can someone hold this IV?”

What they really mean:
“If you’re going to gawk over my shoulder at least be useful.”

When Fire says:
“Advise when the scene is safe.”

What they really mean:
“The MDT says psych patient and we just showered after PT. We’re not in the mood to wrestle.”

When Fire says:
“There is no medical merit here.”

What they really mean:
“I have other emergencies to attend to, so if you can do all the paper work on this one, that’s be nice.”

When Fire says:
“Is he in your custody?”

What they really mean:

“There’s no reason for him to go to the hospital, he can stay in jail.”

When Fire says:

“Can you relocate your cruiser to the north and close the road?”

What they really mean:

“That little thing your car is parked in front of is where we get the water to fight the fire.  Could you move it? kthxbai.”

You Make the Call…Stairway…What Happened

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ymtk-140x200We had a patient very similar to THIS not long ago, or I didn’t, depends on your interpretation of the legal nightmare that is HIPAA, but since we’re learning here, I claim the education exemption.

He fell down the granite stairs, as evidenced by the drops of blood as we came up.  Why is it folks refuse to stay put when they might actually be injured but are held down by bystanders when nothing is wrong?

Up the narrow stairs we find a man in his 80′s with a head injury and a flail section. Double whammy.  In real life we had room to get the board around him and lay him down for the journey.  It was not easy and the issue of placing the board uphill or downhill was a quick learning moment for our EMT student ride along.

But when we returned to the firehouse, I wondered aloud what we would have done if we had not been able to fit the board.

Some possible answers included:

  • Walking him back to the point of injury with C-collar in place.  No, not a good idea.
  • Using the stairchair and buckling him in. Could work, and quick.
  • KED and carry, not much room there unless we include the stairchair. Could help the flail section as well.
  • Load and go, don’t spend time packaging, he needs definitive care.

All certainly good options and faced with a unique presentation we need unique answers.

But let’s not spend too much time in the stairway throwing out suggestions.  Find a solution and go with it.

If you said take precautions any way you know how, you made the right call.

You Make the Call…Man Hole Fire…My Call

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You Make the CallWell, shoot. When I first got hired our training Captain put up a shot of the Tokyo gas attacks and asked us the two best ways to handle such an incident.  People were running everywhere, others lying in the street.

He let us think about it for a few minutes, then let us in on the secrets to dealing with large incidents.

Option #1 is to reach over the center console while pulling out of the station, grab the steering wheel and pull.  The rig hits the door and you’re out of service in quarters, send someone else.

Option #2, if you forgot #1 and found yourself on the scene, was to calmly remove your coat and helmet and blend in with the crowd.

All kidding aside, this is a situation many firefighters will not encounter.  In my area we have large underground electrical vaults that serve as relay points for the City’s electrical systems.  More than once these have failed, caught fire, exploded etc.  hey, it’s electricity, a thousand different things could happen.

The important question, and the reason I shared this photo of an actual vault fire, was to get us all thinking about that first radio report and request for resources that can establish the tone and response over the next 30 minutes.  they say the first 3 minutes of a large incident can dictate the next 3 hours and I believe it.

My Department also has resources specifically designed and staffed to handle these incidents so I simply have to relay to the Battalion Chief that I have a vault fire and the system does what it has to do.

But, here would be my initial actions if that was not the case:

“Control, this is Engine 99, we are on the scene of what appears to be an underground fire, smoke showing.  We are staging upwind at 5th and Main, establishing 5th Street Command.  Strike a full first alarm and have them respond from the south to 5th and Main.”

You get the idea.  The point is to convey what you can without getting too wordy, but get resources rolling, including higher ranks to co-ordinate further response.

I would use the PA to get bystanders away and set up a perimeter, stretching a line part way there to protect persons who wander in if something happens.

That’s my call.

Layout

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Sunday Fun - Get MotivatedIn my opinion the most important person on a hoseline is the layout man.

Some departments staff 3 to an engine, meaning there is no layout man unless the Officer goes back down the line to make things right.

Not mine.

We run 4 to an engine and for good reason: You need 4 people to mount an effective primary fire attack.

Driver/Engineer: Operates fire apparatus, engages and monitors pump and water supply.  Good so far, we have a way of getting water into the hoses, that’s a plus.

Officer: In command of the team. Calls for type, length of hose and where it is to be deployed.

Nozzleman: Operates the valve at the end of the hose, points it at the fire.  Really more complicated then that, I know, but than again, so is…

Layout: Ensure the hose is properly deployed from the apparatus and unkinked entering the building.  Follow the attack team around corners, untangling and advancing line as needed.  Block open doors and move furniture so that when the line is charged it isn’t trapped under something.  Stay back from the firefight to pull line back so the nozzle team can redeploy to another location without standing on a load of spaghetti in the hallway.  And, possibly THE most important role of the layout position is to slow additional responding companies if conditions are unsafe ahead of you.

Even though the Officer has a good view of the seat of the fire, and a good officer knows the conditions around them, they can’t see what the layout person sees.  From a safe distance, possibly at a corner, ready to pull hose while the nozzle gets the “glory,” the layout can scout conditions in other rooms and maybe even get some ceiling fall on them when the truck cuts a nice hole.

The layout knows all the trouble spots that line may encounter if it needs to move through that area again.  The first two folks through had their attentions elsewhere.

The layout is also the one who will be assisting the nozzle team should the conditions warrant an evacuation.  From that position you know where the exits are, not just where the line goes out, but also rooms of refuge, should they be needed.

When the fire is out and overhaul continues, the layout man needs to make sure that line is still available to knock down hot spots in the ceiling and walls by looping it into an unburnt room and placing the nozzle, with nozzleman still attached in a position to redeploy if necessary.

We should never leave the engine without a tool of some kind, but as the layout we need full flexibility so a sheathed axe can really get in the way.  A pump can can also get in the way but makes an excellent door chock and point of no return doorway device.  That little can can keep an advancing fire from getting through a doorway if teams are retreating behind you for at least 2-3 minutes when used properly.  So what to bring?

Depends on construction, location of fire and your Department’s SOPs.  A cop out answer I know, but the truth.

So next time someone else “grabs” the nozzle, remember that they have it easy, now you’ve got the most important spot on the hose line.  If the fire goes out you did your job right.

Now get those kinks out and feed line up to the third floor!

The Premiere Party is LIVE!

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Chronicles of EMS Trailer

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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.

Do 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.

System Abuse: What are WE doing wrong?

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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.

3…2…1…Action! – Providing care with cameras rolling

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chroniclesblogThe 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.

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.

You Make the Call…Restaurant…What Happened

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You Make the Call...Line UpThis 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.

Report from England – Part I

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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.

A true close call

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broad street bulliesIn 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.

the Handover – Close Calls Edition

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Last call for the HandoverThis month’s handover draws from our friends across the interwebs stories of close calls. Times when they or their patients, colleagues or family almost didn’t make it. I was inspired to make this the theme not just because of the holiday weekend here in America, but to remind us all that we are fragile and put ourselves out there sometimes. Hopefully one of these links rings back when you’re in an unsafe or curious situation.


Found with the Where did the angry guy go files-

“What do we do?” asked Eric, his eyes wide.

“I don’t know about you two,” I said, “but I’m about to jump through that window over there.  I don’t know if that guy’s getting a gun or what.”

by Buckman who runs Gomerville

From the I don’t think you should be driving file-

“I was overwhelmed by the dreadful realization that I had just accepted a ride from a highly intoxicated snowmobile rider and we were hurtling through the dark northwoods at 70+ miles per hour.”

from Greg Friese of, among many, Every Day EMS Tips.


From the Thank God you’re driving category-

“This was a serious incident. This was no routine, boy, we almost had an accident. This was my death.

I don’t know if my partner would have stopped on his own if I hadn’t shouted. Maybe. Maybe he had it all under control and was already getting ready to hit the brakes.”

from Peter Canning, a new contributor to the FireEMSBlogs family, at StreetWatch:Notes of a Paramedic

In a section titled simply Gulp

“Jill and I found him lying on the floor, fully clothed and in a coat, eyes shut, but eyelids flickering. An almost certain sign of pseudo-unconsciousness. A fake. I took a step back and called out to him. Jill was still standing by the front door, uncertain how to proceed. Something still felt wrong, so I asked her to go and call for police back up. With hindsight, I should have gone with.”

writes Ben Yatzbaz, resident Insomniac Medic


Found in the Basement selection

“This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor.”

from our pal Chris Kaiser at Life Under the Lights


From the lost in the snow pile-

Dear God, they’re working a search pattern. Please, not tonight. It’s not mutual aid to another fire department; they’re working a grid search with the police. I grab my boots, then pad to the garage to check the fluids in the IV warmer. Anyone caught in this weather without shelter will be near death, if not there already.”

by Mack505 at Notes from Mosquito Hill


From the trust your guts file-

“I give my partner the “time to leave pronto” hand gesture. “Code 3, hurry up”. I give a little oxygen and attempt the IV enroute with no success. I realize that something is not going well for this patient and I don’t have the means to diagnose or fix the problem.”

by Rescue Monkey of Paramedic:Life on the Streets


From the Old School section-

“The smoke level now was to the floor as I grasped the hose line to find my way out. The urge to rip off my mask was strong but my training had taught me this would be fatal for sure.”

by HMHQ Contributor the Angry Captain


and finally, from the Hmmm…that looks wrong category

“A back board was brought up and one of the other Paramedics on the engine teams attended to him pulling off his jacket.  Justin asked us if the building was still on fire. We we told him that yes, it was still on fire, he asked us to put his jacket back on. Not completely out of it.”

from yours truly and the event that launched me into the blogosphere.



Next month’s handover will be hosted by Ambulance Driver, theme TBD, watch his space for details as they develop and, above all else, be safe.

HM Clear.

the Handover – Call for Submissions

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Have to get in a bit about the Handover before I pop along to England next week.

 the Handover - 8th Edition

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

  • Emergiblog
  • Happy Medic Headquarters
  • Life Under the Lights
  • Medic999
  • Rapid Response Doc
  • Rescuing Providence
  • Trauma Queen
  •  

    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.

    Preparation for tomorrow

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    I am finally at home after dinner with Mark, sipping a scotch and thinking about tomorrow’s first day on the ambulance.  I am wondering if Mark will be able to contain himself the first time someone abuses the 911 system, or the second, or the third, when he sees we are required by law to take folks in.

    My mind imagines Mark in awe when we apply our CPAP to the woman who would normally need to be nasally intubated and she not only stabilizes but improves.

    What will he think if we get a chance to pace a symptomatic unstable bradycardia or convert an unstable SVT.

    Will Mark search through my kit looking for pain medications when I have only morphine and oxygen for pain management.

    I have so many things I want to show him about the fire based and private tier model we use that I almost forget about the ocean between us in capabilities for patient care.  Fire engine and rapid response car aside we make differences in different ways, don’t we?

    Tomorrow is Mark’s first day on an American dynamically deployed fire based ambulance and part of me is worried he’ll be angry we can’t do the right things for most of our patients and clients.   Another part of me hopes he sees the benefits of some of the things we’re doing he is not.  There is so much opportunity to learn from one another side by side I hope my clients don’t get in the way of our learning.

    This will also be an opportunity, with the Chronicles of EMS filming along side us, to show he rampant abuse of the 911 system in San Francisco.  How can we solve a problem that is not ours?  That’s an entirely different show indeed.

    So I’ll try not to sweat the small stuff and just do my job like I always do with that green jumpsuit close behind.

    We’ll be in the yard at 830 for our shift at 9.  See you on post,

    the Happy Medic

    the Angry Captain’s Close Call

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    The Angry Captain is on sceneThis month’s EMS Blog Carnival, the Handover, will be hosted here and the theme is “Close Calls.”  With November in the US including Thanksgiving, I thought what better time to share an experience when we had that thought go through our mind “I/they might not make it.”

    Send in your submissions about a time when you, a patient, or someone you know had a close call and I’ll put them together to share.  If just one person can use that information to make their job safer, then we’ll have succeeded.

    So with that theme in mind, here is the Angry Captain’s Close Call.

    8:30 pm February 1982

    The call:  Structure fire, “house across the street has black smoke coming from it.”

    It is a cold winter night with temperatures well below freezing; we are in a relief unit that had no inboard seats so I was belted in on the tailboard. On arrival, we found a residence with black smoke pouring from the rear.  Reportedly, no one was home.

    The home is typical for the area in that the base of the home started as a house trailer with several additions around it. As the first engine to arrive, we pulled a 200’ preconnect and forced entry on a side door that appeared to be the entry. The captain and I crawled in below the smoke and worked our way through a maze of doorways to what appeared to be a fully involved kitchen area. The ceiling was flashing over as I trained the nozzle at the base of the fire. Suddenly, my air pack warning bell went off.

    We could not have been on air much longer than 5-10 minutes. I patted the captain on the back to notify him that we needed to back out. He gestured for me to head out and took the nozzle from me. My training from my previous department was never to leave anyone alone in a fire. As I turned, my air pack quit entirely; no air at all.  The smoke level now was to the floor as I grasped the hose line to find my way out. The urge to rip off my mask was strong but my training had taught me this would be fatal for sure. Holding my breath was all I could do as I struggled to focus on following the line out amid my disorientation from lack of oxygen. As I moved along, I remember hearing a loud mechanical sound further confusing my strange journey through this black maze. The sound grew louder as I slowly followed the hose line hand over hand in the seemingly longest moments of my life.

    Suddenly light appeared as the noise grew to a roar, but I crawled out, finally ripping off my face mask, gasping for air, and collapsing in a snow bank. My next memory was lying on the gurney in the back of the ambulance.  At the hospital, they ran blood gas tests and flooded me with plenty of O2. As my color returned to normal (apparently I was quite gray), I was told that they found me outside our entry point where the truck had hung a mechanical fan at the top of the doorway for ventilation. (The loud disorientating mechanical sound.) I am not sure how long it was that I lay there in the snow bank before I was noticed.  But Mrs. AC got the frightening call about 11 pm to pick me up at the hospital….no one likes that call.

    Lessons learned:

    1.       The air pack I was wearing was found to be working properly back in a warm station house and in fact still had about ½ its air. The speculation at the time was that the moisture in the diaphragm froze causing it to stop the air flow.  Had it been checked at the scene, it could have provided the exact problem.

    2.       Never allow a member to leave alone or leave a member alone in a fire. This was long before 2 in 2 out.

    3.       Always follow your training; i.e. following the hose line out and keeping your mask on in heavy smoke.

    4.       Do not block the egress of the hose line with ventilation. Had I been on all fours coming out feeling ahead with my hands, my fingers may have been lost to the whirling fan.

    This was a true wake up call for me and cemented in my mind how important my training had been and how things can go wrong in a matter of seconds.

    EMS Garage Podcast

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    Happy was a guest on the EMS Garage Podcast, Episode 60, which is now up at EMS Garage.com.

    http://emsgarage.com/archives/390

    Come listen to me and Mark talk about the Project as well as the details to the Blogger Meet-up in San Francisco next Saturday!

    The host’s volume is low and Mark’s accent might throw you for a loop, but it is also a great conversation about using social media to further our EMS missions.

    Special thanks to Chris Montera, Carissa O’Brien, Gary Wingrave, Ted Setla and of course, Mark Glencorse.

    the Happy Medic Channel

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    It would certainly be a premium channel, right?

    What got me thinking about this was my recent experience on the EMS Garage, hosted by Chris Montera.  If you’re not listening to this forum, you need to be.  The twitter blitz that was the 2009 EMSexpo mentioned podcasts and videos, but with my trip from the refresher and trying to catch up on work and the Project, I never clicked over.

    <punishment=”bang head on desk”>Stupid, stupid, stupid</punishment>

    Neat video.  I say neat because it reminded me of one of m favorite shows, Attack of the Show.  On AotS two hosts have a great time sharing news and product reviews geared towards a specific demographic, the 18-35 year old nerd. (myself included)

    EMSexpo live produced clips from the show floor clearly designed for a specific demographic, people passionate about EMS.  Each piece is interesting and fun to watch with both Carissa O’Brien and Chris Montera clearly having fun doing it.

    Motoring in EMS the Segway Way! from Thaddeus Setla on Vimeo.

    See what I mean?  Click through and watch the series of videos from EMS expo 2009, Atlanta.  Neat stuff.

    Perhaps this can expand into a “channel” where podcasts become videocasts and learning videos become a learning series?  I can has host bloopers show?