Ah… a nice day off with the family.

Today you’ve decided to grab the kids and head into the City for some time at the Museum.  The crowds are thick on a beautiful spring morning and you navigate them with the skills of someone who has been through worse.

As you stand in line with another 250 patrons, wouldn’t you know it, the fire alarm  begins to sound.

Great.

Grabbing the little ones you make way with the others towards the exits and are rather impressed with the way folks are actually leaving the building.  On the way out, your little one asks if the fire trucks are coming.  Doing the quick math and having responded to an alarm at this particular building, you know the first due engine is only minutes away so you hurry along to the front of the building.

Outside everyone is asking everyone else what they think caused the alarm.

“Some kid playing with the alarm” someone says.

“What if they just needed to evacuate the building?” someone else asks.

Looking at your watch you realize the first due engine is past due and the alarm bell is still ringing.

10 minutes pass.

Then 15 minutes pass.

No sirens, no engine and everyone is still outside.

Do you step forward and if so, what do you say/do?  This is your response area on your days on duty and something isn’t right, but you have the family in tow.

What do you do?

You make the call.

The Handover, blog carnival roundup brain child of my UK alter ego Medic999 turns a year old this month.

Buckman at Gomerville.com asked for submissions around the theme of an EMS Portrait and the submissions did not disappoint.

Hard to believe it was a year ago Mark emailed me about this idea and I had no idea what he was talking about.  Now it’s a great way to find new blogs and share posts about a theme.

Be sure to read up on next month’s topic and host while there and drop a post in.

Attention all units in the field.

The Mutual Aid Bards are being updated with a couple of new blogs on the EMS radar.

Ambulance Amateur is a volunteer care giver in the UK who so far is quite opinionated by the clients he meets.  I’m adding them as a window into another version of what i saw with UKMedic999 on the Project.

Another new find is the Orange Taxi who I found wandering looking for other folks reactions to the discussion over at CK’s place about EMS pay.  He’s been in the business a bit and has something to say about it. I’ll be listening.

I wish our new blog family good luck with their endeavors.  have a read and if you like them, follow them.

HM

That seems to have gotten your attention.

I wanted to post a bit about the end of the year salaries, but our buddy CK has a far better slant on it than I was planning.

And my usual rant about system abusers seems like an echo in the great conversation going on over at Ambulance Driver’s place.

And with the usual end of the year stuff approaching, I want to gather my thoughts about my resolutions, as well as looking back and seeing how I did on last year’s.  Since the end of the year means getting ready for the tax man I thought I’d pass along a few of the unknown LEGAL deductions you should ask your tax preparer about.  I understand many of you are grumbling, and then some, about the perceived increases under the new guy, but alas, not this year, or next so far.

This is not meant to be official tax advice, hence asking your tax preparer, and if you are taking real tax advice from a fireman’s blog, God help us all.

For example:

If your service requires you to maintain your hair a certain style, 4 haircuts a year are deductions.

If your service sends you from your regular station to another one for the day, the mileage between them one way is a deduction.

If your uniforms are required to be clean, your dry cleaning is deductible.

If you are not reimbursed for meals, nor given time off to eat them, a portion of your meals, or a portion of a pre-determined meal rate for your area is deductible.

Those texts you bought to improve your patient care, yup.

That trip you took to Boca Raton to grab an application and scout out the system.  uh-huh.  But just you, not the wife.

Your refresher, sure.

That new helmet, yes.

The case of scotch to the Captain over at station assignments…not anymore.

Part of your cell phone bill if you use it for work (Medical Examiner, Medical Control), yes.

Mileage driven to and from the station from home, no, unless you meet some really strict rules.

Bridge tolls to and from work, no.

New work T-shirts, yes, if required as part of your uniform.

Laundering said T-shirts, depends.

Union dues, deductible.

Subscription fees to JEMS Magazine, yes.

Receipt from your firegeezer.com mug.  I’ll have to re-read the section under “Mandatory work equipment.”

That’s just a quick list.  Please be sure to ask about the situation in your service.  Fire folks fall under a special exemption from many of the standard working, salary and tax rules, so read carefully and, if in doubt, pay someone who knows about your profession.  In the end, if you plan it right, you can write off a trip somewhere nice for your mandatory refresher training.  But just you, not the wife and in-laws.

I’ll be back in a few days with a year end round up that should bore your socks right off, then we’ll pick up where Mark leaves off when I start my day by day retelling of the England half of the Project.

Mkai?

Pass the word far and wide, the November edition of the Handover is calling for submissions of your favorite EMS/Nursing/Rescue/Fire and pre-hospital care blogs.

This month’s theme is “Close Calls” and revolves around a time when you or one of your patients almost didn’t make it.

But if you haven’t got a tale like that, feel free to pass along a post on another topic.  You can submit an article or post by sending a link to thehappymedic@gmail.com.  If the post is not your own, make sure you let me know your name and why you like that blog.

Submissions are due by 10PM Pacific Time wednesday November 25th.  This is so I can edit the post on my flight back from England to publish it on time.

The December edition of the Handover will be hosted by one of my favorite EMS bloggers Ambulance Driver, topic TBD.  If you are reading this AD, drop me a line with the topic and I’ll hand it over on Friday the 27th.

You know it’s a good meeting when the Chief Administrator of the North East Ambulance Service turns to you and says, “What do you need from us?” Points at the senior managers, “How can we help you?”

Preconceptions were answered for and systems were compared.  I brought up the countless stories we seem to hear about ambulances here leaving old women in the streets for hours and the mandatory meal breaks.  I asked about the fire brigade responding to assist and the rapid response cars being sent before a call is classified.

And I got answers.  From the Chief Administrator.  And they weren’t the usual political safe answers so common back in the US.  He spoke of peeak usage times and limmited resources available in crtain areas, not unlike in the US.  Mandatory stand down times CAN be broken into, it just means the crew gets paid more.  Circumstances such as the ones reported are investigated very seriously and performance standards from call takers, to dispatchers to field crews are all monitored very closely.

While in the Headquarters building I was given the opportunity to listen in on call takers using the new NHS pathways system which differs from Criteria Based Dispatch in an amazing way: It does not classify based on a differential diagnosis, but by specific questions pertaining to the severity of certain conditions.  This allows the computer to narrow down the proper response or treatment pathway the same way those little compters play 20 questions with you.  On one call I listened to never in the conversation or the screen did “Heart Attack or Stroke” come in except for the question about past history.

The car was assigned as the call came in and the call taker could see the unit travelling on the GPS screen and update the caller as to how far away they were.  When you hear all the things about the 8 minute target by the way, that’s from the time the call is answered, not from time of dispatch.  The call taker has a buzz in their ear and the line is instantly connected.  Before she had time to say “Ambulance Serivce” the clock was ticking and doesn’t stop until a vehicle able to transport arrives on the scene.  As the call is coded, if appropriate, the car can be stood down and reassigned wile the ambulance continues, or the caller can be advised to call their Doctor.  Yes, you read that correctly, the person who calls with the stomach ache who answers pertinent negative questions is referred to their Doctor.

In the end, the meeting had a simple message to all of you reading this or thinking about changing your systems:

Patient outcome.  Not magic response times, not little yellow cars or big red trucks, but the desire to do what is right for the patient.  If you arrive on scene in 8 mintes and 10 seconds instead of under eight minutes, but made a life saving intervention, shouldn’t that be a success instead of a failure?  How many systems in the US are tracking their staff this way?  Granted it is a hard metric to judge, but with the electronice collection of data, we can now look at more than response times, so let’s do it.

Mark’s administrative officers were also discussing a possible trial of Syncronized Cardioversion, something the system does not currently offer but we in the SFFD do.

And all because two bloggers felt like getting together.

Ben Yatzbaz, lead sleeper at The Insomniac’s Guide to Ambulances,  was this month’s host of the Handover, the EMS blog round up.  The theme this month was “Children should be seen and not hurt” and this collection will certainly change your mood.  If you need a reminder of the frailty of life and the power of human emotion, CLICK on over and have a read.  You’ll be glad you did.

And he included one of my posts, one of my usual, lighter memories.  One of these things is not like the other…

Next month’s Handover will be hosted by yours truly and will be compiled while I’m in England, so get your links in early.  The November theme will tie in loosely with the Thanksgiving holiday here in the States and will have the theme “Close Calls.”

I’m hoping to hear stories of when you, a family member or a patient cheated death, tricked the reaper, whatever you call it.  Drop me a link of a time you or they made it when the odds were against or the circumstances dire.  Then we can all discuss what we learned and how that event did or id not change our attitudes.

Thanks again Ben, now go and get some sleep.

I had wanted to share this as it happened, but alas, I was still in the closet.  But over the labor Day Weekend my commute goes from 40 minutes to close to an hour and a half as I have to go around the San Francisco Bay Bridge.  Not as glamorous as her sister the Golden Gate, she does her fair share of moving over 1/4 million cars a day from the City to all points east.

Over the holiday they replaced a giant section of the bridge in what is, in the end, a rebuilding of the almost 80 year old giant.

Late last night, amidst high winds, part of the bridge broke, damaging three cars causing one person to be injured and closing the bridge until further notice.  That’s pretty big around here.

The winds have been intense, gusting to a billiondy(HM jr’s word), causing no power outages here at HMHQ, yet, and my satellite TV still works fine, but dang if it isn’t blustery out there.  So much so it is still unsafe to get the repairs on the bridge ironed out.  They have the parts, just waiting for the chance to get them in.

I go back to work Friday, fellas.  Make it my usual 40 minutes?

More on the big “Twang!” HERE