Let it go, this too shall pass

Words that can get you fired. Others include,

She said she was fine;

His lead II was unremarkable and has had heartburn in the past;

Your anxiety can come from nowhere and leave you tachy, lady of 55 who’s mother died of an MI recently;

Damage like this happens all the time, that bruise is normal;

A little smoke inhalation won’t kill you, look at me;

Asthma is not going to kill you, go find your inhaler;

The Doc signed off on the AMA so I’m golden;

Babies sleep all the time;

The snow was too heavy;

It was too hot;

I was tired;

I read in a blog that doing that was alright;

Have you seen this funny youtube cartoon?

Point being that there are a lot of rumors, stories and opinions flying about what happens in our business and it can be very hard to find the truth in a situation with 3 correct versions, one wrong version and 15,000 who have parts right.
I have been known to join the fray when it comes to EMS and Fire Departments who do something I like (Tip of the Helmet) and things I don’t (Letter in the File) but drawing conclusions from a single source is a bad idea.
Have an issue with a story you read part of on facebook? Before you lay it on thick you may want to finish reading the story, then seek out at least 2 more sources to confirm the facts. If you can not get the facts, use the google to find out who to call to get the facts.

If they call you back, great. If not, then you have to go with what you have, but the impulse to post something you may regret will have passed.

If you are the one facing termination for doing something you knew in the moment was wrong, see ya. If you find yourself on job 21 in 24 hours and know that not writing a chart will get you home sooner, keep in mind that not writing the chart could get you home a lot. As in unemployed.

If just yelling at the guy to wake up instead of checking his blood sugar and other vital signs to confirm it’s just Reuben again after another $3 bottle of wine, you yourself could be the one budgeting for the cheap stuff while on unemployment.

Backed the ambulance into another car near end of shift and drove away? Might as well keep driving into the sunset.

We all make mistakes. I make them all the time, but I make sure I’m doing what I’m supposed to be doing for my patients based on the information I have and how that information fits within the laws, protocols and policies I have sworn to uphold. Have I not charted patients? Of course, when it is not indicated. Have I omitted vital signs on my charts? Yes, it happens when you get back and can’t recall the BP, so instead of lying I write nothing.

Being able to defend your actions or inactions with cited policy and protocols in front of you goes a long way to easing stress and the impact on your employment status.

In the end we all need to take a deep breath and find the facts about stories we read, especially in the internet age, when opinion can be mistaken as fact on a regular basis.

“Mr Happy Medic is there a reason you did not awaken the man lying in the street who was later found to be in cardiac arrest?”
“He looked OK to me…”
I’d be fired for sure, and for good reason.

In a number of emails I have been asked for an outline or “thesis” about what EMS 2.0 is. There was talk awhile back about a national EMS 2.0 organization to begin lobbying for the changes we all want to see. Others asked me for my suggested education requirements and how I expected a volunteer Paramedic already working two jobs to go back to school to keep doing what they want to do.

I have no answers to those questions.

Sometimes when asked I reply that I have all the answers, I just haven’t sorted out what questions they go to yet.

I used the phrase EMS 2.0, and I think Mr Chris Kaiser did as well, because it brings up the image of a reboot, or upgrade.
Many of the Windows 7 features I got are neat, but most of it is based on the same things I liked about Windows 3.1, sure it is full of random errors and can be frustrating, but the system is slowly updating itself.

A few years ago I had had it with my operating system and all the limitations I saw in it and jumped into Linux.
I was under the impression I was savvy enough to make code changes to effect the entire operating capacity of the system. And since I had only a basic understanding of the features I so desperately wanted, I was unable to have the comfortable computing experience I expected. The adventure ended months later with a partitioned hard drive and having to choose an operating system each time it started. Drove me nuts. But those who know how to make it work love it and it works fine.

So when I speak of EMS 2.0, I am indeed aware of the pros and cons of an “upgrade.”

Another list of questions I get is about the comparison to Web 2.0, the movement that led to the communities and user submitted content we call the internet today. I recall the early days of FTP file searching by tree late into the night in college, having the entire internet text based as a few html sites began to sprout up. I compare searching roots and file trees then and the “Web 2.0″ experience we have now and realize that it is the inter-activity of the internet that has made it a community rather than just a marketplace.

There is an element there I can identify with when it comes to EMS. One of the Medical Directors who came by the booth in Baltimore asked me how he could use blogs to get his Paramedics to accept changing their protocols. I told him he should listen to what the patients his Paramedics encounter need and let that guide protocol changes. Then I asked if his medics had any way of approaching him about changes and he looked as if no one had ever suggested a medic could ever suggest a policy change, let alone present evidence in support.
“An open door and an honest opinion goes a long way in folks feeling like you care about what they’re doing,” I told him.
“No, I need them to do what I say.” he replied and I couldn’t speak against that because I am not an MD, nor in his system, understanding his troubles and challenges.

So where does this all fit into the EMS 2.0 landscape?

I dunno.

We need change, we need a new re-thinking of EMS, what it is, what we’re doing and why, how, where, everything needs to be re-examined and reformed based on new research, response models, patient presentations and care taker abilities.
How that can happen on a National level all at once is something I would love to see happen, but we all know here are far too many feifdoms, unions, politicians, companies and providers who will fight tooth and nail to maintain the status quo, regardless of the benefits.
There are those who will not move forward no matter what they are shown or told. And not all of them are the old salt medics. Some of the new kids on the EMS block feel they have made it and will just sleep through their refresher every two years and keep drawing the pay check.
Departments will fight to keep licensing requirements low so as not to have to pay their people to seek out education, possibly because the higher educated can draw a premium at the next service over.

From my lofty perch here with my education and high paying EMS job you may think me a dreamer with all this CoEMS and EMS 2.0 talk and you’d be right.
But the Chronicles was a dream a year ago and now we’re set to travel the world doing exactly what we want to do, explore what EMS means.
So I’m going to keep dreaming about EMS 2.0 and hope one day I can meet a crew from a department somewhere who both have an advanced education and operate under protocols or guidelines that give them the flexibility to treat, transport or transfer citizens, clients and patients based on what they need, not what they or some future lawsuit want.
I think we can all agree on that.

But how do we get there? We all get there in different ways at different times, hence the trouble in explaining EMS 2.0 to people at different levels of different systems.

There can’t really be an EMS 2.0 “thesis” or guide, but more of a mission statement, and that I am thinking about.
So far three main principles come to mind and how to expand on them will be up to you. They will certainly mean different things to different people, and that is one of the things I love about it.

My EMS 2.0 is based on three main concepts.
Technology
Teaching
Trust

Using technology to improve our ability to assess and treat,
Advancing our educational levels to not only learn more about our patients and communities, but teach them what we can and can’t do.
We have to earn the trust of those who give us the power to do what we do in order to do more.

In short I need some expensive gear, a pricey college education and then let me go do what I’ve learned and proven competent to do. Exactly what that is will depend on your community.

The future is coming and we as a Profession have a chance to not only make ourselves a respected part of the health care system, but excel in providing care in an innovative manner that can release the burdens the current system is collapsing under.

It is a dream. But it had to start somewhere and if that is all it is for now, I’ll take it, but something is happening out there and I want to be ready if my Chief asks my, “What do you think we should do?”

What are the three concepts your EMS 2.0 platform would fight for? Let me know.

I apologize in advance for the formatting on this post, I worte it on the plane and wordpress’s HTML coding sucks so in the interest of spending more time with my now 4 year old, I give it to you raw.

“Have you met UK Paramedic Mark Glencorse?”

“Have you met Ted Setla?”

I have never before tried so hard to talk to people about something other than getting in the ambulance. It’s not easy to be a barker at these conventions.

Paul, who’s last name I am either forgetting or omitting for my own safety, from Zoll was the leader of the demonstration of the Zoll Rescue net system, who’s presentation was before Mark’s and my own.

He had great one liners and provoking questions that made passersby stop and wonder what the guy in the blue shirt was talking about. That was nice.

Just wandering the aisles at a trade show can seem awkward I’ve learned. As you wander, the folks from all the booths seem to come at you, quickly reading your name badge and asking you some strange question you’d rather not answer.

“What C-Collar does your system use?”

“Well, shoot, it seems to change all the time, why?” and they’ve got you. And they’re good at it, that’s why they’re there.

At EMS Today Baltimore, the Chronicles of EMS team was invited by Zoll to speak about the reality series and where the movement might go.

Charlotte, our Zoll contact, had arranged for a large amount of T-Shirts to be available to conference goers and they were a big draw. Trouble was we didn’t have a space in the booth, or any booth for that matter. Not sure exactly what we were, how we were to interact or what to do, we did what all Paramedics do, improvise and adapt.

A false wall curtain moved, literature stored and a quick ironing of a half dozen shirts up on hangers and POOF! Chronicles of EMS “booth.”

We were in front of the previously hidden storage room for the Zoll folks and they were constantly coming in to get more handouts and materials as they were quite popular.

So Mark and I took position in front of the 5′ wide gap in Zoll products and readied ourselves for the storm.

And this is where the really great part of social media comes in.

As faces approached we tried not to look at the name badges, but just introduce ourselves with a simple “Have you seen the Chronicles of EMS, the new EMS reality series?”

Surprisingly, most folks who wandered by said they had heard of it, or seen something about it, and not in that “Oh, sure I’d LOVE to see pictures of your great grand children” way, but in a “Finally someone can explain this to me” way.

So right there in the booth Mark Glencorse had wrangled a power source and extra monitor to show the episode on a loop. And folks took a look and asked more about it.

A 17 year old EMT student from New York State saw it.

His father, a retired Firefighter and social media skeptic saw it.

And they both wanted to learn more about it.

That is huge.

What else was huge, in my book at least, was the number of bloggers who made the travels to gather in Baltimore for the largest Fire and EMS Blogger meet up in the history of man.

At one point a familiar face wandered over and extended a hand and I shook it. The voice that came with it was none other than Ambulance Driver. Before I had a chance to express my joy in meeting a true beacon in EMS blogging he stepped aside and introduced me to another beacon, Too Old to Work, Too Young To Retire (TOTWTYTR or TOTW). My jaw was on the floor. Having my face all over the show makes me rather easy to spot, but some of the most closely kept secret identities in blogging came forward and said hello. It was amazing.

Even more amazing though was how they stepped back when folks would approach Mark and I and say “I read all the blogs and meeting you guys is so cool.” Mark and I shared an inside glance, then looked 10 feet back and wanted to say “Do you know who is standing right behind you? TOTW and Ambo Driver! Look quick!”

On the morning of the second day I was hurrying through the lobby of the hotel on my way to meet Mark to head for a full day of wrangling folks into the “booth” and share Chronicles. Coming my way through the throngs of high school students gathering for the Model UN Conference was the internet’s Red Headed EMS Stepchild, Chris Kaiser. As I said hello to him an oddly familiar face appeared behind him.

And something happened that would happen over and over again that day:

The second introduction.

You see, we really do live double lives. As I looked to the beautiful (and tall) woman I suddenly realized I was introducing myself to an old friend, Epijunky from PinkWarmandDry. We shared a smile and a hug as if we had not seen each other in years even though we had never met.

Friendships were not made here, they were experienced on a different level.

I offered a hand to a fellow approaching the booth with purpose, another man close behind. It was Fire Critic and Fire Daily, themselves having only met face to face after months of co-hosting a radio show together.

NateEMTB from twitter stopped by to say hello, as did MyrtLife and literally dozens of others who introduced themselves first with their names, then their identities. The names got a polite smiles, the identities a welcoming embrace.

Yes Mrs999 and MrsHappy, we did a lot of hugging. It comes with the territory.

But then there were the other folks stopping by the spot we carved out of the convention floor, a space not even big enough for 3 people to stand, so we stood in the aisle.

It was in this aisle that I had the first of many “Are you freaking kidding me?” moments.

“Hi Justin, Hi Mark. I really like what you guys are doing” said the brown haired man in the striped shirt.

“I’m Bryan Bledsoe.”

I’ve said it in this forum a good deal of times, but this truly was a

blink…blink…

moment.

And I was a fanboy all week. Dr Bledsoe wandered by a number of times during our stay and always had a smile and a handshake to say hello.

It may be a bit late, but if you hate name dropping and fanboyism, you should go read Motorcop because I am about to go 14 year old on you.

I carried my Firegeezer mug on the plane so the baggage handlers wouldn’t damage it. I carried it and a red permanent pen each and everyday on the off chance I would bump into Mike Ward or the Fire Geezer himself to get it autographed. And I did. Both of them. Yup, I’m THAT kind of fan.

Throughout the show, we met people involved in all aspects of EMS and each level seemed interested in what we were doing, both in the show, with the blogs, EMS 2.0 and just saying hello and talking to folks.

I can not select a single moment that was my favorite but I have collected a few that stand out from EMS Today in Baltimore:

Meeting the inventor of the KED, over a beer.

Introducing myself to the Chief of EMS for FDNY who replies, “Yeah I know you guys.”

Talking systems allocation theory with an 18 year old EMT student from New Jersey (I forgot your name but if you read this email me, our talk is not over!)

Being interviewed by THE Dave Statter of Statter911.com who refuses to put me on channel 9.

When a twitter friend, 2 of them actually, accompanied other new friends to an Irish bar in the cold night air near closing time and then not letting me buy them a drink (I owe you squirrel and NJ)

Watching vendors realize the power social media has.

I can’t wait until Denver in April.

HM

I have finally had the opportunity to become one of the folks I mentioned in the trailer of Chronicles of EMS. I am now one of the lucky ones who can travel across the country to visit other providers at a trade show.

As I’ve been reminding you, Zoll invited Mark and I out to EMSToday in Baltimore, Maryland.

And oh boy did we almost not make it on time.

When I was growing up we always got to the airport early. Always. Sometimes by hours. So that just became my normal plan. Get there early.

With two little ones and a just over one hour commute home from work, then turning around and racing to the airport I got there 1 hour ahead of the flight, a nail biter in my world.

Mr Setla was relaxing after a calm lunch and I was frazzled to find our flight not only delayed, but now not even arriving at our destination.

The airline, for whatever reason, saw fit to take the same plane we were on before and reroute it. Not through a different connection, since the same plane continued on to Baltimore, but to send us an hour out of the way to DC.

Despite multiple questions as to the reasoning we were no longer able to land at our purchased airport, we were assured the two airports were not far away from one another at all.

I should have known better.

6 hours later we gather our luggage in DC’s Reagan Airport and ask the locals the best route to Baltimore. Their suggested Super Shuttle was a moderately priced hassle, requiring us to sign in, buy a ticket and wait 20 minutes before getting in one of the half dozen waiting vans.

We were 2 hours later than expected and now an hour away from our hotel. It’s 1130 PM and we’re tired and hungry.

A taxi trip will run us almost $100, but get us there quickly.

Knowing a trip from Baltimore airport to the hotel runs about $40 (Thanks FireDaily for the heads up) our chosen method of transport made perfect sense.

Jay’s Sedan Service is a family run business in the NY/DC/VA/MD area operating just a handful of cars driven by the owners and the care and attention to detail shows. We’ve all been in a leased car vs an owned car and the difference was clear.

Our driver, Jay, made us a deal over the phone and was curbside in less than 5 minutes. En route we started with idle chit chat until we learned Jay is on Facebook and Twitter (@jayssedansvc) with his business and we had to have fun with it.

Next thing you know Ted is ustreaming live video from the back of the Lincoln Town Car while Jay is laughing along with us.

After a touch of traffic we finally arrived at my hotel just after 1 AM local time. I say mine because Ted had been booked by a different group at a different hotel nearby.

Thank goodness for free late night food delivery.

So skip ahead to what my body thinks is 430 AM when my alarm goes off and I open the window to the beautiful brownstone Baltimore clock tower.

I can’t wait to dive in to everything this weekend could create for me, my friends and EMS in general.

We moved into this house about 2 years ago and have been finding little problems here and there as most homeowners do.

Aside from mystery sprinklers (don’t get me started), with recent storms I’ve found limitations on the capacity of my gutter system.

Sure it carries the water from the roof along the gutter to the downspout.  Sure it ties into an underground system that drains into the sewers, but there’s all sorts of non water stuff getting in there.

At our old house we got new gutters installed and had a chance to install a really great, but expensive, product that blocks non water items from getting into the gutters.  With 2 large pepper trees overhead it made the next rainy season far easier to cope with.

But here we have a different problem and a different system.  It would appear that the underground drainage system that ties into the sewer has either failed or become clogged with debris, roots, small woodland creatures, something other than water for sure.

During one of our recent storms I spent hours out in the driving rain trying to flush what I thought was a simple clog only to find it was systemic on that one side of the house.

One side no problems at all, the other hopelessly clogged.

With water backing up against the foundation of the house I had to stop the immediate damage and climbed back up and clogged the downspout.  That sent the water in that gutter over to the other downspout near the front of the house.  My problem was not solved, only no longer an immediate problem.  But now water was backing up at another location, just not right against the foundation and in plain sight.

With the family driving the wife nuts inside (toddlers hate rainy days) and my hands cold I came inside hoping to tackle the problem another day.

When that day came I could only install a patch of the same system that was in place before, a tube running from the downspout off the side of the house towards the neighbor’s yard. (He’s never home, he won’t notice.)  I unclogged the downspout and water rushed into the pipe I dug a trench for and away the water went.

Problem kinda dealt with but still not solved.  The other spout on that side of the house has o elevation where I can make a trench without digging up most of the yard.  Plus, now it’s a huge mud puddle.

I’m not sure what the solution to my problems are, but I know what I have isn’t working as well as it should on one side.  And I don’t think breaking out the concrete on the other side of the house to improve a working system is a good idea either.

I’m researching other ways other folks are handling similar problems and hope to learn a little something that can help me with my troubles.

I just hope I can come up with something before the next storm rattles in and makes more trouble for me.

Thanks for letting me change gears,

HM

It’s been awhile since I had to fire up the typewriter and find carbon paper for these letters, but something very close to home has happened and we need to nip this all in the bud.

First letter in the file-

Jason Brown, Colleton County Firefighter Paramedic, was released from duty last week after posting a cartoon video to his facebook page which featured harsh language and an exchange between a firefighter character and a doctor character.  We all remember Fireman Mike’s suggestions about when to call 911, and the language in that video wasn’t PG, but it lacked the confrontation shown in Jason’s video.  In a perfect world we would all watch this cartoon and laugh because I have had a similar conversation 100s of times in clinics and medical offices wondering just where these folks went to medical school.

But the end of the video is the only part I have an issue with – “We’re going to pretend this conversation never happened…” this implies that the fireman cartoon in the video is going to ignore the complaint and leave.  THAT is the reason this letter is going in your file, for a questionable ending to a cartoon video on the internet.

Second letter should not need to be written, but your knee jerked so hard so fast it went right up and kicked you in the face.

Colleton County Fire-Rescue Director Barry McRoy.  In your termination letter to FF/PM Brown you mention “This video has created an embarrassing situation for this department, our public image and the cooperative relationship we enjoy with Colleton Medical Center. It reflects poorly on you and Colleton County.”

No, Sir, you and your Department made this an embarrassing situation for the department.  Ask Brown to remove the video and make a training film if so inclined to make movies keeps this in house and solves all the problems.

I can only assume your fear of the rest of the country finding out the working relationships your service might really have has scared you into firing anyone who tries to express themselves.

Was it the video, the characters or the fact the world saw it on his facebook page?  I can only assume he is like me on facebook, friends, family and coworkers following along.  When he posts the video maybe 100-200 people see it, maybe half that amount watch it.  That is how social media works. It isn’t put up on every single fire and EMS website for all to see…

…until you fired him for it.  You took an easily fixable in house “choice of words” situation and exploded it into a National example of a public safety agency afraid of social media.  Because of the way you handled this situation I and now my readers are reading about Colleton, whereas last week I did not even know the agency existed.

In my book, you Sir, are the one who should be fired for creating “…an embarrassing situation for this department, our public image and the cooperative relationship we enjoy with Colleton Medical Center. It reflects poorly on … Colleton County.”  Sound familiar?

Both of you need to sit down and TALK about this, face to face.  If the offended Doctor who likely asked you to fire Brown wants to join in, all the better.  Have a talk about the proper way to use social media to move the agency, EMS and medicine forward.

This is a sticky spot to be in for sure.  I’m sure if you look hard enough into my musings there is a reason Colleton would fire me too, and every other EMS and Fire blogger.

But think of it this way:

What if Brown had drawn his video cartoon and had it published in a national EMS magazine instead?  Perhaps a single panel cartoon showing a Paramedic and an MD disagreeing in an entertaining manner for all to enjoy?

Would that be OK?

Should Brown be fired?  I say no.  Reprimanded…perhaps, spoken to for sure, but firing him first thing shows fear.

That is not all.

Editor’s note: No the link to the video is not broken, it is not here.  Best part of all this is that you can find it all over the internet now, I don’t need to link to it here.

I can only assume everyone played this game as a kid, but as rescuers, we play it everyday.
For those not familiar, you and your friends sit in a circle and one person whispers a sentence to the person to their right and so on and so on. The gist of the game is to see how much the sentence changes from person to person either by forgetting the exact words, or rewording it for whatever reason.

Funny thing is, I get to see each step of the game as it goes. This was brought to mind one morning when I got another one of my blog starting runs when I asked, “You called 911…for this?”

The game started when the client (See Glossary of Terms) had a sore throat and went to the doctor yesterday. Our story should end there, but this is managed care, so of course there is more.
This morning, 10 hours after starting the course of antibiotics, our citizen phones the expensive private health care nursing advice line. According to her, she told the nurse, “My throat still hurts, can I use a throat spray to eat? It hurts to swallow.”
The nurse told her to “…hang up, call 911 and tell them you need an ambulance.”

Our client calls 911 and, in clear words, tells the call taker she needs an ambulance for a sore throat.
Call taker follows instructions coding the call as a 26A25, Non-emergent sore throat. It worries me the 911 system even recognizes this, but…
The dispatcher changed the call to a 11D2, choking with difficulty breathing.
The notes on the MDT state she is unable to swallow.
As we arrive code 3 as instructed, we are met by a young woman with a diagnosed and medicated case of strep throat.

“Did you call your doctor today?” I ask after checking all vitals without disturbing findings.
“No, the office said he was too busy, they had me call the nurse line.” She hands me the card.
“What did the nurse say?” I can’t wait to hear this.
“To call 911 for an ambulance.” She says with a small laugh.

After a small conversation I discovered she didn’t feel different, just wanted advice on a throat spray so she could have breakfast. Her throat hurt, but no more than yesterday.

We went full circle in the telephone game this time, where the sentence was the same at the beginning and end, but it was all the junk in the middle that got messed up.

Maybe folks should be able to call us directly in the ambulance for advice since the dial-a-nurse seems to default to us most of the time anyways.

You have never seen anything cuter than THIS.

And if you have, just keep it to yourself.

You’re the boss on the ladder company today and have decided to run the troops through their paces.  The large extension ladder is raised in front of the firehouse.

You’ve sent the young guy up to practice working off the side and locking in when a woman with a clip board casually strolls up and begins to talk to you.

Even though all your member are in their PPE with helmets in place, she refuses to stand back as she makes notes on a sheet on her clip board.

“I notice your ladder is not secured at the top,” she tells you.

“Well No, Ma’am, it’s not, we’re practicing a situation where that doesn’t happen, that’s why this fellow here is holding the ladder,” you tell her while pointing to your foot man holding the ladder as he always does.

She presents credentials from the local occupational safety department and orders your member off the ladder.  She then demands to speak to your supervisor for a violation of safety laws.

What do you tell her?  You make the call.