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

Emergency Services seem to thrive on certificates.

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

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

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

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

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

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

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

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

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

At 11:45 PM on August 31st 2008, a frustrated, stressed and confused person sat down in front of his laptop and started a blog.
The first post was simple enough:

I created this forum as an outlet from work when the lack of common sense so wide spread in our society decides they need help.  I won’t say where I am, nor will I disclose names, dates or too many specifics so as to maintain privacy.  I’ve always joked about writing a book titled, “You couldn’t make this stuff up,” and every day I work I get more content for that volume.  From the broken toes, toothaches and car accidents without damage to the just plain odd and insane, there is no way to describe or prepare what is waiting on the streets.

OK, so I lied.

Had you told me that simple paragraph would lead to improved mental health I would have laughed.  Or that it would lead to meeting people of the same opinion regarding Emergency Services, maybe a giggle and a coy smile.

That it would lead to England?  No way.

But it did, didn’t it?

Over the last 2 years you have let me ramble and rant, complain and ask countless questions without offering many solutions and for that I have no excuse.  We wish we had the answers, but this thing we call Service has so many different forms and functions it is hard to make an argument for any one way of doing things without being proven wrong time and time again.

I like being proven wrong though, that’s why I got married.

Mrs HM wanted to write a little something on this occasion, but she’s less of a writer than I am, but I think she would likely say the following:

Dear internet,

I want my husband back.

Love,

Mrs HM

This forum is powerful, friends, maybe not this site, but sites like it.  Sites where we can share our thoughts, ideas, dreams and frustrations with folks who “get it.”

I stopped writing about the power of social media because you already know about it.

I stopped writing about EMS 2.o because you already know about it.

But I’ll keep thanking you for reading, and hope you keep stopping by from time to time.  If September alone is any indication, year 3 of the Happy Medic will be the biggest and best.

And if not, write it off as my “terrible twos.”

Thanks for taking the time.

Your Happy Medic,

Justin

Today was my second day helping to set up the newest Engine Company in the SFFD, Engine 51 in the Presidio. Today was day 4 of the new services provided and the contractors working at the old firehouse are flying. Last I saw the house it was still dirty and disorganized. Today the painters were touching up while the flooring folks were starting on the final rooms.
I’m collecting photos to put together in a before and after post, so keep an eye out for that.
My next scheduled day on the Engine is after we are all moved in, so that will be interesting for sure!

New paint, new flooring, clean cabinets and bed frames.

The rest is up to us.

Not “us” the SFFD, but “us” the 15 Firefighters, Paramedics and Officers staffing the Company.

This morning we heard word that some of the other firehouses around the City have pledged to donate extra pots, pans and some plates and cups to us to help get us going.

It really is like one big family out here.

And in related news, some of the firefighters previously employed by the Park Service started an abbreviated SFFD Academy this morning.

HM

Break out your green and yellow backgrounds everyone!

“Welcome Back” doesn’t seem right since you were never really gone, just on a long job.  Now you are back home.

In 1915 the home of General John Pershing, famous for leading Montana’s Buffalo Soldiers, burned  killing 4 of his family members.

As with most fire tragedies in the early 20th century, no organized Fire Companies existed until it was too late.

Pershing’s home was withing the grounds of the Presidio (Spanish for Fort) on the North end of San Francisco.  This fort was built during the civil war and most of it still stands today.

You can read all about the history of the Presidio here.

In 1917, the Presidio built a Fire Station, which I went to today.

In 1994, when the National Park Service took over areas of the Presidio, that station became the first and only 24 hour fully staffed Fire Station in the Park Service.

It closed yesterday morning at 7:30.

For political and funding reasons I won’t pretend to understand, the Park Service chose the SFFD to staff the station.

At 8AM yesterday morning all the political leaders and managers gathered at the temporary home of the new Engine Company for photos and introductions.  At the same time, the off going firefighters were cleaning out their station, the one manned since 1917.

There was a nice addition a few years back, more on that soon.

Later in the day we had the opportunity to go by and orient ourselves with the station, the grounds, and the Presidio itself.

This is going to be a long process, we are essentially starting a Fire house from scratch.  No desks, no dishes, no supplies.  The owners of the station are cleaning, installing floors and painting and we hope to live there in the middle of the week.

I’ll do my best to keep you up to date on our efforts.

What I won’t do is take a stand on the reasons for the change, the politics involved, nor will I allow any negative comments about the circumstances.

The company there was identified as Engine 51 and our engine will keep that designation.

HM

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.

I done got me a new phone.
Like you care, right?

Point being, I sent out a tweet yesterday afternoon about having trouble getting the google calendar to repeat on a 31 day tumble so I could easily enter my schedule into the standard calendar on the phone.

After looking for a suitable solution and finding none, I gave the folks at Gasda Software a call and asked if they knew what do do.

20 minutes later I get an email with instructions on how to install the custom calendar they sent.

Those guys sure know their way around calendars, especially for the Blackberry, and now for other phones as well.

Thanks Gasda, saved the day…again.

You all know I am not a fan of little boxes.

I dislike the little boxes we have to cram our patients into to treat them based on chief complaint.

Also on my list is the little boxes we take them to the hospital in.  Bolting a box onto a van isn’t enough.  More on that another time.

On the top of this list in big red letters are the little boxes our call takers are required to fit their callers into.

They must meet criteria in order to be coded, qualified, weighted, and then sent out to the trauma hungry troops on standby all over the City.

Problem is, it doesn’t work.

I do not know Dr Clawson, but I do know his system and that, if a system can correctly act on the information gathered and coded, it works most of the time.

What really gets me going these days is the purposeful miscategorization or non categorization used to move calls out of the call center faster than they need to be.  I am not alone in this experience, getting messages, tweets and emails from folks all over the USA asking me what they can do to improve dispatch.

You can’t improve dispatch.  Not until you improve the callers themselves.

One of my readers described it as GIGO (Garbage In, Garbage Out) meaning, in the most respectful of terms, that dispatch should not be changing anything the caller says and that if the caller is wrong, then I do hope my dispatcher is wrong as well.  If a person calls and tells the dispatcher that the space shuttle has crashed on main street and thousands are dead, maybe it did.  But the problem lies in sending that call out before it is coded.

The two most inexperienced people in the system are the ones guiding the system.  The caller and the call taker.

I have never been to a call that was reported, coded and turned out to be the same thing, mainly for the same reason my patients’ chief complaints never seem to jive with my treatment per protocol:

They don’t fit into your pre-determined boxes.

Many systems run a BLS tier, or perhaps a single paramedic resource to handle Omega, Alpha or even Bravo calls.  Here in mine, there seems to be no rhyme or reason to the assigning of resources on some calls.

A call coded by the system, based on information provided by the caller, to the call taker has been declared a 26A1, a sick call.  Yet in the call classification next to the code is the term BLEED-SEVERE.  And now the call becomes a code 3 and 6 or more lives are at risk.

“Better safe than sorry, right?”  Good thought.  Who is in more danger?  The person who bit their lip and called 911 or the 6 responders using red lights and sirens to respond to the call now thought to be more than it is.

“Then what’s the answer, smart guy?”

Ditch the codes.  Stop the tiny box requirement.

If they call and say “I bit my lip,” Dispatch it as such.  Let the responders apply calculated risk to the situation without being blinded by administrative tricks used to ring the bells faster, improving your call center stats.

If you can send a call out in 30 seconds without gathering all the information, that is not a success.

I am not blaming dispatchers.  That voices that tell me where the sick people are are not the ones in control of the dispatch system, but the ones required to work within it, not unlike me not liking aspects of my treatment protocols.

GIGO.

They relay what they are told and code the call.

It is the trick of changing the code or description that I don’t like.  That is how the cut fingers, bit lips and sleeping people send out a full ALS response and drain the system of resources at a time when we are getting stretched thin.

By changing from a criteria based system to a “plain text” system, two distinct things will happen.

Firstly, crews can use their judgment, ETA and experience to determine their response priority based on what the caller actually said, not what the system thinks they might be saying.

“My back hurts again” is not coded as “Non-Traumatic Pain-Code 3″ so the crews can apply their expert training to audit the dispatches in real time.  I worked in a system like this and it worked.

Secondly, it will become very complicated and difficult to classify and track types of calls for analysis after the fact.

“We don’t know how many CPR calls went out last quarter because we have to go back through each call instead of just pulling the codes.”

A recent study by UCSF and SFFD Medical Director Karl Sporer celebrates the finding that 1 out of 7 reports of a rescusitation in San Francisco turned out to be just that.  You can’t find stats like that celebrated outside of baseball.  1 in 7 was a success.  I see the 6/7 mis-reported or mis-coded calls as room for improvement indeed.

The 3 AM building alarm.  This is the Fire Service equivalent of an abdominal pain from a month ago.  Thing is, when it’s in a retirement home, all bets are off as to what might be going on.

THE EMERGENCY

Audible and visual warning devices triggered by an automatic alarm, water flow indicated.

THE ACTION

When the bells strike at work, I always get out of bed and sit on the corner and wait for 2 distinct dispatcher comments:

1. “Unit dispatch…” Which means it’s a medical job and I should continue waking up, OR

2. “Units stand by for the box…” Which means we have a report of smoke or fire in a building.

But there is a glimmer of hope when the dispatcher calls out a building alarm box because our Truck Company also covers 2 other engine areas.  Sometimes they’re the only ones going out.  Sometimes.

Tonight it’s everyone and we’re quickly on scene to a very beautiful brick 4 story type 3 we drive by all the time wondering what’s inside.

Old people.

We’re met by a security guard who of course is more interested in our supervisor’s name than telling us the situation inside.  A representative from the water department wanders over from a giant hole in the ground surrounded by water department vehicles and informs us they just turned the main back on.

As the pressure slowly built against the sprinkler valve, it likely shuddered and set off the alarm.  We relax and go in to make sure and reset the alarm.

Like in a zombie movie, we enter to see various persons in pajamas and robes wandering the halls and standing on the stairs, all staring at us as we go by.  They say nothing, only watch and slowly begin to come closer the longer we stand at the alarm panel under the grand staircase.  At some time in the past 100 years, this was one hell of a mansion, but now is populated by scores of the aged.

Which is odd, since I’ve never been on a medical run here before.

As we reset the alarm, the occupants begin to slowly shuffle away in different directions, except for one.

He corners the other firefighter and asks her if she knew they had a new elevator installed recently.

“OK, wonderful, thanks.” She says, being as polite as you can at 3:15 AM.

“No, you need a key to use it if the alarm goes off,” he informs her.

“Yes, we have that key,” she says, trying to walk away.

“No, it’s a new kind of elevator, come, I’ll show you.” and he begins to lead her down a hallway.

As much as I wanted to follow and keep her company, she went along as one might go along to look at baby pictures of your third cousin while visiting long lost family.

She eventually emerged, unharmed and still in good spirits, to inform us that it was a standard elevator.  Go figure.  It wasn’t until later I learned that the inventor of the modern elevator, Elisha Otis, died long ago.  I was half hoping that was him, remarkably old and well preserved, in a home for the very old and the very rich.

My Brother from another Mother, Motor Cop, spent another day at his “duck pond” monitoring facebook and scouring youtube for something to ridicule the FD.

He found a video you can watch at THIS LINK and proves that Fireman have all the moves down.

Don’t believe me?  Just compare that video to this one, featuring the REAL Motor Cop.

Village People – YMCA (version originale)
Uploaded by scorpiomusic. – Watch more music videos, in HD!

*No Indians, Manly bikers, cowboys or construction workers were injured in this posting, the Soldier, I’m not so sure.

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