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Thinking about the ones that got away… at Midnight on a Wednesday

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A conversation I had tonight with a very good friend of mine made me think of two older posts that you may not have read. They’re… well they’re very personal posts, but I still read them from time to time when I need to put stuff in my head other than the crap that usually floats around in there these days. Replacing over-thought-about current sadness with past sadness? Who knows if that’s healthy, but sometimes it just has to happen.

Anyway, these two posts are worth a read I think, if you don’t mind an old medic rambling about people he didn’t save in years past.

Thanks, friend. I needed to think about these things tonight.

My first… – My very first cardiac arrest patient

In an Instant – A perspective on a tragic death of a young person after years on the street

Maybe I’ll elaborate on these posts tomorrow… tonight’s not the night for it. I’m on duty and the bunk is calling. Who knew that I’d be shaped so much by my career? It is nights like these where I’m sure that I’m motivated to be a paramedic by things way more important than money… Not that I’ve ever been not sure of that fact… and not that there’s ever really been enough money to convince me otherwise.

Anyway, enjoy the above links. They’re in my brain tonight. I hope you like them.

Posted by on February 24, 2011 • Filed under: bad calls, cpr, cpr fail, Emergency Medical Services, emotions, EMS, EMS Health & Safety, EMS Topics, EMT, Fire Rescue Topics, Line of Duty, Paramedic, Uncategorized

Looking for the link to NIMS training? ICS 100, ICS 200, ICS 700, ICS 800

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Howdy everyone! This is kind of an odd post for me, I know, but I needed a place where I could put up the links for the FEMA NIMS training classes for the EMS employees (EMTs and Paramedics) at my ambulance service. On this page, you’ll find the links to the FEMS National Incident Management System ICS classes required by all EMS people, Firefighters, and other first responders.

ICS 100:

  • IS-100.b – (ICS 100) Introduction to Incident Command System

    • ICS 200:

  • IS-200.b (ICS 200) ICS for Single Resources and Initial Action Incidents

    • ICS 700:

  • IS-700.a National Incident Management System (NIMS), An Introduction

    • ICS 800:

  • IS-800.b National Response Framework, An Introduction

    • If you’re an EMS person, or especially if you’re an employee of the ambulance agency I work for (which I remind the guys NOT to put the name of in the comments section) you should take ICS 100, ICS 200, and ICS 700. While I believe that ICS 800 is not required for line employees, it’s probably a good idea to take it as well.

    Posted by on February 21, 2011 • Filed under: Uncategorized

    Want to read what I said somewhere else?

    1 comment

    Because if you want to read some stuff I said about EMS somewhere else, like on another web page… You can.

    http://www.jems.com/article/administration-and-leadership/where-ems-headed

    My first bi-monthly column is up on JEMS.com. Go have a read.

    Posted by on February 18, 2011 • Filed under: Uncategorized

    Remebering My Father, Chief Richard A. Kaiser

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    I was walking out of a nursing home last night after a simple transport when my brother sent me a text. We talk fairly often; my brother and I, so this wasn’t very significant… except for this text said “11 years today, RIP Richard Kaiser.”

    And I hadn’t remembered.

    Has it really been 11 years? Did my father, Chief Richard Kaiser really pass away 11 years ago? 11 years? Eleven? Years? Has it been that long?

    My dad passed away in his sleep, the cause of death being listed as cardiac arrest of an unknown cause. He probably was a victim of Sudden Cardiac Arrest (SCA), possibly precipitated by a heart attack (MI) that he either wasn’t aware he was having, or didn’t report that he was having. My educated guess is that my father ignored chest pain. If I had to guess about my father, the proud, healthy and vigorous man that he was, I would say that he probably felt some chest pain and ignored the symptoms. I’d guess that he believed, as so many of my patients through the years have believed, that his body wasn’t telling him anything important when he chose to go to bed and see how he felt in the morning. I’d guess that he had been experiencing the pain in his chest all day and didn’t choose to do anything about it.

    My father was a volunteer Fire Chief in the small town I grew up in for well over a decade. The department and the community there still benefit greatly from his legacy. He owned the hardware store in town, was the president of the town’s small water company, and was the general fix-it man for many of our community members when they needed something done. He was always willing to help out anyone in need and was a genuine example of a genuinely good man. I benefit greatly from having his example to lead me in my own life and I am blessed to have had him for the twenty years that I did. I will always be thankful for his legacy and the path he left me to follow.

    I’m a career paramedic and firefighter and I would say that it is probably him that got me interested in the Fire Service, which blossomed into my love of the Emergency Medical Services. Without his lead, I don’t know if I would have gravitated to the ambulance game. Perhaps my bank account would have benefited more so if I had chosen to adopt his entrepreneurial spirit, or even maybe his MacGyver-Like ability to look at something and make it fixed… but I took on his love of helping people. In fact, as his legacy I’ve tried to impart in the kid that I consider to be my own son that “Our family helps people”… and a lot of that comes from my dad.

    After he died, I lead an unsuccessful attempt to place AEDs throughout the part of the county where we lived. The area is very rural. In fact, the town I grew up in, Edgington, IL, is an unincorporated bump-on-the-map surrounded by vast amounts of corn and cows. There isn’t even a post-office. The ambulance that responded was actually the first ambulance I ever ran a call in, and it came from 13 miles away staffed with EMT-Basics. An EMT did respond direct to the scene from her house and began CPR, but she wasn’t equipped with a defibrillator… and ALS care was coming from the city 30 miles away. I was an EMT then but I wasn’t home.

    Needless to say, when someone drops dead out in that area, they tend to stay that way.

    Since my father passed away at age 53, most probably from ignoring pain in his chest, I have been hyper-vigilant on diagnosing and treating heart attacks and chest pain. As a paramedic, my number one pet-peeve is patients who ignore the symptoms of a heart attack and don’t call 911. Trying to “Tough it out” cost me my father. It cost my father his life, and I have got to tell you… there are times in my life since where I really have wished I had him around to talk to. I have tried to stop questioning how different my life would have turned out had my father simply chosen to call 911 and get his symptoms checked out. I have come to terms with the fact that it was his time and that we can’t second-guess or play “what-if”. I’ve even reconciled my feelings that I can’t always be there for everyone all the time, no matter how much I may have wanted to be.

    But people who ignore chest pain and other serious medical symptoms simply because they believe they’re tough or that it can’t be happening to them still bug me. My ambulance partners will tell you, I give these people “the speech” where I expound upon the fact that they should always call 911 for chest pain. Sometimes I even get through to them.

    In remembrance of my father, Chief Richard A. Kaiser of the Andalusia/Edgington Volunteer Fire Protection District, I am asking each and every one of my readers to do me a favor. Please spend some time evangelizing to your friends, family, and other loved ones that they should never ignore chest pain or other symptoms of a heart attack. Tell them to learn the symptoms and make the call to 911 when they have them. You do the same for yourself. Don’t try to tough it out or do anything stupid like that…

    Because I miss my dad.

    Call 911 for chest pain. Just FREAKING do it.

    If you’d like to share something on your Facebook pages, twitter accounts, or print something out and pass it to your friends, please click on this link: “Heart Attack? Call 911 – Don’t Just Burp” It’s a piece where I write about the same topic… just without this level of emotion behind it. I’d like that piece to go as far around as it can go. If my father’s legacy can save any more lives, this is one of those ways.

    Rest in Piece Dad, I love you. Thanks to you all in advance for helping me spread the word.

    Posted by on February 17, 2011 • Filed under: Administration & Leadership, American Heart Association, Command & Leadership, cpr, Emergency Medical Services, emotions, EMS, ems 2.0, EMS Topics, EMT, fire, Fire Rescue Topics, In the Line of Duty, Line of Duty, Paramedic, Patient Management, STEMI, volunteer fire department

    You know what this call needs?? Mo Hi-Lo!

    8 comments

    The High/Low siren, or the “Hi-Lo” as the cool kids call it, is at not only the coolest thing ever to grace emergency response, but it is also the most effective warning tool ever invented. While it is sadly starting to be phased out of some brands of electronic sirens in recent times, this is mostly due to misunderstandings and is a sad reminder of the cynicism of the modern age. The Hi-Lo is not only highly effective, recognizable, and entertaining, but it has a good beat and you can dance to it. It’s use must be preserved and today, February 17th, 2011 has been declared “National Use Your Hi-Low Siren Setting for Some Reason Day” by the National Federation for Things I’ve Just Made Up (NFFTIJMU).

    So, in observance of this groundbreaking and dare-I-say, highly relevant National Holiday,  the NFFTIJMU recommends that every emergency vehicle, nation-wide, utilize the Hi-Lo setting on their sirens exclusively today. It will add cheer to your responses, promote spontaneous dancing among the passengers inside your emergency vehicle (I mean, come on… who DOESN’T dance to the Hi-Lo?) and will let your community members know that you’re cool.

    It is recommended by the NFFTIJMU that those crews operating emergency vehicles not-equipped with Hi-Lo settings on their sirens be required to only function as dialysis and hospital discharge units in observance of the national holiday, except for in cases of emergency.

    Here are some “Facts” about the Hi-Lo Siren that you need to know:

    -         Responding in an emergent fashion with the Hi-Lo siren makes an emergency responder -05% safer, and 110% cooler.

    -         Transporting victims of cardiac arrest to an ER may never be appropriate without ROSC, but if you must, using the Hi-Lo has been shown to increase survival rates by 12% overall.

    -         The Hi-Lo siren was invented by people WAY SMARTER than the people who invented the “Wail” and “Yelp” settings. They also have more fun at parties.

    -         You can’t help from dancing while driving while employing the Hi-Lo setting on the siren. What can the NFFTIJMU say?? It’s got a beat.

    So in observance of the holiday, use em’ loud and use em’ proud! Play em’ Hi and Play em’ Lo! 

    (Note: Don’t believe any of this, just use the hi-lo)

    Posted by on February 17, 2011 • Filed under: EMS Topics

    Heart Attack? Call 911 – Don’t just burp

    7 comments

    “I’m just sore… I must have pulled a muscle in my chest or something.”

    “I keep taking these antacids, but they’re defective or something. They aren’t working like they should.”

    “I have drank like 5 sodas… if I could only belch I would feel so much better!”

    If you’ve been in the EMS business long enough I’ll bet you have heard those exact words before from different people in disparate situations. They’re describing the uncomfortable feeling their having, and not the one they’re sure they’re not actually feeling in their chests. They’re describing to you the uncomfortable feeling they’re having within their psyche. They’re describing fear. They’re describing doubt. They’re describing the hope they want to have that they’re not actually feeling pain in their chests. They don’t want to be having something wrong with their hearts. They don’t want to be having a HEART ATTACK. This couldn’t be happening to them… this can’t be. They’re sorry they bothered you with a silly 911 call. They didn’t want to have all this fuss made for them by the ambulance and the fire truck and the police officers and the ER staff and the Doctors. This is all just so silly! Can’t we all just understand that if they could only belch that they’d feel better?

    But, unfortunately that’s just not the case. That won’t be their path. That won’t be happening for them today. Today, they’re having a myocardial infarction and they’ve got a blocked artery in their heart that is causing it to tell them something… they just don’t want to listen. Honestly, the artery in their heart has been narrowing for a while now, they’ve just been ignoring the warning signs and not taking care of the problem for so long that their heart is becoming annoyed with them. Today, it is getting downright angry at them. Soon, their heart might just become “Pissed Off” and go on strike if they ignore what it’s telling them. Today it’s screaming at them and they’re still trying to do just that… They want to ignore the feeling they’re having, but now they’re scared and they’re starting to bargain. They don’t want to be someone who’s having a heart attack. This can’t happen to them. They don’t have heart attacks. That is something they’re worried about happening to other people, you know… people who aren’t them.

    And yet the pain is there. It’s constant. They can’t seem to shake it or rationalize it away. Belching won’t help, and neither will taking antacids, drinking water, stretching, breathing deeply, or calling their friends to ask them about it. The pain, the weird feeling, the sickness, the dread… it’s not stopping and now it has been going on for hours.

    And now? Now it is getting worse.

    Fear creeps into these patients quickly but still they deny that anything is really wrong. When finally they present for treatment, whether by driving themselves to an urgent care center, by calling their doctor, or by even going to the local emergency room, they’re always shocked and in denial when they’re told “This could be a heart attack”. They defensively react and think that the medical care that is being “forced upon” them is “stupid” or unnecessary, or is “Just too much fuss”. They will still try to not believe it… well, part of them will try. They usually maintain a front. They don’t want to know that they could be indeed having a HEART ATTACK and that now is the time they need to trust the medical profession more so than they ever have trusted it in their life. They can’t fix this on their own, they can’t wish the pain away, and they can’t self heal the problem. By this time… no rationalization or self-healing thing will work. They need hard, conventional medical care… and they need it now.

    As a paramedic, I have seen the type of patient I’ve described above many, many times. I have diagnosed acute myocardial infarctions in multitudes of patients who were angry at me for bestowing even the possibility of the diagnosis of “Heart Attack” upon them. Some have sworn at me, some have been relieved when I believed them, and all were scared. As a paramedic, I can diagnose and begin treatment on many types of cardiac conditions that fall into the “Heart Attack” category people fear so much. Paramedic and Ambulance care in the first stages of a heart attack can make a huge difference in how bad it gets and how much damage is prevented. Ambulance care during a heart attack saves not only lives, but it saves muscle. Consider the fact that during a heart attack, 1% of heart muscle is lost EVERY MINUTE it is left untreated. EMS can intervene, make a working diagnosis, and provide treatment and medications that will help slow or stop the damage.

    And people really just need to forget about doing anything else other than calling 911 when they may be having one.

    Really, if you’re even the least bit concerned that you could be having a heart attack, you should drop everything and just call 911. Don’t call your mom, your son, your friend, your spouse, or even your doctor. Call 911. Don’t do anything else… call 911 and just sit there. Someone in an ambulance will show up that knows what they’re doing. They’ll help you and you need their help. Now is the time to trust them and to let them do their job. Don’t ignore the pain, don’t worry about bothering them, and don’t feel bad for asking for help. You need an ambulance. They’re the best thing for you.

    As a paramedic or EMT who is presented with a patient like this, you have a hard job. Not only must you provide appropriate diagnosis and treatment, but you also have to convince the patient to believe you and allow appropriate care. Reading a 12-lead EKG is easy compared to telling the patient and their family that you must bypass the closest hospital that they want to go to in favor of taking them to a bigger hospital, farther away, that has the cardiac surgery capabilities and cardiology services that they really need. This is the time to become a politician. This is the time to earn trust. This is the time that your skills as a caring and compassionate healthcare provider are going to be put to the test.

    And if everyone stopped ignoring the problem and trusted their feelings, a lot of lives would be saved.

    In the community that I serve, it is actually better medicine for a person having a heart attack to call 911 than it is for them to present to the emergency room. Even if that person immediately presents to the ER at the first warning sign of a heart attack, the ambulance still would have provided better care for them. Today’s ambulances bring appropriate care and highly trained medical professionals right to the patient’s side. Paramedics and EMTs can recognize the signs, help rule out mimics of a heart attack, perform diagnostic tests and an EKG, and can begin treatment with medications that stop, slow down, or even reverse the damage to the heart tissue in progress. The paramedics or EMTs in the ambulance can communicate with cardiologists and ER physicians at the local facilities and have a system in place to bring patients having a heart attack right into the facilities best prepared to take care of them, bypassing facilities that cannot provide the surgical intervention they may need… right away. Being immediately and appropriately treated by a paramedic and the emergency cardiology team early enough in a heart attack can make it almost seem like no big deal.

    And that’s what we all want our heart attacks to be if and when we have one: No big deal.

    So I’m telling you all out there. Don’t guess, don’t rationalize, and don’t hope it will go away. At the very first realization that the feeling you’re having, the pain, the ache, the soreness, the unusual heartburn, or however you describe it may be a heart attack; Call 911. Then sit and wait for us. We promise we won’t be mad if it’s something less serious.

    But you’ll feel better, much better, no matter what it is.

    Please, just call 911.

    Posted by on February 9, 2011 • Filed under: Ambulance, attack, Emergency Medical Services, Emergency room, EMS, EMS Topics, letter to the editor, Paramedic, Public relations, STEMI
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