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April is Autism Awareness Month: Now Let’s Go Farther

Since sometime in the 1970s the month of April has been recognized as “Autism Awareness Month” with April 2^nd being “World Autism Awareness Day”. It’s a time dedicated to increasing awareness of this disorder that is affecting an increasing amount of the population. While just how many people may be affected is up for debate, the prevalence is growing. So much so that last I heard, 1 in 50 kids are born with a varying degree of the disorder.

You’ll hear different statistics out there than the 1 in 50 I just quoted since there is disagreement between various camps in the Autism Community. Understanding, diagnosing, and much more so treating autism is difficult by the fact that “Autism” is a blanket term covering the many manifestations of “Autism Spectrum Disorder” (ASD). ASD covers a complex array of conditions, symptoms, and behaviors that someone diagnosed as being “Autistic” can display. People “on the spectrum” can be minimally affected, or “high functioning” or can be “low functioning” if they are profoundly affected. I can’t claim to understand it myself and I’ve been as immersed in it as I’ve ever been over the last few years.

Yesterday was “World Autism Awareness Day” and I’m posting this article on April 3^rd. You may be wondering why I didn’t post this up yesterday instead of the recap of the fake “news” stories I posted for April Fools’ Day. I waited for two reasons: one being that while Autism affects my life and my family it is still important to show that life goes on every day. Humor is a big part of our family life out of both fun and necessity. Another reason is that I believe there isn’t anyone reading this that isn’t “aware” that autism is a thing that exists. I can’t imagine there is an EMS professional out there who isn’t aware of autism but if you’re not, here’s a link to the Wikipedia page on it, and here’s a link to the Autism Society of America. Go read and become aware. In fact, it’s probably a good idea to go read and understand more about ASD anyway. There is a lot to know. ASD is challenging and complex and even the so-called (and especially some of the self-proclaimed) “experts” may not know as much about it as they claim to. I’m no expert by far and I want to stay out of the politics of the debate so I’ll just say this. If you’ve seen one person with “autism” you’ve seen one person with autism. Every person is an individual and there is no one right way to think about how every person will manifest their symptoms.

So since you’re all aware of autism now, let’s get to the point of this post: increasing acceptance, understanding, and respect. I’m glad that we’re all aware that autism is a thing, as would most parents of children who are somewhere on the spectrum as well as the people who are on the spectrum themselves. However, I’m sure they would be even happier if they could simply run an errand with their child without having to fear the reaction of other people in public. I’m sure they would really appreciate people not reacting to them or their child out of fear and ignorance should the child manifest typical behaviors or make noise when they go into a restaurant to eat a meal. As a paramedic, I can say that we would really appreciate not having to live in fear of calling 911 and having the responders have absolutely no clue of how to behave towards our son. That’s what I’d say people whose lives are affected by autism really want. While “awareness” is super-neat and all, let’s move on to the next step of making life a little less hard for everyone. Chances are that nobody reading this blog is going to be capable of finding an effective treatment, but everyone reading this can do their part to make the disorder less of a bad thing by working on their own behaviors towards people on the spectrum.

As you may know, my girlfriend Amy has been a huge blessing in my life. Her son, Connor, has some special needs, one of which is being on the autism spectrum, specifically diagnosed as PDD/NOS or Pervasive Developmental Disorder/Non Other Specified. Living with Connor has changed my life in many ways and has taught me more about myself than I thought I could learn. I’m different now, and hopefully it’s for the better. ASD is very complex and I’m as aware of it as I think I can be but I wasn’t always this way.Amy has shown me a lot that I didn’t know I didn’t know. When Amy and I were early in our relationship, she used to come and ride with me on the ambulance on a somewhat regular basis. EMS was as new of a world to her as her world was to me and while never really got anything all that complex while she was riding with me, we did have one call that stands out.

We were the 911 service for a smaller city where everyone knew everyone and the public safety community all hung out together. It was normal for the police, EMS, and firefighters to eat their meals together and we all listened in to each other’s radio frequencies. So one day when I heard the police get called to the local supermarket for “A child wandering the parking lot alone who appears to have autism.” We decided to head over there ourselves with the ambulance to see if we could lend a hand. Amy was with us and she was very interested, and I was the shift officer and approved of us jumping the call.

When we arrived, we found the police out with a male child who couldn’t have been more than 10. He was very afraid of the police, appeared to be non-verbal, and was walking away from them whenever they approached him. When we arrived, he was walking back into the store. I walked up to the police sergeant and offered our assistance. I told them that our ride-along had a child with autism herself. That seemed to be enough for them. They parted like the Red Sea and let Amy take charge without knowing her from anyone. We followed the kid through the store keeping a respectable distance and watched him as he searched the aisles. Finally, the boy walked up to a man who was perusing the frozen foods section and got uncomfortably close to him. Being “official” like I was in my EMS uniform, I stepped between them until Amy grabbed me. “That’s his dad Chris, chill out.”

It was his dad and he was not aware of the fact that two paramedics, three police officers, and a ride-along were very concerned about what his child was doing wandering the aisles and parking lot of a grocery store. The kid hadn’t done anything wrong and neither had his father, but we were all highly aware of the fact that we were uncomfortable dealing with a situation that was normal for the father of the child. Sure, he probably should have been watching the kid more closely, but how often would the parents of a typically developing child let their 10 year old walk alone in a grocery store. I’m not overprotective and I know that my 9yo step-daughter is capable of fending off kidnappers should I let her go pick out a box of cereal while I look for a gallon of milk… should this father be condemned for the same?

This event got me thinking that I really didn’t know as much about autism or the world of special needs children, but an event Amy and I shared later really hit home for me. We were watching Annie, the girl-child, play a little league game in a local park when I saw a man mowing his lawn which was adjacent to the ball field. He mowed row after row of grass all with a teenage boy following him in lock step about 3 feet behind. Back and forth they walked together silently, the man mowing and the boy following. I thought it was odd but Amy’s perspective snapped me into focus, “He must not be able to leave his son alone in the house while he mows his lawn. I used to have to mow my lawn at night when the kids were in bed because I couldn’t leave Connor alone for that long.”

At that moment, I realized that there was a whole world I didn’t know about. Even though I had been a paramedic for years and thought that I knew some things, I was ignorant to how the special needs community lives and gets through daily events that are easy and normal for most. I was ashamed. I realized that the reason the police and both my partner and I were so quick to let Amy handle the little boy with Autism in the grocery store was because we were scared. We didn’t know what to do with something we didn’t understand. Give us a car accident, a robbery, a cardiac arrest and we’d be fine working as a team… but give us a small boy that didn’t understand that we were there to help him and couldn’t communicate back with us and we failed.

As a paramedic, I live in fear of the day that I have to call 911 for my step-son. I know most of the EMS people that would respond to a call for help in most of the jurisdictions that we travel in and while darn near all of them are top-notch, I’m still scared. I’m scared because I would be scared of the medic that I was just two years ago. Sure, I was “aware” of autism as being a thing, but I had absolutely no understanding of what it meant. I had no idea of how to manage behaviors from a person with ASD, and I really didn’t know how to manage my own behavior towards them. I had awareness without understanding. Even though now I’m much more well-versed in my behavior towards people with ASD and other special needs, I’m still not as good as I want to be. The subject is complex and requires a lot of study and personal growth. One day I might be as good as I want to be but today’s not that day. I still have a lot to learn.

As I said before, “Awareness” is super-neat and all and as the step-dad of someone with ASD I thank you for knowing that autism exists. Now I ask you to take the next step and give us all a little acceptance and understanding. Nobody here is probably going to find the next revolutionary therapy but we all can stop being rude when we see someone with ASD having a meltdown in public. We can give a little understanding and courtesy when someone with ASD is being themselves in a way that isn’t quite within the social norm because we understand they cannot help it. As caregivers, we can react with kindness and patience when we realize that someone’s communicative needs and thoughts on the situation at hand aren’t what we may expect them to be.

So you can go blue for autism. You can proudly display your puzzle-pieces. Heck, you might even put a ribbon on your car. However all I’m asking is that you give people a little leeway to be themselves and just be nice to people. Not everyone is the same and we all need your respect and maybe even a little help sometimes. That’s what would be really nice.

So in honor of all of those with Special Needs and also the people who love them, Happy Autism Month y'all.

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If you’re looking for training for your police, fire, or EMS agency on Autism, I recommend this group: http://autismalert.org/

If you’re looking for a window on understanding the world of families with children who have special needs, I recommend the “Imperfect community” at: www.ShutUpAbout.com

Posted by Ckemtp on April 3, 2013 • Filed under: Command & Leadership, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Fire Rescue Topics, new perspective, News, Paramedic, paramedic education, Patient Management, Training, Training & Development

Ambulance Roll-Over in Milwaukee – To my friends at MedaCare

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FIregeezer popped up today with this unfortunate story out of Milwaukee, WI: Ambulance Roll-Over in Milwaukee

I read the story and saw that the ambulance was from MedaCare ambulance, which is a good service out that way where a few friends of mine work taking care of the good citizens of the City of Cheddar and Beer.

The story didn't say if anyone was hurt in the incident, so I don't know, but here's hoping that everyone is ok and that any needed recovery happens quickly. We stand with our own here in Wisconsin. The state has an EMS brother/sisterhood that should make other states jealous.

Best wishes to y'all over there at MedaCare. Keep fighting the good fight.

Posted by Ckemtp on March 21, 2013 • Filed under: Emergency Medical Services, EMS Health & Safety, Line of Duty, News

EMS Fights the Flu – The 2013 influenza epidemic

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It’s hitting early, it’s hitting hard, and it’s no joke. This year’s flu season is filling up the nation’s emergency departments, urgent care centers, hospitals, and ambulance run sheets fast. In the US a majority of states are under “widespread” or “intense” flu conditions. No state is currently reporting low levels of flu activity and all states are affected. According to both Google flu trends and the Centers for Disease Control and Prevention (CDC), the US is right in the throes of an intense and widespread flu season that is sickening many people all over our country. The US flu season generally occurs in winter when people tend to congregate indoors, and this year’s locally cold winter is helping the flu spread quickly.

The “flu” is an abbreviation for the disease “Influenza” which is caused by the various incarnations of the influenza virus. The disease has become such a part of our culture that people call almost any minor illness a touch of the “flu.” People say things like “I have the stomach flu” when they have a case of gastroenteritis, or say that they have the flu when they’re feeling a tad under the weather. This causes a lot of misconceptions about what influenza actually is and can cause us to let our guard down about treating the disease and protecting ourselves from it. Make no mistake that the actual flu is a serious illness that can make even an otherwise healthy person incredibly ill. While the symptoms of the disease themselves can seem relatively minor, the intensity of those symptoms and the complications they can lead to are quite serious and can even be fatal.

Influenza is a viral infection that causes symptoms similar to the common cold. However, the symptoms are markedly more severe with the flu than with a cold. The flu brings intense fever, exhaustion, and severe body aches. Influenza is a respiratory illness though it sometimes brings gastrointestinal symptoms like, nausea, vomiting, and diarrhea. The flu can lead to complications such as dehydration, secondary infections, pneumonia, electrolyte imbalances, cardiac symptoms and exacerbations of asthma and COPD. While most influenza-related fatalities are in vulnerable populations such as the very young, older adults, and in those with compromised immune systems, this is not always the case. In the Spanish Flu pandemic of 1918, the Russian Flu pandemic of 1978, and the possible 2009 H1N1 pandemic, most of the fatalities were in the young adult age range.

While modern medical practices do tend to lessen the impact of a flu pandemic in contemporary times, they are still very worrisome as even seasonal influenza epidemics can overwhelm existing medical facilities and cause an estimated 3,000 to 43,000 deaths in this country each year. The CDC cannot accurately count morbidity and mortality from confirmed influenza infections as medical facilities are only required to report deaths from Influenza or “influenza-like-illnesses” (ILIs) in children, however their estimates over the last decade show an average of 30,000 deaths in the US per year. In comparison, in 2009 the CDC estimates that 17,774 people died from HIV/AIDS.

Influenza has caused pandemics, or global infections, throughout human history. While most countries experience epidemics of influenza at regular intervals, the influenza virus occasionally mutates into a particularly virulent strain and spreads quickly throughout the globe. In the 1918 Spanish Flu pandemic it is estimated that between 1% and 3% of the total global population died with an estimated 600,000 deaths in the United States alone. In more remote areas of the country the mortality count was higher with some villages in Alaska being completely decimated. The “Hong Kong Flu” pandemic in 1968-1969 is said to have killed over one million people worldwide with over 33,000 fatalities in the US. The last official pandemic influenza was in 1978-1979, the “Russian Flu” affected mostly the younger population. In the 21^st century, the World Health Organization is attempting to ascertain if the 2009 worldwide outbreak of “H1N1” influenza classifies as a pandemic, with epidemiologists still conducting research. Recently, the CDC has estimated that the 2009 virus killed between 171,000 and 574,000 people worldwide.

Clean your equipment! Don't let your truck be a vector for the spread of disease

The flu is no joke and EMS providers need to practice prevention and infection control. First off, get your flu shot. Ignore the myths about the vaccine and just get it. Immunized healthcare workers are less likely to get sick themselves, are less likely to spread the flu amongst their patients, and are less likely to bring the virus home to their families. EMS providers need to thoroughly clean and sanitize their ambulances and patient care equipment. Hand washing is extremely important, as is the use of proper PPE. All patients exhibiting symptoms of an influenza-like-illness such as a cough, fever, and/or gastrointestinal symptoms should be asked to wear a mask. EMS providers should wear a surgical mask when treating these patients as well. Influenza is spread through droplets that are aerosolized when coughed or sneezed up by an infected person. These droplets settle onto surfaces via gravity and are spread via personal contact or through contact with the droplets while they are airborne. The CDC estimates that the influenza virus can remain viable on external surfaces anywhere from between 2 to 8 hours exposed to the environment. This is more than enough time to cross contaminate your next patient or your coworkers on the next shift. The virus can be killed on surfaces with commonly available disinfectants and regular cleaning and it can be killed on your hands with soap and water or alcohol-based hand sanitizers; However, once a person is infected, the virus cannot be killed with any medical treatment. It can only be slowed down or allowed to run its course.

Protect yourself, protect your patients, and protect your community. Be serious about preventing the spread of the flu. EMS providers are the first line of defense against this insidious disease. Remember that if you are sick, stay home. A person remains infectious for around 7 days after symptoms first appear. Stay home from work until you are at least 24 hours free from fever. Flu prevention is truly an area where EMS is at the intersection of Medicine and Public Health. As with many things, an ounce of prevention can go a long way in the fight against flu.

A comparison of Symptoms between the Common Cold and the Flu

	Common Cold	Flu
Symptoms	Cold symptoms appear gradually and include sneezing, cough, stuffy nose and sore throat. Fevers are very rare and fatigue is mild. Headaches sometimes occur.	Flu symptoms appear quickly (within 3-6 hrs) and include fever, chills, severe aches and chest discomfort.
Severity:	Usually does not cause severe health problems.	Serious health problems, such as pneumonia, bacterial infections, or hospitalizations can occur.
Fever:	Rare	Usually present
Fatigue:	Mild	Moderate to severe
Chills:	Rare	Common
Sneezing:	Common	Rare
Chest pain:	Mild to moderate	Often severe
Coughing:	Hacking, productive cough	Dry, unproductive cough
Headache:	Rare	Common
Stuffy nose:	Common	Rare
Aches:	Slight, but only headaches	Usual and often severe, affects the entire body.
Sore throat:	Common	Rare
Treatment:	There is no cure for the common cold. Cough syrup and other cold medications are available to ease some of the symptoms and make the patient feel a little better. Tea and nasal drops also sometimes help.	Sometimes antiviral medication helps control the flu but often patients simply wait for their body to fight the virus and overcome the disease. Medication is also available to ease patient comfort.
Duration of illness:	Symptoms typically peak two to three days after infection onset, and usually resolve in seven to ten days.	In children, the cough lasts for more than ten days in 35–40% of the cases and continues for more than 25 days in 10%. Adults usually feel better in seven days.
Seasonal?	Not seasonal (occurs throughout the year)	Seasonal (in winter). In the U.S., flu season is generally October to May and peaks in February.
Vaccine?	No	Yes
Causative Organism:	adenoviruses, coronaviruses, rhinoviruses (most common cause), respiratory syncytial virus, parainfluenza virus, influenza virus	Influenza virus

Posted by Ckemtp on January 8, 2013 • Filed under: Emergency Medical Services, EMS, EMS Health & Safety, EMS Topics, Fire Rescue Topics, infection control, News, Patient Management, sanitize, swine flu, Training, Uncategorized

Rockford REACT Crew Memorial Fund

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As you may know, the REACT medical helicopter out of Rockford (IL) Memorial Hospital recently crashed, tragically ending the lives of the three heroes aboard. It’s a tragedy that has profoundly affected the local healthcare and EMS communities. The grief has been palpable and has been expressed far and wide from many communities in Northern Illinois, Southern Wisconsin and beyond. When some of our own are injured or killed while they’re out there just doing what they do it affects us all. We all feel it because EMS is a family. When a tragedy like this one strikes our natural reaction is to want to do something for those directly affected by it. We want to help in any way we can, even by doing something small if it’s worthwhile.

Here’s how you can do just that. The Rockford Memorial Development Foundation has started a fund for the families of the crewmembers killed in the crash. They’re calling it the REACT fund. I have spoken with their foundation and they state that the plans for the fund are to give the total amount collected directly to the families of the three crewmembers, split equally into thirds.

And it’s Christmas and all of the crewmembers have families and kids who will be missing them greatly. I can’t describe how this fund or your support will help them because I don’t know them, but I do know that right now they need to know their loved ones are being cared about by our wider EMS family. They should know that we care about them too, and that their loved ones will be remembered. They need our support and I want you to help see to it that it gets to them.

This is a worthwhile way where the small support from individuals in our EMS family can add up to a big outpouring of care and comfort from all of us. I’ve seen what we can do when we all get together to help our own and now is the time to do that again.

All donations will go through the Rockford Memorial Development Foundation. They have set up a website here: http://www.rockfordhealthsystem.org/REACT.aspx – There is a link on the page where you can donate online in whatever amount you choose, whether it’s $5 dollars or $500 dollars. It’s a worthwhile way to let some deserving family members know that the wider EMS community supports our fallen heroes. Let’s all show them that we care.

I’m also asking all of you who read this to share the web link and the information above through your agencies, networks, and social media friends. I’ve seen the readers of EMS blogs pull together before and I’m asking us to do it again. You can share this page directly, or share the direct link to the Rockford Memorial Development Foundation REACT fund page.

Here’s that link again: http://www.rockfordhealthsystem.org/REACT.aspx

Be safe out there.

Posted by Ckemtp on December 13, 2012 • Filed under: Emergency Medical Services, Emergency Nurse, Emergency room, Emergency Room Nurse, EMS Health & Safety, EMS Topics, Major Incidents, Uncategorized

Dirty Wet Wipes, Millions of Dollars, and the Coming Changes to EMS

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It was quickly turning out to be one of those mornings. The ER was hopping and everyone was busy. We had been taking in a lot of ambulances since the start of the day shift and everyone was trying to muddle through the increasing patient load. While I was in-between tasks, I noticed that one of the nurses had left a backboard in the hallway outside of a patient room. I figured that I had a few spare moments and took it out to the ambulance garage to clean it and throw it in the cabinet. A mundane task wrapped up into a hectic day.

I have to tell you that I wrote and rewrote that first paragraph four times because I couldn’t seem to write it in a way where it sounds interesting. Cleaning a backboard in an ER isn’t all that exciting, right? Why would I write about something like that?

Because after I wiped the board down with the disinfectant towelettes, I was absolutely horrified with what I found.

Pictured: Gross

The handful of disinfectant wipes I used to wipe the thing off with came out filthy. They were mostly black but were speckled with orange-ish brown spots that come from wiping up drops of blood. The board looked a tad dirty when I started and even smelled faintly of pee but I never expected it to be as dirty as it was. It was absolutely disgusting. What makes it all the worse is that there was no way the blood, dirt, and pee came from the patient who was most recently put on the board. That patient wasn’t bleeding, hadn’t peed, and was well dressed from a clean environment. The patient had been placed on this festering petri-dish of a medical tool by the (hopefully) well-meaning ambulance crew who had responded to the call for help. They had put her on this thing and happily whisked her off to the ER for treatment.

So why, you ask, is this important enough for me to write about. Why would I write about one single backboard carrying one single patient brought in by a small ambulance service to a small hospital? Why is that worthy of wider attention?

I’ll tell you why: This one incident epitomizes a coming tsunami of liability, headaches, and hardship for EMS providers around the US that is going to completely blind-side EMS. A few years back the Centers for Medicare and Medicaid (CMS) quietly stopped paying for things considered to be “preventable medical errors” including hospital acquired infections. They believed that they could save substantial amounts of money by not paying for injuries and illness caused by the hospitals that were treating the patients they were financially responsible for. You might have guessed that Healthcare Acquired Infections (HAIs) happen to be the largest group of these preventable medical errors and hospitals have gone in to full battle mode to combat them.

It is estimated that one in twenty patients will contract a HAI during their hospital stay. It is also estimated that around 98,000 patients die each year from them. HAIs are the most common complication in hospital care of patients costing the US healthcare system around $45 Billion annually.

Hospitals have to take care of patients who contract HAIs in their facility; they’re just not paid to do it. There are estimates out there that say it costs an individual hospital between $10,000 and $25,000 (or more) for every instance of an individual patient contracting a HAI while in their facility. That’s not small change and hospitals are spending money like crazy to fight germs. Infection control departments are being fully staffed and well-funded, housekeeping and environmental services workers are sitting through hours upon hours of training, policies and procedures for cleaning and disposing of potentially contaminated items are being written and enforced by the truckload and they’re just getting started.

And we in EMS are largely oblivious to this fact.

Think of this. If this patient would have been admitted and found to have a HAI, who would have been at fault? Think hard, because tens of thousands of dollars are on the line per each individual patient. Is it the hospital, which has an army of environmental services staff, a battalion of infection control nurses roaming the hallways, and a forest of policies and procedures in place regarding meticulous cleaning practices? Or the EMS agency that brought in a patient on the backboard that was as clean as those wet wipes showed us it was?

To my knowledge, no hospital in the United States has ever sued an ambulance service or otherwise attempted to collect from one due to non-payment related to a HAI. But it’s coming. It’s coming sooner than you think it will come and if you’re not ready it will blind-side you and potentially bankrupt your service. If you think that I’m mistaken, fine… however when Millions of dollars are on the table locally and Billions are on the table nationally… I don’t think that I am.

Clean your stuff. Wash your hands. Write policies regarding cleaning and infection control, enforce them, and document their continuous use. It’s not a small issue. This is one of those things where EMS must act now or someone will act for us.

Oh, and on that note, have you heard about Medicare’s new concept of paying for patient outcomes? This is where hospitals that have better results for their patient care will get more money than hospitals that have poorer results for their patient care? That’s coming too. What do you think it will do to ambulance services when the hospitals start to identify services that consistently bring in patients who do poorly as opposed to services who consistently bring in patients who do better? Right now, nobody knows… but that issue is coming too. Believe me, the hospitals are tracking it. It’s time to get to work.

Here’s some light reading for you as well as my references.

http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf – CDC analysis paper on cost of HAIs and benefits of prevention.

http://www.huffingtonpost.com/glenn-d-braunstein-md/hospital-acquired-infections_b_1422371.html – Good article with statistics from about hand-hygiene

http://www.medicalnewstoday.com/articles/80074.php – Medicare to stop paying for HAIs

http://www.hfma.org/Templates/InteriorMaster.aspx?id=22142 – Article about pay-for-performance and pay for patient outcomes

Posted by Ckemtp on September 27, 2012 • Filed under: Administration & Leadership, ckemtp rants, Command & Leadership, disinfection, Emergency Medical Services, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Funding & Staffing, infection control, Patient Management, Training, Training & Development

EMS Providers Carrying Guns – A terrible idea

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Have you ever tried to kill a noxious, invasive weed in your yard? Think of something like bamboo or creeping charlie… something that isn’t serving any purpose and is hurting the growth of the good grass that you want to be in your lawn, something that just keeps popping up no matter what you seem to do.

That, my friends, is how I feel about the recent eruption of posts on Facebook and the blogs lately about how EMS providers should be allowed to carry guns. It’s an annoyance and hurts any constructive growth for our profession.

I’m going to come out right now and say that it is a terrible, awful, no good, very bad idea that needs to be put down the sewer like the turd of an idea it is. EMS providers should not carry guns. Not now, not ever. Never ever never never never. It is a terrible idea fraught with so many perils and pitfalls that it is more than just a slippery slope; it is a death trap that stands to hurt everyone should it come to fruition anywhere.

I didn’t form this opinion lightly. In fact, I strongly support our right as Americans to keep and bear arms. I generally support concealed carry. I don’t take disagreeing with the likes of the venerable Kelly Grayson as anything other than something very serious. I respectfully, yet strenuously, disagree with his opinion and while I know he has reasons for what he believes; I just can’t support his position on this issue.

EMS providers should not carry guns. They should not be issued guns to carry by their agencies; they should not be allowed to carry on-duty even if they have a permit to carry off-duty; they should not be allowed to carry even if they are sworn law enforcement officers working EMS part-time or as a volunteer. I do not say this because I am a bleeding-heart liberal because I am not. I say this, because it is a terrible idea.

Here are some of the reasons why:

1. Using a weapon for defense or as a tool for any other kind of task takes training, experience, and practice. Not only that, it takes lots of training, lots of experience, and lots of practice. Police officers, military heroes, and other professionals who are armed for their occupations receive lots of training, experience, and (hopefully) practice. Without it, any weapon becomes less of a tool and more of a liability. Remember folks, EMS is a profession where members furiously struggle against adding even tiny amounts of time to their initial training classes and can barely be forced to sit through, let alone actively participate in required continuing education classes. Can we ever hope to get them to train, practice, and gain experience in the safe handling and use of a weapon? It’s not possible and won’t happen.

2. Has gun violence against EMS providers spiked recently? Is it really bad out there? I personally know police officers who have been fired upon and hear regularly about police officers who have been shot. It’s terrible for them and I respect the courage they display by simply doing their jobs. While I hear about and have personally experienced physical attacks on EMS providers, the vast majority of them are closed hand attacks perpetrated by mentally impaired, intoxicated, or otherwise disturbed individuals, I rarely if ever have heard of an EMS provider being shot with a gun or stabbed. While I could believe that EMS providers have a higher risk of being shot or stabbed while performing their duties than does the general public, I have never seen data to prove that. I’ll concede though, that it passes the smell test and could be true. However… do you want to know why EMS providers aren’t being shot, stabbed, or assaulted to the extent that police officers are? It’s because we’re not cops. It should never be taken lightly that we are, if not considered neutral in street culture as we are targeted on occasion, largely considered to be non-combatants. We’re not cops. We’re out there to make everyone feel better and are largely being left alone. It’s a finite balance that will be upset the first time that Clint EMStwood pulls out his shootin’ iron and points it at a gang-banger. Once that happens, we lose our neutrality and will be targeted much more often than the comparatively rare times we are now. People will die because of it.

3. More lives have been saved by EMS’s policy of withdrawal from violent situations than could ever be saved by EMS carrying guns. It isn’t cowardly for us to withdraw, it is lifesaving. We do not enter dangerous situations and we do whatever we can to run from them when we find them. Bravado doesn’t figure in to this. We don’t do it because we are cowardly; we do it because it is not our role to face violence. Eventually, people who skirt this rule and do not withdraw run into situations where they must act in a hostile nature to defend themselves or someone else. Eventually, people who do not withdraw injure or kill someone; perhaps they are injured or killed themselves. EMS providers do not have the legal protection, authority, or ability to act in hostile situations. It isn’t our job and it isn’t our job for a reason. That’s what cops do and EMS providers aren’t cops. If you personally want to be a cop, go be a cop. If you wanted to be a cop but found out that it was easier to get a job as an EMT and now hope to bridge the jobs to realize your dreams, then please leave EMS. You’re not helping as much as you think you are. If you just want to strap a gun on your uniform because you think it looks cool, you’re probably not the type of person who reads EMS blogs because of all of the fancy words we tend to use. You may say that we can still withdraw at the same rates that we do now, but I’ll quote my father, who told me that “When you have a gun, every fight is a gun fight.”

Pictured: A possible successor for the IO drill?

You may disagree with me and that’s fine. Please leave your reasoned, courteous debate in the comments section. However I will state that all of the debates on this topic tend to degenerate into shouting matches where the supporters of EMS providers carrying guns prove to me that the state of this country’s educational system could stand to be improved. Do not do that here.

Stay safe out there. If you'd like to read another opinion I agree with, our friend Greg Friese posted this on the same topic.

Posted by Ckemtp on September 20, 2012 • Filed under: Administration & Leadership, ckemtp rants, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS Topics, Fire Rescue Topics, News, safety, Uncategorized

FIrefighter Pre-Hydration – Fight Fire like a Marathon Runner

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Has anybody else noticed that it’s sweltering outside? There’s no other way to describe the oppressive heat we’ve been facing without trotting out the word “sweltering.” The word itself is almost fun to say. I recommend that you work it into as many conversations as you are able these days while you toil outside in the intense heat. It won’t keep you any cooler, but at least you’ll be adding to the vocabularies of the other sweaty people working around you. It sure beats asking them if it’s “Hot Enough” for ‘em. That gets annoying.

In the last few weeks here in Southern Wisconsin we’ve been having some terrible fires requiring response from multiple area departments. Some of them have been heat related and some of them have just come at a bad time, but all of them have had one common denominator. They’ve all been dangerously hot. Not just the fires themselves, but the oppressive, dangerous, and potentially deadly heat on the fire ground due to the weather conditions has contributed to multiple firefighter injuries. Thankfully, most of the injuries have been minor and heat-related but some of them have been worse. I don’t know if the heat contributed to all of the injuries suffered by those brave firefighters, but it certainly couldn’t have helped.

In times like these, all firefighters need to remember the fact that active firefighting activities are nearly the same as competitive sporting events. Firefighters working on active fire grounds have the same or higher demands put upon their bodies as do athletes on the playing field. It is of extreme importance to remember that fact and take appropriate action to keep yourself and your brothers and sisters safe. Extreme weather is a great equalizer. It affects all of us no matter our station in life. Everyone on the scene has the responsibility to recognize the risk they’re taking by exerting themselves outside in these conditions and take appropriate steps to protect themselves. Nobody wants to see their fellow firefighters fall ill and even less than nobody wants to be the firefighter who goes down themselves.

By design, firefighting personal protective equipment provides an effective barrier to thermal energy. This becomes a problem in hot weather because it doesn’t allow for the shedding of excess body heat and raises the core temperature of the wearer quite sharply. While after years of promoting rehab, even the staunchest believer in their own invincibility can usually be coerced or threatened enough to go to rehab after heavy work on the fire ground, rehab is of even more importance during hot weather because it allows the firefighter to shed his or her PPE and allow that body heat to escape. However, it is important to remember in times of extreme hot weather like we’re facing now that rehab after working is not enough to keep you safe from heat-related injuries and illness. It’s simply too hot for normal people to work effectively without prior planning and preparation. Athletes spend days preparing themselves before competing in physical events by resting adequately, storing up calories and carbohydrates, and pre-hydrating. We should as well.

While it is important to keep yourself nourished with healthy food, I don’t recommend that firefighters load up on calories and carbohydrates before every shift like runners before a race. I do recommend pre-hydration. To pre-hydrate is to drink water before you need it and it is important to realize that one should drink water before they are thirsty to maintain normal hydration. While the adequate daily intake of water for healthy adults varies due to temperature conditions, levels of activity, and other factors, the Institute of Medicine (IOM) recommends that adult males take in 3 liters of water per day and adult females take in 2.2 liters. The water doesn’t need to come only from drinking water, and can come from water stored in food we eat. The IOM says that if a human is producing around 1.5 liters of pale yellow to clear urine per day and is urinating at least once every 3-4 hours they are at close to normal hydration levels. However, many factors affect our hydration and it is easy for a person to become dehydrated without realizing it. Dehydration leads to fatigue, headaches, tachycardia, low blood pressure, and other nastier symptoms that greatly affect firefighting performance and safety. It has been stated that it is not uncommon for firefighters to lose two liters of water through sweat while working on the fire ground in full PPE. If you start to sweat that much when you are already dehydrated, you will not be effective for very long.

Pre-hydration is all about keeping your water tank full before you respond and is as simple as drinking water throughout the day and maintaining your hydration levels. Since fighting a fire in full gear can be compared to running a marathon, we may want to emulate their guidelines. Marathon runners are taught to drink 20 to 32 ounces of water 2 to 3 hours before running and then to drink 8 to 10 ounces of water every 20-30 minutes before they run. While actually running, they are advised to drink 8-10 ounces of water every 20-30 minutes as well. It is not advisable to intake a large amount of water before engaging in strenuous activity because it takes time for the water to move from the stomach to the large intestine and be absorbed into the blood stream. Too much water in the stomach at once can lead to nausea and vomiting during periods of strenuous activity. Sports drinks with electrolytes like Gatorade, Power-ade, and others like them should be consumed occasionally to replace any electrolytes lost through sweating however there is no need to pre-load yourself with them as the body does not store more electrolytes than it needs and excretes any excess quite rapidly. Replacing lost electrolytes through food is of great value, and most can be replenished by eating fruit like a banana. In addition, avoid soda pop, carbonated beverages, or beverages that contain high amounts of caffeine and/or sugar as these drinks can actually contribute to dehydration by acting as diuretics.

It is easy to encourage pre-hydration among your crews. People need to drink water before they feel thirsty, and should continuously drink small amounts of water through the day. Place water in conspicuous areas throughout the station and the living quarters. Water that is out of sight is out of mind and can be forgotten. By placing water right in the line of sight of everyone, they are reminded of the need to have a glass or two. You can make the drink more attractive by adding commercial flavorings like lemonade, crystal light, or Mio mixes that add taste without adding too much sugar. Another trick is to place the bottles of water in the engine next to every staffed seat and encourage every firefighter to drink a bottle during any response to a working incident.

By pre-hydrating, you will ensure that you and your fellow firefighters hit the fire ground with full water tanks and can perform at peak levels in this oppressive heat. Keep yourself hydrated and stay safe out there. We’ve sickened and injured too many firefighters lately and I don’t want it to keep up. Turn the tide and drink up. You’re worth it.

Posted by Ckemtp on July 9, 2012 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, fire, Fire Rescue Topics, Firefighter Safety & Health, Firefighting Operations, Training, Training & Development, training-fire-rescue-topics

5 tips for beating the summer heat – An EMS and Medical Stock PSA

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Hey EMS agencies: Looking to help spread the word about staying safe in the heat? Cut and paste this stock PSA to your own site or simply link to this page from your agency's social media page. Here are 5 tips on how to stay cool and healthy that not everyone has heard before.

You probably don’t need us to tell you this, but it’s really hot out there. It’s blazing hot, dangerously hot even. The heat our area is experiencing is affecting everyone, whether we feel it directly or not. While you probably know the basics on how to stay cool and healthy during heat waves such as this one, there are a few things that you may not have thought of yet that can help make this epic heat wave just a little bit more tolerable. Here’s what you need to know:

You’re losing a lot more water than you realize – “Insensible” water loss, or water we lose through breathing, sweating, and keeping our skin, eyes, and mouth from drying out is markedly increased in hot temperatures. Humans lose a shockingly high amount of water this way during a heat wave. You have to proactively replace this loss of water and the fact is that most of us don’t. While the old adage that a person should drink “at least 8 glasses” of water a day may not hold up to scientific study, the Institute of Medicine still recommends that adults consume at least 91 ounces of water on any given day. It doesn’t all have to come from drinking it in, as some of this fluid comes from the foods we eat, and some fruits and vegetables are very high in water content and can hydrate you almost as well as a glass of water can. Drink more water and avoid soda pop and alcoholic beverages, as these can actually contribute to dehydration. The best way to measure hydration level is to monitor your potty breaks. You should be going to the bathroom for a “number one” at least four times per day and the color of the urine should be clear to a faint yellow. When your body is dehydrated it concentrates your urine. The darker your urine is, the more dehydrated you are. Keep it clear.

Watch your kids too – Kids lose a lot of water in the summertime. Even short bursts of outdoor play can burn a lot of water off of a little one. Push fluids and encourage your kids to drink water, tea, and lemonade. Creative ways to get more water in your kids include supplying popsicles and Jell-O, which are both mostly water with a little flair. You can also have fresh strawberries, celery stalks, and watermelon which both add fruits and veggies to their diets while being an excellent source of quality hydration.

Watch for dehydration and heat-related illness – In this heat you can become dehydrated quickly without realizing it. Dehydration is a serious medical condition that can sneak up on a person and make them sick before they know it’s happening. Mild cases of dehydration show symptoms after about 2% of one’s body water is lost. These symptoms can be a moderate to severe headache (like a hangover), dizziness or fainting when standing up, loss of appetite, dry skin, and constipation. You can also feel fatigued and generally ill. In more serious cases, you may experience a rapid heart rate and flushing of the skin. If you notice any of these symptoms, drink water and cool down. You’ll be amazed at how much better you’ll feel. Watch for confusion, weakness, and an absence of sweating because these could be signs of heat exhaustion or heat stroke, which are serious medical conditions. If you believe that you or someone else is experiencing these symptoms, move the patient to cooler temperatures and encourage them to drink cool fluids to replace what they’ve lost and bring down their body temperature. In serious cases, seek medical attention or call 911.

Wear shoes – Invariably, when the sun blazes down this hard, the emergency rooms start seeing burns to people’s feet caused by walking barefoot on hot concrete. In fact, one ER in the state just had a case of significant burns a patient suffered from walking on hot sand at the beach. When the sun is this strong, resist the urge to go barefoot when you’re walking outside. Burns on the feet are more than just painful, they take a long time to heal and make walking anywhere less than pleasant. Be careful.

Be smart about sunscreen – Most instruction labels on sun-protection products advise that you should apply before you go into the sun, and allow some time for the product to absorb into the skin and start protecting it. Read the label on your favorite sunscreen and follow the directions for the first application as well as the schedule for reapplying it. We’ve all been burned in the past but we can prevent it from happening again if we’re careful. You also should put on a hat and find some shade from time to time. A cherry-red hue isn’t in style this season..

Have fun this summer, but stay cool and be careful. Watch each other and make sure people are taking the heat seriously. It is dangerously hot out there. If you need us, we're here 24 hours per day to take care of any emergency needs. We’ll be here, but we hope that you can avoid us altogether by keeping yourself and your family cool and comfortable. Stay safe

Posted by Ckemtp on July 5, 2012 • Filed under: Administration & Leadership, Emergency Communications, Emergency Medical Services, EMS, EMS Health & Safety, EMS Topics, Fire Prevention & Education, Fire Rescue Topics, News, Public relations

Heat Emergencies for EMS – The Summer Time Blues

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It’s just about here! Summer time is awesome in where I live. It almost makes those long winter months seem worth it. Almost. With the warm weather close upon us it’s time to review some of the common complaints that EMS providers seem to see more of in the summer time. Gone are the days of frostbite and hypothermia and here are the days of heat stroke and bee stings. It pays to brush up on these complaints because we’ll be seeing them before we know it.

Heat Emergencies

We humans are a fickle bunch. Get us too cold or too hot and we tend to get sick as the dog days of summer. Since there’s little chance of hypothermia coming in the summer, a review of the hotter side of environmental emergencies couldn’t hurt. In emergency care, heat emergencies are generally classified into three levels in terms of severity. These are:

Heat Cramps
Heat Exhaustion
Heat Stoke

It’s important to remember that these classifications aren’t absolute and are harder to pin down when combined with concurrent medical conditions and other factors such as age, gender, and physical health. It’s also important to realize that some physical conditions, caffeine and alcohol consumption, and prescription medications can diminish a patient’s capacity for thermoregulation and precipitate heat injury.

Heat Cramps – Generally occurring in athletes or those undergoing physical exertion in a hot environment, heat cramps are muscle spasms that mostly occur in the abdomen or extremities. (Core temp 99.1-101.3)

Treatment for Heat Cramps includes general medical care, removing the person from the hot environment, providing oral fluid replacement, and cooling them gently.

Heat Exhaustion – Characterized by Fatigue, weakness, anxiety, intense headaches, profuse sweating, nausea/vomiting, and decreased urine output, heat exhaustion is caused by inadequate fluid intake and excessive fluid loss through sweating. It is essentially hypovolemia caused by hyperthermia and may be the result of several days of inadequate fluid replacement and dehydration. (Core temp 99-104)

Treatment includes much the same as the treatment for heat cramps. Do not give oral fluids to patients with a decreased level of consciousness. If your level allows, start an IV and consider a fluid bolus. Begin active cooling with ice packs to the axilla and groin. Monitor the patient’s vitals closely and watch for cardiac arrhythmias. BLS providers should consider an ALS intercept for fluid replacement.

Heat Stroke – This is a true medical emergency and aggressive treatment is warranted. It is characterized by a decreased level of consciousness, increased pulse and respiratory rates, and hypotension. Skin color, temperature, and moisture findings are not reliable but are generally hot and dry. It is becoming shown that patients that suffer near-fatal cases of heat stroke have a strikingly high 1 year mortality rate. (Core temp >105)

Treatment for Heat Stroke includes aggressive cooling with ice packs, evaporative cooling, and IV fluids. BLS providers should request an ALS intercept. Rapid transport is warranted. Manage the airway and other complaints such as arrhythmias as per protocol.

Watch your coworkers too. Make sure that your fellow EMS people are staying cool on incident scenes, especially when they may be wearing turnouts or other protective gear. When you're not actively performing tasks that require protective gear, strip it off to allow yourself to adequately cool. Push them to drink plenty of fluids and go to rehab when they need to. Be safe out there and watch each other’s backs. We need you out there.

Posted by Ckemtp on April 16, 2012 • Filed under: ALS Intercept, Emergency Medical Services, EMS, ems education, EMS Health & Safety, EMS Topics, EMS training, Firefighter Safety & Health, Paramedic, paramedic education, Patient Management, Training, Training & Development

GPS in the Ambulance – An overreliance on Ms. Kitty

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Actual conversation between me and my partner a few years ago right after receiving an emergency call:

Me: “Lemme get this on the map… I think it’s South of us. Head South… Southeast! Yeah, it’s Southeast of us”

Her: “Whattaya mean Southeast!? I don’t know directions. You’ll have to tell me Left or Right!”

Me: < Scanning the map> “Um… Ok, we’re heading North, so make a Right up here on River Drive and head to Mulford. The street is right off of State and Mulford, one West and two South”

Her:       “It’s what?”

Me:        “Just head to State and Mulford and I’ll get ya in”

Remember that? Remember those days when we used to use paper maps? I do. Man, those days were crazy… back when we had to use those archaic things, right?

Actual conversation between me and a different partner in the much more recent past while driving to an emergency call:

Me:        “Dang it! The GPS won’t get satellite signal! I can’t lock in the address”

Him:       “Where do I turn? What street is it off of?”

Me:        “Hang on, I’ll try to look up the address from my phone… Gah! Why is the connection so slow!?”

Him:       “I’m going to turn down this street… what was the address again??”

Me:        “Um… I think it was… 432 Mulberry… I think… Don’t we have a paper map in this truck???”

Him:       “I didn’t see one. Maybe I can get the address on my phone.”

Me:        “Wait, is that a cop up ahead? I think he’s at the call, drive up there.”

Cop:       “Hey! What took you guys so long!?”

Ain’t modern technology great?

It was only a few years ago that we got GPS machines in the ambulances I ran in. Previous to that we had survived off of our “Stacy Maps” which were these awesome map books designed by a local company. They weren’t sexy or technologically sufficient for the times… but they always got the job done if you knew how to use them. Sure, they were hard to read by yourself if you were the only one navigating the truck, but they worked… every time. No outside force could stop them from working. If you had one, you weren’t lost, period.

Now, with our increasing reliance on the magic voice in the GPS box (I call my GPS voice Ms. Kitty) we seem to be able to get to our calls seamlessly and smoothly… 90% of the time. There are times when the GPS doesn’t work, times when it’s just too darn slow, and times when it doesn’t have an address to lock in to. The GPS just isn’t always optimized for emergency response. I’ve found that my GPS is great when I am dispatched to 9933 Harrison St as a physical address… but not so much when I’m dispatched to “The bike path in the field behind Costco off of the side road next to the blue house”.

I remember a call I got once when I was working a relief shift at a contracted rural station. We had just cleared a call from a downtown hospital when the service got a call for a nasty auto wreck out in the country. Their dispatch asked us to respond as the third ambulance. I usually worked in the city the hospital was in so I knew how bad the regular routes were clogged with construction, being as it was summer in the Midwest. I drove and was able to use my knowledge of the city to get us around every bit of it. I took State St to Prospect, Prospect to Guilford, Guilford to Highcrest, Highcrest to Springcreek, Springcreek to Springbrook, Springbrook to Perryville, to… well, you get the idea. I was able to bob and weave through that city so much that we arrived at the scene in record time… which was just in time to be cancelled and sent back to quarters.

We have 4 seasons in the Northern Midwest "Almost Winter", "Winter", "Still Winter", and "Construction"

What I’m saying is that I knew the city so well because I had been forced to learn how to navigate it by reading paper maps. A skill that sadly, I’m afraid we’re losing as we increase our reliance on the magic directional box and the voices inside of it. GPS is a great tool, but since a huge part of our effectiveness as EMS people is actually being able to arrive at an address in a timely manner, it can’t be our only tool to find one. If you're relying on your GPS as the only tool you have to find the address of an emergency call, you're turning your GPS machine into a life-safety device. I'm sure the manufacturer will agree that It was never intended to be one of those.

My advice is to learn to love your paper maps. Read them. Study them as much as you study your medical protocols. Drive around your wider response area without turning on your GPS. Get lost in it every now and then and try to find your way around. Be sure to pay attention to the hundred blocks, the street names, and the short cuts. Don’t become clueless when Ms. Kitty takes a coffee break.

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For more of my “You Kids Get Off My Lawn!!” ramblings, you may want to check out “Those Darn Kids!”

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Posted by Ckemtp on October 26, 2011 • Filed under: 911 fail, Command & Leadership, Emergency Medical Services, EMS, ems education, EMS Health & Safety, EMS Humor, EMS Management, EMS Topics, EMS training, Fire Rescue Topics, Paramedic, paramedic education, stories, Technology & Communications, technology-communications-ems-topics, Training & Development, training-fire-rescue-topics

“Teamwork” on the ‘bambilance – Shown as a video metaphor
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I read a good article written by (the highly educated) Guy Haskel on JEMS.com today called "Persona Non-Grata" and I've got to tell ya, I've been right there. I've been on the recieving end of exactly what he was talking about in the article and I have all kinds of empathy.

Here's the article - Read it and remember that you simply can't please everybody.

This article got me thinking about some of the more interesting relationships I've had with coworkers and partners over the years. Some of them have been very smooth and friendly and have resulted in some good friendships. Some have been smooth but less-than-friendly and resulted in some comfortable times at work… others?? Well… I'm sure you all can guess.

Have you ever had an ambulance or fire-department shift that felt like this? (This is such a good metaphor)

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Posted by Ckemtp on October 21, 2011 • Filed under: Emergency Medical Services, EMS Health & Safety, EMS Humor, EMS Topics

Get a Pulse, Get a Steak? Random Incentive
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Tonight the girlfriend and I had the rare opportunity to go out on an actual date. It's getting increasingly rare these days that we have time to do so, what with our schedules, work stuff, and my recent bit of travelling for the other job that I have. It was nice to actually get out, go to a restaurant, and not have to cook or eat bad-for-me fast food on the road.

She and I went to one of our favorite places, a midwestern type joint that specializes in mass quantities of beef. At this place you get to choose a large hunk of absolutely beautiful red meat from their cooler, season it to your liking with the wide variety of spices they have on hand, and then grill it yourself over their huge charcol grill while people bring you your beer. It is a concept that is admittedly getting a little more rare around the midwest, but it's certainly something that I haven't seen anywhere else in the country that I've been. These people have given their customers exactly what they want. All the beef one could possibly eat, a salad bar to go with it, cheap drinks, and a good meal will cost you about $17 bux. Yeah, beat that, California.

I noticed on the menu that the restaurant offers gift cards that employers can give their employees. They are good for a full meal for two and come personalized for the employer. Since I'm always on the lookout for a good way to help reward and motivate good EMS people, I mentioned to the GF that maybe I should buy a couple to give the guys as an occasional "attaboy".

"What would you give them out for?" She asked, then answered "How about every time they resuscitate a code?"

Now THAT is a good idea! I'll call it the "Get a Pulse, Get a Steak" incentive program. That way, every time a crew gets that magical cardiac arrest save they and their significant other get to celebrate by roasting them some posthumous cow. It sure beats knowing that all you've got to look forward to is a lengthy report and a horribly messy ambulance or scene to clean up afterward.

Then again, I'm sure someone will point out that it's just too subjective to base the reward on a code save because as we all know, even when everything is done completely "right", completely by the book, and the crew tries absolutely as hard as they can to get the save it still doesn't usually turn out the way we'd like it to. We all know that is true. It just seemed like a good idea at the time.

Thanks for shooting down my awesome idea, imaginary naysayer.

I've been trying to come up with some innovative ways to motivate, reward, and incentivise the best and brightest EMS people out there to want to come in and do the absolute best job they can for the service and the patients every day over the long term. Money and passion isn't enough to carry everyone along every day, people need more than that sometimes and there's simply no shame in it because we all feel that way at times.

I'd love to hear what you or your service is doing to motivate employees. (And don't tell me it's what they're doing in Louisville, because yeah… not cool)

Also, the steak was amazing.

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Posted by Ckemtp on October 14, 2011 • Filed under: Administration & Leadership, appreciation, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS Motivation, EMS Topics, EMT, Paramedic

A Medic Roast in Tennessee
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Some time ago I worked for a service that had a governing board made up of community members from various walks of life. Most of them were business leaders around the area and only one or two of them had any EMS experience. One day I overheard one of the board members talking about problems he was having with the quality control at a factory his company ran in another area.

I was fascinated.

It seems that the workers at this factory just didn’t seem to care about the quality of the product they created. Products came out with grievous manufacturing errors that turned a lot of their finished products into unsellable junk. He described these errors as things that any reasonable person would notice had they spent more than one day on the job.

Joining in the conversation, I asked him “So, how much does the average worker at that factory get paid?”

He replied with a wage that was actually above my hourly rate as a paramedic. It was significantly more, actually.

It shocked him when I said “So they make that much more than I do, and when I make a mistake someone dies and my career is over? That doesn’t seem right at all”

And no, it doesn’t seem right. Every human being on this planet is going to screw something up on occasion. We’re not perfect. Medical professionals and especially EMS people are constantly challenged to adapt their knowledge to unfamiliar situations with incomplete information. On top of that, the body of our knowledge is constantly changing and it’s up to us to know exactly how to seek it out so we’re consistently doing the best for our patients. It’s not easy to be a good EMT or Paramedic and it’s a responsibility that we’re largely not well-paid for. Top that with the fact that even one simple mistake can be a career ender and…

You get this article that I saw this morning in JEMS: Tennessee Paramedic Demoted after Drug Mistake

If you’ve been a paramedic in the field for any length of time and this article doesn’t scare you, you’ve not been much of a paramedic for any length of time. This is real folks. This is something we all should sit up and take notice to.

The article concerns a paramedic who made a medication error. While it doesn’t state what error he made, it seems that he had mixed a medication in a bag of normal saline and infused it to a patient while intending to give a different medication. The article doesn’t specify the medications given but from the patient’s condition an educated person may be able to infer what they were. It also specifically does not mention the condition of the patient before or after the medication was given, leading me to believe that the patient suffered only minor ill. Yes, I know that I’m assuming… but you can’t tell me that the newspaper wouldn’t have been more than happy to blast the headline “MAN DIES AFTER MEDIC POISONS HIM WITH WRONG MEDICATION” if he had died. My guess is that if they downplayed his condition, there wasn’t much to sensationalize about it.

The medic, who had been with the service for 9 years and who had only been disciplined once in that time for missing something on a rig check, had received “above average performance reviews” and more than one commendation in his tenure.

From reading the article, it looks like an experienced medic made an honest mistake. He was reprimanded for it, suspended for 28 days, and demoted to an EMT.

Yeah, you read that right. They voided 3 years of education that this man had completed and knocked his license all the way to EMT-Basic.

They did this for one mistake. One mistake that even the medic’s chief stated was “… accidental and an oversight on his (the medic’s) part”. An honest mistake that everyone reading this article has already made or will probably make in their career. A mistake that was apparently easy to make, even by an experienced paramedic that most probably did not result in grievous harm to anyone.

If the facts truly are as reported in the article and there are no other unreported wrinkles to this case, I call shenanigans. The discipline this medic received simply does not fit the crime. It’s too heavy-handed. The discipline seems arbitrary, unnecessary, and patently unfair.

The chief was quoted in the article as saying that their agency, which is reported as responding to around 29,000 emergency calls each year, has a “success ratio” of “100%” and that “this is not the norm.”
Pictured: Every Paramedic

So he’s saying that the all of the EMTs and Paramedics that must handle 29,000 emergency calls per year are expected to be 100% perfect 100% of the time or he will negate their education, harm their lifetime income potential, and defame them in the national press? I know that he probably didn’t *intend* to say that… but he very much did say it. I know of no other single profession that has so much at stake every time they go to work. To my knowledge, no other profession has so much risk of long term harm to their lives, their family, and their professional career riding on a very much unrealistic goal of being 100% perfect 100% of the time. It’s shockingly unfair… and terrifying. No human being can maintain those expectations. We’re just not able to always be perfect all of the time for an entire career.

And when you think that the pay for Paramedics and EMTs in this country is by and large pathetically low, you might wonder why anyone would ever consider doing the job at all.

I’ll say again, if the facts in this case are accurate and complete as reported, this is an outrage. It’s an abomination. It’s enough to generate national attention about the unfair working conditions and haphazard disciplinary standards that EMS must endure.

I’ll say this too: I support this paramedic and formally place a letter in the file of the agency responsible for doing this to him.

(This part is for Google) If you work for WRCB TV in Tennessee, please feel free to consider this my opinion.

(You can find the original article HERE: http://www.wrcbtv.com/story/15463233/ems-used-wrong-iv-in-melvin-davis-transport)

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Posted by Ckemtp on September 15, 2011 • Filed under: Administration & Leadership, Command & Leadership, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS rant, EMS Topics, Ethics, News, Paramedic, patient care, Patient Management

Death Rate to Increase in London – and – The Medicare Tomato
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Howdy everyone!

I’ve read some things out there on the interwebs lately that I’d like to share with y’all. These are articles that made me think. They also made me feel a certain way after I read them. Individually, they would have been interesting on their own merits. However, when read together one after another, I think they do something to your brain that you should experience.

And let me just say, good luck with this.

First off, I read this post by Rogue Medic that linked to this post by BryanKellet.net entitled “Death Rate in London to Increase”.

As always, Rogue Medic has provided his genuinely valuable insight to the article and I am very much glad he called it to our collective attention. I suggest you read the original post first and then read the Rogue’s interpretation on it. While you’re at it, be SURE to read each and every one of the comments on Mr. Kellet’s article. Read them all, it’s very telling.

Including this one:

"560 frontline cuts is a huge number and your comments with regards to little yellow cars is spot on. Time to start investing in private healthcare company shares perhaps."

Uh huh.

It looks like the London Ambulance service is cutting 560 paramedics from their staff, decreasing available ambulances, and is shifting the focus to Rapid Response cars with a single-medic. While these cuts would be common-place in American cities these days (except of course, for the Rapid Response Cars); doesn’t the NHS support the LAS? Wouldn’t they be fully reimbursed for their care? I thought they had a well-funded healthcare system over there across the pond.

Then read this fascinating look at universal healthcare written by The Happy Hospitalist and posted on his site about a year ago: The Medicare Tomato – It is just an absolutely fantastic article that you need to read, now. If you’re not convinced, read this quote from the piece:

“A consumer came in today at 12:04 pm on March 7th, 2008. He did not complain of any tomato headache. He had no gas pains. He appeared to be in good spirits. He was not orange. His lips were drooling for a chance at free tomatoes. He appeared angered at the lack of options and declining quality. He was at one point found to be pointing and yelling profanities. He took 7.4 pounds of the super duper genetically altered tomatoes (verified by government scales) with a big fat giant grin on his face, yelling, "I ain't paying for it", all the way out the door.”

This guy’s one of us.

I’m withholding comments of a political nature right now. While I have strong feelings on the looming changes in US healthcare and the economy in general, I want to foster the discussion and see a broad cross-section of opinions in the comments section. I want to know what y’all think.

However, if you would like to read some of my articles on what my opinion is, feel free:

The Current US Economy and EMS: An In-depth look at how this mess will affect 911 in your community

EMS 2.0 – A Paramedics First Step in the plan to Revolutionize Healthcare

I’m not picking on my British EMS brethren here. I like the boys in green quite a bit, like my friend Insomniac Medic and @ukmedic999. To prove it, here’s some of my writing on the whole UK thing and how it’s good, too.

A Shoutout Across the Pond to our British EMS Brethren

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Posted by Ckemtp on June 15, 2011 • Filed under: 911 fail, Administration & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Topics, Paramedic, UK paramedics, united kingdom, universal healthcare, US economy

Keeping an Eye on the Sky
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If some of you out there don’t know it yet, I’m away from my home area working one of my jobs in another state. I’ve been gone for just over a month at the time I write this and I haven’t gotten my end date quite yet. I may be here a while longer.

Last night I came back into my hotel room and turned on the TV to find none other than Jim Cantore on the screen talking about my home area. Apparently, the wrath of Mother Nature isn’t limited just to other areas of the country. My area took it pretty hard last night and thank goodness there weren’t any injuries.

My girlfriend (Oh yea, I have one of those now by the way, which you would know if you followed me on Facebook or Twitter) was driving my car during the storm and just happened to drive right into the heart of the gust line, the leading edge of this monster storm. She ended up taking the brunt of it and had to leave the car and take cover in a ditch (Which by the way, is the smart thing to do) she got scraped up a little bit by flying debris and all; but thank goodness… the car is fine. (Love ya honey!)

This storm blew up quickly and just exploded out there. To my knowledge, there wasn’t a tornado formed, but the wind gusts were reported at upwards of 80mph and were forecast to hit over 100mph. The rain was torrential and the storm lasted a long time, lashing the area with high winds for quite a while. It was a bad one, but thankfully not as bad as other areas of the country have been getting. There was some damage, and my local Facebook buddies have been posting pictures of it on their accounts all morning. It could have been much worse, but it was pretty bad by itself. It certainly was a wake-up call.

Talking to my girlfriend on the phone last night after her scary ordeal she told me how she figures she was able to be caught off-guard by the storm. While she drives, she listens to MP3s rather than listening to the radio and therefore did not hear any severe weather warnings. She said that as soon as she saw how bad the storm was getting that she turned on the local radio, but by then it was too late… she had driven right into the path of the oncoming fury. A few days prior to this, I had discussed with her the possibility of employing underground storm shelters in our area and she said how she thought it was overkill. She didn’t think that we had bad enough weather in our area. I assured her we do get bad enough storms often enough, but the conversation didn’t go much further. Storm preparedness, like fire safety, is not a flashy topic. It doesn’t seem to be taken seriously until after something happens. However, as Mother Nature has proven to us this season, we need to be prepared.

The girlfriend is a smart lady, very smart actually. She’s not one to be taken off-guard by anything and can handle most anything that comes. This, however, was a surprise to her and I’m sure it surprised a lot of other people as well. It’s not that we don’t get storms like that in my area, in fact they come quite frequently, but people are still complacent about them. They just don’t think that it could ever get that bad, no matter what they see on the news happening in other areas. There are a lot of things in our society that are affected by our natural tendency to become complacent in our contemporary lifestyles. There are lots of things we just seem to forget can happen to us when we’re caught unaware by the realities of our world. Everything from storm preparedness, to fire safety, to cardiovascular health, to crime prevention, to drinking and driving, to most of the behaviors that keep EMS in business can be attributed to this fact. It’s just how we’re wired, I think.

If I can offer you all out there any advice, it would be to consistently remind yourself of the need to be aware of your surroundings. Maybe it’s the fact that as a paramedic my life is spent cleaning up the messes of the more unwary of those among us, but I tend to believe that most “accidents” can be attributed in most part to a lack of planning and situational awareness. I don’t want anyone to be afraid of living their lives, but keeping an eye on the horizon seems prudent these days. Don’t be caught off guard. I need all of my readers out there and want you to be safe.

Also, if you’re driving and you see or suspect severe weather, turn on the radio and turn off the CD or the MP3 so you can hear emergency broadcasts. It might just save your life.

Have you been to these websites yet?

www.Ready.gov

www.FEMA.gov

www.NHC.NOAA.GOV ß I love this site

http://www.fema.gov/emergency/reports/index.shtm <– A daily read for me, every day FEMA puts out the “National Situation Update (SitRep). It is a wealth of information and I strongly suggest you start reading it too.

www.IcanHasCheezburger.com ß Funny pictures of cats… because this disaster stuff gets depressing some times.

As always folks, stay safe out there.

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Posted by Ckemtp on June 9, 2011 • Filed under: Ambulance, ckemtp, Emergency Medical Services, EMS, EMS Health & Safety, EMS safety, EMS Topics, FEMA, Fire Rescue Topics, first responder, Paramedic, severe storm pictures, Training & Development, Uncategorized

Wake Up! You may have a call…
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Every so often the discussion of the most healthy and appropriate way to wake a sleeping firefighter or EMS person from their slumber in order to alert them to the presence of a call for service crops up in the national discourse. Some believe that soft, gradiated lighting combined with a soothing tone and soft-voices is best for the long-term cardiovascular health of EMTs, Firefighters, and Paramedics. They say that a quick wake up to a jarring alarm tone is unhealthy and can cause long-term damage through a rapid increase in heart-rate and blood pressure.

I think it's BS, actually. I can't seem to get up without the assistance of Gabrial's trumpet, a car battery, and some alligator clips… and even then, I have woken up more than once in the middle of a call, coming to fully-realized alertness in the act of performing CPR or decompressing someone's chest. I think that that's way more startling. Also, our night dispatcher has a voice that would be very well suited to that of a 900-number call-taker and isn't the kind of voice that tends to make a guy want to get *out* of bed. ("Tell me more about the fire, Dave!")

While searching the world's most accurate source of information, the internet, I came across this invention. I love it. I may try and buy the rights to it and sell it to ambulance agencies such as mine.

Here, see for yourself!

In addition, I think this would be an awesome way to get the crews to do their shift chores. The supervisor of the day would keep the machines on until the garbage cans were emptied, the floors were mopped, the toilets were clean, and the training was trained.

I think it's a potential gold mine.

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Posted by Ckemtp on May 23, 2011 • Filed under: Administration & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, EMS Management, EMS Motivation, EMS safety, EMS Topics, Fire department, Fire Rescue Topics, Firefighter Safety & Health, funny, Paramedic, Videos

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.

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Posted by Ckemtp 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

I am not immune
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I’m going to make an announcement:

I am not immune to the things that I thought I was immune to.

You see folks, I am human, and as a human I am fallible, faulty, and flawed… Just like everyone else. I have emotions, thoughts, feelings, vibes, good stuff, and bad stuff that I carry with me inside this noisy brain of mine. I am not immune to the events that affect my psyche, nor am I immune to carrying the baggage that I obtain or the sadness that splashes on to me in my daily travels.

Of course you know that, right? Because for the longest time, I sure didn’t seem to.

I’m a long-time full-time professional EMS person and as such, I thought I was immune to so much of the stuff that I see on the streets every day. I’ve always said that I will jump right in and work in whatever conditions the job and my life seems to throw at me. I just tried never to get any of it on me personally. Death, destruction, abuse, trauma, pain, sadness, loss, grief… all that stuff seems both very real and yet still surreal to me. I thought that I could bear witness to unfathomable human tragedy on a daily basis without any problem. For many years I still seemed to myself to be able to function normally. I thought I was ok with all of this.

And no… no I wasn’t that’s abundantly clear to me now.

You may have noticed that the blog’s been silent lately, and well… that’s for personal reasons. If you’ve been following me on Twitter and Facebook you probably know why I’ve been silent, but on the blog here I’m just going to say that I’ve had quite the personal upheaval. This, combined with a huge change at work has left me little time to sit and think about writing. It’s not that I didn’t want to write, because I truly love this blog and all of the fantastic people it has brought into my life. I just didn’t want to write crappy or say something I’d regret… so I remained largely silent on here.

I have, however, learned some things and have some things to say:

First of all, to my guys at the Rescue Squad: You are more than my coworkers, you are my brothers. Thank you for everything you’ve done for me. I wouldn’t have gotten through this without you. Family doesn’t begin to describe it. Thank you.

Second of all, to my local friends and Family: Ditto the above. I’ve gotten the chance recently to reintroduce myself to all of my old friends. I’ve missed you guys. Thanks for being you and thanks for being there for me.

And Third, to my blog followers, fans, and interweb friends:

I chanced to look at some of the facebook profiles of the people I’ve been talking to online lately. It’s amazing to me how many mutual friends I have with people I may have never met in person or have only met a few times. The names I see out there on the web are common names in my daily life. Since I started this little place on the interwebs the relationships I’ve been able to make with hundreds if not thousands of fantastic EMS people are amazing. You’ve all been there for me as well and I am literally so appreciative of it. You’ve rejuvenated my EMS career and shown me that there is indeed a future for us all in this business. I can’t tell you how much I appreciate it… it’s amazing.

It’s too common for us EMS people to ignore the crap in our own lives and simply drive on towards the next call. We shake off whatever is going on in our personal lives, shake off the sadness and grief that splashes onto us from the streets, and drive on like nothing has happened. We are mission-focused and are confident in our abilities and our immunity. I sure was. I ignored the bad stuff in my own life and focused on my responsibilities. Just like I would have gone on to the next job after a tragic call, I ignored a lot of things and kept my eyes forward. All EMS people tend to do that… we probably have to. The thick shells we develop are most probably a defense mechanism. Personally, psychologically, and physically we ignore what we need and focus on meeting the needs others place upon us. The long hours, the hard calls, the low pay… they do take a toll on us and we have to do more for our own well being than simply paying it lip service. None of us are immune. All of us are human.

It is shocking to me when I look around me at my EMS friends and coworkers and see how much strain they place upon themselves and yet are still able to take the next call. Nobody I know in EMS takes care of themselves like they should. All of them ignore their own well-being. I did that too, and even when I say that I’m going to focus in on taking care of me for a while, I feel selfish.

Well take it from me, you’re not selfish for putting your own needs first every now and then. It will make you a better person, and a better provider. If I could do things over again, I would have met some of my own needs and I bet that things might have changed for me… but I didn’t, and I can’t… and that’s ok. We all have new beginnings in our lives and this is my opportunity to do just that.

To my EMS people out there: Evaluate yourselves right now. Refocus on what’s truly important… don’t play SuperMedic because you’re just as human as I am. I also am issuing a challenge to everyone out there: Just as my coworkers became my surrogate family after my issues and watched me to make sure that I was ok, you all have to do that for your coworkers and friends as well. We depend on you, you should depend on us too.

Stay safe out there.

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Posted by Ckemtp on December 10, 2010 • Filed under: Administration & Leadership, appreciation, ckemtp, Command & Leadership, edemse, Emergency Medical Services, EMS Health & Safety, EMS Topics, Fire Rescue Topics, In the Line of Duty

A Weighted Issue – The Fire Service Helping Private EMS
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There has been quite a bit of buzz lately over a story that happened pretty close to my generic neck of the woods. It’s been featured on www.JEMS.com as well as www.EMS1.com and has blown up the twitter streams. I was made aware of it by the JEMS Facebook fan page posting the link two days ago.

Before I link to the article, I’d like to say that I was immediately on the side of the private ambulance company and I jumped right on the JEMS facebook comments thread to state my case. I figured that there would be some dissention, but that most people would share my view.

But that’s not exactly what happened…

Apparently there is a vast chasm in opinions out there on this issue, and it’s not just the Firefighters vs. the non-firefighters like I thought it would be. The comments section is up to 61 comments as I write this and the discussion is poignant and well reasoned. I still believe in what I said… but I’m willing to revisit the issue

Here’s the article: http://www.jems.com/article/news/illinois-fire-department-refus

So… do you see the discord there?

The private ambulance service, which is a pretty new company that runs only one or two ambulances was started by a paramedic with a dream (yea, really). It took the patient from a rehab hospital to a private residence in Springfield, IL. I don’t know the exact road mileage, but I do know that Springfield, IL is a good 4 to 5 hours away from where the rehabilitation hospital is located. The patient was reported to have been on Medicare and Medicaid and weighed approximately 700lbs.

Yep, this ambulance crew had to take a 700 pound patient on a long distance transfer. I feel their pain.

The crew couldn’t get the patient from their ambulance into the residence when they got there and called the Springfield FD (SFD) for assistance moving the patient. SFD refused to assist them.

Ultimately, the private ambulance crew arranged for another private ambulance from a Springfield area company to come and help them. The job got done and everyone was happy, right?

Well, no… of course that’s not what happened. Someone alerted the media and the story popped up on the wire. Now there’s debate flying all over the interwebs and I for one want to keep it going. Viva debate. Viva discussion.

Here’s my comment from the JEMS Facebook Page:alled “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of it’s tax-paying constituents is reasonable.

SFD gets a letter in the file for this one.

I’m actually familiar with the ambulance service in question. In the area that it mainly operates within, the Fire service is always happy to help out the private ambulances with these types of cases. It has to do with providing something called “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of its tax-paying constituents is reasonable.

SFD gets a letter in the file for this one

That has been “liked” six times since I wrote it.

The rub here for the Defenders of the Fire Service™ is that they say that the “Medical Transportation Industry” is an “Industry” and therefore should have their own plans in place to deal with this type of case. They say that they shouldn’t diminish their ability to respond to emergency requests in order to help out a private business with a client. They say that they would expose themselves to liability, expose themselves to potential injuries of their employees, and that they would be providing this service for free. They say that this isn’t their job and that they shouldn’t be spending taxpayer dollars to help out a private entity.

And… I might concede that to them if I thought it was genuine. I mean, does the fire service help out the towing and recovery industry with cleaning up car wrecks? Do they help out the private fire alarm business by responding to and resetting false alarms? Do they provide private residences with smoke and carbon monoxide alarms?

Yes, of course they do all that. They do other things too. They help out all kinds of community entities, both public and private, for-profit and not-for-profit all the time. The Defenders of the Fire Service™ keep trumpeting their statement that they are an “All-Hazards” emergency response agency that is constantly adapting to meet “the needs that the public are demanding from them”.

All of those community entities the fire service assists have one thing in common, they pay taxes. Some of them pay property taxes, some of them pay rent that goes in-part to pay property taxes, and some of the straight not-for-profits provide services that help the people paying property taxes.

And last time I checked, the SFD does receive property taxes.

Here’s one thing with what I said though… The “All-Hazards response” idea is for responding to “hazards” and I can see where a private ambulance needing a hand isn’t exactly a hazard or an emergent need.

Would any of the Fire Departments I’ve worked on have done it? Yes, absolutely. A citizen needed an assist and we would have marked it as a “Public Assist”. We would have responded non-emergent, helped, and it would have been a non-issue. The person pays tax dollars and we would have looked at it as the same as responding with an engine for a 911 lift assist.

However, I will concede that the Private ambulance service would have been more proactive if they would have called the SFD and asked them if they would help them before they loaded the patient. If the SFD told them “no” at that time, they could have arranged for alternate methods at that time. Instead, they just assumed. They transported the patient to someone else’s sandbox and just hoped that they would play nicely.

And the SFD doesn’t play the way that Mercy Ambulance is used to playing.

If you can’t tell, I’m on the side of Mercy Ambulance here. Although I say that they should have dropped the dime and rang the SFD to ask them before they just assumed they’d help.

One thing’s for sure though, this issue isn’t going away and it will probably become more common. There’s a ton of differing opinions out there as shown by the comments that news story received and it shows that there are EMS professionals on both sides of the fence that have strong and reasoned opinions. This is an issue that would benefit from some discourse and that’s why I’m bringing it up.

What are your thoughts?

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Posted by Ckemtp on September 17, 2010 • Filed under: Administration & Leadership, ckemtp, ckemtp rants, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Fire department, Fire Rescue Topics, Firefighter Safety & Health, News, Paramedic, Patient Management, politics

Speeding to the hospital! or.. Nurses: Above the Law
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While reading up on EMS blogs today I came across this link over at Burned Out Medic:

http://burnedoutmedic.com/2010/08/there-are-enough-traffic-scofflaws-already/

It links to a story written in a magazine called the “Cath Lab Digest” penned by a “Lead RN” with a bunch of certainly impressive sounding gobbledygook after her name. She writes the story of her outrage and subsequent fight against a traffic ticket she received while responding from home to a cath lab activation at her hospital.

Her story is written in her article, which can be found here: http://www.cathlabdigest.com/articles/My-Day-Court

Here’s the reply that I left her:

I read this and saw the “I’m Special” mentality breaking through all over this piece.

You indicate that by virtue of your job and your training:

- You’re so special your cath lab team cannot handle their job without your leadership, even for up to 12 minutes.

- You’re so special that your objective and destination are more important than the objectives and destination of everyone else on the public roadways.

- You’re so special that the law should not apply to you.

- You’re so special that the other healthcare providers on-duty at the time you are called in cannot possibly be taking care of the patient as well as you can.

- You feel cool being called in and being allowed to drive any way you want.

The officer who stopped and ticketed you disagreed with all of the above. I do as well.

In many states, volunteer fire and emergency medical services personnel are allowed to operate their personal vehicles with emergency lights and sirens when responding to emergency situations. This is because the situations they respond to are extremely time sensitive, requiring professional action within 5 to 10 minutes in some cases in order to mitigate the consequences of the emergency. These calls are usually in the hands of lay persons until the professionals arrive.

Your “emergencies” are time sensitive as well. The AHA recommends a 90 minute window from recognition of STEMI to Cardiac Catheterization. The patient is in the hands of trained people from the time of recognition. There is a huge difference in these standards that does not warrant the risk to the rest of the public for nurses driving in an emergency fashion… especially self-appointed “special” nurses.

I would think that the minutes could be saved in earlier recognition of the STEMI, field activation of the Cath Lab team, earlier notification by the hospital, and perhaps having more qualified people on duty around the clock. This would certainly pay for itself the first time the hospital was liable for you killing someone or being killed yourself while enroute to a page.

I’m sorry if I was perhaps a bit hard on you… but this comment goes out to the rest of the “special” people out there. Obey the law and be safe. Don’t kill me or my family because you believe yourself to be special.

Was I too harsh?

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Posted by Ckemtp on September 4, 2010 • Filed under: Emergency Nurse, EMS, EMS Health & Safety, EMS Topics

Shining through Suffering – Learning How to Cope with Sadness in EMS
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Medic Trommashear, who writes great stuff has offered to co-post with me on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

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This morning the wife came home from her night shift on the ambulance and told me a sad story. During the wee hours of the morning she handled a rather nasty fatality accident. The victim, a 20-something male was walking home from a party on a dark country road and tragically, a passing motorist didn’t see him in time and the accident ensured that he’d never make it. Pedestrian vs. car accidents at high speeds have a way of doing that.

Sad stories like this are getting more common for her as she’s immersed herself fully into paramedic school and professional EMS in general. She’s been seeing sad stuff multiple times per week it seems. I can see that it’s wearing on her and I feel her pain. I have experienced it quite a bit myself in my own career and I continue to do so on a regular basis. Jumping into full-time EMS exposes a person to sadness on a level that can’t easily be prepared for. A person just has to jump in with both feet and not be afraid to feel the range of emotions that they’re going to be exposed to. It’s hard, it’s tough, and it’s one of those things a person just has to learn how to overcome if they want to make EMS a part of their life.

That’s the part that most people don’t get, I think. The part where you have to “Learn How” to overcome the sadness and negative emotions we’re faced with as EMS people. A common statement that lay people make when they hear that I am a paramedic is “Oh, I could never do that job and see what you see. I just couldn’t handle it”. Perhaps they’re right, but I would guess that anyone can train themselves to handle almost anything. My pseudoscientific opinion is that we develop our tolerance and our healthy ways of dealing with being exposed to such negative emotions on a regular basis through experiencing it and learning ways to function and feel happy afterwards. It’s harder for some than others and I can’t imagine that there is a single roadmap for learning it. It’s individual. Friends help and so does an understanding family. Good coworkers are great to observe and learn from as long as they realize their own humanity and aren’t simply trying to fool themselves out of bravado. We’re all human and I can testify that we’re all affected, no matter how thick our skin may appear.

Back when I was a new medic I was working a ton of hours. I mean, I worked a lot. I worked TOO much. I worked for days on end without sleep for multiple jobs. At the time, I felt I had good reason. I was attempting college for the first time, taking care of my recently deceased father’s businesses, and trying to sock away money to help my mother. I worked a full-time EMS job, a full-time hospital job, ran the businesses, and volunteered for a separate fire department and EMS agency. It was nuts. I would literally go for days without sleep. During that time it seemed like I was getting slammed by horribly sad calls. I felt I was surrounded by suffering and death. I was working at least two codes a week on average. Mayhem and madness seemed to rule the day. I was getting deeper and deeper and…

I was going nuts.

I was horribly, deeply depressed.

I almost went insane.

I was at my darkest hour when I found myself angry at anything that was cute or fun. Literally things like jokes, teddy bears, and Hallmark cards made me angry. I just couldn’t see how people could stand to look at that kind of stuff when there was so much suffering in the world. How frivolous! What a waste of time! It made me angry to think of anything that didn’t acknowledge the pain I was bearing witness to on such a regular basis. I was depressed and angry. I just couldn’t understand anything other than feeling the pain that the people I was taking care of were feeling. It affected my life, my work, and my human interaction. It was horrible.

Then I had an epiphany that changed my personality and who I am to this day.

Those who meet me know that I like to joke around. A lot. There are things that I take seriously however I do not personally happen to be one of them. My epiphany was that the stuff that was cute, fun, loving, friendly, and/or happy was all that actually did matter in life. We combat the bad with the good, the yang with the yin. I chose to pay attention to the comedy of life and downplay the tragedy. After that revelation, my whole outlook on life and my personality changed for the better. I had found that comedy, friendship, and love were the ways to live my life. Come what may, I can make a joke about it and that makes it ok. I laugh at inappropriate times and seek out the good in life. My life and career ensure that I’ll still have an onslaught of human tragedy thrown at me whether I’m ready for it or not but If I can actively seek out the positive, I may just end up ahead of the game.

To my wife, I love you. Hopefully you don’t end up where I have been… but I’ll be here for you, come what may. I understand what you’re going through and I love you for this any many, many other reasons. Always.

————————————————-

You may want to read one of my most popular posts. It’s an older post of mine where I explore what I call “Splashed Sadness”. It’s along these lines. We EMS people have to deal with a lot. Never be afraid to share it. Don’t hold it in. Get it out and learn how you can cope with it because there’s not a one of us ain’t human.

“Splashed Sadness – A look at Negative Emotions in EMS”

Or “Reflections on an Easter Morning” – another post about a bad call.

Also, don’t forget to check out Medic Trommashear’s co-post on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

(Note: I’ll link to the post directly when it’s up)

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Posted by Ckemtp on August 30, 2010 • Filed under: bad calls, Emergency Medical Services, emotions, EMS, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, inside the mind of a paramedic, Line of Duty, Paramedic, psychology, sadness, Training & Development, Uncategorized

You Can Nap if You Want To! Or You can Leave Your Calls Behind!
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What a week! You’ve been pulling at least a double shift a week at your full-time ambulance job and have been hitting it pretty hard at your part-time job as well. Both services can’t seem to keep their schedules filled and everyone’s been working lots of hours in order to keep the doors going up and the trucks going out. To top it all off, the citizens just can’t seem to be good lately and both services’ call volumes have been high.

You were tired when you got up this morning and were seriously considering a nap after your morning shower, but after a gallon or two of coffee you were bright and shiny in your uniform at your station, ready for another day of EMS greatness.

That was five hours ago though, and the early barrage of calls fired at you this morning has turned into an afternoon lull. Now you’re sitting at your main station, close to the brass, with the words in the educational article you’re reading fading in and out of your bleary, cross-eyed vision. Since the activity level has decreased, you’ve gotten yourself a case of the sleepies that you just can’t shake. Since you’ve been consuming the steaming bean juice religiously lately, your stomach just won’t let you think of having another cup of the acrid station coffee and there’s no shift chores left to do, since you did them an hour ago fighting the same lethargy.

Unfortunately, in three hours you can see a long distance transfer scheduled that you’re probably going to have to do. Four hours of monotonous highway driving and the radio in the truck doesn’t have that great of reception. You don’t have any idea how you’re going to stay awake enough to drive the truck and that’s not even considering the fact that if the tones went off right now for an emergency you probably wouldn’t remember how to put on a band-aid, let alone remember a drug calculation.

You’re tired, you’re fatigued, and your body’s telling you that you’ve been pushing it too hard. It wants to shut down for a while. Your brain won’t think. You’re mouth won’t talk. You can’t keep your eyes open and wake up with a startle when you’ve realized you’ve dozed off for a bit. This is torture.

Sleep deprivation is no stranger to EMS people. We’ve all fought the lethargy caused by long 24, 48, and more-hour shifts. A great number of us work more than one job to make ends meet and pack as much family time and recreation into our off time as we can. A lot of us are going for more education and all of us get woken up from our sleep a lot more often than is healthy to run on calls. I regularly miss full nights of sleep and rarely have a night when I can say I got a full night’s sleep. We get use to it some of the way, but our bodies just aren’t meant for chronic sleep deprivation. We need to reset and reorder our brains and let our bodies recharge once in a while.

Unfortunately, our communities need us and we have to be there for them. EMS is important and it’s easy to get sucked in.

That’s why in this situation, I have very little dispute with taking a “Safety Nap”.

"SSSS-AAAA-FFFF-EEEE...."

The “Safety Nap” is a quick power nap. A shut-down and reset period where a person who never knows when they may be called to be up all night without sleep can rest and relax for a while and ensure that they’ll be wide awake and alert for whatever they may be called to do. I took an hour last shift around 3pm as a matter of fact. I didn’t get to sleep until 1am afterwards and I was up at 5am for a call. EMS is like that, shift work is like that. We have to ensure that we’re well-rested enough to make quality decisions of the type we have to when they need to be made… and we can’t do them well when we’re drooling on ourselves from exhaustion. One of Murphy’s laws for EMS states that “You know you’re in EMS when your favorite hallucinogen is sheer exhaustion” and I have to tell you, I’ve done that while on duty before. It’s just not safe.

There are problems with this, I know. Some will say that we shouldn’t allow ourselves to be scheduled this many hours and that it’s irresponsible to do so. Well, then they can come talk to my bosses and pay my mortgage. Some people will sleep all day if they let them, and won’t put any effort into their shifts unless they have to. That has to be monitored. With that said, a balance has to be sought. I see nothing wrong with the occasional safety nap and I believe that EMS managers should allow it. They also should be unafraid to throw a cup of cold water on the Rip Van Winkles among us to ensure that they pull their weight with the non-call-response aspects of an EMS job.

What do you think? Does your employer allow “Safety Naps”? Do you take them?

I’d write more but Zzzzzzzzzzzzzzzzzz

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Posted by Ckemtp on August 4, 2010 • Filed under: Administration & Leadership, Ambulance, ambulance humor, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, EMS Management, EMS safety, EMS Topics, EMT, Ethics, Fire Rescue Topics, Firefighter Safety & Health, Management, Paramedic, patient care, Patient Management, salary, shift length, Uncategorized

You Know You Work Rural EMS When… (#12234)
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Today I overheard an ambulance service somewhere out in the sticks get dispatched to a “Car Vs. Pedestrian” on a rural backroad. This particular backroad is known to be a real rural speedway, where cars just fly down the road far from any prying eyes of the local traffic cops. Any vehicle/pedestrian interface on this road would be sure to be a real messy call and the rural ambulance service that got dispatched to the call made a pretty good turn-out time.

About ten minutes after dispatch, the county dispatcher came back over the radio and cancelled the response. Apparently the “Car Vs. Pedestrian” wasn’t Vs. a human pedestrian… it was a Car Vs. Deer. Sure, the deer was probably walking at the time it was hit, but even with as rural as this ambulance service is, they don’t handle veterenary emergencies.

To her credit, the dispatcher made sure to inform the ambulance crew that the “Patient has left the scene”.

Now, you may think that the rural dispatcher was just being cheeky and funny when she informed them that the deer scampered away. However, then you wouldn’t be in rural EMS. The dispatcher, who probably has known every crew member since Sunday School did the crew a favor by letting them know that the deer wasn’t there. Us rural folk know that fresh deer meat out of season is a rare delicacy and that the first person to get there gets the carcas.

I’m not incinuating anything… just sayin.

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Posted by Ckemtp on June 25, 2010 • Filed under: EMS Health & Safety, EMS Topics

EMS Week – Introducing EMS to the Public. Spread the word
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This is another in my series of posts that you may send as a letter to the editor of your local newspaper and/or put in for publication on your site to use my words to help spread the message of EMS week. You may use this freely, but please keep it intact.

————————————————

Barely given a passing thought until the unthinkable happens, the emergency medical services (EMS) are always there, toiling in relative obscurity until the flashing lights and wailing sirens of an ambulance remind you that there are indeed paramedics out there waiting for your call. People don’t tend to think of the ambulance service that cares for them and their loved ones as an essential service. They also rarely think much about them when they aren’t in need of their care. Usually then it’s only to wonder “What is taking them so long!?” instead of wondering if they’re currently bogged down with a lack of resources due to funding constraints and/or abuse of the emergency healthcare system.

Ambulances are a part of every community in one form or another and the US certainly has one of the best EMS systems the world has ever seen. Highly trained paramedics and Emergency Medical Technicians (EMTs) have progressed far past what the public perception of them tends to be and instead of being there only to provide a quick lights-and-sirens rush to the hospital, today’s ambulance is a ‘Mobile Intensive Care Unit’ that can roughly provide care equivalent to the first hour or so of care in the Emergency Room. The focus has long shifted from bringing the patient to care and now focuses on bringing care to the patient. While there are a few conditions that warrant immediate evaluation and treatment by a physician there are many more that benefit from immediate stabilization in the field provided by a paramedic or EMT. In fact, the care provided in the first few minutes of symptom onset by a paramedic can make the difference between a ‘bump-in-the-road’ for your health and long-term morbidity and lasting ill effects.

Think of a paramedic as Emergency Healthcare Specialists focused on the Acute, or care of the “Here and Now”. If it’s happening to you and it’s going to harm or even kill you, chances are that a paramedic can step in and make a big difference in the progression of the disease process. They may not be able to cure you, but they can make a good deal of difference in terms of stabilization and in limiting the long-term harm that you suffer.

Even in the United States, and perhaps especially here in the US, there is variability in the level of care and service provided by ambulance services. Each state has their own individual licensing requirements and the level of authority on those licenses varies greatly due to local control within those states. All paramedics and EMTs function under the ultimate authority of a Licensed Physician to provide “Medical Control” and a system of standing medical orders or “protocols” that the paramedics and EMTs use their medical judgment to pick and choose from based upon their working field diagnosis of a patient’s condition. In my home state of Illinois, the medical direction has provided what some EMS personnel would consider to be conservative protocols while just across the state line in Wisconsin the protocols allow much more breadth in the abilities of the paramedic and EMT to care for the patient. These differences can be caused by myriad factors ranging from the personal prerogative of the medical control physician, to local political pressures, and even to distance to a hospital emergency room. The way that a service is configured also plays a roll, with some private ambulance services having experience in “Critical Care” paramedicine, and some Fire Department based providers focusing on short transport times. Within the industry, there is much debate on the topic of what organizational configuration, Fire-Based, Hospital-Based, Private-for-profit, Private-Not-For-Profit, Governmental Third Service, or otherwise provides for the best operational effectiveness and therefore the best patient care. While the opinions have run very high, it is clear that no one solution will work for every community. The public does need to be aware that EMS is not simply a function of “The Fire Department” or “the hospital” or of anything other than EMS itself existing to provide optimal patient care. The terms “Firefighter” and “Paramedic” are no more synonymous than are “Garbageman” and “Librarian”. The importance is that Paramedics and EMTs focus on healthcare and providing the best quality EMS. However some communities have chosen to combine the functions for a perceived cost savings. You should explore the issue in your own community to see what best works.

And that’s the important part.

EMS is in desperate need of public involvement. We are in desperate need of the public giving us more than a passing thought and actively taking an interest in how EMS is able to care for them and in their own healthcare. For too long, EMS and the Profession of Paramedicine have gone unnoticed. We’ve been suffering from public apathy as acutely as our patients suffer from heart attacks and strokes. Now perhaps more than ever, we need you to help us. We have to raise public awareness and work with our communities to provide the best possible service and the best possible patient outcomes.

Within the industry, there have emerged a few powerful ideas that could have far reaching impact not only upon EMS, but upon the entire healthcare system. Loosely entitled “EMS 2.0”, the ideas have come forth from street-level paramedics and EMTs and represent a “reboot” of the entire spectrum of how we do our work. Imagine if a few regulatory and educational changes could save billions in overall healthcare costs. Imagine if paramedics could improve access to primary healthcare for millions of underserved citizens catching and screening out serious disease before they even result in an acute emergency. It would be game changing, and it has a very real possibility of happening if the public would pay attention to us. It’s your future we’re trying to improve. It’s your health that motivates us to get out of bed at all hours to care for you. By your taking an interest in what we have to say, you could improve the health of your community many times over.

Here’s what you can do. First off, speak with your local EMS provider to see what their immediate needs are. In many communities, EMS is understaffed and underfunded. When was the last time you saw your community’s public works or police departments holding a bake sale to raise operational funds or to buy a new bulldozer or ammunition? Fire departments and EMS agencies do it all the time. Learn about how EMS is provided in surrounding communities and in communities of like size in your state and region. Talk with your healthcare providers and community leaders to ensure that their commitments to EMS reflect the lifesaving importance of EMS care. Local politics kill quality in EMS, communities need to tell their politicians to stop petty squabbles and focus on what is truly important. Learn the issues and listen to the people out on the street providing care.

Another good resource for the public to learn about EMS is to look at industry-specific information provided in the trade journals, online sites, and the EMS blogosphere. Whatever the local flavor of EMS that has developed in your community may be, there may be a better option out there. In fact, there probably is a better way and community members need to demand these better ways from their local EMS service or find, expose, and change local political factors that keep new and more efficient operations away from their local service. Medicine changes, so do best practices, and the public needs to demand the best from their EMS providers. Learn what the best truly is. In discussions with local politicos, scare tactics tend to run the argument. Educate yourself on the issues so that you can make the best possible decisions for your EMS providers and for your community.

For more information:

Http://www.JEMS.com – The Journal of Emergency Medical Services

Http://www.EMSresponder.com – EMS Magazine

Http://www.LifeUnderTheLights.com – The Author of this articles industry-specific EMS blog

Http://www.ChroniclesOfEMS.com – A new television show and videocast being produced by street Paramedics trying to explore EMS in an entertaining and informative way. This could be considered the “Face of EMS 2.0”

———————————————————————–

The author, Chris Kaiser, is a nationally registered Emergency Medical Technician-Paramedic licensed in multiple states. He has been providing EMS for over a decade and is a writer and speaker on EMS issues. More from Chris can be found at Http://www.LifeUnderTheLights.com

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Posted by Ckemtp on May 15, 2010 • Filed under: Ambulance, ckemtp, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS Topics, EMS week, ems week 2010, Paramedic

To Kneel or not to Kneel
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“Muungh… What the heck was that!?” I thought to myself as I looked around the darkened room. “Where am I? Why am I awake? What IS that awful noise?” I thought. Something had awoken me from a not-so-good sleep on a not-so-comfy sofa. Slowly, I realized where I was. “I must have fallen asleep in the day room at the station” I thought. “Why am I awake?”. I heard commotion outside and realized that it must have been the radio that woke me up. Somewhere in the dark subconscious recesses of my brain it came to me that the pager said “Person not breathing, CPR in progress”. I pulled on my shoes and thought the most important thought that any EMS provider can have when being jolted from a deep sleep at 0′ dark 30 to try and wake the dead: “I have to pee!”

Once the bathroom duty was completed I slid into the passenger seat of the ambulance and pulled up the address on the map program. My partner pointed the ambulance South while I clicked on the siren. Wailing into the night we went, lights flashing, adrenaline pumping, morning breath so bad I could slay a walrus. “Where did I put that mouthwash?” was my thought. So focused on the job were we.

Arriving at the address just behind the engine company from the first due station we hurried to gather up our gear for the battle ahead. Monitor? Check. Airway and drug bags? Check and Check. Backboard? Check that too. We hurry up to the front door and are met by a middle aged female saying “I couldn’t wake him up! He was fine when we went to bed!” We enter the bedroom and I see the middle aged male on the bed. His lifeless eyes were fixed and unseeing as we approached him. His mottled skin was cool to the touch. Long gone was any fighting chance at life. I knelt on the bed next to his torso to check a pulse and apply pads to get a strip and immediately know what is going to happen next.

“I’m freakin going to have freakin dead guy pee on my freakin knees for the rest of the freakin shift! Dang it! Dang it! Dang it!”

EMS people kneel a lot, and not just when we want a raise or need to get state-to-state reciprocity from an EMS office. At one of the departments I work at we did a big action photo spread of all of the EMTs and Medics in action. EVERY SHOT was me kneeling. Kneeling at a patient’s head working on the airway, kneeling at the patient’s chest starting an IV, kneeling next to a patient to assess them after an injury, I kneel so much that you’d think I have a promotion by now. We all do.

But you’d think that by now I’d know enough not to kneel in poo, pee, blood, vomit, or whatever vile substance is on the bed, floor, or surface that I have to kneel on. I mean come on. I’ve been doing this over a decade now. I have thousands of calls under my belt. I live, sleep, eat, breathe, blog, and study EMS as much as I can stand to (and that’s a lot) and I *still* am stupid enough to put my knees in poo on a somewhat regular basis?

Right now, I’m on the 2^nd day of a 48hr shift a half hour away from my home. Last night, around late evening I knelt in a poo/pee mixture. I was really trying not to here, but the patient began to vomit after we got (the Pt) on the backboard in the cramped, carpeted bathroom (the Pt) was in. I couldn’t log roll (the Pt) without kneeling and the carpet was just saturated with a vile mixture of hours old poo/pee. My knees got soaked in it. And no, if you are asking, I ran out of the house late and didn’t think to bring an extra pair of pants and the pants that I had kept at the station had been taken home for laundering after another like incident.

For times like these, I recommend the “Ckemtp” method of knee disinfection. It applies for those times where call volumes don’t allow you to actually take your pants off to clean them:

Put on gloves. No sense in contaminating your hands. Chances are your knees won’t have broken skin on them unless you’ve been trying to get that promotion (Enough with the “on your knees” jokes! – This is serious!)

Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.

Spray the ever-loving bejeebus out of your pants, saturating your knees with disinfectant spray. DO NOT use bleach-based spray. The milder the better. (see “Clean EMS” for advice on contact times)

Press another towel on the outside of your pants, soaking up as much poo/pee laced disinfectant into the towels as you can. Rub them together a bit.

Re spray with disinfectant and let it air dry.

Remove the towels from your pants.

Call your wife and beg her to drive you up a new pair. Beg. Hard.

Just for the record, my lovely wife was unable to drive me up some new pants. Awesome…..

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Posted by Ckemtp on May 5, 2010 • Filed under: Ambulance, ambulance humor, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, ems pants, EMS rant, EMS Topics, ems uniforms, EMT, Fire department, Fire Rescue Topics, Firefighter Safety & Health, In the Line of Duty, infection control, inside the mind of a paramedic, kneeling, Paramedic, paramedic education, paramedic pants, Patient Management, puke

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Interestingly, I'm really a real person. I am an active Paramedic and I'm out there on the truck every day just like you are. I'm almost always on Twitter, usually on Facebook, and I sincerly love talking back to anyone who cares to connect. Use the buttons below to find me out there on the interwebs. I would love to hear what you have to say! - -

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Archives for ems-health-safety

April is Autism Awareness Month: Now Let’s Go Farther

Ambulance Roll-Over in Milwaukee – To my friends at MedaCare

EMS Fights the Flu – The 2013 influenza epidemic

Rockford REACT Crew Memorial Fund

Dirty Wet Wipes, Millions of Dollars, and the Coming Changes to EMS

EMS Providers Carrying Guns – A terrible idea

FIrefighter Pre-Hydration – Fight Fire like a Marathon Runner

5 tips for beating the summer heat – An EMS and Medical Stock PSA

Heat Emergencies for EMS – The Summer Time Blues

GPS in the Ambulance – An overreliance on Ms. Kitty

“Teamwork” on the ‘bambilance – Shown as a video metaphor

Get a Pulse, Get a Steak? Random Incentive

A Medic Roast in Tennessee

Death Rate to Increase in London – and – The Medicare Tomato

Keeping an Eye on the Sky

Wake Up! You may have a call…

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

I am not immune

A Weighted Issue – The Fire Service Helping Private EMS

Speeding to the hospital! or.. Nurses: Above the Law

Shining through Suffering – Learning How to Cope with Sadness in EMS

You Can Nap if You Want To! Or You can Leave Your Calls Behind!

You Know You Work Rural EMS When… (#12234)

EMS Week – Introducing EMS to the Public. Spread the word

To Kneel or not to Kneel

Connect with Ckemtp and LUTL

Get your Daily Life, Under the Lights

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Featured from across Fire/EMS

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