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Modern (f)Art

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Howdy Everyone!! It’s Ckemtp, your friendly neighborhood EMS and Fire blogger with a few things I’d like to bring to your attention. I’d like to talk to you today about politicians. Not the politicians that are doing such a great job at managing our collective money on the national level… I want to talk to you today about the local ones, the ones who do the important work of making sure our traffic lights aren’t burnt out, that our roads are pot-hole free, and that our sewer systems don’t back up and discharge raw sewage into lakes and rivers and stuff.

Specifically, I’d like to talk about Local Politicians and public art.

My favorite writer, the legendary Humorist Mr. Dave Barry, wrote a piece about public art a few years back that you just have to read before continuing on with this post. It’s actually one of many of his articles that include things about public art, which he defines as “Art that is purchased by experts who are not spending their own personal money” it also involves the phrase “a naked man the size of an oil derrick” and has references to nuclear weapons and alcohol. I love Dave Barry, I really do.

Read this: “Does Public Art Make Sense” – Then come back once you stop ROFL’ing 

This is "Art" I think... Oh I know! It's a bus stop

Then, g’head and read THIS ARTICLE from Michigan Capitol Confidential which talks about the REALLY SMART city of Ann Arbor, Michigan… which is planning an $850,000 piece of public art. It’s really interesting to me that they’re planning this… and I really hope it isn’t made of flammable material because the city is “Facing a multimillion dollar budget deficit” and is planning on laying off firefighters to handle the budget crisis.

Here’s that article again: http://www.michigancapitolconfidential.com/13219

Yes, Ann Arbor, MI, the REALLY SMART city that it is, is laying off firefighters while spending $850,000 (That’s EIGHT HUNDRED FIFTY THOUSAND DOLLARS) on a “three piece public fountain”.

Oh, right… if it’s a fountain, it probably won’t burn down. That makes sense. Of course it might get filled with trash, since they’re laying off the city’s “Solid Waste Coordinator”. Y’know… the guy who oversees the trash pickup for the city. On the other hand though, they are hiring an “Art Coordinator” to, I don’t know… look at the art maybe? Maybe he’ll pick up the trash from the fountain.

Taxpayers, I’m talking to you here. Inefficiencies and, in this case, abject stupidity in local governments are killing us. If I was having trouble keeping up with the maintenance and mortgage in my own house, the first thing that I would do would not be to buy new paintings to hang on the walls. I certainly wouldn’t buy paintings at the expense of paying for trash pick-up, sewer service, or portable fire extinguishers. I think that I would pay for necessities first and niceties second. Responsible people take care of the whole Maslow’s Hierarchy of Needs thing; Food, clothing, and Shelter first and buy pretty things after that. You do the things you HAVE to do well before the things you’d like to do.

At least responsible, SMART people do that… and apparently that’s not the kind of people that the voters in Ann Arbor, MI think would make good city council members.

Or do they?

Maybe they can call this "Art"

Posted by Ckemtp on July 27, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Topics, Emergency Medical Services, Fire Rescue Topics, Fire department, Funding & Staffing, News, Uncategorized, dave barry, politics

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 2nd 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:

  1. 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!)
  2. Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
  3. 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)
  4. 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.
  5. Re spray with disinfectant and let it air dry.
  6. Remove the towels from your pants.
  7. 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…..

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

Grumblemedics

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Grumblemedics, you know them. You’ve seen them. Heck, you may even be one. Whether they’re a Grumble Pee or a Grumble Bee, there’s an apparent glut of them in the profession and I’d like to know why. See, to me, EMS is the greatest job in the world. Sure, there’s the great pay and benefits, but there’s also the great hours, plentiful time off, and comfortable ergonomic working environment. I can’t tell you how many times I’ve been just left with a warm-fuzzy feeling after a shift…

Ok, so that could have been an exaggeration, I know that there are things in this profession that just plain ol’ stink. But I gotta tell you, EMS really is my favorite job. I really can’t imagine doing anything else. While there are times in my career that I’ve wondered if it was an abusive, co-dependent type of relationship, I realize that I would not want to be anything other than a paramedic.

So why does it seem like there are so many Grumblemedics? Could it be the long hours with little chance of getting a day off? Could it be the fact that we must get up at all hours of the night to take care of someone in better shape than we are? Tangent: The other day another crew transported a person with a chief complaint of “Dry Feet”. When they asked him if he really wanted transported, he said “Yeah! I got dry feet!” Or, the one last night where a woman had an NSAID pain patch fall off at 4am and called us because she thought that she was going into withdrawal. End Tangent.

OK, heck with the ending the tangents. There are a whole heck of a lot of calls that can be filed under “They called us for THAT!?” Why do people do this? Why? I mean, I’ve been called for things that I wouldn’t even take an aspirin for more times in my career that I can count (And I know that’s more than ten because I have ten fingers and if you think that I’m going to take off my boots after working in them for all of these 24 hour shifts you’re nuts). Why do people call us when they have a muscle cramp? Why did the guy call me when he got a fish hook in his finger? Why do people who happen to be type 1 diabetics drink themselves into a stupor and then call me first thing in the morning to wake them up? Seriously, I once spent a few months going to some guy’s house every shift bright and early in the morning to squirt him with a little D50 and he’d sign the refusal that would send him on his way. It ended when we began putting him on the cot and starting to drive to the ER before we sugared him up. He’d wake up in the rig just as we were backing into the bay doors and be mad at US for transporting him. Sorry guy, but you obviously need more help than we can give you.

So, there may be times in my career that I’ve been a Grumble Pee, but that might be expected. Heck, if I worked in a factory I’d probably be complaining about the lack of adequate ventilation and the fact that I couldn’t sit in the crew lounge and watch TV for a few hours of my shift. We all complain about things we can’t change or our own perceptions of injustice. I would guess that any profession has those things that the people in the profession just hate. Heck, would any of us want to work retail during the holidays? They don’t even get to jab strangers with sharp objects or have their own keys to the leather restraints.. Now THAT would suck.

You know what my absolute, all-time, worst pet-peeve is in EMS? No? I’ll bet you don’t care either but this is my rant and you can’t seem to stop me. My biggest, all-time, worst pet-peeve in EMS is: People who don’t call us when they need us. Yep, I would gladly take a hundred 3am “lost condom” calls rather than have one potential patient have that occult MI and lose any percentage more of heart muscle than they have to because they didn’t want to call EMS and bother us. You see, I work in rural EMS these days where people are nice, and they don’t want to bother their local EMS service with getting up out of their chairs, and they don’t want to bother their neighbors with having to look out their windows at the pretty flashing lights, and they really don’t think that the fact that the left side of their body is numb is any reason to be alarmed. These non-calls that should have been calls bother me more than any of them, and we all grumblemedics are somewhat on the hook here.

If you’ve read any of what I’ve written, you’ve probably seen my statement that “PR Saves Lives”. It means that the more positive Public Relations an ambulance agency has, the more people trust them, and the more people are apt to call them when they truly need them. I haven’t seen studies on what an effective PR program does in reducing so-called “nuisance calls”, but I have seen recent studies that say like 60% of patients having heart attacks make their first call to a friend or family member upon the onset of their crushing chest pain. I’m here to tell ya, I’m jealous. I want to get that call.

So maybe grumblemedics like I probably will be about an hour from now when someone calls me at 3am for something that I would take pepto-bismol for need to remember that we are blessed to do this job, and that EMS professionals need to approach this business with the heart of a servant. Because that’s what we are. We aren’t here for our health, we’re here for everyone’s health. Sometimes people get scared and call us because they’re scared and it is our job to make them feel better by telling them they don’t have to be scared anymore. Sometimes we need to haul them in so someone with a whole-heckovalotta medical education can tell them that same thing. I decided a long time ago that if I ever got to a point in my life where I had to call the ambulance just so I could get some human contact because my real chief complaint was loneliness that I didn’t need some punk kid with a pulse and a medic card judging me.

Us grumblemedics need to realize that the nuisance calls are never going to go away. We’ve got to realize that there are, however, ways to combat them:

  • Check your Ego at the Door: You serve the public. Not the other way around. You are blessed and dang lucky to be the person that this person asked to take care of them in their or their loved one’s hour of perceived need and you best not forget it, because your mental health is at stake, and their life could be too. The best EMS people approach this job with a servant’s heart.
  • Evangelize EMS: You want the general public to know how to properly use EMS, right? Then what have you personally done to help teach them. Get out there and get the word out. Don’t hide in your station, or in the parking lot you’re posting in. Get the message out about what you’re there for, what you’re capable of, and how friendly you are while you are doing it.
  • Everything is PR: Every single, solitary thing an EMS person does affects the publics’ perception of them, their service, and the profession in general. Really. When you meet up with another crew for breakfast in the morning and talk about how wasted you got last night at the bar don’t think that the people around you aren’t listening. When you swear in public don’t think that the kids who are looking up to you in your shiny uniforms with your neat big truck aren’t filing that away. Take your public image seriously. Exude professionalism at all times because it saves lives. The more comfortable everyone is with your professionalism affects how apt they are to call you first, call you fast, or call you at all in a life or death situation. That can make all the difference for a lot of potential patients.

There’s a lot more that every one of us can do, but I’m tired here and I still have the last 8 of my 24 to do be
fore I have to get up in the morning and do 8 hours with my other full-time job and then do a 4 hour training with my volunteer department. Hey! I have an idea!! Maybe if there weren’t so many grumblemedics and the public took a more positive view of our value to society we could maybe squeeze some more pennies out of them at budget time and get paid better so we wouldn’t have to have so many freakin jobs and work so many hours to feed our families! Yea, wouldn’t that be great!!

As always folks, comments and flames are welcome. Public commentary is most appreciated, but I may always be reached privately at: proems1@yahoo.com

Posted by Ckemtp on April 8, 2010 • Filed under: Ambulance, EMS, EMS Health & Safety, EMS Topics, EMS ethics, EMS rant, EMT, Fire department, Firefighter, PR, Paramedic, Public relations, first responder, friendly, grumblemedics

The Shine Factor

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 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

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You know what I’m talking about here. The distinctly subtle, but powerful mix of sights, smells, and sensory input you find when walking into the apparatus bay of your station. The faint smell of diesel exhaust mixing with rubber tires, the musty smell of damp hose drying on the rack, the smells of not-so-clean turnout gear (best right after a good fire), and all of the various cleaning products used to keep the trucks looking their best. My favorite is when I’m just walking in the station for start-of-shift. It’s about 6am and the guys before haven’t gotten up yet to turn on the lights in the bay or make noise. One of my favorite things to do is to walk around the bay with the lights off, with the sun just starting to glint in from the windows onto the dark floors. It’s quiet. I love the first sunlight making deep reflections off of the shiny paint and gleaming chrome. The trucks just seem to be anticipating the day, yearning for the next call to come in. The atmosphere is electric, and quite palpable. You could blindfold me and take me into any fire station in the country and I could identify it just by smell alone. It’s intoxicating. I think that I like it more than my fiance’s perfume. It’s ok, she’s a firefighter too. She gets it.

So, what I’m about to suggest here plays off of that knowledge that we’ve all got… It’s basically an EKG hooked right up to the morale of your organization. I call it the “Shine Factor”.

Fancy name, huh? Yea, I liked it too. I’d recommend that every person who works in any fire station or ambulance base walks into the apparatus bay every time they start their shift. Don’t go in through any other door. Walk right into the apparatus bay with the memory of the favorite time you’ve ever been there. Take a big whiff of the natural aroma and look to see how much your trucks shine. Check the corners for cobwebs too. Then, simply file the information away in your brain and know exactly how the morale of the troops is doing.

Why is this so simple, yet so powerful, and a lot of the time, so unnoticeable? It’s because every organization has grunts, and the grunts carry out the day-to-day operations of your organization. No matter how many policies are written, budgets are adhered to, or strategic plans are championed by administration, the grunts are out there actually performing the duties that make your organization do what it does. If your department is like every department in the country, the grunts have more tasks than just providing service to the public; they’re responsible for cleaning, maintenance, and upkeep of your equipment. The lower and more “gruntish” they are within the organization, the more responsible for the upkeep they are. This is where the Shine Factor comes into play. Every group has assigned or assumed maintenance and cleaning tasks. Administration can formalize it with all of the written plans, paperwork, and task sheets that they want to, but all those pieces of paper ever do is ensure that the tasks are done to the minimally acceptable level. They cannot and will not make the grunts put in the elbow grease required to get that extra shine out of the equipment. My theory is that only happiness and pride in the organization entice the grunts to go above and beyond, to put the extra few swipes with the rag onto the chrome to really bring the shine out. Think about it, when you complete a task and get it looking good enough to pass muster, you could stop… but if you really have the pride and desire to make the equipment look it’s best, you’re going to go get the magic cleaner in the storeroom and clean out the crust around the lug nuts to make it look perfect, to reflect the personal pride you have in the organization and your fellow grunts.

Do you think that the grunts will spend those extra few seconds, minutes (or in my case, hours.. but I’m obsessive) to make that floor it’s cleanest, or that chrome it’s shiniest if they’re ticked off about management’s latest asinine policy or off the cuff directive? I don’t. It’s human nature. It works on a subconscious level across all of the grunts you have who polish your stuff. If the morale of your department is in the tank, your stuff may be cleaned regularly because the grunts will be sanctioned if they don’t clean off the first layer of crud… but that’s usually where it stops. When morale goes down, the shine factor goes down. When morale goes up and people are uplifted, pride goes up and the grunts put forth the extra effort. It affects more than their performance at the station too, it affects how polite they are to the public, how clean and pressed their uniforms and presentation are reflecting your public image, it affects how much personal effort they put into training, and it may very well affect patient and emergency scene outcomes too. You can regulate all that you want, but the beatings never improve morale. The only things that can do that is respecting your grunts and treating them like adults.

I haven’t formally named it, but I think that new officers and/or managers in the EMS and Fire industry who were promoted from the troops arrive to their new posts with a predetermined agenda. I don’t think that they can help it. Usually, it’s from the mistakes they’ve seen their coworkers make on the streets around them and builds especially upon their own pet peeves. They arrive to their managerial desk wanting to “fix” things and usually the result is a lot of new policy objectives and memos. They know who, at least subconsciously, they want to get back at for the aggravation that they’ve caused them over the years and think that the rest of the organization will share their personal pet peeve. Unfortunately, these attempts to “fix” things usually do just the opposite. The new managers with their personal objectives take things to the extreme. They fail to respect that the people who committed the offenses against the manager’s pet peeves are concerned adults that may have very different pet peeves, and they fail to recognize that every single employee’s pet peeve is micromanagement.

To some managers, paper seems to solve everything. If your ambulance turn-around times are too long in your opinion, you create a paper system to fix it complete with a memo and/or a new policy. The crews fill it out, and it’s supposed to make the management and crews aware of the time it takes them and it’s supposed to fix the problem. Got dirty floors in the trucks? Make a “clean floor” policy with a tracking sheet. Got a crew who uses too much gauze? Make a “Gauze Utilization” flowchart with a tracking sheet. Does your station go through too much toilet paper? You see what I mean. While all management wants to create measurable objectives, all employees hate being micromanaged.

Shortly after I got my first management position my boss, the COO, related to me a story about what he did one day when he found a truck that had been left absolutely filthy by a crew after their shift. Apparently this crew hadn’t been running more than usual that day, and had just left the ambulance filthy. Now, what he could have done, being the COO and all, is write an edict to be handed down through the chain-of-command to have the crew reprimanded from on high about the clean truck policy and the proper utilization of cleaning materials. He could have written a memorandum, or even a shiny new “Clean Truck” policy to enforce the rules. There could have been reams of paper and managerial-type fire power brought down on these guys. But that’s not what he did.

When the crew who had left the truck that dirty came back in for their day shift the next morning the COO met them at the door and lead them to their ambulance. At their ambulance they found a whole host of cleaning supplies… and two chairs. The COO then proceeded to have the medics sit in the chairs while he cleaned their entire ambulance, inside and out, from top to bottom.

Unorthodox? Sure.. Effective? Yes. The problem had been attended to, the desire for a clean
truck was reinforced, and the crews saw just how badly the COO wanted the trucks to be cleaned. Now maybe that’s not something that would work at your department, but it sure seemed to at this ambulance service. Maybe your shine factor would be increased if the grunts got the chance to work with the brass on solving problems like this. Maybe myriad policies aren’t the answer, and teamwork and mutual respect are the answer. Maybe communication increases it. Maybe the full realization by everyone within the organization that everyone has their roles and everyone has to be given the tools to take responsibility for what they own increases it.

Until now, this piece has focused on management, but us grunts can benefit from increased shine factor as well. Right now, you need to decide that you’re going to put in the effort to increase the shine factor in your department. Remember, it’s a subconscious thing. Everyone just feels better when it looks like people are taking pride in the department. Everyone from your partner, the guys, the brass, the public… even you. If the grunts make the effort, it can benefit the shine factor too and maybe the other stuff will come along with it. Positive attitudes breed positive results. It sounds corny, but someone’s gotta make the decision to be the positive change in the organization. Even in a perfect situation, if there even is one, someone’s gotta keep making the decision to keep it that way. Let that be you and others will follow suit.

Now get out there and polish some chrome.

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 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

Posted by Ckemtp on February 28, 2010 • Filed under: Administration & Leadership, Ambulance, Ambulance maintenance, Command & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Motivation, EMS Topics, EMS pep talk, EMT, Emergency Medical Services, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, Management, PR, Paramedic, Public relations, ems 2.0, pride, profession, professionalism

Splashed Sadness – A look at negative emotions in EMS

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WARNING TO NON-EMS PEOPLE: This post is pretty emotional. If you’re not emotionally equipped to handle really sad descriptions of EMS calls, don’t read it.

Here’s a revelation: EMS People are better suited to handling sadness than are laypeople. Of course we are. Not because we are necessarily any emotionally stronger than anyone else but because we have experience in dealing with it. As anyone could see, a good number of the situations we respond to and either assist with or observe are really sad. In my decade or so of riding the ambulances I have come across more situations than I could possibly remember that I wouldn’t want to casually discuss outside of the industry for fear of really making laypeople very uncomfortable. A story that might turn into a running joke among your colleagues might just depress a layperson for weeks.

Like all medics, I have my coping mechanisms and some of them are healthier than the others, they include sarcasm, dark humor, clean humor, Tanqueray martinis dirty and dry up with three olives, blogging, fishing, picking on my soon-to-be wife (9 days till the nuptials as of today!), playing with my boy, fishing, MGD, cigars, and sarcasm. There are a few other things in there too, I’m a rich tapestry.

This blog gets read by mostly EMS people, but there are public people out there that read me too. For both of your benefit, I’m going to relate some stories here of calls that I’ve personally attended to over the years:

  • A 16yo male takes his 24yo soon-to-be brother in law out into the city for the 24yo’s bachelor party. On the way home, they’re both just obliterated after drinking all night. The 16yo boy is driving home and is going way too fast to notice the semi hauling gravel that pulls into the right hand lane of the 4-lane road they’re driving on. The kid notices it at the last second, swerving just in time to impact the passenger side of the car against the back of the semi trailer. The impact shears off the left side of the 24yo’s skull, popping out the left side of his brain and leaving it, mostly intact, in between the front seats of the car (I almost put my knee into it). The 24yo dies a not-so-immediate death (I don’t want to get into it. Hopefully it was mostly painless). I pronounced the 24yo dead and took care of this very intoxicated 16yo. He was barely able to comprehend the terror of the situation and was covered in blood and brains that formerly belonged to the man his sister was going to marry. He was unhurt but I ran him into the hospital anyway. How could I leave him there immersed in the terror of that scene, in the terror of what he was more or less responsible for?

     

  • A 19yo male comes home from the military and his friends throw him a house party. During the party the 19yo takes his 18yo male friend down to the basement of the house to show the friend a new pistol that the 19yo brought home with him. The friend takes the gun to look at it and playfully twirls it around his finger ‘Old West’ style in an attempt to be cool. When he does, the gun fires, shooting the friend from the chin through the top of the skull. When I got to him, he was still breathing and had a strong pulse however it was mostly his brain stem that was controlling the reflex. Most of his brain was splattered on the basement floor. We worked him, transported him to the trauma center, and I believe that they were able to harvest his organs.

     

  • A man and his wife of upwards of twenty years are just bumming around the house on a nondescript weekday. It’s about lunch time and they’re going to eat at home before they go to the wife’s doctor appointment. The wife gets up to make sandwiches, gets to the counter, and slumps to the floor. She never woke up. We worked her very hard, but her heart had just decided that it had reached its allotted number of lifetime beats.

The above short summaries of calls that I’ve been to are sad. There’s no joke that can make them not sad. If you read this, there are two reactions I expect from you here:

  • For non-medical people: You’ve related these stories to yourself. You may be crying. You’ll think about them and your heart will go out to the unfortunate people involved. You’re sad.

     

  • For EMS People: Don’t these sound like good calls? They were. Yep, they were sad and I felt very bad for the people that were involved. Good calls though. What’s for lunch?

I think I remember what I did after the above three calls. I think that it was profound although my memory is pretty foggy after all these years. After the first one, I cleaned up the truck and actually got to sleep the rest of the night. After the second I cleared and went to a few more calls and then had lunch. After the third I um, had lunch because it was lunch time.

EMS people can probably know what I’m talking about here. I call it “The Howl”. It’s the sound that a family member makes after you’ve transported their close loved one to the hospital where the patient is pronounced dead by the ER Doc before the family gets there. So there you are, cleaning your equipment while the ER staff makes the sad announcement to the family. Here comes The Howl of anguish that the family member makes when they hear the news. I’ve heard it time after time in hospital after hospital. It’s loud. It’s haunting. It haunts my dreams some nights. I say that The Howl is an example of direct sadness. Direct Sadness is the pain/sorrow/anguish/horror that a person feels when they are a primary person in the situation. In my position of hearing The Howl after working the patient and unsuccessfully trying to save their life I experience Indirect Sadness. For the coworkers that I tell the story to and the readers of this blog, “Splashed Sadness” is the term I use. I think that “Splashes Sadness” is what a person experiences when hearing a terribly sad story like that.

In this business, Splashed Sadness is everywhere. It is one of the hallmarks of professional EMS. Think about it like this, I will always remember a conversation that happened between a group of coworkers and me one nondescript morning some time ago. They told the story of a college age male that overdosed on illegal drugs, stopped breathing, and was resuscitated from asystole (flat-line) by the paramedic that was telling the story. He mentioned that the fiancé of the patient was in the ER with the most-probably brain-dead patient and was holding the patient’s hand and telling anyone that happened by that they were supposed to get married that weekend. He said that she just kept repeating “We’re getting married this weekend” over and over again.

The sadness contained in that story splashed on to me and I’ve remembered it to this day. It will probably be there tomorrow too…

I responded by asking if they recommended that she cancel the caterer. Then there were fart jokes and wrestling (It was an all male crew that day). That’s how I dealt with the splashed sadness. I try not to get any of it on me and I try to psychologically squeegee any of it that I do get on me off as quickly as possible by interjecting humor and sarcasm into the situation. Extreme humor to deal with extreme sadness.

EMS people gain experience in dealing with negative emotions and sadness through all of these routes, direct, indirect, and splashed. While I have dealt with Direct sadness in cases of the deaths of close loved ones including my father, I don’t want to deal with any more. I get indirect sadness a lot of the days that I show up for work, and splashed sadness happens every dang time I talk to a coworker or discuss a bad call with a peer. I’m splashing sadness on you all right now as you read the above stories. If you’re an EMS person, you can deal with the splashing. If you’re a layperson, I’m very sorry for doing that to you but I did warn you before you started reading. My theory is that the more experience you
get with sadness, the better equipped you are to deal with it.

Or you go nuts.

Or you go nuts and start blogging and drinking martinis like I did.

Maybe I’ll get credit in a psychology journal for coining “Splashed Sadness” in EMS.

 

Posted by Ckemtp on February 16, 2010 • Filed under: Ambulance, CISD, EMS, EMS Health & Safety, EMS Topics, EMS ethics, EMS pep talk, EMT, Emergency Medical Services, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, In the Line of Duty, Paramedic, bad calls, emotions, inside the mind of a paramedic, paramedic education, psychology, sadness, safety

EMS practice

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Did anyone else play a sport (or sports) in high school? I did, actually I played football for a few years. I was on the line, which in my small high school meant that I played every position on the line, both offense and defense, because there just weren’t that many kids out there to play. My graduating class was 83 in my small, small town.

I didn’t touch the ball though. Coach told me just to go out there and hit people. I haven’t touched a football since.

Every day after school we went out there no matter rain, shine, snow, heat, or better things to do and practiced for three hours every night. We did this all season and I hated it. It sucked and sucked bad. However, it did make me a much better football player. It kept my mind focused and kept me in shape. I was a much better “Go out there and hit people” guy than I would have been had I just taken a football class and then played parts of the game every day.

Does anybody do this with EMS? Sure, we all do Continuing Education, but do we really practice as hard as we should as much as we should?

We play parts of the game every day but just as sure as I didn’t intercept a pass and run in a touchdown every game, I don’t perform a pericardiocentesis every shift. I can plink in an IV in my sleep (and do… a lot…) and I probably can treat a STEMI as good as the next guy. Playing the parts of the game that we do more often than the others gets us good practice on what we do most often, and if we don’t allow ourselves to get complacent, that’s just fine. However, how many times have you calculated a dopamine drip lately? Even if you live in the busiest, most dopamine swillingest jurisdiction on the planet you’ve still interpreted Normal Sinus Rhythm a lot more than you’ve shown off your math chops.

The other day I missed a tube. I was caring for a patient who crashed in front of me while heading to the ER. The Pt went from CAOx3 to very obtunded in a matter of a minute or two. The first time I went to tube, (the Pt) was clenched and by the time I got the etomidate ready we were close enough to the hospital that bagging was my best option. When the Pt got sux and sedate juice in the ER I tried again…. and missed.

I freakin hate that! Man, I never miss a tube! At least almost never. I hate it when I do and beat myself up about it. Probably more hard than I should, but that’s just me. I take this stuff seriously if you can tell. The next shift I spent an hour playing with our two intubation dummies and our “Fred the head”. I tubed over and over again every way I could think of. For an hour. Yes, I know that it’s not exactly like the real thing, but it was all that I had access to for practice.

Something cool happened right after I got done with my hour long tubing pennance. I sat down for lunch and immediately got toned out to intercept a code with CPR in progress. I pointed my SUV towards the rural address and hit the gas. When I got on scene, the BLS crew told me over the radio that they were having difficulty with the airway. I walked in, and got the most beautiful tube that I think that I’ve ever gotten. Right in, right through, and right hole.

I think that my football coach would have been proud.

Posted by Ckemtp on February 1, 2010 • Filed under: ALS Intercept, EMS, EMS Health & Safety, EMS Topics, EMS practice, EMS training, EMT, ET Intubation, Emergency Medical Services, Fire department, Paramedic, Patient Management, ems education, ems scenario based education, intubation, paramedic education

Zombies!!!

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I hate horror movies…

A while ago I walked into our crew lounge where the other members of my crew had just popped in some low-budget zombie flick. It was your classic “B-Movie” and had all the hallmarks of every good zombie show that I’ve ever seen. Gratuitous bloodshed by hapless victims? Check. The walking dead feasting on human flesh? Check. A few good looking zombified women? Check and Check. I watched it against my better judgment. I hate horror flicks for all of the above reasons, except for the good looking women of course. I have an annoying habit of taking on the characteristics of every movie that I watch for varying lengths of time. After watching Top Gun, for instance, I drove my car like a fighter pilot for a few days. After watching Star Wars I tried to use the force to get the TV remote from across the room when I lay down on the couch. After watching the South Park Movie I swore every other word. Really. So I don’t like horror flicks because I get scared like a little girl afterwards and I don’t like it.

Unfortunately though, I watched the whole thing like a doofus, knowing full well that I’d be having nightmares later.

Cue the call for the unresponsive seizure victim…

We went to an apartment complex where our patient had fallen into a seizure right by the inward swinging door to his apartment. He had fallen in a way that made it so his body was blocking the door and I could only swing it open a few inches, just enough for me to squeeze inside. He was pretty out of it, and wasn’t responding with anything but unintelligible grunts and groans.

Then, of course, he moved and shut the door, blocking it with his body and trapping me alone in his apartment with him while he was groaning on the floor.

Does it make me a scaredy cat because I thought I was going to be eaten by a zombie?

I hate horror flicks…

 

Posted by Ckemtp on January 29, 2010 • Filed under: EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMT, Fire Rescue Topics, Fire department, Paramedic, funny, humor, professionalism

Equipment Review: Scary Post Ahead

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This was one of my first posts. Since I’m attending an EMS conference, I figured it deserved a bump-up too. Good Luck!

Some of you have been telling me: “Chris, you’re a good paramedic. You should be providing tips and tricks for EMS people so that they can use your hard-won wisdom to improve their patient care. Don’t spend your time ranting about things that bother you in the back of the truck and keep making feeble attempts to make people laugh. Write a serious article, darn it!!”

Actually, I’m really the only one that’s been telling me that, since this blog is only read by like, six people including my mother, fiancé, and my cat… but nonetheless I am going to attempt a serious piece regarding actual patient care issues. As such, I have identified piece of equipment that is carried on my ambulance and is most probably carried on every ambulance in the country. This particular piece of patient care equipment is rarely used, yet critical for patient care when needed. When this piece of equipment is called for, the patient needs it and needs it NOW. Yet, I’m sure that even the most experienced EMTs and Paramedics are struck with horror at the mere thought of its use.

I’m talking here about: The bedpan.

Yes, in my storied career I have been called upon to use a bedpan more often than I would have liked to. The situation is almost always the same, the patient is otherwise stable but the pressures of the bumpy ride on the human bowels are just too much for him or her during the prolonged transport time. Usually in complicated cases like these I prefer to bring along a nurse, since they are eminently more qualified to perform in these critical patient care scenarios. However, as is often the case in EMS, we are called upon to take care of any patient presentation in any patient population and must perform professionally in all situations. I have researched the use of this piece of patient equipment in numerous trade publications and critical care guides and have been struck with the lack of educational materials available for this critical patient care skill.

So, as any EMS writer would do when setting out to write a patient care article, I hit the streets to query other paramedics and EMTs on their secrets for the proper use of the bedpan. I began with the coworkers I have at my two ambulance jobs, one a private, not-for-profit city 911/Specialty Care Transport service and the other a Fire Department based service. Both of them work around 3000 calls per year and run at the ALS level. Here is a sampling of the responses I received:

Question: By a show of hands, how many of you have used a bedpan in the back of an ambulance??

Answer: I raised my hand.

Some of the people there wanted me to clarify the question, they wanted to know if I meant had THEY themselves personally used a bedpan in the back of an ambulance? One guy admitted to using a urinal in the back while transporting a patient. When badgered by the other providers, he clarified by saying that it “was a pretty long trip”. I offered that there have been some situations in my career where I have put the bedpan under a patient who absolutely HAD to go poopie during a trip to the hospital. However, and I just realized that this is the most blessed thing to ever happen to me ever, not one of them has ever been able to “go” with me hovering over them.

Of course, in EMS, I have been covered with every imaginable bodily fluid, including the unholy trinity of urine, vomit, and feces ALL AT THE SAME TIME. And I have plans to erect a statue to the person who came up with the idea of prehospital people administering Zofran (an anti-throw up medication). The other day I spent a few minutes starting a saline lock IV on a lady in her bed inside her apartment just so that I could give her that blessed medication. My fairly new EMT partner wanted to know why I did that, when I usually wait until we’re back in the truck. I let him know that I had been on the foot end of the stair chair going down the stairs before the golden-age of zofran had arrived.

Yes, us “experienced” EMS providers (read: old people who never got real jobs) will tell you that when you can’t let go of the end of the stair chair without letting your patient plummet down a full flight of stairs and the patient chooses THAT EXACT MOMENT to decide that they just *have* to throw up. You well, you just have to close your eyes, close your mouth, lower your face to cover your nostrils, and take it like a true professional. Been there, done that, cleaned the chicken and rice out of my ears with a q-tip. It’s moments like that when you reevaluate your commitment to the profession, and realize that it must be something other than the *interesting* amount of money that they pay you that keeps you coming to work every day. For me, it’s the amount of time that I get to spend typing up articles about bedpans and vomit in my ears… at least it is right now. Has anyone else ever thought that they had been ruined by EMS? I mean, I don’t think that I could ever do an office job. Years of EMS work has left me with the remarkable ability to begin to focus on something like a laser beam for 90minutes tops, then… Hey look!! A Bunny!!

Oh yea, bedpans. So you slide them under the patient and um… Pray that they’re positioned correctly. Wear correct BSI including a pair of gloves, a mask, goggles, and Vick’s Vapo-Rub under your nostrils. Of course, for us old timers, this is required even when you’re making your partner use the bedpan in the back while you drive (heh) Ever So Carefully to your destination. Tell your partner that they need the experience, tell them how professional they are being and tell them that they’re showing true compassion to the patient. Then go out and buy them an ice cream cone filled with Rocky Road. With any luck, you’ll get to eat that too when they suddenly become less than hungry.

In all seriousness, everyone poops. Never let your patient suffer when you can alleviate their suffering with a simple slide of the bedpan under their derriere. Of course, make sure that they REALLY have to go to lessen your risk of contaminating yourself with some really funky pathogens, and also to avoid ticking off the nurses’ lobby by taking their jobs.

Until next time…

 

Posted by Ckemtp on January 23, 2010 • Filed under: Ambulance, Bed pan, Bed pans, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS ethics, EMT, Ethics, Fire Rescue Topics, Fire department, Firefighter, Paramedic, bedpan, everyday ems ethics, odansetron, puke, zofran

Cat Puke Chicken

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Note: This is a repost. I’ve been a busy blogger and this post deserved a bump-up. Also, the “Fiance” in this post is now my lovely wife. Enjoy.

——————————

The other day I got off shift at 8am and had to be to work at my other full-time job at 10am. Since both of the jobs that I work at are about a half hour from my house in opposite directions it worked out that I had about a half hour to go home, perform the personal hygiene ritual, change uniforms, and get on my way to work again. So I did that, got home, fed the cat, and got all prettied up as quickly as I could. Then, without warning, on my way out of the house I noticed it: A pile of cat puke on my rug.

Yes, I like cats. I have one. She’s a keeper, regardless of her regurgitation issues. I think that I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty. So cat puke on my rug isn’t the horror of horrors to me that it might be to some people. In EMS, we tend to get puked on by humans more often than does the regular population and that fact may have further desensitized me to the violent act of emesis perpetrated on my rug by my mostly cute little kitty. However, I do like a clean house and the cat puke on my rug is an issue that normally warrants immediate action.

But of course, that’s not what happened. And for those of you in a spousal relationship with another human being you know exactly what I did. You guessed it, I left the cat puke on my carpet and went to work. For those of you who are not in a spousal relationship with another human you may not understand the thought process here. Yes, as I looked down at the cat puke on my otherwise (mostly) spotless rug the thought that it must be immediately cleaned up did in fact occur to me; but the other thought that occurred to me was: “I can leave and go to work and when I get home, my lovely fiancé will have cleaned this up for me. She’ll think that the cat puked on the rug *after* I went to work and I’ll get off scot free!”

And so that’s what I did. Yes, I *could* have taken the five or so minutes it would have taken to clean up the cat puke… but in my defense I’m a model employee and I need those extra five minutes of early arrival time at work to drink coffee and to tell everyone what a model employee I am. So if I would have cleaned it up I would have taken the risk of not being such a model employee. So you see, leaving the cat puke for my lovely, beautiful, and remarkably intelligent fiancé (who will probably read this, btw) to clean up was not something that I did because I’m lazy. It was something I did so I could continue to bring home the bacon for my family in the most productive manor possible.

That’s what I thought anyway, until I came home late that night after a hard day’s 10 hour shift off of a hard fought 24 hour shift spent saving lives and alleviating the suffering of the sick and injured and stepped in the same pile of cat puke on my carpet that I had courageously not cleaned up the morning before. True, she had put in a paltry 12 hour shift at the fire department practicing for the recliner racing 500 and had fed, bathed, and put our son to bed; but that didn’t stop my obviously well-earned righteous indignation to the pile of cat puke permeating my pile covered floor. She had decided (although she swears that she did not in fact see the pile of puke) that I should be the one to clean up the cat puke using some amount of flimsy logic that I have yet to understand.

So, to tie the above 646 words back into the title of the piece, “Cat Puke Chicken” is not the new special at your local Chinese Restaurant. It is the battle of wills that solidified between my fiancé and I as soon as my sock made contact with partially digested Kitty Kibble. We both subconsciously agreed to ignore the cat puke for as long as we could stand it in order to have the other person clean it up first. (See also: “Laundry Chicken”, “Last Sip of Milk in the Carton Chicken”, and “Couples’ Counseling”). This occurs a lot, unfortunately, in most relationships between other perfectly rational human beings. We know that we don’t like having cat puke on our carpeting; we obviously know that the cat puke should be cleaned up at the first available opportunity; and we also have continued doing the other things that we normally do to keep our houses from turning into slovenly hovels. In fact, while this has been going on I have cleaned numerous dishes, laundered, dried, and folded at least four loads of laundry, and have started (but not finished) three household improvement projects. I’m at least as good as a housekeeper as the next guy (Read: Not a good housekeeper) and I do indeed do my best to keep my family and myself from living in squalor.

So why, as two perfectly rational adults who um, chose to work in EMS, are we locked into this powerful battle of powerful wills? In a word: “politics”. Not the kind of politics that provide the revenue stream for the myriad of cable news networks, but the politics of household supremacy that truly affect our day to day lives. This isn’t Senator So-and-So bloviating about the fact that pork in the stimulus bill is in fact, not pork… it’s me and the woman that I love and want to spend the rest of my life with deciding who shall be the designated Cat-Puke-Cleaner-Upper!! Pulse pounding stuff here.

And as with everything else, this got me thinking about politics in EMS.

Say you’re in a service way far away from anywhere where I work and you have a small volunteer squad that covers the areas that your service is not jurisdictionally bound to cover. Sure, your service would be glad to come if they called you, but somewhere back in history when the powers that be drew the political boundaries they decided that your service was not responsible to respond to the pleas for help that come from that particular geographic area. Suppose that your service just happens to be a small ALS service with two paramedic ambulances and a BLS ambulance on duty 24/7 and the other service was a BLS squad with volunteers coming from home and/or work. These volunteers are dedicated, caring individuals that want to do the best that they can for their friends and neighbors but work in a system where when a call for service comes out it takes about 20 to 25 minutes for the system to get an ambulance to the patient’s side. Say also that the service that you work for has your three ambulances and paramedics about 6 miles from their patients staffed and on duty but you can’t respond because the political system is such that you would be in trouble if you did so.

You may also relate to having that coworker in your EMS or Fire service that just isn’t up to par. They may be a basically qualified EMS provider through the state licensing body, but you still would cringe at the thought of that person responding to take care of anyone in your group of family or friends. They’re a provider that just doesn’t get it. Their care is substandard, their attitude is poor, and you can’t help but feel that the patients being “cared” for by this individual or crew aren’t getting the best medical care possible from your service. You’d want to say something, and normally would, but you’d become an outcast in your agency and would be looked down upon for blowing the whistle. Besides, even if you did the service is short handed and your management wouldn’t fix the problem anyhow because they need to staff the trucks.

Or maybe you can see that EMS in general is underfunded, underappreciated, and undereducated and you can’t shake the feeling that something has to be done to improve patient care industry-wide. You feel powerless to do so, but you’re angered every time you see a representation of bumbling ambulance drivers on TV, or see the local news completely mishandle a news story involving EMS, or especially when you look at your paltry pay check.

In all of the above cases, you’ve got cat puke on your rug and you’re hoping that somebody else is going to clean it up.

As EMS professionals, we know that there are myriad little political games that play out in each and every little jurisdiction a
cross the map. This service may not call this service for mutual aid because someone’s brother once stole a pumpkin from one of the other service member’s brother’s pumpkin patch. “Jim” may not provide good care, but you let it slide because he’s popular with the other crews. Sure, the local fire department gets a kajillion dollars more in funding than your EMS service does and runs like a tenth of the calls that you do, but that’s just the way it’s always been, right?

We need to step up as a profession and clean the cat puke from our carpet. Ignore the politics. Ignore the personal hurt feelings and the power plays. EMS is about the patient. It isn’t about you, or me, or that person down there. We exist solely to save lives and alleviate suffering in the people that we serve in the best possible way that we can. Nothing else matters more than that. So if you can see that cat puke on your rug, and I’m absolutely positive that you know exactly what I’m talking about no matter where you are, you probably have better things to do than be playing chicken. We all need to stand up and say that we are the Cat-Puke-Cleaner-Uppers and that quality EMS is our responsibility, no matter what little political games of chicken are going on. Our patients deserve nothing less.

(Fiance’s note: As of press time, the pile of cat puke on Chris’s floor is still intact solidifying into the fibers of the carpet)

 

Posted by Ckemtp on January 22, 2010 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, EMS, EMS Humor, EMS Management, EMS Topics, EMS ethics, EMT, Emergency Medical Services, Ethics, Fire Rescue Topics, Fire department, Firefighter, Paramedic, ambulance humor, cat puke, edemse, everyday ems ethics, politics, relationships

Everyday EMS Ethics – Social Media and “Smart” phones?

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Today I finally joined The Future™ and got up to speed with the latest technology 2006 has to offer by purchasing myself a shiny new BlackBerry Curve™ “Smart” phone. This thing is SO COOL! I can access my tweets, my facey page, and all of my other online stuff right through it AT ALL TIMES. It’s not an overload, really… I like carrying on 14 conversations at once… at all times. Really I do.

This new addition to my arsenal of cool tech gadgets got me thinking about a story I heard somewhere about a young firefighter/EMT that ran into a bit of trouble with one of these things. Incidentally, this story could have come from any public safety agency anywhere these days, so you probably don’t know whom I’m speaking of here, but if you think you do then go kick that person in the butt for me.

Anyway, this young firefighter/EMT was a full-fledged, “smart” phone carryin’ member of The Future™. Like any good young member, he was fully invested in Social Media. This firefighter/EMT responded to an incident scene and thought that a picture of the incident would make excellent fodder to post on one of the social media sites that he participated in. So, he snapped the picture with his “smart” phone and immediately posted it on the social media site. Appended to the photo he put what undoubtedly was an especially witty and thoughtful comment related to the person(s) who caused the incident.

Thus ensued “all hell” being brought down upon this young firefighter/EMT by the upper echelons of his fire department. Turns out that the Chief, the Assistant Chief, and a number of his coworkers were “friends” of this young firefighter/EMT and were immediately notified of what he’d posted on the social media site. They were not amused in the least and did not find the humor in the especially witty comment that he’d posted with the picture.

I agree with the Chief on this one. Let me be the first one to expound upon the virtues of social media in EMS and Fire. The fact that you’re here reading this is a testament to its potential to positively influence our profession and our interactions with the public and each other. However, its potential to tarnish our image if used irresponsibly is there as well. This case was an example of that.

I never did get a chance to see the picture, but from what I heard of the case the picture did not involve any personally identifiable information. Locals could have seen the picture and identified it, so could those involved of course, but it didn’t violate any laws that I know of.

What it did violate, are the ethical standards in which we operate under. Public safety people respond to incident scenes where we see things not meant for public viewing every day. We’re all familiar, I hope, with HIPAA and the various other privacy laws that we operate under, but we also need to be aware of the ethical standards that guide our interactions with private information.

When I got into this business, the metaphor that we used was “The Coffee Shop”. We were told to keep our shop talk behind closed doors within the service, and not go down to the local coffee shop where people could hear us talk. In the small town I lived in, everybody knew everybody and everybody had a scanner. Even if one of our guys was talking about “This Person” who had had some type of medical condition or had injured themselves in a spectacular way, everyone would know whom he was speaking of. Thusly, we didn’t go talking about what we saw out in the public. It wasn’t a legally mandated standard, it was an ethical standard of behavior that allowed the public to trust us and feel comfortable calling us in their hour of need. People won’t call us when they need us if they fear public embarrassment. Most people, that is.

Nowadays, it’s gotten complicated. With social media sites more popular than ever and showing no signs of slowing down, the impulse for some of our ranks to post information of an ethically non-public nature up there on the interwebz can be irresistible. With my “smart” phone in my pocket at all times, I have an express lane to career ruin right there at my fingertips. All I have to do is act irresponsibly one time with a photo, comment, or post and my career is finished.
And I remember and respect that. 

Professionally Ethical behavior requires that we separate our professional lives from our personal ones. While it would have been no big deal for Joe-Public-Came-Across-An-Accident-Scene to snap a quick pic and send it off, it is a huge deal for a Professional Rescuer to do the same. We were called to the scene to help the people involved. Professional Ethics mandate we leave our personal feelings and personal lives at the station. If the public gets the perception that their personal business is going to be splashed across the interwebz by one of the people who came to help them, then I’ll bet that the public is going to be mad at that.

Just remember, folks. Friends and families of public safety people have always been interested in what we do out there. They always will be. With today’s ultra access into our personal lives that social media can bring, it’s easy for youngins to get carried away and violate the ethical standards on spreading private information. There’s a rule for this and technology hasn’t changed that rule. You don’t use your position of public trust to gain access to and spread private information.

Just don’t do it. Resist the urge and keep your career, and honor, intact.

Posted by Ckemtp on December 1, 2009 • Filed under: Administration & Leadership, EMS, EMS Topics, EMS ethics, Emergency Medical Services, Ethics, Fire Rescue Topics, Fire department, Firefighter, PR, Technology & Communications, edemse, everyday ems ethics, medical ethics, professionalism, technology-communications-ems-topics, whattaya do

The day I didn’t die – Firefighter Close Calls

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Laying prone on the quivering floor, I had been pushed down flat on my stomach by the searing heat and smoke. I was as terrified as I’d ever been as I frantically yanked and tugged on the inch-and-a-half hose line that was stretched down the basement stairs towards the engine company that had disappeared down the dark hole an eternity ago. What had started out as a small, concealed fire with light wispy smoke conditions had quickly deteriorated into this hellish, searing inferno that I was convinced was killing the three men below me.

Twenty minutes before this, my two man tanker company had been first on scene to this structure fire that had been dispatched while we were returning from a small brush fire. We were the closest unit and were first on scene. Light staffing that day caught us when this fire was reported during the height of our daytime volunteer shortage. These factors combined a two-man tanker company together with a two-man brush-truck company to make a primary search of the structure. The light smoke and little heat had lulled us into a false sense of security as we entered the single-family home. The concealed fire between the first floor and the basement caught us unaware. It spread quickly and weakened the floors we were standing on. When I found the first floor had been weakened, I sent out my partner to inform command as we were on the tanker and had no radio communications inside the structure. Unfortunately, another engine company with a hot-shot lieutenant arrived and, despite my fervent protestations to the contrary, he took his three firefighters down the stairs to the basement. I stayed to mark their exit.

Outside the air-horns sounded their three quick blasts, calling for an evacuation of the structure. I stayed, waiting for the crew to emerge from the staircase so that I could lead them to safety. They never showed. The intense heat burned me through my turnout gear as I screamed as loud as I was able through my SCBA mask into the abyss. I tugged on the hose and screamed at them to return, only taking a break to recognize the ringing of my low-air warning bell on my air tank. I had no idea how long it had been ringing, but when I noticed it, it was slow. Instead of a sharp ring, it was a slow ding that was getting slower as I was sucking as much air as I could to yell down the staircase.

This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor. I also knew that the men below me needed me to be there for them when they came out of the basement. They needed me to be there to lead them to safety.

It was a decision that made me choose between leaving my brothers to perish by saving my own life, or staying to face my own probable death. Ding… Ding… Ding… the sluggish bell ticked off my air supply, inching ever closer to the point where it would just stop, leaving me to asphyxiate.

That moment, I chose to flee and save myself. It’s why I’m sitting here typing this story.

I knew where I was in the structure. While it was pitch black from smoke and I was blind, and while every movement made my skin contact my turnout gear and burned me, I turned tail on my stomach and frantically crawled towards the doorway I knew it was only a few feet away. I knew I could make it. I knew my brothers were dead or dying. I knew…

“CRACK” went the floor as it opened up to reveal the inferno underneath my belly. I felt myself falling I saw the flames come up and envelop me. My vision turned from completely black to completely orange as I felt myself falling into the intense heat. I screamed and reached out ahead of me into the darkness. I clawed and flailed forward, grasping on to anything that I could grab to save me. God willing, my fingers found the concrete steps out the outside door to the residence. Inch by excruciating inch I pulled myself up and out into the light and the fresh air.

As soon as I was out of the house I stopped breathing as my SCBA mask sucked into my face for lack of air in the tank. I ripped it off of me and sucked in the sweet outside air. Waiting for me outside, about to try and find me, were the three firefighters who had went into the basement. They had evacuated through a basement door. Nobody knew that I was still inside waiting for them until they made a headcount in the confusing scene and found that I was not accounted for.

Looking back at this experience, I am proud of myself for finding out that I will go up to the last possible second to try and save my brother firefighters… although thinking about the decision I made to turn tail and run, I’m almost ashamed that I didn’t stay past that point of no return.

Of course, my policy is that I go home at the end of the day every day… but still.

Close calls are terrifying experiences. Thinking about losing any one of my coworkers or colleagues is unfathomable. It can happen, however, and we combat this reality with safety and organized command structures. This call was years ago in my career but it sticks in my mind at every call I’ve been to since that day.

Train hard. Keep your wits about you. Take everything seriously.

 

The Hole a firefighter fell through in a strucure fire (uninjured)

The Hole I fell through in a strucure fire (look right by the door)

Posted by Ckemtp on November 25, 2009 • Filed under: EMS Health & Safety, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, Firefighting Operations, Fires, accident, fire, training-fire-rescue-topics

Soapy Demons – Ckemtp is a geek

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Washing Machine Sta 1Ok, so this post really proves just how much of a geek I really am. Just bear with me for a bit.

This subject causes me a lot of personal grief. I know that it probably shouldn’t and that I am indeed a geek for worrying about this issue because seemingly no one else does, however this issue has plagued me for years and I need to get it off of my chest.

This is about the washing machine at the main fire station where I work. I’m at this station a lot, whether I’m working one of my three weekly scheduled paid shifts, hanging around with my wife who works there three scheduled paid shifts as well, or volunteering my time for call response, training, or work projects. So I have the opportunity to use this particular large, commercial, washing machine quite a bit.

It’s a nice machine. It handles the huge loads that we generate on a daily and nightly basis. It cleans the stuff pretty well and runs pretty quickly and quietly.

The problem is, the soap. It does not rinse the soap out of the clothes, bed sheets, blankets, turnout gear, or anything else that we put in there. The “rinse” water is always white with suds and everything comes out soapier than when we put it in there.

I am well aware that this is not a sexy problem. It’s not a big issue and castles will not fall because of it. It just drives me nuts.

When it comes to be my time to use the machine, I run two full cycles at a minimum to rinse out the machine. The third cycle usually has at least some soap in the water but I use it anyway because all of the residual soap that is left in the stuff that we constantly wash in there. The stuff is full of soap! Our sheets, our towels, our turnout gear… everything. After you run a load in there, even after a second full cycle, the water is white with suds on the final rinse phase.

For a few years, I begged, pleaded, cajoled, and bargained to get people to use less soap in the machine. I tried to get the purchasing division to get us a different type of soap that might rinse cleaner. I even went so far as to post up a few memos in the washing room and write a couple of written requests to the purchasing division and the officer above them.

Predictably, nobody cared those times and still nobody cares about the issue now. Everybody still dumps the same big glob of soap into the machine when they start it and then promptly forgets about it. Whomever comes in and removes the stuff from the washer just puts the stuff right in the dryer, still soapy as all get out, and throws another load in the washer. Then, they dump a big glob of soap in the machine and the cycle perpetuates. Honestly, it’s a losing battle for me and I know that I’m the only geek who cares out of the 100 other people on the department. Nowadays I’ve resorted to trying not to care about it so much and also by surreptitiously watering down the soap that we use. I’ve been doing that for years and nobody seems to ever have noticed (until they read this). It helps a bit, but still our stuff is soapy as heck.

Am I crazy? Probably, but consider this: This small issue is hurting my department and the way we function. Really. We spend hours per week cleaning and polishing our apparatus. To do that, we need towels. Lots of them. Now that they’re all full of soap, they don’t soak up water anymore and we have to constantly replace them with new towels that promptly get full of soap and don’t absorb water and leave our trucks streaked with laundry soap and water spots. Then, we replace the towels again and the cycle perpetuates. How much money do we spend on new towels?

Consider this also: Our guys sleep on linens that get washed every day after they’re used. These linens are full of soap and are against our guys’ skin every night. What happens when one of them develops an allergy? Occasionally, some of this linen goes for use on an ambulance… when will we get a patient with an allergy to our soap?

Consider this as well: How much does it degrade our turnout gear to be full of regular laundry soap? Sure, we bought the expensive specialized turnout gear cleaner, but it doesn’t matter because the water we’re using to wash the gear is full of the soap from everything else? Does that degrade our protection? How much are we harming our very expensive protective clothing by filling it with soap? When will the gear fail and someone get burned because of this? Will it happen? When someone gets burned will it be my fault because I didn’t try hard enough to fix an issue that I saw?

Yes, I’m a geek for caring about this issue so much. I feel like an OCD Chicken Little. However, this small, nothing issue is costing the department money overall and could get someone hurt out there on the fireground. After that, I’m sure people will wonder how this could have been prevented. I’m sure also that they’re looking for ways to cut costs now that the economy tanked and tax revenues are down.

And there sits the washing machine, quietly driving me crazy.

How many issues out there do people know about like this? Issues that are small enough so that nobody else cares but that snowball into big problems for the organizations. How many of these issues affect EMS and the fire service industry-wide. How many of them affect everything?

One day I’ll conquer my soapy demon. For now, I have to keep watering down the soap in secret… but as crazy as it seems, I feel that I’m making some small difference. You can too. Be it the way your equipment is checked in the morning, the way you package your lifesaving gear, the way you make sure that the gas tank is full, or the way you do whatever it is you do to make your service the best it can be.

Now get out there and water down your soap. You might just save a life.

Posted by Ckemtp on October 10, 2009 • Filed under: EMS, EMS ethics, EMS safety, EMT, Emergency Medical Services, Ethics, Fire department, Firefighter, Paramedic, edemse, ems 2.0, everyday ems ethics, fire, new perspective, pride, professionalism, soap

Why I love this Job

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Because the owner of this brand new Escalade will ultimately be happy that I’m tearing it apart with the spreaders. (Yep, that’s Good Ol’ Ck on the tool)
Posted by Ckemtp on September 7, 2009 • Filed under: Ambulance, EMS paramedics, EMT, Fire department, Firefighter, extrication, jaws of life

The Handover is coming! The Handover is coming!

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Coming soon to Life Under the Lights, The Handover Blog Carnival!

Yes, Medic999 has convinced me to put my money where my mouth is and host an edition of the Famous EMS Blog Carnival. Hopefully I can live up to the heavy expectations of the readers and fill the big shoes of the bloggers who have hosted before me. The Handover is the biggest and best blog carnival featuring awesome bloggers from the world of the Emergency Medical Services and The Emergency Room (US) and Accident and Emergency Room (UK).

Yep, it’s an international EMS blog carnival featuring the best in Emergency Medical content from around the world. It is published monthly. There are Paramedics, EMTs, firefighters, Nurses, and Doctors that participate. If you haven’t read it before, you should. In fact, head on over to Medic999′s place – http://medicblog999.wordpress.com/ and check out this month’s edition. The theme for his edition is “My First Call” which promises to pull out the emotional, the macabre, and the flat out hilarious stories that we all share as members of this crazy profession we call EMS and Emergency Medicine.

Oh, and you’ve all been waiting for the announcement, so here it is…. The theme for my edition will be:

“Funniest. Call. Ever.”  The deadline for submissions is Monday, Sept 21st and it goes live on Friday 9/25.

Yes, that’s right. Pull out the best call you’ve ever had, the one that you tell in the coffee shop to other medics that still makes them wet themselves laughing or scratch their head wondering how we could ever make this stuff up. We can’t, and that’s what makes it so funny.

Can’t wait to see this month’s edition and I can’t wait to get started on the submissions for my edition next month. Stay Safe, everyone.

Oh, and in case you haven’t seen (and I hid it when I posted it) Here’s the story of my first that I submitted for this Month’s Handover:

http://proems.blogspot.com/2009/06/my-first.html

Posted by Ckemtp on August 27, 2009 • Filed under: Ambulance, EMS paramedics, EMT, ER, Fire department, The Handover, blog, blogger

Operation FEE Line: Exposing the Deadly Side of Kittens on Emergency Scenes

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Funny Pictures
see more Lolcats and funny pictures

Kittens: Deadly minions of the Dark Side, or Cuddly Agents of Evil… You decide.

Today, I faced my own mortality in a daring, high-stakes, high-angle rescue. A life was on the line and my truck company was assigned to respond and snatch it from the jaws of death. We had been requested by the local animal control officers to rescue a cat stuck in a gutter on a steep roof about 14 feet of the ground.

Yea, a freakin cat. At least it wasn’t in a tree, that would have been too cliché.

We brought the tower ladder out of our station with a six man crew for this dangerous rescue and met with the Animal Control Officer on Scene.

“There’s the cat” He said.

The roof was pretty steep, and covered with asphalt shingles. With the sky just starting to let loose with a few sprinkles of rain, the 20 foot drop off the side into a rock garden was starting to concern me. Yes… I know that us firefighters are supposed to be good at working on roofs, but when a building’s on fire we don’t have to care how we may harm the roof by gaining traction. I really didn’t want to harm this nice lady’s roof, so sticking an axe in it to get a foothold was going to be a no-no. We pulled out a 24 foot extension ladder to reach the roof and a roof ladder to keep from falling to our deaths.

Or I should say, my death… because Captain Mike looked at me and said “Since you like cats so much CK, you go up there and get it”.

At this point, you might wonder why I’m being so dramatic about this.

Because cats on emergency scenes are evil death killers of doom and are more dangerous than ninja bunnies carrying lasers.

That, and well… I’ve never had good experiences when there have been so-called “cute little kitties” on my emergency scenes. I always end up flat out on my back. Literally.

You should know that I like cats. Really, (thanks to Gkemtb –my wife for my new readers) I’ve got three of them. However, when there’s a cuddly kitty on one of my scenes, ominous music starts to play and shenanigans ensue.

I learned the horrible truth about cats some years ago. My Paramedic/EMT-Basic ambulance had been called out to a “sick woman” at a local residence. When we arrived on scene shortly after fire and police we found an obviously grieving family huddled around a hospital bed where a frail elderly woman was laying. She was crying as forcefully as her frail body would let her. We learned the sad truth soon enough. The patient had been referred to hospice care a few weeks prior to this when the cancer that she had was deemed to be beyond hope. Her last wishes were to convalesce at home with her beloved husband and her beloved cat by her side. Unfortunately, her husband had passed away suddenly a few days before and she was at home, in her bed, too sick to attend the funeral which was in progress. Her family had become concerned and had decided that a trip to the hospital was necessary. I agreed, even though there was nothing that any paramedic or hospital could do to alleviate this poor woman’s suffering.

So it was a sad scene all around. We loaded her up on our cot and wheeled her into her living room when she became concerned and would not let us leave the house until we locked her beloved cat in the bathroom to keep it from, I don’t know, shredding the curtains or something. I was picked, because as is well known in my region, “CK likes cats”.

I found fluffy hiding behind a couch, pretending to be scared from all of the bodies in the room. Little did I know she was just pretending to be scared, and was really plotting our ultimate destruction. She came to me after a little bit of coaxing, and I picked her up and carried her from the living room, down the short hallway, and entered the bathroom.

The cat, who had been waiting for his minute to strike once I had been thinned from the herd, realized that I was planning to lock him in the bathroom and deployed his needle-sharp, slashing claws of doom and wrestled himself from my hold. I tried to grab him as he got to the floor and began running towards the bathroom door which was towards my back. I reached down and backwards for him, catching hold of him on his back. He slashed and squirmed towards the door, pulling me down and backwards with every razor sharp undulation.

So here’s the scene, I’m bending over backwards for this cat and was falling for his evil plot. Finally I lost my balance and fell. I rolled out of the bathroom backwards, head over heels into a perfect back flip. The fire crew, my partner, the police officer, and the family heard the commotion and witnessed my epic fail which I punctuated by crashing forcefully into the wall of the hallway. For his part, the cat sauntered back into the living room, sat down, looked at the rest of the people there, and licked his chops in a dare to any other would-be hero that would dare to try and cage him again.

No one dared. He stayed out and the patient went to the hospital.

So back to my daring rescue, this call was in the forefront of my mind as I climbed the 24 foot ladder and hoisted the roof ladder onto the small roof. It only fit about halfway on, so I made sure that the hooks were firmly set in the shingles. I knew what cats were capable of. I eased myself onto the ladder and crawled up to the peak of the roof. The cat was on the other side, away from the protection of my roof ladder. I slowly eased myself down the slick, steep, rain-soaked roof towards the cat who was patiently waiting in the gutter at the edge of the roof. I wasn’t as concerned as I should have been, because there was only a 14 foot drop at this side of the roof. I eased towards the cat saying “here kitty” and “I’ve got cheezburgers in my truck and yes you can has one” to her as I got to the edge. I was just able to get my hand on the nape of her neck and was able to grab the scruff. I picked her up out of the gutter and…

No I didn’t fall off, but the cat wrested herself from my grasp and while I was grabbing for my balance she walked up the roof and down to the other side. She sat right down in the gutter on the edge in the furthest possible spot from my roof ladder. At this point of the roof, due to the slope of the yard, there was a sheer 25 foot drop onto a rock garden.

Crap.

Because then I remembered another call, a fire this time. I responded 3rd engine in fresh from the scene of a mutual-aid brush fire. When we got there, we found the other two engines and a truck company had knocked most of the fire down on a single-story ranch type home. They had found a fully-involved attached garage when they arrived on scene and had made a good stop. Now, it was mostly overhaul that needed to be done. The homeowner however, was standing in the driveway begging the IC to rescue his cat that was still inside.

Cue the ominous music when the IC looked at me and remembered “CK likes cats”.

I went in the smoke-filled house with Lt. Tuna in full-gear and SCBA. We searched three rooms and located the cat in the far bedroom of the house. Lt. Tuna secured the doorway to the room to prevent the cat from escaping and I was tapped to go get the cat.

“Nice Kitty” did not like his house being on fire. He especially did not like alien-looking firefighters in full gear trying to grab him. I struggled and flopped around the bedroom chasing the cat. He finally made it to the headboard of the bed. I launched myself prone onto the bed and got a thick-gloved hand on him. He ran to the side, I rolled long ways on the bed onto my back and got another hand on him.

I had
him! Then I realized that I was on a… a waterbed with my hands stretched out over my head onto the headboard holding a sharp kitty who was rapidly finding out new ways to penetrate my leather firefighting gloves with his sharp teeth.

I think that this would be a good firefighting drill. Wear your 70 pounds of firefighting gear and an air pack, sprawl out supine on a water bed, and try to self rescue while holding a cat. I call it the “Ckemtp” drill.

I was stuck, much to the amusement of Lt. Tuna who entered the room, wrapped the cat in a towel, and carried him out of the residence. He left me there to flop around on the waterbed for a while until I was able to roll off of it, hit the floor, and crawl out a broken man.

When I got out of the house, the owner was petting the *really pissed* kitty and was trying to stuff him into a waiting kennel. I did not intervene, I had had enough.

So now this call was knocking around in my brain as I edged ever closer to the sheer drop to rescue gutter-kitty. Joe, another firefighter, had climbed the ladder by this point and handed me a net that had been given to him by the animal control officer.

“The cat’s over there” the animal control expert called up from the ground.

“Thanks” I said.

Joe climbed onto the roof and Capt. Mike moved the ladder closer to the cat and then climbed up to help. The three of us edged closer to the kitty. I nudged him with the net, Joe prevented escape, and Capt. Mike reached over from the safety of the ladder, grabbed the cat by the scruff of the neck, and placed him in the net.

Mission accomplished. I think that the cat let himself get caught though. Probably because my promise of a cheezburger in the truck had sounded better to him than did lapping up freshly splatted firefighters. Man was he ticked when he got placed in the Animal Control Officer’s van and found out I didn’t have one. I could hear him squalling as the guy walked back up to us.

“Thanks for getting the cat” He said.

“Just doin’ My Job Sir. Just Doin My Job.”

But I know that the cat’s out there. He’s plotting his revenge. He doesn’t sleep… he waits.

 

Posted by Ckemtp on August 8, 2009 • Filed under: EMS, EMS paramedics, EMT, Fire department, Firefighter, amulance, cats, rescue

Wow, that takes me back… A paramedic ruminates

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The other day I was up at the station having a conversation with one of our firefighters when she described a call where she found that “this guys legs were like, all messed up. They were like every which way and stuff. Gross”

Now while I have to give credit to great medical terminology where credit is due, I find it amazing how conversations like this can pull me into my own mental imagery. After ten short, well-paid, and relaxing years on the ambulance (ha!), I’ve got, well a few mental images stored up in the ol’ dusty recesses of my mind that pop randomly into the forefront of my mental picture show. I can’t turn them off. It’s completely random with what stimuli will trigger a vivid memory. One minute I’ll be walking up some stairs somewhere, and the next I’ll be mentally carrying someone down some staircase somewhere on a stairchair while the patient continuously pukes on me.

“It’s ok Ma’am”, I’d say. “People tend to puke on me. I get that a lot.”

So, after hearing this most eloquent firefighter describing her “all messed up legs” call, I found myself in the front seat of an ambulance.

This was some time ago, for some service I might have worked for somewhere. I was driving and New Medic partner was riding shotgun. He was describing his most recent fling while I was living vicariously through him describing his most recent fling. This was well before Gkemtb made my life Awesome, so it’s ok. We were headed to BigNun Hospital for a transfer.

“Dispatch to Ambo 74″ Crackled the radio. “Copy Code-3″

“Sweet!” I love getting called off of transfers. NM got out his trusty notepad to write down the address as the tones dropped out.

“dooooooo doooooooo” Went the tones. “Medic 74 respond Code 3 with Blueberry Hill fire. I-333 at the 34 and a half mile marker for the one vehicle roll-over. State police are advising to expedite”

“Cool!” I love trauma, always have. There isn’t a medic alive who doesn’t like good trauma. Sure it’s sad (see: Splashed Sadness) but nonetheless good, adrenaline pumping trauma gets the heart beating.

NM partner, however, being a New Medic Partner, acknowledged the call and said “Uh, Ck? I haven’t had a good trauma yet and I don’t know how I’m gonna do”

“I gotcha buddy, just follow my lead” I said as I flipped on the twinkles and woo-woo’s and headed out to the Interstate. When we got onto the Interstate traffic was a mess. We were shoulder riding through stopped traffic the whole way. Our lane was stopped dead and the other line was completely devoid of cars. That’s never a good sign. It means that both interstate lanes are blocked at the accident scene and traffic can’t proceed in either direction because the incident is blocking both lanes… either that or there’s gawkers in the other lane. Both aren’t good.

After a while of fighting traffic, fire arrived on scene and asked for our ETA before giving their scene size up.

“About a minute” was my reply.

We arrived on scene and found an image that is burned into my brain to this day. The vehicle, a half-ton white pickup truck, had obviously rolled multiple times coming to rest on its wheels perpendicular in the roadway with the passenger’s side facing the ambulance as we pulled up. The patient’s head and torso was hanging out of the passenger’s side window. The patient was face-down with his chest resting on the window about the level of his nipple line. I can still see the 6 inch wide streak of red dripping down onto the pavement from the patient down the passenger’s door. The red blood contrasted sharply against the dirty white paint of the truck.

We called on scene, hopped out of the ambulance, and grabbed our gear.

“He’s conscious and in a lot of pain” one of the firefighters told us as we approached the truck. I had NM stay outside of the truck as I crawled into the open driver’s side door.

The truck was a mess. Apparently the patient was a construction worker as evidenced by the amount of unsecured tools that had bounced around the truck as it rolled, impacting against the unsecured driver countless times and causing a lot of trauma. An open soda bottle had sprayed its contents all over the scene and the patient as well, giving everything a sugary sweet smell that comingled with the bitter smell of the blood that had splashed onto everything.

But that wasn’t what surprised me.

The patient was face down, hanging out the passenger’s side window. A bystander who identified her as a “nurse” had been supporting his shoulders, head, and neck which were outside the truck. Inside, I was shocked to find that his legs had been completely dislocated from the pelvis on down. It was grotesque. Every one of the joints in both of his legs had been dislocated and twisted. His feet pointed backwards, his knees rotated sideways with one being wrapped around the gear shift pointing oppositely from where it should be. His other was wrapped underneath him. Nothing was in anatomic position.

Gross.

And the patient… yea, he was awake and alert to feel all of this.

“Dispatch from Medic 74″ I said, urgently. “Send us the Helicopter. Blueberry Hill fire will be the LZ coordinator. LZ will be the Interstate. Traffic is completely blocked southbound from the scene.”

“Captain, I’m calling in the bird to transport. Can you land it on the roadway?”

“Sure thing” said the BHFD captain on scene, as he grabbed a crew to set up the landing zone.

“Hey NM, whatcha got up there?” I asked. He’d gotten vitals. The Pt was understandably tachycardic but he had a pretty good blood-pressure. Respirations were rapid and shallow. His o2 sat was 100% on the 15-litres-per-minute by non-rebreather mask that NM had put him on. He was in the process of putting the patient in a cervical collar when I asked.

So at this point I had pretty much no good ideas on how to get this guy out of the truck. His legs were just plain FUBAR’ed to use the term correctly. I couldn’t roll him onto his back with his legs the way they were and I couldn’t figure out a way to get them back into shape in the close quarters of the truck. I palpated down the length of the long bones in his legs and couldn’t feel anything that was broken other than the obvious joint dislocations. Finding distal pulses in the feet was pretty much out of the question with his thick boots on. On top of that, now the patient was beginning to actually feel the position he was in and was beginning to moan in pain.

“NM, any ideas on how we’re going to get this guy out from up there?” I asked.

“Aren’t you supposed to be here to figure that out?” was his reply.

After deliberating for a moment, I came up with a bright idea. I had the fire guys get our cot out with two backboards. My idea was to rest a backboard just underneath the passenger’s side window and slide the patient onto it, face down. His legs? Well… I figured that the damage had already been done to them and that since I would probably have to realign them anyway to restore distal circulation that I would just guide them out as they lifted and pulled him onto the backboard from the outside.

I recruited a wide-eyed EMT-Basic firefighter for the inside part of the plan.

“Here’s what I want to do y’all” I talk southern sometimes when I’se stressed.

“We’re going to sandwich him between two backboards. Y’all on the outside are going to lift and pull him onto a board face first. Me and this guy are going to guide him out from this side.” I calmly stated. “Everyone ready?”

“Um, you sure about this CK?” asked the wide-eyed FF/EMT-B. “Yea, you take this leg ‘cuz it’s not as bad. I’ll take (gulp) this one” I assured him.

“Sir?” I asked our conscious patient. “Get ready. There just isn’t any good w
ay to say this… it’s going to hurt a bit. You may want to take a deep breath.”

“Everybody ready? On the count of three. 1-2-3 go!”

They pulled and lifted and slid. The FF/EMT-B and I twisted and guided the rubbery legs around the gear shift and from under the seat. For his part, the patient uttered barely a whimper.

The legs, and this is one of the coolest things I’ve ever seen a human body do, simply “rubber banded” back into position. It was fast and easy the way they just snapped back into place. Freaky like. The patient slid right onto the board and onto the cot.

I hopped out of the truck and over to the patient. We placed a backboard on his back, picked him up between both of them and rotated him into the correct position. I then went to the truck to set up IV lines and let NM stay there to continue packaging the patient.

I ran down two IV lines as they were bringing the patient into the ambulance. I could hear the helicopter landing in the distance.

“Make him naked” I told a FF/EMT-B from the Fire Dept. Using one of my trademarked lines as I tossed him my trauma shears. He did, and to my amazement his legs, save for some abrasions here and there, didn’t look too bad. He had strong pulses in both feet as well.

I completed a head-to-toe trauma assessment as NM popped in a 14gauge IV. The helicopter medic entered and got another 14 in his other arm. We gave our passdown to the flight crew, finished the packaging, trauma assessment, and IVs and handed the patient off to them. They had kept the engine running on the helicopter for a “hot load”.

I hate hot loads. Something about walking under the spinning main rotor blade of a helicopter gives me the willies. We did though, wheeled our cot under the blades to load the patient in the bird. The chopper took off in a cloud of dust, taking the patient the 5 minute flight to the level 1 trauma center.

“So, NM. Was it good for you?” I asked him as we started cleaning up our truck. It was just plain destroyed with all of the treatment we gave this guy. We cleared the scene unavailable and out of service to return to the base hospital to restock and decontaminate the truck.

“I think that I like trauma” NM said. See? Everybody likes a good trauma now and then.

After cleaning, restocking, and returning the truck to service at our base hospital which happened to be the level 1 trauma center where the patient came to, we checked in with the ER doc.

“Hey, how’d the patient turn out?” We asked.

“Not too bad, he’s already up on the floor” Doc answered.

“What’d you find with his legs?” I asked.

“Nothing. His legs were fine. Just the airway and facial trauma. That was pretty much it” He said.

What?? I told him what we had on scene. He was skeptical. He said that he hadn’t found anything with the guy’s legs at all and that they were fine when he checked them.

I never did get a chance to follow up with this guy. I don’t know what ever happened to him. It was pretty common back then with how busy we were, and even more common now with the HIPPA privacy act.

The firefighter I was talking to at the beginning of the story? I dunno what she said while I was in my own little world. Something about lunch?? Hmmm… speaking of which, I remember a time….

Posted by Ckemtp on August 4, 2009 • Filed under: Ambulance, EMS, EMS paramedics, EMT, Fire department, Firefighter, accident, roll-over, stories

Shoutout to EpiJunky

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EpiJunkie over at PinkWarmandDry wrote a post summarizing her thoughts and feelings as she watched one of her patients die in front of her during the whole M. Jackson thing.

Really, she sums it up exceptionally well.

My thoughts on the MJ thing are this. Who cares? People die all the time. Some deserve to moreso than others. Yes, that’s pretty callous… but the media doesn’t celebrate the lives of the people who they should. I’ve had good friends pass over the years, we all have. There were around 600 people at my father’s funeral (in a town of 400 people) and we didn’t even have media coverage. He was the small town fire chief and had spent his life helping his community and saving others. MJ sang some catchy songs.

I know that the media isn’t in touch any more, but the MJ thing illustrates just how out of touch with reality that they are.

She says it better than I do: http://pinkwarmdry.com/blog/2009/07/my-reality/

Posted by Ckemtp on July 9, 2009 • Filed under: Ambulance, EMS, EMS paramedics, EMT, Fire department, mainstream media sucks

Some resources I use daily

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One of my jobs that I don’t blog about much happens to be for an agency that is responsible for responding to disasters. I don’t write about it much, because I want this job to be about my first professional love, which is EMS. However, with this job, I have had the opportunity to travel the nation and meet some awesome people. I’ve gotten in on a lot of cool things and have done things that I wouldn’t have gotten to do without the job. It’s facinating to get a federal eye view of emergency response and there are some publicly available resources that I’d like to post up here. I read these every day and you should too, if you’re interested in these kinds of things.

http://www.fema.gov/emergency/reports/index.shtm – FEMA’s National Situation Report (SitRep)

Every day, the Office of Preparedness and Response puts out the National Sitrep. The publicly available version is published up here on weekdays. It includes vital statistics, upcoming disaster-type threats, wildfire stats, and briefings on national disasters. I read it to see where I might be going on a day-to-day basis. Usually I stay home and run EMS and Fire, but for a few months each year I get to be on-call. Yesterday I placed myself on call and I’m subject to 48hrs notice to be somewhere in the country to do something.

Who knows, maybe Ckemtp is coming to a town near you!

(Interesting side note: I spent a good part of my summer in LaPorte, IN last year. I have a regular reader from there that never comments *ahem*. I wanna know how the fishing is going! Leave a comment!)

The other every site I visit this time of year is the National Hurricane Center – www.nhc.noaa.gov – If you’re in the potential path of a hurricane, you should visit this site, a lot. Most of the other weather outlets just parrot this information. This is the most up-to-date.

Sorry about the slow posting lately, folks. I’m working on a few things for your enjoyment. Gonna need a lot of participation from my visitors though. I want to remake EMS and we’re going to have to band together. Ya in?

Posted by Ckemtp on July 8, 2009 • Filed under: EMS paramedics, EMT, FEMA, Fire department, NOAA, Paramedic, SitRep, disaster, hurricane

Why does being a Paramedic seem so worthless sometimes?

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This isn’t a happy post.

I love EMS and love being a paramedic. I love the job, love taking care of the patients, and love the challenge, excitement, and challenge. I’ve always said that EMS is an abusive, co-dependent relationship for me. I need it and really, I’ve always thought that it kind of needs me too… But as I’ve hinted at here on the blog before, it’s hard to pay the bills on the salary that a Midwestern paramedic makes in a small community. We can work well over a hundred hours per week, can hone our skills as much as we’d like, and can save lives and alleviate as much suffering as one person can handle, but it isn’t enough to put a full tank of gas in our car every time we need to fill up and also to afford cable television. Heaven forbid that we don’t take our lunches to work or want to take our wives out to a nice dinner.

The service that I work for has a cardiac arrest survival rate of between 40-60% (yes! www.callandpump.org) We have advanced protocols, work with a lot of autonomy in the field, effortlessly switch between 911 response and critical care transports, and maintain a 3-5 minute response time anywhere in our community. I carry a critical care reference in my pocket, have to study to keep up with the new changes in our protocols (Coming soon: Field-initiated Therapeutic Hypothermia), and regularly work with physicians to determine the best course of treatment during long-distance critical care transport. Ever maintained a vent, conscious sedation, and 4 drips for an hour-long transport? I do, a lot, and I barely make enough to cover lunch for my trouble.

What other healthcare profession would put up with this? Seriously… I mean, are paramedics worthless?

According to Salary.com here are some job titles and pay ranges for comparable healthcare positions in my town:

Job Title – (percentage of income levels on the right)

10th %

25th %

75th %

90th %

Paramedic (EMT-P)

$29,659

$34,112

$44,181

$48,896

EMT (EMT-B)

$22,285

$25,396

$32,810

$36,449

Registered Nurse (Staff RN)

$49,911

$55,582

$67,474

$72,629

Resp. Therapist (RRT)

$48,129

$51,740

$60,200

$64,292

Radiology Tech. (X-ray Tech)

$39,030

$42,743

$51,168

$55,125

Police Officer

$33,661

$41,185

$58,338

$66,432

High School Teacher

$31,479

$41,345

$61,293

$69,588

HVAC Mechanic

$28,971

$34,026

$46,467

$52,739

Fast Food Cook

$13,013

$15,352

$21,257

$24,294

Security Guard (unarmed)

$21,809

$25,479

$33,272

$36,698

The Median household income in the Zip Code queried is $43,408

So, there are four job titles that make less than paramedics up there, one of them is the EMT-Basic (and that’s a given), the others are the “fast food cook”, “HVAC Mechanic”, and the “Security Guard”. The RN and the RRT (almost) start higher on the bottom scale than the Paramedic’s top income level. A Police Officer, who by definition works for a governmental agency is lower on the above scale than the RN, RRT, and X-Ray Tech, but tops out higher than everyone but the teacher, RN and the RRT. In addition, the Police Officer has a career advancement ladder and benefits including retirement, healthcare, and other benefits. I just got a high-deductable healthcare policy after I found out that I have no sick time. In addition, I’m close to 10% on the above scale.

I thought about writing this post after a good friend of mine who is a HVAC (Heating, Ventilation, and Air Conditioning) Tech told me that he was pretty tired after working last week. He said that he had put in 62 hours and got a WEEKLY paycheck that is more than my biweekly paycheck for working OVER 100 HOURS PER WEEK. He’s a great guy, and he works hard and deserves his money. I’m not saying that he isn’t worth everything he gets. However, last week I saved two lives (Had two “Snatch life from the jaws of death calls”) and took some complicated medical issues in the back of my truck. I taught new EMTs and EMT-Ps and took care of everyone I had contact with to the very best of my ability. I’ve also had some years of college and carry a medical license. Look at the job titles up there. There’s a few of them that can kill people if they have a bad day, however it’s debatable if any of them have more responsibility than a paramedic.

There’s some other information that we can draw from the above scale. There are ten job titles up there. Broken down further:

Minimum Entry-Level Educational level

Certificate

Assoc. Deg.

Bachelors Deg.

Higher

Paramedic (EMT-P)

X

EMT (EMT-B)

X

Registered Nurse (Staff RN)

X

Resp. Therapist (RRT)

X

Radiology Tech. (X-ray Tech)

X

Police Officer

X

High School Teacher

X

HVAC Mechanic

X

Fast Food Cook

X

Security Guard (unarmed)

X

Mid-Career Educational level

Certificate

Assoc. Deg.

Bachelors Deg.

Higher

Paramedic (EMT-P)

X

EMT (EMT-B)

X

Registered Nurse (Staff RN)

X

Resp. Therapist (RRT)

X

Radiology Tech. (X-ray Tech)

X

Police Officer

X

High School Teacher

X

HVAC Mechanic

X

Fast Food Cook

X

Security Guard (unarmed)

X

High-End Educational level

Certificate

Assoc. Deg.

Bachelors Deg.

Higher

Paramedic (EMT-P)

X

EMT (EMT-B)

X

Registered Nurse (Staff RN)

X

Resp. Therapist (RRT)

X

Radiology Tech. (X-ray Tech)

X

Police Officer

X

High School Teacher

X

HVAC Mechanic

X

Fast Food Cook

X

Security Guard (unarmed)

X

The above standards aren’t based upon statistics, and I can’t find where to get accurate, verifiable information on that. However, from my personal knowledge of the above career types through friends and acquaintances that are in the above professions, this is as close as I can get. I could infer that every EMT-B advances to the paramedic level when wanting to advance their career however some communities only have an EMT-B response and there is no reason for some EMS people to attain the paramedic certification. (Really, why would they when they can make more as any other profession with like educational standards) It is interesting that there are progressive career levels for higher educational levels in the other career paths, but not for EMS people.

Are paramedics worthless? Or are we keeping ourselves down? Is there a reason that our salaries are so low?

I think that it is because the public doesn’t know what we do, nor have they been made to care. In my community, the taxpayers pay a minuscule amount to the ambulance service compared to the Fire Department, Police Department, Street Department, Sanitation Department, and pretty much everything else. Is it because the public doesn’t care?

I don’t think so. I think that as a profession, we accept the offensive compensation because we love the job so much. We accept it, and then work for the services that pay us this because there are no viable market alternatives. Unions have made inroads in improving our pay… but at what cost to the true calling of the profession?

EMS 2.0 needs new revenue sources to provide value to our profession. EMS 2.0 needs market valuation for paramedical skills commensurate with our true worth. EMS 2.0 needs people who are willing to become true professionals and hold ourselves to stringent professional standards. EMS 2.0 needs paramedics and EMTs willing to rise to the challenge, and unwilling to accept where we’ve found ourselves.

Are we worthless?

Posted by Ckemtp on July 5, 2009 • Filed under: Ambulance, EMS, EMT, Fire department, Paramedic, ems 2.0, ems salary, paramedic salary, salary

When God made Paramedics

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Usually I don’t get into emotional fluff or “hero-worship” type stuff… but this one’s an oldie but a goodie. I didn’t write it, I don’t know who did… but as I sit here with my beautiful Gkemtb at my side and my kitty on the other side, I wax poetic…

Maybe it’s the beer?

———————————–
When God made paramedics, He was into His sixth day of overtime. An angel appeared and said, “You’re doing a lot of fiddling around on this one.” God said, “Have you read the specs on this order? A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn’t touch, and not wrinkle his uniform.”

“He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again.” “He has to be in top mental condition at all times, running on no sleep, black coffee and half eaten meals, and he has to have six pairs of hands.”

The angel shook her head slowly and said, “Six pairs of hands…no way.”

“It’s not the hands that are causing me problems,” God replied. “It’s the three pairs of eyes a medic has to have.”

“That’s on the standard model?” asked the angel.

God nodded. “One pair that sees open sores as he’s drawing blood, always wondering if the patient is HIV positive.” (When he already knows and wishes he’d taken that accounting job)

“Another pair here in the side of his head for his partner’s safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, “You’ll be alright ma’am when he knows it isn’t so.”

“Lord,” said the angel, touching His sleeve, “rest and work on this tomorrow.”

“I can’t,” God replied. “I already have a model that can talk a 250 pound drunk out from behind a steering wheel without incident and feed a family of five on a private service paycheck.”

The angel circled the model of the Paramedic very slowly. “Can it think?” she asked.

“You bet”, God said. “It can tell you the symptoms of 100 illnesses; recite drug calculations in it’s sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear… and it still keeps it’s sense of humor.” “This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim’s family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call back.”

Finally, the angel bent over and ran her finger across the cheek of the Paramedic. “There’s a leak,” she pronounced. “I told You that You were trying to put too much into this model.”

“That’s not a leak,” God replied, “It’s a tear.”

“What’s the tear for?” asked the angel.

“It’s for bottled up emotions, for patients they’ve tried in vain to save, for commitment to that hope that they will make a difference in a person’s chance to survive, for life.”

“You’re a genius!” said the angel. God looked somber, stiffened, and said “I did not put it there”.

- Author Unknown

——————–

For more on this emotional, fluffy crap read:

“Enough to Make an Old Medic Melt” and,
“Splashed Sadness, a look at Negative Emotions in EMS”

Posted by Ckemtp on July 1, 2009 • Filed under: Ambulance, CISD, EMS, EMT, Fire department, Paramedic, emotions, when god made paramedics

More on EMS Narrative Reporting

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I’ve been getting a lot of Google traffic by people looking for examples of EMS patient care reports. So, to satisfy their needs, (and to increase my Google traffic by people looking for EMS patient care reports, EMS Narrative reports, and paramedic narratives) (yes, those were key words) I am going to write a few completely fictitious narrative reports here, and analyze why I write them the way that I do.

I wrote a good piece on this very subject, and for newcomers to the blog you can find it here: “Soapy Pictures – The EMS Narrative Report”

——————————————-

The narrative is the most useful component of the EMS patient care report. It is the part of the report that is actually read, understood quickly, and most useful to the humans who have to act on the information provided in the patient care report. Humans don’t process the information gathered by all of the check boxes and drop-down menus very well. If you’ve ever had to read many patient charts you’ll quickly understand why. The check boxes and menus store information in a way that is good for computer processing and statistical analysis, but not for rapid human comprehension. A good EMS Narrative report is a short story that explains the events of the call, the decisions made on the call by the paramedics and/or EMTs, the information available to the paramedics/EMTs that they acted upon to make the decisions they made, and the outcome of those decisions. It should also “Set the scene” for the reader, and explain the circumstances of the call, the events leading up to the call, the way that the call was handled, and provide enough information so that anyone reading it gets a good sense of all of the information gathered by the EMS people who were there. I don’t advocate the use of automatic narrative generators as included in some software packages, because computers can’t write something that humans usually find useful.

Think about it this way, you’re writing your narrative reports for these audiences:

  • Healthcare providers farther down the line who will be taking care of the patient after you transfer patient care – These people are not just the Nurses and Doctors at the ER who you leave your patient with. Your PCR (in most areas and if it isn’t this way in your area it should be) is part of the overall patient chart and is the best window to the patient’s initial presentation when their condition is in its most acute stage. Remember, EMTs and Paramedics are “The eyes and ears of the physician” at an emergency scene. A good EMS narrative report on your PCR provides that view of the patient to every healthcare provider who takes care of the patient, including the patient’s primary care physician and any specialists that care for the patient later. I’ve seen many times where a quick-thinking paramedic was able to obtain an EKG strip and a good assessment during a patient’s undiagnosed episode of tachycardia and write a good narrative explaining their assessment findings which then enabled a cardiologist to immediately make a diagnosis and save the patient weeks of wearing a Holter monitor to try and reproduce the rhythm for a diagnosis.

    In addition to all of the above, you will be judged on the quality of your narrative by the healthcare providers down the line, your service will be judged, and our profession will be judged. If you write a narrative report that is full of poor grammar, misspelled words, nonsensical statements, and other gobbledygook, other healthcare providers will think you’re an idiot. If they see your reports as inferior to other service’s reports, they’ll think your service is a bunch of idiots. They may even think that all EMTs and paramedics are complete nincompoops. I’ve heard complaints that the ER people never read the patient care reports that ambulance crews leave for them. Maybe it’s because they have read too many of them that are complete nonsense. Rite dem gud reports gize!

  • Your Management and Your Medical Director – A good EMS Quality Assurance/Quality Improvement program is impossible without good EMS reporting. It isn’t about a game of “Gotcha!”. It’s about documenting how protocols, procedures, policies, and operations really work in the field. If you have a patient that the medical director follows up on after their care in the ER, the first thing that he or she is going to do is read your narrative to find out what you did, what protocol you followed, and why you did it. If you paint them a good picture, they may find the information useful enough to be able to tweak protocols and fine-tune procedures. Sure, you may get a talking-to occasionally, but a well-documented call that doesn’t quite go to plan is always better than a poorly documented call that doesn’t go according to plan. You’re protecting yourself and your crew. If everyone writes a good narrative, everyone is working to improve patient care.

  • Lawyers – Who didn’t see this one coming? It’s not my quote, but I’ve said it before and I’ll say it again: “If you didn’t write it, you didn’t do it… unless it was bad. Then, if you didn’t write that you DIDN’T do it, you did do it”. EMS people get sued sometimes. Nice, caring, professional, and compassionate people get sued sometimes. It often doesn’t make sense why, either. I wouldn’t say that there is an epidemic of lawsuits against individual providers or ambulance services, but it can and does happen more often than we want it to. Writing a “LEGALLY DEFENSIBLE” narrative report is key. Always do this, read more on this below. However, it’s not just lawyers that want a piece of you that read patient care reports. Lawyers that handle civil cases for our patients read them in order to gather information about lawsuits that our patients file. EMS Patient care reports are a wealth of information for civil attorneys litigating workers’ compensation cases, car accidents, accidental injuries, and fraud. By not writing good narratives, we can damage our patients’ legal cases. By providing factual, relevant information, we can protect the innocent parties in legal cases. If you’re ever called to testify in one of these types of cases, you’ll appreciate having written a good narrative. Trust me.

  • Your Own Backside – Remember what I said above about writing a “legally defensible” narrative? This means that you need to write your narrative in such a way that you look like a true professional in the eyes of the court. Even if you did everything exactly right, if you documented the call like a D-minus third-grade book report on “Snuggles the Wonder Kitten“, you’re an idiot in the eyes of the jury. The jury, or judge, thinks that idiots are probably negligent. Therefore, people who write bad narratives are probably doing other things badly, and people who do things badly are doing them negligently. It’s not a good situation and not one that you’re likely to win. I’ve always said that I will make tough decisions when I have to, and will even bend the rules a bit if it is the right thing to do for the patient. However, if and when you have to do this, make sure that you clearly document:

    • The reasons you were in the situation where you had to bend the rules and/or make a tough decision
    • The information you had available to you that caused you to make the decision you did
    • The options you considered that were less desirable than the decision you ultimately made, and why
      they were less desirable
    • Why you felt it was best for the patient, even if and especially if the decision went wrong
    • (Make sure it was the best for the patient)

    Document everything. If it was minus-30-degree weather and it was best for the patient to not put them in a KED because they would be frostbitten by the time you were done, that is information that would help you if they had an occult c-spine fracture from an auto accident. If the patient was trying to knock your teeth out and you restrained them, that is also good information. If you withheld a medication indicated by protocol, say adenosine for a Narrow Complex Tachycardia because you saw a ramp-up (delta wave) between the P-wave and the QRS complex indicative of Wolf-Parkinson-White syndrome where adenosine is contra-indicated, you should probably document that well. Good documentation is documentation that gives a full picture of the scene for those that read your report. Document a full assessment (DO A GOOD ASSESSMENT, then document it). Document your working diagnosis and the differential diagnoses that you considered and ruled-out. Document the treatment you gave per protocol and the response that the patient had to the treatments given. Document how you were dispatched to the call and how you responded. Document information that you gathered from people at the scene, and who those people were. Document what you saw when you arrived on scene. Document more than you think that you should. Make sure that its coherent information. I’m going to harp on this again: By all means possible, USE PROPER ENGLISH, SPELLING, GRAMMAR, and PUNCTUATION! Spell check is a great tool. However, it doesn’t differentiate between the RIGHT words for the sentence, and the WRONG words. Your going to be wrong if you re-lie only one spell cheque (Yes, those were the wrong words. No, Spell check didn’t catch it. Got it?)

In the previous post, I spoke about the fact that I use the “SOAP” method to write my EMS narratives. I didn’t intend to do it this way, and I used to think that I hated it until I realized that it was what I was using when nobody told me to. “SOAP” is an acronym that describes the “SOAP Charting method” I don’t know who came up with it, but the letters stand for “Subjective, Objective, Assessment, Plan” (See HERE to go to the other post to read more on it.) These things help you organize the information in a readable format. I think that they help “set the stage” for the short-story that is your narrative.

Here’s two examples of “Subjective” information:

  • Ambulance 1-J-26 dispatched emergent through the 911 system to the scene of a two-vehicle MVC with injuries on a two-lane 55mph rural highway. Upon our arrival we found a “head-on” style collision between two late-model pick-up trucks with heavy damage to both vehicles on their front driver’s side. Triage was initiated and this Patient (Pt) was identified as critical. There were four injuries on this scene. The Pt in this report was the restrained driver of a late-model pickup truck with heavy front-end damage and intrusion into the passenger compartment. Pt was pinned in the vehicle upon our arrival with his chest set between the steering wheel and the seat. Pt was conscious, alert, and oriented x 2 with labored breathing but no apparent airway compromise. Fire/Rescue notified of the need for heavy extrication and a Med-Pigeon Helicopter was requested for a scene response. Traffic control and the landing zone referred to Anytown Sherrif’s Dept already on scene.

    .

  • Ambulance 1 dispatched non-emergent for the routine scheduled transfer of the 59yo F Pt from HOLY BEAGLE HOSPITAL –Rm #223 to ST. BERNARD REGIONAL ICU. Upon our arrival we found the Pt’s RN who gave us a passdown report on the Pt. Pt had been admitted to Holy Beagle for treatment of an exacerbation of CHF and had been diagnosed with further respiratory compromise related to pneumonia per her physician. Pt was being transferred for ICU care at St. Bernard. Found the Pt Conscious, Alert, and oriented x 2 with ABCs intact.

These are the first type of sentences that I write into my narrative reports. It is “Subjective” information because it sets the scene. It states who you are, how you were dispatched, what you were dispatched for, where you were dispatched to, and what you found immediately when you got there. The second one states who you received information from: The patient’s RN. Notice that I put in statements containing the patient’s level of consciousness, airway patency, respiratory effort, and circulatory status. I think that this helps to show that you began your assessment immediately upon laying eyes upon the patient.

Continuing, some examples of “Objective” information, continuing on with the two narratives above:

  • Pt was still located in the driver’s seat and was able to understand that he had been in a severe car accident. Pt had strong and rapid radial pulses noted but had shallow respirations. Pt was unable to tell us what time or what day it was. C-spine precautions were initiated in the vehicle with a c-collar and manual stabilization as fire/rescue extricated the patient. Extrication took approx. 10min. Patient was removed via backboard and secured with straps, head blocks, and tape. Pt secured on cot. Due to 10min ETA from ther responding helicopter EMS and an estimated 30min transport time to a trauma center, Pt was taken to the ambulance for stabilization. Patient with CC (Chief Complaint) of chest pain and dyspnea.

  • P t was sitting upright in her hospital bed. Pt on EKG monitor showing NSR s ectopy. Pt had been given a 20ga IV in her R hand and was receiving an IV drip of 1000ml Normal Saline at 100ml/hr and an IVP drip of Levaquin via that IV site. RN std that Pt had also received an IV bolus of 40mg Lasix approx 20min prior to our arrival as well as 1000ml Tylenol PO for a recurrent fever, last measured at 101.5 degrees. Pt was on o2 at 4-LPM via NC bringing her SpO2 to 98%. Pt had a foley cath in place (thank goodness). Pt was unable to ambulate due to her condition and resultant weakness. Pt secured on cot and taken to rig. Vital signs assessed and per previous in this report (Yes, this is the ONE thing that the check boxes are good for). Pt denied CC other than of being tired.

This is the second section of my EMS narrative report. It is called the “Objective” information because it is information you get through objective observation (think the scientific method). Objective observation is what you observe while you are there when looking at the scene with a trained eye. This could include the initial assessment (or primary assessment, whatever the kids are calling it these days) and a discussion of the life threats or lack thereof that you see. This is information directly gathered by you about the patient.

The “Assessment” portion, and the continued examples from above: (I write “ASSESSMENT” in capital letters in order to differentiate the report. You don’t have to, but I just always have)

  1. ASSESSMENT: As above. Skin Pale, cool, diaphoretic. Pupils PERRL. No evidence of head trauma. JVD (Jugular Venous Distention) noted. Trachea midline/mobile. Chest with asymmetrical movement to inspirati
    on, markedly decreased breath sounds in both R upper and R lower chest, bruising, abrasions, and what appeared to be a steering wheel imprint left in Pt’s chest with other indications of thoracic trauma. ABD tender to palpation in the RUQ and LUQ, not noticeably distended. Pelvis intact. Extrem c weakening peripheral pulses but good motor and sensation. Pt seemed to be becoming increasingly lethargic, confused, and agitated. Pt was loudly complaining of chest pain and diff. breathing, stating that it “hurt to breathe”. Pt’s Blood Pressure (BP) taken q 5min showed 1st reading at 134/84, 2nd reading of 128/92, and 3rd of 110/98.

  2. ASSESSMENT: As above. Skin Warm, pink, and moist. Pupils PERRL, no JVD, trachea M/M, Chest equal rise/fall bilaterally c diffuse rhonchi and rubs throughout. ABD SNT. Extrem c good Pulse/motor/sensation/temp x 4. Some pitting edema noted to both lower extremities. Pt was resting comfortably and std that she “felt much better” after the Tylenol. Pt denied other complaints.

    The “Assessment” portion of the report is the secondary assessment, the detailed assessment, and/or the focused assessment. At a minimum, it should include what are called “pertinent negatives”. These are things that you should always put in every report. Detail a head to toe assessment. The “pertinent negatives” as they are called, are negative assessment findings. Even if you don’t find anything, you write that you didn’t find anything to prove that you looked at it. I think that you should avoid acronyms such as “normal”, or WNL (Within Normal Limits) as they prove only that you didn’t really look. Normal is a subjective statement. If the skin is pink, warm, and dry, write that. Don’t just write “Skin normal”, because a lawyer will pick you apart on what “normal” is for that exact patient, and just how exactly you are qualified to know what “normal limits” are for that patient population. I always break the assessment portion into the same format: Skin signs, head, pupils, trachea, JVD/no JVD, Chest condition and lung sounds, Abdominal findings, pelvis (for trauma), then extremities. After that, I write specific assessment findings that don’t fit into the above sentence. Feel free to get as detailed as you need to in writing details about the various organ systems. I also write “as above” in the first part in order to tie in any assessment findings that I may have included in the above two sections. This is a very important part of the narrative, write it well.

Finally, the “Treatment Plan” section: (I always write “TREATMENT” in caps, once again, just ‘cuz I do)

  1. TREATMENT: As above. Pt placed on 15-LPM o2 via NRB while still in the vehicle. Bilateral IVs started with a 14ga in L AC and a 16ga started in R AC. Both IVs running 1000ml warm NS fast TKO. Pt placed on 5-lead EKG showing S-tach (Sinus Tachycardia) with occasional PVCs. Pt’s abrasions and various superficial bleeding controlled c gauze and tape. Due to Pt’s increasing dyspnea, narrowing pulse pressures, JVD, and decreased breath sounds on the R side a needle decompression was performed in the R upper chest (beween 2nd/3rd intercostals) with 14ga IV cath and flutter valve placed. Pressurized air return noted in syringe upon penetration of the pleural space. Note trends of vital signs. Pt’s breathing improved markedly and Pt’s LOC began to improve. Pt continuously monitored during and after treatment.

  2. TREATMENT: All inpatients treatments continued. Pt maintained on o2. Pt maintained on EKG showing NSR s ectopy. Pt rested comfortably during transport without any additional complaints. VS (vital signs) q 15min without change observed.

As far as the “Treatment” section is concerned, write what you did and how the patient responded. For routine treatments, such as oxygen, bandaging, splinting, and an IV, I usually just write that I did them if the patient condition is such that they would be automatically assumed to be done. For more complex treatments, such as medication given or the pleural decompression described above, I document the rationale and the technique used. A good rule of thumb is: The more invasive the treatment, the more you should write why and how you did it. You should also write how the patient responded to the treatment, and if you considered one treatment over another, write that too.

To end my report, I put the patient’s disposition. I also include a statement on how I contacted the receiving hospital (in my case) or medical control:

  1. Receiving hospital notified of incoming level 1 trauma by MedChannel radio. Med-Pigeon Flight crew arrived and our crew assisted in packaging the patient. Handed over Pt care to flight crew and assisted with transporting the Pt to the waiting helicopter. Care transferred.

  2. Pt transported and transferred to St. Bernard ICU RN staff s incident or exacerbation of condition.

    The above statements concern what you ended up doing with the patient. Always show that you passed the patient to an equal or higher level of care. Show that it was an orderly and legal transfer. If you are calling into the base hospital or medical control, state any orders received and who gave them to you (“Formerly St. Hospital contacted via MedChannel with orders received to administer 1 amp D-50 per Dr. Marcus. Order confirmed. 1 amp D-50 given per the order”). If you receive no orders, write that too. I always include the phrase “Pt transported and transferred (to whom) s (which means “without” in case you were wondering) incident or exacerbation (which means, “to get worse”) of condition”.

Now, let’s bring together the reports #1 and #2 so you can read them as a whole:

  1. Ambulance 1-J-26 dispatched emergent through the 911 system to the scene of a two-vehicle MVC with injuries on a two-lane 55mph rural highway. Upon our arrival we found a “head-on” style collision between two late-model pick-up trucks with heavy damage to both vehicles on their front driver’s side. Triage was initiated and this Patient (Pt) was identified as critical. There were four injuries on this scene. The Pt in this report was the restrained driver of a late-model pickup truck with heavy front-end damage and intrusion into the passenger compartment. Pt was pinned in the vehicle upon our arrival with his chest set between the steering wheel and the seat. Pt was conscious, alert, and oriented x 2 with labored breathing but no apparent airway compromise. Fire/Rescue notified of the need for heavy extrication and a Med-Pigeon Helicopter was requested for a scene response. Traffic control and the landing zone referred to Anytown Sherrif’s Dept already on scene. Pt was still located in the driver’s seat and was able to understand that he had been in a severe car accident. Pt had strong and rapid radial pulses noted but had shallow respirations. Pt was unable to tell us what time or what day it was. C-spine precautions were initiated in the vehicle with a c-collar and manual stabilization as fire/rescue extricated the patient. Extrication took approx. 10min. Patient was removed via backboard and secured with straps, head blocks, and tape. Pt secured on cot. Due to 10min ETA from ther responding helicopter EMS and an estimated 30min transport time to a trauma center, Pt was taken to the ambulance for stabilization. Patient with CC (Chief Complaint) of chest pain and dyspnea. ASSESSMENT: As above. Skin Pale, cool, diaphoretic. Pupils PERRL. No evidence of head trauma. JVD (Jugular Venous Distention) noted. Trachea midline/mobile. Chest with asymmetrical movement t
    o inspiration, markedly decreased breath sounds in both R upper and R lower chest, bruising, abrasions, and what appeared to be a steering wheel imprint left in Pt’s chest with other indications of thoracic trauma. ABD tender to palpation in the RUQ and LUQ, not noticeably distended. Pelvis intact. Extrem c weakening peripheral pulses but good motor and sensation. Pt seemed to be becoming increasingly lethargic, confused, and agitated. Pt was loudly complaining of chest pain and diff. breathing, stating that it “hurt to breathe”. Pt’s Blood Pressure (BP) taken q 5min showed 1st reading at 134/84, 2nd reading of 128/92, and 3rd of 110/98. TREATMENT: As above. Pt placed on 15-LPM o2 via NRB while still in the vehicle. Bilateral IVs started with a 14ga in L AC and a 16ga started in R AC. Both IVs running 1000ml warm NS fast TKO. Pt placed on 5-lead EKG showing S-tach (Sinus Tachycardia) with occasional PVCs. Pt’s abrasions and various superficial bleeding controlled c gauze and tape. Due to Pt’s increasing dyspnea, narrowing pulse pressures, JVD, and decreased breath sounds on the R side a needle decompression was performed in the R upper chest (beween 2nd/3rd intercostals) with 14ga IV cath and flutter valve placed. Pressurized air return noted in syringe upon penetration of the pleural space. Note trends of vital signs. Pt’s breathing improved markedly and Pt’s LOC began to improve. Pt continuously monitored during and after treatment. Receiving hospital notified of incoming level 1 trauma by MedChannel radio. Med-Pigeon Flight crew arrived and our crew assisted in packaging the patient. Handed over Pt care to flight crew and assisted with transporting the Pt to the waiting helicopter. Care transferred.

  2. Ambulance 1 dispatched non-emergent for the routine scheduled transfer of the 59yo F Pt from HOLY BEAGLE HOSPITAL –Rm #223 to ST. BERNARD REGIONAL ICU. Upon our arrival we found the Pt’s RN who gave us a passdown report on the Pt. Pt had been admitted to Holy Beagle for treatment of an exacerbation of CHF and had been diagnosed with further respiratory compromise related to pneumonia per her physician. Pt was being transferred for ICU care at St. Bernard. Found the Pt Conscious, Alert, and oriented x 2 with ABCs intact. Pt was sitting upright in her hospital bed. Pt on EKG monitor showing NSR s ectopy. Pt had been given a 20ga IV in her R hand and was receiving an IV drip of 1000ml Normal Saline at 100ml/hr and an IVP drip of Levaquin via that IV site. RN std that Pt had also received an IV bolus of 40mg Lasix approx 20min prior to our arrival as well as 1000ml Tylenol PO for a recurrent fever, last measured at 101.5 degrees. Pt was on o2 at 4-LPM via NC bringing her SpO2 to 98%. Pt had a foley cath in place (thank goodness). Pt was unable to ambulate due to her condition and resultant weakness. Pt secured on cot and taken to rig. Vital signs assessed and per previous in this report (Yes, this is the ONE thing that the check boxes are good for). Pt denied CC other than of being tired. ASSESSMENT: As above. Skin Warm, pink, and moist. Pupils PERRL, no JVD, trachea M/M, Chest equal rise/fall bilaterally c diffuse rhonchi and rubs throughout. ABD SNT. Extrem c good Pulse/motor/sensation/temp x 4. Some pitting edema noted to both lower extremities. Pt was resting comfortably and std that she “felt much better” after the Tylenol. Pt denied other complaints. TREATMENT: All inpatients treatments continued. Pt maintained on o2. Pt maintained on EKG showing NSR s ectopy. Pt rested comfortably during transport without any additional complaints. VS (vital signs) q 15min without change observed. Pt transported and transferred to St. Bernard ICU RN staff s incident or exacerbation of condition.

The two reports above could not be much more different, however if you look, they are both written using the same, versatile format. SOAP is a tool for you to use to help organize your information and tell your story of the patient care. Use it as a guide, or a process. Don’t use it as a strict format. It will help you as it has me.

Remember, the SOAP chart is just one example of the EMS narrative report, the EMS patient care report, the Paramedic narrative, the EMT narrative, the ambulance report, or the patient chart. Written well, and you are improving your patients’ care. Write it poorly, and you’re harming your patient and maybe looking like an idiot.

You may print this out and use it with my permission, as long as there’s a link: http://proems.blogspot.com – and my e-mail: Proems1@yahoo.com

Till later, all.

Posted by Ckemtp on June 26, 2009 • Filed under: Ambulance, EMS, EMS narrative report, EMT, Fire department, Paramedic, ambulance report, ems narrative, ems patient care report, narrative, narrative report, paramedic narrative, pcr

The Insanely long work week – Part 14 2/3

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[youtube=http://www.youtube.com/watch?v=n4LwJnuPVbY&color1=0xb1b1b1&color2=0xcfcfcf&feature=player_embedded&fs=1]

This has been my shifts so far. One really good save at the start of it, then… well, this.

I was the cat at the end. I envision that there’s an epic fail coming up

Posted by Ckemtp on June 25, 2009 • Filed under: Ambulance, EMS, EMT, Fire department, Paramedic, fire, shift length

Video – Rockford, Illinois – Train derails and explodes during severe thunderstorm

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June 19th, 2009 – Rockford, IL

So last night, I was working my ambulance job in Wisconsin and MISSED THIS. My Illinois Fire Department sent an engine and a chief through the MABAS system who are still there. I don’t have all the details, but apparently a severe thunderstorm washed out railroad tracks which caused a train to derail. The train was carrying haz-mat. It ‘sploded, sending a fire ball 300 feet into the air.

Wow. And I missed it. I slept most of the night. They are reporting that there is one dead and nine injured. Those poor people. God’s blessings to the rescuers and the victims.

You can get more details at: the Rockford Register Star

Update: Here is some more information from RRstar.com

Posted by Ckemtp on June 20, 2009 • Filed under: EMS, EMT, Fire department, Firefighter, MABAS, Paramedic, Rockford, explosion video, fire, illinois, train derailment, train explosion

“In Their Eyes” – From Guest Author – Randy Lovelace EMT-B

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Ladies and Gentlemen, Boys and Girls, EMS people and Firefighters,

I bumped this post up, because Randy’s such a darn good guy.

This post is placed with the permission of the author, Randy Lovelace EMT-B. He’s a friend of mine and a firefighter/EMT-B at a department where I work. He wrote this article after a training that our department completed and it was just published in our department’s monthly newsletter. I believe that the post needs more exposure, because it is just great. It exemplifies the camaraderie and community spirit that is embodied in our small-town department (that runs about 3k calls a year). We’re an anomaly, our small-but-proud department. We’ve got a fanatically devoted, passionate group of highly trained volunteer firefighters and EMTs that provide the best possible service to our citizens.

I’ve taken out the references to our department because I try to maintain my anonymity to provide another level of protection of patient confidentiality. It doesn’t detract from the piece.

Thanks Randy, great article.

————————————

In Their Eyes

Last Saturday, May 30th, the Mid-Size Midwestern Fire Department held training for all members at the Greenlee Farm site. Everyone that came was kept busy with all the work of training evolutions, scenario management, fire control, safety, and finally, the actual burning of the house on the property.

Throughout the morning, people started coming out to the site to see what was going on and find out why there was so much activity. Many of those people, however, were family members of the firefighters. There were wives, children and significant others all interested in seeing what we do and how we do it.

For the firefighters, the activities were fairly fast-paced. Most of the training was geared towards fire suppression, which required teams to advance hose lines into the burning structure, identify the source of the fire and its fuel, and correlate the conditions inside with a method of fire attack that would result in the maximum possibility of success while subjecting the firefighters to minimum risk. Some new operators were manning the pump controls on the engines, others were shuttling water from the nearest water source to our site, and dumping it into porta-tanks for use by the firefighting teams.

Instructors, safety personnel, training officers and operations officers all worked throughout the morning, checking everything, verifying that all risks had been mitigated as much as possible, and that all planned training was taking place on time to previously determined standards.
For many of the firefighters running evolutions against the scenarios, this was their first time in a burning structure beyond our training tower. This was their first time fighting fire in scenarios where the fire could get away from them, and their first time in conditions where the heat was a physical entity – attacking you as soon as you entered the house.

Our probies proved that morning that they knew how to properly check their nozzle and hose line before entering a structure. They remembered that you turn the nozzle head to the right (for a stream pattern) to fight the fire, and verify you have water, not air, coming out that hose. They didn’t know that our primary interior training officer was intentionally setting the nozzle for a fog pattern every time a previous team got done, just to test what they did remember. Even our newest firefighters remembered that you position yourself outside the hose line as it turns around a corner, and they all got to experience what it truly meant to back up the nozzle man – that they were his eyes, his guardian angel. They learned how much they could ease the work of aiming the nozzle for the nozzle man, or make it extremely difficult to even hit the fire if they positioned themselves improperly. They demonstrated that although the fire was exciting, it was a known force, and they were to look for the unknown dangers lurking in this burning environment in order to protect themselves and their partner.

Our new firefighters all came to understand the reason for properly wearing all their gear even outside the burning building. They got to feel the immense heat of the fire from 10 yards away, and they felt how much their gear does shield their skin from that heat. They learned that a fog spray from a nozzle can create a magic barrier, insulating them from the heat and allowing them to complete tasks near the fire.

At the end of the day, we had probies and rookies saying they’d never been this hot, they didn’t remember a time when they were this tired. Firefighters of all levels of experience were drenched in sweat, looking for any place at all to sit down, rest and cool off. This day, everyone worked their tails off, everyone was tired, and most had aches of one sort or another.
It’s days like this when we could have been mowing our lawns or napping in a hammock that each of us asks, “Why do I do this? Why do I give up my free time to train so hard?”
The answer to those questions could go in many directions. We could say there’s nothing better to do, it’s for the adrenaline rush, it’s for the camaraderie, it’s to get far away from the Wife’s Honey-Do list. But, reflecting honestly, I think we work and train like this for a different reason. I believe a small piece of each of us wants to be a hero. I’m not talking about saving the world all by ourselves, and I’m not talking about the rush to disaster when all others rush the other direction. I’m simply talking about doing something that needs to be done, when it needs to be done, and doing it well enough that we end up making things better, not worse, for all involved parties. I’m talking about doing the right thing, serving our community doing things that others will not or cannot do.

The belief I’ve just stated, however, was modified on Sunday, the day after our training burn and all that hard work. I got a phone call from my daughter, relating something that happened between my son-in-law (a firefighter) and his son, Austin.

Austin was at the fire on Saturday, and he watched everything he could. His eyes were flashing in every direction, seeing what was going on, where the fire was, what the firefighters did to contain it, watching pump operators, watching hose line tasks, listening to the commander give instructions over the radio. He looked for his father, wanting to see what Dad was doing. When his father sat down, Austin joined him, assuming the same posture. And Austin had the biggest smile I’ve ever seen on a child’s face during that entire time.

When he got home, Austin wrote his father a letter, and drew a picture for him. The letter, transcribed exactly, read:

To Daddy,

Dear daddy I loved waching the fire. It was one of the most coolest things I ever sean. I sean a fan fall that was fun. When I get older I hope I am going to be a firefiter. Just like you.

From Austin

(transcribed with permission from Austin and his Dad)

After my son-in-law read this letter, he was quoted as saying “Aw Buddy, that’s great. Thank you. I love you, too!”

When this story was related to me, tears began to form in my eyes, and I started to understand that I just might be wrong about this entire process. These people I trained with on Saturday, they’re not probies and rookies and veterans and officers, these people are family. I don’t train with them, and go to calls with them. I work with them. I work to protect them. I work to accomplish things together that we could never finish alone. And they all do the very same for me. We nurture each other, we care for each other, we make each other better people that any of us thought we could be.

This firefighting family isn’t a replacement for my own kin. But they’re a perfect model of our families at home. We do the same things at the department as we do at home. We protect and nur
ture, we prepare, we train, we work at home just as we do with the fire department.
I realized that we say we have many reasons for being volunteer firefighters, but in the end, we do it for our families. We do this because we have a need to teach our own how important it is to do good things. We teach them that rewards aren’t always monetary, quite often, they’re heartfelt. We teach them that hard work can be its own reward. In this process, we get benefits as well. We raise children that aspire to be like us, children that are excited for what we do, even when they see how hard we work and sweat to accomplish our tasks. We’re teaching future members of society to love the work we love, and we are preparing them to replace us when we’re too old to continue the exhausting pace that firefighting demands. We’re teaching our children that success exacts a toll – exhaustion, aches, sweat, time. Success demands that we first be ready for a challenge before we can tackle that challenge. And we teach them the sweet taste of victory when we’ve done all that work. We provide them with functional families, homes with love and caring, places to be safe from the rest of the world.

As you prepare for Father’s Day on the 21st, take time to reflect on what you’ve just read, as well as the following concepts. Please note, the phrase “father figure” implies gender, but there’s no gender requirement to be a father figure.

1. If you mentor, you’re a father figure to the one benefiting from your tutelage.
2. If you lead, you’re a father figure to those you command.
3. If you’re the Fire Chief, you’re a father figure to the entire department.
4. If you have children, you’ve already met at least 2 of the previous tests.

For each of us, there’s one more benefit. Austin said it in his letter and all of our children have said the same at one time or another. We’ve already done what we’re still hoping to accomplish. In their eyes, we’re already heroes.

———————————-

Comments on this post will be read by the author. He deserves kudos.

Posted by Ckemtp on June 18, 2009 • Filed under: Ambulance, EMS, EMS Blog Carnival, EMS Health & Safety, EMS Humor, EMS Topics, EMT, Fire Rescue Topics, Fire department, Firefighter, Public relations, appreciation, camaraderie, fire, fire truck, funny, humor, pride, volunteer fire department, volunteer firefighter

Good Post on "Rescuing Providence"

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The good Lieutenant over at “Rescuing Providence” has written a good and touching post on one of the simple pleasures in EMS.

http://rescuing-providence.blogspot.com/2009/06/difference.html

Since the wedding (OMG! Today is my 1 week anniversary and I haven’t gotten Gkemtb a gift yet!) (Awwww, I think I’m gonna get a cavity) (Cuz I’m so sweet)

Where was I? Oh yea. Since the wedding I haven’t had time to write any long posts. I’m going to work on it today because I’m on fire shift and so far have been practicing for the recliner racing 500. That’s one of the reasons that I’ve been putting up so many short posts and have been linking to the other great EMS bloggers. The other reasons involve the fact that the EMS blogosphere has been getting really, really good lately and every darn EMS person in the world could benefit from the knowledge and wisdome being put out there every day by my peers in the EMS blogosphere.

Have a great day folks, stay tuned.

Posted by Ckemtp on June 6, 2009 • Filed under: Ambulance, EMS, EMS blogosphere, EMT, Fire department, Paramedic, rescuing providence