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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

April 2nd, 2013 – Review of Yesterday’s “News”

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Yesterday I got a little carried away and put up what I believe a record number of articles posted in a single day. I wrote five hard-hitting, fact-filled pieces of “reporterage” that were examples of the hard-hitting journalism that hits close to home that you in no way have reason to have come to expect from me.

The fact that it was April 1st, 2013 has nothing to do with it as I maintain that most of these stories have at least some grains of truth to them.

Here they are:

·         SeekerCenter: An Option for the Pharmaceutically Denied

·         A Weighty Protocol Change

·         Right In the Nick of Time: Patient Saves his Paramedic

·         Who Needs them Paragods?

·         Paramedic Honored for Inaction in Local Ceremony

Of course, I wasn’t the only one posting about the “news” of the day, a few other bloggers got in on the action. Ambodriver broke the story of Detroit, who tried to privatize their EMS and got no takers as well as Facebook’s new EMS app.

Mick Meyers from Firehouse Zen wrote a serious reaction to a fictional piece written in The Onion about a line of duty death that asked “Are We off Limits?”

Probably EMS1.com took the cake though, with their factual article: Groundbreaking Research – Experts conclude EMS is Unneccessary

I stopped posting on my site when another blogger messaged me to tell me that I “sure was trying hard” that day and I didn’t tell you the story of the ambulance service that… Well, maybe I’ll save that idea for later. Anyway, enjoy this clip show. If you didn’t learn about the stuff in these articles, then you didn’t learn the news of the day.

Thanks for reading! I think for the rest of the month I’ll leave the funny stuff to my buddy Rescue Joe over at RescueHumor.com

 

Posted by on April 2, 2013 • Filed under: ambulance humor, Emergency Medical Services, EMS, EMS Humor, EMS Topics, Fire Rescue Topics, Uncategorized

Paramedic Honored for Inaction in Local Ceremony

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4/1/2013 Eugene, Oregon:

At small ceremony held today, Paramedic Christopher Downdike was honored by his ambulance service for having a near 95% against-medical-advice refusal of transport rate. Among other things, Paramedic Downdike was recognized by both his superiors and his peers for being able to sign off nearly 438 patients during calendar year 2012.

“For service far beyond what we could call ‘normal’ we recognize Paramedic Downdike for managing to not transport far more patients than could have been expected.” Said Chief Norberg of the Mountain Orchard EMS department. “Through his inaction, Paramedic Downdike has been able to save Medicare, Medicaid, and a number of other private healthcare insurance companies vast amounts of money that they otherwise would have wasted on paying for ambulance services.”

Displaying little more than his trademark apathy, Paramedic Downdike said that it hadn’t been easy. “First off, I couldn’t sign em’ all off. I mean, these people… they call us at like all hours of the day for stupid reasons. Why are they calling me when they could just as easily take a taxi or just drive themselves. Is it really a heart attack?? Geez… Not this time, buddy.”

Paramedic Downdike continued to deride patients who he felt were beneath his vast array of medical skills and level of competence. He let us know that most patients with “Chest Pain” were really just victims of indigestion that could probably just take some antacids and “be just fine” and that anyone complaining of back pain was “faking it so they can get drugs in the ER.”

“Call me when you’re dying and I’ll come save you. That’s what 911 is for. If you need a lot of my skills, then we’re good. But if you call me because you’re having something stupid like a broken arm, well then you better be able to sign that piece of paper because I ain’t havin’ it.” Said the heroic paramedic.

It wasn’t a perfect record though.

“There’s this stupid state law that says we can’t really tell someone that we’re not going to take them to the ER if they really want to go, so sometimes we’ve got no choice.” Paramedic Downdike explained. “A lot of those cases I was able to just turf to BLS but some of those yahoos actually made me take em’ to the hospital. Hello bench seat… you ain’t messin up my cot today!”

At the end of the ceremony, Paramedic Downdike received a call for a 2 year old having a seizure. He was heard muttering “Stupid parents who can’t give their kid Tylenol” as he sauntered off to “take a leak” before he left.

Posted by on April 1, 2013 • Filed under: Administration & Leadership, ambulance humor, Emergency Medical Services, EMS, EMS Humor, EMS Topics, Fire Rescue Topics, Paramedic, patient care, Uncategorized

Who Needs Them Paragods?

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4/1/2013 – Rhinelander, WI

Calling the county-based ambulance service “A bunch of dumb, know-it-all ‘paragods” Ernie Slater, a local volunteer Basic Level Emergency Medical Technician (EMT-B) dismissed calling for an Advanced Life Support (ALS) paramedic intercept for his patient with chest pain earlier this morning.

“Those dumb paramedics think they know everything” said Mr. Slater, hitching up his belt which in addition to holding up his EMS pants, also held a wide-array of pagers, radios, and EMS tools neatly arranged in holsters. “We show up and we can take people to the hospital. I mean, what more do they really need?”

Mr. Slater, who refers to Lifestar EMS, the county based paramedic service, as “Death Star” recently graduated from his EMT-Basic class at the local community college. He credits his vast amount of medical knowledge to the fact that he took the class three times before he passed it and had a lot of time to learn the information presented to him by the instructors, of whom he added “Were a bunch of idiots who didn’t know nothing.”

“We’ve got high-flow oxygen and can give nitro pills to anyone who needs em” He declared proudly, giving the patient their fifth pill since he assumed their care. Our service says we give them till the chest pain goes away and that’s what I’m going to do. I’m taking this guy to the ER down the street. I mean, what am I going to need those stupid medics for? Nothing.” He added “I got this.”

For his part, the patient, who called 911 this morning after awaking with crushing chest pain added “I can’t really complain about the care I’m getting, but shouldn’t an ambulance guy take the dip out of his mouth before he comes to your house? I’m pretty angry about him spitting tobacco juice on my carpet but how can you get mad at a volunteer?”

Paramedics, who can perform so-called “Advanced” treatments like starting IVs, giving medications, performing airway management techniques, and interpreting EKGs go to school for a significantly longer amount of time than do EMT-Basics. The length of school which Mr. Slater added “was stupid” and “dumb as hell”.  

“Why would I want to go to all of that extra school? I mean, I pretty much know everything they do and I see no reason why I can’t do all of the things like them ‘paragods” He opined derisively. “Starting an IV is easy and nothing they do is all that hard.”

At press time, Mr. Slater was planning to spend his evening hours playing video games at home rather than attending his service’s continuing education classes scheduled for tonight. 

 

Posted by on April 1, 2013 • Filed under: ALS Intercept, Ambulance Driver, ambulance humor, Emergency Medical Services, EMS, EMS Humor, EMS Topics, Fire Rescue Topics

Right in the Nick of Time: Patient Saves his Medic

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04/01/2013 – Peoria, Illinois

Calling it “A save right in the nick of time” Paramedic Jules Slatterly thanked chronic system abuser Wade Fugman for waking her up at 03:37am last Thursday.

Paramedic Slatterly explains “We had been running pretty hard all day on our 24-hour shift, with around 11 calls between noon and 1am. I finished all of the reports I was down around 0300hrs and was finally able to catch some sleep in the bunk room.” She added “I was so tired I didn’t even take my boots off.”

But that’s when Paramedic Slatterly’s early morning took a turn towards the disturbing…

“We all know that when you’re chronically sleep deprived that you can sometimes have some weird dreams. Well that night, I was having me a doozy of a nightmare. First I was naked in my Freshman English class, then every boy who ever forgot to ask me out on a date came by to laugh at my lifetime income potential as an EMS provider. If I would have been awake I would have been in tears.” Paramedic Slattery stated as she described her nightmare that affected her short amount of sleep that night.

But that’s when Mr. Fugman stepped in for the rescue.

“I was hungry and there ain’t no food like hospital food fo when you’s hungry.” Mr. Fugman told us. “You know them little juice cups? I get most of my Vitamin C from those Cranberry ones. I can’t get enough of ‘um. So sure enough, my sciatica started actin’ right on cue and 911 is just a phone call away.” Mr. Fugman, who calls 911 at least “four or five times a week” stated that he didn’t know he was saving Paramedic Slatterly from her short-lived nightmare, but he said he wasn’t surprised.

“I give those ambulance drivers their workout, I do. Since my sciatica is so painful I can’t be bothered to walk down the stairs from my apartment, let alone walk out of my back bedroom and down the hallway. It’s not my fault that the elevator’s broken. Let them ambulance drivers earn all those millions they get.”

At press time, Paramedic Slatterly was only slightly hallucinating from sheer exhaustion while working at her second part-time job.

Posted by on April 1, 2013 • Filed under: Als, EMS, ems education, EMS Humor, EMS Topics, Fire Rescue Topics, Paramedic

A Weighty Protocol Change

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04/01/2013 – Andrew, Illinois

Calling the move “A necessary step in the obfuscation of Medical Direction” Dr. Herbert Franzen of the Andrew Clinic EMS system laid out sweeping protocol changes for the EMTs and Paramedics under his medical control.

“I believe that all medication doses should be weight-based.” Says the physician, who wears a calculator watch circa 1985 rather than carrying a smart-phone. “Weight-based medication dosages allow for precise administration of medications to the broadest range of patients in an emergency setting. No longer will we just make blanket statements that call for giving, say, 25 to 50mg of diphenhydramine to patients in anaphylaxis. Now, paramedics will simply administer 0.252345 mg per kg in an emergency, making the dose all the more accurate every time.”

Several of the paramedics working for ambulance services within Dr. Franzen’s EMS system have started picking up math classes at the local community college in order to sharpen their arithmetic skills which are needed to comply with the new protocols. Paramedic Mark Hansen explains:

“I work in the system part-time and work full time under another set of protocols. At my other service, we follow ACLS guidelines and administer 1mg of 1:10,000 epinephrine every 3-5 minutes in a cardiac arrest. Now, according to Dr. Franzen we need to mix up a drip of 1:1000 epi in a bag of 250ml D5W and then administer 1.734mcg per kg per minute. It gives me a headache just thinking about it.”

Even common medication dosages like Zofran (ondansetron) are being changed. Commonly, the anti-nausea drug is given in handy 4mg increments which make dosing a patient easy and quick. Under Dr. Franzen’s system, however, the medication is given at 0.346 mg per kg to increase accuracy. Seizure patients will receive 0.452mg/kg of valium if they are under the age 34.2, 0.431mg/kg if they are age 34.2 to 47.6, and 0.344mg/kg if it’s before the vernal equinox.

“My protocols are enforced by a very proactive team of Quality Assurance personnel which make sure that the medics adhere to a very strict interpretation of the rules. Variances in protocol use will not be tolerated” Dr. Franzen said. He added with a laugh “I prescribe some pretty intense ‘reeducation’ for violations.”

At press time, we received a statement from “Gorgonz the Magnificent” from the Sleeter County, IL county fair who stated that with his experience in guessing people’s weights he is considering a career move to EMS. 

Posted by on April 1, 2013 • Filed under: Emergency Medical Services, EMS, EMS Humor, EMS protocols, EMS Topics, EMS training, Fire Rescue Topics, News, Paramedic, paramedic education, patient care, Patient Management

SeekerCenter: An Option for the Pharmaceutically Denied

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Gary, Indiana 04/01/2013

A new service announced today at a small, Gary based company seeks to provide a solution to many thousands of Americans suffering from a growing problem: Repetitive Pharmaceutical Denial.

Gary Lange, Senior Vice President of SeekerCorp announced in a press release dated yesterday that his company “Seeks to aid in the plight of many Americans who keep being denied access to the pharmaceutical enhancement they both need and desire.”

Calling the situation a “Crisis of Epic Proportions” in a subsequent interview, Mr. Lange called attention to the problem.

“Thousands, maybe hundreds of thousands of Americans are denied access to prescription pharmaceuticals in this country every day. These people depend on these prescription drugs to elevate their mood, provide needed relief to the stressors of their life, and avoid facing even another minute without some sort of pharmaceutical enhancement. They are denied access to their needed pharmacological relief by heartless and cruel physicians, nurses, and ambulance crews who cite red-tape regulations, laws, and other procedures for denying these people the prescription medication they desire”

Calling his new system a way to “revitalize and rejuvenate a growing industry”, Mr. Lange has created a website where people who desire pharmaceutical enhancement via prescription medication can get information on how to obtain the controlled substances they want. The site, which does not yet have a web address is entitled “SeekerCenter” and upon its release, will serve as an online information portal for those seeking prescription medications for a number of conditions.

“Some of these people like to feel relaxed and find that Xanax is their preferred method of relaxation. Some people do not wish to experience discomfort and find that premedication with a prescription narcotic such as Vicodin or Demerol really helps them avoid the unpleasantness of feeling pain during their lives. Some people find that they sleep better on Ambien, or wish to remain alert by taking Adderal or Ritalin as an enhancement device” Mr. Lange said. He continued, making air quotes with his fingers as he talked “These people used to have to try and convince heartless physicians to prescribe them these drugs on their own, we want to help with that. We want to provide a solution for those people who desire pharmaceutical enhancement on a recreational or occasional basis without having to struggle against a system designed to keep them from obtaining these drugs without what the ‘Red-Tape Buzz-Killing Doctors’ say is a ‘real medical need”

SeekerCenter will be an online database, search engine, and message board where people seeking medications can share information regarding such things as which doctors are looser with their prescription pads, the schedules of the local Emergency Room physicians, and which unlicensed Central American Online Pharmacies will ship pills that are not simply filled with talcum powder. Mr. Lange compared the service to that of the popular internet search engines.

“You can log into Google and find every doctor’s office and emergency room in a one hundred mile radius… but can you find out which ones are going to give you a shot of Demerol for your chronic back pain and send you home with a script for three weeks' worth of Darvocet? I think not. Our service will help people get these medications. We also will offer advice on such things as how to fake severe pain from say, a hip displacement on the street, and convince the paramedics to inject you with morphine” Lange said. He added “That pure morphine shit is awesome! You gotta try it!”

Mr. Lange is seeking investors for the project, calling the potential “Limitless”. “Soon we plan on adding features such as advertisements for ‘Pain Clinics’ and other doctors who want to help our patients ‘purely out of the goodness of their hearts” he stated, making liberal use of air quotation gestures and flashing a wad of twenties as he said the words “goodness of their hearts.”

SeekerCenter should be online soon and hopes to expand its offerings in every regional market in the United States. Mr. Lange believes that his product will truly help people who believe they have a need.

“Whether it’s a bowl of prescription party favors for your next party, or a way to kick back and relax without worrying that you’re peeing on yourself, now you can find your fix without having to resort to shady, back alley deals from people like I used to be.”

Keep reading this paper for the online address of SeekerCenter. It’s coming soon to a town near you.

Posted by on April 1, 2013 • Filed under: Emergency room, Emergency Room Nurse, EMS, EMS Humor, EMS Topics, Fire Rescue Topics, hospital, News, Paramedic, Uncategorized

EMS Fights the Flu – The 2013 influenza epidemic

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

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

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

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

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

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

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

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

 

 

 

A comparison of Symptoms between the Common Cold and the Flu

 

Common Cold

Flu

Symptoms

Cold symptoms appear gradually and include sneezing, cough, stuffy nose and sore throat. Fevers are very rare and fatigue is mild. Headaches sometimes occur.

Flu symptoms appear quickly (within 3-6 hrs) and include fever, chills, severe aches and chest discomfort.

Severity:

Usually does not cause severe health problems.

Serious health problems, such as pneumonia, bacterial infections, or hospitalizations can occur.

Fever:

Rare

Usually present

Fatigue:

Mild

Moderate to severe

Chills:

Rare

Common

Sneezing:

Common

Rare

Chest pain:

Mild to moderate

Often severe

Coughing:

Hacking, productive cough

Dry, unproductive cough

Headache:

Rare

Common

Stuffy nose:

Common

Rare

Aches:

Slight, but only headaches

Usual and often severe, affects the entire body.

Sore throat:

Common

Rare

Treatment:

There is no cure for the common cold. Cough syrup and other cold medications are available to ease some of the symptoms and make the patient feel a little better. Tea and nasal drops also sometimes help.

Sometimes antiviral medication helps control the flu but often patients simply wait for their body to fight the virus and overcome the disease. Medication is also available to ease patient comfort.

Duration of illness:

Symptoms typically peak two to three days after infection onset, and usually resolve in seven to ten days.

In children, the cough lasts for more than ten days in 35–40% of the cases and continues for more than 25 days in 10%. Adults usually feel better in seven days.

Seasonal?

Not seasonal (occurs throughout the year)

Seasonal (in winter). In the U.S., flu season is generally October to May and peaks in February.

Vaccine?

No

Yes

Causative Organism:

adenoviruses, coronaviruses, rhinoviruses (most common cause), respiratory syncytial virus, parainfluenza virus, influenza virus

Influenza virus

 

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

Look for the Helpers

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“When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. You will always find people who are helping.”

― Fred Rogers

I was planning on writing a happy piece this holiday season. It would have been about family, togetherness, hope, and all of the things the holidays are supposed to truly mean. While I celebrate Christmas at my home, I was planning on speaking of other peoples’ traditions as well. I wanted to tell everyone to have a Merry Christmas or a Happy Hanukkah, and I would have given other appropriate seasonal salutations to those who may celebrate different traditions. This piece was supposed to be about the happy, good things that this time of year is supposed to represent to us all.

And it still is, actually.

The above quote from Mr. Fred Rogers is absolutely appropriate right now. With the recent horrific events that have unfolded in our local area and the nation in the last two weeks it is important to be reminded of the good things that we’re supposed to remember during this season. Mr. Rogers's quote helps us bring that back into perspective. We will always see reminders of the fact that bad things will happen to good people and I fear that we will always struggle with trying to find the reason why. Truthfully, the fact that bad things happen is the reason EMS people have something to do. If bad things never happened then we wouldn’t need paramedics, EMTs, Firefighters, Police Officers, or the military. If bad things never happened, we could go about our lives in relative peace.

And as unfortunate as it is, the fact that bad things happen is a truth of the human condition.

If bad things never happened to good people we wouldn’t be able to see the other side of tragedy. We wouldn’t see the helpers. If bad things never happened we wouldn’t be exposed to the most powerful aspects of humanity. We wouldn’t see compassion. We wouldn’t see heroism. If bad things never happened we couldn’t experience how people come together for good and cause real good to happen in this world. If bad things never happened we wouldn’t see the true power of the human spirit. We wouldn’t see the good if we didn’t experience the evil.

If you listen to an emergency radio you will hear a constant drum beat of bad things happening. You will hear about crimes, about fires, about accidents and injuries, and of people becoming ill. It is incessant and unrelenting in most communities and those of us in the public service know that bad things happen at a rate much higher than what most members of the public allow themselves to believe. It can be quite easy to think that the bad is winning if you listen to the radio long enough. I counter, however, that for every bad thing you hear on the radio you also hear a miraculous fact shortly thereafter. You hear a response. The good answers the bad. You hear someone helping. You hear the fact that someone has decided to charge into the situation to do as much good as they can within a system that our society has built upon intention of helping and doing good. The bad is immediately met by the good.

My favorite quote by Kurt Vonnegut goes “I can think of no more stirring symbol of man’s humanity to man than a fire engine.” I like it because he trumpets the fact that our society has decided to spend money, effort, and time to help those in need. A fire engine doesn’t judge who it helps, it just helps as it is asked. Firefighters, EMS people, and law enforcement people don’t judge either. We were all called to be helpers and we stand in the company of heroes from all walks of life.

Look around you at your fire station, police station, ambulance base, hospital, or wherever it is you work. Look at your coworkers or your fellow volunteers. When you look at them, realize that you are in the company of a group of people who would risk their lives to help a stranger. Remember that these kinds of people exist in this world. Remember that there are more good people than there are bad people and that there are more helpers in the world than there are those who would seek to cause harm. Remember that good is actually winning, will continue to win, and has already won.

This week as we mourn those lost in the recent shooting incidents, the tragic crash of the REACT helicopter, and all of the other bad things that have happened we need to celebrate those who are the helpers. Celebrate the heroes and the good that comes out of the bad. Celebrate the lives of the helpers who were lost. Celebrate and carry on with their spirit of helping.

This piece really is about what the holidays represent. Hug your children, hug your families, help those in need, celebrate the good in your life and remember what life is truly about. God bless the helpers. God bless the good in life and the fact that there is so much of it to see when we open our eyes. The bad may be shocking, but the good is much more powerful.

Merry Christmas.

Posted by on December 16, 2012 • Filed under: Emergency Medical Services, emotions, EMS, EMS Motivation, EMS Topics, EMT, Fire Rescue Topics, Major Incidents, Mass Casualty Incident, Paramedic, Uncategorized

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

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

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

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

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

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

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

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

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

And we in EMS are largely oblivious to this fact.

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

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

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

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

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

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

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

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

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

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

EMS Providers Carrying Guns – A terrible idea

34 comments

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

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

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

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

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

Here are some of the reasons why:

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

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

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

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

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

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

FIrefighter Pre-Hydration – Fight Fire like a Marathon Runner

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

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

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

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

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

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

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

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

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

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

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

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

  1. You’re losing a lot more water than you realize – “Insensible” water loss, or water we lose through breathing, sweating, and keeping our skin, eyes, and mouth from drying out is markedly increased in hot temperatures. Humans lose a shockingly high amount of water this way during a heat wave. You have to proactively replace this loss of water and the fact is that most of us don’t. While the old adage that a person should drink “at least 8 glasses” of water a day may not hold up to scientific study, the Institute of Medicine still recommends that adults consume at least 91 ounces of water on any given day. It doesn’t all have to come from drinking it in, as some of this fluid comes from the foods we eat, and some fruits and vegetables are very high in water content and can hydrate you almost as well as a glass of water can. Drink more water and avoid soda pop and alcoholic beverages, as these can actually contribute to dehydration. The best way to measure hydration level is to monitor your potty breaks. You should be going to the bathroom for a “number one” at least four times per day and the color of the urine should be clear to a faint yellow. When your body is dehydrated it concentrates your urine. The darker your urine is, the more dehydrated you are. Keep it clear.
  1. Watch your kids too – Kids lose a lot of water in the summertime. Even short bursts of outdoor play can burn a lot of water off of a little one. Push fluids and encourage your kids to drink water, tea, and lemonade. Creative ways to get more water in your kids include supplying popsicles and Jell-O, which are both mostly water with a little flair. You can also have fresh strawberries, celery stalks, and watermelon which both add fruits and veggies to their diets while being an excellent source of quality hydration.
  1. Watch for dehydration and heat-related illness – In this heat you can become dehydrated quickly without realizing it. Dehydration is a serious medical condition that can sneak up on a person and make them sick before they know it’s happening. Mild cases of dehydration show symptoms after about 2% of one’s body water is lost. These symptoms can be a moderate to severe headache (like a hangover), dizziness or fainting when standing up, loss of appetite, dry skin, and constipation. You can also feel fatigued and generally ill. In more serious cases, you may experience a rapid heart rate and flushing of the skin. If you notice any of these symptoms, drink water and cool down. You’ll be amazed at how much better you’ll feel. Watch for confusion, weakness, and an absence of sweating because these could be signs of heat exhaustion or heat stroke, which are serious medical conditions. If you believe that you or someone else is experiencing these symptoms, move the patient to cooler temperatures and encourage them to drink cool fluids to replace what they’ve lost and bring down their body temperature. In serious cases, seek medical attention or call 911.
  1. Wear shoes – Invariably, when the sun blazes down this hard, the emergency rooms start seeing burns to people’s feet caused by walking barefoot on hot concrete. In fact, one ER in the state just had a case of significant burns a patient suffered from walking on hot sand at the beach. When the sun is this strong, resist the urge to go barefoot when you’re walking outside. Burns on the feet are more than just painful, they take a long time to heal and make walking anywhere less than pleasant. Be careful.
  1. Be smart about sunscreen – Most instruction labels on sun-protection products advise that you should apply before you go into the sun, and allow some time for the product to absorb into the skin and start protecting it. Read the label on your favorite sunscreen and follow the directions for the first application as well as the schedule for reapplying it. We’ve all been burned in the past but we can prevent it from happening again if we’re careful. You also should put on a hat and find some shade from time to time. A cherry-red hue isn’t in style this season..

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

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

A Quilt Made From Patches – Help a brother out.

18 comments

An old ambulance partner of mine called me up the other day with a favor to ask.

He and I haven’t been on a truck together in a few years, but this guy’s one of the best I’ve ever had the privilege of working with. If Bill asks me a favor, it gets done. He’s good people.

It seems there’s bad news. Bill’s new partner, Noah Filer, an almost-done paramedic student and firefighter with the Durand Fire Department was involved in a terrible motorcycle accident a while back. Unfortunately the news isn’t good. While Noah’s fighting on, he sustained serious, possibly life-altering injuries and will have an exceptionally hard road to recovery in front of him. He’s a young guy, and from all accounts I’ve heard a stand-up guy and a good person with a lot of potential in front of him. I don’t know Noah personally, but a good many of my friends do and if Bill vouches for him, he’s a friend of mine as well.

Noah’s friends and family are making him a quilt made of fire patches and have been asking departments to send patches to his fire department for this purpose. Bill has asked me to help spread the word and ask you to send in your patch and patches from your area so they can be incorporated into the quilt. I’m happy to ask you to do so. Noah’s family loves the idea and his fire/EMS friends are stepping in to make this a reality. I’m asking you to do the same.

Here’s what I’d like you to do:

  1. Get an extra patch from your Fire Department, Police Department, EMS agency, or any public-safety entity that you are a member of or can get your hands on. Send one of your patches and grab a few from your surrounding agencies. Anything will help.
  2. Send the patches to the following address BEFORE MAY 12th, 2012.

Durand Fire Department

P.O. Box 185

Durand, IL 61024

  1. Help us spread the word. If you’re an EMS blogger, would you mind posting up a link to this post or making a post of your own asking your readers to do the same? Would you mind posting this link on your Facebook or Twitter accounts? Would you ask your other Fire/EMS friends to send in a patch or to give you one that you could send in?

I’d really appreciate it. You’re helping out a good cause for a good guy. Trust me, if Bill vouches for him, I do too. I’m sending in all the patches I can grab for the guy and you should to. Please. Both he and his family and friends will really appreciate it.

Thank you.

You can read more about Noah’s story on his CaringBridge web site. It would be nice for his family if you’d send some well-wishes in the form of writing a short note in his guestbook as well.

Bill wrote about his feelings in the guestbook. If you don’t believe that you should send in a patch… read this, you will:

“Dear Noah,

Well it has taken me a week to find the words to write you. You have been my partner on the ambulance since September 2008. Since that time we have spent a third of our lives together. Sometimes you are like a brother to me and other times you are like a son to me but you have always been family to me. Coming to work since your accident is challenging. All of us come in and do our jobs, but there is no laughter, no fun anymore. We all ask each other "how are you" and we all answer each other "I'm ok". But, we're not. This station is empty without you. I worked up the courage to peek inside your locker today to see if there was anything your folks or Jenny would want. I burst into tears and closed the door. I swear kid I've never cried so much in my life as I have in this last week. You have touched so many lives and I know for a fact that there is people walking the Earth today due to some of your actions. You are a hero. Maybe I didn't tell you that very much before, but you need to know that. I had a new fella come and work with me today. He is a great guy, and like you, one with a promising future. But, HE IS NOT YOU. Some days I can eat, some days I can't. Sometimes I can sleep, other times I can't. I just want you to wake up and say Hi, that would make things so much better. I have visited with your Jenny and your Folks several times this week, and I hope they know they can count on me if they need anything. We are all hurting and only you can make us feel better. So keep fighting my friend! I know you can beat this.

I will be waiting as long as it takes for you to get better.

 

Your friend,
Bill Scheider
Paramedic”

Come on y’all, help a brother out.

Posted by on April 29, 2012 • Filed under: EMS Topics, Fire Rescue Topics, Uncategorized

Hangover Heaven? WHY ARE WE NOT DOING THIS!?!?

7 comments

I came across a new business today while I was casually wandering around the Internet and I just absolutely had to share it with the EMS crowd. The company, called "Hangover Heaven" (www.HangoverHeaven.com) is set to open April 14th, 2011 in Las Vegas, NV. (Where else?)

If you haven't already clicked the link their business model is that they have a bus that drives around the strip, picking up the hungover masses, and providing "a small IV in your arm that provides the necessary treatment to continue the party or just get back to your normal self." They have two packages, the "Redemption" package for $90 that provides IV hydration only, and the "Salvation" Package for $150 that provides relief through their "Proprietary treatment" which they say contains intravenous hydration, an anti-emetic, an anti-inflammatory medication, and a "Vitamin supplement" package.

You should really read their website yourself. Some copywriter did a great job of selling what I can only surmise to be a banana bag, ondansetron, and toradol. Those meds and the IV fluid will most probably cure any hangover quite handily. While I think this is a bit cheesy… I've got nothing but respect for their plan. Heck, if anything I'm jealous that I hadn't thought about it first. While I'm not licensed to practice EMS in Nevada, I could easily cruise around the streets of Milwaukee, Madison, or Chicago in my ambulance providing the same services to the over-imbibed folks in those fair cities. If we could ask for cash up front, like I'm sure they are, we could probably pull in a few thousand a week doing this. For that kind of coin any city could afford to fund the pension plan and give the nice EMS folks a hefty raise.

What I'm saying is, come on cash-strapped municipalities, belly up to the bedside and get your medical directors to authorize this service. Your budget woes are a thing of the past!

I do have a few questions though:

  • Is this legal? The owner is an anesthesiologist, but there is no mention of who is actually providing the service.

 

  • I'm a Nationally Registered Paramedic… are you hiring? Please?

 

  • Are you selling franchises? Cuz I could use one here in Wisconsin and Illinois real bad. I'd start my own but I'd need a medical director who would be willing… and the ones around here are probably spoil sports

 

  • Although… I haven't yet asked them if they  are ok with this. They could be. Perhaps it's better that you just sell me a franchise real quick and real cheap-like and we can just keep the brand-name going strong.

In all seriousness. Think of what effect this could have on the already overused emergency healthcare system in the city. I mean, if even 10% of the people who are going to be seen by this bus would have otherwise ended up in the emergency rooms getting largely the same treatment, this company could sincerely ease some of the burden on the healthcare system. It's definitely a cheaper alternative. Even their $150 treatment is way cheaper than a trip to the ER. This bus could immediately benefit the entire system by giving patients an alternative to the traditional, significantly costlier, methods. It will save insurance companies and governmental healthcare payors thousands and free up the ERs from taking care of this patient demographic.

I really do think they're on to something. Wish I'd have thought of it first.The success of this business will go to prove something. If it survives and thrives, then EMS can also find free-market alternatives that will help save our profession and the communities we serve. Obviously it can be done.

In other news, kudos to the State of Maine, who authorized funding for Community Paramedicine. Bravo guys, way to intellegently look for real solutions to your healthcare budget woes. I tip my hat to you. – http://www.jems.com/article/news/new-community-paramedicine-law-maine-loo

Notice anything similar?

Posted by on April 13, 2012 • Filed under: Als, ambulance humor, ckemtp rants, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Humor, EMS Management, EMS rant, EMS Topics, Fire Rescue Topics, Funding & Staffing, humor, IV, odansetron, Paramedic, Patient Management

In Honor of National 911 Education Month – Help Spread the Word

No comments

Here is an article that I'd love for you to steal. Feel free to print this out and send it to your local newspaper in your (or your agency's) name. Help spread the message of the proper use of the 911 system and show your dispatchers some love. Remember, "National Public Safety Telecommunicators Week" is April 8th – 14th, 2012.

Here again, is the National Emergency Number Association's resource and education page

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It’s a crazy world out there.

Mayhem happens. Cars crash, buildings burn, people get sick and injured. We’re all guilty of doing some not-so-smart things every now and then. Usually we’re lucky and nothing happens, we skate by with hardly a thought to the consequences that might have been. However, sometimes it catches up with us. Sometimes those last second chances in traffic cause metal to crunch upon other metal; Sometimes we find out just how well the batteries in our smoke detectors still work; and sometimes we are shown just how fragile life really is. The human body is a masterfully crafted machine capable of doing everything we really need it to, but sometimes it stops working. Sometimes tires on semi-trailers blow while you’re passing them on the interstate. Sometimes your new baby has a seizure. Sometimes your spouse won’t wake up.

As I said: Mayhem, it happens.

While there isn’t anyone out there who would want to dwell on the unthinkable we all know exactly what we’re going to do when we’re faced with it. It’s ingrained into the fabric of American culture and is mostly the same anywhere you go. Everyone knows that when there is a serious risk to life, limb, sight, property, or safety you simply call 911.

“Nine-One-One.” It’s always pronounced that way. Those three numbers are said individually because people who panic over the situation they are calling about used to fumble in vain looking for an eleven key. Nine-One-One. We all remember it and reflexively know that it’s there. We know that someone will answer it and that they will help us when we need it. We know that help is just a phone call away. We know if we call and we really need them that police officers, firefighters, and paramedics will come and help us. We know it to be true and it provides a subconscious level of security for our entire lives. We don’t know what we’d do differently if it wasn’t there, but luckily we know that it is. It affects the American psyche in many ways and probably affects our culture in ways we’ve never studied. Nine-One-One. When we need it to be there, we really *need* it to be there.

April 8th through the 14th is “National Public Safety Telecommunicators Week” as part of the larger “National 911 Education Month.” Sponsored and celebrated by various groups as well as the National Emergency Number Association (www.NENA.org), the events help bring awareness to those who answer our pleas for help. They’re always there around the clock but most people hardly give these trained professionals a second thought. They toil in relative obscurity until we need them. We don’t think about them or the system they command until they’re the calm voice on the other end of the phone helping you deal with the unthinkable. When that happens they’re the most important persons in the world. We need them. They’re the lifeblood of public safety and the life line for everyone from the police officer in a shootout to the firefighter in a burning building to the husband doing CPR on his wife. They deserve our respect and there are a lot of us that quite literally owe them our lives.

There are some ways that you can help your local 911 system:

First: Learn how to dial 911. It sounds silly when you say it, but do you really know how to call it from every device you own? Can you call it from your Voice-Over-IP (Internet) phone? What about your iPhone or Droid? Do you know how to call it from home? From work? What about your kids? If you were unconscious could they figure out how to call 911 from your cell phone? Could they call it from school?

Second: Know how to give a correct location to the 911 operator. Even with the “Enhanced 911 system” that is supposed to provide location information to the dispatcher, your phone may not do it. Think about providing a clear location to 911. Teach your kids their address and their full names.

Third: Stay on the line. When you call 911 do not hang up first. Let the dispatcher end the call. There may be more information the dispatcher has to get from you. Responding emergency units may get lost and need directions on where to go. Every emergency dispatch is a carefully orchestrated series of events between various systems and groups. The fire department coordinates with the ambulance which coordinates with law enforcement and vice versa. The 911 dispatcher is the person who makes a lot of these decisions and has a lot to do in order to get things rolling. If they need information from you they will ask. If they don’t, they’ll end the call first. Please stay on the line and help give them all of the information they need.

Finally, learn CPR. Everyone should know it. 911 dispatchers are trained to give instructions over the phone to you on how to help in a medical emergency, but this is not a substitute for training on what to do. Learning CPR saves lives. Know it and be ready to perform it.

Think about the system and find ways to support the local 911 dispatchers. They don’t get hardly any credit for being the absolute lifesavers that they truly are.

Posted by on April 4, 2012 • Filed under: 911, Administration & Leadership, appreciation, Command & Leadership, Dispatch & Communications, Emergency Communications, EMS, EMS Dispatch, EMS Topics, Fire Dispatch, Fire Rescue Topics, Uncategorized

National 911 Education Month – What EMS can do

2 comments

If you're an EMS person, you should probably know that April is designated as "National 911 Education Month." It is sponsored by the National Emergency Number Association (NENA) and is dedicated to educating people about the proper care and feeding of the 911 system and the dedicated emergency telecommunicators that make the system run. The month spreads awareness of how to use the 911 system properly and culminates with "National Public Safety Telecommunicators Week." NENA has some great resources, including pre-made radio, web, print, and video PSAs, on their website: here.

I've always said that I am NOT cut out to be a dispatcher. I just don't think that I personally have the mental quickness, ability to multitask, or organizational skills it would take to be good at the job. As an EMS professional, I revere my dispatchers and show them as much love as I can. Dispatchers are the omnipresent bits of sanity in our daily schedules. We need to treat them well and give them equal respect. They do a terribly hard job and I salute them for it. You should too.

EMS professionals should celebrate National 911 Education Month as well as National Public Safety Telecommunicators Week just as much as we celebrate EMS week. We need to do this because well, can you imagine any potential benefits to educating the public about proper use of the 911 system? I think I can. Remember, it's not just about reducing nuisance calls that bog down the system; it's also about educating people when they absolutely need to call 911 because it's better medicine for them or better for society in general. I cringe when I see people who have legitimate medical problems that would benefit from EMS care drive themselves into the ER or even go untreated. It's our mission to help them and the first step is to spend time educating people when it is appropriate to call, without being condescending to those that call inappropriately.

Let's make the message as positive as we can people. We're professionals who care for others. Working EMS is a privilege and we need to remember that. I would rather go to 100 inappropriate calls than miss one single call where we could make a lifesaving difference.

In celebration of the month, I'm going to write a few pieces in honor of those that tell us where to go. I'm going to show some love to the voices in our radios and give you some tools to help spread the message at your own agencies. Tomorrow, look for a piece I've written that you can cut, paste, and send in to your local newspaper as a letter to the editor. Every little bit helps.

Posted by on April 2, 2012 • Filed under: 911, Administration & Leadership, Command & Leadership, Dispatch & Communications, Emergency Communications, Emergency Medical Services, EMS, EMS Dispatch, ems education, EMS Topics, Fire Rescue Topics, News, Technology & Communications

Coming Soon – The Law of Unintended Consequences meets the fire service

3 comments

Remember the post I put up a few days ago entitled “A Predatory Ambulance Fee”? It talked about how the Elgin, IL city council is planning to help recoup their costs for Fire and EMS services by charging for refusals.

(This is the link if you didn’t read it: “A Predatory Ambulance Fee”)

This just in:

Apparently they’re not done proposing new fees in the city. They seem to be very serious about recouping their costs and finding new ways to monetize their services. According to this article posted on Firefighter Nation, they’re planning on adding quite a few new fees to their repertoire.

Here’s the link: “Illinois Department Considers Charging Non-Residents for Fire Services” Read it and see what you think.

The article only mentions two specific fees, a $500 per hour fee for an engine response and $2200 for “a serious car accident where someone has to be transported by helicopter.” These fees are interesting enough, but the article also hints that there are further fees forthcoming.

The chief is quoted as saying that he expects most of these fees to be covered by insurance. After all, he says… that’s what insurance is for.

The chief may be very correct with that statement; insurance exists to pay for the unforeseen costs of bad things that happen to people who pay for it. Insurance companies pay these costs based upon rigid contracts they sign with their customers and charge their customers rates based upon the average risk they assume on behalf of the customer. They will only pay for what they are contractually obligated to pay for. While I have no knowledge of whether or not insurance will actually pay for the charges Elgin is proposing in practice, I’m assuming the city of Elgin doesn’t either and if they don’t seem to care whether the people they are saddling with these kinds of fees are insured for them or not, why should I?

It’s not like these insurance companies aggregate risk across all of their customers and will pass the overall cost of these fees to everyone in the area causing everyone’s insurance rates to go up, right?

Remember, I am not against fire departments, cities, and/or EMS services finding new and innovative revenue streams or ways to defray costs. The City of Elgin is not a villain here. It is very expensive to operate a service and I completely understand wanting to recoup some of those costs. These kinds of fees are somewhat the result of a rigid and over-regulated EMS payment system that chains our entire industry and squashes most hopes of innovation. I believe in EMS payment reform. In fact, I demand it.

But guys? While you’re by far not the only department in the US proposing and implementing things like this… you’re all opening Pandora’s Box. Your citizens are going to fight this, the press won’t be good, and you may end up creating more of a wave of dissatisfaction than you’re really prepared to endure. Think about Moline, IL and what they’re going through right now. Could you imagine their chances of winning their fight if they had implemented these fees?

Then again, perhaps they should implement them in Moline and let the revenue sources balance their budgets… In Moline they say they’re operating at over a $340,000 budget deficit and maybe these kinds of fees would offset that deficit enough that they could make their EMS financially viable.

Or maybe the marketplace will decide and departments that do this kind of thing will be put “out of business” (for lack of a better term) by competitive forces.

I would be willing to bet that there’s someone out there that would only charge $450 an hour for an engine response and only $2100 for a “serious car accident”. There are probably plenty of people and companies that would be happy to do fire response for profit. That’s what happens when governmental services start acting like monopolies in a capitalistic system, they get replaced by free market alternatives. Back in Ben Franklin’s day the fire service was a private endeavor that was only made public when the cost of providing protection wasn’t profitable enough to serve the ends the people wanted it to serve. Make the fire service profitable and private industry may find a way to make a solid business model out of it. Don’t believe me? Think Fed Ex and UPS versus the US Postal service.

I’m not saying it’s a good or bad thing. It’s why private industry exists. If there’s an opportunity to make money doing something, someone will step up to make money doing it. These fees, if they become lucrative, may just be the opportunity for private industry to find a business model that didn’t exist before.

I am able to understand why Elgin wants to implement these fees… but I think that this is a situation ripe for the Law of Unintended Consequences. If I could give cities proposing these kinds of fees some advice I would tell them they should find every single efficiency within their existing budgets before they set about increasing revenue through raising fees. Make no mistake, within the contemporary political climate; citizens are going to scrutinize every aspect of your budget when you start trying to get them in the wallet. You may not like what they find.

I don’t have the ultimate answer but I’m keeping an eye on this story. You should too.

Posted by on November 4, 2011 • Filed under: 911 fail, Administration & Leadership, ckemtp rants, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS Topics, fire, Fire department, Fire Rescue Topics, Firefighting Operations, Funding & Staffing, News, northern illinois, politics

Issues: I’m Scared of something, Have a Rhythm, and A New Column Up, Too.

2 comments

First off, my newest column is up over at JEMS.com – You might like it. I’m challenging the status quo. Like I do:

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

Did you read that and then come back? Good! But if not, I’ll link it again for you at the bottom. I’ve got a few other things that are on my mind today. Like this:

If you haven’t noticed yet, my posts are back in a rhythm.

I’m really enjoying all of the feedback and participation I’m getting on the blog since I’ve been hitting it regularly lately. I’m trying to do good, solid posts on Mondays and Wednesdays, with something on Friday to carry me through the weekend. On Tuesdays and Thursdays I plan on the occasional link love and mention of some of the other great bloggers out there. I hope y’all like the schedule and what I’ve been putting out lately.

But this week? The schedule is a tad off…

I wrote a detailed, strongly worded, journalistic, researched, and somewhat opinionated piece on a topic I care deeply about. It went long, so I broke it into two parts and planned to run it this week on Monday and Wednesday.

However, you’re probably noticing that you aren’t reading that post right now. That’s because the post scares me.

I am playing with fire with this post. Literally. It involves a burning issue that’s impacting a fire department that I am very familiar with. They, in turn, are very familiar with me. Their city council just voted to end their ambulance service in a move that they deemed purely financial. In the piece, I gave them strong advice and tough love after thoroughly exploring the issue as best as I was able.

But I’m scared to put it up here, honestly.

Any Fire-Based EMS vs. The World issue is a hot issue, fraught with peril for anyone who should so dare offer an opinion that isn’t “FIRE RULES!!! WHAT ARE THOSE IDIOTS WHO DON’T LIKE FIRE DOING!?!?!?!” I didn’t offer that opinion. While I support those firefighters and my good, long-time friends among them, I simply can’t blindly repeat that dogma. This issue is much, much more complex than that and unfortunately for my friends, that dogma isn’t going to work here. It has already failed and it will continue to fail if they continue to use it. The landscape has changed. Down is now up. Dogs and Cats are living together… Mass Hysteria! is happening and they need some new strategies.

Our friend Chief Reason wrote on the topic on his blog over at Fire Engineering and you can read his opinion on the issue I’m talking about here: “City Fires; Chief ‘retires’.  (Oh, and Art? We miss you over here at FEblogs)

Chief Reason does a good job of explaining the issue. I respect that man’s opinion a great deal and always have… and I’m not saying he’s wrong at all. I’m just saying that the argument he’s using to defend the position he’s defending is well… dated. The reality has changed as I have said and that kind of argument just isn’t going to work anymore.

Read Art’s post on the subject for more. I’ve written on it but am holding the post for a while. If anyone from Moline cares to talk about my opinion, I’d be happy to speak on it. However, I didn’t just write it for Moline. There is a much, MUCH wider issue at hand.

Here’s the deal: This thing that happened in Moline? It’s coming to your town. It’s coming to where you live and if you defend yourselves the same way I see them defending themselves, you’re probably going to lose your fight. (Not that I want them to. I support quality EMS in the City of Moline. I have a lot of friends and family that live and work there and I want the EMS there to be the absolute best it can be)

I’m going to think about posting the piece. Till then, if you care to read it before I decide, e-mail me at ProEMS1@yahoo.com or hit me up on Facebook and I’ll send it to you.

Also as I mentioned up at the top, my newest monthly column is up over at JEMS.com – Pop by and have a read. I’m challenging beliefs there, too.

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

Posted by on November 2, 2011 • Filed under: Ambulance, ckemtp, ckemtp rants, Emergency Medical Services, EMS, EMS Humor, EMS Topics, EMT, Fire department, Fire Rescue Topics, Funding & Staffing, News, Paramedic

GPS in the Ambulance – An overreliance on Ms. Kitty

16 comments

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

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

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

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

Her:       “It’s what?”

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

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

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

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

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

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

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

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

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

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

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

Ain’t modern technology great?

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

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

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

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

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

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

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

What Does “Brotherhood” mean?

12 comments

I read an article yesterday in the Milwaukee Journal Sentinel that unfortunately, didn't surprise me all that much. It regards a professional, career firefighter who chose to opt out of his union due to his political beliefs. He's a conservative, and due to his stance on the political causes championed by the union, he's decided to take his money elsewhere and invoke a little-used "Fair Share" legal clause that allows him to drop his union membership and only pay pro-rated dues for his share of the collective bargaining. He does not pay for the union's wider political activities.

And this? Well, actually I can support it. He's voting with his feet based upon his beliefs. I respect anyone of strong conviction that truly does what they believe to be right. I like that, in fact… no matter a person's political spectrum (Well, almost no-matter their political spectrum)

I rarely talk about politics here, but this case is different. It seems this firefighter has constructed a float commemorating his brothers who died in the Sept. 11th, 2001 attacks and wants to run it in the local Racine, WI 4th of July parade.

The union thugs (Yea, I said "Union Thugs". That's what they are) have issued a fatwah barring any union firefighter from riding on or marching with the float in the parade. They won't comment further on the issue. They just don't want to support the "fair share" firefighter.

Here's the article, you should read it yourself "Firefighters' Union Throws Cold Water on 9/11 float"

As I said, I am not at all surprised by this. I'm still saddened, though. It makes me think it's time for me to pull out my favorite Paul Combs political cartoon.

Kind of says it all, doesn't it?

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Also on another note,  did you read my last monthly JEMS column on Ambulance Service Disaster preparedness? You really should:

http://www.jems.com/article/major-incidents/ems-agency-plans-natural-disasters

 

 

Posted by on July 3, 2011 • Filed under: Administration & Leadership, ckemtp rants, Emergency Medical Services, EMS, EMS ethics, EMS Topics, Fire department, Fire Rescue Topics

Blood Pressure – Vital Knowledge for EMS

13 comments

The blood pressure is one of the most ubiquitous diagnostic tools used in medicine and has a sacred role in EMS. Every EMT and Paramedic needs to be able to get an accurate blood pressure from every patient, every time. It is so widely regarded throughout medicine as a useful diagnostic tool that it’s considered to be one of the “Vital Signs” and pretty much everyone reading this has either taken someone’s blood pressure, and/or has had theirs taken many times.

Of course we know that the blood pressure is the measure of the heart’s ability to pump blood throughout the body. It’s simple, right: Cardiac Output – Vascular resistance = BP. The blood pressure is represented as a number *slash* number, or “Something *over* something” measured in “mmHg” (millimeters of mercury). These numbers represent the “Systolic” and the “Diastolic” pressures, with the Systolic blood pressure meaning the peak fluid pressure of blood flowing through the arteries at “systole”, or the heart’s peak contractile force; and the Diastolic blood pressure measuring the pressure of blood in the arteries when the heart is at “diastole”, or at rest. EMS people use the blood pressure to see how well the patient is “Perfusing” or circulating blood and the oxygen and nutrients it carries to the end tissues it supplies. “Hypotension” is too low of a blood pressure and can result in tissue damage, tissue death, and/or Shock; and “Hypertension” is too high of a blood pressure and can result in all kinds of short and long-term damage to the body, including heart disease, kidney disease, stroke, and many other chronic conditions. In EMS, we use the blood pressure as an important diagnostic tool in such things as trauma to measure blood loss, and also in medical care to determine shock or cardiac compromise.

But we all know the basics, right? Good, if you’re an EMT, you probably should know all that. However, you may not have heard these terms:

  • Pulse Pressure: The difference between the Systolic Blood Pressure and the Diastolic blood pressure. For example, a patient with a BP of 120/80 has a Pulse Pressure of 40mmhg.
  • Stroke Volume: A measure of the volume of blood ejected with each beat. (Stroke volume + Pulse rate = Cardiac Output)
  • Preload: A measurement of the pressure left in the vascular system during Diastole (Or “Left Ventricular End Diastolic Pressure” I’m just going to call it preload)
  • Afterload: The pressure that chambers of the heart must generate in order to pump blood. In the case of the Left Ventricle, it’s the pressure it must create through contraction in order to pump blood into the aorta.

(For everything else you’ve ever wanted to know about blood pressure, read this: “Overview of Blood Pressure” by John Ross)

What if there were more things that taking a patient’s blood pressure could tell you about them?

There are, of course. The blood pressure is way more useful as a diagnostic tool than most EMTs and Paramedics realize. Here are some of the things that the simple blood pressure can help you learn about your patients and the care they need:

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It can diagnose Orthostatic Hypotension

Have you ever seen a medical provider take “Orthostatic Blood Pressures?” These are taken as three consecutive blood pressure measurements taken with the patient in the Supine (laying down), Sitting upright, and Standing position. To properly perform this, have the patient lay supine for five minutes and take a baseline blood pressure measurement. Then have the patient sit upright, wait two minutes then take their blood pressure. Repeat with the patient in a standing position. If the patient gets dizzy for more than a minute with positional changes, that’s a positive sign for orthostatic hypotension, as is a drop in systolic blood pressure by 20mmhg between readings.

What does this mean?

Well, it can mean that the patient is dehydrated, is experiencing hypovolemic shock, has some type of cardiac compromise or an arrythmia, is anemic, has a problem regulating their blood pressure, has an electrolyte imbalance, and a few other conditions. It can also be caused by medications such as Beta Blockers or even Viagra. Orthostatic Hypotension is also a common cause of Syncope, or fainting. It’s an important assessment finding to record in your patient care report and to pass on to the receiving facility.

(Read More? http://www.medicinenet.com/orthostatic_hypotension/page2.htm)

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It can help diagnose a Thoracic Aneurism

The arms are the most common places where the blood pressure is measured. The blood pressure cuff aka a “Sphygmomanometer” is wrapped around the arm at the bicep and applies pressure to occlude the brachial artery. The brachial artery is supplied by the subclavian artery, of which there are the Right and the Left subclavian arteries respectively. It has been shown that there may be a normal 10 to 20mmHg difference in blood pressure between the arms in a small minority of patients. Therefore it is important to take blood pressure readings from both arms when diagnosing hypertension. It is also useful to note when there is a difference in readings above 20mmHg from one arm to another. This can be a sign of Increased intra-thoracic pressure, a Thoracic Aneurism, or something called “Subclavian Steal Syndrome”.

In a thoracic aneurism, a condition with a mortality rate reaching up to 80%, the aortic arch in the chest is compromised. This results in severe pain (usually described as “ripping” or “tearing”), hypotension, and usually death if it ruptures. As the aneurism tears, it compromises the entrance to the right subclavian artery before the left, causing the blood pressure in the right arm to drop. This is an important diagnostic tool to use in diagnosing chest pain and should be documented.

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 It can help detect increased intrathoacic pressure and other conditions

The thoracic cavity is the area commonly called the chest and is the area above the diaphragm protected by and enclosed in the rib cage. As we know, there are a lot of important things in there that humans need functioning properly in order to, you know, live. Pulsus Paradoxus is a condition where the heart’s pumping capacity is compromised by the thoracic pressure and the blood pressure rises and falls with inspiration and exhalation. The blood pressure drops (and sometimes even the radial pulse disappears) with inspiration and rises again with exhalation based upon the volume/pressure of air in the chest. The “paradox” results from the fact that you can hear cardiac beats on auscultation of (listening to) the chest, but cannot detect them with the blood pressure and/or pulse.

What does this mean?

Lots of conditions can cause Pulsus Paradoxus and roughly they can be broken down into three groups: Cardiac causes, Pulmonary Causes, and Other causes.

First, let’s give a nod to the other causes, the non-cardiac and non-pulmonary causes, which are Anaphylaptic Shock and an obstruction of the superior vena cava.

The cardiac causes can be:   (and THANK YOU Wikipedia for being smarter than me and very accessible)

  • cardiac tamponade – A “bruise” of the heart resulting in the pericardial sac filling with blood that cannot escape and compromises cardiac function. (Treated with a pericardiocentesis, which some EMS providers can do in the field. I can).
  • constrictive pericarditis – Inflammation or purulent (puss-filled) infection of the heart which compromises pumping ability.
  • pericardial effusion – Fluid around the heart
  • pulmonary embolism – A blockage in the pulmonary artery or vein
  • cardiogenic shock – Impaired pumping ability of the heart due to cardiac damage or other compromise. Commonly seen in severe myocardial infarctions. (Heart attacks)

It can also be caused by pulmonary (lung) conditions, such as a tension pnuemothorax, COPD, and sometimes in severe and acute asthma, where the patient traps so much inhaled air in the lungs that they cannot exhale the excess pressure due to the inflammation of the air passages.

When you see these signs, make sure to take multiple blood pressure measurements to trend the patient’s progression. Calculate their Pulse Pressures, as cardiac tamponade, tension pneumothorax,  and other conditions are characterized by narrowing of pulse pressure and compromised cardiac output also resulting in hypotension.

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 It can help detect a closed head injury, stroke, or Intracranial Hemorrhage (<– that’s an excellent link)

Cushing’s Triad, aka Cushing’s reflex, is a group of symptoms that has been shown to reveal increased intracranial pressure (ICP), the pressure within the cranial vault around the brain. This reflex shows three distinct signs which are predictive of Stroke (both ischemic and hemorrhagic), intracranial bleeding, head trauma, and some other conditions that raise ICP. These signs are:

  • Slowed pulse rate
  • Markedly increased systolic pressure (high BP) with widened pulse pressure, as the diastolic pressure usually stays normal, and:
  • Irregular breathing (Cheyne-Stokes pattern respirations)

Any time you suspect an injury or condition that may raise ICP, check the blood pressure and look for Cushing’s Reflex. It can help you zero in on the patient’s condition.

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Here are some tips for making sure your blood pressures count:

  • Automatic BP cuffs do an ok job of measuring the blood pressure in a routine setting, but they have weaknesses. They cannot detect pulsus paradoxus, they give wildly inaccurate readings in bradycardia (slow heart rate), and they’re very much affected by the bumps in the road felt in the back of an ambulance. TAKE AT LEAST ONE OR TWO MANUAL BLOOD PRESSURES.

 

  • Can’t hear the systolic pressure? Take a palpated blood pressure by feeling the radial pulse while you deflate the cuff. The first pulse you feel = a reasonably accurate systolic pressure.

 

  • As with a lot of diagnostic tools, the first blood pressure measurement is a spot-check. The second reading creates a trend and reveals a lot more information. Take them every 5-10 minutes on critical patients, and every 10-15 on stable ones, keep mindful of the pattern.

This is by no means an exhaustive list, but it should give you some more respect for the humble blood pressure. As always, follow your local protocols and medical orders and this article isn’t meant as medical advice. Keep learning out there.

Also, feel free to add things in the comments section. I’d love to see what I missed.

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Want to learn more stuff about stuff? Check out:

 

 

Posted by on June 20, 2011 • Filed under: Ambulance, Emergency Medical Services, ems education, ems narrative, ems patient care report, EMS Topics, EMS training, Fire Rescue Topics, Paramedic, paramedic education, Patient Assessment, patient care, Patient Management, Training & Development, training-fire-rescue-topics

Perils of Paramedics Pursing imProper Patient Refusals

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Inspector General Faults DC Paramedic’s Response to ‘Acid Reflux’ Case

This article comes to us from JEMS.com which has a link to the full article over at The Washington Times. It’s not necessary to read both articles, but since JEMS originally called it to my attention it’s only fair to link the boys over there first. Read the full article, please… I want to see if you feel the same way about it that I do.

Ok, ya back? Good.

In this case that is very reminiscent of the case law I wrote about last year in “EMS Case Law – AMA Refusals, Death, and Documentation” – A DCFD EMS paramedic obtained a signed refusal from a patient who called 911 for chest pain. According to the < sarcasm> stellar, just friggin’ stellar < /sarcasm> journalism employed in the story by the reporter (I mean seriously, can any reporter anywhere ever write a story about EMS that doesn’t sound like a 5 year old’s understanding of Mozart?) the Evil paramedic did bad things that caused someone to die.

And, well… Here are some quotes from the piece, although I still think you should read the whole thing:

“The crew found Givens, 39, on the floor of his home after his mother called 911 — “an indication that he may have experienced something more serious than what was later described as simple acid reflux,” the report says.

Although they asked Givens multiple times whether he wanted to be taken to a hospital and he declined, the report suggests responders should have done more to persuade him to go.”

So they find some guy, a 38yo guy, a young guy who lives with his mother (maybe) laying on the floor probably being all dramatic and stuff… I’m sure he was all like “Ow. My chest hurts” and the medics were all like “Dude, we have a low index of suspicion for your condition being cardiac related due to the fact that you’re young and don’t appear to have many risk factors” n’ stuff.

Or something like that. At any rate, I’m sure they were less concerned about this guy than they would have been with say, a middle-aged male with classic STEMI (heart attack) symptoms. Yes, they signed him off AMA while telling him to take Pepto-Bismol, and yes… the article does indeed say this:

“The inspector general’s report also faults emergency workers for not recording fundamental information, such as Givens’ first name, age and medical history and interactions with his family members on a patient care report. The reports are typically passed on to hospital personnel when a patient is taken to a hospital but are considered necessary even in cases in which a patient is not taken to a hospital to provide medical and legal documentation of responder’s actions.”

But that doesn’t mean that they just plain didn’t care about the guy and were encouraging the refusal, right?

“When Givens asked one of the four emergency workers who responded if he needed to go to the hospital, the responder replied, “That’s up to you; if you want to go we will take you,” according to the report.”

Yea… I’m just going to come out and say that the only time I ever use that line is at 0330hrs when I’ve been called out for a stubbed toe in the winter time and I am actively encouraging the AMA.

But this can’t be a systemic problem with the whole administration of the DC Fire Department EMS division, can it? I mean… that’s one of the nation’s busiest fire-based EMS providers and I’m sure they care a great deal about EMS and give it the full attention it deserves.

“A 2009 investigation by The Washington Times into the training and education of the District’s paramedics found many could not pass basic written exams testing their medical knowledge or that they mishandled basic life-saving procedures during videotaped assessments.

The test results of the paramedic who treated Givens were among those criticized by experts in the report by The Times, and the lawsuit filed by the Givens family accuses the fire department of being aware of the paramedic’s “poor performance” but leaving him in the field.”

Um… but that was in 2009! And I’m sure that the DC Fire Department EMS Division has progressed greatly in improving their EMS care and service delivery, right?

DC BLS Ambulances out of service as Hot Weather Arrives

<sigh>

I will admit, there isn't enough information or proof here to make a decision on due to the *amazing* clarity of the reporting here. I'll admit that I read between the lines when I made my judgement and then pulled back from my original thoughts. Then again, it does seem like my worries about this case are correct… I don't know exactly what the truth is, but I'm guessing it's not favorable for DC Fire EMS.

Excuse me, I mean "FEMS."

<sigh>

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Have you ever read my post on the ultimate, most off-limits “no go” topic in EMS blogging? It might tick you off as well.

 

Posted by on June 17, 2011 • Filed under: Administration & Leadership, Case law, Command & Leadership, Emergency Medical Services, EMS, EMS Management, EMS rant, ems report, EMS Topics, everyday ems ethics, Fire Rescue Topics, Paramedic, training-fire-rescue-topics

Keeping an Eye on the Sky

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

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

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

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

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

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

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

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

Have you been to these websites yet?

As always folks, stay safe out there.

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

From the #WTF files – AL Fire Chief Flushes Twins down the Toilet?

7 comments

Holy crap! Read this: Odenville, AL Fire Chief Terminated  FireLawBlog.com

Did I read that correctly? Did a Fire Chief really FLUSH TWO STILLBORN TWINS DOWN A TOILET!?

No way, that's gotta be a hoax… I mean, that can't happen, right? Please tell me that nobody is that stupid. Please restore at least a little of my faith in humanity…

Nobody? <sigh>

FireLawBlog.com's story on this has a link to the St. Clair Times article on the subject, and it looks like there's a lot more to this story than has been reported. The comments on the article are pretty telling… although I still have very little idea on what actually went on here. At face value, I can't see any possible reason that this would have happened. I just don't understand. Maybe if she miscarried into the commode maybe? I suppose they *could* have missed them… right?

Eww.

Also, the former chief defended himself with this cryptic statement, which I've seen repeated three times in various articles on the story:

"There were two of us there, and we followed protocol,” Davis said. “We followed the state protocol issued by the medic who was in charge at the scene.”

Soooo… Um… The medic… issues state protocol? and he/she ordered this? Aaaannnd… I'm sorry I just don't understand the statement. Maybe it's a bad quote, I don't know.

Anyway, here's the followup story. I just thought I'd call it to your attention.

http://firelawblog.com/2011/06/alabama-fire-chief-sued-over-disposal-of-stillborn-twins/

 

 

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