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Heat Emergencies for EMS – The Summer Time Blues

2 comments

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

Heat Emergencies

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

  • Heat Cramps
  • Heat Exhaustion
  • Heat Stoke

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

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

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

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

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

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

 

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

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

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

Wake Up! You may have a call…

2 comments

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

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

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

Here, see for yourself!

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

I think it's a potential gold mine.

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

A Weighted Issue – The Fire Service Helping Private EMS

111 comments

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

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

But that’s not exactly what happened…

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

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

So… do you see the discord there?

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

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

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

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

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

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

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

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

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

SFD gets a letter in the file for this one.

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

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

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

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

SFD gets a letter in the file for this one

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

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

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

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

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

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

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

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

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

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

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

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

What are your thoughts?

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

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

7 comments

Medic Trommashear, who writes great stuff has offered to co-post with me on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

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

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

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

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

I was going nuts.

I was horribly, deeply depressed.

I almost went insane.

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

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

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

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

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

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

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

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

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

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

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

17 comments

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

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

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

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

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

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

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

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

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

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

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

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

I’d write more but Zzzzzzzzzzzzzzzzzz

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

I have been a busy, sleep deprived, lil’ medic

1 comment

The title says it all… MAN have I been a busy guy. It’s summer and the boy is just fun as heck. We’ve been fishin’ and swimmin’ and boatin’ and doing the things that a father and son are supposed to do in the summer time. Plus, as is my style, I’m working around 70-80 hours per week and I’m trying to cram in as much quality family-man time as I can.

Soooo… my posting frequency??? Yea, that’s suffered a bit. I’ll get back to it. I’ve just been busy. Plus, MARDEK3 came out and I’m such a nerd ;)

So, howsabout a rerun? I don’t want to change the permalink, but I think this is a good post.

http://lifeunderthelights.com/2009/11/the-day-i-didnt-die-firefighter-close-calls/
Be back soon, y’all.

Posted by on July 21, 2010 • Filed under: Fire Rescue Topics, Firefighter Safety & Health

Police Car Drivers, Ambulance Drivers, and their responsibilities

12 comments

Look at the pictures below and see if you can identify the three occupations represented by the people in the pictures.

What are their jobs?

What are their areas of expertise?

What would you expect them to be responsible for?

                                     

 

Yep, pretty much everyone reading this and almost every lay person you can think of should probably be able to answer the above questions. The Police Car Driver chases bad guys; The Fire Truck Driver squirts water at things; and the Paramedic takes care of people who are sick and hurt, right? Sure, their jobs sometimes overlap and so does some of their training, but the jobs and the requisite education and responsibilities are different and separate for a reason. The different roles up there are different, specialized, and require expertise in order to be effectively performed… right?

And before you think that I’m opening the Fire Based EMS can of worms, I want to direct you to this news story I just read on EMS1.com – Kentucky EMTs not called for 5 hours until coroner ruled woman was alive. Go read this and then come back please. It got me all riled up and I’m sure it will you as well.

The moral of the story, is that police officers were called for a dead body found in some bushes some where. They started doing their cop stuff and didn’t call EMS to evaluate the body because their cop training told them that the woman was obviously dead. Unfortunately for all involved, when the coroner arrived he told them that their police-issued medical training wasn’t adequate and that the woman was indeed alive.

And yes, I am 100% sure that nobody intended for that to be the tragic result.. people make mistakes, I know… but:

How many times have you been called out in your ambulance to a potential medical emergency and then cancelled while en route? Have you ever wondered who is cancelling you and for what reason? When we arrive on scene, we evaluate the patient and determine their need for transport. We have extensive training to help us do this and we function within a complex set of laws and regulations to help ensure that bad outcomes like this happen as infrequently as possible. Unfortunately, however, things like this do happen, even to experienced paramedics. How many times have you heard news stories about paramedics calling someone dead only to have them be found alive later on? How many times have you heard about occult neck fractures and other severe injuries being found later even after a patient was evaluated by a physician? It happens, folks… and it happens to us medical people too. Even with the training, knowledge, skills, and experience we have that is specifically geared to emergency medical care that is again enhanced by the fancy tools that we carry with us, we sometimes still make mistakes…

So why in the heck would a police officer, who as stated above chases bad guys and does other kinds of “cop stuff”, want to make the decision that someone was dead or not? It simply doesn’t make any sense to me. I have always been leery of having police officers call us off of medical scenes. Even when I know the officer and trust his or her judgment, I know that my medical training and tools are superior to theirs. That’s the way the system is designed, we do medical stuff and they do cop stuff.

I think that there’s a pervasive trend out there that causes dispatchers to send police units first to things like auto accidents and possible crimes in progress and then potentially forget to send EMS. Most of the time, it’s perfectly ok and turns out just fine. Other times, incidents like the above happen. How many times, also, has a police officer determined an auto accident to not require medical response and an occult injury been found later? I don’t know and haven’t seen any statistics… but I’ll bet it happens a lot more than is ever reported.

My advice? I promise to let the cops to their cop stuff. They just need to always remember to call me out to do my stuff. I don’t mind doing the report if I’m not needed or I get a refusal, I just don’t want anyone to suffer needlessly.

Be careful out there.

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Want more of my thoughts on Fire Based EMS? See: “Fiddling While Rome Burns… The ambulance “industry”

Posted by on June 15, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Command & Leadership, Emergency Medical Services, EMS, EMS Topics, EMS training, Firefighter Safety & Health, Paramedic, paramedic education, patient care, Uncategorized

To Kneel or not to Kneel

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

 

 

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

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

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

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

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

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

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

  1. Put on gloves. No sense in contaminating your hands. Chances are your knees won’t have broken skin on them unless you’ve been trying to get that promotion (Enough with the “on your knees” jokes! – This is serious!)
  2. Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
  3. Spray the ever-loving bejeebus out of your pants, saturating your knees with disinfectant spray. DO NOT use bleach-based spray. The milder the better. (see “Clean EMS” for advice on contact times)
  4. Press another towel on the outside of your pants, soaking up as much poo/pee laced disinfectant into the towels as you can. Rub them together a bit.
  5. Re spray with disinfectant and let it air dry.
  6. Remove the towels from your pants.
  7. Call your wife and beg her to drive you up a new pair. Beg. Hard.

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

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

Saved by the Bell? High School Student EMS

61 comments

Ahhh, High School. The classes, the lockers, the bells, the peer pressure, the parties, the immaturity, the congestive heart failure, the overdoses, the emergent response, the…

Wait, what?

I’ve been hearing a lot recently about Emergency Medical Technician training being held in High Schools (9th – 12th grades) with teenage high school students being trained to be EMTs. At first blush, it actually seems like an innovative way for communities to meet the EMS staffing shortage problem head-on. In addition, it would seem to be a great way to get young people interested in EMS. In fact, THIS ARTICLE posted recently by Zoll EMS&Fire on their Facebook page seemed like a good idea to me at first. A county partnered with a technical high school in order to train new EMTs to swell the rosters of their county’s services. It’s gotta be a good idea? Right?

Then how about this service in Darien, CT. that is ENTIRELY STAFFED BY TEENAGERS AND HIGH SCHOOL STUDENTS? (Dept. Web Site)

Or this service, in Hoboken, NJ that has a student emergency response team that “respond(s) with the school nurse to non-emergency calls”? (additional article)

I have been hearing about such things for a while now and even spoke about it with Tiger Schmittendorf on the March edition of the Firefighter Netcast, however I didn’t give it very much thought until I read the “Last Word” section of JEMS Magazine in what I believe was the March 2010 issue (although I can’t find it anywhere on their web site www.jems.com). It talked about our friends in Darien Connecticut that run Post 53 EMS, a service that is staffed and ran almost entirely by high school students. I was a bit peeved after I read that. Then yesterday when I read the article about the service in Sussex County, I got just plain mad. I don’t agree with this at all. In fact, even though I might have been for it without thinking it through, now I am coming out completely against it.

There, I’ve said it. I am against beginning Emergency Medical Technician training in high school and I am most certainly against persons under the age of 18 staffing ambulances. I also must strongly condemn persons under the age of eighteen responding to emergencies, operating emergency vehicles, or taking responsibility for professional level patient care.

Look at the words there and understand just how much I condemn the actions of the politicians and officials that permit this. You are endangering the public, harming the profession of EMS, and creating a systemic negative impact on patient care throughout the system. You run the chance of increasing patient morbidity and mortality, run the risk of getting teenagers injured and/or killed on an emergency scene, and are exposing youth to situations that they cannot possibly be experienced enough to understand.

I am fully aware that the above paragraph is inflammatory and I am aware that the proponents of these situations are not going to like what I have said, but that doesn’t make it less true. Look for a minute beyond the arguments that you are going to make about the kids themselves, who I am sure are all upstanding young citizens who are surely beyond reproach. Look for a minute even beyond the fact that evaluation of the kids themselves must be taken on “a case by case basis” as I’ve heard before when this issue is argued. T o be certain, there are kids that are capable of functioning to the EMT-Basic level with proper, adult, professional supervision… However, I want to know why there is a perceived need?

The communities that support and offer these plans where students are trained to the EMT level and especially those communities where persons under the age of 18 are active emergency responders generally purport to be offering these plans in order to combat a “shortage” of trained emergency responders. This is where my biggest grievance lies. This “shortage” of which they speak is manufactured. It’s false, and it’s created by the very attitude that causes the local political powers to think that a program that provides a consistent stream of young, inexperienced, naive EMTs who are willing to work just for the “excitement”, “honor”, and “cool factor” that these programs seem to offer is a good idea. Here’s the thing, these communities don’t have a shortage of adult, professional EMTs who are willing to do the job. They have a shortage of adult, professional EMTs who are willing to work for peanuts in a system that has no respect for what they do.

Get it? If you have such little respect for EMS and the EMTs that provide it that you are comfortable letting teenage kids work your trucks, you obviously have such little respect for EMS that you provide horrible pay and working conditions to the point where no self-respecting adult can make a living on the wages and conditions you offer them. There’s no shortage of EMTs willing to provide excellent EMS. There’s a shortage of pay and professional respect that causes them not to be able to survive working the available jobs. Trust me, if these communities paid better and provided better jobs there would be no shortage of EMTs. It’s manufactured by their willingness to just have someone with a pulse and an EMT card on their trucks. It’s manufactured by their thought process that EMS is simply childs’ play and that since “any idiot can do it” they might as well put kids on the trucks. The EMT shortage has always been created by lack of pay, poor working conditions, and an unwillingness of local politicians to provide adequate amounts of these things. Creating high-school EMT programs reinforce this by always providing a stream of fresh meat willing to work for nothing. Young people don’t worry about such things as pay high enough to support a family, nor do they care so much about things like insurance, benefits, or retirement plans. They just want to get out there and go to work. 

I make the argument that putting inexperienced high-schoolers on ambulances increases morbidity and mortality using my experience as an experienced long time paramedic. I offer the full body of research that proves that experienced healthcare providers provide better healthcare than do inexperienced ones. The fact that there’s such little research out there does not diminish the fact that you have no such research that shows safety in what you do. I say that your communities would be better served by adult, professional, well compensated providers. I say that they would save more lives and reduce more suffering than do your high-school kids. It is well known that patients have better outcomes when they trust their healthcare provider and you ask your patients to put their trust in high school students. There are many possible scenarios out there where the patient’s very life and/or death rest upon the skilled interventions provided by an EMT. In these situations, even experienced providers make mistakes. You’re telling me that the incidence of these mistakes will not be unacceptably higher using teenagers?

When your Wife, Son, Husband, Daughter, or friend is lying there, dying on the floor, the roadway, or on the cot, will you feel comfortable with your decision to put a high school student at their side to be in charge of their continued comfortable survival? I make the charge that you will not. Your community members do not need a child coming to them in their hour of highest need. They need a professional, adult provider and your system denies them this.

I support EMS education in high schools. I support explorer programs that give firsthand experience and education to teenagers and younger students. I support CPR and First Aid Training at any age. I will support students coming to the EMS station, cleaning the trucks, taking classes with the crews, learning about EMS, and even staffing first-aid stations and special events under the watchful eye of an experienced adult provider. I do not support students responding in ambulances for the reasons I’ve stated above… but in closing I also offer this:

In one of the articles above, someone stated that these programs prepare students for a career in the emergency medical services. They might. However, by their very existence they prepare students for a career in a low-wage, low respect industry that might as well be provided by teenagers. These programs are a slap in the face to our profession. We will never advance when mindsets like these are allowed to propagate and flourish

Your thoughts?

Posted by on March 29, 2010 • Filed under: 911 fail, Administration & Leadership, ckemtp, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, EMS, ems education, EMS ethics, EMS Health & Safety, EMS Management, EMS rant, EMS Topics, EMS training, EMT, Ethics, everyday ems ethics, Fire Rescue Topics, Firefighter Safety & Health, medical ethics, politics, rant, Training & Development, volunteer fire department, volunteer firefighter

The Shine Factor

4 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now get out there and polish some chrome.

——————————————————————-

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

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

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

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

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

Splashed Sadness – A look at negative emotions in EMS

28 comments

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

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

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

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

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

     

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

     

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

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

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

     

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

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

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

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

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

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

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

Or you go nuts.

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

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

 

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

Thank you EMS – Some reasons I love what I do

6 comments

Judging by how I felt this morning when I got up at 06:43 for a seizure victim after getting to bed at 03:30ish beforehand, I would say that I’ve been doing this for a while. I’m not as young as I used to be and I certainly am not the same person I was when I first got behind the wheel of an ambulance and flipped on the flashing lights.

I’ll never forget that first time I ever drove an ambulance lights and sirens. I was so excited. When I was younger I had always wanted to be an EMT and I viewed my first emergency driving experience as the time when I’d really “made it”. I was working as a security guard in a hospital where our security department ran an ambulance service that existed solely to transport patients from a free-standing ER attached to an outpatient facility to our larger flagship hospital with inpatient beds. Mostly we did tech work in the ER and transported every admission to the larger facility. Occasionally we got to “knock the cobwebs outta the siren” and run the ten minute trip “hot”. That was my first time driving in an emergency fashion… it may have not been a clean win since it wasn’t a 911 call… but it was still my first.

However, I digress. This post isn’t about my youth and exuberance that I didn’t know I was in the midst of when I first pinned on an EMS badge. This post is about the person I am today. I’m a paramedic now and I will say that I am proud of my son, my wife, my family, and my skills as a paramedic. I try not to brag on much, but I have put so much effort into all of the above that I am proud of the way they’re turning out. As a paramedic I have put in years of continuous effort to become the provider that I am today and even if nobody else ever cares about how good I was when I retire one sad day in the future, I will, and that’s enough for me to drive on.

I will never have the ability to give back to EMS all of the positive gifts that it has given me. Growing as a paramedic and as a healthcare provider is directly related to my growth as a person. I entitled this blog “Life Under the Lights” because I feel that I’ve lived a significant portion of my own life “Under the lights” of an ambulance. We all share a lot of the same experiences on our journey as EMS providers and we’re only starting to realize our true potential as a profession.

So here are a few things that I am thankful for that I’ve gotten back from my career as a paramedic so far:

-          Thank you EMS for allowing me to see the power and passion in people going through the worst times in their lives… and in some cases the best ones.

-          Thank you EMS for allowing me to have conversations with fascinating individuals I’ve met as I’ve taken care of them. I love hearing the stories my patients tell me… it’s got to be one of the best parts of the job. I’ve learned so much from my patients.

-          Thank you EMS for taking me on a journey through my own emotions and allowing me to feel the highest peaks and lowest valleys of my own psyche as I’ve lived out the world through facing emergencies. I may have never known such things about my own capacity for feeling.

-          Thank you EMS for teaching me that I always have it in me to go on fighting when the stakes are high… Without having to fight through the pain, exhaustion, and other discomforts that you’ve thrown at me I wouldn’t know nearly how much I could take.

-          Thank you EMS for allowing me to meet my wife. I love her more than I love you.

-          Thank you EMS for allowing me to meet my coworkers, some of them have become my closest friends. Maybe I’ve had better parties while on the clock than I have had off-duty. Being at work is just such a blast sometimes.

-          Thank you EMS for showing me that no matter what struggles I’ve been facing in my personal life, that there is always someone out there struggling harder than I am.

-          Thank you EMS for shaping my personality. I used to be a shy introverted person. Now I can almost always come up with something close to the right thing to say by thinking on my feet.

-          Thank you EMS for giving me the opportunity to Drive Fast and Break Things occasionally, it’s the manliest thing I do most weeks.

-          Thank you EMS for making my life exciting. I love the feeling I get when the stakes are extremely high and the adrenaline is pumping… it has to be better than any drug.

-          And finally, Thank you EMS for more than I can thank you for. I (quite geekishly, actually) can relate most things to something I have done or might do in the field. That’s very cool in my book.

Without my starting point in EMS more than a decade ago, you wouldn’t be here reading this right now. I would be some guy doing something somewhere else. My life is shaped because of what I do and who I’ve become from pounding the streets every day. Thanks for making me “somebody”. Thanks for giving me something to write about. Thanks for being as cool as you are.

Posted by on February 9, 2010 • Filed under: appreciation, Emergency Medical Services, emotions, EMS, EMS Blog, EMS Health & Safety, EMS Motivation, EMS paramedics, EMS pep talk, EMS Topics, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Fire Rescue Topics, Firefighter Safety & Health, Paramedic, potential, pride, profession, professionalism, thank you

Why I am Passionate about the Chronicles of EMS

15 comments

If you’re an EMS professional, you should be paying attention to the Chronicles of EMS.

I think every person involved in EMS on any level needs to pay attention to the work of three of the profession’s upcoming giants, Mark Glencourse, Justin Schorr, and Thaddeus Setla. Their collective project is a warp-leap forward for how our profession is presented to, judged by, and thought about by our internal and external observers, customers, and colleagues. With their efforts come Hope… Hope that one day soon EMS will take its rightful place as a true profession; Hope that our profession will get the paid the attention that it deserves; Hope that our educational standards, resource needs, and compensation will finally be improved; and Hope that we will be able to improve our total service to our patients and our community through shedding a new light on our profession.

If this works… everything could change. Everything could change quickly, incredibly, and wonderfully. Imagine if EMS became “cool” and the public finally thought about who we are, what we are, and what it is that we do for them. Imagine if people demanded that their community leaders pay as much attention to EMS as we need them too… Just Imagine.

EMS needs a strong, unified message. The Chronicles of EMS can be that message. It is a professional, smart, and uber-cool message aimed straight at where we want to be going. It is not lip service, it is not Hollywood glamour, and it is certainly not dramatized for profit. It is being prepared by industry-experts who are still working the same streets that we are everyday. Everyone involved is one of us. Everyone involved is passionate. Everyone involved wants this, and they want it as bad as you do.

The reason I write about EMS is because I want to improve our profession and our service to others. I want to make this better so bad that I can taste it and I’m willing to work as hard as I have to. Our patients and our communities deserve the best we can give them and I believe that key to fixing EMS is communication and the spreading of our message. This blog exists for that reason and so do the other blogs in this genre. The other bloggers, authors, speakers, and writers I’ve met have all spoken to me of the same goals. Our profession exists to save lives and alleviate suffering and improving our profession help us save more lives and alleviate more suffering in our communities. EMS does indeed make a difference out there in the world and we’re the ones doing it. The Chronicles of EMS is a great beacon of hope in our collective quest.

EMS Deserves More. Our Patients deserve more; Our Families deserve more; and yes… We deserve more. Mark, Justin, Ted, and everyone involved in the Chronicles of EMS are working hard to give us just that. They deserve our support and our attention.

I’ll be in San Francisco on March 11th for the premier of their pilot episode. I wouldn’t miss it for anything. Look out world, EMS is moving forward.

Posted by on February 8, 2010 • Filed under: Administration & Leadership, change, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, EMS Blog, EMS blogosphere, ems education, EMS Health & Safety, EMS Management, EMS Topics, EMS training, EMT, Fire Rescue Topics, Firefighter Safety & Health, Happy Medic, humor, Line of Duty, medicblog999, News, Paramedic, paramedic education, Patient Management, pride, profession, professionalism, Public relations

Be the Glow Worm – HazMat for EMS.

9 comments

I am not a glow worm.

Full disclosure – This is a repost from 09/2009 – It deserved a bump-up and to fix the video. Make sure to watch the vid!

Hazardous Materials, or “HazMat” as it is commonly known, is scary stuff. At least for me that is. In public safety circles, they’re mainly the concern of firefighters and I’ve never received training on them outside of the realm of the fire department. My EMS only agencies have always told me that we remain in the “cold zone” and wait for patients to be brought to us after decontamination.

And that’s just fine with me. Ckemtp is NOT a glow worm… did I mention that?

But, since I’m also a firefighter I finally broke down one weekend and gave in to the pressure I was under to get my HazMat Operations certification. 40 hours of class, lots of homework, and some very dry PowerPoint slide shows. After the first weekend of the class there’s some things that I’ve learned and figured out.

1. HazMat’s still scary.

2. Ck’s still not a glow worm.

3. EMS agencies really need to train more on HazMat.

“We know hazmat” you say. And I know that you’re saying it because that’s what I would have said before those last 20 boring hours spent learning that I knew nothing about hazmat. HazMat is something that we take for granted in that we think that it won’t happen in our jurisdiction, or that it won’t affect us on our day to day. I happen to hope that it won’t hit during my duty days.

This video is from Seward, IL. A small town in the middle of a lot of corn that found itself one day having a big problem. The video is from a surveillance camera on the side of a grade school in the middle of town. The vid starts slow, but has a definite “HOLY CRAP!” moment about halfway through. You’ll see what I mean, all hell breaks loose.


 
See? Holy hell on crutches! That’s anhydrous ammonia, a common chemical used in farming (and in methamphetamine production). A tanker truck full of the stuff sprung a leak and flooded the town with a toxic cloud. Thankfully, nobody was killed. There were a few firefighters sent to the hospital, and some very scary moments, but it all turned out to be ok. This one’s from the same school. It’s just as scary.

Remember this, a HazMat incident doesn’t have to be the once in a while overturned tanker truck full of MethylEthylBadJuJu. Any every day response can turn quickly into a hazardous materials incident.

Not too long ago, an EMS only agency that I may or may not work for received a call for an “eye injury” in one of our really rural response areas. This call generated a single ALS ambulance only response out to the farm where the injury happened.

The medic and the EMT responded out to the scene, which was about a 15minute emergent response. Arriving at the farm, they were directed to the dairy barn to find their patient.

Their patient was in a lot of pain.

Apparently, he worked for a dairy services company and was delivering product to the farm when he was injured. If you don’t know much about dairies, milk processing leaves a byproduct called “Milk Stone” which is the dissolved minerals in milk solidifying on dairy equipment. Think of hard-water stains. Dairies use products containing phosphoric acid to clean it out. It’s like Lime Away on steroids. This stuff is pretty nasty. Dairies use it in a diluted form, but the supply companies carry the concentrated stuff. This patient was filling a container with the high-powered stuff to dilute it into the customer’s container when the concentrate fell. He reflexively looked right down at the falling container and got a face full of the stuff when it splashed back up at him.

Do you remember that chemical burn stuff you were trained on? He had them. Do you remember the decontamination training you had? What about proper personal protective equipment, do you have it? Do you know when to put it on? Do you know how? What do you know about the chemical?

While treating the patient, one of the paramedics noticed that his EMS gloves was turning white. It was the acid eating through it. A lot of water was used to irrigate the patient, and the providers, before transporting the patient to the hospital.

This was an everyday incident that actually happened. Think about how you’d handle it, because tomorrow it could happen to you.

And once again, Ck is not a glow worm.

Posted by on January 20, 2010 • Filed under: accident, disaster, EMS safety, EMS Topics, EMS training, Fire Rescue Topics, Firefighter Safety & Health, HazMat, Major Incidents, Special Operations, training-fire-rescue-topics, Uncategorized, Videos, volunteer fire department, volunteer firefighter

Thanking Those who REALLY Deserve it – Merry Christmas

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I originally meant to post this during Thanksgiving, but this season seems appropriate enough. I love Christmas. It’s my most favorite time of year. I love family, friends, cooking, and giving gifts. I love Christmas parties, I love the fellowship, and I love being kind to everyone and having them not look at me strangely… ok *as* strangely as they do other times of the year.

And also, I tell people “Merry Christmas”. I don’t say “Happy Holidays”, “Happy Winder Holiday”, or “My lawyer sez to tell you ‘good luck”. If someone responds with “Happy Chanukah”, or “Happy Kwanza”, or “Happy MishMash Shaloob” I’m not offended by it and I’m happy that they wished me the sentiment so there ya go.

Oh, and to my UK friends, Merry Frumpydumples to ye’

So what’s my Christmas post going to be? Well, it’s about thanking who’s really important to thank. As you all know, I’m a volunteer paramedic and firefighter as well as being a career paramedic and firefighter. This time of year in the small towns, it’s pretty common to have people stop by and offer up sweet treats and tell us “Thank you” for what we do for them. Let me make the blanket statement that I really appreciate it folks, even if my waist line and my pending diabetes doesn’t. However, I don’t think that I deserve your thanks.

I have always gotten more from my service to others than I could ever hope to give back to it. I love EMS and I love the Fire Department and I love helping people. I identify with it and I couldn’t imagine my life without it. Even after a solid decade of running my “Life Under the Lights” I can’t imagine doing anything else. I am rewarded a thousand times over by every smile I get, every person I comfort, and every person that I am privileged enough to come into contact with as a caregiver.

So who should the people that wish to thank us actually be thanking?

Well , first thank my wife for every time that I’ve had to get up and leave for a volunteer call in the middle of a family dinner. Thank my kid for every time that I’ve missed out on play time, or story time, or nap time because the pager called me away. Thank my family for all of the times that they’ve had to do without me because I was working mandatory overtime. Thank my wife too for all the nights she sleeps alone because I’m on a 24 and am sleeping at the station. Thank my friends for all the times that I’ve stood them up on plans because I’ve gotten stuck running calls. Thank everyone who cares that I spend time with them, because a lot of the time I could be doing that I’m off caring for everybody else.

Thank the same people for every volunteer or public safety person you know… because without the caring and understanding of the people that truly matter in life for us, we couldn’t be out there doing it for you. They’re the heroes here.

That, and one more thing. I was never in the Military and I probably should have been. This may not be much, but Thank You to all of our Military Men and Women out there serving for me and my family. I can’t write enough to say how much I deeply, and truly appreciate your sacrifice… but from the most humble part of my heart, Thank You for everything you do. The same thanks goes to your families and loved ones as well.

Merry Christmas, Every one.

Posted by on December 24, 2009 • Filed under: 2009, Ambulance, appreciation, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Motivation, EMS pep talk, EMS Topics, fire, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, In the Line of Duty, Line of Duty, News, Paramedic, pride, profession, professionalism

The day I didn’t die – Firefighter Close Calls

16 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

The Drunk Responder

5 comments

Greg Friese, over at Everday EMS Tips, has written a post in observance of Drug Free Work Week – Oct 19-25th, 2009 entitled “When a Coworker is Intoxicated” In it, he asks what we would do as EMS professionals and Firefighters in cases where we suspect that a coworker is under the influence. This originally started as a comment to his post, but it went long enough that I thought I could get a post out of it. Here it is:

Ewww, I hate these situations. I’ve worked full-time EMS for a long time, but I’ve volunteered for longer than that. One would think that this is a problem that I’ve encountered more often in the volunteer services, however I’d have to say that the few times I’ve actually noticed it are about equally distributed.

Thankfully, these situations have been few and far between. However, EMS and Fire people like to drink sometimes (ahem) and the potential exists for this to happen more often than you’d think.

In a volunteer service, the classic example is someone showing up for an emergency call after consuming alcohol. Often, these people sincerely did not want to “show up drunk” but thought that the need was great enough for them to show up after having “Just one or two”.

For the paid services, aside from the absolute taboo of consuming alcohol while on duty, the classic example would be spending a late night out at the bar and then showing up for work in too short of a time for the alcohol to be removed from the person’s system. If you’ve ever had a coworker show up complaining of a hangover, this may indeed be the case.

Both are unacceptable. Personally, I know that my career depends on never doing this. I also know that my patients deserve a caregiver who is on top of his (or her) game. I subscribe to the FAA’s rule governing pilots, or the “8 hour from Bottle to Throttle” rule. I take myself out of the response roster for at least 8 hours if I have had one sip of ETOH and I stop drinking a minimum of 8 hours before having to go on duty.

There’s no excuse for a provider having any amount of alcohol on board while performing any aspect of EMS. If the patient smells even a whiff of ETOH on their provider, that provider is drunk until proven otherwise. Even if the provider is under the legal limit the patient loses confidence. Our patients deserve better. If you had EMS come for a family member and smelled alcohol on the responding ambulance crew, you’d think the same thing and would probably become very angry or fearful for the actions of the responding crew.

Remember, each “drink” defined as one ounce of alcohol, raises your BAC (Blood Alcohol Content) by roughly 0.02%. That amount of alcohol takes approximately one hour to be removed from your system by your liver. Each person is different, and other factors come into play… however if you’ve been drinking you need to leave hours between your personal fun and your professional care.

The problem here, of course, is the percieved effect on the person who reports a coworker for possibly being under the influence. In some agencies there may be fear on the part of the coworker who notices the smell of ETOH or other intoxicant that they will be ostracized by the group for blowing the whistle and turning the offender in. In reality, it is your duty to your future patients and the reputation of your agency to turn someone in no matter the percieved ill effects. However, to make this easier I have some tips:

  1. Act immediately – If this person gets activated for a call or otherwise interacts with a patient, they could cause that patient harm. This is unacceptable.
  2. Enlist the aid of a coworker if you’re uncomfortable immediately going to a supervisor – Get someone else to nonchalantly speak to the person or linger in their vicinity to see if they notice what you do. Go together to report the suspicions even if the other person doesn’t notice what you do. It’s that important.
  3. Remember that someone’s life may very well depend on your actions – Friendship among coworkers is one thing, but a drunk firefighter or EMS provider may very well kill someone. You or another coworker may be injured or killed by their actions on the fireground or emergency scene. Your patients may suffer at their hands because their decision making ability and reaction times are impaired. Can you stand that on your hands for not reporting it?
  4. You may be helping the person through a real problem – Is the coworker an alcoholic? Could they be? Being at work drunk, especially in such an important job as EMS and firefighting is indicative of a real problem with alcohol. Turning them in may be the first, and biggest influence in getting that person help or in allowing them to help themselves.

This is a tough situation, but is an easy call. Keep alcohol and other drugs out of the emergency services. Keep yourself sober and sharp while on-duty or responding. It’s just not worth losing everything over a couple of beers. Have your fun and enjoy yourself while off duty but remember, alcohol can be a wonderful servant but is a terrible master. Do yourself, your career, and your patients a favor and leave ETOH in your personal life, far away from your station.

Posted by on October 22, 2009 • Filed under: Administration & Leadership, Command & Leadership, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS safety, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, Firefighter Safety & Health, medical ethics, professionalism, safety

Follow Up to the Shine Factor – Grunts: Part 1

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

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

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

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

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The other day I determined the most important piece of equipment in my ambulance for the day. It varies from shift to shift, you see. Sometimes it’s one of the sexier tools we carry, like the IO (intraosseous – Into bone marrow) drill or the $25k cardiac monitor. That day, it was definitely NOT sexy but nonetheless it attained the status of the most important piece of equipment of the day. It was (drum roll please): The emesis basin.

For my non-EMS audience (Yes!! I’m getting one!! Keep telling your friends!!) “Emesis” is a medical term for “Raalllpfffegh” or, more technically, “barf”. It’s puke, vomit, throw-up, and the like. It’s something that, (apologetically) has been mentioned a few times in my writings. For EMS people, as I keep saying, it tends to be an integral part of our careers. The “Emesis basin” is a polite, professional term for a puke bucket; A portable version of the Porcelain Goddess that people pray to on hungover mornings if you will. Having one on the ambulance is necessary for a lot of reasons, none the least of which is to keep the puke out of your shoes. If you ever want to see a medical person scramble, and I mean any medical person, yell that you’re going to need an emesis basin quick like.

Quick sidebar story: The other day I was working the clinic when a patient asked for someone to come into his room. He said “I think I’m gonna throw up!” and he definitely looked like he wasn’t kidding. The problem was, when calculating his probable trajectory; I saw that he was aiming for the exact ground level cabinet where the emesis basin was stored. I had to act fast. I sprung into action, diving commando style towards the cabinet. Seconds ticked like hours. Quickly I opened the door and grabbed for the basin, cursing myself in my head for the lack of dexterity I had in getting the basin out the door. If only I had more time! I could…

Yes, he puked on me… Only a little bit though… He just peppered my scrubs a bit with splatter off the floor.

So anyways, the emesis basin was the most important piece of equipment on the ambulance the other day. The patient needed it and needed it right then and there and I got it for her. Luckily for me we had one. Yep, we had ONE; Just ONE bucket that I used ten minutes into my hour long transfer. It was my fault too, because it was my ambulance for the day and therefore the responsibility to check the stock levels and functionality of the equipment was mine and mine alone. The fact is, though, that the emesis basin just isn’t on my mental list of things that I absolutely have to check. I check the biggies really well every shift. I make sure that there’s plenty of EKG electrodes because I really like 12-lead EKGs and I’ll do the fancy right sided ones when I think that they’re necessary. I check to see that we have a good supply of all sizes of IV caths just in case I need to turn multiple people into pin cushions. I check the airway stuff religiously, and even do a monthly op check on my monitor every shift just to make sure it works. That, and I follow our check list to the letter every time.

But I took the emesis basin count for granted, and it almost cost me another vomit bath.

Now, I’m not shying away from my responsibility to check out every piece of equipment on my truck before I head out the door every morning, but really if I was down to my last basin, so probably was the crew before. Since I don’t think that they had to use one, so probably was the crew before them. Then it goes right back to me, when I probably didn’t check it that shift either. More of my fault there then.

Luckily I had the one that I did.

I would wager that one of the most annoying things that can happen to an ambulance person is to find out that you’ve run out of something you need at the worst possible time. Everyone hates that. If it happens a lot it can really tear down The Shine Factor of your organization a lot. It makes the EMT that it happens to blame themselves a bit, but also blame their coworkers a lot more. Nobody likes to bear the blame entirely on themselves so they rationalize that while they may have not exactly checked that exact piece of equipment, the previous crew obviously didn’t either. Then anger starts, and eventually apathy blooms.

Here’s what a grunt like me can do to put an end to this: (Yes, very very simple, I know) Check your freaking truck!

I don’t mean check it like you are told to do per the rule book, I mean check it out thoroughly every single shift. Pull everything out. Make sure that it works. Make sure you know how to use it (couldn’t we all use a refresher on the traction splint?) Make a production of it to whomever happens to be around to see you do it. While you’re doing it, take the extra minute or two to spray something on the surfaces and wipe them off with a towel. It may not be a full decon, but it at least make things cleaner and more sanitary.

A strange thing will happen here, I guarantee it.

First, you will KNOW for sure that your truck is in tip-top response readiness. You can’t fix the fact that it may have 200k+ miles on it, but you sure can make sure that you’ve done your part. It’s a good feeling. Trust me.

Second, you’ve now just picked up a big part of the responsibility for increasing the shine factor in your organization by taking away a big potential aggravation spot for your other crews. They may not deserve it all the time… but at least you’re doing your part to keep everyone happier and to make sure that every patient in that ambulance doesn’t have to suffer additionally from the lack of needed equipment.

Third, by making this a production, and even by turning this into a game, you’ve single-handedly improved the overall care that your organization provides and therefore the pride that your coworkers have in the service. If you do your best truck check, and then challenge another crew to find something that you may have missed, you’re pulling their pride into it too. Make it a bet. Put breakfast or something like it on the challenge. Their pride is on the line too, and that will get them invested.

At a service I worked for in times past, we always stayed with the same truck day in and day out. Since I’m pretty much OCD on truck cleanliness, I got into a competition with another medic from a different station that was riddled with the same OCD that I was. We polished, shined, cleaned, vacuumed, and tried to generally outdo the other with how brightly our truck shone in the sunlight. If I would have had the ability, I’m sure that we would have taken surface cultures to see how sanitary our trucks were (and THAT would be a great topic for an upcoming piece!). That competition put our personal pride into making our trucks the cleanest and shiniest they could be. Once we were invested personally, our pride inspired us to clean the trucks better than any management policy ever could. In fact, management’s best option to further motivate us would probably have been to offer prizes and recognition for the competition. Positive reinforcement other than negative sanctions that there would have been. It works.

Here are some things that I resolve to check each shift:

  • The batteries in my ear thermometer
    • And I’ll make sure that we have the little cover things too
  • I want at least two of every size ET tube in case the first one gets all mucked up
  • Every blade too.
  • I’m actually going to get out the test solutions and calibrate my glucometer. (Yea, when was the last time you did THAT)
  • The child car seat.
  • The portable suction unit, both manual and mechanical.
  • The cot. I’ll bet that the one you’ve got needs at least ONE thing tightened and has at least ONE speck of blood on it.
  • The number of towels in the cabinet. Does anyone else put one on their knee when they
    kneel down at the side of the cot and put the patient’s arm on their knee to cushion the bumps? How many times have you had blood run down on your pants? Now, be honest, how many times have you just felt it easier to walk around that way for the rest of your shift? (Guilty. Ewww)
  • Every other little thing, too.

As always, “Get out there and polish some chrome”

 

—————————————————————-

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

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

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

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

Posted by on March 30, 2009 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, edemse, EMS, EMS ethics, EMS Health & Safety, EMS Management, EMS Motivation, EMS pep talk, EMS Topics, EMT, fire, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, Firefighting Operations, Paramedic, The Shine Factor
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