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Remembering the True Heroes – D-Day, June 6th 1944

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I plopped down on the bench seat next to the patient we had just picked up as my partner closed the door of the ambulance behind us. I’d already gone through the usual pleasantries and introductions with the guy and was making him comfortable for the trip from a small ER for to a slightly larger hospital with an ICU. The patient was sick and advanced in years. I suppose you could say that he was elderly and infirm. The years he had seen were catching up with him and he didn’t seem to think too much of it. He wasn’t very talkative to this ambulance guy who was loading him up and trying to make conversation and I tried to find something to spark it, else I respect his wishes and let him be.

I hooked his nasal cannula up to the main oxygen tank and slipped on the automatic blood pressure cuff. While doing so, I noticed an old, faded tattoo on his arm and figured out what we could talk about for the 30 minute trip to the next hospital. As I was hooking up the patches for his EKG I asked him, “So, you’re a Navy man, eh?”

He looked at me like I wasn’t worth spit and said “Naw, I wasn’t ever one of those bastards.”

I have the utmost respect for the Navy. My grandfather served aboard ship in the Pacific Theatre in WW2 and was one of the lucky and skillful ones who lived to tell about it. I still remember the stories he told, at least the ones he would talk about, and I have always held the service of He and others like him in the highest reverence. So I was taken aback by the patient who’d just derided something I happen to hold so dear.

“Really?” I asked. “I saw that tattoo on your arm and figured you might have been”.

“Son, ain’t you ever seen a Coast Guard tattoo before?” he snapped back.

Honestly, I never had. I live in the Midwest where Coasties are pretty scarce. I’ve only rarely chanced to meet someone who is actually in, or had been in the Coast Guard. His tattoo was pretty new to me and I explained my ignorance to him. He wasn’t offended. He began to open up and we talked the whole rest of the trip to the ICU. He explained his aversion to the Navy by telling me this:

“I was there when they stormed the beach at Normandy and I tried my damndest to rescue the men those Navy guys were dropping in the water. The guys drivin’ the landing craft were opening the gates too far away from shore and making those poor soldiers drop into water too deep for them to swim. Lots of men drowned under the weight of the packs they were wearing without firing a shot. We tried to rescue them, pulled as many as we could into our boats as they were shooting at us. I couldn’t believe that the Navy would do that. I just can’t believe it.”

He continued telling me about his service in WW2 and at D-Day as I sat there, spellbound by his stories. I was in awe of him and what he had done. I was humbled to be in his presence and was enthralled by what he was telling me. He told me stories of the invasion the likes of which I’ve never read about nor heard. I learned more history of our country and the service of the men who defended it in those thirty minutes than I ever could in a history book.

I was humbled. I was honored to be in this man’s presence. I couldn’t believe my luck to get a chance to sit and talk one on one with a living piece of history. What a man he was. I had never heard WW2 stories from the perspective of the Coast Guard and I am so thankful I had the opportunity to hear his stories.

Before I knew it, we had arrived at the destination hospital and I realized I hadn’t done any of the normal things I do on transfers. I hadn’t gotten signatures, I hadn’t written down the vitals more than once, and I was way behind on paperwork as it was. I didn’t care. I had listened to the patient’s stories the whole time and I figure he would have told me had something been wrong. I got the signature and my partner and I unloaded him from the ambulance. We continued talking as we wheeled him up to the floor. He was friendly now and very talkative and I was sad that the transport hadn’t taken longer. When we got him to his room and transferred him to his new bed, the ICU nurse came in to take report. I gave it, there had been no change in his condition from one place to the other and the only thing I did was tell the nurse that the patient was a national hero. It’s not every day that someone from my generation gets to meet and talk to a living part of history, a true national hero the likes of which I could never be.

I never got a chance to talk to the patient again, but I know he’s going to be just fine, regardless of what happens. Men like him take their challenges in stride and overcome them. That’s what being a hero means.

I wrote this on the anniversary of the D-Day invasion June 6th 2011. On that day, 67 years ago, our nation proved we had what it took to overcome the looming darkness and fight the good fight. We still have that resolve within our nation and the men and women of our military are out there proving it every day. Thank you, all.

Here’s an Excerpt from Ronald Regan’s speech given on the 40th Anniversary of the invasion:

"Forty summers have passed since the battle that you fought here. You were young the day you took these cliffs; some of you were hardly more than boys, with the deepest joys of life before you. Yet, you risked everything here. Why? Why did you do it? What impelled you to put aside the instinct for self-preservation and risk your lives to take these cliffs? What inspired all the men of the armies that met here? We look at you, and somehow we know the answer. It was faith and belief; it was loyalty and love.

The men of Normandy had faith that what they were doing was right, faith that they fought for all humanity, faith that a just God would grant them mercy on this beachhead or on the next. It was the deep knowledge–and pray God we have not lost it–that there is a profound, moral difference between the use of force for liberation and the use of force for conquest. You were here to liberate, not to conquer, and so you and those others did not doubt your cause. And you were right not to doubt.

You all knew that some things are worth dying for. One's country is worth dying for, and democracy is worth dying for, because it's the most deeply honorable form of government ever devised by man. All of you loved liberty. All of you were willing to fight tyranny, and you knew the people of your countries were behind you."
"Today, as 40 years ago, our armies are here for only one purpose–to protect and defend democracy. The only territories we hold are memorials like this one and graveyards where our heroes rest."

(Posted from: http://chatterboxchronicles.blogspot.com/2008/06/ronald-reagans-speech-at-normandy.html)

Well said, Mr. President.

Posted by on June 7, 2011 • Filed under: appreciation, Emergency Medical Services, EMS, EMS Topics, Fire Rescue Topics, In the Line of Duty, Paramedic, Patient Management, pride, professionalism, thank you

Remebering My Father, Chief Richard A. Kaiser

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

And I hadn’t remembered.

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

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

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

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

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

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

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

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

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

Because I miss my dad.

Call 911 for chest pain. Just FREAKING do it.

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

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

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

I am not immune

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I’m going to make an announcement:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stay safe out there.

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

Back in the Saddle Again!

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Back when I was a high-school student I was completely enamored with EMS. I just couldn’t wait to slip into a uniform and get out on the streets of an ambulance. While in retrospect maybe I could have refocused the energy I spent researching the EMS gig into something a little more profitable, the sheer amount of stuff I read about EMS in my formative years helps me in my job to this day.

One of the earliest EMS blogs I ever read was one that I found back in High School. I forget the name of it now and I would guess that it isn’t even still up there on the interwebs anymore. However, the writer’s acerbic descriptions of his own life under the lights of an ambulance were hilarious and fascinating to me. I’ve never forgotten the words he wrote.

I was reminded again of one of his stories this morning when I was getting off shift. I’m finally back in the back of an ambulance after spending some time at my secret-squirrel job and I’m loving it. While I wish I got paid more to do what I love, I do truly love what I do. This morning was no different. Again, the EMS gods had me laughing until I cried while an elderly lady screamed in sheer terror.

Yes, I said that. No, I’m not a monster. You would probably have laughed too. Hard.

This morning the radio decided to wake me up around 0430 for the tip-up of the uninjured fall victim. I went, assessed, found nothing, and tipped the poor guy up back into bed. It was a simple call. He signed off on a refusal form, and all was right with the world again. I went back to the station to write the report and after some time spent in between dozing and typing on the Toughbook, I finished my report around 0600. By then it was too late to go back to bed and sleep for an hour, so I stayed up to wash the ambulance and make sure the shift chores were done. It’s the custom at our company to leave the quarters pristine for the oncoming shift, so we do a full cleaning in the morning before shift change. It works for us.

Around 0630, my partner and protégé Chadwick sauntered in to the station. The poor kid had been ran hard and put away wet the day before and looked unapologetically fresh in contrast to as haggard as I looked. Darn Kids. As he helped me dry the trucks and sweep the floor, I was teasing him about catching a late call.

“Can you feel it, Chad?” I would ask. “Right now, there’s some guy that’s waking up and walking up to the toilet for his morning dump who’s gonna vasovagal out and seize on the bathroom floor. It’s your call so when you kneel down, try to avoid the skid marks.”

I kept razzing him as time went on, and when we finished washing the trucks we walked outside to enjoy the crisp, bratwurst-and-cheese-scented Wisconsin morning.

“Did you hear that?” I asked, “that was someone hitting the floor”.

And amazingly, right then the tones went off. It was for a medical alarm that had been activated at a non-medical senior-living high-rise in town. Coincidentally, it was for a fall victim in the bathroom.

Nice.

Chadwick mumbled something that might have been profane I’d think if he wasn’t such a Bible-Thumper and hopped in the truck. I drove because it was his call. On went the lights before I opened the bay door. I think it’s more dramatic if I turn the lights on before I open the door. It just looks cooler that way. Johnny and Roy did it, so I can too. I also wear my helmet like they did. Yay me.

We arrived on scene right before the less-than-optimally-caffeinated police officer who was responding with us. He was able to finagle the key out of the knox box and let us into the building. Apparently last week one of our crew had gotten fed up with the key not being in the box at this building and had opened the lock in a gentle, professional way using his foot. Apparently the building management wasn’t happy with them for doing that, especially since it was for a call that turned out to be a false-trip of a medical alarm. Today we found the key in the box… weird how that happens.

Chadwick and I deftly navigated the long hallway and the small elevator up to the third floor with our stretcher and all equipment in tow. Hypo-caffeine Copper tagged along, and we found the door to the apartment locked up tight. Luckily for the maintenance man, he had the key right handy for us to use.

We entered the apartment with us yelling “Ambulance!” and him yelling “Police Department!”  I thought it was redundant, but hey… he needed to wake up and yelling something helps that. We heard the sound of a running shower and walked towards the bathroom yelling our respective titles.

The patient heard us, no doubt, and did her best Wicked Witch of the West impression as she yelled “Ohhh Myyyy GAAaaawwwd!” We explained again about the whole “Ambulance!” and “Police Department!” thing, but she was having none of it. We told her that somehow her button had gotten pressed and that the machine had called us, but that didn’t seem to ease her fright at having three strapping young men in uniform show up to help her shower, apparently.

After much consternation on her part, and my starting to laugh the tears out of my eyeballs we thanked the lady, apologized for her fright, and cleared the scene to head to the police department for the fresh pot of coffee the officer said he was dreaming about. We hung out, and since I’m a renaissance Medic I tweeted in a HIPAA friendly manner about the call.

Some of the responses included such things as:

 “So I guess the Medical Alarm button is now the ‘Bring Someone to Wash My Back Button??”

And,

“If she pressed the button and got three young public safety types to show up and help her in the shower, is there a way that I, personally could get the button for my own use? We’d have to have a gender setting, of course… As I require attractive young members of the other gender to help me with my showering endeavors”

And,

(something that was absolutely HILARIOUS regarding “Old Lady Boob” that I have redacted from my blog site, you’ll just have to get on to Twitter to see humor of that caliber)

So after this morning’s antics and activities, I can safely say that I absolutely love my job again. I never stopped, but I’m happy that I came back refreshed from my hiatus. I missed the people we see, their twisted humor, and their acerbic personalities. It’s just like the first EMS blog I read said it would be and I praise whomever he was for his accurate description.

Sorry about the lapse in posting, y’all. I’m back and am loving it. Hope you are all too.

Posted by on October 21, 2010 • Filed under: ambulance humor, Emergency Medical Services, EMS, EMS Humor, EMS Motivation, EMS Topics, EMS training, Fire Rescue Topics, humor, In the Line of Duty, Paramedic, stories

What Difference Does EMS Make? Choose Your Own Ending

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John didn’t need his alarm clock this morning. In fact, he was wide awake just a few minutes before it went off. He turned it off so as to not wake up his wife and got up quietly to start the day. Today was going to be great. It was huge. Months of work at the office were finally going to be recognized today in the biggest project meeting he’d had in a year. Today’s meeting would launch his career faster than almost anything he’d done before. He was excited. He was ready.

John showered, shaved, and got dressed up in his new suit that he’d bought the day before. He wanted to look his best for this meeting. Everything was counting on it. His wife Joanne had coffee and a quick breakfast ready for him when he came down the stairs. He sipped on his coffee for a bit as he ate his breakfast. It was really sweet of her to do that, He thought and he told her so with an extra hug and kiss as he left for his commute. He wanted to be to work early today to make sure that he was there to answer any pre-meeting questions. This was the day.

Traffic was light on the interstate that morning and John was moving at a good clip. It was strange, he thought, for traffic to be this kind to him on a Monday morning but he figured it was a good omen. His phone buzzed with an e-mail and he glanced at it. It wasn’t anything that couldn’t wait until he was in the office, he thought. Then a great song came on the radio. John reached down to turn up the volume so he could get pumped up for the drive…

He never saw the cars stopped just in front of him.

Mary took care of herself pretty well for a type one diabetic. Her doctor had told her that. She stuck to her diet, maintained her sugar levels meticulously, and took her insulin on a sliding scale that seemed to be working perfectly. Her blood sugar readings were always right where her doctor said they should be. Mary was proud of that. She worked out and tried to get out walking or jogging the trail at the park at least 3 or 4 times a week. She felt good, looked good, and thought that she was doing all she could to take charge of her health.

It was a beautiful Saturday morning and Mary thought that she should take her dog Patches out for a walk around the pond. Patches was a 1 year old Golden Retriever and loved jumping in the lake to fetch sticks. Mary had taken her morning dose of insulin, popped a multivitamin tablet from her new bottle that she’d bought the day before, and ate a quick bit of breakfast before she put Patches on his leash and started walking to the park. It was about five blocks away and patches knew the route well. Everything was great, until the nausea hit… Mary tried to fight it but knew that she was going to throw up when she started salivating and breathing heavily. She ended up throwing up in some bushes next to the sidewalk. She thought that she was lucky. Nobody saw her hurl up her breakfast and she immediately felt better. It must have just been the new vitamins that made her stomach upset, she thought as she continued walking to the park. She figured that she just wouldn’t take them again.

Mary never felt sick. She just thought that she should take a nap. The rock over there looked like a good place. Why was she so sleepy? Never mind… Just lay down and nap. Nap good.

Luckily, another jogger happened by to find Mary unresponsive.

Work had been scarce lately and Steve was happy to get his truck back on the road. He drove a live-bottom trailer hauling asphalt for a big local paving company and they hadn’t had many big projects come their way lately. Driveway work was steady, but rarely did the company need Steve to drive a big truck out to a site for a driveway job. Steve made his best money and hours when the company had highway work and today was the first day of a big job they’d just gotten. He’d been in line with the other trucks waiting his turn to dump his load into the paver for hours and even though he was happy to be working, he had to pee. Minutes turned into hours and finally it was his turn to drop his blacktop and head back for a new load. He couldn’t wait to be done. He really had to pee by this time and he knew exactly where his next opportunity would be. He backed his trailer up to the paver and raised the bed. Then through his rear-view mirror he saw the people scramble and jump off of the paver. He felt his truck lurch forward as the paver machine was pushed into it from the impact of a car travelling too fast in the construction zone. When he jumped out of his truck after looking to make sure there was nobody coming at him, he saw his friend Luke laying on the ground. Luke was bleeding, bad. The car and the paver were a tangled mess of metal and there was someone screaming at an unmoving figure in the passenger seat of the car.

Steve no longer had to pee…

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Note to blog readers:     I can’t quite decide on what I should do from this point on. I can take two paths, one is a rallying call to community members asking them to put themselves in the place of the people in the above cases and get out there and support their local EMS. The other, is a rallying call to us EMS people… I’ve written it both ways. You can see what you like best.

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Option #1

Every day, Paramedics and EMTs put on their uniforms, fire up their ambulances, and get ready to face the onslaught of whatever mayhem the streets produce for them during their shift. They do a job that is unpredictable, complicated, and vital to the community. These three stories could happen to you or someone you love tomorrow and each of them will require the response of a highly trained, expert Emergency Medical Services (EMS) provider. There are times when your local ambulance service makes the difference between life and death but there are far more times when they make a big difference in a person’s continuing quality of life. By interceding in the first few moments of a medical emergency with highly trained experts, EMS makes a difference for us all. Communities that support their local Emergency Medical Services have better services and community members that are more educated about what makes quality EMS are better suited to support their local services.

You may not think about the people who respond to your call when you dial 911, but all we do is think about you. Get informed, get involved, and support your local Emergency Medical Services.

We’re there for you. We need you to return the favor.

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Option #2

As you come in to work today, lace up your boots, or turn on your pager, think about the patients in the above cases. They’re people just like anyone you see in your day to day life. They and others like them didn’t intend to be placed in the situations they’re facing and to them; theirs is one of the most intense situations of their life. Their very life and the continuing quality of their lives could rest in your hands today. They are depending on you. Their families are depending on you. Your knowledge, skill, and preparation to perform your best are paramount to these people. Their care rests on you. You owe them your best and there is no excuse they’ll accept for poor performance.

EMS providers transcend their self when they lace up their boots and sign on for duty. Society needs us. Our patients need us. We need us. We will never know the impact we’ll have on the lives of our patients, their families, and their communities… but it’s huge. We as EMS providers play a pivotal role in our communities. They’ll never acknowledge it en masse… but that doesn’t diminish its importance. Recognition for our skills isn’t necessary for our skills to be vital. EMS people do their jobs because they’re important. We do our jobs because our guts tell us that what we’re doing is right… and even when we stumble and find ways to improve ourselves and our care, it doesn’t diminish the importance of what we’ve done. We have acted, and we continue to act in the best interest of humanity.

Today you can make a choice. You can make the choice to seek out and become the best EMS provider you can be or you can choose not to. I suggest that you make the right choice but no one will ever be able to force you. Your care is an art and a science. Your performance is based upon hard science and soft intuition. There can never be a book that will tell you exactly what is right for every situation… you simply have to learn it and learn how to make the right decisions to fit the situations you find yourself in.

My advice to all EMS providers is to take the high road. Err on the side of what you truly feel is best for your patient. Do your best. Study hard and learn from those you consider the best among us. As an EMS provider, you bear the burden of an overloaded system that pays poorly and garners little respect. I feel it too. I say that it doesn’t diminish the importance of what we do and it isn’t the individual patient’s fault. They deserve our best no matter what the system is doing to us. It’s our responsibility and our calling. It has been said that the definition of a “Professional” is one who can perform their duty adequately in conditions that would cause the amateur to turn back. I’d say that we’re living in those conditions today, but we still have to perform. Do your best and know your stuff. Lives depend on your commitment.

It is our job to promote ourselves. It is our job to elevate EMS. It is our job to speak out and optimize the system. The fault for its failings lies within our profession and it is our job to change it. All of us, individually and collectively have the responsibility.

Will you answer?

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So I got a little philosophical in this one. Which ending do you like better?

Posted by on September 7, 2010 • Filed under: 911, edemse, Emergency Medical Services, EMS, ems 2.0, ems education, EMS Motivation, EMS pep talk, ems scenario, ems scenario based education, EMS Topics, EMS training, Ethics, everyday ems ethics, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, letter to the editor, Line of Duty, Paramedic, paramedic education, Patient Management, pride, profession, professionalism, Public relations, scenario, scenario based training, stories, Training & Development, training-fire-rescue-topics

When all you have is a hammer… Every problem looks like, lasix?

9 comments

A few years ago I responded to a structure fire on the main engine out of my station. The fire was at a house that had been converted to a dog kennel and grooming shop just a few blocks away from the firehouse and was a short response time. It was a light-staffing day and we responded as a three person engine company. As the senior firefighter I was the acting company officer and my new girlfriend at the time, who just happens to be my wife now, was the backseat firefighter. Get ready for the “Awwww” moment… it was our first fire “as a couple”. There was a number of cool things that came out of the fire, but one of them was the fact that Gina grabbed *my* maul.

My wife and I fighting our first fire "as a couple" - We're the ones in turnout gear

On our main engine, there’s an 8-pound maul (big hammer) that I grab as my tool of choice every time I jump off the truck for a fire. It just tucks so neatly in my SCBA’s belt and is so compact yet handy that I make a beeline for it every time. This time, Gina had taken it, so I grabbed a pick-head axe.

It’s amazing that when I have my maul that every access problem looks like something that I can solve by whacking it with a hammer of some sort. On this fire, I learned that when one has an axe, every problem looks like it can be solved by some sort of chopping.

Moral of the story, Gina and I entered the structure, saved the pooches, and stopped the fire in its trucks with minimal damage. There’s actually a hilarious video that I believe is still on our department’s web site that I’d let you see if I didn’t hide the name of the department(s) I work for due to “I want to remain employed reasons”.

And, like a lot of things on here, I told you that so I could tell you this about an EMS call I responded to an indeterminate amount of time ago. I have the honor and privilege to be the senior medic on most shifts I work and I precept a lot of students on the ambulance. This shift was no different and this 0-dark-30 call illustrates a point that I’d like to explain to you.

The doggies were SHOCKED that Gina took MY maul

For this call, the primary ambulance out of our station responded because they were on the way back from another call and my partner and I responded in our ambulance because we were up on the alternating call rotation. They arrived at the poorly-accessible apartment complex a few minutes before we did and made first patient contact. As it turns out, the middle age patient had ran out of his/her prescription Lasix (a potent diuretic, or water pill) a week or so prior to the call and had been retaining a great deal of excess bodily fluid. The patient’s legs were markedly and grossly swollen and weeping fluid out of fluid filled blisters. The Patient called us because he/she could no longer stand the pain of the cellulitis (infection) that had developed. The patient had no respiratory compromise, his/her lungs were clear, and he/she really had no other complaints. The patient had an extensive medical history of organ failure and disease. He/she was fully alert and oriented, and was able to assist us as we simply picked him/her up and carried him/her to the cot.

As we were loading the patient up in the ambulance and I was about to get into the back to continue my assessment and treatment of the patient, the EMT from the other ambulance who happens to be an almost-done Paramedic student told me, “So those legs are the worst I’ve ever seen fluid wise, you’re going to push some lasix on this one”. I mumbled something and got into the truck. I was tired and wasn’t really able to form complete sentences at the time due to sleep deprivation. I got in the truck and continued my assessment where I found that the frail patient had a blood pressure in the 70 systolic range (Low!) and that in addition to retaining fluid in his/her legs, he/she was also retaining fluid in his/her abdomen and was probably in need of a paracentesis. I managed the patient with a (beautifully executed) IV stick into an impossibly small crooked vein, and gave just enough fluid to bring his/her BP up a bit without adding to his/her fluid overload all that much. I put the Pt on oxygen and a cardiac monitor, which revealed a normal sinus rhythm without ectopy. I obtained a 12-lead EKG as well, which was not indicative of any acute problems. The patient stated that his/her pain was managed by padding and positioning of his/her swollen legs and even though he/she complained of no breathing problems, I put him/her on a bit of oxygen via nasal cannula.

The transport was uneventful, although his/her blood pressure never did come up. The ER later diagnosed the Pt with complete liver failure and toxicity.

But the interesting part of the story is this, when I got back the medic student asked me about giving IV lasix to the patient, as we carry that in our medication stock and have it available as an emergency diuretic for patients in congestive heart failure and/or fluid overload with pulmonary edema and respiratory compromise. He was almost taken aback when I said that I didn’t give any.

I asked him if he did a full assessment. He said that he had tried… but that he didn’t have enough time before I arrived and we took the patient out to the ambulance. I gave him my assessment findings and the news of the very low blood pressure. He said that he agreed with me on not giving the lasix with the markedly low blood pressure but was curious when I explained that it wasn’t the reason I didn’t give the medication.

We in EMS, and especially new providers carry our own hammers… our treatments and medications that we’re able to give in the field. Medics that use these treatments more often are called “aggressive” and it is a badge of honor. In fact, in some cases, aggressive field treatment is indeed warranted and improves patient outcomes. However, in a lot of cases it is not indicated and patients benefit from what we don’t do more so than from what we could have done.

This patient didn’t have any respiratory compromise and while he/she obviously could have benefited from the dieresis or removal of the excess fluid, she didn’t meet the criteria for emergent field administration of lasix, which is respiratory compromise from pulmonary edema. I made the decision to let the physician evaluate the patient and determine the best treatment path that would fit in with the patient’s ultimate plan of care. I didn’t believe that the patient would ultimately benefit from my administration of lasix twenty minutes earlier than the ER could have done it if the physician so chose.

Every treatment we administer must be given with a full assessment of the risks and benefits to the patient for doing so. Every EMS person should familiarize themselves with the long-term care paths of the conditions we treat and try to maximize the long-term benefit to the patient with the acute and short-term care we give. Not every problem is “a nail” and sometimes the hammers we carry aren’t the best ultimate solution for excellent patient care. Remembering how we as EMS people fit into the grand scheme of the overall healthcare system and in the ultimate care paths of our patients will help us all to do what we’re supposed to do, which is to provide excellent and appropriate patient care.

It is also of note, I guess, that Gina rarely steals my maul anymore. Now that we’re married… I “give it freely” to her.. What’s mine is her’s, as they say.

Posted by on June 14, 2010 • Filed under: Ambulance, Emergency Medical Services, EMS, ems education, ems scenario, ems scenario based education, EMS Topics, Fires, funny, In the Line of Duty, Paramedic, paramedic education, patient care, Patient Management, professionalism, scenario based training, stories, Training & Development

In an Instant

19 comments

I just have to write this story down. It’s a bit… well, I don’t know how it is… but if The Happy Medic can use his blog as an online therapy journal, I guess that I can as well.

I just can’t shake an incident that happened to me. I can’t get it out of my head. It happened years ago while I was off-duty and was hanging out with a friend who I haven’t had much contact with in recent years. However, a recent conversation with that friend brought a lot of memories flooding back into my consciousness and I figure that if I write it down it might help me shake it.

I’ve written a lot about sadness in the past, especially the sadness that we as EMS providers are exposed to on a daily basis in our careers. It surrounds us. Most people shy away from the death, destruction, and sheer madness that abound in the Human Condition but EMS people are special. We cannot shield ourselves from the external pain that death, injury, and illness bring. Thankfully this pain is most often being experienced by strangers and our role is to bear witness to it and attempt to intervene as best as any human can when faced by the insurmountable fact that we are indeed fragile mortal beings. While I have worked upon family members, I’ve been blessed in that I’ve been mostly left untouched by trauma and death inflicted on my loved-ones. Not to say that I haven’t experienced the loss of those close to me, just that I can understand that everyone dies and sometimes it’s at the worst possible time. We don’t control that. Sometimes we can prolong the inevitable but a lot of the time circumstances are simply beyond the power of any mortal being.

This case was one of those times.

It was the Fourth of July in the Midwest. The chill of winter had long since been buried in the recesses of our memories and the hot times of summer were upon us. Like good, God-fearing, Red-Blooded, Midwestern Americans we were set upon celebrating our country’s independence in the way we are best accustomed, by getting together and partying our butts off. Midwestern parties, especially the ones frequented by the age bracket I was a member of at the time, involve alcohol, loud music, and strangers popping in and out of the door set upon sampling the festivities. It was common to make new friends and acquaintances and uncommon, at least in the crowd I ran with, to have any trouble. That was fine with me. I was a functioning career paramedic and had been so for a few years. I get my excitement on the streets and am quite content to relax and have a good time when I’m off duty. I still don’t get too loud or too wild and still enjoy observing the antics of more animated people when they have a bit too much to drink. Staying sober has always made things more enjoyable for me when at these kinds of events. This party was no different. A coworker of my best friend had invited us all to his hip apartment in the city which featured the entire rooftop of the building as a patio. My girlfriend at the time, her friend, and I were sitting on a parapet wall of the roof watching the college kids from the school in town have their fun. The party was one story from the ground and was full of people. I only knew probably a good ten percent of the people there, but I’ve always been comfortable making new friends. We were having a blast. Good Music, Good Friends, and Cheap Keg Beer. Good times.

Then reality hit.

I got a knot that set quickly in the pit of my stomach when I heard a sickening crack and saw a crowd of people run towards a sky light that happened to be in the middle of the roof. Walking towards it I could get a sense of what happened. Through the panicked crowd of onlookers I made my way to the side of what was now an open hole. Some kid had been attempting to step over the skylight when he lost his footing and fell. The thin, translucent plastic had given way immediately allowing his body to plummet the twenty or so feet to the unforgiving concrete floor below. I looked down and saw him lying motionless on the floor… It was dark and the visibility was very poor, but I could see the expanding circle of dark blood flowing out from this poor kid’s head.

Snapping into my official mode I grabbed the host of the party by both shoulders. “How do I get down there”. His blank stare of horror met me back as he stammered “I… I… I don’t know”. An anonymous person in the crowd shouted “Someone get a rope and lower me down there” and I knew that the crowd would not be helpful in this situation. I told the host to call 911 and handed him his cell phone that was clipped to his belt. I then left the roof, ran down through the apartment and out onto the street. It was oddly quiet as I surveyed the surroundings. None of the shrieks of the crowd above had seemed to make it to street level. As I looked at the building I found a garage door that seemed to have light shining through its windows that could have come through the skylight. I looked, and sure enough, there lay the kid on the concrete floor of the garage.

They say that human beings have the capacity for great strength when faced with horrific circumstances. I’m no neurologist, or psychologist, or anyone who studies such things… but I believe that it has to do something with the fact that our nervous system keeps our muscles from achieving their full capacity for strength when we’re not under extreme duress. It’s the phenomenon where grandmothers are able to lift a car up off of their grandchildren and such. When adrenaline is so prevalent in our bodies, we are all capable of things greater than we imagine.

This was one of those times for me. My best friend said that above the din of the horrified crowd, through the building and onto the roof, he heard a guttural yell. It was me. I’d simply decided that the locked garage door was going to open whether it liked it or not. I grabbed it and opened it about a foot against the protestations if its locking mechanisms. To that day and from that day on I’ve never accomplished a feat quite like that and I don’t think that I could again. I’ve never been the most physical person I know and the thought of spending hours in the gym picking up heavy pieces of steel in a repetitive fashion simply bores me to tears. While I am a good Midwestern Farm Boy, I can’t claim to be someone who could rip open a garage door with my bear hands if I was asked to do so in normal circumstances. However, this time I did. Nothing was going to stop me from taking care of that stranger.

When I crawled in to the garage I made my way to the kid in the dark. He lay prone, slightly rotated to his Left side, and he was breathing rapidly and shallowly. The air he was moving made sick gurgling noises in his airway that was full of blood. There was blood pouring from his ears, nose, mouth, and scalp and I could guess that his head had stopped his vertical progress when it met the concrete. I checked for responsiveness and found none. Someone from above me yelled out “Don’t touch him!” as I moved to open his airway with a Jaw Thrust and I heard a murmur run through the crowd above as my friend shouted “He’s a Paramedic”. I positioned his airway as best I could with no tools, alone, in the dark and shouted for someone above to send down my friend who was an EMT and my girlfriend at the time who was an EMT and paramedic-in-training. After a few moments, they made it to the garage and together we positioned the patient in a left lateral-recumbent position to protect his spine and allow for the blood to drain out of his airway. We kept him like that until a paramedic in uniform crawled in with equipment.

The medic, an acquaintance of mine, worked for the local fire department. I was not a member and was off-duty and out of my jurisdiction. His partner followed soon after and I helped them ready their intubation equipment after giving them a report on my assessment. They tubed him before we helped them package him in c-spine precautions. After that, the engine company called for a few guys to help them open the garage door. I did, as did some of the other guys there, and this is strange. Even with six guys attempting to raise the garage door higher, the door wouldn’t budge. The engine crew had to slice through the locking mechanism with a saw. There’s no way I could have opened that door by myself but somehow I did. I don’t know how either.

The more experienced members of the audience already know how this story ended… with a family hoping against hope and with the stranger’s life expiring shortly after he took one slight misstep at a party. He didn’t plan to die that day and his family didn’t plan on experiencing the pain and lost that they undoubtedly did. I did go to the ER to check on his status, but only stayed for a few moments after I spoke with his nurse. I didn’t need to hear the family wail and lament. I didn’t need to know who the kid was. I had played my role to the letter and that was all I intended to do. It’s not that I’m callous… just that I get enough sadness on duty, thank you.

And interestingly, from that day I’ve only talked about that incident about three or four times. I’d almost forgotten about it. Really. It was just another traumatic death to bear witness to for a person who dedicates a career to that kind of stuff, it only shocked those who were uninitiated. At least so I thought until I talked to my friend and I was brought right back there to that skylight, to the Fourth of July, and to blood and death marring the innocence of a crowd of people who didn’t know that kind of stuff could really happen.

If you’ve read this far, thanks for helping with my therapy session. I feel better after getting this out. This isn’t a story about any kind of heroics or any nonsense like that, rather it’s a story about futility and fragility. It’s a teachable moment that helped formulate who I am as a person and as a paramedic.

If you’d like more on my feelings on Sadness in EMS, read this: “Splashed Sadness  – A Look at Negative Emotions in EMS”

Thank you.

Posted by on May 22, 2010 • Filed under: blogger, Emergency Medical Services, emotions, EMS, EMS Blog, EMS Topics, EMT, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, mental imagery, Paramedic, sadness, stories

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

Red Lights to the Left of them, Blue to the right! – Coloring Emergency Lighting

51 comments

So you’re driving down the road in an unfamiliar state, let’s say that it’s Iowa or Wisconsin, when in your rear-view mirror you see flashing red lights on a big utility truck coming your way. You can’t really make out what kind of truck it is, but you see red lights flashing so you pull over to let it go by. When it does, you realize that you’ve just pulled over for a tow-truck.

Or how’s this? The same thing happens, but it’s a flashing blue light in Colorado. When you pull over, you realize that you just got pulled over by a snow-plow.

I live in Illinois and work between IL and Wisconsin and there’s quite a bit of a difference between the different lighting colors and upon who can use what color light for what purpose. As a volunteer paramedic/Firefighter in Illinois I run a blue light with no siren in my personal vehicle. Even though I rarely turn it on, I have it in case I get stuck behind a 20mph Grandma on my way to the Big One. Interestingly, the blue light gives me no legal authority or any legal leeway on traffic laws and I must obey all traffic laws even while running the light. I Wisconsin, however, volunteer firefighters and EMS people may use red lights and sirens in their personal vehicles. They have the same legal status as governmental emergency vehicles when they’re driving with their lights activated.

In Iowa, volunteer firefighters may run blue lights in their personal vehicles with no legal authority granted them, and EMS volunteers may run clear (white) lights in their personal vehicles. Volunteers for fire and EMS combination agencies may run a mixture of both, however if a person volunteers for both a separate Fire department and a separate EMS agency, they must be careful to run the clear light for EMS responses and the Blue light for fire responses.

Of course, that’s just for personal vehicles right? Allowing emergency lights in the personal vehicles of emergency volunteers is a debatable issue in some circles. I argue for responsible control of their use and think that they are needed in some communities and not needed in others. Out of the 400-500 volunteer runs I respond to annually, I probably turn on my blue light for less than ten percent of the runs. I use it judiciously, but I know others that I can say did not.

However, this isn’t a post about volunteer emergency lighting and the pros and cons of it. It’s about the messed up spectrum of colors that we use on emergency vehicles in this country. Sure, we have the same stock colors pretty much everywhere. Red, blue, amber (yellow), green, clear (white), and in some states purple (Yes! Purple!). In the southern states, blue lights are for law-enforcement only and red is for fire only. In Wisconsin, law enforcement runs red and blue lights and fire and EMS is red only. In Iowa, up until a few years ago everyone ran red lights except for volunteer firefighters. They changed the law and now allow blue on the Passenger side only. In the City of Chicago, the Chicago Police Department runs blue only and the Fire department runs Red and Green. Downstate Illinois (Read: Outside of the City of Chicago City Limts) runs red and blue for all “Authorized Emergency Vehicles” and blue lights for the volunteers. Green lights are only permitted on stationary vehicles for command lights but can also be used for private security officers. As I mentioned before, in Iowa and Wisconsin, tow trucks run red lights. In Colorado, snow plows run blue. In some states, funeral processions run purple.

Confused?  I sure as heck am.

Consider this: Different lighting colors exist because different members of the driving public see different wavelengths of light in the spectrum (i.e. “Colors”) better or worse in differing ambient light conditions. Also, different colors penetrate different atmospheric and/or ambient light conditions better than others. You can see blue forever at night or in the fog, but not so much in the bright light. Red washes out to amber in the day light but is still fairly visible. Clear lights penetrate for a very long way but can be confused with light reflecting off of a surface almost the same as amber lights. We need a diverse spectrum of colors emanating from our response vehicles in order to ensure that the highest amount of drivers out there are able to see the lights. If someone’s color blind to the particular light color that we choose, they’re not going to see us all that well, are they?

The arguments that I hear for the use of lighting colors don’t hold much weight with me. Who cares if the public is able to see that an approaching emergency vehicle is Fire, EMS, Law Enforcement, ASPCA, Haz-Mat, Tech-Rescue, Volunteer, or miscellaneous. They just need to pull over and get out of the way. One color lighting schemes may give the agency a sense of personality or whatnot, but they’re certainly not the safest way to be seen. An emergency vehicle needs to throw out a lot of light across the spectrum of visible colors in order to help ensure the safest response possible.

So why are we having this hodgepodge of warning light colors? Why do people think they’re a good idea? I can think of a few advantages of having “law enforcement only” colors, as in reducing false traffic stops from people impersonating police officers, but having one color and one color only simply makes it easier for a criminal to get a hold of that one color of light. Why fire would only need red lights is a question that I can’t come up with a good reason for.

So good luck driving out there! If you see me, I’ll be on the side of the road letting a tow-truck go by. Then I’ll run my blue light in Wisconsin because we got a house fire in my district that touches the WI state line and I’ll get arrested for impersonating a police officer. Then I’ll be at work getting into a crash because someone driving out there was color blind to the color red.

Anyone want to add to the confusion? What colors do your state or country use? Is anybody else in favor of a national standard?

Posted by on April 7, 2010 • Filed under: 911 fail, accident, Administration & Leadership, Ambulance, Ambulance Driver, Ambulance maintenance, ckemtp rants, code-3, Command & Leadership, drive fast, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS rant, EMS safety, EMS Topics, Fire Rescue Topics, In the Line of Duty, Iowa, Iowa EMS, lights and sirens, Line of Duty, Management, politics, Technology & Communications, technology-communications-ems-topics, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus, volunteer fire department, volunteer firefighter

Huddled Masses. Healthcare. Honor. EMS.

19 comments

A conversation that I had with another healthcare provider has me pondering a lot of things. Until now, I’d been pondering these things in a solitary way but I think that I’m going to put these ponderable thoughts up on the blog.

This post gets a little more political than my usual stuff. I don’t post politics up here unless the politics specifically relate to EMS (unless they’d get me in a lot of trouble, for example the best EMS delivery model).

But today, I’m making an exception. I think that some of the things that I’m pondering have to be put out there and I think that if I don’t throw this out to the blogosphere I’m gonna go nuts.

I work in a community that has a large Hispanic population. A good portion of them are probably undocumented immigrants from Mexico. Yes, I said “undocumented” and that can mean Illegal immigrants if you so choose to say that. It’s a fact that small towns in the Midwest have been growing by leaps and bounds with undocumented immigrants looking to find work wherever they can. Some of them have legal members of their family that they live with, some don’t.

There’s a huge debate going on in this country over illegal immigration. It’s bigger than me, it’s bigger than this blog, and it’s bigger than EMS. I’m not going to get into my personal opinion on the topic as much as I would if we were discussing this in a bar over a couple of beers, or a country cafe over coffee if you’re a morning person. I can say this: I’m all for border security. I’m all for people following the law and I believe that illegal immigration is a drain on our resources. Those points are barely arguable. Another thing I believe in are the words to a song that I used to sing when I was with a rather patriotic small-town childrens’ choir. The song went something like this: “Give me your tired, your poor, your huddled masses yearning to breathe fee. The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me. I lift my lamp beside the golden door!” There’s a lady that stands in the harbor that has these words inscribed upon her, and they mean something.

I look upon this debate and I see both sides fervently trying to destroy any point-of-view other than their own. The lefties want them here because their hearts bleed for them. The righties think that the lefties want them because they can mold them into a new communist workers’ party. Both of them may be right. I am more of the opinion that America is an experiment. We’re a melting pot of people that have come together over the last two-hundred and some odd years to be stronger in our diversity. I believe that any cultural group entering our melting pot should come here and embrace the American ideals. “Melt” into the pot if you will. This has made us strong over the centuries and has built the country that I love, the one I will stand up for. Europe didn’t do that, they isolated their ethnicities into countries and fought amonst each other for a thousand years. We melted and homogenized into a strong nation full of rugged individuals championing their best ideals. I say that the most successful immigrant groups in the storied history of this nation celebrated their old cultures while melting in to our diverse one.

As far as today’s debate goes, I wonder if that would be the whole rub. Are the new illegal immigrants celebrating their own culture while melting into ours? Or our they placing their old culture on top of the American culture and creating discord within a proud nation? I think that we have always accepted the “Tired and poor huddled massess yearning to breathe free” because of our American Dream. People here have equal opportunity, a guarantee of the equal chance for humans to strive to reach their potential. Everyone has the chance to try and succeed to their own definition of success. “Life, Liberty, and the Pursuit of Happiness” is a guarantee of the chance to pursue. It is not, however, a guarantee of results. Our experiment is that everyone who has the chance will strive to give it their best shot, and that the people who succeed will pull others up alongside them.

I can’t say what’s right here. I don’t know. I don’t want to offend, but here I am, a paramedic. My job is to help everyone and anyone who needs me. I will do so. I have always done so. I took an oath and I honor my convictions. The hypocratic oath means something to me. Healthcare providers are honor-bound to help everyone as much as they can. I always will.

The conversation that we had was short, but he got his point across. I had brought up that while we have a large hispanic population in our coverage area, we rarely have calls involving those hispanic members of our population. I think that this is a bad thing because obviously these people fall ill and get injured at a rate comparable or even moreso than the other demographic groups in our area. I don’t know why they’re not calling but I can figure that it might be alleviated for the good of our community as a whole if we reach out to this population and let them know how, and when, to access the emergency healthcare system. I don’t believe in race and to me “hispanic” is a cultural label and is not even close to whatever “racial” means, but this is a cultural group that should be calling us and doesn’t. It’s deliniated over cultural lines and therefore is handy to address that way.

The other guy thought that it was stupid, pointless, and maybe even wrong to do this. It was because of the “illegal” thing. As strongly as I feel on that issue, and I do have strong feelings, as a healthcare provider my job is to help everyone. Every human deserves the best care that we can give them, every time. I don’t judge people. He shouldn’t either.

Neither should you.

Thoughts?

Posted by on March 25, 2010 • Filed under: Administration & Leadership, Command & Leadership, Economics, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, medical ethics, politics, professionalism, socialized medicine, Uncategorized

Splashed Sadness – A look at negative emotions in EMS

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

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

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

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

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

     

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

     

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

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

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

     

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

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

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

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

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

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

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

Or you go nuts.

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

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

 

Posted by 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

Firefighter Killed, 8 injured in Wisconsin

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Http://www.Firefighterclosecalls.com has this sad news this morning regarding an explosion in Wisconsin that has claimed the life of one firefighter and left 8 others injured.

http://firefighterclosecalls.com/fullstory.php?98993

Our Thoughts and Prayers are with their families and our brothers in the St. Anna Fire Department 

Posted by on December 30, 2009 • Filed under: Fire Rescue Topics, In the Line of Duty, Line of Duty

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
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