As I was getting ready for my first day of work last week, I started loaded up my pockets with the usual stuff that I carry.  In my right leg pocket, I keep my shears strapped into their little holders.  I always crisscross the straps to their snaps.  In my left hip pocket I carry my gloves.  At my new job I was surprised to find that many people carry sterile exam gloves so I started doing the same.  (If we are ever partners, I am an 8 and a half.) I loaded up my belt the same way that I do every day.  Between the second and third belt loop on the left, the clip for my radio goes.  In the same spot on the right side I have a holder for non-sterile gloves.  I usually load it up with four pairs at the start of my shift all rolled a certain way so I can grab a pair quickly if I need them. I then got ready to pocket the last little trinket that I carry: my Smith & Wesson knife that sits clipped into my right front pocket and realized that I could not find it.  I slipped into a momentary panic. Although I have used it just twice in the four years that I have owned it the knife is always sitting there, just in case. Fortunately, I found it in my hamper.  Apparently, it fell out of my pair of pants from the previous shift but it got me to thinking about all of the little idiosyncrasies that I go through in my day.  I have a certain way of doing things in my job that makes me comfortable.  It is kind of my own personal way of holding on to my sanity I guess.  My GPS goes on the windshield a certain way.  I keep my traffic vest in a certain spot in the truck.  My bulletproof vest sits behind the headrest of the back seat on whichever side I am driving.  These things get done every shift.  The same way.  I end up almost unconsciously reaching for things just knowing that they are there.  it is comforting....

No units available.  Not enough paramedics.  Citizens dissatisfied with response times.  The public and private sectors at odds.  Paramedics and EMTs bearing witness to horrors and atrocities on a daily basis.  This could easily be a story line from FOX News in Detroit but it’s not.  These are just a few major plot lines in the documentary Tell Me and I Will Forget. On a snowy afternoon, I decided to look through NETFLIX for something that I had not seen yet and I stumbled upon this video.  I have watched Parmedico, Firestorm, Burn, and any other public safety documentary that I can get my hands on.  While each of them has been extremely moving and left some impression on me, none has been as powerful as this movie. The level of violence in the country of South Africa leaves me speechless.  While emergency responders encounter a lot state side, the level and brutality experienced by South African medics is unbelievable.  In the first five minutes of the movie, you meet Kallie, one of about 400 paramedics working for the government service as he responds by himself without ambulance backup to a shooting.  You watch him work, eventually sedating and intubating a disoriented patient with a hemothorax as he waits on the side of the road for what feels like an eternity for a responding ambulance.  The system is overwhelmed on a daily basis.  The work force is depleted.  Thankfully, however, the public and private sectors seem to work well together. It was interesting to see an overview of what NETCARE 911 a for profit EMS system in South Africa has to offer.  While much of what was expressed was done by their own employees the view of many in the private sector was that they had more equipment, more ability, and better resources to draw from.  It was an interesting contrast to what many find in for profit EMS in the United States which focuses on being the more lean, cheaper option for EMS.  Far too often American private ambulance services are more concerned about their own bottom line than they are patient care. . . at least at the management level. Comments made by...

By now, the New York Times article from last week has made its rounds in the EMS online community.  If you have not read it, I will give you the short version.  Based on the response to the Boston Marathon as well as some other high priority incidents, Federal Emergency Management Agency released new guidelines this past September in regards to the response of first responders to active shooter incidents.  The new recommendations revolve around what FEMA’s fire administrator Ernest Mitchell Jr refers to as “risk a little to save a little, risk a lot to save a lot.”  According to FEMA, risking a lot means sending EMS responders into the “warm zone” of an incident to treat and extricate patients. Most of the article revolves around one particular paragraph of the seventeen page document: b. While the community-accepted practice has been staging assets at a safe distance (usually out of line-of-sight) until a perimeter is established and all threats are neutralized, considerations should be made for more aggressive EMS operations in areas of higher but mitigated risk to ensure casualties can be rapidly retrieved, triaged, treated and evacuated. Rapid triage and treatment are critical to survival. Rush in, keep your heads down, and get out safe.  They have not completely ignored our safety, however, adding a few lines later: d. If exposed to gunfire, explosions or threats, withdraw to a safe area. e. Consider/Investigate the use of apparatus’ solid parts such as motor, pump, water tank and wheels as cover in the hot zone. Understand the difference between cover (protection from direct fire) and concealment (protection from observation). f. Remove victims from the danger zone in a manner consistent with predetermined agency training and standards of practice. LE officers may bypass casualties in order to eliminate the threat. Recommendation “f” leaves me with some hope that there eventually will be more mandated training and education for EMS providers, but the document seems to largely ignore any mandation of this.  There are, however, recommendations made in regards to what FEMA feels should be addressed when planning, and developing standard operating procedures.  For example, much of the treatment modalities recommended revolve around tactical emergency casualty...

Christmas is right around the corner, and it is time to hit the stores, or in my case hit the websites, and get that shopping done.  But what do you buy for the EMT or paramedic who seems to have everything?  Well you’re in luck because here are what I feel are five of the best gifts that every provider should have this year. 1.   Ripshears – These might be one of the best purchases that I have made in my EMS career. They’re affordable, they attach right to your favorite pair of shears, and they do the job.  But don’t take my word for it, check out The Happy Medic’s review! 2.  A subscription to EMS World or JEMS – This is the gift that every EMT and paramedic out there should have.  There is a wealth of information available today on the internet, but nothing beats print media when it comes to trade publications.  I have subscriptions to both, it is one of the perks to going to their national conferences, and if you or your loved one does not, it’s a great gift for the holidays this year! 3.  5.11 A.T.A.C. 8” Side Zip Boots – In my 13 years as a paramedic I have gone through just about every brand and style of boots imaginable: Magnum, Rocky, Blauer.  On my first day last December at my new job, I was issued a pair of brand new 5.11 A.T.A.C. 8” Side Zip Boots.  A year later, I am still in that pair.  First of all, I was always used to going through boots every six to eight months or so.  Most of that I attribute to the harsh New England winters, regardless of what I did, or how much I worked, I never had a pair of boots last me a whole year until now.  These things are great.  They’re comfortable, functional, and really hold up. 4.  A new flashlight – Currently, I own two flashlights: the first I reviewed earlier this year made by Coast Portland.  This one lives in my truck’s door during my work week.  Its bright, light, and functional.  The other one that I own is a...