Mar 5, 2015

In my twelve years from Springfield, I heard the words “start us a 7” come over the police scanner more times than I could count. The number seven was the radio code for an ambulance.  Usually what this meant was the cops had found some indigent on the side of the road that they wanted transported to the hospital, or some assault victim who needed a routine transport for a stitch or two. In a somewhat related incident, a friend shared a conversation that they were privy to that occurred between a fire and EMS dispatcher about a person stuck in the middle of the road in a broken motorized wheelchair.  I am paraphrasing but it went something like this: Police Dispatcher: “We don’t have any way to move the wheelchair.  This is an EMS matter.” EMS Dispatcher: “Neither do we.  It looks like a traffic problem to us.” As always, the outcome was as expected: paramedics responded (eventually. . . it was a busy day) and had to deal with something that was well outside of their scope of practice.  Or how about this one that happened more times than I can count in my career: You respond to a college campus for the intoxicated student.  On arrival, you find a mildly inebriated individual who is being sent by the campus police because it is the “campus policy” that intoxicated students get transported.  The student is defiant, and they are told by the police officer on scene that they can make a choice “hospital or jail.”  Mr. Defiant decides that he is going to be daring and he chooses jail. The police officer responds by putting the patient’s hands behind his back and slapping the cuffs on him.  To you and your partner’s surprise though he does not put the patient in the back of his cruiser.  Instead, he marches him straight to the back of your ambulance where he sternly lectures the student, removes the cuffs and sends him off to the ER in your more than capable hands. I am not saying that these people do not need help.  The problem though is their access point for their desired help, whether...

Mar 2, 2015

Last week I spent Wednesday thru Saturday in Baltimore, Maryland attending EMS Today.  It was my tenth major EMS conference that I have been to since 2010.  I am starting to feel like somewhat of a veteran.  I have seen a lot of people come and go.  I have seen good years, and I have seen bad years.  In 2012, I barely made it out of Connecticut before Hurricane Sandy shut down the northeast. For the first two or three years, there was a certain buzz at the conferences.  Twitter personalities and bloggers were everywhere.  The podcast studio was a constant revolving door of people coming in and out to see who was there and who was going to be on during the next time slot.  Classes were full of innovation.  New speakers were sharing new ideas.  Lines outside of certain doors were so long that you knew which classes were going to be standing room only. In 2013, the conference world seemed to slow down a bit.  JEMS decided to move EMS Today to Washington, DC.  Some bloggers started families.  Others just did not have the money or time to take off of work.  Classes seemed to be the same thing that we had seen the year before.  Sure, the huge push for Community Paramedical education had started but even that seemed to be starting to repeat itself.  It was almost as if we were hitting an educational plateau. From a personal stand point, I had opportunities to take more classes thanks to winning a free registration from JEMS and the generosity of the team at MedicEd who provided me with free registrations in Nashville and Baltimore this year.  Prior to this past week, while I felt like I was getting some knowledge out of class it seemed to be more of a reinforcement of what I had heard in previous years rather than some new innovation. The exhibit hall moved in the same direction.  2011 was filled with speculation of what ultrasound was going to do for prehospital care.  There were new devices everywhere that you turned.  Through the end of 2014 though, not much seemed to change.  The atmosphere this past...

Feb 27, 2015

If anybody had any doubts about how the cast of Nightwatch would be received at EMS Today, all questions were answered at the first day of one of the largest EMS conferences in the United States. I got my first glimpse of the crew at the Physio Control booth signing autographs at the entrance to the exhibit hall.  For a second, I almost forgot that I was at at an EMS conference and thought that I was at ComicCon.  Here was the cast of a TV show entertaining star-struck fans.  But this was not Daryl Dixon or the cast of Firefly.  The group that was signing autographs are just regular people just like the rest of us. Later in the evening, the group made an appearance at Zoll’s Shockfest.  Once again, the marketing team at Zoll knocked this event out of the park.  There was great music, great food, cold drinks, and a fun atmosphere (shout out to Zoll’s Brooke Taylor who headed this one up yet again).  It didn’t take long for everyone notice that the celebrities where in the house. I cannot say enough about how the entire group from Nightwatch handled their fans.  As one would imagine they were mobbed.  At one point, it almost looked like a receiving line waiting to get their turn to say hello to Holly or Dan or whomever they had noticed.  Each of them were all smiles.  They were humble, they were friendly, and they were fun. Personally, I do not feel like I got nearly as much time as I would have wanted with this group, but I feel like I was in the majority with that.  I said my hello’s, tried to put a face to the bevy of tweets that I have sent out about the show (whether they put two and two together or not) and most importantly, I had a chance to thank Holly for shedding some light on my analysis of Gavin. After my review of Nightwatch a few weeks ago, some took exception to my assessment of Holly’s partner, mainly when I said that he looked to me like he was getting burnt out.  One cast member of...

Feb 25, 2015

Friday afternoon I got a text from a friend of mine pointing me towards a debate that had broken out on an EMS related Facebook page about the perception of tattoos and their impact on professionalism.  A lot of this has been spurred along by the beautiful artwork that Holly Monteleone displays on her arm in A&E’s new show Nightwatch.  Tattoos say nothing about a paramedic’s ability to care for a patient.  Thinking otherwise is a debate that I will not even entertain.  The perception that some int he general public might have when they see your tats though is another thing all together.   While I do not have any tattoos nor do I plan on even getting one, a number of my friends have them.  The vast majority of them are pretty cool to look at.  There is a story behind each and every one of them and to that specific person, their selected piece of body art means a lot to them and I respect that.  On the flip side of that coin though, we are often asked to define what professionalism is, and really for the most part it varies greatly depending on the community one serves.  What might be accepted by some might be shunned by others.  This rings true for body art. One of my favorite tattoos stories involves a good friend and coworker of mine who I was on a run with for an elderly female with COPD.  Sitting by her door, and throughout her apartment she had a number of Buddha statues.  We started our patient on her nebulizer treatment and my partner said “Nice statues!  I have a Buddha tattoo on my belly!”  My sly, slick COPD patient looked at him and said “I don’t believe you.”  Not one for backing down from a challenge, my partner pulled his shirt up displaying his full belly tattoo with his belly button matching up with Buddha’s and said “Look!”  The three of us shared a good laugh, and it was a constant topic of conversation for the remainder of the call. I understand tattoos as a form of expression.  As a former supervisor I can also see...

Feb 13, 2015

For the last forty years Hollywood and EMS dramas have not mixed.  When it comes to creating a drama that relatively, not even accurately, portrays the daily lives of EMTs and paramedics, many of us in the field have viewed attempt after attempt with high hopes only to walk away disappointed.  Trauma.  Rescue 77.  Even Third Watch.  None of these shows have even remotely captured what my life is like on the truck or off. Reality TV has not done much better.  Paramedics on TLC back in the 2000’s came close however the show was so poorly edited that I don’t think that they had anybody with an EMT card in their back pocket in the cutting room with the power to say “this doesn’t look right.” While I was excited for its premier, I am sure you can understand my reservations when A&E announced their new series Nightwatch which was set to follow the EMS, police, and fire personnel working the 8pm-4am shift in New Orleans, Louisiana.  My interest was piqued after seeing the trailers though.  I was excited to see that Dick Wolf, creator of  Law & Order had a hand in it, and I was even more excited that it was following one of my favorite reality TV shows ever to be on television: The First 48. The EMS/fire ratio One of the first things that struck me about the show was how the cast was introduced in the premier’s first fifteen or twenty minutes.  Two medic units care for a shooting victim as he circles the drain.  The police officers portrayed in the show search for a shooting suspect.  Then we cut to the fire house where the guys of Squirt 27 are debating what they are going to have for dinner.  I chuckled because that’s how it usually goes in urban EMS.  EMS spends their time in mobile offices with fire department units landing back in a station. Please do not take that as a dig at the fire service.  I have a ton of respect for the men and women who do a job that I have zero desire to do, however, as the show progresses through the...

Jan 25, 2015

About two weeks ago, Dr. Aaron Carroll published an article in the New York Times entitled “Doing More for patients Often Does No Good.”  This weekend, the article received a significant push on social media, specifically, Facebook, on a number of EMS related pages.  I know Dr. Carroll’s writings, and I have listened to him frequently on Stand Up! with Pete Dominick where he is a frequent guest and occasional guest host.  While Dr. Carroll has a number of citations and makes some valid points, I think that the portion of his story about out of hospital cardiac arrest misses the mark.  Here’s why. A number of the studies that Dr. Carroll cites were released between 2007 and 2011.  We are learning, and we are evolving.  Systems throughout the United States have changed their protocols and changed how cardiac arrests are run.  My state’s protocols have been rewritten to include the actual words “High performance Pit Crew style CPR” in the BLS cardiac arrest portion.  They’re getting it, and they are seeing an improvement.  Still though, tossing aside ALS care is a short sighted argument to make, even in cardiac arrest. While I will not dispute that solid BLS care is the foundation and the largest contributor to out of hospital ROSC, we need to look beyond achieving a return of pulses in our prehospital care.  ALS interventions after the return of pulses make a significant difference in patient outcome.  12-lead EKG interpretation, for example, can help determine destination decision for a patient who arrested due to a STEMI.  And let’s not overlook the importance of therapeutic hypothermia, something put on the map in the United States by Wake County EMS in the mid 2000’s. The point is, resuscitation does not stop once ROSC is achieved.  We don’t stand up, high five each other and say “okay, that’s it.  Let’s drive them to the hospital.”  There is more work to do. This statement in particular got my blood boiling a bit: “Some theorize that the things that work have already been incorporated into basic life support.  All that the advanced life support may be doing is slowing things down in the field, distracting people from the useful...

Jan 16, 2015

What makes somebody qualified to teach an EMT or paramedic class?  I took my first EMT class back in 1995 at night while I went to high school during the day.  I knew every single one of my instructors either personally, or more likely by reputation.  They were sage-like legends in the field of EMS.  They were the old guard.  And it was their job to educate the young, motivated naive students such as myself. Fast forward to college and it was much of the same.  For the most part, the people who taught my second EMT class and my paramedic class already had twenty to thirty years in the field.  They lived and breathed EMS and would share story after story about what they encountered over the years.  They talked about the first time that they had to tie an ankle hitch because the one provided with the HARE had been lost under the bench seat, and that was why it was so important for me to learn how to do the same. In May of this year, I will celebrate my fifteenth anniversary of getting a paycheck for working on the ambulance but my life in EMS extends a couple of years past that.  I got my start in the back end of what was the successful days of volunteer EMS.  We covered our calls, did not understand what a ROSC rate was, and were happy to get a CPR save pin every year at our department’s installation dinner.  Daytime ambulances were staffed by mothers who put their kids on the school bus and then turned the pager on, people who worked nights, or some of those legendary EMS providers who taught at night and were otherwise retired.  They donated their time which is something that does not happen very often anymore for a number of reasons some of them cultural, and others financial.  Any way you cut it though, volunteerism in EMS is all but done in most of the country. So here we sit now, half way through this decade, and we need to figure out who takes the reins.  Many of those EMS legends are in the twilight of...

Dec 24, 2014

Although I have a love for politics, I usually do not share many of my political views on this blog unless they directly relate to the industry.  This matter, however, is close enough to share some comments on.  Four years ago, I would have never even thought to write this post because it would have been too close to home, but looking at things from a distance can shed a different light on certain situations and offer new opportunities to comment. Earlier in the month, Holyoke, Massachusetts City Councilor At Large Rebecca Lisi along with one of her city council colleagues was a participant in a “From Ferguson to NYC to Holyoke” protest march in downtown Holyoke.  The stated mission of the protest was “to protest the recent shootings of unarmed black men, women, and youth, and support the call for reforming problematic police practices.”  According to Lisi’s blog her reason for marching was to show her 14 month old son that “human beings have the ability to affect extraordinary changes.”   The march drew criticism due to the crowd chanting, among other things, the title of an 80’s rap song that many see as being derogatory towards police.  I’m sure you know what I am talking about.  I am not the only one who finds her mere participation in such a protest a problem.  The Holyoke Police Union expressed their displeasure with Lisi and her colleague Jossie Valentin. Lisi denies taking part in the chant and said that it “stopped quickly.”  She goes on, however, to praise the Holyoke police department about their continued commitment to community policing, which presents a sizeable contradiction.  She protested police actions and how they relate to her city and then goes on to say that her city’s police department takes the approach that they should take.  She is either very confused or was just protesting for the sake of protesting. Lisi is in a family populated by two generations of New York police Department officers, and says that she has “. .  . a deep appreciation for the hard work and risks that police officers take on every day in the field.”  Why, then, was she a no show...

Dec 16, 2014

In the past couple of weeks, the pattern of assaults against EMTs and paramedics has continued.  If you have not seen the reports from Boston on the attack by a patient on Boston EMS EMT Tony O’Brien, then I suggest that you take a look.  The bite that Mr. O’Brien suffered to his hand is unlike anything that I have ever seen.  Chris Kaiser recently posted an email that he received from a fan who was attacked by a patient.  The circumstances are a little different but the narrative remains the same.  The question now is what will happen?  And what will we as an industry do? Early last week a very well-known EMS leader advocated on social for EMTs and paramedics to show up at a local county courthouse in uniform in a show of solidarity and support for a paramedic who was assaulted on a call.  His attacker’s sentencing was being held, and the hope was that a show of force might encourage a judge to take the sentencing seriously.  The attacker, 25 year old Remy Blaisdell Gagnon, received a sentence of 60 days after undergoing a mental health examination.  All of this was the result of a guilty plea to certain charges in a deal cut by the prosecutor. Personally, I cannot help but feel that this was a slap on the wrist, and I fear that the Boston attack will result in the same.  We are not law enforcement, but we are in harm’s way almost as much as they are and our safety needs to be taken seriously by everyone.  If you are assaulted by a patient, take it seriously and make sure that your employer takes it seriously.  File charges, and when it comes time for a trial or sentencing tell everyone that you know.  Advocate for them to show up to support you.  We cannot let events like this one, or the attack by Brooklyn Assistant District Attorney Michael Jaccarino on New York City EMT Teresa Soler receive such light punishments. If you do not know Soler’s story, I suggest you read up on it.  In November of 2012 She was transporting an intoxicated Jaccarino who has...

Dec 3, 2014

For most of my life I have been a night owl.  Many who have seen me early in the morning can attest to that.  I remember one paramedic who was on modified duty that would come in shortly after I did for my 6:30am supervisor day shift.  He would occasionally get up from his desk and check the volume of my 24oz coffee cup that came to work with me every morning.  On most occasions he would not address me until it was at least half empty. I am better now today than I have been in the past.  I can’t seem to sleep past 8am on my days off.  On mornings when I do have to be at work at 8am, I am usually up by 6:30 at the latest.  Still though, I consider myself a night owl. Before I got promoted, I worked for about four and a half years on overnights.  I worked a lot during the day as well because I have always been a person who works a lot of overtime, but the core of my schedule involved me being at work while most of the work slept.  There has always been something that is very appealing about overnights to me.  Traffic is almost non-existent.  Nurses at the ER’s seem to have a different sense of humor, and a different outlook all together on society.  And let’s face it: the lack of administration and some of the extra red tape that comes along with day shifts just is not there. It took a special person to work overnights on the ambulance as well.  When you are street corner posting at 4am, your body fights you.  It wants to sleep, and it wants to pass out but that is not always possible.  I have always found that those who work exclusively on the overnight seem to respond better when they wake up for a run, or are asked to operate at long stand bys.  They are not winning the fight against their body’s desire to sleep but they are doing better than most people do. The big problem that I saw for years was the overnight crews were often forgotten. ...