Recently, I was checking out some EMS related blogs while enjoying my morning coffee when I came upon a post at Captain Chair Confessions called “I don’t like to take riders.”  In the post CCC talks about the fact that he feels that passengers are a “distraction” to him in the pack and to his partner who would be driving. In a comment that follows, he outlines that his service has a policy that states only a parent of a child under ten can ride in back and all others go up front.  Beyond family members his service has a policy that all other riders are taken “at the crew’s discretion.”  This sounds very familiar to the policy that was in place at my previous employer. I was fortunate that through my seven years as a supervisor I did not field all that many complaints about my team working in the field.  Sure, you would get the occasional nursing home RN who felt that an EMT was rude to them, or someone who complained about being cut off by a speeding ambulance, but beyond that, I took about a dozen calls from people who wanted to go to the hospital with their loved one, and were denied by the ambulance crew. When I approached the crews and asked them what happened, most of them were able to give me a valid reason why they would not allow someone else to come to the hospital with them but there were a few crews that stated “well, it’s up to our discretion.”  And when I asked them what they meant by that, they replied “we don’t take riders.”  I explained to each of those people that this was not discretion.  I would stress them that each individual situation needed to be evaluated and we needed to do what was in the patient’s best interest, and sometimes not having to sit in the hospital alone is in their best interest. I would always do the best I could to back my crews 100% on situations like this if they gave me the ammo to do so.  Calls that involved violence from assault right up to a stabbing...

The WGGB story that I wrote about last week and some recent discussions with a few friends have gotten me thinking about the common media response that EMS services seem to have.  While there are some services out there that are leading the way and showing us what we need to do when it comes to public relations and the utilization of a public information officer, more times than not the attitude is taken that “no news it good news.”  That could not be farther from the truth.  No news means that you, as a community partner, are not doing your job. Not a month goes by that there is not some news story that an EMS service could add their input to.  For example, did you know that February was Heart Awareness Month?  What a great opportunity for paramedics and their leaders to talk about what a person should do when they start having chest pain at home. Another great two prong approach is to share the accomplishments and milestones of your service and your personnel with the community.  Do you have someone who has been working for the service for 25 years?  Write a press release about it, and invite the local paper to come interview them.  Have you gotten a new cutting edge piece of equipment or a new state of the art ambulance?  Invite a TV station over for a tour a demonstration.  Not only does the community get to see what you are up to, but you get to build a positive relationship with the press, and your people know that you are proud of them and want them to be in the spotlight. With so many media opportunities out there, everyone has a chance to talk about whatever they want.  Look at what I am doing right now.  I am blogging, and people are reading it and while not every entry into the media world whether it is social or traditional requires a response, an EMS service needs to be ready to say something besides “no comment.” If people do not know what happens when they call 9-1-1, that is the service’s fault, not the public.  They should...

Have you made the trip to Washington, DC this year for the annual EMS Today hosted by JEMS?  If so, you should come by the JEMS booth on Friday and say hi. Friday morning, and into the early afternoon, I will be there participating in a few podcasts starting at 10am.  The podcast studio will be open and active all day on Friday and Saturday, complete with the social media lounge.  Stop by, say hi, and take in some great...

Another year has gone by, and it is time for the third annual EMS on the Hill Day!  Unfortunately, I am not going to be participating this year, but that does not diminish the need to stress the importance of advocacy not just this week, but year round. There are decisions that need to be made that are not made by EMTs, paramedics, or their services’ leadership.  They are championed, led, and voted on by senators and congressmen who act largely on their gut, and information given to them by their staff.  It is our responsibility as a community to make sure that they are getting the right information.  While year-round advocacy is vital, EMS on the Hill Day gives us a chance to take Capitol Hill by storm and share with them in one unified voice to talk to our representatives and lawmakers about issues that are important to us and our future. Take a look at this video from NAEMT about last year’s EMS on the Hill Day.  And yes, that’s...

One of the first assessment skills I learned when learning about trauma assessment was the “sticky test.”  Done early in the assessment, it was designed to a be a quick once over on a patient to check for any bleeding.  The EMT runs their hands over the patient occasionally looking at their gloves to check for any bleeding that might be severe enough to need immediate treatment.  It is a very effective technique.  I know of people who have found missed stab wounds or injuries simply by looking with their hands. At a fire department where I used to work in Massachusetts and in a few departments in my new system I have noticed EMTs and first responders using black non-latex gloves.  Black.  How are you supposed to see anything or know where your hands have been with black gloves on? On a typical call, I usually go through two sets of gloves, sometimes more.  If I am not taking my gloves off, I am always looking at them before I touch a bag, or my radio, or before I go into my pockets or a cabinet to get any equipment.  How can one do that if they are wearing black gloves? Furthermore, what about black straps or bags?  Doesn’t that pose the same problem?  Maintaining clean equipment is dependent on being able to tell what equipment is contaminated.  It’s time to move away from the red and the black. Green, especially ANSI compliant light green, is the way to go for bags.  Sure, it’s a little tough on the eyes but it makes the provider more visible and it makes it much easier to identify those little pieces of a call that we occasionally take with us. The same goes for straps.  Anything that we can do to make ourselves more visible is vital.  Its time to move away from black. And finally, the black gloves?  Let’s toss those boxes out.  The companies that make them need to stop.  You can’t properly treat a patient if you cannot properly assess them, and you can’t properly assess a patient with black treatment gloves...

Early in January I was contacted by Coast Portland and given the opportunity to review their HP 14 LED flashlight.  Their timing was perfect, as I was in the market for a new light since my old one had seen better days.  This was my first opportunity to use an LED flashlight as all of the ones I have owned prior to this have been halogen.  I have heard from a lot of people that these days, LED was the way to go, so I decided to give this one a try. For the last month, I have been using the light on the job.  Here is what I thought about it: At $65, the HP 14 is affordable and not overpriced.  It advertises a run time on the high setting of just shy of 5 hours, with a considerably longer life of 20 hours on the low setting which when compared to LED flashlight reviews of similarly priced lights is excellent.  In the month that I used the light, I had no issues with the quality of its performance.  The battery life seems pretty true to me and the quality of the stream stayed consistant. The first thing that stood out to me about this light was its overall appearance.  The HP 14 is a sharp looking light.  It is light weight, comfortable in your hand, and easy to use and adjust.  Not only is it powered by 4 AA Batteries, but they are included with the light. Switching from high to low is as easy as double clicking the power button on the back end of the light.  The lower 56 lumen setting offers a much softer but still bright and usable option.  The telescoping focus while quick to adjust but takes two hands to do.  At its narrow setting, you get a nice tight, bright stream, with the wider one giving you a nice area and it softens the light enough that on the low power setting you can easily check a patient’s pupils.  The light needs to be usable not only to illuminate a scene but for patient care as well when being used by a paramedic.  The HP 14...

I recently read a story that came across the EMS wire about an EMSA paramedic in Oklahoma City who was assaulted by a patient and as a result, she lost her unborn child.  Last week, I read a story about a politician or lawyer (forgive me, I cannot find the actual article to reference it) who assaulted a medic and was not charged.  Over at Rogue Medic, Tim brought to light a man who assaulted a Chicago medic who got off easy. Our job can be dangerous.  Sure, for the most part, our calls are routine, and we are not at risk, but then there are those cases, like the ones referenced above, where we are put at risk.  When these incidents happen, I’d go as far as to say that paramedics and EMTs are more at risk than doctors and nurses who have other staff there who could potentially back them up, and police officers, who are trained to deal with such situations.  When a provider is one on one with a patient who could potentially become violent, or does become violent, there is not a more dangerous scenario that we as prehospital providers are put in. Some of these tips are my own.  Some of them I picked up from Mike Taigman and the street safety course he was teaching through EMS1.com a couple of years ago. First of all, each of us needs to remember that scene safety carries into the back of the ambulance.  Next time you’re in the back of your truck, take a look at your surroundings.  Where are the potential “weapons” kept?  Are there sheers or IV needles in the cabinet right next to the patient?  Are they accessible on the bench seat?  What do you keep on your belt, and how well is it secured?  Make sure your sheers are always fastened if you carry them.  And although I have not found much of a use for them in my years as a medic, make sure your knife is discretely tucked away. Work a “pat down” into your assessment.  It can be as simple as a head to toe assessment, and can be very discretely done. ...

I posted a question on my Facebook page asking my followers what they felt the “most innovative change” was that they have seen during their career in EMS.  To date, I have gotten 26 responses of varying degrees of seriousness but the most common one that I have seen is prehospital CPAP.  In fact, one nurse even weighed in with that answer.  I decided to do some research and see what else I could find out about the topic. I remember being an EMT in New Jersey home for the summer back in 1999 and watching the LIFE paramedics pull out a large bag with their CPAP setup out of the trunk of their unit.  It was admittedly an intimidating piece of machinery to me.  CPAP in my home system in Massachusetts was as foreign as prehospital 12-Lead EKG’s were at that time.  We did not get LP-12’s until 2002 or 2003. When I did a Google search for prehospital CPAP, I found an article from EMS World written in 2005 by my good friend Bob Sullivan outlining its use, why it is effective, and why it is so important to start CPAP sooner rather than later.  Some of his references in the article date back to as early as 2000.  The proof has been in the pudding for years, CPAP works. Why then did it take a special project waiver and two years of evaluations to get it approved for use by paramedics in Massachusetts?  Randy Cushing, a paramedic with the Agawam Fire Department was one of the leaders in the push for prehospital CPAP and his efforts finally paid off in 2010 when the change went through in the state protocols giving paramedics standing orders for prehospital CPAP.  Eleven years after I was seeing it used in New Jersey.  Five years after the article, one of many, was posted about its effectiveness in prehospital care.  This leads me to make the broad conclusion that in 2013, there are still probably some systems out there that don’t use it, or haven’t gotten full approval to use it yet. This makes me think about studies such as the one that compared usage of IM...

FNG.  If you work in the field, you know what it means.  Personally, I’ve never been happier to be called something in my life.  Being the new guy here isn’t that tough, especially with the group I am lucky enough to work with. It’s been a month in my new system, and although some things have been a struggle, I have really enjoyed myself.  Some people have referred to things as being like “riding a bike” you kind of never forget.  Moving to a new system as a paramedic though is nothing like that.  I like to think that it is more like driving a car. In a different country. Where you sit on the opposite side of the car. And drive on the other side of the road. And the pedals are reversed. The end point is the same.  We all want to provide good patient care, and turn our patients over to the hospital feeling the same, or better, than when we picked them up wherever we found them.  How we all get there though is different.  Protocols are different, and treatment can be more regressive or (preferably) progressive and sometimes taking those old habits, and those old protocols and completely dismissing them can be incredibly difficult, especially when they’ve been part of your everyday life for a number of years, in my case twelve of them. I’m not going to sit here and try to reinvent the wheel and tell anyone that I know the best way to solve this portability problem because I don’t, short of nationally set protocols that everyone follows, but as long as we are all in our own little sandboxes, that will never happen.  Truth is though, I really like the way things are done where I am now.  Treatment modalities are aggressive, and pretty straight forward allowing a medic to do what they feel is best and all of this with the blessing of our medical director. With each tour, I am feeling more and more comfortable.  Sometimes I feel like I’m all thumbs with two left feet, and a brain that is a step behind, but as I slowly settle back into a comfort...

As 2012 wraps up, I spent a little time looking back at my posts from this year.  It was a turbulent year for me, and although real life tore me away from the blog a bit more than I wanted it to, I still did my best to keep it active, and I think I had some great posts in there. This was a year of change for me.  The working environment that I was in changed drastically, life changed drastically, and I decided that in order to best respond to that I needed to find a new place to call home, and a service that was a bit more in line with what I believed in as a paramedic and more importantly, as a person.  While certain aspects of my life are still working themselves out, I still feel that mission was successful.  Anyway, on to the posts. “Bad Publicity and Saving Face” – No post that I made in 2012 stirred things up more than this one.  I saw more than 6,000 visits to my page as a result of it, and got a number of comments both on the blog and over on Facebook.  It is all about a controversial article that, of all places, was written in a college newspaper.  It is a gut check for everyone out there who has ever told someone what being an EMT is all about, and it is a reminder that our profession follows us into each and every social circle that we put ourselves in.  Check it out, and see what everyone had to say about it.  Then, read the follow up to the article here. “What Would You Do?” – Sparked by a conversation that we had in the office at my part time job, this post was about a sticky situation involving a DNR, and a patient who did not want to be around anymore.  Legally, morally, and ethically, each opinion might differ from the one before it.  There are some great comments in this post. “Officer Gene Cassidy” – Everyday, police officers, fire fighters and paramedics make sacrifices.  This past June, an officer in the city I used to work...