This one is for you.  That’s right: this quarter’s addition of Intervetions was written just for you, the EMT, the paramedic, the field provider.  Inside, you will find stories about training, the importance of communication, and my contribution all about stress management. Even though this is a quarterly magazine, there is a lot of work that goes into it.  The goal of the Interventions team is to give you, the reader, as much quality content as we can.  Personally, I think we have once again accomplished that. Thanks to the entire Interventions team for all of their hard work.  And especially, a big thanks goes out to Justin Schorr for his creativity with the magazine’s layout. Without further delay, I’d like to present to you this quarter’s Interventions Magazine.   Up next: The Interventions team will educate those who make the legal decisions that govern what we do: the...

Two years ago today, I sat in my office staring at a blank Blogspot post screen.  I had tried the blogging thing before but I had never tried writing about EMS.  Now though, after reading blogs like The Happy Medic and Life Under the Lights, I decided that it was time for me to take a stab at it. Now, two years and almost 150 posts later, here we are.  It has been quite the journey so far, and I am sure that there is going to be more to come.  There have certainly been some ups and downs, but as John Hall says about EMS careers, they should be a sine wave, and not a bell curve.  This blog post is not about patient care, management, or anything EMS related.  Its simply to say thanks to you, the reader, for actually taking the time to read the occasionally aimless musings of an EMS professional.  The first 150 posts have been a blast. . . Lets see where the next 150 takes...

I recently spoke with a close friend who related to me a story of a very difficult call that she had to deal with.  Without getting too into detail, she was presented with a young child who was in a very difficult and seemingly hopeless situation.  My friend’s “motherly instinct” kicked in when the child latched onto not her family, not her mother, but my friend.  From listening to the story and everything my friend did, which was not much more than consoling the child and establishing a rapport with her, I could not help but be amazed with the job done by my EMT friend.  This was not an acute medical emergency it was actually nothing more than just a simple transport to an emergency room.  Still though, my friend broke down and couldn’t help but question herself and her ability to do her job as an EMT. In actuality though, she did exactly what she had to do: she stayed calm and did everything someone in her position could for the child: she was supportive and she was an advocate for her, and while after the fact she had trouble dealing with the situation, while it was ongoing, she was as professional as anyone could be. A few days before, I assisted a crew who had a patient unexpectedly get combative on them.  While the scuffle in the back of the truck could have gotten bad, the crew handled themselves as efficiently as any crew I had seen in such a situation.  Within 5 minutes of the patient getting combative, he was properly restrained to the stretcher without a scratch on him and wearing a non-rebreather to prevent him from spitting at anyone.  Again, here was a situation where emotions got high and things could have quickly escalated out of control with one wrong move or one wrong word.  The crew, however, kept as cool a head as possible and handled the situation perfectly. This brings us to the point of this post: no matter what happens, and no matter what the call nature is, one sign of a strong EMT is their ability to put their emotions aside, or as much...

Monday night was my last shift before vacation, and now I am free until March 5th!  Free from my traditional job at least.  There is a lot going on over the next week. Next Tuesday night, I will be heading south for a night in New Jersey followed by the rest of my trip to Baltimore.  That’s right folks: Its EMS Today time!  It seems like just yesterday that I sat watching Justin Schorr and Ted Setla taking their limo ride into Baltimore on UStream, debating for myself the prospect of driving to Baltimore for a night.  I chickened out that time, but I refuse to here on out. Also, next week marks the release of the third issue of Interventions eMagazine.  This one is tailored towards you: the field provider.  I’ve seen the first version, and Justin Schorr has done a great job with the layouts.  The entire team at the First Responders Network is very excited about this one. Watch over the next week on Twitter and here on the blog for updates, and more importantly, if you are going to be in Baltimore, please let me know!  I’m always looking to meet new...

In the early days of EMS, especially in many urban settings, there was a “cowboy” mentality.  Paramedics and EMTs were expected to rush into situations, some more dangerous than others, swoop down, and scoop up their patients and then rush them off to safety.  I’ve heard stories of paramedics carrying everything from mace and collapsible batons on their belts to as extreme as a shotgun under their bench seat. Paramedics from yesterday will tell you “It ain’t like it used to be” I know this for a fact because I say it myself.  As an 11 year medic, I feel I have earned that right.  Newer providers will sometimes try to emulate the “old days” in their own way, carrying black “whatcha gonna do” gloves in their pockets or knives visibly displayed on their belts.  It’s time for everyone to remember that times have changed. While the environment that we work in is still strikingly similar to what it was fifteen or twenty years ago, scene awareness (not scene safety) is taught in a much better fashion.  Thanks to priority dispatch, we are able to deprioritize those less urgent calls allowing us to send crews into certain scenes with more help than they had before.    It is time for us to abandon that cowboy mentality completely and move on to a more patient oriented focus.  As scopes of practices expand, as we are seeing in different parts of the country, the role of the prehospital provider is changing as well and we need to better prepare ourselves for that.  We are asked to solve problems every day, but now we need to use our brains more than our brawn.  A wealth of knowledge and a cool head will take us farther than brute strength and a led foot will. I work urban EMS.  I have for the past twelve years, and I love it.  As someone who came from a calm, cool suburban background, the high volume, potential for high acuity and fast pace keeps me interested in the field.  I have, however, also come to realize that sometimes a safer response comes from either approaching a situation a little more slowly or even...

As I sat having breakfast and reading through the previous day’s news on the internet, a Tweet popped up on my other monitor from Greg Friese about a news article from the Wall Street Journal with the title of The Ultimate Lifesaver about advances in prehospital care outlining how services themselves are the ones who are driving these changes for their communities.  The article, written by Laura Landro, is part of an ongoing series called “The Informed Patient” and I must say, I am impressed with what I’ve read. The most impressive thing about this week’s article is how much Ms. Landro immerses herself into the EMS on a nationwide level, outlining not only the accomplishments that we have made as an industry but also the challenges.  For example: in a video interview, Ms. Landro states that “If you see one EMS system you have seen one EMS system.” The reporting that often takes place when it comes to EMS is most often based on assumptions.  People do not know what happens in the back of the ambulance (because we fail to educate them on this) so they make it up as they go along.  Because of the fear of HIPAA laws, the view of EMS is often from the outside of the rig, and not where it should be: right from the patient’s side.  Without getting right in there and “gloving up” herself, Ms. Landro has succeeded in getting the right story about what is going on in EMS. Ultimately though, she has called us out in the article.  While a lay person might take a lot of positive from what they’ve read, what she has shown us is the gross disparity of what goes on around the country.  Seattle’s CPR save rate should never be five times that of Alabama’s.  Pro Ambulance in Cambridge Massachusetts should have every resource available to them that the Phoenix Fire Department does on the other side of the country.  The only thing different about a cardiac arrest in San Francisco and Springfield, Massachusetts is the way that we handle them. Best practices, folks.  That is what this article should steer us towards.  We need to look...

On October 22, 1987, a Baltimore Police Officer by the name of Gene Cassidy rolled up on a dark street corner and attempted to arrest Clifton Frazier on outstanding warrants from an assault that had occurred the week prior that left an elderly man blind.  After a short struggle, Officer Cassidy was shot twice in the face by Frazier. While Officer Cassidy survived his wounds, he was left blind.  On this day in 1988, the case was “put down” by Baltimore Homicide.  All of the evidence led eventually to Clifton Frazier and he was subsequently arrested and charged. I remember the night that I heard about what happened to Gene Cassidy.  I was just nine years old, and my dad was good friends with Gene’s brother Tom.  Tom and my dad had met during his time with Bell Telephone.  The two had a mutual love for photography, auto racing and Volkswagens.  Our families became close, and we spent quite a bit of time together during the summer when Tom and his family would visit down at the Jersey Shore. I met Gene about a year and a half later when he came down to the shore with Tom.  My dad and I took Tom and Gene out on our Boston Whaler for a trip up and down the river.  Although Gene could not see, he had a great time on our little trip.  I remember Tom telling him, “Don’t smile, you’ll get bugs in your teeth.”  I think that the reason our families bonded was we shared the same disturbed sense of humor. . . I recently started reading the book Homicide by David Simon that tells the story of a year that he spent as a journalist with Baltimore’s homicide division.  It’s a very busy one too, handling not only 200+ homicides a year, but also investigating all of the police related shootings that may occur in the city.  Gene’s story is retold in the pages of Homicide and as I read it, I could not help but remember that day late in the season before we put the boat away for the winter that I was able to meet Gene, and it...

Most of the time when we see change, our gut reaction is to resist it, and do what we can to poke holes in it.  At least that has been my experience at many EMS services.  I guess I am just not lucky enough to work in an environment where fluid change occurs. Some change is really for the positive, and there is no more positive change in EMS that I can come up with than the new ACLS guidelines prioritizing chest compressions.  The problem though is breaking old habits. For my entire EMS career, it was always drilled into our heads that we “must get the tube” and we must do it well or someone would take the ability to intubate away from us.  Since the beginning of time, paramedics have seen their “right” to intubate patients as this sacred lifesaving skill that they must have and that no one should touch.  Through progressive thinking though, it has become more and more evident that intubation is not a lifesaving skill, but it is actually more of a life sustaining one.  In most instances, intubating a patient will help keep their airway patent and keep them alive, especially when sedated. I have studied up on CPR in Seattle and one thing that they discuss at great length is the importance of chest compressions and the minimization of interruptions.  We all need to keep that in mind and we all need to adopt that.  Nine out of ten times, airway is not important.  Early CPR, early defibrillation, and the minimization of interruptions are what are proving to be lifesaving interventions, not pauses in compressions to get a tube or vigorous bagging of a patient to get oxygen in.  Blood needs to go round and round in order for that air going in and out to be effective and measuring end title CO2 proves that. Have you ever had your APNEA alarm on your monitor go off?  The cause might not be a bad tube; it might actually be inadequate compressions.  Low CO2 output is a sign that there is little to no gas exchange at the alveolar level because there is not enough blood going...

January 15, 1972 may be the most important day in the history of EMS when it comes to public relations.  On that day, the first episode of Emergency! aired.  Telling the story of firefighter/paramedics John Gage and Roy Desoto, the show dealt with their day to day challenges which, while they had a touch of “Hollywood drama” in them, were stunningly realistic. The show depicted the pair responding to everything from routine and sometimes comical medical calls to huge fires and disasters.  You got to see them working with the doctors and nurses at Rampart General Hospital and the other firefighters at Station 51.  I first saw the show in 1999, and I honestly cannot think of any television show prior to that or since that more accurately showed the lives of paramedics. Emergency! ran for 7 seasons with 131 episodes aired.  That may seem like a lot of material to come up with to some, but those of us who work in the field know that if nothing else, EMS gives us an almost limitless pool for stories sad, touching, funny and exciting alike to share. Happy 40th birthday, Emergency!  You were able to accomplish something that no one has been able to do...

Friday afternoon while I was checking my email I that I had a new e-mail from the Commonwealth of Massachusetts’ Office of Emergency Medical Services.  Every year around this time they like to send out any pending protocol changes that are being released with the annual March 1st updates.  Version 10.01, due go into effect on March 1, 2012 has a great new edition that I am very excited about. On the summary sheet of expected changes, protocol 1.6 for Post Resuscitative Care had the following addition: Mandating therapeutic hypothermia do not delay transport.  hyperlinked to Appendix V. While the state might need some work on their punctuation and capitalization, I was excited to see that Therapeutic Hypothermia was being added to our scope of practice.  I moved down to Appendix V to see what was in store for me in the coming year.  The new protocol describes the implementation, necessity and reasoning for the use of prehospital hypothermia in the following way: Cardiac arrest patients of medical etiology, who have responded to ACLS resuscitation efforts of any rhythm and demonstrate restored cardiac output and hemodynamic stability, but subsequently display signs of severe ischemic brain injury or coma, are candidates for instituting therapeutic hypothermia. Statistics show a significant number of those who survive out of hospital sudden cardiac arrest suffer from residual ischemic brain injury following cardiopulmonary resuscitation. The return of spontaneous circulation (ROSC), while resulting in the reperfusion of vital organs and the re-oxygenation of tissue, is thought to trigger destructive chemical reactions within brain cells limiting neurological recovery. The process of instituting early external and internal cooling efforts and maintaining mild hypothermia (32-34° C) in the first 12- 24 hours has been demonstrated to be a beneficial treatment adjunct in protecting the neurological function of cardiac arrest victims and improving patient outcomes.  Therapeutic induced hypothermia has been shown to be of significant benefit to select patients; continuation in-hospital is essential to its benefit, and may be a factor in hospital destination decisions by medical control. They get it.  All of the work done by services such as Wake County EMS, MedStar in Fort Worth, Texas and countless others is finally making a...