Last Monday, I posted my views on the story that came out of Prince George County, Maryland involving a child who was transported in the back of a fire truck who was in cardiac arrest.  My opinion about the incident ruffled some feathers but it also sparked some terrific discussion not only on my blog, but it also helped fuel the topic at EMS12Lead, and on Facebook as well. I stand behind my statement that I felt the decision made was reckless and absolutely wrong.  While human emotion drives us, sometimes we need to fall back on our training.  When we walk into a scene, we are there to bring order to chaos, not add to the craziness. I have never had as many comments on a blog post as I did on this one, and while I replied to a few of them within the post itself, I thought I would take the time to share some of them here. Tom Bouthilette from EMS 12 Lead wrote: “It’s easy to second-guess the boots on the ground but unless you’re the one there watching a child die you can’t know what it was like.  There is no “absolute.” While I agree with Tom that there is no absolute, I do not think any of us would sit back and idly watch a child die.  We have training, and we would let that training guide us in caring for this individual with the equipment we had on hand.  Also, isn’t learning from mistakes made and dealing with the tough situations to improve care what we are here for?  Isn’t that why we write, and retrospectively look at situations that have happened in the past, whether they are positive or negative? Matthias Duschl asked: “Why do you see a need for punishing this crew?  I totally believe that we create better medics by analyzing what they do, measuring the outcome, and if something isn’t optimal, we should improve it by training not by suspending people who did something that saved a life but wasn’t according to their protocol.” Without protocol, we are nothing more than cowboys running around the streets shooting from the hips.  Policy and...

Over the years I have seen a variety of EMTs who carry a variety of equipment on their person.  I have seen everything from window punches to elaborate holsters with a round of soft goods to virtually nothing at all.  It made me think about my own personal compliment of supplies that I feel are vital to my job that I carry on my person every day. The amount of stuff that I carry on my full-time job in the city varies a bit from my old part-time job when I worked at an amusement park, and when creating your own supply list I suggest you keep that in mind as well.  Tailor it not only to what you need to have right by your side but also what will be close. 1.  Radio – I always have a means to talk to someone not only via phone, which in a pinch will take too long, but also by radio.  Also, how is anyone supposed to get a hold of me if they cannot get me on the air? 2.  Scissors – The trauma shears I carry at work (in my pocket, not in my belt) have a set of Rip Shears attached to them as well.  This way, I can get through anything I might have to on a scene with little difficulty. 3.  Two spare pairs of gloves – Usually, my first pair of gloves sits in one of my front pockets until I decide to put them on.  My second pair is in one of the leg pockets of my uniform pants, usually on the left side.  Why the left side?  Because that is where I have always put them.  I try to carry the same stuff every day in the same place.  It has become a routine of sorts for me. 4.  Handy wipes – In my other leg pocket, I usually carry eight or ten of our industrial strength individually packaged handy wipes.  They are not just for my crew and I but also for the police or fire department should they need them.  These things are really popular with our first responders, and I swear along with coffee,...

Lately, I have been very emotionally charged at work.  Well, really, that’s a nice way of putting it that I have not seemed happy which has been noticed by many people.  I tend to wear my emotions on my sleeve and frustration is certainly one of those that I do not hide well.  During a “venting” session at shift change a few weeks ago one of my colleagues said to me “maybe you need to reevaluate how you are sharing your message.”  I appreciated those words, and really went beyond that.  I decided to reevaluate my entire approach to how I do some things. It should not be any surprise that I am a control freak, a Type A personality.  That is something from my street paramedic career that I was not able to shake, and it rears its ugly head in my middle management style sometimes.  I am always watching what goes on around me, and often have an opinion about what is taking place.  I tent to express that opinion whether people want to hear it or not.  The first internal struggle that I need to address is I need to come to terms with the fact that I cannot control everything.  My focus needs to be narrowed and more concise during the course of my day.  Putting my energy towards changes that can be made and be productive as a result will make a difference in how I spend my time, and the outcomes that I see from it. I also need to come to terms with the fact that some things will never change, like some people’s beliefs.  People are who they are and I need to integrate myself into the system instead of demanding that the system integrates itself to me.  I need to trust that like me, other people are doing what they feel is in our best interest, and I need to move away from a “my way or the highway” attitude that I sometimes slip into. Finally, I cannot hang my hat on an expectation of praise; you cannot expect that to come whenever YOU want it to.  EMS is a thankless profession, and much like...

Recently, an article was posted about a group of Prince George County, MD firefighters who violated policy and transported a child in cardiac arrest to the hospital in their fire engine with what was described as “limited medical supplies” instead of waiting for an ambulance that was less than five minutes away.  The child, who was reportedly having an asthma attack, arrested in front of the crew.  The paramedic who was on scene made the decision to start transporting in their fire truck after getting what can only be assumed was an unacceptable ETA of five minutes.  According to the Prince George County Fire Department, the patient regained pulses prior to arrival at the emergency room. The firefighters who were involved were not suspended without pay.  Their medical control was not pulled.  They do not even appear to have been reprimanded by their department.  Instead, they have been given valor awards for their life saving actions that day. First, I do not want to overlook the miracle that took place on this call.  A life was saved albeit using very unconventional and potentially dangerous actions.  Effective CPR was done, and the girl lived, without any residual neurological deficits.  I give them credit for their care, but only to that extent.  This does not mean, however, that these firefighters should not stand and explain their actions. As I stated previously, the fire truck that was used on the call had limited medical equipment, and according to the press release, it was not one that was typically used for medical calls.  This leads me to believe that the life-saving actions taken by the paramedic that day was effective CPR which could have been done just as well, if not better, on the patient’s living room floor until a transport capable unit arrived. What about the large amount of departmental liability this crew put their employer under?  The girl had no neurological deficits but if she came out of this with so much as a limp or maybe slurred speech, her family could have owned the entire department, and potentially taken that paramedic for everything he had because of what would have only been described as “gross...

2011 was a big year for me and a big year for EMS in the New Decade.  Born from some ideas discussed over a few beers in Baltimore was The First Responders Blogging Network, and I was fortunate enough to be one of its first members which brought about my domain move from Blogspot to www.medicsbk.com. While as of late there were a few technical glitches, I saw a number of visits and got some great comments, so I decided to share with you the top five articles viewed by you, the reader.  For those new to the blog, I welcome you to check out content that you have not yet seen.  For the faithful readers that have been with me all year, I invite you revisit some of this year’s most viewed and share your thoughts on them. 5.  A Punch in the Gut – In July, the Baltimore Fire Department’s EMS Training Center was shut down.  Read my thoughts on that here. 4.  IntuBrite Laryngoscope Blades – As part of my involvement with the Podcasting Studio at EMS Expo in Las Vegas, I was able to choose what I felt was the most innovative product on the show floor.  Here is my selection. 3.  A Call to Volunteers – Over the course of the last year and a half, I have become quite vocal about the New Jersey State First Aid Council and their efforts to bust EMS in New Jersey back to the stone age.  Here is one of those articles. 2.  EMS in New Jersey – A Call for Action – Here is yet another view of EMS in New Jersey, this one dealing directly with NJ State Bill S-818 and my thoughts on it.  Again, this was a very hot topic this year, and I invite you to read this, especially if you are a New Jersey EMT. 1.  Goodnight, ALCO – On October 31st 2011, AMR Alameda County closed their doors.  A lot of great paramedics and EMTs were forced to find other work in different counties or hop on board with the county’s new provider.  I owe a lot to the folks out in ALCO.  This is...

You are dispatched to a single family house for a patient with abdominal pain.  Just like any other call, you pull up in front of the house, gather your gear and head up to the front door.  After ringing the doorbell, you are greeted by a gentleman n his mid-20’s who is holding a camcorder, filming you as the door opens.  “He’s over here.  I just want you to know, you’re being video and audio recorded.”  How would you react to this?  Would you demand that the man put the camera down?  Would you cite a violation of the patient’s HIPAA rights?  Maybe you would state that your own personal rights are being violated.  Ultimately though, I would like you to ask yourself one question: What’s the big deal? If you are doing the right thing, maintaining a professional demeanor, and delivering the best patient care you are able to, what is the big deal if someone is videotaping what is going on?  Realistically, nothing about what you would do for that patient should change.  The only difference is you have a captive audience. A search through YouTube will reveal what some people would describe as videos of patient neglect or people not being treated with the respect they deserve.  Take the recent video of the Houston FIre and police personnel taking pictures of the passed out woman while they stand around waiting for the ambulance to show up.  The fact is, more times than not, you won’t find the YouTube titles of “Police officer is perfectly respectful during traffic stop.”  Or “Watch this homeless person as they are taken care of by caring and compassionate EMTs” why?  Because there is no shock value to that.  No one wants to watch that boring video.  They want to be outraged and shocked with what they find on the internet. I fully admit that I frequently surf YouTube and religiously check out the CopBlock YouTube page.  Now, while I do not agree with the stance and opinions of many of its members, I like to see how the officers who are taped handle themselves when faced with an aggressive camera person and I have seen good...

To read all of my posts about the New Jersey State First Aid Council, and the struggles of EMS in New Jersey, just click here. For more information on the NJSFAC click here. Earlier this month, I had a friend from New Jersey send me the latest information sheet put out by the New Jersey State First Aid Council in regards to State Bills S818 and A2095.  While the bills are slowly gaining momentum with the current vote on Bill S-818 resulting in 21 “Yes” 15 “No” and 4 “Not Voting” as an official for the NJSFAC stated in a recent email, “The fight is not over.”  EMTs and paramedics that live and work in New Jersey need to understand the true fabric and importance of these bills. The First Aid Council’s intention was to share their views which are in the form of oppositions to many of the amendments that were recently made to the bills.  Here is my rebuttal to a few of their arguments.  Please take a good look at this, especially if you are a New Jersey EMT. FACT: The New Jersey State First Aid Council opposes the establishment of a new lead agency for EMS.  For some reason, the NJSFAC opposes this amendment because it would give “. . . complete control over and all facets of EMS in the state including some that are already overseen by other groups. . .”  My question to this is: what’s the issue? EMS is a fragmented profession, and New Jersey is no exception to this.  In fact, in many aspects the fragmentation of EMS is magnified in New Jersey.  In some states, differences exist in counties.  In New Jersey, the unique setup of each EMS system right down to staffing and equipment varies from town to town and squad to squad.  Rules and regulations vary depending on whether or not you are a volunteer ambulance service or a professional one.  In New Jersey, an ambulance is not an ambulance and an EMT is not an EMT. Establishment of a lead agency for the state would create one entity for everyone to answer about everything.  Standardization could be developed.  Studies could be...

Anyone who knows me or spends any time perusing this blog knows that I feel that scene safety and the wellbeing of those of us who work in this field is the most important thing there is.  As a supervisor, my first goal is to make sure every single one of my employees goes home to their families at the end of the day.  They might not go home on time all the time, but I need to make sure that they go home. This past week I had a chance to attend the EMS1 Street Survival seminar put on by EMS1 and Calibre Press.  The program itself was created from the principles developed as part of their law enforcement scene safety class.  Much to my excitement, the class was taught by Mike Taigman, someone who I have a great deal of respect for. Prior to the class, Mike conducted an online survey that revealed that a quarter of EMTs responding had been involved in a fight or violent altercation with a patient.  75%, however, reported that as a result of those violent altercations they were injured in some way.  These numbers are unacceptable, and the need for training and education is evident.  The focus on the class was not to teach a “rip ’em up, tear ’em up” fight with everyone mentality.  While physical resolution of a conflict was covered, first and foremost, avoiding such a conflict was the priority. Day one dealt with coordinating these scenes and acting as the eyes and ears while someone else makes patient contact.  The focus was awareness: be aware of who is there, be aware of how you got in to the scene (out doors or in doors) and being aware of how to get out of a scene.  The videos and photos, actually and staged, that were shared during this first day were geared towards being focused on those little details that one might encounter.  How would you approach a certain scene?  What windows need to be watched?  How should you enter a house to best appraise what sort of situation you are walking into. When it comes to verbal communication in an escalating situation,...

    When I was fifteen years old, the first ambulance that I set foot on was a 1984 slant sided Braun.  That truck, 219, was a beast.  Gas powered with two tanks that it would guzzle on a Summer day, and to better make sure it was plugged in when you left the station because if you didn’t, it would be dead as a doornail for the next call and you’d be forced to take the van one bay over.  Nobody wanted to take the van. The back of the truck was typical for your smaller box truck.  The s tretcher was side mounted to the left hand wall with a bench seat running down the side and the airway seat where you would expect it to be.  There was really nothing unusual or breathtaking about the back of the truck.  About a year into my time, the dreaded van was replaced with a 1994 Horton ambulance with a center mounted stretcher, but otherwise nothing remarkable to it.  219 was remounted sometime after the turn of the century, and that 1994 Horton, 218, was replaced in 2007 with a brand new Horton ambulance, ready to keep the populace of Island Heights safe. Now, in 2011, 218 and 219 still sit in their respective bays.  219 is still that remounted 1984 box on a new chassis, and 218 is that pristine 2007 Horton, 23 years younger than its big brother just a few feet away.  Here is the problem: if you open up the back doors of each of the trucks, you will find that they are alarmingly similar.  That’s right: 23 years of history, zero progress.  218 still has that same center mounted stretcher, much like its 1994 predecessor did.  The bench seat is still running down the right side, airway seat still in the same spot that it was not only in the old truck, but also in 219.  No bucket seats.  No advanced restraint systems.  No harnesses.  No steps taken to make the providers safer in the back of the ambulance.  Just the same old lap belts.     Now, compare it to the back of an ambulance from “across the...

I recently read a story in EMS World about a paramedic who has been placed on administrative leave for failing to treat a patient.  According to the article, he arrived on scene, assessed the patient, and despite the requests of the BLS ambulance on scene, he decided to go back in service and triage the call to the BLS unit.  The patient was transported to the hospital where they subsequently died. I am not writing this to debate whether any ALS interventions would or would not have made any difference in the patient’s outcome.  There has not been enough information released to even dip one’s toe into that debate.  I am also not going to debate the “liability” issue of a lower level of care taking care of a patient when the higher level of care is present because I feel that quite often, if a patient can be triaged, and the BLS unit willingly accepts to take over care of that patient, then there is no issue with doing that.  I am writing this to discuss comfort levels. Throughout my career, I have viewed ALS as serving many different roles in prehospital care.  They are there to provide ACLS care, pain management, and trauma care just to name a few, but they are also there to be a safety net for BLS providers who may or may not be comfortable with a patient that is in front of them.  With three times the training that a BLS provider receives, sometimes a more knowledgeable presence when caring for a patient rather than a brief pat on the back and a polite “you’ll be fine” is what that lower level provider needs. In the system that I work in, I often work by myself in a fly car (or interceptor, or QRV depending on where you are from).  The majority of the patient contacts that I have are while intercepting with an ambulance staffed by EMTs.  Throughout the course of my day, I will see a variety of complaints from stubbed toes to cardiac arrests, depending on what I am sent to.  After my assessment is done on my patient, and I am comfortable with...