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...