Think back through your EMS career, whether it is a long one or short one. How many times have you been dispatched to this call: “Unconscious in a vehicle” or “Person slumped over the wheel?” I know in my ten years a paramedic, that’s happened more than a few times. Today, however, those calls carry a great risk that could injure you, your partner, other responders, or the unsuspecting public. Back in 2008, Japan saw an increase in their suicide rate due to something called Hydrogen Sulfide poisoning. The person would mix household chemicals together into a potent combination that with just a few breaths can render someone unconscious, and put them into Respiratory Arrest. This also poses a risk to rescuers and bystanders, because often, these suicides take place in confined spaces, which does not allow the gas to dissipate. When access is gained to the potential patient by rescuers, they could also be overcome by the fumes. In the spirit of Scene Safety, what should you be looking for as warning signs? 1. The Dispatch — As previously mentioned, these suicides often take place in confined spaces, such as a bathroom or closet. Most often though, it is encountered in motor vehicles. 2. Warning “signs” — Thanks to the Internet, information on Hydrogen Sulfide poisoning is easily accessible. Many of the sites that advocate for this form of suicide also share the risks to those around them. Quite often, the suicidal party will place signs around where they are to warn potential rescuers of the risks presented before them. They will often say “Warning: hazardous gas” or “Do not open, HAZMAT team required.” 3. Rotten egg smell — Quite often, there is a detectable rotten egg or sulfur smell present, although if the patient is inside a car, you might not be able to smell it. 4. Presence of chemicals/mixtures — Take a good look inside the car before you open the door. Is there a bucket on the passenger seat? Are there any bottles visible in the car? If so, take a big step back, and wait for more help. Hydrogen Sulfide is created by mixing a Strong Acid source with...

Battle On Over Emergency Response Vs. Emergency Caution – Jackson News Story – WAPT Jackson Jackson, Mississippi is back in the news, and Councilman Kenneth Stokes is at it again. Take a look at the video that I linked above, and reread my previous post on this issue. Why doesn’t Kenneth Stokes see what the problem here really is? Its not faster ambulance response, its a larger police presence. The question at hand is should an ambulance respond into a potentially dangerous scene until it has been secured by the police department? My training and my gut both tell me NO. Kenneth Stokes recommends bullet proof vests for AMR’s staff, but a vest isn’t a magical suit of armor that will keep you safe. The right angle to take of all of this is to promote safety at the scene. Bulk up Jackson’s police force. If the city is that unsafe that this has become so much of a problem, make it safer. Expecting AMR’s Ambulance staff to do some of the police’s work for them is unfair, and it puts more people at risk. But, remember, that would cost tax dollars. Its much cheaper to drag the Ambulance Company through the mud, encouraging them to drive into potential “war zones” and put themselves in the line of potential danger. I looked up some information about Jackson, Mississippi. It ranks 4th in the nation for homicide rates per 100,000 residents behind Baltimore, St Louis and New Orleans. In 2009, it was ranked as the 23rd most dangerous city in the United States. If anything should scream for a larger police department, that should. It doesn’t give Jackson the portrait of being a safe city, or a safe place for EMTs and Paramedics to work. What Councilman Stokes is doing is making it more dangerous for the Paramedics and EMTs in Jackson, Mississippi. He’s setting them up so that each time they walk into a scene after the police department, the perception could be “What took you so long?” Every time a truck is posting in a parking lot, or waiting for police to arrive at the scene, it will spark the question of “What...

Last Thursday, I was given the opportunity to participate in an episode of EMS Garage. The topic that night was Liability, and revolved around a news story from Missouri. You can read about it here but the gist of it is this: A crew goes to a chest pain call. They evaluate the patient, tell him its most likely GERD and has him sign a refusal. Later, his family calls 9-1-1 again, and the patient, who is still having difficulty breathing and chest pain, is transported to the hospital where it is revealed that he actually has a Pulmonary Embolism. He dies later that day. First of all, in my eyes, there is no defending this crew. They went outside of their scope of practice, and gave advice that they did not have the right or the training to give. If they had done the right thing from the start and said “well, we don’t know why you’re having this chest pain, but let’s go to the hospital and find out” then this patient might have had a different outcome. I was lucky to be on with a great panel, and there were lots of thoughtful, well informed points made. I urge everyone to take a listen to it. One of the most interesting points and topics to me though was about what should be called “The 11th Hour Syndrome.” Wonder what that is? Well, the 11th Hour Syndrome is what makes a Paramedic change the way they take care of their patient when it’s close to the end of their shift. Do your speed, depth of assessment, and motive change just because it’s almost time to go home? It shouldn’t, but in some cases, it just might. Whether you’re rushing through your assessment, looking at a poor 12-lead because its “good enough” and bypassing that occasional necessary prep work to get a good clean picture, or trying to burn through that last Patient Care Report, the only person that suffers is the person who is receiving the care you’re providing. The hours that one works in EMS can be demanding. This is not your typical 9-5 Monday through Friday job and I think...

Imagine its late in the afternoon. You’re home doing some chores around the house, and you look outside, and notice smoke coming from your garage. What’s the first thing that you do? Pick up your phone and call 911. Somewhere, a dispatcher presses the magic buttons, and a Fire Department is en route to you. What would your reaction be if the Fire Department said “Nope. We’re not showing up.” What would you think as you watched that fire spread to your house and consume all of your possessions? I’d be pretty angry. That’s exactly what happened in South Fulton, TN last week. For the full story, take a look at this link and come on back. FireNation.com Article What it comes down to is this: A family lost their home, their pets, and all of their belongings over a $75 subscription fee that was unpaid. I’ve seen many different view points about this as I’ve surfed the Blogsphere this morning, and some of them really bothered me. There are Firefighters out there who stood up applauded saying that everything went just as planned, and rules are rules. My question to them is: Why are you a firefighter? Why do you do the job? Thats right. I’m questioning your integrity, and your willingness to do what you pledged to do. I have no experience as a firefighter. ZERO. I am very content standing outside of the burning building, so I’ve never walked in your shoes. I have, however, been to many, many fire scenes, and I’ve never once heard a firefighter ask “I wonder what kind of home owner’s insurance these people have.” They are there to help, and do what they have to do to put the fire out and save both life and property. With the help of some twitter friends, some research about the South Fulton Fire Department was done, and here’s what we came up with: The Department is staffed by approximately 20 Fire Fighters, only one of which, the Chief, is full time. The rest of the Department is Volunteer. They have five pieces of Apparatus. Two Pumpers, one Tanker, a “Command Unit” and one Brush unit. Finally, according...

For the next couple of weeks, I am changing my Blog Layout to Pink to support my good friend, April Saling, AKA Epi_Junky and EMS for the Cure, a group dedicated to raising money for research and spreading awareness about Breast Cancer. I urge each and every one of you in the Blogging community to do the same. Head on over to Justin Schorr’s blog, and watch his video supporting EMS for the...