A few weeks ago I was sitting around the station talking to a couple EMT’s about some issues that they had with the translation of a “lift assist” or public assist into a patient refusal.  It was not so much a personal problem since, as one of them put it to me, “If I touch them, I get a refusal” but it was more the actions that they had seen some of their coworkers take to minimize their own paperwork.  Interestingly enough, the debate of “what is a patient” and “who gets a refusal” was a long standing debate that I had with some people during my years as a supervisor. The scenario we most commonly encounter is a simple one.  It is like that old Life Call from the 80’s.  Mrs. Fletcher falls in her bathroom, pushes her pendant and moments later, she is telling someone “I’ve fallen, and I can’t get up!”  EMS, the fire department, the police department, and whoever else gets called is on the way to her in no time.  A few minutes later the crew gets on scene and finds Mrs. Fletcher as they would expect her to be: seated on the floor unable to get herself off the floor and back in her chair.  The responsible ambulance crew gets on each side of her, hooks their arm under hers, puts her back in the chair, and they’re out the door without another word spoken.  The paperwork is simple, and they’re back in service. That is how it happens, right? If they were my ambulance crew that better not be how it happened.  Anytime Mrs. Fletcher finds herself on the floor it is up to us to at least make an attempt to find out how she landed there.  The first question that should be asked is “what happened?  Did you trip?  Did you get dizzy?”  Follow that up with another simple one: “Are you hurt?”  I know, it seems like it would be a no-brainer, but that is not always true. You need to get a look at the medications that these patients take.  Is there a beta-blocker in there?  Are they a diabetic?  These patients need...

I try not to complain very much, and I think compared to most medics I don’t.  Mind you, that’s not a dig at my fellow caregivers, I just think that we are Type-A personalities who want it all, and we get vocal when we don’t get it.  That said. . . This winter, I have had a huge pet peeve of mine rekindled.  In all of my years working in Springfield, Massachusetts there was one thing that I always checked when I was putting my truck together at the start of my shift.  It was not the oxygen, it wasn’t my backboards, paperwork, or anything else like that.  The one thing that I always made sure that I had was a sheet or blanket sandwiched into my stair chair, especially in the winter time.  For me, there was no more necessary item to carry into a scene. I was what one might refer to as “stair chair dependent.”  Many people liked to bring their stretcher to the door and park it there, or leave it on the curb but frankly I did not and still do not like leaving it unattended.  For me it was always easier to carry a stair chair to my patient’s side regardless of their condition so I could have something to use to move my patient to the back doors of the ambulance.  It got used a lot, and there were a lot of butts of varying conditions that saw time on that chair.  For me, the blanket gave me a barrier for my patents to sit on. In the winter time, it helps keep the patient warm.  In every season it gives you a great way to move your patient if they are not able to get over to your stretcher.  Nothing is easier than scooping a patient up with a sheet and popping them down with a draw sheet.  It is one of the simplest and earliest taught “moves” in the industry. And let’s not lose sight of the “don’t reach out” factor.  We all give that speech to our patients about how important it is for our patients to keep their hands in, don’t grab hand...

Last week a news story made its rounds on internet sites and blogs about a New York State EMT who had been suspended for six weeks and then quit his volunteer department for what many called “doing the right thing.”  If you have not seen the article, feel free to follow this link.  Otherwise I’ll give you the Cliff Notes version of the story: Twenty year-old Stephen Sawyer, a member of the Ellenville First Aid and Rescue Squad was at his station alone when a call came in for a four year-old having a seizure.  Sawyer, who is one year under the Squad’s policy stated age to drive but is an employee at a private EMS service in the area was the only EMT available that day when the paramedic on scene “called for an ambulance” for transport.  Unable to find any available mutual aid unit to respond to the call, Sawyer decided to take matters into his own hands.  Sawyer, referred to in one article as a “squad leader,” a member of the Squad’s communications committee and an advisor to their Youth Squad who presumably had knowledge of his department’s policy did what he “felt he had to do” and violated the 21+ driving policy, responded in an ambulance, and transported the patient to a local ER. The response of the Ellenville First Aid and Rescue Squad’s board of directors was to suspend Sawyer for 60 days.  Sawyer then resigned from the squad on the spot. In another article that interviews the Squad’s captain Mr. John Gavaris, the captain states the under normal circumstances, Sawyer might not have been suspended if not for his previous disciplinary record which was not focused on in greater detail.  The response both from his community and the social media EMS community was one of “online outrage.”  People felt that the 60 day suspension was too harsh and called from Sawyer to be reinstated immediately.  Although the argument could be made that 60 days is a pretty harsh sentence, I have to stand with the Squad on this one.  They made the right call. Like it or not, policies exist.  Policies have to exist.  They are what give...

As I was getting ready for my first day of work last week, I started loaded up my pockets with the usual stuff that I carry.  In my right leg pocket, I keep my shears strapped into their little holders.  I always crisscross the straps to their snaps.  In my left hip pocket I carry my gloves.  At my new job I was surprised to find that many people carry sterile exam gloves so I started doing the same.  (If we are ever partners, I am an 8 and a half.) I loaded up my belt the same way that I do every day.  Between the second and third belt loop on the left, the clip for my radio goes.  In the same spot on the right side I have a holder for non-sterile gloves.  I usually load it up with four pairs at the start of my shift all rolled a certain way so I can grab a pair quickly if I need them. I then got ready to pocket the last little trinket that I carry: my Smith & Wesson knife that sits clipped into my right front pocket and realized that I could not find it.  I slipped into a momentary panic. Although I have used it just twice in the four years that I have owned it the knife is always sitting there, just in case. Fortunately, I found it in my hamper.  Apparently, it fell out of my pair of pants from the previous shift but it got me to thinking about all of the little idiosyncrasies that I go through in my day.  I have a certain way of doing things in my job that makes me comfortable.  It is kind of my own personal way of holding on to my sanity I guess.  My GPS goes on the windshield a certain way.  I keep my traffic vest in a certain spot in the truck.  My bulletproof vest sits behind the headrest of the back seat on whichever side I am driving.  These things get done every shift.  The same way.  I end up almost unconsciously reaching for things just knowing that they are there.  it is comforting....

No units available.  Not enough paramedics.  Citizens dissatisfied with response times.  The public and private sectors at odds.  Paramedics and EMTs bearing witness to horrors and atrocities on a daily basis.  This could easily be a story line from FOX News in Detroit but it’s not.  These are just a few major plot lines in the documentary Tell Me and I Will Forget. On a snowy afternoon, I decided to look through NETFLIX for something that I had not seen yet and I stumbled upon this video.  I have watched Parmedico, Firestorm, Burn, and any other public safety documentary that I can get my hands on.  While each of them has been extremely moving and left some impression on me, none has been as powerful as this movie. The level of violence in the country of South Africa leaves me speechless.  While emergency responders encounter a lot state side, the level and brutality experienced by South African medics is unbelievable.  In the first five minutes of the movie, you meet Kallie, one of about 400 paramedics working for the government service as he responds by himself without ambulance backup to a shooting.  You watch him work, eventually sedating and intubating a disoriented patient with a hemothorax as he waits on the side of the road for what feels like an eternity for a responding ambulance.  The system is overwhelmed on a daily basis.  The work force is depleted.  Thankfully, however, the public and private sectors seem to work well together. It was interesting to see an overview of what NETCARE 911 a for profit EMS system in South Africa has to offer.  While much of what was expressed was done by their own employees the view of many in the private sector was that they had more equipment, more ability, and better resources to draw from.  It was an interesting contrast to what many find in for profit EMS in the United States which focuses on being the more lean, cheaper option for EMS.  Far too often American private ambulance services are more concerned about their own bottom line than they are patient care. . . at least at the management level. Comments made by...

By now, the New York Times article from last week has made its rounds in the EMS online community.  If you have not read it, I will give you the short version.  Based on the response to the Boston Marathon as well as some other high priority incidents, Federal Emergency Management Agency released new guidelines this past September in regards to the response of first responders to active shooter incidents.  The new recommendations revolve around what FEMA’s fire administrator Ernest Mitchell Jr refers to as “risk a little to save a little, risk a lot to save a lot.”  According to FEMA, risking a lot means sending EMS responders into the “warm zone” of an incident to treat and extricate patients. Most of the article revolves around one particular paragraph of the seventeen page document: b. While the community-accepted practice has been staging assets at a safe distance (usually out of line-of-sight) until a perimeter is established and all threats are neutralized, considerations should be made for more aggressive EMS operations in areas of higher but mitigated risk to ensure casualties can be rapidly retrieved, triaged, treated and evacuated. Rapid triage and treatment are critical to survival. Rush in, keep your heads down, and get out safe.  They have not completely ignored our safety, however, adding a few lines later: d. If exposed to gunfire, explosions or threats, withdraw to a safe area. e. Consider/Investigate the use of apparatus’ solid parts such as motor, pump, water tank and wheels as cover in the hot zone. Understand the difference between cover (protection from direct fire) and concealment (protection from observation). f. Remove victims from the danger zone in a manner consistent with predetermined agency training and standards of practice. LE officers may bypass casualties in order to eliminate the threat. Recommendation “f” leaves me with some hope that there eventually will be more mandated training and education for EMS providers, but the document seems to largely ignore any mandation of this.  There are, however, recommendations made in regards to what FEMA feels should be addressed when planning, and developing standard operating procedures.  For example, much of the treatment modalities recommended revolve around tactical emergency casualty...

Christmas is right around the corner, and it is time to hit the stores, or in my case hit the websites, and get that shopping done.  But what do you buy for the EMT or paramedic who seems to have everything?  Well you’re in luck because here are what I feel are five of the best gifts that every provider should have this year. 1.   Ripshears – These might be one of the best purchases that I have made in my EMS career. They’re affordable, they attach right to your favorite pair of shears, and they do the job.  But don’t take my word for it, check out The Happy Medic’s review! 2.  A subscription to EMS World or JEMS – This is the gift that every EMT and paramedic out there should have.  There is a wealth of information available today on the internet, but nothing beats print media when it comes to trade publications.  I have subscriptions to both, it is one of the perks to going to their national conferences, and if you or your loved one does not, it’s a great gift for the holidays this year! 3.  5.11 A.T.A.C. 8” Side Zip Boots – In my 13 years as a paramedic I have gone through just about every brand and style of boots imaginable: Magnum, Rocky, Blauer.  On my first day last December at my new job, I was issued a pair of brand new 5.11 A.T.A.C. 8” Side Zip Boots.  A year later, I am still in that pair.  First of all, I was always used to going through boots every six to eight months or so.  Most of that I attribute to the harsh New England winters, regardless of what I did, or how much I worked, I never had a pair of boots last me a whole year until now.  These things are great.  They’re comfortable, functional, and really hold up. 4.  A new flashlight – Currently, I own two flashlights: the first I reviewed earlier this year made by Coast Portland.  This one lives in my truck’s door during my work week.  Its bright, light, and functional.  The other one that I own is a...

This post can also be found at The EMS Leader I remember the first time that I watched Mother, Juggs, and Speed and saw Larry Hagman walk into F&B Ambulance for the first time, and put his resume on the table.  After barely even looking at his resume, Mr. Fishbine hired him, with barely an interview.  No selection process, no nothing.  A guy with a card, getting a job.  Many might see that as a Hollywood shortcut, but sadly in my experience in many places, especially the private industry, the vetting of prospective employees is far too brief.  You then are introduced to the rest of the “team” at F&B ambulance which includes the veteran, Mother.  The guy who is really in charge, seemingly because he is the guy who has been there the longest. I point out this great 70’s movie because it was actually the first exposure to EMS that many people who are my age had.  Sure, I’m 35, and this movie came out the same year that i was born, but even nineteen years later when I was a freshman in college we watched it as part of one of our EMS management classes.  Although my two full time jobs have been with pretty large, put together organizations I have plenty of friends who have and do work in the smaller mom and pop sized section of the industry.  I have heard plenty of stories about people being sent out on the street as fast as they come in the door.  It is time for EMS to take a good look at their career ladder and hiring processes.   First though, we need, as an industry, to decide who we want and decide what a career ladder really entails.  Should the evolution of BLS to ALS really be considered part of that ladder, or is it possible to move “up” the chain in EMS without having a paramedic patch on your sleeve? Can a BLS provider be qualified to be a section leader on a major incident?  Can they receive and utilize the training necessary to deal with day to day personnel and scheduling issues that always seem to pop up?  Far too...