We all have those calls that push us to our breaking point.It might not be one type of call, but we will all find that one specific call that gets to us and sticks with us. Last Fall, I was working a busy Friday night.While listening to the police radio, I heard a “shots fired” call come in.This is not anything uncommon for the city I work in, but I noticed the street name was a street where a friend of mine lived.A few minutes later, I heard an officer who is normally very calm, cool and collected, come over the radio screaming (literally) for an ambulance on that street, and stating that they need to expedite. I started down that way, racking my brain for the entire 5 minute ride for my friend’s house number, but I couldn’t remember it.When I pulled up, there were five or six police cars already on scene, their blue light bars lighting up the street.I went up the steps and turned the corner to find my friend, who incidentally is a PA Student and EMT, doing CPR on a 16 year old girl with a gunshot wound to the head.She was kneeling in a pool of this girl’s blood, and had probably ruined her sweatshirt as well already. We found at that point that this girl still had a pulse, so when my ambulance got there a minute or two later, we loaded her up and sent them on their way.At that point, the focus of my care turned to my EMT friend. “Are you okay?”I asked her, as we stood on her front porch, across the street from what had now become a crime scene. “Yeah, I’m good.”She told me, and then relayed the story of what had happened.She was studying for a pretty big test, and had heard the gunshots come from across the street, followed by the girl’s mother screaming that her daughter had been shot.She waited impatiently for the appearance of a police car, and when the first one arrived, she grabbed her bag and headed across the street with little regard for her own safety. I listened to what she had to...

Is your service ready for “the big one?”You know what I’m talking about: that big call that we all dread, that MCI to beat all MCIs, the one that no matter how much you train for it, you never will be completely prepared.What can you do though to help make the day that your department is faced with a disaster you never expected?A lot of the steps are simple, but because of that, we might be more apt to overlook them. 1.Review your disaster protocols.If you’re on the streets that day, where will you fall in the chain of command?What will the Fire Department’s responsibility be?How about PD?You don’t need to know every move that everyone is supposed to make all the time, but knowing peoples rolls will let you know who to ask when you need something. 2.Make sure your vehicles start!I know this sounds silly, but imagine getting to that moment when someone tells you to “roll the MCI Truck,” and you go turn that key and . . . NOTHING.In my department, our MCI truck is constantly plugged in to keep it charged, but it’s lets face it, it’s a 12 year old ambulance with close to 200,000 miles on it.Once she gets going, she’ll go forever, but to help make sure that she can run, I try to start her at least once or twice a week. 3.What level of certification do you have in Incident Command?Everyone here is required to have 100 and 200, but because of my position, I have to take extra classes, assuming that I will be wearing a vest and hold some sort of authority if things ever went bad.Some might think of ICS classes as dry content, but if you ever need it, you’ll appreciate having taken the classes. 4.Run through scenarios in your head.At my part time job, we have a jar, and on the outside of it, it says “What if, right now?”When things are slow, we pull two different colored pieces of paper from the jar, and one of them will have a location, and the other a situation.An example would be pulling “Big Roller Coaster’s lift hill” and the other...

I have totally immersed myself into the Twitter world, and for the last couple of days I have engaged in some great conversations with some great people. Today, I got into a discussion about a few different topics, but my favorite was professionalism, and our image in the public eye with TheRoadDoctor, Rescue_Monkey, CKEMTP, and In_The_City. I was working at the time, and it was really hard for me to put my phone down. Many great points were made, about how many parts of the industry reward mediocrity, and how there is a “just good enough” attitude, rather than people being driven and motivated to go above and beyond. Was this how people really are, or as In_The_City put it, is our perceived apathy a “learned behavior” taught to us by poor role models? I have a feeling that throughout this discussion, I shared a lot of “head nods” with my colleagues as the great points summed up in 140 characters or less flew across the Internet from Twitter to Twitter. It got me thinking though, what steps can we take to be more professional? Professionalism starts before you punch in. One of the things that TheRoadDoctor and I agree on is that like it or not, the public is watching us, and our appearance definitely shapes the opinion that colleagues and the general public has of us. The first thing that every provider in the industry can do to take a step towards being more professional is simply stopping in front of that mirror before walking out the door. How does that uniform shirt you’re wearing look? How are your boots and shoelaces doing? Is it time for a relacing or a polish? Guys, are you up to your department’s grooming standards? Girls, how’s that hair look? Next, grab a quick breakfast. Don’t rely on that early morning *Insert greasy breakfast sandwich of your choice.* Go in on a full stomach. Its rather refreshing. Finally, be on time. Walk up to that time clock when you’re supposed to, or even better, early. Tardiness is a huge pet peeve of mine. I’m ready to go when I’m supposed to be, and lets face it,...

There is no higher liability situation for a Paramedic or EMT than a patient who does not want your treatment. Nationally, on average, approximately 20-25% of all 911 Ambulance calls result in a non-transport, so refusal scenarios are encountered frequently. Determining orientation to person, place, and time is one thing, but feeling confident that leaving a patient is in their best interest is something completely different. My old Medical Director used to tell us, “I would rather have you take someone to the hospital, even if they disagree with your decision and find nothing wrong, than to let them stay home, and get worse, or even die.” Some cases are pretty cut and dry. The patient understands the potential consequences of their actions, which may or may not include death or permanent disability. Others, like the incidents listed below, aren’t quite to black and white. Take a look at these three unique cases in which a patient was refusing treatment and tell me what you would have done. . . Case #1 — The Overdose We are called for the 30 year old possibly not breathing, with CPR instructions being given. Upon arrival, we find a 30 year old male, with a pulse and a respiratory rate of 4. Family was doing CPR upon arrival. Upon further assessment of the patient, we find his pupils to be pinpoint. Family is stating that they found him like this in the presence of a needle and heroin. The Medics on scene go down the usual treatment route: assisted ventilation, and the establishment of an IV. They decide at this point that they want to get their patient conscious, so they give him an initial dose of 0.8 mg of Narcan. After about two minutes, there is a minimal response from the patient. He is still unconscious, and his respiratory rate is not significantly improved. The lead medic makes the decision to give the patient another 1.2 mg of Narcan, bringing our total dose of Narcan administered to a whopping 2 mg. The patient then regains consciousness. While grateful for the treatment the patient has received, the patient and his family who was previously doing CPR on...

Many of us in the EMS community were shocked this morning when we woke up and read the News Headline about the Bucks County, PA Paramedic who was killed by a Psych Patient he was chasing after. I found out about it from my new friends on Twitter. My thoughts and prayers go out to his wife and children who are now left fatherless. So I went to work today, just like any other day, in my mid-sized far-from-safe American City. It was quite the typical day for the most part: MVA’s, a nice mix of medical, trauma and behavioral calls, busy ERs.. I’m sure many of you know how it goes. But one call stood out to me as soon as I was advised about it. One of my crews had responded to an address for an unknown, which turned out to be a suicidal male. When they arrived, they found a rather irate man in a domestic dispute with is girlfriend. He had taken a handful of pills in an attempt to harm himself. When one of my medics advised him that he had lost any option by his actions of staying at home, and was going to have to take a ride to the ER, he got even more upset, and pulled a knife on my crew. Somehow, the two Medics were able to get it away from him. At this point, they called on the air, and requested that the police department expedite their response. That is when I found out about it. They then stated that the patient was fleeing the scene, and gave out his description. The scenario played over in my head, based on what I had read earlier in the morning. What was going to happen next? My first concern was the safety of my Medics, and making sure they stay safe. I arrived on scene moments before the police department, thankfully to find both medics standing on the front step of the patient’s apartment building, both unharmed. They showed me his weapon of choice: a kitchen knife with a half broken off handle. The patient’s girlfriend then pointed out that he was returning to the...