O'Dark-Thirty

One of my greatest skills comes from being a Mom whose kids didn't sleep as babies.
Seriously.
The oldest didn't sleep through the night until he was two.

I'm a sleep expert.
I can fall asleep anywhere, anytime. Instantly. No problem. Standing up, even.
I have the opposite end covered as well, also from having kids.
I can wake up instantly. From sleep to alert in zero seconds.

Both of these skills are good to have in EMS.
And most of the time, I'm right there, good to go.

But once in a while.... not so much.

Once in a while the pager goes off right as I'm reaching that deepest part of sleep, and although I "wake up" as far as "not sleeping anymore," I don't really wake up quite so fast.  I can tell when this happens because my typical planned and staged getting-out-the-door routine changes somewhat.

Usually, it works like this:
Pager goes off.
Before the tones are finished, before the dispatcher even starts talking, I'm up, and getting ready.
I keep everything I need staged in very specific locations, so I don't have to look for anything in the dark.
Bra, shirt, pants. Socks and boots.
Grab my wallet, cell phone and put on my watch.
Call out to my kids to see if anyone else is coming with me, to make sure they are getting up and out, which they usually are.
Grab the keys, out the door, turn the lights on in the car remotely so I can see the damned thing in the dark, hop in, start it up, and by that time, the other two are piling in the other doors, and off we go.
We can go from first tone to arrival at the station in about 2 1/2 minutes.
Choreographed, we are.
Most times, I can even fit in a quick bathroom break before the dispatcher is done talking.

Then there are those "special" nights.

Tones go off.
I wonder what that sound is. Is it an alarm clock? No, I don't use one. Is the dog making some sort of strange noise? No. What the hell beeps like that?
Oh. The pager.
I wonder if the call is for us? Maybe it's not. Maybe I can go back to sleep.
Oh, right! It has to be, or it wouldn't go off!
Stumble out of bed... damn, it's dark in here.
Where the hell are my pants?
Does the bra go on first, or the shirt?
Is this inside out?
Is anyone else coming? Hello?  Yes, there's a call, what do you mean, you didn't hear the pager?
The dog, the cats, everyone is awake now, can't help but be, what with all the stumbling and tripping and running into walls going on up here. The neighbors are probably up by now, thanks to all the noise.
Hurry up!
Crap, it's cold out here.
Wouldn't you know it, it has to be NOW that there is ice on the freakin' windshield!
Scrape, scrape, scrape... damn. Only made a tiny hole. It will have to do.
Off we go, down the road, thankfully the short, straight distance to the station, with the windows open so we can see to the sides, peeking through that tiny clear spot, trying to stay on the road.
We get to the station, and I realize I didn't grab my watch.
Into the rescue, and THEN, I actually wake up.

Surely we are not the only ones to have this experience?

It can be a "Keystone EMTs" comedy here some nights.

Take Note

 I like taking notes.
Writing things down helps me to remember them more than just reading them, or listening to them. I don't necessarily go back and READ my notes, but I write a lot of them.

During the past few years, starting with my EMT-B class (the first formal class I had taken in quite some time), I've developed a method of note-taking that I find to be the most helpful.

I write down things that are easily listed.
I write down anything I'm not sure I'll remember.
I write down things that a person might highlight in a book, if they were the highlighting sort of person, which I'm definitely NOT. I don't write in books. Period.

Those are the obvious things.
The thing I do that I haven't seen other people do is to add notes in the margins.
I specifically draw attention to anything that I want to look up at home.  This might be a website that is mentioned, or an organization, or some medical thing I want to know more about. It might be something that comes up in class that is related to specific patients I've had, or still have, in the case of repeat customers.

That way, when I get home, I don't have to reread the entire thing. I only have to look down the margin to pick out all the things I wanted to do more research on. It has worked out pretty well.

A few months ago, I came across another opportunity for my proclivity for note taking.

When I returned home from EMS Today, I went to their website to see if I could find out when they'd have information posted about next year.

What I found was the motherlode for fans of note taking.
In case you aren't aware of it... you can purchase audio files for the entire conference for this year and the past couple of years, for an extremely reasonable price of $149 for an entire conference. You can purchase them individually if you like, but that ends up being much more expensive.

So I bought the set of sessions for 2010. That's something like 76 sessions of one to one and a half hours each, for $149.
WAY less expensive than going there!!

Of course, there are benefits of going. Meaning audio files can't possibly be as good as actually being there, in some ways. You can't see anything they hand out or project onto a screen. You can't interact, or ask questions.

But you can do what I've decided to do with all of them.

Take notes.
LOTS of notes.
And if the speaker is going too fast... I can pause it and catch up. Or listen to parts of it over again.

I also can look things up in the middle of the presentation, instead of needing to wait until I get back to my computer. I love this. I have roughly 85 hours of audio. And so far, everything I've listened to, I've learned something.

I highly recommend it.

I purchased 2010 because I didn't attend it, but I plan to go back and purchase 2011 as well. I went to some great sessions, and would love to have the audio from them in order to keep things fresh in my mind.

And then I'll get 2009.

In addition to focused listening while taking notes, I can re-listen to things anywhere I like. In the car. In waiting rooms. In the freaking shower, for that matter.

Yeah. I know. I need to do some things that aren't EMS-related. And I do. But I also have a higher need than most to create my own opportunities for continuing education.  And this is a fabulous one.

Plus... I can share it. There are three of us in this house who are interested. Makes for some odd dinner conversation, that's for sure.

Dispatch Follies

Here we are, almost to the end of the month, and I've kept up with the NaBloPoMo thing. Not only that, but a few folks have even stopped by to read, thanks to Michael over at Rescuing Providence. Word has it he has a new book coming out next week, so be sure to stop by his blog and order a copy or two. I can't wait to see it!

Today as I was wandering the web, my attention was brought to this post over at Unit Calling Central. It's about dispatchers.

I love our dispatchers. Really I do.
Mostly.
But  I have to admit that sometimes, things happen that are pretty funny, and other times, things happen that aren't so funny at all. I like to think that I'm fairly open minded, and give credit where it is due, so I'm not saying that everything is the fault of the dispatcher. Unit Calling had some great suggestions for the general public; I'd like to add a couple of suggestions for the dispatchers.

The best part, by far, of what we've come to call the dispatcher follies is the things they say sometimes that clearly didn't come from any training manual. Like describing a patient as "wigging out." Or the time we heard an ambulance sent to an "eight month old pregnant lady." I'm okay with these, most of the time. They amuse me, and aren't hurting anyone or delaying care.

Also slightly amusing are times when things get a little mixed up, with slips of the tongue misidentifying people and places, but I can't list any here that would make sense to anyone without a lot of explanation about what makes them funny. These also don't usually cause any problems, and are just funny.

And then there are the things that aren't so amusing.
Like calls where we are sent to locations miles from where the incident actually is. As mentioned in the post that got me thinking about this today, this one usually isn't the fault of the dispatcher, it's because people don't know where they are, and/or can't be bothered to stop. The dispatcher can't see through the phone to be able to confirm the location really is where the person says they are.

Likewise, calls where what the dispatcher says is happening, and what is actually happening, bear little to no resemblance to each other, are often because the dispatcher can only go by what they are told, and sometimes the patient, or the family member or bystander, really don't know what is going on. I can't blame anyone for that one, except to wish that people, in general, had more understanding of things and a knowledge of basic first aid.

That leaves the two issues I have with dispatchers that I really do think could be improved.  One, by having better SOPs, and the other, by better training.

Now that Radio Reference exists, I don't need an expensive scanner in order to be able to listen in on the radio system. I can listen online, and I often do. It is interesting how quickly I adapted to it and can have it on in the background, and then perk up instantly when something gets my attention. Did you know that even when radio communications are so garbled that you can't understand a word, the rhythm of "mayday, mayday, mayday" still comes through, clear as a bell? Likewise, a cop in a jam calling for backup is pretty recognizable as "out of the ordinary" sounding. But mostly, it's any mention of my tiny town that catches my ear.

What that translates to is that we often hear radio chatter about calls out here before we get toned out, especially if there is going to be law enforcement involvement. The cops nearly always get told first. I'm okay with that. But what really bothers me is this: the cops get told a LOT more information that we do. They go into the situation having some idea what is going on, most of the time. We get an address, and told to stage. They don't bother telling us about the knife, or the threats, or whatever.

WTF? Why would they do that? It makes me crazy, whether it's for one of our calls, or any of the other agencies in the county. I've been known to swear at the scanner/computer, when I know a friend of mine has just been sent into a situation without all the available information. TELL THEM ABOUT THE GUN, ALREADY!  Sometimes, once we are in the rescue, we can radio and ask for any further information, but what about people who go directly to the scene? They don't have radios, and I swear it often feels like the dispatchers forget that. Why they somehow think that only the chiefs need certain information, I will never understand, especially because most of the time, our chiefs don't show up at EMS calls. They don't need the information at all. WE do.

The other dispatcher error that has elicited a variety of colorful language is when they send the wrong rescue to a call. Our tiny department has a sister tiny department. The names of the two departments are similar. The main roads through the two towns have similar (but not identical) names as well. For some reason, there is one dispatcher in particular who can't seem to get it that they are two DIFFERENT places. The whole reason there are two is because between us is only dirt roads and steep hills. Try flying over those in the winter. Some of the time, we can't get over there, and they can't get over here.

And yet.
We'll get toned and told to go to a location clearly in their response area.
Or they will get toned to go to a call across the street from my house.
I've lost count of the number of times I've called dispatch in the middle of the night to tell them it's not our call, and to please tone the correct department.

I think this one would be best solved during a blinding snow storm. Bring that dispatcher out here to our station, and make them drive to the other one. I think that would make it clear that it's pretty important which one is sent to a call.

So those are my suggestions to dispatch.
1. Please give us all the available pertinent information. The presence of weapons is pertinent. And by "us," I mean the people who are responding, not just the officers. I'm pretty sure you must be at least beginning to notice that it is nearly always the same people responding- and it's not the chiefs. Maybe that isn't the typical situation everywhere- but it is, here.
2. Please learn where things are in the county. It matters, and it's not that big. Add something to your training that pays particular attention to the various places that have similar names, and even more to the instances of the SAME names in different locations. I can give you a list of the most frequently confused, if you like. If I know them... why don't you?

I'll close by adding that I've also heard our dispatchers keep their cool in some pretty hairy, stressful situations. They work together well, and I'm glad we have them. My suggestions are in no way meant to suggest that they aren't professional; they are. But everyone, everywhere, has room for improvement, and often, if you don't bring something to their attention, they may not realize there is an issue.

ps. Do keep saying the occasional really funny off-the-script things. Sometimes, it's just the laugh I need.

Old Folks

When I was about 8 to when I was 11, one of my best friends was the elderly lady who lived next door.  She was a widow, and lived alone, her grown children having long since moved away, and I don't believe I ever met one of them. She was my adopted grandmother, in many ways, especially since I had no contact with my own extended family.

I spent a lot of time at her house.  We had tea together, we weeded her garden, and we watched TV together some evenings. She loved "Truth or Consequences" and "What's My Line?" and would tell me to "hush" when I wanted to ask questions. She loved to talk to me about her late husband, who had been a firefighter for the city, and she was the one who explained to me what the numbered signals meant when the fire horns went off. She still had a chart in her basement showing the location and designation of every pull box.

When I was 11, either she or her family decided that staying in her house was too much for her to keep up, so her house was sold, and she moved into a senior citizen's apartment building. I only saw her twice after that.

That was the sum total of my experience with older people growing up. Both my parents had become estranged from their families, and I grew up not knowing my grandparents, my aunts and uncles, or my many cousins.

As many young people do, I pretty much saw the elderly as... well... old. Distant. Set in their ways. Often cranky, and maybe even a little difficult to deal with.  The woman I knew, of course, was an exception, I was sure, but based on everything else I knew about "old people," be it from books or television or from lumping nearly all politicians in that category, getting older was not something I looked forward to. I mean, who wanted to have to shuffle around, or have gray hair, or end up in a nursing home where no one would ever visit you, ever? Who wanted to get so out of touch with the new, the exciting, all the things that young people valued?

This culture has a very strong tendency to separate people into groups near or at their own age, starting in pre-school, and continuing indefinitely.  There are some places now that do progressive things like having day care centers in retirement communities, or places where college students study geriatrics by visiting assisted living facilities. Even so, most young people don't have a lot to do with older people until they start to become one.

This has been one of the surprising benefits of becoming an EMT.

I have had the pleasure to meet some incredible older people, and in doing so, have learned that "old age" is not exactly what I thought when I was a kid.

For one thing, that line delineating where "old" starts has gotten significantly older, as it has gotten closer. I swear I still feel like a teenager most days. Except maybe trying to get out of bed in the morning.

I've also learned that "old" isn't a chronological age, at all. I've met people in their forties who are clearly old- and people over 100 who are clearly not. I've met younger folks with the physical condition of a person twice their age, and I've met people with a variety of physical ailments who go on living their lives as if there isn't a thing wrong, refusing to let it get them down.

I've had the honor of listening to stories of days gone by, including the history of our town.

I've met couples who have been married for far longer than I've been alive- and I'm no spring chicken. I've seen the way they care for each other, the comfort and ease of knowing each other's thoughts and needs.

I've met older women who are soft and sweet, gentle and ladylike, and I've met some who are as tough as nails and not afraid to let you know it.

Even those who are struggling with memory loss, or some other ailment, often have a sense of dignity and a courteous way of interacting with people that modern life often seems to be missing.

Mostly, what I've learned is this:
"old age" isn't necessarily so bad. If I should be so fortunate as to live as long as some of these people I've been able to meet, I hope I age with the grace that they have. There are some pretty terrific older folks out there, who laugh often, love deeply, and still have inside them that child full of wonder that they started out with.

Learning that is one heck of a gift, for which I am truly grateful!

Making the Connection

Way back in the long time ago, before I was an EMT, I started going to EMS calls because I wanted to start learning before I started my Basic class. I did a lot of watching, and a lot of carrying, and a lot of paying attention.

One of the things I paid attention to was the different medics from the ambulance company.  Even when I didn't know much about the medical part, I already had preferences for some of the medics over others. Some had great people skills. Some were very thorough. Some just made me feel like they knew what they were doing. (And a couple of them were in all of those categories!)

As an aside, later on, when I started my Intermediate class, on the first day the instructor asked us to consider who our "favorite medics" were. She said to hang onto that thought, and to see if we still had the same opinion at the end of the class. She asserted that most people would change their minds, once they had a better idea of what makes a good medic, and had better reasons for choosing a favorite.  I didn't change my mind. My favorites then are still my favorites now, and for the same reasons.

Anyhow.

My first opportunity to work with any of the medics came during my ride time for the Basic class. Two shifts. Not very many calls. But it felt good, and right, and I appreciated every minute of it. I am fortunate to live in a place where the transporting ambulance company is excellent, top to bottom, a professional, class organization. And it shows.

It was right before then, I think, that something odd started happening.
At the firehouse, whenever the topic of the ambulance came up, some of the people would make disparaging remarks. At first, it was along the lines of "you know how they are" and comments about them being difficult to work with. This was completely outside my experience, and was very confusing.

This went on after my then-partner and I became EMTs, and we discussed it more than once. What the heck? What were these people talking about? We had NEVER had any problem with the ambulance crews. Ever. We had nothing but respect for them.

As time went on, we started hearing more specific comments.
Things like "they just ignore the EMTs."  (Not that we had ever seen.)
Or "they take over the scene." (Well... that's what they are supposed to do, isn't it?)
Or "they think they know more." (No argument there. They DO know more.)

We started speaking up, whenever someone complained about the ambulance, and made a point of saying we had not had any bad experiences at all. As far as we were concerned, they were great, and we not only didn't have a problem with them, we were starting to be friends with many of them.

It was, for a while, a great mystery.
I love a good mystery.
Sometimes.
But not always. And this was in the "not loving it" category, largely because it made no sense as far as I was concerned, and also because it felt like people were being rude about people I was starting to consider friends.

So we asked.
Why does everyone say these things?
All we got out of the people making the remarks was a repeat of some of the comments, and some suggestion that "something happened" at some point that led to hard feelings. But no one wanted to tell us what it was.
We finally got the story, or at least part of it, out of a couple of the medics quite a while later. It turned out to be some territorial thing, the kind of which I have no understanding of whatsoever.

That was when we figured out why WE never had a problem.
And it was simple, obvious, and I can't imagine why anyone would ever NOT do what we did.

Right from my first ride, when the medic asked what I hoped to learn, one of the things I mentioned was that I wanted to know what WE could do, out here in the boonies, to make things go as smoothly as possible, and to improve patient care. We had started to hear grumblings about having "problems" and we didn't want to have any. We wanted to work well with the ambulance crews. Isn't that the point? To work together, to provide optimal patient care?

Through what I was told on that first ride, and experiences since then, we came up with a list, of sorts. A plan.

1. Do our job as well as possible. Train, and practice, and get as efficient as we can. The more we can do before the ambulance arrives, the easier it will be for them to continue care, and the quicker the patient will get what and where they need. We are the information-gatherers. We are the first eyes on the scene. If we do our job well, the patients condition will already be improving by the time the ambulance arrives, and we will have great documentation of everything we have seen and done.

2. Provide a patient update to the ambulance before they arrive, whenever possible.

3. Have someone "receive" the ambulance, meeting them, guiding them to the patient, letting them know what, if any special equipment they will need.  Stair chair? Extra large patient? Any unusual conditions?

4. Practice, and become excellent at, patient care transfer. Be able to put the information into a "bullet" and communicate it quickly and succinctly. Learn how to tell WHO to transfer care TO. Don't transfer care to the rider, instead of the medic! Make the transfer as smooth as possible for everyone, including the patient.

5. Once the medic takes charge, get the hell out of the way. This doesn't mean to go away, necessarily, it means to understand that the patient is their patient now. Their patient; their scene. Our role switches immediately to "anything the medics need in order to provide optimal care." It might mean holding things, setting things up, or moving things out of the way. It often means helping move the patient, helping with the stretcher, and/or carrying their gear out of the house. Learn where their gear goes. Learn how to close and put away the stair chair.

6. Continue that assisting role as long as necessary. Sometimes that means hopping into the rig and pulling out equipment to hand to them as needed. Sometimes it means riding to the ER, giving compressions or bagging the whole way. Sometimes it means providing more information. Whatever it means: do it.

7. Continue the relationship outside calls. Get to know them as people. Whenever possible, hang out with them in social settings.  Around here, we have a chance to hang out some at local festivals, where the ambulance company has a tent set up, but not a lot of work to do. We've worked alongside them at festivals as well, providing EMS coverage at large events. We take them cookies at Christmas. I'm friends with many of them on facebook, and keep in touch that way. The more connected we are, the better we'll work together- and that means better care for our patients.

I think we have a great relationship with the ambulance company, from the newest Basics as we get to know them, to our interactions with the medics, the supervisors, and even the owner of the company (who maintains his certification and goes out into the field sometimes). I still have favorites, but I have confidence in even the ones I know the least. They treat us very well on scenes, and seem happy to see us wherever we run into them, even at the grocery store.

I wouldn't want it any other way.

Except for one possible change... at some point, I want to work there, too. :-)

EMS and Social Media: What's it All About?

Having mentioned yesterday that I am grateful for people I can ask when I have questions, today seems like the perfect time to write the post maddog wants me to write.

What is the point of using social media?
Not just tweeting with friends, or posting memes on facebook, but what is the benefit, if any, to EMS?

For me, it is a combination of a number of things.

I started blogging a few years back, before I knew there was such a thing as an "EMS blog." I was writing about other aspects of my life, mostly for myself.

After a while, I started looking for interesting blogs to read, and I don't remember exactly how it happened, but I stumbled across some EMS blogs. I must have been lucky, I guess, because the first few I found were excellent, and led me to others. The first one I remember finding was AD's blog, but the first one I went back and read through every post was maddog's.  Through them I found epijunky and Happy Medic and a bunch of others.  I kept wandering from blog to blog, finding some that were interesting enough to check back once in a while, and others that ended up disappearing. I found a couple of my very favorites: Rescuing Providence and Unlimited-Unscheduled Hours.

It was a whole new world for me.
People, out there, who knew a lot more than I did, had years and years more experience, and were interested in sharing.
I read about calls I'm relatively unlikely ever to see.
I read about calls that I'm VERY likely to see.
I read about mistakes made, and ways to correct or avoid them.
I read training tips and suggestions.
I read stories that touched my heart and some that froze my blood.

I found people who felt like we're on the same team. Folks out there trying to do the right thing, the right way, who understand the importance of caring for people, not just doing procedures.

I realized somewhere along the way how very important they all are to me.

When I went to EMS Today in Baltimore earlier this year, I was able to meet several of them in person, and to meet others I hadn't been aware of. A community. I felt welcome, and valued, and validated in ways I do NOT feel here. They reinvigorated me, and gave me hope. Having people out there who are willing and able to reach out and help, or even just to talk to,  is an extremely valuable- perhaps vital- resource.  I have met even more of my favorite bloggers in person now, either at conferences, or simply because we wanted to meet and are close enough to manage a day trip.

Not only did I find a community of like-minded people, I also found a wealth of online training resources. Ranging from individual blogs, to sites dedicated to online training, I found somewhere to GO when I needed to know more about some medical situation. There are free online training materials, a couple of excellent inexpensive paid online training centers, a fabulous online magazine, and behind those, real people to talk to. I found more training than I could ever possibly take advantage of. It is a complete mystery to me how any organization could EVER not have quality training, since I am tripping over it on a daily basis, on blogs, on websites, on facebook, and coming to my e-mail in-box.

And that doesn't even count finding out online about various nearby in-person hands-on training. In addition to EMS Today, I've found out about and attended training anywhere from 50-200 miles away, and almost all of it was provided for FREE, and taught by excellent, highly skilled and fairly well known instructors.

For the most part, my experience with EMS social media has been extraordinarily positive, and has made it possible for me to expand my knowledge base and continue to increase my skill level, in ways that simply are not possible where I am. It has allowed me to feel connected to something, to feel not so entirely alone. If I were "in charge" I'd work to see that more EMS providers connect with this online network of people and resources, increasing the benefits to everyone involved. I try to do that, anyway, but I'd love to see more people in positions of authority recognize the value of what is happening in the EMS social media world, and to see them promote it instead of being afraid of what they don't understand.  For that, we either need newer, more internet-comfortable people in positions of authority, or those who are there now need to educate themselves on this. It is inexcusable to simply ignore this incredible resource.

Thanksgiving

Here it is, that day that most Americans celebrate as Thanksgiving.
Full of overeating and family "togetherness," no doubt.

I don't usually celebrate on this day. My kids and I celebrate Canadian Thanksgiving, for a variety of reasons, so our celebration happened several weeks ago.

It doesn't mean we aren't thankful today.

To "celebrate," I offer a list of things I'm thankful for at the moment. In no particular order.

1. Kittens.
2. People I can ask when I need to know something.
3. Wind and rain... where wind and rain belong.
4. Family.
5. Time.
6. The opportunity to do what I believe in, and to keep learning, every day.
7. The truth.
8. My dog, who never lies to me and is always glad to see me.

I hope everyone out there has the chance to feel thankful today, and every day.

What to do?

Year ago (I'm not saying how many!) when I was a teenager, I had a doctor's appointment where something happened that I will likely never forget. I was reminded of it recently.

At that appointment, I was instructed to undress and put on a gown. The nurse left the room while I did so. Then, she came back, and at some point, the doctor came in, and did the exam. The doctor left. The nurse left.

And there I sat.
What was I supposed to do now? Were they done? Was I waiting for something more?
I didn't know. No one had told me what I was supposed to do.
So I waited.
And waited.
And waited.
Naked, except for a gown.
Cold and alone.
I was 16.

Eventually, after about an hour or so, a nurse came in the door, and was shocked to see me there.
THEN, and only then, she told me that she thought I had left an hour before, that I SHOULD HAVE left.

No one ever told me they were finished and I should dress and leave. Not one word.
They just walked out the door and left me there.
How was I supposed to know what to do?

We had a call recently with a lovely, sweet elderly lady.
She was very cooperative, if a little confused.
Happy to do whatever I asked.
She gave me her wrist so I could take her pulse.
Held up her arm for the blood pressure cuff.
Smiled for me.
Held out both arms.
She couldn't have been more pleasant to work with or to be around.

The interesting part, though, was that she did ONLY what I asked.
It didn't occur to her to put her arms down, or to relax her arm once the blood pressure cuff was on it.
I needed to ask her to do the things I needed her to do, and then tell her when to STOP doing those things. She needed both.

It's a simple thing, but it's so important.
People, especially people who are not feeling well, who may be scared, or confused, and who suddenly have a houseful of strangers, can't be expected to know what we want them to do, how and when. We need to tell them, and not leave any of it to chance, or assume they'll just know. They may not.

It's not fair to expect more of them than they are capable of, and it's not fair to leave them hanging (sometimes literally!)  while discussing things with a partner, or even while getting information from the patient herself.

So now, I have another thing to add to my presence, in addition to introducing myself and the medics.
Now, I ask my patient to do the things I need from them, and then I remember to thank them for doing so, and to let them know when they can stop, when they can relax. Since part of my goal is to help them be as comfortable as possible, this can be an important part of it.

Lucky, I guess

So I'm doing this NaBloPoMo thing, partly because I just don't have it in me to write a novel in a month but I'm a little jealous of friends who do, and partly to see if it jumpstarts this blog into something more interesting and useful.

The website that is sponsoring the month (offering prizes!) also posts a "writing prompt" every day. So far, I haven't bothered with them. The few I've seen haven't really been useful here.  But today's is different. It's about luck. It asks "What is the luckiest thing that has ever happened to you?"

First, I'm not sure I believe in luck. As they say, the only sure thing about luck is that it runs out. I'd far rather rely on skill, on planning, or even on courage, than on luck.

That said, some things have happened that could be seen as "lucky" if you want to swing that way.

Like the MVA that happened just after we had canceled the ambulance because our patient signed off. That meant that the ambulance- our ALS backup- was less than a minute away, instead of at least twenty. We were within sight of the crash. Not that the MVA was the lucky part, by any means, but if it had to happen, they sure picked a good time, as far as getting help.

Or the several times that we've been toned for something while already in the car, almost at the incident location. For some reason, we've gotten several calls while I'm on my way home, just before the intersection I need to turn at to go directly to the scene. I've heard more than one comment about how they couldn't figure out how I got there so quickly.

Likewise, getting toned after taking food out of the oven, rather than in the middle of baking something.

Or calls during a break in the weather instead of at the worst of it.
Oh, wait. I made that one up. Wishful thinking!

Seriously, if I were to write about the "luckiest thing that ever happened to me" as it relates to EMS, it has to be that I'm in a position to be doing this at all. I've wanted to be an EMT since way back in "Emergency!" days, like so many others, and after heading several other directions, and raising a family, I've been fortunate indeed to be able to do that thing I've always wanted to do.

Not everyone gets that chance- and many who do, don't take it.

Who Put the Pepper in the Pot?

Wow. No hits yesterday. Zero. I guess I'm talking to myself here.
I'm still 21 for 21 for the NaBloPoMo attempt to write every day. We'll see if the habit sticks.

Now for the actual post of the day...

Current events being what they are, I'm reminded of some training that I first asked for a while back.

We had a call where, on our arrival, the patient had been pepper sprayed and was handcuffed and on the ground, screaming.

I'm not going to go into detail about how our patent ended up in that predicament partly because I was not there to witness it, and partly because it would take too long to write about all the problems I HAVE witnessed at scenes, including that scene in particular. Let's just say that some people need more training, especially in dealing with anyone considered to have "mental health issues," including training in de-escalation and in just plain not treating people like crap.

So anyhow.
It's cold out, with snow on the ground. The patient is on the ground, barefoot, in shorts and short sleeves, handcuffed, screaming about both pain from the pepper spray, and about being freezing.

At the time, we had very little experience with such a scene.
As in none.
We were in the proverbial "ink not yet dry on the card" position.

We were told by the cops not to treat the patient. We got a blanket anyway, but it was never given to the patient. We were specifically told not to do anything about the pepper spray in order to keep the patient "more compliant."
The transporting ambulance arrived and was told the same thing.

Before we even left the scene, I was asking for training in this topic. Several topics, really. I was very upset about how the patient was treated (and not treated) and had no information at all to go on.

1. How much authority do cops have on scene, if we are called there? Can they keep us from accessing a patient?  They DID, but can they legally do so? The patient was no threat to anyone. What rights does the patient have, and what rights and responsibilities do we have? What can we do? Both for the patient at the time, and in a case of cops overstepping their authority.

2. We have not been taught anything about how to deal with any of the weapons or techniques the cops use to "control" a person. I had to look up what to do about pepper spray (and didn't find anything I could be sure was valid) and we have no protocols at all. What if they had used tasers? What do we need to know about that? What else do they have, or are they trained to do?

As I said at the start, current events being what they are, the need for this training is more urgent.
I wish there was a class where we could go over all the things that might happen to a person who is either resisting arrest, mentally ill, or, apparently these days, peacefully protesting, and what role EMS should or could play in such an event.
My personal perspective is that we should be there to treat any ill or injured person, and I don't really care what someone's politics are.  I would like to know how best to provide that care.

So far, my requests for such training have been ignored.
I don't know that there is anyone out there offering this particular training.
If there is, I'd love to know about it.

Seasons

Here we are, opening day of hunting season. The "regular season," that is.  Bow season started a while ago.

It reminds me of the seasons around here.

Today marks the change from "falling out of a tree stand" season to the beginning of "accidental gunshot wound" season. "Lost in the woods" straddles both seasons, as does "the deer are spooked and likely to run into the road" season.

It's the time of year to brush up on bleeding control (and to wish, AGAIN, that we had tourniquets) and shock. The time of year to keep good boots handy, and to know what areas hunters favor. To hope for people to take care in the woods during the day, and not shoot each other, and to take even more care driving home at night.

From the fire side, it's chimney fire season, as well as "inappropriate heating method" season.

We are fast closing in on candle and "Christmas tree lights malfunctioned" season, which will likely be closely connected to "shoveling too much snow" season, whether it's the "with a back back" or "with heart trouble" version.


You'd think the department would schedule training to coordinate with the seasons, but they don't.

I do, though.
I keep track of both "what is particularly likely to happen this time of year" and "the basics that could happen anytime" to guide my personal training/practice plan.

And then I hope I won't need it.

Happy's Pizza Box

Only time for a short post this morning.  Spending most of the day at a memorial for our friend.

I saw this post from Happy Medic yesterday. Go read it.  I love it!
(Edit on 11/24- apparently, he removed that post. Bummer.)


It's little things, little "tricks of the trade" that make it so much easier to remember things, and make it easier to connect with patients, too.

Just because a medical emergency is a serious thing, doesn't mean everything we do has to be dry and boring.  Sometimes, a little humor can be just the thing.

Like the time I saw a medic tell an elderly woman that he had x-ray vision, and that's how he knew she needed to go to the hospital.

Or the medic I know who always helps little old ladies up by asking them to dance with him.

People skills are so important.
I'll steal your pizza box technique, Happy.
I wish I could follow you around and absorb your "happy-ness."

Stress Relief

We've been having a stressful time here lately.
Lost a friend, suddenly and far too young, a few weeks ago.
Then lost another a few days ago, this time with a few days warning, but still far too soon.
And to top it off, that same night, we came home to one of our cats dying.

Add to this the typical financial stress, time stress, relationship stresses, and a variety of other stressors, and it all adds up to a potentially explosive combination.

Except what usually happens is it adds up to people being demotivated, depressed and unable to get anything done... which adds more stress.

I thought I'd devote a little space and time here today to talk about stress relief.
Not that this is a topic that I am particularly good at.

Most of the advice I get has to do with "pamper yourself a little," which sounds great, except I don't know what that really MEANS. Most of the things people suggest in that category (dinner out, a massage, a glass of wine, a long bath with aromatherapy candles, etc.) I either can't afford, or have no interest in. And most take time, which is one of the things not in abundance here.

So I need quick, inexpensive little things I can do, or think about, that relieve stress.
And generally, they need to be things I can do by myself, either because I don't have anyone to do things with, or because what I need is some private time.

Here is my current list of most typical things I do to attempt to relieve stress.

1. Sleep. Take a nap.  It tends to help, for several reasons. One is it can get my mind off whatever one-track stress path it is focusing on. It can create a time separation between whatever triggered the stress, and... later. And sometimes, I just need more sleep.

2. Read. Sometimes, some "guilty pleasure" novel is just the thing.

3. Write. This can take several forms, from blogging to journaling to focusing on other things I need to write. Blogging when I want a more publicly-available forum, journaling when it's no one else's business, and I just need to write some stuff out to help myself focus, or just to get it OUT.

4. Cook. This works for me because I enjoy cooking. This time of year, it also helps because I enjoy not being cold, and cooking or baking something will heat up the kitchen and the surrounding areas.

5. Go outside.  This one, it depends on the weather, and on my particular mood.  There are some outdoor places that I love, that can be very stress relieving.  But some days, if it's too hot, or too cold or too buggy, it is less appealing. I know a lot of people for whom that would sound ridiculous, because they are outdoor people who enjoy all kinds f weather and aren't inhibited by even the worst of it- but I'm apparently not one of them.

6. Help someone else. Not only can it get my mind off my own problems, it usually is enjoyable, in its own right.

7. Make something. Creation is powerful. Knit, crochet, build, paint, whatever.

8. Work out. Strength training is very meditational. Walking can be. Running... I hear it is for some people, but not for me.

I'm sure there are more, but those are what immediately came to mind. I'd keep going, but a thousand things are calling for my attention, I need to get ready to go to work, and I have to pay the bills before I go, etc.

What Are the Chances?

If you went into cardiac arrest, right now, what are the chances that you'd survive?

I did some research, came up with a bunch of statistics and websites and stuff, but I've decided not to use them or link to them. It isn't the specific numbers that are important here. None of those percentages matter to individuals. What matters to YOU is your specific situation.

I first learned CPR when I was about 8 years old.
I have re-certified many times since then, going through probably every version of CPR that has been taught at least once.

It seems to me that CPR is a skill everyone would want to have. Who doesn't want to possibly save a life? Or, more importantly, who would want to have to stand there, not knowing what to do, when something so simple might help save a life?  Wouldn't that feel terrible?!?

But as it turns out, it apparently ISN'T something that everyone, or most people want to know.

I did an informal survey of a group of students.
NONE of them said they knew how to do CPR.
NONE. ZERO.
These were college students.
About 40% said that they had taken a CPR class at some point in their lives, but had forgotten how to do it, and weren't certified anymore.
When I said I wasn't interested in current certification, I just wanted to know who would know what to do, none of them thought they would. Not one.

One student said that "the problem" is that while everyone is taught CPR in high school, they have no opportunity to practice it in their daily lives, so they forget how.

It depends on your daily life, I think. :-)

But wait... where is EVERYONE taught CPR in high school?
Not around here.
I have heard of some places, but I would guess that there are far fewer schools that teach it than there are who don't.
I think it would be great if everyone was taught CPR in high school. Or middle school. Or even elementary school.

The local University requires students to pass a swimming test in order to graduate.
I think they should replace that with requiring CPR certification.

The average person- who does not know CPR- has no understanding whatsoever of how important it is to begin CPR as soon as possible, preferably immediately. They are caught up in that fantasy of heroes coming to rescue people, and don't understand that time is SO not on our side in this. The best chance someone is going to get is if someone sees them collapse, and starts CPR right then- far sooner than even the fastest rescue squad or ambulance could ever get there.

So back to my original question.
Where you are, right now,  how many people do you have with you who know CPR?
If you were to suddenly collapse, how long would it be before someone could start CPR?
If you have to wait for rescue to arrive, things don't look so good.
If you DO have someone right there who can start compressions, you're in luck!

Now for the next piece of the puzzle, the next link in the "Cardiac Chain of Survival."
Where is the closest AED?

Where you are, right now, is there one in the building?
If so, your chance of survival just went up.
If not...
How long will it take for one to be brought to you?
Is there one in a nearby building, that someone could run to get? Are you somewhere that the cops carry them, and can one get to you quickly? Or do you have to wait for the fire dept or ambulance?
The average person, who learns most of their medical "facts" from watching TV, may not realize that CPR alone isn't going to save people. They need defibrillation.
Great CPR can buy you some time for that AED... but most people don't perform great CPR.

If you have someone who can call 911 right away, start compressions immediately, and you have an AED right there, your chances are much better than not. If you also live where ALS care will arrive quickly, and the hospital is close, you have a better than average chance of having the possibility of survival.
If not...

If not, things don't look so good for you.
And unfortunately, most people are in this group.

Encourage everyone you know to learn CPR. Encourage your employer and other local businesses and gathering places to participate in a Public Access Defibrillation program.
When it comes down to it, what matters isn't so much what YOU know or what you can do, it's what those around you can do, and WHEN they can do it.

This is important no matter where you are.

If you are out in the middle of nowhere, where EMS is more than 4 minutes away, then it is CRITICAL that as many people as possible know CPR, and that public places have AEDs available.

You may also consider cleaning up your diet, getting on that treadmill, and praying a lot, or something.

Unfortunately for me... my personal situation is NOT the best possible. I have a few things going for me, a few more not in my favor. Most of the ones not in my favor, I can't change unless I live somewhere else.

But at least I know it.

Hello and Goodbye

In any performance, people will remember the beginning, and the ending most. First impressions, and last impressions are important.

This is no less true in many other situations.

I came across a video yesterday that I like, talking about the last things the medic in the video says to his patients. Go check it out.

I think he's right on the money.

I've mentioned before that we have developed the habit, the SOP, if you will, of introducing ourselves to the patient, and telling them "we are here to take care of you until the ambulance arrives."

Then, when we transfer care to the medic, we always introduce patient and medic to each other by name, and I tell the patient that I know these people will take good care of them.

We don't get to transfer care in the hospital, since we're non-transporting, so our situation is a little different than in the video. We are still there after the patient care transfer, and often still assist in the care for some time.  I always make sure to tell the patient goodbye and wish them well, but it isn't usually at the same time as the introduction to the medic(s).

I like the suggestion in the video of using these two phrases:

1. Is there anything else I can do for you?
and
2. It was a pleasure serving you today. (Or a pleasure meeting you.)

I have said those in some cases, but not both of them consistently.

Usually, it's "It was nice meeting you. I wish the circumstances had been better." or "It was nice to meet you; I hope your day gets better."

As for asking about anything else we can do, that's fairly common, eliciting a number of responses ranging from calling a family member or employer to making sure the cat doesn't get out or is fed and watered, or shutting off lights, and either locking or unlocking doors.

At any rate, I appreciated the reminder in the video to always do these things, that they are important. Not only does it make a good first and last impression for us, but it also helps the patient to feel cared for, and sometimes, that's what they need more than any intervention we might be able to do. Certainly, it's always an important part of our job.

The Affective Domain

Wow.
My pal maddog is about to embark on a series of blog posts that have me practically quivering in anticipation.

Go have a read.

The affective domain.
I rarely run into anyone who has any idea what that means, let alone someone who understands how important it is.

Short version:
The cognitive domain is about intellectual, academic thinking. It's about what you know.
The psychomotor domain is about physical skills. It's about what you can do.
The affective domain is about what you FEEL, and how you communicate.

LOTS of places focus on the cognitive domain. Most any college or university, or school at all, puts a huge priority on thinking. And yeah, there's a lot of stuff you need to know in order to provide good patient care.

Some places have some idea how to teach physical skills, but not as many as you might think. I've had classes where they assume telling you how to do something is enough. In order to cultivate physical skills, you have to practice. A lot.

Offhand, I can't think of anywhere that really focuses on the affective domain, that teaches people emotional skills. They might tell you that you need to have empathy- but that's all. They don't teach you how, or give you opportunities to practice. Yet this is the domain that makes such a huge difference in CARING- and after all, isn't that what we're trying to do? Take care of people?

Even more rare is somewhere that will teach TEACHERS how to teach in the affective domain. How do you connect with your students? Without an emotional connection to the material, they aren't likely to retain much. How do you make that happen? How do you evaluate emotional skills?

I'll be keeping an eye on what maddog has to say, and I hope you will, too.

Storm Coming

Storms are heading this way.
On learning this, we began our usual prep for such things.

1. What kind of storm, how big, and when? From what direction?
We watch the Weather Channel, and check radar maps online to see what's coming, and how long we have before it gets here. It's rarely exact, but it gives us some idea.  Right now, it's severe thunderstorms, and some places have tornado watches. Can't tell how much will hit us, and how much will miss, but it looks like we won't escape entirely.

2. How much danger does that present?
Comparing this "weather event" to others we've had, there appears to be some elevated risk, but probably not to disaster proportions. Enough that we need to pay attention, but not enough to be alarmed just yet.

3. What are the specific risks HERE?
Typically, the highest risks with this kind of storm are downed trees and wires, possible decreased visibility on the roads, with an increased likelihood of MVAs.

4. What do we need to brush up on?
Here is where it gets both complicated, and interesting.

For downed wires and trees, if they don't hit anything, it's mostly a matter of standing around waiting for the power company.  If they DO hit something, or start something on fire, that's a different story entirely. We need to remind ourselves what equipment we have, where it is, and what safety concerns there are involved in using it. Consider discussing plans for detours in certain areas, if the roads are blocked. Look at the local map to refresh memories of the smaller roads.

If there is any sort of building collapse, we are not prepared to handle that, so who can? Who do we call for mutual aid, and how long will it take them to get here?  It is highly unlikely that helicopters will fly, so any trauma will have to go by ground- meaning we need to really hustle and not waste any time on scene.

Likewise any MVA with traumatic injuries. No time to waste on scene.
It is possible our ALS back up, transporting agency, could be delayed, either by having no rig available, or by road conditions, so be prepared to do more than usual on our own.
Review trauma protocols.
Review spinal immobilization.
Review bleeding control, and wish we had tourniquets available. How might we improvise if necessary?

Who is in town tonight, and what skills do they have? Consider preplanning who will do what, as much as possible, not knowing what the incident might be. If conditions deteriorate, consider having people standby at the station.

Especially consider communication needs- it's not a subject we have a lot of experience or skill in out here. Verbalize everything, as much as possible.

It's going to be dark, and wet, and otherwise nasty, so remember lighting, and good boots. Don't walk into anything you can't see.

We (the small we, meaning myself and my family, not the dept in general) go over some variation of this every time there is a risk of an upcoming event that has some lead time, so we have time to brush up.

Otherwise, we try to rotate review of different subjects as we can, or seasonally.

The best example of this was the day we reviewed trauma protocols in the vehicle on the way to an incident that we already knew had no injuries- then, while we were on scene, a second incident happened, with serious injuries. I was VERY glad we had just gone over things, so it was fresh.

My ideal would be to always feel like everything is fresh in our minds. Hard to manage- but fairly simple to work towards.

You Never Know

Had an interesting day. It was the last class of a series of classes that I have been teaching.

This particular group of students has been a challenge to me. Each group always has its own "personality," and every group is different, but this group was further outside the norm than most. As if there is a norm.  I had a more difficult time than usual holding their attention, largely, I think, because the average age was younger than most groups I've taught.

About halfway through the series of classes I had to regroup, and rethink, and refine what I was teaching and how I was teaching it. A great opportunity, really.

So today, at the last class, it was time to evaluate performance.
Afterwards, I was left shaking my head.

This group did BETTER than most groups have.
If I were to assign grades (which I don't), the combined "grade point average" of this group was possibly the highest of any class I've taught.

How on earth did that happen?!?

It's partly because of all that rethinking, etc, that I had to do, in order to focus on the needs of this specific group.

But at least some of it had to do with something else.

It is not possible to see into someone else's mind, or into their heart.
This group looked like they were struggling to understand, and especially to be able to do the skills. They looked distracted and unfocused.

And yet, somehow, inside there, they were learning.

Which means that what I was interpreting as lack of interest, or lack of readiness, might have been something else.

This shouldn't have been a surprise to me, at all.
I did the same thing, notably, in calculus class in high school.
I'm sure the teacher thought I had no interest in the subject.
Throughout the class, my grades on quizzes were not very good.
I rarely, if ever, handed in homework.

And yet, I aced the final.
Somewhere in all that, my learning caught up to me.

And I think that is what happened to the group today.
They had a hard time.
It didn't come easy.
But in the end, they put it together.

So how does this apply to EMS?
Besides the obvious application to teaching EMS, I mean.

Have you ever had a patient who doesn't seem to understand what is going on? One whose responses are a little delayed, or who needs more explanation than usual? Or a patient with a developmental delay? A patient with mental health issues? Or even a patient with a language barrier?

Don't be so sure of what they do or don't understand.
It could be a lot more than you think.
Don't assume you can tell what their motivations are.

Listen, really listen to what they have to say.
Look at what they want to show you.
Look them in the eye, and give them every benefit of the doubt.

There could be a million different reasons why they respond the way they do.
There could be any number of reasons why they behave the way they do.

Pay attention.
Be patient.
Remember that helping your patient includes helping them understand.

What People Say

I've heard a number of interesting things in the past 24 hours.
Observations by people who don't understand the subject at hand.

I'm not saying they are stupid (although sometimes, that is also true) but that it is common for people to find themselves needing to talk about things they don't yet understand, even if only to ask questions so that they CAN understand.

Some samples:


1. After witnessing a fairly large structure fire, in the home of friends of his, a man asked me "Do they give firefighters any training for how to talk to someone whose house has burned down?"

The answer is no, not that I'm aware of.
Seems like that would be more likely to be an EMS skill than a firefighter skill, dealing as it does with a person having a rough time and in emotional distress, but I haven't seen any EMS training for such a thing, either. Not really, anyway. A mention or two about being "sensitive" or "understanding." But mostly, it comes down to "I'm sorry for your loss."

An instructor I know once told a story about way back when he was new, and went to his first ambulance call where the patient was already deceased. He had no idea what to do. Didn't know what the SOPs were, who to call, should he stay or go, who calls the coroner, etc. Didn't know what he was supposed to say to the family. Barely knew how to tell if the guy was dead or not.

Since then, he has designed a class for dealing with this situation, hoping to help others not have to go through what he went through, and so that people will be better prepared to help the family members at their very worst moment.

But I haven't heard of any class for firefighters, specifically, dealing with how to talk to family members after a disaster of any kind. Maybe firefighters aren't expected to talk to people in those situations. Many don't.

2. Had a kid (around 12) ask me the following question. Paraphrased, because I never can recall exactly how this kid asks questions. He tends to be verbose.  "If someone is in a fire, and they breathe in a lot of smoke and they manage to crawl out of the house, would the air right there, assuming that nothing falls on them and crushes them, would the air there be breathable?"

It is difficult sometimes to figure out what this kid is really asking.
Does he want to know how much smoke is still in the air right next to a burning house?
Is he trying to figure out how far out of a house you'd have to get to save yourself?

The answer is a little more complex than that.
Would the air be breathable, as in "Does the air in that location contain enough oxygen to support life?"
Yes. Most likely, it would.
Would that be able to save a person who has just crawled out of a burning building, having inhaled a large amount of hot, toxic smoke?
Depends. How much? How hot? What all was burning?
Just making it to fresh air might not be enough to "save" someone.

3. I saw a couple of people commenting on a facebook thread about a fire, about getting tankers to a scene for water supply in an area that does not have hydrants. They were very concerned about what might happen if they had a fire, because they knew that their WELL could not provide water at a rate or in a quantity to put out a fire.

??? Do they really think that is where firefighters get water?  From someone's well?
Highly unlikely.

These same people thought that asking for tankers meant that the fire was particularly big, and appeared to believe that a smaller fire wouldn't require any tankers, that there would be "enough water available." In an area that has no hydrants, at all, those tankers ARE the "water supply." We always have to ask for tankers. It's no big deal, or at least, it's not out of the ordinary.

This is, by far, not the only thing I've heard bystanders (or newspaper reporters!) say about what they overhear at a fire, where they extrapolate from what they have heard, based on no understanding whatsoever of what is typical. But this one- some variation of "There wasn't enough water available to fight the fire! They had to ask for tankers to come in so they'd have water!" is one of the most common, and one that people get the most upset about.

4. A distant family member of mine has recently fallen ill. I don't know her personally at all, and don't really know the also-distant family members who are sharing this information. All I know is what has come to me third-hand or so. She has apparently been diagnosed as having "a squiggly thing in her cranium." And they were unable to do the procedure (first described as surgery, and then as "not surgery, a procedure") because she was "too resistant."

Haven't untangled this one yet.
When getting medical information from non-medical people, first, you have to figure out whether this is the information they heard, or the information they thought they heard and can't quite remember. And is it what the doctor said because they wouldn't understand the medical terminology, or is it their interpretation of the medical terminology.
Then you have to look at regional dialects and accents, and possible mispronunciations or homonyms.

Any guesses would be appreciated.
I can't ask for clarification on this one, because I don't have any way to contact these people, and they'd find it very odd if I asked.
But I really want to know!

11/11/11

It's the eleventh day.
Feels like the eleventh hour.
Long day today.

Came home from work to find my dept out at a structure fire.
I spent the next five hours there.

Not what I had originally planned, that's for sure.
I was already exhausted, and planned to take a nap. Forget that plan.

How is it that we dig deep and find that extra energy, extra whatever, when it really counts?

Emergency Service agencies are filled with people who have the ability to do that. Work hard, then work harder. No matter how tired, now matter how little sleep, no matter how horrific the scene, we have to just get it done. And mostly, we do.

I overheard a college student today, complaining to her friend, about how she didn't know how she was going to make it through her class, since she had only gotten SIX HOURS of sleep.
I don't remember the last time I got a solid six hours.

But it isn't just the ability to function while tired. There are other aspects, too, that I find interesting, or puzzling.

Like how I don't usually need to pee during a scene. Something about the adrenaline, or the need to focus, I don't know what it is, but while I generally run to the bathroom more frequently than average (sorry for the overshare!), it doesn't happen on scene.

Another example is my daughter, who has a history of passing out at the sight of blood.
But she's an EMT. And on scene... she's fine with it. Maybe she only passes out at a little blood? Or maybe only her own? I don't know- but it hasn't been an issue on scene, ever.

One of the reasons I always wanted to be involved in the Fire Service and EMS is that I tend to stay calm, and remain functional, in emergency, high stress, situations.
Now, I know lots of people like that.
What I don't know is why. What makes people able to do that? Where does that come from?

Superstition

Here we are, day ten of NaBloPoMo, and I'm 10 for 10.
I hope I don't jinx myself by saying that!

Yeah.
EMS (and fire service) folks tend to be a little superstitious about some things.

The most common, and most obvious one has to do with saying the "Q" word. If anyone ever suggests things are quiet, two things will happen almost immediately. The first is that any coworkers who heard it will tell the person to hush their mouth, or otherwise give them crap- and the second is that the calls will start coming.

Logically and rationally, there is no way that such superstitions have any truth to them.

Anecdotally, they sure seem to!

I've lost count of the number of times someone has mentioned not having had a particular type of call, and we get one.

The biggest example of this happened a couple of years ago, when we were over at a neighboring department's spaghetti dinner, and sat around chatting with friends there for a while. One of the friends was someone I'd taken a class with early on, and we were comparing the different types of things we had seen. Someone in our group mentioned that we hadn't had a major trauma...

and a couple of hours later, there we were, by the side of the road, two critical patients, two helicopters.

It got our attention.

Since then, we have learned to be very careful.

We still slip up from time to time, and mention the weather and road conditions, sure to provide us with someone in a ditch. Or we'll wonder how a particular patient is doing, and then get "invited" to go see them.

Our new plan is to start being careful about the wording of our comments.

You know, we haven't had an easy, uncomplicated delivery of a healthy, full term baby lately...

Yep. We've been saying that. And crossing our fingers, hoping for the chance.

Got robbed of one today, it turns out.
A friend just down the way- in our district!- delivered his own healthy baby girl this afternoon. As we all know, it was really his wife who did all the work- but he got to catch.  They didn't quite make it to the hospital, as had been their plan.

Close. So close.
We almost made it.
We just need to work on that careful wording a little more, tweak it just right, and surely...

Wouldn't it be great?

A friend of mine is doing ride time for her class.  Today was her first shift, so I listened in on the scanner, hoping to be able to hear what kind of calls she got to go to.

The very first call was for a mental health transport.

As was the next I heard.

All day long, county agencies got toned out for... mental health transports. I was told in my original EMT-B class that the most frequent calls are for mental health transports, and old ladies falling down- and they weren't kidding.

At one point today, an ambulance was at one of the mental health calls, when there was an MVA at practically the same location, and with the nearest ambulance busy, one had to be sent from considerably further away.

I'm sure this issue is not news to anyone who would read this blog. 

At that "training" a couple of nights ago, we were supposed to be learning about things that can be dangerous to responders. Certainly, mental health issues are at the top of that list.

But for the most part, we aren't very well trained to deal with them.

I've had a little training on restraint techniques, and a little on self defense. A lot on "stage for law enforcement."

Nothing on talking to someone who is depressed, or manic, or delusional, or anything. Nothing on de-escalation. Nothing on actually helping these people- just on transporting them.

So I was thinking.

Wouldn't it be great if we could have mental-health specific emergency services? An ambulance staffed with people who ARE trained (and experienced!) to handle these sorts of emergencies. People who are good at it.

Everyone would benefit.

No more ambulances out at a mental health transport call, when there is a need for trauma care nearby.

Services that would really help people, rather than hope to get them somewhere else, where they can get help.

Fewer calls where responders are in over their heads, and end up getting hurt.

I know.

It's not likely to happen.

But I think it would be great.

How Not to Train

Last night, we went to some training at a nearby department.

They were bringing in professionals to offer some training, and invited most of the county to participate- exactly how I think things should be done.

Oh good, I thought, maybe this will be decent training, and we can learn something from it.

My mistake.

Let me mention a little bit about how NOT to conduct training.

First, don't start with saying "This powerpoint is from a different agency, and I'm not really familiar with it, so I'll just read through it quickly. I don't know much about this, so if you have any questions, I probably don't know the answers, but maybe someone else will and can share it."

Please.

And then there were the scenarios.

I don't have anything against using scenarios in training. Sometimes, they can be excellent tools.

But do some training FIRST.

Teach people what to do and how to do it. THEN give them a scenario to use for practice. Set them up for success.

I don't understand why so many places seem to think that throwing people into a scenario for which they have not been trained, so that they'll screw it up, and then be criticized for everything they did wrong, is how to train people.

It isn't.

Period.

Did it occur to anyone that the ONLY things that were practiced were the mistakes?

Do any of them understand that in order to be effective at changing behavior, feedback must be immediate- not half an hour later?

Just because someone claims to be a professional, and claims to be able to provide training, does not make it so.

Any more than calling something "tofu cheesecake" makes it cheesecake.

The Best They Could

There is tremendous resistance to any criticism of emergency services.
Perhaps you have noticed this.

It is taboo for anyone to say anything negative about their own agency, or emergency services in general.
No one wants to talk about mistakes that are made, or problems that exist.

Saying anything about them in public, or ::gasp!:: online has cost people their jobs. We wouldn't want to alarm the public, would we?

The problem with this is that there are problems, more in some places than others, and ignoring them won't make them go away.

I believe the public has a RIGHT to know how emergency services functions, and has a right to know how their local system compares to both average and optimal. They are paying for these services, right? And depending on them, sometimes for their very survival.

And yet... not only is it not allowed to discuss it, for the most part, people seem not to want to know.

They have this image of heroes, and they don't want to consider that it might not be so.
They expect trained professionals to come when they call 911, and don't want to even think about how that might not happen.

Any suggestion that their local "heroes" are not what they imagine is met with indignation, and with accusations of trying to "destroy the fire department" (or whatever agency is in question).

Never mind, for the moment, that people seem to believe in THE Fire Department, as if there is only one, divided into infinite branches, perhaps, but all connected, with the same training standards and same training and experience. Similarly, it is THE Ambulance that comes.

The biggest problem I see with all this is that it's going to take a disaster to get people's attention.
It won't be until they are personally negatively affected that they stop and realize... wait a second. I called 911, and no one came and saved me.

Most of the time, around here anyway, it's "we're so grateful; they did the best they could" regardless of the quality of service or even the outcome.

But sometimes, "the best they could" isn't good enough.
It isn't good enough when there aren't enough firefighters to mount an interior attack.
It isn't good enough when the time it takes to get people on scene is too long to effectively rescue anyone.
It isn't good enough if a 911 call for a cardiac arrest does not elicit a response that includes an AED on scene within 10 minutes.
It isn't good enough if the people who show up aren't trained to do the thing that needs to be done.

If that's the situation, people need to stop saying "well, they did the best they could" and start asking questions about what that "best" IS, and whether it's good enough to GET THE JOB DONE.

It would be even better if they asked those questions NOW, before anything happens that proves it isn't.

Harder, faster

In an incident of odd serendipity, Happy Medic has posted about something I've been thinking about. Close enough to it, anyway.

Go read his post titled Man Up NFL- Ditch the Helmets.

Interesting idea that seems counter-intuitive on the face of it.
But I agree.

I've seen this in a number of different situations. When faced with a possibility of injury during some physical activity, people throw "protective equipment" at it, instead of focusing on increasing the skill level of the people involved.

It's not that protective equipment is, in and of itself, a bad thing.
It's when people start to believe that the equipment allows them to take MORE risks, rather than helping them to take LESS risk, that there is a problem.

You are most in danger when you believe yourself to be safe.

For example, no firefighter would ever believe that he or she could go right into a fire, as long as they are wearing their turnout gear, right? Right?

Oh.
Never mind.

Remember that safety is the responsibility of the people involved, and the skill, attention and focus of those people will always contribute more to safety than any equipment can ever do.
Use safety equipment as much as possible- but don't let it lull you into believing it can ever make anything "safe."

Farmedic

Shortly after I became an EMT, I heard about a class for rural EMTs, called Farmedic. It was described as a class for EMTs to learn about farm rescues, and specifically about dealing with patients entrapped in large farm machinery.

Since there are probably more cows in this town than there are people, and possibly more farm machinery than cars, I thought it would be a good idea to take the class.

Problem was, I couldn't find one to take. The website (then, as now) didn't list any courses in the "schedule" section.  All it said was that they would teach courses "when requested."

So naturally, we contacted them to request one.  That's when we learned that in order to sponsor a course, you had to provide farm equipment that could be overturned, cut, and otherwise damaged or destroyed. Not so easy to come by.

This past September, I received an e-mail that announced a course offering in a nearby county. And there it was: Farmedic, at a place I could get to- and even a time I could get there. We signed up practically that moment.

We drove the hour to where the class was being held, and found quite an amiable group assembled. Most were from the host department, but there were a few who, like us, had come from a considerable distance.

The first thing we learned once the class started was this: Farmedic is NOT a class for EMTs.

It's a class for firefighters. It is about hazards on the farm, including information that would typically be taught in  HazMat, confined space, and high angle rescue classes. It is about extrication. There is very little covered that is about patient care. I have no idea whatsoever why the course is named the way it is- or why we had been led to believe that it was primarily for EMS.

That said, there is no reason why any rural EMT shouldn't take the class, and there is every reason why ALL rural firefighters should.

We learned about different types of silos and the hazards therein, as well as the hazards associated with grain bins. Both topics that have showed up in the news in the past few months, when workers and/or responders have been killed.

We toured a nearby farm to see first hand what kinds of large machinery there is that we'd need to know how to shut off, and to see how they handle manure- one of the biggest dangers on a farm.

But by far, the best part of the class was the hands on practice with extricating "patients" from farm equipment.  We had two pieces of equipment that we were able to use for several different scenarios.

The most important thing we had reinforced was not a surprise: teamwork is vital to success. Everyone had ideas for how to go about the rescue, and it was by listening to all of the ideas that we found what worked. We also learned that the "jaws" can't handle that kind of equipment. An important thing to know!

Our class ended up being delayed halfway through as the instructor and most of the students were deployed to various places to assist with flood recovery, but it was worth the wait. It isn't often that farm machinery is available to "play with" so take advantage of that opportunity when you can get it, rather than waiting until it happens "for real."

For one thing... injured "dummies" don't bleed, and they don't scream.
Although some of those new fancy simulation ones probably can!

If I were in charge, part 1

My daughter suggested doing a series of "If I were in charge" posts, since we talk about it all the time.

So. Here goes.


If I were in charge around here, I'd do a lot more coordinating than gets done. I'd work on getting all of the agencies in the county to work together.  EMS and Fire.

The way it is right now, each agency does its own training- or not. Some agencies have their shit together, and do a GREAT job of providing regular, high quality training.  Others don't. Most are probably somewhere in the middle.

We have found that if we make the effort to find out what training is happening where and when, and ask the right people, we are welcome to go participate in most of the training out there. But in order to do that, we need to know their schedule, and who is in charge, and what they are planning and know all of that in time to ask and get an answer and make plans to go.  That is easier to know with some agencies than others, because we know more people in some places than in others.

I have been to training with about 10 other agencies in the county over the years.

It sure would be easier if someone kept all that information in one place, AND if it became "county policy" that all training was "open door," meaning that any county provider would be welcome. It would save a lot of time, it would save money (by not having to pay to provide the same training multiple times to small groups) and it would make a lot more quality training available, especially to the smaller agencies and/or the people from agencies who don't do any in-house training.

I don't understand why this isn't already being done.
We've never run into any problems with going to other agencies to join in their training. Ever. We have always been welcome.
But we (my kids and I) are the only people in the county doing this.
We never see any other people going to training at agencies other than their own except for a couple of pairs of "sister departments" who regularly train together. We don't see individuals making the effort to get invited to training.
Occasionally, on the nightly announcements the county does, an agency will announce their training and specify that "all county monitors are invited to attend" but that happens maybe two or three times a year, at best.

We have a person called the "county coordinator," but he doesn't seem to do any actual coordinating, at least not anything I'd call that. I have no idea what his job actually is, but that's a subject for another day.

Information Flow

Meant to write about this a while ago, right after the story about my cat, but things didn't go well with the cat, and I was caught up in that for a while, and never got back to the story.

We ended up visiting the vet hospital several times, as the situation went from bad to worse. Turns out the cat had some rare form of bladder cancer. We started him on an experimental treatment, which helped for a while. Longer than we expected, really. But ultimately, there was no cure.

Part of the experience- the part I want to share here- had to do with getting information.

I understand more medical stuff than the average person. I have a fairly large working vocabulary of medical terminology. Anything a doctor (or vet) says to me that I don't understand, I ask about, and ultimately research on my own.  I am definitely the kind of person who wants to know what is going on.

It mystifies me that not everyone feels that way. I run into a lot of people who prefer NOT to understand medical issues, even their own.

So there we were, at the vet hospital, in the evening. Cat was whisked off to surgery, I was told to go home, that they'd call me.

They didn't.
I called them.
Was told the cat was doing well and that we could come visit whenever we wanted.
I wanted to go in the middle of the night, but I don't think that's actually what they meant.

We visited the next day, and talked to the vet student assigned to our case. She said there were tests still to come back, and they'd let me know. She ALSO said that the care so far, and the care he still needed, and I don't even remember (red flag!) what all she said, except that it was going to be extraordinarily expensive.  And that I had to pay half of it upfront, right now, or end of treatment.

Urp.

To make a long story slightly less long, we ended up seeing two vets, three vet students, the pharmacist, several receptionists and the folks who took the payments.

We spent days (not all in a row) expecting them to call with an update that only sometimes came. Other times, we had to call them, and call them, and try to figure out when to call to get the person we wanted.

In short, I spent a lot of time wanting more information than I was getting. It was frustrating, and it was scary, and we were all already very stressed out by the situation.

And it was right about then that I realized that we see people in that situation ALL THE TIME.

The main problem was that I didn't understand the system there, not having had much experience with it. I didn't know who to talk to about what, how to know when to call or who to call. I had to juggle 5 different medications and their schedules and side effects, something I also had no experience with.

It gave me a huge amount of sympathy, and a reason to take a look at the environment we create when we walk into someone's house after they call 911.

Much of the time, they don't know who we are. They don't necessarily know what is wrong, although sometimes they do. Even when they know what the problem is, they don't always know whether this is capital-S-Serious, or not. They don't know which person on scene to ask, they don't know what our qualifications are, and they don't know what is going to happen next.

All of this "not knowing," on top of a high level of stress, does not generally make for an easy, happy situation.

I have been working on being much more proactive in helping patients and their families understand what is happening, when I can. If I'm involved in a true emergency, and direct patient care is taking all my attention, then I can't direct a lot of energy to the family. My goal is for all of us to get better at that so whoever is able to fill that role, will.

My partner a while back started something that we immediately adopted as our SOP. Hello, my name is ______, this is my partner ______. We're EMTs, and we are here to take care of you until the ambulance gets here.

That is the reality of our role out here. Amazingly, just giving them that much information is a HUGE help in their understanding the flow of things. We used to have a lot of confusion out here, about why so many different people show up, and why there are "two ambulances" when they only need one. (At the time, our rescue was an old ambulance, so although it wasn't actually an ambulance, most people thought it was and were very surprised to find out it isn't. We don't have that problem now- our new rescue looks like a state police car. An entirely different set of issues, that. But people pull over for us!)

As the ambulance arrives (and as the situation allows), I tell the patient that the medics are going to come in, and they will probably ask a lot of the same questions that I've asked. I then introduce the patient and the medics, by name, and make the transfer of care.

Once the patient is in the ambulance, I am usually (but not always) out of that loop. I will wish my (now former) patient well, and let them know I have every confidence they will be well taken care of by the ambulance crew. I can do this because I have made the effort to establish a working relationship with all of the people who might be on that ambulance, so I know them by name, and I know a lot about which I've seen be particularly good at which things.  I'm not just mouthing the words.

At that point, my focus shifts to the family and friends.
We make an effort to provide as much support as we can.
We lock doors, turn off lights, feed cats, bring in dogs, etc. We make sure anyone who is going to the hospital knows how to get there. I find myself often explaining to a spouse or child that the fact that the ambulance hasn't left in a hurry isn't because something is wrong- there are some procedures that need to be done that are better done when the ambulance is not moving.
I've talked to children about where their sibling is going.
I've talked to family members about what the sequence of events will be after someone dies, and reassured them that police presence is standard procedure here, and does not mean that anyone thinks they did something wrong.
I've answered I have no idea how many questions about what just happened, what is going to happen, and what isn't going to happen.

I hope I'm able to fill the gap a little, so that people don't feel that additional stress of not knowing who to ask, or what to ask, or where to go.

I just recently had occasion to go to the police department in a city a couple of hours from here. It was a large place, in a large (to me) city, and I had no idea where I was supposed to park, where I was supposed to go, how to get there or what to do once I got to the right window. The entire place was set up with an assumption that everyone who came in there was familiar with the procedures and such. I think almost every "public service" building I've ever been in, from police stations, to jails, to social services buildings, has always had that same sense about it- that you are supposed to already know the drill.

I didn't.
Trying to get someone to help me was a challenge, and the guy who finally answered my question would not win any awards for public relations.

It reminded me, again, of my experience at the vet hospital, and the importance of understanding that many of our patients don't "know the drill," either. They may be going through a totally new experience, having never called 911 before, and have absolutely no idea what is going to happen, or what to expect.

It is way too much to expect them to figure it out on their own under those circumstances. All the SOPs and protocols and procedures we do are very familiar to us, so it's easy to forget that not everyone knows how things go. We have to tell them.