Tuesday, October 23, 2012

The Tough Women Club

It was nearly Christmas. We were just sitting down to watch the Grinch, and tradition in our family is that if you want to see the major Christmas specials- Rudolph, the Grinch, and Frosty- you have to catch them when they are shown. No taping allowed.

Not five minutes into the show, the pager went off.

I knew where the house had to be, being familiar with our response area. It was back behind trees, at the end of a long driveway, with no obvious numbers. WE knew where it was, but the ambulance likely would not.

Sure enough, they missed the house. Twice, at least. We could see and hear them go by, but since I'm not allowed to carry a radio, we had no way to contact them to give them directions.

Meanwhile, we were inside, with the patient, listening to her story.

She told us about her cardiac history. About her stroke history. About being diabetic. About her asthma. She talked about tiring more easily than she used to. And oh, by the way, she casually mentioned she also has cancer.  All of this relayed with no apparent distress, like discussing the weather, or a television show.  She was, as she described herself, "a stubborn old lady." Certainly tough enough to kick whatever this was that made her feel "a little off." We had a good laugh together, the three of us, the "tough women" club, before anyone else arrived on scene.

She reminded me of another patient we had seen, another tough old lady, who made me smile more than once over the years. I wondered if they knew each other, if, perhaps, they had been close friends, they seemed so alike. I could easily imagine the two of them as youngsters, turning heads and causing trouble. This little town seems to grow some tough women, women who live long and well. Women who are good workers, and even better friends. The kind of person you can count on, no matter what.

I just now saw her obituary. She died a few days ago. I'm absolutely certain she was tough to the very end, and probably had friends and family chuckling over some joke, or tall tale. If I had to guess, I'd bet she was comforting family and friends, rather than the other way around.

Godspeed, Alma. Keep everyone wherever you are in line, until the rest of the club gets there, okay?

Tuesday, September 25, 2012


There is a patient we have seen many times over the past few years.
I like her.

She has a rare chronic medical problem, one I had never heard of before meeting her, and am now almost an expert on. When she calls, I know what to expect, where her pain will be, and what I can do to help alleviate it. I love knowing those thing, knowing that I am able to offer her at least some relief before the ambulance even gets there.

It is an intimate thing.

When a person is in a lot of pain, they are rarely at their most sociable best. Anytime someone is very ill, they tend not to be fresh as a daisy and ready to entertain, to say the least.
That we are allowed into that world is an awesome privilege.
She and I have met enough times that she trusts me, at least enough to allow me to be there, to touch her, to comfort her. She knows I care, and I know that she is grateful.

Living in a small town, it is inevitable that we would have friends in common, and we do. We don't "run in the same circle," but we do see each other from time to time at events, or in passing.

It is always good to see her when she is feeling well, when she is out being happy, being a whole, comfortable person in the world. To look at her then, you'd never imagine that she has any medical problem at all. She is vivacious, smiling, confident.

But not once, in any of the times we have run into each other outside her home, has she said hello, or acknowledged me in any way. And not once have I gone up and spoken to her, either.
It is an unwritten agreement, of sorts.
Although there are times when we are as close as people can be, sharing sweat, tears and pain, the rest of the time, I do not belong in her life. I am forgotten. Unacknowledged.

It is not that I expect her to run up to me and thank me every time she sees me.
That would be horribly awkward, at best, and isn't at all necessary.

I just find it interesting that there can BE such separation of connection.

I like how I am able to be there when she is having difficulty, and not have that spill over into a semi-social relationship, just because we live near each other. That we are not "friends" does not lessen the intensity or value of the relationship we have. It may well enhance it by removing all social awkwardness, or any obligation to each other outside the narrow window of emergency situations.

Saturday, September 15, 2012

What the Heck is Going On Here?

I'm having a few thoughts this morning, so I'll share them.

Class is going very well. We have a good group of people, both students and instructors, and I'm enjoying this very much, and looking forward to hanging out with these folks for the best part of a year.

I've found a very useful resource for the class. An obvious one.
The text we're using has an associated website, with lots of study-stuff. Some is more useful; other stuff somewhat less.
I've been taking advantage of the "flashcards" they have set up for each chapter.
After going through them a couple of times, I realized that they are set up to match exactly with the vocabulary list.

Memorization is not, in general, the best tool for learning. It provides no context, and that means much of it will be remembered short term, but not long term. I'm going for long term.

So if the flashcards were FACTS, I think they would be less useful.
But they aren't facts.
They are LANGUAGE.

Perhaps you have noticed that your language, the vocabulary you frequently use, has changed somewhat since becoming involved in EMS. We talk about stuff that no normal (read: "not an EMT") person talks about.

Being comfortable with the language helps to avert those "I know what it is, what it does, and why it is important, but I just can't remember what it's called" moments. More than that, it brings the medical field into daily thoughts, rather than something in a class, on a test, or during a call.

One of the things that knowing the language has helped me do is be an advocate for friends and family who are having some sort of medical experience. This is not a small thing.

Have you ever noticed that the average person has no understanding whatsoever of hospitals or medical conditions? I thought so. They often don't know what is happening, or why. Mostly, they ALSO don't really care to know all the details past "this is going to make me (or a loved one) better so we can get out of here."

I don't know about you, but I have found friends and family to be fabulous sources of medical education. I have also found that it's better if I don't mention this to them directly. The person having the A-fib typically does not find the monitor NEARLY as interesting as I do. The person just out of brain surgery has no actual interest in knowing about the effects of intracranial pressure.

If it's a situation where I have fairly direct access to the medical staff, it works well to have them explain to me what the situation is and what they plan to do about it, and I can make sure it is understood by the patient. I tend to know what questions to ask, and can explain procedures and options. I have found hospital staff very open to this, and willing to provide more accurate, less "dumbed down" information, once they realize I understand what they say.

If I don't have access to the medical personnel, it gets even more interesting. I get to play the "what the heck is going on here?" game. There is great challenge to be found in taking what the average layperson says about a medical situation, and figuring out what is really going on. Especially in the early stages of diagnosis, when no one really knows yet, in the investigative stage. Tests, descriptions, differential diagnoses- these are all rich with the potential of a layperson getting things very confused.

I once had a distant family member describe someone's condition as "she has a wiggly thing in her head." Hmmm. Where to go with that?

I find that I'm pretty insatiably curious about all the various ways a body can fail to function correctly. There is no end that I've ever found. It's no wonder doctors specialize- there are simply too many variations out there for anyone to be well versed in all of them.

I get to specialize in "whatever odd conditions find their way into my awareness" through my friends, family and patients. I look them up. Any time I hear about some medical condition I haven't dealt with before, I create my own "crash course" in whatever that is. Google is the most amazing thing. I can no longer fathom trying to learn about things without it.

I learned a lot of cardiac stuff when my father had an arrhythmia. I've had patients with spinal abnormalities, very rare kinds of cancer, rare diseases named after some combination of people with fascinating combinations of signs and symptoms. Right now, I have an acquaintance recently diagnosed with an unusual type of non-malignant brain tumor.

All of these are not only opportunities to learn about the condition, but to learn about how people respond when they discover they have a serious disease. The whole mental/emotional process is as important as the physical process, and often overlooked. I find this aspect as compelling as the physical part. It's probably where I can actually provide the most help to someone, rather than any of the technical skills I can perform. It's unfortunate that there is so little focus or training provided for this.

Then again, if we were experts on everything, an EMT class would take approximately a zillion years to complete. In essence, it does. Anyone who thinks their learning is complete when they pass the final test, is missing the point entirely. Anyone who thinks a class can "cover" everything we need to know hasn't spent much time in the field.

It's a fascinating world out there.

Friday, September 14, 2012

No Experience Necessary?

As promised, some comments on this post, about a study showing that having a year's experience as an EMT-B before taking a medic class makes no appreciable difference.

I think a LOT depends on the situation, and there is a huge variety of experiences.

I understand what people are saying, about how there is so much more clinical and field experience required IN the medic class, that what little someone may have had in a year before then doesn't make a whole lot of difference. That is probably true for someone in a small agency, with a low call volume, who doesn't go to many of the calls that there are, who have little in-house training available and who doesn't pursue a continuing education on their own. I know people in that situation, and they really don't have enough experience for it to matter much at all.

But not everyone is in that situation.

Some are in active agencies, with great mentors.
Some spend that year not only going to calls, but availing themselves of every learning opportunity they can find.

For those people, that year of experience will make a huge difference. Not in whether they PASS a medic class or not, but in the experience they have during the class, what they get out of it, and their overall maturity and comfort level working up to a leadership role.

The problem is it is difficult to tell which of those people someone is, before observing them for a while.

I do think some things should change.

If it were up to me- and it isn't!- I wouldn't have a flat requirement of having been certified for a specific length of time. I also wouldn't depend on recommendations from that person's agency, because I know firsthand that that may not mean ANYTHING at all about the candidate.

I'd use an interview, a pre-test, and an essay.
Talk to the person, get a feel for who they are.
See how they do on a basic-level written exam.
I'd ask them to write about why they want to be a paramedic, and why they should be accepted in the program. They can list whatever experiences or education they have. They can talk about their work ethic, their commitment, their willingness to work hard.

You can fake a lot of things- but not heart.
That's what I'd be looking for.

Wednesday, September 12, 2012

A Million Years Later...

Best laid plans, and all that. I meant to get back to blogging, but my available time has been at a premium. I'm not complaining, mind you. It's just that the longer I go without a post, the more it starts to feel like something has to be a Big Deal in order to be the first post after that long time, and I never seem to find the time to sit down and write up the big, complex stuff.

So forget that.

An update, of sorts.

It's time for me to re-cert.
Not a big deal, right?
Well... it wouldn't be, if for once the world would simply go along as it should, instead of managing to throw roadblocks up nearly every step.
The state has decided to CHANGE EVERYTHING.
Change what levels of certification there are.
Change the curriculum.
Change protocols.
And... the nearest place to take classes decided not to have a re-cert class and test for the level I am now, since that level shortly will no longer exist, and anyone certified at it would be required to take more classes and certify at a different level within the next year.

Which is great, and stuff.
Excepting for that "I need to recertify NOW" part.

What to do?
The short version of a long, frustrating process is that I'm going up to the next level (which ALSO will shortly no longer exist, but that's another story) and somewhere in the middle of that, they're going to manage to find me a test to recertify so I don't end up with NO certification for six months.

Definitely digging the "go up another level" part.
Still not entirely clear on how this all fits in with all the level changes- and neither is anyone else.
Not surprised AT ALL that I ended up smack dab in the middle of the changing, considering all the curveballs that got thrown at me to certify at THIS level in the first place.

Why not just take a medic class?
I'd love to.
I'd have to pay for it out of pocket and I simply can't afford it.
Long term plan is to actually get paid for this, and work up to medic once I'm doing that, either by saving up, or by working at an agency that will spring for it.

Best part of taking the EMT-CC class?
My daughter is taking it with me! What a team!

We had our first lab last night, and it was great. Excellent instructor team. Good bonding experience, what with the sticking each other with needles part. And to top it off, no one passed out.

Ah, now that I've broken the ice and started writing, there is so much I want to say. Guess I'll have to save it up. The class ought to give me lots of stuff to post about.

Before I go...
There is something I need to mention.

It finally happened.
Something that I knew would happen, eventually.

This here blog is quasi-semi-sort-of-anonymous.
I don't use my real name, although it's easy enough to figure out.
I don't mention my agency, although, again, it's easy enough to figure out if you have any online skills at all- and you likely do.
I'm very careful not to post any HIPAA violations.

And yet.
There are probably some folks who would not be happy about me blogging at all.
Especially because I post some truths that they'd prefer to hide not to acknowledge.

The question has long been how long it would be before someone locally finds this blog and figures out who and where I am.

It won't be long.
How do I know?

For the first time locally, I came across someone who reads the same blogs I do. (That is a pretty funny story, in and of itself.)
And if they read THOSE blogs, it is somewhat likely they will stumble across THIS blog.
I know he's looking.
And it isn't hard to figure out, at all.

So...uh...yeah... if you found me, you're right, this is the one. :-)

Next up... more training opportunities, of course.
And some comments about this post.

Hopefully, sometime sooner than a million years.

Friday, May 25, 2012

Busy Week

Had a very busy week this past week. Lots of interesting stuff and now my brain is full.

An attempt at chronicling my week:

It started out last Tuesday, May 15, with a webinar titled "Fifteen Months in Baghdad ER" presented by Dr Todd Baker and hosted by centrelearn. The thing that struck me the most was how YOUNG the ER team was. A bunch of kids with no experience, thrust into a very stressful environment. Doesn't seem like the best plan in the world.

On Thursday May 17, I made plans to set aside my regular schedule and spend the entire day attending the EMS Web Summit, and I'm glad that I did. It was exhausting, between listening and taking notes without a lot of down time from 10:00-20:30. I learned something of value from every session, even those I had thought weren't going to be particularly useful. Much of what I learned applies to my non-EMS life as well, which made it an even more valuable experience.

I was glad to see good attendance at the event from other folks in this area. Looks like my effort to spread the word was fairly successful. I sincerely hope this becomes a regular event.

After an extremely busy weekend, between working, going to calls, and helping out with a benefit, on Monday May 21, we spent the day in Syracuse at a day-long EMS Seminar. Some good sessions there, including a fabulous one on Pediatric Cardiology that really needed about three weeks to cover everything instead of an hour. The presenter- Dr Harry Wallus- was great, and I now have a huge amount of information to do some follow-up research on. If I thought cardiology was fascinating before, pediatric cardiology is even more so.

Also saw a presentation on new treatments for stroke that include a method to go in and remove a clot physically. Similar in some ways to placing a stent for a STEMI. Open up the artery, problem goes away. The best part is that there isn't the same time-after-onset limitation of tPA. Worst part is that it is still in the research phase, so it's not widely available. I hope they hurry up with that before I have a stroke.

Spent Monday night trying in vain to catch up on some much needed sleep.

Tuesday May 22, we spent the day at the Albany Med EMS Teaching Day. More great stuff. They hosted a nice variety of speakers, gave out a lot of great door prizes, none of which I won, and even gave us a "goody bag" with a few things apparently donated by sponsors. They also had prepared a notebook ahead of time with the schedule and some of the powerpoint slides. Wasn't overly fond of the lecture hall, though. With all the construction going on up there, I hope they'll find a way to provide better facilities for the med school. They are doing some great work there, and deserve something that doesn't have the feel of a mid 20th century insane asylum.

Here is the list of topics during that week:

"My Fifteen Months in Baghdad" Dr Todd Baker
What You Don’t Know, Might Hurt Them!  15-lead ECG Bob Page
Use Social Media to Market Your EMS Agency  Greg Friese
The EMS Mentor Dan Limmer
How to Earn Your Flight Crew Wings Troy Shaffer
Say This, Not That | Critical Elements Of Patient Rapport Steve Whitehead
The Silent Majority: Geriatrics in the New Millennium Rommie L. Duckworth
Abandon The Ambulance This Is EMS In Remote Areas    Jamie Todd
Belly Busters: Abominable Abdominal Trauma Rommie L. Duckworth
Can Patients Survive Epinephrine After ROSC? Tim Noonan
Dazed and Confused: SNS Stimulation in EMS Evan Feuer
Granny Has A Fever: Sepsis Kelly Grayson
EMS Changes Peter Canning
Cardiac Arrest Management Updates for the EMS Provider    Sean Kivlehan
Primary Coronary Intervention for Acute MI    Dr Ronald Caputo 
Heartmate II: LVAD
Evolution in Stroke Care    Dr Michael Jorolemon
Blue Babies: Critically Ill Children    Dr Harry Wallus
What's New in EMS    panel
Reducing offload time in ER   panel discussion
The Difficult Patient    Charles O'Donnell RN
Seizures/Epilepsy    Dr Anthony Ritaccio
LIVE Cardiac Cath    Dr Augustin DeLago
Designer Drugs    Dr Tilney
Trauma Notification/Communication    Dr Tilney
Trauma Case Review    Dr Daniel Bonville
Pediatric Traumatic Brain Injury    Dr Christopher King
Renal Failure and Dialysis    Sue Fallone, RN
Stroke    Deborah Jewell, RN (Stroke Care Center Coordinator)

Can't beat that with a stick!! Seriously. Time for a nap now. If you're near enough to get there, keep an eye out for the teaching days offered by both Albany Med and the folks in Syracuse (a joint venture between Upstate, Crouse and St Joseph's). Well worth attending, even if it's a bit of a drive.

Wednesday, April 18, 2012

Blood Pressure Simulator

How cool is this?!!

Blood Pressure Simulator, complete with case studies, lung and heart sounds.

Don't miss the section on lung sounds.

Came across it by accident while trying to find the video Bob Page uses for his classes, about how to take a blood pressure. I'm still looking for that. Or I would be, if I wasn't distracted by playing with the simulator!

Thursday, March 22, 2012

Medical Videos

Interesting resource. A blog of medical videos. Some live, some animated.

They didn't work for me using Safari, but did with Firefox, so be warned.

The one I watched (the cardiac cycle) was not great, but might have a useful bit in it. I'm most interested in the site because it is actively updated, meaning more videos are added. Something to keep an eye on.

It also suggests to me that there might be other such sites out there.

Wednesday, March 21, 2012

Albany Med EMS Outreach

Loving the folks in Albany today!

First, this morning they announced the schedule and topics for their EMS day during EMS Week.

May 22nd, register by May 11th.  $10 pre-registration fee.

The Difficult Patient
Brain Injuries from Sports
Trauma Case Scenarios
Live Cardiac Cath
Airway A&P

E-mail Art Breault at breaula@mail.amc.edu or Jessica Weir at weirj@amc.edu for more information and/or registration forms.

And if that wasn't cool enough, this evening, they posted a link to join in a live EMS lecture on Toxicology, which was very interesting. They invite folks to join in these lectures every week- like them on facebook to get the announcements and links.
If you want, you can get CME credit for the lectures.

Saturday, March 10, 2012

A Case of Nerves

Practical Exams.

Why is it that nearly everyone gets nervous?

For my first practical, back in my original EMT-B class, I was very well prepared. I had excellent instructors, and ample time to practice. We went through the stations the day before, to get accustomed to the format, and have a chance to go through practice scenarios. It went very well.

In particular for the medical assessment, it went like clockwork. I walked in, was totally relaxed, went through the scenario without hesitation, without missing a beat. It felt great!

The next day, the medical assessment was the fourth station I did.
I walked in, and the moment I walked through the doorway, my mind went completely blank.

I took a few deep breaths. Took a few more.
I ended up doing just fine.

The next time I went through a practical exam, I had prepared extensively on my own. I went through each station in my head. I focused my practice on going through the station the same way every time.

When the day came for the actual exam, I started out the morning feeling okay, but as the day went on, I was more and more stressed. There was no particular reason, but there it was. I noticed everyone else was reacting pretty much the same way. The relief at the end of the day, when I passed everything, was tremendous.

Since then, I've talked to quite a few people during the time they were studying and practicing for their practical. Nerves seem to be pretty much par for the course.

But why?  Why is that?

Most people I know have been well prepared, and I know that they know the skills. Any trouble they have with the exam itself is more from the STRESS, than from anything else.

One could argue that we often need to perform skills in stressful situations, so duplicating that for an exam is a good idea. But I don't think it's really done on purpose. I think the way it's designed, we should all feel confident and prepared and float through it, no sweat.  But from what I've seen, most people don't.

Maybe it's simply that it's so important to us.

Thursday, March 8, 2012

Pertussis on the Rise

News articles are saying that pertussis is becoming more common.  Most articles urge people to get their children vaccinated, but most current information also says that the vaccine is not 100% effective, and that it wears off, so most people over the age of 18 are not immune, even if they were immunized as children.

I went looking for information about pertussis that might be helpful in the field. We aren't going to be treating it, but it would be good if we could recognize it, in order to both get that information to other healthcare providers for our patients, and to protect ourselves and therefore our families.

First, there is a page that has an audio file, so you can recognize the characteristic "whoop" of the disease. That said, it's important to know that not all patients will have that symptom. Once you hear it, you won't forget it. If your patient sounds like that, it is a near-definite diagnosis, but if they don't sound that way, you won't know if they have pertussis or not.

The CDC has a whole section about pertussis, and Wild Iris Medical Education has a Pertussis CME class online. You can read through the class for free; it's $6 to take the test and get credit. Both of those have an extensive list of references and resources.

Medscape also has an overview of pertussis information.

Hopefully, you won't run into it in the field, but as the number of cases rises, it's always possible.

Wednesday, March 7, 2012

The End of the Search

The search was called off yesterday afternoon, when they found her body in a field not far from her home.

Alzheimers Association on facebook

Alzheimers Association CME videos

Medscape's Alzheimers Disease CME Learning Center

Alzheimers Disease Information Center

Alzheimers CME
For MDs and nurses, but the information is still valuable

I sincerely hope this never happens to anyone again.

Monday, March 5, 2012

That Search Story

We were out searching for a missing elderly woman.

Our search team was four people, and the area we were assigned to search was fairly large, so we split into two groups of two. Mostly, we were walking along a little used road, searching fields, ditches, and some woods. It was several hours past dusk, so we were working with flashlights and occasionally, vehicle lights.

However. There was a complex of buildings that were in our area, too. One building had signs on all the doors, indicating it was unoccupied and unused. The entire complex had been "abandoned" a few years back.

My partner and I had the buildings to search, so we split and went around each one, one going clockwise, the other counter-clockwise, until we met on the opposite side.  Most of the buildings were, in fact, abandoned and locked up tight.

But not all of them.
On my search, I found an open door.
It opened into a boiler room. They were working, and the small room they were in was very warm. Nice, considering it was cold and snowy outside. A perfect place for a missing/lost person to get in out of the weather.  The problem was that the boilers sat in the middle of the room, and I couldn't see all the way around them. I didn't want to go in the building by myself to check around the other side, without my partner knowing where I was. So I didn't.

I continued on around the building until I met up with him, reported what I had found, and we went back to the open door.

On the other side of the boiler was another door, one I hadn't seen. It was labeled "Lady's Room" <sic>. Kind of odd, for a door leading out of a boiler room.
We opened it.
It was, indeed, an old (but apparently no longer functioning) restroom. With lockers.
And another door.
My partner searched the rest of the bathroom, while I opened the door.

The door opened into a hallway leading to the rest of the very large building.
All I could see from where I stood was a long hallway in one direction, several connected hallways the other direction, and lots and lots of open doors.

I chose to do a right hand search; my partner took the left hand search.

And that is when things started to get weird.

Down my hallway, the rooms were all very similar.
Not being used, but not empty, either.
Each was about ten or twelve feet square, with no windows. Most had utility sinks. A couple had desks, some had lab cabinets and counters. Most had various containers and junk scattered around.
As I continued down the hallway, the last several rooms were empty, and had some sort of exposed pipes. Gas pipes? Water pipes?

As I reached the end of the hallway and turned around, I saw a sign. There had been no signs going the other direction, but if I had come in the door at the end of the hallway, I would have immediately seen the sign that read "Infectious Agents. No children or pets past this doorway."

Crap. What does that mean?
And why did the very next room have a desk with a gas mask on it?
And the next, some sort of stainless steel tables, and a bunch of oxygen bottles? Blood stains on the floor?

What IS this place?

I met back up with my partner, and told him what I had seen, and that I was kind of creeped out. We had been in the building maybe 5 or 10 minutes, out of communication with our other pair. When we not only saw more hallways full of doors, but a door that opened to stairs, we decided to get outside, find our other team, and finish the search as a group.

They met up with us as we walked out- they had tried to reach us by cell phone, with no answer. No cell signal inside the building. We gave them a report, of what we had done so far. The crew chief called in where we were and that we would be investigating, we went back in, and split up the rest of the building.

My next find, near the base of the stairs, was the first aid station, with the MSDS sheets for all chemicals in the building, and a box on the floor labeled "Emergency Kill Box." There were containers with kits in them that looked to be atropine. (Surely those rooms weren't set up to... gas the occupants??)

The last room was a kitchen and laundry area, with refrigerator and washers and dryers still in place, but not connected.

The whole place looked for all the world like something out of a horror or disaster movie, that had been abandoned in a hurry, everyone just up and leaving. I half expected to find an unfinished plate of food still on the counter, or a television that was still on. I was imagining the Andromeda Strain. I was picturing clandestine operating rooms for illegal human organ trafficking.

It was creepifying. Seriously.

Dark, silent except for the hum of the boilers, and the footsteps of people going room to room, searching. Lit only by flashlights. (Didn't even think of trying a light switch! For all I know, the power was on.)

Clothing on hangers and in piles, left behind. Printed out e-mails taped to the wall behind a desk, as if someone had worked there only yesterday. Painted cinderblock walls, and glossy painted floors, all the easier to wash clean with a hose, if need be. But nothing, anywhere, alive. In the middle of the night, it doesn't take much to get the imagination going.  I had the feeling that if we went back later, it would all be cleaned out, nothing left behind, no evidence of... whatever went on there that no one was supposed to know about. Right out of the X-Files, or the Twilight Zone.

The truth is, we knew what the building had been. A research lab that had closed a couple of years earlier. No big secret.

But if I ever wanted to film a horror movie, I know where I'd go. It was PERFECT. You could almost hear the soundtrack.

Looking back on it a couple of days later, I wish I had put the gas mask on, wrapped a coat around myself, and jumped around the corner to scare the crap out of my partner. He was making fun of me for being creeped out.

He said it was good that I didn't, because he might have called a Mayday before recognizing me. I asked him what he would have said. Name, yes. Location, sure. Problem and resources needed?

He said he would have said "Being murdered."

As creepy as the place was, I wish we had found the missing woman there.
We didn't.
She still has not been found.
It doesn't look good.

Sunday, March 4, 2012

I Haven't Disappeared

After posting every day for three months, suddenly I've missed several days in a row.

I have a ton of things to write about from EMS Today.

I had planned to start writing about them today, but the world had other plans.

I've spent the last six hours out in the cold and dark on a search. No luck yet. Home to get some sleep, and then we'll be back out there in the morning, if the over night crews don't find her.

I have a story about the search, but I'll have to write it later. We found the perfect horror movie set!

Thursday, March 1, 2012

Here We Go

About to head out the door to go to Baltimore.
Yesterday's crazy weather seems to have subsided. Started out with snow, progressed to ice, and ended with a huge thunderstorm.
Now, it's... dark. Very dark.

Planning to make the best of the next 48 hours or so. We printed out schedules and maps and directions.

Decided, based on an unfortunate experience out of town last year, when my car was broken into, not to take anything with us that we wouldn't want to carry around all day. Which means I'm not taking the laptop.

Which means that at the premier blogging event of the year, I won't be able to post.

I'll make up for it when we get home. Once I catch up on some sleep, that is.

Tuesday, February 28, 2012

Another Weather Post

In this odd winter we've had, where we basically haven't had one, why is it that Winter has to decide to show up right when I'd rather it didn't?

Awful predictions for tomorrow, when I need to be elsewhere to teach in the middle of the day.

I can leave early, to be able to get there on time, and if need be, I can stay there late, and hang out until the weather improves before coming back home.  But if I do that, it greatly prolongs the time I'm not HERE, meaning that right when the weather is the worst we've seen this season... I won't be able to respond to any calls.

The other night I was listening to the scanner when I heard a call (not here, but in this county) for a patient having difficulty breathing. A few minutes later, a second activation for that patient, now unresponsive. A few minutes later, a third activation, and not long after, a call for a mutual aid flycar and manpower for a full arrest.

And then, not long after that, a request for law enforcement, and the ambulance went back in service, without transporting a patient.

It's not difficult to read through the lines on that.

It is likely that there, as here, there aren't many providers, and with one or two not home, there wasn't anyone to respond. Mutual aid is great, but it's further away. Not close enough to get an AED somewhere in time to make a difference.

At another recent incident, we were toned to respond to someone with chest pain. Fortunately, I recognized that the address given was wrong. The caller had given the name of the business, and I knew that it really was on a different road with a similar name. We called dispatch and told them that, it was confirmed, and within a couple of minutes, they had sent the right rescue to the right place. If I had NOT recognized the error (and to be fair, if no one else had- several did, including an officer from the actual responding agency), we (and our ALS back up) were going to a place about 18 minutes from here. It could have been that long before we realized that the address did not exist, and THEN dispatch would have been trying to figure out the right address, and only then sending help.  That could easily have been disastrous.

People don't realize how their survival often depends on details they aren't aware of, and have no control over. Who is home when they call. Which dispatcher they get. What the weather is like. How far they live from the nearest responder. Confusion (on the part of the caller, the dispatcher or the responders) because of similar road names. Some of the possible combinations are not good, not good at all.

Sometimes, I'd hate to be a dispatcher. To have someone on the phone, and know that help isn't going yet, as the patient's condition tanks? No, thank you. That had to suck in a big bad way.

If you can spare a good weather thought this direction tomorrow, that would be great.
If we can get the weather to clear just long enough for us to get to Baltimore, that would be great, too.

Monday, February 27, 2012

Almost There!

Only a couple more days before we take off to Baltimore. We're going to leave here as early as we can manage, and try to get as much time in down there in the short time we have available.

I don't know what I'm looking forward to most.

The blogger meetup? Seeing folks we met last year?
The premiere of the Code STEMI web series?
Free CMEs on the show floor in the learning center?
The JEMS Games?
Free CMEs from Physio-Control?
Philips Healthcare Learning Labs?
All the free stuff exhibitors give away?
Opportunities to win free stuff?
The Cook Off?
The New Products Rush?

Impossible to guess.
Now I'm just hoping the weather holds. It's going to be a lot of driving in a short period of time.

Sunday, February 26, 2012


Steve over at The EMT Spot wrote an excellent post about 17 Ways to Become an Awesome EMT.

It inspired me to write my own post.

I believe that whatever you do, you should endeavor to do as best you can. Be excellent. Excellence is not a state, it is a process. In order to be excellent, you need to continue to improve.

Here are some thoughts on what that means in EMS.

1. Keep the focus where it belongs: on the patient. This is all about patient care. No matter how much you know, or how good you are at your skills, if you don't provide excellent patient care, you're not doing your job. Excellent patient care goes beyond protocols, it goes beyond techniques. It includes the patient feeling cared for. It includes providing something that improves the condition of your patient, or, in cases where that is not possible, something that helps the patient's family and/or friends.

2. Extend the concept of care to everyone around you. This might mean your partner, your coworkers, the patient's family and friends, bystanders, law enforcement, and so on. Be aware of situations that may affect anyone on scene, and to the extent you can, help things run more smoothly, more easily, etc.

3. Use every call as the jumping off point for your own continuing education. You can and should learn something from every call, every patient contact, every interaction. Some situations will clearly have more to offer, but every incident will have something. Look things up, write things down, and think things over. Look up medications, medical conditions and research. Study human interactions. Learn about de-escalating tension. Pre-plan what to do if you get called back to the same patient in the future. What do you wish you had known more about this time? Know it next time.

4. Likewise, consider every call training for improved functioning as a crew. What went well? What didn't? What needs to change? Is there anyone who did something exceptional? Let them know that. Positive feedback should not only travel one way. Everyone should acknowledge excellence.

5. Seek out teachers and mentors, both formally and informally. If there is someone in your area who is excellent at something, learn from them. Keep up with conferences and other training opportunities, and figure out who the best presenters are. Go where they are whenever possible. Observe other crews you may work with, and learn who you can trust, who knows their stuff, and watch them like a hawk. If someone were to ask you who you'd most like to work with, you should have a lot of answers, of people you respect and trust, who know what they are doing, and who you know can help you improve yourself.

6. Pay attention to detail. Learn to focus on a call, and create your own SOPs for assessments and the overall flow of a call. Practice. Practice more.

7. Expand your knowledge base outside the narrow confines of your certification level. The more you know... the more you know. The more you understand, the easier it is to see patterns, to recognize things that go together- and things that should not. There is an almost infinite amount of information out there, and as similar as they may sometimes seem, every patient is different. Sometimes the differences may be very subtle, and the more you can put together, the more likely you will be to recognize something that can point other practitioners in the right direction sooner.

8. Take everything you learn and APPLY IT. Use your knowledge to make you a better practitioner. Learning produces a change in behavior. If you don't change anything because of what you learned, what good is it? That change may be to be more confident that what you are doing is the best possible thing, or it may be a change in what you are doing. Whatever it is, something should be different.

9. Share your knowledge with someone. Whether formally or informally, share what you know.

10. Back up your people. Learn to be an excellent assistant. On the flipside, let other people you work with know what helps you most, and help them learn to do that. Put time and effort into the relationships you have with your coworkers. Extend that list to everyone you come in contact with from the beginning to the end of your calls. Depending on where you are in the chain of care, that may include different groups of people.

11. Be honest with yourself. Look at your skills objectively, and work on the things you need to improve. It's one thing to find the parts you love and excel at, and dive right in to learn more about them- and that's a good thing. It's another to find the parts of the job you don't care for, or aren't comfortable with, and work to improve those as well. The harder it is to do, the more likely it is that you need to do it. Learn not to shy away from the difficult parts.

Those are my thoughts for this evening.

Saturday, February 25, 2012

Crumple Zones

Often, experiences I have on calls encourage me to look stuff up when I get home.

Today's topic of interest: crumple zones.

I wish I could post actual pictures, but I am not allowed to. I'll borrow an image I found online, to give you some idea.

See how it works to keep from compromising the passenger compartment?
A beautiful thing.

Truly beautiful.

Thursday, February 23, 2012

Get it Where You Find It

Went to a presentation at a fire department not too far from here. The guest speaker mentioned a couple of things that I wrote down to look up later.

It's later. :-)

The first one was Emotional Intelligence.
The website has a brief description, some stuff for sale (ignore that unless you're particularly inspired) and a few extra things  for free, including a Webinar.

The four components of Emotional Intelligence are:
1. Self Awareness
2. Self Management
3. Social Awareness
4. Relationship Management.

From the website:
"Emotional Intelligence is a concept focused on how effectively people work with others. These Emotional Intelligence skills are unique from a person’s technical skills and cognitive abilities. Multiple studies have shown that Emotional Intelligence competencies often account for the difference between star performers and average performers, particularly in positions of leadership."

The other thing he talked about was Lencioni's Five Dysfunctions of a Team.

Those dysfunctions are:
1. Absence of Trust
2. Fear of Conflict
3. Lack of Commitment
4. Avoidance of Accountability
5. Inattention to Results

You can find some charts and stuff here, and a short video of Patrick Lencioni discussing the concepts here.

Both of these things have a lot of relevance to EMS, or pretty much anything when people have to work together.

Tuesday, February 21, 2012

New Concussion Info From the CDC

The CDC has released a new Fact Sheet on Concussions. I've been seeing a lot of info about concussions in the news lately, and I think that's a good thing.

When I went to their website to have a look at it, I found not only that fact sheet, but a source of one of my most favorite things: Free Information. The National Center for Injury Prevention offers a LOT of free materials, just for the asking.

How did I not know about this before?

They even offer electronic copies of things that are out of print.

There's a limit of 18 publications per order, but as far as I can see nothing to keep you from coming back until you've ordered everything you're interested in.

Monday, February 20, 2012

Making a Plan

How do you plan your training schedule?

I've been finding a lot of opportunities, but haven't really sat down to put it all together into a coherent plan, the way I'd like to.

I need a GIANT calendar to write things on.

I'm starting to compile lists of things to put on the calendar, but no organized way to keep track of everything.

First, there are conferences, big and small. They happen at specific times, so they have to go on the schedule when they are happening.

Then there are occasional local opportunities. I don't usually know about those very far in advance, so they have to fit in at the last minute. They might be a training night at a different department, or something else that comes up, short notice.

There are podcasts. Do I try to catch them live, or listen to the recorded version? Live, they have a specific time on the calendar. recorded, I can peruse the topics and choose when to listen to them- but can't participate.

Webinars- again, I have to choose between live, or recorded. Some are only available live.

Once I slot in all the things that have specific times, I have to look at what I can AFFORD. Which conferences? Which training days? What classes will they have, and how do I choose? By location only, or by topic? By topic, or by instructor? By cost? Distance?

Then I see what days are still open, and start looking at all of the available online training classes. There are approximately a zillion. I also have a year's worth of EMS Today recorded sessions, with three more years available, that I'll get at some point. I've been trying to look at the topics and fill in areas that I don't know as much about. Not knowing much about much, that doesn't narrow things down all that much yet.

I've been trying to alternate different categories: medical/trauma, ALS/BLS, geriatric/pediatric/adult, new/review. I also try to add in things, as they come up, that are real concerns for real patients here. We have some regular patients with very specific conditions that I can always learn more about.

The best part is that as soon as I think I have a good plan, I find new opportunities. Did I mention that that huge calendar needs to be erasable?

I've thought about trying to roughly follow the original EMT-B curriculum, to choose what topics to do in what order, but I haven't actually done that.

I'd be interested in seeing overall plans or schedules that might be out there, but I haven't come across any. I'd think there must be some, somewhere. I just don't know where.

Sunday, February 19, 2012

What Would You Do?

Over on facebook right now, EMS World posted an interesting question:

"If you were designing the EMT-Basic or EMT-Paramedic curriculum, what content would you add that you think is currently missing from EMS education & training?"

There are a whole bunch of comments, many of them with good ideas.

Of course it got me thinking about how I'd answer.

It's not as easy a question as I thought at first glance.

In my opinion, the EMT-B curriculum is both very good, and not very good, at the same time. It's well organized, and covers a lot... but it doesn't cover very much in much depth at all. When I took the class, I already had a background of years of interest in the subject, and years of a strong first aid background. But what if I hadn't?

The first thing I'd change, if it's possible to change it, is to make it much more clear to students that the class is just barely jacks to open. It really is only enough to point you towards all the things you need to learn about, so you know where to start with continuing your education. If the class really covered everything that is in the curriculum, it would take a lot more time, and might screen out a lot of people. That might be a good thing, but it isn't likely to happen.

The next thing I would change is I'd require a lot more ride time. Also, I'd make it more like the requirements for higher levels, where it isn't number of hours, it's what you do during that time. Just requiring hours doesn't make sense. Some people ride with an agency that is not very busy, and don't even have any calls during their shifts. Others might get a high number of calls. I'd want people to see a variety of things in the field before being responsible for any.

Another thing I'd change may have a lot more to do with where I am than with the curriculum, per se. I'd make it more clear what continuing education is required and how to get it. I'd provide students with an outline for the first year post-class, with suggestions for what topics to prioritize. I would give them information about upcoming conferences, and likely a list of bloggers to keep up with.

Now for specific topics I'd like to see given more attention:

1. Talking and listening to your patient. People skills.
2. Call pre-planning and post-analysis: evaluation. DIY CQI.
3. Working as a team, especially with volunteers and not knowing ahead of time who your team will be.
4. More practice with documentation. Not just what goes where, but practice picking it out of the conversation.
5. ALS assist skills.

As for specific medical topics... there are so many, I don't really have a specific list. Instead of a list, I'd focus on teaching people to make their own list, as things come up. I'd encourage and show them how to research topics on their own. How do you find reliable sources of information?

The other major thing I would change would be the state exam. I dislike multiple guess questions, especially poorly written ones, and I did not think the state exam was particularly well written. I know that designing a good test is difficult. I'd like to see more emphasis on actual knowledge than on test taking. It makes a test harder to grade, and more difficult to take, but that just means there needs to be better preparation.

Do you have a list of things you'd add or change?

Saturday, February 18, 2012

Talking- and Listening

EMS World is currently re-running an excellent article about Professional Etiquette.
It starts out by mentioning that this is another subject we really aren't taught in EMT class. We are told to "be professional," but aren't told what, exactly, that means.

A lot of the article has to do with responding appropriately. This is a theme that has been on my mind.

I heard a brief thing on the radio last night, bemoaning how facebook has turned everyone into a bunch of rude people. I don't agree. I think anyone who is rude on facebook was likely rude to start with. One of the things that was mentioned was how facebook has made people expect a more immediate response to everything. I'm not sure that's true, but it does seem like an awful lot of people are in a hurry all the time.

That's the connection my mind made to the article- are we in such a hurry that we are ignoring some of the things we should be paying attention to at a call? Are we overlooking things, not only procedural things, but common niceness and consideration of our patients?

The article points out how rude it is to ask someone a question, and then not wait for the answer. During an assessment, we have to ask a lot of questions. Sometimes, the patient needs to think to figure out how to answer them. I know that feeling. Often, questions don't seem to apply to me the same way they apply to other people, or at least my answers are quite different, and sometimes, I have to figure out how to phrase things, or explain things, so I'm understood. I'm sure patients feel the same way.

One of the things that was a big challenge for me (and many others, I'm sure) at first was learning how to manage a conversation with a patient so that I get my questions answered, AND they get to say whatever they want to say. Some of them want to talk about things in a very roundabout way. Some get easily distracted. Some want to explain their medical history from before they were born, when I want to know what has happened in the past hour.

I didn't get much, if any, instruction in this in class. No guidance on how to redirect when necessary, or on how to really listen to a patient. The medics I have the most respect for are the ones who excel at this, who are able to talk to and listen to their patients.

I'd love to see more articles or blog posts about learning to do this well.

Friday, February 17, 2012

Work Environments

My first job, summers when I was in high school, was working in a greenhouse and in the fields. It was a fairly physical job, and involved a lot of time outside, and a lot of getting dirty. There were quite a few things about the job that I really liked, and an important thing that I didn't.

I had no autonomy at all.
Each day I would be told to do something, and when that task was done, I'd be given another. There was no explanation of the scope of the project, no discussion of what might be the best way to accomplish it. Nothing like that, at all. Multiple times, serious problems would have been averted if I (and other crew) had been told the overall goal of what we were doing, and allowed to have some input into how to meet that goal.

My next job was in a grocery store.
It was, in some ways, pretty similar. Employees were not treated well, except for a couple of favorites. We had no input into our schedules, what tasks we were assigned to, what we wore, or when we could take our breaks. The work itself was not unpleasant, but the environment was. The managers were, to put it mildly, assholes.

Contrast these with my first job out of college.
The pay, although higher than my previous minimum wage jobs, was not great.
We had complete freedom of what hours we worked. As long as we put in enough hours, and the work got done, what hours of the day and/or days of the week we worked was entirely up to each individual employee. For a while, I chose to work from 4am to noon, because it was generally quieter and there were fewer interruptions.
We were given projects to work on, and each required a variety of things to be done. How we did them, and in what order, was up to us. We were allowed to collaborate with each other as necessary.
There was no time clock. We wrote down on time sheets when we worked and how many hours we spent on which projects.
The owners of the company, who were the top engineers, regularly came out where everyone else worked and worked with us, and we were given the opportunity to work with them, to learn more about the job.
The company provided a number of bonuses and benefits that were somewhat unusual.
There was a real sense of camaraderie and fun. We celebrated birthdays, holidays, new babies, engagements, etc. We had a volleyball team in the summers that played against similar teams from other similar companies.
The work itself was about evenly divided between interesting and tedious, but the work environment was the best I've ever experienced. It has been nearly 25 years, and I still miss the place.

I've been thinking about this today, about what makes a work environment a good one.
What makes an employee feel welcomed, respected and appreciated?

For me, it isn't about money.
It isn't about being told I'm great.
It isn't about awards or recognition.

It's about trust.
It's about being treated like an intelligent adult, rather than being controlled like a misbehaving child.
It's about having the opportunity to do the job better, whether that's through having appropriate training, or control over the various components of the job, or having input into how things are done, or having my opinion valued.
It's about having control over my time, and not having it wasted.
It's about having a good working relationship with management, rather than an "us vs. them" feeling.
It's about the people you work with- their friendship, and their integrity and professionalism.

What do you think are the components of a great work environment?
Anything I left out?

Thursday, February 16, 2012

A Couple of Important Online Training Courses

Both of these were required for my daughter's EMT-B class. Neither were required for mine.

Both had information that I did not know.

NYS Mandated Child Abuse Reporting
Relatively long, and relatively dry, but it includes a LOT of information about when and how to report suspected child abuse that I would not have otherwise known. All I knew is that we are mandated to report, but nothing about the actual indicators to look for, the time frame, the paperwork required, or what happens next.

MOLST Training
The website includes even more information than the training does. This one is a little more straightforward, and most of it, I could have figured out on my own. Still, it covered a thing or two that I didn't know.

As I said, they were both required in one class, and not required in another. If I were teaching a Basic class, I'd either go over this material myself, or require it. They both include some pretty important legal issues.

Wednesday, February 15, 2012


A friend found out today that her youngest son is colorblind, like both of his older brothers. It got me thinking.

What kinds of things are there that being colorblind would make more difficult? Are there things that you simply can't do?

The most typical thing people think of is a traffic stoplight, but the first thing to come to my mind was reading the color codes on resistors, something I needed to do at one of my earliest jobs. Can't do that if you can't distinguish between some colors.  I hunted up some info and found out that many resistors these days have numbers printed on them as well, eliminating that potential problem.

As I was looking for information, I found a couple of cool things.

One is a test to find out if you are colorblind. No, not the typical one where you look at the circles of colored dots and tell them what number you see. It's one where you match colors.  Try it. It's interesting. It's called an anomaloscope.

Then, I found a site with all sorts of information about colorblindness in the medical field, including some images that show skin conditions that can be difficult for a colorblind person to see. I hadn't even considered that!  Things like pallor, flushed skin, or cyanosis can be much more difficult to detect.

I don't know that I know anyone in EMS who is colorblind, but statistically, I probably do. Do you? Have you ever heard of anyone having a problem with it?

Tuesday, February 14, 2012

New Exhibitors

I've been spending some time making a plan for which exhibitors I am the most interested in visiting in Baltimore. Since we aren't there for the whole conference, we'll have limited time to do everything we want to do, so I want to make the best use of my time possible.

It's my one chance to see what's new, so I'm starting my list with new exhibitors. It doesn't necessarily mean that they are new companies, or have new products, but they haven't been at EMS Today before, so I won't have seen them in person before.

Advertise themselves as "Innovative Training Systems for Emergency Responders"

"Changing the world's view of medicine" web based educational platform.
Interesting website. It looks like it's more focused for physicians, but I don't really know.

Adjustable oral airways. I have not seen these anywhere before, so I'm intrigued.

Platinum Educational Group

Rescue Essentials
Haven't seen what they offer before. The website suggests a tactical focus, but it also mentions equipment for wilderness rescue, so that's interesting.

Rip Shears
I know folks who swear by them, so I'd like to see them for myself.

Interesting concept, allowing the public to provide more information to 911 call takers.
I'd like to see how it works, what's involved. It's another thing I haven't seen before. I don't now whether it will work here, or whether it's intended for a larger metropolitan area.

Monday, February 13, 2012

Dealing With Dementia

Saw an interesting article this morning.

It's about dementia, and how the number of people suffering from it is increasing, as the population ages.

The most interesting bit had to do with how it's possible for someone to converse easily, sound like they are making sense, and fool everyone around them into thinking they are fine, when they are not. This happens frequently, that people adjust and hide their difficulties, and the people around them make allowances, or simply don't see it. Especially in couples who have been married for decades, they simply complete each other's thoughts and sentences- and cover for each other.

I'm pretty sure I've seen this. Sometimes, it's obvious; other times, not so much.

It's why it's important to really establish whether your patient is oriented accurately, or can just answer questions well. I once had a fairly lengthy conversation with someone before realizing he had no idea whatsoever where and when he was. Sometimes people are remembering something they've done a thousand times, so it sounds and feels like a recent memory, but it isn't. They can talk about it like it happened yesterday- but it was 50 years ago.

One of the things the article mentions is something I've never done.
It talks about how in cases of dementia, there might be things in the environment that are out of place, or clearly wrong. No food in the refrigerator, things in the wrong place, that sort of thing.

It all comes down to something we should already be doing: paying attention.

Sometimes, we're the only care these people get, the only people who see in their houses.  It's not like I want to turn into some sort of weird EMS stalker, but I think there is a place for us to keep an eye on people who are alone, and who may need help but not even know it.

Sunday, February 12, 2012

Permission to Train?

I'm curious about something.

When I joined the fire department, the bylaws required a member to get permission to take any training class that would cost the department more than $50. The reason given was that there was a limited training budget, so they needed to be sure there was money available, and that some people would take expensive training, and then disappear, leave the department, never to be heard from again, and they wanted to keep that from happening.

I don't believe that requiring permission first WILL "keep that from happening," so I'm not much impressed by that line of reasoning. I do understand the bit about needing to be sure there is money in the training budget.

Since our department is small, and my desire for training is large, I started paying for much of my training myself, so as not to overwhelm the training budget. I knew there was no way the department could afford to pay for all the training I wanted, while still using the budget effectively to provide training for the whole company.

The bylaws were recently changed, and for reasons other than those previously given, the current requirement is that every member receive advance permission for ALL training, even if it doesn't cost the  company or the fire district any money.

The original proposal was that such permission, from the chief, and approved by the fire commissioners ( a process that could take several weeks, depending on when permission was requested, since the commissioners don't meet every week) was required before REGISTERING for any training.  We successfully pointed out that sometimes, opportunities for training come up very quickly, or schedules are not made available until the last minute, and a lot of training might be made impossible to attend if a person had to get permission basically before they even knew about the class. It was amended to the current bylaw, that permission (from both the chief and commissioners) must be received before ATTENDING any training, anywhere, even if the member is paying for all associated costs themselves.

I think this is ridiculous, and will act to DISCOURAGE people from training.

For one thing, why would any chief ever deny someone permission to take any class, or attend any training? For what possible reason would permission ever be denied? If the person is paying for the class themselves, there is no financial reason, at all. What other valid reason could there be?

For another, as an example, if I decide to go to EMS Today, at my own expense, to spend time in the exhibit hall, and I end up taking one of the free CME classes offered there... why should I be penalized for that? Why should I be put in the position of having "not followed the bylaws" and opened myself up to being reprimanded, and called before some disciplinary board? Does that make ANY sense at all?

And how does this play out for training classes online?
If I see a link on someone's blog, for some free online training, and it sounds interesting... do I have to wait until I can get permission, possibly for weeks, before I can click that link?

So I'm curious.
Do other places require permission(s) before attending training that you pay for yourself?
Has it ever been an issue?

Seems to me that agencies should be actively encouraging people to take advantage of available training, not throwing up roadblocks in their way.

Saturday, February 11, 2012

Automatic assistance?

Several years ago, we had a call for a suicide.
Dealing with the patient was fairly simple. There wasn't anything we could do.
What was hard, was dealing with the family members.

We were pretty new, and didn't know what to say. Didn't know what to do. We didn't want to go off and leave them, but there wasn't anything in our protocols to tell us what options we had. We were aware of the local suicide prevention group, and that they offer care for survivors, but didn't really have anything to offer other than a suggestion to call them.

Since then, we've started carrying business cards with that information on them, that we could hand out if necessary.

Recently, in a town nearby, there was a suicide of a fairly young person. We didn't know the person, but several of my daughter's friends, and some of my students, did. This one hit a little closer to home, even though we didn't deal with it directly.

A question came up in discussions of it.

In this county, whenever there is a residential structure fire where the damage is enough to make the home uninhabitable, there is a system in place that calls in Red Cross volunteers to help the residents. They provide a place to stay, clothing and food if required, and a lot of information on getting help.

Why is there no such automatic process with suicides?

It seems to me that it would be a good idea to automatically call in suicide prevention volunteers, or someone else capable of helping the survivors. Someone in a position to come in, help them figure out what to do, who to call, what decisions need to be made right away. Provide information on counseling, and if necessary, on clean up. I am certain most people are not at all prepared to deal with such a thing.

Does anyone out there do this?

Any EMS agencies have someone in this position, or an SOP that calls in someone?

If so, I'd like to hear about how it's organized and how it's evaluated.

Friday, February 10, 2012

Why Is It So Hard?

I've been thinking a lot about why it's so hard to make any progress sometimes.

Some folks who have been in EMS for a long time seem to be stuck somewhere. Unable to adapt or change.

That seems odd to me, since adaptation is part of the job description.

Even so, there are people who insist on things being done "the way we've always done it" or at least, the way they like it best, regardless of what the other options might be.

There is something to be said for respecting someone's experience. There are many, many folks out there with YEARS more experience than I have, and given the opportunity to learn from them, I'd love to do just that. But it is difficult to respect someone's "years of experience" if in fact, it was time spent doing not much of anything.

As I've heard others say, instead of someone having "20 years of experience," often what they have is one year of experience, 20 times.

In return for respecting someone's actual experience, I'd appreciate it if they would respect my very recent training and education, my continuing effort to keep my skills up to date, and the time I put in on a daily basis in doing so.

Had a recent situation where someone was being disrespectful, so I'm a little triggered about this issue. I get tired of people assuming I give things no more thought than they do.

When I have a preference for a piece of equipment, I can tell you exactly why, from what experience and/or research. It's never going to be "because it's the only thing I've ever used, and I don't want to have to adapt to something different."  If I have a preference for doing something a certain way, I can explain my reasons to you, why I find that way more effective. It's never going to be "because that's how I was taught" or "that's the only way I know" or "I haven't ever thought about it."

Why is it so hard for people to evaluate someone based on their skills and knowledge, rather than some other scale, like age, or gender, or who "likes" them, or whatever?

Thursday, February 9, 2012

Albany Med EMS

Saw a "Save the Date" thing on facebook this morning, for Albany Med's EMS Week events.

It includes an EMS Education Day on Tuesday, May 22nd.
Which is great for me, since Tuesday is one of my days off.
The notice says there will be 7 hours of CMEs, with the day running from 08:00 to 18:00.

That's all the information so far. I assume as the time gets closer, they'll announce the topics, or at least the registration information.

They also mention an EMS Competition on Sunday may 20th, but that doesn't work so well for me.

While hunting around on their website to see what information I could find, or if I could at least find al ink to the same information somewhere other than facebook, I stumbled across a resource that I can't recall if I've mentioned before, but even if I have, it bears repeating.  They offer a recorded lecture series, complete with exams for CME credit.  They currently have 44 presentations on the list, covering topics from A to Z. All of which I should watch. Holy crap. There's nearly a year's worth of topics, at one a week, right there.

I am not familiar with the presenters, but I am familiar with the guy who runs the show there, Art Breault. I saw him give a couple of presentations last summer, and was favorably impressed. Gives me hope that these will be similarly worthwhile.

Sounds like they have their act together in Albany.

Added note, a couple of hours later:
I went through the capnography lecture and exam.
The presenter was good, but not great. Nothing wrong with it, but not particularly dynamic.
The information presented was good. It didn't go into great depth, but it's only a basic explanation, more suited for people who are not very familiar with capnography, or a quick refresher.
The exam at the end had relevant questions, and although it was multiple choice, for some of the questions you really had to know the answer. I think that's a good thing.
My only complaint is that it did not show me whether I missed any questions, and I can't tell if that's because I didn't, or because it doesn't provide that kind of feedback.
Overall, I'd say if you need some CME credit, or just want the information, this looks to be an excellent resource. I will definitely do more of them and report back on my experience with them.

Wednesday, February 8, 2012

MyHeartMap Challenge

Philadelphia has an interesting thing going on.

It's called "MyHeartMap Challenge"

The website says "This project is a community improvement initiative and part of a research study being conducted at the University of Pennsylvania."

Basically, it's a scavenger hunt, where people find as many public access AEDs in Philadelphia as they can.

I think it's an interesting idea.

It's definitely a good idea to know where the AEDs are in your community, because if you need one, you need it right then, and don't have time to go looking.

I question whether they will get much participation. Most people probably aren't that interested- although I wish they would be. They might get people because of the grand prize, though. It's $10,000. Almost makes me want to go visit the city for a couple of days.

I wonder if any other communities will follow suit?

It bothers me, a little, that I don't know where there are AEDs in the small city nearest where I live. 
I know where all of them are in my actual town, because they're currently at the fire station, in the rescue vehicles. That's easy.
But the nearest shopping area? I don't know. I know the grocery store I usually go to has one, but I don't know where it is. It isn't out in the open. Might be in an office? I know three of the places I teach have one, and they are out where they are easy to get to, so that's great. I know where the one at the shopping mall is. Other than that... I don't really know. Do all the schools have one? I think they are supposed to. What other places are supposed to have one? Seems to me that pretty much any place were large groups gather ought to.

I think I will make a project of this for myself, to find them all. I'm not sure there is a way for me to be sure I've found every one, but I can sure try.

Tuesday, February 7, 2012

Can You Pass the Test?

Tests are big these days. "High stakes" testing. No Child Left Behind. All sorts of tests.

EMS is no different.  Or is it?

At the end of my EMT-B class, we had to pass a practical test before being allowed to take the written test. Same with the EMT-I class.

People stressed out over the practical test. Came in extra hours to practice. Made cheat sheets to read over before going in to test.

After that, there was a week or two before the written test. People studied like mad. Did practice tests.

There's nothing wrong with that, on the face of it. If you have a test, it's good to study for it, right?

The problem has to do with how people relate to tests overall, the history they have with them. Most people are at least somewhat uncomfortable with tests.

By the time they become an EMT, most people have had quite a few years (12 or 13 or more) experience with testing in an academic setting, most often public schools. In that setting, tests are for assigning grades to the student. People cram for the test, take it, and then, may or may not remember anything on the test. If you were to give them the exact same text a month later, many people who passed the first, would not pass the second. A year later? Who are you kidding?

In EMS, we can't take that approach to learning.
We have to learn the material so well that we actually know it, and can apply it in stressful situations.
And to top it off, we never know when we will be tested, or what topic that particular test will cover.

Instead of cramming for exams, we should focus on learning things well enough that exams don't phase us at all. If you make a mistake on an exam, you may not pass. If you make a mistake on scene, the results could be far, far worse. Yet people often have more anxiety about a test.

Here's what I think:
If you know your skills, your protocols, your ability to assess a patient so well that anytime, day or night, in any conditions, no matter how long it has been since you last were tested, or last had a call, you can perform those skills flawlessly, you've done a great job keeping yourself prepared. Likewise, if someone could pick you up at any time and give you the practical exam or written exam you took to become certified, and it doesn't worry you, you fly right through it without a doubt.

If not, if you forget things, or hesitate, or stumble, then you need to put more effort into keeping your skills and knowledge fresh.

I don't know anyone, even my favorite medics, who are perfect.
I doubt such a person exists.
That suggests that we ALL need to keep refreshing ourselves, constantly. Some people may be highly competent, and only need to read through some things every now and then, or spend a few minutes practicing a skill. Others may need to make up for areas that were not taught well in the first place. Most are probably somewhere in between.

Monday, February 6, 2012

Evidence Based? What Evidence?

Lots of talk these days about "evidence based medicine."

I think most people are completely unaware that so much of what has been taught for years and years really isn't based on evidence.  They get confused when CPR changes, and hang onto ideas they were exposed to as kids (but probably have never done) like using a razor blade to cut a "v" over a snake bite, and sucking out the venom.

I think it's great that more and more studies are being done, trying to find out whether our protocols really help or not. It's tricky, though. Studies vary greatly in how well they are designed, let alone carried out. It's very easy to design a study that doesn't really show what you intend for it to show, to fail to take into account all the variables.

Even so, some studies are decent, and it's good to look at them, and to learn from them. Around here, at least, and probably elsewhere, protocol changes are slow to happen, but that doesn't mean we shouldn't be out there learning about the latest information, so that we're able to run with them when we get them.

I was looking for something else entirely this morning, when I came across an interesting resource that I had never heard about before. It is a website called "EMS Evidence Based Protocols" from Dalhousie University in Halifax, Nova Scotia.  It is a database that includes links to research papers (mostly through PubMed or Medline), and then a sample protocol based on that research, for a variety of conditions and situations.

The University also has a program to teach Paramedics how to evaluate research, which is interesting. They offer to teach that course at conferences, and I wish someone would take advantage of that offer.

It's a pretty interesting website, and well worth exploring if you're interested in looking at research. I wish it had more, and hope they continue to add to it. For now, it's the easiest access I have to looking at research, except for some of the things that are more "in the news" like CPR changes. I can only access the abstracts, but I think it may be possible to get the entire papers, if you really wanted to.

Sunday, February 5, 2012

More resources

Stumbled across another great online resource yesterday.

It's Paramedic Tutor's eLearner page.

Looks like it's a couple of years old, and not being updated now, but the stuff that is there looks pretty good.

There are links to youtube videos, playbacks of virtual classroom lectures, and podcasts.

A lot of it is cardiac/12-lead interpretation, but there is a lot of other stuff there, too. I'm drawn to the cardiac stuff because I find it so fascinating.

For those who are interested, he also has a page of information on creating your own educational materials.

This is all courtesy of Rob Theriault, a Canadian paramedic who can be found all over the internet in a variety of EMS-related forums. You can read all about him here. Interesting story. He's one of the folks behind EMS Educast, which I've mentioned before.

There is SO MUCH educational material out there it's simply not possible to get through it all, but this guy is one of the ones to pay attention to. Thanks, Rob.