Tuesday, January 31, 2012

Last Year's Show

Still moping about not going to EMS Today.
Still hoping to go down to the exhibit hall for a day.

Not to meet Randolph Mantooth, although I hear it will be possible.
I'm not interested.
Johnny Gage is real. Meeting some actor will make him "not real," and I'm just not going there.

I spent part of today going through some of the stuff I picked up from the exhibit hall last year.
It's a lot.

I went through it because I was looking for my samples of QuickClot. I found them.

Came across the sample Hurl-E. This was one of the new products showcased last year. Fortunately, I haven't needed to use mine yet.

There was a lot of information handed out. From seizure care, to the national field triage protocols from the CDC. An entire program on improving CQI. One on blast injuries.

In other words, even if I didn't get to go to any of the classes (whimper), if I went through all the information and training material I could get from the show floor, that would easily equal more than the number of class hours provided.

No CME credit, though. Which is too bad, but really, I'm more interested in the information, than in getting "credit" for it.

So I think I'm going to try to do it, as long as the weather allows.

It's going to take a lot of Red Bull.

Monday, January 30, 2012

Will I, or Won't I?

Way back in November, I posted about trying to decide whether I want to take the EMT-CC class or not.

It finally came to the time when I had to decide, and I've decided to take the class.

Trouble is, there may not be enough people for them to run the class. Meaning all that deciding may well end up for nought.  I'll find out tomorrow.

In the meantime, I'm still checking out various sources of training, and trying to keep up with things on my own. If this class runs, I'll need to do a lot of studying on my own, as well as start more ride time and clinical time, so it's a good thing these are things I like to do.

Sunday, January 29, 2012

All Strokes Are Not Created Equal

Strokes have made the news a lot in the past couple of years. There are organizations like Power to End Stroke who are working to increase people's awareness of stroke symptoms and risk factors. I have three or four different refrigerator magnets that list stroke symptoms, from a variety of places.

I think it's great. The more people know about it, the better, and the more likely someone having a stroke will get the help they need.

Interestingly, though, the strokes I've heard about and/or seen have not followed these lists very well.

My first experience with strokes was when I was a teenager and my mother had a stroke. I did not live with her at the time. She was at work when it happened, and she described it as "the wrong words came out." Clearly some sort of aphasia. She said that at first, she didn't know what had happened, and it wasn't until a coworker told her that her face was "crooked" that anyone, herself included, thought to get her any help. Both of these are well known "stroke symptoms"- difficulty speaking and an uneven or drooping face. But she didn't have ALL the symptoms that are usually listed. No one sided weakness, no difficult moving or walking or gripping, no "slurred speech."

I know now, of course, that people don't always have all of the symptoms, since where, exactly, the stroke occurs and what it might impair will vary widely. But at the time, she and her co-workers didn't really consider a stroke until the symptoms had been present for quite a long time, because it didn't match the image they had of "a stroke."

Another experience was when my sister had a stroke. I don't know what her symptoms were. In her case, I only know a couple of details. One is that when the other people in her family went to bed that night at about 11:00pm, she was fine, and they found her, unable to move, the following morning. She said later that she had been lying there unable to move, and unable to get help, for several hours before anyone woke up. When I heard that, it worried me, since what I had heard about strokes was that if you "caught them early" the person had a good chance for recovery, but if it was longer than about three hours, there wouldn't be anything that could be done. She had not been found for at least six hours.

She recovered extremely well. I believe there is a little residual weakness in one of her arms, but that's it. Walking, talking, no problem.

Since then, I've had a number of patients present with symptoms of a stroke, some very obviously so, others more subtle, and others, still, with a confusing combination of symptoms that probably included a stroke AND some other things going on.

So if the symptoms may not match the image people generally have of "a stroke," and if how well someone recovers can't be predicted, then what do we really know about strokes?

The answer is not very much. And a lot. At the same time.

Much of it comes down to people all being individuals.
Some of it is a better understanding of a wide variety of possible signs and symptoms, instead of only three or four, not all of which might be present every time.

It's definitely interesting.
How the brain works is right up there with how the heart works, as far as being totally fascinating.
I especially find it fascinating to see how people recover, and how they don't. What heals, or what does the brain or body find ways to adapt to, and which things seem to be more difficult?

Clearly, another case of not enough hours in a day, or days in a year, or years in a life to learn everything.

Maybe some day we'll have better ways of diagnosing a stroke in the field, and better ways of treating them. Medical science has made a lot of advances, but sometimes, with this, it comes down to "wait and see."

Saturday, January 28, 2012

Things I Want but Likely Won't Get

I keep a list of things I want, or things I'd change, if I was the one who had the authority to make the changes.

Top on my list today is a portable, personal CO detector.
One of those that clip onto something would be great. We could clip it to the bag we carry in to every call.

I was just looking for information on them, to see the pricing, etc. The ones I saw would need to be turned on for each call, and we'd need to learn to do that.

I also saw some disposable detector cards. They last for 90 days, and change color in the presence of CO. Nothing to turn on or off. You can get them for about $3, so replacing them every 3 months would not be expensive. However, they don't have an audible alarm, so we'd need to look at them to notice the color change.

All it would take is one call that comes in as "sick person" and turns out to be "CO poisoning" to make either option worth it. Word is, our dept had such a call not long before we joined. Fortunately, everyone turned out okay, but it easily could have turned out differently. I might just get some of the cheapo disposable ones for myself, and go with that.

For a long time, a new KED, perhaps the K.O.D.E. 2, was on my list of things I want. The old KED we have is in desperate need of replacement, but right now, what I'd like to have even more is a set of good, clear, scientifically valid protocols for spinal immobilization.

I made my original list last year, at EMS Today.
Yep. Still moping that I can't afford to go this year.
Still... maybe I COULD go down for the day, check out the show room, get more ideas for things I want but won't be getting. Tempting. Very tempting, indeed.

Friday, January 27, 2012

Customer Care: series of articles

About a year and a half ago or so, I attended an area training day that included a presentation on Customer Service. It was based on a handbook called Quality Improvement for Prehospital Providers. Click on that for a link to an earlier pdf version of the handbook.

"Everyone knows" that it's important to provide good service. Not everyone agrees on the priority of that service, how to provide it, or how to measure it.

I created a training session on the topic (with some help), that I've also written a blog post about.  Since then, I've looked for other ways to improve our level of service.

Today, I came across a series of articles being reprinted by EMS World.
Here are the links to them:

EMS Revisited: Customer Care, Part 1  What is Customer Service?
EMS Revisited: Customer Care, Part 2  Making a First Impression
EMS Revisited: Customer Care, Part 3  Let Your Patients Know What You are Doing and Why
EMS Revisited: Customer Care, Part 4  Conducting a Patient Interview
EMS Revisited: Customer Care, Part 5  Why Do So Many Responders Dislike Nursing Homes?
EMS Revisited: Customer Care, Part 6  Are You a Professional Driver?
EMS Revisited: Customer Care, Part 7  Looking and Acting Professional
EMS Revisited: Customer Care, Part 8  Implementing Changes: Share Your Vision

Don't forget that EMS World is searchable, so there's always more.

Thursday, January 26, 2012

EMS Today Show Floor

I'm considering going down to Baltimore just for a day, to visit the exhibit hall.  There are several interesting looking free CME classes, and a lot of new stuff to check out.

You can find a list on their website.

The list of exhibitors is here. Each has a description of what they have, and most of them have links to their websites. There is a symbol to show which are new exhibitors.

There is a list of free classes in the exhibit hall here. The whole list of sessions is searchable.

I'll come back and note what I find most interesting when I get a chance.

Wednesday, January 25, 2012

Spinal Immobilization: Nothing But Questions

If you haven't already read any of the various articles and blog posts about whether or not we should be immobilizing patients, or what research there is or is not, supporting such a thing, go read this article from EMS World.

I have a lot of thoughts on the subject, and many questions, but no answers.

It is clear to me that with elderly patients, who may have fallen from standing, or from a chair or bed, backboarding them may well do more harm than good.

It is clear to me that we have a lot of patients from MVAs who are unhurt, due to the improvement in car construction, safety belts and airbags, or just plain luck, who are backboarded due to "mechanism" but don't really need to be. It probably falls in the "neither harm nor good" category for most of them.

Where I'm not clear is this: patients who are injured, who have a mechanism that protocols say we should immobilize... what then? Does it really help?  If it doesn't, then what WOULD? What SHOULD we be doing? How can we help the people who NEED some sort of protection because of a spinal injury?

I have not had a patient who was demonstrably harmed from either being immobilized, or from not being immobilized, that I am aware of.  Still, I'm not satisfied that we're doing the best we can for them.

I'm intrigued by the full body sized vacuum splints. How does this change the effects of being backboarded? Is it safer?  How about those pads they make for backboards? Any real difference?

Mostly, I want to know when there WILL be actual research on all of this.
I confess, it scares me. It scares me that we might be causing harm to patients. That I have protocols I have to follow- but don't know what they are based on, if anything.

I know medics who sometimes choose, under certain situations, to override protocols, when they are sure that it is in the patient's best interest.  I am way too new at this to feel comfortable doing that, so I'm left in a very awkward position.

I got in this to help people.
I don't want to do things that harm anyone, and I want to know, for sure, or at least as sure as I can be,  that what I'm doing actually helps.
Is that too much to ask?

Tuesday, January 24, 2012

Maybe Not So Lonely Soon?

Those of you who have been reading this blog for a while might remember my post about our new EMT who was discouraged from training. I don't think I ever posted about what happened next. Long story short- she defected. Went to be a bunker at a different department. One that has regular training. Where she is encouraged, rather than hassled and discriminated against.

Absolutely the right choice for her. No doubt about it. I actively encouraged her to go because she was not going to get what she needs out here.
A bummer for us, though.

A couple of months later, we had a new member join the department, who was an EMT elsewhere. Several years of BLS experience, with an agency that had a somewhat limited scope of practice.

She's turning out to be okay. Not great at assessments (I think she hasn't had a lot of practice), but she usually shows up, and when she does, she steps right up and offers to help, no skulking around in the background waiting to have her hand held.  Some room for improvement- as we all have- but already a good addition.

And, to top it off, a former member from years ago, long before I was ever involved, has decided to rejoin, and recertify. From the brief discussion I've had the opportunity to have with him, it sounds like he might have his head in the right place, and be another good addition.  If he really does recertify, we could be about to double our resources. There will be four of us who actually show up and do the job.

I'm delighted.
I love doing this, but it doesn't mean I want to do it all by myself!

With four of us, we can do a lot of great training as a team. Maybe enter one of those JEMS Games sort of things sometime. Some places have BLS competitions.

Yeah, I'm getting ahead of myself.
Still, it reduces the stress just a little to have at least the hope of having a real crew out here.

Monday, January 23, 2012

The Purple Bag

In the first class I took that talked about dealing with dangerous patients, or dangerous situations in EMS, it was suggested that we come up with a "code" word to use if the situation was turning bad. The theory was that we might not want to make it obvious to the other people on scene, but we wanted a way to clue in our crew that we needed to get the heck out of there, or, if we could not, we needed someone to attempt to get help from the outside.

The code that they suggested was to say something like "Can you go to the ambulance and get the purple bag?" when there is no such bag, and everyone on the crew is aware of that. What it really means, is to get outside, get to the truck, and radio for help. At the very least, it's a way to make it clear to the rest of the crew that you think something is going terribly, terribly wrong.

Another suggestion was that if you were in a situation you could not get out of, but had a radio, that you could use it to try to get help. Turn the volume all the way down, so you (and the hostile person or persons) can't hear anything someone might say, and key the microphone and hold it open. Then, find a way to include information in your conversation with the people. Try to mention their names, your own name, where you are, etc. If there is a weapon present, and it can be mentioned in conversation, do that. Hopefully, someone on the other side of the radio- dispatch, perhaps- will hear you, and be able to figure out who and where you are, and what the problem is, and get help on the way. This might be a good tactic in some situations, but here, the digital radios make that loud noise after being keyed, so I'm not sure it would work as well. Maybe if you can cover that up.

I've also heard a story about a firefighter near here who once asked dispatch very pointedly "Is EVERYONE coming to this call?" until they figured out he was asking for law enforcement back up, but was in a situation where he couldn't say that without aggravating things.

It's good to have a variety of ideas in your head. That way, you might be able to bring one to mind if you need it, and since there is no way to predict what might happen, you also can't plan ahead much detail for what you'll need to do to get out of trouble.

In firefighting, there is the Mayday call. It's pretty standard now, and departments train on it.

As far as I know, there is no such standard concept or training for EMS. I would think that in some situations, it might transfer over perfectly well. "Mayday, Mayday, Mayday, we're on highway 17 near exit 42, our ambulance has just been hit by a tractor trailer and overturned. There are injuries, send help."

Yes, we could also just radio the information, BUT, that repeated, rhythmic, "mayday, mayday, mayday" is VERY easy to catch on the radio and respond to. I heard a firefighter call a Mayday not too long ago, and although most everything else on the radio was garbled and barely understandable, that rhythm was UNMISTAKABLE.  It totally jumped out at me and got my attention. So if it's possible to do, without making your situation worse, I think it would be a good choice for EMS, as well. I don't know of anyone who is teaching it that way.

I'd love to hear other ideas, especially things people have actually done that got them out of trouble.

Sunday, January 22, 2012

Energizer Bunny Time

I'm tired. I've had a long day. I stayed up too late last night to start with, and got up too early today. Worked for a few hours, and then, right when I got home, thinking I'd get a nap- isn't this how it always happens?- called to a structure fire. This is twice in a row now when I've had that same sequence of events: late night, early morning, hours of work, and just when it was time to rest... nope.

Being a volunteer, it's not possible to predict when we'll get one of the kinds of calls that require extra energy, extra alertness, extra everything. Except, naturally, it tends to happen right when I'd rather it didn't, as if getting that tired conjures up disaster for someone else.

Years ago, I told someone I worked with that she looked tired, and she snapped at me. She said that you should never tell anyone they "look tired" because it's basically saying they look like crap, and who needs to hear that? How does that help anything? If anything, if the person really is exhausted, it will only make them feel worse.

My thoughts at the moment, such as they are, are about what to do when exhaustion runs smack into having to keep going, maybe even up your game.

I'm not talking about caffeine, although there are certainly times when it seems to help.

What else can you do? What can you do to keep yourself going, to stay awake, to keep your partner going?  A quick dozen jumping jacks? A spate of terrible attempts at humor? Singing along with the radio really loudly? (The music kind, not the emergency services kind, although singing along with your dispatcher might very well wake some folks up.)

I have some CDs in the car of music that is loud, fairly obnoxious, and that I don't actually like, but that keeps me awake. I try to keep a little "emergency chocolate" on hand. Maybe even some actual food to combat dropping blood sugar.  Jumping jacks can help sometimes, but generally only early on in the cycle. Wait too long, and I don't have enough energy to get them going, or a good enough mood to want to.

We're accustomed to going to calls, having been woken up in the wee hours by the pager, so we're fairly good at covering each other by reminding someone of anything they blank on. We'll talk on the way to the call, go over protocols, as much to keep from getting distracted and fog-brained as to remember the information.

We're also learning when to bow out, when we really are too trashed to be of any use on scene. A hard choice to make, but occasionally necessary.

Sad to say, but as I get older (ouch!) it takes me longer to recover from true exhaustion, so if I get close to that point, I have to adjust everything to "catch back up." I'll schedule in a couple of naps, and if I can, days when I don't have to do much.

Some of it, though, is sheer will power.  I keep going because I have to. So far, I haven't really tripped myself up, but I haven't been doing this that long.

And of course, eat better, and stay hydrated, goes without saying.
Unfortunately, it also often goes without doing.  :-(

Any other great ideas out there?
I could use a few before I fall asleep right here on my keyboard.

I need to stay awake long enough to see the end of the football game!

Saturday, January 21, 2012

What Was That Again?

I had a very interesting conversation today with the mother of a student. Turns out that part of her job is captioning lectures for hearing impaired students. She is working on a project funded by the National Science Foundation because they have found that deaf students were dropping out of certain kinds of classes largely because the method of captioning video material sucked, and was not accurate enough. As is often the case when things aren't working well, it was a communication problem.

This got me thinking about the variety of situations we come across where there is a communication gap of some sort.

There are several totally different kinds of situations that cause communication problems.

Possibly the most obvious one is a language barrier. If you and your patient don't speak the same language, it can be hard to ask and answer questions. One possible resource is a translator- perhaps a child, or a friend on the phone, or  professional translation service. You might also have a phrase book, or, if there is a particular language that is common where you are, learn some of that language, particularly phrases that would be useful during an emergency.  Sometimes, rudimentary signing can help, or drawing pictures.

Another situation is one where your patient has dementia, or an altered level of consciousness. Perhaps they could normally communicate with you just fine, but not at the moment. This one is tougher because you can't just translate. They may not be able to understand you at all, and vice versa. Try very simple questions or commands. Assist them physically, if necessary. Demonstrate what you want them to do, or help them do it. If there is simply a delayed response, give them time to answer or move.

Because of the conversation I had earlier, I spent a little time looking for resources for EMS for hearing impaired people. The usual places yielded excellent results.  EMS1.com has a good article on Patients With Hearing Impairment.
Greg Friese, from Everyday EMS Tips, also has an article on Assessment Tips for Deaf and Hard of Hearing Patients.  One suggestions I found was to carry a small white board and dry erase pens, since they are easier to write on while on your back. That would be useful for a wide variety of patients.

Yet another situation that involves a communication barrier is when your patient is on the autism spectrum. Because the symptoms vary so widely, it is not possible to simply have a specific plan for how to best communicate with such a person. You'll need to wing it a little, and figure out what works for that particular patient. An understanding of what that means is, of course, a good idea. I've been to three different training courses so far, and learned different things from each one.

A good starting place online is an excellent video from the First Responders Network, one of their "Seat at the Table" videos, Communicating with the Autism Spectrum.  It's about 18 minutes long, and has a couple of guests discussing the issue. It also references a blog (Spirit of Autism) written by a woman who is an EMT, and has an autistic child. She has a page of resources for emergency responders.

Communication is such an important part of what we do that it is well worth the time to consider these types of patient contact situations, and be as prepared as possible.

I'm planning to go out and get a small whiteboard that will fit right into the PCR clipboard. I'm sure it will be useful.

Friday, January 20, 2012

A Whole Lotta Heart

Did you know that Secretariat, who won the Triple Crown in 1973, including winning the Belmont by an unprecedented- and unrepeated- 31 lengths, had an unusually large heart? It was apparently due to an x-linked genetic factor.

I was reminded of that this morning when I came across this article: http://www.drjohnm.org/2012/01/ventricular-fib-contagious/

Two hearts? Wow. Not something you see every day.
Or ever, for the most part.

And THAT reminded me of a call I overheard on the scanner the other day.
A nearby agency got a call for someone, I don't remember the details of the call, except for one of them getting on the radio to ask if the other one was familiar with the patient, because he was the "guy with the LVAD."

I didn't know, specifically, that there were any people with these devices in our area.
The amount I know about them could fit in a thimble.
A very small pinky-sized thimble.

The world working the way it does, I figured that was a suggestion from the universe to do a little research and change that.

Start with the wiki page: http://en.wikipedia.org/wiki/Ventricular_assist_device

There are two different types of these devices, one that uses an action that produces a "pulse," and one that uses pumps that do not create a pulse-like movement.  Is it me, or is this at least a little amusing: people with the second type of pump "will need to carry documentation that says that the lack of a pulse does not mean that they are dead." Imagine being handed such documentation- by the patient.

I know what they mean, but still. Funny image.

There is a lot of information on that wiki page, including links to a variety of interesting articles.

But it's an overview, and none of it tells me what I would need to know about such a patient, except that they may, or may not, have a pulse.

Found an interesting blog post. That's a little better. Heading in the right direction.

EMS World has something to say, too.
Some excellent information there. Worth making into a list and printing out to carry in the rescue.

I'm starting to feel a little better.

Over at EMS Office Hours, they have a podcast on the topic:

I have NOT found any protocols for my state or region, but it doesn't mean there aren't any.

Thank you, internets and blogosphere, for helping me out with this.

Thursday, January 19, 2012

Here We Go Again

Back near when I began this blog, I wrote a post about a time when a new EMT was actively discouraged from training.

Well. Here we are ten months later, and the same thing just happened to me.

At a meeting, when I reminded people that I have been going to some regional training about an hour away, I was told that I shouldn't do that, because I can get "all the CME you need locally."

I responded that I LIKE going there, that I've found all the presentations I've attended to be excellent. I think it is a wonderful opportunity.

I was then told that all I need to do for CME credit is have <the person who was talking to me> sign off after any meeting we have, any time we discuss EMS things.


This is considered "all the CME you need"?

I don't know how to get through to people that I am not interested, at all, in doing the minimum legally required (and I don't think sitting around yacking even qualifies for that). I am not interested in what is easiest, or most convenient.

I want to have the best education I can manage to find. I want to learn from the best teachers and presenters.

I don't think they realize, or can even grasp the concept, that I actively work on this EVERY DAY. I go to conferences and training events. I do online CME classes. I read magazines and books. I practice my technical skills. I discuss all of this with other EMTs on an ongoing basis. My training is not limited to one evening a week.

I may be "just a volunteer," but this is something I am VERY interested in being good at. That is, actively interested, as in I ENJOY learning.

Why is that so strange? Surely I'm not the only one who takes this seriously. I know I'm not. I know plenty of people who are at least as serious.

I don't know why it is so impossible for some people to understand.

Wednesday, January 18, 2012

Job Opening near Rochester NY

A friend of mine just passed along this job posting:

Med-Scribe, Inc. is currently conducting a search campaign for an Emergency Medical Services Manager for an all-volunteer team providing ambulance service to their community on the eastside of Rochester.

The successful candidate for this position will handle the operations of an all-volunteer ambulance corp. This is a diverse role requiring EMT background and experience with human resources, scheduling and public relations. Candidate must have strong interpersonal and managerial skills. Hours: 8:00am-5:00pm with flexibility to cover for board meetings, events, and related programs. The salary range for this position is up to 40K with experience. No medical benefits, paid vacation

REQUIRED QUALITIES: Team player, able to take initiative, self-starter, flexibility, and the ability to think on your feet. This person would be scheduling staff, supervising staff, and assisting in managing volunteers. Eventually may manage other in-agency staff. There are approximately 75-100 active members. Candidate will be required to continuously update the agency and the board on the current compliance requirements. This would be the first salaried employee. This is a direct hire position.

REQUIRED QUALIFICATIONS: Must have a clean driver's license. 2-3 years field experience as an EMT, understands training requirements, current certification: EMT B- at a minimum. Must have management experience. An Associate’s Degree or higher is required.

To be considered for this position, candidates must complete an online application at http://www.medscribe.com and reference order number #1141209.

Amy DeVincentis, Recruiter
Med-Scribe, Inc.
Fairport, NY 14450
Toll free: 1-800-278-1463
Phone: 585-586-0790
Fax: 585-586-0989
email: medjobs@medscribe.com


Sounds like it could be an interesting job.
One I might actually have the qualifications for, if I wanted to move there.
I did a little research, and I'm pretty sure I know what agency this is for.

But is it just me, or is it weird- and WRONG- that this job, as described, includes NO MEDICAL BENEFITS? They want to hire someone to oversee an organization providing medical services that that person could then not afford to use? At the very least, I'd think they'd offer a free ride if necessary. This is a more than full time job, with a huge amount of responsibility.

If the person who they hire has a family, that salary would place someone out of the range where they could get state-subsidized health insurance, but does not provide enough to afford coverage for a family. It falls right in that "stuck in the middle" range of too poor to afford much, but not poor enough to get help.

I don't know much about ambulance services across the country. I know the one nearest here offers medical benefits. Do most of them not? Do most jobs not provide health insurance anymore? Every full time job I've ever had, other than being self-employed, has provided health insurance. Is that not the norm anymore?

I would believe it. The whole system is a huge mess.

Tuesday, January 17, 2012


Last year, I went to EMS Today and loved it.  Sort of caught conference fever, except that I can't really afford to travel much, and can't afford high conference fees. So I don't know if I'm going to make it back there this year. Probably not, sad to say.

On the other hand, I also attended some smaller conferences and "teaching days," all of which were also wonderful and well worth attending. A little closer to home, cheaper fees, cheaper hotels, or the ability to commute instead of stay over.

I've been moping a bit lately about not going to Baltimore, so to cheer myself up, I'm looking at other opportunities. I'm listing them here so I have an easy reference point. Some of them don't have much information up yet, some do, and some have some great material available form previous conferences! Some are very large, some are very small.  The list is not all-inclusive- some of my favorites from the past couple of years don't have any information online yet, not even potential dates. I'll post about them as I find them.

Finger Lakes Regional EMS Council
Feb 24-25
Hobart and William Smith College
Geneva NY

EMS Today
Feb 28-Mar 3rd
Baltimore Convention Center
Well worth going- but expensive
Sells recorded sessions from previous years.

FASNY EMS Conference
March 3-4  $60 plus lodging & dinners (includes breakfast and lunch)
NYS Academy of Fire Science, Montour Falls NY
Pre-seminar March 2nd: 8hrs BLS core

Emergency Care for Individuals With Special Needs- Geriatric and Pediatric
6 CME Hours
Thursday March 8 2012
Albany NY
This program appears to be repeated in Poughkeepsie on Apr 14

"Saving Lives with Dedication Through Education"
Emergency Medical Services Educational Seminar
http://www.emsedsem.org/  includes link to conference handouts from past several years!
$225 early bird registration
March 16th and 17th (Friday/Saturday) 
Pre-conference day Thur March 15th, focusing on the elderly
Crowne Plaza Conference Center, Cromwell CT

Spring Conference in Olean: Treating Tiny Tots
March 23-24
$90/person for people outside their region, includes some meals
Sessions include: Unspoken Rules of EMS, Neglect/Abuse, Special Needs Kids, Impaired Children-drugs and alcohol, trauma/burns, cardiac arrest/resuscitation, CISM.
One of the presenters is Lee Burns, who I've seen before, and really enjoyed.

March 23-24
Henrietta NY (RIT)
Pre-conference Thursday evening
$160 early bird

North Country EMS Annual "Spring Fling"
No info yet on 2012 conference, except dates: Apr 26-28
Alexandria Bay NY

Albany Med EMS Education Day
Tuesday May 22nd
7 hours CME available
I only have their facebook page for info

Northeast Wilderness Medicine Conference
May 31- June 2nd
Upstate Medical University, Syracuse NY
Not much info yet, but you can sign up to get notifications

Fire 2012
Full day of EMS sessions
June 13-16 2012 Turning Stone Casino

PA State EMS Conference
No info yet on conference, except for dates:
Aug 16-17

No info yet on the 2012 conference
In October

Pulse Check!
Includes links to conference materials/handouts for past two years
No info yet on 2012 conference
October 11-14, 2012
Crowne Plaza
Suffern, NY

Vital Signs
No info on 2012 conference
Oct 18-21 2012  Syracuse NY
http://www.vitalsignsconference.com/sessions_2011.htm has a few handouts from 2011

EMS World Expo
Oct 29-Nov 2
New Orleans LA

No info yet
Nov 1-4 Atlantic City NJ

Monday, January 16, 2012

Unanswerable Questions

At a recent call, I was asked that simple question that most family members want to know. Simple questions should have simple answers, but this one rarely does. "Will he be okay?"

The answer I could not say was "How on earth should I know?"
Unfortunately, that is always the answer, because no one ever knows. Not me, and not the doctors, either. The answer I give to that question varies with the situation.

It reminded me of various times I've been asked questions that were difficult to answer, for one reason or another.

Like the first time a patient asked me if they were going to die.
Or the time one asked me- begged, really- to help her die, right then.

What kind of answer am I supposed to give them? There isn't one, and yet, I can't just ignore the question.

I've heard a variety of the "will he be okay" questions, in circumstances that ranged from almost silly (no real injury at all) to not silly at all (where the answer was closer to "I really don't think so.")

I've been asked a few times if a patient was, in fact, dead. Usually when it was pretty obviously so, but clearly they were hoping for a different answer, one I wished I could give them, but could not.

In my original EMT-B class, we were told not to lie when asked these questions, but we weren't really told what to say. We were encouraged not to use euphemisms, so that people would clearly understand what we meant. I get that.

But saying "Yep, grandma's deader'n a doornail" probably isn't the best choice.

It finally occurred to me to look at what all these people were really saying, really asking.

When the patient was dead, they pretty much knew that, so they couldn't really be asking me if it was so. They also ought to know that I can't predict the future, and can't make any guarantees, so they can't really be expecting me to know, for sure, whether someone will "be okay." Hoping, maybe. Expecting, no.

What they all have in common is fear.  Fear of death, and fear of the unknown and unknowable. In addition to any actual answer, such as there might be, they are looking for, asking for, acknowledgment of that fear. For the most part, they are in a situation they did not plan on, probably did not expect, and can't control. With that level of stress, people say things that don't necessarily make logical sense- and that's okay. What comes out is what comes out.

So I try to answer questions when I can. When I can't, I explain why I can't, and express an understanding of their wanting to know.

For the one begging to die?
The best I could manage at the time was "I'm sorry you are in so much pain. We're doing the best we can to make it less."
And I really WAS sorry. I had never seen anyone in such pain before, and it was quite unnerving. It took me a while to learn to separate myself from a patient's pain. Almost as if I got confused, and didn't remember I was not the one in pain. This is a topic I'd love to see a class or conference session on, working with patients in extreme pain.

Sunday, January 15, 2012

Another Resource

And the hits, they keep coming.
Okay, not hits, so much. If I reach double digits on here, I'm having a great day.

But information coming to my inbox, or that I see on facebook or twitter or on other blogs... that keeps coming. There is such a huge amount of excellent training and information out there, I could never, ever, go through it all.

I still try. :-)

Saw this mentioned a couple of days ago.
Free Emergency Talks

It is a LONG list of free recorded talks from a variety of sources. It is intended, from the looks of it, primarily for ER docs, rather than pre-hospital providers, but there is still a lot of valuable information there for us. Assessment is assessment, wherever you are.

Dangit, I wish I could remember where I saw that link, so I could credit them, but I don't.

Saturday, January 14, 2012

Winter Finally Shows Up

I was loving the weather this year, in some ways. Mostly, in the "lower heating bills" kind of way. It has made me a little nervous about what the summer will bring, but for the most part, I've been fairly happy with how the season was progressing. Low key, not much going on.

Until now.
First, they predicted scattered flurries.
Then it was 2-4 inches.
Or 4-8 inches.
Make that 8-12 inches. Wind warnings.
Or maybe it will only be 8 inches.
Or a total of 6-10.
Or could it possibly be that they have NO IDEA?

I'm going with that.

It has been snowing for a couple of days now. Not a lot at one time, for the most part. Yesterday, it did something I haven't seen before. Started the day with crappy roads, then it cleared up. Got bad again, then it stopped for a while and the roads were cleared. Then, yet again, snow covered the roads... and was cleared off. I have never seen that happen so many times in one day, going from really crappy, to just fine, and back again, several times over.

It made it very difficult for people to plan their days, or to know whether the roads would be safe to drive on. They might be fine on the way somewhere, and nearly impassable on the way home.

We had three calls within 16 hours.
Not a lot compared to some places, but a lot for us.
Three completely different situations. I think all the patients will end up doing well, but if I had to guess, I'd guess they may not all be home today. We have some chance of hearing about two of them, being local, but probably won't know much about the third, who was just passing through.

I was fairly pleased with how the calls went. Both in how well we functioned, and in the outcome.

We were the lucky ones for the day.
Several fatalities within a short distance from here in the past week or so. One, we listened in on the scanner last night, and I believe there was another one nearby just a couple of hours ago.
When they shut down the state highways for several hours, that's a great big clue.

The snow is supposed to stop soon. I don't begrudge the winter its share of white fluffy stuff, but I have a totally different relationship with snow now than I did before joining the fire department. It often brings us more work, and some of that is not kind to some of the people out there.

Be careful. Learn to drive in snow, if it happens where you are. Take your time- or stay home. Seriously, people. Wear your seatbelts, don't drive faster than the road conditions allow, and hit the deer.

Friday, January 13, 2012

Who's Your Mama?

Had an interesting thing happen at a call that makes me wonder if there is a place for another aspect of patient care, or, if not, how we can integrate this into what we're already doing.

The call was a minor MVA. A sign off.

It was witnessed by a woman who stopped to help. She didn't feel that she could just keep driving and leave whoever it was there alone.  She went to the driver's door, told him not to move until the EMTs got there. A neighbor came out and offered a blanket, and she wrapped the driver in it, and held his hand.

She told him that for the time being, she was his "second Mom."

She got out of the way when EMS arrived. After the ambulance left, she resumed her "second Mom" role, rewrapping the driver in the blanket as she put her arm around him and walked him to the car of a friend who had come to give him a ride, since his car wasn't going anywhere for a while.

Two things struck me.

One is that for us, as EMS, to tell a patient we're his "second Mom" and to ramble on about taking care of him until his Mommy can, would be a bit out of place. Our primary job is to assess the patient, and see that his medical needs are taken care of. It's not that we ignore emotional needs- we clearly should not- but we aren't our patients' Moms, really. To cast ourselves in that role is kind of personal, and I think for some patients, it would be unwelcome.

The other is that it was very sweet.
There is absolutely a role for doing whatever it takes to help the patient feel cared for, and this lady did an excellent job of that.

So where, in our role, does that fit? How do we provide the best care, physically and emotionally, without overstepping? I think I might consider this aspect more than some providers, since I AM a Mom. Just not usually the patient's Mom, thankfully. It does mean that there is that aspect, especially when the patient is young, whether actually pediatric, or closer to the ages of my kids, who are adults now.

Thursday, January 12, 2012

Back to Basics?

I've spent some time today reading over at The Social Medic's blog, specifically, his post On Why Basics Matter More Than You Think.

He talks about how nearly 2/3 of EMS Professionals are EMT-Bs, and thinks there needs to be a change to a system that supports those people and their position better.

I think there are two separate situations going on.

Many places, there are people who start out as an EMT-B, with a goal of moving onwards and upwards. They know from the start that they plan to take the medic class.  Also, in many places (perhaps the same ones, but not necessarily) there are people who value paramedics, and see anything less than that as some sort of lower life form, or at least, less status.

In that situation, being a Basic is perhaps not a typical goal, or a pleasant place to be. It's hard to do your best work when the people around you don't value what you do.

A different situation is where there are people who DON'T plan to move above the Basic level. A lot of paid fire departments require their firefighters to be Basics, but only provide BLS, so there's no reason for any of them to go to a higher level unless they're going to be working two jobs (which some do). A lot of volunteer fire departments also only provide BLS, so there is no reason for their members to go to a higher level, if they plan to stay a volunteer.

I guess that's a long winded way of saying that I don't think every Basic plans to move on. In some places there is a lot of support for, and sometimes, pressure to, take more classes and become a medic, but not everywhere, by any means.

Another thing Dave mentions on his blog is about conferences focusing on ALS topics.

I have a few thoughts about that, but haven't been to enough conferences to really see how common that is or isn't.

I think in order for conferences to have better BLS offerings, there needs to be more people out there excited about teaching BLS topics. That is a possible direction for people to go in, who don't plan to certify beyond Basic- good, solid, BLS education. It would be a great direction to encourage people in who have the interest and aptitude for teaching. A lot of the classes and conference sessions I've been to have been taught by medics, even if they are BLS topics, but two of the best teachers I've had overall were my original Basic instructors- both of whom were Basics themselves.

Another thing to consider is that there is a lot of information out there. Some of it may be ALS, as far as being about things Basics can't do in the field, but I think much of that is interesting and useful to know. The more I understand about what the medics are looking for and what they need to do, the better I can support that effort, and the better overall care my patient will get. I think the Intermediate class made me a much better Basic, really.

There is something I'd change if I were in charge, though.
My observations of conferences and training events so far suggest that most people who are out getting training on their own time are happier to take classes that don't have tests or practical, hands on, requirements. I don't know how much of that is that many of them don't really want to be training at all,  but are required to, and how much is related to test anxiety, but either way, some things need to change. I'd like to see people more excited about actual hands on training, and in order for that to happen, there needs to be excellent teachers, and encouragement for people to move out of the "as little as possible" mindset.

I'm not so sure I agree that EMS needs to go "back to basics," as much as I think people should be encouraged to wring the most out of it that they can in the first place. That original Basic class covers so much, and so little, at the same time. I'd love to see more people encouraged and excited about really learning that material, rather than doing "just enough." I think there would be more people teaching great BLS conference sessions if there was more demand for great BLS topics, and there would be more demand if more people were encouraged to go learn all they can, and supported in doing so. If that's "back to basics," then yeah, let's do that.

This post is a little disjointed. Sorry about that. I'm typing it in the middle of a birthday celebration, with my kids yacking at me. Time for cake!

Wednesday, January 11, 2012

More From My Inbox

A lot of information comes to my inbox.  I've written about some of it before. There is so much it would be difficult to make a comprehensive list, so I'll post about things as they come up.

First up this morning is the Brain Trauma Foundation. I got an e-mail from them a while back, mentioning a free webinar on concussions, focusing on sport injuries. Listened in on it today. Some interesting information that I hadn't heard before.  You can access their recorded webinars here. The one from today isn't up there yet, but I expect it will be soon. There are thirteen others available.

The other thing that came back to my attention today isn't EMS-specific, but it surely is connected. It's an organization called QBQ (which stands for the Question Behind the Question). Their tag line is "Be Outstanding Through Personal Accountability."  There is a free newsletter that highlights various stories of excellent personal accountability. Some very heartwarming stories- and a few customer service surprises.

John Miller, the guy behind this, is a very interesting guy.  He offers books, podcasts, speaking appearances, classes, a blog, the newsletter, etc.  Go check out the website and see if there's anything there you might find valuable for yourself, or your organization. There is a lot there.

I think he's on the right track. Being excellent is a personal choice, and it starts with taking responsibility for your actions.

Tuesday, January 10, 2012

Nope. Not a Joke.

Did my CPR re-cert this morning.
My day job requires it every year- specifically every year, even though both the ARC and AHA certify for two years now.
I like that. I was disappointed when ARC followed AHA's lead in extending certification time to two years. No way does the average person retain the information for that long.

In preparation for the written and practical exams this morning, I was sent a link to the ARC Refresher site. Nice. Went there and went through all of the short refresh sections. Most of it is meant for the layperson, but they also have a section for Professional Rescuers.

The test this morning was interesting.
Not challenging, particularly. I really do know how to do CPR. Somehow, it's much easier to remember when you've done it on real people.

The examiner was a little surprised to find out that although I'm an EMT, I'm still required by my non-EMS job to re-cert every year in CPR. I told her it's no big deal, I need to re-cert anyway, so might as well do it through them. She suggested that the whole testing process was probably "a joke" to me, since I know what I'm doing.  Au contraire. An opportunity to practice my skills is an opportunity to practice my skills, and I'm good with that.

Especially this particular skill.

Most things that people do, they have some warning, some advanced notice.  They can bone up on whatever it is before having to do it For example, if your faucet is leaky, you can look up information on how to fix a faucet, go get the parts, watch a video or two, and THEN shut off the water and fix the faucet.

CPR doesn't work that way so much.
If you're lucky, you get from the time the pager goes off until the time you arrive on scene.
If you're a bystander (a far better opportunity to help, really) you get approximately no warning at all. You have to know the skill, and be able to perform it on the spot.

In order to do that effectively, you need not to be trying to remember numbers of compressions to breaths or which one you start with.

Like any skill you need in what is effectively a combat situation, you need to have practiced it to the point where it feels a little silly to practice it any more. It is SO there, that practice takes no effort at all. That's a good sign. Practice anyway.

So this morning, going through the scenarios took no mental effort.
It doesn't make it a joke.
It just means that for this particular part of my required skill set, I may not have fallen behind.

Probably helps that I go through cardiac arrest scenarios in my head when I'm driving. Yeah, I'm weird that way.

Monday, January 9, 2012

Pipe Nozzle

Ooh, two posts in one day!

Meant to mention this earlier.

I've been following this guy on twitter for a while, and yesterday, he announced that his book, Pipe Nozzle, would be available for kindle for free all this week (Jan 9-13 2012)  from amazon.

It's based on his blog, http://pipenozzle.com.  Clearly a fire-based kind of a blog, but I don't discriminate against firefighters. :-) 

Seems to be an interesting sort of guy. Describes himself as "someone who uses the First Amendment to speak truth to power" and I kind of like that. He strikes me as the kind of person who doesn't run his mouth a lot, but says something when it's important to him.

So I downloaded the book. Haven't read it yet, so I can't give any sort of review, but since it's free, and only for a limited time, I thought a couple people out there might be interested in the opportunity.

As Long As We Don't Get Caught

Short and sweet post today.

I am very, very tired of people whose attitude can be summed up as "as long as we don't get caught."

I keep seeing it everywhere I go. Everywhere.

People suggesting a friend do something she knows is illegal, and how to cover it up so she won't get caught.

Someone posting really nasty stuff about his wife on facebook, followed by "she isn't on here, so she'll never know."

Scandal after scandal in the news of people falsifying credentials, doing things behind closed doors, etc.

Fire departments not following NFPA or OSHA (or PESH, in NYS) or other standards or regulations. Not mentioning any in particular- there are plenty to choose from, sad to say.

And the list goes on.

Second least favorite bs excuse? When I pointed out today that someone had grossly misrepresented themselves, and then published the information they had gathered, without telling anyone that was the purpose of gathering the information, I was told "Welcome to the Internet."  It's true that there are a lot of dishonest people out there- but it doesn't make it acceptable or appropriate, any more than repeating a lie makes it the truth.

If no one ever stands up and says that these things are wrong, nothing will ever change.

Why is standing up for what is right treated like treason so often? This culture has a HUGE in group/out group problem, I think.  If We do it, it's okay, if THEY do it, it's bad... and it almost doesn't matter what "it" is. Just look at politics over the past several years.

Sunday, January 8, 2012

It's Hard to See a Black Dog in the Dark

How many times have you gone to a call with some preconception in your mind, because of what dispatch said?
How many times has it turned out to be wrong?

Or how many times have you gone to a call that started out calm and suddenly, things went south in a hurry?

It's easy to miss things you aren't looking for. Easy to miss things that blend in with the background, so to speak, things that appear ordinary until you find out that for this patient, they are not. And easy to get distracted by some obvious thing, so you forget to look around for what else is going on.

In EMT-B class, they taught about how a "distracting injury" can make it so a patient isn't aware of pain elsewhere.

Likewise, a "distracting symptom" or  "distracting long distance dispatcher diagnosis" can get in the way of the EMT staying open and aware of the big picture.

Sometimes, I think it would be better if dispatch didn't give us any information, so we'd start from the beginning and be alert for anything.
Other times, I wish they'd give us MORE information... but that's a different story.

It's important to have a method, an order to your chaos. Important to do a full assessment every time, preferably in the same order.

Do I always do that?

Um... no.

I have an excuse. (Doesn't everyone?)
I don't always have time to do a full assessment.
Sometimes, the ambulance arrives at the same time, or very shortly after we do, and I get about 30 seconds with the patient before transferring care.

It's not a lot of time, but it's possible to get a lot of information in that short period of time.

My challenge is to:
a) get as much quality information as I can
b) while establishing patient rapport and
c) documenting everything I find before the ambulance leaves

Some things that help:

1. Using a script for documentation, much like I'd use for a radio report.
2. Really knowing where everything on the PCR goes so I don't have to hunt around. Some of it can be filled in on the way to the call, some between the house and the back of the ambulance. Being able to walk and write, in the dark, is a handy skill.
3. Learning as much as I can about "typical" calls, so I know what to ask, what to look for, without having to try to remember some mnemonic.
4. Practice, practice, practice
5. Good pre-planning and post incident analysis with my team, so we can improve every time. Even if that "team" is only me that day.

And last, but not least:
6. Knowing when something is "not right" or "doesn't fit."  Kind of like Sherlock Holmes: look for what is out of place. It is especially helpful to have a team who all look out for such things, and bring them to my attention. Sometimes, the best information comes from a family member who is talking to someone other than me.

We need to see what is obvious, and find what isn't.
We need to be able to see PAST the obvious.

Saturday, January 7, 2012

Did We Help?

One of the ways I like to evaluate calls is by whether or not we did something that actually helped the patient.

Here are some things I consider:

1. Did the patient feel better when we left than when we got there?
2. Was the patient better emotionally- less scared, etc- when we left than when we arrived?
3. Were we able to provide any treatment that improved the patient's condition? Was there measurable improvement?
4. Were we able to provide information to the medic that was helpful in some way?
5. Were we able to help the patient in some non-medical way?

Sometimes, we're lucky to be able to claim one of those.
On a really good day, we'll get them all.

It might be easy. If the problem is that the patient fell and couldn't get up without help, we're in luck. We can help them up, reassure them that it was fine to call us, let the medics return to service, and help the patient make changes to help prevent future falls.  All good.

Sometimes, it's easy in a different way. If the call is for a person who isn't breathing, and we open the airway and they start breathing again, that's pretty straightforward.

Some of the most difficult calls, though, it's hard for us to tell whether we did anything that actually helped, especially when we don't get to know the ultimate outcome. If it's a major trauma, and we extricate, package, and hand them off to a flight medic... did we do something that helped? Maybe. If they survive, probably. If not... none of that list really applies.

So there needs to be another list. The one that has to do with doing what we are trained to do, to the best of our abilities, and in the patient's best interest. Sometimes, that's all we get. Those times, I wish there was a better way for us to know if what we did was the "right" thing, to know that our protocols really are the best possible care. With various changes to protocols over the years, and new research coming out, sometimes it starts to look like not everything we do is as helpful as we'd like it to be. There are protocols that get held onto long after they should have changed, and other things that simply have no real scientific basis, and I'm not in a position to change any of that.

At least not at the moment.

Friday, January 6, 2012

Body Awareness

This culture is a little bit odd about bodies. Between nudity taboos, weight discrimination and all the ways in which sexuality is repressed, we have a lot of people who are very, very uncomfortable in their bodies.

And, as EMS providers, we find ourselves OFTEN in a position to have to deal with that in one way or another. Patients may be uncomfortable with their state of undress, but generally, most EMS providers get past that fairly early on, and focus on the tasks at hand.

Even so, things can be awkward at times. Younger, or less experienced, providers may be uncomfortable with a conscious and alert patient of the opposite gender, especially one near their own age. Or younger people may feel awkward with elderly people.

It's one of those things that can feel very daunting during the learning phase, but really, once you're out there for a while, it becomes a non-issue. Partly because of familiarity, so it lacks any "shock" value, and partly, because we each learn ways to make the situation as comfortable as possible.

Recently, I had a fabulous opportunity to observe a much more experienced provider in such a situation, which could have been very uncomfortable- but wasn't.

It was a call to an elderly woman having difficulty breathing. One of the more common kinds of calls we get. At this particular call, she had some symptoms that suggested there may be some cardiac problem, so the medic wanted to get a 12-lead.

What followed was a thing of beauty. He was wonderful with the patient!  Very calming voice, explained what he wanted to do, and told her that he would need to touch her breasts, and asked if that was okay. Each time he needed to touch her, he again made sure she was comfortable with what he was doing. Lots of eye contact. Fabulous ability to build rapport. Very self-confident, with no hint of self-consciousness or discomfort on HIS part. His ability to treat it as not a big deal went a long way in her being comfortable.

Writing it down, it sounds like something that should be so common that it doesn't bear discussing. Most people manage to remain professional.  Even so, this example really stuck with me because I hadn't previously seen this particular medic doing patient care very much at all. He has been around a long time, much longer than I have, but the cut of the cards hasn't sent him out our way very often. When I've seen him off duty, he hasn't struck me as being a particularly warm-fuzzy kind of guy, but with this patient, he was the very soul of kindness. It didn't surprise me, exactly- the agency he works for has excellent providers, all around- but I didn't know this about him for sure, from personal experience, and now I do.

I'm glad I got the chance. He has definitely moved from my "not sure" category to my "one of the good guys" category.

Thursday, January 5, 2012

Phone Discount

Way back last summer, we were at a Fire Chiefs show, and were given a flyer about Sprint offering a discount for firefighters. We had just switched to Sprint shortly before then, and hadn't heard anything about it.

I went to the local Sprint store to ask, and they said I needed some sort of official ID. At the time, my dept didn't provide any such thing. But now they do.


Went to the Sprint store again today, and the guy there gave me some paperwork to fill out, including some sort of code number he wrote on it. He said to fill it out and fax it in to them, and I'll get a 22% discount on my phone bill. It's only on the primary line on my account, but 22% off that is better than nothing!

So I thought I'd share.

I went looking for an easy link to provide, but didn't come up with one.
I did find some information that looks like AT&T offers a similar discount, and Verizon offers a smaller one.

So if you didn't know about this, and if you're in a fire dept, check with your service provider.

I haven't heard anything specifically about an EMS discount, but there should be one, I think. Ask.

It does require a new 2 yr service contract, unless you are a new customer, in which case, that service contract is already required. Kind of a drag, that, in principle, but we've been pretty happy with our phone service since we switched, and aren't looking to upgrade, so it works for us.  I just wish we had known about it at the beginning.

Wednesday, January 4, 2012

Thanks, EMS1.com!

I first heard of EMS1.com when they gave me a t-shirt at EMSToday last year.

Since then, they keep popping up with good stuff.

I posted about, and posted a link to one of their videos, and today, another was brought to my attention.

While looking for a more direct link to the video, I found an entire page of well organized links to EMS Tips.

That ought to keep me busy for a while!

Tuesday, January 3, 2012

Only Volunteers

In the way-back-when, long before I was involved in Emergency Services, I knew that a blue flashing light on a car meant a volunteer firefighter, and that I was supposed to pull over for them. I remember seeing them several times, and wishing them well, as they rushed to the fire scene. In my head, they were brave people who were willing to voluntarily put themselves into danger to go help the regular firefighters.

What I didn't know then, and most people don't know NOW, is that they weren't going to go help any "regular" firefighters. I had no idea that the only firefighters out here are volunteers. That for most of the county, this is so. Most of the state, really. I thought they were IN ADDITION TO paid firefighters, but that isn't the case at all. 

I also thought they were always going to a fire- that's what firefighters do, right?

I had no idea of the reality until I joined the local fire department.

It has been a few years now, and one of the things I've learned is that most people, by far, believe what I used to believe. And it isn't just about fire, it's also EMS. It would be entertaining, if it wasn't dangerous.

People think there is THE Fire Department. One. National, I think. Or maybe it's by states. They don't realize that each community has its own, totally separate from all the others. I STILL get people who ask if I went to a call that is clearly in the nearby city's jurisdiction. The one paid department nearby. Well, no, I don't get to go to their calls. I'm not in that department.

That one imaginary national department is also a combination department. Most are paid, but there are a few additional volunteers who "help out." I think they carry the ladders for the firemen. Or something.

Where this all stops being amusing is when you realize that people really, honestly believe this.
And that means that they expect the level of service they would get if it really was all one paid department, with equal availability (manned stations, 24/7) and equal training (Fire Academy recruit training for all firefighters on scene). They call 911, the fire dept shows up and rescues them and puts out the fire, right?

Likewise with EMS. 
They believe that the fire department has manned ambulances 24/7.
All members of the rescue squad are paid professionals. Different levels of training, maybe- or maybe not.
They call 911, paramedics show up at their door within a few minutes, and take them to the hospital of their choosing.

As recently as last week, I had people assume that my EMT patch meant that was my paid job- even though they were people who KNOW what my job is. They must somehow think it's some sort of "part time" thing I do- but they clearly think I get paid. Most people I've told that I'm a volunteer are very surprised to find out there even IS such a thing. I mean think about it... that much responsibility to someone who isn't even a professional? Yes, people have asked that.

There are two parts of this issue that I believe need "fixing."

First is that people need to understand what level of service they actually have where they live.
In a lot of places, this is NOT a comfortable thing to understand.
It is not a comfortable thing for a lot of people in the fire service to talk about, apparently, and there is a HUGE unwritten prohibition against discussing the actual level of service, instead of the "wishful thinking" level. I believe this is unethical.
I am sorry that it is uncomfortable, but people have the right to know so that they can make adequate preparations to protect their families.

The other part is that people who are "only volunteers" MUST NOT "hide" behind that label or use it as an excuse for ANYTHING. The public expects professional services, and that is what they should get, paid or not. Every effort should be made to keep up a high level of training. There is NO excuse otherwise, whatsoever. Excellent training plans are easily and readily available at little to no cost.

When I first joined the fire department, I was surprised to discover that there is sometimes some negativity from paid firefighters towards volunteer departments. I didn't understand it at first. I do, now. I'll come out and say that I think that either volunteers who are slacking need to get their act together (that's not everyone or everywhere- but it is a lot of places), or people need to embrace the idea of higher taxes and more paid departments.

That second part is highly unlikely, so what does it leave?

Monday, January 2, 2012

We Are the People

We are the people of the night.
When others are asleep, we are awake, watching, waiting, to be there when someone needs help. We see the sun go down, and the darkness fall. We see the people who have nowhere else to go.

We are the people of the morning. There when others wake, and there for those who don't. As the sun rises and the new day begins, we change the guard, ever watchful.

We are the people of the day, there when bright sun rays meet rush hour traffic. There when the busy rush around, doing what they do, sometimes what they didn't mean to do. There for the hurried, and for the slow.

We are the people of the storm, dressed and prepared, waiting for what comes. As the snow falls, we stay ready to go out, in any weather, more dependable than the postal service. The worse the weather, the more likely we will be out in it, finding ways to manage whatever challenges it presents.

We are there for the unprepared, the accidental, the "won't happen to me." We are there to ease the final path, and occasionally, to greet the new. We are the unnoticed, unrecognized and sometimes unwanted- yet also the necessary. No one wants to see us, yet most are grateful when they do.

It is both a burden and a gift.

Stay well, stay safe.
Love your family and each other.
Hold fast to the good, and let go of whatever holds you back.

Those who can, must, because those who can't, can't.

Sunday, January 1, 2012


I recently saw this post from The EMS Patient Perspective, about being reminded of his worst call ever.

The first really bad call we went to, no one talked to us about afterwards. I don't know why. Maybe they didn't think about it being the first major trauma for us brand new EMTs. Or maybe the officers who weren't there didn't think about anyone who was there needing any help, because they weren't feeling any effects of what they didn't see.

Shortly thereafter, we had our second "bad call."
For me, it wasn't anywhere near as traumatic as the other one.
For some reason, the chiefs decided we needed an official CISD for this one.

Some people we didn't know came in to talk about the incident. They explained that this was for people who were at the call, but still included officers who weren't there. I don't know why. Maybe the officers wanted some sort of personal involvement so they would know what happened?

The purpose of the debriefing is supposed to be so everyone can talk about the incident in a non-judgmental environment. Unfortunately, that isn't what happened.

Anyhow. That's not the point I want to make in this post.
The trained guy who came in mentioned something to us that I took away from the meeting that I think is both important, and interesting.

He said that we would have "triggers" that would affect us for a long time, possibly years to come. That there was no way to predict what they might be, but that we should expect it to happen. Some little detail that we may not even have been consciously aware of would be connected, in our minds, with what we had witnessed, and when we came across something similar the next time, it had the potential to throw us back into an emotional state connected to the earlier scene, rather than the current scene.

At first, it was an intellectually interesting concept.

Then it started happening.

The first time it happened, something at a scene freaked one of us out, who then needed to withdraw from the scene and let others take over. It was communicated well and went smoothly, not affecting patient care at all, so wasn't a problem, but it clearly alerted us that this "trigger" thing was very, very real.

Over time, I've learned what some of the things are that trigger me. None have made me have to back out of a scene, at least not yet. Mostly, they have happened places other than calls.

A short list:

Glass storm doors.
A woman with a blanket over her lap.
White metal outdoor furniture.
A bed set up in the living room of a trailer.
A couple of specific songs on the radio.

I'm sure there are more that I haven't tripped on yet.

The brain is so fascinating, in all the ways it tries to protect us. They don't always work, but the brain keeps trying.

We try to be aware of what triggers each other, so we can be ready to shift roles if necessary. So far, it has worked well.