Step up!

It has been quite a while since I have been able to sit down and do some solid writing. I have been busy between work, training, and still trying to keep up a social life. Naturally a hobby such as blogging takes a back seat when it doesn’t bring checks to the bank. Sigh….

Anyway, the reason I am writing today is to share a quote that came across my Facebook feed. As you may, or may not know I have started doing Crossfit. Its a no non-sense style to exercising and has really caught on with the masses it seems. As a result of that I spend a lot of time online doing research on techniques, nutritional plans, and connecting to other CF’ers out there. The quote came from Crossfit City Line, on Adams St in Newton MA. 

““Was it you or I who stumbled first? It does not matter. The one of us who finds the strength to get up first, must help the other.”

The purpose behind this quote is to talk about how it is never too late to work on your own personal shape. It doesn’t matter what has happened in the past, all you can do is work on the present and future. One of the great things about Crossfit, is the sense of community. I am still getting to know people in the box I go to, but they are still there cheering me on as I work to achieve my goals.

Now, you are probably wondering why the hell are we talking about Crossfit again? This is an EMS blog isn’t it?

Well yes, it is. Thank you for noticing! Take the idea of physical fitness out of the equation here. Take that quote, and apply it to EMS.

It doesn’t matter who fell first people, we owe it to each other to pick up the pieces and work towards a stronger profession. Keep that in mind next time you are out there and about to speak with a newbie, or a student rider. We all are human, situations happen. Be the bigger person, stand up, and take pride in the job that you are doing. People will notice a lot quicker than you may think!

Patient Assesment – Practice What You Preach

If you think about our job, what is the MOST important part of EMS?

…Is it the ability to sink that uncooperative ET Tube in the impossibly anterior airway?

…maybe it’s the ability to analyze every bump, nook, and cranny of an EKG strip to come up with a life changing, working diagnosis.

Actually, it just ends up being a trick question. The most important part of our job, as EMS providers, is patient assessment. The assessment allows us to do both sides of our job properly and efficiently. Without it, we would truly be a bunch of “Mother Jugs and Speed” Ambulance Drivers.

In EMS we have two major aspects of our job. The first there is treatment, then transport. Treatment tends to be at the forefront of our minds. We go into calls already running through treatment algorithms and protocols based solely on the dispatch complaint. This way, we are better prepared for the decisions we have to make, once we actually have made patient contact. I have two major problems with this train of thought. First and foremost, it causes tunnel vision. It only allows you to see the signs and symptoms that point towards your diagnosis that you have thought about in your head. This is very similar to when police officers only see the evidence that fits their theory of the crime, or the evidence that points to a particular suspect.

The second major aspect of our job is transport. Gone are the days of “scoop and screw,” to the closest hospital. We actually have to base our transport decisions based off of clinical evidence that supports why the patient needs the resources available at that facility. For example, why a patient with left sided facial droop, left sided weakness, and slurred speech needs to go to a stroke center as opposed to a standard community hospital emergency room. We also need to know our resources in our area. I am lucky enough to work within reasonable distance to some of the best medical facilities in the world. I know that I am taking my patients to some of the best facilities, and I know that I am doing them a true service.

If we take away our ability, or better yet, if we flat out neglect the ability to asses our patients then we loose the main attribute of our job that makes us clinicians. We wouldn’t ignore our assessments of our patients. So let me ask you this, why are we ignoring the assessment of our profession?

…yeah that’s right. I just slammed on the brakes, cut the wheel, and turned the bus around!

Being a Paramedic is quite possibly one of the most interesting, and exciting jobs I have had to date. For the record, I have worked as a Lifeguard, Police Dispatcher, Membership Service Rep, Camp Counselor, Maintenance Director, Maintenance worker, and last but not least a Pizza server. I truly come to work each day (despite what my evil, sleep deprived twin might say) looking forward to the challenges that will face me in the back of my 8’ by 5’ by 8’ office.

Why do we, as a profession, constantly accept the “mediocre” as good enough? When is the last time you looked at your paycheck and actually enjoyed seeing the hours to dollars ratio? When is the last time you have noticed how appropriately Paramedic and BLS resources are utilized? How about the last time that you complemented a patient for properly using EMS in the event of their acute misfortune?

Yeah, I can’t remember either.

That being said, lets talk about some ways to make this happen. The next time you debate taking the easy way out vs. the right way, choose the right way. That fight you just started with a nurse because she was too busy to take a report, or gave your some attitude because the needle gauge of your IV angio was too small, that set your profession back a bit. Make your decisions while on duty in the best interest of the job. Patient care comes first, image comes second, and attitude third.

Finally, in order to make the profession recognize and respected we need to get on the same level. The Federal Inter-agency Emergency Medical Services Commission published quite the extensive document showing how varied we are as a service, across the nation. It brings up all the vital statistics to show where we need to beef up, and where we need to scale back. It is important that we take the information in this document and use it wisely. The Fed’s have given us the material, brushing it aside and not following thru will be detrimental to our profession as a whole.

I hope these words gave you a little inspiration on this cold Sunday morning. Take care everyone, talk to ya soon!

A Little Comic Relief

DISCLAIMER: I wish I could take the credit for writting this, It was sent to me by a friend in the industry, and I figured you all could get a laugh out of it. I am breaking down some serious writters block right now, so until then feel free to read away.

Also, if you were the one that came up with this comical little rant, please let me know so I can give you the credit you deserve! Merry Christmas, and Happy Holidays everyone.
Dear :

I am your mostly-friendly, only-slightly bitter, humble neighborhood paramedic. I work long hours under high stress for mediocre wages. I’ve done this for five years. I love my job; I’ve gotten to do some amazing things. I enjoy saving lives. It’s more rewarding than anything I’ve ever done.

In this business, seconds count. I’m serious; the Broncos are on, and I’m hoping to clear your call before the second half starts…

I’m kidding; the Tivo we have at station makes this a non-issue.

Anyway, please make my life and the lives of my colleagues slightly easier. Here are a few helpful suggestions:

1. PULL TO THE RIGHT AND STOP. IF YOU CAN’T GET TO THE RIGHT, JUST STOP. I am driving with lights and sirens for a reason and not just because it makes me look cool (though I do admit, it is kind of fun). Just because I get to weave around you does not mean you can do the same to me. Please don’t cut me off, drive on oblivious to my presence, or try to sneak through the intersection while I’m trying to clear it. Don’t get annoyed and cast angry glances and gestures at me. I’m sorry you’re going to be two minutes late to your pedicure appointment. I promise I’ll make it up to you. Send me your address and I’ll write you an apology. Hell, just to make sure you know I’m really sorry, I’ll have the six year-old in respiratory arrest I’m transporting write you one, too.

2. PLEASE, FOR THE LOVE OF GOD, BE CLEAR WHERE YOU ARE. I’m good at finding big landmarks (office buildings, towers, major stores). Houses and smaller places are a bit tougher. Additionally, people these days are privacy obsessed, and I guess this trend has extended to marking their addresses in the most obscure places. We have GPS, Thomas Guides, and all sorts of other stuff, but it only helps so much. Have someone flag us down if possible, especially at night. At the very least, describe your place to the dispatcher. I really hate driving by your house five times blaring my siren looking like a complete dumbass.

3. THINK BEFORE YOU CALL 911. It’s a number for EMERGENCIES. Chest pain is an emergency. A major, bloody trauma is an emergency. A toothache at 4 a.m. is NOT an emergency. Your sick dog is NOT an emergency (though don’t get me wrong, I love dogs, too). No I’m not a mobile pharmacy dispatched to satisfy your morning narcotic cravings. Also, please don’t use me for “bum control.” I will not whisk away the smelly homeless person camped out in your entryway just because you call him in as unconscious. Chances are, I’ll wake him up, confirm that he was only sleeping, and let him go about his business. Call the police if you want him arrested for trespassing; better yet, just ask him to skedaddle.

4. I AM A COMPASSIONATE PERSON. I love people. I love helping people. However, compassion for stupidity is hard to find at three am when you wake me up from a great dream involving Jessica Alba, Sienna Miller, me, and the neighbor’s hot tub. Please be understanding.

5. PLEASE KEEP THE EMOTIONS IN-LINE WITH THE EMERGENCY. It’s ok to be a little panicky, agitated and emotional during times like this. Who could ever blame you? But please, don’t start hyperventilating and pass out over a sprained ankle…especially if you are just the bystander.

6. I DO ALL I CAN FOR EVERY PATIENT DURING EVERY CALL EVERY TIME. I am a medical professional, believe it or not. I’m not an idiot. I have my BS (with a high GPA to boot). I have over a thousand hours of paramedic school. I’ve run over 2000 911 calls. I’ve been drilled by instructors, FTOs, partners. I have had countless reviews of my work. Heck, I’m even applying to medical school. We have protocols to follow. If everything I can do is not enough, sorry. Believe me, I’m frustrated, too; I wish I could do more.

7. TO THE IDIOTS WHO GET INTO DRUNKEN FIGHTS AFTER LAST CALL. There is no more need to talk shit once you’re in the back of the ambulance under my care. I’m treating you most likely because YOU SUCK AT FIGHTING. Who are you kidding; you’re not so tough. Your improvised Kung Fu really wasn’t a challenge for the 250 lb. bouncer. Also, FYI, I bench over 200 lbs, I’m trained in Krav Maga, I’m sober, and I’m wearing steel-toed combat boots. I really don’t think your inebriated, chain-smoking ass could take me. So shut up, stop cursing, and hold still while I try to patch up what’s left of your face. What, the alcohol pad stings? What happened to they guy who thought he could beat up the world a few minutes ago?

8. BE NICE, RESPECTFUL, AND POLITE TO ME, and I’ll be the same. The meaner you are to me, the larger the needle I use to start your IV.

9. IF POSSIBLE PLEASE LET ME KNOW IF YOU HAVE TO VOMIT. I hate puke. I hate the smell, look, and pretty much everything else about puke. Please let me get you a vomit bag or an emesis basin. Better yet, if you really must vomit, please direct it towards the unhelpful, mean, or rude bystanders on scene. I’ll be more than happy to help you do this.

10. TO THE OBLIVIOUS OFFICE WORKERS SQUEEZING THEIR WAY ON TO AN ELEVATOR WHILE I’M WITH A PATIENT. I don’t care if you only need to go a couple of floors. While you think this may only cause a few seconds of delay, honestly, it takes far less time for me to shove your ass out of the car. I’m not here pounding on this patient’s chest for my own entertainment. You can wait for the next one.

11. STOP ASKING ME ABOUT THE WORST THING I’VE EVER SEEN, DEAD PEOPLE STORIES, OR OTHER DISTURBING SHIT. We all have repressed memories, and I work especially hard at repressing many of mine. I really don’t like talking about death. I got into this business to save lives, not to kill people. Please satisfy your morbidity somewhere else.

Please help me help you. Thank you. And please remember to pull over for lights and sirens.

Sincerely,

Your medic

“Greater Love Hath No Man…”

Memorial Photo from the Facebook Page


Paul Frontiero – a 27 year old New Hampshire native was stabbed Sunday night. According to media outlets in the Boston area, Paul was reportedly helping two females that were being attacked. As a result of his heroism, Paul also suffered multiple stab wounds. This includes a stab wound to the chest, per The Boston Globe.

Personally, I have never met Paul. However, it breaks my heart to see a provider taken from this world for a senseless act of violence. My prayers are with the family and friends of Paul, as this cannot be easy to deal with.

Paul continued to live the mentality of a true EMS Provider, off the clock, never being afraid to answer the call for help. God Bless his soul, and may he be at peace.

Click here to be taken to the Facebook Memorial Page.

Information on his burial and calling hours can be found here. No information about Honor Guards or a uniformed presence being requested at the funeral.

Motivation….(again)

Have you ever noticed how you always seem to find the most random stuff in the processes of moving?

Today, I uncovered something that I have not sat down and read in a long time. I found a letter today that was saved on the deep dark corners of my external hard drive (100% truth, there isn’t some sort of blogging pun in there).

To get some of the backstory for this article, read my post “Gotta Have Faith.” This is the letter that the mother published in the local newspaper (Republican, Springfield MA). I have removed the names of the patients and family for privacy.

Mother has reason to be grateful

Saturday, December 23, 2006

By SUZANNE McLAUGHLIN

smclaughlin@repub.com

HAMPDEN – <PT’s MOTHERS NAME & ADDRESS> has a special reason to be grateful this Christmas.

Her 2-year-old son, <PT NAME>, is alive because three Springfield police officers put their lives on the line for him last summer.

“He has the most beautiful face,” Crane said of her son. “If you see him, you will just want to squeeze his face.”

The toddler was playing in the yard of the family’s home on Oak Hollow Road in Springfield last summer and came up behind the ride-on lawnmower being driven by his father, <PT FATHER>.

When the brake failed to catch, the tractor rolled backward, severely injuring the boy’s legs.

The boy was rushed to Baystate Medical Center by three Springfield police officers.

Due to the severity of the child’s injuries, police decided not to wait for an ambulance, Springfield Police Capt. Robert T. McFarlin said.

Officers Thomas Michel and Clayton Roberson placed him in a cruiser and drove to Sumner Avenue and Allen Street where they transferred him to the ambulance that had responded to the call.

Police Sgt. Paul Browne then drove the ambulance so two paramedics could administer care to the boy.

Michel and Roberson escorted the ambulance in their cruiser. Other officers blocked every intersection en route to Interstate 91 for the ambulance to race unimpeded to the hospital.

“They were going at speeds of 120 miles per hour,” Crane said. “Because of the police officers’ precision decision-making and because they took a risk for my son, my son is here.”

Crane said she also would like to thank the two emergency medical technicians who cared for her son in the ambulance, Ryan Anderson and Hiram Rodriguez.

An emergency room doctor told police if the boy had reached the hospital a minute or two later, he would not have survived because of severe blood loss, Lt. Cheryl Clapprood said.

The toddler is in a brace and has additional surgeries to undergo because he injured the growth plate in his leg, but he is up and walking, his mother said.

“He is here with us, and we are thankful,” she said.

She said she wrote a poem because she did not know how to thank the police officers.

“You never thought once/ Your own life could have been sacrificed/ You’re angels from God that saved not only a boy, but a family’s lives/ And we wish the merriest of Christmases to you.”

It was a great little motivator that reminded me of why I got into EMS…and continues to do so today.

Health and Well Being of the EMS Professional

 I teach EMT-B Students on the side. It’s a nice change of pace from the odd sense of normalcy that is the Private EMS Industry. I go into work every day and get to see people that are genuinely excited to be there and learn how they are going to help someone the next time they encounter an MVC or a Medical Emergency.
I usually get involved with each course quickly, as such, I teach a lot of the early mundane lectures. I dont think there is any lecture (other than maybe CPR) that is as important as the Health and Well Being of an EMT. I can picture the eyebrows that just raised with me saying that. Here is where I am coming from, so hear me out.No one told me that when I was in EMT school, about 7 years ago, about what it would actually be like to deal with the good, bad and the ugly. Basically I was told that I was going to save the world, run home, switch into my leisure clothing, and do it all again the next time the pager went off. I thought everyone would love to see the EMT’s here to save the day. I thought everyone lived, blah blah blah you get the picture. I could sit here and tell war stories all night long, but you know what at the end of it all…you aren’t going to take anything away from this blog post other than a bitter taste of my egotistical tendancies. I want you to know WHY you do what you do. What do I mean? I mean when you pull up to a scene and you put someone in a stair chair to move them 5 feet, or feed an elderly patient’s cat prior to transport. These are things that help us stay connected to the human side of our job. It’s easy to look at each patient as an inhumaine object just waiting to absorb our skills whether that be IV’s ETI’S, IO’s, Chest Decompression etc.

Okay, so I started to get off on a tangent there for a second. I have written this blog post about 5 times so far tonight while I’m dispatching trying to pin down just what I am looking to say. I apologize if I seem a bit scatter brained, because lets face it…I am.

“The Health and Well Being of the EMT-B” is extremely important because it allows us to prepare (albiet minutely) for the stressors that we are going to have to deal with. By no means am I claiming to be a hardened EMS Professional. I enjoy teaching the new students how to properly deal with stress, good or bad. I talk about the dangers of self medication and the benifts of CISM or similar processes.

If you take anything away from this little blog here its that you need to understand that we are all humans, we are still able to feel (for better or worse). Don’t be afraid of feeling sad for someone in your care passing away because its the day that you don’t feel anything that something in your current career path needs to radically change quick.

Stay safe out there everyone! Talk to ya soon!

Rapid Response Vs Transport Only: The battle of intercepts

I was discussing with many of my coworkers lately what the benefit is to having 2 Paramedics always on transport vehicles. The question was raised if it would actually be beneficial to put all Paramedics on rapid response vehicles (commonly known in this area as “Fly Cars”) I figured it would be a good discussion topic to try and get going. Lets break it down:
First, the preferred method is having two paramedics always on a transporting ambulance. This improves transport times, limits intervention times, and seems to have the most bang for your buck. At least it seems that way, right? When an ALS level call is dispatched the response generally (in the Metro Boston Area) is a Fire Piece (engine or ladder) as well as the ambulance. ALS is dispatched to the scene immediately and patient care is initiated. The biggest problem with this type of system is, that if the patient doesn’t warrant a full ALS work up then ALS is tied up on a BLS transport. In my opinion, not the best use of resource

Wake County EMS Rapid Intercept Vehiclebut that isn't really anything that we can control now can we?

To the right this is a Paramedic response vehicle from Wake County EMS. Courtesy of the Wake/Raliegh Fire Blog. Now tell me that isn’t badass!

Second, the less utilized method is the fly car system. What is this? The fly car system sets 2 paramedics up in a patrol vehicle, this being an SUV, or large sedan. In that vehicle there are two sets of gear and 2 paramedics. The vehicle is registered as a class V ambulance and allows for much more flexibility in a busy system. When an ALS level call is dispatched, send a BLS Ambulance with an ALS intercept. If BLS gets there and determines that there is no need for ALS they can easily cancel the resource and now that resource now is available to the coverage area again. If one Medic is tied up on a transport, the other person on the fly car can split (pending patient status) and yet again the ALS is available for another patient. You can also use Fly Car’s for transfers within your coverage area as well if needed.

For some reason this seems to be a hot topic because as with everything else in this profession, everyone has their own opinion. From a grunt’s perspective it seems that the fly car option is much more cost efficient. When you look at it your resources are essentially doubled and not tied down to one municipality specifically. I would love to work in my service area in a fly car.