2012: What Will It Do For You

This post is going to be straying from the usual gun-ho EMS topics, and take it to a little bit more personal level. After all, if we don’t take care of ourselves first…how can we take care of others?

Well, its here. Its 2012. Another year, another chance, another fresh start. That being said, I’m here to offer a few personal & professional points to carry with you through 2012. They say a lot of New Years resolutions fail because they tend to be too broad, and nonspecific. In order for you to truly succeed with your resolution, make it smaller and quantifiable. Take the “I’m going to loose weight,” and make it “I’m going to be able to run five miles in 30 minutes.” Instead of saying your going to be nicer to people, actually open up your smartphone calender and block off time to go to a soup kitchen, or volunteer at a shelter. It will surprise you how quickly you will see your resolutions succeed.

Now that you have an idea on how to write your resolutions, lets think about where to direct your time and energy. This is when I tell you to analyze your professional, and personal lives.

Are they in unison?

……..Are you content?

……………….Are you HAPPY?

We work in a profession of selflessness. Day in and day out, we are asked to give up time. Time spent with our Husbands and Wives. Time spent with our children, and time spent with our friends. We miss meals, holidays, long weekends, vacations, and most importantly sleep.

I want you to think about a couple of questions:

1) Do you still see the joy out of being able to help someone in their time of need?

2) Do you feel like you are trapped, and are generally uninterested in your career any more?

If you answered no to question number one, or yes to question number 2 then it is time for you to move on. You don’t have to leave EMS, just get some sort of change to happen that will renew your love for your job. See about opportunities in training, (speaking from experience) it can be a great renewal to work with people who are excited about the career. You’d be surprised how quickly you will “get the wind back in your sails.” If Education isn’t your thing, then try a change of scenery. Bid on another station, see about cross-training so you can work in dispatch. These are just a few things that you can see about changing at work before you loose all faith in your specific Public Safety profession.

Most importantly, remember those family members, friends, and other various loved ones I talked about earlier? See them. I recently had a 2 week stretch where I didn’t work ANY overtime above my 48 hour schedule. I felt like I had weeks off. I was used to having “hours” off here and there to make it seem like days, but after resting and stuff it really was just hours. I spent time with my girlfriend, friends from college, family members, and people that really do make life seem enjoyable. That happiness is something that your patients, and your coworkers will notice, because no matter how hard you try it is not something that you can hide.

A sense of contentment is what will bring this profession into the next level. If you are contsantly talking about how being a Paramedic isn’t good enough, or is “just a stepping stone,” then that is all it will ever be. If you can’t find the enthusiasm in your job, then why even do it at all?

What ever holiday it is that you celebrate, I hope it was one filled with happiness.

Stay safe in 2012, we lost enough brothers and sisters last year.

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

Stop, and Remember…..

A Time to Remember

Today, I am writing this post as my girlfriend and I are currently 34,000 feet in the air somewhere over the “fly-over states” of the Midwest. We are heading to Vegas for a quick weekend vacation with another couple. It has me thinking of all that I am lucky enough to be able to do in this country. We owe that to a very certain group of people. The service men and women of this country fight day in and day out to maintain our freedoms and protect the life we lead, and all to often, take for granted.

I am writing today to memorialize an EMS ally that many of you may not know. Major John Pryor, was a combat surgeon with a forward surgical unit in the United States Army. December 25th 2008 Major Pryor was killed when his surgical unit went under attack while providing life saving care for our troops in Baghdad.

While attending college in Massachusetts I had the pleasure of leading a campus based EMS organization. That organization, every year, would travel to a national conference held by the Nation Collegiate EMS Foundation. This foundation provided professional networking and training for the colleges around the country that ran their own Emergency Medical Service. Services varied from First Response to full blown ALS transporting services at some of the bigger universities. If there was ever an underground EMS 2.0 Movement, it was here. People here are enthusiastic, creative, and motivated. They are motivated to go out and change the world.

Dr. Pryor was a practicing Trauma Surgeon at the University of Pennsylvania. He would always bring a wealth of knowledge to the NCEMSF Conference. He would show how battlefield trauma care is actively shaping the way that Civilian EMS provides trauma care. He would bring pictures to show the work that was being done overseas, but most importantly he would motivate you to go out there and change the world. Dr. George Koenig (President of NCEMSF Board of Directors at the time of his death) described it perfectly in a letter to the membership:

“He is best remembered by his favorite quote by Albert Schweitzer. “Seek always to do some good, somewhere. Every man has to seek in his own way to realize his true worth. You must give some time to your fellow man. Even if it’s a little thing, do something for those who need help, something for which you get no pay but the privilege of doing it. For remember, you don’t lie in a world all your own. Your brothers are here, too.”

The EMS community lost an amazing ally and advocate that Christmas. He was a humble man, that truly had the power to motivate many.

I had the pleasure of attending a few different lectures of his while at the conference. Once was a Key Note, and the other was a optional lecture. Both times I walked out of there with a wealth of knowledge pertaining to a world I have never seen. Battlefield medicine is a very interesting topic, and something that I have never personally had the pleasure of experiencing.

To all the men, and women who are serving overseas, and their families forced to spend the holidays without them…My prayers are with you that you can find a peace in knowing that you are doing this country a great service. One that I will never be able to pay you back, except with overwhelming amounts of gratitude and support.

Thank You. If you would like to read a little more about Major John Pryor, MD please click here.

Merry Christmas everyone.

Close your eyes…

We are going to do a little “active blogging.” I want you to take a second, put yourself in the public’s shoes who have no knowledge of what us “ambulance drivers” actually do. [Definition: Ambulance Drivers (Noun) – Medics & EMT’s who are so ignorant that they have diluted themselves down to nothing more than human beings that operate a vehicle with red and white lights, more commonly known as ambulances. Ambulances also known as Rigs, Bus, Bone Box (callous snicker), truck etc.] You are transporting a family member of theirs to the hospital, that was complaining of chest pain for the last hour. Sitting nervously in the passenger seat next to you, the family member bends and twists in ways that you are pretty sure used to be anatomically impossible to do. They see thru the pass thru in the bus, and see all sorts of wires, electronics, tubing, and needles in or around the patient. Suddenly it happens. It is the moment of truth. The moment when they ask the age old question – “What is all of that for?”

You pause, deciding to embrace this moment, or pass it off in the front of the ambulance as that awkward conversation you try to have to fill the silence. You brush off the moment, and tell her: “It’s so we can check everything out, it’s protocol.” The person looks at you puzzled, and slightly unsatisfied and faces forward….”oh, ok then.” Is her reply.

Right there, that was your moment. That was the time you could have taken to advocate for your profession. It was a chance to display your pride in what it is that you do. A chance to show the public that the big expensive ride that they are getting to the hospital is actually making life saving diagnosis and providing substantial acute care treatments, AND ALL YOU COULD SAY WAS, “ITS PROTOCOL!”

Give me a break people. I mean seriously, if you came to me to complain about your wages, your working conditions, your equipment, If I were to tell you “its protocol” I would have a couple step grievances, maybe some workplace complaints, who knows. Collecting on my desk before the week is thru.

You work in a profession where with a single act of dialing 3 digits on a phone, a stranger puts their life into your hands. You are so much more than a “ambulance driver” For those out there who’s career is a little on the crisper, maybe even well done, side of life…remember back to Paramedic or EMT school. Remember when you were excited when the instructor would lecture about such interesting topics as cardiology, or trauma? I do. For those who’s careers just got thrown on the EMS Hot Plate, don’t loose that enthusiasm. This is a great career, a rewarding career. You CAN change people’s lives out there. Don’t let that moment pass you by to educate the public on what it is that you do.

That family member I mentioned above, she’s on the City’s Board of Alderman. She is in charge of budgeting. How do you feel now about saying “it’s protocol.” I’ll tell you exactly how she will feel about it, when the budget line item comes up that pays for EMS, she’s going to remember it being protocol. She isn’t going to remember that you have life saving tools in the back of your ambulance, she isn’t going to remember an eloquent explanation of every detail that you perform on a daily basis. She is going to remember that it is just protocol.

We are shooting ourselves in the foot here people, with a 12 gauge shotgun. EMS is an awesome profession. I am proud to say that I work with an excellent group of men and women. Don’t sell yourself short in the eyes of the public, and in your own personal perception of the job. You just never know who might be watching, or listening to you.

The Most Dangerous Job in Public Safety?

Part of the EMS 2.0 mission is to improve the standard of our profession in clinical practice, knowlege base, technology, and safety. These combined makes what I am about to share with you pretty scary. Studies are finally starting to show the REAL danger that is out there from working in EMS. I was cruising the EMS Information sites today and looking at some of the articles that were published in JEMS during the November 2011 issue, by David Page, MS, EMT-P  Titled: “Studies Show Dangers of Working in EMS.”

Studies are showing EMS to be one of the most dangerous professions. Data was examined from 2003 to 2007 found that there were 65 EMS Fatalities, or 13 per year.

“Forty-five percent (29) of EMS worker deaths resulted from highway incidents, mostly due to vehicle collisions, and an additional 12% (8) involved personnel being struck by vehicles. Thirty-one percent (20) of EMS fatalities involved air transportation incidents. It’s important to note that these statistics don’t take into account any civilian or patient deaths that may have occurred as a result of EMS crashes or other incidents.” David Page MS, EMT-P

That is insane!!

We are in a field that is based soley in transportation. We answer a 911 call, we respond to said 911 call, and we transport the patient to the hospital. We haven’t gotten our profession to a treat and release basis yet (frankly I don’t think I want it to get there). So a majority of our mission is transporting a patient, and that is what is killing us the most? WHATS WRONG WITH THIS PICTURE?

Let me give you some examples:

Fire – they figured out that fire will burn you, and smoke will destroy your lungs. Solution? Better bunker gear, and better SCBA to improve respiratory function during interior operations .

Police – They realized…oh hey…bullets? Yeah they’re dangerous…lets put something protect us from that!

EMS – 45% of worker fatalities between 2003 and 2007 were related to 99% of our job function? Oh, but the R&D is too much to come up with a solution?

Give me a break.

I’d love to see our vehicles get to a point where we have a 5 star crash rating for both crew and patient compartments. I realize that isn’t going to happen overnight. This is a two way street where we need to be vigilant as much as management needs to be willing to provide proper equipment and training to make our job safer.

I hope the numbers have decreased since the last data set was collected (2003-2007), because these numbers are just too outrageous to ignore. The official study can be found in Prehospital Emergency Care Fatal and nonfatal injuries among emergency medical technicians & paramedics. Prehosp Emerg Care. 2011;15(4):511–517. A simple Google version will bring you to it.

Until then please remember to come to a complete stop at a red light, and don’t just “roll through it,” Look four times instead of two, and wear a safety vest or some sort of  high visibility uniform attire.

Stay Safe out there everyone, I don’t want to have to stop to give YOU a moment of silence.

Here’s a little collection of Ambulance crashes I have found through Google searches, just in case you were feeling safe and secure in your rig….

Clinical Competencies – 12 Lead Interpretation

Those of you reading in the Massachusetts area know about the recent administrative requirement put fourth by the Office of Emergency Medical Services. The requirement states that all ALS providers in the Commonwealth must demonstrate a set of core competencies prior to December 31 2011. The memo can be read here. It is annoying. If you’re not from the Massachusetts area, feel free to read the memo from the Commonwealth’s OEMS. Let me know what you think. It would be cool to get some opinions from across the country. We all know we need to be able to interpret 12-Lead EKG’s. With that being said, I figured I’d take a few minutes to talk about a specific type of EKG’s that always have given me a problem.

The Infamous – BUNDLE BRANCH BLOCK

There are two types of bundle branch blocks. You have your Right Bundle Branch Block (RBBB) and your (LBBB). It is a relatively simple concept to understand. When you have a bundle branch block, there is a delay in the conduction down the nerve pathways in the heart. We all know that stereotypical wide-complex QRS that is indicative of a BBB.

Views of V1 and V6 with suspected LBBB

Left Bundle Branch Block.

The Left Bundle Branch Block is when conduction is delayed in the Left Bundle, thus causing delayed depolarization. A new onset of LBBB can be indicative of a possible AMI. In order to diagnose a LBBB you must meet the following diagnostic criteria:

  • QRS > 0.12 seconds.
  • Broad monomorphic R Waves in I and V6 with no Q waves.
  • Broad monomorphic S Waves in V1 and may have a small R wave.

In simple terms, the left ventricle depolarizes later than the right ventricle.

Left Bundle Branch Blocks, can also be indicative of AMI. Patients with a questionable new onset LBBB should be treated as AMI until proven otherwise. Of course, this is just the opinion of one paramedic. This blog should not take the place of previously established standard treatment protocols.

Also, LBBB is a classified as an ACS imitator. You want to make sure that you get serial EKG’s in any STEMI patient to monitor for trending. However, this is specifically important in those patients with suspected LBBB. According to  ECGPedia.org (a subsidiary of Wikipedia), there is a scoring system that you can use to diagnose STEMI from a 12 Lead. However, this is not practical to the EMS environment due to time constraints and other factors. If you’re a geek like me, then you will defintaely find it interesting.

The Right Bundle Branch Block

In the RBBB the conduction in the bundle to the right ventricle is slow. as the right ventricle depolarizes, the left ventricle is often halfway finished and few counteracting electrical activity is left. The last electrical activity is to the right or towards lead V1. In RBBB the QRS complex in V1 is always markedly positive. In order to diagnose a RBBB you would need to look at lead V1 again, and have the following diagnostic criteria:

– QRS > 0.12 seconds.
– Slurred S wave in lead I and Lead V6.
– RSR’ pattern in V1 where R1 > R.

According to ECGPedia.org, STEMI Diagnosis in a RBBB is not as difficult. RBBB usually  affects re-polarization in leads V1-V3, these are usually not enough to diagnose ischemia.

That is just my two cents on a topic that I don’t feel was touched on enough when I was in Paramedic school. I am going to direct you to another blog, by clicking here. Its all EMS 12 Leads, all the time. It is a great resource for EMS case review when it comes to cardiology.

Until next time folks, stay safe out there!

“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.