The EMS Ebola Checklist

Since it seems the nationwide panic known as Ebola has overflowed into the EMS sphere I thought it a good time to step in and calm everyone down for a moment.

We’re experts at dealing with interventions based on a thorough assessment.  Hemorrhagic Fever can’t be ruled out via ECG, stroke exam or any of our other tools.

To successfully deal with a patient exhibiting signs and symptoms of hemorrhagic fever in the pre-hospital environment, preparation is going to need to be solid.

  • Contact your local Department of Public Health for an updated copy of their response policy and local resource deployment.  Test the phone numbers in the plan and make sure they work now and that you know what information they want when you call in the possibility of an infected patient.
  • Train and retrain on your PPE.  This is not  race for speed, but a checklist for proper donning and, more importantly, doffing.  Improper removal of the best PPE negates all precautions.
  • Ask direct questions when still at a fair distance.  Monitor CDC bulletins for updated travel alerts at the beginning of each shift and ask questions that can rule out travel and contact with infected persons.
  • Treat the scene like a Hazardous Materials scene.  Isolate, identify, deny entry.  Limit exposure using pre-existing structures like walls, doors, airplane lavatories, car interiors, etc.
  • Ebola is still only in fluids, so limit contact with fluids using approved PPE barriers.  This includes gloves, gown, goggles, booties and cap.  It seems like an extreme measure, but think of all the things we touch with our gloves on.  Push hair out of our face, adjust pants, replace goggles…all these movements could introduce a small bit of vomit on a glove to another portion of the body and eventually we rub our eye or nose and…poof…infected.
  • Avoid unnecessary movement prior to Health Department assessment of the scene.
  • We are the eyes and ears of the local Health Department and CDC.  There is no treatment, no rapid transport, no EMS tool or technique that can help your patient more than making sure the system is in place and responding to what you see and hear.

The trick on a call you suspect to be Ebola (It’s likely not) is to treat it as such until you can reasonably determine the likelihood that I’m right.  That means being a PPE expert, doffing properly and knowing who to call and how to keep people calm in the face of a perceived zombie apocalypse.

As the world panics, we will remain calm, gown up and get the job done.


If a photo is never shared, but a photo of it being taken is, did it ever exist?

A few of you have emailed me asking what I think about Sacramento Kings basketball player Nik Stauskas photographing his per diem money.  Well, not exactly THAT, but the fact that teammate DeMarcus Cousins photographed the per diem photo shoot and shared it.

For those of you who haven’t seen the picture, have a gander:

We’ll save why a pro player needs that much money a day when clearly being taken very well care of when traveling and focus on why this photo even exists.

Who is responsible for this image?

Who is responsible for it being shared?

Is there a difference?

These are questions many public safety agencies skip past when writing short sighted social media policies.  Even though it feels like Facebook and Twitter are here to stay, there are already rumors of the “Next Myspace” with invites to the exclusive Ello drawing hundreds of dollars on ebay.

Departments are encouraged to apply existing rules to new technology by focusing on WHY their members share and how to break the impulse.

CBS reports that the image of the per diem has not been posted to Nik’s public accounts on social media, but he still took the photo.  We can’t say why.  Perhaps bragging to a friend?

Tough part here is that it isn’t the initial photo that caught the attention (although I’m sure it would have) it was another player that thought the situation needed to be shared.

And likely without Nik’s permission, which is where this situation will start getting complicated should the Sacramento Kings organization decide to take action against DeMarcus Cousins.

I’m not saying they should, but what if they did?

What would he be in violation of?  Does your agency have rules about sharing photos, quotes or speaking to the media?  If so, that will apply to in person interviews, emails, texts, posts…all possible methods of sharing media.

Now let’s go back a few decades and pretend someone photographed this and had it developed, then hit the xerox machine and posted it all over the office?  Would the same rules apply?

They should.

“But Justin, it’s the internet!  It’ll be there forever!”

A: Not true


B: Who cares, it’s there, let’s try to prevent the next one.

I found this image funny but I’ve been there.  I remember being the new guy who showed off that first paycheck that had a comma in it.

The trouble is, Mr Cousins, maybe it didn’t need to be shared.

Mr Nik Stauskas didn’t feel the need to share his photo publicly.  Mr Stauskas gets it.

From Trade to Profession – Thoughts from a Reader

Here on the blog I’ve had a favorite photo of Johnny and Roy in the Squad and Johnny looks like someone took a steamer in his cereal. (Chet most likely)

Under it I imagine Roy saying “Don’t worry Johnny, one day we’ll be a profession rather than a trade, just you wait.”

Well, he’s still waiting.

The folks over at Webster’s say a profession is:

A field in which one is in a paid occupation, especially requiring prolonged training and qualification.

We can argue the merits of 2000 hours, but that is certainly prolonged and we do require a state license and there is even a list of folks who passed a special test and get “registered.”  It would appear that, technically, we’re there.  You can relax, Johnny.


However, ask any EMT struggling to get by if they feel part of a larger Profession and they’ll likely tell you no.

Reader Garrett Kajmowicz shot an email to me asking the following question in regards to being considered a profession:

“How many professions exist where you aren’t allowed to buy your own tools?

As it stands, as a paramedic, can you go online and buy your own supply of medications? How about diagnostic equipment like a heart monitor? I think that some form of legal independence is going to have to exist as a part of the trade to profession shift, though I don’t know when, where, or how.


Interesting question there, but I’ll have to go with no. Being able to purchase our own tools won’t steer us one way or the other.  Case in point, no one would argue that being a pilot is not a profession because the pilots do not own the planes.

By the way, now that I work at the airport most of my bad analogies will be aircraft related.  Sorry for the inconvenience.

Being recognized as a profession takes time.  A long time.  Some will argue that we need an over arching Federal office to oversee licenses, skills and practices.  I agree and disagree at the same time.  While many similarities can be drawn looking to our close cousins the fire service (started as slaves chained to street corners) and nursing (started as prostitutes) who both have National level organizations, cabinet positions and offices in DC, we still have no idea what we are so where would our federal agency live?

Are we in the public safety business or the public health business?

Both need to be filled but with drastically different professionals in drastically different fields of specialization.

Our trouble is that we still sit on the fence and cry that the other kids won’t let us play when both teams are a player short.  Do you want 911 or Community Paramedicine?  Can’t do both.  Those who say you can are the same who say you can’t be both a firefighter and a competent Paramedic.

In the past I’ve caught flack for suggesting I was competent in both, but have since specialized.  As my position required more focus on EMS I had to pick a side.  And did.

I say pick one and run with it.  A community can certainly offer (and would be doing a dis-service not offering) both services, but not using the same person.

You want to run 911?  I need you also swim certified, low angle rescue certified and in haz mat and active shooter training.  I need to put you in harm’s way.

You want to do Community Paramedicine?  I need you back in school. Advanced A&P, pharmacology, psych, social work, community planning, administration and education and none of this community college stuff, I need you in the cadaver lab with the pre meds.

Two distinct professions can emerge from our little trade house if we want it enough but back to the original comment from Garrett, no, I don’t think buying my own LifePack 30 (Are we up to the 30 yet?) will make me part of a Profession.

Only I can do that by lifting up my co-workers, my agency and my passion for patient care.  I would hope we are all doing the same.

What do you think of Garret’s thought?  Will being able to order a monitor, ambulance and medications, the tools of our trade, allow us to become a profession?  If so, how? If not, why not?

Tell me in the comments.

A House Divided…

Not a political post, just thinking about firing up the EMS 2.0 machine again here in my home system.  This speech keeps coming to mind.

An excerpt from Senator Lincoln’s Speech to the Illinois Legislature in 1853:

If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it.

We are now far into the fifth year, since a policy was initiated, with the avowed object, and confident promise, of putting an end to slavery agitation.

Under the operation of that policy, that agitation has not only, not ceased, but has constantly augmented.

In my opinion, it will not cease, until a crisis shall have been reached, and passed.

“A house divided against itself cannot stand.”

I believe this government cannot endure, permanently half slave and half free.

I do not expect the Union to be dissolved — I do not expect the house to fall — but I do expect it will cease to be divided.

It will become all one thing or all the other.”


Coast HP7R Rechargeable Flashlight Review

A few months back the kind folks at Coast Portland asked if I’d be willing to test out one of their flashlights at the firehouse.  Sadly I was still in an office and had little to no need for a flashlight.  Hoping buy tadalafil cialis things would change I told them my situation and they asked me to give them a shot as flashlights, not necessarily as firefighting flashlights.


I looked at their website and the HP7R immediately caught my eye.  Compact, LED and capable of being recharged from the wall, not just from a mount in the Captain’s buggy, meant versatility.

This flashlight is heavy duty.  She’ll put out 201 lumens for 7 hours 45 minutes on high and last almost 2 full days at 22 lumens.

For those of you that don’t speak flashlight, that means if you accidentally leave it on it’ll last a long time.  As someone who has eaten through more AAs than I’d care to share this was a big feature for me.

Even bigger was the ability to recharge the flashlight’s 2 Lithium Ion batteries as well as back them up with a standard alkaline battery cartridge that’ll take the AAAs.  Being able to quick change a battery for such a powerful flashlight is awesome.

Even more awesome is that I already have the charger.  The Lithium Ion batteries can be recharged with a micro USB connection, the same one I use to charge my phone and a number of other gadgets around the house.  This means no shortage of cables and cords, both AC and DC, but just in case you are an iPhone house, both adapters are included in the box. (as are the AAA batteries BTW)

And now the bad news:

This is not a good flashlight for being a Paramedic.

First, to cycle through the low and high light output modes, you have to cycle through a strobe feature that would make some emergency scenes downright dangerous.

Secondly, the beam focus is a slide in and out feature, not a twist to focus.  The slide focuses the beam and a slight twist “locks” it into place.  However, the lock is so weak it constantly gives way, especially when deploying it from the belt holster (also included).

However, I didn’t give up on this flashlight.

I took it camping.

IMG_20140903_141527003This is the ultimate camping flashlight.  It is compact and lightweight, fitting on our hiking pack no problem, taking up almost as much space as the multi-tool.  the extra batteries can charge off the 12v system in the van on the way to camp and off the 12v trailer system if we somehow go through all 3 batteries.

The low light setting is perfect for night trips to the bathroom and the high feature makes scanning camp for bears easy.  No, seriously, I can actually say I tested this light looking for bears.  There were none, but that’s beside the point.

And if we ever get lost on a hike that strobe feature will no doubt be seen for 306 meters, just like the box says.


In conclusion, this is a versatile light for non-emergency situations (except for bears and getting lost of course.)  The ability to have extra batteries ready to go, as well as plug the light itself into adapters I already have means I’ll always be able to get light when I truly need it.

At $147.49 it may seem pricy but the features I’ve mentioned mean that added to the ruggedness of the construction I may never need another flashlight or batteries for a flashlight.  Like, ever.


Here are the specs from Coast Portland

  • Long Range Focusing Optic
  • Slide Focus
  • 201 lumen light output
  • 7 hour 45 minute runtime
  • 306 meter (1003 ft) beam distance
  • Battery type: Lithium Ion (2 included) or 4 x AAA (included)
  • Can be charged using AC, DC or USB power sources
  • Aluminum casing; rear switch
  • Impact and water resistant
  • Includes wall mount, speed clip, and heavy-duty sheath
  • Length: 5.58 in. / 14.2 cm
  • Weight: 7.2 oz. / 204 g
  • Diameter: Body – 1.18 in / 3.00 cm; Bezel – 1.47 in / 3.74 cm


Would I make a good Cop? Find out what Motorcop thinks

Get over to Uniform Stories to see if my buddy Motorcop thinks I’d make a decent cop.


Spoiler alert:  You know I’d get lost on day 1.

29,000 deaths vs 6,000. Which should get more attention?

The Ice Bucket challenge raised over $50 Million for ALSA, which is going to be diagnosed in about 5600 people this year.  ALS is responsible for 2 deaths for every 100,000 people.  That’s 2 too many.

Let’s cruise the math.  300 million folks in the US, let’s say half are dudes.  1 in 36 men will be killed by Prostate Cancer so let’s round that number down from 4.1 million to 4 million.  4 Million men currently in the US will be killed by Prostate Cancer in their lifetimes.  29,000 this year alone.

ALS will kill (since it also impacts women we’ll say out of 300 million folks and ALSA states 2 in 100,000 will be killed…carry the 6, divided by pi…) 6000.


29,000 vs 6,000

Prostate Cancer will kill almost 5 times as many human beings as ALS this year.

I’m not anti-ALSA, in fact I’m against most things that kill people (stupidity sometimes gets a pass) but are our priorities in the right place?

I don’t know.

So here’s what we’re going to do:


No one firing up a cigarette or pinching dip can even start to claim they believe in a healthy lifestyle.  There is no sense in literally GUARANTEEING your death by lung cancer (The #1 deadliest and most preventable cancer)


Avoid diet soda like the plague, don’t kid yourself that those 250 calories are making that big a difference in your overall diet.  The sweeteners are linked to a number of health related problems including, wait for it, cancer.  In addition, the caramel coloring added also increases risk of cancers.  I suggest Sierra Mist, natural sugar and no coloring, but in moderation!


Find out who is healthy and who is not and why.  If all your male relatives had prostate cancer, guess what?  If your mother and grandmother have cancer, guess what?


Ask about your risk factors since you talked to all your relatives.  “Doc, all my female relatives have been diagnosed with ovarian cancer, should I be worried?”  “Doc, my uncle had his prostate removed at 55, should I be worried?”


Join Kilted to Kick Cancer in spreading the word about the risk of Prostate Cancer, hell all cancer, and don’t just sit back and jump on the first cause that wanders by on Facebook.  If your family is impacted by a certain ailment, get involved locally!  Donate money, time, food, rides anything and everything to help in your own community.


The white coats far away working on a cure need to be put out of work by us PREVENTING and LESSENING THE IMPACT of cancer.

Cancer is a lot easier to cure when no one gets it anymore.


Get Kilted! Get Checked!


Kilted to Kick Cancer 2014 now in full swing!

It’s that time of year my Kilted friends!

Time to kilt up for a great cause!

1 in 7 men will be diagnosed with Prostate Cancer in their Lifetime, 1 in 36 men will be killed by the disease.

September is Prostate Cancer Awareness Month and we need to start a conversation with men that they don’t want to have: “How’s your prostate?”

In addition, we challenge our Kilted Army to #DunkYourJunk.  Put the ice buckets down everyone and have a seat.  In the ice.  In your kilt.


We start this conversation by wearing kilts everywhere we go during the Month of September when not on duty.


I am part of the fundraising competition again this year and encourage you to join “Team Happy Medic” when donating to Kilted to Kick Cancer using this LINK.

The fundraising contest has some incredible prizes and near the end of the month bloggers around the internet will start to make crazy dares to win.

100% of the funds go towards the cause of raising awareness about male specific cancers, helping those already diagnosed and, of course research.

Get over to Alt Kilt for amazing deals on custom kilts and accessories, including this exclusive KTKC pouch! 

A portion of the proceeds benefit KTKC!

Help us get the word out about this dangerous disease and

Get Kilted! Get Checked!

Set down the Ice Buckets, this is the last video you’ll need to see

Kilted to Kick Cancer decided to wade into the Ice Bucket arena.



Visit Kilted to Kick Cancer for more information!

Don’t forget to #DunkYourJunk!


Get Kilted! Get Checked!

Frequent Flyers

In my new spot serving as the EMS Supervisor for a busy International Airport I have had to learn a new normal.  For example, we get toned out on medical calls for both the approximately 5k-15k people in the terminal at any given time as well as the almost 140k people that circulate through the airport every 24 hours.

Gone are the days of the homeless man asleep in the bus shelter getting a 911 call for being unconscious (Who doesn’t want to be unconscious at 3am?) and here are the new unconscious calls, called in by a flight crew on final approach.

The thing I’m still getting used to, however, is that there will be an ETA included in our dispatch, often 10-15 minutes, which eliminates the need to rush out the door on every bell.  That indeed takes getting used to.  No point rushing out the door and to the gate in 4 minutes when the flight has yet to even land, let alone taxi to the gate.

We’ll grab our gear and access the jetway from the outside and wait for the flight to arrive, often having little to go on regarding the patient’s condition.  The flight crew often calls in “ill passenger” or “vomiting” but the all too common chief complaint is “lost consciousness, now awake.”

You can agree, that could be gosh darn anything.

The rules at our airport say if you call for us we get on the aircraft before anyone stands up, assess the patient and determine the best course of action.  Most often this is finding someone very embarrassed who isn’t handling the flight as well as they hoped.

We do our best for them and handle the encounter like any other EMS system.

The most interesting part of waiting for a flight is when it is an International flight.  Now not only do we have the local police, ambulance company (and their airfield safety escort) but now a whole alphabet soup of customs agents.  If the patient and family needs to be transported they will get quick access to customs and be dealt with first, right there.  They even carry the stamp on their belts.  Very interesting indeed.


More to follow from the Airport soon,


A therapy blog with an EMS problem