Rogue! Madness! Rogue!

All ahead 1/3.

For reasons I was asked not to mention (cue mysterious music and an odd closeup on a surprised face) I was asked to not “do anything online for awhile.”

Well, I think this is long enough.

What brought me out of mandated hiding?

Blog on blog action of course!

Rogue Medic was on one of his usual data driven rants about mechanical CPR devices and how study after study reveal results of, well, nothing.  Read more here.  Personally I’m not a fan of the mechanical CPR devices.  I’d rather spend that money removing the stigma of mouth to mouth from our communities and introducing “Push hard, push fast, call 911″ at the 7th grade level.

And wouldn’t you know it, another blogger and old friend Sean over at Medic Madness jumped on Rogue’s conclusions (well not exactly) in support of mechanical CPR.  More at this underlined word here.

When I read Sean’s article I immediately went over to Rogue Medic for his inevitable reply.

BAM (Complete with surprised Scarecrow image.)

For those of you not clicking on the links (How on Earth are you going to understand why this is so important) here’s the Reader’s Digest version:

Rogue reminds us that the mechanical CPR devices have not increased survival in any location they have been deployed.  ROSC is through the roof, but if ROSC was our only goal the Epinephrine would be gone.  Survival to discharge with no neurological deficit is the goal and the mechanical devices are not helping despite their claims to the contrary.  I can’t say my product does something it does not and not expect to get called out on it when someone with a 10th grade education reviews the data.

But Sean at Medic Madness fires back a sortie of examples of devices his agency deploys that do not impact survival.  Cots, power loaders (what a waste, another topic) and 12 lead monitors are discussed.  He also mentions that in rural systems all the fancy new pit crew compressions centric CPR doesn’t work with only 2 rescuers at the scene.  On the surface Sean is right, that none of those things can be directly linked to survival, but the overwhelming point I read between the lines is that if we’re going to hang survivability as the most important thing what are we doing about it?

We’re talking about it.  Like adults.  No one is challenging Rogue’s license, training or the color of his ambulance.  No one cares if Sean truly is mad, jocks a box for the here privates or rides backwards on a BRT.

The merits of the methods are being discussed for all to see and I count that as a win.  A win important enough to climb up from the depths to share with my remaining readership (Hi mom, Hi Linda).

A lot has changed in EMS since I joined this blogging thing in 2008.  Can you believe we’re finally getting traction on spine boards?  With discussions like Sean and Rogue actually getting to the root of most of the conversations in the ambulance yards and bench seats Nationwide it can’t hurt and I’m pretty sure it’ll get the ol’ brain pans fired up for the crowd gathering who no doubt smell blood in the water.

So a Tip of the Helmet to Medic Madness and Rogue Medic for having the conversation in public and keeping it Professional.

Well done, Gentlemen.

All ahead full!


A Tip of the Helmet – San Francisco Police

You may have seen in recent updates that your pal HM had a rough call not long ago.  While I can’t discuss the particulars, possibly ever, I did want to give some credit to a few folks who made it so much easier to focus on patient care: the police.


Not only did they deal with family and nosy neighbors as we worked, but they did a lot of the behind the scenes stuff.  For example, one officer retrieved additional O2 bottles without being prompted, calling out to us that they were in the hallway if we needed them, and we did.


When we were ready for a backboard they grabbed it and handed it through into the room, AFTER asking which end needed to be handed in first.

As we moved through the small hallways, I noticed a Sergeant moving items off the cluttered stairway and calling out how many steps there were.

Down on the street they had taped off the sidewalk giving us a clear path to the ambulance.

At the hospital they managed family and served as a story teller when the hospital asked questions we had no answers for.


It may seem like simple things or something that should have come naturally, but they have different priorities at the scene than we do.  It is possible that it was simply the nature of this call that got them involved to this extent, but judging by their ability to anticipate our needs, they’ve done it before.


A tip of the helmet to our boys in blue on this one.  Thank you.

A Tip of the Helmet – Literally

South of San Francisco, as the funeral procession for Vince Perez and Tony Valerio weaved along, countless thousands of people took time out of their day to say goodbye.

I recently posted a video of the procession, but a video making the rounds on facebook stopped me dead in my tracks and made me cry like a…well…six year old.

It is another video of the funeral procession, but has a very important story to tell all it’s own.

I’m sure this young man’s parents had no idea they would be inspiring those who had lost a lot of momentum in life, just shooting some video to remember how their son reacted to a firefighter’s funeral. How did he react?

Well, he got his coat and helmet and stood at attention and saluted the engines as they passed by.

My brother from another mother, MotorCop, messaged me soon after sharing it and told me we needed to reach out to whoever posted the video and let them know what an impact it was having. So we did. And we heard back today:

Hello MC & Justin,

Thank you so much for your comments on my Youtube video of the SFFD funeral procession with the little boy & for reaching out to us. That is such a thoughtful and generous thing you would like to do but I have to tell you, his father (my husband) is a firefighter who was on a post that day and I am a police officer and the little boy is our son. We felt it would be a learning experience for him to be a part of the funeral and to understand what those men sacrificed for people they didn’t even know. We wanted him to pay his respects, to experience the brotherhood, love and support for those real life heroes and their families. He is six years old and aspires to be a firefighter, then he wants to be on “mom’s team”and aspires to be a police officer then a medic on the ambulance so he can save and help people. Of course, we would be thrilled and honored with either.

We were equally moved by the overwhelming number of firefighters who saluted and waved at our son as well as the family members of the fallen firefighters who opened their windows to smile and take a photo. To know for that moment they were able to divert their thoughts away from their grief and feel the love, support and admiration we all have for their loved ones, is why we were there. To honor and support the fallen firefighters, their families and extended families of first responders.

We thank you all for your dedicated service and for reaching out to us. Words cannot express our sympathies and sadness for the San Francisco Fire Department and the families of the fallen firefighters. Thank you ALL!!!!!

No. No, thank you. I was having a hell of a time coming to terms with what has happened recently. Suddenly my thoughts would shift to how Vince and Tony died and I’d be frozen, unable to speak, unable to feel, unable to express myself.
The video of the procession gave me some closure, but then I saw this.

And I felt better.

I saw the honor you have taught your son, and at a young age to understand it and stay waving that flag, salute never wavering…
I saw myself to be honest, and I’d imagine MC did too. Both our fathers were firemen and I’m sure he felt the same connection to this young man that I did.

They say some children have a wisdom beyond their years and it is seldom by accident or by chance. No, this child is an inspiration because he is more respectful than half the adults I know and that is a direct reflection on the quality parenting he is receiving.

I, like MC, wish more people took the time to share with their children the importance of family, honor and tradition.

I was ready to make this young man an honorary San Francisco FireFighter, but there is no need. Not only because of his family being already in the business, but because he already is. I’m sure that was handled by Vince and Tony on Friday.

“Get your Paramedic”? A reader needs help

There has been talk on the interwebs lately about how to grab a municipal Fire Department spot. A lot of the advice focuses on getting higher training in the largest aspect of the modern Fire Service, EMS.

The advice is not to become an accomplished caregiver, or to strive to learn what new techniques and treatments may be coming down the line, but to simply “get your Paramedic.”

I have advice to anyone thinking about going to Paramedic school in order to get on with the Fire Department. I’ve said it before.

They want you to work as a Paramedic after you get hired.

Simply getting your license will not move you to the top of the firefighter list, but to the bottom of the Paramedic list. I know some departments offer extra points for your EMT-P, some even make it a requirement. But please believe me when I tell you, they want Paramedics, not just folks who can check that box on the form.

I pursued my Paramedic license when I became frustrated I couldn’t do everything for my patients. That pursuit taught me more about myself than the workings of the EMS systems I would join in the future.

It was my license that got me off the list of 10,000 people and onto the list of 2,000. Better odds surely, but I still had to prove myself a competent Paramedic.

And when I started, the closest I got the the fire engines was parking next to them in my ambulance, where I worked as a Paramedic/Firefighter, not a Firefighter/Paramedic.

If you want to earn and use your Paramedic license in the Fire Service, then by all means, go for it. Write me, I’ll help you study. But if you’re looking to check a box on a form to get a job you desire without fulfilling the requirements of that job, do my family a favor and stay home. I’d rather have a dedicated EMT than a card carrying disinterested Paramedic.

Apply for the job you want and then DO IT. Don’t waste your time and mine on a class when someone who actually wants to participate in patient care could use your seat.

If you really want to get a job in this tough economy, go back to school. Local trade schools offer EMS and fire training these days. Take the intro class and see what it’s all about.

Drop the attitude. Wherever you are testing needs to be considered your very first fire job, if it isn’t already. All your experience, ideas and concepts need to be put on the back burner. Learn the way they do things. Their ladders, their supply lines, their chain of command.

Test, test and test again.

I wrote the above passage over a year ago and never published it.  I have a great many posts I wrote when emotional and set aside to wait until, well, who knows.

A reader reached out about motivation to get through Paramedic School on the way to getting on with the fire department.  Since you now know where I stand on this, both from this post and another from awhile back, I need a favor for this reader.

I’ll call him Bob.  I suggested Bob look outside the overpopulated systems of California for a place that will hire firefighters who are not Paramedics.  While a quick internet search can find specifics on salary and duties, I was hoping you could give a brief feeling of the department near you that is hiring.

If your department or one near you is hiring or about to hire, please leave info about it in the comments section.  I’ve asked Bob to look there for advice on where to look for a job with the FD without having to get his Paramedic, something it seems is not on his priority list to begin with.

And before you decide to spout off against Bob for his decision, keep in mind he is doing the right thing before it is too late.

So in the end I tip my helmet to you “Bob” for reaching out for an opinion from a stranger and listening to it.  It isn’t easy to hear something you don’t want to hear, but even harder to come to terms with where you are compared to where you want to be.

Thanks, guys.

A Tip of the Helmet – Cleveland says “No”

Social Media in EMS - A Tip of the HelmetIt was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:

“This is a huge step for Cleveland,” EMS Commissioner Ed Eckart said. “This is a step back from a long-standing culture in this city.”

And indeed a long standing culture in America on whole.  I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.

Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.

As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that “maybe” call, the actual crushing chest pain that IS an MI is waiting longer for a transport.  We need to stop worrying about what might be and focus on what is.

The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers.  We call it triage.  No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center?  If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.

For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything.  Cleveland says no more.  Cleveland.  No offense to the system there, I’m learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3.  Until now.

A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing.  I hope to learn more about their research and system savings in the near future.  I will most certainly pass that along if I can get it.  Do you have a question you’d like me to ask the Commissioner?  Post it below and I’ll ask him.

Social Media in EMS – A Tip of the Helmet

A Tip of the Helmet to online EMS educator Greg Friese and his extensive research into how EMS agencies need to embrace social media before it gets past them and starts to cause problems. In his September 2009 article, he mentions our efforts here at HMHQ to use this media for positive change in our profession.

Not sure what social networking can do for EMS? Have you ever used a tip you learned online, on twitter or even done a google search for something related to your role as an emergency care giver?

Then you are using social media to advance our Profession. Learn more in the article here,and at the EMS Expo in Atlanta Georgia, where it looks like Greg will be expanding on his article in person. I would attend, but will be recovering from my CO-Op Refresher in New Mexico and preparing for the Project, which starts in less than 6 weeks.

A Tip of the Helmet to Greg Friese. On twitter and facebook and everything. I’m sure he’d have it no other way.

A Tip of the Helmet – HIPAA Mad Libs

A tip of the helmet to Mack505 at Notes From Mosquito Hill.

The recent post joking about how a HIPAA approved EMS blog entry would look sparked a nifty idea over at his home blog.

Mack505 copied the [bracketed] items and sent them to friends as an actual EMS Mad Lib.

The first one came back and it is indeed funny. Give it a shot, here is the list of brackets.

[a location]
[medical condition]
[possible relative]
[partaking in a household task]
[he and/or she]
[mechanism of injury]
[an injury and/or illness]
[municipal service]
[a/an approved medical device]
[patient care procedure]
[medical device]
[medical device]
[an approved setting]
[the appropriate button]
[a body part]
[patient care procedure]
[approved pharmacological interventions]
[Physician and/or Physician’s Group]
[a secular receiving medical facility]
[an approved pharmacological intervention]

Replace your words into the text of the original post and send it to Mack505. Neat idea Mack, I like it and we might just do this again some time.

2 Year old Tip of the Helmet to Orlando

There is so much talking by politicians about how fire stations can be closed without effecting response time without anyone actually showing examples of how a well staffed, well deployed service can handle adversity in a time of need.

This tip of the helmet goes to the Orlando Fire Communications Staff, Orlando Engines 11,6,1 Tower 1,8 Rescue 1, Heavy Rescue 1 and other units at the scene of this large apartment fire recently seen by our friend Beemer and sent along to HMHQ. It is from September of 2007 but could be happening in your town tonight.

The next time a politician in your area thinks that brownouts aren’t such a big deal, remind them that if any one of the first units to this scene had been closed that day, the woman and 4 children trapped inside would be dead. Send them this video, now.

This video is well put together and includes 911 tapes from the woman and the children trapped in a bathroom behind heavy fire.

A job well done.

Great job, now stop!

Recently, I was able to take part in a unique rescue.

Dispatched just after 1 AM to a report of a person in the water, we are the first engine at the scene. Responding behind us are the truck company, ambulance, chief and paramedic supervisor as well as our heavy rescue units. The heavy rescue units are specially trained swimmers and divers but are at least 10 minutes behind us.

We spot her clinging to a thin cable, 15 feet below us along the dock about 10 feet from a large party boat.

Police have arrived and are moving a gang plank to the boat to gain access to the water level. We’ve deployed a flotation device but the victim is either too tired or too confused to grab onto it. Using ladders and hooks we are unable to reach the victim, despite multiple attempts. the water is cold and dangerous for those of us not properly trained or equipped.

We are able to arrange a staging area on the boat to remove the wet clothes and assess injury just as the heavy rescue team arrives, fully wetsuited and ready to work.
They are quick to the water and work safely and efficiently, attaching a rescue device and removing the victim from the water almost without visible effort. They made it look like nothing.
A tip of the helmet to those of you who were involved in the like clockwork water rescue. You delivered me a patient from a place I could not go.

And that’s where the praise ends and your letter begins.

When you removed the victim from the water, you were directed to the awaiting backboard and blankets so I and the awaiting ambulance crew to begin our assessment.
The victim was placed on the board and the straps tightened despite our requests to the contrary. Everyone began shouting to get her off the boat quickly and into the awaiting ambulance.
We asked you to wait. Your part was down, it was time for us to do our thing.
But despite our requests there were more of you than us and away you carried the wet, dripping, cold victim to the ambulance where the wet clothes saturated the floor making working dangerous.
3 minutes it took to get her up the narrow stairs, gangplank and across the parking lot on the pier. All that time the medics are hustling to complete an airway assessment.

Luckily the victim’s airway and major vitals are intact, but she is cold. We removed the clothes and try to contain the amount of water coming from the cot, but there is no stopping the flow from the many layers.

You are experts at what you do. I know that, you know that. You proved it putting yourself into a situation I would not.
Please let me do my job. I didn’t tell you how to get into the water or what to do when you got there, please let me do what I am trained to do.

You get them, I treat them.
That is all.