Category Archives: EMS

Celebrating the Voices

I hear voices.

At least I used to hear voices, before I took this desk job at Headquarters, but before that, in the field, I heard voices.

The voices woke me from my sleep and interrupted meals more often than not and always seemed to know someone was ill or injured.  Most of the time anyway.

For all my griping about MPDS, dispatchers and call takers, they still show up everyday to do a job I would fake a seizure to not have to do.

They take the confused, rambling mumblings of someone, code it, send it and away I go to deal with the problem.  So what if it’s not always what they say it is, all they’re doing is telling us what someone told them.

And many times, after listening to some of these calls for QA purposes, “told” isn’t exactly the right word.

A man is shouting to please hurry! please hurry! but won’t say why or what is wrong.  He simply says please hurry.

The woman holding the lifeless baby can’t get a word through her screaming but the voice still tries to talk her through CPR.

The whispers of the young boy hiding in the closet while someone assaults his older brother in another room are barely discernible because the call taker next to them is dealing with the screaming mother from before.

The voices belong to a group of folks who aim to bring a few moments of sanity to an insane world, and all over the phone and the radio.

Call them dispatchers, broadcasters, call takers, whatever, they still always answer the phone and will always answer the radio when you need them to.

So call up your local dispatch center and see if they have an event planned.  If not, step up and put something together.

Now at Uniform Stories

Your pal Happy is proud to be included as a guest blogger over at Uniform Stories.

Uniform Stories allows you to upload a video about your experiences in uniform, no matter the type, and you know I’ll tell you that is a powerful medium.

Head on over and take a look at the site and watch a few videos and I invite you to upload your own.

If your uniform could tell 1 story, what would it be?

See you there.

Suicide: Know when to ask for help

Pussy.  Wimp.  Lightweight.

 

All things you think people will call you when you ask for help.

They went to the same call you did, they’re fine.  They’re not.

They went through a divorce just like you did and they’re fine.  They’re not.

I failed and they didn’t because they’re better than me.  They’re not.

 

“They” are going through the exact same mental roller coaster you are.  I’ve been there to a certain extent.  When I got hurt I went through every emotion I’ve ever known from thrilling excitement getting back on the Engine to crushing depression that I was one call away from being killed in a fire.  I’ve been confused, conflicted, felt like screaming.  Screamed (it helps) and even cried like a baby.

Dealing with depression can be hard, is hard, will be hard.  Regardless of what people want to tell you, things aren’t always going to be better.  One day you’ll look back on today and be willing to swap feelings for anything.  The trick is going to be what you do about it today.

 

No one controls you but you.  The feelings you feel, the things you think, the situations you run out over and over and over in your head until they get so loud it feels like they’re going to come bursting out of your forehead will only get worse unless you let them out.  Only you have the power to release them.

Start a journal, write your feelings on a single piece of paper.  Get out all the negativity, anger, hate and everything else Yoda warns us about the dark side and look at it.  It’s outside your head and nothing is wrong with that.  Now destroy it.  Destroy all the hurt.  It feels good.  Then take a deep breath and feel the emptiness the hate has left.

 

What will you do with it?

This is the part no one tells you about PTSD, that you can address and overcome your fears rather easily, but even scarier is what might take their place.  If your thoughts were that dark before, what will happen now?  Now there is room for worse!

And for better.

Some fill that void with faith, companionship, adventure, music or art.

Others fill the void with solitude, smoke and the bottle.

 

What you do with the space you make is up to you, but I can tell you from experience that looking for a new challenge every day will lead you to places your old self never imagined.

Some departments offer Critical Incident Stress Debriefing (CISD) but others do not.  It is important to have an understanding of what to expect from your healing process.

I did a brief series on CISD using the band OKGO:

Part I   Part II  Part III  Part IV  Part V

The hardest part is knowing when to ask for help and realizing that anyone and everyone that tells you some bullshit line about having to have thick skin in this business is falling apart inside just like you and may actually want YOU to help THEM, but they’re afraid to ask.

They’re afraid you’ll call them a pussy or wimp or lightweight, laugh at their sorrow because they can’t take it while you’re fine.

Asking for help early can break the cycle of depression not only for you, but for your coworkers, friends and family.

 

I don’t understand suicide and I never will.  It’s a coward’s move and no one can convince me otherwise.  Besides, why not ask for help and avoid the whole mess to begin with?

There are a number of ways to find help, one of which is by following the Code Green Campaign on Facebook.  Click the green star and follow, talk, heal.

Open, Pending

As the default Risk Management guy for my agency (until the new gig kicks in that is) I get routed all manner of citizen complaint that has anything to do with the Ambulances.

As a result I often have the opportunity to do some public relations work right there on the phone.

Did the mean Paramedics stab you with a needle?  Let me just take a look at your chart here…oh.  It says here you’re a known diabetic and had a blood sugar of 21.  Yes, Sir.  Yes I understand you have trouble remembering to take you medicine.  Yes I do think they should have woken you up first before stabbing you with the needle.  But here’s the thing…

Problem solved.

Most complaints seem to come in about 2-4 weeks following the date of service.

Our billing turn around is about 2-4 weeks.

Total coincidence I’m sure, but every now and again I get a phone call that brightens my day.  Often it has to do with someone most certainly under the influence of a central nervous system depressant and their attempt to recover said intoxicant from the Paramedics that took it.

Take Eddie Dean(Not his real name, but think of Eddie from the Dark Tower series).  Eddie called me doing his best Tommy Chong impression, right down to forgetting to answer some of my questions until after I ask “are you still there Eddie?” “Wha?”

Boils down to this:  Eddie is refusing to pay the ambulance bill because the Paramedics stole his marijuana.  Tough part on this one is that Eddie seriously needed some aggressive ALS care a few weeks back and I’ve got a gold star chart to prove it.  He mixed up a few prescriptions for a few diagnosed ailments and…BAM…altered, parastesias, the whole 9.  Most complaints revolve around fizzled attempts at a Lawsuit Chart, which still has to be paid prior to their surely losing case being heard.

Eddie is worried the Paramedics thought he was high at the time, which he claims he was not and I believe him…until he starts to try to explain how high he is right now.  While on the phone with me.  “Like…like right now, I’m able to smoke some and feel good, but I didn’t smoke a lot that night.”

He swears his girlfriend can corroborate that the Paramedics took his weed so I ask for her number to call her.  Eddie didn’t think that all the way through and is asking that I not call her right away, that he needs to call her first to tell her what to say.

Smooth move, Eddie.

On the answering machine at my office is a message that ends with “If this is a pressing clinical matter, please call (my cell phone number).”

Eddie left me three messages yesterday (Saturday) moderately sober and begging me to call him immediately so I can talk to his girlfriend who “can tell you more about what happened because I talked to her already.”

So now I get to hang onto an open file about how while in the midst of a code 3 scene time of less than 11 minutes  at an 8th floor apartment, my crew somehow had time to grab a few little green bags.

Marked:Open, Pending

 

C-Spine Policy Rooted in Science

Friend of the blog Nick Williams sent this on from a Reddit feed.

VMtHUmF

The future is here folks. Long spine boards are no longer the standard of care.

Speaking of the future, I posted all this from my phone. In my pajamas. While drinking wine. #micdrop

A Big Move

I’ve been cryptic about things recently, and for good reason.

Those of you following on Facebook noted last week that I was preparing for an interview, but never explained for what.  Yesterday I got word that it went well.

Starting July 1st I will be assuming the role of EMS Director for the newly formed Detroit Unified Healthcare Service which will rebuild Detroit’s EMS service from the ground up.

Plagued with difficulties for decades the DUHS will erase the problems of the past and build on an EMS 2.0 platform of prevention, home visits and has already connected with a vast network of secondary transport facilities.

Upgrading salary, training and service levels are just the beginning!

More details are to follow as the official announcement will be made on Friday at a joint press conference, we’re still working on getting the house sold here, didn’t expect this to happen so quickly.

This is an exciting time to say the least and I’ll miss the SFFD but this is an opportunity not to be missed!

 

Interested in coming along?  We’re hiring! Detroit United Healthcare Service info

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Comments on ‘a flickering flame’ by Captain Chair Confessions OR How to confine burnout to the area of origin

Fellow EMS Blogger Captain Chair Confessions (CCC) has a post up that will likely sound familiar to anyone who has spent more than 10 days in EMS.

CCC is experiencing the first smoldering effects of burn out.

The reason CCC is going to recover and grow from this experience is their ability to come out and talk about it.  Granted, it’s more of a 1 way conversation considering the way the interwebs works, but it’s enough.

Simply recognizing something is happening is the first sign of recovery believe it or not.

I know CCC is feeling more than they are writing, and that’s OK, because everything will come out in the end.  Every emotion, every angry thought hidden by a forced smile with teeth clenched on a transport everyone knows is unnecessary, everything will see the light of day.

That flickering flame CCC is feeling is easy to ignore and is often missed because of pride.  Misplaced pride, but pride just the same.  We tell ourselves that we need to toughen up, grin and bear it, grow a pair or some other lie we tell ourselves and ignore the growing flickering flame.

Worst part is, at this small stage the flame is easy to extinguish.  Even the softest of breezes causes it to waver.  Believe it or not, simply saying your frustrations out loud can be enough to knock down the tiny flame.  Of course the fuel still remains and needs to be dealt with, but try taking a candle apart while it’s burning and you’re going to get hurt, spread a fire and be in worse condition than you are now.

The amount of fuel in EMS is staggering and I’ve seen shovels on both sides adding more.  Admin needs more transports to meet payroll, response times need to be faster, posting moves aren’t efficient enough…you know the complaints.  At the same time patients are getting less and less emergent and are calling more often looking for the quick service we’ve spent 40 years convincing them they needed.

Somewhere between a missed lunch and an angry call from the QI Captain you run a call like the one CCC had and the flame is back, flickering away in the back of your mind, ready to grow unchecked as soon as it can.

Don’t ignore that flickering, fluttering light.  Talk to someone, anyone, write a letter and throw it away, get the frustration out of your system.  Ever heard of screaming?  Go for it.  Find a local supermarket and ask them if you can borrow their walk in fridge for a minute.  Shut the door and scream.  Go ahead, I speak from experience when I tell you that the sky is a little brighter when you emerge.

From there attack the problem.  Get involved, get active and if things can’t change, then you have to.  Staying in a broken system that refuses to change isn’t healthy for you or your patients.  Move.

Again, from experience, it helps.  I got up, got out and landed somewhere where I eventually, just this last week, had a chance to rewrite our C-spine precautions policy.  And it might just pass.

It took a long time to get where I am, but the flickering flame I spotted when I got hurt was doused when I first stepped into this little room on the internet and began to scream.

And CCC is doing the same thing.

Keep strong Brother (or Sister)!

 

If you feel that flickering of burn out and want to vent, drop me an email, I’ll read it, or not, whatever, just talk to someone, anyone.

You’ll be glad you did.

@KYECOMMUTENBC

Proper use of Long Spine Board pre-hospital

Friend of the blog Nick Williams sent a photo to me about Monday’s commuter train derailment in Chicago that left over 30 injured.  It was upon closer inspection of the photo by KyeCommuteNBC that I almost spit beer onto the screen tonight.

Take a look at this photo for proof that long spine boards are an important tool in the pre-hospital setting.

 

@KYECOMMUTENBC

@KYECOMMUTENBC

Without that long board, someone could have been injured…

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Missing the Grind of the Lightbar

I was doing some math and realized my career in EMS has reached past middle aged.  I have 18 years in and 17 to go.

It made me think of how I am still perceived as a new guy by some and an out of touch almost dinosaur by others.

Thinking back to the early days of when I realized this was what I wanted to do brought back some memories many in this field will never experience.

 

For example:

Manual transmission water tender.  My first paid unit was a 1970s 10 speed double clutch 1000 gallon water Tender.  I learned to drive code 3, work the siren and shift, all while reaching a top speed somewhere in the high 40s.

But as memories went through my head of that beast of a unit a certain sound crept into my head and has stuck for a few days:

 

The grinding of the rotators in the lightbar.

While some of you might still have an “old” rotating lightbar, most of you are likely used to all manner of flashing light bulbs and diodes.

Back in the olden days we had lights that turned on and spun around in circles.  Our old rescue truck on the Reservation had 3 bright white lights mounted on a 12″ diameter spinning disk covered with a sun bleached almost still reddish pink cover.  When you turned it on and pulled out of the station is spun slowly.  When you pressed the button for the old Federal Q siren mounted on the front bumper it would slow and almost stop.  It was not uncommon to reach the scene and go to work only to see the beacon slowly begin to dim as the alternator on the ford pickup could no longer keep it shining and turning.  It was later upgraded to a strobe light and we thought that was the neatest thing ever.

On the ambulance was the Code3 standard lightbar of the time, 2 rotating lights and a series of reflectors as well as intersection lights that swept back and forth on each side, apparently designed to get the attention of drivers coming from the sides.  Those rotators were noisy!

That grinding was constant, loud and almost annoying.  And they were especially annoying if one of the reflectors got dislodged and stuck while on a run at night.  Or in the snow.  Or in the rain.  Or at all.  A single beam of bright red or white light trying desperately to distract you from looking at the road.  And Gods help you if it was an intersection light that got stuck!  That was worse than driving code 3 with your alley lights on.

 

Nowadays the kids have these LEDs that blink in ever impressive patterns.  For those noobs unsure of exactly what I’m talking about when I mention the grinding of the old rotators, imagine how much nicer your drive would be without the high beam flasher motor clicking away under the dash.  You’ll be glad when it’s gone, then 15 years later remember when things were bigger, clunkier and less efficient and miss it ever so slightly.

 

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 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!

-HM