Category Archives: News

San Francisco becomes Gotham City for 5 year old Bat Kid!

San Francisco has been transformed into Gotham City as part of a Make-A-Wish Foundation wish granting for 5 year old Miles.

Learn more HERE and follow the LIVE feed HERE.

 

Bat Kid is being escorted by the caped crusader himself and has already matched wits with a fellow called the Puzzler, who tied a helpless woman to the tracks in front of a run away cable car.  It is rumored that another fellow called Penguin has been spotted near AT&T Park and famous SF Giant’s mascot Lou Seal is missing.

It appears by the names being used that perhaps there is a legal issue with saying he’s with Batman, but the almost 10,000 people expected to take part in this boy’s adventure don’t seem to care.  They’re lining the streets to catch a shot of the Batkid in his Batcar fighting crime while fighting Leukemia.

Proud of San Francisco coming together like this to turn what could have been handled with a simple guy in a suit into a truly memorable and inspiring morning.

Your move New York.

EMS Flashmob

Eli Beer formed an all volunteer First Aid/EMS group when he was 17.  In the process of developing the program he volunteered on an ambulance and was always upset when they would get stuck in traffic.

Eli attributed his dying patients’ demise on the extended response time and wanted to do more for them in the time between when they needed help and when help arrived.

This video goes directly to the core of the Response Time argument and it is important to make a clear distinction between first response and ambulance response times.

We can all agree that getting someone in the door quickly can help guide the rest of the system’s response.  This can be a fire department engine, an EMT Police Officer or perhaps a third service handling first response.  What we don’t need is to send a reclined cot van on every call, nor does it need to get there in 4 minutes most of the time to make a difference.

In this TEDMED talk, Eli talks about how he came to found United Hatzalah and send motorcycles he calls “Ambucycles” to the scene of an emergency to help until an ambulance can arrive.  He touts a 3 minute response time to over 207,000 incidents last year and is using mobile technology to achieve it.

The phone app broadcasts the medical incident to the 5 closest volunteers in the same way CPR needed apps do so in the states.  When he mentioned it was kind of like an EMS flash mob he had my attention.  We’re locked into some old ideas and this one breaks the mold.

 

Why aren’t we as communities encouraging this kind of organization?  Sure there are volunteer First Aid Squads all over, but this is far far simpler than that.  And don’t wave the liability flag here, those folks would have to be trained to get access to the app and with the right kind of basic QA program built in you’re golden.

What do you think of the various things mentioned in this video?

  • Motorcycle first response
  • Volunteers
  • Phone App dispatching

 

Ellerbe may be ahead of his time

DC FEMS Chief Kenneth Ellerbe unveiled a plan for EMS redistribution in the Nation’s Capital and it is getting some nasty comments online and from the local Firefighter’s Union.

I can’t necessarily comment on Ellerbe’s reasoning for his move, since I don’t know what it is, but I can tell you that he’s WAY ahead of his time.  I just think he doesn’t know it yet.

You see, DC FEMS will be down staffing ALS transport units from 0100 to 0700, a time when calls for service are drastically less than the daytime hours.  On the surface, it makes perfect sense.  Cut extra resources when they’re not needed.  If it can be done and still meet the demand for quality ALS transport, great.  If it can be done while still meeting all the guidelines set forth by the local EMS regulatory agencies, great.  (Now our UHU calculations come in handy, don’t they?)

But what happens when your calls for service are ALS?

Ellerbe’s answer is to staff up that ambulance for the transport with one of the 21-25 ALS engine resources and 7 ALS supervisor units.   That also makes sense, until that fire engine is doing something else, like already transporting an ALS patient.  Forget being on a fire or an alarm or rescue, these resources will be BLS as their extra member attends another transport.  now units are scrambling to pick up medics at hospitals or BLS ambulances are out returning medics to their company.

My agency could consider such a move in the future, but it will be doomed for failure because of the high call volume of seemingly ALS calls as defined by the local EMS regulatory agency.  Without decreasing the number of patients, we can’t decrease the number of transports.

If DC FEMS can also flex their ALS Supervisor resources to augment the system of transports, they will also soon run out and someone from the engine will need to return their buggy to the hospital or the BLS unit give them a ride back to their buggy parked back at the scene.  More time will be spent returning units than responding in many cases.

 

Ellerbe’s plan is ahead if it’s time, but as far as I’ve been able to find it will not be as efficient as it needs to be.

Why you ask?

Because it needs to be coupled to a “Respond Not Convey” program, or as we call it on the street, the Paramedic Initiated Refusal.  Refusing transport to certain patients who do not need it is the relief DC FEMS needs to better serve the population.  So long as every stubbed toe and runny nose that wants transport gets it, you will continue to have 4 person ALS engines or ALS supervisors at the scene of incidents waiting for an ambulance.  We call it “Medic to Follow” and it is the number one drain on our system. “But Happy, that’s a BLS run!” Not if they used the magic word “Chest pain” to get triaged faster.  And we all know that NEVER happens…right?

 

With the sudden interest in the Community Paramedic model, many systems will have to address the issue of Respond Not Convey if they want to increase services without increasing resources.  I would love nothing more than to deploy our fleet of ALS supervisors to handle community paramedicine, but we’re dealing with an increase in call volume and market share.  And we have less than HALF the amount of ALS supervisors DC FEMS deploys.

 

Ellerbe’s plan seems like a slap in the face to some, but I see it as a new way of deploying resources.  Thing is, it will work.  That is until a second call comes out.  Then a third, then a fourth and next thing you know Engine 99 is sitting on the curb IFO the clinic awaiting a second engine to respond with a medic so the BLS unit idling at the scene can transport.

 

Just a gentle reminder: These views are my own, not those of the SFFD, the City or any one else, just me.

cilais online

2012 World Series Champion San Francisco Giants

Great series Giants!  See you on Wednesday for the parade!

Pre-Requisites for the Chicago Rescue Squad?

Many Fire Departments have strenuous and extensive requirements to make their rescue squad.

In NBC’s new show Chicago Fire, apparently all you have to do is have worked as an EMT in San Francisco.

Taylor Kinney as SFFD EMS EMT Probie Glenn Morris in Trauma

 

 

 


Taylor Kinney as Lieutenant Kelly Severide on NBC’s new show Chicago Fire

 

Not bad, SFFD EMT to CFD Lieutenant in 3 short years.

Also interesting that both Departments seem to have such lax rules regarding rugged facial hair.

 

After this show is cancelled what do you think Kelly will return as?

CalFire Air Ops up close – VIDEO

Our good pal Dylan, noted BlogStalker, childhood Explorer Scout friend and Chief Programmer at GasdaSoftware got a surprise while out back the other day:

 

CalFire was responding to a slow moving fire that proved difficult to access on Sept 3rd.  It was on site of the Concord Naval Weapons Station, a deactivated WWII munitions depot primed for development if anyone can figure out how to remove all the ordinance. While we could smell the smoke at HMHQ Dylan, from Gasda Software, had a far better vantage point.  I’d be curious to hear the pilot’s thoughts about all the kids at the edge of the pond.

 

And yes, that’s a separate helicopter.

 

Thanks for the video Dylan!

Good Luck MC!

WikipediaTomorrow morning (Monday) our buddy Motorcop is taking the sarg…the seargean…the saarg…well, he’s looking to promote.   In an effort to help him out I was able to pull some strings and get some of the exam questions.

I hope these help!

 

Vehicle 1 is parked facing south 22 feet from a stop sign in a 25MPH zone with hazard lights activated.  Vehicle 2 is traveling south at a speed of 35 MPH wit ha driver holding a cell phone to his head.  If vehicle 2 impacts vehicle 1 after applying the brake pedal for 20 feet, how far away is the Starbucks?

 

A male has been witnessed peeking into windows at the local yoga studio.  When you arrive on scene do you,

A) Detain the man in the london fog coat looking into the window.

B) Question the man in the london fog coat looking into the window.

C) Tazer the man in the london fog coat looking into the window.

D) Point out to the studio owner that their window faces a public street, the blinds are open and it’s daylight.

 

One of your patrol officers fails to report for duty.  Phoning his residence there is no answer, but he answers his cell phone.  He states he is sick and notified the night Sergeant, but in the background you hear an airport announcement.  Do you,

A) Notify him he is in violation of Dept regulations and begin suspension paperwork.

B) Accept his statement and place him off sick, then call in a cover.

C) Call the night Sgt to confirm the story.

D)  WTF guys? Am I not invited on the camping trip again this year?

 

CVC 21100 addresses _______________________________

A) The size and location of mud flaps on commercial vehicles.

B) The allowable length of overhang of an object protruding from a vehicle before it needs to be flagged and lighted.

C) Electric vehicles on sidewalks

D) No one is ever going to look it up, just pick something random.

 

And the question weighted most heavily on the exam:

Responding to a reported man down you arrive to find the local town drunk an inebriated fellow.  Do you,

A) Dismount bike in manly fashion making sure all civilians see the stripes.

B) Assess the situation after growing a bad ass mustache.

C) Ensure the man down is breathing and if not, begin life saving efforts

D) Stand over him, hands on belt and shout “Stay down! The heroes are coming!” after calling for an ambulance.

 

Good luck MC, we’re all rooting for you!

Big Brother or Caught in the Act? SF Buses to Issue Parking Tickets

Flick user Forty PhotographsParking in San Francisco is not a nightmare, but more of a craps shoot.  When Mrs HM and I lived in the City we only had one car and it was a small car at that.  When trying to find parking there was a rule:

3 blocks 6 times or 6 blocks 3 times.

This meant that if you went around the 3 nearest blocks in all directions 6 times you were not going to find a spot and should just find a shady spot maybe no one would see you.  But you had to be careful.  Handicap spots and the little ramps in the sidewalks were big tickets and I would never block a plug (hydrant).  Parking in a driveway or blocking a garage not your own was a guaranteed tow, so sneaking into a half spot was generally attempted, sometimes with success, other times that little white envelope would be waiting for you in the morning.

Unless of course you forgot which day of the week street cleaning was.  Then you’ve got another ticket for that too.

The Department of Parking and Traffic wanders the City in little 3 wheeled bikes and are almost like locusts swarming through the neighborhoods looking for places to earn revenue.  It’s a thankless job and when I see their little trucks parked on a plug and they’re no where in sight I call them in as illegally parked.

But I’ve gotten a bit off topic.

Point is, when you would be sitting at a sidewalk cafe and see a DPT bike go by, you suddenly sprang up and sprinted to the clearly expired meter and gave it another 25 cents for another 4 minutes without a $65 ticket.

But since 2008 the DPT officers aren’t looking around as often.

Listen to KRON 4′s Gabe Slate and Stanley Roberts Team up to look at how transit buses are issuing parking tickets just by driving down the street.

Installed on select Municipal Transportation Buses (MUNI) are cameras that capture images of cars along the bus’s route.  Those videos are then screened by a DPT officer and offending vehicles are sent tickets in the mail.

Unlike static red light cameras, they are able to see if a vehicle is moving, blocking traffic, occupied etc.  However, Happy is not a fan.

Reason being that buses are buses and parking enforcement is parking enforcement.  In addition, I seriously doubt the MUNI drivers are being cited for all their traffic violations, including blocking multiple lanes, stopping blocking intersections, illegal turns etc.  Or perhaps the drivers are safer now that the cameras are installed?

Either way, the City sees some value to the service since over the next 15 months cameras will be installed on all 819 buses.  At a cost of $800,000 in a City facing cuts in Fire, Police, EMS, library, even MUNI is hard to justify.  But in 2010 they recovered almost 1/4 of that cost on only 30 buses.

You do the math.

Some will scream “Big Brother!” and I see that argument and raise you a “it’s breaking posted laws.”

I only hope that the trucks that double park 2 and 3 wide directly next to a clearly identified loading zone get fined as much as the drivers who don’t notice the 3 feet tall letters on the street “TAXI ONLY.”

Perhaps MC could speak to the validity of mounting a camera on the ambulances to capture traffic violations?  I think we could up that 2102 citations in a year in just a few months the way folks seem to go insane around an ambulance.

Do you think this program is a good idea?  Think it goes too far?

The most important chart she’ll ever write

Or he…I dunno.

What I do know is that the Trayvon Martin George Zimmerman situation has got us right back at each other’s throats just in time for the weather to turn nice (sorry Kansas, I didn’t mean it that way).  With the release of some video of the suspect in the police station soon after the incident surfacing, suddenly everyone is a medical expert.  Trouble is, there is only one document that can solve this problem of “was his nose broken and head bleeding?”

 

The PCR.

 

According to reports the suspect sustained injuries and was given “first aid” in the back of the police car by paramedics.

Now, because it’s the “media machine’ we have to assume everything specific is actually vague, right?  So it may have been a BLS unit, a police officer/EMT or a full fledged ALS response unit.

Despite your preconceptions about the case, because you DO have one regardless of the facts, imagine yourself on this response: (I designed it this way, this isn’t how it happened)

PD requesting ALS unit code 3 for GSW victim.  On scene they advise the victim is DOA but another person, in the back of the police car in handcuffs, needs medical attention.  Your partner confirms the DOA while you attend to the person in the police car.

After assessing his injuries, what does your chart include?  That he is in the police car?  handcuffed?  Is he in custody?  Under arrest?  What about your physical assessment?  Is it any less complete because he’s sitting in the back of a police car at night?  Do you move him to the ambulance?  Do you bandage wounds?  Do you clean wounds?  Do you clean clothes?

After deciding a refusal of care or no indication for transport, how is this documented?  Refusal? AMA? It depends on the injuries, sure, but if the patient is handcuffed in the back of the police car, does your system have a cut and dry policy for who can sign for them?

All these questions of what happened when and to what severity are hinging on what could possibly be a poor chart.  A chart that will not only be seen in court, but the way things are going, will be plastered all over FOX News and MSNBC for years.

Writing your chart for CYA takes on a whole new meaning these days.  Do it right. Every time.  You never know when a seemingly straight forward case hangs a hard right turn and crashes into a wall.

 

I’ll leave comments open if they focus on the importance of documentation in an EMS reference.  If I start to see a “debate” of the race-baiting, racist, self defense, stand your ground law, gun nut, 2nd amendment hater BS this has turned into I’m closing comments.  Let’s talk EMS here folks, sheesh.

The Ultimate Lifesaver – EMS in the Wall Street Journal

I got a strange voice mail from the Secretary of the Chief of Department asking if I could talk to a reporter about our advancements in cardiac arrest survival.

Um…yes please?

 

Laura Landro from the Wall Street Journal asked the kind of questions I wish more reporters asked.  Not just asking for our survival rate, but the more important question:

“Why is your number improving?”

We discussed continuous chest compressions, training the entire department to AHA standards and ensuring our BLS fleet can anticipate ALS interventions.  We discussed esophogeal airways, CPAP, see through CPR (from ZOLL), end tidal capnography, so many different tools that come together to make a 9% into a 23%.  And that was all before I got my job at HQ.  It’s nice to highlight the work of those who came before including Jeff Myers, Seb Wong, Brett Powell, Pete Howes.

Hopefully this is just the beginning of a conversation with the public about how EMS impacts their daily lives, not just when they, for lack of a better term, drop dead.

 

The Ultimate Lifesaver