You got WHAT stuck in a bowling ball?

In my memoirs of EMS (Working title – My Life in CQI: Kill me now, just document it properly) some calls will stand above all others.  This, sadly, is not one of mine, but from a friend overseas.

No, not Mark.

I got an email about a curious rescue his agency was called to and was wondering what I would have done.

So, here is the scenario:


A 19 year old male has gotten his finger stuck in a bowling ball.  He somehow wedged it in there so far, it up against the webbing of his hand with very little wiggle room.  Rotating the ball is out of the question as he seems to have the finger next to it wedged in almost just as bad.

25 minutes into the call you’ve tried gel, ice, lubricants of questionable origin (who carries that stuff into a bowling alley?) and brute force.  Prayer is taking place and all options seem exhausted when the decision is made to simply move him, and the 16 pound bowling ball, to the hospital.  What will they do there?  Dunno.


What would you do?

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?

The Legend of the Little Dipper

I had completed my surf rescue qualifications only a week ago and had been carrying my gear on the engine along with the helmet, vest and fins.  My name was on the board finally, assigned to Rescue Watercraft 1 under “Swimmer.”

It is what I had worked so hard to achieve.  Weeks in the pool at the gym, 8 hour days of water training, swimming in the bay, the ocean…it finally all paid off.

On this particular day I had wandered over to the store on the corner for an apple and the radio came alive when I had just left.

“Engine 8 on Fireboat 1, Engine 16 on RWC1, Truck 16 on RWC2, Battalion 4, Medic 99 and RC2 respond for the bay rescue…”

The rest was a blur.

I thought dressing for a fire in a hurry was a challenge.  I needed to go from full uniform to wetsuit, then gear up from there on the short drive to the docks.  In the past, before I got my rescue cert I would drive this leg, then help prep the skis.

Not today.

Today my heart is pounding, the wetsuit is on and so are my boots and gloves.  The vest is bulky and makes it hard to sit in the seats, the fins are clipped to my belt that I’ve made sure isn’t looped through my seat belt.

The tourists are photographing the engine as we come to a stop outside the Marina Office and jump out. 3 minutes.  Not bad.

We’re at a steady jog around the corner and down the walkway to the docks.  At the end rests the rescue boat and the rescue water craft.  They’re uncovered quickly and the operators fire them up and prepare to leave.  We have our possible location of a windsurfer in distress out in the middle of the bay.

My mind swirls with all the training I received.  It’s an ebb tide, meaning the water is leaving the bay, probably around 5 knots.  It’s a chilly afternoon, mid 60s and the water will be in the 50s.

Hood and goggles in place I climb on the ski just as it’s throttling up to make the trip into the windy almost white capped bay.

Why anyone would windsurf in this weather is beyond me.  Clinging to the operator and the hand holds, the rescue board attached behind us looks like a far better place to be but trying to change positions at full speed could prove dangerous, wet and fracking cold.

By the time we arrive at the large passenger ferry who spotted the wind surfer in distress we discover that callers out here are no different than on land.

Our “victim” is a kite surfer who is having trouble getting started back up with the ferry hovering in his wind.

We thank the ferry operator who begins to go back the the three hour tour of the bay and we offer to tow the surfer into a better wind vane.  He climbs on the rescue board and I reach over to grab his board.


Any moderately experienced jet skier will know that you never stand and you especially never lean over when on the water.  I knew that, but in the wind down of adrenaline and finding out I won’t be swimming 100 yards against the tide, I got comfortable…and forgetful.

I can only imagine the comments from the crew of the Coast Guard boat now arriving at our location, seeing a Fire Department Jet Ski with only a wind surfer holding onto the back and 2 knuckleheads in the water.

The kite surfer was back on his way and the wetsuit was doing a decent job, but we were cold.

Back at the docks RWC2 is wondering why my operator is all wet.  The swimmer, sure, but the operator?

“What happened to you guys?” The officer asked, tucked warmly in his turnout coat.

Without missing a beat my operator thumbs in my direction and says, “Why don’t you ask the Little Dipper back there.”


Luckily that name stuck for only a few weeks.  That is, of course, until the Legend of the Big Dipper.

Child’s toys beat researchers to ambulance solution

TOTW has a great article responding to a reported breakthrough in ambulance design by our friends on the other side of the pond. Clicky for ready.

As I was reading that article, and the original he linked to I was taken back to my days in Newcastle upon Tyne with (then) UK Paramedic Mark Glencorse.  I didn’t like the ambulance layout at all, but the full access around the patient and forward facing seat in the back were great.  But it works for the patients they treat, which is one of the hallmarks of EMS 2.0.  That each community has unique challenges and needs unique solutions.  We treat heart attacks the same all over this nation, unless you take into account the training, equipment, vehicles, staffing, location, hospital capabilities, transport times…you get the idea.  With this in mind each community will look slightly different, much like they do now, only we hope to strengthen what is working and eliminate what is not.

Finishing TOTW’s review of the “advances” the littlest of the HM JRs, Miss Eliza, was playing in the room with the ambulance bin.  We call it that because these girls have a lot of ambulance toys.  Go figure.


I peeked over my shoulder to see her little ambulance company lined up for her inspection.


Asking why she did that, her reasoning was to make sure everyone knew what to do today.  But then I began to look at some of the “non-ambulance” toys that had made the lineup.

Then she blew my mind.  Her description of why each vehicle was in the lineup sounded like a research project from my college days.


I give you Miss Eliza’s Ambulance Company LLC.

Miss Eliza staffs 8 distinct apparatus in her fleet

1.  Emergency Ambulance – “I like the noises”  A standard 2 person reclined van ambulance.  This rig likely carries most of her clients, is painted in distinctive colors for safety and has an impressive warning lights and sirens package.
2. Heavy Rescue (for tiny things) – “It does lots of sounds. It has Happy on it.”  Indeed this truck does have the markings “Happy Medic” and a license plate of “Free Ride” (all thanks to the Angry Captain).  But with decreasing budgets at the municipal level, Miss Eliza may be unable to call another agency for extrication or rescue.  It also allows her to train her people with her own equipment instead of having to rely on other agencies.  She’s thinking ahead.
3. Light Duty Transport – “The back opens for the bed in the back.”  This unit is short and narrow, clearly for use at special events.  It fits one provider, who can then drive while the patient reclines in the back.  A great use for tough to access patients.
4.  Advanced Care Clinic –  “I like it colorful” She likes the colors on this rig and the irregular shapes, but I like what’s inside.  Cabinets, sinks, an x-ray machine, hospital type lighting, it really is a clinic on wheels.  Even better, the entire side folds down to reveal a treatment area.  Park this rig at a special event and all those treatment dollars the hospital is getting are now to Miss Eliza.  Added benefit, no need to staff multiple ambulances at the event.  Just call one if you need it.
5.  Rapid Response Car – “Because the car can go fast.”  Jimmy Johnson will be surprised to know he’s been flexed into active EMS duties, but Miss Eliza sees the benefits of getting ALS eyes on scene first to guide the remainder of the system depending on the patient’s presentation.  Perhaps there is a better vehicle available, but she opted for #48, so who am I to judge.
6.  Ladder Truck – “I like the fire truck and the ladder” I see where she’s going on this one, but really, the ladders should be fitted to your heavy rescue squad.  I don’t think we’ll need that 100′ stick nearly as much as she thinks.
7.  Tactical Response Vehicle – “It does new tricks. Goes fast and has guns.”  The SWAT has a giant armored vehicle, we need something too.  Maybe the Green Hornet car is a little much, but pull up in this baby on the scene of a violent assault and the crowd will not only part, but disperse…and fast.  Added bonus?  Competing companies won’t want to meet you at the intersection trying to grab the same call!
8.  Ambulance (Non-Emergency) – “I like that its white.”  At first I thought she was just looking at the colors of the toys, but then I realized…that’s exactly what she’s doing.  The white rigs are passenger vans for non-emergent patients and clinic appointments.  If the little blue van can get me to the airport with 2 hours notice, surely we can apply the same design to scheduled transports to appointments.  Put a modified ramp on the back for wheelchairs and I think she’ll corner the market.


So there you have it.  She didn’t design the inside of an ambulance, that will take a complete redesign from the patient out, not the walls in, but she does bring up some interesting concepts in response models that I think should be considered moving forward, especially if municipalities keep cutting back.


Rogue Medic is in a great mood as of late and this article about the complete joke that is Mechanism of Injury (MOI) hits the nail on the head.  I recently had to triage a car over a patient because of strict trauma guidelines, luckily finding the always available “Paramedic Judgement” to wiggle my way out of it.


The simple point is this: Mechanism needs to be a symbol on a map, not the destination.  With cars designed to crumple around our patients, what if it does take 30 minutes to get them out but they are unharmed?  And the pedestrian clipped by the mirror on the arm by a passing car at 40MPH?  Why are they on a board and in a collar?


Because 30 years ago when this Profession was still trying to figure itself out we bought into some crazy ideas, that’s why.  Now that we’re actually starting to study some of these ideas and finding them hurting more patients than they are supposed to help, we need to start revamping a number of our “standards of care” which actually should read “That’s what everyone else does…”

Whenever I have to document damage to a vehicle (mainly for my recollection of the run later on, just in case) I try to use some basic terms that at least remain consistent in my own description of vehicles.  Those are:

Light truck, truck, large truck, coupe, sedan, wagon, van and commercial vehicle.

Then I go and describe the damage using 3 terms, light, moderate and considerable.

Those are mine and can be widely interpreted.  Maybe I’ll get Motorcop to jump in on this but…A coupe hitting a brick wall at 40MPH will look differently than a van that hits another van at 25MPH.  One is a trauma, the other not by protocol, even though one may indeed have carried far more force.

And even if I do mention light damage to the front of the vehicle, what does that mean? What kind of car? What kind of impact? Against what? Did the vehicle’s protection systems discharge properly?  If the driver was able to self extricate and has no chief complaint, why am I chasing him down with a C-Collar? Because the folks who wrote the policy are in a committee long ago and far away.

MOI is important as far as it gives us an idea of POSSIBLE injuries to consider.  I consider it as a part of the Past Medical History and weigh it just as heavily.  If it does not apply to the patient’s presentation it will be considered, but not relied upon.

One rollover will have a 17 year old girl sitting on the curb completely unharmed while a minor damage collision could yield significant injuries to the passengers.  We won’t know until we assess them.

I remember long ago in far off new Mexico, some medics would launch the helicopter just based on dispatch information of the reported damage.  And we’re back to the telephone game of one person’s “Oh my God! They’re trapped!” and another’s “She’s just not getting out, but looks fine.”

Assess.  Use MOI as a tool, not a guide.  We always look inside the passenger compartment for deformity, blood, marks, bent steering column etc, but we should not be basing a transport on the vehicle.


Then again, try documenting that you let a driver refuse transport who had moderate damage after a head on collision into a guardrail, deploying front airbags with a non-complete recollection of events.

Now if I tell you they hit the guardrail head on after sideswiping another vehicle at 40MPH and spinning around, coming to rest in the slow lane and is avoiding telling the police they cut across 6 lanes of traffic to make an exit…now can I let them go home?  Or should I be chasing him down with a collar?  We all know the answer to that one.


Looking forward to more, Rogue!

You Make the Call – Hanging around

The title is a bad pun, but has a dual meaning, trust me.

You have been dispatched in your first response vehicle to a boat yard for a reported hanging. The location is about a 10 minute drive from your posting spot and no other rescuers are responding with you.

About half way there dispatch advises the reporting party states the victim is in a boat out on the lake and will take rescuers to it when they arrive. The local Sheriffs used to have a boat but budget cuts have it on a trailer in a parking lot.

Arriving at the scene, or at least the closest your rig can get, a man identifies himself as the boat yard manager and motions you to a well kept vessel dockside with 2 other men staffing it. It is larger than a house boat and has plenty of room for all your gear, even the gurney!

Local PD radios you and states they are 10 minutes out with a field investigator and camera and request you do not board the boat until they arrive.

The man on the boat is adamant that you hurry and come with him immediately. It is a 10-12 minute ride to the boat anchored around a corner.


What do you do?

You make the call.

Rip Shears Review

Rip Shear RS-1

A few weeks back I received a care package from the folks at Rip Shears.  Inside was quite the interesting little device, a removable dual blade cutter that can be attached to any standard 7 1/4″ trauma shear. From there you simply start a cut with the shears, then flip and rip. Take a look at this short YouTUBE video from Rip Shears:
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This at first had me nervous.  Do I really need an open blade on my shears?  I wear a pair of shears on my duty and turnout belts and adding something so seemingly dangerous had me concerned I’d be replacing belt loops and turnout straps.

This was not the case at all.  I’ll get to the 2 issues I have with the product after I tell you why I’ll always be carrying one with me in the field from now on.


The Rip Shear seems like a simple device and it really is.  The fact that it is small and detachable means I can move it from shears to shears as needed instead of some giant device.  It also fits nearly perfectly into my existing leather pouch, since the shears fit as well.  I don’t wear BDU pants but did have a chance to test the shears snapped into a pair of Perfection pants supplied by Chronicles of EMS uniform supplier ALLMED.

AllMED Perfection EMT Pant

As you can see the gear does not hamper the ability to wear it, but the pocket just barely covers the blade, enough to likely get caught once or twice.

Drawback #1: The blades in the upward position.

When showing this tool around the ambulance yard one morning, one of the EMTs loved it.  He removed his regular shears from a lateral behind the back pouch and inserted the military green shears.  To show how easily they would deploy he pulled them out, not noticing his shirt got caught, and cut a clean rip in his shirt.  From this experience we chose to reverse the blade direction using only a screwdriver and voila, problem solved.





(l) as shipped (r)inverted


I now carry my own rip shear with the blades oriented down, took 45 seconds to switch.  There are no special tools required to remove and replace the Rip Shears, simply use a phillips screwdriver to remove the three screws, remove the blade unit and the guide unit, done.  The setup of the screws and hardware allows for the inverting of the blade and for attaching it to almost anything.

This far outweighs a single use tool that does not already incorporate itself into gear you already have.  Space in the bags and in my pouch is at a premium these days, so this little guy is more than welcome.


Another early concern was that the open blade would catch a finger.  I have to admit I was scared to handle these at first, but as shown in the photo, even little 5 year old fingers are safe from wandering into the blade area on the Rip Shears.  Fear not my thin fingered friends, you’re safe.

A 5 y/o's pinky finger does not fit

It took about 3-4 shifts to get used to having the slight extra height on my pouch and I now remove it to sit on furniture at work, mainly to discourage dirty looks when folks realize what’s on there.

The Rip Shear is available in black and a really neat glow-in-the-dark material that has been handy to have on a dark road on a night MVC.  Since EMTs can be excitable and use shears only to throw them away, I can easily track down my set and replace the Rip Shear onto another standard shear back at the station.

Drawback #2: The shears provided have a lip on the end too extreme to fit many pouches.  Again, easy fix here, just remove it and place it on a pair that does fit.  You can order your Rip Shear already attached to a set of shears, the website advises the manufacturer may change, so this may have simply been THAT particular supplier.  Yours may be different.


A perfect fit

The versatility of this product more than makes up for the out of the box issues we noticed.  When using the shears they worked exactly as advertised going through a few pairs of jeans in their time on my shears as well as the leather jacket of a very disagreeable clavicle fracture.  They cut like they look like they should.  No problems there.


I had hoped to grab an old pair of turnouts and use them to show how well they cut, but recent events here made it seem in poor taste.  Perhaps someone out there has an old set they would be willing to donate to Rip Shears?


Made in the USA and designed with Paramedic and EMT input I can’t think of a better addition to your kit for around $15.

Visit their website for more details and links to where to buy your own Rip Shears.

Check the trunk


Fisherman’s Wharf in San Francisco is a tourist destination ranked with the best of them. By day you can listen to live music, wander the docks where small fishing boats bring in the catch of the day, get pictures of Alcatraz and a bowl of clam chowder in a genuine Sourdough bread bowl. Yes, I capitalized Sourdough. We do that here.
By night the Wharf is very much the same, but now you can seek a table in one of the swanky restaurants that line the pier, menus overflowing with fresh seafood, most of it alive and swimming just half a day before.

When driving to the Wharf, many folk choose to park on the street or in lots nearby, some of them offering validation for the first few hours.

The others can use valet parking, an expensive choice but handy if parking in a crowded area isn’t your forte.

This particular evening I’m the medic on a 1&1 ambulance, as it was called here, you may know it as “the normal” or “the right way” where you are, at this time it was an oddity.
The bells ring and we’re waiting for our rig to be called. I mean waiting because instead of hearing just us, or us and the engine we hear the fire boat, rescue boat, jet skis, 2 engines, a Chief, an RC and finally, as if an afterthought, our little medic van.

The narrative tells us a person has jumped from one of the piers into the cold summer evening water. Keep in mind our seasons are a little different here too.

On scene we are waved around back of the fancy restaurants and to the lot where the valet drivers park the cars. The first thing I notice is that all of them are backed up to the edge of the pier and, although there is a large log keeping the car from falling in, a person could very easily step over accidentally and as we look over the edge, there he is.

Clutching a large floating buoy protecting a fishing boat from the pier is our patient, cold, wet and shivering, at least 12 feet below us. This is going to be a job for…
…from behind a sea of red and white helmets, denoting the truck company, appears carrying a 16 foot roofing ladder with large rounded hooks on the end. While usually reserved for peaked roofs, it works perfectly for reaching down piers.

When naked and warming under blankets in the back of the ambulance, our new friend tells us how he came to be a fish.

He was attending a birthday party and suddenly realized he had forgotten the gift in the car. Heading down he got the keys from the valet and found his car. When he went around back to get into the truck he fell 12 feet into the water and was underneath the large buoy for a time, just long enough to think he was going to drown. It was a quick thinking valet attendant who saw him cross the parking area, saw him fall and called for help.

Had the lot been empty he could have possibly drowned.

I bet next time you go to get something out of your trunk you look twice to see if there is a floor to stand on.

the Crossover Podcast Episode 14 – An Alameda Drowning and Where did Otis go?

Happy Medic and Motorcop dive into the controversy surrounding the Alameda man who drowned while rescuers untrained in water rescue stood on dry land. Then, as usual, they find a tangent and discuss the costs, effort and resources involved in arresting and jailing someone compared to transport and hospitalization and why many times neither fits.