Category Archives: Training

Baltimore Checklist

Alright ramblers, let’s get ramblin’!

EMSToday promises to be another huge success and the folks at JEMS are working hard to make the conference their best ever.

Aside from world class presentations for every level of practitioner, manager and owner/Chief, a giant exhibit floor and the popular JEMS games on Friday night, there are a number of things I’m hoping to see in Baltimore this year.

First for me is the reaction to the brand new Brady/San Francisco Paramedic Association curriculum being debuted pre-conference.  Partnering with Chronicles of EMS producer Thaddeus Setla, the folks that brought you high quality video production for Beyond the lights & Sirens and A Seat at the Table have raised the bar in education media.  Gone are the days of a camera pointed at a lectern passing for multi-media in EMS education.  The team is signed on to complete the entire tract and you’ll likely see it in a classroom near you soon.

While on the exhibit floor, I’m going to check in with the folks at AllMed and see what’s new in uniforms and equipment.  AllMed is the supplier of the dress uniforms for Beyond the Lights & Sirens and they always have something new and exciting in the booth.  And they’re the only vendor I recall that brings a seamstress to hem those new pants right there on the show floor!

A big topic at EMSWorld was ambulance safety and I’ll be asking some tough questions of the manufacturers this year, mostly why they keep putting a little box on the back of a pickup truck and call it an ambulance.

Home this year is exactly that, our little corner of the Zoll booth #3707.  Last year we were added at the last minute and had to carve out a section in front of the closet.  Those who visited remember the crowded feeling and we ended up just standing in the isleway.  Zoll saw the crowds we were bringing in and have actually engineered a separate section of their new floor show just for us.  Come see it, meet Ted Setla and record your own “I am EMS 2.0″ video.  While there, get a free CoEMS T-shirt and find out how you can be a part of the new First Responders Network TV channel.  Oops, I’ve said too much.

The show is going to be great and the folks at JEMS will no doubt outdo themselves again.

But what to do when the classes are over and the hall closed?  That leaves the out of conference activities to us!

Here’s your cheat sheet:

Wednesday night-

Pratt Street Ale House – Directly across from the convention center, second floor, the Zoll Pre-Conference Blogger Bash, beginning at 8pm – 11pm.  A non-formal, smaller gathering to get fired up for the opening of the conference.

Thursday night-

Uno’s Chicago Grill – Farther up Pratt street in the Harbor, THIS is the meetup everyone is talking about.  Hosted by FireEMSBlogs this is the gathering that last year garnered the attention of most EMS bloggers, most fire bloggers and a handful of Chiefs who were curious what we were up to.  I know everyone last year just came to meet Mark Glencorse, but this year promises to be another amazing success.  The guys from GoForward Media know how to throw a party and have spent a year planning this event to blow all previous events out of the water.  And considering their events in Indy and Houston last year, the bar is set pretty high.  You’ll need the Zoll Pre-Conference party just to condition yourself for this one I promise you!

Did I miss anything?

Beyond the Lights & Sirens turns 1

A year ago we were gathered in the ballroom at the Hotel Frank in San Francisco waiting for Thaddeus Setla to press the play button.

The time finally came to show the audience what we had filmed the previous November in the engines and ambulances of an American EMS system while UK Paramedic Mark Glencorse followed along.  A hush fell over the crowd of EMTs, Paramedics, friend, industry leaders and family when Thaddeus raised his hands and said, “Our online audience is watching it right now, can we dim the lights please?”

Chronicles of EMS – The Reality Series (Season 1 Episode 1) from Thaddeus Setla on Vimeo.

25 minutes later, after a few good laughs and plenty of smiles the show finished and I found Mark in the crowd.  We were near tears seeing what Setla had done to capture the emotion we had experienced months before.  It was like reliving all we had learned in our trans-Atlantic exchange.

The evening was a great success and the following morning found us in Setla’s studio filming the first 3 episodes of A Seat at the Table.

1 year later we’ve released 23 episodes and have plenty more planned as well as in post production.

The reality series got a new name, thanks to our audience and network TV executives are curious to see what else we have in mind.

If they only knew.

In recent weeks you’ve seen A LOT of activity at the Chronicles site because we are gaining partners and growing rapidly.  No longer is “Chronicles” (#CoEMS on the twitter) simply about Justin Mark and Ted in San Francisco.  Chronicles of EMS is now only part of the content planned for he new First Responders Network TV.  We’ve partnered with fire centered production houses to create new original training and entertaining content similar to the EMS side.

And we’re not stopping there.

If Tak Response taught us anything, it’s that cross training outside your discipline is exciting, new and long over due.  For that reason law enforcement will also be included in FRN.TV, focusing on how we can all learn from each other before the incident instead of during it.

We never landed in prime time on Discovery Health traveling the world exploring EMS systems, but we have time to do better.

Keep an eye on the Chronicles of EMS site for details about our new partnership with the SFPA and Brady and how EMTs all over the country will soon be familiar with what we’re doing.

In addition, Seat at the Table has expanded into new territory, sitting down with the International Association of EMS Chiefs as well as sign language expert Louise Sattler to discuss communicating with unique patients.

We’re charging forward in every direction, working on both reality shows, training series, CE content (coming soon) and a host of scripted dramas, comedies and features that will bring EMS into the home of Americans in a way they have never seen before: Accurate and entertaining.

Thanks for all your support over the last 365 days, and I hope we can count on it in the future.

-Justin

You Make the Call – Hotel Rooms – What Happened

This scenario was patched together from a few here at home and from around the community.  My service recently ran a call for nausea that included multiple persons in stacked rooms and handled it well.  But identifying the cause or possible causes of the illness can be difficult when multiple possibilities present themselves.

ICS focuses on being the first in and building from the cold zone forward.  This call would be so much easier if we were donning our Medical Group Supervisor vest and carrying the command kit into the lobby control.

Ah, if only life worked that way.  Most MCIs and Haz Mats evolve quickly and rarely come in reported as what we find.

I added the element of the unknown upstairs to make us think about what ELSE could be happening besides the seemingly straight forward CO poisoning call which, had this been contained to two adjacent rooms, is easy to include in our plan.

Medic 88 responded above us, called for a haz mat response and went off the air.  We got neither a status update on their condition or why they called for the haz mat activation so we must assume the worst: They are compromised.

On the 4th floor we have 3 or 4 patients directly needing our assistance with an unknown number possibly dead, dying or completely oblivious to the situation.  The first instinct is to evacuate the building, but scattering our unknown illness may prove more costly than not, so we need to evacuate to a place of safe refuge.

The enclosed nature of hotel rooms gives us the unique option of being able to stage our evacuation from the rooms to the hallway, establishing a warm zone.  Of course identifying those experiencing symptoms will be difficult so we need a way to identify them easily.  The MCI and triage kits are downstairs in the rig, so we’ll need to improvise.  Advise the persons you have already contacted to put on the hotel white robe (if they’re there) or drape a large white towel over their heads.  Asking them to also bring a clean washcloth to cover their coughs will help contain any airborne illness should it be present.  The 2 masks we carry are on us and we are considered contaminated until proven otherwise.

Now we have our original patients easily identifiable and a method to separate them based on signs and symptoms of illness.

This information now needs to be relayed to the other responding units.  Using clear text is key in this situation.  Identify your unit, establish command, list threats and give your status.  If Medic 88 is unreachable upstairs we must include them as victims until we hear otherwise.

For the time being we should stay on the 4th floor, triaging all the rooms who will answer the door.  Symptoms get a white towel/robe and washcloth, non symptomatic get moved the the other end of the hallway from our rooms.

This is no place to establish a command post or begin to orchestrate the response of additional units.  In most communities the first units on scene will be engine companies with basic gear and SCBA, and until we know what is going on upstairs, they should not enter the 4th or 5th floor.

Haz Mat Specialists can speak in more detail as to how they may approach this situation, but leaving what Medic 88 found unknown, I think makes us think in different ways, determining a solution for each possible situation.

Think about the following changes to the scenario:

Medic 88 reports a faulty pilot light on the water heater common to 403, 405, 503 and 505 and that symptoms clear in the hallway.

Medic 88 reports fumes of unknown origin seen coming from room 505, two patients are down inside that room.

Medic 88 calls a mayday and reports they are trapped on the 5th floor in heavy smoke, no SCBA.

Medic 88 stumbles from the stairway with blisters on their faces and arms, excessive snot from their noses and mouths, begging for help.

A hotel employee approaches you stating the hotel has received a bomb threat.

These are all exotic situations we may never see in out careers, but could actually happen when we are already set up for a different event.  Responding to any of these situations allows us to think ahead, set perimeters and stay back from the nasty stuff, but with dispatch systems keen on getting us out the door ASAP, most times without finishing the coding of the call, a simple code 2 sick call can become a dangerous unknown situation.

Think on your feet, use what is around you to your advantage and don’t forget that in this situation, YOU’RE a victim too.  At least until the heroes in the yellow suits say otherwise.

If you said “Slow down and think this through” you made the right call.

3 Years ago this morning

MAN DOWN! MAN DOWN!

Happy Medic’s 12 Days of Christmas, #HM12DoC

This series of posts was inspired by a number of friends of the blog on an afternoon in late November.  While Chris Kaiser had recently posted an article about what changes I would ask my medical director for, I was mixing a few posts together about some interesting jobs I have run in the last few months.

With that fresh in my mind I was having a live video chat with some of the Chronicles of EMS followers when @ChicagoMedic on twitter posted the Happy Medic’s 12 Days of Christmas in two posts:

“12lead ekg, 11 bls calls, 10mg morphine, 9 homeless psyches, 8 asthma attacks, 7 OB’s crownin…”

“6 priapisms, 5 golden hours, 4 fibbing V-Fibbers, 3 Triple 0′s, EMS 2 point 0, 1 British man.”

When I finally wiped the tears of laughter from my eyes it occurred to me that these three things I was pondering fit nicely together.

So over the next 12 days, I will present the daily EMS topic from @ChicagoMedic’s tweets and why it is important in our field.

Each morning at 0800 PST, check in for another day in the Happy Medic 12 Days of Christmas!

Time to update your Disaster Plan

As you know, we invest in preparation.  Training, equipment checks, drills, studying, all leading to when the bells ring and we are expected to spring forth with knowledge and actions that seem natural to the casual observer.

However, most of us leave all that preparation at work and come home to a completely unprepared family in case of disaster.  This is the reason I developed my own Family Disaster and Evacuation Plan.

Included in the plan are a number of instructions for my family, and me, on where to shut off utilities, how to shelter in place, who to call for help and what to take and where to go if ordered to evacuate.

As part of the plan, my family keeps on hand a 3 day supply of food and water.  You may remember a brief overview of the contents from the 60 Second lifesaving tip before Episode 6 of Seat at the Table.

Well, it’s that time of year to go through the kit and donate all the foods that will be expiring in the coming year and replacing them with new foods, updating your family’s tastes and needs.

If you would like to know more about how you can make your own custom disaster kit, click HERE to go to our Disaster Plan Page and learn more.

You Make the Call – Resources needed elsewhere?

A full structure fire alarm has been struck for a dense residential area in the neighboring district. You catch the alarm while on the way to shopping and as you accelerate you see the first in engine sitting in the parking lot of the grocery store a block ahead.

You’re first due now.

On arrival you have light smoke from the garage of a 3 story type 5 house, approx 30 feet wide and 100 feet deep with the neighboring homes of similar type and so close it prohibits a 360 size up.

Your firefighter has made contact with the owner who states heavy smoke in the rear of the garage but no fire. Inside visibility is clear and his definition of “heavy” is clearly based on never seeing a fully smoke charged room.
In the back of the garage is an over heated electrical panel leading to the elevator control room, the door to which is blocked by storage bins and piles of laundry. Cutting the power immediately makes the electrical box stop buzzing.
As you exit the garage and send your firefighter to search the upstairs for signs of fire, the Battalion Chief calls on the tactical channel and asks for a report and if the entire alarm assignment needs to continue, they have another fire call nearby and could use the units. The engine you passed at the store is now arriving on scene and the officer is listening to the radio dispatch for the other fire.

What is your report and decision about additional resources? You make the call.

A Day with Motorcop – Part 3

OK, OK, I kind of cheated making Day 2 a podcast, but it fit nicely with what I wanted to talk about operations wise.

In our next episode we’ll be discussing our last detail of the day, but first I’ll fill you in on more of our day together.

The bromance was in full swing as we scanned passing cars for seatbelts, cellphones, and crazy activities.  When I drive alone, I often scream at drivers who do unsafe things and don’t seem to understand how to merge or yield.  MC gets to light them up and charge them for it.

We were returning to the PD so Mr MC could use the little boys’ room when we witnessed a car exiting the highway.  As she failed to stop at the red light to turn, a car coming the opposite way was making a left hand turn to go the same direction as she was.  Without even looking, the car making the left had to stop in the intersection as this woman cut him off.

FLASH FLASH – WOOP WOOP

And she kept going.  I almost thought we had another chase on our hands, but she eventually pulled into a parking lot.  After passing 3-4 safe places to stop, she finally pulled into a parking place which appeared to be near her place of business.  As MC approached and cited, I wondered if her co-workers would see us and comment to her later.

We cleared and MC was almost doing the pee-pee dance (which was impressive in his gun belt I might add) we were leaving the lot making the left hand turn mentioned earlier.  As we made the turn a van was coming off the freeway and did the exact thing we just cited the other woman for, and DIRECTLY in front of a police car no less!

Oh my these folks were stupid.

His excuse was that he didn’t see the turn signal on the police car and therefore did not feel the need to A)Come to a complete stop, B)Yield the right of way or C) Shut up when the officer has to scream through an open window for you to pull forward and over instead of waving him through the intersection as if nothing is wrong.

I was smiling the entire time I was out with MC and loved the autonomy he has to move from place to place and see what is happening.  It is just that kind of freedom that dispatchers love to take away from us out on SSM ambulances.  Sending you from 5th and Elm, 2 blocks to 7th, then telling you that posting on 6th is “Outside your response area.”

When I had the chance to work as the Paramedic Captain recently I found that autonomy and embraced it.  I would sit at trouble spots and wait for calls to come in so I could be first on scene and cancel the engine.  The buggy was posted a few blocks up from a tourist traffic nightmare making sure I can see if one of my cars decides to post down there (where they know they shouldn’t).  I even called a few crews on the old trick of being “delayed finishing paperwork” at the hospital by dropping in to see how I could help.

I did get to learn ALOT while riding with MC, including all the nifty new technology out there for our traffic friends.  There are new 3D imaging kits that let them collect data at the scene of a collision that can be rendered in a virtual digital environment.  Kind of like CSI has been doing all these years.

Another neat piece of equipment was the Lidar.  While Radar will use sound waves to confirm range and therefore speed, the Lidar uses laser light and is wicked accurate.  Radar will tell you something over there is going a certain speed, Lidar will tell how how far away and how fast the object is the little laser light is on.  This is a great tool for MC, since he can pinpoint a certain vehicle in a crowd and there is no guess work involved.  Little red light on green car, green car is traveling x speed at x distance away.

Even though MC was available for 911 calls, we only responded to one of those, the MVC we will cover on the Crossover Episode 4- A New Hope.

There were surely more differences than similarities between EMS and police, I knew there would be, but the people doing the job are more alike than I expected.  There are supervisors who could use a few more days on the streets, the over achievers, the hiders, the worker bees, the minimalists and those who exceed expectations, but we all lace up our boots and button our shirts with one thing in the fronts of our minds:  Going out there and doing what we love to do for people who have no idea what we’re doing.

A special thanks to Motorcop for letting me tag along in the car for a day.  I hope to reciprocate if the Captain’s gig gets a bit more regular.  I am curious to see what MC would think about big City EMS.

The Tie – All the Authority I need

Another watch as a Rescue Captain is under my belt and I took an old story from a colleague and applied it to my day.  That was one of the best decisions I made all day.

There have been discussions around the interwebs machine about what makes a Professional professional.  Swagger was one answer, brains another, but I always default to the first thing people see when we walk in the door.

The story relayed to me was by one of the more experienced Captains who was around back in the municipal ambulance days of old (pre-1999).  He told me that some of the crews would carry a black neck tie in their ambulance.  If you encountered a client that demanded to speak to your supervisor for clearly bogus reasons, a quick call on the radio for that crew would bring in a person dressed exactly the same, except wearing a tie.

The trick to pulling this ruse was not ever saying that you were the supervisor, but just walking in with the air of authority, and of course the neck tie, and simply asking what the trouble was.

After a good laugh I got to thinking about it.  As part of my duties I attend the Division Chief’s briefing in the morning and, out of respect for the rank, wear my tie, as do all the other attendees, the Chiefs also in their dress coats and caps.  After leaving that meeting I noted on my computer that an abnormal amount of ambulances seemed to be backed up at a local hospital.

As I pulled up to the large construction area, rigs were crammed wherever they could to unload on level ground, since the hospital was on the edge of a hill. (Ahhh, San Francisco.)

Approaching the area we usually parked I see it being used as a tool staging area and asked the foreman if there was a way he could move his tools to the hill side of the area.  I was ready to defend my reasoning when suddenly he apologized and started to move them.  After confirming I was not the first person dressed in a blue shirt with red patches who asked them to do that, I looked around and sure enough, my tie was still on.  The buggy was parked around the corner and no one calls me Captain, so I have to assume it was the tie or my amazing powers of persuasion.

Appearance is not all it takes to be a Professional, but it is the first thing people use to assume who you are.  Right or wrong, that is how we’re wired, so put them on the right track by looking the part, then act the part.

No tie required most days.

Sunday Fun – Red Lights

Do you have a red light outside your firehouse? Ever wonder why? Besides “tradition” or “it’s just always been there?”
Indeed some of the best stuff on this job comes from the early days of the American Fire Service.

Much like the early days of the railroad, when the brakeman would take the red light from the rear of the train and hang it from the door of wherever he was (Often houses of ill-repute, hence the red light district) the tradition of lanterns at firehouses is similar.

There have been great discussions about why fire apparatus run with the color lights they do. Most are red, some red and blue or red and green, but why red?

In my service the red lantern outside the house signified that the company, or even earlier, the hose wagon and hand pump were in the shed/building. In the early years the community served as firefighters. There is a great scene from the HBO miniseries John Adams when he returns home from a long day and someone outside yells “FIRE!” He scrambles for his coat and grabs his buckets and is out the door. Turns out it was British soldiers firing on a gathering, but that’s a different tale.

When hose carts and pumps are introduced, they aren’t simply parked on the street or in an ornate fire hall, but in a shed. The way to spot the shed was by the lantern hung on the door and a simple marking.

When the piece of equipment was taken out, the lantern was placed on it and the shed would be empty. If the door closed and others came for the pump, keep in mind everyone is mobilized to help, and the lantern is gone, they move to the next shed that keeps equipment.

The lantern on the door signifies the equipment is in place.

As companies began to specialize there was a need for volunteers to organize either at the scene or at the Company Hall. If they arrived at the hall and the lanterns were gone, they would go to the fire. If the lantern is hanging, they would organize a team to pull the gear. A lantern clearly visible from the end of the block saved each member from running to the hall to peek inside.

Here, Ladder companies hung green lanterns and steamers red. In dual company houses there needed to be such a separation to avoid confusion.

Today our ladders still run with a single green light on the front. It also makes it easier to see them coming at night so you can decide whether to lay a line and block the truck or wait a moment and let them through.

Conveniently, as the apparatus continued to evolve, the lantern became a lamp, then a light, then a beacon, now a strobe or LED. And the old position of the lantern is taken by a red light which still signifies to the community that the building is a fire hall. Although now the light is always on.

If you know of a company that shuts their lights off when they are out of quarters, I’d like to know.