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!

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.

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.

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.

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.

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.

My good friend Fire Critic recently posted a quote from a text he is reading about Professionalism in the Fire Service.

READ IT HERE.

A new window will open, you’ll read it, then come back. You know the drill.

I really hope this quote was out of context because it is the farthest thing from a definition of Professionalism I have read in a long time.  Professionalism starts far before and goes far beyond conduct on the fireground and in no means is it the best or only way to prove our worth to the community.  If that was the case I would be working for one of the premiere professional services in the world.

I was originally not commenting on the subject and just letting it go, but I wondered how many younger members may read that and run with it.  Rhett is not a silent or small voice in the modern Fire Service and such a quote unchallenged will only reinforce the rampant un-Professionalism I see permeating our ranks.

Not long ago it was an offense to be out of quarters without cover on.  That means wearing a hat for you younger folk.  Now there are departments wearing shorts.  SHORTS!  I’ll admit, I tried it once during a hot summer in the southwest and I felt like a teenager, not a Professional.  Others go out wearing T-shirts, some of those ratty, holes, lettering fading or, worse yet, a shirt from another agency.  Ever seen an FDNY or CFD shirt somewhere that wasn’t NY or Chicago?

Professionalism starts with the way you carry yourself, your appearance and the way you interact with those whom you encounter.  This is all before the bells even ring.

I could start listing off all the things that I think go into being a Professional, but since the quote from Rhett is a simple statement, I offer the following:

“Professionalism is carrying out your responsibilities to the best of your ability, be they the most mundane or the most exciting, the simple or the complex, the recognized or, most importantly, the unnoticed.”

I quote Rodney Dangerfield, “You wanna know what class is? It’s when you’re alone and you fart and you say ‘Excuse me.’”

On a recent job I needed my old Pal in green, Mark Glencorse, to come to the rescue in his Ford hatchback.

You see, Mark has so many more options than just a reclined cot ride to the ER for his clients and patients.  When I am presented with a situation that does not need that resource, but something both simpler and less expensive, I am told I am crazy. “It will never work” they say. “The abuse will kill it before it starts.”

I hate being proven right.  OK, not really.

On a recent job I was reminded that sometimes people just need a helping hand and a few minutes more than we can offer before they feel better.  Sure a reclined cot to the ER will help them, but so would 10 minutes of chit chat with someone who can help, listen and not judge and point them towards a resource that can help them in the long run.  Instead we sent them ALS to the ER.

We begin our tale in the usual HIPAA fashion, by obliterating the educational aspect of what I want to tell you, and change the facts beyond the letter of the law.

Claustrophobia can be debilitating.  I often think about small spaces and cringe.  Heck I even have trouble tying my shoes or zippering up my boots at work.  Now imagine a full blown, 100% authentic claustrophobic person finally getting up the nerve to ride in an elevator.

And it gets stuck between floors.

Needless to say that when we arrived the person was less than enthusiastic about her condition and her friend inside with her told us she was having an asthma attack.  It wasn’t asthma, but a psychosomatic reaction to her fear which elevated her respiratory rate, heart rate, blood pressure and decreased her sense of reason and hearing.  When the heroes (the Truck) got her free she calmed.  Only after some breathing exercises while pacing the large lobby of the building did her vital signs return to a somewhat acceptable range to discuss her options.

There was no cardiac component, no assessable sign was abnormal for her and she stated the fear and response to the fear had passed.

Then she apologized.  Apologized for bothering us with her “stupid crying.”  I assured her this was exactly what we are for and will always be there to help when she needs it.  She then informed us she would not be going anywhere in the ambulance that was arriving to transport her and if she needed help she would have her sober licensed driver friend take her to her hospital of choice not far away.

We agreed and I gave my usual speech about calling us back, things to watch for, odd sensations that may develop in the coming hours and suggested she contact her doctor and mention the issue.  Then I advised taking the stairs for a few days and we shared a laugh and, surprisingly, a hug.

10 minutes later, while returning to the station I hear other units being sent code 3 to the same address for a person of similar description for asthma attack, worsening, from being stuck in an elevator.

It seems she had a relapse of the fear which her friend could not control and anxiety got the better of her…again.

After speaking to the ambulance crew later, after they transported her to the local ER (while choking and MVA calls went out without ambulances assigned to them), they informed me she again calmed with discussion and distraction, but never had a treatable component.   They never administered medication or initiated treatment, other than a calming conversation, which in this case she needed more of.

My thoughts immediately went to the future, where I could put her in my response vehicle and give her a ride to her doctor’s office to be evaluated for issues related to the claustrophobia.  Instead she took up a space at the local ER and, if I am correct about how busy they were, was likely sent to the waiting room.  The small, cramped, crowded waiting room.

This person was never in danger of losing her life, but no amount of conversation would convince her of that.  This was an emergency, one where it wasn’t my ability to drop an ET tube or cardiovert on site that was needed, but my ability to assess, evaluate, establish a differential diagnosis, then act on it.  Only problem was, I couldn’t.  My system does not allow for what this patient, MY patient, needed, which was a few more minutes of calm conversation and distraction followed by evaluation for a specific condition.

Because of the failure to recognize this needed flexibility, patients all over the US are being strapped to cots with care givers unsafely restrained (if they’re lucky enough), watching them.  Not treating, just reassessing and watching.

Remind me again how 1 person in a hatchback can’t do what my patient needed?

Swalwell 405…where are you?

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My brother from another mother Motorcop and I continue our back and forth between the boys in blue and the heroes in a segment he dubbed The Crossover.

In this most recent installment we knew the back and forth would be great, so I fired up the ambulance, hit the lights and ran a red light on the way for a coffee so we’d run into him.

Topics covered include continuing education for motors and medics, why he can let law breakers go with a warning and how I’m bound to take every Tom, Dick and Harry to the ER no matter what and the burning question: Why don’t motor officers wear chaps?

Episode 1

Thank for listening, more to come!

Our discussion with Dan Gerrard, Bobby Halton and Jow Telles continues in our special look at building relationships in Emergency Response.

Whether a Chief Officer or Probationary Member, all can learn from this discussion, have a look.