A Moo-ving Experience

So you're getting ready for the end of shift when you get dispatched for a tractor trailer on its side.  While you are responding you are told that cattle are involved.  Well, here it is...a mooving experience that I am quite sure will mess someone's day up.

My question for the morning is how do you respond to this one.  Let's face it, you're on the highway.  Dangerous enough until traffic is totally shut down and then there is always so wahoo who wants to drive around the accident like last Saturday when a bystander decided to drive right onto downed power lines that we were trying to block until he got the bright idea to drive onto the sidewalk.

Beyond that there are ninety head of cattle which probably outweigh your crew by a pound or two so if they get goofy, your trauma shears and pocket knife probably aren't helping much.

Just some things to think about this morning as I listen to the morning traffic report and am glad I'm not out there today, though I do get to experience bookends of Memorial Day Weekend.  Yay!  Be safe out there.

Happy EMS Week

Whether you realize it or not, you are likely protected by that other "safety net" known as EMS.  You know, the ambulance drivers?  The people who skip meals so they can take you to the ER because you are experiencing pain in your chest, or your child was injured at their baseball game yesterday, or you had a motor vehicle accident that you didnt think any of, but that caused you to have a cervical fracture you cant feel (yet), but that is going to be a problem sooner rather than later.

These are the same people who also skip sleep during a 24 hour period so they can take your neighbors to the hospital, miss the same baseball games that you attend with ease, and enjoy the experience of being vomited on, assaulted in regular numbers, and make on average less than your local Home Depot cashier.

Yes, I will show up to work when I have a 101F fever on Christmas Day.  (Let's face it, Santa wasn't coming to see me anyway.)  I really don't mind doing this.  Sick is okay.

But, all of this is to say, a thank you might be in order.  No, I don't want cookies or cakes brought to the station, but I would appreciate a gesture of respect.  Those gestures can be best defined as awareness that we have a job to do and you can make it easier on yourself and us.

Part one, on a consistent basis drivers will not even yield to the ambulance as we race to go perform CPR on a two year old.  Please realize we are not using lights and sirens just for fun as they lost their excitement for me about nineteen years ago in what is now a twenty year career.  I actually enjoy fixing that puzzle that is broken for you.

Part two.  Help yourself or at least help us help you.  Two things that the American College of Emergency Physicians are pushing are for citizens to learn CPR and to have a disaster preparedness kit.  These are two easy steps every citizen should take on for themselves.

While for years people have pushed automated defibrillators in the public square and they have worked, we still experience more than eighty percent of sudden cardiac arrest events in private!  This means that if you, the layperson, need to perform CPR, it is likely to be on someone you know and love.  What better reason is there for learning how to push hard and push fast?

The other part of that is the mentality that someone is coming to get you.  Whether it be Katrina, Ike, Rita or hurricanes for many years past there has been an idea that I will just ride it out.  After September 11th, this mentality has to go and it is a moral imperative to be prepared to take care of yourself as disaster approaches.  This may mean to indeed "ride it out," but it may mean to be relocate until the event has past you.  Putting together a kit is not as hard as it seems and with a little regular practice you and your family can be ready to help yourself when the time comes.

Yes, I will come rescue you.  I will sacrifice time with my family so that I can put your puzzle back together, but help me help you.  Now go find a responder and say thanks and stay safe out there.

Attention To Detail

In August 2011, I was invited to the Arkansas EMT Association's annual conference in Hot Springs, Arkansas to present an all day session on leadership.  During this time, I used a lesson I learned from General Colin Powell which was about attention to your people.

The crux of his comments were that you had to pay attention to your people.  In a brain based economy, the most important thing you have is not tools or technology, but your people and their critical thinking ability.  This reminds me of a former boss I had when i was doing natural resources policy in Virginia who said our most important natural resources are our human resources.  I don't know General Powell, but in the latter case, she meant it and it was clear every day that her focus was on her people.  Not just a handshake, cup of coffee, or a hello, but a genuine, "what is going on?"

It brings me to the other point General Powell was making about leadership and people which was when folks don't bring their problems to you it is usually for two reasons.

1. Your people think you are incompetent and can't fix them, or
2. Your people don't think you care...and you can't fix them.

Both are problematic for the leader who needs his or her team to function well in an increasingly competitive environment because at that point the team doesn't think you can lead.

It seems appropriate to remember that the guy with the most cool toys or technology is only the guy with the most cool toys and technology, but if his staff isn't buying into the message otherwise or not "getting it" there should be a siren going off.  Especially when you are in public safety.

Stay safe!

Paperwork And Meaningless Comments

Grrr....nothing makes me madder than organizations that self inflict paperwork on themselves for unimportant reasons, but don't communicate on the important stuff except for meaningless comments about how much someone "means to an organization." Again and again, I hear "thank you for being here. We're excited to have you," but again and again it just aint so.

To the first part, why do organizations go out of there way to make sure you document things that have zero to do with anything? It isn't billing, it isn't patient care, it isn't anything. Meanwhile you have to constantly guess whether or not you even know your current protocols because major changes occur without anyone informing anybody. Excuse me,when didthis drug get added and why didn't we get a basic e-mail? Is our communication really that bad?

On the other, I hate to be needy, but when you say I will get back to you, gosh darn it, I expect you to. This is not complicated, nor should it be. I know you expect me to get back with you, but really is it a two way street or not because I am a little offended. Pick up the phone or type out an e-mail. You know how to do it when you need a shift covered.

I remember a lecture on Critical Incident Stress Management by Vickey Taylor who was talking about this business and how we wanted big incidents and they may be the cause of significant stress, but how the day to day grind and the goofiness would get to you every time if you let it. I guess it is getting to me. Grrr...

Are we playing poker...or why all the cards?

When President Obama was elected, the media promised a post racial life. We were told that we had arrived at the promised land that Martin Luther King Jr. had promised. One where your actions would be judged by their content, or lack thereof. One where everyone could be criticized for their judgment, or lack thereof.

Unfortunately, this is not the case because consistently when someone has complained about President Obama, the charge has come back, this is just old fashioned racism. Worse though, it is filtering down within the elite of Washington DC.

Now when Chief Ellerbe's actions as head of DC Rescue and Fire are protested by his own employees, his PIO decided he needs to drop the race card. I have no idea about what is going on with Ellerbe's administration: the fact that they have changed "official" uniforms multiple times has infuriated many members. The fact that Ellerbe has not made EMS a priority in a department that runs 2/3 of its calls has infuriated me and many DC residents who may one day depend on their "service." However, whatever the protest is about there is one thing that is sure. As an anti-Obama placard shows only losers play the race card.

Toothache

I do a lecture called MiniMe about assessing and treating the little adults, who aren't, known as pediatric patients. Near the beginning I always ask participants, what is it about children that you do not care for that EMS responders have become known as allergic to children and I usually get the varied responses of too little, they don't communicate the same way as adults, different equipment needs which we often are not familiar with, and so on.

My response, who cares? I have yet to run a three year old for being too drunk to find his bed and I have yet to be called because the kid's stomach has bothered him for three weeks and he decides to call at 2 A.M., or even a toothache at 3 A.M.

I don't want to be rude, but if your tooth hurts, why would you wait until 3 A.M. to call 9-1-1? I don't want to be rude and I won't be, but consistently when people call for the goofy stuff I wonder where their priorities are for themselves and their families. You stayed up all day having a good time, but you wouldn't take care of your responsibilities or basic needs until you decided someone else could do this for you. Nice, thanks for the call. You are now spending $1000 on an EMS transport because you wouldn't take care of yourself.

Don't get me wrong. It is always nice to be busy and even have the numbers to make your numbers at the end of the month, but this was pretty high on the 'you have to be kidding me scale'. Thanks for letting me vent and I hope you feel better buddy!

Responding To Our Own

Once again the picture is worth a thousand words. Paul Combs' comment on Facebook to his friend and mentor is poignant and reminds me of the series of responders I have seen take their own lives over the years.

One guy who suffered from manic-depressive behavior was one of the reasons I wrote one of my lectures, One Flew Over The Cuckoos Nest, as a way to show other responders about various psychiatric conditions through movies we watch everyday. Everyone loved this guy when he was manic as he would show up well before the 7:00 shift start time and have every truck checked and was well on his way on station assignments as the rest of us were pulling up. He of course suffered through the darkness too yelling at a BLS ambulance who warned us our lightbar was out on the way to a call to assist them on a seizure patient. The other ambulance of course didn't get on the county radio to embarrass him about the lightbar; indeed his lightbar was engaged per the switch, but it had an electrical short, but this was some of the fear in him that he responded as he did.

Similarly, his outburst when a nurse questioned his use of a non rebreather on a patient who was not oxygenating well instead of a nasal cannula was to hit himself in the head with a oxygen D cylinder. Some of us call that crazy when we respond to these calls on the street, but it isn't crazy, it's pain and he felt it every time a hint existed that he wasn't accepted.

In similar ways, a smart, young, and beautiful girl headed to medical school who worked as an ER tech at a Level I Trauma Center committed suicide by starting an IV and giving herself Etomidate and Succinylcholine.

These examples and many others exist for responders who take their own life. The question is how do we respond to our own, how do we better ensure our partner is there next shift and the one after that and so forth? I think some of it has to do with turning down the volume of some of our conversations. I think some of it probably means we drop some of the sarcasm which is like a thousand little daggers - each comment just another slice into the skin.

I don't know for who Paul Combs grieves, but I understand it and offer a hand of friendship and support to him.

Life, Death, and Everything Else...

Somedays this job gets to me. I just saw the movie Extremely Loud and Incredibly Close, which has its own set of wonderful memories for me from 9-11, but the day starts with the 0001 call where a seventeen year old commits suicide.

We see people in such awkward situations in their life....good and bad, but I never understand the suicide issue. The specifics of what I know of this young person I will leave for another day as I suspect this is quickly headed to court for a number of reasons, but again and again I wonder what brings people to the situations they end up in whether it be suicide, unintentional attempted suicide via racing along the highway at 104 MPH in a 65 limit zone, or not caring for yourself by checking your blood sugar to make sure you are in range.

It is a dark world out there sometimes and I am thankful I have my faith and my church to help me through some of the situations we see everyday.

For my colleagues out there, be safe and stay strong. Clearly there are lots of people who need a helping hand and EMS may be their only opportunity to see some rays of light.

Way Too Close and Speaking Volumes To My Heart ...

Amazing. Thank you Mr. Hanks and thank you Thomas Horn and thank you Sandra Bullock.

Perhaps it is my connection to September 11 that I get this movie. Maybe it is working in Fire and EMS as a responder still, ten years later, but this movie speaks to me.

I think all of the time about the people we meet or who we know in our lives who we never say thank you to enough or I enjoy working with you or those nasty words: "I love you". When Tim Tebow talks about his relationship with Jesus Christ he says would your wife be happy if you only told her you loved her once or do you do it all the time.

Well Mr. Tebow, maybe part of the problem for the mainstream media and many with your Christianity is they have insulated themselves so much in this world and are so self absorbed that they don't bother telling anyone they love that they do care. This movie will get the reviews it gets from critics, but for me it earns five stars as a reminder that tomorrow is unpromised. Today is all you have and it would be best to use it to your ability.

I am not suggesting that days should be used for nothing, but personal recreation, but the commodity that can not be returned is time. Once it is spent, it does not return and time that can heal all wounds is terribly unforgiving. Missed baseball games will never be caught again. Missed third grade plays will never be played again and so this movie hopefully reminds us all that while we must move on from tragedy when it strikes, another use of our time might be to go searching for those people who we can connect with on the most human of levels.

We must let go of the need to say "if only" at the unexpected funerals that come suddenly from national or personal tragedy. Too many times I have attended funerals for victims of all kinds of calamity only to hear the wish lists rattled off like a Christmas list for God.

I do not want to wish. I want to go jump in rain puddles with my children. I want to protect them and tell them I love them today. I want go have an amazing meal with my wife and remind her why she is the girl I married so many years ago.

The movie's title is perfect. How loud do you have to be to understand love and be with your family while you can? How does the message get to you. Apparently for most of it, the message has to be extremely loud and incredibly close, but I got the message. Loud and clear.

Didn't We Consider This Before We Left?

Okay, I realize that we all get defensive about Monday Morning Quarterbacking and the CQI process in general, but for real?

You find a patient semi-conscious secondary to major trauma. Isn't one of the answers to secure the airway? I know there are multiple cases of studies that question the efficacy of ETI and I realize there are several cases where patients were intubated without provocation. Unfortunately, I am also aware of cases where patients were put down without cause and the airway was not secured either, but this just seems like one of the cases where handling the airway on the front end would have made a little bit of sense to me.

In South Carolina, apparently air medical crews do not see the need to manage an airway on the front end and prohibit potentially dangerous activity by their patients. I guess I will give them a big woopsie on this one, but this one doesn't look good and is not an example of treating those patients other EMS responders can't treat.

It will be interesting to see what the patient gets billed for and the end of this. Do they get charged for a helicopter ride by a crew that had to pass him off to someone else?

Don't Like Feedback Do You?

Comment cards, comment cards....really! Okay so the Jim Mora reference probably doesn't fly in the written word nearly as well as his diatribe. However, this diatribe was disgraceful in my opinion. Of all the problems going on in DC EMS and Fire, comment cards are not the issue. While I know it is scary - a little honest feedback is probably a good idea for that organization right now.

Can you say Rosenbaum and the way his injuries were "treated"?

Can you say DC Fire and EMS black list?

Can you say Fire Training Academy cheating scandal?

Can you say DC Fire sex scandal?

On and on...and what we are worried about is customer comment cards...give me a break. There are bigger issues in DC Fire...let's fix those issues before we worry about getting a little feedback.

The worst software ever...

THE worst EMS software system in the world has got to be EMS Consultant's Prestige system. While they claimed a ten minute chart in their sales pitch - surprise surprise - the system has been anything but in the meantime losing valuable patient care information, patient and nursing signatures, and vital signs data. If you are considering a software change, I have to suggest you pick another because this system is anything, but what they sold us. It is actually a little embarrassing how bad it is even and given the status of technical support I am really not convinced they put this one together before selling it.

One of our paramedics referred to the 2006 Movie The Prestige - a movie I enjoyed immensely. In the movie, a magician makes himself disappear, reappear, and disappear again...much like our software system.

In any case, I need to go re-write a few reports that their prestige system has lost for me. Be safe and have a good night.