Wednesday, October 14, 2009

On Sale Now!

The widely used Informed Pocket Guides, now for the iPhone/iPod Touch, are on sale in the iTunes App Store for just $9.99! They have the BLS, ALS, Emergency & Critical Care, RN, and NIMS guides available. I just picked up the new version of the Critical Care as it's my favorite of the bunch.

Just thought I'd share :)

Friday, October 9, 2009

9 Years

This month marks nine years in emergency services for me. I started nine years ago as a volunteer firefighter with Seaside. I still remember my first call—a drunk outside one of the bars downtown. It was the same night I’d first been issued my gear. My dad drove the rescue to the scene, me in one of the rear seats, feeling very out of place.

I remember a lot about that first year: structure fires, cardiac arrests, and car wrecks. I joined the department to fulfill my Senior community service project (called a “Pacifica Project) and didn’t have much intention of sticking with it long term. Nevertheless, I started the First Responder class a few months before graduation. Within a year, I knew where I wanted to go with my life.

A couple of weeks ago, I had to do the ambulance stand-by at the home high school football game. I watched the crowd just as much as I did the game: young men with the faces painted in red and columbia blue, young women with glittered ribbons tied into the hair. Parents were wrapped up into their kids’ letterman jackets, fathers in red Seaside ball caps, mothers in red Seaside hoodies. The Friday night lights were bright, shining onto the white-striped field. The band played fight songs and the cheerleaders lead the crowd in chants of “LET'S GET FIRED UP!” It was a beautiful slice of Americana—and it made me feel a sense of sickly nostalgia.

When I think that I’ve been out of high school for nine years, my 10-year reunion coming up next year, I have the undesired feeling of being old… or perhaps just older. But when I think of nine years in emergency services, I have a feeling that my career is just getting started and that I’m starting to develop the kind of experience that will make me an experienced and respected care provider.

It makes me wonder why I have such contradictory feelings about the passage of nine years. My wife likes to tell me that sometimes I’m still stuck in high school, and maybe there’s some truth in that. I miss a lot of the friendships, the experience, of being in the crowd, instead of functioning on the sidelines. But I’m excited about where I’m going, that I’m married, own a home, have a career, and a stable lifestyle.

Sometimes nine years can feel like a like time and sometimes like no time at all.

Monday, October 5, 2009

The Parapup and the Potato Chip

I was having a conversation with one of my firefighters about the topic of professionalism—what’s appropriate and what’s not in certain situations. We were talking specifically about an incident at a recent out-of-district training event and how bad it made out local volunteers look. As we talked, it reminded me of a few different “professionalism” moments. I thought I’d share.

Professionalism with your Superiors

It’s often been said in my company that they supervisors don’t get any respect because they work as regular crewmembers. There’s some truth to this as we all joke around together and the supervisors like to be friends to everyone. What develops from this though, is a lack of professional courtesy, something that is often passed on unwittingly to our new hires and our paramedic interns.

As a paramedic intern, when you arrive for you internship, you should be like an obedient puppy dog. Eager to learn, eager to run calls, but with an understanding that you are not a regular crewmember and that your rights and privileges are not the same.

I’m doing a fill-in shift and precepting a paramedic intern one spring day. I have a bag of chips and some salsa out on the counter. As a regular crewmember, it’s understood that to have a couple of chips here and there from someone else’s bag of Lays is okay. Partaking of the dip is acceptable. Just don’t empty the bag or drain the salsa bottle. Let me remind you of the point: interns are not regular crewmembers.

So when this wet nosed parapup reaches into my bag of Lays and withdraws friend potato wafer then places said chip in his mouth, you can imagine my reaction. “What the hell did you just do?”

The parapup look liked he had just piddled on the carpet.

“Did you just take a chip from my bag? Did someone tell you that you could have a chip from my bag? No? So who in the hell do you think you are?”

When is it taught to new paramedics that they need to have some respect and professional courtesy to those that are senior to them? At the very least, they should know how to act when they’re in someone else’s house.

Professionalism with our Peers

My brother is a firefighter for the City of Portland and arranged a training event at the Portland Training Tower for the Seaside and Gearhart volunteer fire departments. This was a rare opportunity for out departments to train together at a high-class training facility. We were able to use the live burn house then spent the afternoon in their high-rise building going over high-rise evolutions.

It was at the end of the day, as we were cleaning up, that one of the volunteer firefighters made his way over to one of the Portland firefighters that was observing. While I wasn’t within ear-shot to hear the conversation, the remark that was made quickly worked its way back to my brother and through the rest of the Clatsop County fire departments.

The remark from the volunteer firefighter went something like this: “I have all the same training and certifications that you do, and I have a real job.” (As a side note, this guy’s “real job” is working the counter at an auto parts store.)

It should go without saying that when you’re at someone else’s firehouse/training facility/whatever and there’s a crew on duty, you try not to bother them. In addition, you have to realize who you’re representing and do so in the highest manner possible. Let’s just stop and think for a moment what one firefighter’s comment did to the professional image of every volunteer firefighter there that day and all the one’s that we were representing back home.

Professionalism with Families

On shift on the ambulance one fine afternoon and my partner and I took a cardiac arrest. In my system, we transport all full arrests and don’t call them in the field after running a few rounds of ACLS. So, we start CPR, I place the ET tube, and have the patient on the monitor. Asystole all the way, but we load and go. As expected given the circumstances, the hospital called the code shortly after arrival and the patient didn’t survive.

Talking with the family about resuscitation efforts has always been a difficult thing for me. I don’t like being involved in a families grieving process, and even worse, I don’t like have to deliver the news that we had done all we could but their loved one was gone. In a certain morbid saving grave, when we transport the code to the hospital, I am spared having to notify the family. It’s left to the doctors.

As was the case here. I was gathering my paperwork and helping my partner to clean up the ambulance. The family had been called into the ER bay by the physician and spent a few minutes inside before coming out crying. My partner was making up the gurney a few feet away from the grieving family what he thought he would offer some words of comfort.

“Well, you can look at it this way: everyone has to make the trip upstairs at some point.”

I was stuck, rooted to the spot, and dumbfounded. The family was a mix of mortified, dumbfounded, angry, and in disbelief. I think that maybe for an instant, the family was so mad at my partner that they pushed the thought of their loved on passing aside. Then a nurse quickly escorted them to an empty ER bay, all the while the RN was giving my partner a death glare. My partner, for his part, had the what did I do? look on his face.

My first knee jerk reaction was to take him by the ear and drag him outside. Instead, after the RN had closed the door to the ER bay, I walked up to my partner and told him we needed to have a conversation outside. I had to have a conversation with him about appropriate interaction with family members, how we don’t impart our personal believes upon the grieving, and how saying anything more than “I’m sorry for you loss” is unacceptable.

After that, I then had a talk with the family that went something like this: “Hello folks. I’m sorry we didn’t get a chance to talk earlier. My name’s Jeramy and I’m the paramedic in charge. My partner—Jake—works under my direction. First of all, I want to say how deeply sorry I am for your loss. Secondly, my partner spoke out of turn and does not speak for the rest of the company. I want you to know how sorry I am about his remark. Here is my business card and the name of my supervisor. If you’d like to file a complaint, I completely understand.”

How do you make up for it when an off-the-cuff remark destroys your professionalism and credibility to the ones who matter most: the patients and their families.


Professionalism in the profession of EMS is all about how we act around the public and our peers. As I explained to my firefighter during our discussion, we can goof around all we want at the stations, play practical jokes and what have you, but we are health care professionals when the call comes in. The public and our peers should see us at our absolute best. I thought I’d share a couple of the professionalism moments above because I’m a firm believer in learning from other peoples’ mistakes. And while the parapup and the potato chips may not be the most poignant example, it sure makes for a funny story.