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 :)

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.

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.

Summer Hiatus

Sometimes you take time off without really meaning to. Summer kicked in this year and I found myself pulled in a lot of directions--all of which seemed to be away from keeping up with the blog world.

I played a lot of golf this summer, continued with the EMS Bike Program, went camping with the family and dogs, kept working, kept volunteering, and kept up with projects around the house. But I promise I'm back for now and I'll have new content up soon.

NOWS 2009

After rearranging my weekend schedule, I was able to participate in the Northwest Oregon Wildfire School at Camp Rilea. Every year, our county hosts a multi-agency, live fire, wildfire drill. This was my first year doing it and was looking forward to working with the other departments, the ODF crews, and the helicopters. However, due to rain, we couldn't even get a burn out completed on our safety zone Saturday. Yestereday was a total bust with thunder and lighting storms. Looking forward to next year, though.

2972, the Gearhart FD Unimog. My truck for the weekend.


Putting down a wet line.

Digging hand line.

The rest of the crew on the line.

Attempting to burn out the safety zone.

Lots of smoke, but very little fire.

An ODF lookout, keeping an eye on the (attempted) burnout operation.

Telemarketers and Baby Duckies

A ground level fall today at a care facility was the direct result of a telemarketer. Mr. Johnson got up from his wheelchair to answer his apartment phone at 3 pm today when a telemarketer called to sell ShamWows (or some such nonsense). Hanging up in disgust, then trying to sit back down, Mr. Johnson missed his wheelchair, fell back, and struck his head against the window sill. I advised the patient he should sue.

* ** ** ** *

A two vehicle, non-injury, non-blocking, everyone out exchaning insurance information MVA was the direct result of a momma duck and her long line of little baby ducks. The driver of the Toyota Tacoma slammed on the brakes when "all these baby ducks popped out onto the road from nowhere," causing the little Honda Civic behind him to rear end the truck. No one was hurt and by all reports, all the little duckies made it across the road.

With Little Fanfare

At the beginning of the month, I posted about how I'd be moving to a 12-hour day car. However, my little ambulance company is feeling the pinch of the economic downturn and we've had to cut a whole shift, as well as cut dispatchers and wheelie drivers. Because of seniority and our new shift bid process, my move to the 12-hour car was preempted by another employee, so I'll remain on 24s for the foreseeable future. As much as I was starting to look forward to the 12-hour days (sleeping in my own bed, no more midnight transfers, seven shifts per paycheck), I'm trying to find the bright side to remaining on 24s. I really like my current partner, I've started rotating through all the stations again, and everyday is a Friday (more time for golf).

Little of interest has happened in this last month, and I admit, I do feel neglectful of my blog. So I thought I'd post something juicy. Last year, I started the EMS Cyclist Program at my fire department and while it was a rocky start, I've had continued and increased interest this summer. My volunteers EMS providers are more willing to step up and the program has received a lot of positive support from local business owners and event organizers. The EMS Cyclist Program was also one of the reasons why I was awarded Firefighter of the Year for my department.

Based on this EMS Cyclist Program, my fire chief deemed it appropriate to submit my name to the Oregon Volunteer Firefighter Association for consideration of Volunteer Firefighter of the Year. Today, my wife and I just returned from Medford where last night I received my award plaque for 2009 Volunteer Firefighter of the Year.
I didn't get a chance to say thank you at the awards dinner last night, so I thought I put down a few of my thoughts here. I know that I've been recognized frequently in these last few years, and while my wife and family say it's because I work hard and deserve it, I can't help but feel so completely humbled and underserving of the praise. I feel this recognition needs to be shared with my fellow volunteers and my coworkers. I wouldn't be as lucky or successful today without them. The EMS Cyclist Program wouldn't be successful without the outstanding performance of the team members. Nothing that I do for the fire department (or my job on the ambulance) is an individual effort and I want to ensure that the efforts that I put forth benefit my organizations, not just me. So thank you to all of my fellow volunteers, fire, and EMS professionals.

How To Change It Up

Over the last six weeks I’ve been “reassigned” (i.e. “banished”) to our slowest station on the north side of the river. This has been through no fault of my own—it all has to do with scheduling and who is certified to work where. No big deal really, except that it’s a 70 mile round trip and has cost me a lot in gas to get back and forth. There have been some positives to working the slow station, though. Typically I’ve been sleeping all night. I’ve been able to get my prep work for class done while on shift.

But, the commute is a bitch and I’m blowing through gas money so quick that I feel like I should be just lighting piles of cash on fire. I have to get up earlier than normal to be to work on time. And I run very few calls (meaning I don’t get to practice many skills) and it weights my calls heavier when calculating my transportation (or non-transport) statistics.

So the plan: At the end of the month, I’m moving to a 12-hour day car. After four years working 24-hours shifts and rotating through stations, getting up in the middle of the night for calls, postings, and transfers, I’m trying something new.

My wife and I just celebrated our 5th wedding anniversary, so I think about it this way: for almost my entire marriage, I’ve been away from home, not sleeping in my own bed a third of the time. Time for a change I think.

As seen on CNN

After reading a short article on CNN.com, this was the "Ads by Google" that I saw at the bottom:

I have one thought about this: Fucking bottom feeders. God forbid we try to educate ourselves about the H1N1 virus, or that we talk about proper hand washing and prevention techniques. No. We have to put up with vendors trying to sell $179.95 (plus free shipping!) 5+ Person Flu Pandemic Kits. This "amazing" kit, a $279 dollar value, includes:

• Box of 35 N95 Masks (Latex Free): N95 Masks are the respiratory masks that are rated the best for preventing the spread of contagions (N95 masks are also good for chemical spills, wild fire, etc.)
  
• Box of 100 Exam Gloves (Latex Free, Powder Free)
  
• Box of 50 Disposable Isolation Gowns (Latex Free)
  
• Box of 100 Disposable Shoe Covers (Latex Free)
  
• Box of 100 Bouffant Cap Disposable Hair Covers (Latex Free)
  
• Five Pairs of Protective Safety Glasses (Latex Free)
  
• Five 4-oz Bottles of Epi Clenz Hand Sanitizer Gel

All this can be conveniently yours at a special discount price to make sure that your family is pandemic flu ready.

Gack! I think I've just thrown up a little in my mouth...

Occupational Hazards

Lt. Ray McCormack of the FDNY made a statement at the recent FDIC conference: the fire service needs a "culture of extinguishment not safety." Some of Lt. McCormack's remarks seem pretty inflammatory, but they're the same thoughts that I've occasionally had. Now, I'm just a volunteer firefighter on the Oregon coast, but if an FDNY lieutenant and a small town volunteer firefighter think the same thought, there must be a few people in the middle that feel the same.

I've been involved in the fire service for over 8 years and have worked as a full time EMT/Medic for 5. Even in that time, especially considering the post 9/11 period, emergency services are focusing more and more upon "ultimate" responder safety. As Lt. McCormack puts it:

"Attempting to make the job safer by teaching you to place yourself above those in need is wrong and goes against everything the fire service has ever stood for."

When I first started taking my fire service and EMT training, safety was a matter that was pressed upon us heavily. But it was always prefaced with a statement of: we're doing what no one else wants to do or can do. To put it another way: firefighters rush in while others are rushing out. What we do is inherently dangerous.

Police officers wear bullet proof vests and carry guns because they know they can be shot on any given shift. Firefighters wear turnouts and SCBAs because we know we're entering IDLH atmospheres. EMTs work and move around in the back of the moving ambulance because we know we have to taken care of our patients.

Safety has to be a concern of every emergency responder, but we all do our jobs understanding that there are certain, unavoidable occupational hazards. Even though a firefighter wears his turnouts and SCBA, he knows he may still die in a fire and even though an officer wears his vest, he knows he could die of a gunshot wound. As a medic, I know that when I'm not wearing my seatbelt in the back of the ambulance, that I could die if we get in an accident. My patient is restrained in the 5-point harness, but I take certain occupational risks to render care to my patient.

But I agree with Lt. McCormack that our evolving culture of safety is beginning to hinder our ability to do our jobs. As a medical professional, I attend conferences and read the professional journals. I'm aware of the crash helmets and restraint systems that are being advertised to the EMS community to make us "safer." Several months ago, my supervisors returned from a conference intent upon equipping us with crash helmets. It really just seems too much.

From the fire service, we're required to purchase SCBAs with PASS alarm devices that automatically engage and are engineered with Universal Air Connections (UACs) for the purpose of transfilling the tank. We are required to have RIT teams standing by, ready to spring into action at the first transmission of a "mayday." But in all the case studies the I've ready, I've yet to see a single one where these measures made the live-saving difference.

Lt. McCormack puts it this way: "If you put out the fire, safety is accomplished for everyone on the fireground." And he's right. Getting the job done quickly and efficiently keeps the situation from escalating too much, from becoming too complex, and as a reslut, will keep everyone safer. Our focus in emergency services needs to be on educating responders about a common sense approach to safety. And it also needs to be reinforcing the idea that what we do is dangerous and it is irresponsible to think that we can ever make our jobs 100% safe.