9-ECHO-1

We Don't Get Extra Points For Doing Things The Hard Way....

2012-02-01T22:38:00.058-05:00

Oh, what a tangled mess

I don't like doing extra work. I don't mind doing what it takes to get the job done, but adding a bunch of extra steps because, well, everyone else does it that way, to me, is rather stupid. So,I am always looking at the things I do in the course of my job to see if I can make it easier, faster, and/ or safer.

So in the course of the past few years, I was constantly frustrated with the way that me and my co-workers used our long backboards and straps. It just seemed that every time I had to put a patient on a backboard, it was really frustrating the way that the straps became tangled and stuck. Add to that the times that the straps either didn't line up or the buckles were not compatible, on top of the strap buckles getting stuck under the patient and/or the backboard, well, it made me want to cuss more than a few times.

The picture at the right shows how we store our backboards in the compartment on the ambulances. Some of our fire trucks around these parts also carry long backboards, as well, and they typically have the straps affixed in the same way. Sometimes the straps are 'tucked-in' to look a little better, but most of the time, when you take a backboard out of the compartment, what you see to the right is what you get.

To clarify, we use the long backboards with pins in them. The straps that we use are the plastic, disposable kind that have plastic buckles and hooks.

The problems I have experienced with the straps stored in this matter are that the straps have to be unfastened before the patient can be transferred to the long backboard. And this often means having to untangle them. Before the patient is placed onto the board, generally the straps have to be 'spread out.And then, as the patient is positioned onto the board, the straps find their way under the board or under the patient or both. This causes problems sometimes trying to sort them out, especially when the patient is, shall we say, a little overweight. The pictures below highlight some of that.

When you first get the board to the patient's side you have to unbuckle and untangle the straps.

The straps then have to be spread out in the hopes of getting them in position to move the patient onto the board. And the 'spread out' straps are easy to get where they don't need to be- under board, under patient, and under foot.

Note how two of the straps are under the board and patient. Doesn't happen all of the time, but more often than not.

And one strap is all the way under the patient to the other side, which requires lifting the board and patient... good thing she does not weigh 375 lbs.!

So I started looking at a way to do things better, easier, and quicker. And this is what I came up with.I've used this method on many occasions and it works really well. If I could only get my co-workers to give it a try. So here it is.

The picture above shows how the board looks when you take it out of the compartment. Everything is neat with no tangled mass of straps. The pictures below show how to set it up.

To start, take the two long (female) ends of two straps, and attach them to the uppermost pins on each side. These straps should be positioned to crisscross over the shoulders to help prevent the patient from sliding forward.

Moving towards the foot of the board, skip the next pin, and attach the two short (male) ends on each side as shown.

Connect the buckles, snug them down, and then thread the running ends through the upper opening (the same ones that the long ends are attached at), as shown.

Now, take one strap, seperate the ends, and attach them as shown at the same pin that the other two short ends are attached to. In this case, a short end goes on one side and the long end goes on the other.

Now, moving towards the foot end again, skip over the next pin, and then on the next ones, attach the short and long ends again, however they will be opposite of the upper strap. That is. as you are looking at the board, there should be a long and short end on the same side on each side. This allows for the top two straps to be crisscrossed, while the waist and lower leg straps go straight across.

With the straps set up in this manner, the board, with the straps still in the 'stowed' position, can be positioned at the patient, either beside the patient as shown, or at the head or feet of the patient. This way there is no tangling or bad placement of the straps.

As the patient is positioned onto the board, the straps are still in the stowed position, and they still are not tangled or in a position to get under the patient or board.

Now, with the patient on the board, unbuckle the straps. If any part of the straps are under the board (remember those running ends?), it can easily be pulled out since all of the buckles are on top of the board.

Towards the foot end of the board, those buckles two are above the board, and the running ends are easily accessed for adjustment.

Not the easy access to the buckles.

Everything is ready to go to get the patient secured and ready to go.

The straps are easily placed and adjusted...

And now the patient is ready to go... The patient is secured in a rapid, organized manner, and your protocol directed "10 minute scene time" is preserved...

So that's it. An easier (and quicker) way to attach the straps to the backboard. It takes no longer than the crisscross method used by everyone now, but it avoids some of the pitfalls I see time and time again. If you want more pictures, or have questions, let me know at 9echo1mailbag@gmail.com.

I want to thank the folks at Raleigh Fire Department (RFD) E8, RFD Captain Brian Sherrill, and RFD Fire Academy Recruit Class #35, Wake County EMS4/A, and Mrs. 9-ECHO-1 for their help in getting the pictures done.

And finally, if you're an FTEP candidate and you're riding with me as your FTO, this is required knowledge. Good, maybe, for a '5' rating...

Ya'll be safe!

Encyclopedic Knowledge of Useless Facts...

2012-02-01T16:40:00.000-05:00

My mother had big plans for me when I was young. You see, neither her, nor my Dad, finished high school and she wanted better for me. I think I shot those dreams all to hell by the end of the second grade. It’s not that I spent my days in school sitting at my desk drooling or anything, but I was just, well bored. And I really was not interested in what they were teaching, more than likely by the way they were teaching it more than anything.

My first elementary school

I will never have ‘fond’ memories of school, for the most part. I hated it. All 12 years of it (plus kindergarten, which back then, was not required). Of course, I made a few friends, some of whom I have made contact with with on Facebook, and there are a couple of others that I am still looking for, but just going through the motions, well, I just didn’t care.

The first time I remember really not wanting to be there was during the second grade. And by the time I was in the fourth grade, I was in agony. I understood the concepts of math, science, and the English language. But the way it was being presented, well, just did not hold my attention. I doodled, drew, and daydreamed. Just like a lot of the EMS related lectures I have to endure today, but I digress.

It started with watching the ‘evil TV’. Back when I was six or seven, “COMBAT!” was a first run TV show. If you have never seen it, it is about a small squad of army infantry who fight their way across Europe during WW II. The main characters were Lieutenant Hanley, Sergeant Saunders, and Privates Cage, Kirby, Nelson, and Little John, as well as their medic Doc. The series started an interest in WWII that persists to this day.

But my second, third, fourth, and fifth grade teachers did everything in their power to discourage my interests. While other kids read “Bambi” and wanted to see movies like “Mary Poppins”, I wanted to read “Day of Infamy” and see the movie “The Longest Day”. I was chastised by my teachers in front of some of my classes for my choices. My fifth grade teacher even told my mother that I “was not normal”. Nevertheless, by the time I was in the third grade I could tell you the names of all of the battleships present at Pearl Harbor on 12/7/1941 and which ones were later repaired and went back into action. By the time I entered junior high school (now called ‘middle’ school) I could tell you the differences between an Aichi D3A and a Douglas SBD, a Mitsubishi A6M and a Grumman F4F, a Douglas TBD and a Nakajima B5N, and I could tell you who Husband Kimmel, Chuichi Nagumo, Richard Best, Wade McClusky, Eugene Lindsey, Shigeharu Murata, Takehiro Chihaya, and Shigeru Itaya were.

My hunger for knowledge about WW II was second only to my love of “being a fireman”. By the time I was in the second grade, I knew where every fire station was in Henrico County and the City of Richmond (VA), I knew the make and model of the trucks assigned, and I knew the difference between the types. I also knew the first names of every one of the firemen assigned to Henrico County Fire Stations 8, 9, and 10. We moved back to Raleigh (NC) in 1967, and it did not take long for me to know where every fire station in Raleigh and Wake County (NC) was, what trucks (type, brand, capabilities/ capacities and and age) were assigned, and I could tell you the difference between an American LaFrance 400, 500, 600, 700, 800, and 900 series apparatus, as well as the Mack L, B, and C models, and more.

Need to know the differences between a 1957 and a 1961 Seagrave 70th Anniversary pumper? The differences between a 1972 Superior or Miller-Meteor Cadillac ambulance? Or the differences between a Modulance or Care-O-Van? I’m your guy. And a good friend of mine has even cited me for my “encyclopedic knowledge of wheeled vehicles” in a book about the fire service.

I guess over the years I have crammed every brain cell in my head with useless facts (did you know that the Federal Beacon Ray was available in five different series and three versions of each?).

So anyway, my mother’s dreams of a "Dr. 9-ECHO-1" were dashed at a pretty early age. I guess the biggest part of it was I did not think I was smart enough. I guess after hearing various teachers tell me that I wasn’t smart or hopeless for so many years kind of set the tone for the lack of desire on my part to continue school beyond the 12th grade. To this day I hold an abiding hatred for several of my teachers from elementary, junior high, and high school. I learned their material, but just because I did not learn it their way, well, that made me abnormal.

Fortunately, the desire to just get out of school did not last, nor was it transferred to my daughters.

At the end of this semester my oldest, Heather, will graduate from East Carolina University with her Master’s Degree in Nursing. At the same time, my youngest, Brittany, will graduate from Wayne Community College with her Associate’s Degree in Dental Hygiene. As any parent would be, I am incredibly proud of both of them.

And hopefully, this fall, I’ll start back to finish my Bachelor’s Degree in Emergency Care from Western Carolina University. Of course, in checking the course catalog, I haven't noticed any courses on fire apparatus, WWII Japanese naval aircraft, or Wake County fire stations.

How things change...

2012-01-30T08:38:00.000-05:00

Of late I am back in my 'old stomping grounds', sort of. At the end of November the powers-that-be assigned me to EMS4, which is located in the western part of the Capital CIty, near the NC State Fairgrounds, Carter-Finley Stadium, and the RBC Center.

I call it my old stomping grounds because it is the unit I have spent the second-most amount of time on since I have been employed by the county. Back a few years ago, I spent 13 consecutive months on that unit, at the time working 24 hour shifts. Back then, we seemed to average about five calls in a 24 hour shift, and seldom ran calls after midnight. Actually, I could count on one hand the number of times we did not get at least five consecutive hours of sleep in a night.

Fast forward to now. EMS4 is now a "2x12" unit, meaning we are staffed with two 12-hour crews. My shift is 07:00 - 19:00. My shift is M-Tu-F-Sa-Su-W-Th in a two week cycle, with me being off the days not shown. It works out to every other weekend, Friday, Saturday, and Sunday off. Not bad.

I do miss the camaraderie from working 24s, because I worked with the same folks at the area fire stations. I get to work with all of the different shifts now, but it was nice building the close relationships with the folks at Raleigh FD stations 8, 14, 16, and 17, along with Cary FD stations 1 and 2, and Western Wake FD.

But things change. People get moved around. And the call volumes go up. Remember that average of five in a 24-hour shift? Now it is an average of six or more in a 12-hour shift. And the night shifts run steady all night.

Not sure what has changed. There are no new elder care facilities, no new housing developments... But it does seem like we are responding more and more to doctors' offices and urgent care offices (we have a lot of them in my first due). I'll have to study on that...

Ya'll be safe out there...

EMS Funding and the Perils Therein...

2012-01-28T21:41:00.000-05:00

I saw this article over at EMS1. It is about a legal process going on in Pennsylvania regarding EMS funding and insurance reimbursements.

Part of the problem with EMS is how to fund it. Too many places rely solely on billing revenue, which is set up on a ‘transport for fee’ basis. Sometimes there is a subsidy added, but a surprising number of EMS providers are expected to exist on billing revenue alone. What’s worse, is that there are politicians, city and county and town managers, boards of directors, and EMS agency chiefs/ directors who fully believe that this is possible.

Well, it probably is, sort of.

Over the years I have worked for agencies that relied on billing revenue for the funding stream. There were also other revenue sources, like subscriptions, but the big 'money maker' was billing. And all of the agencies, either intentional or non-intentional, had to take a lot of short cuts, and also had to take a lot of liberties with documentation in order to ensure that the money kept coming in and that the trucks could still go out the door.

We managed to operate, but looking back, it was amazing how much we skimped on things, while other participants in public safety (fire and police) as well as healthcare didn’t have to skimp on much of anything.

I now work for a county government agency that, well, seems to get it. We are not tied to billing revenue, which is a good thing. The general fund covers a lot of our budget. That’s a good thing, too, since a lot of our patients, including those that provide “welcomed repeat business” are not insured, nor do they ever have any intention (or ability) to pay. Plus, it has been realized that there are a lot of things that need to be provided by a modern emergency medical service agency that is not covered by billing revenue.

We operate a county wide major operations support unit (MOSU), an evacuation bus, several district supervisors, several advanced practice paramedics (APP), and a training division. None of those are billable services, nor is the multiple unit response to some incidents, and our ‘treat on scene’ mentality for cardiac arrests, which involves not transporting a lot of patients.

As far as operational and capital costs, each ambulance is replaced on an approximate four year cycle (or less if need be) (this is roughly a 120k mile cycle) and our monitor/defibrillators are on a five year replacement cycle (I know of 9-1-1 response agencies that are still using LP12s from the late 90s). Each paramedic and EMT is issued a complete set of turnout gear (for treatment during a vehicle extrication, for example), a chemical suit (for decon operations and treatment of contaminated persons after initial decon), a full face respirator, and a bag to carry it in.

It would be next to impossible, if not all the way, to support such an operation on billing revenue. I know that some people may call it excessive, but it is what we need to do our job.

So what does this have to do with the funding article referenced? Well, a lot.

It’s hard enough to fund EMS. It’s even harder when EMS agencies are grouped in as healthcare providers (when it is convenient, usually when it does not cost anything to do so) to accept ‘negotiated contract prices’ by insurance providers, yet at the same time people want to exclude us from ‘healthcare provider’ status because, well, it might enable to EMS to actually receive the proper funding it needs to provide the type of services that people, well, sort of expect. And if EMS receives the funding it should, then, egads, EMS personnel might actually get paid a proper salary to do the things we do.

The problem is multi-fold. First, a lot of operators out there years ago convinced their local governing bodies that they could provide cheap EMS. After all, it was just a horizontal ride to the hospital. And in the interim, even as costs rose, they tried to hold on to their contracts, so they kept costs low. Unrealistically low. They avoided, at all costs, the dreaded word ‘subsidy’.

So let’s try an experiment. Let the fire department operate off of billing revenue and inspection fees. Let the library operate off of late return fees, amybe even charge for library cards and wifi access. Let the parks operate from user fees and snack bar revenue. Let law enforcement operate off of ticket revenue. And let the school cafeteria be self-sufficient. No more tax revenue, no subsidies, and no more grants. Period. Just ‘billing revenue’.

Right.

All of these so-called ‘essential services’ are worthy of being tax supported, but EMS isn’t?

OK. That’s part of the problem that leads to court cases like the one in the article.

Another part is the ‘creativity’ that is used to make EMS operate within the confines of billing revenue. I am not debating the worthiness of such endeavors as system status management, to name but one, as it relates to saving money. But I think of what, as a matter of routine, is inflicted on EMS crews that is not even considered to be inflicted on other public safety and healthcare providers and, well, I get a little pissed off about it. Consider telling your local librarian they are not maybe not going to get a meal break for 12 hours, and if they do manage to get a break, they may have to pay for their food and leave before it is ready and not even get back to that restaurant due to calls and posting, or if they do get it, wolf it down while going to help someone find a book in the American history section.

The level of ‘creativity’ to squeeze every last drop of efficiency out of EMS does not seem to be considered in other aspects of healthcare and public service.

A question for all of the EMS managers and others out there that control the purse strings and to those consultant that dream up such crap- are you willing to go sit out on a street corner or in a parking lot for hours on end? Are you willing to live on a daily diet of fast food? Are you willing to work under some of the conditions that you expect your employees to?
(Sound of crickets in the background)

I didn’t think so. But you expect your paramedics and EMTs to. So you can unrealistically save money so that you can operate within the confines of a ‘payment for transport’ model that does not even reflect the true costs of providing the service.

But until the EMS world figures out that you cannot provide true EMS on just billing revenue, cases like are being worked through the courts in Pennsylvania will continue. And likewise, the occasional billing fraud case will continue, too.

Time for a little music break...

2012-01-25T11:22:00.000-05:00

Heard this the other day on the radio. It's one of my favorite 'post-Beatles' songs...

I may be in the minority, but I always liked George Harrison's material more so than the other three after the break-up.

And I just heard this morning that Elton John is coming to RBC Center in March. Elton John has always been one of my favorites, with this one in particular...

The last concert the Missus and I went to was for Eric Clapton at the RBC Center. It was the second time that I had been to see one of his concerts. I wanted one more time to hear the 'plugged in' version of Layla, but had to settle for the 'unplugged' version. So...

Happy Wednesday...

We're Coming...

2012-01-25T10:56:00.000-05:00

The latest...

You can run, but you cannot hide. We will find you.

Random Thoughts and Observations

2012-01-25T10:51:00.000-05:00

DCFD/DCFEMS/Comedy Central

Thanks to Too Old To Work, Too Young To Retire for that lead in.

I guess I am fortunate to have never worked for an agency that requires me to buy my uniform or any required part thereof. Except of course, for the US Army, but they did give me a uniform allowance every year. I am wondering about the DCFD/DEFEMS uniform situation. First, how much warning did everyone have of the name change? Seriously, I don’t know. Was it long enough? First, at what point did someone think that this was a good idea, that is, firefighters having to buy their own cold weather gear, when according to what I read, other DC employees have their stuff provided?

And without rehashing TOTWTYTR's post about the goings on, I too have to wonder at the motive for "re-branding" DCFD. No doubt they have had their share of 'bad press' lately. Of course, with some of the happenings, maybe some of it is 'well deserved'.

More evidence of the dysfunctional nature of DCFD/DCFEMS/CC.

And by the way, from what I have read, it will take more than a 're-branding' to fix the problems there... just sayin'.

Warm and fuzzy feeling of the day…

Validation of your ideas and actions is always nice, even if it is unintentional by the people doing it. Actually, it’s better when it is unintentional. Even if nobody else really knows, you do.

More stuff for the collection…

Back when I was a member of the Yrac Rural Fire Department (late 1970s to mid 1980s), I saw one of these badges. Only one. A good friend tipped me that this one was for sale on eBay. It now has a new home.

I guess some day I have to get to work and complete the man cave.

Baby its cold outside…

One of my co-workers posted this quote on his Facebook wall-

If it’s cold enough for the paramedic to need a jacket, then the patient needs a blanket.

It now has a permanent home on my blog’s Food for Thought. It reminds me though, it is cold. And we should always have enough blankets on our ambulances. I don’t know how other agencies and systems provide for blankets. But around these parts, we are supposed to exchange them out at the EDs. There is even a contract, I am told, between the in-county EDs and the EMS system, for this exchange. It’s funny how hard it is to find them at some of the EDs, though.

MPD…

I know, it’s a known fact I don't care for Medical Priorities Dispach (MPD). I was going to post a couple of nuggets that illustrate why... but what's the point. It's here, I can't change it, so......

Political Comment

So now we know. Southern Republicans favor Southern Republicans. Is this some sort of surprise? I fear we are going to be stuck with four more years of the current president, since the Republicans are busy feeding off of one another. Mr. Romney’s brand of “conservatism” probably will not go far in the south. And I doubt that even with Mr. Perry’s support will it go far in Texas.

The ongoing problem is that the Republicans are doing more to to defeat themselves than the Democrats are. Not that I am a Republican. Registered 'independent' with Libertarian leanings. Pretty damn strong ones.

I just know that our republic cannot stand four more years of what we have.

Speaking of...

No, I didn't watch the President's State of The Union. Took a nap instead...

Interesting Article...

I saw this on JEMS.com about "shake-and-bake meth labs". It seems this is sort of the unintended consequences of restricting the sale of the ingredients for making meth. No doubt a serious problem for some time to come. This is a pretty addictive substance and people will go to whatever means necessary to procure it.

I think it is another reason for emergency folks, particularly EMS folks, to pay attention to your surroundings. I have not seen any infromation on the possible health effects on EMS folks when we encounter these patients. Anybody else out there seen anything?

Bleeding the state dry...

2012-01-16T18:28:00.000-05:00

“How many firefighters do you need, America?” That was the question that was asked by Glenn Beck. I assume he would gladly lump paramedics and EMTs into that question, if given the chance. Sadly, he is not alone. A lot of folks seem to be taking aim at the retirement plans of firefighters, paramedics, and EMTs.

Yes, there are expenses inherit with public safety personnel. Pensions are one of them. And I would concede that some of those pensions are pretty generous.

There are a few blurbs circulating on Facebook, plus I heard a group of locals discussing such things at one of the local restaurants a few mornings ago.

Seems like these folks have sort of, well, bought into the comments, and seem to think that the firefighters, ambulance people, teachers, and utilities people around these parts are also bleeding the state dry…

For the record, mine is not that generous. I contribute 6% of my salary (mandated by law) and my employer contributes an additional amount. If I work for 30 years (or until age 65 if less than 30 years service) then I will draw a pension equal to 1.85% of my “average final compensation” (an average of my four highest paid years) times the amount of years and months of creditable service.

Yes, I have a 401K.

Plus there is Social Security. OK, please stifle the laughter.

That’s it. And it ain’t much.

And by and large, I would wager that most firefighters, paramedics, and EMTs are in the same boat I am.

And some others are in some pretty leaky boats. There are firefighters, paramedics, and EMTs in my area that do not have the ‘generous’ retirement plan that I have.

How many EMTs, firefighters, and paramedics do you need.

I guess that all depends.

On whether it is your chest that is hurting, or your neighbors.

Or whether it is your house that is on fire, or your neighbors.

When it is someone else’s shit that’s involved, we can talk about waste, inefficiency, bleeding the country dry, and destroying our children’s future.

But when we are talking about your shit, then I am willing to bet that you will be singing a different tune.

Yeah, and before people start saying “that’s not what he was talking about”, I know that some of the pensions out there are way more than generous. Like it or not, they will have to be renegotiated. Places like California, and others in the Midwest and northeast, are unsustainable.

But don’t lump us all in that group. Believe me, by the time I have reached retirement age, as well as those who I work with, I will have earned my overly generous retirement that is bleeding the state dry.

Need help from my EMS brethren...

2012-01-14T12:18:00.000-05:00

At least those that do not work in the same county I do. I know the answer to the questions where they are concerned.

First, does your agency/ system use Medical Priorities Dispatch?

Second, in your experience, how accurate is the infromation you are given? As an example, if your response is 'upgraded' to a CHARLIE, DELTA, or EXHO response, how accurate is that infromation, as a rule, in your experience?

Third, what equipment and supplies do you carry 'to the patient's side', and is that equipment determined by the disaptch information, or do you have a policy/protocol requirement to comply with? And if possible, include a picture of what you carry/

Fourth, does your agency/ system have a requirement for restraining equipment in the back of your ambulance during transport?

Fifth, does your agency/ system have a requirement for restraining patients, family members, and EMS personnel the back of your ambulance during transport?

And sixth, does your agency/system routinely carry equipment, bags, and monitors on the stretcher/ cot when not in use?

And seventh, do your first responders carry tourniquets, such as the CAT toruniquet?

Rather than reply here, please send the responses to 9echo1mailbag@gmail.com

Once Again, Military Ethics Lose Out...

2012-01-12T11:18:00.002-05:00

atrocitiesplural of a·troc·i·ty (Noun)

Noun:

An extremely wicked or cruel act: "war atrocities".
A highly unpleasant or distasteful object: "the house was a split-level atrocity".

Atrocities are a fact of war. And they run the gamut of killing non-combatants and prisoners of war, to the mistreatment of non-combatants and prisoners of war, to the ways that armies conduct themselves on the battlefield, all the way to the way we treat the bodies of our enemies.

Most nations of the world have signed various treaties that govern the conduct of battlefield operations, most notably the Geneva Conventions. And we, the United States, present ourselves as “the occupiers of the high ground”.

That is a pretty tough position to hold, sometimes.

Mention certain names to people and they will bristle up, depending on their age. Names like Bataan, Wake Island, Malmedy, and the Hanoi Hilton. Those names represent the incidents of atrocities inflicted upon American prisoners of war. And in all but the Hanoi Hilton, the perpetrators were brought to justice, and in the cases of Bataan and Wake, for example, the leaders were hanged.

But it is not limited to our enemies. Even our allies (at various times) have been guilty of atrocities. The British during the Boer Wars, the Russians after the capitulation of Poland at the beginning of WW II (look up Katyn Forest).

And, it seems that we ourselves are not infallible, prone to the occasional lapse of good judgment on the part of our personnel now and again (My Lai, Abu Ghraib).

And every time the ire of the public back home has been raised. And rightfully so.

And now, we have video of US Marines urinating on enemy corpses. The Youtube video is here. Be warned, it is graphic and not safe for work.

If this video is true, regardless of the circumstances, the Marines must be punished. This sort of behavior is not the kind condoned by the US military, nor is it acceptable under any circumstances.

Now, before any of you go and get your panties in a wad, know this- I have worn the uniform of the United States military. Been in harm’s way, I have. And I find the thought that my brothers and sisters in uniform would commit such an act to be nauseating. I was taught differently by the non-commissioned and commissioned officers I served with.

And no doubt, so were these Marines. But evidently, the lessons did not sink in. These folks are not Marines, by any stretch. They are just wearing a uniform.

And before you say things like "Well, they have been in action", or "Well, they have seen their buddies die", well so have I. And that is not an excuse for the desecration of a dead body. Period.

Grateful I Don't Work In Detroit...

2012-01-10T14:39:00.000-05:00

I have a pretty good job. It ain't perfect... far from it. But when I read about other people's problems, mine pale in comparison, most of the time.

For a while I have been reading about the City of Detroit's dysfunctional Fire Department's EMS. It seems that, well, they don't get much right. And from what I have read, the blame rests solely on the shoulders of some pretty incompetent people that are trying to run things.

Charlie LeDuff, a reporter for WJBK, the Fox affiliate in Detroit, has dogged DFD EMS for some time. A Google search will bring you many of his reports.

Now, a report is circulating that Detroit firefighters were attacked at the scene of a fatal house fire. In addition, there are reports that there was a 13 minute response time by the Detroit Police Department, and that DPD is saying that the 13 minute response time is "acceptable".

Really?

Here are my expectations. If I am on duty as a paramedic or firefighter, and I call for help because I am either getting my ass kicked, or I feel it is about to be, then I expect my local LEOs to treat that the same as a "Signal 25" (the code commonly used for "officer needs help"). That means drop what you are doing, no matter what it is, and get to me. Now. Quickly (albeit safely).

That means if I feel threatened by bystanders or family members, I expect an overwhelming response. Now.

And thirteen minutes (in town) ain't gonna get it.

Fortunately, I don't have to worry about it. Because when I (or any of my other co-workers) call for help, we get that overwhelming, rapid response.

It may take a little longer out in the county, but then, I have noticed that political and municipal boundaries disappear out in the sticks.

I once had to call for help. Yes, 9E1 and his partner were getting their asses kicked. Big time. We were sent to the wrong place, at the wrong time, with the wrong people. All back in the days before enhanced 9-1-1 and all that. But when I got on the radio and yelled "We need some f***ing cops here! Now!", (yes, I said it just like that) within seconds I heard sirens. And in a short time there were eight police officers from two different municipalities, three state troopers, four deputy sheriffs, two wildlife enforcement officers, and two ALE officers on scene. Overwhelming force.

And now for more good news...

2012-01-09T21:52:00.001-05:00

CareerCast has released their rating of various jobs. I hate to say that it is not surprising that Emergency Medical Technician (EMT) rated #6 on the list of 10 worst jobs.

I wonder if paramedic was also included in the broad EMT label, or is this specifically just BLS personnel?

What goes into these studies and surveys? Are EMS personnel THAT unhappy? Or are they simply frustrated? Or does the rest of the world look at our job and scratch their head, wondering why we continue to do what we do?

From time to time there are various articles, blog posts, surveys, or forum comments/threads about recruitment, retention, and morale boosting for EMS personnel.

I think I am going to spend some time reading over some of them, and then I will post my thoughts on it all right here.

Some of it may be based upon what I have seen, some will be based on what I think.

Stay tuned.

Well now...

2012-01-09T21:36:00.002-05:00

I have written two other posts about the Connecticut paramedic who was accused of sexually assaulting a female patient. You can go here and here to see what I wrote.

First, I will stick by my original opinion that the initial reporting, specifically the AP article, was far less than professional. The original AP article was far too biased, given what was made public then, and even with what is known now.

And now he has confessed. He has admitted that he engaged in inappropriate contact with the patient.You can go here and read the latest. There is also a link to the warrant that highlights the confession. But be warned- there is some pretty graphic wording contained therein.

I have to wonder, sometimes, what goes through the minds of some people just before they do something like this?

The public places a tremendous trust in us. We are willingly invited into their homes. They shared things with us, secrets actually, that many times they have withheld from their spouse, their parents, their children, even their own doctor. They will look to us to make things right, to help, to fix everything, when they feel no one else can.

In these moments, in the back of an ambulance, many things have been confided to me. Some of it haunts me to this day. But rest assured it will go with me to my grave.

I have seen people at their most vulnerable. And the thought of taking advantage of that condition never occurred to me. Thinking now that someone would sickens me.

Still, I will reserve judgement on Mr Powell after all of this works its way through the courts. That is the way our country works.

But either way, the fact that something like this could happen, that people could actually violate the trust that the public has in us, and that the press/ media could report on such an incident in the manner that the first reports came out.... well, like I said, sickens me. To the core.

Comment from the previous post...

2012-01-07T23:16:00.000-05:00

I have already received a comment on the previous post. And I do appreciate the comments, and as such I will clarify my beliefs. But first, the comment-

And why is the reporting at fault? Seems they just reported what other folks said. And it seems as though it's in the public's interest for it to be reported.

Yes, it is in the public's interest to report this alleged incident. Key word is alleged. Something I remember from my high school journalism class was "report the facts". The facts are-

1. It is alleged that Mr Powell sexually assaulted a patient.
2. He has surrendered to face the charges.
3. The patient was restrained to the stretcher, as every patient riding on a stretcher should be.
3. The patient was transported to the hospital and she contacted police after she was released.

I may be naive but I truly believe that the press must maintain objectivity and neutrality- report the facts. Sure, comments by public figures are news, and they reported them, and noted who said what.

But the general tone of the article as I read it, as well as several of my co-workers, was that the article was slanted and weighted against Mr Powell. If you want to see how that can affect a case, do a search of The Duke Lacrosse case.

I'll stand by my position that the article was biased, and therefore a case of bad reporting. No matter how you feel about the allegations (and they are nothing but at this point), Mr Powell is entitled by law to due process, a fair trial, judgement by a jury of his peers, and other legal rights as established by law

I do have a question that was raised As to the comments, I guess the most troubling are those by the AMR personnel. There was the one about there being a "national standard" that only one person is in the back of the ambulance with the patient. Really? Show me that standard.

The final comment, to me, suggested that it has already been decided that Mr Powell did something wrong. A simple addition to this comment "This kind of behavior, if true, is an affront to AMR caregivers across Connecticut who provide high quality care to their patients each and every day, with integrity and compassion,".

Mr Powell, in this country, is innocent until proven guilty. The article did little else than report the incident (appropriate function of the press) and inflame opinions against Mr Powell before he has even been tried.

I have seen some pretty bad reporting but this...

2012-01-07T18:29:00.001-05:00

I had no idea that we had finally trashed the Constitution. Reading this article really sort of turns my stomach.

I know, I know... there was a time in my life that I really believed that the cops and DAs and media would not purposely move to try a person in public.

Yes, the media frenzy,as well as the desire to be out in front, making declarations and such, that we as a society will be kept safe, and that various professions will not tolerate such behavior, is all too real.

Like Too Old To Work, Too Young To Retire points out, this is a shoddy bit of reporting. No mention of a trial, a jury, or anything like that. The AP story led off with-

A paramedic raped a woman as she lay unconscious and strapped to a stretcher in the back of
an ambulance on the way to a hospital, police said Friday.

Well then, I guess the police have declared him guilty. Never mind with a trial and all that stuff. Who can be bothered with that, afterall.

The Hamden Police Chief, Thomas Wydra, is said to have stated that 'allegations represent "outrageous and horrifying conduct" by an emergency medical professional.'

I am glad he is clairvoyant and knows exactly what happened. Again, why bother with a jury and all of that stuff?

And the the local AMR General Manager, someone named Charles Babson, is quoted as saying "This kind of behavior is an affront to AMR caregivers across Connecticut who provide high quality care to their patients each and every day, with integrity and compassion."

Nice way of supporting your employees there, Mr. Babson, absent of a conviction or admission of guilt on the paramedic's part.

Innocent until proven guilty. Yes, I think I read that somewhere.

Yeah, I used to have a lot of faith in the American judicial system. Not so much anymore. There is not a better alternative out there, but its' just sad when lives and careers and families can be damaged by shoddy reporting, or by arrogant dispalys of grandstanding.

Maybe Mr. Powell did it. Maybe he is the monster that the media, police chief, and AMR have made him out to be.

But then, maybe he isn't.

Mr. Powell has a right in this country to a trial, and judgement by a jury of his peers. Says so, right there in the Constitution.

If these charges are proven, then by all means administer the proper punishment.

But then, if he is aquitted, I wonder if the same people who are so fast to rush to judgement will be just as quick to apologize?

Somehow, I doubt it.

A little Bob Welch....

2012-01-07T17:54:00.000-05:00

I remember when this one came out in 1977. I heard a bit of it on the radio, so I thought I would share.

Bacon-Chili-Slaw Dogs...

2012-01-06T16:53:00.000-05:00

For years, growing up, I ate plain hot dogs. Dog and a bun. Nothing on 'em. My Aunt Martha once took me to the Longview Pharmacy and fed me plain hot dogs. I was four or five at the time and I ate five or so. They were Jesse Jones hot dogs on plain hot dog buns.

And that was the way I ate them for years. Then sometime in the 80s I added chili, then later onions.

But now, I am out there, livin' on the edge...

You'll need two hot dogs. I prefer Carolina Packers or Steven's (they are made locally). You'll also need two slices of bacon, two hot dog buns, hot dog chili (again I prefer Carolina Packers), a small onion, an Anaheim pepper, cole slaw.

I prepare the bacon ahead of time, placing it in a container in the fridge.

A quick way of preparing the cole slaw is to either get a package of cole slaw from your grocery store, or just shred and chop a cabbage quarter. Marzetti's Original Slaw Dressing is then added to the shredded and chopped cabbage, just enough to make it moist.

Dice up the onion and pepper together. I dice mine up into pretty small pieces.

Grill the two dogs either in a small skillet with a little butter, or on the grill. You can also heat up the bacon at the same time, wither way.

Take the two dogs, split them down the middle, and place them in the buns. Place a strip of bacon in each. Add the onion/pepper mix, then add the chili. It takes about a tablespoon of chili for each dog. Finally, add the slaw on top.

You can top it then with cheese. I have used shredded Mozzarella, Parmesan, as well as the Mexican mix you can buy at most grocery stores.

And for a little extra zing, sprinkle a little cayenne pepper before adding the slaw.

You got to lose to know how to win ....

2012-01-05T16:30:00.000-05:00

That is a line from one of my favorite songs of all time, Dream On, by Aerosmith. Actually, it's my favorite line from the song. I remember when it came out, in 1973, and I would be at home, late at night, listening to WQDR 94.7 (when it was a ROCK station) in my head phones, and the song would come on.

Every time when I look in the mirror
All these lines on my face getting clearer
The past is gone
It went by, like dusk to dawn
Isn't that the way
Everybody's got the dues in life to pay

Anyway, last night Mrs. 9E1 and I were watching TV, flipping through the channels, and came across the Oprah Winfrey interview of Steven Tyler. I watched it a little while, but since 04:50 comes awfully freakin' early, I went to bed.

So now, all day, I have had Dream On in my head....so here it is.

Enjoy...

Repeat Offenders...

2012-01-04T16:38:00.000-05:00

No doubt if you live around these parts you have heard about the 14 year old boy in Henderson who stood up to four would-be home invaders, dispatching one of them with a shotgun blast to the chest. Well, they have arrested two more that were involved and are looking for a fourth.

You can go to the North Carolina Department of Corrections website's offender search portal, and you get the following information on two of the perpetrators-

Jatwaun Davis

Andrew Terry

Now, both of these gentlemen are entitled to a trial and judgement by a jury of their peers. And who knows, maybe they are nothing more than misunderstood young people.

And for the record, I am all about second chances. Even third chances. You see, we ALL make mistakes. And most of the time, we learn from those mistakes. Those lessons are often the ones that stick with us the longest.

However, I for one am sick and tired of these folks who constantly steal other people's stuff, always breaking into other people's houses, hurting other people, and even killing them. Again and again.

If you look at the NC DOC Offender Search, look at some of the people that are out on parole and probation. People that have pretty long records. I mean long records.

The two men listed above, between them have nine convictions. Davis was on probation at the time of this incident. The actions of these two, along with the other two involved, resulted in the death of another person. One of the perpetrators, no doubt, but another human being, just the same. The three surviving would-be home invaders should be held accountable for his death. Their actions and decisions are the sole factor in causing his death.

At the minimum, these three should not get out of prison until at least 2061. At least then they would not be a threat to anyone else.

Thinking About Breaking Into My House?

2012-01-04T07:31:00.000-05:00

Think again.

North Carolina updated the Castle Doctrine recently. Basically, when you break in, and my wife or I are home, well, the law says we can assume that you mean us harm just by your act of breaking in. And we can respond. With force. Deadly force. I don't have to wait until you point a gun at me. I don't have to wait until you take a shot at me. I don't even have to wait until you reach into your pocket...to get a gun or pull out a white flag.

Just break in.

A 14 year old in Henderson just the other day demonstrated that fact and reality for a would be home invader. A now deceased would be home invader. Kudos to the young man for standing up and defending himself and his sister.

Now maybe some for the other states will catch up with NC's lead. You shouldn't have to wait until the other person points a weapon at you, for even fires a weapon at you, in order to respond. The mere fact that they broke into your home is evidence enough that they mean you harm. They are not going to retreat. Once they break in, you can safely assume that they mean you harm. Kind of like this story. I wonder how much different this might have turned out had the young girl know how to use a firearm (12 is not too young to know... I learned how to fire a 12 gauge shotgun at age 6) and had access to one?

When they do break in, at least in NC, you can then blow their sh** away.

Do We Really Need A Federal EMS Agency?

2012-01-01T17:56:00.000-05:00

There is a lot of talk these days about creating a federal agency for EMS guidance and oversight. There are a lot of good arguments on both sides. A lot of the pro arguments center around standardization of educational issues, treatment protocols, and various standards. I also believe that the main push is to due grant funding availability.

It is no secret that the fire service and law enforcement communities receive money in the form of grants. A lot of money. Here in North Carolina there is even state funding grant available. Law enforcement agencies have benefited for years from the Governor’s Highway Safety Program. I would think that a program named "highway safety", and intended to "reduce the number of traffic crashes and fatalities" (emphasis added by me) would also include initiatives to help EMS agencies provide trauma care, but I would be wrong. It is a law enforcement program.

Yes, the Assistance to Firefighters Grants can provide grants for EMS related equipment, but honestly, how many independent EMS agencies receive grant funding? I really don’t know. But from the information I have been able to read, there are a lot EMS agencies (private or hospital based) that are not even eligible for grant assistance, and these agencies provide primary 9-1-1 services to a significant portion of our country's population.

Here in North Carolina there is a grant fund, administered by the state, for Volunteer Rescue/EMS fund, which was created by the North Carolina General Assembly to financially assist North Carolina’s volunteer emergency personnel. It is administered by the Department of Insurance. From a news report on the WTSB radio station web site- “the fund program helps rescue/EMS organizations purchase equipment and make capital expenditures.” According to the report, agencies can apply for matching dollar for dollar grants up to $25,000.00 each fiscal year. Agencies with cash assets of less than $1,000.00 can apply for grants of up to $3,000.00.

This information was included in a news item that highlights the award of $147,319.00 to thirteen different fire departments. There are twenty-four fire departments operating in that county, as well as seven different EMS organizations. I am assuming that none of the EMS agencies neither received nor applied for the grants, which to me causes concern, not because the fire departments received the grants but EMS agencies did not receive grants from a program to assist “rescue/EMS organizations”. But then, it would be really hard for those EMS organizations to apply. Read the requirements-

     Eligibility Criteria:

     -Rescue provider is all volunteer, with the exception of ten paid positions. (Most EMS agencies around here have more than 10 paid employees, including full and part time personnel, to keep the ambulances on the road.)
     -Rescue provider is recognized by the Department of Insurance as a rescue or a rescue EMS provider. (There are not many primary EMS agencies that perform 'rescue' duties any more. Just staying current on EMS is a full time job.)
     -Rescue provider must meet the eligibility criteria of the NC Association of Rescue & EMS.
     -County recognizes organization as providing rescue or rescue/EMS or EMS
     -Rescue provider must be certified by the Office of Emergency Medical Service to request ALS equipment.

That would tell me that the vast majority of EMS organizations in my state are not eligible to apply.

So why do I mention this particular funding program? First, to point out that this program benefits only a small number of the EMS agencies in my state. To that end let me ask the question- How many ambulances, power stretchers, 'half-track' stair chairs, bariatric stretchers, induced hypothermia coolers, ALS training materials and equipment, manual monitor defibrillators with ETCO2 monitoring capabilities, turn-out gear for EMS personnel, etc., were bought? You know, EMS stuff. Second, to help point out the absolute lack of EMS grant funding available. True EMS grant funding just isn't there.

Many EMS agencies are supported solely by billing revenue. Many more only receive limited supplemental funding over billing revenue. And there is a tremendous need for funding initiatives for EMS that are not tied to billing-for-transport revenue.

Me personally, I am wary of any creation of another funding bureuacracy or agency. To that end think Transportation Security Adminstration. Or Department of Homeland Security. Or Department of Education. Or Department of Energy. I don't want to see another federal agency that gets bloated and over reaching and intrusive.

But, on the other hand, for no other reason, there is a need for some sort of equitable grant funding for EMS. All EMS, to include those small Mom and Pop companies that are the only ambulance provider for communities all over the nation. To include those hosptial based agencies that serve their communities because the fire department or local government do not want to get involved in EMS.

Fire departments that respond to a few actual fire calls are receiving funding for custom fire trucks, often duplicating what is available in the next fire department over by just a few miles. They receive up to date PPE and SCBA, and other high tech and modern gear.

Law enforcement agencies receive grant funding for automatic weapons and other tactical gear, SUVs, up to date radar and radio equipment, and more. Even those agencies that see little activity that equires such gear.

And there is money available for fire deaprtments and law enforcement agencies to hire people.

But there is no grant funding that I can find to help EMS agencies to hire EMTs and paramedics, whether for response capability or community prevention initiatives.

And that has to change.

So, with that in mind, even though federal (and state) funding for local initiatives is just somehow wrong to me, I would have to say that in this day and time, with the way the rules are set, then we do need a federal EMS agency. And it needs to have proven EMS leaders, mostly those that realize that EMS has to change the way we do business, to head it up.

.

Gun Control...

2011-12-31T07:34:00.003-05:00

Yeah, I know, I said the previous post would be my last for 2011...so sue me.

I wrote about the incident in Henderson (NC) where a teenager successfully (and lethally) defended himself and his sister from a pair of thugs that broke in. One of the would-be robbers was killed, while the other was arrested a day or so later.

I know there are people who would say this is a reason for more gun control, more stricter rules. This passage from the comments on one of the reports on WRAL TV5 sums up that belief-

"You are the new poster boy for why we need WAY stricter gun control laws."

No, that is the problem. Gun control laws only apply to law abiding citizens. Those that wish to inflict harm and mayhem will be armed. And my guess is they are not going to have a permit.

I say loosen the laws up. Maybe even eliminate them.

Just one caveat- you get convicted of committing an assault, murder, rape, robbery, burglary, or any thing else while armed... at the least you go away for life. Without parole. You kill someone...well...

And while we are at it, let's get the Turks to run our prison system. Or maybe the Chinese.

Random Observations, Rants, and Thoughts...

2011-12-30T22:48:00.001-05:00

2011

2011 is coming to a close. Thank goodness! I guess there is something positive about 2011, but as far as the 9-ECHO-1 household is concerned, good riddance. 2011 started out looking very bright, yet unraveled rather quickly. It is truly disconcerting when you realize how little control you have over events that directly affect you. The year ends with uncertainty, which is unsettling at the least. On the plus side, all of us in the 9-ECHO-1 family have good health, and we all have a roof over our heads, so there, I found something positive.

So to all of my friends, co-workers, fellow bloggers, and readers, I would like to wish you all a very happy and prosperous New Year in 2012.

Atta Boy!

Local folks no doubt have heard about this story. Seems someone tried to break-in to a home in Henderson, NC, and they were met with deadly force by the occupants. Kudos to this young man for standing up and defending his home, and quite possibly, his and his ~~family member’s~~ sister's life.

That clanging sound you hear? No doubt the brass ones that this young man has.

As to the home invader- good riddance.

When the Emergency Folks Have An Emergency…

Yes, the emergency folks have an emergency from time to time. WRAL-TV5 has this report, and the Legeros Fire Blog has this report, with local fire photographer Mike Legeros posting pictures here. The station, #3, is one of the original stations for Wake County EMS, and before that was a station for the old Six Forks Rd. Volunteer Fire Department. I myself was station there for a short time back in 2004.

Glad everyone made it out OK.

And Speaking of EMS...

The APPs around these parts are getting new rides. The Chargers are going and the Explorers are arriving. Medic 93 (Stony Hill) is the first new one, with Medic 91 (Holly Springs), Medic 92 (Bethany Church), and Medic 94 (NC State campus) coming soon. Same mission and markings, just with a big old honkin' push bar on the front now.

Let’s Go Canes…

Mrs. 9-ECHO-1 and I went to the Hurricanes-Maple Leafs game at RBC Center last night. It was a thoroughly entertaining game. The fans were worried, no doubt, as in the third period the ‘Canes were down 3-1. However, a breakaway goal by Eric Staal (#12) and another by Zac Dalpe (#22) tied it, and in OT Staal scored again for the 4-3 win. It was amazing since in games past, with the team down by two goals in the third, a lot of fans would have left early. However, “the loudest house in the NHL” lived up to its reputation as the fans stayed put, and they were thoroughly rewarded with the win.

So anywhoo...one of the traditions at the games (started in 2008) is the sounding of the 'storm warning'- a hand cranked siren. A lot of folks have sounded the siren oiver the years, from local celebrities, Hurricanes supporters, and community leaders. Each year the Hurricanes host Public Safety Appreciation Night. One of the perks is that Public Safety folks around here get reallly good deals on tickets (in 2009 I got a ticket on on the ice and next to the penalty box for $25.00). On Public Safety night they get local Public Safety folks to 'sound the storm warning'.

I think a really good idea for this year's Public Safety Appreciation Night would be for a grumpy old paramedic who is a DIE HARD CANES FAN to sound the siren. To that end, I am offering my services. Call me. Or email me. Or mail me a letter. Or come by EMS4 on any E shift day. Call me. Anytime.

Call me.

Is It My Imagination…

Or is it that every time a dog charges a law enforcement officer, and the LEO shoots the dog, that the dog is always characterized by the owners as “kind”, “friendly”, etc. I don’t know, but I think that if a dog is running towards me, unless I can safely fend it off with my foot, I would probably shoot it , too.

Of course, if it were my dog I might think differently. But, in this case, the deputy did not know the dog, and judging from the pictures posted in the report, I can see where there would be a degree of apprehension on the part of the deputy to see this dog running towards me.

Baby, It’s Cold Outside…

I saw this one on the EMS1.com website discussing the negative effects of hypothermia on the trauma patient. It is a pretty good read, which brings an observation to mind. We need to make sure we have plenty of blankets on our ambulances, especially during the winter time. Just as it is suggested that we wear layered clothing during cold weather, we need to make sure we can layer blankets on our patients (it is even suggested in the article). That does get hard to do, however, when EDs don’t have blankets available for EMS (I’m not calling those around here out, just yet) or when the staff actively get upset when EMS personnel try to get blankets (again, I’m not calling them out, just yet). But I will say that it seems that only one hospital in my county has blankets available for EMS to trade out. At least that has been my experience over the past, oh 2-3 years.

New Year's Resolutions

I've never been much for New Year Resolutions. The small handful I've made over the years didn't last much past January 10th. And the same goes for most people I know. However, I am giving it another try this year.

NYR #1- Lose weight. Actually, I've sort of been doing that. Just a couple of yars ago I was weighing it at about 365. Now I am at 285ish. My goal is to get into and wear the US Army field jacket I wore when I got out of the army.

NYR #2- Go fishing more. I love to fish, particularly surf fishing. And we have some of the best places to go surf fishing here in NC. This spring, summer, and fall I plan on doing it more.

NYR #3- Start back and get on with finishing my degree. I am nine courses away from graduating from Western Carolina University with my degree in Emergency Medical Care. No need in drawing it out.

NYR #4- Spend more time with my wife. It's been hard to do that lately.

NYR #5- Spend more time with my daughters and step son. Heather lives at Oak Island (NC), Brittany will finish her Dental Hygiene degree next semester and will no doubt be getting out on her own, and Brad has moved out and is on his own. I see a couple of pig pickings in our future this year.

NYR #6- Get a couple of projects done around the house. I don't know which ones yet, but I am going to get something done.

I could think of a few more, but we'll start light this year and see how it works out.So, there you have it.

So, in my last blog post of 2011, I want to again wish all of my family, friends, co-workers, readers, and fellow bloggers a safe, prosperous, healthy, and happy New Year.

Dale Johnson
9-ECHO-1

Photo credits (from the top)- Internet picture, Legeros Fire Blog (2), Carolina Hurricanes website (2), WRAL TV-5 website, internet picture

Customer Service for EMS folks...

2011-12-28T21:00:00.000-05:00

I know, there are a few people out there that really hate the term 'customer service' as it relates to EMS. And in a sense, so do I. But, it is what it is.

We are here to provide a service. Basically, we need to meet the patient's needs in a competent manner. We need to do the right thing by our patients. And that can be hard sometimes with the things that some people call us for. But, for the past 40 years we (EMS and the rest of the healthcare industry) have been preaching to the public that for every ache, pain, and boo-boo they should call 9-1-1. Immediately. Because all you have to do is watch any TV show that even mentions any kind of health related malady and there is always some sort of ominous gloom and doom that goes with everything.

So, for every ache, pain, and boo-boo, people call us.

And there are those amongst us (EMS types) that like to think they can decide who needs to go to the hospital and who doesn't, as well as whether or not the caller needs an ambulance or not.

Well, the research kind of indicates we can't. It should be no surprise, though, since most of our EMT and paramedic courses pay slightly more attention than mere lip service to the art of assessment. It's a lot more than reciting some mnemonic...it's having a complete understanding of how the body works when everything is OK as well as how it works when things are a little out of kilter. And the sad fact is EMS education programs seldom go into the depth necessary to address this.

And if you think you can tell who needs to go and who does not, all you have to do is keep a check on the EMS news outlets, because it seems that every so often someone tries to make that decision and things go south really quickly. And spectacularly.

So what does this have to do with customer service?

Well, we got into a Facebook discussion yesterday. What prompted it was an ambulance crew that showed up at the ED I happened to be at. It was an out-of-county unit that had transported an elderly patient from home. The patient had a pretty impressive looking head laceration. Of course, at no time during whatever time was spent on scene, nor during what had to be at least a 45-60 minute transport, no one ever placed a dressing over the wound, nor secured it with a bandage. The patient was holding a bloody handkerchief to their forehead, and judging from the amount of blood on their clothes, I would guess a good loss of blood. And the pale skin sort of hinted at that as well.

Well, my interest peaked, and I sort of eased into the ED to hear the turnover report. Elderly patient, felt dizzy, almost passed out, fell to the floor, striking head on corner of cabinet. Has felt nauseous off an on during transport. The nurse asked what sort of history the patient had, which was followed by a sort of silence, and then the EMT asked the patient was kind of medical problems they had- MI, stents, CVA, diabetes, heart failure...

Yep. Oh yeah, the paramedic drove them in.

ECG? No. So I guess there was no need to ask about a 12-lead.

IV? No.

Oxygen? No.

I know, there are people out there that would say we oversue oxygen, and a lot of IVs are not really indicated. But to me, a syncopal episode or near-syncopal episode in a elderly patient is a cardiac event until proven otherwise. Period.

And that requires more than a ride to the hospital, holding a bloody rag to your head.

Chances are, the patient and their spouse really didn't know any different. The ambulance crew was based in a small town, and the couple were probably life long residents. They probably remember when the EMS provider was a volunteer agency, with 'neighbors helping neighbors'. And they probably think that since the name of the agency is the same, it is the same people, doing their best...

Was this good customer service? Or even decent patient care? To me, not 'no', but 'hell no'.

To me, customer service in EMS is about doing what is right by the patient. I don't think we need to (or should) bend over backwards to appease people. We should provide a service based upon the needs of the patient, and always work to mitigate the patient's emergency. And that entails quite a bit.

Let me think on that a bit.

What can you say?

2011-12-28T20:21:00.000-05:00

There was a pretty big apartment fire around these parts this morning. It is the same apartment complex where my oldest daughter lived up until two years ago. You can read about the fire with this report from WRAL TV-5. There is also a report on the Legeros Fire Blog that you can see here.

So anyway, this passage caught my attention-

Resident Scott Denny said the fire started after he took some ashes out of his fireplace and put them in a cardboard box on his balcony.

I always worried about my daughter when she was living in the apartment. It's not that it is a bad neighborhood. Far from it. It 's even gated with security access. The thing that always bothered me, with apartment fires being sort of common around here, is that something bad can happen that would be due to the negligence of somewhere else.

Actually, one of the biggest fires around these parts was caused by someone's negligence. The Pine Knoll Townes fire was caused by someone throwing a cigarette out. It ignited the pine straw that was used for landscaping. There was a big move to blame the whole fire on the pine straw, which no doubt contributed to the spread, but did not cause the fire.
Negligence did. And a heaping measure of... well... lack of common sense?

It's like everyone just sort of ignored what actually caused the whole thing, displacing dozens of families. After all, we apparently cannot hold anyone responsible for their actions...

And for the latest apartment fire-

" I should have put water on them, obviously, but I didn't."

When are we going to start holding people accountable for their stupidity?

No word on how many people were displaced in this latest fire.

Photo credits- Top picture from 12/28/2011 fire from Legeros Fire Blog. Lower picture of Pine Knoll Townes fire from 2/22/2007 from noted area fire photographer Lee Wilson's Flickr site.

And now...for my "Customer No-Service" rant...5.11 Tactical.

2011-12-27T09:23:00.003-05:00

I am a gearhead. I admit it. Always have been. I just like to have neat stuff. I guess it is a result of two things from my early days. First, there wasn't a whole lot of 'neat stuff' outthere. Sure, as an EMT you could have your big, leather holster with trauma shears, bandage scissors, hemostat clamps (curved and straight), a velcro tourniquet (or two), a plastic bitestick, and a Buck Folding Hunter knife. But otherwise, there wasn't much. I did buy my own Philadephian helmet to use instead of the Bullard 'hard boiled' fiberglass helmet that was issue, but pretty much, I just didn't have the money for much else. Well, other than the Federal FB11H Super Fireball...

But now, I do have some neat stuff. And neater stuff on the way. I just bought a custom leather radio strap from Fireline Shields. Pictures will go up as soon as I get it.

I now have a 5.11 high visibility parka that I use as a rain coat. When it was issued to me, it did not have a liner, however, there are snaps and zippers for a liner.

So, I contacted my local dealers, who told me I would have to contact 5.11 directly. Which I did.

So I talked with their customer service rep (actually, we emailed back and forth). I have been informed that although my parka is designed for a liner, and 5.11 does make that liner, and they do pride themselves on their reputation, that 5.11 will not sell me a liner. Their Customer Service guy, Jeph Valrey, wrote that 5.11 does not sell the liner separately. They offered option of other 5.11 products, that while they will 'work', they do not fit, nor are they designed to do what the liner does, and that is snap and zip into the parka so that you can put it all on at one time.

So, I guess if something happened to the liner, then 5.11 would expect me to do what for a replacement? Buy a new parka and liner?

You hear a lot these days about "customer disservice". Clark Howard, on his daily radio show, rants about that frequently. I think it is a sad state when companies that depend upon us to support them act so arrogantly in the face of providing "customer service". I am not asking them to give me a liner, I am asking how much it will cost to buy one. You know, give them money for it. Money that I work pretty freakin' hard for.

So, I don't have the readership that Kelly Grayson has- not even close. But I do have a group of people that do read this blog regularly. So, I am asking a favor. How about each one of you click on this blog post a few times a day over the next week or so. Maybe we can get it so that this entry about 5.11 Tactical moves up in the Google results.

Yes, I want a liner for my parka and there is no credible reason I should not be able to get it. This is like owning a Chevrolet Silverado Z71, and when the alternator goes bad, Chevroley will not make a new one available to you, and they expect you to either make an alternator off of, say, a Chevrolet Malibu work.

Are they going to stand by their company's reputation, products, and customers, or not?

Again, I don't want them to give it to me. I want to pay for it. And they do not want to sell it to me.

What gives?

The Hurricanes...

2011-12-26T22:31:00.030-05:00

I had never seen a hockey game prior to 2005. And to top it off, I had never been much of a sports person, either. That all changed one afternoon when one of the on-duty supervisors for Wake County EMS called me up and asking me if I was interested in working at the Carolina Hurricanes hockey game that night.

Sure, I said, think that there is mothing like easy OT.

You see, the NHL requires an ambulance on stand-by when the players are on the ice for a game. We're not there for the spectators, only the players- there are other emergency response teams in place for that, and if transport is needed, . And we have a pretty good vantage point, posting with our equipment at the point the Zambonis come out.

Anyway, I went in that night, not expecting much more than around three hours of easy OT.

By the end of the first period I was hooked. I did not understand the game, but that was a small matter. This was A-W-E-S-O-M-E!!! It kept moving, people were hitting one another, there wa a fight....

Anyway, I was hooked, and I have followed them in the good times (2006 Stanley Cup champs!) as well as the not-so-good. There has been a lot of that recently. Well sort of recently.

I have watched the spark get bright with the new coach. We now have a winning streak (two games!). And tonight, the goalie, Cam Ward (#30) received credit for his first NHL goal. Actually, Ilya Kovalchuck of the New Jersey Devils shot it, but since it went into the Devils' net, it was a Hurricanes goal, and since Cam was the last Hurricane to touch it, he got the goal.

WOO HOO!!!

So, since the new coach, Kirk Muller was hired, the style of play has changed. The tempo has increased, the team seems more aggressive. Plus, the defense has gotten much better. In the earlier part of the season, Cam Ward and the back-up goalie, Brian Boucher (#33), have faced dozens of shots (like 30 or more), kind of like they were out there alone. However, in the past four games, #30 has faced around 25 shots, and only two shots in the 2nd period of the Devils-Hurricanes game. Talk about a turn around.

So anyway, the story of how I became a Hurricanes fan.

Maybe the team will make the play offs after all this season. They seem to be coming together and there is a lot of young talent that looks to be coming along nicely.
And by the way, if you're at the game this coming Thursday night 12-29-2011), look me and Mrs. 9-ECHO-1 up at the game. We'll be in section 112 or at The Deck.

C'MON, C'MON, C'MON...

LET'S GO CANES!!!

Frequent flyers...

2011-12-26T12:26:00.002-05:00

You know, when the ED nurses call you by your first name as you are escorted, ambulatory, into the ED, and can recite your birthday without hesitation, I think it is safe to assume you have spent way too much time in the ED...just sayin'...

We're Doomed...really, we are...

2011-12-26T12:25:00.000-05:00

All you have to do to really accept this is to look at any of the news reports about the stampedes for the latest Air Jordan shoe.

Start here.

It is really sad that somewhere, ad executives know that they can create a furor over a shoe. Or anything else.

It is a sad statement about our society is that we actually have people that fall for this stuff, who play into the hands of those same ad execs.

Do I blame the ad foks? Nope.

It is just really sad that people will put that much energy into rushing a store to get a pair of shoes. Breaking down doors. Trampling people. Getting pepper sprayed.

Yep, we're doomed.

Wake Island...

2011-12-22T11:27:00.001-05:00

Tomorrow is the 70th anniversary of the surrender of American forces on Wake Island to the Japanese. The Japanese bombed Wake during an air raid just a few hours after the Pearl Harbor attack, and they continued the raids until, on December 15th, they attempted a landing.

In one of the few bright spots of those early days of WW II, the landing attempt was met with ferocity by the Marines on Wake. Two Japanese destroyers, Hayate and Kisaragi were sunk, and the cruiser Yubari was heavily damaged. Hayate was the first Japanese surface ship sunk during WW II, and both destroyers went down with all hands. It was the first Japanese defeat in those early days.

The Marines had triumphed, but the Japanese were determined. And the Marines were alone, isolated in the vast pacific.

A relief attempt was organized, however, upon hearing of potentially superior naval forces in the area, the effort was canceled, sealing the fate of Wake.

On December 23, the Japanese again attempted a landing at 02:35. After a fight that lasted until the morning, the Marines surrendered. During the battle, Captain Henry T. Elrod, who had shot down two Japanese aircraft and played the pivotal role in the sinking of Kisaragi, was killed. His actions earned him the Medal of Honor.

The captives suffered mercilessly at the hands of their captors. Many were returned to Japan and Japanese occupied China to work in forced labor camps. Several civilian contractors were kept at Wake to perform manual labor. On October 10, 1943, after a particularly heavy air attack, and fearing an American invasion, the Japanese commander, Rear Admiral Shigematsu Sakaibara, ordered that the remaining 98 workers be executed. Sakabara was captured after the war, tried, and hung for the atrocities committed at Wake.

Photo credits- Wake Island device from Wikipedia.

Honor and Leadership...

2011-12-22T08:06:00.002-05:00

I once wore the uniform of the United States Army. I was proud to wear it, proud of what it represented. Looking back, the time I spent in uniform was some of the most rewarding time I have spent on earth. And I met some really great people along the way.

Everytime I have seen the reports of soliders, sailors, airmen, and Marines who were killed in Iraq and Afghanistan it has brought a tear or two to my eyes. You see, even though I left the Army in 1993 I still consider myself to be a soldier. And these young men and women, even though we have not served together, are part of a family that I am a member of. A family of honor and tradition.

And then I read this.

I don't know what happened- hopefully it will come out. And I pray to God that what is being reported is not what happened.

And if it is true that these so-called 'leaders' allowed this to go on, to allow a young man to be tormented and tortured (yes, tortured) to the point that he felt suicide was his only way out, then, in my book, nothing short of standing them up against a wall and executing them will suffice.

For 1LT. Schwartz, if this is true, if you allowed this to happen to one of your soldiers, then you have shamed the entire officer corps of the United States Army. You are the one that had to set the standard that all of your soldiers should have made every oeffort to emulate. You had the responsibility for looking after all of your soldiers.

For SGT. Dugas, SSG Van Bockel, SGT. Holcomb, SGT Hurst, and SGT Carden, if this is true, then you have defiled every value of leadership that I learned and believed in (values that I still believe in to this day) as a non-commissioned officer (NCO). An NCO has to set the higher standard. The NCO is the epitome of what the military stands for. "NCOs make it happen".

And for SPC Curtis and SPC Offutt, if this is true, how you two could possibly fathom that treating a fellow soldier, one who wore the same uniform as you and took the same oath as you, could be anything bordering on acceptable it totally beyond my comprehension. As soldiers, we have to believe that we have each other's back, that when the shit hits the fan, when the rounds are coming in, that our fellow soldiers will leave no effort behind in looking after us, in saving our ass, in not leaving us behind.

It matters not one bit a person's sex, race, national origin, social status, religion, or, gasp, one's sexual preference. We are all soldiers...you know, that whole uphold and defend the constitution thing. And like I said, we have to depend on one another. That soldier who is a little different than you are may be the one who comes and gets your ass when the chips are down.

I hope that this is not true.

But sadly, I fear the worse.

Implications...

2011-12-22T07:34:00.000-05:00

Around these parts a case that happened in an adjoining county has once again made the news. You can go to the WRAL TV5 website and see this report, with links to several more.

Basically, EMS was called to the residence, something occurred between the responding paramedic and the patient, he was not transported, and he died a short time later. That is basically what I know of the call. Other than the legal maneuvering that has gone on in the aftermath. That report can be found here.

So...yesterday I put up a status update on Facebook hoping to generate a little discussion. And it worked. Of course, it was sort of one sided. Kind of a "yeah, he screwed up, but they are throwing him under the bus" sort of thing.

Again, I am not privy to the facts, except as reported, and of course what I have heard from folks who worked in that county at the time. Yes, some mistakes were made, and we will never really know exactly what happened that afternoon. There are two stories, and I think what actually happened is somewhere in the middle.

But, I am sort of reminded of my experience years ago with a patient who refused treatment and transport and was dead within 90 minutes of his signing of the refusal form.

The dispatch was for an 'unconscious person'. After traveling the 14 or so miles out into the rural countryside, as we arrived, I saw an older man walking across the road to a small house, waving us down. When my partner and I entered the living room, I immediately headed to the older female who was lying on the sofa, since she looked like she was pretty sick. She then pointed me to the older man, who was seated in a chair.

He looked worse.

Pale, ashen, diaphoretic. A little cyanosis around the mouth and the hands. And what seemed like labored breathing.

Yep, seen that before. It wasn't good those other times, either.

Long story short, over the next 45 minutes I begged and pleaded with this gentleman to allow me to treat him and take him to the ED. I did get a pulse check (cool and clammy skin with a weak and irregular pulse) and a capillary refill check (a little over two seconds). He adamantly refused a blood pressure check and an ECG (although I could not have run a 12-lead with my now-classic Marquette 1200 'boat achor').

Finally, his wife said "Why don't you just do to the damn hospital?" To which he replied "Naw, God dammit, I ain't. And ya'll can get the hell out of my house!"

He did agree to sign my refusal (and I bet his signature is still embedded in that aluminum clipboard). We went back to the station and I sat down to write (yes, write...we used to have to do things that way) my call report.

And a short time later, we were dispatched to the residence again.

There was no one outside to wave us down this time. I heard the crying from the front yard. His wife was still on the sofa. "He's in the kitchen." There he was, prone on the floor. He had gotten up to get a glass of water and collapsed as he was drinking it.

We started the code, according to the latest guidelines at the time. We had to wait for a neighboring agency ambulance to arrive to help us out (30 minutes later). We emptied the drug boxes (because that is what we did in those days) and transported to the nearest ED about 20 miles away.

Twenty-four milligrams of epinephrine 1:10,000. 300 milligrams of lidocaine. Three milligrams of atropine. 100 mEq of sodium bicarbonate. The maximum dose of bretylium (I don't remember how much that was). 3,000 ml noraml saline. Two IVs. A well placed 7.5 ET tube. And he's still dead.

Word got around fast. At that time, there were only about 15 practicing paramedics in the county. We were a small, tight knit group. And there were a couple of folks at the local hospital who did not count me as one of their favorite people (it may have been my outspokenness, or maybe my winning personality). They were looking to blame this man's death on my cold heartedness.

Remeber that call report? Well, I had documented that I had offered to provide an assessment that he repeatedly refused. I had documented my dozen or so offers to take him to the hospital that he refused. I documented that I had told him that I thought he was having serious medical issues (I actually told him 'heart attack') and that if he did not go to the hospital he could die. And I documented that he repeated it back to me.

And I documented, word for word, what he told me when we finally left.

The medical director reviewed the call, and contrary to what some other folks wanted, he found that I did nothing wrong, that I had handled the call well, and that was that.

All because of a thorough call report narrative.

Now, I don't know the details of what happened in Orange County, but I have to ask this- was there a good call report written? Did he document attempting to contact paraents, neighbors, or school officials? Did he document that the patient, although a minor, had demonstrated capacity to udnerstand the consequences of not going to the hospital? Did he document a thorough assessment, to include more than one set of vital signs, lung sounds, and an ECG?

I don't know. But I do know that a good call report can save your ass, while a bad one will leave it hanging.

I Wish You Could...no, really, I don't...

2011-12-22T06:49:00.000-05:00

No doubt, if you have even seen a Facebook ‘wall’ within the past few days, you have seen this one posted as many folks’ ‘status’-

I wish you could comprehend a wife's horror at 3:00 in the morning as I check her husband of forty years for a pulse and find none . . . I start CPR anyway, hoping to bring him back knowing intuitively it is too late but wanting his wife and family to know everything possible was done to try to save his life.

I wish you could understand how it feels to go to work in the morning after having spent ......most of the night, out on jobs.

I wish you could know my thoughts as I help extricate a teenage girl from the remains of her automobile. "What if this was my sister or a friend?" "What are her parents' reactions going to be when they open the door to find a police officer with hat in hand?"

I wish you could feel the hurt as people verbally and sometimes physically abuse us or belittle what we do or as they express their attitudes of "It will never happen to me.”

I wish you could realize the physical, emotional and mental drain of missed meals, lost sleep and forgone social activities in addition to all the tragedy my eyes have seen.

I wish you could know the brotherhood and self-satisfaction of having saved a life or being able to be there in time of crisis.

I wish you could understand what it feels like to have a little boy tugging at your arm asking, "Is Mommy okay?" not even being able to look in his eyes without tears from your own and not knowing what to say.

Unless you have lived with this kind of life you will never truly understand or appreciate who I am, who we are, or what our job really means to us ...I wish you could though..............So True!

Hmmm... I have been 'living' with this life for over 35 years. And this does not paint a remotely vague picture of what I do.

I wish my brethren could get in tune with what our job really is. One of the problems that we face is people who get into our career for the lights and sirens, the adrenaline rushes, the trauma…only to find nursing home transports, runny noses dispatched as respiratory distress, ear aches, and acute cases of insurancitis at MVCs.

But as to the public…they do not understand what it is we do, what we can do, and what we should do. Why? Because of an image that is perpetuated by tales of life and death struggles, constant horrific car crashes, gun shot wounds, etc.

But then, I guess a description of nursing home transports, non-compliant with their medications psych patients, chronic aches and pains that are 'suddenly' an ~~inconvenience~~ emergency at 02:15, sinus infections, and UTIs are not quite as dramatic..............

Random observations as the world goes around...

2011-12-12T21:36:00.000-05:00

It's Not Rocket Science-

You know, I has sort of become a habit to watch Morning Express with Robin Meade on HLN on the days I am at work (that is, when I actually get to watch TV in the mornings). It’s not that the staff provides any driving, sinsightful reports on current events, it’s pretty light fare (but at least it is not not as bad as, say, E! or Entertainment Tonight, where way too many people get their news!). And there is some good stuff on, like Clark Howard's spots.

And it helps that Robin is easy on the eyes.

But someone should let her know that a botanist is not someone who studies space. Or rocket ships.

bot·a·nist [bot-n-ist] noun. a specialist in botany.

bot·a·ny [bot-n-ee] noun, plural -nies. 1. the science of plants; the branch of biology that deals with plant life. 2. the plant life of a region: the botany of Alaska. 3. the biology of a plant or plant group: the botany of deciduous trees.

Oh well...it brought a chuckle!

The Doobieliner

I went to see the Doobie Brothers back in 1975. That concert is a little hazy, but I really enjoyed the show. I always liked them and I am glad they made another album.

With the new... might as well enjoy a classic, too! (sorry about the oriental characters moving across the bottom.)

 You d

You Don't Save Them All...

Over on Facebook a friend of mine who works for another agency posted about her run with cardiac arrests recently. She's run five over the past couple of weeks, of which one is still alive right now- one out of five.

Not bad odds, really.

But around here we have gotten accustomed to saving a bunch of them. Our save rate for VF/VT arrests is hitting on 40%. For all rhythms combined...it's in the double digits. And that only counts the ones that are discharged from the hospital and are able to function in a normal or mostly normal life.

But still, sometimes we view those that don't survive as 'failures'.

Reminds me of a cardiac arrest I ran years ago. It was at an office and a 50-ish female had collapsed during an afternoon break. We responded and actually achieved return of spontaneous circulation (ROSC), even using the now-archaic methods of the mid 90s. We transported to the local hospital and shortly after she was airlifted to a nearby university medical center.

Her husband was at work at a job site several counties away. Upon receiving the news he gathered their children, who were spread across the region, and they all converged upon the university medical center.

She died that night, but not before her husband and their children had time to gather at her bedside.

He came by the station a week or so later to thank us. I told him that I was sorry for his loss, but I was thinking "Why is he thanking us? She's dead."

He told me that he knew we did our best, but that maybe it was just not meant to be. Then he teared up as he shook my hand, thanking me for the chance to say good bye to her.

As he walked back to his truck I couldn't help but get a little teary eyed myself.

There is more than one way to skin a cat, so they say...

2011-12-10T13:19:00.000-05:00

Recently I had the opportunity to meet a very nice older lady who was complaining of chest pain. In my EMS system, that gets you 324mg of aspirin pretty darn quick. Usually, the firefighters have given before I get there, but on this occasion they had not.

Allergy.

I asked the nice lady about her allergies and she told me that she was allergic to Benadryl and aspirin. She said Benadryl made her sleepy and that aspirin upset her stomach sometimes.

Just about that time my partner handed me the 12-lead ECG that displayed ST elevation in V1, V2, and V3, with reciprocal changes in II, III, and aVF. Add to that her being pale, diaphoretic, and more than a little restless….

So, I told her that it was really important that she take the aspirin for her heart, and she quickly told me she could not take it because she was allergic to aspirin.

OK… plan ‘B’.

Me: “OK, tell you what. Let’s try this newer drug that works just like aspirin.”

She: “OK. Because I am allergic to aspirin. What’s this new drug called?”

Me: “It’s called acetylsalicylic acid. It’s abbreviated ASA.”

She: “OK.” (chews them up)

She: “These sure do taste like aspirin.”

Me: “They do taste like aspirin. But they are acetylsalicylic acid.”

She: “That’s fine. You know what’s best, young man.”

Bullock's BBQ in Durham, NC...

2011-12-09T15:12:00.000-05:00

This afternoon the missus and I rode over to Durham for lunch. It's not often that we get to treat ourselves, so off we went.

To Bullock's BBQ. And as to our lunch, all I can say is this-

Oh. My. Goodness.

This was our second visit. The first time was a few weeks ago and we opted for standard BBQ fair. Eastern NC-style BBQ, fried chicken, cole slaw, hush puppies, and Brunswick stew. It was really good and we decided to go back.

Well, today was the day.

Mrs. 9-E-1 opted for barbecued chicken, mac 'n cheese, deviled eggs, and cabbage. Her description in a word- excellent.

I opted for the Cajun fried catfish, baked potato, and cole slaw. Excellent does not even begin to cover it. Basically, it was the best damn catfish I have ever eaten. Anywhere.

One of the things that makes the experience at Bullock's is the staff. Our waitress both times was Cheryl. Mrs. 9-E-1 made the comment that if we had a restaurant we would have to steal Cheryl away from Bullock's. I have been served by many waitresses over the years, and some pretty good ones. However, Cheryl makes you feel right at home, keeps the tea glass full, and just really seems to enjoy what she does.

I watched her help and elderly couple in the booth next to us, packing up their leftovers and packing them away in a bag for them, and then helping them both out of the booth.

On the way out we had a chance to talk to the cook, who happened to be the one that prepared my catfish. Again, it was nice talking to someone who just really enjoys what she does.

If you're in Durham, stop by. If you live anywhere close by, it's worth the drive. They have an extensive menu with various seafood, chicken, and good all around home cooking kind of fare. They even have vegetarian and low fat fare, which is unusual for BBQ restaurants around these parts.

So go by and feast!

The Other Stuff That Happened on December 7, 1941...

2011-12-07T16:21:00.002-05:00

A lot of people have spoke of the attack on Pearl Harbor today. However, most folks have forgotten, if they ever even knew, of what else happened across the Pacific that day. Japanese forces attacked the Philippines, Wake Island, Guam, Malaya, Thailand and Midway. The early days of WW II in the Pacific were a virtual route for the American, British, and Dutch forces.

The Marines on Wake island held until December 23, 1941. For a loss of 51 naval personnel and Marines killed, as well as 10 civilian construction workers, they inflicted 1,200 casulaties ont eh invading Japanese forces. Those that were captured suffered from numerous atrocities, including the mass execution 98 civillian contruction workers on May 10, 1943.

American forces on Guam surrendered shortly after they were attacked on December 8, 1941 (their time).

The Phillipines finally fell in May of 1942. After the fall of Corregidor Island, the Americans and Phillipino soldiers were subjected to what has beocme know as the Bataan Death March. Over 10,000 prisoners of war died during the march, many summarily executed by the Japanese captors.

Malaya fell with the British surrender of Singapore on February 15, 1942. During the course of the battle the British lost the battleships Repulse and Prince of Wales. In other actions in the Indian Ocean the aircraft carrier Hermes, along with the cruisers Cornwall and Doretshire, with many other ships, were suck with a heavy loss of life. The British soldiers captured after the fighting in Malaya fared just as bad as the Americans captured at Guam, the Phillipines, and at Wake Island.

It was bad, and before it would get better, it would definitely get worse.

There was not a lot of good news that came out of the early days of the Pacific War. Our battle fleet was in shambles. The British and Dutch navies lost practically their entire naval strength that was in place in the region. Thousands of American, British, Dutch, and Philipino soldiers were killed or captured. Those that were captured suffered mercilessly in Japanese captivity.

All because we were not prepared. We were not paying attention. We ignored it. We wanted the world to leave us alone and we would leave them alone in return.

It did not work then and it will not work now. It will never work.

If we do nothing else, we must insure that never again are we caught unprepared. Never again should we as a nation be humiliated and hurt, our citizens and military members hurt in such a manner. September 11, 2001 was a reminder. Thousands of our citizens were killed in that attack that should serve as a reminder of what happened in those dark days of December 1941.

If we do nothing else to pay homage to the souls lost in those early days of the Second World War, we must remain vigilant.

Always.

Wow...those shirts are bright!

2011-12-04T18:23:00.001-05:00

Over at the Legeros Fire Blog, Blog 100, Mike himself, is kow for his Hawaiian shirts. Really bright Hawaiian shirts.

The other day he snapped this picture of one of my scenes. Yes, that is the 9-ECHO-1 Bolance, the Guardian of the Fairgrounds (GOTF), shown in the upper picture and sporting those attention getting blue and yellow chevrons, as viewed from a nearby overpass.

The lower picture is taken from the front of the GOTF, looking back at Blog 100, sporting that BRIGHT Hawaiian shirt.

Ouch, my eyes hurt...

A Clarification Is In Order...

2011-12-03T10:46:00.002-05:00

I’ve been doing this blog now for a little over two years. During that time, several of the local folks I work with have become followers. And judging from the information I get from Sitemeter, I have some pretty regular followers from around the country, and even the world. That’s pretty cool! Now, there are other blogs out there that draw more ‘hits’ than mine. Some pretty good one, too. But that’s OK. I write and people read. I guess the best compliment I have gotten of late was when my blog was quoted during our monthly continuing medical education (CME) by one of the chief officers.

So anyway, during the time I have been putting this blog out I have tried to maintain a veiled attempt at anonymity. Right. Everyone around these parts knows who I am and what I do and who I work for. It probably does not do much for anonymity when my license plate says 9-ECHO-1. So what’s the big secret? Yes, what I write is MY opinion on how I see things. I have no endorsement, nor do I seek one, from anyone other than me. I am honored that a lot of my co-workers read my scribblings, and more than one really good conversation has been started based upon some rant, rave, or observation I have committed to digitalization.

No, others out there have maintained their anonymity a whole lot better. Burned Out Medic’s location is still a mystery to me. Too Old To Work, Too Young To Retire’s location is not totally clear, but he puts little clues (whether or not intentional is up to him) and I THINK I have that figured out. And of course it is no secret that Justin Schorr, blogger at The Happy Medic, works for the San Fransisco Fire Deaprtment.There are others, as well, such as Pink, Warm, and Dry, Rogue Medic, and Looking Through A pink Pair of Trauma Shears that have been able to, at least to me, maintain their obscure locations.

But mine? Well, there is no real secret. So let’s remove all pretenses-

I live in Holly Springs, NC. It is one of the fastest growing towns in the country. Just a few years ago the population was measured in the hundreds. Now, it is a thriving suburban town, complete a WalMart SuperCenter, All Aboard Pizza (a personal favorite), the Holly Springs Barber Shop (where 9-ECHO-1 gets his hair cut), and a population of almost 22,000. The Holland Grill Company is also headquartered here (by the way, I want one of these, so all donations to the cause are appreciated). Several of my co-workers have nick named the town “Holly Rock”.

I am a paramedic for Wake County EMS (WCEMS) (previously referred to as Big County EMS). WCEMS was started in 1976 and originally provided service to the City of Raleigh, and some of the areas immediately around Raleigh. Volunteer rescue squads, based in the outlying towns and communities, covered the rest of the county. Over the years, WCEMS has expanded and now serves Raleigh, as well as the towns of Fuquay-Varina, Garner, Holly Springs, and Wake Forest, along with the Bay Leaf, Falls, Leesville, New Hope, Stony Hill, and Willow Springs communities, along with the Raleigh-Durham International Airport (where yours truly worked as a firefighter back in the 70s and 80s). WCEMS is known around the world for the care we provide, second to none. A lot of folks have emailed me about our protocols, so go here to see them. Want to listen to us? Go here.

You can go here and here to see a lot of information and pictures from around here. The emphasis is on fire, hence the name Legeros Fire Blog, but he does have a lot of EMS stuff there, too.

And if you are so inclined, I am on Facebook. You can do a search for Dale Johnson. I have a 9-ECHO-1 page on there as well. Look me up and say "hi".

OK…so now you know. No more Holly Rock, Capital City, or Big County.

And as always, these are my opinions. Just mine. They are neither sanctioned, condoned, recommended, or even approved, by BCEMS…oops…WCEMS or its administration. Or anyone else for that matter.

But, then again, it is pretty cool when you are quoted in CME. Thanks, Chief!

Simple Adult Truths

2011-11-22T16:23:00.001-05:00

You see a lot of stuff posted on Facebook. Some of it makes you chuckle, other stuff, well...doesn't. An old friend posted these on his wall, and well, they are pretty good. Thanks, Wayne!

Adult Truths

1. I think part of a best friend's job should be to immediately clear your
computer history when you die. (Or at least destroy the hard drive.)
...
2. Nothing stinks more than that moment during an argument when you realize
you're wrong.

3. I totally take back all those times I didn't want to nap when I was
younger.

4. There is great need for a sarcasm font.

5. How the heck are you supposed to fold a fitted sheet?

6. Was learning cursive really necessary?

7. Map Quest really needs to start their directions on # 5. I'm pretty sure
I know how to get out of my neighborhood.

8. Obituaries would be a lot more interesting if they told you how the
person died.

9. I can't remember the last time I wasn't at least kind of tired.

10. Bad decisions make good stories.

11. You never know when it will strike, but there comes a moment at work
when you know that you just aren't going to do anything productive for the
rest of the day.

12. Can we all just agree to ignore whatever comes after Blue Ray? I don't
want to have to restart my collection...again.

13. I'm always slightly terrified when I exit out of Word and it asks me if
I want to save any changes to my ten-page technical report that I swear I
did not make any changes to.

14. I keep some people's phone numbers in my phone just so I know not to
answer when they call.

15. I think the freezer deserves a light as well.

16. I disagree with Kay Jewelers. I would bet on any given Friday or
Saturday night more kisses begin with Miller Lite than Kay.

17. I wish Google Maps had an "Avoid Ghetto" routing option.

18. I have a hard time deciphering the fine line between boredom and hunger.

19. How many times is it appropriate to say "What?" before you just nod and
smile because you still didn't hear or understand a word they said?

20. I love the sense of camaraderie when an entire line of cars team up to
prevent a jerk from cutting in at the front. Stay strong, brothers and
sisters!

21. Shirts get dirty. Underwear gets dirty. Pants? Pants never get dirty,
and you can wear them forever..

22. Sometimes I'll look down at my watch 3 consecutive times and still not
know what time it is.

23. Even under ideal conditions people have trouble locating their car keys
in a pocket, finding their cell phone, and Pinning the Tail on the Donkey -
but I'd bet everyone can find and push the snooze button from 3 feet away,
in about 1.7 seconds, eyes closed, first time, every time.

24. People who forward e- mail without deleting the tons of previous
recipients should be shot and then tarred and feathered.

25. The first testicular guard, the "Cup," was used in Hockey in 1874 and
the first helmet was used in 1974. That means it only took 100 years for
men to realize that their brain is also important.

What we got heah….

2011-11-07T21:59:00.001-05:00

…is failya…to commun’cate.

Anyone who has seen the absolutely superb movie “Cool Hand Luke” no doubt remembers that scene. It is one of my two favorite movies of all time, and by far that is my favorite scene of any movie.

Failure to communicate.

You would think that in this day and time communication would not be a problem. As a society we are very ‘connected’. The phone that I carry can connect me with anyone in the world in an instant. I can access weather reports, the internet, and the blogosphere, as well as drug information, and a whole host of other information in a matter of seconds.

My television has access to hundreds of channel via cable. Via my home phone I can call anyone in the world. My laptop that I am typing this on connects me to the internet, various instant messaging programs, Skype, and all manner of TV and radio.

At work, we have a digital radio system that enables me to talk not only to my co-workers anywhere in the almost 860 square miles in my county, but, being part of a statewide network, I can talk to other agencies and responders beyond my county’s borders. Add to that multiple ‘talk groups’ with multiple channels each, and there is a lot of capability.

Contrast that to ’the old days’. I carried a couple of quarters to make phone calls. We did not have ‘call waiting’ or ‘call forwarding’. On many long distance calls you had to get an operator involved. We had three TV stations. To get our news we had to, egad, read the newspaper.

And back in ‘the day’ our radios were limited, too. Pretty much ‘line of sight’ was the most we could expect. In one county I worked in we had one fire channel and one EMS/rescue channel. In that county a large metro area about 200 miles away constantly overrode our transmissions. And the EMS channel was a statewide channel.

I guess you could say that communication has come a long way. When we use it.

Yep, when we use it. And when we don’t, well, that causes surprises on the emergency scene. And if a little communication will prevent some of those surprises, well, why don’t we?

I tried to find a Timeless Tactical Truth about keeping secrets and preventing surprises, so I guess I will write it now-

“There should be no secrets on an emergency scene. Secrets cause surprises. Surprises are seldom good.”

Basically, that means share the information. We have the ability today, more so than at any time in the past, to share information. For EMS, that means taking a little something from the fire department’s playbook. If you haven’t noticed lately, the guys and gals here in the Capital City are providing a lot of information on their size-ups. It’s change, and it is something to get used to, but they seem to be getting better and better at it.

Unfortunately, here in the EMS world, we have gotten pretty reliant on ‘the button’. The button on the MDT that says “arrived”. The problem with that button is that it does not relay a lot of information, other than you have arrived.

Lately, I have been assigned to a single person unit. I get dispatched to calls with other units and a lot of times I am not the first on the scene. So recently I was dispatched on a “not a cardiac arrest” call. Somewhere along the line that call was upgraded to a “cardiac arrest”. Several more units were trying to add themselves to the call.

Anyway, the first unit arrived. Then the second. Then the third. There was nothing more than a change in status on the MDT map.

So I arrived and noticed one of the responders standing at the back of the residence. Not knowing what the actual situation was, I asked if the need anything. The reply was for a particular piece of equipment to move the patient.

Well, since we work full arrests in place, and no one had announced “working code”, I retrieved the specified article and walked around to the back of the residence.

To discover chest compressions and ventilation in progress.

Over the course of the call a couple of pieces of equipment were needed that would have been on hand if the announcement “working code” had been made.

Over the years I have had a lot of those not-so-pleasant surprises from on-scene units that had not provided a verbal update. A few cardiac arrests, gunshot wounds, babies in the process of being born, and more.

And it is so easy to avoid those surprises. Let some one know what is going on. Everyone is quick to say “you can cancel” (well, most of the time). So why not let someone know if you are working a code, have multiple patients, or the like.

In this day and time, we should avoid the “failya to commun’cate” every chance we get.

I Need A Favor...

2011-11-03T16:47:00.000-04:00

Hey, folks. I need a favor. Actually, my youngest daughter needs the favor.

In case any of you did not know, my daughter Brittany Johnson is a student in the Dental Hygiene program at Wayne Community College in Goldsboro. As a part of her educational requirements, she has to complete a specific number of exams, cleanings, and x-rays. Failure to complete those requirements will affect her final grade.

So here is your chance to stop putting off that dental exam and cleaning, or that x-ray set you probably need. And the price is pretty reasonable, too (actually, it's pretty doggone cheap). If you live anywhere in central or eastern NC, just call (919) 739-6780 to make your appointment. And make sure you specify that this appointment is with Brittany Johnson.

Her and I both will appreciate it!

Everyone should find their niche...

2011-11-02T21:16:00.000-04:00

I think I have found mine.

A little over two years ago I embarked off on what I thought was my career goal. Things did not work out and I found myself back home here at Big County EMS.

Now back in 2008 we embarked off on an idea our medical director called the Advanced Practice Paramedic (APP). There were three basic tenants to the program- high-acuity response, alternative destinations for special population patients, and preventive in-home visits for certain at-risk populations. I was in the original academy, a ‘plank owner’, and was assigned as an alternate for the 14 originals. During the successive months I got to ‘fill-in’ on numerous occasions, but at the time I only got to participate in some high-acuity responses, got canceled on other responses, and even got to ‘alternately destinate’ a few patients ("EMS1, you can cancel, patient has been alternately destinated").

So anyway, when I completed my ‘sabbatical’ to the other employer, I returned to one of my favorite assignments- ‘The Number 9 Bolance’. I have worked many weeks on that unit over the years, met a lot of really good people/ firefighters, and seemed to be a ‘crap magnet’ at times. In my travels as an instructor here in Big County, a lot of my ‘war stories’ come from my trials and tribulations in The ‘Quay.

But then an email changed everything.

I was offered the chance to be assigned to one of the APP units for a few months. The unit is based in the total opposite side of the county from my house and it is quite a drive. But, it is a new environment, new places, seeing some old acquaintances in the fire departments there, and I get to enjoy some pretty awesome sunrises on Falls Lake.

But the best part has come rather unexpectantly. You see, I have been doing this EMS and fire thing for quite some time. And it has always involved going to calls, mitigating the call, and moving to the next one. Now when we embarked on the whole APP thing, I knew that home visits would be a part of the job and I did not know quite how I would handle it.

I’ve never had any problem building a rapport with my patients. And now I get to work with folks in a whole new environment- their home. And without the ‘urgency’ of having to go to the hospital.

I just completed a home visit yesterday on a new client and I am going back in a few days. This will be the first of many visits, not only with this patient/client, but with others. I hope. I am hoping that this temporary assignment evolves into a permanent one.

After spending a while talking with this patient/ client I realized the potential impact that this sort of ‘preventive paramedicine’ could have on the world of EMS as we know it. If we can keep people out of the hospital, working with them to understand and manage their conditions before they have to call 9-1-1, think of the impact on over burdened EMS systems, overcrowded emergency departments, and our on-the-verge-of-collapse healthcare system. If we can convince the medical community of the obvious value of this sort of program that will fill in some of the gaps that currently exist in our healthcare system, the enormous potential is boundless.

Forty years ago I watched a TV show about a couple of firemen who brought this new thing called 'emergency care' into the world's living rooms. People developed new expectations on the care they received during their 'emergency'. No matter how you feel about what happened in the meantime, no matter how you feel about the current state of affairs in EMS, THIS is the future of what we now call Emergency Medical Services.

While we will always need to respond to sudden events, we now have a means of truly making an impact on our patients' lives and well-being.

Be nice...

2011-10-31T21:48:00.000-04:00

Be nice...because nice matters...

That was written somewhere but I can't remember where. But it has stuck with me ever since. You see, here in the EMS business, the public, for the most part, does not really understand the things we do. They really don't know (or care) if you can read a 12-lead ECG and determine axial deviation in 5 seconds. They don't know (or care) if you can do a dopamine calculation in your head in 4 seconds flat. It's important, mind you, that you can read a 12-lead or administer the proper dosage of dopamine (or any drug), but your patient may not understand it. Or maybe more accurate, appreciate it.

But I will tell you what they do appreciate. And they do understand it. Were you nice to them? Were you rude? Did you act as though you really didn't care one way or another if you were there or not? Or maybe they could really tell you would rather be somewhere else. Maybe watching Survivor, or some other such nonsense.

It's important to be nice. In 35 years I have seen letters and cards sent to the local EMS agency/ambulance service/rescue squad, both paid and/or volunteer, and they all have a common thread-

They were so nice.

We could tell they really cared about our (mother/father/grandmother/grandfather/son/daughter/etc.).

They were so compassionate.

Get the idea? No mention about clinical and diagnostic abilities.

Now, while I have read all of those cards and letters, I have also fielded a few phone calls in my day. The thing about phone calls is that they are seldom pleasant. And without fail, unless that phone call was from the medical director or some other officer-administrator type, they too were talking about being nice, or rather, the lack of it.

They call when crews are rude, impolite, or just downright mean. And then there are the ones that are afraid to call, but then you hear about it when you go to a neighbor's house-

They scolded him/ her for not 'toughing it out' until morning and calling their doctor.

They told him/her that they did not need to call an ambulance, they needed to call a taxi.

Or my favorite-

We're not allowed to transport to an out of county hospital after 6 p.m.

That was told to a cancer patient who was in pain, who was visiting her daughter, and who got all of her care at the distant hospital (which in fact was really no more distant than three of the hospitals within the county!). The patient obediently waited until the next day, after 12:00 noon, to call back. I got to take her to her hospital of choice. We talked about her children, about how she wished she would be alive to see grandchildren one day. She died two weeks later. I know who the two paramedics were who told her that and i ahve never thought as well of them ever since (yes, I know who you are).

It is not our job to decide who does and does not need an ambulance. Yes, it's frustrating at times when you are called out at 03:15 for a sire throat or stuffy nose, but that is the system we work in. And that is not going to change anytime soon.

And in this day and time, the person you piss off just may have control of the purse strings.

But that is not the reason you should be nice to people.

People call us when whatever the situation is has gotten the best of them. They are having a bad day or night, quite possibly, from their point of view, the worse day or night of their life. Maybe it is an emergency, maybe it is sort of urgent, but maybe it is nothing more than an inconvenience. Doesn't matter. Be nice.

Because when you stop being nice to some people, before you know it, well, you're not nice to anyone.

You see, we see stuff that some of us eventually become immune to. But we cannot let that get in the way of being nice.

Because nice really does matter.

Time To Re-Focus

2011-10-31T16:45:00.001-04:00

I started this blog a little over two years ago. It was intended as an outlet for me, to vent some of my frustrations, and share some of my observations and experience. Mainly, it was intended to be an EMS sort of blog.

As time went on I added other topics. And I really have enjoyed writing a lot of those. However, of late, well, I have not been all that well focused. And looking back on some stuff I get a little vomit in my mouth and I have to ask “did I write that?”. Yeah, I did.

There’s been a lot going on of late, some positive, some negative.

I got a career change a while back and that has been a lot of what has been affecting my whole attitude of sorts. I have been itching to say something about it, but what I really wnat to say, well, my Mother always told me to try and say something good about someone or not say anything at all. But I’ll just say this. Two people who I had a lot of respect for turned out to be terrible disappointments. OK…I am done with it, never to venture there again. The problem is, I let those two people affect my outlook, my attitude, and well... that's over with.

On the bright side, I did get to go back to work for my previous employer. And a few weeks ago, I got the chance to move into an Advanced Practice Paramedic slot. As of right now it is temporary, so we will have to wait and see how it all shakes out.

With the new job came a new schedule. Instead of 24s I am now working 12s- 07:00 to 19:00. It has been an adjustment, being home every night. I told my wife that this would be the true test of our compatability. We've not killed each other yet.

But anyway, it is time to get back on track, what I wanted to do when I started. I feel like I have strayed a bit on what I started, so it is time to get re-focused.

Back to my passion, of sorts- EMS. What I think, what I believe, what I would like to see…

To my followers, I appreciate that you have stuck with it during my period of, well, straying, wandering, and blabbering. The number of followers is at 61 now…the goal is 100+.

Oh yeah, and I am on The Book of Faces. Search 9-ECHO-1 if the link doesn't work. 'Like' the page. 281 'likes' so far, so let see about 500+.

State Fair

2011-10-20T21:20:00.000-04:00

Mrs. 9-E-1 and I went to the NC State Fair today. Admittedly, I was not all that happy about going. It really has not changed much since the first time I went back in 1963. Plus, I am not a ‘crowd’ person. But, she wanted to go, so we went.

Our first stop was to get something to eat, since we got there about lunch time. We decided to go with an old staple- the foot long hot dog. Some French fires and a Pepsi later, I was ready to take on the fair.

We walked around a bit and our first destination was the gardening and plants exhibit area. Of course, the building was closed, which disappointed the missus, but we walked around a bit before moving on. There was a lot of cool stuff that I wish I had the time and energy for. Oh well.

We spent the rest of the afternoon walking around. I thought about times at the fair in the past, like when there used to be a dirt race track where the stunt drivers performed every year. And the time when I was volunteering with the Red Cross first aid team that used to provide care there and got to meet President Gerald Ford and shake hands.

On this day I got to sample some different barbecue sauces, some ‘fire house’ peanuts, and some a-w-e-s-o-m-e hushpuppies. I also got in a little people watching. And there were some really interesting characters out there. But I did come away with one observation. Actually, I have thought about this before. There were a lot of law enforcement officers present today. And one thing I guess I would like to see is our LEOs start to look a little more like the police officers of my youth and the ones I used to see on TV- Sheriff Taylor, Officers Reid and Malloy, and others. They presented authority and a sense of trust. However, of late, and especially today, I see more and more officers walking around presenting the image of Seal Team 6.

And no, I did not get on any of the rides. I grew out of that long ago.

So I guess I have my fair fix for a few years, although more than likely, Mrs. 9-E-1 will take me along with her next year.

Random Rants, Thoughts, and Observations…

2011-10-09T13:41:00.002-04:00

Spend, Spend, Spend

Looking through the news the past few days the local TV station carries this report. It states that, essentially, we are stuck in this economic crisis because people are not spending money.

What money?

A lot of folks have not gotten any increase in salary for years. I have been fortunate, having experienced a couple of raises over the past couple of years. But at the same time, Mrs. 9-E-1 lost her $65k a year job and now earns around $25k annually. A few months ago my $30k a year part time job was eliminated. That’s a $70k loss over three years. Meanwhile, all of those pesky necessities, like the mortgage, insurance, taxes, electricity, and groceries haven’t gone away, with some of those having increased in the past few years. And then there is that one, on-going necessity- gasoline. Between the other half and I we have to spend about $900 a month just to get to and from work.

Right. Spend money. I am pinching pennies more so now than at any other time in my adult life. And this is not changing any time in the near future. Tell you what, rather than that $1,300 income tax savings The Prez spoke about in his “big plan”, suspend income tax collections every other month. Now that would provide some ‘economic stimulus’.

Of course, our governments, particularly the state and federal ones, would have to do some real adjustments (read ‘cuts’) to the budgets. And of course they will throw out the "we'll have to lay off teachers", "we'll have to cut law enforcement", "the children will suffer", etc.

This is not anything new…

Back when I first got my checking account, every month I had to pay a ‘service charge’ unless I maintained a minimum monthly balance (usually it was $100 or $150). That was to cover whatever costs my bank incurred in allowing me to bank with them (yes, there are costs). I also had to pay a monthly fee to have a ‘teller card’ that I could use at ATMs to get cash.

Over time, banks eliminated those fees to become competitive with other banks. Service charges and ATM card fees went away, and the advent of ‘free checking’ came along. Banks started making their money through credit and lending.

Now, with a lot of the regulatory changes, checking account fees are coming back.

I’m not a banker or an economist, nor do I play one on TV. But I understand that the banks have to make money to stay in business. Any business works that way. Banks have to charge for different services because people write bad checks, default on loans and credit payments, etc.

The Jobs Bill

A couple of questions.

First, this bill is supposed to fund ‘public works’ spending. From what I hear that would include bridges, roads, and more. Well, I have a few observations about that. The first observation is that any time any of these projects are proposed there are all sorts of studies, investigations, impact statements, and more that has to be done before the first shovel of dirt is turned. That takes, in many cases, years. And costs million. My state was just awarded $4 million dollars for “analysis and preliminary engineering on a new connection between Raleigh and Richmond, Va.” And the line is not estimated to be finished until as late as 2022.

So is the Jobs Bill money going to be used for ‘analysis and preliminary engineering’ or construction? I keep hearing about ‘shovel ready’ projects, but those projects have already been studied, analyzed, investigated, and permitted at considerable costs and moneys are already allotted.

Second, who is going to build this stuff? A lot of the people who are out of work have no construction skills. Teachers, computer technicians, factory workers, and more have little, if any, ‘construction skills’. In all probability, the companies that build these projects are not going to hire large numbers of people. They will need specialized equipment operators and such.

Tell you what, scrap the jobs bill. Start drilling for natural gas and oil. Like it or not, that is what our economy depends upon, and will for the foreseeable future, regardless of green technology. Too much stuff depends upon plastic, metal, and diesel fuel. And while solar energy can help, it will not replace fossil fuels for years. And while we are drilling, build some refineries. Drilling for more fuel, as well as building refineries, will help drive the costs of energy down. THAT will get our economy moving.

People will be needed to design he rigs, build the materials, transport the materials, and build the rigs. Then the product will have to be distributed.

And while we are talking ‘public works’ projects, answer this- could we build things like Hoover Dam, the interstate highway system, the Intracoastal Waterway, or even a transcontinental railroad today? Of course not. The permit process has become cumbersome, and any group with a lawyer can launch years of challenges. Like it or not, we have to shorten and streamline this process and restrict the challenges.

The Child Card

2011-10-05T11:43:00.001-04:00

I hate to see anyone’s budget cut. I hate to see agencies lose staffing and equipment and facilities. I really hate to see anyone lose their job.

But I really hate it when people use scare tactics that are not based in anything but emotion. I hate it when supposedly educated people stand in front of a microphone and declare impending gloom and doom. And I absolutely despise it when people play the ‘child card’. You know, sayings like “for the children” and “children will die”. Especially when that assertion is not based on fact.

Well, down in Florida, many municipalities and counties are wrestling with the fact that they are trying to do things that are not economically sustainable. Cities, counties, and towns have written checks to provide a myriad of services that they cannot continue. So of course, at some point, they are going to cut public safety services.

We can all say that we should never do it, but the fact is, it’s coming. There is no denying it. Sure, there are a lot of places to cut before you reach public safety, but I hear things like “we have to be fair”. And then there are groups who will decry the closing of a library, the cutting of various (entitlement) services in the loudest of voices, many times playing various 'cards' to prove mistreatment or even discrimination of some sort.

So it has become especially heated down in Hialeah. Admittedly, I don’t know all of the facts. I don’t know what the situation is down there economically. But I saw this and saw red-

The Hialeah fire department stripped life-saving paramedic equipment - including intubation kits to help patients breathe and defibrillation pads to revive children - from its fire trucks Tuesday, only to undo the changes after what the city called a misunderstanding.

The emphasis by underlining was added by me.

If you are going to make statements like that, make sure it is based upon fact, not emotion.

Fact- there is quite a bit of evidence (scientific, data driven evidence) that intubation of children in the field by EMS personnel is not a life saving procedure. Pediatric airways can be adequately maintained by BLS measures with excellent outcomes.

Fact- there is no correlation between positive outcomes in adult cardiac arrest and other medical and trauma emergencies and the placement of endotracheal tubes.

Fact- it has been demonstrated and proven that the things that saves lives in situations such as cardiac arrest are chest compressions and defibrillation (which can be delivered with an AED).

Now, I don’t’ know how the removal of the equipment (that I will venture is already paid for) from the fire trucks is going to save money, except maybe for defibrillator maintenance costs which should not be too high, provided the units are not ancient. Or maybe it will save money in the future by not having to replace it.

And on another note, from the same report, there was a quote form the mayor saying services will not be affected after cutting 40% of the fire department workforce.

Really? Does the mayor actually think people will believe that? If you cut almost half of something, like a workforce, it is obvious that services will be affected. Let’s be honest with folks. If any agency around here cut 40% of its workforce (EMS, fire, or police) there would be a serious change in services.

Be honest with your constituents. Don't try to tell them the equivalent that if you saw one leg off of the table it will still be stable. We know better. I hope.

Out of the mouths of patients...

2011-10-04T20:52:00.000-04:00

I try to keep my assessment questions simple. I do that becasue it never ceases to amaze me how folks misinterpret my questions. I also like it when I have to go on a fishing expedition to find out critical details.

Example-

Question-"What kind of medical problems do you have?"

Answer- "None."

Question- "Are there any medications or medicines or pills that you are taking?"

Answer- "Yes. They are in this bag."

Upon looking in the bag, and handing them to my partner to write them down, I see things like metformin, Actos, glimepride, pravastatin, atenolol, quinipril, aspiring, coumadin, and more.

Question- "That's quite a few medicines in that bag. What do you take them all for?"

Answer- "Well, there's my di'betus, my high blood pressure, blood clots in my legs, and I think one of them is for the heart attack I had a while back. I ain't sure."

Question- "You had a heart attack? When?"

Answer- "Actually, I had two. The first one was at the mall. They had to beat on my chest and electrocute me to wake me up. Then I had another one in the hospital. They said I arrested."

Question- "Soooo, when did all this happen?"

Answer-"Well, 'bout three months ago."

Question- "I see. So you do have a few medical problems."

Answer- "No, I don't. That's what I take all those pills for."

Remember When TV was Entertaining AND Tried to Teach a "Life Lesson"?

2011-10-04T07:15:00.000-04:00

Well, I do. There were stories of "doing the right thing becasue it is the right thing". Nothing like the fare of "reality" shows today that showcase talents such as back stabbing, selfishness, and snobbishness, or otherwise try to convince us that people really do live like the ones in these shows..

Today is Beaver Cleaver's 54th birthday. Leave It To Beaver premiered on CBS on October 4, 1957.

Maybe one day we will awaken from this drunken stupor created from such crap as Survivor, The Real World, and Big Brother.

And I Hope This Does Not Get Dumped On The Transport Crew

2011-09-29T09:42:00.000-04:00

This story comes out of Illinois. Short version is that an asthmatic child was, for whatever reason, bounced around hospitals until, on the way to a far distant one, his condition deteriorated and he eventually died.

Now I don't know what protocols these folks were operating under. Nor do I know the exact rationale for transferring the child so much, especially by not going to the pediatric ICU earlier, or even on the initial transport.. I just hope that this does not get dumped on the ambulance crew.

But I also noticed a couple of things in this report-

Aaron was again put in an ambulance, something attorneys referred to as a "destabilizing event." He was taken to Franciscan St. James Hospital in Chicago Heights.

Since when is being placed into an ambulance a "destablizing" event? Call me cynical, but this just sounds like it is setting things up to place a lot of blame on that "destablizing" ambulance crew.

"The fact that Aaron was wheezing and struggling to breathe should have been a sign not to put him in an ambulance, Miroballi said."

What? We do it all of the time. Actually, we place a lot of people in an ambulance that are struggling to breath. It's what we do.

"They send him even though he's not stable," he said. "Why they didn't put a doctor in that ambulance with him, or an anesthesiologist or someone who would manage his condition during that long transfer, we don't know."

As opposed to keeping him at the hospital where he is not stable and for whatever reason they cannot correct the problem? And a doctor or anesthesiologist or 'someone' could have done what? 'Someone'? How about they were not placed in the ambulance because the crew was perfectly capable of handling the situation? Maybe because doctors and anesthesiologists are not oriented to providing care in the back of an ambulance.

"Who would send a sick child almost an hour away? That's crazy."

Nearer does not mean better or more capable. You send patients to the right facility that can provide the right care.

Let Me Know How This Goes

2011-09-29T09:40:00.002-04:00

One of the reasons that EMS is held back so much is the ongoing belief on the part of many government officials, elected and appointed, is that EMS should pay it's own way through the collection of transport fee revenue. It is obvious to me that those folks have no real grasp of what EMS should, rather has to become.

Then I see something like this and it becomes clear that some folks don't have a real grasp on who it is we serve-

"Almost every one of those victims has insurance, so it's just a question of properly identifying the insurance carrier and properly billing and collecting from the insurance company. It's not like harassing the person who might have been stricken with a heart attack or stroke or some victim of an auto accident out on the street."

I don't know where I saw it, but it seems that I have seen data that indicates that many folks who have to use EMS do not have any sort of insurance. Or they have Medicare and Medicaid, which have limits on what they pay for EMS. And then there are trauma patients, many of whom require a tremendous amount of care yet many times have no insurance.

I don't know, but it seems this elected official is in for a letdown if he has already counted the millions of dollars he is expecting through transport revenue.

I Have a Better Idea

2011-09-29T09:39:00.000-04:00

Is this a surprise to anyone? Rather than local governments trying to find a quick and supposedly easy way to make a buck, why not try and provide services responsibly. I don't know the specifics of this county's particular budget, but over the past few years I have seen a lot of local governments try and overcome budget shortfalls with things like landfills.

Bad idea. I know, the stuff has to be put somewhere, but did you really think that the neighbors were not going to put up a fight?

Maybe we have to face up to the fact that we cannot afford some of the things we want. Maybe we cannot afford so many greenways. Maybe we need to drive our goverment owned vehicles another year or two. Maybe we cannot afford a high speed train...no wait, that was another story...

So What Did He Expect?

2011-09-29T09:29:00.003-04:00

Two things in life are certain- death and taxes. I have heard that my whole life and it has pretty much prven to be true. Then this report popped up.

I get all sorts of stuff in the mail. Every one wants to refinance my house, give me a credit card with a deal like a 29% hourly interest rate, all manner of sale papers, and notices. Notices that a payment is a couple of hours late, something is about to expire, or my taxes are due.

"If I did get something (like a tax notice), I probably dismissed it," he said Wednesday. "(I thought) 'Oh, I sold that vehicle. I don't owe any tax on that.'"

I sold a vehicle once and when I had the title and tags transferred the nice lady at the DMV reminded me to let the city and county know so I would not owe taxes on the vehicle I no longer owned. Good advice.

I say tough sh** on this one. You should have paid your taxes. So stop whining.

Do we really need to travel from Raleigh to Richmond in two hours?

2011-09-28T21:41:00.000-04:00

Well, according to this we must.

There used to be a rail line between Raleigh and Richmond- the old Seaboard Airline, later Seaboard Coast Line. When SCL became a part of CSX it was decided that the Raleigh-Henderson-Petersburg-Richmond route was not needed. You know, that old pesky cost-benefit thing. The line was taken up many years ago.

Now, in order to do this again, the right-of-way will probably have to be re-acquired (at what cost?). And track will have to be re-built, signal systems put into place, and if it is to be a true high speed train, then there cannot be any railroad grade crossings. While some of the over passes are still there, more will have to be built.

How many millions will it cost in order to travel from Raleigh to Richmond in two hours?

And given this proposal, or given the sad state of mental health treatment in our state, I wonder if maybe this money could be better spent elsewhere?

People Of The Lists

2011-09-27T21:06:00.001-04:00

I’m talking about checklists. It’s another way that folks here in my neck of the woods get things done. It complements our concept of The Code Commander, which I’ve written about before. Go here to check that one out.

Let me change gears. Let’s take two jobs- surgeon and airline pilot. What do you think, if any, difference there is in the intelligence level of the people who fill those jobs? Me personally, I don’t really think there is a difference. Both have to be pretty darn smart to do what they do.

But think about this. What if they make a mistake? Errors by either could have dire consequences, but what is the investment in the situation by either one?

If the surgeon makes a mistake, he is still going home after work. Sure, there could be some pretty serious consequences, for the patient, and maybe for the surgeon’s checkbook (or his malpractice insurance company’s checkbook), but still, he’s going home.

But what about the airline pilot? You know, if he makes a mistake, then how is that landing going to be? Or how about that take-off? A mistake on the pilot’s part could have dire consequences for the passengers, as well as the pilot. Make a mistake during take-off, the flight, and the landing and he may not go home.

So what do pilots do to help them remember all of those little details that can have some pretty dire consequences if you don’t pay attention to them?

Checklists.

When an airliner takes off, the flight crew goes through a checklist.

During an in-flight emergency, the flight crew goes through a checklist.

When an airliner lands, the flight crew goes through a checklist.

Every time.

No matter how experienced the crew is, no matter how routine the exercise is, no matter how trivial the detail, the crew follows the checklist.

Every. Time.

Think about it. Think about the last surgical error you heard about. Lost clamps, instruments, and sponges. Think maybe a checklist that is followed every time, no matter how experienced the OR staff is, no matter how ‘routine’ the procedure is, could prevent those sort of errors.

Damn right they could. Reviewing a checklist jogs your memory on those trivial things like making sure all of the clamps are retrieved, all of the sponges are retrieved, anesthesia is maintained at proper levels, etc.

It works in EMS, too.

I know, there are those out there that are so caught up in their own perceived ability that they think they don’t need a little memory jolt once in a while. Don’t look at me like that. You know, whether you want to admit it or not, that it is true.

No matter your education level, your level of experience, or your self-perception.

We’ve all had those moments. All of a sudden it comes to you that you forgot something, made a slight error, or just did not do something. If you think for even a millisecond that you have not had one of those moments, then you are ~~kidding~~ lying to yourself. Period.

Here at Big County EMS, we’ve been using checklists for a while now. Just about four years. We started with the ‘Cardiac Arrest Checklist’, and we’ve expanded it a little. And more are on the way.

We provide world class care around here that is second to none (to quote Will Sonnet- “no brag, just fact”). We have a tremendously talented group of providers. We have leadership with a vision.

And we have checklists.

Below is our “Post Resuscitation- ROSC” checklist-

Post-ROSC Checklist:

____ FINGER on pulse, mark with pen, MAINTAIN regular checks for 10 minutes

____ ITD has been removed, ASSESS C02 (should be >20 will good waveform)

____ Check O2 supply and pulse Ox to TITRATE to Sa02 94-99%
____ Obtain 12 lead EKG

____ Obtain B/P -- Pressor agent indicated for MAP < 90

____ Evaluate for post-resuscitative airway placement (eg, ETT).  Strongly consider bougie use if airway change is indicated.

____ When pt is moved, perform CONTINUOUS PULSE CHECK during move

____ Unless patient is following verbal commands, continue/initiate hypothermia therapy

____ Assess for & TREAT bradycardia’s < 60 bpm

____ Iced saline is running in 2 lines if possible
____ Mask is available for BVM in case advanced airway fails

____ Once in ambulance, confirm pulse, breath sounds, SaO2, EtCO2, and cardiac rhythm

Think about it. There is nothing about the information on the checklist that is unusual. Some of it is plain ol' common sense. But, it is amazing how many times, without some sort of prompting, that really smart people will forget things like removing the ITD, marking the pulse site, or other stuff.

How many times have you been working a code and realized, at some point, that the oxygen bottle was empty? Or how about whether or not you have a BVM mask handy in case your advanced airway fails?

Like I said, there are a bunch of you out there in EMS Land that will think that this whole checklist thing is a bunch of crap. And if you can guarantee that every time you run a serious call like a cardiac arrest that you are not going to forget one of those 'obscure' little details that can make the difference between a well run call and a clusterf***, then rest comfortable in the fact that you are in the top 0.0001% of EMS folks out there and you don't need a checklist.

But then, are you willing to bet your patient's life on that supposition? Are you willing to bet your career as well?

Cable Network Medical School

2011-09-26T16:00:00.000-04:00

The dispatch at 23:40 for “heart problems, 19B9” at a local subsidized apartment complex that caters mainly to seniors. Just after checking en route, the call is “upgraded” to a “19D4”, with a TAC channel assignment fire department dispatch. A district supervisor also announces to “add them to the call”.

We arrived to find a 96 year old patient, conscious and alert without distress, sitting in a chair, watching TV, with a very pissed off look on her face. Several family members are also in the room, with one in particular talking louder than the others.

After the introduction, “Hi, I’m 9-ECHO-1, what’s going on tonight?”, it rapidly goes downhill from there.

A female in her late 50’s and terribly overweight seems to be the loudest. She responds with “Mama gon’ have a heart ‘tack and needs to go to Big University Medical Center (36 miles away)”.

I ask the elderly patient how she is doing and she replies “I’m fine. I’m just fine. But my daughter…she ain’t right”.

Seems that Mama went to the doctor the day before for her regular six month check-up. And for the first time in her life she was told her cholesterol was ‘borderline high’. The doctor told her she did not need any medication for now, she could probably control it by watching her diet. Besides, no need to start taking a bunch of pills if you don't have to, since you don't take any, have no medical problems, and have not been in the hospital since your now 51 year old youngest son was born.

So Mama came home, driven to the doctor and back by her grandson. Mama went about her business, eating lunch, watching her stories on TV, eating supper, then around 20:30, went to bed.

So daughter comes home around 21:00 after work. In talking with her son she learns that Mama has high cholesterol. Then later on, while watching that evil health network, she sees that high cholesterol can cause heart attacks, followed immediately by a commercial for Big University Medical Center and their world class heart care.

Hence the immediate phone call to 9-1-1.

So, Mama says she is fine and does not want to go anywhere. Daughter insists that Mama’s doom is impending and there is not a minute, no second, to spare in loading her up for a 36 mile ride in the cold night air.

So, anywho, Mama finally consented to go to the ED. Not because we pressured her, but because she just wanted her “dumb ass daughter” to hush up. But she was clear she was not going all the way to Big University. She insisted on going to the People’s Republic Hospital only 10 miles away.

I listened at the ED as the doc politely let daughter know that if Mama was going to have a heart attack, it sure would not be the brand new diagnosis of high cholesterol that would do it.

Got to love all of these folks who get their medical education from cable TV.

The Necessary Change of the Face and Soul of EMS

2011-09-22T15:53:00.000-04:00

A lot of people who are my age, give or take a few years, were inspired by the TV show “EMERGENCY!” It showed us was this new thing called EMS could be, as opposed to the hearses and station wagons with big engines, very little equipment, and operated by folks with more good intentions than anything else, that seemed to be the first line of, well, something, back in the 1960s.

There have been a lot of changes in the intervening years, but now what? I have watched skills and procedures come and go. Concepts that we considered as the Holy Grail of EMS just a few years ago are falling rapidly by the way side.

But what next?

I know a lot of people don’t want to hear it, but let’s take a little bit from the fire service playbook.

Prevention.

We just simply cannot continue to be the “you call, we haul, that’s all” service that we are now much longer. We simply cannot afford it. Medicare, in case you haven’t heard, is broke, or just about there. So is Medicaid. And those two programs alone constitute the major portion of revenue for many of the nation’s EMS agencies. And I am willing to bet my own money on this one- that money is going to dry up, or at least become a lot more restricted.

EMS needs to get in front of injury (and illness) prevention. We need to start a program of following up on certain patient populations, such as CHFers, COPDers, diabetics, falls, and others. And this should be automatic, not suggested or solicited. When we transport someone to the ED, we need to be in a position to let them know that the EMS agency that is transporting them to the hospital will definitely follow-up with them in a few days. And we need to have dedicated folks (paramedics) who designated as their primary job to do these follow-up visits.

So how do we pay for it?

First, pressure needs to be put on the feds to allow Medicare and Medicaid to create payment schedules for these services. After all, what is cheaper? Taking someone to the ED several times in a year, of send one paramedic out to do a little preventive care?

Another way of funding this service is a dedicated tax. Don’t look at me like that. We pay taxes to the local fire departments/ districts in these parts (but for some reason everyone is hesitant to pass and approve EMS tax districts even though there are far more EMS calls than fire calls, plus you are more likely to need EMS than you are the fire department (unless they are running EMS calls) in your lifetime.

And when it comes down to it, what is more important- funding potentially life-saving or ‘quality of life-saving’ programs, or greenways and (insert your favorite stupid pet project here)?

There has been a lot of press attention given to programs in Eagle County, Colorado as well as Wake County, North Carolina.

This is where we are going. Hell, it is where we HAVE to go. The days of "you call, we haul, that's all" are coming to an end. By necessity, since we just cannot keep doing what we are now doing. And it is just a matter of time before the folks controlling the Medicare and Medicaid purse strings realize that this approach can save them money.

Fatal Vision

2011-09-22T15:35:00.000-04:00

The WRAL story on this case can be found here.

Forty-one years ago the murder of Dr Jefferey McDonald’s pregnant wife and two daughters hit the headlines around these parts. McDonald was convicted and is serving three life terms for the crime. The murders were the subject of a book and a movie. It is a case that I have followed since the trial. I read the book and saw the movie, along with just about everything else I can find on it.

Dr McDonald has maintained his innocence all of these years. And his story and account has been consistent the entire time.

Over time different things have come up, at the very least casting a little doubt.

Me? I have always thought him to be innocent. The courts are reviewing new evidence and looking into re-testing DNA evidence from the scene.

Here in North Carolina the Center on Actual Innocence was created to review cases to determine ‘actual innocence’. For example, a man convicted of a murder almost 20 years ago was released from prison due to their efforts. They are funding the DNA review and additional tests.

Maybe at the age of 67 McDonald will finally be released.

The "New" Facebook

2011-09-22T15:28:00.000-04:00

In the true tradition of America as it is today, a lot of people are really concerned that Facebook has changed stuff again. I guess I’ll jump on the bandwagon in that I don’t like it either. But then I didn’t like the LIFEPAK 10 over the LIFEPAK 5. It’ll be OK. We’ll all get used to it.

I had to give this one a lot of thought...

2011-09-14T21:39:00.000-04:00

It is a good possibility that there some folks out there that would misunderstand the intent of the post. But, when have I ever let that stop me?

As anyone who has a pulse knows, our country recently took time out to reflect on the 9/11 attacks on the 10^th anniversary of those infamous deeds. There were ceremonies and events galore. Numerous organizations held many remembrance activities and politicians did not miss an opportunity to speak.

I was working this past Sunday, 11 September 2011. As part of my routine, after I have checked off my car, is to go to the local Cajun-themed chicken restaurant chain location closest to my station and get a large ice tea with lemon. On this day, however, several people were eager to pay for my breakfast, so I had to enjoy the chicken filet biscuit combo with small round potato cakes ‘forced’ upon me, plus try and look cool as several folks stood up and thanked me for what I do and actually provide a round of applause.

At several of the fire stations that I stopped by there were cookies, muffins, and other treats available that had been brought by the public. I have to say that the coffee cake at one of the stations was the absolute best.

Well, towards the end of the day came a couple of reports of, well, something kind of disappointing. It’s nothing new, but still, every time I hear of it I wonder when things will change.

Seemed like a local restaurant, part of a national chain, decided to provide a free buffet meal to ‘emergency responders’. And, as to be expected, there were some responders that took advantage of the offer. Now, it’s not like we are talking a big amount here. This restaurant’s buffet usually will cost you about $10.00, including your drink.

Anywho, all was well until a local EMS crew stopped by. There they learned that the free meal was for ‘emergency responders’, you know, police and fire folks. Not EMS.

Really?

Now let me clarify something. I have never gone into a restaurant looking for discounts and I really have a lot of disdain for those folks who actually ask. And whether or not I, as an EMS responder, get a discount has never really determined where I go and do not go. I have never asked for a discount, and have never caused a scene when I didn’t. Well…there WAS that one time… but that is another story. Further, for that matter, I don’t think that any business owes us, whether EMS, fire, or police, any sort of favors like a discount, bigger portions, better seats, or anything else.

But…if you are going to treat one group of responders who drive up and down the highway with blinky lights and whooping sirens one way, well, I kind of think you need to treat everyone that way. Call me naïve, but that is the way I feel about it. We all have a dangerous job, in its own way. I don’t have to worry about a burning building collapsing on me, but I do have to worry about crazy drivers, crazy patients and family members, and all of the neat communicable diseases that I may take home to my family.

I don’t know what the reason is that EMS is treated so differently. It’s amazing how some of the public’s opinions of us are, well, skewered. With my last employer, we went to the grocery store to buy stuff for supper. Due to the radios and computers and drugs and stuff we had to leave the unit running, and per the chief, on high idle. When we got back to the ambulance a member of the public was waiting and he was just a little bit pissed. “What is the meaning of wasting all that fuel?” he asked. He thought it was rather irresponsible on our part to go to the store, when we should have just stayed at the station and ate the food that the town provided us.

They don’t understand us.

They don’t understand that we do in fact have a dangerous job.

And it’s not from a lack of trying to inform them, at least around here.

Maybe it will never change.

9/11/2011

2011-09-10T12:53:00.000-04:00

As anyone who has been around recently knows that tomorrow is the 10th anniversary of the most horrific attack against the United States ever. There were 2,977 lives that were lost in a cowardly act, supposedly in the name of religion. Since then, more than 6,500 American military members and contractors have died, as well.

I am not going to debate anything about that day and the wars since here. That is for folks far more learned than I.

There are many events scheduled to commemorate the sacrifices made that day. If you feel inclined, by all means attend one.

Me? I will mark tomorrow as I do every other day.

As I prepare for another day at work, I will say a prayer. I will add a little to grant peace to the souls of those lost and to their families, for those lost that day and for all of those lost since as our military has been in harm’s way.

I will then ask that God watch over me and my co-workers, to keep us safe, guide our hands, and watch our backs. I will ask that I and my co-workers arrive home just as we left for work- in one piece.

Then I will put on my uniform (without all of the ‘commemorative’ pins, badges, patches, and decals, which, in my mind, just tend to, well, ~~cheapen~~ commercialize the whole event) and go to work. I will go out and do my job, to the best of my abilities, and try and help others do the same.

And tomorrow night, God willing, I’ll come home.

I think that is what those almost 10,000 people would have wanted. To go about our day as we always do. Because THAT is the one way we will beat those that try and beat us.

Why Don't You Hear About This Stuff on MSNBC, CNN, Fox, CBS, ABC, or NBC?

2011-09-07T09:59:00.000-04:00

With everything going on in the world, it seems to be a fact that the major news agencies focus on the bad, that which emphasizes their point of view on a topic. Yes, the news services are exceptionally biased. Just in case you did not know.

From Iraq and Afghanistan we hear daily of IEDs and homicide bombers. We hear daily of military lives lost and forever altered by injuries.

We hear about the staggering costs of maintaining our presence in those regions.

Let a military member step out of line and the news agencies waste no time in bringing it to our attention- "See? They're all like that!"

So why is something like this buried in a newspaper in the midwest? Why did not the mainstream news agencies pick up a story like this?

I am sure there are many more stories just like this- America's military personnel going the extra mile to bring some good to an area full of bad. We just shouldn't be hearing of this across the land five years after the fact.

The Mini-Van Swagger...

2011-09-06T07:38:00.000-04:00

I know you were trying your best to look cool. And that is no easy task in a mini-van. When you blasted around me on the four-lane, your elbow hanging out the window, lounged back with your sunglasses on…I caught up with you at the stoplight. So where did that ‘burst of power’ get you? When the light turned green you stepped on it, like you were inviting me to drag race you to the next stoplight.

And so it went all the way down the highway. Past the shopping center and hospital.

Past the hospital. How appropriate.

You and your minivan. Your pewter colored minivan. With the stick people family on the back window. All of those ‘terrific kid’ stickers (do you have to keep reminding yourself that they are terrific?). The ballerina stickers are a nice touch, too.

So, how did you explain the ticket for running the red light to her? You know, the one you ran when you tried to pass me again four blocks later. And the child restraint ticket. You know, the one for not having those four kids in the back without child safety seats.

Dumbass.

Driving down the road in a minivan, thinking you are in some sort of high performance vehicle, with FOUR UNRESTRAINED CHILDREN IN THE BACK.

I hope she smacks your sorry ass and takes your nuts and puts them on the mantle for you to look at. Of course, come to think of it, she married you, so what does that say about her?

Betty's Place

2011-09-03T21:27:00.001-04:00

It's been a while since I published a restaurant review. It's not that I haven't been to some good ones, it's just that, well, time has been crunched. A lot. And simply put, other stuff has held my attention. But have no fear, some reviews are in the works.

Now most of the folks that read my blog live around here (NC), but, well, you never know who is reading.

Anyway, last week the missus and I traveled to the Hudson Valley area of New York to attend a wedding. In one of the little villages close by we found Betty's Place.

Located at 1122 Main Street in Leeds, NY, it is a little deceiving at first glance. But this is one of those small town, diner type, greasy spoons that everyone knows about for miles around.

We ate there twice that week and it was crowded both times.

The first day was for lunch. They have a wide variety of sandwiches and burgers, as well as other fare to choose from. I selected the open face burger with sauteed onions, onion rings on the side, and brown gravy all over. The crowning moment, though, other than the absolute delicious burger, was when the waitress asked me how I wanted it cooked- rare, medium, or well. See, here in NC, it is next to impossible to get a rare burger- food safety regs and all that.

I know, I know, there are all sorts of reasons not to eat a rare burger, but that's the way I like them. Period.

Anywho, when that burger came out it was truly heaven on a bun!

My wife ordered a meatball Parmesan sandwich and, well, from the look on her face it was pretty damn good.

We stopped there on our way out of town for breakfast to go. I got a sausage-egg-cheese sandwich on a toasted hard roll. Mrs. 9-E-1 got a buttered bagle. Equally scrumptuous.

Now around these parts I am really fond of BoJangles, particularly a ham, egg, and cheese biscuit. You don't find many sandwiches for breakfast here on a hard roll. But I tell you waht, it's a really good alternative.

So, if you are ever in Leeds, be sure to check them out.

(Photograph of Betty' storefront courtesy of map-kristi via Flickr)

Guilty. Sort of.

2011-09-03T13:57:00.000-04:00

I know, I did not hear all of the evidence. But what I do know is that Robert Stewart traveled to the Pinelake Health and Rehabilitation Center in Carthage (NC) looking for his estranged wife. While looking for her he repeatedly shot people. He killed eight of them.

Yes, he had a lot of 'issues' to contend with (so do a lot of us).

Yes, he was taking a lot of prescription medications (so do a lot of us).

First degree or second degree, on eight seperate instances that day he deliberately and in cold blood shot and killed eight different people. People who had nothing to do with his problems. They just happened to be convenient.

It is a shame.

I don't consider myself to be much of a cruel and heartless person. Really, I don't. But I really think that Stewart is going to be missing out on the justice he so richly deserves.

Gas taxes and gas prices...

2011-09-02T16:22:00.000-04:00

Gasoline tax for New York - $0.634/ gallon
Gasoline tax for North Carolina - $0.486/ gallon

Price per gallon for regular in New York in Catskill, NY - $3.71/ gallon
Price per gallon for regular in Apex, NC - $3.72/ gallon

OK, so what gives? I don't bemoan the sellers their profit margins, but geez...with a $0.15 difference in gasoline taxes I would expect the gas price to be higher in NY...much higher. Oh well...

Price per gallon for regular in Apex, NC - $3.72/ gallon
Price per gallon for regular in Youngsville, NC - $3.47/ gallon

Glad the station in Youngsville is close to my current station assignment...extra five minutes saved me $7.50!

The Peak of Good Living my a$$!!!

Gas prices courtesy of http://gasbuddy.com/.

The One Constant....

2011-09-02T15:49:00.001-04:00

Yep...nothing is more consistent than changes.

There's been a lot of those lately. Everyone that know me probably knows that the experience that was The Peak came to an end in June. Starting in July, I came back to my old employer, Big County EMS. I spent the first month or so on the Number 9 Bolance down in The 'Quay. I was really glad to be back there because, first of all, the guys at The 'Quay's fire department are good help. Second, it is close to home and gas is expensive- damn expensive. And third, I seem to run some pretty good sh** down there. In fact, a good number of the 'war stories' I tell in some of my classes to highlight a point come from calls I have run there over the last few years.

But then...another change.

Let me say first- do not attempt to read email on a Crackberry while driving down the road. Especially at highway speed. Second, don't try to read the mind of the officers appointed above you, nor try and anticipate what they may or may not do, may or may not say. You'll lose. Still it's always nice to get a nice surprise. The ones that you did not even see coming.

With that said, everyone is aware of Big County's Advanced Practice Paramedic program, I think. We started it back in January 2009. There have been several articles written in various media (you can go search them yourself). Here at home, the local paper focused on the vehicle choice (Dodge Charger with police package V8) more so than anything. And one of the local radio hosts decided to attempt to feature the Chargers in a negative way on his morning show.

Anywho, just to get you caught up, the program has three main focus points right now. First, alternative destinations for mental health and substance abuse patients, as well as homeless patients, when the ED is not necessarily the right place for them. This has worked out pretty good. Second, there is follow up with certain categories of patients (right now diabetics, CHFers, elderly falls, and pediatric asthma) to see if we can help them manage their situations to prevent 9-1-1 calls and ED transports (we call them and visit them in their homes). This is also working out pretty good. And finally, to provide experienced providers on high acuity calls (i.e. full arrests, acute airway management, etc.) since we have a lot of 'newer' providers out there (at one time the average experience level here was 10 years- now it is less). The idea is there will be a small number of people that see and do a lot of stuff. And plus, it is always nice to have someone to 'bounce an idea off of' when you just ain't sure. This is also working out pretty good.

Anyway, I was in the first APP Academy and was assigned as an AAPP (Acting Advanced Practice Paramedic). I still rode an ambulance and served as an FTO, but I would be assigned to fill-in when one of the regular folks took time off, which turned out to be pretty often. When I left The Peak to come back to Big County, since I had been out of the loop for a little over a year, I did some clinical rotations on the substance abuse side of things, a couple of ride alongs, and then got my AAPP status back. In no time I was picking up shifts to ride the car.

Well, here is where that 'don't read emails while you are driving' public safety message comes in. See, I got this email from one of the chief people. I checked to see who it was from and it said 'APP Assignment' in the subject line. Now, when things have not been going your way of late, and little speed bumps (and big tank traps) seem to keep getting thrown in front of you, well, you get a little skidish of such stuff.

And well, for reasons beyond my own comprehension (I think it was sort of the "what now?" reaction given some of the things going on in the 9-E-1 household of late), I just expected that for some reason my AAPP shifts for that weekend (two 12-hour shifts) were somehow being cancelled.

Remember what I said about not trying to anticipate what the boss man is telling you?

Well, the message was pretty much 'there is an opening on The Far Northern Territories APP car and I would like to send you there for a few months'.

Cut now to the image of the 9-ECHO-1 mobile running off the road. Yes, all four wheels off of the road. Dust and grass flying. At highway speed. Me at the wheel saying something "OH SH**!!!"

Mr. 9-ECHO-1 himself, the one who ain't afraid to call someone out for doing something stupid while driving... Yep, I admit it when I make a mistake. I'm just glad none of the dozen or so cars around me were carrying anyone who knew me...

So here I am. I'm at The Hill in the Far Northern Territories. Watching over the Harricanes et al (yes, that is spelled right- that's another blog post). Having the most fun I have had in many years. Really enjoying coming to work for, well, the first time in quite a while.

You know, I was talking to someone a few years ago about call volumes in the little rural county I was working in at the time and I said something about EMS needing to do something to try and prevent EMS calls- some sort of community outreach. I didn't know what kind, but something. Afterall, we couldn't keep going to the same people over and over and over because they wouldn't take their metformin or insulin or their Lasix, or needed their blood glucose level or blood pressure checked (seemed always at 01:45). I didn't think much of it, since I didn't think anyone would reallly go for such a thing. Besides, my friend told me, who would pay for it?

Turns out I was wrong. Turns out that a lot of folks around the country (and world) were sort of thinking the same thing.

Then in 2008 I got to start in the program academy for just that.

And now, I get to do it. I already have a couple of regulars I stop by to see. Even got my first phone call yesterday asking one of those "what do you think...?" questions. And I have gotten to see some really talented people do some really talented stuff.

You just never know how stuff is going to work out. My mother has been telling me that for 53 years. I guess she really did know what she was talking about.