Sorry to everyone for not having anything in the past couple of days, but it has been a busy couple of days. There was a lot of working and a lot of moving to do. But now I'm back, with a fresh sense of spirit. Something I observed over the last few days of working is how much my hands are really tied sometimes. For example, during one of my shifts my medic and I were dispatched for a diabetic. We arrived to find the patient unresponsive on his couch. The patient did respond to any sort of stimuli, that is until we tried to start an IV, then all hell broke loose. We were able to obtain a sugar reading of 45 before we tried the IV, but the IV was a no-go. The patient obviously didn't realize what he was doing, but I was unable to control all 4 limbs, so we called for police assistance. When they got there, the patient took one swing at the cop and the next thing we knew the patient was on the floor with the cop on top of his chest and a knee across the neck.
I found myself wondering exactly how this officer would go back to the station and document this use of force. The topic of restraint in EMS is a very grey area. Even when we use "the minimum necessary" only in a case of self-defense, we can still get into trouble. This is why we called the police in the first place. I'm not saying I would have immediately jumped on top of this guy, but in the end, it was what was necessary to get an IV in place and get this patient the dextrose he needed. After he came around he could not stop apologizing, and felt terrrible, and I don't hold it against him. But I wonder just how much paperwork that officer had to do afterwards...
Serve On,
The Public "Servant"
Sunday, January 10, 2010
Wednesday, January 6, 2010
Sunday, January 3, 2010
What do you remember from your classes?
I know this kind of counters my last post, after my little rant, but I was thinking about something after my last call (an EMS for a fall victim, not unexpected when you've accumulated as much snow as has happened in the last few hours here) and I realized how each one of us seems to have a certain trait they come out of training with.
Mine is that regardless of the patient, or the complaint, legitimate or BS, need for an ambulance or not, that the one thing that I truly took to heart when I took my EMT class was that a good provider should be an advocate for your patient. I don't care if you have yelled at me, spit at me, swore you would kill me if the cop didn't have you restrained. I will still fight for you. I recently had a patient who did nothing but complain the entire trip to the hospital about how bumpy it was, how long it took, how hot it was, how uncomfortable she was. But when we got to the hospital and I had to wait 15 minutes for a room when there were only 3 beds occupied in the ER, I had quite the heated discussion with that shift's particular charge nurse. She had personally looked at me 3 times in that 15 minutes and never so much asked me what my patient was complaining of so she could decide if she was getting a bed or going to triage. I spoke my mind to her, and, unknown to me, her head of department overheard the discussion. This was not my intention, but I have never had to wait on this particular nurse since then.
So remember, you can call me whatever name you like. You can lie to me, threaten me, or ignore me, but I promise you if you are my patient, I WILL fight for you.
Serve on,
The Public "Servant"
Mine is that regardless of the patient, or the complaint, legitimate or BS, need for an ambulance or not, that the one thing that I truly took to heart when I took my EMT class was that a good provider should be an advocate for your patient. I don't care if you have yelled at me, spit at me, swore you would kill me if the cop didn't have you restrained. I will still fight for you. I recently had a patient who did nothing but complain the entire trip to the hospital about how bumpy it was, how long it took, how hot it was, how uncomfortable she was. But when we got to the hospital and I had to wait 15 minutes for a room when there were only 3 beds occupied in the ER, I had quite the heated discussion with that shift's particular charge nurse. She had personally looked at me 3 times in that 15 minutes and never so much asked me what my patient was complaining of so she could decide if she was getting a bed or going to triage. I spoke my mind to her, and, unknown to me, her head of department overheard the discussion. This was not my intention, but I have never had to wait on this particular nurse since then.
So remember, you can call me whatever name you like. You can lie to me, threaten me, or ignore me, but I promise you if you are my patient, I WILL fight for you.
Serve on,
The Public "Servant"
Random Thoughts for the Day
First off let me start by saying thank you to The Happy Medic for taking the time to give me a little bit of advice about this blogging thing, and even making it a point to comment on this "up and comers" little slice of heaven. If you haven't seen his site make it one of your goals of the day, http://www.happymedic.com.
With that little plug in for my new friend, I have come to realize that this blog is quickly becoming a form of therapy for me. While I love the jobs I do, let's face it, there's all the "BS" stuff we have to deal with too, and it's been hard for me to find a way to deal with that, until now. I hope that this will be a means to "vent" as well as educate.
The reason that I decided to call this blog The Public "Servant" is because sometimes that's how I truly feel the public views us. I enjoy helping people, and I genuinely cannot see myself in an other career area, but the public has been trained (wrongly, I feel sometimes) to call us for anything. Medical alarms, fires, MVA's. these are givens. But I'm sorry ma'am, I'm not a plumber. I can't fix your pipes, for free or for a fee. No sir, I don't no anything about why your "big block engine" won't turn over.
I can even overlook these aspects, but the one thing, above all else, that absolutely causes me to grit my teeth more than all the others, is when someone tells me "Your taking me to the hospital because you HAVE to." This is when I feel more like a slave than anything else. There is someone having a heart attack 4 streets over, but they are going to have to wait for a further ambulance because I HAVE to take you to the hospital when you won't even tell me why. As least give me a reason.
Like I said, I do love my job.
Serve On,
The Public "Servant"
UPDATE: The Public "Servant" is now on Twitter. Follow along @publicservantpa
With that little plug in for my new friend, I have come to realize that this blog is quickly becoming a form of therapy for me. While I love the jobs I do, let's face it, there's all the "BS" stuff we have to deal with too, and it's been hard for me to find a way to deal with that, until now. I hope that this will be a means to "vent" as well as educate.
The reason that I decided to call this blog The Public "Servant" is because sometimes that's how I truly feel the public views us. I enjoy helping people, and I genuinely cannot see myself in an other career area, but the public has been trained (wrongly, I feel sometimes) to call us for anything. Medical alarms, fires, MVA's. these are givens. But I'm sorry ma'am, I'm not a plumber. I can't fix your pipes, for free or for a fee. No sir, I don't no anything about why your "big block engine" won't turn over.
I can even overlook these aspects, but the one thing, above all else, that absolutely causes me to grit my teeth more than all the others, is when someone tells me "Your taking me to the hospital because you HAVE to." This is when I feel more like a slave than anything else. There is someone having a heart attack 4 streets over, but they are going to have to wait for a further ambulance because I HAVE to take you to the hospital when you won't even tell me why. As least give me a reason.
Like I said, I do love my job.
Serve On,
The Public "Servant"
UPDATE: The Public "Servant" is now on Twitter. Follow along @publicservantpa
Saturday, January 2, 2010
A real EMS job
Yes ma'am, I did drive past your house the first time because you have no numbers on your house or mailbox.
No ma'am, we did not come with lights and sirens on, even though your husband's chief complaint is nausea.
Yes ma'am, I was asleep when you called 9-1-1 because I thought it was OK to sleep at 3 o'clock in the morning.
No ma'am, I am not getting paid to be asleep, I am a volunteer. I was sleeping at the station so that we would have a good response time for your "emergency".
Yes ma'am, I am a trained professional. Volunteer does not mean stupid.
No ma'am, you cannot have your whole family ride in the ambulance with us. One rider only.
Yes ma'am, my partner has to take your husband's blood pressure, even though you made it quite clear that "That isn't what's wrong with him!"
No ma'am, we are not going to use the lights and sirens to go to the hospital that is only 10 minutes away. Your husband is stable and in good hands with my partner.
Yes ma'am, your insurance is going to get billed for this transport. We are not a free taxi.
No ma'am, I will not drive through red lights just because we're an ambulance and you think I should be allowed to.
Yes ma'am, your husband will have to sign that same piece of paper for my partner that he did the 5 other times we've taken him to the hospital. We need a new one each time.
No ma'am, I can't tell the nurse what she is going to do to make your husband feel better. Her level of training is higher than mine.
To the patient in the back: My partner said your were one of the nicest, easiest patients he's had. You were funny and apologetic about summoning us (although you shouldn't, that's why we're here). I wish I could have more patients like you. But next time, leave the wife at home.
Serve On,
The Public "Servant"
No ma'am, we did not come with lights and sirens on, even though your husband's chief complaint is nausea.
Yes ma'am, I was asleep when you called 9-1-1 because I thought it was OK to sleep at 3 o'clock in the morning.
No ma'am, I am not getting paid to be asleep, I am a volunteer. I was sleeping at the station so that we would have a good response time for your "emergency".
Yes ma'am, I am a trained professional. Volunteer does not mean stupid.
No ma'am, you cannot have your whole family ride in the ambulance with us. One rider only.
Yes ma'am, my partner has to take your husband's blood pressure, even though you made it quite clear that "That isn't what's wrong with him!"
No ma'am, we are not going to use the lights and sirens to go to the hospital that is only 10 minutes away. Your husband is stable and in good hands with my partner.
Yes ma'am, your insurance is going to get billed for this transport. We are not a free taxi.
No ma'am, I will not drive through red lights just because we're an ambulance and you think I should be allowed to.
Yes ma'am, your husband will have to sign that same piece of paper for my partner that he did the 5 other times we've taken him to the hospital. We need a new one each time.
No ma'am, I can't tell the nurse what she is going to do to make your husband feel better. Her level of training is higher than mine.
To the patient in the back: My partner said your were one of the nicest, easiest patients he's had. You were funny and apologetic about summoning us (although you shouldn't, that's why we're here). I wish I could have more patients like you. But next time, leave the wife at home.
Serve On,
The Public "Servant"
Things I learned in Firefighting essentials...
This was not what I was going to start this journey into BlogLand with, but following a conversation I had with some fellow firefighters, I decided it was as good of a place as any.
Consider this scenario:
You are dispatched to assist a neighboring department on a structure fire in the early hours of the morning. En route you hear reports from the dispatch center of a working fire in multiple structures. Your engine crew, which consists of 5 members (including the engineer), turns down the road on which the fire is located. You can see the tell-tale orange glow in the sky even though you are still about 3 minutes out. You call for your orders and are told to stage your engine in the lineup and send your crew to the command post for orders. You and your crew pack up, grab your tools, and head toward the incident commander. Once you are close enough to do your own personal size-up you find a two story residential structure fully involved, and the neighboring house has had its' siding melted off. The front portion of the house has already collapsed inward, and this is obviously a defensive fire. Nothing too special about it except "surround and drown".
It is then that you notice that there are 4 engines on scene, 3 tenders running shuttle operations for water supply, and only two 1 3/4 handlines deployed to fight this fire. You and your crew ask the IC for permission to advance a 2 1/2 inch line for a more direct attack, and are given the OK. You deploy the line and make a good hit on the fire from the front, despite the fact that whoever is supplying your hose is running at a higher pressure than needed, as your 4 person crew has great difficulty in controling the line. The fire has been knocked down considerably when the IC orders all hoselines shut down and every to the front of the building to "regroup" and change tactics. At this point your thinking "We have big fire. I have big water. This is working, why are we changing it?".
I don't need to continue. The fire was eventually put out, but it could have been accomplished much quicker. I'm not saying that nothing went right at this fire. No one got hurt and everyone went home. But there were some MAJOR issues at this fire. The most critical issue was that the person who was in command was seriously inexperienced. The commanding officer was a Lt. who was just elected and only has 3 years in the fire service. Officers are supposed to be able to handle situations as needed, but there were two of his chiefs also at this fire just standing around and watching. I'm not saying one of them needed to take command away from him, but someone definately should have been at his side as an "advisor". This incident took twice as long as it should have if the proper tactics had been employed. There was no need for the shutdown of hoselines, as if we had been given another 5-10 minutes we probably would have had the fire under control. There was no danger of collapse onto crews and no one was on the interior. During the 10 minutes that we were "regrouping" the fire had a chance to take a good foothold again.
The second issue was the use of improper handlines. The "home" department in whose district this particular fire was in does not carry any 2 1/2 hose on their engines. They only use 1 3/4 handlines. Had they had a chance at an interior attack this might have been OK, but this alarm wasn't even called in until the fire had self-vented through the roof, because the homeowners were away on vacation. Another problem was the establishment of a water supply. The IC asked for 5 departments to bring tankers for a shuttle, and they ran out of water twice before someone noticed that THEIR ENGINE WAS PARKED RIGHT NEXT TO A HYDRANT. This only demonstrated the importance of knowing your district.
I also mentioned we had an issue handling the 2 1/2 line because the pressure was too high. It was later discovered that this was because of an unqualified person operating the pump. The driver who was supposed to pump decided that he wanted to go play so he told a rookie, who just finished his basics and has no pump training at all, to "handle it". These kind of incidents are going to get someone hurt or killed. It didn't happen this time, but I think we were just lucky.
If I had pulled up to this scene I would have hit the hydrant with my pumper, have the next in engine lay in from the other end of the street from that hydrant, and only used my initial pre-plan companies without the need for extra aid. I would have set up a blitz gun on all four corners of the house and just puked on it. From the beginning all we were trying to do was save the 4 walls. The house was already a total loss with no hope of salvaging anything. There wasn't even a need for a truck for a master stream because there were too many power lines to allow the setup of an aerial device.
To sum up simply, when dealing with a significant incident, such as this fire, make sure that qualified people are utilizing the proper tactics. Had someone with more experience and knowledge been in command of this incident, utilizing proper hose streams supplied by qualified pump operators, this incident would have taken half the time that it did. Knowing your fire district is important too, because if they had, they would have known they had all the water they needed 5 feet away suppied by a 14" water main.
Serve on,
The Public "Servant"
Consider this scenario:
You are dispatched to assist a neighboring department on a structure fire in the early hours of the morning. En route you hear reports from the dispatch center of a working fire in multiple structures. Your engine crew, which consists of 5 members (including the engineer), turns down the road on which the fire is located. You can see the tell-tale orange glow in the sky even though you are still about 3 minutes out. You call for your orders and are told to stage your engine in the lineup and send your crew to the command post for orders. You and your crew pack up, grab your tools, and head toward the incident commander. Once you are close enough to do your own personal size-up you find a two story residential structure fully involved, and the neighboring house has had its' siding melted off. The front portion of the house has already collapsed inward, and this is obviously a defensive fire. Nothing too special about it except "surround and drown".
It is then that you notice that there are 4 engines on scene, 3 tenders running shuttle operations for water supply, and only two 1 3/4 handlines deployed to fight this fire. You and your crew ask the IC for permission to advance a 2 1/2 inch line for a more direct attack, and are given the OK. You deploy the line and make a good hit on the fire from the front, despite the fact that whoever is supplying your hose is running at a higher pressure than needed, as your 4 person crew has great difficulty in controling the line. The fire has been knocked down considerably when the IC orders all hoselines shut down and every to the front of the building to "regroup" and change tactics. At this point your thinking "We have big fire. I have big water. This is working, why are we changing it?".
I don't need to continue. The fire was eventually put out, but it could have been accomplished much quicker. I'm not saying that nothing went right at this fire. No one got hurt and everyone went home. But there were some MAJOR issues at this fire. The most critical issue was that the person who was in command was seriously inexperienced. The commanding officer was a Lt. who was just elected and only has 3 years in the fire service. Officers are supposed to be able to handle situations as needed, but there were two of his chiefs also at this fire just standing around and watching. I'm not saying one of them needed to take command away from him, but someone definately should have been at his side as an "advisor". This incident took twice as long as it should have if the proper tactics had been employed. There was no need for the shutdown of hoselines, as if we had been given another 5-10 minutes we probably would have had the fire under control. There was no danger of collapse onto crews and no one was on the interior. During the 10 minutes that we were "regrouping" the fire had a chance to take a good foothold again.
The second issue was the use of improper handlines. The "home" department in whose district this particular fire was in does not carry any 2 1/2 hose on their engines. They only use 1 3/4 handlines. Had they had a chance at an interior attack this might have been OK, but this alarm wasn't even called in until the fire had self-vented through the roof, because the homeowners were away on vacation. Another problem was the establishment of a water supply. The IC asked for 5 departments to bring tankers for a shuttle, and they ran out of water twice before someone noticed that THEIR ENGINE WAS PARKED RIGHT NEXT TO A HYDRANT. This only demonstrated the importance of knowing your district.
I also mentioned we had an issue handling the 2 1/2 line because the pressure was too high. It was later discovered that this was because of an unqualified person operating the pump. The driver who was supposed to pump decided that he wanted to go play so he told a rookie, who just finished his basics and has no pump training at all, to "handle it". These kind of incidents are going to get someone hurt or killed. It didn't happen this time, but I think we were just lucky.
If I had pulled up to this scene I would have hit the hydrant with my pumper, have the next in engine lay in from the other end of the street from that hydrant, and only used my initial pre-plan companies without the need for extra aid. I would have set up a blitz gun on all four corners of the house and just puked on it. From the beginning all we were trying to do was save the 4 walls. The house was already a total loss with no hope of salvaging anything. There wasn't even a need for a truck for a master stream because there were too many power lines to allow the setup of an aerial device.
To sum up simply, when dealing with a significant incident, such as this fire, make sure that qualified people are utilizing the proper tactics. Had someone with more experience and knowledge been in command of this incident, utilizing proper hose streams supplied by qualified pump operators, this incident would have taken half the time that it did. Knowing your fire district is important too, because if they had, they would have known they had all the water they needed 5 feet away suppied by a 14" water main.
Serve on,
The Public "Servant"
Friday, January 1, 2010
The beginning of something
Well this is it. After months of debating about whether I should, I have finally reached the decision that it is time to join this universe of bloggers. This is my New Year's resolution. Let me start by saying I'm not really sure what is going to become of this. The best I can say is that there will be good posts, bad posts, angry posts, happy posts, and who knows what else. Sometimes I may rant about something that is really bugging me, or I might just come across something I think is funny and decide to share it! I hope that those of you who read this enjoy whatever comes out of my mouth (or my fingers I suppose!) If I post anything that offends you or you find intriguing please share with me. I have no problem with constructive criticism, and there is always a benefit to an alternate perspective.
With all that being said, let me share a little about myself. I am a firefighter and an EMT-B in Western Pennsylvania. I am a volunteer firefighter for a 100% volunteer fire company that provides fire, rescue, and EMS service to an area that is a combination of rural, urban, and commercial development. I also am employed by a non-profit ambulance service. The reason I decided to call this blog The Public "Servant" is because of how I feel the public sometimes views us. I'll get into this more with my next post, which will be my first involving experiences that I have had. For now, I will spare you any more time listening to me. I hope you enjoy this blog as it develops.
Serve On
The Public "Servant"
With all that being said, let me share a little about myself. I am a firefighter and an EMT-B in Western Pennsylvania. I am a volunteer firefighter for a 100% volunteer fire company that provides fire, rescue, and EMS service to an area that is a combination of rural, urban, and commercial development. I also am employed by a non-profit ambulance service. The reason I decided to call this blog The Public "Servant" is because of how I feel the public sometimes views us. I'll get into this more with my next post, which will be my first involving experiences that I have had. For now, I will spare you any more time listening to me. I hope you enjoy this blog as it develops.
Serve On
The Public "Servant"
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