Sunday, December 27, 2009

Pre- Hospital Airways and Oxygen Made Simple

You know, the City has hired a lot of new and by new I mean NEW Paramedics recently, and I’ve been seeing some really glaring gaps in their knowledge base.

Used to be only a select few candidates made the cut. Now, if you have a paramedic patch and proof of City residency you are half way home. Put those folks out on an ALS ambulance with another inexperienced Medic and the crazy good times roll.

I don’t want to get into the Medic who desperately wanted to give his bradycardic inferior wall MI patient Atropine, the numerous knuckleheads who give walking/ talking dopers Narcan, the idiots who treat, then assess, or the crew that does absolutely nuttin’- except scream and hop- in order to expedite transport.

No- let’s back way up and talk about pre-hospital airways and oxygen administration.

Very simply folks- if there is a mechanical impediment to your patients respiratory function, throwing oxygen at the problem will not help.

So, that guy with the half pound of Christmas candy stuck in his trach- the non rebreather won’t help. Oh, I know he’s purple- everyone was hoping you’d maybe do something about that…and the lady who can’t (and proves it) breathe laying flat? Yeah, a cannula at 2 liters will not change things at all.

Nope. Fix the problem- this is EMT class stuff. We shouldn’t have to give this little lecture to Paramedics.

But we do. We do.

Sunday, December 13, 2009

Pedro- Where the Hell Have You Been?

... working, just workin'...

First, let me say- if I owe you a phone call, text message, Tweet or lunch- I'm sorry. Been working a goofy schedule- every time the schedule straightens itself out, someone else quits and the chaos begins again. Crazy.

Second, to my dear friends and family- thank you so much for helping with the dogs. But- who ever taught the "little" dog to poop in the front yard is in very serious trouble.

Third, I know you're just dying to know- where the hell was I last night? Working. Working out in the freezing rain.

Folks- if you look out and the streets all shiny and every conceivable surface is coated with a layer of ice- stay home. Just stay home.

Had the honor of transporting a nice elderly gentleman to the ER in the middle of the storm- Complaint? Runny nose- "it just keeps running..."

Then the crashes started and didn't stop- oh, thanks for the OT folks. Your driving prowess is paying off my house and keeping my garage filled with two wheeled toys...

My partner and I responded to a 12 car smash up- it looked like one of those made-for TV crashes. Cars everywhere, at all kinds of crazy angles. Just one injury though.
Could have used those chopper guys from NBC's Trauma- or Lassie. Could hardly walk on the street because of the ice.

The ride to the ER was crazy- five miles in one hour and ten minutes. The last half mile is a curvy up hill- we had to turn around at the bottom and go up in reverse. Could not go up "the right way".

There were at least two City ambulances involved in crashes. One occurred not far from the crash I worked- they sheared off a utility pole and dropped the wires on the top of the truck.
The other that I know of the Medics commandeered an SUV and transported their patient in it. Now that's Old Skool- or Old West...
All of our peeps are alright...

Around 0700 we ran out of trucks- too many calls and it was taking too long to respond- and Dispatch was holding the low priority calls.

Ever call your ambulance a "bus"? One of our ambulances in another district started picking up the E3 (low priority) calls by stopping at each location, putting the patient on the bench seat and driving to the next patient. They'd load four or five and head for the closest ER.

Finally Police, Fire, and EMS all stopped responding to calls that didn't involve an immediate life threat.

But it's good to know we were able to sneak the dude with the dribbly nose in under the weather.

Monday, November 23, 2009

You Might Be a System Abuser If...

... You may be suspected of NOT having the best of intentions if, say, you're involved in a minor fender bender at 1400ish, drive 20 minutes to your home, do some housework, have a snackie- and then, return to the scene at 1630 to call 911... because you have, yeah- neck pain.

Hey folks- I get paid either way. When the ambulance isn't there when you really need it- don't say I didn't warn you.

Monday, November 16, 2009

What Was That?

Could this be part of the reason no one yields right for your ambulance?

Flea market hauler- complete with decals- or outlines of decals, side and rear emergency lights, and the mount for the front light bar.

Thursday, November 5, 2009

Amazing Emergency Medical Break Through Revealed

Long time big city paramedic Pedro the Paramedic reveals an amazing break through in emergency medicine, that could save you time, money and anguish the next time you contemplate a visit to the emergency room.

Folks, I need you all to sit down. NOW! What I am about to reveal to you will change forever your view of medicine in the modern world.

Let's take a moment- there are still some stragglers who have yet to sit down...


Ok, I can't hold it in any longer. Ka- boom! You will be amazed, astonished, gob smacked to learn that not every medical problem needs to be addressed in the emergency room. More ka-booms! This is big, big medical news- but wait! It gets bigger, and better. Here 'tis- you can go to the ER on your own- yes, without the assistance of the 911 system! Ka-F******-Boom!

So what are we saying here? Well, that bruise on your thigh? The rash on your belly? The blister on your toe? None of that requires emergency medical treatment by anyone other than-hold on- YOU! Argghhh! Duck, KA-BOOM-MOTHERF*****!

But what if you just can't let go of your good friends in the local emergency room? Right- even though you are still enough of an asshole to jam up the ER with the sore elbow from last week, the back pain you've had "for a couple months", the "real big pimple" on your cheek- none, none of these minor events are medical emergencies. So don't call 911. You won't get seen faster- in fact us lazy City Medics will put your ass in a wheelchair and take you to the waiting room.Where you will wait with the girl who felt "a little shaky this morning" and the guy who won't bathe 'cause the water "feels kinda funny" on his skin.

I can feel an epiphany roll across the world wide web like a tsunami. Dare I say it? Yes- Ka- Boom!

To summarize- your minor aches and pains do not require emergency treatment and they sure as hell do not require an ambulance. Got it?

The post script- We had a cardiac arrest in my district that resulted in a save due to bystander CPR and the use of the businesses AED, again by a bystander. One of the Cities Chiefs First Responded and held down the fort while mutual aid came in from two towns south (eight minutes). None of the City ambulances came- we couldn't... want to guess why?

What? You can't guess because the knee you banged getting into your car yesterday really, really hurts and you need to call 911 to get to the emergency room...

Thursday, October 29, 2009

How 'bout This One Boys and Girls...

This story is true. I reluctantly changed the names to protect the knuckleheads involved.

One of the ambulances from my station was dispatched for an “unresponsive male, possible overdose. Police and family on scene.” The crew arrived and found a male in his 30s, obviously and irretrievably dead. The family members who had congregated were extremely upset and angry- presumably angry that their loved one had taken an overdose of heroin and angry that the crew would make no effort to revive him.

By all accounts it was a very ugly scene. Tragic certainly- but it soon would have been just another dead junkie call in a City filled with them except…

… Except for this especially creepy turn of events- Toni, one of the Medics on the call, lost a small purse on scene. The purse was one of those things that folds in the middle and has a pocket for change in the center. Almost looks like a super sized men’s wallet.

Toni’s purse contained her drivers’ license, bank and credit cards, about $100 in cash, several checks made out to her Avon business and a deposit slip. Now, this would have been a pain to lose anywhere, but especially so in a junkie’s house. A dead inner city junkie whose family hates you.

Now the story takes its creepy and horrible turn- Toni reports for duty the next day, finally realizes she has lost her purse and where she probably lost it.

I’m not sure what the proper course of action is in a situation like this. Really, I just don't know...

Toni picked up the phone and started calling the family members whose numbers she had collected the night before-

“Hi, sorry to bother you. This is Toni from City EMS, I need to ask you a very important question…”

Some amateur grief counseling followed and after 20 minutes and two more phone calls she located the purse (now holding $20 cash according to the young woman who had it)

Arrangements were made and the damn thing made its way back to the station.

First- I was there as the calls were made so I can testify this a true and accurate tale of Urban EMS Bloopers, Blunders and you know, whatever…

Second- it was a total idiot move. Learn a lesson from it and don’t be a dumbass.

Photo from Kekka

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Thursday, October 22, 2009

Pedro on System Abusers

The bottom line is- sometimes the EMS system abuser gets you, and sometimes, rarely- you get the system abuser.

Later in your EMS management course of study we will delve further into the world of the system abuser but for now let's just say this- EMS or 911 system abusers come in all shapes and sizes of motivations. Some need attention, some view EMS as part of a city wide rapid transit network, they're drug seekers, on and on and on...

Sometimes, the abusers come from inside the system. Hmmm...

So it's a busy Wednesday in the City, when you are dispatched via the County wide 911 emergency system:

"Medic XX go to St Xxxxxxxx Hospital, 6th floor nursing station for a possible non emergency transport, unknown problem."

Very odd, our 911 system is for emergencies- what the hell is going on? Quick check with the District Chief brings this directive, " Go up there and find out what's going on and then get back in service"

Well, we all know what's going on- the girls on the sixth floor got tired of waiting for a scheduled transport and called it in to 911. That's about to blow right the f*** up on them. Sorry ladies...

"Dispatch show us enroute. We're coming from a distance so start the St Xxxxxxxxx Response Truck up there... uh, until we know what's going on, start the police up there as well."

It took my partner and I a good 10 minutes to make our way through traffic and get up to the sixth floor, where we were greeted by an extremely pissed Hospital Response Medic and a bemused but irritated police officer...

... and an RN who held out a large brown envelope and said, "She's in 602, she's going to XXX Nursing Home"

"Well ma'am we've got a problem. You see, when you activated the 911 system you caused ME to be dispatched on a medical emergency... and I can only take an emergency patient to an Emergency Room. So, what emergency room is the emergency patient in 602 going to?"

"Guys, I'm sorry you had to come up here- but I just couldn't take a chance on some unknown problem what with us responding from cross town to the emergency these folks called in."

"Anyway ma'am, I really need to know right now what's going on and what emergency room we are going to. This is an emergency isn't it? I mean, if it's not-we're out of here and you can explain to the officer and your hospital Medic why they're here and, uh, you know, why we're all here."

Long story, short ending- we returned to service with no patient contact.

I can only assume there was no emergency.

Thursday, October 15, 2009

Pedro On Riding Ghetto Elevators

Ghetto elevators, I hate 'em. I'm talking about the one's with an inch of either green or dark blue paint on the doors, the one's that drop half a foot before they go up. Or when they stop. The one's that are too small for a stretcher even after you fold it like a Transformer.

Ghetto elevators also shudder when they move, have lights that flicker and the cars smell like piss, pot and burning machine oil.

Whenever possible I will take the stairs. I usually arrive on the floor long before the Ghetto elevator. Even when carrying the House bag, even when the landings are filled with Gangstas.

Here is a little known fact about elevators you might not be aware of. Not just Ghetto elevators, all elevators. Store this little factoid away in the back of your mind if you are afraid of elevators:

Once the door of the elevator closes there is less than five minutes of air inside the car. Five minutes. Less if it's crowded. Just five minutes of air.

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Tuesday, October 13, 2009

I Read the News Today...

I watched the TV news today- the top, breaking story was a 300 pound guy who got stuck in a window in the City and died. No doubt a tragedy.
We also learned a deer joined in a backyard football game, a grocery store is selling beer, God is good and does cool stuff with playgrounds, home repairs and birthday wishes, the pro football team has an injured player, the coach had his hair shoe- shined or something...

What's missing? Well, ten percent of the Country is out of work, the economy is in the the swirly end of the crapper-oh and in case you have forgotten- WE HAVE MEN AND WOMEN FIGHTING A WAR OUT THERE... somewhere, umm, not sure- it's never on the news...

Thursday, October 8, 2009

Seasonal Safety Tips

... from your very dear friends in EMS...

It's that time of year again when America needs its annual safety check-up. You know- that stuff the folks in the fire department go out and preach when they find themselves in between episodes of Charmed... (written with a smile)

That stuff is all important- change your smoke detector batteries, check your furnace, buy a pair of snowshoes- whatever...

But those things don't even begin to address how stupid the average person becomes when left on their own to work through even the simplest everyday problem.

So here is the Pedro the Paramedic Fall Safety Short List:
  • If you are going to warm up your car, don't forget to open the garage door- better yet, warm the thing up OUTSIDE.
  • you can't burn the BBQ grill inside- I know, I know- it saves gas and heats up the whole house
  • The ice isn't (or won't be) thick enough
  • Let a pro take down that tree that's growing up through the power lines. You, your pals, a rented chain saw and a case of Bud just don't have what it takes
  • Cinder blocks are not jack stands
  • Snow? Take the bus- 'cause no matter what you think, you're not a very good driver and you didn't crash because of those lazy bastards in Public Works
  • No matter how badly you want to get up on the roof to clean those gutters or put up Christmas lights- don't balance the bottom rung of your 20 footer on the peak of the garage roof to get that extra little boost
  • Sure you want clean stuff but mixing bleach and ammonia won't produce the super cleanser you think it will
  • When you get so drunk on Halloween that the police threaten to Taze you if you don't calm down- hmm, maybe listen this year
Now that is only the shortest of short lists, but, everything above has generated a 911 call that I've responded to- not all of the patients survived. Your list might be, in fact should be, much longer.

And of course no Safety Short List would be complete without an official disclaimer:

The above are presented for discussion purposes only-the author has no way of predicting how stupid you actually are or the extent you may endanger yourself or others because of your innate stupidity or genetic insufficiency. In other words- I am not responsible for you, you are. Good luck with that.

Finally if you get in a jam, it's Nine one one. It is not Nine Eleven. There is not an eleven on your phone- we both know that.

Oh, and if you are the first one this quarter to ask "What's the number for that 9-1-1?" I will punch you. I will.

Saturday, October 3, 2009

PALS Recert

... catchy title eh?

I'm doing my PALS recert tomorrow morning at my Command Hospital. Why? Well, 'cause I'm kinda cheap and it's free there...

I've posted this before- if you take any of the alphabet recerts at an EMS agency you are in and out of class in two hours- or less.

Take the same class in the hospital and it's an eight hour ordeal. I especially love the "practicals"- the looks some of the hospital staff give the intubation equipment is amazing.

That said- I love taking ACLS at the hospital- the boys and girls from the ICU's and CCU's are just dead serious and that is just the way it should be...

But, PALS- people either will not take it seriously or they try to turn the class into some kind of "My Bobby does this thing where..." Hey- some of have to go to work...

So, here is my proposed change to the PALS curriculum for my Command Hospital only- you make your own changes at your Hospital. Now, before you start the but, but, buts- MY Command Hospital has actually had staff meet us at the door and refused to accept critical pediatric patients (Right Vince?)

My new PALS class would go something like this:

"Hello and welcome. I hope you all enjoyed the free coffee. Ok, we all know we're not a pediatric facility, we won't willingly accept pediatric patients and none of you want to be here- so guys and girls... here's the book, here's your card and, uh- see you in two years. Have a nice day!

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Wednesday, September 30, 2009

When Life Imitates Art

No one I work with has mentioned the NBC show Trauma so I'm guessing it's pretty much a non-event. I had the mis-fortune of watching the show and, I know real life doesn't sell, but the show was goofy. Let me tell you right now- if Harold and Kumar had crashed a chopper into the side of a building around here, they ain't gettin' a new one any time soon. So from a consumer point of view, I thought Trauma was goofy, stereotypical, cliched, poorly executed, written and acted.

Again, I repeat my assertion that the ONLY way to save the show is to add Lassie to the cast. Please contact NBC and demand it.

To me the real danger of shows like Trauma, and I'm speaking from my EMS vantage point, is that there are knuckleheads out there that believe that stuff. People we work with or could, in the future, work with. People who identify with these fictional characters and try to incorporate that "stuff" into real life.

So, let me put a dime in the old anecdote jar and run this one past you:

I was working a 12 with Jim, who was both a new Medic and a new hire, and with Jen, who was precepting with me for Paramedic class. Jim and I had never partnered before but everybody said he was hyper and prone to "itchiness". Real Medics, real big city Medics if you will, don't appreciate either trait.

Our first call of the shift was to a nursing home for an "eighty-two year old female. Doctor is requesting transport because of abnormal labs". Ever get a call like that? Oh, I bet you have... usually they are the very definition of a routine EMS call, and I happen to think they are great for students because they can do all their fun Paramedic interventions without the pressure of a patient who is headed down the crapper at warp speed.

Of we go. Jim reaches over and flips on the lights. "Don't need 'em Jim, nice easy ride will do. We're just a few blocks away". Jims respirations went way up- especially at the red light we caught half way there.

Upstairs in the facility we found our patient in bed, alert and oriented, appearing to be in no real distress. Her two grown daughters were there with her.

I took a step back and let Jen take over, Jim was to be her partner and helper.

Jen was doing a pretty good job- she had instantly established a rapport with the patient and her family, and was collecting a detailed history. During the interview I overhead one daughter say " Moms English isn't always so good- we're from Lithuania"

Jim meantime was going nuts- things just weren't moving fast enough for him. Jen was sitting on the edge of the bed talking and I had taken a seat in an armchair in the corner. Things were getting done- but in a calm, relaxed way. And that apparently was not Jims style.

Jim grabbed our brand new Lifepak 12, held it up and yelled " Jen, fer Chrisakes! This is an emergency! Let's get moving dammit! Get her on the monitor STAT!!!"

To make a long story short- we got our patient to the hospital, gave the report and stepped outside to do a little post call review.

"Jen, you did a great job on this call. I know you didn't get a lot of help but you got everything done, you did it well and our scene time was under twenty minutes. Very cool Jenny-Jen"

... and then I turned my attention to Jim...

-speaking loudly-
"Jim, what the hell were you thinking back there? I can't believe what you just did to us. You're an insensitive asshole. Jim, did you know STAT is Lithuanian slang for Your Mothers a whore?.. and you yelled it at two Lithuanian women with a sick Mom. They're gonna write a letter because of you- make sure you write an incident report. Idiot!"

Back at the station Jim stomped inside the crew area and I could over hear bits and pieces of his conversation with the two other crews in the base- "Incident report...he said... I said... STAT... Lithuanian..." Suddenly, laughter- loud, out-of control-hey yer an idiot- laughter.

Jim ran out front, stood in front of me and screamed "You are a prick!"

He never said STAT again...

... but for the three and half years he was in our station, his nickname was, oh yeah baby- STAT.

Monday, September 28, 2009

Fun and Games in the Front Seat of the Ambulance

... this will seem pretty tame to some of you, but when I work with my favorite partner Amy it's a little game we play to pass the time:

"All Along The Watchtower- Hendrix or Dylan?"


"What? Jimi baby- three perfect solos. Three"

"Ok jerky boy. My Girl- Otis or the Temps?"

(Together) "Otis!!!"

"Um, alright there smart-ass... Panama Red- Rowan or the New Riders?"

"Oh man, no fair!"

See? It's fun as hell- and if you know enough music it can go on all day long. Yeah!

Sunday, September 27, 2009

Irony or Tragedy?

Could this just be one one life's little ironies? One of those quirky EMS shift enders?

You're throwing a gas mask back and forth like a football on Friday, flirting with the pretty newscasters, trying to convince your partner NOT to eat the chocolate covered bacon from the little candy shop down the block...

Saturday, before the suns even cracked the horizon, before the traffic, the kids, the dogs, the paperboy- before most people in town are starting real life you're working a traumatic arrest on a five year old who's been gunned down and isn't getting back up- no matter what you do...

Five years old, five years old...

Saturday, September 26, 2009

Real Ain't What It's Cracked Up To Be...

... for real. You know it's funny- we can turn a whole town upside down preparing to host that .05% that run things, but we can't do a thing to keep a little five year old from being shot in the chest and killed in a ghetto, gangland shooting.

Five years old- hell, some of you people might have kids that age sitting on your lap right now, or sleeping in the next room or walking home from school, playing in the yard, laughing, crying, just being alive...

Five years old...

Friday, September 25, 2009

Special Details Are Not All That Special...

... just ask my dogs- they haven't seen me for 48 hours and we have 24 to go. Thankfully my family is able to walk them and take care of the evening feeding- and I've been "sneaking home" mid day to let them out to run in the yard for a few.

That said- I can't really post anything much here- although most of what I know about the detail I'm assigned to is very common knowledge, I'm not willing to let something slip out that will get someone hurt- just for the sake of a good anecdote...

But I can tell you this real quick...

The crews on the street have an unspoken understanding with the local news media- they know we will let them get into a safe distance from fires, rescues and crashes to get their stories- in exchange, they wait for the fat guys in white shirts to show up to get quotes, official type interviews and blow-by-blow accounts of hillside rescues, extrication's, shootings, stabbings and other big and bad stuff. They also realize this is different- I can't let them inch in ANYWHERE.

So, we have a cordial relationship with most of the street level media- they know the deal, keep stuff off the record, ( though they will try to sneak that in the window or through the back door shot), relax- "Hey, how you guys doin? You workin' that game Sunday?" That kind of stuff...

This morning a two person crew was filming near our "corner". When they finished they walked over to say hello, and probably to fish for some little nugget. Let me just say that I am absolutely in love with the reporter from this particular TV station- let's call her Amanda. We said our hello's and then I asked if I could mark this special, historic occasion by making a statement on the record, live if possible...

Sadly, live was not an option, but the recorded "interview" went something like this:

"We are on **** Avenue with the City Medic crew working this area, I'm going to get these Paramedics views on being part of this historic day"

"Amanda, I would just like to say how proud I am to represent the City down here, and I also want to tell your viewers that you are, just, absolutely, incredibly beautiful in person. Just exquisite- ahh, would you like to go for a bike ride?"

We all forced a laugh and went our separate ways. I didn't make the news and I didn't get a date. Oh well...

Wednesday, September 16, 2009

Healthcare By The Pound, The Hiemlich and Just a Touch of Irony

I've mentioned here before the practice of funding medical procedures by having bake sales, pasta dinners and, as was the case recently, a pulled pork BBQ. Now, I was not present for the events that transpired at the BBQ- but I was indeed an eye and ear witness to the events days later at our station.

One of our medics- let's call him Big Tom- decided to have his evening meal at the charity BBQ. Big Tom and his partner parked in the rear of the church hall where the benefit was being held, got out and stood in line. There were several people in front of them and several more folks seated at tables eating. Among the diners was a local VIP we'll call Fat Joe, no- we'll call him Big Fat Joe. Joe was, as I've been told, absolutely jammin' the pulled pork in his mouth. He was tearing at the giant sandwich while grunting and shaking his head back and forth, side to side, when- Big Fat Joe got this crazy wild eyed look on his face, jumped up and, yes, grabbed his throat with both hands. That most classic of signs- Big Fat Joe was choking, not the coughing, gagging thing the public sometimes calls choking, but the occluded airway thing that is indeed choking.

But help is seconds away- the Citys tallest and overall largest Medic is right there, quickly determines that we've got ourselves a choking condition and applies the remedy- the Heimlich... the Heimlich as only a 6'6" 375 pound inner city Paramedic can deliver it.

Well folks, I'm told that Big Fat Joe spit out a blob of pork and goo about the size of a baseball- and he was overcome with a desire to "do something for you guys. Ya' know what? I'm going bring you boys lunch next week"

And so he did. Big Fat Joe and two helpers showed up the following Wednesday with pizzas and boxes of doughnuts. But Joe came on a day when Big Tom, who will eat anything, was off.

Big Fat Joe came on the day the "health food Nazis" were on duty- and none of us would eat the stuff despite Big Fat Joes assurance that "there's nothin' wrong with that stuff, it won't kill ya"

Fortunately, our DC walked in- ah, let's call him, oh I don't know, Big Dick. Big Dick is about my height- 5'10"ish- but out- weighs me by a good 200 pounds. Big Dick saw the boxes and his face just lit up. He grabbed piece after piece, jamming them into his mouth, grunting and shaking his head back and forth, side to side.

So that was just a touch of irony, a little dab- now if his eyes had bugged out and, had he grabbed his throat with both hands... now that would have been some crazy cool irony there my friends.

Tuesday, September 15, 2009

The EMS Legacy of the Dinosaur

The Dinosaurs have turned EMS from a system that served the community into a system that only serves itself- and the Dinosaur.
Don't let your babies grow up to be Dinosaurs.

Photo from: slworking on Flicker

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Monday, September 7, 2009

Our Labor Day Salute To EMS Chiefs

So, how many EMS chiefs does it take to screw up an EMS service? Yes, of course, just one! Now, enough of that- let's get right into the good stuff.

No matter what they're called in your locale- chief, manager, director, supervisor- you just have to wonder what the hell these men and women do all day.

Without further ado, let's explore the inner workings of EMS' big, gooey dysfunctional head... here is my salute to "my" guys". Make your own- it's fun.

The Chief- The very top guy. Has no real function other than to stand beside the Mayor at certain events and deliver sound bites to the media. His favorite sound bite seems to be "Uh, I was not aware of that"

The Assistant Chief- Seems to have a mix of operational and administrative responsibilities. Rumor has it he has worked his way into the 2003 pile of paperwork in his Inbox. Also said to have the power to become invisible- this would explain why none of us have seen him this year.

The Deputy Chiefs- One guy is in charge of trip sheets- not QA or QI- just making sure there is one report for each trip. He has boxes and boxes of paper reports in his office and in his car.

The other Deputies share the responsibilities of:
  • Sending Facebook lollipops
  • Accusing the field staff of misconduct ("We're sure going through a lot of light bulbs out there people")
  • Making sure our gear and training are never appropriate for our mission
  • Playing jumble with the schedule ( Interestingly- the schedule used to make itself- you rotated through the three shifts at your station. Or made switches. After everyone starting quitting, or kept quitting without being replaced, the schedule got really, really complex)
  • Misplacing paperwork of all types- your schedule request, incident reports, whatever.
These guys are also believed to have a limited ability to become invisible.

The District Chiefs- Each has a district they oversee. They are assigned a City EMS SUV and spend their days cruising around with that vacant look one gets when they have nothing to do and eight hours to do it in.
They are also in charge of assigning asshole status to the field staff- for instance: "That Pedro, he's an asshole" "Who's that girl he works with all the time?" "Amy?" "Yeah, Amy- she's an asshole too" "Yeah"

All the the chiefs jointly share the duty of blaming the field staff when things go wrong and grabbing the credit when they go right.

With all that responsibility on the table you would have to believe there would be some pretty stiff qualifications to get a job like that. Nope- just your EMT-P patch and your proof of City residency.

Have a nice day- and put yourself down for two more credits towards your EMS Management Degree.

Wednesday, September 2, 2009

That Swine Flu Thing Isn't So Bad After All...

Just got an official e-mail update concerning the Swine Flu "outbreak":

As a reminder and in preparation of the upcoming flu season, The Bureau of Emergency Medical Services has posted the Statewide BLS Protocol SUSPECTED H1N1 INFLUENZA A # 931 on our website at www.************.us/ems under the PROTOCOL section.

Please follow proper PPE precautions and follow good handwashing techniques.

First- just let me say how relieved I am to learn the H1N1 is now officially a BLS epidemic... and second, after 12 months of build up it's time to either flu up or shut up and move on to another crisis.

Sunday, August 23, 2009

God Works in Mysterious Ways- When He Works...

... which does not seem to be all that often...

Now- the official Pedro disclaimer- I know, from my time on the streets that many of you are VERY sensitive and easily offended. Well, sorry- I really think these two tales will fair better if they reach the world uncensored by one such as me.

Dispatched with the police for multiple patients following a domestic. Walked through the front door and found a two year old female running around yelling "Goddamn bitch, Goddamn bitch, Goddamn bitch!". Her four year old brother hollered " Mom, she's swearing again!". We could see Mom back in the kitchen talking to the police officers. She pulled her cigarette out of her mouth and screamed back into the living room at the four year old- "Well, tell her to shut the fuck up asshole"

Dispatched on a busy Sunday morning to a church for an elderly female who had passed out. We made our way through the ongoing service and found our patient sitting in a pew. My partner asked a few brief questions- our plan was to find out what was going on and move to the truck- when we were interrupted by the amplified voice of the preacher. Screaming at us from the pulpit " Quiet! I'm tryin' to preach up here!". My partner shot me a look that I knew at once meant trouble. He stood straight up, pointed at the preacher and yelled at the top of his voice- "What? Is that what your Jesus would do? Bullshit! Jesus would have his ass down here helping us. If you're not helping then shut the hell up so we can hear what this poor old woman is trying to say. " Noboby said nuttin'... never heard any more about it... til now...

Ok, that's it. Sorry I haven't had a lot of time to spend with you kids but I've got a City to save- one knucklehead at a time...

Friday, August 14, 2009

Stay Back 500 Feet

This video's been around for a while, but watch it and then...

... remind yourself not to ever get that close to some one who is so obviously out of control. Let the cops handle that stuff.

Oh, did you notice the police officer had contact with the guy, backed off and then re-acted- keep that in mind too. Reaction is a great thing- unless it comes after the bad guys reaction of popping you in the head. Don't be afraid to ask to have someone cuffed.

Enough, stay safe and keep fillin' those holes in the schedule.

Thursday, August 13, 2009

Being There

People make mistakes. Wow, that was earth shaking. But people, even extraordinarily skilled and careful people, make mistakes. Bob the Builder cuts one a little short, Pavarotti goes a little flat- happens, it's all part of being human.
When you consistently over time become less and less competent at your job, you're no longer suffering from simple human-itis... Nope, you've crossed over. You are a f*** up.

There is a Creative Commons license attached to this image. Attribution-

Tuesday, August 11, 2009

Teaching Paramedics to Fish...

... or something, anything...

My pal Hank is an EMT instructor who would like to change the world of EMS- shake it loose from the teeth of the Dinosaurs. Today he called to tell me he had signed up for Paramedic class- he doesn't necessarily want to run on the trucks, he wants to educate a new generation of Medics who will go forth and forever change EMS.

Ok Hank. You asked what I thought, so here goes:
  • You don't want to run calls, but you want to change EMS? Hank, that right there is Dinosaur talk
  • I hate to be the voice of negativity but- buddy, you and a 1000 of your Medic converts will not be able to steal EMS away from the Dinosaurs. You can not undo what they have done. You will not gain control of their fiefdoms
  • You need to re-focus your efforts...
Why don't you go to school to be a woodworking instructor? At least then you could teach people a skill they could use to make a living.

Sunday, August 9, 2009

Say It Ain't So Billy Mays...

... say it ain't so...

Did cocaine kill Billy Mays? The autopsy says it did, but...

Saturday, August 8, 2009

Stupid Is As Stupid Does...

...or- There's a little bit of dumb behind every trauma...

Here's a couple recent calls that came with a twist or two-

Dispatched for a MVC, car on its roof in a busy underpass. On scene we found a Pontiac Bonneville with dealer plates, on its roof as advertised. There were marks on the wall near the entrance to the underpass and about 100 feet of Bonneville roof size skid marks running down the roadway. The driver was out of the car yelling into his cell phone.
Turns out the driver was a used car salesman delivering the Bonny to another car dealer. Just prior to the trip the vehicle had been thoroughly detailed- can you see where this is going? The detail guy had applied a nice shiny coating of Armor-All to, among other things, the leather seats, the steering wheel and the brake and accelerator pedals.
The salesman said all was well, except for a little slippy-slide on the seat, until he was cut off entering the underpass. When he went to maneuver all hell broke loose- his hands slipped on the wheel, his ass slipped on the seat and his foot slid off the brake pedal. He hit the wall, which has a slight bank to it, and rolled.

Dispatched, mutual aid with another towns VFD for a "structural collapse" with entrapment. Enoute we could hear lots of excited screaming from the responding firefighters as well as the small towns EMS supervisor. We were almost convinced something big was going on- and as we pulled up we saw rescuers of all unlikely shapes and sizes running, pretty much in circles, around a nice little brick ranch.
My partner and I grabbed the esesntials- First In Bag and Immobilization gear- all the while being urgently, very,very urgently urged to "Hurry up!" by their EMS guy.
When we walked around the corner of the house we saw that a small four foot square wooden deck had broken partially away where it attached to the home. The side closest to the house fell about three feet to the ground, the other end supported by a pair of 4 by 4's. Down in the low end, healthy but extremely unhappy, was a heavy set female maybe 65 or so and a fat little dog.
They were entrapped I guess- but only because neither was able to pull themselves up into the waist high doorway or kick through the railing and escape.
We let the fire department handle the rescue, called it a "no patient" and went back to the Big City.
An interesting side note- we were called in because this town no longer has any Paramedics. Couple months back all the full time Medics walked into the station, dropped off their equipment and left. The towns been depending on mutual aid ever since. Our crews refuse to even go into the station there because of the hostile attitude of the Supervisor and Director. They both happen to be certified as Paramedics but won't run on the street, preferring to stay at the station and send lollipops on FaceBook. Hey- they're hiring.

Ok, that's it- the sun's coming up and I am going to get my day started...

Tuesday, August 4, 2009

I Would Like to Know Why...

... no one will pull over when you're running lights and sirens, but they'll dive right off the road when you come up behind on a Sunday morning breakfast run?

... you get a head wind on both the in and out bound legs of a bike ride?

... the Paramedic patch has become more important than the Paramedic?

... some people become less competent the longer they do something?

... folks out there can't be still, for a moment, just to think- even though their movements are without purpose?

... why some healthcare providers believe the EMS crews time has no value? Perhaps they learn that from our EMS managers.

... why the drug seekers keep getting their fixes in the ER's?

... the good Medics leave and the bad Medics stay?

... EMS providers everywhere, at all levels, allow themselves to be so obviously and blatantly exploited?

... equipment only malfunctions when you really, really need it not to?

... you end up with the worst partners on the worst calls?

... and why does that fat guy in the third floor walk up decide to call 911 for the knee that's been sore the past month right before shift change? How does he know when we change shifts?

... other Medics calls seem more exciting than your own?

... EMS management plays a real life, perverse form of Trivial Pursuit? Oh, I realize it's all in the details- but the important details, not the trivial, not the trivial...

... our really sick patients are understanding and apologetic (some), while the system abusers are rude and demanding?

... junkies think we really believe their stories? ("Sir, I'm telling the truth sir. Really, my grandmother gave me that pill bottle when I lost mine sir. She must have left some of her Oxycontin in there sir when she lent me that pill bottle sir.")

... I'd really like to know why some EMSers go 100 mph to a call, and then stand around with their thumb up their ass on scene. Tell me, why?

... I read a post on an EMS forum a while back written by an EMS manager whose service regularly advertises for Medics in JEMS. He noted his agency has great wages, benefits and working conditions and stated that he was unable to hire or keep Paramedics- well, why? Why?

... and at the heart of the above issue- why doesn't this guy know why? All in the details perhaps...

Stay safe, don't take crazy chances- after all you're just a patch, plugged into a spot on a schedule.
Pedro loves you anyway...

Thursday, July 30, 2009

My EMS Shift Report For Today

Hey- here's a little glimpse into what a real life EMS shift is like. This is my true to life account of today's shift, which frankly was not among my faves.

0640- I'm running late- I like to get in early but ain't happening today. Turn on radio and monitor.
0700- right on time, through the door. Hey, my ex is on shift with us today. She never works out of this station. She see's me, shoots a dirty look and turns away. I walk past without saying hello- which causes... uhh, she mutters "This is bullshit" and runs outside crying. Wha?
0701- Wheee- off to a great start.
0702- The Mumbler's on duty as well- he's not talking either. I wrote him up yesterday for ducking calls and leaving us stuck for an hour and a half.
0705- Coffee, truck check, harass partner
0732- The calls start coming in- thank God!
1010- Deputy Chief Tubby McButterpants is in an EMS management pre-meltdown crisis. He needs a trip sheet I wrote on July 24th. Why? Well I also laid some paper on the Dispatch Center of one of the local ER's for failing to acknowledge our calls to them. DC McButterpants is an old school style EMS manager- he firmly believes if you ignore an EMS problem long enough it will go away. Hmmm- not this one Butterfat- he's been called in to review the tape in order to head off my formal complaint to the Department of Health.

The rest of the day brings more calls- most quite frankly BS- like the young woman who called 911 because the weed she smoked made her "think funny". No shit- that's why people smoke it.

1900- called to the local BK for a woman down. When we pulled up we saw a female, maybe 45 or 50, painted-on tan, dressed semi-nice, kinda stylish sitting on the sidewalk. We walked up and asked that ol' standard "Hey, what's going on today?" She pulled off her shoe and her sock and revealed...right there, on the big toe of her right foot- a bright red, brand new BLISTER... and I freaked out. I'm not usually the one who goes off, but today I just couldn't help it. " You called 911 for an ambulance because you have a blister on your toe? Are you serious?"
2000- Back at the station, going off duty- really wondering why I keep doing this...

Wednesday, July 29, 2009

Palins ALOC Clinical Demonstration

Sorry- my freaky work sked has kept me from my duties here. Equally freaky was the Sarah Palin resignation speech. Paramedic students, nursing students- hell anyone interested in seeing just what qualifies as altered level- watch and learn.
I guess Sarahs portion of this vid is more palpable if you're burnin' one... which I'm not, 'cause I don't- but you could...

Tuesday, July 14, 2009

EMS Management- Yet Another Lesson

We've spent the past couple weeks being bombarded with e-mails and phone calls from our EMS managers about some pretty trivial things- while the really important stuff is left un-attended to, or more typically for the EMS management/ Dinosaur contingent, left half done and forgotten...

Your EMS Management lesson for the day is fairly easy. I'd like for you to get a sense of the frustration level of the average EMS field provider- those nice Paramedics and EMT's you've come to count on day in, day out.

So here goes- and this is for 3 credits toward your EMS Management Degree-

...Image you are on a sinking ship at sea... and the Captain asks you to mop the decks with the water that is rushing through a gaping hole in the hull...

Yep, that's how it feels, that is just how it feels...

Thursday, July 9, 2009

United Airlines Breaks Guitars

This is the kind of cyber-consumerism that companies have been warned about and yet ignore- at their peril... this video has already hit the national news, and been viewed non stop on You Tube- I won't fly United Airlines anymore. They should have just given the guy a new guitar- or, or hey- taken care of the one he entrusted them with...
Heads up- United Airlines Breaks Guitars...

Saturday, June 13, 2009

You're an EMT What?

But first- The Pedro "I wouldn't want to hurt anyone's feelings" Disclaimer

I like and respect EMS providers of all levels- I started my career as an EMT-B, worked my way through Medic class and now work as an EMT- P. I like it, I like you... ok?

There's been alot of talk around the ol' neighborhood about fixing the Paramedic shortage by training EMT-Basics (B) to the EMT- Intermediate (I) level. I believe that there has already been one state that promoted all of their EMT-I's to Paramedic- because that was the only way they could get any Medics on the trucks. Well there's a flaw in that approach- I'll get to it, but first...

My partner and I walked into the EMS room of a major inner city hospital following a call. The ER was busy and the ambulance bay had been filled- as was the EMS room. The conversation seemed to be revolving around, what else, the EMT- B scope of practice.

One EMT-B, who was apparently from out of state, said "Back home I can start IVs", another EMT answered that "Back home I can intubate, well, Combi-tube anyways"

My partner that day was a hard core, long term city medic. He's also a really big guy with a pretty low tolerence for BS. He took a slow look around the room and then said " You idiots are all sittin' around here braggin' about monkey skills. Can any of you jackasses do a f****** Paramedic, ALS patient assessment?"

Ah- and there is the problem. You can teach a monkey to do an IV or to intubate- they could probably do it while riding in circles on a little bicycle. But you can't teach a monkey how to do a patient assessment- and it's the assessment that saves lives. It's the assessment.

So, here we are. On one hand we have a dwindling number of experienced Paramedics, who have done the training, the clinical time, the days and nights on the trucks to learn the ART of pre-hospital Advanced Life Support. And on the other hand we have the Dinosaurs who run EMS- the same folks who have made the field inhospitable enough to cause our current shortage.

The answer? Hell I don't know, but if you want a circus send in the monkeys- we've already got the clowns.

Monday, June 8, 2009

EMS Resource Allocation...

... or how to get the right stuff to the right people right away...

A recent post on The Happy Medics Blog got me thinking about how we do things here in EMS world. Please take a moment to follow the link and read Happy Medics well written, thoughtful post- no sense in me re-hashing it.

We all know that EMS calls run the gamut from "You didn't really call 911 for this" to "Wow, you're really sick dude!" with most in the former category.

So here is how we USED to handle 911 calls around here:

  • The Paramedics could of course, treat and transport the patient irregardless of their complaint. No jokes please about how many Medics does it take to transport a sore thumb- around here the answer is two...
  • The Medics could call for a BLS Ambulance- so the sore thumbs and other appendages still found their way to the ER but the City got to keep its ALS crew in service. Sounds good- except our BLS crews were all let go for budgetary reasons... so scratch this option
  • We could call for "alternative transport"- the Wheel Chair Van. This was great for folks going to clinics or doctors appointments who had somehow been misdirected to 911. But again, the ol' WCV was a victim of the mighty cost cutting sword- gone...
So what to do with all these "patients" with bumps, bruises and other minor complaints and chronic non acute illnesses? Of course- after an assessment, they climb in the back of a full ALS crewed ambulance for a cab ride to the ER.

Anyone who has been in the EMS field for very long knows the frustration that comes from hearing potential life threatening calls being dispatched while transporting Grandpa with a tender nut. Remember how you felt the first time you sliced and diced rush hour traffic to get cross town to that CHF patient- when the ambulance in her distrct was transporting a kid with "itchy legs"? Oh yeah- you remember...

Will things ever change? Sure, but probably not for the better. Because EMS is, without a doubt, the fish that stinks from the head.

Thursday, May 7, 2009

Conversation With an Athletic Trainer

I work as a Paramedic in a major metropolitan area- for some Medics one of the perks of the job are the overtime details at professional sports contests. Baseball season is here and with football fast approaching we had our annual meeting with the local pro football team trainer- afterward his assistant had this brief exchange with me:

I don't know what the big deal is- I can do all the same stuff you Paramedics do.

Huh- can you intubate?

Well, no I... I can't...

Give intravenous drugs like Amiodorone, Verapamil, Atropine, Morphine, Fentanyl- can you even give Benadryl?

No, I-I-I...

Can you interpret a cardiac rhythm? How about a 12 lead EKG?

We ahh, we never ahh...

How about CPAP, pulse oximetry, capnography- you ever do any of that stuff?

No, no I mean ahh...

So pretty much the only thing you can do that I do is hand out band-aides right? You look like you're really good at handing out band-aides.

Yeah, whatever man, I just thought we ahhh....

Look- you can't do anything a Paramedic does. So next time just keep your mouth shut.

Life in the big city folks.

Monday, May 4, 2009

Why the Big Three Aren't Selling Cars...

... or- how I tried to buy a 2009 American truck and failed...

Ok- I read the papers, I know the Big Three Car makers are in trouble. Being a conscientious American I thought I would help out by purchasing an "American" truck this time around.
I started my search on-line- it is after all the 21st Century. So, right off the bat I eliminated all Chrysler products- they make junk and I don't buy junk, GM- just didn't have what I wanted... so I settled on a Ford F-150 pick-up. I already knew how I wanted it so I clicked the box on Fords web site to get an "Online Quote"- that was my first mistake.
Why? Well, Ford doesn't give online quotes- nope- that's just a thinly veiled scam to collect your contact information.
I'll save us all some time here- I soon received about 15 e-mails from my local Ford dealer. The General Manager wrote, the Sales Manager wrote, a Salesman wrote... but no one sent an online quote.
Then the phone calls started- again, the General Manager, the Sales Manager, a Salesman and finally the Sales Manager again. Come on down so we can give you a quote they said...
Ahh, I've checked the inventory you've posted on YOUR web site- I'd like my quote on #123456 please...
I told them that one (or more) of us has mis-understood what an on-line quote is... it's, it's ONLINE right?
Now I'm pissed, but I went anyway. I met with Chuck at the Ford dealer.

Let me show you some trucks! Chuck was all happy and ready to go!
I know what I want Chuck- how much for this one?
Well, what are you trading in?
I'm not.
What...ahh, well, how much did you want your payment to be?
One dollar.
You must be putting down one hell of a down payment.
Nope, not puttin' anything down- how much for that truck- the one right there, 10 feet from us.
Well it's $*** per month.
What's the total Chuck?
Ahh, well, umm...

Hey- you get the idea- round and round we danced till I grew weary of the game and left... and went straight down to the Toyata dealer and bought a brandy- new Toyota Tundra.

Saturday, May 2, 2009

EMS Swine Flu Guidelines

... just on the off chance anyone would be interested- below are the EMS Swine Flu guidelines sent to us by our EMS administrators- yours are probably similar. There's no mention of resource allocation or other "tactical" considerations. But- they did give us the standard; gown, mask, gloves, stay six feet away and wash your hands... I think we all know, some of these are impractical for EMS and, most will be absolutely ineffective in the face of a wide spread outbreak.
Yea, we all know that.
So please- Do not panic- there's no need to... but again, a little pre-planning would go a long way.

The memo:

In response to confirmed cases of swine influenza in Mexico, California, Ohio, New York and Texas, all personnel should be aware when responding to calls for patients experiencing flu-like symptoms including fever, cough, sore throat, body aches, headaches, chills and fatigue. Swine flu is a respiratory infection caused by Type-A influenza viruses that regularly does not normally infect humans. At this point we do not know how easily this particular strain can be passed from humans or the severity of the illness. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions. Every ambulance should be equipped with additional supplies to enhance your protection while treating patients with cough and sneeze symptoms.

The City of __________ EMS Medical Director and EMS Admin are releasing the following recommendations with respect to the potential Swine influenza outbreak. This aggressive approach will help us limit the spread of influenza to pre-hospital care providers, our families, and our patients.

The Swine flu - just like the seasonal flu - is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Some people are at high risk for serious flu complications, such as elderly, young children, pregnant woman, and people with chronic health conditions.

Influenza transmission occurs by large respiratory droplets that are expelled from the respiratory tract during coughing or sneezing. The patient compartment of ambulance should be considered an area at risk for transmission when transporting a suspected influenza patient.

To keep you and your family healthy during this period, please follow theses guidelines when responding to patients with potential flu like symptoms. For our purposes, symptoms of the flu will include a cough and fever but also may include any of the following sore throat, body aches, headaches, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.


Ø To reduce the spread of respiratory droplets patient's with flu like symptoms that are not in respiratory distress should be asked to wear a surgical mask (this is not an N95 mask). Patients with respiratory distress should be placed on oxygen via a non re-breather mask.

Ø Personnel should enhance the patient interview to include specific inquiry as to recent travel, with an emphasis on Mexico, or contact with someone who has recently traveled to Mexico. Additionally, personnel should also establish if a relationship exists with anyone who has been at or in contact with a known high risk location. This information shall be passed on to the receiving hospital.
Offer tissue and advise patient on cough etiquette.


Ø To reduce exposure during treatment and transport EMS crews are suggested to wear appropriate BSI.

Ø Maintain an initial three (3) to six (6) foot standoff distance from the patient as possible with one Paramedic conducting the assessment when possible.

Ø Gloves must be worn for all patient contact.

Ø While interacting with the patient, crew members should wear an N-95 mask.

Ø Wear a gown if soiling of clothing is likely from secretions

Ø Use of eye protection when working within 3 feet of patient recommended

Ø Cough-generating procedures should be avoided inside the ambulance (e.g., nebulizer treatments). Contact command if these procedures are medically necessary.

Ø Prior to arrival at the hospital, notify the receiving hospital that you are transporting a possible influenza patient.

Ø Wash or decontaminate your hands frequently, avoid cross contaminating surfaces or equipment.

Ø Avoid eating, drinking, application of cosmetics, and handling of contact lenses in the patient compartment area.


Ø Patient-care compartments (including stretchers, railings, etc.,) should be cleaned using an EPA-registered hospital disinfectant.

Ø EMS crews should wash their hands as often as possible before patient contact, after patient contact and before returning in service from the Emergency Department

Monday, April 27, 2009

Tracking the Swine Flu...

In the "just in case department"- EMS providers should be keeping an eye on the spread of the "Mexican Swine Flu"

Below are a couple of links to help you track the spread of the swine flu...

Sunday, April 26, 2009

Re- Runs

I've been off for a few and not too terribly motivated, I saw this elsewhere and thought- yes of course; a few lines from the movie “Return of the Living Dead”:

Paramedic #1 : You have no pulse, your blood pressure’s zero-over-zero, you have no pupillary response, no reflexes and your temperature is 70 degrees.
Freddy : Well, what does that mean?
Paramedic #1 : Well, it’s a puzzle because, technically, you’re not alive. Except you’re conscious, so we don’t know what it means.
Freddy : Are you saying we’re dead?
Paramedic #2 : Well, let’s not jump to conclusions.
Freddy : Are you saying we’re dead?
Paramedic #2 : No conclusions.
Paramedic #1 : Obviously I didn’t mean you were really dead. Dead people don’t move around and talk.

Photo from: Felix42

Creative Commons

Saturday, April 25, 2009

Is There a Pandemic In Your EMS Future?

There is a unique and deadly flu virus loose in Mexico- it's also been linked to eight cases in California and Texas. has an article posted- in it scientists are noted as saying the virus has mutated in ways that have not been seen before- and that my friends is one of the first ingredients needed for a pandemic.
EMS folks should keep an eye on this one- for a little background here's a link with info about the pandemic of 1918-

Friday, April 17, 2009

Your EMS Schedule

EMS schedules- Here's hoping yours is a good one that supports a healthy, sustainable lifestyle. Mine, mine sucks. One of my Twitter pals asked about my EMS shift scheduling- I missed the "Tweet" and didn't answer, but I' ll give it a go now...

Basically, 'round here we work 8, 12 or 16 hour shifts- there is no rhyme or reason to this and on occasion you will find yourself working long runs of 12 on, 12 off or, worse 16 on, 8 off. I have worked as many as 18 straight days, taken a day off and gone back for 10 or 12 more days. Ouchie.

Sometimes through bad scheduling, "buddy" switches, poor planning or whatever, you will work a 24 hour shift or even 48 hours- this is officially frowned upon but permitted. We are that short handed- it's only temporary they tell us...

Quite often I will reach a point where I am so fatigued I will refuse to drive the ambulance- so, I can hear you asking- "Pedro, if you are too tired to drive safely, is it safe for you to be in the back with a patient?" The answer is of course- No it's not safe OR fair to the patient...

Photo license Creative Commons
Photo by Ben Dodson

Friday, April 10, 2009

Pedro's Law of EMS Karma

... it's really quite simple- in fact, you don't even have to be in EMS to utilize it.

... Balance off yer f*** ups by doing something absolutely amazing- and you will be free- and UNTOUCHABLE!

Wednesday, April 8, 2009

The Pedro Report...

... considering an exciting career in EMS? Maybe you just want to know what goes on in another part of the world... well, here 'tis- The Pedro Report...
  • We have a number of Medic students in precepting- they all want blood and guts and hate the routine stuff. The amazing thing is that out of 20 or so students, only three are considering a career in EMS after class. The rest are just filling a spot in their resume...
  • Blood and guts? Sure, we've got you covered- lots of shootings, we are in that "you shoot one of mine, I'll shoot one of yours" cycle. Oh, and of course the pissed off drunks and cheated lovers keep right on blasting away.
  • It's memo season- the management must have read an article or been caught napping by some one on council... today I was required to read, sign and return a memo. The subject? A reminder to read all our memo's.
  • Two new Medics started at our station last week- fresh out of school and our departmental training. Neither one has ever been out on his own- so of course they were assigned to the same truck
  • With two new Paramedics on staff it was only natural that someone would quit. Management thinks it's about money- it's not, it's all about ones tolerance to B.S.
  • Our "mutual aid buddies" two towns over finally had to send their manager and supervisor out on a call- their volunteers ran a call also- it was a DOA that resulted in all the volunteers requesting a stress debriefing- and presumably swearing off EMS forever (and ever)
  • My partner and I were physically attacked by a patients husband who became irate at "all the goddamn questions. Just take her and let the hospital do the questions..." He picked a bad day to grab a paramedic- we had PD on scene and the officer was in no mood to play. Mommy to the ER, Daddy to lock-up. Oh well...
  • Don't forget to make a donation to the families of the Police Officers murdered in the recent incidents around the U.S.

Thursday, April 2, 2009

The End of ER

... let us take a break from real life for...

The last night of the television show ER- 15 years of dinner theater actors yelling mindless prattle ends at last.
I've got the shovel- would one of you nice folks kindly kick the bloated, rotted corpse into the hole so we can cover it up... thanks.

Sunday, March 29, 2009

Pedro, The President and the Special Olympics

... Let me just say- I make a living speaking extemporaneously- it's hard, but hey- don't be a stupid ass... 

I'm here today as a health care provider with a Downs Syndrome Child in our extended family- I love him just like... well, just like a kid who grew up to be the President of the United States...

If Barack Obama wants to make light of his shortcomings, perhaps he could compare himself to his predecessor... 

... and I suspect our Special Olympians would do a bit better in all things if the quality of health care was a little better here in the USA 

... and as always- I'm sorry to jump into the discussion late- but, have you folks looked at my schedule lately?

Friday, March 27, 2009

Don't Worry Baby

Hey, this video has it all- cool music, a lefty Tele and- is that a Danelectro Hildago's playin' man? Damn right it is...
Don't worry baby...

Wednesday, March 25, 2009

Dealing With Stress in EMS

... the super short course...
I've been working with a medic student lately- she does ok, but doesn't have a lot of EMS experience- so there are questions...
One question that came up had to do with EMS on-the-job stress- most folks assume that medics get stressed over broken, bloody, diseased bodies or some other horrible event out in the field. The truth is the single most stressful part of my day is dealing with the toxic, poisoned work environment that our management has created- yup- I am saying flat out it is way more stressful to be in the station than out on an EMS call.
So what is a paramedic to do? Well, some of my colleagues have chosen to get out- not a bad course of action I guess.
Me, right now I love my job- I'm really quite good at it- but I'm not going to let it kill me.
So here's my advice on how to cope:
  • Don't get involved in the petty stuff- it never ends and the little stuff is the big stuff to management because they don't know any better
  • Leave home at home and work at work
  • Exercise
  • SLEEP!- set time aside to sleep. I'm starting a 16 on 8 off cycle- when it's done I'm going to sleep- do not wake me up
  • Minimize or eliminate drugs and drink- the time spent under the influence is not restorative
  • Invest in yourself- become super good at your job. That makes everything so much easier and it makes you so much harder to mess with

Tuesday, March 24, 2009

Pedro the Paramedics Rules of the Road III

More super easy stuff you should have learned in grade school- but for some reason didn't...
  • Walk FACING traffic, FACING TRAFFIC!!!
  • Drive or bike WITH traffic- and when driving, same rules as with yer coloring books- Stay inside the lines.
  • If your answer to the question: "Boxers or briefs?" is "Depends..." (Depends on what?..No, no- just Depends...) then just don't drive alright? Don't do it!

Thursday, March 12, 2009

Question Asking 'N Stuff Are Important

Yeah it's an oldie- but I like it and it will buy me time to tell the story behind the story with our Mutual aid buddies- Hey, Pedro the Paramedic loves you! Be safe- and then be cool, efficient and empathetic...

Wednesday, March 11, 2009

Pedro the Paramedic Presents: Rules of the Road II

Hey, welcome class- let me start out by announcing that Pedro the Paramedic is "blocked" on the Internet systems of at least (as of this writing) two big city EMS systems and two major hospital systems- if Pedro is restricted in your town- well sound the alarm...

Ok class the Rules of the Road are super duper simple today- this is a one time only thing, so pay attention and accept the fact that this particular rule has no real exceptions- just follow it and all will be well- here goes:

Do not smash into pedestrians or cyclists with your car ( Yeah jackass, that includes trucks- do not smash into human beings with your truck)

Monday, March 9, 2009

Cruising the Service Area

We had a rough shift yesterday covering for our mutual aid pals- we had a pediatric arrest and a few calls we had to call in mutual aid for the mutual aid- if you know what I mean...
So I was relieved to be assigned to my own town today- not only in my own town, but in my own neighborhood- as an extra truck no less. 
My partner and I hit the streets early and just cruised around- we were diverted here and there for coverage on occasion, but for the most part we just drove...
...  Watched a very elderly female in a long tan rain coat pedal an old red bicycle up a cobblestone paved hill... gangsta's in the doorway, being look-out- one on each side of the intersection and a couple down the block- we turn down an alley and interrupt a business transaction- they don't care too much about us... back up to the main drag- kids are going home from school, the joggers are out, a hunched over old man is walking a black and white mutt with a grey muzzle- the dogs as old as the dude is, they seem really comfortable with each other- I find myself feeling a little sadness- one won't make it without the other...
The suns out, the air is cool, everythings fine- for now...

Sunday, March 1, 2009

Your Sunday EMS Quote O' the Day

... "We don't really do it for them. We do it for us- look, people are going to get shot whether we're there or not. They're going to get hit by cars or run over by subways or whatever. You can't change that. And what the hell,we might as well be there to pick up the pieces. Someone has to be. This is a great job. Where else can you jump into the middle of mayhem and try to sort it out? In the middle of the most crazy, bizzare, violent, scary, disgusting situations, everyone looks to you to help them out- and then no matter what, at the end of the call, you can just walk away. Good, bad, right, wrong, whatever. You just walk away and get ready for another call."
Paul D. Shapiro 
NYC Paramedic 

Friday, February 27, 2009

Pedro the Paramedic Presents- Rules of the Road

This is the first in the series- and it's not just for EMS personnel- it's for everyone.

The other day we responded for a two car crash that occurred in an intersection controlled by a traffic signal- you may have seen them- they are those red, yellow, green things that hang down over the intersection...
Our patients vehicle had been T-boned in the drivers door- she definitely had the green, but after talking with her it became apparent that she was also aware that there was still traffic flying through the intersection from the left.

So, our rule of the road today is in a few parts but still pretty simple...
  1. Look before you enter any intersection
  2. Yes, even if you have the greenie
  3. Do not enter the intersection, irregardless of the color of the traffic signal, if entering will cause your vehicle to be hit by another

Contrary to popular belief, following these simple rules will not cause your genitals to fall off- nope, they'll be just fine- and so will you... and you won't have to deal with Pedro the Paramedic and his little EMS friends...

Tuesday, February 24, 2009

Hey, You Could Put an Eye Out...

... or as we like to call it around here- Lesson 1, EMS Management 102-

I've been informed by a certified EMS "oldtimer"- one of those guys that ran with the funeral home based services in a Caddy hearse rig- that in the olden days, the officer in question would have received an immediate, life changing assbeating...
My, my- how times have changed...

Legal disclaimer- Pedro the Paramedic in no way, shape, or form encourages or approves of any act of assbeating or other violence against anyone, anywhere at any time. Don't hit!

Monday, February 23, 2009

Yet Another Quote of the Day

"Fear is that little darkroom where negatives are developed." 

Saturday, February 21, 2009

Article- "The Failure of EMS"

Here is a link to an article entitled "The Failure of EMS"- it's interesting reading and food for thought- even if, like me, you don't necessarily agree with everything written...

Friday, February 20, 2009

Some Random Dispatches...

... and the calls that came out of them...
I've somehow ended up with a couple scheduled days off- after doing the 16 on/ 8 off cycle and a 48 hour overtime shift- here is just a brief selection of the fun we had:
  • 4 year old girl who ate dirt from a flower pot- mom is hysterical. Eventually Command clears the little girl and we transport mom
  • Homeless man who claims "the devils coming at me with sheets of glass"
  • Mini van vs. Harley- my partner walked up and down the road picking up toes while I treated the patient
  • MVC with refusals- Driver "A" is pissed because he had to shut off ignition and put vehicle in park
  • 80 year old with bright red rash all over- overheard ER nurses saying- "I'm not touching her, we don't know what the hell that is"
  • Dispatched for a 20 year old who "collapsed"- true enough- after getting shot. Lived to fight another day- in fact he started with us en route to the trauma center
  • 16 year old with a fondness for Tylenol- downed 38 for an after school snack
  • A couple "I can't pee" calls
  • Teenager with a loose tooth
  • Cardiac arrest that went well for everyone but the patient
  • Mutual aid into community two towns away- big house fire- they didn't have an ambulance on duty this shift
  • And of course the normal collection of two week old symptoms that get called in right at shift change- how do people know?
Stay safe, Pedro the Paramedic loves you...

Tuesday, February 17, 2009

Just Another Call in the Big City

...2217- Angry mob on the corner, guy got beat up in a fight with a drug dealer... went to put a C-Collar on him, he starts bobbing his head up and down and back and forth, he's yelling "Ain't nothin' wrong wif my neck motherf*****!"... Cop yells back at him "You can't even sue now you dumb asshole"... The patients grandpap is out, waving a baseball bat and the fat activist ladies are everywhere- yelling at the police for not doing anything, yelling at us for being part of the system I guess.
The patient just sat there- he didn't see anything...

Photo by Ireina
Creative Commons License

Monday, February 16, 2009

EMS Management 101- Extra Credit Lesson

In 1960 Douglas McGregor developed a view of working mankind- Theory X and Theory Y-

The really quick summery goes like this:

Theory X- workers are dumb, lazy, hate their jobs, can't be trusted and can only be motivated by constant oversite, threats, coersion, and punishment

Theory Y- people like to work and are inventive, creative and self directed when committed to the "objective". The role of management would be to define the objective and provide a system of reward (wages, benifits, working conditions etc)

So, for ten extra credit points and an instant pass into EMS management 102- which of the above do you believe is the norm for EMS agencies today and is your service an X or a Y?

Saturday, February 14, 2009

Paramedic Reality TV

The part of the video shot in the ambulance is excruciating...

For your daily dose of real life:

Saturday, February 7, 2009

Mommy, What is Mutual Aid?

Well Pee Wee, back in the olden age of EMS, Mutual Aid agreements were a way of assuring coverage to your EMS service area during those times when demand suddenly exceeded supply. Kind of a You watch my back and I'll watch Yours thing. Today- well today a lot of services abuse the mutual aid concept by using it to cover their area- period. It's a way for the chiefs to hold onto their fiefdoms, a way for these miserable hell- hole services to stay operative after they have run off their own paid staff.

Some examples from my immediate area:
  • The busy service to our east has no staff most days between 1800 and 0600- none, nobody
  • The volunteer fire department run EMS service to our south-east regularly shuts down week- end nights. Lights out kids- don't get sick till morning...
  • The service to our north "holds" calls- today they sat on a diabetic emergency for 37 minutes
  • My agency routinely responds through two other service areas to take calls in third- that can't or won't staff their ambulances
So what's the reason for this? Bottom line it's bad management. Pardon, you in the back... the paramedic shortage... you're asking if this isn't caused by the paramedic shortage? Could be, but the paramedic shortage is due to poor management... Right?

The video very briefly illustrates what bad EMS management looks like...

Thursday, February 5, 2009

Priority Dispatch and You...

... we all know that in theory the priority dispatch system is a fine idea. Calls are assigned a number and hence a priority based on the information gathered by the 911 call-taker. Around here an E0 would be a call with immediate life threats, down to an E4 which would include lift assists etc.

Often a caller will utter certain keywords that move a relatively minor call all the way up the dispatch ladder into E- zero heaven.

Here are a couple recent examples:

Dispatched E0 for a 38 year old female in respiratory distress...
What we found- an active, agitated female with a "cold the past two days", who told the call taker she "stopped breathing" yesterday because the "air can't go through my nose"
... yes, we wanted to yell "Breathe through your mouth and blow your nose"- but we did not. 

Dispatched E0 for a 2 year old struck by a car...
What we found- a healthy, happy toddler being held by his frantic mum- the child, being carried by his mother, bumped his head on the open hatch of a parked car as mom squeezed past it and another parked car. The thump was apparently percussive enough that mom, now thoroughly upset, told 911 "Send someone to check my baby. Please hurry, he just got hit with the car"

To quote the old man on the corner, " Damn right the thing's broke boy- but it's the only one I got."