The Collective Us

We have seen reductions in Fire and EMS.  Not to the extent that some of the very large services but by and large just as painful.  Couple this with my new found duties to run the executive side of our EMS service and you have the equivalent of another part time job added on to the work time and subtracted from the family time that was already nearly nonexistent.

Don't get me wrong I LOVE what I do.  I live what I do.  And I revel in the hey you're a firefighter (or EMS guy) can you help me/answer a question/recommend/tell me/show me stuff.  A community connection that I don't take for granted.  But the expectations are rising while at the same time we are being told to do more with the same or less resources.  For example.

During my tenure in service to my county we have added three new EMS stations, closed one, and lost a number of fire brigades due to plant closures and the like.  We have not changed the number of fire stations but now have fewer folks to man the apparatus.  Not unusual.  But last weekend when I took an open shift on the ambulance we drove by three stations that were dark.  We responded 25 minutes to the call that was covered by the fire QRS from the local station.  Apparently no one told me that only some stations man an ambulance during these low call times.

  We have seen an annual increase in the calls for our ambulance from year to year but this year has been exceptional in the quantity of calls.  So far this year, if we don't have anymore calls, we have run a record number of calls.  Each call we get in the last two months of the year adds to that record,  Our call increase is in the neighborhood of 25%.  That's a lot of extra calls.  But the biggest change in our calls is the number  outside our normal service area.  That increase was over 30%.  What's next?

Well at a fire today only one engine and an ambulance were available.  Four people to provide protection to our community.  It occurs to me that this may be the future of our service.  Provide minimal staff and hope for the best.  Relying on second, third, and further alarms to bring in a force capable of taking on the task at hand.  Something we would have done with first alarm personnel years ago.

The "Collective Us" can provide a solution to some of these problems.  But it will take working together at a level unheard of in our area.  Can we bring an ambulance staffed with one person and pick up another on scene to complete the crew?  Should we respond a centrally located unit to every call to make sure that someone gets there in a reasonable amount of time?  Stop looking at areas as mine or ours and start sharing resources   Cover for each other and possible announce units out of service during nights so other trucks are aware of what area they are really covering at any given time.  Possibly reduce the amount of equipment and increase the amount of paid staff.  It's a thought, for the "Collective Us."

Layoffs

Well, the ugliness of present day politics and financial management (mismanagement?) have finally come to roost in my office.  I have had to break the news to some of our most recent hires that even though they have done nothing wrong and quite frankly are doing a good job for us their services are no longer required.

Don't get me wrong, prior to this I have fired employees for cause and although it was difficult working with the union and meeting the requirements to terminate their employment it was a necessary evil to make the whole organization better.  I understood this and some how it seemed reasonable at the time.  Generally the employees even understood that we were following the rules and every courtesy had been extended to them.  We had quite frankly given them the rope to hang themselves.  We never left as friends but at least with an understanding that this was the culmination of decisions that were made by the employee.  I played the heavy but never really felt the pain.

I feel it now as I see my employee.  The somber shuffle into my office.  The twist of heads by their former fellow employees to avoid eye contact.   The deer in the headlights look as they sit in front of me waiting for a pronouncement.  The pain conveyed through their eyes, through their slouch, through their nervousness in the chair.  They speak volumes even prior to our conversation.  They have worked for and next to me, campaigned for staffing and financial reason, read the paper, heard and saw the news, and understood that it is the end of the line.  Last in first out.

I am truly sorry and convey that to them.  They don't acknowledge  because they are already trying to grasp the new uncertain reality that awaits them.  Some how I have failed.  It's no longer about the politicians or some far away decision maker it's only the two of us.  There is nothing else in the universe, just my spoken word and the silence that follows.  I have an acute feeling of inadequacy.  They have an acute feeling of loss. Neither one of us is willing to share with the other.  The meeting is over.  The dark cloud begins to expand from the office throughout the building and over the organization.

Planning, meetings,  adjustment of duties, new policies, and significant change at many organizational levels begins.  Almost with no time to mourn the loss.  There are today's and tomorrow's hurdles to jump.  And  then "Dad I had a great first day at school!" discussion ensues and in closing with the directness only a child possesses, " My friend said their parent lost their job.  I gave them two of my pencils."

I wonder what pencils I have to share?

This Ain't Hell, But You can See It from Here

Allow me to set the stage for you.  It's Friday night.  That in and of itself means little, but tonight was a home high school football game between two rather large local schools.  The home team lost 46-12 or something like that.  Let's just say that there was a lot more attention paid to non-football pursuits in the second half.

Eagle Eye Son:  I think that's a jeep in the culvert.  Firefighter dad:  Let's turn around and investigate.
Hey Bud!  You OK.  Yeah I'm OK.  Waiting.
On cell phone:  911.  Hi this is caring firefighter badge number 135.  There is a red jeep in the culvert near the super market.  He says he's not injured but please call the PD because there's no way he can get out without a tow.  Thanks caring firefighter we will.

911 to chief eleven?  Yes we are aware of a car off the road in that area.  It was reported by another firefighter.  Police have been dispatched.
Chief:  Windshield broken, air bags deployed, injured laying on ground, dispatch station 1, rescue and medic 1, check on a helicopter, send the National Guard, is there a SEAL Team avaialable? Notify PEMA, FEMA, call the TV stations, notify the NY Times and get a camera out here to get my best side.

OK, this just CAN'T be the same stupid nothing wreck I just drove by, can it?  Well, yes and no.  Cue dispatch for the accident right before the staffed ambulance notifies them they are busy with an under the influence requesting police in the ditch near the high school parking lot.  So I feel it necessary to go get the other ambulance so if my kid in the ditch is really hurt he can actually get some assistance.

OK, so rescue gets there, an engine is there and I show up with my crew.  Mistake #1 I take patient care.  Bad news, I recognize the driver.  After a few 'leave me alones' we determine that the other guy here is a non-injured passenger.  Sign here easy.  Mistake #2 showing my deep level of concern used only for those people that inhabit that lowest level of Hades reserved for those under the influence, belligerent, time wasters.  Mistake #3 reducing myself to his level.  He raised his voice.  I told him what I thought and after a few repetitions suggested he walk to the hospital because he wasn't getting in my ambulance.

At that point the assistant chief arrived and directed me to my ambulance in the kind nonthreatening way that a superior does this to a junior officer: "Take a break and shut up."  Cue arrival of large, no VERY large man announcing that this was his son.  Polite discussion ensued between Assistant Chief and man child with occasional input by father.  By polite I mean that they never got around to using the really good four letter words.  Enter the man in gray.

As I heard later the State Trooper had taken as much of this as he could stomach stepped up to the man child and gave him an ultimatum ambulance or patrol car.  Both father and man child were now completely focused on Trooper.  Rescue and engine guys were now circled around all of them and I was sitting in the ambulance.  Trooper says something into his portable and takes the man child's arm and escorts him to the direction of the patrol car.  Feistiness is exhibited by man child and father adds verbal parry expressing his knowledge of the Trooper's linage and lack of a father figure.  At that exact moment three other Troopers arrive.  All exit their cars at the same time ninja like and moved to support the first trooper.

Now I'm not sure about how law enforcement is perceived in your area but generally here one Trooper takes care of most problems.  Maybe you would see two of them if there was a bar brawl, three if it was an uprising consisting of a  whole town, but four Troopers, in one place?  This is for the record books.  First Trooper, Big Trooper, and Behemoth Trooper took man child down, cuffed him, and tossed him in the back of the car as Corporal Trooper talked to dad, who kept saying "I understand, I understand."  Corporal Trooper strode over to us, thanked us for supporting his Trooper and left to follow First, Big, and Behemoth to deliver man child to the institution of their choice.

We stayed to take care of the vehicle and the dad.  Also to take my expected tongue lashing from the chief.  But it was not to be.  He came over to me and mentioned that he had never seen my fuse that short.  I apologized and told him I appreciated the way he replaced me at the scene.  He asked me to give him a heads up next time and maybe he could arrive a little later and either the patient would be unconscious, on a board, in the back of the ambulance, or be shot and hand cuffed to the cot on the ambulance.  I didn't know if he was serious or not.  Better not to know.

Thanks Fire Dad

I grew up in the fire service and emergency medicine thanks to my now retired fire chief dad and my mom a registered nurse working in the OR and ER.  As a young child I remember watching my dad hoist himself up in the cab of the engine as the driver was bringing it to life.  The crew off to put out another fire or rescue some poor soul.  That has a profound long term effect on how you view life, what's important, and maybe more so what's not important.

He taught Red Cross First Aid in the 60s and early 70s before Johnny and Roy, before we even knew what an EMT would be, could be.  He taught those classes at little fire stations around our county to people that hungered for the knowledge to be more than "just an ambulance driver."  I remember those 16mm movies he would borrow for free from the State Fire Academy.  He would preview them at home first and I would watch them too trying to memorize all of the things the "expert firemen" did to help those kids in the bus crash or the family in the crushed car.  Pretty heady stuff for a kid.

I hung around the firehouse as much as I could and when I was able I joined.  He was around to help me, talk to me, and especially listen.  I am sure to this day that all my coping mechanisms are based on all of those things we did together.  Much of the basics I got from classes or reading his Fire Engineering but he helped me apply them and seemed to always know the reason why we did something "that way."

It was through him that I met people that will stay with me the rest of my life.  Rich, Hack, Hugh, Lew, Brad,   Tom, Dean and Kevin, Steve, Jan, Bill, Neal, Chuck and all the rest.  The people I measured myself against.

I'm glad I got to explore this part of life and I am really glad I had a real mentor to help me through.  I can never say thanks enough for bringing me up right, but I can show you what and how I do things now and hope that you get a little smile thinking that you would've done them the same.  Happy Father's Day and the steak is on me.  Bóg zapłać

Luck Is NOT a Strategy

The title is a quote from former Secretary of Homeland Security Tom Ridge.  I am invoking it at a new critical point in providing EMS.  Recently I have noticed a return both locally and nationally to a deeply ingrained but detrimental concept in our care regimen, that of high vehicle speed.

Four minutes, the Platinum Ten, and the Golden Hour are but a few of the time tests we are judged by on a daily basis.  Articles that begin with "studies have shown," or "a relationship has been documented" associating arrival speed and reducing time between the scene and the hospital are always discussed and dissected in excruciating detail.  Each leading both the lay public and EMS providers, at least tacitly, to the realization that speed is a major factor in providing a positive outcome for EMS care.

Why are we still succumbing to these antiquated stereotypes?  Are we truly returning to our days of First Aid and Ambulance Drivers with nothing to offer but a kind heart, a few bandages, and nerves of steel as we break or bend every traffic law and rule of physics?  This is NOT the road that we ought to be driving.  This is not the short cut to professionalism.

Let's all show off in another way.  Let's do a skill demonstration at every call.  Pop on a splint.  Assist with a med.  Work as a team.  Bring everything into the house that you will need.  Stow the attitude and show the care.  There's always someone watching let them see us at our best.

Lady Luck is a fickle partner just when you need her she craps out on you.  Coupled with the way people just point their cars and go, while texting, talking, primping, and eating.  It's easy to see that we already use up much of our luck just arriving at work.  Don't press Luck.  Don't depend on Luck.  Don't hope for the Luck of the draw.  Stay focused, stay safe, and stay alive.

The Obligatory Year in Review

Nothing in this missive should come as a surprise to you dear reader.  In the past year my shift of ne'er-do-wells have responded to more than our share of  thought provoking calls.  It has occurred to me on more than one occasion that there is a significant amount of irony in our work.

This is not the individual call "Karma is a bitch" stuff, but the over all feeling of Fire, EMS, and Police as compared to the ordinary run of the laity.  The irony, as I see it, in our collective jobs is that the best calls are really the worst ones.  Disaster, distress, and tragedy are really what we live for.   The adrenalin pulsing through our blood stream that can quickly burn us out or leave us wanting more.  The feeling that we need to exist, to confirm our existence or our superiority.  Our best day is predicated on their worst day.

Our best - their worst.  Think about it.

Think about it as you pick up the junkie.  Think about it as you push through the dilapidated burning home.  Think about it as you extricate the drunk driver and his expired passenger.  Think about it as you take the confused nursing home resident to the ER, for the third time that week.  Think about your partner, your crew, your family...you.

It costs us nothing to show a little of ourselves hidden under the crusty outer layer we portray.  Compassion for the folks we do the job for.  That don't understand, will never understand, never mind appreciate.  Leave the negativity in 2011 and charge head long into the positives in twenty twelve.
Happy New Year.        Never Forget.