Thrift Store Return

All of us have a second hand store somewhere in our area.  Whether it is a Salvation Army, re-purposed store front, or every Monday in the church hall place.

These places are on the rotating call list for us too.  Wait, you don't have a call list?  Think about it.  Scan your memory bank for the last week or two of calls,  I'll wait...

OK, nursing home, nursing home, other nursing home, chemically challenged individual, taxi, taxi, used stuff store.  There is apparently a law of averages that seldom allows us to deviate from the prescribed dispatch pattern.  Yet it must be interesting or I wouldn't be bothering you now would I?

Start song by Macklemore: "I'm gonna pop some tags/  Only got twenty dollars in my pocket/
I - I - I'm hunting, looking for a come-up/ This is f-ing awesome"

Man lying on the ground in front of the Thrift Store.  I respond to help the BLS crew because I know there is no ALS available.  Sometimes you just need another pair of hands..This is that time.  I pull up behind the Police (a good thing) and see a bystander doing CPR on a bloodied man laying on his back on the sidewalk.

The officer says "clear" and I head on to the sidewalk and let dispatch know it is a full arrest with by stander CPR.  I can hear the ambulance siren in the distance.  Another person with a CPR mask is attempting ventilations on the bloody face of the victim.  Attempting because you would actually have to tilt the head back and actually have to blow into the mask to do anything effective.  Please step away and thanks for your help.

"I'm an LPN I know what I'm doing" says the person doing CPR on the left side of the patient's chest.  OK, stop for a pulse check, who is he and did anyone see him fall? I think you can actually hear the crickets chirping at this point.  Low Paid Nurse tells me he is obviously alive because he is breathing.  Agonal respiration honey, sorry they don't count.  We continue compressions and the ambulance arrives.

It must have been a quiet day because out of town ambulance shows up too and we are connecting the AED and rolling him on a board at the same time. SHOCK ADVISED. Clear... jump.  Check for pulse.  GOT IT!  Let's get him out of here.  ALS pulls in.

Everyone gets in the clown car, I mean ambulance and heads to the ER.  I suggest that the bystander throw his mask away and he says he will clean it because it was expensive.

I approach the LPN to talk about her knowledge base and the quality of her CPR.  After being told that I don't know what I'm talking about because I don't work in Home Health I give a long sigh and ask her to review her Pit Crew CPR process and suggest that taking a radial pulse isn't correct...

Anyway I help the Police pick up the mess we left, let them know how much we appreciate them and listen to the cop's story of how he attached the AED.  I told him he saved the guy's life and that we will recognize him later.  His badge seemed to sparkle a little more as I left.  All in all not a bad day.

Airport CPR

Please turn off your sarcasm meter because the following post will peg the needle.

After a cross country trip to attend my uncle's funeral my father and I were returning home via the fastest accessible means- an airline.  The trip there was uneventful, the family and the funeral were upbeat and I was just concerned with getting my 80 year old retired dad back home.  We made it as far as the gate for the first leg or our return trip.

No this is not about my dad "having the big one"- or even me for that matter.  It's about clothing.

Apparently my dad noticed something odd about a guy not answering his wife and he leaned over to me and said "I probably should have told you not to wear your duty shirt when we left the hotel." What are you talking about?  Cue man falling from chair to the floor and woman screaming.

At the next instant the cattle at the gate appeared in wild stampede.  Not to help mind you but to get a better view of whatever was going on here.  And then the murmur started:  Hey, he's a fill in the blank EMT, fireman, paramedic, do-gooder, and the spotlight came on.

Needless to say my role playing, retired chief, father, gave me the aren't you going to do something look and I headed over.  He said later that he didn't have the "look at me I'm a fireman" shirt on so he felt no obligation...anyway at 80 if he did help we would have probably had two patients.  So begins a lesson in crowd dynamics.

You go get an AED!  You call 911.  Who else knows CPR?  Does he have a history, pacemaker, defib, yada yada yada.  At this point, as I am starting compressions I note that no one is doing anything.  Not talking, not moving, nothing.  Sir, would you please go get an AED?  Can someone move these chairs?  Cricket, cricket, cricket.  From herd of cattle to band of locusts.  Apparently this was the perfect storm of a group of people that had never heard of CPR or 911.  Great.

Soooo, I called 911 as I was doing compressions and began talking to the dispatcher.
What is your emergency?  I'm doing CPR.  I'm a fireman and need ALS here at gate 51 (how appropriate) quickly.
Please remain calm sir.  Is the person laying on the floor?  Look I'm not able to answer your questions right now I'm starting the second round of compressions.
"Antek, mówisz do tego idioty."  Which is what I said in a stern voice to my dad as he came over and picked up the phone and left.  We often talk in Polish when we need to make a point between the two of us.  It was simply "Tony, can you talk to this idiot?"

Finally an airport employee sauntered by and grabbed an AED.  It was the Three Stooges after that as she laid it down upside down, the shrieking AED box alarm screaming in the background and the crowd turning ugly with comments like if he was doing good CPR he would be alive now. Really?

A doctor jumped in to help but lost interest when he realized that there was no one to bill.  AED connected, analyzing, continue CPR.  Rats!  A police officer ran up and told everyone to get back.  Including me.  Ah, I'm doing CPR can I stay?  OK, but no one else.  Everyone get out of here!

So what seemed like an eternity, according to my smiling dad was just about four minutes and the cavalry arrived.  Paramedics, firemen, chiefs, more police, and several guys dressed in suits with behind the ear piece things.  At that point I gave my report and moved out of their way.

They were efficient, but if you know my track record you know that the poor guy never had a chance and the entourage left with the nervous wife in tow.

Epilogue:  My dad actually went to another gate told them what was happening and was probably the one that actually got things rolling.  He collared the cop and sent him over and directed the ALS crew to me.  Not bad for an old guy.  Then he he offered to buy me another shirt to wear but I declined.  Apparently I like the limelight.

Zoiks! Change with Strings

Hey first thanks for coming back to read this stuff.  I have been on a self imposed hiatus and I want to get back to providing the useless drivel that I normally share with witty observations thrown in to keep you off guard.

Let me share my stumble into the 21st century.  Our county is not without its share of supporting cast members.  Generally they are supportive but distant.  That recently changed.  Our county government is spending a large amount of money on emergency services and it has not gone unnoticed.

We have a new multi-county communication center under construction.  The county stood the first year cost of the I Am Responding System to help volunteers track availability and response to calls.  A partnership has been developed between the county, community health, and Fire/EMS to address recruitment and retention issues now and in the future.

It appears to me that the Commissioners have realized the inadequacies of our present system and are doing everything in their power to help us get to the next step...whatever that is.  Now how do we respond?

This new focus, rather than the laissez faire attitude of the past will challenge us to look at both who we are and how we do things.  I'm not sure that it will be well received as it is foisted on us but if we look at the opportunities it opens for us how can we not be excited about the potential?

What is your reaction to new things at work, home, or in your community?
Are you an early adopter, early or late majority, or a laggard?
How can we push our groups to become innovators instead of adopters?
Can we identify positive needed change?
And "what about Naomi?"

Not So Sweet Sound of Music

Doe, a deer a female deer

Ray, the medic on the call

Me, the name I call myself

FA, the start of what was said….

SO, what will my penance be?

LA, it was the newest in the fleet!

TI, it’s technically not my fault!

That will bring me back to

DOUGH we’ll spend to fix this thing!

With my apologies to Julie Andrews.

So the calls were diff breathing, round trip, unknown medical, CVA, diabetic emergency, chest pain...DEER!!!

Somehow the normal bitching about trip sheet paperwork pales in comparison to the detail required for an accident investigation. Ah well, who needs sleep? The good news is that no one was hurt, we were recalled from the scene, and as the officer I was only too happy to call the chief at "zero dark thirty" and update him on the above pictured results with his brand new less than 2500 miles on it ambulance.

Resuscitation was not attempted on the animal.

To be honest I didn't like where the fog lights were mounted anyway.

Just Like We Planned, Not Quite

Friday night is my thing.  I don't know why I have just always enjoyed doing things at the end of the traditional work week.  Recently it was no different.

Many of our firefighters enjoy taking our turn on the ambulance.  It is a real opportunity to get out and interact with the community, dust off a few skills, and just maybe help someone.  I ask for open shifts because the "we live for this" calls are really drying up for the fire only set.

So we are out tonight with an Explorer in our ambulance.  We allow young high school aged students with an interest in health care or EMS to ride along as an observer and maybe help with a few simple things in the back of the ambulance.  It's a great program and the kids get credit for community volunteer work that they need for graduation.  A win win if you will with the hope that they will continue their interest and get the training to replace me in the not too distant future.

We were in the day room listening to dispatch after dispatch all around us until finally the dispatch Gods hit us for an ALS call on the other side of the middle of no where.  We were headed deep into our fourth due area.  Get out the map books!  Luckily by the time we got there the ALS fly car had secured a recall by physician and we headed back out to a non-dirt road.

Then another dispatch a mile from us, covered by the returning  local area crew.  We were thinking about  a nice leisurely trip back involving ice cream.  Then just as they say, when you least expect it, expect it.

Rescue, Engine, Squad, covering ambulance (mine) multi-injury MVC.  Car into a bridge, with ejection and...we didn't hear the rest because we had our siren on and the Turbo begging for fuel.  We were past station five before the chief responded and arrived immediately after the police.

As we arrived on scene we saw a person on the road, and others in the car.  We split and I did Mass Casualty Assessments and prioritized the three patients.  It was at this point that I began to understand how lucky we were that this particular Explorer was with us.  He already had backboards out collars ready and was talking to the police officer holding traction on my patient.  By the time the rescue arrived we had the patient on a board and headed to our ambulance.  ALS arrived and we started preparing for the arrival of a medical helicopter.  Eventually a second medic and another ambulance showed up to complete treatment on the other two patients.  Both units provided transportation to trauma centers.

This is the way it's supposed to work folks.  Efficient, expedient, effective.  Thanks to a bunch of firefighters that "just did their job" and an extra pair of hands that provided us with the stuff we needed even before we needed it lives were saved.

We missed ice cream that night. We even got back after shift but we felt good doing good.  Those calls don't come around everyday but when they do we fall back on our training and the educated help of our brothers.  It's good to know that we can all rely on each other.  Thanks.

EMS WEEK 2013

Let's take some time to review the past year.  No extravagance just see what we've accomplished:
Ah...  OK, not too much.
What about goals?

• Figure out what we're doing and take some classes to remember it.  Incompetence make all of us look bad.
• Not everyone deserves respect, but give it to them anyway.  Because if  you don't you disrespect all the rest of us trying to do a good job.
• Hold the Holier Than Thou for church.  We don't know what other health care providers are up against every day so don't dis them either.
• Driving to a call like you are at a NASCAR event?  Stop and think of the consequences, and hope you don't kill me.  So help me God, I'll come back and haunt you with back to back to back nursing home calls on every one of your shifts.
• Act like a professional and you will be treated like one.  And so will the rest of us.

I appreciate the tenor set by Rescuing Providence, Ambulance Driver, and Happy Medic.  What can you add?

Sometimes It's Simple

Don't Reinvent the Wheel

How often have we heard that statement?  Sure all of our organizations are special, diverse and autonomous but we all fight fire, respond to haz-mats, and even make EMS calls.  That makes us more alike than we ever consider.  We all need vehicles, equipment, supplies, and people.  It might just be that we deal with these in a different way than our neighbor or the larger or smaller department across the country.  But we all must meet both our needs and requirements to make things work in the best interest of our communities.This deals with all of that.

If we personally want to buy something new we can check at local merchants, ask our friends, or cruise the internet.  During the information gathering phase we get tips and tricks that help our cause and some that divert our attention from its original focus.  Yet all of it helps with our knowledge base and comfort factor and have some bearing on our final decision making process.  Why not take advantage of that process and availability of information  if we are having trouble with a specific part of our job?

I'm sure that others have faced many of these same problems or opportunities that we are now staring down.  Possibly they have posted their findings or decision making process on the internet for our review.  Or better yet they are willing to share directly with us by phone, e-mail or letter.  This shortens our process builds on our community and allows us insight into how others operate and face their own issues.

Use what's available.  Give credit to those that saved you time.  Honor the wishes of your resource if they are reluctant or unwilling to share their information.  There are often compelling reasons for their unwillingness.  Most importantly complete your due diligence and confirm the information that you find.   Along that same line, one of my favorite quotes is "You can't trust everything that you read on the internet."  by Abraham Lincoln. Although Honest Abe probably never said that,  using a trustworthy source is paramount in looking for and finding good helpful material.

What does this have to do with anything?  Well I am using my own advice to write our next installment.  Now that you have the background please check back for the real story.  Stay Safe.

I'm Just Sick. Hello Flu

Well in this case brown is not good.  The picture is from the CDC update of flu across the USA.  It indicates that it is widespread across over 80% of the country.  Get the Flu Shot!  It is one of the principle ways to fight against this annual onslaught.  I don't care what you heard about getting sick from it or somebody's second cousin's ex-wife's, child's friend that died.  Without the shot you just get to spread the disease.  Nice way to help.

What else can I do you ask?  Well how about returning to PPE and hand washing?  Great suggestions!  That may include a mask over those with a cough.  Why take a chance bringing the flu back to your family?

In addition you can clean and sanitize your equipment and ambulance.  Yeah, it's a pain in the butt, but it slows or stops the spread of the flu and many other germs.  If you can't remember the last time you wiped down the cot, seats, and walls now's a good time.  Flu can live from 2-8 hours on surfaces so cleaning and disinfecting is a big deal- even when you are busy.  Maybe especially when you are busy!

If you get the flu?  Stay home.  Drugs can slow it or mitigate the symptoms but you have to let it run its course.  That's probably about a week.  During that time every time you cough you share a little with others. Wait until you can't spread it any more.  Or better yet Get the Flu Shot!

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.

In Depth and Personal

This is where the action is.  This is where your reputation is earned.  This is what you see in the paper the next day.  This is what is talked about years later.  But this is just the "Reader's Digest" condensed version.  What is the Real Story?

In 1952 a chief was dressed down by his Council for having the audacity to ask for help from another fire department at a large house fire outside of town.  Within a few years the county boasts a Firemen's Association that has standardized requests for help, radio frequencies, and apparatus numbering systems in three counties.
Everyone uses the same hose thread, the same dispatch procedure, takes training at the same time at the county fire school.  Everyone shares any new way they come up with to make the job easier.  Five inch hose is specified, pump sizes are increased, a new dispatch center is born.

Local level instructors are used for in house and county wide training.  Train the trainer is used to bring in new ideas.  Firefighters begin to certify their abilities and promulgate new training opportunities.  EMS, Rescue, Haz-Mat are all added to the list.  The mantle is slowly passed from father to son and new recruit.

That makes it possible for:

Dispatching a commercial fire
E2-2 and Ladder 2-9 responding.

"Chief 2 requests a second alarm."

"Station 1 and 4 responding, and 7 and 9 covering."
Command to E1-3 take side A, provide your own water supply.

4 provide manpower for attack.

Second Rescue and Truck stage at scene.



We've come a long way.  Longer than most of us realize.

But just like here, we can't see the water supply, but we can sense the job required to pick up, drain, and repack 1300 feet of hose.  We can appreciate the firefighters that stay and do the scut work to be ready for the net call.

And the men that came before us that made our job just that much easier, efficient, and better for our communities.  Thanks for all your hard work.  Yeah both the tired guys today and the nameless brothers that came before.  A great and growing family.

Waiting, YES

OK, left in the dark ambulance (LDA), you've drawn the short straw and have been dispatched to 1-1-2-2 Boogie Boogie Avenue for an unknown type emergency.  Dispatcher releases microphone button but yet we still hear a deep Moo-haa-ha laugh track in the background. Just another day in Paradise.

On scene.  LDA do you need PD on scene?  Ahh, not right now but I'll keep my portable with me thanks.

Hey!  In here!  Hurry!  OK, what's your problem...as I begin looking around at the space paraphernalia located in every wall, drawer, and shelf in the room.  "I feel sick."  I think I surmised that when I walked in here and looked at your decor.  "My stomach hurts, I've been having trouble swallowing for the last few days."   OK, have you been eating normally?  "Yes."  Anything new in your diet, do you take any medications?  "Yes to both. I changed my diet recently based on suggestions by my doctor."  What were his suggestions?  "I need more iron in my diet."  OK

Hey partner, yeah, what do you make of this stuff?  "Oh that's my vitamins."

Wait for it...

Looking at partner, and you have been taking this the last few days?  "Yes, I use the file to take shreds off and then I wash them down with water."  And that's "iron, yep just like the doctor told me."  Sound of silence.

Let's get you out to the ambulance.  "Good I can tell you on the way how I was abducted by aliens..."

Wait for it...

"The last time."

Fire Accounting 101

I hesitate to bring this up on what is usually a comical look at the seemingly dying art of firefighting but honestly money may be the root of all problems, but without it you've got some pretty serious problems too.

We got chief officers, staff officers, line officers, safety officers, more officers than we can shake a halligan bar at.  But who is responsible for the common sense running or the ruining of our financial well being?   In the city it's the comptroller, in the county a treasurer, in smaller places the secretary.  All in line prior to us receiving a plug nickle.  It could be the mayor, supervisor, county executive, council, or commissioner that hold the final purse strings for the fire department.  Do you know who has that responsibility in your jurisdiction?  If you're lucky enough and cover more than one local governmental area you may have several different people with different titles holding separate purses.  What a treat.

OK, so you are either getting money from a taxing jurisdiction, as agreed on between the two groups, from your own hard work (bingo, dinners, carnival, tickets), from your investments (dare to dream) or donations.  You have been given that money in good faith and need to both account for it and be responsible for it.  What's the difference?

Accounting for the money is as easy as keeping a checkbook.  Tracking where the money comes from and how you use it is one of the most basic ways of confirming that you know what you take in and what goes back out.  Being responsible is balancing that checkbook each month compared to the bank balance.  Note the lack of an accounting degree to do any of this stuff.  If you have a truck account, a general account, and a fundraising account you can have three different checkbooks and separately track everything.  What more can anyone ask for right?

Well, as it turns out a lot more can be asked of us, or you and that's where people start to glaze over when I stand up and talk.  Just sit on the tailboard for a few minutes and follow me.

All public and private businesses, and yes even a volunteer fire department is a business, are required to do the simple stuff I have already mentioned.  It's the expected things where we run afoul.  My analogy is a recent one.  Joe Paterno the great Penn State football coach appears to have followed the rules of the college yet because of his position more was expected of him and he recently lost his job.  It's the same with our accounting.  Sure we spend the money on what we feel we need but how do we go about determining that we need it and procuring it for our use?  If we receive money from taxes, fund raising, or outright gifts don't we owe those providers of funds an explanation of how they are used?  Maybe we should even back up a little farther and show the public that we have a plan in place to demonstrate how we expect to receive and spend the monies that we estimate we will receive in the coming year.  That's a budget.

Now a budget can be both a marketing tool and a way to compare sources and uses of funds throughout the year.  I would like to approach it in the most basic way.  How can you plan on spending money for anything unless you have some idea of how much money you will have to spend?  Start a budget by going through the checkbook and locating all of the deposits throughout the last few years.  List the different types of money you received.  Some simple categories are tax money, donations, interest, social hall rent, chicken BBQ money.  You get the idea.  No income item is too small to be listed.  Next using the checkbook, bank statements or monthly treasurer's reports divide the income items into the categories that you just chose.  Keep the years separately so you can see how each one breaks out.  Total the list in each category and that will be the income for each item in your budget.  Total the categories and you have your grand total income for a year.  If you do this for more than one year maybe you can see similarities between the years.

After you have totals you can use one year's information or average two year's totals for a budget.  Some items should not be included in your budget, for example if you received a one time federal grant for $25,000 you cannot count on that money in your next year so leave it out.  Now you say but what about the BBQ we run?  Well if you're going to plan BBQs you generally know what profit to expect and I feel you should build that in to your budget.

Now you have an estimate of what is available for use.  Let's spend it!

List your expenses in much the same way you just found your income.  You can use fuel, repairs, training, clothing, insurance, anything you spent money on in the last few years.  Then categorize and total.  Did the expenses come out less than the income?  If they did you are running in the black, or you have money left at the end of the year for savings or special projects.  This is a good thing.  If the expenses were greater than the income you are running in the red and either you used savings to pay the extra expenses, or you have a loan or credit that covered them for you.  Not necessarily a good thing, but OK if you manage it.

Now use the history you just gathered and project a budget into the future.  If you think diesel fuel is going up add some expense there.  If you think donations are going to be down, reduce that category.  When you are finished you might be amazed how it turns out.  If you are projecting that you will be in the red maybe you have to plan more fund raising, or ask for more tax money to cover the difference.  If you come out in the black maybe it's time to put away money for a rainy day. 

Now a budget is no more than an educated guess on your future, but if you feel comfortable enough to share it with the public they can see you have a plan and know where you want to go.  Hopefully meeting their expectations not just the requirements.

Next can be spreadsheets, financial statements, IRS 990s, comparisons to other departments, audits or a host of other accounting items.  Maybe not as exciting as having the nozzle at the big one, but important none the less.

It's Bothering Me

I worked an overnight last night.  That in itself isn't unusual or a problem it just happened, or didn't happen.

We had meetings during the day and wound up heading home for a few hours prior to my shift.  You know the drill.  Help with homework, clean up, talk a few minutes and head down to check the equipment. Everything finished and fall asleep watching TV.

Awake to "Get up! We have a call."  Didn't hear the alert tone, the dispatch, anything.  Just my partner trying to cut through my sleep induced stupor.  Luckily my autopilot is not broken and I got us to, through, and away from the call.  It was a three hour job with clean up and restocking.

I still can't tell you anything about the call.  It's like I was sleep walking through the entire night.  I've heard about this happening to people, even made fun of people it happened to, but never to me.  Chalk it up to being tired, a good dream, or whatever they say to me.  It occurs to me that I am getting old.

My dad stayed on after I became a fireman.  He pushed cajoled, and taught me common sense all while making sure I was learning the cutting edge as it became available.  I am holding out for my son or daughter in the same way.  I wanted to work together, share, and bond.  I'm just not sure.  I'm just so damn tired.

The One that Didn't Get Away

OK, in keeping with my summer of frivolity I am sharing from the heart on this one.  Pun intended.

I first learned CPR in the early seventies.  It was a great time to start into this thing, EMS, that was truly in its infancy.  We all thought that with a Red Cross First Aid Card and a CPR card we could save the world.  And we were chafing at the bit to do just that.

As time progressed the Gold Standard was thrust upon us and Roy and Johnny saved pretty much everyone that they even walked past.  We even had an occasional save in our greater metropolitan area.  Then Para-medicine arrived for us and greater strides were made toward sporadically beating the Grim Reaper.  Fellow ambulance drivers, attendants, firemen, EMTs, and even Paramedics had their favorite story about the one that didn't get away.  I wanted to tell you mine...but I didn't have one I could share.

Not that for 34 years I haven't tried.  I've tried in Cadillac ambulances, Ford Ambuwagons, van ambulances, Type 1, 2, and 3 ambulances.  Responding from home, with ALS, as ALS, together with fixed and rotary wing medical transportation.  Even with an untold number of rescue vehicles and a more traditional walking or hiking into the scene.  All adding up to a big zero.  Hell I think that the local funeral homes sent me Christmas cards just so I could keep funneling business to them.

It's getting so bad now that I was asked to drive the ambulance to one CPR in progress so that the crew could show me how it's done.  They failed, my string continues.  My partners and coworkers immediately kiss off any chance of resuscitation as soon as I buckle in with them.  They talk in hushed tones about the Doctor Kevorkian of EMS, The Streak, Bad Luck Pete, and use some names that decorum will not allow me to quote.

I think that I first became aware of my issue in college.  As I recall even at that young age I was already well known for my lack of prowess in CPR.  At that time there was a ubiquitous CPR poster that literally hung everywhere that screamed in large bold print "CPR SAVES LIVES!"  Underneath that exclamation was added with black magic marker "Just Ask Pete."  To this day my friends from there specifically have me penciled in their  living wills as CPR provider of choice so they can rest assured that they won't be saved and end up a vegetable from the experience.  

Well in the last two weeks we have had four opportunities to practice our craft.  Three of them I was the crew chief on duty.  We all know how they turned out.  But the other one was different.  It was different in many ways, including the outcome

My son wants to be a pre-hospital RN PHRN.  He wants to fly and bask in the glory of aeromedical nirvana.  He wants this so bad that he hangs around the ambulance begging to go on calls, wanting to help in any way he can just to become inculcated into the EMS System.  Often because he is so persistent he is allowed to ride along and occasionally he helps with lifting or some other menial job that really means the world to him.  In other words he has it bad and the guys are willing to coach him along.

Every year we are directed to stand by at the county fair for the throngs of people that come to milk the cows, ride the horses, and slip something to the sheep.  It is as boring as it gets and the people that approach us with every suspected critical emergency are generally let down easily with an ice pack or band aid.  Not this year.  Re-Pete, as my son is called, finagled his way on to the ambulance for stand by, and free entrance to the fair, was seated on the back bumper with a blue ribbon smile on his face that no one could come a close second to as someone ran up and said a man was laying in the parking lot between two cars breathing weird.  By the time the crew put down their funnel cakes, dumped their five dollar fresh squeezed lemonade, and got ready to respond Re-Pete was gone.

As the crew arrived at the parking lot they heard the canned voice from an AED say "analyzing don't touch patient."  Re-Pete ran to the lot, grabbed an AED and started care for the poor old gent.  The next thing the gathering crowd hears is "Shock Advised, Push to Shock."  Go ahead Re-Pete they say and he gets his first cardioversion right there between the cars.  Normal Sinus Rhythm.  ALS is there and the whole crew, including Re-Pete take off for the hospital at Warp 8.

I couldn't be more proud, oh yeah of my son, but more importantly that whatever I have is not passed on via any hereditary process.  Re-Pete 1 for 1 and dad 0 for 34 years. Maybe I'll just bask in his glory for a while.  The one that didn't get away.