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.