Wednesday, December 29, 2010

Plan B

I have noticed that many of my stories, and those of others have a happy ending because of a "Plan B."  What if Plan B doesn't work?  Has anyone done any planning for those low percentage and high visibility calls when all the stars align just right and you are presented with a major fiasco?

Case in point the December 26-27, 2010 snow storm that hit New York City.  Twenty plus inches of snow blanketed the city with amounts exceeding thirty reported in Northern New Jersey.  This is a Plan B occurrence. But when did it change to a C,D, or E?  When buses unable to move clogged the streets?  When there were ambulances and fire trucks stuck in the street?  When firefighters had to walk a block into a scene because of all the abandoned vehicles stuck in the street?  When priority streets called arteries were not even continuously plowed?  When 1300 EMS calls and an unknown number of other emergency calls were backlogged waiting for any unit to become available to take them (NY Post, NY Times, Phila. Inquirer)?

How do you plan, and what do you do when it's your town of city?  I don't want this to become a Seven Step Process or selecting the best choice technique review.  I just want to get the ball rolling for a discussion of what if based on current events.  A simple way to include all levels of the group and have everyone learn something about abilities and capabilities.

I have long ago forgotten the terminology for sitting around and blurting out the first thing that comes to your mind when a problem or "opportunity" is discussed.  "No answer is wrong, just shoot from the hip."  Then someone writes down the answers and later they are sorted.  At the firehouse it is called the kitchen table.

Here's the way our discussion went.  What if we got 20 plus inches of snow?  I'd ski to work!  I'd find my snow shoes.  I'd probably end up here for a few days.

What about as far as the department?  Well. we have two four wheel drive ambulances.  The medics have a Suburban.  What if there are more than two calls?  We could take the squad it has four wheel drive.  We have those John Deere Gators we use for brush fires.  Yeah, and don't forget the snowmobiles.  Where are they stored?  What if we have a fire too?

You get the idea.  It's not a scripted show.  Talk, remember, relate.  We can see what didn't work on the TV and in the newspapers.  You can literally go as far as you want with this incorporating outside equipment and setting up unified command etc.  Just like the table top exercises that the training and planning guys do just on a different level.

Don't just sit there and say I'm glad it's them and not us.  Maybe you'll even get to Plan F.

Wednesday, December 15, 2010

Click, Click, Rats

Let's set the stage for you.  I'm the driver for the heavy rescue.  I've worked for this particular assignment for years.  Hell it seems like two lifetimes.  I love every part of it.  So when the first call of the night (in this case the whole day) comes in I mount up and hit the start button.  NOTHING, just click, click, rats.  Hand me a light, go through start sequence again, order firefighter to plug us in, tell officer we're screwed, special call squad, quiet except for cursing.  We have now switched to plan B.

Find the charger, locate the batteries (yes, there are five of them), and hope we can charge them up quickly.  Take out the rear forward facing seats to access the batteries hook up the quick charger and...wait.

We are not fond of waiting.

Now, think of charged batteries as a full can of your favorite beverage.  In this case our can was empty of beverage, squeezed by hand, thrown on the ground, and crushed flat by a truck.  These batteries were DEAD.  It's going to take some time to rebuild that can before we can refill it.  Now what the heck cased this major fiasco?

Reviewing the service records for the day we find that radio maintenance installed a new radio head swivel in the cab.  Dead short from new install?  Possibly.  At three minutes the inside cab lights come on.  We're making progress.  At six minutes we roll it over and it starts.  Recall by command.  So, what did we learn?

Trust no one.  Do your checks as required.  Maybe even start the apparatus just like we exercise the tools.  Know your apparatus- even the silly things like where the battery is located. And continue working as a team.  None of us will forget this episode for a long time.

OK, so my bad luck string has been extended.  MVA with entrapment and we are rolling out the doors before the dispatcher took his finger off the transmit button!  We got it knocked.  Two cars a couple of good injuries, fire up the Hurst tools (yeah we have two preconnected), door, dash, seat. Record time!  In fact I think the firefighter using the tool actually put it down and raised his hands like a cowboy riding a bronco.  That's when the engine guys started to reposition their hose line.  I sense that this is not necessarily a good thing.

I turn around toward my rescue and see smoke coming form the tool compartment.  Not a wisp but a full blown column of smoke.  Part of the truck is now out of sight because of the smoke.  The officer and a firefighter are already there trying to figure out what is happening.  As I am taking in the less than positive drama that is unfolding in front of me I detect some movement out of the corner of my eye.  The engine crew is sighting in the compartment and my guys for a super enema.  I casually step in front of them and after a brief verbal altercation obtain a consensus that water flowing at 100 PSI would not be the agent of choice for this particular happening.  I refuse to use the word emergency because that's more paperwork.

After years of electrically rolling up the Hurst hose the springs that fitted over the end of the hose to avoid a kink had slammed into a plastic relay cover just enough times to finally break it and have the spring metal make electrical contact.  Maintenance was summoned repairs were made and other rescues are now getting a  quick review of their electrical components and their locations.

I am working hard to figure out if this was actually number two or if I can think of another issue that gets me out of the "you know they come in threes" bonus.  Maybe it's time to take some  personal days.

Friday, December 10, 2010

EMS Sale! Limited Time! An Historic Event! No Money Down!

We lived through Thanksgiving Pre-sales, Black Friday Big Sales, and Cyber Monday Internet Sales.  Apparently EMS is feeling left out.  So today we are sponsoring a: call 911 for one and receive one free BLS transport masquerading as an ALS call.

I don't know who put the word out on the street but let's say we had more than our usual group of loonies.  This sale thing does not transfer well from retail store to public service.  It's 0630 and the over night boys are just returning after a whole night of not returning to quarters.  They look like, well, the bags under their eyes have bags.  Cue diabolical dispatcher number 911.  Ambulance, Medics difficulty breathing, chest pain, fall, possible OD, arterial bleeding, diabetic episode, psychiatric problem, I don't have any idea what he said because I was focused on my partner and what I thought he said: "You guys look tired why don't you clean up and go home."  No good deed ever goes unpunished.

I have an aversion to assisted living facilities.  I question both the assistance and the living but that's another story.  We arrive at shift change and are accosted by the workers: "Why are you here?"  Well, let's see, we know that you serve a great breakfast?  "Over here ambulance driver."  Allow slow burn to commence.

OK, so I'm not much to look at at 0630, but I have training, I have a uniform, and by God I have a name tag!

"Can you move that THING."
Pardon me?
"That YELLOW thing."
Are you referring to my stretcher?
"You're making me late to breakfast."  (Yeah, sure buddy, let me push this useless thing back five doorways so you can get your fat never mind to breakfast.  Don't worry about that elderly woman in the room that we always have trouble getting into because they got the cheapest elevator they could find, in the smallest size available, and it's built so even a wheelchair takes up most of the room and she's having difficulty breathing.)
Ah, wait a minute sir and we will be finished here.
"She's not sick."  (Odd that's what I was thinking.)
What would make you think that sir?
"She shut her oxygen off last night and didn't turn it back on."  (I may reconsider moving the stretcher for you new friend.)
Hey Newly Minted Medic:  Is her oxygen on?
"She doesn't have any oxygen."
"Yes I do sonny.  It's over there.  Turned it off because the hose gets all tangled up."
Let's put that back on like this young lady.  Cue O2 sat increase from 88 to 95.
"Oh, that feels better.  I can see again."  (Lord just take me now.)
Retarded Nurse #1:  Well  she still has to go to the hospital because I already made out the paperwork.
Cue Sprint commercial, as we stand in silence quiet enough to hear the old guy waiting in the hall pass gas.  I know they dropped a pin but my commercial is way more appropriate.
Do you want to go to the hospital?
"No need to I feel fine."
Sign here.
RN#1: Well you just ruined my whole day.  (Glad to have spread some cheer anywhere I can.)
By the way sir how did you know she didn't have her oxygen on?
"Hi Retired Gentleman."  Hi Elderly Retired Teacher.
I'm on my way to breakfast.  Can I get my teeth from the night stand?
Cue second period of more profound silence broken only by the sound of RN#1 jaw hitting the floor.
Retired Gentleman smiling as he pushes past to grab teeth.
Recall ALS, were returning.  Come on Newly Minted.
RN#1:  Can you take Retired Department Store Worker to the ER?  She hasn't been feeling good since yesterday.
Taxi 1 to it turned out only 9 more to go!

Monday, December 6, 2010

Waiting Room Purgatory

This missive is about appreciation.
During the last few days I must have been in the ER twenty or more times.  Before that, over the course of years I'll bet the person I walked in with never spent more than a few minutes on my stretcher before we waltzed in and deposited them in the good hands of the ER Staff.  That's literally thousands of calls, transports of all kinds, and "bing" go to the head of the line.  I will never take that position for granted again.

I have seen the dark side and I didn't like it one bit.  Powerless does not even begin to describe the feeling of desolation and abject uselessness as you sit there in the waiting room, well, ahhh, waiting.  But let me back up a moment.

My wife and I were honored to host several of my daughter's college friends for a weekend get away before finals.  They had fun, ate and slept too much and finally prepared to depart with me as their chauffeur.  Half way through the trip one of the young ladies developed abdominal pain and within a few minutes we decided that a visit to the ER was in order.  Cue music from the Twilight Zone.

Name, address, do you have an insurance card?  Now what seems to be wrong?  Severe stomach pain What's your age?  Oh, 17 and are you her father? Ah, no.  In loco parentis?  Ah, no.  Form, power of attorney, verbal approval? No to all.  Well then I guess we will just assume she needs care.  Cue evil organ music in the background.

There are now four other groups of people sitting strategically in the waiting room.  We walk in and are ignored, stared at, summarily dismissed, and given the once over as if we were there to take children from their mother.  No one looks sick.  I assume that our person, unable to sit without constant movement and moaning about pain, should rocket to the top of the Triage list.  I was mistaken.

The kid that was sleeping, the guy holding his finger, no not that one, and the old guy that sneered at us as he walked by to the coveted triage room all were seen before our now laying down and crying young lady.  I looked around momentarily for the "take a number" sign worrying that I had missed it on the way from the desk.  Instantly that reminded me of a bakery and I realized I would be starved until we sorted this whole mess out.

As my charges vacillated back and forth between school work and abusive comments about the staff I realized that they were planning a coup.  The girls marched on the RN receptionist and said "This is unacceptable.  Our friend is obviously sick and we have waited an inordinately long time to see a doctor.  Something must be done"  I marveled at their rookie attempt to intercede for their friend but I also immediately tried to distance myself from the expected volcanic eruption of wrath by quickly grabbing my cell phone and dialing 9-1 as I prepared to seek emergency help for these young and less than worldly girls who were about to be instantly chewed up and spit out by this wily veteran of the trenches.

The woman barely moved as I watched the drama unfold in the reflection of the TV tube, taking a breath and not even looking up from her computer monitor she quietly retorted "I don't know where you're from honey, but in my world you have to be the sickest one here to go next.  Please sit down."  She made Cool Hand Luke look like a nine year old with A.D.D.  I was in the presence of an ER God!  They did as they were told.

Eventually it was our turn and with the speed and reflexes of a hockey goalie the ER nurse took in the sick girl spun into the ER and closed the doors in front of the other three friends while at the same time mumbling something about limited space.  Not even the Great Gretzky was scoring an entrance in those doors!  I made the translation for the distraught crew and they again assumed the waiting position.

Mom arrived from her home hours away.  She is an ER nurse and through code words and body positioning she quickly bluffed her way past the receptionist, as if by miracle touched the unknown ER door opening mechanism, and gained entrance into the treatment area.  She stuck her head out and asked the girls to come with her.  They smiled and Cat Walked past the receptionist without realizing that she knew she held the true power and they only gained access to the inner sanctum of treatment with her unspoken approval.  I nodded my appreciation to her and for a nano second I thought that the corners of her mouth were curling up as if to smile, but she immediately regained her super powers and thousand yard stare as she returned to the computer screen.

Blood tests, CAT Scan, poke, and prod and the medical experts, along with the ER Nurse Mom, determined that an appendectomy was warranted and we received notice of such as we completed our return to school.

I now understand the hierarchy of an ER in much more detail than I had ever anticipated.  I appreciate the pass I get from the receptionist when I arrive with my patient, and to some degree I can now sympathize with those poor souls watching me walk by with another patient as they continue waiting in "Waiting Room Purgatory."  It's now time for bed.