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The Great War’s Impact on EMS

This year marks the 100th Anniversary of the United States entry into World War I.  In the history of the world the war to end all wars is considered a significant turning point in history.  There were lessons that were learned and mistakes that were made that paved the road to a future global war.  Scholars look back at World War I and discuss the failure of the Treaty of Versailles or the use of chemical weapons changing how future wars would be fought.  One of the most overlooked topics (until recently) that has not received extensive research and discussion was the role that medicine played in the war and the impact that it had on combat medicine and civilian medicine.  

During this war we see the foundation set for military medicine and we see the impact that Stretcher Bearers and Ambulance Drivers had on patient care.  It was during this war that people realised that you needed first responders out on the battlefield to begin treatment immediately to keep them alive so that the patient could get to the next level of care.  Unfortunately, that lesson was learned in the combat theater and was not given serious thought prior to going to the battlefield.

Today, military medicine is very progressive and the lessons learned in a combat theater are shared with other practitioners and in the last 50 years EMS has benefited from it.  When WWI began, military medicine had not seen any changes since the Civil War.  When the United States entered in 1917, the Army did not have an established Medical Corps.  The Army was left to learn from what the British and French had learned 3 years prior to U.S. entry into the war.   The system that the Americans would copy is by having care being given to casualties on the battlefield.  Care would begin with the wounded receiving care from a Stretcher Bearer and then moving the wounded to an Ambulance.  This concept of providing early care to the wounded gets its first test during World War I.

The Stretcher Bearer has much in common with today’s Emergency Medical Technicians and Paramedics.  A Bearer would go over the top of the trenches into a dangerous environment unarmed with a medical bag in hope of sustaining the casualty until they could get them to the next level of care.  Bearers would work in teams of 4-6 and would often have to carry a casualty miles through thick mud.  These long carries were so long and both carriers and the casualty had experience so much that many bearers felt that they had been 

passing over a life long friend to the ambulance rather than a patient.  Some Stretcher Bearers faced sniper fire and would stay by their casualty protecting waiting long periods of time before they could move their patient on to the next level of care.  

A Bearer could always be recognized from his hands.  The wooden stretcher handles did not always do well in the harsh elements in Europe.  The wood would splinter and was rough causing handlers to have hands that were calloused and splintered.  Bearers were seen by Medical Officers as men that could make a difference in patient care on the battlefield.  Many doctors saw to it that Stretcher Bearers and Ambulance drivers received ongoing first aid training.  Other officers such as Chaplains kept a close eye on Stretcher Bearers and made sure that the overworked responders get sleep when exhausted.

Stretcher Bearers were not the only medical personnel exhausted on the front line.  Once a Bearer removed a casualty from no-man’s land a patient would then continue their journey to a Casualty Clearing Station via Ambulance.  Ambulance drivers would often have to navigate their way to makeshift field hospitals while encountering rough terrain, enemy fire, and patients screaming in agony.

When a patient made it to a Casualty Clearing Station they would be reassessed and decisions were made if the patient needed to be brought to another level of care or treated at the Casualty Clearing Station.  In the first industrialized war of the 1900s nations did not place enough emphasis on patient care.  

Many of the ideas born on the battlefield during WWI are still being used today on the modern battlefield and in EMS.  The Thomas Splint was used to stabilize femur fractures and is still being used today.   When used it dramatically reduced the mortality rate.  At clearing stations doctors began to use X-Ray machines to locate bullet wounds and shrapnel in patients.  Doctors were also learning new ways of treating contagious diseases, burns, and tissue damage.  The lessons learned in Clearing Stations were used to train first responders on the battlefield.  

Military Medicine to Civilian EMS

Many of the common procedures used in EMS can be traced back to World War I.  However; it was not until the mid-1950s when physicians began to ask why lessons learned for emergency medical treatment and transportation during war could not be applied to civilian use.  Drs. J.D. “Deke” Farrington and Sam Banks used these combat lessons to develop a trauma training program for the Chicago Fire Department. This program later developed into an EMT course.

Recently some of the combat medical treatments that are applicable to civilian EMS are the use of tourniquets, hemostatic agents such as Quick Clot, and Chest Decompression.   The concept of 

making sure people on the frontline have the necessary equipment to treat injuries has emerged in Law Enforcement.  Soldiers, Marines, Airmen, and Sailors that operate in a combat theater carry an (IFAK) Independent First Aid Kit on their Flak Jackets including tourniquets, Israeli bandages, and other trauma dressings.  Many law enforcement officers nationwide carry tourniquets or a modified version of the IFAK. 

The U.S. military continues to identify better means of providing care to combat casualties. EMS can now learn from these experiences to improve the capability of the EMT and paramedic so they can provide better EMS care to our citizens.  When we look at the initial care provided to patients in combat or in the civilian world when help is called for the initial treatment begins with a courageous responder showing up with a medical and using their training and experience to get the patient to the next level of care.  That concept of giving an individual some medical training and then sending them out into combat over one hundred years ago to save lives has not changed.  In the future, EMS will continue to benefit from what is learned in combat because unfortunately, war is good for medicine.  

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What Do You Think We Are Doing?

 

Let’s talk about EMS for a minute…

There are industry-level publications, internet sites independent from the magazines and countless bloggers out there that have an opinion. I am no different. I pluck away at the keyboard and think that I can provide some insight, using the experience, which at this point, has spanned more than 20 years. Sixteen of that being in a busy(ish) urban department as well as the private sector, volunteer and any combination of the above. I have been in and out of administrations and held several command positions. I try to give my take on issues that I think warrant attention. I just finished my 24-hour shift which consisted of 8 calls. Not a bad shift. A little lighter than normal. I’m used to the double digits. We didn’t get beat up too bad. So anyway, I know you didn’t ask for my opinion, but you are still reading this so you might as well hear what I’m on my soapbox about this time. Have you a few minutes to kill? Or, at the very least, are you wondering if I will say something witty or lay on the sarcasm that is familiar to just about everyone in EMS? Read on to see if your dreams come true.

So today’s rant; pre-hospital emergency care! Shocker, I know!

Ahhh yes, what we all are doing whether we like it or not. What even the busiest departments in the country can no longer ignore. The fire service’s under-appreciated step-child (in most places) and the thing that pays the salaries of a lot of “dragon slaying”, “grievance filing”, “door slamming, when they get a run”, “treating their patients like shit because they have to be on the medic unit” fire service employees. The thing that has kept some departments afloat during hard financial times. That’s what we will be talking about this time, so let’s explore what is rattling around in my head.

What do you think we are doing out here? It’s a weird question to some, simply because I don’t think it is asked too often. When you ask the new guy or gal, he or she will say we are out here to save lives by implementing all of the groovy things they taught us at the learning annex in our emergency medical technological implementation class. If you ask the “salty dog” they will say that we are the ones crazy enough to stay up for 24 hours straight to cart the crazies to the ED so they can jump on the bus and be back home before you are done with your report. My opinion of us is somewhere in the middle, I think. You may not perceive it that way by the end of this post, but who knows.

Credit: Paul Combs

I can hear you saying, “get to the point” so here we go (you’re not the boss of me by the way). When I was a young, green, two-pager-wearing, CPR mask on my belt, car lit up like a Christmas tree EMT; I was ready to save the world with the 120 hours of training that I received. I was ready to be a “code buster” as noted on the t-shirts of my local squad and ready to snatch people from the jaws of death like I had read about in all of the periodicals stacked up at the squad house. I was “doin it” on the 68 runs I took my first year as an EMT. I was a hero to my family and friends, and my mom couldn’t stop bragging to her coworkers and pointing out the picture of me in my gear that was on her desk. What has two thumbs and drives the ambulance while the medics work in the back? This guy right here! I wouldn’t say I was Johnny and Roy, but I could make a mean cot and restocked the ambulance with 4000 4×4’s because I knew that bus crash would happen sooner or later! Oh, they let me do CPR a few times…….not bragging……….just saying.

Now, when I get to work with a new EMT and their wet-ink Registry card, I find myself wishing I had the same boundless energy to help my fellow man as I did back then. I get a boost from those guys or gals for a minute but find myself spending the day dispelling myths about some of the crap that they were taught in school. At the end of those days, after snatching people from the jaws of mild discomfort, I wonder what kind of Kool-Aid they are feeding them in their training and what they think they will be doing out here on the street. I think back on conversations I had with the senior members of my squad about what we are doing. That’s after the adrenaline wore off from me driving them through traffic with the noise and the cherries activated!

What do you think you SHOULD be doing out here? Do you honestly feel that you are having the greatest impact on your patient’s clinical course, more so than what the hospital will have? Do you believe that YOUR treatments will “make or break” the outcome of the patient’s recovery? Some of that holds true, but there may come a day when you question that, and that’s okay. Some days you will feel like you are just giving people rides or “hauling freight” as someone mentioned to me once, and that’s okay. Just don’t get stuck there!

Or do you feel like I do? Do you feel like you have an impact on the entrance of the patient into the healthcare system at that time in history? Do you realize a greater portion of your patients need to be at the ED more than they need to be with you? Do you try to get as many of your “skills” done before you get to the ED? Do you feel like most of your “skills,” if done well and for the right reasons, will shave some time off of the patients ED evaluation? Do you know, just by looking at someone, that they need services provided by the definitive care facility and not by EMS? Do you feel like what you say in your hand-off report to the ED staff can get the patient what they need more rapidly? I certainly do. I know by looking at the septic, unresponsive nursing home patient with a 518 blood glucose and a 104.5 temperature that I can get them started. They need to be in the ED and ultimately the ICU and not sitting outside the nursing home in my medic unit while I try to get the $35,000 blood pressure machine hooked up, ECG leads on that won’t stay because the patient is diaphoretic and an IV started after two attempts. The patient needs to see the ED

doc, not me. If I get all of those things done on the way to the ED then “YAY” for the patient and me. Don’t get me wrong; we have made leaps and bounds in pre-hospital care with trauma, STEMI recognition and treatment, stroke recognition and pediatrics. We have a direct impact on the outcomes for those patients and need to be excellent at doing those skills in rapid fashion to give those patients a chance at a full recovery. Keep in mind that we are supposed to be RAPID transport. Not everyone needs you to do you. Some of these patients need the ED, plain and simple.

We need to know what we do for our patient affects them throughout their clinical course to their discharge from the hospital. Don’t be afraid to learn as much as you can from the hospital about how your patients progressed through the hospital system and their outcome.

I have had discussions with colleagues about this subject and have been accused of discounting the effect of EMS in the healthcare system. I always argue that point because I don’t feel like I am. (Clearly, otherwise, I would not be arguing!) I am just trying to keep a clear understanding of what I think my role as a paramedic is. I am the initial contact with the healthcare system at any given point, so I feel I should do everything I can to get them to the right hospital for their needs. My department transports to six different hospitals including level one and two trauma centers, a children’s hospital/trauma center and a Veterans Affairs hospital. I am the advocate for most of my patients and have gotten good at tailoring my hand-off reports to get the ED staff to focus on what the patient needs right now, and what they can take care of in a few minutes. I also try to steer my patients to the facility that will best suit their needs. I try to teach that to the new folks, but it is a hard concept to grasp for some.

I tell the new folks to look at it like this. You can be in the ED, or at least half way there, in the time it takes you to sit out in front of the patient’s house fumble f**king around. I understand you’re trying to get IV’s, scrutinizing their vital signs, getting the $98,000,000 monitor to take a blood pressure seven times or putting the patient through the “inquisition” about their past medical history, but you should get going. Put it in drive and get going. Nothing is more awkward than the family sitting in the car in the driveway with the shifter in reverse, waiting for the ambulance to move in the direction of the hospital. I’ve seen thirty-minute on-scene times AFTER the patient is loaded into the unit. That is infuriating to me. What are you doing??? It’s neat to meet new people but Christ on a bicycle, you could have been at the ED by now! Do you think that IV is worth holding up the show? Do you not have the skill level to take a manual BP after your forty-eight attempts with the monitor? I mean really? What do you think we are supposed to be doing out here? Granted, you may need to hold still for a minute to get a clean 12-lead or to do something special before you start bumping down the road. Applying CPAP comes to mind. We have all had that partner that thinks that they are driving a Lamborghini to the hospital and throws you around the patient compartment. Sometimes you need to do a couple of things so you can sit down and not die, but outside of that, you need to get rolling. You need to be good at doing your skills on the move. Surfers don’t win surfing competitions by standing on the surf board on the beach, they ride the waves and do that hand signal thing with their thumb and pinky finger. I have a RonJon shirt somewhere with that on it. Dude. Learn to do your skills on the move bruh!

We need to realize that we are not the wizards of pre-hospital sorcery that they convinced us we were in school. They tried to teach me to be an amateur cardiologist in paramedic school. They tried. I do the best I can. I have dumbed it down to whether the patient is symptomatic or not. It’s cool that I can spot that PAC, but this asymptomatic patient needs to follow up with his cardiologist. I am good at STEMI recognition, but we have dumbed that down to by saying if it sounds and looks and feels like a heart attack, even though you don’t have STEMI signs, you need to treat it as a heart attack. You really never know right? At least until you get a Troponin level……..at the ED. No sir, your properly working pace maker is not going to kill you. Your underlying cardiac disease probably will, but we are all just counting out the birthdays anyway, am I right?? (frowny face emoji)

Photo Credit: Scott R. Rosen

There have been several studies about the effect of rapid transport by the first arriving unit on the scene. One study I read compared the outcomes of patients brought to the ED by the first arriving police unit as compared to the first arriving EMS unit. The outcomes were almost identical, with some outcomes being better when the patient arrived by the police officer. Those results are sobering and will make you wonder if what we do is even worth it. I think that as we evolve, we will continue to examine what aspects of our work do the best and focus our attention on those things. There will be new information, and we will be reactive to it and proactive with it. Hopefully, we will move more quickly to embrace the information; I’m looking at you, departments that are still backboarding! Are you dumb or just plain stupid?? Stop using “standard practice” as a reason to do it. Driving stakes into the brains of “crazy” people used to be standard practice but we quit doing that.

What we do is worth it. I had to put that in there so the new generation of “everyone gets a trophy for showing up” will not throw themselves off a building or be sad. (another frowny face emoji)……(and the one that looks like it is crying)emoji-sad-face-yesyou-read-that-right-ALoN3i-clipart

So ultimately, we are responsible for our actions and what we can provide to our patients. We need to stay current and proactive. We getty_rf_photo_of_ambulanceneed to check ourselves before we wreck ourselves and try hard to provide rapid, quality pre-hospital care. It is what we do and is what we are supposed to be doing out on the streets.

We are often labeled as “Jacks-of-all-trades” when it comes to what we do. If you don’t feel like you have a broad enough understanding of what you are supposed to be doing, go out and find the knowledge. Work in different aspects of this business. I spent some time in a hospital-based air and mobile intensive care system. The short time I was there was invaluable in my eyes because I learned what happens from the time the patient was brought in by EMS until they were discharged. It gave me a different perspective on how I treat my patients, who gets advanced airways and who does not and what skills I can do in the field to impact the patient throughout their clinical course.

Be skilled and be quick. Get your patient to the definitive care that they need. Get your ego in check and do what is best for your patient. Listen to them. When they sweat, you sweat. Listen to the answers when you ask a question. Do your job and do it well. We are out there to be the first person they see on the day that their world may be crumbling. You should be honored that they trust a stranger to help them!

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Hey, What’s it like to be a Paramedic?

I am sure that most of you have heard that question 1 or 200 times throughout your career. It is a topic of interest to the people around you and at the holiday parties that you may be attending this time of year.

Note: I use “Paramedic” as a general term to mean EMT, Firefighter, and/or First-Responder because the general public doesn’t know the difference, usually.

Every Paramedic has an emotion attached to that question. With some, it triggers their depression. In some, it sets their mind on a journey of every horrible call they have been to their entire career. Some get defensive because they feel like they are being scrutinized. Some get excited and are more than willing to tell people what they do and sugar coat the bad parts, so the sweater vest wearing guests don’t reel back in horror. Everyone has their own response to the question but the core of what they tell people is about the same.

ParamedicWhen people ask me that, I have just about every emotion listed above depending on the situation. The last few years, I have gotten a bit evasive because it has proven, in the past, not to be the question that they really want to ask. I try to get them off of the subject as quickly as possible with a quick “it’s a great job, you meet a lot of interesting people or it’s a different thing every day and that’s super duper” type answer. The entire time I am trying to deflect them, I am thinking ” you don’t want to open this Pandoras box” or “please don’t make me think about that stuff right now, I am having a decent time” but I try to wrap it up and ask them what’s up in their life.  It’s worth sitting for the next 20 minutes while they talk about how little Johny did in soccer or how Amanda did in gymnastics. Your kids are awesome (sarcasm). I love my kids (not sarcasm); even more so now that they are becoming adults and are out in the world. By the way, your boy looks like the dead kid I drug out of a 1995 Cavalier back in ’99. I love parties!

Anyway, the person asking the question doesn’t want to know what it is like to BE a Paramedic; they want to know what is the most horrible thing, the second most horrible thing and the top 10 ways you have seen people die as a Paramedic. They want a sample of what you have rattling around in your brain. They watch Chicago Fire and Nightwatch and assume that what they see is the real deal. I will give credit to Nightwatch, at least it is following crews on the street and attempting to show what it is like to be a street medic. I don’t have that many patches on my shirt, and I don’t call every patient “babe” or “Hun”, but it is a decent representation of our job. It is primetime TV however, so the rough stuff is blurred out. We are not lucky enough to

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be able to blur that stuff out of our memory.

 

I have seen several articles and blogs about the subject of this question and I find the responses interesting. They range from the conversation almost ending in a fist fight to the story teller breaking down into a puddle of their own tears, leaving the minivan driving guests trying to figure out why someone would do that kind of work for that kind of money and why that person was invited to the party. Your tears don’t go well with my Chardonnay and the guacamole dip. Whatever the result, we are the ones who are left at the end of the night feeling drained and violated mentally. The act of asking that question is the preface to emotional turmoil for the Paramedic. It is a scary place so answer the question at your own risk.

So what do I think about when that question is asked to me? Well, it immediately fires up synapses that are usually dormant, and it begins the roller coaster of emotion that I usually bury in alcohol before the night is over. If there is no alcohol, I probably would have left the party before the question is asked. Anyway, I usually ask some “safety questions” to the group that is congregated around. Like “do you really want to know” or “you don’t want some of this in your head so are you really that interested”? That is usually my subtle way of telling them that whatever your nightmares are tonight are not my fault.paramedic-main-image

Side note: I don’t want to give the impression that I work the party circuit during the holidays. I very rarely go to parties (the whole introvert thing), and I stay pretty quiet when I do end up at one. I get asked that question at various time throughout the year, but it comes up more for all of us this time of year.

So off we go on our emotional journey. I gauge what stories I am going to tell by the crowd that has formed. If they are people that know me pretty well, I talk about some of the more horrible stuff. If they are strangers, I keep it PG-13ish and leave out some morbid details. Some stuff that we see is impossible to explain to regular people because the only way it makes any sense is to see it first hand and absorb everything that led up to what you are looking at. We digest the information on scene and put it in our brain vault for later. I don’t try to give them a warm and fuzzy feeling about being a Paramedic because it is not warm and fuzzy (most of the time). I am honest and try to make them understand what the healthcare system looks like from the pre-hospital point of view. I try to give them insight on how a Paramedic fits in the overall scope of the system and how what we do affects the clinical course of our patients on down the line. I use the analogy that day or night, you have to go to a place you have probably never been before, talk to someone you have probably never met and decide whether they have a general math question, a story problem or a calculus equation for you to solve and you only have 5-10 minutes to solve it because you will be at the hospital ED in that amount of time. That doesn’t hold their attention for long because lets face it, they are all voyeurs. They want to peer into the dark parts of the job because, deep down, they are excited by stories of the suffering of other people. At least the ones they think are below them in social standing. They don’t realize that they are only one drift across the center line of being that ground beef in the drivers seat. That they are one Oxycontin away from being that unresponsive on the living room floor next to their daughter’s power wheels pink Jeep. That they are that one misplaced candle away from needing to be drug out of the inferno. That they are one cheeseburger away from being that coworker that their office pals had to do CPR on before I get there. They don’t realize that they could be that person that is minding their own business and gets hit with a stray round from the gun fight one street over. They don’t think that they may be a few failed life events away from being that

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homeless junkie I had to revive. They don’t realize, and I am jealous sometimes that they get to go through their day without thinking about those kinds of things or not remembering a call you had six years ago and thinking if I had just done that one thing, that person may still be alive today.

 

So I lay it out for them if they can take it. I talk about working full arrests on people that are younger than them and that those people don’t spring back to life after I shock them then hug me as we sing “don’t stop believin’”. I talk about how I had to lay in mud so that I could talk to the 19-year-old kid that is in an upside down car with the brake pedal jammed through his leg and his dead friends head stuck under the seat from the impact. I talk about how I went to a full arrest at a nursing home to find a guy my age who has been down for 10 minutes before they even called, cool to the touch in the extremities, has cancer and had refused hospice care and have to ask the lead Paramedic “what are we doing with this because someone needs to make a decision”. I tell them about handling 4 or 5 overdoses in the same shift and giving Narcan to the same person twice in 12 hours. I tell them about doing CPR on a 90-year-old woman and feeling all of her ribs break with CPR while her husband of 50 years stands next to me and asks if I need any water or if he needs to take a turn at compressions. I tell them about the time I went on a call to find one of my dad’s best friends crushed under a piece of farm equipment and having my dad ask me every day for a week what happened and how his friend looked when I got there and had to say to my dad “you let me keep that picture in my head. You don’t want it. You just remember him how he was”. They are on the edge of their seats and hungry for more, like waiting for the next action scene in a movie. I give them a lot, but I know when I have had enough, so I switch gears.

I start talking about the people that stop us when we are out getting food to say thank you for our service or pay for our meals. I tell them about the frail old lady who apologizes 30 times for calling me in the middle of the night to take her to the hospital because she is at the end of a very long road and knows that she probably won’t make it out of the hospital this time but wants something to ease the pain. I tell them about how awesome the shift was when I got to sleep all night. I talk about reading to the kids at the elementary school and talking to community groups about fire safety. I talk to them about the fun and frustration of mentoring new Paramedics and new employees. I talk to them about how we support each other when that horrible call kicks us all in the st

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omach. It gets emotional, but I use my 20 plus years of cramming my emotions down my spine and keep the conversation lively.

 

So we all have to deal with that question at one time or another. It brings out emotions in all of us that hang on for hours or days at a time. As I said in the last post, we all have different career paths. I may have seen more than the guy on my left but not as much as the girl on my right. They have been through what they have been through, and I have been through what I have been through. It affects us each a different way. Your answer to the question will be different than mine. That’s the way it is.

What will you have to say when they ask you? I would suggest that you be honest. If you get emotional, let them see that to. It may help them understand that the job you do is not like working on an assembly line or delivering the mail. Your job is woven into who you are and, in time, is wired directly into your heart and brain. That talking about it sometimes helps us to heal some of the wounds that we have acquired over the years of our career. Know when to say when. You need to know when you are done talking about it.

My answer to the question has changed over the years. The one constant is my ruthless attempts to freak my mother out about the situations I get into. I like to hear my mom say “I’m glad you are safe.” It never gets old.

What will your answer be?

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What Percent are You?

Note: The bulk of this post deals with fire department EMS, so if you are not in a department that does fire department EMS, you may find it uninformative. Those of you that do fire department EMS, read on!

As you can imagine, I spend quite a bit of time on social media. I have slow shifts like everyone else, and I have time during my off time to decompress and be a couch potato, so I try to read and follow other fire and EMS blogs and social media pages, just to get a feel for what kind of attitude we have as a “business”. As such, I read articles and posts from various authors about various subjects and in turn, hear various opinions about the same topics or subjects. I am no different. I propose my opinion on subjects and try to give some background as to why I feel the way I do. I will admit that I do not get to travel and dine in the finest firehouses across the country like other “bloggers”, but I get a sense, from what I read, that the issues that I deal with are similar to other parts of the country. Granted, we have varying protocols and levels of service, but we all generally follow the same basic underlying methods and practices to do our jobs.

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(Image courtesy of the Gasper Township Fire Department, Eaton, Ohio)

That being said, I have read several articles about being part of a percentage of firefighters that “gives it their all” or “trains until the sun comes up” or “they are the salty dogs that you should look up to, seek out and gain knowledge from. Ones to model one’s career after”. I agree with that fundamentally, but I have rarely seen articles about finding the senior EMS guy or gal and learning from them.

I have learned from some senior folks. I soaked up knowledge and learned the tips and tricks that made me a better fireman (at least it felt that way). They made me a better operator and gave me perspective on how to train the new guy, now that I am the “senior” man on many occasions. I have learned from street-wise and seasoned medics as well. I have always valued what I learned and have tried to pass it on as much as possible, but I am starting to wonder what the current “senior” folks think this business is supposed to be like in 2016. My opinion of this job seems to get further and further away from their opinion, and I find that curious.

I read recently that the FDNY and Detroit Fire are in the process of a major “overhaul” of their operations. Namely because of the fire load (the amount of fires they are fighting) has gone down and the EMS load is going up. That article struck a chord with me. Here are two of the busiest fire department in the nation taking another look at how they operate. I can almost guarantee that there are men and women in the FDNY and DFD rallying against changes. It’s what we do, right? Change is scary! From what I have read, the unions are taking what appears to be a “middle of the road” position right now so it remains to be seen how this will turn out, but I began to wonder, as I stated before, what the senior staff thinks the fire service should be like in 2016. Were they surprised to hear that they need to focus more on EMS? I am reading as much as I can about their issues, and it remains to be seen.

There is no doubt that a number of fires have dropped off, and the EMS calls have gone up in almost every area of the country. We are turning out on more and more weird and wonderful EMS related calls and even more that are due to the failures of the public health system. It’s a busy life for the fire department EMT/Paramedic, and it will only get busier.

ems27So what of it. What’s the point? My point is this; it seems like our senior staff members continue to tell our cadets, our rookies, our new hires that “slaying the dragon” should be the highlight of your career. That being the 10% firefighter is what it means to BE a firefighter. That “doing work” and “getting some” are what makes a firefighter a firefighter in the firehouse. That EMS is just something that we have to deal with, as if it will go away in the future. Is it really? In 2016, does that make you the model firefighter? I submit that it does not.

Time and time again, I hear senior staff complain that “when they backed the ambulance in this firehouse, we quit being a real fire department” or that we don’t GET to fight fires anymore because we are taking all of these EMS calls. Really?? You have got to be joking! When I was a Chief, I told my staff that if they continued to complain about EMS, I would pay them using the fraction of funds gleaned from putting fires out. Once I broke down the percentage of the money they earned from fire and from EMS calls, they decided to be more proactive about transporting instead of trying to get refusals, and they didn’t feel as salty about not getting to slay the dragon every day.

I don’t see putting fires out as the greatest moments of my career. Yes, I had some great times kicking doors in and throwing water, and I still do. I love being an engine operator even more now and I love working on the truck, but there is so much more I have done that I am proud of. I have touched so many lives over the years. Some of my greatest “holy shit” moments came in EMS. Some of the “jobs” that made my heart pound out of my chest were in EMS. Some of my proudest moments were in EMS, and some of my biggest defeats were in the back of an ambulance. I have made a point to be the one of the 10% that completely changes the mood of an EMS scene for the better when I arrive. I have made a point to know more than the other guys about medicine and the future of our field, and I share that with the new guys. I feel I am part of the 10% but for other reasons that I feel are just as important as knowing how to force a door 29 ways.

Cc_akEUW4AASFx0I am not saying that firefighting isn’t important work. I truly believe in training until you can’t get it wrong. I get just as frustrated with poorly trained firefighters as anyone. I watch the news or videos on YouTube and armchair it with the best of them. I have put as much effort into being a good fireman as I have being a great medic. I will never feel like a bad ass dragon slayer. It is not my nature. I come from a line of lawyers and stamp collectors, not blacksmiths, butchers or bodybuilders. I have never claimed to be macho, but I can think my way through a difficult airway, a confusing medical call or a wicked trauma. Those skills are what makes today’s 10% in my opinion. We are EMS departments that fight a fire on occasion.

I have seen the FTM-PTB (fuck the mutts-protect the brothers) stickers around, and it makes me uneasy. Who are the mutts? Are they the ones that don’t think the same way about the fire service as you do? Are they the ones who think the medic is exciting? Are they the nerds? You should look around. Some of the leaders in this industry are hanging on every word that comes from NIST. The nerds are taking over so maybe it is time for a shift in perspective. I know the usual explanation is that the mutts are the ones who don’t care about training or drilling or working as a team. Can we put those hose jockeys that think that EMS is a stupid waste of their time in the mutt category? They aren’t embracing all aspects of the job, so does that make them a mutt? I mean, they have to stop dropping weights in the workout room or have to stop molesting the forcible entry training prop to take a stupid EMS call so do they have the right attitude about what this job should be in 2016?

The fire service is mired in tradition and therefore mired down in traditional thinking, so I expect change to come slowly. We still don’t realize that the equipment pays our salary, so we don’t take care of it. We are slow to purchase EMS equipment that would drastically change patient outcomes. We are slow to support the part of our business that generates revenue. Big red firetrucks look cool but if the wheels are falling off the rig that supports 1/3 or more of your budget then why would you neglect it? It’s a weird business model that will eventually shift for the better.

(Robinson Kuntz/Daily Republic)
(Robinson Kuntz/Daily Republic)

I rambled a bit on this post, but I hope you can get through that and see my point. It is time to redefine what we see as the “model firefighter” in my opinion. Knowing how to be successful in EMS will carry that firefighter into the future. Making sure they feel comfortable in an ambulance is just as important as them being comfortable climbing a ladder. This is a team sport, so if all of the team members are not trained up, in all aspects of the job, the team will suffer.

I work in a department that, when you promote to Lieutenant, you no longer have to ride the ambulance. I was operating the engine the other day for a newer Lt. and I said: “I trust you with my life in a fire, but I am getting less comfortable with you helping me on the medic”. With a strange look, my Lt. said ” why is that, I’m still a medic”? I said ” it’s because you don’t see patients anymore. Your skills are going to fade”. He agreed, and we had a good laugh, but I was being honest.

So what percent do you want to be? I want to be part of the group that sees past what we are doing today and looks ahead at what we can become. As a Chief, I always was excited about well-rounded employees because I knew I could plug them into any spot and they would excel. Can you excel in every spot? I hope you can!

As I have stated in the past, I am in no way an expert in the field. I am not a professional writer either. I just post my opinions in hopes that it will promote a dialog or get people to think about our business differently.

Thanks for stopping by and stay safe out there!

Blog

My Dad’s A Paramedic

Tomorrow morning, January 5th 2016, a born and raised Texan Paramedic will retire from EMS. Becoming a part-time or speciality paramedic might be in his future, but for now, he will be retired.

This guy has worked his shift and covered other shifts. He took the ambulmace home and parked it in his driveway as that was the way it was done back then. He awoke in the middle of the night, multiple times a night, to respond to 911 calls. He’s laid in ditches with your 12468067_578033670656_2030980316_nfamily members. He’s laid in the summer heated streets on his belly to comfort a child hit by a car. He’s been there when a child was rescued from a storm drain. He’s helped your family member after they’ve had a seizure. He has driven millions of miles in the front seat of an ambulance. He’s crawled into ditches after a tornado to rescue men covered by debris. He’s hugged family members of victims that didn’t survive. He’s carried and “worked” kids that he knew didn’t stand a chance. It’s impossible to count how many people he has touched in his career. A career that spanned for 37 years.

He has created an educational program from scratch as an advanced coordinator and instructor. He taught many EMT-Basic, Intermediate, and Paramedic classes in his years.

Did he change the field of medicine? No.12494159_578033710576_225909165_o

Has he done anything that thousands and thousands of other paramedics, emts and firemen do day-in and day-out around the world? No.

12483268_578033690616_1523739146_oWhat he has done is this job, is remain unwavering, passionate and kept the drive that a lot of people will never have nor see.

He is a Paramedic. A street medic. In my eyes, he is the best Paramedic I have ever seen work the field, (no discredit at all to any of the other EMTs and Paramedics I’ve worked with). You see…this guy I’m talking about is my dad. He’s 63 years old, and he began a career of helping people in 1979.

Tomorrow he will retire. He will hang up his stethoscope (that he never wore because he believes that everything he needs is in the ambulance and doesn’t need it around his neck haha).

Good luck dad. The service of EMS needs more guys that can do this job and see these things for 30+ years.

P.s. I’m proud of you pops.

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Blog

Life of a Firefighter

This weekend, I had the chance to go back to my hometown for a few days. I had just finished off a brutally busy 24 hour shift driving the engine and headed back home to the sleepy little New England town where I was born, raised, and started my career. I rolled in to town at about 10pm and headed to the local watering hole for a beer with my dad. I hadn’t been home in quite some time, and I was excited to see some familiar faces, relax a little bit, and get away from the hectic pace of city life.

 

The place was typically half-empty when I walked in, and my dad was running a little late. I pulled up a stool, ordered my beer, and took stock of the other customers. It’s been three years since I left my hometown, and most of my friends have moved on, so I wasn’t really surprised that I didn’t know anyone in the place. A few girls looked sort of familiar, but one face in particular stood out to me.

 

A pretty brunette, in her late twenties, she was seated with her boyfriend and a few others to my right. She just looked really familiar to me, but for the life of me, I couldn’t recall how I knew her.  I didn’t pay too much attention to it at first, not unusual to see someone vaguely familiar in this pub, we probably had a mutual friend or something. My dad and a few friends of mine arrived and we all started catching up on the small town gossip.

 

For some reason the brunette continued to distract me. I polled my buddies to see if any of them knew her, but no one seemed to have any idea. At this point I was really getting annoyed by this little mystery. I was sort of eavesdropping on her conversation, trying to pick up on any clue that might help me figure it out. She was really happy, she and her boyfriend had just moved in together, gotten a lab puppy, things were going really well in her life it sounded. No clues to her identity though, I decided to give up trying to figure the whole thing out.

fig,asphalt,mens,ffffff.u3

Then she moved her arm.

I’m not sure how I even noticed, but on her forearm, next to a tattoo, were a few small scars. The memory came crashing back down on me.

It was a cold rainy night, on a back road. I remember the rain, it was the sort that soaked you the instant you stepped out the door. She was in the front seat of the car, grey, respiratory arrest, needle on the passenger seat. It was a pretty typical overdose, little Narcan, some oxygen, and she woke up in the back of the truck. I remember specifically how upset she was, crying, screaming, begging us to end her life. The girl, like so many others was hooked on drugs, and just wanted off the roller coaster that is addiction, even if it meant death.

I don’t know this girl’s story, but she seemed healthy, happy, and clean. Who knows what her life is like on a daily basis, addiction is a never-ending struggle, but in that moment she was just another happy girl at a bar.
One of the tough things in this line of work, is that you very rarely know what happens to the people you interact with. The people we serve, we meet on runs, you usually never see them again. It’s always said that you can’t keep score, how many live, how many die, good calls, bad calls. But it’s nice to know, that at least some of the time, things do work out.

I ordered another beer and got back to talking to my Dad, it’s good to be home.

HeroPrep.com

 

Sean Peltier is the Chief of Operations for HeroPrep.com. He is a career Firefighter/EMT and works as a Fire Service Instructor.

Blog

Are You Ready for FirstNet?

Is FirstNet going to change the way we communicate or is it the first major step to Skynet? Could the network become self-aware over time?

Conspiracies aside.

Is your Department talking about Firstnet with their state government? In February 2012, President Obama signed the Middle Class Tax Relief and Job Creation Act. Boring right?  WRONG!  Contained inside this now 3 year old law is a $7 Billion gift to First Responders called the First Responder Network Authority or FirstNet; (FirstNet.gov) an11421418_10152986878322075_1848270963_nd this gift has been funded in the 2015 budget. Thanks Obama…

FirstNet will be the first-ever U.S. nationwide first responder exclusive LTE broadband network available to encourage interoperability and increased reliability with emergency response along with the ability to improve services. The early stages of this idea originated in 1993; technology kept evolving so fast that research committees couldn’t keep up with the innovations. The stuff I’m talking about here is already what we’re doing behind the scenes with commercial cloud based products, commercial internet, and our iPads or Engine laptops. The only difference is that FirstNet is designed for us with resilient protections to guard against failure during times of crisis. FirstNet is the medium we’ve needed to fully realize the spirit of interoperability preached in NIMS. Finally, our current patchwork of Motorola radio systems on different frequencies will all be brought under the same 700Mhz umbrella…NATIONWIDE.

HsAFTkBR_400x400The wide ranging services offered by FirstNet is what’s most exciting. Here is a snippet from Firstnet.gov “The FirstNet organization is the first of its kind. Never before has Congress established an independent government authority with a mandate to provide specialized communication services for public safety. Using nationwide 700 MHz spectrum, FirstNet will put an end to decades-long interoperability and communications challenges and help keep our communities and emergency responders safer.”

 

 

And this is going to be AWESOME! We’re talking ambulances sending pictures of accident scenes ahead to hospitals prior to patient arrival, communication across platforms, the ability to pull up GPS mapping, building pre-fire plans, handheld finger print scanners.

“Using the FirstNet network will improve situational awareness, decision‐making and responder and citizen health and safety. Just as smartphones have changed personal lives, FirstNet devices and applications will ultimately change the way public safety operates. FirstNet devices will work anywhere on the network and will save time when seconds matter. A market of millions of public safety users will bring savings opportunities to state and local budgets. FirstNet will bring the benefits of a single, nationwide, interoperable network that is built to open standards to public safety agencies across the country.”

 

I’m cautiously excited to start seeing this stood up.  It’s going to be interesting to see the kind of information that will be available at our fingertips and how this will enable interoperability.
This network could also provide the First Responder Network Authority with back-end trending data that can be used in ways we have or have not thought of yet. You’re small town volunteer fire department may end up being plugged in too a much much larger control arm. Likewise your metropolitan emergency services may be linked together in a manner that inhibits greater communication and command-ability.  Good or bad, it’s going to be fascinating where this takes our industry.
Have your department arrange a consultation http://www.firstnet.gov/consultation
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Blog

Boss, leader, brother…

imageAccording to Albert Schweitzer, “example is not the main thing in influencing others. It is the only thing”. Leaders must lead by example. It is very simple, but it is easier for some leaders to say it than do it. A leader is defined as “the person who leads or commands a group, organization, or country”. So does that mean that a leader wears a different color gear or helmet; wears gold instead of a silver badge; or have multiple bugles on their badge, collar, and helmet?

Leaders are individuals who will lead their troop from the front line. They know what is right is right and what is wrong is wrong. They adhere to the ethical reason and do what is right, even if it is not the favorable decision at the particular time. They can push the un-driven, train the unmotivated, and persuade the most stubborn of firefighters. They are not afraid to train other people, even though it may show their weakness. Leaders have passion for the job. It shows in everything they do. They wear their uniform with pride when they come to work in the morning, and stand resilient after grueling hours of work. They are dedicated and are proud when they clean their helmets after battling a fire. They do not need other people’s approval because they do not have to prove anything. They do their job because that is what they were destined to do.

imageSo, who are these leaders and where are they? They are all around us. He is working quietly while guiding younger firefighters. He may be filling up somebody’s cup of coffee so that he can make a fresh pot, because he knows that other firefighters were up first that shift on the ambulance. He is the first person out of bed the morning so that he can start the morning chores early. He is the guy pulling out a hose load in the bay to fix what looks like spaghetti in the tray. My point is they are all around us. They are doing things that needed to be done. He does not point fingers. Instead, he works hard. He knows that the best motivated firefighters will follow him because good character and moral integrity are inherent in the best firefighters.

What makes them such good leaders? They work hard, lead the men by example to guide, mentor, and promote integrity, honesty, and commitment. They keep the pride alive in the rest of us. They ease the pain after bad calls. They provide calmness and good working relations in difficult situations. A leader could be the rookie who grabs a broom and a mop a little earlier than normal to get the job done, motivating an elder to assist them in completing the tasks that have to be done.
image

These are just examples. Leaders are not bosses; they work with their followers. You should also know that you lead others, whether you know it or not. You have an obligation to uphold the integrity, the character, and the pride to be a well- trained and motivated firefighter. Remember, training breeds the confidence that is required to successfully accomplish the objective promptly and efficiently. Second guessing yourself makes you slow down, and deprives you of the confidence that makes you motivated. As a leader, you must have the ability to lead a team and drive them to success.

Product Review

HeroPrep.com Overview and Review

As part of Station Pride’s continuing mission to support Firefighter owned small businesses, I took the opportunity to check out HeroPrep.com. When a company is created and operated solely by firefighters for firefighters it always tends to give me the warm and fuzzies. Without knowing any of them personally I already have  an idea of what I’m getting into.

HeroPrep is a firefighter and EMT test preparation website where they guarantee a 100% pass rate on your IFSAC or ProBoard Firefighter 1/2 and/or NREMT test OR your money back! That’s a very bold guarantee for a company to make and I was curious to see how it all worked.recruitlogo15 HeroPrep.com has designed custom study-question test banks that provide thousands of questions across relevant topics.

One interesting facet of HeroPrep.com is that they also operate a Firefighter and EMT job posting website called Recruit911.com. Not only can you prepare to pass your emergency services exams but you can also FIND A FIRE JOB or EMT JOB, once you pass. Seems like a very convenient arrangement of services.

The Website

Upon arriving at the homepage, (www.HeroPrep.com), it appeared very clean, formal and professional. It wasn’t flashy or over the top. The style had a very basic feel about it. You immediately knew you weren’t there to be dazzled and you were definitely there to learn something. The graphics are neat, rustic, and professional.

howitworksThe website consists of a “How it Works Section”, About, FAQ’s, Support, Job Board, and a section on learning how to become an EMT. All of the navigation tabs provided thorough insight into the process and answered all the questions I had for their service.

In order to utilize the multiple-choice, study-question test banks you must first create an account and purchase the desired service. After creating a log-in and password with a confirmation email you were ready to start. This process was easy and a standard across the internet with regards to purchases.

The Dashboard and Test Banks

Depending on the service you purchased you will be given access to your desired study test bank. For example, if you are taking the Firefighter 1 Test Bank; the bank is divided into function categories such as Fire Service History and Orientation, Fire Behavior, Ropes & Knots, Water Supply, Fire Streams and so on.

If you are taking the NREMT Test Bank the areas are segmented into Airway, Trauma, Medical, Obi & Peds, Cardiology, and a specially designed NREMT Test Simulator that mimics the NREMT exam.

I kept looking for an immediate response to my answered questions and then realized I was literally taking a practice test. All of my correct and incorrect answers were displayed upopn completion of each quiz.

Each functioimage_62nal area of the test appears to be thoroughly covered. After completing each quiz you can see a breakdown of the areas you need to focus on. You will see your grade, an explanation of the answer as well as graphs to show your progress.

Every quiz tracks associated data such as how long it took you to complete, how many attempts to pass each topics and so on. There is valuable, usable data that is displayed to help you hone your studying.

As I made my attempts I did not readily notice any repeating questions.

My Discussion with HeroPrep’s Creator

As with any discussion with an individual who owns a company I don’t like hearing their “pitch” I don’t like listening to what’s so great about their product compared to others. I like to form an unbiased opinion based on my actual experience with the service.

With that said, I had a conversation with the creator of HeroPrep.  Currently they provide Firefighter 1, 2 and NREMT test preparation service. In the near future they plan to expand that service into Instructor, the driver operator series, inspector and officer test preparation.

He also explained changes being made with Recruit911.com and a possible package deal. With the purchase of a HeroPrep service you will be given access to Recruit911.

My Honest Thoughts

I’ve invested in several similar services throughout my career.

Taking practice tests or answering practice questions is one of the best ways to prepare for an exam, hands-down. While taking practice tests you become comfortable with physically  taking the test while you are learning and studying. Flash cards are great but they don’t give you that test-taking feeling.

The student dashboard was very basic and simple to navigate. There was nothing flashy it was pure Quiz City. The questions in the test bank were nearly identical to questions I’ve experienced in actual tests.

To be entirely truthful…I actually learned a few things I didn’t know, which made me a little excited. I thought I was going to smoke through the quizzes with no issue but I was stumped a few times. Which, by all rights, is exactly what you want to have happen. We learn from our mistakes.

The test banks were exactly what you would expect from a test preparation website. I attempted to access my account from my iPhone as well as my iPad and the website IS mobile-device-enabled which made taking quizzes even easier. I was completing topics while I was out and about in my Ladder Truck.

 

 

 

 

Product Review

HexArmor Elite EXT Rescue Extrication Gloves

This is a review the HexArmor Elite EXT Rescue extrication gloves. The gloves arrived on a Monday November 10th, 2014 and immediately went into service. image First impression: Glove size is true to fit. I usually wear an XL but requested a large just to be safe so as to make sure they weren’t too big. The large is a little snug on me but they’ll stretch and form with work and sweat. The back of the hand on the glove is well protected with rubber, almost skeleton in appearance, is designed for finger and knuckle protection. The dexterity is great. I was able to retrieve an ink pen from a concrete driveway as well as a quarter. The gloves have red patches, of what can only be identified as cut resistant material. These patches are sewn palm side on the tips of your four fingers and the complete palm including the thumb web. The cuff has an elastic material keeping debris from entering your glove as you work. It goes on a little tight forimage the ease of rapid donning but after I wear them in a bit it may loosen some. There does appear to be some reflective material added to the outer edge of the rubber knuckle protection and the wrist area. It doesn’t appear to be there for much more than cosmetics.

Use: The HexArmor gloves were used for minor tasks like loading hose and equipment into the trucks for a few shifts before I attended a weekend long extrication class. They were worn during all stabilization and cutting scenarios for 2 days totaling approximately 12 hrs total time.

Conclusion: During the 12 hours of extrication the HexArmor Elite EXT gloves held up great! They still look almost new. The dexterity is amazing, allowing for operations to be handled easily without the bulk of other gloves. The “Hex – Skeleton” rubber along the knuckles and back of the hand is tough and very protective. The red cut resistant material in the palms withstood glass and sharp metal with ease. While my gloves were brand new at the class, a simple glance around at the other firefighters in the same class proved that HexArmor gloves is a go to brand for comfort and durability. There were many other firefighters wearing the same model glove as well as other         HimageexArmor models.

Product description from the company website found here http://www.HexArmor.com SuperFabric® brand material palm provides ISEA Level 5 cut resistance and maintains the highest level of protection available in the industry. Durable TP-X® palm and fingertip reinforcement utilizes the highest-level of abrasion resistance while maintaining an oil-resistant grip. Superior back-of-hand impact protection system utilizes an advanced design to dissipate forceful blows over a large area. Exterior and interior seams implement a double stitched core-spun thread, adding further durability and longevity. Reinforced index finger and thumb saddle extends glove life. SlipFit® and anti-debris cuff assists a quick on and off between tasks. Hi-Vis color scheme increases visual awareness. Machine wash.