Syndicated Columnists

Either I’ll be High, or I’ll be Dead

Michael Morse - Rescuing Providence - Fri, 02/15/2019 - 15:23

By Michael Morse

“Either I’ll be high, or I’ll be gone.”

He opened his eyes. The bugs in his head stopped buzzing, and he looked at me.

“You weren’t breathing,” I said.

It was just me and him in the back of an old ambulance in Providence, Rhode Island. A team of people had helped get us to this point. Some of them lingered outside the truck, waiting.

They used to talk of the “Golden Hour” back when I was new at EMS; those precious 60 minutes between the onset of symptoms or a traumatic event and the arrival at the hands of a competent hospital staff. Times have changed, and so has EMS. We are doing things in the field that no longer need an hour or doctors. I learned a few things over the years, and I used something called “The Golden Minute” when I responded to suspected overdose patients.

My goal was to get my patients breathing, not to straighten them out.

“I gave you enough Narcan to get you breathing on your own,” I explained. “You are probably still high from whatever it was that got you here, and there is a very good chance that you could stop breathing again when the drug wears off. “

The person on the stretcher relaxed a little and considered his options. He could flee and shoot up again. He could find a quiet spot and ride it out, hoping he didn’t go back into respiratory distress. Or, he could take a moment in a safe, clean, quiet environment and gather his thoughts.

“Chasing the high sucks,” I said nonchalantly. “You can never recapture the feeling of the first hit.”

He stopped thinking and looked at me again. I’m was no longer a threat. I neutralized the situation; the power I could hold over a relatively helpless person lying down while I looked down on him had been given away. I lifted the back of the stretcher so he was in more of a sitting position and took a seat on the bench across from him.

“You know the worst part?” he asked. I listened.

“I don’t even care if I OD. The risk is worth it. Either I’ll be high, or I’ll be gone.”

If ever there was a time for quiet reflection, it was now. I closed my eyes and let that statement sink in. I hoped my patient was able to do the same.

The Golden Minute had passed. We could talk all day about getting clean, getting sober, getting his life back in order. I could lecture him and do the “You were dead until I saved you” nonsense talk. I could have the police respond and have them do their thing. I could do a lot of things but chose to do nothing, hoping that I’d already done enough.

A firefighter working as a medic in the city was not going to cure anybody’s addictions, but I could certainly lube the rusty wheels of rational thought with some honesty.

“I’m required by law to transport you to an appropriate medical facility,” I said, not really sure if it was true. “In this case, it’s the closest emergency room. It’s a madhouse, people lining the halls, all the rooms full, overworked staff, and not at all conducive to healing.”

Sometimes the magic worked. This was one of those times. He agreed to go willingly. I stood and opened the side door, told the police officer he was all set, and let my partner know we’d be transporting. It was a five-minute ride, silent but comfortable. As expected, the ER was at capacity, people screaming for pain meds, intoxicated homeless men restrained on their stretchers, bored elderly people scattered about, a dozen ambulance crews waiting for triage, and the staff working relentlessly to care for the never-ending stream of people that we bring them.

I said goodbye to my patient and headed back into the city. Another person had overdosed, and police were on the scene.

Originally published in Fire Life

Categories: Syndicated Columnists

So It Begins

EMScapades Cartoon - Fri, 02/15/2019 - 08:43
Categories: EMS, Syndicated Columnists

8 reasons we are on the cusp of Peak EMS

Syndicated Columnists - Fri, 02/15/2019 - 02:46
A bold prediction that EMS patient transport to the hospital by ambulance is sure to peak, level off and decline as we near 2020
Categories: Syndicated Columnists

Emergency Triage, Treatment and Transport reimbursement model is a watershed moment in modern EMS

Syndicated Columnists - Thu, 02/14/2019 - 02:22
EMS leaders react to ET3, HHS reimbursement model that recognizes the value of community paramedicine and emphasizes quality and outcomes
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4 effective strategies to cope with drug shortages in EMS

Syndicated Columnists - Wed, 02/13/2019 - 23:00
Pharmaceutical shortages are an ongoing challenge for EMS providers, but agencies can take proactive steps to address the issue
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5 ways to bring a culture of celebration to your EMS agency

Syndicated Columnists - Wed, 02/13/2019 - 19:00
Regardless of size or service model, here are a few ways your department can honor its employees throughout the year
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Code Red!

Michael Morse - Rescuing Providence - Wed, 02/13/2019 - 08:23


By Michael Morse

10. When a firefighter acts like a fool, the rest of them put a stop to it right quick. Funny thing about firefighters: When one does something stupid, the entire profession is tarnished. We are held to a higher standard. That’s okay; we’ve earned it.

9.  Firefighters don’t care what color, race, gender, shape, or whatever you are; if you can do the job, you are one of them. You don’t have to be the greatest firefighter who ever donned the gear, but you are expected to be competent and to be as good as you are capable of being.


8. If you are unable to do the job and are in need of assistance, firefighters are willing and able to do it for you, every time, without question. Some people are great teachers; others are wonderful cooks, landscapers, scientists, bird watchers, or the million other things that people excel at that make humanity so miraculous. Firefighters possess a lot of those skills, but their most important skill is problem solving when chaos rules–and their willingness to do so for total strangers. That, above all else, sets firefighters apart.

7. Firefighters can cook; a few of them can actually do it quite well.People who never learned to cook never had to take care of themselves, and a people who never had to take care of themselves could never take care of the public they are sworn to protect.

6. Firefighters do housework. Every day. All of them. Together.Firefighters don’t expect others to clean their messes. They are as adept at handling a mop and a broom as they are an ax and a pike pole. Any fire chief who climbed the ranks has cleaned toilets, polished brass, scrubbed the apparatus floor, and done the dishes. Respect is not given, it is earned.

5. Firefighters know exactly where they are going and how to get there when the bell tips. Every time. Everyone. It’s one of our things, and we all expect the others to get us there when it’s their turn to drive.

4. Firefighters don’t fall apart when they are needed the most.Somebody needs to be there to keep the wheels of civilization turning. Somebody needs to be the one whom panicked people look toward when all appears lost. Somebody has to keep cool and keep things together or, when it unravels, do their absolute best to put things back.

3. Firefighters run toward trouble, not away from it. When the public is running away from whatever catastrophe has befallen them, it is reassuring to look over their shoulder and see the backs of the firefighters running toward it. For some, it is all they have to hold onto, and many will never forget that image for the rest of their days. Leading by example, showing what humanity is capable of, providing hope and direction; it’s not something firefighters are aware of, it’s just who they are.

2. Firefighters fight like family, love like family, and treat each other like family. Whoever said blood is thicker than water has never squeezed pressurized water through an old pump into three attack lines and a master stream, charged those lines on command, opened a straight stream inside a fully involved basement, knocked down a wall of fire, drained feeders on a freezing January night, packed a hosebed on a sweltering July afternoon, scrubbed those lifelines on Sunday morning, and drank the cool elixir of lifelong friendship when the job was done. Water is thicker than blood when you are a firefighter.

1. There is no job too difficult, no obstacle too hard to overcome, no living creature unworthy of a firefighter’s best effort, and no excuse for not doing your damndest. Every time.

Firefighters, when among other firefighters, are free to speak their mind, say ridiculous things, be biased, be politically incorrect, get angry, fight, argue, break for lunch, save a life, polish some brass, and argue some more. Then they get on the truck, work like mad, do nearly impossible things, trust the person with whom they were fighting with their life, risk their own life to protect each other, put it all back together, and finish the shift, only to do it again tomorrow.

Categories: Syndicated Columnists

Grieving for Two

Michael Morse - Rescuing Providence - Tue, 02/12/2019 - 12:57

Things they don’t teach in school . . .

Her parents heard choking from behind the closed door. They tried to open it but something held it closed. The stepfather put his weight into it but it barely budged. Some commotion behind the door, then deadly quiet. He kicked the door in.

His stepdaughter, two months pregnant and seventeen years old had tied one end of a stocking around her neck, stretched the other end over the corner of the door then tied the other end to the doorknob. Then she let her body weight go.

The force of the door being kicked pushed her in, and freed the stocking from the top of the door. She was lying on the ground when we arrived, crying. Never have I heard such mournful, desperate sounds. Her body shook, the depths of despair so intense she appeared to be having a seizure.

Red marks on her neck, choking, eyes filled with tears, despondent and alone, in a room full of strangers. And her parents, who stood by, shocked and afraid as we carried their daughter and future grandchild down the stairs and into the ambulance.

We are invited into the most private, heartbreaking and painful moments in a family’s history; not simply brief flashes of time quickly forgotten, but indelible memories that will haunt them for a lifetime.

Be respectful, be kind, be competent, and be worthy.

Categories: Syndicated Columnists

Expect The… Expected?

EMScapades Cartoon - Tue, 02/12/2019 - 09:37
Categories: EMS, Syndicated Columnists

How to achieve operational uniformity with consolidated communication centers

Syndicated Columnists - Mon, 02/11/2019 - 23:27
Striking the balance between agency independence and operational synergy through conflict resolution, funding and governance
Categories: Syndicated Columnists

Do it for Them

Michael Morse - Rescuing Providence - Mon, 02/11/2019 - 13:00

I thought my high blood pressure was hereditary. I used to take a reading whenever I had a chance, and for twenty-three years in was in the 140/90 range – high enough to make me worry but not high enough to REALLY worry about. Now that I’ve had some time away from the tones I’ve been at a steady 120/80, give or take. I guess it was hereditary; I inherited it every time I showed up for work!

Ask any firefighter why they do what they do, and once given a moment to think about it, and get past all the “helping people” stuff, without fail those with a family will tell you that they do it “for my family.” We don’t mind the long hours away from home, the wear and tear on the body, or the stressors of the mind. We consider ourselves fortunate to be able to withstand the rigors of a long career on the domestic front lines, and take pride in our accomplishments. Taking care of our family is what makes us tick, and the reason we get out of bed in the morning.

Only those of us who have put the gear away know what it took from us. We know that at the start of every shift the walls went up. We know that at the end of the shift, most of that wall came down. We also know that over time, those small walls grew, and without our being aware, a giant, impenetrable wall grew around us. While in the fight we didn’t notice the small changes. We were too busy “taking care of the family” to see how we changed. But make no mistake, the family we were taking care of knew something was changing, but they could not define those changes until we let our guard down.

People with normal jobs don’t experience flashbacks, don’t have that gnawing feeling in their gut when they drive and are not burdened with the weight of thousands of tragedies. Knights used to wear chain mail under their suit of armor, and we are not much different. Our chain mail is invisible, and grows heavier as the years progress. We wear it under our turnout gear, and it is supposed to keep us safe from the things that keep us up at night. But instead of keeping the wolves at bay, our protective suit doesn’t protect us, it weighs us down

I had no idea how high-strung I was until I retired. Even then, it took a long time for me to breathe normally, to be able to focus on a conversation, or watch a TV show without breaking out in a cold sweat whenever some actor did a good job of portraying a dead body. To thrive in the difficult environment that I called my home away from home I needed to have some thick skin. I wouldn’t have admitted to PTSD in a million years, or at least until I retired and began to see the world as a nice place.

What I did for my family made their

Image by Eric Norberg

lives more difficult than it needed to be. I didn’t have to keep my growing anxiety to myself. I didn’t have to suffer in silence. There was a better way to get through my career than what I knew, what most of us know. We are the kings and queens of the white knuckle brigade. Admitting that things got to us was okay, kind of, but only for a little while. It was, and is much more desirable to “white knuckle it,” and deal with whatever is troubling us by ourselves. The problems go away, we figure, and we’ll be back to our old selves real soon. Unfortunately, our old selves are taken away every day, and replaced with a more somber, cynical and tired version.

Trends have begun to shift; people are not as tight lipped about their struggles with depression and addiction as they once were. PTSD is a hot topic on most Firefighting/EMS forums. People are coming out, and telling their stories. All of this feel good, love yourself, embrace the madness and get better stuff is helping lots of people. Unfortunately, there are lots of us who have no idea that they are operating at levels of stress that simply cannot be maintained. We secretly look at those of us who have the courage to admit their fallibility with thinly disguised disdain. “Too bad for them,” we think as we read about the latest medic or firefighter who crashed. We just cannot see the cracks forming in our own lives. Our walls are formidable, and without allowing ourselves a little humility they will only continue to grow.

So, what to do?

You owe it to the family that you are doing it for to do it right. One good way to do that is to stay as emotionally healthy as possible. If you can’t do it for yourself, and most of us can’t or won’t, do it for them.

Simply being conscious of your own well being is a good start. An honest and thorough self-evaluation every year or two can help keep your life in perspective. Doing such a thing in your own head is nearly impossible. Good, qualified and caring assistance is available. You don’t have to be nuts to make an appointment with a therapist. Paying someone to listen to you is remarkably liberating. Most of us politely listen to whoever it is we are talking with, while formulating a response in our own mind, thus never truly hearing what the other is saying. A good therapist listens to everything you say, and believe it or not, there is more up there than you ever imagined.


Categories: Syndicated Columnists

8 things we wish the general public knew about EMS

Syndicated Columnists - Mon, 02/11/2019 - 02:48
After watching yet another television show that attempts to glamorize public safety providers, I thought about what really goes on inside our world
Categories: Syndicated Columnists

4 ways to prepare EMTs for violent patients

Syndicated Columnists - Mon, 02/11/2019 - 02:40
If you’re attacked on the job, be mentally prepared, physically ready, press savvy, and able to justify your actions in court
Categories: Syndicated Columnists

Combative patients: Don't be the 'calm down guy'

Syndicated Columnists - Sun, 02/10/2019 - 23:18
Regardless of how good your intentions are, yelling "Calm Down!" in someone's ear never, ever helps
Categories: Syndicated Columnists

Seperating First Responders from Health Care Providers

Michael Morse - Rescuing Providence - Fri, 02/08/2019 - 06:37

Paramedics with bachelors degrees with the same status, pay and benefits as similarly educated and trained healthcare proffessionals?


EMS the third arm of public safety, status, pay and benefits the same as police and fire?

You bet.

For EMS to become the third arm of public safety, right alongside law enforcement and fire departments, some separation must occur.
We simply cannot all be considered first responders while existing with profit as our business model.

For example, private security companies exist for profit, fire inspectors are employed by insurance companies and fire extinguisher businesses flourish. The people employed in these positions are not first responders, nor do they expect to be considered as such.

EMS provides different services under one label. Some are dispatched for life threatening emergencies. Some do routine transports. All of us take care of people who cannot or will not take care of themselves. Only some of the available EMS professionals respond to the unpredictable 911 emergencies.

So, how do we change the public perception that EMS and the people who provide it are almost-but-not-quite first responders or on par with hospital staff?

Seperation. We are all competent providers, dedicated and caring, but we are not all the same, nor do we all want the same things from our EMS experience. There is room in EMS for people who seek nothing more than an 8-hour shift with few complications, transporting stable but unable people.

We have plenty of spots for people who enjoy transporting fragile elderly patients to and from their appointments. Plenty of people need to be taken to dialysis centers and cancer treatment centers. The need for quality healthcare professionals that are capable of transporting critically I’ll or injured people while providing proper care should not fall on the shoulders of first responders. Paramedics with skills comparable RN, PA and NP are needed for these vital roles.

By grouping all of us as EMS, our essential piece of the public safety puzzle is overlooked, and the providers pay the price.
Fire-based EMS is sometimes paid on par with the fire service employees, but often is not. Privately operated ambulance companies pay what the market dictates, quite often wages just above the minimum wage.

The industry suffers from career burnout, depression, lack of motivation and overall dissatisfaction with EMS, leading to increased injuries, excessive turnover and the inability to inspire public confidence.

The common denominator that holds EMS together is the people who respond. We are the people who provide care, professionalism and safe transport to the public, but we cannot expect to all be compensated at the same level as Fire and Police.

Some of us deserve to be on par with our colleagues who work inside the big world of healthcare, and be compensated accordingly.

Categories: Syndicated Columnists

Q&A: How to encourage employee growth and maintain high standards

Syndicated Columnists - Fri, 02/08/2019 - 02:28
Eve Grau, co-founder of Royal Ambulance, shares the company's philosophy for cultivating highly-motivated employees and how it positively impacts their agency
Categories: Syndicated Columnists

6 ways to defend yourself against verbal abuse

Syndicated Columnists - Thu, 02/07/2019 - 22:32
A verbal attack can be personal; here's how to deflect the blow
Categories: Syndicated Columnists

4 tips for airway management mastery

Syndicated Columnists - Wed, 02/06/2019 - 02:51
Successful airway management is the culmination of preparation, practice and technique mastery
Categories: Syndicated Columnists

NAEMT president addresses paramedic education questions

Syndicated Columnists - Tue, 02/05/2019 - 20:51
Our co-hosts discuss NAEMT's position on paramedic education requirements with President Matt Zavadsky
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