Syndicated Columnists

In quiet desperation

Michael Morse - Rescuing Providence - Mon, 02/12/2018 - 16:52

In homes all around us, behind closed doors and behind stoic faces that conceal the pain, horror, and resignation of caring for terminal patients are people who live their lives in heroic fashion; people that will never be acknowledged for their bravery or awarded medals or certificates of appreciation. They get up every day with an all-too-familiar gnawing deep inside their soul, wondering how they will make it through another day—watching, waiting, praying for a merciful end while secretly hoping for a miracle. Being invited into the lives of desperately ill people and witnessing their courage, caring, and humanity instilled in me hope and optimism that stays with me long after my days responding to their emergencies are done.

But it was never easy.

“Rescue 1; respond to 523 Park Avenue for a female unresponsive.”

“Rescue 1, Responding.”

I look at her notes:

End stage renal failure. Diabetes. Congestive heart failure. Hypertension.

There’s a bag of meds next to the bed.

A distraught family.

Three flights of stairs.

Why do the sickest live on the third floor?

Desperation fills the room. It has its own scent.

Adult diapers.

More medications spilled on the floor

 

Two teens, tired and scared.

Their parent.

Their patient, barely breathing, unresponsive, her life nearly over.

She’s thirty-seven. She won’t be thirty-eight.

IV failed, no pressure in the veins.

Blood glucose 11. Glucagon in the triceps.

No flinch, cold, dead flesh.

Minutes pass, a flicker of the eyes, an opening.

“Hi Mom.”

Eyes closed.

Tears flow.

We transport to the ER. I don’t even know why.

All around us people are living lives in quiet desperation. Try and be kind. At some time or another it will be our turn.

Maybe it already is….

…and we’re about to find out.

 

http://www.fireengineering.com/articles/fire_life/articles/2018/february/lives-of-quiet-desperation.html

 

Categories: Syndicated Columnists

How To BS Your Way Through EMS School

EMS Office Hours Podcast - Sun, 02/11/2018 - 12:25

Lets face it. You can bullshit your way through EMT or Paramedic school. Do the bare minimum, skate by the exams, play off your class mates and pass.

Its not hard. I’ve seen people do it. Heck I know kids getting college degrees that have bullshitted their way through. Never taking a note or cracking open a book.

But when does that come back to haunt you? This weeks Office Hours talks all about when that half ass-ary comes back to teach you a valuable lesson.

Take a listen below and be honest. Have you ever BS’d your way through a class, a course or exam? Did it really help you past that moment?

I am confident it most likely did not.

Be sure to pass this on and leave a rating or review at iTunes by clicking the Apple link above.

Getting Along

Michael Morse - Rescuing Providence - Fri, 02/09/2018 - 08:39

Patient # 1 sat in a kitchen chair, but the chair had had it, unable to bear her weight. It collapsed. Luckily for our patient, the floor broke her fall, but she did strike her head and hurt her neck and back. Fortunately for us, she was ambulatory, and we helped her to the ambulance.

She was in a lot of pain, and as we assessed her vital signs a car sped up to us, two men rushed to the back doors and frantically banged away. A girl was stabbed, they said, and bleeding.

We helped her into the ambulance, and she was indeed stabbed, a centimeter wound on the left side of her back. How deep? I don’t know.

She sat on the bench, I started some oxygen and we got moving. Her heart rate was in the 130’s, blood pressure decent but had diminished lung sounds on her left side. I’ve seen stabbing victims circle the drain, and circle the drain quickly. The girl was sixteen, and told us the same people that stabbed her cousin last week snuck up behind her and “got me.”

Her tough facade deflated like most illusionary means of survival are wont to do when somebody else puts a hole in it, and tears held back for god knows how long exploded from her eyes.

Bodily fluids have different reactions on me, blood doesn’t bother me much, I hate puke, piss isn’t all that bad, and it doesn’t get much worse that shit; but tears?

Tears are the worst. I’d rather deal with puke , blood and piss.

I stood in the well next to the bench, applied pressure to the wound and tried to think how best to proceed should she crash, but fortunately she didn’t, and the fifty-three year old lady who had collapsed her chair took over, and held the young girl’s hand, and said some soothing things as we bounced along.

Strange, wonderful moments of grace come along when I least expect it, two women of different generations forced together in the back of an overheated ambulance in the West End pulled together, and found some tenderness in an ugly world.

A Hispanic girl, a black lady and a white guy found some common ground in a cramped space, blood, tears, pain and sweat mixing together to form a short lived bond, and we made the best of a bizarre situation and did the best we could.

We survived, the girl went to surgury, the lady was treated and released and I went to Rescue 1 for the next shift, taking with me the knowledge that kindness has a place in this crazy world called Providence.

Categories: Syndicated Columnists

Just like every other day

Michael Morse - Rescuing Providence - Thu, 02/08/2018 - 10:47

I rounded the corner and saw him lying in the grass in the backyard of a recently renovated home in the West End. From fifty feet away he looked okay, forty not so much, thirty I began to worry, twenty and I knew something was terribly wrong, the last ten feet just happened. His name is Eduardo, and he had just finished work on the house, It was a good job, he told me, in between grimaces.

We had been called for a man down, and that is exactly what we found. his skin was cool and clammy, when he opened his eyes they looked haunted, and he said he had the worst headache ever, then vomited on my shoes. We lifted him onto the stretcher, and he cried “no!” and tried to steady himself. I hoped that he was suffering from vertigo, but knew I was kidding myself.

He took time this morning getting ready, his shirt was new, shoes matched his socks, his dress pants now covered with dirt. A wedding ring matched his watch, both meticulously maintained.

The people who found him told me what they knew, he was doing an inspection, everything was fine, then he said he felt dizzy, then he sat on the ground, and leaned to the side and vomited.

We started an IV, administered oxygen, took his vitals and got rolling. At 220/110, with a “9 out of 10” headache, and a perfect sinus rhythm I thought CVA. I did a neurological exam enroute, everything was normal. But he never opened his eyes. I told him not to worry, that I thought he was having what we call a TIA, or mini stroke, even though I was pretty sure it was a full blown CVA.

Little white lies don’t count when protecting a person I decided, and I wanted him to know that something bad was happening, but certainly nothing catastrophic. He was terrified, but seemed to appreciate my honesty. He nodded his head, and relaxed-a little.

At the ER I got a little testy at triage, I hate it when people just don’t see what I do, and don’t sense the urgency. It’s not their fault, they hadn’t spent the last fifteen minutes with the man, talking to him, touching him, reassuring him, telling him that everything would be okay. They didn’t have much invested, and at that moment, I forgot that. I suppose I was a little nonchalant when I arrived on the scene as well.

Once things got rolling they rolled quickly. The attending ordered some meds and an immediate cat scan. I waited, hoping he was a candidate for tPA. When he came back from Catscan, everything had changed. He could no longer asnwer questions, and his breathing had become erratic. Respitory was called and they inserted a breathing tube.

http://wiki.medpedia.com/Clinical:Guidelines_for_the_Early_Management_of_Adults_With_Ischemic_Stroke#Brain_Imaging

There would be no TPA, his brain scan showed a major bleed. They took him to surgery ten minutes later, hoping to relieve the pressure in his head.

He probably won’t make it through the night, and if he does, he will wish he hadn’t. A few hours ago he was getting dressed, getting ready for another day.

Kind of like we all do.

Categories: Syndicated Columnists

Social science solutions to EMS volunteer recruitment and retention

Syndicated Columnists - Wed, 02/07/2018 - 13:49
By Allison G. S. Knox, faculty member, American Military University Many volunteer ambulance agencies throughout the United States have a difficult time staffing their ambulances. In decades before, it seemed that volunteer ambulance companies had a surplus of members who were happy to help their community in their free time. Now, there is a volunteer shortage with a dwindling amount of people who are ...
Categories: Syndicated Columnists

Good Day

Michael Morse - Rescuing Providence - Tue, 02/06/2018 - 15:37

“Rescue 1 and Engine 13, respond to 328 Calla St. for an infant not breathing.”

Seconds seem like hours. Cars move like dinosaurs on the brink of extinction, sirens and lights ineffective. Gloves go on, mind racing, ghosts invade, I throw them out, the trucks move faster, picking up speed, three minutes pass. Before we stop I’m out the door, mother running,  baby in her arms, blue. I take her, she’s stiff, burning with fever, rigid, then starts to seize.

Oxygen, assisted ventilations, family screaming, everybody tries to do something, I give out tasks, an IV, keep bagging, need a glucose test, find the history, learn Spanish quick, I need to know what’s going on, get a temp, find out her weight, find a pulse, keep her safe, the seizing continues as if she were possessed.

Pulsox rises, seizing continues, can’t get an IV, family hysterical, firefighters busy now, doing their job, Tylenol suppository administered, temp of 104, need a driver, call the hospital, tell them we’re coming in with an eighteen month old, possible febrile seizure, eta one minute.

Give the crowd a thumbs up, look calm, reassuring, I hope, close the door and take the mother’s hand, seat her next to the stretcher, let her know it will be okay, seizing slows down, the baby relaxes a little, the truck rolls, calm now, all we can do is done.

Trauma room ready, medical team takes over, struggle for a while with the IV but eventually get one, Broslow tape extended, dosages and medication ordered, bagging continues.

We clean and restock the truck, another child is having a seizure at the ball field, have to go. Twenty minutes, we’re back, no seizure, just a kid who took a foul ball to the face, iced him down, brought him in and checked on the baby, breathing on her own, fever down, still bluish but okay, mother cries and hugs me.

Yeah, it’s a good day.

Categories: Syndicated Columnists

Q&A: How can leaders identify and help EMS providers who need support?

Syndicated Columnists - Mon, 02/05/2018 - 12:22
Q&A: How can leaders identify and help EMS providers who need support" A chaplain for Allina EMS shares his strategies for approaching colleagues after a difficult call to open the lines of communication By Mike Taigman I have not been to an EMS conference in the last two years where EMS provider suicide, stress management or mental health was not on the program. It seems nearly everyone understands ...
Categories: Syndicated Columnists

Going Back

Michael Morse - Rescuing Providence - Fri, 02/02/2018 - 13:03

Huge thanks to the firefighters

Lilyana

assigned to Engine Co. 9 and Ladder Co. 8 at the Brook St. Station, especially Lieutenant Bob Cataldo and Firefighter Chuck Potter, it was a great visit!

From one of my columns at Fire Engineering…

My grandson loves fire trucks.

Jaxon9

He’s two, and he’s obsessed. When he hears a siren in the distance, he is instantly alert, and he scans his environment for the source. If he could, he would find it, follow it, and be part of whatever it is that made the noise necessary.

Kind of like his Papa.

When I left the fire service after 25 years, I decided that I was done. I had no intention of being a pest and hang around the station, drinking coffee and telling war stories. I had to leave it behind and let the next generation take over.

Or did I?

Now, I can visit the station—any station—with the little guy and nobody will know that the old guy with him is every bit as excited about the trucks, the poles, the gear, the smells, the banter, and the excitement that exists in every fire station ever constructed. I didn’t realize it when I was part of it, but inside those station walls, magic exists. The invisible bond that creates the firefighter family may be formed during the emergencies to which we respond, but it is strengthened when the crew returns to quarters and sorts things out.

“He always wanted to sit in the driver’s seat,” I’ll say to whoever it is that is kind enough to do “the tour” (probably the junior firefighter). “But he’s too little,” I’ll explain, “he’ll have to sit on my lap.”

And back in the driver’s seat I’ll be. And if I’m lucky, I might even get to show him how to operate the pump and then help him open the pipe or raise the ladder. I’ll have to hold the helmet on his head (those things are heavy) and show him how to put a pack on in 10 seconds, how to use an ax and pole to open ceilings, how to operate an extinguisher properly, how to…be a firefighter.

You never know when your last call is happening; it is impossible to predict. We do not have the luxury of savoring the experience, knowing that this is the last time we will blow the air horn; herd cars out of our way; arrive on scene and step out of the rig like the king of the world, ready to handle whatever emergency needs to be handled. We are unaware that our last ride as a responding firefighter already happened, so we finish our careers with a whisper and get on with things the best we can.

As weeks in retirement turn to months and months become years, the memories fade, the smell of smoke leaves your skin and hair for good, and what for many retired firefighters was the most memorable part of their lives is put away. But those memories always come back. We can’t help it—firefighting is in our DNA. Leaving it all behind is not an option. We know we can never go back, but it is nice to remember, and there is no better way to do that than through the eyes of a child.

Will he follow his Papa’s path and be part of the fire service? Only time will tell, but I can always hope. That way, I can still visit the station; only then the excuse will be to see my grandson and bring him some of his grandmother’s brownies. And what’s better than brownies, the company of firefighters, and a cup of fresh brewed station coffee?

Nothing, that’s what.

 

Categories: Syndicated Columnists

A real EMS career ladder for the paramedic profession

Syndicated Columnists - Thu, 02/01/2018 - 15:37
It’s no secret – the EMS community is hemorrhaging people. As the economy improves, more and more opportunities, with better compensation, are available. Credentials such as registered nurse, physician assistant and several allied health professions – all of which typically pay 30-50 percent more than paramedic salaries in most communities – are within reach of motivated paramedics ...
Categories: Syndicated Columnists

Some things I still cannot comprehend

Michael Morse - Rescuing Providence - Thu, 02/01/2018 - 13:59

Four adults had her pinned to the floor, each holding a limb. Her foster mother stood to the side shaking her head.

“She’ll be like this for hours,” she said. The guys from Engine 12 stood back and waited for some direction. We are not trained or authorized to use restraints. The patient, a ten year old deaf girl named Emily continued to struggle as we figured out what to do.

“How do I say her name?” I asked one of the people in the room, a teacher at the Rhode Island School for the Deaf. He showed me. I formed my hand into a representation of the letter E then bumped my chin with it twice.

“How do I say my name?” I asked. I bumped my M shaped hand to my chin twice and knelt beside her.

“Tell her we have to put her on our bed and take her to the hospital.” The teacher signed the message, Emily responded. She said she would go only if the firefighters went with her.

“She spits,” somebody said. I decided to put a surgical mask on her.

“She’ll gnaw on it and might choke. The last time they put masks on themselves,” said the mother.

There was no way a beautiful, scared ten year old was going to make us wear masks. I put the mask on my face, looked at Emily, pointed to her, then the mask. She understood and shook her head, yes. Without a whimper, she let me place the mask over her face, never losing eye contact. I had the guys take over holding her and lifted her to the stretcher. My grip on her arm relaxed as she relaxed. Before I knew it I was just holding her hand as she stopped struggling. We let her go. The staff at the school were impressed but I’m pretty sure Emily was plain out of gas. She pointed at her backpack as we wheeled her into the corridor, one of the firefighters from Engine 12, Dave handed it to her. He was as captivated by her as I was. She reached inside and took out a little electronic video game and started to play.

Inside the rescue Dave kept her entertained while I filled out the report. She was fascinated by everything. She wanted us to take her blood pressure and pulsox so we did. She pointed at the heart monitor. We ran an EKG. She knew which button to push for a print out. I let the paper roll. She folded it neatly and stashed it inside her backpack. Emily’s smile lit the back of the rescue.

At the hospital we waited for her foster Mom and the interpreter from the school. Emily sat on the stretcher and played with me and Dave. Her hair was a mess, her skin still red from the exertion and her brilliant blue eyes still swollen from crying, still she was beautiful. We put her on the hospital stretcher without any trouble as the mom and interpreter came in. As we wheeled her into one of the treatment rooms I asked the mom about the tantrums.

“She was good for a while but I’ve had to leave work three times this month,” she said.

“What causes them?” I asked.

“She has been through a lot. Her mother was making money using her. Her father is in prison for the same thing.” I heard her but didn’t comprehend. “She was being prostituted.”

As they wheeled Emily away she looked over her shoulder at me and Dave, gave us a big smile and a wave. I watched until they turned the corner and disappeared. Dave didn’t hear about her past. I considered telling him but decided not to burden him. Instead I walked outside into the bright sunshine, found a quiet spot and sat there until the cold air made me numb.

Categories: Syndicated Columnists

Marion County: The wild, wild west of EMS in Florida

Syndicated Columnists - Thu, 02/01/2018 - 10:59
In 1968, when all 13 of Jacksonville, Florida’s ambulance services threatened to strike, Bart Walker was an eight-year-old fire buff who hung out with his heroes, the firefighters, whenever he could. “The details are a bit sketchy,” he says of that year, “but within one day, the fire department took over EMS.” “The chiefs used their station wagons to transport patients ...
Categories: Syndicated Columnists

Silent but deadly: The trauma we miss in geriatric care

Syndicated Columnists - Thu, 02/01/2018 - 10:45
EMS providers need to know that when it comes to trauma in older patients, even minor accidents can have devastating consequences. What healthcare providers miss or fail to consider can mean the literal difference between life and death for the elderly. Americans over 65 years old comprise approximately 15 percent of the total population, yet they account for almost 40 percent of all ambulance transports ...
Categories: Syndicated Columnists

Can’t take it back

Michael Morse - Rescuing Providence - Wed, 01/31/2018 - 12:27

“You don’t like me do you?” he asked.

It was late. We had been running all night, he had been drinking all night. He smelled. We smelled. He smelled worse. A lot worse. Days of piss dried onto filthy clothing reeks. It fills the back of the rescue instantly, making me retch.

I could have said, “No, I don’t.”

Having somebody dislike you is far better than not being seen at all.

I could have said, “Of course I like you, you are a fellow human being, and I’m here to help you get back on your feet, brother.”

Everybody needs a little kindness now and then.

I could have said, as I’ve told him before, “I don’t necessarily dislike you.”

That’s better than nothing.

Instead I chose the worst possible thing to say.

“I don’t care enough about you to like or dislike you. You simply don’t matter to me one way or the other.”

9I knew what I said was the last thing he needed. I said it anyway.

He looked crushed.

Sorry about that, Kevin, sometimes I can be a first class idiot.

Categories: Syndicated Columnists

Medic Mindset Podcast: The airway evangelist

Syndicated Columnists - Wed, 01/31/2018 - 09:02
<!--cke_bookmark_434S--><!--cke_bookmark_434E--> In this episode, Ginger Locke interviews Dr. Jeffrey Jarvis. He is the medical director for Williamson County EMS in Central Texas. He is a board-certified Emergency Medicine physician and a paramedic. In this information-packed episode, Dr. Jarvis discusses: Video laryngoscopy Ketamine Delayed-sequence intubation Ultrasound ...
Categories: Syndicated Columnists

A Calendar for every body

Michael Morse - Rescuing Providence - Tue, 01/30/2018 - 13:06

 

Firefighter Calendars are as plentiful as fruit cake this time of year, and everybody loves a firefighter, especially a scantily clad one.

When I was young and pretty somebody asked me to be part of the Providence Firefighters Calendar. I refused, not because I didn’t think I would be a swell Mr. October, rather because my gay friends told me how much they loved the firefighter calendars that they have adorning their locker doors. Not that there’s anything wrong with that, I just didn’t feel comfortable being the apple in the eye of other men.

Now that I’ve reached the age of maturity, with my grandfather’s body to boot, I might re-consider that logic if anybody were to make a “formerly fit but still remarkably handsome considering his body, while still skinny in clothes is actually quite soft and fat” calendar. ANY attention is good attention when you realize that people have stopped looking at you!

But don’t cry for me Argentina, not long ago the most recent batch of Firefighter Calendar Boys were participating in an event for charity. A portion of the profit from each calendar sold helped support some cause or another. To help sell calendars, the event organizers; it was a car wash, had the fellas dress in their bunker pants and boots, no shirts allowed and play with each other’s hoses while being covered with sudsy bubbles.

They sold a lot of calendars.

The rest of us have a lot of pictures.

There are not enough calendars or charitable causes on earth to make up for the torture that the Calendar Boys will endure for the rest of their natural lives, and quite possibly the afterlife because of that event.

So, how did our heroes transform from manly hunks of men with pictures of their chiseled frames gracing the walls of college aged girls dorm rooms everywhere, to broken shells of former men covered in sudsy bubbles whose images are the fascination of gay men everywhere?

They gave in to temptation, thought they would meet chicks and became Calendar Boys, that’s how!

So, why are there no Police Calendars, you ask?

If ever there was a sub-species of mankind other than male police officers who wanted little else from this earthly existence than meeting chicks, I’ve yet to make their acquaintance.

If the above true story does not answer that question to your satisfaction, consider this:

– Have you ever seen a police officer wearing only half his uniform?
– Ballistic vests cover the pecs and nipples
– Nipples sell!
– Do you even want to see a shirtless police officer?
– Police officers covered in sudsy bubbles are not sexy – to anybody!

And how about an EMS Calendar?

I’ve often wondered why there is nobody willing to do an EMS themed calendar with pictures of fabulous looking EMT’s and Paramedics as the focus. I’ve seen calendars using different style vehicles as the models, but never different style medics. The way I see it, there are plenty of different body types to choose from, male and female. Not all medics are perfectly sculpted model material. It is the variation of body styles that would make the calendar fascinating. Sure, EMS has its share of buff people, every occupation has them, EMS is no exception, but it is the variety of body types that would make an EMS Calendar stand out.

I think I would make a fabulous Mr. November, all withered and wrinkled, grey skin to match the grey sky – very sexy!

Categories: Syndicated Columnists

No concept of time

EMScapades Cartoon - Tue, 01/30/2018 - 10:15
Categories: EMS, Syndicated Columnists

Just Culture basics for EMS

Syndicated Columnists - Mon, 01/29/2018 - 16:11
By Brian Behn, B.A., NR-P, FP-C Just Culture takes a balanced approach between a blameless culture and a punitive culture. A blameless culture has no accountability, shoulders are shrugged, people mention “bad things happen to good people,” and move on. The opposite of this is a punitive culture in which honest and unintentional mistakes are punished. A common misconception about Just Culture ...
Categories: Syndicated Columnists

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