EMS Goes To Capitol Hill

As some of you know, I'm involved with NAEMT's legislative advocacy efforts on behalf of EMS. Yesterday, I spent the day walking the halls of the Capitol offices meeting with some of the Commonwealth's legislative contingent - mostly their staffers, but I did get to meet one Representative. This was the 5th EMS On The Hill day, and the 4th one I've attended.

This year, our "asks" were actually pretty simple. On the Senate side, we met with the staff of Senator Toomey and Senator Casey (separately). We were primary talking about H.R. 1791, The Medical Preparedness Allowable Use Act. This bill passed the House in February, and it currently sits in committee in the Senate. It's a pretty simple bill - allows an expansion of approved expenses for the Urban Area Security Initiative grant money to fund chemical/biological countermeasure stockpiles. The money is already there, this just means it can be spent on some more things that could be useful. In the Senate, we also talked about the Field EMS bill, even though there is no companion Senate bill yet. Finally, we asked for the Senators to consider joining the EMS Caucus.

After leaving our first meeting on the Senate side, we were able to get an escort by an intern from Senator Casey's office, so we were able to make our meetings on the House side without rushing too much. We got to walk along next to the Senate Subway tracks (We didn't wait for a subway car for the trip. Pretty cool tour!

On the House side, we didn't have to talk about H.R. 1791, because it's already passed. Instead, we focused on talking about the "Field EMS Bill" - Officlally: H.R.809 - Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2013. The Field EMS Bill isn't perfect - but it gets us talking about quite a few things, and at least gets us a seat at the table. If you've got a better idea, I'm sure NAEMT would LOVE to hear it... but right now, this is their best one.

We also talked about the EMS Caucus. Although there's a Congressional Fire Service Caucus, there's no group focused on EMS - yet EMS calls for service are often 5:1 fire calls.

I think the easiest sell with that was Congressman Glenn "GT" Thompson from central PA (PA-5). We walked in to the office as the House Bells were sounding, calling representatives to the floor for a vote. His staff explained that the Representative was being called away for a vote, but "He has 5 minutes and wants to see you." He greeted us with "It's good to see fellow EMS personnel here". Turns out, he's been an EMT and Firefighter since the mid-1980's, and still serves when he's home.

Here's a screenshot of a tweet HE sent with our group photo:

Congressman Thompson's staff said that the Representative has apparently stopped at a few car crashes in rural Pennsylvania since being elected and provided initial first aid until EMS arrived, so heads up, Central PA folks - that gentleman who says he's a firefighter and stopped to help might also be your Congressman!

Anyway - I think it was a relatively successful day. Last picture before I sign off - This is Chief Touchstone from Philadelphia FD EMS (and NEMSMA), with his Congressman, Rep. Chaka Fattah (PA-2).

Boston Box 1579

Today, the Boston Fire Department lost 2 members on a fire at 298 Beacon Street. The firefighters were from the firehouse right down the street from the NCEMSF hotel I was at earlier this month - in fact, L15/E33 showed up at the hotel several times for false alarm activations on that Saturday,

It was absolutely heartbreaking to be walking the halls of Capitol Hill, seeing the incident unfold on Twitter. Social Media is a great tool... but it also has limitations, and there wasn't a lot of information until BFD spoke with the press this evening.

Mark is someone I follow on Twitter, and I think he said it best. In the Boston area, Firefighters are called "Jakes". Lt. Edward Walsh and Firefighter Michael Kennedy leave behind family and friends, and a whole city is in mourning.

Godspeed, gentlemen.

Heard On The Ambulance

I'm walking though the ED after dropping off a patient.
"Oh,  are you the ambulance?" says the ED registrar.


"No Ma'am... I'm the Paramedic. The Ambulance is parked outside.....Wait... I'm not THAT big, am I?"

Gear Review - Raven Concealment Flashlight Clip

Last summer, Raven Concealment Systems rolled out a new product, a clip for Surefire (and other 1” diameter) tactical flashlights. Of course I bought one. And then torture tested used it in my everyday life.

I've been a Raven Concealment fanboy since '07 (before they were used by the Magpul guys, and their order lead time got ridiculous. Their gear isn't unique, but they do make a good product. So when I saw the announcement for the flashlight clip, I figured I'd try it. It has been the best $15 I ever spent, in terms of firearms/accessories.

I'm no Tactical Timmy, but I do carry a flashlight with me almost all the time. I use it daily - Checking a cabinet in a truck at work, or finding my cell phone dropped under my car. It's incredibly useful to have a bright flashlight handy.

My current flashlight of choice is a Surefire 6PX Pro - good all around light, with decent battery life. I like the Low/High option, rather than the On/Strobe. The low is good enough most of the time, and saves battery life.

Anyway - Back to the pocket clip. It's seen a little use. The finish is a little worn, but the flashlight has dings, too. It's held it's shape in all sorts of trousers over the last 9 months, and still works as designed. The clip has two purposes. It holds the flashlight in a bezel-down position at the top of the pocket for easy deployment, and it has an O-ring for flashlight manipulation.

The idea behind the O-ring is simple - When you grab the light as you would for a Harries stance, you slide your index finger through the O-ring. This allows you to retain the flashlight, and also enables a very cool-looking flip of the flashlight to the back of your hand, to free up your non-dominant hand to reload your firearm or perform other m manipulations. Here's Stephen Pineau demoing the clip - he shows the ring as the first option.

Since I normally use the Harries technique to combine my flashlight with my firearm, this device is just what I needed. If you're scraching your head at the term Harries, here's a link that better explains it.

Install is stupidly easy - You unscrew the tailcap, slide the metal clip over the threads and down to the bottom of the barrel at the tail, and then put the tailcap back on. It's quick and easy, and doesn't impact the flashlight use in any way. There is usually a small gap between the flashlight and the tail cap, so you aren't adding much, and the threads are long enough to handle it.

I wear the flashlight with clip in my left front trouser pocket all the time, either on or off duty. When I'm off duty and laws allow, I have a firearm on my right hip, and I leave the flashlight on my left all the time for consistency.

The light rides relatively low in my front pants pocket, and doesn't stick out. I've only found one pair of pants that had trouble holding the flashlight, and that was a pair of Dickies-brand work pants that seem to have pockets that aren't as generous as most pants. In every other pair of pants I've worn, I've never had the flashlight fall out.

Anyway - This device, overall, gets an A+ from me. It's inexpensive, and makes carrying a flashlight daily much easier. You don't need to worry about light carriers or having the light fall out of your pocket, or get buried under other items in the pocket. It's a fantastic tool, and something I recommend with no hesitation.

If you want to buy the clip - here's the link to RCS's shop.

An Open Letter on Degrees

For some time now, the EMS profession has been looking for a clear leader to emerge. We have been waiting for someone to lead us boldly into the future. Currently, the EMS field is at a crossroads. We are DESPERATELY in need of a degree requirement to help us survive and stay relevant in the ever changing and highly competitive healthcare field. It is well documented that those who possess a college degree enjoy benefits that extend well beyond the simple possession of information as a result of education. As evidenced by the increasingly complex nature of the biomedical sciences, a firm educational foundation is key to providing the best care possible. Learning the skills necessary to stay current and continue to learn throughout a career is part of the value of a college degree. The role of EMS has shifted since its inception in the 1970s toward that of an independent prehospital healthcare practitioner. In order to avoid being left behind the wave of change, EMS professionals must rise to the occasion. We would like to see you and / or other national level EMS advocacy groups visibly and rigorously support a degree based paramedic education. I and a growing number of other EMS providers hold the opinion that our field could easily transition to a degree based field through the following method;

Require all new paramedics to hold an Associate in Science degree.

This requirement would allow for a transition to a degree based model while not threatening the livelihood of current paramedics. Based on the past experience of the ANA, we can surmise that the most vocal critics of a degree requirement will be those current paramedics whose ability to practice would be threatened. Making this degree requirement pertain to future paramedics, and not requiring current paramedic to return to college to remain practicing EMS providers should avoid most grass roots opposition. This model would also allow for the continued use of EMTs by fire departments and volunteer agencies since it would not effect the EMT level provider. Furthermore, an associate level degree requirement would allow for the hundreds of community colleges currently providing paramedic education to retain their programs. Happily, since requiring A.S. level degree education requires more college classes for these prospective paramedics, community colleges should welcome this potential increase in tuition funds.

As with any change in EMS, there will be critics. There will be those who argue against change no matter how much they ultimately benefit from it. I and many of my colleagues stand ready to support you and your organization as you look toward the future. We believe that we cannot, as a field, be successful in the future without being on the same level as other healthcare professions. We cannot expect to thrive and even expand into community paramedicine or mobile integrated healthcare without paramedic leaders who possess the same tools and skills as those with whom they work. We cannot be successful without being a degree based profession. We need you to lead.

Sincerely,

The EMS Profession

Purim

Saturday night, I broke out the kilt for the first time since September.

I went to my synagogue for Purim services. Part of the tradition is that we wear costumes. There was a wide assortment of costumes, both adults and kids. Everything from a Biker Rabbi to a Pirate, with many bibilcal figures in between.

I was Oy-Rish - to honor my shared Irish and Jewish heritage. Conveniently, it was also 2 days before St. Patricks Day, so when myself and my significant other stopped for food after services, no one batted an eye at the kilt. She's already warned me that she's got reservations about me doing KTKC this fall... so it was good that she got to see that people can ignore men in unbifurcated trousers.

Sirens

I finally got to watch the first two episodes of Sirens today (I’d already seen the sneak preview episode, which will air this Thursday). I like it. I think there’s perhaps a little too much focus on bathroom humor… but aside from that, it’s the most accurate a depiction of #MyEMSDay in television I've seen since Emergency!

The characters, thus far, are the clear win. They remind me of people I've worked with. The conversations with each other and practical jokes are akin to things I’ve seen or done in my years in EMS. The personal issues regarding relationships are something I’ve seen many times, and the relationship between partners seems to be accurately depicted.

The nicknames are a nice touch, and something VERY common within Emergency Services. Many newbies acquire nicknames. Sometimes you get to grow out of them, sometimes you don’t. I’ve seen several places where active members don’t know someone’s real or full name, because they only ever refer to that person by a nickname or their last name. Some of the nicknames are based on something in particular, and in other cases, they are assigned seemingly at random. “Why Pedro? Because there were already two John’s”.

I have 2 issues with the show. One is professionalism, and the other is the actual medical care.

Professionalism: Making fun of a patient’s disability - like temporary deafness, isn't funny. I think the show can have just as much fun, while ALSO highlighting the professionalism of the providers and their patient care. On the flipside, I recognize that a 20-minute show doesn't provide a lot of time to showcase both patient care AND witty dialogue, but I hope the show’s writers can find a way.

As for the actual medical treatment: It seems overly dramatic at times, and they seem to not spend so much time focusing on standard treatment. Guess what… it’s TV, not real life. Further, this isn't the first show to have that problem - ER, House, and even Scrubs often focused on “zebra” diagnoses over standard treatment. My biggest gripe is that

I also have a question - What is the level of provider? Are they EMT-Basics? Paramedics? It would be a great opportunity to highlight the different levels of training, and the fact that the more advanced prehospital providers have 1.5-2 years of schooling, if not a college degree.

Anyway - Thus far, I think Sirens has potential. If you can get past the “TV Medical” issues inherent in every show, it’s worth a watch. Further, I think the characters are solid, and there is a FUTURE in this show.

Anyway - Catch up, and watch the next episode Thursday!

http://www.usanetwork.com/sirens

Car Trouble

After my exchange with the woman in Philadelphia, my brother and I had an uneventful ride back to our hometown, and as it was approaching 10pm, but not 10 yet, we were discussing options for dinner. As we approached our exit from the highway, we noticed an older sedan stopped with no lights in the left (passing) lane. This was in a construction zone, with high Jersey barrier walls on both sides of the 2 travelling lanes, and no shoulder. The next pull-off was about 1/10 of a mile up, and was the exit we had been planning on taking.

As I came past the vehicle, I slowed down, and was trying to see if it had been involved in an collision or why it was stopped. Then I heard someone yelling “Can you help us?”. As there was no traffic behind me, I was able to stop and roll down my window, at which point the passenger said the car had died with a dead battery and they needed a jump.

I made a quick assessment and said it wasn’t safe to do that, but if they wanted, they could put the car in neutral and I’d push them off to the exit ramp, and then try to help them. They accepted, and I quickly backed up and got behind their car.

With light traffic, we were able to get the other car off the main highway, and into the shoulder and exit lane. The other car was occupied x2, both young men in their late teens to early 20’s. The driver said they had been on their way back to school, about 7 more miles along the road, when the car died. He speculated that he might be having alternator issues. My brother went back and alerted oncoming traffic of the obstruction with his flashlight, while also paying attention to what I was doing. I grabbed my extra-long jumper cables and proceeded to work with the driver of the other car to connect our batteries.

After some minor issues (the other car’s battery had side posts and minimal area to access the positive terminal), we were able to get them jumped. I told them to head up the ramp and try to make it to a parking lot, and I’d be right behind them. I threw the jumper cables back in my car and took off after them.

I caught up with them at the next traffic light, and the driver said that the car seemed to be running fine, and they were going to try to make it to school. I suggested an alternate route to avoid the rest of the construction zone, so that if the car died again, they would have safe options to pull over, and they headed in that direction, while I headed to drop my brother at his residence.

I found this event to be an interesting occurrence immediately after the brief interaction in my last blog. If you notice, I never mentioned race in either post. Interestingly, both the middle-aged woman and the 20-ish men were all black. So why did I “run” from one, and take risks to help the latter pair?

The first woman startled me - she appeared somewhere where I hadn’t seen anyone approaching. In addition to the threat indicators that I believe I subconsciously processed, I was rattled because I had not seen her until she closed my reactionary gap, and since it was clear that my situational awareness wasn’t what it should have been, I decided that the quickest and safest option was to get away from the situation.

The second pair were in a position of danger. I’ve heard of criminals putting themselves into a position to be able to target a Good Samaritan, but they were stopped dead in the water on a major highway. Had I left them there, even for a few minutes until police or the roadside safety patrol came by, the consequences could have been deadly. I offered them an option that I felt was reasonable (since both of us were in older cars, and my front bumper is already dinged up) and got them to relative safety.

Once we stopped, it was clear that both occupants of the car were more worried about their situation than trying to attack me. I didn’t.notice any of SouthNarc’s “threat indicators” and it was clear that their car was truly disabled. I was also in a better position to control the situation, because I had determined the location our interaction would take place, and my brother was in a position where he could provide cover if needed.

Anyway - that was my Sunday night.

Are You Scared?

As I said in my last post, I had a fun weekend in Boston, the city I was born in at the NCEMSF Conference. At the last minute, I changed my plans. Instead of driving, I took Megabus up and Bolt bus back. Both were acceptable, and the red-eye Megabus worked with my schedule. My brother gave me a ride into and home from Philly (in my car), and the travel wasn't bad.

I had an interesting exchange on Sunday night as I was getting into the driver’s seat after swapping out with my brother. A middle aged woman appeared practically out of nowhere, and had closed to within 4 feet of me at my 11-o’clock, on the driver’s side of my car (she was standing in the street) when I noticed her. It was late (9pm) and I thought I had been aware of my surroundings as I loaded my bags in the car and snapped my holster onto my belt, but this woman startled me and was far too close for my comfort.

She approached from the front of my car and asked “Can I ask you a question?” I had flashbacks to my SouthNarc class at Tactical Conference, and simply said “No”, got into my car, and took off. As I did, she asked “Are you scared”. Being a smartass, I said “no” from behind my closed door, and shifted the truck into drive as I hit the lock button. We “got off the X” without incident, and headed home. I’ll continue the “home” part tomorrow.

Anyway - Let me take a moment to address the idea of “Managing the Unknown Contact”. SouthNarc is a retired LEO who does firearms training, and as he put it in our session, there is a LOT of training about how to address a lethal threat, but very little training about how to handle an “unknown contact” in a public place. He’s got a good write-up that explains his approach: (http://homeguntraining.files.wordpress.com/2013/07/sncontacts.pdf). The bottom line is that when you’re approached by a stranger in public, you need to keep as much distance between you and them as you can, while you assess their actions... and it’s OK to be rude. Especially if they are closing your reactionary gap.

The idea is to halt their approach. If they ask permission to ask you a question, or show you something, you've given them implicit permission to close that gap. My other concern was that someone appeared “out of nowhere”, so I was clearly not as aware of my surroundings as I should have been. I didn't think there was anyone behind me, but I couldn't check because I would turn my back on the first contact.

In hindsight, as I replay the situation in my head while I write this, I can also say that the woman also engaged in both “grooming” and “target glances” - she had a headband in her hair, and she kept touching/adjusting it, and I also saw her glance to her 3-o’clock and behind her. At the time, I didn't consciously process these indicators - but I think I did subconsciously. My solution, although rude, was to continue to get into my car, and then immediately leave. It ended the contact, and removed myself from the situation. In all likelihood, she may have simply been trying to panhandle, or might have been looking for some other type of help - but I felt no need to take risks to be polite, so I left.

My Weekend at the NCEMSF Confrence

I had the honor to spend this last weekend in Boston, at the 21st Annual National Collegiate Emergency Medical Services Foundation Conference. NCEMSF is a great organization, and every year they host an inexpensive national conference in an East Coast city. I’ve attended the last 4, the last 3 years I’ve presented a topic. This year was the largest turnout ever, with over 1100 attendees, and 100+ presentations.

This year, I had several friends and acquaintances that were also presenting. I got to meet several people I’d only met online, as well as catch up with some old friends I only ever see at this sort of event.

My favorite presentation to see was presented by my friend, Scott Kier (@MedicSBK) of EMS In The New Decade. Link Here to his take on the conference.

I myself presented Friday Night (first session), doing a tounge-in-cheek review of recent research to a well-attended session. My session was titled: “Why’d the Medic Do That? A Paragod Explains”. The title is a bit of personal humor - those that know me, know that I’m NOT a “Paragod.” My title stems from working with partners who aren’t as up to date with the latest research, leaving me to occasionally mystify them on a call when I do something crazy, like say “the patient does not need supplemental oxygen” or “we don’t need a backboard.” Some of what I do is heresy to those who haven’t cracked a book since EMT school.

What I found amazing is that there was a full-length session dedicated to EVERY. SINGLE. POINT. I'd covered... Not to brag, but I summed up most of those sessions in about 10 minutes.

Anyway - I promised I’d post my source links for those who attended my session - Here they are. Thanks for stopping by and checking out my blog.

• Scene Safety:
• http://www.naemt.org/Libraries/Health%20and%20Safety%20Documents/EMS_28_BestPractice0513.sflb
• http://dt4ems.com/?p=1368
• http://dt4ems.com/?p=1435
• More Info:
• http://dt4ems.com/
• Cardiac Arrest Management
• AHA/ECC 2010 Guidelines: http://circ.ahajournals.org/content/122/18_suppl_3.toc
• Lights & Sirens / Vehicle Safety:
• http://www.objectivesafety.net/RochesterNewsletter%20July%206.pdf
• http://www.emergencydispatch.org/articles/lightssirenliability1.htm
• http://www.emergencydispatch.org/articles/ambulancetransporttime1.htm
• http://www.usfa.fema.gov/pdf/efop/efo42566.pdf
• http://www.bryanbledsoe.com/data/pdf/mags/Myth4.pdf
• More Info
• http://www.objectivesafety.net/gallery.htm
• Backboards:
• http://www.jems.com/article/patient-care/research-suggests-time-change-prehospita
• http://www.emsworld.com/article/10813735/evidence-against-routine-spinal-immobilization
• http://www.naemsp.org/Documents/Position%20Papers/POSITION%20IndicationsforSpinalImmobilization.pdf
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691505/
• http://www.jems.com/article/patient-care/how-lee-county-fla-ems-implemented-new-p
• More Info @ RougeMedic:
• http://roguemedic.com/2013/08/where-is-the-evidence-for-spinal-immobilization/
• Oxygen:
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941910/
• And refer to the 2010 ECC Guidelines as well