Travel

Well, it's been a busy few weeks out here.

I flew home last week during my 3 days off to see some folks, and pick up a shift at my one job. Why did I need to pick up a shift? Because they said if I didn't work within 90 days, I'd be off the schedule. So I'm now good to have a job to go back to when I finish my temporary government job up here.

Anyway, my encounters with the Thousands Standing Around (http://www.tsa.gov) were unremarkable. Flying out of McCarren, I was running late for a 6am flight, but thankfully there was NO line at security. I opted out of the invasive scanner, and got my free Obamacare health screening from a polite TSA worker.

My Southwest flight home was uneventful. I ended up with a middle seat in an exit row. The flight attendant was VERY clear on making sure those of us seated in that row knew what our roles were, and the flight was slightly early into BWI. As we exited the aircraft, I became aware that the woman sitting across the aisle from me was a sitting US Congresswoman. True to her party, she was sitting on the left side of the plane - but hey, she's flying Southwest, so she's at least attempting to be fiscally Conservative.

Heading back, there was quite a line at 6am at BWI, however it moved rapidly, and I got "randomly selected" for TSA Pre-Check. That was nice. Kept my shoes on, and didn't get groped by some random guy.

The flight home Friday morning was a little bumpy, but otherwise uneventful. I still haven't seen a singing or rapping Southwest flight attendant, and the flight crew going back seemed less enthusiastic than the ones I had Tuesday. We landed back in Vegas on time. I drove straight to work from the airport, and made it in plenty of time.



PS... TSA Pre-Check rant: Because I work for the FedGov, I currently hold a HSPD-12 smart card. If I were a DOD civilian, I would be automatically eligible for Pre-Check, but since I work for a different agency, I'm not. Even though I've had a background check more thorough than TSA's. Government Efficiency right there.

Wildfire

The other week, I finally got the opportunity to complete my Pack Test, or “Work Capacity Test” for my current job. It’s the arduous-level wildland fire physical fitness test. You wear a vest or carry a pack weighing 45 pounds, and walk 3 miles, in under 45 minutes.

This test was the biggest thing that scared me about my new job. Somehow I missed the requirement to pass the test on the application, and I didn’t realize I’d need to complete it until I was in the process of accepting the position. Over 2 months, I was able to work up to the required time and weight, and now my biggest goal is keeping at it, so that the test doesn’t scare me in the future.

Anyway – I took the pack test on July 6th, which was a significant day in the history of wildland fire. On July 6th, 1994, 14 experienced firefighters died on Storm King Mountain in Colorado. The week before, June 30th, was the first anniversary of the deaths of 19 Granite Mountain Hotshots on the Yarnell Hill fire in Arizona. July 10th was the 13th anniversary of the Thirty Mile fire, a fire in Washington State that took the lives of 4 Forest Service firefighters.

That’s 3 major anniversaries in wildland firefighting in 11 days. I’ve read much about all three incidents, including John Maclean’s books on the South Canyon (Storm King) Fire, and the Thirty Mile Fire. He’s a good author, and does a decent job summing up the various investigations, as well as re-interviewing involved parties and trying to put a fuller perspective on the events.

Anyway – One thing I’ve learned in my wildland training is that the 10 and 18 (Standard Firefighting Orders and Watchout Situations) have been written in blood. Yeah, I’m idealistic because I haven’t actually worked a wildfire, but I just can’t understand why the same things happen over and over again.

As the summer continues, to my friends that wear yellow nomex – as the 10 & 18 say: Fight fire aggressively, having provided for safety first.

Helicopters

I've long been a believer in the Bryan Bledsoe School ofHelicopter EMS (HEMS) Usage. Essentially, they have a place in EMS, but they should be like abortion – safe, legal, and rare.

Back home in Pennsylvania, I've been outspoken over the asinine use of HEMS. When you're within a mile of an open and functional trauma center, there is no good reason that you need to land a helicopter to transport your patient... yet I've seen and heard that happen.

Don't get me wrong, HEMS has its place in EMS. The providers often have more advanced tools and drugs, especially for securing airways in traumatically injured patients.

One of my most common places to use HEMS back home is actually at a prison that we cover. We often have some time delays in accessing, packaging, and removing the inmate to the ambulance, and the facility also has a true helipad. If I call for the helicopter when I'm in the facility, it's on the ground or landing by the time I can load the patient and move to the LZ (Landing Zone). Depending on the time of day and road conditions, my drive time from the facility to a Level II trauma center can be as little as 30 minutes, or as much as 45 minutes or more. That meets criteria, in most cases, to allow HEMS usage. And HEMS is actually faster if they are on the ground at the same time that I could start driving.

Now out here, I’ve got extended drive times from much of my territory to trauma centers, and in some places, even a hospital. My two closest hospitals for much of my territory are community hospitals, one of which is technically a "critical access hospital." Additionally, when my patient is down a trail, or on a boat, I’m rarely sitting waiting for a helicopter to land to take my patient away. The crews I’ve worked with are great at minimizing scene time, and usually are in the air within 5-6 minutes of climbing into my ambulance.

Now here’s the fun part. Often, when I send patients by helicopter, they go to the hospital Dr. Bryan Bledsoe works at. That’s just ironic, isn’t it?

Code 4

A few months ago, I blogged about “plain speak” and how terminology changes from place to place. Now that I'm working in the Western US, I've learned a NEW term for an ambulance – out here, it's called a “Rescue”. They have “Heavy Rescue” or “Technical Rescue” units – those are the “rescue” trucks I'm used to talking about.

Anyway – the agency I work for still uses some 10-codes. Things like “give me a 21”, short for 10-21, meaning: call dispatch via phone. Some folks use 10-7/10-8 for out of service/in service, and there's a smattering of other ones, too. There's a new one for me, “Code 4”. It's actually the same as a 10-code I'm used to from the police back home, “10-92”. Code 4, 10-92, or even “92” mean the same thing, ostensibly, “status OK”. That said, the code means so much more than that. The use is very context-dependent. Most often, it's how I answer status checks by dispatch when my unit hasn't been on the air recently.

We also use it for other things. Talking about a disabled motorist: “He's code 4, waiting for AAA.” Or, after a property damage collision, “occupants are all Code 4, just want to file a report.”

An example, from an EMS perspective, is a call I had at the University EMS service, while I was a supervisory lieutenant. I was onscene for a psychiatric emergency, and the other lieutenant arrived, and asked me on our ops channel if I needed anything. My response was “Nope, we're 92 in here, just let me know when the BLS arrives.” Suddenly, by using that 10-code, he knew that a University police officer and myself weren't doing anything useful inside, and were simply waiting for the ambulance to arrive, so the person could go to the hospital for care, after their cry for help.

Another great use from the EMS side is when we are requesting a LE unit to assist us for something minor – forcing access into a house, dealing with securing property, that sort of thing. Over the years, when I've request a LE unit for something minor, it's not uncommon to get more than one, because they all come, just in case I'm in trouble. It's great to know the cavalry will come when I call, but it's also a waste of resources. Being able to use a code that the dispatcher and LE know, that says “I'm OK” can help ensure that my LE friends don't get hurt racing to “assist EMS” for something dumb.

“Code 4” isn't some huge secret. It's online, and can be heard on most scanner apps for western LE agencies. Its use is varied, and very flexible. It, and 10-92, the 10-code from back home, are one of the more useful LE “codes” that I've used.

Jon

Fellowship

I’ve had the opportunity this spring to be involved in something really cool. I’ve been involved with a new group, called the American College of Paramedics. Here’s the idea – Paramedics in the United States becoming a self-regulating body, like is seen in many Commonwealth countries.

From the website:

The title of “Fellow of American College of Paramedicine” represents an EMS practitioner’s commitments to clinical excellence in the prehospital environment, the promotion of evidence-based EMS practice, and development of the EMS profession into that of true allied health professionals. Candidates for FACPM will have demonstrated the following during a 5-year candidacy period

http://acparamedic.org/fellowship/

I’m proud to say I’m part of the fellowship committee, and the Board members seem to be working diligently to make this happen. I think this is a great next step for American EMS. What do you think?

Check out the website:

http://acparamedic.org/

And the Facebook page:

https://www.facebook.com/Paramedichope

Jon

Philly Fire at Level Zero

Philadelphia Daily News has an inflammatory headline today: In case of emergency, say a prayer? Sad part - It's spot on. Getting EMS care in Philadelphia is as much luck as it is anything else. It's a finite resource that has long been neglected.

 

Tuesday brought seasonally expected high temperatures, and with that, predictable high EMS call volumes. That’s NOT a surprise to anyone who follows the saga of PFD*EMS. Add in a small-scale disaster, such as the food truck explosion that happened Tuesday afternoon, and the system went back to Level Zero. And was there a couple other times during the day.

Level Zero is a term in the EMS industry. It means the City has ZERO available transport EMS resources – everything is committed (on calls, at hospitals, cleaning up, completing post-run paperwork, restocking, or out of service for training).

Here’s the thing. Even when Philly DOES have EMS units available… they may not be in every neighborhood. On busy days, it’s routine to see ambulances leapfrog across the city, getting sent on 20 or 30 minute responses as soon as they clear a hospital. Is there really a difference if it takes 10 minutes to dispatch an ambulance that’s coming from 20 minutes away, or if an ambulance from 30 minutes away is dispatched without a delay? Other than the statement of “no medic available” on the radio? The scene gets the closest available suppression apparatus, and they wait for an ambulance.

It’s common in major cities to supplement municipal EMS resources with mutual aid providers. In some towns, that consists of agreements with adjoining towns to help provide coverage for normal flows of service. In other towns, that involves a public-private partnership where ambulances that are primarily used for non-emergent transport are used to supplement the 911 system. Some areas do this more frequently than others, but it’s a common solution.

Philadelphia doesn’t seem to know how to call for help. They have a procedure where quite a few agencies have radios mounted in ALS ambulances that can communicate with PFD’s dispatch so that these units can be used in a disaster. These radios are used in the annual airport drill, and regularly tested, and that’s the end of it.

Philadelphia invested money in the system, and unveiled it 4years ago. Yet, to my knowledge, it has never been used for an actual event. Especially these occasional surge events that happen EVERY SINGLE SUMMER. These surges happen in extremely hot weather, and also on warm summer evenings when the city's "knife and gun club" starts up, and fills the hospital trauma bays with battered and bleeding individuals.

Philly is planning to “fix” their EMS system by hiring a whole bunch of EMS-only EMT’s to ride ambulances, paired with Paramedics, allowing them to return to a all-ALS deployment with more units. That’s the stated goal, anyway. That isn’t going to happen overnight, though. The City should use the resources it has available to cover it’s requirement to provide EMS until PFD*EMS is on a better footing.