Happy Holidays

For the holidays--the next issue of Real Life EMS Magazine. (Click on photo for a larger image)

What is really stressful in EMS? Four jobs. Partner problems. No excitement.

While people continue to imply that the stress in EMS is from witnessing horrible trauma, most providers brown out from non-emergency call after non-emergency call.

Regardless of what your stress is from (maybe the holidays?), stay safe, sane and warm this season. Stay healthy to go out and do good tomorrow, and the next day and the day after that. For the greatest gift you can give your patients is to be there and take care of them...no matter how routine that may seem. The greatest gift to yourself is understanding just how wonderful simply taking care of someone can be.

Happy holidays.

NAEMSE/Massimo part 2

Several days have passed since my initial post about the NAEMSE/Masimo issue. I have certainly had quite a few phone calls and many more emails. One of the most interesting and appropriate calls described Masimo's marketing activities as similar to Invasion of the Body Snatchers.

Picture it. You are one of the few people that hasn't been infected by the Masimo virus. You act like you have...always worrying that one of the Masimo people will see that you haven't been infected...and then eat your head or something.

I made my previous post at 9:02am EST. By 12:00 noon on the same day I had 4 hits on my blog from Masimo in East Irvine, CA. To date there have been 7.

Lets look at what Masimo has done to market (aka push, shove down our throats) their CO-oximetry product.

They developed curricula for EMS providers and distributed it through NAEMSE. NAEMSE sent a letter to its membership recommending CO screening and the educational products developed under a grant by Masimo. Masimo then sent out a mondo press release which was picked up on hundreds of web sites from CNBC, Reuters and market watch to industry news sites.

They developed curricula for firefighters and distributed it through IAFF. I am in the process of obtaining the CD and accompanying paperwork from this mailing. I'll report back on this.

They have a supplement to JEMS this month touting a "Standardized Curriculum on Carbon Monoxide Poisoning." How did this become "standardized?"

They are the only listed sponsor of firerehab.com. Note the dramatic scrolling list of news with a bent towards CO poisoning incidents.

The are behind firegrantshelp.com because the sponsor of this site is firerehab.com (sponsored by Masimo) Check out their sponsors page. Grants for CO-oximetry anyone?

They have sponsored most current research on CO-oximetry. They also regularly sponsor sessions at conferences which relate to their products.

They have giant booths at EMS and fire shows. They give away big things. I got a nice duffel to carry my dirty laundry home from JEMS.

While not a smoking gun, it is interesting to note that some links to materials on CO-oximetry are dead links including a link to an IAFF PDF on firerescue1.com and the Masimo Carbon Monoxide Training Center at the National Paramedic Institute

Enough already. While companies have the right to push FDA approved devices as much as they want (and make as much money as they want) this borders on exploitative and manipulative. How about taking the money you plan to spend on your next round of pointing out just how necessary and important your product is and REDUCE THE $4,000 PRICE TAG so it can do some of the good you claim it does?

Masimo stock, in its IPO on 8/7/07, was offered at $17.00. At last close it was $40.25 (a 136.8% return in just over 4 months). Despite all the good Masimo may claim to be doing through its lectures, curriculum development and web site sponsoring, let's face it, it is about making money for the corporation.

And back to NAEMSE, the letter was wrong. Period. NAEMSE needs to disclose to its members how much it accepted from Masimo on what dates, who wrote that letter and offer an apology to its membership for this ethical lapse--whether intentional, by oversight or appearance.

Am I ungrateful? No. Practical? Likely. Skeptical? Definitely.

Beware of anyone who takes such lengths to tell us what we need. If it was this important wouldn't it be obvious? Maybe the need to spend $4000.00 isn't as obvious as some would like us to think.

Rampart, we're on the way in with a...

...Cocker Spaniel with a broken leg.

In Michigan, Rampart is the animal emergency clinic and the rig bringing in the dog has lights and sirens...if a bill currently in committee makes it to law.

Siren sought for pet ambulance

Just figured I'd lighten the tone a bit after the NAEMSE/Masimo post. I'll have a follow-up for that in the next few days.

As always, thanks to Paul Maniscalco's listserv for finding some of the most unusual stories in EMS.

Be careful out there.

Has NAEMSE gone too far?

I was doing my daily search of EMS news recently and found a press release on EMS1.com from Masimo touting how the the National Association of EMS Educators made a critical medical announcement:

NAEMSE Letter to Members Warns of Critical and Fatal Implications of Missing the Diagnosis of Carbon Monoxide Poisoning

IRVINE, CA - Masimo (NASDAQ: MASI), the inventor of Pulse CO-Oximetry and Read-Through Motion and Low Perfusion pulse oximetry, today announced the National Association of EMS Educators (NAEMSE) has issued guidance to all its members advocating carbon monoxide screenings for patients presenting with any of the signs and symptoms of carbon monoxide poisoning or suspected exposure. In addition, the organization is advocating enhanced carbon monoxide training programs for all EMS professionals to help improve outcomes and save lives.

In a letter to its membership issued earlier this month, NAEMSE said failing to diagnose carbon monoxide (CO) poisoning during the emergency response efforts may lead to poor pre-hospital decisions, including failure to transport, failure to transport to an appropriate facility, failure to properly treat and failure of the emergency department to diagnose. The consequence of misdiagnosis can often result in returning the patient to a poisoned environment, possibly leading to a fatal outcome. Recognizing that CO poisoning-the most common form of poisoning in the United States-is notoriously difficult to detect, NAEMSE said improved screening and implementation of proper carbon monoxide EMS training programs "can no doubt lead to improved outcomes for patients and potentially save many lives."

Too often, even the most skilled first responders can miss the chance to treat carbon monoxide poisoning early because until now there hasn't been a fast, accurate and noninvasive way to detect elevated levels of CO in the blood. However, with the Masimo Rainbow SET Rad-57 Pulse CO-Oximeter, EMS professionals can easily detect carbon monoxide poisoning on the spot in just seconds with the push of a button, allowing for prompt and possibly life-saving treatment. In addition, Rad-57 can also limit the likelihood of long-term cardiac and neurological damage that can result from non-fatal exposures.

"We see first hand the overwhelming and immediate need for carbon monoxide screening during the first response stage and the importance of standardized carbon monoxide training protocols for EMS professionals as a matter of public safety," said NAEMSE President Angel Burba.

NAEMSE will soon have a new online training program available to all its members, free of charge, on their website www.naemse.org. The program-consisting of four carbon monoxide modules developed by Dr. Bryan Bledsoe and approved by top EMS physicians and professionals-covers the physiological dangers of CO poisoning, its signs and symptoms, as well as noninvasive methods for on-scene detection of CO in the blood. The modules include downloadable student workbooks, instructor manuals and PowerPoint slides for classroom presentation. Dr. Bryan Bledsoe is an emergency physician, highly regarded as one of the premier educators in the EMS field, and the leading author of numerous EMS textbooks.

Joe E. Kiani, Chairman and CEO of Masimo stated, "NAEMSE's recommendations for proper EMS training and field screening of carbon monoxide poisoning represents an important milestone in the establishment of new protocols for emergency responsiveness and improved public safety. If implemented nationwide, these recommendations will help reduce morbidity and mortality from unsuspected cases of carbon monoxide poisoning."

Coincidentally, NAEMSE's website welcomes Masimo as a new platinum corporate sponsor. Does anyone smell a pay-off? Can you guess who funded the development of the educational materials on the NAEMSE site? Does anyone actually think that someone at NAEMSE wrote that letter? It smells of being written by Masimo and copied onto NAEMSE letterhead--letterhead quoted on sites like firerehab.com (sponsored by Masimo) and healthcare purchasing.com as shameless Masimo ads.

Perhaps most disturbing is the between the lines implication that CO-oximetry may have a routine use to catch those sneaky non-diagnosed cases of CO poisoning.

Remember when we were all incensed when the AHA pushed Amiodarone after the manufacturer built them a new auditorium? How is this any different? And why would MASIMO do this with NAEMSE? Couldn't they get any clinical associations (e.g. NAEMSP, ACEP) to jump on with this sales pitch?

As a matter of fact, letters in Annals of Emergency Medicine are clearly divided on carbon monoxide poisoning and the role of these devices and act as a good representation of the fact that more research and technology improvement is needed.

O'Malley (O’Malley GF. Non-invasive carbon monoxide measurement is not accurate. Ann Emerg Med. 2006;48:477–478) stated:

We prospectively non-invasively measured COhgb on every ED patient. By the end of the second day of the study, we identified 5 false positive pulse co-oximeter readings. Every patient with an elevated COhgb level as described by the pulse co-oximeter had normal serum COhgb as measured with the blood test (100% false positive). The ED staff became distrustful of the pulse co-oximeter and lost interest in recording COhgb readings on every ED patient. We officially stopped the study after recording COhgb non-invasively on 328 patients and identifying 5 false positive COhgb readings

Suner, et.al. (Non-Invasive Screening for Carbon Monoxide Toxicity in the Emergency Department is Valuable Selim Suner , Robert Partridge , Andrew Sucov , Kerlen Chee , Jonathan Valente , Gregory Jay Annals of Emergency Medicine- 2007 May (Vol. 49, Issue 5, Pages 718-719) replied in a subsequent letter:

...To discredit a new technology based on 5 cases in a study which was stopped after 2 days is premature. Screening tests will have false positive results. Although confirming false positive results by performing venous co-oximetry has costs associated with it, identifying occult cases of carbon monoxide toxicity may prevent significant morbidity and mortality. With new technology in the field of medicine, frequently there is initial skepticism and growing pains. Similar complaints were evident when pulse-oximetry was first introduced in health care to measure oxy-hemoglobin concentration. It took months if not years before this technology was accepted. Now it is an indispensable tool in our diagnostic armamentarium and arguably a fifth vital sign. It is too early to determine the precise use of pulse CO-oximetry technology in the ED. The scientific community will weigh the data as it becomes available in the literature.

The take-home point in this case isn't in the statistical or research dispute. The issue is clearly stated in the last two sentences of Sumer's letter:

It is too early to determine the precise use of pulse CO-oximetry technology in the ED. The scientific community will weigh the data as it becomes available in the literature.

In short, it's not time yet.

In a position paper, "Critical Issues in the Management of Adult Patients Presenting to the Emergency Department with Acute Carbon Monoxide Poisoning," (October, 2007) the American College of Emergency Physicians states that there were 491 accidental deaths from carbon monoxide poisoning in 1998. Non-fatal poisonings were estimated at 15,000 - 40,000 with an acknowledgment that numbers may be higher because of misdiagnosis.

This post is getting long. Look at the references listed here. Make your own decisions. Here is the Dan Limmer position paper as a conclusion:

1. Masimo appears to have funded every study, education curriculum and press release out there.
2. NAEMSE went too far in issuing the press release and recommendations. I'm OK with the curriculum--generally and as a resource for educators--but am opposed to any statements or veiled implications making CO-oximetry a standard of care at this time. I believe this endorsement timed with platinum sponsorship by Masimo takes credibility away from NAEMSE as a national leadership organization.
3. I question the need for every agency to run out and buy a $4,000 device at this time. It is clearly not a standard of care. The scope of carbon monoxide poisoning cases as noted above does not warrant this designation.
4. In firefighter rehab and suspected carbon monoxide cases it may be useful (duh!) and we didn't need fanfare and press releases to tell us this. Firefighters deserve the best of care. In this area CO-oximetry may be useful and warrant recommendation.
5. The technology is in its infancy and will likely improve to be more reliable. At this time any implication that routine screening of patients is necessary or even suggested is nonsense and may in fact cause unnecessary transport and additional invasive testing.

The end.

Motorist charged in fatal ambulance crash

I have several posts on this blog in reference to an ambulance crash that killed paramedic Allan Parsons and seriously injured EMT/driver Arlene Greenleaf.

Today the Associated Press reported the driver of the vehicle that struck the ambulance was intoxicated and has been indicted for manslaughter and operating under the influence of alcohol at nearly twice the legal limit (0.15% BAC).

TURNER - A 30-year-old Turner man has been indicted on charges of manslaughter and drunken driving arising from an early morning crash last summer in Turner that killed a paramedic while he was tending a patient en route to the hospital.

Christopher Boutin is accused of crashing his pickup truck into an ambulance on Route 4, killing 46-year-old Allan Parsons of Wilton. The ambulance driver and Boutin were seriously injured.

Investigators said Boutin was drunk at the time of the July 5 crash and failed to yield to the ambulance, which had its emergency lights on.

The indictment handed up Thursday said Boutin's blood-alcohol level was more than 0.15, which is nearly twice the legal limit for drunken driving.

My continued heartfelt sympathy goes out to the Parsons family. My sincerest wishes for continued, speedy recovery to Arlene Greenleaf and her family. Although nearly 6 months have passed, the impact of this crash will be ever present for these families over the holiday season.

EMS Response: Man Colds

How many times have you been called for "emergencies" EMS shouldn't be called for?

Did you ever notice men are weenies when they are sick?

This video addresses both.

Accessories make the man...

According to WBNG 12 news, a Johnson City, NY Fire Chief showed up to work last month wearing only a hat and tie. And I mean ONLY a hat and a tie.

JC Assistant Fire Chief Arraigned After Arriving At Work Naked

Apparently this was planned because his stepfather showed up to take photos. The chief was arrested for exposure of a person. Difficult to deny with photos floating around.

Oh, the jokes that come to mind... Wouldn't it be embarrassing to have the charges dismissed for lack of evidence?

I hope the hat and tie were at least Nomex.

Feel free to add your own.

Thanks to Paul Maniscalco's news emails for this story.

iPods for NYPD recruits

NYPD Police recruits will all be issued iPods with training material on them. The iPods will contain laws, procedures and other material to study according to an article published by Reuters today.

"Now a recruit can watch a class on 'search and seizure' while going home on the subway," Police Commissioner Raymond Kelly said in a statement.

In a related story from 2005, NYPD blames iPods for subway robbery surge. I hope the recruits are armed if they study on the subway going to work...

If you would like EMS training material for your iPod I'm proud to say that we saw than need some time ago. Check out the EMT Audio Lecture Series.

Crashes and clashes...both too often in EMS

The Burlington Free Press reported yesterday on a crash that killed a patient and seriously injured the EMT in the patient compartment.

The article, Crash spotlights ambulance risks, is a good review of the issues facing EMTs in the patient compartment. With winter squarely upon us we must all be careful out there.


In the clashes category, the Naples Daily News reports on a county system in transition: Power, politics and money beneath fire merger talks. And EMS is squarely in the middle of the clash. While the devil is in the details when negotiating any merger, success is measured years later by how well a central culture of quality and respect is created from several different agencies.

My best wishes to the patients and providers in Collier County for a successful merger.

Virtual hip replacement...test your skills

Thanks to Libby at the Don't take life too seriously blog I am able to post a very interesting virtual hip replacement site.

See if you've got what it takes...and learn something along the way.

The award for most ridiculous medical procedures in a drama goes to...

...Law and Order: SVU "Paternity"

I normally don't take TV shows seriously. I like the Law and Order series. It is always relaxing to watch a good psychotic murderer at 10:00 pm to wind down from a long day.

I tuned in this past Tuesday night (11/28) and saw a nanny murder with a side dish of infidelity, paternity issues and a botched murder-suicide. This only took 40 minutes. What could happen in the last 20 minutes? The worst medical procedural scene I have witnessed in some time on television, that's what.

Elliott Stabler's wife (pregnant, full-term) is being driven to a doctor's appointment by Stabler's partner, Detective Olivia Benson, when they are t-boned by a drunk. During the ensuing rescue the police detective (played by Mariska Hargitay) climbs back inside the wreck and starts an IV under the direction of a FDNY medic. She doesn't just start an IV...she starts an IV from a position an experienced medic would cringe at (but do). Then, without instruction, she tamponades the vein. The medic then hands in a small bag of fluid and instructs Benson to "squeeze the bag." She does, but rather than squeeze and hold the bag she performs this rhythmic squeezing thing that miraculously brings the patient back to life.

It is fortunate that she was brought back because she was then able to push like a fiend to get that baby out in the moving ambulance (sans stretcher straps) on the way to the hospital. Like we would want to intentionally deliver a baby from a woman with internal injuries, in a moving ambulance, alone.

Not surprisingly, she does easily deliver the baby (two pushes), who arrives in the world as all TV babies do (clean, without an umbilical cord, APGAR=10 and crying for mommy). Also without surprise, the patient loses consciousness again after delivering the baby.

I know it is a cop show and this was alleged drama but you really have to see it. If you have a PC you can watch the episode online. Or just watch the last 20 minutes. If you do, please leave a comment here to tell me what you thought.

I suspect that some (if not all) of the FDNY personnel portrayed in the episode were actually FDNY. My sincere condolences to you for having to participate in such dramatic fluff.

Remember when Johnny Gage started the IV on himself in the hose bed of the engine after being bitten by the snake?

Those were the days.

Just when you thought you knew the AHA CPR guidelines...

It looks like more changes will be coming in the future. Studies--and the newspapers touting the results--all seem to point to doing even more compressions and fewer ventilations.

Compression most important in CPR, an article from the Houston Chronicle, reports on a presentation at the AHA sessions in Texas this month. A 50:2 compression to ventilation ratio reportedly improved survival significantly. Devices like the ResQPOD as well as hypothermia seem to also be quickly rolling down the pike.

What I find most interesting--and even refreshing--is movement away from blindly and fanatically following CPR guidelines. In years past you would've had all those cool patches ripped from your sleeve if you one-one-thousanded when you were supposed to one-and-two-and. Gasp!

This reminds me of an article I saw this summer from Wisconsin, Simplifying CPR, saving lives. I like these guys. Do compression only CPR to the tune of "Another one bites the dust?" Sign me up.

Is this medical heresy? Anarchy? Revolution? No, its maturity. We finally realized that guidelines are, well, guidelines.

It looks like I will soon get to add another item to the "things I was trained to do that we now know kills people" list: ventilations. It will have some great company. Stabilizing trauma patients at the scene, gallons of IV fluid, bicarb... Ah, the good old days.

EMS in paradise--and the training is free

18% of the EMT positions in the city of Honolulu, Hawaii EMS are open. To remedy this (apparently sun and surf alone aren't enough) the city is offering paid EMT training. The string attached: you must work for two years after training.

City's offer: Get paid to become a Honolulu EMT

Before you sign up you should know the EMT course in Hawaii is 420 hours. If you would rather take the course on your own for college credit it can also be taken at the Kapi'olani Community College. The EMT course is 20 credit hours.

Aloha.

Real Life EMS

I shot the photo you see on the right while riding with the Portland Fire Department MEDCU. I liked the photo because it was a slice of real-life EMS. Not blood. Not guts. Not dramatic. Just real life EMS.

It has been my contention for some time on this blog that EMS is about taking care of people. Finding the pleasure in simple moments with a patient will keep you vital in EMS when there isn't enough trauma, sirens and excitement any more.

I submitted this photo to an EMS magazine for consideration for cover placement. No go. I'll admit that it isn't the most dynamic photo. But it is real. And it is a moment.

Are we being fed a diet of excitement when in fact we really nibble on routine call after call?

I took the rejection relatively well. Then I thought more about it. Maybe I should create my own magazine: Real Life EMS. Imagine what would be between the covers of this magazine every month.

Imagine no longer. This blog will frequently host covers of Real Life EMS Magazine. The magazine covers you will see are a combination of satire and commentary. I'm sure you have experienced more than one of these situations during your real life EMS experience.

Here is the first cover. Click on it to see a larger version. Enjoy!

And you thought YOU were having a bad day...

At least you're not this crew from Durham Region EMS in Ontario, Canada:

Ever loose your narcs and RSI meds?

Fortunately a citizen turned them in to a pharmacy who called police. Durham Regional EMS was quoted by the Durham Region News saying:

“Our thanks go out to the local resident and the pharmacy for their vigilance in noticing the container and contacting police so quickly,” said Richard Armstrong, the director of Durham Region EMS. “While this is an isolated incident, we continually review our procedures to ensure that proper protocols are in place to help safeguard against such occurrences.”

What else can one really say? I wonder what the conversation was like in the rig?

"Do you have the narcs?"

"I don't have the narcs. I thought you had the narcs."

Pause.

*&%$#@#()&^%$#$

Allan Parsons slide show

It is difficult to believe that almost 4 months have passed since Allan Parsons was killed in an ambulance collision. I shot the funeral for the Sun Journal and also recorded audio.

I recently created an audio slideshow of the funeral which I am releasing so it will be available on the 6 month anniversary of his death. The ceremony was profoundly sad, yet remarkable in the number of providers present and the depth of the respect paid to Allan.

Alan Parsons' funeral slide show

Please feel free to place the link on your web site and forward this to anyone you wish.

Please take a moment to remember Allan and all those in the emergency services who made the ultimate sacrifice.

PowerPoint Slides

This video will undoubtedly show you an EMS instructor you had at some point in your EMS experience. Enjoy

Life After Death by Powerpoint

NAEMT (again)

You may recall that I recently commented that NAEMT was moving in the right direction.

Dan Gerard doesn't seem to be in agreement with this (at least in some regards). His blog gives his reasons for this. I'll let you read those and make your own determination.

I will say that, if true, comments by Ken Bouvier about the numbers of people voting is disruptive and seems to take remove some level of credibility from the process. It is also disturbing that some people received three ballots.

When I ran for president of NAEMSE a few years back several people called me alleging election manipulation at the NAEMSE office. (This is not sour grapes, by the way). It is an example of how organizations can lose credibility--both NAEMSE and NAEMT. And is in fact one difference between a powerful membership organization and a social club for a chosen few.

I have respect for Jerry, Ken and Dan. But it is now time to make this right, NAEMT. Get your records in order, create visible policies that prevent manipulation and walk the walk of the powerful membership organization. Not the social club image you appear to be trying to shed.

Aren't you glad you don't have Orland Park's trustees?

I am continuing my "Aren't you glad you don't work in..." feature which highlights cluelessness, ineptitude or general bizarre behavior by municipalities toward those providing EMS. This week we'll talk about Orland Park, Illinois trustees.

The Orland Park Star printed an interesting article in reference to fire response to medical emergencies.

Orland Park sends an engine company if one is closer than an ambulance. This is pretty common practice and makes sense. In fact the Orland Park FD has an interesting web site explaining their "4 personnel in 5 minutes" benchmark. The site includes this video explaining their services and policy.

It seems the trustees don't get it. For example, trustee Kathy Fenton is quoted as saying:

"I live in the area of station five," Trustee Kathy Fenton said. "If we call for an ambulance, we get a fire engine, and if someone has to go to the hospital, we wait there for an ambulance to come take them to a hospital. I don't understand."

Let me see if I get this right. It is better to wait alone, without medical care, until the ambulance arrives?

Trustee Ed Schussler adds meaningful dialogue (NOT!)

"I think it's an accident waiting to happen when you have these big fire trucks. If they get into an accident with a vehicle, the citizens in the vehicle are going to lose," Schussler said.

Orland Park is doing the right thing for their citizens with the right attitude and getting their chops busted by politicos who just don't understand.

I originally thought that the fire department may not have educated their trustees properly. I did see that it was an acting chief addressing the group. But after seeing Orland Park's web site it doesn't seem education is the issue.

Perhaps the only thing that can fix this is the next election.

Where have I been this week? Scrub club camp

Yes, Scrub Club camp. I ran a week-long camp for nine 11-14 year old kids interested in health careers.

We toured fire stations and hospitals, learned first aid and CPR and a experienced a variety of other activities over 5 days. The photo is at the end of the first day. I sent them home to their parents after bandaging practice. As you can see they practiced quite vigorously.

A great experience for all--including me. But I think I'll take a year off before doing this again!

EMS: Public Safety or Emergency Medicine?

A very interesting article with reader comments has been posted at jems.com

This is part of a discussion that has been buzzing around EMS stations and conferences for some time: Is EMS part of public safety or health care/emergency medicine?

In short, we provide care which is definitely in a health care realm. We bring patients to hospitals. Yet we provide this care in the field dressed like and alongside public safety personnel (police, fire).

The fact that is apparent to most of us is that we don't seem to fit squarely in either place--nor do we feel we get the respect (or pay) that our public safety counterparts do.

This affects all of us in EMS. I strongly encourage you to read the JEMS article and comments. While I am not sure the "Where does EMS fit?" issue is singularly tied to EMS thriving as a profession, it is a key issue today.

Where do you think EMS belongs?

Some abuse the system...others don't

This story in the Sun Journal of Lewiston, Maine tells a story of someone who is definitely not a system abuser.

It seems this 72-year-old woman was ambushed by her daughter with a hatchet. The woman then drove herself to the hospital.

Quite the contradiction to the 3:00 am taxi ride isn't it? Of course I suspect that the mother was trying to protect her daughter from arrest and left the scene to keep the police out of the picture.

Oh the places I could take this post. I'll limit it to two:

Be aware of elder abuse. It is on the rise (as is suicide in the geriatric population). We normally dismiss violence and suicide as a young person thing. Wrong.

and

Assess each patient as if it was the first time you saw them.

I was born and raised in Upstate, NY. We had quite a few frequent flyers at all times of the day and night. Maine is a different story. People here grow old and tough. I have seen twice the number of people (often 80+ years of age) NOT call EMS so they don't bother the "boys" on the ambulance (they don't know "girls" can do this kind of work). Raging chest pain, injuries. Hatchet attacks. Some need EMS and don't call for a variety of reasons.

In EMS there is always a story.

State of the blog

Things are good at the Emergency Care blog. In July there were 1,391 page views done over 802 visits. Perhaps most importantly, an average of 8 minutes (actually 8:08) was spent on the site.

July was a big month. There was much news to note and issues to discuss ranging from the fire service "white paper" to the funeral of Allan Parsons to the potential for an AMR strike.

By other blog standards things have also gone well. Comments are on the upswing. Samantha did respond (a June post) and said that after she finished nursing school she would stay in EMS--although likely on a part time basis. WyoSkiBum stopped by with a humorous response. The bulk of the messages centered around the photos and comments on Allan Parson's funeral.

I have found that several sites have linked to my blog. Thanks to blueridgemedic and paramedic-network-news for the links. If there are more I haven't caught please let me know.

Thanks for stopping by. Please come back, comment, suggest other stories. I'm looking to make August a big month--but hopefully a safer month for those of us in the EMS business.

Chief Justice gets ride from volunteer EMS

Summer in Maine is very busy. The influx of tourists--and U.S. Supreme Court Chief Justices--certainly stirs things up a bit.

This article in the Boston Globe is a wonderful story about a dying breed in EMS: the community volunteer.

This isn't about pros and cons of volunteer EMS. Sometimes it is nice to see good news about EMS. Community involvement and the old fashioned concept of neighbors helping (famous) neighbors is certainly good news. It might be more nostalgic than commonplace today--especially for us old-timers.

And continuing the good news: AMR has not gone on strike.

I hope your summer is great. Thank you for stopping by.

Five articles you should read today...

I peruse the Internet for interesting EMS stories. Here are five I think you should read:

Another opinion on the AMR strike in New England.

Hospice cat predicts patient deaths with amazing accuracy.

The St. Petersburg Florida Times calls death a tragedy. A man codes at a VA hospital but is transported to another hospital 10 minutes away. Tampa Bay Online posted a follow-up

This article is about an EMS conference in India. While you check out this article see if an ad for dating in India comes up on the page. It is a fascinating cultural perspective. It doesn't say "man seeking woman." You look for a "bride" or a "groom." If you go in to the site looking for women you will see that many of the personals were written by the girl's parents--not her.

Some days people really do appreciate what we do.

EMS workers to strike Monday

Foster's Daily Democrat (New Hampshire) is one of many media outlets reporting a pending strike against American Medical Response (AMR) in Massachusetts, New Hampshire and Maine.

This will have an impact on EMS--both emergency response and non-emergency transports--throughout the northeast.

The news article contained the expected positioning quotes from both sides. In this case, I think the union has some valid points--and AMR's pockets seem deep enough to share a wee bit of wealth with its employees.

In addition to a prior post in this blog in reference to AMR, Reuters listed this report on AMR's parent company first quarter earnings:

May 3 (Reuters) - Emergency Medical Services Corp. (EMS) on Thursday reported first-quarter results that topped Wall Street estimates, and raised full-year profit forecast as it continued to win new contracts and renew agreements.

Shares of the company were up almost 10 percent at $36.76 in late morning trade on the New York Stock Exchange. They had hit an all-time high of $40.90 earlier in the day.

Strong performance from the EmCare segment combined with overall cost reductions led to the performance, J.P. Morgan Securities analyst Andreas Dirnagl said in a research note.

EmCare Holdings Inc., the company's emergency department and hospital-based management services segment, recorded a 23.8 percent higher net revenue for the quarter.

American Medical Response, the other segment that operates medical transportation services, saw a 4.3 percent increase in net revenue during the period.
"We continue to look for impressive growth out of EmCare as more hospitals realize the advantages of outsourcing the emergency department to such an efficient operator," Dirnagl added.

AMR can't be the fall guy for the lack of pay and professionalism in EMS. However, I do know several AMR employees in this little corner of the world...and none are getting rich.

To be fair, striking should never be done lightly. In the EMS biz lives are on the line. Both sides need to come to the table in good faith right to the end.

In a recent filing with the Securities and Exchange Commission, AMR was described like this:

About American Medical Response
American Medical Response Inc. ( www.amr.net ), America's leading provider of medical transportation, is locally operated in 36 states and the District of Columbia. More than 18,000 AMR paramedics, EMTs and other professionals transport nearly four million patients nationwide each year in critical, emergency and non-emergency situations. Operating a fleet of approximately 4,400 vehicles, AMR is headquartered in Greenwood Village, CO.

It is time for AMR to show how important their professionals truly are.

More on Ohio EMS fatalities

The Toledo Blade ran a follow-up story to the Ohio EMS fatalities mentioned on this blog yesterday.

With most emergency vehicle crashes, speculation develops about one or two things: was lights and siren transport necessary? and Who had right-of-way? In this crash there was speculation about whether lights and siren were necessary:

Because it appeared the Wellses’ injuries were not life-threatening, “There was no emergency that would warrant running lights and sirens in most people’s eyes,” the sergeant said.

But Sergeant Haas also said something may have happened medically to the couple along the way, causing the ambulance driver to want to get to the hospital more quickly.

“We’re never going to know,” he said. “The people that have that information didn’t make it.”

At least in this case the quote from the police sergeant was balanced.

The right-of-way issue is more complicated. Years ago, ambulances were involved in accidents. "Fault" was the term used to describe the cause of the accident.

Things have changed. Now we call these events crashes or collisions because many are preventable. Fault is important but not the gold standard. An emergency vehicle operator can find themselves not at fault but still in trouble at the agency level because the crash was preventable.

The days of police officers confirming that the lights and sirens were on then automatically giving the other driver a ticket are over. And the results are tragic. This document from the Centers for Disease Control (CDC) looks at ambulance crashes from 1991 - 2002.

In this case the police suspect the driver of the ambulance may not have seen the tractor trailer because of its position in the intersection. The ambulance had the stop sign.

The crash here in Maine is still under investigation. In this case the ambulance was on the main road and the truck that struck the ambulance had a stop sign. I'll post details on both crashes as they develop.

The take-home point: July isn't over and we have already lost 4 EMS personnel to motor vehicle crashes. These crashes kill more EMS providers each year than violence and rescues combined.

We must now mourn and pay our respect to those who died doing the job we do every day. It is about healing. About supporting each other in the small towns of Maine and Ohio where we have lost comrades. Details on the crashes can wait.

But today it must also be about safety. About caution. About rethinking the decisions we make every day. And about re-engineering vehicles and practices to provide the safety and piece of mind we deserve as we care for our patients.

Leading cellist becomes paramedic

Occasionally we forget the low pay and long hours involved in EMS and are reminded of the passion that brought us here.

Leading US cellist Nancy Donaruma, 59, followed this passion and is now a paramedic. Quoting an AP article:

After 31 years in the top-tier orchestra, playing with conductors including Leonard Bernstein, Zubin Mehta and Lorin Maazel, the 59-year-old cellist will go from a hefty six-figure annual income to a "low five-figure" salary.

People of all ages and all backgrounds come to EMS for reasons ranging from interest in medicine, a desire to help, or for those brave enough to admit it, the thrill. Some things are certain, though. The money isn't there. The thrill is fleeting (ask anyone who has transported the patient with a dislodged catheter at 3:00 am). And the work is less than glamorous most of the time.

As cellist Nancy Donaruma said,

"I've always had an interest in how the human body works — and doesn't," she said. "And I do like taking care of people."

I believe you have read similar words here before. EMS is about taking care of people. Those who embrace this thrive, those who don't move on.

If you work at Alamo EMS in New York there is now one additional reason to stay in EMS: free cello concerts.

3 EMS providers die in Ohio crash

An article in the Toledo Blade reports three EMTs and two patients in their ambulance were killed last night after their ambulance was struck by a tractor-trailer and burst into flames. A fourth EMT and the driver of the truck are in the hospital.

These providers were volunteers from a small town. Please remember them in your thoughts and prayers.

More details as they become available.

The business of EMS

In my daily research on EMS I have seen several articles about Emergency Medical Services Corporation. EMSC describes itself on its web site as

...the leading provider of emergency medical services in the United States.

They operate two companies you my be familiar with: American Medical Response ambulance service and EmCare emergency medicine.

This article describes a recent acquisition of Abbott ambulance in the St. Louis area as well as Mission Care ambulance of Illinois, a company called Access2Care (a managed transport comany) and IHM Health Studies Center (a paramedic training program).

The usual quotes about opportunity, synergism and expansion followed:

"This acquisition provides EMS entry into a new market in two business lines," said William A. Sanger, EMSC chairman and chief executive officer, "A strong and well-managed company, Abbott will serve as an excellent platform for expansion of our ambulance services in the Missouri and Illinois markets.
"Abbott's managed transportation business, Access2Care, offers us opportunities to expand our managed transportation services into the commercial market. Abbott's IHM Health Studies Center is a strong addition to AMR's National College of Technical Instruction (NCTI), the largest paramedic training school in the nation."

Those happy, work together, pre-merger quotes are sometimes fleeting. I'd love to hear from some EMS providers in the area to get your perspective.

One thing is for certain, EMS (AMR) is a huge corporation--and getting bigger. And not only in the ambulance biz but training as well. The stock market seems to be taking notice. On August 1, 2006 EMS stock closed at $11.75. As of this writing (just short of a year later) it is selling at $42.90.

Should have bought some of that last year.

Fire service first response--sort of

The Times Herald Record in Middletown, NY reports a story in which a local fire department was asked to cease first response to medical emergencies because they had minimal training and weren't registered as a first response agency.

Interestingly, the fire department wasn't asked to stop by the local ambulance service. It was one of the department's own commissioners who brought this up. According to the paper,

"The members say we should go anyway," said Commissioner Bill Lothrop Jr. He wants only qualified people running those calls, and only when the ambulance is delayed. "Of course we're worried about liability. In today's day and age, isn't everybody lawsuit-happy?"

The Mamakating First Aid Squad which serves Wurtsboro takes a mature, well stated, community-oriented stand:

"Having them there, the patient will feel more at ease," said Peter Goodman, Mamakating's captain. "You're not going to hurt someone by giving them oxygen."

Yes, the fire department should try to get more members trained as first responders. They should file the state paperwork. But in a world where it is more and more difficult to find volunteers, and at a time when people seem less neighborly in general, here is a group of people who want to help. And help they should.

This is also a lesson to advanced life support students and providers. Even without a lot of training I am sure that the efforts of the members of the Wurtsboro Fire Department are deeply appreciated by the citizens. I'd even feel confident saying that citizens of Wurtsboro will remember that bit of oxygen, hand holding and concern much more than they'll remember any skill performed on an ambulance.

Because when it all comes down to it, EMS is about taking care of people.

NAEMT moving in the right direction

Two things recently caught my eye about the National Association of EMTs. They are moving to online elections in which all members can participate and they are hiring an executive director.

While the organization has been in existence for years, many in the EMS community consider NAEMT a club rather than a membership organization with any muscle in EMS. I have largely fallen into that belief over the years.

The previous structure in which a Board of Governors elected officers created the appearance--and in some cases a reality--of a good old boys club was ineffective and incestuous. In the past when I advocated for general elections the concern was that votes off the floor would be stacked for local candidates in the state/region the conference was held. The Internet made this argument moot.

There is also a move afoot to reevaluate the societies within NAEMT. Another good move.

Now that NAEMT has made some significant changes I would say this:

These steps are a beginning to becoming a powerful national organization.

You will need to choose your executive director carefully. Then you will need to create a job description and not micromanage him or her. The goal of this person should be to increase three things: voice in EMS, credibility and true members (not numbers inflated by freebies).

You will need to invest in meaningful leadership development for NAEMT officers and board members. We could easily elect popular people. This does not equal vision or leadership. Over the years I have seen highs and lows in this area.

You will need to get the membership to vote--and then be active in the organization. This will be the true measure of credibility and success. He who harnesses the passion of EMS wins.

Every year at the annual conference Ken Bouvier, Paul Maniscalco, Ed Sawicki and Gregg Lord pull me aside and lobby for NAEMT. They told me things could improve. There was potential. I was skeptical, but respected their dedication.

You now have my attention. I'm going to pay my dues and vote.

Plus, I like to point out good things on my blog from time to time...

Allan Parsons' last ride

A Maine paramedic was killed when the ambulance he was riding in collided with a pick-up truck in the early morning hours of July 7th. Paramedic Allan Parsons was treating a patient in the back and was pronounced dead at the scene.

I am a photojournalist and requested the assignment to shoot his funeral. I included two images in this post. The photo of the paramedic's young son kissing his father's casket ran on the front page of the Sun Journal in Lewiston, Maine.

I included the second photo because it had a profound impact on me. I didn't know Allan Parsons. From the wide variety of passionate speakers I heard at his funeral it was easy to see that he was a dedicated, funny, caring, passionate family man and paramedic.

At the end of the service I pulled the funeral director aside to make sure it was OK to get into the cab of the ambulance as the casket was loaded. This is how I got the image of Parsons' sons at the casket.

I watched Allan Parsons' co-workers load the casket, stand there silently for a moment, then close the doors. I clicked the camera shutter as the back door of the ambulance closed.

I never met Allan Parsons. But from a vantage point no one else had, I saw--no, I felt--the ambulance doors close for the last time.

It was fortunate I had to quickly exit the ambulance so Allan's co-workers could get in to drive him past the hundreds of saluting emergency services personnel in dress uniforms standing by dozens of gleaming ambulances. Because at that moment my skin tingled, my eyes welled with tears and I realized this was the start of Allan Parsons' last ride.

As I write this, 48 hours later, I can still feel the door close. My skin still reacts with a similar chill--even though as a paramedic I have heard ambulance doors close thousands of times before.

David versus Goliath

When I was a police officer there was a noteworthy homicide trial. The top prosecutor went up against a poor, minority defendant who acted in his own defense. The prosecutor lost. Not because of anything he did, it was because the jury felt sorry for the defendant. A classic David vs. Goliath scenario.

David vs. Goliath is a classic story--only now it seems to involve Bryan Bledsoe and NAEMSE. And Bryan Bledsoe is no ordinary David.

Previous posts on this blog have discussed the NAEMSE/Bledsoe situation. It continues. I received the following email from Bryan last night:

To all:

I have received a letter from the NAEMSE attorney in regard to this email I sent in anger. Thus, I must respond:

1. I am not involved in planning or developing another EMS organization nor have I been although it has been suggested by others. I will remain a member of NAEMSE for now.

2. The former NAEMSE webmaster who contacted me and offered material about elections and defamatory emails about me evidently came about these illegally and thus I must retract the statement that an affidavit would be submitted.

3. I would not compromise any contractual relationships between anybody and NAEMSE. First, I do not have that power and do not have that interest. The NAEMSE attorney has accused me of that but has not submitted any evidence to that effect. I have not contacted any vendors or sponsors, never intended to, and have no plans to.

I have attached a copy of the attorney letter if anybody is interested. I will attend the NAEMSE meeting in Hollywood to staff the Brady booth and attend meetings. I will evaluate my need to attend future NAEMSE meetings on a case by case basis. This will end anything I will say in writing or orally about NAEMSE henceforth.

Thanks

Bryan Bledsoe

The email also contained a copy of the letter from NAEMSE's attorney, Pantelis T. Papazekos. Click on the letter to read it.

Disclosure time. I know Bryan Bledsoe. I write for the same publisher. I also realize that by posting this letter I am potentially furthering Bryan's stand.

So what. I think NAEMSE flubbed this one. They threw gasoline on the fire rather than letting it smolder out. They could have taken a high ground. Weathered the storm. Stood on their good intentions. Instead they moved themselves into a defensive position. And it isn't becoming.

More and more people are questioning the intentions of the organization. Why are my dues paying $400/hour to consult attorneys and write letters when NAEMSE should be concentrating on fixing what is broken?

I believe there are many people telling NAEMSE what is broken. Is NAEMSE listening? I guess I'll find out if I get a letter from Pantelis T. Papazekos.

Fire Service and EMS...again!

A document which has been referred to as the "Fire Service EMS White Paper" recently entered my email box.

My first observation from this paper is that 4 well known and talented fire service docs got together and published this paper. The fire service (IAFF, NFPA) quickly flew the white paper "flag" yet there are no logos or indications of endorsement on the paper itself.

It isn't really news that the fire service wants to do more EMS, and in some cases--but clearly not all cases--should. I guess I'm left wondering how a history lesson, a few examples and some muscle flexing gets billing as a white paper. I'm not sure it does the fire service justice and may even sell it a bit short.

John Becknell authored an opinion piece published on the Missouri EMS Association web site in response to the white paper. He brings up some good points.

For EMS to thrive in the fire service deep cultural changes will be required. These changes are the most difficult to make. Many city fire departments have merged fire and EMS and have stumbled (in some cases fallen flat) over these cultural differences. I have blogged about this previously.

In my small part of the world, firefighters are "stuck" on the rescue until they can bid off to a secondary, lower-volume rescue and eventually an engine. Why? Engine companies have a dramatically smaller call volume than the rescue. The least experienced people are always on the rescue. Don't get me wrong, they have the right to bid off. It just isn't good for the system.

In many cases there are no organizational benefits to working more as far as pay or promotion and in many cases it is cultural and career suicide to be a band-aid in a nozzle-head world.

With this paper the fire service has essentially lifted its leg and "marked" EMS as its own. The true test will be whether they have the commitment and institutional flexibility to be the EMS that patients need.

Active Shooter Training

I still do a bit of police work. Having done it so long it gets in your blood and stays there. Like bacteria.

Seriously, I attended a training session focused on how to respond to a call for an active shooter (e.g. Virginia Tech). I find it amazing how philosophies have come full circle over the years.

Long ago, old-time cops just went in and handled whatever came along. Then tactical teams were developed. First arriving officers secured a perimeter and waited for the team. Guess what? We're back to the first officers taking action.

While I am prohibited from talking specific details, the newest thinking is when the first arriving officers hear gunfire, they form a team and combine some tactical training with the need for immediate action to save lives and go in.

Catching up

While taking some time off over the 4th of July I had this feeling I was forgetting something. The blog. Frequent posts grow a blog. Comments make a blog better (hint, hint). So, catching up with the world of EMS:

Jems.com reports another defibrillator save. This time by an ED physician at a church with a defibrillator.

In London, two car bombs were found--fortunately before they detonated. The second bomb is believed to have been planned as a secondary attack to injure rescue personnel and police. The story, if by chance you haven't seen it. Here is the medic's account from the BBC. Be careful out there.

Last weekend I put on my photojournalist hat and shot the protest in Kennebunkport. Three presidents (41, 43, Putin) and 2,000 protesters made for quite a day. There were even counter-protesters. It is always interesting.

You can also see an audio slideshow I produced.

Thats it for catching up. Until next time.

Line of Duty Death - Maine

It has been quiet on the blog this week. I've been in vacation mode. I'll begin posting again with some sad news.

Allan Parsons, a paramedic with MedCare ambulance, was killed this morning in a motor vehicle collision. Allan was in the passenger compartment and was pronounced at the scene.

The driver of the ambulance, Arlene Greenleaf, remains in ICU after surgery. Arlene is 68 and has had a long and strong presence in EMS. Even after receiving a lifetime achievement award she remained in the business. Arlene was driving at 3:00 am when many people with as much seniority have retired and almost all are asleep.

The patient in the back of the ambulance and the driver of the truck that collided with the ambulance are also in serious condition as of this writing.

Maine is a large state with a small EMS community. This loss has been acutely felt throughout this community.

Each year about 20 or 30 EMS providers lose their lives in the line of duty. Please take a moment to reflect or pray for the providers in this horrible crash. And be careful out there.

This just makes sense

What would you do if 12,000 athletes aged 50 - 100 were competing in your city? One would hope you'd say "I'd have a few defibrillators handy."

Louisville, KY did just that when the National Senior Games came to town--and they are 2 for 2 with saves. This article from jems.com and USA Today tells the story.

A secondary theme of the article is the lack of AEDs--and the lack of legislation requiring AEDs--at public gatherings. Quite frankly, at large events the FD and ambulance just can't get to the patient's side in time to make a difference.

Kudos to Louisville. While I hope they won't need their defibrillators again, the games run until July 7th. Lets all hope their winning streak continues.

You can lead a horse to water...

Millstone, NJ is having emergency service problems.

Millstone, NJ has a first aid squad. They also have a fire department. According to an article in the Examiner of Allentown, NJ, they don't work together.

It appears that first aid squad members respond from home some of the time. Firefighters sit in the station, able to respond, but can't.

Even more absurdly, it appears that when the Millstone First Aid Squad is on a call, another Monmouth County, NJ mutual aid squad responds to Millstone...while the firefighters still sit in the station.

Here are some killer quotes from the article:

Millstone Committeeman Ramin Dilfanian in reference to the First Aid Squad and Fire Department:

"I can lead the horse to water, but I can't make it drink," he said. "I can get the groups together, but I can't make them cooperate and work together."

and in the "I'm glad its not my heart category.."

First aid squad member Tina Mitchell said the first aid squad currently does not need the help of the firefighters and that the squad's response times are in line with the mutual aid system in Monmouth County.

So, Tina, what you are saying is that it could be faster if the FD responded but since we're in line with the county, the extra minutes a loved one spends in cardiac arrest is OK.

No, wait! The First Aid Squad has now decided the fire department can respond to cardiac arrests and unresponsive people.

At the fire commissioners' monthly board meeting June 11, first aid squad Capt. Bob Trifiro attended to discuss the first-responder issue. Trifiro told the firefighters that they could respond to emergency medical calls involving unconscious victims and to calls during which cardiopulmonary resuscitation (CPR) is already in progress.

I'm sorry if that doesn't leave me teary-eyed with the spirit of cooperation. Its not enough.

But what about the breathing difficulty patients, the patients with anaphylaxis, those with chest pain that haven't yet died? At least death finally invokes the First Aid Squad's blessing for the FD to respond.

There is a fable about a dog walking over a bridge with flesh in his mouth. He looks into the water and sees another dog with a bigger piece of flesh. He opens his mouth to grab the other dog's meat and loses his into the water--his greed costs him everything.

If I lived in Millstone, NJ and I had to wait even two extra minutes when EMT trained firefighters were there to respond sooner--or if an out of town squad had to respond in while firefighters were there to respond much sooner I'd be livid. Litigiously livid.

Like the dog with the flesh, some squads turn down help when they need it out of a sense of pride, threat--or greed. This leads to the demise of a squad faster than if they took the help and built the team that best served the citizens.

Plus--it is never wrong to do what is best for the patient.

Bryan Bledsoe - part 2

Dr. Bryan Bledsoe's name is one of the most commonly recognized in EMS. A talented (and occasionally controversial) conference speaker, myth-buster and prolific author, Bryan began his medical career in EMS and maintained a strong presence after becoming a physician.

Bryan's paramedic and intermediate books are EMS best sellers. His other works include frequent EMS articles, columns and other texts including pharmacology and critical care paramedic.

The letter, distributed to about 60 individuals via email, is likely to send a significant jolt through the EMS education community. 6 - 8 people hit "reply all" and supported Bryan in his thoughts about NAEMSE. I am sure that many more responded personally. Others may still be in shock.

Since this is my blog, I'd be weaseling out if I didn't voice an opinion. First, the disclaimers:

I ran for president of NAEMSE a few years back. (I lost.) I also ran for the Board of Directors. (I lost.) Nevertheless I don't have any hard feelings over the losses. It wasn't nearly as crushing as losing the 6th grade class president race to Hillary Hart. (sniff) Back to business.

My platform, expressed to anyone who asked including Joann Freel and then-President Linda Abrahamson, was to make the organization more inclusive. My description then (and continues now) is that NAEMSE is an organization that preaches to the choir. As a textbook author I speak frequently with the lone instructor in the fire station who has limited resources. For many non-collegiate EMS instructors joining NAEMSE is a dream (assuming they have heard of it). Attending the symposium is a fantasy. The educator course is a nice project but doesn't substitute for outreach.

On the NAEMSE web site they recently posted the NAEMSE 2007 Organizational Assessment Report and Membership Survey in which everything seems quite rosy. From the emails I have been seeing there are a few people who obviously didn't get the survey. The survey and I are in full agreement in one area:

An opportunity exists to develop new membership pools
outside of traditional academic settings; engage members
who teach in the military, industry, or volunteer EMS
areas. Also, evaluate geographic representation of
members and determine what regions (if any) are
underrepresented in NAEMSE membership.

I should also note that this statement is a bit snooty (at best) by considering academic EMS education "traditional." The academic EMS education model is not the dominant model in the US. It is growing. It is important and necessary. But the "look over the glasses down at the non-academic instructors" attitude is unbecoming and reflects how the organization is out of touch with a huge population of educators.

If you would like to change the name of the organization to "National Association of Collegiate EMS Educators," do so. But if not, there are far more outside of academia than inside.

When I lost the race for president I was told that less than 10% of the membership voted. I wonder how many responses the membership survey is based on?

The bottom line: I was at the meeting at JEMS in 1995 when the hat was passed to start NAEMSE. I am a charter member. I believe EMS education and EMS educators need an organization.

I am pleased that there is a national organization to represent EMS education (although the varied levels of educators and their needs are clearly not recognized or met by NAEMSE). This organization is in a proper position at the helm of the education standards project. We should be writing our own standards.

I am saddened by Bryan's resignation. There were many (including myself) who hoped he would shake things up a bit--and believe that a shake-up needs to happen. Not necessarily because of profound malfeasance, but because we are at a point in the life of an organization (10 - 12 years) where a course correction is necessary.

My membership is in need of renewal this month. I'll renew it for at least one more year. Not out of a profound belief that it is a benefit, but as a creature of habit; perhaps as an optimist hoping there will be change.

When I ran for president I wasn't looking to make waves. I was looking to be a good president. To do outreach. To recognize the varied instructors out there and initiate some organizational and individual mentoring. When I lost, a few people told me "You should get on some committees, maybe run for the board." Meaning I hadn't paid my dues to run for president.

But my reason for running was exactly because I didn't come up through the ranks. I felt I would be good for the organization. Not for massive change, for changes in perspective.

NAEMSE needs a new perspective.

Bledsoe steps down from NAEMSE Post

I received an email from Bryan Bledsoe last night in reference to his resignation from the National Association of EMS Educators Board of Directors. The email, reprinted with the permission of Dr. Bledsoe, is as follows:

Dear Friends and Colleagues:

I have resigned my position as a member of the Board of Directors of the National Association of EMS Educators. I have served less than a year, yet I cannot, in good faith, continue. In the short time I have been on the Board we have effected a few changes. Working with a few other Board members, we have forced the organization to be honest and open about membership numbers. Actual membership numbers are closer to 2,000 or less. This is considerably less than the 4,000 plus often reported. We have had a self-study completed that pointed to some of the problems with the organization and the Board. Whether any of the recommendations of this self-study will be enacted remains to be seen. We have planted the seed of increased organizational transparency and I hope that grows.

I do not see any significant chances for organizational improvement or change for at least five years. I have been a thorn in the side of the Board and the Executive Director. But, based upon recent elections, either my concerns are not shared by the membership as a whole or the “system” is again responsible for stopping change either through obfuscation or simple ineptness. Being on this Board is quite an exercise in tenacity. As an emergency physician, I am impatient and expect results. This trait grates against the culture of NAEMSE.

I have concerns about the organizational finances and the conference. Approximately 60% of the budget goes to fund the office in Pittsburgh. The previous Boards of Directors have entered into a 10-year lease for the office space in Pittsburgh than costs in excess of $5,000 a month. In Pennsylvania, real estate leases also incur other expenses. Approximately 10% of the projected budget for next year will be to fund the Executive Director’s salary and benefits package. I have been repeatedly told by members of the organization that the symposium is not attractive to members, yet the membership survey and feedback provided by the Executive Director would indicate a high level of satisfaction with the seminar and the “Instructor Courses” offered by the organization. I have been told by several corporate representatives that they are displeased with the conference and the organization. Yet, the sponsor and vendor survey provided by the Executive Director would indicate a high level of satisfaction. Regardless, for whatever reason, corporate memberships and sponsorships are down.

I am 52-years-old and have many great things going on in my life. This organization is just one thing that I do not have the personality for. Politics, obviously, are not in my future. If you voted for me last year, thank you. I apologize for letting you down by resigning before my term is up. I am a person of action and integrity and want to live my life in a way that I am comfortable. I obviously made a mistake running for this Board. This organization is a mess—but the membership appears satisfied. Either I was wrong or the “system” has successfully run off another Board member.

I am sorry if I have seemed to take a tone of judgment. I truly wish NAEMSE well. I am just not sure how they will get there.

Fraternally,



Bryan E. Bledsoe, DO, FACEP
Midlothian, Texas

(Since this post is long, I'll comment in a subsequent post.)

Backboard Bubbles

During a conversation with my friend, Jon Politis, I learned of a solution to the pain and discomfort caused by spine boards.

It is well acknowledged that immobilization is uncomfortable. Prolonged immobilization causes pain and can make it challenging for hospital personnel to determine if spinal pain is from an injury or from the immobilization.


Two EMS Asst. Chiefs at Colonie EMS, Paul Fink and Ray Hughes III (both of whom I had the pleasure of learning from in my early EMS days), came up with a practical and inexpensive way to reduce this pain--bubble wrap!

This solution is cheap (bought in a large roll it works out to about 10 cents/patient) and effective. I'm guessing if patients were stressed they could calm themselves by popping the bubbles along the edge of the backboard on the way to the hospital.

I wonder why more squads don't do this? I'll bet a manufacturer will come out with a "medical-grade, hypoallergenic, OSHA approved, association-endorsed" product--which will still essentially be 10 cent bubble wrap...and cost $25.00 per disposable piece.

I'll stick with Paul and Ray's bubble wrap. It just makes sense.

Oman Cyclone

When I was teaching at The George Washington University in Washington, DC, I had a number of good experiences. I got to work for Gregg Margolis (now with NREMT), to have colleagues like Melissa Alexander, Keith Monosky, Beth Adams, Mike Ward and Art Hseih and to live and work in a facinating part of the country.

How does this fit in with the cyclone in Oman?

While teaching at GW my main job was to teach 12 nurses from the Middle Eastern country of Oman to become paramedics and instructors. These nurses-turned-paramedics would then go back to Oman and begin an EMS system from scratch.

Imagine not having an EMS system at all. When the Omani government and GW first talked the Sultan wanted a system to deal with trauma on the highways of a growing and thriving country. Hmmmm...sound familiar? If not, a brief history lesson courtesy of the NAEMT.

The Royal Omani Police (ROP), who also provide fire services, said that the ambulances were only needed for trauma. Our reply: "That is what we thought in 1966." Our early highway/trauma focus is why EMS curricula are developed out of the Department of Transportation to this day.

It is the experience of a lifetime for an instructor to help set a foundation for the EMS system of an entire country. The nurses (10 men, 2 women) were wonderful people and dedicated students. They came into Washington DC during the third week of August, 2001. Far from home, they came to the U.S for a year. Unfortunately, after the attacks of 9-11-01 it wasn't a good thing to be from the Middle East and in Washington, DC.

The stories of the weeks following 9-11 are too many to recount on this blog. The students were harassed in the Metro; discriminated against for housing and purchases. I was contacted on numerous occasions by the FBI in reference to the students.

Then, after the October anthrax incidents in the D.C. postal service, they couldn't even send letters home for fear of contaminating loved ones with anthrax.

The students survived, became medics and instructors and returned home to begin the EMS program.

Back to the cyclone. While we didn't see too much on the cyclone in the news here in the US, I received photos from one of my students. He reports all of my old students are well after the cyclone. I'm sure the country of Oman tested all of their emergency services during the cyclone.

If the emergency services personnel during the cyclone had the character and dedication of the students I know, I'm guessing they did well.

Will Samantha stay in EMS?

In my post about "roving professionals" I mentioned one of my students, Samantha Massey. I was at my state EMS Education Committee meeting today talking with Samantha's training coordinator. I mentioned the initial blog post.

Our conversation led to whether Samantha would stay in EMS when she completes nursing school. Why would she? She can almost double her pay, work in a variety of special units and get a sign-on bonus to start. Not to mention the ability to grow into supervisory and management positions more easily than in EMS.

One reason to stay is the fact she has been involved as a community EMS member for some time. But how much else is there to keep people rooted in EMS?

We loose a lot of good people in EMS. I am going to track Samantha down and ask her to comment on this.

Stay tuned...

My ads changed

I posted the piece on cheese heroin today and suddenly the Google ads at the top of my page all turned to ads for drug rehabs, sober living and urine test secrets.

Not the image I was going for.

So, to correct this, an experiment. Here goes:

Hunting, fishing, game warden, trout, bass, moose, elk, lunker, lures, rifles, ATV, camouflage, buck knives, gut, rod, reel, striper, deer, ten-pointer, pike, bass boat, charter, fillet, hunting, fishing, game warden, trout, bass, moose, elk, lunker, lures, rifles, ATV, camouflage, buck knives, gut, rod, reel, striper, deer, ten-pointer, pike, bass boat, charter, fillet, hunting, fishing, game warden, trout, bass, moose, elk, lunker, lures, rifles, ATV, camouflage, buck knives, gut, rod, reel, striper, deer, ten-pointer, pike, bass boat, charter, fillet.

Let's see what happens. If there are fishing and hunting ads on my site, we'll know. And its better than the drug ads.

Because so far I've made a grand total of nothing from the ads anyway.

Are you a "roving professional?"

Chris Cluff, EMT-I from Kennebunk, Maine brought this article to my attention through a comment on this site (Thanks, Chris!).

Per diems keep agencies alive

This article from the Portland Press Herald highlights themes already mentioned in this blog: EMS as a profession (As a profession why do we have to work 60 - 80 hours/week to afford to eat?) and How many hours do you work? (ditto).

I think this article also shows, woven through and between the lines, the spirit, dedication and ethic of the EMS provider. While we need further recognition (and fewer hours/more pay), we are a proud lot.

In the small world category, Samantha Massey (mentioned in the article--and was one of my paramedic students) was kind enough to model for this photo which was used in the August, 2006 issue of EMS Magazine.

You made us proud, Sam. Thanks.

Hold the cheese, please

CNN reports a cheap, highly addictive drug blend which includes heroin and diphenhydramine has killed 21 teenagers in the Dallas, TX area over the past two years.

Ouch.

Given its name because it looks like Parmesan cheese, cheese heroin is sold for $2/dose or $10/gram on the street. The low price point combined with the fact it can be snorted (not injected) creates a lethal one-two punch.

Diphenhydramine (Benadryl) is obtained from OTC nighttime cold medications. It helps with the depressant effect and keeps the price down. The cold medications are probably shoplifted anyway.

This is reminiscent of the birth of crack cocaine. Back when cocaine powder was $80-100/gram, along came crack cocaine in cheap, single-use rocks. The immediate high obtained from smoking (the high from snorting coke takes about 2 minutes) added to the popularity. No freebasing or volatile chemicals required. (See Richard Pryor) Crack was overwhelmingly popular--and addictive. Let's hope we can avoid this with cheese heroin.

Imagine if the person who invented and marketed cheese heroin put those skills to good use. Talent like that might even be able to re-market Paris Hilton when she is released from jail.

Nevermind. No one is that talented.

Glad he's not my boss - part 2

This one goes into the category of "if you think your city administration is bad, you could always work in Ridgeley, WV."

While cruising the Internet for something of interest I hit the jackpot.

I saw an article in the online edition of the Cumberland (MD) Times-News about how the fire department ambulance is in its thirtieth year. Call volume continues to increase but the paper reports the FD is handling it well. The chief was one of the original EMTs. Good for them. This is nice--but not mother of all stories for a blogger.

While looking at the related story links I saw an article that reported the police chief and town clerk of Ridgeley, WV were fired by the mayor--who called in from jail! Hard to believe, but true. The mayor, Mitchell Reeves, was arrested for fraud one month after being arrested for driving without a license.

It could always be worse. You could be in the public safety biz in Ridgeley, West Virginia.

Glad he's not my boss

If you ever thought your job was bad, it could be worse. You could work in East Cleveland, Ohio.

According to an article on cleveland.com, East Cleveland Mayor Eric Brewer wants firefighters there to assist public works crews in cutting lawns and working in parks.

"We have 54 firefighters, and they have a lot of downtime," Mayor Eric Brewer said Thursday. "Instead of sitting around the station, they'll be assisting us as we beautify the city."

Ken Adams, Deputy Safety Director says "The new duties are similar to other non-fire-related tasks performed by firefighters, such as checking hydrants, conducting fire inspections or visiting schools."

Excuse me, Mr. Adams, but these ARE fire-related duties--and more important than cutting grass. As a matter of fact, according to the East Cleveland web site, the fire department also has a free smoke detector program and a child seat safety program.

In my experience, decisions such as this are made from a lack of knowledge of what firefighters do and are often based on the false stereotype that firefighters sit around the station all day and watch television.

The union believes that the lawn mowing duties may prevent them from hearing their radios and decrease response time. I'm not sure that is a strong enough statement. The lawn mowing duties cause a critical distraction away from (call me crazy, now) fighting and preventing fires!

Looking at response numbers on the East Cleveland unofficial web site, the fire department gets its share of jobs--both fire and EMS. It appears that they are working quite diligently for their money.

I spent some time looking at the web site for Mayor Brewer. He has some high hopes for East Cleveland. Sounds like a shaker and mover may be necessary for the City of East Cleveland. On his web site the Mayor says his "main goal is to take East Cleveland from “poverty to prosperity” during his term in office. Beefing up the city’s service and police departments are vital to his plans, along with eliminating waste and mismanagement, and increasing employee productivity."

Well, although I don't agree with the plan, at least he is one politician who keeps his word.

Mayor Brewer was also quoted on cleveland.com as saying (in reference to mowing):
"Actually, that looks like fun," he said. "I might get out there and cut some grass myself."

I hope he keeps his word there, too. And gets the firefighters off lawn mowers and back where they belong.