Friday, October 29, 2010

Not Important, Part II

It's been a REAL busy week, more on that in another post. I have been drained and this is the first night I've been home all week, and I spent almost all of this evening dealing with personnel issues within my squad. Let's just say I'm shot and leave it at that. I wanted to write  post, but the mental juices are just numb. I was gonna hit the rack after checking a few blogs thinking that might get my mind off the issues my people are dealing with. I happened on this post by the Burned Out Medic and it made me smile and think. I am shamelessly going to do a part 2 of his post. So now I have a story to share...

 My paying job is 10 miles outside of my district. Our facility sits on a hill next to a large body of water and on the other side is the next county west of us. It's another world 'over there'. In addition to be a different county, it has a different commercial ALS agency serving the area, and of course a different hospital. Until they put the bridge up 50 years ago, people from our side would have to drive 5 hours to get there. So we are very separate world.
 I have a scanner in my office which gets very little from my own county because of the metal building I am in the middle of, and I really don't have many channels in there because I am not interested in having it go off all the time, I just want to hear anything that will affect my department or major issues occurring in the area. I rarely leave work to attend a job, and only when it is a major.
 One of the things I hear really well in my office is the EMS frequency for the Hospital directly across the water. It's about ten miles, but in our direct line of sight. I recently removed this frequency from my radio because I found it too distracting at work. It wasn't the amount of traffic on the air, it was the content. I realized that every time an ambulance called into the hospital, I stopped what I was doing and listened. I was hoping to get another story. When I drive around the state I listen to systems all over and I learn things. Good stuff usually, and sometimes I hear bad stuff. Either way, I learn something. But this hospital just never ceases to amaze me. I have to wonder how they train their staff, and how they treat EMS when they walk through the door. Here's a few samples, you be the judge:
 MEDIC: ST. Nowhere, this is Medic 1 enroute to your facility with a 68 year old male currently in cardiac arrest. CPR is in progress at this time, and ALS workup and initial treatment has been completed. Our ETA is 2 minutes, do you require anything further?
E/D: DO you have some vitals for us?
MEDIC: Vitals?! Um, Yeah, I have vitals, but the patient, not so much.

 MEDIC: St. Nowhere, this is Medic 1 enroute to your facility with a 27 year old male who was the driver in single vehicle accident. The vehicle struck a telephone pole at a high rate of speed tearing most of the front end off the vehicle, The vehicle rolled approximately 4 times down an embankment. Extrication took about 30 minutes. The patient appears to have multi-system trauma and was not conscious since our arrival on-scene. B/P is 100/50, pulse is 145 and weak, respiration's are 25 and shallow, pupils are reactive and equal, we have 2 large bore IV's started, drawn blood samples, and are working on a 12 lead for you now. Lungs sounds are diminshed on the right side. Our ETA is 5 minutes, do you require anything further?
E/D: Is this patient on a backboard?
MEDIC: Affirmative, full spinal precautions are in place. ( I suspect a hint of "WTF?" in the drivers voice)
E/D: Does this patient have a collar on?
MEDIC: Um, yes, as stated, full spinal precautions. (Now I KNOW I hear a "WTF?" in the drivers voice)
E/D:[sounding bored] OK, we'll find a bed when you get here. (OK, I'm now saying "WTF" as I sit at my desk)

MEDIC: St. Nowhere, this is Medic 1 currently inbound with a 89 year old male for a psych evaluation from Heavenly Care Nursing home. The patient lashed out at a staff member this evening and struck her with his cane. Vitals are within normal limits. The patient is calm and cooperative and resting comfortably. We should be there in 5 minutes. Do you need anything further?
E/D: Is this persons initials "G.S."
MEDIC: Um, ah, Yes, they are.
E/D: [AUDIBLE GROAN] Okayyyyyy, we'll get the restraints out, and be ready when you arrive.
MEDIC: Good evening St. nowhere, this is Medic 1 about 10 minutes out, we have a {long detailed description of a trauma patinet who feet 30 feet onto a rock outcropping}.
E/D: Standby
MEDIC: {after about a full minute} Ah, St. Nowhere, this is Medic 1, are you still there?
E/D: {Snotty female voice} I SAID Standby! The Doctor is coming!
E/D: {Male voice} Can you give me the ultrasound results on this patient?
MEDIC: Um, no sir. We don't not have ultrasound capabilities. This is not a transfer sir, this patient is coming in to you from the incident scene. [There is no EMS ultrasound available in our area, let alone region, yet]
E/D: You do not have ulktrasound?!
MEDIC: No sir.
E/D: Why not?! [OK, at this point I am looking around for a tape recorder and make a note to bring one in and keep it handy]
MEDIC: Sorry Doc, we do what we can. We're pulling into the E/D now. Out.

So, the Burned out Medic shouldn't feel so alone. It happens elsewhere. I hope he forgives me for writing part II to his post.

Monday, October 25, 2010


A while back, (ok this morning actually) we were cleaning up at a job after placing our trauma patient in the ALS rig for a hot run to the Trauma Center (he was AFU* but the birds were grounded). I mentioned to one of my long time crew mates that we needed to keep a better eye on how many blanks PCR's we had in the clip board. "On the job I did the other night there was only one left in the box. We could find ourselevs in trouble if we run out on a call. We just have to keep an eye on it and be more careful." He looked up at me surprised and asked "Really, what job was that?" I opened my mouth to tell him when I realized I had no idea what call it was or what day we ran that job. Nothing. No clue. I was absolutely blank. I could not remember the patient, the day, who was on the crew. NADA, ZIP, EL-BLANKO.
 I just told him it was a few days ago (which it was, but I had no idea about ANY of the details) and moved the conversation on.
 All the way back from the call I was trying to remember which job it was and it freaked me out that I could not remember anything. I jumped in the shower to clean up from the job and then I remembered the call. It was 3 days ago, in the evening, and all the details came back to me.
 Still this is very freaky that I could completely blank on a job from a few days ago. I wonder if this is a sign of something.

*AFU = All Fouled Up

Saturday, October 23, 2010

This is great...

Just watch it, I don't need to say anymore. What a wonderful piece of work.

Now that you've enjoyed that (and I watched it again a few times), let me remind you that Dave is the artist that did the great series of songs about how United Airlines destroyed their Bass players instrument a few years back. I strongly recommend that yo go to Dave's website and peruse the music, gig dates. and other offerings there. Dave and his friends are Canadian based but they do venture into the south 48 from time to time. I can't help it, I like this guy, I like his music, and feel like he could be sitting in my living room with a few more musical friends and a little beer and we'd be having a memorable weekend.
 Like I said, I like the guy, poke around his site and check out the videos. If you haven't been exposed to the 'United Series", he has a separate drop down menu for that. Start at the beginning, it's worth your time (unless your time is more valuable than mine, but that would require a one-on-one debate.
 Thanks also to Everyday EMS Tips where I picked this whole thing up to begin with.

Thursday, October 21, 2010

It makes me want to SCREAM!

 By now everybody is reading, or glancing through the new AHA guidelines. Every 4 years this huge document is released with huge fanfare like it was the second coming. Most of us read it through to see what skills we are going to have to modify "this time around". Those of us who are instructors are trying to figure out how to present these 'new rules' in the classes we present, and how we will jusitfy them to students who have a clue and realize some of them make little, or no sense. ("What do you mean, 'DON'T check for a pulse'!?")
 The AHA bases a lot of their recommendations on things I don't understand like ' It's too hard to teach' or , 'most people won't learn it correctly'. These attitudes, which generate recommendations for millions of providers, just blows my mind. I am an Engineer, and to me, it's either right or wrong and that determination is based on facts, not opinions. The human body is largely a group of mechanical systems (albeit very wondrous in design and execution) which responds fairly predictably in a given set of circumstances.
 I have been reading the Rouge Medic for a couple of years now, and I confess that I don't fully understand many of the things he writes about. I feel like I've missed the pre-class reading assignments most of the time. None the less, I like his stuff because it makes me think, learn, and do a little research to understand what the he is writing about. Anyway, he's been beginning to get on a pretty good roll with the new AHA guidelines and how they reached their conclusions. As I read his stuff I find myself nodding my head a lot.
 This cycle's recommendations hold very few surprises for me. I will of course have to spend some time on a CPR dummy to see how long I can do a rate of AT LEAST 100/minute for full chest recoil and of course get used to this CAB instead of ABC. But I think I can work with that. With the CPR recommendations I think the AHA is making a mistake in making algorithm changes that confuse the students, especially lay rescuers every cycle, many times based on how difficult things are to learn. They are confusing the students every 4 years. They are MAKING it hard to learn. No wonder they are now recommending that even Health Care Providers  need more training than once every two years. (As if actually doing CPR on a regular basis is not enough.)
Reality is that any CPR with decent compressions is better than running around in a circle. There is a limit to what you can expect from a lay rescuers and it takes a good bit of courage to get CPR started.
 It would seem that the AHA is less likely to act on clinical research than my own states EMS council where it takes YEARS to get a change through. What caught my eye in this years epic document is the recommendations which had to do with the First Aid section.
 Read the section on tourniquets. Whereas the extensive research performed by the military overwhelmingly points toward effective use of tourniquets to reduce hemorrhaging and present a patient to the E/D that has sufficient perfusion to move directly to the O/R as oppsoed to the possibility of exanguination enroute or at the least the need for re-perfusion and stabilization prior to surgery.
 Read the extended document (part 13 in this case) which explains the research they reviewed and the how(?) they reached their conclusions. I didn't look at all the research, but I did re-read this piece of work from the Boston Medical Center which I had read when it was originally published. It was one of the things that made me start thinking about tourniquets again. Another was attending a CME at a state conference wich was givenm by a trauma surgeon who gave study after study supporting the use, with some case histories where the device was in place for over 24 hours and full use of the limb was regained after recovery. This reserch piece form BMC makes a very strong case for the use of tourniquets, yet the AHA says there is not enough evidence. If you read the BMC research you will note near the end where they cite a simliar study where no tourniquets were used and all the subjects died.
 We used to be thought that if you put a tourniquet on, the patient would lose the limb. I am still thinking that this would be preferred to losing their life, which appears to be the real choice we are making.
 Now I realize that the AHA recommendations are for First Aiders and not BLS or ALS providers. However, I truly believe the AHA is providing a dis-service to the public by not leaning in the direction that the available research is taking them. Instead they seem to be taking a 'cover your ass' approach. I also note that they do not recommend AGAINST using a tourniquet, only against using it routinely. In other words, try everything else first. So this bring us back to what was taught in the seventies. However, I was very disappointed to see the reference to irreparable vascular damage resulting from tourniquet use.  I need another couple of evenings to work through the rest of their cited research, but I have a feeling they've got some pretty old stuff in there. Which would explain the archaic viewpoint.
 If you don't share my view on tourniquets, that's fine. Go read the sections on Aspirin and hemostatic agents. Sorry, but this stuff blows my mind sometimes.

Tuesday, October 19, 2010

The Paycheck.

Yeah, we don't talk about it enough in the Volunteer Service, but we are all aware of it. We are all looking for that paycheck and we know it when it comes. Many times they are few and far between.
         - - - - - - - -
  It's fine fine Sunday near the end of February, I remember it like it was lat year. I was taking the opportunity to get some sun and wash some of the winter dirt off the Engine over at Station 1. The Station Captain is also here doing chores in the warm 20 degree weather. I like getting the truck clean, but lately the weather has been so cold that the water freezes before I can rinse it down. Today is THE day.
 A car pulls up on the ramp and I hear the Cap groan. He's not much of a people person and figures this is one of the City folk stopping in for directions like they do almost every time we are at the station. He finds something to do in the bay and leaves me out front to provide cover for him. He knows I like to meet and talk to anybody and figures he's dong me a favor by walking off.
 A middle aged woman gets out of the car and walks on over. "Hi" she says "I own the house down the road where the fire was a few weeks ago and I just wanted to stop by and thank you for saving my house." I smile, thinking about the Cap's instincts, yeah she is what we call a 'weekender', she lives in an apartment in the City during the week and comes up to her second home on the weekends. "Yes ma'am" I say, "Very sorry about your home. we did the best we could under the conditions. I'm real sorry."
 "Sorry?" she says "You're SORRY!?"
 Oh shit!, I think this isn't going right. Then she smiles and says "Sir, you have nothing to be sorry about, you saved my house!"
"Yes Ma'am, we sure tried but the weather was surely against us."
"Yes, I did hear how bad it was that night. I spoke to the Captain, or Sargent, or whoever he is and he told me that you had one fella that got there really quick and knocked the fire down and bought time for everybody else to get there and save the house." I asked her some questions to figure out who she had really spoken with. "yes Ma'am, that was the Chief you spoke with, he played a good part in saving your house with some pretty quick thinking. I am really sorry the we had to rip open that corner of the house, but that's the only way we could get to the fire inside the wall. I know it looks like a mess, but it could have been a lot worse, you were very lucky that night. 12 inches of heavy wet snow, trees down across the roads, most of our firefighters out of town plowing snow. You got real lucky."
 "Were you there?" she asked.
 "Yes, I was."
 "What did you do. are you one of the firemen?"
 "Yes, I'm a Firefighter and an EMT, I do many different jobs, but that night I was just the Engineer. I ran the pump on the Engine."
"Thank you so much. Your Chief said that there was one fireman who really made the difference in holding the fire down until everybody else could get there. Do you know how I could find that man? I'd like to thank him."
 "Well Ma'am, we work as a team. Sometimes one or two of us arrive first and do what we have to. We work as a team and nobody is any more important than anybody else. He was just doing his job."
 "Yes, but the Chief told me that when the alarm came in at 2am, this fella realized right away that everybody was busy plowing snow and he got the truck there through the storm and pushed the trees away with the truck to open the road and knocked the fire down, by himself. That is AMAZING!"
 "Yes Ma'am, sometimes we get lucky, and the firefighter was not alone, two of your neighbors called the alarm in quickly and then stood by to help that single firefighter who arrived with the Engine by carrying tools and spreading out the hose as he directed."
 She looked at me a little sideways. She smiled and said "You were the one! You were the guy, am I right?"
 "Well, yes ma'am, but like I said, you were lucky, and it's a team effort. People started showing up ten minutes after I arrived." (I didn't tell her it was the longest 10 minutes of my life.)
 Then she grabbed me around the waist and gave me a hug, squeezing a little too hard and a little too long for my taste, but I got the point. I could see the Cap inside the shadows of the bay looking at us and shaking his head, he went back to what he was working on.
 She said "You know that house was built in 1886? I figured that if there was ever a fire in it, that it would go up like a matchbook. I still can't believe you saved it."
 "I'm a little surprised myself ma'am, but like I said, you were very lucky that night."
 She thanked me a few more times, got in her car and as she drove off the Cap came back out on the ramp.
 "What the hell was THAT all about?" he inquired.
 "She owns the house we had that fire job at a few weeks ago."
 "I suppose she stopped by to complain that we didn't wipe our feet or left a mess? Damn city people."
 "Nope" I said as I got back to the truck washing, "She just dropped off my paycheck."

Sunday, October 17, 2010

New Stuff, check it out!

Just a quick post here to alert our devote readers to the first episode of Ambulance Matters, hosted by our good friend Mark Glencourse along with a nice selection of his contacts from Canada to London and of course his lovely wife. There is even a late visit by one of those lurkers from the colonies.
  Y'all should go check it out, but put a pot of coffee on first because you won't want to be interrupted once it starts.

Friday, October 15, 2010

Challenges are Realtive.....

 We were dispatched to a group home in our District for a resident that had assaulted a staff member. I can't count the number of times I have been to this residence. It is not very far from my home and I tend to do a lot of "first responder" runs there because I know it will take the regular crew a while to arrive, and because I know a lot of the residents and treat them like neighbors. Most times when I walk through the door, I just ask who the patient is, and expect a first name. Actually, I usually know who the patient is based on the dispatched chief complaint. "45 Year old male in seizures" almost always means that I will be working on Phillipe' for instance. Several of the patients recognize me and I get a big smile, and sometimes a hug.
I like these people. They are all mentally challenged, but they are all caring people with hopes, dreams, senses of humor, and needs just like everyone else. Theirs are just on a different level than yours and mine. When we do our "Santa Run" in December, I always insist that we bring the Engine down the long road to the residence and hand out candy canes because it brings them such unadulterated joy. The crew always leaves with big smiles on the faces, even though they may have gone in with hesitation. But I digress.....
 So we pull up at the scene and a Fire Officer gives me a hurried, and way too detailed description of the assault and I patiently waited until he got to the part informing me where my patient was located. PD was on the scene and informed me that the patient had given them no problems and was cooperative. I asked the Fire Officer to stand down the ALS unit that was headed in. I walked over to the police cruiser where my patient was seated and opened the door.
 "Hi Bob!" I said. "How are you doing?" Bob just grunted. He, of course didn't trust me yet. I had never had Bob as a patient, although he's lived here for about 15years. Bob never had any issues requiring our help, but recently had a med change that seems to be taking some time to get worked out and his social skills are suffering for it until they get the dosage figured out. This is his second altercation in two days with no prior history.
 "Bob, how would you feel about taking a ride with us to the hospital?" Apparently that appealed to him and he bounded out of the cruiser and loped over to our rig, I barely caught up to him to make sure he climbed the steps without issue. The staff, the cops, my crew, and the firefighters were all watching and waiting to see how I would handle this guy and if he would try to take me out.
 "OK Bob, good job. Ok, do you think you could sit on our stretcher here? Just sit right down here Bob." I patted the sweet spot in the middle of the stretcher. He looked at it and I could sense something felt wrong to him. I reached around and lifted up the backrest believing this would give him a better sense of which way his head and feet should go. Bob went for it and put his butt down and tried to get his feet up on the wrong end where the back was already upright. He had his knees up by his chest and wrapped his arms around his kness to help him sit up. "No Bob, sorry. We need you to turn around and face the other way. Lets try this again, ok?" Bob jumped up and stood there and contemplated the situation again. I could see he was really trying to make this work, but the stretcher was not facing the direction he expected. He began to sit again and realized it was 'still not right', but he tried anyway and didn't get as far as he did the first time.
 At this point I can see there is some frustration building on Bob's part and I don't know if he notices the smiles on the faces of those at the back of the rig, but I can hear some noises from them and I am concerned that one of them might actually make a comment that would upset Bob.
 I turned to my onlookers at the back of the rig and said "Doggone it guys! You put the cot in backwards again, no wonder Bob is having a hard time here." The smiles stopped when they saw my facial expression. "Bob I said, these guys messed up again, could you work with me and try to sit on the stretcher the other way?" Bob sat down, thought for a second, then lay down in the proper direction and helped me with the straps. As I clicked the one by his ankles I shot another look out the back of the rig and said "It's a good thing for you guys that Bob here is a flexible guy, otherwise I would have had to make you guys fix this mess."
 Bob and I had a nice ride to the hospital.

Wednesday, October 13, 2010

Really folks, we should know this.....

...... And I'm gonna do my best to help. Yes, I know it seems I am focused on this rehab kick of late, but we all know this is important and I am convinced that all of us working together to spread the word CAN make a difference. So just like my hound when she gets a rawhide bone, I'm not letting it go just yet.
 Over on Command Safety, Chris Naum just posted a nicely written summary of the newly released USFA report on Firefighter Fatalities in 2009. As an instructor this is what I use every year to 'fill in the blanks' on my presentations and justify for my classes WHY the stuff I present is relevant. You can get your very own copy of the report HERE
 But getting back to rehab and what I am tying to sell as the most important function any of us can provide I would like you to go give Chris's summary a good look then come back. If you are really pressed for time, here is the section I would like you to focus on:

Fifty firefighters died in 2009 as a result of stress/ overexertion:
  • Thirty-nine firefighters died due to a heart attack.
  • Eight firefighters died due to CVAs.
  • One firefighter died from heat exhaustion.
  • One firefighter died from a pulmonary embolism.
  • One firefighter died from damage to a heart valve, an acute event caused by the extreme physical exertion.
Now there were 90 Firefighters who died in the line of duty in 2009 and 50 of them were the result of 'stress/overexertion'. That's 55%. Now you would have a very hard time trying to convince me that there was nothing that could be done to reduce that number by at least half. With the exception of firefighters that went down IN the fire, there had to be some warning signs. The reports bear this out in many cases. The problem was that nobody heeded these signs, and if they saw them, they did nothing about it. Most likely, they asked, and the victim said, "nah, I'm fine". I've done this myself, and probably you have to. We came to do a job and we expect to get it done. We can lick our wounds later. But maybe not.
 Look, I'm not one of those 'safety nuts' that believes we can make everything perfectly safe or nearly so. Firefighting is a damned dangerous business. Some of us will die every year and many will be injured, others will suffer debilitating illnesses. This is the deal and there is no way to stop it. I would like to believe that every time somebody makes a serious sacrifice, it is because the risk they took was worth the benefit. Life safety is primary of course, and I personally am willing to take almost any reasonable risk in that situation with my own security. I'm a lot more careful with my crew of course. But that's just me. We have to do that analysis every time we take the leap, "is the risk worth it?". For an empty structure? Hell no! During training? Again, Hell no! Trapped occupants? Maybe, well actually almost every time. But the point is to look at the risk before you jump in and have a plan.
 If I could get one message in the head of every Firefighter and EMS provider in the world, it would be this: Look at yourself and your crews honestly and without prejudice. If you feel like crap, DO something about it! If a member of your Crew looks like crap, DO something about it! If a firefighter you are rehabbing looks like crap, DO something about it! Have the COURAGE TO DO SOMETHING ABOUT IT! For what is, by all accounts, a group of courageous people, we sometimes lack the courage to save ourselves. What's wrong with that picture?

Monday, October 11, 2010

EMS 2.0 or just a good idea?

Sorry I haven't been posting as much lately, but I got a little overloaded reading about subscription firefighting and at the same time things have been a little miserable at the paying job. I've spent my normal writing time updating my resume' and just finished posting it with a strong prospect. Perhaps in a few weeks I'll be a lot happier than I am now, although the thought of 'starting over' at my age is not encouraging.
 But hey, here I am now so lets change the subject. Just because I haven't written anything doesn't mean I haven't been thinking about it.
 I wrote about rehab in a very general way a couple of posts back and have been thinking about it more than I have in a couple of years when I wrote a training program on the subject. I'd be happy to deliver it to any agency who wants it. OH Wait, I'm annonomous, so that won't work too well. Never mind.

OK, so let me tell you something that I believe goes to the root of the problem when it comes to training providers in rehab skills. WE DON'T TEACH REHAB....AT ALL. That is a problem. If your program does include any mention of rehab, it is most likely to mention the warning signs to look for, what the 'danger levels' might be for certain presentations, etc.
 My problem here is that there are no real standards for vitals, the range all over the map depending on the agency. But my big problem is that we fail to recognize that rehab is not provided in the same way we provide care to our regular patients.
 Rehab is VERY different. Think about it. When we see a regular patient, we have been called there by the patient, family member, or other concerned person because there is something to indicate a medical need (at least to them). We have been ASKED to look at this patient. In rehab, most of the subjects did not ask, and even don't WANT you to check them out. We start with what can be an adversarial relationship. This requires different tactics and therefore different training. As a rehab provider you need to make sure you get to see everyone on a regular basis. You NEED to LOOK for problems, because the patient just wants to get back in the fight and will not volunteer any information. It's your job to find any problems that might exist.
 So does this mean you need to be aggressive? Sometimes, but usually not. You do need to be assertive though. You are responsible to identify any hidden problems that could take a Brother or Sister down. One way to do this is to make sure the Incident Command System is supporting your rehab unit (even if it's only 2 of you). If the Firefighters know that will be pulled out if they don't comply, that should get rid of the avoidance issue. Next you need to work with your patients and let them know that your job is to check them out, refresh them, and get them back into the fray. It is most likely that very few, if any, require being pulled from the job for real treatment, but they don't know that. You, as the provider need to be even more professional, even handed, and thorough during rehab than you might with a standard patient. These patients know the score and will easily identify sloppy work. By the same token, if you DO find something, they will eventually realize that you did them a favor by providing proper and appropriate treatment. Remember to stay within your protocols. If your Medical Director permits you to clean and dress wounds to return someone to service, then do so, as appropriate. If it's not in your protocols, then perhaps you can work on getting that fixed, but in the meantime, do nothing you are not both trained and qualified to do. (For great training on wound management and infection control, take a Wilderness First Aid class given by a reputable organization like Outward Bound, Wilderness Medical Associates, or SOLO Schools, or go for the Wilderness EMT, it's a WHOLE different deal, I promise.)
 Having national standards on Rehab and the training that SHOULD go along with it would make a difference. Having at least a solid set of recommendations would be really helpful, but I think it will take a long time for this to happen. I have read a LOT of guidelines from agencies, organizations, and departments from all over and they vary all across the board. I have seen some that recommend pulling a Firefighter that has a systolic pressure over 135 and some that use 160. Some say a pulse over 90, some say a pulse over 125 sustained (not subsiding after 10 minutes rest). It's no wonder everybody is confused!
 This is why I keep going back to the look test. If the vitals are marginal but you have a subject that is energetic, animated, and alert... well then perhaps he/she isn't in such bad shape. Wait ten minutes and do your vitals again. Did they drop? If so this indicates recovery is in progress, and if they didn't maybe you want to get a better history and look a little deeper. When somebody feels like crap, it should be pretty hard for them to fool the provider that is looking very closely. Walk away and do something else. In a few minutes give them a look from a distance. Are they involved in an active conversation or are they slumped in the chair with their head back? The point is, you really have to pay attention and WORK this job. Rehab is not 'going through the motions'. These are your co-workers you're taking care of here.
 If you have an interest in putting on some good rehab training, or just training yourself, the International Association of Fire Chiefs published a very nicely done package in August of 2009. I cannot confirm nor deny that I am acquainted with one of the primary authors, but I can say that there was a considerable amount of work done on this rehab program and it is whittled down to a pointed presentation which includes the PowerPoints, instructor notes, and a nicely done 'Brady style' student guide. All inclusive. I believe it is free to members of the IAFC. If not, then the price is worth it. I was given a review copy just prior to publication and was very impressed. It included new research and debunked a lot of rehab myths like drinking coffee on a fire scene is BAD. (As with most things, moderation counts.) Check it out.

Wednesday, October 6, 2010

Memo to Readers:

Item 1: As I type this I am listening to the debate that rages, albeit politely On Firefighter NetCast about the incident in South Fulton, TN a few days ago. I have read most (there are very many) of the posts on this from very many bloggers and reporters. In the interest of my readers, I will not add my comments to the fray (you are very welcome), but if you need to know where I stand on the issue you can read this post on EMS in the New Decade. It comes pretty close to my feelings. I could not serve as a Firefighter in the South Fulton Fire District and walk into the local diner with any Department identification on my person. I would hang my head in shame. This is not to blame the Firefighters, it is not their fault, but the system they serve has serious problems at the highest leadership level. 'Nuff sed.

Item 2: I am not much with this blog stuff but I managed to make the background mostly pink with respect to Breast Cancer Awareness. I will not, however, place photos here such as you might find over on FireCritic, Although I note that Rhett has removed one of the photos which he had up there last night and was still up there the other 16 times I checked.

That is all.

Monday, October 4, 2010

Live Burn Training: Whats YOUR standard?

 Every year, as part of our training cycle, we review and share the previous years Firefighter Fatality Reports. The latest report is available here. Everybody in this business should make it regular reading every year. Almost every year there are several deaths which occur during training, sometimes these are related to the stress induced during live fire training. The Lairdsville incident is a horrible example of what can happen due to poor planning and lack of knowledge. As a consequence of this and other incidents, my sate has invoked a very strict list of requirements to conduct live fire training evolutions.
 Both my Training Center and my Department has adopted this standard as the baseline for us as a minimum standard. To summarize it includes the basic requirements to have an attack line and a backup line from independent sources capable of delivering at least 120 GPM, having a 3,500 gallon static water supply available, having EMS and rehab active on the scene, and several other basic requirements. In addition, there are instructor requirements such as having at least one live fire qualified instructor for each 5 participants. Live victims are not permitted for any reason. We also supply an instructor to be with each crew as they move through the evolution.
 Eeven with all these precautions, we have had a few 'injury free events' which we were able to mitigate quickly and effectively before any lasting effects occurred. Some of these could very easily have been serious, including one true mayday for a man out of air on the second floor who panicked. Why someone would go in, know his bottle wasn't full is a good question, but the subject of another post.
 All the requirements that are to be met for a live burn evolution means that many Departments in the Volunteer service lack the ability to put on their own training. As we depend on our mutual aid being up to the task for structure fires, we have found it necessary to put on live fire training for as many as 5 other Departments besides our own. We seem to be the only Department with the resources. Ironically, we are using a burn building in one of these districts. They have nobody in their own Department certified by the AHJ to run burns in their building and rely on us to do their in service training.
 In this age of dwindling volunteers, difficulty in getting proper training, and limited funds and resources, I am wondering what other areas are doing to keep their personnel combat ready. Have you compromised the standards? Do you have what you need to pull of the live fire evolutions? What about your mutual aid Departments, are they up to the task? Is live fire training going ut of fashion because of the obstacles? When was the last time you had your crew in a burn building and feeling the heat?

Saturday, October 2, 2010

Please Watch and Remeber

Coming Soon

The Cermonies will be available on this site (provided I set it up correctly) beginning at 6:00pm tonight 10/3, the live Video should be available sometime just before 6:45, Coverage will resume again on Sunday morning. I encourage my readers to watch, think, and remember the fallen.