Snakes in the Bay!

Snakes in the Bay!
Oh those things you find in the ambulance bay (that's a 4 foot bull snake)


Everything you read here should be considered fiction. Patient rights will always be respected. Any resemblance to persons living or not is purely coincidental.

Friday, April 11, 2014

Weekly Roundup 4/11/2014

Important, for many reasons.  Not a "how-to" but more of a "how we got here"

Active shooter EMS -- Discussion
"During an active shooter/active killing response, the first-arriving Fire/EMS responders, not special operations or tactical medical teams, must accept the responsibility for life rescue and medical operations and must work with first-responding law enforcement assets to rapidly deploy into the areas that have been cleared but not secured (warm/indirect threat zones) to initiate treatment and rescue injured victims."

Wake County EMS Evacuation pre-plan (outline) and A.J. Heightman's freaky night in a hotel:

Simple thoracostomy - a case for incision rather than needle decompression
(will be interesting to see what the study yields)
"To avoid the complications associated with needle decompression, a number of services in Europe have adopted simple thoracostomy as an option for chest decompression. Simple thoracostomy is a technique similar to the placement of a chest tube, traditionally done in the ED. It utilizes an incision with a scalpel and penetration directly into the thoracic cavity with forceps and a gloved finger to relieve the tension pneumothorax. The only major difference is that the chest tube isn’t inserted."

Ferno's new cot.  If it works, it's a game-changer for EMS:
VERY similar to one we played with at EMS World, but this is all auto and will load into our tall 4wd ambulances.  I might be in love.

AND A little video crazed this week

How an EMT gets ready for work:

Forget the egg in a skillet "this is your brain on drugs" commercial.
Just show this to the kids, and they will stay away.

It's so funny, because it's true...

Wednesday, April 2, 2014

Weekly Roundup 3/28/2014 (sorry it's late)

I will be reading this, printing it, and re-using it:

Simulation -- not just for EMS

Funny, because it's too true:
I had the, um, privilege of working with some DC Fire/EMS folk a couple years ago.  They are getting focused, for sure, with bad press.  But you don't get smoke without...

Tuesday, March 25, 2014

Field Microscopy - 50 cents each

This is a very cool item, probably one of the neatest inventions I've seen in a long time.

Paramedic Clinicals, Part 1 -- Getting There

I got lucky.

See, when I started this Paramedic adventure a few years ago I knew it was going to be a struggle to get it all done.  Back in 2006 when I was diagnosed with cancer, I used up all my sick and vacation time (as well as a few people who donated their time to me).  Truth is, in the 7 years since, I did not build up much of a "bank" of time.  Vacation days became more precious than work to me and I spent them with my family and friends.

Once I started this Paramedic education, however, I knew that I would be taking a ton of "vacation" days from my normal job in order to do my EMS education on the side.  So I saved up time and money.

Optimistically, I saved enough for Base Camp and EMSWorld Expo, with a few days left over for the slop, figuring I could do my clinicals every other weekend.  You see, I work 5 days then 4 days, then get a 3-day weekend.  I figured I could leave after work on a Thursday, drive 3+ hours to the hospital, work part of a night shift, sack out in the car/shower at a truck stop, work Friday night, sack out in car/shower at truck stop, work Saturday night, sack out in car/shower at truck stop, work Sunday night, drive home (nap in car along way somewhere), shower at home and work 8 hour shift at regular job Monday.  I would get every other weekend at home to recoup, and I could be finished in 14 weeks.

That may have worked...when I was 22, but at nearly double that age I'm just not able to swing it. 
It took 2 nights sleeping in my car to realize I needed:
1.  a bathroom. 
2.  to stand up, stretch, and do yoga
3.  a coffee pot
4.  a fridge with some real food
5.  sometimes a shower AND a bath to soak away 12 hours in the ED
6.  a decent internet connection
7.  someplace I could call "home" away from the hospital

There was no way my original plan would work.

Lo and behold, the idiocy of the Federal Government saved me.  They shut down the government for a few weeks.  I managed to score a fabulous serviceable room at the local Motel 6 for the duration, and managed to knock out 14 shifts of at least 12 hours each.  Although I hated the whole mess, the shutdown really worked in my favor.

Next time:  Paramedic Clinicals -- Day 1

Friday, March 21, 2014

Weekly Round-up 3/21/2014

OK, so I've decided to add a new section, for all the articles and web pages I've read this week, that might interest you, gentle reader.
So here we go:

Provider Suicide.  I've written about it a few times.  A good editorial.

Teamwork...a laudable goal:

Upstroke ventilation in CPR (and ventilation in general)

Lone Star tick bite causes some to become allergic to sugar in red meat.

Firsthand account of caring for your colleagues:

A good reminder on equipment checks:

EMS Movies

Mercedes/Freightliner 4x4 model to USA!!! (Ambulance Ranger REALLY wants one...)

Emergency Vehicle Safety - report shows...

Vegas - "War over emergency response" in Las Vegas - Vegas fire wants to take 75% share...

Monday, March 17, 2014

Distance learning...frustrated with the process

The learning part (didactic) was great.  Going to Paramedic Base Camp was great.
Trying to get someone in rural America (within driving distance) to sign on for my clinical internship took months.  Even after almost a year of pre-planning and discussion.  First choice backed out at the 11th hour, second choice did not communicate well.

Getting intubations was nearly impossible.  I'll save the gory details for later, but approximately 3 months elapsed from my last clinical shift to the week at the Big Eastern hospital OR I had to travel to in order to get my 10 tubes.

Field internship is not proving easy to navigate, either.  Had the site set up over a year ago, and just now am finding out that my school needs to be licensed in the State for me to do my field time (which they are not).

I haven't had the heart to tally my expenses so far, but for you, gentle reader, I will do it and get you an update.  Let's just say that Big Credit Card Companies are in love with me right now, and my diet is far less varied than it used to be.

I'll try to be upbeat in my next posts, but for now I'm just bummed.

Thursday, March 13, 2014

Thank you for your service, officers

K9 Maros
United States Department of Agriculture - Forest Service Law Enforcement and Investigations, U.S. Government
End of Watch: Wednesday, March 12, 2014
Cause: Gunfire

Read more:
Officer Jason Crisp
United States Department of Agriculture - Forest Service Law Enforcement and Investigations, U.S. Government
End of Watch: Wednesday, March 12, 2014
Cause: Gunfire

Read more:

Friday, January 24, 2014

So long, and thanks for all the fish!

Mostly because I've been too busy/lazy/tired/discouraged to post anything lately:

How those of you who decide not to vaccinate are killing people:,0,5576371.story#axzz2rMwGoaYf

And a cool online map of preventable disease:

And these, just for fun
 How to survive being married to a medic:

Sirens - new EMS show, really Dennis Leary?

Thursday, January 2, 2014

Sense of entitlement = high cost healthcare

Yet another reason we need to educate the public, and EMS and ED need to have the option to refer "non-urgent" cases to other services (without being sued at every turn).

Study finds Medicaid expansion drove up ER visits

SALEM, Ore. (AP) — A new study has found that people enrolled recently in Medicaid went to the emergency room 40 percent more frequently than others, often seeking help for conditions that could be treated less expensively in a doctor's office or an urgent care clinic.
The research, published Thursday by the journal Science, comes as millions of Americans gain health insurance this week under the federal health care law, many of them through Medicaid.
The findings help inform a long-running debate about the effect of expanding Medicaid and suggest that hospitals and health officials around the nation should be prepared for an increase in emergency room trips in the coming months.
The study is the third to arise from a limited expansion of Medicaid in Oregon five years ago. Demand exceeded the available funding, so the state used a lottery to randomly choose people for coverage from a waiting list. The lottery created two groups of similar people, one consisting of new Medicaid patients, the other a comparison group of people who weren't selected. It gave scientists a rare chance to evaluate the program in a randomized, controlled study — the gold-standard for scientific research.
Taken together with the earlier findings, the latest research indicates that expanding Medicaid improves mental health and leaves patients more financially stable in the first two years. But it increases spending for hospitals, primary care and prescriptions and doesn't produce significant improvements in measures of physical health like blood pressure or cholesterol.
"We've been able to eliminate some extreme views about the program," said Sarah Taubman of the National Bureau of Economic Research, the study's lead author. "In the absence of that evidence, there were some unduly pessimistic views and some unduly optimistic views" about the effects of Medicaid.
Researchers used hospital records to look at ER use over 18 months for 25,000 people in the Portland area who entered the Medicaid lottery, some who were chosen for coverage and some who were not. Patients with Medicaid made, on average, 1.43 ER visits, compared with 1.02 for those who lost the lottery, an increase of 40 percent.
The study also found that 35 percent of people who weren't selected for Medicaid made an ER visit during the research period. For those who gained coverage, however, the number was 7 points higher at 42 percent.
Men were more likely than women to have additional ER visits, but there was no racial, age or other groups that saw a statistically significant decrease in ER usage among the people selected for Medicaid.
ER visits increased both during nights and weekends and during typical business hours, when ER alternatives would generally be open. The additional visits were exclusively outpatient, and many of the Medicaid patients were diagnosed with conditions that could have been treated in a primary-care office.
The study doesn't pinpoint a reason for the increased visits. In interviews, the authors said there's no data to know for sure but it's possible that patients are quicker to have their injuries and ailments checked out if they know they won't be stuck with a large hospital bill. Some patients may be visiting the ER on the advice of a primary-care physician.
"When you lower the price of something, you're more likely to use it more. That's what we see when we look at the emergency department, hospitals, doctors offices, prescriptions," said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Baicker and economist Amy Finkelstein at Massachusetts Institute of Technology are leading the long-term study into the data derived from Oregon's Medicaid lottery, including the two earlier studies.
The authors caution against concluding that ER use rose because there wasn't enough access to primary care. Their earlier research found that Medicaid patients reported more visits to doctors' offices and use of preventive care.
Oregon's expanded Medicaid population was relatively similar to the group that's gaining coverage under the federal health law, but experiences elsewhere might differ, the researchers said. Oregon opened Medicaid to a tiny share of its uninsured population, reducing the amount of strain on the health care system's capacity. Portland's low-income population is also disproportionately white compared to most other U.S. metro areas.
Alissa Robbins, a spokeswoman for Oregon's Medicaid agency, said the state is aggressively working to reduce Medicaid costs — an effort that began after the period studied. The state has created incentives for doctors, hospitals and mental health providers, and some are targeting frequent ER users.
"Increasing coverage and seeing people use more medical care isn't necessarily a bad thing," said Dr. Renee Hsia, an associate professor of emergency medicine at University of California San Francisco and a health policy researcher who wasn't involved in the study but reviewed it for Science. "The outcome that we desire is not that we don't have people going to see their doctors anymore. The outcome is that we have people who feel protected from (financial problems and) seeking care when they feel they need it."
Follow AP writer Jonathan J. Cooper at .