More on ambulances - a change for EMS 2.0?

Boxes strapped to the back of a truck/van drive me nuts.
As our recent search for a Type 3 for over-snow use showed me, we don't have many options.
Ambulance design and safety are intriguing, and I spent a large amount of time being thoroughly unimpressed by the selection out there.

Look!  It's a bigger truck with a bigger box...

Just watching a 67 minute presentation called "Ambulance Construction 101"
http://www.jems.com/webinar/vehicle-ops/ambulance-construction-101-glo
(Slides stolen from this presentation)
This is a recorded presentation, and I think you should all go check it out.

The presenter, Wayne Zygowicz, attended the RETTmobil (mobile rescue) conference in Germany - I need to go to this, I think.  I am extremely impressed by the European EMS programs.  They employ safety experts, ergonomics experts (gasp!), engineers, solid statistics, and more to produce safer rigs and equipment for EMS providers.

DID YOU KNOW?
THE US AS A WHOLE DOES NOT MAINTAIN DATA ON EMS ACCIDENTS, FATALITIES, OR EVEN THE NUMBER OF AMBULANCES ON THE ROAD.

What does this cost us?  Glad you asked.

In contrast, there has been a European standard since the 1800's.  Standards.  Across multiple countries.  Really?  Can the US be this backward?  How long is it going to take before we make changes?

"I wonder, Is there an acceptable rate of mortality in any industry before an industry decides to take action and look at all the variables that can kill people?"  Good question, Wayne.

This webcast also goes through the construction process, chassis selection, and on to "Extreme Ambulance Makeovers" and spends a lot of time on the "Ambulance of the Future"

This Swedish rig complies with the European standard, and all the consumables are in ONE BAG.  Don't know how our folks would deal with this!  One patient, one ambulance = rig of the future.  Would definitely take a culture change in the US for sure, but a slim ambulance with just what the patient needs?  Crash tested? Comfortable to drive and ride in?  I think that's worth a culture change.

The Loaner

We have a nice ambulance.  It's a Type 1 Ford 4wd powerhouse.  She was brand new last year.  A beautiful white truck with a big box on the back.  I call her Efee.

Following our last service at the garage, I noticed oil drips on the bay floor.  No worries.  Sometimes oil gets on the frame and drips off for a while.  I checked the oil and kept an eye on it.  Every time I swept the bay there was fresh oil.  Also, the brake release handle mysteriously broke off.  Couldn't really see why it lasted as long as it did, considering the tiny chunk of plastic used as a hinge.  So the next service date came up - an oil change and fluid check.  Thad took the rig up to our garage in the morning.  Then the text message came.  The oil leak looked like an engine problem, and the rig was pulled out of service due to the brake release lever being a safety hazard.  Oy!

What to do? Apparently the powers that be decided our area needed only one ambulance, so our "spare" was taken away at the same time we got our new rig.  (Somehow, though, the fire crew managed to get all brand new F-350's for each of their upteen volunteers.  This during a "fleet reduction" year?)  Besides, they reasoned, the volunteer village department is just 5 miles down the road, so we have another backup even if one of the other 8 rigs in our department can't respond.  Sounds fine, I guess, but the volunteer rig is a tiny Type 2, about 50,000 kilometers past it's prime.  The closest relief rig to us is a 1990's era Type 3 is 30 minutes away.

Our EMS director grabbed us a loaner rig.  One of the entrance areas over an hour away had a low call volume, so they had to sacrifice.  The other Type 3 in our system (also a 1990's vintage) arrived.  I went to check it out after work.  And was shocked.

The rig is old, yes.  It's seen a lot of action, yes (over 200,000 km).  The shelves were not organized to my exacting standards, sure.  But it was filthy.  Not dirty, FILTHY!

Dirt and I are good friends.  I can deal with dirt.  But ground-in gunk consisting of sweat, vomit, pee, gore, blood, spit, you name it?  Nope.  To be fair, the rails and action area were in decent shape.  But I could see mouse droppings in one of the cabinets.  The bench should have been blue, but was instead a brownish color.  The white vinyl padding was grey.  I grabbed disinfectant and got to work.  Ms. Medic was on duty and stopped by.  We scrubbed hard for over an hour and got the rig in semi-clean shape.  Mr. Medic dropped in and we ran the inventory list.  Expired meds, expired equipment, etc. piled outside the back doors.  I ran up to the wash bay and pressure washed the outside clean.  Together we put in about 8 man hours just to get the newly dubbed "Mini Winnie" in decent enough condition to go on a run.

And run we did.  We were taking a rule-out cardiac to the community hospital and were about 5 miles out of town when I smelled the exhaust fumes.  Mr. Medic told me this was a known problem.  I thought about setting up welfare checks, but instead opened the side window and turned on the air.  It didn't smell as bad for the rest of the ride, but I checked Mr. Medic's LOC several times just in case.

After every run I do my cleaning, and find more filth to scrape away.

I now feel spoiled with our shiny Type 1.  I just hope we get it back soon.

Currently reading...

Too Old to Work, Too Young to Retire http://tooldtowork.com/
Another gun-totin' hard livin' redneck EMS provider.
Think I'm going to like this one...

(Starting at the beginning, ahem, with page #115)

Also just finished reading "An Elegy for Easterly" by Petina Gappah, meh, it was OK but a grippingly stark view of lives in Zimbabwe and I just wasn't in the mood for reality.

Finally finished the book "MASH: A Novel About Three Army Doctors" by Richard Hooker.  I can recite every episode of the sitcom from memory, like the movie, so I figured I should read the book.  Nice, easy read.  Goes into the medicine more than the TV series - altogether a decent book.

"Advice for a new Paramedic" (HappyMedic)

This is blatantly ripped off from The Happy Medic http://thehappymedic.com/

but it bears repeating. Just as relevant to a First Responder, EMT-B, or EMT-I. My comments are in italics.

Advice for a new Paramedic

Over the years I’ve been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.

I can never stress enough the first and most important tip I have:

It’s not your emergency

No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.

This one is difficult to follow. Adrenaline is pumping, you want to help, but the people I am learning to admire on scene are the ones who are un-ruffled, calm, and quiet. I need to work on this.  A lot.

You will never know enough

There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.

Don't need any help understanding this concept. The more I read, listen, and learn, the less I feel I know...

Don’t tune your patients out

Many folks don’t know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don’t get stuck in the SAMPLE questions, but use them as a starting point.

This is another good one - I like talking with patients and am getting more comfortable asking the probing and leading questions. I try to listen to the more experienced folks, and am feeling more comfortable speaking up for myself. I need to stop interrupting people, though...one of my big faults.

The most important person in the room is you

Scene safety is paramount. It’s not as easy as simply saying, “We’ll wait for PD” like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.

Love the last line.

Don’t leave the hospital so fast

Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it’s pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You’d be amazed how many times I’ve seen a Doc spot something the machine misses.

This is a problem for me. I always feel like I'm in the way in the ED. Easier just to grab the cot and leave, but I need to spend more time in the room when we get there.  Hoping my EMT-B course hours at the ED will help on this.

Buy Dubin’s

Dubin’s Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.

Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.

Ordered it, got it, and started to read. Also bought Thaler's"The Only EKG Book You'll Ever Need" and Phalen/Aehlert "The 12-Lead ECG in Acute Coronary Syndromes."  All are so far over my head it's sickening. EKG reading is still an intriguing mystery to me, but by sheer repetition some of it may be sinking in.

Find your comfort zone and avoid it

If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don’t know the answer to.

Ha! I don't have a comfort zone in ANYTHING yet, so no worries. Actually, this has reared its ugly head already.  I am a fine driver.  Patient contacts - well, I still feel nervous and out of my element.  It's too easy to say, "I can drive."  So these days I try to jump in when someone gives me the option to ride in back.  Patient assessment skills are still weak - have that moment of panic when I'm first on scene and forget everything I've learned.  I need to nail myself down somehow...

Practice humility

People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn’t suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a “war story” but as an addition to a lecture, lesson or discussion.

Again, great advice. I've been lucky so far with mostly grateful patients. The follow-up is awkward and mostly third-hand (through the medic)

Warm lunch, warm dinner, go home safe

Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn’t matter.

Sounds like a good plan to me.

Thanks Happy Medic!

(btw, if you don't read his blog, you should)

Also from the Happy Medic:

My favorite term from his glossary:

Jedi Vitals – When you know the patient is fine, but still need to record something, you pass your hand in front of them just like Obi Wan Kenobi and poof! the vitals come into your mind.

11 September, thinking about the day

Strange.  That's how I feel.
Ten years ago today I was midway through my summer internship with the government.  My first federal job.  By the time I got to work that day there was a distinct buzz going around.  Radios were tuned to the news (no streaming internet for us, no!)  No decent TV reception up here either, without a costly satellite dish - back when those were a spendy extravagance.  Just listening.  Listening to the news in disbelief.  Mental flashes of "War of the Worlds" as surely, this must be a joke, right?

I'm such a newcomer to the EMS brotherhood that I don't really know how to feel half the time.  It's like I'm peering into someone else's agony and I feel like an intruder.

The truth is, we all lost something that day.  Not just EMS, Fire, LE - we lost a feeling of security.  That certainty that we are infallible, those of us on the North American continent.  We all look at things through new eyes - good or bad.  Is that guy in a turban a threat?  What about the person over there?  Is that baggage unattended?  The "Patriot" Act.  The wars against terror our soldiers are fighting.  We all lost a lot.

That's what I think of when I think back to that awful time in the last few months of 2001.

No, I won't forget.
But I've moved on.
I can't live with that day always on my mind, sorry to disappoint.

I'm living my life - a single woman travelling the streets without a male chaperone.   Travelling to other states, provinces, and countries on my own.  Working daily at an office job.  Moonlighting in the EMS world. Writing blog posts for anyone in the world to read (if they have that right).  Gathering with friends when and where I please.

That's my revenge, my way of coping.  To live in this great country and do those things that I couldn't were I born elsewhere.  And I am desperately thankful for that.

- the ambulance ranger -

EMSWorld Expo - Photos

Finally got my photos off the iPod Touch - and most of them were crappy.  Guess I need a primer on how to take decent photos with it.  But here we go!

Long walk into the Las Vegas Convention Center

Nice for organization!  Look how shiny!

What our ambulance would look like if we had any money.

MCI - two cars and a bus - ground level view

Mass Casualty Incident - seen from the monorail

Friday 2 September - Conference Day Three - the roundup

Fewer folks today, which was nice.  Not such long lines to get into sessions.  The end of conferences are quite often like the end of camp - new and old friends hug, promise to keep in touch.  This one was a bit different for me.  As a GIS professional at a GIS conference, I am 100% integrated.  I know most of the stuff that's going on and can really get into it.
This was very different.  I am very new to the EMS camp and pretty much everything is a mystery to me.  As an EMR, I'm probably the least qualified and least experienced person here.  That's a strange feeling for me.  I didn't integrate well into this group.  Now that I think about it, I suppose it was the same for me in GIS.  The first few conferences I felt out of sync - like everyone else knew each other and had some sort of inside track.  They were meeting for drinks, chatting, having intellectual debates over dinner, the whole social aspect.  Once Taylor left I really didn't have anyone to talk to.  Our guys are great, but they are guys and this is Vegas.  I didn't feel too bad for missing dinner with them since they spent the whole time checking out chicks, attempting to get Floyd to talk to a hostess.  To say I would have been out of place is an understatement.
The guys left this morning, so I am the only one still at the conference.  Guess thats a weird feeling as well.  Hundreds of people I don't know who are at least acquainted, or speak the same language, and I don't fit in.
I don't know, maybe I'm just feeling melancholy because this whole EMS thing is a strange new group for me.  Or maybe because I'm such a late-comer to this field.  I'm 37 years old for crying out loud.  I'm great at making maps, doing spatial data analysis, so why do I do this EMS thing?  It's certainly not for the money.
So I have a few hours until my flight leaves.  My grandfather died so I changed my ticket this week to fly back to my ancestral homeland in Washington State.  It will be nice to visit with my family for the day.  Maybe that's having an effect on my mood as well.  Who knows?
Hard to believe, but I'm at a loss for what to do at this point.  My bags are back at the hotel bell desk, I'm checked out of my room, and I still have 6 hours to kill before my flight.  Not interested in gambling away more money, or sitting at the airport for hours in an uncomfortable spot.  But I'm ready to leave Vegas now.  Seriously ready.
Left my ECG and A&P books (ahem, and my nintendo) in my bags, have no internet here, and it's emptying out.  Guess I will bust out of the convention center and head south.  Pick up my bags, give away my monorail pass, and get a taxi to the airport.  Hopefully I can find a semi-comfortable spot to settle in, plug in, and waste a few hours.  Wish me luck.

Gambled some more? Check
Picked up bags? Check
Gave away monorail pass with 2 more days on it? Check
Taxi to airport? Check
Lost my mini leatherman to McCarran security? (with scissors & tweezers in it) Check
Still 3.5 hours early for my flight? Yup

Sigh

Can't wait to get out of this town.

Thursday 1 Sept - EMSWorld Expo Day 2!

Day Two - Whew!
Spent the morning in sessions - then met Mr. Medic and the Pit Boss for some ambulance shopping.Two guys and a gal out shopping for a couple Type 1's and a very special Type 2 - one that is light enough to have tracks attached in place of the wheels to travel over groomed snow.  Of the four salesmen who we spoke with, two basically ignored me (one called me "hun") and only one seemed to realize that I had input into our agency's decision with which ambulance to go for.  I hate that crap.  I am not an idiot who is scared away from the modern conmbustion engine and distracted by pink, sparkly items.   Please just treat me the same as another potential customer.  Okay?
I am sold on the Sprinter (which I just found out Dodge is no longer a part of - just Mercedes and Freightliner now)  I love the way it looks, drives, feels after hard hours in the seat.  It's thoughtfully designed and a great rig.  One small problem.  Apparently, they don't have an all-wheel drive version for sale here in North America.  Europe?  You betcha.  They've got them going on over there.  But apparently they are not certified for the US and Canada.  Lame.
Regardless, I have a lot to say about ambulances.  I detest smarmy salespeople who treat the ladies like morons.  STOP IT!
OK, I'm done ranting now.

I have a few knocks for this place (Las Vegas Covention Center) - a few technical difficulties in sessions, bad internet (either extremely expensive or low quality), and no nap rooms :)
Can you tell I'm tired?

Wednesday - conference day 2 - Part 3

Not many folks at the podcast - probably 'cause everyone was jockying for position at the mass casualty.  All good though.  Got to meet the kilted twins - Ron & Kelly and was on the front row for their intro of the EMS Newbie essay contest winner.
The mass casualty went well, for what I could see from the ground level.  They really needed more bleachers so more of us could get up high to see the action.
Dinner was lovely - went to The Sea at Bally's - the Thai was excellent and I enjoyed myself despite the price.  Floyd, Taylor, and I ordered an appetizer and entree each.  They were awesome.  Mr. Medic and the Pit Boss joined us late and we had a great re-hash of the day.  Apparently I need to visit the SAM splint booth as well as the Stryker booth tomorrow.  And we're going ambulance shopping.  Lots of difficult choices as far as sessions go, but I'll probably use the same logic as today - go to one of the ones I'm interested in, but go for the shortest line.
Not even midnight and I'm back in the room.  Dang I'm being a good person this week!
Taylor is leaving in the morning 'cause she's gotta work on Friday, so I'm losing my 'wing man' and I'm bummed. Oh well.  Still have a couple days of conference to enjoy!