Time to build our paramedic profession infrastructure

It appears that our physician colleagues accomplished more than paramedics since 1968, establishing Emergency Medicine as a specialty in 1979 and Emergency Medical Services as a subspecialty in 2010. (How EMS physicians became recognized and rewarded)

The development of the National EMS Educational Standards in 2009 is a more significant development. (EMS Future is HERE)

Emergency Medicine built upon an existing graduate medical education structure

The significant physician accomplishments were built upon a well-established graduate medical education infrastructure.

A September 2006 article in the New England Journal of Medicine describes the foundation of medical education:

Almost a century ago, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in North America, visiting all 155 medical schools then in operation in the United States and Canada. His 1910 report, addressed primarily to the public, helped change the face of American medical education.

American Medical Education 100 Years after the Flexner Report

Two physician members of the National Emergency Medical Services Advisory Committee referenced the Flexner report when discussing update options to the 2009 National EMS Educational Standards in an all-day roundable on March 28, 2012 (agenda).

All professions with significant academic preparation go through this type of review process.

I used the results from evaluation of the Masters in Business Administration program to discuss the state of EMS Education in 2009.

The Ford Foundation and Carnegie Corporation criticized business graduate education in 1959 as filled with:

• Weak Students
• Inappropriately trained faculty members
• Unintellectual curriculum
• Poor research

What Direction for EMS Education?

From "sticky side down" first aid mechanic to health care professional

The 2009 Educational Standards vaults paramedicine out of the vocational training arena. It will have the same impact as the Flexner report had on physician education and the Ford/Carnegie reports had on Masters in Business Administration programs.

But we have signficant gaps to fill to satisfy the medical professional model.

Need appropriately trained faculty members

I will never forget talking to a community college assistant dean about the Educational Standards. An experienced paramedic with years as a state-credentialed paramedic instructor, she shared that she recently got her associate degree. The associate degree was from the same paramedic program she was running. Not sure she could complete a bachelor degree.

Most community college leaders are required to have master's degree, often they have a Ph.D. or Ed.D. terminal degree.

I have no doubt she is a dedicated, passionate and effective paramedic instructor … but she needs better academic credentials.

The biggest push back to CoAEMSP accreditation of paramedic programs was the requirement that the program director have a bachelor degree. (2008 fact sheet)

In the academic world, those with terminal doctorial degrees "create knowledge" and impact professional/graduate educational programs.

Will you step up?

Mike "FossilMedic" Ward

Remembering a near-miss with LAFD Light Force 35

The 1992 Los Angeles riots after the Rodney King verdict forever changed the perception that firefighters and paramedics were immune to violence during civil disorders.

This eight minute compilation of news video and LAFD radio traffic shows the chaos encountered by the crews.  Crews were "losing windshields" and encountering bottles, bricks and gunfire … with no police assistance available.

At 2:30 into the video is the alert by Light Force 35 that they have a firefighter shot … followed by other companies reporting gunfire.

Jordan was riding directly behind Miller as Truck Company 35 navigated through the smoke and mayhem of Western Avenue. He saw the handgun, then the flash. "Geez, they're shooting at us," Jordan recalled thinking.

Craning his neck, Jordan saw Miller slumped on the wheel. The captain pulled an emergency brake and the 55-foot-long vehicle lumbered to a stop.

Blood was squirting from Miller's neck. Jordan, a wiry firefighter who had worked at some of the city's busiest stations, had seen his share of gunshot wounds. This one wasn't good. "I thought he was going to die," he said. Another firefighter pressed his hand against Miller's neck to stem the bleeding as the crew loaded him into the back of the truck.

Jordan jumped behind the wheel and took off for Cedars-Sinai Medical Center.

Robert L. Lopez (May 04, 2009) 'Miracle' firefighter shot during '92 LA riots back on job. Los Angeles Times

Near exsanguination results in stroke

Laying on the engine cover of the open cab Seagrave tiller truck, Miller, 33,had lost so much blood through his ripped carotid artery that he suffered a stroke.

Scott Harris (April 29, 1993) The Right Choice for Capt. Scott Miller : This 34-year-old Granada Hills family man, this grown-up boy-next-door . . . seems to understand what is expected of him. It has become a matter of duty. Los Angeles Times.

Los Angeles Times also did a video on Miller in 2009:

20th Anniversary Observation:

John North (April 27. 2012) LA riots anniversary: firefighters recall dangers   KABC-TV, Channel 7.

Mike "FossilMedic" Ward

Another Great Racing Movie in the Making

The 1966 "Grand Prix" movie remains a motorhead's favorite, with real racing scenes and cameos by many of the era's competitors. Got a Blu-Ray copy last year for a "boy's night in."

Ron Howard is producing "Rush" which chronicles the 1976 Formula 1 season-long battle between Austria's Niki Lauda and Britain's James Hunt.  Lauda suffers a near fatal crash on the first lap at the Nürburgring.

During the first lap of the 1976 German Grand Prix, Niki Lauda's Ferrari 312B2 spun and hit an embankment off the side of the track. His helmet became dislodged form the impact, and the car fuel tank ruptured.

The car was then hit by another, and it caught fire. Niki Lauda escaped with his life thanks to the combined actions of fellow drivers Arturo Merzario, Guy Edwards, Brett Lunger and Harald Ertl rather than by the ill-equipped track marshals.

At the time, safety vehicles took about 10 minutes to reach the driver, since the accident occurred several miles along the circuit.

RECREATING THE INCIDENT

Dale, (or nurburgdale) writing in the Nürburgring-focused blog Bridge to Gantry, documents recreation of the pivital scene as posted by PistonHeads:

For the full story check my blog post here: http://goo.gl/upJ9v.

Out walking the dog and I happen across one of the most amazing scenes in Ron Howard's new movie; "Rush". Of course, I had my trusty pocket cam… don't know about you but I can't wait to see this movie. Anticipation!

More info at http://www.bridgetogantry.com

It was the last time a Formula 1 race was held at the 'Ring.  The PistonHeads link includes pictures of the production.

Mike "FossilMedic" Ward

Update:  If interested, the BBC Four documentary mentioned by Joseph Schmoe in the comments is excellent!

Topics that will be covered in 10 minute data bursts

The 2012 Agenda for the EMS State of the Science was posted.

Here are the topics the U.S. Metropolitan Municipalities EMS Medical Directors Consortium will be covering Friday and Saturday:

• Myocardial Infarction
• The Outcome of Recent Outcome Studies
• New Devices, New Protocols and New Concerns: Navigating in the "New" Times of Budgetary Constraint
• Mini-Symposium about Call Center Issues in EMS
• Mini-Symposium about EMS and Trauma Care
• Alternatives to EMS patient disposition: Handling 9-1-1 System "Loyalty Program Members"
• Evolving Considerations in Prehospital Emergency Care Practice
• The Therapeutic Edge: Challenges in Pregnancy and Asthma
• Issues in Destination Hospitals and Process Analysis
• Approaches to Termination of Resuscitation
• Safety and Risk Management Concerns in PreHospital Care
• Evolving Considerations in EMS Data Evaluation

More than 50 nuggets presented in ten minute blasts. Hundreds more contacts, conversations, and socializing. Plus, lightning rounds with the Eagles.

It is to EMS what FDIC is to fire.

Mike "FossilMedic" Ward

related posts:

• February 12, 2012:  510 Minutes that shape EMS: The Eagles Speak in Dallas
• May 13, 2008: ALS Response Times? Never Mind
• February 29, 2009: Physicians in Police Interceptors

My first Winter Carnival on the job

Brian and I joined the volunteer fire department at the same time. At 18, he was already focused on his goal to be a physician, attending classes at the local university.

To expand his portfolio, Brian was working as a part-time emergency department technician at the flagship community hospital.

I spend Christmas Eve evening as the ambulance crewmember in charge on the VFD ambulance, Brian was working at the hospital.

It was a dry and warm day, almost hitting 60 degrees. Was above freezing that night, much warmer that the night we ran the sports car crash on the parkway (story here).

Carrying people to the hospital

Advanced First Aid was the certification required to ride as the crewmember-in-charge.  Gasoline and oxygen were the two primary elements of care.

Already experienced the thrill of a 90+ mile-per-hour transport doing chest compressions in a low-top Cadillac ambulance. My shoulders were firm against the ceiling as the backboarded patient was on the stretcher. That 472 cubic inch motor was strong!

Our new Ford/Swab modular ambulance came with an advanced resuscitation tool, a Brunswick HLR 50-90 oxygen powered mechanical resuscitator. Bought a second one for the high-top Cadillac

pontiacambulance provides a video of the operation:

Our experience was that the chest compressor would "walk" even with the chest and shoulder straps tight.

When the fire company responded to assist on a cardiac arrest, they would place the patient in a "Reeves" flexible stretcher.

The plunger would be further secured with triangular bandages tied to the sides of the Reeves stretcher.

The fire company prided itself on the speed and smoothness in applying the HLR machine. It was one of the skill drills frequently performed in the station.

Telephone dispatch

Ambulance runs after 11 pm were dispatched over the "red phone." It was less disturbing than striking the station's tones, turning on the bunkroom lights and activating the volunteer pagers.

Fire companies were rarely dispatched with the ambulance. The ambulance would need to call for assistance once arriving at the scene. A little tricky, since none of the ambulances were provided a portable radio.

"Husband is gurgling in the bed"

That was the information dispatch gave me over the red phone at 4 am Christmas morning.

We were still responding to the incident when our fire company was toned out. The wife called back and used one of the few trigger phrases for an automatic fire company ambulance assist – cardiac arrest.

Many of the lights were on at the house and front door was open. She was doing CPR when we ran up the stairs with oxygen, suction, bag-mask-valve and aide bag. 

Following the HLR protocol, we got him off the bed and into a larger room.  Suctioned his airway, placed an oral airway and started two-rescuer CPR with the bag-valve mask. 

By time we were in a rhythm, I could hear the faint sounds of a wailing Federal 2QB.

I assured the wife that we were doing everything possible for him, and that another crew would be arriving soon to move her husband to the ambulance.

If we had not called dispatch, or were not standing at the ambulance, the fire company assumed CPR was in progress. 

Two of the guys pulled out the HLR machine and Reeves. The engine driver would re-position the ambulance for rapid departure, then set up the stretcher.

The performance was great. Smooth packaging and quick movement to the back of the Ford/Swab ambulance.

We were getting pulses with compression throughout the transport.

Once we got him on the hospital gurney, the physician looked into the wide and fixed pupils with an ophthalmoscope. The vessels radiating from the optic nerve showed coagulated blood, appearing as a railroad train.

The appearance of "box cars" in the back wall of the pupil were a grave prognosis. It was used as an indicator of death when ambulances delivered pre-paramedic cardiac arrest patients.

Ran into Brian, who was looking a little shell-shocked. This was the fourth or fifth patient he had to wheel to the morgue since 11 pm Christmas Eve.

<<<<<<<<<<<<<<<<   >>>>>>>>>>>>>>

We had done everything we knew in 1971.

In re-telling the story, I feel like Squad 10 Firefighter Johnny Gage after he "rescued" an electrocuted lineman in the two hour pilot of the Emergency show. 

I wonder if there would have been a different outcome if we had an AED?

Mike "FossilMedic" Ward

If you are working, may your day be boring. I hope that it is full of food, laughter & joy.

Please spend a minute thinking about our brothers and sisters in the armed forces that are deployed in hostile, desolate or dangerous environments.

Charlie LeDuff posts an update

One Year Later: Detroit's EMS System Still in Need of a Cure: MyFoxDETROIT.com

DETROIT (WJBK) – It's a story we've been covering for more than a year — FOX 2 taking a closer look at the way Detroit manages its ambulance service. What we uncovered was a deadly system on the verge of collapse.

Posted December 20, 2011

Mike "FossilMedic" Ward

Earlier posts:

July 02, 2011: “More Ambulances, More Training, Less Fear” New Detroit Fire Commissioner Donald Austin reaches out to medical community, says 22 new transport units will start arriving in January. Not writing up guys for minor uniform infractions

Yesterday's report raises questions if the ambulances have been ordered.

"… he a member of (prestigious) Rescue Squad"

This is the fifth Winter Carnival with Firegeezer. Each December 25 I post a Christmas-related story from my time "on the job." 

For 2011 I am going to share a story about two teen-aged volunteer firefighter/EMTs working their first Christmas Eve.  Brian and I started at the same time with the hometown volunteer fire and rescue department.

In thinking about the story, I remember an incident when we were both on the ambulance … and a lasting lesson.

"Respond to the GW Parkway for a Signal 9-I on fire "

The George Washington Memorial Parkway is a limited access highway build in the early 1930s that runs down the Virginia side of the Potomac River, originally designed as a "grand gateway and greenway to the Nation's Capital."

Signage is rare on a scenic greenway. In many fire department responses, the actual location of the car crash would be somewhere else on the parkway.

Our response protocol was for the fire company to head to the reported location of the crash, the ambulance would go the opposite direction.

On this winter night, the engine company arrived first. Reported a sports car overturned and on fire. Brian was driving the ambulance and took the next cut-over so we could turn around and get to the scene.

"Fire is out, police say the driver is deceased"

That was the radio report from the engine lieutenant. In that era, none of the firefighters on the engine were EMT-credentialed. Brian and I took one of the first EMT classes run at the community college earlier that year.

The lieutenant had four years at our station. Ran a lot of calls on the parkway and knew many of the Park Police officers on a first-name basis.

The first arriving police officer was a member of a prestigious rescue squad on the other side of the river. The officer used the cruiser's dry-chem to knock down the fire in the interior of the upside down convertible sports car.  The engine crew delivered a couple of blasts from the pre-connect to knock the rest of the fire down.

As we walked up to the scene, it appeared that the car drifted into a stone barrier wall, flipped over and skidded for a couple of hundred yards. The convertible top was ripped off.

There was just enough space between the car and the wall to partially open the driver's door. The driver remained belted into his seat.

Before we got to the patient, the lieutenant told us to get the body bag and lay it out on the stretcher. Fire was building up behind the dashboard. The lieutenant has his crew blast the interior one more time.

Crowing

Crowing is a high pitched sound upon inspiration. More audible than a wheeze. Usually associated with Croup or upper respiratory blockage issues or partial obstruction of the trachea.

It sounded like a baby's cry. Right after the blast from the fire hose.

That startled everyone.

We quickly removed the driver and placed him on the stretcher. In the cold air I could see that he was breathing. His face, arms and chest were black with soot and flecked with yellow dry chemical powder.

We quickly got him into the ambulance, started oxygen and a trauma assessment. He was breathing too slow and Brian started using the bag-valve-mask to breath for the patient.

He had partial thickness burns on his face and full thickness burns to the top of his hands and forearms. It looked like the tops of his hands may have been dragged along the road after the car overturned.  There was some head trauma.

I was finishing the rapid assessment when the lieutenant opened up the ambulance door and said no baby was found. He gave us a driver and we headed to the trauma center.

After this crash, I NEVER accepted as gospel some stranger's assessment of the patient. They were not dead until I assess the patient.

We did something right, here is your subpoena

Almost two years later, everyone on the incident was deposed.

The driver survived and was suing the park police, fire department, federal government (owns the parkway), designer of the brick retaining wall, manufacture of the 15 year old sports car, the shop that maintained the sports car and the Moon to recover damages from his accident.

We never went beyond the deposition phase.

Mike "FossilMedic" Ward

Right place, right time

Richard Connelly got my attention with this opening in the November 14 Houston Press:

John P. Zepeda of the Metro PD's canine squad had performed a routine bomb search at the Ensemble light-rail station October 28. Finding nothing, he tried to head back.

But train after train was filled with morning commuters headed downtown, so he and his dog waited things out. Which turned out to be a lucky thing, for as they were waiting for yet another train they heard someone yell for help.

That someone was dragging Houston Press music editor Chris Gray off the tracks, where he had fallen after suffering a heart attack.

Music Editor Chris Gray Had Luck on His Side When He Had His Heart Attack

Security camera documentation of incident:

Chris Gray Rescue Video from Village Voice Media on Vimeo.

Music Editor Chris Gray's Heart Attack: The Video

Nice work!

Update:  FireHat points out that Officer Zepeda is a retired Houston Fire Captain.

Mike "FossilMedic" Ward

Paramedic/firefighter Justin Shorr takes a headquarters gig

From his website:

On Monday I hang up my turnouts and late nights without sleep in exchange for a promotion and a reassignment downtown. That also means giving up that ever so comfortable and vacation friendly schedule.

I was bummed at first until I realized that now the HMjrs are in school and we can’t just pick up and go somewhere whenever we feel like it anymore. When this job at headquarters opened up it seemed too perfect a fit.

Monday I will take over the vacant CQI position that has been retooled ever so slightly to now officially include research. Talk about a perfect chance to mine the data to see what is really going on out there. I have lofty goals for my service, but it’s going to be a long while of playing catch up and learning the new job before I can start going forward with new ideas.

I also have a new political landscape to consider and will be in direct contact and communication with the regulatory agencies, budget writers and vendors that all have a stake in patient care in my jurisdiction.

It’s an amazing opportunity for me both professionally and personally and I am beyond excited to get started.

A Whole New World

Great job!

Mike "FossilMedic" Ward

Scenes from the Delaware County Ohio Zombie drill

Delaware County Office of Homeland Security and Emergency Management zombie outbreak exercise.

Delaware Gazette video by Andrew Tobias.

Bored and Hungry

Dave Tobias, a Delaware Gazette reporter, was imbedded with the zombie horde and provided a first person account of the event.

They were also a lit­tle bored. Emer­gency per­son­nel, run­ning the event fea­tur­ing roughly 200 zom­bie vol­un­teers, had been stag­ing for nearly half an hour.

Besides an occa­sional reminder, deliv­ered through a bull­horn, for infected indi­vid­u­als to remain inside the Selby Field fence, the zom­bies received lit­tle com­mu­ni­ca­tion from emer­gency per­son­nel.

Fire­fight­ers and para­medics were them­selves busy strate­giz­ing over what mys­te­ri­ous chem­i­cal agent had afflicted the zom­bies, and how to best address it.

Emer­gency per­son­nel, which included 10 area fire depart­ments, Delaware County EMS, Delaware Police Depart­ment and the Delaware County Sheriff’s Office, began accept­ing large quan­ti­ties of zom­bies for decon­t­a­m­i­na­tion 40 min­utes after they arrived on scene.

click on headline for entire story: Zombie-themed County EMA exercise draws more than 200 volunteers

I remember when the Level A chemical suits came out, the incident went from quick to campaign.

Wonder if there is a way to reduce the waiting-around time for role players.

Mike "FossilMedic" Ward