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

Delaware County Emergency Management Agency wants you to die this Halloween.

Ok, not really.

But we would like you to come out and play one of the 250 "living dead" that we need for our Zombie Hazardous Materials Exercise.

There will be a contest for Best Make-Up, Best Costume, and even Best Zombie Walk.

This is your opportunity to help our first responders be prepared.

Being a Zombie this halloween may save a life in the future.

Delaware County, Ohio Zombie recruitment page

Creative approach to a mass casualty staffing issue

Kantele Franko files this report for the Associated Press:

Emergency responders will test their capabilities as they use standard decontamination procedures to “treat” the zombies and make them “human” again during the exercise at Ohio Wesleyan University.

“People got zombie fever here in Delaware,” said Jesse Carter, a spokesman for the local health district.

The exercise and dozens more outreach efforts across the country were inspired by an online post from the CDC.

It attempted to spice up the usual emergency preparedness advice — have a plan, make an emergency kit with water and food, and so on — by tapping into the cultural popularity of the zombie theme.

The May blog posting got 30,000 hits in one day, and it continues to draw thousands of visitors daily, said Maggie Smith of the CDC’s public health preparedness office.

Ohio and Kansas hold mock zombie outbreaks

Selby Stadium event as explained by Delaware County EMA

This will be a “Zombie Exercise” happening on Halloween. The victims once exposed to a chemical will be turned into a zombie. Zombies will have to go through decontamination to be turned back to normal.

We will be testing our first responders with approximately 250 Zombie Victims versus the 20-25 volunteers that assist for normal hazardous materials exercises.

To add to the fun (and the reality), if a First Responder comes in contact with the spilled chemical or a zombie while not wearing proper Personal Protective Equipment, they too will be turned into a zombie and will have to go through decontamination.

This exercise will run from 1:00 PM until 3:00 PM and we plan to have everything wrapped up by 4:00 PM.

Click HERE to see the CDC Zombie Preparedness guidelines.

Mike "FossilMedic" Ward

Stroke patient dies two days after a change in county EMS dispatch policy

A follow-up to this STATter911 post:

Marco Island Fire Rescue ambulance delay report says hospital, FD & other agencies failed to meet community expectations. Chief says citizens deserve answers.

Earlier today, Naples Community Healthcare (NCH) abandons its troubled ambulance service.:

WBBH-TV NBC2 provide the follow-up here: NCH ends ambulance service after patient's death.

NBC2 provides the background for this bad-outcome event:

The NBC2 Investigators first reported a billing battle between Naples Community Health and Collier County Emergency Medical Service in September.

NCH owes Collier County more than $175,000 for EMS ambulance transfers between its facilities.

Collier County Manager Leo Ochs told NCH officials by letter that inter-facility transfers would no longer be performed by Collier County EMS, effective October 1.

On October 3, 80-year-old Marco Island resident Paul Anderson died in the hospital after complications from a stroke. Family members tell NBC2 doctors were unable to operate on Anderson because it took too long for him to get to the hospital.

NBC2 Investigators: Patient dies after ambulance delay.

Please read the first part of the 65 page report provided by Marco Island, Florida, Chief Michael Murphy. You may share my rising tide of anger at a complex system that seemed to conspire to deny a prompt ambulance transfer.

Report HERE via STATter911

No pay = no more transports

The October 1 policy change by Collier County EMS was due to the unwillingness of NCH to pay Collier County for earlier transports. 

Not clear if this means NCH is paying it's overdue ambulance bill.

I predict that all of the players that impeded the dispatch of an ambulance or medivac helicopter will  end up spending ten times the amount of the unpaid transport fees for legal representation and settlement.

Mike "FossilMedic" Ward

My Time and My Dime

I go to a lot of professional meetings, conferences, expositions and trade shows. More than one a month.  It is how much of my work gets done.

Because of other obligations I can only sit through one or two presentations per show.

Not this time …

The inaugural Go>Forward training event is October 21 to 23 at the Ameristar Casino Resort in St. Charles, Missouri. 

Tiger Schmittendorf assembled a great mix of hands-on and face-to-face presentations that will provide skills, concepts and ideas that will help you do your best.

Fire AND EMS

Unique to the Gateway Midwest event is the inclusion of a JEMS seminar during the same weekend.  I was able to add access to that conference for just $50 more.

These are some of the best EMS presenters, who are usually over-booked when they are working at the national EMS conferences.

The social and interactive structure of a Go>Forward event means that I should be able to fully enjoy the presentation AND have an opportunity to chat.

Mike's Schedule

Friday October 21:

The Mental Management of Emergencies: Improving Decision Making Under Stress

This all-day preconference by Dr. Richard Gasaway combines his doctorial research, along with his three decades of street experience, to provide powerful information on how to make better decisions under stress.

Saturday October 22

The morning is EMS-centric:

Keith Wesley, MD, presents Becoming an EMS Professional. Changes in provider and physician roles within EMS require reconsideration of what "professional" means.

A. J. Heightman discusses MCI Management. Besides being the Editor-In-Chief of JEMS magazine, Heightman obsesses about multiple casualty incident management and, through his "day-job," has collected the best examples and stories covering this topic.

David Page presents Cases With A Twist. One of the hardest working EMS educators, co-creator of FISDAP, Page is a driving force within research and advocacy for EMS.

The afternoon has smoke and fire showing

Chris Naum teaches Tactical Ops and the New Rules of Combat Fire Engagement. Naum has been posting some of the best articles on tactical operations, building construction and related history on his blogs Command Safety, BuildingsonFire, and TheCompanyOfficer. I am giddy at the opportunity to sit for one of his meticulously researched presentations.

Chief Steve Przibrowski presents From Silver to Gold – Company Officer to Chief Officer. Covering the issues when going " … from us to them."

Sunday, October 23

A. J. Heightman looks into his crystal ball to see where EMS is going with his presentation Challenging Your Clinical Boundaries.

John Shafer joins Chris Naum in Reading the Building; Predictive Occupancy Profiling

The noon keynote is from Jason Ferris It is not a mission statement … Its a calling.

John Shafer presents a topic he is passionate about, Green Building Construction for the Fire Service. He is one of the newer fireems bloggers, check out Green Maltese.

I wrap up my schedule with Jason Ferris's presentation: Part of the Gang: Indoctrination without Hazing,

Pretty sure I will leave this conference with dozens of ideas, concepts and practicies.

Will I see you there?

Mike "FossilMedic" Ward

go to http://goforwardtraining.com/gateway/ for more information.

Put ffw10 in the promotion code for a discounted registration.

What happens in Vegas … shows up on Facebook.

After catching a 6 am flight … to Boston … arrived at Vegas around noon. Near the Hilton Convention Center I passed a burly man.  He still may wonder who was that fossil in a Cadillac shouting "nice kilt!"

Thursday's goal was to work the convention center floor and connect with some folks.

One way to celebrate your 10th year in ems

Jess Phillips, from Iowa, got a tatoo. 

I found the image striking and appreciate her permission to photograph and post her picture.

Blue light specials

Cygnus co-located fire and law enforcement with EMS World Expo with a shared exhibit hall. Heard more than once the exclaimation "this is so cool."

What was cool for me was checking out the next generation of police cruisers, Dodge, Ford and Chevrolet had fully equipped examples of their sedan and SUV packages.

Still regret not buying that red Caprice PC3 that was momentarily on sale at Chriswell Chevrolet this summer. No satellite radio and 13 mpg city … maybe get a pre-owned 2009 Pontiac G8 GXP.

Zoll, CPR and social media

Was impressed with the Zoll E series CPR Dashboard that provides read-time graphical feedback on the chest compressions. 

The impact of technology and research has changed the ems workplace. Steve Berry shared a story about an IO misadventure that is hilarious … but you have to wait for the "cartoon."

Running outta steam … need to tell you about the Cult of Kilts … not sure if it is related to EMS 2.0 … there are guns involved … and giggly girls staring at great legs …

Mike "FossilMedic" Ward