But I've gone and moved over to http://www.lifeunderthelights.com/

Come check it out! It's so cool!

So I've finally joined the final frontier or something like that. After much prodding, teasing, cajoling, and downright coersion, Ckemtp has joined Facebook and Twitter.

I'm Ckemtp on facebook and, coincidentally, @Ckemtp on Twitter (I think).

At any rate, Gkemtp(it) is managing all this stuff and she assures me that the transition will be painless as I tweet and faceypage or something.

Sometime today the new site's supposed to be up. http://www.lifeunderthelights.com/ if you click this link and it doesn't ask you for a username and password, it's up. Supposed to be sometime today!

Ouch.

Today I begin what I am sure to be a long, arduous process of atoning for my every IV sin. Out of the tens of thousands of patients I’ve treated, I’ve gained intraveinous access thousands of times. Probably I’ve missed a thousand or two more times than I’ve stuck and now it’s time that I pay.

If you’ve been reading my blog for much time, you probably know why. My wife, who is now Gkemtp(it), completed bloodbath class in paramedic school today. She’s now “signed off” to perform IV sticks and is willing, nay, eager, to practice on any willing, or in my case reluctant, warm body who gets in her way. As her husband who she has seen performing IV access skills on countless patients, I am seen as the perfect pincushion practice patient.

When coaching students new in the arts and sciences of darting blood vessels and sliding straws into them I usually say something like: “Don’t be afraid to hurt the patient. Don’t pull away if they whimper. It’s going to hurt, just stick them anyway.” I tell them this because every needle hurts a patient to a varying degree. While I don’t feel needle pricks for intramuscular injections in the deltoid muscle, I think that IVs are rather “ouchy”. When you’ve got to stick a patient, it’s going to hurt them. You’ve got to go in and get it done, don’t be tentative, don’t dilly dally around. Go in for the kill and stick it in there quick. If you’re slow, or you’re trying to be “gentle” you’re actually hurting them more so than you would be if you just were quick and to the point. “Jab that needle in there”, I say.

Of course, sometimes I miss IVs. Sometimes I’m just on a cold streak and I can’t hit a vein to save my life… or the patient’s for that matter. During those periods I feel sorry for my patients, but if they need a line they need a line. Luckily those time periods don’t last as long as they used to after a decade or so, and I promptly return to my usual standards of mediocrity.

And now that Gkemtp(it) is signed off by her paramedic instructors to perform IV sticks, she needs practice dummies. As her husband it’s my duty to pony up my vascular access points and commence the bleedin’.

Owch, ouch, and owwie!

Even though Gina hasn’t technically missed an IV attempt on me yet she has started a few of them on me. It’s not the first time I’ve offered up my tender vascular system for the education of others, and it probably won’t be the last… because there’s four other people from one of my agencies in paramedic school, and three from the other. Every darn one of them is a maniac waiting with a needle ready to pierce me. They ask a lot. They beg, they plead… and in the case of Gkemtp(it) they demand.

Really, I’m freaking afraid to go to sleep at night only to wake up and find myself riddled with holes and in fluid overload!

So, if you’ve ever been my patient when I’ve been having a bad IV streak… I’m sorry. Look, I said I was sorry and now I’m atoning for it.

Gk!? What do you have in your hand!? No!!!!11!!

This is a light week for me, or at least a 7 day period. Yesterday I worked a 12, today a 24, tomorrow a 12, the next day a 24. Then I have a day off, then a 24 then a 12. So by my count, since Saturday and until Friday I'll have worked 108 hours.

Not bad for a guy that's prepping http://www.lifeunderthelights.com/ for some adoring fans... Ok, casual readers but I still couldn't do it withoutcha.

Here are two reasons that I may not have the new site done by the "go live" date (hopefully early this next week)

http://www.peppersprayme.com/ - The language gets a little salty sometimes, but this site is SFW. It's a "big city cop" who writes very well. This is a great blog. I sat down in between calls and read this through to the end. Great stuff and a great blog.

http://secondcitycop.blogspot.com/ - This is an unofficial, under-the-radar, blog written by some people who are probably officers in the Chicago Police Department. Wow is this great stuff. It's currently up on my browser and I'm trying to get work done in between posts.

Check those out. I'll update y'all more on the new site. Please come along with me.

It’s a nice machine. It handles the huge loads that we generate on a daily and nightly basis. It cleans the stuff pretty well and runs pretty quickly and quietly.




Now get out there and water down your soap. You might just save a life.

I would get a post up about EMS Ethics and patient advocacy involving a scenario for y'all...

I would get more done on my new upcoming site that's going live (probably) early next week: http://www.lifeunderthelights.com/

I would write a response to an article that I just read in EMS Magazine

I would.... dang, there's another one

So you’re a licensed paramedic, right?

Hypothetically speaking, you were checking in your truck today and came to the part where you check your drug bag. Now, if you’re like me you look at 5 or 6 different medications every time and check to see if you still know how to use them by pulling the indications for use, dosages, side effects, and contraindications out of the dark recesses of your brain to see if you still know what you’re supposed to know. Hopefully you still know them, but it’s always still good to review to keep your knowledge current. Pharmacology changes a lot as new knowledge is discovered and it takes quite a bit to keep up with it. Hopefully you’re doing this with all of your medical knowledge, because it is constantly changing and what was “the right thing to do” for your patients yesterday may have been found to be ineffective, or actually harmful, by today.

We all know that, right?

So, what’s with your protocols?

Today one of the meds that I reviewed was our good friend Narcan, or Naloxone for those of you who don’t call it Narcan. For non-medical readers, it is a drug that blocks the effects of opiates (from opium), like Morphine or Heroin. From reading the literature available on Narcan, I know that, like every medication, it has a number of side effects, some of which can be fatal or can cause lasting ill effects if not properly managed.

Here’s the information on the medication from www.rxlist.com - http://www.rxlist.com/narcan-drug.htm (block quotes are from that site)

I read more than one source on anything I look up, but I really like the information presented here. First off, it gives the dosage range of the medication as:

“Opioid Overdose-Known or Suspected: An initial dose of 0.4 mg to 2 mg of NARCAN may be administered intravenously. If the desired degree of counteraction and improvement in respiratory functions are not obtained, it may be repeated at two- to three-minute intervals. If no response is observed after 10 mg of NARCAN have been administered, the diagnosis of opioid-induced or partial opioid-induced toxicity should be questioned. Intramuscular or subcutaneous administration may be necessary if the intravenous route is not available.”

Fair enough. In EMS terms this means that if we find someone that we suspect to be suffering from an overdose of narcotics that is unresponsive and experiencing respiratory depression, then we can give Narcan at a dose varying between 0.4mg (400mcg) to 2mg until reversal of the opiate overdose is achieved, or more desirably, the patient’s respiratory drive is restored and they can protect their own airway and breathing. From what I’ve read and been taught, Narcan should be administered in 0.4mg increments and titrated just so it restores respiratory drive and protection. Higher dosages or faster rates of administration can lead to a host of harmful and sometimes fatal side-effects which, although rare, are not something you really want to be dealing with. These are:

(Adverse events associated with the postoperative use of NARCAN are listed by organ system and in decreasing order of frequency as follows:)

Cardiac Disorders: pulmonary edema, cardiac arrest or failure, tachycardia, ventricular fibrillation, and ventricular tachycardia. Death, coma, and encephalopathy have been reported as sequelae of these events.

Gastrointestinal Disorders: vomiting, nausea

Nervous System Disorders: convulsions, paresthesia, grand mal convulsion

Psychiatric Disorders: agitation, hallucination, tremulousness

Respiratory Thoracic and Mediastinal Disorders: dyspnea, respiratory depression, hypoxia

Skin and Subcutaneous Tissue Disorders: nonspecific injection site reactions, sweating

Vascular Disorders: hypertension, hypotension, hot flushes or flushing.

In addition to all of the above, complete antagonism of opiates in dependent individuals can result in acute withdrawal symptoms, which if you’ve ever caused them, result in a violent, tachycardic patient who is very hard to manage.

This can be avoided by judicious use of Narcan, and slow administration of the medication in 0.4mg increments titrated to effect.

So why then do a lot of EMS protocols state that you should administer it in a 2mg IV push? Mine do.

I understand and support having Physician medical direction in EMS. Our educational standards, and lack thereof, mandate that we have doctors directing our medical practice. They have the highest education and we don’t. We need them to tell us what to do and how to do it.

However, what happens when you have a physician medical director who doesn’t update your protocols in response to newly discovered knowledge or currently accepted practice? What if your medical direction just isn’t up to date and mandates procedures that have been ruled ineffective or harmful? What if they’re too hands off and it seems like they just don’t care about whatever it is you’re actually doing out there in the field?

If you were to follow the protocols to the letter and administer 2mg Narcan IV push on a simple narcotic overdose with unresponsiveness, most of the time nothing would happen other than for the reversal of the narcotic. However, some of the time you would be harming your patient by following the rules.

In a case like this, where easily available literature exists that differs from your medical direction, is it ethically responsible for you to diverge from your standing medical orders and change your practice to the safer and more effective route even though you’d clearly be breaking the rules?

I’m not advocating breaking the rules, and I’m not saying that you should disregard your protocols. You would get in trouble, and the doctor wrote those orders for a reason that you may not understand. What I do advocate, however, is that you take an active role in your protocols and assist in advancing them and making sure they’re up to date with the latest, safest, and most effective practices. You can bet that the physician is doing the same thing with their own practice (I hope) and I see no reason why paramedics shouldn’t do the same. EMS 2.0 is going to need paramedics who educate themselves and advocate for the best treatment modalities available for their patients. We can all start by reviewing our own practice and working within the system to change things for the better.

--------------------------

Ok, now back to working on the new blog. Wordpress is driving me nuts! Help!

I just came across this: http://www.dangerouslaboratories.org/radscout.html

It's the story of a 15yo Boy Scout who tried to build a nuclear fusion reactor in his mother's shed. He didn't succeed in creating sustained cold fusion, but he did create enough fissile and radioactive material that the EPA had to come in and activate the National Radiological Emergency Plan.

He contaminated more than a city block with radiation and radioactive particles.

Favorite line from the story: "David earned a merit badge in Atomic Energy in May 1991, five months shy of his 15th birthday. By now, though, he had grander ambitions."

http://blogs.discovermagazine.com/badastronomy/2009/09/14/lcross-impact-site-picked/

Holy crap, they're going to bomb the moon. Oh man, do I wish that I could get to do things like that. Instead, I get poo'd on by people... but that's the life of the medic.

All things are rockin' for the big move to http://www.lifeunderthelights.com/ - I can't wait. It's not up yet, but all things look like they're gonna be a go for go time.

I'm working feverishly on the new site, but I think that I'm going to get a good post up tomorrow.

Sorry I've been so quiet over the last couple of days, but I've had my hands full with the upcoming move. As a handful of other EMS and Fire Bloggers, including my buddies Happy and Medic999, we've joined in on a new blog network.

I'll be getting a ton of new features, easier content navigation, and a lot of cool new toys to play with. My site will be up at http://lifeunderthelights.com/

And I can't wait!

Oh, and one more public thing: AAAAAAAAAAaaaaaaaaaargh!! WOORRRRRDD PREEESSSSSSS!!!

(sigh) learning a new blogging platform is hard.

I got my butt kicked on shift last night. Back to back calls from 2pm to 2:30am. Nothing really exciting, two STEMIs though. I got to brush up on my 12-lead skills and one of them was at an honest-to-goodness chocolate factory. Ever had those little chocolate mints that have a strip of mint sandwiched between two slabs of chocolate? They’re small enough to put in candy dishes, and restaurants give them out with the check sometimes. They’re in a green foil wrapper?

Well I went to the factory that makes those things.

It smelled minty.

Today I snuck in a nap when I got home. Gkemtp(it) took a study break and got a nap too. We woke up to the pager going off and Dispatcher Amy telling us about a bulldozer roll-over. We headed down to the station but didn’t make a truck. It’s ok. Apparently the guy wasn’t hurt much and it was really muddy because it’s raining today. The guys that came back were just covered with mud. Heh.

Like any good volunteer department, the guys (and gals) who responded to the station but didn’t make it to the scene sat around drinking coffee and swapping stories. Man I work with some funny people. We got on the subject of horrible, horrible, trauma. It was probably because we had a handful of probies and a few rookies there and we enjoyed watching their faces. One of the other medics told an awesome story about “toothpaste” phenomenon with a fatality, involving a tow-truck driver throwing an eye like a baseball. I told a story about putting my knee in some guy’s brain. (It was in the center of the seats in a car that I was crawling into at 3am, give me a break. Look, I said I was sorry)

Laughed myself silly, I did. I am a horrible person.

Today I’m working on my upcoming GREAT BIG NEWS!! Yes, there is something wholly awesome coming up. Stay Tuned. I don’t want to give it away… but this is the coolest thing to happen to me today.

Howdy everyone!

There's something on the wind here these days at Life Under the Lights. Change is coming. Something big. Something Wild. Heck, Something Huge!

And I need your help!

While I can intubate two patients with my toes while performing a pericardiocentesis with one hand tied behind my back and decompressing a chest with my teeth, I just haven't seemed to learn anything about graphic design.

Photoshop just ain't my thing. I fix people, not pictures.

So I'm asking you all if you would lend me some mutual aid. An ALS Photoshop intercept if you will. I need a new logo for an upcoming project with the blog. I'd like it to be something involving EMS that fits into the theme of Life Under the Lights (of an ambulance and a fire truck). A star of life, and something fire would be cool too. (Oh, and something involving rural EMS too... hmmm)

THE ONE I CHOOSE WILL GET A SURPRISE GIFT AT AN UNDISCLOSED TIME! Heck, I'll even put up all submissions and give credit to anyone who submits their ideas.

Questions, comments, and submissions go to my e-mail: ProEMS1@yahoo.com

Thanks!

http://www.emsresponder.com/print/EMS-Magazine/EMS-Dirty-Secret/1$7057

Thom Dick is my hero.

If you've never read the above article that he got published in EMS Magazine, you really should. I read it once. Then I started a blog. My picture is in this piece. I'm the red head, under the lights.

It looks like I touched a very obvious nerve with my last post on frequent fliers: Someone Failed… Is it the System? – Everyday EMS Ethics – Every EMS person, and almost every healthcare provider is faced with the problem of the frequent flier… someone who, for whatever reason, consumes more time, energy, and resources than does almost any other part of the population.

I got three great mentions from the post.
- Happy medic chimed in with his view: “EMS Fail or Client Fail”

- Medic999 answered both of us with his view from the UK side of things: “The Frequent Customer”

- And a nurse blogger that I hadn’t found yet gave me a mention as well: “The 80-20 rule and Emergency Health Care”

Before the call that I wrote about on that very shift a landscaper who was working on the lawn near our fuel pumps came over and struck up a conversation while I was filling up the truck. Nice guy, he was. We talked about the community’s ambulance service and I filled him in on some things that I want the public to know about us, and about EMS in general. He was pretty intrigued and stated that he had no idea that our calls ran into the thousands from just that small town. He had no idea that our pay was so low, or that the town paid us such a pittance in tax money. As for the call volume, he asked:

“But aren’t a lot of those calls from people who don’t need an ambulance and are just wasting your time?”

Nope. Only new paramedics fall into the trap of judging their patients. I don’t like to judge, although I’m human too, but it’s my job to take care of people. I’ve given my whole career to taking care of my fellow man on their terms, not mine. I want to help people and it’s why I’ve gotten up every morning for the last ten or so years. I just wish that I had the tools to really help them, to do something other than just haul them off to the ER. I wish I had more professional authority to do something different… maybe even to show them some tough love to break their cycle of sucking at the teat of society.

Again, call me naive.

Honestly, since I wrote that post I’ve been extremely busy and haven’t had the time to put the requisite effort into writing something to equal the caliber of my blogger buddy’s collective answers. However, this gives me an opportunity to trot something out that I wrote a few months back. I think that it’s an answer to the frequent flier problem. I don’t think that it will ever be truly “solved” unless everyone suddenly decides that they are the masters of their own existence and takes full responsibility for their own lives, but then again, in that case EMS wouldn’t be much fun anymore.

Here’s the link to that post: “The Current US Economy and EMS – An In-Depth look at how this mess will affect 911 in your community” With all of the new readers I’ve been getting, I’d like to see if I can get more input on this one. Enjoy.

A tempestuous night is blowing outside the station walls. The cold night air is stirred wildly, blowing splatterings of rain against the glass window of my bedroom. The wind howls through the trees conjuring up fantastic images of the disturbed environs of the world outside my bunk room. Having gone to bed early, I cannot remember the dreams I must have been having but judging from the fact that my sheets were in such disarray when I awoke, they must have not been pleasant.

I awoke to a familiar but unwelcome voice, the night shift dispatcher coming from my radio. He spoke of a seizure in the next town over. The local ambulance service from that jurisdiction was calling for a paramedic to intercept and assist them with their call. I was due, it was my turn to be ripped from the warmth of my bed and respond to their aid.

I pulled on my clothes and zipped up my shoes. Since whomever controls the seasons in my area has decided to outright skip Fall and move straight to Winter I pulled on a jacket as well. Stepping out into the night air I halfway expected there to be a late September frost on the ground. As I started my truck and keyed the address into my GPS I cranked up the heat to stop my shivering. Hopefully this wouldn’t be too challenging for me in my sleep deprived, freshly woken up state. Hopefully I can wake up enough to safely drive. I shook my head violently to clear the sleep from my bleary eyes and keyed up the mic:

“Dispatch, Medic 84 is enroute to intercept Anytown”

The night shift dispatcher answered me and I switched to Anytown’s frequency:

“Anytown, Medic 84 is enroute to your scene”

With the red lights flashing over my SUV I pointed out into the deserted city streets. Anytown was about ten miles away from my station over country roads. The address was a few miles into their city limits. Curiously, the address they called me to was just a few short minutes from Anytown Hospital and it was strange that the EMT-Intermediate volunteer service had called me to an address where they would usually just scoop and run ILS to the ER. I figured that this must be one of those “Seizures” where the patient seized because of the fact that their heart stopped. People will oftentimes have a seizure when their heart does something funky, like stop, and blood flow is slowed or stopped to their brain. An old paramedic instructor I had once put it this way “Brains need blood flow to be happy, stop the blood even for a second, and the brain gets pissed off”. Everything seemed to get pissed off to that guy. An MI causing arrythmia was a “Pissed off heart”. Diabetes was a pissed off pancreas. A drunk at the bar was pissed off at his liver and so forth.

I wondered what this patient had that was pissed off for her.

The roads were open but the night was pitch black. The wind was blowing my small SUV in all directions but straight. Thinking that this was probably a bad call, I pushed the gas as hard as I felt was prudent with the driving conditions. I didn’t meet any traffic to get in my way. Just as I was coming into their town, a familiar voice crackled over Anytown EMS’s frequency:

“Medic 84. We still need you to respond but you can slow it down to non-emergent. We’re short an “I” and it’s going to be you”.

Ohhhh, so they couldn’t staff the truck fully and responded using me to make their full crew. Now I understood. Anytown EMS is a good service with dedicated people, but sometimes even the best volunteer service needs a hand. That’s what mutual aid is for. We have an arrangement with them in such circumstances so that our intercepting paramedic can make up a full crew for them by partnering with one of their EMTs.

I turned off the lights and just cruised silently through their deserted town. Yes, I popped the lights on momentarily to get through a couple of stop lights, but who’s counting, right? Arriving on their scene the EMT came out to me and said:

“You don’t need to bring anything. This is her third ambulance ride in 24 hours. She spilled a glass of water and (a family member) called because she thought she was “having a seizure” and needed to go back to the hospital”

Oh, now I remember this address. I don’t even work for this town and I’ve been here like umpteen times this year. The patient is one of their frequent fliers. Every community has them. I swear, without our frequent fliers we’d be short like a thousand annual calls. Think of the sleep time I could get.

Climbing up into the ambulance, I met the patient for the umpteenth time this year. She was in no distress and this is where her part in the story ends. My question isn’t about her. Honestly, the question here could be about any frequent flier in any community that has an ambulance response.

Why do we have them? Why do they depend on us so much?

The patient in this example had been to the ER twice already in the previous twenty four hour period, both times being transported by EMS and both times being taken home in a private car by family. Both previous times she had called her General Practitioner physician and had been referred to the ER because she said the word “seizure”. I can hardly blame the GP for recommending she call 911 rather than phone triaging her and suggesting she come into the office. But remember, it’s not about her. I can think of probably ten patients right now that I would consider to be among my personal roster of repetitive patients (I only have ten fingers) and their use of the emergency healthcare system for management of their chronic complaints is staggering in comparison to the use of it by the general population. Last year, every shift for two months we would respond to the same gentleman’s house to wake him up by popping in an IV line and giving him some D-50. We got pretty tired of it, as you can imagine. Most people with diabetes manage their illness pretty well and only occasionally need the assistance of an ambulance crew. This guy chose to manage it by drinking hard alcohol. I swear that I wanted to just leave the IV in place so that I wouldn’t have to start one the next day.
We fixed it by refusing to treat him on scene and release him anymore. It is common practice in my area to “sweeten up” a comatose diabetic with low blood sugar by popping in an IV and giving IV sugar (D-50), or in milder cases, by giving them high-sugar foods and making them eat until they regain full mental faculties. Once they regain their senses, all but a few of these patients sign a refusal of treatment form and do not wish transport to the ER. However, for this patient, we would find him unresponsive, so we would pack him up, move him into the ambulance, start the line and sugar him up while enroute to the ER. Once we were transporting, he couldn’t refuse to go and would end up at the ER for hours. Finally, he started managing his diabetes better because it was more convenient than waiting at the busy, urban ER we would take him to (yes, it was the closest. I work in many different jurisdictions).

However, the above solution just passed our problem we were having with the ambulance response onto the already overburdened Emergency Room. Yes, it “solved” the problem by increasing the patient’s level of personal inconvenience (although we still go to this guy about once or twice a month), but at what cost?
Who or what is causing the failure for these people? Who or what is causing the failure for this whole patient population? Is it the system that fails to adequately educate them on how to properly care for themselves or cure their ailment? Or is it the patient who is unwilling, or incapable of caring for themselves?

For both of the above named patients, socialized medicine already exists for them. They’re wards of the state as far as healthcare is concerned. One of them owns a house, one of them is in a free, government subsidized apartment, one is in one state, the other is in another. You and I pay for their healthcare and almost their every need.

Is this the system’s fault? Is it their fault? Who should pay for the failure?

I’m writing this after coming back into my bunkroom and finding my sheets and blankets twisted into a ball. Everyone else in the house is snoring because of the abrupt weather change. (and DDex, if you read this YOU FREAKING SNORE WORSE THAN NACHO!) Whatever dreams I was having before this call came out must have been strange.

Until the next…

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Update:

My blogger buddies Happy Medic and Medic999 took off from this post and wrote their point of view on their respective blogs. Here they are. Join the discussion.

Ok, so the first post was pretty reactionary.

I'm right about the medical aspect of the show though. I don't know who your paramedic technical consultant is... but me thinks if he was really good at what he did there would be NO WAY that you would make such eggregious mistakes ON THE PREMIER EPISODE!

If you don't have a paramedic on this show, and a REALLY GOOD ONE. You're going to lose your EMS audience. Really.

And... after watching the show... I don't want it to fail.

So guys! Take my advice! Really, don't mess up on the medical stuff. Don't portray paramedics as drama queens, and don't make it all about the interpersonal drama. Show some mundane stuff. Don't make it like Third Watch was in the end, or ruin it by making it all about the overly dramatic personal lives of the characters.

Ok, I'm ranting. I'll stop until I can make a coherent post.

Um... dang it.

Hows come EVERY media representation of EMS shows us as either incompetent idiots, or complete asses?

I don't know why I thought that this show would be any different.

Really? "He was in the Iraq war. He's on anti-anxiety meds. Let's give this guy WHO WE'VE BEEN GIVING EPI TO and DEFIBBING WITHOUT AN ANTIARRYTHMIC (who's in asystole, btw) ATROPINE... WHICH WILL MAKE HIS EKG look like a triangle and GET A PULSE BACK!!!!111!"

Oh, did I mention I'm watching this surrounded by a room full of paramedics and EMTs??

They just lost us all.

Ooooo!! The helicopter blew up!!!

Maybe.... I'm still watching

Today the Boy was playing with one of the junk mail “newspapers” that we get involuntarily delivered to our home when I thought of a way to actually make it useful. I tore off a long, narrow piece of it and made him a Bernoulli strip to play with. For those of you who don’t know, a “Bernoulli Strip” is a long, narrow piece of paper that you hold just below your bottom lip and use your mouth to blow straight out. The strip then floats up and lays perpendicular from your mouth in response to the faster moving stream of air above the strip.

It works because of the “Bernoulli Principle” which was devised by the 18th century physician and physicist Daniel Bernoulli and published in his text, “Hydrodynamica”. It states that with velocity of an inviscid flow, as velocity increases, pressure decreases. So, the Bernoulli strip shows that as you blow outward and increase the velocity of the air above the strip, the static air below the strip of paper is of higher pressure and pushes the strip upward towards the faster, lower pressure airflow.

Bernoulli’s principle of fluid dynamics also made possible a method for physicians to measure the blood pressure of patients by sticking a glass tube directly into an artery and measuring how high the blood rose inside the tube. This method was the preferred method of measuring blood pressure for 170 years!

In this simple experiment, where he found out, basically that higher velocity fluid was of lower pressure than lower velocity or static fluid, he ended up changing the freaking world. Why? Because airplanes fly because of the Bernoulli principle. Wings, or “Airfoils” are shaped according to Bernoulli’s principle, with a longer humped surface area on the top and a straight edge on the bottom.

(Yes, there is the Radial Velocity theorem and the whole battle between Newtonian flight that is raging in the physics community. I’m not smart enough to get into it. They both seem plausible to me.)

So why, you ask, am I putting the above on THIS BLOG, where I usually write about kneeling in poo?

Think about this: Bernoulli published “Hydrodynamica” in 1738. Powered flight became possible by the Wright Brothers in 1903. Yes, a lot of others contributed… but the basic principle that made it all possible had been around for 165 years.

What if Daniel Bernoulli had had a blog?

I imagine that the post would have detailed the experiment that he conducted. His twitter feed would have said “Whoa! Check out the experiment I just did. I made a piece of paper float… It’s on my blog”. His readers and peers would have read it, commented on it, linked to it, and participated in the discussion. The wider community would have devoted a lot of brain power to it. My guess is that flight would have been made possible inside of 6 months.

Ok, maybe that’s a stretch… but you see what I mean. The community participation, shared brain power, the collective engagement of an interested wider audience: That’s the power of this medium. With each post by every blogger, we invite you to participate. We all think of comments as gold. I do. I love when I spark a conversation on my blog and I like participating in the ideas brought forth by my fellow bloggers and commenters. Each idea, like Bernoulli’s simple strip of paper, has the power to change the world.

EMS is an industry sorely neglected by the people actively practicing it. Our profession has been controlled by outside influences and groups for too long. There’s a lot of players trying to dictate the profession, and most of them have an interest in keeping our educational standards low and our pay dismal.

But that time is coming to an end. You have the power, right here in your keyboard, to change everything. I don’t want to sound pretentious or even naive, and maybe I am… but I look at the EMS blogosphere as the end of the status quo in EMS. The times they are a changing, and I have an important role to play in it just because I say that I do. You have just as much of a role as I do because you’re here reading this. Reading articles in a magazine transmits information to you, and that’s important. However, reading blogs transmits information to you and invites you to transmit information back to them. The next reader intakes both opinions, and calculates their own response. Bad ideas are found out, good ideas round out and float to the top of the collective consciousness. Everything can be analyzed, absorbed, participated in, and reworked rapidly. Ideas are shared immediately.

Change happens. A single EMS professional, or even a group of them, often feels powerless to make changes they feel are positive. EMS politics keep a great many good ideas and new ways of improving care down for various reasons. Most of those politics are swept under the rug and kept from the light of day. Just like in Chicago, corruption only exists in the dark. While I’m not calling day-to-day EMS politics “corruption” per se, shining the light of scrutiny on both of them tend to bring positive change.

Welcome to the EMS blogosphere. It is the single most powerful force for positive change in the profession I’ve ever seen. We are the future. The bloggers, the readers, and anyone whose ever punched “EMS” into a search engine are poised to usher in the change in the industry we’ve all been yearning for.

Here’s the call to action: Bring a friend. The more eyeballs we have reading the ideas put forth in the EMS blogosphere, the more participants we’ll have in the marketplace of ideas. Together, we’re strong and are growing stronger with every post, comment, and thought put forth about our profession. We’ll change everything… but we need you to do it.

“Bring a friend to the Blogoshere” I like the sound of that.

Lumo from My Life in A&E is a girl.

A crack team of researchers working around the clock has determined that Lumo is indeed a female (and we're told that she's an aesthetically pleasing one, as well) and that all rumors, or comments describing her Handover contributions that refer to her in the masculine are false.

Sorry Lumo...

First of all, THANK YOU EVERYONE for making yesterday my biggest blogging day ever. My version of The Handover Blog Carnival (see below) has so far generated over 1000 unique visitors and over 3000 page views SINCE YESTERDAY. Wow.

So, if I got any new readers from that awesome showing, welcome aboard. I hope that my random neural firings live up to your expectations. (Hint: don't have any expectations, it's easier that way).

Speaking of Randomness, it is once again Saturday and I am once again sitting here at the Fire Station working on the BRT (That's the "Big Red Truck" for those of you not in the biz). Saturday randomness is almost always guaranteed on this blog as I try not to use my brain on the weekend. I try not to use it on weekdays too, but sometimes a coherent blog post leaks out.

This is not one of them.

Cracked.com is a humor site that I think rivals The Onion as one of the most entertaining sites on the whole interwebs (Note: I did not put a Z a the end, Happy). They put up This article on: "5 Awesome Cases of the Internet Owning the Mainstream Media" - TOTWTYTR, I think that this will be right up your alley. Man, this site is funny.

I'm actually working on two intlliggent... entelagunt... integument... um, smart posts right now. They use actual research and stuff like that. They might just change the way you treat your patients. It did for me. Hopefully by the end of the day.

Again, welcome new readers. Always feel free to comment, always feel free to click on my e-mail address at the top left of the page. Click on the Random post button, see my favorites. Enjoy yourself if you'd like.

Our first post comes in from our friend The Crusty Ambulance Driver.

After him!! He’s having a seejure!! It’s not every day that you get to call in the Fire Department’s helicopter to help you catch your patient.

This was one of those days.
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Ever hear the one about the One Armed Fisherman? He caught a fish that was (holds up arm) "THIS BIG!"

Har. Yea, our friend The Happy Medic chimed in with that one in my comments section a while back ago. He just won the contest :)
Oh, and you can get Swine Flu from Fish, right? Guys? Right?
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Folks, sometimes Life in Manchvegas gets a tad strange. Our buddy Walt T. tells the story of a woman who just was having a bad day.

Then the SWAT team showed up. I'LL KILL YOU!! My love :)

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Ok, so this is just some gosh darn funny stuff. Prepare yourself for Ambulance Driver's contribution. Don't read this in church. You probably should pee before you read it too. I laughed my ever lovin arse off.

“Purty Healthy Sheckshy Titties”, “Find your happy place! Find your happy place!”

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Mack 505 over at Notes from Mosquito Hill discusses those weird things we do with the other social miscreants we work with. I’m sure you’ll know what he means here. EMS is a family. A horribly, horribly dysfunctional family.

 “Hey Partner: “Ice cold Beer?” Yea, you know.


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Lt Michael Morse, or L-T as I call him, over at Rescuing Providence has written this short, punchy, and very, very funny post. It's everything you need to know about life wrapped up in one, eh, "little package".

Lord of the Rings

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Happy Medic once told me that I could improve my blog by adding "More Explosions and Bikinis". I agree. Thanks to EMS Chick and Just Me, Just My Blog I bring you two posts featuring explosions written by female EMS bloggers who empirical evidence has shown, sometimes might wear a bikini.

"So, ya went poof, huh? Weird." - Just Me

Why do we check our stuff? Because sometimes things blow up and spray you with hazmat. - EMS Chick


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Making up this month's Handover has allowed me to find this blog from a blogger by the name of Philly Dan. He was doin ambo work when Medics like me may have been in diapers. Great reading over there. Thanks for submitting!


Defib Shocks are for the patients, right? I like this one a lot. Cadillac ambulances wading through floods always get me.


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Lumo, over at My Life in A&E, a UK Medic blog that I read a lot had a late submission that just squeaked in past the deadline. He asked me if it fit the description of a funny call.


Hell yea it does, it's got wee.

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Thanks heavens for stupid people. Without them, the Emergency Medical Services would be boring. Stupidity makes our world go 'round. As my momma always told me, "If you stick your finger too far up inside there, you'll poke your brain and get a paulsy!"

Actually , she said "Some people exist just to serve as a warning to others" FireCap5 over at Not Trained, but We Try Hard! put forth a post about a recent canary he had.


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Alright folks! Hope you made it down here. Great job to all of the great bloggers who submitted some funny, funny posts. What follows is some other posts from around the web that I thought needed some attention.

Oh, and some shameless self promotion too. Shamless self promotion.

One of my favorite bloggers who seems to be WAY smarter than me, Rogue Medic, has written a post on Correlation and Causation, featuring one of his favorite comic strips. There's cows, and a lot of the stuff that he's famous for. Great stuff as always.

Greg, over at Training Success is a buddy of mine who I finally prodded into becoming a blogger. He's a Haz-Mat wizard. He wrote a good post about role playing in training scenarios from a class that I was in. Check it out.

My cousin is a blogger who I really want to come to Blogger or Wordpress. She writes great, but her blog is over at Myspace. She guest posted her funniest medical story on my blog. Here it is. - You can find her Myspace blog on the post. She does a lot of political stuff.

Here's some shameless self-promotion :) I write on a blog called The Awesome EMS blog - I wrote this here a while back ago and I think that the video is freakin hilarious. I give you Skateboard Fail. Any blogger who wants to co-write on this blog is welcome, I need help on it.

And with that, this edition of The Handover Blog Carnival has come to an end. Y'all rock for coming over and having a read. Be sure to look for the next edition coming out next month over at The Insomniac's Guide to Ambulances. The theme will be Kids - Seen and Not Hurt. Now, ladies and gentlemen, allow me to play you out.

This post was written by my cousin Jill. She’s a darn good blogger who writes a blog on her Myspace page. I’m trying to get her to move over to blogger… but have yet to be successful in my endeavors. She wrote this post for this month’s Handover.

You can find her blog HERE

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I worked as a registration secretary when Ck was a security guard (before he passed all the haughty Paramedic classes and became insufferable....but funny.)

These were the bad old days of the Trauma Center.  Before they got a clue and put an actual nurse or paramedic behind the desk for patients to meet when they came in.  I didn't know these were the bad old days at the time, I just often encountered circumstances when the nurse wasn't there, like an obvious stroke (run for a wheelchair and put them in it while yelling for the nurse) or a guy carrying his severed finger (say, oh wow, and get a styrofoam cup for him to put it in - and a towel - while alerting the nurse)...

The nurse I worked with most often was a somewhat pragmatic, sometimes sarcastic and moody woman...that I came to know really well, called Connie.  Connie got breast cancer shortly after I started and I was with her through five years of surgery, chemo, radiation, a re-occurrence of cancer that they MISSED...and finally medication and death.  She was at work two weeks before she finally died.  She was the best triage nurse I worked with.  She just knew her stuff, and loved it.

Since I was experienced in the ER, they had me work when Connie did in those last days.  We supported each other.  I did the heavy lifting and gave her a break when she needed it.

And, as you can imagine, it was emotional for me.  We knew that Connie was dying.

Sometimes, though, I got to work with Patti. Patti was just a bit younger than Connie and was a very bouncy Christian who was always just a lot of fun to be around.

I always felt a lighter weight on my shoulders when Patti was there.

One day, in the middle of a slow afternoon with Patti on as triage nurse, a man came in followed by a white-haired woman, his wife.  She was absolutely magenta.

I asked the man to fill out our short complaint sheet with name and problem.

When he gave me the sheet, I saw that the complaint was "pencil in rectum".

So, of course, I immediately put them in the side office and handed the sheet to Patti, who was in the office behind me.

I sat at the desk while Patti triaged the fellow.  She said to him, "So, uh...how did this happen?  Did you maybe get out of the shower and sit down in a chair and not know that the pencil was in the chair?"

I thought, "Oh this nurse is gooooooood...she has given him the perfect out!"

But then, the fellow, failed to say..."Yeah!  That's it!  That's what happened!"

As his wife turned redder and redder he decided, instead, to be totally truthful about the elementary tools he needed for better self-satisfaction....

He said, "Then "floooooop" it was gone!"

I had to go into the office (he chose to stand) and finish registering the fellow.

Then Patti took them back to a room in the ER.

When she came back out into the lobby, I looked at her (we had an empty lobby) and said:

"Flooooop!"

I don't think I've laughed that hard in years.

Remember those commercials for the cable TV station TBS that ran here in the US where they had the "Comedy Lab" testing stuff to see if it is funny?

Well, this month's Handover Blog Carnival is WAY better than that.

Remember back when Family Guy, The Simpsons, and South Park were in their earliest seasons and were really, really funny?

Well, this month's Handover Blog Carnival is WAY better than them too.

Remember Groucho Marx, Abbot and Costello, and Charlie Chaplain?

Well, this month's Handover Blog Carnival is WAY better than all of them.

Remember every internet comedy site? The Blue Collar Comedy Tour?

Well, you get the idea.

Coming Friday to THIS VERY BLOG is The Handover Blog Carnival. The theme is "Funniest. Call. Ever." I swear that I've been laughing my butt off. My goodness, EMS folks are funny, funny people.

Don't miss it!

*Note: The Handover Blog Carnival may not actually be funnier than the above named comedy delivery devices.

A while back ago I had a kick where I did a scenario-based EMS ethics piece that took a look at a possible situation that could be faced by some Paramedics and asked readers what they would do in that case.

The response was pretty good. You should add your opinion here.

I use a lot of scenario based training for the EMS people that I teach. I teach a lot. Being the old, grizzled veteran that I am (shameless self plug but looking at the kids these days entering the profession sometimes I feel like shaking my fist at them, hiking my jeans up to my navel, and yelling at them to “Get off my lawn!”) I have the opportunity to mentor a lot of newer providers and precept a fair amount of students. During our slow periods, I find that giving the students an informal scenario helps them to step outside their thought processes and really think about what they would do when faced with a like situation.

I like it so much, that I even do it to myself. I’ve mentioned that I come up with most, if not all of my blogging ideas when doing other, mindless tasks. A great deal of my post ideas come while driving. I allow my mind to wander to imaginary concepts and ideas. Since I’m so immersed in EMS on a daily basis, a lot of those thoughts go right back to EMS, and “what if” scenarios come into my mind. Some of them are about patients that I’ve had, the “what if this had happened” kind of questions. Others are completely random scenarios that I wonder what I would do if I happen to be faced with the situation.

Einstein conducted what he called “Thought Experiments” to assess theories that he could not experiment with in a laboratory. One of the ones that I’m most familiar with is his “Flashlight on a Train” thought experiment. In this well documented case, he hypothesized that the speed of light was a constant and was not affected by outside forces. He imagined himself on a long, open railroad train with himself standing at the caboose, or end car of the train. He imagined shining a powerful flashlight from the rear of the train through the cars to the front engine. Using some logic that I am not familiar with because I’m no Einstein, he was able to theorize that the light from the flashlight would hit the train’s engine at the same time and that the light would travel at the same speed no matter how fast the train, and therefore the light source, was travelling. Unlike a missile fired from a jet plane that’s speed would be affected by the speed of the plane that fired it.

So how do Einstein’s thought experiments connect to EMS?

I equate the personal scenarios that I think of and the scenarios that I use to keep my students thinking outside the box to Einstein’s thought experiments. There are things in EMS that we do not do very often. Skills like synchronized cardioversion, surgical airways, and complicated drug administrations aren’t everyday things. Neither are difficult patient presentation with complex layers of comorbid conditions. These are high-risk, low frequency events that trial lawyers dream about. When you need to perform these tasks or think around a list of contraindications when your patient needs action now, having thought about them prior to having to perform is lifesaving.

One of the things I hear the most from paramedics and EMTs is how they run though a list of possible scenarios, patient presentations, and treatment modalities in their heads when dispatched to what sounds like a particularly nasty call. I do that sometimes too, although less now than I used to. Spending the time thinking about these things when you have the time to really ponder the issues is very beneficial and even fun… if you’re an EMS geek like me.

So next time you and your partner are bored sitting in your parking lot waiting for the next call, toss around a few “way out” scenarios. Your care will benefit from it. You might too.

I guess it's now somewhat more official... after much kicking, screaming, and crying... Ck is kinda now a glow worm. At least in certification, that is. I passed my HazMat Operations level class and now glow just a bit more than I did before. Honestly, I'd been putting off the class because I'm terrified like a little schoolgirl about hazmat, however the instructors did a good job of teaching me about the stuff. Now, I'm still scared of the methyl-ethyl-badstuff but at least I can operate around it.

Or something like that.

I'd like to call your attention to the newly created blog located at http://trainingsuccess-greg.blogspot.com/
This is one of the instructors from the class who I got into a conversation about blogging with. He's a newcomer to the blogosphere, but one heck of a resource on hazmat. He decided to create a blog to share his knowledge. This guy is like a walking encyclopedia on the chemistry side of things. I added it to the blogroll tonight and will be checking in on him fairly often.

You should too: http://trainingsuccess-greg.blogspot.com/

A while back ago, Steve over at http://theemtspot.com wrote a great post on Gaining IV Access. In the post, he’s got some great strategies for getting your IV starts every time.

But, as we all know, sometimes you just can’t get the darn catheter to go into that tiny vein for whatever reason. Try as you might, it seems like you’re going to be turning the patient into a pincushion before you establish your IV access. Sometimes that’s fine, when the patient is pretty much stable and you just need access. But when the fit’s hitting the shan, you’ve got to step it up. Luckily, our friends in the medical product industry have been working hard to beef up our firepower.

My favorite alternative way to make holes in people’s circulatory system is this:

The EZ-IO or, the intraosseous Drill, is a great way to get a big circulatory access point in a hurry. It’s stable, it’s reliable, and works in a hurry. I’ve used it and we carry it on every ambulance that I work on. I don’t do paid endorsements, but if the company that made this wanted to offer me a ridiculous sum of money to endorse this product, I would.

Intraosseous infusion was just for pediatrics when I first got into the game. We carried the Illinois bone marrow aspiration needle and used it for bad peds. We still do, and the thought of jamming that big ol’ needle into a baby’s tibia still gives me a touch of the heebie jeebies. However, I have to say that it’s one of those things that is absolutely needed when it is indeed needed. Adult patients weren’t so lucky. Before the EZ-IO came about if we couldn’t get a vein in the field with an IV cath on a critical patient, chances are the patient would have to wait for a central line in the hospital. Sure, we can attempt access in the external jugular vein one time and we can always give endotracheal doses down an ET tube in cardiac arrest situations, but I don’t really like any of those methods. The EJ because of the risks involved, and the ETT method because I’ve never really seen it be effective nor read any really positive research on the method.

Now, with the EZ-IO that’s changed. For our service, with cardiac arrest save rates between 40 and 60% depending on the literature you’re reading (Really. www.callandpump.org) most of our medics don’t attempt an IV on a code. If they, or I, am the only advanced level provider, the patient is “drilled” right off and that is our only circulatory access point during the initial resuscitation effort. If there is an EMT-IV tech, EMT-Intermediate, or an additional paramedic present, I will attempt one AC IV placement or direct it to be attempted, however I will most likely drill the patient for secondary access. For most truly critical patients, I place two IV sites. One is capped and acts as a backup site unless aggressive fluid resuscitation is needed or another provider takes over the medication part of the resuscitative team.

There’s been only one study that I’ve found on the effectiveness of the EZ-IO… and yes, this comes from the manufacturer’s web site… but I give them a modicum of credibility because they’re not selling something that hasn’t been around for quite some time as a viable method.

Q. Is IO better or just equal to IV for fluid, drug delivery?

A. The only human IO pharmacokinetic trial reported that IO flow levels are equal to that of IV as supported in the ACLS guidelines issues in December 2005.  Drugs injected into the IO space of the tibia, sternum and humeral head all reach the central venous circulation within one second which is faster than drugs given through IV in a low flow perfusion state

and this:

Q. What are the risks with this product - infection, leakage, bone not healing?

A. The documented overall complication rate associated with intraosseous insertion and infusion is less than 1 percent.  Potential complications include extravasation (leakage), dislodgement of the needle, compartment syndrome, bone fracture, pain related to infusion of medications/fluids and infection.  To date, there have been no reported complications from use the EZ-IO® product system. Overall IO experience in thousands of children and 4,000 adults show the infection rate to be less than 0.6 percent and those are usually not serious and can be treated as outpatients.

Medical mumbo jumbo, I know. I just love this tool. You should have it and use it too. I’ve seen it save lives, save outcomes, and make life much easier on poor, overworked paramedics.

Of course, that’s not to say that there aren’t alternative IO tools out there. I’ve been through a class on the BIG: Bone Injection Gun, and while I’ve heard generally positive things about it, I’ve never used it personally. I also have not had the chance to use the sternal IO access device (I believe it’s called the FAST Sternal IO) however, I found this video on it that came from the military medics that do use it.

Yes, that guy is CONSCIOUS.

Yes, it gives me the heebie jeebies to watch that. I’ll let students practice their IV skills on me… but A FREAKING STERNAL IO!? Those military guys have my respect, because they’re crazy. He didn’t even whimper when another guy was JABBING 6 NEEDLES INTO HIS BONE!

Although, I did get tazed for love one time. I guess I’m crazy too.

Thanks for reading, y’all.

On Friday the 25th of this month The Handover Blog Carnival, the biggest, best, first, most awesome, and a whole lot of other superlatives blog carnival featuring awesome bloggers from the EMS, ER, and A&E blogosphere is coming right here to Life Under the lights.

Yes, that was a weird sentence. However, this is going to be a weird carnival!

"Funniest. Call. Ever." - That's the theme. Come explore the humor of the emergency medical professions. You'll never be the same. I promise. Also be on the lookout for something, um, kinda special.

OH! And Bloggers. The deadline is Monday 9/21. It's well, been a hoot reading the submissions. Can't wait to see yours!

Oh, and this is open to any health blogger. Can't fit the theme? Cool. We'll getcha in. Just get your posts in early.

Once again, the deadline is THIS MONDAY!

I love my Job. I love the Pay. I want to be here every day.

Oh wait, I AM.

Don’t get me wrong here folks, my Abusive Co-Dependent relationship with EMS is a loving one. I couldn’t imagine not being a paramedic. I couldn’t imagine not being a firefighter. It’s just that where I live, the pay sucks and in order to make a living at it, a guy’s gotta put in the hours.

And I do. A lot of them.

And Gkemtp(it)’s at home, in bed, all snuggled up with our 3 cats (Nikita, MJ, and Captain Fantastic) while The Boy is curled up in his bed probably dreaming about snakes and snails and puppy dog tails or something like that.

Me? Why, I’m at work of course. It’s what I do. I’m a rural paramedic.

When I was a younger guy (I’m still young, mind you) the hours didn’t seem so long. My time at work was spent with my friends, who coincidentally, were at work with me. I made lasting friendships with my coworkers and partners and I cherish them. I never seemed to mind putting in weeks averaging over 100 hours for months on end.

Now, I still average 80 to 100 hours per week, every week… but I think that I’m getting tired of it a lot more easily than I used to. Maybe it’s because after marrying the girl of my dreams and finding myself the daddy of an awesome little guy I have a lot more at home to think about. Maybe that’s why these weeks are seeming longer. Maybe that’s why I thought to write this at midnight, while on duty, with my freshly made bunk less than 20 feet away. Maybe that’s why the 9 calls I put in during the first 12 hours of my day seemed to wear on me when I got to come home for a 3 hour break (supposed to be 4, I got off late). Maybe that’s why I lingered a bit at home this evening when the pager went out for an unresponsive 20ish male 30min before I was supposed to come in. I still responded to the station and made the scene like a good medic. I didn’t delay the response… But a bigger part of my soul is at home these days, and I feel it.

At least I got to read The Boy a story before I left.

Ladies and Gentlemen, this is why I blog about EMS. It’s because I think that by banding together, with every reader I get and share with the other awesome bloggers, that we can make a difference in the profession. Call me idealistic, call me crazy, call me naive.

But at 12:27pm sitting next to the truck, I think we can do it. EMS 2.0 is all about our participation in something bigger and better. If we can realize our potential, maybe, just maybe, I and others like me can stop having to burn so much of our candles at work. Maybe we can push up the wages to a living level. Maybe we can improve our profession.

I know we can.

Thank you all very much for reading me, I’m honored as always.

Howdy everyone! I cannot wait for my chance to host the upcoming edition of The Handover Blog Carnival, the premier EMS blog carnival on the Interwebz. Look for some cool things that I'll be throwing in there with what is already shaping up to be some great stories. I've been laughing pretty hard while reading them, so I know that you will too. The theme is "Funniest. Call. Ever." and the theme relates to funny, humourous, and just plain strange emergency calls. However, we're also opening up a general submission form to any EMS blogger. If you've got an EMS, Emergency Medicine, or medical post I'll put it in. This is a great way to read some awesome content, learn some, laugh a lot, and meet some bloggers you may not know. Oh, and the deadline for submissions is 9/29/2009. The sooner you get them in the easier it is on me. Thanks everyone! Looking forward to your posts!

I am not a glow worm.

Hazardous Materials, or “HazMat” as it is commonly known, is scary stuff. At least for me that is. In public safety circles, they’re mainly the concern of firefighters and I’ve never received training on them outside of the realm of the fire department. My EMS only agencies have always told me that we remain in the “cold zone” and wait for patients to be brought to us after decontamination.

And that’s just fine with me. Ckemtp is NOT a glow worm… did I mention that?

But, since I’m also a firefighter I finally broke down this weekend and gave in to the pressure I was under to get my HazMat Operations certification. 40 hours of class, lots of homework, and some very dry PowerPoint slide shows. After the first weekend of the class there’s some things that I’ve learned and figured out.

1. HazMat’s still scary.

2. Ck’s still not a glow worm.

3. EMS agencies really need to train more on HazMat.

“We know hazmat” you say. And I know that you’re saying it because that’s what I would have said before those last 20 boring hours spent learning that I knew nothing about hazmat. HazMat is something that we take for granted in that we think that it won’t happen in our jurisdiction, or that it won’t affect us on our day to day. I happen to hope that it won’t hit during my duty days.

This video is from Seward, IL. A small town in the middle of a lot of corn that found itself one day having a big problem. The video is from a surveillance camera on the side of a grade school in the middle of town. The vid starts slow, but has a definite “HOLY CRAP!” moment about halfway through. You’ll see what I mean, all hell breaks loose.

See? Holy hell on crutches! That’s anhydrous ammonia, a common chemical used in farming (and in methamphetamine production). A tanker truck full of the stuff sprung a leak and flooded the town with a toxic cloud. Thankfully, nobody was killed. There were a few firefighters sent to the hospital, and some very scary moments, but it all turned out to be ok. This one’s from the same school. It’s just as scary.

Remember this, a HazMat incident doesn’t have to be the once in a while overturned tanker truck full of MethylEthylBadJuJu. Any every day response can turn quickly into a hazardous materials incident.

Not too long ago, an EMS only agency that I may or may not work for received a call for an “eye injury” in one of our really rural response areas. This call generated a single ALS ambulance only response out to the farm where the injury happened.

The medic and the EMT responded out to the scene, which was about a 15minute emergent response. Arriving at the farm, they were directed to the dairy barn to find their patient.

Their patient was in a lot of pain.

Apparently, he worked for a dairy services company and was delivering product to the farm when he was injured. If you don’t know much about dairies, milk processing leaves a byproduct called “Milk Stone” which is the dissolved minerals in milk solidifying on dairy equipment. Think of hard-water stains. Dairies use products containing phosphoric acid to clean it out. It’s like Lime Away on steroids. This stuff is pretty nasty. Dairies use it in a diluted form, but the supply companies carry the concentrated stuff. This patient was filling a container with the high-powered stuff to dilute it into the customer’s container when the concentrate fell. He reflexively looked right down at the falling container and got a face full of the stuff when it splashed back up at him.

Do you remember that chemical burn stuff you were trained on? He had them. Do you remember the decontamination training you had? What about proper personal protective equipment, do you have it? Do you know when to put it on? Do you know how? What do you know about the chemical?

While treating the patient, one of the paramedics noticed that his EMS gloves was turning white. It was the acid eating through it. A lot of water was used to irrigate the patient, and the providers, before transporting the patient to the hospital.

This was an everyday incident that actually happened. Think about how you’d handle it, because tomorrow it could happen to you.

And once again, Ck is not a glow worm.

Here are two quick videos that I thought were very, very cool. You'll feel smart after the first one... then not so smart after the second. Enjoy.




Ok, after that one. You should be feeling smart. Remember all those things from Biology class? I remembered a lot of them

Now, here's the real one... without the pretty music and with an actual narrator telling you what's what.

I woke up this morning to just another day.

I’m not proud of it, but I have to admit it. Yes, I know what day it is. I know what happened on this date eight years ago. I know what was happening at this very minute that I write this on that horrible, terrible, infamous day eight short years ago.

I remember it like I remember yesterday, probably even more clearly. I was on duty on the ambulance in the small town where I grew up. My grandmother called me and asked me “Do you have your television on?”.

I didn’t, I was sleeping. She woke me up when she called. My friend PJ and I had gone on duty at 5am and were catching a few Zzz’s before heading down to the station. It was just another day then, too.

“We’re under attack” She said. “They’ve hit the World Trade Towers in New York and it’s burning”

“We’re what?!” I asked her

“Someone’s attacking the United States, we’re at war. Turn on your TV!” She told me.

Now, my Grandmother was a young, spry 93 year old back then. At 101, she’s going strong. I’m not exaggerating. She retired at 92 and hasn’t slowed down at all. She’s amazing. She’s seen more than anyone I know, has lived through quite a bit of United States history, and has really experienced it. She’s not one to panic, and not one to exaggerate. When she said this, my blood ran cold.

Then I flipped on the TV.

My God…

I turned on to see the top of the first tower burning furiously. Some talking head was saying something about an airplane hitting it. I didn’t understand what I was seeing.

Then the second plane hit.

Grandma was right, we were under attack. Our way of life was under attack. Our right to exist as a nation was under attack. Our Mothers, Brothers, Sons, and Daughters were under attack by, as President Bush put it, a “Faceless Coward”.

Some kind of guttural noise came from me as I saw what happened next. You know what happened too, the first tower fell.  Hundreds of people died. It was a terrible thing to watch on TV a thousand miles away… I can not even imagine what it was like to be there. I never want to experience it.

I don’t know how the conversation with my Grandmother ended… but I know that we went down to the ambulance base, fast. I felt like I was responding to something… I wasn’t of course, but at the time I was ready to run to Ground Zero as fast as I could and help somehow. I didn’t know if there was anything else going to happen. I knew that whomever was attacking us wasn’t going to attack anywhere in my jurisdiction, but I was thinking that since we had a Military base in the middle of a metro area 30min away and since Chicago was about 2 hours away that it was possible.

Silly, maybe… but it’s what I did as a young 20 year old. Probably what I’d still do today. Except for now, I’m more advanced my career and have a position where I can respond to things like that. People that know me first-hand know that I have a job that I work a few months per year. Some ask me why I still do it because it’s inconvenient as a family man, this is the reason why.

When we got down to the ambulance base… all we could do was turn on the TV and watch… Powerlessly… as our brothers and sisters suffered.

Then the second tower fell.

You know the events as well as I do. That day progressed in a haze of raw emotion, a feeling of uselessness, and sitting in front of the TV. At one point, we ran outside because we heard a loud plane flying over and panicked.

It was an airliner flanked by two military jets on each side. It flew right over our ambulance base. Standing there, small, and diminished by the events of the day, I saluted whomever it was up there… and prayed that they’d make the right decisions.

I did a lot of praying that day.

So I feel bad that this morning when I woke up, on duty, I was feeling that this too, was just another day. We cleaned the trucks and the quarters for shift change, and went to our morning shift-change crew meeting. Somebody mentioned that it was Sept 11th. I had remembered…

but I hadn’t remembered.

On my way home, I was listening to the radio like I always do. I usually have the radio on the pop station, because I like the morning show, or on country because it’s good music.

The DJ asked everyone for a moment of silence… and I was silent.

Then the audio played. It was sounds and voice recordings from radio traffic, 911 calls, and media sources from that day. It was powerful, raw emotional stuff… And it brought me right back to that day where I stood, small but ready, in my small town, a thousand miles away from the events where people I don’t know, and didn’t know, died as patriots for our great nation. My brothers and sisters, my countrymen. No… OUR brothers and sisters and OUR countrymen. Our martyrs. Our patriots. Our friends. Our neighbors. They suffered on that day at the hands of faceless cowards.

I cried. I pulled over and cried like a baby.

Barbarians! Cowards!! We will hunt you to the ends of the earth and cut you down for what you did to us!! Our unity knows no bounds!! Our strength as a nation knows no limits!! You will pay!!

Tragic… awful… pain… how horrid to die in such a manner. How horrid for the families of the lost. How heroic of the police officers, the firefighters, the medics… How courageous. How strong. We stand with you, here and now. Still. Never wavering in our support for you. Life and light triumphing over death and darkness.

September 11th has been decreed by congress to be a national day of service. It is now called “Patriots Day”. This move is one of the few things that this congress has done that I fully support. Today is not about me, it’s not about you. It’s about our nation, our unity, and our strength in service to all. Liberty and Justice for All too.

Remember. Participate in the ceremonies. If you’re town doesn’t have one because you’re in a small town, travel to go to one. If you can’t, and you’re a volunteer firefighter or medic, go to the station and polish up the trucks. Make them look nice. Bring your family down.

Teach your children what today means. Let them know that we will always stand strong against Evil… even when we have a black eye and we’re bleeding. Teach them that America is not Evil but that we stand against Evil in the world.

Today is not just another day… and I’m sorry I woke up that way.

Howdy everyone,

  I've been just plain busy over the last few days and I'm sorry that I've not been posting as much as I usually do. Bear with me though, I've got some good stuff on the burner. Big things are coming. Cool things too (I hope!)

  Since I started this blog, my readership (and Thank you) has increased a lot. I'm honored and very appreciative that y'all come to read me. So, here's a rerun that I never thought got as many reads as it should. Hope you like it.

http://proems.blogspot.com/2009/03/cat-puke-chicken.html

Sorry about the lack of posting for a day or so, y'all. I've been really busy (and there are some huge things on the horizon!) but in the spare time I've had, I've been reading some of the other really great bloggers out there. TOTWTYTR has posted a great piece on Fire Based EMS which has already been fanning the flames.

http://tooldtowork.blogspot.com/2009/09/boo-freakin-hoo.html

Read it. Read the comments too, it's fun to watch people get angry

My buddy Medic999 is hosting the Grand Daddy Medical Blog Carnival of them all over on his site http://medicblog999.wordpress.com/ - Head on over and check it out. There's a ton of good stuff over there. Wow, a lot of stuff I hadn't read too. It's going to take me a while to read it all.

Lo’ my brethren, I shall tell you a tale. This is a tale of daring, and of courage true. The Knights of the Land named RescueSquadia are small in number but large in bravery and true of heart. Our enemies may laugh at us to our faces, but they make comments both snide and snarky in our absence.

On this day, the Knights of the Realm gathered ‘round the particleboard table in the castle keep for the Meeting of the Morning and changing of the guard from the knights on watch for the day before. King Chief, supreme emperor of the land slumbered deep in his well-appointed chamber far from the castle keep for today was a day of celebration. Today the flags fly high and the townspeople rejoiced in their leisure. They gave nary a thought to the knights of the realm now charged with the protection of their health from the scourge of the demon Alcoholio and PartiaTooHardus. Lord (Tall) Christopher was the appointed master of the day and addressed his brave knights by name.

Lt. Chris “Brave knights, Sir CK, Sir Thaddeus, Sir Nacho, and Lady Nik. Pray tell me of your readiness to serve our fair land on this day of celebration! Today we shall fight the demons and shall seek to avoid confrontation with the Scourge of Transfer Longdistancia and the Call of the Nursing Facility Skilled.”

Sir CK “Lt, I pray thee to remember that everything today shall be treated at the level of life support basic. For today, this brave knight paramedic is lethargic and crabby after my long, hard battle with insomnia the night before.”

Lt Chris “Sir Ck, pray I smell upon thee the scent of the feces of the male bovine and I tell thee that life support of the advanced shall be performed today, unless the turn to perform life support of the advanced shall fall to me, Lord tall of the day. Then, I shall call upon the Basic knights of the realm to handle the call so that I might increase my time to slumber deep and prepare myself for the coming challenge.”

Sir Thaddeus “The scent of the feces of the male bovine permeates deep into the nose of this Knight Basic.”

Lady Nik “I concur”

At that moment, a great disquiet fell upon the chamber for the pager of great inconvenience rang out with its non-emergency tone. All of the knights looked at each other with new resolve, knowing that a time of inconvenience was near.

Lt Chris “Lo, the great Dispatcher Sir James is not in his chamber on this day for want of celebration of the holiday. Today the call of the pager of great inconvenience beckons for me and for me alone. The duty is mine, and I shall answer”

Lt Chris brought forth a gadget from his armor created by the wizards of the tower BlackBerry which allowed him communication with faeries at length. He spoke to them through this dark magic and a deep furrow came upon his brow.

Lt Chris “Sir Thaddeus, I implore thee to my service! As a Knight Basic of the realm, I pray thee to use thy status as Knight Basic of Least Seniority of this day to press forward on a quest of great valor.”

Sir Thaddeus “Dang it… oh, I mean – Lt Chris, why dost thou roust me from my daydreaming? What is this quest of which you speak?”

Lt Chris “Brave Sir Thaddeus, I implore thee, at the hour of highest sun you shall leave upon a quest. Gather thyself a Wheelchair chariot and obtain thyself a patient from the Nursing Facility Skilled and transport them to their appointment. For today, the squires of the Wheelchair van, um, er chariot service are at rest.”

Sir Thaddeus (Grumbling) “This is the feces of the male bovine…”

After telling tales of valor and gallantry the knights went forth to the Bay of Ambulancia to ready their chariots and weaponry for the battles sure to lay ahead. Chariot Medic 98 was due for a thorough cleaning, disinfection, and inventory per the Scroll of Daily Chores and the Knights bravely met the challenge with gallantry. Soon, the Bay of Ambulancia was filled with the noise of brave knights hard upon the tasks of checking and cleaning weapons and chariots. All chariots and weaponry were in order and the Task of Morning coffee and further shooting of the feces of the male bovine commenced.

A lot of feces of the male bovine was shot by the brave knights as they partook in further morning coffee. I, your humble narrator shall spare you the details. Sir CK, however, undertook the task of searching the ethereal plains of YouTubery for videos hilarious to post upon The Blog Life Under the Lights.

Sir Thaddeus, the begrudging, parted company with the rest of the knights in his Chariot of Wheelchair transpotery and undertook the quest. The rest of the knights gathered in the main office, er, castle walls and surveyed the landscape preparing for battle.

As the sun rose higher in its celestial arc upon the summer sky, very little noise spewed forth upon the boxes of communication affixed to the knight’s armor. The brave Lord (tall) Christopher again roused the knights from their preparing for battle with a call to order, for a new quest was upon them.

Lt Chris “Brave knights, my innards are rife with a craving for lunchy deliciousness. I ask thee, what are thy plans for a sumptuous repast for the noontime meal?”

Sir Nacho “Lt Chris, I too am famished and wish for that we partook to the banquet hall De Taco Bell for our noontime meal. The fair maidens at the Counter of Ordering in the Banquet Hall De Taco Bell have my fancy and their sustenance is rife with sought after deliciousness.”

Lady Nik “Skknnnnnnnnxxx” for a spell of lethargy had been cast upon her and she had fallen to slumber in the Castle Lounge”

Sir CK “Brave knights, I ask thee a question. I have been preparing a recipe of utmost deliciousness. My heart and soul are willing to lay down my culinary skills at your feet for your sustenance. I pray thee ask, shall I smoke the baby back ribs for the evening meal?”

Lt Chris “Sir Ck, your head is full of duncery! That shall not help me in my quest for lunchy deliciousness and the noontime meal!”

Sir Ck “Dunderhead! Lord (tall) Chris, it is the evening meal I spoke of, I shall have to prepare the beast for roasting now if the meal shall be of desired deliciousness in time for the evening meal!”

And so the knights waited for the return of Gallant Sir Thaddeus and then left on a quest for the Banquet Hall de Taco Bell where for Sir Nacho had been smitten by the serving maidens. Sir Ck did not quest with the others, as he was busied by the task to drive traffic to the Blog Life Under the Lights in celebration of the Labor Day Extravaganza. Soon thereafter, Sir Ck departed in the Chariot ALS Interceptor for the Walled Realm of Mart for the procurement of sustenance for the evening meal. He fought hard and slay many a dragon and shopper in the quest for the most delicious baby back ribs of beast and other sundry accoutrements for his Rib Recipe of great magic passed down by his clan before him through the centuries. Retiring quickly for the food preparation chamber, he began the arduous labor of preparing the magical recipe. The Baby back ribs of beast had just been placed in the magic potion of marinade when a horrendous noise issued forth from the box of communication upon Sir Ck’s hip. A citizen of the realm was in need and Brave Sir Ck and Lady Nik were being called upon to charge to his rescue.

"To Chariot Medic 98!” shouted Sir Ck as he and Lady Nik set forth for the harrowing rescue. The demon CVA was possibly attacking someone and our magic talismans were needed to stave off some of the damage whilst transporting the patient to the Kingdom of Eeearia for further evaluation by the Lord High EeeArr EmmDee.

After a hard fought battle, Sir Ck and Lady Nik emerged back into service victorious against the demon CVA. Sir Ck wasted no time in removing the Baby Back ribs of Beast from the magical potion of marinade and rubbing them with his magic dry rub powder made from a secret blend of magical herbs picked from the fields of the Walled realm of Mart. Once this task was performed, the fires of Grilling were prepared and the smoking of roast beast commenced.

Lt Chris returned to the Knights chambers and was pleased with the progress of the roasting beast. The smell of which filled the land with happiness and joy. This was until the tones of foreboding emanated from the box of communication on the knight’s armor set forth upon them.

“Lo there be a collision involving multiple chariots with numerous townsfolk needing our magic healing talismans in the next kingdom over” called forth the box of communication. Lt Chris, sensing that this would be a call of great gloryhoggishness spoke to Sir Ck.

“Sir Ck! Since henceforth thou shalt be cooking the roast baby back ribs of great deliciousness, wouldst though send me in your place to the collision of multiple chariots on the mutual aid to the next kingdom over?” asked Lt Chris.

“Serve me well, Lord (tall) Christopher, Serve well in my place… for I shall be in the middle of evoking great majicks in pursuit of great deliciousness for the evening repast whilst though is battling the Demon Trauma brought forth by the scourge of Alcoholio” brave Sir Ck did say to Lt Chris.

Lt Chris fought well alongside the companionship of Sir Nacho against the Demon Trauma in the next town over and after returning from the Kingdom of Eeearia and after speaking with King EeeArr EmmDee they did come back to the Castle Keep of ResqueSquadia to enjoy the finest Baby Back Ribs of beast magically roasted in great deliciousness. Great rejoicing did commence and the feces of the male bovine was shot over videos played forth from the Ethereal Plains of YouTubia of Indian brothers dancing and singing (which has really been a theme today, hasn’t it)

And I, your humble servant narrator shall end this tale of bravery. It has not ended. The brave knights of the realm ResqueSquadia still lie in wait until the next Changing of the Guard ceremony which will commence in 8 short hours. New knights will take their places. Lives hang in the balance.

Sleep well, citizens. Sleep well

Sorry y’all, Sir Ck and the Brave Knights of the Realm ResqueSquadia have been busy running calls.

So, to bring you all into the spirit of the next post that’s coming up, I present to you Eh Shrubbery!

More from our Indian Friends – This is a PSA stressing the importance of taking our prescription anti-seizure medication.

At least stay around until 0:26. Wow. Can someone hand me the valium?

Howdy everyone! In honor of the holiday today that we’re having here in the US (Labor Day for those of you in the international section of the audience) I thought that I would do something different. I came in to work today with my 4 other coworkers and we determined that since we’re all working while everyone else in town has the day off, that today would be a day of fun for us. I’m carrying that over to the blog, and for today I will be randomly posting random fun stuff.

Hint: If you’re on duty today too, use this to annoy your coworkers… I am! They’ll appreciate it, trust me.

Our friends from the Indian Subcontinent start our the Labor Day Extravaganza with this offering. It carries an important message. There’s only one thing on here that might be a little NSFW at the very end (if you work for a catholic hospital, don’t play it… Everyone else will be fine)

Check back throughout the day, I’m going to be using this blog like Twitter for the day and putting up lots of random stuff.

Anyone want to do a contest? In the spirit of my upcoming version of “The Handover” where the theme is going to be “Funniest. Call. Ever.” (coming up next month, btw) the person who puts up the best Clean! joke will win a free plug to any safe-for-work website that they want me to link to, bloggers who I haven’t added to the blog roll will win a blog roll link. Cool?