Friday, July 18, 2014


The other week, I finally got the opportunity to complete my Pack Test, or “Work Capacity Test” for my current job. It’s the arduous-level wildland fire physical fitness test. You wear a vest or carry a pack weighing 45 pounds, and walk 3 miles, in under 45 minutes.

This test was the biggest thing that scared me about my new job. Somehow I missed the requirement to pass the test on the application, and I didn’t realize I’d need to complete it until I was in the process of accepting the position. Over 2 months, I was able to work up to the required time and weight, and now my biggest goal is keeping at it, so that the test doesn’t scare me in the future.

Anyway – I took the pack test on July 6th, which was a significant day in the history of wildland fire. On July 6th, 1994, 14 experienced firefighters died on Storm King Mountain in Colorado. The week before, June 30th, was the first anniversary of the deaths of 19 Granite Mountain Hotshots on the Yarnell Hill fire in Arizona. July 10th was the 13th anniversary of the Thirty Mile fire, a fire in Washington State that took the lives of 4 Forest Service firefighters.

That’s 3 major anniversaries in wildland firefighting in 11 days. I’ve read much about all three incidents, including John Maclean’s books on the South Canyon (Storm King) Fire, and the Thirty Mile Fire. He’s a good author, and does a decent job summing up the various investigations, as well as re-interviewing involved parties and trying to put a fuller perspective on the events.

Anyway – One thing I’ve learned in my wildland training is that the 10 and 18 (Standard Firefighting Orders and Watchout Situations) have been written in blood. Yeah, I’m idealistic because I haven’t actually worked a wildfire, but I just can’t understand why the same things happen over and over again.

As the summer continues, to my friends that wear yellow nomex – as the 10 & 18 say: Fight fire aggressively, having provided for safety first.

Wednesday, July 16, 2014


I've long been a believer in the Bryan Bledsoe School ofHelicopter EMS (HEMS) Usage. Essentially, they have a place in EMS, but they should be like abortion – safe, legal, and rare.

Back home in Pennsylvania, I've been outspoken over the asinine use of HEMS. When you're within a mile of an open and functional trauma center, there is no good reason that you need to land a helicopter to transport your patient... yet I've seen and heard that happen.

Don't get me wrong, HEMS has its place in EMS. The providers often have more advanced tools and drugs, especially for securing airways in traumatically injured patients.

One of my most common places to use HEMS back home is actually at a prison that we cover. We often have some time delays in accessing, packaging, and removing the inmate to the ambulance, and the facility also has a true helipad. If I call for the helicopter when I'm in the facility, it's on the ground or landing by the time I can load the patient and move to the LZ (Landing Zone). Depending on the time of day and road conditions, my drive time from the facility to a Level II trauma center can be as little as 30 minutes, or as much as 45 minutes or more. That meets criteria, in most cases, to allow HEMS usage. And HEMS is actually faster if they are on the ground at the same time that I could start driving.

Now out here, I’ve got extended drive times from much of my territory to trauma centers, and in some places, even a hospital. My two closest hospitals for much of my territory are community hospitals, one of which is technically a "critical access hospital." Additionally, when my patient is down a trail, or on a boat, I’m rarely sitting waiting for a helicopter to land to take my patient away. The crews I’ve worked with are great at minimizing scene time, and usually are in the air within 5-6 minutes of climbing into my ambulance.

Now here’s the fun part. Often, when I send patients by helicopter, they go to the hospital Dr. Bryan Bledsoe works at. That’s just ironic, isn’t it?

Tuesday, July 15, 2014

Code 4

A few months ago, I blogged about “plain speak” and how terminology changes from place to place. Now that I'm working in the Western US, I've learned a NEW term for an ambulance – out here, it's called a “Rescue”. They have “Heavy Rescue” or “Technical Rescue” units – those are the “rescue” trucks I'm used to talking about.

Anyway – the agency I work for still uses some 10-codes. Things like “give me a 21”, short for 10-21, meaning: call dispatch via phone. Some folks use 10-7/10-8 for out of service/in service, and there's a smattering of other ones, too. There's a new one for me, “Code 4”. It's actually the same as a 10-code I'm used to from the police back home, “10-92”. Code 4, 10-92, or even “92” mean the same thing, ostensibly, “status OK”. That said, the code means so much more than that. The use is very context-dependent. Most often, it's how I answer status checks by dispatch when my unit hasn't been on the air recently.

We also use it for other things. Talking about a disabled motorist: “He's code 4, waiting for AAA.” Or, after a property damage collision, “occupants are all Code 4, just want to file a report.”

An example, from an EMS perspective, is a call I had at the University EMS service, while I was a supervisory lieutenant. I was onscene for a psychiatric emergency, and the other lieutenant arrived, and asked me on our ops channel if I needed anything. My response was “Nope, we're 92 in here, just let me know when the BLS arrives.” Suddenly, by using that 10-code, he knew that a University police officer and myself weren't doing anything useful inside, and were simply waiting for the ambulance to arrive, so the person could go to the hospital for care, after their cry for help.

Another great use from the EMS side is when we are requesting a LE unit to assist us for something minor – forcing access into a house, dealing with securing property, that sort of thing. Over the years, when I've request a LE unit for something minor, it's not uncommon to get more than one, because they all come, just in case I'm in trouble. It's great to know the cavalry will come when I call, but it's also a waste of resources. Being able to use a code that the dispatcher and LE know, that says “I'm OK” can help ensure that my LE friends don't get hurt racing to “assist EMS” for something dumb.

“Code 4” isn't some huge secret. It's online, and can be heard on most scanner apps for western LE agencies. Its use is varied, and very flexible. It, and 10-92, the 10-code from back home, are one of the more useful LE “codes” that I've used.


Monday, July 07, 2014

Be Careful Who You Criticize

Going through Medic School, I had a classmate that sat behind me, and felt it was her business to keep reminding me that I was on my second time through. It was hurtful, but also pushed me to do better. I wanted to be one of the first from my class to actually GET the shiny Registry patch, and I was. I was second place, behind the OTHER guy who had repeated medic school that year (someone I respect, and I was honored to be in second place behind).

I finished, and have worked for several years as a paramedic in the same area. I continue to encounter this person as I go through life. Oddly enough, she didn’t actually ever PASS National Registry, and has never been able to practice as a Paramedic. This year, she decided to try again. I really do wonder if there’s someone in HER class, reminding HER that she failed to complete medic school the first time. I also find it mildly disappointing that she won’t admit to her previous conduct… but hey, some people are just like that.

In the end, Karma comes back to bite you in the ass. Every time. So follow the golden rule, and treat others as how you’d like to be treated, and maybe you'll have an easier time of things. If nothing else, it helps to not go through life angry at others.

Friday, July 04, 2014


I’ve had the opportunity this spring to be involved in something really cool. I’ve been involved with a new group, called the American College of Paramedics. Here’s the idea – Paramedics in the United States becoming a self-regulating body, like is seen in many Commonwealth countries.

From the website:

The title of “Fellow of American College of Paramedicine” represents an EMS practitioner’s commitments to clinical excellence in the prehospital environment, the promotion of evidence-based EMS practice, and development of the EMS profession into that of true allied health professionals. Candidates for FACPM will have demonstrated the following during a 5-year candidacy period

I’m proud to say I’m part of the fellowship committee, and the Board members seem to be working diligently to make this happen. I think this is a great next step for American EMS. What do you think?

Check out the website:

And the Facebook page: