Philly Fire at Level Zero

Philadelphia Daily News has an inflammatory headline today: In case of emergency, say a prayer? Sad part - It's spot on. Getting EMS care in Philadelphia is as much luck as it is anything else. It's a finite resource that has long been neglected.

 

Tuesday brought seasonally expected high temperatures, and with that, predictable high EMS call volumes. That’s NOT a surprise to anyone who follows the saga of PFD*EMS. Add in a small-scale disaster, such as the food truck explosion that happened Tuesday afternoon, and the system went back to Level Zero. And was there a couple other times during the day.

Level Zero is a term in the EMS industry. It means the City has ZERO available transport EMS resources – everything is committed (on calls, at hospitals, cleaning up, completing post-run paperwork, restocking, or out of service for training).

Here’s the thing. Even when Philly DOES have EMS units available… they may not be in every neighborhood. On busy days, it’s routine to see ambulances leapfrog across the city, getting sent on 20 or 30 minute responses as soon as they clear a hospital. Is there really a difference if it takes 10 minutes to dispatch an ambulance that’s coming from 20 minutes away, or if an ambulance from 30 minutes away is dispatched without a delay? Other than the statement of “no medic available” on the radio? The scene gets the closest available suppression apparatus, and they wait for an ambulance.

It’s common in major cities to supplement municipal EMS resources with mutual aid providers. In some towns, that consists of agreements with adjoining towns to help provide coverage for normal flows of service. In other towns, that involves a public-private partnership where ambulances that are primarily used for non-emergent transport are used to supplement the 911 system. Some areas do this more frequently than others, but it’s a common solution.

Philadelphia doesn’t seem to know how to call for help. They have a procedure where quite a few agencies have radios mounted in ALS ambulances that can communicate with PFD’s dispatch so that these units can be used in a disaster. These radios are used in the annual airport drill, and regularly tested, and that’s the end of it.

Philadelphia invested money in the system, and unveiled it 4years ago. Yet, to my knowledge, it has never been used for an actual event. Especially these occasional surge events that happen EVERY SINGLE SUMMER. These surges happen in extremely hot weather, and also on warm summer evenings when the city's "knife and gun club" starts up, and fills the hospital trauma bays with battered and bleeding individuals.

Philly is planning to “fix” their EMS system by hiring a whole bunch of EMS-only EMT’s to ride ambulances, paired with Paramedics, allowing them to return to a all-ALS deployment with more units. That’s the stated goal, anyway. That isn’t going to happen overnight, though. The City should use the resources it has available to cover it’s requirement to provide EMS until PFD*EMS is on a better footing.

EMS Goes To Capitol Hill

As some of you know, I'm involved with NAEMT's legislative advocacy efforts on behalf of EMS. Yesterday, I spent the day walking the halls of the Capitol offices meeting with some of the Commonwealth's legislative contingent - mostly their staffers, but I did get to meet one Representative. This was the 5th EMS On The Hill day, and the 4th one I've attended.

This year, our "asks" were actually pretty simple. On the Senate side, we met with the staff of Senator Toomey and Senator Casey (separately). We were primary talking about H.R. 1791, The Medical Preparedness Allowable Use Act. This bill passed the House in February, and it currently sits in committee in the Senate. It's a pretty simple bill - allows an expansion of approved expenses for the Urban Area Security Initiative grant money to fund chemical/biological countermeasure stockpiles. The money is already there, this just means it can be spent on some more things that could be useful. In the Senate, we also talked about the Field EMS bill, even though there is no companion Senate bill yet. Finally, we asked for the Senators to consider joining the EMS Caucus.

After leaving our first meeting on the Senate side, we were able to get an escort by an intern from Senator Casey's office, so we were able to make our meetings on the House side without rushing too much. We got to walk along next to the Senate Subway tracks (We didn't wait for a subway car for the trip. Pretty cool tour!

On the House side, we didn't have to talk about H.R. 1791, because it's already passed. Instead, we focused on talking about the "Field EMS Bill" - Officlally: H.R.809 - Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2013. The Field EMS Bill isn't perfect - but it gets us talking about quite a few things, and at least gets us a seat at the table. If you've got a better idea, I'm sure NAEMT would LOVE to hear it... but right now, this is their best one.

We also talked about the EMS Caucus. Although there's a Congressional Fire Service Caucus, there's no group focused on EMS - yet EMS calls for service are often 5:1 fire calls.

I think the easiest sell with that was Congressman Glenn "GT" Thompson from central PA (PA-5). We walked in to the office as the House Bells were sounding, calling representatives to the floor for a vote. His staff explained that the Representative was being called away for a vote, but "He has 5 minutes and wants to see you." He greeted us with "It's good to see fellow EMS personnel here". Turns out, he's been an EMT and Firefighter since the mid-1980's, and still serves when he's home.

Here's a screenshot of a tweet HE sent with our group photo:

Congressman Thompson's staff said that the Representative has apparently stopped at a few car crashes in rural Pennsylvania since being elected and provided initial first aid until EMS arrived, so heads up, Central PA folks - that gentleman who says he's a firefighter and stopped to help might also be your Congressman!

Anyway - I think it was a relatively successful day. Last picture before I sign off - This is Chief Touchstone from Philadelphia FD EMS (and NEMSMA), with his Congressman, Rep. Chaka Fattah (PA-2).

Gear Review - Raven Concealment Flashlight Clip

Last summer, Raven Concealment Systems rolled out a new product, a clip for Surefire (and other 1” diameter) tactical flashlights. Of course I bought one. And then torture tested used it in my everyday life.

I've been a Raven Concealment fanboy since '07 (before they were used by the Magpul guys, and their order lead time got ridiculous. Their gear isn't unique, but they do make a good product. So when I saw the announcement for the flashlight clip, I figured I'd try it. It has been the best $15 I ever spent, in terms of firearms/accessories.

I'm no Tactical Timmy, but I do carry a flashlight with me almost all the time. I use it daily - Checking a cabinet in a truck at work, or finding my cell phone dropped under my car. It's incredibly useful to have a bright flashlight handy.

My current flashlight of choice is a Surefire 6PX Pro - good all around light, with decent battery life. I like the Low/High option, rather than the On/Strobe. The low is good enough most of the time, and saves battery life.

Anyway - Back to the pocket clip. It's seen a little use. The finish is a little worn, but the flashlight has dings, too. It's held it's shape in all sorts of trousers over the last 9 months, and still works as designed. The clip has two purposes. It holds the flashlight in a bezel-down position at the top of the pocket for easy deployment, and it has an O-ring for flashlight manipulation.

The idea behind the O-ring is simple - When you grab the light as you would for a Harries stance, you slide your index finger through the O-ring. This allows you to retain the flashlight, and also enables a very cool-looking flip of the flashlight to the back of your hand, to free up your non-dominant hand to reload your firearm or perform other m manipulations. Here's Stephen Pineau demoing the clip - he shows the ring as the first option.

Since I normally use the Harries technique to combine my flashlight with my firearm, this device is just what I needed. If you're scraching your head at the term Harries, here's a link that better explains it.

Install is stupidly easy - You unscrew the tailcap, slide the metal clip over the threads and down to the bottom of the barrel at the tail, and then put the tailcap back on. It's quick and easy, and doesn't impact the flashlight use in any way. There is usually a small gap between the flashlight and the tail cap, so you aren't adding much, and the threads are long enough to handle it.

I wear the flashlight with clip in my left front trouser pocket all the time, either on or off duty. When I'm off duty and laws allow, I have a firearm on my right hip, and I leave the flashlight on my left all the time for consistency.

The light rides relatively low in my front pants pocket, and doesn't stick out. I've only found one pair of pants that had trouble holding the flashlight, and that was a pair of Dickies-brand work pants that seem to have pockets that aren't as generous as most pants. In every other pair of pants I've worn, I've never had the flashlight fall out.

Anyway - This device, overall, gets an A+ from me. It's inexpensive, and makes carrying a flashlight daily much easier. You don't need to worry about light carriers or having the light fall out of your pocket, or get buried under other items in the pocket. It's a fantastic tool, and something I recommend with no hesitation.

If you want to buy the clip - here's the link to RCS's shop.

Sirens

I finally got to watch the first two episodes of Sirens today (I’d already seen the sneak preview episode, which will air this Thursday). I like it. I think there’s perhaps a little too much focus on bathroom humor… but aside from that, it’s the most accurate a depiction of #MyEMSDay in television I've seen since Emergency!

The characters, thus far, are the clear win. They remind me of people I've worked with. The conversations with each other and practical jokes are akin to things I’ve seen or done in my years in EMS. The personal issues regarding relationships are something I’ve seen many times, and the relationship between partners seems to be accurately depicted.

The nicknames are a nice touch, and something VERY common within Emergency Services. Many newbies acquire nicknames. Sometimes you get to grow out of them, sometimes you don’t. I’ve seen several places where active members don’t know someone’s real or full name, because they only ever refer to that person by a nickname or their last name. Some of the nicknames are based on something in particular, and in other cases, they are assigned seemingly at random. “Why Pedro? Because there were already two John’s”.

I have 2 issues with the show. One is professionalism, and the other is the actual medical care.

Professionalism: Making fun of a patient’s disability - like temporary deafness, isn't funny. I think the show can have just as much fun, while ALSO highlighting the professionalism of the providers and their patient care. On the flipside, I recognize that a 20-minute show doesn't provide a lot of time to showcase both patient care AND witty dialogue, but I hope the show’s writers can find a way.

As for the actual medical treatment: It seems overly dramatic at times, and they seem to not spend so much time focusing on standard treatment. Guess what… it’s TV, not real life. Further, this isn't the first show to have that problem - ER, House, and even Scrubs often focused on “zebra” diagnoses over standard treatment. My biggest gripe is that

I also have a question - What is the level of provider? Are they EMT-Basics? Paramedics? It would be a great opportunity to highlight the different levels of training, and the fact that the more advanced prehospital providers have 1.5-2 years of schooling, if not a college degree.

Anyway - Thus far, I think Sirens has potential. If you can get past the “TV Medical” issues inherent in every show, it’s worth a watch. Further, I think the characters are solid, and there is a FUTURE in this show.

Anyway - Catch up, and watch the next episode Thursday!

http://www.usanetwork.com/sirens

Plain Speech

“Medic 3 to Dispatch”…

“Medic 3 to Dispatch”…

…

…

I look at my partner… “why aren't they answering.”

My partner says: “why are you calling them Dispatch? Try calling County”.Terminology… the downside to my nomadic life.

Post 9/11, everyone in public safety went to “plain speak”… we no longer use obscure 10-codes, and instead use regular speech. Sounds like a great idea. Except there are still plenty of regional differences.

What do you call your communication center? Depending on where I am, they are County, Communications, or dispatch.

What’s a “Medic Unit”? – In most systems I work, it’s an ALS ambulance. In one, it’s specifically a dual-medic unit, and in another, it’s a single medic in a chase car.

What happens when you get cancelled from a call? Depending on where I am, I’m either cancelled or recalled. One place, I document that I was “placed in service.”

As part of my company’s response to Hurricane Katrina, I had the opportunity to work with providers from across the country. We noticed that for describing a single unit, we had 8 different words, Unit, Squad, Truck, Ambulance, Medic, Bus, Rig, and Car.

Working with 4 different dispatch centers can be entertaining. I often find myself hesitating before speaking on the radio, making sure I’m using the correct version of plain speak for that service.

Plain speech isn't a one-size-fits-all solution. In any area, plain speech can be its own code.

Crossing the Floor

For those of you that don’t know, I’m currently challenging myself by taking Fire I. I grew up volunteering with the local Volunteer Fire Department, starting in the Explorer post at 14, and spending 5 years as an active member. At the time, I was more interested in EMS than Fire, and in addition to attending EMT school, I did a lot of training at the department level for firefighter… but I never completed an official fire academy.

For the last year, I've been a member of a volunteer department within the Prince George’s County Fire Department in MD. I've been reminded how much I missed doing the fire stuff, and how fun it can be. PGFD is a busy system, and is the closest a volunteer can get to being part of a large urban department. From my perspective, we all play by the same rule book, and everyone gets along (usually). It’s busy, and my station operates with volunteer staffing on evenings, weekends, and holidays. We have career staff 7am-3pm Monday-Friday, but volunteers cover the rest.

I’m most excited to be riding on the Rescue Squad. The Squad is a heavy rescue truck, or a toolbox on wheels. From vehicle extrications to industrial accidents, to technical rescue, they do it all. The knowledge in the firehouse is amazing, and many of the members are eager to share their experience with those willing to learn.

Anyway – because I never did fire school, I've got to start from scratch. I did the County’s volunteer recruit orientation program (Fire Service 101, and some other needed stuff), as well as completing in house training on our apparatus, including equipment operations and locations, as well as SOP familiarization (Standard Operating Procedures). I’m riding fire apparatus as an exterior firefighter. So I’m riding the rescue for calls. I can also assist with tasks outside the fire structure, like throwing ladders or other operations – but I’m not allowed to put on an airpak and go in to an IDLH (Immanently Dangerous to Life and Health) atmosphere.

It’s a blast. I realize how much I missed it. Stay tuned for more posts from the fire side.

EMS Today 2012 - Part 1

I came into Baltimore Wednesday night in time for the EMS 10 awards. It was great to see Tom Bouthillet get an EMS 10 award for the EMS 12-Lead blog (http://ems12lead.com). Oh and let's not forget about the rest of his team - David Baumrind and Christopher Watford.

Congrats to Tom and the rest of the award winners, and a HUGE thank to to PhysioControl for putting on the event and inviting me.


Then it was off to Pratt Street Ale House for the EMS 2.0 reunion. Gotto see Random Ward (haven't seen him for all of 3 days), MedicSBK, Ted Setla, Chris Montera, and the rest of the gang. Also got to meet a fellow Ham Radio geek that I've known online for a few years... Good actually meeting you, James!

Looking forward my first sessions on Thursday.

Trying to Get a Leg Up

 While I’ve met a LOT of cool Fire and EMS bloggers (and know quite a few LEO and Firearms bloggers), I’ve got a new favorite blog. Sorry, it’s not my buddy Chris at LUTL (my old favorite)… It is a new addition to the blogosphere: Joe Riffe over at Prosthetic Medic (http://prostheticmedic.blogspot.com/).

Joe’s got a pretty heartbreaking story… He’s a paramedic with Louisville Metro EMS. He was hiking one day, slipped and fell into a waterfall, and has made the tough decision to have his lower left leg amputated. His hope is that as he heals, he’ll have more function with a prosthetic lower leg than he can hope to have with his current foot. His very real dream, is to become a Prosthetic Medic, and return to full duty. He’s been posting a LOT, and I’m looking forward to following his recovery.

I’ve been following his posts for about 2 weeks, and today, he’s been admitted to the hospital to have his amputation. Joe, I’ve never met you, but you’re a member of the great brotherhood of Paramedics, so I hope you are able to achieve your goal, and I hope your operation goes smoothly.

Up In Smoke, and why is EMS treated different then other employees?

Nicotine Tests Could Cost Fla. Medics Their Jobs

http://www.emsworld.com/article/article.jsp?id=17983&siteSection=1

The above article is the top news story on www.EMSWorld.com right now. Long story short, it appears that the county is now in the EMS buisness, so the EMS employees are now County Employees. The policy change doesn't go into effect until October of this year.

I've never been able to understand why so many people in EMS, the fire service, and LEO's smoke. We've all seen people dying of tobacco-related cancers. My favorite irony is seeing a firefighter come outside from a fire, and take off his mask on his way to rehab... and light up a smoke. If you really want to inhale smoke and carcinogens, why bother wearing a pack?

To be honest, I'm of mixed opinions. While I personally, don't smoke, and can't understand why people do (it's disgusting and harmful to your health). I don't see that my employer (especially a government employer) has any right to tell me what I can and can't do when I'm NOT at work/in uniform.

My biggest concern of the whole article, though, is this line:

“The nicotine test only applies to uniformed workers, like law enforcement. Paramedics and ambulance crew members will be required to take a nicotine test starting on Oct. 1.”

Why does it only apply to uniformed workers? Is there a different policy that applies to the rest of the county employees? The ones that sit behind desks all day, and get real lunch breaks? The article isn't clear, and I can't find anything else quickly online – If someone can enlighten me, I'd appreciate it. If there is no policy for the “office dwellers” - than this policy is out of line.