Experiences

So Ms. Paramedic posted about her EMS Kryptonite and more importantly she accurately identified that everyone in fact has one. Yes, you have an EMS Kryptonite and believe it or not so do I. This is the story of the call where I discovered exactly what it was…

It was spring 1996. I was working with my regular partner at the time, da Silva Bullet, and we had just cleared out of Bellevue from dropping off a nursing home patient with your typical non-functioning gastric tube and sepsis. The dispatcher then sent over a page for us to respond to a medical building a few blocks away on East 34 Street for an overdose.

“An overdose? Did they have one too many cans of Ensure?” I joked as we took to the street.

“You never know. You just never know,” my partner said with a laugh.

Now personally, I love medical buildings. I love them for the simple fact that I can go in straight away with the stretcher. We’ve been to this building and quite a few of its offices before so we pull up, get the stretcher with all our gear out, and walk into the lobby with it’s marble floors and doorman who happens to be higher paid than we are.

“What floor?” the doorman asks as he follows us to the elevator bank where I press the button for the cargo elevator.

“Tenth floor clinic,” my partner replies as the elevator chimes and the doors open to reveal a large elevator draped with protective moving covers.

The doorman nods and then asks, “Which one?” I look at my partner, he looks at me, and we both shrug.

“We’ll figure it out when we get there,” I answer as the elevator doors slide closed. Up in the elevator we went to the 10th floor where the elevator chimed again, the doors slid open, and we stepped out.

There were three different offices on the floor. There was a radiologist, a psychiatrist, and some sort of laser procedure office. I looked at my partner as he looked at me. We both shrugged and started with the door on the left.

The radiologist receptionist, never looking up from her copy of Cosmo to either look at us or call anyone, denied that we had been called for anyone there. The psychiatrist receptionist did indeed look up, and even called into the back, but alas there was no one in need of an ambulance… at least not yet.

I have to be honest, I was pretty perplexed by the location and the call type. I mean really, are we talking about an overdose of gamma rays? Was the Incredible Hulk waiting to smash me in this clinic? Or maybe someone had a hole burned through their head? That surely would be interesting. “You know, I’d think it would be a burn call or something coming out of here,” I said as we strolled with our stretcher into the laser clinic.

“Who knows what it could be? It isn’t like the call takers and the call makers are the brightest of the bunches,” my partner gently reminded me that accurate information regularly failed to flow our way.

As we walked in the door a woman from down the hall scurried our way. “Oh thank goodness your here! Right this way!” she called, motioning us down a hallway. We walked to where she was standing and she opened the door into an exam room.

As I followed her into the room I was greeted by the face of a pale and serious looking man in a lab coat… and a pair of stiletto high heels pointed at me over his head. “Glad your here,” said the man as my eyes wandered past the stiletto heel to the dark stockinged ankles, further up the leg, and that were then sheathed in a black pair of pants before my vision was blocked by the angle of the chair they were reclined in. “She was prescribed some Valium as a sedative before the procedure and instead of taking the prescribed dosage, she took six times as much as she should have,” the man continued to explain.

“I’m assuming her blood pressure dropped out?” I asked as I stepped inside and to the right so that my partner could follow inside.

“Yes, it dropped out so we put her in trendelenburg and gave her oxygen. The blood pressure was 80 over 50 sitting up,” he said. From the right side I could see a bit more of the patient, a silk blouse, brunette hair, and her hands (that were being held by a friend who was a small petite dynamite looking blonde) were manicured with bright pink nail polish. It was obvious that this was not our typical nursing home patient type. I figured she was probably here from some Lasik surgery for her vision and the nerves got the best of her.

“Can we put her supine so I can take another blood pressure,” my partner asked. The man nodded, said “Her only history is a severe case of Hirsutism,” and stepped to the left side so he could adjust the chair. I had never heard of Hirsutism, but it didn’t sound contagious since it was an “ism” disease.

“Which hospital would you like to go to?” I asked in general as the chair began to move.

“We’re from California, so it doesn’t matter to us,” said the small petite blonde friend. California? Why would you fly across the country for eye surgery? When I looked up I realized why…

This beautiful young girl had more facial hair than I did. She had a full blown goatee. For a second I was shocked… and then… then I felt it. My lunch was coming up, and it was coming up quick! I turned and thankfully the door was clear… so I exited the room and proceeded to projectile vomit my ham and swiss cheese sandwich down the hallway.

I couldn’t believe it. I had seen tons of blood, been knee deep in urine and feces, laid my hands upon the lower intestines of a patient, seen a decapitation, smelled the decay of a heat wave death and NONE of that had ever made me feel queasy, let alone vomit in front of a patient.

My partner came out and asked, “Dude, are you okay?”

“Yeah, I think I can do this,” I said wiping my mouth with a napkin, “I just can’t look at her.” I grabbed the stretcher, wheeled it into the room and just kept my gaze away from her. I stood behind the stretcher while we walked and when we lifted it in (because back then we had to actually bend down and lift the patient on the stretcher) I did so facing the street.

She really was a very sweet person from the sound of the conversation in the back… I just couldn’t bear looking at her or I might have ended up sliming her in another purge of my own stomach contents. Afterwards, I felt really bad about what she must have thought about not only me but more importantly herself by my reaction. Sure I still got the job done, but I got it done by probably making the patient feel worse than they already had which had caused them to fly across the country looking for treatment.

And that was how I discovered my EMS Kryptonite… and how I finally knew what I had to prepare for. It’s true that I still become queasy when I meet a woman with more facial hair than I have, but hopefully I can make the call happen without making them more self conscious about their condition than they already are.

Have you discovered your EMS Kryptonite yet? Feel free to share in the comments or in a blog post of your own…

Facebook is really an interesting platform. The barriers to participate are limited to an internet connection and the basic understandings of e-mail and web browsing. Because of this low barrier it can provide a bridge where the generational gap is narrowed. Not so much on thinking, but rather on communicating. While there is evidence of this on many levels, the recent comments on the JEMS links regarding the situation in Pittsburgh has really highlighted it for me personally.

To illustrate my point here is a screenshot of a comment left by Larry Grayam. Now there are dozens of comments like Larry’s, but his stands out to me for a specific reason that I will get to.

First, I find it impressive that his first EMT class was in 1968. I was always under the impression that the designation of EMT didn’t start until the 1970’s after the disastrous 1960’s jigsaw puzzle of Red Cross certifications, but that’s really a minor point. Back then I know that latex gloves were not in fashion, portable oxygen was a luxury, and no one had yet invented the plastic disposable cervical collar. Today latex gloves, high concentration oxygen, and disposable c-collars are all commonplace and have become the “standard” of treatment. There are other such comparisons that can be made, but I think you understand my point.

What is also different today, as Larry points out, is back then “THE PATIENTS NEEDS ARE ALWAYS YOUR FIRST PRIORITY. It seems that our new modern EMS has not learned this simple lesson.”

Today we are about Body Substance Isolation (BSI) and Scene Safety. You as the provider come first, everyone else is second.

Why has this changed from Larry’s days as an EMS provider?

So let’s be honest, we have learned this simple lesson. We learned that when patients transmit diseases to us through blood or urine, we are the ones who have to live with their past indiscretions. We have learned that when we emotionally invest ourselves in the well being of our patients, we become emotionally divested from our families and we are the ones living in broken relationships. We have learned that when we physically place ourselves in harms way, we will be forced to fight for the financial ability to get the help that we once provided access to for others. We have learned that when we make the ultimate sacrifice, our sacrifice will not be acknowledged or will be overshadowed by the same exact sacrifice as other professions in the eyes of the public.

The fact is we learned that it is not in either the patient’s best interest or our own to continue with such a blind mentality because at some point… we’re just not going to be there anymore whether it be from illness, injury, mental instability, or death. So tell me Larry, then what happens to the patient?

Now this is not to say that EMS providers should not be compassionate and as you may or may not know I am an advocate for caring rather than treating. This is not saying that we should not put in a solid 666% effort to do everything we possibly can to reach, care for, and transport a patient. Yet, I’ve learned my lesson about exactly what happens when you place the patient first above all else. I learned it when I got divorced, I learned it when one of my partners got stuck by a dirty needle in a patient’s pocket, and I learned it when 220 stories of concrete and steel came down taking my friends and partners (who were busy putting the patient first) away… forever.

See, I’ve learned it Larry (and everyone else from that era with this antiquated thinking) and in an odd way I’m really glad that you and your partners never had to.

I like Twitter.

I stress the word like because I find it useful for some things, but not so useful for many others. This doesn’t mean that I don’t believe in it’s power or it’s influence, just that I recognize the limitations the tool has and my expectations don’t exceed it. It’s important to remember that as you read on.

So in the same vain of answering Greg’s question, I am now going to answer a question most recently asked by Steve Whitehead on Twitter that deserves more than 140 characters will allow:

Can The Real Protocol Please Step Forward?

There is a reason why medicine is still considered an art.

You can have two patients with the same complaint, but because of having vastly different histories the same treatment applied to both may help one but harm the other.

This is one of the reasons why you will find some vastly different protocols across the country. What works well for some areas may not work well for others, and what works well for some patients may also not work well for others.

In My Experience

It’s important to understand that I am New York State Certified, so my experiences are limited to working within NYS Protocols. On the fifth page of those protocols under the Introduction heading appears this paragraph:

God bless the New York State Department Of Health Bureau of EMS.

The Continuing Problem

Unfortunately, even with that paragraph there, it still leads to problems. EMT recruitment is as easy as checking the ABCs. If you’ve got a pulse and can breathe you can become an EMT. The current education is centered around the protocols and complying with them as opposed to independent thinking with good clinical judgement, because by not following them you run the risk of being held liable if anything goes wrong with the patient.

Why is that 90 year old patient with osteoporosis strapped to a backboard after falling out of bed? Protocol.

Why is that hyper-ventilating patient suffering from an anxiety attack wearing a non-rebreather set to 15 liters per minute? Protocol.

Why is that patient sitting on a roadside construction sign (next to the car he was in when rear ended ever so slightly and obviously got out of) being strapped into a soft Spinal Immobilization Vest? Protocol.

Burn The Protocol Book, Care For Them All, Let The Triage Nurse Sort It Out

I once had a paramedic who would always refer back to the protocol book. If you were turning cyanotic and gasping for breathe in the tripod position in front of him, he would take a minute to look it up in the protocol book before giving you some much needed oxygen. This over reliance on protocol is a bad indicator that our education model needs to be revamped, our recruitment methods are not working, and that we are more concerned with the potential lawsuit down the road than we are the patient in front of us.

If that paragraph didn’t exist in the NYS Protocols, I probably wouldn’t be in EMS anymore today. Heck, I probably wouldn’t have made it out of my first year because strapping down 90 year old patients with osteoporosis is just not something I think I could actually do with or without legal “justification”.

Which is another thing I blame protocol for. EMTs and Paramedics use protocols as justification for providing treatment that doesn’t benefit the patient, but benefits them. Such as taking the patient to the nearest hospital as opposed to the hospital the patient has a doctor at. Sure in a perfect world hospitals would be able to share records, test results, and other information… but right now they can’t. It’s a major shortfall of the healthcare system that we won’t be able to solve, but for that specific patient we may be able to alleviate that issue as well as some anxiety by simply taking them the extra mile (or five) to where they already have received treatment.

Finally, I hate protocol because so many people think that providing patient care is a black and white issue when it is far more complicated than that. Sure protocol can provide you guidance on the basic treatment a patient should receive, but it doesn’t provide you with a methodology or the tools to provide exceptional patient care. As I said before, there is a difference between treating and caring for your patients. Which one would you rather do? Which one would you rather be on the receiving end of?

I say burn the protocol book, care for them all, and let the triage nurse sort it out.

This post is solely representative of my own opinion and using my local protocols as an example. It’s important to educate yourself on your own local protocols and adhere to them as required. I am in no way advocating violating protocols just for the sake of it.

This past Friday I got my large French Vanilla ice coffee light with cream and with four Splendas, set my iPod to listen to podcasts, and hit the road to Baltimore for the EMS Today Conference in Baltimore. The trip was pretty uneventful, making one stop at the Walt Whitman rest area for… well… rest, and arrived in Baltimore around 12:15.

I parked by the M&T Bank Stadium (where parking for conference attendees was free) and walked the 4 or so blocks over to the convention center. Once there I checked in to get my conference badge from Lauren who was extremely helpful and answered all my important questions… namely where I could find the restroom. Did I mention I drink large coffees? So of course right after that break, I got an ice coffee from the lobby Starbucks, where I was glad to see that the decline in customer service at Starbucks was not just a New York City phenomenon.

Once done there, I descended to where the exposition hall was. Going down the escalator was what looked to be an 8-10 foot tall banner from Zoll touting some of their exhibits… including a panel for The Chronicles of EMS. I have to say that it is great when innovators support innovators, and that was just one of many examples of that I saw while there.

Entering into the exhibit hall I went left and began going up and down the aisles checking out vendors and their products. I’ve gotten pretty used to doing exhibitions, so I walk in the middle of the aisle unless I see something I’m interested in. If a vendor throws a hook my way in an attempt to real me in, I’ll generally start off by asking, “What’s the price point?” which usually makes them wince. I’m not a fluff kind of guy, I’m all about the bottom line. This is kind of my way of really saying “I’m not interested in your product which is probably overpriced, but thanks anyway,” and most of them back off. I was pleasantly surprised that there weren’t very many of those at all.

Finally I reached the Zoll booth which was actually right by the entrance only in the complete opposite direction from where I had headed when I first walked in. As I looped around the booth grabbing some literature and checking out the latest Zoll innovations, I found myself looking at none other than Ted Setla (@Setla).

So I approached him and said, “Hey, I know you!”

He looked at me with a slight look of fear before there was that spark of recognition… and thus began the rush of meeting face to face those who I’ve been conversing with over the past 11 months or so. Ted and I talked briefly about his set-up and what was going on so far at the show. He explained that Justin and Mark were down the aisle at the live podcast for EMS Garage (@emsgarage), and then I was able to turn an old partner of mine who spotted me there onto Ted and the Chronicles of EMS.

Leaving Ted to continue to swoon the passerbys at the Chronicles of EMS Booth, I wandered down to where the EMS Garage was doing a live podcast. It was a standing room only crowd, so I stood off to one side in order to get a good view. Then I worried that I might be violating fire code by blocking a fire lane because it was pretty crowded for the podcast, and I moved closer to a a beautiful tall redhead who I completely accidentally bumped into. She turned to me, turned away, and then quickly turned back and said, “Oh my god. I know you.” I had literally just bumped into soon to be Paramedic Epi_Junky of Pink Warm and Dry. Imagine that coincidence!

The live podcast was featuring Justin Schorr (@thehappymedic) and Mark Glencourse (@ukmedic999) who had to depart mid-stream for their presentation back at the booth Ted was holding down. The host Chris Montera (@geekymedic) then called up Jamie Davis (@podmedic) and… of all people… me to come up and join him!!!

You can watch the video that was live streamed of the podcast by clicking on the picture above

After extolling the virtues of Social Media for EMS Agencies and soliciting fertilization for my farm in Farmville, I finally had the opportunity to actually meet Jamie and Chris who are incredibly passionate about EMS and Social Media. There can be no better advocates for that marriage than those who are turning out high quality content… and those two are definitely at the top of the list.

While basking in the afterglow of the live podcast I also was finally able to meet the fabulous Chris Kaiser (@ckemtp) who I constantly find myself nodding in agreement to his blog posts and I found myself doing the same thing in his presence as well. I was also afforded the opportunity to finally meet Rhett Fleitz (@firecritic) who I’ve corresponded with numeorus times about all sorts of issues and his podcast partner John Mitchell (firedaily). This was closely followed by meeting Justin Schorr and having a nice conversation with him about the going ons and how word about #CoEMS is spreading. At this point, pretty much everyone went their own way with plans to meet up later that night at the big Blogger/Tweeter Meetup… and I once again found a restroom. Did I mention the Starbucks Coffee was large too?

After using the fine facilities in the exhibit hall, I still had about an hour before me lecture to kill, so I found a nice comfy spot on the second (third?) floor. While I was there checking Twitter and some e-mail, I was approached by none other than the EMS Blogfather Kelly Grayson (@ambodriver) and his friend. I don’t remember exactly what was said, because I was in shock that THE Kelly Grayson had felt the need to come over and introduce himself to me. It was a shocker moment which I shared on Twitter:

My girlfriend was concerned by that tweet, and called me. That conversation went something like this:

Her: Is everything okay?
Me: I just met Kelly Grayson!
Her: Kelly who?
Me: The EMS Blogfather, Kelly Grayson!
Her: I have no idea who that is.
Me: You know the book that sits ontop of my computer? He’s the one who wrote it!
Her: Oh. Cool!

Now I’m not always the sharpest tack in the box, because after that conversation with her I realized that I also potentially met another iconic EMS Blogger who prefers to preserve his anonymity. I happen to have alot of respect for anonymous bloggers because I think others undervalue or overlook their contributions simply because they don’t use their real name. It’s not the blogger’s identity that matters, but the content that they produce. Anonymous bloggers usually have to build a bridge of trust from the ground up by providing solid reliable information instead of the trust that gets afforded to you when you disclose your name and service. So a hat tip to that gentleman for remaining fiercely independent.

So after my session, which ironically (or not) was about Social Media, I headed over to where the big EMS Blogger Meetup was at the Pizzeria Uno. There I got to continue chatting with those I had met earlier as well as finally actually meet Mark Glencourse, and we even shared a Kodak moment that you can see somewhere out there on the internet. I have to be honest, the excitment that Ted, Justin, and Mark have for the Chronicles of EMS is not only off the charts but damn near contagious, and that can be a strong catalyst for the change we need.

I also had the opportunity to meet Mike Ward (@fossilmedic), Chris Eldridge (@thedridge), Sebastian Wong (@sebwong) and Carissa O’Brien (@carissao) who insists that I trademark my eyebrow. The conversation was interesting, the gossip about who else was going to join the “FireEMSBlogs.com” lineup was entertaining, the experience enlightening, and the food was delish.

Unfortunately, the clock struck 10 and it was time for me to make my departure since I still had a 4 hour drive ahead of me after my 1.7 kilometer walk back to my truck. Leaving such fine company was a bit sorrowful. There were conversations that had started online concluded, and in their place new ones arose in person that undoubtedly will be continued online. It served as an important illustration of what effective communication among passionate people can accomplish, and the power that Social Media has in helping that along.

The heat from the freshly minted summer season was coming off the pavement in waves as we rocketed down the southbound Van Wyck Expressway. “Why did we get dragged down here again?” I asked while whipping the steering wheel to the left as we rocketed off the Van Wyck Expressway and down onto the Belt Parkway.

“The Far East is hopping and they dragged all the Jamaica units to The Rock already,” explained Freakzilla as he calmly pulled up the history of the call that was unfolding, “Add in the munies getting toned out no radio response. Time for their overtime tour change.”

Being pulled into another area was par for the course on 51D. Even though our official Place At Rest (PAR) was located in the 112th Precinct, the Computer Aided Dispatch System (CAD) that FDNY used incorrectly identified us as being in the 102nd Precinct. Due to its 1980’s antiquity the system would then recommend us first for a call that would be 9 miles away while a call that was literally around the corner from where we sat would go to another unit… while we were sitting there. Of course with the warmer weather came a higher call volume, more municipal units out of service from seasonal Line Of Duty Injury (LODI) leaves or vacations, and therefore we voluntaries were left to pick up the slack, which at times involved us traveling to places the computer estimated well beyond our usual under 10 minute travel time.

We still beat the computer every time.

Our journey ended on a softly lit street lined with manicured lawns in front of one family homes in a Queens/Nassau County borderline community. We parked in front of a fire truck that was disembarking the local firefighter first responders. Freakzilla pushed the button to signal our onscene status as I climbed down from the cab and walked around to the side of our truck. Slinging our combination trauma/oxygen bag across my back and grasping the stairchair in one gloved hand I began sauntering towards the side entrance where the firefighters were beginning to make a lined and orderly entry.

As I stepped onto the porch in the wake of the wafting scent of half-burnt barbecue I saw a slightly balding tall man with a grim scowl standing on the other side of the procession. His arm was wrapped around a softly sobbing woman. Once I reached the couple I placed my free hand on the woman’s arm and asked, “What’s going on?”

The woman looked up at me with red puffy eyes. She was incapable of speaking and turned to the man. With a somber voice he said, “Her sister is in the upstairs hallways. I don’t know what’s wrong with her. She’s barely conscious.”

As I was about to question him further, Freakzilla interrupted me from the doorway, “Dawg, watch your step. These bags are full.” I turned towards the doorway only to watch him walk through and into what appeared to be a cloud of haze in the well lit house. I released my hand from the sobbing woman’s arm and moved into the entranceway of the home.

Once I stepped inside there was a definitive climate difference. The air was hot, humid, stale and rotten. I was standing in a large living room that took up most of the first floor of the house and was filled with white tied shopping plastic bags with a variety of print on them.

Thank You said one.

Come Again said another.

Where I was standing they were abruptly up to my waist and progressively rose to the height of the ceiling against what were supposed to be the front windows. I carefully followed a very narrow path that had been cleared leading to a staircase. As I began my ascent, bags started flying over the banister into the main room. Upon landing some of them opened and spilled their contents out.

Feces from one bag.

A take-out food tin with some sort of yellow goop from another.

“What the hell?” I asked not sure who, or what, was tossing this shit around.

“They’re all over. We’re just clearing a path to the patient so you guys can get her out,” explained a firefighter from the top of the staircase, “It looks like she hasn’t left here in over a year and at some point, the toilet stopped working.” I finished my climb and followed another firefighter’s pointing finger to the end of the hallway where Freakzilla was finishing a set of vitals on a pale hefty woman in a state of undress who was slumped against the wall on her toilet.

I unfolded the stairchair as he undid his blood pressure cuff. “We need to get her out,” he said unfolding the sheet that had been on the chair seat. “It looks like heat stroke but we can’t treat her here. There are fleas and roaches all over. I don’t know what else and I really don’t want to find out.” I nodded in agreement and moved in to grasp her under her arms. Once my hands were locked, my body pressing against her hot pile of flesh, Freakzilla nodded his head and scooped her legs. With a pull and a twist she was in our chair. After another quick adjustment we wrapped her in the sheet, more as a protection of her modesty than anything else, and strapped her into the chair.

I glanced around the cramped room. The wallpaper was peeling with dark brown stains from the ceiling down in long streaks. The mirror appeared to have spots of fungus growing on it, and was cracked open enough to reveal a medicine cabinet with brown medication bottles strewn on its shelves. “What’s in there?” I asked nodding my head towards the medicine cabinet.

He glanced back before saying, “It’s all empty psych meds. The scripts are over five years old. It’s definitely a cocktail for depression, maybe some schizophrenia or bi-polar on the side. I’m not sure what she’s supposed to actually be taking and I don’t think the family actually knows either. The guy told the firefighters its their first time here in over a year at least, if not more.”

I carefully pulled her out of the room and was able to swing her around so that I could push her instead. Freakzilla reached into the bag strapped to my back and pulled forth a non-rebreather mask, running the oxygen hose over my shoulder, and then he placed the mask over the patient’s face before stepping in front to lead the way.

“One David are you in here?” called a voice from the doorway, “It’s medic Four Young.”

“Yeah we’re coming down with the patient,” I called back, “We can’t treat up here. Get your truck set-up for a heat stroke.”

“Yeah we see the problem. We’ll meet you outside,” the voice called back. With that Freakzilla grabbed a hold of the bottom of the stairchair and we carefully carried the patient down while the firefighters made the original path wider so that we could wheel the patient out. Unfortunately once we got down we realized the path still was not wide enough as the new bags were pushing down forcing others further out. Instead of accidentally ripping one of the bags open and spilling its contents out to step in or roll through, we carried the patient right out the doorway and into the cool, crisp, and clean air outside.

As I came through the door I could hear a cracked voice screeching, “It’s not easy! Don’t judge me! It’s not easy!” cried the woman who had been unable to speak less than five minutes before. “Don’t you judge me! You have no right to judge! It’s not easy!” she continued to screech as Freakzilla and I carried her sister past her and down to the path that lead to the street.

“It’s not easy…” she sobbed as we rolled her sister to the waiting medic truck, …to love the mentally ill… echoed in the silence of my mind.

No. It’s not easy.

The stories on this blog are in compliance with HIPPA regulation. Identifying details have been changed to protect the patient’s identity. If you think I am talking about you, I assure you that I am not.

In March 2000 I opened The Parkway Hospital EMS Unit 51 David (51D). The unit was dispatched by the Fire Department Of New York Bureau Of Emergency Medical Service to emergencies and incidents that were called in through the New York City 911 system or from either the FDNY Fire Suppression Communications Center and the New York City Police Department. The unit served primarily western Queens from a home atom of 102A. The assigned Cross Street Location (CSL) for the unit to standby was at Queens Boulevard and Union Turnpike.

We were the only unit to come out of The Parkway Hospital for over a year and we entered into a cut throat territorial system from which we had to carve our piece. During my time there I worked primarily the overnight shift starting my week on a Thursday night and ending on a Sunday night. They were 12 hour tours, 48 hours a week, and 36 of those hours were usually spent with my partner known as Freakzilla… and I could have asked for no better. We were The Lone Wolves In The Wild Wild West.

With an average nightly call volume of 10+ calls, there were a lot of things we did. There were a lot of things we saw. There were a lot of people we touched… and who touched us with their stories. Due to things beyond our control, both political and budgetary in nature, in May 2005 Freakzilla and I took truck 5900 on it’s last ride as 51D. While the unit may not be in the system anymore, its spirit of having the knowledge, the ability, and the desire to get it done lives on…

The squat two story red brick building was deceiving from the street. While it’s length ran half the block, it actually went an additional two floors below street level. The metal grid covers on the windows behind the wrought iron fences surrounding the building weren’t there to keep people out. It was to keep people in.

“What do we have?” I asked my partner.

Freakzilla reached over and pressed a button that momentarily bathed his face in the green light of the data terminal screen before he swung it over so my eyes could read the blazing letters. Emotionally Disturbed Person. Segment 7. Violent. Wait for police. With no sign of a sector car on the street, Freakzilla hopped out to grab the bags. This wasn’t anything new. This was just how we rolled. I got out of the truck and walked to the side of the ambulance where he was pulling the bags out. I grabbed the stairchair and shut the doors.

We walked up the gradient staircase to the front door of the facility. ONLY AUTHORIZED PERMITTED. IDENTIFICATION REQUIRED. CURFEW 10:00PM SHARP was emblazoned on the door. He swung it open and we walked through the vestibule to the second metal door with it’s glass on top giving a view of the actual lobby. Through the glass of this door we could see the front desk and the man sitting casually atop it. He was dressed in the blue blazer uniform typical of these types of facilities and mindlessly thumbing through a supermarket rag magazine.

Freakzilla knocked on the glass. The man on the desk did not look up. Freakzilla knocked on the glass again. The man on the desk still did not look up. Freakzilla looked at me, and I swung the chair against the door like a baseball bat with the loud thwacking sound of the metal on metal reverberating through the vestibule. The man jumped up suddenly at the sound and hurried to the door. He fumbled with the keys on the ring before finding the right one to insert into the lock, turn it, and let us in.

“You called 911?” asked Freakzilla as we casually walked through the door.

“Uh yeah,” the man replied as he quickly inspected the door to see if there was any reportable damage. The bottom of the door had multiple dents, dings, scratches, and paint chipped away that he couldn’t really tell if anything was new. “It’s downstairs in bee level,” he replied as he closed the door and relocked it. “I’ll take you down. Follow me.”

We descended down the dimly lit staircase to the sounds of babies crying over televisions and the mixed smells of macaroni and cheese with rice and beans… all typical of a New York City family homeless shelter. The blue blazer lead us to a door with it’s lime green paint chipped away to reveal the metal underneath in various locations. He made a motion with his hand towards it and then stepped back.

I stepped up to the side of the door jam while Freakzilla stepped to the other side. There was a loud female voice and a lower male voice coming from the other side of the door, but we couldn’t hear what they were saying. I looked at Freakzilla and he nodded. I made a fist and pounded on it three times before calling out, “EMS.”

The arguing from the other side immediately stopped and we could hear the three shuffles to reach the door. The doorknob clicked and swung open. The person who had opened it was a female about 5 and a half feet tall wearing a worn gray and purple jogging suit. Brownish hair came out from the top of her head cascading into hues of blonde ending into semi-curls that hid behind it a face that was over coated with make-up to hide the wear and tear. Recessed into her eye sockets were brown pupils surrounded by bloodshot white.

“Thank God! Officers I need your help!” she cried, “I had $800 stolen from me by the bitch in that room over there!” She pointed a finger across the hall before continuing, “She took it and I need it back! I want…”

Freakzilla held up a hand to stop her and said, “Ma’am we’re not the police. We’re EMS.”

“EMS? Well how are you going to get my $800 back?” she asked, seemingly legitimately perplexed. “The other officers were of no help and I need that money!”

“So the police have already been here?” I asked, as the door across the hall clicked and opened slightly.

“Yes! They said they can’t do anything because I have no proof, but you have to understand, this is a mistake! I don’t belong here!” she cried, releasing her grasp on the door and allowing it to swing open. Behind her was a typical one room shelter apartment. There were bunk beds behind the door. On the bottom bunk was a man, and on the top bunk were two boys, possibly ages 11 and 7. All three of them were peering from different positions behind the wood from under the standard issue gray wool blankets they issue to prisoners and homeless families alike.

“What do you mean you don’t belong here?” asked Freakzilla, trying to ascertain the root of the problem.

“I don’t belong here! My husband lost his job a year ago! We lost our house!” she explained beginning to wave her hands around and turning her head from side to side to talk to both of us, “I am not one of these people! Do you understand me? I am not one of them! I lived on Staten Island for crying out loud! I am not one of them!” She turned specifically towards me and said, “I am one of you!”

One word popped into my mind. Delusional. It was a common thing to get called to these shelters for people who were having emotional breakdowns over their dire situation.

Freakzilla didn’t skip a beat, even though he had just been insulted by this patient, “Well we should take you to explain the situation to the doctors and maybe they can help you get to be where you need to be.”

“Really?” she asked, her eyes suddenly becoming wider and seemingly brighter.

“Really,” I lied.

“Can we all go?” she asked, motioning towards her family.

“I don’t think…” I began before she cut me off.

“I don’t want to leave them behind though!” she said, beginning to get riled up again.

“What’s your name dear?” I asked calmly, interjecting something benign into her once again rising adrenalin.

“It’s Cassie,” she said hesitantly before exhaling, “Cassie Smith.”

“Listen Cassie, I think its probably better that you go first and get things set-up,” explained Freakzilla, “This way they can rest here while you’re making the arrangements you need to. The quicker we get over there, the quicker you can get taken care of.”

She looked at us both through the stringy hair. We could see that her brick wall, like the life she had been living, was crumbling. “Oh, okay.” she surrendered after a few more seconds of contemplation. With a quick glance backwards she walked into the hallway and brought the door closed on her family…

This was in 2004. I often wonder about what happened to her and her family. Did she get the help she needed? Were they able to get back on their feet? Did they make it? That’s one of the downsides of this business. We touch people for 30-40 minutes when they are at their most vulnerable and then we’re out of their lives… and they’re out of ours.

As much as things change, things stay the same.

The stories on this blog are in compliance with HIPPA regulation. Identifying details have been changed to protect the patient’s identity. If you think I am talking about you, I assure you that I am not.

In March 2000 I opened The Parkway Hospital EMS Unit 51 David (51D). The unit was dispatched by the Fire Department Of New York Bureau Of Emergency Medical Service to emergencies and incidents that were called in through the New York City 911 system or from either the FDNY Fire Suppression Communications Center and the New York City Police Department. The unit served primarily western Queens from a home atom of 102A. The assigned Cross Street Location (CSL) for the unit to standby was at Queens Boulevard and Union Turnpike.

We were the only unit to come out of The Parkway Hospital and we entered into a cut throat territorial system from which we had to carve our piece. During my time there I worked primarily the overnight shift starting my week on a Thursday night and ending on a Sunday night. They were 12 hour tours, 48 hours a week, and 36 of those hours were usually spent with my partner known as Freakzilla… and I could have asked for no better. We were The Lone Wolves In The Wild Wild West.

With an average nightly call volume of 10+ calls, there were a lot of things we did. There were a lot of things we saw. There were a lot of people we touched… and who touched us with their stories. Due to things beyond our control, both political and budgetary in nature, in May 2005 Freakzilla and I took truck 5900 on it’s last ride as 51D. While the unit may not be in the system anymore, its spirit of having the knowledge, the ability, and the desire to get it done lives on…

Four years ago today I was travelling with a task force of 10 ambulances to North East Texas for Hurricane Rita relief operations. That experience didn’t solely provide me with an intimate knowledge about what works and doesn’t work in a disaster response, it didn’t just give me new found appreciation for Chef Boyardee, and it didn’t only give me the opportunity to further develop myself as a leader. It also gave me my first experience with the power of Social Media.

The Sabine County Letters

It really started innocently enough. A few e-mails passed back and forth between my company’s senior leadership regarding our progress.

I took the initiative to take those initial emails and provide more in depth narratives as to what was going on. While ideally it would have been a daily occurrence, working in a disaster area does not guarantee that you would have internet access. In the early days of the deployment there were some nights that Doc Croc and I would drive 2 hours to a town with cellular service to send the message from “The Range“. When I would finally get signal, I would also receive emails of encouragement and support from people throughout the company who had been forwarded my emails by others. The act of the creation of that media with the feedback that was therefore fostering a conversation is exactly what Social Media is all about.

In the end it consisted of 15 e-mails over the course of the 25 day deployment. Collectively I refer to them as The Sabine County Letters, but what they really were was my first foray into Social Media and is what I point to as the catalyst to get more involved in the practice.

Taking It To The Next Level

I am unequivocally a Social Media Evangelist. I believe in the power of Social Media to have the power to change people’s individual lives. I also believe that the same power could be utilized by First Responder Agencies to not only improve the preparedness levels and disaster response outcomes in their communities, but to also change the public’s perception of who we are and what we actually do. While I could sit here and pontificate on these points as I already have done, there is a point where we need to evolve and go to the next level.

In order to help Agencies and personally get to the next level I have co-founded PIO Social Media Training in a partnership with acclaimed educator Greg Friese of EPS411. Our mission is simple: empower Agencies to effectively engage in the creation of Social Media to achieve their own unique goals.

We are going to do this through different educational opportunities utilizing the very format that we are promoting. Our educational offerings currently include an email based Social Media Bootcamp for individuals and Agencies to help them get started using Social Media as well as 5 Reasons and Methods For PIOs To Develop and Distribute Social Media Webinars. Future offerings will include a Guide To Social Media Policies For Responder Agencies and The Social Media PIO Handbook.

Since Social Media is about the ability to have conversation, we also will be writing articles on the PIO Social Media Training Blog, you can find us on Twitter @piosmtraining, and also on our PIO Social Media Training Facebook Page.

It’s time for First Responder Agencies to become more involved with their communities effectively. Social Media is a tool that can deliver those results.

Learn how to do it at PIO Social Media Training.

Read the EMS Magazine article on The Role Of Social Media In EMS

Today is the 4 year anniversary of my deployment to north eastern Texas for Hurricane Rita relief operations. To be honest, its hard to believe that 4 years have actually passed since then. I remember things that happened on that deployment as if they occurred yesterday… but there are also times it does seem as if it was decades ago. Leaving the night of September 22, 2005 for parts unknown was as close as you could come to mixing adrenalin with fear and fusing it with NOS.

The first 27 hours of our deployment was spent traveling 1,253 miles on the roadways of I95, I495, I66, infamous I81 with its population of suicidal deer, I40, I640, I75, I24, I59, I459, I12, and I20 before being sheltered by Chief Rose Shaifer and the Vicksburg Fire Department in Mississippi as Hurricane Rita was making landfall directly ahead of us. I know that I for one was grateful for their hospitality in both the use of their firehouse to bunk in and for the hospitality of the Ameristar Casino in providing us with dinner that night and breakfast the next day.

Some people may find it extremely odd or out of place for a municipal fire department would aid a private EMS service. In the face of unknown odds and challenges, there is a certain camaraderie amongst First Responders irregardless of their service type. It’s important to remember that in the end, we are all doing this for the same basic reason.

Helping others when they are unable to help themselves.