My mind is constantly pondering the what-ifs of life, especially if it involves Emergency Response. I have been blessed in my life to be a part of just about every type of agency that provides services to people in crisis. They all differ greatly from one another, but have internal pieces that are the same between them that have to fit together like a puzzle in the face of disaster. All of these duties fall into the scope of a well organized incident command.
My description is in itself an Oxymoron, in the fact that well organized, and incident command do not go together real well. You can plan and train and hope that all goes well in a mass casualty incident, but it is rare that the real deal goes off without a hitch. As responders, we are all trained in the art of incident command and the need for it on scene. I call it an art, because it is open for interpretation. The idea is to have structure. A structure that is fluid and dynamic so to adapt to any situation. To provide a sense of calm and organization to an otherwise nightmare. Its like trying to put an egg back together.
I personally have been involved in many calls in which triage and incident command were needed. I personally find it to be one of the most difficult things to do when arriving at a multi-casualty scene. When there is a situation that is going to involve multiple agencies, using multiple resources, incident command is imperative.
To roll up to where people are screaming, and shouting for help, reaching out for you and you just have to walk past them to access the scene is tough. Triage is hard but effective. To do the most good, for the most people, with the least effort. We have always been trained to respond to the call, arrive on scene, get out and help the victim, that is impossible when there are 10, 20, or 100 patients. Here is a little tip to the non medical readers of this blog that may one day find themselves in a mass casualty event....If your sitting up and screaming at us for help, we are going to walk right by you..congratulations, your a green tag. Its the quiet ones we have to worry about.
Large agencies that have a heavy response load, are better at dealing with incident command and triage than smaller, ill equipped agencies. That being said, lets think about this..If we had to pick a department that we thought would be the best at it, who would it be? Lets say good ol' FDNY. Huge department, unlimited resources, vast experience, good command structure right? Do you think they ever planned on the events of September 11, 2001? Could you ever be ready for that? I figure they did the best anybody could do in that situation and they still had a ton of problems. A total breakdown of command at times with no accountability. Rogue responders roaming around doing their own thing, should we run? should we dig?
All of this to bring me to my real point of this rant.The Aurora Colorado theater shooting. A nut walks into the dark theater and opens up with gas grenades and bullets from an assault rifle. Just in that sentence alone, we know we need the response from 3 agencies. Law enforcement for an active shooter, fire department because of need for breathing apparatus, and EMS because we know we will have casualties, and probably a lot. A total of 70 to be exact with 12 that ended up dying. This was a true nightmare for responders.
I have listened to the full dispatch recordings and this is my opinion. A lot of people are saying that an awesome job was done by reponders, but there were a bunch of problems that I heard that I am sure they have addressed. I am not one to go behind people and second judge things, or armchair quarterback, but this is why I chose to mention it. Several people involved in the response have complained about the other agencies publicly, and the media has run with it.
First off, I know the dispatchers did an awesome job keeping things together and being professional. They received incoming calls and got the responders on the way, updating them every few seconds. There was an Engine company on scene really quickly, really before they had the info of the number a patients involved. They struggled to sort things out at first, and make a decision on where staging and command would be. This is time critical. That has to be determined quickly because that info has to go out with dispatch as additional units are assigned. Make your decision and stick with it, only move if it becomes a safety risk. responding units need to approach the scene from the same general location, and not get caught up by passing through the scene to get to staging. Ambulances were showing up on all sides of the mall and being flagged down by victims and officers to stop and take on patients, this was a major problem. Command could not keep up with resources, because they were not coming to staging. Command was trying so hard to wrangle these "hi-jacked" ambulances, that they lost the ability to send available units in from staging, they were just sitting there.
Now, as for law-enforcement. This was a tough one. They are charged with being the only ones that can really enter the scene. Active shooter protocol prohibits rescuers from entering the scene I am sure. Officers were encountering multiple victims with all sorts of injuries and calling them out. Without a secure scene, the medical help isn't coming. It ended up with officers trying to bring medics in, officers screaming on the radio over and over again for medics, and officers just giving up and putting victims in cars and racing them to the hospital. This probably saved lives, but was very problematic in the grand scheme of things as far as command goes. There was an incident command structure up and running, the only problem was that each agency was running their own. Numerous times, out of frustration, I heard a ranking police officer demand that the Fire captain in command meet him ASAP, almost like calling him out for a duel.
So they had command, but not a unified command. The commmanders of all 3 agencies should have been together so the left hand knew what the right hand was doing and so forth. I heard a lot of problems that could have been solved if just 3 people could have talked to one another. Pointing fingers at each other in the media is a mistake, and hurts your people. Get together, learn from it, fix it. It was a tremendous tragedy that is hard to manage in any aspect, but everyone in this business can learn from the mistakes.
So as we go forward in our day as rescuers, we quietly sit in our stations and read our books, watch our TV's, read training manuals and think about what we will do tomorrow when we are off. Remember this, there were responders doing just that on September 11th,2001, at 08:45am not knowing the world was about to change. Many of which did not come home that night.
Triage in the field is a nasty beast. While there, you fight a battle between emotions, knowledge, reality, and spiritual belief. It is only natural, on the day after, to start second guessing decisions made in the blink of an eye. You need to have faith in yourself and the people working with you and not dwell on the what-ifs, because that is where the demons live. Do your best, pray a lot, and stay strong because today is a new day and someone out there needs you.
Wednesday, August 15, 2012
Thursday, June 28, 2012
Ghost Towns
In working in EMS, you experience everyday life a little differently than everybody else you may know. It may not bother you to eat your lunch while your co-workers talk about blood and guts, but to see a bicycle laying in someones front yard brings back memories of a particular bad call you had with a child. I know that EMS workers have a warped sense of reality about the world around us. Some people that work in emergency services may have a spouse that also works as a responder so dinner time could be a time to vent and share, to maybe reset back to normal. I do not take my work home with me to share the things that I see everyday. There are two reasons; one, most people cant wrap their brains around some of the things that we get to experience, emotionally and physically. People think that they want to know, but its not like that, even when we are being "honest" we tend to sugar coat it a bit. The second is that we don't want to re-live it again, even for the sake of telling a good story. I cant tell you how many times I have been on a call that any major news company would kill for, but I go home and never speak a word of it. This is where pre-hospital medicine differs from other jobs such as law enforcement and fighting fires, what we do is a secret. The newspaper prints the calls the other agencies do, but not EMS. Could you imagine if newspapers had columns listing the medical calls and details of the patients...pretty scary.
My family thinks they have a good understanding about what I do. They are probably about 45% correct. Its like when your standing in line at the store and the clerk or someone ask you "Have y'all been busy?" You always reply "yeah, pretty busy". Their response is "Lots of car wrecks and stuff?" Sure cowboy, working wrecks, shootings, stabbings, delivering babies, jumping out of helicopters and still had the time to go to the hospital and visit with all the people that I saved with CPR yesterday. I just don't have it in me to explain that my day has pretty much just been hand holding, moving elderly patients in and out of bed, and explaining to a 20 year old why he isn't dying of a heart attack because he has gas. The only blood I have have seen today is from the I.V. I missed on the 96 year old DNR patient I was transporting from the nursing home. Where is William Shatner and his dramatic pause as he describes the race against death on the next episode of Rescue 911?
Then you always have the brand new rookie EMT student that rolls in the door to do ride time with you, with their brand new uncreased black boots, $20 stethoscope and clean white shirt and a head filled with aspirations of saving lives, ready to be a hero and acquire some good stories to tell while standing around the bar with their friends. I think back to the days when I was in school, and the head full of dreams about working in EMS and wondering what it was all about. Looking back now, I have to say that I had no idea what would really happen to me. The places I would learn my lessons were most unexpected , and my most rewarding calls didn't ever involve heroics. I look into the eyes of these incoming students and try to instill the patience and control that it will take for them to have a truly rewarding experience in EMS. That they will have a far less impact on people, than people will have on them. The joy of seeing someone in Wal Mart that you know wouldn't be there if you hadn't been with them late one night, and they might not even know it. To share a bond with a family because you grew close to them as you cared for a family member over and over as they died slowly over a year with some sort of terminal disease. EMS is a fickle bitch as they say, you lose some of your soul there but you gain so much more from the people you reach out to help everyday.
I often feel like I could be a real estate agent in our community because I can drive down any street and my wife will point out houses and remarks how much she likes this one or that one or hates the way this one looks and all I think is, "yeah I remember being in that house doing CPR, or in that one trying to comfort an alzheimer's patient that had fallen. The ones that look nice from the outside but are stacked to the roof with stuff on the inside because of hoarding or smell so bad of pet urine that your eyes burn when you are in them. I truly see the world through different eyes. I also drive the highways and roads and remember each corner, straight away and slight bend that we worked to extricate a patient in a race against time. Noticing the small memorials erected at roadside by grieving family members as you remember how different that scene looked the night of the accident. It gets inside you, it becomes a part of what you are. The wise ones wont let it get them down, but use it, learn from it, to make them a better Medic on the next call.
I opted to write this blog based on my EMS experiences because I am always asked about my job from the people that don't do it, and to maybe let others that work in this field know that they may feel the same as I do about things. People ask us to come into their lives when they are at their worst and to guide them back to normal. Sometimes it takes great effort and knowledge of Pharmacology and Physiology, but most of the time its just holding a hand and reassuring them that things are going to be okay. To walk into a chaotic scene and take control and make it all better and make some more memories.
My family thinks they have a good understanding about what I do. They are probably about 45% correct. Its like when your standing in line at the store and the clerk or someone ask you "Have y'all been busy?" You always reply "yeah, pretty busy". Their response is "Lots of car wrecks and stuff?" Sure cowboy, working wrecks, shootings, stabbings, delivering babies, jumping out of helicopters and still had the time to go to the hospital and visit with all the people that I saved with CPR yesterday. I just don't have it in me to explain that my day has pretty much just been hand holding, moving elderly patients in and out of bed, and explaining to a 20 year old why he isn't dying of a heart attack because he has gas. The only blood I have have seen today is from the I.V. I missed on the 96 year old DNR patient I was transporting from the nursing home. Where is William Shatner and his dramatic pause as he describes the race against death on the next episode of Rescue 911?
Then you always have the brand new rookie EMT student that rolls in the door to do ride time with you, with their brand new uncreased black boots, $20 stethoscope and clean white shirt and a head filled with aspirations of saving lives, ready to be a hero and acquire some good stories to tell while standing around the bar with their friends. I think back to the days when I was in school, and the head full of dreams about working in EMS and wondering what it was all about. Looking back now, I have to say that I had no idea what would really happen to me. The places I would learn my lessons were most unexpected , and my most rewarding calls didn't ever involve heroics. I look into the eyes of these incoming students and try to instill the patience and control that it will take for them to have a truly rewarding experience in EMS. That they will have a far less impact on people, than people will have on them. The joy of seeing someone in Wal Mart that you know wouldn't be there if you hadn't been with them late one night, and they might not even know it. To share a bond with a family because you grew close to them as you cared for a family member over and over as they died slowly over a year with some sort of terminal disease. EMS is a fickle bitch as they say, you lose some of your soul there but you gain so much more from the people you reach out to help everyday.
I often feel like I could be a real estate agent in our community because I can drive down any street and my wife will point out houses and remarks how much she likes this one or that one or hates the way this one looks and all I think is, "yeah I remember being in that house doing CPR, or in that one trying to comfort an alzheimer's patient that had fallen. The ones that look nice from the outside but are stacked to the roof with stuff on the inside because of hoarding or smell so bad of pet urine that your eyes burn when you are in them. I truly see the world through different eyes. I also drive the highways and roads and remember each corner, straight away and slight bend that we worked to extricate a patient in a race against time. Noticing the small memorials erected at roadside by grieving family members as you remember how different that scene looked the night of the accident. It gets inside you, it becomes a part of what you are. The wise ones wont let it get them down, but use it, learn from it, to make them a better Medic on the next call.
I opted to write this blog based on my EMS experiences because I am always asked about my job from the people that don't do it, and to maybe let others that work in this field know that they may feel the same as I do about things. People ask us to come into their lives when they are at their worst and to guide them back to normal. Sometimes it takes great effort and knowledge of Pharmacology and Physiology, but most of the time its just holding a hand and reassuring them that things are going to be okay. To walk into a chaotic scene and take control and make it all better and make some more memories.
Thursday, June 14, 2012
Divine Intervention
Just a little short story about the very first accident I ever worked as a paid EMT on the ambulance. I had experienced quite a few calls in the years as an explorer and a first responder, so i wasnt completely green, but there is something different about it when you roll out in the unit and are the one responsible for getting these people to the hospital. I was on the call with a man that had been an EMT for years and years before I came into the picture. I felt comfortable with him and relied on his experience to make me less nervous.
We responded to a one vehicle MVA (motor vehicle accident) on the open highway not to far out of town. When we arrived, we found a car had run off the road and slid into a fence row, continuing down the fence row dragging it down the side of the car. The kicker was the momentum of the car threw the driver sideways across the seat, causing him to have his back hanging out of the car window as the barbed wire fence ran across him as the car slid. Needless to say, his back looked like hamburger. A helpful (read as idiot) bystander had grabbed the patient and pulled him up onto the highway. The one detail I will never forget about this call was.....Rain, and lots of it. It was pouring down on us in buckets as we pulled up to the scene. A group of ladies that were passing by, on their way to a prayer meeting I guess, had circled the patient in the highway and were holding a blanket or something in the air above him in an attempt to shield some of the rain. We pushed our way in to the patient, with the women all praying and jumping around...speaking in tongue so loud we couldn't hear what the patient was telling us. After several attempts to hear, my partner stands up and loudly tells the women.. "God sent us to take care of the patient, if you really want to help, pray for this rain to stop!" I chuckled in disbelief but continued to do my job. Without pause, the women switched gears and began to chant about the rain and asking for a pause in the weather. We were able to get the patient boarded and on the cot with all the extra hollering going on, and began rolling to the ambulance as the rain stopped. As we loaded the patient in the unit, I acknowledged the ladies on scene and thanked them for their help. I assured them that the patient would be okay because they apparently had a hotline to the man upstairs.
So every time i step out of the unit, and walk towards my patient, I know that I am only a tool of a higher power, and that God is with me in my attempts to help reduce the suffering of the people I encounter.
KMG 365
It started when I was very young. The thrill of watching Johnny and Roy rescue people on the TV show Emergency was enough to hook me on how I wanted to spend my life...helping people. Some of the scenes on the show seemed a little silly and over the top though, I always thought that they were added for spice..it was Hollywood after all. After working in the field for 30 years now, I realize that the things portrayed happen all the time. Thats right, 30 years. I started fulfilling my dream of emergency service when I was 13 years old as an Explorer for the Russellville Fire Department. We had an excellent program that allowed us true hands on experience, a chance to really get a feel for a career in firefighting. I tinkered in firefighting on and off for years after that, into adulthood, but had a desire to go even further. When I was still just 14 or 15, I joined another explorer post at Pope County Emergency Medical Services and found my calling. I enjoyed the environment and the challenge involved in emergency pre-hospital medicine.
I shared doing fire service and emergency medical services simultaneously through out high school, but knew that EMS was where I was heading. My first year of college, I worked midnight shift as a dispatcher at the Dardanelle Police Department, went to college during the day, and EMT school in the evenings. Things got a little tight at times, and sleep was a luxury. It worked out though, finished EMT school and tested out, gaining my certification to save lives. I was hired to work part time for Yell County EMS that was a struggling, troubled ambulance service at the time, with a director that we wondered if he had a clue as to what he was doing. But I was a new EMT, with a desire to save the world, so of course I did it. The service was different than what I was used to, having cut my teeth at what was considered to be one of the best Ambulance Services in the state, I had no idea what to expect. I was impressed with the people that worked at this new service, and their ability to do the very best with what limited means they had, and to be proud of it.
I then went to work at The Arkansas Department of Health in Little Rock, working for Emergency Management because I needed a full time job to pay the bills. I continued to drive back home on the weekends and work in Yell County part time, but there wasn't anything full time available. There were only 5 full time employees, and one of those was a secretary. A new EMS director was brought in, and the winds of change followed him. He called me in Little Rock one day and offered me a full time spot, he was excited about the direction he envisioned the service growing in the future and I saw a chance to get in on the ground floor of something great. I packed up my stuff in the big city and moved everything to Dardanelle to begin a new chapter in my life, and boy was it a ride. to condense this story, and leave out all the good parts, the service has grown since 1990 from 5 employees and no buildings of our own and Ambulances parked out in the weather all the time, to a full time staff of around 30 or so with nice stations in 2 cities and a training complex. From 2 ambulances to a fleet of 8 now, sometimes running 5 or 6 at the same time. The service grew with the leadership of our director Sidney Ward, and the hard work of some very dedicated staff. I am very proud of the service I work for, and still enjoy going into work everyday. I'm not going to lie, its been really rough at times, but overall...I am living my dream. I heard someone say once.."find a job you love doing, and you will never work a day in your life". Well that is me. I find myself answering the same kind of calls that I watched Johnny and Roy answer on Emergency, and have collected a mass of stories that people would not believe. That is what this blog will be about, the everyday experiences of me and my co-workers and the real life stories of humankind, good and bad.
So come along with me on this ride...the names and locations have been changed to protect the innocent, but the stories and the people are real. You cant make this kind of stuff up!! Oh yeah, you get bonus points if you know what KMG 365 means.
I shared doing fire service and emergency medical services simultaneously through out high school, but knew that EMS was where I was heading. My first year of college, I worked midnight shift as a dispatcher at the Dardanelle Police Department, went to college during the day, and EMT school in the evenings. Things got a little tight at times, and sleep was a luxury. It worked out though, finished EMT school and tested out, gaining my certification to save lives. I was hired to work part time for Yell County EMS that was a struggling, troubled ambulance service at the time, with a director that we wondered if he had a clue as to what he was doing. But I was a new EMT, with a desire to save the world, so of course I did it. The service was different than what I was used to, having cut my teeth at what was considered to be one of the best Ambulance Services in the state, I had no idea what to expect. I was impressed with the people that worked at this new service, and their ability to do the very best with what limited means they had, and to be proud of it.
I then went to work at The Arkansas Department of Health in Little Rock, working for Emergency Management because I needed a full time job to pay the bills. I continued to drive back home on the weekends and work in Yell County part time, but there wasn't anything full time available. There were only 5 full time employees, and one of those was a secretary. A new EMS director was brought in, and the winds of change followed him. He called me in Little Rock one day and offered me a full time spot, he was excited about the direction he envisioned the service growing in the future and I saw a chance to get in on the ground floor of something great. I packed up my stuff in the big city and moved everything to Dardanelle to begin a new chapter in my life, and boy was it a ride. to condense this story, and leave out all the good parts, the service has grown since 1990 from 5 employees and no buildings of our own and Ambulances parked out in the weather all the time, to a full time staff of around 30 or so with nice stations in 2 cities and a training complex. From 2 ambulances to a fleet of 8 now, sometimes running 5 or 6 at the same time. The service grew with the leadership of our director Sidney Ward, and the hard work of some very dedicated staff. I am very proud of the service I work for, and still enjoy going into work everyday. I'm not going to lie, its been really rough at times, but overall...I am living my dream. I heard someone say once.."find a job you love doing, and you will never work a day in your life". Well that is me. I find myself answering the same kind of calls that I watched Johnny and Roy answer on Emergency, and have collected a mass of stories that people would not believe. That is what this blog will be about, the everyday experiences of me and my co-workers and the real life stories of humankind, good and bad.
So come along with me on this ride...the names and locations have been changed to protect the innocent, but the stories and the people are real. You cant make this kind of stuff up!! Oh yeah, you get bonus points if you know what KMG 365 means.
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