By now, most of you EMS types have read about the South Carolina firefighter-paramedic who got fired over an Xtranormal text-to-movie video he posted on his Facebook page.

Opinions on the incident range from “Whatever happened to free speech?” to “Serves the idiot right.”

Without question, the video was in poor taste. It was profane, scatological, reflected poorly on EMS and the fire service, and played into every tired stereotype of paramedics and nursing home nurses. But hey, if poor taste and potty humor were a crime, I wouldn’t even have a blog.

In my opinion, Colleton County Fire Rescue’s administrators bungled the handling of the incident, and overreacted by firing the medic in question. My guess is that they had no formal policy on social media, but you can bet they, and others, will develop one after this brouhaha. Let’s hope the policies developed are more even-handed and well thought out than their handling of this incident.

Here at The Borg, we were reminded of our social media policy after this story hit the news. I can sum it up for you in one sentence: “Don’t act an ass in public while representing yourself as an agent of this organization.”

That’s pretty broad, and open to much interpretation, but that’s all that really needs to be said. When you post, respect patient confidentiality, don’t air your agency’s dirty laundry in public, and don’t make any statements you’d be ashamed to own, because there is no such thing as anonymity on the internet.

Above all, I think this guy’s biggest sin in posting this video is that it just wasn’t funny. Just another tired anti-nursing home rant, really, one of a gazillion such war stories told by paramedics every day.

I’ve seen a number of these videos across the blogosphere, and none of them are particularly funny. I’ve thought about making one myself, but they don’t have any pure EMT characters, only cops and firefighters, and I reject that on general principles.

Then again, the original was a pretty hard act to follow:

[youtube]http://www.youtube.com/watch?v=_m64cy1MMPg[/youtube]

I rank Atropine 12 out of the 33 drugs we carry.

Aside from routine use in cardiac arrest, I use Atropine two or three times a year for patients with symptomatic bradycardia. I have no reason to believe it does any good at all in cardiac arrest, but as far as symptomatic bradycardia, as long as the patient is not in a third-degree block, I have had good success with Atropine.

Earlier in my career, I used Atropine a bit more, but that was before I knew that many people thanks to beta blockers had every day pulses in the high 40’s, low 50’s. I also used to more readily give it to a patient having an MI (heart attack), which can increase their oxygen demand and cause more damage. Now I only give it to patients having an MI if they are hypoperfusing. Ah, the learning curve.

The best bradycardia calls are for the patient passed out in the bathroom. You find them on the floor, cold and clammy, no pressure, pulse in the 20’s. Straining to go to the bathroom, their vagus nerve overpowered them, knocking their heart rate down and they lacked the ability to rebound on their own. We used to give a full amp of Atropine, now we give 0.5, and if that doesn’t work another 0.5 mg, etc. A couple times I have given the full 1 mg by mistake. Old dogs. Still the drug works well, the pulse picks up, the patient wakes up, the skin colors up and drys out and all is well in paramedic land. “You fixed them,” the doctor says to me in the ED. Music to my ears.

If I don’t have atropine in my kit, I can always pace the patient. Other options are Dopamine and an epi drip.

***

We can also give Atropine to organophosphate poisionings, but I have never had one.

***

Atropine (Atropine Sulfate)

Class: Antimuscarinic
Parasympathetic blocker
Anticholinergic

Action: Blocks acetylcholine (ACh) at muscarinic sites

Indication: Symptomatic bradyarrhythmias
Cholinergic poisonings
Asystole
Refractory bronchospasm

Contraindication: Relative contraindication wide complex bradycardia in the setting of acute ischemic chest pain

Side effects: Tachyarrhythmias
Exacerbation of Glaucoma
Precipitation of myocardial ischemia

Dose: Bradyarrhythmias – 0.5mg , may repeat every 3-5 minutes

Asystole – 1mg MR q 3-5 minutes (total max. dose 3mg)

Organophosphate poisonings – 1mg – 2mg; may repeat as needed

Route: IV push

Pedi dose: 0.02mg/kg IV

Those fine folks at Co.34 are bringing the FDIC experience to the Washington, D.C. area. Thanks to co-sponsors, the Chillum-Adelphi Fire Department is delivering a day long training session by Ray McCormack, with the focus being on engine company operations (We can only imagine the surprise by those on L.28 who may have thought they converted him to the dark side).

For $40.00 you get “The Dirty Dozen“, 12 errors engine companies make; “Line Boss“, details about the crucial decisions engine company officers have to make; and breakfast and lunch. Plus, it’s a safe bet you won’t hear terms such as ‘crew resource management’, and ‘victim survivability profile.’

The event is being held 12 April, 2010 at 0830 hours at the George Washington Masonic Temple in Alexandria, Virginia. As a bonus, keep your directions so you can return in May for another classic event. Register here.

Be sure to give him feedback on Urban Firefighter Magazine as well!

He asked me my thoughts on the matter and I was unable to get them to him in a timely manner, so here they are.

I scanned over the recent report on the 2009 LODD’s of Captain James Harlow and Firefighter Damion Hobbs.

While I am not as in depth as Bill is, I offer my thoughts which came to mind. My thoughts are more National in thought than just on the Houston FD.

The report pointed to a couple of things:

1. The lack of use of a thermal imaging camera (TIC)
2. The firefighters leaving the hoseline
3. The Captain not doing a 360 degree walkaround
4. The Captain not taking his radio

1. The lack of use of a thermal imaging camera (TIC)

Most departments roll with a firefighter, an officer, and a driver. If the driver is pumping, two firefighters are going in. Two firefighters to make an attack on the fire with a hoseline. One on the nozzle pulling hose, the other helping drag hose and talking on the radio if need be.

Who is going to carry the TIC? If that is an issue, put more staffing on the apparatus. In the HFD LODD report, it does state that in this case there were 3 firefighters going in but one had issues with their mask. In my department that would be an imaginary firefighter…We run with 3 total.

I agree that TIC’s have their place in finding victims,  the seat of the fire, or possible means of egress. However, it is not the end-all!

2. The firefighters leaving the hoseline

From what I could tell, this point was processed by where the hoseline was laying vs. where the two men’s bodies were found.

I can only imagine that their last minutes on this earth were sheer terror and panic. I like to think that if I were in their shoes I would revert to training, experience, and knowledge and throw my brother firefighter over my shoulder and walk out the front door. However, we both know that we have gotten tunnel vision, fought panic and anxiety in situations less as life threatening as this.

I cannot correlate their final resting spots as cause for stating that they left the hoselines for any other reason than they realized death might have been imminent had they not.

3. The Captain not doing a 360 degree walkaround

Ah…the 360 walk-around. That ever present topic/tactic in presentations, training, and literature. That thing that I have never seen a first arriving officer do. That thing that incoming Incident Commanders rarely do.

I will put stock in this one….with caveats.

In a perfect world, we would pull up past the house getting three sides of the layout on arrival. My 2 firefighters in the back (remember that never happens in my dept.) would pull a line and force the door while I checked out the Charlie Side. I would then get back to the front of the house with my firefighters and develop a quick strategy (meaning possibly changing the point of entry upon my view of the backside of the house)

If I didn’t, the next in companies would or at least the BC upon arrival.

The truth in my department (urban firefighting hydrants/apparatus/crews bountiful on fires) is that if I were to do a walkaround, the next in engine would put the fire out before I got back up front…hypothetically.

I guess in my perfect World, if it were more than a bread and butter/room and contents fire we would do a walk-around or the BC close behind would do one and relay any pertinent information to us prior to us getting in too deep.

4. The Captain not taking his radio

He forgot it apparently. I have no excuses on this one. For the company officer, having a radio is a must. We have all forgotten something at one time or another. Did it prove fatal in this case? Maybe, there is no telling that if he had it he would have been able to get firefighters to his crew quick enough to save their lives.

Be sure to check out Bill Carey’s breakdown of the LODD here as well.

Photo by Dylan Brown / Independent Record

White powder calls will probably never go away.  Most are easily handled with a good threat assessment by police or fire.  A few rise to the level that they need to be tested by the local hazmat team.

A white powder sent to the Montana Department of Labor and Industry in Helena, Montana included an unusual twist. Several sources are reporting the package included a “triggering device” that reportedly dispersed the powder when the package was opened.

Responders evacuated the immediate area and isolated three people exposed to the powder.

The 83rd Civil Support Team was called in to assist with product identification.  Although the identification of the actual product was not disclosed, it was determined to be non-hazardous.  You can read the whole story here.

So this guy is lying in a hospital bed being treated for his pneumonia, and he’s got a non-rebreather mask strapped to his face.

A nurse’s aide comes in the room, and the guy asks, “Are my testicles black?”

The aide, long since used to dirty old men, ignores him, checks his vital signs, refills his water pitcher and leaves.

Later, the respiratory therapist comes in the room to administer an albuterol nebulizer, and the guy asks again, “Are my testicles black?”

Pointedly, the respiratory therapist replies, “That’s not my area, Sir. You’ll have to ask your nurse.”

After lunch, the nurse is hanging the guy’s IV piggyback of antibiotics, and he asks, “Are my testicles black?”

The nurse leaves the room in an indignant huff, and tells the doctor that something must be done with the patient in 403.

Wearily, the doctor trudges down to the room to have a word with his patient. When the patient sees him, a look of profound relief flashes across his face, and he says, “Thank God, it’s my doctor! Tell me, are my testicles black?”

The doctor flips back the sheet, gives the man’s genitals a cursory examination, and says, “Mr. Jones, there appears to be nothing wrong with your testicles.”

The patient heaves a mighty sigh, pulls the non-rebreather mask away from his face and says, very distinctly, “Are. My. Test. Results. Back?”

**********

Riddle me this, Batman: If you could replace every oxygen delivery device on your ammalance  – every venturi mask, simple face mask, partial rebreather, nasal cannula and non-rebreather -  and replace it with a device that does the work of all those things, is less claustrophobic for the patient, and prevents you from mistakenly checking your patient’s testicles, would you do it?

Yeah, I thought so.

The OxyMask is a nifty little doohickey I’ve seen at the past few trade shows I’ve attended, and the device intrigues me somewhat.

Pictured: pediatric, adult, and multi-OxyMask, suitable for aerosolized medications.

Basically, it’s a skeletonized oxygen mask, fitted with a proprietary venturi system that allows delivery of oxygen concentrations ranging from 24%-90%, depending upon flow rate. That encompasses the practical oxygen delivery concentrations of everything from nasal cannulas to non-rebreathers, folks. Plus, you can suction through ‘em!

Using a separate adaptor, they’ll allow end-tidal waveform capnography with any monitor that uses Oridion’s CO2 monitoring technology. Sadly, no such adaptor exists for you folks using Zoll monitors.

Here at The Borg, we stock our rig shelves with at least 6 nasal cannulas, 6 non-rebreather masks, and 6 hand-held nebulizers, and if we need a nebulizer/mask combo, we have to cannibalize a non-rebreather to do it.

We could do the same thing with a half dozen each of the pediatric and adult OxyMulti Masks, and take at least 24 otherwise superfluous hunks of plastic off our rigs.

The company even has a variant that looks just like a telephone operator’s headset, for the occasional patient with facial burns or trauma.

For an oxygen delivery geek like me, this thing just looks neater than kitten toes. I think I’m gonna have to plant a bug in the ear of The Borg’s product review committee, and see if we can’t get a few of these things to play with.

Any of you EMTs out there use ‘em in your system? What are your thoughts?

]]> http://ambulancedriverfiles.com/2010/03/product-showcase-oxymask/feed/ 2 http://firespecialops.com/2010/03/10/workers-trapped-when-a-bridge-suddenly-raises-in-florida/ http://firespecialops.com/2010/03/10/workers-trapped-when-a-bridge-suddenly-raises-in-florida/#comments Wed, 10 Mar 2010 19:14:04 +0000 Gary Sharp http://firespecialops.com/?p=378

While I was out playing hazmat, Dave Statter was doing his reporter thing, combing the earth for fire & ems news.  He gave me the heads up on this story.

ABCActionNews.com reports that Four Broward County Department of Transportation employees found themselves hanging on for life Wednesday morning when the drawbridge they were working on suddenly raised and became stuck in the up position.  Firefighter used a ladder  truck to bring the workers down.

She said she was fine;

His lead II was unremarkable and has had heartburn in the past;

Your anxiety can come from nowhere and leave you tachy, lady of 55 who’s mother died of an MI recently;

Damage like this happens all the time, that bruise is normal;

A little smoke inhalation won’t kill you, look at me;

Asthma is not going to kill you, go find your inhaler;

The Doc signed off on the AMA so I’m golden;

Babies sleep all the time;

The snow was too heavy;

It was too hot;

I was tired;

I read in a blog that doing that was alright;

Have you seen this funny youtube cartoon?

Point being that there are a lot of rumors, stories and opinions flying about what happens in our business and it can be very hard to find the truth in a situation with 3 correct versions, one wrong version and 15,000 who have parts right.
I have been known to join the fray when it comes to EMS and Fire Departments who do something I like (Tip of the Helmet) and things I don’t (Letter in the File) but drawing conclusions from a single source is a bad idea.
Have an issue with a story you read part of on facebook? Before you lay it on thick you may want to finish reading the story, then seek out at least 2 more sources to confirm the facts. If you can not get the facts, use the google to find out who to call to get the facts.

If they call you back, great. If not, then you have to go with what you have, but the impulse to post something you may regret will have passed.

If you are the one facing termination for doing something you knew in the moment was wrong, see ya. If you find yourself on job 21 in 24 hours and know that not writing a chart will get you home sooner, keep in mind that not writing the chart could get you home a lot. As in unemployed.

If just yelling at the guy to wake up instead of checking his blood sugar and other vital signs to confirm it’s just Reuben again after another $3 bottle of wine, you yourself could be the one budgeting for the cheap stuff while on unemployment.

Backed the ambulance into another car near end of shift and drove away? Might as well keep driving into the sunset.

We all make mistakes. I make them all the time, but I make sure I’m doing what I’m supposed to be doing for my patients based on the information I have and how that information fits within the laws, protocols and policies I have sworn to uphold. Have I not charted patients? Of course, when it is not indicated. Have I omitted vital signs on my charts? Yes, it happens when you get back and can’t recall the BP, so instead of lying I write nothing.

Being able to defend your actions or inactions with cited policy and protocols in front of you goes a long way to easing stress and the impact on your employment status.

In the end we all need to take a deep breath and find the facts about stories we read, especially in the internet age, when opinion can be mistaken as fact on a regular basis.

“Mr Happy Medic is there a reason you did not awaken the man lying in the street who was later found to be in cardiac arrest?”
“He looked OK to me…”
I’d be fired for sure, and for good reason.

From the AP:

Four workers are safe after being trapped on a drawbridge stuck in the up position Wednesday morning.

Broward Sheriff’s Office rescuers saved the workers from the bridge in the 2900 block of east Atlantic Boulevard.

City spokeswoman Sandra King said hydraulics failed on a bridge under reconstruction, causing it to rise while Department of Transportation workers were still on it.

Three workers were harnessed and brought down easily, but a fourth was left trapped in the air over the Intracoastal Waterway. 

None of the workers were injured.