Friday, February 12, 2016

Dial 911!

Several days ago I was watching the second season finale of Nightwatch, carried by the A&E Network. For those not familiar with this show, it offers a glimpse of the public safety professionals in New Orleans. Chronicling the events from 8 p.m. to 4 a.m. of a given day, Nightwatch follows the activities of law enforcement, fire department and EMS personnel during part of their shift. Both seasons thus far have been fun to watch, but probably not the obvious reasons of high drama and exciting footage. What really made me appreciate this show is the camaraderie shared amongst the various crews. The lightbulb went on and I knew I had the topic for my next (this) blog.

Back in the early 90’s, I worked in EMS, starting out as an EMT-Basic (EMT-B), working my way through EMT-Intermediate (EMT-I) and finally earning my paramedic (EMT-P) certification. I did this for several years before moving into an entirely different field, so naturally the inevitable changes and advances in pre-hospital medicine escaped my attention. Please forgive me for resorting to a cliché to express my point, but really, the more things change, the more they stay the same.

Growing up in south Texas, I never had a particular interest in medicine. I had no desire to go to medical school or work in the healthcare industry. I was more interested in an aviation related job, preferably as a pilot. During my high school years, and this was at the height of the Cold War, my chosen path once out of high school was one of the service academies. I mention my interest in the military to illustrate where my focus was at the time. I was ready to climb into an F-14 to fight “the red horde” that would surely invade. Yes, I know. Remember, it was a different time then.

Plans changed, though, and I ended up enrolling at Texas A & I University in Kingsville. Yes, it goes by a different name now, but to me it will always be Texas A & I. I don’t ever call it by….that other name. I joined ROTC and started taking military science classes, which eventually earned me a commission in the Army Reserve.

Anyway, while in high school, and part of college, I belonged to the local volunteer fire department of my small town. While I might not have had a specific interest in medicine, I did enjoy firefighting. The department even sent me to the annual “fire training school” at Texas A & M in College Station. I had a blast there that week, no pun intended, and learned some very useful skills.

In 1989, about the time I moved up to Colorado, CBS premiered a new show called Rescue 911. This was one of the first “reality” shows that I can remember. The show’s format consisted of recreating dramatic rescue calls from across the US. Oftentimes the actual participants helped recreate the story. Each show had several segments featuring a given emergency, with the actual recording of the 911 call typically as a background sound track. Either news footage or re-creations (or both) told the story of the responding fire, EMS and law enforcement units as they performed the rescue.  There was no real attempt to show the hour-to-hour interactions of the various crews, as this didn’t fit the format of the show.

I mentioned in passing that I moved to Colorado in 1989, again due to life having fun with my plans and arbitrarily changing them. I’ve learned to just accept these changes as more often than not I end up doing something better, more fun or having opportunities arise that I otherwise wouldn’t have been able to take advantage of. So, once I got settled in Eagle, the small Colorado town I moved to, I joined the local volunteer fire department. This is where I earned one of only two nicknames I’ve ever had. More about that in a bit.

An interesting facet of living where I did is the way the local fire and EMS agencies are set up, at least at the time I was there. At the time, both Eagle VFD and nearby Gypsum VFD, as well as the Western Eagle County Ambulance District (“WECAD”) were supported as part of a “tax district.”

I guess at this time it would be a good idea to make an official disclaimer a part of this particular blog. Given the nature of both fire and EMS calls, and HIPAA, I want to make clear certain aspects of what I’m writing.

From this point until the end of the blog, material and/or identifying facts about persons, places, things or events have been altered to protect the identity of those involved unless specifically noted otherwise. This does not include publicly available records. By proceeding further, the reader acknowledges this disclaimer and fully understands that no identifiable information relating to any given case has been intentionally released.

With that bit of business completed, let’s step back in time about 25 years and see how much has changed, and how much hasn’t. Don’t worry, I won’t write about any gory calls I’ve been on (yes, there were some really gory calls), or bring up old tragic situations that some of my friends in Colorado who were there with me would recall. Nah, this will be more light-hearted than that. You will hear some “war stories,” though.

 My very first response with Eagle Fire happened to be a medical assist call.  At the time, it was standard procedure to dispatch either Eagle Fire or Gypsum Fire, depending upon where the call originated, along with WECAD. For most calls, the primary apparatus was a light pumper/rescue squad, Engine 912. It looked similar to Squad 51 from the Emergency! TV series….similar, but not identical. As I hopped up on the tail board, and we headed out of the station, my mind definitely conjured images of Johnny and Roy speeding to the rescue. Thankfully this call was for a minor fall, and the person wasn’t even transported to the hospital. The biggest majority of responses seemed to be either medical assist calls or auto accidents. Many times I felt useless on these scenes, as I didn’t have any medical training. At least on traffic accident calls I was either directing traffic, manning a hose or helping with extrication of a patient. Once the department announced that they would pay for an advanced first aid class (“AFA”), I took advantage of the opportunity. My motivation was to be a better help to the fire department, and this would definitely allow me to do so.

What was that? Oh, my nickname? No, I didn’t forget, but now that you mention it, here’s the story. It was just my second training meeting at Eagle Fire and several of us were sitting around a large table in the main room. The Chief looked at me and apologized for not remembering my name. There was a rather large guy sitting directly across from me who grinned and said “We ought to call him Tex.” He got a good laugh out of that until….

Not to be outdone, and with as straight a face as I could muster, I poked him in the chest and said “That’s SIR Tex, to you, buddy!” I sat back, expecting a hearty laugh. What I heard, though, was more of a collective gasp. “J” got a “Did he just say what I thought he said?” look on his face and his grinned slipped a little. About that time the person to his left very discretely removed J’s Mag-Lite he had on the table of him and glanced at me nervously. This wasn't one of those small flashlights. It was the size of a small baseball bat. The room got very quiet.

I was just beginning to wonder what major faux pas I had committed when J burst out laughing and said “I’m gonna like this little pipsqueak! He has the balls to get lippy with me.” This seemed to immediately cut the tension. Little did I know that this guy had a reputation for a short temper and quick fists. We actually became good friends after that, and from then on I was known as “ST.” Disclaimer aside, that was a true story.

About the time I was finishing my AFA class, we were dispatched to a CPR in progress call. We got on scene just before WECAD, and one of the medics happened to be a member of our department as well. As we got the patient loaded for transport, he looked at me and said “ST, can you come with us? We need someone to help with compressions.” I didn’t hesitate, and jumped in the back of the ambulance and off we went. Watching the medics work was fascinating. This was the closest I had been to actual advanced life support in real life. Two things surprised me, though. One was how quiet the noise was when the defibrillator fired. Movies and TV portray this as a loud “thud,” but honestly it’s more of a “click.” The other, sadder surprise was that a flatline on the monitor doesn’t make that BEEEEEEEP we are used to hearing on TV. There was no sound at all. Now, obviously I can’t say that all monitors are silent like that, but every one I’ve seen in the field and various emergency departments have never made that sound.

On the way back from the hospital, I asked many questions about that call, EMT training and what it was like to work on the ambulance. The first tendrils of interest were starting to intertwine themselves in me. I had a regular job, so I wasn’t interested in doing that full time, but doing a 12 or 24 hour shift definitely sounded like it would be a unique experience. I started volunteering more and more to help out in the back of the ambulance as the need dictated and to nobody’s surprise, I signed up for an EMT-Basic course at Colorado Mountain College.

Of course I still responded with Eagle Fire at every opportunity when I wasn’t at work. I still had a blast “dragging hose” and “putting the wet stuff on the red stuff.” Having some medical training boosted my confidence and I felt like I was actually contributing to the department and keeping my community safer. I would go to me regular job during the day, and have EMT classes a couple of nights per week. Throw in the fire department training meetings and there was no worry of being bored.

After obtaining my EMT-B certification, I started taking part-time shifts with WECAD. At this point, WECAD was based off of Cooley Mesa Road about halfway between Eagle and Gypsum, near the approach end of runway 25 at Eagle County Regional Airport (EGE). What a bonus! I could watch aircraft take off and land right from EMS HQ. I would typically work 12 hour shifts, partnered with one of the paramedics. Now that the EMS bug had bitten me, I wanted to take more training. Colorado had a program for EMT-B’s to be authorized to start IV’s and apply MAST after taking a special class and having specific protocols from the agency’s medical director.  Any current medic reading this, listen carefully for the dinosaur’s roar. MAST are no longer used, and a Google search will reveal why.

Now that I was an EMT-B with IV/MAST certification, I started taking as many shifts as I could. Most of these were relegated to the weekend, as I still had a day job. When I wasn’t pulling a shift with WECAD, I would respond with Eagle Fire. As both communities started to grow, and the call volume increased, the WECAD board started considering more full time positions. I looked carefully at the pay scale, benefits, and advancement opportunity and seriously considered applying for one of the new positions.

The decision was made for me, though, as I received my orders for the Field Artillery Officer Basic Course (FAOBC, or just OBC) at Ft. Sill in Oklahoma. Remember me mentioning about attending a service academy and having plans change? See? It did have some relevance. While at A & I, I belonged to a combat engineer unit in the Army Reserve. I had orders for Engineer Officer Basic Course in Ft. Leonard Wood, MO, but when I moved to Colorado, and joined a National Guard unit there, I also changed branches to the Field Artillery. My vision wasn’t good enough to qualify for aviation, and there were no combat engineer units close by. Basically, I could choose between infantry and field artillery. Infantry? Screw that! So, off to Ft. Sill I went for the next several months. Desert Shield/Storm happened while I was at Ft. Sill, and was over by the time I graduated. Just before leaving for Ft. Sill, I found out the company I worked for filed for bankruptcy and we received our layoff notices. At least I would be getting a paycheck from the Army while I was at Ft. Sill, so it wasn’t a total loss. I’d worry about getting a job when I got back to Colorado.

While living in Colorado I shared a house with my brother. We initially lived in Eagle, but when the house we rented got sold, we found a house in nearby Gypsum. I had only been in Gypsum for a few months before reporting to Ft. Sill. After graduating from FAOBC, and the follow-on FACBOC (Field Artillery Cannon Battery Officer Course) I arrived back in Gypsum and promptly started taking enough shifts at WECAD to be close to full time. I did this for almost a month before being offered a full time position there. Naturally, I also joined the Gypsum Volunteer Fire Department. I needed a hobby, right? Our house was just a short drive from the fire station, so I was able to make many calls with Gypsum on my days off from WECAD. Since I was now a full time employee with WECAD, the board graciously offered to pay my tuition for an EMT-I course.  The only downside to this was the two hour commute, one way, to class twice a week. It was tough, but totally worth it.

Having my EMT-I certification now qualified me to be the senior medic on the shift, with an EMT-B as a partner. At the time, at least in Colorado, an EMT-I was the equivalent of an EMT-P in other states. An EMT-I in Colorado could do most advanced procedures, including intubation, drug therapy and other advanced cardiac life support procedures. Paramedics had a more skills and much more clinical training.

I’m going to use the term “medic” as a generic term for EMT-I/EMT-P, although the standard convention is to use the term “medic” only for EMT-P’s. This is mainly for convenience, and to hopefully not confuse the issue with all these acronyms. There’s already a ton of acronyms in medicine. Trust me, you don’t want me to start writing in all acronyms. It won’t be pretty.

WECAD was a rural service, in that we served not only Eagle and Gypsum, but covered some outlying towns as well. Our district was oriented mainly east/west, but we also covered such towns as Bond and McCoy, Colorado. These were a long drive due to winding mountain roads. Even when leaving immediately after being dispatched, it could be over an hour to get to the northernmost part of our district. We would transport to the nearest two hospitals, each about 25 miles away. Depending on where we were, patient preference, and the weather, we would transport to either Vail Valley Medical Center in Vail (east of us) or to Valley View Hospital in Glenwood Springs (west of us). Our average transport times from scene to hospital were on average 30 minutes plus, and even longer during icy or snowy conditions. For you medics reading this, think back to your first classes, and how the instructor probably hammered home how important it was to have short scene times, especially with trauma calls. Throw in a long transport time on top of that and you can imagine the priority we placed on short scene times. With I-70 running the length of our district, we responded to many auto accidents on that highway, especially in the winter.

We had three full time senior medics, who pulled a 24 hour shift, a day medic from 8 to 5 Monday through Friday, a bookkeeper/office manager and med pool personnel. The med pool were essentially volunteers, and would be the second medic on call to back up the senior medic. While the senior medics were required to stay at EMS HQ during their shift (except on a call, of course), if we had a med pool medic with us, it was their option to stay at EMS HQ during their shift or meet us on scene. Since many of our med poolers lived “up valley” (Avon, Edwards, Eagle-Vail, etc), they would stay at EMS HQ with us and sleep in one of the bunk rooms. Senior medics shared their own bunk room. We would work a 24 hour shift, from 8 am to 8 am. As an example, we would work Monday, Wednesday and Friday, then have four days off. I actually liked this system, as we got to work with different partners. We had a few regulars who would sign up for more shifts, so it was common to work with a partner on multiple shifts. I won’t try to BS anyone and say I didn’t have any favorites. Of course I did, more than one. They know who they are, right Andy?

EMS-80, our primary unit

Both Eagle and Gypsum were still relatively small communities when I worked there. We were dispatched through the Colorado State Patrol, who had a dispatch center in Eagle. We would be dispatched via pager system and VHF radio. Everyone seemed to know everyone else, and most had lived in the area their entire life. This tended to pose a problem occasionally for an outsider like me. Here’s an example, and one of my favorite “war stories.”

We were called to an auto accident just off of Gypsum Creek Road a little after midnight. I knew basically, kinda sorta where to go, but wasn’t totally certain. My partner for the night was from up valley, so she was even less familiar with the area than I was. I called dispatch for more information. “Eagle (CSP dispatch), EMS 80 (us), we are heading south on Gypsum Creek Road, but I don’t see any lights yet.” I had heard Gypsum Fire call on scene, so I knew to look for their lights.

“EMS 80, Eagle, that’s affirmative. Head south on Gypsum Creek Road and turn right on Daggett. It should be just past J.A. Bonham’s place.”

Oh, yeah, that’s helpful. I glanced over at my partner and she just shrugged in return. Who the hell is J.A. Bonham?? I was about to call dispatch again when one of the Gypsum Fire officers saw our lights.

“EMS 80, 1414 (Gypsum unit), as soon as you turn on Daggett you’ll see our lights. Just keep on coming.”

Sure enough, I made the turn and saw my Gypsum guys ahead. Our patient was a bit shaken up, but not injured. He refused transport and we cleared from the call. The next morning I was having breakfast with Gypsum’s Fire Chief and asked who J.A. Bonham was. Apparently that was supposed to be a good landmark.

The Chief grinned at me and said “J.A. Bonham? He’s been dead for twenty years, but everyone knows that place.” Well, not everyone, Chief. I sure as hell didn’t know. Just writing this brings back memories of that cold night, and how utterly frustrating it was trying to find J.A. Bonham’s place. I’m tempted to take my wife back there for vacation, and casually mentioning to some of the locals about J.A. Bonham’s place. Now, even 20 + years after that call, it won’t surprise me a bit if people still remember where it is.

will comment about the way we were dispatched in those days, though, versus what I see now on Nightwatch (and the way many other services do it, and have been doing it). I'm NOT saying that other ways are wrong, just how I perceive it. When CSP dispatched us, they would use mainly clear speech, with occasional 10-codes. "Attention Eagle Fire and EMS, multiple car accident westbound I-70 near mile marker 148. Time is 1630." Nice and clear, usually, with no doubt about what we had, even for the rookies. Apparently New Orleans EMS uses an alphanumeric system to classify their calls. Again, I'm NOT saying this is wrong or bad, but I can just imagine getting a call with that system at 2 in the morning. "Respond to a 34-S on the corner of...." Knowing myself, I would have to think: "34-S, is that a gunshot case or kid throwing up?"

As I’m writing this, I also happen to be watching Nightwatch: Memorable Cases and Chases. Cool! It’ll help me remember a few more things to compare to my time in EMS, and brings me full circle back to what prompted this particular blog. The most striking differences are in the technology. When I was with WECAD, the top of the line cardiac monitor was the Physio Control LifePak 10. We also had an older LifePak 5, but the “10” was our coolest unit. These ran about 10 grand each, so we had only one. This model can monitor in 3 leads, which is really beyond the scope of what this blog is about. A quick look on eBay just now showed me several complete sets for just under $300. Wow! These days paramedics routinely run 12-lead monitors, which is what is found in hospitals. This is a good thing, although I’m glad I only had to learn to read and interpret 3 leads and not 12.

Other improvements over my time include the “cot,” or stretcher as some would call it. Our cot was a Ferno 35, which in and of itself is a nice model. What I see the Nightwatch crews using, though, appears to have some sort of hydraulic assist mechanism which helps them load the cot into the ambulance. This is especially nice (and much safer) when handling heavier patients. Being somewhat of a technophile, I’ve fully embraced electronic forms of communication versus paper. To me, it’s just more efficient and convenient. When working for WECAD, our patient reports, or “trip reports,” were carbonless, multi-copy forms that we would document the nature of the call, our observations and treatments and other pertinent information. Normally our long transport times would allow us to finish this document, which ultimately became part of the patient’s medical record, by the time we reached the hospital. Of course, if we had a critical case, we spent our time performing treatment and care and would finish the paperwork once we got to the hospital.

I’m glad to see that modern EMS crews use either a laptop or tablet device to perform the same function. I would love to know how this data is transferred to hospital personnel, though. Is it done wirelessly or via other download? Maybe one of the Nightwatch medics will comment on this (and does it have Candy Crush installed?). Oh, come on! I was kidding about the Candy Crush thing. Lighten up!

One aspect of “then” versus “now” that hasn’t changed, and I’m happy to see this, is the camaraderie of the crews. Seeing the Nightwatch crews like Nick and Holly, or Dan and Titus banter back and forth as they respond to a scene remind me so much of when I would do the same with Andy, Tyler, Terri or others. I swear I've had pretty much the exact same conversations. Keely, I haven’t forgotten about you, either. We just didn’t have a position similar to yours back in the day. You deserve a shout out here, though, as just by watching you do what you do, I can tell you’d be a blast to hang out with. So, to all you Nightwatch medics I mentioned, the first round is on me the next time my wife and I make it up to New Orleans (or one of y’all make it to the Houston area).

Their names, by the way, are hyperlinks to their Twitter profiles. Check them out, and follow them on Twitter if you have an account. I follow them on my account, and its fun reading what they have to say. This camaraderie isn’t limited to just their own crew. The bond extends to their law enforcement and firefighting colleagues as well (and as it should be). We all rely on each other to do our respective jobs and have each other’s back. Just ask the guy who was foolish enough to push me on an accident scene. One of the Eagle PD officers saw this and had him in handcuffs in short order.

Since moving back to Texas in the mid-90’s, I’ve been happy to reconnect with my friends in Colorado. I enjoy seeing how some of the firefighters and medics I ran with now have grown kids doing the same thing. It’s not a cliché about the fire service and EMS being a “family business.” WECAD has since merged with ECAD (Eagle County Ambulance District – the agency covering the eastern part of Eagle County) to become Eagle County Paramedic Services. Thanks for answering my question about shift times, ECPS. I think I pulled a 48 hour shift once or twice with WECAD, normally to cover for someone, but it wasn’t often. I did 12 hour shifts, like the Nightwatch medics do, as a part timer and when I did private EMS back in Houston. I think that sometimes a 12 hour shift is actually harder than a 24, but that’s just me.

To all the public safety personnel I ran with, thanks for the memories. To those who are currently active, thank you for what you do and stay safe.

Until next time......

carpe cerevisi

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