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EMS Delivery and Leadership: Officer Down!

4 comments

 

On Waiting 

The DC press was all over a recent incident where a Metropolitan police motor officer was struck and injured by an auto while stopped in far southeast DC, close to the border with Prince George’s (PG) County, Maryland.  No DC ambulances were available and the officer was eventually transported by a PG unit after one was requested.

You would think that no one ever had to wait for an EMS transport unit before.

While this appears to be about “wait times” it is also about how DC works with neighboring jurisdictions.  For example, PG, Montgomery, Arlington, Fairfax, Alexandria, etc. have essentially integrated their dispatching protocols at the 911 level so that the closest unit is often dispatched based on their availability.  It matters not where they are from.

 Automatic Aid

The fact that a PG ambulance treated and transported the officer should not be an issue, the wait should be.  DC Fire and EMS (DCFEMS) or DCFD, whatever you want to call it, should be working to integrate as fully as possible with the other Washington area Council of Government fire departments.  (The fact that they are not is amusing, in at least one aspect, since so many DC firefighters volunteer in PG and neighboring Montgomery County, Maryland.  They integrated in their own special way.)

The “wait time” issue is thorny, complex and longstanding.  This is just one example.  DCFEMS Chief Ellerbe seems to want to run the department as if it were a business:  staff to meet the demand.  If you ran a clothing store and 90% of the customers came in from 5PM to 9PM, you wouldn’t have 90% of your employees working in the morning.  They would show up at 5PM.  This is hardly rocket science but it is a big change for the department.  And, there will be times when an ambulance is not readily available, that’s why we have fire companies with EMS (including Advanced Life Support) capability.  That’s also why automatic mutual aid is essential.

 Leadership

And another major issue is leadership:  Ellerbe as fire chief and IAFF local 36, the union that represents the members.  Has Ellerbe really tried to get labor buy-in for this and other changes?  Is labor basically “thumbing their nose” at any healthy and effective change?  (It’s easy for labor to be mired in the status quo as leaders are likely to be tenured and not especially fond of rocking the boat.)

Who can argue against a rational model that deploys the resources in such a way that they are likely to be available when most needed? If Ellerbe’s ideas fall within the parameters of a professionally acceptable approach to deployment of fire and EMS resources, the council (and the Mayor) should give them a chance to work.

Agendas

At the end of the day, the Department (and the union) is made up of a variety of folks with their competing agendas.  It would be nice if it were a sure thing that Local 36 was interested in the welfare of the citizens but I am not sure that is the case.  As an example, this past New Year’s Eve, 100 folks called in sick resulting in 12 ambulances being placed out-of-service.  According to a local media outlet, “one man died from cardiac arrest while waiting for an ambulance on New Year’s Eve.”  Some ascribe this to firefighters being pissed off about not receiving holiday pay on Christmas Eve.

Finally, regarding  unfilled paramedic positions, it is a widespread problem across the US.  Paramedics do a large majority of the work and are often treated like third-class citizens by firefighter co-workers.  No wonder people won’t take the jobs or become burned out.  Returning to the business aspect for a moment, would Microsoft treat their most productive employees the same way?  (We know the answer to that question.)

 

Posted by on March 16, 2013 • Filed under: Administration & Leadership, Command & Leadership, EMS Dispatch, EMS Topics, Funding & Staffing, Safety and Health, Vehicle Operation & Ambulances

Let’s Live…FOREVER!

28 comments

 

“Harrowing” and “Horrifying”

The Associated Press reported yesterday that an 87-year-old Bakersfield, CA, woman collapsed at the dining hall of her assisted living facility and that staff refused to perform cardio-pulmonary resuscitation (CPR).  She died.

Now, all hell is breaking loose.

Never-mind that the “residents of the facility are informed of the policy (no CPR) and agree to it when they move in.”

A nurse is being vilified by the ignorant media, politicians and others needing to score points as she was simply doing her job and adhering to policy.  The policy is not a “do not resuscitate” but rather a “will not resuscitate.”  No difference, just they are telling you instead of the other way around.

This situation highlights the fact that apparently healthy people, especially the elderly,  can die of natural causes and not need or want resuscitation.  This potential eventuality had been explicitly addressed without the need for the “DNR” order.  There are many ways to skin the cat.

We westerners think we will live forever and that every sentient being should go to the great Walmart in the sky with four broken ribs, a lacerated liver and a tube jammed down our throat.

From California Advocates for Nursing Home Reform: “Independent living facilities should not have a policy that says you can stand there and watch somebody die…How a nurse can do that is beyond comprehension.”

From the California Board of Registered Nursing: “The consensus is if they are a nurse and if they are at work as a nurse, then they should be offering the appropriate medical care.”

And this bon mot from Assemblywoman Mariko Yamada, chair of the California Assembly Aging and Long-term Care Committee, “This is a wake-up call.”  (Not so much.)

This is shaping up as another example of the “Hot McDonald’s coffee/I’m stupid so i’ll sue you”  world we inhabit.  Frankly, it’s 2013, if you are in any facility and they lack one or more Automatic External Defibrillators (AEDs), they aren’t serious about “sudden death” lifesaving regardless of what they say or who knows or will administer CPR.

If I defy the odds and live to be eighty-seven and am in the dining hall and go into cardiac arrest, I’ll sue all right.

I’ll sue whoever dares to touch me.

 

 

Posted by on March 5, 2013 • Filed under: Dispatch & Communications, EMS Dispatch, EMS Topics, Values and Ethics

Responder Safety: When Attention is “Tunnelled”

6 comments

American Airlines 2253

Does what we expect to happen influence our awareness?

Why is constant monitoring essential?

AA 757-200 Over-run
(AP)

Snowy Day

2253 was a Chicago to Jackson Hole, Wyoming (JAC), flight with experienced pilots flying in challenging but typical winter conditions.  (The Captain had extensive experience flying into JAC.) JAC is located at an altitude of 6,400 feet and the active runway was 6,300 feet long.

Weather conditions were better than forecast with light snow and winds though the aircraft would be close to maximum landing weight.  The flight crew conducted a very thorough en-route briefing evaluating runway conditions, weather and aircraft capabilities.

Runway conditions deteriorated during the final third of the length so the plan was to touchdown in the first 1,000 feet and come to a stop quickly.  The aircraft slows and stops using a combination of main gear hydraulic brakes, engine thrust reversers and “speed brakes” or “spoilers.”  These speed brakes cancel wing lift and allow the weight of the aircraft to settle on the main gear so the hydraulic brakes will be fully effective.

Deployed Thrust Reverser

Approach

Engine thrust reversers are manually deployed by the flying pilot after touchdown and the speed brakes can be “armed” for automatic deployment or manually activated at any time.  In addition, the aircraft has a system that automatically confirms that it is on the ground so that deployment is appropriate.

The aircraft was configured for landing, the first officer was the flying pilot and the captain was tasked with monitoring pertinent systems.  He would confirm and call out successful deployment of reversers and speed brakes, a common procedure.

 

Looking Aft

“Two in Reverse”

The aircraft touched down exactly as planned and the Captain called out “deployed” and “two in reverse” suggesting that the speed brakes and thrust reversers were operating.  In the split second after touchdown the “on the ground” sensing system cycled from ground to air to ground again at the exact moment that the flying pilot was manually deploying the thrust reversers.  They froze in mid-deploy position.  In addition, because of an undetected fault in the speed brake system, they also failed to activate.  The aircraft was barreling down the runway, unable to stop and heading for a sketchy runway surface.

Two things were wrong but the pilots noticed and focused only on one–the thrust reversers.  The National transportation Safety Board (NTSB) referred to this as “tunnelled attention” since the pilot responsible for monitoring the “big picture” allowed his focus to be drawn to one area.  The problem with the speed brakes could have been instantly resolved by manually moving the lever to the deployed position.  Activating speed brakes even with late deployment of the thrust reversers would have stopped 2253 on the runway.

“Big Picture”

The NTSB discussed the inability for either pilot to pull back to focus on the “big picture” even though both commented that they were not slowing down.  One of the aspects touched upon is our tendency to expect automated and highly reliable systems to always function correctly.  (The Captain saw the speed brake handle start to move and assumed the rest.)  Our analogous examples could include SCBA, fire pumps or patient monitoring systems.)

Luckily, 2253 rolled to a stop in heavy snow about 500 feet past the end of the runway.  Their ski trip started early.  We can profit by training ourselves to keep the big picture and by not falling into the trap of expecting systems to always function flawlessly.

 

Posted by on February 27, 2013 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, Firefighting Operations, HazMat, Safety and Health, Technology & Communications, Training, Vehicle Operations & Apparatus

London Fire Brigade: Boris Knows Best

4 comments

 

Mayor Overrules Brigade Leaders

Boris at the Wheel?

London’s Mayor Boris Johnson is pressing ahead with cuts to the London Fire Brigade (LFB) which would result in a decrease of 520 firefighters.  A dozen stations and some 18 engines would be closed or placed out-of-service.

The LFB is one of the world’s largest fire services, deploying about 5,800 firefighters at 122 stations across the 600 square mile city.

A few days ago the  London Fire and Emergency Planning Authority declined to press ahead with the measures citing a threat to public safety.  The Mayor was apparently unconvinced.

American born and conservative politician Boris Johnson is gaffe prone, absurd and re-electable.  A bit of Johnsonian political philosophy: “if you vote for the Conservatives, your wife will get bigger breasts, and your chances of driving a BMW M3 will increase.”

The Fire Brigade’s Union (FBU) regional secretary for London, Paul Embery, said, in part: “These cuts are reckless and wrong, and it is an outrage that the mayor is going against the democratic decision of his own fire authority and the wishes of most Londoners. The mayor makes the absurd claim that these cuts would somehow improve public safety. But the London Fire Brigade’s own figures reveal that the cuts would result in increased response times for nearly five million Londoners, with only a fifth of the capital’s population seeing an improvement.”

One wonders if the FBU would have a stronger hand if they engaged in the integrated delivery of both basic and advanced medical care?

 

Posted by on February 3, 2013 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing

EMS Fees Redux: Quacks Like a Duck

8 comments

The Insurance Scheme

Duck

A recent post here detailed the upcoming plan for Montgomery County, Maryland, to join other Fire/EMS departments in charging those in need of EMS care.  All-in-all it was a bit of a love fest as management, labor and the volunteers are all on board with the plan.  Money does have a tendency to smooth the way.

Apropos of these fees, there was a story in the news recently about a City of Los Angeles incident where good Samaritans, helping at a car accident, died of electrocution and suffered the apparent double miss fortune of catching a final ride to the hospital, for which, they will be charged.

According to Yahoo, “City fire officials say they do not have the power to circumvent municipal codes and waive the mandatory paramedic fees, even in cases during which a citizen is accidentally injured or killed.”

I said previously that it is those least equipped who wind up getting shafted by such fee schemes:  the frail, the elderly, the mentally incompetent. To that list we can now add grieving families.

Frankly, it is nothing more than a government run insurance monopoly.  The Fire/EMS department charges you a “premium” in the form of taxes in exactly the same manner as you pay a premium for auto or homeowners insurance, whether you use it or not.  Then, if you actually need the “coverage” you are subject to a deductible, in this case the fee.

Mr. Monopoly

If Fire/EMS departments are going to be in the business of selling “EMS Insurance” they should invite other providers to bid on the provision of the service to ensure that citizens are receiving the best care for the lowest cost.  This will be anathema to some but it is the price to be paid for selling your services.  You should be forced to compete for the market share.

A. Philip Randolph

Labor should be especially ashamed as they are historically the presumed protectors of the little guy.  A. Philip Randolph, the famed labor organizer, said, “The labor movement has been the haven for the dispossessed, the despised, the neglected, the downtrodden, the poor.”  Well, not anymore.  Labor is lined up to levy a charge on a service that has already been financed by public revenue.

The plain truth is that health care dollars are in short supply and if those dollars are used to pay for a service that has already been paid for under the guise of “cost recovery”, the “little guy” loses in the short term and everyone loses in the long one.  Critically, labor loses the most as they forfeit their commitment to fairness on the altar of faulty and dubious profit, the very thing they say they hate about management.

Sources: Yahoo, Hasbro

Posted by on September 6, 2012 • Filed under: Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing, Values and Ethics

Your House Fire Comes to $41,655. Cash or Credit?

13 comments

Oh, your taxes?  That was just in case you needed us.

Montgomery County, Maryland, is one of the richest and most educated counties in the United States.  Their 2013 approved fire/rescue budget is $196.6 million, an increase of $16.6 million over FY 2012.  Just what does $197 million dollars get you?  Apparently not a ride to the hospital if you are sick or injured.  That, my friends, will cost you extra.

The Washington Post reports that County residents and others unfortunate enough to require medical transport will soon be paying $300 to 800 for the privilege.  Perhaps for the $300 fee you have to get into and out of the ambulance on your own.  In addition, you will only have a choice of the two closest hospitals and there will be an additional fee if you insist on a trauma center.

Ambulance

 

Now for $800, the cot will be wheeled to your bedside, you have a choice of any hospital, including MedStar, music of your choice will be played en route, and if your medical condition allows, light hor d’oeuvres will be served.

It turns out that the County’s volunteers have fought the fee in the past but reached an agreement with the bosses where they will receive a 15% cut of the $18 million annual take.  Now they are on board.

Residents are exhorted to remain calm as no one will actually have to pay. “County officials said that in nearly all cases, private insurance companies, Medicare and Medicaid would cover the cost of ambulance service…”  In a county where every other person has a post-graduate degree they are to ignore the fact that the costs of health care are skyrocketing and that Medicare and Medicaid are under attack.  Ignorance is bliss.

This brilliant economic model where taxpayers fund the emergency service to the tune of $196 million dollars but have to pay if they actually need it, should be extended to fire operations, as well.

If you call the fire department because you think you might have a fire, but you don’t, there will be a standard $2500 consulting fee as they have a look around and find nothing.

Fire Truck

If you actually have a fire, a matrix will be used to determine the cost based on the water used and the number of hoselines, and ground ladders deployed.  The use of master streams and aerial devices is not covered in the  matrix and are charged separately.  For example, the deployment of a standard rear-mount aerial for use under five floors will cost $1500.  Tillers and platforms are more.

County officials are exploring a “Diamond Plate Plus” program where any property owner, for an annual fee of $5,000 will be covered for one EMS call and one two-alarm fire per year.  This should not be confused with the annual tax bill because taxes are paid just in case.

(Source:  WP, Patch, Wiki, MC)

Posted by on August 14, 2012 • Filed under: Administration & Leadership, Command & Leadership, EMS Topics, Firefighter Politics, Funding & Staffing