Wednesday, November 26, 2008

Final Conclusion in Teen's Death.....

Atlanta 911 Chief has final word on recent teen death

The autopsy concluded that classroom horseplay caused a fractured clavicle, which severed the teen's subclavian artery.

Several factors contribute here:
1. The call was dispatched as "chest pain", with probably NO indication of trauma or injury.
2. Without suspicion of trauma, paramedics might treat treat cardiac arrest based on the presumption of a cardiac etiology, not factoring in occult BLOOD LOSS requiring fluid challenge.
3. Lack of the extra hands makes working the arrest difficult, but NOT impossible. This was a load and go call. Take the school officers to help perform CPR if fireman aren't available. They were trained in CPR. Some help is better than NO help. Clinically and Legally speaking. (From personal experience the police are less big-headed, and will actually listen to your directions and requests, and can perform adequate CPR just as good as a fireman. Too many cooks spoil the soup, same with paramedic patches.)
4. Being that Benjamin Mays High School is minimum 10-15 minutes from *ANY* hospital (barring that Southwest Community Band-Aid Station was not open this week!) - With a subclavian bleed, even a KNOWN or SUSPECTED ONE... the child didn't have a fighting chance chance. Consider the response time, contact time, extraction time, and transport time. The child needed high volume transfusion until a SURGEON could repair the artery -- ONCE, AND IF, THEY EVEN FOUND THE SOURCE OF CARDIAC ARREST WAS AN ARTERIAL BLEED.
5. Even if EMS "got him back" enroute... the ER would have never found the bleed in time. He would have coded again, and eventually the code would have been called.

That's the sad truth of it all.

I'm very sympathetic for this family and this community's loss. Sometimes, EMS can't save them... even if dispatch hadn't cancel the extra hands.

Friday, November 21, 2008


I heard the groans already. Many adept paramedics and EMT's cringe at the word. Stereotypically, when fire department personnel shows up at your scene (and nothing is actually on FIRE), things tend to go to shit quickly.




...I miss the witt and humor of EMS and ER staffers.

Yeah... that's just damn funny.

THE DNR SONG - Sung to "Rockstar" by Nickelback

Tuesday, November 18, 2008


Inspired (if only briefly) by Eric over at EMS HAIKU for this one. says I'm a Kinda Dorky High Nerd.  What are you?  Click here!

Wednesday, November 12, 2008

Blogger Spotlight: TONY TRIMBLE

I have much admiration for this fella. I'd say gentleman, but that's just not Tony. He's a gruff ole medic, wise beyond his years, experienced in every fucked up scenario you could ever imagine. A former super-uber-military special ops kinda guy too.

When I hired on at Grady EMS, he was a field supervisor. In recent years, he resigned from supervising to work prn while getting his RN (BSN?). Once inside that privileged world of starched white scrubs and MRSA infested hospital wards, he concluded that a paramedic's idea of work ethic far surpassed the concept previously established by the estrogen soaked, gossipy, PMS having, whiny, cackling hen bitches up on the floor. So back to EMS he came. When I left Grady, he was just a good ole field medic again. Last I heard - he recently resigned. I could only begin to guess why. We all have our reasons.

Although I have urged him to sign on to blogspot, he has yet to take me up on the offer as far as I know. His MyspaceBlog is public, and I urge everyone to browse his posts and archives. It's a great read!

...And yes, his GA Paramedic # is 337. He was one of the first batch of Paramedics that the state graced with a patch from the State Composite Board of Medical Examiners.

His most recent batch of posts are titled "Things Tony is not allowed to do while on duty" with a follow up segment titled "As an EMS Supervisor, Tony is not allowed to..."

* * * * * *REPOSTED* * * * * *
During 27 years at Grady EMS, I complied a fairly extensive list of the "Things Tony is not allowed to do while on duty".
Yes, having a sense of humor on the ambulance does keep you in trouble with the boss.

1) Not allowed to refer to the ambulance as "The Poor Man's MARTA"
2) Not allowed to keep score of 'codes' on the outside of the ambulance with a rubber stamp silhouette of human with a slash through them.
3) Not allowed to refer to his job function as the "WalMart greeter for Heaven"
4) Not allowed to refer to the 'poof of smoke' from poor defibrillator skin contact as 'another successful exorcism'.
5) Not allowed to respond to a dispatcher's assignment of a call with "You've got to be shittin' me"
6) Not allowed to tell the supervisor to "Take out the crayolas and go color" when working a mass casualty incident.
7) Not allowed to tell firefighters that you'll ask for their opinion only if the patient suddenly bursts into flames.
8) Not allowed to refer to the new interns as 'little Doclings'
9) Not allowed to refer to the Director of Operations as "She who must be obeyed"
10) Not allowed to refer to EMS administration as the 'Keystone Kops'
11) Not allowed to refer to a mass casualty incident as a 'clusterfuck'
12) Not allowed to place a hand on a patient's forehead while shouting "By the power of Jesus be healed!" immediately following the administration of D50.
13) Not allowed to refer to police officers as 'blue canaries' when at a Haz-Mat spill
14) Not allowed to list a patient's condition as 'Boneyard dead'
15) Not allowed to list 'full of shit' as an assessment
16) Not allowed to respond to a supervisory instruction with "I don't think so"
17) Not allowed to coat the bench seat with 'Armor All' in anticipation of receiving a dumbass patient
18) Not allowed to stand over a multi-trauma patient and say, "Oooohthat'll leave a mark"
19) Not allowed to recommend a tubal ligation to patients having their 5th, 6th, or 10th child.
20) Not allowed to hold up an Olympic-style score card at a post-suicide scene
21) Not allowed to mark out the names of cardiac arrest patients from the Atlanta telephone directory as a means of performing a death notification
22) Not allowed to tap dance and sing, "Guess who died in bed today…do-dah, do-dah" as a death notification
23) Not allowed to respond to a dispatcher with "Bite me"
24) Not allowed to give directions to the nearest housing project to lost out-of-towners
25) Not allowed to play the 'William Tell Overture' or 'Flight of the Valkyries' as a substitute for the siren
26) Not allowed to play the Ringling Bros. "Here come the clowns" over the PA as the fire department arrives at the scene
27) Not allowed to answer a firefighters question with "Because I'm smarter than you"
28) Not allowed to ask a police officer to shoot an annoying patient29) Not allowed to send a family member for the bathroom plunger when performing a home delivery
30) Not allowed to ask for a 'burger and fries' while handling a seizure at McDonald's
31) Not allowed to refer to naso-tracheal intubation as 'snot locker duct work'
32) Not allowed to refer to a Basic EMT as 'my porter', 'scribe', or 'strong back/weak mind'
33) Not allowed to refer to a nurse as the 'band aid bimbo'
34) Not allowed to refer to the on-site supervisor as 'comedy relief'
35) Not allowed to preface a treatment with "This is going to fucking hurt"
36) Not allowed to respond to a patient's choice of hospitals with "It was nice knowing you"
37) Not allowed to list 'pavement pizza' as the assessment for a pedestrian struck by car
38) Not allowed to play 'guess the part' with people hit by a train
39) Not allowed to write "I didn't see shit' on a supervisor's investigation paperwork
40) Not allowed to play 'How many assholes can we stack inside the ambulance' at a multi-patient scene
41) Not allowed to identify the ambulance as 'Lethal weapon 240'
42) Not allowed to refer to a new medic's paramedic numbers as 'a license to kill'
43) Not allowed to choke the driver for almost getting the ambulance in a collision
44) Not allowed to mark 'unknown' for gender on paperwork for gay patients
45) Not allowed to refer to hospital administration as 'Satan's minions'
46) Not allowed to tell an intern, "I need a real doctor"
47) Not allowed to question an MD order with "Not in this lifetime"
48) Not allowed to answer a dispatcher's inquiry about location with, "We're fucking lost"
49) Not allowed to respond to a fat person's request for a stretcher with, "That ain't happening"
50) Not allowed to hook a finger behind a fat patient's ear while shouting, "Up Maja…Up!"
51) not allowed to refer to the EMS administrative offices as 'Fantasyland'
52) not allowed to refer to admin memos as 'stone tablets given to him by a burning bush'
53) not allowed to stop in mid-sentence to explain a multi-syllable word to the director
54) not allowed to pull behind a large parked truck, throw on the lights/siren, and scream when he notices his partner sleeping soundly.
55) Not allowed to write memos to supervision in bright Crayola colors
56) Not allowed to refer to the 'Attending Physician' as the 'Senior Witch Doctor in Charge'
57) Not allowed to ask a crabby nurse, "Did someone light the string on your tampon?"
58) Not allowed to refer to Trauma 1 and 2 as "the abattoir".
59) Not allowed to refer to the CPR room as 'The Pearly Gates"
60) Not allowed to ask a firefighter if they want a band aid for the scrapes caused by dragging their knuckles on the ground
61) Not allowed to ask for a doctor without their head up their ass
62) Not allowed to write a two page memo in single-space typewritten to explain why the air conditioner isn't working
63) Not allowed to speculate as to the actual grade school level EMS administrators were in when they dropped out of school
64) Not allowed to explain to female patients that PID means 'Pus in Dere'
65) Not allowed to explain to the male companion that PID means 'Pussy is Disabled'
66) Not allowed to grade marksmanship on victims of gunshot wounds
67) Not allowed to point out visible organ structures to multi-trauma patients
68) Not allowed to check a new hire's date of birth to assure that they are old enough to drive

69) Not allowed to refer to EMS as a human-variant of UPS
70) Not allowed to describe a multi-trauma patient as 'fucked up beyond belief' over the med radio
71) Not allowed to explain "Pink is good…Blue is bad" to an intern
72) Not allowed to observe "All bleeding will eventually stop" in Trauma 1
73) Not allowed to suggest that the ER Docs kill a chicken and shake a rattle at the patient
74) Not allowed to growl, "His soul is mine" when working a seizure in the middle of a church service
75) Not allowed to hand EMS equipment to a big-mouthed bystander with the instructions, "OK…you fix him"
76) Not allowed to direct reporters into an active Haz-Mat spill
77) Not allowed to tell bystanders that the reason for all of the agencies being present at a scene was that it was an actually an alien encounter…not a Haz-Mat situation
78) Not allowed to tell an entrapped driver of an overturned car, "Bitchin' parking spot, Dude"

79) Not allowed to call a multi-stab wound patient 'a human sprinkler' over the med radio
80) Not allowed to document a tachycardia as 'RPM's set too high'
81) Not allowed to ask a crabby nurse "When did you last get laid?"
82) Not allowed to offer to superglue a talkative partner's lips together
83) Not allowed to address a hygiene issue with "Do you know that you smell like a goat?"
84) Not allowed to sign the supervisor's name to a written warning for being a smartass
85) Not allowed to hand a surgeon a piece of candy while saying, "Nice costume Kid"
86) Not allowed to drive on the sidewalk…with or without pedestrians being present
87) Not allowed to describe a surgical wound as 'split from asshole to appetite'
88) Not allowed to question a Director's instruction with, "What exactly were you drinking?"
89) Not allowed to refer to defibrillation as 'jumpstarting a corpse'
90) Not allowed to throw a patient complaint into the trash before they leave the room
91) Not allowed to laugh hysterically while taking a patient complaint about an EMS crew
92) Not allowed to discuss plans for lunch over a decomposing corpse with a new hire
93) Not allowed to pause in mid-resuscitation to ask a passing waiter, "What was he having…I eat here fairly often"
94) Not allowed to refer to the dispatcher as 'The Great Oz'
95) Not allowed to offer an employee 'wall to wall counseling'
96) Not allowed to cut an employee's ID into small pieces while questioning, "Guess what this means"
97) Not allowed to offer to glue an overly active kid's feet to the floor
98) Not allowed to refer to the human resources department as 'Touchy Feely Central'
99) Not allowed to the legal affairs office as 'the courthouse bordello'
100) Not allowed to explain hospital bypass as 'circling 285 until somebody dies' to a patient's family

10 years of EMS supervision also created more than a few 'situations' that prompted me to created "As an EMS Supervisor, Tony is...."

1) Not allowed to answer the supervisor's telephone with "And your silly ass problem is…"
2) Not allowed to assign problem employees to the zone furthest from the office.
3) Not allowed to put two lethal employees together to keep the body count as low as possible
4) Not allowed to giggle when accepting a resignation
5) Not allowed to suspend an employee for 'being a pain in my ass'
6) Not allowed to hold a 'career options' counseling session for pain in the ass employees
7) Not allowed to drag patients out of the ambulance by their ears
8) Not allowed to launch patients out the side door of the ambulance with a boot
9) Not allowed to have patients arrested for 'being a waste of protoplasm'
10) Not allowed to give problem employees a ragged out ambulance every shift while explaining that the unit is a 'special assignment' ending the same day as their employment
11) Not allowed to explain to complaining patients, "You needed to be verbally abused"
12) Not allowed to say, "What the fuck did you do this time?" to initiate an investigation
13) Not allowed to compare an employee's driving skills to Helen Keller
14) Not allowed to offer to shove a cell phone up an employee's ass
15) Not allowed to evaluate an administrator's idea with the words 'addle brained'
16) Not allowed to offer employees 'a blunt force vasectomy'
17) Not allowed to write 'dumbass', 'as lazy as the day is long', 'oxygen thief', 'useless as tits on a boar hog', 'should be executed', 'waste of skin', 'estrogen overload', 'couldn't find his ass with two hands and a roadmap', 'clueless', 'should be employed by the fire department', 'EMS administration material', 'toxic personality', 'my karma payment', 'our effort to meet the EEOC requirement for hiring the mentally handicapped', 'a blunt instrument of fate', "Saint Peter's apprentice', 'proof that we've offended God', 'intellectually challenged', 'candidate for placement in a wood chipper', 'should not touch any viable lifeform', or 'fucking dangerous' on any employee evaluations
18) Not allowed to remind the EMS Director that the Easter Bunny isn't real
19) Not allowed to write memos ending with, "And so the prophets spoke"
20) Not allowed to ask employees of the Human Resources Department, "Do you actually do anything of merit?"
21) Not allowed to tell administrators, "Don't try to think, it will cause you to have a headache"
22) Not allowed to keep a jar of Panadol on the desk for Operation Manager visits
23) Not allowed to tell the ER Attending, "If you piss me off, I'll have every diverted patient brought to your hospital."
24) Not allowed to divert a nasty drunk to North Fulton Hospital
25) Not allowed to request that an employee relax their anal sphincter to allow more oxygen to reach their brain


Oklahoma to debut new sirens you can FEEL...

At $400 each, it will cost roughly $40k to outfit this service's entire fleet with a new siren aimed at PREVENTING future collisions by UPGRADING OUTDATED TECHNOLOGY. This new siren is designed to increase ambulance "visibility" by making inattentive drivers FEEL the ambulance that is coming their way, thus reducing the likelihood of a response related crash.

When contemplating the expenses of a basic ambulance crash:
Repair or replacing an ambulance worth $75k-$125K
Repair or replacing a civilian vehicle worth $10k-$50K
Injuries and medical expenses - potentially immeasurable.

$40K in preventative expenditures! This purchase pays for its self when it prevents the first crash!!!

This is a lesson that could be shared with OTHER EMS AGENCIES!

Spending a little money here and there for "quality" vehicle maintenance, stretcher servicing and maintenance, NEW STAIR CHAIRS and other new equipment, and YEARLY driver's training goes a long way... most especially when compared to the money spent on repetitive vehicle maintenance (for problems that NEVER get fixed after multiple trips to the repair shop), settlements on personal injury claims from patients injured on defective stretchers, settlements on personal injury claims from collisions with civilian vehicles, --- OH... AND DID I MENTION ALL THE LOST HOURS, MEDICAL EXPENSES, AND SALARY BENEFITS FOR INJURED EMPLOYEES FORCED TO UTILIZE WORKERS COMPENSATION.

On a side note... $40k is a drop in the bucket when considering an operating budget of MILLIONS of dollars, and the potential revenue from billing for EMS services!!!!