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Semester Over … Blogging is not!

With my English class that prompted this blog coming to an end I will not be posting as frequently, nor to any set prompts. I will try my best to keep up any funny posts or memes I come across when i am waiting for a call to come in.

Since the beginning of the course I have become a probationary member at Aetna Hose Hook and Ladder Fire Company and started my Fire School training. I have responded to 3 Cardiac arrests and a number of accidents. I have yet to go to a working fire but I am ready to crack the hydrant if needed. I am also working on getting my national registry test so I can getting my Delaware EMT.

TO all of my fellow responders, and to everyone else as well, stay safe and have a happy holiday’s. Wear your seat belt and please do not text and drive!!!!

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Book Review (11)

A history of Military Medicine – From the Renaissance through modern times

Gabriel and Metz

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If you are interested in Military or Medicine this is a great read. Not going to lie some parts seem boring but the book itself explores the broad range of realities that come with war. He talks about the development of modern war and traces its back to its roots in the 17th century. He talks about the biggest killer of troops back then was diseases and the poor conditions. He explores the concept of modern industrial warfare and how war itself has become a machine. With advancements in technology both for weapons and medicine diseases nor bullets, tanks and missiles are the leading cause of loss of manpower. However War itself has exceeded anything we could possibly believe. Men from both sides are incapable of fighting due to psychological collapse. It is a very interesting read, definitely a book I will be picking up again in a couple years and relate my own medical experiences too. If you have a grandfather or an uncle who is a military book I would recommend you pick up a copy for them.

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Academic Review (12)

     Vesa E. Lund, author of the academic journal “Tactical EMS revisited – analysing the benefits needs a wider perspective,” claims that studying the benefits of tactical EMS needs a wider perspective lasting several years. He uses research specific to one city, not the rest of the country and states why the system works so well in Helskinki. The author is writing this in order to explain why more research needs to be done in order to implement a national system in order to make it as effective as possible. This article is intended to addressee politicians and the public who are interested in the benefits of tactical EMS in every Finland community.

     Although Finland is not the United States, and nowhere near the diverse geographical region and size, it is researching TEMS to possibly adopt it into Finland’s everyday EMS system. It is a great example of how tactical EMS training can be incorporated into existing systems to save lives if a situation arises. The Author explains how rare a situation is and how training for all would not be effective. I agree that training for all in tactical specific situations would not be cost effective but having tactical response teams with tactically trained ALS/ LEO personnel on the team (Jim Morrison’s “Officer-Agent/Medic” Model) is very effective. I believe that Finland is a great example of how people as a whole are changing and that means the first response procedures and training has to evolve with the times in order to save the greatest number of lives possible. The system that Finland has incorporated includes advanced tactical training and will be implemented in a way that minimizes response times ultimately saving lives.

http://www.lib.udel.edu.proxy.nss.udel.edu/cgi-bin/getit.cgi?sid=gale%3A&aufirst=V.&aulast=Lund&atitle=Tactical+EMS+revisited+-+analysing+the+benefits+needs+a+wider+perspective&date=2012-08&genre=article&issn=00015172&issue=7&pages=931&spage=931&title=Acta+Anaesthesiologica+Scandinavica&volume=56

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"Crooker"

As I sat in the back room typing away on FaceBook an older man named “Crooker” came in and we started talking. I asked one question “What got you interested in firefighting?” That turned into this long discussion. The following are my notes.

Started at 17 Delaware city firehouse. Gathering going, when his brother joined he joined. They had 3 apparatus, 2 engines and a grass truck. Not many fires, everyone came, young guys rode the hose bed to the fires. Sometimes they had 9 or 10 people ona  truck that fit 6. If you wanted to go, you went. Totally different, now it is all safety, everyone goes home. Back then we were just happy to prove their skills. You were not a fireman, you were a lineman, get hose off engine give to nozzle man. Back then airpac was voluntary. They went in with booster line. Guys on the roof to ventilate and opened up roof and knock the fire down. Actually pushing the fire ahead of you to break the fire into steam to put the fire out. It is very hot and confusing. Most guys were holding breath inside. It was a completely different set of rules and regulations. After you were trained in fire schools in house you became fireman I II III. After fire was knocked down, lineman’s came in and practiced skills. 1 fan per truck. Blow water out of window, caused air to come in. Became nozzle man, had to get a job, and enlisted in the air force.

 Once you became 18 you had to register for the draft. Depending on qualifications you had different grade. Most young guys were classified 1A (be drafter) He enlisted, went to Vietnam.  Tried to cross train into crash crew. He was a back up fireman. He got air force training. Stateside bases were undermanned. He was home for 30 days, every day spent at the firehouse

It is weird to be happy in such a dangerous job. The old men said why are we doing this? The whole thing is it is not for the firefighters it is for the families. So they had a body to bury, families back then were very tight. Everyone was a hometown person. He met a girl in Montana settled down and got married. He then started riding again. Got a job at DuPont. He knew some people at Aetna, started riding along with Aetna in December 1969. Been here for 45 years. Joined Delaware City in 1962, 50+ years in the business. He was active, it was well expected in the entire state. They were from the old school, most in the military. It was a semi-military group. They were used to taking orders and getting chewed out. They straightened you out, you either quit or did it right.

Money was made by sending them out to the families of the area and gave it in for the fund drive. That is what kept them going. Also accepted city, state and county money. Ladies auxiliary, ladies ran it but the money comes to us.

When he got involved he had no family, mother died at 12, father at 1. His leadership came from the men at the house. They took him under their wing. When he joined here it was a bigger organization, had two stations, now we have four. Now they are shorter on manpower, recruiting from UD. Most old timers came from other stations, lived closed to the firehouse, could get trucks out really quick. Guys live farther away making response times longer.

Times have changed: it is all about safety. Firefighting is the most dangerous jobs in the world. Most states are paid, not Delaware. It is getting rough due to the volume of calls and the manpower. Today the fire service handles everything: rescues, water in the basement. Ambulance crews know addresses, even if they know it is bullsh*t they have to go. Has to get state involved when people cannot take care of themselves. Started with emergency calls only, now is everything.

We had Cadillac’s, not big boxes; trip to Wilmington was 17 miles away. Then had to drive back, sometimes had another run. An active ambulance person would spend 6 7 or 8 hours as a volunteer. They did transports.

We had an ambulance club; they normally had shows up to attract people to donate. People who didn’t donate got a note asking for money. IF you donated (even 10$) then you and your family was covered for one year. They gave the cheapest service, as times changed, ambulances got bigger, more training was needed.

Now everyone is a volunteer but they aim to be professionals.

People can donate money to other organizations instead of the firehouse, even though we can help them 24/7. With the economy down the money coming in is down, costs keep going up and up.

Looking back on his 45 years, it has been a great time filled with life long friendships. It is unbelievable the amount of friendships are still around. It is a “Fraternal brothers hip.” There is always something for everyone to do. If you like ambulances we will push them that way. This is one of the biggest companies in the state. Still volunteer, but it is probably going to change. Just trying to provide the best service, as professionally as possible, still as volunteers. Have some paid as a backup, but mostly volunteer. 

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Time for change

Although there is no specific law that I find unfair in EMS in New Jersey. I believe it is time for the policies to be reviewed and the structure for how EMS to be reconsidered and possibly an entire new system implemented. EMS is a relatively new field and in the past few years their have been changes in what we know. EMS in NJ does not have medical command and each agency has to have their own medical direction from a doctor associated with the squad. I believe that with the changing times that how EMS is set up on the state level needs to be rewritten. There are some basic tasks, such as giving eli, nitro, aspirin, CPAP, fluids and blind intubation devices that are simple to use and statically save lives that EMTs are not allowed to use. With a restructure these easy, simple to use drugs/equipment will save lives on the streets. Unfortunately the last two bills proposed to congress have been vetoed by Governor Chris Christie. 

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Hope - Image Analysis (Blog 8)

Photo: Thanks to Medneck Central - Reaper

An ambulance has been the symbol for help for the past half a decade. Since then kids have been taught that if they need help call 911 and an ambulance, firetruck and a police officer will arrive just in case. In this Image there is a car in the background. This car symbolizes the person in distress. He or she may be unconscious and possibly not even breathing by him or herself right now. It is the job of the first responders to make sure that this victim is extricated from the car in an appropriate time using appropriate equipment and transporting the patient to an appropriate facility as quickly as possible. The fire truck in the background symbolizes first responders as a whole. Even though they are not equipped to transport the patient they are usually the second on scene after police and have some equipment so they can start helping the persons involved. The last part of the image, and the first part one notices, is the open ambulance compartment in the back. This symbolizes a safe haven. Once you are in the back there are people who are trying to help, who have the skills and experience that give you the best chances for surviving whatever prompted the 911 call to begin with. There should be a stretcher in the back, however the crew has probably taken the stretcher, along with the tools and equipment for proper c-spine stabilization, to the scene of the accident. Overall the image symbolizes hope. The only hope a person may have in a dire situation. This image also symbolizes what many young men and women do everyday to risk the lives of a stranger. The danger, excitement and possibility of helping someone all make the reward outweigh the risk. This right here is why I do what I do. If you want to become part of it, go to your local firehouse and see what you need to do to get started. Maybe one day you’ll be providing hope for a stranger.

Image thanks to https://scontent-a-iad.xx.fbcdn.net/hphotos-prn2/1385947_10151929621343624_1372767600_n.jpg

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MLEMS.org

My hometown EMS squad, Mount Laurel EMS, had an outdated website for years. The layout was blurry and pixilates and the information was years outdated. The member login was outdated and only served as a place to put links for the websites we use. This changed last year when one of our supervisors Dave took the website on as a project as his. Now mlems.org is a fully functioning website that is up to date and is used as a resource for everyday operations for Mount Laurel EMS. Some links, like getting to the application, can be multiple steps but all the information on the website is laid out in an organized function. The color choice of the website, much like my blog, makes sense. It looks clean and looks good on both the desktop and the mobile versions of the sight. The website clearly demonstrates the capabilities that Mount Laurel EMS has to offer. Great job Dave!!!!

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5 Controversies

Axe vs Power tools:

Power tools can prove to be a great resource. They cut down forced entry times dramatically but the problem is that they can fail. I am an avid supporter of carrying power tools on trucks due to their capabilities however I would still like to have a good-old-fashion halogen bar and axe to rely on if needed.

Blue lights for volunteers vs No blue lights

Every volunteer is a little bit of a wacker. They love the lights and the sirens and the thrill of helping people but are blue lights necessary when responding to the station? No. They may help launch a truck faster but what are the risks involved? Is it worth shaving 30 seconds off your response time only to have another call go out for a volunteer who ran a red light and s now in a ditch? The risks simply outweigh the benefits. Especially when people have the over-tendency to overuse them for personal reasons.

Transporting lights vs transporting no lights

On the topic of lights. When transporting a patient the old school philosophy was everyone gets lights. In reality it only saves about a minute off your time to the hospital. For most patients one minute will not be life or death, and for those where one minute will make a significant difference lights and sirens should be used. Unless the call is an ALS call and I do not have medics I am not going to risk my crew’s safety, the patient’s safety nor the safety of those around us. As fun as the lights are, they are again not worth the risk.

CPR with ventilation vs compression only CPR

For the medical professional who is trained with professional CPR ventilations should be 30:2 (according to AHA standards for adult one-man rescuer CPR; 2010.) However compression only CPR is a way to start CPR early because dispatchers can give directions over the phone once a cardiac arrest is suspected. I believe that everyone in the public should be trained on compression only CPR and may attempt ventilations if possible and safe. In this case, yes, I would use lights to this call.

Legal Duty to Act vs Moral Duty to Act

Legally speaking once you begin to give patient care you have to transfer care to someone of equal or higher level training then you are. This means, as an EMT, if someone passed out in the street and I began treatment. I am legally responsible to continue care until I have transferred care to another EMT or high via verbal report. However what is the moral duty to act? As a volunteer I joined my department to help people. It does not matter if I am “working” or not. I choose to assist people when I am on and off duty. However, because people are quick to sue; I rarely identify myself as an EMT. AS far as they are concerned I am just a good samaritan. I believe that the risks of waiting for a unit before rendering care to certain patients will prove to be detrimental to their health.  As a trained individual I feel that I have a moral duty to act, not just a legal one. 

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Do you want to help?

First responders are the first line of defense for people in need. Volunteering is easy to do, anyone can do it. If you want to volunteer your local first aid squad or Fire Department is probably looking for volunteers. The application process is not that hard to do. Even if you do not want to run into burning buildings there are plenty of things you can do to help. Next time you are passing your local fire house, feel free to stop by and check them out. They’re always looking for help. 

P1: First Responders help people when they are in need

[P2: You as a person want to help people]

P3: Volenteering is easy

P4: Your local First Aid Squad/ Fire Department is looking for volunteers

P5: You can volunteer in many different ways.

C1: If you want to help people you can volenteer with your local Fire Department/First Aid Squad as a first responder.