L.C.E.S. For EMT’s

Some of you who are familiar with wildland firefighting are already well versed in the safety acronym L.C.E.S. It was developed in 1981 and continues to be taught in wildland firefighting curriculum as a handy checklist of things we should have in place when operating in dangerous environments where conditions can change fast.

L.C.E.S. came about when retired U.S. Forest Service Superintendent Paul Gleason looked at fatal fires over the previous 20 years and identified the four elements most likely to save your butt when stuff goes really wrong. The acronym he created is simple and it works.

In wildland firefighting changes in weather and fuel sources can mean that the operating conditions can go from good to “everybody run” in the blink on an eye, so L.C.E.S. is practiced pretty religiously.  One area of EMS where I feel is has tremendous application is when we’re working in traffic on accident scenes. I’d like to see us EMS folks adopt the L.C.E.S. mindset any time we’re working in the street or on the roadside.

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To Walk or Not To Walk?

The Happy Medic (THM) recently posted a fantastic topic on his blog. I love diving into controversial decisions that we have to make every shift. Here’s one of those questions that we need to answer on just about every call. Should we walk the patient to the pram or carry them?

This is one of those things that we have no choice but to address in every system on just about every call. How to we get the patient to the pram? When is it OK to walk them?

It seems like this subject got rolling on Justin’s (THM) blog when EMS types from around the country started sending him feedback about his role in the documentary film, The Chronicles of EMS. He was surprised by the volume of comments about him choosing to walk patients to the ambulance.

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5 Hard Questions EMS 2.0 Will Need to Address

“Success is to be measured not so much by the position that one has reached in life… as by the obstacles which he has overcome while trying to succeed.”

- Booker T. Washington

With multiple premiers of The Chronicles of EMS and a wave of enthusiasm from the EMS Today conference in Baltimore, the future of EMS looks bright, blindingly-bright. I’m incredibly optimistic about where this crazy experiment in EMS is headed, but I also see some big hurdles in our path.

Put on your shades and let’s talk about what I feel are the five biggest challenges to EMS reform.

1.) We’ve been talking a lot about unity and standardization, but individual EMS systems are unique in every way. How do you influence standardization and still allow for the tremendous leeway required for EMS agencies to be optimized for the communities that they serve? Can EMS agencies be different in geography, financial resources, administrative structure, culture, call volume, compensation and certification/education level and still find enough unity to advance the profession together?

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Safe At Home

A good friend of mine is being sued by a former patient. I don’t know if that statement gives you anxiety the way it gives me anxiety. I’ll admit it, I have an underlying fear of having to defend myself and my actions in a court of law.

I’m not scared of being held accountable for the medical decisions I make. I feel that I tend to make fairly good decisions, thank you very much, but the legal process can be expensive. And let’s be honest…because this is just you and me talking right? Sometimes the right thing to do is far from clear.

In a court of law, everyone is allowed the benefit of months of preparation, and then days and weeks are spent mulling over decisions that were made in real time. In EMS, real time moves faster than you might think. And good, well meaning, experienced paramedics labor to do the right thing.

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The February EMS Roundup

In the coldest February, as in every other month in every other year, the best thing to hold on to in this world is each other.

                    – Linda Ellerbee (American Journalist)

And what better way to bring the EMS world together than the Internet? February was full of news and fun at The Spot. I hid inside from the Colorado cold and wrote about how to set up an IV line firefighter style. I asked you if you knew what was in the last issue of Splatter. (If you subscribed you’d know!) We discussed tips for mastering the head-to-toe assessment and getting people to hang up their cell phones. The premier of The Chronicles of EMS was the coolest thing is the blogging world. And we explored credibility and redundancy before launching into two posts on hypothermia. (Specifically how to assess it and how to treat it.) Then we wrapped up with a few musings about what it means to be passionate and what it’s like to be a firefighter. My fingers bleed for you.

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I’m A Firefighter

I don’t know if you knew that. It’s entirely possible that you missed it on the about page. If it seems strange that a firefighter would create a blog called The EMT Spot, consider that the fire service employs more EMTs than any other agency or industry. (Including private ambulance service.)

I didn’t begin my career as a firefighter but I’ll certainly end my career as one. I think I always knew that was the case. I’m a firefighter for a lot of good reasons.

I’m a firefighter because I believe in the honor, the history and the tradition of the American Fire Service.

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Passion Counts

If you’re going to design a ski resort I imagine that you don’t need to really like skiing, but I bet it helps. I imagine the same is true for most jobs. I would guess that a movie buff would run a better movie theater, a salesman would perform better if he was a true believer in his product, a car detailer would be more successful is she loved cars and a fitness trainer would be far better is he had a burning desire to improve people’s health.

For jobs that require skill, insight and good judgment (Like our job does.) passion counts. Passion is important.

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Responding to Hypothermia

Part 2 of a 2 part series. (Part one is here.)

In our last post we looked at some of the causes of hypothermia, both typical and atypical. Then we talked a bit about the recognition of the hypothermia progression and what patients might look, feel and act like as they progress through their hypothermic condition.

Now let’s look at some of the guidelines for treating our hypothermia victims.

On the surface, treating hypothermia might seem deceptively simple. The treatment of mild hypothermia often is simple. Bring them in, stop the cooling and rewarm them. But as we progress into moderate and severe hypothermia, things get more complicated. Here are 12 guidelines to consider when the patient is more than just a little chilled.

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What is Hypothermia Anyway?

Part 1 of a 2 part series. (Part two is here.)

We all understand that hypothermia occurs when the patients core temperature drops secondary to exposure to cold. But, clinically, what is hypothermia really? What happens to the body as it cools down and struggles to maintain its core temperature? Can we predict a patient’s relative core temperature based on our physical findings? Is treatment really as simple as bringing them in and warming them up?

Let’s review the basics of the hypothermia progression and explore how to treat these sometimes challenging patient presentations. Put your mittens on, this is a chilly ride.

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The Chronicles of EMS

In case you missed it, something big happened in EMS over the weekend. Last Friday night EMS folks from around the world gathered in San Francisco for the premier of the reality series The Chronicles of EMS.

If you haven’t seen the first episode yet, you can find it right here. I strongly encourage you to take 20 minutes out of your day and watch it right now. This series and the individuals who surround it are worth watching not only for what they are doing, which is incredibly cool, but for what they represent.

The Chronicles of EMS isn’t just an extremely cool EMS documentary. It’s a milestone. It’s representative of a shift in the conversation about what EMS is, what it’s supposed to be and how we’re going to help it evolve. The conversation about the future of EMS is shifting away from the policy makers and mainstream EMS media and becoming guided by the individuals on the street who are doing the job each day. It’s an interesting and powerful shift.

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