Boston CommonBoston EMSBoston Medical CenterEmergency Medical ServicesEmergency Medical TechnologyEmergency ResponseEMSEMTEMTParamedicQuincy MarketTHE BLOG WEBSITE OF AUTHOR C.B. GARRIS

A great new addition to an already gold standard in EMS!   Hats off to Mayor Martin J. Walsh and Boston EMS for increasing their staffing to meet the needs of one of the nations greatest cities.  Boston EMS has hired twenty new EMT’s and purchased ten new ambulances to increase their response fleet. Whenever visiting Boston, I am stuck by the pride I feel for the men and women that serve in their EMS program. I have spent many a day in Boston riding on the T, enjoying a nice walk through Boston Common, strolling through the Quincy Market building at Faneuil Hall for a quick bite, or picking a delicious culinary excursion in the North End; it is a city that embraces history, tradition, and excellence. Boston is also steeped in a strong tradition of excellent patient care, and a strong brother and sisterhood of the emergency response service.  This city holds a very special place in my own personal development as a paramedic.  I hold the professionalism and quality of the EMT’s and Paramedics of Boston EMS in the highest regard, having completed my paramedic clinical internship at the Boston Medical Center.  On many a day and night in the city’s very busy emergency department (which often seemed more like a MASH unit), I had the fortune of working side by side with these very skilled responders.  They demonstrate poise in our profession and are a model of success.  Boston’s EMS system is one of the few free standing independent municipal EMS systems in the country.  This very admirable quality coupled with the comprehensive backbone of world renowned medicine in the Boston area, and the very noble community outreach that Boston’s EMS has maintained over the years; Boston’s EMS system is not only outstanding, but it continues to demonstrate their flexibility in commitment to their mission by adding greater coverage in staffing and equipment.  Best of luck to all the new additions coming to Boston EMS, and I hope all of they and their fellow responders remain safe.  I truly hope the citizens of Boston know how lucky they are.

 

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Click the above image to view the article from the Boston Globe

 

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Emergency ManagementEmergency Medical ServicesEmergency Medical TechnologyEmergency ResponseEMSEMTEMTParamedicTHE BLOG WEBSITE OF AUTHOR C.B. GARRIS

Many people never want to think of our world as a battlefield, but in this post 9/11 era of domestic and global terrorism and unrelenting everyday violence; the time has come to reevaluate the current manner in which emergency medical services, and specifically how trauma care is accessed and delivered.  The following article reminds me of the true science of how EMS began, with the EMS White paper which was published in 1966 by the National Academy of Sciences as the paper entitled: “Accidental Death and Disability: The Neglected Disease of Modern Society”.  The White Paper illustrated the need for an immediate and more comprehensive reform on emergency medical services and trauma care; which was citied largely based on lessons learned in combat during the Vietnam War, the Korean War, World War II and World War I.  It identified how emergency communications and appropriate transportation to definitive care were grossly lacking in the United States.  This current article illustrates how far we have come in trauma care, but how much further we should be striving for, as we move further into the 21st century.  I have had the distinct honor of training members of our elite armed forces, while they learned how to treat major trauma in the urban combat environment; in an effort to prepare them for deployment abroad.  Acknowledging our partnerships with other branches of medicine, allows us to collaborate and strive for the best possible outcome for our patients.

American College of Surgeons Commits to Preventing 30,000 Trauma Deaths Per Year

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Emergency ManagementEmergency Medical ServicesEmergency Medical TechnologyEmergency ResponseEMSEMTParamedicPost Traumatic Stress DisorderTHE BLOG WEBSITE OF AUTHOR C.B. GARRIS

I viewed a very interesting and poignant article today that all EMS personnel and managers should read.  In it the author takes on a very difficult and often overlooked aspect of Emergency Medical Services; the topic of the emotional welfare of EMS workers and the need for Critical Incident Stress Debriefing (CISD).  Long it has been where one of our own fraternal brothers or sisters has a need for intervention, with the often overwhelming instances of job-related or personal stress.  It is incumbent upon all levels of staffing; provider, supervisor, manager and command, to recognize and intervene when we see one of our own in trouble.  Agencies need to create, partner with and maintain CISD programs that provide confidentiality and efficacy.  Please take a look at this and pass this one to your fellow coworkers.  Let’s all step in and do something positive for our colleagues, before we find out that they have done something negative to themselves.  We can change the pattern; but we must stand up and admit there is an issue, that is is okay to need help and that we are willing to be there for each other.

Why EMS providers are at risk of becoming a second victim

EMS providers face near-constant stress and tragedy which the profession can no longer ignore

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Hello to all, and sorry for the delay since my last posting.  Something that we all need to really pay attention too, is that which matters most.  Yes, you guessed it, those around us; family, friends and pets.   For some, not necessarily in that order.  Especially for those of us in the EMS community, we know full well how life can be snuffed out in a split second, despite our best efforts.  It is something that we should respect.  As much as it is probably the cause of a lot of PTSD amongst those in our field, in some ways there is a silver lining.  We have the chance to really understand WHY we should be caring for those around us, telling them how very much they mean to us, how we love them; and then backing it up with action.  It is so imperative to show those around us what they mean to us.   Never take those important to you for granted, because you do not know how short those moments with them are until they are gone.  Make sure that you put down that damn cell phone and ipad, and hug the people you love.  Technology is fine, but nothing can ever replace a hug.

 

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THE BLOG WEBSITE OF AUTHOR C.B. GARRIS

Much needs to be said for the EMT & Paramedic.  So often in this society, they are the forgotten ones.  Exposed to repetitive trauma daily, they perform often herculean examples of lifesaving that many would run from.  This is often the case, and yet they remain underrepresented, underpaid and under acknowledged.  There are many reasons for this triad of issues, some political, some socioeconomic; but nonetheless, it doesn’t end up well for the EMT or Paramedic.  Long hours, struggling to make ends meet; but yet always expected to be fresh and on point to make crucial decisions at all times.

Through the extensive training that we all go through, there are some things that you have to bring to the table. This is a job for the passionate.  You have to care; you have to want to get involved. If you take a stance that you can pick and choose who you are going to help; this is not the profession for you. You will underserve your patients as well as yourself.  There are many different personalities that are drawn to this field.  One question you should ask yourself is; what kind of EMT or Paramedic do you want to be?

Do you want to be a leader or a follower?  Do you want to do what the “other” guy/girl did earlier that day that you know was questionable or wrong; or do you want to be the person who steps up to the plate?  How many of you began your career wanting to have an impact and be the difference that this field calls for?  How many of you wanted to respond to a call and make the patient all better?  How many of you found yourself feeling nervous in your early days, and then difficult to be the EMT or Paramedic you wanted to be because of peer pressure?  How many of you look back on calls and after really soul searching, wonder if you could have done better or done something differently?  How many find themselves categorizing patients by how they look or because of their situation? How many have let your own pre-dispositions or those of others effect your patient care?

In any field of profession, you have good and bad, effective and ineffective; and you have to make a decision.  How many of you find you are very reactive patients when on duty, but when you are driving home off-duty, refrain from stopping at a bad accident and deciding not to stop to render aid?  How many of you have blinders on when off-duty?  Doesn’t that violate the premise of what you have become?  You went to school and work everyday in a capacity to render aid to others; so how do you find it so easy to just pass a situation where there is no one to help?  Again, what kind of provider do you want to be?  Has it ever occurred to you, and perhaps this will be the first time by me saying this; that if you can drive past an accident or something where someone may be hurt when you are off-duty, don’t you think that you can also then invoke that same cognitive dissidence when on-duty?  Isn’t it fair to say that if you are a trained healer and first responder; those skills and broad-spectrum aspects you are supposed to be providing are supposed to be present always? If you can turn off who you are trained to be, which generally is or should just be an extension of who you are; what happens if you actually have the ability to turn off that spigot inside of you, choosing who to help? Our role as EMT’s and Paramedics is to be the force of change, to be the protectors and advocates, and go beyond the expected.

Do you feel you are more liable off duty than on? One of the problems with our society over the years, is that absolute disconnect between consideration and the lack of it. So many people are more concerned with themselves than the world around them, and no one wants to get involved. How many times have you been on the road at night, and you see a car swerving in a manner that suggests driver impairment; yet you don’t pick up the phone and call 9-1-1? How many just say, “I don’t want to get involved?”  Ever think about whether or not you could have inadvertently saved a life that night?   This field is about getting involved.  How many of you really go the extra mile?  Just because you saw a colleague with many years on the job skipping steps or being lazy, does that mean you have to be? Just because you have been to the same address a dozen times, does this mean you go upstairs to the patient’s apartment without your gear? Do you really want to answer in a court of law why you went upstairs to an apartment on the 16th floor with none of the equipment you are supposed to bring with you? Is that even the morally correct thing to do? Do you want to be in an inquiry or in the press because you decided to go against your training and someone suffers needlessly because of it?

An area of great concern I have found over the years that is true to my heart; is how practitioners seem to let the need for the involvement of Child Protective Services and Adult/Elder protective services fall by the wayside.  This is a multi-pronged issue. Many EMT’s and Paramedics just don’t even know it really exists.  Very often, the fact that we are all mandated reporters seems to be a topic rarely approached during the education of the EMT and Paramedic. For those that may be aware of it, they have no idea how to even activate such resources.   There is a huge need for advocacy of children, the elderly and those with special needs. As EMT’s and Paramedics, we are often the most essential link in resource activation, because we are getting very raw and effective intelligence on a situation.  When 9-1-1 is activated, it is a defacto open-eyes warrant to enter a premise.  The fact that you were called gives you supreme access where help beyond you may be needed. You will see things that create a very complete picture when something is wrong.  This can be in the case of child/adult/special needs patient suffering from abuse and/or maltreatment.  What you do in those moments and the moments after, can literally save lives AFTER you depart.  In addition to the moral responsibility you have, you also have a legal responsibility.  Every EMT & Paramedic is a mandated reporter.  This means you are required by law to report ANYTHING you observe fitting criteria or even if you just think something if not right.  Failure to do so, aside from the fact that it can prolong suffering and cost lives, can land you with hefty legal fines and even jail time.  Yes, it is that serious.  It matters not where you work; whether in an area surrounded by horse farms and mansions, or the depths of an inner city urban environment, you are bound by law.

I have worked in many different environments, urban, suburban and even rural.  There are many who believe that abuse and neglect only happens in “certain” communities and couldn’t happen in others.  There are some who feel that they are afraid to identify these issues, because the person(s) involved could be community donors or in position of political influence; which can have an impact on agencies, volunteer or paid.  The fact is that you have a job to do, and no one can nor should attempt to influence your reporting of incidents.  Some don’t report because they think the law enforcement officer or the hospital staff will do it, because it can be an uncomfortable situation to activate protective services.  The fact is that if your gut is telling you something is wrong, make the call.  Please, go find the phone numbers to your local Child Protective Services (CPS), Adult Protective Services (APS), Elder Abuse and Neglect Services and that for special needs.  If you can’t find it, contact your local law enforcement agency or the hospital you work with, they all have it.  If this is not something you are familiar with, please consult your state’s office of the above listed protective services or Department of Children and Families (DCF).  They will list what to look for and how to identify many of the scenarios to make the call.

I will share an example. Years ago, when I was working as a Paramedic in an extremely, financially upscale suburban community; I received a call for an unknown condition.  It is very common that many would never suspect what I am going to share, would ever happen in an upscale community.  Upon arrival a well-dressed male in his late 30’s or early 40’s met my partner and me at the base of the driveway.  Immediately I noticed something off about him, more so in his affect.  Although he was waiting for us, he seemed to have a flat response, almost like he was somewhere else in his mind.  He led us up the driveway and instead of taking us through the front door, took us through a basement entrance, which just seemed odd because we needed to be acrobats to get through all of the objects in our path.  On the outside, the home looked immaculate, but the inside looked like it had been strafed by a military bombing run.  Everything looked out of order and the gentleman seemed not want to answer questions I was asking or couldn’t.  It was very dark inside the house and I was then getting gravely concerned not only for what we were going to find, but also for our safety.  I had called for a law enforcement response.  As we worked our way through the mess of the home, I thought I saw a body in the distance, but the darkness of the room was making it difficult to confirm.  Just as I realized that what I thought was a body was a swath of laundry piled up, I looked behind me into another room off the kitchen and saw an elderly female, essentially upside down on a futon bed, semi-conscious and writhing in pain.  I noticed that the kitchen was a mess and there was blood on the floor.  I immediately asked the law enforcement crew to step it up, and I asked the son what happened.

The son did not want to answer me at first, and then it looked like he had physical trouble doing so.  He mentioned that his mother fell three to four days prior, and that he and his father moved her from the floor to where we found her. I asked why hadn’t they called 9-1-1 right away, and he said his father didn’t want too.  Obviously this was sending up all kinds of red flags.  The son kept telling me that his father wanted her to now go to a particular hospital, and that was the one thing he was adamant about.  That also seemed strange.  The mother was in her 70’s and was in pretty bad shape.  She looked malnourished, uncared for and unkempt. She was a very sweet woman who was in a ton of pain.  With her in so much pain, it was unclear where all the injuries were.  I was almost sure her pelvis was broken, along with other fractures, some possibly older than just a few days prior. She had a multitude of bruising and other ailments.  Once spinally immobilized, I popped my monitor on her, and found her in a dangerous arrhythmia.  As I went through a number of treatment protocols with her, I also felt it best to start getting her moving to specialty care.  The son seemed totally disconnected, as if he couldn’t understand the urgency and why them not calling 9-1-1 was wrong and had infuriated me.  He seemed like a gentle man, but he had some serious cognitive issues.  With multiple therapies in place and while heading for the appropriate hospital for this patient, I asked the son why is it that the father/husband wanted his wife to be taken to a specific hospital.  He then tells me that his father/husband is a physician.  I did a double take.  I then did a triple take.  Yes, I was even more pissed.  How could a member of the medical community do this and allow it to happen?

Once at the hospital, it turns out that a doctor who knew of the doctor stepped into the treatment room and listened to my briefing to the ER staff.   I told them that this was now an Adult Protective Services case and I would be making the notification.  That lets them know that there will be an investigation and whether they call or not, I would.   That doctor who was a colleague of the physician heard this approached me, telling me it was not necessary for me to make the call, and that his people would be making the call.  I looked at him like he was an absolute idiot and kept walking.  He got in my face again and so I told him flat out that the call was being made, and based on the fact that he knew the doctor in question, that if he mentioned me not calling one more time; I would consider that hindering what could be the prosecution of a criminal investigation and I would be more than delighted to notify the authorities. As you can imagine, that ended our conversation quickly.

I made the call to the appropriate elder services agency; they were speechless. They took the information and were taking it from there. I received a follow up call from the agency about three weeks later thanking me. It turns out there was a long line of neglect and/or abuse on the female patient.  They removed the female from the house permanently. Further, they also ended up removing the adult male.   It turns out my initial impression of him was spot on. He was apparently the victim of years of abuse/neglect also, and his cognitive impairments were a direct result of that situation.  They said they’re jaws hit the floor when they put it all together.

I remember when the aggressor arrived at the hospital, with a well-tailored expensive suit on that must have cost thousands of dollars.  Not a hair was out of place on this guy.  Here was that situation, an expensive home, an educated person and two victims. No one would have ever suspected. How many times had anyone been in the home and not notified protective services about something being wrong?   This we will never know; but on that day I was able to be the force of change.

It is important to remember that as an EMT or Paramedic; we have a job to do. That job cannot be shirked by peer pressure, socioeconomic affect, presumptions or an attitude that it is someone else’s problem. Sometimes in our role, all we can do is be the advocates. There are those that will tell you don’t bother, or don’t go making waves or that it’s someone else’s issue.  Remember, you have a responsibility, professional and moral.  Ask yourself, what kind of EMT or Paramedic do you want to be?

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Something that I find amazing in this society, is how pets are not provided the respect they deserve.  It amazes me that this day in age, people in specific, those in real estate have such an issue with animals.  In a recent conversation with a friend, I was informed that when she went to purchase her own home, the local housing association actually attempted to enforce a policy where no dogs were allowed.  My friend and her husband were about to spend hundreds of thousands of dollars, and they were being told that even though it was completely their home, dogs would not be allowed.  That obviously affected the sale, which in turn did not happen.  Animals are our friends and all of our responsibility.  They should be welcomed into our homes always.  I know some cities which have relatively high single populations, and yet they have some of the toughest and most stringent real estate oppositions to animals, dogs in particular.  It is clinically proven that dogs lower blood pressure, bring a sense of warmth, affection, responsibility and bring good general feelings.  They extrapolate feelings and responses that even the most emotionally closed off person cannot hide.  They are natural healers, protectors and are good for all of us and we can be good for them.  Every home should have dogs.  Aside from their constant comedy and unfettered loyalty, they make people safe at night and there for us always.

Something needs to change in this society, where animals are valued as much as humans.  If a person is violently injured in an assault, it’s a felony with harsh penalties; it should be with animals also.  Animals are at a much less advantage, and if they are harmed and fight back appropriately; they can end up being the one put to sleep for doing nothing wrong but protecting themselves from intentional harm.  This needs to stop. Who in society decided to take it among themselves to be the judge, jury and executioner of so many animals?  Why?  Because they can’t find an immediate home?  So the answer to that is to end their lives? Interesting how no-kill shelters often don’t make it a point to advertise the animals they have animals available, they just take the life of the animals.  Just because this has been the method for so long does not mean things cannot change.  This method of euthanasia because of a lack of housing needs to be revisited and changed.  Perhaps if more effort was put into working at finding homes, foster care and other alternatives; we could get away from this practice of harming animals because of human shortcomings.  Why is euthanasia done in this manner; just because humans have thumbs and because they can?  Who made us the species to decide this is best?  Our species is far more flawed than that of dogs, and we as a species need to show them more respect.

Perhaps if landlords and the like eased up and stopped being so materialistic; maybe we can all come to some better ways of dealing with this issue.  Maybe if more landlords in rental situations all over the country allowed more dogs, maybe far less would be getting removed from this earth way to early.  Perhaps if those in charge of real estate eased up a bit, there would be more housing for these wonderful four-legged pals, and this devastating practice of killing dogs and other animals would stop.

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So as I connect all the points of this blog, please feel free to enjoy and laugh at the errors, mix-ups and how auto-correct sends what should be a normal, everyday sentence, into oblivion.  The holidays are upon us, so please shop well, be safe and remember that it matters not how big or expensive a gift you give to someone; all that truly matters is the fact that you thought of that person. The best gift you can ever give anyone is the gift of your time, the gift of acknowledging them; and most of all, your love.  That is something that is priceless, inexplicable and the most powerful of all.  Remember that as we go about our days, for those of us fortunate enough to have our ducks in a row, not everyone has the same.  Many people walk about, seeming just fine, but are one step from falling apart.  There are many stressors out here today, some general and some specific.  As you go about your day and if things go awry; please try to remember that the people around you are human; mistakes happen, accidents occur and generally everyone is just trying to live their life.  In these instances, please try to take a gentler tone with others.  Sometimes all people really need is understanding.

One thing I will bring up here is something that irritates me beyond words.  In every state of our country, IT IS ILLEGAL TO TEXT OR USE YOUR PHONE (HAND-HELD) WHEN YOU ARE DRIVING.  Despite this fact, I would safely say that 95 % of the time when I am out and about, I see people consistently violating this.  PLEASE.. if you have to have a conversation or if you have to text, pull off the road and find a safe place to have that conversation.  The incidence of severe injury and death related to accidents caused by violation of this regulation is astronomical.  Do you really want to be responsible for the death of another, just because you had to text a message that could have waited; or because you were so distracted by that hand-held phone conversation?  Just the same, those on bicycles and skateboards, and even pedestrians walking are equally as guilty for texting at the same time, and not looking before they cross into the path of an oncoming vehicle.  People, PLEASE; you are NOT immune to bad stuff happening.  It only takes a second before your life or someone else’s will change forever.  Please be careful.

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Hello to you all and welcome to my new blog page.  In the coming days and beyond, you will find all kinds of additions to this page about issues facing EMS, my career experiences in nearly thirty years of emergency services and my perspectives as a result.  Additionally, I will be providing new and past passages and poems, perspectives on current events and how they relate to the field of EMS and public safety in general; all kinds of photos, audio and video as well.  For those of you who have read PARAMEDIC: M.O.S.; I thank you for doing so.  I do hope the message is clear and it helps to illuminate EMS personnel and brings attention to our field.  For those who have not yet read my book, it can be obtained by clicking one of  the following below:

PARAMEDIC: M.O.S. at AMAZON.COM (Kindle, Paperback & Hardcover)

PARAMEDIC: M.O.S. at BARNESANDNOBLE.COM (Paperback, Hardcover & Nookbook)

PARAMEDIC: M.O.S. at TRAFFORD.COM – (E-book, Paperback & Hardcover)

You are also more than welcome to click on the link below to visit the website for PARAMEDIC: M.O.S. AT:

The website of PARAMEDIC: M.O.S.

At the outset of this, I want to say to all of my fraternal brothers and sisters out there, that our world is an ever-evolving and always changing place.  Our roles in public safety mandate that we all stay on our toes, look out for each other, train continuously and keep our wits about us.  The world is becoming an even more dangerous place, in a profession that for us already has inherent dangers at the outset.  I implore all of you to take stock of those around you, pay attention to each other.  If you have differences, please try to keep the mission in mind and put those aside.  We are all people with feelings, ideals, thoughts, souls, history’s and more.  Our profession of public safety is one that requires compassion not only for our patients and partners, but also for ourselves.  Stress hits everyone, so it is important to be aware of things in your life, professional and personal.  It is also imperative that you pay attention to those you work with for signs of being overwhelmed.  Post Traumatic Stress Disorder is a common issue that public safety personnel are encountering and dealing with more and more.  It is easy to think you are not being affected by the consistent trauma you and your coworkers witness daily, but the fact is that it takes a toll on many.  With the continuous advent of terrorism raising its ugly head more and more, threats are higher and everyone must remain in a constant state of vigilance.  Unfortunately, many first responders in this country have seen the devastating results of both domestic and global terrorism.  It is brutal, ugly and it can have lasting effects.  I ask you to think before you act, size-up everything and if your gut tells you something does not feel right; request the right assistance and back up that you will need to ensure you go home safely at the end of your tour.  I will be addressing these issues more in detail in the days to come.

This blog will also be a place to discover new music, wonderful pictures, nutrition, fitness and healthy suggestions of ways to enjoy your life outside of your job, no matter what field you work in.  We only get one life and it is important that we find a balance in all aspects.  I hope you enjoy my blog.  No matter what you do out there, please be safe and as the saying goes; if you see something, say something.

As always: In honor of pets everywhere, please take a moment out of your day, and locate your local animal shelter.  Please consider giving one of the millions of undomiciled pets a safe and forever home.  Please refer to your local shelter, most of which even have their own websites or just drop in.  Perhaps you are open to fostering pets as well.  There are many agencies that need foster homes for animals, until a forever home can be found.  Whatever the status, please reach into your heart and give animals the gift of a wonderful life; and see how no matter what your life situation, how they can improve it.  The best way to put a stop to unnecessary euthanization of animals, is to bring them into a loving home.  No animal should be put to sleep, just because they don’t have a home. Please find your local shelter and bring home a pet today, forever.

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