firefighting

Paramedic everyday carry - 3: Pens

I could nerd out about pens for a while. In fact, I might do so right now.

Some EMS providers don’t care about the pen they carry. They grab the closest thing at hand, probably a clear blue bic with a flimsy plastic cap that promptly gets lost. Who cares, right? There’s a hundred more pens just like it, back at the firehouse. If they forget one, they just ask to borrow yours.

We call these people “monsters.”

When you really pay attention to the tools you use, even the most mundane ones, you start to see how every preference is shaped by your environment and how you chose to interact with it. I want a pen that:

  • Clicks on. I want to jot notes without needing two hands to remove a cap, which I would lose anyway. If I’m getting my gloves dirty/bloody, I tend to try to keep one clean as long as I can, and that’s the pen hand. (I also change gloves frequently on gross calls. Medics: change your gloves. Seriously. Don’t be out there doing your best Hawkeye Pierce impression on a trauma call. And if you don’t know who Hawkweye Pierce is, it’s not because I’m old, it’s because you don’t know your history. Change your gloves. That is all.)

  • Can write almost anywhere: the back of my glove, or on ECG paper, or fabric tape. I don’t do the notes-on-glove thing very often, because of the way we divide roles on a call. The lead medic runs patient care, while the driver gathers history and enters it into a tablet. That will eventually become the report we transmit to the hospital, as well as our permanent record of care. My driver, it she’s any good at her job, should be capturing info as we gather it. So, the rookie doing a blood sugar test knows to call out the result and make sure the driver acknowledges it. The driver also summarizes info for the lead medic, in case I didn’t hear a particularly salient piece of medical history (“patient is a diabetic” or “patient is taking blood thinners” or “the last time I ran this patient, they coded and we resuscitated them”). But every now and then, something comes up while the driver is busy, and I have to scribble a bit of info on my gloves. Then I have to keep that shriveled up glove somewhere handy as a reference, because I change my gloves on calls, as you should. In those situations, I want a pen that can write anywhere.

  • Has a thin tip, but not so delicate that it isn’t easily legible. Personal preference.

  • Is cheap enough to be bought by the pack and tossed out at any sign of contamination. Or can be easily replaced when, on a day when I had more faith in my fellow medics than they deserve, I loaned it to someone, who then kept it and sent a shitty bic pen through departmental mail to taunt me. I’m looking at you, Paul.

Anyway, I use Uni-Ball Jetstream Retractable Ball Point Pens with a 0.7mm tip. Bought in a 3-pack, each one runs under $4, and usually lasts me a couple months. You can also buy them in a 12 pack, which is a much better deal. It writes smoothly, doesn’t bleed, and, well… that’s it. It’s just a pen, after all.

I once bought myself a nicer pen, with a metal housing that looked very slick, and I really liked it… until it got lost. It only set me back about $12, but when it came time to replace it after less than a year of use, I balked. This is why, as they say, we can’t have nice things.

I also highly recommend carrying a Sharpie marker of some type. I use a Sharpie Twin Tip, which has both a traditional fat marker on one end, and a thin nib on the other. Why do you need a sharpie? Because, in a mass-casualty event, when you apply a tourniquet, you’re supposed to write the time of application on the victim’s forehead.

Seriously. Have I ever done this? No. I’ve applied lots of tourniquets, in non-mass casualty events, and I just write the time of application directly on the tourniquet, where the manufacturer has helpfully provided a space for me to do so. (In case you’re interested, most of the tourniquets we use are the Combat Application Tourniquet type, in bright orange. They seem less fussy to apply than others I’ve tried, particularly with blood slicking things up, and they seem to do a good job at stopping arterial bleeds. I’m not an expert, just an enthusiastic user.) Not that I wouldn’t do the forehead thing if the necessity arose. As it happens, I write on our tourniquets with a sharpie.

I also use if for a million other tasks, like scribbling expiration dates on packages, because medication manufacturers delight in shrinking the text of their expiration dates to the point where you need an electron microscope to verify them. And other Sharpie things.

Don’t be a monster. Carry your own pen. And do I need to mention the gloves again? Good.

Next episode: eye & face protection

Paramedic everyday carry - 2: Flashlight

Note: I don’t receive any money or free stuff from manufacturers. My links include affiliate tags in case someone decides to buy a tool I recommend.

My main flashlight

I peer into lots of cars late at night, trying to determine if the person slumped inside is asleep or unconscious. I pick my way through strangers’ yards, in the rain, looking for an open window, because someone at this address has called 911 but no one is answering the door. I start IVs in unlit basement sublets. I use my flashlight several times every shift. It sits in a low-profile holster on my right hip.

To be honest, I think holsters look kind of dumb. I use one anyway. I could carry a flashlight in my pocket, but if I get blood on my gloves, there’s no way I’m going to fish around in my pants for it. The items in the holster are right at hand, and I can get at each of them by feel.

DSCF4780.jpg

The flashlight I carry is the Streamlight 66118 Stylus Pro LED (AAA battery version). I bought this flashlight almost seven years ago (I just checked my Amazon order history), and I can hardly believe it’s still going strong. Streamlight has an excellent reputation in the fire-rescue world for making solid products. For a light that costs less than $20, this has proven itself many times over.

What I love about this light:

  • It’s small and thin - just a little fatter than a medical penlight. It could be lighter, but the metal shell gives it a heft that I like. At 100 lumens, it’s very bright for its size. It takes normal AAA batteries, so I don’t have to plug it into a charger and leave it behind when its charge gets low. It’s cheap, so when I finally destroy it, I won’t sweat buying the replacement.

  • It doesn’t have a lot of ridiculous detailing on it. The makers of flashlights have a serious problem with greebling. Gear makers think people want every surface to be embellished with angular protrusions and pointless textures. That’s why I generally avoid any product with the word “tactical” in its name. - they tend to be cluttered with nonsense details to make them look cool. Hey, medics: don’t carry shit to make you look cool, carry shit that works. This flashlight has ridges at each end, which make it a little easier to handle with slick gloves, and a pen clip, and that’s about it.

  • Its metal case has put up with a ton of abuse. It also produces a surprisingly loud sound when I knock on the windows of cars or houses. I knock on glass a lot. You’d be amazed. People call 911 all the time because they see someone sleeping in a car, and they’re afraid to approach the vehicle to check on them. Bear in mind that when I knock on the window, I’m not wearing any more protective gear than the caller was. The only difference is that I’m paid to knock on the glass.

  • It has two functions: on and off. I don’t want my flashlight to turn on in low-power mode, or blink furiously in rescue-me-from-the-face-of-Everest mode. I want it to turn on, light up something, and turn off again. Simplicity is your friend in stressful circumstances. I want everything I use to work exactly as I expect. Also, it has a rubberized pushbutton on/off switch on the butt, which I like better than the Maglight-style twist on/off, or a side button, which tends to get switched on accidentally.

  • Did I mention that this is really, really bright? It’s actually too bright to be used to check pupillary response. In a pinch, I can use the very edge of the beam, but I never shine this directly in someone’s eyes. Really, medics: don’t do it, even for unconscious people. I have no idea how many lumens can cause retinal damage, but I’m not going to risk it.

  • Okay, I might as well admit that after writing the last bullet point, I went down a little google-hole about light exposure and retinal damage, and the answer isn’t as simple as lumens. It appears to be about the focus area of the exposure. It doesn’t sound like 100 lumens in a flashlight beam will cause lasting damage. Don’t do it anyway. If you wouldn’t want to look directly into the beam while conscious and alert, don’t blast it at someone who is having a Very Bad Day.

  • The only reason I have to emphasize this is I know you, medics. I see you. Don’t think I don’t know what you might do.

What I don’t carry: a medical penlight. That might surprise some people. Penlights are weak-sauce as flashlights, borderline useless. They have one function: to check pupils, which I do on nearly every call. But we tend to carry about a million of them, stuffed into every bag and crevice on the ambulance, so there’s always one within easy reach.

My second light

I also carry a headlamp in a small bag that I grab on high-acuity calls. I can’t count the number of times I’ve started IVs under terrible lighting conditions, whether in poorly-illuminated apartments or outside at night. In the past, I either handed my flashlight off to someone else, which took up a set of hands, or put it in my mouth, which was gross. I mean, I know where this flashlight has been.

I carry the Steamlight Bandit LED Rechargeable Headlamp, because I received it as a gift. Almost any headlamp will do. This one is about $20, and has held up very well. I like that I can detach it from its headband and clip it directly to my radio strap.

The advantage of a headlamp is obvious: you don’t have to entrust your light to the rookie, who promptly shines it the wrong direction. The downside: you have to be careful where you look, because you don’t want to blind one of your fellow rescuers. And if you have hair, which I don’t, then you might get blood or something on your hair when you reach up to turn it off or remove it. I recommend shaving your head. No more bed-head on those late night calls… anyway, that’s a discussion for another time.

Honorable Mention

I used to carry a Streamlight 88830 PolyTac Right Angle Flashlight clipped to my radio strap, and it was extremely bright and useful… until it came off and got lost. When I lose something that costs $50, I think twice about whether to replace it. In this case, I made like Elsa and Let It Go.

Next episode: pens

Paramedic everyday carry - 1: Introduction

There’s this amazing online phenomenon in which professionals in various fields show off their “EDC,” or everyday carry. Seeing which tools an expert carries with them at all times is a fascinating way to gain insight into what they do, and how their experience informs their abilities.

I first came across this genre in the form of a video in which grandmaster maker, comicon crasher, and mythbuster Adam Savage empties his pockets, explaining the purpose of each item, and I found it totally enthralling. (One of the most surprising insights was that he does not bother carrying any kind of multitool, because he generally works where more specialized tools are within easy reach, and travels so often that he can’t carry a knife.)

I’m a firefighter/paramedic with thirteen years on the job, and many more as a volunteer before that. I’m very particular about the tools I carry with me. I thought that the story behind those items might be useful for both fellow medics and anyone interested in the world of EMS.

I have some very basic expectations of each of the items I carry:

  • It must work according to my expectations. It doesn’t need to be fancy or high-performance, but I don’t want things to fail when I need them on an emergency incident.

  • It should be low-profile. My uniform pants, unlike some in the industry, don’t have extra pockets to stuff full of extra junk. I use a very small holster with a limited capacity, so I’m very particular about what goes in it. I also have a small bag, provided by my fire department, which I’ve customized with essential tools.

  • It has to be replaceable. With some exceptions, nothing can be very costly. If it gets trashed or contaminated beyond hope of cleaning, I want to throw it away and get a new one.

  • It must be in the same location every time, exactly where I expect it, so I can reach for it without thinking. The last thing I need under the stressful circumstances of an emergency incident is to be fumbling for something and wondering where I put it. Most people I know in fire-rescue are borderline obsessive about their gear in this way.

Next episode: the flashlight.

Oh and btw here’s the video of Adam Savage’s EDC that got me into this.

The day after

I work a strange schedule: 24 hours on, 48 hours off. In practical terms, I get up at 4 every third day, schlep to the firehouse to be on duty at 6AM, and work until 6AM the next morning. When I roll out of the station, I have exactly 48 hours to recover before starting the process over again.

Most days when I get off work, I go home, try to recoup a little sleep with a short nap, and have a day in which I write and run errands with low expectations for myself. I'm coming off a shift in which I've usually been privy to some horrible shit, and the primary goal of the day is to avoid and suppress it. I have a bunch of rituals designed to reinforce the firewall between the world of perpetual emergencies and the quiet of home, but it is work to maintain the defenses.

Over time, I've noticed something about the day I get off work. It's like the third rail of my days. I'm more likely to have an argument with my wife - so much so that I avoid discussions of meaningful topics. I'm overcome by strange and sweeping emotions. I have sudden, compelling ideas - maybe I should buy a strange wig at Goodwill and wear it to the Odesza show! - and tend to see myself as damaged, if not outright psychopathic for my ability to tolerate such constant doses of human suffering. 

Then I get a normal day, in which things feel pretty normal. Then I go to work. Those are the normal days.

 

The Cocoanut Grove nightclub fire

I occasionally help teach EMT classes, and one of the topics I enjoy covering is multiple casualty incidents (MCIs). I frequently use examples from real incidents, and I've searched for so many recordings of fire-rescue radio transmissions during active shooter incidents that I probably have my own electronic file somewhere in a bland national security data warehouse.

As a firefighter, I'd heard of the Cocoanut Grove fire, which played a tragic role in the advancement of fire safety regulation in the US. I stumbled across it again and took an unexpected deep dive into the history of the fire.

In 1942, despite passing routine fire inspections, the nightclub was a fire trap, even by the lax regulatory standards of the day. In addition to placing cloth and palm-frond decorations on the walls and ceilings, the club owner had locked up emergency exits and windows to prevent patrons from slipping out without paying their tab. 

The Cocoanut Grove was full beyond capacity on the night of November 28, 1942. A patron in the downstairs lounge removed a light bulb so he could kiss his girlfriend in the darkness. A sixteen year-old waiter, who took the job to help pay expenses for his ill mother, was told to screw the bulb back in. He climbed on a stool, struck a match to see what he was doing, and restored the bulb to its place. Shortly afterward, flames began to spread across the ceiling. Flames and choking smoke spread so quickly that some patrons were overcome at their seats, their bodies later recovered with hands still grasping their glasses. Archive.org includes hundreds of pages of witness statements.

In all, 492 people lost their lives that night. The fire is credited with spurring changes to both fire protection standards and burn treatment

Investigators said they could not point to the match as the cause of the fire (other investigators have theorized the fire began as a result of an electrical spark igniting fumes from the club's air-conditioning system), but many people blamed the young waiter for the tragedy, and he bore the stigma for the rest of his life. 

Thankless jobs

Within the world of fire/rescue, there are two particularly thankless jobs. First, 911 dispatchers, who are the first point of contact for the emergency system, and who must sort out the chaotic, frightening moments of an unfolding emergency*. The other thankless position is the one who arranges to have the correct staffing at every fire station, every day. Both these positions have this in common: when they do their jobs exceptionally well, no one pays any attention. When they screw up, letting their humanity show over the phone or radio, or short-staffing a station, everyone calls them out on the mistake. 

I would have thought that was the textbook definition of a thankless job: one in which good performance goes unrewarded, but bad performance is immediately condemned. This chart proposes more axes of thanklessness, including pay, public opinion, stress, and environment. 

For obvious reasons, I found it interesting that this and other lists classified fire/rescue as "thankless." It's true, I don't always get thanked for what I do, but I also enjoy having a career that's lauded and seen as worthwhile. More importantly, firefighting is listed as one of the careers with highest job satisfaction. That list, which discusses the "crummiest careers" and what makes them so rough, is worth a read. Not surprisingly, we don't reward the people who have to deal with our junk (literally and metaphorically) nearly as much as we should.

[* If you want to hear why I have so much respect for dispatchers, listen to this audio of a dispatcher handling emergency radio traffic after three police officers were shot while responding to a domestic disturbance. She is calm and controlled on an extremely tense and emotional incident.]

You aren't just what you think you are

@History in Pictures is a great twitter feed that mines photo archives for stunning moments from the past - some grandiose, some intimate, some curious, some utterly bizarre. Just one example:

There are many different ways to unpack and interpret this image, some of them outside my experience and understanding. Certainly, there are some who would pose the question - why protect an avowed racist from the impact of his beliefs? Why should he receive governmental protection that is less commonly afforded to those he vilifies and would gladly oppress? On the other hand, if we aren't willing protect the rights of all citizens, who decides whose freedoms will be protected, and whose will be ignored?

Looking at this image, though, I mostly feel sympathy for the police officer. Although my job is wildly different from law enforcement, I also wear a uniform, and I'm often perceived foremost as my role, not as a man who will go home at the end of my shift.

That's not such a bad thing. People who call me should be able to count on me to fulfill the duties of my role. They shouldn't have to negotiate with a fallible man, and potentially face criticism if I disapprove of their decisions or lifestyle. The uniform should represent something reliable, fixed, steadfast. 

My uniform provides a benefit to me as well. Although I'm not a wild fan of the superhero genre, I understand on a visceral level why we envision them wearing costumes. My uniform is protective - it shields my psyche from what I see on the job, In theory, it's something I can remove when I return to my everyday life. 

I've been in situations, like this officer, in which I do what I'm there to do, regardless of my opinions. I treat all patients, regardless of who they are or what they've done. I do my job, because in certain moments, my job is actually more important than I am. It outranks me, my personal preferences, and my opinions, because someone has to do it, and on that particular day, I happen to be the one. 

Maybe your job isn't your job, but I'd be willing to bet you've got work to do out there, things that are bigger than you and me.