Friday, September 2, 2016

Scene Safety IS Important

This article, EMS Wake-Up Call, and others similar have been passed around social media lately.

To sum up this article: a patient's mother said, 

"'While my daughter lay in her bed dying, your paramedics and 
firefighters were hiding. So I’d like to know: Is your priority 
to provide emergency medical services to the people of this 
community or to stand by, watching out for yourselves 
while people die?'"

The author says that he thought long and hard about that statement. He came to a mindset that, 

"the first priority of EMS providers is not, as my wake-up 
caller said, to save lives but to protect ourselves–even if it 
costs someone else’s life. I’m not sure that priority can 
be sustained in today’s society. Truthfully, it seems 
horribly and terribly outdated [emphasis mine]."

He believes that, 

"The practice of staging EMS resources for every unresponsive 
patient where drugs or alcohol are involved, every suicidal 
threat, every elderly nursing home patient who assaults a staff 
member, every psychiatric-related call, and every response where
 law enforcement is dispatched needs to stop. Refusing to 
enter an active shooter or hostile event scene without a police 
escort to render immediate care to dying victims also needs to end. "

I've listened to the conversation spurred by this article, and I see it being hailed as the new direction that we in EMS need head in our training and understanding. I see a bandwagon forming. But I'm not convinced.

The author makes faulty arguments and encourages a dangerous shift in mindset that is not only potentially catastrophic to individual providers but is psychologically unsound.

First, while it's sad that some people might die because I chose to protect myself, basing a decision upon that sadness is an appeal to emotion, a logical fallacy. Emotion does not determine fact.

When I am dispatched,

I have a duty to act.
I have a duty to serve.
I have a duty to help.
I have a duty to provide medical care.

I do NOT have a duty to die.
I do NOT have a duty to sacrifice, endanger, or potentially endanger my mental or physical health.

These may seem like powerful statements, but they are not an appeal to emotion. I am not manipulating emotions and asking someone to change their mind based upon the sadness created within them. It is a statement of responsibility and of the job I was hired to do. To endanger myself in light of known or assumed risk is not in my job description.

The facts remain that no scene is safe, true, but that is not an excuse for recklessness and not a reason to not treat scenes with caution. Risk is something assumed differently by different people. This is why we must have professional standards and uniformity in policy that is rarely interrupted based upon changing situations. The author was bothered by across-the-board policies such as not entering a scene with an unconscious person when drugs or alcohol are involved, but such broad declarations prevent people from being pressured to change their priorities in the heat of the moment, based upon emotion, when minds may not be clear or all variables considered.

"Over the years, EMS has drifted far apart from our public 
safety brothers and sisters in our ability and willingness 
to acknowledge, recognize, and effectively manage the risks 
we all face."

Is this a true statement? Has EMS truly drifted from public safety due to faulty risk mitigation?

Perhaps we drifted because of a change in identity that we are not, in fact, public safety workers, but health care providers. And really, we have improved in risk mitigation. We have made our jobs safer, more efficient, and continue to improve as every year goes on.

"As a consequence, the public is beginning to question 
our ability to do our jobs."

Again, is this true? Does the the public really question our competence in light of risk mitigation or is he relying on anecdotal evidence from a distraught mother? And even if the public does question our tactics, does that matter? Even if the public views us a certain way, does that mean that we are not, in fact, competent? The author is attempting to equate staging policies with incompetence.

What concerns me most is the psychological underpinnings of this stance. I see:
--an unhealthy need to rescue and take responsibility for other people at the expense of self
--to derive purpose and a sense of self-esteem from self-sacrifice (read: competence in the eyes of the public)
--choose to enter and stay in a rescuing situation despite cost to self
--to try to fix complex situations of others in trouble at the cost of self
--a pattern of engaging in rescuing situations at the cost of self, even though well-intentioned

This is not good policy. This is not a healthy mental stance. These are hallmark signs of codependency. With the mental health of EMS workers in shambles, we don't need formal policy that institutionalizes poor mental health. 

Strong mental health includes an acceptance of responsibility for self. No one is responsible for meeting my needs and keeping me safe. I am responsible for myself and others come after me. This is actually a kindness because it allows others to do the same instead of caring for me. We often hear this concept described in training as, "Don't make two victims." By caring for myself, I prevent myself from becoming a victim that others must rescue along with the original victim. This is sound policy and sound mental health.

Our determination of staging policies will continue to change as time passes; understanding of risk grows and values change. However, we should base policy changes upon logical, healthy arguments--not faulty appeals to emotion and a sense of codependency.

Policies should be set by experts in risk management who understand the field and, with cool heads, look at situations and determine what is appropriate. Policies should be based on a sense of responsibility to first to self and then to the community, not some emotional and non-existence duty of self-sacrifice.

Only when we care for ourselves in healthy ways can we truly serve our communities in lasting ways.

Monday, July 4, 2016

America

Fireworks
Parade
Watermelon
Flag
Apple Pie
Veterans
Independence
Liberty
Freedom
Civics
Devotion
Duty
Justice
Patriotism
Equality
Inequality
Hypocrisy
Poverty
Desecration
Bigotry
Encroachment
Racism
Conquest
Genocide
Lynching
Struggle
Loss
Strife
Hope
Valor
Unity
Service
Courage
Cooperation
Responsibility
Community
Light
Life
Glory
Happy Fourth

Wednesday, June 15, 2016

Coping with a Bad Shift

There are difficult shifts, and then there are shifts that pummel your body while shredding your heart. The public sees the lights and flashes and sparkles of EMS, but those of us in it recognize that it's not about glory or heroism. It's seeing the darker, grittier side of humanity and, oftentimes, feeling the searing pain of loss alongside those directly affected by an incident. Here are some ideas for coping:


1) BE SAFE

STOP. Are you physically and mentally able to continue your shift? If not or you are in doubt, contact your supervisor immediately and tap out, if necessary, even if it's just for a brief time or a quick rest. There is no shame in admitting your limits, and it helps no one if you become an additional victim.


2) Put yourself back together

Take things one step at a time and get yourself presentable again. Pull out the SHTF bag (see below). Wash up or shower. Change your uniform. Clean your boots. Whether you clean the rig beforehand or not will depend on the situation and the policies of your service, but go through whatever motions you need to get yourself back to your normal physical baseline.

A side note: sometimes the greatest act of service one crew can do for another is to clean a truck and get it functional again so the affected crew can focus on themselves. I have watched with admiration as a supervisor told her crew to go get cleaned up and took the mop herself to clean the rig. THAT is true leadership.


3) Rehydrate and refuel

Drink a big glass of water. Stress is dehydrating, and hydration helps you cope with stress. Don't forget to get a solid meal as soon as you can as well. If you have trouble eating under stress like I do, then make sure there are people who help monitor that you take that next bite.


4) Don't procrastinate

I know it's tempting to try forgeting the events of the call, but that report isn't going away and those details are going to fade quickly—all the moreso because you want to forget. As soon as you are able, get your narrative written and all the boxes checked. Sometimes that can even help you process what happened. Then move quickly to the next step...


5) Activate your support system

Notice I didn't say build—I said activate. That means you already know who you are going to call to support you. Find someone to talk to without reservations and spill it all.

--your partner (caution: she/he may be having difficulty coping)
--coworkers
--your significant other
--close friends
--an EMS dinosaur
--the leader of your circle of faith/or the on-call Chaplain
--your service's mental health providers


6) Be a good partner

It's important to respect others' coping mechanisms, but it's also important to be there for your coworkers. Check up on those around you. Talk to them. ASK how they are doing after the call, on the next shift, a week later, a month later. Get through things together and have each others' backs. Sometimes more peace can be found over beer and tacos than in any conference room.


7) Recognize if you need further help

Anyone can get beat down working in EMS, but if your difficulties (sadness, insomnia, chronic health problems, flashbacks/dissociation, depression, sexual difficulties) last more than two weeks, interfere with your daily life, and/or you are having thoughts of suicide, contact a professional or your service's EAP. If someone you trust recommends you get help, LISTEN.

There are also resources that can help:

Safe Call Now
206-459-3020

Code Green Campaign



SHTF Bag

--Spare uniform

Make sure the uniform in your bag is decent (no old, faded BDUs) and check occasionally to make sure it still fits. Include another belt (the webbed ones can be difficult to clean quickly) and include an extra set of pins, should you need them.


--Nice, comfortable (pretty) unmentionables

Just because this bag isn't accessed often doesn't mean you have to put the old, worn out clothes in it. When you pull this bag from your locker or vehicle, you need pampering. Go for the high end stuff that's comfortable and builds confidence.


--Good socks

Just do it. In fact, never don't do this.


--Boot cleaning tools or extra boots

Brushes, picks, whatever you use. You don't want to get stuck using an old paintbrush handle from the engine bay to dig clay from the treads. Trust me on that one. It sucks. Also, remember an extra set of boot laces. A broken lace can put you out of service.


--Trash bag for dirty uniform/boots

Some things you can wash at the station. Some things you can't. But you don't want contaminants in your bag or in your car. Plan for containment. Remember also that sometimes a uniform is not redeemable. If that happens, cut your loses and request another.


--Laundry detergent/fabric softener

Washing clothes at the station is great, but it can be mildly uncomfortable when your clothes smell strange. Use your home detergent to add more normalcy.


--Shampoo/conditioner/toiletries--your favorite or a special smell

When you're covered in mud or someone else's blood or worse, it's not a time for the bargain shampoo. Get a travel bottle (or small refillable bottle) of the good stuff or your normal faire. Don't forget a bath poufy and/or razor.


--Hair dryer/Make up

Throw in a clippy or scrunchy in case you don't have time to dry your hair. Makeup may not be essential, but it contributes toward confidence, inner strength, and normalcy. Don't underestimate it. Even your favorite lip gloss can go a long way.


--Tea/Coffee/Money for soda

Whatever your pleasure is. Mine is Celestial Seasoning Peach Tea with a little box of apple juice thrown in for sweetness. You may need to commandeer the station coffee maker with beans from the local coffee shop or hit up the soda machine for a name brand soda instead of the knock-off you normally drink to save money.


--Special treat/Gift card/Money for a snack

Chocolate. Full stop.
Or if you're like me and keep your bag in the car (melted goo anyone?) then some other special snack. What's your favorite candy bar? Favorite milkshake? Special munchie? If you can't keep it in your bag, try a gift card--you'll be less likely to worry about your budget if it's already been allocated and purchased for just such an occasion.



--Book/video game/MP3 player

You've dealt with your physical and emotional sides, but if you catch the chance to give your mind a break, TAKE IT. Escape for a while into a good book, a new game, or some great music. Some services are not set up to accommodate this, but if you are lucky enough to have downtime, use it to your advantage and be intentional in your rest.


Saturday, June 11, 2016

Who am I?

I’m a fucking princess with
shiny satin and tiny bows and
full diplomatic power.


I rock the tiara and
the little black dress. I’m
on a mission. My decisions rest
on my authority. I choose


my destiny,
my relationships,
my friends.


to smile.
   laugh.
to argue.
   cry.
to be silent. I decide


whom I kiss.
whom I fuck.
what words I use. I talk


about what I like and don't like.


I listen.
encourage. I’m
caring,
compassionate, and


self-sacrificing.


But I examine what bothers me, confront
when words should be said. Ask


hard questions
grapple answers
face fears
admit wrong.
And abide—ever abide—when right.


Stand
for myself. I am not difficult. I
have standards. I’m strong.
beautiful.
sexy.
I’m brave.
important.
worthy.
I matter,


not because someone told me, but because


I determine it so.


I’m a work in progress.
Screw up.
Fall down.


With flaws and issues and scars, but
my sleeves are rolled.
I’m getting my shit together. And
if you want
to be by my side,
You need to be working on your shit, too.

Thursday, June 2, 2016

Crossing the Line Excerpt on EMS1


EMS1 has published an excerpt of Crossing the Line! 

Sunday, May 29, 2016

Memoriam

Gravel plods through grey mist.
Hooves clip clop with carriage wheels.
Dew spatters glossy black shoes
Measured, counted, and centered.

Friday, May 27, 2016

Great music! And check out that shirt!

Garrett Weaver gave a great concert on Facebook and check out his SHIRT!! Give him a listen--the music is really enjoyable, and there is a plug for Crossing the Line at about 27:00.

Saturday, January 16, 2016

Signing!

I'm pleased to announce that I have signed with Flashover Press! Crossing the Line will be published this spring and will be available for pre-order very soon! Thank you all for going through this long process with me.


Tuesday, September 22, 2015

10 Stethoscope Tips for EMTs and Paramedics

1) Choose the right scope

Make sure you have the right tool for the job. Disposable and cheap stethoscopes are often recommended for students, but these stethoscopes have poor sound profiles. If you have young ears, a cheap scope may be good enough for government work—but if you have less-than-perfect hearing or need a full range of sounds for diagnostics, then you will need a good scope. 

Tuesday, September 1, 2015

Goodbye

A blank page
To purge the pain.

Announcement

As DevLove Press is unable to carry my project past launch in a satisfactory manner, I have withdrawn 'Crossing the Line' from publication. Those who pre-ordered the e-book from Amazon, Smashwords, iTunes, Barnes & Noble, or other outlets will NOT receive the book on September 21, 2015, and no money will be deducted from your account.

Saturday, June 20, 2015

The Dark World of Domestic Violence

Articles on OIDV are very, very rare. This one is well done and looks at several facets of the issue.
* * * *
'The power. The badge. The gun. The brotherhood'
* * * *

Wednesday, June 17, 2015

Butterfly

The butterfly hunts by day

Tuesday, June 16, 2015

How to Write About Rape

1) Make certain rape fits the plot line. 

Writers sometimes choose to portray rape because it’s easy to get a reaction from the reader. With rape, it’s easy to get repugnance. It’s easy to create hatred. This laziness, though, results in shallow, unsustainable emotion. 

Book Expo America

'Crossing the Line' ARCs were distributed at Book Expo America in New York. 
I've never been to New York, but my book has. 
That's pretty cool.





The Cliff

Rest.


But
I hear thunder.


Peace.


But
I see lightning.

An Acceptable Victim

*TRIGGER WARNING: SEXUAL VIOLENCE*
When discussing sexual violence, there are 'unacceptable' victims and 'acceptable' victims.

Expectations

Kelly Grayson wrote in this article
'Partners tend to meet the expectations you set for them.

Friday, June 5, 2015

For His Own Good

He joined because he wanted to "help people."
It drove him, motivated him, fulfilled him.