Among the classes we have recently taken has been a class given by Dr. J, our medical control doctor and one of the Emergency Room physicians at our local hospital. Dr. J is a fantastic doctor and he’s a pretty darn good teacher as well, which is probably why he’s a fellow at the Academy of Emergency Medicine. So, when Dr. J gives a class, you’d think people would take a little something away from the class. And, if you took anything away from Dr. J’s class on Multiple-Casualty Incidents, or MCI’s, it should probably have been the fact that the first unit on scene becomes Incident Command upon arriving at the scene of an MCI.

True to Dr. J’s fashion, he didn’t just teach us this in the classroom, but he also had us try the concept out at our large, once-annual MCI training scenario at the local high rise. This year, the Medical Simulation Training Center at the local Army base did the moulage kits on our casualties, who were volunteer students from the local high school, which added a heck of a lot of realism.

But the problem with a canned MCI scenario like this one is that everyone knows what they’re supposed to be doing. “Wait,” you wonder, “Isn’t the whole point of this training to ensure that everyone knows what they’re doing? So how can that possibly be a bad thing?” Well… here’s why.

When you run a canned MCI scenario, everyone knows what they’re supposed to be doing because it’s discussed in great detail before we’re ever paged out to participate in the scenario. We know who’s going to be running triage and who’ll be rehab. We know who’ll be at Incident Command and where our ambulances will be staged. Which is great. Except for the fact that you don’t know any of those things when you’re responding to a real MCI.

Cue a real MCI.

Coming back from Search-and-Rescue training with the local K-9 team in Fulton, we were just outside of Small Town when I was passed by MC’s truck, running blue lights and going about 80 in a 55. “Funny,” I thought as I pulled back onto the road, “I didn’t get a page. Maybe it’s just a fire department thing.” After checking CAD Page my phone, I find that the Rescue Squad has been paged out along with the fire department for a structure fire. Hum. That’s a pretty routine thing and usually requires an ambulance to stand-by somewhere while firefighters do their thing. It’s not usually something that requires extra hands.

Just as I was about to turn into the main street, about a mile from the Squad, I got a phone call from KB. KB knew that we were close by because I’d asked hubby to text him when I turned off Route 11 to ask him what the turn was to get to 126 – the one I always miss but that we usually take returning from transports to Syracuse in the ambulance. So he knew I was only a few minutes out. He sounded frantic and wanted to know if I could come into the squad right now because there was a fire in a building with a central oxygen system and one firefighter was already down and the Lifeflight was in the air.

So I headed to the Squad, grabbed my stethoscope and reflective vest from the back of the Jeep, handed hubby the keys so he could drive it home, and hopped into the ambulance, all under the calls of “HURRY UP!” from inside. I saw that one of our rigs was already out and the third was still in the bay, with neither crew nor EMT ready to take it out, which was a little surprising since we usually don’t have a problem getting drivers or EMTs to crew all three rigs when there’s a big incident. (But a lot of our people are also firefighters and went on this call with the fire department, rather than the rescue squad, I assume.)

On the way, KB filled me in on the fact that, apparently, the building on fire was our local hospital – more specifically, our local Emergency Room. That’s not a good thing. At all.

As we pulled up on the road overlooking the hospital, just prior to our turn, I saw that a ton of equipment was already in place. The entire parking lot in front of the Emergency Department was flashing and blinking lights on fire trucks, ambulances, police vehicles, volunteer firefighters’ personal cars, and so on. Two fire trucks were right in front of the ER’s entrance and our other ambulance was backed in to the left of those. We had no ability to join them there with other vehicles and fire hoses blocking the way, so we looped around and staged in the adjacent parking lot, then jumped out to locate command to find out what we were going to be doing or whether they wanted to stage us elsewhere.

As it turned out, the crew of our first rig was comprised of our Squad’s president (and Chief 2), an EMT, and her driver, also an EMT. They were inside, caring for a firefighter who’d been injured in some way and for whom the Lifeflight had originally been called but had since been cancelled. Eventually, Chief 2 came outside to ask for a c-collar and tape, which we handed her from her rig, and a short while later, her driver came outside to inform us that mutual aid was coming but the EMS coordinator had not yet arrived, so he didn’t know where they needed to go or where we needed to go.

Stepping back here a second …

We’re at a scene now with the Fire Department, police, and EMS. Other agencies are on their way for mutual support and there is NO Incident Command framework, at least for EMS, because “the EMS coordinator isn’t here”. What is wrong with this picture?

Meanwhile, we can see four other ambulances from surrounding departments on the high road, about ready to turn toward the hospital and we’ve got no place to direct them to. KB and I looked at each other and told MB, the driver – “You were first on scene, YOU are the EMS coordinator. Make a decision.” KB suggested staging them in the parking lot where we were staged, as it would be easy for them to load and go from there, and once we got a sort-of-committal from MB, I headed down to the police road block at the entrance to the parking lot to direct those rigs into the upper parking lot where we were, which is where they went.

A short while later, which everyone staged nicely and ready to go, MB showed up and told us that we should stage behind the hospital, at the rear entrance, so we all lined up and drove around the building. Only problem being that there isn’t any damn room back there, so having pulled two rigs up to the building, the rest had to be quite a ways back and taking any of the rigs out of there to transport would have required tight, 3-point turns past other rigs, a fire truck, and various dumpsters. And, obviously, this literally put us up against the building … probably not the best place to be, necessarily, in a structure fire. But, we were sent, so we went.

That is, until our Chief came around the building and told KB that he was now EMS command because nobody else more qualified, such as the EMS coordinator, had arrived yet and she “was busy” on the other side of the hospital doing whatever it was they were doing over there that didn’t include becoming EMS Command on arrival as the first rig on scene. With KB becoming EMS command, of course, that also meant I was now out a driver. Another little detail nobody seems to have considered.

In the end, none of the ambulances were needed – luckily. The firefighter injured was treated at the hospital, and the structure fire everyone was looking for had turned out to be “a strong odor” pulled in from outdoors by the ventilation system, possibly from people starting up their wood fireplaces for the first time this season, or someone being dumb enough to burn their trash and plastics in said fireplace (which is not particularly uncommon in these parts, especially now that burning trash outdoors happens to be illegal). The mutual aid rigs were sent home and we stayed on scene for a while longer until we, too, were released. (KB was surprised they didn’t end up forgetting about us.)

Overall, I think it was a lesson learned in how not to handle Incident Command at an MCI. And a lesson learned regarding the fact that taking the classes and required tests (such as all the FEMA classes we have to complete online) does not equate actually know what the heck you’re supposed to do when placed in that situation. It was disappointing to see. Fortunately, nobody got hurt but I don’t think it should have gone the way it did. (But it’s not my place to point that out.)

Okay, there are still some places where I have been getting good customer service. My local McDonald’s is staffed by some incredibly nice people who probably know me by name by now … or at least can identify me by my car … and they’ve been giving me pretty good service, save for the occasional mix-up where I’ve gotten a vanilla McCafe shake instead of a chocolate one, but that’s no biggie. But elsewhere around here? Not anywhere near the same amount of service.

Seems like many of the places around here are stocked by people whose give-a-damn is broken but who still expect the customer to be nice to them and even tip them although they provide no service that would be worth a tip, save for the non-monetary kind, such as – “Here’s a tip: provide some customer service if you want me to give you extra money for it.” Remember, kids, the definition of a “tip” is a “sum of money as reward for their services.” It’s a reward. Not an entitlement.

But I digress.

There are a few places locally that have done an overall worse job than others recently, so I’d just like to mention them.

The first is our newly opened Dunkin’ Donuts. It’s been open for less than two months and service is already complete crap. We’ve stopped in once so far and probably won’t be going back anytime soon. Aside from the fact that the place looked like it hadn’t been cleaned since the day before, with straw wrappers and other debris littering the floor, the staff made an equally bad impression in unwashed, wrinkled, stained white shirts, bad tattoos showing on their necks and arms (even in areas where they could have been covered, were they to wear their shirt sleeves down), and very slow, unfriendly service.

The second one is our local Brigade Quartermaster store on base. I went in there with the express purpose of buying a pair of boots. Walking in, I was the only customer. Yet the store clerk was, of course, nowhere to be found to be asked a question. When I finally did find her to ask whether they are able to get the boots in black (so I could wear them for both Civil Air Patrol and at the Rescue Squad) rather than the standard tan, the employee seemed put out that I’d asked her such a difficult question and suggested I Google it, she didn’t know. The rest of the interaction with her wasn’t any more pleasant … like when I stood at the register ready to check out and she was yakking it up with an employee from one of the other stores by the door, completely ignoring me.

Incidentally, I’ve noticed that male soldiers going to this store never get this sort of brush-off treatment I got from the (female) staff in there. Makes me wonder if they work there looking for a date. Or a hubby. At any rate, I wound up complaining to corporate about that particular shopping experience and got a nice email back telling me they’d given both the employee and the manager some additional training. (Whatever that means.)

My latest bad customer service experience was at the local Pizza Hut, which has been offering a $10 for any pizza, any size if you selected takeout instead of delivery. Hubby and I ordered a large Hawaiian, which is our default pizza order, and headed over there to pick it up. We were helped quickly by one of the teenagers working there who brought out our pizza, showed it to us to ensure it was the right thing, and then informed us that the woman at the other register (the “takeout register”) would check us out as soon as she was done.

The woman at the other register was identified by her name tag as the General Manager and she was the only person in the store who didn’t look neatly dressed and groomed. Her hair was disheveled and both her apron and Pizza Hut shirt were wrinkly, stained, and dirty. Not a very good impression from the person who’s supposed to be the manager, especially considering that all the teens working there were well-put-together! Not only that, but she was on the phone. For the next eight minutes! Around minute five, hubby was wondering whether we should be going to Stefano’s (the local Italian joint) instead but I suggested that since we were already here and the $10 pizza was a good deal (and usually very good), we should just wait.

When the Manager got off the phone, she offered no apology at all, not even a quick, “I’m sorry for the wait.” She just started to ring us up. As I handed her the money, I couldn’t help but commenting that “The pizza is probably cold by now.” Instead of apologizing, the Manager said, “Why’s that? Oh… because I was on the phone so long? I can only do one thing at a time.” Which sounded a whole lot like, “Go fuck yourself. I’m the manager and if you don’t want to wait, don’t fucking eat here.”

Needless to say, corporate got an email about that one, too. And I’ll be recommending to my friends on both the rescue squad and both fire departments to order their pizza someplace other than Pizza Hut – thankfully, we do have other pizza options right in town, too.

Have you recently dealt with bad customer service? How did you handle it?

Not quite.

First, there seems to be this huge amount of outrage that Tea Party protesters would bring guns to a protest rally. zOMG. They’ve got guns. The world is gonna end! Revolution is upon us. Fact is, however, that the places where Tea Party protesters have brought firearms to rallies are all places where carrying firearms is perfectly legal.

New Mexico, for example, which is cited in the first article snippet on the Buzzfeed page, allows open carry without a permit of any kind. 25 other states do as well. Overall, 42 states allow open carry (with or without a permit). And as much as the media would like to make believe that only a nut would carry firearms to a political rally, the fact remains (and even the media has to admit) that this happens to be perfectly legal in most places.

The fact that police doesn’t generally show up to Tea Party protests is also a falsehood … police show up plenty to political rallies, whether they’re conservative or liberal in nature. The fact is, however, that they rarely feel the need to arrest people at conservative rallies, such as those held by the Tea Party, because those protesters don’t behave in a way that bears being arrested – they don’t usually present any sort of risk to others, don’t block roadways, don’t squat on private property, and don’t leave trash. When told to disperse, they disperse, rather than shouting and acting like a threatening mob.

You also don’t hear about cases of protesters being raped, assaulted, or robbed at Tea Party rallies. At Occupy Wall Street in Baltimore, on the other hand, they’re circulating pamphlets that discourage women who were raped in the protest camp from reporting their rape. In Seattle, a protester was arrested after exposing himself to children. And, of course, residents of New York aren’t happy having the protesters in their back yards where they add noise, block roads, harass people who are on their way to work, and present a general health and sanitation hazard. I don’t think I’ve seen any such complaints about the Tea Party movement.

If Occupy Wall Street has a sensible point to make, they are missing their chance to do so by allowing the sort of conduct that is being allowed in their protests – squatting on private property, defecating on police cars, rape, robbery, assault, harassing average people going to work, blocking roads and sidewalks, and so on, and so forth.

There are plenty of ways to protest – in public and with signs – that will get the message across and will do so without turning whole neighborhoods against them due to their conduct. There is a reason so many people are thinking of the Occupy movement as a bunch of lazy, lay-about, dirty hippies … for the same reasons people assume hippies are dirty and lazy. Because there are those who give that impression and, as the saying goes, the squeaky (or should that be, the smelly?) wheel gets the grease. The yucky get noticed, basically.

As far as I’m concerned, I don’t think the Occupy movement as a whole has any clue regarding what they are actually protesting for or against. I understand why it started and what the original reasoning behind it was, but then it started to look more and more like every single protester had their own idea as to why they were there and what needed to be changed. And then they completely lost me with the list of demands that seems to be changing by the minute. Some demands are reasonable. Some are ridiculous … like free college education and open borders migration. My personal ridiculous favorite is the call for “a guaranteed living wage regardless of employment.”

Nuts!

But, what really bothers me the most is this “the 99%” claim. How dare these people to presume that they are speaking for me? Or that their interests, whatever they are, somehow represent mine. And I’m certainly not in or anywhere near the 1%.

At any rate, I don’t believe I have done any blogging at all about working as an Emergency Medical Technician (Basic) since that entry months ago about the very obvious description of paralysis one of my fellow students offered in class once. Since that entry, I’ve taken my final written and practical exams, and (if I might brag for a bit), finished with 93% on the written exam and passed with full points on my practical exams. I also received college credit – 4 hours worth – for the course which is reflected as a 4.0 on my transcripts. Please bear with me while I toot my own horn for a second.

While taking my Basic class, I was required to complete 10 hours of ride time with a local ambulance squad before I was permitted to take the final exams. Ride time is a requirement so that new EMTs, such as myself, get the necessary hands-on experience under the supervision of an experienced proctor, rather than just theoretical knowledge, before they become certified to work as an EMT in their respective states. And while many of us did a fair bit of griping about making that ten hours in time to be admitted to the final exams, it’s an important and necessary thing. While it’s certainly a requirement to have all the theoretical knowledge, it’s a different matter altogether to use it, hands-on, in the field. On a real life patient. In a stressful or rushed situation.

I was extremely lucky during my ride time in that I was paired with proctors who were paramedics with many years of experience in the field. But what’s more is the fact that these proctors didn’t just let me watch – they let me do, under their careful supervision and with their help. And I think that was possibly the best way to be introduced to working (civilian) emergency medicine in the field – being able to do it from the start, with someone to look over my shoulder to ensure I did it right.

I know that many of my fellow students were not so lucky – some were allowed only to watch. Others were paired with proctors who didn’t actively teach and explain, just sort of had the students “follow along”. And a few students figured they’d to the “smart” thing and spend their 10 hours of “ride time” in the ER instead of the back of an ambulance – where, subsequently, most of them ended up watching and making beds, rather than getting any hands-on experience at all.

After finishing classes and receiving my EMT card, I joined the squad I had done ride time at and began my training there. But wait, you say … you just became an EMT. Why are you starting training at the squad? You should already know all that an EMT needs to know!

What they don’t tell you prior to taking the EMT class or even in the EMT class is all that extra stuff you have to learn at your squad that you do not learn in class. A lot of it, such as ambulance operations or working with helicopter life flights or writing PCR’s (pre-hospital care reports) is touched on in class but it isn’t covered in-depth – that’s what your ambulance squad is for. They train you to do these things the way they’re done in that particular squad. And, as I’ve come to find out, squads have specific ways of doing things. Some, for example, now write all-electronic PCR’s. My squad does not – we write our PCR’s by hand, on the state forms, and then enter them into the computer after a run, which submits the PCR to both the state and the company that does our billing. And there are specific ways we do checks on our ambulances to ensure that everything is stocked, nothing is expired, and all is where it should be. And so on, and so forth.

It took a few months, but I finally was cleared to run on my own for both transports and emergency calls. It mostly took “a few months” because of the low call volume – while large cities such as New York or Washington, DC are hopping (in a manner of speaking) all day and night long, our upstate area tends to be relatively quiet and we often have days where we don’t get a single call at all. Naturally, that makes getting cleared difficult because you have to do so many runs with a more experienced person until everyone feels you’re ready to fly solo.

Up here, our bread-and-butter calls are to the local nursing home. And while they’re our most common type of call, they are also our most frustrating type of call, for a couple of different reasons.

One – because the nursing home is located, literally, behind the hospital. It would probably save everyone time and money if the hospital simply built a covered corridor connecting the hospital with the nursing home, and patients were simply wheeled from one location to another. The length of the corridor would be approximately equal to the length of two ambulances. I’m not even kidding. It’s that close.  In the absence of a corridor, a lot of ambulance calls could be avoided if the attending physician took five minutes out of his day and simply walked over to the nursing home to see whether a patient actually needs to be admitted, or whether the nursing staff at the home is trying to send them for no reason other than “acute evaluation syndrome” (patient must be seen now for no good reason at all).

Tw0 – because the local nursing home seems to be staffed entirely by future rocket scientists, which I mean in the nicest way possible. These are the most incompetent people I have ever met in a group, save for our elected representatives in Washington, DC. Whenever we receive a call to the nursing home, it is an absolute given that none of the nurses attempting to tell us what happened were actually there when it happened. They’ve always “just gotten there” and “have no idea” why the patient is unresponsive or bleeding.

Often, calls to the nursing home are for patients who have been in pain or unresponsive for hours and received no interventions. Sometimes we get calls for patients who are obviously deceased and have assumed room temperature by the time we arrive. But if we come and take them, there’s less paperwork for the nursing home to do. Once, we received a call for a diabetic patient who had been unresponsive “since lunch” (three hours ago) and was found to have very low blood sugar. Nursing home staff had then attempted to help the patient by administering oral glucose – for those who don’t speak “medical”, that’s glucose paste inserted in the mouth. One of the first things EMTs learn is that nothing, ever, goes into the mouth of an unresponsive patient – except an airway. Certainly not oral glucose. But those are the things we deal with at the nursing home.

Besides nursing home calls, we do a lot of local “trauma” calls to the homes of elderly patients who have fallen or who are suffering from breathing trouble, chest pain, or abdominal pain. Those are our most common “elderly” calls. Sometimes, we’re called mainly because the person wants someone to stop in and talk to them for a while.

Once, we went to a call three roads from our station – KB (a paramedic), GS (a fellow Basic), and myself – to the home of an elderly lady who had supposedly slipped and fallen. She was laying on the kitchen floor when we arrived and had no complaints of any pain, having hit anything, or having felt dizzy at all. She’d simply slipped and not hit anything on the way down, she just couldn’t get back up.

After our assessment, GB stood her up and helped her into her chair. He started asking her if she wanted to go to the hospital and she said she’d rather stay home and maybe lay down in her bed. Then she looked at me and said, “Can you straighten my bed up for me?” This was an unusual request but, sure, why not … we’re here to help. While I straightened up her bed as nicely as I could and hoped it would meet her standards, she turned to KB, the paramedic, and said, “Is she making my bed? Does it look nice? Is she doing it right?”

A very large percentage of what we do, and where we make much of our money from insurance companies, is transporting patients from our local hospitals to larger facilities in Syracuse and Utica (and, occasionally, Burlington, VT) where patients have access to specialty resources or further diagnostic resources. We’ve got a lot of good stuff up here, but we don’t have a trauma center in our immediate area. We also don’t have cardiac surgeons. For example. Which means that many of our patients are looking at a long, bumpy ride in an ambulance – or, if they’re bad enough, a short ride in a helicopter once the helicopter makes that 30 minute flight to get to us to pick them up.

Transports are not a bad thing – well, for the patient, they are uncomfortable, but they’ll eventually get them to the resources they need. For us, they can be long and tedious. Sometimes they can be quite entertaining. Sometimes they’re just plain nerve-grating. A lot of that depends on the patient. And some of it depends on traffic. But, overall, it’s generally an easy way to get paid and as long as I get paid $50 per transport (before taxes), I’m not complaining about the tediousness of doing basic vital signs on a perfectly stable patient who’d rather sleep the whole way down.

And then we’ve got the small percentage of “interesting calls” – trauma calls such as car accidents, domestic disputes, and all that sort of good and interesting stuff that keeps the days from being same old, same old.

My very first car accident was one I went to while I was still doing ride time with KC, one of our paramedics. As a result, I got to do very little but it was a good introduction to my first ever trauma call. Our patient was a middle-aged diabetic who remembers blacking out and then remembers coming to just to find that her car had gone off the road and was seconds from colliding with a tree trunk that had recently been chopped down and was laying crosswise in the yard. A baffled homeowner, in the middle of chopping down some of the trees along the roadside, had stood on his porch, wondering what in the heck had happened and watching the scene unfold.

The entire roadside was lit up by flashing red, white, blue, and amber lights as several fire trucks, police cars, and our ambulance were on scene. When we arrived, a bystander was in the rear seat of the vehicle holding her neck, a first responder had taken a set of vital signs for us, and firefighters were cutting the patient free of the vehicle. All that was left for us to do was applying a c-collar, extracting her using our KED (which was cool, because we’d literally just done this in class the previous lesson), and getting her to the hospital.

The patient was not seriously injured – she’d broken her ankle but was otherwise intact – and kept apologizing profusely for “being so stupid” to run her car off the road and “making us all come out there for her.” But she was in a fair bit of pain and we wound up linking up with a paramedic from a different squad who hopped in the ambulance to administer medications to her after meeting us by the roadside in his fly car.

I don’t know what happened then, because as I was the only one not doing anything of use after helping to splint the ankle, I was chosen to drive the other squad’s fly car to the hospital, following the ambulance. So here I was, an EMT student, driving the Chevy Blazer fly car, lights and sirens blazing, behind the ambulance all the way into town. It was pretty cool. Until I parked the vehicle and realized I had absolutely no idea in the world how to turn off any of the lights with dozens of switches staring back at me from various locations.

That same day, we also met a helicopter at the landing zone and took the crew to the local hospital to pick up their patient, another car accident victim who was going to the nearest trauma center. When we arrived at the hospital with the flight crew, Dr. J, one of our emergency room doctors, was inserting a chest tube into the patient and asked us to come in and watch. Dr. J is all about teaching and always likes having his medics come in and observe emergency room procedures.

We’re extremely blessed to have Dr. J because he is a fantastic doctor with many years of experience in both civilian and military medicine. Dr. J was a responder in New York City on 9/11. He was an emergency room doctor in San Antonio, TX. He is a fellow at the Academy of Emergency Medicine. We could not ask for a better mentor, teacher, and doctor to work with. (Nor could we ask for better Medical Control to call up when we need something!)

Aside from vehicle accidents on our local roads, we get a fair number of our more interesting calls from nearby Fort Drum, which is one of our “mutual aid” locations. If Fort Drum sees a large accident – like a HMMWV rolling over in a training area or two trucks full of troops rear-ending one another, chances are that we’ll be out there for the call and transporting patients.

It has been my misfortune to always be as far as possible from the location of the call when the most interesting calls come in. Trauma call that requires a helicopter to be called? I’ll be in Watertown, getting my shopping done when that happens. Hunting accident that ends in a fatality? I’ll be just pulling off base after getting my shopping done at the commissary. It’s really quite frustrating because calls never seem to happen when I’m at the squad or at least within a reasonable distance to respond. (Though it never fails that we’ll get a call while we’ve got training classes scheduled … our MCI class, for example, was interrupted by an MCI.)

Well … here’s to interesting calls in the future.

I made Finn dress up for Halloween. He’s being “fat Puss-in-Boots” from “Shrek Forever After.” What can I say … it was an easy choice and an even easier costume, and the similarities are uncanny. *snerk*