Reflections on the Passing of a Paramedic ...

EMS people, especially in our early careers, tend to feel invulnerable. I'm the rescuer ... bad things won't happen to me because it's my job to be here for everyone else. My first experience with that was in the mid 80s when I was working as a paramedic for a "home town" ambulance company and responded to a motorcycle accident. It wasn't the first ... and certainly wouldn't be the last. I'd had a few years in by then and things were becoming a little routine. It turned out the "victim" in this case was a fellow paramedic and was in traumatic cardiac arrest after hitting a stopped vehicle then getting catapulted accross a major highway. The trauma center staff (the ones who were able to function in the face of familiarity) did thier best, inclusive of cracking his chest, but Frank was gone. My husband (at the time) was a cat scan tech in the same hospital and there to comfort me, but all I felt was numb. I was numb through the next week; the retelling of the story, the viewing, then the funeral. Our ambulance led the procession. One of the responding LA County firefighters was with us.

There was no CISM program back then. We were on our own. We thought the funeral would put closure on the event. Two years later I learned what PSTD was. The other thing I learned from that experience was that it was the newer employees, the ones that didn't even know Frank, were affected the most. That's when I understood how we tend to weave this "web of invulnerability" around us. Then, when we lose one of our own, it's like a sharp smack to the head and a recognition of our own mortality.

This week, some 20 years later, I went to a memorial for another paramedic killed in a motorcycle accident. His name was Rob Brooks. He was 38. he had worked through some very rough times in his life to become a sucessful 11 year medic and father. His last post on his Facebook page was to thank people for birthday wishes. He worked in west Contra Costa County, a tough place to work, but where lifelong friendships were formed. "West County people" are a rare breed and won't work in any of the "milder" parts of the county.

II always have a reluctance to go to "one more" of these memorials because I've had to acknowledge the deaths of too many firefighters, cops and EMS people over the years. Most of them were taken before thier time, like Rob. Only a few years ago Contra Costa County lost two firefighters when a roof collapsed. The memory is still fresh. Each of the people whose memorials I attended took a part of me with them.

There had to be at least 500 people in this very large church. Every seat was taken and people were standing in the doorways. The fire department and police presence was mindboggling. It was a sea of class "A" uniforms. I wouldn't have expected this kind of turnout for a private paramedic. It says something about our county and the people that work in it. AMR was well represented and the General Manager, Leslie Mueller, was there in her to acknowledge Rob. The Alameda County AMR Honor Guard showed support from our neighboring county. There were employees and former employees I hadn't seen for years. One, a former partner for Rob, came all the way from North Carolina. When the procession left, they were led across the bridge by the red Reach Air Medical helicopter.

The thing that struck me about this was that this is the way it should be. There is so much talk about public/private conflict. This comes from the top end; from the political spectrum and the need to position for turf. When it comes to the real work in the streets though, it's all about the relationships you form as a person and a medical professional. I got my first job as an EMT during the time when there were few women and we were only marginally accepted. I had to work harder to prove myself as a competent medic ... and a woman. After that I would spend half my day at LA County Fire station 20. The guys taught me much of what I needed to know to be successful in paramedic school. The first memorial I remember was when one of them died in his sleep one night. He was in his 30s.

At Rob's memorial the amazing outpouring of support and love from the fire and police as well as the EMS community showed that we can work as team ... as a family. This is critically important when there are those who would target us as victims of violence or terrorism. The enemy should be those that wish to harm us, not each other! This memorial showed that true solidarity can exist. This is the basis for the concept of EMS 2.0: When it hits the fan, we're all at the same party."Boots on the ground" people get that. Thank you, Contra Costa County, for being that example. Thank you, Rob, for being who you were and such an inspiration.

Join me for a podcast on "Firestorm" from GenMed

Natalie and Jeremiah welcome special guest Sam Bradley to the show, and talk about their experience in San Francisco at the FIRESTORM Movie premiere.

I've adopted two kids ... well, not really ... and they're really not kids. They have, however, deemed me the "EMS 2.0 Mom" so I guess that mean they're the "EMS 2.0" kids. For more what EMS 2.0 is, see the previous posts.

The "kids" in questions are Jeremiah (@jeremedic) and Natalie (@msparamedic). I met them both through the "Chronicles of EMS". Actually, Jer got into this after listening to an interview I did with Greg Friese on one of his many podcasts. Now he's a very active blogger, Twitterer and podcaster.

The two of them, with a few others, started a podcast called, "GenMed" which is geared toward the newer EMT/Paramedic. I. of course, represent the EMS dinosaurs. Maybe I should start the "DinoMed" Podcast. Either way, I love these two and what they're contributing to prehospital medicine. They asked me to be on one of thier first podcasts. The discussion revolved around the premiere of a very intense film called, "Firestorm", an frank look at issues within the Los Angeles EMS system. Having spend 17 years of my career there, it had particular interest for me.

From the site:

FIRESTORM follows The Los Angeles City Fire Department undereducated population. The LAFD handles all emergency medical services for the city of Los Angeles, and currently 82% of the department's work is medical, rather than fire-related. Eleven hospitals have closed in just five years in LA, and the challenge of delivering more than 500 patients per day to a shrinking number of hospitals is overwhelming to the LAFD. With resources strained, and 911 being used for everything from heart attacks to stomach aches, LAFD paramedics have become virtual "doctors in a box".

Jeremiah has Worked in Los Angeles since 2006, and Sam for the first half of her career. They bring a local prospective to the discussion, contrasted by Natalie, and her experience in Louisiana.

Please take a listen and see what you think. This is the **real** state of EMS. From there you can follow Jer and Nat, thier websites and blogs, and #CoEMS. Find it here!

Did You Ever Wonder What You Would Write in Your Last Blog?

I never knew Carla Zilbersmith, although I wish I had. I learned about her from the e-mails updating her condititon at Los Medanos College where we both work. Carla is dying from ALS. The e-mail today talked about her last blog post. I almost didn't read it, but somehow felt compelled to ... as if I owed it to her.

The title of her blog says, "Carla is a mother, humorist and writer. She writes about life, art, politics and the things that scare her."

Death is apparently not one of those things. This is just a snip of what she has to say:

"I learned a lot from my experiences with ALS, as well as my experiences writing this blog. Almost everyone has a story of loss or longing and almost everyone desires a way to find meaning in our lives that whirl past us so quickly. Almost all of us count our loved ones as our most cherished commodity and yet, so many of us don’t have or make time to spend with them. We want to stop and smell the roses, we want to fully embody gratitude in our hearts and minds, we want to be the best ‘us’ we can be, and yet the road is beset with detours and roadblocks.

I will gradually fade in people’s memories, so that even my son or my dad will have to look at a video or a picture to remember what I looked like and what I sounded like. This blog, whether it becomes a book or not, will be relegated to the shelves of both minds and/or libraries. Nothing lasts forever. The formidable boulder becomes a grain of sand swept away into the sea. All we have is now. I’m going to keep making the most of my now. I’m going to try to avoid preemptive sadness and I’m going to urge people who read this to…

I don’t believe that to everything, there is a purpose. I don’t believe in a logical, just universe. I believe in randomness. Having said that, if me dying has been helpful to anyone or made anyone realize the depth of love they have for this world or for the people around them, then I’m pretty pleased about that. I’m also really stoked that I’ll be eternally good-looking. Personally, I was not looking forward to arthritis, jowls, cellulite, or the inability to recognize when I was wearing too much perfume.

I have decided that while Mac and others may continue to post, this will be my final post. I’ve said everything I want to say and everything comes to an end. ALS has been calling most of the shots, but not this one. I get to decide when this great experience called the blog is over and I call it. It’s over.
It’s been an honor to have people read and comment on this blog. Thank you for everything you have taught me and for all of the kind words that have lifted my spirits. News will continue through this blog, including specifics about my funeral, which I guarantee you will be the world’s most hilarious funeral ever conceived by man ... but you already knew that, didn’t you?"

You owe it to yourself to read this, and perhaps the others that chronicles this amazing woman's life and journey with ALS. What would you write if you knew it was your last blog?

Carla, Goodbye and thanks for leaving some words of wisdom for the rest of us  ...




Carla's Blog

Red Lights, Hot Spots and Disaster

Hi All ...

A made a decision today to separate my writer's blog from my EMS blog. As much as the two may go together in some respects, the audiences are quite different. The similarities are in the desire to share stories. This blog will follow podcasts of stories by members of my writer's group and non-EMS works. The new blog, "Red Lights, Hot Spots and Disaster", is an attempt to encourage EMTs, paramedics, nurses, docs, firefighters, law enforcement personnel and disaster workers into sharing the stories of their professional lives. Why did you decide to be in the profession you chose? What drives you to keep doing it? Where do you see yourself in five years? What are the high points and low points of your job? We'd all like to know. Come on over and join us. Bring a story, a thought, a comment or a discussion. We'd like to hear from you.

For the non EMS people just looking for a good story, stay tuned! There will be more chapters of "Bruno Fenster Saves the World" and some new offerings! If you'd like to contribute a story, let me know!

Sam

Down Coat or Mosquito Netting?

A week ago Tuesday I was driving from Northern to Southern California to meet with a representative from Washington DC to work on a national training project. Car travel for me generally assumes being firmly entrenched in the iPod zone. I actually look forward to long drives as it’s an opportunity for me to catch up on my favorite podcasts and audiobooks. That might explain my complete mystification when I dropped into the hotel bar at 7:30 to see news footage of the Haiti earthquake on the TV. Me: “So, when did that happen?” Bartender: “Oh, about 3:00 this afternoon.” That’s when my iPhone came to life with e-mails from the team speculating about a possible deployment. Deploying to Haiti would be our first international mission. So, there I was, sitting at the other end of the state with an all day meeting scheduled the following day. The next morning we met for breakfast and guessed that my team would probably not be deployed before the end of the week. International travel creates a whole new set of complexities to the already daunting task of sending multiple teams of thirty-five people into a disaster area. We were wrong. DMAT CA-6 and other teams were moving out by the end of the day. Even though I wasn’t on the current roster, I was disappointed about being left behind. Disaster medical people are a unique bunch and thrive on working in the worst of circumstances. The extremely austere conditions in Haiti would provide an especially  challenging opportunity.

Who are these people? In 2008, I was doing an article for JEMS magazine that was ready to go when my (then) employer decided I wasn’t high enough in the food chain to author the article. The magazine liked it, but it didn’t see print. In the process of creating it, I interviewed some of my team members to try and explain what drives them to do what they do. This is a chance for their thoughts to come off my hard drive and to be shared with you.

David Lipin went from being a partner in a computer networking business to joining DMAT CA-6 as an EMT. Within a few years, he became the commander of our team. In our opinion, he’s the best in the system. (No bias, here!) I asked Dave what attracted him to disaster medicine.

“I got into disaster work because it's so different than my ‘day job’. It works a different part of my brain, is almost like a vacation, and ultimately, is just so darned satisfying. The best part is the grateful responses of patients we treat at disasters. No bills, no insurance, no worries -- just medicine”. Dave devotes himself to this work full time now, and states that he’s “living his dream”. When asked about his best memories of deployments, he told me: “Watching a baby girl being born at the Superdome, and seeing my wife at the airport upon returning from Ground Zero”. I’m anxious to hear what experiences he brings home from Haiti.

Annie Bustin is an experienced RN who is a triage nurse in San Francisco, and the Disaster Coordinator for her hospital. In my opinion, she exemplifies what a nurse should be. (No bias here, either!) She is also the Operations Chief for DMAT CA-6. When asked what attracts her to disaster work, Annie said, “Being an RN in the emergency department allows me to use my critical thinking skills. I can be creative, go outside the box, and actually do something for a patient to make them feel cared for. It’s incredibly satisfying.  Disaster work is that same feeling, but a thousand fold. It’s knowing that you're right where you're supposed to be, that you can give your blood, sweat and tears to a stranger without them ever knowing it; without the world ever knowing it.” 

Annie is motivated by the fact that she has the skills to make a positive difference in someone’s life during the worst of circumstances. “I can give back to the human race. I can give a piece of myself to healing the injured, ill, broken and destroyed victims of a disaster. I can give hope where there is none. How can you turn down a job like that?” Deployments aren’t always easy, and Annie described her most memorial moments of Katrina as too private to share. “It's an emotional moment that’s as strong now as it was then.” But, she’s treating people in Haiti as we speak. Her words reflect beautifully how many of us feel, “At the end of the day, when you can finally lay your head down somewhere, a sense of peace and mercy falls upon your breaking heart. And you know then, that you've come home”.

A DMAT or any disaster medical team is not just about the medical personnel. The team can’t function without a place to practice and sleep; the use of electricity, water and sanitation; and certainly, communications. Critically important team members include the logisticians or, as we affectionately call them, the “loggies”. In answer to the question, “Why do you do this”, a loggie told me; “Because I have a screw loose in my head. Who in their right mind pursues a career and a hobby where you run toward a situation that other people are screaming and running away from? The best part is the feeling of accomplishment that you've done something to help, that you gave them your best shot, and you got people through it. It’s the satisfaction of having to improvise and create something that helps the team or a patient, by using non-standard thinking and a creative skills set to make a piece of chewing gum and a Band-Aid into a heart monitor. It’s what “loggies” do best.” He’s right … loggies are the most creative and resourceful people on the planet.

We see an amazing number of people in the few weeks we’re in a disaster area. We suture, hydrate, cleanse and salve their wounds. We comfort them the best we can. What makes a deployment difficult is never having closure on the stories of the people we treat: parents separated from kids; loved ones floating away after a hurricane or flood; people missing under the rubble of an earthquake; the loss of beloved animals and everything they own. We can’t tell them, “It will be all right” because we know it won’t be. We don’t know where the homeless will go or whether they’ll ever see their families again. We can tend to their wounds and replace their meds, but we can’t repair the psychological devastation that will remain long after we’re gone. It almost leaves us feeling guilty for having an intact family and home to return to.

Yet, we love to remember the moments when something happens that brings a little light to the darkness: a family is reunited, a baby is born, or a life is saved. At Ground Zero we met the family of a lost FDNY firefighter that we still remain in contact with. I wrote about Christian Regenhard in the story about my Ground Zero experience in the book, “To the Rescue, Stories of Healthcare Workers at the Scene of Disaster.” After Katrina, CNN profiled a story about a woman whose mother still hadn’t been located many months after the hurricane. Dave recognized the missing woman as one they had seen when the team was trying to make their way to the Superdome and some people were pushing her up the freeway on a gurney-like device. The team stopped and attended to her then provided for her evacuation. Even though the prognosis for her was certainly not good, Dave was able to provide some much needed closure for that family … all recorded on CNN. Now the team is back in the lights of the CNN cameras doing the good work that they do. They are there with the USARs, religious and non-governmental organizations; the American military, and the Comfort hospital ship to name just a few.

Okay, here comes the rant … It’s my blog, I can say what I think. Every time I hear negative comments about the US response to Haiti being too slow or not good enough, it annoys the crap out of me. To those people: before you criticize, know the facts. First of all, there is no mandate for us to be there. We are a humanitarian nation and choose to be there. When the call comes, team members have to get off work and prepare their families, while the government processes a deluge of travel orders. They have to determine how to safely get them into the disaster area, especially when there are issues like damaged ports, lack of aircraft fuel, and a semi-functional and overloaded airport.  Then, there are the issues of security for the personnel and getting huge caches of equipment to the teams. News flash: There is no means of instantly transporting people and equipment and have them land in a light beam in an affected area an hour after a disaster … end of rant.

So, am I going to Haiti? I don’t know. If the call comes, I’ll be ready as will many of us who missed the boat ... or plane, the first time. I’ll remove the down jacket and fleece I packed for a trip to Alaska and replace them with bug spray and mosquito netting. If I don’t go to Haiti, there will always be another disaster somewhere ... sometime …

If you read this far, you might be interested in another disaster blog by a friend of mine, Deanna Polk, called “Global RN” at  www.globalrn.blogspot.com.

Well, it’s time to turn on CNN and see if I can find my team. We had given ourselves a motto of “Caregivers to the Nation.” I guess we need to change it now to, “Caregivers to the World”. Stay safe, my friends.