It's been a tough week with all the 911 memorial activities. I wanted to acknowledge the 10th anniversary of what was a life changing experience for me, but it soon became an all-consuming task. My e-mailbox, as well as my Facebook page, was flooded with 911 related videos, tributes and pictures from well meaning friends. I appreciated the contributions that paid tribute to those that were lost that day, but not the ones that showed the worst of the event. I didn't really need to see pictures and videos of bodies falling from the windows. I have enough visual memories, scents, and sounds permanently etched in my mind.

Well, it's all over now, and for most Americans, 911 will slide back into the recesses of their minds.

Sunday I was invited by my old friend, Jane, who is a Deputy Chief with the Livermore-Pleasanton Fire Department, to co-write and present a piece on USARS and DMATs at Ground Zero. It was an honor. As a federal government employee with the National Disaster Medical System, it's forbidden to wear the uniform for anything but official trainings and deployments, but they made an exception in the case of 911 10th anniversary tributes. The event itself was amazing. It was in a huge theatre (almost filled to capacity) and included all branches of the military with police and fire honor guards. There were speakers, bagpipes, videos, the flag folding, and the tolling of the bell. Quite impressive. Afterward there was a very nice reception where the folks could meet the participants and the Search and Rescue dogs which included Orion, the only Ground Zero dog still alive in Northern California.
I had written this piece for another purpose, but decided to use it here instead. I looked back at the things I learned while deployed at Ground Zero - the things can still impact me today. I wanted to share them with you.

Twenty-Five Lessons from Ground Zero

Sam Bradley, BS, EMT-P

“I think the essence of life is laying down your life for others. If you’ve ever felt that no one loves you, just look at a fire truck going by. Then you’ll know that somebody does.”

Regina Wilson, firefighter, Fire Department of New York.

Quoted from the book, “Women at Ground Zero – Stories of Courage and Compassion”

by Susan Hagen and Mary Carouba.

I received a gift last year. It was one of those large patches that honors the World Trade Center disaster. Embroidered within it are the patches of FDNY, NYPD and the Port Authority. If was left for me at our county EMS agency by someone in Public Health. It was to show her appreciation for a lecture I did for the County Medical Reserve Corp on my Ground Zero experience. The focus of the discussion was on critical incident stress in disaster. I spoke to a packed house. It was nice to know that, even after 9 years, people still cared.

In thirty-two years as a paramedic, I learned how each patient interaction, no matter how mundane or redundant, creates a certain level of stress. Some reach you on a very personal level - others will change you forever. A major airline crash and responding to the traumatic arrest of one of my fellow paramedics did it for me.  Unfortunately, I discovered the meaning of post traumatic stress disorder by experiencing it.

By the time I joined a federal disaster medical assistance team in 1997, I had taken a significant amount of training in critical incident stress management (CISM). I felt prepared - better than most, I thought. It was that training that qualified me to be put in charge of CISM for the sixteen of us that responded to New York City to provide medical support for people working on the “Pile” at Ground Zero. Saying it was a life-changing experience is like saying Hurricane Katrina was a squall.

Lesson #1: It’s hard to manage someone else’s stress when you’re in the thick of it yourself.

Lesson #2: You can’t effectively defuse people (or yourself) when you’re in a “work” mode.”

Lesson #3: Everyone will react differently to events based on their individual experiences and coping skills.

Lesson #4: Going to a memorial service to honor one of the fallen firefighters was difficult, but gratifying.

Lesson #5: Meeting his family, learning more about him as a person, and making him one of our own was even better.

Lesson 6: Three horn blasts meant a body was found. Heavy equipment would be silenced and all work would stop as everyone honored the fallen. The same ceremony was repeated several times a day as firefighters walked along side a flag draped body on a gurney which would be loaded into an FDNY ambulance and taken to the morgue for processing. It was painful to watch, until I realized that one more family had closure. Most never would.

Lesson #7: Wearing steel toed boots on ground that was still 800 degrees below the surface was painful.

Lesson #8: Disconcerting can be defined by opening the back door of a treatment tent to see the headstones of a church graveyard covered in 6” of dust and the trees above decorated with brightly colored and torn clothing.

Lesson #9: It was gratifying to know how much the world cared based on the donated supplies from boots to teddy bears, and well wishes from people on the streets, for helping New York by being “out there”. We appreciated the ever-present hot meals made available to us by local restaurants and served up by local volunteer agencies. The largest pot of jambalaya I’ve ever seen was transported and cooked up by a contingent from New Orleans.

Lesson 10: The cards from children that decorated our “respite” spoke of anger, patriotism and the kind of fear that kids in this country should never have had to experience. Firefighters were their new heroes, but they also acknowledged the ironworkers, trash truck drivers and volunteers. The cards had messages of, “I hope you’re not dead or I’ll be sad”; “remember your family”; and “relax and take some time for yourself”; We didn’t.

Lesson #11: Children are smarter than adults.

Lesson #12: We were told the air we breathed probably contained the DNA of 1000 people. If so, I carry them with pride.

Lesson #13: Taking a special mission onto the Pile itself during a caving operation was the singular most intense experience I have ever had. In the deepest part of the most infamous place on the planet, it became very clear that myself, my partner Andy, and the firefighters were not alone. All I could do was tell them, “I’m sorry” ….

Lesson #14: Talking to firefighters who were already psychologically (and, most likely physiologically) crippled tore my heart out.

Lesson #15: Hot french fries and cold martinis (with three olives) after a shift at 0100 was the best part of the day. We could share experiences with the other half of the team and make peace with the events of the day ... as much as that was possible.

Lesson #16: We wrote a message to the firefighters on a plywood board the day we demobilized. We learned later that teams that came after us followed our lead (and the team before us). That board was secured, sealed in Plexiglas and was transported to Atlanta for our annual conference the next year. My handwriting is now in a museum somewhere.

Lesson #17: Trying to assimilate back into “real” life was extremely difficult.

Lesson #18: I was really pissed then.

Lesson #19: I still am.

Lesson #20: When it comes to Ground Zero, emotions still sit very close to the surface.

Lesson #21: The person that left Northern California in October of 2001, isn’t the same person that returned two weeks later. My temper is shorter, I’m much more skeptical, and I have way less tolerance for stupidity.

Lesson #22: Disaster workers aren’t easily discouraged, even in the worst of times. A few of those that deployed with me have left the team and disaster work. Others went on to experience other deployments like Hurricane Katrina and the Haiti Earthquake. Disaster work is what they live for.

Lesson #23: Each disaster takes a piece of our sanity, yet we’re driven to go back for more.

Lesson #24: I’d do it again in a heartbeat.

Lesson #25: Memories of feelings, sounds, and odors from Ground Zero live in the far reaches of my mind, but, comparatively, I’m lucky. I met a pastor from Iowa several years ago. He had also been at Ground Zero. At the time I met him he would become incapacitated whenever he heard heavy earthmoving equipment, music he associated with a movie about Ground Zero, or three blasts of a horn. He has recovered, although not completely.

Am I still angry? Yes. Why? Because 343 firefighters, police and EMS people died along with thousands of civilians? That responders still need to have government physicals every year to see if the poisonous air we breathed has turned our cells to cancer? That too many Americans have forgotten that day like it was just another bad “B” movie? That we hear more about a pop star’s latest addiction or infidelity more often than the ongoing suffering of those firefighters and their families? Because there are radical extremists that still focus their lives on destroying ours because they don’t agree with our way of life? That good Muslims are chastised for the acts of a few radicals? Yeah ... all of the above.

It mattered to me that people came to the meeting that night to listen to my story.  To know that firefighters, law enforcement, EMTs, paramedics, nurses and docs are willing to go out there every day and brave those dangers, face their demons, and fight the good fight tells me that the bad guys will never win. They can take our lives, but not our spirits. They sought to weaken us with fear, but initial shock turned to resolve and a level of patriotism this country hasn’t seen in a long time. I am proud to have had the honor to take care of those heroes at Ground Zero and form a posthumous friendship with a young firefighter that died way too soon on September 11, 2001. We’re still in touch with his family. Christian, you will always be in my heart.

This brings home the importance of being physically and mentally prepared for what we face, not just in disaster work, but every day on the streets and in our ERs. Situational awareness can’t be taken for granted. The bad guys are still out there and first responders are their targets. That’s why I believe in the efforts of all the experienced professionals who strive to make sure that every cop, firefighter, disaster worker and medical practitioner is aware, well-trained, and safe. It’s a new world … a much more dangerous one, and we need to prepare each other for 21^st century threats.

Stay safe out there!

Is Gender Really an Issue in EMS?

My Canadian EMS friend, Stephan, asked if I would write an article about women in EMS. I found myself going back to how things were when I started in the early 80's as opposed to how things are today. I thought I might share with you. What were your experiences?

When I started my EMS career in Southern California in the early 80’s, there were very few women in the field. On my first ambulance job, there was myself on one shift and a gal named Lori on the other. That wouldn’t have been so bad except for the “female attendant” rule. In LA County, no female 5150 could be transported without a woman in the unit. So, that meant I got to run all my calls plus everyone else’s female 5150s. The company had about six units in the area. The male partners I worked with weren’t crazy about the extra workload. It was made worse by the fact we were working a very busy 911 transport unit. (LA County Fire paramedics don’t transport: they rely on the local private ambulance company. I think that was the first true 1:1 BLS/ALS system). There was also the fact that we had a major state psych facility in our area and we could expect several trips to the county hospital on a daily basis. 15-17 calls a day wasn’t unusual. By my second year as an EMT I decided I needed to go to paramedic school. Even though I loved the business, I was already burned out!

What about relationships? The thing that aggravated me the most when I was trying to establish myself, (and therefore all women) as competent, the company would a hire a cute little 110 pound blonde ( blondes, don’t get your panties in a wad. Back then I was a 120 pound blonde!) who had more interest in finding a firefighter for a boyfriend than taking care of the old or infirm; and the world would end if they mussed their hair or broke a nail. The firefighters were more than glad to carry her equipment or lift her side of the gurney (or occasionally take her out), but she never really gained their respect as a prehospital professional.

There were plenty of naysayers that were strong in their beliefs that women had no right to be on ambulances any more than on fire engines. (Some of them are still around). There was also no question that the work was physically demanding … a lot more than it is now. We had two-man gurneys that had to be ground lifted, and the paramedic equipment that surrounded the patient was a lot heavier. All of that and, of course, the patient, had to be factored into the total weight I had to share with my partner. After a long shift my back was hamburger, but it wasn’t a gender thing. He was hurting as much as I was. There was definitely chiropractic service in my future! The good part was the upper body conditioning. I had some pretty good guns back then!

I worked primarily with two different fire departments: LA County and Santa Fe Springs. When I started, there was initial skepticism, but most of the firefighters gave me the opportunity to prove myself as an EMT, then a medic, and a person. Before long I was spending half my day at LA County Station 20 and had made some good friends at SFS Fire. Some of them are still friends today.

Even back then, before women in the field were as acceptable as they are today, making relationships had a lot more to do with attitude than gender. Yes, I went in with a deficit and had to work harder to prove myself, but, if you’re competent, you’ll gain respect. Even now, if a new EMT or medic comes into a new area with a “look at me, I’m a Paragod” attitude, it won’t take long before they’re ignored by the guys and the butt of firehouse gossip. It takes a lot longer to undo a bad first impression than to create a good one in the first place.

In my case, as an EMT wanting to go to medic school, I made it clear I was going to absorb all the information and training I could from those ALS firefighters. Recognizing that, they took the time to teach me about reading EKGs, pharmacology, cardiology, and critical thinking skills. It was a blessing that I was able to work alongside them as a partner. It prepared me well. A few of them even had the desire to train me to be the first LACO female firefighter, but that didn’t happen. It was actually a good thing. Cindy, the real first female had one hell of a time establishing herself. I was working in the same area with her and interacted with her even though she wasn’t at that station all that long. I tried to ease her load a bit. It was much like being two hens in a yard full of roosters. We had to look out for each other. I didn’t envy her. She was the one carrying the torch for all of womankind and the whole world was watching.

So, times have changed and a female on an ambulance or in a firehouse isn’t all that unusual. But remember: how you’re treated, and how positively your reputation is established has much more to do with how you treat others and show respect to them. Firefighters are a team, and to be accepted as part of that team, they have to learn to trust you. If you approach your job with an attitude that’s open to constructive criticism and have a “teach me” mindset, it may make the difference on whether you’re seen as someone who’s tolerated or someone who’s respected as a part of the team.
Stay safe out there!

Guest Post - Asbestos Exposure and Mesothelioma

I was contacted on Gmail by a young man named Matthew Phillips who asked to contribute a guest post for this blog. He's a student at the University of Central Florida and an advocate for assuring that EMS people, firefighters and police have the knowledge to protect themselves in environments where the danger may not be obvious. He also enjoys writing and is trying to get experience in all types of topics to expand "his pallet".

Here's Matt's contribution. Feel freee to comment to him here.

When I was eight years old, we lost our house, and not because my parents couldn’t pay the bills. It was because of Hurricane Marilyn, the “big one” that wrecked my home and threw my family into a state of hopeless chaos. I remember my mom wrapping shaky arms around me and my 18 month old brother. She was 7 months pregnant and... well, terrified.

I also remember the moment I felt like everything would be okay. My father had walked for miles to find us help and when he finally returned, he wasn’t alone. Those trained to relieve the panic and suffering of others stepped in. Our family and others like us received food, medical attention and information that probably saved our lives and certainly made it easier for us to go on.

But here’s my question. Who’s saving the life-savers?

Prior to the mid 1970’s, car parts, home insulation, dry wall, and heating appliances contained a natural mineral called asbestos. Because of its heat and fire-resistant qualities, asbestos was supposed to make homes and families safer.

But when disturbed by crashes, storm damages, and fire, asbestos fibers are released into the air. When inhaled, the fibers can cause a deadly lung cancer. Mesothelioma symptoms are often subtle and can be confused with symptoms of more common, more treatable illnesses.

Don’t wait for symptoms of mesothelioma to show. Because of an extremely long latency period (20-50 years), symptoms often don’t lead to diagnosis until the cancer has metastasized. Treatment then becomes difficult or impossible and life expectancy is usually no more than a few months.

Because EMT’s, firefighters, and other emergency response professionals and volunteers are required to work in places like car accident scenes and older homes and buildings, they are at high risk of asbestos exposure. Though the government has created assistance acts for those already exposed to the poison, prevention is the best solution to the problem.

To help prevent mesothelioma and to help save the lives of those who work to save ours, share what you know. Information is powerful and knowledge can promote mesothelioma screenings and the elimination of all asbestos use. We can do our part to help.

Too Much Material, Too Little Time, and a Vision of the Future

As I click the blog links that #CoEMS puts on Twitter for the EMS/Fire blog community, I find myself envious. Not only do I wish that I had put out some of that great material myself, but I think of all the things I'd love to blog about but never seem to have the time to post.

At the end of the day when you leave your 9-5 or shift work job, you collect your check and there's a on the other side of the timeclock. When I left the State after a two year project and started working for myself, with it came a whole new level of responsibility and accountibilty. It was all about getting the contract work done, even if that meant working nights and weekends. The downside is having too little time for things that I would like to be doing. The upside of this life is, that I'm not doing any one thing until I'm bored and drooling. Anyone that ever worked EMS would never be happy in some cramped office cubicle crunching numbers.

I don't think I've ever had just one job. When I was an EMT I was also working as an ER Tech. I did Red Cross work and was a Ski Patroller. As a medic, I went back to teach at the school where I was trained. Teaching became something I loved and have been doing since the late 80's. I've never figured out the exact numbers, but I know the EMS careers that started with my training are well into the thousands. Recently, at TAK Response, I ran into a Captain from Sparks, Nevada and recognized him immediately. I think he went through my EMT class in 1987!It's definately nice to know where thier careers have gone. I'm still in touch with quite a few.

So, I teach; do EMS training and QI for a fire department and a dispatch center; and do field training exercises for the federal government during the summer. That's the meat and potatoes. You gotta admit though, at least there's variety. I'm also the training Officer for Disaster Medical Assistance team CA-6, so there's always potential for a deployment.

What's down the road? That's the fun part. 2010 was stellar in terms of opportunity and meeting fantastic people. I was involved in the first ever TAK Response EMS/Fire/Police/Homeland Security conference in San Jose last September; I'm working with a training center called Public Safety Training Group in Brentwood; and I met a couple fire guys that are creating an awesome electronic PCR on an iPad called "iPCR". The product is by and for firefighter EMTs and paramedics and the iPad format is going to rock the EMS world. I will be doing a lot of work for them in an advisory capacity. And then there's Chronicles of EMS.

I "met" Thaddeus (Ted) Setla on Twitter. I followed his links to the "Level Zero Movie" that he created for Alameda County (where I first worked in Northern California) and was blown away at the sincerity and quality of his work.

I can't tell you how many relationships (read: friendships) I've made at 140 characters at a time. Ted always has his antennae out for talented, like-minded people that could compliment his effort of making EMS a better place. When I was in the field I had a lot of great ideas, but the boss would just pat me on the head and tell me to go back to my ambulance or polish my boots. "Boots on the ground" folks had no say in how good patient care can be accomplished much less how an operation should be run. Social media changed all that. Through Twitter, facebook, LinkedIn etc., EMS people have formed a community to discuss, commisserate, share, and create ideas on how EMS should be. We educate ourselves on best practices for patient care; we create CE opportunities that are exciting, interesting and relevant; we can rant on our blogs and can invite other opinions if we have a question. Occasionally we have a live "tweetup" and share a beer. We communicate through social media, blogs, podcasts, websites, Skype, and now video. On an occasional Saturday night someone might tweet that there's a Scrubs party on one of the streaming video channels. We get together, watch an episode of Scrubs, chat and laugh our asses off while @chicagomedic serenades us with his guitar. We have west coasters east coasters, Canadians and Brits. It's a great party with great friends. You just have to bring your own beer!

But, I digress. So Setla gives me a call one day after I first started seeing him on Twitter, and I hear about his vision for Chronicles: having a UK medic and a San Francisco Fire medic actually working within each other's system and filming it. What a great concept! The comparing and sharing of concepts now reaches across the pond. This idea led to the "Seat at the Table" discussion forum on the Chronicles site which allows field people to give voice to thier ideas - that which we never had in the 80's and 90's. I was proud to be among those who were invited to those first sessions. That was the proverbial "tip of the iceberg" of what Chronicles can and will be doing. So many creative people, so many good ideas, and now, so much good collaboration is bringing the Chronicles team up to a level never yet achieved by a bunch of fireguys and medics. Don'tcha love it! the good part is that people from all across the country, and even across the pond, get to be part of it. Wait till you see what's in the works for 2011!

Since this blog goes out to multiple places, I'll also throw out there that creating quality video isn't cheap and the types of things we're doing requires expensive equipment and lots of travel and accomodation expenses. Any vendors out there that want to tap into a huge, committed bunch of EMS people, (with thier own significant following) consider sponsoring Chronicles. Our hope is that PBS stations will also start taking notice of a show with "real people" doing "real medicine". Check us out at www.chroniclesofems.com. If nothing else, it's fun to watch Justin, a fire medic turned spokesperson. He makes me feel all fannygirly!

On a personal note, I've finally completed my BS degree (seems oddly appropriate as I'm generally full of it); done a few EMS podcasts; and want to get back to my own podcast that's been sadly neglected. Speaking of podcasting, I'm having fun doing a major role in a friend's full production podcast novel. Last month I bit the bullet and submitted my novel to a national contest. I guess we'll see if I'm going to spend my golden years writing New York Times best sellers!

Well, this was supposed to be an update, not an explosion of verbal diarrhea. Immodium anyone? I guess I've been holding back too long. I have a guest column coming up, but I think I'll make that a separate post. I'd love to have you follow my blog and/or make a comment. It's feels awfully lonely here with just 11 friends. Maybe more visitors would stimulate me to produce more content! (Maybe I can put Justin's picture on the top? That would bring in the women!)

If you're more interested in my writing life rather than EMS life, pop over to http://thesambradley.blogspot.com. Again, I'd love to hear from you!