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.

EMS 2.0 in PDF ... Check it Out!

I've been spreading the word about Chronicles of EMS and the concept of EMS 2.0 ever since they came into my life. I'm a believer. I also had the good fortune to spend some time with Justin, Mark and Ted on a few "A Seat at the Table" episodes which made me even more of an evalengist. These guys, and many that are following them are doing an amazing job of allowing "boots on the ground" firefighters and EMS folks have a say in how the broken system of prehospital care might be mended. Justin put a lot of effort into this document and I know everything he does comes from the heart. Take some time to read it and share.

If you're in the Northern California area, or even if you're not, come see us at the TAK Response Conference (www.takresponse.com) in San Jose September 14, 15 and 16. Justin and Ted will be there (with cameras) along with Natalie (MsParamedic) and Jeremiah (Jeramedic). We're filming "A Seat at the Table" episodes on the 15th and will have a "Tweetup" on the 16th. Check www.chroniclesofems for details. We'd love to see you there!

In the meantime, here's a taste and a link of the EMS 2.0 PDF. Thanks, Justin, for all your hard work on this.

The term "2.0" brings to mind backing up all your desktop photos in anticipation of some new version of software you're using. It isn't the same, some buttons have moved, the background is different, but it still does the same things. EMS 2.0 does the opposite. We intend to completely change the way the program works while leaving all your favorite features in place, keeping it comfortable ....


Find it Here!

Follow the discussion about "Firestorm" on the GenMed Podcast

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!

Have You Ever Wondered What You'd 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.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?

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?"

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


Carla's Blog

What Does This Mean???

Find out here ...

The UK HART Team - a New Concept in Interagency Cooperation

This appeared on my JEMS Connect Disaster EMS page. I thought it was interesting and worth sharing ...I'm sure Ian would appreciate some feedback.

My name is Ian (Dixon) and I am a Paramedic from one of the UK's new Hazardous Area Response Teams, known slightly confusingly known as HART teams! We are part of a National programme to provide paramedics in the'hot zone''. In the UK Fire, Police, and Ambulance services have traditionally been entirely distinct with no crossovers, but in the 21st century things have changed and new working relationships are developing. Since 2001 a movement has developed quickly to put operational ambulance staff inside the inner cordon/hot zone, from which we had previously been excluded, on the grounds that the casualties and the Fire and Police personnel deserved better medical backup. The HART programme was developing quickly but was not operational when the 2005 London bombings occurred. Shortly afterwards the prototype HART unit was established in London with an Urban Search and Rescue team set up in Yorkshire. In 2008 the Yorkshire Ambulance Service began recruiting for a full HART unit incorporating the very successful USAR team, and in 2009 we went live. The remit appears to be similar and yet distinct from other models of disaster relief. The UK has (will have very shortly) 12 HART teams spread throughout the country with similar set- ups in Scotland. Each team has 42 members consisting of 7 teams of 6 people. My unit is a mix of Paramedics and EMT's, all from the ambulance service, but with a broad range of previous experience including ex firefighters, Police , Military, civilian search and rescue etc. We are FULL TIME HART operatives being paid by the Dept. of Health at the National level but employed by the regional ambulance service. The extensive training covers extended duration BA to provide medical/rescue back up to our Firefighter colleagues, and CBRN training to provide the same for the public, Firefighters, Police, and the military. Amongst other training is HAZMED, civil disturbance, and of course the confined space and working at height elements or USAR. As a new resource to the UK resilience we are building more bridges between ourselves and our own frontline EMS colleagues; our Firefighter colleagues ; the Police and the military. Currently tasked only to the UK , most of my brothers and sisters look forward to the near future when we hope to be able to be available in Europe and beyond if required. The recent Italian earthquake was right on our doorstep, and unfortunately somewhere in the world is in the same position on a monthly basis.
We have sent people on training exercises in other jurisdictions most notably in Denmark, where work with all three services and foreign military including some from the USA was said to have been beneficial to all. It would be great to hear any feedback/experience or comments from the wider EMS community, and perhaps in particular from any contacts similarly tasked. Ps, happy Easter its cold and miserable here in Northern England.......

You Have to Watch: Chronicles of EMS, "A Seat at the Table" Episode 5

I was honored to have "A Seat at the Table" in Thaddeus Setla's new "Chronicles of EMS" video discussion series with Chronicles hosts, Justin Schorr (San Francisco) and Mark Glencorse (UK). As I represented the older generation, Natalie Quebodeaux (Louisiana) represented the new generation of EMSers. Chris Kaiser (Wisconsin) brings a different perspective from rural EMS. What we have in common is blogging, podcasting, social media, and a desire to make EMS a better place to be. Join us in this discussion of social media; the good, the bad and where this might take us in the future!

Find it here!