Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

2 killed in 100-foot fall from Ohio water tower

The men were painting the structure and fell after their scaffolding failed

Teacher tried to stop well-liked student shooter

She tried intercept gunman Jaylen Fryberg before he shot himself; he had recently been named a homecoming prince before the attack that killed one girl and critically injured four others

Calif. fire district uses crowdfunding for new ambulance

Officials hope the campaign launched on Indiegogo.com this week will raise $50,000 toward the cost of a new ambulance

Ebola-ready ambulances hit Texas streets

The interior has been completely covered in plastic and stripped of equipment

Ill. man, toddler hit by truck, killed

The blow knocked the man and his dog into a ditch and flung the 2-year-old down the roadside

Man chops off penis after breakup

He called medics after he couldn't stop the bleeding

2 dead, multiple hurt in Wash. school shooting

One person was killed in high school shooting in addition to the lone student gunman

Hero of the Week: EMT treats lightning-strike survivor in storm

Jessica Galvin made the life-saving call to treat him on the scene; she is the first woman to receive her community’s local EMT of the Year award

Ohio fire, EMS practice pet saving techniques

Responders say they have found people in emergencies worried more about their pets than their homes

UFC fighter cradles bleeding 94-year-old, calls 911

After falling and slashing her head, the injured grandmother crawled out to her driveway screaming for help
Top

EMS1 Topic Articles

2 killed in 100-foot fall from Ohio water tower

The men were painting the structure and fell after their scaffolding failed

Teacher tried to stop well-liked student shooter

She tried intercept gunman Jaylen Fryberg before he shot himself; he had recently been named a homecoming prince before the attack that killed one girl and critically injured four others

Calif. fire district uses crowdfunding for new ambulance

Officials hope the campaign launched on Indiegogo.com this week will raise $50,000 toward the cost of a new ambulance

Ebola-ready ambulances hit Texas streets

The interior has been completely covered in plastic and stripped of equipment

Ill. man, toddler hit by truck, killed

The blow knocked the man and his dog into a ditch and flung the 2-year-old down the roadside

Man chops off penis after breakup

He called medics after he couldn't stop the bleeding

2 dead, multiple hurt in Wash. school shooting

One person was killed in high school shooting in addition to the lone student gunman

Hero of the Week: EMT treats lightning-strike survivor in storm

Jessica Galvin made the life-saving call to treat him on the scene; she is the first woman to receive her community’s local EMT of the Year award

Ohio fire, EMS practice pet saving techniques

Responders say they have found people in emergencies worried more about their pets than their homes

UFC fighter cradles bleeding 94-year-old, calls 911

After falling and slashing her head, the injured grandmother crawled out to her driveway screaming for help
Top

EMS1 Columnist Articles

EMS, fire departments can do more to recruit women, minorities

Discrimination and bias continue to plague the public safety industry, especially in the fire and EMS service. Most departments report abysmally low percentages of women, blacks, Latinos and Asian populations in their ranks.

There are a myriad of cultural, academic and socioeconomic reasons why fire and EMS crews don’t represent the general community population. To be fair, the problem goes far beyond the departments themselves; I see this issue every day in my paramedic academy, with few minority and female students in the class.

Providing a few thousand dollars to help women enter the FDNY ranks is a good step, but a small step. Departments have to do more to encourage under-represented members of their communities to consider public safety as a career. Moreover, departments need to actively push for organizational changes within the station walls, creating a culture that welcomes this as a critical opportunity for overall growth and strength.

A public safety department that mirrors its community is reflective of policies that promote trust and engender support. Having greater insight into cultural norms and behaviors strengthens tolerance and understanding of the non-clinical and non-operational aspects of the job.

It’ll take a lot more commitment from department leadership and crews to triple the number of female firefighters, which would then make it a whopping 1 percent of the entire staff.

Do you think they could do it" Do you think they want to"

Public health sectors need teamwork to address Ebola concerns

By Anthony S. Mangeri
InPublicSafety.com

On October 8, Thomas Eric Duncan, the first person ever diagnosed with Ebola in the United States, died at Texas Health Presbyterian Hospital in Dallas where he was being treated. This first case of Ebola Virus Disease (EVD) being diagnosed in the U.S. reinforces the need for a comprehensive approach to community preparedness that includes public health, healthcare, and emergency management.

This case illustrates the need to reinforce and strengthen our approach. The hospital initially failed to identify Duncan as a potential Ebola victim, delaying the notice to public health authorities.

Upon confirmation of Ebola, the public health system’s emergency preparedness and response protocols went into effect. Public health agencies implemented long-exercised response strategies to mitigate the threat to the community by tracking down and quarantining (as necessary) the more than 100 people who may have come into contact with Duncan.

Read full story: Public Health Sectors Need Teamwork to Address Ebola Concerns

Current PPE not ready for Ebola threat

Ebola is potentially a much more deadly disease than some of the global epidemics we have faced before. Certainly, the hope is that our medical and response infrastructure will contain what should be a small number of exposures and resulting confirmed instances of the disease in our country.

Yet, the news coming out of the global health surveillance is that this situation is a possible disaster that could get worse before it gets better, requiring extreme vigilance and preparedness.

Emergency responders may be some of the more likely individuals to come in contact with infected persons. Responder PPE is a truly relevant topic as there are claims that individuals wearing PPE have become infected with Ebola.

We have all seen the news footage of individuals dressed in seemingly piecemeal ensembles of various garments, face wear, and gloves. These images portray a near encapsulation of medical aid workers and others in the affected West African nations.

Experts familiar with PPE rightfully question some of these outfits and raise inquiries about what constitutes appropriate PPE for these hazards.

Hot-button issue
Specific calls on this subject have consumed a good portion of our time in recent weeks. There is considerable misinformation, misrepresentation, and unfortunately, a certain level of opportunism coming to bear in the world of PPE for biological protection.

Surprisingly, the United States is not as prepared as it should be and the reasons for the circumstance are not very compelling. Back in the late 1980s, OSHA enacted the blood-borne pathogen regulations in 29 CFR part 1910.1030.

At that time, the overriding concern was that of HIV/AIDS, followed by increasing risks for transmission of various forms of Hepatitis. With regard to PPE, the regulations defined appropriate PPE as clothing and other items that kept blood and body fluids from contacting the wearer's skin or underclothing.

OSHA did not get any more specific in setting specific test or validation criteria for establishing minimum PPE performance. However, interpretations were made that the rules covered emergency responders within the population of health care workers, to which the standard was originally intended.

Test methods
In anticipation of the OSHA rule, two standards organizations developed a standard to fill the PPE definition void created by OSHA. The American Society for Testing and Materials, now ASTM International, developed emergency test methods for assessing the penetration of protective clothing fabrics by blood/body fluids and fluids containing viruses.

These methods respectively became ASTM F 1670 (synthetic blood penetration resistance) and ASTM F 1671 (viral penetration resistance). The tests established very specific conditions for evaluating clothing performance against biological hazards and were validated through research to show correspondence with field exposures.

Concurrently, the National Fire Protection Association created a standard for protective clothing worn during emergency medical operations. That standard, NFPA 1999 became a reality in 1992 and incorporated the ASTM F 1671 test method as a principal requirement for demonstrating protection against blood-borne pathogens.

It also set criteria that clothing seams meet the same criteria for barrier performance as the material and that the overall clothing and other items offer liquid integrity (prevention of inward leakage) as well as relevant levels of strength, durability and function.

Industry's response
While NFPA 1999 has been in existence for 22 years and has gone through repeated revisions, now in a 2013 edition, the PPE industry response has been irresponsibly lackluster.

Although there are now 18 manufacturers with 51 styles of single-use examination gloves that are certified to the standard, the other types of protective clothing addressed in NFPA 1999 are poorly represented. Other than examination gloves, there are several gear manufacturers that make reusable protective garments that have been certified to the standard. And some manufacturers offer some types of footwear for EMS applications, although usually for other purposes that have been dual certified with NFPA 1999.

There are no manufacturers that have certified other products to NFPA 1999 that are frequently used for protecting first responders against liquid-borne biological hazards, including the PPE categories of single-use protective garments, cleaning gloves, various forms of eye and face protection, and different footwear options such as full footwear and footwear covers.

Some of these manufacturers claim that the demand has not supported efforts to undertake certification. And so, the marketplace has plodded on with some forms of protective clothing that have not been properly qualified.

A different threat
Certainly, there have been decreasing concerns about HIV and Hepatitis owing to various infection-control practices that may have lessened the perceived need. And, our most recent epidemic concerns have involved air-borne pathogens, not liquid-borne pathogens that are the subject of NFPA 1999.

Yet, the case of Ebola is much different and now the nation is scrambling for the right PPE.

So what is the right PPE" After all, there are several companies positioning products and even selling kits specifically claiming their appropriateness for protecting against Ebola.

If you believe what some manufacturers have written, impervious clothing is the right choice. It would seem to make sense and so a lot of the clothing being sold is actually chemical protective clothing converted to a new purpose.

Yet that clothing may not be constructed with sealed seams, have a design that offers poor interfaces and be difficult to doff, which in itself creates a contamination hazard.

At the other extreme, there are materials being touted for Ebola that are generally particular barriers offering no holdout of liquids under any sort of normally applied pressure. Then there are the myriad of facemasks, gloves, and other paraphernalia that are needed to make up an ensemble.

What to buy
We would suggest that departments specify products compliant with NFPA 1999, but that request simply cannot be fulfilled with available product. Short of that, we recommend that organizations procure clothing constructed of materials and sealed seams that pass ASTM F 1670.

Breathability is a huge plus and will result in gear that is more comfortable and likely to be worn properly, but the range of products meeting both characteristics is limited. The clothing should have integrity, meaning flaps that cover zippers, and the ability to create interfaces with gloves, footwear and face wear. A hooded coverall is preferred.

There are several styles of NFPA 1999 compliant examination gloves available — these should be doubled up. If physical hazards are expected, select thicker (greater than 11 mm) unsupported nitrile or neoprene gloves.

The interface of the gloves with the garment is going to be a problem — gloves tucked inside the sleeve or outside the sleeve are inadequate. Unless the garments provide some mechanism for creating this interface, it is near impossible to use some form of tape.

Face, hood, feet
For face wear, most medical facemasks are not going to cut it. A full facemask with a P100 filter is best, though many organizations recommend the lesser N95. Short of that, goggles combined with a half facemask respirator and full face shield providing complete coverage of the eyes and face is the next best option.

The hood interface can be a problem and tape may be the only remedy for this deficiency. Unless, you are willing to sacrifice expensive footwear, footwear covers that also have sealed seams and adequate wear surface, so that bottom does not abrade through the first several yards on asphalt. And there must be some way to secure these to the bottom of the protective garment.

There are other options, which may or may not be available. Hopefully, portions of the unresponsive PPE industry will be shamed into developing appropriate NFPA 1999 compliant products and other choices as soon as possible. Yet, as domestic stockpiles of even inadequate clothing may be depleted quickly, organizations must still attempt to put some form of protection in place.

By the way, while there are many demonstrated methods for decontamination involving serious pathogens, the reuse of knowingly contaminated gear even if washed and sterilized, invites a great deal of uncertainty. Consequently, we recommend isolating and condemning gear unless some definitive determination can be made.

Inside EMS Podcast: Does EMS need cameras in ambulances?

Download this quick clip on iTunes, SoundCloud or via RSS feed

In this week’s Inside EMS Podcast, hosts Chris Cebollero and Kelly Grayson discuss a medic accused of fondling a woman in the back of an ambulance, and how EMS can both defend itself against these types allegations and make them less likely to happen.

“I can’t help but think cameras in the back of the rig might be the nuclear response to this sort of thing,” Grayson said.

Cebollero says it sounds like it’s being introduced as a form of punishment, but contends there’s nothing wrong with that thought.

“Is there really a negative"” he asked. “I think it could be very helpful.”

Grayson said he would like to think EMS doesn’t need “the all seeing eye of Big Brother,” but Cebollero suggests it makes sense to put ambulances in the back of the ambulance, and then even use that technology to send patient information to the ER.

“On the face of it, it sounds like a great idea,” Grayson said. “I just also think it’s ripe for abuse and unforeseen consequences that we may not grasp as of yet.”

They also debate whether more EMS providers are becoming involved in misconduct destroy the public’s trust. Grayson stands by his position that it’s not more prevalent than it has been in the past, it just appears more in the news. But he acknowledges that “perception is reality.”

“What’s it going to take to clean up our image"” Grayson asks.

They also talk about response time problems in San Francisco, and relate it to a story a Md. department that improved response times by 27 percent by adding more BLS ambulances and cutting back on dispatch protocol questions before assigning a unit.

“Hold on to your hats San Francisco,” Cebollero said. “They did it by adding more ambulances to the fleet. Image that. It’s like witchcraft.”

In the clinical issue, they debate the idea of putting more BLS providers on the street in order to move ALS providers to more of a community role, running ALS interception if it’s needed.

Cebollero brought up the problem that advanced-level providers are often not available for calls where their needed, such as cardiac and respiratory calls, or to do 12-lead interpretations.

“You know why we’re not having them there" Because they’re too busy running calls that do not require their unique knowledge and skill set,” Grayson said. “We need more BLS providers, and let the ALS providers do ALS things.”

Guest Tom Bothillet also joins the show to talk about the importance of ECG knowledge and 12-lead interpretations. He discusses some common mistakes, and provides resources to improve our education.

Here are links to some of the articles and other items mentioned on the show:

How EMS can practice CDC guidelines for Ebola patients

The CDC published recommendations for how EMS providers should manage Ebola, as three cases have now been reported in the U.S.

The news has panicked some local areas. Parents are pulling their children out of schools, attending town hall meetings, and communicating their fears to their local congressmen

As EMS providers, there is the strong possibility that we will have to care for a patient with Ebola, or another communicable disease.

In this video, I review the CDC guidelines, which provide a brief overview of Ebola, the symptoms, and how it is transmitted. I also present the agency’s recommendations of performing a patient assessment, infection control, the proper use of PPE, cleaning EMS transport vehicles, and follow up/reporting measures.

We have all been taught in school how to perform all of these procedures, but how often is it correctly performed" I highly advise you to practice these procedures for all of your patients, because we never know when we will transport that “one.”

How to deliver the perfect EMS apology

Here is a secret about being an EMS leader: We make mistakes.

Not many people know or acknowledge this, but it's real and something you will encounter in your leadership career. And because we make mistakes, there may be the need to apologize for your actions.

I recently found myself in the situation where my emotions got the better of me, and I found myself in the position of having to say I’m sorry. The perfect apology in a business setting can be a bit more involved than what's required in your personal life, where friends and family usually forgive us for transgressions.

In business, colleagues and peers can chose to hold a grudge, thus affecting your professional abilities and effectiveness. With this in mind, delivering the perfect business apology can be slightly more complex.

Yet whether it's written or verbal, there are five basic components of a good apology.

  • A sincere apology opens the doors to communication with you and the other person.
  • It displays your willingness to admit to your mistakes.
  • It helps restore dignity to the person hurt or insulted.
  • It displays your remorse for your actions.
  • It shows you acknowledge your actions had a negative impact on the other person.

The perfect apology in four steps

1. Convey remorse

This first step is the most important because it shows that your words are honest, sincere and authentic. In addition to starting with "I'm sorry," or "Please forgive me," you should also add the reason for the apology, as in, "I'm sorry for reacting the way I did, and I feel embarrassed for acting unprofessionally."

You should also convey an apology as soon as you realize you wronged someone. Being real is the key here; if you have an ulterior motive it may be transparent and minimize your apology's effectiveness.

2: Take responsibility

During your apology, you may be tempted to explain your actions away. Even though you think it may be helpful, making excuses can actually weaken your apology. Don't pass the blame onto someone or something else.

Instead, you need to empathize with the person and demonstrate that you realize your mistake and regret the action. Try not to make assumptions about how they felt, but putting yourself in their shoes and picturing how you would have felt in the same situation can help deliver a strong message.

3. Make amends

Making amends means taking the necessary actions to make the situation right again. A simple statement like, "If there is anything I can do to make up for this incident, please ask," goes a long way.

You also need to be prepared to follow through, and not just make your statement an empty promise.

4. Promise it won't happen again

This is a vital step because you need to reassure the person you will change your behavior, and begin rebuilding trust in your ability to fixing the relationship. With that said, once you promise to change the behavior, if you don't follow through you will do irreversible damage to your reputation and your trustworthiness.

Once you have apologized, you should also not expect instant forgiveness. It may take folks different lengths of time to process the information and feel comfortable enough to forgive you.

The person you are apologizing to may even become angry and give you an earful in return. You should allow him to vent, and at the end of the rant give a final apology.

In your daily responsibilities as an EMS leader, we deal with tons of different situations that may lead to the need for an apology. On a final note, if your behavior could result in legal action or possible liability against you or your organization, delay your apology and seek the advice of your legal council.

Why EMS leaders should embrace healthy conflict

By Steve Knight, Ph.D.

In EMS and the fire service, teamwork is the essence of much of our successes. Whether deployed on firefighting apparatus with multiple personnel or a single EMS unit with two personnel, nearly all work is accomplished through the deployment of teams.

However, there are times when our team's social and cultural norming processes may serve to diminish innovation and cause us to resist change — and that can happen when we avoid conflict.

Conflict can be defined as disagreement, opposition, and variance. For many of us, our natural tendency is to avoid conflict, especially in the workplace. But since conflict is a natural occurrence in relationships, our efforts to eliminate conflict come at the cost of candor, honesty — and accountability.

Artificial harmony

If not careful, our desire for harmony can be more appropriately identified as a lack of trust in a team where dissenting voices can be heard without reprisal. If you want to test whether your team has a trust problem, observe the degree of consensus in a formal meeting, and then compare that to the informal meetings afterward at the water cooler, at lunch or behind closed doors.

Management guru Patrick Lencioni identifies this phenomenon as artificial harmony. Over time, low candor and conflict-avoidance behaviors will result in team mediocrity.

In emergency services, accountability is most often formally viewed as a function of discipline; that is, whether or not the team members are following a bureaucratic set of policies and procedures. One of the first and most glaring problems with this approach is that few policies and procedures have any correlation to team performance of the mission.

Informally, accountability is more rightly viewed as discipline for the team members for any actions or beliefs outside of the group culture, such as shunning, distancing, or marginalizing the member that is outside of the cultural norm.

However, in most instances, and I believe the EMS mission handles this better than the fire mission, accountability has little to do with performance of the mission. In a low-accountability environment, mediocrity will reign and eventually employees will begin to serve themselves, rather than the team or the mission, because they perceive their performance as having little value.

Why conflict is healthy

A certain degree of conflict is necessary for the health, success, and continued pursuit of excellence in an organization. Hefitz and Linksy identify it as disequilibrium. Jack Welch calls it candor. John Kotter refers to it a sense of urgency.

This healthy conflict is good for teams and organizations because it challenges the status quo, forces the teams to consider different points of view, and ultimately results in a high accountability environment.

Leaders must ensure that a team environment is created where all members are provided an opportunity to share their thoughts and beliefs in a safe and respected environment. Leaders must learn how to allow the conflict to rise and create some disharmony in the group, but know when to move toward resolution.

Far too often, our "fix it" team mentality does not tolerate conflict so we address it immediately rather than letting the process work itself out. At times, leaders must be the ones to generate some conflict if it is needed to get dissenting opinions — and to show that there is no payback for not always agreeing with the boss.

Of course, ground rules must be established for what healthy conflict looks like, and respect and professionalism must be upheld. Healthy conflict furthers the depth and breadth of innovation and change, but ultimately, a decision must be made.

Consensus in the decision is not the ultimate goal of the process (other than those rare occasions where everyone truly agrees). Paramount to success and accountability is the understanding and belief that the team's ultimate decision is a result of open, honest and candid dialogue.

About the author:

Dr. Steve Knight, a Fitch & Associates consultant, brings more than 25 years of fire and EMS experience to the firm. He served for nearly 17 years as assistant fire chief for the City of St. Petersburg, Fla. He has been a subject matter expert for both the National Fire Academy and the Center for Public Safety Excellence (CPSE), a nonprofit corporation that serves as the governing body for the organizations that offer accreditation, education, and credentialing services to the first responder and fire service industries.

Knight has also served as team leader and assessor for the Commission on Fire Accreditation International and has held multiple faculty appointments in Fire Science and EMS. Prior to coming to Fitch, he served as senior manager of a consulting team within the Center for Public Safety Management.

How an ambulance crash defined an EMS agency’s care

When the leadership team of Minnesota-based Allina Health EMS was awakened in the early-morning hours of Jan. 18, with the news that one of their ambulances had been involved in a devastating head-on collision they knew how they would respond.

Their actions were guided by a deep understanding of what matters to them, a desire to show how they cared in a big way, and a determination to stay ahead of storytelling about the event.

Just after 1 a.m. the ambulance was transporting without lights and siren a stable medical patient on a rural, two-lane highway when it collided head-on with an SUV. The impact ripped apart the SUV and destroyed the ambulance.

The lone occupant of the SUV suffered multiple traumatic injuries. The attending paramedic was unresponsive with a severe head injury. The lower extremities of the EMT driving were crushed.

The only uninjured person — the medical patient on the stretcher — placed a desperate call for help with the injured paramedic's cell phone.

Other ambulances quickly responded. By the time the leadership team learned of the event, the driver of the SUV and ambulance crew were on their way to area hospitals.

'We'll show you how much we care'

Allina Health EMS is the medical transportation arm of a $3.4 billion not-for-profit hospital and clinical corporation headquartered in the Twin Cities. Allina's EMS operations serve more than 100 communities throughout Minnesota, with 570 employees responding to more than 90,000 calls per year.

Regional Director of Operations Kevin Miller received the initial call and immediately headed for the hospitals where the critical patients had been transported. On the way he contacted other team members.

Their top priorities were:

  • Ensuring the injured were getting the best possible care and support.
  • Notifying and informing families.
  • Assuring the rest of the Allina staff were informed and enlisted to help as needed. Allina EMS President Brian LaCroix was in Arizona at the National Association of EMS Physicians’ conference and immediately prepared to return to Minnesota.

Miller started notifying families of the injured and convened a leadership team conference call to make certain that Allina's response was coordinated, honest, transparent, generous, and reflected how much the organization truly cares about its employees and its patients.

Five months earlier, during a two-day leadership retreat, the Allina EMS team had wrestled with what distinguishes their organization and them as leaders. In sorting through the usual litany of lofty corporate values, they had recognized that a deep sense of caring was really at the soul of their organization.

They noticed that the highest levels of inspiration, motivation, and satisfaction came when field staff and leaders had opportunity to demonstrate caring.

Their discussion at the retreat led them to talk about the myriad of uncontrollable factors in emergency medical work, including the nature of the call, the severity of a patient's clinical presentation, the location of a patient, the socio-economics and politics of health care, and the challenges facing their large hospital-oriented parent company.

The discussion also touched on how much Allina could control, such as how they treated employees, patients, families and communities. They wanted all their relationships to be characterized by an overt demonstration of caring.

Toward the end of the retreat, Twin Cities Operations Director Jeff Czyson summarized what mattered in a single declarative phrase, "We'll show you how much we care." The phrase stuck and as the retreat concluded, the team committed to living out that declaration in the coming year.

Whatever it takes

In the immediate aftermath of the crash, Allina's leadership team had ample opportunity to demonstrate caring in a big way. They ensured the injured were supported, providing practical support to families in terms of companionship, medical information, accident information, emotional support, transportation, food, lodging and simple errand-running.

"We decided to do whatever it took," LaCroix said. "We didn't know the details about what had caused the accident and that wasn't our first concern. We wanted everyone to know we were there to help. Cost wasn't a primary concern."

The team offered support and full information to the family of the SUV driver who was in critical condition and later died. The family of paramedic Brian Nagel, also in critical condition, needed to travel from another part of the country. Czyson, Miller and other Allina staff stayed with Nagel until family arrived.

In addition, Allina provided a uniformed EMS provider to stay at the hospital for as long as was needed to be available to support and assist the family in any way. Allina helped Nagel's family publicize a Caringbridge website that brought thousands of wishes of support and prayer from around the world.

EMT Tim Daly's lower extremity injuries were severe and would confine him to a wheelchair for months. In addition to supporting Daly and family during his hospital stay, Allina employees immediately began helping Daly's family prepare his home for a wheelchair. Ordinary tasks like transportation, medical equipment, meals and encouragement became an organization-wide project.

News of the crash was quickly reported by local media, but not before the leadership team helped to guide the story to be about the injured and their need for support.

Contrary to the common corporate practice of saying little about an event until all the facts are known and public relations and legal departments have been consulted, LaCroix took a risk and within hours of the accident began providing information about the event to his entire staff through public Facebook postings.

The initial posting spoke frankly about the crash. Nagel was unconscious and in intensive care and his prognosis uncertain. Nagel's family wanted people to know what was going on, that Nagel was in need of support and prayer, and they wanted LaCroix to get the word out.

Rather than wait for the usual corporate news release, he moved quickly and communicated from the heart through Facebook. When local media picked up the story, they quoted from LaCroix’s posts. The quotes helped focus the story on the care and support of those who were suffering, which Allina has continued throughout the year.

Neither of the crew members have returned to full duty. After five days in a coma Nagel woke up, and has continued to make progress in recovering from a severe TBI. Daly has had several surgeries and is regaining use of his legs and feet.

"This has been a team effort," LaCroix said "Everyone in our organization has stepped up. It's been amazing to see how much people really care."

What are some misconceptions TV has taught you about EMS?

Emergency! Chicago Fire. Sirens. Bringing out the Dead.

These are just a handful of the EMS shows and flicks we’ve all fallen prey to watching. While entertaining, they also have their teaching-moment downfalls.

We asked our fans on Facebook to share some inaccuracies they’ve seen while watching a TV show or movie about EMTs and paramedics. Here are some of their responses.

Have something else to add" Post it in the comment section.

"Disregard scene safety, just run in!" — Ana Silva

"Traffic always gives emergency vehicles the right of way." — Michelle Battey

"Screw c-spine. Just get that guy in the truck!" — Kory Smith

"Yelling 'C'mon!' or 'Stay with me!' always brings the patient back to life.' — Georgie Pirie

"All EMS workers are thing and neat." — Amanda Barber

"CPR is only performed for a few seconds before you dramatically say, 'We lost em.'" — Jessica Byrd

"That doctors wait outside the hospital in the rain for the ambulance to arrive, and help move the patient from the ambulance stretcher to the hospital stretcher." — Kathy Merchant-Kliwinski

"The great pay. Everyone lives in a beautiful home and never stresses over which bills to pay." — Michael Reigner

"That you can shock asystole and bring someone back." — Chelsea Taylor

"We get to sit down and eat meals like normal people. We never get splattered with blood, puke, urine or feces." — Bob McGee

Blauer's new boots are put to the test

I’ll be honest; I’m a boot snob.

I recently received a pair of Blauer's new Clash Boots to evaluate. I really did not think fancy lacing and rugged lightweight comfort could sway me from my go-to brand, but boy was I wrong.

My current boots have a fairly loose, flat heel. The first few minutes in the Clash brought immediately improved heel control and balance. By also being a little more on the balls of my feet, I discovered it was easier to keep my footing and maintain forward-momentum hiking.

This became glaringly obvious when I went off-road in them. On a breaking shale hillside, I always felt in control. It was also noticeable coming down steep hills when the improved posture kept me more upright on a tight descent. They even have fence-climbing grooves in the toe.

Build

The construction materials are also exceptional. Full-grain leather provides real strength and protection, while the nylon panels offer ventilation.

The end result is a rugged, protective boot that is surprisingly light. An oil and slip-resistant rubber sole, with hybrid traction tread pattern, give you grip on and off the pavement in rain, snow or shine.

Blauer’s waterproof membrane enhances waterproof leather, suede and nylon materials, blocking water from coming in, while still letting perspiration out.

I went outside after a summer pop-up rain shower and stood in a puddle about 1 to 1.5 inches deep to test the waterproofing around the main seams. As I was standing there waiting for telltale signs of moisture, my wife walked out onto the porch.

“What are you doing standing in a puddle"” she asked.

“I’m testing a pair of boots, honey,” I replied. Without hesitation, the retort: “Well, you look pretty stupid.” I suffered this embarrassment without one drop of water entering the boots.

Comfort

I really like the extra cushioning in the sole, particularly in the heel area. It’s very shock absorbent, and is radiused to enhance driving comfort on a long shift.

I spent my first day in the Clash almost exclusively on my feet. The firm lacing system and bouncy heel led me to try a few low test PLF’s off a wall. These boots are amazing jumpers. They would be great for a paratrooper or in a pararescue situation.

The flexible compression-molded EVA midsole and PU foam heel cushion also helped provide long-lasting impact absorption. The antibacterial and moisture-wicking lining kept them comfortable and dry.

I was also surprised that absolutely no break-in period was required. I had brought a back-up pair in case the break-in got rough, but I never needed them. The Clash was comfortable from the start to finish of a very long day.

Easy on, easy off

The BOA lacing system is astonishing, and my favorite feature of the boot.

For those that have not seen it yet, it combines the speed of a zipper with the support of a lace. It’s quickly becoming popular in sports footwear, and ski boot companies even use it.

BOA provides you a quick in-and-out of the boot, and is engineered for comfort and performance. The system has a braided stainless steel cable for long-lasting durability.

I quickly grew to love the BOA system. Twist and pull, and off the boots come. A quick twist or two, and you are tightly laced for maximum ankle support.

The other thing I like it the flexibility where you need it. The lacing gaps are strategically placed so that some flexibility, like foot extension, is useful. I just can’t get over how cleverly this boot combines rigid ankle and forefoot support with a surprising range of motion.

Blauer makes the Clash in a variety of styles. They have both 6- and 8-inch-tall versions and waterproof, non-waterproof and insulated models. Whether you work in the desert or the mountains, you can find a model suited to your specifics needs. Prices range from about $130 to $170.

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EMS1 Tips

7 ways to best use, or avoid, capnography in the field

EMS1 readers shared their suggestions on how to get the most out of the method

Active shooter response: Are you physically ready?

Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active shooter incident is going to require repetitive bursts of significant physical activity.

Energy-saving tips for your station

Earth Day 2012 takes place this Sunday, with events planned held worldwide to increase awareness and appreciation of the Earth's natural environment. So, it's a good time to see what you can do at your agency to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT Basic or Refresher Class.

CPR class instruction: 5 ways to make it great

My most recent healthcare provider recertification was memorable for all of the things the instructors did well.

Patient assessments: How to avoid free-for-alls

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

Patient assessment: A non-linear process

On a skill sheet, patient assessment is presented as a linear process: First size up the scene, then complete the primary assessment followed by the secondary assessment.

Blood pressure reading tips and tricks for EMS

One of the things I'm most often asked by students and rookie EMTs is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"

How to use Slideshare for EMS

Slideshare is an online community and tool for sharing presentations.

How to get optimal battery life from your devices

The batteries in your wireless cell phone, tablet or laptop are probably not the same old Duracells you used in your childhood walky-talkies.
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