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

star emblem

news

rss imageEMS1.com RSS Feeds

EMS1 Daily News

1 killed, 26 injured in Calif. tour bus crash

Video footage at the scene posted online shows debris strewn all over the side of the highway as firefighters worked to remove the victims from the cars

Building a strong EMS team: Overcoming conflicts

When team members do not mesh well, it can add stress to an already stressful environment

Photo roundup: EMS Today 2017

Did you attend this year's conference? Add your photos in the comments

Mich. firefighters honor fallen brother at stair climb

Volunteer firefighter-EMT Ron Savage, 63, suffered a cardiac event while training Saturday

LODD: Mich. firefighter-EMT dies during training exercise

Ron Savage, 63, was well-known throughout his community as a firefighter-EMT and news anchor and reporter

Listen: EMS1’s columnists share passion, origins of joining EMS

Inside EMS Podcast co-hosts Chris Cebollero and Kelly Grayson each sat down with the Medic2Medic podcast

Man tries to steal ambulance with patient, crew inside

Crews said they were treating a patient in the back of an ambulance when the man jumped into the driver’s seat

Va. EMS to use mobile ultrasound to better treat patients

EMS providers will be able to email photos or videos to hospital officials before arriving

Paramedics find, revive patient’s turtle after crash

After arriving at the hospital, the youngest patient told crews he lost his pet turtle in the crash

EMS provider cited after ambulance crash

The ambulance was not responding to an emergency call when the crash occurred and there were no patients on board at the time
Top

EMS1 Topic Articles

1 killed, 26 injured in Calif. tour bus crash

Video footage at the scene posted online shows debris strewn all over the side of the highway as firefighters worked to remove the victims from the cars

Building a strong EMS team: Overcoming conflicts

When team members do not mesh well, it can add stress to an already stressful environment

Photo roundup: EMS Today 2017

Did you attend this year's conference? Add your photos in the comments

Mich. firefighters honor fallen brother at stair climb

Volunteer firefighter-EMT Ron Savage, 63, suffered a cardiac event while training Saturday

LODD: Mich. firefighter-EMT dies during training exercise

Ron Savage, 63, was well-known throughout his community as a firefighter-EMT and news anchor and reporter

Listen: EMS1’s columnists share passion, origins of joining EMS

Inside EMS Podcast co-hosts Chris Cebollero and Kelly Grayson each sat down with the Medic2Medic podcast

Man tries to steal ambulance with patient, crew inside

Crews said they were treating a patient in the back of an ambulance when the man jumped into the driver’s seat

Va. EMS to use mobile ultrasound to better treat patients

EMS providers will be able to email photos or videos to hospital officials before arriving

Paramedics find, revive patient’s turtle after crash

After arriving at the hospital, the youngest patient told crews he lost his pet turtle in the crash

EMS provider cited after ambulance crash

The ambulance was not responding to an emergency call when the crash occurred and there were no patients on board at the time
Top

EMS1 Columnist Articles

Building a strong EMS team: Overcoming conflicts

By Allison G. S. Knox, American Military University

Working in emergency medical services can be extremely stressful for responders. To provide the best service to patients under such conditions, it’s critical that EMS teams be comprised of a group of trusted people.

However, building a strong team is easier said than done. When team members do not mesh well, it can add stress to an already stressful environment. It is important for those in EMS to know how they fit into the team environment and contribute to the overall team effort. Individuals must also know how to effectively diffuse and overcome any challenges that may arise within the team.

Some scholars argue that individuals come together with the “forming, norming, storming, performing” framework. According to researcher Judith Stein, under this framework, people essentially need to figure each other out and work out their differences. After doing so, they are much better able to effectively perform as a team.

DISCUSS ISSUES OPENLY

In all teams, it is inevitable that there will be conflicts among members, which can make it difficult to work together. When this situation arises, it is important for team members to talk out their differences directly. It does not help the situation or the team performance to turn the situation into gossip. When team members discuss their differences openly, they are often able to come to a resolution.

TURN TO MEDITATION

There may be times when team members cannot work out their differences. When this happens, mediation can often be an effective solution. In EMS, it is important to discuss these issues with the chief or another person in a managerial position. The goal is not to get someone into trouble but rather to come to a mutual understanding and compromise over the issue at hand.

Especially in EMS, it is important to have strong and collaborative teams. Ultimately, each team member is responsible for his or her role in the team and must figure out how to work together and to iron out differences before it becomes an issue. Speaking to each other about these issues in a civilized fashion is ideal, but mediation may be needed if initial discussions are not constructive.

How community paramedics use of point-of-care devices

SALT LAKE CITY — Point-of-care testing is a tool for community paramedic patient assessments in the out-of-hospital setting that is convenient for the patient and providers, easy to use, leads to a more prompt field diagnosis and results in more timely treatment. Desiree Partain, clinical program manager with MedStar Mobile Health, introduced how community paramedics are using handheld, portable blood analyzers in a presentation at EMS Today.

Partain discussed the benefits and drawbacks to consider, as well as the regulatory hurdles, involved in implementing point-of-care testing. Much of the presentation was based on the lessons Partain and MedStar has learned through implementing its point-of-care testing program

Memorable quotes on point-of-care testing by community paramedics

Partain repeatedly emphasized the importance of first defining the department's goals for a community paramedicine program. The program goals, along with the target patient population, should drive the decision to purchase a handheld blood analyzer. Here are three memorable quotes from Partain's presentation.

"The important thing is identifying the needs of your specific (community paramedic) program. Truly define what is important to your agency. What patient populations are you going to be treating""

"Get the right equipment to meet the needs of your program and the patients you are trying to serve."

"If we are giving paramedics point-of-care devices, we need to give them information on how to use the data."

Top takeaways of point-of-care testing

Partain's presentation was a helpful introduction to point-of-care testing and how it has been implemented by MedStar mobile integrated health care personnel. Here are the top three takeaways:

1. Benefits of point-of-care testing

The benefits of point-of-care testing include speed, portability, convenience, connectivity and quality assurance. A portable blood analyzer allows community paramedics to provide more information to physicians than they could do with vital signs and a physical exam.

2. Understand regularity requirements

EMS clinical managers need to review and understand the Clinical Laboratory Improvement Amendment (CLIA) waiver requirements. A CLIA waiver is most likely to be granted when there is low risk for incorrect results, such as blood glucose testing or a CHEM 8 which is chemistry, electrolytes, hematology and blood glasses.

3. Treatment goals come first

Partain described a post-discharge heart failure patient and how a field diagnosis with point-of-care testing led to earlier intervention for the patient. The treatment, provided in the patient's home, was quicker and more convenient for the patient than transport and treatment at the hospital.

A point-of-care testing program needs to driven by goals for specific patient populations. The testing needs to be articulated in specific patient protocols, such as a heart failure protocol. The MedStar protocol directs both the use of an iSTAT device and what to do with the data the iSTAT returns.

Learn more about point-of-care testing

Partain discussed the importance of initial and ongoing education. Here are several articles about prehospital conditions which might benefit from handheld, blood analyzer data.

Rapid response: Spotting senior abuse on EMS runs

What we know: This week CNN released a jarring investigative report on rape and sexual abuse taking place in nursing homes and assisted living facilities. CNN cites Administration for Community Living, a branch of the U.S. Health and Human Services Department, statistics that there have been more than 16,000 reported cases of sexual abuse in these facilities since 2000.

It’s reasonable to believe there are many more cases that went unreported.

The attacks on patients are most often carried out by someone on the facility’s staff. Many attacks went unpunished or lightly punished. In at least one case, a facility executive was accused of covering up sexual attacks.

Why it matters: The Centers for Disease Control and Prevention says that in 2014 there are 15,600 nursing homes in the United States. The 16,000 reported attacks doesn’t mean each facility has had one, but the number is big enough that such attacks could happen anywhere.

According to a NASEMSO study, there were nearly 37 million calls for EMS service in 2009; of those, 28 million resulted in transport.

I found no hard data on what percentage of our annual runs are made to these sites. But those with nursing homes and assisted-living facilities in their jurisdictions know that they account for many of their EMS runs.

We know from our own dark history that sexual predators will disguise themselves as caregivers. EMS is often the first outsider to encounter a long-term care patient.

The CNN report highlights the importance of knowing what to look for and what to do if things don’t look right. And frankly, there are more questions than answers at this point.

Two big questions

1. What to look for"

The CNN report showed that this type of sexual assault often goes unreported and is only later discovered. That discovery may come when the person is seen for something like difficulty breathing.

If there’s little or no family contact, firefighters may be the first trustworthy person these patients see from the world outside their facility. Patients may describe the attack to medics in the safety of an ambulance or medics may observe injuries not related to the nature of that particular call.

Either way, departments that run EMS with one or more long-term care sites will need to think through how to teach medics what signs of abuse to look for on these calls.

2. What to do"

There’s an abundance of protocol information for law enforcement on how to handle sexual abuse cases. That’s not true for fire-based EMS.

Fire departments will need to develop procedures to communicate this information to police and emergency department doctors — especially if police do not routinely respond to medical emergencies at these sites.

Firefighters and medics will also need to learn what to say to patients who confide in them that they are abuse victims. This takes skill and can be made harder when that patient’s physical and mental capacities are diminished, as with dementia patients.

They’ll also need to teach responders the proper way to preserve evidence and document the call when abuse is suspected. In one case CNN reported, a victim saved her abuser’s semen in her bra, but was unable to hand that over until three weeks following the attack.

Further reading

White Shirts: Uniform care 101

Answering the call: A paramedic's 10 days at Standing Rock

I spent 10 days on the Standing Rock Indian Reservation, North Dakota, in late December 2016 caring for the people drawing attention to the construction of the the Dakota Access Pipeline. The challenge of providing medical assistance in a remote location with severe weather conditions was well-suited to my life experiences and skills as a paramedic. But my decision to participate in this medical mission was confusing to some friends and family and also controversial to others.

I went to the Standing Rock Indian Reservation after a lot of research and discussion with friends and family. I grew up in a small town in Alaska where I did not have running water for the first few years of my life. I worked at fire and EMS agencies with transport times of one to two hours or more. I also worked for the Alaska Interagency Wildland Fire Medic Program, which provided medical services on wildland fires, and I worked as a medic in the oil fields on the North Slope.

Living and working with limited modern resources and in extreme environments are not new experiences for me. Had I not had the experiences that I did I likely would not have gone to Standing Rock. Part of the reason I felt compelled to go is because I knew I had the experience and skills to tolerate the environment and treat the types of medical complaints that were likely to be common.

The Dakota Access Pipeline is a oil pipeline that is being constructed to transport crude oil from the Bakken fields in western North Dakota to refineries in southern Illinois. It travels along an existing pipeline route that would take it under Lake Oahe, near the current borders of the Standing Rock Indian Reservation. The Standing Rock Sioux Tribe has objected to the construction of the pipeline on the grounds of treaty violations, the presence of sacred sites and the potential for irreparable environmental damage. In April 2016, a member of the Standing Rock tribe set up a camp on the edge of the reservation closest to the pipeline’s planned route. People flocked to the camp to show solidarity with the Standing Rock tribe, and additional camps have been constructed in the area.

Legality of providing paramedic care

The legality of providing medical care in the camps was an issue that was raised multiple times when discussing the trip with friends. Because Native American reservations are considered sovereign nations, the tribal government is allowed to set their own rules for EMS licensure. Having a state license is not required unless the tribe chooses to require it. Part of the vetting process included submitting copies of my identification and national registry certification. I was also warned to make sure I brought a photo ID and my national registry card with me so that my identity could be verified once I arrived in camp.

I also made arrangements with my parents to bail me out of jail in the event that I was arrested. While I did not anticipate being arrested for being a caregiver, I wanted to make sure my bases were covered.

Volunteering for the Medic Healer Council

I’m a full-time college student and I knew that with the poor internet service in the camps I would not be able to go until winter break from classes, which would put me in camp over Christmas. I was OK with that since there would likely be people who would want to head home at least temporarily and so it would be a good time for me to provide reinforcement.

I submitted a volunteer application with the Standing Rock Medic Healer Council and was contacted by a volunteer coordinator who interviewed me and provided me with information about some of the cultural guidelines I would be expected to follow. I was asked to learn and follow the Seven Lakota Values of:

  1. Prayer
  2. Respect
  3. Compassion
  4. Honesty
  5. Generosity
  6. Humility
  7. Wisdom

I spoke with several people who had been in the camps, including other medical providers, about what to expect. I drew upon my Alaska work experience to know what to pack and also consulted with some of my more outdoorsy friends. Here is a list of the supplies I brought with me.

My idea was to plan for the worst case scenarios for traveling to Standing Rock and staying in camp. Even knowing that many supplies have been donated to the camps, I did not want to assume any items would be available for me to use.

I borrowed much of the equipment I took with me, which helped keep my costs down and allowed me to avoid buying gear that I would likely never use again since winter camping is not exactly something I planned on making a habit of. My packing list was nearly perfect. I used or gave away about 95 percent of the things I brought with me, while also not discovering anything I needed but didn’t bring.

Getting to Standing Rock

From my house to the camps is almost exactly 1,000 miles. I planned for two days to drive to North Dakota and three days to drive home. I planned for an extra day on the way home just in case I ran into bad weather I would have extra time to get back before I had to be in class and at work. My departure from Washington was delayed due to bad weather in Montana that closed the interstate, but once I got on the road the drive was fine and I arrived in North Dakota on Dec. 20, 2016. I spent the night in Bismarck before heading to camp the next morning, which was the first of my 10 days at Standing Rock.

Arriving in camp

I checked into camp on the morning of Dec. 21, 2016 and attended an orientation to camp life that covered everything from how to use the composting toilets to how to dress appropriately when attending a sweat lodge. After orientation I was directed to one of the other camps on the reservation that was in need of additional staff. I was warmly greeted by the people working in the medical yurt who were happy to have the additional help.

Providing medical care

The main medical team for the camp I was in consisted of an RN and apprentice herbalist, both of whom had been onsite for a couple of months. There was also another RN who was spending a couple of weeks at the camp and a resident physician was shared with the other camps.

Providing medical care in an environment like the camps at Standing Rock is dissimilar to providing medical care on an ambulance. Much of it falls into the primary care category; with things like sprains, strains, colds and coughs. Burns and respiratory issues were two of the most common chief complaints, which was exactly what I was expecting after working in the wildland fire camps in Alaska. We were able to treat the majority of the medical complaints on site and when necessary we would refer people to a clinic or hospital in Bismarck. We provided integrated care, using both Western, or conventional medicine, and herbal medicine, and the medic yurt also served as a healing space for people who needed to talk or recuperate.

We always had to be prepared for any possible injuries from conflicts between the residents of the camps and law enforcement and the DAPL employees. This meant being prepared for patients with pepper spray exposure and inhalation, hypothermia and traumatic injuries.

One of the other responsibilities of the medics is sweeping the camps before every storm to make sure people are prepared and also sweeping the camps after the storms to make sure everyone made it through OK. The medics also help ensure the general health and safety of camp residents, such as making sure everyone had a carbon monoxide detector in their sleeping space.

Living in camp

Daily camp chores included making sure there was adequate firewood, boiling water and doing dishes, cleaning the medical space, and evaluating our inventory levels. The firewood situation was the most frustrating part of living in camp. Most of the wood that had been donated was either wet or green or both, which means that it did not burn very easily. On days when we had extra medical staff, I helped work on insulating and preparing a new, larger yurt that was going to be the new medical space.

Most of the nights I was in camp I slept in my tent.


Inside the tent. (Photo/Ann Marie Farina)

The heater I had was too powerful for the tent, so I only ran it briefly while getting ready for bed or when waking up in the morning. Even without a heater, I was able to sleep comfortably by putting my 20 F sleeping bag inside my 0 F sleeping bag. It was even warmer in the tent after the blizzard due to the snowpack.

The blizzard was one of the more intense things I experienced while at Standing Rock. On Dec. 25, we were hit with a blizzard that dropped 12-15 inches of snow in 24 hours and had wind gusts of up to 60 mph. Due to the wind, I couldn’t unzip my tent door without it becoming filled with snow, so I packed up my spare sleeping bag, my cooking equipment and my blizzard supplies and moved into one of the new yurts I had been helping insulate. I stayed there for two nights with the members of the yurt building crew.


Pre-blizzard. The propane canisters made excellent anchors. The canvas tarp was tied to itself with rope going under the tent. (Photo/Ann Marie Farina)


Post-blizzard. (Photo/Ann Marie Farina)

Our camp primarily used solar power for electricity, which was supplemented by generator use when there wasn’t enough sun. Many days we didn’t have to run the generator at all, which was great since many days the generator didn’t want to run (I’m probably being unfair to the generator here. It is a perfectly good machine. We just didn’t hit it off very well). There was a community center located in a large military tent where breakfast and dinner were served daily, and where elders would tell stories and there was almost nightly drumming and singing.

Gratitude

I’m glad that I went to Standing Rock and I wish I had been able to stay longer. I met many incredible people while I was there, from around the United States and also from Canada and overseas. A diverse number of languages and cultures were represented, with the one thing we all had in common was that we felt compelled to go to Standing Rock.

During my 10 days there, I saw the Northern Lights dance for the first time in 10 years. I fell asleep listening to drumming and singing and the owls and the coyotes. I now have a Cuban abuela and a Lakota unci (pronounced oon-chi) — grandmothers — who are two of the strongest (and most stubborn) women I have ever met.

Going to Standing Rock enabled me to get in touch with my roots as a paramedic. My experience was also a good reminder that there are many ways to help people as a paramedic that aren’t tied to working in a traditional EMS setting or working on an ambulance.

What does DCAP-BTLS stand for?

By Sarah Calams, EMS1 Associate Editor

Anytime you're studying for a test, it's automatically easier to memorize information if you can use or create an acronym.

In EMS, there's an endless amount of terminology and phrases. When you're on scene, it's not helpful if you just say, "Don't forget DCAP-BTLS."

Memorization may get you a passing grade on a test, but you must also understand and implement the learned knowledge in your day-to-day calls as an EMS provider.

What does DCAP-BTLS stand for"

  • Deformities: Is there an abnormality in the shape of a body part or organ compared to the normal shape"
  • Contusions: Do you notice bruising" In extreme cases, this can cause blood to seep, hemorrhage or extravasate into surrounding tissues.
  • Abrasions: How severe is the abrasion" Your treatment will vary depending on the severity, but be sure to always clean and remove any debris.
  • Punctures/penetrations: Penetrating trauma suggests an object didn't pass through, while perforating trauma is associated with an entrance and exit wound.
  • Burns: Treatment depends on the severity of the burn.
  • Tenderness: This shouldn't be confused with pain. Tenderness is triggered by discomfort when an affected area is touched.
  • Lacerations: Treatment depends on the type, cause and depth of the wound. Minor wounds heal on their own, while puncture wounds are more prone to infection.
  • Swelling: This is an abnormal enlargement of a body part or area. Swelling may occur in response to infection, injury or disease.

OK, now say it with me. DCAP-BTLS: deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations and swelling.

Do you like using medical abbreviations to recall information during on-scene patient care and assessment" Let us know what you prefer in the comments below.

What you need to know about Beriberi and Wernicke's encephalopathy

The first time I heard about Wernicke’s encephalopathy was October 17, 1994. I know that because I have a habit of dating classroom notes, as if they might expire a week or two later.

That Monday evening, I was two months into paramedic school, trying to keep up with pharmacology. The seventh of 21 drugs on the agenda was thiamine, also known as Vitamin B1. In my hurried scrawl, next to thiamine’s dose (100 mg) and indications (AMS, DTs), I wrote, "Admin before D50 to help metabolize glucose" followed by "Warnikey(")." The question mark was to remind me I was guessing at the spelling, a consequence of the professor’s Midwestern twang that made diseases sound less German.

By the end of the lecture, I still had no idea what "Warnikey" was, but at least I knew what to do with thiamine. Or did I"

What is Wernicke's Encephalopathy"

Wernicke’s encephalopathy is an acute neurological condition caused by thiamine deficiency, also known as beriberi. The disease affects the thalamus and hypothalamus and usually presents as confusion, loss of coordination (ataxia), and visual disturbances such as rapid eye movements (nystagmus) and double vision (diplopia). Long-term alcoholics are at greater risk for Wernicke’s encephalopathy because they don’t absorb thiamine well, but any condition causing malnutrition, such as anorexia, Crohn’s disease, chronic infection and gastric bypass, can lead to thiamine depletion.

Thiamine: 100 mg, 500 mg or zero mg"

It’s true that the antidote for WE is thiamine; however, that 100-mg dose we had to memorize is sub-therapeutic for many patients. Definitive care for WE is usually several 500-mg boluses of IV thiamine over the first 24-48 hours before tapering to 100 mg of oral medication daily.

Another misunderstanding about thiamine is that presumed alcoholics must be targeted for that vitamin more emergently than other hypoglycemic patients. Yes, thiamine is needed to metabolize sugar, and long-term alcohol abusers are more likely than others to be thiamine deficient, but it’s unrealistic to assume chronic ETOH abuse is always evident in the field. Classic signs of inebriation such as slurred speech, poor coordination and an alcohol-like odor can be caused by other etiologies, while many true alcoholics show no signs at all of their disease.

Besides, alcoholics aren’t the only ones at risk for thiamine depletion; so are infants, the elderly, pregnant women and patients on furosemide or digoxin, to name a few. And beriberi can present with systemic signs and symptoms unrelated to WE. Heart failure, nausea, sleep disturbances and irritability are just a few consequences of insufficient Vitamin B1.

There’s a 24-hour window from onset of WE until permanent damage is likely, but death from profound, untreated hypoglycemia occurs much more quickly — within an hour or so. Since blood glucose can be checked easily in the field while B1 levels cannot, it’s widely considered reasonable to administer dextrose without thiamine prehospitally, then transport patients for further evaluation.

At my last EMS agency, we didn’t even carry thiamine. I wondered if we were behind or ahead of the curve, so I took an informal survey of large EMS organizations like the ones in New York City, Nashville and Chicago. Only two of the 10 systems I checked still include thiamine in their protocols. At only $10-15 per 100-mg dose, it’s not the cost of the drug, but its perceived value that’s limiting prehospital use.

A fate worse than Wernicke’s

Say your semiconscious diabetic wakes up after a dextrose bolus and refuses transport. A repeat episode of low blood sugar isn’t the only risk that patient is taking.

As discussed, Wernicke’s encephalopathy is a short-term, reversible consequence of thiamine deficiency, but what happens when WE isn’t treated within its 24-hour window" About 20 percent of those patients become comatose and die. Most of the rest develop Korsakoff’s psychosis: permanent damage to the parts of the brain involving memory. Retrograde amnesia, inability to form new memories, confabulation and hallucinations are the most common signs and symptoms.

Korsakoff’s psychosis isn’t curable; sufferers are permanently handicapped and often require ongoing supervision. I remember one Korsakoff’s patient whose family tried caring for her at home. They force-fed her through a nasogastric tube and tried to prevent her from seeking alcohol, but she ended up in a hospital and died of multiple-organ failure.

WE and KP are often grouped together in the literature as Wernicke-Korsakoff syndrome. You might hear the disease referred to nonchalantly as "wet brain," but there’s nothing casual about its toll on victims and their families. Prehospital providers should be aware of Wernicke-Korsakoff although most of us will never play a role in preventing it.

Works referenced
1. Bowman J. Thiamine before glucose, where’s the science" The Resuscitationist. www.resuscitationist.com. Accessed 11/06/16.

2. Alzheimer’s Association. Korsakoff Syndrome. www.alz.org. May 2016.

3. Lanska DJ. Korsakoff’s Psychosis. Encyclopedia of the Neurological Science. Elsevier, 2014.

4. Sanders MJ. Paramedic Textbook: Second Edition. Mosby, 2001: 1025-1030.

5. Hsieh A. Drunk versus diabetes: How can you tell" www.ems1.com. 07/31/11.

Inside EMS Podcast: How AMR's medical team will help NASCAR drivers

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined by Dr. Edward Racht, chief medical officer at AMR, and Edward Van Horne, president and CEO at AMR. They discuss AMR's partnership with NASCAR and how they will meet the responsibilities of taking care of drivers on the track.

Why it is brave to let someone know you are hurting

By MJH in Boulder, 7 years in EMS

To the emergency worker thinking about taking your life … I am here for you.

There is a reason that in this industry we all call ourselves brothers and sisters. We are all here for each other, because family is the most important. And you are family.

I know you feel lonely, like no one cares, like no one knows what you are feeling, what you have seen, or what you have done. This is why we are family, because we all know what it feels like, we have all seen what you have seen, and we have all done what you have done.

We understand and can relate to you like few outside of our profession can, and for that, we will always be here for you, and we will always care about you. We are many, and to think that you are alone in a time of need is not true.

There are thousands of us around the country … your family, all wanting to help you through this, but you need to ask.

We can’t help if we never know how you feel. It is not brave to keep everything inside; it is brave to speak up, to let someone know you are hurting, so we can be there for you.

You will not burden us by speaking up, by telling us how you feel, or asking for help. You would burden us by not speaking up, because if you take your life, we would all think it's our fault, that we could have done something to help, that we should have known you were hurting and just didn’t pay enough attention when it could have counted. This is the burden that we would struggle with.

We all love you, even if we have never met you. Every one of us would jump at the chance to help you, a member of our family, if we only knew you needed it. You see, it would be incredibly painful for us to lose you, as it is for every death within our family.

Even for those of us that have never met you, we will grieve. You have an enormous family across the nation, and the world that all want to see you be the best you can be, and succeed in life.

Please talk to us, let us know how you are feeling, what you need and we will be there for you. I promise.

5 things to know about assemblyman and EMT Freddie Rodriguez

California Assemblyman Freddie Rodriguez introduced the EMS Workers Bill of Rights earlier this month, which includes the rights to rest and meal breaks, protections against on-duty assault and access to mental health care.

Since the proposal of the bill, EMS1 columnist, former paramedic and lawyer David Givot went a step further than Rodriguez's proposition. He applauded the first step taken in this important legislation, and recommended that California's private EMS providers should have the same legal protections as their fire department counterparts.

Rodriguez said as a former EMT, he was "obligated and proud to stand up and speak out for thousands of hardworking individuals who are integral to our health care system."

As EMS providers, it's important to know about your state's politicians. Proposals and bills may not always directly influence EMS, but it's essential to know the person behind the ballot when they do. Here are five facts about assemblyman and former EMT Freddie Rodriguez.

1. Rodriguez worked as an EMT for over 30 years

Before being elected as a member of the California State Assembly, Rodriguez was a Pomona City councilmember and an EMT in the San Gabriel Valley. Currently, Rodriguez works part-time as an EMT with AMR in Irwindale. He represents the 52nd Assembly District, which includes the cities of Chino, Montclair, Ontario, Pomona and portions of unincorporated Fontana.

2. EMS Awards

In 2005, Rodriguez helped the victims of hurricanes Katrina and Rita. He was awarded the California Star of Life for his volunteer contributions and rescues.

3. Helping firefighters, too

When Rodriguez was a councilmember, he helped restore firefighting positions in Pomona. He made sure that shifts were fully staffed and crews were properly equipped to respond to calls.

4. Public safety supporter

When elected to the State Assembly in 2013, Rodriguez made it clear that he was an advocate for public safety. He helped develop SOPs in order for emergency responders to better respond to active shooter incidents. He also introduced AB 1719, which requires districts to teach hands-only CPR in high school.

Additionally, Gov. Jerry Brown signed into law Rodriguez's AB 69, which established practices and procedures for downloading and storing police body camera footage.

5. Public service runs in the family

Rodriguez and his wife live in Pomona. They have four children — one of whom continued in his father's public safety footsteps. Their son, Vincent, currently serves as deputy sheriff for the Los Angeles County Sheriff's Department.

Top

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.

3 energy-saving tips for your EMS station

Earth Day, or any day, is a good time to see what you can do at your agency and home to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT course or refresher class

CPR class instruction tips: 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 is 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 education and training

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.
Top

© Copyright 2010–Robert Vroman, All Rights Reserved • Robert@Robert-Vroman.com
Content/Image Use and Legal Policy