EMS Outside Agitator

I just stumbled upon a “civilian” out there who really understands what is going on with EMS. His name is John Dubensky and I bet he’s been reading our blogs! He writes for an on-line rag www.cracked.com . Okay, You can Slam! me for using this as a source with any credibility. But when you read some of their articles — especially the one’s meant to de-bunk common wisdom – they are so bare knuckles right on, well, you have no choice but to laugh at the tragedy!

Gang, the truth is the truth, and this is close enough for me: http://www.cracked.com/article_19798_5-terrifying-secrets-about-riding-in-ambulance.html! Graphic, below, is from the article.

The article came out May 15th (today!) and already there have been 512 comments! Some fun ones:

I got in a serious car accident as a passenger last year, and kept going in an out of consciousness, head bleeding, and I couldn’t think straight and my whole right side of the body was hit, so what did the ambulance do? It didn’t even turn on the sirens…

In fact, I was rather encouraged by all the support that came out from the public. Sure, a medic respondent took the article to task on many points. But his/her conclusion ran:

I do agree that the system is severely abused, EMTs suffer from PTSD, and the work burns you out. If we had better safeguards in place some of this could be reduced, but there are protocols in place to reduce these issues presently. I think a big problem with EMS is the abundance of ignorant, under-educated EMTs on the streets that don’t know what they are doing and lack improvisation.

One thing Cracked forgot to mention: Killing your patients. It happens to everyone. Whether it gets reported or not, patients WILL die because you showed up to work. Push the wrong drug, or the wrong dose? Perform a skill like endotracheal intubation (breathing tubes) or cardioversion (shocking) wrong? Fail to catch a critical change in a patient’s status or miss a diagnosis? Someone is going to die, and their blood is on your hands. You either learn from it and make yourself better, or it haunts your dreams and you quit. It happens to every single provider–doctor, nurse, paramedic or otherwise. Anyone who says it doesn’t is lying.I guess I must sound pretty burned out right now, huh? But you know what? I’ll take it. That’s the burden we bear. The fat, angry, violent, back-breaking burden. And when my days off are over and my week starts again? I’ll be back out there, hauling your drunken asses off the street and praying for someone sick enough to need my help. Because that’s just what we do.

That’s a dose of reality right back at you, isn’t it? Although not pristine, the article is more than adequate to have gotten a lot of attention. What more can be said than we need more of this and it’s OUR responsibility to make sure more people get to hear of what we really experience.

I’ve been AWOL, concentrating on marketing my book, something I dread like hemmorrhoids; I’m an Artiste, dammit, not a Shill! But something exciting has been evolving and it’s time for you to hear about it!

At first, my book was an exercise to save my soul; an attempt to make sense out of my experiences as one of the first paramedics. It turned into part of a much larger American story that I am only just now getting to understand.

It wasn’t too long ago that a lot of our medicine was practiced within the matrix of community and connection. In the Stone Age by today’s standards, fifty years ago the Doctor’s bag held most of the tools available to treat patients and he brought it to your house! But things started to morph very quickly. The tools got bigger and more complex, new species of drugs spread like rabbits and the Doctor took on the roll of High Priest, now sequestered in the Institution where he/she uses all these Mysteries-Cloaked-in-Secrecy to prolong our lives but not necessarily improve the quality of them. It’s all a big experiment that is still in its infancy.

When I joined EMS around 1974 there was little more than “Head, Hands, and Heart” to work with. Within five years I was an Emergency Room on wheels! By 1985 a crucial transition had completed; Medicine no longer expressed itself as a by-product of people connecting with each other, it became something “delivered”. Once we started to have to use gloves to protect ourselves from our patients (as a result of AIDSfear) the umbilical cord to our Mother was cut.

All of this happened most visibly in EMS. We actually were the embodiement of that crucial transition of medicine. These were the times I wrote about; the times when I found myself with all these things to place between me and my patients whereas yesterday I had no choice but to face the humans I transported eye-to-eye. In a sense, EMS was a great metaphor through which to examine a societal movement toward institutionalization of most aspects of our human interaction. I, as a medic in a brand new approach to patient care, happened to be a reflection of that shift.

Since 2005 my focus has been to get the book out there and make it the best piece I could to express a lot of the worlds that my EMS colleagues experience but don’t talk much about. My focus has been on using my writing to influence the culture of EMS; to expand it a little to include conversations about Bigger Pictures than shifts and pay and how everyone marginalizes us. By working online as a Community Leader at EMTLife.com I’ve been building on what you’re teaching me (through other of my websites, Blogs and writings) and translating that into vehicles to help me reach broader audiences; first medical practitioners of all stripes and then the general public.

I’m jumping off the cliff now and going for a Mainstream Readership: Talk about scary shit!

A few months ago I decided that it was time to invest in a publicity program for the book. I’ll be doing a lot of Radio Interviews. I’ve been doing everything on my own to date. To be transparent, pretty much all of my effort to sell the book has been through simply being an on-line presence and doing my work in the EMS community. Sure, every now and again I mention it, but for the most part, I’m depending on word-of-mouth to carry it here. As soon as I get rich, you’ll know about it.

So, in one respect, I’m still learning what the book is really about and where to make it most useful! I give you all full credit for helping me see how best to use the book as a vehicle to increase the public’s awareness of how valuable we are to society, and how costly it is for us to do the work. I believe the public-at-large can actiually help us to become the profession that we never really became.

Here is a recent interview I did on-line with Dresser After Dark, on Blogtalk Radio with Michael Dresser. Enjoy, and please let me know what you think:

Russ Reina-5-01-2012-Track 1

Probie to Practitioner feeds me! She asks questions of us and herself about things not often expressed openly. By instinct, I pounce on them and throw in a dose of what I construe as reality, and I know my pictures often ain’t pretty! (See PtP’s More Newbie Worries On Burnout).. Her recent musings, I’m Not So Perfect After All! brings up a few more things worth taking a look at. I’ll let her tell you (edited for space):

I hit another landmark down my journey to becoming a fully competent practitioner… It wasn’t a proud moment…

Maybe not, but it’s an important landmark in her awareness of herself in relationship to the job as she herself senses. The only reason I’m blogging this is to promote medics to think about and experience themselves fully. Not everyone is going to go to the places PtP went to here. But through her experience, if they listen they will learn a new Mechanism of Action that everyone in EMS is exposed to.

The gist of her story was that she picked up an emotionally distraught woman, around her own age, who was contemplating doing herself in. She extended herself to her, both professionally and personally through honest conversation on the ride in to the hospital. Then, a while later (presumably days or longer afterward),there she was, transporting the same girl again, with the same problem:

I’d had repeat patient’s before. Every ambulance corps has their frequent flyers. So I’m not sure why this is so different. Maybe I actually expected this patient to get better. On some level, I liked to believe that I’d made a difference in this patient’s life. In my mind, I probably made out my impact to be much larger than it actually was. I really wanted her to get better, and I must have really expected her to get better too. When she didn’t, I was a little shocked. I felt a little like I had failed her. Obviously that’s not the case; this is no one’s fault, and certainly not mine. Although I worked to not show it, I was upset with her for reasons I couldn’t place.

“I was upset with her for reasons I couldn’t place.” How incredibly classic because this is exactly what happens, sometimes we get pissed off at out patients and we don’t know why. At first glance it seems it’s because we extended ourselves personally. We’re supposed to be professional, yet, there are some situations that there’s nothing left to do but BE personal. In this case, PtP’s only available tool to work with were her words and her heart. Of course she used them, she’s a professional! It’s usually after the call, however, that it all comes together and we start asking ourselves “Did this one hit me so hard because I let my professional guard down? Why was I so open?”

But this case exemplifies what happens to a lot of medics. On that particular call, PtP was sitting in the back of the ambulance with herself! From what she says (and of course I’m guessing) this call hit her personal Hot Button, or one of them, anyway:

But I guess she was like a lot of young adults, myself included. She was losing hope over figuring herself out, over finding where she truly belongs. I’m not sure she realized the permanence of what she was contemplating…I felt a little blindsided.

The blindsiding is a common experience in EMS. Certain cases weasel their ways into our hearts when we’re not looking. In this case, I can hear PtP’s inner kid screaming, “It was just as tough for me once and I didn’t try to do myself in!!!” Okay, maybe I’m getting carried away, but can you hear how this particular patient — in some way or another — hit close to home? PtP said:

I can connect with almost any patient. Well, so I thought…

She thought right; in fact, PtP REALLY connected with this one, and probably before she even realized it.  Maybe next time, she’ll better understand her limits and boundaries and be better able to keep her professional hat on, but this one got close to home before she had a chance to prepare for it.

I suppose I was frustrated that all of our efforts in the medical field hadn’t—and weren’t—helping her. And I had no idea how to fix that. And, to be truthful, dealing with this new understanding made it hard for me to reach out and connect with my patient on the same level I did before. I was wrongfully angry with her, and found myself trying hard to be there for her the way I did originally had. Why was this so hard for me?

There’s a Shadow side to working in EMS. It goes something like this:

Most people enter EMS with the understanding that people can be weird. They’re somewhat prepared for the onslaught but most didn’t have any idea how many of varieties of weirdness there are! Once they start to explore different neighborhoods of weirdness they realize some of those dark alleyways they’ve been down before and somehow managed to pull themselves out of. When they see people staying stuck in those alleyways, they sense it could have been themselves. That hurts and with that comes anger.

Little gems like the one PtP speaks of are invaluable lessons because, really, who coulda thunk we could start hating a patient on our second call with him/her? Of course, “hate” is an exagerration, at least it is now. But three years down the road, after having fielded perhaps a hundred of these, believe me, she’s more likely to be harder than softer. For every one of these calls she’ll have three of people who really wanted to live but couldn’t. The first thing we tend to do is to shut down and insulate ourselves from feeling any connection to our patients. Maybe this ain’t so great.

The fuel for the fire right now is likely VERY personal to her. And that’s not a bad thing. She is learning what she can give and when. So when PtP says:

I empathize and develop a relationship with patients, and I suppose it was only a matter of time until I didn’t, or couldn’t. I just hope that this landmark isn’t any more significant than that.

I have to respond in this way: This IS a landmark for you, PtP. You can decide that empathy is dangerous to your view of yourself as a professional or you can view empathy as a tool that you can learn to work with along with other tools of your profession. In my humble opinion, empathy and connection  supercharge everything else you do.

You’re going to run in to a lot of patients just like her. You’re going to find yourself “living in” a lot more patients than you ever bargained for. Even though you’ll despise some of those reflections, you’re going to have to learn how to put that aside and do what you can for their betterment. At your very best all you can do is offer your patients more time to make life-affirming choices and pray that they’ll take advantage of your gift. If they don’t and you end up picking them up again and again for the very same thing, it’s simple, once again you’re going to have to learn how to put your own stuff aside, connect where you can if it’s useful and safe, and do what you can for their betterment.

That’s what a professional does.

These are very challenging questions you’re asking yourself and us. Things like these need to be faced rather than swept under the rug so professionals can learn how to deal with that terribly unruly human being that lives inside. Each person who reads this can find his or her own personal examples of how patients hit their Hot Buttons. Every person reading this will do something different with what they learn. But the important part is you’re asking them to look.

None of us in EMS is completely immune from that particular call that hits us so deeply and personally that we may not ever be able to recover. If we build up the habit of learning from each other about the things that usually don’t get spoken about, we’ll have more places and people to go to when the shit hits the fan.

Thanks for taking the risk!

CCC lit a firestorm across the EMS blogging world in this post, and since I’m a humble firetender, it’s my pleasure to keep it burning; maybe even transmute it a little!  Rogue was kind enough to jump in and also list some of the Bloggers that have been commenting on the loaded issue of feeling comfortable being referred to as “Ambulance Drivers.”

Naturally, I chimed in and in the process saw a few things that I wanted to comment on, for one purpose only; to keep the conversation going. This is all valuable stuff everyone’s been talking about and the term “Ambulance Driver” was just the spur these topics needed. The question that arises for me is even though the descriptor “Ambulance Driver” may work for us now, will it carry us into the future?

It’s Disclaimer Time, folks!!!

“Us” is you. I haven’t lifted a gurney since 1985. Back in 1975 I was sure I was stepping on to the ground floor of what was soon to become a valuable and valued profession. I’m here asking you “Why didn’t that ever happen?” Not with an accusatory finger but with a challenge; “Isn’t it about time to make this a profession?”

We’re I not clear on Kelly Grayson’s intent and certain that he will be one of the people leading EMS into this new era, I’d be reluctant to fixate on the term. (A little, anyway!) But, as Kelly himself says, in the final analysis, it’s one’s professionalism that tells the story and in that he shows no inconsistency. He brings honor to the term. Remember “Ambulance Driver” is just the jumping off place for bigger issues.

Back to our regular programming…

Back then, the term we bristled at was “Hack” so I can see some improvement!

You have models to go on to build this into a profession. Nursing is one. They built expanding scopes of practice commensurate with the increasingly complex center of technology that the hospital had become. They took on the person-to-person duties that Physician’s once handled. Today, those connections have largely trickled down to Nurse’s Aides! Bottom line is they expanded their own value to medicine by filling in gaps that Doctors were leaving open as they became more entrenched in keeping up with an ever-increasing body of scientific knowledge of disease entities and products designed to overcome them.

What I think is that if you really look at the people you serve — the actual people you serve — and recognize that gaps you’re being called on to fill and get yourself adequately trained to fill them, yes, you can turn this into a profession. You’re fulfilling a much more complex and important niche in the fabric of society than you give yourselves credit.

I see the territory of EMS changing rapidly into 80% social service and referral — sometimes resulting in transport – 15% emergent medical responses and 5% acute emergency availability. EMS has become a societal stopgap measure designed to pick up the pieces left behind as the populace is cured by modern medicine just enough to be chronically ill. The problem is people call EMS because THEY think they’re Acute! So you get pissed off because you think you’re here to treat acute! You’re not; you’re here to treat what ails them, and you know what? You’re not adequately trained to do it! You’re trained to intervene a litlle and then transport.

A response in EMT Medical Student’s Blog  to Rogue places arguments about use of the term in proper perspective:

Imagine if EMS providers took this much interest in discussing the poor state of EMS education.
Imagine if EMS providers took this much interest in discussing the issues facing reimbursement for the services that EMS provides (including removing the transport requirement).
Imagine if EMS providers took this much interest in developing EMS research.
Imagine if EMS providers took this much interest in developing systems to prevent calls.
Imagine if EMS providers took this much interest in tackling any of the vastly more important issues rather than being called an “ambulance driver.”

Imagine if EMS providers put as much interest into making EMS into a profession (instead of the current “profession in name only” situation) that we currently do complaining about the term “ambulance driver.” We might actually get something done.

Medic 51 emphasizes two crucial parts of the formula for our future on his blog.

If we want to establish EMS as a true profession and a part of the healthcare system we have got to start having some pride in ourselves. We have to start standing up for ourselves.

The part that’s not getting grasped is that EMS is part of a much larger healthcare system. It no longer needs to function in its own bubble, and, in fact, does injustice to the populace it serves while insisting it’s all about emergencies. Standing up for ourselves means acknowledging the actual world we function in and develop the skills we need to handle it professionally.

But there’s a leadership aspect to it as well. In a sense, for this phase, everyone in EMS needs to take on more responsibilities in being people worthy of respect as Coma-Toast speaks to here:

There are several levels of leadership that one must go through to earn respect. It’s not automatic and must be earned. In the early stages of your leadership role, people follow you because they have to. You’re the supervisor, manager, or director. But with position comes responsibility. You’re not only responsible to your people, but more importantly to yourself. An indispensable quality of a leader is the ability to evaluate themselves before trying to influence others.

The Social Medic is equally aware of where the future is headed and I think he’d agree; right now, we’re not quite there. There are things we must do:

• Understand how we are perceived so we can change it
• Deciding what to call ourselves by the public AND amongst ourselves
• Be prepared to tell our own story to change that perception
• Do it while remaining a professional caregiver* regardless of what we are called in the mean time

So maybe the whole issue isn’t about the words, it’s about the attitude. Flash says in Rogue’s blog:

February 22, 2012 at 9:51 pm

Believe it or not, there are other people out there who care enough to look into where we’re at now — even though they are not and haven’t been involved in EMS – and offer invaluabe perspective:

Ray Bange, on Rogue’s Thread

You can talk as much as you like within the occupation and EMS sector  but you will continue to have difficulty getting appropriate recognition of funding needs, training and clinical practice until you reach the ears of the decision makers and alter the perceptions of kindred health professions and the public…You need to get paramedics into positions of policy development both locally and nationally and you need to develop a stronger sense of inner strength and professional ethos and ‘own’ the profession. (My perception for what it is worth)  That’s what the national professional body in Australia has been doing for some years – and it works!  It takes time but a promoting a coordinated consistent message does have an impact… (emphasis mine)

One of the more effective ways I have used to bring about change is to monitor the media and then engage the program producers, directors, scriptwriters and journalist who help to shape the public opinion.  Politicians will soon respond to that because most of them want to stay in their positions.

In essence, the dog has to wag the tail. EMS practitioners need to SHAPE their own futures.  A valid starting point is changing the image of it in the public’s eye. Isn’t it abundantly clear no one else has done it for them to date?

My last comment will be to make my position in all of this clear as a bell:I opened my first volley with CCC by referring to him with this term. He responded:

I’m flattered to be considered an “esteemed colleague” by the way.

Most everyone I’ve been talking about in the EMS blogging world are still out there, in the field, doing the work. Please forgive any presumption that I am still in your league, I get carried away sometimes.

Dave, over at the Social Medic is weighing in on this little brou-ha-ha over the term “Ambulance Driver”. So is Kelly Grayson and others so I guess I hit a nerve. GOOD! That’s what I’m here for aren’t I? My only agenda, oft repeated, is to promote medics seeing themselves as being part of a Bigger Picture. Really, what a ridiculously outrageous a thing to ask of you! Dave starts off with:

It seems Captain Chair Confessions has some bloggers in a frenzy over a post where he basically tells everyone to get over being called an “ambulance driver”.

EMS Outside Agitator rolled over in the proverbial professional grave and declared that there are no ambulance drivers in the Emergent Medical Services.

Medic 51 was aghast at the horror of accepting the title because of blood, sweat, and tears put in to gain the knowledge and earn the patch.

And then… as if on cue… I read a story from EMS1.com titled UK boy “dies after ambulance crew’s sat nav broke”. Sat nav being short for satellite navigation which is the same or equal to the Global Positioning Systems (GPS) used today in the United States.

First of all, reports of my death have been slightly exagerrated. Though the grave is “proverbial”, in my attempt to attain rigor mortis, I have not flip-flopped in my coffin. That day will come soon enough!

Let’s start by saying the term “Ambulance Driver” is only one small component of the point of what I’m trying to make in much the same way that being drivers of ambulances is only one small component of the role that EMTs and Paramedics play.

Language as a vehicle for building a common perception of reality is a fact of life so let’s at least look at it. In a minute, I’ll give you a great example of how language changed a common perception and that change has defined the work you do today!

My central point is not that we need to bray about how we’re a profession (which we’re really not for reasons covered in my blog) but at this point, we haven’t even got the word out that we want to be!

I appreciate Kelly’s humility because really, this is all “just a job”. AND, who’s Kelly talking to? It’s us.

When he gets introduced to speak, however, at sessions with the general public, I hope it’s not as an ambulance driver, or “America’s Favorite Ambulance Driver”, but as the writer of “A Day in the Life of an Ambulance Driver” which he makes clear. I don’t experience him as someone who is furthering the public’s impression of us as being nothing more than “Hacks”.

Once again, I have zero quibble with his choice of words for himself precisely because, as has been mentioned and truly does count for a lot, he walks a professional walk. Besides, that’s his “Brand”! It works for EMS as a whole, and I probably need to see what Kelly’s up to in his presentations to the public-at-large befiore I say anything more.

What we say to each other is one thing. But something is amiss because the message that the public has gotten is that we’re there when you need to get out of an uncomfortable situation and NOT that we’re there when you really need us. Who’s fault is that, I have to ask?

Language IS important and I’m sorry, on that end we’re setting ourselves up for marginalization in a vital protection agency that is going to demand more and more from us as medical generalists with a specialty in handling emergent situations.

Dave says: “So if someone wants to call me an Ambulance Driver, I’m okay with that. Not because I have low self-esteem like EMS Outside Agitator seems to think… but because it’s an aspect of my profession. In fact, if you really thought about it, it’s probably the most VITAL aspect of it.”

I’m fine if you and everyone else is okay with calling yourselves that, but I think you are minimizing yourself and that troubles me a little because you deserve better. I beleive you’ve lost perspective and, as I said in my blog “allowed” the agencies that control you to control you because you have not claimed your own value to the community. It’s time to claim it..

We are specialists in Intervention. It once seemed to be Medical but things have changed. We’re  stuck in the Hellish place of having to cope with people in true need to get somewhere, but the only place to bring them is ERs and the only people to take them are us. They deserve more outlets; we can help them to get them, but not as ambulance drivers. We’re going to have to become professionals that lobby for change in the systems that serve the populace.

And transportation, though once the definitive aspect of Emergency Medical Services, is simply no longer the “most VITAL aspect of it.”.

It’s true, a couple of British medics couldn’t read a  map so the issue of whether or not they’re paramedics is moot; they couldn’t even be decent hacks! Their failure was in one aspect of delivering the service. It was critical and defined the efficacy of everything else they could offer under those circumstances, but isn’t our job juggling many different things to make a difference in people’s lives?

They failed as professionals because professionals must deal with and master each and every aspect of the things they’re trained to do.

And, by the way, how many agencies do you know that actually train their medics how to drive an ambulance? It isn’t even in the curricula. Sorry, but I’ll continue to wince at the term.

What would happen, if only for a little while, like a few years – We did something like this:

Back in the 1960′s, the American National Red Cross along with other allied agencies like the Scouts wanted to change the perception that the public had about people stricken by illness or injury. The common word for such people was “Victims”. That didn’t do justice for anyone and ESPECIALLY for those who were called upon to help. The victim remained a victim all the way to the hospital!

I recall what amounted to a publicity campaign where articles showed up all over (Reader’s Digest and the like) specifically reporting that “victim” was no longer proper language to describe the stricken. The proper word was now “patient”.

I guess the campaign worked because you probably never thought of your patients in any other way! And how much did the change of that little word affect the work you do? What does that tell the public about what it is you do? Victim is about disaster relief. Patient is injury under treatment, an assertion that the person is under the care of medical personnel. They may be a victim before you get there, but once you arrive, that’s a patient.

So what if we helped get articles published that spoke of what we do in terms of reality? What if we educated the populace on the proper use of Emergency Services? What if Paramedics and EMTs became faces speaking to the public about how we need help to help them best?

Oh, but I almost forgot; I’m dreaming! We still only have one place to bring patients and we haven’t established educational standards high enough to grant us credibility when we ask to design Emergent Medical Systems that work for the people AND us.

I dunno, maybe I’m nuts, but I’ve been saying since about 1975 if ambulance drivers want to build this mess into a real profession they’re going to have to make it happen for themselves. They’re going to have to re-create themselves from the ground up. They’re going to have to change how they are percieved or nothing will change.

Something I might have missed, and re-reading Kelly’s R-E-S-P-E-C-T blog it dawned on me that I wasn’t thining in terms of Correcting anyone when they called me an ambulance driver. I was thinking in terms of making the effort to correct that image in the public’s eyes so I wouldn’t have to any more.

Can you see the difference?

Our esteemed colleague at Captain Chair Confessions really screwed the pooch (IMHO) on his latest blog entry: Get over yourselves, drivers. He says it’s okay to be referred to as “Ambulance Drivers”. That’s not the message we need to send out to each other, the public, OR ourselves for that matter. In part, he says:

But, do you actually drive an ambulance as part of your normal work duties? Oh, you do?

Then get over it.

As a profession, the best way for us to present ourselves as professionals is to look good, with clean, iron (SIC) uniforms, and provide quality care in a timely and efficient manner. Not bitching about what we are called by the general public.

Show me the cop who accepts being called a Gunslinger. Show me the Fireman that tolerates being called a Hoser. Show me the Nurse who is fine with being called an Asswiper. Each of those things are the LEAST of what they do.

Yes, individually we each have the right to joke around with each other about what it is we do, but unless we start etching into the minds of the public-at-large that the work we do is important and professional and WAY beyond the appearance of a nicely pressed uniform we will never gain the traction needed to turn EMS into a true profession. A Doorman wears a nice uniform, but maybe that’s a bad analogy because Doormen get tipped!

I’m sorry. After forty-plus years Ambulance Drivers is exactly what we are and it’s because WE have not made it otherwise. (No offense meant to Kelly Grayson personally )  The place it has to start is how we view not each other in places like these blogs, but how we view ourselves, to ourselves. I’m talking about standing up to claim what we do as worthwhile.

It’s an image, self-image and self-esteem issue as much as anything else. We have to be willing to talk about ourselves and each other as if the work we did was valuable. NO, we don’t have to come off as heroes but for Chrissakes why can’t we just be honest about our contribution; even if it is running IFTs! There’s nothing wrong with coming up from the bottom as long as the system you’re part of helps you come UP instead of go nowhere.

I see it all the time throughout the EMS cyber-world; there’s a consistent befuddlement about why things aren’t different or better in EMS. Medics refer to themselves as being subject to the institutions that confine them, whether it be the hospitals, private companies or fire departments, City, County or State, the Docs, the Nurses you name it!

What’s missing is that none of those institutions are standing up for our good name. They are in full agreement that we are no more than Ambulance Drivers, and again, IMHO, they like it that way. It  is economically feasable, if not an economic necessity, to assure that the people in their charge do not unite. God forbid we’d have to pay them what they’re worth to society. (If you really can’t see how you contribute, this may be a good time to leave.)

And unity of purpose and mutual support and respect must be the starting place if anything is to change. And that will not happen while we continue to call each other Ambulance Drivers. Unless we unite to change our image in the eyes of the public AND the eyes of the systems that employ our services, we will continue to be dogs under the table, relying on the scraps others toss at us for our nourishment. They keep us fed because they know when they call, we wag our tails!

It’s time to stop being subservient, but it’s gonna cost you your nice comfortable cushion and your doghouse.

Just so my position is clear I want to repeat that the primary reason EMS is not a profession is because of burnout. There is not enough consistency and longevity in dedicated personnel to make the profession stick. EMS is a transient’s playground. It is for this very reason that we need to start raising our own standards to give EACH OTHER reason to stick around and make a difference. And it starts with language.

How hard would it be?

What if every Newspaper in the country had to publish a Correction every time they referred to an EMS professional as an Ambulance Driver? Do you think after a while they’d start using the proper terms for the personnel they are reporting on, like EMT or Paramedic? Do you think they would make a better effort to identify the professionals they refer to in their articles and photographs in the future? That will only happen if we take responsibility for the protection of our image.

I guess that would take someone in your service to actually keep up with what is being reported and how your service is portrayed. Gee Whiz! Maybe that same person could begin generating articles that will teach the public what EMS does, why, and how they can help us help them. What if WE were to establish ourselves as Experts at what we do? Who is doing that for us now? And by Experts I mean professionals assigned to attend to the emergent medical needs of the public.

“Emergent” you say? I thought we were in the “Emergency” business? From the Free Dictionary:

e·mer·gent (-mûrjnt)

I don’t know if the phrase “Emergent Medical Services” has been coined before. I know I have used it a couple times here and in other of my writings, but that is where we’re going if we haven’t already arrived.

Who are you kidding? The reason EMS isn’t working as a profession is because it still thinks it’s a specialty when everything it responds to is getting more and more broad and complicated every day.

Uh-oh, and here comes the BOMB!

WE are not recognizing that the world of EMS has left Johnny and Roy behind. If they want to catch up, they’re going to have to go back to school to learn more about anatomy, physiology, pharmacology, disease entities, sociology, management and psychology (for starters!).

YOU, my friends, are going to have to go back to School! I think ole Rogue would agree.

Full disclosure: the only schooling that I would subject myself to after my compulsory stints in High School and college a couple years was Paramedic training and that primarily because it was equally practical and textbook. I am the world’s worst student (though I did Ace my curricula; well, almost Ace. Would you beleive…?).

WHY MORE SCHOOLING?

* Because the role you play in the larger picture of what Medicine has become has expanded exponentially from what was true at the beginning of EMS and you really do not have the knowledge you need to do the work you’re being asked to do.

* Because the people you serve both need and deserve that knowledge to get them to the next level of appropriate medical care

* Because you will need the educational credibility so you can help define and shape new aspects of Emergent Medical Care for the future so that the people in your care have somewhere to go OTHER THAN the Emergency Room.

* Because when it’s time to come to the bargaining table, you’ll won’t have to listen to, “Listen you Monkey, there’s a million of you guys on the line out there.”

* Because no one is going to create new career paths for you. You’re going to have to do it for yourselves.

So really, my friends, listen to your friendly EMS Outside Agitator when he tells you you’ve fallen behind and it’s time to catch up to the realities of your job. Unless you step up to the plate and help SHAPE the future, you’ll keep coming up with rationalizations that justify your being called “Ambulance Drivers.”

The truth is, you can count on the majority of your time for the next decade or so being dedicated to hauling Baby Boomers from Hospital to Clinic to ER to Nursing Home to wherever the doctors want them to be and wherever insurance will pay for it. And can’t you see the most of the transports that you do will actually become the ones that insurance pays for? You will do more of these because they pay, and NOT necessarily because it is needed. You will be encountering a tremendous amount of creativity in the facilities you service!

From what I’m reading now (since part of my job as a Community Leader of EMTLife.com is to read as much of everything posted on the site as possible), this theme of EMS being 90% non-emergency transport and about 1% true essential, life-saving intervention is suddenly popping up all over the place. Just the idea that today the proportion of paramedics to EMT’s has taken a tailspin tells you where the needs of our communities lies; predominately in transport services. I think the market is starting to catch on!

In the 1980′s, in California, it was split pretty much even, maybe a little over 50% on the emergency side. But, I completely understand today’s frustration because I began EMS in a coverage area for mostly retired folk in Florida. There, it was 90% and it took me a few years to move away from having the frustrated and even angry voices that I hear so loudly today echoing in my brain. If I’m going to be transparent, I’d have to say my empathy had hit its lowest while doing what I called “hauling flesh” (for no damn reason because, after all, I went through training to save lives, not move bodies!) and that contributed mightily to my having to admit to myself I had become an impersonal Flesh Mechanic. Even back then, I thought if I could run the calls Johnny and Roy did, then I’d respect myself!

Your immediate future seems to be more clear; namely that the proportion of time you have available to render worthwhile interventions will diminish until all of my generation is out of your way!

But in sitting on this topic, mulling it all over for the last week after studying threads entitled “Do we REALLY save lives?” and “Greatest contributer to burnout in EMS“ it came to me that the question isn’t do we save lives any more. It has now become “How often do we get the chance?”

And that is where proportions come in. They are changing on all levels, my friends.

One of the things surfacing again and again is the high volume of what are termed “BS Calls”. As I define them, these are calls where transport is called for; not by virtue of need but because that is what you were “called” to do…transport.  This, after all, is the essence of the Industry and for most services, where the money comes from. The job description that was once called “The Emergency Care and Transportation of the Sick and Injured.” has morphed into ”The Transportation and Care of the Sick and Injured, with Emergency Protocols.”

And you can’t forget that there has been a significant breakdown in the extended family system as well. People once relied on their nearby friends and relatives to provide them the support they needed until they could get to a doctor. We have created an institutionalized medicine delivery system of which you are the delivery boys and girls. People who turned to each other now turn to the hospital, you’re stuck with that as a reality, not an excuse or judgment. The miracle of modern medicine has created the system of which you are a part. Bottom line, you’re a major conduit into the institution, a certain proportion of the population “feels like” the only access they have to the institution is though you, and in their minds, the institution is where everybody has to go to have their healthcare needs met.

I’m not trying to be disrespectful here to you who are doing the work. Any day now I will need a couple of you to haul my carcass somewhere because insurance will pay for it and I could use the company.!

But the reason won’t be because I have an emergency; it is MOST likely to be because I have something Chronic. My point is that the proportion of your calls will be weighted on the side of chronic illnesses under uneven control. Most of your patients are part of a juggling act of medications, some “proven” while others are in some stage of evaluation or testing. In so many cases, the only sure thing about your patients is that they’re not dead!

Another Community Member who is finishing up medical school overseas with a long background in EMS added some much needed perspective to the conversation. He said:

But disease that affects people changes over time. 100 years ago if you got an infection, you would most likely die from it. In history, many of these diseases were acute in onset. Acute treatment was a valid solution.

In today’s world, the diseases of our day are chronic. The largest killers develop over decades and are not responsive to acute treatment. Procedures like cardio bypass maintain function as best they can, they do not reverse disease.

So when you try to use yesterday’s treatments, for yesterday’s reality (in today’s world — my note), you become invaluable (SIC) and obsolete. As our knowledge of medicine advances, the expert opinion of yesterday is dispelled.

“Acute,” “Chronic!” Do you know what that told me? In 1980 there was a lot more Acute going around; a lot more acute cases to be treated! And when you think about this as well, in 1980 there weren’t so many ambulances and paid personnel. Therefore, once again, proportionally, there were a lot more serious calls available per medic.

My musing (unsupported but I bet could be shown by someone wanting to look) is that in my time, the proportion of people injured in motor vehicle accidents was considerably higher. I was pretty busy on car wrecks and had few, if any, BS transports “just to be safe”. The truth is, cars are now built like brick shithouses and people just don’t get hurt as much, as often, or as badly. Could it be that the traumas of today are less traumatic? From today’s medic’s perspective, I would imagine it just feels like there aren’t that many trauma calls to get when what is really happening is that there’s so many more medics, and most everybody is so busy running IFT’s they just don’t get exposed to them all that often. Besides, most of the car wrecks are non-injury, how much fun is that?

But what the quote more directly reflects to me is that in 1980…

I know I’m harping on this “Back in my day!” shit but if you really look at it, all I’m saying is there has been a subtle shift going on that has taken hold before the stories told about “What it’s like out there!” have had a chance to change. It looks like this has happened overnight, but it hasn’t. It’s just our sudden discovery that the world that EMS formed around has passed away and now we’re working under completely different circumstances. 

…back in 1980, diseases went quickly into acute stages. A person in ailing, yet stable, health would reach a sort of “tipping point” and suddenly spin out of control; often with fatal consequences, and certainly with immediate intervention needed. That’s where I came in and those are the stories I told you about the world you were getting into. But today, so many of those very diseases — largely through the availability of pharmaceuticals — have been kept in check so well that the afflicted don’t crash, they slump! And that’s where YOU come in; to pick them up off the floor,and  take them to the hospital for an adjustment.

That’s a much more harsh and crazy-making world you’re in than I was.

But it’s also a huge ray of hope, yet, you’re going to have to make a huge adjustment. You have the chance to form this into a real profession but ONLY if you educate yourself to be able to be an essential part of the Continuity of Care of the chronically ill.

That means, as I’ve already suggested, learning pharmacy inside and out and actually getting to better understand disease processes. That way, under a doctor’s orders you may be able to re-direct patients on the use of their (often voluminous) prescriptions, eliminating trips to the ER. The system has a minimal need for treatment of true emergencies, though you damn well better be the people ready and trained to intervene in them!

Do you think a trade school education will allow you the knowledge to do that?

If you want to relieve yourself of the burden of being horizontal taxis then you’re going to have the respectability to be invited on to committees that design recieving facilities other than ERs. You’re also going to have to be an expert in the use of and referral to community resources, and maybe, just maybe, become adept at handling people. Right now, you’re being trained to handle emergencies and it’s clear that’s the smallest part of what you do.

I know all you want to do is to handle emergencies; that’s all I wanted to do, too! The illusion we share, however, is that it’s always been about emergency medicine. It never has been that way, it has always hinged on transportation. You can accept and live with that, or you can do what it takes to build a realistic profession based on the actual needs of your populace.

Then, you can also design a multi-tiered system so that there are true career paths instead of dead ends. But for that to happen, you’re going to have to dedicate the time to educate yourselves.

Our colleague Probie to Practitioner hasn’t been around long enough to be burned out. Or has he? As FNG as he is, he’s already looking it straight in the face. Maybe that will save him and act as a role model for the rest of us! In his recent Blog, his reflections prompt me to take a shot at adding some perspective.

I’m at a stage in my career where the over-the-top newbieness is starting to wear off. Sure, I usually do still get excited when my pager goes off. But now, sometimes I groan. And I don’t spring out of bed and run for my car at 2:30 a.m. with quite the enthusiasm I used to. I know I’m still a “newbie,” and probably will be for some time.

Your body won’t change much, but you sure CAN get old here pretty quick! It’s about finding yourself entering a sort of Twilight Zone (apologies to Rod Serling, but more about Thanks for the clear metaphor!) because once you enter EMS, your reality becomes a bit different than those around you. Really, how enthused can you be about getting up at 2:30 a.m. to handle what you’re sure will be nothing at best, and system abuse at worst? My gamble is you thrust yourself into a Vision of Glory (like most of us) and now find there’s not a whole helluva lotta glory in the work.

That’s typical, but what is not is that you’re putting it out there pretty close to when you started to experience it. It may not seem like a great thing now, but let’s work WITH it rather than just let it pass.

Most of the older paramedics still see me as the peachy, young, eager FNG. If I wasn’t so happy most of the time, they’d probably shake their fists at me and grumble that in their day, they didn’t have any of these fancy power cots, or stair chairs, or ambulances with engines instead of horses, and gosh darn it they were grateful.

“Back in the day” for them wasn’t a whole lot better than today is for you. Not too long after they started, they took for granted what they had, just like you may be doing now. And, of course, the picture they paint will SOUND to you like they’ve always been more humble than you percieve yourself to be right now. Remember FOGs have an investment in magnifying the FNG’s insecurities; it’s something to do with dues you’re expected to pay, just like they had to. It’s part of the culture, and yes, I’ll cop to having been part of forming it!

The other day, a paramedic who I respect quite a bit was venting about a call we’d just been on. I listened, acknowledged his feeings, and tried to explain what I thought the patient had been going through.

Can you see how different you are from the medic? Someone had to explain to him a theory of what the patient might have been going through. Since you were probably the only voice in the conversation who cared, that’s a little crazy-making because now you’re in the position of having to interpose your point of view over the dominant paradigm which is, let’s face it, to NOT really care!

My point here is that after a relatively short time of being in the job, even though to ourselves, deep inside where no one really hears us, we STILL have this voice saying “I came here to help other human beings”. But adjusting to the culture means these are words that are not spoken any more. The problem with this is without reinforcement of your very human experience, you forget that you ever had those concerns in the first place, as is evidenced by…

It wasn’t an argument; it was a discussion. We talked about our different views for a while, respectfully. Then he sighed, looked at me, and said, “You know, I’m jealous of you sometimes.” My confusion was pretty evident. “You’ve got this new perspective on everything. You still walk away from calls with that buzz. I don’t anymore.”

That “Buzz” he was talking about is the childlike part of himself that has gone somewhere so far away he’s forgotten what it feels like!

Burn out. It’s something I’m both terrified of and fascinated with. We talk about it early on in EMT school, when the idea of it happening to us is unfathomable. It’s something that happens to other people, but not me. I’m not going to get it because I really love this field, and it’ll always be that way. Right?

Not quite. You get into this mess because you have an idea of what you’re stepping into. You thought it might be a brownie but it turned into a Cancerous dog’s refuse. I’ll gamble again and say perhaps a struggle you’re experiencing right now is more about the sudden realization that human beings can be quite disgusting; so much so that you’re questioning if pure souls are granted to everyone. That is the neighborhood you work in now.

The choice of how to adjust to that reality is yours.

For those of you who have been in the field long enough (I’ll let you decide what that means for yourselves), I have questions. Is burn out inevitable?

If you think I have a rosy picture to paint, I have to apologize. From where I sit (I began working EMS in 1973) I can honestly say burnout IS inevitable. I say that because in 39 years, nothing in the culture has changed to provide medics the kinds of support they need to avoid it. You, my friend, however, may be just what we need to start changing that. You are breaking the EMS Code of Silence!

Now let me make clear that if you don’t end up puking from the emotional roller-coaster that EMS is, you’ll still fall out of the damned car because the machine was designed without seatbelts. What I’m saying is you are stuck in a viscious circle. If you don’t burn out from losing your heart because you weren’t taught how to tend to it you’ll burn out on the politics. There is almost negligible job security or upward mobility within the so-called profession. Managers in all systems deal with that reality every day so they do not have a reason to provide career-paths.

And why is that you may ask? Because there is SO MUCH burnout, turnover is rampant. With that comes an absence of voices and the fighting troops needed to push this into a real profession through education and raising the bar for standards of care for the patients. My example is Paramedics of the future will have to be trained as Sociologists and Pharmacists to cope with the needs of the people who they serve. YOU will have to make sure that happens! Unfortunately, you have to still be in the game for that to happen. Look around you; who amongst your peers will be standing by your side?

Until medics respect themselves first and then demand respect from others because of it, they’ll remain Hacks!

All of the preventitive measures that we take…do they simply delay the onset?

Help me out here…WHAT preventative measures?

You are hinting at having very human conflicts about the work you do. Very personal things. Things that might even make you want to cry sometimes. What things you’ve been taught to do to tend to your human, moral, philosophical, emotional and spiritual sides do you speak of? Is it fair to say a theme going on here is, at its simplest, an experiencing of your loss of innocence? What role models do you have of people who acknowledge that that’s part of the process? Maybe, in one respect you’re sure you’re burning out when what’s really happening is this is just the first time you’ve had to face yourself in this way.

Sure, I advocate balancing your life, keeping your focus on relationships, be the Mom or Dad that your kids need and have fun for Goddsakes! But don’t forget your hearts.

And look, Folks, I completely acknowledge that half of you function on a completely different level than the things I’m talking about and half of the remainder of you only get mild twinges now and again. For most of you, these are not places you need to go. That IS the dominant culture and I accept and honor it! So  at this point, let me make it clear that I’m not pushing for EVERYONE to be so touchy-feely, I’m just trying to make a little more room for the others to stop thinking they’re out of their fucking minds!

Does it come at you gradually, taking you before you realize its presence? Or does it hit you suddenly, maybe over the course of a single call? Maybe a combination of both, where you only realize the early signs and symptoms once it has abruptly manifested itself? What were those early signs and symptoms? How long were you in EMS before you considered yourself “burnt?”

Can you tell I’m a Compulsive Gambler? This time, my bet is that most burnouts wake up one morning and realize they misplaced their humanity many years before. “The Work” becomes something they just can’t do anymore and because over the years they’ve put on increasingly thick layers of protection to insulate themselves from day-to-day traumas, they’ve completely lost track of why. Some, if not most, DO have the luxury to start to identify the aspects of the job that really don’t work for them, but they don’t burn out they ease out intelligently and the culture demands that those remaining never really get to understand their reasonings.

We really don’t talk to each other much about things that are real, do we?

Can it be cured? Have any of you realized that you were burnt, and then taken steps to reverse it? Did it work? Or is it something that only goes into remission?

I know so many who have set a limit for themselves. Some newer EMT’s nudge and whisper to one another, “The day I do something like that, is the day I put in my two weeks notice.” Have you ever reached that limit? If you did…did you actually do what you swore you would all those years ago? Or did you stay?

(These are such incredibly juicy questions; thank you!)

Personally, I had to work really hard on placing that aspect of my life in perspective. I had to ask myself, over and over, what am I a part of? Why have I come to be here and WHO do I want to be as I do the work? Am I choosing to be a Flesh Mechanic or do I just happen to be a human being who does his very best for others in need while delivering a highly technical service? And to be more frank, this was a continual roller-coaster I was on, only occasionally attaining equilibrium. Ultimately, the politics of Union organizing did me in, so my joy at being a human doing humans’ work wasn’t able to sustain me. One step deeper and I’d have to say my experience of humanity betrayed me; perhaps I lost faith in it.

I burned out in 1985 after twelve years. The burnout rate was at 3.5 years! Does that make me an expert? Absolutely not. I burned out because my experience of the job was discovering that little parts of me were dying all the time. Some I could resuscitate, others not. After a while, it was the cumulative weight that did me in. Certain things at certain times hit me. It was all quite custom-designed. I suspect you’ll find the same; burnout is all very personal. Yet, by learning from each other, we can conceivably limit the amount of pain we’re in along the way; maybe enough  to make burnout in EMS on a par with other vital protection agencies.

Before you quit or slit your throats, let me make something clear. If you ALL change the culture and start talking with each other as if this shit mattered, and learned how to support each other through these changes, YES, EMS could become a profession with room for you to grow and prosper! But until you take on that responsibility for yourselves, no, I don’t think that will happen.

If you consider yourself burnt, why are you still in the field? I don’t ask this to be mean, or to suggest that you leave. Only you can make that decision for yourself. Considering that I know nothing about your specific situation, I’m in no position to pass judgment in one way or another. I’m simply asking what makes you stay?

I know it’s something of a sensitive subject, but if you decide to share your story, I’d be very appreciative. It’s been on my mind a lot lately, and frankly, I’m worried. If you’d rather email me individually, so you don’t have to put it out in public, feel free to email me at probie.to.practitioner@gmail.com

Thank you so much in advance.

…and here is where your friendly firetender exits Stage Right, because this is the most important question here and you are the only ones who can answer it. Please, be our teachers; for all our sakes, we need you to step up to the plate!

A mangled BMW carrying a California mother, her 10-year-old daughter and 10-week old baby was suspended over a 100 foot drop on a Santa Barbara, CA highway. Here’s the newsclip. Please watch it.

The story revolves around the fortuitous arrival of a Navy Seabees forklift which was able to stabilize the vehicle, preventing it from falling into the ravine. The vehicle had been rammed into and compressed by an 18-wheeler which slammed into it and then fell into the chasm, killing the driver. The woman and children, trapped in the car, were teetering on the edge of eternity. According to the clip, the Santa Barbara County Fire Department had been on the scene and trying to extricate them “all afternoon”.

I’m real curious about what that must have looked like especially because the video coverage that began once the forklift was in place sent shudders up my spine! There were up to ten, maybe more, turnout-clad firemen clustered around and on the car, leaning on and into each other and the car, seemingly (or is it clearly?) doing NOTHING coordinated!

Here, maybe this will help…

Maybe the guy standing on the car leaning into the sheetmetal that was against the woman’s back (Helmet 30) was in charge. Do you think so?

Perhaps it was the guy supporting himself with his hands on the pulverized guardrail (Helmet 18). Or maybe it was the guy standing on the lift bent over with his hand sticking into a sliver of space supporting the woman’s neck (Helmet 24). Nah, it must have been the two guys with the red helmets (VMP1 and Unknown) who were grabbing the woman and squeezing her out from between two slabs of metal like jerking a slice of bologna out of a sandwich! But wait a minute, the guy on the forklift (Helmet 24) may not be supporting her neck, it seems he’s holding on to the metal that supports her for dear life as he is bending over and grabbing…is that the woman’s FEET? Holy Christ, that’s what they are!

Meanwhile, Yellow Helmeted Bass has his legs wrapped around the back of Red Helmeted VMP1. I guess that’s supporting him and helping him be more flexible as he so carefully maneuvers the poor woman. Well thank God Yellow Helmet 31 and Red Helmet T11 are there to back HIM up. I was beginning to worry there weren’t enough personnel available to do the job right!

Let’s see, I count six yellow helmets, three red ones, an extra shoulder, and wait a minute, way in the back is that a WHITE helmet. How stupid of me, and all this time I thought no one was in charge! And now I can glimpse the sliver of a black helmet as well!

Okay, so what do we have? Twelve bodies crammed into the space of a Volkswagen; it must be a Clown Car!

Okay, let me calm down here again. I need perspective. Let’s ALL look at the newsclip one more time.

Well, there were a number of shots, many of which were duplicated and quick clips but at least twice I counted no less than 12 Firemen literally swarming over the car and at least three times they repeated the sequence of Yellow Helmet 30 CLIMBING all over the metal that was wedged against the woman’s back!

To be perfectly frank, sick Bastard that I am, on first view of this clusterfuck I had to laugh because it felt so familiar! The only time I shit my pants in the field was when I was inside the cab of an overturned 18-wheeler on a Santa Barbara highway trying to start an IV on the driver who was hanging upside down, supported by a shoulder harness and by his legs which were wedged in by crushed metal. There was gas leaking into the cab and just outside of me, a cluster of my comrades-in-arms, the SBCoFD were setting up a circular saw to grind open the door and get us both out! I screamed out something barely intelligible like No! NO!!! Gas, the GAS!!!!! and God or Something interceded and the fact that I’m writing this today is testimony to the fact that there really are miracles in this world!

I’m so sorry, but I just have to look at the newsclip one more time.

Yup, there’s a Red Hat, now, LEANING INTO the pulverized concrete railing!

And the extended shot of Yellow Helmet 30 shows him not moving but HOPPING around on the metal of the car leaning on the back of the woman!

That’s it, I can’t look no more, I’m getting a hemmorhoid.

Remember I said the newsclip said the FD had been working “all afternoon” until the Seabees showed up? They must have been strategizing very, very carefully. They must have thanked God the Seabees showed up. Whoever must have been in charge probably exclaimed, “Okay, Boys, now we can jump all over the car!” Oh, I forgot, I didn’t see anyone in charge, or did I miss something?

Maybe all these years have made me lose perspective. Maybe I’ve forgotten how hard stuff like this is. Maybe I’m deluded that the way to handle a scenario like this would have been with two pairs of hands wearing surgical gloves instead of 12 pairs wielding sledge hammers, and one guy close by directing ancillary resources while one more did nothing but maintain crowd control and monitor scene-safety.

Looks like I’ve become a simpleton and once more in my life, since the woman, her kids and all the firemen survived, I believe there’s a God!