The Unwired Medic

Teaching EMS providers & other public safety pros about using mobile tech to improve their practice, patient care, continuing education, scene safety, general entertainment, & productivity.

November 29, 2018
by The Unwired Medic
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Do you still belong in Public Safety?

Depression is a terrible thing. It’s even worse when you begin to contemplate ending your life. And you’re probably filled to the brim with “awareness”. If anything, you are more acutely “aware” than most. I’d like to propose an alternative solution to coping with your demons. Maybe it’s time to consider moving on from EMS, Fire, or Law Enforcement.

I know. You’ve invested a lot of time and education, and you’ve poured your heart and soul into it, but are you getting back what you are putting into it, or is it slowly eating away at you? Are you able to be the person you want to be now? Are you able to separate your identity from your dedication to your work? Are all your friends also in public safety? Do you only talk about your work and the things you have seen? If public safety is also your off-duty identity, I submit the answer is quite possibly “no”. Maybe the Return on Investment isn’t so good anymore. When an investor sees that their returns aren’t worth what they are putting in, they move their investments to something that does return enough. They don’t keep funding a dying thing, hoping to get a little more return.

Hear me out. There are plenty of career alternatives. Photography, technology, sales, counseling, occupational health, public health preparedness (PHP), emergency management (EM), OSHA/MSHA, post-secondary education, educational upgrade to a higher level of care provider or specialist, and so much more. A lot of these options can be quite intrinsically rewarding. Personally, I found education, and both PHP and EM very rewarding. Career counselors can even survey your skills and interests and give you alternatives to evaluate too. You can also keep going in public safety on a part-time or reserve status, or volunteer for a DMAT or something.

But for your own sake, if your outside life is getting to be indistinguishable from work, you seriously need to take stock in yourself and be honest in your evaluation. We don’t need bitter old codgers and we don’t need people on the edge of losing it, one more call away from signing off permanently. You to be whole and compassionate, even for a simple lift assist or IFT, but most especially for yourself and your family. Burn-out is real and even I’ve been there for a time. I’ve asked myself why the hell I keep getting out of bed for this if I can’t get anything more than a paycheck (and not really a very good one at that). My family deserved better, and especially I deserved better. You do too. Be honest with yourself and do what is right for you. Don’t be the next last call. Don’t be the next reason we put a mourning band on our badges. You are better than that, and you have the power to prevent that and reclaim your happiness. You deserve it and don’t ever let yourself believe otherwise. You don’t have to force yourself to pretend to be happy in public safety. It’s a big investment in our lives to be here, but maybe the smart money is on diversification. The smart investor knows when it’s time to spread out his portfolio, and when it’s time to move on to a new thing.

It sounds cheesy AF, but a line The Gambler, by Kenny Rogers, really applies here…

“You’ve got to know when to hold ’em, know when to fold’ em, know when to walk away, and know when to run.”

November 2, 2018
by The Unwired Medic
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Verizon’s Palm Device – Redundant or Boon?

Verizon Palm

So, it’s not really a phone that makes calls, texts, runs Android with a full suite of apps, has a 12MP camera, runs social media, does voice commands, plays media, can run without your regular phone, but syncs with it (even iPhone)?

So we finally have a (not) phone that fits into that so-called “phone pocket” built into your pants. Right!

It seems it may cost an additional $10/mo and if you are an iOS device user, you have to disable iMessages to sync texts. And for you nostalgia types, no Graffiti. 😠 That’s a problem for texting on such a small screen, so use a stylus, fat finger a lot of things on the keyboard, or voice-to-text. Still, this may be a great option for #EMS, as I am hesitant to bring a $1k phone on scene with me, but I still want comms with dispatch, supervisors, and medical control, and may want to jot down some notes. Maybe an #ePCR app will work with it while you take quick notes on scene until you can get back to a tablet or laptop. Maybe this can replace a handheld radio for dispatch comms via an app like iamresponding. This could be a real boon to public safety.

This could provide instant access to WISER and ERG, ePocrates, Medscape, and MicroMedex Drugs/Compatibility/Peds/NeoFax, your medical reference ebooks like Harrisons and others, assorted specialty calculators, your pocket field guides, ICS Forms, and allow you to Bluetooth to your cardiac monitor. I would need to test this with mobile device management suites like Airwatch, but I imagine it could support encryption and lost device protection. There are lots of possibilities, and at a third the price of a flagship smartphone, I could see this being very useful in public safety.

#Verizon #VerizonWireless

September 26, 2018
by The Unwired Medic
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Backboards in the dumpster?

This is a travesty! Please don’t do this! Save those backboards!

Upcycle, MF’s! Those make awesome:

  • Toboggans
  • Workbenches
  • Garage and rafter shelving
  • Many float so you can use them in the pool or as a poor man’s surfboard
  • They also make good bachelor coffee tables
  • Plant shelving for vertical gardening
  • Pergolas
  • Line your truck bed for transporting things you don’t want damaging the bed
  • Replace the top part of a bench seat after the padding rips apart
  • And much more!

Whatever you do is fine, as long as you quit using them on patients! Share your ideas to upcycle with old backboards (wood and plastic) in the comments below!

September 22, 2018
by The Unwired Medic
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Notification Fatigue

Alarm Fatigue…

Some time ago, nurses were studied and found to be suffering from alarm fatigue, which became especially problematic in areas like the ICU, ER, and Cardiac/Telemetry units. Bed alerts were being tuned out. Arrhythmia alarms ignored, and more. Have you spent time admitted to a hospital? How long does it feel like it takes the staff to respond to call lights and IV pump alarms (staffing issues notwithstanding)? Seems like an eternity sometimes. Honestly, it’s not their fault. They cope with their work environment to their ability to tolerate the constant and incessant onslaught of beeps, tones, pages, and dings fairly well, but when is it too much?

Yes, You Too…

How are we in public safety any different? Tones for call outs, pagers, cell notifications, MDTs, radios with squawks and chirps, and then we have our own monitors too, like pulsoxes, ETCO2, glucometers, cardiac monitors, vents, apparatus alarms and chimes, sirens and horns.

Now, lets throw smartphones and fitness bands and smartwatches in to that. Social media, entertainment, fitness, and gaming apps all pining for every moment of our time. “Did you see Joe Nobody’s recent update?” “An event was just posted by this business you visit once a year.” “Traffic congestion on your way to work. Try this route to save 1 minute.” “Special Star Team Event Begins NOW! Login and place on the leaderboard!” “I see you haven’t stepped on your smart scale in a few days. Step on and track your progress towards ignoring your fitness goals now!” How can you be at your best serving the public when you are drowning in alerts and app notifications?

Notification Fatigue…

Today, I decided to sleep in after treating a long-standing migraine, so since I personally have turned off the sound and vibrate notifications on almost everything. I got two text messages out of the blue from a K-12 charter school. My kid goes to one, but not their high school, which implemented their first Varsity team this year. The text program is part of SchoolReach, and the text messages are only used for notices of closures, construction by the schools, Code Reds and Yellows, and other urgent matters. Today they decided we, the parents of all the K-12 students, just had to be told to come support their Varsity team and fill the bleachers.

Simply put, whether a text, an app, or other thing that is deemed worthy of incessant intrusion regardless of relevance, must be dealt with, because none of these platforms gives 2 bowel movements about how you feel today or that you just ended a long, tiring shift, or that you work graveyards.

What can you do?

In my text message notification issue, I promptly responded to school administrators that this expansion qualified as notification fatigue and that the six other ways they keep telling us this information, regardless of campus, are sufficient, and to please stop the madness. App developers, my voice is lost in a sea of apathetic users, so I don’t bother. There are other ways to handle them

For starters, your apps notifications can be configured for silent, vibrate, and audio. They can send push notifications. Good app developers also let you decide how often they can send them. If they don’t offer sufficient options, usually in the phone setting under apps, you can block all their notifications completely. If you can’t see your way to diminishing the amount of notifications you get and are busy responding to most of them, perhaps some self-evaluation is in order. Is it nomophobia? Unsubscribe from text messages and notifications for things that aren’t really important. Do you need an e-mail and text and app and smartwatch notification to tell you what new movie is on Amazon Prime Video or Netflix or Hulu? Do you need to see EVERY social media update that platform’s algorithm deems important enough to ping you on? My kids weren’t that needy as babies. Yours?

Personally, I’ve quit a couple games and more than one social media platform recently. Others I have decided to take a few days or a week away from altogether to force myself to remember there is a sky and sunshine and stars and real people I could be spending my time with. No one will remember me for my social media prowess, but they will remember me for being a part of their lives.

See? Nobody cares!

To rephrase Smokey the Bear, “Only you can prevent unnecessary notification fatigue.”

By the way, don’t forget to subscribe to my blog and social media pages for notifications on my infrequent ramblings and musings. MTFBWY, live long and prosper, and for God’s sake people, let’s be careful out there!

January 22, 2018
by The Unwired Medic
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Ehrmagerd! Fentanyl!!!

From the Northern New England Poison Control: “The risk of significant opioid exposure is minimal for first responders who encounter fentanyl, carfentanil or other fentanyl analogs in the field. The evidence suggests that limited precautions, such as nitrile gloves, provide sufficient protection from harm. Use of excessive protective equipment could delay patient care and prevent first responders from performing their duties well.”

Fentanyl Everywhere

Sensationalistic articles are popping up like wildfire about Fentanyl exposure. So how on earth have Paramedics and Nurses been able to give Fentanyl and Duragesic Patches to patients for decades without dying of overdoses? It’s astounding any of us have survived!

Look, the hype and hysteria is just that. Touching a drawer handle isn’t going to make you weak-kneed and give you headaches and make you feel like you will pass out. You’re awake and fully lucid one second and lying on the floor the next. That’s just not reality. What we seem to be missing from all these reports are toxicology labs proving Fentanyl is the culprit. I have no doubt some of these cases are psychosomatic due to the stigma over Fentanyl and its cousins, like Carfentanil.

Are the drugs dangerous? Sure, with extensive exposure and even injection of high doses.

Should we be concerned with exposure? Yes, but no more so than with contracting Hep C, influenza, or any other communicable pathogen.

Now, the Northern New England Poison Control has released some solid, common sense guidance on dealing with Fentanyl (and related drugs) exposure, and NOTE the guidance on administration of Narcan (naloxone). Only for RESPIRATORY DEPRESSION! Not for any other symptom! This is what proper use of Narcan is for. Not for pinpoint pupils, not for fatigue, not for weakness, and NOT AS A PREVENTATIVE MEDICATION “just in case” you come across Fentanyl.

Download the .pdf flyer on Fentanyl and please pass it arpund as a memo to your department, and train on this too!

http://www.nnepc.org/shop/fentanyl-carfentanil-fact-sheet-for-first-responders

Here are some photos of the document:

EDIT: The following information is the position of the nation’s boards of toxicology experts:

ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to
Emergency Responders

The position of the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology
(AACT), is as follows:

Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to
emergency responders is extremely low. To date, we have not seen reports of emergency responders developing
signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity. For routine handling of drug, nitrile gloves provide sufficient dermal protection. In exceptional circumstances where there are drug particles or droplets suspended in the air, an N95 respirator provides
sufficient protection. Workers who may encounter fentanyl or fentanyl analogs should be trained to recognize the
signs and symptoms of opioid intoxication, have naloxone readily available, and be trained to administer naloxone and provide active medical assistance. In the unlikely event of poisoning, naloxone should be administered to those with objective signs of hypoventilation or a depressed level of consciousness, and not for vague concerns such as dizziness or anxiety. In the absence of prolonged hypoxia, no persistent effects are expected following fentanyl or fentanyl analog exposures. Those with small subclinical exposures and those who awaken normally following naloxone administration will not experience long-term effects. While individual practitioners may differ, these are the
positions of American College of Medical Toxicology and American Academy of Clinical Toxicology at the time written, after a review of the issue and scientific literature.

https://www.acmt.net/_Library/Fentanyl_Position/Fentanyl_PPE_Emergency_Responders_.pdf