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Will Your Student Become Your Teacher ?

The oldest relationship known to man people claim is that of husband and wife.  I think there is one relationship slightly older and just as sacred, that of  teacher/ student. When fire was discovered or more appropriately when someone discovered how to start a fire and he or she showed or “taught ” others how to start a fire the relationship of teacher and student was born.

When we talk of teacher/ student relationships we invariably talk about the responsibility the teacher has to the student.  That is of course to teach , but in any  successful relationship it has to be a two way street. I remember a song from the 80′s while I can’t recall who sang it, the lyric where profound, ” Everyone has two jobs. Those that know, your job is to teach and for those that don’t know your job is to learn”.

Much less talked about is the obligation of the student in the teacher/ student relationship ? The student’s job is obviously to learn but it’s more than that. A good student makes a good teacher better, but a great student can change the world. What differentiate a good student form a great student is the amount of effort and enthusiasm they bring to the learning opportunity.  They challenge the teacher to be a better and to strive for greatness hence allowing the teacher to learn and grow.  A great student bring greatness out of their teacher.  It’s a give / give relationship, being a good student makes the teacher better and having a good teacher makes the student better.

I have the pleasure at this stage in my life to be teaching a great student how to play tennis.  She is a much better student than I am a teacher which inspires me  strive to be the  quality  of teacher deserving of a student of this caliber. She challenges me to be more than I thought possible.  What makes her a good student ? Her desire to learn all that I can teach her is veracious. She challenges me when she doesn’t understand something to explain it in a way she will understand.  She shows up early for every lesson and does more in every class than I ask of her and always stays late and continues to work after the lesson is over. She comes prepared to learn . She practices and hones her skill outside of class so when she comes to class she is better than when she left. Then we can fix what may not be working and address things she may not understand. She’s not talking when she should be listening. She is not ashamed of what she doesn’t know and that makes her open to learning new things. I know she doesn’t agree with everything I say and I wouldn’t want her too. At the appropriate times she challenges my thoughts and stances. What makes a good student a joy to teach is their unwavering desire to learn.

How many times have we as EMS providers sat in a class and someone feels the need to challenge the instructor in a confrontational or disrespectful manner because they think they know more or the information being introduced rubs on someones insecurity ?  They view the fact they don’t know something as an affront to their intelligence. How many of us have been in a class with a person like that ? How many of us are that person ? I admit sometimes that is me, after 24 years in EMS when much younger instructors attempts to teach me something there is a little resistance. I have to be honest I am not always a great student which I believe has hindered my ability to be a great teacher at times.

I’m not throwing stones in a glass house because I acknowledge I am not a very good student at times and need to improve. The mark of a great student is when they become your teacher.

 

 

Do EMS Providers Always Know What to Do ?

The entire country is in shock and mourning at the evil that has been inflicted on our children. SEMSNation sends it’s deepest and most sincere condolences to the victims families and we also send our prayers to our law enforcement and EMS family who did a wonderful job, but must live with these images in a very intimate way that few outside the industry understand. If any of our family need help coping  with this I hope provisions have been made to provide for them.

This week let’s take a slight detour and talk surviving the unthinkable active shooter scenario. I’m not an expert on this topic. This has highlighted a deficiency in my training which I intend to correct immediately by attending a few classes to learn more about the subject. There are two things I want to share. First is a civilian training video by Jim Wagner discussing how to survive an active shooter by employing the strategy of playing dead. The second is a post by Robert Farago entitled “Why you shouldn’t engage an active shooter & what to do if you do“. I did not write this Blog and I can make no claims as to the validity of the information. What I am doing is offering the SEMSNation community some food for thought on this topic. Imagine what would happen during  your next event if there where an “Active Shooter”.  What  would you do ? How do we prepare for the after math of such an unspeakably evil deed ?  

Don’t forget to check out episode 2 in the series “Self Defense  for the EMS Provider”. Click Here

Jim Wagner

Why You Shouldn’t Engage an Active Shooter And What to Do If You Do

Posted on December 12, 2012 by Robert Farago

 

I learned a great deal about police procedure at the SIG SAUER Active Shooter Instructor’s  Course. If there’s one key piece of information that an armed citizen facing a gun-wielding madman in a public place needs to know it’s this: a police officer who sees you with a firearm in your hand will shoot you dead. Nobody sets up a perimeter and waits for the SWAT team anymore. No one shouts “FREEZE!” The first law enforcement officers arriving on the scene of an active shooter enter, guns drawn and attempt to neutralize the threat. I repeat: the threat is anyone with a gun. Which means two things . . .

1. Don’t engage the shooter

You don’t have to watch as a madman takes innocent life; you have the right and (one hopes) the means to stop a lethal threat. But give the opting-out option serious consideration.

Protecting the lives of your loved ones and yourself (which protects them) is your first obligation. There’s nothing wrong with running away/hiding from an active shooter. More than anything else, the arriving police need intel on the shooter or shooters. If you provide it, you’re a hero.

“I couldn’t live with myself if I didn’t stop someone from taking innocent life.” Fair enough. It’s your life. Just realize that getting shot by the police is only one of the many downsides of taking on an active shooter. For example . . .

People don’t like people who shoot at them. If you engage an active shooter he’s going to engage you right back. If you have your family or friends in tow—as in near you—taking shots at the madman will draw fire towards your loved ones.

At the risk of emboldening the gun control industry, it’s also true that you might miss the madman and hit an innocent bystander. Or that another armed citizen might mistake you for the active shooter, or the active shooter’s accomplice. Or you might get shot by the accomplice. Or accomplices.

Yes, there is that. The public’s begun to assume that active shooters work alone. Cho, Loughner, Hasan, Holmes—one sicko per incident. T’ain’t necessarily so. One word: Columbine. And another: terrorists. While you can never know the whole story, a decision to shoot or not to shoot is only as good as the information it’s based on.

Bottom line: don’t rush in where angels fear to tread. Again, anyone with a gun in an active shooter scenario is a threat. You, another armed citizen, the bad guy, an undercover cop—anyone. And everyone involved is a little . . . stressed.

2. Be fast and move

If you’re going to engage an active shooter, whatever you do, don’t forget the “speed” part of “speed, surprise and violence of action” recipe for winning a gunfight.

With cops on their way, you have a small window of opportunity. Adrenalin will make it seem like an eternity between the onset of horror and the cops’ arrival, but the time available to bring your weapon to bear is measured in seconds.

Less if you’re not engaging at the very start of the incident. Less if an armed officer is already on scene.

It may seem obvious, but the closer you get to the threat the greater your chances of hitting your target. If the situation is desperate, consider moving towards the shooter. Call it commitment or craziness. Either way, you need to act decisively.

Seek cover but don’t get married to it. Odds are you’re facing a long gun of some kind. Those odds suck and the bullets coming out of the business end do so at warp speed; enough to prove that what you thought was cover was only concealment.

[NB: When the S is done H'ing the F, reholster and cover your gun soon as humanly possible. Or put the firearm down and move away (recognizing the possibility of multiple threats).]

I write this as an armchair warrior. I don’t know what I’d do if faced with an active shooter. I hope I never find out. But there’s one thing beyond dispute: it’s better to have a gun and decide not use it than to not have a gun. Period.

Related links

[image credit http://www.thetruthaboutguns.com/2012/12/robert-farago/why-you-shouldnt-engage-an-active-shooter-and-what-to-do-if-you-do/]

http://newyorkcityguns.com/2012/08/the-five-stages-of-an-active-shooter/

Practical Defense Podcast

http://www.palladium-education.com/practicaldefense3.shtml

http://www.policeone.com/active-shooter/articles/5882617-Run-Hide-Fight-Video-shows-how-to-survive-a-shooting-attack/

http://www.psychologytoday.com/blog/riding-the-alligator/200911/how-survive-active-shooter-incident-such-fort-hood

http://www.thetruthaboutguns.com/2012/12/robert-farago/why-you-shouldnt-engage-an-active-shooter-and-what-to-do-if-you-do/

What’s a Duty to Retreat ?

Roy and Johnny are at the hospital talking to nursing staff enjoying a moment of downtime in the mist of a very busy shift. The radio comes alive “Medic 1 respond for an injured person on the street, 1208 O’Donnell Street, the time is 127hours, Medic 1 acknowledge”. Johnny grabs his portable and responds, “Medic 1 responding. The two paramedics start their unit, flip on the lights and are off headed to the bar district of the city at 1:30am looking for an injured person on the street. The two medics think about what it could be ? Roy says, “You know this is probably a bar fight and we get the loser” They both laughed. Arriving on location they meet the police who inform them they can’t find anyone. After asking communication for any further information they drive around investigating. They would hate to have the patient found unconscious in someones yard. Johnny catches a glimpse of a person sitting in an alley.

Johnny :“Stop, I found him”

Roy :“How do you know ? “

Johnny:“Who else would be sitting in an alley covered in blood, but our patient ?”

Roy : “Good point”

Roy backs Medic One up so that the scene lights illuminated the alley and calls communication to give and updated location and request police. As the two paramedics approached the patient they find him covered in blood cutting himself with a broken bottle. Roy the lead medic asked, “Sir what is going on tonight ?” Just then the patient stands up, screams and charges Roy attempting to stab him with the bottle…

Duty to retreat and Use force what are they and how does it affect EMS providers ?

Duty to retreat is a specific component which sometimes appears in doctrines governing self-defense, and must be addressed if the defendant is to prove that his or her conduct was justified. Some jurisdictions where the requirement exists, the burden of proof is on the defense to show they acted reasonably chiefly by demonstration that all necessary steps where taken to avoid a physical confrontation. Secondly showing that you took all reasonable steps to leave the situation thus demonstrating your intention not to fight before being driven to using force.

Use of force describes a right of an individual to defend against, settle a physical altercation or prophetically prevent a violent encounter. The use of force may be used to discourage an attack or to terminate a continued attack. In the United States the governments allow police, citizens, or other public safety personnel to employ force to actively prevent imminent attacks or the commission of a crime and even for deterrence.

I am not a lawyer so I am only conveying information that has been conveyed to me please don’t take my word as gospel. In the scenario does Roy have a duty to retreat before he defends himself ? Regrettably I believe he does, if he can. We are not law enforcement and are not trained to defuse violent encounters. I have seen it in my career medics get into very serious trouble because they stayed in a situation instead of retreating. I remember an instructor telling me years ago that we [EMS providers ] have an obligation to go into a situation but no obligation to stay if our safety is at risk.

Roy’s first responsibility would be to call the police which he did when he arrived and if he could retreat to the ambulance or beyond. The challenge will be physiological. Under extreme stress fine motor skills do not exist, so trying to operate the unlocking handle on a door is gonna be tough.

Assuming Roy is unable to retreat and must use force in defense of his life, then what ? I was taught and I teach all my students to avoid confrontation at all cost. If they must fight use only the minimal of force necessary to withdraw from the confrontation. The Samurai had what they called the hierarchy force doctrine which stated when using force in defense of ones self and individual had an ethical duty to retreat before restrain, restrain before injure ,injure before maim, maim before kill and kill only as a last resort. One of my favorite authorities on this topic is Jim Wagner who developed THE JIM WAGNER USE-OF-FORCE LADDER™ .

Quote Jim Wagner

Being a civilian who is learning personal protection does not isolate you from the law. Ignorance of the laws of the land is not a legal excuse that will protect you, especially when it comes to excessive force cases. Most civilian martial artists have no idea just how much trouble they can get into legally, even when they, in good faith, were just trying to protect themselves or someone else. There are a few well meaning martial artists right now sitting in prison, because they didn’t know where to draw the line, or even where the line was at in the first place when it came to the use of force. This is why I created the Use-of-Force Ladder for Civilian Self Defense™. Although “the ladder” is similar in concept to what the military and civilian law enforcement agencies must follow, my ladder is specifically designed for civilians.

Jim Wagner’s theory clearly defines the levels of threat a person is facing and an equally appropriate response level to that threat. Use of Force Ladder and the Samurai Use of Force doctrine do not differ dramatically, what Wagner’s theory does do very well is articulate exactly what an appropriate civilian use of force response is to particular threats.

Example1: If someone is talking aggressively but has not made any physically threatening gestures. This is a threat level 2 and can be defended appropriately with a confident demeanor or verbal deflection.

Example 2: Roy finds is in a threat level 3 situation where reasonable force may be used . We discussed last week what is defined by “reasonable force”.

I recommend that you read more of Jim Wagner’s writings he is very well versed on this subject and other self defense topics.

Back to the alley:

Roy was caught by surprise and backs up to leave but his retreat is blocked by a fence and two cars. The patient closes in fast with the broken bottle raised above his head in a stabbing motion. Roy just reacted and grabbed the patient’s wrist, like he has done in class many times over the years and led him to the ground and disarmed the bottle from his hands. He was uninjured and the patient received no injuries. The police arrived just after the confrontation which only took seconds to unfold and arrested him. The patient was transported to the local ER and detained for a 72 hour psych evaluation.

Next week we will continue our exploration of Self defense doctrine and EMS.

Enjoy the introductory episode of Self Defense for the EMS provider.

Visit and learn more about the skills and theory discussed in this episode click here

 

 

http://en.wikipedia.org/wiki/Use_of_force

http://en.wikipedia.org/wiki/Duty_to_retreat

http://www.usadojo.com/articles/jim-wagner/use-force-ladder.htm

[image credit http://www.usadojo.com/articles/jim-wagner/use-force-poster.htm]

[image credit http://www.theaustralian.com.au/sport/football/outrage-as-boy-6-injured-in-brawl/story-fn63e0vj-1226450457937]

What would a reasonable man do ?

Recently Super Storm Sandy hit the east coast of the United States. Where I reside received nothing more than a little rain, but New Jersey and New York where not so fortunate. After the storm Maryland sent a contingent of EMS providers to New Jersey to assist with the aftermath. I was a little concerned when a friend of mine posted on Facebook that they where being sent into an area that was experiencing civil unrest and spotty cell coverage.

November 1 near Cardiff, NJ via mobile

Units will be doing 911 calls in Newark NJ, and possibly search rescue and recovery. We have been advised cell service is hit or miss but sms messaging works well. We will keep you up to date. We have been cautioned that there is some civil unrest in our theater of operation

3051Like · · Share

 

Anyone that knows me knows I am a staunch advocate of EMS personnel training themselves in the art of self defense. Day in and day out we may not need the skills but increasingly EMS personnel are called into more and more volatile situations such as civil unrest or violent protest. Hurricane Sandy is fresh in our memories but let’s not forget November 2011 riots that broke out at Penn State, March 2010 the riots after a University of Maryland basketball game and the EMT injured in New York at the Occupy Wall Street Protest. It may just be me but civil unrest seems to be on the rise with EMS providers on the front line as usual,poorly trained and equipped, as usual.

What self defense laws govern our response to a violent attack ? In the eyes of the law what constitutes a violent attack ? When is it appropriate for a public safety worker, namely EMS providers to use self defense techniques ? How will our actions be judged in the eyes of the law and public opinion ? I started researching self defense doctrines, but first I am not a lawyer, I am a paramedic that has extensive training in the martial arts. I am not offering legal advice or direction, consult your legal adviser for that. I am simply exploring the realm of self defense and some of the consequences of using it. I work in an environment that may pose a higher probability for civil unrest then normal, although there is no data to support that statement just my opinion based solely on my 23 years of experience in special events.

I generally tell my students and EMS personnel as a general “rule of thumb” use only enough force to stop the attack so that you may withdraw from the situation. If you use an once more you are opening yourself up to who knows what. In this country “Monday morning quarter backing” is our national past time. We have millisecond to make decisions and react and the people who will judges those actions have hours and days to pass judgment and the advantage of knowing the outcome in advance.

I believe generally  if you hurt someone while defending yourself you may ultimately find yourself in more trouble than the person that attacked you. Remember EMS providers are no civilians, but public safety workers. People wrongfully assume we have the skills and training of a Navy Seal, when the reality is very different. Our training is minimal to none existent in handling violent encounters. Let me state this again I am not a lawyer or an expert concerning the legal side of self defense but I make the statements I make based solely on my experience in the profession. For 20 plus years I’ve watched the watching the consequences EMS personnel have had to face after a violent encounters and I can honestly say they have not always been treated fairly in my opinion.

Since I reside in Maryland I started my research with Maryland Self Defense Doctrine.

Law principles of the doctrine of self-defense:

In the case of Baltimore Transit Co. v. Faulkner, 179 Md. 598, 20 A.2d 485 (1941), which involved a civil lawsuit for assault and battery, the Court of Appeals of Maryland set forth the general common law principles of the doctrine of self-defense:

The law of self-defense justifies an act done in the reasonable belief of immediate danger. If an injury was done by a defendant in justifiable self-defense, he can neither be punished criminally nor held responsible for damages in a civil action. . . . One who seeks to justify an assault on the ground that he acted in self-defense must show that he used no more force than the exigency reasonably demanded. The belief of a defendant in an action for assault that the plaintiff intended to do him bodily harm cannot support a plea of self-defense unless it was such a belief as a person of average prudence would entertain under similar circumstances. The jury should accordingly be instructed that to justify assault and battery in self-defense the circumstances must be such as would have induced a reasonable man of average prudence to make such an assault in order to protect himself. The question whether the belief of the defendant that he was about to be injured was a reasonable one under all the circumstances is a question for the consideration of the jury.

Id., 179 Md. at 600-01, 20 A.2d at 487.

The Court of Appeals said that, even if the plaintiff had struck the defendant’s employees first, the plaintiff would still be entitled to prevail in an action for battery if the defendant’s employees, in repelling the plaintiff’s acts, “used unreasonable and excessive force, meaning such force as prudent men would not have used under all the circumstances of the case.” Id., 179 Md. at 600, 20 A.2d at 487.

Maryland seems to place a person’s culpability on the “reasonable belief of immediate danger.” and “such force as prudent men would not have used”. My question is what is the standard for EMS providers ? We know the legal standard for police officers and soldiers’ use of force is different than for civilians. The reason is based on the fact that these two groups of people have received training to deal with violent encounters. It is assumed that an average civilian has not had the same extensive training hence their reaction would reasonably be expected to differ. Civilians enjoy a lower standard for “ person of average prudence would entertain under similar circumstances” than trained public servants. EMS providers may exist in a legal limbo because generally EMS providers receive no specific training to deal with violent encounters, but we often find ourselves in violent situations with the perception that we have received such training.

What are the standards an EMS provider can expect to be held to ? What if the provider has received self defense training on your own, then what is the standard ? I will explore all these questions and hopefully shed some light on the legal ramifications EMS providers may face if they ever find themselves having to defend themselves and their actions are called into question.

Next week when I release the second blog in this series as well as the first episode of self defense for the EMS provider. To view the upcoming show please become a member today.  Join Today

Self Defense For the EMS Provider

 

 

Reference

[Image from http://www.ems1.com/special-reports/595161-Careful-dont-let-him-bite-you/]

http://blogs.villagevoice.com/runninscared/2011/11/emt_injured_whi.php

http://en.wikipedia.org/wiki/Right_of_self-defense_in_Maryland

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC4QFjAA&url=http%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2010%2F03%2F04%2FAR2010030405060.html&ei=V1jBUNa-FrK30gGvyIDoDw&usg=AFQjCNGzfsy7qbVtisKK_rJZH7GcyfVuLQ

 

INTERNAL AFFAIRS: Communicating During a Tragedy

In the wake of Hurricane Sandy this seems like a very fitting repost…especially while our brothers and sisters are still in harms way in New Jersey & New York

God Bless

To clarify I did not write this article it appeared December 1, 2006 in EMSWorld Magazine … Someone representing himself as working on behalf of EMSWorld contacted us … so instead of the article appearing here I am providing the link only … it’s important information and can be useful to the community… OK JB?

http://www.emsworld.com/article/10322213/internal-affairs-communicating-during-a-tragedy

 

Sports Safety Systems Go High Tech

Every medic has been there at least once; you are attending to a patient and you encounter something completely new. It could be a medication you have never seen, or a disease you have never heard of. For an event medic, it is often a sports safety system we have never seen and we often have no idea how it works. Of course this can be prevented with proper preplanning by event medics and event organizers. However, this article will focus only on several new sports safety devices that event medics should be on the lookout for. Sports safety systems are now ubiquitous in most sports. From helmets and eye protection, to knee and elbow pads, many sports now require some safety protection. However, as sports practitioners become better, faster, higher flying, and more daring, safety systems have had to keep up. Also, new technologies that are lighter and stronger allow athletes to take their craft even further. Several of the following products are brand new. And some have been around for quite some time, but are only now seeing widespread use. Either way, event medics always need to be on the lookout for these new safety devices.

Eject Helmet Removal System

The Eject Helmet Removal System is a device that is used, not to protect an athlete, but to prevent further injury during helmet removal after an injury. The device is a small folded bag, that is pre-installed in the helmet, or inserted by trained medical personnel. The bag is then slowly inflated, slipping the helmet evenly off the patients head. When used properly, the Eject is said to reduce the movement of the cervical spine during helmet removal. This device is most commonly seen during Motocross events, and has seen wide acceptance among riders. Some motocross organizations are now requiring riders at their events to have the device pre installed. The maker of the Eject, Shock Doctor, also makes a version that is designed to be inserted after a crash if there is not a pre installed device. It is important to note that proper training is a must before using the Eject system.

The above and more information available at www.shockdoctor.com and www.ejectsafety.com

Point Two Air Jacket

The Point Two Air jacket is a relatively new device designed to prevent, and reduce the severity of, injuries sustained during equestrian events. The device is a vest worn by the rider. The vest has a lanyard attached to the saddle which, when pulled (as during a fall), will cause the vest to rapidly inflate. The device is said to better protect the rider from thoracic, abdominal, and some spinal injuries, than the current standard, non-inflating vests. The manufacturer, Point Two, says the vest fully inflates in 0.1 seconds, and protects the rider six times better than standard equestrian vests. The Air Jacket, or others like it, are now in widespread use at some equestrian events, mainly the discipline of eventing. The vests are not generally used for horse racing or steeplechase events. EMS providers should know that the vests are fairly easy to remove after inflation, and are safe to cut away after inflation. Care should be exercised when treating a patient with an un-inflated vest. The vest should be properly disabled before removal. Also, the vest provides no special protection to the cervical spine, and normal precautions should still be taken.

The above and more information available at www.point-two.co.uk

HANS, Hutchens, and Isaac Devices

Head restraint devices are, fortunately, now almost universally accepted as required car racing safety devices. After several high profile deaths in the racing world from basilar skull fractures, the motor sports world went looking for a new safety device. These devices work by simply restraining the head from whipping forward during a high energy frontal impact. This prevents what is known as whiplash, but also the much more deadly basilar skull fracture. The device most commonly seen is the HANS device. HANS stands for Head And Neck Support. The HANS is used by most professional motor sports organizations. The similar Hutchens device was once very popular, but usage has declined in recent years. The HANS and Hutchens devices use simple webbing connected to the back of the helmet to the racing harness or a brace. The webbing prevents excessive movement of the head. The Isaac device, while operating on the same principle, works slightly different. The Isaac uses small shock absorbers, or dampers in place of webbing. For EMS providers, a working knowledge of how to extricate and treat patients wearing these devices is vital. There is no single consensus concerning the proper removal/no removal by EMS providers. Therefore, be sure to consult your medical director, and the event medical staff before the event.

The above and more information is available at www.hansdevice.com, www.isaacdirect.com, and www.hutchensdevice.com

The above safety devices are only a few of many new safety devices that are developed every year. As an event medic, it is imperative that proper training, research, and preplanning are done, so that all event medical staff are aware of the specific needs of each event. If you still happen to encounter something new and unknown at an event simply work around it as best you can, or enlist the help of the event staff or other athletes, as they may know what you don’t!

This article is not sponsored by and is not an endorsement of any product. It is meant only for the education of EMS personnel on new sports safety devices. Eject, Shock Doctor, Point Two Air Jacket, HANS Device, Hutchens Device, and Isaac Device are trademarks of their respective owners.

http://www.ejectsafety.com/home.html

 

Proper Hydration & Cold Weather Events

During the summer months there is a heightened awareness of the importance of proper hydration. Unfortunately as the weather gets cooler people are not as cognizant of the significance of proper hydration. Event organizers and medical personnel need to be aware that it is still important to make sure the participants are properly hydrated even during the cooler months. In the summer months everyone is aware of the devastating “one, two punch” of dehydration and extreme heat which if unchecked can rapidly deteriorate into heat exhaustion or worse, heat stroke. The profound and rapid deterioration noticed in a person suffering from dehydration in the summer months are not as common in the cooler months. Make no mistake, dehydration is still a major concern, but the symptoms are harder to spot. Instead of a rapid decline, a more gradual regression often presents.

As in the summer months dehydration among older adults and children can exacerbate existing health issues. As people add layers of clothing in an attempt to stay warm and move around they sweat more profusely than previously thought and lose fluid. Chris Solomon, author of the article“How winter conspires to dehydrate you” states, “skiers who are wrapped in layers often have no idea just how much they’re sweating. A normally-attired skier exercising moderately to heavily at 32 degrees can lose 4 pounds of sweat in just one hour”

Another culprit is the weather which removes moisture from your body by way of the skin, nose, and throat. This is why complaints of both dry skin and mucus membranes increase during the winter months as the wind and sun cause the moisture to evaporate.

Concerns for EMS

If we take a moment and recall from our training the pathology of perspiring. The act of the body “perspiring” pulls liquid from the bloodstream to the surface of the skin. Once on the surface it evaporates causing a cooling of the body. Perspiring without replacing the fluid causes the blood volume to drop and the heart to work harder to maintain adequate circulation.

Hypothermia caused by the evaporation of the perspiration is a cause of concern to the medical provider. An early sign of hypothermia is shivering which is caused by the body rerouting blood from the extremities to the core. This coupled with the decline of the volume of water available to the body can cause diminished circulation resulting in premature fatigue and lapses in judgment. These two factors can contribute to cause accidents resulting in devastating life altering injuries.

What to do

The current guideline for proper hydration in summer time heat is that a person should consume enough fluids to urinate every 45 minutes to an hour, or a minimum of 2 liters of fluid a day. This is still a good rule of thumb even in the cooler months. Your medical response should not over look the need for proper amounts of water for participants just because it may not be scorching hot. If you find your service protecting a cold weather event, you should use to passive interview method, described in the book “Special Events Medical Services” to gauge a participant’s orientation and general cognitive comprehension. If there is a cause for concern, then proceed to the next step in your jurisdiction medical treatment protocols.

Prior to the event take time and familiarize yourself with the signs and symptoms of hypothermia, dehydration and the treatment modalities for both. This is especially important if you don’t deal with cold weather emergencies often. Make sure that you are prepared for the weather’s effects by reading your protocols – even if you feel you know what to expect.

Ensure that you have plenty of water and blankets on hand. Make sure every jump bag has at
least 1 to 2 emergency blankets and have a practiced plan and designated location for rewarming.

By taking simple steps you can reduce the need for medical assistance dramatically. It’s always
better to be overly prepared for weather related health issues than not.

related links

http://www.backcountry.com/store/newsletter/a42/Cold-Sweat-Winter-Dehydration.html

Do You Always Play Till The Whistle.

This week’s blog isn’t about EMS, Special Events or Martial Arts it’s kinda about life in general. As everyone knows by now I was a tournament level tennis player and played through college. I stopped playing around age 25 and just stated again this year after being elbowed in the eye twice during a pick up basketball game. I took on a student, a very talented young lady and I am teaching her the game. This is how the natural cycle works I was taught by Steve and now I am passing along my experience and teaching this young lady and one day she will pass on these skills to someone.

At the conclusion of our weekly lesson her dad , my student and I always talk about what we learned that week and what I want her to do during the upcoming week. The assignment I gave her was to practicing her service toss every day and serve 2 baskets of ball every time she goes to the court. I told her I want her to start playing matches and our philosophy is we play all comers. Meaning we play who ever wants to play us. I said to her,” you should even play the guy Scott”, who is the local courts “Top Hitter”. She got a look on her face like “are you crazy, he’s too good I can’t beat him”.

This is what my dad calls a teachable moments. I had to impart the warrior philosophy my tennis coach instilled in me years ago. What he impressed upon every student was to compete for every point no matter how hopeless it may seem. He had a no quit attitude and he expected every student he taught to have it. There is no ball he believed he couldn’t run down or would not be willing to run down. He bestowed the understanding that we could only worry about things we had control of and not to concern myself with anything else. I had absolutely no control over my opponent. I couldn’t control if he was better than me, older ,stronger or more experienced. I also had no control over the weather, the condition of the court, bounce of the ball or bad line calls. So I was conditioned to pay these things no attention once so ever. I was also taught that winning and losing is beyond your my control thus winning was never the goal. The goal was to compete and compete hard..

The things I had control over and Steve held us accountable, were being prepared to play every point to our maximum ability. I had control over my conditioning and I was expected to be in top physical condition at all times. You didn’t attend a Steve tennis camp, you survived it. It was impressed upon me that I had complete control of my attitude and that I must stoke the flames of desire and the fighting spirit for every point.

Steve constantly reminded us with “one more drill” that we could always practice more and improve . Per the Steve doctrine during a match never focus on everything pick one or two things and that’s it . I would chose “watching the ball” and “contact point”. Through my years as a tennis player and in life I am constantly amazed how far these rules have taken me. I’m constantly amazed at the number of people just unprepared or unwilling to compete as hard as they can even for a short period of time. I have learned this much about people, “ A Barking Dogs Rarely Bites”.

I passed these words of wisdom along to her with an added piece of my own and I told her if she did these things she will win way more than she loses but she will still lose , a lot but don’t worry about that because there is no such thing as losing in life, there is only experience. More importantly I told her,” If you do these things winning and losing won’t matter because you will always feel good about the effort you put forth and you will feel good about yourself and that is what we call confidence and confidence is unstoppable ”.

Steve like every great teacher was teaching his students about more than just tennis, but life . Jim Brown said it best in the movie Any Given Sunday : You do it as tough as it is possible to do. And you do that in all things. You die hard! That’s what I’m talkin’ about.

Analog or Digital ?

Navy.mil Photo of Navy Seals

A few years ago an old friend contacted me. He began to explain that he had been injured at on the job and forced to retire. I asked him what he was going to do ? he said he was up for a job with Federal Government , but he would have to go back to school and finish his degree. I didn’t want to bring him down any more than he already was, but I thought it was unlikely he would get the job. Why would they wait for him to complete a degree for a job they obviously needed filled now? Why wouldn’t they just hire someone with all the needed qualifications now ? The time to prepare for an opportunity in the future is now.

I see young folks increasingly make this mistakes over and over again in pursuit of money. They sacrifice the future, where the really big pay offs are for what they perceive as an immediate benefit today. Dropping out of school or college to join the fire department is not a wise move. As I advance in age I am sure of only one thing and that is the world is not becoming a simpler place.

The EMS work force of the future will be more akin to Special Operators of the famed Navy Seals. Our future work force will rely more on college graduates with technology backgrounds. Simply having a paramedic license will not be enough they will be required not only to be outstanding physical specimens  but have much more training. Future providers will be experts at information gathering, data processing , Tactical Medicine, Haz Mat Operations, Critical Care Transport , SEMS Certified, and High Angle Rescue capable as a minimum. like Military Special Operators their schooling will never be complete.

The reason why this is the future is simply money! While it may cost more up front to find and train these operators the cost going forward 20 to 25 years with much smaller and better trained work force will afford jurisdictions substantial savings. The selection process will be rigorous to garner one of these coveted positions. This means no one will wait for you to become qualified, you must arrive first day over qualified. The great news for those ready for the future is that compensation will be substantial because there will be fewer people and they will be well compensated.

If that argument is not enough for young people to pursue as much education as possible before entering our field think about this, EMS and Public Safety is like professional sports. The sad truth is not many EMS providers make it to retirement and even fewer make it to retirement unscathed and uninjured. When I was with the fire department I was told the average career of a paramedic was 8 years. That meant like a professional NFL players I would need a second career after my playing days where over. Your playing days can end for a number of reasons and career ending injuries are not uncommon in the NFL or the Fire Service.

Remember two things the world is becoming a much more complex place,don’t fall into the trap of being an analog employees in a digital work force. Prepare for your future opportunity now.

 

 

 

What did we learn today ?

I would like to share a short story about a lesson I learned a long time ago and have never forgotten. In my current position I have the opportunity to meet and work with many young medics. I was conversing with one the other day and I said ,”I don’t like teaching some new medics” and she replied,”Your not unique most people in EMS don’t like teaching new people”.

That’s a problem, when I was a pup of a medic many years ago I had some of the best medics in the world teach and mentor me. Carl During, Bobby Jones, Tom Skinner and Ken Batson to name a few  shaped my early career and later came Sharone Stewart , Tom Kelly and Bill Little. They taught me and mentored me, not in a formal way but they took every opportunity to share their knowledge and experience with me. Fast forward to today what has changed ? I think I know and I can best explain in a story from my past.

One of my best friends in the world , we will call him Murray was a 6 foot 4 inch point guard with an awesome jumper and a great inside game and played for a major Division 1 program and for a time was a serious pro prospect. During our summer breaks Murray and I would visit different courts around the city and county trying to find “good” games. We where looking for the best players to play against. This particular summer day we heard that the best players where at Murphy Homes in the inner city. Being suburban kids we just didn’t go into the city but if that’s where the best player where then that’s where we where going to be. Off we went in the 1985 Volkswagen Quantum 5 speed war wagon. Still my favorite car of all times, but that’s another story.

Murray was playing particularly well that day and some how I ended up sitting out a few games. I think its just how it lined up when we shot for teams, I really don’t remember the particulars. The thing was that day Murray was talking a lot of smack because the local didn’t initially respect his game and made some disparaging remarks about him and they may have even mentioned his mother. They didn’t know him all they knew is he wasn’t from around there. That day he played as well as I had ever seen him play, he couldn’t miss and he let everyone know it. Jumper after after jumper, lay up after lay up he was money. The local basketball court legends didn’t like being shown up by 2 outsiders. I include myself in this because he was my friend and we where there together.

After like his fifth strait win and shooting a jumper in the face of the best player on the other team and just humiliating the poor guy in front of his friends I look up and Murray is getting the crap beat out of him by it seemed like everyone in the projects. I go running in to help and I get the crap kick out of me. Fortunately back then there where no guns you just took your beating and left and that’s exactly what we did.

Bruised and battered we made our way to the war wagon and home to the suburbs. Limping home with black eyes, busted lips and bruised egos I sarcastically asked Murray,” What did we learn today ?”

In all seriousness those guy taught both of us a life lesson we have never forgotten, humility. To be humble in all things you do. Never humiliate someone because your better or know more. That being humble will take you further than being cocky. These guys didn’t mind losing they just didn’t like being humiliated. Murray and I had an obligation while winning and losing to conduct ourselves in a classy respectful manner and to afford everyone their dignity.

What is missing from these new medics that makes older medics not want to teach them ? Yup a trip to the basketball court.

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