Michael A. Di Iorio | La Zone Grise

Michel A. Di Iorio

Il vient un temps dans la vie de chacun, où il vaut mieux vivre le moment que de le questionner et/ou le défier à outrance…

Nous avons tous répondu à des appels qui tombaient dans la zone dite « grise »… soit la Dead Zone des services d’urgence, dont l’instruction théorique ne couvrit pas toutes les possibilités. Ce genre d’appel à l’aide fut chose courante à l’époque des services de médecins à domicile (pré-US), et malgré les progrès associés à l’implémentation de protocoles universels, il y en a toujours… mais on n’aime pas trop les ébruiter…

Parlons-en de cette zone grise, alors…

J’étais/je suis un père qui place sa famille en tête de liste d’importance et de priorité, alors ce fut sans difficulté que je me suis retrouvé cœur et âme jusqu’aux coudes devant l’impasse du devoir professionnel contre le devoir paternel, et ce, dans le butoir très étroit de la soirée de noces de la fille unique de mon patient…

J’étais en devoir depuis quelque 27 heures et des poussières, car mon quart de travail pré US couvrait du vendredi à dix-huit heures, au dimanche à vingt-trois heures. Nous commencions à peine à déguster notre délicieuse pizza spéciale, jumbo avec extra tomates et oignons… c’était inclus dans l’offre, quand la radio s’est mise à cracher l’adresse d’un hôtel huppé de Laval, et bien évidemment, notre véhicule étant le plus près, les mouettes ont mieux mangé que nous ce soir-là; les boomers se souviendront de l’époque ou l’ambulance nous servait quasiment de caserne. Le motif de l’appel fut une détresse respiratoire; nous étions donc autorisés à utiliser les gyrophares et la sirène.

Vu l’opulence des préparatifs accessoires à l’occasion, l’endroit fut bondé d’une clientèle exubérante et mixte, tous à la recherche d’un éclatement digne d’un samedi soir de canicule. Nous avions donc adopté comme stratégie « l’entrée discrète », quoiqu’on nous a immédiatement repérés et dirigés à l’étage de l’immeuble. Le père de la mariée attendait notre arrivée, impatient et visiblement mal en point.

Après nous être identifiés à la satisfaction de notre patient (il s’agissait d’un avocat ontarien en vacances au Québec pour célébrer les premières noces de sa fille unique), nous avons procédé à son évaluation secondaire. S’ajoutant aux causes externes immédiatement identifiables (température étouffante, salle surchargée d’invités, etc.), il présentait un tableau typique d’angine de poitrine; i.e. : il s’agissait d’un homme dans la cinquantaine, sédentaire, souffrant d’embonpoint, hx de diabète, haute pression, beaucoup d’émotions fortes en peu de temps, et comme facteur déclencheur supplémentaire s’ajoutait le stress associé à l’arrivée imminente du moment de la danse du père avec la mariée… je lui ai donc répété qu’il serait plus prudent de consulter un avis médical, et quoiqu’il réalisa l’imprudence de son geste, il refusa obstinément de considérer un transport vers l’hôpital… tant qu’il n’avait pas fait un tour de piste de danse, ne serait-ce qu’une fois avec sa fille…

De plus, il nous interdisait d’avertir les invités de son malaise, car il ne voulait pas nuire au déroulement de la soirée; il voulait surtout éviter de distraire les nouveaux mariés, car aux yeux du père, il s’agissait de l’un des plus beaux moments de la vie de sa princesse. C’est d’une poignée de main de fer et d’un regard embrasé que le père de la mariée m’a communiqué ses priorités et conditions : il nous laissait le transporter à l’hôpital… à la condition préalable et ferme que nous lui accordions le temps d’une danse avec sa fille. La ratification se lisait dans les yeux de son épouse devant la résolution de son mari à accomplir ce devoir paternel avant de la quitter…

Nous avons revérifié ses signes vitaux avant de lui placer une petite Nitro sous la langue, et enlevé le masque d’oxygène. Au bout de quelques petites minutes, nous l’avons aidé à regagner ses pieds, afin de lui permettre d’accomplir son devoir paternel sous l’œil complice de notre surveillance. Et quoiqu’on le surveille, le dilemme et le débat demeurent aussi vifs dans mon souvenir qu’ils l’étaient ce soir-là… même que nous l’ayons applaudi comme les invités.

Radieux, il céda la main de sa fille à celle de son nouveau mari, et se laissa diriger à l’abri des regards, d’où nous pouvions l’installer confortablement sur une civière, et le placer sous oxygénothérapie. En ajustant son masque d’oxygène, j’ai senti sa main entourer la mienne, qu’il a serrée très très fort… en soufflant un « Thank you ! »

Quelques mois plus tard, le patron est venu nous interpeller avec une enveloppe à la main, qu’il s’empressait de nous remettre, avec un sourire et une bonne poignée de main. Il s’agissait d’une copie de lettre de remerciements à l’intention du maire de Laval, le félicitant de SON service d’intervention préhospitaliers, et deux jeunes paramédics qui étaient en devoir un certain samedi soir d’août 1980… la lettre décrivait, en langue anglaise, l’angoisse du père, pour qui cette danse avec sa fille fût le moment culminant de sa paternité. La lettre louangeait les paramédics en devoir (nous) pour l’intensité de notre compassion humaine ainsi que nos compétences, car le personnel de l’urgence avait souligné l’importance de notre intervention avant et après la danse du père avec la mariée, pour laquelle il fut très reconnaissant.

On s’est longuement interrogés sur la zone grise qui barde, en hypocrite capricieux, ce genre de situation et ses conséquences. La décision d’obtempérer à la requête du père aurait pu avoir des conséquences tragiques sur ses chances de survie, et la décision de tenter le tout pour le tout aurait pu déclencher une crise de trop, sans compter l’émoi qu’une telle démonstration aurait eu sur les invités.

Malgré qu’il s’en soit tiré, et que sa fille ait vécu ses noces de rêve, selon la volonté de son père, ce cas chatouille les marges de la zone grise pour la moyenne des intervenants consultés.

J’y pense encore de temps à autre, ayant récemment vécu le mariage de ma propre fille, quoique je ne souffre pas des symptômes désagréables associés à une crise d’angine. Je comprends l’importance de ce beau moment dans le cœur d’un père… et je crois qu’en de circonstances comparables, j’aurais sans doute agi comme lui, malgré l’imprudence évidente de son geste.

Et… si vous étiez l’un des intervenants en devoir en cette soirée caniculaire d’août 1980? Le moment venu, comment auriez-vous tranché devant le refus d’obtempérer du père, à moins de lui concéder quelques moments de compassion, et bien sûr, votre discrétion?

Comment auriez-vous justifié votre décision/intervention… dans la zone grise?

Norm Rooker | Ghosts (part 1)

Photo courtesy of Stephane Brunet (c) 2011

Ghosts (part 1) by Norm Rooker

How many of you have read Joe Connelly’s 1998 semi-fictional book ‘Bringing Out The Dead’?  Joe, a former New York City EMS paramedic, spun a very realistic tale of the dark side of EMS.  The parts they don’t tell you about, or at best maybe hint at, in First Responder, EMT & paramedic school.

Made into a movie a few years later, the story is about a burnt out paramedic, played by Nicholas Cage in the film, who is among other things, haunted by his own personal EMS ghost. A former patient, a young female asthma patient, that he was unable to save.  Our exhausted and extremely crispy but still striving to do his best medic keeps spying her out of the corner of his eye in various crowd or street scenes as he responds to calls.

If you haven’t read the book or seen the movie I won’t spoil it for you. But the fact is that most any medic, firefighter, law enforcement officer or ED worker with more than a few months of experience will tell you, if they trust you and are being honest with themselves, that they each have their own “ghosts”.

Those calls or patients that have jarred us or have an emotional impact on us.  The ones you could do nothing for.  The ones if you could have just done this or that differently, a little quicker or maybe just that elusive “something else” that the outcome might have been different.

The one that the VCR/DVR in your head keeps playing over & over again. Or years later will suddenly replay out of the blue triggered by a seemingly innocuous event.

One of the minor disadvantages of a career spanning almost 39 years as an EMT, Paramedic, Firefighter, Rescue Specialist & what not, is that like most of you, I have had more than a ghost or two in my life.

Former patients and/or calls.  Sometimes not even my call but one that happened to someone I knew.  My mind would obsess about how I would have handled that call, that situation.

For instance, back in the late 80’s several friends of mine responded to one of those freak, once in a career, type calls. The call and the patient’s death haunted/danced in & out of my dreams for almost 18 years.  Mainly because at that time I wouldn’t have done anything different than they did. And great medic that I liked to believe I was at that time, I would have come up with the same tragic outcome had this call been mine.

My mind & subconscious chewed on this rescue problem for almost 2 decades until I finally worked out both how to have correctly and realistically identified that patient’s unique predicament and how I would have then run treatment and rescue/extrication with a real chance of success.

The story.  A mother was driving a carload of kids to an after school event.  They were on the highway and heard a loud thump from the bottom of the car & simultaneously the mother felt a burning sensation in the back of her neck at the base and a sudden weakness.

She was able to safely decelerate and pull her car off to the shoulder of the highway.  One of her kids used her cell phone, this was back in the late 80’s when not everyone had one, and called 911.

My friends were on the first responding engine and ambulance.  On their arrival they got the kids out of the car and safely in the care of a police officer.

Their physical assessment revealed a conscious & awake woman c/o of a sudden onset of a dull burning sensation at the base of her neck with full body weakness.  Physical exam was unremarkable except for a lump/deformity with no point tenderness just to the right of her spinal column at the C7/T1 level.  No medical history to speak of, no RX or drug allergies and normal vital signs except for a slightly elevated pulse.

At a loss for the cause of the sudden onset but noting the deformity the woman was placed in c-spine precautions including a c-collar and KED, Kendrick Extrication Device.  Just like many of us would have done.

The problem came when they attempted to extricate her from the driver’s seat out onto the backboard.  This wasn’t any, “Ma’am, can you swing your legs around and have seat on our backboard.” type extrication.  This was the full blown deal.

They went to lift her up to swing her torso around in preparation to laying her flat on the backboard when she let a little moan and died.  One of my friends said the closest way he could describe it was like a cartoon where the color just drained out of her from the top down.

They also discovered they were encountering resistance from her hips, so they lifted her a little higher and discovered there was something sticking out of her.

It was only after they angled her head out of the driver’s door and lifted her almost 3 feet into the air that they discovered the problem.  Rebar.

The California Highway Patrol accident reconstruction team discovered that a 6 foot piece of rebar had fallen off a vehicle and was laying on the highway.  The woman’s car had driven over it at just the wrong angle that the rebar bounced off the pavement and penetrated up through the floor of the car, the driver’s seat and into the driver.

It was one of those freak billion-to-one accidents.  But that didn’t change the shock, horror and frustration for my friends who had a patient that was alive when they got to her and during their actions to “help”, died in their arms.

They ran the code but it was one of those “Humpty Dumpty” type of resuscitations.  The kind where all the King’s horses and all the King’s medics couldn’t put Humpty Dumpty back together again.

This wasn’t even my call.  I never met this woman.  I have no idea what she looked like or even whether she was a good mother and/or wife or not.

But still, I obsessed on the incident.  This could just as easily could have been my call and I am pretty darn sure that I would have taken the exact same actions with the same tragic results.

It took almost 18 years of chewing all aspects of this call over in my mind.  Both conscious and subconscious before I had worked out all the pieces to have maybe, MAYBE, run this call with a different outcome.

I will tell you that the very first thing I did/changed was to start being more consistent in applying that wildland fire safety rule “Look up, look down, look all around” to my patient assessments.

As humans we pretty much look at, view our world and surroundings at eye level.  That looking down for clues/evidence, especially like we see now on TV shows like CSI is a learned or trained behavior, not one that comes naturally to most of us.

The same holds true for looking up.  For overhead obstructions, safety issues like something dangling on a wire or a thread above us.  Everything from a FF waiting in ambush to dump a bucket of water on you as you pass by to IEDs, Improvised Explosive Devices to overhead obstructions prior to swinging an axe or raising a ladder.

Shortly after this accident I incorporated feeling under the patient’s car seat as part of my assessment.  Especially when I had a situation/presentation that wasn’t adding up. While I have never found a patient impaled by rebar, from time to time I have found some clues to my patient’s presentation/predicament at that moment.

That was the easy part. The next challenge was to figure out how to extricate a similarly trapped/impaled patient safely and get them to the hospital alive enough to give the trauma surgeons a viable chance at saving this unfortunate individual.

Being a rescue specialist, I was already teaching structural collapse rescue at the time, I chewed on the extrication side of the problem.  How to stabilize the rebar and cut it between the seat and the floor of the car without jarring or shaking it so badly as to further cause internal injuries to the patient?

How to remove the roof of the car, disconnect the seat from the car and lift the patient and seat as a unit and lay it down on a backboard?  How to secure the seat and patient to the backboard, supporting their legs and the sides so that they had a stable ride to the hospital immobilized in the same position we found them only laying on their, the car seat’s, back? This included how to realistically build up a support for her legs so they didn’t just dangle or flop about.

She was one of my motivations for taking the NFPA, National Fire Protection Association, approved Basic and Advanced Vehicle Extrication courses.

In the meantime, once extricated, how would I go about “packaging” her for transport and what treatments, effective treatments would need to be rendered?  And while all of this sounds good on paper and in my head, I also had to figure out how to communicate the situation to first my fellow medics and FFs on scene so they would accept my proposed plan of action and secondly the receiving hospital so that they would have the appropriate resources ready when we or the air ambulance hit the door.

When I had worked all this out, I was finally able to say goodbye to this woman’s ghost. A second-hand ghost at that as she wasn’t really mine to begin with but rather had become mine via adoption.

This unknown woman was neither the first or final “ghost” of my career.  My first “ghost” came into my life Thanksgiving Eve 1975.  I was 19 and had been an EMT for just over two years.  Most of my experience up to then was either as the medical (cadet) sergeant on a not very active ground search & rescue team or as an EMT for a redneck “mom & pop” private ambulance service that almost exclusively did routine transfers.

Anyway, it was Thanksgiving Eve and I was sharing my first bachelor pad with three good friends I had known since grade school, Boy Scouts and the Civil Air Patrol.  We had all been cadets in the same CAP Squadron that ran a “ranger” team.  It was that CAP affiliation and timing that allowed two of us to have been selected to be part of the second pilot EMT class run in the State of Connecticut over the summer of ‘73 between my junior and senior year of high school.

All four of us have since gone on to careers in emergency service.  Brett and Fred in law enforcement, myself as a paramedic/FF/rescue specialist and Dick as a FF, and ultimately Battalion Chief for the Washington DC Fire & EMS Dept.  Indeed Dick ran part of the roof operations in the battle to save the Pentagon on the night of September 11th.

But that all was in the future. Going back to that Thanksgiving Eve evening, we were just four 18- and 19-year-olds, one in the Army, two going to school full-time and me working full-time as an EMT for Northern Virginia Ambulance Service.

The company, as an early Christmas present, had just issued all of us windbreakers with the company name on the front and back.  Being young and unbelievably proud of what I did, I of course wore that windbreaker on and off duty.

Remember, this was a bachelor pad.  Decorated in second hand and yard sale furniture.  The bunk bed that my brother and I had shared when our ages were both in the lower single digits was disassembled and was now two of the beds for our apartment. The center of decoration for our living room was a combination TV set and high fidelity stereo and an 8-foot wooden bar that one of us had come across at a yard sale and just knew that we had to have.

We weren’t slobs, but we sure weren’t what you would call neat-nicks either.  Brett, who was active duty with the 3rd Division “Old Guard” artillery battery had a waiver to live off-base with us.  For some reason Brett got it into his head after dinner that Wednesday evening, we were going to clean/police the place up for the holiday.

For an even stranger reason, that seemed like a good idea to me as well and the two of us set into it with the gusto and enthusiasm of youth.

A couple hours later we had the place ready to receive our parents should they drop in to visit.  The last task left to do before we called it a night was to take out the trash.

It was a cold November evening so we both donned jackets, me of course in my NVAS windbreaker.  As we carried the trash down to the dumpster we heard a horrific crash.  Our apartment happened to be alongside Interstate 95 by an exit/on ramp.

Photograph courtesy of Stéphane Brunet

We both saw the fireball from the wreck rising up above the tree line along the edge of the highway.  I gave my trash to Brett and ran towards the fence.  By the time I finished clambering over the 8-foot chain link fence and barbed wire fence the first arriving fire engine and ambulance were on scene.

As I came down on my feet and turned to the wreck I saw the fire fighters restraining a man with badly burned arms fighting to get back to the burning vehicle.  I heard two sets of shrieking screams coming from the fully involved vehicle and a child’s small voice calling from the back of an otherwise empty ambulance.

I asked the firefighters if they needed a hand and they directed me to the back of their ambulance.  I climbed in the open back doors to find a young boy, maybe 8 or 9 laying on the gurney with probably 60% second & third degree burns, mostly to the right side of his body.

It was just the two of us back there.  I looked around and grabbed a bottle of sterile water and began pouring it on his burns.  I still remember how the water steamed and rose off of him.  And the smell.  That unique smell of burnt hair and flesh.

I didn’t’ have any trauma shears on me.  I was a young EMS newbie/geek, but even back then I didn’t carry trauma shears on me when I was off duty.

So I found the OB kit, pulled out the scalpel and began cutting this kid’s burnt clothing off him as best I could.  I used the sterile sheet and dressings from the OB kit to cover this young man’s burns and then continued to cool with bottle after bottle of sterile water.

And it was not like this youngster was screaming or writhing in pain.   Just the opposite, he was lying quite still and speaking in a clear, English accented voice inquiring “Please sir, can you tell me how my mother and sister are?”

Blessedly, the way the ambulance was facing and the sounds of the fire engine in pump mode as the firefighters worked to put the car fire out were drowning out the death cries of two of his closest family members and the mourning wails/keening of his badly burnt father who was being treated/restrained in a second ambulance that had arrived on scene after I had initiated taking care of this young man.

I learned later that the father, a counselor officer for an Eastern European country had just brought his family over to the US that very week and he had been showing them the beauty of the Virginia countryside.  He was driving them back to their new living quarters when a drunk driver accelerated up the on-ramp and rear-ended their vehicle causing it to explode.

The father received his burns pulling his son out of the burning vehicle and was trying to go back to attempt to save his wife or daughter when I clambered over the fence and joined in the response.

I rode into the hospital with the FF/paramedic crew, assisting them as they started IVs administered MS, morphine, and all the time trying to find new ways to avoid answering this young boy’s inquires into the status of his mother and sister.

Afterwards the fire crew thanked me and gave me a lift back to my apartment complex.  I worked on the ambulance Thanksgiving Day and then went home on Black Friday to spend the rest of the holidays with my family.

All the time still hearing this young boy’s calmly questioning voice in my head.  Well that and the anguished cries of his dad and the death screams of his mother and sister.

I realized later, much later that this boy was in shock.  That he wasn’t feeling the pain, yet, of his severe injuries that looked and smelled so bad to me.  This young man became one of my driving motivations to become a paramedic so that I could do more than just fake my way through treating him and just pouring water.

I learned this young man succumbed to his injuries a week later. It was because of him that I made it a point to learn all I could about burns, burn injuries and the best way to aggressively, but not overly aggressively treat them. Burn injuries became one of the first subjects I taught/lectured on in various EMT and paramedic training programs.  When I broke out onto the national speaking/lecture circuit, this was also one of the first talks I marketed.

Even now, sharing his story with you over three decades later I still hear his voice in my head.  His spirit doesn’t “haunt” me.  Rather it motivates me.

And continues to do so.  Even though I am in the autumn of my EMS/rescue career I still pursue how to take care of these patients better.  One of the many items on my “bucket” list is to take the ABLS, Advanced Burn Life Support course.

(EMS treatment pearl for those burn patients who are in pain.  If all you have for treatment is Fentanyl or Morphine but medical control is being stingy in allowing you to administer it. You know, following the cardiac/pulmonary edema algorithm for the administration of MS rather than the one for burns/trauma,  “Start with 2-4 mg MS and call back in 10 minutes if you think the patient needs more.”

First of all, don’t wait 10 minutes and when you call back in, stand near your still loudly screaming/shrieking/moaning patient and after making a request for an additional MS order, tell them to hold on a minute while you move out of the vehicle/into another room as you can’t hear their response over the patient’s cries of pain.

Pretty sure that they will become much more liberal in the amount and frequency of MS they will allow you to administer.)

There are of course other “ghosts” in my life/career but I will save sharing some of their tales for the second part of this essay.  I promise to follow up with it in the next month or two.  Until then stay safe, and as my friend Hal first said to me many years ago, always strive to do your best to practice Big Medicine.

Photograph courtesy of Stéphane Brunet

 

Newman | Playlist for The Big One

Stanstead QC | December 13- Big Update to Announce:

The quest to build The Playlist for The Big One now includes an opportunity for artists to submit their tunes to Big Med on Sonicbids.

http://www.sonicbids.com/BigMedicine2

For those of you who don’t know, Sonicbids helps bands get gigs and promoters book the right bands. The list of folks who are booking great music on Sonicbids is pretty damned impressive – SWSX 2012, Canadian Music Fest, bonnaroo, MTV – and, of course, Big Medicine.

We’re going to feature two or three new artists every week as we build out the Playlist for The Big One. I’m hoping the next Big Med Porch Party will include a few special guest appearances.

You can visit the Big Med Music section to listen to/watch new artists already added to The Playlist for The Big One.  If you’re a musician or know a musician whose work should be considered for The Playlist for The Big One, get hooked-up with Sonicbids and submit your EPK for consideration.

Music often serves as an escape hatch from the high-end stress that is a constant companion for life on the job. Music provides a soundtrack for our memorable calls. Here’s Norm Rooker on working a code in 1986…

“Like running hot to a cardiac arrest call to Jefferson Starship’s “We Built this City”.

It was early 1986 in east San Jose. Cindy Petretto and I were running hot through mid afternoon traffic for a cardiac call, CPR in progress. And what job isn’t made better with a good sound track in the back ground?

We had a classic rock station cranked up, radio KOME (yes, that is a real call sign and they’re still on the air) and while they played a number of rock classics as Cindy threaded us through the just out of school afternoon traffic, the song that was playing as we pulled up on scene was that Starship classic.

Like so many of our cardiac arrests, first responders were already on scene and CPR was in progress. The patient was in a coarse v-fib so we did what we always do, gave her a 200 watt second ride on the lightning and, surprise of surprises, shocked her right into asystole.

Unfortunately a not all that an uncommon but unintended outcome for this V-fib treatment. So now our patient is flat lined and we were attempting to stimulate her heart back up with various chemicals so we could shock it again. Hopefully with a different outcome.

I was on my A game that day and not only got the tube on the first shot but also turned around and sunk an EJ, as the patient had nothing for veins peripherally and Cindy wasn’t having any luck in either arm.

We worked that code to the point of calling it and Cindy was on the telephone with a Base Station Attending getting permission to do so when the patient’s heart said “enough already” and decided to rejoin us. I have never seen this before or since but our patient’s heart spontaneously converted from Aysytole to a perfusing sinus tach. (4 rounds of Epi 1:10,000 and 3 mg of Atropine tends to make the heart beat a little faster, when it chooses to respond.)

“Wait a minute doc! Forget the pronouncement, I need a Dopamine order!”

“What????”

Cindy and I brought our patient into Valley Medical Center, The Big Valley, where she was admitted to ICU but did not survive her event and passed away for good two days later. We received a nice thank you note from the family not only thanking us for our efforts, but also for giving their family a chance to get together and say their good byes to their mother, grandmother, sister, beloved wife, etc..

It was signed by what we guessed was the entire family. While Cindy and I had succeeded in telling the Grim Reaper “Not Today!” for our patient, and had a fantastic, make that great field save, we were humbly reminded both that it is not a true save unless the patient is able to resume their normal life and that we had not anticipated how many lives our efforts were actually making an impact on.”

I’m still building The Playlist for The Big One.

The Playlist got its start when I invited readers to submit their suggestions for the ultimate soundtrack to listen to while responding to The Big One.

We received a lot of references to mainstream classic artists and tunes however we also were ref’d to some outstanding emerging artists and little known musical gems.

The blog piece continues to morph and has evolved into a complete music section on Big Med.

Now, I’m asking for more of your suggestions and this time around I’d like you to attach specific meaning/context/memories to each piece you submit.

Think of this as the soundtrack for a TV series never made.

The original Playlist for The Big One:

If you’re going to be really prepared for The Big One you’re going to need some great tunes. So, I asked people to send me their suggestions.. the list continues to grow.

Simple Minds–Alive and Kicking

Glenn Frey–The Heat Is On

Men At Work–It’s A Mistake

When In Rome–The Promise

– The previous four tunes were added to The Big One list by Norm Rooker on July 13 2009

Molly Hatchet–Flirting With Disaster

Stevie Ray Vaughn–Couldn’t Stand The Weather

Loudness–Hurricane Eye

The Scorpions–Rock You Like A Hurricane

The Talking Heads–Burning Down The House

ACDC–Thunderstruck

Jimmy Buffett–Volcano

Santana–No One To Depend On

The Rolling Stones–Gimme Shelter

Jerry Lee Lewis–Great Balls of Fire

Johnny Cash–Guess Things Happen That Way

Al Green–Let’s Stay Together

The Dells–Oh What A Night

Big Joe Turner–Shake, Rattle, and Roll

The Animals–We Gotta Get Out Of This Place

REO Speedwagon–Ridin’ The Storm Out

Sara Groves–Tornado

Kenny Loggins–Danger Zone

Jimi Hendrix–Fire

Barry McGuire–Eve of Destruction

Tracy Lawrence–Texas Tornado

Fontella Bass–Rescue Me

James Taylor–Fire and Rain

Bruce Springsteen–Across the Border

Bruce Springsteen–Fire

Bruce Springsteen–My City of Ruins

Tragically Hip–New Orleans is Sinking

Led Zeppelin–When the Levee Breaks

KISS–Firehouse

Chicago–Does Anybody Know What Time It Is?

Hank Williams, JR–A Country Boy Can Survive

Elvis Presley–All Shook Up

Jimmie Dean–Big John

Bing Crosby–White Christmas

The Crazy World of Arthur Brown–Fire

Katrina & The Waves–Walk on Water

REM–It’s The End Of The World As We Know It [And I Feel Fine]

Gordon Lightfoot–The Wreck of the Edmund Fitzgerald

ACDC–You Shook Me All Night Long

CCR–Have You Seen The Rain

Tears For Fears–Mad World

Moby–The Rain Falls and The Sky Shudders

Live–Lightning Crashes

Beck–Earthquake Weather

The Alarm–Rain in the Summertime

Gnarls Barkley–Run [I’m A Natural Disaster]

Jars of Clay–Flood

The Cure–Shiver and Shake

The Smiths–Panic

Depeche Mode–Shake the Disease

New Order–Confusion

Richard Wagner–Ride of the Valkyries

Billy Joel–

Land of Despair

Only the Good Die Young

Pressure

We Didn’t Start the Fire

Phil Collins–

Against All Odds

Land Of Confusion

Roof Is Leaking

Electric Light Orchestra–Concerto For A Rainy Day

Standin’ In The Rain

Big Wheels

Summer and Lightning

Mr. Blue Sky

Bad Company–Burning Sky

The Talking Heads–Life During Wartime

CCR–Bad Moon Rising

The Bee Gees–Stayin’ Alive

Bad Company–

Shooting Star

Downpour in Cairo

Lynyrd Skynyrd–Smokestack Lightning

Call Me The Breeze

Dead Man Walking

Gimme Three Steps

Rocking Little Town

Life’s Lessons

Need All My Friends

Alison Krauss–Didn’t Leave Nobody But The Baby

The Whites–Keep On The Sunny Side

The Allman Brothers–Blue Sky

Ritchie Blackmore’s Night–

The Storm

Mid Winter’s Night

Gone With The Wind

Blue Highway–Still Climbing Mountains

Bonnie Raitt–Deep Water

Cate Brothers–There Goes The Neighborhood

Doobie Brothers–Black Water

Lonesome Road–Higher Ground

George Strait–Ready For The End of the World

By The Light Of The Burning Bridge

 The Dixie Chicks–

Landslide

Top Of The World

 Chris Thile–Brakeman’s Blues

Alison Krauss & Union Station–

Dark Skies

Bright Sunny South

Rain Please Go Away

John Anderson–I Fell In The Water

John Hiatt–

Cold River

Wintertime Blues

The Grascals–

Keep Me From Blowing Away

Rolly Muddy River

Nickle Creek–Why Should The Fire Die

Rhonda Vincent–Drivin’ Nails in My Coffine

Ray Charles–Heat Of The Night

Red Thunder–

Water Night

Heart Beat

Steely Dan–

Rikki Don’t Lose That Number

Everything Must Go

Trace Adkins–If I Fall [You’re Going With Me]

Van Halen–Judgment Day

The Greencards–Weather and Water

Whiskey River Band–Dancing Around The Fire

Enya–A Day Without Rain

Johnny Paychek–Take This Job And Shove It

The Bloodhound Gang–The Roof Is On Fire

Golden Earring–

Twilight Zone

Radar Love

Deep Purple–Smoke On The Water

The playground song ‘Ring Around The Rosie’

Green Day–Warning

Twisted Sister–We’re Not Going To Take it

The Who–

Who Are You

Won’t Get Fooled Again

Santana–Oye Como Va

Peter Gabrial–Red Rain

Seals & Crofts–Summer Breeze

Jonathan Edwards–Sunshine [Go Away Today]

Paper Lace–The Night Chicago Died

Johnny Nash–I Can See Clearly Now

Little Feat–Texas Twister

Rush–

Between The Wheels

Manhattan Project

Force Ten

High Water

Workin’ Them Angles

Yngwie Malmsteen–Blitzkrieg

Cold Chisel–Cheap Wine and a Three Day Growth

Thin Lizzy–The Boys Are Back In Town

The Foo Fighters–In Your Honor

Edwin Starr-War

Rose & The Arrangement–The Cockroach That Ate Cincinnati

Bobby Russell–The Night The Lights Went Out In Georgia

A. Sevison–Give Me Oil For My Lamp

Kingston Trio–This Little Light Of Mine

Al & Willy Simmons–It’s Raining, It’s Pouring

Queen–Another One Bites The Dust

Peter Seeger–All My Trials

The Beatles–With A Little Help From My Friends

Johnny Cash–Goin’ By The Book

Train–Calling All Angels

Nick Cave & The Bad Seeds–[I’ll Love You] Till The End Of The World

Men Without Hats–Pop Goes The World

The Doors–Riders On The Storm

KT Tunstall–Miniature Disasters

Neil Young–Like A Hurricane

Johnny Cash–

Ring Of Fire

Five Feet High And Rising

Jimi Hendrix–The Wind Cries Mary

Billy Ocean–When The Going Gets Tough

Pat Benetar–Hit Me With Your Best Shot

U2–Sunday, Bloody Sunday

Destiny’s Child–Survivor

Reba McEntire–I’m A Survivor

Gloria Gaynor–I Will Survive

Rihanna–Emergency Room

Foreigner–Urgent

Ultravox–Reap The Wild Wind

Blue Oyster Cult–Burning For You

The Trammps–Disco Inferno

George Winston–New Orleans Shall Rise Again

Bruce Springsteen–The Rising

Gypsy Pistoleros–Livin La Vida Loca

The Psychedelic Furs–Heartbeat

Aurora & Zon del Barrio–Revolu

The Gitanos–Que Loco Mundo

Michel Rivard–Toute Personnelle Fin Du Monde

Monty Python–Always Look On The Bright Side Of Life

Jen Nelson–For What It’s Worth

Steadman–Wave Goodbye

Parks and Gardens–You Are Dead

Grace Potters & The Nocturnals–Ain’t No Time

Jenn Franklin–What Took You So Long

Alvin Jett & the Phat noiZ Blues Band–Angels Sing The Blues

Karen Kosowski–We’ll Find You

The Crystal Method–Keep Hope Alive [There Is Hope Mix]

Norman Greenbaum–Spirit In The Sky

Tom Petty & The Heartbreakers–Free Fallin’

EMF–Unbelievable

Love And Rockets–Ball of Confusion

Belinda Carlisle–Heaven Is A Place On Earth

The Fixx–One Thing Leads To Another

Elton John–Saturday Night’s Alright For Fighting

Echo & The Bunnymen–People Are Strange

Van Halen–Runnin With The Devil

Bill Noonan Band–Get Off My Land

Hot House Flowers–Hallelujah

Joshua Lebofsky–The Redemption Song

Richard Seguin–

Chanson Pour Durer Toujours

Ice Comme Ailleurs

La Maison Brule

Les Temps Changent

Ten Toes Up–Trip On Troubles

Patti Smith–Are You Experienced?

The Clash–Should I Stay Or Should I Go

Queen–Keep Yourself Alive

Bon Jovi–Wanted Dead Or Alive

Stephane Wrembel–Water Is Life

Kool & The Gang–Emergency

The Lovin’ Spoonful–Summer In The CityThe Eagles–Hotel California

Earth, Wind & Fire–That’s The Way Of The World

Tom Fenton & Ice Nine–Don’t Go Down To The Fallout Shelter [With Anyone Else But Me]

Tom Lehrer–

Pollution

So Long, Mom [A Song for WWIII]

We Will All Go Together When We Go

Prepared

The Brothers Johnson–Get The Funk Out Ma Face

The Foo Fighters–Times Like These

Priorities

I am stubborn. My wife warned me not to try and change that lightbulb on my own. She told me I ought to ask our neighbour from across the street to lend me a hand. I waited for her to go over to one of her friends for tea and muffins and then I decided to give it a go.

“I have fallen and I cannot get up,” I said in slow and determined fashion to the emergency operator who answered the call I placed to 911. I remembered that series of television ads and winced at the realization I had just used the same line to call for help.

“No, I am not having any difficulty breathing. Yes, I hit my head but no, I did not lose consciousness. No, my neck doesn’t hurt. No, no chest pain to speak of. Yes, I do have some terrible pain in my hips. I am 81-years-old. No, I do not take any prescription medications of any kind. No, I am unable to get up on my own. The pain in my hips is quite intense and it gets worse when I try to move.

“Yes, I understand there might be a lengthy delay before the ambulance gets here. I know it’s very cold outside and I understand you must be very busy. I would not have called if I could get up on my own. I fear I have injured my hip otherwise I would not be calling for help.

“Pardon me for asking but I thought we had first responders in our town who might be able to help me before the ambulance crew is available. Oh, I see. They only respond to higher priority calls. Well, I do understand. I will do my best to stay comfortable until the ambulance crew arrives. Yes, I will certainly call you back if anything changes or I feel worse in any way.”

The light of the afternoon faded into the early darkness of a winter evening and the ceramic tile floor quickly lost any of the heat it had retained. I struck up a conversation with the cat but the cat lost interest and walked away. I watched the time on the microwave clock move slowly minute by minute. I fought the urge to pee.

I concentrated on looking at the photographs of our children and grandchildren we had proudly hung on the livingroom wall. I couldn’t remember the phone number at my wife’s friend’s house. I wanted to cry.

I couldn’t believe that I was all alone, had called for help, and no one was on their way yet. I wondered what level of priority my call for help was for that first responder team.

Were they only concerned about life and death? Were they so busy they could not even spare a moment to check on a resident of the community who had confirmed he was in a spot of trouble?

Had they no idea how important it was to provide a physical presence for someone in a time of extraordinary need?

And so, I lay alone on the kitchen floor with a badly bruised hip for more than forty minutes before the ambulance crew and my anxious and bewildered wife arrived simultaneously.
___

Right. The preceding was just me, Hal Newman, trying to imagine what it would be like to be all alone and waiting for emergency medical assistance after having been classified as a priority Two or Three call on a day chockfull of priority One calls.

Calls of every priority should be responded to and not only by an ambulance crew.

Actually, I believe it would be rather interesting to have a first response team specially trained to respond to calls of a lower priority to determine whether or not those patients actually need to be attended to by the much scarcer ambulance-based paramedics.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives.

The clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory.

It’s not about what uniform the responder is wearing. Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the EMS they deserve.

Be well. Practice big medicine.

Newman: A minifesto for the Quebec pre-hospital care system v 2.0

Stanstead QC–Our out-of-hospital care system needs to be redesigned by people who are dedicated to the needs of the end-users [I despise the words ‘patient’ or ‘beneficiare’ because ‘patient’ implies you must wait before receiving care and ‘beneficiare’ implies that healthcare is a benefit – and not a basic right] and the people who actually deliver the emergency care.

We need to stop looking at prehospital care as a back-loaded system that starts when an imaginary stopwatch is triggered after someone recognizes an emergency has occurred and calls 911. The problem with this model is that the clock will continually be reset once the person in need has received treatment and has been delivered to the ER. No one is looking at ways to prevent the emergency in the first place.

How many healthcare workers come to Quebec from other jurisdictions and are held in place while exams are written and scores are compiled? Why can’t we create an EMS/CLSC-linked organization that trains people to visit clients in their homes, verify that their environment is safe, check that their meds are up-to-date, check their vital signs, even run an ECG or draw bloods to be checked at a local hospital?

Wouldn’t it be economically and socially advantageous to have a first response team specifically trained to respond to calls of a lower priority to determine whether or not those clients actually need to be attended to by the much scarcer ambulance-based medics? We need to adopt the EMS Community Care Model right across Quebec – and especially in the outlying regions where healthcare human capital is more thinly spread. I’ll bet that could substantially reduce the number of times the words “aucune ambulance disponible” are transmitted to waiting first responders.

Firefighter first response programs are performing beyond expectations. They should encompass every part of this province. Firefighters who believe in the possibilities need to engaged as emissaries for this approach – they need to become part of a core of leaders who can mentor other firefighters. I’m tired of watching naysayers rise to the top of the leadership ladders. Fire dept first response should be funded appropriately and cities and towns should start realizing that this is an investment that assures tax payers of living long and fruitful lives – and continuing to contribute to Quebec society.

There should be automatic external defibrillators [AEDs] in every public building and many of the private ones. Police officers should be equipped with AEDs. CPR courses should be a requirement to graduate from elementary school.

We should have advanced life support [ALS] paramedics on every ambulance – and when we’re done with the ambulance crews we ought to start looking at ALS firefighter medics.

We need to pay the ambulance medics a living wage that recognizes the enormous contribution they make to our lives – and not treat them as some afterthought to the system. Without them the crippled system would have collapsed long ago. And we need to begin treating our paramedics like the community heroes they are and find ways to reward their service to the rest of us; i.e., tax credits, educational scholarships, family death benefits for line-of-duty deaths.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives. That damned clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory.

Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the emergency care they deserve.

My family deserves the best emergency medical system available. Doesn’t yours?

Suggestion: Talk to each of your elected representatives and ask them why they believe your family deserves anything less than the best possible prehospital care. Our prehospital care system is nothing if not equitable in delivering substandard services so it really doesn’t matter who you are when you or someone you love places a call to 911.

Newman: Failure to launch first responders sends a message

Stanstead QC–I believe that a strong Emergency Medical Service – including first responders – sends a strong message to all parts of a community. We care enough about each of you to ensure that there will be qualified care providers by your side as quickly as possible each and every time one of you calls 911 for assistance.

So what is a town saying when it continues to delay the launch of its medical first response service? We just can’t see past the paperwork to the potential benefits this program will bring to our community. We’re too busy fundraising for the new arena to realize there will be no one to respond lest a child gets hurt on the new ice surface. We’d like you to bring your business to our town but you need to know that if the ambulance is on a run you’re strictly on your own out there.

There are no good excuses for not having a first responder service in a rural town like Stanstead. Not a single one. We have one ambulance available at a time here. If it’s out on a call the next one might be coming from Magog or Coaticook – 20 minutes away if all is right with the world and a lot longer if it’s midwinter and there’s a storm blowing through the region.

Clearly, the Stanstead Ambulance Service recognizes the need for first response. The Ambulance service was the prime mover for the town’s public access defibrillation program which saw five automatic external defibrillators deployed in publicly-accessible buildings. The AEDs are a solid link in the chain of survival. First Responders are the next essential link in that chain.

The chain can only be as strong as its weakest link. And the potential for lifesaving is not maximized when there are enormous delays between accessing the EMS system and the arrival of ambulance medics.

We moved here last June. During the summer there was talk about establishing a medical first response program in town. It didn’t happen. Last Christmas word went out the town was seriously considering launching a first response program. Applications were taken. The rumoured launch date for first response was May 1st.

I put in my paperwork before the program was even officially announced. I waited to hear if my application for the first response program would be accepted. Eventually I heard I could expect an interview with the new Fire Chief and the EMS Coordinator responsible for the project.

I’m still waiting.

So is rest of the community.

Failure to launch sends an equally powerful message.
Sadly, it’s the wrong one.

Be well. Practice big medicine.

The man who fell from a roof and landed in our driveway

Stanstead QC–Pietro said it sounded as if something had fallen from a truck driving too fast down Stage Road. Trucks often drive at breakneck speeds past the ‘Please be careful. This could be your child’ signs so it didn’t require an enormous stretch of the imagination to think that one of them had lost part of a load out in front of the house.

Pietro has always listened to the quiet intuitive voice within. He’s built a successful career paying careful attention to all that his senses can capture consciously or unconsciously. He said something drew him out to the road to investigate the source of the sound.

That’s when he heard the low moans coming from the bushes at the foot of the home across the street. He moved quickly and took in the jumble of ladder no longer defying the law of gravity, the homeowner, an ankle twisted at an impossible angle – and the blood.

Pietro called for Lili. A long professional history of being first on the scene of extraordinary human difficulties served him well. He sized things up and began providing first aid to his temporary neighbour.

Lili and Pietro were farmsitting while Ghyslain & Nathalie were away on a family vacation down South. Other than a brief end-of-the-driveway conversation earlier in that morning when I had paused during my daily FMOS cycling ride, Lili and Pietro hadn’t had much contact with the folks across the road.

Pietro and Lili and the dogs all instinctively knew the man who fell from the roof needed to go to the nearest ER as quickly as possible. He was confused and kept asking after his wife, who was about seven holes into a morning round of golf out at Dufferin Heights. Unfortunately, he was sufficiently disoriented to be unable to take in the seriousness of the situation and adamantly refused to have an ambulance called to his home.

Pietro and Lili convinced the man who fell from the roof that he needed to be seen by a healthcare professional and so they bundled him into the backseat of their well-weathered Volvo wagon and headed into town to have him seen at the local CLSC [community clinic].

Sometimes CLSCs can be real stopgaps and provide a critical link in the continuum of care between initial incident and treatment at a hospital ER. And occasionally they fail to step up and assume their place of special responsibility in the community. Sadly, the man who fell from the roof was turned away from the CLSC without even enjoying the benefit of being seen.

“He needs to be seen at an Emergency Room,” someone said. “You’ll have to drive him to Magog.” Magog is a half-hour drive up Highway 55. No mention of calling an ambulance to the CLSC. No other suggestions.

Pietro and Lili turned the Volvo back onto Dufferin Street and then onto Fairfax but instead of turning North onto Highway 55 they continued across the overpass and pulled into our driveway where they expected to find me, a retired paramedic.

I was at the Stanstead Ambulance station for the launch of the community-wide Automated External Defibrillator initiative.

Dianne and the girls were home. Di took one look at the man who fell from the roof’s ankle and decided, in unison with Pietro and Lili, to call 911. The emergency medical dispatcher who took the call was our friend and neighbour Dany, who instantly recognized the address. After the ambulance was en route for our driveway, Dany called another friend Bruno to check on me figuring for certain the caller had screwed up the age of the patient and that it was me who had fallen from the roof.

“No, it’s not Hal,” Bruno told Dany. “He’s standing here beside me.”

And then Bruno motioned me over and said, “No one is answering at your house and the ambulance just responded for a man who fell from a roof.” After hearing “your house” and “ambulance” I was already running toward the car. Bruno was yelling something in my direction however the windows were up and I was already in motion.

I arrived home to find Di and the kids in the drive. No sign of the ambulance, the paramedics, Lili and Pietro, or the man who fell from a roof. With their patient already aboard, the paramedics were en route to Magog. Later, another ambulance crew would transfer the man who fell from a roof to the University of Sherbrooke Medical Centre to undergo surgery on his foot and ankle.

I went back to the ambulance station where Bruno, a paramedic supervisor, said, “Didn’t you hear me? I was trying to tell you that everything was okay.” I laughed and told him I had forgotten the cardinal rule of being a paramedic – before responding to an emergency it’s always a good idea to pause and check your own pulse.

After tracking down man who fell from a roof’s wife, Lili and Pietro drove her to the hospital – and then got back to tending the house, the horse, the goat, the dogs and the cats.

Later that week, Dianne went over and she and Lili baked up a storm of muffins made with freshly picked blueberries.

In the country, life happens.

Quebec’s prehospital care system and the tragedy on the ski hill

by Hal Newman

Natasha Richardson died yesterday. She succumbed to injuries suffered on a beginner’s trail at the Mont tremblant ski resort. She was 45-years-old.

Some folks have suggested that a neurosurgeon and an MRI within two hours of injury might have made a difference.

Sacre Coeur Hospital is a long haul [about 80 km – 36 miles] from the Ste-Agathe Hospital where Ms. Richardson was initially transported – that’s a very long ride in an ambulance.

I cannot help but wonder if the outcome might have been different if the accident had occurred in a jurisdiction with advanced care paramedics and an integrated helicopter medevac system that would have ensured rapid transfer to a tertiary care facility.

And that lingering doubt shows no sign of fading, especially in light of the news this morning that the first ambulance crew called to the scene left without ever even seeing Ms. Richardson.

Interestingly, when there are NASCAR or Formula One races in Montreal, there are medevac helicopters on standby to transport injured drivers from the track to one of the two major trauma centers that serve Montreal.

Sadly, that’s not the case for the rest of the year and for the rest of the people.

So, while there are Advanced Life Support paramedics based on ambulances, firetrucks, and helicopters everywhere else in the G8 – here in Quebec, the powers-that-be have decided ALS paramedics are just not necessary for the chain of survival.

That’s your chain of survival, folks. To quote Jim Duff, “It’s the system that begins with a 911 call and ends when the hospital moves you out of intensive care — or to the morgue.”

In Quebec, we don’t have Advanced Life Support paramedics because, despite the embrace of all things secular, when it comes to our provincial Emergency Medical Services [EMS] system we have placed our faith in God – and the skills of the resurrection specialists working in our hospitals’ ERs.

If God is smiling down upon you, you just might survive the ride in the ambulance that delivers you into the hands of his emissaries in the ER.

With one of your feet already firmly planted in death’s door, the nurses and physicians of the ER will do their darndest to successfully pull you back towards the light. And once you’re confirmed to be back among the ranks of the living, there will be high-fives all around in the crash room as yet another soul has been saved.

And if you die, well, you died because you were destined to do so despite the best efforts of the team waiting in the Emergency Department.

You just cannot have an effective Advanced Life Support Emergency Medical Services [EMS] system in a society that has bought a lifetime prescription to the notion of supporting a monopoly on who should save lives.

In Quebec, physicians save lives. Ambulance technicians [primary care paramedics] deliver patients to the physicians.

Perhaps one day soon we will begin placing our faith in the people who have the wisdom, experience and courage to work the frontlines of emergency medical services instead of having them continue to serve as the pick-up and delivery service for the ERs.

In the meantime, you can try praying for a miracle.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives.