Targeted interventions help Ft. Worth system reduce call volume

Like many EMS providers, Ft. Worth’s MedStar has its frequent flyers. And like more and more EMS organizations are discovering, MedStar found that helping
those callers with targeted individual interventions can be a successful strategy for reducing the strain they put on the 9-1-1 system.

Systems rarely have to identify more than a handful of chronic callers to make a difference in this way. In Ft. Worth, there were 21 who, during 2008, collectively
accounted for more than 800 transports to emergency departments. That resulted in nearly $1 million in ambulance charges–most of it uncollectable. Those
callers became the initial focus of the Community Health Program, established by MedStar in 2009.

The goal of the program is to reduce nonemergency 9-1-1 calls, help patients get more appropriate healthcare and reduce overall costs to the system. Under
the program, providers developed individual care plans for each of those 21 system overusers. With those plans, those callers now get regular home visits
from advanced practice paramedics to assist them with whatever needs the program identified.

Those needs fall into several broad categories.

“Around half of them are mental health issues and psychiatric-type complaints,” says MedStar Associate Medical Director Jeff Beeson, DO, RN, LP. “Another
percentage is folks who can’t quite figure the system out. Some have legitimate medical complaints, but their specialist is at one hospital, their other
specialist is at another hospital, and our healthcare system is so fragmented, there’s no communication between the two, so they don’t know what to do.
One doctor tells them one thing, another tells them something else. Some have been sick and were discharged from the hospital without understanding their
discharge instructions.

“Our system is broken, and we’re the only common denominator. We know we transport Mr. Smith to a different hospital every three days. The hospitals don’t
know it, because they don’t communicate. So we’re the ones who need to do something about it.”

Potential subjects are identified through internal review of call records (more than 30 calls in 90 days), employee referral, and the suggestion of program
partners. With each visit, advanced practice medics assess the patients, and make sure they’re taking their medications and following up with their primary
care providers. The most needy get visited every day; others on an as-needed basis. Some, ultimately deemed system abusers, receive transport only to assigned
medical facilities, regardless of their preference.

For many, the visits represent not only proactive medical outreach, but a sorely needed source of social interaction.

“We had one lady who was calling just because she was lonely,” says Beeson. “We hardly ever transported her. So knowing that, we started visiting her three
times a week. Now she doesn’t call us anymore. She just wants someone to sit down and talk to her for a few minutes.”

Since its inception, the Community Health Program has saved more than $1 million in EMS and emergency room costs, and reduced 9-1-1 use by its patients
by an estimated 64%. For more, see
www.medstar911.org/community-health-program.

What is the Chain of Survival all about? It is certainly about Early Access, Early CPR, Early Defibrillation and Early ACLS. It is also about a series of
critical interventions, coordinated roles and responsibilities. But what the Chain of Survival is truly about is survival itself.

A life saved.

That’s why Providers do what they do. It’s not about the lights and sirens – it’s all about the patient and good patient care. It’s about a strong Chain
in the Community. Community CPR, and PAD. Because we know that a strong Chain increases the chances for survival from sudden cardiac arrest.

Why do paramedics support the Chain of Survival? Because we know that there is no greater image than that of a recovered sudden
cardiac arrest patient leaving the hospital and beginning to live the rest of his or her life.

Our modern lifestyles make cardiac arrest the number one killer. Two out of every three deaths occur before the victims even reach the hospital. The losses
to families and costs to communities are enormous.

“Survival of cardiac arrest depends on a series of critical interventions. If one of these critical actions is neglected or delayed, survival is unlikely.

The American Heart Association has used the term Chain of Survival to describe this sequence.”*

Some communities with a strong Chain of Survival report survival rates as high as 30%. A series of related and connected events, the Chain of Survival defines
the roles of bypCPR, Cardiac Arrest, Emergency Medicine, Survivalstanders, dispatchers, first responders, emergency service personnel, paramedics, doctors and nurses, coordinated as a team to help save
lives.

*References: Emergency Cardiac Care Committee and Subcommittees. American Heart Association.

There have been two things that have kept me away. One is online burnout and the other is fulfilling my obligations as a National park service Rranger and firefighter… I’m done with all that for now, and I can settle down to write again.

And, with what’s going on in my life…I desperately need to.

To all of you who I’ve left in the unknown…I’m sorry. I can’t say anymore than that. Some things are just so painful, you have to deal with them on your own.

Rod’s fine. Dogs are fine.

More later.

We weren’t doing anything. We were just sitting around bullshitting when the alert tones went off. An accident. EMTs responded, as customary. It was simply called in as “a car accident, injuries unknown,” so it was perfectly normal for the EMTs to go out first. Not long after, we, the ALS boys were being called out. Here’s what I found.

I found a hysterical firefighter-EMT attempting to intubate a teenage girl. As I got closer to the patient, I saw the reason for his hysteria. It was his own daughter. One of the other EMTs tried to get him to move away and ended up flat on his back. After a third failed attempt to intubate, I gently moved my friend of ten years aside and intubated his little girl.

We lost her in the rig on the way to the trauma center. I shocked her and re-established a good cardiac rhythm.

I called the ER and told them we had a thirteen-year-old girl coming in who’d arrested and had a closed head injury. Once we got her to the ER and I filled out the paperwork, I went to wait with my friend. We didn’t have to wait long. The doctor came out and told my friend the words I never thought I’d hear.

“Your daughter has a closed head injury and is not responding to noxious stimuli. I’m sorry to say that she is brain dead.”

I’m sorry to say is stuch a stock phrase. It is as useless as any words are in that situation… the sound that escapes my friend is a primordial one…inhuman…animalistic. I put my arms around him and he clings to me as if drowning. My vision starts to blur as the tears come.

This morning, my friend announces that he’s retiring. He’s gone on his last call.

I feel the need to celebrate the life of a girl, and the career of a friend.

I can’t help but feel empty…

We’re called for a teen not breathing. The address is a convalescent home. It makes no sense.

Then we pull up. There is a car parked askance by the entrance, two front doors and a back door open. The engine still running.

In the front lobby two nurses and a police officer kneel over a small body– a boy of maybe ten years. One nurse does chest compressions, while the other
holds the bag valve mask over the boys face and tries to breathe for him. The police officer attaches a defibrillator.

I kneel down by the head. The robotic voice from the defibrillator says, “No shock advised. Check pulse. If no pulse, continue CPR.”

The boy is lifeless. I feel for a pulse. None.

My partner Rod attaches the cardiac monitor to the patient while I take out my airway kit.

I slip the tube into his throat. I glance up at the monitor. Asystole. Flat line.

I look at his arms for a vein. I see nothing, so I take out an IO bone needle. I pull back his pant leg, swab his tibia, then twist the needle down hard
like a screw. It pops as it goes through the bone.

I push epi and atropine. No response.

“What happened,” I ask now.

His parents were driving by, a nurse says. They brought him in, he wasn’t breathing. They said he wasn’t feeling well today. We started coding him right
away.

I look up at a woman sitting in a chair, looking glazed. A man stands behind her, no hand on her shoulder. Then I notice a silent row of residents in their
wheelchairs in a semicircle around us.

I see in my head this scene from above. Us kneeling around a lifeless child, trying to make his heart beat and to fill his lungs with air. The honor guard
of the aged around us. The scene gets smaller and smaller as the camera view goes up through the roof, through the night clouds and up into the stars.

I hope this evening finds you well in spirit, if not pain free.

As many of you know, my ortho doctor decided not to give me any post-op pain
meds, feeling that I could get by wwith what I had at home. I have a very high
drug tolerance, and a very low pain threshhold, and even though I take some of
the strongest opioids, if I have a new pain problem come up, or get into a bad
Lupus/Spondylitis flare, my nine pain meds can’t fight the battle…

An old doctor friend of mine Doctor Dominique, who is in my group and who has
agreed to take over my primary care, gave me some Norco. She gave me 100, and
she guessed, with me taking 12 a day, 2 every 4 hours, that I’d run out pretty
quickly. She hoped that my post-op pain would be somewhat diminished after the
first week and I’d be able to get by.

Saturday, I called her and told her just how bad it was. My knee was swollen up
to the size of a soccer ball, I couldn’t walk on it and nothing, and I do mean
nothing, was doing any good. She commiserated with me, and told me as she was
on her way out to Quebec, where she is from and also has a practice, (she
rotates), to go to ER if I needed.

I, not wanting to bother anyone, just suffered. Sunday passed in the same sort
of haze, but today, the pain was even worse and my blood pressure, which tends
to skyrocket when I’m in severe pain, was in the stroke out region…
Reluctantly, I called in an ambulance crew.

Now, it’s always been embarrassing to me, when a medic like me, and I’m a good
medic if I do say so myself, (my colleagues agree), has to call for a rig. My
friends were available and were going to take me but they were a few miles away,
so they sent a fire truck to sit with me and monitor my BP…

This was part of the same fire crew that had given me a hard time last time
about my service dog. I did have them written up. I apologized, and they both
agreed that they’d deserved the write-up.

As senior medic in our corps, I have some clout.

So, finally, the ambulance got there and Dewey and I were whisked away to the
hospital. I decided to go to the same hospital which had performed the surgery,
seeing as how they would have all my records and everything.

We get there, and they put me in the waiting room. I raise holy H*** . I say,
“No way are you sticking me in this waiting room to wait for hours when I could
have a blood clot.” My friend Jeff, one of the medics who brought me in, went
over to the desk and the nurse said to bring me to triage.

After giving me the third degree on why I took nine schedule II meds and why
they were not working for me, and why I didn’t have most of my injectables, (I
am given a supply of injectables, if I use them as I normally do, I don’t run
out early, but if I use them as prescribed, I run out a day or two early). I
don’t ask for early refills. I explained that the reason I was out of my
Fentanyl and Demerol injections was that I am due to get them on wednesday, and
I had permission from my pain doc to up my dose if I needed because of surgery.

Finally, Dewey and I are taken into a room and another nurse comes in. She,
too, gives me the third degree. Then she rips the bandages off my incisions,
(nice of her), and says, “They’re not draining, your leg is bruised but not that
swollen).

I said, “Oh yeah, watch this!” and I hopped off the stretcher. As soon as I
did, my knee began to swell, within a few minutes, it was the size of a
softball, that being the swelling. She said, “Oh my God, I guess you are in
pain, you poor thing. I’ll go get Doctor J.”

She leaves and I wait a while. By this time, I’m slipping out of consciousness
and a man, who I assumed was the doctor, comes in and said he had some pain
patches for me, where did I want them. I said, “pain patches? What kind?”
Imagine a drunken slur and you’ve got it about right.

He said, “Fentanyl, you take fentanyl.”

I mumbled that I did but by injection. He explained that they didn’t have
fentanyl injection in the ER. So, I got two 75 mcg patches on my right arm.
Then he taped them down. He warned me that they may take a few hours to really
kick in. I told him I was a paramedic and wasn’t stupid. Thank God, he took it
with good humor.

Then, the doctor comes in, and he talks about giving me something for pain. I
explained that I had already been given Fentanyl patches, and then he said he
wanted to do an ultrasound of my leg to make sure there was no blood clot.
There wasn’t.

After that, they let me go home. It was obvious that I was still in pain, and I
didn’t know this until I got home, but the doc had given Rod, who had come to
get me, some Fentanyl for breakthrough pain called actiq, which is a losenge on
a stick… Rod had two of them, since the doc told him it could be several
hours before the patch began to work…

Everyone there was so impressed with Dewey and how well he behaved. He made me
proud. I can’t wait until my Dobermann in training, Demon, can be the same way.

So, that’s my story, and…I’m sticking to it, or rather, it’s sticking to me!

–
Dodge

It went something like this. Rod took me and two books. One for him about telivision, and one for me called Leaderdogs for the Blind: Whither Thou Goest,
about the forming of that particular guide dog school. Why? You ask? Because I have been active in training dogs for service/guide and protection/law
enforcement work, as well as detection, search and rescue and competition, since I was 12, and it was my first thorough reading on the subject… And one
of my favorite books still today!

We had to wait for a looooooong time. Apparently doctor was behind. We made it to chapter 4. This book is out of print and was written in 1982, but if
you are a serious dog person, get it, read it, take notes!

Anyway, finally, they brought me back into a room. There was the usual changing into a gown stuff, which Rod had to help me with, because they wouldn’t
let me take my morning meds, no other docs have ever had a problem with me taking an opioid injection a couple hours before surgery. Then I was ready.

One of the nurses came in and gave me two pills, both for my stomach, then, they took me to “the Holding Area”. And I’m like thinking what the hell did
I do wrong?

While I’m there the first nurse who comes up to me starts talking to me about my service dog. I’m like how do you know I have one? I ask. She says they
wrote him, and his name and breed in my chart, along with how beautiful he is. She even let me see it. I had not brought him up there with me. The plan
was for Rod to bring him at the end.

I was then spoken to by the nurse anesthetist. She noted that I was very opioid/drug tolerant. I mentioned it, but she said she was aware, and by the
tone of her voice and her body language, she was. She talked to the circulating nurse and the anesthesiologist who then both came and talked to me. The
anesthesiologist said, “Well, since you didn’t take your meds, we’ll just give you what will get you up to the point as though you had, then, we’ll give
you the extra narcotics for your procedure.” They also gave me some verced, because I was so scared I was shaking. I wasn’t scared long. I received
that, plus Dilaudid and Fentanyl.

After giving me”enough narcotics to kill a horse” and being surprised that I was still chattering like a magpie on a sunny day, the anesthesiologist was
about to order me to have more, when the doctor said he was ready. this meant I got them on the move.

Flashback to the age of two, and when I had an organ transplant… A big room…bright lights…no one telling me a thing and them just slapping that mask
over my face and me freaking out.

This time, at least they warned me, and honestly, I was too relaxed and pain-free to care. I had nice pain free thoughts.

… … … … .. … … … …

I was “Mary”. I was dying. They told me I couldn’t go home because I was dying… I was very upset.

… … … … .. … … … …

I woke up. I found out later that there had been a Mary in the room. She had coded and slipped away. She was 99.

She gave it her best shot, but obviously, it was time for her to come home.

First thing I noticed upon waking was THAT I HURT! There was a nurse right there who asked me if I was in pain and I said yes, and immediately, I was given
some morphine. Again, “Enough to kill a horse.” It last a little over an hour and again…same dose.

The second thing I noticed is that I was freezing…I was covered with blankets. The third thing I noticed was… I had to pee. They bring me this bedpan
and I’m like, “Heck no, I can walk to a bathroom.” Nope. Well, I finally gave up on that, since they wouldn’t cath me or let me sit up and peeing lying
down is against my instincts. Probably against yours, too. Yeah, I know, I’m being gross, here. No more gross, I promise.

Finally, I was ready to go back downstairs. I did and I basically waited around a while, but this time I got to see Rod! I was so happy to see him.!
I was also happy to see Dewey Mooey who lapped my face with kisses, and bumped my knee…twice!

Then, finally…finally…Finally… They brought me a wheelchair and I was able to do what nature intended. Thank you God!

More waiting and I got to leave.

While I was in recovery, and Rod was speaking to the doctor, Rod tried to explain to the man about chronic pain patients, breakthrough pain, etc, etc, and
that all these meds I take only help me deal with the myriad oooooos and ows I face every day, and there are a lot of them, not knew ones that might crop
up…He wouldn’t budge.

Not to worry, Dodge was prepared. Dodge thought ahead, and he did get some post op pain meds…just not from his surgeon. Thank you Doctor D!

I got out of there and was so hungry I could have eaten an elephant, so after stopping at my favorite place for take out, I came home, where I ate and have
been resting ever since.

I’d like to thank all those who gave me courage, all those who prayed, with the help of whatever deity, and all those who’ve helped me out… You know who you are.

You all call me “hero”. Ahhh, but you are wrong. It is your random acts of invisible kindness — a cyberhug here, a phone call there, an offer of help here, etc, that make *YOU* the real heroes.

I love you all…More than words can say. You, you are my reason for living.

–Dodge

THIS POST WILL CAUSE YOUR SIDES TO SPLIT!!!!!!

Due to a power outage, only one paramedic, me and a driver, responded to the call. The house was very dark so I asked Kristen, a 3-yr-old girl to hold a flashlight
high over her mommy so I could see while I helped deliver the baby.

Very diligently, Kristen did as she was asked. Mommy pushed and pushed and after a little while, Bryan was born.. I slowly lifted him by his little
feet and spanked him on his bottom.

Bryan began to cry.

I then thanked Kristen for her brave help and asked the wide-eyed 3-yr-old what she thought about what she had just witnessed.

Kristen quickly responded, “He shouldn’t have crawled in there in the first place… Smack his butt again!”

If you don’t laugh at this one, there’s no hope for you!

Cecil Williamson – West Country Witchcraft – 2 of 2

Alex Sanders Witchcraft 1970

Alex Sanders Fire Spirit Ritual

Living the Wiccan Life Episode 14, Raymond Buckland

Janet and Stewart Farrar {nudism}

Thought you would find those interesting.

As she was still in mid-rant, she heard a tap on her window and looked up into the face of a very serious police officer. The officer ordered her to
exit her car with her hands up.

He took her to the police station where she was searched, fingerprinted, photographed, and placed in a holding cell. After a couple of hours, a policeman
approached the cell and opened the door. She was escorted back to the booking desk where the arresting officer was waiting with her personal effects.

He said, ”I’m very sorry for this mistake. You see, I pulled up behind your car while you were blowing your horn, flipping off the guy in front
of you and cussing a blue streak at him. I noticed the ‘What Would Jesus Do’ bumper sticker, the ‘Choose Life’ license plate ho lder, the ‘Follow Me
to Sunday-School’ bumper sticker, and the chrome-plated Christian fish emblem on the trunk,

so naturally…I assumed you had stolen the car.”