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Sunday, December 26, 2010

Planes, Trains, Ferries, and Automobiles - Euro Style

After stepping down as the EMS Chief of SF Fire in November of 2010, I wanted to take some time to recharge my batteries and get to a place where no cell phone could reach me and to enjoy things that I wanted to do.  Many years ago, my good friend, Mark Ferras and I took a trip to the UK to try and make it to the Scottish Highlands to visit the Malt Whiskey Trail, but alas we were thwarted by snow in the mountain passes.  But while we were tooling around the English countryside in a rented vehicle trying to stay on the left side of the road, we saw many great sights and visited many a pub.  It was in a pub that I put some coins into the jukebox and randomly selected a song called "News from Heaven" by a group I never heard of before called Runrig.

It was one of those songs that just grabbed me and I was hooked.  I looked for every Runrig CD in the UK before we left and took them home.  As I researched the band, I found that they routinely toured in Europe and the UK.  It became an item on my bucket list to see them live one day.

Now fast forward a decade and I am blessed to make the acquaintance of a certain Geordie Paramedic from the Northeast of England by the name of Mark Glencorse.  I met Mark when he came to the States as an exchange program to learn about our EMS System with one of our Firefighter Paramedics, Justin Schorr.  Mark blogs on the Internet as UKMedic999 and Justin blogs as The HappyMedic.  When I knew I would be leaving my administrative position as the EMS Chief in June, I decided that what better place to see Runrig than in Newcastle Upon Tyne (actually Gateshead) where Mark lived.  I would have a friendly face to ask what pubs to frequent and which to avoid.  I left for the UK on December 12th and looked forward to a break.  After a short time in London, and a train to Newcastle, I met up with Mark and met his family.  They were kind enough to open up their home to me as if I were an old friend not just an acquaintance.

The live performance of Runrig was phenomenal, spending time with Mark and his wife Sandra was even greater.  They were kind enough to take me to one of the best Indian restaurants where I had an exquisite Chicken Tikka Masala.  I got to learn about the local history and visit a castle that belonged to Sandra's family.  Met a wonderful woman, Miss Groves, who shared a fantastic history of the Durham Cathedral and spent time in the Shrine of Saint Cuthbert.  I found that the best fish and chips is served with mushy peas and is to be enjoyed in subzero freezing weather on the docks of the quays in Seahouses.  I was too cold to sit on the quays as Mark suggested.

As my holiday ended on the Sunday before Christmas, I encountered the trials and tribulations of having your flight canceled out of London's Heathrow Airport because of snowy weather.  But the friendly United Airlines customer service agent told me that the first flight out of London would be on Christmas Day due to all the travel disruptions.  However, if I could get to Paris, France by Thursday, I would be able to leave on an earlier flight.  So on Tuesday, I set out for Paris from London.  The high speed Eurostar train between London and Paris was operating at capacity and would not take any new bookings so that meant that I had to go the traditional route before the Chunnel came into existence which was to get to Dover and take the ferry to Calais.

On the ferry, I met a nice couple Sophie and her boyfriend Anthony from Brussels who helped introduce me to Mr. Darocha and Sylvain and Jennifer.  Sophie  and Anthony were trying to get home to Brussels and found another couple who would give them a ride home from Calais, Sophie said that as she was trying to get home, she would try to find me a ride to Paris and that was how I met Mr. Darocha, Sylvain, and Jennifer.  Mr. Darocha, Sylvain and Jennifer lived in Paris and wanted to get back that night.  They were kind enough to help me book train tickets on their computer; a great help since I neither spoke nor read any French except for “thank you and please".  From Calais, we hired and shared a cab to Lille, France which was a terminus for SNCF and caught a high speed train to Paris arriving at 12 midnight Wednesday morning in the City of Lights.

On the train from Lille to Paris, I got into a conversation with my seatmate, a lovely French Polynesian university student who was studying politics and her friend who was also studying politics in Paris, both returning from a holiday in Amsterdam.  She told me that she loved President Obama.  She asked me what I thought of  Nicolas Sarkozy and I was embarrassed to say that I knew nothing of the French President except that he was married to the model Carla Bruni.

I noticed she was reading Alexis de Tocqueville's "Democracy in America" and we talked about how both our governments were similar and different.  I told her that America really hadn’t changed much since de Tocqueville made his observations 175 years ago except for that America’s economic divide had widened further and early efforts to stymie generational transfer of wealth via the inheritance tax had been weakened and the very rich were becoming successful in establishing and ensuring dynastic wealth.  She asked me what Americans thought of the French and I told her that the popular media fanned the flames of anti-French sentiment after the French government opposed the 2003 invasion of Iraq by our country.  I told her that we Americans had a short memory, for we would not be a country if the French had not helped our nascent and emerging country secure independence from King George in 1776.  She reminded me that France was very grateful to America for helping liberate her country from the Germans in World War 2.  We parted at Gare du Nord saying that it was important to remain friends and seek common ground in both our country's interests.

Meeting up again with Sylvain, Jennifer and Mr. Darocha, we made plans to get something to eat.  Sadly Sylvain and Jennifer had to catch another train home to Versailles and could not break bread with Mr. Darocha and I.  Over beer, oysters, and Vittel, I learned that Mr. Darocha was an artist by profession and he told me about contemporary art, how much he loved the vibrancy of Manhattan, and how important it was to enjoy art, any art, just let it touch you and make you feel.

I met many new friends and learned that we are really not that different, but I admit that we as Americans are somewhat insular in our world view.  Everyone was friendly and helpful and for that I am thankful.  It was quite an enjoyable adventure very unlike the comedic journey portrayed in the movie Planes, Trains and Automobiles.  What could have been a tremendous drudgery with stress and pain turned out to be a joy; and as in the movie, the important thing in all our journeys through life is mutual concern for one another and cherishing our families and friends.

Good travels my friends.

Wednesday, November 17, 2010

It's been a while...

It has been a while since I posted on this weblog and the reason is that I finally have some free time now.  On November 1, 2010, I returned to my previous posting and position as a paramedic supervisor at the San Francisco Fire Department.  Due to budget cuts, my position as the Section Chief of EMS Operations was de-funded for the 2010-2011 fiscal year.  De-funding means that the SFFD chose to not fill the position but not totally eliminate the position from the budget with the hopes that in the future, the organization may be able to re-institute the position.

From July to November, the Chief of Department appointed me the Acting EMS Chief until she could select my replacement.  The new Assistant Deputy Chief of EMS is a very capable and energetic member, Chief Jeff Myers.  He will serve the EMS Division well in the upcoming years.  It is a challenging time for all of our members because the City and County of San Francisco faces two upcoming budget cycles where there is a projected $400 million deficit per year.  My position was de-funded in a $500 million deficit budget cycle during 2009-2010 as our fiscal year runs from June to July.

Coupled with the financial challenges is the uncertainty of the City of San Francisco's Open EMS system as the State of California EMS Authority removed the anti-trust exemption enjoyed by the Exclusive Operating Area in San Francisco favoring the SFFD, AMR and King and American Ambulance.  Will the City and County of San Francisco issue an RFP for the EMS Transport market in ALS 9-1-1 and ALS Inter-facility transports? Will the City and County of San Francisco not be required to issue an RFP?  Many questions remain unanswered at this time.

I finished my first shift back in the field this morning and it was a very nice re-introduction to the day to day operations of EMS.  As the weeks come, I will find many topics to share with you and I hope that you continue your excellent work and be safe on the streets.



Tuesday, May 18, 2010

Change, change, change...

It has been a month and a half since I posted but my absence has been due more to the amount of work that I have had to finish.  A new shift bid is being prepared for the 140 paramedics and EMT-B's at my station, one that involves rotating weekends off.  And many other projects that need attention.

Some changes and restructuring of EMS in the San Francisco Fire Department is in the works but more to follow in a later post.

Sunday, March 7, 2010

Old Friends, New Friends, and Transitions

Coming out to Baltimore, MD, this weekend was a bittersweet occasion for me.  I had plans to come out with a team of paramedics and EMT's from our Department to compete in the JEMS Games.  Unfortunately, the plans for the team to compete could not come to fruition at the last minute.  Compounding the situation was the fact that I had already bought my plane tickets for EMS Today and something sad had been weighing on my mind since Monday, earlier this week.  The thought of just staying home crossed my mind.  However, I am glad that I came out because I got to see an old friend with whom I used to work with back in San Francisco.  It was always a joy to come to work and see him because he had such a positive attitude and was an uplifting person who was very supportive of our mission working as paramedics in San Francisco.

It was also energizing to  meet a group of young men and women that I think are on the cusp of, if not having already moved the future of EMS ahead many leaps and bounds through the power of social media.  Blogs, Twitter, Facebook, podcasts like the EMS Garage, and the whole medium is a very powerful tool in the hands of these young professionals.   I remember reading nationally syndicated EMS authors and columnists and they would pontificate about one issue or another.  While back in our home jurisdictions, we would have had the same discussion and conversation and either suffered under the dilemma or found our homegrown solution to the problem.  Many of the finest young minds in my EMS generation could never get heard because they weren't in the right geopolitical location or in the right EMS club to find a national publication or conference circuit to share their gifts.

Well,  JEMS, EMS Magazine, Rescue 911 and everyone else in the comfortable national EMS Scene, prepare to be rocked with force of a revolution that rivals that in the descendants of the Persian Empire.  These young minds are out and growing and from the looks of the growth or non growth of JEMS Connect, EMS United,, and others, I don't think the people are going to be satisfied with just hearing from someone just because they have written a textbook, speak regularly at a national conference, or have a lot of alphabet soup initials behind their names.  Quiet and unassuming professionals like a firefighter paramedic from San Francisco and a paramedic from the United Kingdom helped with the creative genius of a paramedic/filmmaker in the private ambulance sector have set EMS Communications on a national and international arena on its ears.

Getting to meet all these new and bright minds with cool names after their @ symbols was heartwarming for me because I have seen the future of my profession and the future is bright.  They are not tolerant of chicanery, flattery, or cow chips when they blog and write, they have a message to share and they tend to tell the truth in a plain, unvarnished manner and format.  Many of them have insights into the problems of our profession that rival those of the alphabet soup professionals who have gotten nice initials like EFO, PhD, CMOD, CFOD, JD, MEd, MA, MS, MPA, MBA, M (whatever).  It might happen one day that we won't need to buy EMS management textbooks any more, just type a question in to the EMS Cloud Computing network and someone will have an answer for you.  I'm daft you say?  Well, maybe, but who would have thought that a small internet event  list started by San Franciscan, Craig Newmark in 1995 would have decimated the viability of brick and mortar print media by killing classified ad revenue.  I for one am going to pay attention to the new clarion call.

The reason for my bittersweet reaction this week was the juxtaposition of meeting all these new friends and trying to cope with the loss of a good friend.  My friend, Jack Grogan, whom I respected greatly, died last Sunday night of a cardiac arrest coming home to his family in San Jose, CA.  He arrested at the airport and was the recipient of the highest level of pre-hospital care.  Bystander CPR, AED readily in place, rapid arrival of ALS.  In my mind, he should not have gone, San Jose did everything right and yet he was not able to be resuscitated.  What makes it so ironic is the fact that Jack had a Sudden Cardiac Arrest many years ago on an airplane and was successfully revived.  Jack was a passionate and tireless volunteer for the Sudden Cardiac Arrest Association as a co-Founder and member of their Board of Directors.  Jack worked hard with the San Jose Fire Department to get San Jose recognized as a Heart Safe City.  He came out to San Francisco last year in August of 2009 to help the San Francisco Fire Department and SFGH Base Hospital with a symposium for the paramedics and EMS community to learn about best practices in cardiac arrest management and improving survival in the field and in the hospital.  Jack and his wife Anita brought out many survivors to share their experiences with the many paramedics and nurses attending the symposium.

I could go on for many pages of the accomplished life that Jack led but please take the time to read his obituary here:  John "Jack" Grogan's Obituary in the San Jose Mercury News

As much as Jack was a hero for dedicating his life to the service of others, I have a plea for my new friends that I met his weekend to dedicate their lives with a new mission in his memory.  Please use your power to share Jack's story far and wide.  Share the mission that Jack was passionate about to make all our communities the best that they can be in improving cardiac arrest survival.  Thank you for reading. 


Monday, March 1, 2010

The responsibility of a blogger and the accountablility of social media users.

The social media community is very concerned about a situation in South Carolina where a firefighter paramedic was terminated from his employment by the Chief of his department for a posting to his social media site.  Many people have filled the blogosphere with comments expressing outrage over his termination and disagreeing with the actions taken by the Chief of the local county fire department in South Carolina.  One of my colleagues whom I respect very much and is partially responsible for me to even begin to write in this environment has weighed in with his opinion here:

The Happy Medic - Letters in the files are flying today

I am going to stick my head over the parapet or my neck out and state that I do not agree with Happy Medic but not for reasons of just standing by another Chief.  I believe that while all citizens of our United States of America have the inalienable right of free speech, that right does not bring with it absolution from consequences of our speech.  Then the next question is whether or not the punishment fits the crime or is the disciplinary action excessive compared to the severity of the violation.  It is in that question that I believe that one needs to go to the community where the offense occurred and to the organization where the offense was recognized, investigated and acted upon.

Colleton County Fire - Rescue

When I went to the site, I read that this is a rural/suburban ISO Rating Class 4 county fire department that has responsibilities to provide fire suppression and EMS to 1054 square miles with 68 paid cross-trained personnel and 250 volunteer members in the South Carolina Lowcountry; and was created in 1994 by aggregating many of the local fire districts or departments.  The Chief appears to be family oriented from my assessment due to his recognition of three occasions in February 2010 where there were births to members of his department.  The Chief or the department also trusts in God.  I also saw that the Chief and the Department supports a Fire Explorer Post (#661) that follows the strict guidelines of the Boy Scouts of America.

I looked into whether or not South Carolina was a "Right to Work" state and it appears that it is by virtue of legislation and not due to incorporation into the South Carolina State Constitution.  I then looked at a local news feature that had links to all the documents that were made available to the public at this site: story by Hatzel Vela

Maybe by now, some of you are getting what I am trying to say.  Many departments have different standards for what is considered to be "conduct unbecoming" or "unacceptable behavior".  There is a great deal of variability from agency to agency and region of the country to region of the country.  A California sheriff's department has terminated deputies in the past for calling in sick when they were not sick.  I don't believe that a member of my department would be fired for such a transgression but the Sheriff of that department made a business case reason for his policy and created a nexus to the professional standards of his administration and the need to maintain the public's trust in his peace officers and their truthfullness and veracity.  I heard him defend his policy once by stating that if a deputy was willing to lie about their status to get a day off, where would the officer draw the line about lying in regards to evidence found on a criminal suspect or the elements of a crime that he or she was describing.  In this day of public distrust of law enforcement, and challenges to the objectivity of police officers such as Brady and Pritchess motions, the mere perception of untruthfulness of a police officer can damage a law enforcement career.

I understand the concern that the other EMS bloggers have about this case involving the firefighter from South Carolina.  It even gave me pause to think about whether or not I should continue or to just pack it in.  I came to the realization that this individual's lack of understanding of the political landscape of his own department and community may have done him in.  The power of media is great, everyone has heard of the adage, "Never argue with a man that buys ink by the barrel."  And there is another, "God created all men and Samuel Colt made them all equal."  I look at the power of social media on the internet in an analogous manner with Samuel Colt's .45 Peacemaker.  What used to be the purview and domain of newspapers and traditional brick and mortar media, is now the capability of everyone with an ISP account or access to the internet.

Instead of arguing about the merits of the individual's termination or not; that is a matter for his legal representation and the employer/employee relationship between the respective parties.   I think it is more important to recognize this as a reminder that all our comments in the open forums require us to be cognizant of what we post and how we post.  Yes, many of our profession may have felt the feelings expressed by the firefighter paramedic from South Carolina but would a member of the public feel the same way?   Would a member of that community in South Carolina feel the same way that I do when I smile and think to myself, I have been there?

I can tell you that I will continue to post but I am now reminded of my responsibility to my profession, my department, and my colleagues and I will hold myself accountable for that.

Saturday, February 27, 2010

A quick note to thank you for the encouragement.

To my small band of followers, thank you for sharing but as I learn more about the new social media and start to read the other blogs out there, I am profoundly struck by the thoughtfulness and lucidity of the other bloggers and their posts.

I was especially enthralled by reading a post that Mr. Chris Kaiser recommended.  I met Chris a few months ago when they had a small social occasion at Gordon Biersch Restaurant to tweet up a meeting with Mark Glencourse.

Chris recommended this post by Mr. Jeremiah Bush:, called "ALS Kills People".  I have read and re-read the post several times and I believe that every EMS manager, EMS educator, and Medical Director should use it as a starting point to discuss the future of how their system can progress in the future.

Kudo's and props, Jeramedic for making us all think about this.

Marching in a parade.

I want to thank my colleague Mark Glencourse from Medic 999 for encouraging me to continue adding to this blog site.  I was thinking what could I possibly write about in the future and something came to me as I was coming home tonight from a very nice occasion.

Tonight was the Chinese New Year's parade celebrating the Lunar Year of the Tiger.  The parade started in 1860 and as long as I have worked in San Francisco; the Public Safety Departments, police, fire and EMS have participated in the parade.  Tonight, the Command Staff of the SFFD, three San Francisco Fire Commissioners, and many uniformed members of the department and their families marched along the route to represent the Department.  Marching with us were members of the Neighborhood Emergency Response Teams (known as CERT in some communities) and the San Francisco Fire Reserve.

I try to make it every year but sometimes other commitments took precedence but I have been lucky to participate in a majority of the CNY parades.  I noticed this year that we had more spectators and many were happy to see the fire department, we received applause and in some sections of the crowd, they cheered us loudly.  I would estimate that there was about a hundred people out tonight marching.

We had members from all ranks and nationalities participating; it just wasn't for the Chinese or Asian members of the Department.  And that was what I realized was so great.  We really are a diverse department and we are so much richer because of that.  The San Francisco Fire Department has one of the largest percentages of female firefighters and female firefighter/paramedics.  SFFD is well represented in the Asian, Hispanic, and African American communities.

I realized how important it was that we showed this diversity to our community.  When I was a child, I remember my parents telling me how important it was to study hard in school and find a nice career as a doctor, or engineer, or pharmacist, or certified public accountant.  It was important to not go into a blue collar job and seek a respectable profession that wasn't hard on the body or dangerous to life.  I know that my parents who were poor and laborers wanted something better for me and my brother and sister.

But when I became a paramedic, they were somewhat hoping that I would come to my senses and go back and study harder to try and get into medical school.  I am glad that I became a paramedic because over the years, I realized how important it was for me to go back into Chinatown and take care of an elderly woman who did not speak English.  How important it was for me to ask her the OPQRST questions in Cantonese as I was working up her chest pain.  Cultural competency is an often overlooked value in our profession and EMS education.

After the parade, we all went to a local fire station to take a group picture and then we went to a Chinese restaurant for a large banquet dinner.  The dinner was paid for by the Asian Firefighters Association and during the welcoming remarks, the President of the AFA stated how glad he was to see all of the marchers at dinner.  He told us that we were all family in the Fire Department and in the Community regardless of our nationalities or creed.

Each and everyone of us who serves the community as an EMT, Paramedic or Emergency Medical Responder has one patient in their career that they made a huge difference in.  I am glad that I became a paramedic and that I get to work in the City where I grew up and I get to make a difference in the community of my youth.  Maybe tonight, there was a young boy or girl in the crowd who saw all the diverse firefighters and paramedics and thought, "Hey, he or she looks just like me, maybe I can be a firefighter or paramedic too.."  And we in San Francisco will be so much better off because of that.

Friday, February 26, 2010

I've waited 28 years for this.

Last night at a SFFD Fire Commission Meeting, the Chief of Department was able to report something positive to the Commission. A report of an occasion that was momentous in my 28 year paramedic career in San Francisco. It was the first time in 28 years that the public ambulance service in San Francisco had met it's response time goals in all districts of the City of San Francisco. From January 2010 to Feb 2010, the overall Citywide 90th percentile response time for a transport ambulance was 8 minutes and 58 seconds.

I remember when I first started riding along with the DPH ambulances in 1976. I was a Medical Explorer Scout at the United States Public Health Service Hospital at 15th Avenue and Lake Street. Robert Giudice was one of the paramedics I got to ride with. There were only 8 ambulances on during the day and 5 at night for a city of 700,00 people. There was no 9-1-1, the public had to call 431-2800 to reach CMED at 50 Ivy which was also Central Emergency Hospital to request an ambulance.

In the 1980's I went to paramedic school at John Adams and did my internship on a DPH unit with Ben Dorcy and Tom Pickford as my preceptors. The number of ambulances didn't change much in the 1980's. In the mayoral administration of Diane Feinstein, the SF Chronicle headlines castigated the ambulance response times of the Department of Public Health as, "Same Day Service."

In the lat 80's and early 90's, there was much hope that the ambulance response times would improve because of a change in leadership of the DPH SFGH Paramedic Division. A young emergency physician named Charles Saunders brought new management tools and administrative skills to upgrade the ambulance service. Dr. Jim Pointer was the Medical Director of the SF EMS Agency and revamped many of the backwards and antiquated medical protocols bringing San Francisco EMS to the forefront of the time in progressive EMS service.

In spite of all their efforts, the SF General Hospital just wouldn't expend any resources to fully fund the ambulance service the way it needed to be. When the merger of the Paramedic Division into the SFFD happened in 1997, the ambulance fleet consisted of 19 vehicles and we fielded 12-14 in our best days. The average response time was 10 minutes which meant that the 90th percentile response time was in the range of 14-15 minutes. Today, the ambulance fleet numbers 41 ambulances and we deploy 21 ambulances at the peak times.

I know the merger has been very hard on the paramedics and EMT's of the public ambulance service in the past 12 years. We lost some very good people because of many missteps and failures to address problems that arose. But regardless of how my colleagues feel the path should have been, one thing is unchallenged.

The San Francisco Fire Department has committed the resources necessary to achieve a goal that had been eluding my professional efforts for 28 years. I think I will try to absorb that for a few days to let it sink in and see if I can postulate about what that means for the future and what is in store down the road for EMS in San Francisco.