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Texas EMS Conference, the awards ceremony.

The awards ceremony for Texas EMS were held today in Austin at the EMS Conference. Some of the awards that were announced were:

  • EMS Public Information/Injury Prevention – Fayette County EMS, La Grange
  • EMS CitizenJasiah Rubalcava, San Antonio
  • EMS TelecommunicatorPatricia Ancelet, Nederland
  • EMS EducatorRonna Miller, Dallas
  • Designated Trauma FacilityCitizens Medical Center, Victoria
  • EMS AdministratorBryan Taylor, Seminole
  • EMS Medical DirectorHenry Boehm, Brenham
  • EMS First ResponderKemah Fire Department, Kemah
  • EMS ProviderAustin County EMS, Bellville
  • EMS Person of the YearPhillip Rogers, Fort Worth
  • EMS Hall of FameVan Williams, Webster
  • GETAC’s Journey of ExcellenceRonald Steward, San Antonio
  • Hall of Honor (line of duty deaths)Michael Hatley of Houston, December 29, 2011, and Michael Steffen of Salt Flat, March 12, 2012.

It was a packed house and it reached a near boiling point when the colors were raised and tribute was paid to those that have died in the past year who are our brothers and sisters in emergency situations. I am very proud to say that you could hear a pin drop in the entire area as we stood for the ceremony. As is custom a table was left out for those that have been lost, as we never forget them.

The flags that were given to the families is a small consolation for the loss that they have felt but I believe that any of us know the risk and would feel honored to have our peers stand at attention to say goodbye.

I personally thank each and every one of you that go out there and do this job each and every day. We all know the survival rate for anyone is zero at some point, so let’s enjoy each day and do what we must with spirit and vigor. I feel blessed that I was able to see this ceremony and have to say that as the bagpipes were played while the color guard marched out of the location many in attendance were reminded of those that have gone before their time and wept. They were tears of pain but also of some solace. We were all family in that room at that time.

Texas EMS Conference so far

So far I have been having a great time, fellow EMS brothers and sisters from Texas have been seen all throughout the city and it has been a blast. I am not sure I should be writing this since part of “blast” has also been drinking a few beers, I hope like myself all my EMS family is being safe out there. Tomorrow the classes begin and I hope to bring some of the information I receive to you, my audience. I have met many different and inspiring people and am working on at least 3 bios from the exhibit hall. I always leave these EMS conferences filled with hope and pride for what so many of you do for all of us.

I hope you are all safe and enjoying life wherever you are and promise to keep you updated. We are a young field when you take everything into consideration, we have been in existence much less than fire and police departments, but we have made great strides and hope it continues. I am getting ready for bed as I type this and hope to learn much tomorrow.

Good night.

So it begins.

So it begins, my journey towards obtaining my Flight Paramedic Certification has commenced. If I learned one thing after these last three days of hardcore review it is that I have so much to learn.

The only true wisdom is in knowing you know nothing.


I am going to be studying for the next month or so and then will attempt to pass it. We were taught by Clinical Analysis Management and I have to say it was one of the most educational 3 days of my career. Not to say that I haven’t had other great courses in my EMS career, but let me say that even though half of the information was way above my head (not to mention scope of practice) the other half was still so educational I am not kidding when I say it is going to have a significant effect on my future patient care. The class was taught by Anthony Baca, (MBA, MSNc, RN, LP, CCRN, CFRN, FP-C) and Traci Shortt, (MBA, BSN, RN, CCRN (Adult), CFRN).

Now let me say that if I had been notified of the subject matter that we would be covering, in other words if I had been told to review everything I have ever learned about EMS and learn all laboratory analysis and interpretation, I would have been much better suited to take this class. As it was I think conservatively I was able to keep up with about half of the information that they were giving. I was recording the lectures and am going to be reading up on a lot of the information in the ASTNA Patient Transport textbook. Hopefully that and then listening to all the lectures again will be sufficient to pass the exam.

If any of you are able to attend one of their classes or hear them lecture I highly recommend it. If you can read up on some literature and then attend I think it will be a lot more understandable. They know their stuff, that’s for sure.


I am starting to study for my chance at challenging the Certified Flight Paramedic (FP-C)examination. I am lucky that my company is having a training session and is willing to pay for our examination. I have looked at some of the information and think this will be one of the most challenging tests I have ever taken. I hope I am up to the challenge. Any thoughts on what I should study by any of you that have gone through it in the past?

The Art of Self-Reliance

The Art of Self-Reliance

No man who is not willing to help himself has any right to apply to his friends, or to the gods.- Demosthenes
I teach occasionally. The first thing I start with when I teach any first aid or CPR courses is explaining how important it is for everyone to be self-reliant. At least to a degree. Now let me explain, I’m not talking about having 6 months worth of food in a bomb proof underground bunker (if I could afford it I might consider it) what I’m talking is about being self-reliant with the basics of survival. I’m talking about everyone knowing basic CPR, yes the no breaths version is perfectly fine. Everyone should know the basics of the Heimlich maneuver. Everyone, and I mean everyone, from Elementary school to adults should know the basics of controlling a bleed. I have been called to assaults where a small laceration to the temple area have made people look like they were shot with a 50 cal just because no one on scene decided to apply pressure. The times that a tourniquet needs to be used on an artery or venous bleed are far less common and so I don’t consider them extreme necessities but they do occur and I don’t understand why people wouldn’t want to have this skill. It’s one of those skills that I would rather have and never need than need one day and not have. What about anaphylactic reactions? Come on people, every day there are more and more people having allergic reactions to a wider and wider range of items. Learning simple symptoms can save someone’s life. Learning the difference between an allergic reaction and an anaphylactic reaction could give a person a fighting chance. I’m not talking about the technical terms either, just know if someone is showing a lot of itching, trouble breathing, hives, swelling or a sudden case of wheezing they are having an anaphylactic reaction. Knowing that over the counter Benadryl (diphenhydramine) can help but is not the definitive treatment if it’s a true anaphylactic reaction is also crucial. Or what about this one, get called out to a residence for possible MI, because the person has left sided paralysis and they’ve already administered aspirin. Knowing the difference between a heart attack and a stroke is pretty extreme. Even so I see many people mistake the two. Know that weakness to one side of the body, facial drooping and slurred speech is a sign of a stroke and remembering that the time of onset of the symptoms is vital to a possible recovery. A heart attack usually presents with pain to the chest radiating somewhere and does not improve with breathing or position of the body. Both have time fighting against them, but each has their own treatment protocols. Aspirin should not be given to a possible stroke patient under any circumstances unless a physician is ordering it for that specific patient. Another common problem is dehydration and heat related emergencies. Just because young kids have tons of energy and are able to run around like if they’re never going to run out of steam doesn’t mean parents should let them. Knowing that dehydration is something easier prevented than dealt with once you are having symptoms is important. Once someone that is dehydrated begins to vomit it is going to get more difficult to get him hydrated. If, however, parents, coaches and trainers can remember to keep everyone hydrated during exercise, sports events or just a hot day out in the park you can avoid any problems. What if the kid doesn’t want to drink water during play? Make it mandatory in order for them to continue to play. The main thing about being self-reliant is also knowing when you are reaching your limit. I have touched a few times on the misuse of the 911 system and in the future will be trying to look at that issue further, for now however, I am going to say that while self-reliance has it’s purpose there is also a limit. Everyone needs to know that there are certain things that we are going to need help with, such as a real injury, an ongoing stroke, an active heart attack, and a thousand other things that should prompt us to call the emergency number. No one should ever wait to see if the left sided paralysis they are feeling is going to wear off. No one should see if that chest pain that is causing them to have shortness of breath and dizziness will be helped by an Rolaid. It’s crazy that sometimes the people that least need an ambulance call for one and the patients that should have called wait until hours if not days later to call? Self-reliance, at least to a moderate degree, should be something all of us strive for. We never know when it might come in handy.

Government waste

Government waste is something we will always have. It is impossible to completely erase, just as vital to making a government function as politicians. I don’t think anyone will disagree that government spending is running crazy. It affects all of us and some of us in the EMS community are being affected more. Budget cuts are shutting down ambulance services, some that have been greedy are causing others to pick up the slack for patients that are being left to fend on their own.

I came upon this article by Andrew Napolitano and found it hit the mark right on the head. I am adding the link bellow but will quote him here:

The same Congress that professes outrage over the GSA and the Secret Service escapades does whatever it can get away with every day. It writes whatever laws it wants; it regulates whatever behavior it chooses; it taxes whatever events it thinks will keep it in power. And it does so with utter disregard to whether its work is permitted by the Constitution.

It isn’t everyday Fox puts up an actual fair and balanced article. I’m not picking on them, I understand each company has to protect their own interests. This one is a must read as we get closer and closer to the next election. We owe it to our future generations to buckle down and set up longer term objectives than just the next election.



Hero: A person who is admired for courage or noble qualities.

It’s not everyday a person gets to test just what they’re made of. Some of us may never know. Some do what they can with what they have and then they are thrust into a situation that tests them.

This is what happened to Mike Moyer, Fire/EMS chief, on February 15. As reported by the helicopter he was a passenger of was flying in a rescue operation with Ken Johnson the pilot and another team member Ray Shriver. They were on a mission looking for an injured snowmobiler.

When the helicopter crashed, injured, Mike Moyer pulled his two partners out of the wreckage and dragged them to a safer area. I wish I could say he dragged them to safety but I can’t since Ray Shriver died due to injuries from the crash.

I have recently heard many people talk about how some don’t pay attention to true heroes and remember them for what they do. I had posted about this story earlier in the week and wanted to take a moment to say, “Thank you for all you’ve done, I don’t know you personally but I know the job. And you did yours on that call. Hope you have a speedy recovery and sorry for the loss of your coworker.”

Naked man steals fire truck and kills a person

Authorities say a man who was naked stole a fire truck at an apartment complex in South Carolina and sped away, killing a pedestrian who was walking on a sidewalk.

Police say the driver was pulled from the fire truck after it crashed into trees and he began fighting with police and paramedics. A Beaufort police supervisor was not immediately available Saturday to confirm the driver’s identity.

The man jumped behind the wheel of the fire truck after firefighters with the Beaufort-Port Royal Fire Department responded to an apartment complex.

The Beaufort County coroner’s office says 28-year-old Justin Miller of Port Royal was killed by the careening fire truck. The fire truck also hit several cars.

Read more:

Breaking News, Medics don’t sleep as much as others!

A new article in JEMS writes about study that revealed that medics don’t get very much sleep. (Link at bottom) My first thought is, you needed a study to tell you that?!?! Come on JEMS are you serious? And then you rank medics as getting more sleep than police officers? Really? Where have you seen police officers working 36 to 48 hours? I have seen some medics do that. 


It even goes into how medics throughout the year will work approximately 180 hours more than the average person. Just 180? I did a little math based on the 120 hour work week of a medic on a 24 hour 48 off schedule. I came up with somewhere closer to 500 hours more worked by a medic than an average person with an 8 to 5 job. That’s with me giving the average worker 8 OT hours per week!!! 


JEMS thanks for reporting something we all already knew, but come on, 180 hours more than the average person was way under-balled.

EMS God, I think there are two of them and I have named them.

To those of us in EMS that respect the EMS Gods and would never utter the words, “it’s been a pretty quiet shift”, ten minutes before our shift ends, I have named the EMS Gods. I think there are two of them and I will explain why.


The first is who I call Chaos. 


He’s a sneaky one, but we have probably all danced with him in the back of our ambulance. Who among us hasn’t dealt with him as our ECG monitor suddenly becomes a magnet for all artifact in a quarter mile radius? How many of us have not seen our perfectly established IV ripped out by an unsuspecting partner? Come to think of it Chaos probably employs many of our partners, this theory would explain so much. 


Chaos doesn’t just work in our ambulance, he also works against us prior to us arriving at the emergency. Sometimes he works by making a person suddenly allergic to something he’s eaten his entire life. A peanut butter sandwich suddenly sends a patient into anaphylactic shock, even though he has worked at a deli for the past 5 years and eats it on a regular basis. Oh and just for a few extra giggles the call is actually dispatched as a seizure, on the third floor of an apartment (did you catch that? I started by telling you it’s in a deli). I can’t totally blame Chaos for messing up my dispatcher on that call, the police were involved also. (You see what I did there, Chaos works through police just as much as he works through dispatchers). 


Chaos can be evil though, don’t ever give him an inch. (I’m using “him” for Chaos very loosely, as you will see the other God is much more feminine). 


I have seen Chaos kill random pedestrians and bicyclists. I have seen Chaos poison people and cause a simple stumble by a person walking down their stairs turn into an open femur fracture (yeah that call came in as “fall injury” with no indication I was about to walk in on a trapped, bleeding and very angry patient). 


Chaos is the whimsical and occasionally sadistic God of EMS.


Consequence, now here is a God that takes very little pity on any of us. Consequence walks among us and spares us of many things, but he remembers. Consequence makes us need that one item, in a list of a couple hundred, that we didn’t make sure of during our unit check off. And of course it’s no where to be found during the emergency where it’s needed the most. Consequence watches us eat the food we eat and skip the exercise we shouldn’t skip and then hits us with diseases we shouldn’t have. 


Consequence is the “I told you so” God of EMS (remember what I said about this God being more feminine? Who’s better at the “I told you so’s” than women? Ask any married guy and he’ll tell you no guy can stand a chance against a woman who has just proven you wrong. Which is why I rarely let it happen. :)


Consequence works through our patient’s and many times will give us a glimpse of what we can try to avoid. Too many times we ignore it. (I’m looking at all you heavy drinkers who transport someone with cirrhosis of the liver and don’t stop to think where they might have gotten it, smokers who transport COPD patients in respiratory failure, diabetics who eat two burgers for lunch after transporting a patient with BKA home, hypertensives who forget their pills after running with lights and siren to the nearest stroke center with a patient who can’t move their right side….I could go on forever.)


Chaos and Consequence. Can any call not be placed in one or the other’s ballpark? 


Chaos and Consequence. When we make a mistake is it not one or the other? Most of the time when we have a complication on a call isn’t it a Consequence for an action we did or didn’t do? Can’t remember the dosage? Shouldn’t we have looked at that protocol instead of playing that game on our phone during our downtime? 


Chaos and Consequence. Respect them, our EMS Gods, prepare for them. Never fear them. For when we get called out during the longest ten minutes of our shift as we are looking out hoping to see our relief there early, and we cringe because it’s just another “fall”, maybe it’s just Chaos and Consequence wanting a little dance.

A Heart


“The human heart stripped of fat and muscle, with just the angel veins exposed.”

“This is the vasculature of an actual heart (porcine heart, identical to human heart). The blood is replaced by a plastic substance which fills all of the veins, capillaries, etc, then the heart is put into a solution that dissolves all the tissue, leaving this incredible detail of a heart.” (Via Glockoma)

A Heart



“The human heart stripped of fat and muscle, with just the angel veins exposed.”

“This is the vasculature of an actual heart (porcine heart, identical to human heart). The blood is replaced by a plastic substance which fills all of the veins, capillaries, etc, then the heart is put into a solution that dissolves all the tissue, leaving this incredible detail of a heart.” (Via Glockoma)

Waveform Capnography Part 1


It’s been a long time since I’ve posted anything instructional, and looking at the sheer size of the topic I decided to separate this into multiple posts just to over it all. This post will cover the basics of waveform capnography as well as some anatomy and respiratory physiology that is important to understand as you begin to interpret waveforms.

So what is capnography?

Simply, capnography is a measurement of exhaled CO2. We already did this previously with colorimetric CO2, however, unlike colorimetric monitoring, capnography is not affected by alcoholic beverages or other carbon dioxide producing agents that are exhaled. Also capnography does not take “a few breaths” in order to display a change in the measurement, the change is instant when being viewed on the monitor.

You should also keep in mind that capnography and oxygen saturation are two different measurements. spO2 measures “how much” oxygen is attached to the available hemoglobin. As you also know, spO2 is easily fooled by carbon monoxide as it bind with hemoglobin. The spO2 sensor will detect carboxyhemoglobin and only see that something is bound to the hemoglobin and give a false reading. For an in depth video on hemoglobin, check out this video

Capnography will also be an accurate indicator of perfusion and the effectiveness of your or their respiration or ventilation at the cellular level. This is due to several physiological processes that occur with respiration. It is important to know because it is vital to understanding exactly how capnography works, and diagnosing and treating respiratory problems and illnesses more effectively.

The first thing to understand about cellular respiration is that it takes several different actions working as one. It takes oxygen from the lungs, glucose from the liver, and in the body cells it takes insulin produced by the pancreas. Insulin acts as a transporter, carrying glucose into the cells from the bloodstream. Brain cells are the only cells in the body that use glucose directly from the bloodstream without needing insulin. This is because insulin can not cross the blood/brain barrier, which is why when the glucose level in the bloodstream drops confusion and neurological disruptions result until the glucose level is restored.

When you breathe in, oxygen and carbon dioxide exchange places at the capillary beds in the alveoli. The outgoing CO2 is waste product from the cells, which means that cellular metabolism is taking place. The membrane barrier in the alveoli is in fact so thin that it allows oxygen and carbon dioxide to diffuse at the molecular level using a pressure gradient. The oxygen is then picked up by the hemoglobin forming and carried to the cells. When it reaches a capillary, the barrier thins again allowing molecular exchange using the same pressure gradient. When measuring blood gases, there are several different terms used to express this function, PaCO2and PetCO2 are the most important.

PaCO2 is the partial pressure of CO2 in arterial blood. This number should be small and the PaCO2 actually serves many functions. Your brain regulates your breathing rate and blood pH by monitoring this. If the pH of your blood stream increases, this number will increase, which increases your respiratory rate and depth in an attempt to “blow off” the additional acid. You see this in active DKA patients, as it is a very early sign of acidosis.

PetCO2 is the partial pressure of CO2 at the end of expiration. This measures the concentration of the carbon dioxide in the alveoli as they empty. This is an important indicator of many different metabolic functions. The main ones we are interested in is cardiac output and and adequacy of ventilation. If cardiac output is low or ventilation is inadequate, the measurement will be low because carbon dioxide is not being exchanged at an adequate rate.

That’s enough physiology for now. In Part II we will begin covering the waveform, it’s parts, and how it relates to the physiology of respiration.


Kodali, Bhavani-Shankar. (June 2010). Capnography In Emergency Medicine – 1911. In Capnography. Retrieved from