A Story from an Interstate Median

I don’t like to talk too much about my career in emergency medical services (EMS) because I always ruin the magic and romance for those outside the field. Despite what the media may have you believe, most of what I do is routine and, while never boring, isn’t particularly interesting. In fact, when I am most thankful to be an EMT, I’m usually not even at work. Rather, I’m just living my life. I am about to describe one of those moments.

I make the drive between State College and Morgantown several times each month and consider myself a resident of both cities. The route is hardwired into my head and I could probably drive it in my sleep (but I won’t, I promise!). I rarely notice much of the drive unless something has changed. Earlier this month the trip was running as any other until about 20 minutes from my Morgantown home. Beginning the descent into Morgantown I notice a thick plume of white smoke or dust and traffic is slowing down. I quickly find the source.

A few hundred feet ahead of me is an upside down SUV. A bystander is attempting to direct traffic out of the inner lane. I ask her if fire or EMS is there. She states that they’ve been called but the crash just happened. I pulled into the median, parked, grabbed my phone and my keys and walk up to the SUV wearing a t-shirt, yoga pants, and my favorite red flip flops. While walking over I had to prepare myself for the fact the scene may not be safe and the victim or victims may be seriously injured or even dead.

As I get to the SUV I find two other bystanders helping the driver of the SUV self-extricate from his vehicle. One is a retired police officer and the other a volunteer firefighter, so we cover the public safety trifecta. The victim, now the patient, is in remarkably good shape. His injuries appear to be largely superficial and he is conscious, alert, and completely oriented. The tense situation gives way to a waiting game. But given the nature of his injuries, there are many things we can begin to do in anticipation for the ambulance.

So the volunteer firefighter and I began to clean up and control bleeding. At any point when I or anyone else needed anything to help this person, it magically showed up. When we asked for water, a case of bottled water showed up. When we asked for more bandages, someone had gauze pads in their vehicle. When we needed a blanket or a coat, someone volunteered one in their car.

After about 20 minutes, the Cheat Lake Volunteer Fire Department and Monongalia EMS arrived on scene. Before letting them take over entirely, there was one last way to help. The patient had insisted on standing up once freed from the vehicle, something I can’t blame the patient for. But given the mechanism of injury, spinal immobilization was indicated. We call the technique a “standing takedown” where a patient is immobilized from a standing position. While the firefighters did all of the lifting, I stabilized his head and neck (great mental picture: I’m wearing a t-shirt and yoga pants and the firefighters are all wearing yellow turnout gear). Once he was packaged it was time for me to go. When I got back to my car, which was strategically positioned to act as protection from traffic, I took one quick picture of the scene before one of the firefighters created a gap in traffic for me to continue on my way.

I sure hope the patient had a good outcome and safely made it to wherever they were going!

State of Emergency

Emergency medical services (EMS) is a funny discipline. It is a little bit health care and a little bit transportation, and it is certainly more of an art than a science to make an ambulance service work for a community. A fundamental problem rests in the EMS vehicle fleet. There are very few standards governing the design of an ambulance. Indeed, as my good friend Dr. Nadine Levick of the EMS Safety Foundation likes to point out, there are more standards governing the transport of cattle than sick and injured people in the United States. What this has given us in the United States is a lot of large, bulky ambulances that perform poorly in crashes and are not ergonomically optimal for the care of patients or safety of healthcare providers. Indeed, if the box of an ambulance is struck or rolls over, the result is often devastating. Attempting to alter the system is as altering any behemoth machine or bureaucracy is, next to impossible. But there’s a small group of renegades who have kindly invited me along as they work to incite change.

My direct relationship with the Transportation Research Board (TRB) dates back to Fall 2009 when I was a Christine Mirzayan Fellow assigned to the board under the guidance of Dr. Rick Pain, the guy everyone goes to if transportation safety is involved. Dr. Pain’s responsibilities include the oversight of safety related committees and subcommittees (if you’re interested in learning about TRB committees, click here), one of which is the EMS Transport Safety Subcommittee. The real beauty of TRB committees and subcommittees is that they often bring together many perspectives on an issue. I often think of it in terms of shining a white light through a prism. In terms of the EMS subcommittee, it brings together physicians, civil engineers, ergonomists, emergency medical technicians, and even vehicle designers. Seminal to the mission of this subcommittee has been the presentation of three EMS safety summits. The second was in October 2009, and the third was this past month on February 29^th.

The goal of this third summit was to tie together the results of the previous two summits, set an agenda for moving forward, and illustrate solutions—both that can be implemented today and others that may require a greater depth of planning. For me this meant making the trek from State College, PA to Washington, DC. But when it’s your colleagues at stake, it’s a no-brainer to make the trip and be committed as an agent of change.

During the summit we looked at tackling the problem through improved education, application of scientific research, and shifting fleets over to safer equipment. Some of the highlights included:

• The introduction of NAEMT’s 8-hour safety class
• Illustrations and diagrams of ergonomic studies looking at where providers actually touch and reach within an ambulance
• Implementation of the “safest ambulances on the road” in Ontario and Texas
• Fleet management systems for reducing fuel costs, improving driver behavior, and understanding area needs in large emergency medical services systems
• Listening to EMS leaders consider system improvements from an interdisciplinary perspective.

The final result of these summits is intended to be a document. The summits culminate in the span of a day. A written document, as well as the recordings of the summits, have a much longer life and ability to reach a broader audience. The recordings from the last summit are already online here. The document, on the other hand, is a greater project, brining all three summits together and describing where we’re going and ways to get there. That document is may area of greatest influence and a responsibility I am keen to manage.

But perhaps most importantly, contributors are not paid. All participants have day jobs who do this just because it is import. We are all volunteers even though it doesn’t match the stereotype of the high school candy striper or young male volunteer fire fighter. Volunteerism is alive and well in transportation, and in this case we’re conquering a true state of emergency.

This is Why we THON

In the wake of the Jerry Sandusky scandal it has not always been easy to be a Penn State student. It seems like the entire campus is subject to a greater level of scrutiny even in matters which have no connection to the absolutely tragic situation. But ever the resilient, Penn State students rallied all year to raise money for pediatric cancer. The culmination of these fundraising efforts is lovingly referred to as THON. THON is a 46-hour “dance” marathon, which over the span of the weekend will fill the Bryce Jordan Center to capacity several times.

As a graduate student, THON had largely been a mystery to me. Indeed I thank my EMS coworkers for not only teaching me but getting me excited for THON. THON is the largest student-run philanthropy in the world. It is also one of most efficient charities in the world, 96-percent of funds raised go directly to families affected by pediatric cancer or to pediatric cancer research.

I worked as an EMT during THON. This offered a unique vantage point. I was able to explore the BJC and interact with more people than an average spectator. Throughout the weekend I treated dancers, volunteer staff, and spectators. Everyone had a moving story as to why and how they got involved with THON. In many of the Greek organizations on campus involvement is expected, but the idea of being 18 or 19 and having a chance to save or improve a child’s life is a deeply moving decision.

Negativity is simply not permitted inside the culminating event, despite the challenge of being awake for 46 consecutive hours for the dancers. To combat negativity and thoughts of quitting are moralers, family, friends, and thousands of people who often deprive themselves of sleep in the stands cheering dancers along. On both Saturday and Sunday I worked from midnight to 8:30am, and when I would walk out onto the floor of the BJC at 4:00am, I could see thousands of students dedicated to the cause dancing in the stands, right along with the dancers on the floor. Indeed, in the wee hours on Saturday morning my pager was completely silent. During a period when we normally would have several 911 calls, there was nothing.

The feeling of being inside the BJC during THON escapes description. The love in the air is palpable. It is dangerously close to euphoria. The colorful and whimsical clothing is almost dreamlike. Dancers wear neon colors with capes, sashes, and tu-tus—most spectators do to. And yes, despite the fact THON is a completely alcohol-free event, thousands of college kids would rather be there than in the bars. Truthfully, I can understand this. After all, this year THON raised $10,686,924.83, all for the kids.

Describing THON is a challenge, so I will leave you with a photograph. When I left THON at 9:00am on Sunday, seven hours before the dance marathon ended, this was the view from the floor. This is before we knew we beat the previous year’s record and at hour 39. Five minutes later when I left the BJC, the line was a quarter mile long outside because new spectators were only let in as spectators inside left. Truly, this is what Penn State is all about. This is part of why I am a proud Penn Stater and over the past week, the feeling has only grown.

If you'd like to contribute to the fight against pediatric cancer, please visit this website.