Category Archives: Emergency Communications

How "New" Will "Normal" Actually Be?

Be careful what you wish for. Just a few months ago, before the words “COVID-19” and “social-distancing” became a regular part of our conversations, I was speaking with the Operations Chief of an EMS service about the difficulty in hiring and retaining paramedics. He said it would take “a downturn in the economy before we could hire enough medics” since candidates typically gravitate toward stable jobs in public service when the market is in a recession. Well, its technically not a recession, but the current pandemic is clearly stressing the world economy and even altering patterns of use for many EMS agencies. In some areas of the country, call volume is now out-stripping capacity while others find themselves in a very different place with far fewer calls than normal. So, as we even consider whether we still need the paramedics we had planned, the immediate questions become “what is ‘normal’,” and “what could be so ‘new’ about it?”

The past can often be a good guide. My primary job in consulting is helping agencies with the optimization of their resources. Doing this successfully requires that I can discover patterns from history to guide forecasts of the immediate future. This is a difficult position when the world is no longer behaving according to the regular fluctuations of the past. Yet, as an undeterred student of history, I continue to search for models that can illuminate the path before us as I did regarding demand in my previous post. There is no shortage of significant anecdotes from history to review, but each has its limitations when applied to today.

My first study was the so-called “Spanish Flu” of 1918-19. It was the deadliest pandemic in history that infected nearly a third of the human population and killed well over 20 million (or by some estimates more than 50 million) victims, including some 675,000 Americans. This historic pandemic had a similar effect to today by shutting down world economies and hiding its population behind face masks. The scariest consideration of a modern parallel to this period would be the idea of an even more devastating second (or even third) wave of infections yet to come. This historic flu, however, was still not able to destroy the world order as some feared. In fact, it preceded one of the greatest economic expansions of industry leading to a period that would be known as the “Roaring Twenties.” The score of our current pandemic is merely a shadow of its predecessor with less than 5 million worldwide infections known and slightly more than 300 thousand total deaths around the globe. So, could we also expect a similar economic boom following our current crisis? That is highly doubtful as the economic conditions preceding this shutdown were entirely different than a century ago. And I’m also not sure we would necessarily want that same exuberance that stemmed from a generation that developed an attitude of “nihilistic hedonism” born from a season of austerity and fear caused by the disease. The age group primarily affected at that time developed a laissez-faire attitude toward life fueled by a rapid rise in prosperity induced by sweeping changes in technology, society, and economy. It was literally the beginning of the modern age – and then came the worst economic depression ever.

Fortunately, the current death toll is still far too low to engender a similar sociological backlash even in a time of modern polarized politics echoing the protests of the last century. With a presidential election less than six months away, many states have entered some form of “Phase 1” of a controlled economic reopening of society. There are probably as many anecdotes as opinions with states like Texas going big on economics over epidemiology compared to the more cautious moves of hard-hit states like New York and New Jersey only ‘cracking open’ slowly. While scientific advances are promising, we still do not have a vaccine, effective treatment, or even reliable tests. Yet we seem reliant on the promise of “contact-tracing” in an environment of community-spread rather than recognized efforts elsewhere at “contact-isolation.” So we can likely plan on seeing more cases of COVID-19 in the coming months and political reactions will likely vary with an increased influence of politics.

What is likely to be lasting from our current experience are new “telemedicine practices” being implemented by physicians and widely accepted by a public that fears even going to the hospital at the moment. If EMS will ever be able to justify the continuation of Community Paramedicine practices or possibly even extending them through their own Mobile-Integrated Healthcare outreach (or as a home-provider within the telemedicine practice of doctors) it will be right now. If the opportunity of the current crisis passes without making political gains to extend the reach of EMS, it will only be more difficult to accomplish in the future. We have also seen traditional conferences gone virtual to eliminate travel and large physical gatherings. Although the experience lacks some of the traditional perks, it has huge cost and time savings. Similarly, professional-referred journals are quickly giving way to a faster social exchange of information and ideas online that bypasses traditional peer-review being replaced by a new social review creating “healthcare influencers” online. To continue this trend, we must figure out how to “qualify” these social icons in the long-term and socially circumscribe their power.

There are also examples we could study of pre-hospital responses to HIV/AIDS, MERS, and SARS. Even though each occurrence caused a significant public panic and subsequent EMS response, their lasting influence quickly waned and the lessons they taught for preparedness were not applied nationally to help us respond to a pandemic. Consequently, the real strategic question we must consider in planning for the future is fortunately not how society will react or estimate how many cases of COVID-19 we will experience, but what effective change will be wrought related to how EMS functions or is financed going forward. As we contemplate moving out from the Department of Transportation  where we are paid only for moving patients, we could consider the terrorist attacks of September 11, 2001, as another example of a precedent model. However, that initiating event concluded within hours and its perpetrators targeted an ideology rather than a lack of immunology. Both passions and fears were inflamed worldwide by these coordinated attacks, but the only lasting results have been legislation expanding government surveillance in the Patriot Act (reauthorized yet again nearly two decades after the event), the creation of a new government bureaucracy over the traveling public in the Transportation Security Administration (which remains focused largely on airline travel which was the target of the terrorists at that time), and the longest on-going war of American history.

Today, the enemy has no flag and the world (or even our industry) also has no unified leader to coalesce a response tactic. Even in the field, the providers of EMS services cannot agree on whether we represent public safety (which justifies an essential funding stream for the public good) or that we provide bona fide healthcare services as a part of an integrated service stream offering appropriate care anywhere from the home to a hospital (that is worth reimbursement independent of driving someone to the hospital.) What history teaches us are several lessons. First, government responds to situations that expand its own interests and that are simultaneously supported by the affections and desires of the public. Even during this EMS Week, it is doctors and nurses who are seen on the front lines of the pandemic war even though the tip of the spear is made up of Emergency Medical Services professionals who go into the homes of the sick and reach through the wrecked vehicles of the injured to risk themselves in the preservation of others. We will continue to be the ‘invisible third service’ as long as we struggle with our identity and lack the statement of a value proposition for a suitable underlying financial mechanism. Second, government consistently responds along an evolutionary path to the last threat rather than a forward-thinking approach. Until we can justify the payment for necessary treatment on scene in addition to any transport to definitive alternative destinations, we will not see revolutionary change. Even wars can be waged indefinitely as long as no one notices they continue. 

We may see some fluctuation in demand for a while, but in the long-run we will return to a familiar normal fare of heart attacks, strokes, and falls once again. It may not be the exact same place we left months ago, but it will not be an entirely new place either. The struggles we fought before will continue to be our struggles again. Hiring and retaining paramedics will again become a topic of discussion as we continue to fight for budgets to maintain our response metrics. That is unless we can learn from one other historical example that comes from back in 1843.  That is the year that Charles Dickens published his famous work known as, A Christmas Carol, where the the Ghost of Christmas Yet to Come prophesies, “If these shadows remain unaltered by the Future, the child will die.”


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Filed under Administration & Leadership, Dispatch & Communications, Emergency Communications, EMS Health & Safety, EMS Topics, Funding & Staffing, Major Incidents, News, Special Operations, Technology & Communications, Training & Development, Vehicle Operation & Ambulances

How is COVID-19 Affecting MARVLIS Users?

The current situation around the new coronavirus is developing rapidly. As we begin to map more cases in new areas along with tracking the shortages of PPE supplies we are also hearing the CDC update guidance for healthcare providers with constantly changing advice. Even the stock market is falling as investors try to make sense of the extent of the impact of cancelled public gatherings and increased social distancing.

While there are significant new challenges around exacerbated staffing shortages created by potential quarantines of first responders, it is still, at least to some degree, business as usual for EMS. Panic over the declared pandemic is not eliminating the “normal” calls to which we must respond. Medical emergencies including cardiac arrests, cerebrovascular events like strokes, diabetic emergencies, and acute respiratory attacks (including COPD, bronchitis, emphysema, and asthma) in addition to common influenza and pneumonia occurrences in this season are all still happening just as before. Similarly, traumatic events are also continuing to happen as a result of motor vehicle collisions or by trip hazards in the homes of the elderly. It is these “routine” calls that are the very reason the most high-performing EMS agencies across Amercia began using MARVLIS in the first place. Now, the added pressures of concern over COVID-19 are requiring additional precautions that can delay care and increase the costs of delivering service to our communities, it may even cause an increase in call volume soon.

The need for efficiency in operations is never greater than during a time of emergency or crisis.


While the vast majority of EMS calls have not changed significantly in response the crisis so far, it is likely to have an impact as the pandemic grows in extent across time and jurisdictional borders. As that happens, the query used in MARVLIS Demand Monitor can be modified to highlight past respiratory emergencies to help prioritize nursing homes or the residences of the most vulnerable elderly populations. On the other hand, if the concern is that this population cannot be so easily identified, MARVLIS Deployment Planner can be used to create a geographically balanced plan that position ambulances throughout the service area based on the best ability to respond anywhere given any potential service level. MARVLIS Deployment Monitor has settings to provide automated recommendations for unit movements to match the plan according rules you can control to either minimize the time to reach that optimal configuration or limit the number post moves that crews experience. The most recent releases of MARVLIS include a “hotspot accuracy report” that allows MARVLIS Demand Monitor to grade the ability of competing queries in making the most appropriate forecasts and MARVLIS PSAP Monitor can allow neighboring mutual aid resources to be seen live on a map.

As the current crisis evolves, it is good to know that experienced advisers are available at Bradshaw Consulting Services to help MARVLIS users modify their application configuration to assist agencies in meeting their changing business objectives. As resources become more constrained, the flexibility of MARVLIS becomes more apparent.

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Filed under Administration & Leadership, Emergency Communications, EMS Health & Safety, EMS Topics, Funding & Staffing, News, Technology & Communications

Christmas Responders

A special Christmas poem for first responders…

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Filed under Emergency Communications, EMS Topics, Fire Rescue Topics, Opinion, Training & Development

How To Perform CPR: The Crucial Steps You Should Know (and Share!)

This important article (and the associated graphics) is reprinted as a guest blog with permission from Monica Gomez, a freelance health and healthcare writer. Originally published at  The animated GIF images alone are worth sharing!

Anybody can and anybody should learn how to perform CPR (Cardiopulmonary resuscitation): According to the American Heart Association, a stunning 70% of Americans don’t know how what to do if somebody is experiencing a cardiac emergency because they don’t know how to administer CPR or they forgot the exact technique. This is especially alarming since almost 90% of cardiac arrests occur at home — where patients depend on the immediate respiratory care response of their family members. In brief, knowing how to perform CPR can save the life of a loved one someday. CPR-How-To CPR-How-To-AdultsCPR-How-To-ChildrenCPR-Cats-and-Dogs

While 400,000 cardiac arrests happen outside of hospitals each year in the U.S. alone, hands-on CPR can actually double or triple an adult’s chance of survival. However, you need to act quickly. At four minutes without oxygen, the patient will suffer from permanent brain damage. At eight to ten minutes, the patient can die. Almost 90% of cardiac arrest patients die because no one performed CPR at the scene.

Before You Start CPR

First of all, check if the patient can respond by tapping them on the shoulder and shouting “Are you okay?? If they don’t respond, call for medical emergency services immediately. If others are around, instruct them to call 911 and if you’re alone, do it yourself. If the patient is an animal, call the closest animal hospital. If you happen to be near an AED (defibrillator), read the instructions and give one shock to the patient (this applies to humans only).

CPR Steps For Adults and Children 9 and Older: Hands-Only CPR

  1. Lay the patient on their back and kneel next to their neck and shoulders.
  2. Place the heel of one hand on the center of the patient’s chest.
  3. Place the heel of your other hand over the first and lace fingers together.
  4. Keep your elbows straight and align your shoulders directly over your hands.
  5. Begin compression:
  • As hard as possible
  • At least 100x/minute
  • Allow the chest to rise fully between compressions.

TIP: Give compressions to the beat of disco hit “Stayin’ Alive?!

CPR Steps For Younger Children and Infants

  1.  Tilt the head back a bit and lift chin to open the airway and check for breathing.
  2. If there’s no breathing, give either of these two rescue breaths:
  • Child: Pinch the nose shut and make a complete seal over their mouth
  • Infant: Make a complete seal over their mouth and nose.
  1. Blow in for one second, so the chest visibly rises and repeat this once.
  2. Give 30 chest compressions (100x/minute):
  • Child: Push with one or two hands about two inches deep
  • Infant: Push with two to three fingers about 1.5 inches deep.
  1. Repeat these steps three to four times.


Pet CPR – For Dogs and Cats

[Follow these CPR instructions for puppies]

For Animals Under 10kg/22lbs:

  1.  Use the one-handed technique, wrapping the hand over sternum and chest.
  2. Give 30 chest compressions (100-120x/minute).
  3. Allow the chest to fully recoil between compressions.
  4. Give two mouth-to-snout rescue breaths after each set of compressions (30:2).

For Medium to Giant Dogs:

  • Position the animal on its side.
  • Use the two-handed technique, placing your hands over the widest part of the chest.

For Deep, Narrow-Chested Dogs Like Greyhounds:

  • Use the two-handed technique, placing your hands directly over the heart.

For Barrel-Chested Dogs Like English Bulldogs:

Place animal on its back and use the same positioning and technique as for adult humans Whether you perform CPR on an adult, child, infant, or pets, DO NOT STOP unless:

  • The patient starts breathing
  • An EMS or another citizen responder takes over
  • An AED is ready to use
  • The scene becomes unsafe
  • You are physically incapable of continuing

Make sure to practice and/or brush up your CPR abilities today, so you’re ready to potentially save someone’s life in the future! Furthermore, if you’re interested in making it your profession to help people suffering from respiratory conditions like asthma, bronchitis, lung cancer, heart attack, stroke, chronic obstructive pulmonary disease (COPD) or sleep apnea, you should look into Carrington College’s respiratory care program. This two-year program combines classroom lectures, laboratory instruction, and clinical experience in order to prepare you to work in a variety of healthcare settings. If you’d like to assist and educate people regarding respiratory health concerns, our training program is the ideal fit for you!


Filed under Dispatch & Communications, Emergency Communications, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Patient Management, Technology & Communications, Training, Training & Development, Videos

Influencing Paramedics on Twitter

I like lists. They are typically neat and definitive. I am sure that my friend @ChecklistMedic would agree that they also help bring order to the chaos that often defines our work in the field. For those of us trying to leverage social media to keep current on EMS thought (or Community Paramedicine or Mobile Integrated Healthcare), Twitter can be a chaotic cacophony of voices. While there is some value in all those voices, my time limits how many I can actively engage each day. Consequently, I look forward to each Friday when my timeline fills with thoughtful suggestions of Friday Follows (#FF). Please note that I said thoughtful suggestions. That certainly does not include the pandering lists of accounts that simply retweeted you this week or include some implied quid pro quo of mentions. So when I heard about a service called Little Bird that creates lists of influential social media accounts, I decided to give it a try. Unlike Klout, that is heavily activity-based and compares all users against all other users for a universal ranking, this new service ranks users based on relationships and topics of discussion.

Not surprisingly, my first list was focused on EMS, but I was surprised to find that many accounts appearing near the top of that list did not actually discuss EMS topics. While they have some involvement in EMS, I was really hoping to discover the accounts that shared ideas and thoughts on the condition and improvement of the field many of us still name as Emergency Medical Services. After some tweaking I created a second version. This list moved several of my own favorite accounts further down the ranking and other unsuspecting accounts appeared. I still hope to get all that worked out, but I decided to switch tactics for the moment and chose the topic as Paramedic instead. This avoided many of the accounts that simply refer to EMS without actually taking part in its development. Paramedics have the vested interest I wanted, but the inconsistency with which we use the term in the United States skewed the results to include a more international flavor. Maybe that isn’t always so bad though. We need to learn from each other and reach outside our comfort zones. So today, this is my #FF list!

The Top 100 Influencers of the Paramedic Topic on Twitter:

1. @jemsconnect
2. @Paramedic_Mike
3. @Chroniclesofems
4. @Ldn_Ambulance
5. @EMS12Lead
6. @paramedic_tutor
7. @EMS1
8. @iParamedic
9. @NYCEMSwebsite
10. @InsomniacMedic
11. @EMSWorldNews
12. @ParamedicComp
13. @gfriese
14. @ParamedicsUK
15. @TorontoEMS
16. @OntParamedic
17. @hp_ems
18. @CdnParamedicine
19. @setla
20. @theHappyMedic
21. @OntarioMedic
22. @EMSBlogs
23. @PAC_Paramedic
24. @scottthemedic
25. @Ornge
26. @podmedic
27. @AmboDriver
28. @flobach
29. @geekymedic
30. @RescueDigest
31. @UKAmbulance
32. @TPAnews
33. @sunmedicgirl
34. @Paradan
35. @jods10503
36. @LDNairamb
37. @hemsparamedics
38. @zollemsfire
39. @rescue_monkey
40. @Sham00911
41. @MedicSBK
42. @Ambulance_news
43. @tbouthillet
44. @romduck
46. @Pell_Paramedics
47. @NiagaraMedics
49. @EMSEduCast
50. @WeParamedics
51. @UKMedic999
52. @cmedik
53. @AmbulanceJunkie
54. @911_redhead
55. @OAPC2014
56. @TEMATrust
57. @WpgParamedics
58. @CPBSOfficial
60. @PenguinEMT
61. @unwiredmedic
62. @SteveWhitehead
63. @stjohnambulance
64. @diagnosisLOB
65. @SendAParamedic
66. @Ambulanceman1
67. @MsParamedic
68. @gfriese
69. @TheBHF
70. @ParaPractice
71. @NancyEPerry
72. @MattTheMedic
73. @ParaACP
74. @gregmedic1
75. @NWAmbulance
76. @PedroParamedic
77. @IrishParamedic_
78. @hybridmedic
79. @clchjan31
80. @ssgjbroyles
81. @NiagaraEMS
82. @SamBradley11
83. @chicagomedic
84. @paramedicpaul
85. @ChiefDiMonte
86. @North_IndMedics
87. @FossilMedic
88. @Ckemtp
89. @ParamedicAssoc
90. @EMS_Louisa
91. @K9kazoo
92. @PerthCoEMS
93. @Paramedic_Daily
94. @Jeramedic
95. @MedicCat
96. @999flymo
97. @emsgarage
98. @RedCross
99. @Stroppyambo
100. @CAWParamedic

Watch for more lists to come.


Filed under Administration & Leadership, Conferences, Emergency Communications, EMS Topics, News, Opinion, Social Media, Technology & Communications, Training & Development

Quick thoughts from TriCON 2012

The theme for the TriCON 2012 conference in San Diego was “Breaking Barriers” and that is certainly what TriTech presented during the plenary yesterday regarding their next generation dispatch system and their consolidation of recent business acquisitions. The crowd was clearly the biggest ever for this conference at about 430 users. A show of hands made it clear that the majority of these attendees were VisionAIR clients with VisiCAD users a clear runner up in representation. However the future direction for TriTech was definitely a merger of several systems, both internal and external to the business, as explained during the opening session called “TriTech Update: One Company.” It was explained that the products would be simplified into a family under the names of “Inform”, “Perform”, and “Respond.” While the names were beginning to be used this week, it was admitted that it will take some time for the actual rebranding to be complete. Attendees at this conference would almost exclusively fall under the “Inform” name reserved for the larger volume clients using applications now called VisiCAD or VisionAIR. Smaller dispatch clients would be in the “Perform” category and “Respond” will include EMS and billing systems.

This type of re-categorization even extended into a restructuring of the organization around functional “centers of excellence” that would be geographically recognized. San Diego, for instance, will become the center including GIS integration and Castle Hayne will host law enforcement functions. Darrin Reilly, the new COO, explained the need to reorganize the company allowing them to take advantage of future trends given that fact that IT evolution will be greater in the next 12-60 months than ever before.

The apparent effect of this reorganization was already evident in the product demonstrations that began with a significant ‘rethinking’ of the integration of CAD and E9-1-1. An illustration that showed how CAD could work differently – and even be implemented incrementally – contained significant integration with Google technology. Integrating search powered by Google into the call-taking screen significantly enhances search as well as map display tools and ultimately dispatcher knowledge.

Integrating the phone system with the CAD enables new features such as automatic call-back dialing by clicking on the phone number displayed on the dispatcher’s screen. Mapping of the incoming calls provides a visual “spatial awareness” that can provide advanced prioritization as a step toward Next Generation 911. In the case where several incoming calls are clustered around a documented incident while others appear at a great distance, it can be assumed that certain calls may be redundant reports while others could be regarding new incidents. The demonstration also showed the possibility of integrating live report calls directly into the TriTech Mobile application for immediate access by first responders.

There was more talk about the benefits of spatial technology integration yesterday with users asking for updates to the TriTech applications in order to support current ArcGIS 10 technology from Esri, but more focus seemed to be on Google-based mapping from the TriTech presenters rather further leveraging GIS technology beyond simple geographic display.

Then this morning Brian Fontes from NENA discussed the future of NG911 answering the questions “What is it and where are we going?” Following that presentation were several other break-out sessions, many of which focused on law enforcement applications which appeared to me to be somewhat disproportionally represented given the audience.

Now off to TriFest in Old Town San Diego tonight!

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Filed under Conferences, Dispatch & Communications, Emergency Communications, Technology & Communications

Response Time Zero

The best possible response time for any emergency is immediate. This is no simple theoretical goal, but a physical reality everywhere that a Public Safety Dispatcher, using standard Emergency Medical Dispatch protocols, can be reached by phone. These calm “voices of hope? quickly perform an initial triage to determine the type of medical or trauma situation being reported, dispatch appropriate emergency services as necessary, and provide quality instruction to the caller before any additional help arrives on scene.National Academies of Emergency Dispatch

The Navigator conference in Baltimore this week, sponsored by the National Academies of Emergency Dispatch, celebrated the efforts made in the last 33 years since Dr. Jeff Clawson developed a set of protocols in an attempt to reduce the number of Code 3 medical runs through proper resourcing and to promote dispatching as a profession. Now there are 65 million emergency calls for service each year to just over 3,500 Public Safety Answering Points (PSAPs) worldwide where the best are recognized as Accredited Centers of Excellence (ACE).

But not all calls requesting service are equal. Using the Medical Priority Dispatch System (MPDS) protocols, automated through software like ProQA, the initial triage phase is automated to provide a standardized format for carrying out the practice of priority dispatching. The acuity of the call is determined to categorize the dispatch response. Increasingly that response may include the possibility of alternative service endpoints in certain systems reforming the traditional “you call, we haul? strategy where each call ends with a transport to the hospital. For systems authorized to use it, like many in Europe, PSIAM provides a secondary level of triage, commonly performed by nurses, for any lower acuity incidents that should not require an ED visit. This is a dramatic departure from the norm in the US and one that will require vertical integration of healthcare providers starting with EMS, the practical gatekeepers to a significant amount of healthcare in the community. Recognizing EMS as healthcare providers is also a shift in thinking from the prevalent public safety mindset and one not taken in current healthcare reform.

The first link in the chain of the emergency response system, however, is the Emergency Medical Dispatcher. These are the true First Responders who are immediately present at the scene providing care even though they cannot see or physically be present with the patient.


Filed under Dispatch & Communications, Emergency Communications, EMS Dispatch, Technology & Communications