Don't Be Part of the 1%

Where are we?

Finding an emergency can be a bit like playing the lottery. Sometimes everything goes perfectly and we find the house without any trouble. Other days we are just baffled. There is a long list of things that can go wrong:

• The house/mailbox has no markings
• The mailbox number is covered with snow
• The mailbox is missing a number
• The mailbox is marked only on the end and not the sides
• The mailbox number is unreadable
• The mailbox only has a last name listed on it
• We drove past the house (see above) and the next neighbor isn't for half a mile
• A panicked caller gave the wrong address
• It raining/snowing/sleeting/ooblecking and we missed the marking
• We were dispatched to the wrong town. Did you know that there is a Mountain View Rd/Dr in Richmond, Jericho, Bolton and Williston?

We realized that we had a problem since we started tracking this problem back in April. Fifteen percent of the time our response was delayed due to a poorly marked address. Often we had first responders that went through the trouble of locating an address prior to arrival so that number may be even higher. The 1% of calls that had a big delay (>5 minutes) could actually make a difference in a patient's outcome if they were presenting with a serious problem.

We decided we wanted to offer reflective, green, 911 address signs. Although this is not a new concept we wanted to make this the easiest process anyone could imagine and make cost a non-issue for anyone that wanted a sign. 

We were fortunate that the Ketover family of Richmond wanted to fund a project that would have an impact on the community. One stipulation of their donation is that signs should be free for participants in Medicaid, WIC and Dr. Dynasaur. Now that a funding source was available we just needed to figure out how to keep costs down.

Mike mounts a sign in Richmond

We purchased sign blanks with high intensity prismatic sheeting and reflective numbers in bulk quantities so we could realize some cost savings. Next we implemented online ordering (google forms) and payment (Paypal). We also offered free mounting to wooden mailbox posts for anyone that has a power tool deficiency. 

Much better

So far we've sold 27 signs (5 were given away for free) with very little marketing effort. We are slowing down our marketing operation because we ran out of 2s much faster than any other number but we should be fully operational again in early January.

For anyone that would like to order you can go to our online order form. Our supply of 2s should be replenished by early January and we'll take care of our backlog of 2 containing addresses.

Please remember that no sign lasts forever. Even well made signs generally only have a life of 7-10 years. Take a look at your mailbox today and order a sign if it isn't well marked. If you have any questions or have a challenging marking situation get in touch with me and we can work out a solution.

Have You Ever Seen a Dead Body?

When people find out I work as an EMT one of the first questions that comes up is: Have you ever seen a dead body? The answer is yes. It only took a few months of working in EMS to see a dead body. It was definitely an uncomfortable feeling the first time I encountered it. It was an elderly gentleman that died at home in his kitchen. One of his neighbors found him and called for an ambulance. In this case he was already in rigor mortis which generally occurs about 3-4 hours after death. There wasn't much we could do other than to secure the scene for the police and the medical examiner.

Since then I've seen probably 20 to 25 deaths. Some are peaceful and others are traumatic. Each one is different and brings its own set of challenges. The most common scenario we see is a call in the morning for someone that didn't wake up. These are known as "untimely's" in the EMS world. Really though, they are anything but untimely. Typically they are elderly people with a host of medical conditions and it should come as no great surprise that they died. While sad for family and friends I think most of us would prefer to die in our sleep.

Traumatic deaths are a whole different story. They typically occur in car and motorcycle accidents and take people that are younger. Many of them are not wearing seat belts or driving aggressively while others are minding their own business and doing everything right.

By this point I've learned that death is unavoidable. We will all end up there one way or another. We can avoid risky behavior and decrease our chances of a traumatic death. We can exercise and eat well to avoid obesity and heart disease. Sometimes we're stuck with bad genetics and we just have to deal with what we're dealt.

When the time comes we can usually make some choices in how we want to go. There are DNRs, DNIs, living wills, palliative care, organ donation and many other options. The most important thing to do is have a discussion with your family about what you want before and after your death. With a little planning the end of life can be less chaotic and your family can focus on spending their time with you rather than trying to figure out your last wishes.

Can You See Us Now?

Old ambulance markings

A few years ago we made a radical departure from how our ambulances were marked. We realized we were doing a number of things wrong and not maximizing our visibility while operating on the roadways. One of our members did a ton of research and figured out what we could do to make ourselves more visible. This required a huge departure from our current color scheme and took a little while to get everyone to buy in.

The new markings

Color
The first big change was moving from maroon to a yellow and blue color combination. The fluorescent yellow color is highly visible both day and night. The decals are also made with a retro reflective material meaning that they reflect light back to the driver.

Contour stripes

Contours
The entire ambulance is outlined in a retro reflective stripe. Being white it is hard to see during the day but at night it makes it obvious that a driver is approaching an ambulance.




Chevrons

Chevron

Chevron are the inverted V pattern found on the back of emergency vehicles. The idea is that they draw a drivers attention toward the vehicle because it is so unique. Some of the key points to designing an effective chevron are:

• Make each line at least 6" wide. Any less and it makes for odd optical illusions.
• Select contrasting colors: blue & yellow, red & yellow, red & white, blue & white and green & white are recommended.
• Cover only about 50% of the rear of the truck. 100% becomes distracting and costs more.
• Chevrons should only be on the rear of a vehicle otherwise it causes confusion

We've been quite happy with our ambulance design and plan to hold on to it for a long time. In doing this research it is surprising how many ambulances are designed for good looks rather than visibility. If you want to learn more you can check out this FEMA publication.

How to Buy an Ambulance

Purchasing an ambulance is quite an involved process that takes about 9 months from start to finish. Right after the holidays we began working on a list of specifications that we thought were important and began taking a broad look at what was available. After a month we settled on a few companies and had them come out with their vehicles.

We figured out pretty fast that most new, well built ambulances aren't that different. Each has a few features that stand out but in the end it would be hard to go wrong with any of them. A more challenging question for us was which chassis do we put it on. We were unhappy with our current Ford E450 and were  looking for something different. We had our choice of Chevrolet and Dodge.

After much deliberation we decided to mount our new truck on a Chevy C4500 chassis. That information was sent off to two ambulance manufacturers and they came back with quotes a couple weeks later. After more deliberation we decided on a Braun Super Chief XL on a Chevy C4500 chassis.

Then the waiting began. Six months of production and some fine tuning of the design led us to the recent delivery our new truck. Once the truck arrived at our station we still needed to figure out where all the equipment will be located, radios needed to be installed, graphics needed to be applied and drivers needed to be trained. All this took another month and countless hours of work.

We are thrilled with the truck so far. It has been out on four calls in the last two days and has gotten great reviews from crews and patients. Thankfully we only have to go through this nine month long process every 4 years.

Enterovirus

No doubt you've seen the news about the respiratory virus effecting much of the country. How does an ambulance service react to such news?

First, we assess the threat to our providers. It generally does not cause severe distress in adults. In fact, adults may only have mild symptoms. Although our providers may not be at risk we still need to think about their families.

To protect our providers and their families we need to know how the virus is transmitted. The CDC tells us that it is transmitted through direct contact and droplets from sneezing and coughing. We have stocked our ambulances with extra face masks, gowns and eye protection to keep everyone safe. We also reminded our providers that hand washing is one of the most effective means of preventing disease transmission.

After we have made sure that we remain safe we next deal with preparations for extra patients. To treat kids in respiratory distress we may administer oxygen and/or a nebulized medication such as albuterol or ipratropium. We've checked our supplies and ordered more as needed. We don't expect a large influx of patient so we are not planning to have a second ambulance in service.

If this outbreak had more serious symptoms that put our providers at greater risk we would initiate our pandemic disease plan. This limits the size of crews and the number of providers that come in contact with sick patients. We would also limit public gatherings and group trainings at our building.

Don't hesitate to call 911 if you've got a wheezing child that you are concerned about. Our EMTs are well trained to deal with this emergency and can get treatment started well before arriving at the hospital.

For more information check out the CDC's page on Enterovirus D68.

This week is child passenger safety week. It is a great time to reevaluate your kid's car seats to make sure they are still the best choice for your child and are still installed properly. Here are a few quick tips about which car seat is right for your child:

• Kids under age 2 should be rear facing. There are 5 times fewer injuries when they are involved in a crash. We would prefer that kids stay rear facing up to the rear facing weight limit of the seat.
• Once kids move out of a rear facing seat they'll go into a forward facing seat with a harness.
• The earliest you would ever want to move a child to a booster seat is at 4 years old and 40 pounds. Again, we would prefer that kids stay in a harness until they reach the forward facing weight limit of the seat. 
• Vermont law says that kids should remain in a booster seat until age 8. Even then, they should be roughly 4'9" tall before moving to a seat belt. Some cars with deep back seats may require your child to be even taller than 4'9". 
• All kids should sit in the back seat until at least age 13. The front passenger seat is the most deadly seat in the vehicle.

How do you make sure your car seat is fit properly in your car:

• Both seat belt OR LATCH(car seat anchor points located in the corner of your seat) are great ways to secure your car seat. Beware that most vehicles only have LATCH seating positions on the left and right sides in the rear of the vehicle. Check your owners manual. LATCH also has child weight limits between 40 and 65 pounds depending on your vehicle.
• Your car seat should move no more than 1" side to side when moved where the seat belt / LATCH goes through the seat.
• Use your tether (a strap that connects the back of the car seat to the vehicle seat) for forward facing installations. This can reduce the chances of your child's head hitting the seat in front of them in a significant crash.

If you are having a tough time getting your seat installed or just want to be sure you got it right set up an appointment with a car seat technician to check your seat. Richmond Rescue offers car seat checks on the first and third Tuesday of each month from 9am to noon. We also offer appointments at other times. Contact carseats@richmondrescue.org to make your appointment.

There are many other fitting stations around the state. Find one nearby and get your seat checked today. 

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