Just Plain Ruff

i know that we have discussed this Ad-nauseam but I have been asked a question by someone I respect. Here is the question::::: Do the field EMS providers or helicopter EMS providers in the region utilize aeromedical resources inappropritately? How much has the use of helicopters increased since CMS and HCFA began reimbursing for them? What is this communities thoughts on this question.

In my discussions with Chief Wong, who I have a great respect for after getting to know him better through emails. He sent me this email and I am going to follow through with the questions he asked me on the email. I think that his questions have great validity. LinkedIn Sebastian Wong has sent you a message. Date: 10/13/2009 Subject: RE: TV show Trauma Dear Mr. Ruff, You are welcome to pass my reply on to any of your friends in EMS in the region as long as it is the whole message and not edited or redacted. I also ask that you send a message from my own opinion that while the "pilot" episode was way over the top, there is an opportunity with this show to open a dialogue over some very important issues facing our profession. I respectfully suggest that you re view the "pilot" episode and tell me if you can answer the following questions: How does your service deal with a line of duty death? What mechanisms exist in your service to handle the difficulties that employees experience from the stress of their jobs? Do the field EMS providers or helicopter EMS providers in the region utilize aeromedical resources inappropritately? How much has the use of helicopters increased since CMS and HCFA began reimbursing for them? And if you do re view the episode, the Mayor's wife is the young blonde woman who gets into the helicopter with a sprained wrist. Best regards, Seb Wong.

I posed some questions to Sebastian Wong who is the Section cheif for the EMS Division at SFFD. Here is his reply, he requested that I do not edit nor redact any of his email response. You will see some insights as to the origens of this show that are not public knowledge. I have more of a dialogue with Chief Wong but you get the picture from this email response of his. AS for the original technical advisor, it seems that his suggestions fell on deaf ears and he got fed up with the BS that the producers put him through and he left the show after a episode or two. Here is where Chief Wong's email to me starts: ::::::::: Dear Mr. Ruff, I am involved with the show only in the capacity that they come by the Station 49 and visit like any member of the public can. I think you are interested in how this show began, to that end, I will try to answer your questions. The show was created by Dario Scardapane, a writer. He had ideas fed to him about how heroic the profession of EMS was. The ideas came from a friend or acquaintance he met in the Los Angeles City area who was an EMS worker Dario wrote the script for the pilot and sold it to a production company run by Peter Berg. The production company committed financial resources to film the "Pilot" episode. The producers went to the San Francisco Film Commission and asked for assistance with the permits necessary to film the "Pilot" episode. The command staff of the SFFD received a copy of the "Pilot" and they were not amused nor pleased with the depiction of the profession of EMS or its paramedics or EMT's. The Department's initial response to requests for assistance from the producers was "No". However, the producers used politics to try and get the "Pilot" made. They appealed to the Mayor's Office and the Mayor's Office told the command staff to provide the necessary assistance. The reasoning from the Mayor's Office was that, the general public would understand that this show was fiction and the local economy needed the additional financial revenue that a TV series produced on location would generate. It didn't hurt that the producers put the Mayor's lovely young wife in the "Pilot", who by the way is an aspiring actress. "Pilot" episodes are usually produced in a way to entice Network TV Executives to buy the series; so they have large amounts of sensationalized and stylized themes. It is also designed to try and lure audiences to the series and then try to capture their interest enough with subsequent storyline development to keep ratings up and the renewal of the series. (i.e. more money coming back to the production company who invested a lot of money up front) The original technical adviser that was hired is a paramedic currently employed by us. He is an excellent paramedic and has worked for several systems that are also excellent EMS systems, Austin City-Travis County being one of them. He also had the advantage of being a former Network TV Executive who worked for the Fox Network prior to him leaving that job and becoming a paramedic. His initial efforts to correct the inaccuracies were unsuccessful. The most interesting battle involved the use of Atropine in the cardiac arrest scene at the 280 freeway. Jeff told the writers that Atropine was not in the ACLS Algorithm or in the SF EMS System treatment protocols or any protocol for that matter but he was overridden by the writers and the creative production staff because the writer liked the sound of the word "Atropine". The frustration of providing input and not having it heeded proved too much and he resigned from their employ after the third episode was filmed. My involvement in the program is that I am the operations manager of the ambulance division for the SFFD. The actors came through my ambulance deployment center and rode with SFFD paramedics and EMT's. The production staff also visited the deployment center and tried to pattern the set after it. I have met the creative staff and tried to share with them how inaccurate the show is and how it could produce negative impressions of our SFFD crews. The producers assured me that it was not their intent to ridicule the EMS profession or the SFFD but to try and demonstrate the heroic nature of the profession. (We will see.) To answer your question, I am involved in the show in as much as I am required to open the doors of my station to them should they want to schedule a visit to the station or schedule the actors for ride alongs. I did not write the script nor provide them with any technical advice except for my concerns that I have shared in other boards. My involvement will continue as long as the Mayor tells the department to provide assistance to the producers. I have no regret for having no control over what the producers and writers put out. NBC is a free standing business that is not controlled by the City of San Francisco or the SFFD. The writers have a First Amendment right to write whatever they feel like writing provided it meets the censorship standards of the network and the FCC. If I were the Executive Producer or Writer, I would regret it but I am not and If I were the Executive Producer or Writer, I would put out a totally different show. I find it interesting to read the comments of the paramedics, nurses, Helicopter EMS crews on the NBC board, the "EMS Professionals against NBC's Trauma Facebook Page" , and the TRAUMA page on FB. There are some comments that would damage our profession more than the show. I am also disappointed with the level of EMS education, some of the posters clearly do not have a good grasp of the subject matter. And many of the posters are about as egotistical as the fictional "Rabbit" character. I sense that due to the nascent profession that EMS is, 35 years of history vs. 150 plus for fire departments and police departments; the members are very sensitive because they have no singular voice to rally around. The IAFC EMS Section is protesting because the show is based around Fire Based EMS services. NAEMT is upset over the sex in the back of the ambulance and the clinical inaccuracies. As for what stuff that happens in San Francisco on a regular basis? We are a busy metro sized department. We have never had two helicopters collide in San Francisco. We have had several MCI's with the latest happening in July of 2009 injuring 53 patients that we triaged, treated, and transported in 90 minutes (without using helicopters). The car into the street fair has not happened in San Francisco, (that story came from an incident on the Santa Monica Pier in Los Angeles County). We have had a gunman shoot 23 people and kill 13 in a high rise office building 1993 and I was at the 101 California MCI. We get about 1-2 shootings a week, 2-3 stabbings a week. 1-2 greater alarm fires a month and 1-2 MCI's a year. The rest of the calls are similar to what you would see in other Metro Departments. As for sex in the back of an ambulance, highly unlikely due to the aversion most of our crews have to contracting MRSA, which is a serious occupational risk. I am proud of the men and women that are the SFFD. We provide excellent clinical care and compassionate service to the citizens and visitors of San Francisco. I have been in the profession for 34 years and I believe that I can distinguish reality from fiction. I hope I have answered your questions. Feel free to call or write back. Seb Wong

Out of respect for the writer.

Actually, the original advisor did indeed have EMS background, as a matter of fact, he had some significant ems background but when your efforts to correct the inaccuracies in the script go unheeded then you leave the program. I'm not sure who the new advisor for the show is.

I have received a response from the guy I emailed and have yet to receive permission to post it here. Needless to say - this is a real eye opener as to his response. One thing for sure is that the Mayor of San Francisco's wife (a budding actress) was given a bit part in the show to get the Mayor to sign off on the permits. hmmmmmmmm kind of political gerrymandering if you ask me.

I agree, I have several people in my sunday school class to cheap (ha ha) to get cable and too cheap to buy the commercial antennas soi they built their own. They love em.

'Car 3000 pounds, biciclyst(sic) 200 pounds. Pretty good mechanism even at 5mph with a cyclist with no protective clothing or equipment. I would have boarded and collared him unless he refused. I suspect you had a patient with a thoracic spine fracture right?

I have sent an email to one of the guys who admits that he had some sort of advisory role prior to the show being in production. I asked him some pointed questions in a nice ruffems sort of way. I am interested in his reply if he does reply. The main question I asked is if he is proud of his involvement. I also asked him if stuff like what happens on the show really happens on a regular basis like it does on the show.

We need to get a list of the advertisers in this trash heap of a show. If enough of us send letters to the companies advertising on this show then some of them will pull their sponsorship. Does anyone want to bang their head against the wall to find out what advertisors are on the show?

Absolutely that is Why I said to get Social services or Elderly services involved. Did you just run this call? If so did you leave him? Unfortunately, you did not give the info about him beng kicked out. That puts it in a different light. Did he agree to stay at home and let you leave? Did you discuss the conditions to the caregiver? (damn I key again) Did you involve medical control?

Ok, I was joking on the trial by fire but not by much Ours is at least 2 - 3 days of inclass orentation on the hospital polices and procedures, restraint usage and other stuff. Remember we are hospital based so we need to know what the hospital requires as well as what the EMS side requires then at least 2 weeks (36 hours a week) on in ER orientation and then several days of 3rd person in the ambulance. After that you are on your own with an EMT or with a medic. Dual medic trucks are rare except for day shift. But due to staffing shortages there might be less than 3 days of ER orientation and 1 day of EMS ride time. Depends on your level of experience on the ambulance or in the ER.

First off I'm not going to leave a patient in this condition unless the patient tells me to leave them. I'm going to call medical control and see what they advise. If medical control says leave him then I'm going to leave him. There is no way that this is a new occurrence and the dog urine smell proves it. I'm probably going to remove the matress protector also and make the caregiver wash it. People live like this every day but we just don't see it. I'm then gong (damn I key, t won't work) to call the Elderly Abuse and Neglect hotline and hotline this household. It appears to me that they are in over their heads and they need help. Bottom line, If the patient tells me to leave them and they are A&Ox4 then I'm gong to leave them but I will express my concerns. I'll bet the patient lives like this every day when he's not in the hospital. Ruff

Dwayne, 've been thinking about this for the past day or so. What was the underlying reason that Obama actually got this award. If it indeed was given for his vision of a safer and less nuclear world, a vision of peace that I feel is attainable but probably not for many years. Did giving the award to Obama cheapen the prize, Yes I believe somewhat it did. Do I agree with their giving it to him? Absolutely not. But let's look deeper into this. Over the past 9 years and for several years before that, we were involved in wars that were devastating to the countries involved. Serbia, Croatia, Iraq and Afghanistan. Now Serbia and Croatia might be a stretch but we supplied troops to the UN so yes we were involved. We had administrations that bombed or attacked various areas in Iraq, remember the no-fly zones??? Clinton bombed the no fly zones and some strategic areas in Iraq. We helped the Kuwaiti's throw out Saddam. We helped rebuild Kuwait. The world see's us as just as bad as the Iraqi's. Not a good thing. Fast forward many years and we have a president who has "reached out" (I use that term loosely) and given speeches and rhetoric that sounds really good and has turned some heads out there. This has gained some notice of the powers that be in the Nobel arena. Has he done anything yet? NOPE. Will he succeed in doing what he has set out to do? remains to be seen but we do have countries that have not talked to each other in many years talking. The Nobel prize people are taking this rhetoric and counting on Obama to deliver. I personally think that this will hurt him in the long run if he does not make good on his promises to the US and the world. I don't think this is just cronyism or posturing by the Nobel prizer's but they are making a deposit that Obama is going to have to pay back. I think that in the end, the aims of Obama will not happen and this will be the rallying cry for the Republicans to use in 2012. They are going to use this as ammo to work to get him out of office. They can say "Yes he got the peace prize but he did not bring peace" and that will be Obama's Downfall. There will be other accompanying circumstances like a budget deficit of 3-5 trillion of which we won't be able to pay but that's for a different discussion. Obama has some big plans to fulfill and the Nobel prize is just the catalyst to force him and the democratically controlled congress to make these plans a reality. Really, they control the white house, and congress and they have the ability to get this done but of course, re-election will play heavily on the minds of congress. If they see that the decisions they make in congress will make them un-electable then they are not going to go for these changes. It's a catch-22 Damned if you do and damned if you don't. Those are just my random thoughts on this issue.

He was nominated for his vision of things to come according to the nobel prize report. If Obama's vision comes to fruition then it was a good decision but this smacks of cronyism or favoritism. There are 209 nominees of which almost all have been more successful in promoting world peace. The land mine group comes to mind quickly. The physician in the congo going up against the bad people there also should have been considered rather than one person who had a vision. I have a vision for world peace and I guess I could have won maybe. The awarding of this prize to Obama actually cheapens the award for all the past winners. But I do offer him congratulations for the win though.

This article just jumps out and screams "cost over patient/crew safety" It sounds like this is a comedy of errors. Flying between two thunderstorms, flying in the rain, flying without night vision goggles and not having the equipment to show that you are too low or too close is just nuts. Why don't these companies learn from previous accidents?

I found that after 8 years in the field and going back to get the registry after letting it lapse for 6 of those years, that it was much much harder. All the stuff you learned in your class to pass the registry and then all the stuff you do on the street are at complete and direct odds of each other. There's the national registry way of doing things, A B C D E and don't deviate from it, and then there's the field way of doing things, see something wrong fix it, fix it and go on, then re-assess. My guess is to get into a refresher course or a course that will prep you to take the practical test. If you go into the practical test unprepared then you WILL fail.

I tried to search and find a list but all I found was a number. 209 people were nominated. 1 chosen. Not saying that he was not the right person but I think that there were others insanely more qualified.

never never never bow to me. That's what's inappropriate. but I digress I would also like to see the others on the list of nominees. I would bet that the list was very short. actually I correct the above statement supposedly according to this website there were 209 nominees. http://blog.taragana.com/n/record-205-nominees-for-2009-nobel-peace-prize-13899/

Why is this not appropriate??? All I asked was for discussion, if people here cannot keep it civil then those should not respond. I'm asking what your thought were about this honor to Obama? I disagree with it but I don't make those decisions. If you can respond and keep it civil then I think this is a very appropriate discussion. Besides it's not posted in the EMS forum but the personal section.

The reports I'm getting is that deaths from N1H1 are on the rise. Multiple deaths in multiple states. I'm only thinking that it's going to get worse before it gets better. I'm going to take the vaccination when it is offered to me but I will not go out and seek it out. I wonder how much it will cost????

Barack Obama for the Nobel Peace Prize. Discussion???

Trial by fire Baby, trial by fire!~!!!!!!!!!!!

The nanny state strikes again.

Actually what killed this patient was not the paramedic or the sux. They were the bringers of death but this patients disregard of dialysis and then going shopping is what killed him. Had he have not missed dialysis for 5 days he might have survived. He had enough time to go shopping then he had enough time to make it to his dialysis appointment.