Holiday Cheer in EMS

This is what happens when you let us out in public. Happy holidays folks!

--CW

"What Teachers Make"

This is why I teach.

--CW

Oh, How the Tides Have Turned

My station is currently in the process of releasing several probationary EMTs who are all one or two calls from getting the "Senior EMT" stamp of approval. Recently, I ran a call with one of these probies where we ended up calling in medic back up for a chest pain patient. This EMT happened to need an ALS assist to finish the last step of his release process, and this call was the perfect opportunity to achieve that, as the medic wanted to start a line on our patient. Our sparky EMT had just reviewed how to spike a bag of saline, so clearly, the stars were in alignment for this EMT, and his excitement was palpable. In fact, his excitement was so palpable that I found myself giving advice that--not too long ago--I myself would have been on the receiving end of:

"Hey, kid...deep breath. Focus."

It was amazing to watch the effect my single comment had on the quality of his patient care. It was like a flip was switched, and his mind and body jumped out of overdrive, and I could see him remember why he was there and what he had to do beyond spike the IV bag and get the assist.

Then about five seconds after I watched the effect of my comment hit him, the effect of my comment turned around and hit me: in this situation I was no longer the "sparky", no longer the EMT that got jacked up over every big call, and I became the EMT that others look to for guidance.

After the call, the probie found me as I was wiping down the cot outside of the EMS room: "Thanks," he said, "I really needed that in there. You, know, to refocus and stuff." That simple "thanks" may have been the most rewarding moment of my career thus far.

I will be hitting my two year mark of being in EMS in two months, and am becoming a preceptor in two weeks; it's kind of strange to think about just how much the tides have turned.

Interlude

Okay y'all. The second part of my "basic interventions" series is in editing and should be posted in the next few days or so. Until then, I thought I'd share a tune with everyone.

This song has been stuck in my head for a few days now, and has become an increasingly appealing pipe dream to get me through this week.

May you be able to unwind and unravel all night long,
CW

CPAP: Making Sick Patients Better

If there were a single intervention whose effectiveness I had to say impressed me nearly every time, it would have to be the power of CPAP (Continuous Positive Airway Pressure).

I've mentioned this before, but there are few things more intimidating than being a fairly new EMT and walking into a situation where your patient is clearly sick and you're faced with a 45 minute ride to the hospital. I can hear the patient's respirations from two rooms away--the loud, wet gasps that tell you "Oh crap...", and my mind jumps to envisioning exactly what sight will greet me a mere 30 feet away.

She's tripod-ing, perched on the edge of the bed, and her eyes are wide open and pleading--trying to communicate a desperation that words are failing right now. She is frightened and she knows that there is something very wrong with her right now. Her years are catching up to her, and she wonders if this is it. You can see the edema in her lower legs from 15 feet away, her swollen ankles peeking out from the modest nightgown she dons.

Your observations begin to mold into a concrete set of suspicions about what you're facing, and you start racking your brain for everything that your remember about congestive heart failure. Does she have a history? Cardiac? Respiratory? Otherwise? Medications--what's she been prescribed? Those neatly lined up pill bottles on the bedside table tell a much larger story, I'm sure. When did all of this start?

Her husband is rambling nervously at my side, and I tune into "COPD", "she takes pressure pills", and "she takes  water pills". At this point, I'm at her side, and introducing myself and taking her hand. The death grip that follows is no surprise. I feel for a pulse and it's racing beneath my fingers. It takes a split second for me to make the "load and go" decision.

We apply hi flow oxygen, shift her to a rolling chair borrowed from the kitchen, and wheel her to the entryway where our stretcher sits at the opening to a narrow maze of halls in this one story home. The transfer is efficient and professional, and I am anxious to get her into the back of my truck where I have something that might relieve both the patient's and my own anxiety.

A month ago, I had spent two hours of CE preparing exactly for this situation. A month ago, our OMD had devoted two hours to educating his EMTs about an intervention that works, and works perfectly in certain circumstances: continuous positive airway pressure, or CPAP.

Positive Airway Pressure is a form of ventilation that EMTs are introduced to early on in their educations. When you are taught the "A" of ABCs, you learn the necessity of ventilating with a bag-valve mask (BVM) in certain situations where either the airway is compromised and the individual is unable to breathe adequately on their own. Ventilations with a BVM are a means for providing Positive Airway Pressure. However, the majority of my patients that have been on the receiving end of a BVM are usually no where near able to communicate with me; rather, they hover right around "unresponsive". Yet there is a whole other class of patients that are alert and able to communicate, yet could also benefit from Positive Airway Pressure with a continuous flow. Thus, CPAP was born as an intervention for a variety of conditions ranging from sleep apnea to congestive heart failure to chronic obstructive pulmonary disease (COPD).

As we transitioned the patient from house to ambulance, I quickly and mentally reviewed my indications and contraindications for CPAP. My patient hit nearly every indication for CPAP and no contraindications appeared to be present; thus began my first experiment with rigging up the CPAP and applying it to my patient.

There is no better sense of satisfaction and relief when you start out with a patient who is clearly very sick and 45 minutes out from the hospital, and 10 minutes down the road there is notable improvement in your patient's condition because not only are they tolerating your intervention, but they are also benefiting from your intervention.

What's even more satisfying is when you arrive at the hospital with a patient who is in congestive heart failure, yet due to the lack of several notable signs and symptoms the doctor has trouble telling exactly why you brought in this patient.

The great thing about CPAP is that if your patient can tolerate it, and the indications are present, CPAP can, and often will, make your patient better. More often than not, providers at the basic level are already intend to, and often do, apply hi flow oxygen to a patient who is having difficulty breathing. It is one of the most fundamental protocols that you learn as an EMT-B. In many ways, CPAP is a jacked up version of hi flow oxygen whose mechanism of operation makes it much more effective in certain situations. If OMDs around the country are already willing to let their EMTs utilize high flow oxygen, then why not expand their access to yet another tool that can make an even greater difference for patients whose symptoms are drilled into our heads, but for which there are very few things that--nationally--we, as basic level providers, are able to do to alleviate such symptoms. CPAP is a tool that can make a difference, and isn't it our goal as providers to bring our patients to the hospital in better condition than they were when we received them?

I may be over simplifying the science behind why CPAP, or I may not fully understand why it is often a skill reserved for individuals at the Advanced Life Support level due to the whole "newbie" thing, but I can tell you this. It's as frustrating as hell knowing that local protocol was the only thing preventing a BLS truck from administering an effective intervention  at the pre-hospital level when my grandmother went into congestive heart failure. Even though she lives less than a mile away from a staffed rescue squad in a suburban New England town, she landed in the ICU for four days because of a lack of timely and effective interventions--interventions that she failed to receive until she arrived at the hospital. And last time I checked, that's not what EMS is all about.

There are some services that keep their EMTs on leashes with a scope of practice so narrow you could fit it on the head of pin; Small-City Service in the town where I go to school in Virginia is one of them. As a BLS provider at Small-City Service, you are rarely viewed as more than a medic chauffeur or BS (and yes I do mean BS, not BLS) transport unit. And then there are services like mine, Small-Town Service, VA where we have an OMD that understands the value in giving his providers the tools they need to do their job well and to treat their patients accordingly.


And isn't THAT what EMS is all about?

I Haven't Forgotten!

I thought that the start of the month might be an appropriate time for a public service announcement for all you loyal followers (thanks guys!):

I haven't forgotten about the mini blog series I promised on 12-Leads, King LT Airways and CPAP. It's nearing completion (about a month after I promised it), and I think I'll start with my posting on CPAP as it's a skill particularly salient to my life at the moment.

Hope you all are well!
--CW

Question for the Day

What's your favorite way to avoid burnout?

I was reading an interesting post over at AmboDriver the other day, and it was a serendipitous moment as this is something I've been struggling with a bit recently. So in the name of my ever curious nature, I ask all of you: what do you do to let loose?

I'm looking for some good ideas, so fire away!

--CW

Everybody, Somebody, Anybody and Nobody

"This is a little story about four people named Everybody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody's job. Everybody though that Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."--Anonymous

There's been a huge shift in mentality in this country in the past few decades. Vague, I know, but it's true in an ungodly amount of contexts; attitudes about sex, marriage, adulthood, responsibility, accountability, parenting, education, politics, and civic involvement have all changed drastically since my parent's generation. While the shift in many of the attitudes I have just listed deeply concern me and make me frightened for the world that my generation will inherit and be responsible for living in and attempting to fix, I'd like to spend a bit of time discussing the last one that I mentioned, civic involvement, including attitudes towards community, volunteering and citizenship.

This change in attitudes about civic responsibility is something that I've been thinking about for awhile--for a lot of reasons. It is something I've been discussing a lot with my fellow volunteer EMTs in the context of the rescue squad, and this idea has also been consistently resurfacing in discussions with my social studies education cohort as we've been talking a lot about the responsibilities that social studies teachers have to their students, including fostering a notion of civic responsibility and citizenship.

There is a radically different approach taken to volunteering within and for one's community in today's world of instant gratification and looking out for the top dog than there was even ten to fifteen years ago. Growing up, I was regaled with stories of the tight-knit community that my mom grew up in the mid-20th century Midwest. It was a place where friends and neighbors served one another in a capacity unfathomable to many small towns today. I was raised on my maternal grandfather's reminiscences about the civic capacities he served in, and the pride that he derived from not only serving his local community, but also his country as a military man. I was raised by parents who understood what it meant to serve as they volunteered much of their time in the schools, as coaches and as church leaders. Growing up, I never lacked role models of citizenship and commitment to the community, and I think that foundation of support is what continues to drive me today in my dedication to public and civic service. I am lucky in that regard.

Unfortunately, people like my parents and grandparents are fading in numbers. While they are people who understand that doing what is right can be satisfying in spite of the hard work and thanklessness that  community service often demands, they are largely outnumbered by people who expect (and often demand) such time consuming and passionate dedication for nothing in return. Today, we live in a culture that has socialized us to expect instant results, instant pleasure, and minimal effort when we do something. Just think about the smart phone revolution in the past few years. Never has been accessing information and entertainment been as rapid and effortless as it is in our technologically driven society.  However, volunteering in and for a community does not always offer such immediate rewards for such little input, and I feel like I can accurately say this drawing largely on  my experience as an EMT.

As an EMT, I am required to run a duty crew once a week for 12 hours. When it is my duty night, there are roughly 1000 individuals relying on me to fulfill my commitment to the community. Running for such a small-town service, if I fail to show up for my shift then we may not get a truck out of the building that night. There are few acceptable reasons for me to miss my shift, and if I do it's my responsibility to find coverage. For my actions, I am held accountable. Not every night in EMS is glamorous though, and there are nights where running duty conflicts with some other interest of mine or is an inconvenience at best. Some nights I show up and we don't turn a single wheel. Some nights I arrive at the station planning on (and needing to) complete several homework assignments or tasks, and we proceed to run all night. Every once in awhile I may run a call that taxes my patient assessment skills and ability to triage and treat; more likely than not I will spend a call addressing the feeling poorlies or "take me to the hospital because I said so." It is in this capacity that I serve my community, and I serve it proudly--regardless of the situation.

However, the town where I run is not the area in which I was born or raised. In fact, it is a community in which I am a transplant whom for some reason has become attached to the people and the way of life in this sleepy little town. I have chosen to make this little town my community-- and in tradition with the values upon which I was raised, my responsibility. There are many like me whom have stumbled across this community and have found a place to serve and call their own. Yet the dwindling numbers of native volunteers baffles me when I see so many transplants ready and willing to serve this area. When the rescue squad first came into existence, it's membership was comprised of a thriving group of individuals and families that were directly served and benefitted by the rescue squad. It was public service staffed by and for the community it called home.

But in recent years, membership has dwindled. In reality, there are about 25 individuals who run all of the calls at our service and about half of them commute into our little town once a week for their duty shift. New members are recruits that aren't residents of the town; they come from neighboring cities and towns, attracted by the pace of calls and type of patient care a rural, small town service offers. For a community that often prides itself on taking care of its own, there are very few residents that see volunteering for places like the fire department and the rescue squad as a worthwhile means of living out that pride. There are many that talk the talk, but few that walk the walk, so to speak. The responsibility is consistently passed down the line, thinking "How wonderful it is to serve (insert person X/place Y), but it's not my responsibility. Someone else will take care of it."

And that unaccountable attitude is more pervasive than I feel comfortable admitting. Not only do I see it in the town where I run EMS, but I see it in the classrooms I teach in as well. The other day I was discussing hot topic current events with a student in the government class I work with. When I asked them if there were any specific policy issues that they cared about, they replied, "Care? Why should I care? It's not like I can vote or do anything about it? I'm not even of age." When I pointed out that come the next election year, these would be issues that would concern them as they would be able to vote, they replied "It's not my responsibility to change anything. My vote doesn't even count in the grand scheme of things. I'll just let everyone figure out what to do about it all. There are people smarter than me out that can care." This is not the first conversation that I have had that echo such sentiments; even over a matter as simple as voting, there is that same widespread sense of passing along the responsibility to another. Yet the line eventually runs out and the duty cannot be passed on anymore; someone is eventually held responsible, and, thus, accountable.

And at that point, voluntary service becomes a duty. In fact, maybe that's the way it's supposed to be; that we all have a duty to serve our community in some capacity. Maybe it's this understanding of citizenship and service that has gotten lost over the past few decades. Maybe we've been passing the buck for too long that the notion of responsibility has gotten lost in the shuffle. Maybe, just maybe when we reach the end of the line people will be jolted back into realizing what it takes to make a community run.

I have long realized my duty to serve and I do so with a sense of pride and satisfaction that I have yet to find anywhere else, whether it be in the back of an ambulance or in front of a high school classroom. I only hope that Everybody realizes their duty as well, and Somebody steps up, before Nobody does what Anybody can (and should) do.

Deja Vu

I ran a call yesterday--a priority black cardiac arrest. There really wasn't much to do by the time we arrived on scene. The medic unit was already placed in service, and we ran a strip just to confirm asystole; not a surprise really, given that we had a 15 minute ETA to the scene and the estimated down time was close to 30 minutes or more by the time we arrived.

But what threw me on that call more than anything else was a missed turn on the ride back to the building. Lost in conversation about the call, we missed the road for the most direct route back to the building, so we continued on down to find the nearest driveway to turn around in.

It was pure luck that I looked out my window as we pulled out away from the driveway to head back down the road, and I gasped at what I saw. An eerie feeling made its way down my spine. There was a black fence at the end of the driveway, with horizontal three slats, and the house number running down the corner post.

The last time I saw that fence and house number, there had been a body wrapped around the corner post, and a motorcycle in the ditch. And I had proceeded to work another code, with similar results: priority black.

Deja vu, no?

And as we rode back to the building, I couldn't help but notice only that they had repainted the house number, but left the crack in the fence.

Blog Series--Update

Hi friends...This is not a post of serious substance, just a quick update on the delay in my mini-series on BLS (or what I think should be BLS) skills.

Needless to say, it's that glorious time of year that all university students must face head on: midterm season. My midterm season is in it's full glory at the moment, so it probably wasn't my best idea to introduce a new series of post just as it was getting underway. However, fear not, I have not forgotten about my promised posts and musings (I know, you're so eager for them). I am still chipping away at finishing them, it's just taking longer than I hoped given my extremely limited (and ever decreasing) amount of free time.

On the bright side: I have a new favorite read in the EMS blog-o-sphere. I've added her to my list of the best of the internet, so you should take the time to check out Probie to Practitioner and see what she has to say.

Well that's all for now, folks!

TTFN,
CW

Scope of Practice, the Introduction

I've been having a lot of conversations recently regarding scope of practice, more specifically skills that are included in protocol. This has been a hot topic in VA recently, as it has been nation wide as well, due to the future changes that the national registry will supposedly be undergoing in the near future.

However, this discussion or protocol and scope of practice has always been a hot topic. Just check out one of the many blogs in the EMS blog-o-sphere (maybe AmboDriver or StreetWatch?) and you'll come across many posts that discuss the inclusion or exclusion of certain skills, drugs, etc. from protocol, and the merits of each.

But rather than focus on reforming the skills that EMTs around the country should undoubtedly have access to, I'd like to talk about several skills and pieces of equipment that I have found indispensable in my own experience while running at a rural rescue squad; in fact, I believe they are indispensable no matter where you run.

If you run with my service, you're looking at--unfailingly--at least a half hour transport to the nearest hospital, most likely closer to 45 minutes, maybe even an hour if you get sent on a mutual aid request. This exceedingly long transport time, potentially with a critical patient, is something that I don't think a lot of big city (or small city) providers fully understand the reality of. At my station, the majority of volunteer crews mark up at the basic level. Our medic level providers are few and far between, and as a result we rely heavily on a nearby county career-staffed station for medic-level services. QRVs are virtually unheard of, and if you have more than one crew in the building a shift, then you're the exception not the rule. While we do have access to a helicopter service for some of those calls that you know are going to be bad when you hear them go out, if you don't put them in the air immediately, there is a distinct possibility that ground transport may be just as efficient as flying them out. And you would be shocked to realize how long 30 minutes in the back of an ambulance with a patient who is seizing uncontrollably (and you have no medic-level rendezvous in your near future because they're on a call in their own first due) can feel.

So given that context, I want to talk about the merits of having the following three skills approved at the Basic level: 12-Leads, King LT Airways, and CPAP. In the following three posts, I will discuss some of my personal experience with these skills and pieces of equipment, as well as potential advantages and disadvantages. On the whole, I will be straightforward and say that I think these three skills are significantly more beneficial than they are problematic, but if you disagree, I would like to hear your ideas.

Coming soon: 12 Thoughts about 12-Leads.

Til next time,
CW

Some Calls You Never Forget

In EMS, there are just some addresses that you remember. Some of them may be associated with frequent fliers, some are associated with the most bizarre calls of your EMS career, and some are forever associated with those calls that leave ghosts behind.

In EMS, we all have those calls that we'll never forget. Over time, the may fade or blend into the memories of other calls, but they are never truly forgotten. In time, you are often able make peace with those ghosts left behind from tough calls, but in a small town EMS service there's a very good chance that you'll never be able to let them truly rest.

Small town EMS is an entity unlike any other. When you run those "oh sh*t" calls, they are to addresses that you may know; they are for family, friends, people you have grown up around, and maybe even members of your own department. That's not to say that you don't run those same calls in big city EMS, they just happen to be a bit more concentrated out here in the country.

I ran a call with a good friend of mine awhile back--ultimately, a fatality from an MVC (motor vehicle crash). The call was one of a series that we had that night (because where I run, when it rains it pours); this was our second response from the hospital, and as we were en route to the scene, we were advised that we were facing a potential code.

My friend and colleague happens to be small-town-born-and-raised, as many of my fellow providers are. Even as a transplant from the North, one of the first things you understand about this town is that it's a tight community, and when you hear a potential code go out over the radio you start fervently wishing that it's no one you know--that this time you'll get lucky and you won't be working a family friend or acquaintance. There was a look that flashed briefly over my friend's face, a look of desperation like I had never seen from her before.

Needless to say, she was not so lucky that night. Our transport for that call was to the hospital, but more specifically the morgue. The front of the truck was silent on the ride in, with few interruptions limited to the tones for the rest of the county dropping quietly in the background.

No words were needed that night, at least not immediately. The talking will, and does come, and the support of other providers can help you reconcile your actions as an EMS worker and make peace; yet the question remains, how do you grieve? Because it these kinds of situations you are not just a provider, you are a friend, a loved one, an individual who shares more common ties with the patient than just a singular call.

It's a question that I'm not sure a lot of small town providers have yet answered; in fact, I think that there are many answers to this question that are as unique as the relationships between patient and provider themselves. But I do know this: there are just some calls that you never forget. And that's okay.

Entre'act

Before I post my next musing, I feel like I should give a quick rundown of the rules that I will be following for discussing actual EMS calls on my blog. I'm borrowing liberally from Peter Canning of StreetWatch, one of EMS' most prolific authors and bloggers (and also, a personal role model of mine), so I will direct you to the following page:

• http://medicscribe.com/blogging/

I will try my best to convey the heart, or the essence of each story, but to protect my patients, fellow providers, the service I run for, and myself, there will be several alterations of superficial details.

I hope you enjoy the posts to come,

CW

Band Wagon

I have now joined the masses. Follow me @CountrySpark_CW on twitter.

You can blame my Teaching with Technology class for this one :)

Role Models

I've come to the conclusion that when the going gets tough, the tough find role models that can provide that extra bit of incentive and support to achieve one's goals--and then they get going. Recently, I've been feeling kind of overwhelmed by life, particularly by the demands that my academic pursuits have been making on my time.

For those of you who have been around since the beginning, the fact that I am simultaneously pursuing both an undergraduate and graduate degree comes as no surprise. For those of you that know me personally, the fact that I am on an accelerated track for both degrees is also not new information. For anyone with a bit of common sense, the fact that I am struggling and under some pretty intense stress should not blow you out of the water.

As a result of this academic (and many-other-factors induced overload), I've been floundering a bit. For most of my life, I have been largely intrinsically motivated. I choose to do and pursue things that I am passionate about because accomplishing those acts makes ME happy. There was a substantial period in my life where I struggled with the lose-lose reality of pursuing not-quite-passions because I believed that they would make other people happy, and thereby make me happy; it turns out my theory was horribly wrong in that regard.

And I'll be honest: history and teaching do make me happy. In fact, they are two of the things in my life that I am most passionate about (if there is confusion on this point, I refer you to why I started the blog in the first place...); however, lately I've realized that my personal fulfillment in the pursuit of an undergraduate and graduate degree is hardly cutting it anymore. I feel as if sometimes my workload is isolating me from the relationships that will make my eventual achievement of these goals enjoyable. Sometimes I feel like Hermione Granger.

No...I'm not kidding. If you want a better understanding of why I identify with a fictional character, read this; maybe then you'll understand. To me, Hermione Granger is an inspiration of sorts; the girl who didn't let anything get in the way of her voracious academic pursuits; the girl who wasn't afraid to fight for her dreams and what she believed in; the girl who valued her friendships above all else; the girl that I grew up idolizing. Yes, Hermione Granger has been and always will be a role model to me as a still-trying-to-find-my-way, at times graceless, yet well intention-ed young adult. With some of the stuff that I have been dealing with in the past few months, having a role model like Hermione has provided me with a model of how to keep on in the face of adversity and challenge.

That's not to say that all of my role models exist in the fictional realm. I am so unbelievably blessed to have an extraordinarily high number of impressive and commendable individuals in my life after whom I can model my own actions and choices, as well as rely on for support. And since my life has kicked into high gear recently, that support has been indispensable. So I would like to say a thank you to a few people whom have remained steadfast in their support, compassion, love and inspiration in recent months. Your companionship and dignity with which you live your lives continues to amaze me, and makes everything that I am working towards that much richer.

To my mom: I love you and you are truly one of the strongest women and supporters that I know. I don't know where I would be without you in my life.

To my adopted grandfather and mentor: your kindness helped a very lost little girl find her voice and her way, and I look up to you in more ways than you will ever know. Thank you for taking this fellow Yank under your wing, and teaching by example that a little bit of compassion, humility, laughter and common sense can take you far in this world.

To my beautiful cousins and sister: each of you have inspired me in unique and varied ways to try and be the best person that I can be. Each of you are veritable fonts of strength, grace, compassion and fun, and I am constantly amazed and humbled by the women you have turned out to be.

To the three musketeers: it always comes back to you. You are the rocks at the center of everything I do, and I know that we can face anything together and come out stronger for it.

To the family that I have chosen: friendship does not even begin to cover what I have with each and every one of you. Celebrating life's little moments and pleasures with you, whether it is a rich cup of coffee, or one another's triumphs and achievements, has left an indelible print on my heart.

It is with and because of each of you that the stress becomes manageable and the rewards become richer and the memories become stronger. You are the true role models that are helping me get through the overwhelming stress that enable me to keep my head in the game, channel my inner Hermione Granger, and face each challenge head on with no fear and the sweet taste of satisfaction. Thank you, and I love all of you.

What Exactly Is Social Studies?

So I realized that in my last post, I may have jumped ahead of myself. If you were to create a taxonomy of social studies (the field in which I am earning my Masters), history would fall under the heading of social studies. That is to say that before one can discuss history education, one must consider the greater category that it falls in. In order to correct such a massive oversight, I offer the following. Enjoy!

Welcome everyone. Get ready, because critical thinking time begins now. Today's lesson will examine the following question: what exactly is social studies? There are a few things that I would like you to think about as we make our inquiries today. They are:

• What disciplines make up social studies?
• What is the "point" of social studies?
• Why do we teach social studies?
• How can we make learning social studies fun?
• Why is social studies relevant to your life?

To get you thinking, I present the following situation:

Your name is Harry Potter. You have been chosen and marked by the Dark Lord as his equal. Your mother died to protect you, and you have powers beyond your own that protect you as a result; these powers derive from love. You have twice faced Voldemort and and you know that a third meeting is imminent thanks to Sybill Trelawney's prophecy. You also know that there is a single remaining horcrux (remnant of his soul that binds Voldemort to the realm of the living) beside the one that exists within you. You have a choice to make. Sacrifice your life for the destruction of Voldemort, or let Voldemort reign once more?

How could an understanding of disciplines found within social studies allow you to turn the advantage in this situation? We will return to this question a little bit later.

If nothing else, I hope that at the end of today you take away this understanding: social studies is a series of interconnected disciplines that focus on human interactions with a variety of institutions, individuals, and places, and the study of these disciplines can provide individuals with the necessary skill sets to be informed and contributing citizens.


Now if you would, I ask that each of you take a moment to briefly consider what disciplines you believe would fall under the heading of "Social Studies". Some that come to mind for me, include but are not limited to: history, geography, human (cultural) geography, sociology, anthropology, archaeology, philosophy, political science, civics, religion, economics and psychology.

Have you ever previously considered just how diverse a field social studies actually is? If you were anything like me, you probably had a class that was called "Social Studies" in middle school but you never actually knew what they meant by that term. Did it mean history? Did it mean memorizing maps? Did it mean learning about other cultures? Was it ultimately a mixture of all of the above? Again, if you are anything like me, you would probably identify most with the latter of all those questions. But the question begs to be asked...why does this mixture of random subjects matter?

I posit this in response: social studies matters because it helps students  learn essential life skills that force them to think beyond the scope of their individual existences. We teach social studies because we aim to prepare our students for a global, interconnected and complex world that requires them to understand the dynamics of cause and effect, the value of grounding logically based arguments in evidence, thinking critically about sources of information, and understand how past actions and decisions can influence present and future circumstances and events. Earlier, I argued that a social studies education "can provide individuals with the necessary skill sets to be informed and contributing citizens," and I stand by that claim. An effective implementation of social studies curriculum can produce an informed and engaged citizenry that is prepared to meet and overcome the challenges that your students will face and be saddled with in their lifetime.

But while this all sounds well and good in theory, I am sure that many of you would be quick to point out that with many, if not all, of the disciplines that I have listed, your experiences have been overwhelmingly less than stimulating; and this is the part that returns to my previous post on teaching a "dead" subject.

Unfortunately, it is exceedingly easy to fall back on the standard method of teaching social studies. For those of you that have enjoyed J.K. Rowling's masterpiece that is Harry Potter, I invoke the image of Professor Binns' History of Magic class: dry descriptions of facts, individuals and events, in a monotone voice, in the face of death or other such trivial happenstances. Thus, the alternative becomes the critical question: how do we not become the Professor Binns of social studies? This is a question that pre-service and in-service teachers alike grapple with on a daily basis. How can we "hook" our students into caring about social studies?

To this end, I would like to return to my initial question and situation (re: Harry Potter). For a child of the 1990s, that situation alone would have made devoting my attention to the subsequent lesson worthwhile. For a child of today, Suzanne Collins' The Hunger Games trilogy offers ample material in which to base a social studies lesson that will have many students hanging off their seats and eager to draw connections. There are many possible answers to the question I posed though; having a understanding of the past can better inform Harry about his present choices and the possible consequences; understanding the psychological condition of  Voldemort can help him better plan his strategy to victory; understanding the political machinations of the Death Eaters allows him to better understand how to dismantle their reign. I could go on and on, and regardless of how far fetched this may seem, there is a legitimate connection that can draw in students. It is the art of finding those connections that social studies teachers must focus on and make a priority.

As I continue down my teaching career path, this question will arise again and again. And when it does, I hope to be able to provide additional answers and suggestions along the way. Additionally, if you have ideas or comments regarding this topic, I would love to hear them. Dialogue on this topic is welcomed and encouraged.

If nothing else, I hope that I made even the tiniest bit of headway in convincing you that there is much more to social studies than you ever believed, and that it is indeed "a series of interconnected disciplines that focus on human interactions with a variety of institutions, individuals, and places, and the study of these disciplines can provide individuals with the necessary skill sets to be informed and contributing citizens."


--CW

Stuck In My Head All Day

http://www.youtube.com/watch?v=v_yTphvyiPU&ob=av2n

Because this music video makes a girl's heart scream of adoration and cuteness, and it's a great song :)

Love, CW

How to Make History Come Alive, or the Dilemma of Teaching a "Dead" Subject

I once had a history teacher play a word association game with the class at the start of a new school year. The stem word: "history". There were many responses that dealt with famous events, famous people and famous places, but the word that stuck out most in my mind was the word "dusty".

When the student who tossed out "dusty" was asked to explain their reasoning, they presented the following train of thought:

"Well, whenever I think of history I think of an old man sitting in a dusty old library, poring over dusty old books, wearing a tweed coat, and glasses that sit half way down his nose...smudged with dirt and dust."--Anonymous

The picture this student painted was that of an antiquated, stale, decrepit..and dare I say it, "dead" subject.

Let me be the first to present a rebuttal: history is not dead.

In fact, I cannot thing of a subject that is more relevant to the on going interactions and decisions of our daily lives. Every thing we do, every decision we make is informed by past events. Whether we are talking in the context of a person, nation, or international community, the past is inseparable from our daily lives. I could provide numerous examples grounded in psychology, historiography, sociology, etc. to further my point, but I fear that we would be here much longer than I planned if I were to do that.

However, it is not this oversight that irks me the most about this student's assessment of history; rather, it is the fact that in some ways the student is right in his characterization of history. For centuries, the study of the social sciences was "an old man sitting in a dusty old library, poring over dusty old books, wearing a tweed coat, and glasses that sit half way down his nose...smudged with dirt and dust." Only is this starting to change now as the twenty-first century unfurls before us. We now have resources that can take those dusty old tomes of time and make them come alive for students. There have been major advancements made in digitizing history in the past two decades, and this trend has opened up a world of possibility for teachers and students alike. It is now just a matter of finding ways to use those resources in new and exciting ways.

This semester, I am taking a lab class called Teaching with Technology as part of my teacher education program. Each week, we play with a new set of teaching tools that help us create new ways of incorporating technology into our humanities classrooms. For this class, we each have websites chronicling the projects and thoughts that we have about incorporating technology into the classroom. If you're even slightly interested, you can follow my progress here.

My greatest challenge in the coming year will be to figure out how to make history come alive for my students, and I hope that you will join me here and revel in that journey. I'm excited to play and challenge myself and my own creativity. As always, if you have ideas of your own on this subject, feel free to chip in at any time. In doing so, you just might find your ideas memorialized in my lab's final project!

Explore, Dream, Discover--CW

The Involuntary Commitment Dilemma, cont.

So...have you been pondering? Come up with anything exciting? If you did, I hope you'll consent to sharing...

But until I hear back from you, I shall now commence a monologue on my own thoughts.

The first thing that I would do is finish assessing my patient and going through my own checklist for getting a refusal. The patient, comes first, and Officer Congeniality may need a subtle reminder of that. Secondly, don't engage with crazy; coming back with a snarky, "You do realize that what you're suggesting amounts to kidnapping, Oh Officer of the Most Sacred Law?" won't get you anywhere productive. If there's one thing that I've learned in my two years in EMS (sparkie though I may be), it would be that you want to be friends with as many people possible that show up to a scene. (Especially if you run in a rural area like I do, and there's only one or two golden guns in town that regularly show up to bail you out when you get the call for "domestic violence, scene not secure"). So this is where I would remind you to play nice.

And now that you've consciously reminded yourself to choke back that witty, sarcastic rejoinder that would have felt so fricken' good, I would suggest that you invoke the inherent usefulness of your partner in distracting the patient while you request a word with Officer Congeniality out of the ear shot of said patient. (If the reasoning behind this is unclear, refer to above point: play nice and make friends). There is nothing you want less than to embarrass an officer of the law who is wrong about...well, the law...in front of a patient. Calm and cool is the way to play this one, and hopefully you will get lucky and Officer Congeniality will see the error of his ways.

Should this not come to pass, you do have options. In our jurisdiction, medical command is always a viable option. Explain the situation, and most doctors will come back with a "Really?! Yes, you have permission to release the medically stable drunk man." On the off chance that your fail to get such a doctor with common sense, you may be told to transport regardless. In this case, put on your salesman hat and try for the transport one more time. If you fail yet again, go back to Medical Command and state your case. However, under no circumstances should you transport the patient without their consent. Even if the officer says that they will follow you to the hospital, that is going beyond your scope of practice and beyond his scope of the law. The officer, in order to properly invoke and ECO (emergency commitment order), MUST have legitimate proof that the individual is either a danger to himself or others without medical intervention.

So I've managed to muck things up for you and answer fewer questions than you thought I would, right? Well welcome to the world of refusals. Rarely is there an easy answer, and some of the most interesting ethical questions in EMS (I think) arise out of situations involving AMA and the art of the refusal, as well as the role of ECOs. So to pose a new question to you: has there been any questions or debates that have sprung up among you and your colleagues after a refusal or ECO?

Til next time, CW

It's Here!

Football is back.

http://www.youtube.com/watch?v=AlXDo5WhQXI&ob=av2e

Refusals and the Involuntary Commitment Dilemma

Refusal [ri-fyoo-zuhl]: one of the more complex decisions an EMS provider is faced with on a daily basis; a refusal of medical evaluation, treatment or transportation; a rejection of emergency medical services often made against medical advice.

Today, many EMS workers practice in a world where there is little flexibility in regards to a patient's ability to refuse medical care. We practice in a world where practically any call that does not result in patient transport is considered "against medical advice", regardless of the actual circumstances; we work in an environment where judgment calls about your patient's true needs could easily mean the revocation of your livelihood if your assessment of the situation is wrong. We also happen to work in a world where the resources that we have at our disposal are often abused by those who do not in fact need them, and used sparingly by individuals who could actually benefit from our services in the manner which they were intended to be used.

Given these circumstances, it's a hardly a surprise that refusals are the grounds for some of the most profound decisions an EMS worker makes. How do you navigate the presses of the patient's needs, your organization's protocol and the availability of resources when dealing with a patient who is attempting to refuse medical care--all without jeopardizing the patient's well-being and your scope of practice?

In my first due, the most common refusal situation that we come upon--that oft puts the provider between the patient, concerned family, neighbor, etc. and a hard place--are individuals who are intoxicated either in their own homes or in public, but aside from being intoxicated appear to have no medical complaint. I don't know about your local protocol, but in my protocol if an intoxicated patient is attempting to refuse care, they technically are in violation of one of the conditions for an AMA refusal. However, I am not allowed to people-nap just because they are drunk and the law enforcement personnel on scene is trying to get out of taking responsibility for the individual, or a family member insists that they go to the hospital. If the patient can prove competency, meet my alertness and orientation guidelines, has stable vitals, no mechanism of injury, no chief complaint, and are refusing my care or transportation, then I am bound to release them after informing them of the potential consequences of refusing care.

Situations like the one I just described are the ones that generally come back to bite you in the butt; however, we do have a few measures in place to help you CYA. In our jurisdiction, if there is a possibility for concern, yet a refusal of care, the crew that responded to the call can ask the duty officer to make a welfare check a few hours later. Also, it should go without saying that in this situation medical command can be your best friend. Provided you supply medical command with accurate and detailed information, the decision is really then out of your hands. Finally, documentation, documentation, documentation is a priority. As with any refusal, documentation that is thorough and accurate is essential. Laziness and refusals are never a good combination, and a refusal should never be seen as the easy way out.

But now comes the twist...you've been dispatched for an "unknown problem, man lying on bench" and you arrive on scene to a patient who has copious amounts of ETOH on board, and a policeman with a low tolerance level. It's 11:30 on a Friday night, and this officer's headache is only just beginning. You approach your patient, do some assessment and then offer to transport the patient if he would like to go, to the hospital. You make the offer because it's the patient's choice of whether or not it's an emergency, not yours, but ultimately he doesn't want to sober up. There doesn't appear to be anything medically wrong except for the fact that he's drunk--and he freely admits to it, bordering along the line of hubris. But drunk, at least to this officer, qualifies as a medical problem--the EMTs jurisdiction, not his (at least for tonight). So as you start going through your AMA checklist, Officer Congeniality butts in with the bomb: the threat of an involuntary commitment. So, I pose this: what's your next move?

I hope the first thing that you said was know your laws; if there is a law that impacts your scope of practice, know it. If there's a law about transporting a patient while restrained, know it. If there's a law about committing patients involuntarily to medical care, know it. One of the first things that they teach you in EMT class is that you play many different roles in dealing with your patient--one of them being the role of advocate. If you don't know your states', county's, city's, etc. laws, then you cannot appropriately advocate for your patient. For example: in the state of Virginia, a patient cannot be committed to the care of medical providers unless the two following conditions are met in conjunction with a demonstration of mental illness or compromised mental health: 1) the patient is a risk to themselves, or 2) the patient is a risk to others.

So assuming you know your laws, how do you proceed next? I'll pose my thoughts in an upcoming post. Ponder as you will until next time :)

A Bit of Background, Part 2

I essentially stumbled my way into EMS. The winter of my senior year of high school, I was bumbling through a job interview for the summer camp I had worked at the two previous years. I use the term "bumbling" because the camp director is quite possibly one of the most intimidating 6'7" giants I know, and I don't think my answers were ever more eloquent than "yes, sir" or "no, sir". So of course, when he asked me if I would like to take on the additional responsibility of becoming a trip leader for the camp sponsored hiking trips I was left with two options: "yes, sir" or "no, sir". Given that I happen to love hiking and the great outdoors, I went with the former. The director then proceeded to inform me that I was to come up to camp two weeks earlier than the majority of the other counselors and partake in a mandatory training class for this new part of my job; I was to become a Wilderness First Responder.

The reasoning behind this training made perfect sense; given that I would be venturing into a formidable mountain range with eight campers (who were for the most part under age 16), it would make sense for me to have a reasonable knowledge base of emergency medical skills and situations in a wilderness setting on the off chance that something actually went horribly wrong. SOLO Wilderness and Emergency Medicine School was the group that provided our training, and if you are ever looking for an extremely professional, knowledgeable and well run wilderness medical training class, I would highly recommend SOLO above all else (http://www.soloschools.com/). The WFR class is an 80 hour long class and provides an amazing foundational skill set for anybody who is an outdoors enthusiast or interested in pursuing an outdoors-recreational line of work.

Needless to say, I fell in love with my WFR class. I loved the content, I loved the practicals and I loved the sense of knowing that I could be useful in a crisis situation. The class didn't just teach you how to do medical things in the woods. It taught creativity; how to use what resources were available to you; how to manage under stress; how to interface book knowledge with practical application; how to work as a team; and how to be a leader. And luckily for me, all of these lessons came at a incredibly formative moment.

That fall I shipped out to university. University is this amazing opportunity for self-discovery, self-definition and finding direction. In all honesty, those were three areas in which I found myself greatly lacking upon arrival at the school of my choice. Sure, I knew what I kind of wanted to do with my life, but other than that I was S.O.L., to put it quaintly. Cut to gracious stumbling act, part two.

When I arrived at university, I found this amazing wilderness oriented rescue group that was a perfect fit for my interests. My savior complex was satisfied (*grin*), as was my love for the great outdoors, and I finally had a practical application once more for the knowledge I had accumulated during my WFR class. Less than a month into my membership of this group, I was presented with a new option for pursuing what was quickly becoming an evolving passion: EMT class.

Getting my EMT was the best thing that I have ever done. It opened up a whole new world to me that I quickly fell in love with. It was a brand new body of knowledge for me to explore and master, and once again social media played a really big role in my new found passion. In fact, social media only fueled my "sparkie-ness". I was (am?) insatiable, and attempted to get my hands on every POV and piece of information that I could that dealt in some way or another with EMS.

And now we come to today, where I am making my own attempt--minor though it may be--to make a contribution to this world that I have come to love so much, and that has welcomed me with open arms. This blog may be graceless at times, and my ideas or questions might be rough at best, but like the start of my career in EMS, I am not afraid to stumble.

Song of the Summer

http://www.youtube.com/watch?v=aRh-vBOS-dU

Nothing better than a barefoot and blue jean night.

A Bit of Background, Part 1

When I was little, I never knew how to answer the "CW, when you grow up, what do you want to be?" question. My answer was rarely ever the same, and my dreams were constantly evolving. When I was around the age of five, my answer was "nurse, doctor or teacher". By the age of ten, my answer was "lawyer, fashion designer or teacher". By the time I hit age fifteen,  my answer was "researcher, journalist or teacher....or maybe all three if I can swing it".

But as making a university choice became an ever-present reality, I was forced to narrow down just what I thought I might want to do with my life. The looming decision forced me to turn to introspection. Just what kind of work could I see myself doing and actually enjoying? What kind of degree would allow me to pursue a passion in my life? Heck, what exactly were my passions in life? And so I started thinking about what I had spent almost eighteen years of investing my life in; what came immediately to mind was my love for reading, tutoring, working with kids, and volunteering. How did I incorporate all of this into a potential career?

To me, teaching jumped out as the immediate natural conclusion. Better yet, teaching is an immediate way to affect change. Educators deal with the future of our nation on a daily basis, as the children and young adults that we work with are the citizens and leaders that will be responsible for combating the political, economic and social conditions that recent generations have created. Educators get to foster creativity, passion and the critical thinking skills necessary to analyze and create solutions for the future. Educators also get to witness daily triumphs of their students; these are the tangible moments that make the job worthwhile.

And yet there are many schools in which those daily triumphs are a rare occurrence for students and teachers alike. There are schools where students have been written off, unable to be helped by the system that is considered by many to be the cornerstone upon which our nation is built; and unfortunately, I agree. There are many students who are being failed by the current state of American education. But we're also at a pivotal moment in education; there is enormous potential for change. And it is within this constantly evolving environment that I want to make my career.

Educators, as a profession, are moving towards evidenced based teaching practices. This is a huge step in the right direction, in my opinion, because if you look at other established professional fields they conduct themselves based on practices that they KNOW will work. And as new literature and research becomes available, they modify their practices accordingly. It has taken the educational world a long time to reach this way of thinking, but I believe that it is truly for the better and that makes me excited about one of the life paths I plan on pursuing.

Ultimately, I plan to use this blog to discuss many of these practices and the research and literature behind them. I want to generate discussion because I know that for each study that claims there is positive evidence for employing certain practices, positive evidence of certain correlations etc. there is always a counterpoint. And whether you want to teach or not, these issues are relevant to every individual. One of the greatest things about American education is that it is compulsory and free; however, the system cannot be utilized to its fullest potential unless anyone who has benefited from (or maybe even more importantly, has been done a disservice by American public education) participates in the discourse.

I don't expect you to agree, but I hope that you do have an opinion.

The Life I've Chosen

About two years ago, I had that moment that most people can go a lifetime without feeling. It was that "So this is where my life has been heading all along..." moment--a moment of elated epiphany--that of course was followed by an overwhelming sense of "Oh sh*t. This is where my life is going. Now what am I going to do about it?"

How did I get to that moment, and what exactly was my realization, you ask? Well, let me introduce myself first and then we'll get to that.

My name is CW. I'm country girl at heart (read: reformed Yank), living in the great state of Virginia. I'm a university student working towards a bachelors degree in history and a masters degree in Secondary Education, and with all that oh-so-rare-and-spare free time that I have, I'm a volunteer EMT in a rural community just outside of where I go to school.

From the time I was old enough to have an opinion, I've shared it. From the time I was old enough to know what a goal was, I've had one. While the goal was always changing when I was younger (because god forbid a 7 year old actually have a set opinion on what she wants to do with her life), in recent years I've settled on wanting to shape America's future. I want to help people. I want to change a life.

Now you're probably thinking, "THIS is the goal that she settles on?! How on earth are wanting to save the world, and that pivotal epiphany she talked about one and the same?" Well, truthfully, it kind of just happened. And by kind of just happened, I mean one day I realized that everything I had ever truly been passionate about was related to affecting change and helping people. Go figure, that I found an outlet for that in becoming an educator and an EMS worker.

Education and EMS are a life I have chosen, and that I love. But in choosing two such fields, I have inevitably found myself being plagued with this impending sense of responsibility to humanity (read: this is my "Oh sh*t" moment). How do I ensure that my contribution to education and EMS are not solely for selfish purposes? How do I make what I do matter? How can I channel that enthusiasm that "sparkies" are so fondly known for into something productive and generative? And this blog became part of the answer to those questions.

When something takes over my interest I like to ask questions, I like to share my passion with others and I like to learn as much as possible about a given subject. Luckily for me, social media has taken a strong root in both EMS and education. I have found some great individuals and resources in both fields that have inspired my foray into EMS and education, and I have come to a point where would like to add my own knowledge, experience and questions to what is out there. I claim no expertise, no finality or even a semblance of brilliance in regards to my contributions; however, I hope that someone out there might find a morsel of meandering thought that is of value to them.

This blog is primarily about EMS and American education, but you can expect to learn a bit about me outside of those two realms of my life. As I said, this is the life I've chosen--in more ways than the two fields I see myself dedicating my life to. I've chosen the southern way (but darn if I give up fresh NE seafood and my Boston Red Sox), country livin', and the music to which I geek out. These will be making an appearance among my musings, and I hope you enjoy.