Thursday, June 11, 2009

Don't leave me

I learned something today.

I recently took a class at the state Fire Academy, certifying me as a Fire and Life Safety Educator. This is a subject very near and dear to my heart, for a variety of reasons.

I am working on organizing a class in the Fall for middle school aged kids, and will undoubtedly write about that here off and on. As part of my preparation for that class, I have been researching a variety of fire safety issues, including what is taught to what ages- and what is not.

One of the things that is fascinating about fire safety is that even people who know better, often don't act on what they know. For example, one might think that firefighters are the most safe people, as far as making sure there are not hazards in their house, that they have enough detection devices, and that they practice what they preach.

Not necessarily so.

At our house, we are pretty paranoid about it, having had a serious fire. We have more smoke detectors than you can shake a stick at, of various types. We have Carbon Monoxide detectors. We have escape plans and fire drills, and talk about it all incessantly.

Even so.
There are a variety of things we could do to make our house safer, that we somehow don't manage to get done.
And if WE don't, as paranoid as we are, I can only imagine what other people do- and don't do.

I read some statistics yesterday that said that according to the National Fire Protection Association (NFPA):

Fire is the third leading cause of accidental deaths. Residential occupancies account for most fire fatalities and most of these deaths occur at night during the sleeping hours. 1.5 million Americans are injured by fire each year. It is estimated that each household will experience three (usually unreported) fires per decade and two fires serious enough to report to a fire department per lifetime.


This means that most people, at some point in their lives, will have a fire.

The most common cause of home fires is unattended cooking. Food left on the stove while the person leaves the room to do something else.

I've been guilty of this. If the heat is turned down low, I know the food won't burn, and there isn't anything near the burner that might catch fire, then what's the danger?

Well.

This evening, I was cooking pasta. Boiling water, basically. What's dangerous about that?

When I turned the burner on, it lit as usual. A few seconds later, for some unknown reason, the fire went out- but the gas was still on!! If I had left the room, I would not have known this happened. And if the gas had built up, and found an ignition source...

Have any of you ever seen a building that has had a gas explosion? Probably some of the folks reading this have. Hopefully, most of you have not, and never will. Let's just say that being inside that building would be a most unpleasant experience.

I'm cured, that's for sure. I will NEVER leave the room with the stove burners on again. I strongly encourage you to do likewise.

Tuesday, April 21, 2009

How much?

We're almost to the end of the semester. Soon it will be time for the evaluations again. I can't wait!

We did a couple of things a little differently this semester, so it will be interesting to see what, if anything, that changes in the reviews we get.

The main things I've been thinking about:

How much does someone need to know in order to be able to do the things they need to do?
How much intellectual understanding is necessary, and why?
How does the progression of the class change, depending on the goal of the class?
What level of precision is reasonable to expect in 12 weeks, and how is that affected by whether or not the student will be continuing?


The university PE classes have always been sort of the "odd man out" in our overall program. These people will almost all NOT be continuing students. They take one class, for a semester, get their credit, and move on. They aren't really dedicated to the sword, and most of them don't want to put in the effort such dedication would require. They want to pass the class, maybe. They want to be able to say they "fenced in college."

For the most part, that's fine. In the fire service, this class would be at the "awareness level." Learn enough about it that you can recognize it, know what it is, and know who to call for additional help, but no real training to deal directly with the situation. These students will have seen a little fencing, learned a little about it, tried it on for a day or two (like a level A hazmat suit) to see how it feels, but they aren't likely to ever need to use it.

We show them a lot of things, but don't expect much, if any, technical precision in any of it. Enough that they aren't an immediate danger to themselves or others, but not enough that they can perform any of the techniques at anything close to what they would need to defend themselves. We simply don't have the time to do that, nor do they have the interest, most of them, to sustain that level of training.

Our introductory class elsewhere has a slightly different purpose. It is designed to give the student enough exposure that they can decide whether or not this is something they are interested in enough to continue. It is also designed to support and be preparation for the continuing classes that follow it.

What this means is that we require a higher level of precision, right from the start. We introduce things more slowly, giving more time to work on each skill before moving to the next. If we didn't do that, we'd have people slogging through a bunch of uncoordinated movements, none of which would build towards the goal of learning to fence. We still need to have things move along relatively rapidly, in order to reach that goal of helping people decide whether this is for them. It is a different balance of information/precision than the PE classes.

Once a student finishes the introductory class, and chooses to continue, indicating that they have made a commitment to fencing, the continuing classes move at a MUCH slower pace than any of the introductory classes. NOW, we're trying to gain skill. This requires much repetition, and time to integrate each skill. There is no point to moving ahead more quickly, since the results would be counterproductive.

Back to the classes this past semester and my questions.

How much does a PE student need to understand, in order to do what they need to do?

That has to start with an agreement of what they need to be able to do, and the answer is... not much.

What I would like the class to be able to do:

1. Not hurt anyone.
2. Have some semblance of moving without undue distress, and without falling over.
3. Try a few things with the blade that suggest the skills of fencing.
4. Have fun doing it.
5. Gain an appreciation of what is involved in being able to do this at a high level of skill.


Some of these are easy to evaluate, others take some consideration.

The first one- not hurting anyone - is easy to evaluate.

The second one takes some decisions about what that means. At what level will I make corrections, and what will I "let slide"?

As we introduce each skill, we give a lot of feedback, both to the group as a whole (because they all make similar mistakes) and to each student (to point out to them specific things they need to focus on). We describe and demonstrate each skill, facilitate practicing it, and keep reminding them of the details. Most students, after some practice, will begin to incorporate the skill, and begin to self-correct. But not all of them. Some will, even at the end of the semester, still make fundamental errors, things we have pointed out and corrected over and over and over, either unwilling or unable to make any changes.

In the PE classes, as long as they aren't dangerous, we don't care. We don't have the time to continue to give individual corrections to someone who is not invested enough to make changes. At that point, people who are making an effort- and that is easy to see- will continue to get as much individual feedback as we can provide. Those who are phoning it in can do whatever they do, as long as it's not a safety issue. They will get reminders, but they will be broad concepts, not specific details, since they can't process any details for skills they aren't even beginning to do.

In the other intro classes, we continue to try to give a lot of feedback, to a point. Some students will clearly not be making an effort- but they also usually stop showing up to class. In these classes, they aren't concerned about a grade, so if they decide they aren't interested, they just quit. Anyone who still shows up is making at least that much effort, and almost all of the time, will be making improvement in each class. Those who are not- and there are usually one or two- are probably there because their parents make them go. We'll give them some reminders in each class, but if they don't respond, then they just don't.

Once we are past the intro level classes, we give individualized feedback for all students, as much as we can, with the expectation that they will focus on the feedback and make corrections.

When I was a student, rather than teaching, I was hugely impressed by the Master's skill at being able to give individual feedback to every student, at exactly the level they needed in order to work on exactly what they needed to work on. Turns out that although it certainly takes effort and energy, it isn't hard to do, with a body of knowledge that has a clear progression of skills.

The third class goal- trying a few things. That's simple. We do that.
And the fourth, have some fun, that's pretty clear, too.

But the fifth one... gaining an appreciation of what is involved. I'm not sure we ever really meet that goal. Some appreciation, sure. Real appreciation- I don't think it's possible at this level because there is no frame of reference. I need to think about that one some.

This semester, one of the things we did differently has to do with how much theoretical knowledge we presented in the PE classes. We skipped some stuff we have introduced in all the previous semesters, information that is critical to understand if you really want to learn to fence. It was an experiment. It felt... awkward. Odd. Incomplete. But that is probably because I have ALWAYS had that included, whether in a class I've taken, or one I've taught. Force of habit, or of expectations. My question became whether the CLASS missed that material, or if only I did.

The answer surprised me somewhat.

Looking at their level of understanding, compared to previous years, they clearly understand way less. We didn't teach it to them.

But looking at their level of physical performance... it was the same, and in some cases, slightly better. Granted, "slightly better" is probably a score of 5% rather than 4%. They don't have any real skill to speak of, so there is not a lot to compare. The important thing is that their skill level was NOT worse. This suggests- but does not prove- that the information we omitted was not necessary at this level.

I suspect that their level of enjoyment of the class is unchanged. They can't miss what they don't know exists. I will be interested to see if we get any clues from the evaluations about the overall level of enjoyment of the class, compared to previous semesters.

It might be worth continuing this experiment. Do they actually enjoy the class more, and feel like they have gotten more out of it, if we don't clutter their brains with too much theory? Do they WANT to understand more (quite possible), but need to understand less? Is it more important for them to experience the scientific nature of the way everything works together, theoretically, or is it more important that they make some broad movement attempts, and feel how that feels?

They answer, of course, is yes. Or no. Or it depends. All of the above, and none of it.

It's ALL important, and necessary, for someone who wants to be able to fence at a high level of skill- and why would anyone want to do it any other way?

But it is, perhaps, not all important for a PE class.

I need a larger sample size to begin to evaluate this.
And I need to get past my own biases and preferences and intellectual overattachments, too.

I mean, really. Look at this overly long vomitosis of wordiness. I overanalyze everything.

Maybe, just maybe, NONE of the theory, none of the explanation, is really important, in the grand scheme of things.

Sunday, April 19, 2009

What's Your Number?

A week or two ago, I wrote a short article for our local newsletter thing, about having house number signs that are readable from the road, at night. It started out:

Imagine this.
It's 3:30am.
You're woken by the loud beeping from your pager,
and a voice in the night telling you that there is an emergency.

It went on to weave a tale of being unable to find the number, having to slow down, trying to avoid missing the number and having to find a place to turn around. In the story, the person stopped breathing before anyone could find the house.


This morning, the pager went off at 4:30.
I jumped out of bed, grabbed my watch, hopped into my clothes and shoes and headed out the door.

As we drive down the road, I, as the passenger, was looking for house numbers. I knew approximately where the house would be, but not exactly.

I saw number 1537.
The next readable number was 1395.

The house we were looking for was 1401.

We missed it. Had to find a place to turn around.

Fortunately, our outcome was better than in my original story. The patient turned out okay.

But it so easily could have been otherwise.

We drove back by that stretch of road this morning. I wanted to see what the numbers were, what I had missed, if I should have seen one that I didn't. The answer is that no, I didn't miss anything. In that stretch of road, there are no readable house numbers. Lots of houses with black mailboxes- some, but not all, across the road from the driveways- with tiny numbers, or no numbers at all.

We only get one chance to see the number. We can look at a mailbox, at the house, or at a sign at the end of the driveway, but we don't get to look at more than one place. If what we look at doesn't have it, we're on to the next house. Sometimes, it's hard to even see the house, if you can see it at all.

This is an old, old story in emergency services, the need for visible, readable house numbers. Some places require people to have their numbers painted on the curb, and repainted each year. I think that's a great idea. But out here, there aren't curbs. Some places, the houses are pretty close together, and the streets are well lit. Out here, there are long stretches of dirt roads with no lighting at all. And the distance between houses varies widely, from feet to miles. Likewise, the numbers are not a predictable amount apart- and sometimes, aren't even in order! One road near my house, the numbers go 548, 592, 560, 602. Fortunately, I drive by there several times a day most days, so I know about it.

My point in mentioning it is not only to encourage people to put large, reflective, white-on-dark number signs at the end of their driveways (not across the street on the mailbox!!), although I would be pleased if everyone did that.

It's to question why it is, how it can be possible, that so many houses do NOT have numbers that can be read from a vehicle driving down the road.

There are a few varieties. Let's look at each one.

1. Numbers on mailbox, but too small to see. I think these people assume the numbers are there for the postal service. The thing is, the mail truck stops at every house most days, so it is easy for them to see the small numbers, from a stopped position right by the mailbox. And they know what the next number will be, because it's printed on the mail they are delivering. So small numbers are no big deal.

2. Numbers on the end of the mailbox, not on the sides. Likewise, great for the mailman, not possible to see from a distance.

3. Sign, but across the road from the house. Better. And it's convenient to put it on the mailbox post. But sometimes, it's not as clear as you might think what house that mailbox goes with, especially if there are several next to each other. Plus, it is usually the passenger who is looking for numbers, not the driver, and that puts the number on the far side of the road, more difficult to see. It also causes swivel-head, trying to figure out where the mailbox is, which side to look at.

4. Number on the house, big as day. Great, for confirming that indeed, this is the house that goes with that number. Or for when you are visiting a friend, and have directions to the house, but need to be sure it is the right one. Easy to see- once you have driven into the driveway. Trouble is, we won't be driving in that driveway before we know the number. So we won't see it.

5. Number sign, at the end of the driveway, but parallel to the road, rather than perpendicular. Again, good for confirmation, but not possible to see while driving. Some of these I've seen are on lovely decorative posts. Nice to look at maybe, but not helpful.

6. Number obstructed by something. Often by the mailbox flag, or the newspaper tube. Yes, it's easy for YOU to see that number, because you already know what it is. Not so easy for us.

The question remains, why do people do these things? Why is it that they sometimes put considerable effort into how they mark their houses, but choose to do things that aren't appropriate?


I think most of these people believe they have done an adequate job. After all, THEY know what the number is, and where it is, and they see it every time they drive in their driveway. It works fine for the mail delivery, and for friends coming over, so what's the problem? No one else has any trouble finding their house. The FedEx guy hasn't ever complained.

I think the problem is one of perspective.
Coming from the perspective of already knowing the number, any of those variations are easy to see.
But from the perspective of in the dark, in an emergency, trying to find which house is the right one, none of them work well at all.

Most people don't ever HAVE that emergency perspective, and happily so.

Most people, when they need to find a house number, slow down and look. I'm sure most people have been behind a driver doing just that, more than once. You can tell exactly what they are doing. From that perspective, as long as there IS a number, somewhere, it all works out fine.

The important thing that this all illustrates is how easy it is for people to have different perspectives, sometimes dramatically so. How one person can believe that something has been done, and done well, and another can see it as entirely useless.


And I'm not only talking about house number signs.

Wednesday, April 15, 2009

Six Degrees?

One of the reasons I wanted to be an EMT is so that I can be there for people in my community, ready and able to help them at a moment's notice. I want to be a familiar face in times of trouble, so that it won't always feel like a sudden houseful of strangers.

I didn't realize just HOW familiar things would end up. Or how very small the world is around here.

A couple of weeks ago, we responded to a major trauma; a pick-up truck rollover with one person trapped and the other ejected.

Turns out that one of the first drivers to come upon the scene and stop was a woman whose niece is the girlfriend of one of the patients. Another one of the first people to stop was a firefighter from a neighboring town, who happens to also be an ER doc down the road a ways- who knows the patients.

I found out the next day that one of the members of our department goes to church with the grandmother of my patient.
And another member of the department told me that he is her ex-husband's cousin.
And just last night, discovered from a woman who assisted in my EMT class last summer, that my patient is the father of a good friend of her son's.

A couple of days ago, I had a repairman here fixing my water pump, who suggested I might know his father-in-law. And indeed, I do. He's one of my favorites of the fine older folks in town we see from time to time.

Met a guy at an incident last week who was good friends with the father of a guy I dated in high school.
Met a FF/EMT yesterday (out here assisting in a search) who went to high school with my sister.

I've had my father as a patient. Taken care of both parents of a friend of my daughter's. Seen numerous parents of people I've gone to school with. I've lost count.

And even people I don't know, there are connections. We had a patient last week who didn't make it, and the announcement at her college was made by... the husband of my best friend from junior high. The same former best friend whose son took his firefighter 1 class with my son.

The concept of "six degrees of separation" has become popular in the past several years.

Around here, if you get TWO degrees of separation, it's unusual. And I doubt anyone makes it to three. Everybody knows everybody, or knows someone who does.

I think it adds to both the stress, and the satisfaction, of the job. It feels great to help out folks you know, or whom folks you know, know. And it feels crappy not to be able to help them. Two sides of the same coin. Add to that the feeling that once we meet them, EVERY patient becomes "someone we know." No anonymous EMS out here.

There's an EMS book out there, by Michael Perry, called Population 485: Meeting Your Neighbors One Siren at a Time. No kidding.

It gives a whole new feel to the landscape, as we drive past place after place where we've been. A litany develops. That's the house where the woman fell, then the one where we had the stroke patient, and then that really sweet guy who died last year, remember him? And there was the alarm activation that really was an alarm doing its job, saving the people and the house. And the house where the single Mom was home alone with her baby and got really sick and we needed to help find emergency childcare, and that house is so-and-so's Mom. And this is the one where we couldn't get the patient to hang up her cellphone. It goes on and on. Accidents, fires, sickness, injuries, and the occasional baby, all paint a very intimate picture of a place.

Maybe I'll post more from that little book I found last year, the history of one of the local fire departments. Turns out, especially in a small town, that the history of a place IS the history of the fire department. That's who witnesses all the major events, the major changes, along with a long string of more personal events. And those are the people who end up knowing nearly everybody.

Wednesday, March 25, 2009

fighters

Most people would say that fighting is violence, and violence is bad.

People who fight tend not to be respected in the dominant culture.

People who fight for a living- boxers, for example- are often considered to be "brutes" who are unintelligent. It is often suggested that if they were smart, they would do something else.


And yet.

What is the best thing someone can say about a person who is very ill or injured, or who is near death or heading that way, as a way of creating hope? "She's a real fighter."

Interesting.

Tuesday, March 3, 2009

Principles

Last night's training at the firehouse was knot tying.

I love knots. Been tying them since I was a kid.

Our county has the good fortune of having some state fire instructors who also love knots, who are skilled at both tying and teaching. You can easily recognize their students.

Last night, it was interesting that the people who have had recent training through the county were all having a grand time, tying knots, sharing different ways of tying the same knots, tying rope onto and around just about everything in the room. But the people there who have NOT had recent training... had not even heard of some of the basic fire service knots. Yet another suggestion that people need to keep current on their training. One among many.

Anyhow.
Being knot loving folks, we came home and have been consulting the knot book, learning a few new ones today. Came across this quote below, which I love not only because of what it says about knots, but because it applies to many things that I do and love, fencing included.


"The appliances of this chapter verge on the mechanical in nature. Many of them grip the rope, instead of the rope's gripping the appliance. They are designed either to make a quicker or an easier coupling, or else a simpler one that the inexpert cannot go wrong with. The greater proportion of them were made for the use of either the horseman or the housewife, and considerable ingenuity has been expended in their construction. Some of the horse-and-carriage fittings have been sketched from memory. Others were salvaged from the family garage that had started out in life as stable and carriage house.

It may seem unprofitable to resurrect such material, much of which is obsolete today. But knotting is merely the application of certain mechanical principles, and a principle itself can hardly become obsolete. As conditions change, new applications are bound to appear. The fact that something is not required today is no reason for believing that it will not be needed tomorrow."

Clifford W Ashley, The Ashley Book of Knots, 1944

Sunday, February 22, 2009

A world so small, a heart so large

A few days into the EMT-B class, our instructor suggested that we get a scanner so we could listen in on medical reports, and learn from them. We get relatively few calls out here in the middle of nowhere, so we need to learn from as many sources as we can. Listening in to the radio reports, and especially the flight medics, we could hear how they give the reports, what interventions they have done, and a variety of other details not readily available elsewhere.

One of the first things we learned is that the flight medics are fantastic. They give their reports by the book, head to toe, easy to understand and follow. A good model for us, to hear that pattern over and over, the rhythm and flow of the report giving us a mental template to use in acquiring the information to give our own patient reports.

Another thing we learned early on is that we can recognize the voices of most of the ambulance personnel, so we know who is going on the call. This does a couple of things. One is to give us further information about each of them, their ability to be focused and calm, the clarity and completeness of the information they provide, adding to the level of trust we have in them when we work together. It also lets us know who to worry about, sometimes, depending on the situation they are going into- or on the road conditions.

We also hear a much wider variety of situations than we've gone to ourselves.

We have gotten into the habit of turning the scanner on when we hear someone get toned out for something that sounds like an interesting EMS call. We run through the call either in our heads, or sometimes, if we're both listening, with each other. Does the location of the call give us any information? Is this somewhere they have been before? What would you do first? What should we be concerned about, with that mechanism of injury? We'll visualize and/or verbalize the assessment we would do if we were on scene. It's decent practice for us, and more than once, we've ended up with a similar call relatively soon after hearing one on the scanner.

So last week, when we heard a call for someone who fell from a tree, we turned the scanner on, and followed the incident as long as we could.

My first thought was that I was glad that I didn't know anyone that age who lived in that location.

I was concerned for the patient. It didn't sound good. They called for a helicopter before arriving on scene, to get the flight team going and ready to fly. Called in an engine to set up a landing zone nearby. This is a common precautionary measure, but this time, it sounded like it might be necessary. There are so many injuries possible with a fall.

We don't get a lot of detail on the scanner unless we pick up a flight medic; since the radio system was upgraded a few months ago, the local ambulances give their reports on a frequency we can no longer pick up. This time, it turned out that the helicopter couldn't fly due to bad weather, so they had to transport by ground. Once they were loaded to go, we didn't get any further information over the radio. All we knew was that the suspected injuries were serious.

As we turned off the scanner, our thoughts and hearts were with the patient, hoping things would go well and he would be okay.

They didn't.
He wasn't.

Usually, we never know how EMS calls turn out. Privacy laws prevent us getting further information, unless we happen to know the patient personally, and hear things through friends or family directly.

The thing is, I don't actually know where every person I know around town lives.
And I definitely don't know where they all work, or where they might be at any given time of day.

Turns out that this patient was someone I know.
The husband of a woman I've known for many years.
A prominent figure in the local activist community.

I found out the next morning that he did not survive.
He leaves behind his wife and their four daughters. Three of whom I've watched grow up, and the youngest of whom I remember when she was born.

My daughter and I attended his wake today. There was an outpouring of community support which was nice to see, but it's a bit sad that it takes something like this to bring everyone together.

As it always is, it was a reminder that none of us know how long we have left. That death comes suddenly and surprisingly. That no one is prepared, but everyone somehow goes on.

In an odd way, I feel like I was there when it happened. I wasn't; I was only listening in on the radio, hearing just enough to know someone was in trouble, but not enough to know who, or to suspect how it might affect me personally. I wish I had been, if only to be able to give my friend some understanding of what happened and how. She is struggling to make sense of something that makes little sense.

Today, she was surrounded by love, by friends and community, by an outpouring of grief to hold her close, to hold her up while she mourns. She greeted everyone who came in, with a hug and a smile, and not a few tears. It must have been difficult, even while affirming the man she knows her husband to have been.

His burial is tomorrow.
Most of the people who were there today will fade back into the background.
My friend will somehow go on, having lost her partner, her love, the kind and gentle man she has spent most of her life with.
She will raise their daughters to remember him with love, and to honor his memory by continuing to work for the causes so near to his heart.
How she will do this, I don't know. Just that she will.
My heart goes out to her.

For Ellen, I wish comfort and grace, hope and love, family and faith.
For Peter, I wish the peace he has worked so hard towards.

Obituary