EMS in the Summer of 2016: The Country is Hot and Our Streets are Boiling Over.

July 28, 2016 Comments off


“Hate Takes Too Much energy.”

PO Montrell Jackson, Slain Officer, Baton Rouge Police Department


Beep! Beep! Beeeep!  “EMS Unit 5, are you in-service? EMS Unit 5 at 15:10 hours. Beeep!” Your dispatcher quips. Time for you to sign on and go in-service.

Something is not right.  Something you really can’t put your finger on is bothering you.  You have checked your ambulance and are getting ready to go in-service.  The checklist is done, you have ambulance call reports but yet there is something lingering in the air. There is something stopping you from going in service and putting the vehicle in drive. “Did I forget to check something? Did I forget my radio? What is it?”

This summer is different.  Sure it is another hot July, the cities are boiling over but for God’s sake, they are killing police officers without warning.  There are some horrendous things that happen in the world that we take in stride and go on.  Once in a while, however, there are events that really make us stop and think.

“How do we go out into the streets and provide care when they are killing police officers without warning?”

In Dallas Texas there were 5 police officers murdered during a public demonstration.  These five officers were gunned down by a sniper during a protest.  How do we as EMT’s and paramedics go out into the streets when violence can erupt in a gun flash killing police officers without provocation?

I know there are soldiers who are facing much worse conditions in Iraq and Afghanistan. But this is our homeland, this is where we live.  We are supposed to be safe. This is our home! Unfortunately, the senseless violence and retaliation at home are not new.

I thought the August 2007 shooting of 4 college friends in Newark, New Jersey was horrendous.    But it seems like violence keeps happening and the body counts keeps rising.  (Read about the Newark shooting here:  http://www.liveleak.com/view?i=a61_1186417476)

Officers Wenjian Liu and Rafael Ramos were murdered in what investigators believe was a crazed gunman’s ­assassination-style mission to avenge Eric Garner and Michael Brown on December 20, 2014,  in Brooklyn NY.  These officers were sitting in a marked police car during a terrorism response drill when they were murdered.

On June 5th the deadliest mass shooting in U.S. history took place when a gunman killed 49 people and wounded 53 in the early morning hours of June 12 at Pulse nightclub in Orlando, Florida. (Read about the Pulse Nightclub shooting: http://www.cnn.com/2016/06/12/us/orlando-shooting-timeline/index.html )

It feels like the war is here in the streets of our country. Actually, there is war in our city streets. We live in a different world now.

How do we as EMT’s and paramedics go out into the streets and provide care when there is so much unpredictable violence. How do we go out in the streets when police officers are being murdered in the street in Dallas, Texas while monitoring a protest or in Brooklyn, New York while staffing a terrorism drill?

In past decades there were risks from responding to a shooting, crime in progress or a large fire.  But we as responders were not targeted.  Now police officers and responders are being targeted during down time between calls or in situations you would not suspect violence.

How do we go in service and help the public? 

I was working in the Bronx in the summer of 1988 when we were very understaffed and short on   vehicles. People were waiting an hour for an ambulance and we were in the news daily, the public met us with criticism and anger.  We went out and did our jobs, because we were the system to those people we met.  Eventually, the system improved and things got better.  We overcame tough times by focusing on our actions and our patients.

During the tough times, we stayed the course by being tough and doing our job, kept focused and did our job.  We learned to diffuse anger and focus people on the problem at hand. 

My partner would say, “What is the use? People hate us and we can’t get any slack from them.”

I replied, “Don, we can get through the day by doing our best, focusing on our patient and showing them there is some good in EMS.  To the people we meet today, we are EMS.”

By concentrating on our job at hand, our safety and persevering in tough times we can provide emergency care and feel good about the impact we are having on the public.   We are the public service to those we meet, make the difference by being the buffer.  We can help diffuse tensions and attitudes by being the buffer, acknowledging their concerns, get them to focus on the matter at hand.

When you operating in the streets keep your eyes and ears open.  Stop, Look, Listen and think.

During your daily responses follow you instincts, vary your response routes and approach common call locations from different directions, use different entrances. When you have a problem call for backup and a supervisor.  Worst comes to worse leave the scene and regroup at a safe location.  It is a good policy to talk these issues out with your partner before you run into a problem.

“If real trouble erupts, I will meet you back at the ambulance if we are separated.  If we are in a high-Rise I will meet you in the lobby.”

Safety Rules to Live by and Stay Alive by

  • Stop, look, listen and think.
  • Communicate with PD and Fire, share information.
  • Consider stopping down the block to evaluate situation and wait for other responders
  • Remember to use hard cover to protect yourself. Examples would be a rock wall, a building.
  • Stay out of line-of-site of a shooter.
  • Think Big. Choose a distant location when staging vehicles and responders.

To learn more about responding to terrorist incidents read: The Downwind Walk: A USAR Paramedic’s Experiences after the Terrorist Attacks of September 11, 2001.  Check it out at:   http://amzn.to/29FCd4f

I have always found the worse the conditions the tighter EMS and PD get.  We are in this together and in the end, we are all people who want to make it to the end of our shift.   I call the effect of worse conditions in the street bringing responders and people together The Downwind Effect.  On September 11, 2001 people from all levels of income, color and different services were all covered in dust and depended on each other to survive, they were all gray and dust covered.  They were united.

In tough times like these EMS can be part of the solution.  We can demonstrate professionalism and care for the public.  Caring does not only mean patient care but also basic courtesy and kindness to the public when circumstances allow it.  An old partner of mine opened my eyes to the fact we don’t have to defibrillate or intubate to make a difference.  George would say, ”Those emergencies ae rare, we can help the public every day.  Kindness means more to them than ALS, plus we don’t have to re-stock.”

Steps for diffusing anger and resentment:

-Demonstrate Respect  

-See the person, not the actions and words.

-Listening skills – reflect back to them what you hear them saying.  Show concern and understanding

-Focus those involved back to the current problem at hand.

These times we are experiencing are history in the making.  We are working in times when the country is evolving and democracy is being tested.  Our number one priority is to stay safe, stay alive.  We have to stick together with police in fire in dire situations.  We are all brothers and sisters.  We also have a commitment to help the public, show respect and listen to their concerns.  We do not have to solve their problems, just listen and acknowledge.  We can complete the circle by focusing them on the situation at hand.  People who see the big picture see humanity, not color of uniform, ethnicity or wealth.   We are all people who live together and have to interact with respect.

Stay safe, keep your eyes open and be prepared to help people.  Now go in service and make a difference!

The words of Police Officer Montrell Jackson seem to sum up the problem of the Summer of 2016 very well, “Hate takes too much energy.”

I personally think there is more good in this world but hate has a better press agent.  The actions of many can outweigh the negativity of a few.

To learn more about responding to terrorist incidents read: The Downwind Walk: A USAR Paramedic’s Experiences after the Terrorist Attacks of September 11, 2001.  Check it out at:   http://amzn.to/29FCd4f

About the author: Steven Kanarian is a 25 year veteran of the FDNY EMS, Educator and author and speaker. StevenKanarian@gmail.com, @MedicMentor.












Categories: EMS Mastery

3rd Annual Upstate Prehospital Medicine & Trauma Teaching Day: We Are One

May 9, 2016 Comments off


I am pleased to provide a copy of my E-Book Pulmonary Edema vs. Pneumonia: The Classic EMS Diagnosis, for the attendees of this conference in Upstate NY on May 16th.  The Conference will be held at the LODGE AT WELCH ALLYN,  Located at 4355 State Street Road, Skaneateles, NY.

Information about this FREE Conference can be found at: www.upstate.edu/ weareone

****Be sure to stop by the vendor area and check out my book: The Downwind Walk: A USAR Paramedics Experiences After the Terrorist Attack’s of 9/11.   I am contributing the funds raised from this book to help a paramedic who is very ill from her September 11, 2001 work at Ground Zero.  This is the only EMS book about September 11, 2001.   See you at the conference.

Here are the Links to the E-Book:

e-book-pulmonary-edema-sk PDF VERSION


Kindle Version Available on Amazon.com

steve fdny photo



Categories: EMS Mastery

How EMT’s and Medics Can Make Extra Money Without Working On The Ambulance

April 9, 2016 Comments off

 Stop Trading Hours For Dollars


Change your hour for dollars mindset: >Free E-Book if you act now. Limitless! to receive your free book: Limitless by Matt Llyod.

The Problem

I was having a conversation with a paramedic partner of mine who said he owed $7,200.oo on his credit card.  “Dave, aren’t you concerned?” I asked. ”

“Nah, when I need to I will do some overtime,” Dave said.

“Dave, we take home about $150.00 dollars for each overtime shift. That means you would have to do 47 shifts of overtime, if you can get the shifts.  Plus, you take college classes and have a wife. When exactly do you plan on doing these shifts?”

Dave thought.  “You’re right, if I had to do 2 shifts a week, I wouldn’t be paid off for 24 weeks of doing two overtime shifts a month. If I can get the overtime.  Plus there is nothing to say I would not charge more in those weeks.”

The Limited Mindset

We are brought up conditioned that you get paid by the hour and get overtime for hour over 40 hours in a week.  We learn to charge things on credit and play catch up.  The problem with trading hours for money is we only have 168 hours in a week.  We are limited by our thought of trading time for money.

What if we could make money based on the value we offer people rather than the hours we work for others?  We are all held back by our limited thinking.

I explained this to Dave and he replied, ” You cannot make money other than showing up for a job.”

“Sure you can Dave.  If you think like the owner and provide value to people you can make money out of proportion to your available: For example, my book, The Downwind Walk   A USAR Paramedics experience’s after the Terrorist Attacks of September 11, 2001 is for sale on Authorhouse.com.   I wrote the book and sell it on-line.  I did the work and produced a product.  I get a check every quarter based on sale sI make.  Although it is not a lot, I am bringing on money while doing other things.”

Dave replied, “That really doesn’t count because you donate the money to EMT’s and Paramedics who are affected by 9/11. For example, you can donate to help a paramedic who is ill from 9/11 and I will send you a free autographed book. 

Changing Your Mindset

“Dave, we are limited by our mindset of working the hour for dollar rat race.  We were brought up that way and we have to change for the new times.  I have enjoyed working by the hour and then teaching.  But now I am working on building a business I can make income from on the side.  Maybe one day I can retire and travel rather than have o work 50 hours a week and spend my days off resting.  My friend Matt Lloyd wrote a book called Limitless, Escape the Rat Race and Make Money in the New Economy.  If you want I can have him send you a copy.”

Dave thought for a second, “The book is free?  I guess it can’t hurt to read a free book.”

“I’m telling you dave, making money based on value and knowledge is much better than being paid by the hour. Take a second now and e-mail Matt so he can send you a free book.  I don’t know if he can keep giving out books for long.

Change your hour for dollars mindset: >Click Here Now to receive your free book: Limitless by Matt Llyod.


Categories: EMS Mastery

SonoOpinion: Does absence of cardiac activity predict resuscitation failure? #FOAMed

Categories: EMS Mastery

Writing Contest Winner — THE LANGUAGE OF MIDNIGHT, by Nancy Gwillym

September 21, 2015 1 comment

I am pleased to announce the winner of Paramedic Mastery Blogs writing contest. The winner is Nancy Gwillym from Brooklyn, NY.  This story tells the unique story of life in EMS on the Midnight tour. Congratulations Nancy.  You have won a HD Action Cam Digital Video Camera.


The elderly woman leaned on her cane and with her other hand shook her fist at me yelling that not only should I die a slow miserable death but so should my parents who were responsible for bringing me into the world. In her flowery summer dress on this hot summer night she, in many ways, resembled my sweet, late grandma with her grey curls and large glasses. She could have been anyone’s grandmother, standing at the corner bus stop trying to catch the last bus home in time to watch some late night talk show. And here she was yelling expletives at a small paramedic over loud diesel engine noise.

What was the great infraction that warranted this unsolicited criticism? My ambulance was parked in her bus stop and when she had demanded I move it I told her that although we would be quick, we had a critical patient we needed to stabilize first. To be fair this may have been insulting in that we told her what she already knew- she had been standing at the bus stop and had watched all the emergency personnel bring up the bloody mangled body out of the subway station adjacent to her bus top. I was exhausted, sweaty and dirty after carrying our man (along with several pieces of bulky equipment) up the stairs in the hot sauna of the NYC subway system in July. Now being berated by an angry bystander who cursed like a sailor, I was drained both physically and mentally. I asked if she was going to let the police and firemen, who whose vehicles were also in the way of her bus, know how she felt as well. That’s when granny spit out the “F” and the “C” word at me. I guess I just have one of those faces. The darkness of night brings out the best in people.

Anyone who works the overnight has, in some way or another, belittled the work environment of the day people. We’ve mocked, however insignificantly, their endless runs to clinics and schools, the traffic, the crowds and all that incessant ambient noise. We’re inwardly proud of the way we can do things they do while fighting our circadian rhythm. We haven’t changed or adapted our sleep cycle, no one really can, we just deal with it- a happy trade-off to emergency medicine done under the romantic glow of moonlight. Everything at this hour is more intense, more angry, more honest. It feels as if people tend to show less restraint, more emotion. It’s not always a good thing. But the dialog is often entertaining.

After our train job we went in search of refreshment, We worked in one of the highest crime areas of Brooklyn. A major disappointing factor in that is that there are no decent places to get even a snack when it gets dark out. Most of the high end choices for us were found in places attached to a gas station. We lingered around the extensive convenience store selection of power bars when a commotion was heard outside.

“Shot Rings Out!”

“Two shots were suddenly heard and my partner and I made sure to stay behind the flimsy metal shelving. It was a weeknight and late but it was hardly an anomaly.

We called for assistance on the radio and when it all seemed to calm down a few minutes later, we left the safety of the candy bar aisle for the uncertainty outside. In the middle of the street lay a large man on the ground. He was in between street lamps and it wasn’t easy to make out much except for his size. He was the only one not running around so we started to head his way. Before we got there a door opened and made an audible slam. A large woman, clad in neon yellow active-wear, an ironically smart fashion choice for this darkness, ran into the street towards the man between the street lamps. She was mumbling mostly to herself “Oh-my-god-oh-my-god-oh-my-god.” We were approaching the man at around the same pace but she got there first and threw herself upon him. “Baby! Was you shot? Oh my God you is!” Holy shit! Now, now Julio,” she said, “Whatever you do, don’t panic. You got to be STRONG. You hear me? STRONG! Just like I was when I was shot, just like Uncle Joe was when he was shot, and also like my father, you know, when he was shot. Even though he didn’t make it he was strong right up until the end. Now its your turn. You gotta represent the family. You gotta be STRONG!”

We interrupted the inspiration speech and asked Julio where he was shot. “My arm” he said. We checked out his left upper arm with my partners flashlight and indeed, there was a little bullet hole near his shoulder with some minimal blood. I asked if he had gotten hit more than once. He shook his head and started to cry. Typical thug. I sighed. I’m sure I rolled my eyes. Here was this big tough guy laying in the street, crying. I was embarrassed for “Gangsta” culture. A quick cursory once and twice over with the flashlight and palpation revealed nothing else. He completely ignored us cutting clothes and touching him as he spoke to his family member. My partner, a man of few words, gave me the nod and went to move our ambulance as I took his pulse. I tried to solicit some information from Julio who continued to ignore me for the most part, trying to tell his family member who he needed to talk to in terms of vengeance, I surmised. The woman, thankfully, told him not to worry about all that at that moment, that the most important thing was remaining STRONG.

She turned to me with great concern and sternly said “You ain’t takin’ him to no Woodhull, are you? You can’t take him to Woodhull. They’re the ones that killed my father. You CAN’T take him there.” Woodhull wasn’t a trauma hospital and not even a consideration for us so I assured her that no, we wouldn’t be taking her to the hospital that had apparently “killed” her father. She turned back to Julio, “Get through this, you gotta get through this. Help the lady out, she asking you questions she gonna need to tell the doctors. Talk to her!” she said. He made a face that clearly indicated this was not his priority. My questions about his bullet wound, now that the tears were dry, were more of an annoyance. “Please, all my shit is in my wallet, in my pocket” he told me and then went back to telling the woman who she needed to contact. I went through his front pocket and found his wallet. His pants were super tight and it took me some time to wiggle it out. I opened it up and found his Medicaid card and some kind of ID for a school bus operator. One of them gave me some pertinent information which I scribbled on my glove. I struggled to squeeze the wallet back into a pocket it didn’t seem big enough to fit in and then thankfully my partner pulled up with our truck. I asked him for some medical history and he seemed to be annoyed that I was interrupting his conversation.

After a few of the standard questions about medications and surgeries he turned, exasperated and said “Bitch” though not in any kind of derogatory manner, really. It seemed more of his way of addressing females he was not familiar with. I didn’t take it personally. Sometimes its an accurate term, I suppose. “Bitch, it’s all in my wallet everything you need to know.” He became impatient and told me to get his wallet already, what was I waiting for? A small alarm went off in my head recalling how difficult it had been to remove and then replace his wallet into pants that were straining with the bulk that was already in there. I went over to his leg and gave it a little squeeze. Nothing. “Did you feel that?” I asked. He looked at me confused and it didn’t seem to click for him what was going on. I squeezed again. Nothing. Great. Let’s check out this little bullet hole one more time. His arm was rather large and very soft and fleshy. When you first looked at the hole as he lay on the ground and his arm was pressed against his body and the ground, if you looked directly down on it, it would have appeared to be the front. But if he had sat or stood up and gravity had let everything fall to its usual placement the hole would have been more to the side. And at the correct angle, that wasn’t evident during our initial assessment, there a clear path for the one single hole to point towards his spine. There was no exit wound. The bullet could have been anywhere. And before it stopped it had transected his spinal cord. He’d probably never walk again. It looked like he really did have something to cry about in the middle of the street. I guess the cursing would happen later.

The sun began to rise a few hours later and we handed off our radios and equipment to the incoming relief shift. There was a third person with them, a new intern riding with them for the day. (This was yet another perk denied to those of us at night.) The well rested trio smiled at us and asked us how the night went. “Get anything good?” one asked. “Some old woman yelled at us. You’ll probably read about it in the papers,” my partner answered with a wry smile. The older of the day shift crew shook his head and with a wry smile of his own turned to the intern “These guys who work the overnights are just different. One of the first things you will learn out here is that nothing good ever happens after midnight. But these two, they seem to like it.”

Categories: EMS Mastery

Thank You to My Readers on the 14th Anniversary of 9/11!

September 7, 2015 2 comments

“How Did I Move Forward From the Loss of “That Day?”

I appreciate my subscribers to http://www.ParamedicMastery.com.  This week reminds me of the great people I have worked with in EMS, many of which are still good friends.  As this week starts our brothers and sisters are changing their Facebook Profile pictures to flags and eagles.  It is great to see that people remember and will not forget.  EMS is really about the community and those we work with.

We should care as much for the person next to us,as the patient on the stretcher.

September 11, 2001 was a huge disaster which stopped New York City, the United States and most of the world for a few days. The magnitude of the disaster was huge; 7 buildings, 2 airliners, 10 EMTs and paramedics, 343 fire department members, 79 police officers and some 3,300 civilians. When the disbelief turned to acceptance the struggle was to understand the parts the stories, the events and the whys.

Especially for me the information was important.  I went down to the World Trade Center at 1:00 pm on 9/11/01 and did not go home until 3:00 pm on 9/13/2001.  We were in news blackout working hour to hour, bucket to bucket, hope to hope. In the years since I have transitioned from understanding to asking myself, “How do we move forward, not forgetting, but not stuck in the moment.  I vividly remember nights at Ground Zero with the American Flag hanging above the Pit.

Call to action: Please leave your American flag out the night of 9/11, well lit, to honor the emergency responders and military who have given so much on 9/11 and in the years since.

I enjoy doing acts of kindness and generosity in the name of EMTs that died on 9/11.  Somehow, this helps me and makes me feel good about the loss on 9/11.

I have been giving a presentation that called, “After The Siren Stops, Taking Care of our Own.”  I have received excellent feedback on this lecture.  As many of you know I have written the only EMS Book about September 11, 2001 in the world. The Downwind Walk: A USAR Paramedic’s Experience’s after the Terrorist Attacks of 9/11.

I will continue to teach EMS the lessons of 9/11 and how to take care of our own. I plan on speaking at conferences next year and doing book signings.

To show my appreciation to my subscribers I plan to do the following:

  • Ground Zero Tours: I am available for tours around Ground Zero and New York City for EMT’s and Paramedics who are visiting The City. E-Mail me for details.
  • I am planning on recording a book reading this week about what it was like on 9/11/01 to 09/12/01 at Ground Zero, excerpts from my book. I will post this on my web site. http://www.paramedicmastery.com for free.
  • I will be scheduling lectures around the country and world in the next couple of years as we approach the 20th anniversary of 9/11 to share the EMS lessons of 9/11, the great people we lost and how to take care of our own going forward.

Please e-mail me @ StevenKanarian@Gmail.com  if you are interested in a tour in The City or sponsoring a book reading/ signing.

Have a great week as we approach September 11 2014.  Honor those EMTs and paramedics we have lost through your caring and professionalism.   Do something in name of a person who died on 9/11, through you they will live on.

Travelling Is My Passion

Well travelling is one of a my passions at least. I  love living, dining and travelling.  In a nutshell I enjoy living life and experiencing the world.  Through travel we can meet new people and see interesting things.  Sometimes travel gives us a break from everyday life, other times travel gives us a comparison so we may appreciate what we have.  Often i feel travel gives us perspective on our lives and helps us see what is really important.I want to start this blog so I may highlight the great people I meet on the road and the best experiences I find so you too may enjoy  life and all the treasures the world offers.WP_20150325_15_16_22_Pro

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