A.J. Heightman’s Review of Episode #1 of BOSTON EMS

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All photos: ABC Television – Episode 1

The first full season of the ride-along series Boston EMS premiered on ABC on Saturday July 30th. It’s an up-close and personal look at the men and women of Boston EMS filmed by ABC in a format different from the popular A&E NightWatch series featuring the personable crews from New Orleans EMS.

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At the start of the show, the statement is made by a Boston EMS crew member that they are actually “Urban Warriors”. It was a statement that I found to be very powerful for a show that is geared to the public on a national TV network.

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For this new series, ABC positions a camera operator in the front shotgun seat, which forces one of the crew member to ride in the patient compartment. I personally like the multi GOPRO camera placement and interactions that the production company for Night Watch uses but each allows the public to see what we do and how we do it. That’s what’s important.

The high-profile that this series will bring because it is on a national network outweighs my preference for camera placement and “front seat” crew interaction.

I’m very familiar with the Boston EMS system and staff, and a big fan of the BLS/ALS tiered response modes used in Boston. It uses a few seasoned, high call-volume, paramedic crews at most major incidents and critical calls and avoids the skill decay and retraining needs experienced in many EMS systems.

There are some who are critical of this limited ALS unit deployment pattern. Yes, it’s true that there are some high priority calls that do not get a paramedic but, the reality is that the highly skilled Boston BLS crews, working in a dense urban environment, with five major trauma centers and a dozen other closely spaced specialty centers, are able to adequately address the patient needs without ALS.

This leads me to my comments on an amazing incident featured in the first episode of BOSTON EMS when police, fire and EMS were dispatched to the Boston Commons for a man with a backpack who literally cut his heart and lungs from his body.

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Paramedic Petrina Sullivan and her partner responded and were advised to stage in a safe location until police ensured that it was safe.

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Petrina, who says on camera that her “instinct and nature is to protect other responders”, firmly tells an incoming fire crew to hold their position because it was not yet deemed safe by the PD. When the engine driver tells her that they were not aware it wasn’t declared safe yet, Petrina tells him that he needs to “read the notes” – a great teaching moment.

She also pointed out that “he has a backpack” – emphasizing, in this dangerous time in the world, that backpack could kill a host of responders.

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Once the scene was declared safe, I particularly liked the approach that Petrina used with this critical patient by not delaying care to perform Advanced Life Support. She pointed out that he was purely a surgical patient and applied firm direct pressure to the organs exposed through the wound throughout her contact with the patient – to stem his bleeding.

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She carried this basic pressure care through – from the location of the incident to the ambulance, into the ambulance and all the way to the hospital. This type of basic life support care results in saves for trauma patients of this nature.

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While the personalities of the crews and their accents are different from those we see on New Orleans’ Nightwatch, the professionalism and camaraderie is very similar between the two EMS systems.

In this first episode of Boston EMS, EMT Nick Camacho teases his female partner, Beth Rivas, saying that she needed to put her hair in her “tactical ponytail”.

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Beth got him back later when a drug addict walks away from her after receiving Narcan, saying “I’m all set. I’m alright.” Camacho, who was not with her because he was quickly collecting syringes in the alley where they were located so that neighborhood kids would not get stuck and contaminated, walks back to the ambulance, finding Rivas all alone after her patient. He starts to chide her for letting the patient flee the scene and she asks him, “Where were you Needle Boy”.

It was a classic EMS moment.

This heroin overdose, a call which I’m sure is being handled throughout many systems every day in America today, pointed out to the public the role Boston Fire first responders are playing in their EMS system. They arrive and administer Narcan to a non-breathing patient before the Boston EMS crew arrived on scene, saving his life.

It was apparent that Boston EMS appreciated the efforts by the Boston fire personnel, arriving and administering Narcan to assist this patient, because the Boston EMS crew points out on camera that “the fire personnel saved his life”.

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There are a lot of lighthearted moments with patients, something that I have always enjoyed and something I think the public will enjoy getting a glimpse of.

During one incident, a woman who was struck by a vehicle actually held onto the side view mirror that was broken off when it hit her so that she could prove that that was the vehicle that was the cause of her injury. She hands it to the EMS crew to prove the driver hit her.

Another classic moment occurred when the woman’s blood pressure was found to be elevated. She seemed curious about why it was so high and the male EMT tells her that it might be because “he was really handsome.”

There were also a lot of good teaching moments in this first episode.

For example:

The medium-duty Braun ambulances on the streets of Boston have red seat belts that allows supervisors and others to see that the crew is properly seat-belted in the cab when responding to calls.

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The Boston EMS Units, like the New Orleans EMS ambulances, are equipped with the Whelen Howler sirens that use low frequency tones to penetrate/vibrate vehicles through a vibration action.

In addition, the crews, have body armor available to them in addition to reflective safety vests.

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Whenever stepping outside their vehicles on a roadway, properly don yellow vests that are labeled “Boston EMS”. This is not just a good safety idea but a good public relations opportunity to have the name of the organization on the vest.

The “tone” of crews’ voices also matched the needs of each situation. This was readily apparent in this first episode. After the stern voice she use with the engine crew at the stabbing incident, Petrina Sullivan, a seasoned paramedic and a mother, showed her motherly instincts and a compassionate tone when talking to a patient who fell 15 feet from a scaffold. The tone of her voice made him feel comfortable with her care and her decisions while in her ambulance.

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The audience watching Boston EMS also gets a good flavor of what it’s like to be on the streets in a busy EMS system. At a scene where there was a potential “jumper” in East Boston, Lieutenant Eric McDevitt, the on-duty EMS supervisor, responded in via “silent mode” so he did not startle or agitate the man on the edge of the roof. His comment – good for the public watching the series to hear – was that “people that want to take their lives are very unpredictable.” The EMS crews worked closely with the Boston fire department technical Rescue Team and the police department as they talked to jumper potential jumper out of taking his own life.

In another great scene, Stephen Dennis and Nick Camacho Camacho responded to Boston Symphony Hall for a 95-year-old woman who had a medical emergency. This call epitomized the joy of EMS and the fun it can be to take care of geriatric patients; people who have lived a long time and enjoy kind and compassionate care. The woman, with a cute, firecracker personality, referred to herself as the “Bionic Woman” who had several things replaced and even pointed out her quote fancy underwear. But, the funniest part of her time with the crew came when she said “you all are very kind and considerate and handsome, but you have to lose some weight!”  It was a subtle comment of what she noticed – that many providers, myself included, need to take off some weight.

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Another call involved a woman who had been struck by a bicycle on the street and was extremely upset and out of control. Her hysteria was very well managed by EMT Taishana Lewis.

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I would be remiss if I didn’t put on my EMS administrator hat and offer a few critiques and teaching points that EMS crews should get from this first episode. First and foremost, there should be no eating in the patient compartment of an ambulance because of blood-borne pathogen concerns being transferred from the back of the ambulance onto an item being eaten.

In addition, there were several times when a driver, began response to two calls with a coffee in her one hand. Two hands should be on the wheel of an emergency vehicle at all times. Enough said.

At the heroin overdose call, once the patient was brought around and became conscious and oriented, the female EMT attempted to get him to go to the hospital, escorting him to the side door of the ambulance. But, as referenced earlier, he suddenly bolts up the alley and out of sight. Her partner was not with her at the time because he was collecting at least a dozen syringes that were lying in the area where this patient was found and treated.

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This was an effort to keep neighborhood children and others from getting stuck with contaminated needles. However, the teaching point is that the overdose victim very well could have attacked the female EMT.

So, while the actions of the EMT were commendable, it could have had a dangerous outcome with the crew being separated. I don’t mean to criticize the crew, just want to point out that it is never a good idea for the crew to be separated unless they absolutely have to be.

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The end of the first episode featured two additional teaching moments for the public. First was that we in EMS are subjected to random drug testing. A female EMT is shown leaving her ambulance to go for a random, annual drug test which required her to contributing a few strands of hair for testing. I liked her attitude and comment, saying that it didn’t bother her because she would be found to be clean anyway.

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The second was when an EMT (Randy) stopped by his mother’s home in their district to use her bathroom. It was pointed out that she frequently takes care of the crews by cooking them dinner. It showed a very human side of our job, showing how important family support is in EMS because of the stressful nature of the job. This segment portrayed that very well to the public.

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In the next episode which will appear will be on Saturday at 10 PM Eastern Time, the crews will respond to a four-alarm fire and manage a patient who is hypothermic.

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This show has great potential and I would encourage EMS providers to watch it, support it and critique it in their own way. My hat is off to Boston EMS for opening up your ambulances and crews for the public to experience EMS – similar to what the New Orleans EMS system has done on Nightwatch.

We all know that is a very complicated process to be involved with the TV show and probably presents more heartburn then pleasure to the EMS administrators and medical directors.

Before you critique this show or Nightwatch, I ask that that you take a look at how your service operates as well as what your protocols and processes are that could be subjected to public view. I find many times that people who are critical of other EMS systems or crews feel that their system is perfect, but we all know that you can find flaws or miscues on almost any call.

The real measure of any of this system is its consistency and quality and it’s consistency in its performance.

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Go to http://abc.go.com/shows/boston-ems/episode-guide/season-1/01-boston-ems-072515-episode-1 to watch Episode 1 and other episodes

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