Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Preparedness and Insurance

At Mitigation Journal, Rick Russotti has been writing and podcasting quite a bit about preparedness, lately.

We do not do a good job of preparing for low frequency, high impact risks.

For example, Pittsburgh’s Public Safety Director, Michael The Luddite Huss, was able to get away with a deadly lack of preparedness, right up until it became apparent that the outcome of this lack of preparedness is that some people will die. Michael The Luddite Huss was able to hoodwink most people into believing that his mistakes were not his fault, but the failure of the people who work for him to use medieval technology to make up for his lack of preparedness.

We don’t need to prepare for emergencies. We can just hope for the best and sacrifice some of the expendable low level employees when our lack of preparedness is exposed.

The recent storms may be teaching us the wrong lessons. The storms were not as bad as predicted, which is good for the moment. The problem comes when we try to convince politicians that we did not waste the money spent on preparedness; That we need to spend money on preparedness each year; That we need to spend much more when the events we have prepared for actually do happen. What is good for the moment when things weren’t that bad may not be good for the moment when things are very bad.

These same politicians will spend money on insurance without a thought, but when we call it preparedness, a form of self-insurance, we are expected to produce some sort of tangible return. This is a mistake.

Insurance is not an investment that should produce a positive return, even if something bad happens. Insurance only helps to decrease the losses from whatever bad happened. Flood insurance is not supposed to pay to put everything back the way it was before a flood. Life insurance does not bring the person back to life. Auto insurance does not prevent collisions. Insurance is supposed to help to manage losses. Not having enough insurance means that there is personal liability for losses outside of what is covered by the policy.

We should expect to pay for these types of insurance for years decades without filing any claims.

We should expect that the return will be less than what we paid in, except in the most extreme circumstances. We should be pleased that we paid out more than we received. This means that we have been fortunate. Others have been less fortunate and we should be pleased that we did not receive the payouts the less fortunate people received.

This is a part of being a responsible adult.

Yet, when it is preparedness, we expect the rules will work differently.

We got away with it before, so we expect that we will be able to get away with it again. Those subprime mortgages are a good investment, because our models predict that there will only be a catastrophic default every so many hundreds of years, so we will invest in them for so many hundreds of years minus one. Bad stuff only happens after everyone has had time to prepare for it – right?

It is safe to drive through this water covering the road, because I drive on this road all of the time and my car has never become stuck before.

Right?

We have a couple of storms that are not as bad as the worst case predicted, not even as bad as the average case expected. Do we appreciate that we have been lucky? No. We complain about the money wasted because things were not as bad as we expected.

When we do not prepare, each time we get away with this, we receive positive reinforcement that we have made a good decision. More money for something else.

When we do prepare, each time we do not have a disaster, we receive negative reinforcement that we have made a bad decision. Less money for something else.

When disaster hits, the disaster denialists will find scapegoats to sacrifice to the political Gods.

When disaster hits the prepared communities, the disaster will be much less of an event, almost a non-event compared with what is happening to the denialist neighbors.

This is not really different from patient care. Those dealing with many more unstable patients than everyone else are probably just not able to handle patient care. If they are constantly yelling and using life or death treatments, maybe they are just not able to recognize what life or death means.

Maybe the greatest threat to the life of the patient is the presence of the panic medic yelling at others because he is not prepared to deal with sick people.

 

Panic is not a sign of preparedness.

 

Blaming other people is also not a sign of preparedness.


Signs from the National Weather Service.

.

What is Preparedness


Over at the Mitigation Journal, Rick Russotti has been very busy on this topic because of a recent court decision.

Tenet Health Care (disclosure-wise I used to work for them and I was not impressed in any positive way with the organization) lost a case for $25,000,000.00.

OK – I don’t know how accurate that number is, but the number is $25 million. By putting in all of the zeros, I am suggesting an accuracy that I do not know about. The reason I do it anyway is that I want to get people to notice the amount. Maybe you look at it and say, in the world of TARP, that is small change. What would be the amount if the building were the ambulance service, or fire house, or police station?

A July, 2011 court decision requires Tenet Health to pay $25 million to those patients and civilians who took shelter at Memorial Health Center and died or suffered injury. The court ruling is based on the belief that the medical center failed to establish an evacuation plan and that by poor design, the backup power system was vulnerable to flooding…that is, they failed to plan, prepare, and implement adequate preparedness operations.

How ready are we to deal with a disaster?

MJ 215 A Message from Katrina: Hospitals be ready. Part One

MJ 216 Message from Katrina: Hospitals be ready. Part Two

When is 25% preparedness acceptable?

Forward thinking: Bringing the Katrina decision home

Interview with Ceciel County, MD County Emergency Services

My opinions on Hospital Emergency Preparedness are nothing new

And these posts and podcasts raise an interesting question –

New signage on the revolving door and other doors stated “This hospital is not a shelter”.

What difference will that make? It isn’t as if a hospital can turn people away, but what about other facilities, such as the ones I mentioned above – police, fire, and ambulance buildings?

Will we be putting up barbed wire as a part of disaster preparedness?

Electrified fences might not be a good idea in a hurricane.

Will the the term hurricane fence take on new meaning?

Effect of the recent Katrina ruling

What should we be doing to prepare for disasters, regardless of the type of disaster?

.

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell

In the movie The Dark Knight, there is a wonderful quote.

Bruce Wayne (Batman): We all know how much you like to say: “I told you so.”
Alfred: On that day, Master Wayne, even I won’t want to… probably.

Well, the defenders of Public Safety Director Michael Huss and those trying to scapegoat Paramedic Josie Dimon are not Batman.

To those who claimed that Public Safety Director Michael Huss was not making a scapegoat out of Josie Dimon to protect himself –

I told you so.

To those who claimed that Josie Dimon was responsible for the death of Curtis Mitchell because she was having a bad day, used some inappropriate language on a recorded phone line, and did not disregard orders from dispatch to be reassigned to another call on a day when all ambulances were working non-stop in very unpleasant conditions –

I told you so.

I am not a fan of saying I told you so, but I think it is a well deserved response to the arrogance and incompetence displayed by Public Safety Director Michael Huss and Mayor Luke Ravenstahl.

“In concluding that Dimon should be returned to work, the arbitrator found that despite that a major winter snowstorm had been forecast, the mayor of the city and the director of public safety Huss had gone to a resort about 50 miles away to celebrate the mayor’s 30th birthday and only discharged Dimon two months after the incident, following media criticism of the city’s failure to deal well with the snow emergency,” the union said.[1]

Were any plows used to assist crews in getting to Mr. Mitchell or getting Mr. Mitchell to an ambulance?

No.

Were any 4 wheel drive vehicles used to assist crews in getting to Mr. Mitchell or getting Mr. Mitchell to an ambulance?

No.

Were ambulance crews expected to ignore the orders of dispatch to go to the next call, but also transport the next patient while digging to Curtis Mitchell?

Yes.

Were ambulance crews expected to take themselves out of service for hours and endanger other patients to make up for the lack of planning of Public Safety Director Michael Huss and Mayor Luke Ravenstahl?

Yes.

Would a few 4 wheel drive vehicles have made it possible to transport Curtis Mitchell to the hospital the first time he called?

Yes.

Would a few 4 wheel drive vehicles have dramatically cut the waiting time of patients that was sometimes 10 hours long?

Yes.

Was this a failure on the part of Josie Dimon?

No.

Was this a failure on the part of Public Safety Director Michael Huss and Mayor Luke Ravenstahl?

Yes.

Is this an excellent case study of how not to prepare for a disaster?

Yes.

Is this an excellent case study of how not to deal with a preventable death?

Yes.

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.[2]

This is from an excellent podcast covering this same storm. The podcast describes how to prepare for potential disasters. –

Thank you to The Social Medic for bringing this to my attention.

See also Common Sense Prevails from Too Old To Work, Too Young To Retire.

For the I told you so part. I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Union says reinstated paramedic was a scapegoat
Tuesday, February 15, 2011
By Joe Smydo
Pittsburgh Post-Gazette
Article

[2] From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

.

The Scapegoats Will Be Punished

Apparently, my last post was just about the time the news was published.

Acting Crew Chief Josie Dimon, a union employee was fired after she was heard on transmissions between paramedics making disparaging, profanity laced comments such as “this ain’t no [expletive] taxi service.”[1]

Is that inappropriate? Absolutely.

Should someone be fired for speaking that way with dispatch? There are going to be many different approaches to that question.

How has the city handled any previous cases of use of obscenity on the radio?

How has the city handled any previous cases of bad attitude expressed on the radio?

If there have been any cases of similar behavior, was the person(s) fired?

Is the use of a public forum (using a press conference to announce the firing) special to this case?

Did the bad attitude and use of obscenity contribute to the death of Curtis Mitchell in any way?

If she is such a bad employee that she needs to be fired, why did I hear that she was working on the street and had to be called back to base just before the press conference?

Why was the discipline kept a secret, even from those being disciplined?

What is the top secret higher standard that Mayor Luke Ravenstahl and Public Safety Director Michael Huss are enforcing?

It certainly is not a higher standard of disaster preparedness, because they did not fire themselves.

Or maybe they did, but it is also top secret.

Were EMS crews told that they would not receive any assistance?

Were EMS crews told that they would have to dig themselves through the snow to their patients?

Since the snow was coming down fast and being blown back where people shoveled, that would mean digging their way to the patient and then back to the ambulance with the patient.

How long do we want to have a patient outside, while having medics do the job that should be done by equipment?

If a patient is dropped, is that the fault of the crew carrying a patient on snow and ice covered roads?

Who came up with this plan?

Not the medics.

What about 4 wheel drive vehicles? Supervisors could respond with 4 wheel drive vehicles to safely transport patients, rather than dragging/pushing/dropping the patient through the snow and ice.

That would be a good plan.

That was not the plan in Pittsburgh.

After the storm, the decision was made to send the fire department on calls to help shovel snow and carry patients.

Apparently, Mayor Luke Ravenstahl and Public Safety Director Michael Huss think that Pittsburgh has a bunch of fire fighters sitting around with nothing to do.

Let’s send fire fighters to do the work that should be done by snow plows and/or 4 wheel drive vehicles.

If there is a fire, maybe Mayor Luke Ravenstahl and Public Safety Director Michael Huss will decide that the fire department should just walk to the fire and throw snow on the fire.

Why waste money on the appropriate equipment?

Nobody will mind waiting for fire fighters to walk to the fire. Would they?

We don’t need no stinkin’ snow plows!

An excellent plan!

What else is part of their plan?

Crew Chief Kim Long, also a union employee, and two non-union supervisors, District Chief Norman Aubil and District Chief Ron Curry were suspended for three days.[1]

There is no mention of anything they did that justifies these suspensions.

2 independent investigations cleared the medics. Even the wife of Curtis Mitchell does not blame the medics.

Scapegoats.

What about Mayor Luke Ravenstahl and Public Safety Director Michael Huss?

They may not have created all of this mess, but they couldn’t seem to be able to figure out how to call the National guard until days after the death of Curtis Mitchell.

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.[2]

I agree. We did have time to prepare.

Why wasn’t Pittsburgh prepared?

Just get out and walk is not an acceptable disaster plan.

Don’t worry. If anything bad happens, we’ll just blame the people who did not work hard enough to make up for our lack of planning.

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] 4 Receive Disciplinary Action In Hazelwood Death
Mar 23, 2010 2:56 pm US/Eastern
KDKA.com Pittsburgh
Article

[2] From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

.

What kind of punishment do you get for NOT disobeying dispatch?

There is a video in the article. It cannot be embeded.

Tony Weinmann, president of the Fraternal Association of Professional Paramedics, said Monday that the city notified two paramedics of pending discipline in connection with Curtis Mitchell’s death.[1]

These paramedics have received notice that they will be disciplined, in spite of being cleared of responsibility in 2 separate investigations. They have not been told what kind of discipline, although it has been leaked to the press that at least one will be fired. At the time this story was published, this morning, one of the paramedics was still at work on the street.

She was still not aware of what kind of punitive action will be taken by the city for being cleared by 2 independent investigations. If she is investigated a third time and cleared, maybe Mayor Luke Ravenstahl and Public Safety Director Michael Huss will have to execute her.

Pittsburgh Public Safety Director Mike Huss would not confirm reports of discipline, but he said the city has completed its investigation and is planning a news conference at 1:30 p.m.[1]

It is now 3:00 PM and still there is no new report of the form of punishment.

His longtime partner, Sharon Edge, told WTAE Channel 4 Action News that she didn’t think the two paramedics should lose their jobs.

“I think they used them as a scapegoat. I don’t want them to get fired because that wouldn’t be right, and Curtis wouldn’t have wanted that,” said Edge.[1]

2 independent investigations and the person most affected by the death of her common law husband. The same conclusion. The medics are not at fault in causing the death of Curtis Mitchell.

Scapegoats.

The paramedics’ union criticized city leaders on Saturday, saying, “It is quite obvious prior to this incident that the city was ill-prepared for this snow disaster. The administrators in charge of the public’s safety did not put the employees of the city of Pittsburgh in a position to carry out their responsibilities in an effective manner.”[1]

Now, if I were the skeptical type, I might suspect that this is an attempt by the people responsible for the handling of emergencies in the City of Pittsburgh to deflect blame onto someone else. Secret higher standards for the people actually doing the work, but lower standards for those in charge. Why so many secrets?

Would that be an unreasonable suspicion?

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.[2]

Cecil County does not handle emergencies the same way that Pittsburgh handles emergencies.

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Paramedics To Be Disciplined For Man’s Death After Snowstorm – Curtis Mitchell Died, Despite Repeated Calls To Pittsburgh 911
ThePittsburghChannel.com
Posted: 3:54 pm EDT March 22, 2010
Updated: 11:02 am EDT March 23, 2010
Article

[2] From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

.

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I


I have not been on any of the podcasts covering the Pittsburgh EMS response in the snow and ice, when Curtis Mitchell died. I just listened to the EMS Garage podcast that covered this as a part of the episode.

It seems that the less you know about what happened, the more you blame the medics. The topic seemed to be dominated by comments stating, the news said, or the news didn’t say.

Do we trust the news to get the story right?

Few people seem to be surprised at how little information was released.

Originally, the information released was that a couple of medics responded 3 times, but those medics refused to get out of their truck because they were lazy.

We now know that there were 6 different medics. The medics did not refuse to get out of the truck. The medics were canceled by dispatch. It appears that the crews were then reassigned to other patients, because they were running non-stop all day. Calls were waiting for ambulances to become available.

Running non-stop transporting patients in the snow and ice is somehow lazy?

This is to be expected during disaster conditions. This does not seem to be the experience of the critics, even though they claim to have extensive disaster experience.

These medics transported a lot of other patients.

How did the patients get to the hospital, if the medics did not get out of the truck?

How did the patients get to the hospital if these medics were lazy?

In this case, it appears that the media were fed misleading information by Public Safety Director Michael Huss. The man responsible for public safety essentially pointed his finger at the medics and squealed, They did it! They did it! They did it!

OK, squealed may not technically correct. That doesn’t mean that it is any less fair than anything Public Safety Director Michael Huss said. He is responsible for public safety, but apparently only when the sun is shining, but not too much sun.

Two mistakes, that many people have repeated –

The medics never got out of the truck.

And –

The medics never tried.

Does anyone have any evidence to support either statement?

Does anybody really think that this is true?

Why does anyone believe this?

Insanity?

Immaturity?

Gullibility?

Mass hallucination?

I believe that the reason is a lack of critical judgment.

Did any news report make either statement? If the medics did not get out of the truck, and no help was sent, who dug the ambulances out of the snow?

Public Safety Director Michael Huss did say something about the medics needing to get out of the truck, but is there any reason to believe that the words of Mr. Huss are at all credible?

The comments of Public Safety Director Michael Huss were what originally caught my attention. The comments remind me of a child trying to explain that he does not know what happened to the missing chocolate chip cookies, even though he is covered with melted chocolate.

Maybe the child is not guilty, but am I going to start looking for some mysterious stranger or maybe a cookie monster?

Still, this is the explanation that was repeated on the podcast. There was some dissent on the show, but the uninformed critics of the medics did seem to dominate the discussion. I like the EMS Garage. Chris Montera does a great job of encouraging discussion on important topics. This was a segment that will encourage people to blame the wrong people. This will encourage people to ignore disaster planning, because the medics can just get out of the truck and walk. The only way this is disaster planning, is by turning something that is not a disaster into a true disaster. Then management will blame the lowest people on the totem pole.

In a different podcast, covered on both Mitigation Journal and the MedicCast, there is a different approach to the topic. That is in Part II. Then there is Part III.

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

.

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III


Why the flurry of posts on the death of Curtis Mitchell?

The Pennsylvania Department of Health has exonerated the paramedics of any wrongdoing, but that ruling seems to carry little weight with city officials.[1]

Just a few quotes to highlight the problems in Pittsburgh

Mr. Huss (public Safety Director Michael Huss) said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[2]

On Friday, (Mayor) Ravenstahl reiterated that the city has its own rules.

“When you look at the state’s requirements that nothing was done wrong, we feel differently,” said Ravenstahl. “But one thing that’s important to understand is that we have higher standards — in terms of what we expect from our paramedics here in Pittsburgh — than what the state requires.”

Ravenstahl, along with other city officials involved in the case, has not revealed what those standards are.

“We’ll disclose that at the time when we make an announcement. It’s not [public disclosure] at this time. We will make it available,” said Public Safety Director Michael Huss.[3]

Double secret probation?

[youtube]Y0cF2piwjYQ[/youtube]

Apparently, Mayor Ravenstahl thinks he can shield his friend from any blame for poor planning, by blaming the paramedics, who were following lawful directions from dispatch. The medics were not as tactful as they should have been, but that was addressed by the medical director before the first press conference.[4]

This would be suspicious, if someone were attempting to get rid of Pittsburgh EMS and have the fire department take over EMS. Has anyone asked what the fire department was doing during this storm? Was their behavior better than the behavior of EMS? Public Safety Director Michael Huss is a retired fire chief. Maybe he knows.

We’re successful because our business, be it fire department, EMS, combination, career, volunteer, emergency management, emergency operation, or in my case emergency services – We have got to be flexible, forward thinking, out of the box type people. That’s when we’ll do the best job.

When people come at you with something that you did not predict, and you can sit back for a few minutes and go, “There’s a way we can deal with this,” and make it work, then refine it for the next time. That’s how we’re going to have success.

– Cecil County Director of Emergency Services Richard Brooks.[5], [6]

That kind of thinking doesn’t seem to be possible in Pittsburgh.

For links to other writing/podcasting on the subject, see Part I or Part II.

Footnotes:

[1] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[2] City may discipline EMS workers – Man died at home despite repeated calls to 911 during snowstorm
Thursday, February 18, 2010
By Sadie Gurman,
Pittsburgh Post-Gazette
Article

[3] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[4] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

[5] MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services
Mitigation Journal
Podcast

In the Mitigation Journal blog on the same topic –
EMS Under the Bus in Pittsburgh – 02/28/10

[6] Snow Storm 2010 Response and Episode 208 of the MedicCast
MedicCast
Podcast

.

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II


As opposed to what I wrote about in Part I, there is a more thoughtful, more thorough approach to disaster planning covered on both Mitigation Journal and the MedicCast.

Cecil County (Maryland) Director of Emergency Services Richard Brooks is interviewed.

This is a podcast that is very important to listen to.

There are many important topics that people do not understand. For example, if there is the possibility of a disaster, how much preparation is appropriate? When the disaster does not happen, there will be many critics, so some places avoid preparation.

Better not spend too much. That will look bad, if the storm is not as bad as forecast. If the worst happens, we can just blame the medics.

That is an important contrast between Pittsburgh and Cecil County. It is true that Pittsburgh has a lot of financial problems that other places do not have, but this should have encouraged them to call for help earlier. The National Guard has 4 wheel drive vehicles. Pittsburgh needed 4 wheel drive vehicles. The National guard has snow plows. Pittsburgh needed snow plows. The decision to call early should have been easy.

When 911 calls are put on hold for 10 hours, you might want to consider that you are dealing with a disaster. Maybe avoiding dealing with a disaster is their style.

When you have 911 calls on hold for 10 hours, you need to admit that you are overwhelmed. You need to use your brains, rather than having crews wandering around in the snow, doing things that should be done by equipment. The Luddite approach leads to deaths.

Public Safety Director Michael Huss clearly does not believe in using critical judgment. His response was for the medics to tie themselves up on one call for hours by getting out of the truck and walking to the patient. Then possibly endangering the patient by having 2 people try to drag him through the snow and ice. Mayor Ravenstahl seems to be defending his buddy.[1]

We all had ample time to prepare.

– Cecil County Director of Emergency Services Richard Brooks.

In the interview, Richard Brooks describes using critical judgment and encouraging his people to use critical judgment. He describes it as thinking outside the box. I do not like the phrase for a bunch of reasons. One is that it has become overused by so many people. Richard Brooks uses it appropriately.

Michael Huss doesn’t seem to want medics to appropriately use equipment. He seems to want them to just use their legs. If they do that, he seems to think that the lack of preparedness will not be noticed.

Why?

He knows what happened, so he thinks that he knows how to avoid it in the cheapest way possible. He is wrong. Monday morning quarterbacks usually are.

Public Safety Director Michael Huss encourages us to think as Luddites. Technology is evil. Destroy all tools. And blame the medics.

We’re successful because our business, be it fire department, EMS, combination, career, volunteer, emergency management, emergency operation, or in my case emergency services – We have got to be flexible, forward thinking, out of the box type people. That’s when we’ll do the best job.

When people come at you with something that you did not predict, and you can sit back for a few minutes and go, “There’s a way we can deal with this,” and make it work, then refine it for the next time. That’s how we’re going to have success.

– Cecil County Director of Emergency Services Richard Brooks.

That is not the bureaucratic response. The bureaucratic response is to sacrifice low ranking personnel to protect the jobs of their bosses (the ones who really caused the problem).

Cecil County will not have to deal with explaining a preventable death to the media, because they will be prepared for disasters. When their preparation does not lead to an easy solution, they will start trying other things.

How much thought is required to decide to send a 4 wheel drive truck to pick up a patient, rather than have the medics re-enact the Iditarod? If we use the right tools, we are able to help more people. If we use critical judgment, we are able to help more people. If we use the Luddite solution, we endanger everyone.

I am very critical of people who discourage the use of critical judgment.

I think that the only way that the statements of Public Safety Director Michael Huss make sense, is if we abandon the use of critical judgment. We would need to engage in a willing suspension of disbelief.[2]

Reasonable people only engage in a willing suspension of disbelief to enjoy fiction. Fiction, that otherwise would be seen as unbelievable.

Public Safety Director Michael Huss does not even provide good unbelievable fiction.

The official report from the medical director is not fiction.[3]

There is more in Part III

Podcasting on the death of Curtis Mitchell:

From Mitigation Journal

EMS Under the Bus in Pittsburgh – 02/28/10

And in the Mitigation Journal podcast –

MJ156: Winter Storms: Interview with Mr. Richard Brooks, Director Cecil County MD, Emergency Services – 02/23/10

From the MedicCast

Snow Storm 2010 Response and Episode 208 of the MedicCast – 02/28/10

From the EMS Garage

Up to My Pips: EMS Garage Episode 75 – 03/02/10

Writing on the death of Curtis Mitchell:

From Too Old To Work, Too Young To Retire

Trouble Right Here In Three River City – 02/19/10

Comment From Someone In Pittsburgh – 02/20/10

More From Pittsburgh – 02/23/10

Update On The Pittsburgh Story – 02/28/10

And Then I Realized… – 03/01/10

Fertilizer – 03/22/10

Human Sacrifice – 3/24/10

The Tapes Don’t Lie, But People Do – 3/29/10

The Drama Continues In Pittsburgh – 5/12/10

Let The Scapegoating Begin – 01/06/11

Common Sense Prevails – 02/15/11

From David Konig

EMS Blog Rounds Edition 32 – 03/09/10

Why You Need A Social Media Presence: The Case Of Pittsburgh EMS – 02/22/10

Yes Mary, It Is A Transportation System – 02/19/10

From 9-ECHO-1

Pittsburgh…my take on it – 02/23/10

Still Don’t Make It Right… – 03/20/10

From A Day In The Life Of An Ambulance Driver

As usual the truth is somewhere between the extremes – 02/20/10

From Pittsburgh Legal Back Talk

The Power of Saying “I’m Sorry”. – 02/21/10

Medic’s Perspective on Mitchell Case. – 02/22/10

The Need for Evidence Before Assessing Guilt. – 02/23/10

The View from Foggy Goggle. – 02/25/10

I have also written about this here –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] Investigation Clears EMS Workers In Snowstorm Death – Mayor Says City Has ‘Higher Standards’
ThePittsburghChannel.
Posted: 4:58 am EDT March 19, 2010
Updated: 5:34 pm EDT March 20, 2010
Article

[2] Suspension of disbelief
Wikipedia
Article

[3] Medical Call Review for 5161 Chaplain Way 2/6/2010
Ron Roth, MD Final 2/15/10
Medical Director, City of Pittsburgh, Department of Public Safety
Medical Director, Allegheny County Emergency Operations Center
Free Full Text

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