Thomas Himmel’s masterplan for Bad Ems GC in western Germany includes a redesign of greens and bunkers which includes significant regarding of the eleventh fairway The second green will be raised by three-and-a-half metres to combat shade issues.. and Himmel’s sketch of how the second hole will look Josef Poetter Golf has started work on the Thomas Himmel renovation at Bad Ems Golf Club located halfway between Cologne and Frankfurt has a course where the original design is attributed to Karl Hoffmann after the course had fallen into repair and disuse following World War II which will be carried out in two phases (this year and in 2026) involves the redesign of greens and bunkers sandcapping on the wettest holes (three and nine) a new storage pond and a new short-game area “The facility was getting old and out of shape due to lack of investment,” said Himmel old oak trees were visually lost due to the wild growth of plants around them The redesign will give the course a more open parkland feel and other alterations to ensure the course is suitable for the modern game Changes include expanding the greens to add more strategic variety and spread the wear as well as improve their drainage and to extend the playing season.” Himmel says his redesign will also address some of the “slightly boring and featureless” holes This work includes removing greenside bunkers adding more runoff areas and relocating fairway bunkers so they are more striking from the tee and add more variety to the playing experience All bunkers will be renovated and feature CapillaryFlow “There will be some steeper but maintainable grassy steps and edges within the fairways,” said Himmel “The addition of fescue grasses in out-of-play areas will help promote a more natural parkland look Some trees and shrubs will be trimmed to let in more light and improve air flow.” There will be big changes on holes two and eleven “The second green will be raised by three-and-a-half metres to lift it out of a shady and humid sink surrounded by trees,” said Himmel “And the eleventh will be significantly flattened to improve playability across what is currently an almost unplayable cross slope at the first landing area.” In addition to work on the range (new artificial tees and target greens) Himmel has also designed a new short-game area to be built on a space previously used as the first tee “The complex has been designed to allow players to practice an array of shots from 10 to 90 metres The course is expected to reopen in 2027 ahead of the club’s centenary in 2028 Thank you for completing the form, here is your download: "+jQuery("body").attr("docName")+" Thank you for completing the form, here is the link to your on-demand webinar: On-Demand Webinar Link The What Paramedics Want in 2024 report produced by EMS1 and Fitch & Associates found respondents to the 2024 EMS Trend Survey ranked leadership No 4 in the critical issues facing EMS today (behind only retention cohosts Chris Cebollero and Kelly Grayson expose the unpleasant side of EMS leadership by naming the top 10 signs of a bad manager From communication breakdowns to micromanagement nightmares while dishing out hard truths about inconsistent leadership Want to know if your manager is part of the problem – or if you’re on your way to becoming one Enjoying the show? 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All rights reserved.Do Not Sell My Personal Information Share on FacebookShare on X (formerly Twitter)Share on PinterestShare on LinkedInLOUISVILLE (WAVE) - After multiple children in Henry County had adverse reactions to a specific high blood pressure/ADHD medication officials with Henry County EMS issued a public health warning to families all children that have had adverse reactions are expected to recover all children with reactions were prescribed Clonidine Oral Suspension and it was filled at MedSave in Eminence Bothur said families should not give their children any Clonidine Oral Suspension that was filled at that location Bothur believes the medication shipment was a “bad batch” and he has singled out where it came from Bothur told WAVE News he believes the problem was isolated by Monday morning Henry County EMS said children had symptoms of “unconsciousness/unresponsiveness Bothur said “multiple” children had adverse reactions to the medication but he could not say how many or give any information on their condition as the situation involves sensitive medical information When it’s his turn to write the narrative for the ePCR every sentence has multiple grammar errors and misspellings Important details about assessment and care are often left out but he always wants me to just “sign the dam report” so we can clear the hospital for quarters or the next call He’s also the crew chief so it’s not easy for me to call out his poor writing skills As a co-signer am I liable for his mistakes How can I make sure we have more accurate and more professional narratives without turning him against me The worst part about your question is that it is so common in EMS What you are experiencing is happening everywhere – despite my best efforts to the contrary The short answer to your long question is: yes, you may be considered liable for the mistakes contained in the patient care report if you are cosigning as to its accuracy and the like were ingrained into us and reinforced daily Dangling participles and elbows on the dinner table were often met with the same response Over the years, though, we have grown lazy and complacent. Everyone gets a trophy, and nobody fails in school, so we simply don’t care as much about once-important notions like spelling, grammar and etiquette Work ethic seems to have gone the way of the dodo It stands to reason that complacent EMS providers and grammatical and spelling errors are all too common in patient care reports The more sinister issue you point out; the much much bigger problem that will directly affect you is the reality that “…[i]mportant details about assessment and care are often left out…” of his reports My experience has been that omissions in documentation equate to omissions in care and that is what will bring you both down The law views EMS partners as a team; each provider is responsible for the [known] conduct of the other if you are both paramedics and you see your partner about to commit a treatment error and you don’t intervene if you know or should know that your partner is documenting improperly or incompletely or you own everything in it and everything that is missing How you fix this problem without straining the relationship is delicate work until it is not Partners are supposed to have each other’s backs Partners are supposed to look out for one another Partners are supposed to protect each other The partner who drives you to be better is the partner you know you can trust The partner who expects you to lie for him or her is the one you know you cannot trust; that is the one who will burn you before he burns with you Your crew chief partner is not acting like a crew chief so I cannot tell you definitively how to handle it I understand wanting to go available faster The problem is that our duty to the patient we just transported is not satisfied until we have provided the kind of accurate and thorough documentation that affords the patient and the hospital the best opportunity to provide continuity of care.” Maybe your attention to quality will be contagious; problem solved Maybe the conversation needs to be a little more direct “Incomplete documentation is bad for the patient Making sure that the ePCR is as good as it can be is not a ding against you; it’s me being a good partner and us doing right by the patient.” A wise person once told me that doing the right thing is not always easy go over his head; you may need to drive the culture of your agency to a better place; a higher standard My feeling about providers who resist improvement is that they don’t belong in EMS The conflict you are facing with your crew chief is the same conflict that countless EMS providers face every single day your question and this answer will help you and them What are your thoughts on how to solve this problem what feedback from your partner would be most helpful to you Do you have an EMS legal question for me? Email me David@thelegalguardian.com and I will consider it for an upcoming EMS1 column Note: I am only licensed to practice law in California Any response to hypothetical questions is intended for educational purposes only and is not intended to be nor should it be considered legal advice has been updated with a video and additional recources Reviews and recommendations are unbiased and products are independently selected Postmedia may earn an affiliate commission from purchases made through links on this page I take a deep breath before hanging up my robe and entering buck naked into the coed Friedrichsbad spa I’m in Baden-Baden where the deeply ingrained German sauna culture means bathing suits and towels are not allowed in mixed-sex but with my prudish Canadian sensibilities I’m on the wellness route to check out two of them Nothing soothes quite like a spa so what could be better than an entire town devoted to the pursuit of pampering culture and medical science centered on mineral-rich springs that provide therapeutic treatments and balneotherapy (bathing) Hot thermal waters bursting with beneficial micronutrients have gurgled below the ground for millions of years with centres of well-being springing up around them since Roman times But the healing spa phenomenon with its tradition of “taking the cure” (sipping inhaling or bathing in thermal water) really reached its peak in the 18th and 19th centuries when the crème de la crème of European society flocked to these spa towns for a little R&R in high style shaded colonnade-lined promenades and lavish hotels were the place to see and be seen for well-heeled aristocrats They were also glamorous meeting places among influential heads of state who conducted international diplomacy in their bathrobes and spent days strolling spa gardens sipping healing waters and nights at concert halls or gilded casinos when swaths of the middle classes joined these luminaries kicking off a boom in wellness travel and pioneering modern tourism In 2021 UNESCO designated 11 of the roughly 400 towns along the European Route of Historic Thermal Towns as World Heritage sites These Great Spa Towns of Europe are in Austria By signing up you consent to receive the above newsletter from Postmedia Network Inc The next issue of Travel Time will soon be in your inbox Interested in more newsletters? Browse here. while sleek new complexes up the ante with modern treatments The perfect prescription for today’s world-weary Tucked on the banks of the River Lahn in a lush valley about 100 kilometres northwest of Frankfurt Known as Germany’s “Imperial Spa,” Bad Ems boasts impressive spa architecture and a storied past as a health resort frequented by emperors nobles and Europe’s elite on their restorative tours of the continent his uncle Kaiser Wilhelm I and Richard Wagner all regularly came to soak up the beneficial effects of the thermal waters the town and its natural mineral springs are just as beguiling today Fifteen natural alkaline-muriatic acidulous springs (the only ones of this type in Germany) bubble up from the geological Bad Emser Quellsattel forming the town’s thermal network Tip: Pick up a souvenir drinking glass from the tourism office to try the mineral-rich waters from public fountains around the centre a wellness experience in true Imperial style The star of the hot springs show is the Robert-Kampe-Sprudel whose 57˚ C water flows by pipeline to the Emser Therme a modern thermal pool complex home to Germany’s first floating river sauna With a long history of bottling its mineral water Bad Ems has also been turning leftover mineral salts into lozenges for 150 years made by steaming and pressing the salts after the water evaporates are a perfect memento to pop in your suitcase If you can tear yourself away from the waters Germany’s poshest spa town is utterly charming Known as the “Summer capital of Europe” in its heyday the cultural elite met here for holidays in the 19th century That belle époque old-money cachet lives on in stately hotels spa hall and parks lined with horse-drawn carriages Baden-Baden packs a contemporary punch with vibrant music and theatre scenes outdoor activities and sophisticated shopping Its magical thermal waters rich in sodium chloride have attracted royals writers (Dostoyevsky sold The Gambler to settle debts racked up in the casino) and celebrities for millenniums The 800,000 litres that rise to the surface daily through 12 springs that I step out of my own comfort zone (and clothes) into the textile-free space Sitting atop 2,000-year-old Roman bath ruins Friedrichsbad has provided its Roman Irish bathing ritual since 1877 Mark Twain wrote “… I left my rheumatism in Baden-Baden.” I left my inhibition — my self-consciousness slipping away as easily as my spa robe when I boldly enter the coed circuit The prescribed 17-step curriculum of showers slathered in creamy lotion and swaddled in warm sheets Note: Soap and brush massage must be booked in advance The city’s oldest patisserie is the spot for traditional kaffee und kuchen a German tradition meaning “coffee and cake,” especially when it’s the regional specialty Black Forest cake is lined with old-fashioned apothecary cabinets and stunning ceiling Pick up some Traumeel to bring home — the original formula of the anti-inflammatory cream (no longer available in Canada) is manufactured in Baden-Baden this cosy spot’s Tartes Flambées are showstoppers — the apple dessert version flambéed with Calvados right at the table In the evening go for broke in baroque splendour at the Casino proclaimed “the most beautiful in the world” by Marlene Dietrich its richly decorated Red Room and Salon Pompadour come courtesy of Parisian interior designers inspired by Fontainebleau and Versailles Take a spin on the roulette wheel in jaw-dropping opulence where shimmering chandeliers drip from hand-painted ceilings their lights reflected in gold leaf mirrors To fully appreciate the glam architecture and rich history take one of the daily guided tours — the 1 p.m Note: Dress code is smart casual for the slot machines To join the fashionable crowd in the gaming area break out the elegant evening wear à la James Bond The recently refreshed long-haul fleet interiors boast 30 Business Class seats complete with cosy duvets and striped slippers In-flight amenity kits include reusable tin boxes and insulated lunch bags The first row Prime Seats come with wider bed snack basket and pyjamas (for additional cost) Soak up the history of the 300-year-old property on the river you can pad down for a treatment in your bathrobe The writer was a guest of the German National Tourist Board and Condor Airlines. No one from either company read or approved this article before publication.  transmission or republication strictly prohibited This website uses cookies to personalize your content (including ads), and allows us to analyze our traffic. Read more about cookies here. By continuing to use our site, you agree to our Terms of Use and Privacy Policy The World Heritage Centre is at the forefront of the international community’s efforts to protect and preserve World Heritage partnerships for conservation Ensuring that World Heritage sites sustain their outstanding universal value is an increasingly challenging mission in today’s complex world where sites are vulnerable to the effects of uncontrolled urban development Our Partners Donate Take advantage of the search to browse through the World Heritage Centre information This transnational serial property comprises eleven spa towns located in seven European countries: Baden bei Wien (Austria); Spa (Belgium); Františkovy Lázně; Karlovy Vary; Mariánské Lázně (Czechia); Vichy (France); Bad Ems; Baden-Baden; Bad Kissingen (Germany); Montecatini Terme (Italy); and City of Bath (United Kingdom) All of these towns developed around natural mineral water springs They bear witness to the international European spa culture that developed from the early 18th century to the 1930s leading to the emergence of grand international resorts that impacted urban typology around ensembles of spa buildings such as baths kurhaus and kursaal (buildings and rooms dedicated to therapy) colonnades and galleries designed to harness the natural mineral water resources and to allow their practical use for bathing and drinking as well as spa-specific support infrastructure These ensembles are all integrated into an overall urban context that includes a carefully managed recreational and therapeutic environment in a picturesque landscape these sites embody the significant interchange of human values and developments in medicine Ce bien en série transnational comprend onze villes d’eaux situées dans sept pays européens : Bad Ems ; Baden-Baden ; Bad Kissingen (Allemagne) ; Baden bei Wien (Autriche) ; Spa (Belgique) ; Vichy (France) ; Montecatini Terme (Italie) ; Ville de Bath (Royaume-Uni) ; Františkovy Lázně ; Karlovy Vary ; et Mariânské Lâznë (Tchéquie) Toutes ces villes se sont développées autour de sources d’eau minérale naturelles Elles témoignent de la culture thermale européenne internationale qui s’est développée du début du XVIIIe siècle aux années 1930 conduisant à l’émergence de grandes stations internationales qui ont influencé la typologie urbaine autour d’ensembles de bâtiments thermaux tels que des bains des kurhaus et des kursaal (bâtiments et salles dédiés à la cure) conçues pour exploiter les ressources naturelles en eau minérale et les utiliser pour les bains et les cures d’eau thermale ainsi que des infrastructures de soutien spécifiques aux stations thermales Ces ensembles sont tous intégrés dans un contexte urbain global caractérisé par un environnement thérapeutique et récréatif soigneusement géré dans un paysage pittoresque Ces sites témoignent collectivement de l’échange d’idées et d’influences dans le cadre du développement de la médecine Este sitio serial transnacional abarca los célebres balnearios situados en once ciudades de siete países europeos: Baden bei Wien (Austria); Spa (Bélgica); Františkovy Lázně Karlovy Vary y Mariánské Lázně (Chequia); Vichy (Francia); Bad Ems Baden-Baden y Bad Kissingen (Alemania); Montecatini Terme (Italia) y City of Bath (Reino Unido) El desarrollo de todas estas localidades se debió a la existencia de manantiales de aguas minerales en sus territorios Dan testimonio de la cultura termal europea internacional que se desarrolló desde principios del siglo XVIII hasta el tercer decenio del siglo XX Esto condujo a la emergencia de grandes balnearios internacionales que influyeron en su estructura urbana que se organizó en torno a los edificios y estancias (“kurhaus” y “kursaal” en alemán) dedicados a las terapias termales columnatas y galerías concebidas para explotar los recursos naturales de agua mineral y utilizarlos para baños y curas de aguas termales Las ciudades balnearias crearon también numerosos jardines mansiones residenciales e infraestructuras específicamente destinadas a la conducción de las aguas termales Todas esas construcciones se integraron en conjuntos urbanos de gran belleza paisajística celosamente organizados para la administración de terapias y la realización de actividades recreativas El conjunto de estos balnearios es representativo de la importancia del intercambio de ideas e influencias en el marco del desarrollo de la medicina The Great Spas of Europe bear an exceptional testimony to the European spa phenomenon which gained its highest expression from around 1700 to the 1930s This transnational serial property comprises eleven spa towns located in seven countries: Baden bei Wien (Austria); Spa (Belgium); Karlovy Vary Františkovy Lázně and Mariánské Lázně (Czechia); Vichy (France); Bad Ems Baden-Baden and Bad Kissingen (Germany); Montecatini Terme (Italy); and City of Bath (United Kingdom) dynamic and international spa towns among the many hundreds that contributed to the European spa phenomenon all the towns developed around mineral water sources which were the catalyst for a model of spatial organisation dedicated to curative treatment facilities and colonnades designed to harness the water resources and to allow its practical use for bathing and drinking was complemented by exercise and social activities requiring visitor facilities such as assembly rooms villas and related infrastructures (from water piping systems and salts production to railways and funiculars) All are integrated into an overall urban context that includes a carefully managed recreational and therapeutic environment of parks Buildings and spaces connect visually and physically with their surrounding landscapes which are used regularly for exercise as a contribution to the therapy of the cure Criterion (ii): The Great Spas of Europe exhibits an important interchange of innovative ideas that influenced the development of medicine balneology and leisure activities from around 1700 to the 1930s This interchange is tangibly expressed through an urban typology centred on natural mineral springs and devoted to health and leisure Those ideas influenced the popularity and development of spa towns and balneology throughout Europe and in other parts of the world The Great Spas of Europe became centres of experimentation which stayed abreast of their competitors by adapting to the changing tastes sensitivities and requirements of visitors the principal agents of transmission were the architects designers and gardeners who created the built and ‘natural’ environments framing spa life the property displays important examples of spa architecture such as the ‘kurhaus’ and ‘kursaal’ colonnades and galleries designed to harness the natural mineral water resource and to allow its practical use for bathing and drinking Criterion (iii): The Great Spas of Europe bears exceptional testimony to the European spa phenomenon but gained its highest expression from around 1700 to the 1930s either externally (by bathing) or internally (by drinking and inhaling) involved a highly structured and timed daily regime and a combination of medical aspects and leisure including entertainment and social activities (e.g dancing) as well as taking physical exercise within an outdoor therapeutic spa landscape These parameters directly influenced the spatial layout of spa towns and the form and function of spa buildings or ‘spa architecture’ Urban parks and promenades allowed people taking the cure “to see and be seen” by others The eleven component parts that comprise the serial property represent the most exceptional examples of European spa towns All component parts share a set of determining characteristics formed during the most significant “culture-creating” phase of their history and development the heyday period from around 1700 to the 1930s Each and every one continues to function for the purpose for which it was originally developed The series illustrates the main stages of the development of the spa phenomenon starting with the most influential spa towns in the 18th century to the development of model spa towns in the 19th century to towns that are testimony to the last stages of the phenomenon in the early 20th century Boundaries are determined in relation to the mapping of the attributes that convey Outstanding Universal Value namely: the most important spa structures and buildings used for thermal-related activities; the social facilities and buildings for leisure and pleasure; accommodation facilities; related spa infrastructure; and the surrounding therapeutic and recreational spa landscape Buffer zones are drawn both for the protection of spring catchments and important setting All component parts and their constituent elements are generally in good condition Elements requiring conservation either have works already planned with their current state of conservation maintained Upgrades and redevelopments made to keep pace with standards of services can create tensions with their conservation as historic buildings Challenges in the adaptive reuse and technical upgrading of industrial structures pose similar challenges The property meets the conditions of authenticity in terms of form and design All component parts express the Outstanding Universal Value of the property through a variety of common and highly authentic attributes: mineral springs which maintain their natural physical qualities location and setting; a distinct and highly legible spatial layout and a well-maintained location and setting that combine to retain an enduring spirit and feeling; spa architecture even though some buildings have experienced change of use; the spa therapeutic landscape and continues to be used for the purpose for which it was designed; spa infrastructure much of which is either original or evolved on original principles and remains in use; continuing spa use and function despite the need to meet today’s standards The veracity and credible expression of attributes embodied in structures that date from around 1700 to the 1930s the principal period of contribution to Outstanding Universal Value is further evidenced during substantial and sustained conservation works that are informed by expansive archival collections of plans publications and photographs held at each component part Responsibility for the protection and management of each of the eleven component parts of the property rests with the national/regional government (in the case of Germany and local authorities of that State Party) Each component is protected through legislation and spatial planning regulations applicable in its State Party or individual province as well as by a significant degree of public/charitable ownership of key buildings and landscapes Each component part has a property manager or coordinator and a Local Management Plan in place conforming to the overall Property Management Plan An overall management system for the whole property has been established with a Property Management Plan and Action Plan agreed by all stakeholders made up of national World Heritage Focal Points and/or a representative of the highest monument or heritage protection authority keeps track of matters relating to the property made up of the Mayors of the eleven components is responsible for the operational coordination and overall management of the property in close consultation with the Inter-Governmental Committee The Board sets and manages the budget for the overall management functions and directs other activities for the property as a whole The Site Managers Group includes site managers for each component part The Site Managers Group is essentially an expert group for debate and exchanges of experience and to advise the GSMB on relevant management issues The international structure is supported and serviced by a Secretariat jointly funded by all the component parts An important concern will be to continue to develop cooperation and collaboration between the individual component parts and to ensure that the property as a whole is effectively managed and the overall management system is adequately resourced Development pressures may be an issue since these are living cities which will need to continue to adapt and change to maintain their role as spa towns Managing tourism so that it is truly sustainable may also become a challenge A management approach at the landscape level which considers the relationship between each component part and the broader setting is also needed to maintain views to About  .  Contact  .  Donation Archaeologists from Goethe-Universität Frankfurt am Main have revealed a groundbreaking discovery at a 1st century CE Roman fort in Bad Ems they uncovered a series of wooden defensive spikes strategically placed in ditches encircling the fort served as formidable barriers against potential attackers a defensive tactic referenced in Roman writings such as Julius Caesar’s “Gallic Wars.” Professor Markus Scholz from Goethe University Frankfurt emphasized the significance “The finds have remained preserved in their original functional construction context offering a unique glimpse into ancient military engineering.” marks the first time such defensive technology has been archaeologically unearthed overturning previous reliance solely on written accounts Director General of Cultural Heritage Rhineland-Palatinate lauded the comprehensive insight into the Roman Empire’s era facilitated by these findings designated “Auf dem Ehrlich,” sprawled across an area of 8 hectares a testament to meticulous fortification techniques of the time possibly controlling Roman mining activities highlighted the role of oxygen-poor wet soil in preserving these artifacts describing the sediment layers as crucial to their remarkable state of conservation undertaken at the Leibniz Center for Archaeology (LEIZA) in Mainz have allowed for the meticulous preservation of these ancient wooden stakes “These seemingly inconspicuous wooden stakes are a small sensation for archaeology which the specialist in Roman military matters in me particularly rejoices I am personally very proud that the laboratories for restoration and conservation at LEIZA once again could contribute their unique expertise to permanently preserve the wooden finds,” remarked Professor Alexandra W The book “The early imperial military installations near Bad Ems in the context of Roman mining” offers a detailed account of the project’s findings and implications for understanding Roman military and economic activities in the region and website in this browser for the next time I comment Δdocument.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()) Learn how to describe the purpose of the image (opens in a new tab) Leave empty if the image is purely decorative This was not the first attempt of the Russian Empire to suppress the Ukrainian culture and language and The Ems Ukaz followed the notorious Valuev circular of 1863 to supplement its basic provisions One of the formal reasons for the Ems Ukaz promulgation was a memorandum sent to the tsar by Russian political and cultural figure Mikhail Yuzefovich (who was avid Russian patriot in which he accused Ukrainians of aspirations to live in a free Ukraine "in form of a hetman-led republic." On the same day The Ems Ukaz banned imports of any Ukrainian books into the territory of the Russian Empire from abroad creation of original works in the Ukrainian language and making translations from foreign languages into Ukrainian staging of plays and delivery of public lectures The local administration was ordered to intensify supervision to remove the books in Ukrainian from libraries and make sure that the Ukrainian language is not used for teaching in primary schools The Ems Ukaz was the reason to shut down the South-Western Department of the Russian Geographical Society in Kyiv The professors of Ukrainian nationality were sacked from their posts at Kyiv's University of St Vladimir This decree became one of the manifestations of the colonial-national policy of Russian tsarism in relation to Ukraine and denounced the existence of 25 million Ukrainians The idea of "Little Russia" and "Little Russians" - a kind of second-class people capable only of serving devotedly “father the tsar” - was being drummed into the heads of Ukrainians and the whole world Although the Ems Ukaz hampered the development of Ukrainian culture and national liberation movement Ban on the use of the Ukrainian language in print in the Russian Empire make many authors (Nechuy-Levytsky Drahomanov and others) publish their works in Halychyna which was then under the rule of the Austro-Hungarian Empire This step strengthened the positions of the pro-Ukrainian forces and united Ukrainians residing on different sides of the border 1905 with the promulgation of the so-called "Manifesto of Civil Liberties" by Emperor Nicholas II While citing and using any materials on the Internet links to the website ukrinform.net not lower than the first paragraph are mandatory citing the translated materials of foreign media outlets is possible only if there is a link to the website ukrinform.net and the website of a foreign media outlet Materials marked as "Advertisement" or with a disclaimer reading "The material has been posted in accordance with Part 3 of Article 9 of the Law of Ukraine "On Advertising" No 1996 and the Law of Ukraine "On the Media" No 2023 and on the basis of an agreement/invoice Online media entity; Media identifier - R40-01421 Last week, Inside EMS cohosts Chris Cebollero and Kelly Grayson laid out the top 10 indications of a bad EMS supervisor (Did you miss it? Catch it here!) This week they’re tackling the top signs of a bad employee lack of initiative and a bad attitude – that’s not you Listen as our duo reflects on each characteristic and where they have seen (or exhibited!) those traits in their career Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas The little town on the Lahn became famous around the world as a spa resort for emperors and kings in the 19th century Although you are not as likely to bump into royalty these days UNESCO granted Bad Ems World Heritage status as one of seven ‘Great Spa Towns of Europe’ It is arguably the greatest international honour that can be bestowed on a spa town The banks of the Lahn in the spa town of Bad Ems Natural mineral water springs form the heart of these spa resorts They have been the focus of European spa culture since the early 18th century colonnades and galleries grew up around them so the springs could be used for bathing and taking the waters you can soak up this wonderful spa culture as a haven of modern wellness in a sophisticated historical atmosphere and treatments for both prevention and well-being the most famous of which is the Emser Kränchen which is renowned for its healing effects on respiratory ailments No doubt you have also heard of Emser Pastilles which have been produced from Bad Ems spring salt for 150 years So you can suck on the spring water as an alternative to drinking it The spa quarter in Bad Ems still makes for an impressive sight, which you can enjoy in all its glory from the bridge over the Lahn. The Kursaal building with its marble hall forms a key part of the complex The styling of the room is dominated by the many different facets of Lahn marble This local stone is really at its finest when polished to a high-gloss finish floor and wall coverings are all fitted with Lahn marble It is something the marble hall has in common with the Empire State Building the Brühl Palaces and many other magnificent buildings all over the world Lahn marble was a real export hit for centuries This glittering backdrop takes you back to imperial times when the world’s powers that be held court here A guided tour provides more insight into the glorious past of the spa resort and the history of Lahn marble The impressive marble hall for events in Bad Ems and you can watch the gentle flow of the water as you enjoy your sauna you feel like you are floating over the river It has a relaxation quality all of its own and you can simply leave your troubles behind The FlussSauna of the Bad Ems thermal bath invites you to relax In the Bad Ems thermal baths the focus is on health What connects the baths in Bad Ems to the Empire State Building in New York It is the shimmering marble from the tranquil Lahn valley that is fitted in both buildings But the colourful limestone polished to a high shine by the region’s expert stonemasons is so lovely that you can happily gloss over that Martin Seidler tells you how it got from the Lahn to the rest of the world Archaeologists have found ancient Roman "barbed wire," famously used and written about by Julius Caesar for the first time near a German silver mine Julius Caesar used an ingenious system of ditches and stakes to defend his soldiers from an encroaching Gallic army in modern-day central France archaeologists have discovered the first preserved example of similar defensive stakes which likely protected an ancient silver mine A student team made the unprecedented discovery in the area of Bad Ems, halfway between the present-day cities of Bonn and Mainz in Germany, on the former northern border of the Roman Empire Archaeologists have been working in the area of Bad Ems since the late 19th century Early excavations yielded processed silver ore along with wall foundations and metal slag so researchers believed that they comprised smelting works dating to the early second century A.D a hunter noticed odd crop formations and told archaeologists at Goethe University who later found that the area hosted a 20-acre (8 hectares) double-ditched Roman camp with the remains of around 40 wooden watchtowers.  Related: Vast subterranean aqueduct in Naples once 'served elite Roman villas' This year, the student team led by Frederic Auth unearthed the preserved wooden spikes in the damp soil of Blöskopf Hill which held a second recently discovered Roman camp 1.3 miles (2 kilometers) away from the first fort proving that the two forts significantly pre-dated a larger system of fortifications known as the "limes" that was constructed in A.D The limes (meaning "boundary line") was the fortified border wall that ran along the northern Roman Empire —Ancient Rome: From city to empire in 600 years —Smooth wooden phallus found at a Roman fort was likely a sex toy —When did Rome fall? Bad Ems had plenty of silver — around 200 tons of it were found centuries later — but the Romans did not dig deep enough to get to it It is possible that the Romans set up camp to defend themselves from raids as they tried to mine this important raw material Get the world’s most fascinating discoveries delivered straight to your inbox Kristina KillgroveStaff writerKristina Killgrove is a staff writer at Live Science with a focus on archaeology and paleoanthropology news Her articles have also appeared in venues such as Forbes, Smithsonian Killgrove holds postgraduate degrees in anthropology and classical archaeology and was formerly a university professor and researcher She has received awards from the Society for American Archaeology and the American Anthropological Association for her science writing Pompeii quiz: How much do you know about the Roman town destroyed by Mount Vesuvius Mini ice age was final death blow to Roman Empire May's full 'Flower Moon' will be a micromoon What do we do when we’re saddled with a toxic partner we can’t escape and management seems just as bad After my column on toxic partners, I received a number of comments from EMTs who are stuck with a toxic partner or make him understand what a jerk he is?” A few comments displayed a staggering lack of introspection enough so that it makes me wonder if they read the Raylan Givens quote at the beginning of the article the only common denominator in all your dissatisfying relationships is you If you can’t get along with anyone you work with being a jerk doesn’t disqualify you from most EMS jobs don’t violate protocol in any way that places the agency at legal risk or angers the medical director and aren’t insubordinate to your superiors you can be a four-star jerk to everyone else Absent any complaint from coworkers that falls into the sexual harassment or racial discrimination categories When their behavior renders them unemployable because the rest of the crews refuse to work with them many managers are leery (often unjustifiably so) of saying anything derogatory about employees when a prospective employer checks their references so desperate to put meat in the seat that they ignore the fact that the meat is rancid Respected EMS chief and consultant Jon Politis refers to this phenomenon as the “cross-pollination of a**holes,” and he’s right These people will spend their careers bouncing around from agency to agency even when what’s needed is an angry mob of former partners and supervisors with torches and pitchforks to run them out of the profession They rose through the ranks because they were good employees but not necessarily good medics and the skills they employed on the street don’t necessarily translate to a supervisory role Without mentoring and training from their superiors their career ladder ends in a position they are wholly unsuited for to a top tier of the organizational hierarchy composed of people who are bad at their jobs So what do we do when we’re saddled with a toxic partner we can’t escape and management seems just as bad you take another lesson from Jon Politis: “You can’t un-jerk a jerk.” If you’ve honestly evaluated your own behavior and concluded that it’s not you then the only thing you can do is vote with your feet I know that leaving isn’t an option for many of us but that’s the only way the culture will change at many of these agencies the agency runs out of people willing to work for it or the people who are willing to work there are so mediocre that the agency develops a bad enough reputation that taxpayers municipal leaders or shareholders demand change I can’t vote with my feet,” you’re probably saying and put down new roots in a community and a career where you can be happy you are responsible for how you treat others Failure to acknowledge that might be the very reason your toxic partner spreads his discontent to everyone else; in his mind and maybe your attitude will be the one that rubs off on others Read next: Toxic Partners: The damage they do in EMS fire chief of Orcas Island Fire & Rescue in Eastsound fire chief of Orcas Island Fire & Rescue I came to the fire service for a love of the work and the team environment the fire service unites a diverse group of individuals around one common goal – helping someone on their worst day it did not occur to me to ever want to leave the line and move to admin As I transitioned from volunteer to career I had a variety of experiences with fire chiefs I worked for; some positive and some negative it became apparent to me that positive cultural change can’t happen effectively when it is only being driven from the bottom up An organization’s leadership sets the tone for what the culture of the team will be Back when I was training for a few different running events “You can’t outrun a bad diet.” In the context of my work environment “You can’t outwork bad leadership.” I realized that in order to help bring about the cultural development the fire service was in need of I would need to be willing to put myself in the arena in a leadership role Two of the best chief officers I had the honor to serve under encouraged me to enroll in a Fire Service Administration degree program I did so and earned a BS in Fire Service Administration from Eastern Oregon University my goal is to continue to build on the positive groundwork we have laid in the last two years at OIFR When I joined OIFR as assistant chief in 2021 it was amidst significant turmoil between labor and management Volunteers rarely just dropped by our headquarters station Many told me they avoided it altogether because it felt like a dark cloud was hanging over it and some days I have trouble finishing a project I am working on because volunteers and career staff pop into my office so frequently this is the best “problem” a chief officer could have labor and management have the best relationship I have ever seen (including during my own time as a union officer) and volunteers have told me time and time again how much they now enjoy working with the career staff My goal in the next year is to continue to foster these strong relationships while also looking forward to the significant impending apparatus needs of our aging fleet Our relationships need to be built on trust it is my job to extend my trust to my personnel This doesn’t mean that everything is perfect; extending trust means that I know their intentions and purpose in their work Every conversation I have with those who report directly to me has to start with that premise when we sometimes have to discuss how we get our common goals accomplished When we have a good pattern of communication and trust it is easy for me to stand up for them if needed As far as showing them that I care about them as a person My job is to serve the members of my department so that they can go out and do their best work to serve the public or roll hose with them after a fire or training but if my heart and mind aren’t in the right place from constantly refocusing my own mind on acts of service toward the members of the department that I am responsible to One of my favorite quotes is from political satirist and Journalist O’Rourke; “Everyone wants to save the earth; but no one wants to help mom do the dishes.” I remind myself that “doing the dishes” is as much a part of my job as anyone else’s Read next: Chief Insights: Foster a culture of respect with consistency in leadership. Division Chief of EMS shares how to be the leader you always wanted to work with Several local townships have questioned the Joint Powers Board they’ve been labeled combative or misinformed Let’s be clear—asking tough questions about a system lacking transparency While a few board members speak out during meetings they often go silent when facing their own constituents Perham Township’s board voted to exit the Joint Powers Agreement with cause They saw a structure that claimed equality on paper but failed in practice That decision was met with media attacks and accusations of secrecy more townships are following suit — and being dismissed just as quickly as members exercise their legal right to withdraw — a right clearly outlined in the original agreement — the board is proposing bylaw changes to make it harder to leave the City of Perham logged over 500 EMS calls Even combining call volumes from non-members and other participating townships Yet townships are expected to shoulder a biased financial responsibility That’s not collaboration—it’s exploitation that biased 70-30 funding formula (based 70% on year-round residents and 30% on seasonal residents) heavily favoring the city — was passed with little debate And now the Joint Powers Board is fast-tracking EMS into a taxing district with a vote already scheduled for April 29 Some townships haven’t even brought it up in a public meeting Perham Township has 565 taxable parcels with an average value of $380,000 The City of Perham has nearly twice as many parcels — but with a lower average value of $224,000 Perham Township residents may end up paying more And while some businesses benefit from tax exemptions Because tossing public dollars at a broken system doesn’t fix it — it just funds its collapse It’s about whether we’ll keep bailing water from a sinking boat hoping it’ll stay afloat — or whether we’ll finally repair the holes transparent governance our communities deserve Beyond the minimal expression of awareness frontline clinicians may be offered peer support follow up by chaplain or other meaningful assistance And the relational support given to paramedics is vital associate professor of paramedicine in Melbourne “The categorization of whether a job is ‘good’ or ‘bad’ becomes ambiguous when a job leaves a significant impact on the psyche of the personnel Such jobs may be ‘good’ due to the clinical challenge they may well be considered ‘bad’ because of the emotions attached to the incident The extent to which a job is classified ‘bad’ is dependent on the individual practitioner ‘Bad’ jobs are those that the paramedic strongly identifies with due to the emotional impact or the way in which they identify with the event” [1] It is immensely valuable to utilize the language of “ambiguous” in describing a particular call It might be good for the clinical challenge an ambulance service will do well at minimum to acknowledge the event and its potential for anguish the extent to which a job is considered bad depends on the individual Two paramedics arrive at the scene together one of them may comment that the incident was challenging but not personally distressing The other may report that it was one of the worst scenes they’ve had in a long time In the context of good and bad calls, Katie Tunks Leach presents key findings from a study that explored paramedic perspectives on the role and value of chaplains in the ambulance service [2]: “Relational support (as opposed to managerial operational or clinical) was important to paramedics They valued having someone available who was outside the chain of command whose sole focus was on paramedic welfare and to connect them to further support if required .. The study was carried out in New South Wales Ambulance which has the largest multifaith ambulance chaplaincy program in Australia Two themes were identified: scope of the chaplain’s role and organizational factors influencing the chaplain’s role When relationships and professional capability were established paramedics highly valued what they believed to be proactive and reactive support provided by ambulance chaplains regardless of their personal spiritual or religious beliefs Study participants observed that chaplains were proactive making the time and effort to build relationships Embedding chaplains within the organization was overwhelmingly viewed as positive if they met paramedic needs Participants spoke of a protective culture suspicious of outsiders in uniform and easily recognizable to paramedics promoted the idea that chaplains are part of the ambulance family going to paramedics in their workspaces rather than relying on them to make an appointment or attend a specified location Support included taking staff off-road for coffee and riding in ambulances with crews to talk in between jobs… These pre-existing relationships and activities undertaken by chaplains were seen to promote conversation and help-seeking participants felt safer divulging personal information to a chaplain they knew and were familiar with…” paramedics also spoke of support provided by chaplains called out to significant jobs or ‘on-scene’ and jobs eliciting strong emotions or with personal impact (e.g paediatric cardiac arrests and death by suicide)… Post-incident support was also identified as part of the chaplain’s role Paramedics spoke of the value in knowing chaplains would check in on them after ‘calamitous sad stuff’ in person and via phone” [2] These findings suggest embedding appropriately trained and equipped chaplains in EMS may in fact promote conversations around wellbeing and help-seeking because staff are seeking help from someone they already know and trust Relational support is vital for emergency healthcare providers everywhere These findings suggest that for EMS support to be effective they should openly acknowledge the bad calls Support staff do it because we care about people even though we know that providing compassionate care will take a toll on us as providers As the paramedics in Tunks Leach’s study summed it up: “Sometimes you just need to talk Sometimes you don’t need anyone to say anything to you about it It comes down to paramedic wellbeing is the main function.” Learn how mental health support programs can alleviate stress in the workplace 1. Beyond the front line : an interpretative ethnography of an ambulance service / by Louise Colleen Reynolds. - University of South Australia (unisa.edu.au) 2. Tunks Leach, K., Simpson, P., Lewis, J. et al. The Role and Value of Chaplains in the Ambulance Service: Paramedic Perspectives. J Relig Health (2021). https://doi.org/10.1007/s10943-021-01446-9 Louise Reynolds, PhD, is associate professor of paramedicine at Victoria University and editor of “Understanding the Australian Health Care System - 4th Edition.” Katie Tunks Leach, RN, is a PhD candidate and chaplain at New South Wales Ambulance and author of “The Role and Value of Chaplains in the Ambulance Service: Paramedic Perspectives.” The European Route of Historic Thermal Towns offers a dreamy train adventure like no other routine and unchecked high-flow oxygen administration reaches toxic internal levels within minutes This article was originally posted at Limmer Education and is reprinted with permission with the billions and billions of cells within our body they operate using only 5% of the oxygen we intake it is not immune to disease – some of which cause hypoxemia and/or hypoxia Administration of supplemental medical oxygen This concept has been taught in initial and continuing education classes for years and written into protocol after protocol with the mindset “more oxygen is better.” A pulse oximetry reading as close to 100% as possible is the gold standard and achieving anything less than that is considered inadequate patient care For example, if a patient suffers from respiratory distress or hypoxia The answer is: respiratory distress/hypoxic patients should always receive supplemental oxygen but only to the point of re-establishing normal saturations the AHA recommends maintaining SpO2 saturation readings between 94 to 99% [5] Continuing oxygen delivery outside this parameter is not helpful Here are essential points to remember about hyperoxia: oxygen diffuses from the alveoli into the blood the residual nitrogen creates enough pressure to keep the alveoli inflated even though oxygen transfers into the blood from the alveoli When providing oxygen at concentrations higher than 50% it replaces nitrogen as the primary gas in the lower airways and alveoli [3] the volume of inspired nitrogen (and its level within distal alveoli) diminishes significantly the gas that helps to keep alveoli inflated is eliminated fewer alveoli are available to participate in gas exchange This situation rapidly results in ineffective external respiration and the development of hypoxemia the EMS professional observes this and increases the oxygen flow hoping to relieve the resultant anxiety and developing dyspnea What begins is a vicious cycle that leads to pulmonary dysfunction and anatomical damage: The patient progressively inhales higher oxygen concentrations as the flow is increased causing more and more previously functional and intact alveoli to collapse This increasing atelectasis further decreases lung surface area for the transfer of oxygen into the blood Here is another complication that develops from excessive oxygen levels within the alveoli: There are alveolar cells called Type 1 and Type 2 (easy enough right?) Type 1 cells make up the alveolar epithelium (alveolar wall) Type 2 cells make and secrete surfactant and function as stem cells for maintaining the alveolar epithelium (i.e. As the alveoli collapse from the nitrogen depletion and oxygen exodus This damage stimulates Type 2 cells to proliferate and subsequently differentiate to try and replace the injured Type I cells a portion of the Type 2 cell population becomes abnormally enlarged [4] The side effects of this are a thickening of the alveoli/capillary membrane (increased distance gas has to travel between blood and alveoli) and a local fluid buildup (surfactant) within the alveoli This produces a ventilation/perfusion mismatch that progressively worsens as more and more oxygen is delivered to a patient becoming a precursor to the development of ARDS and pulmonary hypertension there are even more insidious oxygen side effects that cause bodily damage One of the culprits is a reactive oxygen species (ROS) which is a type of unstable molecule that contains oxygen and readily reacts with other molecules in a cell Many of these are produced in the mitochondria as a by-product of the electron transport chain and ROS presence can exponentially increase damage – particularly of concern are the cells that makeup heart It is an atom that has one or more unpaired electrons in its outermost shell [6] Oxygen has two pairs of electrons that are continually searching for a partner thus making it a very potent and highly reactive free radical by nature Free radicals bind with just about anything within the body with an electron and change their chemical structure sometimes damaging them by stealing the electron the body has a built-in defense outside of the immune system that is specific to free radicals Many are derived from fruit and vegetables (e.g. vitamins E and C and beta-carotene) and have “spare” electrons they can safely donate to free radicals effectively satisfying them and turning off their urge to steal from other cells and tissues Cell damage occurs when free radicals outnumber antioxidants The damage is directly proportional to the number of free radicals present at the site of injury [2] supplemental high-flow oxygen administration may very well induce further unnecessary tissue damage by flooding it with free radicals Now that you are aware of the potential consequences of prolonged high-flow oxygen administration let’s look at how this affects patients experiencing cardiac chest pain secondary to coronary artery disease It’s been traditional practice to give high-flow oxygen to these patients under the premise that it was helpful to a stressed consider these three points of evidence: One study showed that hyperoxia reduced cardiac output by 10-15% in both healthy volunteers and patients with coronary artery disease systemic vascular resistance was increased remarkably in patients with heart failure [13] it suggested that routine use of high-flow oxygen in uncomplicated AMI may result in a greater infarct size and possibly increase the risk of mortality [6,10] Five minutes of supplemental oxygen by non-rebreather mask decreases coronary blood flow by 30% increases coronary resistance by 40% due to coronary artery constriction and blunts the effect of vasodilator medications like nitroglycerine [2,11] Hyperoxygenation of the blood in the lungs displaces CO2 from hemoglobin which then accelerates the rate of CO2 removal If there is a significant decrease in serum CO2 and reduced oxygen delivery to the left heart develops decreased blood flow causes ischemia that progresses to injury and pneumonia found that the use of CPAP with a low oxygen percentage of 28-32% was highly effective in the treatment of respiratory emergencies by medics [6,12] the patient may receive the benefit of CPAP but not develop the hyperoxia consequences EMS professionals who are scared to withhold high-flow oxygen and the notion that more oxygen isn’t necessarily better let’s look at the current American Heart Association Guidelines for Emergency Cardiac Care and CPR AHA recommended: “There is insufficient evidence to support [oxygen’s] routine use in uncomplicated ACS based on monitoring of oxyhemoglobin saturation the updated care recommendations state: “The provision of supplementary oxygen to patients with suspected ACS who are normoxic has not been shown to reduce mortality or hasten the resolution of chest pain Withholding supplementary oxygen in these patients has been shown to reduce infarct size minimally the withholding of supplementary oxygen therapy in normoxic patients with suspected or confirmed acute coronary syndrome may be considered” [8] there may be even further evidence and change The 2017 DETO2X trial also lends support to decreasing the use of high flow supplemental oxygen as it concluded: “The use of supplemental oxygen does not appear to offer any benefit to patients with acute myocardial infarction in patients with an O2 saturation > 90%” [9] Another conclusion from a 2019 study done in New Zealand concluded “in patients with suspected ACS who do not have hypoxemia routine oxygen therapy provides no benefit and should therefore not be given” [1] There are many reasons to avoid delivering prolonged Nitrogen washout increased oxidative stress from free radicals and alveolar damage from oxygen toxicity can all be prevented by flowing oxygen at a rate that maintains a SpO2 between 94-99% If a patient is maintaining this level on their own EMS professionals have the means to titrate oxygen therapy to patients’ needs and those needs most often can be met by low-flow oxygen A patient who needs oxygen should never be denied it – hypoxemia and hypoxia must be corrected Changing the way we think about and train providers on oxygen administration Limmer Education’s mission is to help students pass the NREMT and educationally sound products written by leading national educators including pain relief for trauma patients and breathing aid for kids with asthma The review is the first to use specific safety and clinical quality measures to evaluate patient care 2024 (HealthDay News) -- The care you receive in a medical emergency may hinge strongly on where you are when you need it That's a key takeaway from a comprehensive review of the nation's emergency medical service (EMS) systems by researchers at Icahn School of Medicine of Mount Sinai in New York City They found that EMS agencies that responded in mostly rural areas were less likely to treat low blood sugar or improve pain for trauma patients.  Those agencies were also more likely than urban or suburban EMS systems to use lights and sirens unnecessarily even though research has found a higher likelihood of accidents injury and death when lights and sirens are used during emergency transport Lead author Dr. Michael Redlener an associate professor of emergency medicine at Mount Sinai said the difference between the top- and poorest-performing agencies on these key measures was notable "This work is not about blaming bad EMS services but about uncovering opportunities to improve patient care," he said in a Icahn news release "We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat." government officials and the public to know about the quality and safety of care that is being provided and find ways to make it better The review shows that care is not solely determined by how fast an ambulance can get to a patient "While fast response times are essential for rare critical incidents -- like when a patient's heart stops beating or someone chokes -- the vast majority of patients benefit from condition-specific care in the early stages of a medical emergency," Redlener said The new study -- published Feb. 13 in the journal Prehospital Emergency Care -- is the first to use specific safety and clinical quality measures to evaluate patient care across the entire U.S Researchers reviewed all 911 responses nationwide for 2019 -- more than 26 million in all from more than 9,600 EMS agencies.  They assessed specific quality measures in each call outlined by the nonprofit National EMS Quality Alliance This included treatment of low blood sugar as well as medication and transport safety Researchers also compared performance by agency size and location — urban pain for trauma patients improved in only 16% of cases 39% of kids with wheezing or asthma attacks did not receive breathing treatments during their call No stroke assessments were documented for nearly one-third of patients with suspected stroke potentially delaying or missing time-sensitive treatment There's more about America's emergency assistance system at 911.gov Your care in a medical emergency may hinge strongly on where that emergency occurs This article is part of a series. Click here for the previous article Thanks for your continued support by reading these articles and for the kind emails about how you are making a difference by implementing some of the strategies from this series I am always so happy to hear about public safety leaders putting additional control measures in place to prevent tragedies I have focused on the 10 Families of Risk: Once again (solely for purposes of continuity and absolutely not to fill up space) here is the chart I’m using to explore this issue: We have addressed the issues on the right side of the chart, the external behaviors that sometimes cause personnel grief Now we will move to the left side of the chart – the internal behaviors that can end up in tragedy Let’s start with the top left corner: the internal intentional misconduct issues that plague public safety department operations around this great nation. Too often, I read about cops and EMS providers and firefighters and correctional officers doing bad things I am fed up with misconduct in public safety We all get painted with the same broad brush When some bad cop does something bad 2,000 miles away from your police department that behavior negatively impacts you and your personnel Same thing for other public safety agencies On a related note, we have an obligation to make it difficult to do bad things on purpose. If you look at public safety news headlines for the next five days, I guarantee you will find some intentional misconduct dealing with money: cops stealing from the DARE fund volunteer firefighters embezzling funds raised to purchase new equipment A simple requirement of two signatures on a check would do away with a lot of this behavior I am always amazed that one person will have control of the checkbook with no audit process in place to see how the money is being spent either city cards or cards in the name of a given charity During some of my tenure with the California Highway Patrol I had a state credit card – and I was very very aware of the rigid audit process they had in place to make sure there was no misuse I read cases involving assigned credit cards being used for personal benefit including fancy watches or other types of jewelry This is not limited to police departments; I am familiar with similar cases in fire departments and other city entities If you get very bored some night and there is nothing to do and there are no reruns of the greatest TV show ever (that would be CHiPs) do a Google search for “financial scandal in Dixon Illinois” and you will be shocked How could one person steal so many millions of dollars from the city and not be noticed “Why do you never take a vacation?” I explained to her that on the patrol I could bank my vacation time up to a certain number of hours and then at the end of my career I could “sell it back” to the state It was a common practice to not use vacation time until you were maxed out You have to take two weeks consecutive vacation every year and if you come onto bank property during those two weeks you get fired.” When I asked her what the logic was behind this rule she patiently explained to me that if you were pulling some sort of financial scam it would likely unwind in two weeks and you would be caught I stored this piece of information in my head way back then I learn about a narcotics lieutenant from a major police department who has successfully avoided going to the FBI National Academy for years the chief orders him to go in spite of his protestations a huge scandal is uncovered in the narc unit run by the lieutenant His absence (against his wishes) allowed it to be discovered there are many other forms of internal intentional misconduct going on But I’ll save that for our next visit together Without knowing the root cause of the behavior problem Gordon Graham has been actively involved in law enforcement since 1973 He spent nearly 10 years as a very active motorcycle officer while also attending Cal State Long Beach to achieve his teaching credential USC to do his graduate work in Safety and Systems Management with an emphasis on Risk Management and Western State University to obtain his law degree In 1982 he was promoted to sergeant and also admitted to the California State Bar and immediately opened his law offices in Los Angeles An assistant chief with Austin-Travis County Emergency Medical Services has retired amid allegations of having intimidated a person in his office in one incident and placing his head on a woman’s buttocks during an exercise drill in another who was with the medical service for 25 years left in early February while he took his remaining vacation days Both investigations were closed once he announced his retirement documents with the service’s office of professional conduct show Hawley was accused of “intimidating” conduct during the first incident The second report accused him of “unprofessional” behavior and was filed in January Austin-Travis County EMS officials said in a statement that they followed proper procedure in their investigation “Due to the nature of the second complaint Chief (Ernesto) Rodriguez began the process of placing Assistant Chief Hawley on administrative leave pending the outcome of the investigative process,” the statement says Assistant Chief Hawley requested and was subsequently granted a leave of absence Assistant Chief Hawley elected to file for retirement after 25 years of service … Though neither investigation reached definitive conclusion ATCEMS determined it was incumbent on the department to address these allegations openly and transparently no matter the rank of the individual involved.” the woman said Hawley came up behind her and urged her to run faster while she was making her way up the stairs during the drill pushing me up several flights of stairs,” she said in an interview with the medical service’s office of professional conduct “It was at least two or three flights of stairs.” She recalled him saying something along the lines of “Hurry up with those stairs The woman told the EMS interviewer she thought it was inappropriate and “something he definitely should not have done,” but not sexual assault someone who served on a work group with Hawley complained that he or she felt intimidated after a one-on-one meeting with Hawley The meeting happened right after this person Hawley and Rodriguez had met to talk about a petition that was circulating among EMS personnel “Chief Hawley used language that was threatening and confrontational and then even used body language that made me feel very intimidated and threatened,” the person wrote in an internal complaint Chief Hawley made a point to come towards me and shut the door before continuing the conversation and implying that I need to get in line.” That investigation was also closed after Hawley announced his retirement he said he did not think he had behaved in an intimidating way “I thought it was an overall positive experience,” Hawley said While officials interviewed someone about that conversation the person mentioned that Hawley once licked someone’s face There are no publicly available disciplinary records to confirm that incident “So to give you an idea of where things are whose name has been redacted in public records … I just really think he doesn’t know how to behave sometimes.” Futurity is your source of research news from leading universities (Credit: Getty Images) You are free to share this article under the Attribution 4.0 International license Anger levels among EMS workers rise when the quality of their sleep falls Emergency medical services (EMS) work is notorious for long and oftentimes odd hours with overnight shift work a part of the job It’s bound to affect one’s mood and now The researchers looked at the sleep patterns of 79 EMS workers from Central New York. They found that EMS workers who typically experienced poorer sleep quality reported greater anger levels Workers who routinely experienced poor sleep quality reported anger levels that were 18 to 35% higher compared to workers receiving fair sleep quality days when workers experienced poorer sleep than usual were characterized by higher levels of anger On a day when a worker experienced poorer sleep quality than usual for them their anger levels were 5% higher on that day regardless of their typical sleep quality “We examined sleep quality as opposed to sleep quantity This was intentional,” says Bryce Hruska an assistant professor of public health in the Falk College at Syracuse University who led the work “While both sleep quantity and sleep quality are important sleep metrics research indicates that sleep quality may be a superior predictor of many health and emotion related outcomes.” “There are documented connections between anger in the workplace and the impact that it has on organizational function and employee satisfaction,” says Hruska when supervisors use anger to influence employees’ behaviors it may promote retaliatory behaviors and lead to strained interpersonal relationships This could be really problematic for a field like emergency medicine because high functioning teams are crucial for ensuring effective patient care.” As for what’s causing poor sleep and more anger Hruska says it’s likely the difficult nature of EMS work during the pandemic “Even though we are transitioning out of the “emergency” phase of the pandemic as COVID-related hospitalizations continue to decline The long hours that are a routine feature of the profession are being felt more deeply,” says Hruska With this in mind, Hruska says it’s critical that sleep quality is considered crucial for EMS workers “Our research suggests that habitual experiences and behaviors might be important targets compared to impactful yet more infrequent day-to-day experiences some EMS workers tend to take more overnight shifts than others Establishing an agency policy that limits the number of consecutive overnight shifts might be important,” says Hruska “Sleep hygiene habits are also important. Regular over-caffeination or lack of physical exercise can detract from sleep quality Sleep hygiene education training during employee onboarding may help to raise awareness around the importance of practicing habits that promote sleep quality.” The results appear in Sleep Health: Journal of the National Sleep Foundation Source: Syracuse University Add your information below to receive daily updates LBV Magazine English Edition After successfully concluding archaeological research campaigns at two Roman military camps near Bad Ems the findings and discoveries have been presented to the public in Mainz researchers have managed to recover sharply pointed wooden stakes from a Roman defensive trench (1st century AD) virtually intact this defense technique and potentially lethal trap for attackers were only known through written sources: now these stakes have been archaeologically recovered and examined in the specialized restoration laboratories of the Leibniz Center for Archaeology (LEIZA) comprised of experts from the General Directorate of Cultural Heritage of Rhineland-Palatinate (GDKE) has summarized the scientific results in a publication We found the sharp wooden posts in a defensive system in the inner pointed ditch of the small fort It is remarkable that the findings have been preserved in their original functional construction context The exceptionally good preservation of the wooden objects and the very well-preserved and recovered fabric remains from this period are mainly due to permanent waterlogging This type of access obstacle was already described by ancient authors like Caesar but this is the first archaeological evidence of such a pila fossata throughout the Roman Empire Markus Scholz from Goethe University Frankfurt the 23 wooden finds were delivered to the specialized laboratories of LEIZA for conservation and restoration over the following 2.5 years We owe these unusually well-preserved archaeological finds mainly to the moist soil with low oxygen levels which was covered by dense layers of sediment I had never had to deal with such compact sediment layers adds: These wooden stakes from the military camps near Bad Ems of which the Roman military specialist in me is particularly pleased I am also personally very proud that LEIZA’s restoration and conservation laboratories have been able to once again utilize their unique expertise to permanently preserve the wooden finds The remains of the two Roman military camps which were occupied for a few years around the mid-1st century AD were discovered as part of a three-year scientific project between 2017 and 2019 It is highly likely that the camps are related to the search for silver veins under the Roman governor Curcius Rufus as transmitted by the Roman historian Tacitus This discovery was not made until 2016 by the volunteer monument conservator Jürgen Eigenbrod the forest area at “Blöskopf” was considered a Roman foundry due to its location above the silver mines of Bad Ems and in the vicinity of historic mining remains (Pingenfelder) from the 19th century it was dated between the 2nd and 3rd centuries Following surveys and excavations conducted between 2018 and 2019 researchers discovered that it was a small fort of about 0.1 hectares apparently used to control a Roman mining district around 50 AD Inside this small fort is one of the oldest stone buildings on the right bank of the Rhine identified as the central defensive structure of the complex Director-General of Cultural Heritage of Rhineland-Palatinate remarked: It is rare to have such a deep look into the era of the Roman Empire I want to thank all the experts from numerous disciplines who have participated in this project and highly recommend this publication on the topic LEIZA | Dr Markus Scholz (Hrsg.): Die frühkaiserzeitlichen Militäranlagen bei Bad Ems um Kontext des römischen Bergbaus Berichte zur Archäologie an Mittelrhein und Mosel Bd Subscribe to get the latest posts sent to your email Archaeologists from universities in the United States and Denmark found deep within the Actun Uayazba Kab cave in Belize two small stone tools dated between 250 and 900 AD that… men and women gathered to play a game called Cuju A team of researchers has succeeded in recreating for the first time in a laboratory experiment a phenomenon that until now only existed as a theory in the realm of… the Cantonal Archaeology of Aargau carried out a rescue excavation between early May 2024 and the end of March 2025 The Egyptian archaeological mission affiliated with the Supreme Council of Antiquities announced the discovery of a group of defensive structures and a system of moats that could indicate… In the southeastern area of the city of Rome archaeologists excavating inside the Triton Baths within the monumental complex of the Villa di Sette… Why did some animals from ancient eras become fossils while others simply disappeared without a trace A recent study on the cave paintings of the Altamira Cave in Santillana del Mar Cantabria (Spain) has concluded that some of the artworks it contains could be much older… A team of paleontologists from the University of Leicester has managed to decipher one of the many enigmas of the dinosaur era—the exact moment when pterosaurs Rome achieved numerous military victories that allowed it to grow and dominate nearly the entire known world in Antiquity Receive our news and articles in your email for free You can also support us with a monthly subscription and receive exclusive content presented a session titled “Customer Service in EMS: The Forgotten Art,” at EMS Today TAMPA, Fla. — Lillian Bonsignore, EMT-P, CIC, chief of EMS Operations for the FDNY, presented a session titled “Customer Service in EMS: The Forgotten Art,” at EMS Today Bonsignore noted that those in EMS are “people people .. “sometimes we lose focus as to what our mission is.” “If you’re interacting with another human being we need to be proactive about their needs,” Bonsignore noted Following are poignant quotes from Bonsignore’s presentation “Never mix up our mission with our politics What color pants you wear has nothing to do with the impact you have because you showed up that day.” “Accept the fact that we’d like to transform the profession of EMS we have to accept that there are some things we don’t do well and we could do better.” “We are people who believe we have the answer and the willingness to execute that answer for a stranger.” Bonsignore shared strategies to improve communication and customer service: inflection and your words should all be working together to say “I am here to take care of you.” Try a little smile “your emergency is over – I am the answer to your emergency.” Most importantly, practice genuine empathy An audience member noted he doesn’t get complaints about medics who read a 12-lead wrong; he gets complaints about medics who are jerks Here are 3 takeaways from Chief Bonsignore’s discussion on EMS customer service Focus on external as well as internal customer service Bonsignore made the case that for EMS leaders paramedics and CFRs going out and doing the job as well as the support staff who set them up for success – are even more important than external customers how are they going to go out and interact with patients on a daily basis “If someone comes into work and we make them miserable they’re going to go out there and make someone else miserable.” I have to recognize that the leadership I provide is a service,” Bonsignore stressed “I am there to serve them; their job is to serve the communities but we don’t always do a good job of taking care of each other,” Bonsignore said “If we’re only talking to each other when there’s a problem We often hear that leaders spend 90% of their time on 10% of the people who can’t get out of their own way “spend 90% of the time on the people who do a good job You give them the opportunity to come along.” Customer service improves EMS provider safety Another not-to-be overlooked or understated benefit of good external customer service in EMS is it can be a de-escalation tool they’re generally not throwing you a party when you get there,” Bonsignore said “Nobody deserves to come to work and be assaulted in any way.” She noted she tells her providers to remove themselves from a potentially violent incident can diffuse a potentially volatile encounter before it turns violent reducing the likelihood of conflicts and assaults it reduces negative reactions,” Bonsignore noted A benefit of good internal customer service provided by Chief Bonsignore: The FDNY has 4,100 EMTs and paramedics in the EMS Bureau as well as more than 10,000 firefighters trained to the CFR level and additional volunteer partners More than 1,200 ambulances fight the gridlock each day The FDNY EMS runs 800-plus different tours every day with hospital-based EMS partners contributing an additional 400-plus tours They serve 8.5 million residents – which increases to 17 million when visitors and workers are added and surges by millions for holidays and events EMS responds to 1.5 million calls a year and over 4,000 calls each day – each which has the very real potential to be an MCI with that many people sharing 303 square miles Bonsignore has gone the extra mile when it comes to engaging with her staff One of the first things the did after her promotion and spend 2-3 hours getting to know the people who serve the mission in New York City She also cut out the chain of command in field feedback forms ensuring provider concerns are directed straight to her office her leadership team recognizes the unit of the month with a celebration followed by a lunch with Chief Bonsignore and Assistant Chief Suriel at a restaurant with “the best chicken parmesan in the city.” After which the recognized providers are invited back to headquarters to spend the afternoon with the rest of the senior leadership team of the FDNY “If we can do this in a city that runs 1,200 ambulances a day If we can find the time in 4,000 runs a day I would argue anyone can,” Bonsignore opined Learn more about how to care for your patients and your personnel with these resources from EMS1: responsible for defining original editorial content managing expert contributors and leading execution of special coverage efforts she served as an editor for medical allied health B2B publications and communities Kerri has a bachelor’s degree in English from Saint Joseph’s University strategies and stories with Kerri at khatt@lexipol.com Home/Firefighting and salvage and overhaul reveal no fire extension Once the benchmarks are complete, the incident commander (IC) sends you and your crew back to the station to clean up and get back in service. The fire lasted two hours because of salvage and overhaul efforts Your crew is exhausted but happy that no civilians were injured or killed The cook is ready to start lunch when a tone is sent to your station for a medic response The crew loads up and you radio to dispatch “Medic 14 is responding to 1234 1st Ave.” Dispatch informs you that this is a multiple shooting reported by neighbors in the area Dispatch does not know the number of victims or if the police are on scene Responding to a Multiple-Victim Shooting You read the notes as you respond and notice that the police are now on scene As your ambulance pulls up to the staging zone you notice numerous police cruisers positioned blocking the street from access You radio to dispatch Dispatch states that the police have the scene secure and need medical ASAP The officers inform you that the scene is safe The officers have four patients who have been carried two houses to the south of where the shooting occurred The suspect has barricaded himself in the target house with three hostages This warm zone area where the officers have extricated the patients will have to be a temporary triage Prior to your arrival, officers who are Special Weapons and Tactics (SWAT) trained had applied tourniquets to extremity wounds your crew triages the patients based on severity and survivability There are three RED Tags and one YELLOW Tag A 55-year-old female patient has a gunshot wound (GSW) to the neck with no airway compromise There is a pool of blood underneath her back and head Starting a SWAT Medic Program The next patient is a 20-year-old male who has bilateral femoral GSWs Both upper thighs have tourniquets in place Both tourniquets were placed appropriately by the officers—high and tight you maintain that this patient is still a RED Tag since humans can lose 1,500cc of blood inside of one thigh Since there are bilateral GSWs to the thighs this accounts for possibly 3,000cc or approximately half the volume of blood for most adults This does not account for any blood loss outside of the body the patient more than likely has lost even more blood sustaining this high level of trauma You pack the junctional wound at the groin with a hemostatic gauze and have an officer hold pressure You direct a crew member to place a chest seal on the chest wound The abdominal wound is covered with a dressing and bandaging; pressure is being held by another crew member Stop the Bleeding: Basic Hemorrhage Control A tourniquet was placed by the police; however there is a large amount of blood still streaming down his arm Since you performed an ongoing assessment of all interventions You leave the tourniquet in place but tighten it up more The bleeding stops and now this patient is deemed a YELLOW Tag The fourth crew member was assigned to treatment officer duties and interventions were executed in a few minutes with positive results Even though you were not attached to the Tactical Emergency Medical Services (TEMS) unit this day you implemented and executed the needed interventions TEMS medics are required to have this level of expertise and confidence when performing their duties regardless of their rank You also informed dispatch to have the incoming medical units enter onto 1st Ave then exit down Frost Parkway (which is a cross street) Frost Parkway leads back to Larry Boulevard and to the trauma centers This tactic is safe since the target house is four houses past Frost Parkway to the north This allows the incoming medical units to exit the scene safely by preventing them from having to pass in front of the target house All patients are transported safely to the nearest trauma centers The SWAT team and negotiators have also been activated to mitigate the situation The SWAT team and the TEMS medics arrive on scene and are briefed by SWAT command and you Medical incident command is now assumed by the medical officer from the TEMS team You are told to return to service after clearing the scene The scenario above is similar to how a call may develop in Akron the methods and procedures articulated here may or may not reflect how a situation may be approached in other cities or municipalities This type of scenario is referred to as a “Signal 100” in Akron The majority of TEMS and SWAT activations are planned warrant/drug/gun raids this type of scenario is probable and occurs in many cities and municipalities across the United States TEMS is more than just a medic in a helmet and vest TEMS medics are versed in many topics and must be prepared to think outside the box to assist command in problem solving and mitigation Even though there is a TEMS medical director who oversees the team his ability to give orders on scene is stymied by many factors medics are given standing orders by the medical director TEMS interventions are unique and require some leeway for tactics and treatments to change given the complexities of the encounter at hand The Akron SWAT and TEMS teams function in a unique manner based on best practices Even though our education and knowledge base are derived from a vast amount of sources Our training is a culmination of research-based case studies and hands-on psychomotor repetition acquired in-house and from nationally recognized training conferences such as the Ohio Tactical Officers’ Association (OTOA) conference Other trainings used are the Ohio Fire Academy in Columbus and CONTOMs courses found throughout the country The Akron Fire and Akron Police way of training is very effective; however it is not necessarily a paradigm for all departments and may not fully fit the environmental and geographic demands of other parts of the country The needs of the community are paramount; SWAT and TEMS best practices must address and fit these needs there are situations that do not fit neatly into an algorithm or a protocol TEMS medics work in the gray zone and must be able to use their mental file folders to mitigate a bad scene These mental schema or file folders are built through years of experience TEMS medics are trained in operator tactics SWAT teams were developed in the late 1960s in Los Angeles because of increasing violence aimed at the civilian population and police officers after the Watts Riots Los Angeles SWAT became a full-time position because of rising violence and drugs in the city Tactical medicine grew from necessity in the military Battlefield deaths were rampant because there were no triage or treatment protocols roughly 89% of casualties on the battlefield in the Vietnam War died of exsanguination Tactical Emergency Casualty Care for High-Threat Environments Prior to TCCC, casualty fatality rates (CFRs) on the battlefield in World War II were 19.1%. In the Vietnam War, CFRs were 15.8%, and in the Iraq/Afghanistan conflicts the CFRs were 9.4%. Tourniquet use was nonexistent and then minimal at best It was not until the early 2000s that a cravat and stick were used as a tourniquet and no junctional treatments were made available was used in copious amounts to raise blood pressure numbers This overirrigation of the vascular system was busting up clots and making the body more acidic because of chloride in normal saline There was a need for profound change if lives were to be saved military studies were conducted and TCCC guidelines were incorporated This included triage changes and new treatment modalities SWAT teams had recognized the need for medical interventions during training and real-time deployments since SWAT trained and worked in austere environments like the military A committee for tactical medicine was formed comprised of doctors This committee is referred to as the Committee for Tactical Emergency Casualty Care TECC standards and guidelines were born in May 2011 to provide a paradigm for SWAT and other incidents in the civilian world TCCC had its limitations in the civilian world because of scope of practice and language An example is the use of chest tube placement by medics in the military If severe thoracic trauma is assessed and definitive care is hours away then it makes sense for medics in the military to perform more invasive treatments trauma centers are usually close enough to limit a medic’s scope of practice Chest seals and chest decompression techniques are adequate when treating operators Even though tactical medics are in place during SWAT events to practice good medicine in bad places I would be remiss if I did not mention that there is a caveat: timing Good medicine in the tactical setting (at the wrong time) equals bad tactics Bad tactics equals operator or medic death Death equals mission failure and a grieving spouse Return of fire is the best medicine depending on the stage of the incident The medical threat assessment (MTA) is the number-one most important factor for mission success from a medical standpoint Always plan for the “What if?” Failure to plan will produce a “What now?” mentality Part of the MTA is designating a rally point—a more secure location usually two to three houses away from the target house The rally point should be in the direction of the evacuation route if things go bad It is the meeting place to retreat to if needed Considerations in the MTA should include number of suspects and their background neighborhood culture (friendlies/unfriendlies) Other considerations depend on the situation The Need for Joint Hazards Assessment Teams These kinds of missions can also stretch out over many hours They require a united effort to mitigate the dangers on scene and negotiators collaborate to devise a plan Many dangers are considered such as the following: suspect’s fire power suspect’s explosives knowledge and capabilities suspect’s implementation of these capabilities Medics have to be prepared to use every facet of their training and must know how their equipment functions SWAT officers have been exposed to high-potency drugs during Signal 100s and raids Medics must be ready to decontaminate anyone with exposures to drugs our TEMS Medical Unit carries large amounts of Naloxone and a hydrant bag we can hook up to a hydrant to irrigate exposed skin The top three preventable deaths in the tactical setting include exsanguination extremity trauma exsanguination comprises 60% of preventable deaths and airway compromise has been found to be approximately 6% of preventable deaths “Other” is the category into which remaining injuries fall and are considered 1% of preventable deaths Junctional and truncal wounds sustained in the tactical setting would be two examples that fall into this category (1) In this multifaceted and high-speed exercise tactical medics observed and coached the SWAT operators as they dragged a 185-pound dummy and applied a tourniquet to a live operator with a simulated femoral artery injury These activities are performed as the operators are now energy depleted after shooting exercises and physical exertion Fine motor skills are usually the first to become compromised when the stress is high and energy levels drop Tunnel vision may also set in as the operators’ focus is on the injured operator and a successful completion of the task The operators’ right hands are taped as they hold a tennis ball to simulate an injured and inoperable hand secondary to a GSW Tactical medics have the responsibility to train SWAT operators in medical treatments because they may never make it to the hot zone to render care The Trauma-Science Intersection and Prehospital Care Extremity exsanguination can be controlled by simply applying a tourniquet high and tight If there is more than one wound to the extremities located in various areas then placing the tourniquet high and tight will stop the hemorrhaging Placing the tourniquet a few inches above the wound may be adequate for that wound; however if you cannot visualize the entire extremity there may be wounds located higher on that extremity Another reason to place tourniquets high and tight is basic anatomy Even though the medical terms and bone sizes are different the bones in the upper extremities mirror the bones in the lower extremities The upper arms have one bone (humerus); the lower arms are comprised of two bones (radius and ulna); the upper legs are the femurs (one bone); and the lower leg bones are referred to as the tibia and fibula (two bones) and nerves traverse along the medial aspect of the upper arms It is much easier to compress the vasculature against one bone This is more effective than compressing below the elbow joint because the arteries and nerves run in between the radius and ulna Hemorrhage is very difficult to stop when compressing vessels in this area this is the same for the lower extremities When assessing a casualty in the tactical setting an initial assessment based on a general impression is a good place to start A rapid trauma assessment will suffice if the patient assessment is broken down into three main sections: extremities Place a tourniquet high and tight on extremities holding the pressure for 30 seconds to 3 minutes depending on what hemostatic agent is used Cover truncal wounds with a gloved hand if chest seals are not readily available place the seal’s valve directly over the wound which may be located anywhere on the torso; check from the neck to the navel If you notice a tension pneumothorax developing Find the clavicle because the first rib is located directly under this bone The second rib is located approximately one finger width below this bone The third rib is found measuring the distance the same way Insert the 14g needle over the third rib in the intercostal space This insertion site should be midclavicular on the injured side If the trauma is located on the left side of the patient’s thorax then be careful not to insert the needle into the heart which will direct it outside of the cardiac box If you cannot access the midclavicular insertion site (which is common in the tactical setting) then insert the needle over the fifth rib on the anterior axillary line perform this on the injured side of the thorax The midclavicular insertion site is usually difficult to access because of the SWAT operator vests and gear Stages of care in the tactical setting are categorized by levels of danger and Tactical Evacuation Care (TAC-EVAC) (cold zone) overlap at times depending on the severity of the operation The hot zone is the area where the operator The goal here is to extricate or direct the person out of the danger zone The best medicine here is to return fire and find cover then he should do so as quickly as possible then staying in place may be the best course of action until other plans are enacted then he needs to either return fire and find cover to self-treat or stay behind cover and self-treat immediately if pinned down medics may need to provide medicine across the barricade This is when the injured cannot self-extricate and cannot be extricated by team members or medics because of heavy fire The medic essentially directs the injured how to self-treat on the portable radio Depending on the severity of the injury and the amount of blood loss the medic must be able to articulate treatment procedures clearly and succinctly Heavy blood loss will cause the injured to become confused Speaking slowly and calmly will potentially keep the injured calm and focused on self-treatment Every step of the self-treatment process must be explained at an elementary level to avoid confusion if blood loss has led to shock (2) This photo illustrates the need for tactical EMS in today’s world This training was a collaboration of the Akron Fire Department’s Tactical EMS crews and the Akron Police Department’s SWAT team during a two-day scenario-based training in conjunction with Cleveland Clinic Akron General & Summa Health Systems in Akron The injured patients in this scenario were shot in multiple areas of the body; operators and medics were required to take command of the scene and get the injured to definite care quickly Controlling blood loss and preventing hypothermia are crucial Blood will not clot appropriately as the core body temperature drops If an operator is injured and cannot return fire mnemonic: Remote assessment and treatment (place tourniquet) Utilization of assets and distraction (smoke and Evacuation/Extraction method and egress options (help us help you) Act (OODA) gives the injured operator the ability to think logically looking for cues and patterns in the decision-making process he can always go back to the observation part of the loop and reassess from there These items also get caught on carpet and other areas or objects Tourniquets have unraveled and have been fully displaced after snagging on objects during patient movement These prior interventions must be reassessed and subsequent intervention may be required such as retightening a tourniquet or placing a new tourniquet above or below the previously applied tourniquet Airway patency and work of breathing are very important while treating in this zone of care This zone is usually located at the rally point Medics are still in danger if the situation escalates or encroaches into the warm zone Operators and other law enforcement personnel are still needed to provide security assessment to check for injuries: Massive hemorrhage Triage patients if multiple casualties are found is used in Akron’s EMS protocol to sort patients based on severity of injuries: Sort and Treatment/Transport has been used with success in our EMS system regarding accuracy and speed of patient care Check for trauma to the airway from projectiles Start with the head-tilt chin lift to access the airway if no trauma is involved A jaw-thrust maneuver is warranted by trauma though Place a nasal or oral airway adjunct and bag the patient if breathing is inadequate or nonexistent You may need more advanced airway devices such as a supraglottic airway device or endotracheal intubation A last resort is to perform a cricothyrotomy by inserting an airway device through the cricothyroid membrane for definitive airway security Follow local protocols regarding procedures EMS Response to the Active Shooter Place both hands on the chest walls to feel for equal chest rise and fall Gathering a full set of vitals in this zone may not be viable A quick assessment of lung sounds using a stethoscope would allow the medic to locate the development of a tension pneumothorax he may be able to tell you that he cannot breathe adequately Abnormal respiration rates and audible wheezing and rhonchi are more tell-tale signs of a tension pneumothorax have difficulty bagging the patient with the bag valve mask An absence of lung sounds on one side or the other is another good indicator of this injury Chest decompression on the injured side is one treatment to use A chest seal is another treatment used in this zone if a sucking chest wound is found Vital signs and IV/IO access should be referred to the cold zone and medics are considered secure from further danger regarding the suspects’ attempts to perpetuate harm This is not to say that dangers may not arise while in transport such as vehicle collisions Cold zone treatment requires an “all hands on deck” approach More advanced treatments such as IV/IO initiation and fluid replacements fall into this zone Drug administration may be warranted if the patient goes into full arrest Consider drugs that protect from clotting compromise Protection from hypothermia should also be of high importance since blood will not clot once the core body temperature falls below 90°F Exposing the patient is necessary; however covering the patient with blankets and increasing the temperature in the transporting unit are critical The Circulation and Hypothermia/Head Injury in M.A.R.C.H can be assessed in the warm zone if there is time Assessing the Circulation section should focus on the levels of shock Decompensating shock is avoidable if bleeding is stopped and thoracic injuries are treated appropriately be sure to check for a low blood pressure and a rising pulse Package the patient for evacuation and follow department protocols for trauma transport Keep in mind that interventions are important but must be performed with accuracy and care initiating an IO and running the fluid wide open to raise blood pressure have been shown through research to be counterproductive and deadly Prolonged and excessive hypothermia will also lead to higher levels of mortality if gone unchecked An acidic system and a drop in core body temperature will not allow the body’s natural clotting cascade to function properly This will lead to the injured bleeding out Just remember that acidosis + hypothermia = coagulopathy Coagulopathy refers to the inability of the body’s blood to clot posttrauma This is referred to as the lethal triad of trauma When there is a compromise in the integumentary system the vascular system will also be compromised if the trauma is deep enough the body’s clotting factors are activated to stop the blood loss When enough blood is lost from a critical injury The vascular system constricts to raise the blood pressure the amount of circulating blood is not adequate for perfusion of the cells and water are lacking at the cellular level now When the cell does not have an adequate oxygen supply the cell’s metabolism changes from aerobic to anaerobic The byproduct of anaerobic metabolism is lactic acid and other substances Lactic acid causes the pH to drop from the normal range of 7.35-7.45 medical personnel have loaded the patient with high levels of normal saline or lactated ringers solutions These fluids have no oxygen-carrying capacity the average temperature of an IV bag of fluid is approximately 70°F to 72°F the chloride in normal saline is measured to be a 5.5 on a pH scale This is a high level of acidity being introduced into an already acidotic vascular system it is important to keep the patient warm by increasing transportation unit temperatures and removing the blood-soaked clothing if possible Avoid introducing too much IV/IO fluid into the patient’s system Simply maintain peripheral pulses at 90 systolic Too much fluid will bust up clots formed previously The chloride effect will also break down clots formed The temperature of the IV/IO fluid will also exacerbate an already dropping core body temperature IV/IO fluid warming devices that heat up intravascular fluids are a great practice during transport administration of packed red blood cells and fresh plasma is the best solution in trauma Slowing acidosis and hypothermia can be done but this is usually an uphill battle depending on the severity of the injury Working in austere and dangerous environments is not new for prehospital professionals and a good level of situational awareness is necessary Tactical medics face difficult situations and are required to bring their “A” game every time they are dispatched for a raid or a Signal 100 every mission should be considered compromised Keep your medical and tactical knowledge up to date Train daily to keep your skills intact and fluid it must be transferred from the mental file folders to the hands for psychomotor skill enhancement Knowledge not used is only knowledge if the medic cannot perform accurately and competently in the field when it counts Use your knowledge to develop skills through constant training and fellow EMTs/medics deserve only the best To quote Ancient Greek Poet Archilochus: “We don’t rise to the level of our expectations; we fall to the level of our training.” 1. Springer and Verbillion (2006). “Tactical Emergency Medicine:” AHC Media-Continuing Medical Education. https://reliasmedia.com/articles/140073-tactical-emergency-medicine 2. Gerecht, R. (2014). “Trauma’s Lethal Triad of Hypothermia, Acidosis & Coagulopathy Create a Deadly Cycle for Trauma Patients.” Journal of Emergency Medical Services (JEMS) April 2014. https://www.jems.com/2014/04/02/trauma-s-lethal-triad-hypothermia-acidosis/ Ohio Tactical Officers’ Association (OTOA) Conference training courses for TEMS paramedics 4. Cotton, B.A., et al (2006). The Cellular, Metabolic, and Systemic Consequences of Aggressive Fluid Resuscitation Strategies: journals.lww.com (Shock: August 2006-Volume 26-Issue 2- p Tactical Combat Casualty Care: Lessons and Best Practices Center for Army Lessons Learned (CALL Publications) Course Manual; National Association of Emergency Medical Technicians (NAEMT) and operations officer for the Akron (OH) Fire Department (AFD) He has 17 years of experience as a firefighter and 15 years as a paramedic He also has 12 years as a tactical medic with the AFD/Akron Police Department He has functioned as an arson investigator and investigated postblast scenes where explosive devices were used Alden has a master of arts degree in applied behavioral sciences from Wright State University in Dayton and a baccalaureate degree in sociology/criminology from Urbana University in Urbana He served as an instructor in sociology at the University of Akron for six years 2017 may very well be one of the most tumultuous years for EMS Against the backdrop of a highly charged national political landscape field care professionals saw an array of changes as well While some of the events highlight the success of an industry on the cusp of change others demonstrated that we continue to be dragged down by boorish behavior Mobile integrated health and community paramedicine may have come of age in 2017 With numerous initiatives showing good results in terms of patient outcomes and cost effectiveness attention is now focused on reimbursement for field services that don’t result in ambulance transport but the potential to direct the right patients to the right level of service and reduce unwarranted stress on existing EMS resources is promising Speaking of technology, public safety experts have already started the discussion on driverless ambulances With rapid development of automated automobile technologies in areas such as assistive braking and collision avoidance the promise of fully automated vehicles serving both consumer and EMS is not very far away Overall, injuries plague EMS providers. A study conducted jointly by NHTSA-EMS and NIOSH found EMS workers suffer physical injuries at a rate of four times the national average The top five causes of EMT/paramedic injuries are: more ergonomic equipment and a philosophy of carrying only those patients who medically require it will improve those statistics Going home at the end of the day should be everyone’s goal we are held to a higher standard in our communities That responsibility requires refrain and professionalism while on the job The #metoo campaign brought a lot of attention to sexual harassment in the workplace with all types of famous people losing their jobs over allegations of inappropriate This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page While we spend time talking about the importance of care and compassion of the patients and people we serve we need to do a lot more to improve the care and compassion we show to our fire and EMS brethren buttercup!” and “This is a fire company; we expect people to have thick skin then get out of the firehouse!” I have heard people jokingly call each other derogatory and offensive names which were presumably intended to be in jest I have also heard people getting screamed and cursed at for not completing assignments I could definitely go on with other examples These kinds of comments and behaviors have no business in the fire and EMS workplaces These comments and behaviors are each examples of bullying in action People in EMS and the fire service see a lot of terrible things that people in other professions do not have to deal with and being emotional about some calls does not make anyone a bad EMS provider or firefighter We all need to work together to eradicate bullying behaviors in the fire and EMS workplace and these five suggestions are a good place to start If you see one of your coworkers getting emotional or having a rough day ask the person if they are okay and if there is anything you can do to help Never suggest that your colleague should suck it up or get thicker skin If your organization has an Employee Assistance Program (EAP) It is never okay to make fun of your coworkers What you think is a harmless joke may not be so harmless to the person hearing it a bigger person knows that he or she is big and that person may laugh when you joke about their size many people just internalize comments and put on a brave face regardless of how well they may seem to outwardly take it it can be very frustrating when people don’t do their jobs properly especially when they continue to repeat bad behaviors after you have already counseled them about it If someone has to listen more closely to hear you If you see someone getting bullied at your workplace Tell the person who is exhibiting bullying behaviors that it is not okay and tell them to stop Talk privately with the person you saw getting bullied and ask if they are okay and if there is anything you can do to help Report the bullying behavior to management If the perpetrator is a member of management try reporting the matter to another member of management or to the HR or compliance officer If you are a member of management and you get a complaint about bullying behavior or you witness bullying behavior it is your job to promptly take action to stop it Supervisors should not look the other way when they see bad behavior We are all guilty of gossiping to a certain degree spreading rumors and stories about people can be very hurtful to the person who is being talked about Just because you know something or think you know something about one of your coworkers that someone else doesn’t know this does not mean that you need to spread the story it is still best to just keep the information to yourself Just like EMS providers and firefighters must show care and compassion to patients and the people we serve we must show a similar degree of care and compassion to our coworkers The problem of EMS providers and firefighters committing suicide is real and we can’t allow bad behaviors in the workplace to contribute to the problem It is incumbent on all of us to take immediate action to change our own negative behaviors toward our coworkers into positive behaviors that support a caring workplace culture Let’s work to save our coworkers lives just as hard as we work to save our patients and fire victims PWW has been the nation’s leading EMS industry law firm PWW attorneys and consultants have decades of hands-on experience providing EMS managing ambulance services and advising public private and non-profit clients across the U.S Visit the firm’s website at www.pwwemslaw.com includes the caption “Hail Byrd!” – Byrd being the name of their primary academy instructor Photo/West Virginia Department of Military Affairs and Public Safety The photograph is infamous now: 34 West Virginia correction officer trainees with their faces blurred, raising their arms in an apparent Nazi salute and there was intention to include it within graduation packets All recruits in the photo have since been fired several other instructors were suspended without pay Dozens of young men and women have had their career plans dashed Some people are quick to blame the instructor Byrd is clearly responsible for the outcome according to an investigation that took place after the photo came to light several students started using the gesture when greeting Byrd a couple weeks into the academy “The gesture was done with Byrd’s knowledge,” the report read “The investigation disclosed that she encouraged it and at times reciprocated the gesture.” Further the investigation found that eventually Byrd directed her class to use the hand gesture while taking a photo of the class and reprimanded students who resisted joining in But this situation cannot possibly be the result of just one rogue instructor Many people knew what was going on with the recruit class A secretary who was asked to print the photo asked Byrd why the class was posing in that manner and investigators said Byrd responded with “because I’m a hard-ass like Hitler.” The photo was also seen by a captain who never addressed Byrd about it and did not attempt to stop the photo’s distribution “I saw the picture and did nothing,” the officer acknowledged And that is exactly how things like this happen Someone pushes a boundary and instead of immediately reining that person in someone in authority either ignores or enables the behavior More people join in and exaggerate the behavior indifference and bad judgment allow the inappropriate behavior to become normalized This type of normalization cannot happen as a singular event This incident came to light because it was so egregious Not only was the photo widely available but it was also intended to be an official handout during a formal graduation ceremony the behavior that led up to the photo being taken had gone on for weeks secretary of the West Virginia Department of Military Affairs and Public Safety that is inappropriate behavior; do not do that again Why didn’t she understand that such behavior was unacceptable She was a product of the system she worked in – a system that included other instructors who expressed concern about the gesture being used And it is known that there was at least one officer with power over the instructor who knew what was going on and did nothing Some of those others involved have been suspended or fired for their leadership failures an action justified not only by her actions in this incident but also by her subsequent claim that she was unaware of the hand gesture’s historical and racial implications She claimed that she thought it was just a greeting several cadets recognized the gesture for its historical implications and refused to go along with the class during the academy Others felt pressure to fit in and went along but voiced their concerns to classmates 10 members resisted but were ordered by their instructor to give the gesture Seven of those cadets told investigators they made a fist so that they appeared to comply with Byrd’s demand without directly mimicking a Nazi salute And even though some tried to do the right thing The existence of such a picture of law enforcement officers just isn’t tenable in these times of instant and eternal access to all photos that have ever been posted on the internet These recruits were failed by their leaders not just the one who directly betrayed them perhaps some of those leaders were also failed by their role models and supervisors in the past That’s how it usually happens – the inertia of bad behavior often outweighs individual efforts to stop it Leadership is about vigilance when it comes to normalizing behavior Sometimes it is hard to see it when you are in it and that is why there must always be ways that people can stand up and say how they feel expressing different points of view without fear and the big losers were those young cadets now perpetually blurred out from their potential futures Leaders of Greenville County's black community gathered Friday afternoon to demand public hearings and reforms at the county's EMS department while rejecting the county's proposal to hire a consultant to look into emerging criticisms of the operation executive director of the nonprofit group Vision 25 the group said that EMS employees should be allowed to speak in an open forum about the department's challenges without fear of retaliation the county's governing headquarters near downtown Greenville "We do not want to see these issues swept under the carpet or rug by the utilization of a consultant without a public hearing from those employees," Smith said The Greenville County EMS Department has been under scrutiny all week after an anoymous petition came to light that harshly criticized the operation's management team and pointed to severe personnel shortages More: Greenville County EMS director puts in for retirement Standing beside Smith was Greenville County Councilman Ennis Fant who along with councilmen Lynn Ballard and Rick Roberts has said that public hearings would be a good idea "Council has a history of things that make them look bad and they know it's going to make them look bad they put it off on a consultant and let time pass so the public forgets about it and it goes in the trashcan," Fant said "We are trying to make sure that kind of pattern doesn't happen." More: Petition blames Greenville Co. EMS leadership for poor response times and 'toxic' conditions and County Administrator Joe Kernell has said he will update the Greenville County Council on the EMS department's status at a committee meeting Tuesday afternoon Also at the press conference were U.A pastor of Bride of Christ Baptist Church; Chuck Duckett with the Baptist Ministers' Fellowship of Greenville and Vicinity; and former Democratic candidate for Congress Brandon Brown families who have come to his funeral home, where people have died waiting for an ambulance "I'd rather fix EMS than have families shopping for a funeral home," Brown said A top concern in the anonymous petition was ambulance response times and The Greenville News this week filed a Freedom of Information request to obtain EMS call logs for the past five years The petitioners state they remain in full support of EMTs and paramedics who work at the agency but say it is “in critical condition and demands immediate intervention.” They add that the current leadership is endangering lives in the community and creating a toxic work environment for staff.  County Councilman Butch Kirven said after the press conference that a good plan would be to solve the most pressing problems now at EMS and then possibly bring in a consultant to look at how to make sustainable fixes in the department Holding a public hearing and inviting county employees to speak openly while promising protection against any retaliation from administrators The County Council should first let Kernell consult with EMS employees and get to the bottom of some of the allegations "The employees have got a voice," Kirven said "The question is how do they appropriately channel it. Right now it's an employee-employer situation The Greenville County Council sets policy and passes ordinances but under the council-administrator form of government Kernell handles day-to-day operations and personnel An agenda for the council's 4 p.m. Tuesday committee meeting posted Friday afternoon but did not detail what Kernell will present to council members regarding EMS operations Kirven said he expects members to ask a lot of questions and expects the meeting to be heavily attended The council will then have a closed-door meeting to discuss a legal claim against the county.  "Our policy is we want a first-class EMS operation that protects the health and safety of all our citizens," Kirven said lay the facts out and let's decided together the best way to address problems at EMS." 2021 at 3:33 pm ET.css-79elbk{position:relative;}An EMT wearing personal protective equipment prepares to unload COVID-19 transfer patients at the Montefiore Medical Center Wakefield Campus in the Bronx borough of New York City (Photo by John Moore/Getty Images)ACROSS AMERICA — For years Garrett Hensley has responded to emergencies as an EMT in Mesa Hensley works the EMS ambulance and responds to emergencies He's seen and taken care of numerous coronavirus patients since the pandemic began last March it's the community Hensley has served for years that is helping him Co-workers and friends of the 51-year-old have raised nearly $10,000 to help Hensley and his family all of whom have tested positive and are recovering from severe symptoms "I have never felt that bad in my life. It was horrible," Hensley told ABC-15. He described the body aches, fever and low oxygen levels that have plagued him since he first tested positive for the virus a month ago "They ended up calling a code on him because he ended up going into respiratory arrest and that's how he ended up intubated," Hensley said "I know this is a horrible virus," he added Hensley still needs oxygen and struggles to walk But he's still hoping to return his work helping others as soon as possible "We want to see him back safe and healthy," said Adam Yarlott It's definitely not the same at the station without him." Read more via ABC-15 Arizona States that were counting on added coronavirus vaccines from a federal reserve are learning that no such reserve exists according to a Washington Post report Friday The revelation comes after Health and Human Services Secretary Alex Azar said Tuesday that the federal government planned to start releasing vaccine doses that were being held in reserve so they would be available as second shots for those who already had received their first dose available doses already had been shipped out in December — meaning nothing was being held in reserve or stockpiled citing state and federal officials who were briefed on distribution plans Second shots will still be given to those who received a first dose because states continue to receive their regular shipments But local and state health officials now may have to off on their plans to increase eligibility for vaccines because allocations will not increase as expected and puts our plans to expand eligibility at grave risk," Oregon health Director Patrick Allen wrote in a letter Thursday to Azar In a turn of events on Friday, Azar announced his resignation as head of HHS Capitol and how President Donald Trump's slow response to condemn it have "tarnished" the reputation of his administration and the accomplishments of Operation Warp Speed Azar's resignation will be effective on Inauguration Day the same day he would have left office without resigning "The attacks on the Capitol were an assault on our Democracy and the tradition of peaceful transitions of power that the United States of America first brought to the world," Azar said in his statement "I Implore you to continue to condemn unequivocally any form of violence to demand that no one attempt to disrupt the inaugural activities in Washington or elsewhere and to continue to support unreservedly the peaceful and orderly transition of power on January 20 despite reports of limited supply and no reserves President-elect Joe Biden on Friday said getting 100 million shots into Americans' arms in his first 100 days in office is only the beginning of his coronavirus plan "You have my word: We will manage the hell out of this operation," Biden said But he also underscored a need for Congress to approve more money and for people to keep following basic precautions avoiding gatherings and frequently washing their hands Biden's Friday address came as the worldwide coronavirus death toll surpassed 2 million More than 391,000 of those deaths have been in the United States alone The address also came just hours after Biden unveiled a $1.9 trillion plan to speed up vaccines and pump out financial help to those struggling with the pandemic’s economic fallout During a nationwide address from Wilmington Biden detailed the "American Rescue Plan," which would meet his goal of administering 100 million vaccines by the 100th day of his administration and advance his objective of reopening most schools by the spring It would also deliver another round of direct economic aid to cash-strapped Americans Biden proposed $1,400 checks for most Americans which — on top of $600 provided in the most recent COVID-19 relief bill — would bring the total $2,000 The plan would also extend a temporary boost in unemployment benefits and a moratorium on evictions and foreclosures through September “We not only have an economic imperative to act now I believe we have a moral obligation,” Biden said he acknowledged that his plan “does not come cheaply.” Meanwhile, a new coronavirus mutation has been found in the United States and it may already be the dominant strain in the country researchers at Southern Illinois University have found According to a preliminary paper submitted for peer review the so-called 20C-US strain accounts for about half of all U.S SUI researchers are calling it "homegrown and widespread." strain of the virus — a variant called B.1.1.7 — the U.S strain has undergone mutations in the proteins that form the virus's spiky crown These spike proteins help the virus attach itself to cells in the nose and can even penetrate the blood-brain barrier It's these spike proteins that Pfizer and Moderna's vaccines program cells to replicate The variant first discovered in the U.K. has now been confirmed in 12 states, according to the Centers for Disease Control and Prevention a fourth positive coronavirus case was confirmed Thursday among lawmakers who were inside the Capitol building during the Jan Adriano Espaillat of New York said he has the coronavirus Espaillat said that he's isolating at home and will continue his work representing his Upper Manhattan district At least three other House members have tested positive after a group of representatives went on lockdown in a secure location on Capitol Hill when supporters of President Donald Trump stormed and ransacked the Capitol Massachusetts Congresswoman Ayanna Pressley said Wednesday her husband who was with her during the Capitol lockdown tested positive for the COVID-19 virus and was showing mild symptoms It’s not clear where and when lawmakers caught the virus But the Capitol’s attending physician has told House members they might have been exposed to someone in the room who had the virus At least 3,776 deaths and 248,007 new cases of coronavirus were reported in the United States on Friday, according to a Washington Post database The Post's reporting shows that over the past week new daily reported deaths rose 13.9 percent and coronavirus-related hospitalizations are down 3.5 percent Currently, more than 127,235 people are hospitalized with a coronavirus-related illness in the United States, according to the Covid Tracking Project As of Saturday, 46 states and Puerto Rico remained above the positive testing rate recommended by the World Health Organization to safely reopen Alaska and the District of Columbia are currently below that rate the WHO recommends states remain at 5 percent or lower for at least 14 days As of Saturday fternoon, the United States had reported more than 23.6 million cases and more than 393,700 deaths from COVID-19-related illnesses, according to a tally by Johns Hopkins University Stay up to date on the latest coronavirus news via The New York Times or The Washington Post Get more local news delivered straight to your inbox. 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Share on FacebookShare on X (formerly Twitter)Share on PinterestShare on LinkedInCOLUMBIA SC (WIS) - Several Richland County EMS employees are making claims that a county administrator told them they should kill themselves or just quit if they are unhappy with their jobs the assistant county administrator for public safety reportedly said those remarks during a Thursday morning meeting with about 100 Richland County EMS workers Bronson told EMS workers of a list of complaints he had received from an employee We have received a list of grievances from a former paramedic with Richland County It's unclear if Gottlieb's list is the list Bronson was referencing before his comments That list is an 8-page document of issues Gottlieb wished would be fixed "So I'm looking through this list with 50 different problems and if it's really that bad you can just kill yourself or leave," Bronson reportedly said according to one of the people in the audience One we just lost a deputy because of suicide I don't think he understands the gravity of the situation we're here because we love what we do," the audience member said This comes on the heels of a WIS Investigation that spoke with several current and former Richland County EMS employees who claim a harsh work environment with issues such as understaffing completely preventable deaths due to those long response times Richland County is one of the busiest counties in the state responding to close to 70,000 calls a year and increasing according to several sources who we spoke with during our investigation Those same sources also say nearly 100 people have quit in the past several years but several things that were gnawing on me for a while," Matt Gottlieb said I can't get you a lot of detail because of HIPPA [law] But let's just say that a patient didn't get the best care and died because of it." We attempted to contact Bronson directly by visiting his office Friday morning but we were met by county public information director Beverly Harris who said Bronson was only available through appointment Harris also said the county would not be issuing a comment "We're not going to comment on something that was said at an internal employee meeting," Harris said we've since learned Bronson apologized to EMS workers through an e-mail forwarded to us by a source close to the situation Bronson said his comments were "inappropriate and insensitive." Bronson went on to say in the letter that he has received some type of punishment for his comments but that punishment has not been made public "The disciplinary action I received was appropriate and the time I spent in the woodshed was both painful and appropriate," Bronson said Bronson also called upon his own experience with suicide saying he lost a family member to it after he completed college "The pain of losing her in that matter is deep and everlasting," Bronson said "I should not have allowed either the heat of the moment nor the situation to lead to a moment of such callousness." also promised to respond to the concerns addressed by EMS employees Richland County Administrator Gerald Seals also released a statement saying Bronson's comments were "inappropriate" and "cavalier." "While public recounting of the incident has been mischaracterized the fact that such comments were made will not be tolerated Although this Assistant Administrator promptly apologized more needed to be done – and he has been disciplined I also apologize for what happened and regret that an employee in the Administrator's Office spoke in such a manner I am committed to ensuring all County employees know they are valued and respected," the statement said ** 8/14/17 UPDATE: Kevin Bronson submitted his resignation on Monday morning. Read more here. In last month’s column we held the mirror up to ourselves as both professionals and a profession We examined three every day patient and equipment handling errors that not only cause many of our injuries but also cause the patients a fair amount of anxiety and discomfort From lifting and loading the cot to the classic sheet drag patient transfer there are poor lifting techniques in our profession that we must stop doing Let’s look at two more lifts that we do that can cause a lot of injury and look at better ways to get them done The National Institute of Occupational Safety and Health (NIOSH) defines any lift below the knees “lifting in the danger zone” cot and patient lifts from the floor are all in the danger zone This is the area where the negative load on the tissue is so severe that you have the highest chance of sustaining an injury By far the long board lift is the most dangerous lift we do “in the danger zone” so it only makes sense to master that movement When lifting a board always do the following: In the last 6 years I have trained thousands of responders to lift a long board I can confidently say that less than 40% can do it properly Everything from strength to flexibility can affect your biomechanics The next time you have to lift a spine board or a patient off the floor use a flexible stretcher like a mega-mover or transfer tarp and then move the patient who is on a long board onto the flexible stretcher When you lift the board with the flexible stretcher your lift height is at roughly knee level This gets you out of the lifting danger zone and takes the dangerous load off of your back Flexible stretchers area great tool to use on most calls and not just for bariatric patients It never ceases to amaze me that there can be 4 or 5 responders on the scene yet when it comes time to load the cot there is still just one person on the end and one lifting the carriage One of the good things about the powered cot is that you have to load and unload the cot with 2 responders on the end due to its weight Since many services still have manual lift cots this practice must become part of how you do business It makes no sense to load a cot on scene by yourself if there are responders on scene to that can raise the carriage for you Two people loading the cot together at the foot distributes the load which means you will not have to “fight” to get the wheels into the patient compartment For those times that it’s just you and your partner having to load the cot try this maneuver: Get into a deep squat with your chest against the foot end of the cot Since you are in a deep squat when you stand up the cot is at a much higher load angle All you have to do now is to push the cot into the ambulance Another benefit of this approach is that it limits spinal extension (leaning back at the top of the lift) step out of the box a bit and realize that one of the keys to making your job easier while also reducing your chance of getting hurt is to work smarter and not keep doing what you have been doing insanity is doing the same thing over and over again expecting a different result Lift smarter and reduce the load on your body every chance you get We can do these every day tasks better and safer the Romans established two military camps in the Bad Ems area near Koblenz in the 1st century AD This is the result of research carried out as part of a teaching excavation that spanned several years and was carried out by Goethe University’s Department of Archaeology and History of the Roman Provinces in cooperation with the federal state of Rhineland-Palatinate Several surprising findings were made during the process the exciting research story earned young archaeologist Frederic Auth first place at the Wiesbaden Science Slam.  who teaches archaeology and the history of Roman provinces at Goethe University returned to Bad Ems toward the end of the excavation work all the photos sent by his colleague Frederic Auth showed but a few pieces of wood Scholz was ill-prepared for what he saw next: a wooden defense construction consisting of sharpened wooden stakes The martial-looking structure was intended to deter enemies from attacking the camp to modern barbed wire – are referenced to in literature from the time The damp soil of the Blöskopf area obviously provided the ideal conditions: The wooden spikes which probably extended throughout the entire downward tapering ditch around the camp The work of the Frankfurt archaeologists and Dr Peter Henrich of the General Directorate for Cultural Heritage of the German federal state of Rhineland-Palatinate uncovered two previously unknown military camps in the vicinity of Bad Ems situated on both sides of the Emsbach valley The excavations were triggered by observations made by a hunter in 2016 spotted color differences in the grain field indicating the existence of sub-surface structures which bears the beautiful name „Ehrlich“ (the German word for “honest”) confirmed the thesis: the field was crisscrossed by a track that could have originated from a huge tractor it was a double ditch that framed a Roman camp Geomagnetic prospecting later revealed an eight-hectare military camp with about 40 wooden towers carried out in two campaigns under the local direction of Dr The 3,000 soldiers estimated to have been stationed here probably had to sleep in tents Burn marks show that the camp was burned down after a few years located some two kilometers away as the crow flies The „Blöskopf“ is no blank slate when it comes to archaeology: Exploratory excavations carried out in 1897 uncovered processed silver ore raising the assumption that a Roman smelting works was once located there The thesis was further supported by the discovery of wall foundations For a long time it was assumed that the smelting works were connected to the Limes built some 800 meters to the east at around 110 AD have now been disproved: The supposed furnace in fact turned out to be a watchtower of a small military camp holding about 40 men It was probably deliberately set on fire before the garrison left the camp The spectacular wooden defense structure was discovered on literally the penultimate day of the excavations – along with a coin minted in 43 AD proof that the structure could not have been built in connection with the Limes But why did the Romans fail to complete the large camp instead choosing to abandon both areas after a few years Archaeologists have found a possible clue in the writings of historian Tacitus: He describes how attempts to mine silver ore in the area failed in 47 AD the team of Frankfurt archaeologists was able to identify a shaft-tunnel system suggesting Roman origins The tunnel is located a few meters above the Bad Ems passageway which would have enabled the Romans to mine silver for up to 200 years – that is the silver was mined in later centuries only The Romans‘ hope for a lucrative precious metal mining operation also explains the military camp’s presence: They wanted to be able to defend themselves against sudden raids – not an unlikely scenario given the value of the raw material further research is necessary,“ says Prof whether the large camp was also surrounded by obstacles meant to hinder an enemy approach but traces could perhaps end up being discovered in the much drier soil The fact that the Romans abruptly abandoned an extensive undertaking is not without precedent 200 tons of silver would be extracted from the ground near Bad Ems The soldiers who were ordered to dig the tunnels obviously had not been too enthusiastic about the hard work: Tacitus reports that they wrote to Emperor Claudius in Rome asking him to award the triumphal insignia to the commanders in advance so they would not have to make their soldiers slave away unnecessarily The research in Bad Ems was carried out jointly with the Directorate of State Archaeology in the General Directorate for Cultural Heritage of Rhineland-Palatinate the Institute of Prehistory and Early History at the University of Erlangen-Nuremberg and the Berlin University of Applied Sciences Also involved were the hunter and honorary monument conservator Jürgen Eigenbrod and his colleague Hans-Joachim du Roi as well as several metal detectorists with the necessary permits from the historical monument authorities The project was financed with support from the Gerhard Jacobi Stiftung the Society for Archaeology on the Middle Rhine and Moselle and the German Research Foundation (Deutsche Forschungsgemeinschaft The wooden spikes have meanwhile been preserved at the Römisch-Germanisches Zentralmuseum in Mainz Publication: A monograph on the archaeological excavations in Bad Ems is currently being prepared How do biology teachers inspire students about their subject The first “Workshop on Biological Sciences” brought together eight students from Wie begeistern Biologielehrer*innen Schüler*innen für ihr Fach Im ersten „Workshop on Biological Sciences“ trafen acht Studierende des Kibbutzim College of Frankfurter Wissenschaftler vertritt deutsche Forschungslandschaft bei UN-Umweltkonferenzen bei denen der Fokus auf internationalem Abfallhandel und Chemikaliensicherheit liegt Die Goethe-Universität Frankfurt zuletzt als Joint Researcher am C3S und am Potsdam-Institut für Klimafolgenforschung Frankfurt’s Städel Museum and the Department for Geriatric Medicine at Goethe University Frankfurt are developing an app for people with Frankfurter Städel Museum und Arbeitsbereich Altersmedizin der Goethe-Universität entwickeln App für Menschen mit Demenz Demenz ist bislang nicht heilbar Wie die klassische Methode der Hirnstrommessung bei der Schlaganfalltherapie eine Renaissance erlebt Die klinische Neurophysiologie befindet sich in einer spannenden Wie MRT-Bilder bei Diagnose und Therapie von Hirntumoren helfen können Hirntumoren – Gliome – sind schwer zu behandeln und deshalb © 2024 Goethe-Universität Frankfurt am Main | Impressum | Datenschutzerklärung | Cookies verwalten The brightness and warmth of the summer is a chance for us to recharge our batteries But when the sunny days get shorter and the colder seasons beckon then we start to need a bit of comfort and calm There are plenty of ways to top up your energy levels in harmony with nature in Rhineland‑Palatinate: being close to the water breathing in fresh air and feeling the earth under your feet Our journey through the state tracks down the elements and even discovers a fifth one that is typical of Rhineland‑Palatinate There are an impressive 15 mineral springs The spa resort of Bad Ems sits in an idyllic spot in the lower Lahn valley near Koblenz and is an ideal spot to regain strength from the element of water Bad Ems was one of the most popular spa resorts in Germany Many European monarchs and artists had summer residences built in this ‘global spa’ in the 19th century And the tradition lives on. People still flock to Bad Ems to relax and enjoy the beauty of nature. The thermal spa featuring the first river sauna in Germany is especially popular Visitors can swim in 6,600 square metres of thermal waters leave everyday stresses behind them in the sauna park enjoy a massage to relieve their tensions and exercise in the fitness area Or simply daydream while enjoying the view over the Lahn Heraclitus famously declared ‘panta rhei’ (everything flows) View of the outdoor pool at the Emser Therme thermal baths in Bad Ems Relaxing at FlussSauna on the Lahn at the Emser Therme: in Bad Ems Fire: Bad Bertrich volcanic Eifel thermal spa The volcanic spa is an idyllic spot and the perfect place to get closer to the force of fire. There is fire blazing under the ground here, and the Vulkaneifel Therme in Bad Bertrich captures its energy The swimming pools are filled with healing waters straight from the volcanic depths Pleasant naturally warm temperatures of 32 degrees Celsius and valuable natural minerals are good for the body The Vulkaneifel Therme is wonderfully relaxing and the only Glauber salt thermal spa in the whole of Germany The saunas also lean heavily on volcanic activity Five saunas from different volcanic springs and a steam bath bring warmth into the depths of your body and increase your feeling of well-being There are luxurious relaxation rooms where you can enjoy the lasting effects of the heat and let relaxation flow through your body Relax in the mineral waters of the Vulkaneifel Therme Bad Bertrich Outside area at the Vulkaneifel Therme in Bad Bertrich Air: Salinental health park in Bad Kreuznach just in the middle of Rhineland‑Palatinate Take a deep breath – the fresh breeze is good for the lungs and the bronchial tubes Relaxing walk along the graduation works in Salinental Wine is the core product that shapes the environment from picture-perfect sloping vineyards to cosy wine bars But WellVinEss is not just about wandering through the vineyards before enjoying a glass or two; wine and grapes also play a central role in the treatments These include bathing in Riesling or Pinot Noir (the former stimulates a grapeseed oil massage or a grapeseed peel A Rhineland‑Palatinate journey for the senses In its idyllic setting between the Moselle and the volcanic Eifel the spa resort of Bad Bertrich in the GesundLand Vulkaneifel is home to the only Glauber’s salt thermal spring in Germany The spa resort of Bad Ems offers a range of preventative wellness and restorative treatments to escape the stress of everyday life the state-accredited spa resort of Bad Kreuznach is the largest open-air inhalatorium in Europe Enjoy your time in the Felke town of Bad Sobernheim on the barefoot trail or with a treatment in one of the leading medical wellness hotels in Rhineland Palatinate Rhineland-Palatinate and Saarland have healing baths climatic health resorts and spas where you can nurture your vital spirits in relaxing… SEARCHThe global authority in superyachting Ruth Bloomfield explores Germany's renowned spa towns, unpacking the many reasons to buy property here... If anywhere in Europe can lay claim to being the birthplace of wellness it is Germany, where the wealthy have flocked to take the waters since antiquity. The country is home to three of Europe’s 11 UNESCO World Heritage spa town sites – Baden-Baden and the smaller towns of Bad Ems and Bad Kissingen – all an easy drive from Frankfurt Airport. Venerable guests have included Mark Twain, who said he had “left his rheumatism” in Baden-Baden, and Marlene Dietrich, who described the town’s casino as the most beautiful in the world, as well as a trio of contemporary power couples: the Clintons, the Obamas and the Beckhams. Victoria Beckham recently told her Instagram followers that she and David visit yearly for an “annual MOT”, having “literally everything” checked out. Baden-Baden’s international reputation (the name means “the baths of Baden”) is staked on its spas and clinics – you can visit the glamorous Friedrichsbad bathhouse or book a treatment at hotels such as the Belle Époque-era Brenners Park-Hotel & Spa – but there are other reasons to buy property here. Those who wish to immerse themselves in nature have the 600,000-hectare Black Forest on the doorstep, and the town itself is both beautiful and useful, with an opera house and theatre, Michelin-starred restaurants and designer stores. “Even though the population is only 55,000 people, it is a very special place – a luxury city, an oasis with a lot of international flair,” says Peter Schürrer, managing director of Baden-Württemberg Sotheby’s International Realty. Baden-Baden’s prime property is centred around Lichtentaler Allee, an exquisite park that snakes its way southwards from the town centre. Around it are a dozen or so streets lined with fairytale white stucco mansions. The average asking price in Baden-Baden stands at €4,144 (£3,551) per square metre for houses and €3,457 per square metre for apartments, says Thomas Zabel, managing director of Savills Residential Agency Germany. But around Lichtentaler Allee, buyers can expect to pay upward of €10,000 per square metre and, since the houses are large, prices start at around €4 million. These homes rarely come up for sale. Before the invasion of Ukraine they tended to end up in the hands of Russian owners. Today, says Schürrer, they may be bought by wealthy Germans as a main or holiday home, or by Swiss, Italian or American buyers. Those who intend to make Baden-Baden their permanent home tend to be families attracted by the good schools and retirees for whom the outstanding medical facilities appeal, he adds. His prognosis for the future is that prices have reached their lowest level in the prime Baden-Baden market, although he expects values to remain flat in the short and medium term. Schürrer agrees that the power balance of the Baden-Baden market switched in 2023 from sellers to buyers, who now have a far greater choice of homes than in the recent past. He believes this imbalance will cause prices to stagnate this upcoming year, and three or four years beyond that. Looking on the bright side, Zabel believes now is a good time for buyers to pick up a prestige property at a sensible price. “For buyers, entrance prices are cheaper than before, and they are not going to lose money over the next two years,” he says. Located 10km east of Baden-Baden, Schloss Eberstein was built in the 13th century and comes with 43 hectares of grounds, including gardens, forest and vineyards. Currently a boutique hotel, it could be converted into a spectacular 7,180m2 private home. €19.5 million, sotheybysrealty.com Latest news, brokerage headlines and yacht exclusives, every weekday SubscribeSign up to our newslettersSign up to BOAT International email newsletters to get the latest superyacht news, business analysis, exclusive event invitations, and more. Boat International Media Ltd © 2008 - 2025. Content presented under the "BOAT Presents" logo is an advertising feature and Boat International Limited has been paid to include this content. Gothamist is funded by sponsors and member donations Christopher Robbins is a New York City reporter covering transportation, affordable housing, local politics, and criminal justice. His work has also appeared in New York Magazine, The Village Voice and The New York Times. Chris is a graduate of Patrick Henry High School in Roanoke, Virginia, and enjoys biking to Fort Tilden in the summertime. 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