Thursday, September 11, 2008

A true story

Before I wrote the first report on EMS occupational injuries for NAEMT, I knew more than my fair share of EMS brothers and sisters who had suffered back injuries, were involved in car wrecks, TOO TOO MANY who were physically assaulted, unfortunately one guy who was shot, and a couple who were stabbed.

As part of the EMS honor guard I had done line of duty death services for many of our own in the NY, NJ, and PA area. Every-time we went to ceremony, I always felt terribly guilty, because afterward I said "It wasn't wasn't anyone I knew..."

My response was never like the scene from "Full-Metal Jacket", where the Marines are standing around one of their own, and the view is from the deceased's perspective...

One guy says "Go easy Cowboy", and they go around from one to the next, another guy says, "Semper Fi" until they finally get to a guy called Animal, and he says "Better you than me"...

I was never like that! While people wanted to talk about how our long loved brother or sister had lived their life, or if they were injured, the great times they USED to have, I wanted to find out the who, the what, the why...

Why did they have to die or get hurt...

Was there a better piece of equipment to use...

Could we have done a better job designing equipment for them to do their job...

Was there a safer ambulance...

Were there better radios/methods of communications...

Was there a better way we could train or prepare people for work...

Better procedures...

Because I didn't want it to happen AGAIN. I admit this is always painful, but I wanted to KNOW.

One young man in particular, stands out, his story will always live with me. We had sent our honor guard over from UMDNJ for his funeral. Units came from all over, as far north as Boston and as far south as Washington, D.C. This young man was an EMT who was killed while loading a patient into the back of his ambulance.

He was struck and killed by a drunk driver who drove into the back of his EMS unit, killing him and critically injuring his partner. I don't know if he even knew what happened, but I do know one thing, he was at his most vulnerable, he couldn't even throw his hands up to protect himself because he was holding on to the stretcher. He wasn't going to let his patient fall, he never left her side.

I wanted to ask someone "Was there anything that could have been done to protect them..." but somebody else asked the question. Nobody knew the answer.

Now I know that you will say "well just keep drunks off the road...there was nothing you could do..." but what if there was?
Was there? When I became Chairman of the National Paramedic Division and I started to ask questions, the one thing I found out, there was little data and even less research on how or why we are injured in the line of duty.

Every-time someone was injured, every-time someone died, I heard the same thing..."Never again"or "lets learn from this one boys..." .

But how? We didn't share information, we didn't have any data to develop meaningful injury prevention programs. If we had good data, GOOD INFORMATION, we could then begin to incorporate this information into EMT and paramedic classes, into training programs for CPR, ACLS, PHTLS, perhaps even preventing someone from dying in the line of duty or suffering a career ending injury.

Then I heard about Nadine Levick, who was talking about ambulance crashes and how we should make our vehicles safer...I had good friends who were doing the beginnings of EMS injury research say "...we really don't understand the MAGNITUDE of this problem..."

Why wasn't anyone else paying attention to what these people were doing?

It still begged the question: Without data, without information, how do we develop meaningful injury prevention programs? How do we stop repeating the cycle of injury, disability, and death?

There were so many things we didn't know and and we needed to learn, from wellness-fitness programs for EMS providers, to how to respond to terrorist incidents, how Mercedes Benz crash tests ambulance. So many different ways to protect us. Were any of them fool-proof?

No, but it was better than what I knew, which was nothing.
It just made me ask:

If we had better ambulances and better driver training, would deaths in emergency motor vehicle collisions decline?

If we had wellness-fitness programs and better training would we have less back injuries?

If we had better procedures and training, such as what you see in Israel, could the injuries suffered by the police in the abortion clinic bombing in Sandy Springs in 1997, have been avoided?

I knew in my heart what the answers were, but did anyone else?

While I knew quite a few people who had suffered line of duty injuries, I never lost a partner. I had known cops and firemen who had died and it was always a terrible loss. It was from other peoples tragedy and loss that I became motivated to try and find out what I could about EMS occupational injuries. I wrote the first occupational injury report, and it was at this point I knew what I didn't know! Yet there has to be a better way I thought.

Still every-time someone died, it was never anybody I had been partnered with. I asked every night I went out on the street, "Please let me and my friends come home tomorrow..." It wasn't until I lost someone close to me that the mantra "Never again" took on whole new meaning...

At 9 pm on September 11 I spoke your name. I was afraid to ask, but I had to know. We were organizing the volunteer squads for stand-by at Rutgers University in Newark. They had too many people down at Liberty State Park. I had waited too long to ask about you, but now I was at the point I had to know, I had to ask because I couldn't concentrate on what I was doing.

In a small voice I said "did anyone hear from Dave or Bobby?"

Mario Piumelli said to me "Bobby called his wife and told her he was OK...nobody has heard from Dave..."

I took a deep breath...Dave Lemagne was my relief for 5 years...a happy guy with an infectious smile, I said a soft prayer and hoped for the best. Maybe he would turn up at a hospital somewhere. Police officers from NYPD had turned up at a slew of hospitals in NJ, I hoped Dave would show up somewhere.

I was too scared to ask about anybody else.

The next day on September 12 I talk with Bill C. I said to him whats up, and I should have been suspicious, because Gene O turns his head away when I ask this question. Gene can't hide his emotions very well.

Bill tells me "they found Bobby's radio-car..."

I don't comprehend this because I say, "ya, but Bobby's ok, he called his wife..."

Mario, who s standing next to me, jolts me back to reality "Danny, he called his wife before he went inside...nobody has heard from him since..."

I went numb.

On September 26, I BEG to bring personnel over to NYC. It is the last day NJ will have resources on scene at the World Trade Center. On the ride over it is very quiet.
Gene O looks over and asks me, 'are you ok?'

"Ya I 'm good"

I go inside with Gene and he introduces me to several people from FDNY EMS he has been working with. I make an excuse to go outside. I walk to the fence and I stand looking. Words escape me as I look around. This is the one time in my life I don’t know what to do or say. Overwhelmed by the magnitude of this event, it is one thing to see it on the news, it is another to stand here and look. I still cannot comprehend the what, the how, or the why. This is one time I cannot bear to ask, "what could we have done better to protect our own"...I step forward, staring into the faces coming off the pile, and I wonder 'will I see you...', but like specters, they come toward me, appearing, but you aren’t there…
still I hope, maybe you will appear...

I must have looked overwhelmed because I feel a gentle hand on my back. I hear Gene behind me say, “You OK brotha’?”
I turn to Gene. “Ya, thanks, I’m good, bro’ ”

A Paramedics Tale

In my neighborhood, where I grew up, it was tough. You had a mix of people from around the way, to serve as examples of what was right or wrong. I knew people who were stone cold hoodlums, arch-criminals. I had friends who became junkies, addicted to pills, heroin, you name it, they would do it. I had friends who became cops, firemen, accountants...In my family I had people who were writers, artists, doctors, lawyers,  a U.S. Congressman even! It was definitely a different way of life, because you made choices early on.

When I first got involved in the field of emergency health services, I was fortunate enough to meet many people who had a profound impact on who I became and what I do. I feel I have been graced to have met the different people I have throughout my life. I remember my first EMT instructor, my first partner, my first boss. Maybe it is a New Jersey thing.

I am serious!

Wait hear me out!

Being from New Jersey, you are ultra sensitive about who you are and where you are from. Some people, SOME PEOPLE from NJ have this overwhelming feeling that you need to make excuses for where you’re from, where you lived, where you went to school. It was almost as if being conceived and born here was the ultimate stigma. You were constantly the butt of jokes, from Lou Costello on up. You would catch Dave Letterman making “Jersey Jokes” on his talk show during the opening monologue. It was strange, but even within New Jersey there was a pecking order. If you were from Newark or Jersey City, it was over! Those were the worst “Jersey Jokes”. Maybe that’s why people from New Jersey will bond together, avoid the “jokes” made at our expense. We seek out other people who have the same experiences, the same memories.

If you from New Jersey, you walk with a certain confidence, part bravado, part I don't care what you think. If you were from Newark or Jersey City this was especially true, you never cared what people thought because you were cool.

In my case, I would immediately identified with a guy from an urban area, even if it wasn’t Newark, because you had the same memories of crowded public schools, catching public transportation, hot summer nights on the corner with your friends, cruising with your friends…

Besides identifying with a guy from being around the way, now we add the EMS factor. Whether you are talking Newark, Jersey City, Elizabeth, NYC, Philadelphia, San Francisco, Chicago, I don’t care where you are from, you are in a special brotherhood. Next to police and fire departments, I used to tell new guys at work we were members of the third largest street gang in our city. Where I worked, one of the busiest EMS systems per capita in the United States Newark, you have seen so much death, despair and heartache, something really has to be bizarre to get you to turn your head. You can tell the difference between a car that backfires and real gunfire. You know what it means to “hump” (work HARD) in the summer time. You have seen tragedy, people at their best, and unfortunately, people at their worst. You know what it’s like to depend on your partner.

Robert Cirri, (Bob actually, Robert was only used when he was in trouble he told me), was a guy you could trust, a guy you could depend on. He was a likable, easygoing fellow. He had a smile that could light up a room.

Like me he was an Italian-American kid who grew up in a big city (I grew up in Newark and Bob grew up in Hudson County/Jersey City). We had many a discussion on good Italian home-cooked food and what it was like growing up in the dwindling Italian neighborhoods of metro NY-NJ. I was assigned to his paramedic unit and he (and Debbie Ehling!) was going to teach me about being a field paramedic. He had a presence that could be felt when he walked into a room. Bob was the ultimate “no pressure” preceptor. You could be in the middle of the worst trauma, faced with a difficult intubation and Bob was always right there, ready to help out, with either words of encouragement, maybe a little cricoid pressure, something. He never “hovered” right over you, making you feel more pressure then there already was. Now I don’t want to leave out Debbie Ehling, she was just as important as Bob, she was Bob's partner and the other preceptor entrusted to my development, don’t get me wrong, but I will talk about Debbie another time. If you did a good job, he would give you a hearty back-slap when all was said and done and tell you “That was great bro’!” (another word used as a term of endearment was “cuz” an abbreviation of cousin. Cuz and Bro are endemic to the Italian-American culture in the Northeast. Hey you have to be from NJ...). If you made a mistake, he never chastised you but instead he would say, “Hey I know that is pretty tough, can I show you a better way to do that…”

Bob would quiz me on different drugs or pointed out the intricacies of the different equipment we had to use. He was clinically astute, always reading, always asking questions. Bob always knew the best places to eat as well as where to “people watch” to make the day go by faster. Smooth as silk, he never got himself into a situation on the job where he had words with people, and if he unknowingly walked into a situation that was “in progress” he always had your back. He was all and all the kind of guy you would want for a steady partner and a friend.

I think I really connected with Bob because we both enjoyed helping people. Bob was an Auxiliary Police Officer and he wanted to ultimately become a full time police officer in a large department. He said the pension and benefits were better then in EMS. I asked him if he was going to give up being a paramedic when he became a cop and his reply was “Never. I worked to hard to get this and I love doing it”.

After I became certified as a paramedic I had the opportunity to work with Bob in Jersey City and again later on when Bob worked per diem in Newark, NJ. When I was promoted to Supervisor/Chief in Jersey City, Bob gave me my rank insignia for my collar. He then took me out after work for a beer to Jules Tavern in Jersey City to celebrate. We always had a good time, and not only at work either. It could be running over to Manhattan for some late night Chinese food at Wo Hop, going for dinner at Laicos in Jersey City or bar hopping in Hoboken, we always had fun.

I remember when Bob got hired by the police department. He loved that job! I remember talking to Steve Velasquez, who reminded me of a story when Cirri graduated from the Police Academy. Bobby was going around showing everyone his badge, and honestly it was impressive. Billy Newby had a badge in his drawer that said "Pussy Inspector", for people who needed to inspect young cats, that was essentially the same size and shape as Bobby's police badge...I couldn't resist, I swapped badges when Bobby wasn't paying attention and handed it back to him. He kept showing it around for about an hour or so before somebody pointed it out to him.


Bobby still loved being a paramedic. We continued to work together for a while. I would see him at different times too, either at an ACLS class or a conference, or even when he was working as police officer. If I was in the dispatch center every once in a while on a weekend I would hear him calling in a report to the hospital where he still worked as a paramedic. As with all things in life we move on to different places. I started to become more involved in education. Bob studied hard and got promoted and eventually moved into training. Our opportunities to interact were fewer and farther between, but if we did see each other we could generally be found laughing about something, “Do you remember the time when…”

No matter what though, whenever I saw him he still had that ear-to-ear grin and that same look on his face. It told the whole story...

Hemingway once said that "Man is not made for defeat. A man can be destroyed but not defeated, you cannot destroy his will to survive..."

Hemingway also said every true story ends in death.

September 11, 2001 in the NY/NJ area was a beautiful day. The sky was crystal clear, the sun was shining, it was a perfect morning. On this day terrorists hijacked four planes, two of them they flew into the World Trade Center Towers in New York City in one of the worst events to occur on American soil. A scene imagined by Dante in his wildest imagination could never equal this. Victims running everywhere, flaming debris and human bodies raining down from 90 floors up.

In his office in the Training Academy, Lieutenant Bob Cirri of the Port Authority Police Department (former Jersey City Medical Center EMS Chief and Hackensack Medical Center Paramedic), responded to the Towers. Donning his self-contained breathing apparatus, he headed into the World Trade Center. From outside the World Trade Center, Bobby called his wife to tell her he was OK.

He headed inside, where he assisted in directing rescue operations and proceeded to the upper floors to ensure that patrons who could not navigate the stairs got out. He and his men assisted several people down to the ground level, who otherwise could not get out.

Inside of One World Trade Center Lieutenant Cirri was heard from via radio, coolly and calmly, directing and participating in rescue efforts. The Port Authority Command Post updated Lieutenant Cirri that one tower had already collapsed, and the building he was in was also in danger of collapse, to abandon all rescuer efforts and exit the building immediately. He was given the order to evacuate. Lieutenant Cirri stated that they were in the process of carrying down a woman who was wheelchair bound, who couldn’t get out otherwise. She was being carried down in a rescue chair (a stair chair for my EMS brothers and sisters).

The radio came alive, with a direct order from the ranking officer, leave the woman and get out of the building, NOW.

Lieutenant Robert Cirri advised the command that he and the 5 other Port Authority officers and the men from FDNY with him were going to get her out. He was not going to abandon his patient.

Tense moments passed. In the command center for the Port Authority Police, they anxiously monitored the radio, the clock ticking…they watched as local, national, and international TV broadcasts, transmitted the horrors for all to see.

Finally, after what seemed like an eternity, the radio crackled…Lieutenant Cirri could be heard, his voice strong…He transmitted a message to the Operations Center for the Port Authority Police “…we are downstairs in the lobby, I can see daylight…”

And then…silence…

After the collapse of One World Trade Center, Lieutenant Robert Cirri and his men were initially listed among the missing. Many of Bobby’s friends went to the site of the World Trade Center, to dig…to pray…to cry…to hope…

On February 11, 2002, while removing debris from what would have been the lobby of One World Trade Center, a woman was discovered strapped into a rescue chair belonging to the Port Authority Police Department. Next to her was Lieutenant Cirri, his men from the PAPD, and the other members of the FDNY. Bobby never left her side.

Bon Viaggio mio fratello, you are missed by all, never forgotten, and always loved.

PAPD PO Steve Huczko RN, EMT-B and PAPD PO Dave Lemagne, MICP, I didn’t forget you brothers, I am just too heartbroken to write anything else.

Today's posting is dedicated to all of the men and women of the Port Authority Police Department that I have come to know over the years, to the personnel of the PAPD, FDNY, FDNY EMS, NYPD and my other brother and sister EMTs and paramedics who gave their lives so gallantly. Their stories are no less poignant.
Stay safe my brothers and sisters. I will see you in the street.

Wednesday, September 3, 2008


Who I am

I have 20 years experience as field EMS provider in Newark, NJ. I was first certified as an EMT-A in 1981 volunteering as an EMT on the North Ward First Aid Squad, Newark, NJ. In 1983 I then secured a position working EMS as a Basic EMT in Newark NJ. I became a paramedic in 1985. At this time I became involved in education, first as a CPR and EMT instructor, later as an ACLS, PALS, PHTLS, and AMLS instructor. I then became a faculty member at the George Washington University paramedic program.

I was a Tour Chief for Jersey City Medical Center and later on I was the EMS Director for the Saint Barnabas Health Care System. My activities in NAEMT include: Immediate Past Chairman National Paramedic Division/NAEMT – I authored the very first report to NAEMT on EMT and Paramedic Occupational Injuries in 2000 with a follow-up report in 2001, I was the NAEMT representative to CAAHEP and to CECBEMS, I also served on the NAEMT Committee for the development of the first AMLS program.

I have worked as a consultant to the Pan American Health Organization and Bahamian Ministry of Health on EMS. I was also lead consultant to the Hong Kong Fire Services Department on the Paramedic Ambulance Service Re-Design.

I am currently the EMS Coordinator for the City of Alameda Fire Department (Alameda, CA) and the Treasurer of the San Francisco Paramedic Association. I was featured in the book "Into the Breach" by Jana Abrams-Karam.

What I believe

We need to be engaged, as engaged as our brothers and sisters in the police and fire services. Only through an active membership and leadership will we accomplish great things for the EMS community.

What is NAEMT's position on the Ryan White Care Act?

In 2006, the emergency-response provisions were removed from the Ryan White Care Act by Congressional staff members. This omission places every emergency responder at risk. This wasn't a malicious act, but it is an issue of vital importance to the health and safety of EMS personnel everywhere.

NAEMT must actively engage the leadership and members on this critical issue. We need to contact every member of Congress and we need to do it yesterday. This is a vital issue and the Executive Board of NAEMT must be INVOLVED. NAEMT must put out a policy statement on this issue, so that the media and members of Congress know where we stand.

EMS Occupational Health

I wrote the first report on occupational injuries for the Association. I know how important this issue is. Look at the International Association of Firefighters and the Fraternal Order of Police, these groups have truly stepped up for their membership.

What do we need to do?

NAEMT must sponsor a national occupational injury summit during our national meeting. I would seek to bring the various stakeholders in EMS and occupational health together, to develop an agenda and work plan for reducing occupational injuries in EMS. We also need to recognize EMS organizations that are working strides in reducing occupational injuries. We must provide this information on those successful programs to all EMT’s and paramedics.

NAEMT must also approach Congress to give us the tools we need to protect EMT's and paramedics and to gather data so that we may begin to understand the scope of the occupational health problem in our profession. Only then can we begin to develop curriculum for health, safety, and well-being of EMS personnel everywhere.

We owe this to our profession.

Federal Interagency Committee on Emergency Medical Services (FICEMS)

FICEMS represents all of the federal agencies that have their hands in EMS. What is the problem with FICEMS? It has no teeth. It controls no budgets or money, and cannot hire or fire anyone. The reports they will submit to Congress do not have to be acted upon. They cannot dictate policy. This was made evident during the release of the Institute of Medicines (IOM) report on Emergency Medical Services. The IOM stated that we need a single lead federal agency for EMS PERIOD. EMS by committee DOESN'T WORK.

We cannot ignore this fact. When the Ambulance Fee Schedule was first published, and Medicare stated that IV therapy was not an ALS skill where was FICEMS? It was as if Medicare (who controls the re-imbursement money) and NHTSA (who writes the curriculum for EMT's and paramedics) never had a conversation about what is an ALS skill and what is a BLS skill. Yet they both sit on FICEMS. When Medicare stated that EMS providers MUST obtain a verification signature for emergency patients transported to the hospital, where was FICEMS? The EMS event for most patients and their families is stressful enough, never mind what the EMS providers must deal with. Imagine this: You are on an emergency response, it is of a critical nature, with a life hanging in the balance. Now I am going to ask you for a signature for payment, and draw attention to the fact that this may or may not be covered service... This was a good idea? Since Medicare controls the money, they get to decide what hoops we must jump through to get it. Where is FICEMS in all of this? Using my previous example of the Ryan White Act, where was FICEMS?

NHTSA houses the only home for EMS in the federal government. Go to the NHTSA website ( ). Where does it mention EMS?

In 2008 the federal EMS Office in NHTSA was funded for two million dollars, with a staff of 11. In Alameda County California, the County EMS Office is funded to over 25 million dollars with a staff of 35. In 2005 EMS received only 4 percent of the federal funding for first responders. In the last federal budget and trauma programs received zero dollars.

We need to do this better!

The U.S. Department of Health and Human Services has already begun to move toward an office of Emergency Medical Services. We need to support this office, ask for federal funding and recognition, and ask that the president bring together all of the current agencies, spread through a myriad of federal departments, be consolidated into this one federal office.

Then, with the power to hire and fire, to control budgets, to provide grants and assistance, will EMS even BEGIN to have the recognition we desperately deserve.
The membership overwhelming supports a federal agency, I support a federal agency, EMTs and paramedics nationwide deserve a federal agency, funded and staffed to be equal with the police and fire services.

NAEMT has to do better!

We need to approach this issue by working collaboratively, we need to listen to the needs of the membership and we need to listen to learned bodies such as the Institute of Medicine. I want an Association that is going to take my needs and the needs of my brother and sister EMT's and paramedics seriously. An Association that is responsive to the needs of its members and that is willing to work for its members.

My name is Dan Gerard and I want a chance to do better for you and the Association. Please cast your vote for me as Director at Large.

Thank you,