Public Access First Aid with Seth Goldstein

[TODD DEVOE] Seth, tell me a bit about yourself and how you got to emergency management or emergency services, and a little bit about what you’re doing with your product.

[SETH GOLDSTEIN] Sure. So, my journey in medical services started back in the late 90’s, I was… I have a bachelor degree in environmental science, and I was kind of on a path to working for a company like National Outdoor Leadership School, doing long back country trips with clients and students. And to do that, I needed to get my EMT basic, they all required it; that was the minimum level of training that they wanted to send you out there with. And I took an EMT class at a volunteer firehouse, deep in the Catskill mountains, so it was actually Woodstock, New York’s company 5, and I realized pretty early on that I really liked the medicine, I really liked the science of it; so I ended up kind of changing directions, started working as an EMT for a commercial ambulance service, which I’m sure it’s no different in New York than it is in most… other places around the country. It’s honest work, but it’s hard work, and it certainly doesn’t pay an awful lot. And I realized that, you know, I thought I could do more. And so, after doing that for a year or so, I went to paramedic school, became a paramedic in 2000, and continued to work as a paramedic in New York. Had an opportunity to move out to the Denver, Colorado area with my then fiancee, and worked for Denver Paramedics for about a year, which was just fantastic; what an eye-opening experience. I thought that I kind of had my stuff wired tight, having been a medic for three years, four years, at that point, here in New York. And I was… I had an awakening. It’s a very progressive system in Denver, the standards are unbelievably high. And it was a tough adjustment. You know, circumstances brought me back to New York with my house, and you know, bought a house, started settling down. Continued working as a paramedic, kind of worked up through the ranks of a commercial ambulance service, got into management, got into quality improvement, and eventually, got into education full time. I kind of went full circle and started running paramedic training programs at a community college level, which is really where all those… all the medic programs in New York state right now are affiliated with colleges.

[TODD DEVOE] Right, right.

[SETH GOLDSTEIN] Mostly, community colleges. So, I did that for a while. And while I was doing that, like, so many good stories. I knew a guy, and… he was a former colleague, a former kind of mentor of mine. Roped me into starting some work with New York State Homeland Security, which was… at that time, it was really starting to build up its curriculum, its repertoire. And that was in 2007, 2008, and the domestic Homeland Security community was still kind of trying to figure out what to do about the Mumbai attack that happened in 2006 in India. It was a little bit of a game changer, it was not weapons of mass destruction, which we had spent so many years trying to prep for. It was very simple, it was very orchestrated, and it was very well executed. And we knew that we didn’t have a great solution for 10 guys with small arms, making amphibious landing, which could happen anywhere! And so, we started to develop a curriculum in New York state to help kind of manage that, and we’ve had some pretty good success. We have a fantastic class that we’ve run through our Homeland Security Training Center in New York, called “Against Active Shooter Tactics”. And it’s… it brings multidisciplinary forces, so it had EMS fire representatives and law enforcement; street level folks, not super high speed tactical SWAT-y guys, and we teach them some tactics to manage multiple shooter scenarios. And there’s core learnings that can bring that back and works for single shooter scenarios and other problems, but… a lot of it comes down to communication, a lot of it comes down to being able to integrate with both other agencies within your discipline and agencies from other disciplines in the emergency response community. The reason that… the way that connects to what I’m doing now is that the design team for Mobilize Rescue Systems is basically a bunch of guys that… we’ve been teaching TECC and active shooter response with for Homeland Security. We were approached by a group of entrepreneurs at the Rochester, New York area. Based essentially in our experience in teaching and providing that kind of curriculum and care, and they had this idea that they were gonna make a kit, a first-aid kit; a box, a unit. The name is kind of… we settled on “kit”, but it’s been called a bunch of different things over the few years we’ve been designing it. And they wanted something to be available in that type of event for the by standers, the rescuers present, to be able to do something. And we thought it was a good idea, we ran with that. I think that the mission for the mobilized product line has expanded a little bit. We’re not solely focused on active shooter events anymore, because… although they’re horrific and they do require some timely care to get the best outcomes for the victims, there’s still a small fraction of emergencies that occur daily, weekly, monthly. Once we kind of realized what we could do using the technology and the available over-the-counter medical inventory, we said: “well, if we’re gonna do it for bleeding control, and we’re gonna do it for airway management, why can’t we do it for seizures? Why can’t we do it for allergic reactions? Why can’t we do it for chest pain?” which are things that happen every day all over the place. And that question, we were able to answer and design a product that’s gonna work no matter what the emergency is.

[TODD DEVOE] Right. You know, it’s funny… you know, all the first-aid kits… you know, the university where I teach, we have these little boxes that have first aid on them. And when you put them out, there’s some ok stuff in there, but for the most part is like, bandage and stuff like that, which is really useless when it comes to a major issue that happens. So, I really understand the uptech, the upgrade, I would say, in this kit that you guys have created. So, back in the day, when we first went to the public access to AED, and I know there’s a lot of push factor by paramedics and whatnot, by saying: “no, people don’t understand how to use them, and it’s gonna be difficult”, and they were able to really make those simple and… when I teach, I talk about this little 8 year old girl who, in Chicago airport, saved her grandfather’s life, basically because there was a public access to AED there, she was there for her sister’s girl scout training… and I suppose she learned how to use it. So I always say: if an 8 year old can use it, anybody can use it. And I think this kit that you guys have created is along the same line. If I can use it, anybody can use it.

[SETH GOLDSTEIN] You know, ironically, I have… I have three boys. Right now they’re 11, and I have 9 year old twins. During the design process, though, my twins were 8. And they were my test subjects for a lot of the instructions that we came up with; because we needed it to be that simple to use. A lot of our clients get some onboarding training. You know, they wanna know a little bit more about it if they’re gonna put it in their work environment, but we designed it from day one with the understanding that it could be a public access device. And so, all the language is plain English. There’s no medical jargon in it. The questions are very simple. Usually, yes or no. And the way we designed the algorithm… you know, lately, I’ve been describing it kind of like a “choose your own adventure” novel I used to read when I was a kid. So, on the first screen of the app, the possibilities are endless. It thinks that it’s dealing with a huge emergency with lots of victims and everybody is trying to die. Which… it can do that. It will help you triage and prioritize true life threats versus… you know, lesser emergencies. But as you offer more information and answer the questions in this real kind of simple yes and no format, usually about 5 or 6 questions in, it knows what you’re dealing with. And it’s narrowed down the scope of the emergency down to a point where it can start giving you some instructions. And usually… just like an EMT or paramedic, we start by real basic stuff, we narrow it down, we get them a little comfortable, we position them so we can provide some interventions, and then… you know, it provides a set of interventions that are well within the range of safety for untrained rescuers. We drew that line well on the side of safety. But you’re still able to provide some fairly intricate care. You know, I was doing the demo with one of the guys that I worked with in the firehouse last night, and he went through an amputated limb scenario, and… it walks you through the process to getting the limb and using one of the biohazard bags and the ice pack to put the pieces that have come off, package them the same way we would on an ambulance, essentially. I had forgotten about that part of the algorithm, it’s not some place that we go often in demonstrations. And I’m sitting there, going: “wow! That’s pretty sophisticated.”

[TODD DEVOE] So, do you envision this product being like an AED on the wall, on the side of buildings… is that the design of the kids, what you guys kind of wanted to push for?

[SETH GOLDSTEIN] You know, it’s funny. I don’t see myself as a salesman. You know, I was… I helped design the app and helped make some of the early decisions on the product, so… I haven’t gotten my head too wrapped around where it could go. Like, I was so focused on the mission of being creating it, so that it could accomplish the goal of medical care. Looking back at it now, yeah, I think it could go anywhere. I mean, if you have a demonstrated need for an AED in your location, then… some risk manager has said: “look! There is the possibility that someone could experience a medical emergency here, and we want to be able to do something about that in the 10 or 15 minutes before the ambulance gets here.” And I don’t… I think the same principle, the same logic, should apply to all medical emergencies.

[TODD DEVOE] Yeah, yeah.

[SETH GOLDSTEIN] You know, AEDs are fantastic if you’re in V-fib or V-tach. If you’re not, they’re not all that helpful! So, when you think about all the other emergencies that are out there, that people experience every day… our products are design to walk that bystander through the process of managing that. You know, for a short term, they’re not designed to replace somebody with medical training, you know? If there’s an EMT that happens to be walking by, or a nurse that’s in the airport, or a doctor… we don’t trump their medical experience, training and their judgment. But for that person who wants to do something and is terrified, because… this is it, this is the only emergency they’re probably gonna have to manage; there’s no reason they should feel helpless. Open the box, turn it on, and go!

[TODD DEVOE] Right. I agree with you there. I rescued this idea here, the first thing I envisioned was: wow, this could be something where it is going where all the EADs and fire extinguishers are, because… you know, obviously, the fire extinguisher isn’t replacing firefighters. The AED is not replacing a paramedic as it is now, and obviously, this kit would just be something to enhance that, and it can save lives. When I first saw it, I was like, wow! This is something I need to talk about, because I think this could really be a game changer in how we do this. You know, because… you know, there’s a false point – I think it’s called a false point. And I’ve played it a little bit, and I know… where I live, my fire department is really pushing that out. County-wide, they really want people to do this. And you know, just giving people the ability to do CPR, and they see the value in that. Adding this to that, I mean, this could definitely save lives. I mean, there’s been countless times when I was a paramedic where I’ve run calls where people were cut very severely, and the people around them have a nasty towel… you know, holding that. And wow, this is pretty gross. But you know, that saved a life. But if you had something like this, where someone who doesn’t know what they’re doing has the right equipment, that could be a game changer. And this could replace those cheap first aid kits.

[SETH GOLDSTEIN] Sure. Yeah, you open that white box hanging on the wall, and… first of all, it’s rated. Meaning, there’s nothing all that useful in it. You know, there’s a two by two, there’s some band aids, there’s some triple antibiotic ointment, which… you know, that stuff has a place. Sometimes, you have a paper cut and you need a band aid. And I don’t think that was really part of our mission. We did put that stuff in our kit, mostly to make it… it’s ANSI compliant, you know? OSHA, it’s a thing, and there are industries, there are clients of ours that are very heavily regulated, and we don’t want them to have to buy our product and the little white box that hangs on the wall on the break room. So, we added that stuff in there. We don’t provide instructions on it; you know, if you need a band aid, get a band aid. That’s not something that we think somebody is gonna need… hopefully, not gonna need a whole lot of help managing. But you know, it could be a game changer, and I think that’s part of the… you know, as we start to break out right now, we’re starting to gain some good traction, but it’s hard sometimes for people to understand what it does. We try to explain it to you, and they’re looking like… it’s just not like anything that’s out there right now. Based on inventory or even the capabilities that it provides for an untrained rescuer. So I usually say: seeing it is believing it. Once you open the lid and you see it open up… launch for the first time, it suddenly becomes very understandable.

[TODD DEVOE] Yeah, I think it’s really kinda cool. Like I said, I could see this for sure going into schools, for sure; you know, obviously, places like airports, places where we have a lot of people going around, where you need to have something like this.

[SETH GOLDSTEIN] Of course.

[TODD DEVOE] You know, I… a few years ago, there was a mass shooting that I went to, and when I entered the room, there was… he was a trained EMT, but he was across the street from a construction site, and he came over to help out, right? He’s a former marine, so they tend to want to go towards the action instead of running away from it. And I look at him, and I go: “what do you have for your first aid kit?”, and he showed me this little tiny white box that he had, and it had really nothing in it. And he was attempting to help people with just that little kit, and I could see his face, the frustration that he had, that he didn’t have what he needed to treat. In the room, there were 8 people that were shot in that room, and there was one person in the parking lot that was shot as well. But he was in the salon, the beauty salon, and you could see the look on his face, that he was like: “I wish I had more.” And when I brought in the stuff I had with me… it was funny, at first, I was gonna kick him out, I go: “what’s your training?”, he goes: “I’m an EMT”, I’m like: “You’re staying with me.”

[SETH GOLDSTEIN] Yeah, you’re my man.

[TODD DEVOE] Yeah, so stand by me and we’re gonna start treating these people. And… but yeah, if you have something like this, that could have made a difference for that guy’s ability to treat those victims.

[SETH GOLDSTEIN] Yeah, absolutely. It’s the right equipment in the right hands at the right time, it’s what makes a difference. And it doesn’t matter if he’s a surgeon or just a bystander that gets just in time training with the right piece of equipment. The ultimate outcomes are sometimes outside of our control, but… you know, something else that was definitely on our mind as we designed this was kind of the psychology of the rescuer too. So, whether he’s an EMT or just somebody else who is uninjured or minorly injured that wants to help, we want them to be able to walk away from that event knowing that “there wasn’t a whole lot else that I could have done. I opened the kit, we used… it told me what to do, I used a bunch of equipment, we put on a tourniquet, I sealed the chest, we rolled somebody into the recovery position, we did all these things, I used the emergency blankets to keep them warm, because that’s what it said”… and you know, as I said, the ultimate outcome might be outside our control, but at least that rescuer is gonna walk away from that saying: “I did it. I did something. I did everything I could have done.” Because you know as well as I do, it’s not the calls that go well that stick with us, it’s the ones that you walk away from going: “what if I…”, or “I wish I could have…”, “if I had only known…” And that was also part of our design process, it was empowering them to do something, both for the sake of the victim and for their own sake, you know, walking away from that, so they can feel… good is probably not the right word, but I think you understand where I’m going. We want them to feel like… “I did everything I could.”

[TODD DEVOE] Yeah, you’re absolutely right about that, as far as the psychological aspect of the rescuer, because… you’re right. The calls I remember are the ones that really did not go the way I wanted to go.

[SETH GOLDSTEIN] Yeah, absolutely.

[TODD DEVOE] Yeah. I sound like a broken record here for the listeners, I kind of apologize, but this is exciting. I see this kit as being a paradigm shift as something that you can put on the wall next to the fire extinguishers, and the person who grabs it can work with it. Because… statistically, any situation, 95% of all rescues are performed by the lay-person. And that’s the CPR in the middle of the shopping center, or whatever. You know, those of us that come in lights and sirens come a little bit later and start doing our stuff; but 95% of all successful rescues are done… started by the lay-person. You know, and you think about that in a disaster context, right? That gets much bigger. So that’s when we have the CERT programs, and the other community volunteer programs that we have, because… we didn’t have enough (inaudible). And you know, there are stories that I can talk about… I have a friend of mine who was a captain with the L.A. city fire department. I’m after the earthquake, and he’s driving down the road, and he gets slowed down by this nurse, and she’s like: “hey, are you guys going to help me?”, and he goes: “what’s your training level?”, she goes: “I’m a nurse”, he goes: “great, you’re in charge, but we gotta go this… we have to get to our drive through.”

[SETH GOLDSTEIN] Yeah.

[TODD DEVOE] You know, so for the earthquake, in that case, it is the lay-people who are gonna be doing… she’s not lay, obviously, but… you know, it is the average citizen, not the fire department, that’s gonna come to the rescue. And in this case, it could be a force multiplier in that.

Public Access First Aid with Seth Goldstein

[SETH GOLDSTEIN] You know, and I remember having a conversation… you know, as we were starting to get closer and closer to a functional model of this during the design process, we had a conversation about the value of it in a disaster, where… imagine if you could just pull up with a trailer of them, and open it up, and say: “here. Go. Grab one of these and go.” And force multiplier is the actual phrase that we kept using. Even… because originally, one of the ideas that the business folks that we worked with… they really thought that the ambulance services might be a market for this, and you know, we kind of… an ambulance provider shouldn’t need the instruction that’s in the kit, and they should have all the equipment that’s in the kit. They should already have it in an ambulance. But as we started talking about disaster response, like: “well, what if an ambulance had a handful of these, or a version of this, that they could pitch to somebody in an emergency?”, or like, your scenario, where you’re rolling into a multivictim trauma situation, and you have your gear; because that’s your gear and you’re gonna use it. But you have… you know, you could toss one to the EMT, or you could toss one to the salon owner and say: “here. Just open it up, follow the instructions, treat those people over there in that corner.” And that’s… that has the potential to be a big deal, you know, to change things. I just read something this morning, actually. It was an article about lockdown as an emergency management measure in a school shooting. And I’ve been having this conversation for about a year with school that we’ve been dealing with mobilized products in the assumption that the lockdown is the ultimate solution to that problem. It’s just a farce. You know, it solves a portion of that problem, but the question is: how do you know when lockdown isn’t working? You know, and I’ve asked teachers, these classroom teachers: “how does your lockdown end?”. And often times, the answer is: “it ends when the principal comes and unlocks the door, or when the police officer shows his badge and I unlock the door.” And my next question is: “well, what if smoke comes underneath the door while you’re on lockdown? Or the fire alarm goes off?”. I mean, I had a teacher say: “lockdown ends when the principal comes and unlocks the door.” And they’ve been conditioned to think that that is the end of… that’s it. That’s where they stop responding to that emergency. And we just did some training out in Aurora, Colorado, at a private school. And clearly, they’re sensitive, especially being where they are, and what the history is in that part of Colorado to active shooter events. And they took one of our small kits; not the biggest one, they have those in the hallways where their AEDs are. But they took the smallest kit, which is really the size of an iPad. You know, it’s a life threats only kit. And they put one in every classroom; and this was their idea, this wasn’t our idea. Cause they’re thinking ten steps ahead, where… if we go on lockdown, the police aren’t coming to us right away, the fire department is definitely not gonna get in here right away… like, they understand the mechanics of that response, to the point where they need to be self-sufficient, and they need to be self-sufficient in the place where they attend people to take refuge, which is in their classrooms. So, their classrooms are all equipped with some basic first aid equipment, and now they have a kit, and the kit comes with a little download. Every student and staff member in the school has the app on their phone, and so, it doesn’t matter where they are; they have access to life saving medical equipment. They’re giving themselves the best chance to manage that situation for the… I mean, who knows how long it can take to get an EMT or a paramedic into that building? It was just very progressive thinking on their part. You know, they’re thinking about a specific disaster, you know, an emergency management situation, but… it was cool. You know, talking to the facilities guy and some of the staff out there, I mean, all of their teachers have emergency management 100 and 200 from FEMA. Like, any of their teachers could step outside and assume incident command.

[TODD DEVOE] Wow, that’s great.

[SETH GOLDSTEIN] Yeah, and look for police, fire representatives and request unified command. I don’t know what I would do. If I went up to a school and the teacher came out and said: “where is your incident commander? We need to set up unified command!” I don’t know what I would do.

[TODD DEVOE] That’s awesome.

[SETH GOLDSTEIN] It was a cool conversation, I have to say. It’s progressive, for sure.

[TODD DEVOE] So, ok, real quick. So, I have some more questions for you, and one is gonna be a hard one.

[SETH GOLDSTEIN] Oh, boy.

[TODD DEVOE] This one is an easy one. So, if somebody wants to get a hold of you, how would they get a hold of you?

[SETH GOLDSTEIN] The easiest way to get a hold of us is right through the website. It’s www.mobilizerescue.com. All of the design team members have on our team page, you can access our e-mail through that. There’s a generic info button you can hit to send us questions. And my e-mail is super tricky. It’s Seth@mobilizerescue.com. So… and yeah, we’re… we make ourselves available. We’re still a small company, but we’re everywhere. We’re trying to be… everything for everybody while we’re pushing this thing out there.

[TODD DEVOE] That’s awesome! Ok, here is the hardest question of the day.

[SETH GOLDSTEIN] All right.

[TODD DEVOE] If you would recommend one book to somebody who wants to get involved in this business, emergency management, emergency response, what would it be?

[SETH GOLDSTEIN] One book… that is a really hard question. You should have prepped me for that. I’ll be honest, I don’t read a ton of books, usually the ones I’m reading are on the side. One of the ones that I really liked was “Leadership Lessons from Westpoint.” And it’s not so much of an emergency management thing, it’s kind of a general view of how to deal with things. And there was another one I had read a long, long time ago… you know, most of the books that are out there paint a very… you know, I think about the paramedics that have written books, and a lot of them are… they paint a very particular, and often times, stereotypical view of what we do. I think that if people wanna be good and have longevity in our industry, a lot of it comes down to perspective. So, you know, being able to step back and see the big picture is important, and communication skills. And not just like… not high end hierarchical communications, but just being able to interact with people from the patient level, all the way up to… you know, to a boss. I think about my interactions with the fire chief at the fire department that I worked for and things like that. Being able to understand what’s appropriate, and being able to effectively communicate what needs to be communicated.  It’s important. It makes a huge difference. You know, as a paramedic instructor, I used to tell students all the time, you know… an EMS call is like a gigantic eight ball sitting on the edge of the biggest hill you’ve ever stood on, right? And it wants to roll over you and crush you. And if you walk out to that eight ball, and you put your hand out right before it starts moving, you can hold it there, and you’re never gonna lose control of it; you can hold it there with one hand. But as soon as you start to make some bad decisions, and a lot of those come down to communication or work ethic types of decisions. And I’ll use myself as an example – the first time you roll up on a cardio call and you realize you didn’t check the batteries in your monitor and they’re dead… the eight ball starts rolling. We’ve all run that call, you’ve all been on that job at some point. You’re never gonna catch it. It’s gonna run you over, and you’re gonna get to the hospital… cause you’re eventually gonna get to the hospital. But it’s gonna be a ragged mess. It will be obvious that you have chased the ball down the hill the entire call. Not all the time, but often times, those kind of hot messes can be avoided by good communication with you and your partner, good communication with outside agencies that are arriving on scene, and good communication with your patient. And the rest of it kind of falls into place, I think, when you’re able to collect the right information and pass it on to the right people. You know, a little bit of mastery of your skills. But I think a lot of that is easy when you’re relaxed, and you have general control over the rest of what’s going on. So, I don’t think I really answered your question about books. The book specifically, but I think a lot of the things that impacted me the most, you know, as I was learning how to do this were books that expanded my ability to connect with more and more people. You know, anything from motorcycle maintenance to… kind of whatever you can read to have that little ounce of connection. That’s important. So I guess it’s kind of… it’s a broad base that you’re looking for, not something specific.

[TODD DEVOE] That’s an awesome answer to that question. That’s kind of what we’re trying to get out of this, when I ask that question, is what can you do to better yourself, and I think that answers the question well. All right Seth, I’m gonna let you go, thank you so much for being here, and I’m looking forward to hearing more from you.

[SETH GOLDSTEIN] Excellent. I look forward to hopefully being on again. Thank you so much.

[TODD DEVOE] All right. Thanks.

Links

www.Mobilizerescue.com

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