Code Blue: Information for Writers with Sarah Clark

______________________

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A CODE BLUE is defined a cardiac or respiratory arrest.

Here to help us understand what

happens during a CODE BLUE is Sarah Clark. 

Sarah spent 29 years as a nurse. Her positions included: ICU, Emergency Department, Med/Surg, telephone triage, long-term acute care, and teaching at the nursing school. For the last 3 ½ years, she has been the simulation coordinator for hospitals.

If you are writing a crisis that begins outside of the hospital, most likely the patient will be arriving in an ambulance.

Prior to arriving at the hospital the EMS will have sent a bullet-ed report to the CHARGE NURSE. 3-5 minutes before arriving they will encode – this is the report/notification.

At the beginning of the shift, the charge nurse will have assigned rooms within the Emergency Department. Emergency is now called E.D. not E.R. by hospital staff. 
* Your lay person would probably still call it the E.R. 
* It would be a mistake to have the doctors and nurses call it that
   now. 
The charge nurse is on the radio and manages the room flow. The charge nurse will assign the case to a room. 

When the EMS unit brings the patient in, they go straight to their room/nurse.

If they coded on the scene or in the ambulance, several things are already in place for the hospital staff.
· The patient will have pads already in place (often, one on back
   and one on front) for performing shocks and be on a backboard,
   facilitating CPR compressions. 

· The patient will be intubated
· The patient will (when available in that locale) have a LUCAS
   unit in place. A LUCAS will perform chest compressions for 
   CPR, leaving the health providers hands free for other things. If
   the LUCAS is in place, they will most likely leave it at the
   hospital until the patient is no longer in need. It has a battery and
   can operate for around three hours without be connected to a
   power source. It can be plugged in and many ambulances have
   electrical plugs. 

· The patient will have an I.V. line in place.

If the patient comes in with vital signs, then as a writer, you need to decide which of the above you would like to have in place.

Let’s pretend for a moment that a patient presented at the E.D. with signs of a cardiac event. While in the E.D., he codes. Immediately the team goes into action.

Here are the players:

· Medication R.N.
· Airway Manager
· Person Performing Chest Compressions
· Code Cart Manager
· BLS Team Leader - this is the PROVIDER. They no longer call

  the person making the decisions “doctor” with the lack of 

  physicians the provider could be a physician, physician's assistant,
 or nurse practitioner
· Documenter
· Family Guide 

MEDICAL RN stands on the right hand side of the patient. 

· Check for IV access, patency (the quality of being unblocked)
· Establish IV if none present.
· Prime tubing with 1 liter NS (normal saline)
· Administer ordered meds
· Communicate when med has been administered
· Protect the IV site. This is IMPERATIVE. That IV is the patients

   life line in an emergency. If the nurse can not find a vein they

   will place the line in the bone with an IO or intraosseus line. T
   The nurse will say “Drill ’em.” This method is fast and relatively
    safe. 

   VIDEO QUICK STUDY Trigger alert. Graphic. (12:00)
* The IV line is most at risk when the patient is being moved from
   one stretcher to another. GURNEY is a term that is no longer in
   use.

Ambu Bag

The AIRWAY MANAGER :

stands at the top of the stretcher and is usually a respiratory therapist. This is NOT a nurse. A respiratory therapist has an associates degree – a two-year degree in providing respiratory aid.

· Open airway
· Ventilate with Ambu bag 

· Requests suction setup 
· 2 People: 1 to seal the airway and 1 to squeeze the
  bag 

  * An Ambu bag is 100% oxygen. 

  * During a code the patient is manually ventilated. 

· This person will often stand on the left, or if need be, they can get

    right up on the gurney with the patient. This person needs to get

    the chest compressed a full 2” or it is ineffectual. Most people

    will wear out after two minutes and need to be replaced. 

· Any qualified person can do the compressions. 

· They monitor/check for pulse 

· If the patient did not come in with EMS then they will place a

   back board and a Zoll pad (for shocks) there are 2 pads – one on
   the back and one on the front. They can cause fire (chest hair)
   They no longer use paddles.

· Two people can rotate responsibilities to give the person giving

   compressions a chance to rest. They must monitor the quality of 

   the compression.

· Stands next to the cart –  everything they will need during a

  code is in the cart. She will hand people things as they are 

  needed. 

· They must be a nurse, and it is best if they are familiar with the

   layout of the code cart
· They hand in:

  * Back board 

  * Zoll Pads

  * Set up for suction
  * IV tubing with one liter of NS 
· Prepare the Empinepherine 
· Hands in meds as ordered
· Operates Zoll defibrillator
· Communicates with the runner for needed supplies

So for example:
The provider will say, “Give an amp of Epi.”
Code cart manager replies, “Epi.” As she hands it to the medication

                       nurse.
The medication nurse says, “Epi.” Then administers the meds and

                       says, “Epi’s in.” 

BLS TEAM LEADER
· This is the provider (doctor/physician's assistant/nurse practioner)
· Stands at the end of the bed and does not do anything hands on to

   prevent tunnel vision. 

· Needs to be able to see everything
· Makes all decisions about the patient 

THE DOCULMENTER
· Ideally, this is the patient’s nurse – in reality it will be a newer 

  nurse. The documenter stands next to the provider.
· Charting – documenting everything that takes place
· Ensure participants sign the code sheet
· Timer – is UBER IMPORTANT!

“It’s been two minutes. Time for a rhythm check.”

EVERY TWO MINUTES:
· Check the rhythm on the heart monitor
· Check pulse in the femoral area of the groin. That would be here:

· Change out the compressor if they are human. 
· Decide if you are at a shockable rhythm
· Shock them.

“It’s been three minutes do you want another epi?”

EVERY THREE MINUTES:

· Epinephrine helps vaso constrict to shunt the blood to the heart 

  effectively – it is the first line drug to use in a code, and it can be

  administered every three minutes. 

FAMILY GUIDE
· Determines if the family wishes to stay
· Positions the family near the exit
· Answers questions briefly and honestly
· Reminds the team the family is present (tendency towards gallows

   humor to break the stress)
· Escort the family out if needed


In every hospital there is a RAPID RESPONSE TEAM. This is a pre-code team that includes an experienced nurse and a respiratory therapist. They identify the patient’s risk of coding and move him to ICU.

NURSES SAY “CRAP.”

When do they stop?

1) The patient is stabilized
2) The patient is declared deceased
    · Typically, they will call it if the efforts have not worked and 

       the patient flat lined for over twenty minutes.
    · If they were brought in with a flat line, it’s usually called – 

       because of the length of time they were down. 

    · If the spouse/parent is on the way, for example, they 

      will try to continue efforts until the spouse has arrived. 

    · Often it’s the family that asks the team to stop 
    · Sometimes they continue for longer than they normally would

       have to give the family time to come to the conclusion on their

       own. This helps with the grief process. 

And there you have it. 

A huge thank you to Sarah Clark  for her expertise.

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Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

Cops Gone Bad: Information for Writers with Police Chief Scott Silverii

originally posted September 2014 ___________________________________________________________________

Fiona - 
Hi Chief, thanks for joining us on ThrillWriting - that's a very nice kilt you're wearing. Can you tell us about the special occasion?
(Great legs, BTW)

Chief Scott Silverii sporting his pink kilt he'll be wearing
at the Warrior Dash to support breast cancer research.

Chief Silverii -
It's great to be back. I love your work - the content is actual police academy quality. 

Sure, My police department - The Thibodaux Police Department is teaming up with author Liliana Hart to raise awareness and money for cancer research. The kilts will be worn by officers and team members participating in the Warrior Dash on Oct 11 in Louisiana - that even includes Liliana Hart.


Fiona -
What a great cause. 

I know that you are very involved with your community and are often seen doing spectacular things to bring awareness and needed funds to worthy causes, I remember your pictures from Breast Cancer Awareness month last year. As a matter of fact, I only know good cops. Really good cops who serve on duty and off. But I also know that's not always the case. Do you mind if we chat about that? Please first tell us about yourself.


Chief Silverii -

Thank you, we are the city's police department after all. Yes, tough topic, but let's talk about it. 

I'm Scott Silverii - I'm from south Louisiana's Cajun Country. I've been in law enforcement over 24 years and currently serve as the Chief of Police in the City of Thibodaux (La). I began my non-fiction writing once I completed my PhD in Anthropology from the University of New Orleans. I self-pub my dissertation - A Darker Shade of Blue and then sold an extended manuscript to Taylor & Francis Group where it was published by CRC Press - Cop Culture: Why Good Cops Go Bad.

Fiona -
Temptation. When one is in a position of authority it is so easy to cross a line. What kinds of roadblocks are inherent in the system that would help to weed out people who might abuse their authority prior to coming onto a police force?

Chief Silverii -
It begins with an in-depth application process that includes a quality background investigation. Too often, agencies accept friend referrals - those usually implode down the road. Education is also key - the officer must be taught the dangers inherently associated with independent positions of authority. Accountability is the base line - without it, everything fails. No room to turn a blind eye, or allow your buddy to slide - paths of least resistance lead to falling for temptation.

Fiona -
Once an officer has taken his oath, as they move deeper into the cop culture, how much do cops overlook the wrongdoings of other cops? It seems to me, if it's not nipped in the bud, you'd have cops gone wild.

Chief Silverii -
It can become a slippery slope. Officers are afforded a wide range of discretionary privileges associated with performing their duties. You can't paint them into a box with policies for every possible encounter. It's difficult for cops to judge other cops on actions attributed to discretion.

Corruption can take many forms and levels from not performing your duties to committing crimes. There is a Code of Silence that is inherent. It's the “us versus them” mentality. This begins in the police academy - cadets learn that the class is punished for the mistakes of one. Therefore, they cover each others butts to save themselves from the discipline - while building brotherhood, it also teaches covering up and the No Rat Rule.

Fiona –
You're writing a novella that takes a fictional look at this, can you tell us about your plot line

Chief Silverii -
I was invited to join you and five other amazing authors in an anthology called Unlucky 7 - each author writes a novella based on a small town murder mystery. My work, Bayou Backslide, looks at the temptations of police work. Even in the face of investigating the ultimate act of victimization - murder. What I find fascinating about writing about police fiction is exploring more about the effect the job has on the officers, than whether or not the officer can do the job. This work will look at how temptation, discretion, autonomy, and misplaced loyalty effect the cop, the agency, and the community.

Fiona -
Very interesting. Okay, let's look at some of those aspects. Just coming home from the Writers' Police Academy, we learned about some of the awful things that cops experience on a daily basis. Over time, they develop an "us against them" mentality. Can you talk about some of the things that impact an officer and the changes that are globally seen by individuals facing the challenge of police work?

Chief Silverii -
WOW - WPA was another amazing event. I'm still on a cloud.

The culture of policing is a powerful influence. If you are familiar with Janis' concept of Groupthink, it's similar in this profession.

Policing depends upon homogeneity or everyone looking, walking and talking the same way in order to be cops- compliant. No room for the Bruce Willis or Mel Gibson characters. Though they make for great movies, they would also make bad reality.

Officers go through transition stages of socialization - or Fitting In.
*Once they enter the academy - they realize that everything they
  thought they knew about the job from watching TV, movies, and
  reading is WRONG. 

• They must accept that the only way to succeed the academy is to modify their thinking and beliefs to those of the culture. 
• In training they must juggle this next life behind the badge that requires silence and full commitment - that obviously causes trouble at home with spouse, kids, family and friends.
• Finally, the officer is cut loose to work on their own. They are vulnerable to the temptations because no one is directly watching them over the course of that 12- hour shift.

Fiona -
Over time, how does this effect the "bad cop's" decision making?

Chief Silverii-
Path of least resistance. Complacency becomes the rule. Not making waves is the ethos over “to protect and serve.” - If I work hard, then you look bad. If I make a mistake while making lots of cases, then the sergeant will get the grief - therefore, don't make cases. Mike Roche reminded me of a saying – “Little cases = little problems, big cases = big problems, no cases = no problems.”

Fiona-
So that would be the kind of thing one would expect in any organization.

Let's talk about cops who go over to the dark side. The ones who think they can, and possibly do, get away with some pretty heinous stuff. To charge them would look bad for the sergeant. What kinds of things could a bad cop do that is particular to that cop because of their position?

Chief Silverii-
It's unlimited - From trading sex for a traffic ticket, to taking bribes for providing security, or looking the other way. Even allowing the drunk to drive off because the cop doesn't want to do the paperwork is unacceptable.

Understand, we are talking about a small population of cops fitting this dynamic - most are committed and honorable public servants, but in a club of over 800,000 there's gonna be bad apples.

Fiona -
Agreed.

Can you tell us writers who are writing good cop/bad cop plot lines what might happen once the police find out that a cop has been involved in something pretty big - a murder or drug distribution for example - how do you police the police?

Chief Silverii –
Internal Affairs are the organization's integrity gatekeepers. They operate independently of general police assignments and are often unpopular among the other cops. Old days they were called the Rat Squad. A chief or sheriff also has the option of referring cases to the state police, the state's attorney general, or a federal agency.

Fiona -
The federal agency would depend on the crime. As my last question - what would you like us to know, what would I never guess about this particular topic?

Chief Silverii –
The process of socialization is so powerful that it takes a special (not impossible) person with an established moral / ethical center to avoid the pitfalls. I applaud those individuals. The old guard is retiring or dying off. This new era of technology and accountability is leading us into the next phase of policing. I’m so excited. It's on the horizon. It takes forward thinking, fearless men and woman to stand in the gap and demand a better way. It's time for a Cultural Revolution in policing.

Fiona -
I am grateful to them for their service and grateful to you for sharing and also for letting us see how fab you look in a kilt.

Police Chief: Information for Writers with Chief Scott Silverii

Chief Scott Silverii, PhD

Fiona - 

Today on ThrillWriting, I'm very pleased to introduce you to a friend and fellow writer, Dr. Scott Silverii.
Dr. Silverii serves as the Chief of Police in the southern Louisiana city of Thibodaux in Lafourche Parish. There, he enjoys the honor of public service. His twenty-four plus years in policing provides the experience and vision to believe there is always a way to help others. 16 of those years were spent in policing's special operations groups with thousands of undercover narcotics and SWAT missions.

His passion for public service flourished while growing up in the heart of Cajun Country, leading a life seasoned by the Mardi Gras, hurricanes, humidity, and crawfish etouffe.

Hi, Chief. Can you start by telling us about how you got involved in writing both your non-fiction and your fiction works?

Chief Silverii -
I began my non-fiction writing once I completed my PhD in Anthropology from the University of New Orleans. I self-published my dissertation - A Darker Shade of Blue, and then sold an extended manuscript to the Taylor & Francis Group where it was published by CRC Press - Cop Culture: Why Good Cops Go Bad Link 

Amazon $3.99

Last year, Lee Lofland invited me to teach at Writers' Police Academy (WPA) and introduced me to the amazing world of writers. I tried my hand at crime fiction as a way to decompress from the years of grad school. I loved the challenge of transitioning from the formal, rigid academy rules and also the narrative police reports - to the descriptive content of mystery fiction. Have you ever heard, "Show. Don't tell?" Ha! - I have, plenty of times.

And that's where I had the pleasure of meeting you and becoming friends. 

(This is a LINK to a ThrillWriting article about the concept of Sheepdogs and Dr. Silverii's doctoral thesis)

Fiona -

One of the things that you talked about in one of the WPA classes was your time doing SWAT duty after Katrina. Do you think that that experience has helped you in your position as Police Chief?

Scott Silverii working a SWAT detail during the aftermath of Katrina

Chief Silverii -
Yes, my 16 years in SWAT taught me more about conflict and crisis resolution than any other experience I've had. The Katrina deployment taught me the value of compassion under extreme conflict. The ability to combine strategic functions measured by compassionate consideration helped shape the vision for leading my agency as their Chief of Police.

Fiona - 

Can you tell us a little bit about the scope of your position? As I keep up with you from day to day, it seems you're stirring a lot of pots.

Chief Silverii - 

Chief Silverii with his son

Definitely - First and most importantly, I'm a dad. All else occupies crevasses between our time together. 

As the city's Chief of Police, I'm solely responsible for every function of the agency. Being a full-service provider includes activities ranging from school crossing guard, animal control, trustee work crews to patrol officers, detectives, academy training to SWAT and narcotics ops. 

Of course, my time participating as a part of those assignments are limited. My primary duties include providing a crystal clear direction for progressing the agency. Included in that is the training, promotion, staffing and all the fun administrative things. 

I also serve as an ambassador for the city and love meeting people in our city. Related to my position, I also serve as a subject matter expert in the analysis and application of data and mapping to increase officer effectiveness in reducing social harms. Working smarter rather than harder. 

I was named as an Executive Fellow for the Police Foundation - that was very exciting.

Fiona - 
Congratulations, Chief, that's wonderful. 

With your PhD in anthropology, do you develop or refine the ongoing training of your dept.?

Chief Silverii
I look at the culture of policing from a bigger perspective. I try to incorporate theoretical principles with practical application. Sometimes that results in revised training. Other times, it's reflected in policy initiatives such as social-norming or employee engagement. 

Cop culture is a tough environment - the dynamics involved in being "socialized" are complex and a mastery of those elements are critical for effecting sustained change.

Fiona - 
Globally rather than specific to you and your department, in speaking with your peers, what are some of the common issues that arise that might create tensions and difficulties in the departments? What about between LE (law enforcement) and the public?

Chief Silverii - 
The position of Chief is to develop, share, and ensure a clear vision of public safety. Unfortunately, not every officer will share that vision. Cops are like anyone else where decisions and consequences are involved. It's vital that they follow policy and approved practices. 

Tension is at the highest when disciplinary action is assigned. Chiefs must find the balance between being friendly with the troops yet not being their friend. That's a huge challenge and often gets blurred. Also, being the one giving promotions, assignments, preferred schedules, etc. a chief will never make everyone happy - it can be a lonely duty, but it's a calling to serve and another to lead.

Fiona - 
One of the questions I traditionally like to ask is: In media and books you've come across characters who do your job. What stereotypes are incorrect? What do you see consistently mis-written, what would you like to see done differently in portrayals of Chiefs?

Flashbang and Entrance Formation

Chief Silverii- 
Oh goodness - running the span. 

While I'd like to say that portraying the hapless and the corrupt Chief is incorrect, the truth is - it takes all kinds. I've known both extremes and all in-between. 

By and large, most Chiefs are committed career law men who are often limited in demonstrating their full potential by their political appointments by a mayor, council or city administrator. 

Chiefs are not typically elected, but are appointed by elected officials. It would be rare if they operate autonomously, and that contributes to the national average tenure of a Chief is about 2.3 years in an agency. 

I'm biased of course, but I'd love to see depth written - the way a Chief grieves over the loss of a person in their city. Lots of time in media/books the chief is a fat-cat in a suit focused on their next political move or appointment. The reality is, Chiefs are always focused on their staff and how to improve their working conditions. It doesn't make for sexy TV, but a Chief takes as much pride in their detectives busting a case as they do ordering a new fleet of cars for the officers.

Fiona - 
My other traditional question is about the story behind your favorite scar.

Chief Silverii- 
Favorite scar on me, or that I left on a bad guy?

Fiona - 
YES!

Chief Silverii - 
Kidding.

My right palm is filleted from the tip of ring finger to below the wrist. I was the Drug Task Force Commander during an undercover op. The agent gave the bust, and this jacked up drug dealer high on a non-natural product charged at me. After battling one-on-one in an isolated field for everything from his escape to my weapons, officers arrived. End result - he went to the clink and I went to the ER - surgery followed with minimum loss of hand use.

Fiona - 

What am I not asking you, but I should? Is there an aspect of your job that you'd like to expand upon?

Chief Silverii- 
Yes, I'm trying to promote continuing education for officers. I've benefited from advanced degrees and applied them to the job. It's actually so complex, but too many officers get trapped into believing that it's all about arresting people. We cannot arrest ourselves out of the social ills plaguing our country. I'd like to see victim advocacy and alternative methods of handling citizen complaints explored rather than tossing everyone in jail.


Fiona - 

Amazon Link 99 cents

I agree whole-heartedly, thank you. You just came out with a short story set in your part of the world. Can you tell us about your project?

Chief Silverii- 
You introduced me to writing the short story for a contest. I wrote, then edited and then cut to meet a super concise word count. I loved the discipline and intensity of the short story. I wanted to create a continuing series of episodes based on the same characters and location. I'm so passionate about Cajun Country and law enforcement, that
I combined the
two.

This series spun from the characters
in my competition short story and has
grown into a multi-part adventure that
I'm continuing to develop with each
episode. 

It's also a great way to hone my Show/Don't Tell skills. The protagonist - Sheriff James Walker is true blue and committed to protecting the citizens of his parish. What I'm loving is the depth of conflict, crisis and resolution he deals with daily - all the while leading an agency sworn to protect the public. His scars (in & out) make him human and identifiable.

Amazon Link 99 cents

Fiona - 
And reading them will probably be a great learning tool for my fellow crime writers in that you know your
stuff backwards and forwards. We've talked
a bit about police culture, what about
writers' culture are you bridging the two pretty easily?


Chief Silverii - 

The last year has been so rewarding through the relationships I've developed with writers. It's an
honor to consult with so many
who are committed to portraying
the cop life, culture, procedure
and practices with laser accuracy. 
I enjoy consulting on selected
projects and manuscripts; it gives
me the opportunity to meet new
people and learn new skills in the
writing craft.

Amazon Link 99 cents

Fiona - 
Thank you so much for spending this time with us. What
are you up to this evening?

Chief Silverii- 
It's time to eat crawfish stew
Fiona - 
Well, enjoy! 

A big thank you to my readers for stopping by. If you have any questions or comments, please leave them below. They will post asap, but they are moderated so you don't have to wade through spam.

Also, you can connect with Chief Silverii at this LINK

Fiona Quinn's Newsletter Link, Sign up HERE

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

Related articles

• Chief Scott Silverii, Ph.D. Named Executive Fellow | Police Foundation
• Is Your Hero a Sheepdog? Character development for Writers
• Chief: Thibodauxs low crime rates result of smart police tactics
• 10 Questions with Chief of Police Scott Silverii