EMS on AIR Podcast

S2:E7 "A Down and Dirty COVID Update for EMS – A discussion with Chris Haney about where Michigan EMS rules come from and why I should care." Recorded November 23, 2020

November 30, 2020 EMS on AIR Season 2 Episode 7
EMS on AIR Podcast
S2:E7 "A Down and Dirty COVID Update for EMS – A discussion with Chris Haney about where Michigan EMS rules come from and why I should care." Recorded November 23, 2020
Show Notes Transcript

In this episode, Geoff sits down with one of his long-time colleagues and friends, Chris Haney, Director of Operations at Star EMS.  Chris is a fixture of the first responder community in Oakland County, Michigan with over 37 years of experience in EMS.  He enjoyed a full career at the Pontiac Fire Department prior to his time at Star EMS.  Throughout his time on the job, Chris has been a part of pretty much every committee, work group and task force you can think of in our county, region and state EMS system.  He's here for a down and dirty discussion about what the everyday EMS provider in Michigan should know about the current COVID rules, emergency orders and related protocols. 

Let’s face it, we’re all going through a LOT of COVID fatigue in the prehospital community.  It’s hard to stay current on the “need to know stuff,” that “they” want us to know and do AND keep up with the constant barrage of COVID related calls.  Not only is there almost too much information out there, but much of it seems like it contradicts one rule or another which just makes things more confusing.  Trust me, we get it.  To make it easy, clear and concise, Chris and Geoff thought it would be a good idea to just sit down and talk about the various “things” the boots on the ground should know.  We also thought this would be a good chance to give everyone listening some background and context as to how the various medical control authorities, regional networks and the State of Michigan EMS system work in concert to share information back and forth to best serve the specific conditions of our diverse communities. The pandemic has given us an example to show how this giant state-wide system works and this talk may shed a tiny amount of light on a topic that isn’t always so clear.

Now, there’s NO WAY you can teach someone how a state EMS system works in a 25-minute podcast and today we’ll just skim the surface.  However, by the end of this episode I think you’ll find clarity regarding the general process of how EMS rules, protocols and directives cascade downward and upward in Michigan. 

Visit EMSonAIR.com for the latest information, podcast episodes and other details. 

Follow us on Instagram @EMSOnAIR.

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  

Support the show

  
Hello, and welcome to the EMS on AIR Podcast. The mission of this podcast is to keep healthcare provider safe, informed and prepared. Today is November 30, 2020. I'm Geoff Lassers, and I'll be your host. This episode was recorded on November 23, 2020. And I'm a little bit behind in the editing process. But don't worry, we have a steady stream of content coming up. In addition, we'll continue to be releasing EMS on AIR podcast episodes on AmericanCME.com. This means that EMS providers can earn EMS continuing education credits by completing an entire podcast episode and then a brief post course quiz and survey, visit AmericanCME.com. Click on the courses link then click on free courses. Scroll through the course list and look for the courses with the EMS on AIR podcast logo. There's 11 episodes on there right now and continuing to release about four or five in the next month or so. So, if you're licensed is coming up, get on over to AmericanCME.com and get you some credits. Did I mention that you can access all of American CME's content for free? Yeah, free.

  In today's episode I sit down with one of my longtime colleagues and friends Chris Haney Director of Operations at Star EMS. Chris is a fixture of the first responder community in Oakland County, Michigan W ith over 37 years of experience in EMS. He enjoyed a full career at the Pontiac Fire Department prior to his time at Star EMS. Throughout his time on the job Chris has been a part of pretty much every committee workgroup and task force that you can think of in the county region in the state of Michigan. He's here for a down and dirty discussion about what the everyday EMS provider in Michigan should know about the current COVID rules, emergency orders and related protocols. Let's face it, we're all going through a lot of COVID fatigue in the pre hospital community. It's hard to stay current and the need to know stuff that they want us to know and do and keep up on the constant barrage of COVID related calls. Not only is there almost too much information out there, but much of it seems like it contradicts one rule or another which just makes things more confusing. Trust me, I get it. To make things easy, clear and concise, Chris and I thought it would be a good idea just to sit down and talk about the various things the boots on the ground need to know. We also thought this would be a good chance to give everyone listening some background and context as to how the various medical control authorities regional networks in the state of Michigan EMS system work in concert to share information back and forth to best serve the specific conditions of our diverse communities. The pandemic has given us an example to show how this giant statewide system works. And this talk may shed a tiny amount of light on a topic that isn't always so clear. Now, there's no way you can teach someone how a state EMS system works in a 25 minute podcast episode, and today we'll only be skimming the surface. However, by the end of this episode, I think you'll find clarity regarding the general process of how EMS rules, protocols and directives cascade downward and upward in Michigan. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@OCMCA.ORG. Also, check out our updated website EMSonAIR.com. For the latest information, podcast episodes and other details. Follow us on Instagram @emsonair  and please whatever podcast platform you use, subscribe to our podcast and leave us a rating and a review because it really does help us grow this thing. Enjoy the podcast. Good morning, Chris. 

Chris Haney  3:37  
Good morning, Geoff.

Geoff Lassers  3:38  
 How are you?

Chris Haney  3:38  
Outstan ding thank you, and yourself?

Geoff Lassers  3:40  
 I'm good.

Now you've been on this podcast before? 

Chris Haney  3:43  
Yes. 

Geoff Lassers  3:43  
But it's never just been me and you? 

Chris Haney  3:44  
Right.

Geoff Lassers  3:45  
Who are you? What do you do? Where do you do it? Give our listeners context when they hear the dark, deep voice of Chris Haney. Who is this guy?

Chris Haney  3:53  
Okay. Well, again, my name is Chris Haney, I've been in EMS about 37 years. At this point, I'm a director of operations at Star EMS. And I'm fortunate enough to sit on a lot of county, local and state committees. And I think it's a good time to have a chat about where we're at keep it real and keep it down to earth with all the information that's out there about COVID and what the boots on the ground are supposed to do.

Geoff Lassers  4:17  
Right on, as somebody wanted to come in here and talk about the boots on the ground and really give us an update. Give me an idea as to if I don't know you and I know you are a well known person in this community. Like you said, You've been here 37 years I'm only 38 years old. Give us an idea as to your background in the context of why should I take this advice from you?

Chris Haney  4:36  
Well, I think the number one is, I and MANY are here for for you in the safety of you to see you go home at night and not have a problem. Remember we've been through SARS and Avian Flu there's been a whole lot of things come through EMS and Fire over the years and this is one that certainly grabbed me by the collar shake you this isn't going away and we have to deal with it. So number one of everything is the safety of our personnel.

Geoff Lassers  4:59  
Okay. So director of Star EMS, I can certainly understand that you got a lot of people over there, How many you got?  hundreds?

Chris Haney  5:06  
Oh there's probably 150 that we've got, you know,

Geoff Lassers  5:08  
that's a lot of people to manage. And then you got your whole dispatch center you got, it's just a big operation. But your current contact with these types of things isn't just with Star EMS. So can you give our listeners some background and how you work with the other agencies that not only surround you in a mutual aid capacity, but also, logistically, you're involved with planning at a regional level for all of this COVID stuff and moving resources, logistics? 

Chris Haney  5:35  
Sure Geoff, we've got a commitment as we provide services, transport and some primary 911 service to the Oakland County residents and different departments. This trickles into communicating back and forth on a daily basis about exposures and personnel that run the scene that we were on, that could be exposed, ie, Waterford Regional, Oakland County Sheriff's etc, that we have to make sure that we get the word out to everyone if there's been a possible positive Corona patient that we've identified. This can go from the Regional Trauma Network to the Region 2 North folks where we are actually on a SPR team, a Special Pathogen Response team, that we work with transports throughout the state of Michigan if needed, Ebola group that we've worked with and train. So this is all a whole network of just sharing information and training and getting our folks the ones that are the boots on the ground, as I said before.

Geoff Lassers  6:27  
so in our system isn't just a group of people working in different types of fire departments, EMS agencies, private, public, we're also semi-integrated as human beings into other systems representing not only our agency, but our area.

Chris Haney  6:40  
Oh, absolutely. And these are times now that has really put a spotlight on our search protocol and mutual aid, the opportunity to work across lines, even state lines are probably greater now than ever before.

Geoff Lassers  6:52  
Right. And a lot of times, I think that any primary first responder system is going to have a policy that's unspoken, if we share resources when it comes to piece of paper rules, strategies, so we're not reinventing the wheel right? We're all on the same page. And this is really seems to leverage into everybody at least working together, in a we not me capacity, because at the end of the day, 911's got to get answered no matter if it's my area or not, that area is calling us to help.

Chris Haney  7:17  
That's absolutely right. We've got now more than ever shortages in the workforce, due to exposures, we've got people that are places that have been off for extended time, and others so not only do we have to look at the opportunities to help each other with mutual aid, they're staffing, severe staffing issues in an already staffing crisis in non- COVID days and in our business in Southeastern Michigan, may not see the challenges as we do in Northern Michigan where if they have five or six employees that are out for one reason, another COVID or other that could be half of their entire division workforce, and their mutual aid may be coming from extended miles from one another. So I know the state has even looked into asking if we have personnel that would be willing to relocate and assist other areas. But how that looks to all of us right now. Probably not promising because we have our own staffing challenges.

Geoff Lassers  8:08  
Yeah, so the staffing challenges didn't just appear when COVID showed up, we already had staffing issues. And like every other industry, it's being affected this way by human beings at agencies that need to show up and actually do work. So a big reason why you're here today is to kind of help give guidance as to the quote unquote, what they are making us do, when I say they I get this, it's sarcastic. It's really like the rule. You know, and it could be CDC, it could be the state, it could be med control, it could be all those things, right? So give me some context, or what are they saying in these rules that me as a health care provider need to be aware of to give context as to not only maintaining masks and social distancing, which you can say that a million times it hasn't changed. But what has changed a little bit has a little bit of one, I can go to work or not go to work. And when do I get tested and it could get really confusing. And I know with 150 employees there and working with other agencies that have strategies with similar problems. Walk me through this quagmire problem we're dealing with.

Chris Haney  9:11  
Sure Geoff. And that's an excellent point. If I could I want to work this backwards, if I may.

Geoff Lassers  9:16  
Please. 

Chris Haney  9:17  
We've got the boots on the grounds. I say again, they're come to work and they're told that we have to do this. You have to wear a mask to wear masks and ambulances and when congregating. I mean, at the end of the day, we've we've been consistent with this message but I don't know as if the paramedics, EMTs and firefighters really understand where this comes from other than what we have to do. And I think that, that working backwards that we've got the Oakland County Medical control that works in conjunction with all the state people we have folks on committees, there's protocols that we look at we adopt or we initiate an emergency protocol that says that you shall, you must, you will and that's all based on science and best practices. An example would be the CPR protocol. That for a certain criteria or category of patients that were going to do CPR only, and not do ventilation. That's not something that we just came up with Oakland County Medical control. This is based on evidence and best science in trying to keep the safety of our people working the trucks and the ambulances. So we are also a part of the regional protocol system. That means we've got DEMCA, St. Clair and many others.  Geoff, how many are there? Nine, is it? 

Geoff Lassers  10:26  
Yeah, there's nine MCs currently contributing to that. Yeah.

Chris Haney  10:29  
So again, when we're when we're asking folks to go across county lines, we want to stay consistent with the message. There'll be some small variances, but for the most part, they're under the same oversight and overview that we are that we that these protocols, get them out and be consistent right now, and I won't waste too much time here. But if you look at our website, OCMCA.org. We've got four protocols right now that affect the COVID disease, the things that we talked to in our circles before was oh my gosh, there's so much stuff. And then there was coming from the state executive orders, emergency protocol orders, or some that were taken down, put back up. So right now, that's an awesome spot to land to look and see what we have for COVID. And the state is an area we'll get to in a minute about the COVID.

Geoff Lassers  11:15  
Now, you're bringing up a really good point that our protocols, which again, OCMCA.org/Coronavirus will take you right to the four protocols. There's nice table there that explains the protocol name, and a description of what's in it. But those protocols aren't just made up from the people's opinions that are sitting in there. They're steeped in science. And like we said at the beginning of this we kind of borrow information that other people are doing. So obviously these four protocols represent best practices from the information gathered at a state and federal level. And you want to work backwards there. So walk me through that process of where did your selection process come from for that criteria? Where did you pull it from?

Chris Haney  11:56  
Again, at our MCA level, we try to get all the information out so Thank you Geoff for the podcast. So the more information, the better. So we're working with the MCA, the group that we do, the regional folks in Oakland County, touch Oakland County, and with the state, the state of Michigan, we have the EMS bureau that we work closely with nearly on a daily basis with meetings updates, where we're going with the EMSCC is a group of all individuals that make up the state of Michigan Health Care.

Unknown Speaker  12:25  
What is the EMSCC? I wasn't really familiar with that till just a couple years ago. Give me a context of what that is because it's really like it's a big committee to represent the whole state.

Chris Haney  12:33  
 It is, it's the EMS Coordinating Committee for the state of Michigan. It's made up of providers that represent fire, pharmacy, ambulance, hospital groups, police officer groups or public safety groups, I should say, a whole bunch of other individuals. It's a steering committee that policies, laws, concerns, protocols, go to the vet to take back to our organizations and coming out and ultimately vote.

Geoff Lassers  12:57  
Is it a pass through entity back and forth between lawmakers and agencies that would utilize the EMS services, not just EMS because like you said, it's not just the people using EMS. It's the extension. It's the pharmacy that we get our medications from it's you know, maybe equipment or logistics and and worrying about other pandemics, anecdotally looking in and never being a real part of emscc, other than a spectator, I see it as a way of gathering information from the agencies, and then taking it to the lawmakers of the state. And then vice versa, as its intent there. Is that how it works?

Chris Haney  13:31  
That is Geoff. In fact, we do have different representatives that sit on emscc, which is nice. This can work two ways. There's sub committees within emscc. That could be example of legislative operations, safety, education. So all these items that are brought, it's a two way we can bring information up to emscc. Or they can bring it to us for review. The makeup allows us to bring it back to our constituents to review and make comments, which is an outstanding tool and vehicle to try to get what we think is the best for our end users.

Geoff Lassers  14:05  
And so the emscc right now is being used as the tangible arm to get the information in and out for COVID throughout the agencies and sharing these best practices at the state level.

Chris Haney  14:15  
That is true.

Geoff Lassers  14:16  
And then that's what's driving our protocol creation and modifications based on our conditions. Because what we experienced in Southeast Michigan is different than Tawas in the U.P. right, so our protocols are going to be different,

Chris Haney  14:27  
And the state will put out and as I do visit their website, you can click on their covid tab, they do have a whole list of protocols that are sent out to everyone in the state. And it's up to the MCA if they want to adopt them or make changes or create their own at the MCA level.

Geoff Lassers  14:43  
So if I'm just cruising that website, and I'm come across those protocols, and I'm an Oakland County ems provider, they may not apply to me because my MCA has not adopted. And that's that's something I always want to make clear to people is that their state protocols and county protocols or make control protocols. We call them system protocols in Oakland County, I think many agencies do. But the big part to take away from that is the emscc, And the state puts out protocols. And really the department does by way of emscc. And the MCA can adopt those protocols and or make changes to them with approval of the state quality assurance task force, which is another subcommittee of the emscc.

Chris Haney  15:23  
 True, alot acronyms and committees flying around here.

Geoff Lassers  15:26  
Yeah we're confusing people a little bit. But what we're saying here is the state puts out protocols, med controls, either adopt them, modify them, or don't accept them based on a number of strategies and rules. So that's where our protocols come from is the recommendations from from emscc at the state level, vetted through QA Task Force, but they get their information from even a higher level of source. So where does the State get their guidance from?

Chris Haney  15:53  
That's a good cleanup on that Geoff, because it can get convoluted. But it is fairly simple. If you look at it a linear approach that we communicate back and forth constantly with others, so in other states, so with the emscc, I guess, if we're talking hierarchy in the COVID sense. So let's go from our MCA and then to the state EMSCC or the State Department. Let's go to the next hierarchy would be MIOSHA and Michigan Department of Health and Human Services. Those are the are driving orders right now through the state that we have to adopt.

Geoff Lassers  16:25  
Would it be safe to say that the emscc functionally looks at  MIOSHA and the MDHHS, for guidance on where the rules and the data are coming from to make their suggestions and recommendations through EMS.

Chris Haney  16:39  
Absolutely. And perhaps for those that are intimately involved with this there's probably many more things that weigh into this, but that is correct. So you've got Michigan Deparmtent of Health and Human Services. And that would be director Gordon, that put up November 9, the information for the gathering prohibition and face covering order.

Geoff Lassers  16:56  
Now, what that one was in response to after the state supreme court shot down the executive orders, correct? 

Chris Haney  17:03  
Yeah correct, 

Geoff Lassers  17:04  
And now let's give a little bit of background in context of that people were confused a little bit of what that meant. Dr. Faust, originally a few episodes ago gave us an update and stated that that was specifically shot down on a procedural technicality. And within 24 or 48 hours, Director Gordon took those executive orders and  reinstated them  essentially in a different format and put out an order. So nothing really changed. So the state Supreme Court's decision really made no procedural change to anything that we do. correct?

Chris Haney  17:41  
That is correct. That was on October 2, the supreme court concluded the governor was not authorized to issue  EO's addressing COVID after April 30. So there were a lot of orders. As you know, if you've looked at the issued and resend it, it got to be quite a flurry of different orders.

Geoff Lassers  17:56  
So at the end of the day, we're still doing the exact same thing we were doing before, where mask social distance, and when I'm at work, there's additional rules for that as well.

Chris Haney  18:06  
That's correct. Between the MIOSHA emergency orders and MDHHS that covers pretty much everything was in the EO, there may be some other variances.

Geoff Lassers  18:15  
the guy who just goes on calls exact the end of the day, when I go to work, I get it, that every call I go on, when I get that ambulance, you put your mask on, and then I go to the call. I'm going to do all that. But give me all the little nuances in between. What about the drive to the call? What about when we're just in the station? What if I'm in the station, but I'm alone? Walk me through that and what the rules of the game as the state and the federal and, and what our protocols are really indicating right now. So that all the people that are just going to work are clear.

Chris Haney  18:47  
Sure, Geoff, I think we've covered this several different ways. But it's confusing, and it can be, especially when I've got new hires that come on that they haven't been through the march to now. So it's an update for them as well. But in short, if you're in uniform, you that mask on that's in the ambulance with a patient in the back. That's one man up front. Even this state has sent out correspondence, asking all the leaders of EMS to make sure that you kind of endorse this to make sure if you're in uniform, outside of the truck have a mask on. We beat that up pretty hard. Now, I might also just be good opportunity to slide in there that there have been cases that have gone to the state office that individuals had pictures taken that didn't have a mask on and were close to one another. And those will result in a correspondence from the state saying, Listen, you need to make sure that this is done. And send me your information for training your logs your plan, that you're going to make sure that this doesn't happen again, or the plan that says you're following the covid plan. So it's not pleasant to get one of those, I'm sure.

Geoff Lassers  19:47  
 Make it very clear to everyone listening. There have been life support agencies in Michigan that have received notification from the state that indicated that they have pictures of personnel in their trucks, not wearing masks. In the situations that I'm aware of this wasn't like they were taking pictures on a call, they were hanging out at the station. And it appeared that somebody or somebody were not wearing their mask. Now, it was a picture that they took themselves and found its way into social media. And I think that's pretty much how the state found out. So if they do find out they're going to make their way. And that's how serious of nature the state is taking on this. And I think it's important to really find out that if your agency is called into question, it is with evidence that you're not doing it. The state rightfully so is going to ask for Well, what is your current policies? And how have you been enforcing them? And if they're not within their current purview of guidelines they're going to make you adhere to it. So it's better to know before you get told something happened, I think,

Chris Haney  20:44  
and Geoff, just to set the tone here. The state they're asking, we've put it out to our people. It's an ask, they haven't come hard with enforcement. There is a fine that can be loaded with that to this date. I don't believe there has been a fine.

Geoff Lassers  20:57  
Last I heard the state put out a notification that sure do they have the legal ability to Yes, have they done it at all? No, they have not done it yet. In Michigan, for my understand, they don't want to threaten anybody. They just want to keep people safe.

Chris Haney  21:11  
Yeah, that's it end of the day, I guess we are role models to the community. And I've had plenty of discussion on this. But in short, lets wear our masks, wash our hands and be safe at that kind of moves me into the station setting. You know, we have our folks that when they come in the headquarters of Star they're to have their mask on as they do in the ambulance to come in. And we have areas that are identified to where the travel is limited. We don't want the road personnel in areas of billing and other office areas. And if there is a meeting that needs to occur, we'll make that happen just to come out to an area and meet, the whole idea is just to try to keep everyone safe, you are required to wear a mask in a building equal effort, all this information in the plans that are posted in the plans, you can search on the website, I don't want to dive into the weeds on this. 

Geoff Lassers  21:58  
Now i mean, we have to wear a mask in every building going to Michigan right now anyway. So it's not like it's new. 

Chris Haney  22:03  
Right, If you're sitting, you know, in the break room, that's one of the biggest things Dr. Fales at the state had brought to us was that's a concern right now is where a lot of these exposures are occurring is it you go into a break room area, and even though your social distanced, you pull your mask off, and you're talking and, and that's a great opportunity. So just be careful on all those settings. But wear a mask. And if you're in your office by yourself, of course you don't have to wear a mask. But if you have someone and you're having a discussion or meeting you should social distance and have a mask that's best practice because we don't want to have someone take it home, and then give it to their loved ones. And the same thing we watch on TV every day, you know, just be careful and mindful.

Geoff Lassers  22:42  
And you mentioned Dr. Fales, I just want to notify everybody. Dr. Fales is the state Ms. Medical Director. That's what he's referring to. Okay, so it sounds like there's really nothing new there. It's a constant reinforcement of what they've been saying the whole time, where mask social distance in the building. And I don't know that's been in a different at any point through this pandemic, it just seems to be continued to the point of more agencies are becoming more logistically responsible for it, you're bringing up a little bit of an example of well, we facilitate meetings differently, we literally take them to a different room, we're trying to limit exposures of human beings, you may not need the road crew over there by the dispatchers, they're not on calls. So that really does take care of things of what I need to know and what they are doing. If they catch my agency or me not doing it, and nobody's really getting slapped for it. It's just, Hey, what's going on, let's make sure we're adhering to these rules. Another thing I want to just recommend to people is just going to consider when the driving ambulance, you're also driving a billboard. And depending on if you're passing, I don't know, Karen, and she sees you with your mask off, or no mask or whatever. And you're sitting in that ambulance, who knows who she knows and what phone number she has, and who she's going to call. So at the end of the day, just remember who you're representing and your own personal vehicle and your personal life. That's a totally different story. But for now, I think we all know what we're saying here.

Chris Haney  24:02  
Agreed, Geoff, those are some outstanding points. And just in closing to this I'd like to hit on again,  to make sure I know we get busy, we're gonna get busier if we have staffing challenges, and the hospitals are busier. But make sure we take the opportunity to do a good deep clean on the vehicles and your equipment. It can get busy and some things can be overlooked. But again, we have to make sure we take that time to pay attention to the details right now. 

Geoff Lassers  24:26  
Yeah, take a minute to make a minute clean your workspace. I do know that I've learned a lot about this a little bit off topic but I've learned a lot about what you can and can't put on your work gear. You know the the monitor although we keep cleaning it you know sometimes somebody either wipes down the monitor I say the monitor because it's plastic but anything plastic like Oh, what's that film? Is that good for this? So we've learned a lot about our cleaning supplies. So yeah, if there's actually a good CE on American CME, keep it clean if you want to learn about disinfection in your work environment. So shameless plug there, Chris, you got anything in closing thoughts for people?

Chris Haney  24:58  
No I've just got a lot of information, a lot of papers in front of me. And there's a lot more to this in detail with plans and orders and timelines. So I think for the most part, we're good. But if anybody has any questions, and it's not answered within your department or division, feel free to reach out and there's always always a voice here the county that  will help you out. A couple things to I think I would like to add is if you have any issues within you know, there's listeners that may not be a part of an agency could be retired individuals. If you have any problem maintaining your credentialing, your CE's your BLS card, ACLs pals, there's nothing right now in place to hit the pause button with renewals or anything, there's still most of our things that we do as far as CE can be obtained distant learning, virtual with the exception of pediatric MI-MEDIC administration. But if there's any issues that you're getting close, or having problems, contact Sabrina at the state, Sabrina will help at least guide you or talk to us here at the county, because we want to make sure we're maintaining the currency of the license.

Geoff Lassers  26:03  
Yeah and if you're outside of Michigan don't call Sabrina, She's gonna think that's weird. That just for people in Michigan, we do have a number of listeners outside of the state. And by the way, Ohio is our second biggest market and then somewhere in Washington. So for all you guys out there listening from Ohio, and Washington, what up? Thank you for listening. But Chris, thank you for coming in today, we're gonna pick up this at another time. And I'm glad we at least got to both kind of cathartically workout some of these things that we keep hearing and give people some context because I know we both you and I get a lot of phone calls on what do I follow? What do I do and the other day, it's pretty clean. We have protocols, they come from data, they come from guidelines, they come from recommendations, usually at the regional, the state, and federal level. And all of these things kind of talk in a cascade to talk to each other.

Chris Haney  26:45  
And you are so right because it's easy to get confused with you get so many other things going on in life. And when we talk there's different audiences. You've got the folks that are human risk and health and safety and the ones that maintain logs for the Department of MIOSHA and other and then we have the folks like us that are boots on the ground that want to know the down and dirty.

Geoff Lassers  27:06  
That's right.

Well, that's all for the show today, everyone. Thank you for listening, Chris, thank you for coming by today. We always appreciate your participation here. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also, check out our updated website at EMSonAIR.com. For the latest information podcast episodes and other details. Follow us on Instagram @emsonair and please whatever podcast platform you use, subscribe to our podcast and leave us a rating and a review. It really does help us grow the podcast. Thank you for listening to the EMS on AIR podcast. Stay safe and have a great day.

Transcribed by https://otter.ai