I had some downtime at Newark Airport a few weeks ago. And by downtime I mean 5 hours camped out on a chair near the terminal B baggage claim. I splurged on the Boingo wireless and used the time to make some site changes. A few of those changes:

1. Social share buttons moved to side bar. +1, Twitter, and Facebook like have been moved from the top of the post to the left side of the post. Your shares of Everyday EMS Tips posts are a leading source of site traffic. I really appreciate every share. Thanks.

Click on the social share buttons to Retweet, +1, of Like

2. Training Tab on Nav Bar. I added a three drop downs to the Training tab on the nav bar. These are resource pages. So far I have created resource pages which link to other posts for:
a. Hot Topics – 12 Lead ECG, Capnography, MCI and Bath Salts
b. Patient Assessment – patient assessment and vital sign measurement related posts
c. Race Reports – recaps of races I have run in 2011.

Do you have other suggestions for improvements to Everyday EMS Tips? Many of the changes I have made have come through user comments.

Thanks for your ongoing support. Your occasional clicks on ads and purchases through affiliate links help me cover the costs of hosting and sending the weekly email newsletter. Thanks!

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Blog.CentreLearn.com – My day job is being the Director of Education for CentreLearn Solutions. I add about two posts a week to the CentreLearn blog and manage our social media accounts.

Top Questions about CL Courses for Firefighters, Paramedics, and EMTs

Build your own Online Training Content

FDA Drug Safety Communication on Zofran – this article was contributed by paramedic Steve Cole. It is packed with information.

Medical Author Chat – on the EMSBlogs.com network I host the Medical Author Chat podcasts. Episodes are infrequent. When I can I also add posts related to my enjoyment of reading and writing.

Interview with Dr. Benjamin Luft about We’re Not Leaving about the initial and long-term response at the World Trade Center on 9/11.

My review of We’re Not Leaving.

Recent reads and news will bring you up to speed on my late summer and early fall reading list. I also announce taking the tablet plunge and pre-ordering an Amazon Kindle Fire.

EMS1.com

How are you doing in EMT Class? Use the ideas in this article to assess your progress. Self Assessment: Tracking Your Progress in EMT Class.

A new Everyday EMS Tip at EMS1.com on using Slideshare for EMS.

EMSEduCast

Rob Theriault and I helped Bill Toon by presenting at workshop for Kansas EMS educators. The workshop was repeated on three consecutive days. Rob recorded our 3rd session which was about teaching EMS and technology. You can view our recorded presentation.

PIOSocialMediaTraining.com

Some ideas on how a public safety agency can use an auto responder email campaign.

Loving the Run Blog

I shared my tips for running while on business or leisure travel at the Loving the Run Blog.

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I have been watching lots of New York City Marathon videos to get a sense for the course, logistics, and size of both the field of runners and the crowds spectating. This is the best one I have found. It also speaks to the commitment it takes to train for and run a marathon. One of the great joys of my life.

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Outstanding and brief training video on Bath Salts from Paramedic educator Malachi Winters.

I also have compiled this post of training programs, resources, and articles about Bath Salts.

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A CE Mash-Up is a technique to design and deliver a continuing education program using materials available for use and consumption on the internet. Each CE Mash-Up will suggest content to combine in your own blog post, website, or learning management system.

Slideshare Presentation

View this presentation, innovations in stroke care from EMS Educator Rom Duckworth.

Articles

Search the article archives at EMS1.com, EMSWorld.com, and JEMS.com for articles about updates in stroke care, innovative treatments, and transporting patients to stroke specialty centers.

Podcasts

Look for episodes in the archives of the MedicCast, such as episode 252, about stroke assessment, treatment, and care.

Learn about Stroke Alert

Does your community have a stroke alert program? Check out this video from the HealthONE Stroke Alert program.

What else would you put in a stroke assessment and treatment continuing education mash-up?

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2. Three Stroke Assessment Memory Aids Stroke is the third leading cause of death. Prompt recognition...
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Even though my official family motto is “Can I make a Suggestion.” (note that is with a period and not a question mark) I often struggle with responding to feature requests and service improvement suggestions on the education programs I create.

Over time I have developed a set of general replies that are finessed to the specific suggestion. So student/customer etc. suggests a feature.

1. We actually already have that service, functionality, or design you are seeking. I can explain it now or show you later.

2. We have had that same idea and our working on implementing it. Variation: many other users have made that same suggestion and we are working on implementing it.

3. That is an interesting request. I need more information and will schedule a time to discuss it with you more.

4. What other suggestions do you or others have?

How do you handle feature requests and service improvements?

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Every job, every employee, and every employer has these essential duties or job function:

• Sales
• Customer Service
• Education
• Maintenance

How do these functions manifest in your workplace?

Sales

EMS, especially when provided by a public agency, doesn’t have to do traditional sales and marketing. What EMS does need to do is communicate its value to the community. If the community is not sold on your value the result is doing more with less or even worse … doing less with less.

Customer Service

In EMS our customers aren’t just the patients. The customers we serve change throughout the day. Your customer might be  an internal customer. The customers for the fleet mechanic are the drivers of the ambulances. The billing department is one of your customers. Are you providing them a timely and well prepared patient care report so they can optimally recover charges.

Education

We always have opportunities to educate and many times we educate by doing and showing. Someone is always watching.

Maintenance

Sweeping has never been on any of my job description, but it has been part of every job I have ever had.

What are the other big duties of every employee in every workplace?

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Today I depart for Reno, Nevada for the 2011 National Association of EMS Educators Symposium. The annual event brings together paramedic and EMT educators from around the world for training, product evaluation, and networking. At NAEMSE I am looking forward to:

1. Co-Presenting Effective Visual Presentations with Kyle David Bates. We have previously presented this workshop at NAEMSE and other EMS educator conferences in Florida, Illinois, New York, and Alaska. Learn more.

2. Talking about online education with other EMS educators that are using web-based tools for initial and refresher training.

3. Exploring Reno by foot. I have a 20 mile training run planned for Saturday morning. @UnwiredMedic is helping me plan a scenic, challenging, and safe running route. Care to join me for all or a portion of the run?

4. Seeing presentations from the best of the best in EMS education.

5. Re-uniting with EMS education colleagues. Some I just saw two weeks at EMS World Expo. Some I have not seen since EMS World Expo 2011.

6. Gathering topic and guest ideas for future episodes of the EMSEduCast – the podcast by and for EMS educators.

7. Sharing lots of EMS education success stories and resources on Twitter using the hashtag #NAEMSE.

Are you attending NAEMSE? What are you looking forward to?

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Screencasting has many potential applications for emergency response educators and training officers to discuss new or updated protocols, proper use of scheduling and ePCR software, or how to interact with other web-based content. Since most free screencasting tools, Screenr, limit the length of a screencast recording follow these tips for creating screencasts that are effective.

1. Cover one thing per screencast. Don’t attempt to teach analysis of all cardiac arrhythmias in one screencast. Instead discuss one arrhythmia per screencast. Do the same for any type of software use or protocol discussion.
2. Practice screen actions before recording. Open the application windows and browser tabs needed for the screencast. Practice moving between applications in the sequence you will in the screencast.
3. Eliminate the clutter. Close unneeded applications and browser tabs before starting. Resize the screen capture area to the most essential aspects. Avoid having large areas of white space in the capture area.
4. Outline or script the audio. I prefer to outline the narrative I will speak as I record my onscreen actions instead of writing a script. I think an outline gives me a more relaxed and natural tone. A script might be best if you need to follow an exact list of steps or criteria.
5. Start recording with the best image. A thumbnail image of the screencast will often display the first image frame in the video. Start recording on the final product of an instructional screencast or some other descriptive visual that will entice viewers to select and view the screencast.
6. Edit as you record. If the screen capture tool allows you to pause as you record you can edit as you go. This might mean switching between applications or pausing the recording as you enter your username and password so that is not shown to the audience.
7. Determine audience for screencast. Many screencasts allow distribution through blogs and other social media channels. You even have the option to allow others to link to the screencast or embed the screencast in their own blog or website. Before publishing the final screencast make sure you have selected the appropriate distribution properties.
8. Review your work. Make sure you covered all the things you needed to cover. Also look to make sure the capture area does not include things you don’t want the world to see like your username, passwords, browser tabs open or software that is running.
9. Publish and share. The breadth and distribution of your screencast depends on your goal, topic, and intended audience. Social media tools, like Twitter, Facebook, and Video allow wide distribution of screencasts. Many screencast product websites and video sharing sites allow and encourage visitors to embed screencasts in their own blogs and websites.
10. Make screencasts. Since it is free to make practice making several screencasts. Just pick a simple topic and give it a try. Use the easy to use Screenr tool to get started.

View, share, and copy my screencasts at Screenr and videos at YouTube. Share your screencasting tips, suggest a screencast, or ask questions in the comments area.

Screencast description of ebook, The 4 Most Important People for your Professional Network.

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Update: on 5/16 (1 day after the race) the race organizers emailed all participants that the race had been mis-marked and we ran an extra .15 miles. See my Part 2 race report for more on that plus some final details about the race.

Earlier today I completed the Green Bay, Wisconsin Cellcom Marathon. It was a terrific day that will be remembered for a well organized race with terrific volunteer and fan support, incredible wind, and a new personal record finish time. (my results)

Finishing my lap around the inside of Lambeau Field

Marathon Training
I began training for the marathon, my sixth, in early January. This was my first Spring marathon so I logged some miles in January and February running in the dark and temps some times in the single digits. I also logged more training miles for this marathon than any other on a treadmill at the Stevens Point YMCA. Fortunately I enjoy both running outdoors in the dark and cold and treadmill running. I can do a 7 to 11 mile treadmill run without much mental anguish. Some runners detest treadmill running. I had one memorable night on the treadmill when Rocky IV was on the television. I found myself bobbing, jabbing, and keeping pace as Rocky Balboa trained in frozen Siberia for the battle with Ivan Drago. I even whooped out a couple of times to cheer on Rocky, much to the amusement of other YMCA runners.

This year I ran a 5 day a week training schedule. In the past I have used 3 day (the Run Less Run Faster) and 4 day (Hal Higdon) training plans. Things went well for me on this schedule. I stayed injury free while running the highest miles I have ever run. I even had my first 50 mile week. I also was fortunate to not have any colds throughout the entire winter and spring.

My biggest concern with the training plan was that my longest training run, 22 miles, was the 2nd Saturday of April. I have been on a taper ever since. In the end I think this worked out well because I focused on increasing speed and intensity as the workouts got shorter.

My final training run was this past Wednesday in Las Vegas where I was attending the Fire-Rescue Med conference. I ran a 7 mile loop from the Orleans to the south end of the Strip to Flamingo Blvd and back to the Orleans. I really enjoy running the strip as the sun is rising. There are lots of other runners and just enough late night stragglers to keep the sightseeing interesting.

Pre-Race Preparation
Packet pick-up was Saturday in the Lambeau Field Atrium. The atrium was packed with vendors and a record number of half marathon and marathon participants. I was going to buy some Power Gel, but the lines were too long. I was relieved to read in the race guide that Gu would be distributed on course at about miles 7, 13, and 20. This is unusual. Most marathons I have run hand-out Gu or some other gel pack at just one point. Usually around mile 20.

I tried to have a low key day on Saturday – Sam’s Club for food and sundries and a few other errands around town with family. I grew up in Green Bay and the rest of my immediate family still lives there. In addition to light shopping I focused on staying normally hydrated, eating simple carbs, and avoided afternoon and evening caffeine.

My day cooked a terrific supper of pasta, chicken, vegetables, and ceasar salad. I passed on dessert. I limited myself to just a single helping of the main dishes, drank plenty of water, and washed the meal down with a glass of low-fat chocolate milk – the beverage of champions.

After dinner I laid out my clothing and reviewed the forecast for the 1000th time. The race day forecast was chance of rain showers, mid to high 40s and high winds. Two out of three would be OK, but all three would make for a tough day.

Race Day
I set my alarm for two hours before start time. I try to eat breakfast as soon as possible to maximize digestion time (and bathroom opportunities). My breakfast was laid out the night before two packages of apples and cinnamon instant oatmeal with homemade granola mixed in, half a bagel (dry), 16 ounces of water, and 8 ounces of coffee. I drink coffee every morning and want to maintain status quo as much as possible on race day.

The drive up to Lambeau Field on Oneida Avenue was clogged with cars turning from the left lane into the stadium parking lot. I raced up the open right lane, to the front of the line, and was allowed to turn in. I call this type of merging Chicago Style (If you have ever been stuck in road construction traffic in Chicagoland you are familiar with this style of driving). Fortunately the lot was still more than half empty so all the runners/fans I drove by were able to get parking spots.

My first stop was the row of 40 porta potties. Those blue doors were the busiest buildings in Green Bay for the next hour. On my first trip the line was only 6 people deep. I have been to lots of races and I have noticed the line to the porta potties is always about the same distance away from the door. I vocally encourage the people in front of me to make bold moves when a door opens. After I was done with my business my wife, running the half marathon, wanted to use the indoor plumbing. We worked our way through the crowded atrium and found the line to the women’s restroom was half a football field long – shocker. So we headed back outside. Now the lines for the blue houses were at least 30 people deep. When the lines are long always get in the line in the middle of a long row of porta potties. Also I recommend choosing a line that is mostly men, especially on a cold morning. We usually have less layers to remove, at least for number one. Again I had to encourage those in front of us to make bold moves. For reasons not clear to me some races have a line for every door. While other races, this morning included, have a line for two or three doors. Aggressive lines can easily start using four or five doors if the lines to their left and right are timid. I say be bold.

With the clocking inching closer to the 7 a.m. start the magic blue doors finally opened for us. I made my second and final visit, jogged to the gear drop conveniently adjacent to the porta potties, and worked my way to the preferred start corral. Based on user projected finish time some marathon and half marathon runners were assigned to the preferred start corral closer to the front of the start area. This works out well because their are less people in the congested first couple of miles.

The Race!
After oodles of announcements, the National Anthem, and other words of encouragement we were off. My goal for the race was 3:30. I decided not to run with a pace group, but to stay just ahead of the 3:30 pace group. Since the marathon and half marathon start together, as well as a marathon relay, lots of runners blast out of the start area. Having done this several times before I know how important it is to start as close to my goal pace, 8:00 minutes/mile as possible.

Because of the cold and wind I was wearing an old fleece top that I planned to drop along the course. I kept that on for the first 1.5 miles. Since the route is generally through residential neighborhoods I kept the fleece on until I could drop it next to a sign at a fluid station.

Much of the early morning cloud cover had blown off before the start and because of the late Spring most of the trees were leaf free. It promised to be a sunny course. My race outfit ended up being shorts, short sleeve t-shirt, and coolmax running cap. I am always surprised to see other people running the same pace as me in twice as many layers. I also wore my Road ID, sunglasses, and a simple IronMan watch. I train with a Garmin GPS watch but those satellite is not as precise as the measured course. The differences causes great frustration among runners that feel like they either run too far or too short between mile markers. Thus it is important in training to learn to “feel” your race pace and not become reliant on the pacing of a GPS watch. Or run the race with a pacer.

Very few of the mile marker flags were standing because of the NNE wind which was report in the low 20 mphs at the start, rose to about 30 mph during the morning, and with gusts reported in the low 40s. The flags were lying in the grass and the mile numbers were also painted on the street. I missed several mile markers in the first 10 miles where the course route was wider and still a dual route for half and full marathon runners.

By the 6 mile mark I realized that I was feeling fit and confident. I was running slightly ahead of my goal pace and not being bothered by the wind or other faster moving runners. The crowd was very enthusiastic and I felt great running by people bundled in parkas.

After generally running west the marathon route turns south at about the 6.2 mile mark. This was the first long leg of running with the wind. I felt like I had a sail behind me and was running smoothly on the broad stretch of road to the 8 mile marker. I was taking gatorade every 3 miles, drinking in stride using a great tip I learned from the Run to Win blog to pinch the top of the cup. I also took a vanilla Gu packet at about the 7 mile mark. I was first handed a chocolate espresso but threw that one back when I was able to grab vanilla.

At about the 8 mile mark the course turns east, climbs as small hill and then takes a confusing set of turns through a residential neighborhood with another small hill. The turns ended with a turn north into the full furry of the wind. Thankfully this stretch is short before the course turns east with a progressive downhill on Morris Ave. After crossing Ridge road the route is all downhill to the Fox River. The highlight of the 10-11 mile section was my kids, niece and nephew, sister, and brother in-law cheering me on. I gave all the kids high fives and was propelled onward by their cheers.

After I saw my family the course continued eastward through an industrial park. The wind blasted through gaps in buildings. I got in step with a group of 5 women running together at my pace and benefited from their draft with the quartering wind.

The marathon and half marathon split after an agonizing two block run straight into the wind. Lots of runners peel off at this point for the run back to Lambeau. After the split we quickly turned south and I was feeling top notch with the wind at my back. I was surprised to hear cheers from my friend Scott at about mile 12 as he was waiting for his wife. The next few miles went really smooth. I took another Gu packet at the 13 mile mark and kept up with the fluids. I only drank Gatorade during the race. I would take a water cup to rinse off my sticky hands and sometimes splashed a bit into my mouth.

The route crosses the Main Street bridge in DePere. The bridge rises from the West to East side and the wind was roaring down the river corridor. I caught up with the group of five women (now just four) on the bridge. I used them for a draft, but their cohesion crumbled half way up the bridge and forged onward on my own. After the bridge the course turns north onto the fox river trail – a mixed use urban recreation trail just on the banks of the river.

At about the 16 mile mark I heard two people behind me discussing a drafting strategy. I think they were marathon relay runners because they seemed pretty fresh. I decided to fall in behind them and continue to benefit from the draft. They were running a bit faster than I planned to run so I dropped off their draft. When I realized it was harder to run solo than it was to run at their pace I surged back to them. The three of ran together, without speaking for several miles. The wind through the trees and breaking waves on the river was so loud we couldn’t have talked if we wanted to.

One of the other runners dropped off as we neared downtown Green Bay. Myself and the other runner caught another small group and began running together. Around mile 20 I took another Gu and then was energized to see my family around my mile 21. My son yelled “this is the greatest day ever.”

By now I was doing the math and knew, baring catastrophe, that I was well on my way to a new personal record (PR). The trail narrows significantly through downtown Green Bay and my small group had a near miss when the runners in front of us went three wide. All I could do was shout “three wide” and hoped they watched enough NASCAR to know they were about to get run down by faster moving runners. Somehow I pushed through them and carried on.

The WIND! The farther north we ran the stronger the wind gusted. Just before we crossed the river on the Walnut St bridge I had the sensation that I was running in place. Many runners were doing all they could to move forward. I was able to pass a mess of people in this short distance. After the river crossing the wind was behind for the trip south and west back to Lambeau.

At mile 24 I felt my left hamstring tremble – I dropped a very loud F-bomb that was hopefully lost in the wind. Fortunately it stabilized but I knew I could run any faster. At mile 25 my right hamstring began to tremble and my quads were shot. I took one final Gatorade and hoped for the best.

The finish for the marathon includes running west towards the stadium and looking directly at the finish line, but then you suddenly turn south, quickly west, and run uphill to the tunnel inside Lambeau Field. This is a particularly difficult finish because you run downhill into the bowels of the stadium and its warm dry air and then through a narrow tunnel, just 12 feet across that has two way traffic. When I ran into the stadium I felt re-energized by the cheering crowd and knowledge that the finish was close. I sort of heard my family as I ran by, but my field of vision was pretty narrow and I wasn’t hearing much. The exit from the stadium is the same with a run up and out, sharp left turn – straight into the run for 50 yards and and a final right turn east.

I was thrilled to see the finish clock display for me a new personal record – 3:27:20. My previous best was about 3:33:10.

Other than sore quads and tender hamstrings I felt the best I ever felt at a marathon finish. Especially since I had no chaffing! After getting my medal and t-shirt I reunited with my family and began to layer up and search for food. The wind was still howling so I got cold fast. I enjoyed a couple of cookies, banana, and a chocolate milk. My stomach said no thanks on the beer and bratwurst. Maybe some other time.

One of the best runner and fan features of the Cellcom marathon is the chip times for each timing mat are instantly sent by text message or email. This allowed my family to closely follow my progress and be in place to cheer since I was moving a little faster than anticipated.

How did I manage to set a PR? I think it was a combination of:

• Running higher mileage during training
• Increasing my speed and intensity as the training mileage dropped
• Staying illness and injury free throughout the training period
• Eating enough pre-race, but not too much
• Taking Gatorade only and Gu twice in the first half marathon
• Banking some seconds when the wind was at my back
• Intentionally drafting behind other runners on the long stretch into the wind
• Digging deep when my hamstrings began to tremble
• Amazing support during training and on race day from my wife and family

Links:
Green Bay Cellcom Marathon
Road ID – identification for endurance athletes

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