On Studying...

I had an instructor that once said that we would study more after we got out of school than we ever did while in class. Even though I have the utmost respect for that instructor, I had trouble believing him. Just like a teenager, as I grew up he got smart all of a sudden. By growing up I mean gaining experience as a paramedic.


I have opened my paramedic text so many times in the past few weeks I am thinking that I may have to buy another one because the spine is wearing out. I have been recently fully cleared to ride with anyone. Lately my supervisor has made full use of this. I have been working with the round-robin of brand spanking new EMT's and Intermediate's, not even one new paramedic.


One of my favorite shows to watch is ER. I have started collecting past seasons and my wife got me a few of them as stocking stuffers for Christmas. I have been watching them lately. It's kinda funny, I have watched that show for a long time. But now it invokes a much different thought pattern. I don't know if any of you readers out there watch ER, but as the name implies it's about an ER and the doctors and nurses that work there. There are paramedics in the show, but they are all just extras. They do make us look good most of the time, they roll into the ER with their patients neatly packaged, ready to hand off care with a quick, concise report. Then they roll back out, usually unnoticed as the drama of the ER unfolds.


The reason I mentioned this is that while I sit here watching this show and see the different types of trauma and medical patients that they treat, I wonder how I would treat that patient or that presentation if it were me.


So that leads me back to the original topic of discussion...studying. When I see a presentation or just think about something that may happen. A situation that is unlikely, but nonetheless a possibility each day I go to work. That in turn leads me back to my text, protocol book and of course the Internet.


It's funny how things work. They don't turn you loose until you have the experience on the street, but by the time you have the experience you are so far removed from the classroom that you've forgotten all the little details on all the stuff that hardly ever happens. I know that we are all supposed to be machines in our ability to remember every little thing on the fly, but that's not what happens. At least not to me. When I finally graduated, I never wanted to see another textbook, much less spend hours staring at one. So for the past few months, that is exactly what i have done, or rather what I have not done.

But to be honest I am terrified that something will happen and I will not remember what to do. Like the exact placement of the BIG on an adult patient, or how to mix an epi drip or some off the wall pediatric dosage. So I study, all the time, every time something new comes to mind.

I know that in the end it will only make me better, but I wonder if all new medics go through this...

BRM

Just another day...

I apologize to the readers who come back to my little corner looking for something to read and have been disappointed. With the new baby and the other two kids, the Wife, work, teaching and taking classes, I've not had that much time to write. So here is the account of my last shift...

We had a student rider to come and do his clinicals with us. Have you ever noticed that whenever a student comes, it's either feast or famine? Either you run the worst calls or absolutely nothing. Well, this student is a "white cloud", meaning that we run nothing. Every time he has showed up I can count on being able to catch up on my sleep.

I kinda hate it for the guy because my cert card is barely dry and I remember all too well what it was like to do field clinicals. I know that he wants to get out there and tube someone, push every drug we have in the box and shock people 'till all the batteries are dry. I've offered to answer any questions he has. He's asked a few, I showed him all about the monitor, CPAP, BIG gun, MAST trousers, the pressure infuser and any other piece of equipment that we have on the rig. We've went over all 42 drugs in the box and he knows them by heart. So now we just sit around and watch TV or sleep. You know, just another day in EMS.

Last shift, he had no sooner pulled his little hatch-back car with all the EMT stickers and red lights out of the parking lot than the tones went off. We didn't stop for almost 8 hours. God, I wish they'd let him ride for 24 hours instead of just 12.

First call was for a choking at a nursing home. Nothing to it, little old lady got choked up on her mystery meat and the nursing staff freaked. You shoulda seen the look on the doc's face when we brought that one in...

Next was a CVA (stroke). Middle aged man had an acute onset of right-sided paralysis with blurred vision also in his right eye. No prior history except for diabetes and migraines. His symptoms were fully resolved way before we got there, and we only had a 4 minute en route time. He's a little sweaty, but otherwise he looks fine. The first responders say that his pressure is like 280/ 140 and they took it 3 times just to make sure.

We got him in the truck and they were right on the money. IV, O2, monitor and we were on the road. I gave him 2 sub-lingual nitro's and a clonidine. We were about 40 minutes away from the hospital and I actually got to see the clonidine work. Finally got his pressure to 160/ 100 and that was good enough for me. He never had any complaints whatsoever.

The last call of the shift was for a reported unconscious. We get there and the first responders are freaking a little bit. An elderly lady is propped up in bed, unresponsive, breathing about 30+ times a minute and looked like crap. We got her out to the truck and got to work. Her O2 sat's were in the 70's and her capnography was 23mmHg. History of COPD and CHF and lung cancer that was in remission, but no wheezing and no rales. Her lungs sounded good, for the little amount of air that she was moving. She came back around before we got to the highway and stayed that way until about 5 minutes prior to pulling up at the ED. She just finally wore out. I had my intubation stuff ready, but there wasn't any time, so I got a nasal airway in and bagged her the rest of the way.

As we moved her over to the ED bed she woke back up. We waited around just to see what they would do for her. I figured about CPAP or BiPAP, my partner thought they should just tube her. I didn't think she needed it and if they did, she would probably never come off the vent. Her sats dropped to 50 by the time the doc decided to do something about it. I didn't feel like watching them let her die, so we left. Not sure what happened. We got back and slept for the few hours before the morning wake up call.

And that was just another day...

BRM

The Power of Being Nice...

My partner came to our service from the Big City EMS down the road. He has what I call the "Big City Attitude" most of the time. Don't get me wrong, he is an excellent medic and when someone is actually sick, he is one of the good ones to have around. But he had no patience whatsoever. Especially when it comes to patients that fall into the "BS" category.

We had a good day last shift, not too many calls. All but one were BLS, the other was just a simple diabetic. We sweetened her up and then she refused. She was a little old lady who had delt with her diabetes for over 20 years. Her husband had delt with it as well. All the while we were trying to start an IV he was up and moving around the little apartment they shared. You could tell he was nervous. He knew exactly what was wrong and that we would help her, it had happened many times before. But he was still anxious over his wife of over 40 years.

My partner was getting irritated at the husbands actions and how he was worrying us all with his advise and him going on and on about how she hadn't been taking care of herself as of late. I could see the growing frustration in my partner, so I stopped looking for an IV and got up to help the man look for whatever it was that he was searching for at the moment. I talked to him and offered reassurance that his wife was going to be OK. The look in his eyes was relief as someone was actually paying attention to what he had to say.

The rest of the day was all BLS. Most of them at nursing homes. Another little old lady fell and now she was having hip pain. She was scared that her hip was broken. Even though there was no deformity, shortening or rotation, I handled her with the same care that I would with my own grandmother.

A large lady had fallen out of her wheelchair while trying to get to the toilet. She was over 400 pounds and did not smell very well. She was having some trouble breathing and was embarrassed of being on the floor. We helped her up and I gave her one of our bedpans so she would not have to move from the bed to do her business. I listened to her story of how she had just been released from a long hospital stay for an infection. We got her situated and then left.

All through the day I made it a point to be nice. To listen to my patients, no matter what the circumstances or what they had to say. I noticed that as I continued to "be nice", my partner's attitude also changed. He didn't completely loose the "Big City Attitude", but he toned it down a great deal. It was as if my actions were effecting his. That by seeing how I was toward the patients, he unconsciously was doing the same.

Interesting how our attitudes and actions affect others around us, even those who we look up to and should be teaching us.....


BRM

10,000!

Today this blog hit the 10,000 mark! Thanks goes out to all those who have me linked on their blogs and the people that have come and read and commented. Thank you all very much!

BRM

Two's....part two

The very next shift we get called out for another MVA about a 1/2 mile from the one the shift before. It's dark and it's raining...again. We get there and it's also another T-bone type collision. Deja vu, I think.

Luckily, this one isn't as bad. I had one patient that was sitting outside her car and crying. She had been wearing her seat belt and the airbag had deployed. I put a c-collar on and place her on the board and get her out of the rain and into the truck. A full assessment revealed some minor cuts and bruises. Overall she was a lucky kid, her car took a hell of a hit. We dropped her off at the ED and headed back to the county.

Sometime after 2am we get a call for an unconscious. When we arrive, the house is small and cluttered. There are several people standing around this large man laying on his back on a bed in the living room. He's unconscious, sweaty and barely breathing. The bystanders say that he just got back from a military hospital overseas. He had been shot 3 times in the back while in Iraq. He hadn't been stateside for 2 weeks.

His pupils were pinpoint and non-reactive. They said that he hadn't taken anything, but the fire department that showed up to help found a bottle of morphine tablets that was empty. It had been filled 3 days before. We had our culprit.

It took all four of us to get him loaded on a board and then to the truck. I wasn't working with my regular partner, he had taken the shift off. I had another full-timer from another truck. He was real laid back and made me call all the shots on every good call we ever ran together.

When we finally got the patient to the truck, everyone was looking at me for answers. I got everyone moving. Start assisting ventilation's, get a blood sugar, start a line and get him on the monitor for starters.

A minute or two later that's all done and they are looking at me again as I finish taping down the line. I re-access his breathing and decide to intubate. I tell the fireman to try to put in an oral airway to see if the guy has a gag reflex. It goes in easily. I instruct him to keep bagging while I get my stuff ready.

Tube in hand, I slide the blade in and the guy bites down, hard. Then he raises up like he's gonna get off the cot. At first I thought he had broken his teeth on the metal blade, but luckily he didn't. Hhmmm....well, intubation is out, I don't want to try that again. I look at my partner and tell him to give some narcan, 0.5 mg to be exact. He gives it while I am still at the head.

This is the part where I get puked on, again. I had eye protection on this time at least, but I still had puke all over me, including my face. I have administered narcan before, but never have I had a patient puke with so low of a starting dose.

One of the fireman suctions the patient and my partner bags him while I wipe the crud from my face. The patient is still unconscious, but his breathing has improved. I put the oral airway back in and decide to bag the patient all the way to the hospital.

When we get there the doc orders 2 mg of narcan IV. I step out of the room to finish giving my report while they give the medication. I watch in semi-amusement as the nurse that is trying to get another line sidesteps a little too late to avoid the brown stream that suddenly erupts from the patients mouth.

The patient didn't get any better and they eventually RSI the guy. We left after that and didn't go back that night so I didn't get to find out how he turned out.

So concludes the tale of the two's. You see, in my experience everything comes in two's. I had two MVA's with pediatric females and then two calls where I got puked on. This wasn't the first time I've had a case of the "two's" either.

Oh yea, if I never give narcan again it will be too soon....

BRM

Two's....part one

Most people say that everything comes in three's. My experience is that everything comes in two's....

Just after dinner we get a call for a MVA (Motor vehicle Accident) with a pin-in. We get to the scene and my partner drops me off at the first vehicle and then speeds the 100 yards down the road to the other vehicle.

The van had moderate front end damage but no one was inside, which was a good thing. That usually meant that whomever was inside is OK, at least OK enough to move under their own power. It was night time, it was drizzling and there were lots of people standing around so it was hard to make out who might have been inside the van.

I grabbed someone and asked and he points me to the 3 people sitting on the side of the road. I walk up and ask if they were indeed the passengers of the van and they said yes. I asked if anyone was hurt and they said no. They also said that they did not want to be taken to the hospital. About that time the fire department showed up and one of the guys asked me if I needed anything. I told him to do a quick check and get vitals on the three people sitting there and then if everything was OK, get the refusals. (I had known this particular Fireman for awhile and had worked with him, so I trusted his judgement.)

I turned my attention down the road toward the other vehicle and see a mass of personnel surrounding it. I trot down that way to see if I am needed. My partner was about half in and half out of the car from the passenger side trying to assess the patient and figure out exactly where she was pinned at. She probably went for about 300 lbs and she was in a semi-compact car. A fireman was in the back seat holding c-spine and everyone else was either standing and watching or getting the rescue tools together to try and pop the door.

I started my usual walk around the vehicle when someone hollered at me. I turn to look and there at the side of the road stands a woman holding a shirt to a girls forehead and there was blood all over the girls face and chest. Another teenage girl was standing beside the two crying hysterically into a cell phone.

I walk up and ask the stupid question "Is everyone OK?" The woman says that she is a nurse and that both of the girls were in the accident. The girl with the blood all over her is just standing there as if in a daze. The nurse says that she has a nasty cut on her forehead and the shirt was all that she had to put against it to hold pressure. I said that she did the right thing and then look around for some help. No one is paying any attention to me, the rescue is in full swing and no one can hear me above the roar of the machines.

I tell the woman to hold tight for a minute and that I would be right back. I run to the truck and grab the spare jump-bag and snag a first responder from another dept. that just happened to be driving by. I was glad it was her, because she is very good and I trusted her as well. I asked her to get me a backboard and to pull the stretcher from the truck. I turn back to the scene and my two pediatric female patients.

The first responder is right behind me as I get back to the patient and we put a c-collar on and immobilize her from her standing position and then get her on the cot and to the truck. The nurse and the other patient follow behind. I hear in the background another ambulance coming in hot. Someone must have called for the second in.

I pull the soaked shirt away from her head and take a look. She has a laceration from just above her eyebrows leading into her hairline. I can see the glistening white of bone as I clean the wound and get bits of glass out of it. Then I put a dressing around it and finish my assessment. She has abdominal and left hip tenderness and her vitals are a bit off, as of the beginnings of shock. I start a line and get her on O2 and the monitor. She is conscious but not really there, doesn't remember what happened or exactly where she is.

The other patient, a teenager, is still crying, but not as hysterically. She has only a minor cut on her leg and I can't find anything else wrong with her. About that time the EMT from the other truck comes up and asks me if I needed anything, I said just a driver. He runs to the scene and then runs back to my truck and gets in. He looks back through the cubby-hole and asks me where to? I tell him Big City General and make it fast.

We get to the ED with no major problems, both patients maintained all the way there with no further complications. I give my report and walk back to the truck to start cleaning up....

Later that night as we were coming back from a routine transfer to the local ED we hear another truck asking for help. We were the closest, so we asked dispatch if they wanted us to go. We got the green light and headed in that direction.

We pulled up and the crew was already in the other truck with their patient. My partner opened the back doors to a mess. The patient was a large man, he hung over both side rails and each end and was slightly blue. He was unconscious, breathing shallowly about 8-10 times a minute.

The senior medic was getting his intubation equipment out and the other medic was trying to get a line. I went to help with the airway and my partner helped with the line and getting the monitor on. I got a BVM (Bag Valve Mask) out and started assisting with ventilation's. The other medic was ready to intubate and stuck the blade in the patients mouth.

He started gagging and jerking around. He's still got a gag reflex, I thought. But the senior medic is still trying to get the tube. After about 3-4 tries he sticks it in and I listen for lung sounds. "Your in the stomach", I say. He grabs the bag and starts squeezing anyway. We watch his belly get bigger. He yanks the BVM off and at that time the patient pukes.

If you've ever put a tube in the esophagus and the patient vomits you know what happened next. The vomit now had a barrel to shoot out of. The puke hits me square in the face before I had time to react. My partner and the other medic starts to gag as puke hits the ceiling of the ambulance. Senior Medic grabs the tube and tries to pinch it off and only succeeds in increasing the velocity of the stream. Needless to say it was a mess.

The patient is still breathing on his own and starts to aspirate the vomit that is inside his mouth. The senior medic looks at me and says "You try". I said that the patient was breathing on his own and has an intact gag reflex, so if you want to tube him, why don't you do it nasally? He wasn't hearing any of it and told me to do it.

At this point I faced a delima. He is a very respected Medic with 20+ years of experience, and the ink on my certification card is still wet. If this was my patient, I would never have tried to intubate him orally. We don't have RSI, so that is out of the equation. I would have nasally intubated him if anything, barring that I would have just bagged him all the way to the hospital. In the end I gave in to the senior medics glaring stare.

I told him to leave the tube in place so there was only one hole to hit. I get it on my second try and lungs sounds are questionable. I know that I am in, because I saw the tube pass through the vocal cords, plus there was condensation forming on the tube. I tell the others to get me a capnography filter and then we would know without a doubt. About that time the patient starts coughing and I look down. Apparently I hadn't been holding the tube well enough because he coughed it back up, inflated balloon and all.

"What do you want to do now?" I ask the senior medic. He says that he will just bag him the rest of the way in. I say OK and me and my partner get out of the truck and they pull away.

I look down at myself and I am covered in reddish puke and sweat. I peel my uniform shirt off and try to wipe the chunks out of my face and hair the best I can. I feel disgusted, both with the medic on the other truck and the fact that I had backed down from him, not to mention that I was covered in someone else's puke......

To be continued....

BRM

The Haldol Lady....

Everyone that works in EMS knows that you talk with your co-workers in a certain language. You reference the calls that you ran by the circumstances surrounding it and not the patients name. This is the story of "The Haldol Lady".

We were having a pretty good day, not too many calls. We had taken a patient to the little hospital that we have in-county and were cleaning up after. Dispatch comes over the radio with a transfer for a "routine medical" at a nursing home, no other info. The call is all the way on the other side of the county so we get in and get on the road.

We pull up at the facility and there are two CNA's waiting outside for us. Hmmm...they don't usually do that. Normally we have to hunt them down them down to glean the small amount of info that they have. I get out, yank the stretcher from the back and Another New Partner (ANP) and me start towards them. I notice that one of the young CNAs has a nice fresh bruise on her cheek.

As we approach one of them says that they are glad that we were finally there to get her off their hands.

"She's been beating the crap out of us and we are fed up with it", the other one says with a motion towards her bruised cheek.

"You guys shouldn't have any problems, she likes men". Great, I think, another transport trying to keep away from a groping old lady.

We wheel the cot down the hall to the room where a few other CNA's and nurses are standing. I get the report. Elderly female, over 80 years old, getting increasingly belligerent and combative. History of frequent UTI's, arthritis and mild Alzheimer's but she had never been violent before.


As I step tentatively into the room I see the woman in question. She is laying on her side, facing away from me.

"Hey I'm BRM from such-and-such EMS, what's going on today?"

"Fuck you, you sumbitch! Get the hell outta my room!"

Hhmmm....not the response I was looking for.

I turn and look at ANP to see if he has any thoughts on the subject at hand. To make a long story a little shorter, he doesn't have any bright ideas either. All our Paramedic charms don't work. Nothing that we can say or do will get her to get on the cot and ride with us.


We start to ask her the "legal" questions. You know them, "Do you know where you are? What day/month/week/year it is? Who is the President of the United States? How many quarters are in a dollar? She had answers to all of them, just not the right ones. (I had to look at one of the nurses on the day of the week question, because I didn't know that one either.....)

So we declare her not competent to make her own decisions and take her welfare in our hands. I went ahead and called for the local cops to come. I knew that we were in the right legally, but it's nice to have some law enforcement witnesses and eventually a sheriff''s deputy arrives. He doesn't do anything but watch, which is OK, that's all I wanted him there for anyways.


I decide to take a blood sugar because of her altered mental status and the fact that she hasn't eaten anything in a while. It takes six of us to hold her down while ANP pricks her finger for the drop of blood we need for the glucometer. 15 seconds later we rule that out, her glucose level is normal. The end result of that was to make her even madder.

There is no way we can take vitals, she won't sit still long enough. She does have a good strong, regular radial pulse and for now that's good enough for me. I deduce that she's not having any difficulty breathing, being as she's able to curse full sentences at everyone in the room. Plus she had no complaints other than us at the moment.

Me and ANP walk out into the hall and both of us say "Haldol" at the same time. So no discussing about further treatment. I get on the horn and call Medical Control and give my report and ask for 5mg of Haldol intramuscular (IM). I get what I asked for and go out to the truck to draw it up. On the way back in I recruit help from the nursing station. They do a semi-formal dog pile on her and I jab her in the hip. We all stand back and wait for the medication to take effect.

And we wait and we wait and we wait. It has no effect at all. Well, I think...she is about 250 on the hoof, maybe we need more. I call back to Med Control and ask for another 5mg. I get it and we go through the whole process again in the other hip. And we wait, again, to no avail. 10mg of Haldol and she is still pissed, maybe even more so now that she's had a needle stuck in each hip.


We all wipe the sweat off our brow and look at each other. I am out of ideas at this point. ANP doesn't have any light bulbs above his head either. And all the staff is looking at us to solve this particular problem.


We walk back out into the hall and talk. The only thing I know to do is to call back to Med Control and let them figure it out. I do and then an order for another 10mg of Haldol, in two 5 mg injections each. The only problem with this is the fact that we only carry 10 mg on the truck. We are fresh out.


I ask the nurse if they have any and she says yes. She pulls out this great big multi-dose vial with 50 mg in 10cc and starts to try to figure out how much she should draw up. After about 5 minutes watching her do her calculations and another nurse giving her well meant, but incorrect advise I give her the correct answer 1cc. She gives me this skeptical look over her glasses. You know the one that says "Who the hell are you to tell me anything? I'm a registered nurse with 4 years of education at an accredited college, countless years walking these halls medicating the sick, plus I'm at least 30 years your elder".


I give her the calculation so she can check for herself. She scribbles some more and finally draws up 2 syringes with 1cc of the medication in each one and hands them both to me with a huff. I also hear her say as I turn to go back to my patients room, "Ain't my ass if he's wrong". I pretend I didn't hear it and keep walking.


When I enter the room I find that my patient is no longer in her bed. There is a gaggle of facility employees and my partner in the adjoining bathroom. I peek my head in and see her sitting on the john. Apparently a new CNA came in and thought that she could do what no one else could and get her on the stretcher. She made it exactly half way before the patient made a pit stop and now she wasn't moving.

At this point my patients is wearing thin. I elbow my way into the doorway and let everyone know the plan. We are going to bodily get her up and put her on the cot. I have moved her bed out of the way and placed the stretcher in its place. So hopefully she won't really know the difference until it's too late.

It worked, in a way. We had to force her legs up once she sat down. After that we placed a sheet around her and tucked it under the mattress, then placed the straps and cinched them down so that she couldn't move but could still take a breath.

I got one shoulder free and jabbed her with one of the 5mg syringes. Then we roll her out and into the truck. At this point she is struggling something fierce. Shouting curses that would make a sailor blush and wriggling like a snake on coke. It took everything I had to keep her on the cot. Then she used the only weapon she had left, her mouth. She started spitting at me and that put me over the top. If she hadn't been old enough to be my grandmother I think that she would have started to have trouble breathing due to great pressure on her airway. As it was, I couldn't bring myself to do that. I just wiped the spittle off of my face and placed a non-rebreather on her with the appropriate O2 settings.

I gave her the other 5 mg and again, as expected, it had absolutely no effect. That was a total of 20 mg of Haldol and she was still just as feisty as when I first laid eyes on her. We made it to the hospital and put her in a bed. I gave my report to a stunned nurse and went to the bathroom to get myself back together again. My shirt was untucked, spit on my face and sweat dripping from my nose.

This was the first time I had ever given Haldol in the field. The first time ever, even in clinicals when I was going through medic class. And it didn't work. If I never have to give it again, it will be too soon.

BRM

Reunion...

I've read Peter Canning's books, both of them. In one he describes his school reunion. I'm not going to get into detail, if you want that go read his books. Recently I went to my own high school reunion.


I don't think that I had as hard of a time as Mr. Canning, but it wasn't easy. We didn't have a lot of money and I wasn't a great sports star. Needless to say, I wasn't popular and got picked on quite often. I stood up for myself when I'd had enough, but that never solved anything. My grades weren't the best and I hung around with the wrong crowd. Sounds like a lot of high school kids huh?


Anyway, I get this invitation for the reunion and am immediately indecisive on whether or not to go. My wife is supportive and says that either way is fine with her. No help there.


In the end I went, with Wife in tow. We had an OK time. I saw a few of my old friends and we had some laughs. By far the biggest topic of the night was how many times who had been divorced and how many kids did everyone have. The gossip of high school rears its ugly head.


It was interesting to see all of the old popular people migrate to one another. And to see how they had fared. Most had gained much weight and topped the divorce list if they had even married at all. Call me a grudge holding bastard, but I found it extremely funny to see them in their drunken revelry. Just like old times....


The next biggest question was "What are you doing now?" Closely followed by "Where are you living?"


The look in people's eyes was one of fascination when I told them I was a Paramedic and that I had moved away from the place of my upbringing. I'd had feelings of inadequacy going in. The feelings that most others would be doctors and lawyers and successful businessmen. That I would pale in comparison. Boy was I wrong.


The president of our class is installing security systems, door to door. Another popular guy is literally digging ditches. The prom queen is an assistant manager at a drug store. Not that these aren't honorable jobs. Trust me, I know that in these times, whatever will put food on the table is good enough. But I would have expected more from these once-prominent people of my school. Those that had went on to the big and expensive universities, while I went straight to work and then finally to a community college on my own dime.


It's funny how things go. The "nerdy" ones of the past are the successful ones of today, with the best looking spouses and lovely families. While the rich and popular of yesterday are the average joes of the present.


We left early, with promises to keep in touch. Scribbling phone numbers and email addresses on napkins. I doubt if I'll ever hear from most of them again, at least not until the next reunion.



BRM

Don't Fear the Reaper....

I turned the radio on as I drove home from work this morning. I tuned the FM band to an oldies rock station and "Don't Fear the Reaper" was playing. Fitting, I thought. For the past week I've been seeing dead people.

I've run more code blue's this week than any other in my short history in EMS. The total is up to 11 I think, but really, who's counting? Only three of them have been actual working codes. The rest have been a mix of different varieties of suicides, fatal wrecks and the others were just found dead.

Two of the codes were a hopeless cause. Both were unwitnessed arrests and both were asystolic when we got there. I worked them both because I felt like I needed to and other than the flat green line on the monitor there was no other reason not to. I didn't even get any Epi blips with either one.

It's a statistical fact that there are more suicides attempts in the county that I live and work than in any other in my state. I don't know why, but the people here just hate to live. I think I've seen just about every kind of suicide attempt that there is.

A man hanged himself naked in the front yard, his kids found him while they were going out the door to catch the bus to school. Another man put a hose from the tailpipe of his car into the interior and gunned the engine until he fell asleep and woke up dead. His wife of 23 years found him. A troubled woman ran her brand new Mustang at over 90 miles an hour straight into a concrete bridge pillar. A 16 year old kid put his hunting rifle under his chin and pulled the trigger with his toe. A 70 year old woman put her pearl handled revolver to her temple. All her affairs were neatly laid out on the couch in the front room. And pills....Jesus, the people around here love their bottled death.

The man with COPD found dead in his living room. His O2 and neb treatments almost within reach. The diabetic dead on his cold kitchen floor. His power had been turned off and someone had noticed the smell. The list goes on and on.

The other code that I ran actually had a shot. His was a witnessed arrest in his front yard. We were just around the corner and found him in V-fib. Shock, drugs, pump. Loaded him up, tube down the throat, more drugs, sirens, lights and diesel. A rhythm came back but it was way too slow, drugs wouldn't raise it. Gave him some juice through the pads, just enough. Bump. Bump. Bump. That's it, just to 60 beats a minute. Pulse check, yep, there they are, nice and regular. We got capture. He died anyway. Not long after we got him on the table in the ER.

The song goes off and something else comes on by the Beatles. I'm not a big fan of the Beatles so I turn it off and drive on in silence. I glance up in the rear-view mirror and see Him. He and His black hood and grim stare. Him with His cold hands and fathomless heart.

"I don't fear you", I say out loud to him....

BRM

Eyes....

I worked with an EMT yesterday. My partner went home sick early in the morning and the EMT in question was the only one that could come in on short notice. I've seen him around a few times. He's about done with Medic school but he's not arrogant about it. Many of the students that are at the end of the class think that they know it all. I wonder if I was like that... I suppose I was. It's funny, I've not had my patch long, on one hand it seems like yesterday, on the other it seems like years....

Anyway, we had a few good runs and the call volume was back to normal. Which is good because with the baby and 2 toddlers at home, sleep is a thing of the past.

I got woke up from a nap by a call for a pedestrian struck. At first I thought I was dreaming, well dream is too nice of a term. I thought I was having another nightmare. The dispatch info was almost the same: Pedestrian struck, small child, no other information at this time. As I realized that I wasn't dreaming I got up and started for the truck and then I started sweating.

When we got there, I took one look and I knew it wasn't going to be as bad as last time. The child was laying on the ground, screaming. His mother was kneeling over him and the whole family was there as well.

The kid had no real major threats. He had ran out behind a car and his lower leg had been run over. He had an obvious tib/fib fracture and a possible hip as well. We stabilized the leg and loaded him up. With the mother on board and the rest of the family in tow, we made our way to the hospital. And that was that. I breathed a sigh of relief once care had been transferred to the nurse.

In the early hours just before dawn I was woken up again for a possible code blue, our talk for a person down and not breathing. We arrive and go inside. There is a middle aged woman lying face down in the bed. Her two small children are there and looking scared. The oldest one had called 911 just like she had been taught in school. There is a bottle of pills scattered across the floor below the bed. I roll her over and note the purple face, cool extremities and slight rigor. She has been down for a while. My EMT partner, the fire department and a cop all look at me.

"What do you want to do?" their eyes ask.

I almost turned around to look for someone else, someone else besides me that they are looking at. I know there is no one else. It's my decision and mine alone. This is the responsibility at its best and worst that my patch provides.

Anyone that has been in this business for even a short time has probably had to decide not to work a code. This was my first. Due to the condition of the body, I knew it was pointless. I also knew that it would only traumatize the children even more to see their mother being put through that.

I'm not ashamed to say that I hesitated in my response to all those eyes. I knew what I should do. I should just attach the wires, run my strip, call the Medical Examiner, etc. etc. All this happened in the space of about 2 seconds in real time. But in my head it stretched out for what seemed like an eternity.

I made my decision. I told a few of the first responders to get the kids out of there. I attached my wires and ran my strip. I called my supervisor and then put in my call to the Medical Examiner. I had taken a look at the pill bottle on the floor and it wasn't something she would have taken in an emergency. Also there was an empty alcohol bottle on the night table and a piece of paper tucked under it. I'd call this an open and shut overdose.

Since I was in charge, it's also my responsibility to talk to the survivors. There is no other adult in the house. There was only the deceased and the 2 kids. The question I began asking myself is, How do you tell two kids less than 10 years old that their mother is dead?

I did it. I did it with tears on my cheeks, but I did it.... I don't know what else to say about that.

As family members were called and friends and neighbors start to arrive. I got the rest of the story. The husband and father had died not a month earlier, car accident somewhere in the mid-west while he was away on business. The woman didn't take it well her sister said. How do you take it well I wanted to ask her. I didn't, I kept my mouth shut and noted down all the pertinent information for my report.

How does someone do that? How does someone get so far down to swallow their own death with a bunch of cheap wine and their kids are in the next room?

I don't know about anyone else that was there. But I went home and picked up my kid and didn't let go for a long time...

BRM

Contact....

I've finally created an e-mail account for the blog. So if anyone wants to comment or ask a question and doesn't want to leave it on here, feel free.

blueridgemedic11@yahoo.com

BRM

I'm Back...

First shift back and let me tell you, I was ready. Don't get me wrong, I love my Wife and Family. But I am not the type that can sit around the house for very long. I got my "Honey-Do List" done and several other things that I have been meaning to do around the house and yard and then...nothing. My son is of course a new-born and does nothing but eat, sleep and poop continuously. My wife won't let me hold him all the time and God didn't give me the equipment to feed him right now. So I was tired of watching the same movies on HBO and sitting around on my widening ass. Like I said, I was glad to go back to work just to have something to do.


Some things changed while I was gone. I am no longer working with New Partner. Now I have Another New Partner. The last one got moved to another station that was closer to where she lives and now I am working with someone else. He's been a Medic for a while, but hasn't been with our company very long. While I think I will miss New Partner, me and Another New Partner (ANP) seem to get along well, so I think it will be OK.

Our first day together was a fairly busy one. We ran about 8 calls. I know that's not a lot for some of you out there but our calls take around 2 hours from dispatch till we get back to the station. So that's approximately 16 out of 24 hours on the road. A normal day is about 3-5 calls, give or take.


Most were routine BS calls, a fall, nausea/vomiting, anxiety attack, minor dyspnea and the like. The one that wasn't made ANP and me scratch our heads...


The call came out as a seizure. We get to the house and there is a young man laying on the floor having what looked like at first glance a seizure. But he wasn't jerking around and he hadn't pissed himself. No one was there but a female friend of his that was freaking the hell out. He was going in and out of these spasms and wasn't responding to anything. His whole body would just lock up and then he started frothing at the mouth.


ANP went to the truck to get things ready and with the help of a first responder I got him on the stretcher and to the truck. ANP had everything ready and had the Valium out and was getting ready to draw it up because the patient hadn't stopped the spasms.


We didn't give the Valium, luckily. There was a first responder who had been talking to the patients mother on the phone trying to get some kind of history and he came back to the rig and told us what he found out.


The patient had a cardiac history that included tachycardia and had 2 ablasions done over the past 4 or 5 years. Well, we had already put the patient on the monitor, done a 12-lead, started an IV and gotten a blood sugar reading and gotten base line vitals. His rate would jump to about 140 while he was having the spasms and then return to around 80. Other than that and the fact that he was still spasming and unconscious, everything else checked out fine. The first responder is also a Medic and works with us part-time. He then tells us that his wife has the exact same problem with the exact same symptoms. He said that the spasms were caused by extreme pain but there was really nothing that we could do for him. The guy did look like he was in a hell of a lot of pain. So we got moving to the hospital.

About that time he woke up. He went from zero to oh shit in about 1/2 a second. He wasn't postictal at all. He was just scared shitless and didn't know where he was or who we were. Once we had him calmed down he was OK. He didn't want to go to the hospital but we talked him into it. All the way there we was conscious but he still had these spasms. With them he was having extreme chest pain. I called in to Med-Control and told them what I had. I don't think they had a clue either because I didn't get any orders or even suggestions on what to do. So we just got him to the ED and that was that. I still don't know what was really going on with him. I've asked several other experienced Medics and they didn't have an idea either.

So that was my first shift back... Busy but interesting...

BRM

I'll be back....

....sometime in the next few weeks. I took a little time off from work to spend with the family unit. I'll continue with the writing once I go back on shift. Until then...

BRM

My Son...

My son was born a few days ago. I can't begin to describe the feelings that I felt when I held him for the first time. There are no words in the English language to articulate it....

Ya'll welcome my son, Kaleb Grey to the world....

BRM

Wow...

I got an award....


Thanks goes out to Sandy G!

Other blogs that I can't live without and read almost every day...

A Day in the Life of an Ambulance Driver,
Baby Medic,
Boobs, Injuries & Dr. Pepper,
Rocky Mountain Medic and
Street Watch: Notes of a Paramedic.

These are just a few, all the others on my "Great Reads" list are exactly that, great reads. I would recommend all of them. Thanks again Sandy!

BRM

The Storm...

A few posts back, I spoke of The Calm. A commenter warned me of the storm that always follows it. I should have listened...

On the way to work yesterday morning, I was wondering who I would be working with and if last shift was just a fluke. I speculated on the possibilities of working with the same New Partner (NP) again, or someone else. When I pulled up, her car was there and my suspicions were put to rest. She had made a point to get there before I did and was half-way through checking off the truck by the time I pulled in. With a big smile on her face she said hey and asked if I'd slept late. Smartass..Hmmm...I think this partnership will work out just fine.

Everything went as usual for an hour or two, then all hell broke loose. The entire county exploded and all 5 trucks got a call in less than 15 minutes. Ours was a routine transfer from a nursing home to Big City Hospital for a "routine medical", whatever that means.

Well it turned out to be not-so-routine. Out patient was an elderly lady with decreased level of consciousness (LOC) and no blood pressure to boot. We got underway and amazingly I got an 20 gauge IV in her arm. After a bucket-load of fluid, her pressure hadn't changed and her LOC hadn't improved. I couldn't find anything else wrong with her, 12-lead was good, her Foley catheter had urine in it and it was clear of junk, she wasn't running a fever, lungs were clear, pupils were reactive but sluggish. I was thinking maybe stroke, maybe an MI without ECG changes, hell I was grasping at straws by this point. I even gave some Narcan in case it was Opioid, even though her pupils weren't pinpoint.

No matter what was causing this, I knew I had to get her pressure up. So I started a dopamine drip and it worked! This action might seem very mundane to a lot of my readers and colleagues, but this was the first time I had done it, ever. Even in all the clinical's, I had never even seen one started. Needless to say I was nervous, but I couldn't help grinning as I watched her pressure rise to 96 by palpation and I stopped increasing the drip and it held. She even started moaning a little by the time we got her to the ED.

The next call was an allergic reaction, another bee sting. This time it was a 19 year old and she was having a full anaphalactic reaction. Luckily her parents knew all about it and stuck the patient with her Epi-Pen and it slowed the reaction till we could get there. But it wasn't enough. NP gave her another shot of Epi under the skin, and some Benadryl and Solu-Medrol through the IV I had started. She was still wheezing, so a couple of nebulized Albuterol treatments cleared her up on the way to the hospital.

We slowed down a bit after that, did another routine call for a guy with the flu and a three year old who had fallen off the back porch of his grandparents house. A few bumps and bruises, but otherwise he was OK.

We had just finished eating dinner and the tones went off. A possible Code Blue (Cardiac Arrest) at an assisted living facility. NP was almost jumping out of her skin with excitement. We get there and she practically drags me down the hall from the front of the stretcher. We see our patient, elderly male, laying on his back and he is purple from the nipple line up. Not a good sign.

The staff have no idea how long he has been down, the last time anyone has seen him alive was approximately 30 minutes before we got there. He is a full code, no DNR. I drag him to the floor, start bagging him and doing chest compressions while New Partner got the monitor out and attached the pads. Asystole, shit. The first responders show up and together we get him on a board and then to the cot. Once we get to the truck, NP goes for a line while I get out my intubation stuff and the squad members set up the IV lines and do CPR.

NP wasn't successful at the IV's so I told her to get the BIG gun out. It's a special device that puts a needle directly into the bone, that way we can give fluids and medications to the patient directly into the marrow and then it gets to the blood stream quickly. I dropped the tube on my first attempt and checked for breath sounds. I'm in! I look up and see NP grinning like a fool. She nailed the BIG gun on her first try as well.

The patient was still flat-line on the monitor and we started pushing the drugs and I told the squad to jump out and but I would need a driver. Me and NP worked the rest of the code by ourselves for the 15 minute ride to the local ED.

We didn't get him back, didn't even get any Epi-blips on the monitor. But I felt like we had gave it our all and done everything we could. Our supervisor was there when we arrived and he had heard everything on the radio. He was grinning from ear to ear. Later he took me aside and said that he was proud of me and that I was defiantly on my way. I imagine I turned about 8 different shades of red from this compliment. I thanked him and went to clean my truck. Running a code is a messy business, there were wrappers and equipment all over the place. About 45 minutes and 2 trash bags later we were all cleaned up and I checked us back in service.

That was the last call of the day, we actually got to sleep all night. Before I went off to bed, the phone rang at the station. It was my Training Officer. He was calling to tell me he had heard the call and had heard that we did exceptionally well. This man is the only one that could really intimidate me. I'm not sure exactly why, but he does. So a comment from him was a great thing to hear at the end of the day.

Cleared....

My service told me that I would have at least six months before I was cleared to work as a solo medic. With the shortages, I had a feeling that it wouldn't take that long.

Yesterday I showed up for work and my regular partner wasn't there. I usually show up 15-20 minutes early so I can get things done and not be in a huge hurry. Drink a little coffee, talk to the crew that is going home, that kind of thing. At 2 minutes till 7, in walks this brand new medic. I know her, but I've never worked with or around her. I've not had my patch for even 3 months yet, she has had hers about a week.

"You lost?" I ask.

"Nope, I'm working with you." she replies. Oh Shit.

About this time the station phone rings and I go to answer it. It's my supervisor and he's telling me what I just found out. Apparently 2 other medics had called out sick at the last minute and he couldn't get it covered with anyone but her. My partner got moved to another truck to work with a Basic EMT. He goes into his "pep talk" saying that I will be fine and that I am a lot stronger medic than I give myself credit for. Sheepishly I say OK and hang up the phone.

We get all the station duties done and go to breakfast. No calls yet. Me and Partner For the Day make small talk and I take a little nap in the recliner. I wake up and get some lunch. Still no calls.

My first call as a cleared solo medic was the most mundane that comes. A routine transfer from a nursing home to a doctors office, then wait and return. The next call was for a possible suicide. We staged for about 2 hours and then got cancelled by the cops, I never found out what happened on that one. We then went and got supper and back to the station.

The tones went off again for an allergic reaction, bee sting. The first responders were giving us a short report while we were en route and it sounded like a decent call. We get there and found out differently. He was having a reaction, but nothing "life threatening". A little O2 and benadryl and he was fine, we transported him to the local ED anyway.

My supervisor was at the hospital and about 45 minutes later we finally left. He had to give us a big talk and tell us all about how it used to be "in the old days". Don't get me wrong, I was raised to respect my elders and I do respect him for his age, station and experience. But in the year and a half that I have worked for him, I have heard the same speech at least 20 times.

On the way back we get another call, a stroke. The first responders on that side of the county were also saying that it was going to be a "load and go". I respect these first responders a little more, as they have proved their credibility to me time and time again. I step a little harder on the go-pedal and we eventually get there.

They were right, again. The patient was having an active stroke with symptoms starting 30 minutes prior. Complete left sided weakness, facial drooping, unequal pupils, incontinence and a lot of confusion. That squad functions at the Intermediate level and already had an IV in place, so that was one thing less to do. This was Partner For the Day's call so I let her run it. We got him loaded and finished assessing him and I asked her what else she wanted. "To get to the hospital" she replied. I agreed and down the road we went.

Half-way there she steps up between the seats and tells me all she had done and asked me what else? I tell her a few little things and then hand her the phone to call the Big City ED and tell them what we are coming with. She looks a little skeptical but does a good job overall.

Afterwards we are talking over the last 2 calls and she is asking me all kinds of questions and I actually have the answers. It felt good to help someone else. Not sure if she will be back next shift or who will be there when I walk through the door. But I have new confidence that I can get the job done.

BRM

The Adventures of Monkey Boy...

I was sound asleep when the tones went off. I cracked open one eye and listened to the dispatcher give out the call. 24 year old male. Abdominal pain. Great.


I get up, put my uniform shirt on and make my way to the truck. My partner was right behind me. We drove out to the middle of nowhere to a single wide trailer with crap laying everywhere all around it. Up the rickety steps, inside the house and we see our patient. A rescue squad member that I knew was trying unsuccessfully to get a blood pressure on the guy, yelling at him to sit still.


It wasn't working. Our patient was rolling around on the couch yelling. At first I couldn't understand what he was saying, then it came clear.


"My belly button is gonna fall out!"


I tried to keep from snickering and took a look at my partner and saw that he was trying to do the same. I made my way through the trash heap that was the living room to the guy. Then started in on my assessment.


He was indeed a 24 year old male that said he was having abdominal pain. He had went to the local hospital earlier that day with the same complaint and was sent home. He had been having this pain for 2 months, non-stop, with no relief. I started to ask him the pain scale thing and didn't even get 2 words out of my mouth before he screamed 12! 12! it's a 12! I took it that he had heard that question before. Wonderful. No other medical problems and no medications. At least none that were prescribed by a physician. Although he did have some laying on the table next to the couch that must have been prescribed by the local ABC store and his trusty neighborhood chemist. There was a definite odor of alcohol around him and his beard, mustache, nose hairs and eyebrows were singed.


As we started to get him up and make our way to the stretcher he stated something that I hadn't heard before.


"I think I swallowed a monkey and he is trying to eat his way out of my stomach!"


What? I must have heard that wrong. Nope. I heard it right. He kept saying it all 18 minutes of the transport. He wasn't sure how he swallowed the monkey or even when this supposedly happened. But that was his story and he was sticking to it.


Now before you, dear reader, get your panties in a bunch, I did do a full assessment. As much as he would allow. I could find nothing else wrong with him. All his vitals were fine, ECG looked good and there was no pain when I palpated his abdomen. Further evaluation revealed...well...nothing.


Then I began with further questioning. Like, have you been to any foreign countries where monkeys are native? What about the zoo? Have you fed the monkey in your belly lately? What does he like to eat? Is it male or a female monkey? (I was worried that maybe the primate inside his abdomen could be pregnant). What type of monkey was it? I mean I had to know what we were dealing with. Was it a small cute one, or a big hairy orangutan? Important questions that a thorough Paramedic like myself needs to know.


Needless to say that he didn't know any of the answers to the important questions. He didn't know what type/size it was, how it got in there or what it liked to eat, since he hadn't eaten in 3 days. All he knew was that it was inside of him and wanted to get out. That is what was causing his pain and he wanted help.


For my part, I took him to the hospital to get him that help. Although I didn't think they had a veterinarian on call.


The nurses all groaned when they saw him. They remembered him. But I lifted their spirits when I told them of his new complaint.

That's one thing I love about this job, you never know who you're gonna meet and what they are gonna say. Till next time...


BRM

Thanks again.....

....to all those who left a comment on my last post. It humbles me to think that there are still people out there that care about another persons suffering and pain. This job tends to put you in the mindset of otherwise.

I will definitely have to try some of the things that were suggested. I guess the thing that bothers the the most is the fact that I will soon have a son of my own. The dream took on new form once my mind wrapped itself around this idea. It's like I was the father of the dead child. I don't know how if could handle loosing my son.

I appreciate all the comments and well wishes from everyone.

BRM

Never forget....

I woke the other night choking down a scream, sweating and trying not to wake my Wife. I couldn't really remember what the dream was about at first. I just knew that it seemed familiar, like I'd had it before.

I sat up and went to the bathroom and splashed the sweat from my brow with some chilly water. As I looked up into my face in the dim light of the small nightlight by the sink, the dream came back to me with a vengeance. For just a second, I wasn't looking into my own eyes, but that of another man. A man screaming with rage, terror and grief. I gripped the edge of the sink and stared back into the reflection that didn't seem like a reflection as I remembered something that I thought I had long forgotten. But we never forget do we? I don't think so, even though we try, we never forget.

Just about anyone who has spent time on the streets as a cop, firefighter, or paramedic can tell you stories of their nightmares, if you can get close enough to them to get it to come out that is, this is one of mine....

Awhile back I was riding around in my truck, not doing much of nothing when my fire department/ rescue squad got a dispatch: Pedestrian struck. I flipped on the blinkers and motored over that way.

I was the third person on scene. The first was a fireman who didn't have much in the way of medical training, but eager to help. The other was a classmate of mine from early medic school. The scene was thus: A large sedan parked at the end of 10-15 feet of black marks on a curvy residential street, 10-15 bystanders that had come from out of their homes to gawk and one 5 year old child laying in a spreading pool of his own blood.

At this point I went into my "EMT Mode"- no emotions, just get the job done. I walked up and asked the fellow classmate what he had. I'll never forget his answer, "It ain't good BRM". As I was walking up, surveying the scene, I couldn't see the child in his entirety. I trusted the classmate for the hands-on stuff for the moment, and I was the only one at the time with any supplies whatsoever. So I started pulling stuff out of my bag and asking questions at the same time.

"Is he conscious?" I ask.

"No" he replies.

"Airway, Breathing, Pulse?"

"No, no, maybe."

"Maybe?"

"I can't seem to feel one" he says shakily.

I kind of nudge him aside to check for myself. This is my first, unobstructed view of the patient. It's a site I don't think I'll ever forget. His head is a mess of blood, hair and torn flesh. His shirt is torn in several places and blood is oozing out of many of them. One of his little arms is bent at an distorted angle back and behind him. His legs are mashed and bleeding and he has only socks on his small feet. This all took place in about 2 seconds, although it felt a lot longer at the time. I had the fireman hold what he could for c-spine while I inspected the child's airway and assessed for breathing. He wasn't, not good. His airway was full of blood and I asked for the hand-held suction in my bag. I got most of it suctioned and remarkably it stayed clear as far as I could tell.

In goes the tiny oral airway and I ask for the BVM to start breathing for him. Classmate hands me an adult one and I remember that is all we carry. Due to budget restraints we were never issued the pediatric or infant ones. I fit the mask to his face the best I can and give a squeeze feeling for compliance and watching for chest rise. It doesn't. I try to get a better seal and I am looking at his head this time when I squeeze. As I put pressure on the plastic bag I notice bubbles popping out of the top left side of the child's head where most of the damage seems to have occurred.

I can't believe what I am seeing. I try again and see the same results. I realize that the entire inner anatomy of the child's head is pretty much gone. The air I am trying to put into his lungs is coming out the side of his head. What the hell do I do now? I feel for a pulse and there is a weak one in his neck.

I can hear the sirens of the fast moving ambulance by now. It's almost here, but in my focused state of mind I didn't hear it. There are others on scene now, other EMT's and rescue personnel but they are just standing there looking at me. One asks me what I need and I say a surgeon. I'm thinking that is the only thing that can help at this point.

I continue bagging with the Classmate holding as good of a seal as he can with the over sized mask. Knowing that the effort is pretty much futile with all the bubbling coming out of the skull, but hoping that at least some of it is getting where it's supposed to go. I had also applied all the gauze pads I had to try to staunch the blood coming from his head, also futile, but I didn't know what else to do.

The ambulance arrived and 2 medics that I knew jumped out. You could smell the brakes cooking. We loaded him up and by that time the weak pulse I had earlier felt was gone. CPR and down the road we go. They tried to intubate, then tried to cric him. Neither worked, there was just too much trauma. They worked him for a long time at the ED, being a kid and all, no one wanted to give up. Eventually they did and we made our way back to the truck. Other fireman/ first responders from my department had followed us and cleaned up the truck so I rode with them back to the scene.

They had moved my truck down the road a little, to make room for the yellow tape the state cops had put up for their investigation. That's when I got the story. That's when I found out the rest of the horror.

The child was playing in and around the road. Neighbors said that he lived about a quarter mile away in a trailer park. He was always playing near the road. Most thought of him as a nuisance. He would throw rocks and such at cars and other devious things. A few had spoken to his mother, but being the alcoholic that she was, she just got defensive and cursed the neighbor out.

The child also had an older sister, 11 years old. She saw it all happen from the side of the road, about 6 feet away and was the one to run and ask someone to call 911. I can't imagine the thoughts of that little girl as she tries to grow up and find her place in the world.

The driver of the car was cleared from all charges. It was determined that he was driving within the posted limit and that he would not have been able to see the child in the road because of the curves. I never even saw the man. I don't know if he even got out of his car, I'm sure he did, but I didn't know it. Even though he has no criminal charges, I can imagine that if he ever got behind the wheel again, he would see that little boy crashing into the front of his car. If it were me, I'm not sure I could ever turn the key to another vehicle again.

He is a grandfather. He had his 2 young grandchildren in the car with him, ages 6 and 8. No one but God knows what kind of emotional scaring occurred to them that day.

After the investigation was over, we had to do the clean-up. We poured sand on the blood and tried to wash it off the road. It had poured from under the boy and ran all the way to the other side of the road and pooled in the dirt shoulder. I've drove through there many times since and I don't think it ever washed away completely, but that could be just my imagination.

We found the child's shoes. One was right behind the spray-painted marks where the car had been sitting, the other was about 15 feet farther up the road where the initial contact was made. This was the first and only time I had ever seen anyone actually knocked out of their shoes.

About this time we heard an engine growling its way toward us. A small pick-up came over the hill and several fireman had to jump out of its way. It skidded to a stop in the grass just beyond the yellow tape that was still up. The vehicle had barely come to a halt when a young man wearing mechanic's overalls jumped out. He was screaming before the door was open. He was screaming his son's name.

Someone had eventually called him at work and he came here instead of the hospital. He and the boy's mother were separated and initially no one knew how to reach him. One of the EMS supervisors was still on scene and apparently knew the guy but had not made the connection between him and the child. I was about 5 feet away when they stopped him. I could see the strain of the tendons in his neck as he pulled against those that had ahold of him.

I could see into his eyes as they told him that his only son was gone. I stood, unable to move, frozen by that mask of terror, grief and rage as I realized that the eyes that I was looking into were my own.

At this point I woke up.

At this point I always wake up.

It had been a long time since I'd had this dream. Up until now, it wasn't my own eyes that I was looking into as I awoke. But my wife is pregnant with our first child and now the dream has taken on a new form. I couldn't sleep afterwards. Instead I lay awake, cradling my wife, my arm protectively around her pregnant belly.

My wife also works in EMS as a Paramedic. But she doesn't have any of the experiences that I have had. So she can't really understand, even though my best attempts at trying to articulate my thoughts to her. She is my rock, but this time it seems that I break my waves around her, instead of on her. Even though she wants to help and understand, she is unable to stop the torrent that floods my mind.

So I am trying this, other than my wife, no one has heard this story in its entirety. I guess that I am hoping that by writing this out, I can somehow free the rat that is trapped in my mind.

BRM

My service....

I said in one of my last posts that I would get back to the topic of to go or stay with an EMS service. I got several great comments and I thank all those who did. I am gonna take a minute to talk about my service and you can tell me if you would leave...

We are a smaller, rural service. About 60 total employees. We run 5 trucks at 4 different stations. The shortest transport time to the Big City is about 20 minutes, the longest is 1 1/2 hours, and that is going emergency traffic.

We do have a small in-county hospital, but they only have about 130 beds and the ER has 5, only one of which is behind actual walls and not a curtain. We also have an urgent care/emergency room/ lab/CT scanner facility. Not much goes there except a cardiac arrest and very minor stuff. It's most beneficial to the local doctors office's for the use of the lab facilities, X-Ray and CT scanner. Neither of the in-county facilities have an actual MD on scene 24 hours a day. Most times you get a PA or NP with a doc on call. Sometimes you only get a nurse if the doc-in-the-box was out of rolling MD's when they needed one. Not sure how they get away with this, but it happens.

We work a 24-on, 48-off schedule like most other services in the area. There are a couple that work 24-on and 72-off, but only one is within driving distance. The pay here is on par with the area as well. Of course the Big City service pays a little more, but we are at the top of the average for the state. Benefits are decent. For employee's the insurance is free, and that includes medical, dental and vision. There is a few other plans for employee and spouse, employee and dependant (for a child), and a family plan. They are all decently priced. We also have the option of secondary insurance if the employee chooses. The only thing that is not covered under the county policy is life insurance, but you can get that through the secondary company or own your own. We also have one million in malpractice insurance provided by the county for each employee.

Con-Ed is also provided for all the employees and is of course mandatory for all the full time people. The training officer is very good about sending out emails for upcoming classes and conferences in the area. He usually finds a way to get you off work to go if you want to and he's always, so far, found a way for the county to pay for those classes/conferences. Not many people go to the specialty ones like Advanced Burn Life Support, Rope-Rescue, Dive-Rescue and the like. The reason is that they don't get any extra money for it. To me that's just a bad attitude, but in a way I can understand.

The call volume is fairly low in my opinion. At the busiest station you could run between 6-10 calls per 24 hour shift. The slowest has gone 2-3 weeks without running anything, but that rarely happens. Most of the time they run 2-3 calls, but they are also the farthest out from anything resembling society, much less paved roads. Up there you hear banjo music every night. Its where the men are men and the sheep are nervous if you get my meaning.

Now for the bad stuff.... There is no room for advancement. We have a director, assistant director, training officer and 3 supervisors. That is all the management that we have. With the turnover, anyone who has at least about 3 years in as a full-time Medic is considered a senior medic and those are who the students and trainees are put with. None of the management is going anywhere anytime soon, in so far as retirement goes.

There are also no raises. Well, you get one at 6, 12 and 18 months after you get hired, but they are so small I never even noticed them on my check. After that, nothing. It's been 6 1/2 years since the last cost-of-living raise came down the pipes and it ain't looking good for this year either.

So that's pretty much my service. I know this sounds like a recruitment speech, trust me it's not. I'd just like to hear what other people think the service that I work for and whether or not they would leave or stay. I am happy with it for now. I don't see myself going anywhere anytime soon, if ever. But you never know what the future may bring.

BRM

Been away....

Been awhile since I last posted. Sorry to those readers that come looking. The Wife and I went on a little pre-baby vacation, which was very much needed. I will post in the next day or so.

BRM

To Stay or Not to Stay....

I've made comments in other posts about my service being shorthanded when it comes to Medics. This has become an understatement. I have only worked for 2 EMS services. The first was a Basic transport service. It started out like many others, a small Mom and Pop operation where the owner still ran calls on the truck. Eventually, sadly, they got a little too big for their britches and forgot about the little people that made them what they were. I left them for several reasons, the major being an increase in my education and I couldn't use it there. Other reasons included several disagreements with the management and the overall day-to-day grind of the place. It just wasn't what I signed on for. So I left.

Now I have been with my current service, an ALS service, for about a year and a half. Not that long by many standards, and I completely agree. But my seniority is quickly growing. This is due to Medics leaving and leaving quickly. In that year and a half about 15 senior Medics have left. And I'm not talking about Medics that have been here for a year or 2. I'm talking about 5-15 year Medics. Some left because of Nursing school, we all know that Nurses on average make a hell of a lot more money, so I can understand that to some degree. Others leave because of personal disagreements with the management, which is inevitable, first rule of management should be that you can't make everyone happy. But the rest? I don't really have a clue.

We have lost a lot of people to "Big City EMS" just down the road. They pay a little more, not much, but a little. Their call volume is 2-3 times greater, they have 3-4 times as many employees and they have the availability of 12 hour shifts instead of 24. They can have a call completed from dispatch to return to quarters in less than an hour. They have a major hospital inside the county and that is where they transport everything, so their turn around time is quick. To me this is a bad thing, you don't get a chance to be a Medic. They vary rarely even start an IV because they can load and go and have the patient inside the ED so quick, there is rarely any point. I can see why some Medics like this. The ones who are lazy or don't know what they are doing and the ones that are burnt.

I'm not downing the urban EMS service. The basic service I worked for was in an urban setting and we ran the basic 911 calls. I have some good friends that work in the urban setting, and I know several great Medics that also work in the big city. It's not for me, but someone has to do it.

Back to the original question.....why do people leave? Maybe it's just me but I was raised to have pride in my work and loyalty to that place. Sometimes things piss me off and I bitch a little, but I'm not going anywhere. I love my job and I love my service. I try to recruit whenever I get the chance. I don't think others think like me in this way. I don't think that loyalty ever comes into play for some people. For me EMS is a career, a lifestyle if you will, not just a job. I may sound corny or pathetic or like a greenhorn, but that's just the way it is for me. I don't live and breath EMS 24/7. I take my time off and I try to leave my work at work and not bring it home with me, but EMS is my passion, I don't know how to say it any other way.

My service is comparable in many ways to other services. We are on average with other services as far as pay. We still work the 24/48 schedule. Time off is great, we generate about 24 hours a month for new employees and that goes up with your vested time in. Other benefits are on par with the area as far as insurance and all that. Depending on which station you are at you could have between a 30 and 90 minute transport time, and that's emergency traffic. Our call volume is fairly low. An average day is 3-6 calls. Each call will take about 2-3 hours from start to finish. Due to our long transport times, we have excellent protocols with a lot of freedom and flexibility. We also have a full drug box with RSI and thrombolytics. I know this sounds like a pitch for employment, its not, just trying to give the reader a sense of my service.

So why is it that Paramedics leave? Is it because of the money? different scenery? different type of service? I'm at a loss on this issue.

Another problem that we along with other services are having is hiring. From the little info that I can glean from out training officer we have very few applications coming in and even fewer who can pass the entrance testing. This is a statewide thing. I have heard that the director of our Office of EMS said that there is a shortage of 2-3,000 Paramedics across the state. Why is that? When I went for my test, there were over 300 people in the room. They broke us up and all of the people testing for Intermediate and Paramedic filled only one classroom which was less than 40. Forty out of 300! That is proof to me that there just isn't that many people going for the Paramedic patch.

I think I'll end my rant here and pick up later after a few comments.