Medic Alert....

I was checking out a favorite EMS news website and found this article about a new Medic Alert wrist-watch. Some of you out there may have heard about it, but I haven't. Just trying to spread the word.

A must read for EMS....

I just read a post over at EMS Haiku about Respiratory Therapist being afraid of EMT's taking their jobs away. Anyone who is an EMT, Intermediate or Paramedic should read this article, it's very....interesting.

and honor....

Had clinicals at the hospital ED today. For most of the morning it was boring. Me and 2 other students just sitting around. Not even a drunk to harass. After lunch it picked up some. Then this elderly gentleman came in with a chief complaint of being light-headed. His pressure was something like 70/40. Only other complaint was slight belly pain an hour or so prior. We got 2 lines going and put about 2 liters of fluid before his pressure finally came up. No other symptoms until he got ready to be shipped to the big hospital down the road. When the crew got there to transport he started talking about a little bit of shoulder pain. But you could see in his face that he was hurting more than he was letting on. He seemed to be the kind of guy that never goes to the hospital and never really complains no matter how bad it hurts. He was being transported for a major AAA. It started at the arch and went all the way to the illiac crest. The doc told him that they were sending him down to talk to a vascular surgeon. The patient promptly told the doc that he wasn't going anywhere except home, he had "chores to do". Then the doc started pulling out the "big" words to explain to the patient how bad it was. Well, as you could guess, neither the patient nor his family had any clue what he was talking about. Eventually my preceptor, a medic, explained to him what was going on. Then the doc looked at the patient and told him that at his age, he had an almost zero chance to survive. Well, he took it better than I would have, but you could see the fear in his family's eyes. I didn't know what to say. A few minutes later the crew that was transporting him asked me if I would ride in with them, in case something happened on the way. It was a pretty eventful ride. We talked about his family and his grandchildren and him being in the war and his farm and his wife, how they met 50 years ago and how he still loved her. Never once did he say anything about the reason we were having this conversation, or why we ever met at all. Never once did we talk about the fact that he was going to die. But then again, I guess we did. In talking about his family and his life, maybe he was trying to come to terms with it. On one hand, I wish I never met him. I wish we never had that conversation. On the other, I'm glad. He may never see the outside of that hospital again. I'm glad that I was there to hear what he had to say. To be a witness to the testimony of his rich and full life, however brief our talk was. I can only hope that when my end comes, I can take it like he did....like a man......with dignity and honor....

Curse....

Sometimes I think this job can be a curse. Not the everyday work, just the knowledge. My wife is pregnant with our first child. I went to the cath lab at the local hospital the other day for paramedic clinicals. I ended up in the pediatric lab. There were all these little bears and clowns and other assorted cartoons on the walls. I asked the nurse that was precepting me how many actual kids they do caths on. She said that 2 days a week they usually have a full schedule, somewhere between 12-20 per day. Of course these are kids with birth defects and the like. She gave me a book to look over while they were preparing for a cath and there was nothing that I could do. It was full of all kinds of defects that kids can have, it was over 2 inches thick with small type. This on top of all the other things that can go wrong. I was talking about this and various other things with the wife, she's got 2 kids from a previous marriage, both healthy. She says that I shouldn't worry myself as much as I do. I try to take her advise, but I guess sometimes I can't get it out of my head. Kids have a hard enough time trying to make it in this world when they have 10 fingers, 10 toes and all their organs in the right place. But to take any of that away and the difficulty increases infinitely. I know that there are people out there with disabled children and I mean no disrespect. I'm not worried about how I will deal with it, I just want my child to be happy and healthy. The other way this "knowledge" is a curse is with other family members and loved ones. Sometimes the doctors don't always tell them the whole truth and then they ask me what I think, like I know anything. On the rare occasions that I do know a little something, I face a dilemma, to tell or not to tell? Then there's the times that you actually run someone that you know. That's happened to me a few times, I ran my second cousin who was so badly hurt that I didn't recognise him until much later when another family member asked me about it, then my grandmother who took too many nitro's and bottomed out her pressure. Not sure how to get around this. I've been told that you should never tech a call when it's someone you know if you can help it. Try to let your partner do it if possible. With my cousin, I never knew it was him, so it didn't bother me and with my grandmother I wasn't working, just responding off-duty when I heard the address over the radio. Not sure if I could stand back and let someone else work when its someone I know and love. I guess like so many other things in life, I'll cross that bridge when it comes.

Nursing Homes.....

My last post spoke of an experience of mine at a nursing home that pissed me off to say the least. What pissed me off the most was the fact that she had sat there all day with an obviously broken arm. The staff, for whatever reason, decided that she needed an x-ray. WHY? It doesn't take an intelligent person to see what I saw and say, "yep, that's broke." Then no one was going to own up to it. I can't say that someone intentionally broke her arm, but along with the inability to speak, she was also bed-bound! She couldn't even roll over without help! So someone had to be with her when it happened. OK, calming down now....

This isn't the only thing that has ever pissed me off at a nursing home. Respiratory distress and the patient is on 2 liters with a mask, calls for confusion and the patient has diagnosed dementia and various other incidents. But I've given this nursing home thing a lot of thought. Why do the staff at these places do what they do? Are they really that stupid? Or are they just un-educated? I guess it maybe the optimist in me, or maybe the lack of experience, but I just can't believe they are all total idiots. I mean every now and again you get a good nurse or tech and they are actually on a first name basis with the patient and know their history and why they are going to the hospital when we arrive. It doesn't happen often, but every once in a while you get lucky. Another thing is that, at least around here, the nurses can't do much of anything without a physician's approval. If anything happens to the patient, no matter what the nurse may think, they have to call the doctor. Now lets take a new nurse straight out of college and goes to work in a nursing home. At this point some people may say this is a obvious show of lack of intelligence. But as my pappy used to say "different strokes for different folks" and some people hear their calling in different places. Back to our nurse, he/she wants to do good, wants to take care of the elderly, the infirm and the demented. But every time he/she sees something that needs to be done, he/she has to call the doc. Every time one of his/her beloved patients falls, he/she has to send them out. Every time one of them hiccups yep, you guessed it, call the ambulance. Now, honestly, wouldn't that discourage you? it would me. So now take that same nurse and put 5 years experience on him/her. For 5 years he/she can't do anything on his/her own. He/she gets reliant on that doc to make all the decisions, because he/she doesn't have a choice. Ambulance Driver along with many other EMS bloggers have made many statements on how to improve the standard of care in nursing homes including better pay, benefits and facilities. I agree with all of those. My idea is why not give them some protocols? Things they can do own their own before calling the doc and subsequently calling EMS. Simple things like starting an IV and giving fluid for dehydration, antiemetics for nausea/vomiting and education on oxygen delivery devices. I don't know about other nursing homes, but the ones around here can't do even these simple things without calling for physician approval first. Now I know that I am not even a medic yet, and I am still "wet behind the ears", but I see this as something that can be done. I think that if you give the staff a little autonomy, (with the proper education), they might take a little more interest and improve the care in these types of facilities. I'll get off my soapbox now. But I would like to hear what my 2-3 readers think about this. Especially the ones with more experience than I.

Rage....

It seems as though I am on an emotion kick, so I will continue down this path with a call I ran some time ago...

Called out to a nursing home/rehab facility for a possible fracture. When we get there and go upstairs to the patients floor we are greeting by the lovely nursing staff with most of the required paperwork. Thinking this was probably BS I started sifting through the paperwork looking for specific things that would affect my care when I noticed a radiologist report dated that day. It stated that a portable x-ray was taken and that the patient had sustained a transverse fracture of the humerus. The funny thing was that it had a time stamp of when it was received by the nursing home staff. It had been 6 hours since they had received it. Me and my partner made our way down to the patients room and find a thin elderly female lying on the bed. Tears were streaming down her face, her gown was dirty and the TV was playing a re-run on the "snow" channel. Taking a look at the patients arm I noticed it was swollen no less than 4 times the opposite arm. It was also at an obvious 45 degree angle. When asked, the nurse said she didn't know how it happened, the patient was found this way that morning at shift change. The patient couldn't talk, due to a previous CVA, but she could understand her surroundings and what we were telling her. I started seeing red at that point. I went back to the rig and got an IV set-up and the narc box. We gave her some morphine to dull the pain she had been living with for the past 12 hours or so and got her moved. By the time we got to the ED, I was in a rage. We gave our report and told the staff everything we had seen. We wrote reports about it and talked to the supervisor. As far as I know, nothing was ever done about it. No one was ever punished, fired or even talked harshly too. My BP still goes up whenever I think about it.

Grief....

In this job grief is a household name. We see it day in and day out. Most of us deal with it fairly well. I can deal with people dying. I can deal with running a code on someone that was just talking to me. I can deal with the dead teen, mangled in the little red sports car that Mommy and Daddy just bought for them. What I have always had a hard time dealing with is other people's grief, those that are left behind. Like the young wife that is just realizing that her husband of less than a year is dead.

We are called out to an unresponsive, unknown cause. En route we are advised that CPR instructions are being given to the caller. Shit. From the driveway we can hear what sounds like a banshee screaming somewhere inside. We walk in to find the young woman holding her late husband and wailing. While my partner pulls the woman aside, I take a look at him. Not breathing, no pulses and the beginnings of lividity. I attach the leads and run my strip. He's dead. I'm sorry I tell her. I can't stand the look in her eye's begging me to tell her this is all just a dream. I gather my equipment and walk back to the truck, careful not to touch anything because I know this will be a medical examiner case with the cops in tow. I call the doc and he agrees with our decision not to resuscitate, then the supervisor to get the ball rolling. Eventually the house is full. Cops, a detective, the ME, and family. The wife is inconsolable. I feel the tears start to well up in my eyes and have to turn away and walk outside. I light up a cigarette and try to banish the feelings that are coming. I wonder, does it ever get better? Will I ever get over it? If I do, what does that make me?

Humor....

Reading through other blog's humorous stories and thought I'd share a one of my own...

Alert tones wake me up. I look at the clock and my eyes seem like they are glued together, can that be right? I've only been asleep for 20 minutes? I hear my partner going out the door so I jump up and put my boots and shirt on and head for the rig. Luckily for me, before I get out of the station I notice a draft. I look down at my legs and notice that in my haste, I forgot something... my pants. I hurry back to my bedroom and jump in with both feet. Can't imagine what my partner would have thought if I'd gotten in the truck bare-legged...

Bright Red Blood......

GI bleed. We have a student today and she was asking about etiologies of GI bleeds on the way to the call, she hasn't covered them in class yet. I tell her they're usually very nasty smelling, not this time, thankfully. Patient was alert and sitting up when we got there. She said that she had felt like she needed to use the bathroom and nothing but bright red blood came out. We get her into the truck and start doing our thing and head on down to the hospital of her choice and she says she needs to go again. So me and the student get her on a bedpan real quick-like. When she finishes and the student removes the pan, I look and see nothing but bright red blood. She does this twice more before we reach the ED. Her LOC (level of consciousness) remains great and her other vitals are normal during transport. Her belly is a little tender on the left side just under her ribs, but other than that, I can't find anything else wrong with her. No history, no recent sickness, nothing. Oh well. Arrive at the ED and give report to the nurse. He looks at me like I'm an idiot when I tell him the patient has lost an estimated liter or two of blood. Then I show him the bed pan and trash can that I had emptied it into and his eyes get big. I say nothing, just set the pan in the sink and walk back to the truck. The student asks me what I thought was causing all the bleeding. I looked around for my paramedic partner, she was still in the ED, so I said "Not sure". Then I listed all the things that I knew of that can cause the symptoms the patient had.

It's weird being in school and having to be the teacher. I find that I like teaching though, I have done a few con-ed type classes and helped out fellow students in class. I like the feeling and idea of giving back. I'm planning to take the methodology class after finishing Medic so I can teach. Methodology is required around here to do any substantial teaching. It's supposed to teach you how to teach. Not sure that it helps. I've had a few instructors that it apparently didn't. Not sure how I'll fare, I hope that eventually I will be a good Medic as well as good instructor. Got to walk before you can run I guess....

In the beginning......

I've decided to start a blog, obviously. Contrary to the title, I am not a Medic, at least not yet. I am a Paramedic student. I work for a local agency as an Intermediate while I'm finishing school. I've only got 2 months left and it's all over, finally. I've been reading other EMS blogs like Ambulance Driver, Rocky Mountain Medic and Baby Medic just to name a few and thought I'd jump on the band wagon as well. I don't have the medical knowledge of some and none of the writing prowess of others, but I guess I'll give the the ole' blue ridge try. My goal here is to try to relate some of the thoughts and emotions that I have felt being a student and working in EMS.

I guess this is the part that I tell you, the reader, about myself.... I'm 27 years old and the step-father of 2, with one of my own on the way. I've been around EMS/Fire/Rescue for all my life, my Dad was a Medic for years before wising up and moving on to bigger and better. Even though I was a volunteer for quite awhile, I never thought of it as a career until about 3 years ago. Not sure what made me take the plunge, but either way here I am. I worked as a Basic EMT for about 2 years and now I have been working as an Intermediate for about 1. Sometimes I think I'm trying to pay my dues and work myself up through the ranks. Although I know there are some out there that think 3 years is nothing, and I know in a sense they are right, but oh well, I'm doing what I can. Other than that there's not much to tell...