Tuesday, December 16, 2008

No Idea...

Had a call last shift and like many calls that I run, I have no idea what was going on...

The call was for a respiratory distress on a child. We get to the daycare center where the call was and go inside expecting to see a child in distress. Instead we see a smiling, laughing, playing kid. The workers at the facility said that the little patient had turned blue. Now, when you get a call for respiratory distress call and the people on scene say the patient was blue, you expect the face, or at least the lips and maybe nail beds to be blue right? Wrong.

They said that the patient's feet were blue, well actually everything from the knee down. I asked if he was having trouble breathing? No. Wheezing? No. Crying? No. Did it seem as though he was in pain? No. Acting different than normal? No. What was he doing before, during and after? Nothing, just playing. Hmmm... So he wasn't acting like there was anything wrong with him at all? No. They just noticed that his legs were blue.

The patients legs and feet were fine when we got there. The first responders who got there before we did said that the kids feet were a bit cyanotic, but quickly returned to normal. I continue my questioning...

Any past medical history, medications, allergies? No to all. Last meal and what was it? Lunch, mac-n-cheese and apple juice, same as every Tuesday. Did you change the brand of food, drink anything? No. Any new people, toys, carpet, anything new at all? With a weird look, they answer no to all. Well, I'm completely stumped at this point. Either they don't know this child's complete medical history, or they are hiding something to try to keep themselves out of trouble. The patient is too young to talk to me, so I can't ask him any questions. But my partner has been playing with him and checking him over. She tells me that the kid seems fine, nothing wrong that she can see. Vitals are fine, cap refill is good, lungs sounds good, neuro check is good and he seems to be acting like a kid his age should act.

Then the grandmother shows up and I find out that she is the child's primary caregiver. She tells us that the history is slightly skewed from what we were told. The patient was a preemie, and only 2 pounds when born. But the kid is 16 months old. I ask her if he had any medical problems? No, none at all, his doctor said he was the picture of health. I ask if there was a reason that he was a preemie? She darts her eyes away from me. I tell her that I need to know if I am to make an informed decision about her grandson. She leans in and tells me that the child's mother was a meth addict. I ask her all the same questions that I asked the staff and get the same response. No other history, and nothing new around the child.

I tell her that he seems to be fine now. And that, according to the staff, the child displayed no other symptoms during the episode. I tell her that if it was my child that I would want this to be checked out by a physician, at the very least, his regular doctor.

She doesn't want him to go to the ED, nor be transported by us. But says that she will call the doctor and see if he can be seen today. She signs the refusal and we leave.

I have no idea what would cause this. My first thought was cardiac. But if it was his heart, I'd think it would have systemic symptoms. At least it would have involved his other extremities, not just his legs. My other thought is maybe a congenital defect that hasn't been found yet. Maybe some kind of peripheral vascular defect in his legs. Maybe it was some sort of arterial spasm. I've never heard of it in a kid, nor just in the legs. But who knows? I'm just a paramedic...


Monday, December 1, 2008

When God Make Paramedics...

...an oldie, but goodie...

When God made paramedics, He was into His sixth day
of overtime. An angel appeared and said, "You're doing a lot of fiddling around
on this one." God said, "Have you read the specs on this order?

A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn't touch,
and not wrinkle his uniform."

"He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again."

"He has to be in top mental condition at all times, running on no sleep, black coffee and half eaten meals, and he has to have six pairs of hands."

The angel shook her head slowly and said, "Six pairs of hands...no way."
"It's not the hands that are causing me problems," God replied. "It's the three pairs of eyes a medic has to have."
"That's on the standard model?" asked the angel.

God nodded. "One pair that sees open sores as he's drawing blood,
always wondering if the patient is HIV positive." (When he already knows and wishes he'd taken that accounting job) "Another pair here in the side of his head for his partner's safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, "You'll be alright ma'am when he knows it isn't so."

"Lord," said the angel, touching His sleeve, "rest and work on this tomorrow."
"I can't," God replied.
"I already have a model that can talk a 250 pound drunk out from behind a steering wheel
without incident and feed a family of five on a private service paycheck."

The angel circled the model of the Paramedic very slowly.
"Can it think?" she asked.

"You bet", God said. "It can tell you the symptoms of 100 illnesses; recite drug calculations in it's sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear... and it still keeps it's sense of humor."

"This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim's family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call

Finally, the angel bent over and ran her finger across the cheek of the Paramedic.

"There's a leak," she pronounced.

"I told You that You were trying to put too much into this model."

"That's not a leak," God replied, "It's a tear."

"What's the tear for?" asked the angel.

"It's for bottled up emotions, for patients they've tried in vain to save, for commitment to that hope that they will make a difference in a person's chance to survive, for life."

"You're a genius!" said the angel.

God looked somber.


Author Unknown


Monday, November 24, 2008


NameThatDisease.com - http://www.namethatdisease.com">Name That Disease


Another Article...

Here's another article about problems in EMS...



Thursday, November 20, 2008

Can 911 Be Saved?...

I read this article on the Men's Health website. Finally some support for EMS...


Wednesday, November 19, 2008


I'd bet money that just about everyone in EMS, no matter their level of practice, has been asked why they do what it is they do. And if they have been doing this job for any number of years, they've been asked why or how they have stayed in as long as they have. I was asked the other day by one of my EMT students. I've been asked several times over the years. It seems that my answer changes over time.

Originally it was about the rush. You know what I'm talking about. The feeling you get when the pager goes off. You rush to the rig and tear off with lights blazing and siren wailing. Get to the call and maybe get to do a bunch of cool shit, see someone all fucked up. Then after it's all over you sit back, beat your chest and holler at the moon to let everyone know how stoked you feel.

Don't get me wrong, helping people is a major reason that people, including myself, got into this business. But the rush is equal or greater than the want to help people. If anyone reading this is honest with themselves, I believe that they will agree with me. People may initially get into EMS for helping people, but the rush keeps them coming back.

Now, 13 years have passed since I ran my first call as a spunky teenager. The rush is still there, sometimes. Other times, not so much. At times, I find myself falling asleep while my partner drives us emergency traffic to the call. It's not that I'm burned out, far from it. But like AD said once, either you find something to love about EMS, or you get out.

Even before the rush, there was my Dad. He got his paramedic a year before I was born. To say that I grew up in this business is an understatement. My daycare was the EMS station. The ladies that did the billing were like surrogate mothers to me. Hell, I even had my own locker with a blanket and GI JOE's, complete with toy ambulances. Until my Dad left EMS in the late 80's to be a flight medic, I lived at the EMS station; eating, sleeping and helping the guys wash the trucks. (I was the tire washer....)

For many years I was in the fire dept and volunteered as a first responder. But my inherent disregard for authority led me to rebel against my Dad and his chosen profession. I have to give it to him though. Even though he loved EMS and medicine in general, he never pushed it on me, he let me make my own decisions as far as my career was concerned. So I never even considered it as a career till about 5 years ago when I finally realized that I couldn't run away from it any longer. Nothing else I did was ever satisfying. I'd learn everything I could and usually excel in whatever it was I was doing. Then I'd hit that wall. Either there was nothing else to learn, or I couldn't advance my position to be able to learn any more for one reason or another.

So I turned to EMS and I haven't looked back since. In medicine, I found an ever satisfying subject. There is just so much about the human condition that no one person will ever know it all. So I found "it". The thing that could keep me busy for the rest of my life. That's the real reason I'm in EMS. I can never learn it all, there will always be something else to learn.

The second reason that has came around in the past year or so is teaching. I love to teach. I realise that in the grand scheme of things, I don't know much. But what I have learned, I enjoy passing that knowledge on to others. That's the only thing I can see myself doing other than being a field medic. I would someday like to be a training officer, or maybe over a medic program at a local college.

Those are my reasons for doing this and sticking around....


Friday, November 7, 2008


Have you ever ran a call that made the hairs on the back of your neck stick up? You know that feeling that something just isn't right? Well, if you ever get those feelings, you need to pay attention. Your mind and body are trying to tell you something...

We get dispatched to an obscure address for a respiratory distress. Dispatch tells us that its beside a church, but no other information is available. But if memory serves me right, that church is abandoned. We arrived to find an old pickup sitting next to the church. I can see someone inside the truck. The windows are up, the doors closed and the vehicle isn't running.

I get out of the rig and it hits me. Something isn't right here. For one, if it is a respiratory distress, most people wouldn't be sitting cramped up in a vehicle when its over 70 degrees outside. I would imagine the door would be open to try to get some fresh air. Maybe even sitting with their feet on the ground, tripoding, etc. depending on how bad they were struggling to breath.

I make my way around the back of the truck, keeping a good distance. The windows are tinted so I can't see much inside. But I can see that the person isn't moving. Looking around the scene, there is nothing out of the ordinary. Nothing that would raise my suspicion level. It's the truck, or rather the person in the truck that's got me worried.

I continue to walk around the vehicle towards the drivers side door, keeping my distance. The hairs on the back of my neck starting to raise and someone has dropped a large rock in the pit of my stomach. As I get level with the driver, I can see it's a man. He doesn't seem to be in any respiratory distress from where I'm standing. Plus, he doesn't look at me. It's like I'm not even there. He continues to ignore me as I holler at him, approaching slowly. My partner has sensed my hesitation and is slowly bringing the cot and equipment out of the truck, keeping his eyes on me.

I get to within a few feet of the truck and the driver is still not paying me any attention. I move towards the front, in his line of sight and he still ignores me. I can see that he is alive. I can see him breathing and his eyes blinking. That's enough for me, I holler at my partner and tell him to get on the radio and get the cops here, now. We are right down the street from the sheriffs office, so it shouldn't be long before they get here.

I start to back off, keeping my eyes on the driver, not daring to turn my back. Just then my foot hits something and over I go. I land on my ass and see the rock sticking out of the ground that my heel struck. I hear my partner hollering and I look up.

I see the driver standing outside the vehicle. How the hell did he get out of the truck that fast? He has his hands in the pockets of a jacket that seems a bit too big. I can see his eyes. They seem blank. I don't know how else to say it, it was like the lights were on but no one was home, literally. Because I started talking to him and it made no difference. He was looking at me, but other than that, nothing, no response at all.

He takes one step towards me and stops. I start backing up, pushing with my hands and the bottoms of my feet. Trying to put distance between the two of us. I see his arms start to move. Then I see a something from a nightmare coming out of the pocket of his jacket. Flat black, metal and dangerous. A gun.

I get to my feet in the blink of an eye as he raises it level with my face. In an instant I am covered in sweat and my heart leaps into overdrive in my chest. It's amazing how big the barrel of a gun looks when it's pointed straight at you. My mind does some quick calculations. I am too far from him to jump at the gun and try to knock it away and there is nothing around me but open ground, so no help there either.

This is it, end of the line for you BRM... I close my eyes and a picture of my family jumps before me. I whisper a prayer and hope that it's a clean shot and it doesn't hurt...

I open my eyes and he is just looking at me. Then he moves his hand and puts the barrel in his mouth. The report is loud, but not as loud as I would have thought. I feel something wet hit me in the face as he falls to the ground. I can't move. I can't speak. I can feel someone shaking me.

I turn to see my partner is holding me by the shoulders, shaking me and saying something, but I can't hear him. I look back at the guy on the ground. His eyes are still open. The expression hasn't changed, still that blank stare.

Slowly my hearing seems to return and I hear approaching sirens and my partners voice, screaming at me now.

"I'm OK," I say. I remove his hands and wipe my face. My hand is red. I turn and walk back to the ambulance and sit on the tail board, my expression blank...

The entire event took less that 10 minutes.


Sunday, November 2, 2008

"This ain't basket weaving...

...these are people's lives you're dealing with."

That's a quote from my EMT-Basic instructor. He said it on the first day of class. He was trying to make us understand the gravity of the subject we were about to learn. Since then I've taken this statement to heart and used it in my own classes and with students that I precept.

A few days ago I got switched to another station and worked with an Intermediate that was in Medic school. He was a month from graduating. I figured that I wouldn't have to do too much those 2 shifts. He should be able to function pretty much without me. Boy, was I wrong...

First call we get is for chest pain. The first mistake he makes is taking the clipboard in with him. Leaving me to get the stretcher and equipment. I follow him into the house to find him writing down basic demographic info on a patient who looks like shit; pale, sweaty, breathing about 30 times a minute and I can hear her gurgling from across the room. He has no equipment, so he hasn't even taken a blood pressure, nor has he asked her anything except her name, social security number, date of birth and phone number. I quickly step in and do a quick assessment and direct the patients son to help me get her on the stretcher.

My student/ partner gets the idea and finally helps us wheel her out to the truck, forgetting the monitor and jump bag in the process. Eventually he gets everything back to the truck and starts helping me treat our patient. He wants to give her nitro and aspirin before the IV, monitor or even a B/P. I calmly give him the cuff and stethoscope and point to her arm as I get her on some oxygen while asking her all the pertinent questions.

Eventually we get all the basics done and I move some leads around to see if that big fat inferior MI has a friend. Sure enough, she's got an associated right sided MI as well. My partner is looking at me as if I just grew a second head as I do all this. I really wanted to have him back here on this one so he could maybe learn a thing or two. But I can't wait, we've been on scene for almost 10 minutes as it is. I just tell him to drive...

After the call he just sits there in the drivers seat and asks no questions whatsoever. I'm not sure if he's thinking it over, or he really isn't curious about what I was doing and what was wrong with our patient. When I was in his position, you wouldn't have been able to shut me up for all the questions I would have been asking.

I let this go on till we get back to the county line. Then I start asking him questions. Like, what the hell was he thinking not taking anything in with him? Why was he asking demographic questions instead of accessing the patient? etc, etc. As we move on in my questioning I start to quiz him on his drugs. That's when I start to get even more concerned. The boy doesn't even know his basic drugs. Like the dose for aspirin, nitro, charcoal and the like. So once we get back to the station we go over every drug in the box...all 46 of them. I tell him that I'm gonna give him another quiz later that night. Well, he studied some, but retained nothing. Eight hours later, he couldn't remember anything we went over that morning.

I get almost disgusted when he starts to blame his instructor. I tell him that the EMT-Paramedic course is a college level class, taken at a college, this isn't grammar school. You have to take the initiative to learn on your own, to study on your own and to ask for help if you need it. He seems to understand and take what I am saying to heart.

The next shift is no better. He still knows nothing of his drugs, ACLS, ITLS, or even his own protocols. I'm not sure if I should just give up, help him, or brow beat the hell of out him.... I end up spending the rest of the shift trying to give him a crash course in pharmacology and patient assessment. I have no idea if it did any good or not. It scares the hell out of me that there is a possibility that he will eventually be out there on the streets treating patients, maybe even me or my family...

I just don't understand some of the students nowadays. Maybe I'm just too hard on them or try to judge them against myself. When I was in class, we had to make at least an 80 on every test and keep an 80% average or we were gone. My thinking on this was...if I make an 80, then statistically I know 80% of the information. What if I need that other 20% to help someone, or what if someone dies that could have been saved because I didn't know that 20%? Now I made 100% on a lot of tests...but not all, not by a long shot. But that made me sit down and study even harder to learn what I had gotten wrong. And even making a 100 doesn't mean that you know all the material.

I didn't fuck around in class like many of my other classmates, I didn't make fun of others that were called to the front to do a mega-code and didn't do the best. I was usually one of the ones that always raised his hand when the class was asked for an answer and I often made the class longer than usual because of my questions. For this I was dubbed "Rescue 911" from some of my classmates. But I didn't care, because I knew that eventually it would be my ass out there with a life possibly on the line.

I haven't changed my thinking or reasoning on this subject and I doubt I ever will. Because this ain't basket weaving, these are peoples lives we're dealing with....


Friday, October 17, 2008


I want to share a story with you... This story is about two people. One of them is an 18 year old girl.

Jessica woke up to the sound of her alarm clock and her mother hollering from down the hall. She didn't feel like it, but she rolled outta bed and planted her feet on the carpet and stretched. The sun was just making its way over the horizon and it promised to be a beautiful day. Jessica made her way to the bathroom and showered, put on clean clothes and sat before her mirror brushing her long dark hair. She paused to put a picture or two in an album that was laying on the table. A project of hers that she had been working on. It was filled with photos of her family, her dog, her friends at school and her boyfriend whom had recently asked her to the prom. She was so excited about it. Her and her girlfriends were planning to go dress shopping today after school.

She looked up at the clock on the wall and realized that she was gonna be late. She sent a text message to her boyfriend not to look for her before school and another to her friend whom she gave a ride to saying that she was running behind.

Running downstairs she grabbed her books and her keys, gave a quick kiss to her father reading the paper at the kitchen table and out the door she went. Jessica yanked the door open of her little sports car and jumped in the drivers seat. Off she went with a flash of brake lights at the end of the street....Her parents never saw her alive again.

Jessica stopped at her best friends house and didn't have to wait long before her friend came running out holding 2 steaming pop tarts wrapped in paper towels. They ate as they went. Jennifer eating and driving and be-bopping to the latest tune on the radio, grinning around her pop tart. She was speeding, but that didn't seem to matter. She knew the road to school well and had lived here all of her short life.

A delivery truck loomed in front of her as she navigated around a sharp bend in the road causing her to jam on the brake. Cursing, she pulled to the left to see if she could get around, a car blaring its horn caused her to jerk back into her lane. She knew a short cut to the school was just up ahead. Riding the tail of the truck in front of her, she was mentally counting up the times she had been tardy, knowing her first period teacher would cut her no slack.

With her turn just ahead, she could see the road as it cut away from the highway she was currently on. She swerved to the left and accelerated. Too late did she see the full sized pick up coming straight for her. Too late did she hear the sharp intake of breath from the passenger seat. Too late for Jessica...

I woke up that morning to the sound of the alarm clock ringing its shrill tones to anyone within earshot. I reached over and jammed the snooze button down almost hard enough to break it and rolled over. I lay on my back and stared at the ceiling in the semi-darkness. I rolled outta bed and stretched. I made my way to the kitchen to start the coffee machine and headed for the shower. Drying off after my morning wash I could hear the steady drip-drip of the coffee machine. I sat on the edge of the bed and dressed, making sure my name tag was straight in the mirror and putting the Cross pens my wife gave me for Christmas last year in my shirt pocket. I crept into each of the kids bedrooms and gave each a soft kiss, trying not to wake them, then back to my wife for another kiss and whispering "I Love You", hearing the mumbled return.

I slung my bag over my shoulder and grabbed my coffee and out the door I went. I sat in my truck for a few minutes, letting it warm up before backing down the drive. I be-bopped to a favorite tune playing from my i-pod as I made my way to the station. Getting there and then completing my morning ritual of checking of the truck, placing things within easy reach where I like them. My partner has taken the day off and a new part-time EMT has taken her place for the day. While we sit around chit chatting the pager goes off...

MVA less than five miles from the station. Bystanders on scene state the vehicle is down an embankment, multiple patients, patient status: unknown. I look at my watch and think: school traffic.

We jump in the rig and tear out, siren wailing. We arrive on scene in a few short minutes and pull up next to a small red car pointing straight down the embankment, the hood smashed in and resting against a tree. My partner had already jumped out of the rig, almost before I got it stopped. I grabbed my turnout coat and the jump bag out of the back and hurry to the edge of the road. My partner is already down the hill at the drivers side. He looks up and I can see the fear in his eyes and he yells "You better get down here."

I make my way down the 15 foot embankment to the drivers door and look inside. I see a young girl, obviously unconscious, her head pinned between the seat and the post of the door. I also see another teen aged looking female in the passenger seat. She looks dazed. I ask her if she is hurt. She says that her leg is hurting and is pinned in the floor board, she can't get it out. I tell her in the most reassuring voice I can muster that its going to be OK, that I am a Paramedic and am here to help.

I reach in and lay my hand on the chest of the driver, she isn't breathing. I notice that she is also pinned in a very bad way. I can't see anything below her chest, the steering wheel is bent and broken, the dash is pushed all the way over her thighs against her chest. I turn to tell my partner to get the BVM and he is no where in sight. Damn...where the hell did he go? I yank the zippers on the bag and grab the equipment I need and then try to place it on the patient. I cant reach in far enough, because of the way the vehicle is sitting and the mangled portions make it impossible for me to get both hands where I need them. The back window is halfway down, so I take my coat off and throw it over the patients head and grab the top of the back window and jerk. It shatters, sending glass everywhere.

Now I stick one hand in from the font and the other in from the back, bagging the patient as best as I can. I feel for a pulse in her neck. She has a strong one, but I can tell without having to count that its too slow. I feel my vision starting to narrow, the all to familiar feeling of tunnel vision. Shaking my head, trying to clear it and keep my thoughts and feelings in check, I look around for help. To my astonishment, I see an off duty Medic making his way towards me. He asks me what I need. I say my airway box, extrication equipment, monitor and someone to go to the other side of the car to check on the passenger. He promptly turns and marches back up the hill. Returning in just a few minutes with the familiar red and white box that contains all my airway supplies and several people in tow, I recognise one as another off duty medic in fire dept turn out gear.

They split as they reach the car, the first off duty medic coming to me and the others going to the opposite side of the car. I say we need to intubate this one now and he gets the equipment in order with relative speed. I can't intubate as I normally would, due to how the patient is positioned. So I hand the blade back to him and he sees instantly what I am thinking before I speak. He goes in from the front window, the blade reversed and uses a technique we always called "potato digging" and others call "the tomahawk method". While I reach through the back window with the tube. Working in unison, we manage to position her airway with very little movement of her head and neck. During this I notice something very bad. She has a definite step-off about midway down her neck. Her neck has got to be broken, I think. I peer inside her open mouth and also see that she has braces. For some reason this disturbs me. This is not supposed to happen. I am not supposed to be sticking a tube down someones throat that is still wearing braces. Christ Almighty....

The next shock happens as I ask for a little pressure. He responds by pressing down on the front of her neck, the cords pop into view, but with a shocking revelation. I can see the almost gleaming white of the vocal cords. But they are clamped shut. No darkness between them that is my target for the end of the tube. I remember something at that moment that my instructor had told me. I pull back my head slightly and send a hot breath down the tube, while watching the vocal cords. Nothing, no response. I try again. Still nothing. I try to push through them, nope...not working. I pull out and grab the bag again. Thinking, I'm gonna have to trach her.

My monitor is laying on the ground and I tell my coworker to get it ready as I check for a pulse. She still has one, and it's slower than before. I can hear the rumble of the equipment as the crew on the other side of the car attempts to pop the door to free the passenger. I can see her face peering out from under the turnout coat that is over her head. Her face is white as a sheet and her mouth stands agape. I realize that she has been watching me attempting to stick a tube down her friends throat and just as quickly realize that there is nothing I can do about it right now.

"Is she gonna be OK?", she hollers over the loudness of the spreaders and screaming of metal on metal.

"We are doing everything we can", is my return as I mentally reach 5 in my count and slowly squeeze the bag. Knowing full well that I didn't answer her question. Thankfully she doesn't ask again, but I see the tears start streaming down her face.

I turn my attention back to the driver and my coworker. He has the pads out and is trying to find enough room on the patient to place them. He has her shirt up yet there just isn't enough room to place them properly because of her position and the distortion of the interior of the vehicle. When he is done, the pads are almost touching. I look down to the screen and see the complexes look fairly normal, but way too far apart. I ask for the trach kit with dread. I have never done this before on a patient.

He tears away the plastic with hands that are shaking, his dread apparently matching my own. I switch places with him so he can bag and I can cut. I prep the area, and do what up to this point I have only done on a pigs trachea. He attaches the bag and squeezes air into the patient. I listen to lung sounds and they are decent enough that I know I did it right. I step back wiping sweat from my brow and take stock of the scene when I hear a long beep from the monitor at my feet. Looking down I know what I will see...flatline. No, not now, please not now.

I look over and see that the other crew is having difficulty getting the other patient out, as her left foot is still pinned under the dash. Just then I hear someone shouting at the top of the hill. Something about another patient down the hill on the other side of the road.

Time seemed to stop. It was decision time. The dreadful decision that I didn't want to make. I take stock of my patient. Probable broken neck, airway compromise for an untold amount of time, asystole, probable multiple internal injuries, etc, etc. I add this up and realize that there is nothing I can do and there are too many others here who need help. I reach down, and hit print on the monitor, tearing off the strip and sticking it in my shirt pocket.

I grab the radio from my belt and tell dispatch, "Confirm code blue on scene." As I make my way around the car to the other victim.

We get her out eventually and get her packaged. She has several scrapes, cuts and bruises, an angulated left wrist and an open fracture to her left ankle. We make it up the hill with her and to my waiting ambulance.

There I learn of the other patient and vehicle. It was down an almost 50 foot embankment on the other side of the road. I never even saw it. Another crew had arrived and had gotten him packaged and loaded while I was down the hill with my 2 patients. I also learn the chopper is waiting for us just up the road to take our patient to the nearest trauma center. I finish my assessment, start a couple large bore IV's, splint her leg and wrist as we make our way to the LZ.

We hand off the patient and the bird takes off. I sit on the bumper with my head in my hands. A fireman comes up and offers a smoke which I gladly take. Drawing deep on the cigarette. We start to clean up the back of the truck and I realize my airway box and jump bag on still on scene. We make our way back to the scene and the supervisor advises us that our equipment is in the back of his truck. They are still in the process of getting the dead girl out of the car.

I grab the equipment and take it to my truck. Then grab my camera and return to take a few pictures, careful not to get any shots of the body or license plates. We make our way back to the station. I learn then where my partner went. He had went back to the truck to get the things he thought we would need and while rounding the back of the truck had heard someone yelling. He looked over the embankment and saw the other vehicle and went to help who ever was inside.

The rest of the shift was uneventful, a few calls, nothing of note. The next morning I came home and printed the pics I had taken from the wreck. Reliving it all over again. Wondering if I had made the right decision. I take the pictures and place them in a photo album that is laying on the table in my office. In it are other photos of wrecks I have run, notes on various calls and interesting 12 leads that I have saved.

I sat looking at it for a long time...remembering...


Monday, August 4, 2008

Looking back...

I've hit the year mark. One year as a paramedic. Actually that mark came about 4 months ago. But it seems almost like yesterday that I was still going to class and clinicals. Still had the world in my grasp so to speak, at least that's what I thought then. I suppose that to some, well...to most, I am still wet behind the ears and I guess I would have to agree in some aspects.

When I got out of school I thought that I was ready to take on the world. I was ready to cure the ill, bring the dead back to life and make little old ladies walk again. I can't help but to laugh at that now. It's intereseting the changes that you go through as you gain experience. It's also interesting the things you forget as time goes by.

When I was in and fresh out of class I could spout off just about anything you wanted. Pediatric dose for some off the wall drug? Bam, right there it was, on the front of my mind. Now? Hmm, have to think about it a little first. I used to look down on some medics for not knowing some of those things. Now I see why. I'm not excusing myself or others. It's our job to know these things. But sometime things just kind of fade from memory without constant vigilance.

In this past year I've went from a brand new medic to a now FTO. Thats short for field training officer. The training officers for the region that I work in have gotten together and started this program for FTO's. The old precepter program is outdated and none of the 5 services in our region nor the students riding in those counties use it. So a bunch of us from each service have been sent to all kinds of classes on how to teach in the field. A lot of it is very interesting and has helped, but the rest is fairly boring and stuff that we, being students once ourselves, already know. Anyway, I now get students that come to do clinicals on my shift and the new hires when they are doing their orientation rides.

I find that I enjoy it though. I have also been teaching for about a year now. I love to teach. In some ways, I like it more than actually running calls. I had an incredible instructor through my Intermediate and Paramedic classes. We learned so much more than what was in the books. I enjoy giving back the little knowledge that I have and the little tricks and things that the more experienced medics have taught me along the way.

As far as me being a FTO now, I'm not really sure what to make of it. We've had a lot of turnover recently, as most services around here have. There is also that gap that seems common place in EMS. There are a lot of medics with 15+ years of experience and then a lot with less than 5, with not too many in between. I don't know if I was picked to be in the program because of my competance or just lack of options. Think about it, a medic with only one year of experience is teaching others how to be a medic. Doesn't seem right to me sometimes. It seems like the more experienced people should be the ones teaching. But since it fell in my lap, I do the best I can with what I got. I hope they go away with more than they came with.

Thursday, July 31, 2008

I'm back...

I reckon I'm gonna try this bloggin' thing again. I apologize for the readers that have come back looking for something and finding nothing. I have a lot of excuses, most of them probably not good ones... So I'll spare you...


Saturday, April 5, 2008


I hate Narcan. I really, really do....

The last two times I have given it, I got puked on for my efforts. This time I got into a fight.

We got the call for a chest pain that turned into an unconscious while en route. Me and my partner look at each other thinking this is gonna be a code. We get there and it's a whole other story.

The patient had ingested an unknown amount of alcohol and possibly taken some Vicodin. He was completely unconscious and unresponsive. We get him loaded up and do our thing. All his vitals, 12-lead and blood sugar are normal. Except for his breathing; about 8 times a minute and shallow and his pupils; constricted and nonreactive, everything is normal.

I decide to give him 0.5 mg of Narcan. A few minutes later nothing was happening so we decided to head to the ED. My partner was standing on the back step talking to a family member when the patient decided to wake up. He immediately began to struggle against the cot straps. I tried to calm him and let him know what was going on. He wasn't hearing any of it. He said that we should have let him die and when asked, he said that he had been trying to kill himself. In my county that is enough, they are then deemed a danger to themselves and they are going to the hospital one way or the other.

He then wanted to fight. He took a swing at me and caught me on the side of the face and then another on the chest before I could get around to his head to control him. I've been trained on how to subdue people, both medically and non-medically. I read an article in EMS Magazine a few months ago on restraining a patient and got several tips that I used that night. I went straight to the captains chair and laced the fingers of both my hands under the patients chin and pulled back. This pins the patients head to the cot, closes his mouth to inhibit biting and spitting and you are still able to control airway and see the entire patient and keep monitoring. A very good technique as it worked very well, is easy to do and is safe for the patient. I recommend it to anyone that needs it.

My partner jumped back in and on top of his legs. One of the first responders came in and tried to get his arms and got socked on the jaw for his effort. The patient continued to fight and curse and generally make an ass of himself while we called for the sheriffs department. All this happened in about 30-45 seconds, although it seemed like a lot longer. We got a non-re breather on him and just held him there. The reason for the mask was one to administer O2, which never hurts and another to keep him from spitting. He wasn't yet, but it usually doesn't take them very long to start after they figure out that they can't do anything else.

We held him until the deputy got there and placed him in custody then cuffed him to the cot. We got his legs strapped with cravats and put the shoulder straps on so he couldn't move his upper body. The patient then got the bright idea that he would choke himself on the V made by the chest strap and the shoulder straps. He wasn't the brightest crayon in the box, but he gave it the all American drunk try. I let him, I was tired of fighting with him and I figured that he would either give up or pass out, I didn't really care which at that point.

Eventually he gave up and he finally calmed down during the transport. Then he started bawling, going on and on about how the world was out to get him and how life generally sucked for him. I didn't feel like it, but I listened to it and tried to calm him further and told him that there were people at the hospital that would like to help if he wanted it.

We got him to the ED and turned over care with a promise from him that he wouldn't give any of the nurses any trouble. I don't know what happened to him after that, but I have a feeling that I will see him again at some point.



This is something that I have heard about several times, but never actually seen myself.... We get the call for a routine eye injury, no other information. We get to the house and find a guy standing at his kitchen sink flushing out his eyes.

We ask what was going on and find out that he had glued his right eye shut. To make a long story short, he picked up a bottle that he thought was his prescription eye drops and applied it to his eye. He stopped said application when he felt the burning. His teenage daughter had been putting on fake nails with the glue and had set the bottle down on the end-table where her dad, the patient, usually put his drops. To his credit, both bottles had the same color top and were the same size. It was an honest mistake, but one that me and my partner couldn't help but to laugh at. Luckily the patient thought it was just as funny.

We called the local hospital to ask for assistance in dealing with this matter and the doc on call in the ED gave us some unorthodox advise: rub some Vaseline in his eye. What? Yea, you read it right, put some Vaseline on it. He said that it would remove the super glue.

So, we did it. We asked the family if they had some and they did and then we did. To every one's amazement, it worked almost instantly. It left a glob of glue on his eyelash and he kinda ripped it off, pulling most of the lashes of with it, but he could see out of his eye.

We flushed his eye some more and he said that it wasn't burning anymore. Other than a little redness, he was fine. We tried to get him to go to the hospital, but he wouldn't hear of it. He did promise to see his eye doctor the next morning.

Like I said, I've heard about this before, but never actually seen it myself. I did learn something useful though. It's good information for anybody, but especially anyone with kids.


Monday, March 17, 2008

Blogger Blues....

I apologize to my readers out there who haven't heard from me in quite a while. I guess I've got the blogger blues. I just haven't been running anything worth writing about, or that I haven't written about already. I have 2 calls that are somewhat noteworthy and I will try to jot them down sometime this week. I was out of work for a few weeks due to an injury and I have also been teaching an EMT class for the last month, so I haven't had a lot of time. I know that is no excuse, but there it is. Like I said, I will try to do better in the near future. I thank those who come back looking for something to read and I apologize that you have had to go away empty handed so to speak.


Tuesday, January 15, 2008

No Clue....

I ran a call last shift and I had no idea what was going on with this guy...

We get called for an unconscious. Dispatch calls us back while en route and says that the patient is now conscious. Upon arrival the patient is a mid-30's male sitting up and talking. He doesn't look as if he feels well, but not in any specific distress.

I start my assessment and found out that he has been having multiple syncopal episodes for more than a week. He had been to see his doctor and had been to the ED and was diagnosed with "Occipital Neuritis". I didn't have a clue what that was, so I started asking questions.

He said that there was something wrong with a nerve in the back of his head and that made him pass out. He was also experiencing severe headaches, sensitivity to light and nausea. The only other medical problem he had was hypertension. His only medication was a anti-hypertension med. He said that he had been diagnosed and treated for the HTN a few years ago.

The reason he had called EMS this time was because he had passed out and hit his head. He had a pretty good goose egg on the side of his head, but otherwise was OK. We obtained orthostatic vitals and there was no change. He said that he had been eating and drinking normally, no bowel or urinary abnormalities, no recent sickness and no recent trauma other than the fall. His blood sugar and 12-lead were also normal.

During all this assessment, he passed out 3 times. At first I thought he was maybe faking. But after a serious sternal rub and an extreme pinch to the web between his thumb and forefinger, I figured he was really out. Plus I've never seen a patient faking and actually smack his head against something hard enough to leave a mark and not flinch. Each syncopal episode ended within 30 seconds and he was not disorientated upon waking up.

We got him to the truck and started a line and put him on the monitor. During transport his headache, nausea and sensitivity to light seemed to get worse. I wasn't sure if it was from his condition or the bumpy/ curvy ride in the truck or both. So I turned off the lights in the back and tried to make him as comfortable as I could. He passed out several more times during transport. His vitals and 12 lead stayed normal during the episodes.

Eventually I have him 4mg of Zofran for his nausea, so he wouldn't puke in my truck and to try to make him a little more comfortable. That helped with the nausea but he still had a lot of pain. I wasn't gonna give him morphine for that and he had already taken 1000 mg of Tylenol before he called us.

We got to the hospital and turned patient care over to the nurse. The doc came in and this is usually where I make my exit but I stuck around for this one. After the doc did his assessment I followed him out and asked him what occipital neuritis was. He looked at me and said that he didn't have the slightest clue.

Since then I still don't really have a clue. I've asked several people and have done an extensive Internet search all with no real answers. So if anyone out there has any information I would be grateful. Since that call a few of my co-workers have run him for the same thing and no one seems to know what's going on...


Thursday, January 10, 2008


Have you ever had one of those calls that you wonder about? You know, the ones that you're not sure if you did the right thing? I have them every once in a while. This is one that happened a little while back.

We get called out for a difficulty breathing. We get there and there is this 50-ish year old male sitting up and talking. He has a home health nurse and she is there giving us the report on why she felt it was necessary to call us.

The patient in question had a history of stomach cancer, COPD, hypertension, recent pneumonia and a productive cough with green tinged sputum. He doesn't seem to be in any distress at the moment. The nurse said that he had been suffering from dehydration and she had started an IV and had been administering fluids. That is apparently when the trouble began. The patient started getting short of breath and anxious. So she stopped the fluids and discontinued the IV.

The patient didn't want to go to the hospital, but apparently trusted his nurse and wife and various other family members on scene, and decided to take the trip to the Big City Hospital down the road.

We put him on some O2 and get him loaded up. His vitals were within limits, O2 saturation was good and his lungs had some diffuse congestion throughout all quadrants. 12 lead and capnography were both normal. I started an IV just for precautionary measures and kept it at a KVO (Keep Vein Open) rate. He still said that he felt fine and he didn't seem to be in any distress.

On the way down, I do a little more detailed exam and find that his ankles and abdomen are swollen. He says that this is normal for him from time to time. His abdomen has some bruising and he doesn't know why. I take another look at his medication list and he isn't on any blood thinners or diuretics.

He still says that he feels fine and I have to agree that he does not seem to be in any distress. He says that he is a little tired and just wants to sleep. So I lay his head back and turn down the lights so he can take a cat nap for the remainder of the trip.

That is when I notice the JVD (Jugular Vein Distension). I put the puzzle pieces together and come up with pulmonary edema. I take another listen to his lungs and still only hear ronchi or congestion. I was taught that if you have the patient cough while listening then the sounds will clear and then return if it is ronchi, besides the obvious sound difference between ronchi and rales. Well, this is what happened when I had him to cough.

This is my dilemma; his pedal and abdominal edema, JVD and the fact that he started having trouble breathing when he was getting IV fluids all point to pulmonary edema. The other half to the equation was that he wasn't having any trouble breathing, he wasn't anxious, his blood pressure was normal and I didn't hear any fluid in his lungs. The blood pressure and heart rate I could explain away on the beta blockers he was taking to control those very things.

I didn't treat him with anything other than O2. He made it to the hospital fine and never once displayed any signs of respiratory compromise. But I have wondered since then if I shouldn't have treated him. Maybe he did have edema and I just mistook it for ronchi. Who knows? But I still wonder...


Thursday, January 3, 2008

The High....

I have had lots of different experiences in my life, lots of different highs. From smoking pot in high school, to jumping out of a perfectly good airplane at 15,000 feet, to scuba diving, white water rafting and rock climbing. Other than my son being born, I would have to say one of the biggest highs I've ever had is simply being a Paramedic.

I think that is probably the biggest reason that we all get into this line of work and stay for any length of time. Sure, you can tell people that it's helping people, but all of us love to race down the road to some trauma that sounds nice and juicy. We are all adrenaline junkies at heart.

But the other side of that is just the job, the ability to actually reach people. The other day was just another day. I was working, as usual, with an EMT. He was just about done with his Paramedic, but other than clinicals, he had no experience above a Basic EMT. But he is the type that I love to work with. He likes asking questions and actually welcomes constructive criticism.

I've found that I love to teach. I don't know a whole lot, but what little I do know, I like to pass on to those that actually want to learn. I love it when the student gets this look during our conversation. You know that look, the one where you can almost see the neurons firing inside his head and the light bulb burning brightly.

The other part of the job is just being nice to people and seeing their response. I had two ALS patients last shift. One was a difficulty breathing and the other was chest pain. Both were elderly and had extensive history. Both were terrified of what was happening to them. With kind words and gentle touch, I think I eased their fears just a little. Or maybe it was just my imagination. But both patients seemed more comfortable and relaxed. I always pat a shoulder or shake a hand and tell them I hope they feel better soon and that they are in good hands as I leave them in the ED. I got what seemed like sincere thank you's from both of those patients.

As I left the ED from both patients I had a spring in my step and I felt good. I've read that it costs nothing to be nice and that you get out of something what you put in. I believe it. It was also an excellent teaching experience as I found out later. The EMT I was working with is part-time so he works with many different medics. He commented on my hospitality towards my patients and told me horror stories that we've all heard on how some medics treat their patients.

I told him my philosophy on attitude in EMS:

Always be good to the first responders. They are, for the most part all volunteers, so at 3 in the morning, when the blood pressure that they give you is completely wrong, don't berate them for it. Just take it in stride and thank them. If one of them is in your way, be nice and ask, don't tell, him/her to please step aside, and always listen to what they have to say. Just as our patients are different when we roll them into the ED, sometimes the patient was different when they arrived as to when we arrive. You never know when you are gonna need their help, so don't piss them off and always say thank you for whatever help you do get. Even if they didn't do anything more than just show up.

Always be good to your patients. It is their emergency, no matter how mundane it seems to you. They felt is was bad enough to call 911, so it is worth your time to be there. You are getting paid to do a job, not brow-beat people for their decisions.

Always be nice to the nurses, at all the facilities and the ED. This is something that I have figured out recently. Most people in EMS hate nursing homes. I have no love for the places myself, but the people that work their are not all lazy and ignorant. Someone has to do the job, and I sure as hell wouldn't want it. I've realized that if you give them your attention and listen to whatever it is that they have to say, they remember you and eventually you'll start to get better reports and have plenty of help when you need it. And again, always say thank you for whatever help you get.

Always be nice to the dispatchers. I hear people giving them hell all the time for wrong addresses and cross-streets and wrong dispatch information. This is another job that I wouldn't want, but someone has to do it. Just be nice and take it in stride. These people can always find a way to make your life a living hell if you piss them off.

So the words are, be nice. Eventually it will all pay off in the end and it will make your life and your shift much easier. I've read EMS books about this type of subject and I've seen a few medics that live and work this way. I learned from them and I try to teach that to the ones that I can. That is my high...