Monday, November 24, 2008

Whoo... -">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....