Blue Ridge Medic

Trauma...

2009-10-12T21:39:00.002-04:00

OK, I know I haven't posted in forever but I got to put my two cents in on this new show "Trauma." I've been reading other posts, websites and NBC's site and this show is getting a lot of shit. I don't understand what the problem is.

Yea, OK it's not exactly realistic. Every episode so far is packed with some kind of MCI and you got medics doing outlandish stuff that most people in this job never see or do. But guess what? It IS TV! What show on the air is true to life? Do you think anyone would actually tune in to see a crew doing granny totes, sick calls and dialysis runs for an hour? Hell no they wouldn't.

Now, what about other TV shows out there that are emergency or medical based like Rescue Me, ER and House? Does anyone think that everything that happened on ER was true to life? I saw false intubations, doctors defib asystole and many other things. Yet, that show went on forever and was critically acclaimed.

How about Rescue Me? I love that show and I've been a fireman for 15 years. Yet it portrays us in a completely negative way. That show is nothing but drinking, drugs, screwing, adultery, abusing, murdering, lying and cheating with a few fires thrown in for good measure and it has been on the air for several years.

And House? I love that show too, never miss an episode. But does the public think that every doctor is like House? Does the public or anyone for that matter think that medical professionals act that way in the hospital? I would have to say no, they realize that it is TV.

The next beef I have is with people wishing there would be a new "Emergency" with ole Johnny and Roy or their comparing Trauma to Emergency. Have any of these people actually seen Emergency? Johnny and Roy were always going to some major wreck, heart attack, something blowing up or falling in. Granted, I wasn't around back then, but my dad was and he said that was bullshit back then just like it is today. So stop comparing everything to Emergency.

Another one that most people love was Mother, Jugs and Speed. I agree it was a great movie, but what happened in that one? An EMT accused of having dealings with drugs, another that smoked weed and the star drinking while driving on shift. Plus sex in the back of the rig, yet people loved that movie.

One other show that still comes on Discovery was "Paramedics." A reality show based on us. Even they just showed the juicy stuff, and very little of routine day to day.

I just don't get it. I'm kinda glad that we finally got a show of our own. They cancelled the last one "Saved." I wish people would shut the hell up so maybe this would might stick around for more than one season. There are a ton of cop shows and very few fire or EMS shows.

Just remember, it's TV! Not reality!

BRM

Another Great Read....

2009-05-21T20:11:00.001-04:00

...and very educational too.

Prehospital 12 Lead ECG

Enjoy...

BRM

Vindicated...

2009-05-21T11:59:00.003-04:00

Ran into a bit of trouble a while ago. All over a damn refusal...

Got a call for a CVA. We get there and this guy ain't having a stroke. All he had was numbness on one side of his leg, which he had a history of. His grand daughter was there, freaking out and she was the one who called us. He didn't want to go, he didn't want her to call 911. So of course he refused. He let us take his vitals and do a stroke screen on him. All were normal. We let him and his granddaughter know that he hadn't been examined by a physician and that we could not tell him definitively that he wasn't having a stroke and that we would be happy to take him to the hospital. He refused all of that. He was obviously competent and he was now informed of his condition. I felt he had every right to refuse further care and transport. So he signed my paper and we left.

About 3 hours later we get called to the local band-aid station for an emergency transport to the big city hospital for a stroke transfer. We get there and it's him. The charge nurse is pissed and she doesn't even give us a report, just points us towards the bed. We walk over and talk to him. The patient has no clue that he is being transferred or why. He said he only came to the hospital to shut his granddaughter up. We load him up and start towards the truck. That's when the nurse grabs my arm and tells me that the patient should have been transported from the scene and she will be making a complaint for further investigation about the situation. My reply was "OK" and we continued to transport.

Later that day the quality assurance guy from our service comes to call on us. He asks what happened, he already had a copy of my report so I told him that it was all there. He wanted to know more, so I pretty much told him the same thing that I had typed. In a round about way, he accused me of selling the refusal or encouraging the patient to refuse. Well that pissed me off and I let him know it. I asked him if he and everyone else in management didn't trust my judgment as a paramedic, then why in the hell was I out there on the road? Why was I able to function as a medic at all if he was going to question everything that I did? He finally left. The next day the charge nurse came to me and apologized for her actions. I accepted and I thought that was that. I was wrong.

Apparently he and the charge nurse are good buddies and he wasn't about to let it go. The next week I was at the office and he calls me into his little corner. He shows me a customer service questionnaire that he says that he sent to the patient about that call. He said that he had made this little form up some time ago but had never sent it to any patient so far. So this would be the first. Well, I start to get pissed all over again, but I managed to keep my cool. I asked him if he was going to start sending these out on a regular basis. He said no. I asked if he was even going to send them out randomly, he said no again. His explanation was that the budget wouldn't allow for it. Bullshit I thought. So I asked, "This is the only survey that you have ever sent out and the only one you're ever going to send out?" He just looked at me and I just about lost it. I turned to walk out and over my shoulder I said, "This sounds a whole hell of a lot like discrimination to me." I kept walking before he could reply.

I left the office steaming. I felt like this was a fucking head hunt and my head was on the chopping block. I also found out that the patient in question got sent home the same day, actually within a few hours of us taking him there. He wasn't having a stroke. I guessed our Q/A guy found that out and it just pissed him off that much more, since I was right about the patient. But that didn't change the fact that I had pissed off his buddy.

Well a couple of weeks go by and I get an email. It's the survey, apparently the patient had filled it out and sent it back in. It contained an excellent review of my care, on both calls; the refusal and the transport. It even had a handwritten comment saying how good the care was. I think I laughed out loud when I read it. It must have put a burr in his ass to get that back in the mail.

So now I am fully vindicated...

BRM

Great Reads...

2009-05-19T00:38:00.002-04:00

Two new blogs I recently happened upon. They've been around a while, but I'm...well...a little slow..

Pink, Warm and Dry

Paramedicine 101

Transferred...

2009-05-15T19:13:00.003-04:00

In my three short years working for my current employer I have now worked at every station. They call me the shift whore. I am usually the one that has to move around when a Medic is needed to work with an Intermediate or Basic. But now a co-worker has been injured and my semi-permanent station is the farthest from civilization that you can get in our county. It's over an hour to the nearest major hospital from our response area and that's going emergency traffic.

We also get the fewest calls of all the stations. That in itself isn't so bad, I get plenty of time to sleep, work on lesson plans for my teaching, read and stare at the walls. When we do get a call it usually takes about 3 hours to get back to the station.

Yesterday we traveled through 4 different counties, not counting our own and went to 5 different hospitals for a total of 7 calls. Most of them were bullshit, one actually needed to go. That one was a bad breather. Her house was sweltering and her rain-barrel girth and permanent growth in the shape of a cigarette glowing at the end of her fingers certainly didn't help. I wanted to tell her this but didn't, just put her on O2, loaded her up, gave her a few nebs and listened to her talk in a raspy voice for the 78 minute transport.

Anyways....I reckon that's enough bitching for the time being...Till next time..

BRM

One of My Very Own...

2009-05-06T23:02:00.003-04:00

These past few months have seen a couple of my career goals come to light. I finally finished my Level I EMS Instructor. That took almost a year and a half to complete. The other is finally getting my own EMT class. I got a call the other week by the coordinator of the EMS program of the local community college that I have been teaching part-time for. It seemed like he was in a bit of a bind and my name popped up on his radar.

Apparently there was a course scheduled for this summer that didn't have a maximum capacity, or someone forgot to put a cap on it when they did the paperwork before the class began. Well, to make a long story shorter, there was over 40 students that showed up for the first day and no where to put them all. Hence why I got a call.

I had made it known that I wanted my own class for some time now, whenever the powers that be deemed me experienced enough to handle it own my own. Evidently, that time has now come. So for the last few days I have been running around trying to put a lesson plan together, go through all the presentations and generally getting everything ready.

The night before the first class I was nervous as hell. At first I couldn't really understand why. I had been teaching for some time now, and I knew that I knew the material. I don't have a problem with standing in front of people and talking. So why was my gut in knots and my hands all sweaty?

Then it hit me. This one was all mine. Whether the students pass or fail will ultimately rest on my shoulders. Plus, if I am ever to continue on to further goals, like being a training officer or a coordinator of a program, this was the first step. I figured that if I fuck this up, I probably won't get another shot for awhile, if ever.

Now I know that not all students will pass. The drop-out/ fail-out rate is almost 50% in EMT-Basic courses around here. I have dealt with problem students of many different types and been through many courses on how to deal with various learning styles, etc, etc.

As far as my teaching style...well...I try to roll with the punches that come and also try to get the information to the students in as many ways possible. That way, hopefully, most if not all will understand the material, pass the test and ultimately become good EMT's.

So..with all that in mind, I got some more work to do....

BRM

25,000....

2009-01-30T23:13:00.001-05:00

25,000 visitors and counting. YeeHaa!!!

On Learning...

2009-01-28T11:35:00.002-05:00

I had an instructor who once said that you can learn something from everyone that you come in contact, no matter for how long. I kinda took that to heart and now try to apply it to my work as well. I tell my students the same thing. Every patient that you come into contact with, you can learn a little something if you want to.

Even if it's just a routine doctor's office visit or a dialysis run, you can learn. If not from the person, due to being in a comatose state, then their chart and medical information. I always try to keep this in mind as I go about my job. I think it helps.

The other night we got dispatched for a psych transfer. The address was all too familiar. It was Joe again. Joe is a mentally and physically handicapped, 25 year old who is also deaf. He lives with his mother and grandparents. We go out to their house at least once a month when Joe decides to get angry and either hit one of his caretakers or throw stuff around. Tonight was no different.

You really can't blame the guy. He has the mental capacity of a 6-8 year old. Like any kid with that mentality, he pitches a fit once in a while. The problem is that he is exceptionally strong. I've seen him toss around 2 deputies from his wheelchair when he really gets going.

When we got there the cops had him handcuffed and everyone was sweating. After a while Joe calmed down and stated that he wanted to go to the hospital, so they took the cuffs off. His case worker was there and she basically told him that he was going away for a while, it wasn't going to be just an overnight thing. He seemed to understand and was OK with it. He went about packing his things.

We got him into the truck and I climbed in after him. Knowing how he is, I tried to keep him calm and in a good mood. It seemed to work. For some reason, even though I didn't know how to use sign language, he kinda took to me. He showed me his comic collection that he had brought along and through simple gestures and writing, he told me about the video games he liked. He even taught me a little sign language. I really enjoyed the ride with him.

We got him to the hospital without a problem and got him into his room. He promised to be good to the staff and we left. My partner was just kinda looking at me on the way back. I asked her why. She said that she had never seen anyone be that way with him before. Most people just stay away from him and leave him alone for fear of provoking an attack. I told her that wasn't the way I do things. After all, he is just a big kid.

BRM

Ice...

2009-01-02T21:39:00.003-05:00

I left for work this morning a bit early. So I could take my time. You see, this morning we got our first taste of winter weather. It was sleeting a bit when I left, it was really putting it down by the time I got to the station. Usually it takes me about 20 minutes to get to work, this morning it was more like 35-40.

Does this seem complicated? I watched the weather the night before and saw that there was a good chance of bad weather coming in. So I got up and got ready early. Then I left for work early. So I wouldn't have to rush, and so I could go slower and be more careful.

Now I know that many people may not have a TV, or watch the weather if they do. But when you get into your vehicle and there is white stuff falling from the sky and there is a whole bunch of this white stuff covering the ground and roads, is it that much of a stretch to begin to think that it may be a slightly dangerous situation?

Apparently not around here. The really dangerous situation is when you get this white stuff falling from the sky and a human with a 4-wheel drive vehicle and open road in front of them. There were a lot of said people out this morning. We had 7 in 30 minutes just in my area. I have no idea what the total for the county was, but it was a lot.

People don't seem to realize that, on ice, it doesn't make a difference what type of vehicle you have. To prove this fact, I was once on a military base during the winter. I saw a full sized tank driving along on a cement pad outside of the motor pool. It hit the ice and went sideways and there was nothing the driver could do about it. So if a tank slides on ice, what makes u think your shiny new 4x4 is gonna just drive right on through?

Luck was with us and everyone else today though. I can't imagine what the monetary cost was for all the damage done, but as far as I know no one was seriously hurt. The other lucky thing was that the schools are still out for Christmas break. I can only imagine what it would have been like with all the kids on the roads this morning.

BRM

No Idea...

2008-12-16T23:06:00.003-05:00

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...

BRM

When God Make Paramedics...

2008-12-01T20:09:00.003-05:00

...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
back."

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.

"I DIDN'T PUT IT THERE" He said.

Author Unknown

BRM

Whoo...

2008-11-24T21:12:00.000-05:00

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

BRM

Another Article...

2008-11-24T20:57:00.000-05:00

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

http://kob.com/article/stories/S661228.shtml?cat=10134

BRM

Can 911 Be Saved?...

2008-11-20T20:30:00.002-05:00

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

BRM

Reasons...

2008-11-19T12:21:00.002-05:00

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....

BRM

Instincts...

2008-11-07T07:47:00.003-05:00

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.

BRM

"This ain't basket weaving...

2008-11-02T22:01:00.004-05:00

...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....

BRM

Story....

2008-10-17T20:44:00.005-04:00

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...

BRM

Looking back...

2008-08-04T19:48:00.006-04:00

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.

I'm back...

2008-07-31T20:15:00.002-04:00

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...

BRM

Fight...

2008-04-05T22:19:00.003-04:00

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.

BRM

Glue...

2008-04-05T22:01:00.003-04:00

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.

BRM

Blogger Blues....

2008-03-17T09:30:00.002-04:00

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.

BRM

No Clue....

2008-01-15T21:26:00.000-05:00

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...

BRM

Wondering...

2008-01-10T22:46:00.000-05:00

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...

BRM

The High....

2008-01-03T20:48:00.000-05:00

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...

BRM

On Studying...

2007-12-31T20:36:00.000-05:00

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...

2007-12-10T20:59:00.000-05:00

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...

2007-12-07T21:31:00.000-05:00

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!

2007-11-14T17:03:00.000-05:00

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

2007-11-13T23:36:00.000-05:00

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

2007-11-13T10:38:00.000-05:00

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....

2007-10-28T23:48:00.000-04:00

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...

2007-10-09T00:34:00.000-04:00

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....

2007-10-08T23:56:00.000-04:00

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....

2007-10-02T23:03:00.000-04:00

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....

2007-09-30T01:16:00.001-04:00

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...

2007-09-27T01:54:00.000-04:00

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....

2007-09-17T23:11:00.000-04:00

....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...

2007-09-13T11:00:00.001-04:00

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...

2007-09-09T23:57:00.000-04:00

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...

2007-08-27T16:17:00.000-04:00

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....

2007-08-24T10:17:00.000-04:00

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...

2007-08-18T08:24:00.000-04:00

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.....

2007-08-18T07:59:00.000-04:00

....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....

2007-08-12T22:20:00.000-04:00

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....

2007-08-12T21:37:00.000-04:00

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....

2007-08-12T21:35:00.000-04:00

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....

2007-07-31T17:53:00.000-04:00

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.

First time...hopefully the last.

2007-07-22T19:15:00.000-04:00

Up until this point this has been an EMS blog. My EMS blog. I have been careful not to put too many personal things and experiences in this blog. I'm pretty sure that I am still anonymous, no one has contacted me in an effort to try to ascertain my identity and I want to keep it that way. I have seen too many bloggers, mostly EMS ones that get into loads of trouble all because of not being careful. That being said, I am going to write about something that happened to me today, my day off. This is not an EMS post.

I was at Wal-Mart today. Just nosing around, picking up a few wants and a couple of needs, nothing special. I paid for my things and made my way out to the truck. About halfway there this guy walks up to me and says hi. At first I figured he wanted to sell me something, but his clothes were not that of a salesman. He didn't seem to be homeless, but he did have a bag over his arm. He asked for money. Now usually I don't give money away, I work hard enough for the little I got. But today I was feeling generous. I said sure, I reached into my pocket and pulled out what I had, about $1.30 and handed it to him. He looked from his palm to me, back to his palm and to me again. Then he said "That all?" I just walked away. My truck was in sight and I just wanted to get to it and get home. I heard the crunch of his shoes on the asphalt as he turned. I glanced over my shoulder and he was just standing there looking at me.

At this point my "oh-shit-o-meter" just perked up a few notches. Using my ears as my eyes behind me I just kept walking towards my vehicle. About the time I open the back door to put my bags in I heard him walking towards me. Now, don't get me wrong, I am no coward. But I believe that it's better to turn the other cheek and keep your head down than go looking for trouble. In my experience, enough trouble will find you that you don't have to go looking for it. But if that trouble does find you, be ready.

I opened the drivers door, got in and shut it. I put one hand on the key to start the truck and the other underneath the seat. When the door opened (I had a feeling it would at any minute), I was ready. It was yanked open and there he was, the same motherfucker that I just gave money to. I yanked my peace and stuck it about 1/2 inch from his beady little eyes. It's amazing the amount of white that I could see. I don't remember the color of his eyes, but I do remember the acres of white as he stared into the barrel of my 40 cal.

I wished I could have come up with something catchy to say. Something like Bruce Willis or Clint Eastwood would have said. But this is the real world and I am not afraid to say that I was scared shitless. The only thing I could say was "I don't want any trouble".

He backed up, turned around and walked away. I sat there, put the safety back on and shivered until I had to grab hold of myself so I wouldn't fall out of the truck. When I had pulled myself together enough to form a rational thought I picked up my phone and called the cops. The rest is just a blur. The cops came, I gave a statement. They left. I drove home.

I'm not sure what his intentions were. Maybe he intended to do harm, maybe not. Maybe he just wanted to ask directions. I don't know and I don't care. If he had wanted something, he should have asked when I gave him the money. If someone jerks open my door, either my vehicle or my house, I feel that my life and my family's life may be in danger and I will act accordingly.

For the record: "I am a gun-toting, card-holding NRA member, I also have my conceal-to-carry license and they can have my guns when the pry them from my cold dead hands." There that said, if I offended any of you, just re-read the above paragraphs and put yourself in my shoes. As I said, I don't know what his intentions were, but if they weren't just to ask where the local 7-11 was, then what other reason would he have to follow me and then yank open my door? What if? What if he wanted to take my truck, or just off me right there in broad daylight in the middle of a Wal-Mart parking lot. It happens, just watch the local news any night of the week if you don't so.

So all of you gun-haters out there, you can kiss my ass. This was the first time I have ever pulled a weapon on anyone and I hope that I never have the opportunity to do it again. But I am glad that I have it. I am glad that I had it with me. The only reason it wasn't on my person today was that the Wal-Mart I visit has a no-weapon of any kind, concealed or otherwise sign on the front door. I left it under the seat because of it. I am a law-abiding, gun-owning citizen and I will protect myself and my family if I feel threatened....

This was the first and only time. Jesus, I hope that I never have to again.

Irritated.....

2007-07-16T08:25:00.000-04:00

The other day I was sitting in the dayroom and overheard a conversation. There was this medic who just got back from vacation and he was talking to another medic about his return flight being delayed. Now this in of itself wouldn't be a problem. Anyone who has flown more than a few times can sympathise with being delayed, held-up or otherwise postponed at the airport. At this point my interest wasn't peaked.

Needless to say, if I am writing this, eventually my interest was peaked....

I couldn't help but overhear, this particular guy has a very loud "indoor" voice, added by his conviction of how badly he was wronged by the delay. He went on to say that at first everything was fine. The flight was on time and he boarded as usual. The plane took off and everything was hunky-dory. Then he said that about an hour into it he was "rudely" awaken by one of the stewardess asking if he was a doctor or nurse. He said no. Then he asked why? She said that there was someone in first class that was in need of medical attention.

Now at this point, I would have stated that I was a Paramedic and would like to help if I could and then let the staff decide if I was what they and the patient needed/ wanted. Maybe it's just me and maybe I'm just naive, but I would like to think that any card holding EMT, no matter what level, would have stepped up and offered their help. That's just what we do.

But not this guy. He was napping for God's sake! Asshole, I say. He just said no and went back to dreaming whatever dipshits like him dream about. I personally hoped it was that one where he was falling and wakes up screaming and pissing himself.

Anyway, he goes on to say that captain of the plane decided to make an emergency landing to get this person some help. Apparently there was no other person on board with medical training or like him, there was no one willing to step up to the plate and at least try to help. So he was delayed for about 7 hours while the plane waited on the tarmac.

Eventually he found out what had happened. An elderly woman was having a heart attack. Full, classic symptoms: crushing chest pain, shortness of breath, pale, cool, sweaty, nausea and feeling like she was going to die. The kicker was one of the stewardess noticed it and asked her. The patient denied it at first, said she didn't want to bother anyone. That didn't last long because she eventually passed out!

Now this was the point I just had to say something. This is sort-of out of character for me. You see, I am new at this Medic stuff. The ink on my card isn't even dry yet and this guy has been around for about 5 years or so. Not an old-timer by any means, but he's been around longer than I have. I usually try to follow the old rule of "seen and not heard." Someone once told me that God gave you 2 ears and 1 mouth, which do you think you should use more? Plus he was one of the cocky types. You know the ones, the guy who thinks he's King Shit of Turd Mountain, a "Para-God".

But this wasn't the time for that. I put down the JEMS magazine that I was pretending to read and turned to face him. He noticed my piercing glare and asked "What?"

"What?" I said. "How can you wear that patch on your arm and call yourself a Medic?"

"What the hell are you talking about?"

I then proceeded to tell him my thoughts on his actions in a decidedly heated fashion. We ended up nose to nose. My supervisor picked that very moment to walk in. He got between us and split us up and asked what in the hell was going on? I just walked out. He came after me in a few minutes and I told him what the other guy had said and the fact that it pissed me off and I couldn't hold my tongue any longer. I was sorry that I caused a scene, but I wasn't going to apologize to that asshole. He leaned back on his haunches and squinted at me, then grunted and walked back inside.

I got in my rig and waited on my partner. He eventually came and we drove off. He was laughing. I asked him why. He said that our supervisor had come back in and the other medic was still ranting and raving about me and the fact that I had the nerve to open my mouth in his presence and all that bullshit. Well the supervisor told the asshole in question that he should maybe close his mouth and listen to the "kid" then walked out leaving that particular fuckstick with his jaw hanging somewhere down around his knees. It's also both funny and irritating that I am still referred to as the "kid", even though I am almost 5 years the elder of the asshole. But that's another post altogether.

****
On a side note, I have heard that airplanes carry full ALS gear on board in the event that someone has a need for it. But there is no one that can use it and that is why they ask for someone with medical training. I am not sure about this, but if anyone who is reading this knows, please leave a comment and let me know.

New Partner....

2007-07-11T00:13:00.000-04:00

For the past 4 months or so I have been without a permanent partner. We, like so many other services, are short-handed on Paramedics and I have been with part-timers or my supervisor. I am finally out of the "round-robin" of part-time partners. The higher-ups have deemed it necessary to give me a semi-permanent partner. I say semi because he is on loan from another shift. We are together until I am cut loose to function on my own. Then I will be put with an Intermediate or Basic partner, which are much easier to come by for hiring.

I used to give over my keys to the rig to him every morning, but other than that I know very little because he has not been with the service for very long. We are the same age, but he has been a Medic for about 5 years or so. We have been together for about 2 shifts and have only ran 5 calls. We have been really slow as of late. He does his calls and I do mine, with little talk between us.

The one call that had anything to it was a chest pain. Not sure what his intentions were but he kinda stood back and let me do all the work; O2, IV, monitor and treatment. It was my call, but I am used to working as a team and doing things accordingly. With 2 Medics, you can get things done a lot faster if one is doing one thing and the other is doing another. Maybe he was trying to see how I do things or if I could do them. Either way it got done, I don't think that the patient was having a heart attack anyway, but I treated him like he was. Partner meanwhile just stood there watching then got up front and drove.

I don't necessary think he's lazy. Maybe he's just pissed at being moved against his will, even if it is for only 6 months or less. It took about 3 months for me and my first partner to get to know each other and work well together. He was really quiet at first, then I couldn't get him to shut up. Hopefully the same will be the case with the new partner...

Ratings....

2007-07-10T23:57:00.000-04:00

Interesting, I would have thought it would have been at least PG-13...

Mingle² - Free Online Dating

The Calm...

2007-07-02T15:46:00.000-04:00

A recent commenter posted that this lull I'm having was just the calm before the storm. Well, if the length of the calm has anything to do with the severity of the storm, I'm in for it. For the past several shifts, I have done almost nothing. A few routine transfers, fire stand-by's and one chest pain.

But that one I could do absolutely nothing for. She had major peripheral edema, but her lungs were clear. She has so much edema and her extremities were so swollen, that despite me and my partners repeated attempts, we could not get an IV in place. She had substernal chest pain that radiated to her back and to her left arm. the monitor showed A-fib, a new onset as far as we could tell, with a few PVC's thrown in to boot, other than that her 12-lead was OK. We had her on O2, but that was pretty much the extent of our treatment. She already had her aspirin about 2 hours before our arrival, so that was out. With our protocols, we can not give nitro without an IV in place, so that was out as well.

She made it to the ED, not sure how she fared there, but I hope that she's OK. I wish I could have done more for her pain. I felt pretty useless just sitting there holding her hand all the way to the hospital. Everyone said that I did OK, there was nothing else I could do. But they didn't have to see the pain in her eyes for 35 minutes.

Imagine that.....

2007-07-01T12:09:00.000-04:00

First Shift...

2007-06-25T08:41:00.000-04:00

Just got home from my first full 24-hour shift as a Paramedic. Not a lot to tell, only ran 2 calls. One was a difficulty breathing and a couple of nebs fixed her right up. The other was a near-syncope. At first I was thinking cardiac because she had a stint put in about 2 weeks ago. Her vitals, blood sugar and 12 lead were all normal, so no easy fix there. I slipped an 18 in her hand and we headed down the road.

I happen to look up at the monitor and saw a big ole PVC go marching across the screen, then another and another. She was in trigiminy for a minute or so and then nothing. I stopped dead in my tracks wondering what the hell do I do now? Then I got ahold of myself and remembered there was a person attached to those wires. "Treat the patient not the monitor". I turned to her and asked her how she was feeling and she said OK, no problems. She looked OK and felt OK. So maybe the PVC's were normal for her, I kept one eye on the screen for the rest of the transport anyway. She went in and out of it the whole time, but never so much as raised an eyebrow in discomfort. Oh well, nothing to be done for it I guess...

Must read....

2007-06-23T22:04:00.000-04:00

I just finished "People Care, Career-Friendly Practices for Professional Caregivers". I think it is an absolute must read for anyone who works in or around EMS and the health-care industry. I especially think it should be included in the EMT and Paramedic program as required reading. Some of the things that are talked about are common sense, at least to me. But it opened my eyes to a lot of other things. I have to admit my face probably flushed with shame a few times while reading, remembering times that I treated a patient or family member a certain way that I shouldn't have. I know that I will try to do better now. I just wish that I was observant and kind enough to notice these things before hand. I can't do anything about the people that I have already faced, but I can do better with the next one. (I'm not up on the whole copyright thing, but I hope that the authors of this incredible book won't have a problem with me endorsing it on my little page.)

On a side note: I passed my oral boards with our MD. I was sweating bullets, let me tell you... After it was over I realized that I had made it a lot worse than it actually was. But isn't that the way it always goes? The anticipation of the thing is usually worse that the actual thing?

Anyways, I am now a fully-functioning Paramedic, I can finally do all the things I have been training for. It's been one hell of a long road. I have to admit I am scared shitless and eager all in the same heartbeat. Scared because when that next call comes I wonder what will I do, will I freeze up with a major brain-fart? or run screaming from the back doors? Eager because I want to prove to myself that I deserve to wear that patch, that I belong in that truck and that I can be a good medic and all that entails.

As an old instructor of mine once said, now that your out of school your real education begins, so "Go forth and do no harm". He's not on the street anymore, but I hope that with my actions, I can make his memory proud....

Perfection.....

2007-06-19T17:16:00.000-04:00

My sister-in-law visited us this past weekend. It went OK, me her and the wife sat around after the kids had gone to sleep and drank coffee and talked. We talked about all the grown-up things that, well, grown-ups talk about like religion, politics, raising kids, marriage and relationships and of course EMS. Me and the wife are recent Paramedic graduates and the sister-in-law is just starting her education in EMS. She tried to get into nursing school but for one reason or another didn't make it, so she decided to go into EMS.

Not sure how we got onto the subject, but we started talking about grades and how well a person did on mega-codes and the like. The sis-in-law made a comment about me getting pissed if I didn't make 100% on every test. Apparently the wife and her had talked about this before. I then tried to explain myself and why I felt that way.

Yes, it is true that I expected nothing less than 100% on all tests. Is that wrong of me? As one of my first instructors told me, "This is people's lives that we're dealing with, it's not basket-weaving." For that reason, EMS students are held to a higher standard than other educational disciplines. We were required to make at least an 80 on all tests, unlike other classes that only require 70. I'm not sure if that is the way it is in other places, but that is the way the Paramedic course is around here.

I suppose I took that instructors words to heart. Maybe a little more than I should have, but it pushed me to learn more and be better, I think. Think about it statistically, if you make average of 80%, then that means you only know 80% of the information. What if late one night in a ditch somewhere someones life depends on that other 20% that you weren't paying attention to? Or didn't care to learn because an 80 was passing? I for one don't want to take that chance. I want to be the best I can be both for myself and more importantly for that patient that I haven't met yet. Which is always the very next one.

A few of my friends and classmates would get irritated when I would only make a 95 on a test, they would say, "You did better than I did". What they didn't understand was it wasn't a competition with any of them, it was between me and myself. I didn't really care what anyone else made. I wanted everyone to pass, but other than that it was always an inner competition. For some reason no one understood this, even the wife who was in the same class I was in. It was almost like they took it as a personal affront to themselves if I was hard on myself. I never understood this and still don't. Is it wrong of me to push myself to be the best I can be?

Perfection is something that no one can achieve, I know that. I also know that the scope of medicine and the human body is way too much for any one person to grasp and know everything about. But what is the hurt in trying to achieve that? Even knowing that it will never happen? Some people say I am just setting myself up for a fall, but thats not it. I know that I will never know everything nor ever be perfect. I know that no matter how good you are, there is always someone out there that is better. You will never be the "best". I know that I will make mistakes during my career. Hell, I've made plenty already, but I want to be able to learn from them and try not to make the same ones again. I strive everyday to be the a good caregiver, the best I know how to be. Everyday I strive for perfection. What is the harm in that?

Precepting....

2007-06-13T19:58:00.000-04:00

Last night on MedicCast, Peter Canning and several other great bloggers talked about precepting and being a preceptee. I guess I thought I'd like to add my two cents in...

During the last year I have been working as an Intermediate and going to Medic school. So pretty much the entire time I have been what we call a Paramedic Intern. That means that as long as there is a Medic in the back of the truck with me, I can perform as a Medic. This has been excellent in terms of experience for me.

My partner at that time wasn't that great of a formal teacher. He never really said, "Do it this way or try this." He wasn't that great at teaching me 12-leads, or the A&P of the job. He was a stickler for the rules. He once told me that he did things by the book when asked if there was anything that he did that he knew was different from others. This is not to say that he wasn't a good Medic, he was a great one, just not a good formal educator in my opinion.

The one thing we was good at, and I am grateful for, is that he would let me do about anything I wanted to do. Just about every call he would step back and let me do all the talking and interviewing and most of the treating of the patient. He would help out and put them on the monitor or start an IV if I wanted one, but that was about it. In other words, he treated me like a Paramedic. I will be eternally grateful for that experience and freedom that he allowed me and I think it has made me better for when I am cut-loose and on my own.

He quit and went on to bigger and better about 3-4 months ago. Since then I have been in the round-robin of Medic partners. I never know who I will be working with from one shift to the next or even from one hour to the next on some days. In a way I like this as well. I am getting to see how other people do things and that helps me to form my own way. Some of the people I have worked with allow me to do anything I want. They see me as a Paramedic, even though I just finished class. Others still see me as a wet-behind-the-ears, dumbass Intermediate and they don't think of me as anything but an IV tech and a driver. Those are the days that I don't really enjoy, but it does show me what I don't want to be and how not to act. A select few Medics that I have worked with see me as I am, a brand new Medic with a several years experience as a Basic and Intermediate. They allow me to run the call, but add little hints and helpful tricks of the trade that make our job a lot easier, or subtly remind me of something that I have missed. These are the days that I love and I take away a lot of information and experience when the shift is over.

I read a lot of other blogs that are written by people in much the same situation that I am in like Baby Medic, I Heart EMS, and Medic March. It seems all of the different companies have different approaches to precepting and clinicals. Now that I have finished class and passed my test, I am waiting on all the official paperwork to finish and I will do my oral boards with our Medical Director. Then I will be able to function as Paramedic. I will still be working with an experienced Medic for at least a couple of months before I am completely cut loose. After that I will be free to work with anyone, an Intermediate or Basic partner. (In the past it has been 6 months to a year, but with the current Medic shortage, it won't be that long.) Meaning that I will be a stand-alone Medic, as we call it.

I guess we are very informal around here because we don't have any paperwork or check-list that we have to complete before we are cut-loose. In some ways I would like for that to be implemented, a list of objectives that I would have to meet so I would kind-of know where I stand. As it is, it's just a certain amount of time, it's not even based on patient contact hours. I don't think the current system is a very good idea. Everyone learns at a different pace, everyone has different strengths and weaknesses. What might take one person a year may take another only a few months to learn and get comfortable with. I think the focus should be on the individual rather than a set amount of time for everyone. Then again, I work in a rural setting. If your waiting on a code or a good trauma you might have to wait a long time. Once I ran two codes in one day and then nothing for a few months, its feast or famine around these parts.

Paramedic....

2007-06-08T14:48:00.000-04:00

I passed!!!!!!!!!!!!!!

It's over....

2007-06-02T13:13:00.000-04:00

Done, finished. Now just got to wait for the results to come back. Hopefully I will know something in the next week or so. I'll be walking on eggshells 'till then..

All or Nothing.....

2007-05-31T22:56:00.000-04:00

Tomorrow I go for the state test. 150 questions that determine if I get to practice what I have been going to school and working for the past 2 1/2 years. I've studied and went over everything that I can think of and a little extra on the things that I had difficulty with. I think I am ready....

P.S.- Thanks for all the comments on my last couple of posts. I have talked to several other medics that I know and respect both as medics and as educators about the questionable calls of late. Through them and the comments that I have received I believe my course of thinking and treatment were right, which in turn has increased my confidence in my abilities. I thank my readers and commenter's for that....

A lot to learn #2.....

2007-05-25T16:46:00.000-04:00

Here we go again..... I have had the opportunity to run some decent calls here lately. But all of them have made me re-think my critical thinking skills as a prospective new Medic. I don't see myself as a sparky kid that wants to push every drug in the box and use all the nifty tools I have available. But I think that if the patients need it, well...they need it. That's what we're there for. I'll let you decide...

Called out for decreased level of consciousness. Arrived to find an elderly lady sitting in a chair and you could hear the snoring from the hall. History from those on scene was non-existent, something like GERD and insomnia. We get her loaded up and start doing our thing. In the midst we find that her blood sugar is 48. OK, we can fix this, started a line and gave her some D-50 and she perked right up. Vitals were otherwise OK. She is slightly cool and very diaphoretic, both could be explained by the hypoglycemia. Her only complaint is slight, diffuse abdominal pain. I put her on the monitor and saw some depression, so I decided to do a 12-lead.

You tell me what you see, (I know that the clarity isn't that great, but it's the best I could do). Maybe I need to go back to 12-lead class, but I see depression in leads II, III, AVF, 5 and 6; elevation in V1, V2 and V3; with a left bundle branch block. She is completely alert now so I ask about her history. She has no cardiac history what-so-ever, only other things were diabetes and hypertension.

This is where me and the Medic I was working with differed in opinion. I saw an elderly lady with atypical pain and 12-lead changes who also happened to be hypoglycemic. We fixed one, and now we need to work on the other. I was proposing 325mg of aspirin and a spray of nitro, (she was already on O2), and a no-delay transport. In my mind she was a poster child for atypical presentation for MI. But, alas I was overruled. My partner saw an elderly diabetic that we fixed. He was not concerned with her 12-lead or her presentation. So we did nothing, just ran her in routine traffic and that was that. I didn't even ask him why afterwords.

So, am I right or wrong? Am I thinking correctly? Or am I the over-eager, sparky new kid? I think I am right, I think that the other medics that I have worked with are either burnt out, lazy, incompetent or scared. I don't know which, possibly a combination of all 4. Then again, sometimes I'm not so sure. This is just one call out of several here lately that me and the Medic have disagreed on the level of care that was needed. And I am usually wanting to treat the patient. Either because I think that something needs to be fixed right now, or for preventative reasons to try to head off something before it gets worse. The other thing is that I have been working with someone different just about every shift for the past month or so. So it's not just one person that this has happened with.

On the other hand, I have ran a few calls with 2 different medics that pretty much let me run the show and agreed with my decision making. One call was a trauma from a MVA that ended up coding on us. The other ended up being a head-bleed that had been down for almost 12 hours. That lady was in bad shape, she had fallen and puked. She was all bruised up and it looked like point lividity, except she had a pulse. She had also been laying in her own vomit for those 12 hours and had aspirated. I wanted to tube her but she was clenched and I couldn't get a nasal tube to pass. So I gave her a couple doses of Versed and then tubed her. The only thing either Medic did was bag the patient and hand me stuff when I asked for it.

So, do you see my delima? On one hand I am being told that I shouldn't do anything and the other we went all the way. I'd appreciate any and all comments on this matter.

A lot to learn....

2007-05-17T21:58:00.000-04:00

It's funny how sometimes you think, "Yea, I can do this job", only to find out that you don't have a clue....

Get called out for an elderly lady that is sick, nausea/ vomiting for the past 3 days. When we get there she is just sitting on her chair, her husband fills in all the details for us, because she is stone deaf. The over-sized hearing aids are malfunctioning and a high pitched squeal is coming from one of them. We have her take it out and it makes us feel better, if not her, because she couldn't hear it in the first place.

We get her in the truck and go to work. Vitals, IV, a little O2 via nose-hose and monitor. Hhmmm... Her pressure is like 80 over nothing and she's got a rate of 32. Well, the BP could have been explained by her lack of intake and excessive output for the last 3 days, then again it could be compounded by her rate. She is pale and cool to touch, but dry. Radials are weak and her breathing is OK. History of CHF and a few other things.

We start down the road as I am thinking of exactly how I want to treat this woman. I don't know what her normal vitals are, so I don't know how far off what I am seeing now is. I've always been told error on the side of the patient, and to treat the patient, not the monitor. Another look at her and to me, she's slightly lethargic, or she could just be sleepy. Skin is not so great, and her breathing is a little faster now, but her lungs are clear. I decide on a small fluid bolus and recheck her BP. It is about 72 over nothing. 12-lead shows sinus brady, nothing else. Well, she is obviously deteriorating. I pull out the atropine and push 0.5 mg. while I am thinking I may have to pace this woman.

I take another look at the monitor screen and the little yellow blips are getting more numerous, but wait....those are the dreaded PVC's we've been taught about. OK, I can do this, check a pulse and see if they are perfusing.....nope...they are not. Damn. Change her over to a face mask and pour the O2 to her. I call for orders for Versed because she is not out of it enough to pace her without it. I get it, give it and start to try to pace her. It doesn't work. Shit, what now? The PVC's are continuing and getting worse. I am thinking she is getting ready to code on me any minute. The only other thing I can think of at the moment is R on T. OK, lidocaine first and then maybe dopamine. I pull it out and before I can push it, she goes into v-fib. Fuck me sideways. I shock her. Flatline. Damn. How in the hell can I do this own my own? I do the best I can. Luckily we are just a few minutes out from the ED. We pull in, pumping and pushing and grunting, trying feebly to bring her back. She never recovers.....

None of this ever happened. Well, some of it did, this was a call I ran, the woman did have a rate of 32 and a BP of 80. But I was driving. I am still an Intermediate, I haven't taken my state test yet, so my paramedic partner rode in with her. She is still alive. She never coded. But, if I was the medic I probably would have treated her at the time. And this could all be true instead of something that scares the living hell out of me. After the call, riding back to the station, I asked my partner if I would have been wrong to treat her. He outlined pretty much what I just wrote about. He wasn't an asshole about it, he was just talking and teaching. But in my mind, I could have killed her. I layed awake that night thinking. I realized that the classroom world and the real world are two totally different things. You can be the best in class, ace every test, know all the protocols back to front, be able to recite everything about every drug in your box, and you still don't know shit. I realized that I still have a lot to learn....

Free at Last!

2007-05-17T10:15:00.000-04:00

Free at last, free at last, thank God Almighty I'm free at last! Paramedic class is over! I have now completed all clinical time, all class time, the final mega-codes and passed my final exam with a 97. Damn, it feels good. Now all I have to do it pass the state and national registry exams.

Exams....

2007-04-27T00:05:00.000-04:00

Sorry for no posts in awhile, it's crunch time in Medic class. We have but 3 short weeks to go and I'm trying to study up for the state and national registry exams, not to mention the final in-class exam. Had a pretty good shift the other day though, a code in the morning and a trauma arrest from a MVA later on. Hopefully I will get to post about it in the next couple of days, if not sooner.

.......

2007-04-17T08:11:00.000-04:00

Let us pray....

Ninjas.....

2007-04-09T11:26:00.000-04:00

Just got home from 48 hours straight. 24 at my regular gig, another 24 at my part-time one. We didn't do a whole lot at either place. A few transfers, a couple of nausea/vomiting and one drunk.

The call came out as a 10-73, (our radio code for a person in need of psychiatric help). We staged with the rescue squad at the top of the street while the local cops went in to see if there was any danger. We got cleared and went on in. As we entered the house, a run-down two story with fading paint and creaky steps, we could smell the beer that she had apparently been drinking all day. The patient was a middle-aged woman that was arguing with the cops that she wasn't going anywhere. Then she sees us and jumps up and runs behind the couch. We stop mid-stride, wondering what to do next, the cops are looking bewildered. One of them slowly walks around the couch and asks her if she's OK. I hear some whispering and then the cop turns to look at us and starts snickering that slowly changes to guffaws. Wondering what in the hell is going on, I walk over and look behind the couch. She sees me and starts screaming, startled I jump back. The cop is trying to tell me something, but unable to because he is still snorting through his moustache. I stand there, waiting for him to let me in on the joke. He finally drys up and motions for me to walk back to where my partner and the 3 squad members are standing. He then tells us that we are scaring her. I return with a "no shit". He starts snickering again then motions to our heads. We are all wearing black toboggans, pulled low over our ears to keep out the cold night air. "She thinks you guys are all ninjas and here to get her!" We all bust out laughing. I take off my head-gear and walk over to the couch. I stand back and start talking to her, letting her know that we are EMT's here to help her. That we were definitely not ninjas. After a few minutes, she peeks around the side of the couch and asks me if I am sure. I tell her yes, I am sure. She slowly comes out from behind the couch and looks around at us. Everyone had taken off their toboggans and I guess she didn't see the threat that her alcohol-fogged eyes had shown her. So she sat down and started drinking again, which of course was the only logical thing to do. She then starts to flirt with us. Telling us that we were all very cute and why didn't we all sit down and have a beer. Eventually we decide that she is just drunk, not a threat to herself or anyone else and try to obtain a refusal. My partner is explaining the form to her and she is listening intently. When he gets to the part about "if you will just sign right here, we will get out of your hair ma'am," she says "one one condition." Intrigued, said partner asks what that condition is. The patient states with a straight face that she wants all of us, 2 EMS, 1 cop and 3 squad members, to line up and turn around so she can take a gander at all of our hind-parts. At that point I lost what little composure I had left and almost fell to the floor laughing. My partner, between bouts of laughter himself tells her that isn't going to happen and just sign the paper. As predicted, she continues to refuse to sign until we all show her our bums. Well, to make a long story shorter, we all took a backwards bow as we made our exit. My partner had to stay behind, no pun intended, to get the paperwork signed. He eventually made his bow as well to the tune of whistles and cheers from the lady of the house. That was yesterday, the story has already gotten around. This morning on the way home I stopped by a gas station that is owned by one of the squad members, one that wasn't on the scene. Behind the counter was the wife of said squad member. As she rang me up she asked me how the ninja training was going. "Fine, just fine," I said as I walked out.

History.....

2007-04-03T15:19:00.000-04:00

A nice little page I found to remind us all of our history....

I can remember when I was a kid, the service my Dad worked for still had one of these.

gold patch....

2007-04-02T08:22:00.000-04:00

Decent shift, not too many calls. First was a little old lady that couldn't breath. She was discharged from the hospital for the same thing the day before. Personally I think she just liked the food there, or the staff waiting on her hand and foot, or something. Then ran another gentleman with the same thing. He was a little more serious. Got to the house and he was laying in a hospital-type bed in obvious distress. He had a chest tube coming from the left side of his chest that was attached to a vacuum pump. His son was slightly frantic running from one side of the bed to another, clearly not knowing what else to do for his father after he had increased his oxygen from 2 liters to 4 by cannula. The man had a whole list of medical problems and medications. We got him loaded up and headed down to the big hospital. My partner looked at me and said, "You OK with this?", well I could tell that he would rather drive, so against my better judgement I said yes. I put him on a mask and increased his liter flow, took vitals and got him on the monitor and started an IV en route. Everything was checking out pretty good, O2 sat was down a little, but given his history I figured that was probably normal. His lungs were slightly diminished, but no rales, rhonchi, wheezing or stridor. But he kept complaining that he couldn't breath. While I was looking at him, fidgeting around trying to make him comfortable, something just didn't click, felt like I was missing something or there was something else going on with this guy. Well, we were about 15 minutes from the ED and I remembered capnography. I got it out, unraveled it and hooked it up to the monitor. When I turned back around to put it on him, he was all clenched up in a seizure. Shit. I hollered to my partner who was oblivious to the goings-on in the box, content to drive and listen to his music, to step it up, he was seizing. OK, what do I do now? Valium, yea! Shit, I can't! I'm not a damn Medic yet!!! I looked out the window, we were about 8 minutes out as the sirens started blaring. Looked back at the patient and he stopped seizing. Sigh of relief, now re-assess. That's when I noticed he's not breathing, no pulse, but the monitor was showing a nice sinus rhythm. PEA! Fuck me! Shit on a stick! Damn it! I layed him back real quick-like and checked for pulses one more time just to make sure. Nope, nothing. Dead. I grabbed an oral airway and threw it in and bagged him a couple times and started compressions, hollering at him to wake the fuck up! I reached over and flipped open the jump bag and grabbed an epi which I ripped open with my teeth. Then I slammed it in with one hand and went back to pumping on his chest. My partner took this moment to ask what the hell was going on? In the 2 seconds before the words came out of my mouth, I called him everything but a son of God, then answered him in as calm a voice as I could manage that the patient was in PEA. A few minutes later we got to the ED and roll in with me doing CPR. The charge nurse looked completely dumbfounded, "I thought you guys had a difficulty breathing?" she says to me as we roll past her to the room. I give report while they scramble up the people to continue the code. I can't really blame them, the report I gave was completely different than what we came in with. After a few minutes a tech takes over for me as I wipe the sweat from my brow and strip my gloves off. My partner is just looking at me, I say nothing as I walk back outside. He comes out as I am smoking and putting the cot back together and has the nerve to look at me, laugh and say, "I guess I should have taken that one". Needless to say, I was a little hot under the collar. I've ran codes before, this wasn't my first rodeo. This was just the first one that I did on my own, granted that it was only for 10 minutes, but I've not even graduated yet. I tried to take it in stride, chalk it up to a learning experience. "What doesn't kill you makes you stronger" and all that. Now I sit back and try to take stock of what I learned about myself. I learned that I could have delt with it a little better, I don't think yelling at the dead man on my stretcher helped anyone. It's a good thing a family member wasn't riding with us. I learned that in the midst of the shit, I did remember how to read the monitor and what to do, even though it was just CPR. Hopefully next time I will do it a little better. Hopefully next time won't be until I have that gold patch on my arm.

Medic Alert....

2007-03-27T23:09:00.000-04:00

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....

2007-03-24T22:26:00.000-04:00

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....

2007-03-24T20:56:00.000-04:00

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....

2007-03-23T14:56:00.000-04:00

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.....

2007-03-21T23:13:00.000-04:00

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....

2007-03-20T22:22:00.000-04:00

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....

2007-03-20T12:00:00.000-04:00

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....

2007-03-17T18:28:00.000-04:00

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......

2007-03-17T14:24:00.000-04:00

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......

2007-03-17T13:18:00.000-04:00

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...