NameThatDisease.com - http://www.namethatdisease.com">Name That Disease
BRM
Monday, November 24, 2008
Another Article...
Here's another article about problems in EMS...
http://kob.com/article/stories/S661228.shtml?cat=10134
BRM
http://kob.com/article/stories/S661228.shtml?cat=10134
BRM
Thursday, November 20, 2008
Wednesday, November 19, 2008
Reasons...
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
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
Friday, November 7, 2008
Instincts...
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
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
Sunday, November 2, 2008
"This ain't basket weaving...
...these are people's lives you're dealing with."
That's a quote from my EMT-Basic instructor. He said it on the first day of class. He was trying to make us understand the gravity of the subject we were about to learn. Since then I've taken this statement to heart and used it in my own classes and with students that I precept.
A few days ago I got switched to another station and worked with an Intermediate that was in Medic school. He was a month from graduating. I figured that I wouldn't have to do too much those 2 shifts. He should be able to function pretty much without me. Boy, was I wrong...
First call we get is for chest pain. The first mistake he makes is taking the clipboard in with him. Leaving me to get the stretcher and equipment. I follow him into the house to find him writing down basic demographic info on a patient who looks like shit; pale, sweaty, breathing about 30 times a minute and I can hear her gurgling from across the room. He has no equipment, so he hasn't even taken a blood pressure, nor has he asked her anything except her name, social security number, date of birth and phone number. I quickly step in and do a quick assessment and direct the patients son to help me get her on the stretcher.
My student/ partner gets the idea and finally helps us wheel her out to the truck, forgetting the monitor and jump bag in the process. Eventually he gets everything back to the truck and starts helping me treat our patient. He wants to give her nitro and aspirin before the IV, monitor or even a B/P. I calmly give him the cuff and stethoscope and point to her arm as I get her on some oxygen while asking her all the pertinent questions.
Eventually we get all the basics done and I move some leads around to see if that big fat inferior MI has a friend. Sure enough, she's got an associated right sided MI as well. My partner is looking at me as if I just grew a second head as I do all this. I really wanted to have him back here on this one so he could maybe learn a thing or two. But I can't wait, we've been on scene for almost 10 minutes as it is. I just tell him to drive...
After the call he just sits there in the drivers seat and asks no questions whatsoever. I'm not sure if he's thinking it over, or he really isn't curious about what I was doing and what was wrong with our patient. When I was in his position, you wouldn't have been able to shut me up for all the questions I would have been asking.
I let this go on till we get back to the county line. Then I start asking him questions. Like, what the hell was he thinking not taking anything in with him? Why was he asking demographic questions instead of accessing the patient? etc, etc. As we move on in my questioning I start to quiz him on his drugs. That's when I start to get even more concerned. The boy doesn't even know his basic drugs. Like the dose for aspirin, nitro, charcoal and the like. So once we get back to the station we go over every drug in the box...all 46 of them. I tell him that I'm gonna give him another quiz later that night. Well, he studied some, but retained nothing. Eight hours later, he couldn't remember anything we went over that morning.
I get almost disgusted when he starts to blame his instructor. I tell him that the EMT-Paramedic course is a college level class, taken at a college, this isn't grammar school. You have to take the initiative to learn on your own, to study on your own and to ask for help if you need it. He seems to understand and take what I am saying to heart.
The next shift is no better. He still knows nothing of his drugs, ACLS, ITLS, or even his own protocols. I'm not sure if I should just give up, help him, or brow beat the hell of out him.... I end up spending the rest of the shift trying to give him a crash course in pharmacology and patient assessment. I have no idea if it did any good or not. It scares the hell out of me that there is a possibility that he will eventually be out there on the streets treating patients, maybe even me or my family...
I just don't understand some of the students nowadays. Maybe I'm just too hard on them or try to judge them against myself. When I was in class, we had to make at least an 80 on every test and keep an 80% average or we were gone. My thinking on this was...if I make an 80, then statistically I know 80% of the information. What if I need that other 20% to help someone, or what if someone dies that could have been saved because I didn't know that 20%? Now I made 100% on a lot of tests...but not all, not by a long shot. But that made me sit down and study even harder to learn what I had gotten wrong. And even making a 100 doesn't mean that you know all the material.
I didn't fuck around in class like many of my other classmates, I didn't make fun of others that were called to the front to do a mega-code and didn't do the best. I was usually one of the ones that always raised his hand when the class was asked for an answer and I often made the class longer than usual because of my questions. For this I was dubbed "Rescue 911" from some of my classmates. But I didn't care, because I knew that eventually it would be my ass out there with a life possibly on the line.
I haven't changed my thinking or reasoning on this subject and I doubt I ever will. Because this ain't basket weaving, these are peoples lives we're dealing with....
BRM
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
Friday, October 17, 2008
Story....
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
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
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