Friday, January 30, 2009
Wednesday, January 28, 2009
On Learning...
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
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
Friday, January 2, 2009
Ice...
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
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
Tuesday, December 16, 2008
No Idea...
Had a call last shift and like many calls that I run, I have no idea what was going on...
The call was for a respiratory distress on a child. We get to the daycare center where the call was and go inside expecting to see a child in distress. Instead we see a smiling, laughing, playing kid. The workers at the facility said that the little patient had turned blue. Now, when you get a call for respiratory distress call and the people on scene say the patient was blue, you expect the face, or at least the lips and maybe nail beds to be blue right? Wrong.
They said that the patient's feet were blue, well actually everything from the knee down. I asked if he was having trouble breathing? No. Wheezing? No. Crying? No. Did it seem as though he was in pain? No. Acting different than normal? No. What was he doing before, during and after? Nothing, just playing. Hmmm... So he wasn't acting like there was anything wrong with him at all? No. They just noticed that his legs were blue.
The patients legs and feet were fine when we got there. The first responders who got there before we did said that the kids feet were a bit cyanotic, but quickly returned to normal. I continue my questioning...
Any past medical history, medications, allergies? No to all. Last meal and what was it? Lunch, mac-n-cheese and apple juice, same as every Tuesday. Did you change the brand of food, drink anything? No. Any new people, toys, carpet, anything new at all? With a weird look, they answer no to all. Well, I'm completely stumped at this point. Either they don't know this child's complete medical history, or they are hiding something to try to keep themselves out of trouble. The patient is too young to talk to me, so I can't ask him any questions. But my partner has been playing with him and checking him over. She tells me that the kid seems fine, nothing wrong that she can see. Vitals are fine, cap refill is good, lungs sounds good, neuro check is good and he seems to be acting like a kid his age should act.
Then the grandmother shows up and I find out that she is the child's primary caregiver. She tells us that the history is slightly skewed from what we were told. The patient was a preemie, and only 2 pounds when born. But the kid is 16 months old. I ask her if he had any medical problems? No, none at all, his doctor said he was the picture of health. I ask if there was a reason that he was a preemie? She darts her eyes away from me. I tell her that I need to know if I am to make an informed decision about her grandson. She leans in and tells me that the child's mother was a meth addict. I ask her all the same questions that I asked the staff and get the same response. No other history, and nothing new around the child.
I tell her that he seems to be fine now. And that, according to the staff, the child displayed no other symptoms during the episode. I tell her that if it was my child that I would want this to be checked out by a physician, at the very least, his regular doctor.
She doesn't want him to go to the ED, nor be transported by us. But says that she will call the doctor and see if he can be seen today. She signs the refusal and we leave.
I have no idea what would cause this. My first thought was cardiac. But if it was his heart, I'd think it would have systemic symptoms. At least it would have involved his other extremities, not just his legs. My other thought is maybe a congenital defect that hasn't been found yet. Maybe some kind of peripheral vascular defect in his legs. Maybe it was some sort of arterial spasm. I've never heard of it in a kid, nor just in the legs. But who knows? I'm just a paramedic...
BRM
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
Monday, December 1, 2008
When God Make Paramedics...
...an oldie, but goodie...
When God made paramedics, He was into His sixth day
of overtime. An angel appeared and said, "You're doing a lot of fiddling around
on this one." God said, "Have you read the specs on this order?
A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn't touch,
and not wrinkle his uniform."
"He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again."
"He has to be in top mental condition at all times, running on no sleep, black coffee and half eaten meals, and he has to have six pairs of hands."
The angel shook her head slowly and said, "Six pairs of hands...no way."
"It's not the hands that are causing me problems," God replied. "It's the three pairs of eyes a medic has to have."
"That's on the standard model?" asked the angel.
God nodded. "One pair that sees open sores as he's drawing blood,
always wondering if the patient is HIV positive." (When he already knows and wishes he'd taken that accounting job) "Another pair here in the side of his head for his partner's safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, "You'll be alright ma'am when he knows it isn't so."
"Lord," said the angel, touching His sleeve, "rest and work on this tomorrow."
"I can't," God replied.
"I already have a model that can talk a 250 pound drunk out from behind a steering wheel
without incident and feed a family of five on a private service paycheck."
The angel circled the model of the Paramedic very slowly.
"Can it think?" she asked.
"You bet", God said. "It can tell you the symptoms of 100 illnesses; recite drug calculations in it's sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear... and it still keeps it's sense of humor."
"This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim's family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call
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
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
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
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