Cab-ulance Tales

Another step closer

2012-01-20T13:32:00.000-05:00

So, as some may know, I got my NREMT-P back in June. Due to wedding plans, and some other things (including my own laziness), I have not gotten a job, but I did apply for a boatload of them. Last spring I applied to my home county for both dispatcher and EMT-B (I didn't have my medic yet), and while I went through the whole process for dispatcher, I only got through the written test for EMT-B. By the time the physical test came around, I had gotten a wicked case of bronchitis, and could barely get from my couch to the bathroom without loosing a lung.

So last week I got a call from county HR about 'the EMT position.' I was confused, since I didn't finish off the testing process, but I went along with it. I know they are opening up hiring for medics and EMT's soon anyway, so it seemed likely. Imagine my surprise when I get a call from the sheriff's office for a background check for dispatcher.

Is it my dream job? No. But it's a job, it's a good job, and it will pay the bills. And, it gets my foot in the door with the county for when they do open hiring for medics. In the meantime, I get a different look at the same field, and have time to get some seasoning as a medic so that when I do get hired somewhere, the intern process will be quick and painless.

Which leads me to the other step I'm taking. In less than a week, I will be taking my state protocol test. To say I am almost more nervous than when I took the NREMT-P test is an understatement. Our state protocols tend to be rather convoluted and obscure, and they delight in testing on the most obscure parts that you will never use. But, I have some good friends who are helping me study, I have a study guide that was given to me by someone I barely know, and I am working hard on getting it done and so on.

In the meantime.....I'm stressing.

Only one, but it was a head-scratcher

2012-01-08T11:10:00.000-05:00

I rode overnight the other night, with one of my favorite crews. I was lucky enough to have a BLS crew in house all night, so I could ride 3rd on the medic. This is something I do as often as possible since I am not operating as a medic right now and most of the medics I ride with allow me to do assessments and ask me my treatment plans and such. It's good practice for me for when I am the 'lucky' one. In the meantime, I don't have to do paperwork.

So anyway...We got a call to a residence for an elderly patient complaining of 9/10 abdominal pain. Had abdominal pain all day, woke up feeling poorly, and had gone about daily duties until the pain just got too bad. History of strokes, IBS, vertigo, and an appendectomy as a child. Vitals on scene were stable; in fact the first BP we got was better than mine. The patient was a poor historian, and family members filled in the blanks, but the history of the current problem was slightly sketchy. Abdomen was soft, no masses, with some slight tenderness over the LRQ. We were considering constipation, but the patient had even written down what time he took care of that particular problem this morning. The thought of a AAA crossed both our minds, but the patient just didn't look right for it. No sudden onset of pain, the pain was cramping rather than stabbing in nature; it just seemed like an issue of IBS or constipation.

However, the patient looked like crap. Pale, slightly diaphoretic, with that clammy nature I've learned over the past 16 years is the hallmark of the truly sick. The BLS crew had chased us, and the EMT (who has been an EMT for over 20 years) seemed surprised that ALS would transport (both the medic and I had that "feeling" that this one was not quite right).

The patient insisted on walking down the stairs to the stretcher outside and did so without incident. We had a nice quiet ride to the hospital, non-emergency. No 12-lead changes, no EKG changes, vitals remained stable, pain didn't move, and we talked with the patient a good bit en route. As we were pulling up to the ambulance bay, the patient suddenly grimaced and said "Wow, the pain just got worse."

This particular hospital we went to is not really known for moving fast when we arrive. For a moment, I half expected them to shunt our patient out to triage. The charge nurse took one look at our friend, and hustled into action. The patient was transferred, blood drawn, 12-lead done, and doctor hurried in. The patient's color looked slightly better, but now BP was somewhere around 80/50, rather than the nice 116-120 systolic it had been for us. The patient was also now telling the doctor that the pain had been around for 2 days, and the abdomen was now tender. I'm not sure what all they did, but by the time we cleaned up and were leaving, the patient was alone in the room again.

The hospital thought AAA as well, and I know they were working up the patient for that. The chief is going to call down and see if he can get an update on what exactly was wrong.

So yeah, lesson of the night was to listen to your instincts, children.

Of course, as par for my expectations, that was the only call we had. I don't get many chances to ride with ALS at my volunteer house, and it seems that when I do, we barely turn a wheel.

Slacker-ific

2012-01-04T23:07:00.000-05:00

So, yeah, I'm a slacker. Things have been both busy, and boring all at the same time. Since I last posted, I got married, which took up a good portion of my time with planning and other nonsense. I've been training (on and off, thanks to the aforementioned wedding) for a triathlon, and ran in the Marine Corps Marathon 10K (that's 6.22 miles for those of you who don't do metric). Like I said...busy, and yet boring.

What I have not done is been working. Again, slacker. We are lucky in that we are surviving on my husband's (wow...still feels weird to say that) salary alone, but things would be much nicer if I was working. I've put in mad hours at my firehouse (was made a sergeant this summer as well), working on my intern status at my medic unit (also volunteer), and getting ready to take my state certification test. Oh yeah, and applying for jobs.

One job I had applied for last year was with my local county. I passed the written test, the interview, and when it came time for the physical, I had to bow out because I came down with bronchitis, and couldn't walk up the stairs at my house without losing a lung, let alone walk on a stair mill for 3 minutes in a 50 lb vest. The only up-side was that I figured by the time they hired again next year, I'd be a full-on medic, and more 'hireable.'

Today, while I was transporting a patient who really didn't need to go to the hospital via ambulance, I got a phone call from an unknown number. Now, generally, I don't answer unknown numbers, but I have been lately because of all the job applications I've put out there over the past few months. However, since I was with a patient, I was good and turned my phone off. Imagine my surprise when I listened to the voice mail after dropping the patient off at the hospital, and it was the county HR office calling in regards to the EMT position. Seems that my name is up next on the eligibility list, and they were having issues with my background check. That happens when you change your name after marriage, evidently. They weren't very clear on when the hiring process would begin, or what I would have to do (do I need to take all the tests again? etc), but at least I'm up there in the running. I could have a job as soon as the spring. This makes me infinately happy. The fact that I'll have my state ALS card by then is just icing on the cake.

Oh, and I'm signing up for a mini-triathlon in March. Expect some discussion of my training on here too....

Randomness

2011-07-14T15:07:00.000-04:00

A couple of things in a quick drive-by post as I procrastinate doing things to prepare myself for my trip in 2 weeks.

Three months ago, my resting HR was up around 86 or so. The other day, my resting HR was 72. Still not breathing super well on my bikes and runs, but what do you want with asthma? I may not have lost any weight, but at least I have proof that SOMETHING good is happening from all this training.

I am sitting here with an ice pack on my left ankle. No real increased swelling, but the normal swelling is there. Lots of aching around the lateral malleolus, mostly under and behind it. Some pain around the medial malleolus, but not as much. My chiropractor has been 'popping' it back into place every few weeks (yes, I go to a chiropractor, but do not rely on him to diagnose any major health problems. He's there to readjust my back and shoulders, because my musculature and connective tissue pulls my bones in randomly strange directions, and it helps to have someone trained to put them back where they belong. Because, as one of my orthopedists have said, my joints are hypermobile, I'm too young for surgery to correct the most severe of them, so I just have to suck it up and deal.) Anyway, main chiropractor is on vacation, so stand-in chiropractor adjusts my ankle because it's really been painful lately. He asked what I had done to it, and I said I didn't know (because, really, I don't). I told him I rolled it a lot, with some pain that didn't last long. Lots of rebound tenderness around the medial and lateral malleolli (?) but I couldn't really trace it to any specific time. I mean, my ankle has been rolling around randomly since I was a kid. He suggested I go to an orthopod and get it x-rayed, and possibly an MRI, as he suspected a 'chronic sprain'. The conservative treatment for which is 2 months in a cast, followed by extensive physical therapy. Aggressive treatment would be surgery to fix the ligaments and tendons in place, prevented any sideways motion.

Yeah, no thanks.

He also suggested a more aggressive ankle brace. So I picked one up, to be used when I'm just walking around and hanging out. For fencing, running ,etc, I have kinesiology tape. (love this stuff, and no, they don't pay me)

In other news...I have been promoted to sergeant at my volunteer department. It's on the EMS side (there is a large division between fire and EMS). I'm not sure what my duties will be, other than pulling a duty week every 6 weeks or so, and heading up a clean-up crew. It has been hinted that I will be the one in charge of the duty calendar, but that remains to be seen. I will also be helping with drills and training, and will likely have one drill a month to organize and run. I have several ideas for drills, but if anyone has some ideas for drills they like for EMS folks) many of which have little experience, I'm all ears.

I find myself irritated with people who are in charge of things who don't let you know when something has happened. How am I supposed to meet my requirements by the deadline if I am not given the full amount of time/information until halfway to the deadline? I understand people are busy, but how long does it take to shoot off an email or something?

Which reminds me...I need to send off a few emails....

Officially official, and other things

2011-07-11T17:26:00.000-04:00

I got my disco patch in the mail the other week. I am now officially a paramedic. Now all I have to do is get my state certification.

In other news, I recently read this post by Rogue Medic. The part at the bottom about MD scaling back helicopter transports is what got me. Now, I have to say...when I first moved to MD, I was astounded at what patients they would view as needing to fly. Patients with a fractured femur who were less than 10 minutes from a Level II trauma center. Patient's who were alert and oriented appropriately, although drunk as skunks, who had not lost consciousness during the collision, who wanted to REFUSE TO FLY (the patient was talked into flying to a Level II center that was approximately 30 minutes by ground).

Since the crash of Trooper 2, the state of MD has 'cracked down' on the use of medivac flights, which I fully support. Way too many patients are flown without need. The problem we are seeing, however, is in areas that do not have close access to specialty centers. For example, the closest eye center to my area is over an hour away (I admit that this is not a hugely long distance for some, and indeed, when I lived in PA, I wouldn't have considered this an abnormally long distance). Some time ago I had a patient who had been struck in the face with some kind of broken glass, and the wound involved the eye. The patient was complaining of severe pain, and was unable to see out of the affected eye (there was also EtOH involved). I called for an ALS unit (technically we are not permitted to call specifically for pain management, but I do it anyway), and consulted with the eye center. The eye center accepted the patient, but would not authorize a helicopter to transport the patient because the vitals were stable. The medic was upset, given that the trip is about 1.5 hours one way, but to my mind, that was the correct call. (The fact that the medic only asked for and got orders to give the patient 4mg of morphine total is another post all together).

A more recent call saw a patient mangle their thumb on a table saw. There was significant involvement to the bone of the thumb, though the only portion of thumb recovered at the scene was the fleshy part. The medic who was dispatched (I was on the BLS unit) consulted with the local 'chop shop' hospital (they can't deal with more than the most basic of emergencies) and the hand center, which is about 1.5 hours away. Once again, the patient's vitals were stable, bleeding was controlled, though the patient was in a fair bit of pain. To be honest, I am unsure of what exactly was said on the consult (I was in the back of the ambo with the patient), but the hand center refused to allow the patient to fly (again, a decision I was perfectly comfortable with). Here is where things get sticky. Per our protocols, a patient with a full or partial amputation of any finger or thumb should be transported to the nearest specialty hand center (there is only one in MD actually). I classified our patient as priority 3, as he was stable, but he did potentially require 'time sensitive intervention' at the hand center (I'm no hand doc, and while I suspected nothing could have been done for the thumb, I have no earthly clue what they could have actually done). The medic on scene made the decision that the patient would go to the local hospital, rather than be driven the 1.5 hours to the hand center. And, as far as I was made aware, this was because the state protocols also state that if the trauma center or specialty center is more than 30 minutes away, the patient should be taken to the local ER. So the patient lost half the thumb, because this was not something the local ER was equipped for.

Again, I have no clue what they would have done at the specialty center. The remainder of the thumb was pretty mangled, but I have no idea what would have happened.

Which brings me to the point of this post. I am not in any way, shape, or form advocating more medivac flights. Not even a little bit. However, much of the state protocols are written for the areas that are closest to the main hospitals. Those of us who are father out from the specialty centers and trauma centers are left handicapped. We can't fly if the patient is stable and the doc at the trauma or specialty center says no, but protocols don't generally allow for transporting more than 30 minutes away. From some areas I run calls in, the closest Level II trauma center is more than that.

Another example, as relayed by a medic at my station (a medic who I would trust with my life and the lives of my family...she's GOOD), was a patient who was in a fairly severe motorcycle wreck involving wildlife. The patient was alert and oriented, but a bit combative, and complaining of severe chest pain, and had been thrown a good distance. The medic, who feels the way I do about helicopters, consulted with the closest Level I center (in DC), and the closest Level II center (about 40 minutes without traffic), and requested a helicopter (not sure of the patient's vitals, but I suspect she was concerned about chest wall and/or heart and lung injury), and was denied. She transported by ground to the Level II, but was contacted later by one of the state medical directors and was given an "atta girl." The hospital that refused the request was 'spoken to.'

Anyway, those of us in the 'wilds' of MD, away from the major hospitals and such, are being hamstrung if we choose to follow protocol exactly. I have no problems transporting my patient by ground to a specialty center if their situation warrants it, regardless of how far it is (most of them are about 1.5 hours away, without traffic), but not all EMT's and medics are so willing to do so. Especially in the busier areas where taking a medic unit out of the area for 4 hours or more is a hardship to the rest of the area.

It's official....

2011-06-17T15:02:00.000-04:00

But not officially official,yet, if you know what I mean. I have been duly informed by the National Registry of Emergency Medical Technicians that, with the passing score I earned on the computer test, provided I pass my psychomotor skills test, I will be granted the dubious honor of becoming a paramedic. Of course, I passed the skills test on June 4th.

Two years of my life, and countless hours driving back and forth to class and clinical, and I am done. The disco patch will soon be in the mail. There are times when I still wonder if I went the right route. If I should have stayed with the whole biology thing, and kept on looking for a job (usually those thoughts came when I got calls from biotech recruiters while in school). I realized with about a week or 2 left of school that I had made the right decision.

How did I know?

I stopped biting my finger nails.

For as long as I can remember, I've been a nail biter. Bored, stress, whatever...I bit my nails down to the quick and beyond. Nothing I or anyone else (read: my mother) did stopped me from biting my nails. Bribery, threats, funny tasting chemicals, tips, polish; all went by the wayside in my single-minded attempt to chew my nails down. Usually boredom was the problem.

So imagine my surprise when, with just a few weeks left till class, and theoretically the most stressful time I could be going through (finals, graduation, NREMT tests), I realized I had no desire to bite my nails anymore. I still am not biting my nails. And while I am still stressed (finding a job, state protocol test, etc) I am not biting my nails still.

Who knew that getting into a field you really liked would make such an immediate difference?

Of course, after playing a bit of frisbee with some of the kids at the station today, and breaking a nail, I realized why have longer nails is not such a good idea given my activity levels.

Anyway, I am now a NREMT-P. The card is in the mail.

May God have mercy on my souls (and the souls of my patients).

Halfway there

2011-06-07T11:44:00.000-04:00

Graduation has occurred, though I wasn't actually there to experience the joy that comes from sitting in a hot room with 3000 of my not-so-closest friends while listening to boring speeches. Figured I'd already been there, and done that, so I skipped. The fact that I got back from Florida the day before, where I had approximately 4 hours of sleep over the course of 5 days, walked around the parks all day long, and battled feet covered in blisters was a large part in my decision to stay home that day.

The National Registry practical has come and gone. I passed with one retest on an oral board. Now I'm just waiting for them to send me my stuff so I can choose a testing site and date for the written.

So now I look for a job. Unfortunately, there aren't a lot of departments hiring right now, thanks to the economy. I will be putting in again for the alphabet agencies, such as FBI, DEA, ATF, and Marshals. I'm finding in myself another case of wanderlust, the intense need to travel again; to uproot my life completely and move somewhere else. I have that restless feeling that occurs every few years. Working for one of the agencies would satisfy that need to travel. But that need to travel and go places is competing with the feeling that I get from being a firefighter and EMT...that I am a member of something that is important. That I am helping people and am part of something larger than myself.

I have a hard time explaining this to people. The Engineer particularly has a hard time with it. He's one of those people who has known what they were going to do since they were little, because that's what mom or dad did. He has no desire to move around, and travel more than for a brief vacation, and even then, he doesn't have much desire to do even that. He is not equipped to understand where I am coming from, and where my 'adventurous' streak (as he calls it) longs to take me.

So, yeah. I'm trying to find a job now, anticipating that I'll pass the written test in a few weeks. I'm attempting to curb my desire to uproot myself and my life (and my fiance) to get a job in a different state. In the meantime, I'm working out, my training schedule being derailed significantly by school, illness, travel and injury. I am running the Marine Corp 10K in October, and a sprint triathlon in September. Not to mention a friend's wedding in September, and my own in October.

Almost there

2011-05-10T11:01:00.000-04:00

My paramedic program has several hoops for those of us hoping and wishing to get out and get on with life. In addition to the standard classes and finals and papers and so on, we have two comprehensive exams we have to take in order to be approved to test for national registry. One of those is a 'oral board review,' given to us by our medical director and some other person, sometimes a medical director, sometimes an experienced paramedic who is an alumni of the program. The questions were given to us at the beginning of the semester, mainly because the way our instructors made it sound, we had to answer these questions as if we were attempted to become board certified in some specific medical field. Questions such as 'What is the pathophysiology of cardiogenic shock? Include in your discussion the concepts of preload, afterload, right and left sided heart failure, systolic dysfunction and diastolic dysfunction. Also, describe the prehospital and emergency department treatments for cardiogenic shock.'

So yeah, there were 11 questions along those lines. We had to pick two numbers out of a box and those were the questions we would do.

To say that I was stressed out may be the understatement of the year. I cried on the way to school. Everytime I started laughing while talking with my classmates, I would start crying. I don't think I sat on the seat the whole time I was being questioned. And it wasn't nearly as bad as we were told it would be.

So the next stress point for me is the skills evaluation, which is next Monday. We use a Sim Man system, that breathes and everything. On Tuesday, I have my last final, and then I fly to Florida.

Because when I pass paramedic school, I'm going to Disney World.

Now if I can just kick this cold/allergies that is making me feel like my head is 3 sizes too big.

So close I can taste it

2011-04-30T00:34:00.001-04:00

Nearly there. Three more weeks until freedom rings...and I have to find a job.

Every thing I do at this point is a reminder that I am one step closer to that coveted and long-elusive paramedic card. Finished my paper, done with clinicals, took the practice test, last test in this class, last homework in that class...all a reminder that God-willing, I'll finally have my disco patch. Granted, it's worthless until I find a job, but the fact that I'll have it in my hot little hands is a good start.

Fifteen years ago I became an EMT-B because I wanted to make sure I could handle the stress of being a doctor. While in class I thought about becoming a medic, but would not have been able to handle the combined load of medic school (plus clinicals) on top of my 18-20 credit semesters for my undergrad. And the family wasn't happy about the EMT class...you can imagine what would have happened with the idea of medic school.

But the idea stayed with me. Through college, the failure to get into medical school (primarily a paperwork snafu that went unresolved, so that my applications were essentially circular filed), the failed attempt at nursing school, and several dead-end biotech jobs. EMS was the one thing I kept coming back to; the one thing that never bored me to tears or frustrated me until I wanted to totally quit and never come back. It was the one thing that made me "light up" as a friend said.

And on June 3rd, when I finish my practical test and am just waiting for them to send that card, I will have finally finished the journey I started all those years ago, when I was hoping just to gain a little extra knowledge before med school.

And the next person who says, "but you're so smart! You should be a doctor" will be shot.

Light!

2011-04-21T10:56:00.000-04:00

My clinicals are officially over! I am that much closer to finishing. All I have to do now is finish my paper and the presentation that goes with it, pass my oral boards, 2 more tests and a final.

Hardly anything....*snort*

Sometimes you wonder...

2011-04-04T11:03:00.001-04:00

So, my question was this: Is this how the alarm company sent it to dispatch, or did dispatch come up with this as a summary?

Sounds

2011-03-31T07:23:00.001-04:00

There are many sounds I hate. I now have a new one.

The sound of a mother crying over her 18 year old child's body.

She was the one who found him unconscious, not breathing, with no pulse.

Pierced me to the heart, it did.

No parent should have to bury their child.

Surprise!!! Your turn!

2011-03-23T02:01:00.003-04:00

It really sucks when you walk into drill night and the person charge says "Hey, remember those ideas for drill we were tossing around the other day? Why don't we do one of those!"

This is especially hard when you were talking about scenario-based drills and you haven't had the chance to come up with any scenarios. Not to mention that aside from you and the person in charge of drill there are only 2 other EMT's and everyone else isn't in class yet.

Still, I don't think I did too bad. I threw together an MCI drill, giving people slips of paper with various injuries on them, and told the EMT that they were first on scene and only had 2 more units coming immediately available, and to triage the patients. They then had to defend their decision. It made a lot of people stop and think about what triaging is supposed to do. I think I need to come up with a set of cards with various injuries on them so we can do this again.

Also, I suspect that I will be called into action again to help with drills, so if anyone had any ideas for good, relatively short drills, mainly for brandy-new EMT-B's and those that are basically first-aiders, please share. Also, any good calls that you could share (without violating HIPAA of course) would be helpful in making scenarios to help train the new kids.

Surprise!!! Your turn!

2011-03-23T02:01:00.001-04:00

It really sucks when you walk into drill night and the person charge says "Hey, remember those ideas for drill we were tossing around the other day? Why don't we do one of those!"

More BLS than ALS

2011-03-16T14:05:00.001-04:00

So, I consider the system I've spent most of my time in to be fairly lP optimal. Sure, it's not perfect, but compared to the other systems I've experienced over the past 1.5 years, it worked pretty well. For the most part, BLS calls were handled by BLS crews and ALS calls by ALS crews. Any overlap was due to dispatch and patient reporting, which is normal.

Compare that to a nearby area in which I spend a fair but of time for clinicals. While their system is similar to the one I am most familiar with, they seem to have far fewer BLS units. They also have required every recruit class in the past several years to become medics (at the least, EMT-I's). This means you have a whole bunch of ALS units running BLS calls, and a lot of medics getting burned out quickly.

And a bunch of medic students who getting a poor ALS clinical experience. In my time in that county, I can count on one hand the number of ALS calls I have had, over at least 120 hours.

Now, I know it may seem counter productive to complain...after all, if they want to pay me for being a glorified taxi driver, then by all means. And I understand the desire to provide advanced care for as many people as possible. But in this day and age with budgets being what they are, it may behoove departments to remember that our call volume is generally 80:20 BLS:ALS. It might be a better idea to have more BLS units and strategically place the ALS units to a better advantage. You may find you have better, less burnt out medics, and more money in the bank.

Then again, I'm just a student...what do I know?

Of Lionfish and laziness

2011-02-21T16:57:00.000-05:00

Ok, so I haven't been super forthcoming recently. I blame school, and a general sense of malaise about the whole school thing. No, I'm not burnt out (except on school), but I am getting heartily bored of going to clinicals and getting shafted as far as calls go. Not that I'm wishing ill on anyone, but someone has to get sick or hurt in order for me to garner enough checks in the boxes to make the NR-EMT folks happy enough to let me test.

So, over semester break, I spent a lot of time at my volunteer house. Didn't get too many calls (my white cloud-ness continues even there), but the few I got were interesting. I did get to look all smart and stuff when we got a call for a lionfish sting (there was an episode of Bones that involved a lionfish stinging someone to death). It was literally around the corner from my station, and I googled it on my fancy new Android phone as we were pulling up to the place. Luckily, the patient had also used superior google-fu (though I suspect it was the kids who did it) and was already treating things in the correct manner. The patient could have gotten to the hospital on their own, but they were newish to the area, and hadn't had the pleasure of needing our lovely local ER's, and were unsure of how to get there. So, we had a lovely drive down, where I continued to google 'lionfish stings' and found that what happened was not so uncommon after all.

I also had the pleasure of seeing a patient in SVT (going from sinus tach to SVT) and helping the medic push adenosine, which failed to have the desired effect, but the patient converted anyway. I swear I see more interesting things at my own station with the medics than I do when I am at clinical.

Point in case: at a recent field clinical (in a system where the medics run everything from hangnails to heart attacks, and I'll leave it to you to guess which is more common), all but one of our calls was a BLS call. I did get the hard IV stick when called on, so the day wasn't lost completely for me. However, the last call took the cake, and was so ridiculous I couldn't find anything to warrant writing it up to count. The patient called because they had been constipated for several days and their back hurt. The patient had actually gone to work earlier in the day, and a family member was kind enough to ride to the hospital with us, leaving their perfectly good car at home. REALLY?????? Just when I think people can't amaze me anymore, I am proven wrong.

In other news, I've been busy training. Not just for paramedic school, oh no. Because I don't have enough on my plate right now, what with finishing school, attempting to graduate, studying for the NREMT-P tests, and planning a wedding, I have decided that it would be an excellent idea to begin training for a triathlon. this from someone who is woefully out of shape and has a hard time running up the stairs. I have started a Couch to 5K program (C25K), have a cheap, beat-up road bike on a bike trainer, and have been swimming at the pool on campus. Thankfully, my class schedule this semester allows for a bit more time in the mornings, which I take advantage of. It also gets me on campus earlier so I can get a good spot.

So I am looking at scheduling a mini-sprint triathlon locally. It's at the end of March, and is a bit backwards so no one freezes (generally the routine is swim, bike run...this one will be run, bike swim), with small distances (1.4 mi run, 4 mi bike, 250 m swim) that I think I can do without killing myself. The bad part is right now I have what I think is tendonitis in my right knee. My yearly physical is conveniently on Thursday, so I will be able to ask my doc what she thinks.

The general plan is that not only will the triathlon training get me motivated enough to keep working out, thus losing weight for the wedding, but it will also get me in sufficient shape to test for a fire department over the summer. At least, that's the plan, should any departments in the area actually scrounge up funds to hire a class.

It's the end of the semester as we know it....

2010-12-10T11:52:00.004-05:00

Today is my last day of clinicals. I am spending my day in a firehouse in Smaller County (that I hope to possibly get hired in when they open applications this month), attempting to defrost my hands. Who decides it's a good idea to wash the ambo in sub-freezing weather anyway? My sleeve is wet where the water ran down from the hose. I miss the sauna in McMurdo's Station 1.

Anyway, as stated, it's the end of the semester, and I have a chance to breath. Facebooking has been possible, but that's about all I've been able to muster. While this semester hasn't had the intensive class time and tests of last year, it has been a study in time management, of which I am a poor student. Three days of clinicals a week, several papers, and a couple of tests thrown in for good measure have had me hopping around like a headless frog the past few months. I have had some interesting calls, which I will regale you all with once the semester is done for good next week and I have time to take a breath and actually think. Next Monday is ACLS class (finally!), and Tuesday is my final presentation for my research class.

I will say that I find myself endlessly frustrated by the seemingly arbitrary skills and the number of times we have to perform each skill in order to finish our ride-along time. In apparent direct contrast to the new AHA guidelines, we are required to record the number of patients we ventilate, (one patient=one ventilation) and we are required to ventilate 20 patients. However, we are not required to track or have a certain number of patient's we perform compressions on. I don't know about anyone else, but most working codes, where one would be performing ventilations, tend to come in late at night, generally after we are forced to be out of the firehouses. Not to mention that even as a live-in at a relatively busy, non-medic staffed station I didn't have 20 working codes in an 8 month period. So please explain to me how I am supposed to get 20 ventilated patients between September and December (and then again in February to April). I am quite frustrated.

Add to this that I seem to be the ultimate 'white cloud.' Medics breath a sigh of relief when I walk through the door, knowing that the next 8-12 hours will be easy. The most calls I have run on a medic unit in a 12 hour period was 5, and only one of those was an ALS call that required more than a bandaid and a bit of comfort. Not that those things aren't important, but as a student who is required to have a certain number of specific skills (IV starts, ventilations, medication administrations, etc) these type of calls do not really help, aside from the assessments (which, admittedly are also important, as I need assessments for things such as respiratory distress, chest pain, altered mental status, syncope, psych, OB, etc). Most of these I have, but we just don't run that many trauma calls (most of those being of the BLS type). Therefore, I find myself behind in trauma, psych, and AMS assessments. I have a plethora of respiratory calls, but very few chest pain calls. The OB calls will come when we do our L&D rotation next semester, and I find myself hoping that I will be able to get more hospital time next semester to attempt to check the appropriate boxes. However, even the nurses at the hospitals are happy to see my wander in, as my presence guarantees a quiet 8 hours.

All told, I am not unhappy. In fact, I have had several calls that were excellent teaching opportunities, both as far as assessments, skills, and interpersonal relations go. I've learned lots of what not to do, and some of what to do. How to deal with difficult nurses and doctors, when to treat and when to let it ride, and so on. Riding at my home station isn't quite as good, because I can't practice as an ALS provider, but the medics there know I'm in school and let me ride with them to work on my assessments. One of the medics (I seem to be the only one who likes her) is an excellent provider, and quizzes me on what to do next, and basically runs through the call with me, what I would do next, medication dosages and so on. It's very nice to have that extra help.

But I am very glad the semester is nearly over. Just 4 more short months, and I'll have my second BS degree, and be a licensed paramedic. Then it's just a matter of finding a job.

Faking it...

2010-11-11T10:58:00.002-05:00

Honestly, if you're going to insult my intelligence by lying so blatantly to me, the worst you can do with your sob story is gin up some real tears. A two-year old can come up with better crocodile tears than you.

Last night proved a classic example of pain. I read a book once, You're Never the Same Once the Air Hits Your Brain, written by a neurosurgeon (sorry, can't remember the author's name) where the good doctor, as a young medical student/intern, learned the difference between real pain and 'fake' pain. Note: when I say 'fake' pain, I don't necessarily mean that the patient is faking being in pain. They may very well be in pain, and usually are in some discomfort, and therefore, must be treated as such (never tell anyone they aren't in pain. No one feels pain the same, and what may be a 10/10 to one patient could be a 4/10 to another). But 'real' pain vs 'fake' pain patients will differentiate themselves.

Patient one called for abdominal pain, due to gallstones. A previous attack had shown what the pain was, and, though surgery was scheduled, another attack came on. The patient complained of pain at a 10/10, and could not find a comfortable position. The entire 25 ride to the hospital was spent with the patient moving around constantly on the captain's chair (no stretcher by patient's request, as it would restrict movement too much), stretching, breathing, sighing, and doing everything to not cry. The patient couldn't describe the pain very well, only that it 'hurt badly' and was so distracted by the pain that she couldn't even remember her age, could barely walk, and just could not find a comfortable position. When asking the patient questions, we had to frequently remind her of the question we asked, or ask several times, as she was so distracted by the pain that she would forget within seconds of what we asked.

Patient two actually called for chest pain, but arrival on scene showed it was a frequent flyer patient with a history of back problems and general muscle pain and spasms. Frequent flyer-ism is not unusual with chronic pain patients, as they call when something happens to disrupt their homeostasis; they run out of meds, have a particularly bad day (weather can do this), or overstretch themselves, and need more relief than they can get from their home meds. This patient had a history of spinal issues after a recent (within the last year) car accident. This car accident was reported to be the patient's fault but the patient was currently suing everyone involved, from the other driver to the police and EMS departments for poor handling of the case. A laundry list of medical history accompanied her. The entire call consisted of much screaming and yelling, and then crying as she related her story, complete with embellishments I'm not sure are ever possible. Her story was related with a lot of detail, including dates and names of those involved. By asking our own questions, we were easily able to distract the patient from her pain complaints, and when we asked about pain in general, we got an answer of 'It's the same.' However, if we immediately asked about a specific body part ('What about your big toe?), the answer was a scream or wail of how it hurt so badly.

Do I doubt either patient was in pain? No. Again, pain is extremely subjective, and who are we to say that a patient has pain or not? Chronic pain patients often have high pain tolerances, and acute exacerbations of their pain are often accepted with resignation and familiarity, and they tend to not trend towards the dramatic side of the scale. Patient in 'real' pain are often unable to describe the pain unless prompted with suggestions, because all they know is that 'it hurts.' Patients in 'fake' pain often use colorful imagery, such as ' it's sharp, like miniature elves are running up and down my legs, stabbing me with red hot pokers.'

Again, this is all very subjective, and I tend towards the treatment rather than not. Patients in pain are in pain, and whether they are trying to sucker you for drugs or for insurance-itis or they are totally and completely really in pain, they all should be treated the same. Keep a high index of suspicion, but don't discriminate.

Another note: I have minor chronic pain. Severe carpal tunnel in both hands, constant shoulder pain that has only been partially relieved by rotator cuff surgery, and lower back pain are my friends. I am no where near some of these patients level of pain, but I also have a high pain tolerance (my rotator cuff was torn for over a year before it was repaired, and that was a year of push-ups and weight lifting and firefighting). So, I'm just saying I have a very slight view of what some patients go through.

WEEEE!!! It's Stream of Consiousness time!

2010-11-01T17:05:00.002-04:00

Why yes, I am still alive. Clinicals are eating my life. And yet, I do so little at them. The past few weeks have been full of medic unit clinicals, with less than 20 calls to show for it. And today, I sit at a station far from home, bored to tears. Only one call all day thus far, and it was a BlS run, which netted me ZERO patient contact credits.

I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.

I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.

I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.

Though I didn't help my case much by having a dozen buffalo wings for lunch today.

I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.

Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.

In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.

By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....

Eyebrow raiser

2010-10-03T20:21:00.003-04:00

Clinicals are still eating my life. I think I'm putting in more hours/week than if I was actually working.

Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.

If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.

So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.

So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.

Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.

So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.

I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).

I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.

I will be better than that in the future.

Really? That's it?

2010-09-20T21:06:00.003-04:00

Papers are eating my brain.

In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).

Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."

Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????

You might as well spray that morphine in the air for all the good it's going to do the patient.

OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).

I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).

Right then....

2010-09-03T12:20:00.002-04:00

First of all, a huge CONGRATS!!!! to Epi on passing her NREMT-P and becoming a full-fledged medic! So proud of you, girl, and I hope to be able to write the same thing next June.

School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.

This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).

My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.

Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.

I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.

Slow times

2010-07-30T09:12:00.002-04:00

Not much has been happening. I am leaving for a 2 week camping trip tonight, and when I get back, I have 2 days before I leave for a 3 day camping bike trip. I'm very excited.

I've been trying to work out more lately. I'm tired of being tired, and I would like to lose weight before my wedding next October. I am short and round, and I'm tired of that shape. My problem is that I often start going to the gym, and in a few weeks, maybe a month or two, I lose my motivation to go. I think the problem is that I have no goal. While it may be sad to say that losing weight and getting in shape and being healthier should be goal enough, it's not.

My fiance loves to run. He ran cross-country in high school and college, and occasionally runs now. He's one of those lucky few that is tall and thin with a high metabolism (though it is starting to slow down). A good friend of ours, who is also working on losing weight, has discovered that he also likes to run, and is training for 5K races. His wife, who hates running, will be entering a body fitness competition next fall (Fall of 2011) at the ripe age of 54.

So I decided I needed a goal. Something to train for. A specific item to work towards, rather than the more nebulous finish line of 'lose 'X' pounds by 'Y' date. I thought back to the activities I like to do. I do like to lift weights, but there is no way I could be ready for any kind of body competition in less than 2 or 3 years. I like to bike ride, and I love to swim (I am a fish). I remembered that in the early days of my pre-teen and teenage years, I would spend the summer in the pool and on my bike, and when I saw my first triathlon on TV. I would swim several laps in the pool, then jump out and hop on my bike and ride around the neighborhood a few times, then drop off my bike and run the same route. So, I decided that next summer I would run a triathlon.

Now, I have no doubt that I will not win. But that really isn't the point. The point is to finish, be in good enough shape that I won't die on the route, and be happy when I finish so that I want to continue. In the future, should I continue, I am sure I will start competing to place, given my competitive nature, but for the first one, I just want to finish.

And before anyone thinks I'm totally off my rocker, triathlons come in various sizes. There is the Ironman, the half-Ironman, Olympic distance, and sprints. The sprints are the shortest ones, consisting of about a half mile swim, a 13 mile or so bike ride, and a 5K run. If I work hard on training, I should be more than ready to do one by next summer.

My one concern is school. This year, I only have classes twice a week, with clinicals the other 3 days. I'm concerned with how the clinicals will affect my training, given that the hospitals do not have workout rooms, nor do some of the fire stations I'm in. Time is another factor, as clinicals don't exactly have time built in to work out. But, it doesn't take long to knock out some push-ups and sit-ups, squats and lunges, and there are always pylometrics to bust your ass some. Nutrition will be a challenge too, but I think that eating properly will almost be easier than working out. I just have to say 'No' when the medics go out to eat.

So that is my plan. I've already started the past 2 weeks, by doing some interval training, circuits, and other fairly intensive workouts. Spinning is now playing a large role, and I am going once a week. I'd like to bump it to twice a week, but my schedule will not allow that once school starts. I have a good beginning cycling program that I will be starting when I am home from all my trips, and I will likely add swimming in the mornings twice a week before classes.

My goal is a sprint triathlon in July next summer. I probably won't be posting too much of my progress here, because I have a workout journal on Livejournal. If you happen to have an account on Livejournal and want to be added, let me know.

Anyway, that's the plan. I have some EMS related posts swirling around in my head, and I will probably work on them during my 3 week of relaxation.

I LOL'd

2010-07-12T10:53:00.002-04:00

Today's xkcd was LOL funny. I immediately thought of Rogue Medic.

At least there's catchy music...

2010-06-30T10:58:00.002-04:00

Having been reminded that the state protocol updates take effect tomorrow, I realized that I really should waste 30 minutes of my life and view the 'update rollout videos' before I'm taking off riding status. I suppose I should be grateful that they've put it up online so we don't have to go through classes face to face, wasting a whole day.

New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters anyway...in my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.

Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.

But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.

And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.

*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.

At least the protocol rollout has catchy music...

PASS!!!

2010-05-26T08:55:00.002-04:00

I am officially an NREMT-I!!!

Now I don't have to worry about it till next year with the NREMT-P test.

By the way, what the heck is with the security for the written test? ID, fingerprint, palm print, photo, signature. Can't take anything into the test area with you, not even chapstick. What the hell? How is my chapstick a security concern? I mean, really? I know that they administer tests for people other than NREMT, but is there really a need for all this? I thought they were going to ask for a DNA sample next!

Waiting....

2010-05-25T10:58:00.002-04:00

In case anyone was wondering, I passed my practical NREMT-I test on Friday. I only had to retest IO, since I had a minor equipment issue (unknown if it was brought about by operator error or not. I chose not to challenge it, and just retest the station). So yes, I passed. Happy day.

The day before the test I didn't have time for terror, since my laptop gave up the ghost, and I spent much of the day running around on errands, and getting a new computer. Now all I need to do is get a sled so I can move all my files from the old hard drive to the new one. It isn't a huge deal, but it would be nice to have my wedding information instead of having to redo the budget, guest list, etc all over again. I also have to finish moving my music, since iTunes was being sullen and didn't get all my music from the external hard drive, leaving me to transfer everything myself. It's good, in a way, since it will allow me to go through and erase all the duplicates and so on. I am a bit miffed about the loss of all my playlists, though.

So, at 0800 this morning, I took my NREMT-I written test. I was done in just over an hour, and took another 20-30 minutes to review all my work and the flagged questions. There are still a few I am nervous about, and I left feeling that I either knew my shit or didn't know anything at all. I should get results sometime this afternoon.

Since I had to be in the glorious County of Monkeys this morning for my test, I decided to meet my old co-workers for lunch. I've come to realize over the past year and some that getting laid off was probably the best thing that could have happened (something I voiced then, but didn't quite believe). I enjoyed working for that company, mainly due to the people there, but felt trapped. It was a vicious cycle I went through on a fairly constant basis, becoming excited about a new project and working as hard as I could on it for several weeks, only to gradually become disenchanted with it when it dragged on too long. I would slack off, get depressed, and then something would happen, or I would think of something that would take me back to that excited, busy state again. It was like I was manic depressive, but only about my job. During my low periods, I would constantly talk about leaving and going back to school to become a paramedic, just as soon as I'd paid off more bills. Well, you know how that goes...For years I never left, aside from the trip to Antarctica, and one of the main reasons I didn't go back to the Ice was because I felt it would be pushing my luck to leave again less than a year since I'd been back.

Ironically, I was laid off a month short of my year anniversary of being back from the Ice.

So today, the day I took my test and took one more step towards fulfilling my dream (I'll consider it a full step when I find out if I've passed), I am once again meeting with my co-workers, my tie to my former life. It's a strange circle I feel I've come to, honestly. I readily admit that there is a part of me that still misses working there, but I think it's more for the loss of the camaraderie and those other intangibles other than the work itself (in fact, I'm sure of it). I miss the verbal sparring, the joking, and laughter we shared. I miss being surrounded by people mostly my own age, and, truth be told, I miss being 'the kid.'

Don't get me wrong...I'm enjoying where I'm at now, and I enjoy (mostly) my classmates. But being a full generation older than everyone but my instructors (one of my instructors is a year younger than I am) is wearing. At least at my old job, while I was younger than most, I had a good appreciation of things the people older than me enjoyed. My current classmates have very little appreciation of what came before, and I find it discouraging to make jokes and have only the instructor laugh. It's depressing to have to constantly explain things to the children in my class.

All the same, I am happy where I am now.

But I'll be happier when I know I've passed my test.

Terror

2010-05-19T21:43:00.003-04:00

We went to the Joint Services Open House at Andrews AFB this weekend. I am now peeling like a snake. My face got extremely burnt, thanks to some expired sunscreen and a whole day on the flight line. My back got sunburned the day before, gardening in a tank top. See pictures here.

In other news, my NREMT-I practical exam is on Friday. I am terrified. The last time I took it, I failed the medical, trauma, and both cardiology stations. This time, I feel fairly confident in everything except dynamic cardiology. We haven't had much time in class to do actual practice in class; most of our dynamic practice has been more of a 'practice by committee' kind of thing. So today we finally got a chance to actually sit down with our instructor and do a dynamic station. I did it twice. And failed twice. And we don't have practice time tomorrow, because our instructors are setting up the test.

I am in terror. I don't know how I'll handle it if I fail. I feel confident about all the other stations, and feel confident that I will fail dynamic cardiology.

To make matters worse, The Fiance will not be in town this weekend, which means I have to get up at 0330 Friday morning in order to be at the test site at 0800 (it's 1.5 hours away, which means, at rush hour times, I need to budget at least 2 hours, if not 2.5 to get there).

I'm hoping to get to the firehouse tomorrow, in the dream that someone there can run me through some dynamic cardio scenarios.

On the plus side, in happier news, The Fiance got word today that once his exile in NJ is complete, he will be placed on a project here at home, that will last for at least a year and a half. Which means he will be in town for the wedding. And my senior year of this program (assuming, of course, I pass my NR test, and make it to senior year).

Right-sided MI's

2010-04-22T21:16:00.002-04:00

So, I was responding to a post by RevMedic over at EMS Haiku (go there to see the actual strip) who was talking about a right-sided MI he might have caught through careful assessment and so on. I was talking about a tip that I got from a doc during a clinical on the medic unit, and realized Hey! This is one of those things I could put in my blog!

So here it is. Thinking logically, the lead V1 in a 12-lead EKG is the exact reciprocal of the lead placed on the back in a 15 of 18 lead (I don't know which one, since we haven't studied them, only talked about them briefly). Therefore, if you see a depression in V1, you should expect that there is reciprocal elevation in that lead on the back. Thinking further, the lead on the back is pretty much directly over the right ventricle, and therefore it makes sense to see elevation there.

So yeah. While it is not diagnostic by any means, seeing ST depression in V1 lead, when you don't see reciprocal elevation in any of the reciprocal leads, should lead you to suspect a right-sided MI, and move your leads over to double check.

A small light

2010-04-18T20:32:00.002-04:00

I'm beginning to get excited. Only 2 more clinical shifts left for this semester. It's been fun, but I'm heartily tired of waking up at 0500 or earlier every damned morning, including weekends.

This weekends clinicals were relatively boring. A pseudo-busy shift at the hospital (you know the ones, where you are running around all day, but at the end of the day you look at your paperwork and say 'Wow, I hardly did anything today!') and 2 days at the same medic unit (a total of 24 hours) with only 3 calls. Luckily, I don't have to worry quite so much about patient contacts this semester, but it would be nice to get at least a little ahead of the game.

On the plus side, I cranked out the last 4 trauma homework assignments, finished my take-home test, and did almost all of my clinical paperwork yesterday and today. The only school work left is 2 papers, various tests (of course), a presentation, and the NREMT-I test. There are some other issues that I have to work out, which is it's own ranty post, so stay-tuned.

Paper due Thursday, paper due Monday, then a bit of a breather till May 12th. There is a small light at the end of the tunnel, for this semester at least.

I think my IQ just dropped a few points...

2010-03-28T17:21:00.001-04:00

Look, I am all for making mistakes. It's how we learn best. I am all for asking questions so you DON'T make mistakes. But seriously people...use your brain. It's that organ located in the lump 3 feet above your ass. If you occasionally engage that organ, you can save yourself from a lot of mistakes, and make yourself look less like a fool, and more like someone I'd want treating my family.

For my hospital time clinical, I go to a large, well-known university hospital. They also have a peds ER upstairs from the adult ER, but the critical care rooms (trauma rooms) are down in the adult ER. So whenever there is a consult for the peds ER, the adult ER listens in, just in case they end up coming to the adult ER.

As an aside, any paramedic student doing time in a hospital should listen in when a medic unit does a consult. Not only does it let you know if there are any traumas or serious medical cases coming in that you could look in on, but it also shows you the difference between a good consult and a bad one.

Any way, yesterday I heard the box go off, and listened in with the charge nurse. It was a consult for peds, but we listened in. The information was as follows:
12 year old male picked up from school with chest pains and trouble breathing. Unknown medical history per patient and school nurse. All vitals unremarkable (BP something like 120/80, P 80 something, R 18, O2 sat 100% ra). EKG shows NSR, IV with lock.

All sounds ok right? Then the medic consulting dropped the bomb. "Given that the patient is past the age of puberty, we would like to know if we should give NTG and ASA."

WTF?????? Are you serious? With vitals like that, and a kid who's 12, you want to give NTG and ASA? First of all, per MD protocols, a child is considered pediatric until age 15. Secondly, per MD protocols, NTG is no indicated in children. Thirdly, haven't you ever heard of Reye's Syndrome? You know, what possibly happens in children who are given aspirin? (Granted, I don't know the time frame and dosages required to give a child Reye's Syndrome, but still).

But the biggest problem here is this. Regardless of the age and so on, look at the vital signs. There is ZERO sign of any kind of heart problem, and, absent any concrete history, I'd be hesitant to give ANYTHING.

So yeah, I think my IQ dropped a few points listening to that consult.

At any rate, the rest of the clinical on Friday went well. The clinical Sunday went well too. Not as many skill check-offs as I would like, but several good medical patients that were serious head-scratchers and a good experience to sit in on.

You CANNOT be serious...

2010-03-10T21:43:00.002-05:00

Heard on the county radio tonight at the station: Haz Mat call for the 'smell of chemicals outside' someone's house. Chief gets on scene, sets up command. Engines are on scene, detect chemical. "Yeah, we can smell it, it's a slight smell of skunk."

Command cancels all incoming units, EMS units call in asking if they are canceled too.

Command: "No, keep EMS coming. The woman is on the balcony, complaining of respiratory distress from the smell."

Seriously? You smelled 'chemicals', and called 911. I can actually understand that, having been around a skunk when it initially let go, and it does smell like chemicals at first. But, the skunk is outside. YOU are outside. You are having respiratory distress. From a skunk? How's about you just GO INSIDE?????

Sometimes you just can't make this stuff up, you know?

4 more days

2010-03-08T21:28:00.003-05:00

Till spring break. I have managed to get almost all of the projects due this week done; just the take home test and group presentation to finish. Spring break will be spent most likely trying to get ahead of the work load for the last half of the semester. And trying to find a job.

EMS Today was interesting, though it was hard for me to really get into a lot of things when I was there mainly with my fellow students. They all mainly wanted to get the stuff for the assignment done and then get the hell out. I would have liked to stay longer, check out some of the things I missed the first time around (due to long lines at the booths) and see the Chronicles of EMS at the Zoll booth. Maybe next year.

I did end up staying in B-more longer than I planned, since the plans for getting the group project done fell through. Classmate N and I walked down to Inner Harbor and hung out watching the last cannon shot on the Connie. Then we went up to Uno's for another drink and a snack. A friend drove up from home to pick me up, got lost several times, and we finally got home and dinner around 2030. Long day.

I looked for the bloggers I read, TOTWTYTR, AD, and Epi, but never actually recognized anyone. Perhaps next year I'll actually meet people.

And away we go!

2010-02-27T10:21:00.003-05:00

The season of clinicals has begun. Tomorrow will be my last day without a clinical till the end of March (not counting spring break). So far, clinicals have been pretty good. The last few have been relatively slow, but the calls have been good ones, real head-scratchers, as it were. A diabetic with N/V/D who was extremely diaphoretic, whose 12-lead showed an inferior infarct. We gave him NTG, and it bottomed his BP from 170-ish/110-ish to 70-ish/40-ish. WOW! Yesterday I was at a station that was a block from the hospital, so we didn't do a whole lot of interventions, but we had 2 combative patients (one I had to put in an arm lock to keep him from punching me and the other providers), and an unresponsive.

So far the semester has been hectic. More papers, more homework, more quizes, etc have me running in circles. I'm actually kind of glad that the last few clinicals have been slow, since it gave me an opportunity to catch up on homework and get a little bit ahead. I almost feel like a single mother, what with the dogs and all, although I have the ability to leave a 1 year old and an 8 year old alone for 8 hours and the state won't lock me up. I have a whole new-found respect for my mother and Epi who worked, went to school, or both, with children who couldn't be left alone for hours on end. Luckily, I have a very good friend who works and lives not far, who is willing to swing by and let the dogs out and feed them when I am in class or clinical. Next week is EMS Today, which I will be at on Friday, and maybe Saturday morning. We have an assignment associated with the Exhibit Hall, so I won't be able to take any classes, but will be available for dinner and drinks after if anyone is interested.

In other news, the large amounts of snow we got are melting, and my yard has puddles all over it. The wind in the past few days has dried out a lot of it, especially since it came with a little bit of sun. The lilies are coming up, and I have to divide them as soon as they are up a bit more. C is planning a fence around the gardens, since Kaylee has found her way through the wire ones we put up last summer. The veggies that can be started inside are started, and the herbs are going as well. Most things are going in containers because we just don't have the space.

And now, I have to use the last few free hours I have today to go prune my roses and pull up some weeds. It's cold and windy outside, but the sun is a-shinin'.

And so it begins...

2010-02-14T21:20:00.003-05:00

First off, I have survived the epic snows of DC. No crashes, no roof cave-ins, all is well here. See pictures of my dogs and neighborhood here. Look under the Weather gallery, under Snowmageddon 2010. I haven't minded all the snow as much as some people (it kind of reminds me of high school in NEPA, when the snow actually stayed on the ground for more than 2 days), though it's been hell on my schedule. I had just started getting into the swing of classes again after winter break, and then we had a week off. Though I did get in some good hours at the fire house.

Secondly, perhaps in reaction to the large amounts of snow in my yard, I have started my seedlings for the spring. We are trying to have a modified veggie garden, in containers on the porch. We don't have very good soil, and we don't have the money to build raised beds. So, the herbs go in the bed by the house which is the oldest and therefore has the best soil, and the veggies will go in the containers, and we are co-opping with a friend for use of her porch as well.

Thirdly, we have started clinicals. I have to have 200 hours by the end of April, essentially. Thankfully, due to my schedule, I didn't have to make any hours up because of all the snow days we've had this week (haven't been to school since last Thursday).

The most interesting thing I've experienced at clinical so far is the lack of plowed roads in the county I was in on Friday. There were a lot of unplowed roads, and therefore a lot of patients that had to come out by Hum Vee. I've never had to do that before, and it was an experience. It also netted me my first ride in a Hum Vee (the story of that call will be told in a different post). The hospital clinicals have been cool, since I'm at Johns Hopkins. WOW!!! That's all I have to say about that. The doctors let me watch them do all kinds of stuff. The first time I was there I 'assisted' (as in, I helped the patient stay on their side, and handed the doc stuff) while the doctor drained an abscess on someone's side. This week I watched some surgeons drain some seroma from a patient's abdomen. Rather than send the patient upstairs, the surgeons come down to do the minor things. Very cool.

So far my schedule isn't too bad. I'm short one hospital clinical shift, and 4 medic unit shifts, but I do have a few open days I can use. And I can pull a hospital shift during the week (since I'm practically guaranteed to be able to leave on time. So I've got some time.

And now, to print out my clinical journals, and go to bed.

Back to the Grind

2010-01-31T20:00:00.002-05:00

Well, classes have started up again, and this semester looks to be a royal bitch. We have to do 200 clinical hours. The crappy part is that, due to the state furloughing the teachers, we cannot do ANY clinical time during our spring break, which, frankly, I was counting on to be able to make all my hours. So far, I've signed up for most of the shifts I need, though I'm still a few hours short. The fact that C is in NJ for the next 5 or 6 months means that I have to be home to take care of the dogs during the week. This makes it difficult to do clinicals during the week, since I have to be home for the dogs at night (I do have someone to let them out and feed them at night, but I can't leave them alone all night long). I could do clinicals after classes, but then I won't be home till midnight or later, and then to get up at 0500 for classes will be a bitch. This means that I have only Fridays (no class on Friday so we can do clinicals) and weekends to do my hours, which means I won't be able to see C when he is actually home. The original plan when I decided to go back to school was that he would be home to take care of the animals so I could crash at someone's place closer to school if I had to do clinicals or something late. But what are you going to do? At least he has a job. So far I'm only 4 or 5 shifts short, and worse comes to worse, I'll plan for a week of evening/night clinicals and C can take the dogs with him for the week so I can stay at a place up near school.

The snow they called for this weekend hit and we got a fair sight more than they said we would. Shock. It ruined our plans for Saturday, but we made new plans and cleaned the kitchen. The counter and backsplash behind the sink have a large gap between them and I worry about all the water getting up in there and making the drywall and such moldy. So we caulked that space and straightened up, and basically just cleaned up the house and put clutter in it's place.

I've been having sleeping issues recently, and I don't know why. I do have occasional bouts with insomnia, and I suspect it's just the change in my diet and exercise that is screwing up my system. I was doing well over most of the break, going to bed and waking up at a reasonable time, and since my surgery, I have not been doing well. Unable to sleep, staying up late to read and finish books, sleeping really late. I need to get back on a good schedule, and hoped that this weekend would help, since C goes to bed fairly early. Last night struck that one down though, as I was stressed after scheduling out clinical times, and went on a stress-related crying jag. To relax, I grabbed a book, and stayed up reading the whole damned thing.

On the good side, I'm taking a SAR management class this semester. I'm excited about it. In April, we take a 3-day SAREX for training. It should be fun. I'm hoping that after this semester is over, and Kaylee the nervous K-9 has had some obedience training, I can get back to SAR. I'm not sure yet if next semester's schedule will allow it, but I'm hoping.

One more week until I can ride again. I can't wait.

Twingy, yet alive...

2010-01-14T23:16:00.002-05:00

This lack of gallbladder thing isn't so bad. All the steri-strips are gone, and there is minor stinging when the skin stretches a bit much, especially around the belly-button. Muscles aren't bad, aside from stiffness when I stand up from being in a sitting, bent-over position, much as if I had done too many sit-ups a few days ago at the gym.

I am on a 20-lb lifting restriction until Feb 8th, which means no medic clinicals until then (I figure ER rotations are ok, as I am less likely to need to lift people). No fencing or rock climbing for 6 weeks total (5 weeks now) and I'm figuring no heavy lifting at the gym (or sit-ups, for that matter) for the same amount of time. No need to get a hernia now. I can do cardio as soon as I feel I am able, so that'll be my work-outs for a while.

I've been experimenting with new recipes of late. Being at my mother's house (supposedly recuperating for the week) allowed us to try numerous things. We had chicken pesto with broccoli, lemon caper chicken, a very light, brothy asparagus soup, and some corn and crab fritters. Tonight I made a chicken with potatoes and celery, lots of garlic and spices. Tasty indeed.

Next week I have to get my pissed-off face on with financial aid at school. They pitched a fit last semester because I had only set up to pay for the fall semester, and was told to get the loan for both semesters. Then they sent a check for the amount of about half the total (one semesters worth), and now they are charging us for the amount for this semester. Someone is going to feel my wrath.

Now, I normally don't get into politics on my blog, because I don't generally express my opinions in words well enough to not piss someone off (and I have few enough readers as it is). But seriously...Pat Robertson? Dude needs to Go. Away. He's certifiably bat-shit crazy. I've thought so for a long time, but this one takes the cake. I'm pretty sure that God is not at all pleased with his 'prophet.'

And this guy tried to run for president? Sheesh. This is obviously why we just can't have nice things....

Post-surgery

2010-01-09T06:29:00.002-05:00

It is now 0630 and I have been up since 0430. Guess Percocet only lasts 6 hours for me. Oh well.

The surgery went well, the gallbladder was removed (there were several stones with evidence of some slight inflammation and infection) and the surgeon could not eyeball the 'atypical' FNH's in my liver. So I will have to eventually see a GI specialist for that, since the radiologist was unwilling to conclusively say that the very slightly atypical nodules were FNH.

At any rate, I seem to have developed a slight sensitivity to latex. I have round itchy rash spots where the heart monitor electrodes were, and the bandaids are driving me to distraction. There is, in fact, very little pain. A bit of cramping, similar to the cramping I had during the gallbladder attack, and some muscular pain at the incision sites, but even that feels more like a few too many sit-ups at the gym than anything else. There is some pain on deep inspiration, but even that isn't too bad, and my fear of atelectatasis is greater than than the pain.

I have a warm dog curled up beside me, who refused to go to bed with C and the puppy. I suppose I should be flattered that he feels the need to protect me, or something.

I am hungry. But I will wait for C to get up. Poor guy. I think he was more worried than I was about the surgery, and didn't sleep well at all the night before. Add that to a bad week at work, and he was wiped out yesterday. Sunday I head to my mom's house for recovery. Mainly it's so that I don't have to get up every five minutes to let the dogs in and out of the house.

My feet are cold...

2010-01-03T21:41:00.002-05:00

It is extremely cold here at the Home of the Gnome (relatively speaking, of course). I haven't experienced such low temps and wind chills since Antarctica. And no, that is not an exaggeration. Living in a townhouse on a concrete slab with 20 year old windows is not conducive to keeping a warm house. I'm reluctant to turn the heat up anymore, given the increase in energy prices, and so I am relegated to cuddling under blankets. Sadly, my other heat source is on his way to NJ for the week, and therefore is not here to help me warm up. I suppose it's all for the good...colder temperatures are supposed to be better for your metabolism...burning calories to stay warm and all. Though I'm not sure that the temps in the house are low enough to suffice for that.

The holidays are over, and for one I am grateful. I love the holidays, but this year just seemed to sneak up on my from out of nowhere, and before I knew it, it was a week before Christmas, I had no presents purchased, and I had to get the house ready because I had to head to St Louis, and Chris was not home (he had to work the weekend before Christmas, and was in NJ). The blizzard didn't help much, but overall didn't crimp my overall plans. The dogs loved it though...

I was supposed to have surgery this coming Friday, to remove my gallbladder (after one attack, and the confirmation of gallstones). Given the craziness of the past few weeks, I forgot to schedule my pre-op appointment, and therefore will likely have to reschedule the surgery. This leaves me with a timing issue, what with classes starting up on January 27th. Given the surgeon's indication that I will require at least 2-4 weeks for recovery, postponing surgery could push into the beginning of classes. Then there is the whole surgery thing overall. I have not had any problems since Labor Day, which was the only attack I have ever had. I have since tried (and mostly succeeded) in decreasing my overall fat intake, and I hope to continue doing so. So I wonder if I should go through with the surgery, when, if I watch my fat intake, I may not have another gallbladder attack for years, if ever again. Getting surgery will set me back at least one month, if not more, in several areas, such as fighting, the gym, and other things. Not to mention that the insurance company has not been making this easy at all. I am quickly reaching the point where I am going to crawl through the phone and confront people face-to-face on this issue, since evidently, sarcasm does not translate well through the phone lines.

At any rate, things are going to be boring for the next few weeks. I have to order books for classes, and determine if I want to add a class to my schedule for this semester. I will be severely lacking in human contact over the next few weeks, given that everyone is working, Chris is in NJ, and if the surgery is done, I'll be stuck in the house, unable to drive. You may get more posts then.

Nothing new here...

2009-12-04T17:20:00.002-05:00

Nothing new has been going on recently. The end of the semester is coming up, and with it, the final push for, well, finals. Next week is the last full week, and then finals. So far, grades are ok..I'm holding steady at B's, and a few borderline A's, which isn't as good as I had hoped, but better than it could be. At least I understand the stuff.

We are finally learning 12 -leads. The guy goes a bit fast, but it's more than I learned in EMT-I all those years ago, so it's something. A few take-home tests are due next week, and then it's just the tests. I'm excited for break, even if I am getting my gallbladder out just after New Year's.

On the station front, I am working with the new membership committee to help revamp the probie program. I really like this department, but it has a lot of things that make me say "WTF" On the other hand, Rockville was the same way. One of the things that makes me twitch about this station is the long-time officers. They're nice guys, but they have a bit of a warped sense of things, in my opinion. While working with one of the newer EMS officers, we decided that perhaps a solution to the 'lack of pride' issue we see in some of the kids and newer members (mostly the younger ones) would be to add a bit of history to the new member orientation. Nothing really in depth, but just a sense of where we came from. Things like when the department was started, maybe some pictures of the early days, stuff like that. The fact that we we had an LODD last year would be added in too, just to make sure that the newer members know and understand, and don't forget. When I asked an officer for help on the history (there isn't anything on the website) I was asked why, and when I said it was for the new probie book, the reply was "Why would you want to bore them with that stuff?"

I was floored. Why is the history of the department such a taboo issue? No wonder there are issues with people showing up and taking care of the station (we have to have 'clean-up weeks' to make sure that the station gets cleaned on a regular basis, and there are no dishes left in the kitchen cause no one cleans up after themselves and people just throw the dirty dishes in the trash after a few days). The officers bitch and moan about the 'young kids' and how no one has station pride and all that, and yet their attitude isn't helping. If the kids knew where they came from and had a little history to have pride in, maybe they would take more responsibility (then again, maybe not).

Some of us on the EMS side have instituted a buy-in dinner for anyone who wants on drill nights (Tuesdays and Fridays). Someone makes dinner, and then it's a $5 buy-in to eat. IOU's are accepted. Not a single one of the officers has eaten that dinner. I've seen some of them come in and ignore the invitation to eat, not even bothering to ask what is for dinner, and go out and buy something. How is that a good role-model to the new people? If the officers won't even sit around the kitchen table and eat with everyone else, what signal does that send to the new people? This place has to be the most disfunctional firehouse I've ever been a part of.

On the other hand, they do some things really well, and the disfunctional-ness means that they aren't uber-concerned with a lot of the Mickey Mouse bullshit I had to put up with at the other place. No 4 hour meetings because everyone is arguing Robert's Rules of Order, or spouting off just to hear themselves talk. Still there is a lot of growing room. And I like it there.

Clinical

2009-11-16T21:56:00.002-05:00

I can't say I was super-impressed with my clinical this weekend. Only 3 real calls (the others were crap calls that didn't really require us to be there, and the medic didn't even write a refusal). No IV sticks, and the medic I was with was not nearly as cool or nice as the one I was with last weekend. On the other hand, it did teach me how NOT to interact with my coworkers. In fairness to the medic, he was very good with the patients. Just not me or his partner.

Again, on the other hand, I ran an OB that actually gave birth, for the first time in my 11 years in this field. Thankfully, it was not in the back of the medic unit, but it was on the stretcher. The patient was a multiple pregnancy, multiple birth, and the kid just flew out. We did make it to L&D, but the nurses and doctors there were too busy arguing over which monitor to put on her and weren't quick enough in moving the patient over to the hospital bed. It would have been nice, since even though her water broke on our stretcher, I would have liked to NOT have to clean up after the actual birth. Still, it was nifty, but I am damned glad it happened in the hospital.

Nothing exciting happened after that, aside from the IV I missed because it was a crappy vein, and then got pushed out of the way by the medic, who was very easily frustrated. It made me mad, because her AC was a pipe, and her hand was a little spidery thing that you see in arthritic people. Irritating, because I wanted to go for the AC first, and he said that you had to do hand first, and when I couldn't get it, took the AC himself. Later he said 'You can put down that you did IV's if you want, I don't care.' I'm not so desperate that I'm going to cheat, jerk.

Hung at the firehouse for a bit after that, and then home. Lazy Sunday, though I did get some gardening done to clean up the yard for the winter (as noted yesterday).

Today was our last test before finals. It'll be very very nice to have several weeks without having to hurry and study for some test or another. Gotta check the schedule again...we start learning 12-leads in a few days.

I can haz Christmas tree!

2009-11-15T20:52:00.002-05:00

We got a Christmas tree today.

Yeah, I know it's early. See, I love Christmas. It's my favorite season (winter) and my favorite holiday, and not just because you get presents. It's because for just a few weeks out of the whole year, the majority of people act the way they're supposed to act, getting off the all-about-me bus and think about someone else for a change.

Anyway, we'd talked about getting a Christmas tree this year, but because C is in New Jersey over the holidays, we decided not to get one. We didn't have one last year, because he was in North Carolina. The year before, I didn't really have one, since I was in Antarctica. A tree, to me, is central to Christmas time. When I was growing up, it was a tradition for my mom and I to decorate the Christmas tree together, listening to Christmas music. When I was living at the firehouse, we had a tree that we decorated (albeit without the Christmas music). When I was living with Bee and Foo, we decorated the tree the day of the Christmas party, with all the people who came early, while Foo cooked for the party and Christmas music was playing. So yeah, Christmas trees have been rather central to my Christmas experience for a while. Not having one is hard. Not having C around is also hard, especially since we have not really spent 'holidays' together since we started going out. Yes, we are together for the actual holiday, but he's not around for the holidays, you know, the time leading up to the actual holiday when it's nice to have family around to listen to the music, see the sights, and so on. I keep reminding myself that it could be worse...at least he comes home most weekends, and he is not in a dangerous place (aside from the fact that it IS New Jersey). I have friends who's husbands are military, and are downrange for the holidays, so I know I could have it worse. It's still hard though, not to be able to share my favorite holiday with the one I love.

Anyway, we've discussed Christmas trees, and whether we should get one or wait till we have a house that will fit it. We've bought at least one ornament every year we've been together, so that when we have a tree, it's not naked. But when we went to the home improvement store today to get mulch, grass seed, and top soil to fix the yard(and how odd does it sound saying that 2 weeks before Thanksgiving?), I saw that they had little potted dwarf evergreens. We talked about getting a taller one to put in the corner of the yard where the hydrangea used to be (but died), and saw that they had cheaper one that were much smaller.

So we got one. It's only about 2 feet tall right now, and is outside now. C plans to build a small table to put it on in the corner of the living room, we'll leave it potted, and in the spring, we'll plant it. In the meantime, C, who has become enamored of the LED lights being advertised on TV, wants to put lights and ornaments on the tree while it's inside. Granted, some of the ornaments we have are bigger than the tree itself, but we'll figure it out. Maybe a bow for the top.

But for now I am excited. I have a Christmas tree, and although C will not be here during the week, he will be around on weekends, and we can do some decorating the weekend after Thanksgiving. The fact that the tree is potted means it won't dry out, and we can plant it in the spring.

So now I can have my dream of sitting in the living room, listening to Christmas music, the only light coming from the tree in the corner. The only thing missing is the fireplace.

One thing at a time.

Illness

2009-11-10T16:04:00.002-05:00

When we last left our intrepid adventurer, she was asking cardiology questions. We actually did find the answer in pharmacology class later on (oddly enough).

At any rate, now that I am off antibiotics, my throat is sore again. A trip to the doctor today (since strep throat and I are such good friends, and I have no desire to have scarlet or rhuematic fever) I thought that was the prudent thing to do. According to my own personal Marcus Welby, I still have blisters all over the back of my throat and my tonsils, which is most likely the cause of the intense pain I have been having upon swallowing (but only on the right side). New antibiotics (Keflex) make me hope that I will kick this. A blood test to rule out mono has also been taken. However, the lack of fever and extreme exhaustion make me doubt it is mono.

This weekend was my first field clinical. I was in Baltimore City, and things weren't super busy, but they weren't really slow either. I did manage to get one IV on Saturday, and ran my first 'real' GSW. Yes, it took 11 years to get a real GSW. Most of them have been either 'it's not really a gunshot' or so much a gunshot that the cops cleared us before we got on scene. This one ended up being an organ donor, but still...Sunday was even slower than Saturday, with several 'man down' calls though there was one that might have been a dissecting aneurysm. I go back on Saturday for my last one, and I hope that I will get at least 2 IV's.

In other news, my back is still sore, though I suspect (read: hope) that today's extreme pain is due to awkward sleeping last night. I have a date with a heating pad later tonight, and perhaps even some more serious painkillers than Advil.

In the meantime...I have a pharm test to study for tomorrow.

Question for the masses

2009-11-04T17:06:00.002-05:00

A question has been raised in my cardiology class that no one seems to be able to answer to the student's satisfaction.

What is happening, at the cellular level, that causes ST segment changes during an MI? I know it has something to do with repolarization changes due to dead and dying or ischemic tissue, but she wants to know the specific reasons behind the amplitude changes.

Any takers among my 2 or 3 readers?

It Lives!!!!

2009-11-03T18:43:00.002-05:00

I am alive, no thanks to the strep throat I got last week. Just as things were getting together.

Still, I survived 2 tests during that time, one when I was sicker than a dog, so I can't be too upset.

The semester is halfway done. I'm getting excited about being a quarter of the way done. I would like to be doing better, but I can't complain over much about B's.

Today was the H1N1 vaccine clinic on campus. I was supposed to be a runner, which meant that I was supposed to be taking filled syringes from the vaccine fill-up station to the various station giving the actual shots. I ended up taking care of a classmate who got sick, and walking her back to her dorm. When I got back, I made sure the stations had syringes, and spent the rest of my time there filling syringes with vaccine. Not the most exciting of 'clinicals' but good practice.

This weekend starts the first round of clinicals. I have 3 days of riding on a medic unit to get IV sticks before the 50 mile marathon in late November (yes, that was 50 MILES, not KM. A bunch of silly people run 50 miles up the Appalachian Trail in western MD, and the medic students have the responsibility of fixing the rampant dehydration and foot funk they will have by the end of the 50 miles.), so this Saturday, Sunday, and next Saturday will be spent in Baltimore. Hopefully my curse of no calls won't carry over too badly so I can actually get some calls. One of my classmates delivered a baby this week at her clinical. I don't really want to do that.

Drill tonight at the firehouse. I have some ideas I would really like to implement, but I haven't found the time to write them down to give to the Sgt. Also, have to study for my test tomorrow. Time to get cracking. There may still be time to pull A's out of my ass in these classes.

Still Alive

2009-10-20T17:30:00.002-04:00

In the past few weeks, I have survived a CT scan (to check on the liver abnormalities found on the US for the gallbladder attack), been sick with allergies, thrown out my back, and given a presentation for class (I HATE giving presentations in front of a class).

On the other hand, I also got an A on that presentation, got an A on one test, and a B on several others. So, aside from the back pain and the limitations it's imposing (no riding the ambulance recently, no serious fencing), life hasn't been too bad.

Tonight is a drill night at the station, and then dinner with friends at Hard Times, where food is cheap and plentiful, and I will have leftovers for lunch tomorrow.

Tomorrow. Which reminds me, there are some phone calls to be made tomorrow, since the school saw fit to reimburse me for a not-insignificant amount of money that I didn't actually spend. At least, I don't think so. I knew that whole loan snafu would come back to haunt me.

Making do

2009-10-11T22:19:00.002-04:00

School is kicking my butt. Not in the 'study, study, study' way, though there certainly is a lot of that, (in fact, I have a test tomorrow), but more in the 'up early every day' way. Compounding the issue is the fact that C is in New Jersey for the next 6 months, which means I am chief cook and bottle washer for the dogs and the house. C does come home on weekends, but that's generally not enough time to get everything done. Basically, I'm still working out my schedule, trying to get to bed early at night (clearly a FAIL for tonight), and it's kicking my butt more than I expected.

Time to study. Maybe I'll have more to post about when we start clinicals....

Sunday

2009-09-27T20:39:00.003-04:00

Nothing like chilling at home all day Sunday, working on homework and other stuff.

The house is relatively clean, including the dogs, which is good, since C leaves tomorrow for NJ for the next 6 months. Oh, he'll be home on weekends, but that doesn't count much when he'll be sleeping all day Saturday, and half of Sunday, and then have to either go to bed super early, or leave Sunday evening. One day, I swear, I will be able to spend a full calendar year with my love. By this, I mean that neither one of us is away for a significant period of time over the course of a year. Consider, we started dating in January of 2007, I left for Antarctica in October 2007-February 2008. In October 2008, C was sent to North Carolina for what was supposed to be 4 weeks, and ended up being 5 months. He came back in February 2009 when I got laid off. No he's being sent to NJ for 6 months. So yeah, one year we'll spend the whole year together.

In other news, I tanked a cardio quiz. Very disappointing and led to a brief crisis of faith where I doubted if this was the right move for me. I'm especially worried about the test from Thursday now. There is another quiz in cardio tomorrow though, so think good thoughts for me.

Add to all this money woes in regard to whether or not we'll be able to pay for everything for the wedding, and you have one lovely weekend. Granted, some friend's of mine have had a much worse week than I have, with people dying and finding out that others have serious cancer, so I should really count my blessings.

Which reminds me...appointment with the surgeon on Tuesday to see if I have to have the gallbladder out ASAP or if it can wait a bit.

Neat stuff

2009-09-16T22:44:00.002-04:00

So last night I dragged my sorry butt to the firehouse, which I haven't seen in about a week (which I must rectify) for drill night. I've never actually been to a 'drill night' as every time I'm there on a Tuesday, I've either gotten the night wrong, and we don't have drill because we have a business meeting the next night, or I am on the ambulance and get sent out on a call that doesn't get me back to the station until drill is done.

This week was special. There is a gentleman living in our first due who has a Ventricular Assist Device (VAD). This is a little magnetic pump that is inserted into the left ventricle that, via centrifigul force, pulls blood from the ventricle and sends it through a shunt to the aorta. The atria are unsupported, but they do still beat. You will still get an EKG reading. It usually is associated with an internal pacemaker. And you will not get normal heart sounds. At all. Essentially, the heart is no longer really beating (though, if the pump fails, it can beat effectively enough to maintain life for a short period of time). The blood is being moved through the heart by this pump.

Here's the kicker...he has no pulse! Read that again. NO....PULSE. Also, no blood pressure, unless he is really super hydrated. This makes treatment slightly difficult, to say the least.

The interesting thing I found was that there are several hundred, if not thousand of people across the country who have different varieties of these things. Before last night, I wouldn't have known what to do if I had a patient present to me with no pulse or blood pressure, yet he was upright and talking.

The most important thing about the whole lesson was that he CANNOT be separated from his bag. The wire that controls the pump is connected to a computer in that bag. I shudder to think what could happen should an emergency happen (say, a car accident) and responders attempted to move the bag too far.

Anyway, these VAD's are mainly for people who have serious heart failure and are either waiting for a new heart, or aren't going to get one, and this allows them to have a much higher quality of life than they would otherwise have. I'm sure the nuisance of carrying around a mini-computer in a bag and having a wire come out of your side is much more tolerable than the nuisance of getting winded walking from your bedroom to the bathroom.

It's an interesting thing, and once more shows what technology can do. If you don't already know about these things, look them up. These people can be travelling through anyone's area at any time, and could have a problem.

Besides that...it sounds wild!!! Like your standing near high tension lines or something. Seriously, if you don't care about anything else about this nifty bit of techology, look it up just to hear what it sounds like!

The man is keepin' us down!!!

2009-09-10T16:54:00.003-04:00

..as it were...

Today I had a revelation of sorts. Our instructor climbed up on his soapbox about MAST trousers (a soapbox I share, given my hard science background and the overall lack of research that goes into most EMS decisions). Having come to the Promised Land of EMS (as the People's Republic of Maryland would have you believe) from a state that didn't believe in killing thousands of trees every year just to change 3 words in the protocols, I have viewed much of EMS here quite skeptically. From the insistence of people (who should damned-well know better) on flying patients based on their MOI to the hospital that is within visual distance of the accident scene,to new regulations every time the governing body gets bored, to in refusal of the state medical board to allow medics to use medications that are used every day in other parts of the country, I have become heartily tired of the stupidity that runs rampant in the EMS systems around here. Rogue Medic's recent posts have only provided food for thought.

I digress. At any rate, during the discussion of MAST trousers and why we are suddenly prevented from using them, he began railing against a certain segment of the medical community and why paramedics are the only licensed professionals in the entire country (that I'm aware of, please correct me if I'm wrong) that have a group of other professionals over-seeing, passing judgement and making rules for us. I think I've been slowly approaching this particular revelation, but today I got smacked in the head with it, and it makes sense.

To use the examples used in class today, sitting on the next computer over when we take our licensing test is a plummer, and next to the plummer is an electrician. Both of those professionals require a license, with the appropriate test, just as paramedics do. But neither one of those professionals has another person, say an electrical engineer, or a fluid mechanics physicist, sitting over top of them to give them codes and tell them what they can and cannot do, and what pipes or wiring they can and cannot use.

So why is it, that as a paramedic, I will have to defer to some guy sitting behind a desk somewhere, who hasn't touched a patient in decades, tell me that what I do for my patient is the correct thing to do? Why don't paramedics write protocols for paramedics? Why is it that doctors, who many times haven't the foggiest notion about what EMS is all about in the 'real world,' are the ones who say what we can do, what meds to give, and so on? (I admit that there are several exceptions to this, and I'm painting with a wide brush, but let's face it...by the time many docs get to the point in which they are writing protocols, they are generally more politician and businessman than doctor). One person in the class answered that it was because paramedics usually only have a high school diploma, and because you are dealing with 'life and death' situations, which require the higher education of a doctor. He was challenged with the facts that electricians generally have high school diplomas and 2 or so years of education (same as most paramedics in this country), yet they are given control over their own domain. The argument of 'life and death' is a strong one, yet, if the electrician does a shoddy job, and the client's house burns down with the client inside it, is it also a life and death situation? Yes, there are shoddy medics, who do it only for the extra money or quicker promotion potential (in a FD run EMS system) and there are crappy programs out there that do nothing but teach to the test and just churn out as many medics as they can. Quantity, rather than quality, is often the idea.

I had an ER doc (granted, he wasn't a medical director, but in all honesty, what would stop him from becoming one if he wanted to?) once complain that paramedics only gave lidocaine for V-tach, when amiodirone was a much more effective drug. Here was someone who was giving paramedics drug orders via radio, who didn't understand that the state of Maryland does not allow amiodirone to be given under their protocols (not that I can blame them, given it's hideous expense).

So why is it that paramedics are forced to subjugate themselves under doctors? Because the AMA refuses to allow any profession that may challenge the all-knowing doctors. They don't allow nurses to diagnose..instead, nurses are relegated to 'nursing diagnoses' which say nothing important when they say 'the patient is having ineffective breathing' rather than stating the obvious 'the patient is having an asthma attack.' I've had doctors pitch a fit on me for 'diagnosing a patient,' which, given the lack of proper letters after my name, I am prohibited from doing. I have seen, over the past 10+ years, the progressive 'dumbing down' of EMT and yes, paramedics, due to the reluctance to do such revolutionary ideas as 'diagnose.' EMT's are now taught to pass the test, and not question the information they are given. No thinking...just treat.

And yet, what is the solution? Surely the 'dumb paramedic' issue could be solved with more programs that offer a bachelor degree in Emergency Medical Services. It leads (in my not-so-humble opinion) to better providers, as a provider who has been taught to think can better treat the patient. Even now, we are moving in that direction with the influx of Associate degree paramedic programs. I think that, much as nursing has, gradually we will move away from simple 'certification' programs, then away from the Associate degree programs and into the realm of bachelor degrees. Nursing, physical therapy, and several other medical related jobs have traveled the same route. But the problem is how to break free from the over-seeing doctors? They won't ever let EMS go willingly.

I know there are several arguments, but I have to go and will deal with them later...

Week 1 down!

2009-09-04T16:46:00.002-04:00

Well, week 1 is in the books. I am sitting in the Commons, a kind of 'town square' thing that houses several eating places (ala carte, really), the bookstore, and several other things. Had this been King's, my former place of higher education, I would call it the Student Center. This place, being much bigger, has this, and another student center type place.

I've forgotten how much fun it could be on campus. Seeing other students walking to their dorms and apartments, seeing people playing frisbee (and croquette, even) in the quad, and in general relaxing after a week of classes brought back a strong nostalgia of what-has-been. I miss being able to just walk down the hall, or up a set of stairs, or even just across campus to see my friends. Getting together on a Friday night to role-play, or watch a movie. Getting up late on Saturday and going to the park to play Ultimate. Watching football on Sunday with the whole group of friends.

I find myself wondering what might-have-been had I had this radical idea of medic school (rather than medicAL school) and had come here 13 years ago. Would I have met the same people eventually? Would I have met C? If I hadn't met C, and decided to come here now, would I opt to lie on campus rather than at the Crofton house?

These things go through my mind, but I know I wouldn't trade those years for anything. There are things I would do differently, but I can't complain about the track my life has taken overall. I have friends who have been with me through thick and thin for 13 years. Not many people can say that they've remained friends with people from college for this long after college, at least not with as large a group as we have maintained. And now, S will be having a baby in a few months. 13 years ago last week, S and I met for the first time, along with R, who has 2 children now. I am continually amazed that, even though some of us have moved away, we have remained friends enough to keep in contact with each other through more personal means than facebook.

In other news, I'm sitting here because C is picking me up. The Gnome-Mobile is safely stashed in a parking garage on campus, and we will be heading north to the Poconos for a visit with parts of my family. This weekend will be full of good food, family, and lots of catch-up reading for school.

This flexi-keyboard is working ok, although the harder keystrokes make it harder, as does the necessity of hitting the keys perfectly square. Still, I'm getting better at it.

Speaking of things I'm getting better at, actually going to the gym is getting easier. I'm getting back into the swing of things, and I'm learning more about form vs weight. And today I can actually move. The diet is a harder thing for me, but even if I eat 'bad stuff' I'm learning to eat less of it, and I hope that eventually I'll just phase that nonsense out of my diet. It's a process.

More on school

2009-09-03T14:55:00.002-04:00

While I'm thinking about it, and have some time to breath, another few notes on school.

Our main instructor is rather kick-ass, and reminds me of Rogue Medic, in that Why is nothing in EMS based on research??? sort of way. Can't say I blame him (either him, that is), given my hard science background and the fact that if any of the sciences I've ever dealt with did things that way, nothing would have ever been done. Pharmacology is a beast, in the evenings in the middle of the week after 2 other classes, but at least it's taught by a guy who has a good sense of humor and can make as light as possible from a heavy and dry subject.

Other than that, the netbook is working well, though I find I can't type notes on it like I had planned. But it is good for pulling up the slide presentations we use and following along. I am one notebook short, which will have to be rectified this weekend. I have more reading to do than I did for my first degree, and, given my inability to read for long periods of time (at least, when it's dry and boring material), this is rather nerve-racking. The other problem I'm running into is the battle of over-confidence. Much of this I have done before...not so much in undergrad the first time, but rather in the 11 years I've been doing this, in nursing school, and then the EMT-I class I took. I find myself reading sections and saying I know this stuff, and I am tempting to skim past that bit, or not pay attention. But I have to, lest I miss some important tidbit of info that will pull the whole kit-and-kaboodle together. It's a new sensation, and I'm not much for it, really. But I'm terrified of missing something that will come back to haunt me on a test somewhere down the line. I find myself being completely anal-retentive and hyper-vigilant. I can only hope it lasts.

On the good side, in one of the hardest classes we have, we had the first of our daily quizzes, and I (am pretty sure) got 100%. Yes, it's only a quiz, and no, they will not always be this easy. But it's a start.

In other news, I am heartily tired of being called by work. I told them time and again that I can't work during the week, due to my schedule, the work load, and the commute. Yet I get a call asking if I can come in on Tuesday, or Wednesday, or Friday. I finally emailed my schedule to my supervisor, since he wasn't there the day I brought it in. Hopefully I won't get asked to work wonky shifts like 2p-midnight. Once C heads out of town, I'll have to get home to let the dogs out and feed them. I really am beginning to wish I had a different part-time job.

First day of school

2009-09-01T15:01:00.002-04:00

Today was the first day of paramedic school. An easy day, as they go, with only 2 classes, running from 0800 till about 1200. Which is good, since my lazy ass took itself to the gym yesterday for the first time in about 4 months, which, in turn, led to some fairly incredible muscle soreness today, mainly from squats, but a little bit from the push-ups.

The good news is that my 0800 Tues/Thurs class is now mostly only on Thursdays. The bad news is that Wednesdays are my late nights, with class running till 8pm. I'm wishing he had opted to have classes on Tuesday, but I'll take what I can get. The other bad news is that I find myself behind the 8-ball as far as reading goes, thanks to a company that shipped the wrong book, and then forgot to ship the correct one after I called them to fix things. Good thing I read fast, eh?

The other good news, however, is that all loan issues have been straightened out, and while I still need to electronically sign things, once I do, the money will be in the system for the school, and all I need to do is contact the FA director, who said she would request the withdrawl of the late fee from my account. I'm not sure how good a 'request' from her is, but it's something.

In the meantime, today, I need to run some errands out, and then come home and read. Lots of reading. Lots and lots of reading.

NIMS is boring

2009-08-18T23:16:00.002-04:00

So tonight I found out I've been laboring under a serious misconception. I thought I had all the ICS/NIMS classes I needed. Turns out I only had one.

So, since I'm not doing much in the next few weeks, I will be spending some serious, quality time with the ICS websites, taking -200, and -800 (just did -100) this evening. How fun!

On Facebook, I'm reading about all the people who are going back to the Ice, and finding that I really want to go back. Impossible now, what with school starting shortly, but someday. Perhaps after the wedding?

On the school front, loan has been applied for and sent to the school, which has to certify it. Arguments have been made with the registrar over the status of my Eng Comp class, which I took, and can't prove, since not even I keep a syllabus for 12 years, and King's doesn't have the course description online (it seems that class is no longer offered). So I'll be making some phone calls in the coming weeks to see if the department chair has something to help me out.

I seem to be in a strange place at the fire house. I'm a probie, and therefore subject to all the normal rules regarding probies (curfew, no staying overnight, no hanging out in the lounge, etc), which is just fine by me. I need time to get acquainted with these people and learn my way around THIS particular station. And I'm not flaunting my long-time certification either...in fact, I'm trying to downplay it. But I've been cleared to ride as OIC by all the EMS officers, routinely asked to help out on probie nights, and other things that seem to belie my probie status. It's a tough position to be in, and I'm still trying to work it out. I really am trying hard to remind people that I do still have probie status, but it's hard when you are so far ahead of some of the other newer members. And it's hard to have to keep reminding the officers that I haven't been shown how to sign in on the log book, given a passcode to get in the door, or gotten the ability to sign on to the station computers.

Though I guess that could be taken as a good sign....

Craziness

2009-08-17T15:41:00.002-04:00

This summer has been nutty.

Between working 10+ hours/day, 5 days/week, trying to get stuff in line for school in the fall, getting things together at the fire house, and getting stuff ready for vacation, I've barely had time to breath.

I dropped to part-time at the ambo company, and actually haven't been back since just before vacation. Last week wasn't good, what with getting things back together at the house after vacation, and with C's parents coming up for a visit. They left this morning, so I can relax a bit again. I like them a lot, but they are very...MidWest, and I am not, so I feel as if I always have to be on good behavior. No swearing, that kind of stuff.

Fire house stuff is going well. I got excused for the meetings and such I missed due to work, and have already been signed off as an OIC. Which is funny, since I still don't know what the hell is going on, and everyone kind of just assumes that I know what's going on since I've been doing this so long. But I've hashed things out with the EMS Captain, who was in my refresher course last year, and he's on board with everything that's been going on, so no worries on that front. Tomorrow night is drill, and the first one I'll have been to, so it should be interesting. The only things I have to do between now and then is get an account on the state's online reporting system, and make sure I'm up-to-date on the new protocol updates, and I should be good to go. Aside from that pesky 'probie' status of course.

Vacation was wonderful, if a bit wet the first week, but it was everything I needed and more. If anyone is uber-curious about what I do in my spare time, check out my pictures.

As for school stuff, I have placed out of the computer class, thanks to a quick run to the bookstore to buy an 'Access for Dummies' book. The class just covered the Microsoft Office Suite, and it seemed rather silly to me to take a whole semester class just to learn one program. So I gave myself the quick, 2am crash course version, which seemed to work, since I found out today I passed the challenge test, and can remove that class from my fall schedule. Today was finding funding, which I did, and am just waiting because C has to cosign my loan. Tomorrow will be a trip to campus to argue with the registrar, who have muddled up my transfer courses, and are telling me that I have to take several credits-worth of classes that I have already taken. Parking permit has been obtained and will be mailed here (though it doesn't go into effect until the second day of classes, so I have to remember to bring quarters for the meter), and once the loan is fully approved, the only other thing is finding the money for books.

Which brings on a mini-rant. I know books are expensive...I remember my eyeballs bugging out at having to pay over $100 worth of books for one class. And I figured things would be more expensive now, given that it's been nearly 10 years since I last bought books. But seriously..nearly $1000 for books alone? And that's including the used price for those I could get used. Amazon, thankfully, has prices that are a bit more sane, and the chair of the program sent us a link to another place to get books a little more cheaply, but still. It's a bit ridiculous.

I do still need to get a bookbag and notebooks and so on. But things are slowly coming together. I'm beginning to get excited.

And on that note, a plug...For those of you who don't know, EMT-extraordinaire and far-more-prolific-than-I blogger Epi is also attempting medic school, and is having some financial difficulties. While my own adventures prevent me from helping her out right now, I'm asking all 2 of my readers to consider helping her our. She has a recent post up that explains all. Please, help an incredible EMT move up the ranks.

Talking to God

2009-07-22T23:22:00.002-04:00

Several things on my mind right now, and it's hard to keep hold of any of them, given my level of exhaustion. It wasn't this hard to get ready for vacation and work last year, was it? Though perhaps the amount of prep time in the evenings had something to do with it.

I can't complain much though. So far this week, I've gotten off shift on time every night. I keep expecting it to change, but the EMS ghods are smiling on me. So far. I expect tomorrow will suck several big donkey dongs, but we'll see what happens.

After the horrible day that was yesterday, today was relatively good. I was back with Bald Partner, and the FNG (a new hire that we are training, who really is a FNG. He's been an EMT for 3 or 4 months...he's still all new and green and squeaky). We ran 2 patients, both of whom could walk. The second one was a psych patient.

I hate psych patients. Even given my ability to read people's body language and facial expressions, psych patients are just too unpredictable for me to feel truly comfortable. Today's patient was different though. Clearly suffering from some sort of psychotic break, her manifestation wasn't violence or random voices...she thought she heard God. I didn't read the paperwork (FNG did all the paperwork, thank heavens, because I would have been hard-pressed to give this patient the attention she deserved AND get my paperwork done at the same time), but she had been taken from her home from the police early in the morning, and, by her claim, had been left without food or water all day at the EEP facility. She claimed they hadn't let her read her Bible, took it from her, wouldn't let her pray, all manner of horrible things (including claiming that the Devil kept shutting her up when she tried to talk to the workers there). And all she wanted, she said, was peace. Life, peace, and to feel safe.

I felt sorry for her. She wanted help, but she was so afraid. It took me a while, but FNG and I got her calmed down. I got her to feel safe with us. Not hard when you consider we were taking her from a frenetic place with screaming people. She kept calling us her guardian angels that she had prayed to God for, and God told her that He sent her guardian angels. She cried when we left her at the psych hospital, and calmed down when we told her we would visit her if we could, and that she was safe here, and they would take care of her.

As much as I bitch about days like yesterday, when everything in the world goes wrong, days like today remind me why I put up with the shit from dispatch, and the disregard from the company BigWigs. Because I can take a patient who was terrified of the world, and make them feel safe. I can take someone who was crying from fear and turn them into tears of joy, and make them laugh. I can teach a person a very small way to assert some control over their fear, simply by teaching them to control their breathing. I made a difference in someone's life, if only for a very small amount of time. As cynical and jaded as I've become about people and life in general, patients like this really do remind me of why I enjoy this job so much.

And they very often come when I need them most. Like today, when I was questioning my whole plan to become a paramedic, and how could I survive years of dealing with crap like this, only with more letters after my name, and did I really want to do this, and how could I get out of having to do this even part-time. That, my friends, that is fate right there.

And faith. I may have a somewhat twisted view of the world, I may question my purpose here (really, who knows what their purpose is, anyway?), I may be more superstitious than is generally healthy, but I have a firm belief that everything happens for a reason. The fact that I get patients like this, who reaffirm for me that I am doing something right, after I've had days that make me question my continuation in this field, means that Someone up there is telling me that I'm on the right track. I'm doing something right.

I've been told by several people that I have a gift. The gift of empathy and understanding. I'm not sure how much of it is gift, and how much of it is humanity. I've worked with a lot of EMT's in the years, and with many of them, it's hard to believe they mean it when they tell someont to 'Take care.' Is it experience that seperates those with a 'gift' from those who just go through the motions? I don't know. I do know that Bald Partner has the same 'gift' as I am purported to have. He doesn't use his as much, since he drives on every call, but even though he tells just about every patient the same thing, he is sincere. I believe that he really does want them to get better. When we ran the code a few weeks ago, and said goodbye to the wife, he grabbed both her hands and said I'm sorry for your loss. But his words, though cliche, were sincere and you could tell she knew he meant it.

Bald Partner and I have talked about it, and both of us feel that it is a manner of treating every patient as if they were your family, and how you would want a member of your family to be treated. Maybe it is as simple as that.

In other news....a young member of my firehouse (early 20's maybe) who isn't an EMT yet had an exposure a few days ago. From talking to her this morning, there is no info on the patient who gave her the exposure, so they're doing the whole nine yards of prophylactic treatments, as far as I know. I know transmission rate is very low for most of the diseases we worry about, but it's still a scary time.

Toast

2009-07-21T23:17:00.002-04:00

I am toasty. I feel like I'm in exactly the opposite boat as I was in with my last job. The last job was a case of love the company and the people (well, till they laid me off, at least), hate the work. This time it's love the work, hate the company and am ambivalent about the people.

I hate the fact that the employees that bring in the money that keep the company afloat are treated like crap, because there is always more where they came from. My supervisors are blowing sunshine up Bald Partner and my rear-ends, about what wonderful employees we are, and how much they value our hard work and initiative, yet, when we show initiative, the company does not recognize it.

Take this example...The other week, we stopped to get a bite to eat since we had some time. We parked in a parking lot for a college, that had a sign posted for the local bank for no parking. There was NO sign saying that this was for the college only, etc. In the time it took us to run in and order our food, our ambulance was towed. Luckily, a bus driver saw it, told us, and took us to the tow yard, where we met the tow truck as it was off-loading our poor ambo. My partner and I had a call waiting, so I ponied up the $200 to get the truck out of hock, and we went on our way. The fact that we were early for our assigned call is just icing on the cake.

Yesterday we were told that the company would not reimburse us (me) for the expense of paying for the tow. Let me just iterate....that $200, at the measly hourly rate I am paid, is almost 2 days pay. And I am in the highest pay bracket for basics! Yet I was told by my supervisor how much he values us for just doing it and getting the job done. Well, let me assure you, supervisor-man...should something like that happen again (and I will try my damndest to see that it doesn't) I assure you I will do just like all the other crews do, and wait for you to come down to pay for the ambo. Especially since you are so much better paid that I am, and because at the measly rate I am paid, and thanks to the company's refusal to reimburse me, I can no longer afford to do such a thing.

Hell, the company won't even reimburse the toll fees you may have to pay (for the privledge of travelling through Baltimore rather than taking the time to go around it) in the chance that the truck you're in doesn't have an EZPASS. That's pretty cheap if you ask me....Going through the city easily cuts off half an hour or more of time (much more if it's rush hour), and yet we have to foot the bill for the tolls if we dare try to make the company look good.

Today I was paired with a guy, who while very nice, is in a bit of a spot and is in one of those years where nothing goes well. I won't go in to details, but suffice to say, neither one of us was paying attention, and we nearly broke the ambo. Things were caught in time, but the ambo was put out of service, and we took the last, oldest unit left in the bay (everything is out of service). Which didn't have AC in the cab.

Hoping that we still had AC in the patient compartment, and not too worried because most of our patients are elderly and don't like the AC anyway, we took a call for an hour long transport. Again, no details, but the patient was very sick, got way overheated (as did I), and it was all I could do to keep her from vomiting all over my ambo. I tried ice from a cup in a glove (couldn't find ice packs), and water on a sheet to keep her cool, but nothing much was working. It was just to damned hot. I also endured evil looks, sighs, and eye rolls from the patient's family member riding in the back with me. I continually apologized, the entire trip. I apologized as we attempted to find the correct building and endured the snarky remarks from the family member about why an ambulance couldn't find a hospital (because, you know, all ambulances and their crews know every single hospital in every single city, and every building on every single large hospital campus). I continued to apologize as we tried to find elevators, and after we got the patient on the bed. And I meant it. Had that been a family member of mine, I would have been burning up the phone lines about why such a horrible vehicle was on the road..no AC, and can't go faster than 60 mph without vibrating wildly in the back.

I am toast. I am burnt. I am tired of caring, and having no one give a shit about me. I am tired of doing my job, and getting nothing but shit for it in return. I am tired of being used and abused, and of having nickle and dime OT being the norm rather than the exception.

I have 2 more days on full time, and then I switch to part time after vacation. I'm hoping that moving to part time will allow me to take this more in stride, but I'm wondering if I am not permanently burnt on this. I like the job, but I know most of the other companies around here are the same way, so I don't know that I can escape.

Depressing thought...

I'll try for a happier post tomorrow....after all, I go on vacation in 3 days.

Creepy Crawlies

2009-06-27T06:10:00.003-04:00

I've been to some sketchy places in my time. There was the one house from my time in PA, that didn't have flooring through half of it (sub-floor only), and the people had more hamsters than I've seen in a pet store. I've had to disinfect my boots on more than one occasion simply because I stepped in patient's house.

Never had I seen more bugs than in this patient's apartment yesterday.

We had been warned, but the warning never really does it justice. Bugs everywhere...crawling on the floor, the walls, the furniture. All kinds of bugs too...bed bugs (mostly these), roaches, gnats, and I think I saw a few fleas, but I'm not sure. There were also bugs that I've never seen before, and had no idea what they were.

Luckily the ride wasn't too bad, as in long, and the patient was a pleasant man. Ex-Navy, who was so proud of his service that he said that if he hadn't been married, he'd have stayed in permanently. He didn't look his age, aside from the way he moved (arthritis in multiple joints), but was all alone in the world. No siblings remained, and his children and grandchildren were halfway across the country. He had a home health aide, but the apartment manager said they didn't do much, and given the state of the apartment, I believed it.

Still, it was all I could do to not scratch my whole body. The whole call I had the feeling of creepy crawlies all over me. Drove me batty. It didn't help that the building was generally warm, and I had sweat running down my back, which aided the creepy crawly feeling. It took us an hour to decon the unit. My partner just took the cot out and hosed it down, then wiped it down with bleach. I did the same with the stair chair, before we bleach mopped the inside and got the seats and walls with disinfectant spray.

Ugh...I still get itchy thinking about it.

I guess karma does work, because we got to base last night at 1901, and were able to head home. Amazing.

Oh, and for the record....There was never anything on fire. T just wanted to see what the reaction of the BossMan would be.

Funny things

2009-06-26T08:56:00.003-04:00

Several funny snippets of conversation heard yesterday.

T come rushing into the day room at base: Anyone have a fire extinguisher?

Bossman, who comes in at that exact time: Why do you need a fire extinguisher?

T: I can't tell you.

BossMan: Then I can't give you one. Will there be a problem if I can't give you one?

T: Well, if you don't give me a fire extinguisher, we might need something larger....

**********************************************************************************

We found out Michael Jackson died yesterday as we were taking a patient to a stroke rehab place. When we got to the floor, we had to wait a bit, since they had just had someone code, and were taking that patient to ICU. As we were waiting, I asked the nurses if they had heard the news.

Me: Did you hear the news?

Nurses: Which news?

Me: Michael Jackson died today.

Nurses: No way! Get out! Really???

Unit Secretary: Oh My God! Oh!! Oh!! Oh!!!

Me: Are you ok? Do you need to sit down?

Short Nurse comes up and hears all the talking: What happened?

Nurses: Michael Jackson died.

Short Nurse: Who killed him?

I was rolling. So was everyone else. She got mad that everyone was laughing at her. But come on! That's funny right there....

***********************************************************************************

I called Mom to let her know about Michael Jackson.

Me: Did you hear Michael Jackson died?

Mom: No! Really? He wasn't that old. What happened?

Me: Heart attack, evidently.

Mom: Well, they say when you have a heart attack at that age, it's most likely fatal.

Me, thinking, As opposed to all the other heart attacks at any other age?: Well, it's a shame.

Mom: Yeah. Well he was a weird dude, but he had some good songs...

********************************************************************************

In other news, after several weeks of OT and working late, Bald Partner and I have gotten off shift early the past 2 days. Wednesday was a long distance trip to the outer edges of MD, which took just about all day. Yesterday was a 'busy day' (we didn't really see a difference), and we thought we'd be running late. After our last call, which ended about 1815 or so, they nearly sent us up to Baltimore, but someone must have had an attack of the smarts at dispatch, because we actually were told to disregard and head back to base.

I'm expecting today to be a late day, since we've been pretty light the last few days.

Errr...say again?

2009-06-21T20:54:00.003-04:00

So last week, my partner and I did a late transport that was made later by some crap at the hospital. We cleared the call at a few minutes after 1900, which is the end of our shift. The dispatcher got on and said I need to you do a pick-up at Hospital X. We looked at each other, and Bald Partner got on the radio and reminded dispatch that we were at the end of our shift. Her response? Well, I'm stuck with the call, so you don't have a choice.

We called our supervisor and asked for clarification, and decided to be nice (though the dispatcher had been snotty) and take it, since it was on our way home. The fact that we had other issues (the clipboard is a piece of crap that won't hold paper, and when we grabbed the clipboard some of the paperwork fell out, necessitating a trip back to the hospital and then back again to the nursing home) meant that I didn't get home until 2230. I hadn't eaten since 1300, since we aren't allowed meal breaks, and have to eat on the road on the way to or from a call. BossMan said that he would get back to us with the policy on taking calls after shift.

Two days later, BossMan gets back to us with the reply. As long as you are in a unit, and not at base, dispatch can put you on a call and you can't refuse. Since we don't ever get back to base before our shift ends due to traffic and other problems, this means that the only thing allowing us to go home in a timely manner is the good graces of dispatch.

Is this standard procedure for other companies? Because it seems pretty sketchy to me.

Dichotomy

2009-06-18T22:31:00.002-04:00

As promised...a little late since tonight is the first night I got off shift at a relatively sane hour in several weeks.

A few weeks ago, we took a patient home from BMH (Big Military Hospital). It was hot and humid, and his apartment had a total of 25 or so stairs to navigate, from sidewalk to apartment. We used the Reeves, since he was weak and we weren't sure of his ability to maintain an upright posture long enough to get him upstairs.

So, before we leave any hospital to take a patient home, I make sure to ask the nurse if there is someone home waiting for them. I would hate to take a patient (especially one who can't really care for themselves) home and leave them alone. The nurse in question for this particular patient called the apt and got no answer. Several calls later, the social worker avowed that she had spoken to the wife, and that she was home. OK, so off we went.

My partner usually runs to the house to prepare the way for whatever form of transportation we are using for the patient. It took him a while to come down from this one. Mrs Patient had been asleep. Ok...

So up the steps we go, with the patient in the Reeves, and his wife chattering at us the whole way (btw...wife was easily 30 or more years younger than the patient. Not judging...just sayin') about how we have to be careful, and how much work she has to do with him, and so on. Again, temp is around 90, and there is no AC in the building. Bald Partner looks like he's taken a shower with his shirt on.

We get up and get him in bed so she can 'clean him up.' She's trying to clean him up, and is ignoring my attempts to get her to sign my paperwork. Then the phone rings, and she answers that, flopping down on the couch to argue with the daughter who is screaming at her that the man needs to be in a home (I'd say he does), and so on. She hangs up, and goes back to the patient, ranting all the time about the daughter, and how much work the patient is and so on. She talks to him roughly, and treats him roughly, pulling him around to work all the sheets out from under him.

I finally get my signatures (after she ignores what I'm saying about signing her own name because she's too busy complaining about how much work he causes her) and escape to the AC in the truck.

Compare that to this on the same day:

Elderly man from BMH, also going home. The call home is answered by the wife, who says that she is there and waiting anxiously for him. We arrive, and are met on the street by the neighbor who cuts their grass. He takes the bags of belongings for us, and my partner makes sure we can easily get around the house. We get the patient inside (less stairs, plus ability to use stair chair), and while he's debating where he wants us to get him to, his wife nearly pushes my partner out of the way so she can hug him. The patient decides to go to the bedroom, where he has a chair in front of the window AC unit, and can watch TV. We get him in there, admonishing him to be exceedingly careful when he gets up, get our signatures, and leave with the sound of the wife, patient and neighbor thanking us. As I'm leaving, I hear the wife asking her husband if he's hungry, and does he want a sandwich.

Amazing to me. Two families, just a few streets apart, just a few years apart in age (well, the patient's at least). And yet such a dichotomy of reactions, I'm left fairly stunned.

As an aside, we took the first patient back to the hospital this week. He was moderately stronger, so we used the stair chair this time. Thankfully, it was also much cooler. The ER at BMH knows him and his wife well.

***********************************************************

In other news, my new netbook came today! I got it for school, so I don't have to keep removing our primary computer, and so that Fiance can have a computer when he gets home from work should I need to crash at school one night. Now all I need to do is switch out the hard drive in it for a slightly larger one. I don't think I'll be doing this on my own. Foo has great computer foo. I'll get him to help me tomorrow when we go to install the window AC unit in their house. Their HVAC went all kerflooey.

I had a post

2009-06-15T21:39:00.003-04:00

I had a post, about the dichotomy of 2 patients who seemed similar enough to each other on the surface, and how different their home lives were. But it's late, and I need to go to bed.

I have a blister on my hand, just inside the webbing between my thumb and index finger. You know, the place that gets all the pressure when you grab things. Yeah. It sucks.

Today was, thankfully, a light day, in terms of calls. One round trip (which technically is two calls, since you have to do the paperwork for the return trip) at 1300, and then one at 1700.

Unfortunately, the 1700 call was for a bariatric patient. Evidently, he wasn't bariatric enough to require the special unit, so all we needed was the wider stretcher. So we pick up the stretcher, run some errands, and head to the hospital.

Except the genius on dispatch at that time gave us the wrong room number...a number that doesn't exist in the hospital. Add 30 minutes to drive to a different building thinking it's there, and then back to the main building with the correct room number.

Anyway, we needed some extra hands on this one. Dood was 375lbs. Add the 50-60lbs of the wider stretcher in there, and you have me and my partner attempting to deadlift about 215lbs each. I think my max deadlift (one rep, max weight) is about 150lbs. I'm no slouch. But when I tried to pick up my end of the stretcher today, I didn't move it. I don't mean it moved, but I couldn't lift it to drop the wheels down either. I mean it was like a cartoon when the character strains and strains but doesn't move the boulder kind of thing.

But seriously...Dispatch really needs to arm us with the correct info. I mean, come on...this kind of weight is break-your-back-and-go-on-disability-forever kind of stuff. My partner, who is pretty damned strong and can lift a lot of weight, had issues lifting the back end to get the patient in the ambulance. And that was with part of the weight supported by the truck!

FUNNY!!!

2009-06-12T23:51:00.003-04:00

Bald Partner and I saw this on ESPN as we were waiting for lunch at a wing place today.

Flash mob

Some days...

2009-06-12T23:23:00.002-04:00

...I love this job.

I was hugged by a patient's wife today after I brought him home and got him in bed, after Bald Partner and I made damned sure not to knock over any of her knick-knacks or put dents in her walls and woodwork with the stretcher.

Some days I love this job.

Even when I nearly punched a nurse today.

I really don't care how tired you are. I really don't give 2 shits about the fact that you are technically off-shift. I will even let the rudeness you showed me by not giving me report (when we showed up 5 minutes before the end of your shift but you were busy) and then repeatedly telling me that you were off-shift and trying to pass me off to your replacement (who had yet to get report from you). I'm trying to be understanding about you being tired at the end of a long day, and that you are probably way over-worked. You may even have to go pick up your grandkids or something, and the traffic is going to be horrible, etc...

But when you are brisk and rude to a patient, and tear her onion skin when taking out IV #1, and then wipe the open sore with an alcohol swap, I lose a lot of my understanding. When you roughly handle a patient and repeatedly dig at her skin, trying to pull off the tegaderm covering IV #2, and you bring tears to her eyes and make her cry, I start to get angry.

Constantly talking about how you're not supposed to be here and you're so late and you shouldn't have to do this IN FRONT OF THE PATIENT, while you're TEARING AT HER SKIN AND MAKING HER CRY makes me want to throttle you. Finding out later that the large bandage on her OTHER arm covers a wound ALSO caused by you makes me want to get you fired.

The fact that the patient involved is not only a veteran, but a fellow nurse, makes it even worse.

You clearly can't do much of your job anyway, since you had another patient who needed to go to radiology earlier in the afternoon, and you got him ready to go at 1700.

I said something to the charge nurse on the way out. Be thankful that the patient thought you were 'a good nurse,' because I sure as hell didn't think so. She requested that I not file a formal complaint, though I'm still seriously considering it. It's already written up. My partner is all on board with it.

Still, I made that very same patient smile several times, and even laugh as well. I made sure she was comfortable, especially since moving her to the stretcher caused her to cry from chronic pain. When I said goodbye to her, she said thank you, and meant it. I could see it in her eyes.

Some days I love this job.

Even when the social worker at the emergency psych clinic tells me I can't look at the notes of the patient I'm transporting because of 'patient confidentiality' (as if my partner and I are not fellow health professionals), and that WE were not the company she called, and this is how Other Company does it and that should be good enough for us. And she won't tell me the patient's medical history, medications, allergies, etc. She won't even tell me if this is a voluntary or involuntary commitment (it was involuntary, btw).

Even when the patient starts to get aggravated because we didn't take him to his house. He didn't start swinging, and he quieted down nicely when we told him we were stopping here for a bit.

The nurse at the in-patient facility thought the behavior of the social worker at the emergency center was extremely unprofessional and disrespectful, and was very nice to us, explaining many of the procedures she had to do while we waited with the patient.

And on top of it all, we scored 2 hours of OT.

It was a good day.

Too much of a good thing....

2009-06-09T22:39:00.002-04:00

I don't mind OT, really I don't. After all, money is money. But 2 days out of 7 (so far) where I got off on time is beginning to become a bit ridiculous. I submit (once again) that dispatch really needs to learn about traffic in the DC/Baltimore Metro areas.

Today my partner was off, doing his interview for the Balt. County FD. Hopefully he did well. I got to work with someone else, which was nice, but I do miss my partner. It was nice to have someone driving who knew their way around though.

This morning we took a young woman from DC to Baltimore for in-patient psych treatment. She was deaf, and was able to read lips only if I spoke very slowly. I was able to sign a bit (I know the alphabet and a few things like please, thank you, sit, hungry, etc) but I felt really bad for not being able to talk to her effectively on the hour long drive up. I always wanted to learn sign language and just never have. Perhaps something to do when I'm in medic school?

Because, you know, I won't have enough to do.

We had some pretty gnarly storms here this morning and evening. The morning ones woke me up, and I realized just how scared poor little Kaylee is of thunderstorms. She's actually almost as afraid of the lightening as she is of the thunder. I really need to start working her. She's beginning to get those neurotic border collie characteristics, and that needs to be nipped in the bud.

The evening storms caught us as we were leaving Baltimore. Heavy rain (the kind you can't see through), winds, lightning, hail....it was crazy. Add that to the fact that the GPS took us through Baltimore (though I'm not sure the highway would have been much better), and the O's were having a game tonight, and you can understand why I got almost 2 hours of OT tonight. It makes up for the half hour I got off early last night.

I went to the firehouse last night and started getting stuff done for my 'probie book.' It's not hard, and the other EMT's find it amusing to be asking me things like 'change the O2 bottle,' or 'demonstrate use of the portable suction.' All I really need to work on is where things are on the ambo. I was planning on going tonight, but with getting home so late, I really didn't want to. Hopefully tomorrow night is better.

And now, bedtime. Got lots to do tomorrow before work.

More stuff

2009-06-07T22:14:00.003-04:00

A second post in a night, but mainly because I'm still quite irritated about the whole dispatcher thing the end of last week, and if I end on that note, I'll be too irritated to sleep well tonight.

Friday my partner and I picked up an hour of OT before our shift started. We were told it was a standby for a PSA against smoking. We figured we'd sit around for a few hours, listening to the radio and reading or whatever.

We were wrong. It was for a video against smoking, and my partner and I were playing EMT's. Three hours of pulling the cot in and out of the ambo, picking up a 250 lbs guy on the cot (about 7 times), and then putting him back in the ambo. In the rain. All in all, it wasn't bad, and it was an hour of OT.

This week I think I only got out of work on time once. Thankfully it was a Thursday (Thursday's are practice days). I'm a firm believer in OT, but it was a bit ridiculous. Then again, I probably won't think so when I get my paycheck on Friday. Which, I might add, is now on direct deposit, which means that my bank SHOULD be giving me an extra $75 for it. I'm not complaining.

I really like my partner, aside from his total inability to pay attention to the GPS, or my directions. His sense of direction is suspect, but he's a good guy. We agree on a lot of things. This week, while listening to news radio (around here, you live by 'Traffic on the 8's' on the local news network starting around 2pm) we heard the story about the couple who spied for Cuba for 30 years. My partner's repsonse? 'Fuck 'em! That's treason, and they should be killed for it!"

I do like the job, really I do. I like the patients, and talking to them, and learning about them and their life (well, at least the one's who can talk). I get infuriated at the often uncaring nurses and doctors that the patients and their families have to deal with, and I help when I can. But the stupidity on other levels of this job drives me up the wall. Such as being sent 50 miles out of town during rush hour an hour before we are to get off shift, and having the dispatcher say "ok" when we tell her that traffic will prevent us from getting out there in less than 2 hours. On our way, we are asked if we have a pulse ox (we don't...they are too expensive to waste on BLS units, so only the ALS have them due to the LifePack 12's). She gets back to us just as we get off the highway, to tell us that we are cancelled from the call, due to the fact that the patient 'requires a pulse ox, and that's an ALS skill." Insert massive eyeroll here. And here we have another reason why I like my partner...he shares my distain for the medical community's insistance that the pulse ox is required and valid no matter what. At any rate, we swung by an ice cream parlor before heading back, since it would be another hour back to base. Without traffic.

I do enjoy it, but I miss emergency calls. Waiting around all day in a truck, waiting to shuttle patients from one place to another is boring. I like the patients, but it's really not enough. I wouldn't mind doing this job as a second, part-time job, but to do it full-time, all the time...nah. I just don't have that temperment. I find myself repeating the mantra "just till August, just till August." Luckily, given that I have a lot to do between now and August, and that I have a 2 week vacation coming up in late July, early August, the time should pass very quickly. And I've joined up with a fire station near the house, so that might quell the boredom a bit.

I still have to talk to the bank about a loan for school, and pay my bill. I have to register for my classes and buy my books. I also have to get things made and fixed for my vacation.

I really would like to take Krav Maga. Right now I just don't have the time, and when I'm in school I won't have the money.

I got invited to take the Phase 1 test for the FBI. Gotta take PTO for it, but I might be able to make it up with some OT on the weekend. I'm not sure how I feel about it, but I'm pretty sure that the process takes a long time, so school will likely be finished anyway. Although, given the current state of affairs at the DOJ, I'm not sure that it's something that I really want right now.

Random thoughts on a Sunday night...

A letter to the dispatcher...

2009-06-07T21:52:00.002-04:00

I understand that you are 2.5 hours from us. I know that you have never had to drive in DC. I know you have a job to do to send us on calls.

But it's a rainy Friday afternoon in DC, when it's predicted to be a gorgeous weekend. We had to get from the top-side of DC to the middle, including getting fuel along the way. You did NOT send us a page for the call, you just told us to head to Virginia. You did NOT tell us we were going to be put on a call.

Therefore, when we are attempting to make our way through a mile long back-up of traffic, calling and copping an attitude with me is NOT a good idea. Telling me that you don't believe that it takes near an hour to get from where we were to where we are now (including filling up the tank with fuel) is an especially BAD idea. Then, when I request the page for the call, you say "Don't tell me that you're claiming now that you didn't get the page," really makes me pissed off beyond your ability to understand. You should bless my partner, who kept me from ripping you several new assholes over the radio.

This occurred a day after the same dispatcher got mad at us for 'taking too long' at the hospital because the patient was non-verbal, and we had to get information from the wife, who took a bit longer to get to the hospital. Then sent us to another hospital, but did not send us the page. We tried to call her for 20 minutes, and got no response. We had to call our supervisor and have him call dispatch in order to hear from her. And when we finally got the page, it was incomplete. We finally got the whole page, and found that it was wrong, and it took her another 20 minutes to find out where exactly the patient was. This of course was after she got an attitude with me again, wondering what we had been doing, and why we hadn't found the patient yet.

It seems that my partner gets a better response from her than I do, even when I really am trying to be nice.

I don't deal well with stupidity. I deal less well with it when it's coming from someone who is supposed to have the information I need.

I REALLY don't deal well with people calling me a liar.

She used to be on night shift, which meant that I only had to deal with her for an hour or two. Now, for some reason, she's on day shift, which means that I have to deal with her all day.

I'm letting my partner talk to her from now on. I don't think I can have another day like Friday, or I may drive up to Philly and try to smack some sense into her myself.

Heros and Villains

2009-05-29T08:30:00.002-04:00

I met both a hero and a villain yesterday. First, the hero, because he deserves higher billing...

We took a patient to Military Hospital yesterday from his home, for some wound care. He is a WWII combat vet, and a holder of the Purple Heart. As he tells it, his unit was searching for some downed pilots in the jungles of some Pacific island when he was shot in the leg. His leg essentially had a hole in it, with all kinds of fun stuff hanging out of it. He says he got shot around noon, and his unit helped him splint the leg, and fashion a crutch out of bamboo, and they continued on. They were held up by a Japanese ambush patrol, but were saved by another unit who ambushed the ambush. He finally made it to the field hospital around 6pm, where doctors argued over whether or not they could save the leg. They decided to try, and just cleaned it out, put sulfur powder in it, and put a cast on it. Two months later, he developed an infection and they found that maggots had gotten into the cast, which is pretty gross till you think that the maggots cleaned out all the old, dead flesh, and left the new growing flesh. This soldier spent a year in and out of various hospitals until he was given a medical discharge.

This is even more impressive when you consider that this man had already served his time in the military before the war, and then decided to sign up again to fight in the war. Not only that, but he had to go to Maryland to sign up, because DC did not allow any of it's residents to be deployed (something about retaining a protective force around the nation's capitol).

Think about all that for a second. You are searching for some downed pilots, get part of you leg shot out, and walk for 6 hours in the jungle on that leg, avoiding enemy patrols, and ambushes. You finally make it out, and the doctors want to take you leg. They decide to let you try to keep it, but wait another 6 hours. That's 12 hours with a giant bullet hole in your leg, folks.

There are so few WWII heros left. I was lucky that this guy was completely coherent and able to tell me his story. So many of the other WWII vets we transport aren't that lucky.

Now for the villain...

We were in Big Government Hospital, waiting by the elevator to go upstairs to pick up a patient. We were waiting patiently, and had already been waiting about 5 minutes. One elevator was down, and it was a busy time, and with all the wheelchair-bound patients, the elevators were filling up quickly. A woman in a wheelchair came up to us, and said 'You're blocking the elevators,' (you know, because we were standing there for no other reason than to block the elevators) to which my partner replied, quite nicely, 'Well, we're waiting for the elevator.' The woman then went on to loudly complain about the elevators here at BGH, how they never worked right, etc etc.

Then she proceeded to make comments about us. I'm pretty sure she wasn't speaking to anyone in particular, but said 'These people think they're more important than the patients, but they're not.' Then she said 'If they think they're getting on before me, they better watch out.'

We didn't reply, because there wasn't much point in it, and because there was a huge crowd there, but it really irritated me. We had been letting patients and people go on before us for about 10 minutes, making us late for our pick-up, because we well know that a stretcher takes up a lot of space, and the area was very busy. The fact that she came up after we'd been standing there for 5 minutes and started making those comments was totally uncalled for and I really was tempted to say something, but couldn't think of anything sarcastic and nice enough to say that wouldn't leave us as the 'jerks verbally attacking a patient in a wheelchair.' But I just really don't understand the point in making those comments, and then continuing to make those comments. Which I think is what makes me the most pissed. Why be so mean and bitchy to random strangers who are trying to do their job and help your fellow patients? Do you feel that insecure in your position as a patient that you have to run down other people? Or did you just need that elevator THAT much?

Of course, this is the same person who would complain and bitch at us for being late to pick her up if she had needed transport, I'm sure.

Partner

2009-05-27T22:24:00.003-04:00

I like my partner. Truly I do. He's a nice guy, despite his insistence that we listen to R&B all fucking day! We get along fairly well, and while I don't see us getting to the stage that Epi did with her partner, it's not a bad deal.

However, my one beef with him is about driving. He generally does all the driving, because, quite honestly, I have a hard time seeing over the dashboard in the driver's seat (it goes up a bit, which obscures my view of the front of the truck, which makes me uncomfortable). He brakes a little hard for my liking, and takes corners a bit hard as well, but that may also be the difference between an ambulance and a van-bulance.

But where I really get annoyed with him is his following directions. Or rather, not following directions.

To be fair, he does know his way around DC and some parts of MD much better than I do. And we do have a GPS for most things. But he consistently misses the directions the GPS gives, and we end up turning around because we passed the nursing home or whatever (usually with the patient on board). Today, we had to find our way out of a neighborhood. I set the GPS to head to the local hospital, telling him to just use it to get out of the neighborhood so we could get back to the highway. He called me to the window because he got turned around twice, taking my directions for getting on the highway, but then listening to the GPS because it was telling him to turn around. No biggy, as I knew where we were and easily got us back on track.

Then we were getting close to the destination hospital, and I knew exactly where we were going, so I told him what exit to get off at and so on. We ended up on a different road, totally lost, because he saw the hospital off to the side and thought that's where he needed to go. Fifteen minutes later, we finally made it to where we needed to go.

I really wouldn't have minded so much, except that the patient was having some respiratory issues, and we really needed to get where we were supposed to be.

All that said, I really do like the guy. He just really needs to listen to my directions when I say I know where I'm going.

All else is on the GPS.

By the way, I have joined the darkside and moved to smugmug for my photo needs. Picasa was nice, but I'm at 99% of my alloted space, and smugmug is unlimited. It also has some nifty features I liked, and it's relatively inexpensive, especially with a promo code from a friend.

http://gnomish.smugmug.com

Some of the people I meet

2009-05-26T21:35:00.002-04:00

First some house-keeping....I finally saw that I got comments! w00t!!! Unfortunately, I can't seem to find the button that sends me a message when I get comments. Help, anyone? (I am so illiterate at some internet stuffs)

Anyway, a good deal of my patients come in vegetable form, but I do occasionally get those that are alert and oriented x 3. The other day I had a gentleman who had worked as a technician for the FAA, and had traveled all over the state testifying in various state courts for an organization against rape crimes. Not because he personally knew someone who had been raped and murdered, but because he heard about the crime against a bright, beautiful young woman, and felt so strongly that he just HAD to do something. He was bed-bound due to a previous stroke, and yet his mind was as sharp as any I have ever encountered. I truly believe what I told him...That he had experienced and forgotten more history than I had learned thus far. He laughed.

Then I had another gentleman with whom I had a very interesting conversation about politics. It started about 2A rights, and extended into politics in general. I gave him some websites to peruse, which he said he would when his wife wasn't home, since she didn't like him reading political stuff, as it made him angry all the time. (heh)

I had an elderly woman who had grandchildren and great-grandchildren in abundance, who were coming to visit her for Mother's Day. We talked about her children and them visiting her in the hospital. When we left her, she wished me a Happy Mother's Day. When I told her I wasn't a mother (aside to my dogs), she said that she wished it to me anyway, since she wouldn't be able to wish it to me when I did have children.

I had a patient who lectured me on my 'adventurous ways.' He countered my complaint that C doesn't want to come rafting with me because it's too dangerous with evidence from his friend (who fell out of a raft and hit his spine on a rock, becoming an instant paraplegic). It doesn't make me want to go rafting any less, and I felt horrible leaving him in the absolute HOLE of a nursing home he was stuck in.

The patient's family is also very fun. When I was still 'training,' a patient's wife and I had a long conversation about anything and everything while we were stuck in traffic and then taking a detour to her house.

On the other hand, dealing with people all day, everyday, is taxing my poor, introvert brain. I had thought originally that C was the one who had a bit of a stabilizing effect on my temper (and the judicious application of the hormones from the birth control I started taking about the same time). Now I'm wondering if it was the lack of 'people' in my day. In the lab, I could escape people fairly easily, and most of my co-workers knew that I didn't like people much, and left me alone.

Now that I'm back in an ambulance, I'm finding that my road rage is back, although it is still somewhat less than it used to be. Perhaps I'm finding balance.

Do the Shuffle!

2009-05-26T09:03:00.003-04:00

Though I may bitch and moan about doing the interfacility shuffle, I'm still thinking it's better than the lab job. I do like the patients. However, my tolerance for stupidity is getting less and less, especially in regards to dispatch.

See, our 'area of operations' is DC and Baltimore (more DC than Baltimore, truthfully, but we do venture up there about once a week). Evidently, years ago, we had our own dispatch, in DC, which makes sense, since movement in a vehicle around DC is only understood once you've experienced it. However, because it made sense, management decided that it must go, and dispatch was moved to Philly. None of the dispatchers in Philly have been to DC, let alone driven around here.

Are you seeing where this is going?

Now, I have to say, I totally understand the difficulty dispatch has. They have to send a truck, and while they try to be nice if we are coming to the end of our shift, sometimes they just don't have a crew to send to cover a call, and the board is full up for the next shift. And most of the time, I don't mind...Overtime is overtime, after all.

However, calling us at 1700, when we are well off the beaten path (meaning the Beltway) in VA, and telling us that we have a pick-up at 1800 up in MD, halfway to Baltimore, is not an efficient use of crew resources. In normal traffic, that trip would take about 45 minutes. However, in beltway rush hour traffic, that is a 2-3 hour trip. When dispatch then calls the crew at 1810 asking for an ETA, and the crew says 'We're sitting in pretty heavy traffic, and we haven't made it to MD yet, so probably another hour and a half to 2 hours,' it is not conducive to have a crappy attitude over the radio. The crew was not being snotty, and the sound of the dispatcher (who is 2-3 hours away, sitting in A/C, NOT in a hot truck in miles of traffic) sighing heavily into the radio and saying 'Well, just do your best,' is not in the best interest of crew morale. In fact, perhaps checking the internet for traffic in the DC area (which is easily found via several websites) would be a better use of time.

Or perhaps, when the crew says it will take another hour and a half or more to get to the destination, and it is close to the end of their shift, finding another crew who could get the job done in that same amount of time would be a better use of crew resources.

Or, as I've said before, perhaps having dispatchers spend some time in the field with crews, driving around in the traffic here, would give them an understanding of why it sometimes takes 2 hours to go 15 miles.

Or perhaps not...

The new puppy

2009-05-17T18:35:00.003-04:00

So, we adopted a puppy because I wanted to try working her in SAR. She is a 6 month old black lab and border collie mix. I'm not sure how well she'll work out though. She loves kids, and loves men, but she's very submissive to women, which concerns me a bit. She listens to both me and C equally, so that's not really an issue, but she just seems to be on guard all the time around women.

So far, she mostly knows 'sit' and is working on 'down' which is coming along. She's pretty good about her recall, although, like any puppy, she isn't really good about it when she's distracted by something (which is true of any of the commands...something we're working on). She is a bit of a jumper, and C and I really have to stop allowing her to jump on us, except when she's given the command 'up.' She's mostly house-trained, but if we don't notice her at the door to go out, she'll pee on the carpet. But she doesn't have a good tell, so it's hard. And annoying.

I go to my first SAR training next Sunday. Well, not first, but first in several years. I'm looking forward to seeing many of the people again. I had gotten out of it when I went to nursing school, because I just didn't have the money to drive all over creation. Plus, they didn't have any provisions for someone who didn't have a dog. Now I have a dog, so we'll just have to see if she passes their evaluations. If not, I'll just have to work as a walker until we move to a bigger house and I can get a dog that will work out.

Of course, we haven't payed for the new puppy yet (her name is Kaylee). I keep trying to get the woman in the rescue organization to email me her address, but she keeps forgetting. I need to call her again.

She and Kobe get along well, except when there is human food involved. But she is getting a bit better about that as well, and there is much less snarling when an event occurs.

Any way, here is a picture of Kaylee, and the bottom one is Kobe.

It's raining again...

2009-05-14T21:59:00.002-04:00

It's raining again. At least we had 2 or 3 days of spring, right?

Today was a rare day, and made the earlier (more horrible) part of the week seem like a distant memory. I made it a late start, but got there in time. MB, the supervisor, gave us his favorite truck, which was clean on the outside (OMG!!!) and mostly clean on the inside (double OMG!!!!) No crumbs on the floor, not a whole lot of trash inside. Wonderful.

Dispatch posted us to the VA. Of course, the day I bring my lunch. But we were able to go to my favorite deli in the city, and get lunch, which we then ate in our new favorite spot when posted to the VA.

I love the National Shrine. Easier to access than the National Cathedral, and they have a free parking lot across the street.

So, we got to eat lunch. Aside from a brief attempt from dispatch to give us a call (it was out of Virginia, and we are not yet certified as EMT's there), we were undisturbed for almost 2 hours. We got a call for the VA, but when we got there, the patient decided he didn't want to go (evidently, you can do that in the VA). So we left, and told the nurses to call dispatch back when they had convinced the patient that, yes, he really did want to go home.

So, back to our spot at the Shrine. We watched a collection of older middle school (perhaps young high school) students from Wisconsin get off their coach bus and head towards the Shrine. Which was interesting, considering there is a road between the lot and the Shrine. Not an overly busy road, mind, but not one I would like to cross with a butt-load of teenagers. Not to mention that buses usually drop off their charges in front of the shrine and then come over to park.

We got another call at a nearby hospital, for a patient to go to a place down in Virginia. At 1600. In DC. Needless to say, traffic was a bit of an issue, and, though we got off the floor in record time (all the paperwork was done and the patient was ready!), it still took us till nearly 1800 to get to the rehab place.

Dispatch decided to be kind to us, and let us head back to base. Considering the traffic, we made decent time, and got back to base EXACTLY at off-time.

My dogs are crazy. The puppy still occassionally attacks Kobe for sniffing at areas where she has eaten people food. She hasn't done it in weeks, yet she did it tonight. I have no idea why. Perhaps I could ask the vet when I take her in next week. Still, they have been playing and such for the better part of the last 30 minutes, so I can't complain. They do get along fairly well.

Company comes tomorrow. I have to finish cleaning. Unsure of what we'll do this weekend, but if the weather is as bad as they say (all rain, all the time) I'm leaning towards something inside. Perhaps climbing?

Insurance stupidity

2009-05-13T22:53:00.003-04:00

I really wish I was better able to put my rants into eloquent words. I just always feel like I'm ranting aimlessly, not doing much to effectively put my thoughts into words. But whatever....I'm still doing it.

SO the other day we got a call to take a patient from the hospital to his house. I wasn't sure about this one as soon as I walked on the unit, and checked on the patient's room. I could hear him breathing from where I was in the doorway. Even the nurse's were saying that the man needed to stay in the hospital. No home health care, no home O2, no home suction....and only his equally elderly wife to care for him. The patient was bed-bound, and pretty much awake, but un-responsive. The nurse had taken off the O2, and the patient had developed what I call the 'fish-eye stare;' the stare of someone who doesn't have enough O2, and whose brain is shutting down due to lack of oxygen.

So why was this man, who so obviously needed to still be in the hospital, being sent home, especially to a home that was not equipped to care for him? Because his insurance had decided that they were no longer going to pay for his hospitalization, and had cut off payment at noon that day. Therefore, the hospital was sending him home. Our company would take him home, and charge the insurance company for it.

We managed to finally get him home (see previous post rant on nurse's not having the patient ready to go when we get there), to a house that was supremely unfit for a person who is constantly ill. His wife, a tiny woman who 'had a cold' apologized for the state of the house and how it had been built years ago, before anyone thought of disabilities. I had put the man on O2 on the way over, just to give him a chance at staying home a little longer, but I would bet my next paycheck, his wife called 911 not an hour after we left.

So, let's add things up. Insurance company pays for X number of days in hospital, and won't pay any more. Patient requires more hospitalization, but is sent home because insurance won't pay for more hospital time. Private ambulance company take patient home, and charges insurance company. Patient needs more time in hospital, so 911 is called, who comes to take patient to hospital and (most likely) charges insurance company again. Patient is taken to ER, who charges insurance more money to see the patient, and treat him, and bed him until another bed opens up on the floor. Patient goes up on the floor, and stays until insurance stops payment again. Or until the patient is healthy.

Or until the patient dies.

Rinse and repeat, ad nauseum.

So you can see my irritation here. I've ranted about insurance companies before, though not here, and their ridiculous policies that have no relation to reality. One example is my old insurance company's policy that physical therapy is limited to 30 visits, regardless of medical need. So, you know, don't have a stroke, or any other serious medical issue that may require extensive therapy to recover from.

It is my firm belief that anyone who works in the policy making department of an insurance company should be made to spend time with EMS crews (both public and private), and on the floors in hospitals and in ER's, so they can see what happens in the real world, as opposed to some mythical virtual world where everyone is magically healed after X days, and there are never complications.

After several days in the new job....

2009-05-11T21:59:00.002-04:00

And I'm still pretty sure it was better than the old lab job.

My shift gets more OT than pretty much any other shift. For some reason, dispatch can't ever find any other ambulances for those 1830 transfers, so we get snagged for it. Which of course, puts us late. Usually, really really late. Like 2 hours late.

Still, we got off early tonight, so it's not so bad. And only 2 calls today.

Ok, so a new pet peeve of mine, based on the things I'm learning on this new job. If you, as the nursing staff, or discharge planner or whatever, call my dispatcher and tell them that you want an ambo for a transfer at a certain time, it behooves you to have ALL the paperwork ready by that time. Don't wait till zero time, and then panic when you see us and run around like a chicken with no head and try to get the paperwork together. I WILL stand at the nurses station and stare at you. I WILL tell anyone who asks me if I've been helped that I'm waiting for YOU to get the paperwork together. My patience is rapidly beginning to run out, and I WILL start calling dispatch and telling them that you are NOT ready. This may cause dispatch to start tendering our call times to give you that extra time you so obviously need to get that paperwork together. Since, clearly, it is hard for you to get the paperwork organized in the 6 hours between the time you learn that the patient is leaving and the time that I show up.

My company is starting to track times. It seems that my partner and I consistently get the calls where we show up and the nurse for X patient is at lunch, and no one knows what is going on. Or the ones where the nurse doesn't have the paperwork together, or the patient has to finish dinner, or the medicine hasn't come up from the pharmacy yet, or it's shift change and no one will talk to me because they are either giving or getting report. This will screw with our times. We also, working the 11-7 shift, consistently get the longest transports that take us through the worst traffic.

Still, it is better than being a lab rat.

Another rant to come tomorrow on the idiocy of insurance companies, and how it is stupid to allow people with a BA in business to determine medical policy.

But now...

GO CAPS!!!!!!!!

New Job, different from the old job...

2009-05-03T22:11:00.002-04:00

Well, I started the new job on Friday. Thirteen hours in the back of a small ambulance without A/C on a muggy, rainy day. Lovely. I'm pretty sure it's still better than the desk job. We actually only ran 4 calls in those 13 hours. Transport only is a bit boring, and I wasn't too sure about some things that the guy I was riding with was doing, but since the appropriate equipment was in absence, I have to figure that it's how most of them do it. A little sketchy to my taste, but I suppose I can do things 'the right way' when I get cut loose. My new schedule will be Mon-Fri, 11a-7p, which isn't horrible, but I had been hoping for a fewer day, longer shift schedule. Still there's time to change, and the only other shifts available involved weekends, which I just really can't do.

On the other hand, in August, I'll be starting paramedic school. I applied and was accepted. Getting laid off is scary and unfun, but I took it as a chance to do what I've been wanting to do, and talking about doing for years. The fact that I went on several interviews for science jobs, and never got a one (even the one I was sure to get, due to lack of grant money) makes me think that this was one of those 'meant to be' things. Sure, the pay is significantly less than what I was making, or what I could be making if I had stayed in science, but money isn't everything, and I'd much rather be shuttling patients back and forth from hospital to nursing home and back again than sitting at a lab bench, shuttling chemicals from beaker to beaker.

In other news, we got a new puppy. I have to call the woman to get her address for sending her the check (it's been a 2 week trial thing to make sure she'd work in our household, and with our other dog). Things are still a bit sketchy at times with her and the older dog, since she is a total puppy, but she's a quick study, and most of the issues we had were more related to her lack of socialization with other dogs than actual aggression. I'm hoping she'll work out for SAR.

Why do they air commercials for Sonic, when there isn't a Sonic around here for miles and miles (and hours)? Why do they taunt me so????

It's been a while

2009-04-08T23:08:00.002-04:00

Yeah, I've been away. Not long after my last post, I was laid off from my day job. While I was only mildly surprised (things had been rather hinky of late), I was upset, at my loss of income, mainly, but also at the loss of daily contact with a bunch of people I genuinely liked.

Once the first wave of being upset subsided, I realized that this was an actual, dyed-in-the-wool golden opportunity. For years, certainly since I got back from Antarctica, I had been talking more and more about going back to school to get my paramedic cert. Something always held me back, usually the fact that I was earning money and paying off bills, but also the fear of not having a job, not having an income, and leaving my work friends. Being laid-off took the decision out of my hands.

So, aside from having to find one more EMS recommendation for school, I have applied to paramedic school, and, provided I can get that last recommendation filled out, I will be starting in August.

As for paying the bills, I have interviewed for several scientific jobs, and yet haven't gotten an offer. Even the interviews I thought went well haven't yielded an actual job. So I'm taking it as a sign that I'm supposed to go to medic school. As such, I applied to a transfer ambulance company, and had an interview today. I was told by the managers that I should get a job, and they'll be calling me in the next week or so. The orientation class is expected to start the 22nd of this month or so. They claimed they are flexible with schedules to accommodate classes, and while the pay isn't near what I was making as a scientist, I have to admit, for an EMT-B, it ain't bad, and as soon as I get reciprocity with VA and DC, it'll go up. Once I get my paramedic cert, it'll go even higher (though it'll definitely take a few years to get back up to where I was in biotech).

I know, not as exciting as a 911 system, but I believe that it might help me while I'm in medic school, especially as far as patient assessments go. It may also give me the opportunity to take EVOC, which I never got the chance to take as a volunteer.

Speaking of volunteering, I'm rather torn. I started with a new company, about 15-20 minutes from my house, this time last year, but had to leave when I had my shoulder surgery. I was still on probationary status, and haven't been back since. I'm debating if I should attempt to go back to that station, or if I should write it off and try the one that is within walking distance of my house. I think (or I would like to think) that a closer station would mean I would go more often. I also didn't feel very comfortable at the other station, though I will readily admit that much of that could have been a lack of time there. At this point, I'm not even sure I should show up.

And since the fiance and I aren't moving any time soon, I really need to get back with a station.

On the other good side, all my gym time will make it easier for me to get back in the firefighting mode shortly. This makes me very happy.

They should require IQ tests for that...

2009-01-26T12:22:00.002-05:00

We get called out for the 'child injured' in a townhouse/apt community, though I can't remember where. I believe I was actually riding the medic unit for once.

Not long after we get on the road, the call is upgraded to the 'toddler struck by a car.' Needless to say, the pucker factor goes way up all the way around. On a call like this, a helo is automatically dispatched.

It doesn't take us long to get there, and we are greeted with a near-hysterical mob. The police have beaten us there, and are talking to the driver of the car, who is hysterical. Mom is holding a crying baby, and is nearly hysterical. The patient is about 3 years old. There is no blood, no guts, only a bald spot on one side of the tots head, and a spot of grease on the forehead. We struggle to get the story, but it goes something like this...

Mom had to finish folding/putting laundry away, and kid wanted to stay outside and play. Mom figures that the windows are open, so it's ok, and lets her 3 year old stay outside under the watchful eye of the neighboring 5 year-old, and the 10 year old watching that one. Mom figures it's ok, because there are adults floating around talking (hey, it was a nice day).

The 3 year-old decides that it's a good idea to play in the parking space because there's dirt there. The baby-sitters (the 5 and 10 year-old) try to haul the kid out, but the kid keeps going back, and they eventually lose track of the toddler they are watching, while playing whatever game it was they were playing.

Meanwhile, nice older neighbor lady comes home, and pulls into her spot. She doesn't see our intrepid toddler sitting on the ground playing in the dust pile, and is alerted to the fact that something was wrong only after she hears a thunk hit the front of her car and sees the neighbor kids waving their arms and screaming.

We get there, grab the kid and mom, and hightail it to the LZ. The flight medic hops in, and looks the kid over. Again, no swelling, no bumps or bruises, jsut that bald patch on the side of the head, and the grease mark on the forehead. No one could answer if the kid lost consciousness, because the neighbor kids were too upset, and no one else was paying attention. Hell, mom only came outside when one of the kids started yelling for her. Meanwhile, toddler is awake and fighting mad.

Never did find out the outcome of that one. They flew the kid to Children's. My best guess is that the bumper hit the top of the head, knocking the kid over where the tire could skim the side. But that's only my guess. We saw the kid for all of 7 minutes, so who knows what happened later.

Brief Hiatus

2009-01-09T09:00:00.002-05:00

Now that the season of joy and goodwill *snort* is over, I have time.

The fact that my paying job is slowly killing me with work notwithstanding.

I do have several posts percolating in the back of my head, but they aren't yet fully concentrated into full-strength posts, so they'll have to wait a bit. I'm finding that this blog is moving more towards medical type stuff I read/hear about, in addition to calls I've been on, so it seems I may have to change the 'description' or something.

Meanwhile, for your (all 3 or 4 of you who read this blog) reading pleasure, I submit several funny things heard over the radio.

Dispatch: Ambulance XXX, please respond to the location for the allergic reaction to cocaine.

Medic XXX: County, we are transporting an 18 yo female to Local Hospital, not feelin' well after smokin' a doobie.

Dispatch: Engine XXX, respond to the previous location for the rekindle.
Engine XXX: Copy that dispatch, who reported it?
Dispatch: Engine XXX, the rekindle was reported by the fire remediation company.

Engine XXX: County, be advised we have a small fire on the desk, started by what appears to be a short in the cord to the computer.
Dispatch: Copy Engine XXX. Do you want us to fill the box?
Engine XXX: Uh...negative County. Our rookie just put the fire out with the water can.

Dispatch: Engine XXX and truck XXY, respond to the location for the automatic fire alarm.
Engine XXX: Copy County. Had the alarm company been notified? I believe this is the 5th AFA we've had to this location in the past 3 days.
Some time later....
Engine XXX: Uh, County, could you fill the high-rise box for this location on the 14th floor? And please ask my driver to bring my SCBA up?

Ambulance XXX: County, could you please have the police respond to this location?
Dispatch: Copy Ambulance XXX. Do you want them Code 3?
Ambulance XXX: That's an affirmative, County. Which is why we've had our Emergency Button activated for the past 5 minutes.

Dispatch: Ambulance XX, please respond for the injured child, non-traumatic.
Ambulance XX: Copy County. Is there more information on the call?
Dispatch: Ambulance XX, caller reports that child pulled a grandfather clock on his head.
Ambulance Officer (to driver): If that's non-traumatic, I'd hate to see what EMD generates as traumatic!

'Tis the Season

2008-12-23T08:01:00.002-05:00

I don't really have a lot of stories about holiday calls, mainly because I was usually back up in the wilds of the Poconos with the family for Christmas. I do have lots of winter calls, but somehow that doesn't equate to the same thing.

'Tis the season for stove fires,
Fa la la la la, la la la laa!
Suicides and frequent fliers,
Fa la la la la, la la la laaaaa!

Food on the stove calls and kitchen fires are common this time of year, since people start cooking a lot more with the cold weather and holidays, and then forget that they left the stove on with the pot still on the burner as they bustle off to wrap presents or whatnot. Then the kitchen fills with smoke, and they call 911.

Myth says that suicides are up during the winter holidays, due to those with family troubles or problems with the long dark nights. Truthfully, I haven't ever run more suicides during the holidays than any other time of hte year. However, I have noticed a trend towards more attempted homicides during this time of year, usually towards family members. Several years ago, a medic I know went on a call for 'one stabbed' on Thanksgiving. Turns out Son wanted to carve the turkey and Dad said no. So Son grabs the carving knife and carves Dad's arm instead.

The frequent flier calls usually do edge up around now though...either due to the cold and needing a bed and a couple square meals, or the elderly and lonely who just want someone to talk to. For some elderly, especially the widows and widowers who live alone, the holidays can magnify the lonliness, and that can magnify that little ailment that they deal with on a daily basis into something huge and troublesome. Sometimes they only need someone to sit and talk to for 10 minutes, sometimes they need an actual trip to the hospital to ease their mind (not that I like burdening the ER any more than it already is).

Another thing my old company did around this time were 'Santa Runs.' We'd take an extra crew, and the reserve engine and the front line ambulance and put Christmas lights on (ambo was available for calls). Every night was a different neighborhood, and we'd head out with supplies of mini-candy canes. Once at the start of the neighborhood, the unlucky guy would dress out as Santa and we'd replace the deck gun with an old seat. Santa would sit on the seat with the scene lights shining on him, and everyone else would hop on the tailboard or sideboards (or running board of the ambo) and we'd put the lights on and head down through the neighborhood. Short bursts of the siren would call all the kids out and the firefighters, dressed out in their turnouts with Santa hats on, would hand out the candy canes. The ambo usually had on the 24-hour Christmas music station on the radio and would blast it out the PA speakers. And just so no one felt left out, one of our Assistant Chief's neighborhood would have a Hannukah party and we would head over with bags of chocolate coins and blue lights on the engine. Lots of fun for all.

All in all, this was a good time to be at the station. Neighbors would bring candy and cookies and such for us, kids made us Christmas cards, and there was always something going on. One year we had a spare fridge sitting out in the day room (it broke and hadn't been taken to the dump yet). One of the captains and one of the master firefighter's were from an area that was well known for it's farms and 'hicks.' So someone wrapped extra lights around the fridge, duct taped up 2 old socks (one with a hole cut in the toe) and wrote 'Redneck Christmas' in black Sharpie on the fridge, and the name of the captain and the master FF under each of the socks.

You know, much as I like life now, there are times I miss living at the station.

Disturbed

2008-12-11T13:52:00.002-05:00

I can only remember being disturbed by a call a handful of times in my career as an EMT. By disturbed I mean totally grossed out, or horribly sad, or scared for my life, making me rethink that whole 'emergency button' thing.

Horribly sad.

Call for an elderly man 'not right,' possible stroke. We got there first, the medic was on it's way. I seem to have wiped the details from my mind (thank God) but I remember that the guy was just totally blank. As in, not seeing who was there, not speaking, the whole thing. The medics took him in. I have no idea what happened to him eventually, but the thing that made me cry was his wife of 60-something years, holding his hand as they wheeled him out to the ambo. "It's ok dear, I'm right here with you. Dear, it's me, look at me." I got back to quarters and cried like a baby. All the calls I've been on, and none have hit me as hard as that one. For whatever reason, I was able to empathize with her on a level I never had with any other family member before, and the idea that this man who had known her for 60+ years, had been with her through thick and thin, children, grandchildren, and who knew what else, would most likely never recognize her again. The thought terrified me, and made me mourn for her in a way that my tiny little black heart had never mourned for a patient before.

Flat-out gross:

Called to the local stacking shack (I can't in good conscious call this a nursing home, as that would imply the act of nursing and care) for an elderly man vomiting, possible GI bleed. Luckily the pt was pretty far gone in dementia. Dude had a colostomy bag, and it wasn't till we were halfway to the hospital that I looked more closely at the bag. The stuff in the bag was eerily familiar, and I realized that the same stuff in the bag was the stuff that the staff had tried (unsuccessfully) to clean off his face (to be fair, they mostly got it off his face, but there was stuff stuck to his lips and in his fake teeth). Um...WOW!!!

Terrified for the lives of myself and my partner:

Called out at 2am for the MO (mentally off, yes it is a call-category). Arrive on-scene to find the son outside. Mother hasn't taken psych meds for a bit, and is acting 'crazy, but she won't hurt you.' Against my better instincts, we go in without calling for the police. My partner, Ostrich Boy, stands just inside the doors, propping it open slightly just in case we need to bug out.

Seems the patient really hasn't been taking her meds. She's pacing in the house, wandering back and forth, not really lucid to us or her son, pretty tight in the grip of mania. The few times she stops and stares at me in her hallway, I am spooked. She has that totally blank look on her face, the blank stare in her eyes is a reminder of others I've seen just before I've been attacked.

I generally pride myself on my ability to talk to patients and get them to do what I want. I have a good bedside manner when I want it, and I've had all manner of patients open up to me. So I talk to the woman, keeping my voice low and slow, asking her what meds she's on, asking her if I could take her BP (son says she's also HTN and called someone earlier this evening cause she didn't feel well). She has a few moments of calmness, when she asks her son to find her meds cause she really needs to take them. He finds them and she takes one, but continues her pacing. My partner and I stand in the hall, waiting for the resolution. Ostrich Boy has already called for local PD to come without lights and sirens but to not hang around. By now they are waiting in the parking lot for us, and dispatch has called us 3 times, checking our status and making sure we're ok. Another 10 minutes goes by and she's finally calm enough that she lets me take her BP. Her face is still blank for the most part, but her eyes are no longer empty, and I can see humanity flickering deep in there. Her BP is high, and we tell her we'd like to take her to the hospital to get checked out and maybe get better meds. Her son pleads with her, and, now that she is clear, she is more worried about him studying for his final tomorrow (later today) than she is about herself. He convinces her that he'll study in the waiting room while she gets checked out, and she finally relents and lets us take her in. I can tell she's a good mother. She doesn't live in the best part of town, but her son seems like a good kid, and the whole ride to the ER she's crying about what a good kid he is and that he deserves better than her and how proud she is of him.

All in all, it ended well, but there was a period of time there when I was sure I'd be pressing that emergency button on my radio.

Conundrum

2008-12-05T14:22:00.002-05:00

I often bitch about people who I take to the hospital because they call 911 for what I feel are spurious reasons.

But I am often confronted by the feeling of whether or not I should feel sorry for them. Usually it depends on my mood and how tired I am at 3am. I really do try to remember that 'they feel it's an emergency' but when you find people who just use the system cause it's there, it's hard to remember that.

Here are my 2 big conundrum makers.

LOL or LOM (Little Old Lady or Little Old Man) calls around midnight or 0200 or so. They've been sick for a few days, not serious, but now they want to be seen. No fever, vomited sparingly (ie, no dehydration). Doesn't feel comfortable driving at night, especially when they're feeling poorly. Usually you hear from them, 'I'm so sorry to call you at this late hour. Normally I wouldn't, but I just feel so poorly and it's getting worse. I don't know that I can wait till morning to see my doctor.'

These people I generally feel sorry for, and have very little irritation with them. Sometimes they don't even have a car. They're almost always on a fixed income, so getting a cab to drive them may be a hardship, and who knows what kind of health insurance we're talking about, so maybe they've tried a clinic but the wait was too long or something. At any rate, these people usually have some kind of hardship, and they certainly don't abuse the system the way younger people do (sweeping generalization here though...) I have had to convince elderly people to go to the hospital when they are having 10/10 crushing chest pain and trouble breathing.

The second ones are the 30 or early 40-something couples. One of them is sick, and has been for a while, limited vomiting, low fever...generally the same symptoms as above. Usually they call between 0200 and 0400, sometimes earlier, because they are sick and woke up the spouse, or what-have-you. The line usually goes something like this. 'Sorry to call you, but I've been sick for the past couple days. My doctor won't see me till next week, but I'm feeling really sick and threw up twice 2 days ago.'

The spouse usually chimes in here. 'I'd take him/her myself, but the kids/babies are sleeping, and I don't want him/her to drive by themselves.'

Where I ran, we were 10 minutes from 2 hospitals. These people generally also had at least 2 cars in the driveway, and very nicely decorated houses with all the ammenties. These people were the ones I would get irritated with. I totally understand not wanting to wake up the kids or the baby to drag them to the hospital for an unknown amount of time. There are cabs you could call, I'm sure you have neighbors (though perhaps not at 0200). What made you think this was an emergency in any way, shape, or form?

So the conundrum is this. Why, given a fairly similar situation, should I feel sorry for the older person, but have nothing but contempt for the younger family person*? If I am irritated at one, shouldn't I be irritated at both?

And don't get me started about the 40-something people who call us out at 0300 because they don't feel good, but have an appointment with their doc in the morning, and don't want to go to the hospital. Sometimes I suspect the spouse just called 911 to keep the sick one from bitching anymore.

*The middle-aged guy who was vomiting all evening and trying to wait to see his doc in the morning, and couldn't go 5 minutes without dry-heaving is totally exempt. Although he DID try to get in the car and drive. Backing out of the driveway made him hurl.

Non-Medical Rant

2008-12-04T09:31:00.003-05:00

And now, from the caffiene-fueled anger center of the Gnome...

I watched Rudolph, the Red-Nosed Reindeer last night.

When the hell did the PC-idiots change friggin' Rudolph?

I can't remember what the song originally was, but it's no longer there. The song when Rudolph and his new misfit pal Hermie the wanna-be dentist leave Christmastown, they sing a song. But the song I heard last night is definately not the same as the one I heard as a kid.

And, pointed out to me by a friend who watched it with his young daughters (I was in the kitchen making cookies), they have removed the part where Hermie reaches up to the general area where the 'Bumble's nuts should be with his pliers and squeezes. The 'Bumble gets a funny look on his face, and Cornelius tackles him off the cliff. Now Cornelius just tackles the 'Bumble off the cliff.

Who the hell was the PC nut-job who made these changes? It's not ok anymore to teach kids that if you act like an asshole, you'll get kicked in the nuts?

It's not ok to sing whatever it is that song is about? (I can't remember the words off the top of my head). Well, hell, while we're at it, why don't we just stop showing Rudolph, since it's a movie that shows that not everyone is a special snowflake, and that sometimes you get made fun of. I mean, we wouldn't want to offend or upset any kid who gets made fun of in school. Seriously...even Santa tells Rudolph's dad that he should be ashamed for having a kid who's different than everyone else. If anything should offend someone's sensitive sensiblities, that should. Isn't Santa supposed to be an equal opportunity gift-giver? Clearly that mind-set doesn't transfer over to those in his employ.

Come to think of it, Santa gets made out to be a real dick in this movie. He's snappy with the elves over that stupid song, he tells Rudolph he's no good cause he's got a light-bulb for a nose (although as soon as Santa needs something from Rudolph, that light-bulb is great and wonderful and awesome and Rudolph is now a member of the community again), gets mad at his wife for trying to cheer him up...the list goes on.

While we're at it, why not just cut out the whole Rulolph song from kid's holiday songs? After all, Rudolph gets made fun of and ostracized by the rest of the reindeer community cause he's got a glowing nose. That might offend someone who has rosatia or something. I mean, this is a clear instance of discrimination based on appearance. Where are the lawyers? Someone should be pushing Rudolph to sue for discrimination and pain and suffering. Come to think of it, are those elves legal immigrants? Does Santa have a license for making toys? How many reindeer does he have? Does he have a license for owning more than 'X' number of livestock? Once the lawyers sue on Rudolph's behalf, they should go after Santa for all those violations.

Honestly people. Come on. Surely there are more and better things you could be censoring than a stupid fucking kid's Christmas special (note, I said CHRISTMAS, not HOLIDAY. Last time I checked, Santa was associated with Christmas). What's next, changing Frosty because it might offend magicians who feel that the magician in the movie paints them in a bad light? How about taking out all instances of Lucy taking the football away and making Charlie Brown fall, because that could upset people who aren't good at sports. Not to mention all the times Charlie Brown gets hit with the ball in baseball and gets his clothes knocked off. Someone may get offended at a semi-naked cartoon character.

Many generations of kids grew up to be perfectly fine adults seeing that stuff on TV (don't get me started about Looney Tunes being too violent). In fact, I don't know any sane adults who think that it's ok to kick people in the nuts and tackle them over a cliff for being a jerk (much as some of us dream of doing that), and I don't know anyone who's been scarred for life because a talking reindeer with a lightbuld for a nose, and an elf who wants to be a dentist rather than make toys say they're misfits.

There is only one thing I personally find insulting about Rudolph the Red-Nosed Reindeer. And that is when Donnor essentially tells Rudolph's mother to 'stay in the kitchen and make me a pie, bitch!' while he goes out and looks for Rudolph (cause, you know, he's the big bad male with horns on his head. Never mind he's useless in a crisis and gets his ass knocked the hell out by the 'Bumble.) Of course, the 'women-folk' go out anyway, and of course get into trouble, and have to be saved by the men. But you know what? This stupid movie is a MOVIE that was made in the 50's or something, when that was the attitude of the day. And if I feel that it would anger me too much (not that it does, because I know how to take something in the context of the time in which it was made) I can always exercise my right to not watch it. I don't need some weenie in a suit who got beat up by the other reindeer making my damned decisions for me.

If you can be offended by a stop-motion photography movie about elves and talking reindeer, I think you have bigger issues.

If you can beat me down the hill to the ambo, you don't really need one...

2008-12-04T07:43:00.002-05:00

Last story in the blizzard trilogy, I swear...

John-Boy of the first evening had left sometime during the second day, and in his place was a new driver. A nice enough woman, I'd worked with her enough to know that her EMT skills were not that great, but she was a good partner, and knew enough to know what her limits were. We got along well, but she didn't drive that well. Normally, she was slow, seemed to hit every pothole in the road, and often got lost once off the main roads. On a day when the roads were mostly covered with an inch or more of snow/slush/ice, the slow driving was a plus, the potholes were non-existant, and it was hard to get lost on the back roads when a huge county plow/dump truck with a flashing yellow light was leading you in and out.

It was evening when we got toned out. I know we hadn't eaten dinner yet, but it was dark. The call was for the possible stroke. 'This better be an 80 year-old woman who is fucking paralyzed on one side,' I growled. (Most times, 'stroke' calls are really strokes, but for some reason, they send it BLS rather than ALS, since 'there is nothing that ALS can do for a stroke.' No really...I swear...but that's a rant for another time...)

We get to the road leading to the development, but it hasn't even been touched since the snow began (it had stopped by now). There is a small plowed-out area at the end of the road, mainly just the place where the plow was pushing all the snow from the main road across the street.

Oh, did I mention this road we STRAIGHT UP A FUCKING HILL????? So help me God, it looked like it was straight up. Slow Driver pulls across the street (the ass-end of the ambo is sticking out into traffic) and says to me, 'Where do I park?' Mind you, there is zero road shoulder.

'Just pull into the clearing as much as you can to get us off the main road,' I tell her. What does she do, but pull practically straight in, launching the ambo's front tires into the pile of plowed snow. I told her, 'That's not what I meant, exactly,' but it's too late, we're stuck. She tries to back out, but all she's doing is digging holes with the tires. We decide to leave it as is, call for a back-up just in case, and slog up the hill (dragging the Reeves, the O2 bag, and the aide bag). I'm wearing my bunker pants, and the snow is packed in up to my knees, which ironically, is lower than the level of the snow I'm slogging through (I could have sat down without moving much). We finally get up to the house, and knock on the door. A middle-aged woman answers, with a 4 inch thick pile of folders and papers in her hands.

Now knowing this to be a complete BS call, totally exhausted from dragging my ass and all the associated crap for a real stroke up a huge fucking hill with snow up to my hips, I nevertheless attempt a smile. Slow Driver is at the bottom of the stairs with the O2 bag and the Reeves, since the stairs are about 10 ft off the ground, and are coated in ice, and the landing up top is even worse. 'We're with the ambulance, Ma'am. Did you call 911?'

'Why yes I did, but that was 20 minutes ago. What took you so long?' I want to say Two feet of fucking snow, bitch. But I don't, and she goes on without really waiting for a response from me. 'Well, you see, 2 nights ago while we were eating dinner, I experienced some slurring speech, fuzzy vision, and some tingling in my right arm. But it only lasted about 15 minutes, and then went away. Yesterday afternoon I had the same thing, only it lasted a little longer, maybe 20 minutes, right Frank?' Frank, who I assume is her husband, is a little squirt of a man, and stands behind her, nodding emphatically at all she says.

'So why did you call us tonight?' I ask, forcing my eyeballs not to roll back and stare at my brain.

'Well it happened again tonight, for about 10 minutes so I figured I would go to the hospital. I brought all my medical records too.' This she says proudly, as if it will be a huge boon to the hospital that all these papers will be around. Because, you know, no one in the ER knows how to get your damned records from the computer.

'What time did this happen?' I ask. Meanwhile, we are still standing outside. She hasn't invited us in, and normally a patient or family member will step back from the door to allow us to at least access the light of the house for a proper assessment. But she stands directly in front of the door, blocking what little light is coming out, and not allowing me to come in. At least I have the warm air coming from the house. Poor Slow Driver is stuck 10 ft below me, on the snowy walk. The temperature is dropping, and the wind is picking up. The roads are not going to be nice soon.

'About 3 hours ago,' she replies. 'Frank, get my coat.' Frank scurries to get her coat, and hands it to her, along with her keys, cards, and cell phone. She hands me her 'medical record' while she pulls the coat on, and then steps out, oblivious to my caution about the ice. Somehow I make it down the steps carrying the aide bag and her medical records, which she takes from me the minute she's on less slick ground. I point towards the ambo at the bottom of the hill. 'That's our ambulance,' I tell her. Slow Driver has already headed down the hill to work on getting us un-stuck, and I struggle down the hill, dragging the aide bag and now the O2 bag (Slow Driver left it so she could high-tail it down). The patient has set off at a pace worthy of Sir Edmund heading down Mt Everest, and is down at the ambo before I can get halfway down the hill. I finally make it down, and find that Slow Driver had been digging more holes with both the back and front tires. I check with dispatch to see where our back-up is, and fill out the paperwork. The back-up that arrives is an ALS unit, whose medic is less than impressed to see an upright, walking talking stroke patient. I explain that we got stuck, and all the woman needs is transport. He rolls his eyes and they take off.

So, now we are stuck. Slow Driver has dug holes so badly that the entire weight of the ambo is now supported by the snow packed in underneath it. And remember, this is not new-fallen snow. This is snow and ice plowed from the roads, so it is hard and chunky. I am in turnout pants, with snow packed up to the knees, rubber turnout boots, and my job shirt. There is no hat, there are no gloves. I take out the shovel and Z-hook from the side compartment, and attempt to remove enough snow to at least allow one set of tires traction. No dice. I go back to the front of the ambo to get rid of the snow behind the front tires. Still nothing. I try not to snap at Slow Driver's inability to do anything but gun the engine when she tries to rock it out (not that rocking an automatic transmission is the easiest thing to do). I'm standing to the side during one of her attempts to gun it out of the space when I hear the knocking of metal on metal. Sure enough, we've thrown a chain. But only half a chain, since the side in by the dualie is stuck fast. Maybe I can get it off when we get out and I have a bit more room.

Luckily, about 30 minutes after our patient left with the ALS unit, a county plow comes up and takes pity on us. He comes at us from the front, piling up a good bit of snow to protect the ambo, and pushing the ambo backwards out of the snow. He also gives us some heavy-duty zip ties to hold the chain on, swearing that it'll work. We thank him profusely, and head on our way home.

The trip home took at least an hour. Mainly due to the stops we had to make to replace the zip tie after it broke. We are crawling at about 10 mph, well below the 25mph you are required to use when driving on chains. I am hungry, cold, and my hands are wet and frozen and dirty. About 10 miles from the station we run out of zip ties, and have to just pray to make it home.

Once back at the station, we find a lovely thing has happened. The chain has caught on the sheet metal that comprises the wheel bed for that wheel, bending and pulling it up so that is caught on the chain that covers the rest of the wheel. We can still drive, but it just continues to bend the metal. We put ourselves out of service, and call the mechanics, one of which come out to the station to see what he can do. Unfortunately, our air line in the station is compromised, and the engine is out on a run, so there is no way to run the air jack to raise the ambo on that side to pull the wheels off and cut the metal. He manages to get the chain off, and heads back to headquarters, where we will meet him shortly. The metal sheet is touching the tire, and there is not enough room to get leverage to cut it off or bend it back.

The engine gets back, we tell the captain we're heading to HQ, and slowly head out with no chains. The problem is fixed there (the metal is cut off) and we find out we aren't the only ones experiencing issues. The truck tried to get down a road in a development known for tight roads, and not only slid and hit a couple cars, but was stuck and had to be towed out. The ambo at HQ went on a call with the medics for a heart attack, and there were no plows available to get them down the small side road. The patient ended up staying dead because they had to walk a quarter mile down the road in knee high snow with the cot. The young EMT I was mentoring had a hard time with this one, as she was riding on the medic unit at the time. She couldn't wrap her head around the fact that he was already dead when they got there, and regardless of how much CPR or drugs they pushed in the guy, he would likely have stayed dead. The fact that it was her first death didn't help. What did help was that they went on a labor call not long after, and they helped deliver the baby at home. Circle of life and all that.

We get back to our station, and put ourselves back in service, now with only half a wheel well on one side. The chains go back on, and I get ragged on by the engine crew for throwing a chain and allowing my ambo to get dinged up from the chain banging around.

Yeah, the blizzard was much more exciting than the un-hurricane we went through later. That was just boring.

Here's Your Sign..

2008-12-03T08:40:00.002-05:00

First things first...

Yay! Someone commented on my blog! I am loved! Thanks EE, glad you like it, and I hope things are going well with the new little one. Good to see that the pup is doing better as well.

So, in the last post, I wrote about the stupid things people call you for during bad weather. I have much more where that came from...that was just the one day. The next day had a fun call as well, which I will relate later. This post is all about the Night the Snow Started Falling.

As some may know, here in the People's Republic of Maryland, snow is considered to be a strange thing. Many people born here don't see it often enough to understand how to drive in it, and for many of those who move here from colder climes often quickly forget how to handle themselves in the cold and snow, perhaps having had their brains bleached by the intense summer sun (which has gotten so hot a co-worker of mine had the nylon string on her fuzzy dice in the car melt. I'm sorry, but your damned car SHOULD NOT get that hot unless you are in a fucking desert).

Ahem.

Anyway, the snow (really, and precipitation falling from the sky, regardless of temperature) seems to turn the people around here to mush-brained, mouth-breathing idiots. On this particular night, we were hunkering down, waiting for the other shoe to fall as soon as the snow started (the night already had boasted a woman attacked by her son, who insisted we come into the house with her while the son was still there. Um, no). The snow had started falling lightly, and soon the roads were covered with a good 2 inches of the stuff. Tones drop for an MVA (we call them PIC's) on a road that is at best a hell to drive in the sun. As we head out, driving slowly, we are updated. Now dispatch is telling us that the patient is at home. We pass the car in a ditch, and make it to the house. The patient is a woman who was driving home, slid into the ditch, but was only going about 10 mph anyway. She has a cut on her hand from her fingernail. We, of course, offer to take her to the hospital, but she refuses, and we head home again. The engine has beaten us there, and is in the middle of putting on their tire chains, as the snow was getting too deep to use the on-spots anymore.

My driver, who otherwise was a reasonable, well-intentioned man, and a good partner, decides that he doesn't want to wait for the engine to finish with the blocks, and decides that he could put the chains on himself, without raising the tire up. First he tries with the air-jack, but the air line in our station runs under the concrete floor, and has a hole in it somewhere. The engine is still on blocks, so we can't use their air chock. So he decides, on the virtue that he did it with his daddy's pick-up truck, that he can just lay the chains on the floor and drive on them, then hook them up.

Insert banjo music here.

He decides to do one at a time, 'in case we get a call.' The first one he gets on but can only hook the front. He can't get enough slack to pull it around inside the dualie. Suddenly the bat phone rings (the bat phone is our direct line to dispatch. When they call, you either have a fire in your first-due, or someone screwed up). Sure enough, we have a first-due fire. My driver, John-Boy, is still fighting with the tire chain, only now he's frantic (having just completed Fire School I). The engine driver has literally just dragged the blocks over to me, and as soon as the engine company is dressed, they are gone. I finally convince John-Boy to go up on the blocks so we can take the offending chain (now twisted around the dualie axel once cause he spun the tires on concrete trying to move forward to loosen the chain) off the tire and just get going. After digging holes in the concrete floor, we get up on blocks and get the chain off, and follow the tracks of the engine (which is good, because the engine took the print-outs and John-Boy was cursing at me so much that neither one of us heard the address).

John-Boy parks at the bottom of the hill, at the hydrant the engine dropped at. He's parked the ambo across the road, in clear violation of the policy against ambo's blocking access that other fire equipment might need. He hops out, intent to charge the line to the engine as soon as they call for water. (While our SOPs state that ambo drivers and officers must be able to do this, it rarely happens, as the second-due engine is so close, by the time the first-in engine needs water, the whole box assignment is on scene and another engine driver usually performs the duty.) Meanwhile, the squad from headquarters is tearing (as much as a multi-ton apparatus can 'tear' in 5 inches of snow and tire chains) around the corner, with the driver motioning wildly for us to get out of the way. I can't drive the ambo. John-Boy can't hear me yelling for him. Luckily for me, Bald Old Man, who is a driver, hopped on just before we left, and moves the ambo out of the way, with a few choice words for John-Boy when he gets back to the ambo.

The fire is put out quickly, being contained to just the car port. The engine had hit an hydrant across the street from the house; the hydrant wasn't marked on the map books, and made a quick knock. However, lugging 1200 ft of frozen LDH (Large Diameter Hose; ie 4 inches or larger in diameter) up hill in what was now 6 inches of snow and then forcing it back into the hose bed was decidely NOT fun. Forcing the frozen handline and supply line that had been used back onto the engine was also not fun.

And what was the cause of this fire? The home-owner, in a fit of...something...had decided to build a fire in his (mostly) un-used fireplace that evening. Wanting to go to bed, but not wanting to leave warm coals in his fireplace, he shoveled them out into a plastic trash bag. He knew better than to leave them inside, and figured that even if they were still warm, it was cold enough outside to toss them out and let them cool. In the closed plastic trash bag. So he tossed the bag out into the carport, next to his car. Several hours later, an explosion woke the neighbors several houses down, who went outside and saw Mr Intellegent's car port on fire, and called 911. Mr Intellegent and his wife never woke up until the fire dept started knocking on their door. It was assumed that the 'explosion' was the tires on the car popping.

Ah yes. Winter here does seem to make people's brains ooze out their ears.*

Tomorrow the finish of the blizzard stories, including how my driver broke my ambo, and the patient who had to go to the hospital so badly, he beat me down the hill to the ambo in 2 feet of snow.

* People's brain's oozing out their ears during 'weather' is not isolated to MD, as I saw it happen often enough in PA. Nor do all people in MD take leave of their senses when forecasters say that 'weather' is coming....I'm sure that there are people in Western MD and up near the border of PA who are sensible about this kind of thing.

There's 2 feet of snow out, and you called me for THAT?!?!?

2008-11-21T08:20:00.002-05:00

Which is what I wanted to say, but didn't. I try my hardest to be nice to everyone, despite my callous thoughts. I don't get bitchy till the patient starts it.

It had been snowing since last night. The county plows couldn't keep up with it, and were only keeping the most main of main roads clear. Once we got into the developments and such, we were on our own. Sometimes, if there wasn't another call, and they got to you in time, one of the small guy plows, the guys with plows on their pick-up trucks, would preceed us into the communities, making sure we wouldn't get stuck. More often that not, especially as the day went on and the snow accumulated, we were on our own.

The call toned out for the 'sick person.' I grumbled as I climed into the officer's seat. "This better be for real," only I'm sure there were more expletives in it than that. It was barely 9am, and I had been out all night on car wrecks and a house fire (never put your warm ashes in a plastic bag and pitch it into your carport, where it falls under your car. No, it was not cold enough outside. Obviously). My partner didn't say anything, but we drove out into the snow.

The snow in the development was brushing the undercarriage of the ambo. In another few hours, we wouldn't be able to make it in here without help from a plow. It was a nice development with modest townhouses, and we found the right one with little trouble. The patient was inside at the kitchen table, looking fairly normal, if slightly pale.

I started with my usual. "Hi, my name is Gnome, and this is my partner M. What seems to be the trouble today?"

The woman smiled at us, not looking very sick. "Well, I've had this stomach bug for a few days now, along with some head congestion and coughing. I just feel sick, and can barely keep anything down. I tried eating breakfast this morning, but it came right back up, and then I couldn't stop vomiting." Her husband is patting her shoulder, and I hear the unmistakable sound of Saturday morning cartoons coming from the other room.

"And then she tried to blow her nose and her nose was bleeding and it wouldn't stop either, for like 15 minutes!" the husband chimes in.

Through questions, I find that this happened around 7am, and it took them about 2 hours to decide to call for an ambo, mainly because she was still feeling ill, and when she tried to drink some orange juice, which came right back up. We take vitals, all which are within normal limits, though she does feel a little on the warm side. She says she's been running a low grade fever since yesterday.

I start giving them options. "Well, we could take you to the hospital, and you'd probably get in pretty quick, but there's no garuntee you could get home today. The roads are all closed to all but emergency traffic, more or less, and your development has almost 2 feet of snow on the roads. The main roads are not much better; the plows can't keep up with the snowfall. So there aren't any taxis that would get you home."

They nodded, and after a brief discussion, decided to stay home. I gave her some ideas to keep food and drink down, because she was likely dehydrated. "When you drink something, make sure it's close to room temp. Not too sweet, not too acidic, or that will upset your stomach. Take a small sip, barely enough to swallow, because your stomach is sensitive right now, and large quantities will make it reject anything that gets put in it. Same for food. Dry toast, or crackers are good right now. But nibble on it so that you don't shock your stomach." They nodded, and seemed to feel better. We told them to call us back if they felt they really needed to go to the hospital, and left.

We got sent from that call to a man with horrid stomach pains. Met us at the curb, hopped into the back as soon as we pulled up. I sat him in the captain's chair. "I have these horrible pains, I don't know what they are. I've never felt anything like this before. I think it might be appendicitis." Pains were centered over the abodomen, spanning both the LRQ and the LLQ. NO change in pain level on palpation, rated 10/10. We head off to the hospital, and I'm in the process of getting vitals when he lets one of the biggest farts I've ever heard from someone. Thank God it didn't stink, cause our windows don't open.

Red-faced, the man apologized. "I am so sorry! I never meant to do that. But hey! I feel better now. The pain's all gone!" He seems more embarrassed that he farted in front of me than that he called 911 for gas pains. Then he asks the coup de grace. "Can you take me home? I don't want to go to the hospital now."

I sigh, inwardly. We are closer to the hospital than his house now, and at the rate the snow is falling now, we'd never get back into his development, plus the man is wearing slippers, so it's not like he could walk the half block back to his house. "I'm very sorry, sir, but we are a one-way service. We can't take you back to your house. We can only take you to the hospital. I am sorry." And I am. Sorry that the hospital staff will have to deal with him when there's nothing wrong with him.

He takes this news well, smiling and sitting back, and talking to me about the improbability of gas pains sending him to the hospital. He still doesn't seem embarrassed; rather he's talking about 'better safe than sorry' and how it could have been something more serious. I just keep writing, wondering how the hell a man in his 40's could possibly not know the difference between gas pains and appendicitis. We pull up to the emergency room waiting area door, and I walk him in. He has a seat in the room, and starts watching TV. I go to the nurse's window and give her a brief report. She chuckles. "At least now I've got a good story. Things are pretty dead here today, for obvious reasons."

Two hours later (about 15 minutes after we get back to the station) we get tapped out for the same address as the first call. This time, we have to wait for a plow to get us into the development...the snow is now above the undercarriage, and when the drop-down step comes out of the side door, I have to knock the snow off of it. We arrive at the house, and the husband and wife are waiting outside for us. Bags are packed. They hop in the back. "I did what you said and it was working," she tells me. But then I fell asleep on the couch for a bit, and when I woke up I was so thirsty that I drank the whole glass of water and it just came right back up. So we decided to call you back."

I only nod and sigh. They tell me that they got a neighbor to watch their kids. It takes us 45 mintues to get to the hospital, which is normally a 10 minute drive. This time, the patient was on the stretcher, so we wheeled her into the emergency entrance. I gave report to the nurse, and we headed back home. AN hour later, we pulled into the station.

Yeah, I try to be nice to my patients. I try very hard to believe that they really and truly thought that this was an emergency. Usually I succeed.

To Fly, or Not to Fly?

2008-10-20T10:06:00.003-04:00

That is the question.

There's been a lot of talk on various sources about the pros and cons of HEMS. Don't get me wrong. I'm all for it in the right circumstances. I have flown several patients out myself. Five, in fact. In the 10 years I've been an EMT. Three were peds cases, two were adult traumas. In all 4 cases, I had (as did the medics with me) every reason to believe that time was of the essence. Both peds cases were head injuries, and while one of them could have been driven, it was rush hour in the metro area, and getting to the Big Children's Hospital would have taken over an hour, if not closer to 2 hours. The second peds case I flew was a status epilepticus secondary to a fall down the stairs. The third was a toddler who had been 'run over by a car' and while he didn't appear to have any obvious injuries, there was a large patch of hair missing from his head, which lead both me and the medic to believe the by-standers story that it was his head that was in contact with the tire. How much? Who knows, but I'm not really one to take chances with a toddler.

The first kid actually ended up only having a moderate concussion and depressed skull fracture (after pulling a fully loaded bookcase on himself!) and spent 2 nights in hospital, only because mom wanted him to stay the second night just in case. They stopped by about a month after it happened to say thank you, with cookies. Lucky kid.

Both adults were head injuries from an MVA, with altered mental status and other injuries like bilateral humerus fractures or a femur fracture, etc. In one case I was driving home from work and came on scene before the FD. Luckily, I knew the Lt on the engine, and when I said that the guy was going to need a helo, he listened to me. Granted, the guy could have gone by ground, but again, it was rush hour and even with lights and sirens, it would have taken over an hour to get to the Level II trauma center.

I got my EMT certification in a state with a lot of rural areas, and I happened to work in a semi-rural area (some small cities, with LOTS of emptiness and the closest trauma/burn/anything bad center was about an hour away on the state turnpike). The closest helo was about 45 minutes away by ground, and had to be called special by the county to the state in order to get them going. I can't remember EVER flying someone when I was up there. Granted, I didn't have much of a chance to most of the time, but the mentality up there was to get a good assessment and learn to deal with a lot of shit yourself, because the helo was only for REAL emergencies. Good, bad, or indifferent, that was the way it was.

Then I move to a smaller state with a much higher population, in one of the most populated areas in the country. The HEMS around here is run by the state. No 'helo shopping' around here. And a federal police service has medics on their helos, so they can help out when we need them to. Their AC are also larger, and can carry more people/patients. I see a lot more patients being flown to various places here than I ever saw in Rural Area state. One would think it would be the opposite, with my primary call area being within spitting distance of 3 hospitals, one of which is a Level II Trauma center, and within an hour (in good traffic) of 3 Big City Hospitals. I've had an opinion about this proliferate use of HEMS when you are so close to relatively definitive care, and a recent call I went on before my surgery only cemented that belief.

My EMT instructors HAMMERED us on assessment. How can you decide what is best for the patient when your assessment is lacking? And in areas where the closest hospital may easily be an hour away, assessment is key. Continuing assessment is also key. And by having a good assessment, and KNOWING your assessment is good, you have confidence. Confidence that you haven't missed anything glaringly obvious, and confidence that what you write on your run sheet will stand up.

When you lack confidence in your abilities, you are more likely to call for someone with more skills to help out. This can be a good thing sometimes. But when that someone is a flight medic who comes on a big whirly bird, this can be a bad thing. The flight medic is unlikely to refuse the flight, because flights mean money and continued existence (and jobs) for him or her. In private companies, that money comes in the form of billing the patient (and a helo flight is VERY expensive). In public, like where I'm at, that comes in the form of state and federal monies, which are given based on need...in this case, usage of the service. So, because of the lack of confidence of the medic, and a poor report to the doctor (which does not paint an accurate picture of the patient) and a doctor afraid of 'zebras' and the extra money it will cost the hospital if the patient really IS a trauma who needs to be at a trauma center and has to be flown by private HEMS, a helo is dispatched, extra flight hours are put on the helo, taking it out of service faster, and in general, risk is run to everyone.

Equal to the lack of confidence, (and perhaps, and indirect result of lack of confidence) is the 'what if' scenario. 'What if' the patient has serious trauma injuries that are being masked by EtOH? 'What if' the patient really is hurt and deteriorates while we're taking them to the lower level trauma center? Constantly looking for the stampeding hordes of zebras doesn't make you a better provider. I've heard of doctor's with this same problem. I blame the lawyers and policy makers for making every medical provider from EMT up to surgeon uber-paranoid about lawsuits for 'what if' situations, so we over-treat in the hopes that the zebra will be caught. In the meantime, all those extra costs (or risks) are being passed down to the patient and public. But in reality, is this really totally the fault of the lawyers and policy makers? Why are some providers comfortable in treating patients as they present and others want to do everything under the sun 'just in case?'

In my opinion, it comes down to confidence. Confidence in assessments, abilities, and documentation. If you are confident in your ability to assess and treat, and then document EXACTLY what you did, the times you did it and why (not always needed, but it helps), then there should be no reason for you to call for a higher level provider unless it is truly needed. If you can back up what you did, why worry? Sure, something may slip by. But I was always taught that if you are acting within your scope of practice, and with the best interests of the patient in mind, and you document why you did what you did, then you should be covered.

Sadly, for so many, this is no longer so. Perhaps I just haven't gotten bit by the lawsuit bug yet, or been trampled enough by zebras to have this worry. Hopefully I never will.

Cab-ulance

2008-10-17T09:03:00.000-04:00

I've been credited with initiating several partners with this term. I'm not quite sure how or where, since I don't recall first using it, but there you are. And I do tend to forget what I've said when I'm transporting a patient at 3am. Heck, one partner even said I used it over the radio when calling into County that we were enroute. Again, not something I recall.

At any rate, it's no secret around my dept that I have a deep and utter loathing for people who use the ambulance for their own personal taxi. Granted, there are exceptions to this, and I'm ok with that, and I've been told that other EMT's admire me for my 'outward' politeness to these system abusers (though my partners know full well what is going through my head at the time). I know many other EMT's and medics feel this way, and in fact, had an instructor in my EMT-I class who has been in trouble for taking a 'patient' (and I use the term lightly) to the hospital by telling the person to get in the back, and then getting back into the front seat himself, and dropping the person at the doors to the waiting room.

NOTE: I DO NOT condone this action. I did find it funny as hell when he related it to the class, and I wish to hell I had the cojones to do it, but I fear for my certification.

Here are some instances in which I have had the urge to tell the person calling an EMERGENCY VEHICLE for taxi-transport to F**K OFF!!!!

-the guy who has a history of kidney stones, thinks he's getting it again, and has abdominal pain of 3/10. Lives on a road that barely exists and is full of potholes. Has the energy to pack a suitcase, and wait for us at the end of the driveway, and then walk back up the driveway to the house to call 911 back and complain we aren't there yet, because we are lost. Upon putting his keys into his suitcase, I notice 2 car keys on the ring, and saw at least one car in the driveway when I was playing bellhop and loading up his suitcase into the ambo. Total time: 20 minutes getting to his house. 5 minute drive (no flashy lights or sirens because it's 2am) to the hospital, 15 minutes to put guy in triage and wait to give report to the nurse because the ED is full, 15 minutes back to the station.

-the mother who called 911 because her (old enough to know better) son was jumping on the bed and when the mattress slipped off, he cut his foot on the springs. Granted, the slice was deep, and probably painful, though the kid was remarkably calm, and definately needed stitches. Call comes in around 6pm, just as dinner is getting on the table. Upon arrival to the scene, there were so many cars in the driveway (and on the grass, and in the road) that we had to park one house away and walk everything in. Upon being told by the Lt riding charge that Jr needs stitches and a tetanus shot, but mom (or any one of the 15 adults standing around) can take him herself once we bandage the foot up (because arriving on the big white box with lights that aren't flashing doesn't mean you have to be seen immediately), mom states (and I quote) "Oh that's ok. Jr has never ridden in an ambulance, and thinks it would be neat, so we'll let you take him. I'll have someone follow in a car." Because clearly it is a priveledge for us to take your old-enough-to-know-better son and yourself to the hospital, just to take you to the waiting room (because both the adult ED and the peds ED are full) and listen to you complain that the wait will be too long.

-the 20-something year old woman who was complaining of lower back and flank pain on one side. Had no desire to go to the hospital, just wanted to know if she had a kidney infection. I almost hugged my Lt when he told her (with a straight face) that the ambulance's portable x-ray machine was broken and she would have to either go to the hospital or to her PCP. She didn't get it.

-if you cut yourself, and pass out at the sight of your own blood, and then call 911, don't get mad at me when I ask where the cut it. If I can't see it, it probably doesn't warrent a trip to the ED. Now, while I am not made sick at the sight of blood (my own, or anyone else's), I can understand that cutting yourself with a sharp knife is very painful and that some people have that reaction. I really am trying to be understanding and put your mind at ease. Your vitals are all fine, and the headache you feel is probably left over from the adrenaline rush which caused you to get all weak and wobbly anyway, and most likely is NOT from bumping your head on the cabinet as you slid to the floor. Oh, and having your wife constantly question me isn't helping...Man up, dude.

-Note to nursing home staff. I know it's hard to work in a nursing home, and I know the pay is crap. I know you have to pass a ridiculous amount of tests and audits and that you get treated like criminals every time a patient dies. Trust me, I've worked there....I know. But here's a few things I'd like you to think about....Just because the doc told you to ship the patient out to the ED because you woke him up at 2am because patient A has a cough doesn't mean you have to call 911. There are transport services around that can do the same job. The only difference between them and me is that I come in 5 minutes, after putting my own and other's lives in danger by running hot, and I don't charge a fee, unlike the transport service, that, depending on call volume, may get there in an hour or so, and will charge you.

Also, calling for the 'unconscious person' because you checked on them at 8 when you cleaned up their dinner tray and then didn't check on them again until midnight shift change won't go over well with me OR the medics when it turns out the patient was merely sleeping, and took out their hearing aides. Looking at me wide-eyed with astonishment when I was able to magically wake them up won't win you any points either. Obviously the patient is stone-deaf, and can't hear you whispering for them to wake up at the doorway.

As I said before, I've worked in nursing homes and such. I know the nurse to CNA ratio is low, and patient to carer ratio is extremely high. However, I made it a point to know my patients (and I was in a rehab place, so it was quick turn-around) so that if 911 did have to be called, I would know what was going on with them. Calling me for anything and having the CNA meet me, and tell me they don't know what's wrong with the patient is not helping you, me and most of all the patient. This is especially true for when you call me for a fall. If the patient falls, and you suspect something is wrong, PLEASE do not pick them up and put them back in bed, and then wait till the next shift comes in so that they have to call. Make them comfy on the floor and call and wait. I hate hearing the patient ask me not to hurt them again when I have to move them. It breaks my heart, and since it's been hypothesized that I don't have much a heart anyway, that is no mean feat.

And while I have several other beefs (especially with nursing homes), my last one is this. Many people go to a nursing home because they cannot be cared for at home. The vast majority of the time, these people are just waiting to die. Sorry to be blunt, but that's how it is. If I am old and sick, the LAST thing I want is to be moved from my bed and my belongings and sent to a cold, impersonal hospital to die. I have a DNR-B for a reason, and that reason is that I WANT TO DIE PEACEFULLY!!! I don't want to die with the sounds of a hospital ED being the last things I hear. So calling an ambulance for the 99 year old person with end-stage lung cancer and Alzhiemer's Disease who has a DNR-B, and at midnight shift change had a blood pressure of 50/10, a heart rate of 20, and a respiratory rate of 4-6 (and it's now 0130 because you HAD to finish shift change rounds) is probably not the best practice. Yes, I know you get investigated by the state every time a patient dies on grounds, but really? And yes, the doc told you to ship them out, (which I hate, because the patient is NOT a package to be 'shipped') but when you wake a doctor up at 1am and tell him the patient's vitals and not much else, what else do you think he's going to say? I really dislike transporting what is essentially a corpse to the hospital because you don't feel like doing the paperwork.

Being named the 'Angel of Death' by the ED nurses because 6 out of 10 patients I transported over a 2 day period (all of them nursing home patients with a DNR-B) took their last breath as I moved them over to the hospital bed doesn't make me much happier with you, by the way.

Perhaps this nursing home rant should be it's own post. I think it will be. But the next post I think will be one in which I discuss the times I don't mind being a cab-ulance. Those times include little old ladies or anyone who can't drive themselves for something that they otherwise would have.

You always remember your first...

2008-10-16T07:20:00.000-04:00

I took EMT-B class in NorthEastern PA (yes, it deserves being capitalized) during my sophomore year of college, between 1997 and '98.. I had wanted to ride an ambulance since I first started seeing them on the sidelines of the high school football games, while I was playing drums in the band. How cool, to be in those orange jumpsuits, driving around town lights and sirens to save people's lives!

I already had plans to go to medical school after college and then working in an ER or as a trauma surgeon (hey...I had dreams...), so when the opportunity came to take an EMT class, I figured, why not? By becoming an EMT and working car wreck scenes and heart attacks, I learn if I can hack the pressure and stress that comes with working in emergency situations, right?

So I took EMT class, and excelled, I'd like to think. My instructors made sure we could think our way out of a problem, because honestly, the way EMS was in PA at that time, you may very well find yourself on a trip to the trauma center an hour away with one medic in the back with you and the driver in the front. There was no helo on every corner, and the local Level II trauma center only took people with their particular insurance. And if you wanted to go to a specific hospital, you better either call when you're on the doorstep, or call before leaving scene, because the doc taking your call could very well refuse your patient, sending you to another hospital. We didn't do a lot of rendevous with the medics, because they were hospital based in a delta truck (van) and we had to respond to the station and then get to the scene, because the ambulances were housed in the city council building, along with the fire dept and the police, and the local jail. There was a room upstairs with the computers to do your reports and a couple of couches, but you weren't allowed to sleep there. Therefore, there was a lot of being woken up in the middle of hte night and calling in to dispatch and driving to the station to get the ambulance out. Dispatch, who was contacted by the county (who received the 911 calls) would tone out whatever was needed. You got 3 tone outs, 2 minutes apart, before mutual aid was activated. If you called in as the aide, or EMT, you would head to the station, but if they didn't raise a driver, it would go to mutual aid and you just drove across town at 3am for nothing. I can't say that I got a lot of experience there, but I learned a lot from the medics who beat us to the scene and treated the patients while they waited for transport. Our dept didn't have a lot of money, so I learned to improvise a lot of things, and I learned that if shit goes downhill, you can't freak out. You have to suck it up and deal and learn from what is going on so you don't let it happen again. A partner of mine had to once ride with a 300lb pt in the back of the secondary ambo, with a stretcher that wouldn't go down all the way and therefore wouldn't fit in the brackets. The patient was critical, and for once they had beaten the medics to the scene and set up a rendevous. I remember him relaying the story to me, him a new EMT on his second call, terrified that the medic would open the back and see him holding the broken stretcher against the brackets with his feet and have kittens. You can say that I learned early in my career the importance of 'Improvise, Adapt and Overcome.'

I got my certification in January of 1998. In NEPA, winters tend to be a bit rough, and one night, about 2 weeks after getting my card in the mail, our tones dropped for an injured child after sledding. It had been snowing and sleeting all day, and we hadn't had classes. So my partner and I piled into his truck and headed over to the station. We made it just as the ambo was pulling out and jumped on. We got on scene, and the medics, rescue chief, assistant rescue chief, and half the dept had already gotten there (lots of people responded in the POV's from home if they heard the ambo had a crew). We got there just in time to help put the backboard on the Reeves and slip and slide down the icey road to the ambo.

Everyone piled on. The rescue chief, the paramedic, myself, and my partner. A firefighter drove, and the patient's little brother sat in the front seat. The patient was a tall kid, somewhere in his early teens (I can't remember his exact age), who had been sledding down the street at night with his brother. The parents were out, maybe shopping, maybe working, I don't remember. The patient hit a tree after jumping the curb, and had been found by the first people on scene under a car.

I don't remember much about the trip to the hospital, or the patient's treatment. I remember that he didn't have a mark on him, save for a stripe of grease on his forehead, obviously from sliding under the car. I remember being given trauma shears by the medic and being told to cut his pants. I remember that it was a long-assed ride, with the on-spot chains down, slowly driving up the highway in the snow, the emergency lights reflecting off the flakes. I remember that we couldn't call for a helo because of the weather.

The most memorable thing though, was this. The rescue chief, also a medic, called the closest hospital, General Hospital, to give report. The doctor on the other end of the radio, after learning that the patient was a minor and the parents had not been contacted yet, refused the patient, instructing us to take him to We'll Take Anyone Hospital. Neither one was a trauma center, but the local level II trauma center didn't like to be bothered at night with patients who didn't have the right insurance. WTAH was 20 minutes up a major interstate on a good day. Tonight was not a good day.

Cursing a blue streak, the rescue chief told the driver to head for the highway. 45 minutes later, we were at the hospital. I don't remember much more than what I've written, perhaps because while cleaning up the ambo I slipped while going out the side door and fell, hitting my head on the floor. Don't know if I had a concussion, but I certainly had a headache for the ride back. And I do remember that 2 days later the news reported that the patient had died of a closed head injury.

Being in Maryland now, I tell that story, and people are incredulous. Perhaps I got some details wrong, being a newly minted EMT with ZERO experience with the hospitals and doctors and things of that nature. But I do remember having a box on the back of our run forms where the patient had to put their insurance info, or sign if they didn't have any. And I do remember the hospital, specifically General Hospital, being VERY interested in which box was signed. And I distinctly remember the rescue chief cursing the doctor at GH as we drove slowly to WTAH, impuning his degree and the questionable tactics of allowing a hospital to turf what could be a critical patient to a hospital father away on a horrid night to be out driving because insurance coverage couldn't be confirmed.

Whether the law in PA had changed by then to allow uninsured people payment options or not, I don't know. I didn't know much about the law in PA at that time. But when I tell that story to my EMT students, they don't believe it. Not the part about the hospital turfing the patient, or the part where the next closest hospital was more than 10 minutes away.

Beginning

2008-10-15T19:17:00.000-04:00

I'm starting this blog because I didn't want to continue on the Antarctica blog, keeping that one rather special for my Ice time.

But I have so many calls crammed into my head that I need to get them out. So while I'm recovering from surgery and waiting to be cleared to ride again, I figured I'd empty out my brain of 10 years of EMS calls. The good, the bad, and the ugly.