Gettin' my Learnin' On

Though it's technically Day 1 of the EMSToday conference  I am on Day 2.  Yesterday was a long day of EKG learning, with a whole day session of Tim Phalen's STEMI class, followed by a short session about wide-complex tachycardias.

And lest the poor man think I'm stalking him, the first session today was his class on AV blocks.  Absolutely wonderful stuff, and though I need to check my notes for better understanding, of was happy to realize that my months of not doing paramedic stuff have not entirely eroded my skills, and I was only slightly glassy-eyed during the sessions.

Today continues with Ambulance Driver's class on firearms trauma  and then an afternoon class on concussions.  Sadly, the exhibit hall doesn't open till tonight, do I can't go browse during my break.

And, more mostly good news yesterday.  I will soon be once again a contributing member of society (and my household).  I got a job as a dispatcher in my county.  It's not what I really want, the schedule blows, and the pay sucks, but it's still a job.  And with luck, I can parlay it into what I do want.

Meanwhile, I'm gettin' my learnin' on here at EMSToday.  Wheeeeeee!!!!

Leavin' on a jet plane

Tomorrow evening I will be sitting in a seat in a large metal tube, preparing to hurtle across the Atlantic Ocean.  By morning I will be in Europe, specifically Germany, where I will meet up with my husband, and where we will drink good beer and eat good food and visit nifty sites worthy of the new lens I bought for my DSLR.

Since we heard he was going to Europe, I have been lax in my exercising, losing daylight in helping him figure out where we want to go, how to get there, and many other things (he's a bit skittish about international travel).  As a result, I find myself constantly tired these last few weeks.  Tonight I will go to zumba and at least make it seem like I'm on the right track.  When we come back, all bets are off.  My overly-large rear will be running, biking, spinning, zumba-ing, and weight lifting.

In other news, I am going to the EMS Today Expo at the end of this month, and this year, I get to take classes!  I am unbelievably excited, and not just cause it means I will be all done with my con-ed for the next go-round.

Not many overly interesting calls recently.  Mostly things that make the eyebrow raise, although these calls are good for training the new kids.  And we have a slew of them too.  I have a couple of observations to make regarding some EMT's I've run into on scenes that have tripped my 'bullshit' meter into overdrive, and I may be getting a reputation for getting some folks in trouble.  But there is no call in this field for shitty behavior, to patients or to fellow providers, and falsifying a call just to get ALS to take the patient because you're getting off duty soon (thus not only incurring a bill for the patient, but also taking another ALS resource off the street) is the height of laziness and unprofessionalism, and regardless of if you are volunteer or career, you need to be professional.  There needs to be accountability, and for too long there has been none in favor of having enough crews to get the trucks out on the street.

PASS!! Now what?

So, I passed my MD state protocol test, which now affords me the ability to practice as a paramedic in my home state.  As soon as I've jumped through all the hoops that the appropriate ALS affiliated company that I spend my time with has placed in front of me.  (Gotta have all the boxes checked in this state, you know.)

Still, I find myself entering the state website, and clicking on my con-ed report, just to see the paramedic patch flash up there; it makes me all warm and fuzzy inside.  Now, all I have to do is figure out how to apply the con-ed I've received to both NREMT and the state.  Evidently there are multiple hurdles to this, and I will need some help from other state medics in the navigation of the swirly waters of the wonderful state of Maryland's EMS system (and NREMT, but they aren't quite as easy to poke fun at).

I do have to say though, that in both my recent recert classes (ACLS/PALS/CPR and PHTLS), I was heartened by the number of experienced paramedics (both those who were born and raised as medics in this state, and the imports) who mocked the system we currently must slave under.  The ridiculous protocol changes, the lack of attention to evidence-based medicine, the apparent unwillingness to move with the times; all was fair game during these classes.  It made me feel immensely better, to know that there are other medics, some of which I will be working closely with in the future, who are striving to bring our state's EMS system into the current century, kicking and screaming.  To know that other medics feel the same way I do about 'defensive medicine' (the way EMS is taught in this state) make me feel a little less alone.

In other news, I recently got the notice that the local county is hiring another dispatcher, and my name is still on the eligibility list from taking the test last spring.  I'm guessing mine is the LAST name on the list (the oral interview did not go well, as I responded quite negatively to one of the interviewers questions regarding where my loyalty would lie...paying job or volunteer station.  After speaking to several people and describing the interview, I was told that the individual in question 'had it out' for anyone from my station...whatever), but they are finally contacting me.  I have also heard, from a possibly less than reliable source, that the county will be opening up hiring for paramedic positions sometime in the next month or so, as there are no more medics on the eligibility list and there is talk of putting more medics in more stations.

Now, what I would prefer to do is be in the field as a medic, rather than in the dispatch center answering phones.  Some say that the dispatcher position is a good idea, to get my foot in the door, and would make it easier to move laterally to the field as a medic.  Others say it would make it harder, as once they have trained someone as a dispatcher they are less than willing to let them leave for a field position (it's an issue the sheriff's and corrections have had in the past as well).  So now I am torn.  Assuming the background check goes well (I have lived a boring life, so that much is pretty well assured), I will be offered a job in comms.  Do I take it? Do I decline?  I need a job.  It may help me or it may hurt me.  I can always work for a transport company in the meantime until I am hired as a county medic.  The pay is slightly less than dispatch, but the hours are much more variable.

Dilemmas...

Another step closer

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

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

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

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....