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....

Officially official, and other things

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....

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

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

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

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!

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...

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

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!

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!

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.

More BLS than ALS

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

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....

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.