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?