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Booze in the Nose.

15 comments

of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

 

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

There is only one problem with this:  alcohol in a beverage has no odor.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

So the moral of the story is that we need to examine how we chart suspected intoxicated patients. Being highly suspicious of all medical conditions that could cause these symptoms is important too:

http://www.monkeydoit.com/medical-act-drunk.php

DIABETES
Symptoms of diabetes may make a person appear drunk or intoxicated.
A person with diabetes may exhibit abnormal behavior as a result of the many different signs or symptoms associated with the disease. The signs and symptoms listed here only relate to symptoms that mimic drunk or intoxicated behavior. Generally, these are warning signs that a person needs immediate medical attention and should be treated as a medical emergency. Police dealing with suspects often times mistake diabetes for drug or alcohol use during field sobriety exercises. 

Signs & Symptoms of Diabetes
-- The smell of acetone on the person's breath
-- A distinctive fruity odor on the breath (Police Officers often mistake the smell as alcohol during a field sobriety tests)
-- Dizzy, has trouble keeping balance
-- Altered states of consciousness
-- Arousal such as hostility or mania
-- Apprehensive with no obvious reason
-- Unusual nervousness
-- Disoriented in place or time
-- Confused when asked simple questions or confused in general about circumstances
-- Sweaty with clammy perspiration
-- Inability to concentrate on what you are telling them or on the tasks at hand
-- Sudden mood changes
EPILEPSY
Epileptic seizures generally happen without warning for most people. A seizure is a brain disorder of abnormal electrical activity in the brain. Seizures may be either partial or generalized and will present signs and symptoms that very among individuals. 
Signs & Symptoms of Epilepsy
-- May appear detached from reality
-- The person might be in a dreamy state 
-- Dizzy, unable to maintain balance
-- Falls down
-- Staring spells
-- Unresponsive
-- Walks away during a conversation
-- The person may have pupillary dilation
-- Sweating
-- Problems speaking
-- They may display an inability to answer questions
-- Contorted posture / limbs appear twisted
-- Flushing
-- Memory and time distortion (they may not remember what just happened)
-- May appear unrealistically fearful
-- May exhibit emotional signs of heightened pleasure
-- May exhibit emotional signs of displeasure
-- May appear aggressive or angry
-- Complete loss of consciousness
BRAIN INJURY
Brain injures will generally have signs and symptoms that relate directly to what part of the brain was injured. Here are just a few symptoms that someone could easily mistake as the person being drunk or intoxicated. These will vary among individuals and to what extent the brain was injured.

Signs & Symptoms of Brain Injury
-- The person may exhibit tremors
-- Dizzy, unable to maintain balance
-- Unable to make simple movements of various body parts
-- Inability to perform a sequence of complex movements
-- Unable to focus on tasks
-- Sudden mood changes
-- Inability to focus attention visually
-- Difficulties with hand and eye coordination
-- The person may suffer from hallucinations or visual illusions
-- They may have difficulty in understanding spoken words
-- They may show signs of aggressive behavior
-- The person may slur their speech 
Brain Picture -EpilepsyALZHEIMER'S
Alzheimer's or dementia is unique for every individual. Alzheimer’s is a progressive and fatal brain disease and the most common form of dementia. The signs and symptoms like the other medical conditions listed here may mimic impairment or drunkenness.

Signs & Symptoms of Alzheimer's
-- The person may show signs of paranoia
-- There may be drastic changes in mood
-- Confusion is quite common with people suffering from Alzheimers or dementia
-- They may have problems speaking
-- The person may exhibit aggressive behavior
-- It's common that there will be problems with remembering things

The Mendoza Line

4 comments

Do you ever feel like we’re playing a losing game?

The other day I went through my cardiac arrest statistics. Dispatched to 91 cardiac arrests since I became a medic. ~30/year. I have worked approximately 50% of those. I have EXACTLY 1 cardiac arrest save.

ONE!.

If this were baseball, I’d have a batting average of 0.01098901098901099.  OOOH! If we call all of the no start calls “sacrifices” I’d have an average of 0.021739130434782608. If we only say that the ~45ish times I’ve actually worked an arrest count as “at bats”, then I have an amazing 0.022222222222222223.

In baseball the record for lowest career batting average for a player with more than 2,500 at-bats belongs to Bill Bergen, a catcher who played from 1901 to 1911 and recorded a .170 average in 3,028 career at-bats. I’m well below the “Mendoza Line”

What is YOUR batting average?

 

 

 

 

Mostly it’s the getting by thing…

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We all joke in ways our families, friends and patients don’t understand. See around the 3:20 mark of this video:

Godspeed, friends!

Sincerity

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If you are just trying to be dramatic and get attention, downing a bottle of tylenol is a really crappy way to do it.

Because you’ll probably die. Not might. You will most likely die, if you take 100 Tylenol capsules. I’m sorry, but I didn’t do it to you. If you need help or attention, ask. If the people you ask don’t pay attention, ask someone else.

Or suck. It. Up. If you don’t really want to die, don’t do something that is most certainly going to kill you. And PS, killing yourself is a petty, selfish and disgusting act. Killing yourself because your 15 year old pimply faced boyfriend broke up with you for cheating on him with his pimply faced best friend is just fucking stupid.

The Speech

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“Mr Thompson…. Today when we arrived your wife was not breathing, her heart was not beating. We began CPR and hooked her up to our cardiac monitor. The monitor showed that your wife’s heart had stopped. It had no electrical activity.

At that time we continued CPR while administering heart-starting medications and inserting a breathing tube. After nearly 20 minutes, nothing has changed.  Her heart is still not beating. She is still not breathing.

I give you my most sincere condolences, but she is deceased and there is nothing more we can do. I’m very sorry sorry for your loss. ”

This is how it plays out in my head. Well put, accurate, somewhat concise…

But it never comes out as well and they never let you get that far. It is even harder in untimely deaths.

What do YOU tell people when their loved ones have died?

Open Letter to Yvonne B. Singletary

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Found this letter on one of my favorite bloggers facebook pages. Yvonne is a Cathlab Nurse in Houston.
Here is her letter:

September 14, 2009 at 0500 my on-call beeper went off with a STEMI notification. Within seven minutes I was in my car and on the way to the hospital. At 0519, I was stopped by a patrol car for failure to come to a complete stop at a stop sign. I told the young officer that I was on my way to an emergency case. I was in full scrubs, wearing my ID badge, and carrying the beeper with the texted message. The officer apologized for the inconvenience. He then went on to explain to me that he had to write a ticket because I did run the stop sign. It took him twelve minutes to complete writing out the ticket, then explain my court date. I reached the hospital at 0545. I was the lead RN in the cath lab crew.

The American Heart Association and the American College of Cardiology have set the door-to-balloon time that is most fortuitous for ST-segment elevation myocardial infarction patients as 90 minutes or less. Here at St. Luke’s Episcopal Hospital, in Houston, Texas, we have gotten our after-hours door-to-balloon time down to an average of about 50 minutes. Studies have shown that the sooner the occluded vessel is opened, the more heart muscle is saved from infarction.

Although that young officer was polite and professional in doing his job, he made a serious error in obstructing me from doing my job. I accepted my ticket, then proceeded to the hospital. Luckily another nurse just happened to be in the lab early that morning and was able to help with the case.

When I got home that night, I thought about the options open to me in dealing with the ticket. I had three. I could pay the $230.00 ticket outright, I could plead guilty and ask for defensive driving class, or I could plead not guilty and fight. If I plead guilty, the ticket would go on my driving record (raising my insurance premium). If I pled guilty and asked for defensive driving my record would be clean, but I would still have to pay $110.00 for the privilege to take the class, which then cost an additional $45.00. If I pled not guilty and lost, I could still take the defensive driving course. I was mad and full of righteous indignation. So, I pled not guilty.

November 2, 2009, I went to court. I did not hire an attorney. I didn’t believe that any attorney could tell it like I could. Now Shakespeare has written that anyone who represents himself in court has a fool for a client. Giving Mr. Shakespeare his respect, he wasn’t an attorney or a nurse.

Before court, I searched the literature supporting door-to-balloon times. I got a letter from our STEMI Coordinator, Larry Brown, RN, verifying the page and the importance of my presence in the case. I had a copy of the staff assignments for that day with my name as the lead call nurse. I had also pranced around in front of my mirror for a month practicing my defense.

My husband went with me for moral support. I really appreciated him at my side. I was ready for battle. When my turn came, the case was thrown out because the officer did not appear. I had mixed feelings about that. I was relieved that it was all over. But, I also felt that I had been denied my day in court. I wanted to tell the judge, the jury, the policeman, and that courtroom just how important it was for me to get to the hospital expeditiously. I wanted to say that I did not recklessly blow a stop sign or drive dangerously.

I was not able to tell my story in court, so here I am now to tell the tale.

I am currently working on getting an appearance before the City Council. They need to know that each one of them, as well as I, could fall victim to myocardial infarction. I want them to realize that there is not a single cath lab in Texas, along with most of the U.S. (that I know of, and I have searched) that has twenty-four hour in-house trained cath lab coverage. I am aware of programs that have trained emergency department (ED) staff and rapid response (RR) nurses to take steps to getting patients steps closer to the lab before the trained team arrives. As a matter of fact, here at St. Luke’s, our ED and RR nurses are trained to take steps to getting the patient to the lab and set up for the cath team. However, the training and expertise to proceed with the case rests with the cath team.

So, for each minute that a cath team member is delayed receiving a traffic ticket, one minute is lost to getting the most expert care to a heart attack victim.

I am conducting this fight not just for myself, but for the many other team members that have received and are still receiving tickets. As I asked around, I also encountered several doctors who also said they received tickets en route to STEMIs and other cardiac emergencies.

When I approach City Council, I will present my case, and possible solutions. This issue can be addressed in several ways. First, when appropriate ID and evidence of a call is presented to the officer, I would like a city ordinance passed to allow the driver to go without further action.

Next, if the driver is caught on the red-light camera, he/she should be able to present evidence of a call and be forgiven (if an adequate stop was made). I have also received a ticket from the camera. I was answering a call at 0200 on another day. I stopped, checked for oncoming cars, then went through the light. That ticket was $75.00. The third option is for the officer to accompany the driver to the hospital to verify the call.

With hospitals all over the nation pushing (and rightfully so) the door-to-balloon initiatives, there must be some cooperation between local police and healthcare professionals. I live in a large metropolitan city. The average employee lives thirty minutes away. There are six red lights and four stop signs on my way to the hospital. Although I do my best to get to the bedside as quickly as possible, my brush with the law has made me more cautious. I in no way condone reckless driving or speeding. However, I really feel that we should be allowed some leeway, especially in the pre-dawn hours when the streets are barren (except for the lurking officer).

I am writing this article before I go before City Hall because I want readers to send me emails to take with me from around the nation. I want the Houston City Council to know just how seriously we take our business of saving heart muscle and lives.

The one sure way to get the absolute best door-to-balloon time is to have twenty-four hour in-house cath lab staff coverage. In these trying economic times, I do not see that as a viable option any time soon. So for now, we must work to get the best times as safely possible.

Yvonne B. Singletary can be contacted at zybs01@yahoo.com. She notes that she did make it to City Hall and addressed the City Council, but will address the results in a future article. She welcomes your emails.

Dear Yvonne B. Singletary, RN, BS, RCIS, CCRN, CVRN (your must be awfully proud of yourself with all those fancy letters after your name…)

I wish the officer would have been there in court that day. You have no right to disobey traffic laws when you are not in an emergency vehicle. You have not taken Emergency driving courses. You do not drive a vehicle equipped with emergency lights and sirens. You do not have the RIGHT to put others at risk.

YOU were at fault. It is YOUR fault that your patient had to wait 12 minutes for him to write a ticket–all because you couldn’t wait mere seconds at a stop sign.

YOU do not have the right to put other drivers at risk when responding for a hospital page. In fact, you very likely could create a whole new(and more critically injured) patient in the process.

Do not speed. Do not blow stop signs/lights. Do not complaint about being caught breaking the law.

The fact of the matter is that ambulance transporting code 3 do not save much time at all. Whatever made you think you deserved some privilege to break the law is foolish, at minimum.

In my state Volunteer Firefighters, even with flashing blue lights, cannot speed. Why should you be able to run lights and break the law? WHY?

The 3 seconds you would have wasted at that sign are not worth putting the citizens of your community at risk. It is your fault that the patient waited 12 minutes to see you, not the fault of this officer.

Obey the God Damn Law.

Sincerely,

MedicThree–the guy who will have to scrape up the the poor sap you or your colleagues run over…

I encourage my readers to contact her(as she wishes) at zybs01@yahoo.com

Uninspired.

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For months I have struggled to keep this blog alive. I have posts inside me. I have posts started. I just can’t muster them out. This is really the way a big chunk of my life is going. I am incredibly happy with my wife and son, but something is amiss.

I am often distracted, barely able to pay attention to the simplest of things. Medically, I am an undiagnosed ball of annoying symptoms–not debilitating but the sum of them is wearing me–and my family–out.  I stugle to be the man I promised my wife I would be, while being a father I respect and a paramedic I would trust.

That is all I want–to be a good husband, father, and paramedic. Just like the subtitle to my blog. That is me. There is little more to me than those three things. Sure, I am a son, a brother, a friend. But the sum of these three things defines the man I am today.  Yet I find myself uninspired. I have an amazing wife, an adorable 1 year old son and a job I love doing and I am just uninspired. When I get home, I kiss my wife, hug my son, and go to bed. I fail miserably at sleeping all day and then repeat the cycle.

I make goals–to work out, eat better, spend wiser, study harder–yet I never follow through with any of them. I set these goals again and again and I always end up where I started. Uninspired.

I have the desire to move past all of this, but I just need the right push? What will that push be?

Being an EMS Dad

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I’ve been a paramedic for about 19 months. Not very long, really. My first year was spent working for two teeny tiny services with teeny tiny call volumes. The last seven months with a service that runs right around 10,000 calls a year with 3 trucks covering. Needless to say, I have experienced a lot more in the last 7 months than I did in the year prior to this.

I have been a father for just under a year. 11 months and 7 days, to be exact. As a father I know I will be learning what to do for the rest of my life. My son is amazing and if I didn’t have the amazing wife that I do–well, there isn’t a shot in hell I could do this on my own.

What I didn’t expect was for the lessons EMS would teach me about being a father. The skills I’ve learned since becoming a father are less about medical procedure and more about communication, lessons, and reality.

Reality is the hardest part. Shit happens. Inevitably Asher will get hurt. Inevitably Asher will get sick. Inevitably Asher will make us mad, and I’ll be forced to discipline him. Some how, working in EMS has taught me some skills to be better prepared(or so I am hoping!).

The most surprising skill tune up I’ve gotten while working on the streets came in the form of communication. My communication skills suck. I bottle things up, take them out on those I love, and then don’t understand when they get mad about it. I can be hot tempered, ill mannered, and down right inappropriate. Dealing with frustrating, rude, and down right worthless patients over the last 19 months has taught me that sometimes despite what you think and feel about someone, you have to be able to do your job with self restraint.

Self Restraint. Compassion. Patience. Even now when Asher is so young and innocent, these qualities are getting more fine tuned. After a long night at work, coming home to a screaming baby isn’t easy. Then again, Mrs. MedicThree was home alone with him all night–I don’t imagine me coming home and ignoring them helps her get out the door much either. Before being a medic, father, and husband it was all about me. Now, it rarely is.

Being a medic has taught me how to diffuse situations that could otherwise end badly. Calming a psych patient down, giving stern advice to someone abusing the system, and making sure I am doing so within the bounds of being a Paramedic–and not a judge–is more than a challenge at times. When I first started doing this, I would jump down someones throat for “wasting my time”. Now I understand that sometimes it is easier and better to spend a minute or two trying to figure out(and make the patient) what the hell is going on.

When it comes to life at home, it is more logical to take a breath and treat my family with the respect they deserve. Does this mean I am always cool and calm? Nope. I get stressed. But I like to think that when big things come up I can handle myself–this is something that prior to EMS I’m not sure I could do.

The most unexpected part about being an EMS dad is how being a dad has changed being a medic. Pediatric calls give me a different chill I couldn’t imagine pre-fatherhood. The way I communicate with patients and families has evolved greatly since being married and becoming a father. I spend a little more time trying to make my patients feel better than I did before–most of the time this is done by talking. Sometimes I am a little stern–call it honest–but sometimes that is exactly what the patient needs, and sometimes it is what they want.

Trying to pick and choose the parts of EMS I bring home to my family is the hardest part. Learning how to cope with the realities of my job and the challenges of being a husband and father will continue to be the hardest thing I encounter on a daily basis–but I’m excited for the challenge.

In this line of work it is easy to try and separate your personal and professional lives completely–but it is impossible to succeed. Finding a way to allow them to compliment each other is the key to survival.

Whatever it is.

13 comments
Cause when she loves love me
Girl that’s how I feel
Cause when she loves me I’m on top of the world
Cause when she loves me I can live forever
When she loves me I am untouchable

My wife is my queen. Without her I assure you that I would be completely lost. This song has a way of describing just how we work. It just all of the sudden clicked with us. We had an on again/off again relationship that lasted several months. Shortly there after I moved 1826 miles to Florida… For many reasons… But mostly because I was afraid of who I was becoming.

So I ran. I ran fast. I left my dog, my friends, my family, and I ran. I spent 11 months in that dreadful state(good god… humidity is supposed to end at some point). It was really my only option.

Butit worked. I grew up. I learned how to work hard–and I learned that what I was doing wasn’t for me. I learned there is more to life than what I want… but what I NEED. Then one night I found what I was looking for…. one thousand, eight hundred and twenty-six miles away from where I was. So I packed up my little red VW bug and moved my completely heterosexual ass back home. I tried to play tough. I tried to deny how I felt. But I couldn’t.

So I moved in with her. I married her. And we had a beautiful baby boy. She is my rock. My soul mate.

She is my wife. Whatever it is that brought me back, I’m not 100% sure. But SHE brought me back. Nothing else could ever have the power over me that she does.


The Little Ambulance that Couldn't

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On December 7th, 2008 I took a job with a little ambulance service in my hometown. The town where I grew up–where my parents still live. My wife and I moved back home this spring.

The Little Ambulance that Couldn’t has one hell of a reputation. When I was hired on I thought most of it was BS. I was HOPING it was all BS. They said the owner was crazy. They said he was unprofessional, unqualified, unstable…. They said the medics were out of practice, that they were just stretcher jockies.

I tried. I really, honestly tried to make the best of it. I needed an out, and this was it. I took what I had and ran with it… But the breaking point was always on the horizon.

Every time someone went wrong at the Little Ambulance that Couldn’t it was always the end of the world. Out of soap… the sky is falling. Missed an IV… the apocalypse is near! Had a patient get pissed…. OMG… The dinosaurs are coming!!!

The LCTCn’t was more concerned with LOOKING like a real ambulance service than BEING a real ambulance service. We spent more time sweeping, washing trucks, and mopping floors than we did running calls. Since January 1st I was ON 46 calls. I was lead on 26. On 12 of those calls there were 3 or more staff members on the call(any time we had an “exciting” call, every damn staff member in town showed up cause they thought we NEEDED the help. I’m sorry, but I don’t need 27 people vying for control of MY call.).

The owner at the LCTCn’t had a hair trigger. Any time something tiny happened he went off half cocked. When business was bad he wouldn’t hesitate to let us all know how we were all replaceable and he was willing to work 24/7(I raise you this and challenge you to actually do this now!).

I am a paramedic. I want to run calls, restock my truck, and run some more. I’ll wash my rig when it is dirty. I’ll mop a floor when it NEEDS it. I won’t do busy work for the sake of doing busy work. I’ll also take a nap when time permits.

When you treat me like I am disposable, I will do everything my power to prove you otherwise. Step one, walk out. Step two, fight back. Step three…. Win.

Do not try to intimidate me with reminder mailings of my confidentiality agreement. My complaint with the department of labor is well within my rights. You have failed to realize everything I did for you during the last 7 months. I wrote your protocols, designed your website(which you are now unable to update without me), implemented your EPCR program(which you are clueless on) and set up and maintained your internal network. You have no one who can do these tasks. Enjoy finding a medic/maid/IT guy to replace me.

When you are working back to back to back 24 hr shifts with your medics who can’t even spell succinocholine let alone provide you dosages. Enjoy your CPAP device I researched that you aren’t even sure when to use. Enjoy back to back 8 hour transfers. Enjoy continuous turnover because you aren’t willing to take the tools we gave you to succeed.

You’ve proven all you care about is LOOKING like a real ambulance service. When you’re ready to BE a real ambulance service… don’t call me. I have moved on. Gone. Done. Finished.

Good Bye.

Life

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Life has been very busy/stressful/challenging lately. I have been having a hell of a time with my current job and have been looking for my way out. My boss doesn’t seem to think that 2×24 hr shifts + 3×24 hr call shifts is “working us too much”. Funny how 3 months ago he stopped working real shifts altogether since it was destroying his family life.

My family is supposed to magically survive though.

Don’t think so dude. No job will ever be worth sacrificing my family. My wife, son, and even my dogs are more important than a paycheck could ever be. The stress this job has put on my family for the last 3 months is incredible.

I’m realistic. I know that having a 4 month old son is hard. I know that the stresses a new baby can put on a relationship are rather intense. But they are nothing compared to what this job does.

I hope to have magical results for you all in 48 hours.

Godspeed, friends.

PSYCHIC PARTNER

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“If shit doesn’t change around here he is going to lose all of his best medics”

me. “Yup. I hear ya”

Inside my head…. “it is already too late”

Failure.

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For 7 months I have tried to reverse what I consider to be my biggest failure of my life. I work hard. I try to improve things. When that doesn’t work, I give up. I know… I’m a type A personality. I’m a leader. A fighter. I strong person. But I can’t fight this fight anymore.

Every day, I wake up—if I even slept that night, and spend an hour dreading work. If I’m on call I fear any chance I have to go in. When I’m ON I get sick. I dread the conversations with coworkers, the tedious tasks, and the shit morale.

I feel as though I’ve failed. I moved my family and implanted us here with no other options… Well… One other option. My initial first choice. The problem is… the THOUGHT of going there could get me fired here. No… It WOULD get me fired.

I’m damn scared. I do NOT want to let my family down. I want need to succeed. I need to prove myself to my family. I need to prove myself to… me. All I want is to be a Paramedic. All I want is to succeed. Yet every move I make ends in failure. My first job was a failure. This is an EPIC failure.

What would you do? I’m signed into a lease for at least a year. Further, I love being here. We are in my hometown, a mile from my parents, an hour from my in-laws, and I feel spoiled. My son certainly is. I know my parents love having a grandchild close. What do I do?

Wish me luck.

Partners.

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I have some great partners. I’ve also got some really, really crappy partners. Some of them just know what to do. Others need me to hold their hands while they take a crap. Some just can not figure out what being a partner means.

 

So……

A partner is:

-A friend who shares a common interest or participates in achieving a common goal

-A member of an intimate relationship

-A member of a partnership

-A business partner

-Partner (business rank), a member of a law firm or accounting firm which is formed as a partnership; sometimes senior employees of the firm may have the title "partner" (e.g., "salaried partner") to indicate a profit sharing status; salaried partners are distinguished from equity partners, who own the business.

-A participant in a partner dance

 

Things partners should NOT do…

-Throw you under the bus every chance they get

-Use you in a piss poor attempt to further their own careers

-Kiss your ass after doing so

-Ask you for favors after doing so

-expect you to do them favors after doing so

-expect me to NOT give them a reciprocal bus-throwing-under

-Expect me to NOT succeed and leave you bloodied in a ditch off a dirt road in Idaho.

Seriously. When the oldest person at your station is the most immature, idiotic, and pigheaded dumb ass staff member, you know you’re in a ginormous cluster fuck…

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Oh, and some things you should not try to tell me that you are "allergic" to:

-Epi. Seriously? You’re adrenal glands are going to have to disagree

-Sugar. Specifically Glucose. You’re fucking kidding me, right?

-Ammonia? You do understand the difference between an allergy and a hypersensitivity? You get that NO ONE likes how breathing in ammonia makes you feel…

-Right?

-PS… since you are allergic to ammonia, sugar, and epi… what would you like me to do about your "allergic reaction" now that you are in anaphylactic shock? Fucking black magic?

-If you are allergic to sugar why are you drinking a humongo gas station Reese’s Capafrapasugarladencino?

 

The pediatric dose of Benadryl would actually give you MORE Benadryl than the adult dose… based on weight. F-tard(that is me restraining myself.)

 

How in the HELL did one small company with 8 full time employees end up with a concentration of 3(THREE) people with the same set of nearly impossible allergies? 

 

You are a walking, crazy talking, plumb fucking nuts train wreck.train_wreck-782867

Um… Yeah….

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So, It has been rather apparent that I can’t make my mind up. At all.

In the past 6 months I have:

  • Abandoned MedicThree.com
  • Started and abandoned glutenfreedad.com(no longer hosted)
  • Started and flopped on courtesyshock.com(still up)
  • Started, but done nothing with medicdad.com
  • And now I am back with medicthree.com. Format might be a little different, as you can see, but back I am. I have new motivation for some posts, and my fears of exposure are all but gone. A few people
    here know me in real life. One of them is one of my supervisors–but, if I can’t trust her… I’m in a world of hurt anyways!

Anyways… I assure you that by the end of the night there will be an ACTUAL POST HERE…

So… Let me know how things are going! What do you think?!?!?

NEMSMS

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The National EMS Memorial Service is a sad-that-its-necessary, but glad-someone-stepped-up organization. Something I hadn’t realized was that one of my childhood neighbors is on that list.

Hit closer to home than I would’ve liked. I was only 14 years old when they died. He had a son a year older than me and a daughter two years younger than I. It is amazing that someone I honestly only met once or twice has made me feel the way I do right now.

Maybe its a case of whoa-is-me, maybe its a case of –I’m-having-a-baby-and-I’m-terrified-of-fucking-up. I’m not sure…

May God have Mercy on your Souls.

May God have Mercy.

Be safe out there, friends. Godspeed.

The tale of Medic 3 and the dumpsters…

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I’ve got a little more to tell about my weekend trip with the wife, but thought I’d give you a tidbit from last week…

We were called out to the tribal clinic last thursday for about the 123423th time. I did what I do every time, back down the line of employee cars and up to the door. Or that was the plan. As I’m backing my partner starts giving me that “what the hell?” line of questioning.

He thinks its stupid that I’d back in here. He’d rather I pulled in forward and backed out with the patient on board. I think the problem with this is that I would then have to back INTO the patient parking lot after the employee lot.

So we go back and forth about this as I’m idling back. Then… CRUNCH-bang-SMACK-thud. I look out the passenger side mirror to see a dumpster–wait TWO dumpsters that are obviously not in their original position. I managed to hit one, it hit the other, which hit the garage door behind that….

Too boot I was giving my partner shit about the deer he hit 5 days earlier just before we pulled in. Karma is a bitch.

To make matters worse, as I come in I let the secretary know to have an estimate done on the garage door(small ding… no damage to our rig) and she gives me this guilt trip about how those were BRAND NEW DUMPSTERS…

SERIOUSLY??? Wtf?

Shades of Gray…

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In EMS there are a thousand shades of gray. Possibly millions. We have protocols that direct us to which shade we should be occupying, but often your patient doesn’t present exactly how the protocols suggest they might.

One thing is clear: When you’re in over your head admit it, ask for help, and move on. Paramedics often don’t like calling for a helicopter because it as if they have to admit that there is something they CAN’T do. Thats right! You heard it here first. Sometimes Paramedics can’t do shit. Hell. Most of the time we can’t.

When people ask me what my job is like, I respond the same. It is 70% hand holding and soft talking, 10% prophylactic medicine(ASA, Nitro, Oxygen), 15% Bullshit(drunks, pseudo-psychs, et), and 5% real medicine(cardiac arrest, resp failure, resp arrest, allergic reactions, overdoses, trauma).

Most of the people that call 911 need an ambulance no more than they need a taxi. Such is life. The problem is those mundane calls put you in a groove that sometimes you(or your partner) can’t shake off in a real emergency.

This was the case recently with our SOB(dispatched as abdominal pain) call from last Thursday. I knew he was in bad shape, but didn’t realize how bad. When I couldn’t get a BP or line, my partner said for me to get on the road. I asked if he wanted a chopper. He didn’t.

Our service(for now) doesn’t have CPAP or RSI. He didn’t want to tolerate the mask. He needed an airway or assistance, but we didn’t have a line so we couldn’t calm him down… My partner attempted 14 IVs. I’m sorry, but at no point should 14 prehospital attempts be ok. If you really need a line, go IO.

If you can’t do that. Fly the patient. Do something. Do do ANYTHING just for the sake of doing something though. Do what your protocol says to do. If you can’t do that, contact medical control for orders. Admit you are in over your head.

Your patient will thank you. Unfortunately ours can’t and now we get to sit through 3 hours of M&M

People die–but when they don’t LIVE because you opted to provide a lower level of care than you are capable, you don’t belong here anymore.

Sometimes you can do everything perfectly…

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And people still die. Rogue Medic’s post about ON the Clock’s post(yeah, I know) got me thinking TOO.

Sometimes we get there too late. Sometimes we can’t get that “vital” IV. Sometimes things just don’t work out. But then, sometimes you do everything you can, all in record speed–only to “fail”.

As EMS providers we see a lot of dead people. We see a lot less people actually die. Sometimes when we get there, the circumstances haven’t lined up to allow for survival. Sometimes people die.

One of the first lectures we got in Medic class said just that. You can do everything right–everything–and sometimes PEOPLE DIE. It is sad. It can be hard. But it is true. 

One of the most important things we can do is to be strong. Sam at On the Clock is getting there–so am I. Some patients hit me harder than others. Sometimes people die. 

It is important to remember that for us to do our jobs, we need to be able to live, learn, and move on. Some might find this harsh–but you can only take a little piece from each death you have in this job–if you take it all home, you’ll end up at the bottom of a bottle or signing your name at the end of the saddest letter ever. 

Take a step back, and remember–not everyone can be “saved”. We don’t get to pick them. But more people out there need our help and you have to be ALIVE to do your job.

Good Luck and be safe out there. 

All hell broke loose

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today. Seriously. ALL HELL BROKE LOOSE.

I was woke up by my pager at about 0600, multiple victims assualted by a broom handle(and maybe a brick). Blood alcohol of .352, .308, and .251. Sounds more like a gun caliber than what a blood alcohol should be. Of course, no one wanted treatment. Of course, we treated them all. 

I then got home, took off my boots, and the pager went off. Again. This time it was for a 84yo who fell at the nursing home, 3 hours prior. Easy Peasy.

After about a 2 hour nap I was again woke by the god awful sounds of the pager. This time it was to a 60yo male who passed out at the Casino. We get there, he looks just fine. No hx of syncopal episodes, minor cardiac hx. He has a BP of 105/63, pulse 58, and looks absolutely fine. Somehow though, my partner is convinced that these numbers are horrible.

Again, TREAT THE PATIENT, NOT THE MONITOR. Neither of those numbers is cause for alarm. Hell, if I had a BP of 105 I’d be extatic. Whatever. Finally I convince him that if they don’t want US to transport them that we have to honor that, and they go to the ED.

We went behind them, because my partner is still concerned that this guy is going to code. Being a small hospital, if that were to happen, we’d be called anyway. Whatever, the only thing I had going on was a sweet nap. We get there, I sit in the waiting room and watch some Discovery Channel, all while my partner gets all worked up cause now that the patient is relaxed his pulse is in the high forties. Guess what, patient is still fine–looks fine, feels fine, not really worried. 

About 45 minutes later he finally decides that if they need us they will call us. He is convinced we will be transporting this guy to the heart hospital in Sorta Big Town. Guess what–2 hours later–no pager tones.

alkjdasf;lkajsdf;lkjasdf! Seriously. The only thing that frustrates me more than trying to talk a patient that doesn’t want(or need) us to transport them in our $800 taxi is someone who doesn’t even realize the patient doesn’t need us. Oh, and Versed is NOT an analgesic.

More to follow. 60 hours left of my 168 hours of paramedical glory. 

Sitting. Waiting. Wishing.

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So… Took my CBT exam today. Walked out feeling like a huge moron. There were questions I just absolutely didn’t expect. Even worse… the whole “choose the MOST correct answer” bullshit just riles me up. You aren’t choosing the CORRECT answer. You are choosing the MOST correct answer. The answer is often not the one that I would chose to do in the field.

Computer Adaptive Testing(CAT) also makes judging your performance on the test very difficult. Unlike a written test in class, this test will either get easier or harder, depending on how big of a moron you are.

Whatever. I’m pissed, anxious, and preparing myself for the reality that I might have to retest. Hopefully I’ll have something to tell you tomorrow. I’m well on my way to being my own Psych patient.

Registry Smegistry…

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Thats right. Screw you National Registry and Pearson Vue. So it turns out my local Pearson Vue doesn’t have a CBT exam slot for me until July 11th. Yeah… That’s right. My new job is scheduled to start July 7th(and even by then I won’t have a state license). The next closest location isn’t available till July 8th.

Nope, that won’t work either. So… I’m left to drive 138(.87) miles to podunk community college in a different state to take my CBT exam. Better yet, it’s at 9am, supposed to be there by 0830. That means I need to leave by 0615… so I should get up by 5:30, realistically 0600… Fantastic.

I’m not too worried about the practical exam, which as of now is 9 hours away. I’m actually so confident that I’ve put all my eggs in one basket and planned a bbq/drunken bonanza at my little ghetto abode after the test. Brilliant, I know.

None the less… I hope to be reporting back to all of you faithful readers tomorrow with good news and one less step to go in my Paramedic journey of misery.

Until then… Chicken Wing.

Do Parents not PARENT anymore?

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So Today was a day that I can bet won’t ever repeat itself. At least that’s what I’m hoping.

It was really a pretty slow day. 8 hrs, 4 calls, nothing serious–well, that depends on your definition of serious. Calls 1&2 were run of the mill.
Calls 3&4… Well, they make me wanna hurl.

Dispatched code 3 to an Elementary School–on a psych. 11 year old girl who wanted to kill herself. She has made suicide gestures, had a plan(posted on myspace.com) and was very, very depressed. She’s FUCKING 11 YEARS OLD! What the hell is going on here? What happened to 11 year old girls playing dress up, house, reading cute books with pink covers and harassing little neighborhood boys?

To make it better, Dad(the sperm donor) could care less and wouldn’t be coming to the Hospital. Mom–well, she’s in prison–obviously more part of the problem than the solution.

Her aunt is the only one who seems to care enough to come… So she’s getting checked into a Pediatric Psych unit on a Mental Health Hold and she’s all by herself. Why do I see this ending badly. Maybe not today, or tomorrow, or next month. Eventually though the system will be done failing her and One of us will get to scrape her off the floor somewhere.

Absolutely disgusting.

Call 4. Code 2, same god damn school. Apparently they have a hold on the niche for kids with overwhelming psychiatric issues.

This one is 10. Yeah, that’s right. 10 god damn years old. He is “diagnosed” (by an overwhelmed, over-eager family practice Doctor, no doubt–not a psychologist or psychiatrist(Don’t get me wrong. I love doctors. They are smarter than me. But Family Practice doctors have as much business diagnosing and treating mental illness as I have treating cancer)) with ADHD and Oppositional Defiant Disorder(my fav… so he doesn’t like authority… find me a kid who DOES).

He decided teacher was pissing him off, so he kicked, screamed, bit, clawed, spit and threw a chair at him. Then the principal. Then PD.

I told him he had to go with one of us. Either with us in the ambulance with cool toys or the Police car with Handcuffs and a spit hood. He calmed down(like most people do when confronted with this situation) and walked out with us. Mom was no where to be found. She is an aide at another school in the district and was on a “personal” day. PD and school staff tried to locate her at home, friends, family. No luck.

One of the more memorable parts of that call–asking if he knew what meds he took. Benedryl. Every night. What could that be for?!?!?! Hmm…. Good Night.

What are our kids being thrown into psych facilities so often now? Case 1 was legit. She needed help. Case 2 needed parents who actually parented. We are failing our kids. We’re failing the future. I’m actually scared out of my mind about it.

Humorous Pictures
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You’ll have to forgive me, but these are just too funny…

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Check out LOLCATS.

I told myself I wasn't going to go there…

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But… I have to. I had decided yesterday I wasn’t going to talk about this particular patient. It is just one of those, need to get it out of your head, please don’t make me see it again, how could this happen–calls.

20 minutes left in our shift, we had gone Bravo and we were pulling into the garage–when The tones come out. Called for a 3 mo with “Burns” at one of our local problem clinics. Code 3.

We’re thinking it’s a BS Call. A) Who would take their baby with severe burns to a clinic and not call 911 or go to the hospital. B) it’s 20 min till the end of our shift and we’ve done a good job annoying the dispatcher today with our demand for details(we were sent on two transfers and when getting to County he didn’t even have the right building… sorry for wanting to know where to pick up the patient from…)

We walk in the clinic and the nurse starts spewing out details. 2nd and 3rd degree burns to 15-25% of the baby. That would be bad if it happened to me. If it happens to a baby–that can be deadly, and quick.

To boot, mom is a Nurse. Says she was on her way home and the Nanny called. Freaking out. Said that “something happened”. Yeah, no shit.

Apparently nanny had been trying to “wash” off some poo from a diaper change gone wrong. Apparently nanny was able to make Tap water eat skin and fless. Yeah.

My ass. The burn patter isn’t one of running water from a faucet, and it wasn’t one from sitting the baby down into the water. Seriously, the only thing I can see is if water was gently poured from a bottle or pan–you know, the kind you BOIL things in. Cause really, what Water faucet produces water that could cause these kinds of burns–and how couldn’t you feel the heat radiating out of the sink.

My chubby ass gets hot doing dishes in luke warm water. How could you not feel the heat coming at you. She claims she just forgot to check the water.

My faith in humans couldn’t be much lower–well, I guess we’ll see about that in a few hours…

We are trained.

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We are trained to save lives. We are trained to get up early, rush to work, do what it takes, and get to the scene. We are trained to push through blood/guts/tears/vomit/feces to find the cause. We are trained to decipher the difference between minor symptoms. 
We are trained to treat. We are trained to diagnose. 
We are trained to respond. We are trained.

But are we trained to take it all home at night and deal with it?
I’m not sure. Sure, CISM is there to help–but you have to reach out for that. De-briefings are standard sometimes… But even then, you have to go to bed at night with everything you’ve done in your head. You have those pictures there. How do we decode that into something to strengthen us–not tear us apart.

Maybe that’s part of what being a seasoned medic means. You learn how to deal. You learn how to cope. Hopefully that isn’t what has turned so many of the medics I think of as “burnt out” or disgruntled away from their love for the field.

Someday I hope to answer that question a little better.