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I am Sam: EMS 2.0

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When I should have been sleeping Thursday night, I was watching “I am Sam” on TBS. I actually tried to walk away from it a few times, but I guess I’m a sap for that kind of thing. Well, not really, but whatever. This post IS a little bit rambling and a lot scattered. Mostly because I’m a LOT emotional about it. I’m sick of watching “EMS Professionals” treat patients with complete disregard for the most basic of human needs.
backtop_iamsam
It got me thinking about the countless parenting lessons the Main Character “Sam” offers us. As a mentally handicapped dad with an IQ around 70, the struggles WE all face on a daily basis are compounded–yet somehow he does it better than most parents could imagine. So… Because it is what I do, I TWEETED it. Next @EMS2Foundation asked me a simple question, that made my mind spin out of control.

do you think there’s any good lessons from “I am Sam” for EMS personnel?

Obviously I am Sam is full of Life lessons in general, but I think that the overwhelming theme is about compassion and understanding. I’m not sure what it was about this question that really got me going, but it did. I actually got frustrated trying to write this post–not because I can’t find the words or ideas, but because the basic concept–one we ignore all too often–is so easy. It is almost easier to follow this concept than what most of us do, but yet we still continue on.

What is this concept? Treat our patients with Respect, Integrity, and Compassion. The EMS Blogosphere is abuzz with EMS 2.0 discussion. Seems as though every one of my fellow bloggers has written an EMS 2.0 post–so I guess I HAD to follow.

For those of you who are living under a rock in West Texas, EMS 2.0 is:

EMS 2.0 is the global effort to reform prehospital emergency care. We are an open community that includes members of the general public, medical professionals, and policy makers. All of us are committed to reforming prehospital emergency care world wide.

Personally, I think it should start on a much more basic level.

Respect. Integrity. Compassion.

Respect.
It seems to me that medics have this God Superiority Complex that justifies the way they treat others–Our patients are scumbags, bums, drunks, and thugs. Our patients DESERVE what they got. Our patients don’t deserve good care. Our patients don’t deserve critical thinking. Why should I respect someone who doesn’t respect me?

Sure, we see a lot of bad eggs. Part of why we see them is the nature of BEING a Bad Egg. Bad Eggs do stupid shit. Bad Eggs make bad decisions. But…. Bad Eggs are still people. Do we expect the bad eggs to magically un-rot if we treat them like crap? Right…. Don’t get me wrong–I am not suggesting you coddle drunks and seekers. I AM suggesting that you don’t disrespect them. I AM asking that you don’t maliciously maltreat them. I AM asking that you give your patients a chance–now when they take that chance and piss it away by swinging at you, that is a new discussion.

I think that if we treat patients with respect, the image of EMS will only get better. Often we have this public persona that we are lazy, dirty drunks–much like the patients we hate–yet we don’t do anything to improve this image. It is OUR responsibility to ACT professional, and Respecting our patients is the foundation of that.

In the Movie, Sam doesn’t shove anyone down. As a matter of fact, it is striking how much he tries to NOT disrespect anyone. Our patients deserve to have a care provider with this dedication–yet often they end up with far less.

Integrity.

adherence to moral and ethical principles; soundness of moral character; honesty.

I think the easiest way for EMS professionals to honor the integrity of our patients and act with integrity ourselves is to Follow the EMT Oath. What you say? We have an Oath? Yup, and while we might not put our hands on a bible or be sworn in like some public servants, we are still obligated to uphold this Oath.

Be it pledged as an Emergency Medical Technician, I will honor the physical and judicial laws of God and man. I will follow that regimen which, according to my ability and judgment, I consider for the benefit of patients and abstain from whatever is deleterious and mischievous, nor shall I suggest any such counsel.

Into whatever homes I enter, I will go into them for the benefit of only the sick and injured, never revealing what I see or hear in the lives of men unless required by law.

I shall also share my medical knowledge with those who may benefit from what I have learned. I will serve unselfishly and continuously in order to help make a better world for all mankind.

While I continue to keep this oath unviolated, may it be granted to me to enjoy life, and the practice of the art, respected by all men, in all times. Should I trespass or violate this oath, may the reverse be my lot.

So help me God.

A big part of Integrity is Pride in one self, pride in your profession, and pride in what you do. If you are missing one of these parts, maybe this profession isn’t for you. Maybe someone a little more disconnected is your cup of tea. These aren’t optional parts of doing our jobs the RIGHT way. If we can’t act with honor, why bother?

Compassion.
Likely the most underused tool in our “kits”. To do this job for a long time you almost have to disconnect from your patients. The things we see and do are hard on the strongest of hearts, let alone one who allows them to eat you up. What that doesn’t mean is that we should disregard the significance of the moment for our patients. Our patients are in pain, dying, sick, or injured and it is our job to assess, treat, and transport them to the next level of definitive care.

DSCF2108 Young and Elderly handsAssess, TREAT, and transport. Treating our patients doesn’t have to involve and IV, medications or the LifePak 12. It could simply mean providing a compassionate ear to calm them down. More often than not, my patients don’t need any “medical” care, yet few people outside of medicine are prepared to offer them what they need. They need someone who has “seen it all” and able to reassure them, comfort them, and be honest with them.

BE HONEST. Compassion doesn’t mean making false promises. You should all know better than to go all TRAUMA on me and yell at your patients for dying or promising they’re gonna live. If they’re gonna die, you don’t have to say “Look, you’re dying”, but you NEED to make them aware(obviously if lucid) of the severity of the event. You MUST be compassionate and part of that is being honest. Tell them what they NEED to know. Tell them in a way you’d expect me to tell your mother.

Sure, EMS 2.0 is about a lot more than all of this “simple” crap, but what point is there in wasting the effort to improve the rest of EMS if we aren’t doing the bare minimum for our patients. The smartest, best groomed medics can still disregard the simple basics of patient care.

In the end of the day, if you aren’t treating your patients the way you’d expect me to treat your 85 year old mother, step back and ask yourself WHY? Then fix it.

If you haven’t seen I am Sam, you should. Sure, it’s sappy and silly, but honestly there is little excuse for us to not all live with the same Love and Care for others that Sam does for his daughter Lilly. Either we decide to do our jobs with Honor, Respect, Integrity and Compassion, or we’ve decided to insult our patients AND our colleagues. What point is there in improving the rest of EMS if we can’t address the most important part?

Posted by on October 31, 2009 • Filed under: Uncategorized • Tagged: , , ,

Faces.

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Deep inside every EMS professional is a storage bank. A file of faces, sounds, scene’s, and stories. A nightmare bank, you might call it. Imagery is my life. Before I wanted to be a medic, or a doctor, or a tank driver I wanted to be a photographer(I opted out because I wanted to make money! What was I thinking!!). I remember things by color, shape, texture and style.

I remember people by faces. Soft, pale, wrinkled, weathered, gray, bloated. Faces are my connection to the past.

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

Week two of my internship. I’m very unsure of who I am. Of what I’m doing. I feel like every call I am doing something wrong. Everyone keeps dying. I know, I know. People die. Everyone dies. But up until this point I had never had someone die in my hands. I’m not sure I’m capable of doing this. I’ve just run back to back arrests and we’re en route to… my first ped’s code.

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

I am trying to stay calm. I’m looking down at little hands. At tiny feet. I’m looking down but trying not to look. I’m trying to not look his face. 18 months old. EIGHTEEN FUCKING MONTHS OLD. I look up.

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

I can’t figure out what is worse. Feeling such a tiny person squeeze in my hands, hearing the sound of BVM ventilations into tiny lungs, or looking up and seeing the man responsible for it all. We knew from the minute we walked in that this didn’t just happen. This baby boy didn’t just die. Healthy baby boy’s don’t just die. He was shaken. Violently. The back of his head had been pulverized like crab legs in a Pacific Northwest diner.

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

I walked to the truck. My gear half gone, my heart missing, my soul crying. I sat there. Just waiting. My preceptor says to me… “sometimes it isn’t about them. Sometimes it is about us.” But this isn’t about me. This is about a little boy who will never see another birthday. Who didn’t get to see the fireworks, or the Christmas trees, or the fucking Easter Bunny. This is about a man so sick that he took the life of his own son.

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

The nightmares come. The nightmares go. I remember very little about my patients. But a few of them have found a way deep into my soul. They keep me going. They make me work harder, think harder, try harder. The nightmare bank eats at you as time goes on. The only thing you can do is fight to push the nightmares out, and good days in.

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

Now I sit here. I look at my boy. How sweet, how pure, how innocent. I have a hard time not putting the face of a little boy I met a little over a year ago. I didn’t know that boy’s name–and that saddens me. All he is to me is a face. I’ve found my peace, but he is still there. Do they ever go away?

Posted by on July 5, 2009 • Filed under: baby, Coping, FirstTime • Tagged: , ,

Stand By for Tones

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It is 0300 and the fog of a dark sleep is interrupted by the shrill of my nemesis, the Motorola Minitor V. I love doing my job, but at 0300 no one likes doing anything (outside of stumbling home from the bar to burn eggs and bacon). The tones sound and a gruff but friendly dispatcher give me my assignment: “truck 1, medic three, medic 2… high speed MVC, head on, 2 unrestrained passengers. Reporting party states 6 year old son is not alert, barely breathing, has pulse.” The dispatcher gives directions to a rather infamous intersection on the edge of my little county.

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

I have blood on my arm. My fear of other people’s bodily fluids is strong. I’d rather cut my own finger off than get someone else’s blood on my… or IN me…

This time I’m not bothered though. The blood is that of a 6 year old boy. A non-breathing, bloodied and mangled 6 year old boy.

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

I pull myself from my daydream. I look down at my patient and know my tasks. Secure the airway, maintain breathing, collar, board, load and go. I roll through the tasks like I’ve done this thousands of times. I’m confident. Proud.

I’m scared shitless.

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

As I pull into the little town ER where I will meet my hellicopter crew, I give report to the little town RN and the little town DOC. I’ve done by myself what I didn’t know I could do with 5 assistants. As I roll the little boy to bed 1 he is starting to buck the tube… Bad, but good. He hadn’t shown any signs of responsiveness since I arrived by his side. We slide him off my bed and the Doc asks if I’m ok. I’m grey. My face is blank, emotionless. Neither fear nor grief shows through.

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

I sit at home on the couch. My wife by my side. Tears running down my face. All I can think of is what if’s. Not knowing that at this very moment that little boy is sitting up in his hospital bed, half smiling at his mother. I cry a little, mostly out of fear. I’ve got a little one on the way. But I cry.

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

Several days later

The phone rings. A voice I recognize, but not sure where from, says to me… “do you remember me?”

I respond… “I’m sorry, I’m not sure”

She says… “My name is Amanda. You saved Daniel’s life. We took him home today. Just wanted to say thanks.”

My throat tightens. My eyes water. I can’t find any words.

Amanda says… “do you want to talk to Daniel?”

Posted by on June 27, 2009 • Filed under: FirstTime, Heart Strings • Tagged: ,

Baby Asher

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Born 2/5/09 after 15 hours of Pitocin induced labor… Ended up being pulled with forceps because his heart rate plummeted during contractions.
So far… Fatherhood is the most beautiful, terrifying, scary, fun, and challenging thing I have ever done. Hopefully I’ll manage to STAY home this week… I’m on call a few days and it is hard to say…
I love you little boy.
Posted by on February 8, 2009 • Filed under: baby, father, FirstTime, Good Stuff • Tagged: , , ,

Code 4

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Little Ambulance, Code 4, Cardiac Arrest, 200 W House you’ve been 3 times in 40 days.

One of the hardest things about small town EMS is that inevitably you run on someone you know, or like today, you run on a “frequent flyer” for the last time.

She wasn’t the bad kind of frequent flyer though. She was the best patient I’ve ever had. Today was my third and last time giving her a ride.

Her husband will probably follow soon. Stage 4 Lung cancer, prostrate cancer, CHF. Like his wife, it will be too late before we even get there. They have no family close, so when he goes hopefully he isn’t all alone.

I   checked him out and tried to make sure he knew we were there for him before I left. I don’t think he heard a word we said.

May God Have Mercy On Your Soul. god have mercy.

Posted by on January 27, 2009 • Filed under: Code 4, Coping, FirstTime, Heart Strings • Tagged: , , ,

Teaching

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This weekend I’m teaching 2 sections of our refresher. 

1) SIDs
2) Neonate care
Anyone have any good resources for either?
Posted by on January 20, 2009 • Filed under: FirstTime • Tagged:

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.

Posted by on November 9, 2008 • Filed under: Failure, FirstTime, Home, Life • Tagged: , , ,

The Results are In!

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Some of my non-EMS readers might find this horrible… Me, I find it relaxing.

Well, the first weather-related MVC of they winter season has happened.
A 30yoF driving to the Tribal School had (luckily) just passed over the river and started to fishtail. She then hit a (small) bridge (over dry ground) and cartwheeled over the top of it. ~3omph, unrestranined, and she was in my ambulance before I even had a clue she was my patient…
I obviously didn’t board her initially, but did get to do it at the ED entrance since the “Doc said so”… I think that she was in more pain(as is frequently so) after boarding, then prior to.
Thanks future Medical Director… We sure saved one today…
I don’t think any of the bets specifically chose today–nor where any all that close. Maybe we’ll find a new bet!
Posted by on November 7, 2008 • Filed under: FirstTime • Tagged:

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?

Posted by on October 29, 2008 • Filed under: Failure, FirstTime • Tagged: ,

Field of Dreams, German Beer, and Wiener Schnitzel

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This weekend has been a blast. The wife has brought me to Cedar Rapids, IA as our Anniversary/My birthday trip. The wierd thing is this is the first trip we’ve really done on our own! We’ve went plenty of places, but our familes are always there. Not this time! 

We left yesterday at 0600 from Small Town USA and dropped the dogs off with my parents(sorry mom….). We stopped in Dyersville, IA to see the Field of Dreams Movie Site(one of my favorite movies). The trip was long overdue from a missed opportunity from when I was 6, where my mother bribed me with a hotel with a pool(for what I found out to be a 2 mile out of the way drive!) instead of going to see it. My wife thought this to be a horribly sad story and insisted we drive 2 hours out of the way to go there for 7 minutes in the rain. 
Today we woke up and Headed to the Amana Colonies. They are a former German Communal Colony that disbanded in the 30′s. They are well known for their Kitchen Appliances, furniture, and Family Style Dining. I had the Wiener Schnitzel from the Ox Yoke. It was amazing. I also had it family style which means I had bowls of potoatos, corn, gravy, coleslaw, and cottage cheese to gorge on. They also have some damn good German Beer, wine, and fudge! 
We walked out with 2 bottles of wine for the wife’s post-baby bottle of wine, and 12 bottles of locally brewed “german” beer for daddy-to-be’s sanity(just kidding….).
After we went through all of the shops and a few other of the Colonies we headed to Tanger Outlets for some overwhelming outlet mall shopping…. Good god. That’s all I’m saying…
We then headed back to our hotel, rested a bit, and went to find some pet stores that weren’t open(we always check out the pet stores wherever we go!). Then we went to the mall, realized it’s time to start getting baby stuff, and freaked and left. 
The best/wierdest/craziest part was next. We went to a Haunted House called Frightmare Forest.  Honestly, I’ve never spent 9 bucks for a haunted house–or spent 25 minutes in line–but it was awesome! It took us over 1o minutes to get through it and we only took the “short” path. The wife LOVES Halloween and since I’ve failed to get the decorations up yet this was the least I could do. 
Sorry I haven’t been on top of posting. Honestly I’ve been in a real funk/block lately. I’m not content with my work situation and I’m trying to find a way to make it work. Expect more soon, and maybe something about EMS!
Posted by on October 26, 2008 • Filed under: FirstTime, Life • Tagged: ,

I feel…

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Like death… 

Sick day numero uno. 

Ps, figuring out which stroller/car seat/etc to go with sucks… Being who I am–it is likely to be the most expensive one there is…

Posted by on September 17, 2008 • Filed under: FirstTime, Life, Stress • Tagged: , ,

Tales from a Small Town, Pt 2

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So here I am having completed my first 7 day stint in Small Town USA enjoying the end of my first day off in a string of 3. I’m trying to look back and see what I’ve learned, what I’ve seen, what I’d do differently and honestly, I can’t remember a damn thing.

I can however remember the all you can eat Crab Leg dinner I had last night out on the Rez. Seriously, it’s like heaven–for 15.95, and I didn’t even get food poisoning!

So here are some firsts from this week:

  • My first time driving code 3–when it mattered.
  • My first all you can eat crab leg buffet
  • My first full week on call
  • My first AAA (on my own)–It was HUGE 10x10x14 cm(no, I don’t have a handy CT scanner in my truck, thats what the radiology report told me… remember, small town)
  • My first small town parade–actually two of them–one was about 4 blocks long.
  • My first Pow Wow. Indian Tacos are the bomb. It was an eye opening experience.
  • My first fireworks Stand by. Pretty laid back. They learned their lesson a few years back. Boom.
  • And tomorrow… I get my first Paycheck as a Medic! Oh, wait, what am I excited for? I already found two nickels today.

I’m sure I have more, but my head is spinning. I’m pretty much on my own now. Beings we don’t have “protocols” or “procedures” to follow its up to me and my boss when I’m doing being FTO’d. And well, I’m not learning much from the FTO process so I think we’re done. Fortunately we ride medic/medic (except in very rare situations calling for a second truck) so I’ve always got someone there to pull my head out of my ass if need be.

Posted by on July 23, 2008 • Filed under: FirstTime • Tagged:

When to become a Paramedic. The battle to the death…

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So… My buddy EE over at Backboards and Band-Aids thinks that you should be an EMT for 2 years before you go to Medic School(mind you, she is slow and her post isn’t up yet…). This is a rather common belief in EMS. Lots of people hate rookie medics and even more so hate rookie medics with no field experience.

Enter me. I have no field experience(field internship excluded), was never a EMT-B in the field, and went about 4 months between Basic class and the start of my Medic class. During that four months, I worked in a crappy warehouse job. Yup. Not EMS.

But my experience in school exposed me to a variety of Prospective Medics. We had about 5 students with some field experience. Emt-B, Emt-I/85, etc. Some had a couple years, some had 6 months of field experience. All but 2 of them ranked below me in the class. 2 of them were dead last in the class. Does that mean anything? Not necessarily. While I think a good foundation of info is important in EMS, you learn a lot of things–and are tested on a lot of things–that you will never, ever need to know. So my ability to regurgitate pointless pieces of information on a test doesn’t mean I’m a good medic. Being first in class or being last in class doesn’t discern your abilities either…

However, I think the one thing that was different from me and my “seasoned” classmates was their attitudes. I came into class knowing I knew jack shit. A few of them came into class knowing they knew everything. They knew they were perfect at skills. They knew their assessment was top-notch. Sure, my assessment was weak. I think my lack of field experience was the only reason it was weak. But… I think my clean slate allowed me to pick up solid skills, while discerning good practices from bad practices.

My first solo assessment in the field I flopped around like a fish out of water… Finding a groove and flow is tricky, and that set me back from my “seasoned” classmates. What didn’t set me back from them was a false impression that I didn’t have anything to learn. I haven’t met a medic student who was a practicing EMT who didn’t have this problem. All of my classmates who were practicing EMTs walked into class with their heads high and their chests puffed out. They had the typical “future paragod” look on their faces. To this day I still know that I know nothing…

So I think the real positive side to me not having been a practicing EMT was that I knew I had to try harder. I had to compensate for what I perceived as a weakness, and in reality may have proven a strength. I didn’t come into medic school with false impressions, bad habits, or a shit-tastic attitude. I walked in the way I walked out. Knowing that Medic school is only designed to create “Entry Level Competent Paramedics”. Not Paragods.

I think one of the Most important factors in deciding to go to Medic School is AGE. I was in the middle of the age bracket in my class. Not to say all 18-19 year olds aren’t ready to be Medics–But I KNOW without a doubt that I wasn’t ready at 18, 20, or 22. Obviously my friend EE is much wiser than her years on this planet. I look to her as a Role Model–despite her disgruntled, un-compassionate ways…

EE Knows her shit. She is also doing what she can to better herself, and her family. She isn’t like most of my younger classmates. So maybe it isn’t “AGE” so much as it is “life experience”. When you are truly and adult–not just legally–then I think you are ready to enter Medic School, regardless of experience… But if you can’t figure out a Basic Skill, and appreciate their uses(not everyone needs an IV, Tube, or obnoxious over use of medical terminology…) then you need to get your head out of your ass. I am willing to bet the people who have lead many to think unexperienced medics are bane on the existence of EMS have dealt with people who just shouldn’t be in EMS. I don’t think it was their lack of experience in the field that was the problem–it was their lack of experience at all that was the problem.

Posted by on June 28, 2008 • Filed under: Blogroll, FirstTime, Good Stuff, Stress • Tagged: , , ,

Sitting. Waiting. Wishing.

3 comments

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.

Posted by on June 23, 2008 • Filed under: Failure, FirstTime, Life, Psych, Stress • Tagged: , , , ,

Good News all around…

7 comments

So… I’ve made it through 2 days of practicals at school. It is definitely weird to be in class again…

We took a 210 question test yesterday that is supposedly very indicative of the pass rate with registry. I got an 80%. Not thrilled, but it helped me identify some areas I need to study.

Next… I found a job. It’s with the service described below. I’m pretty excited about it. Now all I have to do is actually become a paramedic…

We found a house in said town too. Pretty nice older house, 2 bedroom, 1 bath, blah blah. It’s cheap, nice, and only a block from the station.

Finally, the exciting news. We’re expecting! Not real far along right now, but we couldn’t be more excited. And terrified. We have dogs–but that doesn’t exactly equate to children…

Anyways… time to do a little studying(by osmosis), get some rest, and get at it again tomorrow…

Posted by on June 18, 2008 • Filed under: FirstTime, Home, Kids, Life, Stress • Tagged: , , , ,

Slow Day. Crappy Weather.

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So the time for me to venture home again is coming up rather quickly… I should be home in something like 37 hrs. That is if I can push through the crap weather up here in the upper midwest.

Seriously. I’m about to reach into the heavens, grab Mother Nature by the throat and bitch slap her. Snow one day. 70 degrees the next. WTF?

It started today chilly, ended with freezing rain, mixed with huge wet snowflakes, and to boot… There was just thunder and lighting overhead.

How dare you Mother Nature. You will pay.

Today was real damn slow. 2 calls. 1 transport. The second was a 21 yo female who was practicing Defensive Tactics (code for despite the fact that she weighed half what I did, she scared the piss out of me) who after completing training started feeling like her heart was “going to fast”.

Well, it was. 220 bpm. SVT. Hook her up to the monitor, 12 lead, O’s, and do a quick SAMPLE. My preceptor’s partner was the “lead” on this, but I was in charge. She seems slow… I wanted to do Adenosine on scene and she kinda hesitated, so we moved her to the truck, kept trying to calm her down(a little SOB, more anxious). And then I just got the Adenosine out and prepared to have at it. I started my IV, hung a bag and attached my syringe when the partner says “are you sure that’s what you wanna do?” I look up at her, partly in amazement, partly in a I wanna slap you and push you out of the back of this truck on the freeway during rush hour… and my preceptor says “Damn straight that’s what he wants to do. How about I pace your heart at 220 and see if you’d like it slowed down a little”.

I stated that Cardioversion was NOT necessary. She was stable. She just needed someone to help pull on the breaks.

I pushed 6mg Rapid IV, flushed it, and low and behold… her rate hit 95 quick as could be. Within minutes our distraught, nervous patient was joking, laughing, and enjoying her 70 minute transfer(to the best damn hospital in the world… Free slushies, cookies, sammies, fruit and more for EMS staff!(If you didn’t know this already… the “EMS room” at your local ED was the best damn invention ever..))

Other than that, I watched a lot of Deadliest Catch and some random show on True TV. And I got a good nap. Off too bed so I can prep for my 530p to 530a shift tomorrow…. and then the trip home!

Posted by on April 11, 2008 • Filed under: Code 3, FirstTime • Tagged: ,

Yahtzee!

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EMS is one of the few career paths where other peoples’ misery makes our day interesting. As a matter of fact, it is pretty much essential to making our days complete. If we have boring calls, we are bored. Some of us are Trauma Junkies. Some love medical calls. Me, I like crazy people. Crazy people–I can relate to them. I’m just a few clicks from being off the rocker myself so crazy people are easy for me. Plus, you can mess with them…

Today we ended our shift(literally.. we were pulling into the garage and got toned out… again) with a “psych pt on the freeway”). Yes. ON the FREEWAY. Get your attention?

Apparently our lovely 22 year old passenger had fled(ran away aimlessly) from her group home(I love group homes. They supply 40%(made up statistic) of our patients. Most of them who need an ambulance about as much as I need a meth addiction.

This girl was mildly MR, but not bad. She had some depression, which is commonly associated with mild MR young adults. She said she had thought about killing herself–this was as close to a suicide gesture as she had ever made, and I’m not so sure it was intentional. None the less, she earned herself a 72 hour stay at one of the “finest” mental health facilities in the region. By finest I mean understaffed and overworked. They aren’t bright either–their ambulance garage is 500ft of winding hallway away from the ED.

Here’s where the fun starts. She states that she is 5 months preggers and due in LATE SEPTEMBER. Wait…. I looked at my preceptor, and casually asked him: “Is my math ok?” He looks up. “You’re a friggin’ math genius”. Yup… seems that our pt has planned to carry her twins–or was it quints–a few months extra. Yup. You’re nuts.

She was also the primary care provider to 3 young children from her friend who died in a car accident–or did she kill herself? Anyways. Somehow I’m not so sure that the group home has room for the 3 youngins. Whatev. I love a good story.

At least she has an excuse. Better than the uppity people we pick up who act like they weren’t drinking when then rammed that innocent pole.

Anyways–enough about crazies… more about Craziness.

Our first call of the day was for “one down, with burns”. We hear ‘one down’ as CARDIAC ARREST. Not so much. She wasn’t burned either, but that’s neither here nor there.

Apparently our mid-forties pt had just had lunch with her friends and a nice eatery in one of the burbs. She had got into her car, started to leave and apparently lost control of the car, hit a parked car… and her foot was still on the gas. This caused the front wheels to keep going till the point of starting on fire and thus where the “burns” I mentioned earlier came into play.

A bystander punched out the window(only to get himself a trip to the ED too) and pulled her out after turning off the car.

PD and FD arrived on scene about 7 minutes before us. One of our medics just happened to be at the restaurant too. He stated her BP was 240/120, she was posturing and had lost control of her bladder. Her friends said she complained of a headache.

Upon our arrival she was no longer posturing, but her BP was still 200/100. This is a scoop and go. She responds barely to painful stimuli. Not looking good.

En Route we start two 16′s, monitor, 12 lead, blood sugar, pulse ox, blah, blah, blah. I keep trying to talk to her, occasionally getting a little grunt. 10 minutes into our transfer she starts responding with coherent phrases. Appropriate too.

She can tell me she has had a head ache for a week. She has been taking Aspirin every day for it–shit. She doesn’t remember what happened at all. She can tell me everything before it happened though.

10 minutes ago I had a tube out and ready to go, and now she is holding a bucket and wants to puke. Who woulda thunk.

At that point I was dumbfounded. She presented like a classic bleed. Her history presented that way too. But bleeds don’t wake on their own. They don’t just get better.

Wrong. Her CT showed an 11mm ACA Aneurysm near her pituitary gland. WTF. They planned on going in and coiling it(spring to open the vessel).

Yup, one of those days.

Posted by on April 10, 2008 • Filed under: Code 3, Crazy Calls, FirstTime, Psych • Tagged: , , ,

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.

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Posted by on April 9, 2008 • Filed under: Cats, Failure, FirstTime, Kids, Psych • Tagged: , , , ,

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…

Posted by on April 4, 2008 • Filed under: Code 3, Failure, FirstTime, Pediatric • Tagged: , , ,

It's official… someone noticed!

4 comments

EE over at BackboardsandBandaids.blogspot.com gave me some incredibly kind encouragement this evening.

I appreciate any response from anyone, but being given the best advice(that we wish we could take… but I feel like I’m clenching the needle with my teeth while I pull the tourniquet tighter) I have to give a big thanks to EE and Future PA over at http://backboardsandbandaids.blogspot.com for the props!

Take the time to check them out! They’ve got all kinds of goodies going on over there!

I’m planning to keep them at the top of my “to read” list so give them a try!

Posted by on April 3, 2008 • Filed under: FirstTime • Tagged:

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.

Posted by on April 2, 2008 • Filed under: Coping, Failure, FirstTime, Stress • Tagged: , , ,

I want to tell you lies

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This is going to have to sum up the last few days. Not sure I have it in me to write it all out.


I WANT TO TELL YOU LIES

I want to tell that little boy his Mom will be just fine
I want to tell that dad we got his daughter out in time
I want to tell that wife her husband will be home tonight
I don’t want to tell it like it is, I want to tell them lies

You didn’t put their seat belts on, you feel you killed your kids
I want to say you didn’t … but in a way, you did
You pound your fists into my chest, you’re hurting so inside
I want to say you’ll be OK, I want to tell you lies

You left chemicals within his reach and now it’s in his eyes
I want to say your son will see, not tell you he’ll be blind
You ask me if he’ll be OK, with pleading in your eyes
I want to say that yes he will, I want to tell you lies

I can see you’re crying as your life goes up in smoke
If you’d maintained that smoke alarm, your children may have woke
Don’t grab my arm and ask me if your family is alive
Don’t make me tell you they’re all dead, I want to tell you lies

I want to say she’ll be OK, you didn’t take her life
I hear you say you love her and you’d never hurt your wife
You thought you didn’t drink too much, you thought that you could drive
I don’t want to say how wrong you were, I want to tell you lies

You only left her for a moment, it happens all the time
How could she have fell from there? You thought she couldn’t climb
I want to say her neck’s not broke, that she will be just fine
I don’t want to say she’s paralyzed, I want to tell you lies

I want to tell this teen his buddies didn’t die in vain
Because he thought that it’d be cool to try to beat that train
I don’t want to tell him this will haunt him all his life
I want to say that he’ll forget, I want to tell him lies

You left the cabinet open and your daughter found the gun
Now you want me to undo the damage that’s been done
You tell me she’s your only child, you say she’s only five
I don’t want to say she wont see six, I want to tell you lies

He fell into the pool when you just went to grab the phone
It was only for a second that you left him there alone
If you let the damn phone ring perhaps your boy would be alive
But I don’t want to tell you that, I want to tell you lies

The fact that you were speeding caused that car to overturn
And we couldn’t get them out of there before the whole thing burned
Did they suffer? Yes, they suffered, as they slowly burned alive
But I don’t want to say those words, I want to tell you lies

But I have to tell it like it is, until my shift is through
And then the real lies begin, when I come home to you,
You ask me how my day was, and I say it was just fine
I hope you understand, sometimes, I have to tell you lies

~ Kal The Rebel ~

http://www.thelunatick.com/ems/i_want_to_tell_you_lies.htm

Posted by on March 31, 2008 • Filed under: Coping, Failure, FirstTime, Stress • Tagged: , , ,