30 January 2010

On the Engine

What child hasn’t stood on the sidewalk, perched atop his bicycle, his leg a human kick-stand, and marveled at the big red fire truck as it screams down the street racing to some unknown location. O’ and the sound of a federal Q siren peaked out to a piercing scream demanding attention from miles away it would seem.

The wide eyes watch the engine as it makes its way through traffic; the red and white lights flicker and dance, the chrome and brass sparkle as it reflects the shimmering sunlight. The air horns blaring in only a way that fire truck air horns do….just something about them air horns on a fire truck.

As the engine approaches closer, the kids strain their eyes trying to make contact with the firemen, waving like it was their best friend who would surely recognize them standing there in awe on the street. Inevitably, at least one of the firemen in the jump seat, if not the driver or officer, would return the wave, making some kids day a little brighter. Then as if almost by instinct the kid will mount his bicycle and peddle for all he is worth trying to catch up to the fire truck. Most likely he’s thinking in his mind that he is now part of the procession, a standalone cadre of moral support for the brave firemen.

I know this kid. I was this kid, and so were the many of us who grew up on the streets of Hopewell, Va. As was often the case, I would actually know the person driving of whoever was on the truck.

I had an insider’s view from the earliest days of my childhood. My grandfather was the fire chief at the Hopewell Bureau of Fire and my dad was a fireman too. Most of dad’s friends and most friends of the family were fireman. And from what I can remember they all shared a bond that would take so many years for me to understand and appreciate.

I remember when mom would take my brother and I to the fire station. Nothing special; just a little visit with dad or to take food that would be cooked for lunch or dinner. A time or two we would end up there just as everybody sat down for dinner and we would join them for dinner. That image of 6-10 guys sitting around the dinner table sharing a meal that one guy had the task of preparing sticks out for some reason.

I remember how the fire trucks were lined up in the bay; Engine 22…23…24 and Ladder 17 on the far end. Engines 25 and 26 were across town at Station 2. They were shiny and bright red except for 24 which was the first “lime green” to begin the transformation to the high visibility color. They seemed so big; all lined up in the bay, driver’s side door open with a coat hanging on the door handle, and boots with the top rolled down and then folded back up to the knee. It was just normal to go and climb up in the truck and sit in the driver’s seat pretending to rush to the scene of a fire. My mouth would be crooked off to one side as I forced air out the side to make the sound of a siren, which was my Federal Q. Or we would run over to the brass pole that stretched up to the second floor, wrap our hands around it and jump up and down on the thick rubber mat around the bottom as we slung ourselves in circles. This was our playground.

I also remember climbing the steep red painted steps that led to the second floor were the kitchen, bunk rooms and living area was located. Walking into the cavernous area always made me feel so small because there was always an echo in there. The floors were painted a shade of burnt red, almost burgundy, and they were always polished and buffed to a shine. They had this buffing machine, and I seem to remember that every so often there would be someone buffing that floor in the mornings. It was clean; just immaculate. I can appreciate it now, but back then, that’s just the way it was.

Once a year there was an open house at the fire station that everybody in the whole city it seemed would come to. They would empty the hose bed of Engine 23 and pile kids in the empty area. Along the sides there were the things that stuck out like benches. Kids would be packed along the sides and out in the middle of the hose bed. Two firemen in full turn-out gear would man the tailboard as the truck would make a long trip around an area known as City Point. The driver would turn the siren on from time to time and blow that loud air horn while the lights on top of the cab flashed out their warning. This was the highlight of our lives at the time.

My grandfather died in 1980 after a line of duty injury that contributed to his death, it was only a short four years later that my dad too would leave the fire service. Over the years the sights, sounds and smells would fade away to distant memories that only a picture would bring to remembrance…until yesterday.

I have realized that I am quickly approaching the pinnacle of my training in EMS. After I obtain my Paramedic degree, there will be only one thing left that I can do and that is to get a critical care endorsement. I also see the trend that EMS has taken with merging or being consumed by the fire service. With all this in mind over the last year, I’ve been making preparations to start cross training, so last week I man’d up and joined the volunteer fire department. So here we go again, starting at the bottom, learning new rules, people and methods of operation; I’m up for it and ready to get started.

But here’s the reason for this whole posting. I had the pleasure of doing some field clinical hours required for the Paramedic program at the fire department yesterday. They are a combined service that does fire and EMS, and I was assigned to Co.2. At that particular station they have one Medic truck and one engine with a compliment of four men. While we were not on the bus doing the EMS thing we were just doing what firemen do…checking equipment, cleaning and of course eating and watching TV while falling asleep.

The whole experience hit a high spot when the fire tones dropped for a fire alarm at the middle school. I asked the Medic that I was with, who was also the engine officer, “I’m with you?”

“Yep, let’s go”

So there I was. I was sitting in the rearward facing seat behind the driver absolutely beside myself with excitement. I cannot even begin to describe the emotions that welled up inside of me as that big ‘ol Detroit 60 wound up and the truck began to move out of the bay. It all came back like a rushing river in my mind. The sights and the sounds of my childhood flashing in my mind like a movie stuck on fast forward. I looked for a kid on the sidewalk as we raced down the street that would be waving so I could wave back. He wasn’t there. I wondered if it would ever be possible for me to one day be sitting in this seat with my turn out gear on, air pack at the ready and listening to the radio traffic of the first due engine arriving on scene and confirming a working structure fire.

It was then that I knew what I would have to do. I would have to carry on a legacy that my grandfather started back in the mid 1960’s as a career firefighter. This is also a legacy that my dad carried out for ten years with his service to the Hopewell Bureau of Fire. Now it’s my turn. I may be a late bloomer, but I will bloom none the less. Who knows, maybe one day I’ll ride Engine 23 again out of Hopewell Station 1. It won’t be the ’69 ALF that I remember, but it will still be Engine 23 that lives in my memories.

My heart will always be with the medical needs of the people in my community and I will serve them to the best of my ability. However, the kid in me will now forever want to climb up in that engine and race to the fire and fight the fire breathing beast… and soon I will.

God, help me always remember to wave back.

27 January 2010

And the ship starts to turn.....

As any of you who have read some of my post over the past month or so, you may have seen a developing trend and started to reach a conclusion. You may have concluded that I'm a cantankerous 'ol fart and can't find peace with anybody or anything. Or you might have seen the passion for my job smothered by frustration with my local system. Well, if you're thinking one or the other, chances are they're both right....for right now anyway.

For all the faults that I have found or identified in my system, there is one area that that fosters an environment for these types of things continue and to also grow.

The one thing we lack here in this area is accountability. Truth is that everybody around here just kinda does what they want to, how they want to and when they want to all for the sake of "getting the call covered". Well today that has changed!!

For the last five months there has been another surge for the volunteer agencies to try and implement an oversight panel comprised of a panel chosen by the ensconced leaders of those organizations. Basically what this would have amounted to is the continuation of the fox guarding the hen house.

Today I had the honor and privilege of attending a meeting of our county supervisors and hear the debate that will eventually lead to the transference of power and oversight of EMS to our Department of Public Safety.

"What!! You already had a Public Safety department established and the had no oversight authority?"

That's right folks. Each of the five rescue squads in our county were only answerable to their respective board of directors or chosen leaders. Each squad has different bi-laws, different SOP's, different priorities all under the auspices of serving their community. Public Safety's only role was to be available to assist the volunteer agencies if they asked for it and to be a liaison between the providers and the OMD.

Today we start the formation of a system. A system where a standard of care will be even across the board. A system that will be united for the sole purpose of ensuring that each and every citizen gets the care they need and deserve without political wrangling and posturing from those who me have ulterior motives.

I don't have any misguided views or thoughts of a utopian paradise evolving. I also know that this will be a long process that will purposely be implemented as to not hurt feelings and peoples pride; but this is a start, and that's all I/we have asked for!!

24 January 2010

Still here....

I know it's been a few days since I've posted anything, but it's been really dry as far as EMS goes. I've got a couple in draft phase that I hope to bring out by tomorrow. We'll see how that goes.

As for now, I'll be playing nurse to my wife who started experiencing debilitating stomach pains around midnight. She agreed to let me take her to the hospital so I could get her an anti-emetic and something to ease the pain. Turns out that she is next in line for a stomach virus going around.

Of course while we were there I got called into action to assist with a code that developed in the ER. Patient presented with SOB and a very distended abdomen; as soon as he got on the ER bed and laid back, he coded. After an NG tube and a rectal tube, enough pressure was relieved to stop hindering the venous return and he regained a half-way perfusing pulse. As we were discharging, he was off to the O/R for surgery.

Stay tuned...more to come!!

19 January 2010

On Duty

I almost feel a bit of shame for writing this piece, but it's fresh in my mind. My intentions when I started this was to write original stuff that one may consider impactful.

So I feel kinda bad that I have so soon deviated from my own path and taken the lead of another. But hey, this is EMS. Nothing original in this field, right? We all borrow from each other and expand and expound on one anothers ideas. After all, isn't that the whole idea behind EMS 2.0....sort of?

Last week Medic 999 did an article on what the most important piece of equipment was to the paramedic. I found it quite insightful and really enjoyed reading the discussions and rationales for everyones choice.

I want to take this one level lower; to the personal level. What do I carry on myself when I am "on duty"? Now this could vary somewhat depending on what day of the week it is for me. A lot of folks call me a "whacker" because of all the junk I carry in my personal vehicle in my response bag. And of course there are times when I am just out and about when I happen to be in the area of a call and decide I need to respond for one reason or another.

But when I am purposely available, whether it be on the job or at a volunteer station, there are things I want immediately at my disposal.

First of all, I want to be recognized as a professional. A uniform sets you apart from everyday citizens and identifies you as a part of a group that is specially trained for a specific task. This uniform must be neat and clean and readily identify your association. I'm not so worried about level of training be identified, because we're all ambulance drivers anyway.
Just a quick thought about the pants in a minute. First, the boots. Gotta have some rugged looking duty boots, and of course they must have the zipper on the side. It's hard to wake up in the middle of the night and try to tie the darn things while finding your mouth wash and trying figure out where you're actually going. It's a whole lot easier to just slip 'em on and go. Now, those pants. If you wear pants that don't have eight pockets, two of which you'll hardly ever use and two on the bottom leg that you'll never use, are you really a true EMT to begin with?

The next thing is just purely personal preference. I like to wear a rescue belt with a quick connect buckle. This can serve two purposes. One, if I have to go down an embankment to access a patient, I have something to tie "me" off to and if I need to keep things with me I can attach it to my belt. Two. A rescue belt can be used in the event a patient is in immanent danger and you need to anchor the patient somehow. And of course...it keeps your drawers up.

A radio is absolutely essential piece of equipment. I can think of nothing worse than being in a house while your partner steps out to get something from the truck and something goes wrong. The patient could crash. Family member or bystander goes crazy. What about an unknown domestic dispute and the aggressor jumps out of the closet. I want someone to not only know where I am at all times, but I want to be able to let someone know if something goes wrong. This is also the primary way to know what is going on in your district and position yourself for a call or an intercept.

Ink pen. Pretty self explanatory. If it wasn't written...it wasn't done. For me, it's more like if I don't write it, I don't remember it.

Some don't wear a watch. Some can't wear a watch as part of department/agency policy. I personally feel naked with out one, so I have to have one on all the time. I know you can tell if a patient is tachy or not with out one, but I just want a good sound number.

I also keep at least two pair of gloves on me at all times. Rule number one; if it's wet and sticky, I don't want it on my hands or any other part of me if I can at all help it. I'll be the first to admit that I've got a bad habit of getting in a hurry and neglect to put gloves on, but I make sure I have an extra set of hands to help with a procedure. Beside, how did everyone get that NREMT-P... B-S-I, scene safe. I'll try to do better.

Aaahhh, the ever symbolic trauma shears, or parameds if you prefer. Nothing says trauma like a scissor toting Paramedic. I don't care if the last time I used them to expose was a month ago. There's always the loose and wayward screw that needs tightening or the tough as steel bag of Doritos that needs to be opened in an OCD fashion.

Last but not least is the stethoscope. Of course no self respecting medical professional can be with out the signature stethoscope slung about the neck.

I read an article in JEMS a while back about the status symbol of the stethoscope. I never really gave it much thought as to why we wear it around our necks like we do, but I do. I think I do it just to show off my Littmann Master Cardiology my wife got me as a gift last christmas. But seriously, I do like to have it handy when I go in to do a complete assessment. Some lung and heart sounds are just heard better with one.

Well folks, that's what I'm wearing when I'm ready for action(on the outside anyway). I know I forgot something, but that's the great thing about having an edit button. Oh yeah! Somebody will for sure bring up "Lite Brite", my high visibility reflective jacket. Since I work nights all the time...I want to be seen.

Mark, sorry I took a lead from you on this topic, but I haven't had any good, bad or ugly stuff in the past day or two. My well was just about dry.

16 January 2010

Pleasantly Surprised

For all the gripping, complaining and bitching I'm known for, you'll appreciate this one I hope.

I don't fit in where I work and I really just don't do well where I play. Surprisingly enough though, as a kid I got high marks in "Plays well with others". Maybe it's me, maybe it's them or I could just be a product of my environment. Who knows? However there is one thing I have come to realize. There are more people out there like me, and this should make a lot of you afraid...very afraid.

We were called to our local hospital the other day to transport a patient to another hospital because of an AMI. We get to the ER and naturally the first thing I look at is the monitor, and sure enough....FAT 'ol MI. The nurse gives me the run down. She tells me the patient presented to the ER with difficulty breathing via EMS and complains of no pain at all. Since the patient is 89yo...it makes sense to me.

We get the patient switched over to our stretcher, as well as the I.V. pump infusing Integrilin and a saline drip. I apply the monitor pads so that I could, well...monitor of course.

So there we are bopping on down the road. I asked the driver to not run lights and siren just as a measure to keep the patient from getting excited. As an additional measure I put his wife in back with us; they were just absolutely inseparable. Worked all the way around for everybody.

The drive took all of about forty-five minutes. We arrive at the receiving facility and hand off the wife to the son who will accompany her to the waiting area. We anticipate that he will be going to their ER for a work-up in that hospital....but, oooooh no, that was no to be.

As we entered the ER we were greeted by a smartly dressed lady who identified herself as the director of cardiac services and asked if we the ones coming in from M^pjlxsville. We said that we were indeed the ones. "Follow me" she said, "he's going straight to the cath lab".

She led the way through the emergency room stating loudly to a few doctors and others who were in our line of travel, "Excuse me...cardiac coming through....make way, cardiac".

Now, I'm liking this lady. She takes her job and the life of the patient very seriously and this is obvious. Yeah she came off as brash, but she had every right to and I liked that.

As we left the ER area, she quickened her pace and led us through a few twist and turns and then down a long corridor. "What took you guys so long?" she asked over her shoulder never breaking her stride. "They said an hour ago that ya'll were transferring the patient then...it shouldn't have taken you but thirty minutes to get here", she continued.

O.K., she was serious about this. I thought we were in for it now.

Then out of sheer ignorance the guy who was driving had to open his mouth; it's just his nature to not know when to shut-up. "Well, we were moving pretty good until we started hitting traffic and stop lights", he said as if he was dismissing her concerns.

"That's why ambulances have lights and sirens", she stated matter-of-factly. Again, she never broke stride.

The driver, not to be out done decides to open his mouth yet again, as is his nature. "If you wanted him here that quick, they should have flown him" he quipped.

She stopped dead in her tracks and spun to face him. "It's would take LONGER to fly him here than for you to drive him thirty-five miles", she said. Then she spun around and was off again at an even quicker pace as if to make up for any lost time.

Then she started in on a lecture about how we have 90 min. to get to a patient from the time of event, until the time of balloon insertion to avoid permanent ischemia damage.

I KNEW THIS SPEECH!! I had read about the "D2B90" protocol back when I was just an EMT-B a few years ago. I had also just recently read an article about this protocol and how it was making some big differences in patient outcomes, along with hypothermic stabilization.

Aaahhh, this lady was singing MY song. She finally conceded that maybe our not using a siren was a good idea...but we could have ran lights at least. Of course, she was right.

We entered the cath lab and she introduced the assembled team of nurses and the doctor, who began their job with ferocity.

I presented her with the patients medical records and obtained a signature for such. I told how hearing her singing "D2B90" was music to my ears and unfortunatly, we don't use that protocol where I come from...we don't even have a 24hr cath lab, not even an on-call cath lab. Most of our MI's are transferred north or south about an hour away.

She further explained her position at the hospital as the coordinator for Duke Cardiac Services in the region and that she would be more than happy to help me push for this locally in my area. I was beside myself to say the least. I told her that I was just a lowly field provider and that we need people with her passion to make a push for protocols like this. What she said next floored me. She told me "No, we need more people like you, to push this from the bottom up. Somebody has to recognise what's going on and immediately start the process".

We exchanged contact information and I was on my way. I left with a new sense of pride and optimism in my profession. Surely this pride will be bruised as soon as I notice my next STEMI and notify our ER. That's just the way it is. At best, I can hope to see an ER Tech. waiting for me when we arrive to do a 12-lead and verify my findings. At best the patient might be in a cath lab during the next hour or two.

I will follow up with her and see where this is going to go. Who knows...maybe a beautiful thing blooming around here. Unfortunately, we first have to get someone to actually answer the ER radio when we're calling in our patient reports.

"D2B90"...it's a beautiful thing.

13 January 2010

Don't Come Over Yet

For all the excitement that I have with my new found hobby of blogging, I'm still having trouble accept just how backward EMS is in some areas.

God I wish, but only wish, that I could get on board with some sort of exchange program. The reason I can only wish is because as exciting as it would be to go to another country and observe first hand, sadly I would have to bring them into my system where I work.

Now I have a couple of options available to me to accommodate someone, but neither one is going to leave a good impression. Let's look at them both for a minute.

We could have some exposure to the volunteer side of my life.

We could show up to the station for the start of a shift at 0700. Depending on the morning we'd show up to an empty station with unwashed trucks in the bay and possibly the chance of a stocked truck. We would go ahead and start the normal routine as you would in any station, checking off the trucks, washing them and making sure that yourself and the equipment are ready for duty. Somewhere in the middle of all this the tones would drop for a serious call and we would find ourselves toning out for a driver. If all the right stars are in alignment and the preacher's been paid right, in about ten minutes some well meaning citizen volunteer would show up having just gotten out from under his pick-up truck fixing a transmission leak or something. He'd be as clean as one could expect given his earlier duties and he would be absolutely fine running a call like this.

While we're waiting for our driver, one of our illustrious unemployed line officers who lives in Power Trip, USA is trying to coordinate a MCI response from the next county over with more static in his radio than intelligible words. Now, he can't come help this time, but he knows what we'll need and how it needs to be done.

We would most likely show up to this serious call in one piece and begin our patient care duties while Fred is still on the radio signing on scene, checking for medivac availability, trying to talk to the responding fire apparatus and getting a message from dispatch that his wife called and said she would be getting off work early. Meanwhile we've got the scrape on the patients arm bandaged up and obtained a patient refusal.

I'm serious folks...this is my life.

Then we'd get back to the station just in time for some of the regular members to show up. They will have the latest news on who did what and who said what to who. Someone else will most assuredly have the answer as to how this or that should be addressed or fixed. Our well intentioned friends will also have their latest take on how protocols should be changed; this so they have other stuff not to do right. All the while telling the trained Paramedics how we are wrong. Mind you now, we are amongst the smartes BLS providers known to man.

We will subject ourselves to overhearing conversations about how a particular call went down and how so 'an so should have done this or that. Then they'll begin to bash the medic who shows up to help out on a BLS call and offers some suggestions on how to better treat a certain condition the patient is experiencing.

Oh boy!! Another call. We get up, get our jackets on and head toward the bay...just in time to see a truck pulling out of the bay and signing enroute with a BLS crew of three plus two junior members on board. Never mind the fact that we have a guest with us, and ALS to boot.

This could be repeated on any given day with little variation.

I could bring my guest to work with me for a whole different set of experiences that would surely leave him/her scratching their head.

We'd show up about 15mins before 1900 and get the low-down from the shift before. The usual information about which truck is out of service this time or what LG (little god)wants done a particular way tonight that's the same any other night.

The other crew departs and we settle down for a little T.V. while one of the four of us begins to fix dinner. Somewhere about this time the phone may ring for a transport from dialysis returning to a managed care facility. Luckily we don't have to worry about that tonight; my partner jumps on it and saves the night.

The county and city radio traffic can be heard in the background while the respective stations go about their business. My guest will get a personal introduction to who actually represents EMS around here this way. It will be sad to say the least, depending on how busy it gets.

While dinner is cooking we go out back to check off or trucks. Four by fours...25 (dingy and yellow). 5x9's...10. Cravats...4. O2...empty of course. And the routine carries on the same as it would anywhere else in the world.

After dinner, we do our station chores. Clean and mop the bunk room. Sweep the office and take out the trash. Clean the parking lot; usual stuff.

Sometime in the next hour or so a call might come out for one of the volunteer squads in the county. Cardiac patient with chest pains. Nobody answers. We head to our truck because we are the back up for the volunteers if they can't cover the call. We sit in the truck waiting to be dispatched, thankful that we're no more than five minutes out. Two minutes after the initial dispatch, mutual aid tones are set. Again nobody answers so we head on out of the parking lot. Here we are now five minutes after the call and it's getting ready to be turned over to our agency when a volunteer truck marks up.

Are you ready for this folks?

A BLS truck signs enroute to this call from the other side of the county. They have to come right past our station to get to it and we must now stand down. 'O well, back inside for some good 'ol T.V. and Facebook time. Fifteen or twenty minutes later they will sign on scene. Five minutes later they are toning out for a Medic truck....ya think?!?

Sometime tonight we'll get the opportunity to go to a nursing home to pick somebody up out of the floor. Or we'll get to go to the ER and take someone back to the nursing home so they can fall again. We'll quite possibly get a call for an out-of-town trip to a cardiac center or to a level one trauma center; that can be fun at times and a second set of hands would be great.

Eventually there will be a call missed by the volunteers for a belly ache and we'll head on out to assess this call. Enroute to the belly ache call, the same station will receive a second call for an unresponsive subject. With miracles upon miracles they will pull a crew together to answer that one. Now understand, we will have to pass this unresponsive call while going to the belly ache. We'll advise them of this fact and request for them to allow us to divert to the unresponsive while their BLS crew handles the belly ache...just makes sense to me. They'll hem and haw over the radio how they will have a member on scene POV in five minutes and then they will advise us back if we are needed. Meanwhile, we are arriving on scene at the belly ache a few minutes after their member signs on scene and calls a working code.

If you've read this far, you may think I'm exaggerating. I assure you I'm not. This is the real day to day life of EMS in my system. No oversight. No accountability. No ration or reason other than...because we can.

It is for these reasons that I'll never invite another Paramedic to work beside me in my system. And the reason is mostly out of sheer embarrassment.

12 January 2010

A Little Friendly Competetion

Over the last few days there has been a battle waged amonst the bloggers of fire and EMS, and it's been quite funny to watch it unfold.

It's no too often we find ourselves in a competition that we can actually laugh at though. Most of the competition I see is departmental and agency squabbleing with the associated back stabbing and politicing. But boy 'o' boy are the bloggers a ruthless lot when it comes to blog of the year.

I have learned so much recently from each and every one of these individuals who take the time to share their hearts and thoughts about their respective lives. The content is so real, you can't help but feel the report' developing as you anticipate the next article or discussion about a topic. Then there are the times where the debate kicks in and a few friendly barbs are exchanged; that's the fun!!

Regardless of who wins the Fire/EMS blog of the year (Medic999 will, lol), it's duely won. The ones who made it to the finals are just as much winners because of their dedication. I and many others are dedicated to reading them all just as much as they are dedicated to writing. And it is TIME consuming on both ends.

I know my ramblings will never make it to that level, but I've formed a very valueable network with some people who are making things happen in their part of the world.

So BLOG ON!! my friends and let's keep the profession moving forward...and have a little fun along the way.

Congratulations Mark, a little prematurely at this point, on a sucessful first year and we're looking forward to many more.

09 January 2010

REALLY?!?!? You need it when...

Just for the sake of time, I'm not going to go into a lot of detail here. But I've gotta vent and you're reading this....so you're fair game.

When I'm at work during the nights, I don't mind running ALS back-up for the county. Sometimes when things are slow and I'd much rather catch a nap, I really just don't mind doing it. It's just my nature I guess; but some of this stuff has got to stop!

My partner and I were on post in the western part of the county last night when a volunteer squad received a call for a subject experiencing nausea and vomiting. They had a crew available and responded. Knowing that they had a crew and it was, or sounded like, a BLS call; we repositioned and posted at Base 2...a more central location. There we've got some recliners, T.V., facilities and creature comforts.

Now it took us about fifteen minutes to get there and we had just gotten settled in when the volunteers signed enroute to the ER and requested ALS assistance. The com-center set tones for ALS and then contacted our agency for availability. My super contacts me to see if I'm interested, and I figure what the heck; "sure I'll go". We mount up and head up the road about five miles to rendezvous.

I enter their truck with my I.V. stuff in hand and ready to distribute my life saving skills accordingly. Nothing to this. Been sick for the past three days throwing up and denies any drug usage OTC or Rec. Vitals all in normal parameters. I.V. established and a 250cc bolus for good measure. Life saved, we're good. Right?

We clear up and head back to Base 2 for some shut eye. Just as I've gotten my boots off the same stations tones drop for a cardiac with chest pain. The same crew signs enroute and my partner and I mount up to head in that direction non-emergency.

Now you've got to understand that the way our ALS assist works around here is crazy. We can't call the com-center and tell them we've got a medic truck in the area; we've got to wait until we are requested to respond. I know; stupid, right? It is!!

We've pulled over about a mile from the call location and I get in the back to get my leads loaded, that way I can just grab my monitor, jump on their truck and get a 12-lead. As I'm finishing that, they (the BLS crew) sign enroute to the hospital. I wait and fully anticipate that they will be toning out for ALS at any second.....but they don't. So we go down the road about a mile and pull into a shopping center to wait. Sure enough here they come, lights a flashin' and siren a wailin'. I pull out behind them and follow at a distance. They're running about 60mph and running pretty hard. I figure there must be something going on in there and surly at any minute I'd get a call asking if I was available. Didn't happen. They continue on down the road at warp7 pulling away from me the whole time. Finally, at a point where they're about 3THREE3, that's right; THREE minutes from the ER, the ask for ALS to be toned out.

I get a call asking if I'm available, and I have to say "no".

If they stop and I get on the truck to do ANYTHING besides say "Hi my name is...", that will delay the patient from definitive care at this point. Besides that station is getting ready to drop a call and we'll have to go pick it up. But to my surprise, they pull a crew out of the woodwork and cover it.

I went on to the ER to ask the crew why they waited so long to get the help the patient needed. Their response absolutely floored me.

"We knew you were tired and the last thing you said was that you were going to try and get some sleep". True, I did say that. But, REALLY!! They continue with their sorted explanation saying that the patient had already taken some aspirin and their pain went from an 8/10 to a 6/10 and "was feeling a little better". However, "she was having a little tightness in her chest and we thought she was going to get better by the time we got to the ER, but she wasn't". I shit you not folks...she said this with all sincerity and believed herself when she said it!

Nothing I could do, so I said my piece in only a way that I can and went on my way.

I just don't get it. You call me out, and I don't mind, for a patient who is dehydrated and could have waited until they got to the ER for fluids. But a patient with a cardiac history experiencing pain of 8/10 with "tightness" in her chest....and you wait until you're three minutes from the ER to ask for a medic truck!! One, because you thought is was going to get better. Two, because I said I was tired! REALLY!! C'mon guys...get it together. This is insanity at its finest.

Thanks for listening. Off duty, lights out, we'll do it again at 1900hrs.

05 January 2010

Baby, It's cold outside....

Well it seems winter has set in and plans to stay for a while. The grass has reached the point where it looks as close to dead as one can imagine. The birds only appear sporadically for food and the battery in the truck sings it's pitiful woes every time I crank it.

It's been consistently in the low 30's for the past week or so now, and the weather man said this morning that we should expect it to be like this for at least another week. It's bitter and the wind cuts right through you. But I'm even more thankful that I don't live or work in the "coldest place in America"...International Falls, MN. They said the temperature there was a high of -37 degrees, and that's without the windchill.

So the bottom line is this; it's cold, and I can't think of a better time to talk about cold emergencies and how we can combat them in the field.

First before anything else is preparation, and I'm not even talking about equipment yet. Think about your demographic. Are most of your citizens elderly or do you have a certain percentage of people who may be having trouble paying for a heat source? Are there homeless in you area that are susceptible to the cold?

Knowing who will help greatly with the what. We know that with the weather in the extremes it doesn't take long for hypothermia to set in especially to those who brave the cold with exposed skin or little clothing. According to the experts, life threatening hypothermia can occur in an average size male, who is not performing any activity, in as little as an hour.

You knew it was coming; scenario time....You're called to a scene where PD is out with a male subject behind a shopping center in the wee morning hours, he is lethargic but responsive to interview. You notice that he is disheveled and notice several bottles of what used to contain alcohol strewn about. Assessment reveals some significant findings; B/P(-), P(-), SCT(-), BG(+/-80), SpO2(+/-94), EKG(SR@58). Your patient says he had a run of bad luck, lost his job and has been on the streets for a week now; no family and no where to go. Your community has no outreach programs available.

How are you going to treat this patient? Does he require treatment beyond what you can provide? Do you warm him up and just send him back out into the cold or do you start active rewarming and transport hoping to at least get him out of the weather for the night? Now this is just some food for thought. No pass or fail.

We as providers need to be ready to deal with these very real scenarios. Our trucks and equipment should not contribute to an already bad situation. Suppose an elderly lady has slipped on some ice and is not able to move due to the pain. You show up 20mins. later with a truck that is barely warm, put her on a cold backboard or scoop stretcher and then on a cold cot. What have we done to her situation? She's uncomfortable as it is due to the pain and cold due to short-term exposure and we have just made it worse. Imagine if it were the guy above and he was totally unresponsive and we done this to him; did we make it better or just continue his environment to a lesser degree?

We as pre-hospital providers need to be aware of all the different ways that our actions and our environment can effect the patient. Sometimes we're not able to offer a warm cot or backboard, so carry an extra couple of blankets just in case you need to wrap a patient up to provide a barrier against a cold cot or board.

For those severe cases where active warming is necessary, keep a bag of saline solution wrapped in a heating pad on a low or medium setting. Or just have the heating pad ready and wrap the line around the pad several times to allow the fluid to warm a little before entering the body. Just remember, normal body tempature is around 98.6 degrees, so even room tempature fluids are not doing any good at this point. If your on post or at a station without a heated bay, you may have to get creative with your treatment, but ultimately it is up to you to provide a pleasant environment and care on those cold and blustery days.

Stay warm my friends!

03 January 2010

Around the World (Web Site is Up!!!)

Well, I've really done it this time!! As is my nature, when I get an idea or a thought I tend to run with it wide open until completion. For the last four days I've been working on my website, tweaking it here, tweaking it there; trying to get it just right. But I've found there is no just right and it will never be finished. There is always something that will need to be repositioned or added to make me happy...did I mention having OCD is not helpful.

One of the most frustrating things has been my complete lack of understanding of HTML...or what it stands for at least. But I've come to realize this, it can make or break a site. I have tried a hundred different ways to move my blog directly to the website, but I can't seem to get the HTML code to work for the comment portion of the blog. Not that I don't like Blogspot, I do, but I just want more control over my content and have to clutter up my page with banners and ads. Anywho...

I'm really happy to be joining the ranks of fellow bloggers in tackling the monumentious task of trying to redefine prehospital care. Now I don't have any grand thoughts that a website will do that, but it does give people access to our ideas, problems and agenda.

I have a short list of things that I will be defining and discussing over the next month or so that is related to the system that I work with-in. We here in our county are at a turning point as far as how EMS is governed and provided to the citizens. The past few months have been ripe with accusations, ideas, solutions and even a few ostriches who refuse to take their heads out of the sand and concede we have some problems.

As for the website, if anyone has any ideas on how to do a blog outside of a host, please let me know. I'd also like a little feedback if you happen to pop over to the site at www.firstduemedic.com

01 January 2010

Flip the calendar

Here we are again with aother decade in the books. Seems like it was just last week when everybody was scared that the end of the world was upon us with the impending Y2K event. Thankfully that turned out to not be the case.

I wanted to take a moment to reflect on the last year and some of the highlights that were significant for me. The one thing that sticks out the most is my passing of the first year medic class. That has by far been the greatest personal achievment that has provided immediate benefits. With the sacrifice that my family has made in time and patience, I count myself truly blessed.

Another thing that developed in the later part of the year was this blog. It has been a great outlet for me to express my thoughts, opinions and frustrations. I have also had the priviledge of making the aquantence of some fine folks with the same passions for their work that I have. They may not realize it yet, but they have taught me some things already by proxy. Also this might be a good time to mention it, I've gone big time with the launch of my own website, you can see it at www.firstduemedic.com.

As for 2010 I have just a few things I need/want to acomplish. First and foremost will be the taking and passing of the National Registry Paramedic Exam followed immediatly with obtaining the Critical Care Paramedic endorsment. I plan to graduate with an Associates degree by the end of the year to round out my educational goals. Somewhere in the middle of that I hope to obtain my FireFighter certification.

All in all, 2010 will be just as busy as 2009 was. It will present its own challenges even more as my wife continues to persue her Paramedic degree and work out her career in law enforcement. The kids may not realize it now with our absences for classes and our jobs, but they are our driving force right now to finish what we started so long ago.

With all that said about what I have to look forward to doing this year, I seem to forgot to mention something.....Oh yeah, I gotta loose weight.

Happy New Year to you and yours and may the year be full of good things.