28 February 2010

I am what I am...

I’m back! Hope I haven’t been excommunicated or anything yet since I haven’t been out “visiting” much. I just have not had a lot of spare time to devote to reading blogs and writing as I usually do, and boy do I miss it.

We’re coming down to crunch time around here as my trek towards the NREMT-P glitter enters its final stages and May 12, 2010 is circled on my calendar. This has been a long two years and there have been a lot of ups and downs along the way. A lot of learning has gotten underway and a new mindset has emerged. I will hate to see it all end soon, but at the same time I am so ready for it to be over. Luckily there is going to be a few months off for me before I trace off to the University of Georgia to take the Critical Care portion that will set me at the pinnacle of training in EMS.

With the clinical rotations at the hospital almost done, there’s nothing left really but a bunch of field time under the watchful eyes of a preceptor; who I think just appreciates the opportunity to just sit back and ride third-man. It does get mundane having to do this in a clinical/student atmosphere since this is what I do for a living as well. It just ends up being the same ‘ol stuff over and over, almost like a recurring nightmare or something. Add in amongst all this the remaining course work, studying and finals approaching; it’s almost more than I can stand. Oh, and of course let’s not forget that I fancy myself to be a family man, and all this “free” time on a truck takes some pretty valuable time from the wife and kids. But alas…it’s almost over!

A little housekeeping is necessary as I continue on. I got a message on FB the other day from an individual who was curious as to how I can call myself a “medic” when I’m just an Intermediate, but a NREMT-I mind you.

It’s a legitimate question I guess.

In all fairness I admire the person for taking the time to educate themselves. Then the other night at work another discussion came up about who calls themselves a nurse. Seems that an LPN, or a LVN in some areas, should not be allowed to call themselves nurses because they do not go through as much schooling and training as an RN…really? Apparently, a CNA is as an EMT…a LPN is as an Intermediate and of course an RN is as a Paramedic.

This to me is a wierd analogy because I as an Intermediate (we as medics) can do more outside the hospital than most of them can ever immagine doing inside the ER. I guess they will just be happy with the respect the have garnered.

Now I’m not really sure how this washes out in the hierarchical ladder of certs and licensures, nor do I really care. I came to the conclusion a looooong time ago that it doesn’t matter what my title or position is in life, just as long as I do my job to the best of my ability. John Q. Public is gonna call me a lot of other things, like an Ammalance Driver, or an EMT, and to some, everybody who shows up on the ammalance is a Paramedic. John Q. Public also doesn’t realize what I, you or anybody else on that ammalance can do as far as procedures are concerned or what drugs can be administered. They just want a ride to the ERrah , gimme sompin’ for pain and nausea or there is of course the legitimate 911 caller who will expect you perform heroically and save the day due to a life threatening illness/injury. So it really doesn’t matter what you are to me as long as you do your job as trained and certified, and do it in a professional manner.

Let me see if I can make this short and simple.

I’m not gonna get into a pissing match about who calls themselves what. What does matter is that it comes down to the discipline and the skill set. I’ve never represented myself as a Paramedic, however, the great Commonwealth of Virginia has seen fit to align the skill sets (protocols) of the I-99 level and those of the Paramedic in almost a mirrored fashion, with the exception of a drug and/or procedure two that calls for on-line orders… that are usually given depending on the provider. Do I like it? No. I know some Intermediates who will NEVER rise to the knowledge required for the Paramedic level because in truth they are incompetent in a lot of areas that matter most. But still yet, when they are on a truck, it is a medic truck none the less. On the same hand I can count the reasons some Paramedics I know should not wear the title either because the are as unprofessional as they come. But there it is folks, call it what you may, but when I show up you will get the all that I have been taught, trained for, certified by my state to practice and all that my OMD will allow me to do. I guess the beautiful thing is that when someone does get their Paramedic in Virginia, they come out into the field with a leg up in the game already having had some experience in the field.

So yes, as much as some may not like it (me included sometimes), I am a medic for all practical purposes. Just as the basic trained soldier on the battlefield who wore a red cross on his helmet was a medic, so am I. I do however, reserve and revere the title of Paramedic as someone who has been trained to the minimum levels required by a sanctioning body to practice at a certain level and has the professionalism to operate as a skilled physician outside of a skilled physician’s direct control.

Now in the words of the great Forest Gump of the renowned Bubba-Gump Shrimp Co. ……That’s all I have to say ‘bout that.

21 February 2010

What's in your wallet?

Years ago during a particularly tumultuous time in my life I decided that there were some things that I couldn’t do by myself. I was self employed at the time and business was good, but trying to run the business and working it at the same time was just wearing me down. Add on top of that the strains of raising a family while being away from home three or four nights a week and you see where this can lead to real quick.

With all the stress and strains of life weighing me down and my burdens many, I did what every red blooded American and convicted felon does…I sought God. Don’t groan yet, this is not a Sunday school lesson.

I didn’t necessarily have a churchy upbringing and it wasn’t a big part of my young adult life. However, I had had some exposure to the good Christian teachings as dictated by others that knew better how my life should be, so I wasn’t exactly clueless as to what was going on.

One Sunday morning I was sitting in church and for whatever reason, this one phase from the pulpit hit me and sank to the pits of my being… and stuck. Of course I didn’t know this at the time, but that seed had been planted and time would cultivate this seed to a tangible product.

“If you can, or will, find something that you are willing to do for free…that is your calling. But if you can find a way to get paid for what you are willing to do for free, you have found the keys to unlock for yourself a prosperous lifestyle.”

A prosperous lifestyle…hmmmm…sounds good. I could live with that.

Fast forward to present day reality if you will. I’ve realized what prosperity is not by now. Naturally when I first heard this I spent many hours and days thinking about what I could do that would lead me to the riches. Man, I needed to find something that I really loved doing and find a way to make me a lot of money doing it. That’s how I interpreted what I heard that morning. Now either I’m not doing something right in the riches department, or prosperity must be something else.

For those of you who find your sustainment in the delivery of emergency (or not so emergent) medical services you know what I mean when I say “You ain’t gonna get rich doing this”. I know it; you know it and it would appear that the establishment knows it as well. Yet we keep on doing this day in and day out. Some do it at two or three different places. Others do it as their chosen profession and still find time to do it for free. Still some just do it because they truly enjoy the experience for whatever reason and get nothing in return except for a small pile of personal satisfaction.

I have to say that there is nothing more satisfying that I can imagine myself doing at this point in my life. For all the flat tires in my system and red tape that I deal with along with the endless political posturing that we must endure, I truly love what I do.

There’s nothing more satisfying than knowing that you have intervened in someone’s life and truly made a difference somehow. Even all the rides that we provide across the U.S. on the biggest publically funded taxi service in the world are comical after the initial anger wears off.

I get paid every day in one way or another. Not by check of course, that comes too weakly (bi-weekly), but in greater things that are far more valuable.

Let’s not forget the stories told by the nursing home resident, needlessly on the way to the hospital for a little bump on the arm. I take some solace in knowing that I gave them a change of scenery for a few hours while being held a captive audience for their life story.

The difficult patients off their psych meds. They are convinced someone is riding on the tailboard following them, or the one who has cut themselves to shreds and wants to take me out with them. From them I will get patience and tolerance.

Even the drunk driver who kills another human being gets his/her due as well. They will allow me to realize that my job is to fix and sustain the human body; that’s why I’m not a police officer or a judge. He gives perspective.

The patient who waits until I get to their house before they decide to code. They give me the drive to stay on my game, to tirelessly train and study, they think that I can fix what’s wrong if they can just hold out until I get there. These guys give me confidence.

Who can forget the lady who is waiting at the curb with her suitcase as you pull up in an ALS rig that is the last available for the next thirty minutes or so? It’s a cold night and her power has been turned off because she has no money, she has nowhere to turn and seeks refuge from the cold night air in my bus. She’s also knows that when she gets to the hospital there will be a small portion of food available for her during a four to five hour work up that will be nothing short of a full physical. She pays out with compassion and understanding.

How about the guy that the cops have just fed a concrete and grass sandwich to because he beat his wife and kids and tried to resist an arrest. He makes me love my job too. It is because of this guy that I will never go to jail for loosing my temper and killing someone. If I can spend twenty minutes alone with him in a closed environment, knowing what he has just done, I can control my emotions and anger through anything. He gave me self control.

For the infant who met the enemy SID, the one whose body I will have to do unimaginable things to just so the parents will know that they tried…that I tried. This little one will give me a deeper appreciation for life and learn to protect the fragile memories with my undivided attention.

Finally there is the frail old man who is in the process of taking his last breaths. He has run his race and fought the good fight. He wears his memories in the wrinkles on his face and his body is so tired. There is nothing I can do now because he has already purchased his final ticket. It is gold and has a big stop sign embossed on it that tells me to let him go out like a champ. It tells me that he is in control of these final moments. We lock eyes and he breathes one final time; he is now just someone’s memory of happier times. He gives me respect and dignity.

Yes, there are times when I almost loose it with the way things play out on the job. I do not like the way things have to be done. There are too many injustices that we must overlook out of professionalism and decorum; but this is our job…this is what we do.

Until the dawning of a new day when society figures out how to deal with all its’ problems, we will continue to be the dumping ground. Because of this we will be the doctor, the nurse, mental health counselor, moderator, baby-sitter, guard, taxi driver, locksmith, doorman and the list goes on forever.

I will probably never get to buy a custom built yacht as a Paramedic, or even a used one for that matter. My cars won’t be fancy and my family won’t take lavish vacations to Europe. We’ll only have one house to live in and it will not be on the lake front. I’ll have to punch a time clock to verify my presence for the foreseeable future to generate a steady flow of funds to my bank account. But for all that I do not and will not have, this much I know; I am rich with the things that matter most.

The moral of the story?

Prosperity is not so much about what you can see; yes it helps to see it, but it’s about what you do with what you can’t see.

I’ll bring home a check that is redeemable for a small amount of cash… but the experience is priceless.

19 February 2010

Strength in Unity

I had a post that I wanted to put up today but I decided that I would give it a couple of days to sort itselt out.

Instead, I want to build on my last discussion about people of like minds with this timeless classic from Aesop's Fables.

A father had several sons who were perpetually quarreling among themselves. When he failed to heal their disputes by his exhortations, he determined to give them a practical illustration of the evils of disunion; and for this purpose he one day told them to bring him a bundle of sticks. When they had done so, he placed a stick into the hands of each of them in succession, and told them to break it in pieces. They each broke the stick with ease. He next took the sticks, five at a time, and again put them into his sons' hands. They each tried with all their strength to break the bundle of sticks in their hands, but none were able to so much as make them crackle. He then addressed them with these words: "My sons, if you are of one mind, and unite to assist each other, you will be as this group of sticks, uninjured by all the attempts of your enemies; but if you are divided among yourselves, you will be broken as easily as these sticks."

17 February 2010

--He who leads with no following is merely taking a walk--

I knew it was bound to happen. It was just a matter of time before the question would be asked and I would find myself in the position of defending “The Chronicles” and “EMS 2.0”. Sadly enough I was ready, only because I had internally asked myself this same question just to do a little self-check on my motivations. I’m not a self-serving person, so I do that quite often.

“You sure have been talking a lot about this Chronicles of EMS stuff lately…posting stuff on face book…sending out emails and stuff. What do you think, they’re gonna ask you to be on TV or something?”

The way it was asked really caught me off guard. It was almost accusatory and had a lot of jealous overtones. But what really made me feel uneasy was the fact that I was in the process of telling a few people that I had intentions of going to Baltimore, MD for the EMS Today Expo. The question came just as I was saying that I was excited by the opportunity to speak with Justin, Mark and possibly Ted in person and maybe there would be others who I only knew from Blogville that I could finally meet up with.

Yeah, so maybe I am a little star struck…maybe. There are a few of us at work who refer to the authors of certain blogs by name as if they are our next door neighbor we’ve just talked to before coming to work. It’s like "You know, Justin brought up a good point the other day" or "and Chris said…” and “…Rhett said that…”. That’s just how much we have come to identify with our colleagues in the profession. Hey, we blog after all, we get a little intimate with our feelings and quite literally let it all hang out sometimes.

So in answer to the question I was posed with I answered it this way. “Who in their right mind would turn down an opportunity if it were presented…but I am not seeking any public recognition. My only intent is to align myself with and solidify my professional network with those who are like-minded and are positioned to make a difference”. That is the honest to god truth.

It was only this past November that I stumbled across this blogging stuff…I never knew anybody was doing it in relation to EMS or any other segment of public safety. Sure I’d heard of blogging and I’d read blogs about different things, but never had I stumbled across something that I was passionate about, like changing EMS and the way it is delivered. So quite naturally I became hooked on reading blogs and eventually starting commenting. Before I knew it I had a burning desire to put my thoughts and experiences out there and contribute to the discussions. These are the people that I can identify with! They’re saying the same things I’ve been saying for three years now! I AM NOT ALONE!!! Yes, these are the people I want to be around and align myself with because I’m a firm believer that you become like those with whom you associate, and quite frankly there are not a lot of people that share my vision around here I’ve found...the hard way.

This became even more evident to me early yesterday morning when I had an opportunity to listen to the latest podcast from EMS Garage(Episode 73). The part of the discussion that really got me stoked was when they started talking about how we identify ourselves; what is our identity in the public arena.

The truth could not have been told any truer (is that even a word?) when someone made a comment along the lines of we really don’t have any established history in EMS…the fire service has 200 years of practice on us. And they’re right. We are still stuck being the bastard child of the health care industry and living in the orphanage at the fire house. We don’t have fourth and fifth generation Paramedics to look back on with pride and admire their traditions. It is for that reason that I do admire the structure of the fire service. I like the order, the discipline, the traditions, the daily duties and the way that they are carried out.

Someone else said that sometimes it’s considered punitive to be assigned to the bus instead of the engine. For that reason alone I’m willing to cross train just so I can qualify for a job with a municipal fire service. Put me on the bus…leave me on the bus…I really don’t care, that’s where I’d rather be. The public would be better served by someone who actually wants to be there anyway.

But it’s the camaraderie that I long for at work, a sense of purpose and being an integral part of a system with a clear cut defined job function.

I’ll close it up with this final thought and reference a very moving speech that was posted yesterday(Part I PartII ). I watched this speech and was almost moved to tears as this FDNY Lieutenant spoke from his heart about what it means to be in public service.

We in the pre-hospital care field need some heroes too. We need someone to start living legendary lifestyles and become a legend in their own right. We need Paramedics to be willing to put on the super cape and perform heroically in the field with honor, character and integrity. I want my sons and my daughter to tell my grand kids that their grandpa was a Paramedic just like they are, and pass the stories on down through the generations.

I look back on the service that my grandfather and father gave to the City of Hopewell Bureau of Fire with pride. My grandfather died before he probably knew what a Paramedic was, but I’d like to think that if he did, he would have been one. My father left the service just as his station was staffing EMT’s on an engine, I’d like to think he would’ve been one of the first had he stayed on.

So am I looking for notoriety or fame? Absolutely not. I just want to make a difference and leave the world and/or the system better than it was when it was handed down to me.

16 February 2010

Sir, You have just committed a bloggable offence!

I developed a new saying the other day out of the clear blue that helps me identify something that deserves some of my attention. We see and hear some of the darnedest things out here, don't we?

However, sometimes in all the frustrations that the job brings, I forget to look at the lighter side and find the real humor in the mundane. But here lately thanks to a gracious young lady, the well written Ms.P, who has impressed me with her keen and sensitive eye, I've kinda learned to see through the problem or situation for what it really is. The past week or so has brought this saying to life several times among the crew at work. Now anytime we see, hear or observe something, for lack of a better term...stupid, we acknowledge it with a cautionary, "Sir, you have just committed a bloggable offence". And the bloggable offences will be dealt with accordingly in the courts of The Gate Keeper. Any others will be referred to the appropriate respective department, i.e. sympathy, anger, ect.

So there were two such bloggable offences in the past two or three days, both from the mouths of doctors.

Nooo! Really?!? Doctors say stupid things?!? Yep... Read on.

My partner and I bring in a lady the other night in imminent respiratory failure. Now when we got to the house she was in some distress, but sustaining well. Breathing is a little labored so we replace the 100ft of nasal cannula on 2L O2 with an NRB to get her sats up. As we are loading her into the truck...you guessed it, she deteriorates. I end up doing a one man vent assist all the way to the ER; no RSI here and nasal intubation is out for us.

We wheel her into the ER, transfer her to a trauma room and the respiratory team takes over. The doctor comes in and asked, "Is she a full code?"

"Yes she is" I say with the utmost of certainty.

He squares off and asks, "How do you know?"

Are you KIDDING me I'm thinking as I reply, "Because she doesn't have a golden ticket" refering to the DNR of course.

Then he asks me as if the idea should have been the first thing in my mind before BSI/Sceen safe, "Well, did you ask".

"No" I answered, feeling so beat down like I was the biggest goof for not asking the patient or her family just how much of my job do you want me do? Just how much are willing to pay tonight. It's kinda like, "Do you want fries with that"? Or, "For an additional $5.95 we'll wax your car and vacuum the inside if you'd like"

Then he continues, "I always ask, that's the first thing I want to know."

With all the professional decorum I could muster, I simply turned, walked away and acknowledge that he had in fact just committed a bloggable offence.


This morning we are in the trauma room working a code waiting for the Doc to grace us with his presence, CPR in progress and the whole nine yards. Yes it was a full code..and yes I asked.

The doctor walks in and just blurts out and asks, "What happened?"

"She quit breathing and then her heart stopped", I state matter-of-factly. Why else would we be doing this to a human body?!?

The nurses lost it!!

He too had just committed a bloggable offence.

So just remember, they're out there for all the world to see if we just open our ears and listen for Capt. Obvious as he opens his mouth.

13 February 2010

Are we ready?

WOW!! I can think of no better way to express how I felt last night as I participated in the live premier of Chronicles of EMS...although 2500 miles away.

I was great to put faces and voices together on the live stream. Those of us who were relegated to cyberland had our own little party going. We were trading jabs and commenting about what we were seeing and truly having a good time. I was really surprised at how the hosts were interacting with us in the peanut gallery, they really made us feel a part of the party.

I have been trying all morning to put a definition on exactly how I feel after seeing the first episode. I was very well put together and you could easily see the professional quality. I have NO doubts that this will be picked up by one of the networks and become the next COPS series. It was just that impactful!

But how can I convey my feelings and apprehensions about having to wait for the dawning of a new era though. Let me put it this way. It's like just finding out that you have the winning lottery numbers on a Thursday night. However, Friday and Monday are holidays and the lottery commission offices are closed. You show up on Tuesday morning and are told that you will need to go to the state capitol to claim your winnings. UGH!!

You drive all day, get there at 4:30pm figuring you still have time because they don't close until 5:00pm.

Well guess what! The lottery commissioners kids pet goldfish just died before you got there and he is rushing home to console the kids and will be taking the next day off to "heal" the wounds of the missing goldfish saga.

It is now Thursday morning 8:29am...one week later. You are standing at the front doors of the lottery commission with your winning ticket in hand. 8:45am....9:00am....10:15am...NOBODY!!

With the hopes and dreams that have brought you this far in life, you call the number on the back of the lottery ticket in hopes that there is somebody inside sleeping who just forgot to come open the front door. 1 ringy dingy...2 ringy dingy...3 ringy dingy... Hello, you have reached the Your State Lottery Commissioner's office, our offices will be closed on Thursday and Friday of this week for a Your State mandated audit, please call or come by again on Monday.

Are you feeling the pain?!?!?

This where I am with the CoEMS project and EMS 2.0 for that matter. We are on the cusp of a breakthrough. We have the people at the ground level who have ideas and solutions that WILL work.

We have goals, dreams, desires and a longing to change our profession for the betterment of everybody who may one day dial 911,999 or 112.

It will be a long road and there will be obstacles that will discourage many. Some may fall by the wayside and loose focus in their frustrations. But it is us, the stretcher lifters, who now bear the responsibility to carry this movement to the final stages and see the end of our dreams.

Somebody made the statement about Dr. King last night or in one of the blogs this morning, about how he and the people who converged on Washington D.C. in 1963 to tell the world about their dream had no idea the changes that would be made because of that day. I know it has certainly changed my life and my way of thinking. Because of Dr. Kings courage I feel invincible and plow through the opposition of what is right and decent. I can stand in front of those who would do harm and declare that what they are doing is wrong. I too have a dream...

Likewise we may never fully realize just how much February 12, 2010 will mean in a hundred years to the health care industry.

Fellow professional EMS providers...I AM READY!!

Come what may, I will cash in my winning lottery ticket!

10 February 2010

Charlie Foxtrot: Part Deux

To all my loyal readers,firstly "Thank You" and I appoligize for my extended absence. There are many things I can do, but think, write and engage in dual emittance is not one of them. I had a bad "bug" for a few days...but we're all better now. So, back to business!!

When we last left our mild-mannered medic, he was laboriously toiling away at work; doing really important stuff, like reading, studying and strengthening his intellectual horizons…he was reading blogs.

Searching for truth.

Digging for facts.

Yearning for knowledge and insight.

Longing for the understanding that seemed so distant.

Then the phone rang. “Who needs me now? What face of death must I stare into?”, he wondered silently with great anticipation.

But alas, the great medic cape need not be donned, for it was not that evil was afoot…but yet another flaw in our health care system.

* * * * * * * * * * *

I listened as the supervisor took the call. From the one sided conversation I could only gather one thing; an emergency it was not. This due to the repeated attempts to tell the caller that if we send a truck to pick him up, we would not divert regardless of the nature of the call.

We saddled up and started towards the “scene”. I was told that this guy who called was at a convenience store waiting outside for us. He was involved in an MVC about two weeks ago and was now wanting to go to the emergency room because his back hurts, but if we got a more important call, “we could go to it and then come back for him”. Now, of course I have my doubts and rightfully so. This is just not adding up at all. I tell my partner that I’ll take this one…get the refusal ready. I wasn’t going to go and show my butt or anything, but I was going to really get a feel for what the problem really was and treat accordingly. I just had my radar on for system abuse due to some recent happenings.

We pull up at the convenience store and I see a young lady talking to a guy standing at the front doors. They both look our way acknowledging our arrival, she throws her hand up as she turns to leave and he tells her that he’ll see her tomorrow. The guy starts walking over towards me, puts a little spot of spittle on the end of his finger and dabs out the Black n’ Mild he’s smoking.

“I know…it’s already out”, he says sticking out his hand as if to shake mine as we close our distance.

“What…what’s out”, I ask stupidly while reaching for an ink pen to occupy both hands.

“This”, he says lifting the now extinguished Black 'n Mild into the air with great fanfare.

“Oh, gotcha. You know those things can kill ya, right?”

“Well sompens gonna eventually” he answers as if it’s his standard reply.

I size the guy up. He’s probably about fifty-ish with long oily looking hair sticking out from under a mesh type ball cap. Scraggly beard. Clothes are rather disheveled and would probably scare a whole box of laundry detergent away if he came anywhere near it. His gait wasn’t the least bit indicative of someone with back problems…we’ve all seen the backache walk.

“So what’s the problem this morning” I ask, ready for whatever may come.

And he starts, “I had a wreck on the 21st…hit a deer out on County Line Rd….damn thing came through the windshield and I ran off the road into a ditch.”

“O.K…..so what’s the problem this morning?”, I ask again as patiently as I can.

“My backs a hurt’n”, says he.

“Where about”, I ask while positioning myself so I could see exactly where he was going to point.

“Man, just all over”, he says as he throws his arms up in anger and disgust with my probing, “just take me to the hospital so I can get me something for the pain”.

Well, now I know what this is all about…as if I didn’t know before.

“Did you go to the doctor when you had the wreck”, I queried.

“Hell no, I didn’t have no money”, he spouted back at me.

“So, how have you been tolerating the pain until this point?” I asked causally, “or have you done something recently to aggravate it?”

“M’friend ga’me some ‘Codones’ and that helped a little bit”, he told me. I could sense he was getting a little perturbed with me at this point. This guy just wanted to go to the hospital.

I told him that before we go anywhere he was going to get a full work up from me first so that I could rule out any life threatening injuries. I did the whole CNS bit, grin…follow my finger…PERL, you know the drill. Then he went crazy.

“Man, ‘nuff of this, just take me to the dang hospital…I need sompn for pain…I can’t bend over”, he said as he leaned forward in an attempt to show me how limited his ROM was.

“All right, all right, don’t get in a tizzy and hurt yourself” I cautioned him, “but I do have just one more question”.

“What” he asked gruffly.

“How’d you get here…to the store” I asked.

Get ready, here it comes.

“That lady I was talkn’ to over thar…she brung me here because we was at the Dutch Inn and they was gonna close and they told me I had to leave”, he explained as if it made perfect sense.

“Why didn’t you just get her to carry you to the hospital…it’s only two miles in the other direction”, I said matter-of-factly.

“B’cause she was going that way…not that way”, he yelled while flailing his arms about like a conductor in the crescendo of a musical masterpiece, “now c’mon, let’s go” he told me and started off for the other side of the truck towards the curb door.

It was about three steps into his trek to the hospital that he realized he had dropped his cigar while flailing his arms, backtracked, bent over (fully) and picked it up and then continued to the side door.

I open the door for him, put him in the captains seat and asked that the seat belt be put on. He complied while stating “I told ya’ll when I called that if anything more important came up that ya’ll could go take care of it and I would be waiting when ya’ll got done”.

I somewhat admired the guy for owning up to the fact that this was not an emergency. However, under state law he was entitled to transport to definitive care, emergent or otherwise.

* * * * * * * * * * *

Well, this is not a news flash here, but our system is indeed broke in so many ways. There are a couple of things that stick out in my memory about this call that kind of lumps a whole bunch of problems into one incident.

I’m not going to give rationale so much as I am just shedding some light on the issues we have in America with healthcare and EMS in general.

1) This guy was in an accident and declined evaluation and possible treatment all because he “didn’t have the money for it”.

2) The patient in question has a treatable sign/symptom, for which he wants to go to the ER to have fixed. He admittedly can not pay the bill and most likely will not be able to pay for the pain meds if he is given a prescription.

3) Chances are, he was probably unemployed and most likely would not have contributed much to the National Health Plan if there was one.

4) He called out an ALS ambulance when he had alternative transportation available.

5) This was our last ambulance available. If we had a serious life threatening emergency call while we were dealing with this guy, somebody could have suffered needlessly.

6) When a citizen calls for emergency service, someone has to respond…regardless.

7) I have no other options available to me other than to transport to the ER. What if we did have a 24hr. free clinic available?

8) This guy could/can/did dictate to me where and when I was going to take him.

9) The service we rendered will not reimbursed for, neither will it be collectable.

10) What if this had been a true emergency and the patient refused care because of inability to pay for treatment.

We’ve got a problem. The 64 million dollar question is….How do we fix it to accommodate everybody? Surly not every locality or municipality can be pigeon holed, we’ve got to start somewhere. Any ideas?

04 February 2010

Charlie Foxtrot

Just when I thought that I had obtained some sort of immunity to stupidity and it's uncertain effects, a new strain emerges. I seriously can not figure what in the world people are smoking these days that has disengaged their brains from their mouths.

Yes, I know I'm in rare form here lately. The mild mannered medic in me has been pushed to the side by the balls-to-the-wall guy who's overdosed on stupidity. I've tried to ration and reason why things are unfolding like they are; karma, complacency, overexposure or burnout. Call it what you may but two times in one day is enough.

We start out this morning right after getting home from my three mile walk around the mall. I'm tired. Not that we had a busy night or anything, but just staying awake all night is enough to make you want to sleep. I've got my pager off and in the charger, however my wife has her radio on unbeknownst to me and this starts a chain of events.

A call comes out in a neighboring jurisdiction for a subject who has fallen in the driveway and is not moving. The alerted station only has a driver and requests an EMT. No response. I'm really not feeling it this morning and have no intention of getting my uniform back on and hauling it out for this. Just ain't gonna do it. There is a fail safe in our system that dispatches a private service in the event the volunteers can't cover a call, and I'm o.k. with this because I happen to work for the service and know what's going on behind the scenes.

The call is dispatched again two minutes later for mutual aid...only this time the call has been upgraded to a code blue (cardiac arrest). I'm still not really worried because I know that right now there is a medic truck from the private service getting enroute to the scene and they are just waiting to be notified by the dispatch center to respond before marking up on the county EMS channel.

Too smooth to be true isn't it. After all, this is my world we're talking about.

All hopes for a good outcome are dashed when a volunteer EMT from my station marks up and says he'll be enroute to assist the neighboring station and wants them to go ahead and respond the truck. Now what this has done at this point is this; that EMT just put a stop to an ALS response. The volunteers in our county have first priority to cover a call, regardless of the type of call. Crazy, I know. While others are planning for EMS 2.0, we're stuck on EMS .25.

Realizing this and and having heard the call, I am compelled by my gut conscious to get out of bed, get my clothes on and get to this call. I am at best only five minutes or so from the scene and dispatch is now advising that there is a firefighter on scene and CPR is in progress. Damn; why couldn't the friggin idiot realized that by the time he or anyone else could get there, a medic truck would have either already been there or just about there.

I back out of my driveway and advise dispatch that "I'll be enroute to participate in this Charlie Foxtrot also." This is exactly what this over-zealous EMT had created by wanting to play the hero instead of letting the call go to the career providers. For those of you who are clueless, we're talking about a genuine cluster f^@*. I've become a little more vocal here lately in calling it as I see it in hopes of making my point. I know it may not be the wisest thing to do...but anyway.

My wife is with me and we're on scene in about five minutes. CPR is in progress as stated, however it is an unwitnessed arrest. I asses, verify pulslessness and apnea and apply the quick patches; asystole. I leave my wife to oversee the preporation for and movement of the patient to the truck while I go to get my lines and meds set up. I am so thankful when I hear another medic signing on scene to help out. It turns out he heard the same thing I did and diverted from his plans to come help out.

Somewhere about the time they were starting to load the patient, EMT Hero shows up...now ten minutes later. He beebops up to the truck grinning and says, "What d'ya say there brother...I got here quick as I could".

"What do I say?", I retorted. "What do I say?...I say you're a completely ignorant dumb ass. You stop an ALS response just so you can run your little red lights and make five dollars for helping cover a call! You are absolutely clueless!!" is pretty much what I said. All this while preparing to intubate the patient. The other medic was just as mad as I was but instead concentrated on establishing IV and IO access and left the berating to me.

After the whole code is over, one of the members from my station comes over to me at the ER to let me know that EMT Hero called him and said he was going to "write me up" for disrespecting him on scene. Somehow he thinks his appointment to the position of fleet officer entitles him to a certain level of stature and prestige and sets boundaries that can not be tread upon.

I'm not sure, but I think I had an emotional moment right then when I heard that.

Part Two: To follow

I'm sitting at work doing what I do at work....um,you know...work (reading blogs). We've got two trucks out of town.....

02 February 2010

I'll be right on over...

So I know already that I’m probably gonna catch some grief over this one. I can hear it already.

“Patient advocate are ya?” or “Best patient care possible, no matter what is it?”. I can hear the jabs coming already. Go ahead…I’m a big boy, I can take it.

Seems that these days everybody is up in arms over the whole “socialized medicine” thing and how it’s gonna kill grandma or people will be left dying in the streets waiting for some elective surgical procedure. Seriously people, get a grip. If we were not so caught up on ourselves being a nation of “I want it NOW!!”, we’d be storming the capitol steps demanding a European styled medicine system. If we were not so lawsuit happy and ready to take every doctors lake house and Porsche just because they won’t give us our next opiate fix, maybe we could tell the truth to the system abusers. Maybe then we could get down to the business of getting diseases cured and that other important stuff like fixing acute and emergent problems instead of waiting for a simple cold to turn into pneumonia that exacerbates your emphysema from smoking two packs of cigarettes a day for thirty years and now has you knocking on deaths door.

So…what brings this about? Glad you asked.

We get a call the other morning…at 0330, you know the ones. Nauseous and vomiting, needs transported to the ER. Usually not too big of a problem. I don’t mind so much going out and BLSing in a call like this, as aggravating as it may be, but with six to ten inches of snow on the ground and a sheet of ice on top of that for good measure; not too happy about this.

My partner and I (not my usual partner…whole ‘nother story) head out to an outlying subdivision a couple of miles outside the city limits. We turn off the main road which is treacherous enough as it is with ice and packed snow, onto the street where the sick person who is vomiting lives. Now the emergency is over, reds ‘n’ whites off and scene lights on so I can see house numbers.

We’re perusing the neighborhood when dispatch calls our truck on the radio. Now I know we haven’t passed the house because I’m watching house numbers you see. Surely to god this isn’t gonna be one of those calls where the patient just stopped breathing…it’s happened! Lucky us. They just wanted to let us know that the caller called back to let us know that the patient is “vomiting violently”. Violent vomiting you say? Right. Exercising the demons is probably more like it.

I start thinking about my course of action. As long as it’s not a poisoning or an overdose, she’s getting 12.5mg promethazine, maybe 25mg if she’s a good actor and a biobag minus the in-flight movie.

We pull up in front of the house and I immediately know why we are there. In front of their cutesy little house sits a snow-covered car surrounded by a yard and driveway covered with maybe six inches of snow…and not flake has been disturbed.

I back in while signing on scene. Grab my jumpbag and begin the trudge to the front door, all the while feeling a little bad for disrupting the pristine picture perfect scene worthy of a Thomas Kincade rendition.

I’m greeted at the front door by a rail-thin man clad only in his matching gray thermal long underwear. He begins to hurriedly tell me that his wife has been sick for the past three days and has been throwing up ALL night. “She’s thrown up so much there’s nothing left to throw up”, he tells me as he leads me to the hyperemetic patient. I guess where I’m at two plus two don’t equal four, because nothing left to throw up and violently vomiting isn’t working for me.

I reach the back bedroom(of course) after winding my way through, around and over the clutter strown about the house, to the sight of a 250lb plus lady sitting on the edge of the bed with a trash can between her knees.

“Hey, what seems to be the problem?”, I ask.

“I’ve got diverticulitis” she answers.

“How long has this been going on, the vomiting that is?” I asked trying to find my route of possible treatments.

“About three days” she says flatly. **Note for record…It only snowed YESTERDAY!!**

I look into the trash can between her legs and see that she has produced some content, not a lot and nothing particularly concerning with the appearance. So I continue on with checking vitals and my interview, feeling the situation out. Then I finally get to the question that we all love to ask, just hoping to make the patient realize what a turd they are for calling at this time of morning for this,

“So…How is what you’re experiencing now any different than it was twelve hours ago?”

“Nothing really, I just can’t stand being sick anymore”, she says like I’m an ass for even asking the question. Obviously she’s entitled to endure as long as possible and then call me when she tired of enduring…silly me, what was I thinking?

Well, obviously she wants us to get her to a place where she can be cared for better than she can care for herself at this time of morning and consents to transport…obviously. I even offered to help her get to the car; she doesn’t think she’ll make it and her husband can’t worry over her and drive too. My partner (seriously, another story) and I retreat to the truck to retrieve the stretcher all the while wondering how we will get it to her through the muck and mire inside. We quickly realize what a chore this is going to be as we attempt to roll it through the snow. HA!! Yeah, we don’t have the four wheel drive model. We end up having to basically carry it to the porch. We envision out loud doing this with her 250 lbs of violently vomiting diverticulitis ridden whiney butt on the stretcher. Why do I do this job again? O yeah, kids got to eat…I remember now.

I go back into the bedroom to assess her mobility. “Can you walk if I help you?” I ask offering her a chance to help herself in the search for definitive care.

“I had hip surgery three years ago, but I got this cane that I use…I think so” she says as she eases herself off the bed and onto the floor.

“Careful now, don’t be in too big a hurry” says the man in the gray thermal underwear. All this time he’s been standing in the background not saying a word. Every so often I’d cast a glance his way to see if he wanted to chime in. Nope. He just stood there and dutifully nodded to her recounting of the incidents leading to our presence.

The patient is now waddling her way through the clutter in much better fashion that I have managed this far. I guess some things do come from experience. She makes it to the front door of the house without so much as a grunt or a groan. I guess it’s worth mentioning that we’ve been on scene at least fifteen minutes by now and she hasn’t vomited once, violently or otherwise; not even a wretch.

She climbs onto the stretcher and we strap her in so “she doesn’t get there before we do”(c’mon, you say it too...don’t deny it) and cover her with a paper thin sheet and a slightly thicker blanket to protect her from the frigid night air. This will also add an extra layer of insulation if we happen to dump her butt in the snow while trying to plow our way to the truck.

We strain our backs one more time, taking a yet undetermined amount of time off of our usefulness to society allotment, and lift her to the loading position. We then begin the arduous task of plowing our way through six inches of snow back to the truck for this all important trip to the hospital. I’ll not put in print the words that formed in the deep dark recesses of my mind during this journey of about 50ft., nor will I admit to what I really wanted to do.

As we get the stretcher loaded into the truck and secured to the locking bar, I step back so as to allow ample room for my partner to enter the truck to exercise those well honed BLS skills that only a man of his caliber can. After all, he’s a supervisor; surly by now he realizes that she doesn’t need any life saving invasive interventions. He mounts the box in a fashion that leaves no room for interpritation about how he feels having to ride this one in. “Don’t like it…then medic up” I think inside while laughing under my breath.

I shut the doors and do a little ambu-pat as if I really expected the truck to pull off into the night with the siren wailing just like they do in the movies. As I turn to go towards the drivers side, the man in the gray thermal underwear, now wearing work boots that are untied, appears and asks, “Can I tell her somp’n right quick?”

“Sure thing”, I say as I open one door.

He pokes his head in the open side while leaning on the closed door and says to his not violently vomiting, diverticulitis ridden, whiney 250lb hefty wife, “Hon…I’ll be right on over, soon as I get dressed.”

The guy is lucky I didn’t use him to make snow angels!

~~And a special "Thanks" to my alcoholic friend for letting use his laptop so that I may continue my work while my PC recovers from a viral infection~~