The Gate Keeper

Still Alive and Kicking

2010-10-09T02:16:00.004-04:00

Well, where do I start? My goodness it's been a long time since I've taken the time to put thought to "paper". Not that I haven't had anything to say, but there has been a lot of stuff that has either prevented me or discouraged me from continuing like I had wanted to.

I too, like Medic999, faced some opposition from my superiors. Now let me be clear about this, mine were for reasons far removed from his. Most of my opposition came from the fact that my writing style was personalized and in some sense unbridled, and some were quite unhappy with my airing our dirty laundry to the world. But true to form, I'll maintain consistency in telling it like it is, but with a little more tact and grace. Soooo, where did we leave off....

I guess the biggest change is that as of a couple weeks ago, I became a fully growed Paramedic (wink, wink). Some goofball in Columbus, OH was either sleeping on the job or slap drunk and somehow pushed my National Registry stuff through and generated a certification card with my name on it! Why is that a slip you might ask? Well, I'm glad you asked.

You see, I work nights and for the past five months we've been working CRAZY overtime. I'm talking about 130hrs a month overtime on top of my regular shift. Anywho, I had worked on a Friday night and was scheduled to test in Roanoke, Va the next Saturday morning. Just as luck would have it, we got our butts handed to us on a silver platter. I think that night between three trucks we had like 16 calls, and several were inter-facilities. I didn't even so much as get to look at a pillow much less put my head on one. During the daytime before I came on-shift I had worked eight hours at the ER(Now theres a blog series that I can't wait to get into), and that preceded by another busy shift.

So here I am in Roanoke at the Pearson Vue testing site, tired as hell, eyes bloodshot and haven't even touched a book or note card in a month. One of the reasons I waited so long to test was because I just didn't have the time too....seriously. They run me through the usual security stuff to make sure I ain't gonna cheat my way through this thing and sit me in a nice comfy cubical. There in front of me is this computer, keyboard, mouse, dry erase pad.....and a pair of ear muff thingies.

I resist the urge to put these ear muffs on because I know what's gonna happen if I do. However, there are about ten other people in there and most of them must have been taking a test that required them to type out an essay paper or something. Man, those keyboards were justa rattling away and I had to give into temptation or go mad with all that pecking.

Ahhhh, silence. Pure silence like a winter day at dawn with a fresh coating of snow. The only sound I could hear was the S1 and S2 of my heart. Sure enough, just as fate would have it, I started to get sleepy about ten questions into this beast. Now I know they have cameras everywhere watching the testing room and I am overly conscious about them laughing at me because I'm falling asleep in there. But sure as I'm typing this right now I start to do just that...I fell asleep no less than four times while taking this test! I'd be reading a question and next thing I'd know I'd wake up with my head just about on the keyboard. Once i actually woke myself up because I snored. OMG I was so embarrassed. I'm not even gonna mention how I felt when I walked out of there knowing that I was tired as heck taking this test; but I actually fell asleep taking it! I knew beyond a doubt that I had just wasted $110 and two and a half hours driving time.

For the next day and a half I felt like crap...literly. Not that I know what crap feels like mind you, but I would imagine that crap has some what of a complex being at the end of the food chain an all. All I could think about was the fact that I had told several people that I was going to take it that day and every body was expecting to know the results when they posted on Monday.

Well, that Monday about 9:00am, I entered the web address for the National Registry website. With a knot in my gut the size of a butterball turkey I entered my log in information, refusing to allow myself to believe that it would say anything other than that I was still an Intermediate. But sure enough, there it was. Right beside the word "Level" was the title that I have studied so hard for, fought so hard to defend and wanted so badly to wear with pride...PARAMEDIC. It was a surreal moment to say the least, almost like I couldn't believe what I was seeing. In the back of my mind I was just absolutely sure that somebody had messed up and sometime later that day they would realize what had happened and return to fix the mistake. So I fought off the urge to check it again...and lost.

I'm willing to bet that I checked my certification status no less that ten times that day. And every time I would see that title under my name I would get just a little more giddy each time. By the time I went to bed that night it had just about sunk in; I actually slept through the National Registry Paramedic exam...and passed!

Well, that's all for now. I've got a lot more I want to get back up to speed on, and I will over the next few days or so, but one of the biggest projects I'm going to be undertaking is a complete overhaul of my website. I want a new look and make it more "professional" if you will.

Until next time....Medic Up!

Race Weekend in Martinsville

2010-03-27T09:10:00.004-04:00

It's that time of year again...well, at least one of them.

Twice a year the population of our county triples with the influx of well over 150,000 people from all across the U.S., just to watch some cars and truck drive at a break-neck pace in a circle.

They come from everywhere; Maine, Wisconsin,New York, Florida, and I've even seen a license plate from Texas sporting around town. Everybody here for the thrill of watching their favorite drivers battle for the lead and wishing the driver they love to hate would hit the wall in the turn. It's all in good fun though.

Dedicated fans start rolling in about three days before the Sunday race and set up temporary housing in parking lots and rented out front yards. For the next few days they are our neighbors, blending in with the happenings of the locals. They shop in our stores, buy our gas and patronize our restaurants and you would never know they were foreigners unless you happened to catch the hard accent of a Yank.

Some of us just tolerate the influx of the fine folks from all over and of course the business owners can't get enough of them. I would dare say that some business owners peg their entire business on these two times a year. All in all, it is good for our economy and it does lend a certain excitement to the air.

For me it's just more of the same. Somewhere either at the track or in the surrounding area I'll have an oppertunity to make an impression on somebody and introduce them to our locality as a representative of our EMS system.

There will be the drunks (my favorite), the falls with broken bones and inevitably, without the shadow of a doubt, there will be at least one cardiac arrest in the stands where the whole world can watch you perform your art. The heightened sense of awareness will be on our minds though, knowing that this environment could be a prime target for terrorism. We'll be vigilant and bring our "A" game at every turn, but we too will get caught up in the smells of high octane fuel and the thunder of thousands of hosepowered engines hurling around the track.

So yes, once again go I...out into the crazy masses to distribute my charm and charisma, and possibly some quality-of-life sustaining care to the energized masses who will fall prey to their own inhibitions. But I will do it with a smile because I know that they will soon be gone and leave nothing but their trash and other remnants of their brief visit.

Funny....real funny

2010-03-23T08:17:00.002-04:00

A little change in pace before I pick my next carefully chosen battle.

I'm not always wound up about something as one may think, shoot I have fun just as much as the next guy and even involve other people in my antics. We've got to have a release in this line of work or we'll be as batty as those we serve.

My partner may not approve of my sharing the perils he has participated in or been the subject of...but it was funny. The first one I can't lay claim to but it goes something like this.

We'll just call my partner Paco for the sake of discussion. Paco and I have have worked together for two years now on the bus and we've seen just about everything. Paco's an all around good guy and will do just about anything you ask him to...as long as it benefits him in some way. But the guy is a little gullible and avails himself to these sort of things. The good side of it is that there is usually a learning experience in it for us all **snickering**.

Paco was working one night with Guy and there was this particularly messy call he was involved in. There they were at the hospital, transferred care and were now in the process of restocking the truck.

Guy: Damn, I knew I forgot something.

Paco: What d'ya need, I'll get.

Guy: Run inside and tell one of the nurses I need a set of fallopian tubes from the cabinet.

Paco: Okay

And he did....

We rode him pretty hard about that one for a while, after all it was funny. Admit it!! You're sitting there right now thinking of some poor schlump you can pull that one on.

It took a while before the time was just right for another one.

We are doing what seemed to be a routine transport to the hospital, but I decided to give it a twist and give it a little urgency. Now, when we're transporting in, it's the driver that calls the report in to the ER.

I'm in the back and I'm all serious, I'm taking blood pressures and looking intently at the monitor. I'm really working the patient up good. You would think the patient was a major multi-systemic trauma victim the way I'm checking her over.

Paco (from the front): What you want me to call this in as?

GK: **with ALL seriousness** Just tell them 70yo female with an acute priapism.

Paco: Want me to run code?

GK: No need to run hard, just nice and steady if you would.

You should have seen the looks on their faces when we walked into the ER. There wasn't a cheek that wasn't being bit to keep from laughing.

Then the other night it hits again. We're doing another routine transport and have just loaded the stretcher into the truck. I can tell he just doesn't feel like riding this one in...for whatever reason.

GK: Paco, jump up in there and get me a B/P, I'll come in the curb door and do my thing up there.

Paco: O.K. (and dutifully jumps on in)

What did I do? I shut the doors, got in the driver seat and we went to the hospital; all the while watching an obviously disgruntled Paco through the rear-view mirror.

I know....mine is coming! Bring it!

Food for thought

2010-03-18T00:05:00.003-04:00

I got bored...so I dug down deep within and found some pearls of wisdom. Take it for what it's worth, but it made me feel better.

1) You get what you are willing to pay for.

2) That which you neglect will eventually neglect you.

3) My dest-in-y will be determined by what's best-in-me.

4) A person only fears that which they don't understand.

5) Perception is 9/10 of reality.

6) Control is given, not taken.

7) Your success will never be determined by someone who is not determined to succeed.

8) A person of little value is easily bought.

9)In theatrics, it is the people backstage who see the real performance.

10) The person who yells into emptiness will only hear what they have said...and nothing more.

Paramedic v. Nurse

2010-03-15T00:02:00.006-04:00

**Newsflash** Hold all presses for news release, the Gate Keeper is an a$$ because he asks questions to a nurse. Well who woulda thunk. Let me fill you in on this one.

We’re called to a local managed care facility (nursing home) the other night for a patient experiencing some difficulty breathing. When we get there, as usual, there is no nurse with the patient who is in need of emergency treatment. Let me stop and spin tires here for a minute.

Would somebody please tell me why it is o.k. to call for an ambulance that is supposed to transport a patient who is supposedly sick enough to be outside the capabilities of the facility…and yet doesn’t have a nurse close by to manage said patient who is in such bad shape. Furthermore, why do the nurses not have proper training on the use of oxygen therapy and the delivery devices for said therapy? Really!?! Wouldn’t you think that we’d need to have that little baggie under the mask inflated just a little bit, and guess what my genius friends…five liters ain’t cutting it and two liters per minute with twenty feet of canula ain’t gonna do it either.

O.k., so I go to the patient’s room and sure enough she is having a rough time of it with her breathing. I ask a young lady who follows me into the room how long this has been going on.

“Oh I’m just an aide…I’ll go get the nurse.”, she says and scurries out of the room.

The patient is CA/Ox4 and also has some secondary issues with pain in her abdomen (RLQ) radiating down her right leg. For this she has had a morphine pump prescribed by her primary physician. I’m more concerned with the breathing since it is so labored with use of accessories. She is also pale and diaphoretic and which narrows my differential down even more.

Before long a nursely looking type appears in the room. I think I recognize this fella from the hospital, and if I’m not mistaking he also works in the CCU, so I breath a sigh of relief and start my interview with him. The patient was having such a hard go of it breathing, I didn’t want to stress her any more by getting her to talk.

I turned from the patient to ask the nurse, “When did all this start?”

“I’m not sure…I don’t work here all the time”, he answers not realizing he has just let me down already. Is this a standard response for any nurse who works in a nursing home that is taught in orientation or is there a special nursing class just for excuses and responses to EMS personnel?

It wouldn’t bother me so much if it was only every other time, but this is EVERY time I go to a nursing home to pick up a patient…any nursing home it seems.

Not thinking I continue on, “What kind of health history does she have?”

“That’s a good question”, is all I get.

Thinking that I may actually get somewhere with the next question, much to my chagrin I try again, “what types of medication is she taking”?

“That’s a good question too”, he responds

Really?!?! You mean to tell me that with two years training and many more years experience, the only thing that I have learned to do is ask good questions. What’s more amazing to me at this point is that this guy has just recently graduated from nursing school with the same two years of training, albeit in a different discipline. Of course you would think that a nurse would at least know the answers to some of these general assessment questions.

I’m just plain disgusted at this point and ask if we can get a chart or something or get someone who does know what’s going on with this patient.

Just then another nursely looking type walks in with some papers cradled in her arm. Maybe we’ll get somewhere with this one I hope deep from within my soul.

“Here’s her paperwork” she says while thrusting some papers in my direction.

“Whoa, just a minute…what exactly is going on here…how long has this been going on?” I ask.

“I’ve already gave the report to the ER and Dr. Hey’you wants her brought on over”.

“Well, that’s all fine and well, but I have to treat her between here and there…she’s not looking too good… I need to know exactly what’s going on”.

By this time I guess I had said some magic word that gave me security clearance to some personal medical history and events leading up to this point. She started in with her rendition of what was going on while I was in the process of hooking up the EKG, which showed an old infarct or even maybe an area of ischemia.

I’m going to stop here with the “case study” just because I want to preach a little bit about being a professional.

First of all, if a physician had came in my truck, dressed in the same uniform and asked the same questions, would it have made any difference what questions were asked. After all, are we not the eyes and ears of the physicians who have given us standing orders to act on their behalf?

I know there are nurses who don’t like us for one reason or another, and most don’t want to hear our reports at handover only because they are going to ask the same questions that we just did. Many more will certainly not want to hear about any pre-hospital treatment performed because that will just remind them that we do assessment based treatments rather than physician ordered treatments.

The reason that I’m so fired up over this is because this nurse happens to be friends with another friend of mine and called him to say that I just came across as a smarta__ and acted like an a___ole because of the questions I was asking.

I am a professional. I am a patient advocate. It is my job and responsibility to assess the mental acuity, history and needs of the patient and then render the treatments necessary to preserve life and/or the quality of life until care is turned over to a higher trained individual, or in most cases someone in their charge, such as a nurse.

It does not matter to me who the patient is, where they come from and it certainly doesn’t matter what their social standing is. I refuse to accept the mentality that just because a person is in an environment such as a nursing home, that they have given up all rights to make decisions for themselves if they are able.

I can not tell you the number of times I’ve heard a nurse tell a patient “you have to go, the doctor said to send you over” all the while the patient is protesting going anywhere. If the patient can tell me who they are, where they are, how they are and why I’m standing there…they’re in control of their destiny, period. Now I feel the need to clarify something here. I know that sometimes a patient will not want to go for fear that they might inconvenience someone, but if their condition warrants a visit to the ER, it is still my job to advocate for the patient and I’ll do everything in my power to encourage them to seek treatment. But it stops there. I don’t and will not participate in the coercion of a patient to do something they do not want to do.

For the ones who cannot speak and think for themselves, I wish I had the power to say (after a thorough assessment) “No there’s no need to for them to go to an emergency room” just because they bumped into a door. I would love to protect those that don’t need or understand what’s going on from the battery of test and the isolation of the ER.

My tongue will bare the scars from the teeth that kept me
from saying the things I want to say, but my conscious will be clear because I gave every patient the best even when others around wouldn’t.

**Just to note. This same nurse does in fact also work in the CCU. This is the same CCU where the students from ALS cources go to do their clinical rotations for their respective program training. Supposedly they have a lot to teach up there, but I’m sure this one doesn’t understand what his true responsibility is to the medical profession.

A time for reflection

2010-03-12T22:24:00.005-05:00

It’s been a whole week now since I’ve gotten back from the EMS Today/CoEms/EMS2.0/flash vacation trip to Baltimore. Little did I know that that little trip would accomplish so much. I had my expectations, but never did I suspect that it would accomplish so much in so little time.

I came back last Sat. night and went straight into work…literally. I found myself whipping through the city streets going to this belly ache call and then the next with a renewed sense of job satisfaction. Somehow those belly aches seemed just as important as the AMI to me tonight. I guess it was just realizing that there are others out there doing the same ‘ol mundane stuff I am and facing the same problems and frustrations…just like me.

Even the casual run in with the non-caring nurse (so it seemed) at transfer of care didn’t set me off this time. It was only later into the wee morning hours that I had time to reflect on the conversations I had in Baltimore and it was then that it hit me. I had been imparted a seed of wisdom from the Happy Medic that most likely has changed the course of my career.

Really? Was it that dramatic you might ask.

To me it was...let me set the stage.

I’m sitting at Uno Chicago on the inner harbor of Baltimore enjoying a beer and grilled shrimp, courtesy of JEMS and George Washington University, with some guys who have made their way down from northern Joysey. To my right is this little guy that has more energy than Chernoble before it blew. He’s a medic I’m told, but doesn’t quite fit the image of such a creature. He’s no bigger around than a sapling but has the coolest gelled hair thing going, smartly dressed and quite articulate he is.

We’re talking about this little radio type show he does. Yeah, I’d heard of it; a couple of medical types get together in some garage and talk about all things EMS. He’s just all excited and so am I for some unknown reason as we are talking like we were in a garage, a very noisy one at that.

Out of the corner of my eye I catch this ruggedly handsome paramedic type approaching and I abruptly turn to say hello. This little bite size of a guy turns too and recognizes who it is, then introduces me to this man who has probably already tagged me as a groupie from our earlier encounters. With bedazzling speed and one swift motion he is out of his chair; he grabs this tall man by the arm and guides him into the seat that he had just vacated. With that, the little bite size medic is gone. Off to his next chance encounter with an unsuspecting guest who will never guess what name really appears on his driver’s license.

Here I am, sitting with the Happy Medic to my right. “It’s him…it’s really him”, I catch myself thinking before I realize that we’ve already talked a couple of times earlier today.

“So, having a good time?” he asks leaning in for a response.

“Wonderful time, just fabulous” I replied.

We engage in some small talk about this that and the other before I decide to take the plunge.

“Is this an inappropriate time to talk shop?” I ask.

“No, not at all”, he says without reservation leaning in.

I had so much that I wanted to ask on this trip, so many unknowns. Where do we at the ground level fit into the grand scheme of things. All of the who, what, when, where, why and how’s that you could think of were running through my mind. I came with questions and so far I had only found a hint of an answer. Ted Setla and I had talked briefly about The Chronicals coming to my area and how that could be made to happen. With that I came away with a clearer understanding of the mission of the project and how conversation would provide the starting point for change. That much I could appreciate but he surely didn’t understand where I come from. Here we don’t acknowledge our problems, and we certainly don’t talk about them. How does this work for me I still wanted to know.

“How does this work for us on the ground, those at the bottom of the totem pole?”, I started. “How do those of us who have ideas, complaints, concerns or problems get heard. How do those of us with integrity effect a needed change among those who could care less?”, I asked pleading for a simple answer that would fix it all.

I was about to get the simple answer that I so desperately needed to hear. However, unbeknownst to me, I knew the answer already.

HM thought for a second and spoke forth his wisdom, “You just be the person, the medic, that you want everyone else to be”.

What? Really? Was it that simple? Could that really work? Am I the one who will set the tone and the pace for professionalism around me? These are the thoughts that ran through my mind as I registered what I had just heard. Then he continued…

“Are you a Paramedic?”

“Testing in May”, I answered.

“Then what…” he asked.

“I’ll finish my associates next Fall semester”

“…and then…” he asked returning the volley.

I motioned to the George Washington University banner hanging behind me on the wall and answered “going to GW to complete my bachelors”.

He sit back and threw his hands up, “sounds like you’ve already got it figured out. It’s then that you can go to those that matter and approach them with your field experience and tell them you’ve got an education just like them and demand to be heard. You’ve got to approach them on their level.”

From that point forward it was all a whir as he talked about how he handled situations that surfaced in his world. I was then that I realized that I was missing one ingredient that will be the catalyst for all this information…patience.

This will take time. It’s not going to be an overnight thing by no means and more than likely I may not even see it in my life time. But what I do know is that my contributions, however small, will be added in with those of like mind and spirit, and that will be what makes the difference.

So here I sit… being patient. Watching time and events unfold around me in slow motion, revealing the master plan one piece at a time.

It’s not as frustrating as I imagined it would be, but then again, it’s only been a week. But now is a growing period. This is a time to flex my patience muscle that will lead to the ability to deal with the complications that arise from the evolving of our profession.

I will just go on doing what I do…being the kind of person I wish everyone else would be.

Baltimore Meet-up

2010-03-06T07:31:00.003-05:00

I absolutely love waking up in a hotel room! I'm not sure what it is though; maybe it's just knowing that I don't have to make my bed if I don't want to. Oh shoot, who am I kidding, I don't make it at home if I don't want to.

Now that I've had a few hours sleep, maybe I can try and channel my thoughts about the happenings of last night at the EMS Today Expo here in Baltimore, Md.

We didn't get to see too much of the floor displays since we didn't get here until a little after 1:00pm. What we did see was noting short of a living combination of a JEMS, Galls, Boundtree Medical or any other EMS type catalogue. Everybody has something they want to sell that is going to make our jobs easier. I feel so loved! It's almost like they care or something, because surely they don't think that we actually have funding for any of this in these hard times. I say this with love :)

The highlight, and of course the purpose of this trip was to go to the meet-up of the Chronicles of EMS, EMS 2.0 and the bloggers of all things Fire and EMS.

Who knew that I would ever be in the good company of the guys and gals that have become like an extended family over the past five months. It was awesome to sit and talk one on one with Chris Montero from EMS Garage! I never knew they made medics in bite size.

And of course there was Justin and Ted who took the time to to really spell out the vision and offer ways to make it happen in the trenches. The heart felt sincerity of these guys and the dedication of their spirit to making EMS work for everybody was almost magnetic. Even if you hated your job now you came away with a whole new perspective and appreciation for what we all do. Better than that though, you (I) came away with a more clear vision of where this is going. Rhett Flietz was just super; he really brought the involvement and application of social media down to my level. This guy is like a guru or something and a wealth of knowledge to boot.

I would be remiss if I tried to mention everyone who was there; just so many well knowns from our little circle. Good thing this blog has an edit feature.

But more than all the people who were just great to be around, there were the people who made this happen. I'll come back later and link names and organizations this weekend and post pictures. But JEMS and Goerge Washingtom University went A-L-L out with the party. I really expected to look up at any minute and see to big guy walking in at any minute, because I thought I was in heaven. Free beer and wine; and the food just kept coming!

There's just sooooo much more I need and want to mention, and I will later when I have more time. For now I though I need to get checked out of this room at the Sheraton on the 18th floor and get to the exhibit hall and try to take in some sights. Then it's back to work and out on the streets of Henry County tonight; but the lights will seem a little brighter this time.

Be well!!

Medical Unknowns Part II

2010-03-04T19:49:00.002-05:00

Maybe this was a bad time to post something needing a reply with everybody at the EMS Expo in Baltimore this week....but let's pick up where we left off.

Just as I walk outside my cell phone rings. It’s the office wanting to know if everything all right. “Don’t mean to be short right now but this guy is kicking our arse…I’m calling the attending now..bye”

Call the ER and just my luck I get one of the doctors who doesn’t particularly like us “para”medical types. I explain the situation to him, tell him what I’d like to do and get shot down mid-flight, “I just don’t like Haldol…just get him here best you
can”, I’m told.

I walk back inside the building and back downstairs and what-do-ya-know, there stands Jim outside the bathroom door, still in his under drawers, just ‘a smiling and looking around at all the attention he’s drawn.

“Hi…how’re you?”, he says to me as I approach him.

“I’m good, how are you?” I ask quizzically

“I’m good too” he says with not a clue as to what’s been going on.

“Ummm, Jim, can I get you to have a seat over here for a second so we can talk?”

“Yep”, he says as he makes his way over to the bench and sits down. He looks down at the monitor sitting in the floor and asks, “What’s that thing?”

“That’s a heart monitor”, I explain to him, “It allows me to take a look at how your heart is behaving…are you having any…..”

“How much you reckon it cost?”, he interrupts me mid-sentence.

Willing to play this out I answer “I’d say around 18 -20 thousand dollars…some a little more depending on the…”

“Phewww, that’s a lot”, he interrupts again and says taken aback by the amount I guess, “how many channels does it get you reckon?”

I realize what he thinks it is and just so I don’t get carried away with the technical aspects of the Zoll M series, I just give him what he wants to know, “Well, this one here gets 12”.

“Phewww…. ours gets about 60”, he goes on obviously talking about the cable T.V. there.

I’m at a total loss here. For the life of me I haven’t a clue about what’s going on. Did a leak solve all his anguish? I know I can get a little bullish too when I’ve gotta go, but I would just let it go if somebody was trying to hold me down to a bench and I had to go that bad.

About that time, two county deputies walk in and look over the situation. “We were told you guys were getting you tails kicked…ya’ll ok?”

Well ain’t this embarrassing now? I spend a second or two explaining what had just happened with the staff trying to butt in at every turn to help recount the incident. They just smile and knod, “We’ve had it happen too” they say. I’m pretty sure they thought I was crazy or something and just left us to our now complacent patient.

I decide I’ll take a chance here at this point to do a proper assessment and ask Jim, “Do you mind if I hook my antenna up to you and see if I can watch channel two?”

‘Ol Jim chuckles a little and grins, “You can try…but it won’t work.”
That old saying, he may be slow but he ain’t stupid…here we have it in real life.

I do a four-lead. My wife and I take the time to explain to him everything that we’re doing. Jim just sits there, straining his neck backwards and down trying as much as he can to see everything were doing.

“Well lookie there…perfect picture…channel two looks good and coming in crystal clear”, I tell Jim while noting a normal sinus rhythm. My wife has also gotten a NIBP and Sp02 which is all in normal ranges. The B/P is a little elevated, to which I attribute to our recent scuffling.

“Awww, that ain’t no T.V. show, that’s just a bunch of lines”, he says calling my bluff.

“But they’re good lines, the kind I like to see….are you hurting anywhere?”

“Nope”

“Any trouble breathing or getting your breath?”

“Nope”

I continue with a full CNS evaluation from the head down, PERL and he can wiggle his toes.…responsive to all commands and no deficits are notable. Not a clue.

I turn to the nurse standing to my right who has since gone to his room and returned with his clothes in obvious anticipation that Jim is going on a field trip, “Do you have all his medications together?”

“He doesn’t take any…just an aspirin every week or so; I think he had one yesterday”, she states.

“Well, I tell you what”, I say directing myself to the two staff members standing there,” you guys go ahead and get him dressed. I’d like to take him on over to the hospital and get him evaluated just to be on the safe side. I don’t see anything obvious and really don’t have any reason to suspect anything specific….but I just want to be sure, for his sake. I’m just puzzled about what set all this off”.
“Oh yes, absolutely, he needs to go”, one states emphatically as if there was a question if I would really take him. Both start fussing about getting his pants and shirt on and making him presentable for his trip to the ER.

Jim stands up, looks around at everybody and says, “Ready?”

Just to be sure, and willing to give the man his due I ask him if he feels like he can walk O.K.

“Yep, come on…this way”. Jim leads off with my partner/wife holding on to his arm, up the stairs and out the door to the ambulance parked right outside.

“We goin’ in that?” he asks pointing his finger along the entire length of the truck.

“Yeah, we’ll sit right back here…I’ll let you lay back so you can take a little nap if you’d like”, I tell him while opening the rear doors and boarding the truck to lead the way for him.

“Phewww, never rode in one of these before”, he says grabbing the hand rails and hoisting himself in.

“Nothing to it, eh?” I get Jim settled onto the cot and I hook the leads and B/P cuff back up.

The trip to the ER is non-eventful and my reassessment unremarkable. We talk about where he’s from and what he likes to do for a while. Jim’s curious about the cars behind us that he can see out the back glass. Over and over he asks why they’re following us, and over and over again I explain to him that they’re not following us; they just happen to be going the same way we are. Then I spend even more time trying to elaborate where they might be going, never really appeasing his curiosity.

Even more was his curiosity about the cost of everything. He wasn’t so much concerned with what it was; he just wanted to know how much it cost, and every time I gave him a ballpark figure he would answer with the same “Phewww, that’s a lot, ain’t it?”

Well, the rides over, Jim’s got to pee again, and we’re going into the ER. Jim is sliding over to the ER bed when he says, “Phewww, my head hurts”.

Oh… really?!?

“Where does it hurt at there Doc?” I ask feeling like goon now that there is a nurse standing there watching and listening to the patient tell me something that no one has mention…and I didn’t ask.

Jim reaches back behind his head with his right hand and rubs gently, “right back here where I hit it when I fell last week”.

Well…well…WELL!! What. Did. Ronnie miss THIS time?!?

I’ll leave it here for the sake of time. But I did find out later that night that he did in fact have a subarachnoid bleed, which of course there was nothing I could do anything about.

He did have to pee, and I think that was a contributing factor to the whole ordeal.

I’m thinking that the fact he woke up and had a full bladder was causing a small fluid overload in the venous system. I further surmise that this increase in venous volume was further elevated when he awoke which triggered the sympathetic nervous system, constricting the veins and thus caused increase ICP to the point where some cognitive function was compromised due to the pressure on the brain. I’m not sure, but I believe the aspirin came into play here as well causing more internal bleeding in a possible unstable clot

I can only see this as a viable option since the symptoms were in fact relieved after urination.

What do you think?

Medical Unknowns Part 1

2010-03-02T13:38:00.003-05:00

I have a two part story that I'm going to post this week. However, this one requires some audience participation.

I like to get feedback from time to time on my assessments and handling of a situation. I don't mind constructive criticism the least bit and at times I actually encourage it... o.k. need it

So if you would, read the following part of the post and tell me a couple of things:

1) What would be your working diagnosis?

2) Would you have done anything differently?...what?

I'll post the second part Thursday evening before I leave for the meet-up in Baltimore...so here we go!

I’m sleeping the other morning and I’m jostled awake by the tones dropping for a station out in the county. Possible heart attack or seizure dispatch advises.
Surely somebody would know the difference given the location of the call I think to myself. It was at an assisted living facility that houses mostly functionally MR residents.

Anyway, the volunteer station is not able to muster a crew so I haul it up off my little nap-mat and head to the truck. My partner, who happens to be my wife this morning, and I saddle up and head on out through the city to the call. We don’t get to work together much unfortunately, but when we do I like it just fine. ;)

I’m notified over the radio that the nurses think a resident is having a heat attack or something. Regardless of what it is, it sounds serious I’m told.
I push it kinda hard because we’ve got right about a 10min. response time from where we are in the city to the scene. There’s not a lot of traffic out at 5 o’clock on this morning so we make pretty good time.

We arrive on scene at the home and pull around to the side entrance. Oddly enough the refuge for these people who need help with their ADL’s is an out of service church building converted to a home…of sorts, but hey, it works.
As I pull up I notice a nurse; RN, LPN, CNA…I don’t know, she was wearing scrubs…she is motioning frantically for us to come on in. I grab my I.V. kit and the monitor, my partner/wife grabs the jump bag and we head in to the facility. Down the steps to the basement level we go, twisting and turning through the halls around obstacles following this frazzled lady who can not take the time to tell me what in the world is going on.

I enter a room that has three beds arranged in a Tetris like fashion. On the bed to my left I see a man in his 50’s wearing nothing but his skivvies and a t-shirt, being, or attempting to be, restrained by a well meaning staff member. This guy was giving her hell. He was trying to get up and she was trying to hold him to the bed. He’d go up and she’d push down. It was kinda comical watching it for a second because it looked like she was pushing the guy down onto a spring and he would just pop back up. To add to the humor of the occasion, every time she would push him down she’d say “Jim, stay still” or “Jim, please be still”. Well Jim wasn’t having any of this.

“What’s going on this morning?” I asked holding back a laugh.

“I think he’s having a heart attack or something”, she started. “He woke up while we were dressing Larry” she said motioning to a half-dressed man watching intently from across the room, “and just grabbed his chest…he started trying to get up but he just looked like he was in so much pain and I told him to just lay still and we’d get him to a doctor.”

“What kind of medical history does he have?”

The nurse behind me chimes in and says, “Well, he is retarded and he is a diabetic…we checked his sugar after we called ya’ll an it was 162.”

Retarded huh? Now, is that subjective or objective? C’mon lady…this ain’t my first rodeo, I’ve been in this place before.

“What’s he normally like…his personality…how does he interact?”

“Oh, he’s real nice. He don’t give us no problems at all…he just likes to help out and watch T.V.”, I’m told with a voice of utmost assurance.

I told the other staff member to let him go and I grabbed Jims left hand with mine. “Sit on up here big guy”, I said as I helped him to the edge of the bed. “What’s going on with ya this morning?” I asked trying to elicit a response.

Jim just sat there on the edge of the bed kind of rocking back and forth a little and looking around the room while chewing on his tongue it looked like. I noticed that he was breathing rather hard but attributed that to the ultra light-weight UFC match I had just witnessed. He wasn’t diaphoretic and really showed no signs of distress other than the fact he seemed to be a little agitated.

“Jim, are you hurting anywhere…anything not feeling good”, I asked with no response.

Jim stopped rocking and looked up at me with big ‘ol tired eyes and expelled a big huff of air. With strength I didn’t expect he stood up and stood still for a second as if he was getting his bearings about him.

He stepped off on his right foot and headed towards the door that leads to the hallway. “Where’re going there buddy?” I asked and followed behind holding to his arm.

Now I’m trying to get into his mind and figure out what’s going on. I’ll give him all the leeway he needs so as to not agitate him and try building some report’. What must he be thinking right now? He’s probably scared…or is he mad? Does he have a clue as to what’s going on?

Jim headed out the door, turned to the left and started down the hall. “Where’s the bathroom?”, I ask curiously.

“Right down there…at the end of the hall”, the nurse says

Jim moves on with a slow and steady gait, moving on past the curios looks and gazes of the other residents. Well, maybe we’re getting somewhere now I think to myself.
Ol’ Jim here just has to pee, pure and simple…but why isn’t he talking?

Just when I thought we were about to put and end to this call just by letting the guy go pee, he walks right past the bathroom door to the end of the hall. There is an old church style bench there against the wall that faces the direction we just came from and we head towards that. By his arm I lead him to the bench and ask him to sit down, he shrugs a little and flairs his elbows out a bit trying to shake us off. O’ boy!

I certainly didn’t want it to get this way but I just couldn’t let him wander around aimlessly after being told that his mental status is altered from normal. I need to figure out what’s going on; is this a stroke…was their glucometer off of something?

I finally get him to sit down and my partner/wife is getting a lancet and strip ready. I’m attempting to do a stroke assessment when out of nowhere this guys stomps his feet and flings his arms and lunges up at me with his head into my gut. Damn, that hurt. I can’t let this guy just get up and go running off at this point because something’s not right here. I put my forearm across the back of his neck and try to push him down to the bench he’s sitting on. This guy is strong and starts bucking like a wild bull or something, flailing his arms and stomping his feet. I can’t say for sure if he actually “hit” anybody but he was wearing me out just trying to restrain him.

Complicating the event even more was the insistent shrill voices of the staff pleading with Jim to “stop” and to “calm down”. They were making me want to have a fit.

While all this is going on I tell my partner to go ahead and try getting another glucose reading while I try and hold him still. You can just imagine the battle that ensued over that; I think she did end up getting hit in the process while pricking his finger.

Glucose level 147. Well hells bells…what is up with this guy?!? He finally manages to stand up and I just back off and tell everybody to just stand back for a minute. Then he just sits back down as if it’s all over.

I get my cell phone out so I can call the ER attending physician for orders for Haldol. One thing I know for sure; I want to get this guy evaluated and find out what’s going on. I don’t have a cell signal in the basement of this building and they don’t have a cordless phone either. So against my better judgment I run upstairs and outside to call the ER. I’m not too concerned for my wife’s safety at this point; we’ve got two teenage boys and I know what she’s capable of handling. That firery red hair packs a mean punch all by itself.

O.K., so there we have it. What do you think was going on here? What did I miss? What would you have done differently?

I am what I am...

2010-02-28T15:10:00.002-05:00

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.

What's in your wallet?

2010-02-21T10:35:00.005-05:00

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.

Strength in Unity

2010-02-19T12:00:00.004-05:00

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."

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

2010-02-17T09:48:00.013-05:00

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.

Sir, You have just committed a bloggable offence!

2010-02-16T08:35:00.005-05:00

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.

AND THEN!!

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.

Are we ready?

2010-02-13T09:46:00.004-05:00

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!

Charlie Foxtrot: Part Deux

2010-02-10T12:57:00.006-05:00

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?

Charlie Foxtrot

2010-02-04T00:37:00.007-05:00

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.....

I'll be right on over...

2010-02-02T10:40:00.002-05:00

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~~

On the Engine

2010-01-30T05:39:00.004-05:00

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.

And the ship starts to turn.....

2010-01-27T02:20:00.005-05:00

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!!

Still here....

2010-01-24T06:44:00.003-05:00

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!!

On Duty

2010-01-19T08:25:00.012-05:00

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.

Pleasantly Surprised

2010-01-16T08:48:00.007-05:00

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.

Don't Come Over Yet

2010-01-13T01:17:00.004-05:00

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.

A Little Friendly Competetion

2010-01-12T16:59:00.004-05:00

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.

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

2010-01-09T07:53:00.006-05:00

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.

Baby, It's cold outside....

2010-01-05T07:54:00.004-05:00

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!

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

2010-01-03T22:51:00.005-05:00

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

Flip the calendar

2010-01-01T01:16:00.004-05:00

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.

First Due Medic

2009-12-29T03:37:00.010-05:00

Identifiable names, numbers, and locations and been changed to protect the identity of the ones who my not want to be identified

I decided to wait a while before I recounted a call I ran on 18 Dec, primarily so that I could possibly share a good outcome. Unfortunately, this is not going to be the case. It’s rather troubling to me that this call had the outcome that it did, this in part because the one reason I do this work is to ensure the best possible quality of life for the people that I come in contact with.

It is my assumption that every person that is subjected to my care should benefit in a positive way from our encounter. Now we all know that this is not going to be the case every time. Life happens in a weird way sometimes and death does most certainly happen. Maybe it’s my glorified view of our chivalrous actions that makes me want for all that is good; for whatever reason. However, I’d like to hope that it’s just something engrained in my genetics that make me strive for the best for my fellow man, be it neighbor or stranger.

I had only been home from work for an hour or so the morning of 18 Dec. As is my custom, I left my pager on so that I could be available to lend a hand in the county volunteer system. The career side of my job doesn’t afford a lot of opportunity for a lot of EMS work outside of inter-facility transports, so I sort of have to stay involved at whatever level I can to stay sharp.

I was reading some blogs that I follow when my pager went off.

“CCom to Station 25…possible heart attack…caller is stopped at The Quick Store on 585 South…caller advised her husband started shaking and then slumped over, not sure if he is breathing…. CCom first page at 0959.”

The first thing that registered in my mind was that the person dialing 911 had stopped at a convenience store that was right below my house. If it were not for the trees, I may be able to see the store from my front porch. It was close and I was already on my way out the door before the dispatch was over.

Unfortunately there was only one person at the station at that time and they were in the process of requesting an EMT or a driver for the call as I started my vehicle. This was wasting precious time as I waited for the request for additional personnel to finish paging out so I could mark up>

“CCom this is 172” I radioed backing out of the driveway.

“172”, dispatch replied.

“I’ll be responding POV, have Station 25 roll a truck and meet me on scene”, I advised.

“Station 25 did you copy 172?”

“10-4 CCom, we’ll have a truck in route momentarily” came the standard reply for acknowledging a call.

I couldn't’t help but think of all the possible heart attack calls that we get on a weekly basis in our county. A call that we take so seriously, dropping everything to rush to the scene to start definitive care, only to find somebody who would be better served by a cab company. To top it all off, how many unresponsive calls do we get that end up being a patient refusal of service when we get on scene? There had been a few recently and I couldn't’t help but think that this be just another one of those type of calls as I pulled into the parking lot of the store.

“CCom to 172”, dispatch called over the radio.

“172”

“Caller advised she’ll be standing by in a red cavalier”, I was told.

“10-4, I’m on scene…I’ll be making contact in a second”, I said as I got out of my vehicle.

I zipped my hi-vis jacket and holstered my portable radio while I made my way across the parking lot to the red vehicle parked cock-eyed in front of the store. It was about this time that I heard the truck signing enroute from the station, thankfully they were no more than five minutes away if it turned out to be something. There was an older lady standing inside the passenger side of the red car talking loudly to a man inside the car and shaking him trying to get a response. She was visibly upset and started recounting the events in an excited fashion leading to her calling 911 as I approached.

“Hi, my name is Gate, I’m a Medic here in Horry County….calm down and tell me again what happened…slowly”, I told her as I reached in to shake the gentleman who was slumped forward in the passenger seat of the car. He was held back only by the seat belt that ran across his chest.

“We was coming to Millville to see my grand-daughter…about the time we crossed the county line he started having trouble breathing and he told me he didn’t feel right”, she told me in as calm a voice as possible. I shook the man by his shoulder and got no response, so I did a light sternum rub; nothing. Placed my hand flat on his chest to chest for rise and fall; nothing.

“Then when we was coming through the curves back there, he just started shaking and just fell over against the window”, she continued.

I grabbed his right wrist to check for a radial pulse while checking for a carotid with my other hand; again, nothing. All the while during my assessment the lady who turned out to be his wife, continued on with her recounting of the events leading up to this point. For all the important information that she may have been giving at this point, I was not listening; I was zeroed in on the fact that this man was or had been clinically dead for less than five minutes by now.

“172 to 2510”, I said into my lapel mic.

“2510, go ahead”, the driver replied.

“Step it up, I need you here five minutes ago”, I said with some urgency in my voice.

“10-4, we’re about two minutes out”.

“CCom this is 172…this will be a working code blue”, I advised them.

Reaching inside the car and unhooking the seat belt, I worked my left arm in behind his back and then placed my right hand under his right armpit. With one swift motion I lifted and pulled at the same time pulling my now patient free from the car. It was then that I noticed a small crowd had gathered, some realizing that something was wrong. I placed the man on the cold asphalt parking lot and again quickly checked for any signs of breathing and a pulse; again, nothing.

I located my landmarks on the patient’s chest and placed the heel of my left hand on his sternum covered by my other hand. The guy had some drool coming out of the corner his mouth I noticed. It was then that the germaphobe in me welled up and called for passive air flow. I was really thankful for the knowledge that the body has about 15-20 minutes of oxygen in reserves at the cellular level and that inter-thoracic pressure would move enough air passively to sustain efforts for a few minutes. I started to compress the chest of the man who obviously was in cardio-pulmonary arrest. 1 & 2 & 3 & 4 &…….I counted out loud.

“OOOOOOOooooo NOOOOOOOOoooooo”, came a painful wail from behind me. I didn’t stop to look around, but I could only assume it came from his wife.
“Is something wrong with him?” an innocent and obviously uninformed bystander asked from beside me.

“Yeah… he’s kinda dead right now”, I said before I could catch myself. I’ve always had a problem with stupid questions, and this was certainly one that qualified as stupid, but the answer was purely instinctual.

I was really getting some good compressions in when I noticed the potential for some head trauma. Every time I would compress, his head would come up off the ground and then hit the ground when I released. Realizing this was not a good thing in general, I also realized that there were people watching. Amazingly enough though, not the first person stepped up and identified themselves as a CNA who works at the nursing home, nobody said “I know CPR, need some help”. They were all just watching the big guy lunging into the little guys’ chest….maybe they were transfixed by my high-vis jacket, I don’t know. Anyway, I went to one handed CPR so I could use my other hand to cradle his head and keep him from getting a subdural hematoma.

Enter our local volunteer heroes. The ambulance can be heard coming down the road for miles thanks to the piercing wail of a Wheelen siren through 200w speakers. As the truck entered the parking lot at mach II, siren still wailing and bumper smacking the ground, dragging on the way in; I wasn’t too sure how this was going to go from here on out.

The driver of the truck, an EMT that we’ll just call Fred, comes huffing over to where I am empty handed and asks, “What do you need?” Now I know we’re a long ways out from national standards of training yet, but BLS skills are pretty much the same world over. We’ve got a working code, common sense says that the next thing we are going to need is a BVM and ….. a monitor/defibrillator. Instead of wasting my time having to recite protocols and bring everyone up to speed, I just tell him to get me a stretcher, which he dutifully retrieves. Over the radio I now hear our radio hog who also serves as the band-aid purchasing agent for the rescue squad signing on scene. The next thing that puzzles me to this day is why the next thing out of his mouth is him advising dispatch that we have a working code and we’re going to need ALS. However, there are some things I try not to think about only because it hurts so much.

With the patient now on the stretcher and moving toward the truck, I run ahead and get the LifePak 12 and I.V. set up. With the stretcher now entering the truck, I apply the quick patches and switch the monitor on and set the leads. Now let me state this before continuing on any further; I absolutely despise the quick patches. I think every truck should have paddles on their monitors…I digress. With the monitor now I on and CPR stopped, I immediately recognise V-Fib. "Charging…all clear"…ZAP!...and CPR continues. I did finally take an opportunity to insert an OPA at this point, place a pillow under his shoulders and give a couple good breaths with the BVM w/ O2.

Now let’s talk about CPR for a minute here. Well, rather who is doing CPR. Fred is a 5’6” 350lb man who wears nothing but sweat pants and t-shirts at any given time of the year. He is also known as the guy who has more belly to cover up than T-shirt to accomplish the job. Now Fred is giving it all he can with CPR, more than once exclaiming how hard it is to do this. Needless to say, I’m not really concerned how tiring it is, just do it and do it right. Band-aid purchasing agent is standing at the side door in spectating mode just enjoying the show. I would have much rather had him in the back; not too bright a kid, but he was a former Army guy and he was fit. There would be no chance of him coding too from doing CPR; but Fred said he had this covered.

Checking the patients’ arms, I quickly realize he is going to be a tough stick, but I notice he’s got some nice jugs.

“Trendelenburg, Fred!”, I say

“Huh”, came his reply accompanied with a bewildered look befitting his appearance.

“Put his feet up…raise the foot of the stretcher”, I clarify

“Oh...O.K., that’s what I thought you meant”, he said refusing to concede he didn’t have a clue.

I inserted an 18 gauge needle in the right external jug getting immediate flash, following with a flush and starting a line of normal saline fluid. Turning to my left to grab the drug box I notice Band-Aid purchasing agent still standing there watching all the festivities.

“Code 3 please, no lights…no siren. Nice and smooth”, I tell him. He quickly slams the side door shut and runs to the front of the truck and jumps into the driver’s seat. In no time flat we lurch into motion as me and Fred continue our battle with death.

With 5cc’s of Epinephrine drawn up in a multi-dose syringe, I go ahead and push 1mg and flush the line. In between all this I’m trying my best to oxygenate the patient. Thankfully his neck being hyper extended was doing the trick. As I’m getting a pre-fill of Lidocaine I notice we are closing in on our second set of two minutes of CPR.

“Hold CPR” I say to the only person doing CPR. A quick glance at the monitor tells me it’s time to defibrillate again to knock out this V-Fib.

“Charging…ALL CLER"...ZAP!!..."continue CPR”, I say, and then give a few good breaths with the BVM. By this time we’re starting to get some gastric backflow and I decide to chance an intubation. I glance up at Fred and felt sorry for the poor guy. He looked like he could just lay down on the stretcher with the patient and die right there. He was now getting to the point where chest compressions were just intermittent and circulation and perfusion was just wishful thinking. The intubation was unsuccessful partially due to the crap I had spread around the head of the stretcher keeping me from getting all the way down to head level.

I needed to get a round of Ladocaine in and quick so I urged him, “Hard and fast there Fred, you’re his heart now!” Just as I had assembled the Ladocaine pre-fill in true Johnny Gage fashion, Fred was taking another break from doing CPR and I looked at the monitor and saw an organized rhythm. Shocked at this but pleased, I checked for pulses; none. PEA I can work with, so I psyched Fred up some more by telling him, “Keep at it Fred, you’re doing it ‘ol man…we’ve almost got him back…stay to it!”

Back to work Fred went pumping for all he was worth and sweating like a logging mule in July. I hit our pt with another 1mg of Epinephrine, continued to ventilate and suction the airway as best as I could manage all the while getting the Atropine ready. One milligram Atropine in and by this time we were about one minute from the ER pad. Just for good measure I gave another round of Epi as we were getting everything together to go into the ER.

Once inside I give my report to the attending physician and they continue resuscitative efforts. After about ten minutes of multiple drugs and one more shock, he is now intubated and on a ventilator; they bring out the doppler to listen for a pulse. First there is the loud screeching rubbing sound, the room fell silent, then the faint sound of blood perfusing and the artery expanding and contracting….music to our ears!!

“Get me a pressure”, the doc says.

After a minute, “167/95”, came the reply.

By golly we had done it!! I went out to the squad room to get started on my paperwork, which would take the next 45 minutes. That would be followed by exchanging the drug boxes at the pharmacy to get us back in service.

By the time we left, the patient was in the cath lab. I was so excited I could barely stand it. Everybody wants a save, but now came my real worries. What quality of life would he have past this point? Only time would tell. I decided then that I would follow his route to possible recovery. My hopes for his full recovery were bolstered even further later that day when I received a call from the hospital. My patient had been taken to ICU and was on a vent.

I went by to see him only once after that. The nurse in ICU told me that his diagnosis was alcohol induced myocardial myopathy, so I guess that explains the flask in his jacket pocket. They said he had very minimal neurological response and again only time would tell. Another factor not in his favor was the 5-10 percent cardiac ejection fraction.

Fast forward eleven days. I find out today that that he has been moved to a long term care facility where he will most likely live out his days in a vegetative state due to hypoxic brain damage. I now question myself over everything done during the call. Was everything done perfectly? No. Could we have done some things differently? Absolutely. This will be another learning experience where I will never again wait until I get to the truck to start care; care starts at contact and transport comes after stabilization.

I’ve been assured by the attending physician and trusted co-workers in the field that whatever damage he suffered started before I got there and my job was to keep it from becoming worse. I worked with what I had available. In a perfect world or even in the ER his chances may have only been marginally better.

With this being my first “save”, I am more frustrated than ever because of the outcome. I can’t help but feel that this guy and his family would be better off if he would have died; but I’m not the one that makes that call. I do my job because that’s who I am, and I work with what I’ve got.

Gonna take it to the world

2009-12-26T17:08:00.002-05:00

I just received a phone call a while ago from a trusted friend about a hair-brained idea he and another friend had. Looks like I'm going to be involved in a stream cast. With all the possibilities now days to broadcast yourself to the world, I guess it wasn't too long coming for me to jump on the bandwagon. It looks like there is a project in the works called Ask the Medic. Pretty clever title I guess, but nobody ever listens to the medic, and we certainly don't listen to each other. Now let me be clear about this, I am on board with this idea 100%, but I have some reservations.

Anybody who has been around the EMS/Public Safety scene for any length of time knows the EMS community is a hard nosed crowd to be around. We are, or can be the most cinical and critical of other providers skills, tactics and interpretations. I'm not really sure what the whole platform will be about with this production and I surely hope I don't develop the idea that this is going to change the world. It may. But so far other like "shows" and/or podcast haven't changed the world, but they are starting to roll the tide.

From what I understand there is going to be some humor to all this with my segment called "Ronnie's Raging Rants".....trust me folks, I'm good at it. If there's something that deserves a little rightous indignation; I'm on it! There will be some teaching and critiquing I'm sure, but most importantly of all, an opportunity to put a light on our own EMS system as it continues to develop. Maybe an opportunity to do some real in-depth interviews with local influences and a little research will avail itself.

Whatever may happen with this, I hope... no I'm sure, it will be for the good and betterment of EMS. A little tongue-in-cheek humor will no doubt will emerge and maybe even some issues that deserve a few minutes in the spotlight will get the attention they deserve...or warrant(pun intended).

If you've done this kind of thing yourself, let me know how it went for you. Give us some suggestions, ask questions and have a good laugh at our expense, we won't mind a bit.

As soon as I have more details I will post them here and on Facebook.

Until next time....Medic Up!!

Just not christmas

2009-12-25T14:52:00.007-05:00

I feel bad for this, I really do! But for some reason, it just doesn't seem to be the same christmas that I knew when I was younger. It seems that christmas has been hijacked by commercialism and "It's OUR day christians". Everybody has an opinion about what to leave "in" christmas and what to take "out". It seems to me that christmas is now about what everyone else wants it to be about.

I really could not even get into the giving spirit this year just because of the lives of a certain segment of our community. There are so many who have lost jobs this year and are having a really rough time finding work. Naturally, they will have to prioritize and I'm sure there are plenty of kids who will do without to a certain degree. I've been into people's homes and seen the meagerness of their holidays, and it doesn't strike me as being a festive season. Although we have been blessed this year with steady employment and a fairly stable budget, there are those who haven't and I am no better than they are. I haven't chosen to join them per say, but only to deny myself the self-imposed obligation to get people a gift on one particular day of the year when I otherwise would not on any other day.

I simply chose not to go crazy this year. I personally spent less than $100 on gifts; my wife, well that's another story. But, the kids were surprised with some things and genuinely happy with others.

Tonight I will go to work, and will probably go into a home and see that someone else had a meager christmas as well. I will still wish that their circumstances were better, but I will not feel the guilt that would be associated with my extravagance.

Who's Training Who?

2009-12-17T22:23:00.005-05:00

The one thing I take pride in is the amount of training that I have subjected myself to in order to get to where I am in my career. Granted, I'm not there yet and hope to never really get "there". I hope to be a lifelong learner and change with the times and advancements in the industry. More than the training is the amount of time my family has had to sacrifice, well, not being a family.

As of right now I'm on the last leg of becoming a National Registered Paramedic...four more months!! Luckily, I live in a state that has a level of certification that pretty much mirrors the Paramedic protocols as far as skill sets are concerned. It's nice to be taught at a Paramedic level and tested at that level and then given a year to work in the field learning and getting your street smarts in. I've been blessed to have been trained by a man who takes his job seriously and has a lot of pride in his program. He is a stickler for doing things right and having integrity and good moral character, and he tries his darndest to instill those values in his students. We are drilled hard on ACLS protocols, proper procedures and honesty is demanded when doing field and hospital clinicals. Over the past year and a half, these same values have been passed on to me and a few other in my class....some will remain true to their belief that a certification is all they need to make life good for them. I beg to differ.

What bothers me is that there are some agencies that will trump their professionalism just because they provide a career staff. They trump even louder because they require their employees to submit to mandatory bi-weekly "training"...well, some of the employees anyway. My eyes were opened the other day at a training session where we were supposed to do our quarterly skills check offs that are required to maintain an active certification. At this particular station was an EMT-Enhanced provider who was going to show us how to do an intraosious needle insertion. Now, let me explain this, an Enhanced in Virginia is much like an Intermediate in the rest of the country. They can do I.V's, D50, Albuterol, Epi during a code and not much else. In Virginia, an Intermediate can do just about anything a medic can do...some things we have to call for orders on, i.e. Dopamine ect. This guy in all his infinite wisdom proceeded to tell us that all we had to do was just locate the knee cap, come down a finger width under the knee cap...and drill. No Indications, contraindications and lets not overlook the fact that what was described was NOT the location to insert an I.O. needle. In this group was myself, another EMT-I and a Paramedic who CAN do this procedure being told wrong how to do something that he can NOT do in the field!! This insult to our combined years of training was further exacerbated when he began to instruct an EMT-B how to start an I.V.....inappropriatly again. Why was this individual assigned this task you might be asking. I can only assume it's because he has been in the "business" for about seven years and has garnered some favoritism as a reward for his loyalty; I really just don't know!

There has got to be a dividing line somewhere, and I'm just not sure where it is. If only all the talk of our company being the best were true. Sure, it all sounds good on paper and when giving a sales pitch, but when the rubber meets the road, it's all white-wash and fluff. The saddest part of it all is that there is no oversight of training and enforcement of state rules and regs are spotty at best. Most if not all or this validation is left up to the individual agency and leads to nothing more than the fox guarding the hen house. I do wonder though if this kind of stuff "happens everywhere"? Is it like this in a municipal service where there is supposed to be an established hierarchy that is qualified to teach, train and/or instruct?

If we are going to have anything, let's at least have some integrity. For all the profitability and good public relations that we would strive for, there is nothing more important than maintaining a level of professionalism that can not be questioned by anyone, whether it be internal or external. This leaves me in a state of frustration as I try to figure out how this situation can be fixed. I do realize that it didn't get this way overnight and it certainly will not be fixed by next week. What is even more frustrating, is that I am just a lowly field provider somewhere near the bottom of the totum pole. I have the ear of some, but their hands are politically tied and they are limited in their reactions.

But this I promise to those who will come after me and who are now working beside me...I will continue to stay abreast of the latest developments in pre-hospital and advanced medical care. I will honor those who have come before me by staying true to the skills they have developed and perfected through the years. I will with all that is in me protect the interest of the patient first, foremost and above all else. I will promote patient advocacy in any public forum in which I represent professional pre-hospital care. In all that I do I will...DO NO HARM.

The Birth of a System

2009-12-05T15:32:00.008-05:00

Over the past month I have followed the happenings between two Paramedics who live and work 8,000 miles apart. I don't exactly recall how I stumbled onto their story, nor does it really matter...I'm just truly thankful that I did. Here's their story in a nutshell, Justin is a Firefighter/Paramedic in San Francisco, Ca and then there is Mark who is a Paramedic in the UK. Both have an affection for their respective jobs that rivals anything that I have ever seen here in my little section of southcentral Virginia. What I first noticed was that they were both thinkers; not a bunch of grippers. They went a lot deeper into their jobs than just protocols and shift schedules, but about important things like the health care system as a whole and how we as pre-hospital providers fit into this health care system.

Enter The Chronicles of EMS. This project was developed to be the beginning of an exchange of ideas and to provide an up-close and personal view of EMS. To make a long story short; Mark comes to the U.S. to work for a week or so and Justin goes to the U.K. to do the same. Both are now able to write about their experiences and share different viewpoints from each others respective jobs. This has allowed not only me, but thousands of others to have the opportunity to share a second hand experience that can challenge our ways of thinking about how we do our jobs.

After stumbling around related blogs and looking up protocols from other countries, I happen upon Garth Van Zyl who hails from Franschhoek, Western Cape in beautiful South Africa. Now this guy is the real deal as he is in the true beginning stages of building an EMS system and shares his thoughts in his blog . I'll leave it up to you to visit his website and read his story and inspiration, but turns out he is THE system for his community.

It is events and happenings like this that give me hope for a bright future in EMS. I live in a part of the country that is strong with the volunteer spirit. There's nothing more noble than to set aside your personal time, or your own life for that matter, and give for the benefit of your neighbour or a stranger in need.

For one to think that this way of giving to the community can remain the chivalrous act that it has been forever is naive. I have unfortunately seen some changes in the past three years in my county that should be raising red flags. These changes in attitudes, personalities, and methods of operation have caused me to to become an outspoken advocate for a change that will hopefully take us in the direction of becoming a true profession. I am not saying that volunteerism should go by the wayside! But there has got to be accountability for the actions or lack thereof when the system gets a "flat tire".

I do believe that the downfall of pre-hospital care began a downward trend when it started being seen as a money making opportunity. ANY agency that has their eye on the bottom line will not make decisions that are beneficial to the patient or the community, unless proper safeguards are in place to advocate for the provision of service.

Well, I did get of on a little tangent there didn't I? As I have stated before, I am optimistic that change and good things are on the way worldwide for EMS and/or pre-hospital care. This change will not come as a result of copious blogs and gripping around the station or even gripping at business meetings. Change will have to first start in ME and YOU! And when WE decide to band together and do what is right for the community and the citizens , and demand the same professionalism from those we work with, then and only then will change happen.

I titled this section The Birth of a System for one reason. I see a new way of thinking starting to emerge around the world. This way of thinking is going to cause some labour pains, but a birth is immanent and will be worth the pain in the long run.

Stay strong and focused my friends! We're almost there!!

It's not what it was dispatched as!!

2009-11-28T09:43:00.003-05:00

This is a response to a local managed care facility, dispatched as a person experiencing difficulty breathing.....below is the reason why. The patient was having an AMI covered up by the SVT; not good.

She was an 83yo lady having "difficulty breathing", and she was, w/ upper resp. "grunting", bases=rales...NRB to replace 2L/NC she was on. Pulses= absent perf. and thready carotid...to say the least she was symptomatic.

Due to proximity to ER (-5min) I didn't waste a lot of time w/ I.V. and/or meds because her veins were so depleted. Just to be doing something enroute to the ER I do a quick EKG because she has a history of bradycardia. Turn it on and...THIS!! By this time, we're less than 2mins out and I had no time for Adenosine or time to cardiovert. It was probably for the best that I didn't have time to do either one for this patient, because with this presentation all the squiggly lines might have straightened right out. Pt has a DNR and expires 10min after arrival at ER.

My lesson was this. Regardless of time, I have at my disposal the same initial tools that the ER is going to utilize when I do get there. So as it should be, the ER is brought to the patient for one on one care. The ER may have one MD and four nurses for twenty patients.....I am their best bet.

Take the time to diagnose and begin interventions as soon as you realize something is not as it should be. After all, that is the reason we do this job.

Thankless Giving

2009-11-25T22:34:00.000-05:00

There are moments when we must ask ourselves why we do this job. I am grateful that these times of true evaluation are few and far between. I'm not sure if it's my type "A" personality that allows me to to enter a chaotic situation and try to instill some order. Or, is it my underlying belief that each and every one of us have a duty to their fellow man and neighbour to be of assistance in their time of need. Whatever the reason, this I know to be true, death and I must come to an understanding and develop a better working relationship. Death is more powerful than I alone or in the company of the greatest physicians in the world will ever be. Death has more tools and ammunition available than the meager supply of medications, algorithms, and quick wit that I have. While I will never agree with the job that death must do, I do question the method in which it must be carried out sometimes.

Tonight I heard the cries of anguish from a mother who watched life cease for her 12 yer old son. For all the begging and pleading with her god, it was to no avail. I don't know what could have happened in the hours leading up to the time when he decided that putting a cord around his neck and hanging himself seemed to be better than his circumstance. Was it sadness? Was it anger? Loneliness? Frustration? What could have been so bad that this young boy on the brink of manhood would side with the opposing side and concede defeat? I wonder if he heard his mothers wailing and sobs as the final neurons in his brain ran out of fuel. Did he feel the pain of chest compressions and defibrillation? Was this the finality as he imagined it would be? Were his questions about life and death revealed in his final moments?

I have no doubt that through out the coming days and weeks that his mother will be asking the same questions. These are some of the questions that will remain unanswered for a lifetime. Tonight I grieved with this mother, as did all those around and within the sound of her cries. Some choked back emotion and continued about their work while I, and others removed ourselves from the environment to quietly reflect on our own lives and to shed tears with and for the mother.

In a twist of true irony, I was less than a half mile from this young boys house having dinner with my fellow crew members when he made his final decision. About that time a family was getting up from their table to leave when the husband stopped just past our table, took a few steps back and said, "I just want to say thank you for what y'all do, not just because tomorrow's Thanksgiving, but we really appreciate it". With the utmost in humility we returned the thanks for his generosity and kind words. All the while just up the road, a group of seasoned medics and firefighters waged war with a ruthless thief.

Death, my adversary, and I will continue doing our jobs to the best of our ability. With all that is in me I will fight against it's efforts and effects. I only hope that in time I will come to understand the meaning of its existence. Until then, we coexist, with purpose and passions that only the giver of life will ever understand. I, and others, will continue to give. We will give our all with or without thanks or public recognition. Only because that is what we were made to be; givers.

Not soon enough

2009-11-23T14:34:00.000-05:00

Today they are holding a funeral for a lady that didn't get to fulfill her final dinner plans. It almost seems inappropriate that it's cold, raining and just plain miserable outside today. This lady and I had never met before 20 Nov '09 that I'm aware of. It's quite possible that we'd passed in Wal-Mart or at Kroger grocery shopping. As far as I know, her family had never known or met me before that day. But on that Friday I became a part of that families memory of a mother, a wife, a sister, an aunt, neighbour....and I'm sure the list goes on.

I wasn't even supposed to be on shift that day. I work night shift; graveyard if you will. I was just doing a favor to fill in for personnel shortage. My partner was a new guy that I had just shook hands with earlier that morning, I didn't even know the guys last name at this point. He was a career firefighter in a neighbouring city and an EMT in his own right, but he was a hose monkey through and through. And he liked to talk....A LOT. He had a line of questions that would rattle off like a Gatling gun not even waiting for a complete answer before firing the next. Needless to say, he had gotten on my nerves already in our short acquaintance since I'm not a big talker myself.

We had just gotten cancelled from a call for a volunteer agency in the county so I stopped at one of the out-lying stations to hit the john. This was more of an opportunity to waste a little time before heading back to our main station, since it's somewhere I don't particularly like to be during the day. So there we were headed back across town. We were sitting at a traffic light at a pretty big intersection; I was on the phone with the Paramedic course director at the local college when it started.

"Base to 12"

"Hang on a sec Jay.....12"

"Respond to 350 Woodlawn...subject unconscious"

"Responding...any further information?"

"Negative"

"Just great", I think to my self as I turned on the lights, gave a few "whoops" with the sirene and started to ease across four lanes of traffic to make a left hand turn. The good news is that we were in a great spot for this to occur, less that three miles from location and a straight shot with only two turns....five or six minutes out, tops. I had a pretty good idea where the road was so I hit it kinda hard getting there.

We arrive on location and backed into the driveway. Approaching the house I notice it is a modest brick home in a well kept neighbourhood, nice cars in the drive. "Might be something to this one" I think out loud approaching the side door. Usually when you get a call to a house like this one, it's a legitimate call.

"EMS", I announce as I knock on the door.

Through the door I see an older man coming across what must have been the den talking on a cordless phone kind of anxiously. Nothing too weird with that except he was only wearing a pair of red and white stripped boxers and his glasses. Yep...defiantly not good.

"I think she's left us...she's in here", he leads the way to a very normal looking kitchen, not so much clutterer, but used. My first impression when seeing the patient was not a good one. Her head was laying against the corner of a stainless steel stove, she lay in between that and a kitchen table. I didn't see any blood pooling under her head and was very thankful for that. The husband told me that he was downstairs getting dressed, they were going out for dinner, when he heard a loud thud from upstairs. He called out to her and got no response so he came upstairs and found her like this.

No pulses, no voluntary respiratory efforts. Not good. I tell my partner to get me the ZOLL, IV and drug box. I radio in to the county dispatch center that CPR is in progress. It is then, and only then that they decide to dispatch an engine company for first response and manpower, better late than never I guess. I give a couple of breaths with the BVM and start compressions, painfully aware that the husband is directly behind me watching this saga unfold. All the while he is on the phone giving a play by play to whoever it is he's talking to about my efforts.

My partner re-emerges with the requested equipment with-in two minutes. Drug box in one hand, monitor in the other and IV box tucked neatly under his arm. I was pretty impressed by this actually, until he spoke.

"Want me to start a line?" he asks.

"Can you do that?" I replied with a quizzical tone in my voice. I thought he was at least an EMT, if he was higher trained it would have been nice to know by now.

"Well, I mean...do you want me to set it up"

"Absolutely...after we get the pads on...post haste". I'm sure he didn't know it at the time, but this is my way of saying hurry it up and get it in order.

I'm doing some pretty good CPR while he tears into a shinny pack of defib pads all the while fumbling with wires and cords. He's got the defib pads in his hands and tracing a cord to find the end. I quickly realize thet the cord he is tracing is the power cord that didn't get unplugged from the back of the monitor. I direct him to the rear pocket and tell him to put the two red ends together. Done. I cut the lady's sweater and bra while he applies the pads. Monitor on...pads....analyze...hot damn, course Vfib! We've got a fighting chance here I think to myself as I tune up 200 joules and push the charge button.

"ALL CLEAR!" Zap

I continue CPR while man-child is going to 'start me a line'. The next time I look up he has a lock and a pre-fill in his hands looking at them like he had just gotten bit or something.

"Which end goes on the tube?" he asks so innocently. Maybe they're not used to the needless system in Pitt county, but he ain't got a clue as to how this is supposed to work. I ask him to take over CPR while I get the stuff set up. Instead of coming over to the side where I am and taking over, he starts pumping where I need to be. Now I've got to crawl over him to get to the IV and drug boxes. Equipment assembled and in hand, I crawl back over the mountain of EMT that is my partner to start the IV.

"Hard and fast" I remind him. He had obviously taken a CPR course from TV due to his weak symbolic efforts.

I'm quite impressed that I can see a pipeline of a vein screaming for an 18ga, and get it without having to chase and fish. She's patent, 1mg epinephrine in. Analyze, and its still Vfib...charge..."ALL CLEAR!"...zap.

By this time the first responders have arrived and boy am I glad to see them. They bring in a back board and the stretcher from our truck without even asking what we needed. One guy was on his game that day and I was so glad that he took over extrication at that point.

"Don't worry about the spider straps...get her on and get her out...one man on each corner", he instructs this newly assembled mass of eager helpers. This frees me up to get the drug box and monitor out to the truck and set up while they extricate.

I lost track of the husband during all the rush and didn't really notice it was him standing at the back doors, now fully dressed, as they brought his wife out and loaded the stretcher in the truck. He stood there, watching strangers doing things to his wife that must have seemed so brutal and barbaric to the average person. I only hoped that he realized we were doing everything by the book for her. I felt sorry for him as I put aside the thought of my own wife and how I would feel if our roles were reversed.

Out of all the people that show up to help, I end up with ONE in the back of the truck. She's a pretty seasoned Enhanced provider so at least the patient will get adequate CPR. Hose Monkey jumps in the drivers seat and we're at warp six in no time flat. After all the cables are hooked back up, a quick glance at the monitor and we've got an organized rhythm! If only we should be so lucky I think to myself. No pulses, carotid or radial. DAMN...PEA!!

I delve into the drug box and grab the atropine, flipping the pre-fill and injector caps in true Johnny Gage fashion and push it followed by a flush. I then try to pull up a multidose of epinephrine but that requires two hands. At this point I'm thinking maybe I could ride the mechanical bull at Arizona Petes or do some west coast surfing the way this guy is driving. Forget trying to intubate with all this action, so I sink a combitube just to secure an airway. I wish I had time to do this before, but the OPA we had was working. Then the truck comes to a near screeching halt and I hear from the front "Do I got right or left". For the love of god, can this get any more dysfunctional!

"To the right, Hero" I say as I peek out the front realizing the hospital is now in sight. It is only then that I realize he had missed the turn that would have taken us directly to the hospital. But if he would have made that turn, we would have missed all the stop lights and turns.

"Did you call in a code?" I ask.

"Do what?" he asks like I had just asked to borrow a hundred dollars.

It was only as we were wheeling into the trauma room that I realized he finally did call it in...as we were pulling onto the pad. Nurses were scrambling and no doctor in sight, but we continue to do our job.

We worked this lady for 45mins, and it was a long, grueling 45 mins that ran a full gamut of emotions. I'm not entirely sure what made this lady collapse and I may never know. But what I do know is that we got there as quick as we could and worked through a cluster of problems, but in the end our efforts were futile. Her husband had said his last I love you, the last goodbye and had their last dinner by himself. The sobs of a greiving husband is a sound I will never get used to, because I painfully realize that I too one day may be one.

Later that night my wife and I went out for dinner with the kids. Dinner had a special meaning for me as I greived silently for this man and his wife that I had never met.

The Few....The Proud

2009-11-09T10:50:00.001-05:00

Why The Gate Keeper? Because I...we need to be, and you probably agree! Unfortunatly we are in a day and age where someone has to be the one willing to stand up for what is right. There seem to be too many who are wiling to circumvent the rules, regulations and the standards that are set forth to dictate what is right and or decent.

In my profession there is a great divide between the true professionals and the wish-we-were professional paramedics. Granted, we're not doctors, but we know just enough to work independantly of medical oversight and provide a favorable outcome for the patient. This is what sets us apart from the rest of the health care professions. With this responsibility woven into the mantel that we wear, one would think that we would have at least half the respect of a real doctor. But due to the abuse of the priviledges and courtisies afforded us, disregard and lack of adherance to a code of ethics, we continue to relegate ourselves to that of a bastard child of the allied health care system.

In this blog I hope to teach myself to be more forgiving of others as they grow and become well rounded in their art and skills. It is too easy to be hyper-critical due to the inconsistancies of the respective systems throughout the United States and even the world. From my daily routines in EMS, whether it be on the career side or volunteer, I hope provide a more clear picture of the evolution that is taking us from good samaritians to that of a respected professional health care provider.