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Look for the Helpers

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“When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. You will always find people who are helping.”

― Fred Rogers

I was planning on writing a happy piece this holiday season. It would have been about family, togetherness, hope, and all of the things the holidays are supposed to truly mean. While I celebrate Christmas at my home, I was planning on speaking of other peoples’ traditions as well. I wanted to tell everyone to have a Merry Christmas or a Happy Hanukkah, and I would have given other appropriate seasonal salutations to those who may celebrate different traditions. This piece was supposed to be about the happy, good things that this time of year is supposed to represent to us all.

And it still is, actually.

The above quote from Mr. Fred Rogers is absolutely appropriate right now. With the recent horrific events that have unfolded in our local area and the nation in the last two weeks it is important to be reminded of the good things that we’re supposed to remember during this season. Mr. Rogers's quote helps us bring that back into perspective. We will always see reminders of the fact that bad things will happen to good people and I fear that we will always struggle with trying to find the reason why. Truthfully, the fact that bad things happen is the reason EMS people have something to do. If bad things never happened then we wouldn’t need paramedics, EMTs, Firefighters, Police Officers, or the military. If bad things never happened, we could go about our lives in relative peace.

And as unfortunate as it is, the fact that bad things happen is a truth of the human condition.

If bad things never happened to good people we wouldn’t be able to see the other side of tragedy. We wouldn’t see the helpers. If bad things never happened we wouldn’t be exposed to the most powerful aspects of humanity. We wouldn’t see compassion. We wouldn’t see heroism. If bad things never happened we couldn’t experience how people come together for good and cause real good to happen in this world. If bad things never happened we wouldn’t see the true power of the human spirit. We wouldn’t see the good if we didn’t experience the evil.

If you listen to an emergency radio you will hear a constant drum beat of bad things happening. You will hear about crimes, about fires, about accidents and injuries, and of people becoming ill. It is incessant and unrelenting in most communities and those of us in the public service know that bad things happen at a rate much higher than what most members of the public allow themselves to believe. It can be quite easy to think that the bad is winning if you listen to the radio long enough. I counter, however, that for every bad thing you hear on the radio you also hear a miraculous fact shortly thereafter. You hear a response. The good answers the bad. You hear someone helping. You hear the fact that someone has decided to charge into the situation to do as much good as they can within a system that our society has built upon intention of helping and doing good. The bad is immediately met by the good.

My favorite quote by Kurt Vonnegut goes “I can think of no more stirring symbol of man’s humanity to man than a fire engine.” I like it because he trumpets the fact that our society has decided to spend money, effort, and time to help those in need. A fire engine doesn’t judge who it helps, it just helps as it is asked. Firefighters, EMS people, and law enforcement people don’t judge either. We were all called to be helpers and we stand in the company of heroes from all walks of life.

Look around you at your fire station, police station, ambulance base, hospital, or wherever it is you work. Look at your coworkers or your fellow volunteers. When you look at them, realize that you are in the company of a group of people who would risk their lives to help a stranger. Remember that these kinds of people exist in this world. Remember that there are more good people than there are bad people and that there are more helpers in the world than there are those who would seek to cause harm. Remember that good is actually winning, will continue to win, and has already won.

This week as we mourn those lost in the recent shooting incidents, the tragic crash of the REACT helicopter, and all of the other bad things that have happened we need to celebrate those who are the helpers. Celebrate the heroes and the good that comes out of the bad. Celebrate the lives of the helpers who were lost. Celebrate and carry on with their spirit of helping.

This piece really is about what the holidays represent. Hug your children, hug your families, help those in need, celebrate the good in your life and remember what life is truly about. God bless the helpers. God bless the good in life and the fact that there is so much of it to see when we open our eyes. The bad may be shocking, but the good is much more powerful.

Merry Christmas.

Posted by on December 16, 2012 • Filed under: Emergency Medical Services, emotions, EMS, EMS Motivation, EMS Topics, EMT, Fire Rescue Topics, Major Incidents, Mass Casualty Incident, Paramedic, Uncategorized

Thinking about the ones that got away… at Midnight on a Wednesday

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A conversation I had tonight with a very good friend of mine made me think of two older posts that you may not have read. They’re… well they’re very personal posts, but I still read them from time to time when I need to put stuff in my head other than the crap that usually floats around in there these days. Replacing over-thought-about current sadness with past sadness? Who knows if that’s healthy, but sometimes it just has to happen.

Anyway, these two posts are worth a read I think, if you don’t mind an old medic rambling about people he didn’t save in years past.

Thanks, friend. I needed to think about these things tonight.

My first… – My very first cardiac arrest patient

In an Instant – A perspective on a tragic death of a young person after years on the street

Maybe I’ll elaborate on these posts tomorrow… tonight’s not the night for it. I’m on duty and the bunk is calling. Who knew that I’d be shaped so much by my career? It is nights like these where I’m sure that I’m motivated to be a paramedic by things way more important than money… Not that I’ve ever been not sure of that fact… and not that there’s ever really been enough money to convince me otherwise.

Anyway, enjoy the above links. They’re in my brain tonight. I hope you like them.

Posted by on February 24, 2011 • Filed under: bad calls, cpr, cpr fail, Emergency Medical Services, emotions, EMS, EMS Health & Safety, EMS Topics, EMT, Fire Rescue Topics, Line of Duty, Paramedic, Uncategorized

Remebering My Father, Chief Richard A. Kaiser

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I was walking out of a nursing home last night after a simple transport when my brother sent me a text. We talk fairly often; my brother and I, so this wasn’t very significant… except for this text said “11 years today, RIP Richard Kaiser.”

And I hadn’t remembered.

Has it really been 11 years? Did my father, Chief Richard Kaiser really pass away 11 years ago? 11 years? Eleven? Years? Has it been that long?

My dad passed away in his sleep, the cause of death being listed as cardiac arrest of an unknown cause. He probably was a victim of Sudden Cardiac Arrest (SCA), possibly precipitated by a heart attack (MI) that he either wasn’t aware he was having, or didn’t report that he was having. My educated guess is that my father ignored chest pain. If I had to guess about my father, the proud, healthy and vigorous man that he was, I would say that he probably felt some chest pain and ignored the symptoms. I’d guess that he believed, as so many of my patients through the years have believed, that his body wasn’t telling him anything important when he chose to go to bed and see how he felt in the morning. I’d guess that he had been experiencing the pain in his chest all day and didn’t choose to do anything about it.

My father was a volunteer Fire Chief in the small town I grew up in for well over a decade. The department and the community there still benefit greatly from his legacy. He owned the hardware store in town, was the president of the town’s small water company, and was the general fix-it man for many of our community members when they needed something done. He was always willing to help out anyone in need and was a genuine example of a genuinely good man. I benefit greatly from having his example to lead me in my own life and I am blessed to have had him for the twenty years that I did. I will always be thankful for his legacy and the path he left me to follow.

I’m a career paramedic and firefighter and I would say that it is probably him that got me interested in the Fire Service, which blossomed into my love of the Emergency Medical Services. Without his lead, I don’t know if I would have gravitated to the ambulance game. Perhaps my bank account would have benefited more so if I had chosen to adopt his entrepreneurial spirit, or even maybe his MacGyver-Like ability to look at something and make it fixed… but I took on his love of helping people. In fact, as his legacy I’ve tried to impart in the kid that I consider to be my own son that “Our family helps people”… and a lot of that comes from my dad.

After he died, I lead an unsuccessful attempt to place AEDs throughout the part of the county where we lived. The area is very rural. In fact, the town I grew up in, Edgington, IL, is an unincorporated bump-on-the-map surrounded by vast amounts of corn and cows. There isn’t even a post-office. The ambulance that responded was actually the first ambulance I ever ran a call in, and it came from 13 miles away staffed with EMT-Basics. An EMT did respond direct to the scene from her house and began CPR, but she wasn’t equipped with a defibrillator… and ALS care was coming from the city 30 miles away. I was an EMT then but I wasn’t home.

Needless to say, when someone drops dead out in that area, they tend to stay that way.

Since my father passed away at age 53, most probably from ignoring pain in his chest, I have been hyper-vigilant on diagnosing and treating heart attacks and chest pain. As a paramedic, my number one pet-peeve is patients who ignore the symptoms of a heart attack and don’t call 911. Trying to “Tough it out” cost me my father. It cost my father his life, and I have got to tell you… there are times in my life since where I really have wished I had him around to talk to. I have tried to stop questioning how different my life would have turned out had my father simply chosen to call 911 and get his symptoms checked out. I have come to terms with the fact that it was his time and that we can’t second-guess or play “what-if”. I’ve even reconciled my feelings that I can’t always be there for everyone all the time, no matter how much I may have wanted to be.

But people who ignore chest pain and other serious medical symptoms simply because they believe they’re tough or that it can’t be happening to them still bug me. My ambulance partners will tell you, I give these people “the speech” where I expound upon the fact that they should always call 911 for chest pain. Sometimes I even get through to them.

In remembrance of my father, Chief Richard A. Kaiser of the Andalusia/Edgington Volunteer Fire Protection District, I am asking each and every one of my readers to do me a favor. Please spend some time evangelizing to your friends, family, and other loved ones that they should never ignore chest pain or other symptoms of a heart attack. Tell them to learn the symptoms and make the call to 911 when they have them. You do the same for yourself. Don’t try to tough it out or do anything stupid like that…

Because I miss my dad.

Call 911 for chest pain. Just FREAKING do it.

If you’d like to share something on your Facebook pages, twitter accounts, or print something out and pass it to your friends, please click on this link: “Heart Attack? Call 911 – Don’t Just Burp” It’s a piece where I write about the same topic… just without this level of emotion behind it. I’d like that piece to go as far around as it can go. If my father’s legacy can save any more lives, this is one of those ways.

Rest in Piece Dad, I love you. Thanks to you all in advance for helping me spread the word.

Posted by on February 17, 2011 • Filed under: Administration & Leadership, American Heart Association, Command & Leadership, cpr, Emergency Medical Services, emotions, EMS, ems 2.0, EMS Topics, EMT, fire, Fire Rescue Topics, In the Line of Duty, Line of Duty, Paramedic, Patient Management, STEMI, volunteer fire department

A Late-Night Rant about Petty Politics in EMS

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I had to think about a Facebook comment that I just posted on my personal Facebook page. Admittedly, I’m pretty angry right now and I probably shouldn’t be writing. It’s been a long night, you see… and I’ve had it up to my eyeballs with what I’m angry at.

However, this blog is my therapy and I can use it to get some stuff off of my chest whenever I see fit, right? Good, then here goes.

Tonight I’m going to forget that my computer has been acting up on me and has lost two 1000word-plus articles that I was lining up for the end of the week. I’m not even going to mention that I’m behind on a lot of projects because I’ve been overwhelmed with work. I’m not even going to talk about how the workload that I’ve let pile up has been making the blog suffer… Nope. I’m going to jump to the front of the line and bring that Facebook comment right here, to the front of this blog page where a few thousand EMTs and Medics might read it this month.

“Revenue Preservation, Area Preservation, Ego Preservation, and Political Capital Preservation” – These things are the top priorities of some EMS agencies I’ve dealt with over the years. Patient care is on the list, but its way down on the bottom of these agencies’ priorities. Some agencies have their priorities straight, but more it’s more common than I’d like to admit that EMS agencies have those four things at the beginning of this paragraph firmly implanted into their unwritten mission statements.  

I’ve written at length about EMS politics and how I hate them. For example:

-          Is What You Do “The Best You Can Do”

-          Volunteer Fire/EMS – Taking the High Road and Letting Go

-          Two Cases, One Letter: From One Paramedic’s Struggles, Change Can Come

-          Cat Puke Chicken

-          EMS 2.0, Bernoulli, Fluid Dynamics, and Changing the World

-          And Much, Much more…

And tonight, again, I’ve seen yet another example of the worst kind of EMS politics. I’ve seen these situations countless times before and I’ll see them countless times again, I’m afraid. People who don’t put the patient first have missed the whole point to this EMS thing. We’re here for the patient. We’re here for the citizens. There is a selfless aspect to EMS that must be respected in the preservation of the greater good. To miss that for almost any reason is to disrespect not only the foundation that EMS was built upon, but also the foundation of the entire healthcare system.

“First, Do No Harm”

Yea, that’s the first pledge of the Hippocratic Oath, the same one that Physicians take when they become doctors. EMS people are an off-shoot of physicians and we should follow those four words up there as much as they have to. Using the citizens of your jurisdiction as pawns in a political game is to violate those most sacred of oaths. EMS people tend to feud for the flimsiest of forgettable reasons. These feuds escalate unchecked for years until every action taking by the opposing party seems only to reinforce the perceived validity of the petty feud, even when the original actions or inactions that caused the feud were lost to history or died with the people who started the feud to begin with. Often, neighboring squads hate each other for no reason that they can remember. Factions within a single EMS agency may feud internally for no good reason whatsoever. These things escalate and escalate until patients are harmed by them… for no reason at all.

And if there ever has been a reason to harm a patient for a petty feud between services, between cliques, or between individuals, I’ve yet to hear it. In my opinion, using a patient as a pawn in a political game is the worst kind of offense.

These petty EMS politics, these laughable feuds, and the little kingdoms must have the light shown upon them. As I said in my probably politically incorrect Facebook post:

“I don’t like it when Petty People play petty politics with peoples’ lives. Really, people die from the kind of stuff I’m angry at without ever knowing that they were pawns in a political game. EMS politics must be exposed to the light so that the people that play them can be scattered like the cockroaches they are.”

Do you see anything that I’m going to be in trouble for tomorrow when people read that post? Remember, that’s on my personal account… not the blog account. Yes, I do take personal responsibility for everything I say on this blog page or in any of my public speaking or writing for that matter, but there’s a chance that people I know and may or may not have been talking about will read that tomorrow. My guess is that I will be the bad guy for saying it.

And frankly, I don’t care.

As I said in the post that I linked to above, Volunteer Fire/EMS – Taking the High Road and Letting Go – I am willing to bury each and every hatchet I do now hold or have ever held and solemnly pledge to conduct myself in friendship, mutual understanding, and for the good of the ideals in which we all should share. My guess is that there are people out there tonight who should do exactly the same. Don’t let petty politics harm those whom we’re pledged to serve. It’s not about us. It’s about them. It’s about our ideals.
It’s bigger than us. We are more than the sum of our parts. Don’t forget that.

I know that this hasn’t been the most polished piece I’ve ever posted up here, but everything I’ve said I believe. That’s why I’m a blogger. It’s why I’m a paramedic as well. Thanks for letting me rant.

The EMT Oath as adopted by the NAMET

EMTs have an Oath as well...

Posted by on October 27, 2010 • Filed under: Administration & Leadership, change, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, emotions, EMS, EMS ethics, EMS Management, EMS rant, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, medical ethics, Paramedic, politics, professionalism, rant, Uncategorized

Shining through Suffering – Learning How to Cope with Sadness in EMS

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Medic Trommashear, who writes great stuff has offered to co-post with me on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

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This morning the wife came home from her night shift on the ambulance and told me a sad story. During the wee hours of the morning she handled a rather nasty fatality accident. The victim, a 20-something male was walking home from a party on a dark country road and tragically, a passing motorist didn’t see him in time and the accident ensured that he’d never make it. Pedestrian vs. car accidents at high speeds have a way of doing that.

Sad stories like this are getting more common for her as she’s immersed herself fully into paramedic school and professional EMS in general. She’s been seeing sad stuff multiple times per week it seems. I can see that it’s wearing on her and I feel her pain. I have experienced it quite a bit myself in my own career and I continue to do so on a regular basis. Jumping into full-time EMS exposes a person to sadness on a level that can’t easily be prepared for. A person just has to jump in with both feet and not be afraid to feel the range of emotions that they’re going to be exposed to. It’s hard, it’s tough, and it’s one of those things a person just has to learn how to overcome if they want to make EMS a part of their life.

That’s the part that most people don’t get, I think. The part where you have to “Learn How” to overcome the sadness and negative emotions we’re faced with as EMS people. A common statement that lay people make when they hear that I am a paramedic is “Oh, I could never do that job and see what you see. I just couldn’t handle it”. Perhaps they’re right, but I would guess that anyone can train themselves to handle almost anything. My pseudoscientific opinion is that we develop our tolerance and our healthy ways of dealing with being exposed to such negative emotions on a regular basis through experiencing it and learning ways to function and feel happy afterwards. It’s harder for some than others and I can’t imagine that there is a single roadmap for learning it. It’s individual. Friends help and so does an understanding family. Good coworkers are great to observe and learn from as long as they realize their own humanity and aren’t simply trying to fool themselves out of bravado. We’re all human and I can testify that we’re all affected, no matter how thick our skin may appear.

Back when I was a new medic I was working a ton of hours. I mean, I worked a lot. I worked TOO much. I worked for days on end without sleep for multiple jobs. At the time, I felt I had good reason. I was attempting college for the first time, taking care of my recently deceased father’s businesses, and trying to sock away money to help my mother. I worked a full-time EMS job, a full-time hospital job, ran the businesses, and volunteered for a separate fire department and EMS agency. It was nuts. I would literally go for days without sleep. During that time it seemed like I was getting slammed by horribly sad calls. I felt I was surrounded by suffering and death. I was working at least two codes a week on average. Mayhem and madness seemed to rule the day. I was getting deeper and deeper and…

I was going nuts.

I was horribly, deeply depressed.

I almost went insane.

I was at my darkest hour when I found myself angry at anything that was cute or fun. Literally things like jokes, teddy bears, and Hallmark cards made me angry. I just couldn’t see how people could stand to look at that kind of stuff when there was so much suffering in the world. How frivolous! What a waste of time! It made me angry to think of anything that didn’t acknowledge the pain I was bearing witness to on such a regular basis. I was depressed and angry. I just couldn’t understand anything other than feeling the pain that the people I was taking care of were feeling. It affected my life, my work, and my human interaction. It was horrible.

Then I had an epiphany that changed my personality and who I am to this day.

Those who meet me know that I like to joke around. A lot. There are things that I take seriously however I do not personally happen to be one of them. My epiphany was that the stuff that was cute, fun, loving, friendly, and/or happy was all that actually did matter in life. We combat the bad with the good, the yang with the yin. I chose to pay attention to the comedy of life and downplay the tragedy. After that revelation, my whole outlook on life and my personality changed for the better. I had found that comedy, friendship, and love were the ways to live my life. Come what may, I can make a joke about it and that makes it ok. I laugh at inappropriate times and seek out the good in life. My life and career ensure that I’ll still have an onslaught of human tragedy thrown at me whether I’m ready for it or not but If I can actively seek out the positive, I may just end up ahead of the game.

To my wife, I love you. Hopefully you don’t end up where I have been… but I’ll be here for you, come what may. I understand what you’re going through and I love you for this any many, many other reasons. Always.

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You may want to read one of my most popular posts. It’s an older post of mine where I explore what I call “Splashed Sadness”. It’s along these lines. We EMS people have to deal with a lot. Never be afraid to share it. Don’t hold it in. Get it out and learn how you can cope with it because there’s not a one of us ain’t human.

“Splashed Sadness – A look at Negative Emotions in EMS”

Or “Reflections on an Easter Morning” – another post about a bad call.

Also, don’t forget to check out Medic Trommashear’s co-post on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

(Note: I’ll link to the post directly when it’s up)

Posted by on August 30, 2010 • Filed under: bad calls, Emergency Medical Services, emotions, EMS, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Firefighter Safety & Health, inside the mind of a paramedic, Line of Duty, Paramedic, psychology, sadness, Training & Development, Uncategorized

In an Instant

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I just have to write this story down. It’s a bit… well, I don’t know how it is… but if The Happy Medic can use his blog as an online therapy journal, I guess that I can as well.

I just can’t shake an incident that happened to me. I can’t get it out of my head. It happened years ago while I was off-duty and was hanging out with a friend who I haven’t had much contact with in recent years. However, a recent conversation with that friend brought a lot of memories flooding back into my consciousness and I figure that if I write it down it might help me shake it.

I’ve written a lot about sadness in the past, especially the sadness that we as EMS providers are exposed to on a daily basis in our careers. It surrounds us. Most people shy away from the death, destruction, and sheer madness that abound in the Human Condition but EMS people are special. We cannot shield ourselves from the external pain that death, injury, and illness bring. Thankfully this pain is most often being experienced by strangers and our role is to bear witness to it and attempt to intervene as best as any human can when faced by the insurmountable fact that we are indeed fragile mortal beings. While I have worked upon family members, I’ve been blessed in that I’ve been mostly left untouched by trauma and death inflicted on my loved-ones. Not to say that I haven’t experienced the loss of those close to me, just that I can understand that everyone dies and sometimes it’s at the worst possible time. We don’t control that. Sometimes we can prolong the inevitable but a lot of the time circumstances are simply beyond the power of any mortal being.

This case was one of those times.

It was the Fourth of July in the Midwest. The chill of winter had long since been buried in the recesses of our memories and the hot times of summer were upon us. Like good, God-fearing, Red-Blooded, Midwestern Americans we were set upon celebrating our country’s independence in the way we are best accustomed, by getting together and partying our butts off. Midwestern parties, especially the ones frequented by the age bracket I was a member of at the time, involve alcohol, loud music, and strangers popping in and out of the door set upon sampling the festivities. It was common to make new friends and acquaintances and uncommon, at least in the crowd I ran with, to have any trouble. That was fine with me. I was a functioning career paramedic and had been so for a few years. I get my excitement on the streets and am quite content to relax and have a good time when I’m off duty. I still don’t get too loud or too wild and still enjoy observing the antics of more animated people when they have a bit too much to drink. Staying sober has always made things more enjoyable for me when at these kinds of events. This party was no different. A coworker of my best friend had invited us all to his hip apartment in the city which featured the entire rooftop of the building as a patio. My girlfriend at the time, her friend, and I were sitting on a parapet wall of the roof watching the college kids from the school in town have their fun. The party was one story from the ground and was full of people. I only knew probably a good ten percent of the people there, but I’ve always been comfortable making new friends. We were having a blast. Good Music, Good Friends, and Cheap Keg Beer. Good times.

Then reality hit.

I got a knot that set quickly in the pit of my stomach when I heard a sickening crack and saw a crowd of people run towards a sky light that happened to be in the middle of the roof. Walking towards it I could get a sense of what happened. Through the panicked crowd of onlookers I made my way to the side of what was now an open hole. Some kid had been attempting to step over the skylight when he lost his footing and fell. The thin, translucent plastic had given way immediately allowing his body to plummet the twenty or so feet to the unforgiving concrete floor below. I looked down and saw him lying motionless on the floor… It was dark and the visibility was very poor, but I could see the expanding circle of dark blood flowing out from this poor kid’s head.

Snapping into my official mode I grabbed the host of the party by both shoulders. “How do I get down there”. His blank stare of horror met me back as he stammered “I… I… I don’t know”. An anonymous person in the crowd shouted “Someone get a rope and lower me down there” and I knew that the crowd would not be helpful in this situation. I told the host to call 911 and handed him his cell phone that was clipped to his belt. I then left the roof, ran down through the apartment and out onto the street. It was oddly quiet as I surveyed the surroundings. None of the shrieks of the crowd above had seemed to make it to street level. As I looked at the building I found a garage door that seemed to have light shining through its windows that could have come through the skylight. I looked, and sure enough, there lay the kid on the concrete floor of the garage.

They say that human beings have the capacity for great strength when faced with horrific circumstances. I’m no neurologist, or psychologist, or anyone who studies such things… but I believe that it has to do something with the fact that our nervous system keeps our muscles from achieving their full capacity for strength when we’re not under extreme duress. It’s the phenomenon where grandmothers are able to lift a car up off of their grandchildren and such. When adrenaline is so prevalent in our bodies, we are all capable of things greater than we imagine.

This was one of those times for me. My best friend said that above the din of the horrified crowd, through the building and onto the roof, he heard a guttural yell. It was me. I’d simply decided that the locked garage door was going to open whether it liked it or not. I grabbed it and opened it about a foot against the protestations if its locking mechanisms. To that day and from that day on I’ve never accomplished a feat quite like that and I don’t think that I could again. I’ve never been the most physical person I know and the thought of spending hours in the gym picking up heavy pieces of steel in a repetitive fashion simply bores me to tears. While I am a good Midwestern Farm Boy, I can’t claim to be someone who could rip open a garage door with my bear hands if I was asked to do so in normal circumstances. However, this time I did. Nothing was going to stop me from taking care of that stranger.

When I crawled in to the garage I made my way to the kid in the dark. He lay prone, slightly rotated to his Left side, and he was breathing rapidly and shallowly. The air he was moving made sick gurgling noises in his airway that was full of blood. There was blood pouring from his ears, nose, mouth, and scalp and I could guess that his head had stopped his vertical progress when it met the concrete. I checked for responsiveness and found none. Someone from above me yelled out “Don’t touch him!” as I moved to open his airway with a Jaw Thrust and I heard a murmur run through the crowd above as my friend shouted “He’s a Paramedic”. I positioned his airway as best I could with no tools, alone, in the dark and shouted for someone above to send down my friend who was an EMT and my girlfriend at the time who was an EMT and paramedic-in-training. After a few moments, they made it to the garage and together we positioned the patient in a left lateral-recumbent position to protect his spine and allow for the blood to drain out of his airway. We kept him like that until a paramedic in uniform crawled in with equipment.

The medic, an acquaintance of mine, worked for the local fire department. I was not a member and was off-duty and out of my jurisdiction. His partner followed soon after and I helped them ready their intubation equipment after giving them a report on my assessment. They tubed him before we helped them package him in c-spine precautions. After that, the engine company called for a few guys to help them open the garage door. I did, as did some of the other guys there, and this is strange. Even with six guys attempting to raise the garage door higher, the door wouldn’t budge. The engine crew had to slice through the locking mechanism with a saw. There’s no way I could have opened that door by myself but somehow I did. I don’t know how either.

The more experienced members of the audience already know how this story ended… with a family hoping against hope and with the stranger’s life expiring shortly after he took one slight misstep at a party. He didn’t plan to die that day and his family didn’t plan on experiencing the pain and lost that they undoubtedly did. I did go to the ER to check on his status, but only stayed for a few moments after I spoke with his nurse. I didn’t need to hear the family wail and lament. I didn’t need to know who the kid was. I had played my role to the letter and that was all I intended to do. It’s not that I’m callous… just that I get enough sadness on duty, thank you.

And interestingly, from that day I’ve only talked about that incident about three or four times. I’d almost forgotten about it. Really. It was just another traumatic death to bear witness to for a person who dedicates a career to that kind of stuff, it only shocked those who were uninitiated. At least so I thought until I talked to my friend and I was brought right back there to that skylight, to the Fourth of July, and to blood and death marring the innocence of a crowd of people who didn’t know that kind of stuff could really happen.

If you’ve read this far, thanks for helping with my therapy session. I feel better after getting this out. This isn’t a story about any kind of heroics or any nonsense like that, rather it’s a story about futility and fragility. It’s a teachable moment that helped formulate who I am as a person and as a paramedic.

If you’d like more on my feelings on Sadness in EMS, read this: “Splashed Sadness  – A Look at Negative Emotions in EMS”

Thank you.

Posted by on May 22, 2010 • Filed under: blogger, Emergency Medical Services, emotions, EMS, EMS Blog, EMS Topics, EMT, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, mental imagery, Paramedic, sadness, stories

Splashed Sadness – A look at negative emotions in EMS

29 comments

WARNING TO NON-EMS PEOPLE: This post is pretty emotional. If you’re not emotionally equipped to handle really sad descriptions of EMS calls, don’t read it.

Here’s a revelation: EMS People are better suited to handling sadness than are laypeople. Of course we are. Not because we are necessarily any emotionally stronger than anyone else but because we have experience in dealing with it. As anyone could see, a good number of the situations we respond to and either assist with or observe are really sad. In my decade or so of riding the ambulances I have come across more situations than I could possibly remember that I wouldn’t want to casually discuss outside of the industry for fear of really making laypeople very uncomfortable. A story that might turn into a running joke among your colleagues might just depress a layperson for weeks.

Like all medics, I have my coping mechanisms and some of them are healthier than the others, they include sarcasm, dark humor, clean humor, Tanqueray martinis dirty and dry up with three olives, blogging, fishing, picking on my soon-to-be wife (9 days till the nuptials as of today!), playing with my boy, fishing, MGD, cigars, and sarcasm. There are a few other things in there too, I’m a rich tapestry.

This blog gets read by mostly EMS people, but there are public people out there that read me too. For both of your benefit, I’m going to relate some stories here of calls that I’ve personally attended to over the years:

  • A 16yo male takes his 24yo soon-to-be brother in law out into the city for the 24yo’s bachelor party. On the way home, they’re both just obliterated after drinking all night. The 16yo boy is driving home and is going way too fast to notice the semi hauling gravel that pulls into the right hand lane of the 4-lane road they’re driving on. The kid notices it at the last second, swerving just in time to impact the passenger side of the car against the back of the semi trailer. The impact shears off the left side of the 24yo’s skull, popping out the left side of his brain and leaving it, mostly intact, in between the front seats of the car (I almost put my knee into it). The 24yo dies a not-so-immediate death (I don’t want to get into it. Hopefully it was mostly painless). I pronounced the 24yo dead and took care of this very intoxicated 16yo. He was barely able to comprehend the terror of the situation and was covered in blood and brains that formerly belonged to the man his sister was going to marry. He was unhurt but I ran him into the hospital anyway. How could I leave him there immersed in the terror of that scene, in the terror of what he was more or less responsible for?

     

  • A 19yo male comes home from the military and his friends throw him a house party. During the party the 19yo takes his 18yo male friend down to the basement of the house to show the friend a new pistol that the 19yo brought home with him. The friend takes the gun to look at it and playfully twirls it around his finger ‘Old West’ style in an attempt to be cool. When he does, the gun fires, shooting the friend from the chin through the top of the skull. When I got to him, he was still breathing and had a strong pulse however it was mostly his brain stem that was controlling the reflex. Most of his brain was splattered on the basement floor. We worked him, transported him to the trauma center, and I believe that they were able to harvest his organs.

     

  • A man and his wife of upwards of twenty years are just bumming around the house on a nondescript weekday. It’s about lunch time and they’re going to eat at home before they go to the wife’s doctor appointment. The wife gets up to make sandwiches, gets to the counter, and slumps to the floor. She never woke up. We worked her very hard, but her heart had just decided that it had reached its allotted number of lifetime beats.

The above short summaries of calls that I’ve been to are sad. There’s no joke that can make them not sad. If you read this, there are two reactions I expect from you here:

  • For non-medical people: You’ve related these stories to yourself. You may be crying. You’ll think about them and your heart will go out to the unfortunate people involved. You’re sad.

     

  • For EMS People: Don’t these sound like good calls? They were. Yep, they were sad and I felt very bad for the people that were involved. Good calls though. What’s for lunch?

I think I remember what I did after the above three calls. I think that it was profound although my memory is pretty foggy after all these years. After the first one, I cleaned up the truck and actually got to sleep the rest of the night. After the second I cleared and went to a few more calls and then had lunch. After the third I um, had lunch because it was lunch time.

EMS people can probably know what I’m talking about here. I call it “The Howl”. It’s the sound that a family member makes after you’ve transported their close loved one to the hospital where the patient is pronounced dead by the ER Doc before the family gets there. So there you are, cleaning your equipment while the ER staff makes the sad announcement to the family. Here comes The Howl of anguish that the family member makes when they hear the news. I’ve heard it time after time in hospital after hospital. It’s loud. It’s haunting. It haunts my dreams some nights. I say that The Howl is an example of direct sadness. Direct Sadness is the pain/sorrow/anguish/horror that a person feels when they are a primary person in the situation. In my position of hearing The Howl after working the patient and unsuccessfully trying to save their life I experience Indirect Sadness. For the coworkers that I tell the story to and the readers of this blog, “Splashed Sadness” is the term I use. I think that “Splashes Sadness” is what a person experiences when hearing a terribly sad story like that.

In this business, Splashed Sadness is everywhere. It is one of the hallmarks of professional EMS. Think about it like this, I will always remember a conversation that happened between a group of coworkers and me one nondescript morning some time ago. They told the story of a college age male that overdosed on illegal drugs, stopped breathing, and was resuscitated from asystole (flat-line) by the paramedic that was telling the story. He mentioned that the fiancé of the patient was in the ER with the most-probably brain-dead patient and was holding the patient’s hand and telling anyone that happened by that they were supposed to get married that weekend. He said that she just kept repeating “We’re getting married this weekend” over and over again.

The sadness contained in that story splashed on to me and I’ve remembered it to this day. It will probably be there tomorrow too…

I responded by asking if they recommended that she cancel the caterer. Then there were fart jokes and wrestling (It was an all male crew that day). That’s how I dealt with the splashed sadness. I try not to get any of it on me and I try to psychologically squeegee any of it that I do get on me off as quickly as possible by interjecting humor and sarcasm into the situation. Extreme humor to deal with extreme sadness.

EMS people gain experience in dealing with negative emotions and sadness through all of these routes, direct, indirect, and splashed. While I have dealt with Direct sadness in cases of the deaths of close loved ones including my father, I don’t want to deal with any more. I get indirect sadness a lot of the days that I show up for work, and splashed sadness happens every dang time I talk to a coworker or discuss a bad call with a peer. I’m splashing sadness on you all right now as you read the above stories. If you’re an EMS person, you can deal with the splashing. If you’re a layperson, I’m very sorry for doing that to you but I did warn you before you started reading. My theory is that the more experience you
get with sadness, the better equipped you are to deal with it.

Or you go nuts.

Or you go nuts and start blogging and drinking martinis like I did.

Maybe I’ll get credit in a psychology journal for coining “Splashed Sadness” in EMS.

 

Posted by on February 16, 2010 • Filed under: Ambulance, bad calls, CISD, Emergency Medical Services, emotions, EMS, EMS ethics, EMS Health & Safety, EMS pep talk, EMS Topics, EMT, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, In the Line of Duty, inside the mind of a paramedic, Paramedic, paramedic education, psychology, sadness, safety

Thank you EMS – Some reasons I love what I do

6 comments

Judging by how I felt this morning when I got up at 06:43 for a seizure victim after getting to bed at 03:30ish beforehand, I would say that I’ve been doing this for a while. I’m not as young as I used to be and I certainly am not the same person I was when I first got behind the wheel of an ambulance and flipped on the flashing lights.

I’ll never forget that first time I ever drove an ambulance lights and sirens. I was so excited. When I was younger I had always wanted to be an EMT and I viewed my first emergency driving experience as the time when I’d really “made it”. I was working as a security guard in a hospital where our security department ran an ambulance service that existed solely to transport patients from a free-standing ER attached to an outpatient facility to our larger flagship hospital with inpatient beds. Mostly we did tech work in the ER and transported every admission to the larger facility. Occasionally we got to “knock the cobwebs outta the siren” and run the ten minute trip “hot”. That was my first time driving in an emergency fashion… it may have not been a clean win since it wasn’t a 911 call… but it was still my first.

However, I digress. This post isn’t about my youth and exuberance that I didn’t know I was in the midst of when I first pinned on an EMS badge. This post is about the person I am today. I’m a paramedic now and I will say that I am proud of my son, my wife, my family, and my skills as a paramedic. I try not to brag on much, but I have put so much effort into all of the above that I am proud of the way they’re turning out. As a paramedic I have put in years of continuous effort to become the provider that I am today and even if nobody else ever cares about how good I was when I retire one sad day in the future, I will, and that’s enough for me to drive on.

I will never have the ability to give back to EMS all of the positive gifts that it has given me. Growing as a paramedic and as a healthcare provider is directly related to my growth as a person. I entitled this blog “Life Under the Lights” because I feel that I’ve lived a significant portion of my own life “Under the lights” of an ambulance. We all share a lot of the same experiences on our journey as EMS providers and we’re only starting to realize our true potential as a profession.

So here are a few things that I am thankful for that I’ve gotten back from my career as a paramedic so far:

-          Thank you EMS for allowing me to see the power and passion in people going through the worst times in their lives… and in some cases the best ones.

-          Thank you EMS for allowing me to have conversations with fascinating individuals I’ve met as I’ve taken care of them. I love hearing the stories my patients tell me… it’s got to be one of the best parts of the job. I’ve learned so much from my patients.

-          Thank you EMS for taking me on a journey through my own emotions and allowing me to feel the highest peaks and lowest valleys of my own psyche as I’ve lived out the world through facing emergencies. I may have never known such things about my own capacity for feeling.

-          Thank you EMS for teaching me that I always have it in me to go on fighting when the stakes are high… Without having to fight through the pain, exhaustion, and other discomforts that you’ve thrown at me I wouldn’t know nearly how much I could take.

-          Thank you EMS for allowing me to meet my wife. I love her more than I love you.

-          Thank you EMS for allowing me to meet my coworkers, some of them have become my closest friends. Maybe I’ve had better parties while on the clock than I have had off-duty. Being at work is just such a blast sometimes.

-          Thank you EMS for showing me that no matter what struggles I’ve been facing in my personal life, that there is always someone out there struggling harder than I am.

-          Thank you EMS for shaping my personality. I used to be a shy introverted person. Now I can almost always come up with something close to the right thing to say by thinking on my feet.

-          Thank you EMS for giving me the opportunity to Drive Fast and Break Things occasionally, it’s the manliest thing I do most weeks.

-          Thank you EMS for making my life exciting. I love the feeling I get when the stakes are extremely high and the adrenaline is pumping… it has to be better than any drug.

-          And finally, Thank you EMS for more than I can thank you for. I (quite geekishly, actually) can relate most things to something I have done or might do in the field. That’s very cool in my book.

Without my starting point in EMS more than a decade ago, you wouldn’t be here reading this right now. I would be some guy doing something somewhere else. My life is shaped because of what I do and who I’ve become from pounding the streets every day. Thanks for making me “somebody”. Thanks for giving me something to write about. Thanks for being as cool as you are.

Posted by on February 9, 2010 • Filed under: appreciation, Emergency Medical Services, emotions, EMS, EMS Blog, EMS Health & Safety, EMS Motivation, EMS paramedics, EMS pep talk, EMS Topics, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Fire Rescue Topics, Firefighter Safety & Health, Paramedic, potential, pride, profession, professionalism, thank you

“CPR Theatre” – Pediatric Deaths, resuscitations, and futility

16 comments

This post is a cooperative joint topic with two widely respected EMS bloggers, Steve Whitehead from Http://www.TheEMTspot.com and Greg Friese, from Http://www.EveryDayEMStips.com – Our topic is supposed to be on why it is that EMTs, Paramedics, and other healthcare providers will sometimes “go through the motions” and continue on with futile resuscitations with pediatric cardiac arrest victims. I’m sure that they will have very insightful posts on the topic, as they always do. Here’s my take.

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Can someone say “emotionally charged”?

One of the truths about where I’m sitting right now is that I’m chained to a lot of potential responsibility. Today, like a lot of days I’m one of two paramedics on-duty in my service area and the next call is mine. No matter what the next call is, it is my responsibility to get up and answer that call… without regard the horror that fate may be sending me to bear witness to and intervene in. All medics have to accept this inherent part of the job. One of the worst of those possibilities is that it may be a call that involves the significant injury or illness to, or even the death of a child.

Mention the possibility of a child’s death to even the most cynical and seasoned of healthcare providers and you will send a very cold chill down their spine. It’s just horrible. For me, the blessedly rare times that I’ve lost a child have been sentinel events in my life, things that are often thought of but rarely spoken of… almost always spoken of only to comfort the pain of a colleague experiencing the same thing. The loss or suffering of a child just burns into our souls and leaves an indelible scar that only someone who has experienced it can have true empathy for.

And I for one, wish that I didn’t have the empathy that I have for it.

Heaven forbid that I ever have to be one of the parents with pleading eyes at one of those tragic and traumatic scenes. I just can’t imagine what they go through when I’ve said “I’m Sorry”. I can’t imagine their pain, and frankly I don’t want to. As a parent myself the thought is blocked from my conscious mind and relegated only to the deepest recesses of my subconscious fears. Losing an adult patient is one thing, as we humans come to know that our lives are fragile and that our price of admission is to be removed from this existence. It’s a knowledge that we get as we progress through life and gain the experiences, both good and bad, that make us who we are and will become. However, the terrible thought that one could be ripped from us in their age of innocence is an affront to everything that almost everyone holds dear… and it’s more than a lot of us can bear to make the last decision of a child’s life. Instead, we try. We try hard and we keep trying. We hold out hope against thought and fight on, sometimes against futility.

But in my mind, I think I know why it is… because no healthcare person wants to be the person who looks into those pleading eyes and says “I’m sorry”. That decision takes an enormous emotional toll upon the parents and family, of course… but also upon the EMT or Paramedic. It’s ultimately easier on us as EMS people, we reason, to fight on. To race headlong into futility and hold out hope that someone else won’t have to say “I’m sorry”. At least we won’t have to.

There are probably psychological studies out there that I haven’t read that deal with the issue of whether “CPR Theatre” is harmful or helpful to the long-term well being of the surviving family.  These studies are probably well-researched. I took a class once that told me that it was better for family members to be in the resuscitation room inside of a hospital to witness the events as healthcare people try to save their loved ones… and I can understand that I guess. Perhaps it is better to witness that “everything possible was done” for your departed loved one. I don’t know.

As healthcare providers, it is our sworn duty to alleviate suffering as best we can using the tools at our disposal. I, like most of my colleagues, realize that the secondary and tertiary patients that we treat are the family members and their grief reactions to the tragic circumstances that resulted in their calling us. I am reasonably comfortable handling their grief reactions and sadness when an adult passes on scene but I am humbly inadequate to be of much comfort to a parent that has just lost their child no matter how I might try.

My guess that futile CPR theatre can be explained as being more for the parents and families of departed children than it is for the slight chance that we might have missed something. We make the effort in the name of showing to the family members that “everything possible” was indeed done, up to and including running their child lights and sirens to a hospital. I’ll even admit that in the back of the ambulance while I’ve done this, I’ve prayed right along with the family that just perhaps this once we would have a miracle. Never once has it happened.

Here’s a mea culpa for you, even though every time I’ve gone through the motions I’ve said it was for the family…  It may really have been for my own benefit as I’ve stated it could be above. I am a paramedic and I’ve seen my share of pain, but I don’t think that I can look a parent in the eyes and say “I’m sorry” ever again. I just don’t want to and as I write this, I can’t imagine that I could do that and then come back and look the guy in the mirror in the eyes without wondering if maybe this time would’ve been the miracle. I am probably selfish for this practice… but is that wrong?

From a completely actuarial perspective, no futile resuscitation should be performed due to safety concerns and the unnecessary costs involved. I agree that with adults, transporting cardiac arrest victims is probably deadly. I also understand that no ambulance should risk a lights-and-sirens trip to transport a body to the emergency room. However, I am not an actuary. In those cases I’m a witness to horrible emotional pain and I want someone else to be the one who says “I’m sorry”. It’s human nature, perhaps.

In my career, I have told parents “I’m sorry, there’s nothing I can do” in cases where it was blatantly obvious that the child was long beyond hope of any intervention. I’ve done it more than once and I can see the places where I’ve done it in my mind to this day. Sometimes it’s completely obvious that there is indeed nothing that anyone can do. However, occasionally I have indeed known this and just done it anyway. Perhaps it’s completely subjective. Perhaps it was my level of experience and intuition that guided me at the times I’ve made the decision. I’ll tell you this, it certainly wasn’t a decision made from the pages of a textbook.

I don’t have the answers to this. But I do want to go home and hug my kid. My only advice to the EMS people out there is to realize that we’re all human, and that all you have to do is your best. Be compassionate, and use your best judgment. For that’s all we can ever do.

For more on this powerful topic for EMS, head over to Greg Friese’s page and also to Steve Whitehead’s page. You also may want to read “Splashed Sadness – A look at Negative Emotions in EMS” where I further explore the sad side of EMS and our reactions to it.

Posted by on January 5, 2010 • Filed under: Ambulance, bad calls, cpr, Emergency Medical Services, emotions, EMS, EMS Blog, EMS ethics, EMS Health & Safety, EMS Topics, EMT, Ethics, everyday ems ethics, Fire Rescue Topics, inside the mind of a paramedic, medical ethics, Paramedic, patient care, Patient Management, psychology, sadness, The EMT Spot, Training & Development

Guest Post – An Open Letter to Wisconsin Physicians Concerning Do-Not-Resucitate Orders

32 comments

This is a guest post written by a local paramedic that has an important message to get out about Physician involvement with Do-Not-Resuscitate (DNR) Orders. I’ve included it in its entirety. It’s an important issue. It takes such an emotional toll on the EMS providers and the families of our patients. Please share this with your colleagues and loved ones.

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An open letter to the Physicians of Wisconsin:

“Medic 1, Engine 7 respond to 123 Anystreet for a male unresponsive. Time out 21:19.” 

This simple statement spoken by a dispatcher starts a series of events that will place an EMS crew in a moral dilemma, a family in a confused and angry state, and a personal physician sitting at home, unaffected.  As the responding EMTs and Paramedics enter the home in response to this call, they see an elderly female cradling an elderly male in her arms. She is sobbing and distraught.  The elderly female holds in her hands the lifeless body of her life long partner and soul mate who seems to have finally given up his long suffering in this world.  The lead EMT quickly approaches the patient and finds that the patient is in cardiac arrest.  The female states that she always knew that he would die in her arms.  She states how long and difficult these last months have been with his terminal illness creeping into their lives and stealing her husband away.  The Lead EMT asks if the patient has a DNR (Do Not Resuscitate) order. The wife states that he does.  A quick check of wrists and ankles does not produce the state approved DNR bracelet.  The EMT’s crew stares at Lead EMT looking for direction.  They know that unless there is a valid DNR bracelet on his wrist they must start CPR and perform life saving measures.  The Lead EMT knows that the clock is quickly winding down, they must act soon.  She asks the spouse again about the DNR and where it might be in the house.  The spouse states that there is a copy of the DNR at the hospital.  She states that she filled it out at the months ago at the doctor’s office.  The spouse says, “I never got a bracelet.  The doctor knows that he didn’t want anything does, can’t you call him?”

Meanwhile, a county away, a physician sits at his desk, dictating the notes of the day.  He is completely unaware of the drama that is unfolding in the darkness of night and the darkness that is enveloping one spouse’s life.  This physician has practiced medicine for years, graduating medical school in the early 1960’s.  He has been kind, caring, and concerned for every patient he has seen and is highly regarded within the medical community.  When he first started in medicine, ambulances were simply Cadillac station wagons that whisked through the night.  They moved the sick and injured from point to point without offering much more than a fast ride.  Over the decades the rules changed, medical advances occurred, and now an ambulance is a rolling emergency department with full advanced life support abilities.  Unfortunately, unless a physician takes an interest in EMS this change has occurred without notice.

The lead EMT removes the patient from his spouse’s arms.  They move him to the floor and start CPR.  The crew has no choice, they have no valid DNR order and they have been summoned by a 911 call from the spouse.  The spouse screams at and pleads with the crew to stop, she doesn’t understand why this is happening.  Her husband has filled out papers; they have them on file at the hospital.  She thought this wouldn’t happen.  The spouse watches as I.V.’s are started, defibrillator pads applied, and an endotracheal tube is placed into the airway of her spouse.  The spouse is now frantic.  This was never supposed to happen.  Why aren’t the EMT listening to her? She knows what her husband wanted, they were together for over 50 years.  Medications are now being given and the EMS crew is trying to coax a pulse out of a tired heart.  The crew shoots looks at each other questioning what is right and wrong.

The lack of a DNR order puts EMS crews in a terrible moral and ethical dilemma.  They must proceed as the law states; but their hearts are heavy and they are unsure if they are truly doing the best for the patient or the family.  They sat in on the trainings years ago about the DNR bracelet.  The instructors said it would eliminate these situations, patients would speak to their personal physicians, sign all the necessary forms, and then the patient would be issued a DNR bracelet that would clearly state the patient’s wishes.  Yet time and time again, this scenario repeats itself and each time the frustration grows.

After 45 minutes of CPR and three rounds of ACLS medication, medical control is contacted.  The ED physician is advised of the situation and advises the crew to terminate all efforts.  The crew cleans up and a mournful wife sits by her husband’s side again, holding his hand.  This is where she wanted to be all along, just holding his hand and looking for support in this darkest time in her life.  Instead, she had to witness the brutality of a full ACLS code.  The ribs breaking, the I.V.’s being placed, the monitor screaming out orders in its electronic voice.   The peaceful, honorable death she had hoped for has been taken from her, she will now have the visions of CPR and strangers doing procedures to her husband that neither of them ever wanted.  These are events that we can never go back in time and change.

Our physician is now walking to his car.  Rattling through his pocket looking for keys that he can’t seem to find.  He will receive a call later tonight from the county coroner explaining what has happened.  He will be honestly horrified to hear of the efforts by the EMS unit and will wonder why this has happened.  Ironically, he doesn’t know that he set these events in motion years ago by not securing a DNR order for his patient that EMS crews are able to honor.

“Medic 1 and Engine 7 are clear, no transport, coroner on scene.”  This will be another long ride back to the fire house.  Emotions are running high, the crew is upset.  They can’t figure what is making them angrier, the fact that this happened or the fact they know it will happen again.  The cycle continues.

I would ask that each primary care physician look into the laws as they apply to DNR orders and EMS providers in the State of Wisconsin.  We do not have the luxury of time.  We must make decisions within seconds.  We NEED the DNR bracelet.  All we need to know is “yes or no” to CPR.  We have NO time to read through long winded orders or other legal documents.  This is a problem that we must fix and fix fast. You have the power to fix this. Please do so.

Respectfully,

Todd A. Bluhm, Paramedic

Posted by on December 3, 2009 • Filed under: 911 fail, cpr, cpr fail, crisis, DNR, Do Not Resuscitate Order, Emergency Medical Services, emotions, EMS, ems 2.0, EMS ethics, EMS rant, EMS Topics, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Fire Rescue Topics, medical ethics, Paramedic, patient care, Patient Management, physician, professionalism, rant, southern wisconsin

Will your career survive a decade or more in full-time EMS? Take this three question quiz!

13 comments

This is a simple test that you can use to see if you have the proper mindset to make it a decade or longer in this insane profession we call EMS.

NOTE TO NON-EMS PEOPLE: This post is geared especially to those in the industry. It explores humor that we employ to keep us with a healthy degree of insanity. If you’re not in the industry and you find this to be disagreeable in some way… well then in the words of Motorcop: “You’ve got the wrong frikkin’ blog pal!” Go read about scrapbooking or something.

This is a simple three question blog based quiz that you can use to determine if you have the right mindset needed to make it more than a few years in this crazy, wild profession we call EMS. If you fail this quiz, um… well then you should tear up your EMT card immediately or not. Nevertheless, if you find this at all funny, you’ve come to the right place. Howsabout that?

Question #1:

You’re working a service that employs two paramedics per day to support BLS ambulance crews in your jurisdiction and beyond. The other paramedic on duty with you that day responds to a neighboring jurisdiction and manages to resuscitate a patient in cardiac arrest. He transports the patient on-board the BLS ambulance to the local community hospital that does not have ICU admitting capabilities on site. Shortly after he transports the patient to the small ER he contacts you asking you to respond down with the ambulance to stat-transfer the patient to a tertiary ICU approx 1.5hrs away lights and sirens. The patient’s got three drips going, is receiving bolus cardiac meds, is on a ventilator, and is not doing well. The ER doc wants the patient outta there as soon as he can get him reasonably stabilized for emergent transport. Oh, and before you ask, the helicopter’s not flying due to weather. You’re it, Buddy.

You arrive at the ER with your EMT-Basic partner and um, you’re “enthused” about the “challenge” you’re about to face. Walking into the ER you hear more than the expected commotion coming from the patient’s room. You enter the room to find the ER staff performing CPR and attempting to resuscitate the patient after he went into cardiac arrest again. You and your partner assist, but despite everyone’s best efforts, the patient unfortunately expires.

When you return to service and get back to quarters, you expect your coworkers to:

  1. A.      Be supportive and consolatory, understanding that you’ve just been through an intense, traumatic experience.
  2. B.      Make fun of you and suggest that you’re an incompetent paramedic because, after all, the other paramedic “saved” the patient… then you showed up and killed him.
  3. C.      Insist that you’re an agent of the grim reaper and pin up another chalk outline with a line through it on your “Bulletin Board of Death” they’ve got going.

Question #2:

Your rural ambulance responds to a local community health clinic for a “Woman in Labor”. Upon your arrival you find a 36 week pregnant female Gravita 3 Para 3 (3 Pregnancies, 3 live births) with contractions 5 minutes apart. The physician wants the patient transported to the local OB unit that is 45minutes away lights and sirens. You load the patient in the ambulance after assessing the patient and find that she is an otherwise healthy pregnant patient possibly in early labor. You initiate ALS care including o2, an IV, and an ECG monitor for good measure. Your partner points the ambulance towards the hospital and you take off lights and sirens. Ten minutes into the transport, the patient’s bag of waters ruptures and the patient states that she urgently feels the need to push.

Do you:

  1. A.      Tell your partner to pull the ambulance over to the side of the road in a safe area so that he can come back and assist while you pull out and open up the OB kit, preparing for imminent birth.
  2. B.      Administer a fluid bolus in the hope that you can slow the imminent delivery.
  3. C.      Calmly tell your partner to “Drive it like he stole it” and coach the patient in “trying not to push” while you try answer “B” and hold her legs firmly closed because hey, who wants to clean up afterbirth all over their ambulance?

Question #3:

You’ve just returned your ambulance to service after a mundane call on a particularly busy day. The other ambulance in the jurisdiction has not had a rough of a day as you’ve had and was out getting lunch when you returned to the station. Before you have the chance to radio dispatch and let them know that you’ve restocked and are back in service from the previous call, the tones drop for an unresponsive male patient that sounds like he has a severe lower GI bleed. Although you’re probably two blocks closer to the call than the other truck, they are dispatched because you haven’t gone in service yet. Their most direct route to the scene puts them right past the front of the station where they’re sure to see you on their way by.

Do you:

  1. A.      Call dispatch on the radio and inform them that you are indeed in service and will respond to the call if they wish you to do so.
  2. B.      Quick, hide! Close the station door and pretend that you’re not yet back in quarters. They deserve to get the call, they’re only out two blocks farther than you are, and you don’t want them to see you and know that you’re ducking it.
  3. C.      Run out to the front apron of the station and smile and wave as they drive by! Hiiiiieeey!! Enjoy the butt bleeder! Don’t forget to write!

Extra Credit Question:

                How many fingers do you think that the other crew will wave back at you with when they pass you in the previous question?

Answers:

If you answered mostly “A’s” – Congratulations, you’re a new, competent, caring EMT. Feel proud of yourself, but you’re probably not going to retire from this job. I could be wrong… but you’re pretty straight laced. Have fun with that.

If you answered mostly “B’s” – You’ve been in the business a while, haven’t you? You’re well on your way to developing the hard outer shell you’ll need to survive for a while in this business. Just don’t lose your gooey center.

If you answered mostly “C’s” – Um, you’re one of my coworkers, right?? Guys, come on… Why’d you go and dump a bucket of water on me last night while I was sleeping? If you’re not one of my coworkers, e-mail me and I’ll send you an application. You’ll fit right in.

Posted by on November 6, 2009 • Filed under: ALS Intercept, ambulance humor, camaraderie, Emergency Medical Services, emotions, EMS, EMS Health & Safety, EMS Humor, EMS Motivation, ems scenario, ems scenario based education, EMS Topics, inside the mind of a paramedic, mental illness, Paramedic, paramedic education, scenario, scenario based training

Someone Failed… Is it the System? Everyday EMS Ethics

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A tempestuous night is blowing outside the station walls. The cold night air is stirred wildly, blowing splatterings of rain against the glass window of my bedroom. The wind howls through the trees conjuring up fantastic images of the disturbed environs of the world outside my bunk room. Having gone to bed early, I cannot remember the dreams I must have been having but judging from the fact that my sheets were in such disarray when I awoke, they must have not been pleasant.

I awoke to a familiar but unwelcome voice, the night shift dispatcher coming from my radio. He spoke of a seizure in the next town over. The local ambulance service from that jurisdiction was calling for a paramedic to intercept and assist them with their call. I was due, it was my turn to be ripped from the warmth of my bed and respond to their aid.

I pulled on my clothes and zipped up my shoes. Since whomever controls the seasons in my area has decided to outright skip Fall and move straight to Winter I pulled on a jacket as well. Stepping out into the night air I halfway expected there to be a late September frost on the ground. As I started my truck and keyed the address into my GPS I cranked up the heat to stop my shivering. Hopefully this wouldn’t be too challenging for me in my sleep deprived, freshly woken up state. Hopefully I can wake up enough to safely drive. I shook my head violently to clear the sleep from my bleary eyes and keyed up the mic:

“Dispatch, Medic 84 is enroute to intercept Anytown”

The night shift dispatcher answered me and I switched to Anytown’s frequency:

“Anytown, Medic 84 is enroute to your scene”

With the red lights flashing over my SUV I pointed out into the deserted city streets. Anytown was about ten miles away from my station over country roads. The address was a few miles into their city limits. Curiously, the address they called me to was just a few short minutes from Anytown Hospital and it was strange that the EMT-Intermediate volunteer service had called me to an address where they would usually just scoop and run ILS to the ER. I figured that this must be one of those “Seizures” where the patient seized because of the fact that their heart stopped. People will oftentimes have a seizure when their heart does something funky, like stop, and blood flow is slowed or stopped to their brain. An old paramedic instructor I had once put it this way “Brains need blood flow to be happy, stop the blood even for a second, and the brain gets pissed off”. Everything seemed to get pissed off to that guy. An MI causing arrythmia was a “Pissed off heart”. Diabetes was a pissed off pancreas. A drunk at the bar was pissed off at his liver and so forth.

I wondered what this patient had that was pissed off for her.

The roads were open but the night was pitch black. The wind was blowing my small SUV in all directions but straight. Thinking that this was probably a bad call, I pushed the gas as hard as I felt was prudent with the driving conditions. I didn’t meet any traffic to get in my way. Just as I was coming into their town, a familiar voice crackled over Anytown EMS’s frequency:

“Medic 84. We still need you to respond but you can slow it down to non-emergent. We’re short an “I” and it’s going to be you”.

Ohhhh, so they couldn’t staff the truck fully and responded using me to make their full crew. Now I understood. Anytown EMS is a good service with dedicated people, but sometimes even the best volunteer service needs a hand. That’s what mutual aid is for. We have an arrangement with them in such circumstances so that our intercepting paramedic can make up a full crew for them by partnering with one of their EMTs.

I turned off the lights and just cruised silently through their deserted town. Yes, I popped the lights on momentarily to get through a couple of stop lights, but who’s counting, right? Arriving on their scene the EMT came out to me and said:

“You don’t need to bring anything. This is her third ambulance ride in 24 hours. She spilled a glass of water and (a family member) called because she thought she was “having a seizure” and needed to go back to the hospital”

Oh, now I remember this address. I don’t even work for this town and I’ve been here like umpteen times this year. The patient is one of their frequent fliers. Every community has them. I swear, without our frequent fliers we’d be short like a thousand annual calls. Think of the sleep time I could get.

Climbing up into the ambulance, I met the patient for the umpteenth time this year. She was in no distress and this is where her part in the story ends. My question isn’t about her. Honestly, the question here could be about any frequent flier in any community that has an ambulance response.

Why do we have them? Why do they depend on us so much?

The patient in this example had been to the ER twice already in the previous twenty four hour period, both times being transported by EMS and both times being taken home in a private car by family. Both previous times she had called her General Practitioner physician and had been referred to the ER because she said the word “seizure”. I can hardly blame the GP for recommending she call 911 rather than phone triaging her and suggesting she come into the office. But remember, it’s not about her. I can think of probably ten patients right now that I would consider to be among my personal roster of repetitive patients (I only have ten fingers) and their use of the emergency healthcare system for management of their chronic complaints is staggering in comparison to the use of it by the general population. Last year, every shift for two months we would respond to the same gentleman’s house to wake him up by popping in an IV line and giving him some D-50. We got pretty tired of it, as you can imagine. Most people with diabetes manage their illness pretty well and only occasionally need the assistance of an ambulance crew. This guy chose to manage it by drinking hard alcohol. I swear that I wanted to just leave the IV in place so that I wouldn’t have to start one the next day.
We fixed it by refusing to treat him on scene and release him anymore. It is common practice in my area to “sweeten up” a comatose diabetic with low blood sugar by popping in an IV and giving IV sugar (D-50), or in milder cases, by giving them high-sugar foods and making them eat until they regain full mental faculties. Once they regain their senses, all but a few of these patients sign a refusal of treatment form and do not wish transport to the ER. However, for this patient, we would find him unresponsive, so we would pack him up, move him into the ambulance, start the line and sugar him up while enroute to the ER. Once we were transporting, he couldn’t refuse to go and would end up at the ER for hours. Finally, he started managing his diabetes better because it was more convenient than waiting at the busy, urban ER we would take him to (yes, it was the closest. I work in many different jurisdictions).

However, the above solution just passed our problem we were having with the ambulance response onto the already overburdened Emergency Room. Yes, it “solved” the problem by increasing the patient’s level of personal inconvenience (although we still go to this guy about once or twice a month), but at what cost?
Who or what is causing the failure for these people? Who or what is causing the failure for this whole patient population? Is it the system that fails to adequately educate them on how to properly care for themselves or cure their ailment? Or is it the patient who is unwilling, or incapable of caring for themselves?

For both of the above named patients, socialized medicine already exists for them. They’re wards of the state as far as healthcare is concerned. One of them owns a house, one of them is in a free, government subsidized apartment, one
is in one state, the other is in another. You and I pay for their healthcare and almost their every need.

Is this the system’s fault? Is it their fault? Who should pay for the failure?

I’m writing this after coming back into my bunkroom and finding my sheets and blankets twisted into a ball. Everyone else in the house is snoring because of the abrupt weather change. (and DDex, if you read this YOU FREAKING SNORE WORSE THAN NACHO!) Whatever dreams I was having before this call came out must have been strange.

Until the next…

—————————————-
Update:

My blogger buddies Happy Medic and Medic999 took off from this post and wrote their point of view on their respective blogs. Here they are. Join the discussion.

Posted by on September 29, 2009 • Filed under: 911 fail, ALS Intercept, Ambulance, edemse, emotions, EMS, EMS ethics, medical ethics, Paramedic, politics, socialized medicine, universal healthcare

When God made Paramedics

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Usually I don’t get into emotional fluff or “hero-worship” type stuff… but this one’s an oldie but a goodie. I didn’t write it, I don’t know who did… but as I sit here with my beautiful Gkemtb at my side and my kitty on the other side, I wax poetic…

Maybe it’s the beer?

———————————–
When God made paramedics, He was into His sixth day of overtime. An angel appeared and said, “You’re doing a lot of fiddling around on this one.” God said, “Have you read the specs on this order? A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn’t touch, and not wrinkle his uniform.”

“He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again.” “He has to be in top mental condition at all times, running on no sleep, black coffee and half eaten meals, and he has to have six pairs of hands.”

The angel shook her head slowly and said, “Six pairs of hands…no way.”

“It’s not the hands that are causing me problems,” God replied. “It’s the three pairs of eyes a medic has to have.”

“That’s on the standard model?” asked the angel.

God nodded. “One pair that sees open sores as he’s drawing blood, always wondering if the patient is HIV positive.” (When he already knows and wishes he’d taken that accounting job)

“Another pair here in the side of his head for his partner’s safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, “You’ll be alright ma’am when he knows it isn’t so.”

“Lord,” said the angel, touching His sleeve, “rest and work on this tomorrow.”

“I can’t,” God replied. “I already have a model that can talk a 250 pound drunk out from behind a steering wheel without incident and feed a family of five on a private service paycheck.”

The angel circled the model of the Paramedic very slowly. “Can it think?” she asked.

“You bet”, God said. “It can tell you the symptoms of 100 illnesses; recite drug calculations in it’s sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear… and it still keeps it’s sense of humor.” “This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim’s family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call back.”

Finally, the angel bent over and ran her finger across the cheek of the Paramedic. “There’s a leak,” she pronounced. “I told You that You were trying to put too much into this model.”

“That’s not a leak,” God replied, “It’s a tear.”

“What’s the tear for?” asked the angel.

“It’s for bottled up emotions, for patients they’ve tried in vain to save, for commitment to that hope that they will make a difference in a person’s chance to survive, for life.”

“You’re a genius!” said the angel. God looked somber, stiffened, and said “I did not put it there”.

- Author Unknown

——————–

For more on this emotional, fluffy crap read:

“Enough to Make an Old Medic Melt” and,
“Splashed Sadness, a look at Negative Emotions in EMS”

Posted by on July 1, 2009 • Filed under: Ambulance, CISD, emotions, EMS, EMT, Fire department, Paramedic, when god made paramedics

My First…

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I can still smell the freshly cut grass baking in the summer sun and feel the breeze chasing leaves through the trees. Just one thought brings me back there to that time, to that place. My life forever changed as another life ended and I tried in vain to save it. I was young, naïve, and unprepared for the journey that life was telling me to take.

I was fifteen years old and He was in his seventies. His life ended there in that field and My life’s passion began next to his final call from God. The shock of seeing death close-up sparked emotions in me that I’ve never quite felt again. I was unprepared for what I was going to devote my life to and like every lesson EMS teaches a person, being unprepared was MY problem. EMS was ready for me to be taught.

My first code was my friend Roy. I was working in a Boy Scout Summer camp as kitchen help and Roy was the long-time camp director. He was retired US Navy, a sea-dog who had found his second calling in shaping boys into Men one summer at a time. He was a friend and father figure to all who knew him. I was truly honored that he had given me the chance to work on his staff. I had been coming to the camp for years as a boy and had finally been hired on as a staff member. I thought that it was so cool, the fact that I was the camp dishwasher notwithstanding. I was THERE. I was a part of things. I was what I had looked up to for so many years of my young life. I’ve always wanted to work in helping others. Probably because my father was a small-town Fire Chief and owner of the local hardware store and my Mother (the Saint) is a teacher. I’m trying to teach my son the lesson that my family taught me, that my family helps people.

I was fascinated with EMS, first-aid, the fire service, CPR, and anything with flashing lights. I had no clue of what I was trying to get myself into but I wanted to be a part of it. I even tried to petition the state into letting me take the EMT class before I was 18 years old. They said no, and I was crushed. Undaunted, I still learned as much as I could, read EMS textbooks, and waited and wished to be part of my first real emergency. I wanted to help people so badly that it burned inside of me. I was the classic young Ricky Rescue, whacker, or whatever you call an EMS geek in your neck of the woods… I laugh at it now, but it was no joke then. It consumed me. Maybe if I would have spent that time learning how to pick stocks, or how to play the guitar, or how to hit a baseball I would have been better off; but I was infatuated with EMS.

It’s funny now, because as much as I do it today after ten years or so on the truck, I’m still in love with it but I control it and not the other way around. I don’t have any EMS tattoos, nor do I wear t-shirts emblazoned with silly EMS slogans. I *do* have a blue emergency light in my car, but it’s simply because my volunteer department runs around 3000 calls per year and we’ve only got around 8 paramedics to respond. When we’re getting third and fourth calls out sometimes I have to get to the station real quick like. I rarely use it.

One hot, sticky summer day I was busy washing the hundreds of dishes dirtied by a dinnertime full of hungry boys. I was looking out the window of the dish room when I saw a car rocketing across the grassy main field of the camp towards a camp site. It was strange and was very abnormal. I ran outside to see what was going on and saw a commotion at a camp site on the far side of the field. I ran towards it. I wanted to know what was going on. I was a staff member. It was my job.

Being a teenager, I made the quarter mile sprint with ease. I ended up looking through a crowd of people that had gathered and…

Holy Mother of… that’s Roy! They’re doing CPR! Oh my God…

I had to get up there to help, and help I did. There was an adult there who said that he was a volunteer EMT from an ambulance service somewhere. I said that I knew CPR. We performed 2 man resuscitation on him using the strictest Red Cross CPR procedures. 15 compressions. Two breaths. I was giving the breaths without a barrier device. He was throwing up.

I don’t know if you can tell as you read this, but I’m getting chills as I write. I can still taste the vomit in my mouth. I can still feel it burning in my nose. This was almost fifteen years ago and I can see it and feel it now as I write about it as clearly as if I was there. I am writing this at a fire station as an experienced paramedic with an ALS ambulance, a fire engine, and a ladder company within 30 feet of me and I have the urge to take the ambulance out and go save Roy. I wanted to save him more than I had ever wanted anything in my life. I’ve saved my last two codes. I can do it now. Let me go back.

You know that it ended badly. I didn’t. I did CPR until I was relieved by the local volunteer BLS ambulance. They hooked up their new AED (a shiny new LIfepack 300!) and it announced “shock advised”. Two shocks and continued CPR brought on a “no shock advised”. They transported him to an ALS intercept 25minutes down the road. The ALS crew worked on him for the 25 more minutes to the hospital ER. The ER pronounced Roy dead.

I had huddled with the other staff members in the camp command post. We were proud of our efforts and were confident that our CPR skills had prevailed. When we got the call, well… you can imagine how the youthful joy turned into something dark and devastating.

My Father and Mother arrived because they’d heard the call go out over the radio waves. One of the EMTs on the ambulance had called them to tell them of the bad news as well. We took a long walk around the camp while they listened to my story. After that, Dad began to talk.

He told me of the patients that he’d lost as a firefighter, as an “ambulance driver” in a Cadillac, and as the Fire Chief. He told me of notifying parents that their children had died. He told stories of great pain and sadness that only an emergency worker knows. I’d never really heard him talk that way or tell those stories. Then my parents gave me a hug and let me know that things would be ok in time. And they were.

But Roy’s the first patient that I carry with me. He’ll always be there and I’m glad to have him in my psyche. I came to that Boy Scout Summer Camp as a boy. I left a little closer to being a Man.

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Posted by on June 22, 2009 • Filed under: aed, Ambulance, boy scouts, cpr, emotions, first call
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