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Hangover Heaven? WHY ARE WE NOT DOING THIS!?!?

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I came across a new business today while I was casually wandering around the Internet and I just absolutely had to share it with the EMS crowd. The company, called "Hangover Heaven" (www.HangoverHeaven.com) is set to open April 14th, 2011 in Las Vegas, NV. (Where else?)

If you haven't already clicked the link their business model is that they have a bus that drives around the strip, picking up the hungover masses, and providing "a small IV in your arm that provides the necessary treatment to continue the party or just get back to your normal self." They have two packages, the "Redemption" package for $90 that provides IV hydration only, and the "Salvation" Package for $150 that provides relief through their "Proprietary treatment" which they say contains intravenous hydration, an anti-emetic, an anti-inflammatory medication, and a "Vitamin supplement" package.

You should really read their website yourself. Some copywriter did a great job of selling what I can only surmise to be a banana bag, ondansetron, and toradol. Those meds and the IV fluid will most probably cure any hangover quite handily. While I think this is a bit cheesy… I've got nothing but respect for their plan. Heck, if anything I'm jealous that I hadn't thought about it first. While I'm not licensed to practice EMS in Nevada, I could easily cruise around the streets of Milwaukee, Madison, or Chicago in my ambulance providing the same services to the over-imbibed folks in those fair cities. If we could ask for cash up front, like I'm sure they are, we could probably pull in a few thousand a week doing this. For that kind of coin any city could afford to fund the pension plan and give the nice EMS folks a hefty raise.

What I'm saying is, come on cash-strapped municipalities, belly up to the bedside and get your medical directors to authorize this service. Your budget woes are a thing of the past!

I do have a few questions though:

  • Is this legal? The owner is an anesthesiologist, but there is no mention of who is actually providing the service.

 

  • I'm a Nationally Registered Paramedic… are you hiring? Please?

 

  • Are you selling franchises? Cuz I could use one here in Wisconsin and Illinois real bad. I'd start my own but I'd need a medical director who would be willing… and the ones around here are probably spoil sports

 

  • Although… I haven't yet asked them if they  are ok with this. They could be. Perhaps it's better that you just sell me a franchise real quick and real cheap-like and we can just keep the brand-name going strong.

In all seriousness. Think of what effect this could have on the already overused emergency healthcare system in the city. I mean, if even 10% of the people who are going to be seen by this bus would have otherwise ended up in the emergency rooms getting largely the same treatment, this company could sincerely ease some of the burden on the healthcare system. It's definitely a cheaper alternative. Even their $150 treatment is way cheaper than a trip to the ER. This bus could immediately benefit the entire system by giving patients an alternative to the traditional, significantly costlier, methods. It will save insurance companies and governmental healthcare payors thousands and free up the ERs from taking care of this patient demographic.

I really do think they're on to something. Wish I'd have thought of it first.The success of this business will go to prove something. If it survives and thrives, then EMS can also find free-market alternatives that will help save our profession and the communities we serve. Obviously it can be done.

In other news, kudos to the State of Maine, who authorized funding for Community Paramedicine. Bravo guys, way to intellegently look for real solutions to your healthcare budget woes. I tip my hat to you. – http://www.jems.com/article/news/new-community-paramedicine-law-maine-loo

Notice anything similar?

Issues: I’m Scared of something, Have a Rhythm, and A New Column Up, Too.

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First off, my newest column is up over at JEMS.com – You might like it. I’m challenging the status quo. Like I do:

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

Did you read that and then come back? Good! But if not, I’ll link it again for you at the bottom. I’ve got a few other things that are on my mind today. Like this:

If you haven’t noticed yet, my posts are back in a rhythm.

I’m really enjoying all of the feedback and participation I’m getting on the blog since I’ve been hitting it regularly lately. I’m trying to do good, solid posts on Mondays and Wednesdays, with something on Friday to carry me through the weekend. On Tuesdays and Thursdays I plan on the occasional link love and mention of some of the other great bloggers out there. I hope y’all like the schedule and what I’ve been putting out lately.

But this week? The schedule is a tad off…

I wrote a detailed, strongly worded, journalistic, researched, and somewhat opinionated piece on a topic I care deeply about. It went long, so I broke it into two parts and planned to run it this week on Monday and Wednesday.

However, you’re probably noticing that you aren’t reading that post right now. That’s because the post scares me.

I am playing with fire with this post. Literally. It involves a burning issue that’s impacting a fire department that I am very familiar with. They, in turn, are very familiar with me. Their city council just voted to end their ambulance service in a move that they deemed purely financial. In the piece, I gave them strong advice and tough love after thoroughly exploring the issue as best as I was able.

But I’m scared to put it up here, honestly.

Any Fire-Based EMS vs. The World issue is a hot issue, fraught with peril for anyone who should so dare offer an opinion that isn’t “FIRE RULES!!! WHAT ARE THOSE IDIOTS WHO DON’T LIKE FIRE DOING!?!?!?!” I didn’t offer that opinion. While I support those firefighters and my good, long-time friends among them, I simply can’t blindly repeat that dogma. This issue is much, much more complex than that and unfortunately for my friends, that dogma isn’t going to work here. It has already failed and it will continue to fail if they continue to use it. The landscape has changed. Down is now up. Dogs and Cats are living together… Mass Hysteria! is happening and they need some new strategies.

Our friend Chief Reason wrote on the topic on his blog over at Fire Engineering and you can read his opinion on the issue I’m talking about here: “City Fires; Chief ‘retires’.  (Oh, and Art? We miss you over here at FEblogs)

Chief Reason does a good job of explaining the issue. I respect that man’s opinion a great deal and always have… and I’m not saying he’s wrong at all. I’m just saying that the argument he’s using to defend the position he’s defending is well… dated. The reality has changed as I have said and that kind of argument just isn’t going to work anymore.

Read Art’s post on the subject for more. I’ve written on it but am holding the post for a while. If anyone from Moline cares to talk about my opinion, I’d be happy to speak on it. However, I didn’t just write it for Moline. There is a much, MUCH wider issue at hand.

Here’s the deal: This thing that happened in Moline? It’s coming to your town. It’s coming to where you live and if you defend yourselves the same way I see them defending themselves, you’re probably going to lose your fight. (Not that I want them to. I support quality EMS in the City of Moline. I have a lot of friends and family that live and work there and I want the EMS there to be the absolute best it can be)

I’m going to think about posting the piece. Till then, if you care to read it before I decide, e-mail me at ProEMS1@yahoo.com or hit me up on Facebook and I’ll send it to you.

Also as I mentioned up at the top, my newest monthly column is up over at JEMS.com – Pop by and have a read. I’m challenging beliefs there, too.

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

GPS in the Ambulance – An overreliance on Ms. Kitty

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Actual conversation between me and my partner a few years ago right after receiving an emergency call:

Me:        “Lemme get this on the map… I think it’s South of us. Head South… Southeast! Yeah, it’s Southeast of us”

Her:       “Whattaya mean Southeast!? I don’t know directions. You’ll have to tell me Left or Right!”

Me:        < Scanning the map> “Um… Ok, we’re heading North, so make a Right up here on River Drive and head to Mulford. The street is right off of State and Mulford, one West and two South”

Her:       “It’s what?”

Me:        “Just head to State and Mulford and I’ll get ya in

Remember that? Remember those days when we used to use paper maps? I do. Man, those days were crazy… back when we had to use those archaic things, right?

Actual conversation between me and a different partner in the much more recent past while driving to an emergency call:

Me:        “Dang it! The GPS won’t get satellite signal! I can’t lock in the address”

Him:       “Where do I turn? What street is it off of?”

Me:        “Hang on, I’ll try to look up the address from my phone… Gah! Why is the connection so slow!?”

Him:       “I’m going to turn down this street… what was the address again??”

Me:        “Um… I think it was… 432 Mulberry… I think… Don’t we have a paper map in this truck???”

Him:       “I didn’t see one. Maybe I can get the address on my phone.”

Me:        “Wait, is that a cop up ahead? I think he’s at the call, drive up there.”

Cop:       “Hey! What took you guys so long!?”

Ain’t modern technology great?

It was only a few years ago that we got GPS machines in the ambulances I ran in. Previous to that we had survived off of our “Stacy Maps” which were these awesome map books designed by a local company. They weren’t sexy or technologically sufficient for the times… but they always got the job done if you knew how to use them. Sure, they were hard to read by yourself if you were the only one navigating the truck, but they worked… every time. No outside force could stop them from working. If you had one, you weren’t lost, period.

Now, with our increasing reliance on the magic voice in the GPS box (I call my GPS voice Ms. Kitty) we seem to be able to get to our calls seamlessly and smoothly… 90% of the time. There are times when the GPS doesn’t work, times when it’s just too darn slow, and times when it doesn’t have an address to lock in to. The GPS just isn’t always optimized for emergency response. I’ve found that my GPS is great when I am dispatched to 9933 Harrison St as a physical address… but not so much when I’m dispatched to “The bike path in the field behind Costco off of the side road next to the blue house”.

I remember a call I got once when I was working a relief shift at a contracted rural station. We had just cleared a call from a downtown hospital when the service got a call for a nasty auto wreck out in the country. Their dispatch asked us to respond as the third ambulance. I usually worked in the city the hospital was in so I knew how bad the regular routes were clogged with construction, being as it was summer in the Midwest. I drove and was able to use my knowledge of the city to get us around every bit of it. I took State St to Prospect, Prospect to Guilford, Guilford to Highcrest, Highcrest to Springcreek, Springcreek to Springbrook, Springbrook to Perryville, to… well, you get the idea. I was able to bob and weave through that city so much that we arrived at the scene in record time… which was just in time to be cancelled and sent back to quarters.

What I’m saying is that I knew the city so well because I had been forced to learn how to navigate it by reading paper maps. A skill that sadly, I’m afraid we’re losing as we increase our reliance on the magic directional box and the voices inside of it. GPS is a great tool, but since a huge part of our effectiveness as EMS people is actually being able to arrive at an address in a timely manner, it can’t be our only tool to find one. If you're relying on your GPS as the only tool you have to find the address of an emergency call, you're turning your GPS machine into a life-safety device. I'm sure the manufacturer will agree that It was never intended to be one of those.

My advice is to learn to love your paper maps. Read them. Study them as much as you study your medical protocols. Drive around your wider response area without turning on your GPS. Get lost in it every now and then and try to find your way around. Be sure to pay attention to the hundred blocks, the street names, and the short cuts. Don’t become clueless when Ms. Kitty takes a coffee break.

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For more of my “You Kids Get Off My Lawn!!” ramblings, you may want to check out “Those Darn Kids!”

“Teamwork” on the ‘bambilance – Shown as a video metaphor

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I read a good article written by (the highly educated) Guy Haskel on JEMS.com today called "Persona Non-Grata" and I've got to tell ya, I've been right there. I've been on the recieving end of exactly what he was talking about in the article and I have all kinds of empathy.

Here's the article - Read it and remember that you simply can't please everybody.

This article got me thinking about some of the more interesting relationships I've had with coworkers and partners over the years. Some of them have been very smooth and friendly and have resulted in some good friendships. Some have been smooth but less-than-friendly and resulted in some comfortable times at work… others?? Well… I'm sure you all can guess.

Have you ever had an ambulance or fire-department shift that felt like this? (This is such a good metaphor)

 

Wake Up! You may have a call…

2 comments

Every so often the discussion of the most healthy and appropriate way to wake a sleeping firefighter or EMS person from their slumber in order to alert them to the presence of a call for service crops up in the national discourse. Some believe that soft, gradiated lighting combined with a soothing tone and soft-voices is best for the long-term cardiovascular health of EMTs, Firefighters, and Paramedics. They say that a quick wake up to a jarring alarm tone is unhealthy and can cause long-term damage through a rapid increase in heart-rate and blood pressure.

I think it's BS, actually. I can't seem to get up without the assistance of Gabrial's trumpet, a car battery, and some alligator clips… and even then, I have woken up more than once in the middle of a call, coming to fully-realized alertness in the act of performing CPR or decompressing someone's chest. I think that that's way more startling. Also, our night dispatcher has a voice that would be very well suited to that of a 900-number call-taker and isn't the kind of voice that tends to make a guy want to get *out* of bed. ("Tell me more about the fire, Dave!")

While searching the world's most accurate source of information, the internet, I came across this invention. I love it. I may try and buy the rights to it and sell it to ambulance agencies such as mine.

Here, see for yourself!

In addition, I think this would be an awesome way to get the crews to do their shift chores. The supervisor of the day would keep the machines on until the garbage cans were emptied, the floors were mopped, the toilets were clean, and the training was trained.

I think it's a potential gold mine.

Wheel of the Regulars: Turn Turn Turn

5 comments

“Howdy April! “

“Hi Chris”

“I gotta ask ya… How did I look in my underwear tonight? I wore a special pair just for you”

“Um… What?? What do you mean?”

“Well, you always seem to call me to come over here just after I’ve gotten into bed and right as I’m going to sleep. I figured you probably have a camera in my bunk room at the station or something”

“Uhhhh…”

“I wore the pink ones. They’re special. Just for you.”

This conversation pretty much actually happened the other night. No, her name wasn’t “April” (because I’ve changed the name) and I wasn’t actually wearing pink underoos (they were purple) but the sentiment was there just the same. Even in my relatively small jurisdiction we have our share of “frequent fliers”, the regular patients who call 911 all the time and seem to make up an extremely disproportionate number of our annual calls for service. They’re our regulars. We know their addresses by heart and cringe every time we hear them come over the radio. Sometimes the regulars are sweet people, nice folks in every way who call us for legitimate reasons… other times; they’re not.

Regardless, the regulars are fixtures at every single EMS station I’ve ever been to. Every service has their share and every service knows them by heart. We get to know them, and they get to know the crews as well as drug seekers get to know the local ER docs. Sometimes they even get to know our shift schedules and only call on days where they like the EMTs that are working. Sometimes they just don’t care and call when they’re lonely, or when their scalp is itchy, or when their feet are dry, or when they’re sure the kid down the hall is up to no good and they know the cops will come when they call for an ambulance… etcetera.

Sure, I could be a good little EMS blogger and give you a bunch of useful strategies on how to positively affect the lives of these patients and offer them resources on how to more constructively manage their healthcare/loneliness/insanity needs… but not tonight. Tonight is the second night of an unscheduled 48hr shift and I know… I JUST KNOW that the camera in my bunk room is very much functional and someone is going to see my polka-dot underwear and call for me just as my head hits the pillow.

So tonight I’m going to tell you about my new idea for a game we can start to play here at the unnamed ambulance service where I work.

I call it, the “Wheel of the Regulars”

I plan on making a “Wheel of Fortune” style game board complete with a rotating wheel made out of plywood. I will put a spinner on it and divide it up into sections. In each section, I plan on putting the initials of our most prolific EMS regulars… the ones who we are almost guaranteed to see multiple times in one week. I’ll make it so that the wheel can be spun manually, and will eventually stop with an indicator showing the initials of one of the regulars.

Each morning at Start of Shift, I plan to have each crew-member take a turn spinning the wheel. That will be their bet for the day… if the regular whose initials they have randomly chosen through their spin calls 911 during the shift, they will win a prize. Their bets can be hedged by the EMT estimating the time the patient will call down to the minute, and the employee who gets closest to the time the regular patient actually calls will win an additional prize. I have a feeling that we can get a pretty good pool going with this and that it will be loads more fun than the run-of-the-mill sports pools that go around this place. I figure that if the game gets big I can make a lucrative side business selling the game board and the system for playing the game.

Maybe I ought to sell this idea to the people who brought out the EMS Monopoly game?

Nobody has found a really effective way to deal with regular EMS callers yet (Could I call them “Prolific Patrons”?) because the problem is as multifaceted as it is expansive. Sure, there are tools out there for our use, but none of them are very effective.

And until we find a way to fix the problem, we might as well have some fun with it. I even tried to come up with a song to sing while the wheel was spinning, but all I could think of was this:

 

Have a good night, everyone!

Does How Your Brain Works Affect Your Patient Care?

8 comments

Hey everyone, before you read the post below, watch this video. This is part of a test:

Now, after you have watched the above video and reacted to it in some way, read the following humorous statement:

“Some helium floats into a bar. The bartender says “We don’t serve noble gasses here!” The helium doesn’t react.”

(Ok, if you’re not a nerd.. The noble gasses (of which helium is one of) are non-reactive. Ha!)

Which one of those two things made you laugh harder, if at all? Did you have a positive or negative reaction to either of them? Both?

The reason I ask this, is because I told my partner that joke about the helium today. His reaction: “Wow… All that knowledge and you still can’t tile your bathroom floor.” He came to EMS after being a contractor and working in the trades. You know, doing stuff that you have to do with your hands. I did too, honestly, since I pretty much grew up on a farm with a father who owned a hardware store. So you’d think I’d be handier than I actually am. I can fix things, sure… but I certainly couldn’t build a house. That’s just not how my brain works.

Years ago, while working in an emergency room I overheard two physicians having a discussion about another ER physician who was very popular with his coworkers and patients. This doctor was friendly, jovial, kind, and nice. I liked him quite a bit and was a little weary of the other two docs talking about him. They talked about how nice this other doctor was to all of his patients and how they wished they could have him follow them around to all of their own patients and be the “nice” doctor who made their patients feel better while they attended simply to the cold, hard realities of their patient’s medical needs. Their solution was that a happy medium could not be reached, and that a healthcare provider was either “too nice and incompetent” or “competent, but a jerk”.

And today, after my coworker brought up the severe need for a new tile floor in my bathroom, I thought back to that conversation. He and I are both paramedics. While I’m more experienced and have been a paramedic for more than a decade longer than he, He and I both take care of the same types of patients with the same types of complaints and make similar results. We follow the same standing medical orders and work under the same medical director in the same ambulances. However, since his brain works so very differently than does mine, how can we possibly achieve the same results?

People choose their physicians based upon their personalities as much as they do anything. They want to develop trust in their doctor, and the interpersonal relationship between doctor and patient on outcomes has been widely speculated upon and researched. I wonder if the same phenomenon exists within EMS. Does the way our personalities, experiences, strengths, weaknesses, and other traits affect our patient outcomes? If my brain is wired so very differently from my partners, how does that affect his patients’ care over my own?

I don’t have the answer to the questions I’ve asked here, but I’ve become pretty curious about this over the last hour or so. To help answer the question of what personality type you think makes the best type of paramedic or EMT, I ask you to write your opinion in the comment section below. I think that we might get some pretty darn interesting answers. 

Be sure to put which humorous thing you most enjoyed above somewhere in the comment.

(Oh, and so two Atoms were walking down the street. One said “Oh no! I’ve lost an electron!” to which the other replies “Are you positive??”)

 (Also, my friend with the Ph D in chemistry said that the helium joke was “A real ARGON-er” – Get it? Ha! Nerd humor is nerdy)

Those Darn Kids!

16 comments

These darn kids and their new-fangled toys!

Hey, at least I aint @FossilMedic 's Age yet.

Call me old fashioned if you want to, but allow me to hike my EMS pants way up higher than my belly button and talk in my Old Grizzled Medic ™ voice for a second here. You see, the kids these days are doing something that just tans my hide. What, with their iPhones, and their iPods, and their iPads, and me with my iGlasses and the Etch-a-Sketch… Confound it! I just don’t understand.

You see, Youngins… back in my day we didn’t have all of these fancy techno-toys that we do now. When it came to running on the ambulance, we made do with what we had and that was the way we liked it. What, with all of the trudging 20 miles to work in the feet of snow uphill with the both ways and whatnot we earned our measly pittances and then trudged back home to our coal-heated shacks to jitterbug away the three hours we got off of work in between our 120 hour shifts. We didn’t need all the pansy stuff you enjoy now.

We did our medical care to the best of our abilities then. We actually had to LIFT our patients into the ambulances on the cot, rather than having the little button lift 700lbs with one finger. We had to look at actual paper maps to find addresses, rather than having the nice lady in the GPS tell us where to go. Heck, we even had to write paper reports on our EMS calls BY HAND USING A PEN.

Paper reports written by hand do one thing and only one thing very well. They suck. They are simply awesome at sucking. They stink on ice. They are medieval torture devices left over from the Monty Python version of the Spanish Inquisition and honestly, the day we switched over to computerized reporting I stabbed a wooden stake through a stack of the dreaded Illinois “Bubble Sheet” EMS report forms. Then I poured gasoline on them, turned around and flicked a match behind my back as I walked away in slow motion without looking back at the explosion and flames. I was wearing sunglasses. It was epic.

It was Just Like This! Only with more geekery and no little girl and I was shirtless...

Paper reports could be documented at the patient’s side but it just always seemed so darn inconvenient to do so. I did it occasionally during long transports, or when we were running back-to-back calls and I wanted to jot down the high-points of each call on the report form so I could accurately remember them when I got the chance to catch up on my paperwork. It wasn’t uncommon to be “down” four or five reports in those days because we were just so dad-gum busy and the reports took so blasted long to `complete. A stack of those paper reports could give you writers’ cramp for days. Especially the Illinois “Bubble Sheet” forms which I used for years, they were awful monstrosities constructed to worship the demon “ScAnTr0nn” who mandated that little bubbles be filled out perfectly for every name, address, and number you scrawled on the form. Those evil little dots cost me hours of my life, a good amount of my hair, and most of my sanity. After using the awful bubble sheets for years, I switched systems to a place that utilized a somewhat less-evil paper report form, and then back to a place that still used the hated bubble sheets, and then Huzzah! To a place that had computers.

Although I must admit that the hand-strength I developed from writing those awful things made my one-handed beer can crushing trick a hit at parties.

The first report I wrote on a computer was a simple little form written on a then state of the art laptop that weighed approximately 17523lbs. It took forever to load, locked up and lost reports frequently, and was an absolute gift from God. Then, the regional EMS system stepped in and put computers in the EMS report rooms at the hospitals because nobody could ever figure out how to hook up their ambulance laptops to the ancient dot-matrix printers they’d provided for us. Those programs were sweet! I hate switching my hand between a mouse and a keyboard 15 times per second to enter data and the reports we used on the desktop were forms I could simply use the keyboard with the whole time. I actually typed faster than the program could keep up and knew just how many times I had to tab through a list to mark the correct spot on the form without seeing it on the screen. I’d end up having the report typed out a few seconds before the machine caught up and put the words on the screen. It. Was. Awesome.

Still, those reports were something that could only be done away from the patient’s side. We all had note pads to jot down info we wanted to put on the report while we were treating the patient and we took those notes to the computer to enter into the report. Nowadays, them kids with their fancy technology have Toughbooks with touch-screens that they use to write their EMS reports and since their invention, I’ve noticed a trend.

It first started when I noticed my medic protégé Chad had a habit of bringing the toughbook in with him to emergency calls. He’d grab the jump kit, the o2 bag, and the computer. Then, while he was interviewing and assessing the patient, he’d be starting their report.

This dismayed me. Again, call me a crazy old coot and an old-fogey… but I believe that we should not only focus 100% on the events of the call and upon what the patient is telling us, but also that we should give the appearance that we are doing so. You just can’t make me believe that a patient is going to feel that we are listening to that which ails them and are paying attention to their needs when we have our nose in a lap-top. Sure, it may save time on the overall reporting process by allowing the EMT to get an early start on the documentation, but it also ends up taking more time on scene to wait for the computer to enter in information. I also think that it takes away the EMTs ability to fully observe everything that is going on with the patient and the scene around them. It robs one of their situational awareness and of the nuances of the patient assessment.

That, and it’s just plain rude.

It bothers me enough that I launched a whole ridicule-based diatribe against my young protégé and shamed him into no longer bringing the computer into calls with him. I have no problem if he begins the report at the patient’s side during transport as long as he has completed everything that needs to be done and he makes sure to monitor the patient thoroughly. That’s cool, I guess. I am glad that he won’t have to suffer the pain of hand-written EMS reporting. That’s a cross us Grizzled Old Medics™ bore for you with honor.

You’re welcome. Now get off my lawn, and STOP USING THE COMPUTER IN FRONT OF THE PATIENT!!

Back in the Saddle Again!

4 comments

Back when I was a high-school student I was completely enamored with EMS. I just couldn’t wait to slip into a uniform and get out on the streets of an ambulance. While in retrospect maybe I could have refocused the energy I spent researching the EMS gig into something a little more profitable, the sheer amount of stuff I read about EMS in my formative years helps me in my job to this day.

One of the earliest EMS blogs I ever read was one that I found back in High School. I forget the name of it now and I would guess that it isn’t even still up there on the interwebs anymore. However, the writer’s acerbic descriptions of his own life under the lights of an ambulance were hilarious and fascinating to me. I’ve never forgotten the words he wrote.

I was reminded again of one of his stories this morning when I was getting off shift. I’m finally back in the back of an ambulance after spending some time at my secret-squirrel job and I’m loving it. While I wish I got paid more to do what I love, I do truly love what I do. This morning was no different. Again, the EMS gods had me laughing until I cried while an elderly lady screamed in sheer terror.

Yes, I said that. No, I’m not a monster. You would probably have laughed too. Hard.

This morning the radio decided to wake me up around 0430 for the tip-up of the uninjured fall victim. I went, assessed, found nothing, and tipped the poor guy up back into bed. It was a simple call. He signed off on a refusal form, and all was right with the world again. I went back to the station to write the report and after some time spent in between dozing and typing on the Toughbook, I finished my report around 0600. By then it was too late to go back to bed and sleep for an hour, so I stayed up to wash the ambulance and make sure the shift chores were done. It’s the custom at our company to leave the quarters pristine for the oncoming shift, so we do a full cleaning in the morning before shift change. It works for us.

Around 0630, my partner and protégé Chadwick sauntered in to the station. The poor kid had been ran hard and put away wet the day before and looked unapologetically fresh in contrast to as haggard as I looked. Darn Kids. As he helped me dry the trucks and sweep the floor, I was teasing him about catching a late call.

“Can you feel it, Chad?” I would ask. “Right now, there’s some guy that’s waking up and walking up to the toilet for his morning dump who’s gonna vasovagal out and seize on the bathroom floor. It’s your call so when you kneel down, try to avoid the skid marks.”

I kept razzing him as time went on, and when we finished washing the trucks we walked outside to enjoy the crisp, bratwurst-and-cheese-scented Wisconsin morning.

“Did you hear that?” I asked, “that was someone hitting the floor”.

And amazingly, right then the tones went off. It was for a medical alarm that had been activated at a non-medical senior-living high-rise in town. Coincidentally, it was for a fall victim in the bathroom.

Nice.

Chadwick mumbled something that might have been profane I’d think if he wasn’t such a Bible-Thumper and hopped in the truck. I drove because it was his call. On went the lights before I opened the bay door. I think it’s more dramatic if I turn the lights on before I open the door. It just looks cooler that way. Johnny and Roy did it, so I can too. I also wear my helmet like they did. Yay me.

We arrived on scene right before the less-than-optimally-caffeinated police officer who was responding with us. He was able to finagle the key out of the knox box and let us into the building. Apparently last week one of our crew had gotten fed up with the key not being in the box at this building and had opened the lock in a gentle, professional way using his foot. Apparently the building management wasn’t happy with them for doing that, especially since it was for a call that turned out to be a false-trip of a medical alarm. Today we found the key in the box… weird how that happens.

Chadwick and I deftly navigated the long hallway and the small elevator up to the third floor with our stretcher and all equipment in tow. Hypo-caffeine Copper tagged along, and we found the door to the apartment locked up tight. Luckily for the maintenance man, he had the key right handy for us to use.

We entered the apartment with us yelling “Ambulance!” and him yelling “Police Department!”  I thought it was redundant, but hey… he needed to wake up and yelling something helps that. We heard the sound of a running shower and walked towards the bathroom yelling our respective titles.

The patient heard us, no doubt, and did her best Wicked Witch of the West impression as she yelled “Ohhh Myyyy GAAaaawwwd!” We explained again about the whole “Ambulance!” and “Police Department!” thing, but she was having none of it. We told her that somehow her button had gotten pressed and that the machine had called us, but that didn’t seem to ease her fright at having three strapping young men in uniform show up to help her shower, apparently.

After much consternation on her part, and my starting to laugh the tears out of my eyeballs we thanked the lady, apologized for her fright, and cleared the scene to head to the police department for the fresh pot of coffee the officer said he was dreaming about. We hung out, and since I’m a renaissance Medic I tweeted in a HIPAA friendly manner about the call.

Some of the responses included such things as:

 “So I guess the Medical Alarm button is now the ‘Bring Someone to Wash My Back Button??”

And,

“If she pressed the button and got three young public safety types to show up and help her in the shower, is there a way that I, personally could get the button for my own use? We’d have to have a gender setting, of course… As I require attractive young members of the other gender to help me with my showering endeavors”

And,

(something that was absolutely HILARIOUS regarding “Old Lady Boob” that I have redacted from my blog site, you’ll just have to get on to Twitter to see humor of that caliber)

So after this morning’s antics and activities, I can safely say that I absolutely love my job again. I never stopped, but I’m happy that I came back refreshed from my hiatus. I missed the people we see, their twisted humor, and their acerbic personalities. It’s just like the first EMS blog I read said it would be and I praise whomever he was for his accurate description.

Sorry about the lapse in posting, y’all. I’m back and am loving it. Hope you are all too.

You Can Nap if You Want To! Or You can Leave Your Calls Behind!

17 comments

What a week! You’ve been pulling at least a double shift a week at your full-time ambulance job and have been hitting it pretty hard at your part-time job as well. Both services can’t seem to keep their schedules filled and everyone’s been working lots of hours in order to keep the doors going up and the trucks going out. To top it all off, the citizens just can’t seem to be good lately and both services’ call volumes have been high.

You were tired when you got up this morning and were seriously considering a nap after your morning shower, but after a gallon or two of coffee you were bright and shiny in your uniform at your station, ready for another day of EMS greatness.

That was five hours ago though, and the early barrage of calls fired at you this morning has turned into an afternoon lull. Now you’re sitting at your main station, close to the brass, with the words in the educational article you’re reading fading in and out of your bleary, cross-eyed vision. Since the activity level has decreased, you’ve gotten yourself a case of the sleepies that you just can’t shake. Since you’ve been consuming the steaming bean juice religiously lately, your stomach just won’t let you think of having another cup of the acrid station coffee and there’s no shift chores left to do, since you did them an hour ago fighting the same lethargy.

Unfortunately, in three hours you can see a long distance transfer scheduled that you’re probably going to have to do. Four hours of monotonous highway driving and the radio in the truck doesn’t have that great of reception. You don’t have any idea how you’re going to stay awake enough to drive the truck and that’s not even considering the fact that if the tones went off right now for an emergency you probably wouldn’t remember how to put on a band-aid, let alone remember a drug calculation.

You’re tired, you’re fatigued, and your body’s telling you that you’ve been pushing it too hard. It wants to shut down for a while. Your brain won’t think. You’re mouth won’t talk. You can’t keep your eyes open and wake up with a startle when you’ve realized you’ve dozed off for a bit. This is torture.

Sleep deprivation is no stranger to EMS people. We’ve all fought the lethargy caused by long 24, 48, and more-hour shifts. A great number of us work more than one job to make ends meet and pack as much family time and recreation into our off time as we can. A lot of us are going for more education and all of us get woken up from our sleep a lot more often than is healthy to run on calls. I regularly miss full nights of sleep and rarely have a night when I can say I got a full night’s sleep. We get use to it some of the way, but our bodies just aren’t meant for chronic sleep deprivation. We need to reset and reorder our brains and let our bodies recharge once in a while.

Unfortunately, our communities need us and we have to be there for them. EMS is important and it’s easy to get sucked in.

That’s why in this situation, I have very little dispute with taking a “Safety Nap”.

"SSSS-AAAA-FFFF-EEEE...."

The “Safety Nap” is a quick power nap. A shut-down and reset period where a person who never knows when they may be called to be up all night without sleep can rest and relax for a while and ensure that they’ll be wide awake and alert for whatever they may be called to do. I took an hour last shift around 3pm as a matter of fact. I didn’t get to sleep until 1am afterwards and I was up at 5am for a call. EMS is like that, shift work is like that. We have to ensure that we’re well-rested enough to make quality decisions of the type we have to when they need to be made… and we can’t do them well when we’re drooling on ourselves from exhaustion. One of Murphy’s laws for EMS states that “You know you’re in EMS when your favorite hallucinogen is sheer exhaustion” and I have to tell you, I’ve done that while on duty before. It’s just not safe.

There are problems with this, I know. Some will say that we shouldn’t allow ourselves to be scheduled this many hours and that it’s irresponsible to do so. Well, then they can come talk to my bosses and pay my mortgage. Some people will sleep all day if they let them, and won’t put any effort into their shifts unless they have to. That has to be monitored. With that said, a balance has to be sought. I see nothing wrong with the occasional safety nap and I believe that EMS managers should allow it. They also should be unafraid to throw a cup of cold water on the Rip Van Winkles among us to ensure that they pull their weight with the non-call-response aspects of an EMS job.

What do you think? Does your employer allow “Safety Naps”? Do you take them?

I’d write more but Zzzzzzzzzzzzzzzzzz

To Kneel or not to Kneel

23 comments
“Muungh… What the heck was that!?” I thought to myself as I looked around the darkened room. “Where am I? Why am I awake? What IS that awful noise?” I thought. Something had awoken me from a not-so-good sleep on a not-so-comfy sofa. Slowly, I realized where I was. “I must have fallen asleep in the day room at the station” I thought. “Why am I awake?”. I heard commotion outside and realized that it must have been the radio that woke me up. Somewhere in the dark subconscious recesses of my brain it came to me that the pager said “Person not breathing, CPR in progress”. I pulled on my shoes and thought the most important thought that any EMS provider can have when being jolted from a deep sleep at 0′ dark 30 to try and wake the dead: “I have to pee!”

 

 

Once the bathroom duty was completed I slid into the passenger seat of the ambulance and pulled up the address on the map program. My partner pointed the ambulance South while I clicked on the siren. Wailing into the night we went, lights flashing, adrenaline pumping, morning breath so bad I could slay a walrus. “Where did I put that mouthwash?” was my thought. So focused on the job were we.

Arriving at the address just behind the engine company from the first due station we hurried to gather up our gear for the battle ahead. Monitor? Check. Airway and drug bags? Check and Check. Backboard? Check that too. We hurry up to the front door and are met by a middle aged female saying “I couldn’t wake him up! He was fine when we went to bed!” We enter the bedroom and I see the middle aged male on the bed. His lifeless eyes were fixed and unseeing as we approached him. His mottled skin was cool to the touch. Long gone was any fighting chance at life. I knelt on the bed next to his torso to check a pulse and apply pads to get a strip and immediately know what is going to happen next.

“I’m freakin going to have freakin dead guy pee on my freakin knees for the rest of the freakin shift! Dang it! Dang it! Dang it!”

EMS people kneel a lot, and not just when we want a raise or need to get state-to-state reciprocity from an EMS office. At one of the departments I work at we did a big action photo spread of all of the EMTs and Medics in action. EVERY SHOT was me kneeling. Kneeling at a patient’s head working on the airway, kneeling at the patient’s chest starting an IV, kneeling next to a patient to assess them after an injury, I kneel so much that you’d think I have a promotion by now. We all do.

But you’d think that by now I’d know enough not to kneel in poo, pee, blood, vomit, or whatever vile substance is on the bed, floor, or surface that I have to kneel on. I mean come on. I’ve been doing this over a decade now. I have thousands of calls under my belt. I live, sleep, eat, breathe, blog, and study EMS as much as I can stand to (and that’s a lot) and I *still* am stupid enough to put my knees in poo on a somewhat regular basis?

Right now, I’m on the 2nd day of a 48hr shift a half hour away from my home. Last night, around late evening I knelt in a poo/pee mixture. I was really trying not to here, but the patient began to vomit after we got (the Pt) on the backboard in the cramped, carpeted bathroom (the Pt) was in. I couldn’t log roll (the Pt) without kneeling and the carpet was just saturated with a vile mixture of hours old poo/pee. My knees got soaked in it. And no, if you are asking, I ran out of the house late and didn’t think to bring an extra pair of pants and the pants that I had kept at the station had been taken home for laundering after another like incident.

For times like these, I recommend the “Ckemtp” method of knee disinfection. It applies for those times where call volumes don’t allow you to actually take your pants off to clean them:

  1. Put on gloves. No sense in contaminating your hands. Chances are your knees won’t have broken skin on them unless you’ve been trying to get that promotion (Enough with the “on your knees” jokes! – This is serious!)
  2. Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
  3. Spray the ever-loving bejeebus out of your pants, saturating your knees with disinfectant spray. DO NOT use bleach-based spray. The milder the better. (see “Clean EMS” for advice on contact times)
  4. Press another towel on the outside of your pants, soaking up as much poo/pee laced disinfectant into the towels as you can. Rub them together a bit.
  5. Re spray with disinfectant and let it air dry.
  6. Remove the towels from your pants.
  7. Call your wife and beg her to drive you up a new pair. Beg. Hard.

Just for the record, my lovely wife was unable to drive me up some new pants. Awesome…..

Foot-in-Mouth-Itis. Stupid Things We Say in EMS

21 comments

A letter I received from a reader who states that she is a paramedic student has gotten me thinking. I’m going to include her letter in this post with her permission, but before I do I would like to speak a little bit about things that we say to patients. EMS and all of emergency medicine tends to be full of emotionally charged situations being handled by emotionally drained people. Sometimes our experience in dealing with situations that lay people find to be traumatic can lend itself to our making comments that we find perfectly acceptable to make at the time we make them, and yet upon reflection seem like the wrong thing to have said. I can’t tell you just how many times I’ve been in trouble for my mouth. I will say something that I intend to relieve the tension of a situation and to provide comic relief that I think is cute and funny, completely thinking that it is above-board and not-offensive to anyone, and then find out that some wet-blanket took offense.

Honestly, I make it my policy never to make a dirty joke. All of my “patient friendly jokes” are clean enough to tell to my five-year-old with nary an off-color word or adult reference in sight and sometimes still people look at me like I’ve dropped a live weasel in the ball-pit at the McDonald’s Play Land. Like some random time ago where a patient who had overdosed, scratched her wrists with a dull knife, and was found trying to hang herself apologized to me during my assessment of her because she hadn’t shaved her legs. I said “Oh that’s quite alright, Ma’am.. You weren’t planning on needing them anymore and besides, you shaved your wrists real nice”. I believe the question I got from my partner after the call was “Does your Brain-Mouth filter even work anymore?!” He was laughing as he said it, so obviously it was funny. The patient laughed too.

I have stock comments to the common questions and situations that come up on calls that I trot out when needed to liven up the situation. Some are movie quotes, some are lines that I’ve stolen from other providers, and some are straight up from my strange brain. Like when I find someone lying in bed that needs to be lifted over from the bed to the cot with a sheet and a couple of people. Some beds are way too wide for me to work from my feet and it’s often useful to crawl right in bed alongside the patient to lift them over. I ask them “So when was the last time you had a strange man in your bed?” The unconscious ones almost always laugh. I have yet to have an older lady blush and be embarrassed and the comments I get back are always entertaining. Also, when I’m palpating an area of a patient’s body to see where they’re hurting such as for an injured extremity or the like, if the patient yelps out in pain when I touch something I excitedly declare “Found it!!” It’s much to their relief to know that I know where it is that they hurt. I also have what I call the “Poor Man’s X-Ray”. If someone thinks that something’s broken on their body, I grab it, give it a good squeeze and a shake, and ask them if it hurts. If they say “Yea that hurts” it’s probably not fractured. If they say “YEeeeeEEaaargh!!!” it probably is.  

So, exactly how serious do you think I’m being with all of that above there? Here’s the test. If you took me serious enough that you want to call my medical director to tell him to pull my license… I was joking!! Ha Ha!

I remember probably the worst thing that I’ve ever said to a patient ever, and in all seriousness I still feel bad about this comment to this day. Early on in my career I worked as a Security Guard *slash* EMT at a big regional 400 bed hospital/trauma center/psyche center/everything center. Usually I worked alone on weekend nights and it was an absolute zoo. While this was one of the most enjoyable jobs I’ve ever held, I was in way over my head for an eighteen year-old country boy working in the big city. One day we had a patient come in who had been witnessed swallowing baggies full of what was presumed to be crack cocaine during a traffic stop. He was belligerent as all heck, swearing at us and trying to swing at the police officers who brought him in, the nurses, and myself. He looked at me and said “So what the (colorful word) is going to happen to me now you (something my mother would be unhappy with me if I typed on my blog, or even thought about for that matter)” I asked him “So, are you a religious man?” To which he replied “Blankety-Blank No!! You Blankety Blankin Blank blank!” I said back to him “Well you probably should be, because you’ll need to be saying some prayers”. Then he seized and went into V-Fib. I have no idea if he survived. I honestly feel really, really bad about that. I wish I hadn’t have said it.

So when you read this letter, go easy on the paramedic student who sent it in. She seems to feel pretty bad about saying what she said and since I’m going easy on her, you probably should too.

Here it is:

I did something colossally stupid today.   Something so… irresponsible and cocky that I truly can’t believe I allowed it to happen.

I allowed myself… to assume.

To assume that as a paramedic student I knew enough about a patient’s condition that I could safely make a statement to a family member, when in reality, I should have just kept my mouth shut.

It was careless. It was reckless, and it resulted in a family being given false hope.

He was brought into the ER by two of his daughters for a syncopal episode. He hadn’t been feeling well for a few days, and his daughters had been forcing him to eat. When they found him on the floor next to his bed writhing in pain, they loaded him up and drove him over to the local ER.

His VS upon arrival were… less than ideal. Hypoglycemic, hypothermic, hypotensive.   He had the hypo’s covered. His coloring was even less impressive than his vitals. A few amps of D50 and some warm blankets later and we had 2/3′s of the hypo’s resolved. He was no longer altered, he was flirting with the nurses, and the color had improved.

Still, his BP was crap. His tank was dry. He needed fluids, and after his third liter bag, his BP in the 60′s started to creep it’s way towards 70 and 75. I did a happy dance in my head.

Then it happened.

I was removing some of his blankets and replacing them with some that were straight from the warmer when daughter number 3 asked me a question. “His blood pressure is still so low, should we be worried?” Me. The only one in the room with them that had any medical experience.

Five sets of eyes were on me in an instant.

I finished tucking a piping hot blanket in and casually said something to the effect of, “His BP is coming up, he’s just a bit dehydrated. One more bag and I’d be willing to bet that his pressure is better than mine.”

Ugh. How could I let myself say something like that?

I didn’t know that he had a fractured hip.
I didn’t know he was in kidney failure.
I didn’t know he had a leaking AAA.

I didn’t know the complete picture, and I should have just kept my mouth shut.

I guess it goes without saying, but his blood pressure never came up. It dropped, and it dropped again, and it dropped again.

The family was informed of the complete picture. A DNR was signed. Hospice was called. He died before he could even make it to the inpatient hospice facility.

A family was given hope, because I gave it to them. And I had no right to do that. Watching them emerge from a family consultation room, one by one with blood shot eyes, holding each other when just two hours earlier they had been laughing and joking with their father…

That was probably the hardest lesson that I’ve learned in school. It’s one I’ll never forget, or forgive myself for.

——————————- 

So the student who wrote this letter expects to be flamed for it… I’m willing to bet that the response will be just the opposite. We’ve all been there. We’ll all be there again.

What about you?

Advances in Prehospital Analgesia and Conscious Sedation

10 comments

Pain is endemic within Emergency Medical Services, whether it’s the pain from a grotesque traumatic injury, the chest pain from a heart attack, or the emotional pain suffered by the local teenage drama queen in response to a minor texting-while-driving incident. EMTs and Paramedics must become better at overall pain management and in conscious sedation. Luckily, there are researchers and pioneers working on new and innovative strategies for just that end.

Researchers at the Plover, WI Polytechnic Institute of Cosmetology and Cheese Making  (PPICCM) have been bringing some cutting edge research to the forefront of Prehospital Pain Management and Prehospital Conscious Sedation and have released some new technologies for use in the field. They have field tested these devices in the dive bars in and around Plover on Friday and Saturday nights and even once or twice on the infamous “TwoFer Tuesdays” down at MoeLarry’s Curly Fries and Cheese Bar. They have come up with compelling data that your agency should consider for your own use.

Tradtionally, EMS providers have had a few choices for use in prehospital analgesia and conscious sedation. Advanced providers and paramedics have injectable medications for use, and basic level providers and EMTs have basic splinting and positioning for use in controlling severe pain and the secret weapon for use in putting people to sleep. These medications, including Morphine, Fentanyl, Toradol, Aspirin, and sometimes Nitronox have proven to be very effective, but all of them carry with them side effects and the risk of allergic reactions that can prove fatal in some patients. So can the medications used in Drug Assisted or Rapid Sequence Intubation Techniques: Etomidate, Succynocholine, and the like. To reduce the risk of poor outcomes from these medications, the researchers at PPICCM have developed the following tools:

  • The Open Handed Slap – This is effective as a calming technique for persons who have become hysterical due to superficial trauma to their fingers as well as for family members overcome with emotion due to their loved-one’s bout of indigestion. An example is included below:

 

  • The Mallet Method of Anesthesia Induction – Pioneered by the indomitable Drs Moe, Larry, and Curly (and previously by Dr. Shemp), the use of mallets in induction of conscious sedation is well documented. Simple, yet elegant in it’s use, cranial contact by the fast-moving business end of a mallet is highly effective in reducing any complaints of pain from a patient. In fact, just the visual feedback recieved from opening the case the mallet is stored in and showing the patient that you are preparing to use said mallet is effective in reducing complaints from most alert patients. However, if needed for use, one or two blows in rapid succession is shown to be quite effective in the literature. An example is included below:

 

  • Transcutaneous Oxygen Therapy (TOT-WTYTR) - This method involves pressing the external wall of a “D” sized oxygen cylinder against a bony prominence of a patient in the throws of a violent reaction towards EMS providers. Use of TOT can be handled by both Basic and Advanced providers and it’s effects are determined by the speed and location of the bony prominence that the side wall of the oxygen cylinder is applied to. Lower extremities can be calming while the head and cranium can induce anesthesia and facilitate Rapid Sequence Intubation in most patients. Unfortunately, there is no accompanying video literature for this particular therapy, however it is a simple technique to learn.

Thanks to the brilliant scientists at the PPICCM, prehospital anesthesia and analgesia is in good hands. These simple yet powerful techniques are scheduled to be released for use by my agencies on April Fools Day and should NEVER EVER be used by yours. Ta’ Y’all. Happy Spring.

Ten (or so) things that you should try to do with every patient

9 comments

 

I am not a perfect medical provider. In fact I’m really only practicing prehospital medicine (Ha ha!) but there are a few things that I try to do with every patient to improve my care for them and improve their comfort level as I care for them. I can’t claim that I always remember to do these things, but I really try to. I think that you should too.

Here they are (in no particular order other than ZIP code):

  1. Always introduce yourself and your partner to the patients and their loved ones using your first name. I wouldn’t want some upstart guy in some uniform type thing just randomly poking at me. I think that it reduces patient anxiety when you properly introduce yourself to your patient. I say “Hi, I’m Chris and I’m a paramedic with F&B Ambulance Service and Taxi Squad. This is my partner Fuzzy McGee. What is your name Sir/Madame?”

     

  2. When you’re in the back transporting the patient after you’ve given them most of the care you were planning to give them, go over your assessment again. Ask the patient questions that get them to expand on their original answers. Challenge yourself to find anything that you may have missed. 
  3. Play a game with yourself. Try to have the patient diagnosed by the time that you get them to the ER. If you can’t figure it out, fire up the internet when you get back to quarters and look it up. You’ll learn a lot of good medical information by doing this. I have.

     

  4. Once you get the patient in the back of the ambulance if they’re not facing an immediate “Life-or-Death” crisis ask them “Is there anything I can do to make you more comfortable?” Maybe another pillow or moving the head of the cot up or down would help them. Do it if they ask.

     

  5. Try not to have the pillow stuffed under the patient’s shoulder blades. It makes it uncomfortable when they’re lying on the cot. Moving the pillow up from under their back and placing it under their heads makes them a lot happier. They won’t know to ask for it. Just do it.

     

  6. If you find a patient down with an isolated fracture or dislocation get pain meds in their system before you start splinting or packaging them. It does take a bit more time, but you’re not being very humane if you don’t.

     

  7. You are the patient’s advocate when you walk in to the imposing world of ER care. Your job is to present them to a medical system that is overworked and overtired. Stick up for them and make sure that the medical care providers that are following you learn about what is wrong with the patient before you throw him or her to the wolves… er, um, nurses. I mean nurses.

     

  8. Before you hand off your patient to the ER, ask them: “Is there anything that I haven’t addressed? Is there anything that you would like me to be sure and tell the ER about?”

     

  9. Explain to the the patient WHAT you are going to do and WHY you are going to do it.

     

  10. Approach EMS with a servant’s heart. No matter what some EMTs may think, we are here for the patients. It’s not the other way around.

     

By trying to do these things you’ll provide better patient care. I think that I’ve grown as an EMS professional by doing these things. I’ve also grown as a person by doing these things. Let me know how this works out for ya.

Firefighter Vs. Nursing Home – I can relate, can you?

5 comments

Yesterday morning when I came into work, the guys were laughing about something playing on one of their cell phones. Being that I work with some um, “colorful personalities”, it literally could have been anything playing on that little screen and heck yea I was interested in seeing what it was they were busting a gut over.

The video, surprisingly related to EMS for that setting, was one of those videos made with the lego characters entitled “Firefighter Vs. Nursing Home” and I immediately related to it. The setting is supposed to be a nursing home, the “firefighter” in the video is supposed to be a paramedic or EMT, and it’s as funny as it is sad. It’s funny because you hear the “nurse” talking in the video and she’s saying things that you’ve heard from every nursing home you’ve ever been in. I mean, this could have been the “nursing” home up the street from me, or one of the myriad up the street from me in my other job, or any one of the ones in any place I’ve ever worked.

Let me know if you’ve heard these phrases:

“I just came on shift”, “She’s not my patient”, “She’s altered”, “I don’t know her history”.

If you’ve been in EMS for like, 5 minutes and have been to ONE “Nursing Home”, you’ve heard these phrases. It’s like there’s a nursing home handbook that every person that works in one has to read to get the phrases that they’re supposed to use with EMS providers… Really it’s uncanny how similar this is to hundreds of interactions I’ve had with nursing home staff.

I’ve embedded the video below here… and I have to put some warnings on here. First of all: There is some blue language, including a few utterances of the grand poobah of swear words. There’s also a reference or two to an “adult situation”, and obviously the person who made this (and I don’t know who it was, it was not me) was expressing huge amounts of frustration with his or her own interactions with “nursing” home staff. So if you don’t want to hear swear words, sassy-talk, and a reference to an adult situation, don’t watch it.

Oh, if you’re a nursing home nurse, or a CNA, or anyone who has worked in a nursing home, or has a friend who’s worked in a nursing home, or has someone who might work in a nursing home that you might be friends with and you’re mad at me for putting this up there… here’s my stock reply:

“Not everyone who works in every nursing home is a bad person, it just seems that way sometimes”

“Some of y’all are actually almost human beings”

and…

“I sure would NOT want to do your job, I couldn’t… ever… so Thank God for you if you care and you’re good at what you do.”

Mental Quickness – Do Smart Alecks Make Better EMTs?

8 comments

Alright, I admit it. Driving to work this morning was a bit of a challenge. We had two inches of fresh snow and the tires in my car are in desperate need of replacement. Yes, I drive a Subaru and usually it’s all-wheel drive does awesome in the snow… but I cheaped out on the tires, and they’re honestly a bit mismatched size-wise. Therefore driving it in conditions even remotely slick is hard as heck. I would have driven the SUV and had no problems at all but the wife had to drive the kid to school and then had to drive into the city afterwards and I wanted her to have the safe vehicle. Who cares if I go into the ditch? Work can do without me if they have to, but I need my family to be safe.

Since I think of things to write about when I drive, this morning brought my thoughts to how hard I had to concentrate on the road and the minute adjustments of the steering wheel and the accelerator needed in order to keep the car safely on track. Like everyone who knows about driving in slick conditions, I kept my eyes on the road ahead of me in order to “read” the changes in the road surface before I got to them in order to be ready to quickly make the adjustments needed to keep the car heading in the right direction. See a dark shiny patch? Foot off the gas, be ready to steer slightly away from it when the car slides in that direction. See a pile of snow with a frozen rut running through it? Minutely avoid it if possible and steer into the slide with just enough change in the gas to power through the slide. I made it to work, but I had to call in a favor to have a guy stay over for me for ten minutes. I let him know the night before that he might have to, and I did leave early… but I’m not wrecking the car just so I can save a few moments.

I consider myself a pretty good driver in the snow. In a vehicle with good tires I wouldn’t even worry about anything less than 6 inches this far into the winter season, but today was hard. I’m not patting myself on the back here, because if I would have put good tires on the car in the first place I wouldn’t have been in this position, but isn’t that most of what we do in EMS? We end up using our mental prowess to clean up other people’s messes caused by their lack of planning all the time. Today wasn’t much different. The amount of mental power and concentration needed to keep a car moving forward safely in snow-covered conditions is actually quite staggering when you think of it. You have to make quick observations of rapidly evolving conditions, surmise what you think the presentation of the road surface means to vehicle’s path of travel using your limited observations paired with your past experience and knowledge, and come up with a near simultaneous decision on how to handle the situation ahead of you. If you find yourself to be wrong, based upon the car not reacting the way you want it to, you have to instantaneously correct the situation while adjusting for the conditions ahead… or crash.

Now picture yourself managing a challenging patient presentation, one requiring a handful of pharmacological and physical interventions. You’re pretty much doing the same thing as driving in snow. Just like playing a game of chess, you have to be “thinking a few moves ahead” in order to keep up with what the patient’s physiology is going to throw at you. Do you have a fall victim with a broken hip in need of pain control? Did you think that they’re possibly going to drop their blood pressure with a dose of morphine? Well then you better be ready to give fluid to bump it back up to acceptable levels. However, what if you’re treating a CHF patient that would suffer further from the added fluid? What if they were a patient with Chronic Renal Failure? Would that affect your initial dose of morphine based upon the unknown factor of untoward hypotension? In my Northern system, I’d choose to use Fentanyl over Morphine in that case because of the lessened risk of hypotension, but in my Southern system I’d just have to start with a lower dose of Morphine and slowly titrate to an acceptable level of pain control once I gauged the patient’s response to the med.

How about a patient with a large anteriolateral MI? Their Left Ventricular function is soon to be compromised if not treated in a cath-lab. You need to increase blood flow to the Left Ventricle and decrease overall cardiac work by decreasing afterload with use of nitrates, but that’s going to decrease their cardiac output and blood pressure by decreasing their preload as well. You need to stabilize the infarct as best as possible while maintaining the patient’s hemodynamic state, and you may need to consider supporting their left ventricular function with the use of a vasopressor such as dopamine to treat possible cardiogenic shock. In this case, careful observation of the patient’s presentation and all information available to you is of paramount importance in order to make the minute treatment decisions necessary for your patient’s best possible outcome.

It all comes down to “Mental Quickness” or having the mental prowess and state needed to rapidly intake complex information, process it against your knowledge base, and then make reasonable decisions on a course of action in a very short period of time. We call people who are good at this “Quick Witted” and it applies to myriad situations in daily life. People who are good at this are usually funny, are quick to react to new situations, handle change fairly well, and make darn good EMS providers. I practice by trying to have a joke ready for any situation… so you could also call a person who’s mentally quick a “smart ass”.

You can practice your skills at being mentally quick the same way I do. Use humor and try to make good comebacks to the hooks and barbs that your coworkers and friends throw at you. When we’re sitting around busting each other’s chops… we’re actually practicing our EMS skills, right?

Think about it. Exercise your mind through reading, learning new things, and trying to come up with new ways to think of existing information. You’ll be funnier, more popular, will be able to knock your buddies down a peg better, and will improve your patient care.

Zombies!!!

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I hate horror movies…

A while ago I walked into our crew lounge where the other members of my crew had just popped in some low-budget zombie flick. It was your classic “B-Movie” and had all the hallmarks of every good zombie show that I’ve ever seen. Gratuitous bloodshed by hapless victims? Check. The walking dead feasting on human flesh? Check. A few good looking zombified women? Check and Check. I watched it against my better judgment. I hate horror flicks for all of the above reasons, except for the good looking women of course. I have an annoying habit of taking on the characteristics of every movie that I watch for varying lengths of time. After watching Top Gun, for instance, I drove my car like a fighter pilot for a few days. After watching Star Wars I tried to use the force to get the TV remote from across the room when I lay down on the couch. After watching the South Park Movie I swore every other word. Really. So I don’t like horror flicks because I get scared like a little girl afterwards and I don’t like it.

Unfortunately though, I watched the whole thing like a doofus, knowing full well that I’d be having nightmares later.

Cue the call for the unresponsive seizure victim…

We went to an apartment complex where our patient had fallen into a seizure right by the inward swinging door to his apartment. He had fallen in a way that made it so his body was blocking the door and I could only swing it open a few inches, just enough for me to squeeze inside. He was pretty out of it, and wasn’t responding with anything but unintelligible grunts and groans.

Then, of course, he moved and shut the door, blocking it with his body and trapping me alone in his apartment with him while he was groaning on the floor.

Does it make me a scaredy cat because I thought I was going to be eaten by a zombie?

I hate horror flicks…

 

Equipment Review: Scary Post Ahead

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This was one of my first posts. Since I’m attending an EMS conference, I figured it deserved a bump-up too. Good Luck!

Some of you have been telling me: “Chris, you’re a good paramedic. You should be providing tips and tricks for EMS people so that they can use your hard-won wisdom to improve their patient care. Don’t spend your time ranting about things that bother you in the back of the truck and keep making feeble attempts to make people laugh. Write a serious article, darn it!!”

Actually, I’m really the only one that’s been telling me that, since this blog is only read by like, six people including my mother, fiancé, and my cat… but nonetheless I am going to attempt a serious piece regarding actual patient care issues. As such, I have identified piece of equipment that is carried on my ambulance and is most probably carried on every ambulance in the country. This particular piece of patient care equipment is rarely used, yet critical for patient care when needed. When this piece of equipment is called for, the patient needs it and needs it NOW. Yet, I’m sure that even the most experienced EMTs and Paramedics are struck with horror at the mere thought of its use.

I’m talking here about: The bedpan.

Yes, in my storied career I have been called upon to use a bedpan more often than I would have liked to. The situation is almost always the same, the patient is otherwise stable but the pressures of the bumpy ride on the human bowels are just too much for him or her during the prolonged transport time. Usually in complicated cases like these I prefer to bring along a nurse, since they are eminently more qualified to perform in these critical patient care scenarios. However, as is often the case in EMS, we are called upon to take care of any patient presentation in any patient population and must perform professionally in all situations. I have researched the use of this piece of patient equipment in numerous trade publications and critical care guides and have been struck with the lack of educational materials available for this critical patient care skill.

So, as any EMS writer would do when setting out to write a patient care article, I hit the streets to query other paramedics and EMTs on their secrets for the proper use of the bedpan. I began with the coworkers I have at my two ambulance jobs, one a private, not-for-profit city 911/Specialty Care Transport service and the other a Fire Department based service. Both of them work around 3000 calls per year and run at the ALS level. Here is a sampling of the responses I received:

Question: By a show of hands, how many of you have used a bedpan in the back of an ambulance??

Answer: I raised my hand.

Some of the people there wanted me to clarify the question, they wanted to know if I meant had THEY themselves personally used a bedpan in the back of an ambulance? One guy admitted to using a urinal in the back while transporting a patient. When badgered by the other providers, he clarified by saying that it “was a pretty long trip”. I offered that there have been some situations in my career where I have put the bedpan under a patient who absolutely HAD to go poopie during a trip to the hospital. However, and I just realized that this is the most blessed thing to ever happen to me ever, not one of them has ever been able to “go” with me hovering over them.

Of course, in EMS, I have been covered with every imaginable bodily fluid, including the unholy trinity of urine, vomit, and feces ALL AT THE SAME TIME. And I have plans to erect a statue to the person who came up with the idea of prehospital people administering Zofran (an anti-throw up medication). The other day I spent a few minutes starting a saline lock IV on a lady in her bed inside her apartment just so that I could give her that blessed medication. My fairly new EMT partner wanted to know why I did that, when I usually wait until we’re back in the truck. I let him know that I had been on the foot end of the stair chair going down the stairs before the golden-age of zofran had arrived.

Yes, us “experienced” EMS providers (read: old people who never got real jobs) will tell you that when you can’t let go of the end of the stair chair without letting your patient plummet down a full flight of stairs and the patient chooses THAT EXACT MOMENT to decide that they just *have* to throw up. You well, you just have to close your eyes, close your mouth, lower your face to cover your nostrils, and take it like a true professional. Been there, done that, cleaned the chicken and rice out of my ears with a q-tip. It’s moments like that when you reevaluate your commitment to the profession, and realize that it must be something other than the *interesting* amount of money that they pay you that keeps you coming to work every day. For me, it’s the amount of time that I get to spend typing up articles about bedpans and vomit in my ears… at least it is right now. Has anyone else ever thought that they had been ruined by EMS? I mean, I don’t think that I could ever do an office job. Years of EMS work has left me with the remarkable ability to begin to focus on something like a laser beam for 90minutes tops, then… Hey look!! A Bunny!!

Oh yea, bedpans. So you slide them under the patient and um… Pray that they’re positioned correctly. Wear correct BSI including a pair of gloves, a mask, goggles, and Vick’s Vapo-Rub under your nostrils. Of course, for us old timers, this is required even when you’re making your partner use the bedpan in the back while you drive (heh) Ever So Carefully to your destination. Tell your partner that they need the experience, tell them how professional they are being and tell them that they’re showing true compassion to the patient. Then go out and buy them an ice cream cone filled with Rocky Road. With any luck, you’ll get to eat that too when they suddenly become less than hungry.

In all seriousness, everyone poops. Never let your patient suffer when you can alleviate their suffering with a simple slide of the bedpan under their derriere. Of course, make sure that they REALLY have to go to lessen your risk of contaminating yourself with some really funky pathogens, and also to avoid ticking off the nurses’ lobby by taking their jobs.

Until next time…

 

Cat Puke Chicken

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Note: This is a repost. I’ve been a busy blogger and this post deserved a bump-up. Also, the “Fiance” in this post is now my lovely wife. Enjoy.

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The other day I got off shift at 8am and had to be to work at my other full-time job at 10am. Since both of the jobs that I work at are about a half hour from my house in opposite directions it worked out that I had about a half hour to go home, perform the personal hygiene ritual, change uniforms, and get on my way to work again. So I did that, got home, fed the cat, and got all prettied up as quickly as I could. Then, without warning, on my way out of the house I noticed it: A pile of cat puke on my rug.

Yes, I like cats. I have one. She’s a keeper, regardless of her regurgitation issues. I think that I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty. So cat puke on my rug isn’t the horror of horrors to me that it might be to some people. In EMS, we tend to get puked on by humans more often than does the regular population and that fact may have further desensitized me to the violent act of emesis perpetrated on my rug by my mostly cute little kitty. However, I do like a clean house and the cat puke on my rug is an issue that normally warrants immediate action.

But of course, that’s not what happened. And for those of you in a spousal relationship with another human being you know exactly what I did. You guessed it, I left the cat puke on my carpet and went to work. For those of you who are not in a spousal relationship with another human you may not understand the thought process here. Yes, as I looked down at the cat puke on my otherwise (mostly) spotless rug the thought that it must be immediately cleaned up did in fact occur to me; but the other thought that occurred to me was: “I can leave and go to work and when I get home, my lovely fiancé will have cleaned this up for me. She’ll think that the cat puked on the rug *after* I went to work and I’ll get off scot free!”

And so that’s what I did. Yes, I *could* have taken the five or so minutes it would have taken to clean up the cat puke… but in my defense I’m a model employee and I need those extra five minutes of early arrival time at work to drink coffee and to tell everyone what a model employee I am. So if I would have cleaned it up I would have taken the risk of not being such a model employee. So you see, leaving the cat puke for my lovely, beautiful, and remarkably intelligent fiancé (who will probably read this, btw) to clean up was not something that I did because I’m lazy. It was something I did so I could continue to bring home the bacon for my family in the most productive manor possible.

That’s what I thought anyway, until I came home late that night after a hard day’s 10 hour shift off of a hard fought 24 hour shift spent saving lives and alleviating the suffering of the sick and injured and stepped in the same pile of cat puke on my carpet that I had courageously not cleaned up the morning before. True, she had put in a paltry 12 hour shift at the fire department practicing for the recliner racing 500 and had fed, bathed, and put our son to bed; but that didn’t stop my obviously well-earned righteous indignation to the pile of cat puke permeating my pile covered floor. She had decided (although she swears that she did not in fact see the pile of puke) that I should be the one to clean up the cat puke using some amount of flimsy logic that I have yet to understand.

So, to tie the above 646 words back into the title of the piece, “Cat Puke Chicken” is not the new special at your local Chinese Restaurant. It is the battle of wills that solidified between my fiancé and I as soon as my sock made contact with partially digested Kitty Kibble. We both subconsciously agreed to ignore the cat puke for as long as we could stand it in order to have the other person clean it up first. (See also: “Laundry Chicken”, “Last Sip of Milk in the Carton Chicken”, and “Couples’ Counseling”). This occurs a lot, unfortunately, in most relationships between other perfectly rational human beings. We know that we don’t like having cat puke on our carpeting; we obviously know that the cat puke should be cleaned up at the first available opportunity; and we also have continued doing the other things that we normally do to keep our houses from turning into slovenly hovels. In fact, while this has been going on I have cleaned numerous dishes, laundered, dried, and folded at least four loads of laundry, and have started (but not finished) three household improvement projects. I’m at least as good as a housekeeper as the next guy (Read: Not a good housekeeper) and I do indeed do my best to keep my family and myself from living in squalor.

So why, as two perfectly rational adults who um, chose to work in EMS, are we locked into this powerful battle of powerful wills? In a word: “politics”. Not the kind of politics that provide the revenue stream for the myriad of cable news networks, but the politics of household supremacy that truly affect our day to day lives. This isn’t Senator So-and-So bloviating about the fact that pork in the stimulus bill is in fact, not pork… it’s me and the woman that I love and want to spend the rest of my life with deciding who shall be the designated Cat-Puke-Cleaner-Upper!! Pulse pounding stuff here.

And as with everything else, this got me thinking about politics in EMS.

Say you’re in a service way far away from anywhere where I work and you have a small volunteer squad that covers the areas that your service is not jurisdictionally bound to cover. Sure, your service would be glad to come if they called you, but somewhere back in history when the powers that be drew the political boundaries they decided that your service was not responsible to respond to the pleas for help that come from that particular geographic area. Suppose that your service just happens to be a small ALS service with two paramedic ambulances and a BLS ambulance on duty 24/7 and the other service was a BLS squad with volunteers coming from home and/or work. These volunteers are dedicated, caring individuals that want to do the best that they can for their friends and neighbors but work in a system where when a call for service comes out it takes about 20 to 25 minutes for the system to get an ambulance to the patient’s side. Say also that the service that you work for has your three ambulances and paramedics about 6 miles from their patients staffed and on duty but you can’t respond because the political system is such that you would be in trouble if you did so.

You may also relate to having that coworker in your EMS or Fire service that just isn’t up to par. They may be a basically qualified EMS provider through the state licensing body, but you still would cringe at the thought of that person responding to take care of anyone in your group of family or friends. They’re a provider that just doesn’t get it. Their care is substandard, their attitude is poor, and you can’t help but feel that the patients being “cared” for by this individual or crew aren’t getting the best medical care possible from your service. You’d want to say something, and normally would, but you’d become an outcast in your agency and would be looked down upon for blowing the whistle. Besides, even if you did the service is short handed and your management wouldn’t fix the problem anyhow because they need to staff the trucks.

Or maybe you can see that EMS in general is underfunded, underappreciated, and undereducated and you can’t shake the feeling that something has to be done to improve patient care industry-wide. You feel powerless to do so, but you’re angered every time you see a representation of bumbling ambulance drivers on TV, or see the local news completely mishandle a news story involving EMS, or especially when you look at your paltry pay check.

In all of the above cases, you’ve got cat puke on your rug and you’re hoping that somebody else is going to clean it up.

As EMS professionals, we know that there are myriad little political games that play out in each and every little jurisdiction a
cross the map. This service may not call this service for mutual aid because someone’s brother once stole a pumpkin from one of the other service member’s brother’s pumpkin patch. “Jim” may not provide good care, but you let it slide because he’s popular with the other crews. Sure, the local fire department gets a kajillion dollars more in funding than your EMS service does and runs like a tenth of the calls that you do, but that’s just the way it’s always been, right?

We need to step up as a profession and clean the cat puke from our carpet. Ignore the politics. Ignore the personal hurt feelings and the power plays. EMS is about the patient. It isn’t about you, or me, or that person down there. We exist solely to save lives and alleviate suffering in the people that we serve in the best possible way that we can. Nothing else matters more than that. So if you can see that cat puke on your rug, and I’m absolutely positive that you know exactly what I’m talking about no matter where you are, you probably have better things to do than be playing chicken. We all need to stand up and say that we are the Cat-Puke-Cleaner-Uppers and that quality EMS is our responsibility, no matter what little political games of chicken are going on. Our patients deserve nothing less.

(Fiance’s note: As of press time, the pile of cat puke on Chris’s floor is still intact solidifying into the fibers of the carpet)

 

Swinging a Sledgehammer and Thinking about the UK… Strange times

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So here’s the good news. The ambulance service I work for up North, “Ambo’s R’ us” has finally taken the leap and is getting us a new station. Yep, that’s right folks. I will no longer be living in squalor whilst working up here in the vast frozen wastelands.

Except for one little hitch in the gittyup.

In big ambulance services, when one gets a new station, usually the service employs people to work on the station, build and/or remodel the station, and move the stuff from the old location to the new one. Not so in a small, rural ambulance service. Nooooo…. Here, a paramedic is expected not only to work on the ambulance during their shift, they’re also expected to put on their tradesman hat and get their hands dirty.

So, yep… today Ckemtp was not *just* a paramedic. Today yours truly was a demolition man, a moving man, a wall-paper remover, and a carpenter’s apprentice. All of my crew mates were today too, as were the crews yesterday, and so will be the crews who are unlucky enough to come work ambulance shift any time in the next couple of weeks.

But here’s my mea culpa confession folks: I’m not handy.

There, I said it. I am so not handy that hardware stores actually have my picture up on their walls stating that I must ask for staff permission to enter their premises. Apparently they want someone to follow me around with a fire extinguisher because there’s a concern that I might come into contact with a carriage bolt or something and the resulting sparks will start a fire. I, like most of my colleagues, became paramedics because we’re generally not handy enough to get a good paying job in the construction and/or “real job” industry.

What’s that you say? You’re a full-time paramedic/EMT and you own/work/watch a construction business on the side? Well good for you. I don’t. I write stuff about stuff and ride ambos.

The dreaded “other duties as assigned” clause in my job description is being stretched so thin here that you can hear it singin’ in the wind. I didn’t sign up for this. It’s actually very hazardous to my health and well being for me to be doing anything remotely construction or “handyman” related.

There’s a lot of reasons why, the risk of fire, explosion, and/or structural collapse being amongst them… but they’re not the real reasons that I’m so worried about this. You see, I have a lovely wife named Gkemtp(it) who is the absolute light of my life. However, together we own a home which happens to be the scourge of my existence. Like EVERY guy who owns a home, my home is full of things that are disintegrating at an alarming rate. There’s ALWAYS something that needs fixing and they rarely respond to an IV, o2, and monitor. Heck, even my clock radio didn’t do well with defibrillation. I can’t give my clothes dryer Epinephrine to get it started again, my clogged drain didn’t respond to a heparin bolus, and my leaky faucet leaked right through an occlusive dressing. I just don’t understand my home and its malfunctions the way I understand humans and their maladies. It’s awful.

So my wife knows that I am the opposite of the handyman… and she’s pretty ok with it, lest she nag and have me end up breaking something much, much worse than it was before I tried to fix it. I *like* that she’s ok with it… And I don’t need her to think that I came to work, built us a shiny new ambo station, and learned how to be Bob Vila with an NREMT-P patch. It’s bad enough that I clean toilets, vacuum, and do dishes here at work. If she found that out, she might make me do more of that at home.

So I’m stuck here. I’m destined to make anything I fix much worse than it was before, I’m destined to demolish something I’m not supposed to demolish, and I’m destined to make an egregious wiring error that’s going to burn the place down while I’m sleeping inside of it and I won’t even get to go to the fire because I’m on ambulance detail!

Maybe I should move to the UK and work with my good buddy Mark Glencourse, of Medic999 fame. One of the biggest things I took from the Chronicles of EMS, his and Justin Schorr’s (The Happy Medic) foray into cross-national EMS exchange (Soon to be an AWESOME TV show!!) is that UK firefighters DON’T CLEAN THEIR OWN STATION! Yes. They FREAKING HAVE CLEANING CREWS THAT COME IN AND CLEAN UP ALL BUT THE MOST SUPERFICIAL MESSES! Hell, they even have a bona-fide chef to cook for them.

And here I am, scrubbing toilets and swingin’ a sledge hammer here in the ‘States.

So, I’ll keep toiling until I break something so bad that they make me go post somewhere where I can’t hurt myself, and Mark will keep living in the lap of luxury.

Maybe being a Limey isn’t so bad.

A quick Shoutout to EMS Chick

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EMS Chick has shared a bit of my EMS geekery on her blog “That’s BLS, not BS” (which is a title I just love). She wrote a post about decontaminating the ambulance from a LOT of mud… and um, showering with EMS equipment too…

http://emschick9.blogspot.com/2009/12/hidden-joys-of-ems.html

I wonder what results one would get if they fired up Our Friend Google and typed in “EMS Chicks Showering with EMS Equipment”. Are ya back? Good, now try it with the “safe search” off. (Note to my wife, I did not try this)

Take care everyone

My Biggest Blogging Fears and Heart Attacks

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Want to know what my biggest fear as a blogger is? It’s that one day you may find out that I’m an idiot. You’ll find out that there are things that I don’t know, and those things that I don’t know will be something that “any idiot should know” and if I don’t know them you’ll think that I’m not as smart as “any idiot”.

Take this issue for an example. Say you have a 48yo M Pt with substernal chest pain. He indicates with his hand that it’s radiating towards the lower left part of his chest from the manubrium. He stresses that he doesn’t perceive it as “pain” per se, but that he feels it more as a “pressure” and he rates it at a 4 out of 10. He denies that it exacerbates to movement or palpation, and it doesn’t change with respiration. His skin is slightly flushed and moist and he complains of some shortness of breath. He states that he’s been experiencing it for an hour or so, and that it’s getting worse despite antacid tablets and an aspirin he took. The patient has no medical history and takes no meds. He does have a family history of heart disease but has never experienced any problems.

What would we do here? Easy: a 12-lead, IV, o2, and EKG Monitoring is in order. You do that and get…

A normal 12-lead EKG. Nothing is wrong with it. Not a darn thing.

Doesn’t that suck? I mean, no, not for the patient of course… but for you. Now what are you going to do? Are you sure that this patient’s chest pain isn’t caused by cardiac ischemia? You’ve seen the 12-lead… but you also see the patient’s presentation. They seem to contradict each other, don’t they? If this patient had three boxes of ST segment elevation in three leads, you’d know right what to do and the treatment would be pretty straight-forward, right? Now it’s not so clear.

I’ve vacillated in my career between giving nitroglycerine to these types of patients to make sure that there isn’t something I’m missing with them. My usual decision is to prophylacticly give one NTG tablet (0.4mg SL) after the IV is in place under the doctrine of treating the patient and not the monitor; but I don’t call the cavalry, activate cath lab, or give them the bigger drugs we have to give them (Our STEMI protocol includes: o2, Asprin, Nitroglycerine tablets and paste, Morphine, Metoprolol, and Heparin while bypassing the closest ER by a minimum of 45min to go direct to a hospital with interventional cardiology capabilities)

You tell me that I should contact medical control for these cases and I do if I have something vital to ask that I’m unsure of. I do know that I can’t possibly know everything about everything there is to know about. I also, like probably a good number of providers out there am sometimes afraid to be found out as an idiot by asking a question that “any idiot should know”.

So there you have it. Like most people, I’m afraid to be found out as an idiot and it’s keeping me from asking questions that may give me the appearance of being stupid and ignorant.

Unfortunately for my urge to go hide underneath a rock, I have a blog about EMS that I feel compelled to write something on every day. This means that eventually, I’m going to write something that is so stupid and ignorant about something that you are going to find me out for being an idiot. I may even ask a question about something that I should know by now and you may laugh at me for not knowing the answer to the question I ask.

So I’ve made up my mind. From now on, with you as my witness, I am going to be unafraid to ask dumb questions about things I should already know about. If I don’t know something, I’m going to assume that there’s someone out there that doesn’t know it either… and I’m going to write those answers down here on this blog just for that person… and for you.

I hope that maybe you might start being unafraid to ask those types of questions too. You never know what you might learn. The only cure for this affliction is to buck up and ask the questions, knowing full well that every single person out there feels the same way that you do… and is scared of being found out themselves.

Or you can come here and find out the answers that I’ve found out for you. I’m already a known idiot… no sense in you risking your own neck.

See you tomorrow, Folks.

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.

The Project is coming and I’m Helping

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“The Project” is coming. As I’m sure that every single person who reads my blog knows, Happy Medic and Medic999 are planning the first International Medic Swap between the United States and The United Kingdom’s EMS systems. It’s beginning very soon, and I’m very excited about it. Fact is, I just plain can’t wait for Mark (Medic999) to pop over here across the pond and get a taste of Good Ol’ US EMS. Then, I’m sure that I’ll be anticipating Happy heading over to Mark’s side of the pond just as much. I’m planning on making it over to one of them to hang out with the two biggest stars in EMS blogging.

There, that’s enough fawning over my two best blogger buddies. Now it’s time to add something that’s missing from this whole equation that I think that I’m amply qualified to provide. Here guys, this is my gift to you. Enjoy. I’m helping.

Today I sent out a Facebook comment directed towards my friends on the Packer’s side of the line congratulating the Packer’s fans for being so “Sportsmanlike” after being decimated by their former godlike QB. I’m not a Packers fan, and actually I’m not much of a sports fan… but I do like Bret Favre. Not so much for the sports, although he is an artist with a football, but because he really seems like a stand-up guy in the vapid egotistical wasteland that is contemporary “professional” sports.

But enough about that. This is about my Facebook comment. Medic999 popped up and commented that, basically, we US people were whiny little crybabies and our favorite sport is meant to be played by 8-year-old schoolgirls who have sprained ankles. (I’m paraphrasing).

And with the ensuing exchange of comments, I figured out what I could add to The Project.

Trash Talkin’ that’s what!

So, ya Lilly Liver’d Limey (What does “Lilly Livered” mean?) Whatcha gonna bring to show us US medics? Huh?

Oooooh, so your little car is GREEN with BLUE CHECKERS on it! Mine’s a big SUV with a big powerful engine. It’s a 4×4.

Just got the IO drill? Hmmm, had that for a while over here. Yep, good thing you’re catching up.

Oh, so you’ve got “Tail Lifts” to pick up your stretchers for you, huh? Here we’ve got these things we call “muscles” and “brute force”.

 Hmmm, so you UK guys run all blue lights and have “nee naw’s?” We run Lights and Sirens, or “Code-3” or “10-39”. Yea it’s manly! Ever heard a Federal Q? You’re going to. Better bring some aspirin, you’re gonna getcha self a headache.

You may have played some Rugby, but we occasionally run in to burning buildings. I get to go to work and “Drive Fast and Break Things” when I’m on the fire side. We get to swing axes and mauls and tear apart cars with hydraulics. What do you guys have? Crumpets? What’s a crumpet?

Awful quiet over there from your side of the pond. What’s that? Nothin…. That’s what.

(Attention, the above has been all in good fun. No offense intended. If you were a whiny cry-baby and couldn’t take a little trash talk, then I apologize)

Could it be? A Good EMT-B Student?

4 comments

What is with students these days?

I precept and mentor quite a few students these days. Maybe it’s because I’m old and my memory is going south on me, but I don’t think that I acted quite like this current crop does when I was a student. I think that I took it seriously. I think that I respected the elder members of my profession and did what they told me to, right?

I always tell students that I’m a real jerk when I’m precepting them. I’m not… but I like the whole Mr. Myagi (old reference, look it up youngins) thing. You know, “Wax on Wax off” equates to something EMS related or what not. I try to reinforce the things I think that are important for them to know to be a good provider at whatever level they’re currently working on. Everyone has to work on their assessment and patient communication skills. Everyone has to get good at MANUAL BPs, listening to Lung Sounds, Abdominal Sounds, and their patient’s stories. Everyone has to get good at not being afraid to assess the patient in a competent, professional way. I figure that once they get the assessment and the friendly, professional communication thing down, the rest can be reinforced pretty easily.

Recently I’ve been adopting the “Dr. Cox” school of mentoring students. I love the TV show Scrubs. On the show, Dr. Cox torments his young protoge’ relentlessly and calls him a different girl’s name every time he addresses him. I think that it’s funny as heck and I’ve been doing that lately. The first student I did it to left the program after a week (Not my fault! He was running with another medic a lot more than he was running with me!) and the second, well… the second student I pulled this on really surprised me.

He was an EMT-B already, but was fresh out of class and was working for a fairly slow volunteer service that one of our part-timers volunteers for. She had brought him over to get some experience on a busy service and since I was her partner for the day, he got to be subjected to my whims as a preceptor. I think his name was Stacy, Jennifer, or something.

We had two calls right off the bat. A refusal at a “Nursing Home” that called us for a patient with pink eye, and a “Elderly Man out of Control” at a farm house way out in the country where the County Sheriff ended up transporting on. This kid seemed to be good luck, considering that we weren’t having to go to any coffeeless hospitals that early in the morning. Our streak of luck ended when we caught a tranfer from an ER to a secondary admitting hospital for an elderly lady with a GI bleed.

This was perfect for the kid. It was about an hour-long ride with the patient. Plenty of time to teach the kid “friendly banter” skills with the patient and also to have him do a reassessment q 15min while I sat back, cracked jokes, and worked on the three reports. Win win. We picked up the patient at FavoriteSmall Hospital ER and got her in the truck. He was quiet at first, as all students are, but I made a deal with the patient. I asked her if she could help me get the student over his shyness. Oh boy, she did. She talked his ear off the whole way and he participated in the conversation like a champ.

Yes, I think that it’s important to connect with your patients on a human level. He did that pretty well, actually.

The only thing that I thought he needed work on was how he took blood pressures in a moving truck. Admittedly, that’s a hard skill to master. One of my cardinal sins is to make up a BP and tell me the made-up number you “think” it is. He may have done that.. but I didn’t call him on it right away. Instead I waited until after the trip because the patient was very stable.

“So Denise, how sure are you on those BPs you took? Because… I didn’t know if you could really hear them or not..” I asked him.

“Uhhh, well I was pretty sure… mostly… a little I think” he stammered.

“Stacy, just make sure that you tell me you’re not sure if you’re not sure. I’d rather use incomplete information than fictional information anytime. I’m not accusing you, just curious here.”

After we got back to quarters, the calls died. The other truck ran a DOA but we didn’t get anything for hours. Knowing me, I sat down and worked on the blog for a while and ended up putting a couple of hours into the new site design. After two hours, in walks the student and takes a BP on me. Apparently the kid had spent the last few hours taking Blood Pressure readings on every person at the base!

I think that his name was Joe. He can ride with me anytime.


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