Tuesday, January 5, 2010
1:02PM - In-Laws Wedding
Tuesday, July 28, 2009
9:22PM - Close Encounters of the...
Allow me to share with you a story.
So there I am; dutifully doing a clinical/intern rotation in one of the more 'remote' (Read: Rural) agencies that we were offered the chance to ride with. My goal here was to see how things worked outside of the "big" city, in a place where your average patient transport time was about an hour.
As the morning progressed, and we saw a few patients. After the first few, I had a tremendous personal "EUREKA" moment. Turns out people are people, no matter how far from the city they may be. Their problems, anxieties, and fears don't really change. So much for country living.
But this isn't a story of one young mans journey to self enlightenment. There will be no "coming of age"-ness to this tale. No. This is a story instead, of how I was almost murdered by a platoon of US Special Forces.
Dispatched to an allergic reaction, at a factory on the outside of town. So there I am, a guest in this foreign county stuck in the back with the only view to the outside being what I can see through the side-door cut out, and the back doors. As we were racing down the road (Dispatch felt this was 'bad', and told us so.) I offhandedly made the remark to my preceptors in the front seat. "Good god is that a lot of razor wire." For that's what I could see. At least a mile of razor wire, on top of a 12 foot high fence in front of this otherwise unassuming forest. "Heh." was the answer I got from the front seat. Slowly our ambulance decellerated and took a turn into the razor wire. Peering up between the front seats, I saw that we were driving into the razor wire. Or more accurately, a security gate cut out into the razor wire fence. As we drove past the automated doors, I turned and noted that the people at the gates were wearing camo uniforms and carrying assault rifles. "Oh, fuck" I would have said outloud had I not at that moment turned to look once more out of the front of the ambulance. My mind need a moment or two to adjust to what it had seen. Slowly it began filtering in information, albeit in a random and abstract order. Some of the more obvious fragments: Armed Escort, Massive Factory, Army Minesweepers, A lot of Army Minesweepers, Soldiers on Parade, Driving Into The Hanger, More Minesweepers being assembled, More Soldiers, Backdoors being opened, ASSAULT RIFLES, SOLDERS WITH ASSAULT RIFLES, LOTS OF SOLDIERS WITH ASSAULT RIFLES.
And other such nonsense. I was far too focused on the job at hand to even notice anything other than what was... oh who was I kidding. I stepped outside, told the soldiers what needed to be unloaded, and then looked around the inside of this massive 433,000 sq/ft factory. (I verified the size later.) So we were lead to the patient (Himself a uniformed soldier, if you sense the theme), who was exhibiting acute/albeit non-life-threatening symptoms of Montezuma's Revenge. Or badly reheated mexican food if you want to be more specific. And not say, an allergic reaction. So without even thinking, I did my thing. Kneeling on the floor before him, talking to him, assessing, etc. Just like I'd been doing it for years. (And at this point, I think I have. I'd have to actually count days.) But as I was talking to him, my spider-sense was tingling and so I looked around. At the ring of soldiers, all protectively encircling their stricken comrade, and glaring at me. Like I mean, Glaring. Like, "I haven't eaten in 6 days because I've just crawled down the desert mountains on my belly with only a knife to fend off the wind, dust, rocks, and scorpions and you are holding the last steak for 12 miles." Glaring. I looked the emblem on their shoulder, some fancy schmancy stylized "AA" sort of thingy. I think it also said something about 101 such and such. *shrug* And then I looked at the emblem on MY shoulder. "paramedic STUDENT". Suddenly, the whole concept of "scene safety" took on a whole new meaning. And I was shaken badly by this whole scenario. Truth be told, I was actually scared. (Reminder: Edit out that part later.) So I did really all I could to turn the odds in my favour. "Can we take you to the hospital, please?" "Sure." "Great." Stood up, stood back, and let the fire guys do their thing of getting the patient on the cot and outside to the ambulance. As I was walking out, this very large, immacuately coiffed, and very very NOT humorous looking man steps in front of me. I can reasonably guess that he at one point in his life, or another, probably bit the heads off his sisters Cabbage Patch dolls and left the severed bodies laying around because he enjoyed hearing her tortured cries. That sort of humourless. "May I come with you?" Says he. "Yes sir, you may." Say I. Then some hidden aspect of training kicks in. "But you'll have to ride in the front." Says I. "I will end your life impudant man" Says he. Well, not really, but if a grunt could say a thousand words... those would be in there.
So there I am pushing the stretcher through this very large hanger, surrounded by soldiers. Some armed, some not, with one of their own in my STUDENT care.
The rest of the call unfolded in typical Fold A into B order. As I was making my usual cheesy small-talk while starting a large IV into the patient, I made mention how unsettling it was for me to have been in there; being a resident alien and all. He smiled, and said he understood completely.
He was also Canadian.
Monday, March 16, 2009
9:51AM - Hello world!
So, yes Virginia, he is still alive.
I won't say that I've forgotten this bloggy-thing, but I will say that with everything happening this is one of the lowest priorities. Sorry. You know I still love you right?
Currently I'm juggling, in no particular order. 1 E911 EMT-I job, 1 E911 EMT-B job, EMT-P school, EMT-P clinicals, Appropriate Study/Research papers for previous, Various Con-Ed requirements, 1 Marriage, 3 Cats, 1 New house (Our first), 4-5 hours of sleep, 1 WoW raiding character (That's Mr Twilight Vanquisher to you). Add in eating, and well, there's not a lot of time left in the day for things like my once-faithful readers. If I had some way of just beaming updates from my brain, without having to sit down and type/edit/format stuff at an un-mobile computer terminal, it'd be a ton easier to do. Donations will be accepted for the buy me a laptop fund! I keed. I keed.
Another throttling factor, is the current discussion on the ethics and legalities of blogging. Let's face it, I hold a position that has a ton of legal, ethical, and moral responsibilities. I come into your house unannounced, in your time of need, having been woken up after 20 minutes of sleep, and become more intimate with you than most people in your life. Then, after 35 minutes, I walk out of your life forever...we both hope. We also have a responsibility to our profession to educate the public as to what we do, and to encourage trust in us. If I'm on here writing derrogatory comments about all the stupid I see it could be construed as demeaning of my profession, breech trust, undermine the fabric of society, and cause my great grandchildren to have to carry the weight of the lawsuit. Or so I'm told. As of yet, I've no hard and fast 'thou shall not''s from any of my employers.
So, I can write!
Fortunately, this last week has provided numerous moments of complete and utter sublimation that just must be shared.
Words of EMS Wisdom: If your shift starts at 6am, and you are doing CPR by 7:30am, it is a *bad* day.
( The storiezCollapse )
Friday, January 9, 2009
10:27AM - Not Mine, but Funnier!
Found while reading my various EMS Blogs and Periodicals. It's not my writing in the slightest, but since I've been sort of kind of (completely) neglectful in updates - the least I can do is to provide you with something in lieu of my own laziness.
Stolen/Borrowed with love from http://roguemedic.blogspot.com/
(Start shameless copy)
Once upon a time, in an EMS system far, far away, there was a brand spanking new medic. No, I did not spank him, but some others did. This is the story of how they were wrong. A story of how they were the ones, who needed to be spanked.
In this system, the medic is all by his lonesome, in a fly car, in the middle of nowhere. Our hero, Spanky, is brand new as a medic, is not familiar with the area, and has not even had a real orientation to the system. In other words, this situation is just made of WIN!
In this moderately busy system, there are 911 calls. Dispatch sends out the ambulance and medic for the particular location of the call. So far, so good. Spanky is dispatched, not to his own territory, the nowhere that he does not even know his way around. Spanky is dispatched to the next medic's territory, a whole different nowhere, a nowhere that he did not even know existed prior to being dispatched. This nowhere is between 10 minutes and 20 minutes away. That time is assuming that one proceeds directly to the location.
Spanky is driving like he is at Daytona, because that is the way he sees other medics driving. He is reading the map at the same time, because that is what the other medics do, too. Texting while driving would only improve driving ability, here. Spanky is kind of lost, but after some assistance from dispatch, he does arrive on scene.
The dispatch was for cardiac arrest. This is back before the concentration on not interrupting compressions. The main reason for a medic to drive 10 - 20 minutes to a cardiac arrest is in case the person turns into a vampire. The medic is the only one authorized to drive a stake into the vampire's heart. It is an invasive procedure, after all. Hospitals become upset if ambulances transport vampires without staking them, first.
Spanky arrives, parks, grabs his gear, and goes to the ambulance. The ambulance is sitting there, lights flashing, maybe the siren is also on, and the driver is sitting in the driver's seat, ready to go. Spanky opens the doors to the back of the ambulance, where the patient is. As soon as the door closes, before Spanky has a chance to grab a seat, a history, a patient assessment, or even to catch his breath, Ricky Bobby takes off.
Now, to properly understand the benefit provided by Mr. Toad's Wild Ride, while you are reading, you should bounce up and down and side to side, occasionally throw yourself into the wall. If no wall is handy, throwing yourself off of a balcony might be a reasonable substitute. You should imagine that you are trying to deliver patient care, while this is happening. I even tried to type this post, while using this method, but I crashed the computer.
(End Shameless Copy)
Remember folks...Stake your own vampires, and let us sleep.
Tuesday, November 11, 2008
To those who left their home, their families,
To those who never came home,
To the men and women who swallowed the terror in their hearts to fight for me,
To those caught in between,
For innocence lost,
For those who suffered through atrocity and persevered,
Thought I have been called to duty away from the land my family gave their lives for,
For my grandmother, and my grandfather,
For those who continue to make the same sacrifices,
I do now, and always will, remember.
I will honor your sacrifices, and love today, tommorow, and forever.
My children will be raised to know, understand, and love you through the stories and pictures of your sacrifices.
On this Remembrance Day, and all those to come,
I will always remember.
For those who do not, will not, or can no longer,
Wednesday, July 23, 2008
1:30am, dispatched out to the middle of nowhere for an abdominal pain call in a female of advanced age. We'd already been running pretty hard, this was our 4th call since coming on shift at 6pm. They teach you in school that "All abdominal pain in a female is pregancy until proven otherwise." Personally, I hold a different standard. If she's got osteoperosis, I'm not ruling *in* pregancy for any call other than "Hip Fracture". So we get there, saunter up to the door of this very. Very. VERY rural farmhouse that was built circa 1867. I swear to god, there were banjo's backing up the crickets. For serious. Entering to find a husband and wife, both well over 70, sitting around a black and white TV with an antenna with I Love Lucy on. Both of them had been partaking in the sauce this evening. Patient had been having pain for well over a week, but just decided at 1:30am on a Friday night that it was just too bad to live with. (By the way, we love that. Tell it to us everytime you see us "I've had this pain for a week...". I guarantee you'll get the best customer service like that.) So my partner is talking to the patient, and I'm talking to the husband trying to get an idea of what's going on and what sort of medical dealings she's had in the past. The following is an exact recap of that conversation. The punchline is in there, I promise. But, like my osteoperosis crack you need some sort of medical knowledge to 'get it'.
Me (Who after 12:30am tends to get more than my usual level of terse): Can you tell me what she's been in the hospital for in the past?
Husband: Who? Me?
Me: No sir, your wife.
Husband (Drunken countrified accent): Well, I tell ya what her doc's told me.
Husband: (Motioning me closer) Well, her doctor said she's got a problem with her heart.
Me: How so, sir.
Husband: Well, he says it stops working for minutes at a time.
Me: (Getting nervous, and flipping on our lifepack with my toe) When was the last time this happened?
Husband: Oh, it's not a problem son.
Me: (Holding a package of Defib pads) How is it not a problem, sir. Does she have a pacemaker?
Husband: Naw, no need. Doc says her liver takes over pumping blood. So if you see her stomach jumpin' up and down, it's okay. It's just her liver working as her heart.
Me: . . .
Friday, June 20, 2008
One of the hardest parts of the job is inevitably, dealing with the patients themselves. I can teach anyone to start an IV line. I can teach anyone the algorythm to use to save someone's life in cardiac arrest: and then drill them till it flows on an unconscious level. How to load, lift, and carry a stretcher? Absolutely. I can teach you what drugs you need to administer "If you see this...". What I can't teach you, what in fact anyone can't teach you, is how to actually talk to and empathize with a patient. Someone who's unconscious or barely conscious? (Or dead for that matter.) No problem. But when you've got a living breathing person, with their own idiosyncracies; (I never claimed spelling was something I'd mastered yet.) you're in a whole other world. See, the brain is a wonderously fantastic little device. It, as you may know/suspect, regulates your entire state of being. Some on a conscious level, most on an unconscious level. It can kill you just as easily as it can keep you alive. So one of the chief aspects of therapy that we have to bring to the table is that mystical 'bedside manner'. Like it or not, to your patient, something is wrong enough that they (Or their friends/family) felt it necessary to activate the emergency system. We have the responsibility of seeing people at their absolute worst, at their most urgent time of need. And in those times, it's up to us to help them. Sometimes that means providing the appropriate treatment and medication, sometimes that means simply holding their hand and listening to them. Sometimes of course, it also means playing straight shooter and reigning them in using blunt force logic and reasoning. It's probably the hardest part of our job, and it's something that you can't teach. You either have it, can develop it with practice, or have no hope in hell of ever being good enough with people to help. There's another category for those who are close to or burnt out, but that's another chapter. I'm blessed enough to have this ability innately. I've come a very long way in EMS in a very short amount of time exactly because of this. By nature we have to be good at identifying people's personalities, and we always know who can and can't handle people at their time of need. See, it doesn't matter what *WE* think, we're not the ones who called 911. We're not there for ourselves, or our paycheques, we're there for the person who dialed 911 asking for help. I make less than $11 an hour. If I was only concerned with money, I could make more at Best Buy - with better hours, less stress, and less strain on my family. But then, I wouldn't be fulfilling my own personal goal to leave this world a little better place each day. Not many people who push high end TV sales can really make that claim in seriousness. And if you catch someone who does, please give them my phone number. It's pretty easy to remember. 911.
Wednesday, April 9, 2008
11:55AM - Something Different
The following is slightly different from my normal format, but I felt it was powerful and important enough to include as it does have some interesting perspectives on it as to what it means to do EMS, both the good and the bad.
It is a copy of the narrative I submitted following my most recent clinical rotation at one of the local hospitals. As part of my training to go to the Intermediate level, we are required to put in a certain amount of hours in various places in the ER.
This narrative was generated for my most recent Critical Care Unit shift.
Thursday, March 13, 2008
Chances are, most EMS/Fire folk can and will frequently beat you around the head and make your life seem meaningless, dull, and insignificant in light of the 'bad days' they can have.
Here's a little pearl to help bring your own day into perspective. Free, as it were, to my LJ readership.
On shift at 7am. Dispatched at 7:03am (After starting the coffee maker working, alas) to a call at a local skilled (!?!) nursing home.
By 7:14am I was inspecting 88 y/o bleeding vagina.
Yeah man, that 8:15am unexpected meeting must suck.
I'm totally in agreement with you.
Wednesday, March 5, 2008
The Good, The Bad, The Incomprehensible.
An EMS Rookie's Perspective: Volume II
Last time I wrote, I managed to somehow make a full 12 hour shift sound interesting, fun, and jam-packed with amusing facts. Going forward I knew that this wouldn't be a format I'd be able to keep going forever. The fact of the matter is, we're zen masters of the art of "Hurry up and Wait". Depending on what service you work at, you may get anywhere between 2 and 10+ calls a shift. So if you consider that a typical call depending on the level of "Pucker Factor" (think about it, it'll come to ya. I've faith.) may get turned (This is me working on my street cred by using regional lingustic shortcuts. Word.) in between 15 and 60 minutes, well... that leaves a lot of time over the course of a shift. And as decent a writer as I am, you'll forgive me; but I just can't make 10 hours of sitting around a station polishing fire trucks (Apparatus, sorry) sound interesting.
So, what I plan to do going forward is to let the 'good ones' accumulate, till I get about 3 or 4 that I can then throw out.
So why am I writing this?
Us vs Them vs Us vs Everyone Else.
There are a few rules of engagement in EMS. One of these, is that everyone on a truck is convinced that those in the Dispatch center are only working there between shifts at McArby Bell. To be fair to my dispatch readers, the converse of this is also true. They are convinced that those of us on the trucks are only working there between shifts for environmental services at the nearest hospital. The main crux of the frustration and mutual resentment is that on the road, we are entirely dependant on our dispatchers. To tell us where to go and what's going on. We're cowboys. We like doing the wrangling. We don't like being wrangled. We also don't like having to repeat ourselves. You'd likely be shocked to know how often regions go without coverage because someone in a dispatch center didn't hit a button to put a truck back in service. For example: "Medic 98 is clear and available." "Copy Medic 98, show you clear and available" Okay. Now this seems like a rational, reasonable exchange of terse information. Absolutely 100% sufficient to get the job accomplished. Now, when you hear two hours later, "Dispatch; Medic 98." "Go ahead Dispatch...." "Medic 98, why aren't you cleared from your last call?" It is at this point that you become very proficient in the art of speaking at the radio, without depressing the push-to-talk button. But what's worse than that, is the complete lack of relevance our dispatch information either is, or isn't. "Medic 98 respond to Blahblah for 48 year old Male with fractured extremity and hemmorage." Okay. So, you're up and out of the station, rolling down the road. You think to yourself you've got a great idea of what to expect. You're going to roll up. You're going to find an older dude. He's going to have a broken arm/leg. It's going to be bleeding. No problemo. The reality is; you roll up. Find a 9 year old with his hand stuck in a mason jar, crying, and hysterical, while his dad tries his best to reassure him. While holding a hammer. "Oh, thank goodness you're here." Says the hammer wielding parental unit. "I was just about to break the jar." "Uh sir, we were told that there was a 48 year old male with a broken arm, or leg or something. And blood." "Oh heavens no, I said I wanted help because I was going to have to break the jar around my son's hand and was worried it'd cause bleeding." ". . ." That's an example of information irrelevant by its presence. My personal favorite. "EMS Report. Medic 98 respond to YYZ Mega Computers at Blahblah Rd. Cardiac arrest. Unknown patient. History of previous cardiac events. Response code 3"
My brain just about emerged from my head carrying an umbrella, a suitcase, and a one way ticket to Maui when I heard that one. So let's see. We know that someone, somewhere at this industrial complex the size of Haiti, is having a cardiac arrest. We don't know whether it's a male or female. We don't know his/her/its age. We don't know his/her/its race. But we do, somehow, know that his/her/it has a previous history of cardiac arrest. To this day I don't know how you end up with some pretty specific past history on a patient without knowing which restroom they use, or a relative age. And things like this, are common. Very. I'll leave it up to the dispatchers to respond in kind. I'm sure we do some seemingly idiotic stuff too. But I'll let someone else defend them. Me? I want to go home close to the end of my shift tonight. So I'll be sure to tip you next time I see you at McArby Bell.
License and Registration, Ma'am.
It's about 20:30. Me and my partner were scheduled to get off at 19:00. But, because of a transport to a nursing "facility" that had to be done, we ended up in some extremely rural area about 50 miles out of our normal coverage area. Clearing from our drop off, we get a "request" from dispatch to head back inside because they've got a problem with a patient and would like an evaluation. We're so far into overtime, we don't even care anymore. Sure. We go. We do our thing. And 30 minutes later we head back outside to our ambulance to begin heading home. Walking up the hallway to the entrance, we come across.. a wheelchair. Empty. Sitting by the door. We stop. Look at it. Shrug, and keep going. Now, before I go on, I need to point out that it's very common for us to leave ambulances running while we're inside doing a call. In a business where seconds can matter (God I love being able to be justifiably dramatic!), not having to wait for the glow plugs, or power system to fire up, hey..it adds up. So we're walking out to our ambulance and see the passenger door open. We approach, now pretty on guard, and find this elderly woman sitting in the passenger seat looking at us in desperation. After a few minutes of explaining that no, we can't take you, I head back inside to find one of the CNA's, or RNs, or LPNs, or whoever she was that happened to draw a certificate out of a Cracker Jack box and applied here. I find one, a young woman flipping her hair in the reflection from a photo of the founders of the facility and informed her that one of her charges has not only escaped, but has taken up residence in my ambulance. "Oh, well that's not my responsibility." "I'm sorry, I thought you worked here." "Oh, I do. I just don't..wait, did you say a patient of ours is outside?" "Yes ma'am. That's what I said." "Oh my god." And she goes scampering off. A few minutes later, an alarm goes off (?!?!) and a posse comes out to the ambulance and pretty much drags our would-be stow-a-way back inside. Stopping long enough to plop her into the empty wheelchair (Ah-hah!). As we sat there observing this surreal moment, the woman turned back to us with venom in her eyes and spat out, "I hate you." as she was dragged back into her facility. Throwing protocol to the wind, I lit up a cigarette and looked at my partner. "So, was it good for you?"
Cross your I's, Dot your T's, and Don't forget to pack your Head.
I had a very rough Christmas. Being the rookie, naturally, I get the crap shifts. Paying dues, seniority, whatever you want to call it... I'm on shift. This last christmas was one of those days. Now, before I proceed; a warning. Not all of this job is happy, fluffy, laugh a minute, "Oh that Hawkeye, he's so bad.", and the like types of feeling. It's hard. And when it gets bad. It's bad. Being able to maintain an emotional disconnect is an absolute necessity. This is something you either develop, or don't. The following two anecdotes are on the 'bad' side. Just saying. But I add them as a way of providing contrast, and as a mini-sermon on the absolute and utter importance of making sure that if you are told to do something by your doctor; you do it. Period. I don't care how much of a drag it is. How busy you are. If you're told that something is absolutely important for you to ensure you do; you do it. Pull into work at 7am on Christmas Day. Partner by the door as I walk in. Says not a word. Grabs me by the arm and drags me out into the lot towards our Baratric Unit (Huge specialized ambulance for huge specialized people). Our call? To assist neighbouring county's EMS and their FD with the extrication of 700 pound man. I work for a local transport/convalescence facility when not doing Fire Department/School stuff, and this sort of patient is one of our companies specialty 'niches'. Arrive to a maelstrom of people. 2 Ambulances, 2 QRVs, 1 Supervisor, 1 Batallion Chief, 1 Engine Company. Long story short; the man was visiting his family from out of state. He had been diagnosed with sleep apnea and prescribed a CPAP machine to wear while sleeping. For whatever reason, he didn't bring it. Didn't purchase a replacement. He will not get a second chance to make that mistake. Dead at 48. He should have followed his doctor's orders. If he had of, he'd not have put his family through that on Christmas day. And that was the first call of the day. The last one was even worse in terms of emotional impact, and again it could have been avoided due to attention to detail. A family was having a final christmas with their son/husband/uncle who was in his last few days following an illness. He was laying in the bed he and his wife shared in healthier times. At the end of the proceedings, we were dispatched to return the man to his hospice bed. As something to walk into, not something I'll ever forget. My partner spoke with the patient's wife getting things in sequence, while I did a patient assessment. This man was in the last few hours of his life. No doubt about it. But. The wife had failed to secure a very important document. The one which says, if the patient is to go into arrest in front of us, we are not to act. We point out that without this form, we will have to do everything we have at our disposal. She does not wish this. We understand, but without the form... Communication breaks down at this point, and we tactfully withdraw. To this day that room haunts me, and the wails of the wife as she realized that her husband was going to die in their bed in front of her. If she had only had that form. If the damned facility had only made sure that she had one before they let him go. If. If. If. Long story short, all of that could have been avoided but for a crossed I and/or dotted T. So remember, when dealing with medical professionals... If they tell you to do something. Do it. Or get a second opinion, and then do it. And make sure it's documented, that you have *all* of your documentation up to date, and with you if you have need for it. It can matter. A lot.
And that folks, is this episode. I'll try to stick with all fluffy happy stories next round!