Foxx

Close Encounters of the...

2009-07-29T01:25:19Z

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.

To be the man, you have to beat the man....

2009-05-15T04:38:14Z

This will be the record of one of the most memorable calls of my life, and one which I will carry with me throughout my career. I know, I know. I've said that before. And each time I was telling the truth! This one will be no exception.

And it all started off so innocently.

91 y/o F with altered mental status (AMS). Our EMD indicates an emergency/code-3/Hot response. Further information while en route comes out that she just doesn't seem to be acting right.

On the way over, I'm talking with my paramedic partner about the various differentials of AMS. Him, who has on occasion guest-instructed my 'medic class, likes what he hears well enough that he looks over to me and says "Well, regardless of what she ends up being, this call is all yours Paramedic Patterson." I attempt to explain to him the philosophical (and legal) differences between being an Intern and being a credentialed professional. "If you walk like a duck, look like a duck, and quack like a duck..." is his response.

So after a 12 minute response time to an area only settled by those with a permanent desire to flip off those with response-based performance markers (IE: Pizza, Plumbers, and EMS), we pull up. I guess to some degree I noticed that the first responders were calling us for location updates a few times; after all I just wrote that, but it never really "clicked" as something out of place. And so, entirely oblivious to the LIFE CHANGING event that was about to club me like a seal, I ever so casually made the necessary arrangements to back my ambulance into the driveway. Weaving like a pro around various fire vehicles, POVs, potted plants, and what I think was an engine block to a '67 Chevelle 450cc.

As many of us do, we walk into a scene with a plan. A plan based on the information that we have gained from dispatch, our previous experiences, the area we're responding to, conversations with our partners, and so forth. A plan. A set sequence of events that we've got in our mind to rule out (or rule in) whatever it is that's the most likely culprit. In this case, I totally had it all figured out.

A) I'd walk in, and try not to step in any of last weeks meatloaf.
B) I'd scope out for the best way to get the stretcher in, and the patient out.
C) I'd introduce myself to the addled old lady in question.
D) I'd perform a quick stroke screen, followed by a trauma exam, and have the FD gather me some vitals and glucose readings.
E) Make the bleepy-thing with the squiggly lines work.
F) I'd ask the family what hospital our dear 91 year old wanted to go to?
G) Get some more information from the witnesses/family while the FD was loading up our patient.
H) Extricate her from the house either on the sweat and backs of 6 young virile firefighters or my failsafe backup a package of twinkies.
I) Get an IV started in the back of the truck, fix the glucose if it was off-kilter.
J) Depart at a leisurely place.
K) Impress with my completely suave, and efficient delivery of premium care.

This plan made me happy. Sure, a few things could be flipped around. The order was malleable. But it was structure, it was order; and it most certainly helped to calm the nerves of going under the "Microscope" of precepting scrutiny.

There is a very famous quote by one Helmuth von Moltke, a German general, that is very appropo here. Go on, look it up; I'll wait. Or perhaps you can guess. I'll offer a hint, it involves an intrinsic flaw of the concept of plans.

So, after ever so calmly placing the truck in park, I turn to my partner who has reclined back with his hands behind his head and big black shades pulled down. "Let me know how it goes." I thank him for his assistance.
Somehow, in the noise of everyone running around, I didn't pay much attention to the 'rap-tap-tapping' on my driver's window. One of the firefighters is there. "Hiyah." Say I, oozing professionalsim. "What's happening?" "Oh, sorry. I guess we forgot to call." says he. "Pardon me?" says I. "Really sorry about that guys." says he. "Okay, what? Are we not needed?" Say I. "She went into arrest right infront of us." Says he. "Wha-huh?" Splutters I. "Sucks to be you." snores my partner. I fly - in a dignified manner I'll have you know, out of the ambulance. And note my partner hasn't moved. "Coming?!" Say I, to my partner. "What did I say on the way over here, Paramedic?" says he. "Asshole." Say I. And head inside. As I go, I give instructions to three of the firefighters to grab my equipment bags and bring them in behind me.

Someone, someday, is going to become very rich by writing a gospel of EMS proverbs. This book will become standard reading in all EMS classes in the world. This book will help to bridge the gap between the text and the street. It will contain such gems, for example, as: "The higher the acuity of the patient condition, the farther from the door the patient will be." Further, it will have such insight in it as "The higher the acuity of the patient, the more of a packrat the patient will be. With the amount of materia owned (and stored) by the patient being inversely proportionate to their relation to the poverty line." I hope it will be me. I would like to be very rich.

So I weave my way to the farthest back room of the house, dodging the hostile environs with a grace Cassius Clay would be proud of, and find our patient laying on her bed. Two of the firefighters are hovering over her, checking for a pulse. A third has a BVM device and is breathing for her. Through luck, I know one of the FD from previous work and trust him. "So, what's going on?" "I can't find a pulse." "Okay. Did she have one when you got in here?" "Yes." "Okay. And how long have you been looking for a pulse?" "I don't know, a minute?" "Okay. Can we get her on the floor, and maybe start doing some CPR?" "Oh, yes. Okay." And so the lady is unceremoniously placed onto the floor of her bedroom (A 5' by 5' square, I'm convinced.) and CPR begins. The hallway has become backed up with observers (As codes tend to attract, regardless of where they're done. Another factoid reserved for my book.) As CPR is progressing, and I'm prying apart the AED in my hands to get at its cables, my partners head appears in the doorway. "Oh, come on. Please tell me you're not proposing we do this here?" Remember how small I mentioned the room was. "Well, no." I reply. "Great. Why don't you pick her up, and bring her into the living room. I've got some space cleared off, equipment down, and a backboard set up for you." "I thought you said you weren't helping?" "Yes, well. The sun was in my eyes."

And so we go into the living room. As we go, I make a point of placing our pads on the patient. And so, after a 30 second harried shuffle, we're into the room. As we get in there, from some unknown fount of wisdom, I start giving orders. Things are done. CPR is started. BVM's are squeezing. IV's are being started. Lifepacks are connected, and telling me we have an asystolic patient.

Rather than being in the middle doing things, I'm standing back near the head watching. Chest compressions are a bit light, and I ordered them corrected. Ventilations are a bit iffy, and I council on how to relax and count out a better pace. Drugs are being ordered, and drawn, and administered. People are taking turns doing CPR. A fire captain is at the back with his clipboard recording times and drugs.

I knew what had to come next. The scene was pretty much running on its own at this point. So I grab my intubation kit, and go about assembling what I needed. At numerous points I thought I was ready only to remember "Oh yeah, I need 'x'". Stylet? Yeah, guess I'll need that. Syringe for the cuff? Yeah, probably. Some sort of tube restraining device? Probably. So after a few false-starts, I'm ready to go. I have my blade, my tube, and my trusty trusty Mac 3 blade that I painstakingly checked and cleaned this morning at the start of shift. "White Tight and Bright" is the only way to get in my bag. And so, for the first time in over 365 days - and only my 2nd time in my EMS career (On a person) I go in. Insert, position, lift... wait, why is it so dark? Where's the light? I swear. I pull out, get our BVM guy back on getting to breathing as I regroup. I ask my partner, who's between drug administrations to pull me the backup Mac blade (a 4). He complies, and hands me back the Miller 3.

Now. From the first day we're taught intubation as I's, we're told to be proficient in both blades. For a variety of reasons. The fact is, we're told over and over again to practice with both.
I'm that stubborn, sarcastic person in the back who thinks to this; "I'll just always be prepared and have my Mac 3, no need to be overly familiar with the Miller.
And yet, here I am, mid-code, with a Miller in my hand. And I understand. I note my partner/instructor/preceptor smiling at me evilly and know. I KNOW he did it on purpose, for that exact reason. And what's worse, is he knows that I know, that he caught me. He makes a little head bobbing motion as if to say, "Get on with it then."

Turns out I practiced just enough with the other blade in order to get the job done. No problem. In and out in under 15 seconds. Verified with auscultation, visualization, capnography, colourmetric, one good tube. I secure it, and then stand up and continue to watch how things are unfolding.

I see the patient's family in the room, and acknowledge them. I ask them if they know what's going on; and they reply they are pretty sure they know what's going on. I take the time to explain to them what's going on, what we're trying to accomplish, and what the odds of our success typically are. They nod, and continue watching. And I continue marshalling. And this isn't even something I'm trying to do - it's just about all I'm able to do with everyone having a job and doing it already. I check the rythm periodically, and we're going into and out of a PEA/Asystole rythm - which is a truly bad sign.

A hand appears on my shoulder, and the shift supervisor (One Al Hunt) asks if there is anything he can do for me. I offer him a recap of how everything has unfolded; what we've done, what we've seen. He takes it all in, and asks me if there's anything I'd like to do. I look at my watch, and note how long we've been fighting this particular battle. "Yeah, there is. May I see your cell phone?" He asks me why, and I justify my position that we've been at this for over 30 minutes now all-told, and that there was no point in carrying on with the inevitable. I was going to take his phone, call online medical control, and get orders to discontinue. He agreed, and handed me his phone.

And I took his phone, called online medical control, and got orders to discontinue.

And so, after polling everyone in the room as to their thoughts, feelings, or ideas for things we haven't tried yet, I nod and thank everyone for their hard work, excellent performance, and order all operations to cease.

And thus we ended. In talking with my partner, and supervisor (Who had been there for longer than he let on.), the general verdict was that it had been an extremely efficient, organized, calm code.
You'd never of guessed, that it was the first non-scenario code that I have ever run - from start to finish - as the man in charge.
And so, another milestone in my EMS career is passed. And it was good.
Now, if I can just get started on that book. . .

Paramedic and Cardiologist at Large!

2009-03-25T12:51:38Z

So.

40 y/o M with complaint of heart palpatations and dizziness.
Found laying on the couch. Cyanotic, Diphoretic.
Patient endorses a long, complicated cardiac history. Has an implanted defibrilator.
Is not able to say what long term diagnosis was made, because one has never been made. Does say that he has history of going into V-Tach for reasons unexplained. My impression is that both him and his wife are very intelligent, and so am willing to accept what they both say as the truth. (As they understand it.)

Is in exceptional physical condition, and in an exceedingly affluent neighbourhood. Used to run Boston Marathon's until about 15 years ago when this heart issue started.

Called EMS this afternoon after being woken up by a 'fluttering in his chest'. Defibrilator has not gone off today. Says it's keyed to go off when his HR reaches 130+. We're clipping along at 128 currently, so I'm moving all metal objects away from him and making sure my stethoscope doesn't dangle.

I'm one of two basics, and one medic on the call. Medic is content to stand in the back of the room and let me play. We've got an engine company rearranging furniture, holding the wife's hand, and getting all our Bio.

Leads going on, LP12 coming online, I'm absolutely dreading what the 3 lead is going to show. It comes on the monitor, and I double take at it. It's an organized rythm, SA in origin, with wide and ungodly looking QRS. I blink at it, and turn to the medic and mouth "What the *fuck* is that?" She's got the same expression on her face and mouths back "I don't know."

12 lead placement ongoing, and I pull off a strip of the 3 lead to look at. Consider glasses, but then realize that it is in fact just that bizarre.
Tilt my head a few times, nothing coming to me. Ask the patient a few more questions about his V-Tach, and to make sure he's still alert while I'm doing this. Also trying to work out in my head the things that tend to morph into V-Tach. He is. Just my B partner is giving him the "We're about to do a 12 lead" speech, I've finished deconstructing the pathway in my head. I don't think I actually said "Eureka!" out loud. In fact, I'm fairly certain what I said in fact was "Holy shit, there it is." The reason it looks so bizarre is that the delta waves start marching up almost immedieatly after the T's, which are inverted. It looks more like an army of snow-cones than an actual rythm.

The LP12 starts its analyzing algorythm and I turn to the patient and start asking him a whole bunch of new questions. "Has anyone ever mentioned WPW? Or said the word "Wolf" around you when discussing your heart?

"No." Says both the patient and the wife.

By this time the 12 lead strip is coming off, and is immediately snapped up by the medic. (Who's no longer at the back of the room)
"Wow, great catch." She says.

And on the 12 lead, it jumps right off the page. There be Delta's in that there P-R interval.
And in something that nobody I've talked to has ever heard of before, the LP12's "Man in the Box" prints neatly at the top
"Sinus Tachicardia"
"Wolff-Parkinson-White"

At this point, we all co-ordinate the "Let's get the hell out of dodge" dance, and are out the door in about 3 minutes.
The ambulance tears out at Code-3 while we all hope the guy manages to maintain till he gets to the ER.

As it was my turn to drive the 'Medic car, I don't know how things shook out on recieving end. But when I arrived he was in the acute cardiac bay with people swarming over him. I walked up to his doc later and asked about the diagnosis, and treatment. "Are you the one who saw the WPW?" "Yessir." "What would you have done for him?" He asks, not answering my question. "Nothing in the field. Once here, you're going to have to try to shock out that rythm and force the current back down into the AV node and out of the Kent bundles. Long term? Probably electro-radio-whassitcalled to try to sear out the conducting pathways."

The doctor gave me that stern look, fixed his glasses a bit, then turned and pointed to the chart on his computer screen.
And 'lo, the patient was scheduled to go have radiofrequency catheter ablation, or something similar.

I was pretty hard to be around for the next hour or so as I did my little dance of joy.

Hello world!

2009-03-16T13:53:06Z

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.

So, there we were in the ED of one of our resident Level I's checking in our patient who had decided to go on a bender the night before. He probably could have handled the 12 pack well enough. It was the bottle of listerine he used to cap it off that really ended up being the most problematic. So no shit there I was, just sort of hanging out while my partner and our student were talking to the charge nurse, when over the morning din came a strained voice from one of the trauma bays. "Can I get some help in here? And a Code Cart?" Like meerkats on the savannah, pretty much every head turn as one in unison towards the curtained bay. Me of course, with my mad EMS reflexes, was already mid-run. I had a brief moment of lucidity as I ran past the curtain towards the patient's thorax. How dangerous a thing is a closed curtain in a MAJOR hospital. Yes, it's Level I, but beyond that it's one of the largest most prestigious hospital/ER's in the world. And when a patient lands in the trauma area, there's 'badness'. Even worse when they feel the need to curtain it off. And god help you if the first thing your mind notes when you arrive is "Hurm. That's a sterile field." (I'm not going to explain that last, it'll be an easter egg for my Medical professional readers.)
But what did you seeeee? You uh, sure you want to know? Reeeaaaaaaaaaaalllllllllllly sure? Well okay. In truth I was going to tell you anyway, but I wanted to make you beg for it. I'm just like that.
So the patient is this 410 pound woman. And there's this doctor, calmly sitting on a stool, in his sterile little world. And he's doing surgery on this patient. Real, proper surgery. Not the sort that you do with endoscopes and the like. Scalpels, saws, knives, suction...surgery. And 'lo, this woman's heart has stopped beating.
So I do the right thing, and get up there and start with the CPR. Which, lemme tell ya, is kind of like pushing my van back and forth trying to rock it out of mud.
Yes, bad morning. Not as bad as the doctor's, certainly. Not even close as bad as the patient's, and those who love her.
But, as Darwin pontificated greatly upon, one shall always rise in times of stress to truly ascend to previously unheard of levels of "bad"
In this case, that honorific would fall upon the poor poor person who was training on the charting, administration, co-ordination desk. The charge nurse, as she was wheeling the cart in (The other 20 people in the room had run past it.) informed this new hire to page the emergency response team. A collection of people responsible for responing to codes in the ER. Simple.
The procedure is simple. Every doctor carries a pager. You page the doctor's pagers with something to the effect of "Emergency Response to the ED"
What you don't do however, is page every doctor. In the hospital. In the very big hospital.
For the next 10 minutes, a stream of very out of breath, panicked doctor's streamed to the ED only to be told of the error.
"Oops" somehow doesn't cut it; does it? Hopefully they'll let her out of the storage room soon.
We did manage to get the patient back, and I hear she's doing well in the ICU.

Further words of EMS Wisdom: Where there's smoke, maybe you're just a dumbass.

I love nursing homes. I do, honestly. They provide a care, and service that is vital in today's society. I just wish their hiring practices included ensuring that their staff has a higher IQ than your average turnip. I'm trying to be fair to turnips here, some of them are pretty smart.

So here's one of my favorite calls of all time. Our county is just falling apart, calls are pouring into 911 hand over fist. Dispatch is absolutely at their wits end, having to triage which calls get EMS and which get put on hold. Never, ever, a good scene. We were in the process of unloading a patient when my cell phone rings. It's the lieutenant, we need to get back into service as quick as possible. Okey. So we clear, and immediately get sent to a fall, non-emergency. So we start heading that way. However, it's the middle of a large East-Coast university during class change, nothing is going anywhere. It happens, so we just do our best. After about 3 minutes of being stuck in traffic, we get re-assigned. Possible stroke at a nursing home, emergency response; patient's face is drooping badly to one side and speech is slurred. Well shit, sounds about right, but it's about 16 miles away. Of which, 8 has to be taken through the middle of city. So we go into emergency mode, and do our best to work our way out of the university. Not normally so bad, but apparently we were running in stealth mode today, and the flashy lights and the louder than god siren was so loud that their little student brains were unable to register the sounds. Suffice to say, we had to come to a screeching halt numerous times in order to not squash one of the doctor's of tommorow. We're gonna need those.
What I want to build by all this, is that we were severely creating a traffic issue and hazard issue to all of those in our way. And pretty much shutting down traffic at one of the busiest times of day. Not to mention causing a number of people to flee for their lives - but in my defense, they shouldn't be J-walking anyway.
So we get about 10 out of the 16 miles there, when suddenly over the raid. "Unit en route to stroke at suchandsuch, cancel response per complainant." We blink, and go down to non-emergency traffic, and look at each other. "What the hell..." Over the radio. "Dispatch, Supervisor. Can you give us more information on why we're cancelling response?"
And then, the words that will remain with me for the rest of my life.
"Affirmative. Apparently the nursing staff found the patient with facial droop and slurred speech and called 911. However, it's come to be known that the patient was at the dentist's office today for a root canal and still has anesthetic. It just took them 15 minutes to figure this out."
So we turned around, and headed back towards our original fall call. We were still laughing as we walked up to the poor guy who fell off his roof. He appreciated the levity.

One of these days, I'm going to get around to my "Instructions on how to Drive" omnibus post. Perhaps next time.

Not Mine, but Funnier!

2009-01-09T15:30:50Z

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.

On the 11th day, of the 11th month, at the 11th hour...

2008-11-11T16:27:39Z

To those who left their home, their families,
I remember.
To those who never came home,
I remember.
To the men and women who swallowed the terror in their hearts to fight for me,
I remember.
To those caught in between,
I remember.
For innocence lost,
I remember.
For those who suffered through atrocity and persevered,
I remember.
Thought I have been called to duty away from the land my family gave their lives for,
I remember.
For my grandmother, and my grandfather,
I remember.
For those who continue to make the same sacrifices,
I remember.

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,
I remember.
Thank you.

http://www.youtube.com/watch?v=f4NZsD0zjAQ&feature=related

And this is why I don't work the night shift. . .

2008-07-23T13:45:32Z

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: Oh.
Me: Well?
Husband (Drunken countrified accent): Well, I tell ya what her doc's told me.
Me: Please.
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: . . .

Mind Over....Something or Other.

2008-06-20T12:32:52Z

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.

Here are some examples of calls in the last month (or so) where the ability to focus on the psychiatric needs of the patient were sorely tested.

Responding to a call of "Assault" at a local mall. One of those calls that you roll your eyes to on dispatch, and spend most of the time on the way to the call griping about how you never got to finish that last bite of lunch. Once you get on scene though, all those thoughts go out of the way pretty damned quickly. You've got a female in her early 30's who has escaped from a residence near the mall, and ran inside for shelter where staff at one of the stores saw her and called 911. She's a victim of a sex-slave cult, and has been imprisoned for the last year. This morning, her captors forgot to lock her shackles, and the basement where she was kept. She's not from this city or state, and ran to the only place she could see where she could go and maybe get help. She had a lot of very severe injuries from being shackled and beaten. And was quite, scared. Obviously. I spent a good 15 minutes with her, alone in the back store room of the place that took her in for help, just talking to her. Finding out her story, recording it for the inevitable trial and for my own documentation. You've got all of about 10 seconds to earn someone's trust in some cases. Stuff they don't teach you in class, stuff they can't.

Another one, you hear another unit get sent to a Possible OD-Frank. The "Frank", in that system at least, is short-hand for another F word that rose to fame with a certain Mortal Kombat game many decades ago. After about 20 minutes after they get on scene, they call for another unit to be sent in very short order. We arrive into the middle of a cluster-fuck of CSI proportions. You've got the crime lab, sherrif's office, local PD, detectives, fire department, EMS units all over the place. And as you approach, you've got this very thin, very shaken young girl under-20. She and her boyfriend had been shooting/snorting/drinking a very respectable list of narcotics the previous night, and passed out in their car in front of his parent's house. Parent's came out at 11:30am to find their son dead, in the driveway, and this girl woke up beside her dead boyfriend. You've got a 15 minute ride with this hysterical, and potentially unstable patient. You need her to calm down, and try to focus on being still alive. You also need to find out what happened for the inevitable investigation, because you can be damned sure the SBI (CSI) is going to be waiting for you at the ER to find out everything you found out. And the more that you can tell them, the less they have to try to question the patient. In our role as patient advocates, it's our duty to try to do the best by the patient. I held her hand all the way in, and got her to focus on the fact that she was still alive and that she needed to take this as a warning sign. Her boyfriend had run out of chances, but she hadn't.

Male in his mid-twenties on a country road in the northern part of the county. Driving to work in his 24 hour old SUV. Swerves approaching a blind curve because he sees deer in the road. Swerves too far, loses control of his car, hits a bicyclist, rolls his car off the road with the biker underneath for a few revelations. (Before said biker was thrown underneath an oncoming van. Uhh, yes, the biker died.) In the best of circumstance someone who flips their car a few times has bought themselves a one-way ticket to the trauma bay at any Level 1 facility. Add in the fact that this person is extremely cogniscant of the fact that he's just, however inadvertantly, commited murder, and you've got a real bad situation. My job is to make sure that he remains calm, and doesn't throw his vital signs out of whack, keeps immobilized, and to...get as much information as I can for the...etc,etc.

You have to focus on the fact that, no matter how or what circumstances it came to be, your patient before you is all that's important. I don't care if this guy went on a rampage through a school and killed 20 kids, for the next 20 minutes he's my patient. I'm responsible for immedieate medical intervention, and making sure he gets to a place where he can recieve definative care. My own judgement MUST be suspended for as long as that patient is in my care. Sure, I can blog about it and vent after the fact, but the fact remains I'm not doing my job if I can't afford that person the absolute limits of my professional support during the time his care is entrusted to me.

However, some scenarios are easier than others. The above are easy to grasp the seriousness and respond appropriately. Sometimes, it's most difficult to remain serious and empathic in times of sheer stupidity...

The other day we had a response to a middle aged female with Chest Pain. So we go tear assing across the county, the system was already heavily taxed so our fly car and ambulance had about an 8 minute response through rush hour traffic. Wee-ooooh-weeeee-ooooh-wee-GETTHEHELLOUTOFTHEWAYYOUSTUPIDDRIVER-ooooh, etc.
My partner assesses the patient, I brief the ambulance crew, then interview the doctor who was insisting that we go into his office to talk. Okay. EKG shows nothing. Notta. A normally function heart working overtime. That's all, that's it. The story comes out from the doctor, that a few days ago our patient had recieved a plea via email to help a young Zimbabwean prince who was in danger of being overthrown, and he needed our patient's desperate assistance to make sure that his family's money and fortune wouldn't be taken by the military coup. Our patient, kind loving sort that she is, offered to help him out by hosting his money over here. Our patient's sister, who apparently doesn't hold young Zimbabwean princes in such high esteem, had 24 hours previous gone to the county court and had an injunction put on our patient's finances and taken over stewardship of her entire banking rights as she felt our patient was apparently not mentally competent enough to handle her own. So next time you see one of those emails and wonder aloud "Is anyone truly stupid enough to fall for this..." The answer is, "Yes."

Then last week there was the woman who's anxiety regulation is so out of whack, that she pushed herself up to 210/174 (!!!!!!), with a HR of 166. We tried for a good 10 minutes to talk her down. Me and my paramedic were standing in the back discussing the legal ramifications of RSI as a means for dealing with her. Eventually our shift supervisor (who thank god was principle on the call) threw his hands in the air and looked at the woman who was sobbing, hyperventilating, and pushing her HR up past 170 (!!!). He stood up, and his 'bedside' voice entirely went out the window and he adopted his "You just backed over a Lifepack and destroyed it, because you didn't have a spotter voice." (There's a story for another day there. No, wasn't me.) He picked up the LP12 and placed it in her lap and said, quote, "Look at this. See these numbers? These numbers mean that if you do not calm the hell down, right now, you are going to die. They are dangerous. See them? See this? These mean your death is imminent if you don't knock it the hell off." I can't really fault him for trying the tough love approach; after all, I was fidgeting with a Laryngoscope and smirking at my partner. Turns out, it worked, and after about 5 minutes her HR had come down to 120, and her diastolic had dipped below 100. But for crying out loud. . . Remember what I said earlier about the mind?

That's all for this month. Just keep in mind the next time you see an EMS crew the sorts of challenges they themselves have to face of a psychological basis every day, things that you can't teach, things that you can learn only with great difficulty, things that you don't want to do: but someone has to. Buy 'em a coffee, or beer. Because chances are good, you're making double what they are. Yet we still stand vigilant, and ready for the tones without any hesitation or second thoughts. Because hey, we're going to leave the world a little better place than it was when we woke up.

The Catching of Moby Dick...

2008-05-26T14:55:54Z

Most EMS workers will go through their entire careers without doing it.
Many will try, but the odds are infintesimal at best.
And yet, the other night while working on a 12 hour clinical shift (That went 15.5 hours) I happened to accomplish what many won't.
What's that?
Well, you'll have to read on; won't you.
It was a clear and stormless night. . .

Medic 11 had been returning to base following a call that had come in a few minutes after our shift had been relieved. As we had been stationed down in Garner, we were the only unit to take it. So we were already about 1.5 hours after quitting time and sort of surly about it.

The CAD lit up, and the radio chirped up that there was an arrest in progress downtown, on the 28th floor of one of the larger buildings in the downtown core. The driver looked up, and pointed just down the street. "There". He, to his credit, asked the rest of the crew if anyone had any serious real objections about going. Less than a half a second later we were running Code-3.

Amusingly, the first thing my preceptor had said to me in the morning was. "What do you need to be finished?" He had been in the lounge the last Wake CO shift I had done and heard my conversations with my preceptor of that day that I was nearing the end of my clinicals, and would most likely be finishing out in my remaining Wake CO shifts within the week. My response was that I could make a very good argument about all pathologies documented or not, but that I was very weak on cardiac arrest as I had never had one. "Never had one?" The man with the special "Code Commander Extraordinaire" chest pins asked. "Well, then we'll get you one today. You have my word on that." He then proceeded to walk around the ambulance pointing at the various doors. (It's surprising how much variation there exists among Type-III's). "When we arrive at an arrest, your job is to get this bag and a long board."

The above paragraph is only included for completionism, as 14 hours later, I remembered exactly what he wanted. It should be noted before I get into the meat of the call, that my preceptor O'Boyle is regarded in the Wake county system as their #1 code quarterback. He has the most saves in the entire county system, something that in discussion with him he is intensily proud of; but also something he strives very hard to maintain. Moving on.

We arrived on scene at the front door, and to a man we unloaded the ambulance and strode into the building with that "We're only not running because we're trying to look calm, collected, and in control" run-stride-shuffle. We got to the elevator, 28th floor. I had my long board, and suction bag. The stretcher was loaded such that if it had been a camel, the poor thing would be collapsed on the sand unable to move. On the way up in the elevator, my preceptor pointed at me and his partner (Both EMT-I's...sort of) and said "When we get in there you are doing this, you are to do this, then this, then get on this." We both nodded. I can't stress enough how this little step of organization helped; because when the elevator doors opened it was right into the middle of most EMS' workers utter nightmares.

The scene was a two-story reception hall. Where they'd knocked out the floor, and placed in spiraling staircases. You could probably buy a new ambulance if you had sold the chandelier. There were people... everywhere, and they were all wearing suits and dresses worth thousands of dollars. In fact, you could probably buy a new fleet of ambulances with the silverware alone. Our patient was on the second floor, which was unreachable by our elevator. We rolled to the bottom of the staircase, and grabbed the bags and raced up the stairs. I had the "Thomas Pack" (WCEMS Equivalent), suction bag, trauma bag, LP12, Longboard and didn't even feel the slightest traces of protest from my muscles as I took the steps up two at a time. I remember this clearly because in the back of my mind I realized this was very not good; my adrenaline was running too fast. So I started making adjustments in my rate of breathing and stopped looking around because I didn't want to get there and be quite so amped up. So I focused on my orders. I was to start two IV lines, assess the CPR, and then get on airway "By any means necessary". My EMT-I partner was going to intubate, and my preceptor was going to hang back, assess the scene, then begin preperations for Hypothermia protocol while calling the shots.

It was a very good thing that us three had entered with a plan. I saw the "Raleigh Fire-Rescue" shirt on a man on his knees rocking up and down rythmically before I saw anything else. "There." I pointed and we moved across the large dance floor with people in suits worth more than my car parting before us. The scene struck me as very chaotic. One FF was doing compressions (Very well), one was at the head with a BVM with an insufficient face seal and the head flopping everywhere. Patient was a mid-60's female patient, very obviously dead. A quick snapshot of the EKG showed me fine V-fib. The two paramedics from the primary unit were huddled over their LP12 analyzing the rythm (!!??!!). Nobody seemed to know what they were doing in a micro and macro cosmic sort of way, and there were about 4 members of the engine company standing around with nothing to do. Well, we'd fix that. My preceptor, he of the very deep and loud voice, stepped up and instantly started assigning people "little tasks" which in hindsight was brilliant. My EMT-I partner and I cleared over and instantly got to work. I dropped the bags at the foot of a firefighter and told him what I wanted set up and placed where around the head area. I started one IV line, pointed to another FF near the primary medic's bags and instructed him to do the same. Someone got assigned "Start pulling drugs" as well. I then prepped the sight for the IO and got the drill set up and handed to my preceptor. By that time my EMT-I partner was ready for her first tube attempt and I went over to her. I took over bagging, had suction ready, and began pre-oxygenating. At her 'ready' signal, I counted out to those near me what was about to happen, and called her in. Suction in one hand, my other providing Sellick's Maneuver. Her first attempt lasted the entire 30 seconds, and failed as she couldn't pass her initial tube choice through the vocal cords. For the record, I will never go for an 8.0 as my first choice in a super critical environment. She called failure, I got back in and began bagging.

Patient was in Asystole at this point. I was focusing only on the tasks I was assigned, which at this point was airway. In order to prevent myself from falling into a panic, or from getting my heartrate up too high, I was pretty oblivious to anything that was going on outside of the patient's lungs, pharynx, mouth, eyes. Though I did look up at the LP12 as we progressed to check our progress. My EMT-I partner was about to make her second attempt, having downsized to a 7.0, so we prepared and she made her second attempt. Again, a failure. And by this time, she had stimulated the patient's gag reflex and there was aspiration. I already had suction ready though, and immedieatly began aggressively trying to get everything out I could. However, our patient apparently had 'wolfed' down quite a bit without thoroughly chewing and we had a number of large particles which made for some bad moments. My partner called over to my precepter that she'd failed twice, and she was out. He came over, and took her place. My EMT-I partner would be regulated to a support role for the rest of the call on the outside of the ring. When my preceptor was ready, he went in with a 7.0 and failed his first attempt. Fortunately, bagging was functioning adequately for the moment, but we *had* to get a tube down in order to initiate hypothermia protocol. "I hope you're as confident as you say you are" my preceptor told me as he nudged a spare laryngoscope to me. "Because if I fail this, it's going to be up to you." I nodded and kept bagging away. He began to go in for what was this patient's 4th attempt. During the maneuvering, one of the dance hall staff had circled around to try to make some room by moving a serving table out of my preceptor's wway. He had gone entirely prone to try to get angle, and was considerably bigger than my EMT-I partner. In the process of moving the table, my preceptor suddenly screamed in pain and I snapped my head up. They had moved the table onto my preceptor's knee. I looked up to find a ring of Raleigh PD that had come in during the call and had formed a ring around the scene keeping a barrier of the party goers from getting to close. I shot the closest PD a glare, and tipped my head at the dude who had just injured my partner. It's amazing how communicative such a simple glance can be. The individual who had tried to rearrange the room was 'removed' from the scene very quickly after that. My partner was in obvious pain, but his adrenaline was obviously not letting him feel it. He got the tube on the 4th attempt. Capnography was placed, and I got back on bagging. We had the patient at 35 with good waveform. Not so much on the rise and fall, but lung sounds were appropriate and no gastric pressure. We had it. My preceptor stood up and walked over. I never once heard a 'clear' call, so for whatever reason the patient wasn't defib'd. I suspect they were trying to either capture or convert her since she kept vasillating wildly between rythms. I was looking at the LP12 quite a bit to continue to confirm waveform and capnometrics so I was the first to note it. The paramedics were all in the middle of the hypothermia induction. "There!" I called out, as I noted the rythm had changed to a sinus brady w/ pvc. Like, 42 brady, but still. CPR was stopped, someone checked cartoid and I checked radial. "Have cartoid." they called. "Have radial" I called. My preceptor's head shot up from where he was infusing the frozen saline. "It's time to get out of here." I had already been through two suction units, enough FR's to have my own personal pile of snakes at my feet. I was glad to get out of there, and get to an ambulance because we didn't have any more portable suction units and our patient was bound and determined to aspirate on her undoubtably overpriced dinner.

I actually managed to find use for a technique that I had learned a few months ago during a clincial with respiratory therapy for using the secondary port on the FR for getting rid of larger segments.

We got the patient loaded, and rolling. I didn't ask, wasn't told, but immedieatly jumped into another medic's unit. I was airway damnit, and I wasn't giving up my assigned role.

Transport to the hospital Code-3 was a lot calmer, and cooler since we didn't have so many people. Just 4 of us in the back working on the patient was a *lot* easier to control and everyone had something to do. Our Capnography node had been completely destroyed during the process by vomitus, and had to be replaced. But even the new one wasn't providing an accurate reading. Having read an article on this a few weeks ago I knew it was because it wasn't properly plugged into the port on the LP12 but as one of the medics was fussing with it we got intermittent readings in the 35 range with good waveform so I knew that we were still good. I didn't feel this was a good time to bring up the theory of "You have to also plug the damned thing in right" so I kept it to myself. But I did make a mental note to thank my mother-in-law for that JEMS subscription.

As my preceptor wasn't the 'lead' on the call legally, he was regulated to driving the unit.

By the time we got her to the hospital, of bloody course, she had crashed again. *sigh* So we get her onto the WakeMed bed where once more we had far too many people around and began to go back through the flow chart starting at compressions. They were ineffective, and pretty poorly done, so one of the medics flew past and pushed the nurse out of the way and took over. For the first time I found myself without a job, so I started prepping things and listening for any "Get me" or "I need a" and made myself useful that way. It was also here that I took over compressions on the first swap. I'm told my waveform was fantastic, but that was really not something that I can admit to having paid attention to. I was just focused on doing what I was trained to do, doing them as I saw that first firefighter doing them. After a few rounds I heard my preceptor cheer, "There we go, he got it! Good work!" and at that point noted we were back into the Sinus Brady w/ PVC rythm. I stepped back, left the bed area, and leaned against the desk and let the WakeMed staff entirely take over.

Back at the station, three and a half hours into overtime, I then started talking to the people that were at the call. The district chief, who had been at the scene, had picked up myself and my crew to take us home. I made a point in going to all the people that were there and getting feedback from everyone. I specifically wanted to hear things I was weak on, or could do differently. Nobody had any negative criticism, or even constructive criticism. They were all really fond of my calm, cool demeanour and methodical way of moving from task to task. My preceptor didn't believe me that it was my first.
"Wait, we popped your cherry on that one?"

The ops supervisor made a point of telling me that, "You've just done something that many in EMS will work their entire careers to never get. Your first code, and your first save. Congratulations."

The final part of my day was spent in the relative calm of the sidewalk outside the station with my preceptor having a cigarette. "So, sir. How was I? Was there anything I could do better or differently?" "Max, you were invaluable. Do not, ever, change a thing. You came in with a plan, you stuck with your plan, and you were ahead of me every step. Even in a system and protocol you're not familiar with, you did exactly what I asked when. That is the most valuable thing you can ever do. Invaluable. You earned that save with us." I nodded and we sat there in silence and stared at the skyline for a moment in time just watching the night.

A post-script to the evening came when on my way to my van the district EMS chief came up to me. "Wake County will be hiring basics, and intermediates in the near future, you know." I smiled at him, and thanked him. I tipped my Orange County EMS hat at him (That I had been wearing all day.) "Thank you sir, but for the moment I'm happy with where I am." He nodded. "I can respect that, but if you ever change your mind, make sure to let me know. We'll have a cardiac arrest save "1" badge waiting for you." I shook his hand, thanked him, and drove home.

I didn't sleep a single bit, all night, and had a 7a shift with my fire department. Dead tired, exhausted, but I didn't care. Not one, bit. I had brought the dead back to life.

Something Different

2008-04-09T16:00:43Z

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.

The lessons, and experiences I gathered through this particular clinical will without a doubt be with me for the rest of my life. Both in, and beyond EMS.

The importance of this CCU shift goes back to my ER Shift on the Saturday prior (04/05. Near the end of my shift, Durham EMS brought in a 79 y/o F with chest pain, and irregular rythm 2/2 DKA. As my preceptor and I were 'caught up' with one of our patients being off for tests, I went over to help the nurse on her admission. The lady was obviously altered, but in a pleasant way. I assisted with transferring her, dressing her, initial assessment, and the whole thing. Her initial blood check caused the glucometer to come back as '>700' which I remembered as being amusing that there was in fact a limit. I also got to see an EKG with a very pronounced T-elevation due again to the DKA.

At that time, all I took out of that patient contact was the mild amusement at the aforementioned 'breaking' of the glucometer. (Lab results placed the sugar at 934) [Normal range is 90-100. Anything above or below can be lethal].
The relevancy of the above story will become apparent.

On arrival at the ICU I was sent to charge, who hmm'd and haw'd and looked at the assignment board to try to find me 'the most interesting patients'. One of the nurses standing offered, 'Well, they just pushed the code cart into #5.' At which point that's where I was sent.

I noticed the name first, since the woman from Saturday had a fairly unique and memorable name, but on looking in the room I could barely make her out. She was completely supported with ET, Ventilator etc, etc.

Over the next three hours, me and my preceptor provided what comfort care we could to both the patient, and her family. But the damage was far, far too extensive and she died while we could do nothing but stand back and allow the family their grief.

The attending doctor was also, and absolutely vital part of my experience. Dr. Branch was, I gathered, the 'head' of the department. And he was doing rounds with student doctors of his own. Much to my surprise, he showed me respect, and actively singled me out for input during the final process. In a sequence that I will always remember, we were gathered outside the door. Dr. Branch, the 5 student MDs, the 1 'Fellow', my preceptor, the charge nurse, and myself. Dr. Branch was speaking to the MD's, explaining everything he had done 'within reason' and everything he had done 'beyond reason' for the patient, and that he had no ideas. He asked the MD's if they had anything they wished to add. Like many students in such cases, they all sort of shuffled their feet and looked down while remaining silent. He then turned, looked directly at me, and said, 'Max, what about you? If you have any ideas, or input, please. Tell me.' Once I got over my temporary moment of being stunned at the
spotlight, I turned around and looked at the patient. I looked at the giant monitor by her bed with all her vitals, and turned back to him and looked him in the eyes and answered the following. 'Sir, there *is* nothing we can do. Everyone has done everything they could. I was there when EMS brought her in. They had done everything by the book. The nurses in the ER did everything they could. You and yours, you have done everything you could. Right now, we are breathing for her. We are regulating her heart. We are controling her pain. Since I've been here this morning her MAP has been in the low 50's, high 40's. And that's just in the last two hours. Her chart shows this has been the case since about 6 hours ago. Even if there was some miracle, at this point, her brain will never function again. We've done everything that can be done, but there is simply nothing left to do. In my opinion, for her and her family's sake, we need to let her go.'

Yes, I really did say that. I've always been a good speaker in the clutch. While I was speaking, I did notice the typical 'head bobs' from those listening. Dr Branch took a step towards me, placed his hand on my shoulder and looked me in the eye and said, 'I agree. That's exactly how I feel. That was the right answer.'

He then turned around, and went off to talk to the family. To get their permission. I wasn't there for that discussion, but he came back in a few minutes later and with a simple 'cut throat' gesture, initiated the 'winding down' process as we discontinued the various drips. At this time, I was instructed to push 1mg (!?!) of Epi IV in order to buy the family enough time to gather, and have their peace. Suffice to say, it barely had any effect. Enough, as it happened, but with was very subtle.

As the family was leaving, the patient's husband went out of step to walk towards me and shake my hand. He looked me in the eye and said, 'I know everyone did all they could.' Choked with emotion, I responded lamely that 'Yes sir, I promise, we did.' He then thanked me, gave me a hug, and with the rest of his family left the CCU.

This was the first time, a patient or otherwise, had ever died before me.

I requested of my preceptor that for my own therapy, I be allowed to discontinue all of her tubes, IV's, and even the PICC (Allowed by protocols due the lack of consideration for patient's health). I can't explain why it was important, but it simply was, for me to be the one to gently place her in the body-bag, move her to the covered gurney, and take her downstairs. Where I also moved her into the freezer, uttered a brief prayer, and closed the freezer door on her life.

It was doubly important for me, because as I had began with, I was there during her admission and assisted with that. How could I ever quantify that perspective?

The entire experience challenged my empathy, my composure, my nerves, and most importantly my resolve. For this is a scenario that will be repeated numerous times over my career, without question.

I'm happy to say, following these events, I'm still here. I'm still resolute, and I'm more confident than ever that this is what I need to be doing.

We won't always win. No matter how good, how knowledgeable, and how aggressively we act. It's our job to fight inevitability, to do our best to keep Death at bay for as long as we can. Using everything at our disposal. But we have to know, have to accept, that in the end - we won't always win.

I know now, without equivocation, that I am okay with that. I still want to fight.

So you want to do my job?

2008-03-17T01:15:31Z

Here's a brief list of things that you need to know, and memorize, before even stepping foot into an ambulance.

-All emergency calls will wait until you begin to eat, regardless of the time.
Corollary 1:
Fewer accidents would occur if EMS personnel would never eat.
Corollary 2:
Always order food "to go".

-The Paramedical Laws of Time:
There is absolutely no relationship between the time at which you are supposed to get off shift and the time at which you will get off shift. Given the following equation: T + 1 Minute = Relief Time, "T" will always be the time of the last call of your shift. E.g., If you are supposed to get off shift at 08:00, your last run will come in at 07:59. (Or if you have early relief coming in you will see you relief sitting at the first stop light from the station, waving!)

-The Paramedical Law of Gravity:
Any instrument, when dropped, will always come to rest in the least accessible place possible.

-The Paramedical Law of Time And Distance:
The distance of the call from the Hospital increases as the time to shift change decreases.
Corollary 1:
The shortest distance between the station and the scene is under construction.

-The Paramedical Rule of Random Synchronicity:
Emergency calls will randomly come in all at once.

-The Rule of Respiratory Arrest: All patients who are vomiting and must be intubated will have just completed a large meal of Barbecue and Onions, Garlic Pizza, and Pickled Herring, all of which was washed down with at least three cans of Beer.

-The Basic Principle For Dispatchers:
Assume that all field personnel are idiots until their actions prove your assumption.

-The Basic Principle For Field Personnell:
Assume that all dispatchers are idiots until their actions prove your assumption.

-The Axiom of Late-Night Runs:
If you respond to any Motor Vehicle Accident call after Midnight and do not find a drunk on the scene, keep looking:
somebody is still missing.

-The Law of Options:
Any patient, when given the option of either going to Jail or going to the Hospital by a Police Officer, will always be inside the Ambulance before you are.
Corollary 1:
Any patient who chooses to go to Jail instead of the Hospital has probably been in my rig in the past.

-The First Rule of Equipment: Any piece of Life-saving Equipment will never malfunction or fail until:
a)You need it to save a life,
or
b)The salesman leaves.

-The Second Rule of Equipment:
Interchangeable parts don't, leak proof seals will, and self-starters won't.

-The First Law of Ambulance Operation:
No matter how fast you drive the Ambulance when responding to a call, it will never be fast enough, until you pass a Police Cruiser, at which point it will be entirely too fast. Unless you are responding to an "Officer Down" call then it is physically impossible to be travelling fast enough!

-Paramedical Rules of The Bathroom: If a call is received between 0500 and 0700, the location of the call will always be in a Bathroom. If you have just gone to the Bathroom, no call will be received. If you have not just gone to the Bathroom, you will soon regret it. The probability of receiving a run increases proportionally to the time elapsed since last going to the Bathroom.

-Basic Assumption About Dispatchers:
Given the opportunity, any Dispatcher will be only too happy to tell you where to go, regardless of whether or not (s)he actually knows where that may be.
Corollary 1:
The existence or non-existence of any given location is of only minor importance to a Dispatcher.
Corollary 2:
Any street designated as a "Cross-street" by a Dispatcher probably isn't.
Corollary 3:
If a street name can be mispronounced, a Dispatcher will mispronounce it.
Corollary 4:
If a street name cannot be mispronounced, a Dispatcher will mispronounce it.
Corollary 5:
A Dispatcher will always refer to a given location in the most obscure manner as possible. E.g., "Stumpy Brown's Cabbage Field" is now covered by a shopping center.

-The First Principle of Triage:
In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient.

-The Gross Injury Rule:
Any injury, the sight of which makes you want to puke, should immediately be covered by 4x4's and Kerlix.

-The First Law of EMS Supervisors:
Given the equation: X - Y = Quality of Care where "X" is the care that you render and "Y" is the assistance supplied by any Supervisor. If you can eliminate "Y" from the equation, the Quality of Care will improve by "X".
Corollary 1:
Generally, Field Supervisors have no business in the Field.
Corollary 2:
The level of technical competence is inversely proportional to the level of management.
Corollary 3:
Technology is dominated by those who manage what they do not understand.

-The Law of Protocol Directives:
The simplest Protocol Directive will be worded in the most obscure and complicated manner possible. Speeds, for example, will be expressed as "Furlongs per Fortnight" and flow rates as "Hogsheads per Hour".
Corollary 1:
If you don't understand it, it must be intuitively obvious.
Corollary 2:
If you can understand it, you probably don't.

-The Law of EMS Educators:
Those who can't do, teach.

-The Law of EMS Evaluators:
Those who can neither do nor teach, evaluate.
-The Paramedical Law of Light:
As the seriousness of any given injury increases, the availability of light to examine that injury decreases.

-The Paramedical Law of Space:
The amount of space which is needed to work on a patient varies inversely with the amount of space which is available to work on that patient.

-The Paramedical Theory of Relativity:
The number of distraught and uncooperative relatives surrounding any given patient varies exponentially with the seriousness of the patient's illness or injury.

-The Paramedical Theory of Weight:
The weight of the patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of floors which must be descended while carrying the patient.
Corollary 1:
Very heavy patients tend to gravitate toward locations which are furthest from mean sea level.
Corollary 2:
If the patient is heavy, the elevator is broken, and the lights in the stairwell are out.

-The Rules of Non-Transport:
A Life-or-Death situation will immediately be created by driving away from the home of patient who has just thrown you out of their house. The seriousness of this situation will increase as the date of your trial approaches. By the time your ex-patient reaches the witness stand, the Jury will wonder how patient in such terrible condition could have possibly walked to the door and greeted you with a large suitcase in each hand.

-The First Rule of Bystanders:
Any bystander who offers you help will give you none.

-The Second Rule of Bystanders:
Always assume that any Physician found at the scene of an emergency is a Gynecologist, until proven otherwise.
Corollary 1:
Never turn your back on a Proctologist.

-The Rule of Warning Devices:
Any Ambulance, whether it is responding to a call or traveling to a Hospital, with Lights and Siren, will be totally ignored by all motorists, pedestrians, and dogs which may be found in or near the roads along its route.
Corollary 1:
Ambulance Sirens can cause acute and total, but transient, deafness.
Corollary 2:
Ambulance Lights can cause acute and total, but transient, blindness. Note: This Rule does not apply in California, where all pedestrians and motorists are apparently oblivious to any and all traffic laws.

The Law of Show-And-Tell:
A virtually infinite number of wide-eyed and inquisitive school-aged children can climb into the back of any Ambulance, and, given the opportunity, invariably will.
Corollary 1:
No emergency run will come in until they are all inside the Ambulance and playing with the equipment.
Corollary 2:
It will take at least four times as long to get them all out as it took to get them in.
Corollary 3:
A vital piece of equipment will be missing.

-The Rule of Rookies:
The true value of any rookie EMT, when expressed numerically, will always be a negative number. The value of this number may be found by simply having the rookie grade his or her ability on a scale from 1 to 10.
For rookie EMT's medical skill:
1 = Certified Health Hazard, 10 = Jonny or Roy.
For rookie EMT's behind the wheel:
1 = Obstruction to Navigation, 10 = Mario Andretti.
The true value of the rookie is then found by simply negating the rookie's self-assigned value.
Corollary 1:
Treat any rookie assigned to your Unit as you would a Bystander. (See The First Rule of Bystanders, above.)

-The Rule of Rules:
As soon as an EMS Rule is accepted as absolute, an exception to that Rule will immediately occur.

So you think you have bad mornings?

2008-03-14T00:39:29Z

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.

foklens @ 2008-03-05T14:07:00

2008-03-05T19:08:17Z

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?

Because!

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!
Cheers.

Night One

2008-01-30T19:06:36Z

Rookie Shift #1:
Or: Holy shit they're asking for ME when they call 911!

Now, in preperation for my first 'real shift' in this new Fire Department EMS gig, I went and got a more 'severe' hair cut. I had laid the boots to half the unruly mob on my head back in September. Now, it was time to scalp the rest, earlier last week. So when I arrived at the station for my first shift, and the Captain looked at me with a unmistakable "Who are you, why are you wearing my uniform" look, I had to coax him into remembering that yes he did have a new EMT who was coming in tonight for his first "No hand holding" shift. And, AND, it was 7pm to 7am.

As he had entirely forgotten I was to be there (Despite it was in clear lettering on the calendar) he hmm's and haw's and looks at me, looks at the other part-time EMT, and decides I look the more 'professional' of the two and gulags me to the infamous "Station 2". S2 being the EMS only station in the middle of the district that gets the 'best' calls. This wouldn't phase me in the slightest were it not for the conversation I had with the Asst-Chief EMS an hour previous to which lead to her quote of "When people get more confident in your skills, you'll likely see more time at Station 2 since it's just one crew EMS only".

Great! So I make it to S2 not through a confidence in my skills, but through sheer indifference! Rock on! Go team Me!

After sitting through two hours of 'Fire Fighter Daily Training", I was ready to practice jugular IV access on myself. Really. 2 hours of watching Fire Fighter memorial/funeral coverage videos to remind us to be safe, and not make stupid decisions. 2 hours. With about 1/2 of that being money shots of the grieving widows and orphans. Seriously. So now I'm firmly convinced that I'm going to become one of those statistics of rookies who die on their first shift. 2 hours. Funerals. Great. Fabulous.

The medic unit had moved over to Station 1 for training, so it was time to skulk back to Station 2. I guess they're used to all rookies and new people completely being incompetant, because it took me about 15 minutes to convince my captain, and crew that I did indeed know where this station was, wouldn't get lost, no I don't care that the last 3 rookies they sent there still haven't turned up ever again. Unphased, I departed and made it there well ahead of the ambulance itself. At least they didn't act all surprised to find me loitering by the doorway when they showed up.

Note to self: Loveseats aren't comfortable places to sleep at my height. Further note to self: Bring a pillow and blanket on nights. Patient linen...Well, let me say this. I'm going to start carrying around a backpack with a nice, warm blanket on the off chance I have to attend someone whom I actually care about.

Enough about that, let's discuss calls! There were 4 between 12a and 7a. So firmly in the category of a 'busy' night.

How new am I? I'm this new. I was afraid I would miss the alarm going off. That I would sleep through it. That I'd just keep snoring through, oblivious, while the Medic and Driver left their wayward EMT dreaming peacefully on the couch. That I would wake up with the sun and yawningly look around wondering where everyone was.

Wow. Was that a stupid concern. The first time I heard it, what I can only explain to the un-initiated as a Howler Monkey having coitus with a Garbage Disposal system, I was actually standing and going into a seizure before my brain decided to peek out through the blast doors of consciousness enough to go, "Woah, uh, wha..where...oh right, the Truck!"

Medic Report: Patient is 33 y/o male suffering from a GSW. Addressaddressadress. PD and Medical Response Code 3.

(For those who don't know, Code 3 is the full lights, sirens, audible glory of a pissed off emergency service vehicle asking you ever so politely to, 'Get the fuck out of the road. Old Chap. Tut. Tut. Please. NOW.')
Oh, and I should probably do this too. G:un S:hot W:ound. Apparently, and I certainly missed this directive in the procedure book, there is an appropriate dance that must be made at being sent out to a GSW. A happy, festive skipping that must be done. I say this because I was the only one not doing it. "Yay! Gunshot! Time for fun!" went the other 2/3 of my unit. I'm proud to say my complete indifference and reserved sauntering to the unit threw off the air of professionalism, and apparently came off as "Oh, *yawn*, not another one."
So we get out on the driveway, lights come on, 'Medic and driver are discussing quickest route when...

Dispatch, this is Medic 8. We're 3 minutes from scene. Stand down Medic 62.

At this point, the entire front of the ambulance erupted into the sort of reaction you'd expect from a group of guys watching their favorite (Geographical Appropriate Professional Sports) team blow a game in the last few seconds. You see, our GSW had just been stolen from us. Our 'medic swapped to the Ops channel and told Medic 8 that they were those who indulged in the having of sex with mothers. This was met with laughter on the other end, and a verbal 'pat pat' on the head as they sent Cindy, Don, and Betty Lou Who back to bed with milk and a cookie.

So back we go into the station, grumbling and griping about getting sniped, and I squeeze myself back into the loveseat. By this time, I'm glaring angrily at the ceiling because when I find that alarm speaker, I'm going to castrate it with a roll of duct tape and a pillow. Fool me once.... About 10 minutes after this, just as we had all started going back to sleep...

Hold on baby, this Howler Monkey is almost there....

Medic Report: Patient is on the phone with 911, recently assaulted, claims profuse bleeding. Patient is standing on the end of a driveway at addressaddress. PD response Code 3. Medic response Code 2.

(Code 2 is regular traffic. Sure, we still trash talk anyone not smart enough to get out of our way, we just don't use the flashy lights and loud things.)

If that alarm survives the night, I'm going to claim it as a tremendous testament to my emotional maturity. So off we go. Now. During our saunter over to an admittedly NOT SAFE scene, our dispatch location changes 3 times. See, this guy is on a cell phone. One which does not accept incoming calls. (?!?) Here's what was dispatched. 1 Ambulance Unit (That's us. HI MOM!), 4 Police Cruisers, 1 Engine (Fire) Unit. So you've got 4 units actively looking for this guy, and 1 unit (Us! HIHIHIHI!) who damned well do NOT want to find this guy before the PD do. Eventually out of the concern that maybe this guy is really FUBAR, we join the search a bit. Nothing. 10 minutes later, everyone is convinced that this is a false alarm. And so, we clear and go back to station in case we're needed. The PD keep searching. Apparently, this is common in the 'poorer' region of Durham. We're pretty sure from the notes the call taker is getting that there is really a patient out there, and that he probably does need help, but we can't spend all night looking for him. Back we go to S2, and back I cram into the seat. I decide that the pillow over MY head may be more condusive to my further affiliation with this department.

OH YEAH BABY. LIKE THAT. YEAH THATS HOW I LIKE IT...

Did I really. REALLY, earlier worry that I wouldn't hear that infernal thing? I go back to thoughts of practicing my external jugular IV technique. Which at this point, is non-existant. (Hint: That's the point.)

Medic Report: Patient Ageage recently assaulted, bleeding on head. PD is with patient at this time. Medic response Code 2. Ops Channel 3
This is Medic 62: Is this the same patient from earlier?
Ops3: Yessir.

So. Baaaack we go. Arrive on the scene. All 4 PD cars from earlier are here, and all 4 PD guys are standing around what looks like a grizzly bear that wandered down from the hills, got his head stuck in a Slurpee jar, and now is just wanting to find a cave to crawl into to hibernate. The police are all, ALL, looking like they're having the time of their lives.
And now we meet the gentleman who introduces himself as "Bulldog". If you ask him, he's a former Marine, SEAL, Airborne Ranger, Navy Diver, Army Grunt, Demolitions Expert, Sharpshooter, Engineer, Mechanic, and all around just one man army. He is also...drunk. And in his grizzly adams like beard, he has what I'd estimate to be maybe about 5ml of blood. Yet he's convinced he's dying. The very moment we get in earshot, we note that the police are absolutely clowning it up. Turns out Bulldog here was evicted from the "House" he shared with another person. As all his bags are packed, and sitting on the end of the little gravel path into a copse of trees or "Driveway". (One of the police helpfully offers to take the bags to the ambulance. Dropping them in the back with a snicker while proclaiming, "His magesty's matched luggage.") Some memorable quotes from the resulting assessment.
"I checked out the house. The person who assaulted him is there. Charming fellow. Very sophisticated."
"House?"
"Well, okay. More like a shanty."
"Well, this is a nice neighbourhood."
"Oh, absolutely. I'm thinking about moving in next door."

The police laugh at us as we begin wheeling in the by now fully immobilized "Bulldog", and actually break into a Can-Can line while singing, "Na Na Na Na..Hey Hey Hey...Goodbye" as we depart with our patient.

The transport was about what you'd expect from a very large, homeless, and drunk man who's convinced he's going to die. Many, many shared looks between me and the Paramedic who by and large is just perching on the bench seat twirling his pen and wondering how the hell he's going to call this in.
"Feel free to do whatever you want."
"You need anything else?"
"Nah. But if you want to start an IV, give 'er."
"Sorry, not an I yet."
"But you're in the class right?"
"Yep."
"Then give 'er. I'll sign you off a stick."
"Sorry man, we haven't even done the class portion of it."
"Oh. (Long pause.) Want to learn?"

We both snickered, but didn't poke the poor drunk Bulldog. He was already going to have a hell of a hangover in the morning, and likely will lose a great section of hair in the removal of the C-Collar and Head Blocks we had to put down due to some past medical issues of his.

So we get back at about 3:30 am. We all sort of grunt at each other in acknowledgement then fall/collapse/contort ourselves into our appropriate sleeping area.

I'm already getting into the hang of up, down, up, down. At least well enough in that I fade off to sleep...And we almmmoooosssttt make it to the end of our shift....

MORE HOWLER MONKEY/GARBAGE DISPOSAL SEX THIS TIME WITH AN ICE MAKER PROVIDING FLUFFING DUTIES!

Ugh. Night 1: I'm happy to report, I hate that thing. And my head is going to be ringing for dayyyyyyssssss. It's also 6:30am I note, which means, I we missed the relief crew by 15 minutes and are likely going to be out till 9am. #*$%$&%$!

Medic Report: Patient is an ageage woman at Assistedlivingfacility. Possible seizures, was found by nursing staff this morning unconcious and not alert. Addressaddress Medic Response: Code 3

There wasn't really anything to this last call that as a regular prowler of the halls of nursing homes I wasn't down with. The typical situation where Granny decides to try her damndest to wake up dead, and her 'care givers' object with that as a course of action. She was a full DNR/DNI, so there'd of been nothing we could have done anywayl. Fever of 106.7F.

And so, with Grandmother safely delivered to the ER, and not having made a fool of myself all night, I gave the apparent standard currency of "Low gutteral grunt, with 1/4 head nod" and slunk to my car. And slept.

And not once, did I hear any howler monkey's getting it on with household appliances.
Bliss. Rapture.
Can't wait to do it again.