Archive for the EMS Category

Guest Post: Flaws in EMS Education

Posted in EMS, Guest Posts on December 1, 2010 by medic61
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Tonight’s entry is a guest post from @MattTheMedic, an off-shore paramedic who has recently started his own blog. He’s an incredibly intelligent and witty guy, so if you aren’t following him on twitter you should check him out! After you’ve read, please head over to his blog and say hi, and feel free to comment on this post to let him know what you think!

—————

To draw an objective conclusion about the flawed state of EMS Education you first have to admit there is a problem. Unfortunately I was unaware of the problem because I thrived in the earliest (and easiest) stages of said training.

The EMT-Basic program is a class designed for the lowest common denominator.

Good at memorizing things? Great.

Have half an ounce of common sense? Even better.

Willing to unquestioningly accept that 2 + 2 = 5 (90% of the time)? Awesome.

Medical directors are gonna love you.

At this point we’ve stumbled upon …
Problem #0 *: The EMT-Basic program is a watered down course that most 8th graders could pass with a little help. As long as you’re capable of memorizing and making your hands do what you tell them, you’re in. You’ve also just met the criteria to work in fast food.

I did not understand this problem due to the relative ease in which I negotiated the class. And this is not to say that I’m a rocket surgeon, by any means. I consider myself of average intelligence and had the benefit of running for 6 months on my local volunteer ambulance prior to ever stepping foot inside the EMS classroom. But, if you can remain calm, remember a few simple mnemonics (SAMPLE, DCAP-BTLS, AVPU, etc.), and memorize the practical sheets, you are the new Golden Child of EMS.

Please do not take this as a dig on my EMT-Basic Instructor. He was a wonderful teacher with too many students, too little time and a long list of things (mostly silly things) that the state required him to talk about. He was, and still is, one of my EMS heroes, an awesome Paramedic and a genuinely great person who I consider myself lucky to have had the opportunity to work with.

Also, please do not read this and think that I’m taking anything away from being an EMT-Basic. I was one for nearly 8 years. I bought into the “BLS before ALS” concept with my whole heart. I believed “Paramedics save lives; EMTs save Paramedics.” I was certain that I was better than 95% of any “Para-God” out there. I used to honestly believe I was the greatest thing to happen to EMS since Johnny Gage and Roy DeSoto. I was a genius and all you had to do was ask me. I’d tell you how badass I was. I’d give you the contraindications for a traction split while doing a keg stand. You could wake me up from a dead slumber and I’d rattle off how many CCs of air the blue balloon took to be fully inflated on a Combi-Tube. Need a pro Bag-Valve-Masker? I was your man. I was the master of all that was the BLS Craft. Life was so much simpler back in those days.

Then came working in an Emergency Room for 2 ½ years. At the same time I was working for a private ambulance on a 911 ALS truck. Then, ultimately, it came time for me to go to Paramedic School.

After about 2 days working in the ER, 2 weeks of working on an ALS 911 truck, and 2 months upon entering Medic School I had 3 minor epiphanies that equaled one coherent though:

“What I don’t know is not only dangerous, it’s nearly criminal.”

It was the perfect storm.

It was like I was Jake Blues screaming “YES! YES! JESUS H. TAP-DANCING CHRIST… I HAVE SEEN THE LIGHT!”

But, it turns out; I’d only recognized there was a problem. Not a solution. Yet.

To be blunt; I didn’t know D.I.C.K.

Differential Diagnosis: I’d never even heard of this until I entered Paramedic School. Hell, the only thing I’d ever heard was “We don’t diagnose in the field.” And I believed that. Thus, a systematic approach of figuring out what was the matter with my patients never occurred to me. Sure I’d been taught to get a SAMPLE history, but no one ever explained how to formulate a plan of how to use said information.

Intravenous Access: Although I knew Medics could start IVs, I had little idea of why they could do it. And I was mostly unaware of the fact that ability to start an IV was not a treatment. It was a means to an end. The act of starting an IV itself has never once saved a person. All I knew was that it was damned cool and I wanted to be able to do it. Many people want to be paramedics solely to “do cool stuff like IVs and intubate.” And likely half of them couldn’t tell you why they want to do those things.

Cardiology: I knew two things about the heart to be true: If there is no pulse start CPR. If there is an AED available get the patient naked and slap that puppy on. I was clueless as to the “Why” and “How” of AEDs. Sure I picked up little pieces of the puzzle here and there, but no one sat me down and explained V. Fib or V. Tach to me in EMT class.

Ketoacidosis, Kalemia, Kussmal, K (Potassium): Some of these words I’d heard of, some I had not. Sometimes I just pretended to know what they meant so I didn’t appear stupid. Regardless, I was not prepared to describe, in great detail, any of the things above. In all honesty the only thing I knew about K (Potassium) was that there was a cereal I liked called “Special K.” And even at that, I still wasn’t sure if I was eating flakes of Potassium or just some corn flakes with really awesome marketing by the Kelloggs Corporation.**

The solution to problem zero seems relatively easy:
Make the class harder, to better prep EMT-Basic’s for Paramedic School.

• Teach Differential Diagnosis early. Let’s stop pretending that our students will remain EMT-Basics for the rest of their lives.
• Increase time spent on Anatomy and Physiology.
• Introduce Pharmacology earlier and more extensively (For starters, focus on the drugs these EMTs will end up handing their Paramedic partners)
• Teach them basic cardiac rhythms so they don’t feel overwhelmed later on in life. Or, at minimum, explain the concept of a P, a QRS and T waves.
• Give an intro to medical terminology (Or at the very least commonly seen EMS terms)
• Add more required Ambulance ride time and more ER clinical time.
• And lastly, institute an entrance exam to weed out the people you don’t want in the back of an ambulance taking care of your loved one.

Why don’t we stop pandering to the lowest common denominator? Just because you’re capable of passing a state mandated test does not prove you are ready to hop in the back of an ambulance.

To rectify this problem would be to kill a large sub-section of EMS, since many people are fine with staying Basics (especially in more rural/volunteer areas). The EMT-Basic may not be the backbone of EMS in the United States, but they most certainly are the legs. Sadly, making the course harder would eventually just be a case of shooting ourselves in the foot. I don’t have a perfect solution, but doing just a couple of these things could certainly help. EOR. – MW

*Problem 0 due to it being a problem before you even get started in your EMS career.

** Side note: The first thing I tell anyone interested in going to Paramedic School is to enroll in a medical terminology class at their local community college.

Women in EMS

Posted in EMS on November 15, 2010 by medic61
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I went to career day at an elementary school two weeks ago and got to talk to the entire second grade. I got a lot of great questions about what it’s like to work on the ambulance and treat patients, and I really enjoyed talking to the class. I got to show them a bunch of pictures of me with Drew, Eric, and other partners, and they really seemed to enjoy that.

Each class, however, astutely picked up on one common theme of the pictures: I was the only woman in each photo. Each class asked why there weren’t more women in EMS and why all my partners are male. I didn’t really have a good answer for them, to be honest. I told them about people who had told me that I couldn’t do EMS or fire because I was a woman but how I showed them by doing it anyway and being *good* at it. I used it as a teaching opportunity for the idea that you can do anything you want when you grow up, as long as it is within your means. (Sidenote: when my mom told me that I could be anything I wanted to be when I grew up, I asked her if I could be Christopher Columbus. Not sure why, but I thought that would be pretty awesome.)

But I couldn’t give them an answer as to why EMS was a traditionally male-dominated field. I tried to think it through a bit more, but came up blank. Medicine is a strange field for gender stereotypes, really. Physicians are typically thought of as being male, nurses are typically pictured as female, and EMTs are thought of as male. But, why?

In sociology we discussed that since physicians have to attend many years of school before being able to practice, it is something that many women do not wish to do. Since they bear the physical burden when starting a family it often isn’t feasible to take that much time off during one’s time in medical school. Of course, this isn’t always the case, but we talked about how this sort of set the precedence for doctors being typically male.

Alternatively, we discussed how nursing is a field that requires less time in school, which often lends itself more kindly to those who wish to start a family and still have time for school. Clearly more goes into it than just this for both MDs and RNs, but it’s a cursory assessment, I guess you could say.

But what’s the deal with EMS? I feel like the ratio of men to women is equalizing more and more, but that the stigma still exists for women in the field. I know that I, personally, have encountered many instances where I’ve been told that I wouldn’t make it as an EMT simply due to my assigned genitalia. But…why? I know that I keep asking this, and it’s because the more I think about it, the more it baffles me.

So I guess what I’m asking is for reader input. Do you see this gender stereotyping of the field the way I do, or do you perceive it differently? What is the gender ratio like at your station? Have you experienced any discrimination in the field based on your gender, or have you witnessed it? What are your thoughts on why this exists?

I’d just like a little insight, and figured you all would have some more ideas!

Stay safe out there,
Sam

Character Counts

Posted in EMS on October 27, 2010 by medic61
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Last week, I had the privilege to go to a local elementary school and talk to four classes of fifth graders about being an EMT. They were studying the pillars of character for “character counts week”, which include fairness, caring, responsibility, trustworthiness, citizenship, and respect. The teachers had found several people who have professions that embody these ideals to come in. A priest, a coach, and a firefighter also got the chance to speak to the eager children who were happy to have a break from the routine.

I got up in front of the first class and awkwardly started. “So, I’m an EMT…” I said, and wondered where to go from there. It was surprisingly great, however, because the kids seemed to fill all the silences with stories and questions. I finished my little talk and let them ask me more questions. There was a brief lull, so the teacher interjected.

“Sam, do EMTs make a lot of money?” She said this with a little twinkle in her eye because she knew that we don’t, and that the kids probably thought we were on par with physicians.
“Well, no, they typically don’t,” I said, “but I actually volunteer as an EMT.”
“So that means you don’t get paid at all?”
“Right, I give my free time to work as an EMT.”

I saw a little boy’s eyes get very big. His mouth dropped open in shock, and he started to clap. The rest of the class joined in. Immediately, tears came to my eyes, as I was completely caught off guard. The little boy kept this open-mouthed grin, and then said “oh my gosh, when I have free time I just watch tv or play with my friends!” I had told them about how I work two jobs and go to school full-time along with teaching at my church and volunteering on the rescue squad. He looked at me with pity in his eyes and said, “don’t you ever get to play with your friends?”

I know I’m busy, but I’m happy this way. I told him that even though I keep my schedule pretty full, I still find time to watch tv, play video games, and see my friends. He seemed relieved, and accepted this with some hesitation.

What I find interesting, though, is what each class had in common. Without fail, each class asked “what’s the worst thing you’ve ever seen?” I’ve had little kids ask me this before, but for some reason I was unprepared that day. The last time someone asked me about the worst thing I had ever seen, I just blushed and looked at my feet. They don’t really want to hear the truth, but think they do. And to be honest, I don’t really know how to explain to someone the nightmares that still come, or the times I collapsed in the shower with giant sobs sticking in my throat. You can tell them the event that is “the worst,” but you can’t tell them the aftermath. But, after an awkward pause, I came up with a response.

“Whenever anyone gets hurt, it’s always bad,” I fumbled. “I mean, sometimes it’s worse than others, but it’s never good to get hurt. I think that the worst things I’ve seen are car accidents, though, because they’re typically avoidable, and the injuries can almost always be avoided with the use of a seat belt. How many of you wear your seat belts every time you get in the car?”

I watched the hands shoot up in the classroom and smiled. “It’s so important that you remember to wear them every day, no matter how far you’re going,” I said with more confidence.

One little boy, who has my mother as a teacher, said, “your momma told us that she doesn’t leave the driveway until she hears all the seatbelts click. Is that true?”
“Yep,” I smiled, “she wouldn’t even start the car until I had my seat belt on.”
“What about you? What do you do if a friend doesn’t want to wear a seat belt?”
“I just tell them that it’s my rule that I don’t go anywhere without everyone wearing their seat belt, and if they won’t wear one, then they can’t ride with me.”
“Wow…that’s really cool!”

I was pretty proud of myself, to be honest. Never had I been able to turn that painful and awkward moment into a teaching opportunity, and as I saw a little boy mime the action of buckling his seat belt, I had to smile.

Tonight, my mom brought me the thank you notes the children had written me. Almost every one had a star of life, or an ambulance on it. I can’t truly explain how much this meant to me; the sentiments inside expressed that perhaps I had actually gotten through to them a little bit.

So I can share my happiness with you, I thought I’d post a few of them (a few fronts and a few insides) here on my blog. I just love the pictures!

Take care out there,
Sam






Ridealong

Posted in EMS, Miscellaneous on October 11, 2010 by medic61
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It’s been a long time since I’ve done a ridealong with another department; the last one I did was for my EMT class when we had mandatory ride time. I really enjoy seeing how other departments function and getting experience with providers more experienced than I. So, when Rhett (aka The Fire Critic) asked me if I’d like to ride with him, I jumped at the opportunity. It’s not every day that I get to do a ridealong, but it’s even less frequently that I get to ride with an internet celebrity.

Rhett and I met at EMS Today this past year (March 2010), and we had been friends on twitter for some time. I’ve been an avid reader of his blog for ages, so when I found out that we only lived about 45 minutes away, I was floored. We even had some mutual friends on the department, which I thought was pretty neat.

One fine Sunday morning this past month, I made my way up to the department. I had breakfast with the guys and got to meet each of them and hear about how amazing it is that Rhett is riding the ambulance; he usually sticks to the engine ;) I know with ridealongs it’s usually a day full of calls or a completely quiet day, so I was wondering what would happen. Rhett took me back to sign the release, and before I could finish my signature, the tones dropped for a house fire.

Now, it wasn’t anything major, but still, it was a house fire! We didn’t spend too much time there, and right as we cleared from the scene we were dispatched to “amputated toes.” At this point Rhett and his partner started shooting me dirty looks from the cab and mumbling things about busy days with ridealongs! It wasn’t a true toe amputation, but it was close…it reminded me why I’ve never mowed the lawn in slippers.

So after clearing up, we go about the day as usual and I get to hang out with the guys a little more. Things are finally settling down when we get dispatched to a diabetic problem. Dispatch notes state that the patient is “conscious and breathing,” so I expect to see someone with low blood sugar who is easily fixed with some juice or glucose. Yeah, right.

Rhett is getting things from the ambulance while his partner and I go inside. We find the man on the floor in the back room, unconscious. The partner touches him to try and rouse him, and then looks at me; his skin is totally dry, and we suddenly realize that this isn’t a diabetic problem at all. Rhett comes in right as we say “oh shit, it’s a full code.” To make a long story short, we work him all the way to the hospital when all we expected was a little low blood sugar. I couldn’t find my BDUs due to moving recently, so I wore jeans; during CPR I ripped a big hole in the knee, so they are now my “CPR pants” :)

We ran one more call, and it was a welcome relief to do something that wasn’t a huge call! I left after about eleven hours and I was exhausted; it’s not often that I work that hard in EMS! The guys tried to claim that it was me who was the black cloud, but I told them it could just as easily be Rhett, since this was only the third time this year he rode the ambulance!

I had an absolute blast all day, and hope I can ride another shift with them sometime in the future. Rhett also wrote up his account of the day here, so please go give it a look if you have the time! If you’ve never read his blog, definitely give it a read, and be sure to follow him on twitter @FireCritic!

Be safe out there,
Sam

Baptism by Fire

Posted in EMS on August 8, 2010 by medic61

It’s been months since I was in the ambulance. The last time I was, I was lying on my back, strapped to a board, looking straight up at the ceiling.

“Do you know what happened?”
“There was an accident,” I said.
“Do you know what day it is?”

I feel really stupid. I know that I ask these questions to my patients all the time, and I’m really embarrassed that I’m struggling right now.

“It’s um…I know it’s April,” I say sheepishly.
“Right, good job…any guess on the day?”
“Not really, I’m sorry.”
“Don’t apologize, Sam.”

My head is throbbing and my neck hurts. I feel dizzy and nauseated, like the morning after my 21st birthday. I guess that’s what happens when you hit a stationary object at 55mph.

I spend a few days in the hospital, being treated for a concussion with some neck strain, vertigo and amnesia. I don’t remember a lot of the hospital, and my memory had made the car accident seem minor to me. After I’m out of the hospital, the insurance adjuster tells me I need to go to the body shop to get the things I want out of my car before they take it away. I know my car is “totaled,” but it feels like that’s just an insurance term.

I drive up to the shop and they direct me around back. The guy gives me some instructions about getting the doors opened, and gives me a plastic bag to put things in.

“Were you driving that?”
“Yes sir, I was.”
“You’re really lucky to be with us; you must have been wearing your seat belt.”
“Oh absolutely, I don’t start the car unless it’s on.”
“It’s really weird that your airbag didn’t deploy…if you hadn’t been wearing your seat belt, you probably would have been ejected, and–”
“Yeah,” I say, interrupting him, “definitely.”

I walk around the corner and see my car, and my jaw drops. I mean, I knew I had done some damage, but I didn’t have any clue as to the extent. I stand there, tears running down my face, just looking at my car. The only thing I can manage to say is “holy shit.” Standing in front of that car, I’m suddenly faced with my own mortality and how unbelievably lucky I am to be alive.

I can’t say that I’m not scared every time I get behind the wheel now. I’m hyperaware of my surroundings, and I’m constantly terrified that something is about to happen. I know that with time this will fade, but for now, it’s still very fresh in my mind.

So I’m in the ambulance again, for the first time in months. I’ve moved to a new town to start nursing school, so I’ve started running with a new station, but this is my first “real call” with them. The tones had gone off earlier, asking us to respond to a single-vehicle MVA, so I had pulled on my clothes, grabbed my radio and headed out the door.

It’s an MVA. I’ve seen car accidents so many times that I don’t even think twice about them anymore. We head to the scene, and I rest my feet on the stretcher rails, listening to the radio traffic.

As we pull up, I can hear it before I can see it. I hear the sounds of a fire raging, and I stick my head around some bushes to get a glimpse. There’s a car lying driver-side-down on a small bridge, burning. The flames are jumping high into the treeline, and I hear the banter of the firefighters.

After it’s out, we approach to try and locate a patient; I look at the car and I feel my chest tightening. I can’t tell what kind of car it was. I can’t tell what color it was. It’s completely destroyed, and we can’t find the driver anywhere. I look inside the car, half expecting to see flesh melted to the seats; I don’t understand how anyone could survive that.

We search the trees, the area below the bridge, the sides of the road; the driver is just…gone. Standing there, I’ve got this creepy feeling that he was young, maybe my age. I’m thinking of him lying in a ditch somewhere, being too weak to cry out for our attention. I imagine his family, and the articles that will be in the newspaper tomorrow. I feel the pressure of tears behind my eyes, and I look away to the sunrise.

“Uh…medic 1-1? We’ve got a male subject here in the field, wanna come take a look?”

It’s our driver. He’s walking around a bit confused, but he’s alive and he’s upright. He’s very young and has a look reminiscent of a scared baby bunny. Immediately tears come to my eyes, and I want to hug him and tell him how lucky he is to be alive.

“Are you hurt?”
“No, not at all…I have a little mark from the seat belt, but I’m okay.”

He answers all the questions I have about person, place, time and location. His pupils are reactive, his blood pressure and pulse are good, and he’s barely got a scratch on him. We wrap a blanket around him, and he signs a refusal; I’m shocked beyond belief.

As we drive home, I’m just so thankful. I’m thankful he’s alive, and I’m thankful I’m alive. I remind myself how it can all be taken away in an instant. I can see the smoke and steam rising from the car as we drive away, and as I take a deep breath, I am reborn.

It’s good to be back.

Saying Goodbye

Posted in EMS, Partners on June 1, 2009 by medic61

I’ve written this entry more times than I care to admit to. I’ve been chastised about it not being posted, and I’ve considered hitting the “Publish” button a few times. I couldn’t figure out why I couldn’t finish this post, but I think I’ve finally put my finger on it.

When I finish this entry, it’s real. When I update with this post, it’s out there for the internet world to know, which makes it a lot more tangible, I think.

Drew graduated in mid-May, and this past Wednesday we spent our last shift together as partners. He’s back in his hometown gearing up for a summer internship and grad school, and suddenly he’s not my Drew anymore.

It’s been a really hard semester. I’ve been dealing with some heavy things, and my friends have been there to support me. Drew and Eric have been there for me every step of the way, and I am so thankful to have them in my life.

That’s why it’s so hard for me to know that he’s no longer my partner. Drew is someone I’ve shared many sleepless nights, heartfelt conversations, late-night talks, hysterical moments, and fun weekends with. He is one of the few people who will really stand out in my mind years down the road when I think of my time in college.

No one makes me laugh the way he does. The voices we do, inside jokes we share, and words that he misuses are hysterical to the point of insanity. I’ll never hear the word “ineligible” again without thinking of him, nor will I be able to make it through the song “Nights in White Satin” without laughing.

At the same time, he inspires me like no one else. Professional to a fault, charming and sincere, he pushes me to be a better provider–a better person. I’ll never forget the way he treated the woman who thought she had radioactive urine. He never looked at her strangely, laughed at her, or ignored her complaint. He promised her that he would take good care of her, and that’s exactly what he did. He’s calm under pressure, knowledgeable, and easy to work with.

There will be other partners. There will be other inside jokes, other late-night talks, other traditions. But there will only ever be one Drew.

So to Drew, the partner I never expected but will never forget, thank you. You’ve made my life better by just being in it. Good luck in everything you do; you’ll do great, like always.

And when you’re in charge of some fancy-pants fire department, don’t forget about us little people, okay?

Take care out there,
Sam

Twisted Metal

Posted in EMS on March 14, 2009 by medic61

“I know it’s not good to say the q-word, or to taunt the EMS Gods, but…”
“But what,” I ask hesitantly.
“But I want to run a call. We’ve been quiet for the past month or so overnight. You, Eric and I are finally staying here all night by ourselves without any paid providers. I want to be able to prove ourselves I guess.”
“You and me both,” I sigh.
“Well, goodnight,” Drew yawns quietly, “hopefully see you before morning.”

I sleep fitfully, dreaming about my classmates and my family. I catch myself snoring once, and talking in my sleep another time. I dream that I hear us getting toned out for a multi-vehicle car accident. I’m jarred from my dreams by the alarm ringing angrily in the dark. Only then do I realize it’s actually happening.

“Station 1, central. We’ll have a medic in route shortly,” I respond hoarsely.

Drew and I jump in the medic while Eric takes the zone truck. I’m excited; we’re en route and the engine hasn’t even marked up yet. That’s when I realize that Drew had gotten out of the medic and is now standing on a chair, forcing the garage door open. It’s gotten stuck on something, and Drew looks like he’s perched pretty precariously on the chair. The door opens enough, and we’re on our way…but so is the engine.

“Damn,” I sigh, “guess we won’t ever be first on scene!”

The engine pulls in front of us at a stop light, and we follow it to the scene. I do a size-up from the passenger’s seat. There’s a van with minor damage that I can see, and a whole lot of debris (including a tire) littering the road. I get out and walk past the tire and see a red 4-door sedan sitting perpendicular to the road. The entire back left is destroyed, seats smashed up against each other. Our patient is trapped in the driver’s seat, and I hand a c-collar to the firefighter who’s taken c-spine control. I notice a laceration to the left side of his head, and a lot of blood coming from somewhere I can’t see.

The firefighters extricate him, and we get him situated on the backboard. As we strap him down, I ask some preliminary questions while Drew and Eric get the medic ready.

“Hi there, my name is Sam, I’m with the rescue squad. Can you tell me your name?”
“Brian,” he replies groggily.
“Hi Brian, do you know what happened to you?”
“Yeah, I was in a car accident, right?”
“Yes sir. Do you know what today is?”
“Um…Sunday, right?”
“No, it’s actually Thursday morning.”
“Oh, that’s right.”
“It’s okay, don’t worry about it. Tell me where you’re hurting.”

As we take him to the medic, he tells me he has some neck and back pain, but nothing else hurts. We expose him and Eric and I notice a fracture to his left wrist. Drew is booking it to the hospital; I can’t expose him before we’re already halfway there. A student splints his wrist while we get the IV, call the hospital, and get another set of vitals.

His pupils are constricted and sluggish, and he seems to be going in and out of consciousness. As Eric calls report to the hospital, I assess him again.

“Brian, can you tell me who the president is?”
“Um…no, no I don’t think so.”
“That’s okay. What happened to you today?”
“Was I walking on the street?”
“No sir, you were in a car accident.”
“Oh, oh that’s right.”

Eric gives me a worried look as we get closer to the hospital. Drew gets us there before I realize it, and we unhook Brian from our machines. We wheel him into the trauma room where I’m surrounded by fully gowned hospital personnel. We slide him over to their bed and try to get out of the way. I feel a hand on my back and see a former coworker standing beside me.

“Hey Sam,” she says from behind her mask.
“Oh hey,” I reply with a smile, “take care of our guy here, won’tcha?”
“You know it,” she winks.

The back of the medic is a wreck. Little puddles of congealed blood speckle the floor, and trash is strewn all over the back. The EKG leads hang limp across the floor, and loose change from his pockets has found its way into the stair well.

Drew and I clean with the student while Eric writes up his report. We spray out the back and sanitize every surface. We roll up the leads, restock the IV box, and hose off Drew’s safety vest. He made very little contact, but somehow managed to get covered in blood. It’s as if he rolled around in this guy’s blood; we can’t figure it out. Eric and I made a lot of patient contact, but somehow managed to avoid the blood.

Eric finishes his report, and we all climb back into the ambulance. He updates us; looks like Brian has a bleed in his brain. I look over at the student; she looks a little white.

“You okay?”
“Yeah,” she sighs, “but I could use a drink.”
“Ah yes, I hear that,” one of my partners chimes in from the front seat.

Seeing how it’s not quite 9am, we stop at Starbucks instead.

Crispy

Posted in EMS on January 12, 2009 by medic61

I’m starting my third year of EMS this January. Two years behind me, and I often feel like I’m still as green as the day I started. I know I’m still a newbie. I know I’m not seasoned and wise and knowledgeable. That’s okay with me.

I work in rural EMS. We ran 2,338 calls this year, which was an increase from last year’s 2,237. I’m going to go ahead and blame it on this lady. In any event. I work approximately 18 hours once a week on the ambulance. Mathematically speaking, I should run an average of 4.8 calls per shift, or 249.8 per year. Let’s just say I ran 250 calls this year. The year previous I didn’t work quite as much, so let’s give it 200 calls in 2007. That would be a grand total of 450 calls in my short EMS career.

I still walk into the building with a smile on my face. I still get excited when the tones drop. I still make rookie mistakes and feel insecure and wonder if I’m doing things right.

But I’ve worked in the emergency room, too. That was a real baptism by fire. “Hi, you’re new here? Cool. We have 18 sticks on the board, two traumas coming in, and a suspected STEMI in the waiting room. Never started an IV before? Here’s an angiocath. Have at it.” Okay, maybe not so harsh, but it was pretty rough. There were the babies and toddlers I had to stick to whom I couldn’t even explain things. There were the druggies and the psych patients and the fakers. There were traumas that had me staring in the eyes of kids younger than I was, who were dying from violence. There were people who touched my lives. There were coworkers who stressed me, amused me, distracted me and then there were the ones who looked after me.

My fingers grew familiar with the ridges of the angiocath. I found myself feeling my boyfriend’s veins absentmindedly while watching TV. I became one of the most accurate IV techs in the ER. I knew my way around tiny, rubbery, pediatric veins through to wiry, leathery, geriatric ones. Every stick was as exciting as the next, but it always hurt to see someone die.

So why is it, then, that while nearing 20 years of life, and starting my third of EMS, I can see the burnout creeping into my hands? I can feel it lurking over my shoulder on every call. I can hear it in my voice when I talk. I can smell it in the ambulance. I’m not burntout. I’m just a little crispy. But I know it’s coming.

I can remember patients’ names and birth dates, and the faces they made. I can remember every time I’ve seen someone die. I can recall the sounds made by patients with blood in their airway, or fluid in their lungs. I can remember things that struck me, like the twenty year old boy who was shot in the femur who died wearing boxers patterned with teddy bears. I can remember a time when I told people the worst thing I had seen whenever they asked–I just hadn’t seen something bad enough yet.

Two years as an EMS provider in a rural county. 450 calls. 7 months in the ER. I feel like I don’t have the right to notice the burnout. I’m still so new, right? I’m still so excited and polite and appreciative. I love talking to school kids about the ambulance. What’s more, I still love the job itself.

And as I write this, I’m not sure why I write this. Maybe it’s to ask for reassurance that I’m not losing it. Maybe it’s to ask for reassurance that I am. Maybe it’s so I can hear other people’s stories of burnout. I don’t know why. But it needs to be written.

Take care out there,
Sam

Margaret

Posted in EMS on January 8, 2009 by medic61

Her name was Margaret O’Neil, and I could just tell that before her kidneys failed her, she was a firecracker of a woman.

Tiny and frail now, my partners and I would have to place two pillows on our stretcher,lift her out of her chair, move her over gently, and be careful of her foot when we set her down. She’d cuss you out if you hit her foot on something along the way, but then she’d take a moment to breathe and be flashing you that big grin of hers in no time.

I’m not sure why she liked me. It might have been because of that time when Ken was driving so fast and recklessly that we were being thrown all around the back. After repeated pleas of “Ken, can you slow down?” and “Ken you’re driving too fast,” I looked at Miss O’Neil and said “please excuse my language in the next few seconds.”

She just giggled and nodded her head.

“Ken, what the fuck are you thinking driving like that!? We have an eighty-four year old woman in the back of our ambulance for whom we are responsible. We pick her up from home, take her to dialysis, and bring her back. If you don’t slow the hell down I’m reporting your ass, okay?”

She looked up at me with tears in her eyes from laughing so hard. She thanked me as I adjusted her pillows, and we never had a problem with Ken driving again.

Maybe she liked me because of how I interacted with her family. It was quite clear that her son-in-law didn’t like her at all and was just waiting for her to die. He’d help us move her every day, and thank us, but at some point she’d make a little noise or a whimper and he’d lose it.

“Margaret, what the hell’s yo’ problem!? E’ry little thing’s gotta hurtcha and annoyya and I don’t get what the hell is wrong witcha.”
“I can’t imagine how difficult it must be for her to rely on other people for her movement. ESRD is a pretty painful disease to have, and I, for one, am absolutely okay with whatever she has to say about it. You complain away, okay Ms. O’Neil.”

She’d just look at me and smile, thanking me wordlessly. I worried about what happened to her when she was in there by herself, stuck with these young people who forgot the cardinal rule of respecting one’s elders.

She was my favorite patient. I’d see her at least once a week, because sometimes we’d be stationed somewhere else for the day. But days that I took her were my most favorite. We’d sit in the back and talk for the entire ten minute trip to the dialysis center.

One day we had to take her to an eye doctor, wait with her, and bring her back. While she was being seen, I sat in the waiting room reading a yellowed copy of a Nickelodeon Magazine.

“Is there a Mrs. Montgomery in the waiting room,” I heard someone ask from the door jamb. I raised my hand tentatively at first as I looked around to see if there were any married Montgomeries hanging around.

“Mrs. O’Neil has asked that you come back to the exam room for a moment, Mrs. Montgomery.”
“Um, you can just call me Sam,” I stuttered, obviously perplexed, “Can you tell me what she needs?”
“She doesn’t need anything, Mrs.–”
“Sam. It’s just Sam.”
“She doesn’t need anything, Sam,” the nurse said with a pained sigh, “she just gets nervous when the doctor comes in and would like to hold your hand.”
“Oh, of course! I’d do anything for Mrs. O’Neil.”

I walked in the room and took a seat on the exam table next to our stretcher where she still lay. She reached out her hand blindly for mine, as the doctor was examining her eyes, and I held her hand. I could feel the tension leave her body once our skin was touching.

“Are you married Sam?” She was one of my only patients who called me by name, and didn’t call me Samantha. I loved her for it.
“Oh no, heavens no,” I laughed, “I’m not even seeing anyone.”
“Good,” she replied with a little nod that threw the doctor off his game.
“Well, I don’t know, I’d love to be dating someone right now.”
“Oh, child. Don’t rush it. Please promise me you won’t rush it.”
“No worries, Ms. O’Neil. I promise.”
“Sam,” she said and her eyes grew big. The doctor was writing prescriptions now, so she adjusted herself to see me.
“Yes ma’am?”
“Sam, don’t marry a bad one. Do you know what I mean by that? You’re too pretty to marry a bad one. Don’t let him hit you or drink every night or not support you, y’hear? I married a bad one once. Didn’t know I had a choice. You have a choice, Sam, okay? You always have a choice.”

I don’t know why I started crying, but as tiny tears traced their way down my cheeks, she let go of my hand and wiped them away.

“Promise me that, Sam, okay?”
“I promise, Ms. O’Neil.”

That was the last time I had seen her. I held her hand all the way back to her house as she told me about her abusive ex-husband who drank every night and beat her just for fun. She told me about how the man her daughter married never laid a hand on her but still scarred her emotionally with the things he would say. She told me how beautiful I was, how long and elegant my fingers were. She put my hand up to her cheek and in turn touched my own.

We got out, moved her from the stretcher to the wheelchair (ever mindful of her sore foot), adjusted the pillows behind her, and helped get her up the stairs. I made another smart comment to her son-in-law for the way he treated Margaret, but I didn’t really care. I knew this was my second to last day here, and she wasn’t scheduled for any runs tomorrow. Might as well say what I felt.

“So I’ll see you on Tuesday,” she said.
“Actually, Ms. O’Neil, I had to quit because I’m going back to school this semester.”
“Oh thank heavens, child,” she said with a grin, “you know school is heaps more important than this job.”
“Yes ma’am.”
“Good! This job will always be here. Better jobs will always be there. Go to school, do well, and get a really good job, okay?”
“I promise.”
“And don’t marry a bad one.”

I was glad that the last time I had seen her was a good time. I felt fortunate that I wouldn’t watch her deteriorate over time into a foot-less, frail, shell of a woman. I never wanted to see her get so weak that she couldn’t talk–just whimper. I didn’t want to see that fire in her eyes go out. I was lucky to be leaving.

The last time I saw her she was full of life, smacking her son-in-law’s hand when he touched her pillows, and lecturing Ken about his driving. She gave me a hug and kissed my cheek sweetly.

“Remember what I said,” were her last words to me. And when I heard that she had died, I wondered what her last words were to anyone on this Earth.

Miss you, Margaret. I’ll do you proud.

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Mama Who Bore Me

Posted in EMS on November 21, 2008 by medic61

Her hand is cold as it makes contact with my face. She’s looking right at me with these cloudy green eyes, lost in her overdosed haze. I’m supporting most of her weight as she tries to pee before we go. I’m literally her rock right now.

“Sarah,” she says longingly as she strokes my face, “Sarah I’m so sorry.”

She smells like my mom. Her hair is long enough that it reminds me of playing with my mom’s hair as I sat behind her on the couch. A burning wetness stings behind my eyes, and I force it back.

In a moment of lucidity, she snaps.

“Oh GOD just go, just let me die, Sam. Jesus just go, I just want to die, I took all these pills and I just want to die.”

I help her up from the toilet, pulling her pants up while juggling her weight with the basket I hold for her as she tries to vomit. I flush the toilet with my foot, and bear hug her all the way out to the stretcher.

“My husband doesn’t love me. I asked him for a divorce. He knows I want to die, he told me to just fucking take the pills and get it over with and just do it. He has a death wish for me.”
“Mary, we’re going to take you to the hospital now.”

I don’t even have a set of vitals on her. Eric and Jake wheel the stretcher out to the ambulance as Mary clutches my hand like it’s her lifeline. Without letting go, I climb into the back with Jake as Eric heads for the driver’s seat. She keeps looking at me without seeing me.

She sees her daughter, Sarah.

“Sarah, I just love you so much, you and your brother, you know? I’m so, so sorry. You’re so beautiful. You’ve gotten so much older since I saw you last. And your hair, it’s so long.”

She stops, her head hitting the stretcher with a thick smacking noise that sickens me.

“Oh god the drugs, Sam, the drugs are kicking in.”
“Mary, I need you to stay with me. My partner is going to start and IV on you to give you some fluids and medicine, okay? I’m just putting these stickers on your chest so we can get a picture of your heart and make sure it’s okay.”
“Okay, okay, I’m trying.”
“No one sleeps in the ambulance, isn’t that right, Sam,” I hear Jake say as he spikes the bag of saline.
“It’s the second rule of the ambulance,” I say, referencing Frank Pierce’s number one rule without letting on.
“I’m here, I’m with you.”

I tie the tourniquet around her arm and feel for a vein. It’s beautiful, and I know Jake can get it with no problem. I move over so he can stick her, and try to keep her talking.

“Mary? Mary? Mary, stay awake.”

She doesn’t move. I rub her sternum deeply and she groans, opening her eyes.

“I’m here, I’m awake. Oh, Sarah, you’re so pretty.”
“No sleeping, Mary, I need you to stay with me right here, right now.”

Her head smacks against the stretcher again, and her arm drops.

“Mary,” I yell at her as I rub her sternum again, “Mary open your eyes.”

She doesn’t move. I rub it again, with more force, and she doesn’t even flinch.

“FUCK,” I yell at Jake as I hurdle over the patient and stretcher in one fell swoop.
“What?”
“She’s not breathing.”

I pull out the bag-valve mask and rip the plastic off. It floats in the current the heater produces, waving eerily. I hook up the oxygen and drop the stretcher back. I position her, lift her chin, and make a tight seal with the mask.

I watch her oxygen saturation levels rise as I breathe for her, my hands responsible for her life. Jake finishes the IV and pulls out a nasopharyngeal airway to keep her airway patent as I bag her. I see things flying around the back as he applies lubricant to the airway, pulls out suctioning equipment

Every five seconds, I pump a life restoring breath into her body. Jake gets orders for Narcan and pushes it, but there’s no result.

She wakes up long enough to pull out the airway as she vomits, and promptly returns to her previous state. I try to hook up the suction and still keep her alive as Jake yells vitals up to Eric to call into the hospital.

My hand is cramping from my grip on her face–on her life. I push the annoyance out of my mind. Bag, I tell myself once every five seconds, but it’s not enough. I need the metronomic tattoo I usually get from the bridge we drive. But tonight we go to a different hospital, away from bridges and rivers.

I hum. It’s quiet enough that Jake can’t hear, but I know that some part of Mary does. It provides me a steady, calm rhythm to which I can bag, and connects Mary to her daughter, at least in my mind.

Mama who bore me
Mama who gave me
No way to handle things
Who made me so bad

Mama, the weeping
Mama, the angels
No sleep in Heaven, or Bethlehem

Some pray that one day
Christ will come a’-callin’
They light a candle
And hope that it glows
And some just lie there
Crying for him to come and find them
But when he comes they don’t know how to go

As we arrive at the hospital, I continue the song in my head, too embarrassed to be heard. It’s partly out of respect–respect for Mary and Sarah and the sanctity of the bond. I bag her as we change beds, as they expose her indecently on the table.

I allow myself to be pulled out of the room by the current of those around us. Propping myself up against the wall in the EMS room, I close my eyes tightly and shake my head.

“You alright,” Eric asks as he comes in.
“Yep,” I lie.