I’m was kicked back in a blue recliner at Station 22, munching on popcorn and watching “The First 48″ on A&E. I’d done my station chores, finished the daily training, read some case reviews, inventoried the meds in our supply cabinet, deep cleaned our reserve truck and was seriously considering a nap.

My partner looked over at me and reached his paw into the can of popcorn. He threw a few kernels of kettle corn into his maw, chewed and then says, “Sure is quiet.”

I shook my head as the pager beeps.

Quiet, he says.

This bullshit post nasal drip/cold/bronchitis/crud drove me to the Doc in the Box yesterday to get a scrip for a Zpak and some Flonase. I went after my shift, on my way home, so I was still in my uniform. Amazingly, the Nurse Prac just asked me what I wanted in the way of a scrip. I told her, she nodded, told me it sounded appropriate and with a few taps on her tablet, sent it in to the pharmacy. In and out in 10 minutes, with a 10 dollar co-pay. Why don’t the sniffle/snotty people who call an ambulance just visit the Boxed Doc? Oh, that’s right… Because they don’t take Medicare and there’s no Sierra Mist and Meal Trays to be had.

Sorry. I’ve still got a sore throat and a headache and I’m a little cranky. I’ll be better tomorrow, I’m sure of it.

The shift, post turkey, was one for the books.

Our first call was a cardiac arrest that was downgraded to a delta response when the patient started hollering “Get yo drunk ass offa me” while the dispatchers tried to coach telephone CPR. Next was a seizure call that vanished into thin air. Following that wild goose chase was a Delta response to a scuffle over some Black Friday deals at the local Big Box store that rhymes with “Hall Dart”.

All I wanted was some nice, quiet, tryptophan induced snoozing along with Kari Byron and Punkin’ Chunkin’ on the Discovery Channel.

At least the rest of the night was quiet. I’ll do it again tonight.

In light of some of the discussion and recent news articles over the perceived delays in rotor transport vs. ground transport, let’s imagine a multiple vehicle accident with one Priority 1 patient who’s entrapped and requires extrication. On the initial assessment it’s obvious that this 23 year old female patient has severe chest trauma and will most likely need to be intubated as soon as the extrication is performed. The incident commander looks over your shoulder as you get a line set up and your partner leans in to the mangled car to slip a non rebreather on the patient. “I’ll start the helicopter”, he says.

You stop to consider the transport decision. You’re about 40 minutes by ground from a Level II trauma center and if you want to get the patient to the big Level I, that’s going to take a helicopter flight. As the patient is being extricated, you ask the dispatcher on the radio to advise the flight time from the scene to the Trauma Center. He has you stand by and a minute later he replies that Aviation states they can make it there in 30 minutes.

It was a simple door pop to get the patient out of the car and you glance over to see the firefighters are securing the patient on a long board and moving her to the ambulance.

“Cancel the helicopter!” you shout to the IC as you jog to the ambulance.

“What!” the bystanders exclaim.  “This is a priority 1 patient who needs a trauma center!”

You’re right. The patient needs a helicopter, but not at this exact moment. See, it turns out that I can get her to definitive care faster than the helo can. Remember, that optimistic “30 minutes to the hospital” doesn’t take all of the actions into account. Where I am, it’s about 6 minutes for the helicopter to get dispatched and off the ground. A 14 minute flight to the scene. 6 minutes to load the patient in the helicopter from the waiting ambulance. 30 minute flight to the Trauma Center. 6 minutes from the helipad to the resuscitation bay. That’s 62 minutes.

Now, if it’s a prolonged extrication, where it’s going to be 20 minutes or more before the patient is freed, it may be prudent to fly that person to the trauma center, but if I have to wait on scene for the helicopter to land, preflight intubation and other interventions to happen, the patient to be loaded… well, then I’m gonna just have the ambulance start rolling toward the bright lights and cold steel.

I can be on the road in 2 minutes. If I need to intubate this patient, I can do it en route. Same with bilateral lines, a chest decompression or any other intervention I may need to accomplish. There’s just not enough room for me to do that stuff in a State Police Bell 407.

This patient may very well need a helicopter, but not until I get her to the ED. If she needs to move to another hospital for advanced care and management, there is an air evac service that can take the patient to wherever she needs to go.

In my book, I’m almost always going to cancel the helicopter. The time it takes to transport a patient via rotor vs ground is really worth a second look if you’re placed in the position of “helo or no helo”. Don’t fall into the trap of “hurt people always go in the helicopter”. It may make more sense and lead to a better outcome if you just drive.

A few months ago things were looking rather bleak in Medic 22 land. I was in a funk. Unmotivated. Depressed, if you will. I never thought it would happen to me. I was always pretty chipper and cheerful and people usually liked being around me. Thanks to a slew of bad decisions, a divorce, an incredibly toxic relationship and some other issues that hit all I was once, I was whacked hard with the depression stick. I was in a hole and it wasn’t looking like I could climb out.

I blogged about it a few months back, and Mark Glencourse posted a comment that said, “I’m sorry you are having such a hard time at the minute mate. You are describing exactly how I was in my own life about 10 yrs back. Mine went on for a little while, but things have a way of finding a route back to where you start to feel better, whether that be through counseling, medication, self help, or a new opportunity in life. Whatever it is for you, I hope it comes along soon. Thinking of you.”

I saw that comment again today and it struck me. Mark’s line, “…things have a way of finding a route back to where you start to feel better, whether that be through counseling, medication, self help, or a new opportunity in life…” was so so true. I feel better than I’ve felt in years. Counseling, a small dose of an SSRI and a new job, and the home to go with it, have made all the difference.

So, to any of my readers who may be going through a tough time, remember that things WILL turn around. And if you get to the point where you need to talk, drop me an email. I’ve been there. I understand.

WARNING: Academic info follows!

SNPeCPR or “Snappy CPR” may eventually change the resuscitation model. We know that pressors like Epi and Vasopressin have little value in increasing survival to discharge, but vasodialation with Sodium Nitroprusside looks promising in this early pig study. To my medic friends, READ THIS ARTICLE! It’s amazing stuff!
http://www.ucdmc.ucdavis.edu/emergency/education/residency/journalArticles/NitroprussideInProlongedCardiacArrestCritCareMed2011.pdf

The last few months have been crazy.

I mean, straight up, move across the county, leave your friends, end a relationship, start a new job in a place where you don’t know anybody, crazy.

But, I’ve done it and I’m back. I feel better than I have in almost a year and I think I’m starting to get things back in order. Back to a place where I feel like my life is back under my control and I don’t have to apologize for my past mistakes.

So, what’s the deal? Well, I’ve moved to the East Coast, I’m working for an amazing third service ALS only department, living in a small condo with my dog and loving life.

As in the past i’ll be writing about my daily experiences and sharing discoveries I make along the way. And, as always, I’ll be obfuscating any and all patient details and information to keep the HIPAA-potamus off my back.

It’s good to be back. I’ve got stories to tell and I’m ready to share them. Again.