Paramedic School is right around the corner and that means I only have 9 more shifts on the 24 hour truck I’ve been working on for the past several months.

To say leaving the 24s is bittersweet is an understatement. Will I enjoy spending nights at home with my wife, sleeping in my own bed? Absolutely. Will I miss those long, busy 24 hour shifts on the truck? Absolutely.

There are a lot of people at OAC that don’t want to work 24s. To those people, you don’t know what you’re missing. Let’s be honest, we all do this job because we’re a bit of an adrenalin junkie. Most people won’t admit it and they say things like “I’m in EMS because I want to provide excellent care for my patients.” I’m throwing up the BS flag. If you just wanted to provide great care, you’d be a clinician somewhere. There is still something to be said for being part of the team working to stabilize an emergency. Being on the truck is fun. It doesn’t matter if you’re a medic or an EMT-B, being in the mix is the reason most of us still do it. Hey, I’ll be right upfront with you. I’ve put dozens of accident victims on backboards, and I still enjoy using my skills on the scene of an MVA. same thing with most of the other calls I do. For some reason, EMS people like to downplay the fact that the job is exciting. Almost as if they’re ashamed that the job can be fun as well as challenging and rewarding. Guess what folks? It IS fun! Let’s embrace it. We can sometimes make a difference and still have a good time doing it. And hey, if it ever stops being exciting or fun, burnout won’t be far behind and you should look for a new job. Maybe selling shoes.

So yeah… 9 more shifts. It’s bittersweet.

Our quarters are moving to a new location. The lease was thankfully up on the Rat House and the crew is working out of new quarters toady. I don’t know exactly where it is, but I understand it’s only a few blocks away from the old spot. I won’t miss those old quarters. The whole place smelled musty and the occasional “shots fired” made it a unique place to sleep. But, we could get to  calls on the west side of the district like a shot, and most of those were assault or trauma calls.

I’m also a little bummed out about splitting up with my partner. We get along great and over the last few months we’ve developed a rhythm that is comfortable and works well. We have a good reputation with the fire guys and enjoy working with most of them. I really like my shifts with her and she’s become a very competent EMT. Having a good partner is a joy.

So yeah, it’s bittersweet.

I’m really looking forward to moving on to the next step. Medic school will be difficult, but I’m extremely competitive and I know I’ll do well. I’m excited about ride time and clinicals, yet I’m nervous and kind of scared. Will it be an excellent adventure? Yes. Do I still want to puke when I think about it? A bit.

As for work while a student, I’ve applied for a ER Tech position as the local hospital. It would work a little better with my school schedule and I’d have a bit more responsibility. If that doesn’t pan out, I’ll still be doing fills and floats at OAC. I was told I just need to pick up 4 shifts a month to stay as an active employee.

As I finish my last couple of full time shifts as an EMT-B and move into school full time, the focus of my blog will change a little. I’ll be writing more about medic school, my personal life and the challenges that I’m sure to run into along the way. If you’re a constant reader, I sure do hope you continue to come back and leave your comments and thoughts. I appreciate every one of you.

Medic999 has again compiled a slew of blog posts about “the first emergency” in the monthly Handover blog carnival.

I didn’t contribute to this one, but many of the bloggers I read every day did, and I’m sure they’d appreciate you checking it out.

Click RIGHT HERE to go, read and enjoy!

You’ve got a sore back?
And it’s hurt for the last month?
To triage with you.

Late night rescue call,
Respond Code Red to leg pain.
Really? 9-1-1?

The medics arrive -
CPR, ROSC.
But, is this a save?

Lorazapam huh?
Well, I think you took too much.
Hello, Ma’am? Wake up!

These kind of suck, but I was just reading about haiku and I got the itch.
I’d love to see yours. Remember, the pattern is 5 – 7 – 5.

I’ve recently found this blog, and I’m now a fan!

If you haven’t been by “Notes from Mosquito Hill” yet, stop by. I’ll bet you’ll be adding it to your blogroll.

I did.

Last night was simply ridiculous with the number of canceled and unfounded calls.

Sleep? What’s that?

We were up and rolling to a call about every 45 minutes through the night, only to be Greened on every one. From shortly after midnight until the shift change at 0800 this morning, we did 9 calls with only one transport. The rest were either canceled en route, canceled on scene or upgraded to an ALS response.

I think I’ll take a nap.

Sent from my Verizon Wireless BlackBerry.

Tonight, we’ve been going non stop.

Every time we clear from a call, roll back to quarters and I take my boots off, our radio starts squawking. “22, respond red with Fire.”

It is now 0247. I have removed my boots yet again, and have climbed back into my rack. Our last call involved taking a guy to the hospital who amputated the tip of his right middle finger by slamming it in the door. Ouch.

When we arrived, the guy’s girlfriend had the finger chunk wrapped in saran wrap and resting in a tupperware container on a bed of ice. It looked like some unappetizing leftovers.

Fire had him bandaged and he was more embarrassed than anything else. He kept apologizing for getting us out of bed. Really nice guy.

Its been another typically busy night on the truck so far. Now, if only I could get one more hour of sleep.

Sent from my Verizon Wireless BlackBerry.

We don’t get there often, but when we do visit, we know we’ve got the hook up.

Faraway Med has a nice EMS room with a fridge that’s always stocked with juice, milk, soda and water as well as chocolate chip cookies, fresh Chicken Cesar salads and pretty decent sandwiches. There’s a big sign on the wall that says “Thank You EMS! Please help yourself.”

Having access to a quick snack is a real treat on a busy day, and I always make sure to say thanks to the staff whenever I visit.

Sent from my Verizon Wireless BlackBerry.

Well, let’s see… there’s lot of stuff going on, but nothing stupendous. There hasn’t been one specific item worthy of a blog post, so here’s a few random thoughts…

…and even though this may sound negative, it’s really not. It’s just a look at some of the goofy stuff that happens on shift.

I recently took a few folks who experienced a traumatic event to the ED. One was a motorcyclist who connected with a Jersey barrier at a high rate of speed. He was placed in C-spine precautions and his lower extremity FX was splinted. Aside from a huge amount of road rash, he had no other injury. Claire and I whipped out our handy-dandy trauma shears, cut all his clothes off and delivered him to the ED. On arrival the nurse looked at me and said, “Why is he naked?”

Then, shortly after, we took a guy who was struck by a bottle in an assault to a different hospital. No LOC, no other injury. Just smacked with a bottle. No pain other than the lead lac. Bleeding controlled. We deliver him to the ED and the RN asks me, “Why isn’t he trauma stripped?”

I can’t win.

I had the pleasure of showing up at an ED that was on divert with an assault patient. This particular ED does NOT want a call prior to arrival. Instead, EMS just shows up like an unwelcome house guest at dinner time. On normal nights thay just want us to roll in and give report at the triage desk. however, our dispatcher failed let us know the ED was on saturation divert, so I had to feel the full wrath of the highly pissed Charge. That was fun. Not.

Over the last few shifts we had a higher number than usual of patients with VERY minor complaints use us as a taxi, while the husband/wife/mother/father/significant other followed behind in the car.
I said to one system abuser patient, “It will be cheaper if you don’t go in the ambulance. You’re fine to ride to the hospital in the car with your mother.”
Patient replied, “No, that’s OK. I’ve got medical coupons.”
“Get in the truck.”

I bought a mop to keep at our quarters to mop out our rig, as the company won’t supply us with one for some reason. Strange. New ambulances, but no mop. And our HEAR radio STILL doesn’t work.

I’ve had to practice several instances of “CYA backboarding”. Most recently a the scene of a VERY low speed MVA. When I say low speed, I mean less than 5mph. Absolutely no mechanism. I couldn’t even tell which cars were in the accident and which belonged to the throng of bystanders. Everyone was out of the cars. They tell us on the radio that one 24 year old kid is c/o of back pain. The kid that’s out, walking around, on his cell phone, smoking a cigarette.
That kid.
When we roll up the fire guys say, “We just need your bed. This guy has back pain.”
“Oh no,” I reply. “Back pain following an MVA gets a C-Collar and LSB.”
The fire guys argue with me. “Really? Are you sure?”
I can’t believe they are questioning that fact that a MVA patient needs to go on a board if he says the magic words, “I HAVE BACK PAIN.”
So, standing take down, board, collar, tape, head bed… loaded.
The Fire LT takes me aside and says, “What a waste of time. He doesn’t need to go on a board.”
I agree, but point out the 25 people standing around with cell phone cameras snapping pictures. Might be a good idea to follow the protocol, huh? I also remind him that the Trauma Doc expects all patients in MVAs to be on a board until they clear them off. Oh yeah, one last thing LT, my name is on that run form and while we all know the kid doesn’t need to be on a board, he’s going to be on it ’til he’s cleared in the ED.

Oh yeah, it turns out his back pain was from a fall off a ladder a few weeks ago.

We had a nice instance of fake seizures. Fire got on scene and the EMT freaked out and called for an engine company and medics! Seriously? It was evident that the patient was faking when I read her BGL level to the medic. When I said “It’s 299,” she stooped flopping around and said “Huh?” while she looked at the glucometer. The she continued the fake seizure bullshit all the way to the ED. “Ma’am, please stop seizing so hard. You’re going to fall off the stretcher.” It was amazing how she mellowed out.

I changed the lyric to Tom Petty’s “Runnin’ Down a Dream” while we were en route to a call. It was playing on the radio and I was singing along… “Goin’ to a Rectal Bleed…”

One local ED RN gave us ice cream sandwiches on a very hot day. That was nice.

It’s the small things, ya know?

More soon. Medic 7, out.

Read this.

I kicked in… I hope you can, too.

She’s good. She’s smart. She’s one of us. And now, she needs a little help.

I just finished the last 24 in this set and then ran to the airport. My wife left yesterday, and I'll meet her on the Jersey Shore later tonight. Sun, surf and Cheese steaks. See ya in a week.
Sent from my Verizon Wireless BlackBerry.

When I write my blog, I usually write about my day on shift or the calls that I find interesting. However, I thought this time around I’d blog about something that that I hate having to write about.

Screwing up.

Hey, we all do it, and the key to learning from your screw up is owning the fact that you messed up and making sure you never do it again.

So, here’s today’s screw up.

We responded with fire to a 72 year old woman c/o abdominal pain with N/V. We had a long response time and when we arrived on scene the Fire Guys had already completed their assessment and had the woman ready to hop on our gurney. As we put her on the bed and wheeled her out to the truck I got the report from the Firefighter. She vomited once this morning, vitals stable, pain is 10 out of 10, history of CA with mets. He handed me a SOAP and said, “all her meds are on there and all the history, too.” Meanwhile, the PT is moaning and crying, “This is KILLING me,” all the while dry heaving into a puke bag. So, I hop in the truck with a thanks to the Fire Guy and we start to head in the direction of the ER where the Zofran is.

I don’t really look at the SOAP he hands me.

See where this is going?

So, as we get ready to head to the hospital, I grab a set of vitals and start to ask questions. She’s crying and screaming and not really able (nor willing) to answer questions. She’s tense and writhing around so BP is next to impossible. History is impossible. Any question I ask is answered with an “OhhhHhHHhhhhhh! This is KILLING me!”

At least I have a list of the meds and details from the Fire SOAP so I can get some sort of history and a baseline.

Oh shit. What the HELL is this?

The med list is a faded chicken scratch with meds like “amanmansndoopilinne” and “merrrvostatataninolol”. There is one incomplete set of vitals in the flowchart. The narrative portion of the SOAP is blank.

Seriously? Are you kidding me? So, I ask a few more questions. “Ma’am, I really need to know what medications you’re taking.” She heaves and spits into the bag. “FUCK YOU! Don’t you understand…this is KILLING me!”

OK, well, I’m not going to get anything from her. I’ll try to decipher as much of the med gibberish/scribble as I can and when I give report to the RN, I’ll explain what happened.

I squint and strain and manage to figure out at least half of what was written, but the rest will remain a mystery, lost forever to the ravages of a lightly pressed carbon copy.

So, flash forward to the ER. Patient moved from the cot to the bed. ER tech is helping to place the patient in a gown. I start the report to the RN, who is sympathetic to the fact that I can’t read the shit that I got from the fire guys. So far, so good. I give the basics as I know it. Onset at 0900. Vomited once. Several days since a BM. Nothing unusual with food/drink or meds. Blah, blah, blah.

Then the Doc walks in. “What’s the story here?”

I recap the details and he interrupts me. “I need a complete med list for this woman.” I say, “Sorry Doc, I don’t have a full list, but her daughter will be here in…” He puts a hand up like a cop to stop me. “All due respect, that’s not good enough. Your job is to bring me a patient and the information I need to treat the patient.”

And he was right. I dropped the ball. I trusted the Firefighters to get me a good list and a complete report. I didn’t get either and I looked like an ass.

Am I mad? Only at myself. It was a stupid mistake and one that I’ll never make again.

See, here’s how it works here. Fire gets the 911 call. They show up, assess the patient and decide if they need a BLS truck (me) or the Medics. If they want us, they call the dispatcher who then pages us to respond. In some cases it may be 30 or 40 minutes from the initial dispatch. When we arrive on scene, the firefighters hand over a patient and a (sometimes) complete SOAP. We will sometimes even get a decent report. Other times it’s simply, “This is Joe. He doesn’t feel well. Run him up to the hospital.” It’s then up to us to do another FULL assessment and interview and try to get a complete picture of what the HELL is going on before we arrive at the ER. Usually I’m pretty good at it. I usually find the stuff that fire missed or glossed over. However, there’s plenty of things that slip through the cracks when the patient gets handed off 2 or three times before the report is given to the ER.

So, the lessons from all this are; Don’t trust the firefighters or anyone else to get patient info. When Fire tries to give you the bum’s rush because they want to get back in service, make sure you’ve got EVERYTHING you need before you leave the scene. Oh yeah, READ THE SOAP before you let the Fire Guys out of your sight.

I should have known better. And now really I do.

I’ll own this mistake, but I won’t get burned again.

Some of you may know my paramedic program is taught by Mike Smith.

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and an editorial advisory board member for EMSMagazine. Smith is a featured speaker at EMS EXPO, October 26-30, Georgia World Congress Center, Atlanta, GA.

Yeah, that Mike Smith.

Like me, you’ve read his stuff in JEMS, now EMS Magazine, for years, and maybe read one of the several of the books he’s authored or co-authored. If you’ve used Nancy Caroline’s Emergency care in the Streets 6th Edition, you’ve read Mike’s work. Perhaps you’ve seen him speak or met him at EMS Expo.

I’m pretty excited, and honored, to have been accepted to his class. This isn’t some shady fly-by-night “Medic Mill”. It’s a top notch program with a great reputation of turning out great medics.

One of the best quotes from Smith is found in a 2005 article on education, published in EMS Magazine.

“Describing paramedic class, one student said, “Every day, I go get my head torn off and buckets of knowledge poured down my neck.” Very visual, but quite descriptive of the content load.”

Yeah. That’s the kind of class I want. Certainly not easy nor the quick way to a Medic patch. It’s a class that will push me to become an excellent entry level medic.

After that, I’ll have to own my patch, and additional education is up to me.

A question that’s been nagging at me, “When medic school is over, where am I going to work?” I’ve been thinking hard and long about becoming a Firefighter, even if its a volunteer position, simply for the experience.

But, here’s the problem. I really don’t want to fight fires. I just want to work as a medic, but here in Washington, medics not attached to fire are few and far between. I think the guys who are dedicated to firefighting are amazing, but its not my thing. I’m really not into strapping on an airpack and running into a burning building. I also don’t think it would be fair to the guy that really wants to be a firefighter for me to to be hired for a job that he’s been training and testing for, just because I’m a medic.

So, what should I do? Work hard, get into great shape, test and test and test and try to get a FF/Medic job? Or should I just keep looking for that private ambulance/third service job that I know is out there somewhere?

I know we’ll eventually move back to the East Coast, and I just hope I’ll have luck finding a Medic position where I don’t have to work as a firefighter.

Sent from my Verizon Wireless BlackBerry.