The first day is behind me and I’m officially a paramedic student.

Not much to report about the first day. As expected, there was a lot of Administrivia; the rules, the dress code, uniforms for clinicals. All the nuts and bolts that will make a class of 24 diverse people work together as a team. Our long days are split, a 2 and half hour morning didactic session, an hour of PE, lunch and then another 2 and half hours of class. Wednesdays are the short days, the skills lab days, and I’m in the later session for that. First lab is today. They didn’t tell us what was up, but I’m guessing BLS skills assessment.

Of course, we dove right into the course work. Starting with the first 5 chapters of any EMS textbook. You know it, say it with me, “The Well Being of the Paramedic” and the “Ethics/Legal Issues”. Our first quiz is tomorrow.

It looks like we’ll start airway and IV skills next week, and then our clinical rotations start by the third week of October so we can start getting lines and tubes.

As I was sitting in the classroom yesterday and the instructor was welcoming us to the program, I still couldn’t really believe that I was there. Just a little over a year ago I was considering the thought of applying to medic school. That year of prerequisites sure went fast.

In other news, “Medic 7″ is moving to a new station. I’m sliding this blog to it’s own domain, getting involved with a larger blog project and I’ll be changing the designator on my medic to a different apparatus number. The new station isn’t quite built yet, so hang on for more details. But trust me, this is a good thing.

Today is the last day of freedom; medic school starts tomorrow morning at 0800.

My last shift at OAC was surprisingly wacky. Busy, to the point where I almost didn’t get all my PCRs written. I mean, I like it busy, but when the dispatcher is screaming at you to get in service for a pending call while you’re unloading the patient from the truck, well… that’s a little much. The triage nurses were unsympathetic to our plight, and we were backed up in the hallway, sometimes 3 or 4 crews deep.

Aside from the regualr “ill person”, “ill diabetic” and “man down/possible intoxicated”, we did several diff breathers, mostly just sniffles and snot. It’s a matter of course, when the weather changes, people get congested. I wanted to tell some of these people, if they just blew their nose, they could save a trip to the ER.

One interesting call came in as an “unresponsive male, possible CVA”. When we arrived, we found a mid 60s year old male, outside an assisted living facility, sitting in a lawn chair, with a fixed gaze, non-verbal. When we arrived there was a Charlie Foxtrot of firefighters working him up. At least 6 or 7 getting in each others way. And, true to form, just as the the dispatcher told them, they were tunneled in on that CVA idea. Well, okay. Let’s let the fireguys do their thing, while I try to hunt down some details. I learned from an aide that this patient self medicated, so I peeked at his med list, then looked at his pupils and thought, “overdose”. I told the lead firefighter that it didn’t really present as a CVA and I thought the patient might be gorked from too much Oxycodone. The firefighter looked at me with disdain and said, “Uhh, this is a CVA. He has a history of past CVAs. Just put him on your stretcher and go red to the hospital.”

…So, we put him on the stretcher and went. It was a short ride to the ED and while en route, I patched and told them what I thought was going on. We rolled into the trauma room, the Doc did a quick exam, took a look at his pupils and said, “How ’bout some Narcan.” He got 0.4 and woke a few minutes later looking pissed and asking why he was at the hospital.

When I saw the fire crew at another call later that night I made it a point to tell them that it was indeed an OD, not a CVA. I think the fact that he had pinpoint pupils was the first clue. Second clue was the almost empty bottle of Oxy in his jacket pocket.

Some people just get tunnel vision.

Anyway, I think I’m set for school tomorrow, and anxious and ready to get underway.

We had a busy day yesterday. It figures, right? My last full time tour and the volume of calls has been kicking my ass. Yesterday we did a couple of MVAs, a GI bleed, several “I don’t feel so goods” and the other assorted calls that make up a typical day working on a BLS rig. I think it was 16 or 17 calls, all told.

Around 11 yesterday morning, we were called out with fire for a “non cardiac chest pain” call. Medics had already come and gone. They did an eval and cleared the guy the for BLS.

We arrived on scene and the firefighter with the clipboard said to me, “This is Wayne, He’s been living on the streets  and he’s been drinking and doing drugs this week. Today he wants to go to detox and get some help.” I said okay and introduced myself. The guy walked over to our truck, waved off the helping hand I offered and climbed in. He settled himself on our stretcher. My partner, who was in the back this time around, started to ask him some questions. As she was getting a BP, he looked around the truck and then at me and asked, “Is this just a BLS rig?” I smiled and said yes. He laughed and said, “No 12 lead? No ET tubes? No fun stuff?” He must have been amused by the look on my face as he reached in his wallet and pulled out his laminated National Registry EMT-P Card. He had a state cert, too.

He told me that he hadn’t practiced for a couple of years but would love to get sober and get back to it.

We rolled to the ER and as we were waiting to check in at triage, we talked about where he had worked as a paramedic and his stint as a remote medic, taking care of the guys working in the oilfields in Alaska. As my partner was doing the handover, he asked me to make sure the nurse looked at the big abscess on his foot. He had been shooting heroin and had an infection.

As I walked out, he wished me good luck in medic school and recommended Dubin’s book. I laughed and told him I already had it, and it was a big help. He gave me a fist bump as I walked by.

Man. That was tough. Medic to street junkie.

Wayne, how did you get there?

I do love this t-shirt. I found this in a t shirt store in Leavenworth WA and had to have it. It’s NOT associated, affiliated or endorsed by the paramedics in Leavenworth.

But, I bet they wish they thought of it.

Sent from my Verizon Wireless BlackBerry.

I’m working with a substitute partner today, so of course we’re getting slammed. It never fails.

We just got back from a 5 car MVA on the Freeway. No major injuries, but LOTS of patients to put on backboards. One car had a family of 5, with 3 members in C spine precautions. 9 patients total. Needless to say the freeway was a legitimate mess.

We’ve been to a couple of overdose calls, a hypotension/hypoglycemia call that required medics and we were at the same house twice today for an ill male who refused to go the first time. Guess what? Second time I show up, you don’t get a choice. You’re going. End of story.

OK. So now I’m sitting in quarters, watching a movie called “The Recruit”. Al Pacino, Bridget Moynahan and Colin Farrell. Pretty good movie.

More later.

I had just over 20 years working in radio full time before I decided that it was time for a career change, and I quit my job to return to school to pursue my dream of becoming a paramedic, and eventually an EMS educator.

Even though I don’t work in broadcasting any longer, I am still asked to occasionally help out with project work. (It’s kinda the equivalent of helping your neighbor paint his garage.)

At any rate, the vendor that I was working with on this project is a long time friend. Without my knowing, he apparently called my wife to see if there was a “thank you” gift that they could purchase to show their appreciation for sending this lucrative project their way.

It showed up today. And it’s great. Rather than buying some gizmo I don’t need, they decided that a Gerber Hinderer Rescue Knife was the perfect gift. And it is. Very welcome and totally unexpected. My wife knows I’m a knife-geek, so this was a great addition.

Thanks to my wife and friends. You all rock.

I’m thinking about attending EMS Expo. is anyone else going? I think it would be cool to meet up with some fellow bloggers and have some friends there.

I think everyone who works in EMS has been buttonholed by someone with a gleam in their eye that wants to hear “the gory details.”

“You guys must do a lot of crazy stuff,” they usually say, leaning in, so they don’t miss one ounce of the blood and guts.

“Yep,” I always reply. “Just yesterday I had to do a call, Hell… several calls, before I had a cup of coffee. Now that my friend, is CRAZY!”

“Nah, c’mon,” they say. “Tell me something good!”

The simple fact is, most of what I do on a daily basis would bore the hell out of the average person. It’s nothing like the helicopter crashes and fiery tanker tuck explosions like you see on the TV shows. It’s a lot more mundane than that.

For example, I just took a 67 year old man with MS to his wound care appointment. He has a large decub on his posterior that needs constant attention. He’s a very cool guy, and once I got a baseline set of vitals and the important points of my PCR written, we had a great conversation about music, our favorite restaurants and the TV show Mad Men, which, it turns out, we both really dig. He was an advertising guy in the 60’s and 70’s and he told me stories about his exploits that make the main character of Mad Men, Don Draper, look like a saint. We laughed the whole way to his doctor’s appointment and when we got there, he grabbed my hand and said, “Thanks for the laughs. This is best I’ve felt in weeks. Will you take me to my next appointment?” I paused, because I hated to have to tell him that I was going to medic school, and next week would be my last set of full time shifts. He smiled and said, “That’s okay, if you spend time and talk to everyone like you talked to me, you’ll do great.” I shook his hand again on the way out and when I got out in the hallway, I wiped a tear from my eye.

Damn, I love this job.

I’ve mentioned in previous blog posts that I currently work for a BLS service that responds as “transport” with several different fire departments. In my district, we are the primary truck for a full time municipal paid department and a department that is staffed by career guys during the day and vollies on nights and weekends. Both of these calls occurred during my last tour, and while I wanted to write about them a couple of days ago, it took me a while to figure out exactly how. I figured I’d just show the good and bad.

There have been a lot of  stories in the news and a lot of chatter in the blogosphere about how firefighters don’t want to do medical calls. I don’t think it’s necessarily true. I know plenty of firefighters who are great EMTs and medics. Unfortunately, I know others who should stick to putting the wet stuff on the red stuff. There’s a great post from TOTWTYTR’s blog about fire based EMS.

Speed is not the primary factor in treating resources. Getting people to the scene with the knowledge, ability, and desire to treat sick people is more important. Four firefighters standing around a sick or injured person administering the “Stare of Life” while the officer asks for the ETA of the ambulance is not medical care. Frankly, it’s not even the appearance of medical care. Nor is giving oxygen to everyone, whether they need it or not.

Amen, brother. I don’t lump all firefighters together, but if you read both stories below, you’ll see the difference from my perspective.

1-

We had just cleared from the hospital when, on the fire radio, we heard an engine dispatched on a aid call for difficulty breathing at a SNF right around the corner from where we were. We radioed our dispatcher and told them we’d take the call. As we waited in traffic at a red light, the engine came around the corner and the officer waved us in. We pulled up right behind the engine. The firefighters went in first, we grabbed our stretcher and followed. When we got to the second floor, there was a flurry of activity. Nurses and aides were running around, an ancient suction machine was on a cart outside the door and inside the room a 65ish year old male was laboring to breathe. He was still moving air, but not much. The firefighters quickly got medics en route and put the patient on a NRB and started an assessment. I ran down to the rig to grab an extra O2 bottle and when I came back up, the firefighters had a 3 lead and Pulse Ox set up. The patient looked like he was going to crash and the lead firefighter asked me to grab the BVM from their airway bag. I pulled it out and connected it to the O2 just as the patient became apneic. We started bagging and heard the medics coming down the hall. There were now 7 us in the room, three firefighters, 2 medics, my partner and me. We all managed to stay out of eachother’s way and we all knew our job. One medic tossed me a bag and I spiked it as he got the line and he got some Etomidate and Sux on board. As the second medic went for the tube, he grabbed his McGills and fished out a ginormous hunk of food that had been sitting just above the cords. I had never seen a medic clear an obstructed airway with McGills before, so that was interesting. It was a mix of quick BLS followed by rapid response ALS. The patient was extubated in the ED shortly after, and following a night in ICU, was discharged the next day. That call went pretty well. On scene time, 22 minutes.

2-

We respond with Fire at 2130 for an 85 year old female, vomiting and weak. We arrive on scene (non emergent) about 6 minutes behind fire and they were just getting a first set of vitals and history. There were 5 firefighters on scene. The patient had a hx of IDDM, hadn’t taken her insulin or eaten due to a minor outpatient procedure earlier that day. I started doing some snooping and found discharge paperwork that showed the patient did receive some versed for sedation, and the side effects of vomiting, weakness and confusion were consistent with that. However, this patient did have a cardiac history as well, and the firefighters rightly called for a medic eval, even though the pt did not have any chest pain or SOB and we were close to 25 minutes into the call when they decided to holler for ALS.  As we were moving the patient down a flight of stairs to my truck, she vomited a copious amount of juice (which her spouse had given her prior to our arrival, thinking her weakness and tremors were from hypoglycemia.) The patient also stated she had to go to the bathroom badly and couldn’t wait. So, my partner and I carried the patient to the toilet while the firefighters followed us and we helped her stand and pivot to sit. I pulled off her vomit covered clothes and grabbed a robe for her. She was slightly short of breath from all the moving around and a little anxious. The lead firefighter said, “I think I’ll put her on some Os when she’s done.” I suggested not waiting. He told one of his guys to put the patient on 8 lpm on a NRB. 8 liters? Really? How did you come up with the magic number of 8 liters? I said to him, “She’s been vomiting and her sats are fine (98% on room air). She’s kind of freaked out and I don’t think she’ll tolerate a mask, how about a couple of liters on a cannula?” The firefighter putting the pt on O2 looked at me and said, “Uh, no. My boss told me 8 on an NRB and that what’s she going to get. And who are you, anyway?” I shrugged my shoulders and watched as they fumbled their way through a 3 lead EKG, patches not sticking and the patient shaking from chills because they removed the robe I had wrapped around her. As I was peering at the monitor over the shoulders of the three firefighters in turnout gear crammed in the bathroom, one guy saw me looking and turned the monitor so I couldn’t see the screen. After they ran about 2 feet of strip, one firefighter in the bathroom said loudly, “This looks like an arrhythmia to me.” A few minutes later, when I was out in the hallway, I asked if I could see the strip. The lead guy handed it to me and I asked him if they had been trained in reading EKGs. He asked why.  “Just curious,” I said, and handed him back the strip. (It was a sinus rate of about 80 or so, with loads of patient movement artifact.) The poor firefighters were paralyzed without the medics on scene and were afraid to do anything, including moving the patient from the bathroom to my truck, and they certainly were not going to listen to me. Talk about the “Stare of Life”. So, I grabbed the vomit covered clothes and tablecloth, put them in the laundry and cleaned up as much of the mess as I could. I then went into the living room and kept the husband company and distracted him from what was happening down the hall.
The medics showed up and while the rookie medic did the evaluation, the lead medic and I, who had been on several calls together that day, chatted for a few minutes. I watched the rook stick his head in the bathroom then pop right out to say, “Why is this woman on a mask? Switch her to a couple of liters on a NC please.” My partner, sitting in the living room, snorted with laughter, because she had heard the firefighter earlier when I suggested the same. The lead Fireguy sauntered over to us to give report and an overview of the history and said, “Also, we ran this strip and it looked fishy, so we wanted to get you out here for an eval.” The lead medic looked at the mile long strip and asked, “What do you see on here that’s fishy?”  The FF replied, “uhhh…” The medic then handed it to me and said, “You’re going to medic school in a couple of weeks. Have you been reading Dubin’s book? What is this?” I looked at the strip and said, “Looks like a lot of artifact to me, but I may be wrong.” The medics got a clean 12 lead and, as expected, the patient was cleared for BLS. Our
on scene time was an incredible 1 hour 17 minutes.

I enjoy running calls with the first department, I dread calls with the second.

TOTWTYTR says:

To add insult to injury many in the fire service tell members of the public that all the ambulance does is “give them a ride to the hospital” because “the firefighters do the real treatment” … Some fire departments do a good job of EMS because the people at the top understand that it’s important and that attitude filters down through every level. Unfortunately, a lot of them … provide crappy fire based EMS while claiming they are helping.

‘Nuff said.

The first day of the tour is in the books, and I’m feeling pretty good, even though we, once again, got NO sleep last night. The day started quiet with only one call before 1500, but it became another of those “up every hour” nights, so I made sure to grab a much needed power nap as soon as I got home. We were rolling to a call at the airport very early this morning and I was so exhausted I fell asleep while we were en route. When we arrived on scene  I’m sure I made absolutely no sense when I was talking to the first responder firefighter and it took me several attempts to put together a coherent series of questions so I could figure out what was going on with the patient.

“So, you’ve been vomiting, you say? Hmm. How long has this been going on? What did you eat or drink? Did you vomit? Oh yeah, you said that?”

I was so tired I felt like Gumby. Writing the PCR was real a challenge with my rubber arms.

My partner and I got a really nice compliment from one of the district Engine Companies early this morning. The LT walked over to me as we were clearing a scene and said, “Hey, congrats on Medic School! We’re really going to miss you. You and Claire are our favorite crew to work with.” It’s always nice to hear the fire guys think we’re doing an OK job.

We moved into the new digs and our new crew quarters are very nice. Very spacious, clean, neat and convenient for freeway access plus, it’s a straight shot to our most often frequented areas in the first due.

A week or so ago, I got wind of a new hiring bounty from The Borg. They are actively recruiting EMTs from OAC to defect to the Borg. They’re paying $500 to the Borg EMT that recommends an OAC employee and paying $1500 to the OAC employee when they get hired. Everybody at OAC knows about it, but nobody’s quit to take them up on it. Yet. The lure of a quick $1500 bucks is pretty strong to some of the kids that work there. Of course, all of my Borg friends were calling and trying to get me to fill out an application. No thanks.

…I’ve been thinking a lot about the 24 hour shifts I’ve been working. When I was contemplating moving to 24’s, Walt made a comment about how I’d probably like them. He was right. I really do like working a 24. Aside from the nights with no sleep, it’s a great shift. It’s long enough to get into a groove, and if you work with a good partner, it can be a lot of fun. Last night, before it got busy, Claire and I watched “Bringing out the Dead”. She had never seen the movie, but I wanted her to see how Martin Scorcese’s voice as the dispatcher sounds like our late night dispatcher at OAC. We were cracking up. “34 X-ray. Respond to the three car accident. Two taxis and a taxi!”

It looks like there’s going to be some good things happening with my blog. Keep an eye here for details. More about the big changes, soon.

We got some help deconning the rig. Thanks TC.

Sent from my Verizon Wireless BlackBerry.