Hi all. I’m still on the holiday break, and rather than frolicking in a winter wonderland, I’ve been fighting a miserable cold since the first week of December. As I mentioned in some past posts, my wife has taken a new job in the southern part of the country while I finish school in Seattle and work on selling our house. I’m actually down south with my sweetie now, and have been for the past week. I can already tell I’m going to really like living here a lot. The people are nice, the weather is great, the cost of living is significantly less than the PNW and frankly, I’m tired of living in the perpetual gray that is Seattle.

As the year is quickly coming to an end, I wanted to thank each of you who’ve read my blog and commented on my posts. Medic School continues on Jan 4^th, and this quarter is going to be even busier with clinicals and classes. It looks like I won’t have a free day until mid February. I’ll keep you updated with what’s going on. This quarter, I’ll be taking more of a “lead medic” role on ALS calls and I expect to really learn a lot.

I’ve also started to compile a list of things that I want to accomplish over the next year. Not really New Year’s resolutions, more so a list I can refer back to and check off as I get things done.

In 2010, I want to:

• Attend a comprehensive difficult airway class.
• Remove fast food and soda from my diet totally.
• Clean out the garage and sell all of the junk
• Make it a priority to work out once a day.
• Lose some more weight.
• Make sure I tell my wife I love her, every day.
• Remind myself why I decided to become a paramedic whenever I have doubts.

Sounds easy… but doing it every day might prove to be difficult, but I’ll work on it.
Friends, I hope you all have a great 2010 and keep checking back… I promise to get back on the posting track very soon.

When you’re a paramedic intern, your field rotation is a tremendous experience. You’re playing in the big leagues now, brother. It’s no longer imaginary patient scenarios; it’s the real deal. You’re standing in the middle of someone’s living room at 2:40 in the morning and you’ve got a sick person sitting on the couch in front of you, and you’re expected to treat him or her appropriately. Oh, and did I mention that all eyes in the room will be watching your every move?

In talking to my preceptors, I’ve found that most paramedic interns don’t have much trouble with the actual medicine. However, they do have trouble with the other 22 hours of the day. The time they spend in the firehouse with the crew. So, to help those medic students who may be venturing out on their first field rotations, I’ve compiled a list of handy tips to help you make the most of your field time and to keep you from ruining it for future students. Most of this is common sense… but remember, this is from my preceptors, at my ride site. Your mileage may vary.

First, remember that you are a guest in somebody else’s home. Respect for the house and the crew is your number one priority. Simple things mean a lot. Wipe your feet. Knock before you just barge in. It sounds pretty easy, but you need to remember that the crew in the firehouse is a family, and you’re an interloper that can easily disrupt the delicate dynamic that exists. Oh yeah, bring a gift. To be more precise, bring food. Cookies, muffins, something. Here in the PNW, it’s expected that the medic student bring Ice Cream on the first day of rotation. Snacks are always appreciated. Don’t make a big deal about it, just put the cookies or muffins on the counter in the kitchen. It’ll vanish before you know it.

Arrive at least 30 minutes before shift change. Introduce yourself to everyone. Look them in the eye, shake their hand and say, ‘Hi, I’m, ______ a medic student riding here today.” Be proactive in letting people know who you are and that you’re part of the crew today.

Learn what’s expected of you as soon as you walk in. On your first day you should be asking where you ride on the engine and what spot you take on the medic unit. Which bed is mine? What bag or box you’ll carry into the house. Where is the mop and broom? Figure out where to find your traffic vest for MVAs. Ask if you need a helmet and gear for calls. Anything you need to know should come out as soon as you get there. Ask your preceptor or the senior firefighter, “Hey guys, this is my first shift here. What do I need to know?” And don’t wait for them to volunteer that info, get it!

Expect to work. Don’t fall into the trap of letting the crew treat you like a probie where you’re expected to scrub toilets and kitchen tile grout for your whole shift, but pitch in with the station chores. Don’t wait to be told. Grab a broom or a mop and get to it. The crew may not say anything to you, but they’ll notice that you’re helping and they appreciate it. Usually station chores can be done pretty quickly and then you can move on to the real business at hand…

Learn the location of everything on the medic unit. Everything. Spend as much time as you need in that truck to be able to put your hand on anything your preceptor may ask for or you may need in the course of doing your job. If the same equipment or medication is in multiple locations on the truck, know them all. It should be your mission to do a full rig check every time you walk into that station. Physically inspect every drug vial. Touch them all so you make the connection with the location in the drug box. You want to be able to open the box and know exactly where the Adenosine or Solu-Medrol is. Touch every piece of equipment in the truck. Do you know how to turn their brand of monitor on? Where’s the capnography plug in? How many sets of combi-pads are in the rig? Is every laryngoscope blade bulb tight, white and bright? Can you put your hand on the bougie without having to root for it in the airway bag?

Spend some good quality time with your preceptor and get to know what he or she expects from you. Conversely, let your preceptor know where you think need help and guidance. Expect to be grilled on your medicine and treatment plans by not only your preceptor, but also other medics in the station, the shift captain, the MSO and anyone else who happens by. Don’t think you can skate through this. You need to know your stuff. You need to know drug dosages. You need to know WHY you give certain drugs. You need to be able to grab gear off the truck without fumbling. Your preceptor is watching to see how much you know, how you handle stress and where your weaknesses are. When you roll out together, some preceptors may want you to just observe how they run calls for the first shift. Others may tell you to run it all while they stand back and observe. It’ll be up to you and your preceptor to find that comfortable groove where you can get great patient care experience and he can guide you in shaping your practice. And if he or she knows you need help with certain skills, they can be right there to help you out with tips and tricks to get it done.

Have some presence. My instructor calls it “Medic Swagger”. You’ve simply got to be decisive in your treatment and interaction. After all, you’re going to be the guy that everyone on scene looks at for answers. There’s nothing worse than being unsure. When your preceptor says, “This guy’s rate is 42, what are you gonna do?” Don’t scratch your head and say, “Uhhh…maybe some Atropne?” That is the wrong answer my friend. If you know it, say it. If don’t know, ask your preceptor. Don’t guess. If you do guess, expect to get grilled on treatment for that situation when you get back to the firehouse. This isn’t something you’ve got to have nailed on your first shift, but soon after you start riding, you’ve got to be able to step up to the plate and be the medic.

After the call, you clean and restock the rig. No questions. Just do it.

Study. There’s going to be downtime at the station. You better have your books with you. Use that downtime to feed your head and prepare for the next class. If your preceptor is a newer medic, chances are he’ll quiz you on some esoteric stuff that you’ll be expected to look up and report back on. No, he’s not picking on you. Well, okay he IS picking on you, but he’s also helping you to learn. And just think, in a few years when you’re precepting a medic student, you can do the same.

Dinner. On some shifts the evening meal is a big deal where the cooking starts just after breakfast. For other shifts, it’s pizza or Thai food ordered in. You’ll need to talk to your preceptor about what’s expected. At the station where I ride the rule is, Medic Students are not expected to cook and are never asked to buy in. The guys there remember what it was like to be a student and how having no money is the norm. I appreciate that, but I always offer. (And yes, I did cook for the crew a couple of nights ago. My roasted chicken with wild rice was received with rave reviews.) If you don’t cook or pay in, you’re still expected to help. Did you hear that? Offer to help! When dinner is done, clean the table and the kitchen and do the dishes. Don’t say anything, just do it.

Coffee. Make sure there is always coffee on. If you’re studying in the kitchen, it’s easy to do. I always throw a couple of bucks into the coffee fund when I’m there. One of my preceptors doesn’t drink coffee, so she always loudly announces to the crew that I can drink her share. The captain on that shift has a constantly full mug, so I make sure there is always a fresh pot on. Remember, it’s a respect thing.

Fitness. Most crews have a period of time during the day set aside for PT. If you’re comfortable working out with the crew, ask if they mind. Most don’t. Some spend their PT time “discussing” department politics, and they may not want you around for that. Don’t be offended. However, you should take an hour out of your day to work out. My firehouse has a great workout room and I spend at least an hour in there every shift.

There’s an old joke in the fire service, “If I wanted your opinion, I would have told you what it was.” While you’re not expected to be silent, it is prudent to keep your yap shut. You have two ears and one mouth, so do twice as much listening. If you’re studying in the kitchen and two firefighters come in talking about something, don’t insinuate yourself into that conversation. If they want to talk to you, they’ll include you. Most times they will. If a discussion becomes heated or turns into a rumor mill discussion, it may be better to quietly pick up your books and head to your bedroom or the bay.

At my station, evenings are pretty mellow. They cross staff a medic unit and engine so we have a small crew, usually three and me, sometimes a crew of five plus me. Around 1900 or so most of the guys settle into their recliners for some TV. Medic Students are never allowed to sit in a recliner unless they are invited. Don’t ever break this rule. You are not there to watch TV. You’re there to study and learn. Now, most preceptors will give you the wave and say, “Hey, put those books away and come over here and sit down.” When I’m invited to watch TV, I do so for a short period and then excuse myself to study more or hit the rack. Be polite, but don’t expect to just hang out and watch the tube. It’s not cool.

Sleeping at the firehouse is tough for some. One guy I know can’t sleep unless he’s almost totally naked. That’s got to be rough. If you’re that guy, don’t make them wait for you. The fireguys have bunker gear to put on, so they can be ready pretty quickly. I usually just sleep in my uniform pants and a t-shirt and throw on a quarter zip with my Student ID for that middle of the night call. I also keep a box of Altoids in my jacket. Mints are always appreciated in the middle of the night. Also, make sure your bed is made neatly and you keep everything orderly in your room.

To clarify, this is MY situation and it may be different for you. ALL of our clinical time is with Fire. There is no separate ALS only service. ALL of our rotations are 24 hour shifts. We spend the entire shift with the crew, and many of the students pull 48′s to meet the criteria for number of required ALS calls, as juggling the required field time with hospital rotations and classes can be difficult. Unlike some Medic programs, we don’t do “ALS Engine Sleepovers.” ALL of our patients are transported by Fire Medic Unit, even the BLS calls, and the medic student has patient contact with every single one of them. I ride the busiest ALS unit in the county and average about 16 calls per shift.

Many of the departments in my area cross staff both an Engine and a Medic Unit.The engine has a full compliment of ALS gear on board but it’s not the primary ALS response unit. However, if the engine rolls on a fire call, the medic student is expected to be on board. If the engine responds to a call that tuns out to be medical, the medic student and preceptor will manage that call to the hospital on a separate medic unit which will be called to the scene to transport.

Your field rotations can be a great learning experience and you can have a lot of fun. Just remember to respect the crews you’re working with, say please and thank you and pitch in on the work. “I’ll do it” is a great attitude to have. I’m sure you’ll do fine. If you have additional tips, put ‘em in the comments section. I’d love to keep this post as a living document for new medic students to refer to.

Constant reader, my apologies. I feel simply awful that I’ve neglected you and all of my other my blog readers for the past few weeks.

However, I do have an excuse.

It’s the final couple of weeks of the first quarter of Medic School. That means I’m cramming clinical and ride time in, studying all of the material we’ve covered for the past 3 months and trying to have a little bit of life on the side. It’s tough.

So, I’m sure you’d love to read about what’s been going on… here’s a little recap of the past few weeks.

I’ve shown some marked improvement in my IV skills. It’s simply a Jedi Mind trick. If I visualize the catheter advancing in my mind, it will happen when I do the skill. I also met some great nurses and other medics during my ER rotations that are helping to hone my skills.

The ER rotations are fun for me. I know some of the other guys look at them as a waste of time. “Let me get my sticks and get outta there!” I like talking to the Docs and learning more about how THEY evaluate the patients and what happens after we bring ‘em in. It’s really a great learning experience. I do my last ER shift of the quarter tomorrow morning.

My ride time has been strange, to say the least. I’m riding with a department that has 4 platoons and medics that float from station to station depending on debt days and staffing needs, so I never have the same preceptor. That’s something I’m not really happy about. Although, I guess at this point in my education, it’s more about me learning how they work in the field.

My first 24 was pretty laid back. 2 ALS calls, both very minor. My preceptor told me, “Just do it. If you’re gonna kill someone I’ll stop you.” Not exactly the learning environment I was hoping for. But, all went okay, and I didn’t kill anyone.

I just finished a 24 this morning and it was another strange one. The first medic I was assigned to was very cool and seemed really interested in training and teaching. We really clicked. However, he was only working a couple of hours on a fill, so he left at noon. The senior medic who came in to cover the rest of the shift wanted nothing to do with a student. The third guy on the truck was a precepting medic and he was running all of the calls. It was confusing and a little messy and I just tried to stay out of the way and do what I could. The Captain on the shift said he could send me to another station if I wanted to work with just another medic. By that time it was mid afternoon and I figured I’d just stick it out.

Three ALS calls for the day. A possible CVA, a cardiac arrest and a fall/fracture that was ALS due to pain meds.

The CVA was really a marginal ALS call. The PT had some slurred speech and left arm drift. We did run a 12 lead as she had a history of Afib, got a dexi and we tried to get a line. No success. The transport time was short (under 5 minutes) so I suggested that we just load and go. Nobody disagreed, and off we went, code to the ER.

Shortly after that we responded to an Extended Stay motel for a “Citizen CPR”. Young adult male, unknown down time. Best guess? “Awhile.” The guy was at least 300 pounds and gray when we arrived. He was asystolic on the monitor and that never changed through 40 minutes of ACLS. I did attempt to get the tube, but no dice. The guy was huge. A Mallampati Class 4, no neck and his jaw was pretty rigid from the extended down time. But, I figured I should give it a go. The medic handed me a Mac4. (not my choice. I wanted a Mac3, due to the size of his mouth.) I grabbed a pillow off the bed and crammed it under his shoulders, stuck in the laryngoscope to take a look and couldn’t see the cords. I mean, I couldn’t see nuttin’! He had very little jaw excursion and it was tough even getting a look. One of the other medics switched places with me and just shoved the tube in while I gave some cricoid pressure. He told me he didn’t see the cords either and just went for it, hoping he’d hit the trachea. Good bilat breath sounds and the capnography was showing a good wave form with ventilation. Luck? Experience? Maybe some of both.  I wasn’t comfortable enough to just try and jam a tube in blindly. The guy also had no veins and he wound up getting an IO drilled in each tibia and we pushed drugs that way. We worked him for 40 minutes and after we called it, the story we got from the cops was that he had a history of sleep apnea and took a bunch of Percocet with his buddies … and that was that. Lots of help on this one. There were 4 guys on my Medic Unit and we had an additional Medic Unit and an Engine Company. So aside from the firefighters and cops, there were LOTS of medics on scene. At least four, plus me (the 1/3 medic.)

Later in the afternoon we rolled to a call for a mid 50’s female that fell and dislocated or fractured her ankle. It was on the verge of becoming an open fracture, so we did a pillow splint and got her in the truck. It took a long time to find IV access, as she had no veins. She eventually got a 20 in her hand, some fluid and 10mg of MS that really took the edge off by the time we arrived at the ER. Personally, I think I would have lingered a little longer on scene to get the IV and some pain meds (and maybe some Diazepam) on board before we took that long, bumpy ride to the ER. But that’s a personal preference thing.

The rest of the night was quiet. Pizza for dinner, got a lot of studying in. However, I don’t know if I’ll go back for a ride with that shift again. I guess I just have to take what I can get.

I’ll admit, spending long shifts in a fire station is a little awkward at first. I have a history with Fire, so I know the rules. But, it seems that some of the other students didn’t and that makes it rough for all of us. When you’re a student doing ride time at a fire station, you need to remember you’re a guest in someone else’s house. I’ll write a full blog post on “how to behave during field shifts” in the next day or so. I think it’ll be valuable to anyone who is nervous or unsure about what to expect and how to act. The EMS part is easy… it’s what you do for the other 22 hours that you need to think about. Here’s a couple of big tips; don’t argure with your preceptor and always do the dishes!

Okay then… Today is Sunday so that means some football, some studying and early bedtime to get up and ready for my final ER shift in the morning.