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.

• You can not kill yourself by taking 5 Nitrofurantoin.
• Crank does not make you a zombie. Ativan makes you a zombie.
• If you touch me again, you’re getting arrested.
• You need to vomit in the little blue cup.
• I need to know all of the meds you take. Not just some of them.
• Spitting at me will also get you arrested.
• You have to actually breathe to get any effect from a neb.
• Taking ASA will not cure a UTI.

I said all of these things yesterday.

I volunteered, and was selected, to be one of the medics that will be deployed to Haiti to assist with the ongoing medical missions that are still being conducted in country.

The current situation in Haiti is as bad, if not worse, than it was immediately following the earthquake. The number of people that are seeking medical attention, some for the first time, is simply staggering.

I’ll be deployed with EMPACT Northwest, a group of local medical professionals that has been operating in Haiti since the earthquake.

It looks like my team will be leaving for 10 days at the end of March. I’m pretty excited about the opportunity and I’ll write more about this soon.

As promised, here’s the post about my favorite EMS iPhone apps. These are the apps that I use to make my life easier. And yeah, I didn’t receive any compensation for this post.

First, The Paramedic Protocol Provider. I work in several different county systems. All have very different protocols. With the PPP, I can have them ALL at my fingertips. This is WELL worth the $7.99.

The Informed ALS field guide. A must have. And the new version rocks.

EMS Tracker is a great way to track scene times, vitals and procedures. Valuable. And, IT’S FREE!

When I work a code, I hand my iPhone with Full Code Pro to a firefighter and just have him push the buttons to mark what we’re doing. It makes charting the code so much easier.

Weight Calc? Pounds to Kg. Yeah. Find one you like. Easy and free.

My most used app is Epocrates. It’s the PDR, in your iPhone. Man, I love this app. Also, free.

Medscape is from WebMD. Some interesting stuff in here. Worth the sign up. The app is free.

MedCalc is handy for drug dose calculations. I don’t use it often, but it has come in handy.

If you ever have a burn patient and you need the Parkland Burn Formula or you can’t quite recall the Rule of Nines, you should have uBurn Lite. Another freebie.

I lost my DOT ERG, so I bought the app. You may not need this, but I do a lot of response on the highway and I want to know what’s in that tanker that’s leaking.

PALS Advisor was bought simply for the resuscitation drug dosages. I don’t know if I’d buy this again, but I already have it… so, there ya go.

PEPID is another great Go-To app when I’m stymied about a drug overdose or a toxic ingestion. Another great free app that you should grab if you don’t already have it. Did I mention it’s free?

So? Did I miss one? Is there a great app you can’t live without? Let me know!

If I stop and look at what I’ve accomplished in the last year, I guess I’m pretty lucky. I managed to finish paramedic school at the top of my class despite some rather harrowing personal issues, I’ve managed to find a full time job as a 911 medic, a part time job as an IFT medic, pay most of my bills on time and I still manage to feed myself most days.

A bunch of my friends aren’t working and there are guys from my medic class that may never find work as medics. It’s bad. There are so few jobs out there, it’s tough to find anything. I’m lucky, and I know it.

I’m lucky that I’m getting great experience. On my last shift I cardioverted a guy in Afib with RVR, treated a couple of STEMIs, had patients with symptomatic bradycardia, a CVA, a couple of good assaults, a major trauma MVA and a GSW. That’s ONE shift. That’s the kind of stuff some medics in slower systems may not see in a year. It’s so damn busy that I’m becoming a faster medic just by working with the other guys. If I don’t get my 12 lead and IV within a minute or two of getting in the truck, I simply won’t have time before I get to the ED.

I’m having a great time. And I’m learning every day. And I don’t take any of it for granted.

My next post will be a list of MY must have EMS based iPhone apps. The stuff that saves my ass.

It had been a pretty quiet shift so far. It was just after lunch and the other medic and I were discussing the merits of the particular games were we playing on our smart phones. He was bombing pigs with Angry Birds and I was pummeling a buddy of mine in Words with Friends.

“You see,” I started to explain, “it’s just like scrabble, but I’m using an iPhone, which is eleventy million times more sexy than that droid you’re playing with.”

WhoopWhoopWhoopWhoop!

The radio interrupted me.

“Medic 22, an ALS response to a one car rollover, 1652 McGilvery street.”

We jumped up and headed to the rig. I hopped in, grabbed the mapbook and my partner put us in route.

“McGilvery is only a couple of blocks from here,” my partner said. “It’s the third right off Division Ave.”

I knew where it was. A quiet street, lined with well kept houses built in the 60s. Nice yards. Lots of trees. No curves and a speed limit of 25. And 1652 would be smack in the middle of the block. How did a rollover happen there?

“Medic 22, the RP is stating the vehicle is on it’s roof in the front yard of 1652, one patient, unconscious, trapped in the vehicle.”

Are you kidding me?

We rolled up and sure as shit there was a small Toyota or Nissan on it’s roof in the front yard of a nice split level ranch in the middle of the block.

As we eased to a stop, I could see that the patient had somehow self extricated from the mangled wreck and was now hunched over against a tree with a bloody towel held to his face. The medic that was doing my county check off stood in the background while I approached the scene and sized up what was happening.

Here’s a better picture of the scene.

One unstable car on it’s roof. Car parts and assorted flotsam and jetsam scattered everywhere. One patient, covered with blood. About 50 bystanders crowded around, several screaming. Police and fire not yet on scene, but approaching quickly, based on the number of sirens I hear in the distance.

This would be my first major trauma as a solo medic. Yeah, there was another medic there, but he was just observing and he specifically told me he would function only as a basic, unless I really was screwing the pooch.

So, yeah. Back to the bloody kid.

“Wha happen? Wha happen? Wha happen?” That’s all I could get out of him. At least his airway was patent.

A fire engine rolled up and I had a firefighter grab c-spine while I pulled the towel away from the kids face.

Wow.

He had a huge open wound that ran from the bridge of his nose into his hairline. A wide open, gaping hole in his head.

Jeez. If I shoved my finger in there I could touch his piano lessons.

I grabbed my portable radio and notified dispatch that I was calling a trauma alert for a head injury.

In less than 12 minutes, we got Mr. Rollover packaged, loaded in the rig, a 16ga in his AC, a full set of vitals, a call to the ED and delivered to the waiting trauma team at the hospital.

It was quick. We were moving with a purpose.

Who am I kidding? I’m not taking credit for that. It was the work of some kickass firefighters and my EMT partner getting the kid packaged up expeditiously.

12 minutes from dispatch till we were at the trauma center. The trauma doc was happy. That was good stuff.

And, it turned out well, too. The kid didn’t scramble his brains, only suffering that huge lac and a broken nose.

I stopped into the trauma bay later that day. He was sitting up in bed, a huge dressing covering that lac. His whole family was there; sisters, older brother, mom and dad and his girlfriend holding their 1 year old daughter.

He looked up when I walked in.

“Hi. Do you remember me?” He shook his head, wincing at the pain it caused.

“I’m the paramedic that brought you in a couple of hours ago. How much do you remember?”

He looked down and said, “I guess I was hauling ass up McGilvrey, doin’ about 70 and I flipped my car, but I don’t remember that. I just remember not being able to move and somebody telling me that I was gonna be okay and that they were taking care of me. Then I was here.”

His dad walked over and shook my hand. He looked me in the eye. “Thanks,” he said. He didn’t have to finish “…for taking care of my dumb ass kid”. His eyes said it for him.

I said goodbye to everyone and headed back to the rig.

The senior medic climbed in the back seat and shoved his evaluation sheet at me through the hole leading into the cab.

“Approved to practice independently”.

Once again, I’ve been cut loose. Once again, I’m scared to death.

God… Or whoever is calling the shots, Thanks for letting me do this job. I’m glad I found something I’m good at.

I just wrapped up a 48 at the ALS IFT job. It was pretty quiet, with only a few calls to interrupt by busy schedule of napping interspersed with the Mythbusters marathon on Discovery.

I had a G1,P0, 32 weeks with contractions 4 minutes apart who needed to go to a hospital with a NICU. She was very nice and, as usual, demurred when I offered my name for the baby. She did not deliver in my truck, thank god. I don’t mind delivering a baby, it’s the cleaning up the mess that I don’t need.

I also transported a 24 year old guy who, rather unfortunately, weighed 475 pounds and was experiencing some “palpations”. I put him on the monitor and saw he was in sinus tach with trigeminal PVCs. Interesting. Some O2 and away we went. We’re not treating PVCs here unless there are symptomatic, so no Ami or Lido was warranted. Nice guy, just a shame to see such a young guy in such a spot.

We ate like kings over the last few days. The BLS B shift made a huge dinner and treated the duty medics to ham, smashed potatoes, stuffing, green bean casserole and pie with ice cream. In return, the ALS crews covered some BLS calls to give the crews a break so they could relax and eat dinner in peace. They seemed to really appreciate the fact that we jumped in to cover for them.

I start a 72 at the busy 911 service tomorrow morning. I’ve passed the protocol test and 12 lead/STEMI test that the county requires and after one more rotation with a senior medic, I should be good to go solo. I’m excited, but scared shitless. This service is busy as hell, very high speed and has a LOT of trauma and very sick people. For example, on my last shift, there were 2 GSWs, several major MVAs, a couple of codes and all manner of priority 1 sick folks. That was in 48 hours, in a city of 75,000. Crazy.

Anyway, I’m laying in bed with a cup of coffee and the dog curled up next to me, just relaxing. I hope everyone had a great Christmas and Santa brought you everything you wished for.

More in a day or two.

Last night, while laying in bed with a cup of tea and the dog curled up next to me, I had a thought. I suddenly realized that I should be thankful for the good things I have in my life and stop wallowing in self pity.

Enough.

I’ve been punishing myself for past mistakes for far to long. I’ve had enough of the self flagellation. Publicly whipping myself with nettles only makes me look foolish and doesn’t do anything except prolong the pain.

So, to that end, I’m done with the bitching, whining and complaining and this blog will return to what it was intended for. A vehicle for me to talk about my ongoing paramedic education, interesting calls, learning experiences and ways I think we can further the profession of paramedicine.

I’m at work at my second job now, the IFT ALS service, watching ESPN and thinking about lunch. No calls so far today, and I actually hope it stays quiet. I had a crazy 48 hour shift at the 911 ALS job, and a day without anything major sounds good. I’ll be working a 48 over Christmas at this job, so the medics with little kids and families can have Christmas with their loved ones. It’s the least I can do.

I had a couple of good calls on the 911 shift, including a status asthmaticus that I found tripoding and unable to speak who was not opening up following non stop at home albuterol nebs. It made me pucker a little, but I managed to get his sats up with a Duo neb, Solu-Medrol and Mag by the time I got to the ED. I had the tube kit open and ready to go, but he was doing better and able to talk when we got him in the treatment room, thank God.

I also am the refusal king. In one 48 hour shift I managed to use all of the refusal forms in the medic unit. ALL OF THEM. Crazy.

Anyway… I’m back on track. I’m feeling better and I’m getting back to focusing on the EMS calls.

I bury myself.

I work a zillion hours. I take every overtime or coverage shift I can. When I get a text from dispatch looking for a medic for an out of town trip, I’m on the phone in moments. “I’ll take that shift.”

I immerse myself.

When I’m with a patient in the back of the rig, they are my singular focus. We talk, we laugh, I monitor their vital signs. Sometimes I give them medicine to make them feel better and forget their pain.

I’m drowning.

When I’m not on a call, in the rig or at the station BSing with the other medics and EMTs, I’m overtaken with such a wave of sadness that it defies any description.

I’ve been a bad person. Bad. I destroyed the trust and kind heart of a woman who did nothing but love me through my own selfish and heartless actions. I am beyond any penance. I know that I am past the point of forgiveness and I am destined to forever be submerged in this well of pain as punishment for the things I’ve done.

I just hope that I can be a good, kind caring medic for my patients and help them through their pain, even as I struggle to cope with mine.

It’s a small consolation, but right now it’s all I’ve got.

I didn’t get hired at my fire department, but I am #1 on the list.

The decided NOT to hire a medic, even though we’re short a medic and we’re calling in per diem guys and racking up overtime like nobody’s business.

Eh. Oh well.