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Lessons learned.

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Lesson #1- ALWAYS have that bougie out and ready! Lesson #2- Cric pressure is your best friend. Lesson #3- Suction, suction, suction.

I wake with a start when the red light in my bedroom flicks on and the tones blare from the overhead speaker.

“Medic 22 with Medic 11, upgraded ALS response for a traumatic fall…”

I hop from my warm bunk and stuff my feet into my still warm boots and walk out to the bay and climb in the medic unit. I settle in the back and put on my headset. The captain turns to look at me through the pass through.” This is for you, ya know. 11s doesn’t need the help, but they know we have a student so they called us in.”

As we speed down the quiet streets, the radio mutters updates in my headset. “Bagging the patient.” “We need your C-Spine gear.”

We show up to a mess. The patient is a 50ish year old guy who had either been assaulted or had a standing ground level fall. Either way, it doesn’t matter. He’s in bad shape. A mushy occipital fracture, decorticate posturing and an airway full of blood means he is getting a tube.

The medic on scene finished starting the IV, lookes up at me and asks, “Can you go set up my truck to RSI this guy?”
“He looks to be around 150 pounds?” I guess.
“Sounds about right.”

The firefighters get to work packaging the guy on a board while I run over to Medic 11 and grab the intubation roll. I set out a 7.5, a mac 3, and  pull the bougie from the airway cabinet and lay it within reach on the bench. Then I start drawing up the drugs. 140mg of Sux, 20 of Etomidate, the Vec, the Versed. I label all of the syringes and carefully place them in order on the counter next to the head of the stretcher. Suction? Set. Vent is out and plugged in. I am as ready as I’ll ever be.
The stretcher comes crashing and rolling into the back of the rig. The Captain is bagging, the guy is seizing. A firefighter I don’t know is holding the man’s arms to keep him from pulling the mask from his ruined face. 11’s medic asks me to get a BP as he pushes some benzos. As I pump up up the cuff I hear the medic tell my preceptor, “No, you can go, I’ll just take your student.”
Monitor on, pulse ox, capnography showing a good waveform.
Down the road we go. Blood everywhere. The suction thrums, slurping in the guy’s mouth.

The medic asks if I think I can get the tube. I tell him I’d give it a shot.
“This is going to be a hard one,” he says. “He’s got a bunch of facial trauma, his airway is full of blood, he’s in a C-collar…” He trails off, looking at me expectantly.
“Well, no time like the present,” I say.

He smiles as he pushes the Etomidate and Sux while I pick up the laryngoscope in my left hand.

Posted by medic22 on January 17, 2010 • Filed under: EMS Topics, paramedic

The prep for medic wanna-bes.

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I wrote a post the other day called “For future paramedic students” and made an offhand remark about acetylcholine and how important it was to know what the hell it is and what the hell it does.

A reader, Mistie, asked in the comment section, ” I’m a basic going to medic…any tips?”

Oh Mistie, do I have tips. Enough that I felt it warranted it own post, rather than just a reply in the comment section.

So, here’s the stuff you need to think about before you even apply to medic school.

Pre-education:

Unfortunately, today’s prerequisites for many medic programs are pretty lax. If you really want to succeed at paramedic school, and in turn be a well educated medic, you really need to go beyond the bare minimum of what is required.

If your paramedic program only requires that you complete a 5 credit A&P “survey”, you’re doing yourself a disservice. Take a FULL 10 credit A&P series. Of course, you must take a college level Bio prior to A&P. And here’s a big tip: Keep those books for reference. Don’t sell ‘em back! If you have time, take a chemistry and microbiology course, too. It’ll help. Trust me. And hey, if your college offers it, Pharmacology is a safe bet, too. (I didn’t take Pharm, and wish I did. I do plan to take Pharm as soon as medic school is finished.)

One item that often gets overlooked. Study skills. If you haven’t been at school for a while, your study skills may have gotten rusty. It’s vitally important that you have a good grasp on college level study techniques,  have good writing skills, completion of basic composition (English 101) and solid test taking skills.

Also, make sure you have a good grasp on basic math skills. The medical math portion of the paramedic program isn’t difficult, but many people have trouble with it. If you need remedial math help, get it now and get comfortable with multiplication, division, addition and subtraction. It’s really just basic algebra for drug doses. Conversion of weights and volumes and decimal conversion to fractions are essential. Practice it every day until it becomes second nature.

If you have poor study habits, now is the time to fix that. Get some help. The sheer volume of information that you’ll need to take in is amazing. Medic school isn’t like  a foreign history course, where you can cram for the exam and forget it all in a few weeks. This is information that you’ll need for the remainder of your career. It’s stuff you’ll put into practice every day on the job. It’s important stuff. You’ve got to comprehend the material when you study, and you need to remember it.

EMS Skills

There is a lot of debate about the time that you should work as an EMT before taking on medic school. I believe the length of time as an EMT should be dependent on the individual and vetted through scenario testing. If you’re a competent EMT, have good, solid BLS skills and are comfortable around patients, you’ve got a great foundation on which to build your paramedic skills and education. If the idea of simply talking to patients scares you, if you still fumble when you backboard or C-Collar a patient, maybe you need to spend more time building confidence and basic skills. I think a year on a busy BLS truck is a good foundation for “getting your sea legs” in EMS. But, that’s me. Everyone has a different opinion.

Balance/Wellness

This may be the hardest element to include in your “pre-paramedic” prep. It’s vitally important that you still have a life when you’re in medic school. Time with friends and family will allow you to decompress and keep you grounded. The wellness aspect should be an ongoing lifetime commitment. Make time to exercise, really focus on eating healthy and remember that YOU are number one. Without a well functioning body, you’re just going to be another broken down Paramedic with a sore back that wishes he or she worked out and focused on core strength before that devastating career ending injury.

I’m sure there more I could add to this, but I’ve got a cardiology quiz on Tuesday to study for, I’m still trying to fit more ER clinicals and work into my busy schedule then there are free days and the dogs are barking to go out.

If you’re planning to pursue a paramedic education path, I wish you the best of luck and I hope some of these tips help.

Posted by medic22 on November 14, 2009 • Filed under: EMS Topics, Training & Development, Uncategorized

A collection of thoughts, muddled.

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Not a collection of a muddled thoughts.

Instead, on display is a random collection of things that I’ve been noodling around for the last few days.

  • We made the decision. My wife took the job. We’re moving again. (Anyone want to buy a house in Seattle?)
  • Moving sucks. My wife is giving notice at her current job today. She is planning to be at the new job in mid November. Aggghhh. Lots to do. I will stay here, in the PNW, until June when my medic program ends. With luck, I’ll get hired at the new place. Yeah, that thought isn’t stressing me out at ALL. Neither is the idea that my best friend will be 2000 miles away for the next 8 months.
  • I think EMS 2.0 is a great idea, but I’m sick of all the chest thumping and dick swinging. “My idea for EMS reform is better than YOUR idea.” The truth is, EMS needs are different in every area, and not one model will be a universal fit. It’s going to take a long time for change to come about and the priority should be on educating the public about what EMS is and, more importantly, what it is not.
  • I did worse on that last quiz than I thought I did. I missed 12 questions. WHAT? Yep. 12. That sucks. The only light at the end of the tunnel? All of the quizzes in total are only worth 15% of the grade. And I’ve aced all of the others. Not something to stress over. So why am I stressed?
  • I picked my 3 choices for ALS ride time. The first choice is an agency that’s 80+ miles from home, but one of the buisiest. Go big or go home.
  • I hate flying. I’ve decided that airline travel, which used to be somewhat enjoyable, is now akin to riding an overloaded school bus in a third world county. Never before have I fell more like a sheep than I did on one of the flights I was on over the weekend. I hate being crammed in and treated like cargo.
  • Some of my classmates need to be smacked. The bravado and ’supermedic mentality’ is starting to grind on me. I want a t shirt that says, “It’s less about the skills and more about the relationship.” Most of the fire monkeys that are in my class simply for the patch would look at me with disgust and call me a hand holder.
  • The is a person in my class that is on her THIRD run through the medic program. Why do they keep letting her in? As my Dad used to say, “You can’t polish a turd.”
  • I don’t know how I’m going to find any time to work between class, studying and clinicals. How do people do this?
Posted by medic22 on October 28, 2009 • Filed under: EMS Topics, School, paramedic

Busy, busy, busy.

3 comments

I’ve been swamped with school stuff, so here’s the quick update for all 3 readers.

1) I was checked off for field/OR intubations. Only 4 out of the 24 people in my class had technique good enough to be checked off this time around. Kinda scary. On a rubber “Fred the Head” it’s not all that difficult. It all changes out on the street. Feel free to read this blurb on Airway Management and some thoughts on medics NOT being allowed to intubate.

I don’t understand why some medics let their Ego eat their Brain. Frankly, if there’s something better and easier … I’m all for it. I don’t care if it’s an ETT or a King or a Combi. If it gets me a patent, secured airway, I’m all over it. Who I am is not tied to the skills I can perform. And yes, I feel if endotracheal intubation is going to remain in my scope of practice, I must be competent. If that means I need to get 12 good tubes a year, or continuing education, so be it.

2) I’m flying to a beautiful part of the country this weekend with my wife. She has a great job opportunity and the head honcho from company that wants to hire her wants to meet me, as well. So, they’re flying us in, putting us up and doing everything they can to make sure we like the place. Having been there before, I think we will. If she takes the job, I’ll stay here and finish school and sell the house.  By the way, the place we’re visiting has an outstanding Third Service EMS agency, and they’re looking for medics. So, that’s a BIG positive.

3) As part of the airway discussion mentioned above, the EMS 2.0 thing is fired up again and everybody in the blogoshpere is weighing in with their opinion. Where is EMS as a profession going? Some say MORE medics, some say fewer medics. Some say fewer skills for basics, others say more skills for basics. Up the educational requirements or keep them the same. Christ, it all makes my head hurt. I will, at some point soon, fully weigh in with my take on where EMS should go … after all, I am one of the “soon to be new medics that will be working to drive the process forward.” I just don’t have the time to do it now. I’m working on committing drugs and dosages to memory, and that’s a little more important.

4) I’m picking my agencies for ride alongs next week. I’ll let you know how that goes, too.

Posted by medic22 on October 23, 2009 • Filed under: EMS Topics, Patient Management

Well, here we are!

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Ahhhh. Smell that? It’s the scent of a fresh blog. Mmmmm. Smells delicious.

Welcome to the new “Medic 22″, formerly “Medic 7″. (But, you knew that.)

I’m stoked to be here. It really is pretty cool to have been invited to move to FireEMSblogs.com along with some of the other folks that will be publishing here. Lots of the people I respect and read everyday are now part of the family over here. Firegeezer, Happy Medic and 999Medic especially. It’s going to be a great, vibrant community of bloggers. I’m excited to be a part of it.

Anyway, what’s going in in my world? Glad you asked.  Medic School is non stop. And by that, I mean it’s full on, no holds barred information overload. You may have read my post below extolling the virtues of flashcards. They have really paid off! Three quizzes in, I’m kicking ass. I haven’t missed more than 2 or 3 questions per quiz, and that’s significantly better than most of my classmates. Some of the guys in my class now study with me and my cards at lunch everyday. It’s really amazing how well you can soak up information when it’s in little bite sized chunks. And that’s the best way to deal with pathophisology. Small bite sized chunks.

We’ve put a lot of tubes in Fred the Head. Like 150 each. There’s many training heads, and the instructors want us to learn perfect technique so we don’t walk into the OR and fumble through our tubes. Every moment we’re not doing something else, we’re supposed to have a laryngoscope in our hand, putting tubes in. Our partners watch like hawks. Every now and then, from across the room, you’ll hear a whispered, “You’re on the teeth!”

small digitalThis is my lab partner, digitally intubating Fred. He was not happy.

As far as life on the ambulance, I haven’t worked much in the past few weeks. I’ve been busy studying and trying to spend some time with my wife when I can. Luckily, the scheduling folks at OAC understand and they’re very cool with me working when I can. I’m on a 13 hour day car tomorrow, so I’m sure I’ll be working an interesting mix of IFT and fire calls. If anything groovy happens, I’ll make sure to blog about it.

In the meantime, it’s back to my pharm flash cards and the memorization game of dosages, names and contraindications.

Posted by medic22 on October 16, 2009 • Filed under: EMS Topics, Training & Development