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Here’s what’s new.

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I’ve done a slew of ER clinical time, a whole bunch of ALS calls, and I have a new preceptor. I’m booked solid, scheduled for clinicals, field shifts, ER, OR, Lab and class time from now until the end of the quarter. I may have one or two days off in there.

Out of all of what’s listed above, I’m happiest about the new preceptor. If you read my “Lessons Learned” post, he was the medic on M11. After that call we talked for a while outside the ED and we really hit it off. Soon, the conversation turned into “Ya know, if you’re into it, I can to talk to our MSO and see if I can be your main preceptor.” Yeah. I was into it. I’ve ridden a couple of shift with him and the crew on M11 and it was a great move. He’s been a medic for 12 years and loves to teach. Loves to let students get in the thick of things and is still excited and interested in EMS, something that was rare with some other medics I worked with. It’s a really good thing.

We’re cranking through school. Toxicology, Environmental, OB/GYN all down and now it is all about trauma, pedis and geriatrics. PHTLS and PALS will be all I think about for the next few weeks.

We took a surprise quiz today that knocked everyone for a loop. At the end of the expected material there was an added bonus: two pages of drug calculations. Yikes. After not doing ‘em for a while it was a rude awaking. I’m digging out the drug calc worksheets and running through some problems this weekend. I won’t get caught out again.

Really, medic school is turning out to be a much better experience then I thought it would be. Everyone in the class is truly excellent. All are different, but each is a great patient care provider. I’m thrilled to work with all of them and I consider each a friend.

OK, it’s bed time now. I’m off to the ER tomorrow morning and then an OR shift on Monday Morning to try and knock out some intubations. Let’s hope everyone gets a tube and the Docs decide to NOT go with LMAs. Wishful thinking, I know.

Be safe friends.

Posted by medic22 on January 29, 2010 • Filed under: School, paramedic

Dave and Tom

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I feel awful about not writing more frequently… but ya know what? This is time I need for myself. I need time to study and learn and process all of the new info that I’m sucking up every day. Just being around the medics I’m working with is great. I’m getting a lot of the nuts and bolts of day-to-day practice almost by osmosis. Just by working with them, and watching how they interact with patients and each other, I’m learning the art of having presence as a medic. And, to a lesser extent, I’m making careful note of the things I’ll never do when I’m a medic. These are valuable lessons my friends.

I’ve been on some excellent calls recently. Calls that I’m sure seem mundane to my preceptors, but present me with a new learning experience every time I step out of the medic unit. Every chest pain call is an opportunity to hone my assessment and interview skills and tighten up my IV skills. I’m working hard on delegating tasks to the EMTs and other medics with me. These guys and gals want me to run the scene and they’re poised, ready to jump when I say the word, all to help me succeed. I just need to tell ‘em what I want. And that’s a little hard, when sometimes I don’t know myself. But I’m getting better.

I made some mistakes over the past few days. I’m moving fast. Sometimes too fast. Going down the checklist in my head at a chest pain call at 2 in the morning…

“Okay, Tom, let’s get this gentleman on the monitor and some O2… Dave, can you grab me another set of vitals while I get the aspirin and nitro?”

Tom, my Medic preceptor, hops right to getting the patient on the monitor and some Os flowing on a cannula while Dave, the Firefighter EMT that’s with me, looks up from his BP cuff and says, “As soon as I’m done here, I’ll go spike a bag for you and set it up in the truck. I’ll make sure to set the nitro next to your IV roll.”

“That’s great, thanks Dave.” I mouth a silent “thank you” in his direction. He winks back.

And don’t think that Tom didn’t catch that. On the way back to the station after that call Tom asks in the headset, “So, how’d you do?”

I review the call in my head before I answer. I had a great rapport with the patient, we were laughing and joking on the way to ED. I did an great Q&A. Got a 12 lead in the first 5 minutes in the door, got ASA on board quickly, got an 18 gauge in the right AC while we were en route…

“Well,” I start.

Before I could go any further, Tom says, “It was pretty nice of Dave to save your ass with the Nitro, huh?”

“Yes. Yes it was.” I answer slowly.

These guys aren’t out to bust my balls. They’re working to make me the very best medic I can be. And I appreciate that. That’s why I don’t mind helping with chores around the fire house or cleaning up after dinner. These guys don’t get paid to teach me. They like teaching. And I appreciate it.

And yeah, I wasn’t gonna give that guy any nitro ‘til I had a line. I know better than that. But Dave was there to back me up.

I love riding with these guys.

Posted by medic22 on January 24, 2010 • Filed under: EMS, Partners, Training, paramedic

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

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

Oh, I can do this.

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So, I’m not a math whiz. I make no bones about it. I’m more a “right brain” creative type. When I go out for dinner with the wife I usually wind up looking at the bill and saying, “Hmm… Honey? How much tip should I leave this guy?”

So, yeah. Math. Not a fan.

However, the medical math portion of medic school is surprisingly easy. I thought it would be a lot more complicated that it is. Of course, I haven’t had a quiz yet, but I’ve been able to figure out all of the drug calculations without too much brain sweat. My question is this, how many of you guys do the math in your head? Does it just kind of stick after a while or do you work the calculations out on paper or with a calculator every time? I mean, I know the Dopamine clock makes the drip rate easy, but you still have to get there…

drugs

We do our first round of skills check off in lab this afternoon. This is the precursor to us getting out of the classroom to do our first hospital and field sticks and tubes. We’ve got to get a lot of them, so they want us out there practicing the monkey skills as soon as we can. It nice to know that the “skills” portion of my program, while not minimized, is secondary to the education portion of the class. After all, anyone can learn how to tube a dummy, but not everyone can learn the rationale of when and why and what the possible repercussions of shoving that tube into someone will be. That’s the important stuff. Same goes for drugs or IVs. Some medics follow the cookbook and push a tan box during a code, but they never learned the why. In our class, it’s ALL about the why.

And that is why I love it. Fill my head!

There’s a big quiz tomorrow on pathophiz, acid/base, medical math and pharm. I’m feeling okay about all of it, but we’ll see how it goes.

The pace continutes to be fast and furious and we jump right into cardiology next week. That will continue, along with additional pharm, right up to the quarter break.

Posted by medic22 on October 21, 2009 • Filed under: School, paramedic, training-fire-rescue-topics

Let me clarify…

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I just received an email from a good friend of mine, a friend who has been a true cheerleader throughout my career change endeavor. He read my post from a few days ago where I mentioned that I was not going to apply to medic school this year and via email, proceeded to chew my ass.

“What do you mean you’re not going to medic school?”, he ranted in a lengthy email. “You’re an idiot! You quit a great job to follow this path and now you’re not going follow through?”

Whoa. Chill turbo. I just said I’m not applying to medic school this year, here in the PNW. I doubt we’ll be living here in a year, and if we are…well, then I’ll apply then.

OK? So yes, I’m still planning on applying to Medic School, just not this April 1st.

Posted by medic22 on March 2, 2009 • Filed under: School, paramedic

I wish I was this eloquent..

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I’ve been reading Peter Canning’s blog for a while. Peter is a Paramedic in Hartford Connecticut, and he’s got a gift. Not only does he seem to be a good, caring medic … but the guy can write. He’s published a few books full of “stories of the street” and I find a little pleasure in knowing that I know where he’s going when he mentions places in Hartford. I know what it’s like to talk to the North Central C-Med dispatcher on Med 10. It’s familiar. It’s what I want to do and yeah, the stories are exciting. There’s a little adrneline junkie in all of us, otherwise, we’d be taxi drivers.

But, I read one of his posts called “The Line” earlier this evening, and I think it really summed up why I want to be a medic. It’s not because I want to be the guy in charge, or the medic that always gets the tube. Instead, I want to continue to learn from every call and give future patents the gift of past experience.

Learning how to be a better medic every day. That’ll be my goal.

Posted by medic22 on December 14, 2008 • Filed under: EMT, Peter Canning, paramedic

?Respiratory Therapist

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As I consider my next steps, I’ve been thinking more and more about RT school in the fall.

I also wonder about coupling RT with a paramedic cert. It might help with getting a CCT job.

And finally, I’d like to be the guy that’s able to help that kid that can’t breathe. (I remember how scary it was when I was a kid with asthma.)

Hmm. I guess it’s worth looking into.

Anone have thoughts?

Posted by medic22 on December 4, 2008 • Filed under: RT, School, paramedic

Decisions, decisions…

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As I mentioned in a previous post, before I can be accepted into a paramedic program here in Washington, I have to have a current EMT certification. As I’ve also mentioned, my certs lapsed about 5 states and 15 years ago. (My old Connecticut EMT number started with an “89″ if that’s any clue as to how longs it’s been.)

It turns out that I now have a couple of options. I was planning on the accelerated W-EMT (Wilderness EMT) class in Leavenworth in October, but last week, on a whim, I took the entrance exam for the North Seattle Community College EMT Class. What do you know? I passed.

So, now I have to decide if it’s North to Leavenworth or North Seattle.

As an aside, I was kind of surprised when I found out that North Seattle had a pre-class test. When I took EMT back in the late 80s, I just applied, sent in my 200 bucks and I was in. It’s not so easy today. Apparently the EMT class at NSCC is so popular that several hundred people test for the 30 available class slots and the 10 alternate slots every quarter. Most of those folks testing are Seattle firefighter hopefuls. It’s a plus if you’re already an EMT when you apply, as it’s a condition of employment.

But, I made the cut and now I’m leaning toward North Seattle for several reason. One, it’s much cheaper. Two, it’s closer. Three, the credits will go toward the elective portion of my degree. Seems like a no brainer.

If I do decide to attend the Fall quarter at North, I’ll also be taking the paramedic prerequisite A&P (Anatomy and Physiology) and an Integrated Studies course that is required for the degree program.

Posted by medic22 on August 19, 2008 • Filed under: EMT, North Seattle, WEMT, paramedic

Testing, testing..

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It’s been a while since I posted anything new, so here’s what’s going on. As you may or may not know, before I can be accepted into a paramedic education program, I have to be a current, working EMT for a year. So, that means I have to get re-certified as an EMT Basic. (I knew I never should have let those certs lapse!)

Last night I took the pre-test for the North Seattle EMT class. Everyone I talked to said it would be a killer test, but I thought it was pretty easy. It was all based on the Red Cross Emergency Response Curriculum, which is the basic DOT First Responder criteria. So, it turns out that there’s 40 slots for students in that class and about 150 people were testing last night. Most were guys that looked like they were young firefighters, hoping to add EMT skills to their repertoire prior to getting on with a local department. There were only a few older guys like me. I was planning on taking the WEMT course at Remote Medical in Leavenworth and banging it all out in 20 days, but after talking to my adviser, she suggested that I take EMT at North and apply those 10 credits toward my degree. Duh! At any rate, if it should happen that I don’t get accepted into the North Seattle program, I can either still take the Remote Medical class in Leavenworth in October (which I’m actually registered for) or apply for the King County EMT program in Bellevue that Search and Rescue sponsors, and thus will cost me nothing! There’s lots of options. I’m also excited because I didn’t realize how close I was to getting most of the AA degree requirements knocked out, so I can move on to a regular university. Radio… gotta love the fact that you can work in the business, make a ton of money and do it without a degree. The real world is a little different.

Posted by medic22 on August 12, 2008 • Filed under: EMT, North Seattle, WEMT, paramedic