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.

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.

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.

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.

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.

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

Hmm. No wedding ring.

Well, that doesn’t mean anything. Maybe she doesn’t wear it at work. Who knows? It can’t hurt to do a little detective work.  The ED secretary told me she was single. Aha. The plot thickens.

So, I decided to ask around a little more. Yikes. All of the other medics told me to stay clear. “She’s a bitch.” and, “She hates medics.” I also heard “She’s got an attitude.” and, ”She thinks she knows it all.”

Never one to to listen to advice, I forged ahead, asked her for her number and if she was interested in getting a drink with me.

Well, what do you know? Indeed she was! “And thanks for asking!”

Then, as we were planing on when we’d get together I mentioned that I was on shift Friday night, and I wouldn’t be able to meet her until later in the evening. So, instead of a drink, she offered to cook dinner for me, saying she’d make me a better steak than Morton’s. After my shift, she came over to my place, took over my kitchen, seared a couple of amazing fillets and whipped up a salad, we drank wine and talked and laughed til midnight.

The moral of this story? Don’t let other people make judgements for you. And, if you drink 2 bottles of wine, take aspirin before bed. :/

My then girlfriend (also a medic) and I left Seattle on a Monday night and flew to Miami on a Red Eye. Thanks to Benadryl, I slept the whole way. We hopped an Air France 737 to PAP and arrived on Tuesday morning around noon. Absolutely no problems with the flight, customs or passport control. When you get to Haiti, the first thing you notice is the heat. Damn. It was around 95 and humid and the smell of burning garbage hits you when you walk out of the air conditioned airport. (And that’s one of the last times I experienced AC in Haiti, ’til my last day in the country.) Prepare to be mobbed by “baggage guys” that will swarm all over you and try to grab and carry your bags. We had a translator meet us at the exit,and he sent the hordes of “helpers” packing. We had each been loaded down with over 100 pounds of supplies, clothes, food and whatnot, so grabbing a baggage cart was important. It was 2 bucks US, and well worth it.

Our translator lead us out to the parking lot where I had my first experience with a Tap Tap. A Tap Tap is the Haitian taxi, usually an old pickup truck with some metal frame in the back for seats and a canopy on top to provide shade and shelter from the rain. Everyone rides in Tap Taps. It’s not uncommon to see 20 people crammed in the back of one of these trucks, careening down the road. The only rules of the road, as far as I could tell were; drive as fast as you can, use any flat portion of the road or sidewalk as a travel lane and use your horn as much as possible. We rode in Tap Taps during the whole trip and while the driving made me close my eyes and assume the crash position a few times, we never hit anyone, nor did I see a Tap Tap MVA while I was in Haiti. Good thing, because if a Tap Tap crashed into anything, it would eject EVERYONE in the back and would result in a legitimate mess.

While in Haiti, we stayed in Petionville, an eastern suburb of PAP, on the side of a mountain. The group I traveled with has a house there, rather spartan by American standards, but pretty damn nice to the Haitians. We had agenerator for electricity, some cold running water for showers and toilet flushing and army cots with mosquito nets to sleep on. Not bad. Our crew of translators lived there and really made us feel at home. Our first day in country was a “chill out and take a nap day”, followed by a nice dinner and some cold Prestige, a fantastic Haitian lager. Over beers, we got the lowdown on what had been happening in the country, what our crew of translators was up to and what we could expect the next day at the Project Medishare Hospital.

Project Medishare, a service of the University of Miami, is running Hospital Bernard Mevs, the only critical care and trauma center in Haiti. The hospital is staffed by volunteers that rotate every week and oversee an ER, ICU, OR suite, PACU, Med/Surg unit, Ortho clinic, wound care clinic, a pharmacy and a “fast track” type urgent care. Below is the ER/ICU crash cart. I love the sign on it. “This is the CODE CART. Do not use the supplies if no one is coding!”

WhileI was there, I overlapped with two separate teams. First was a group of nurses, docs, medics and others from Urbana Illinois. They left on Saturday and were replaced by a whole new crew from the Bay Area. All great people, really dedicated to what they were doing. I met a maxoillfacial surgeon who rebuilt a guys face, a pedi trauma surgeon who worked 14 hour days in the OR helping kids, an ortho doc who seemed like he never slept and a ton of nurses who worked round the clock to keep patients alive in the ICU. Amazing people. Every one of them. My job at Bernard Mevs was to work in Triage with other medics, a nurse and a Doc, when he could get free. We were designed to be the gatekeepers to the hospital. In theory, we’d be seeing only emergent patients, stabilizing them and moving them on to the ER.

(That little hut abouve is the Triage area.)

In reality, we saw just about everyone. We referred as many to the day clinic as possible, but the flood of patients was almost non stop and we we wound up doing procedures in the triage area and then sending them home them without an ER visit. We had several docs (both Haitian and American) with us throughout each day, and they were more thanwilling to let the paramedics treat patients under their supervision. I learned to suture wounds, provide antibiotics, get treatment for Cholera started and how
to call the “Cholera team” to transport those patients to the “Cholera Camp”.

Supplies were always hard to come by, and if I hadn’t brought some boxes of large gloves, we would have been out of luck. Finding meds could be a chore, too. Pyxis, schmyxis. We had a box!

We went through hundreds of grams of Ceftriaxone, gallons of betadine, piles of 2×2 gauze and miles of kling and tape. It was an experience that most paramedics will never have, but one I highly recommend to everyone.

Some highlights? I had a guy come in with a foot that had been crushed after the quake. He had some medical treatment shortly after, but none since. I was told he simply needed a dressing change, but I was not prepared for the maggot infested mess that remained of his foot when I unwrapped the dirty diaper he had been using as a dressing. He had a BKA about 2 hours later.

I watched a Tap Tap come screaming up to the gate with a 20 something female in the back, in cardiac arrest, after being electrocuted while bathing outside at a refugee tent camp. We worked that code for 45 minutes, with no luck. The medics ran the code, while the docs and nurses looked on.

I did a “CCT transport” of a head injured male, intubated and sedated, in the back of an old ambulance without a stretcher lock or straps. We had to take the guy to St Luc hospital for a CT scan, as the scanner at Bernard Mevs was not yet operational. No drug box, no vent, no monitor. Just me, a doc, a nurse, a BVM and a scrub top pocket full of Benzos. No kidding. One of the scariest rides of my life. The stretcher was sliding around… we were bagging the guy and checking the lung sounds every minute or
two to make sure the tube didn’t become displaced.

There was a ton of trauma, lots to learn, amazing sights to see, great food, an amazing beach… and some of the most fantastic people I’d ever had the pleasure to meet. I feel in love with my new Haitian friends and can’t wait to go back.

Want to know more? Just ask… or visit http://www.papmo.org

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.

I said all of these things yesterday.