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I just thought I was busy before…

I’ll start by apologizing for it being so long since my last post… It’s incredible how fast the time flies by.

At the beginning of school the information came quickly, but was manageable – I had figured out ways to effectively manage my time between studying, work and wee ones – For a week or two at a time it seemed like drinking from a firehose (as I posted about a few months ago), but after that particular module things would settle back into that intense but manageable level I had grown accustomed to. I had found effective strategies to study and retain the info – I lulled myself into believing “ah this isn’t so bad” and for a few weeks I didn’t understand why I had heard so many stories about how hard paramedic school was.

Then we finished Cardiology and all bets were off.

In the two months since cardiology we have covered our medical/trauma and pediatrics modules as well PHTLS, PALS, and EPC. Reading assignments of 100 pages a day in one text-book and another 70 in a supplemental book became the norm on a different topic or body system each day. If the early stages of class were like drinking from a firehose… the last few months have been like drinking from “Old Faithful” or maybe Niagara Falls.

In addition to all the class work there have been 250 hours of clinicals to do.

It took everything I could do to keep myself afloat in class for the last few months. My grades dropped from A to B and after a few of the exams I wasn’t sure that passing was a certainty.

Now I understand what all the “fuss” was about.Understand that the above isn’t meant to gripe or complain about school – I merely offer it as an explanation for my extended absence. All of you that sport the disco patch have been through the same or similar experiences – my situation is not unique by any means.

There is a month of didactic left – operations – it should be some of the “easier” material we have covered in class.

There is a small mountain of other things I would like to share – a layoff – a new job opportunity – moving into teaching classes next semester – the impending field internship – but there isn’t time for all of it today. Let’s say I have a lot of things to share with you all – now I just need to find the time to peck it all out.

Hopefully, I will do a better job of finding time to log in here and peck on the keys for a bit over the coming weeks to keep you posted.

 

 

 

Posted by on April 8, 2012 in Paramedic School, Personal

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Any Surprise? Do you agree?

Recently, CareerCast published a list of the 10 worst jobs in America in 2011 and low and behold coming in at number 6 – EMT.

“On the other hand, jobs like EMT have considerably better hiring prospects, but rank among the 10 worst jobs of 2011 due to harsh working conditions, high stress and inexcusably low pay given the extremely important nature of the work.” Source

Reading through the list it seems the factors they weighed into their rankings were : Work environment, Stress, Physical demands and hiring outlook it also seems they weighed in average pay across the nation. According to this site – the 5 jobs worse then EMT : Roustabout, Iron Worker, Lumberjack, Roofer, Taxi Driver in order from 1 to 5.

I have worked a few of those jobs throughout the years, and I have known people that have worked the ones I haven’t. I agree they are all worse jobs then being an EMT, but not for the reasons the site says.

For those of you that do not know my history, I walked away from owning a successful residential remodeling company to return to EMS, taking a SUBSTANTIAL pay cut in the process. Since making that decision I haven’t looked back even a single time.

The ranking may be helpful for someone considering entering this profession, possibly alerting them to what they are getting into. I’ve seen the wide eyed wonder drain out of many noob’s eyes when they realize this job isn’t what most people think it is. For those people, I can see where a list such as this may be helpful. However, for those who have been around for more than a couple years, it’s no surprise that an outsider would rank our chosen profession so low.

The list does take into consideration the low pay, the “disrespect”, the strenuous conditions and the stress – I do not dispute any of those things – they are all a part of the job. There are a number of other factors that I can see being viewed negatively by folks both inside and outside the profession – what I don’t see factored into the ranking are the rewards.

Speaking only for myself – I didn’t come back to EMS for the money or for the “hero” image – I had done this long enough before leaving the field that both of those bubbles had been burst for me. I didn’t come back for the adrenaline rush, or the driving fast or any of the other things a lot of folks enter the field for – I came back for the intangible rewards of the job.

Not many people get the opportunity to know they make a difference is someones life – I’m not talking about the naive notion that – we save lives for a living… sure on the rare occasion it does happen – but that isn’t what we do everyday. When it does happen its more timing and luck then anything we do. What we do do (if we are any good at this job) is make what is potentially the worst day of a person’s life better.

Riding to the hospital with 95 yo nana while gently holding her hand and maybe even coaxing a smile from her – knowing that she will remember my face long after she has faded into my memory… knowing my presence alone made what was an incredibly difficult experience for her better in whatever small way – that’s a reward most people don’t get.

I’ve described this job many times as the highest highs and the lowest lows and sometimes the two are separated by one call… an emotional roller coaster some days.

When it’s all said and done and I take off my boots for the last time years from now (I hope) I will “retire” from the streets knowing without a doubt that I made a difference – a real difference in making people’s lives better. For me that makes being an EMT the best job in the world and makes every other job out there ahead of it on the worst jobs list.

What about you? Are you surprised by the rating? Do you agree with it?

 

 

Posted by on January 12, 2012 in EMS, EMT, Personal

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Defining Moments

In talking to some of my fellow students and a couple of the instructors, it seems that the students who do the best in Paramedic school all share one common trait – they had a single moment when they knew it was time for paramedic school.

Dictionary.com defines epiphany as “a sudden, intuitive perception of or insight into the reality or essential meaning of something, usually initiated by some simple, homely, or commonplace occurrence or experience.”

It’s term I’ve heard used far too often, and usually in the wrong context, but in this case I think it is rather fitting. Some of the “moments” I’ve heard are major events, running an extremely critical without ALS assistance, MCI’s etc, but for most it was a seemingly benign event that turned the light bulb on for them.

For one of my instructors – the moment came when he no longer broke into a profuse sweat when the “tones dropped”. He tells of having to wear sweat bands on his wrists to keep his hands any semblance of dry, and of sweat running down his face to the point it often obscured his vision. One day he just realized that it wasn’t happening anymore and he knew he was ready. It’s kind of humorous when he tells the story, but for him that was a defining moment in his career.

For me it was a little more subtle, but no less of a moment of clarity. I ask you to try to remember those first couple of calls you were sent to as a brand spanking new EMT, and see if any of you can relate.

For the first little while every call I got was “life and death”, the radio would crackle I would hear my unit number and every pore in my entire body would squeeze out a single drop of sweat… my pulse would quicken and the giant ferris wheel in my stomach would start revolving. For the first month or two my more experienced partners would have to put their hand on arm and say – just breathe man – we got this.

I remember thinking it was going to take me forever to get over that adrenaline dump when the radio told it was our turn at the plate. Slowly, man down unknown medical calls stopped becoming cardiac arrests in my mind, MVA’s stopped needing every victim to be cut out of the car and rushed to the trauma center… and I hit my stride.

Even on those truly rare occasions  now when we get an actual critical call – I’m a cucumber – cool collected and able to perform my job as expected without needing to change my undershirt because it’s soaked with nervous sweat.

A few months into my current job I was assigned a new partner – a brand new paramedic – ink not even dry on his cert yet. Watching him work his first few scenes was like looking into the “back in time’ mirror… I could see the nervous tension just below the surface on each and every scene, and was reminded what those first few calls were like for me too. He held his own and became not only a great partner but a great friend.

A few more months and I got another new partner – yet another brand new paramedic with ink still wet on his cert – the same things I said about my first new medic partner apply equally to my second…

Then one day we were sent to a local clinic – they had a patient in sustained V-tach that needed to be taken to the hospital – hearing the call over the radio – I flipped on the lights and the siren, and did my best maverick impersonation to navigate us to the facility….

Somewhere between the lights coming on and the rig coming to a stop in front of the clinic I noticed that all the color had drained out of my partners face. He fumbled with combination to the narcotics safe and we literally had electrode confetti throughout the back of the rig… And then it happened –

I reached out and grabbed his arm – and said – Man breathe – we got this….

At that single moment, it became clear to me I was ready. How that translates into I’m ready to challenge myself by taking my skills and knowledge to the next level, I can’t exactly say for sure, but it was like someone flipped a switch and all of a sudden I knew.

That’s my epiphany, defining moment, whatever you want to call it – How about you? What were some of the defining moments in your career? What was it that finally whispered “your ready” into your ear?

 

Posted by on January 5, 2012 in EMS, EMT, Paramedic School, Personal

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Speaking of Beginnings…

The stories of how people end up in EMS are always fascinating to me… So while everyone is talking about beginnings, I thought I would share my story…

A long time ago, in a galaxy far, far away – Wait that’s another story

I guess it was 1988, 89 something like that – I was living in Kalamazoo Mi and trying to find my way in the world – I received my discharge from the Marine Corps and really had no idea what I wanted to do with my life.

Shortly thereafter I started dating a girl – you knew the story would involve a girl didn’t you?

Anyway – Both of her parents were a part of the local volunteer Fire Dept. and her mom was a first responder on the ambulance as well as a firefighter. I still don’t know exactly what it was about the stories they shared that I found so fascinating, or what it was about becoming a volunteer I found so appealing, but I always sat and listened to the war stories with a sort of wide eyed wonder. Eventually her mom talked me into coming down and finding out what it was about… that was it I was hooked.

I joined at the first opportunity I could, although if memory serves me correctly I had to attend several meetings and then have someone nominate me for membership. After the nomination process and attending more meetings I was finally voted on and made a probie.

Great I’m a member – now how do I get lights and a siren in my car ?!? It’s funny looking back on it now, and funny how such a stupid question can change the course of your life – but hey I was a young guy and lights and sirens were cool to me back then (and they meant I could drive fast 😉 ) The answer was simple – complete your probationary period, AND either firefighter 1 and 2 or EMT school. Hmmmm FF 1and 2 was offered free by the department but it was like one class a week and near as I could figure it would something along the lines of a millennium to finish (my sense of time was a little off back then too) or I could EMT school – 1 semester and a couple hundred bucks – well that was a no brainer.

I attended my initial EMT training at Kalamazoo Valley Community College and was certified as an EMT-Ambulance (yes that’s what the certificate said) I still remember the instructors name – Paul Dickens NREMT-P and my first clinical rides with Mall City Ambulance.

After graduation I got a job with Mall City on their non emergency transfer car and loved every minute of it…

Eventually, I moved back to NY and worked my way through several private companies before ending up with NYC EMS (which was NOT a fire based service back then).

Several years later I again moved this time to Texas for personal reasons… and it was the beginning of the end of my initial period in EMS.

The town where I lived had a volunteer fire based service and a private company that provided 911 service… Jobs with the private service were few and far between so I joined the local VFD and became a part of the “first response and rescue” service.

Provided purely for your laughing pleasure.... Judging from the "pornstache" you can probably guess the decade LOL

 

While I was there I finished my FF 1 and got trained in the use of the hurst tool, high angle, low angle and swift water rescue – I had an absolute blast – BUT (there’s always a but isn’t there?) the devotion to the volunteer squad and the training didn’t leave tome for a real job – and the VFD didn’t pay – so being unable to find an EMS job, I went back to my old standby of construction, which was what I did to buy beer lunch money in High School.

Eventually the time demands of the job and the family took what little time I had left from the VFD and I resigned because I couldn’t give them the commitment they deserved.

When renewal time rolled around, I saw no point in renewing my cert – I wasn’y using it anymore so what the hell let it lapse…

Fast forward 15 years and you will find me running my own construction company, successful but ABSOLUTELY HATING every minute of my days. I started to fall into a depression and while soul searching I realized how much I hated what I did… It was cross roads time – Can I take the HUGE pay cut and come back to EMS and not hate my job or do I suck it and keep bending nails?

After a long period of soul searching and lots of support from friends, family and loved ones – they convinced me it was more important to be happy.

I researched schools and moved here in the hopes of working for the service that runs my paramedic school program – I enrolled in EMT school (again… what was that comment about letting that certificate lapse… )and I haven’t looked back even once since making the decision.

Here I am now – 1/4 of the way through paramedic school (a second time for that as well) and on the cusp of making what has truly been the dream of my adult life into a reality – fortunately I’ll graduate before the Mayan calendar ends _ so even if the world does end in December – I’ll go out with a disco patch on my arm

What about you – share your story below – and tell us if you choose EMS or if it choose you…

 

Posted by on January 3, 2012 in EMS, EMT, Personal

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A New Beginning

Happy 1st day of 2012 everyone.

I always prefer the beginning of a new year as it’s hopes and dreams have yet to be dash on the rocks of reality yet… it is still full of hope, wonder and optimism.

I typically don’t do the whole resolution thing, I have set goals that I work towards all the time and in reality a new year is just a time for me to reaffirm those goals and the path I’m taking to achieve them, with that said here are my top expectations and goals for the new year.

  1. Finish Paramedic School – It won’t be enough for me to just finish (not that that isn’t an achievement in and of itself) but to finish school with a job offer from the service that runs the program… anything less will be failure in my mind.
  2. FINALLY quit smoking for good… There I said it in public even so I can’t take it back now.
  3. Start taking more time for ME – exercise and more trips to the mountains, I need to find a better balance between work, school, family and personal stuff – somehow I always put myself last
  4. Find a way to step up into some sort of leadership position within EMS – either as a teacher, or mentor or even with NAEMT to help spread what EMS is capable of and help us get to where we want to be
  5. To post more regularly here – It’s a great release for me and really helps keep my stress level down
  6. An end to 10 years of struggle – fingers crossed
  7. Advocacy – More of us need to be part of the solution
  8. To write at least one article for publication in either JEMS or EMS World – Several of you have suggested it, I just haven’t listened – I hear you now – I’ll give it a go at some point

I keep hitting enter like I’m going to keep adding to the list, but those are already pretty lofty goals for a year that’s going to end the world in December…

How about you – What are your top resolutions oe expectations for the coming year – feel free to share them below.

 

Posted by on January 1, 2012 in Personal, Uncategorized

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Goodbye to Yesterday

I suppose it is borderline obligatory for a blogger to post a “year in review” entry. A time for us to reflect on the year we are leaving behind and look with optimism toward the year ahead. It is for me perhaps a good time to take of measure where I am and where I want to be.

2011 has been somewhat of a whirlwind for me both personally and professionally – I sometimes forget just how far I have come.

When 2011 ushered itself in I was driving a wheelchair van waiting for an EMT position to open up at the company where I work. Having 7 1/2 years of experience prior to taking that job it was “humbling” to have to reinvest myself in the dues we all have to pay when we enter the profession. By the end of the month I was doing my third rides to clear to independent duty on the bus.

I went through two partners before being forced by my employer to go to part time status if I wanted to pursue my education.

I discovered EMS social media and the multitude of blogs out there. I read and I read and I read somemore – somewhere in the recesses of my mind I decided I wanted to give this blogging thing a shot… it started with random stuff – I read something that moved me, or about a shift whatever… after a couple months EMS Blogs.com decided to pick up the blog – which was really an honor to me – and now a lot more people read the blog then ever before.

The days when I put out what I believe is a killer post – I’m often disappointed at the numbers of people who read it – or how often it is(n’t) shared on FB or whatever – then I remember what a privilege it is that even one person takes the time to read the drivel I spout here. At those times I remind myself the reason I write is to “vent”, to process, or just to release some of the pent up “stuff” this job brings out in us all – whether anyone reads it or not – I still get that.

I wrapped up all my pre-reqs for paramedic school and stressed my way through the spring hoping I would get the nod for what is THE program for me… after a couple months of sleepless nights and constant stress I got the acceptance letter  and for the last three months paramedic school has all but been my life.

I regularly work on a 911 car now in one of several districts that our company is the provider for… It’s a rare occassion anymore when I work a flex car doing routine transfers.

I’ve learned that I know even less then I thought I did, and that anyone who says they know all they need to is full of crap.

I’ve gotten better at leaving all the “preconceived” notions about calls and patients behind, and am trying to learn to maintain a high level of suspicion on all calls.

I’ve realized that all the fancy machines that go beep and buzz and whirl – they dont really tell you anything you shouldn’t already know from a THROUGH assessment.

I am slowly making the transition I believe is the hardest part of going from being an EMT to a paramedic – being the team lead and running things.

It’s been a year of tremendous growth and rapid change, and one I’ll look back on with fond memories… see you in 2012

 

Posted by on December 31, 2011 in EMT, Paramedic School, Personal, Uncategorized

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A Day Under The Lights…

For those of us who live this crazy life, share this insane passion for walking on the lunatic fringe day after day, the following is just another day… For those of you who don’t here’s a glimpse in what it’s like to spend a day under the lights…

0300 – The alarm clock explodes in the darkness, shattering the illusions of peace and quiet I enjoy in the tranquil place in my mind. My escape from the brutality of the real world in which we live is over. Dragging my all but lifeless carcass out of bed to the kitchen, the aroma of coffee just a half a shade lighter than mud makes its way to my nose…

One cup in… I open the closet containing my heavily starched uniforms and select one for the day, on goes the ballistic vest, the crisp white shirt, and the highly polished boots.

A gentle kiss to the forehead of the boys before leaving the house and 30 minutes later I pull into the garage. The rig is checked, necessary equipment gathered and we are out the door… 30 seconds, not even enough time to make it to the driveway and the radio crackles to life… Medic 8 I need you at…. for a man down… it’s 0408

Can you imagine the helplessness I feel as I check the pulse of the lifeless body on the floor, the feeling of inadequacy I’m filled with as I have to look up into the horror filled eyes of the man’s wife of 40 years, her barely audible pleas to save him blasting through the early morning silence like thunder.

I know it’s too late, and as much as I would like to clear the call and get back to that second cup of coffee in the rig; I give my partner that look – the one that says I know it’s hopeless, but we’re gonna work him for his wife’s sake. Without missing a beat the pads go on, the compressions and interventions start – not for the long gone soul lying between my knees, but for his wife, that she may feel some comfort in knowing everything that could have been done for him was.

We’ve known all along that we would pronounce this gentleman, all we’ve really done is prolong the time we have to decide which words to use to tell her. Knowing that she will hear them over and over in her head, likely for the remainder of her days, it’s no small task to figure out just what to say.

The helpless inadequate feelings have to be replaced with quiet confidence and the strength to reassure her when she starts wailing that if only she had found him sooner he might still be alive.

We pronounce the gentleman, and put ourselves back in service.

1/2 way to our assigned post – Medic 8 I need you at….. for an MVA with entrapment

 As I reach into the twisted metal to help the firefighters extricate the battered and bloody teenage girl from the carnage caused by a full speed impact into the concrete divider, my mind wanders, wondering how I would react if this was my sister, my daughter, how would I react to the news of the accident?

30 minutes after they arrived on scene the fire crew has succeeded in freeing her.

Her soul beat her body out of that pile of twisted metal by at least 10 or 15 minutes.

She is pronounced on scene – this time we don’t go through the motions.

Loading the gear back into the bus my mind again flashes – to opening a door and finding a police officer standing there; his head down as if examining the shine on his shoes, his hat in hand, a voice that wavers ever so slightly as he begins “ma’am I’m sorry to inform you… ”

This time when we go back in service, we don’t even get an assigned post – Medic 8 I need you at…. for a 96 (psychological emergency)

Still not even 1/2 way through that second cup of coffee, we arrive on scene – the man standing there bleeding around his handcuffs isn’t happy to see us – he knows that our presence all but guarantees that his suicide attempt will be unsuccessful.

We load him into the bus and transport him non emergent to the local trauma center – 10 minutes of the most scorching verbal abuse I’ve ever been unfortunate enough to experience. (I went through Marine Corps bootcamp at Parris Island – so that’s saying something) I’m forced to put a spit hood on him, because no amount of trying to calm him or reassure him that I’m there to help curbs his deadly accuracy with his bodily fluids. The verbal lashing continues all the way there and through our hand off to the receiving facility.

The nurse who takes my hand off report only half listens, more concerned with what and who her fellow ED nurses did last night. When the doctor comes in she calls us “the ambulance people” and only gets 1/4 of our report right.

We are trained to not take the verbal abuse of our patients personally, and we are conditioned  shortly after we enter the field to expect lack of respect and belittlement from some less educated “medical professionals.”

We are told to let it roll off our backs – in theory it works –  in real life sometimes not so much. I’ll tell you with my voice that it didn’t bother me, that I’m used to it by now and we’ll crack a joke or two in a pathetic attempt at veiling our true feelings… if you listen to my eyes though they tell a different story.

The radio is full of life now, seems the city has started to stir and as it does it inevitably chews some of the residents up. We have to wait our turn to clear the hospital, and when we do we are immediately dispatched again.

Medic 8 I need you at ……. for a 45 female with chest pain.

More inappropriate jokes about 12 leads and hoping shes at least 1/2 way attractive en route. In other company the jokes would be seen as cold, harsh maybe even borderline perverse, for us its more of the same.

It’s almost sad now that I think about it the ways we mask the impact of the job, the masks we wear among the only other people who really understand what we go through.

Upon our arrival, we are straight faced and all business.

We find our patient lying on the couch, her husband trying to to keep their 4 children at bay while we enter. Two steps in the door and my partner and I share a knowing a look – she’s sick no question about it.

We work fast, running through our interview and packaging her for transport. She’s having a massive STEMI (non medical translation – REALLY BIG heart attack) the cardiac alert is called in and we make haste for the door. It’s almost funny how our training totally takes over and we lose all the humanity of our job when its a serious call. 1/2 way through the livingroom I’m reminded of the humanity as I feel a small little tug on my sleeve.

I look back wondering what I could have snagged my sleeve on and am met with the epitome of innocence, maybe 5 years old,  tears streaming down his dirty face – his voice cracks as he speaks… “Mr is my mommy gonna be ok?”

It never ceases to amaze me when the bulletproof shell I have built around me breaks down, somehow its always at the times when I need it the most. I can’t look him in the eye, and I stand there for a second, trying to cough words around the lump in my throat, the tears well up in my eyes as I squat down and tell him she’s in good hands and I’ll do everything I can for her, but we need to get her to the hospital.

It’s hollow, it’s not what I want to say… I don’t have the time to give him an gentle embrace and I’ve been doing this long enough to know not to make promises I have no control over… I can’t explain how it isn’t up to me if she makes it or not, all I can do is try to get her to the cath lab before I have to work another arrest today.

She makes it to the cath lab and hopefully beyond – but I have more calls to run, I’m only half way through my shift I can’t take the time to follow up right now.

Six hours later – we pull into the garage – the afternoon was a little easier than the morning, not as much acuity to our calls and no more death notifications, so I’ll take it. We service the rig and get it ready for the next crew.

12 hours – no time for breakfast, no time for lunch and back to the barn 30 minutes past end of shift, another typical day.

The guys are all standing around talking about their day on the street – I’d love to talk some, maybe it would help to prevent some of the burn out I’m racing headlong toward – but I don’t have time…

I have class for the next 4 hours and if I’m lucky I can make the cross town drive and get there in time.

2200 (10 PM) class is over and in 30 minutes I’ll pull into my driveway – I’ll get my leftover dinner out of the microwave, and eat it cold like I always do so the beeping timer doesn’t wake anyone.

I stumble through the darkness careful to avoid any noisy toys so i can kiss my boys on the head before collapsing into bed at 2345 (11:45 PM)…

0300 will be here before I know it and I’ll have to it all over again.

For those of you who don’t live this life, or live with someone who does -I wish you could realize the physical, emotional and mental drain of missed meals, lost sleep, lost family time and forgone social activities that we all experience, not to mention all the tragedy our eyes see each and every day that we pull on our uniform.

I wish you could know the brotherhood we share and the satisfaction of having saved a life on the rare occasion when we get lucky enough to actually do that, the sense of purpose that comes from being able to be there in times of crisis.

Unless you have lived with one of us, you will never truly understand or appreciate who I am, who we are, or what this job really means to us…

I wish you could though.

 

Posted by on December 29, 2011 in EMS, EMT, Personal

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OOPS I did it again…

Somehow a month has passed – where any of those days went I can’t say for sure. The last weeks of class were extremely busy with ACLS certification, as well as classes on shock. Throw into that working as much as possible to make Christmas better for the kids AND trying to get clinicals knocked out so I don’t get behind on those and the days just flew by.

There were a few stretches in there where work/clinicals went on for 96 consecutive hours… needless to say I’ve been whooped. The break from classes and homework were right on time allowing me to squeeze in more work and clinicals before Christmas.

Pushing myself so hard I expected it to be me that broke down, at some point my eyes refusing to open to the alarm clocks beckon, or just getting sick from being so worn down. Instead it was my truck…

While driving to work yesterday morning the driveshaft of my truck literally fell out on the highway.

I'm pretty sure THAT isn't conducive to driving

Being afoot has given me some unexpected time off from work and clinicals, and while I have a 500 page cardiology book to work through (that’s the next 5 weeks of classes) I am going to take advantage of the time to get some writing done. Yes Mom I will study too I’m already 1/4 of the way through the Cardiology book.

What most people don’t understand is that pecking on these keys is a therapeutic release for me, and I have been missing it greatly. So for the next few days I will be taking advantage of the new found time to catch up on posts and get the pent up stress from school, work, the holidays and yes, even broken down vehicles out.

I have been sitting on several topics for posts, waiting for the opportunity to allow my brain to put together a semi cohesive thought.

If not now, when?

 

Posted by on December 28, 2011 in Paramedic School, Personal

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Interesting Perspectives

This week I had the opportunity to gain a unique and interesting perspective on a call from an angle we as EMS providers don’t often get to see.

It was an “off week” from class due to Thanksgiving and I decided to use the extra time to get some of my clinical time in. Wednesday night from 2300 to 0700 I worked in the ED, and Friday morning at 0645 I was in the OR.

During my extremely busy ED shift a trauma activation came in – “gun shot wound to the head – pulseless and apenic – CPR in progress”

I knew what to expect having called in activations to this busy urban facility in the past… call in the Calvary – Trauma 1 was readied while the ambulance was en route – The docs and nurses had their stuff wired as they readied the room… who’s getting first pressure, who’s got the drug cart, who’s going to bag, who’s recording… They orchestrated the symphony before the particular piece of music arrived. The senior resident was at the head of the bed ready to conduct and all of the members of orchestra stood ready – shortly thereafter the “sheet music” arrived via gurney.

He was a large 30’s male CPR was in progress and they moved him from the gurney to the bed in no time flat. Report lasted about 10 seconds.  (I had heard about these “loud and proud” reports in the trauma room, but I’ve never seen one given, it was impressive.)

Immediately after he was placed on the ED table – compressions resumed, lines were started, orders called out. Doc asked why no tube was in place, medic replied with,  “jaw was clinched and we couldn’t get it”.

“Fair enough” he said as he inflated the cuff on the tube he had just dropped.

Two minutes – nothing.

“Let’s go one more round and call it.”

I climbed up on the stool next to the bed and began compressions – fast and deep, fast and deep over and over – while it shouldn’t be any different it felt like I was being graded by all the docs and nurses in the room and I wanted to be sure every single compression was as perfect as I could get it.

Two more minutes – and one of the docs says – “I have a pulse”, initial pressure was something like 60/30. Meds went in and a physical exam began.

Here’s where it started to get interesting, the patient did indeed have a “hole in his head” and a broken jaw, he also had a hole in his back and in his right bicep. ED Doc decided that the hole in his head was not due to a bullet (no palpable fracture or crepitus below the wound) but that the other two wounds were. A chest tube was inserted and 2300 cc of blood were drained from his chest – he began to stabilize and was sent up to trauma surgery.

The rest of the shift was pretty uneventful and at 0700 I called it a day.

Friday morning rolled around and I headed up to the OR, I was more than a little nervous about intubating my first actual patients. It was a slow day in surgery with only 3 cases scheduled day (a typical day sees between 20 and 30 scheduled surgeries in the 13 different OR suites). The first case however intrigued me, it was the gunshot victim I had worked in the ED.

He had been taken into trauma surgery from the ED and had the bleeding in his chest and right arm controlled, a second chest tube inserted and then was sent to SICU to stabilize before further surgery. Since he was already intubated there wasn’t much I could do, but I was allowed to observe from bedside.

They reopened his chest and after removing several handfuls of clotted blood they began to examine his lung. When the surgeon found out I was a paramedic student and that I had worked this guy in the ED he invited me to “scrub in”.  What an amazing opportunity – how many of us get to not only observe but actually scrub in on a patient.

After the obligatory hand washing to your elbows, the whole dressed by the nurse twirl to get the gown on and sterile gloves I was ready. The surgeon invited me to watch over his shoulder as he showed me the damage the bullet had done to the lung tissue, he explained what he was looking for and at. It was amazing to see the lung in his hands as it inflated, if I looked at just the right angle I see the pulsating aorta as it exited through the diaphragm – this beat cadaver lab hands down.

Satisfied that he had adequately repaired the lung the doc said he was going to attempt to find and remove the bullet – “do me a favor – hold this” he said as he gestured at the retractor sticking out of the guys chest. I looked around through the safety glasses I was wearing, not seeing anyone else he would have been talking to, I pointed at myself (careful not to touch the gown) and said “me?”

I swear I could see the surgeon smile through his mask while he reassured me that I could in fact hold his retractor.

I took a firm hold and was careful to follow his instructions to the letter… he found the bullet and repaired some more damage, it was fascinating to watch. My amazed wonderment overcame any lactic acid build up in my shoulder and arm and I didn’t miss a beat. The surgeon explained to me what he was doing and why as he did it.

Once he was finished and getting ready to close I asked where the bullet had entered and what it had damaged. He invited me around to the other side of the bed and explained that the bullet had just missed the spinal cord and the aorta, and he slid his hand way into the patients chest – he lifted his hand lifted the lungs in the process and said – Here slide your hand against mine – be careful not to rip your glove there are some broken ribs back there.

Could this experience get any better? I slid my hand into the patients chest and could in fact feel the shattered ribs, the vertebral column and the pulsations of the aorta – I’m pretty sure I had that same look a kid who sees Cinderella’s castle for the first time has – It was a truly amazing experience, one I will probably never get again.

Interestingly enough even after surgery the docs weren’t sure if the hole in the patients head was due to a bullet or something else. I suppose it doesn’t really matter, and is a further illustration of how inexact our practice can be sometimes.

It also gave me perspective that most EMS providers never get – while I didn’t actually pick this guy up on the street, I did get to “follow” him from his arrival in the ED to his discharge to ICU. What an amazing experience and how fascinating to watch the treatment plan be implemented and carried out.

 

Posted by on November 28, 2011 in EMS, EMT, Paramedic School

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Hindsight is always 20/20 or If had known then…

It’s only been a short while since paramedic school started, but I am already looking back to the prerequisite courses with regret. Just like most programs, my school required an A & P pre-req, as of this year they changed the minimum from needing 8 credits worth to 4; instead of the year-long course they are now accepting a one semester intro to A & P (I have my own thoughts on that, but I’ll save them for another day). I opted for the 8 credit 32 weeks of Anatomy and Physiology knowing that the knowledge gained there would provide a strong foundation to build upon during paramedic school. That was a wise choice and I have no regrets about that at all… here’s what I do regret –

Listening to all the paramedics who told me I’d never need to know most of what I was learning. The Krebs cycle (now called the Citric Acid cycle) Action potentials, Ph… the list I’m sure by the end of school will be extensive.

I have said many times that I am not now nor have I ever been interested in being a cookbook medic… give this drug for this then give that drug for that – regardless of the patients presentation… In my mind all chest pain does not necessarily equate to Oxygen, Aspirin, Nitro and Morphine – that’s not to say this isn’t effective treatment for chest pain – just that I don’t believe just because the patient says they have chest pain we HAVE to follow that particular algorithm every single time…. I want to be allowed  encouraged expected to actually THINK.

Here’s the thing that no one bothered to tell me – to understand a drug… ANY drug – you have to understand the physiological actions of the body process the drug effects FIRST in order to then understand how the drug alters that physiological action.

Do you need to understand those specifics to pass the NR exam? probably not… but again I am not interested in just memorizing a list of drugs and what they are used for… I have always wanted to know the hows and whys behind the pharmacology.

We had three lectures (the first three pharm classes) that were all about action potentials – what ions move where when, how that effects the cell and what happens when we alter the normal phases with chemistry. Two of those lectures focused strictly on Vaughan Williams antidysrhytmics  4 (5) classes of drugs that are classified by which ions movement they effect (and beta blockers).

Why did no one tell me this sooner, why did no one say… hey bud- make sure you remember that stuff cause its going to come back big time in p-school? Does it go to the educational standards of other paramedic schools where as long as you can remember the drug info on the NR sheet they don’t care if you understand what you are doing? Is it more the medics I spoke to are by definition “cookbook” and I just didn’t know it until now? Sadly, I don’t have the answers to those questions.

As a basic I wanted a good solid foundation to build on, but I only had people who had been through paramedic school already to guide me as to what was important to learn and what wasn’t. So if you follow this blog and are preparing for paramedic school – I’m telling you now

LEARN about cellular physiology – study action potentials, which ions move during which phases and what that means both to you as a provider and to your patient. Study the ways that the body maintains homeostasis, learn µ, α,and β receptors – where they are located and what they do. THIS simple thing will make your pharmacology classes SO much easier.

I am wasting valuable study time re-learning stuff I should have had down before school started – Don’t make that mistake.

Don't neglect the cellular physiology when you prepare for P school - so figures like this one don't cause you panic

 This stuff IS important and yes my friend you DO need to know it if you want to progress beyond being a cook book medic.

You can’t say I didn’t warn you…

As a reminder its Movember, and I’ve donated my face to raising awareness and funds for Men’s specific cancer… please make a small donation to help raise awareness and funding for research… You can make a tax-deductible donation here

 

Posted by on November 2, 2011 in EMS 2.0, Paramedic School

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