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Rites of Passage

Ask any prospective paramedic student what they worry about trying to learn and you will likely get an answer that contains at least one of these words: Cardiology or Pharmacology. For some students – myself included the answer contained them both. Adding to my level of anxiety is the fact that the program I am attending is all but legendary locally for its program – and more legendary then the program is the exam – 200 questions – 100 multiple choice and 100 short answer questions relating to 14 different rhythm strips, with roughly a four hour time limit – Highest score ever on the test was a 98.

Interesting to me was the number of practicing medics sitting in the back of the room to “refresh” their knowledge base. The program allows it’s employees to sit in on Paramedic School lectures for CE’s – typical classes have one or two medics back there – Pharmacology had 5 or 6 – Cardiology had 15 – 20 easily EVERY NIGHT for the entire section.

We were told to purchase calipers – as there was no way we could pass the exam without them… Granted most medics don’t even carry them let alone use them in the field – but they wanted to be sure we knew how to break a strip – even the most complicated strip down.

The exam lived up to its reputation – it was EASILY the most difficult test I have ever taken – memorization wouldn’t have helped – the exam required a genuine understanding – after we took the test they told us that as far as they were concerned anyone who got a 70 on that exam was an expert in the field of pre-hospital ECG interpretation – I got a 92 – but I certainly don’t FEEL like an expert…

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If only it was this easy

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Cardiology started with the warning that the instructors goal for us was if someone ever asked us where we learned cardiology we didn’t embarrass them when we gave their names. Both of the instructors are captains at the division I want to work at and one of them is instrumental in the hiring process – cause you know the standard student anxiety over cardiology wasn’t enough for me – I had to ramp it up a little.

I have heard many times so far during school we don’t use a certain book for this because a good one doesn’t exist to teach you what we want you to learn (More experienced providers that write – take notice) Cardiology was an exception – they did have a book for that – but it’s interesting the one they choose.

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Practical Guide to ECG Interpretation By: Ken Grauer MD FAAFP

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Available from Amazon here if you are interested.

What makes Dr. Grauer’s book so interesting is that it is out of print – The program actually contacted Dr Grauer (he includes his contact information in the book in case you want to contact him about the book or cardiology in general – wow) to ask his permission to copy the book for their students – all 500 pages of it.

The process they taught us for breaking down a strip was methodical but lengthy – in fact it takes me 10 to 15 minutes to go through each step and wrote the findings out –

  • Rate
  • Rhythm
    • P- Are p waves present in lead II
    • Q – is the QRS wide or narrow – (if wide examine for BBB)
    • R- Regular or irregular
    • S – Single or married – are the wave complexes married to each other or separate
  • Intervals
    • PRI
    • QRS
    • QT
  • Axis (fasicular blocks?)
  • Hypertrophy
    • Right or Left atrial abnormality
    • Left Ventricular Hypertrophy
    • Pulmonary Disease pattern
  • Infarction – any signs of infarction, strain or ischemia?
    • Q – are Q waves present in any lead? are they pathological? are they expected in that lead?
    • R – Is the R wave progression normal? where is the zone of transition?
    • S – ST segment changes – Elevation, depression, strain pattern?  Are the changes related to a vessel or global? What area of the heart is affected?
    • T – Are there T wave changes? what do they indicate?

The answers to all of these questions only give you HALF of the information you need to interpret the strip – This just gives you the descriptive analysis of the strip – you have to take the patients presentation and past medical history into account or the “clinical impression” as the book calls it.

Dr. Grauer also says that to get the most accurate information possible from a strip you should try to have a prior strip available for comparison – and our instructors took that one step further – if you can actually get a prior strip (unlikely in our setting – but stranger things have happened) was it the patients strip on admission or on discharge ?

My head has been spinning with all the information contained in this module – Brugada’s Syndrome, Ashman’s Phenomenon, WPW (Type A & B),  Default Vs. Usurping rhythms, differentiating between V-Tach and SVT with aberrant conduction, Fib-Flutter, the potential causes of a tall R wave in V1, the causes of QT prolongation…To the point where I have to run through the steps I listed above mentally or I end up staring at the strip with a blank look on my face.

The most reassuring message came after the exam – you don’t have to be an expert at this stuff now – nor do you have to be an expert during your rides… or even during your Field Internship when you get a job as a Medic… You DO have to be an expert when you are cleared to independent duty and are making the interpretation “solo” – That’s a relief I have probably another year of practice then.

Our instructors recommended several books and a few blogs to take our studies further – I’ll share them here in case some of you may be interested

Practical Electrocardiogr aphy by Henry J. L. Marriott (Hardcover) - Called the bible of ECG by our instructors

Pathophysiology of Heart Disease 4th (Fourth) Edition by Lilly (Paperback)

Pure Practice For 12-Lead ECGs: A Practice Workbook by Robin Purdie RN MS (Paperback)

 

The blogs they recommend – Dr. Grauer’s Blog , www.ecgpedia.org , www.ems12lead.com , Dr. Smith’s ECG Blog

Be good – get good – or give up

 

Posted by on February 15, 2012 in Cardiology, EMS, Paramedic School

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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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It’s MOVEMBER… and I’m proud to be a MO BRO

For the first time in over 20 years there isn’t a caterpillar over my top lip…

Why is it so important? Here are some facts about Men’s Health from the Movember website:

The average life expectancy for men is five years less than women (presently 77 years old compared to 82).
1 in 2 men will be diagnosed with cancer in their lifetime and 1 in 3 women will be.
Evidence suggests that about a third of the 571,950 cancer deaths expected to occur will be related to obesity, physical inactivity, poor nutrition and thus could be prevented.
1 in 6 men will be diagnosed with prostate cancer in their lifetime.
240,890 new cases of the disease will be diagnosed and 33,720 men will die.
Testicular cancer is the most common cancer in American males between the ages of 15 and 34.
8,290 men will be diagnosed with the disease and 350 will die.
Smoking accounts for at least 30% of all cancer deaths and 87% of lung cancer deaths
An estimated 115,060 men will be diagnosed with lung cancer and 85,600 men will die from the disease.
While not as common, men can get breast cancer. About 2,140 new cases of invasive breast cancer will be diagnosed among men and about 450 men will die from the disease
The most common cancer in the US, skin cancer strikes 1 in 5 Americans.
An estimated 43,890 men will be diagnosed with skin cancer and 8,080 men will die from the disease.
An estimated 13 million adult men over the age of 20 in the US have diabetes- and a third do not know it.
Approximately 50 million men and women in the US have high blood pressure- almost 30 per cent of them do not know it.
About 1 in 3 adults has high blood pressure, and blood pressure tends to rise with age.
1 in 8 men who suffer from mental illness actually seek help (inspire.org)
Four times as many men commit suicide compared with women
24% of men are less likely to go to the doctor compared to women
Let’s face it, men are known to be more indifferent towards their health, especially when compared to the efforts of women, who proactively and publicly address their health issues in a way not traditionally seen with men. As a result, today the levels of awareness, understanding and funding for support of male health issues, like prostate cancer, lag significantly behind causes such as breast cancer. [1]

Prostate Cancer

The Stats

1 in 6 men will be diagnosed with prostate cancer in their lifetime – a new case is diagnosed every 2.2 minutes.
A man dies from prostate cancer every 15.6 minutes.
240,890 men will be diagnosed and 33,720 will lose their lives to the disease.
Prostate cancer is the most frequently diagnosed cancer in men.
A man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
The incidence rates are significantly higher in African American men.
97% occurs in men age 50 or older.
Prostate cancer is over 90% curable -if detected and treated in its earliest stages.
While there are cases of prostate cancer showing up in younger men, it is recommended that men begin an annual screening at age 50 and at age 40 if there is a family history. [2]

Testicular Cancer

The Stats

Testicular cancer is the most common cancer in American males between the ages of 15 and 34.
The number of men diagnosed with testicular cancer has grown by approximately 60% over the past 35 years, but the reason for this is not known.
8,290 new cases of testicular cancer are expected to be diagnosed in 2011
350 men will die from testicular cancer in 2011 [3]

SO…. I’ve donated my face to Movember & men’s health, please give so it may grow: http://mobro.co/jeffzaffino

 

Donate to Movember and help fund research into testicular and prostate cancer

If you know me, you know I am (was) VERY attached to my stache… It was TRULY a big deal to shave it off (even if I could regrow it), but it was the very least I could do to support this all important cause… Surely you can spare a buck or two to show your support.

I am looking into some kind of prize for the highest donation, SO stay tuned for that.

If I raise over $20.00 by Friday November 4th, I’ll post pics before and after pics of my freshly shaved mug.

With or without the prize PLEASE give to Movember and help fund research into testicular and prostate cancer.

 

[1] http://us.movember.com/mens-health/

[2] http://us.movember.com/mens-health/prostate-cancer/

[3] http://us.movember.com/mens-health/testicular-cancer

 

Posted by on November 1, 2011 in Personal

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Do you realize ?

That we have been granted a unique privilege by society, to enter into individuals most private lives (to share their most intimate thoughts, feelings, emotions and sorrows) it is a rare privilege which we think so little of and teach so little about in our medical schools, yet it is central to everything we do”

– Fisher “Back To Happiness” 1987

Those words resonate with me at the level of my very being. It is something we so often take for granted. I wonder how many of us stop to actually think about it…

Think about what it is like for someone to call 911 – to know that regardless of who shows up, the police officer, the fire fighter, the paramedic – regardless of who it is – they are opening up their entire life; to you… their home, the most sacred aspects of their lives – mostly without limitation because the situation is out of control for them and they need help…

That is what we do everyday, when we go on 911 calls.

There is an awful lot of gravity to that – what an incredibly special a privilege that is.

Speaking only for myself – I am not a very trusting person, I do not welcome strangers into my home – in fact I am VERY thankful the state I live in has a “Make My Day Law” – I feel strongly about that personally…. But when I need help; I’m calling 911 and no matter who shows up it’ll be “by all means, come on in.” All of a sudden everything flips, because I feel out of control in the situation and I ask for help.

It is all of us that are put in the position to help those people – I hope we always remember what a truly special opportunity that is…

It is a delicate line we walk each and every time we put on our uniform. That fine line between EMT or paramedic/patient relationship and public safety.

Where do lines of confidentiality begin, and end… where are we willing to blur them a bit? ARE we willing to blur them at all?

Due to HIPPA laws we are not allowed to tell the police officer how many drinks our “drunk driver” patient admitted to… but in the interest of public safety do we allow the officer to stand at the back door of the rig and listen to the responses our patient gives to our assessment questions? Do we ask the officer to ride along for “our safety” so he can get the information he needs for his investigation and we don’t breach HIPPA laws? Or do we steadfastly protect the privacy of that patient and close the doors of the bus behind us when we get in and tell the officer he can meet us at the hospital and do his investigation there?

What is the right answer to that question… both options are completely legal – and neither is necessarily right or wrong.

What about the call you respond to for chest pain and see a huge pile of cocaine on the coffee table? Does that change the answer, does it influence your judgement?

I’m not talking about the “mandatory reporting” issues those are clear-cut… I’m talking about those calls that fall squarely in the middle of that grey area.

Where do your ethics draw the line between respecting that immense privilege you are granted in being allowed into someones most sacred and private places and the general safety of the public? Have you ever thought about it?

It was suggested that we think about these tough decision type of calls ahead of time, so that we can make a split second decision we can live with when we are called upon to do so.

In theory that sounds like a damn good idea, however, I wonder if that isn’t like playing “Who Wants To Be A Millionaire” on your couch… It’s easy to find the answers when there is no pressure…

When there isn’t $ 1,000,000 on the line and no lifelines left I can right off the top of my head tell you that Dr Ignaz Semmelweiss is the Hungarian obstetrician that required his students to wash their hands in an antiseptic chloride solution before examining patients, and because of that simple task, maternal death rates plunged from a high of 18 percent to a low of nearly 1 percent in 1847. (Our pharmacology instructor is a big fan of “cocktail party trivia”)

I wonder if the memory of that particular nugget of information would come quite so easily with the spotlight shining on me under all the pressure a game show contestant feels…

Is coming up with answers to these difficult ethical questions any different?   Isn’t it easy to know what the right answer for you is sitting there at your desk reading this? Isn’t it easy for me to say “well this is what I would do” hiding behind the blinking cursor of this blog?

I’m not by any means suggesting we should never think about these things… more that, I’m not sure we can answer them with any degree of certainty until it is OUR feet that are being held over the fire.

What do you think?

 

 

Posted by on October 24, 2011 in EMS, Ethics, Paramedic School

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Unexpected Outcomes

Have you ever had one of those periods in your life when you looked around and found the scenery wasn’t quite what you expected? After traveling a short time down the trail you stumble upon something that wasn’t listed in the guide books and far surpasses what you expected to find during the journey, and you begin to wonder how did I get HERE?

After reading “EMS social media: Why get involved?” in the summer 2011 issue of NAEMT news, I realized there was a whole world of fellow providers to connect with. I joined twitter, began reading blogs that I had never seen before and connected with providers from around the world. I had tapped into the passion of EMS providers, and I wanted in.

After a few weeks debate over whether I could add something to the treasure trove of knowledge out there, I decided to give it a go – after all we do all have a unique perspective to offer. I picked a name for my blog and I typed and I typed and when I was done with that I typed some more… I’m pretty sure Mom enjoyed those first few posts (although she is admittedly biased). Then something happened – a comment, then some feedback, now a subscriber, and another and another… wait people are actually READING my ramblings?!?

(That first comment was from Ambodriver – THANK YOU Kelly, a welcome from you meant a lot to me, and the fact that you didn’t suggest I find a dark stinky place to shove my opinions was encouraging.)

Today I look around and realize my dive into the social media world took me further than I ever expected…

Little old me- here at EMSBlogs – WOW

I wonder if this is how those people on American Idol feel… someone told me once I could sing – what the hell I’ll try out – what I’m going to Hollywood ?!? Holy crap, now what?!?

For the sake of your hearing and your sanity, I’ll avoid posting any clips of me singing – trust me you appreciate that more than you know.

So here I am standing in the middle of that big stage, spotlight firmly fixed; trying hard to make my voice come out of a glottic opening that seems way smaller than it was an hour ago.  Today the keys seem harder to press, the screen seems brighter and the blinking cursor seems way more impatient then usual – I’m sure that will slowly fade as I get more comfortable in the new house.

I have followed the “heavy hitters” of the blogosphere – Rogue, AD, and Gfriese just to name a few. They taught me how little I really know, they showed me how to become the medic I want to be when I finish school, they inspired me to challenge myself to be better, to learn more.  While I don’t consider myself to be in the same league as any of them, I hope you find something in my ramblings that challenges you to be better, that inspires you to grow on a professional level – if along the way ONE provider becomes better for having read something here – I’ll consider the effort spent a wise investment in the future of EMS.

Please come on in, pull up a seat, kick off your shoes and get comfy, there’s cold ones in the fridge. While you are here, take a moment to poke around, there’s some really good stuff hiding in the closets.

Most of all say “HI” or offer an opinion if you have one… I’m equally interested in what YOU have to say.

 

 

Posted by on October 4, 2011 in Personal

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