P.S. To "Quick Note"

What an ambulance can do for you:

If you are truly having an emergency, a medic crew can provide life saving interventions. We carry meds like epinephrine, nitro, adenosine, cardizem... We have CPAP, we can start IVs, IOs, needle decompress, cardiovert, defibrillate....

If you have a sinus infection....we can give you a piece of guaze to blow your nose (we dont even carry tissues)

If you sprained something-we have icepacks

If you have a headache-we have childrens ibuprofen

If your nauseated, we may offer you a shot in the butt of zofran.

If we just sit and talk with you the entire trip to the hospital, you are either a psych patient, a homeless person who wants a warm place to sleep, or a worthless pansy.

An ambulance DOES NOT, I repeat, DOES NOT get you seen faster. I will put you out in the waiting room and you will wait just as long.

An ambulance ride DOES cost an arm and a leg, and if it is non-emergent medicare/medicaid and most other major insurance companies will NOT cover it.

Brian's in PSYOP, maybe I can get him to print this in a pamphlet and we can air drop thousands of them on Fayetteville....

Quick note....

If you can't afford to get your prescription filled, how are you going to afford the ambulance ride? Oh, thats right, you don't ever plan on paying.

If you are having a true emergency, I don't mind in the slightest.
If you seriously have no other means of transport or enough immediate cash for a taxi, I sympathize.
If you have a cold, six cars in your driveway, and at LEAST one other adult with a valid drivers license (who then follows behind or wants to ride up front), I resent you, a lot. It is hard to think well of humanity when THAT is over 50% of our calls.

EMS Christmas.

Sometimes I get bored on the ambulance. Even in the midst of running calls I occasionally have to cudgel my brain into focusing on the task at hand instead of meandering off on it's own. Sometimes those meanderings bear pretty interesting fruit, and lately, I've been stuck on Christmas Carols. So not only do I blow the air horn in rhythm with my favorite carols while driving lights and sirens (Jingle Bells is especially effective) I've come to making up some specifically EMS related variations to the classics relevent to the calls we receive in abundance this time of year.

"There's No Place like Psych for the Holidays
So if you're feeling stressed out or alone
A strip search, bed, and gown are all yours for free
For the holidays theres no place like Psych Zone!"

"Tis the Season for Drunk Drivers
Fala lala la, lala, la, la,
Coming home from Christmas Parties
Fala lala la la, lala, la la
Hitting curbs and trees and fences
Falala, falala, la la la
Neighbors call the ambulances
Falalalala, lala, la, la"

"Santa Baby, slip a lawyer under the tree,
for me
I've been an awful good boy
Santa baby, and hurry to the precinct tonight

Santa Baby, a get away car with rims that spin,
I'll wait up for you here, Santa Baby
so hurry to the precinct tonight.

Think of all the jobs I've missed
Think of all the people that I haven't hit
Next year I could be on parol
If you check off my Christmas List, boo doo bee doo"


I admit the lyrics are pretty horrible, but they are entertaining to think up at work. I'll post more if I come up with any additional. Any other suggestions on how to keep in the Holiday spirit at work without getting fired?

Partnerships

Everyone has been in that annoying situation where a task is set and you are supposed to accomplish said task with the help of one, or multiple, complete strangers. Ok, maybe not complete strangers, maybe just a seldom talked to classmate, a co-worker you know by sight but your seperate "circles" don't "co-mingle". In any case, you are now going to be spending undetermined amount of hours with this individual (or individuals) working on a project that is important to complete well (whether for a good grade or for the simple sake of not getting fired). Novels could be written about the frustrations that result.

I submit that riding an ambulance offers up a deeper and often more complicated forced relationship. It is not just a project that has an eventual end, it is your job. Every shift. Every day. Every week. Every month. You get the picture. I have had a wide range of partnerships on the ambulance-from obssessive compulsive to lazy, from politically incensed (lots of NPR) to the pregnant and hormonal- but my most recent partnership brings a certain something extra to the table. In a nutshell, he farts. Constantly.

My partner is an excellent medic, with more experience than I and a wonderful easy going personality that makes the ride enjoyable. He likes to game (PSP, XBox, WoW), is a sucker for the adoption fairs at PetsMart, and is devoted to his "woman" as he affectionately calls her. My last partner and I had a rough initial two weeks, she doesn't warm up to people very quickly and I was no exception. We were also polar opposites which didn't make matters easier. My partner now, however, is very comfortable easing into the partnership role. Maybe a little too comfortable.

My first night on the ambulance he started talking about farting. Too late I received a text message from his woman warning me to establish a "no fart policy" ASAP. At this point, my fellow medic had already stepped outside of the ambulance multiple times to relieve himself of some extra pressure. I began learning about his reputation for clearing out entire Fire Departments after using the facilities. He told me unabashedly that he had bowel surgery as a small child and the variety of sounds and smells he now produced was a long standing side effect.

Since then, I have been subjected to the widest array of farting noises I have ever encountered from one human being. He could be his own museum. Artillary fire, tractors, the revving of motorcycle engines, trumpets, pig squeals, splats, rumbles, groans, you name it. So far he has only let loose the quieter, but far more potent ones, inside the ambulance a handful of times. Often he is cat-napping, and apparently the rule is he can't be held accountable for anything that happens when he is asleep. Convinient. If he's awake, and it's silent (a rarity in and of itself) he can't help but giggle within the first few seconds so I get a warning.

So next time you bemoan a partnership, just think to yourself. Is it 12 hours at a time, every day (or in my case night) you work, for months on end? Are you forced by the nature of your job to spend the majority of those 12 hours in the cab of a vehicle with said partner? Does your partner have non-stop flatulance issues? No? Quit whining.

Musings on the fraility of human existence...and bones.

As a paramedic I get up close and personal with death and dying in all it's various forms. And I witness it in it's natural habitat, so to speak. BEFORE the tubes and wires and beeping machines, the sterile cot and stark white lights. I see it slumped over on the living room couch, drowning from the inside due to a tired heart, or gaze fixed to one side, mouth drooling, flat on the kitchen floor as a vessel in the brain says "Enough crack!" and bleeds into the cranial cavity. The heartbreaking dilated pupils and pale still form of a 6month old boy on a stained sofa surrounded by the toys and clutter of the siblings he won't ever get to play with, mom and dad hysterical in a cornor.

You get to learn a little about death and loss and grieving when you deal with it on a regular basis. Death has it's sweet side. The relaxed passing of the 90 year old cancer patient in his sleep, free of pain after a long life. The 86 year old dialysis patient whose spouse has passed before her and she's ready to join him. Most of the time  the "Do Not Resucitate" form is truly a Golden Ticket.

At this point, you may be wondering where "bones" fit into this little narrative. Well, how about...right here. Trauma is the other side of death that we EMS-ers (including Fire Department First Responders) see quite a bit of. You become amazed at how much the body can withstand in some cases and in others you are reminded uncomfortably of how easy it is to be broken. So, bones. Those concrete pillars of the human frame. The hardened core of our structure, protecting the brain and vital organs, giving us mobility and dexterity. Without bones, we'd be amoebas. Or sharks (if you have enough cartilage). I like bones, the skeletal system was my favorite in anatomy class, I was fascinated by the osteoblasts and osteoclasts and the intricate design of marrow and layers with openings for vessels like a hub in the center of  little bone cell cities. Bones look tough, resiliant, fashioned into weapons in some places. Yay bones!

Thats what I initially thought of bones, but slowly, insiduously, my appreciation of bones turned to one of discomfort and sometimes horror. Thats it?? That thin porceline cap is supposed to protect my brain?! Not only that, it's breakable enough to dent my brain matter, but too stubborn and unyielding to let my brain swell without injury. They drill holes in peoples skull because what seems a somewhat minor concussion leads to swelling and the stupid, stubborn skull (so easy to break!) won't budge to give the brain room. Fingers and toes we expect to break, they even look breakable, but how easy to break a wrist! Two bones, snap snap, and a floppy hand. And jaws, a big, angular, tough looking bone. I had a motorcyclist who face planted. His jaw and cheekbones were so shattered the his face slid down into his neck. Talk about a weak chin. He was completely unconscious, but somehow still breathing. Every time we tried to assist ventilations with a bag valve mask and some O2, air would blow out a hole along what was left of his jawline, spraying everyone with blood like a benevolent whale. We were all red freckled by the time we got to the hospital. His face was so mushy, we couldn't get a good seal on the mask. Bones, pah!

There are two major long bones in the body, the humerous (upper arm) and the femur (thigh). I've seen both broken. Another motorcylcist had rearended a different motorcylcist on a major highway and went flying. There were pieces of his bike everywhere and inside the thick, skin glove of his person he had a tib-fib fracture (lower leg bones) and a humerous fracture. His bicep, a fit mans bicep, swelled to twice the size of normal, the skin streched painfully tight as blood and fluid congregated at the site of his humerous fracture. So easy to break!

Motorcyclists, sheesh. I've seen one with BOTH his femurs broken. And his pelvis. He was mushy from neck up and waist down, but his torso only had road rash. I'm used to thinking of the femur as a big bone. A tough bone. A really hard to break bone unless you hit it just right. This guy had both broken, and one sticking out like a broom handle, 2-3inches of bone exposed to the world. All I could think was, "Are you sure thats bone? It's so small!" There it was white on the outside, yellow and red ringed at the break. I could see the marrow. So small!

Bones. Bones are supposed to be the tough part of our body, and all they're protected by is easily torn muscle and paper thin skin. I think I'm going to invest in body armor. Trauma can be more devestating than illness, it claims the young and dumb in the prime of their drunken lives, as well as the innocents simply in the wrong place at the wrong time. Accidents, assaults, falls, MVCs...trauma is random and indescriminate. And bones, those Brutus's of the body, so ready to snap when you need them most, tearing up your tender insides instead of shielding them from outside forces. I am wary of my bones.

Here I must end, or I'll be late for work....

P.S. Instead of making EMS workers more leery of death and truama, we tend to be rather cavelier about it all. Death is inevitable and trauma not always unavoidable, so why worry? Still, it's hard not to get a funny jolt in your stomach when you scrape someone off the pavement and realize how breakable you are...

Driver's Ed post script

I saw a new lane changer today. I've seen it happen before, but I didn't remember it in time to write it in my Driver's Ed post, so I'm adding it as a post script.

The Fake Out: This lane changer has all kinds of mixed signals. A nervous breed of driver, often the very young or the very old, this driver knows the legistics of lane changing but hasn't quite mastered the technique. They'll flick on their blinker in the direction they want to turn and leave it on for approximately 3 seconds and then they'll turn it off, wait 2 seconds, and then floor it into the other lane. You can almost hear the relief roar out of the engine as they congratulate themselves on succesfully navigating the trechary of lane changing without getting squashed by a bigger car. They have many near misses, because the turn signal flick on on then off before any attempt at lane changing has begun just makes other drivers think they hit the signal by accident, so other drivers are taken by surprise when this car darts out into the other lane, the Fake Out driver's knuckles turning white with the tension of his death grip on the steering wheel. Amusing to watch from a safe distance, annoying up close and personal.

Thats all!

Oh, except I had an extremely unpleasent experience on scene of a call last night because they dispatcher was an idiot and told us the police were on scene and the scene was safe when the police hadn't even been dispatched. Yeah. So when some guy runs up to the ambulance and throws open my door to yell at me I have nothing but a ToughBook to bash his head in if his intentions are hostile. Thanks a bunch.

THATS all. Toodles!

Drivers Ed

As a paramedic I do a considerable amount of driving, not only the forty minute commute to and from work, but also the 12 hours of driving an ambulance all over the county during shift. I've begun to see patterns in driving behavior and today I'd like to share the categories I've created for lane changes.

When driving the ambulance, I get cut off on a regular basis. The truck is slow to accelerate-especially w/a pt in the back-and slow to brake as well. People don't want to get stuck behind an ambulance. With that in mind, I will begin the categories with the rarest of all lane changers. SO rare, I think I've only seen it ever happen a handful of times. I can't come up with a fancy name for this type of lane change so I shall simply label them:

The Correct Lane Changers: These very rare breeds are going at a moderately faster speed than you are, ensure that they are a few car lengths in front of you and no red lights are changing in the near path of travel before indicating with their turn signal for a few seconds and then smoothly changing lanes. I believe these drivers lead well adjusted happy lives with good stress coping mechanisms and are always punctual. Perhaps that is why they are so rare.

The Drifters: These lane changers have their head in the clouds. They don't use turn signals, I don't think they're even aware of the lane change until it's over-if even then. These drivers sometimes indicate their lane change by slowly hugging the dotted line for a few feet and then tire by tire they just...float...across...The dangerous thing about drifters is they're often prone to slam on their brakes when they finally do realize they've cut off an ambulance, but thankfully this is usually quickly followed by flooring it. My theory is it's a delayed guilt reaction. Drifters, I feel, are generally good people and not horrible drivers, but they're tired, or they're preoccupied and they just aren't entirely paying attention.

The Dragonfly: These are the ones your parent used to mutter "THOSE are the drivers the police should be pulling over. That is so reckless." But secretly, most of us are a bit jealous. These drivers don't use turn signals, they don't have the time for them. They dart in and out of traffic, squeezing in front of you so briefly you barely have time to flick them off before they're gone. Yes, they are a speeding, yes, they are reckless, yes-as a paramedic-I'm already thinking about having to backboard them when they eventually wreck...but for the moment, these quick changing dare devils make rush hour traffic look so easy.

The Self Righteous: I had a personal run in with one of these a few days ago. These drivers have both hands on the wheel, a seatbelt is on every person in the vehicle, back of the seat is straight up and down, turn signal is ON! And on....and on....and on... The Self Righteous truly wants to be a correct lane changer, but they invariably forget two key points. One, when you put on your turn signal, it is indicating you are moving in that direction in the immediate or near immediate future...not ten minutes down the road. When you don't move, people stop believing your turn signal. Also, although the Self Righteous check their mirrors religiously, they don't check their blind spots. So these dangerous bad boys are the epitome of unpredictible. They say they're getting over with their turn signal, but they dont, did they just forget its on? are they going to move now? it's been three minutes and they're slowing down with that lane of traffic but they still haven't gotten over...BAM! They make a mad dash for the other lane, without checking to see if a car is next to them. Sometimes they notice in time and swerve just as violently back into their original lane of travel gesticulating wildly, or in my case, they run into the other car. The driver was extremely irritated, got out of his car and yelled at me "I had my turn signal on!" Yes, you did, but see I was actually driving in the other lane...

The Red Light Thief: A very popular one for cutting off the ambulance which is really not a good idea since ambulances take a bit of time to stop... These lane changers are also often habitual tailgaters, but not always. They are a beast to be taken into consideration every time a stop light is approached. These drivers decide on impulse that the other lane will move faster when the light changes. So, even though they are practically stopped and there is a car (or ambulance) fast approaching the light in that other lane, this driver decides to make a break for it. Light Thieves are a nuisance.

The Lazy Boy: These drivers are cousins to the Drifters-they take their sweet time crossing lanes. The distinguishing factor, however, is the turn signal. Lazy Boys will briefly flick the turn signal on after almost completing the entire lane change. It's a brief flicker, only a tap, and seems to indicate not so much "I am going to move to the left" as "I moved to the left, oh yeah, here's my signal." Lazy Boy's often drive pick up trucks or utility vans.

The Procrastinator: This driver often ends up in serious accidents. The Procrastinator is in the farthest possible lane from the direction he needs to turn in less than fifty feet. The Procrastinator also tends to frequent major highways with 6 or more lanes. These drivers don't exactly change lanes, they cut through them at an almost perpendicular angle to make an impossible turn on two wheels. The Procrastinator uses his turn signal like the Lord's Prayer, hoping that the blinking will stave off disaster as they fly across the lanes. A particular annoyance-although it is slightly amusing-is when a procrastinator needs to turn left while I'm driving lights and sirens down a highway. The Procrastinator flies across the lanes and cuts off the ambulance then realizes we're driving emergency traffic (I liberally use the air horn to emphasize this point) and the Procrastinator either flies back across traffic (again, without really paying attention to other drivers) or slams on his/her brakes right in front of the ambulance. Not your brightest driver, Procrastinators are often intoxicated or hopelessly lost or both.

Me First: The Me First driver is, in my opinion, one of the most frustrating lane changers to experience. These drivers hate to be passed, they-like their title says-have to be first. So even if the car in front of them is going five or more over, these drivers simply HAVE to speed up around them and cut them off. Whats worse, after they pull in front of the other driver they often slow down, ambling along at inconsistent speeds between slow complacency and race car driver to ensure that other car doesn't pass them. I loath Me First drivers.

These are all the categories I have for now, they popped into my head while driving routine to the hospital and witnessing two Drifters and a Red Light Thief change lanes in front of me. Anybody have another category?

STEMI!

I had an official STEMI patient! I caught it and got to call it in and everything. The pt went to the cath lab and had complete blockage of the Right Coranary Artery. Bunch of stuff was done including thrombolytic removal and stent placement. The pt has an excellent prognosis for recovery. :)

Oh, a STEMI is an ST elevation Myocaridal Infarction. i.e.; a heart attack that shows up on a 12 lead.

Anyway, it was neat to see one and get to help the pt, makes me feel a little less like I'm in over my head (like I feel some days). Especially since a few months ago I had a pt with all the Elevation and Depression of a STEMI but it turned out to be prior damage. The doctors said it was right of me to call it since there was no way for me to know that the 12 lead was normal for the pt (the pt had even told me he had never had heart problems before), but you still feel dumb activating the cath lab. It was nice to call it and be 100% justified, especially since it means the pt gets to the cath lab that much quicker.

Good times

Favorite Dispatches

My first ever "lights and sirens" call as a student almost two years ago.

Dispatcher: "Medic #, 27D1, possible GSW (gunshot wound), Buffalo Wild Wings."
We're all like "Yeah! A good call! woohoo!"...but then...
"Medic # change that to a stabbing..."....alright, still maybe a good call!
"Medic # cancel the call, fork stabbing."....we all start laughing.



New favorite:

Dispatcher: "Medic ###, 26A1 sick person. Female pt states her breasts are floppier than usual.*pause* and softer..."

**Maybe half an hour goes by as the unit gets to the call and checks on scene...then...**

Medic Unit: "Dispatcher, this is Medic ###, we're back in service, patient refused transport, problem supported."

I could not stop laughing. Just so you know, the radio recordings of 911 dispatches are all public domain, you can ask to listen to them at any time. I would be so curious to document a list of the most bizarre calls! People really do call 911 for ANYthing.

Frustration outlets

Sometimes I'm not so much interested in form as I am in just getting whatever exasperation I have out of my system. Paint works well for this. This was one of those calls that you laugh helplessly at because there is really nothing else you can do...besides grab the Stair Chair.

In other news, Remus desperately needs bath and I am truly procrastinating giving him one because it is a time consuming hassle and he hates it. But he really stinks. Buh.

Picked up two schizo's in one night a few shifts ago.  It was an interesting night.

Happy Easter!

I hope everyone had a wonderful Easter weekend, it's the first time in a looong time that I've missed an Easter Sunday service. I love sunrise service! Instead, I had a very busy, very stressful weekend at work. (Fri, Sat and Sun night) I was in the "slowest" zone of our rotation Saturday night and ended up having a Cardiac Arrest first thing Easter Sunday morning. Mad props to my partner and to the FD already on scene doing CPR. This is only the second cardiac arrest I've "run" officially, the rest of them there was always another paramedic on scene who got there first. And, very apropos for Easter, this was the first Cardiac Arrest I've ever been a part of where we got a pulse back. Oy.

Let me explain a little something about working a cardiac arrest. You know on TV, besides the LOUSY rendition of CPR (you don't bend your elbows to do chest compressios), everyone is all busy and shouting orders and looking important with their scrubs and white coats and snarky terse comments. A real cardic arrest can be frustratingly boring and a lot of physically hard work. CPR, done correctly, is no joke. Try doing CPR for two minutes, take a 20 second break, and repeat.  Now imagine you're trying to do it while wheeling a stretcher down a hallway, now try while going 90mph in the back of an ambulance down the interstate, now down country roads, now wheeling the stretcher into the hospital. Imagine doing this for 40 minutes. Let me tell you something, you're arms will give out, your legs will give out, and tomorrow your abs will feel like someone repeatedly punched you in the gut. Cardiac Arrests are dang hard work and I truly thank God that the Fire Department has a bunch of adreniline junkie guys who will do CPR till they drop.

Only one person can do CPR at a time, however, so this is how Cardiac Arrests work from my perspective. Game plan, I handle drugs, my partner does airway. We get on scene, FD is already doing CPR and have airway managed. The first 2-3minutes of a cardiac arrest is where it is pure chaos. The AED pads needs to be switched over to our monitor and the four leads put on, airway assessed and additional airway management done if necessary, plus capnography and rescue pod need to be added to the BVM, an IV needs to be established-if no IV get the bone drill and ZZZZZZZZZttt! IO them (bone needle through the tibia under the knee). All this needs to happen pretty much at the same time. The rhythm needs to be assessed once a 2 min cycle of CPR is done and then the first drug needs to be given. After that, you stand around....2 minutes of CPR....rhythm check! YAY get to shock and/or push another drug! Flush w/NS aaaand back to waiting.....2 minutes....oh goodie finally another rhythm check!... as a paramedic, I feel absolutely useless during those 2 minute waits and two minutes seem like an awful long time. Your adreniline is on overload, too, especially after those first few hectic minutes. I'm still fairly new at this, so I haven't perfected the calm, almost bored look some medics have acquired while working a code, I am pretty fidgety. I get the next drug I think I'll need to use prepped and make sure I have all the alternatives within reach, I'll check lung sounds to make sure my airway guy is doing ok, I'll get a bag of fluid hanging, I'll...sit...and...try to ....find someting....BAH! It's really annoying.

To make matters worse-from that perspective- but better for the patient- is when they regain a pulse. Oof. So we get a Blood Pressure, keep double checking the pulse, push Sodium BiCarb ready, cover pt with a blanket... H's and T's...Pt loses a pulse? Restart CPR. Push  Epi after rhythm check, another cycle CPR, another drug, another cycle CPR... Pulse again?! Fudge. Now I REALLY feel useless. Another BP done, monitor the airway (again)....theres not much else for me to do. If an antiarrhythmic was used I can hang a drip...keep checking airway...pulse...BP...rhythm...tidy the ambulance...remember to breathe...


So the cardiac arrest was my Easter morning wake up.


I'll leave you with two of my new favorite "Chief Complaints" from pts showing up at the ED.
"I cut my mouth on a taco and it hurts."
"I'm cold, hold me."

Hope everyone had a glorious Easter celebrating the glory of our risen Saviour and our subsequent salvation and freedom in Christ!

Baby Mama Drama...

In honor of my visit to see my adorable niece Emma, I figured I'd take a moment to post two of my favorite ridiculous "baby" calls from work. Recently, we've had a rash of children from 6 months to 2 yrs falling off of couches, but my favorite calls are usually from new moms.

3am, call goes out to our unit for  "severe respiratory distress" of a 2 month old baby. We arrive, are told by the VERY young mother that the baby is sleeping and has been for an hour. The GRANDmother pipes up, yeah the baby is sleeping but earlier during the day and evening she's been "frothing at the mouth". ....really? So we walk up this perfectly healthy rather cute baby girl, who is thankfully not too cranky for being woken up out of a sound sleep at 3 in the morning. There is nothing wrong whatsoever with this child, she's smiling and making agreeable baby noises and then, to the immediate distress of the surrounding family members she...wait for it...blows a spit bubble! The grandmom flies into a panic searching for something to wipe the kids mouth while gesturing "see?!?! She's been doing that off an on all day!" We are completely nonplussed. This is the severe respiratory distress? Thankfully, we were able to convince both mom and grandmom that this was completely normal and obtained a refusal.

Another call at 4 am, a few days ago, thankfully another unit jumped it for us. "26A1 (sick person), 3 week old female, pt is crying, mom doesn't know why." Yup. If your baby cries, it is now a medical emergency.

Oh, and just an FYI, if you give your toddler RED colored Children's Liquid Tylenol and then the child vomits, that red color is from the tylenol, it is not blood. Vomited blood does not look cherry flavored delicious.

**Disclaimer. I am by NO means underestimating the stress of having a baby, but a modicum of common sense is probably a good idea to obtain before procreating. Some things should be understood before embarking in the glories of motherhood, like the fact that babies cry (sometimes for no other reason than crankiness) and that they also blow spit bubbles. Three cheers to all those moms (including my sister) who don't immediately panic and call 911 when their diminutive charges make funny noises or, in Emma's case, snores. ** Additional disclaimer, if that baby had been crying non-stop for awhile (I don't know the full story because another unit took the call) I'd rather the mom call someone-including 911-rather than shake the baby to get it to be quiet.

Also, my niece has the cutest ears. :P

To whomever it concerns...which isn't many...

SO. I know this blog is supposed to be all about Remus, which it is, mostly, but I think I'm going to expand topics. A.) Because as cute and goofy as Remus is, I'd much rather be playing with him than writing about him and B.) Because other aspects of my life make more interesting and varied reflections, i.e., the fact that I run around on an ambulance all night. Also, on the more traumatic calls, writing about them helps me "deal".

Very tentatively then, I would like to include some Paramedic-ish-ness stuff on here. I will, of course, not use any names or locations or even dates on any call stories I reiterate, and I'll also try very hard to leave out any pt descriptors. Why do I feel compelled to write all this down? Well, because it's what I do and it seems shockingly misunderstood at times.

To begin. I live in a rural county. The EMS system is on a 24 hour shift basis, the Paramedics ride around in "Quick Response Vehicles" (QRVs) which are SUV's with lights and sirens, and meet the first responder EMT Basics on the ambulance on scene. In the rare case that the person actually needs a medic, the paramedic rides in the ambulance and one of the basics drive the QRV to the hospital. I rode clinicals out here and several times in a 12 hour shift I had no calls, or 1 call. A "busy day" in the county I live in, is 4 calls.

I WORK in  one of the busiest systems in the nation.  The city we serve is very densely populated and so are the surrounding areas still in the county. We work on 12 hour shifts, because it's too busy to work on 24. A light night shift is 4 calls, though I have had a night with only one call. It was bizarre. A  busy night is 8-12 calls. A light day I don't think ever happens, and a busy day can hit 11-14 calls depending on whether we're working interfacility transfers. Oh yeah, transfers. There is a seperate EMS system that is supposed to handle all interfacility transfers. If we had to handle all the emergency calls AND all the transfers, the entire system would bog down and we'd have Alpha calls waiting for hours for a response.

I work nights. Why? Because  the call volume is lower on BS (though we do get plenty of drunks), there are more psych calls (my favorites!) and most of the Gunshot wounds/stabbings/drunk driving accidents happen at night- at least in my limited experience. In the summer it's also cooler, which is a plus, though it sucks in the winter.

I suppose I should explain some abbreviations and "technical terms" that I'll use frequently.

Code Purple: When the hospital has literally run out of beds. Meaning, it's not just the ER that's full, the upstairs floors are all full as well which means people who are admitted through the ER are stuck in the ER until an upstairs bed is opened, which bogs down the ER. It is not uncommon for wait time in the ER to be over 6 hours and us to leave pt's on hospital beds in the hallway in front of the charge nurse with a paramedic crew doing holding.

Holding: When Code Purple goes into crisis and in order to free up medic units (i.e. Not have us stuck in the hospital for hours waiting to move our pt to a bed and transfer care to a nurse) we move our pt's to any available beds in the hallway and transfer care to a medic unit who then monitors vitals, etc., until a room and a nurse free up.... sometimes this seems highly ironic to me. If the hospital is full to bursting, why is it so important that we get "units back in the field!" as quickly as possible just to bring in more pts for whom we have no room?

Pt: Patient

SOB: not a very nasty person. It stands for Shortness of Breath.

MVC: Motor vehicle collision. (There is no such thing as an accident!...according to EMS charts that is...)

CAO x3: Conscious, alert, and oriented to person, place, and time. (I actually never use this abbreviation in my charts for legal issues, but this isn't charts)

Cold call: No lights and sirens
Hot call: Lights and sirens.

EKG: A type of monitoring of the elctrical activity in the heart. You know, like on all the medical shows. It indicats heart beats in spikey lines and has a really annoying beep. Technically it should be ECG but apparently that's harder to pronounce that way so people say K instead of C. Either that or it was originally designed by Germans. I'm not sure, someone else look it up.

12 lead: a much more indepth picture of the electrical activity in your heart. The standard EKG monitors in 3 leads, the 12 lead shows, well, 12- and views the inferior, septal, anterior, and lateral portions of the heart. This is where we can diagnose...anything that needs diagnosing. The EKG is pretty worthless on leads II, III, and aVF (take my word for it if you have no idea what I'm talking about) for any diagnostics except rhythm changes.

15 lead: move 3 electrodes around to view the R ventricle and posterior portions of the heart.

STEMI: ST segment elevation myocardial infarction....i.e. heart attack. I think I'll explain any other cardiac terms in context with the story.

Pads: refer to the cardiac pads, large sticky gel pads wired to the monitor. Used for defibrillation (I'm clear, you're clear, we're all clear? Shock!), pacing (like a pacemaker, just on the outside), and cardioversion (heart is in hysterics, we've got to "slap" aka "shock" it across the face. BUT it can't just be at any ol' time-otherwise we'd just defibrillate-because if it happens at a certain time in the heart's electrical conduction we could kill the pt. So the monitor "syncs" with the heart first, and THEN slaps it out of the hysterics,)

"Working a Code": means doing CPR and pushing appropriate drugs in a cardiac arrest. We don't always work codes. Yes, I have called time of death on scene.

I think that's enough for tonight. I've got plenty of stories back logged and I'm headed to work again tomorrow night so I should never run out of inspiration, (though I've got to figure out a way not to give out any pt indicators.) Plus, I will continue to include Remus stories. He's a part of what keeps me not just sane, but happy. Hopefully this way I won't bore people in every day conversations by constantly bringing up Remus OR EMS. If you get bored reading, you can always stop and I won't ever know :)

Paramedic-ish-ness

Supposedly this blog is all about Remus, but I can't help but interject posts on other areas of my life because as much as I fawn over my irrascible hound he is not the only thing that occupies my time. Usually when I write about my job the rants succeed only in venting of my frustration at the ugly or stupid side of humanity that I run in to repeatedly. This post should have a more cheerful tone, even if the subject matter is slightly morbid.

Saturday night suffered a rash of violence, and I and my partner where staffing an additional truck to provide additional coverage in an area of high call volume. I had two calls of significance; one that resulted in the pt being placed on a vent and very likely brain damaged and the other pronounced dead as soon as I dropped him off at the ED. (I was annoyed by the disinclination of the doctor to even attempt to continue the rescue efforts, but that is a different story entirely). Instead of feeling depressed by the events, I went home feeling gratified and pleased that for one night I actually was allowed to perform the job I had been trained to perform. It might seem strange to be satisfied over my luck in having two calls that were actually emergent, but it was a much needed relief from the dullness of taxi-ing the stupid to the waiting room. I have been trained to identify and treat emergencies, it was wonderfully rewarding to do so.  I won't deny it was also a boost to my confidence level. From feeling the stupidest and worst of paramedics due to my own inexperience and everyone elses' easy confidence, to handle such calls, and to bring up objections from intuition that proved to be correct as the calls progressed, made me feel I had risen at least a step up from the bottom of the heap. There is still a very great deal that I need to not necessarily learn, but to solidify in my own understanding, so that the knowledge is easily and instinctively acted on. I am glad that I am making progress, however, and at times when I see that I have helped and/or at least provided every medical attempt possible under the circumstances, the work is not as unbearable or overwhelming as it was initially.

Also, I just finished reading "Pride and Prejiduce" and cannot help but laugh at the effect it has had on my writing. Remus is still gimpy but considerably less inclined to whine the day away since the removal of the Fentanyl patch and the replacing of his pain medication with Tordol instead. Brian graduates from Psyop training this Friday and I am permenantly on night shift.