How I got into EMS

I asked a question on Twitter last night to my fellow EMS bloggers, and after several of them posted up links to posts to explain, I realized I had nothing to tell how I got into it.

How did I get into EMS? A kinda long route, at least it seems long to a 22 year old.

When I was a Jr in high school I was thinking of going into the military, it had been a long tradition in my family. I was thinking of either going in as a medic or getting some college under my belt with ROTC and becoming a helicopter pilot. I talked to recruiters, took the ASVAB (second highest in the state my year :) ), worked out, and generally tried my best to get to where I wanted.

That changed on May 5, 2005. I was riding up to the next city to see a movie on a half day from school. Our town at this point had lost it’s only theatre and we had nothing to do. I’d headed up there so many times I could have gotten there in my sleep. Except there was 55mph winds and I was riding up there on a Kawasaki EX500R.

I had just gotten on the interstate at MM150 on I25 in NM, when a gigantic gust of wind hit me. Since I was riding a very light bike, and anyone who’s ridden motorcycles knows how wind treats us, I got blown all over. I ended up getting blown into the rear trailer wheels of an 18-wheeler. My left leg hit the hub and I bounced off and hit the concrete barricade on my right side. The semi just kept going since he wasn’t even aware a little bug had hit his trailer.

All of that is kinda fuzzy to me, as I remember seeing the bottom of the trailer somehow, then starting up at the face of my boss. She owned a deli I worked at, and her and her husband were both volunteer firefighter/EMTs. She kept me calm and waited with me till help got there. She helped the city FD package me and take me to our little bandaid stand they called a hospital.

They couldn’t be sure of the extent of my injuries, so they called a bird from the state trauma center and wanted me flown up there. I don’t remember any of that ride since I was so doped up when they got ready to load me up. The next thing I remember is being stuck on a board in a hallway for several hours. Not a fun experience.

I wound up with a compound tib/fib fx, 2 broken ribs, a concussion, some road rash on my left leg, a broken right pinky, shattered left ankle. Not too bad for hitting a semi at 75mph. The accident actually ripped off my left boot and shredded my jeans. My gloves and jacket had withstood the accident decently well, but were cut off by the responding EMTs (and broke several pairs of their shears). The helmet I still have on my shelf in between my two daily riding helmets. It is cracked and scuffed, but a good reminder why gear is important.

The road to recovery was a long one, I had several surgeries after the accident and I still walk with a limp occasionally. I resigned myself to not being able to serve our country in the military like I had wanted, but just wanted to get myself through high school and figure out what I wanted to do.

I wound up graduating on May 20th 2006 and was still trying to figure out what I wanted to do. EMS had been a thought in the back of my mind since I was recovering from my accident. But I was near one of the premier schools for blowing things up, and I decided that since I couldn’t serve, I’d get a degree in Explosives Engineering.

I loved the idea of doing that, I could go to work and help develop munitions for the govt, or serve with the police and disarm weapons. Unfortunately I didn’t like the math required for engineering, and I was your typical first year college student. I didn’t wanna actually do anything. And it didn’t help that I went to college in the same little town I graduated high school in, so the drama from the year before tended to follow me.

After the first semester I was put on academic probation and then academic suspension after the second semester. I was devastated. By the end of the second semester I had tried, and made progress, in turning everything around. But it was too little too late. I had no idea what to do.

My mother is actually the one who suggested I move north to the city for a year and get some classes up there under my belt and, since I’d talked about it on and off, maybe take an EMT-B class and give it a try. It made more sense to me than just hanging around and doing nothing down there for a year. So in July of 2007 I made a move 70 miles north to the city.

I started in EMT class and loved it. Every day was a new learning opportunity and I made sure to bleed my instructor dry. I found that I loved the idea of working on an ambulance and working outside on a regular basis. Plus it flared up the idea of being a military medic once again and I knew I’d found a niche that I liked.

My instructor was an EMT-I getting ready to go to medic school and he pulled me and two others aside and told us that he thought we should consider going further and starting the paramedic pre-reqs at the community college we were at. Knowing that he thought that highly of me, I did just that the next semester.

But first was the NM EMT testing. I had to drive 4 hours to the next smaller city south of us to take the test. I was so nervous during it that I didn’t think I’d pass. I was the second person done with the written and felt ok about how I did on it. But then came the practical scenarios and skills. My first group was two random skills. Combitube and drawing up a dose of a med and giving it (I got Epi). That was no problem. Combitube went great and I drew up the 0.3cc of Epi 1:1 just like I was supposed to and administered it to the arm just fine.

Then came the pt assessment scenario. I don’t even remember what it was now, but I know I just froze. I forgot gloves and failed no matter what I did. They told me I’d have a chance to redo a scenario and I knew that it was my last shot. I got together with some classmates and we all quizzed each other and I felt better about it. I went in and nailed the scenario. I remember the proctor telling me “And they failed you the last time?” as I walked out the door, this time feeling much better about everything.

It was a long drive home that night, but I was ecstatic about everything. It just was down to the waiting. I was working for a motorcycle dealership at this point (and still riding) and my boss was getting pretty amused and how frustrated I was, having my brother check the mail every five minuted and not getting anything.

Finally 4 days after the test site, I went home and checked mail. I remember what our teacher had told us. “Small envelope, no good. Big envelope, welcome to EMS!”. I went through my mail and got nothing. Then I noticed a key to the package boxes. I went over to them and there it was. A big envelope from the NM Department of Emergency Medical Services. Inside was my certification, a patch, and a big certificate. I think I called everyone and told them that night. I also stopped by my former teachers class and thanked him and shook his hand one more time.

I started Advanced Trauma the next semester and had even more fun. I also wound up meeting the girl I would get engaged to later on that year. That semester I also found a big road block to me working anywhere. I was only 20. Luckily though I heard from a friend that an IFT company was hiring and that I might see about getting on with them as a dispatcher. I figured what the hell and put an application in.

I got an email the next day from their director of field operations asking if I would be willing to work on a rig as an attendant only until I turned 21, instead of being a dispatcher. It took me all of a half second to decide and I sent him an email 5 minutes after getting one telling him I would love to work on a bus.

I worked there for almost a year and loved almost every minute. Even if it was primarily IFT I learned a lot and I asked as many questions to the RNs and MDs as I could get
away with. During that time I got engaged to my ex (which if you’ve read more of this blog, you know she IS my ex and just got married in fact to my old partner) and completed all of my pre-reqs for my medic program. And got accepted to the program.

The pretty much brings this up to date as to when I started this blog. Since then I’ve had my share of ups and more than my share of downs. But I think back to the first day of EMT-B class and realized that’s when the bug bit me. I can’t imagine myself doing anything other than medicine. And EMS is and will always be my first love in the medical field, hopefully I can pay it back everything it’s given me.

Getting tired

I didn’t wind up going on shift on Friday. I wound up heading to base instead of station 6. I had gotten a page on Thursday night to report to base at 0830. That was it. So I was actually pretty nervous.

Got to base and I ran into who my partner was down as. She hadn’t been told what happened and was pretty shocked to hear about it. She wished me luck and I got called back into the admin office.

They told me that they have had 4 accidents in the last week and a half, and they were not going to be putting up with it any longer. Since I was the newest employee who had been involved in one, I was essentially getting fired to be made an example of.

So now I’m out of work again, and feeling very frustrated. It seems like I’ve been frustrated since I moved to Colorado altogether. My roommate suggested that since the lease we took over ends on July 31st, I might wanna consider moving elsewhere or think about if I still want to live here.

I do have one option. The other ambulance company I was supposed to have an interview with has it scheduled for the 4th. I forgot to call them to cancel it when I got hired on at the other company. I also put apps out for ED Tech, ICU Tech, Urgent Care Tech. We’ll see what happened.

And of course the idea to move came to mind. I don’t have any idea what to do. Lets hope the interview on the 4th goes well.

The shift from hell

I think the shift I worked yesterday was the second worse shift I’ve ever had, second only to a couple Christmas’s ago when I rolled my rig running hot to a call in bad weather.

Day started off pretty well. Got to my station at 0645, got a report from the offgoing crew and did a quick truck check with the days partner. Hadn’t worked with him yet, but he seemed really cool to work with and was more than willing to put up with me getting lost in Denver.

At just before 0700 we got our first transfer of the day. A mental health hold going to one of the behavioral health facilities in the city. No problem. My partner attended as I drove. The patient was very cooperative and gave us no problems for the hour long transfer that we had.

After that was the curse of being the only BLS truck on with no wheelchair vans on yet. We wound up going from station to station picking up ticket work and dropping off supplies. Then we got called back to base. Apparently they were pulling an EMT off of the ALS truck because he had just gotten two tickets from a photo van a week or so ago, so he was on driving restrictions. Which meant I was going to be driving the rest of the day.

He was not happy, to say the least. So that made for an awkward first couple of hours. But he started to lighten up a little once we started talking. Made for a little bit better of a day. We just posted at our station for a while and played pool and generally tried to make doing nothing go by a little bit faster.

We got our first call, a wheelchair overflow. No problems with the call or the initial transport. We gave report over to the RN at the facility and then headed out. This is when the bad started again.

We were on our way out and apparently I picked the wrong way to go out. It had a metal low overhang sign (one of hte completely solid post setups), and I kinda questioned if we’d fit. Both of us were thinking that our rig was about a foot shorter than it really was figured from eyeballing it that we’d be ok (we were in the fleet’s only type II, which actually is the tallest unit in the fleet by about a foot and a half due to the lightbar on top, which is a very old, very big lightbar.).

I took her under the bar at idle with my foot covering the brake. Very very slow. The bar went over our head with no problem, then we heard a grinding sound. I slammed the brake and when I did I saw something land beside my door. Low and behold it was my light bar sitting on the ground right by the drivers door. The first thought that went through my mind was ‘oh shit.’.

Called dispatch and then called the admin on duty and were told to go to base. I’m freaking out pretty good about all of this (and still am) because I’m brand new to the company, only been here about a month. I’m afraid that I’m going to get fired. We toss the lightbar (which is relatively intact) into the back of the rig and start driving back to OHQ. I don’t think I’ve ever driven more paranoid than that.

They just had us sit around while they all talked and maintainance looked the bus over. I got called into a meeting with the FTO and injured medic who did our new hire orientation and basically got asked if I had been thinking at all and what exactly happened. I explained myself, took full responsibility since I was the one driving the truck. Then they told us they have no idea what will happen, and that they’d let us know once they knew something.

I had to sit around base for a few more hours and waited while they brought another bus back to base and we prepped our replacement unit. I was told I’m on driving restriction until further notice (which meant me and my partner both couldn’t drive) so they were bringing another 24 hour BLS truck back and would put me and one and my partner on another.

The rest of the 24 went by incredibly slow since I’ve been freaking out since abotu what’s going to happen to me. Everyone I’ve talked to at the company who heard (which by two hours after the incident was just about everyone, even the offduty crews) has been telling me that people have done worse and not gotten fired. It helps, but not a whole lot.

Although it doesn’t help that admin is pissed in general right now. We had another unit get a complaint about cutting off a semi, one unit hit a bread truck and took the mirror off, and then there was my partner.

But the drug test will come back negative and we’ll see what they do. For the meantime I’m attend only (which is what I started with way back with my first company) on a busy BLS 24 hour IFT truck. Should be fun.

Who I am

I had a friend over on Facebook tell me that I needed to update my little bio slot… Currently all it says is, “I’m me… Nothing more.”

Now, I think that spells it out pretty well. But just so she has some clarity on the subject.

I’m addicted to medicine. I love helping people and learning how people work. Especially in the realm of emergency medicine and pre-hospital medicine. So much so that my goal is to make it to medical school and become a medical director for an EMS service.

I have horrible luck with women. I thought I was not in love with anyone when an old friend walked back into my life. My ex-fiance just got married, one of my best friends from HS I never talk to, another ex is moving to CO to live with her boyfriend, and another old friend I’m falling for big time. But of course I could never tell her that 😛

I love learning. Yep, part of it ties in with the above, but not just medicine. I love learning about engines. I love learning how to do new things. I love school.

I’m not the brightest about keeping my mouth shut. It’s gotten me into trouble more times than I care to count. I say what I think, and the brain/mouth filter usually has some pretty big holes. Part of that is why I’m not a Paramedic right now. It’s also why I have made some people pretty upset with me in the past.

I love working with my hands. Yet another thing that attracted me to medicine. And why I love shooting and working on vehicles. There’s something comforting about knowing that I can do things that others can’t with my hands.

I love shooting. Paintball, photography, real guns. Doesn’t matter. Shooting things relaxes me and blows off steam.

I love riding motorcycles. I feel so free while riding. It’s like I was meant to travel like that (pity I haven’t ridden in a while). Racing them is also pretty damned fun.

I am very competitive. I like to win, and I make no apologies for it. I put 100% into everything that I do with my life, and I expect others to as well. I don’t want to win just because someone is feeling lazy that day. I want to earn it and want to feel good about winning.

I love reading. I will read anything and everything, down to the labels of my shampoo while I’m showering, just because. Books and I are old friends and it’s a friendship that will never fade.

I am fiercely loyal to the people I love. Friends and family. If you hurt someone I care about, there will be problems. If someone I love needs something, I will do it to the best I can, with nothing asked in return. Do not slander my friends and family in front of me, I would not do that to you.

I love music. I believe life should have a soundtrack, and that’s why I listen to music as often as I can. Sometimes I wish that music would start playing at the appropriate time in my daily life.

And lastly. I am an EMT. I am proud to be one. I love helping people. It brings so much other things that are a part of me to the front. I want to become a medic, and I plan to as soon as I possibly can. Even if it means that it’s time to live on Ramen for a year.
I want to make a difference in the profession I love so dearly. It’s given me a purpose when I needed one. Given me hope for what I can do to make a difference in this world. Given me drive when I was sorely lacking.
EMS is one of the noblest professions out there. I don’t just mean the trauma and cardiac arrests, either. Those are important to what we do, yes, but not the most important. Our most important task is to be the safety mechanism for so many people. We are the ones who see what is actually happening to someone in their life. We are advocates for the people who need it the most, when no one else will step up to fill in.
I believe we are due for a change, which is why I believe so strongly about EMS 2.0 and am proud to support it and #CoEMS. I believe we will come into our own. It just takes the dedication and love of people like @AmboDriver, @MsParamedic, @CKEMTP, and everyone else out there that supports what we are trying to do.

In short. I’m me. Nothing more, nothing less. I have never cared if people like it or not. I make no excuses for myself.

Cold cold cold

Yesterday was the last day of classroom orientation and geo mapping. Tomorrow is the first FTO ride I have. A big change in everything from what I’m used to. New scope of practice (that is incredibly restrictive from what I’ve been privileged to work under), new protocols, new procedures. Luckily the monitors and most of what is on the truck is stuff I have used, so no problems there. But it’s gonna be a few hard days.
And to top it off, it’s snowing… in mid-May! Makes me miss NM just a little bit.

Although getting used to all of this is somewhat like medic school. You sit there and try to absorb enough knowledge to make a difference. And then you pray you’ll remember it correctly when the time comes to use it. My first major call in internship solidified this feeling.
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Bus 2176, respond code three to the Corner Motels, Rm 155. Severe respiratory distress. Coded 6C1.”

My preceptor looks back through the porthole and just nods at me. “You ready for this? Hang on”

We take off following the directionals on our MDT. It’s a pretty rought ride in the box. I think our EMT partner forgot someone was in the back. “Good thing I’m belted in,” I think to myself. I’m a little nervous, this sounds like the real deal we’re going to.

We get on scene to our patient and he’s sitting there in classic tripod position, pursed lips, unable to talk to us at all. He looks scared, he looks very tired, and you can see his chest heaving with the effort of breathing. Every breath he takes brings up sputum, pink and frothy looking. He’s hooked to a home concentrator via nasal cannula running at 4 liters per minute, about as high as that thing will get.

On the table he’s sitting behind there’s a note. “Take me to VA” and “Hurry!” are both written out on the paper.

I freeze. I have not been on a bad 911 call by this point. My primary experience is IFT! And lots of drunks we’ve had until now. I’m not sure what to do. I know this is a Very Bad Thing, and Very Bad Things are something medics are supposed to be able to deal with.

I start off with the basics, have my EMT take vitals. Have the fire dept go get the meds and find out what he’s on. It starts to come together. I need to take a few breaths and calm down.

“This is not my emergency, it’s my job,” That thought keeps running through my head as I start to work. Fire medic has the IV? Good. Monitor is showing Sinus Tach. We need to get a 12 lead. No big bad signs noted there.

I start working just like in class, thinking it through and letting it flow. Lasix IV, 40mg, since he’s taking oral Lasix. BP is high, squirt of nitro. Get him on the gurney and start moving. This is a longer transport than most in this city, since he’s going to the VA.

Another 12 lead hooked up. No distinct ectopy. Maybe a partial bundle branch block. Take another set of vitals. BP still high, another squirt of NTG.

Think think think. I feel like I’m forgetting something. Ah! CPAP. Get the control box and mask out. Tell him what’s going to be happening. He nods his head when I ask if he’s ever used CPAP. Another nod when I ask if it has worked before. Good.

Hook up to our bus tank, turn it on and start increasing pressure until he nods that he has to work to breathe out a little. After a few moments it’s plain to see that he’s starting to feel a little better.

You can see it just looking at him how much he seems to relax once he starts being able to breathe easier. Looking outside, I see I’m about 10 out and call into the VA.

Ask for clearance to go to Med3 on the radio. City Radio Base gives me clearance.
“VA ED, VA ED, this is Bus 2176, code 3 traffic.” Trying to raise them. It’s not completely unheard of for the VA to not answer the radio. It’s happened more than my fair share when I have ER transfers I need to call on coming in from a SNF.

“VA ED, go ahead 76″. Yes! They are alive over there.

“This is TJ, medic intern on 76,heading to you code 3 with an elerly male, on scene very short of breath due to acute pulmonary edema secondary to CHF. 0.8mg NTG administered, 40mg of Lasix administered. 18g IV in right A/C. Currently doing much better on CPAP. Vitals are as followed…” rattle those off from my note sheet. “ETA 10 minutes. Any orders?”

“None, see you in 10″.

I clear the channel and tell Radio Base I’m clear. I’m feeling more confident after seeing how well my patient is handling the treatment. I sneak a look at my preceptor sitting tucked there in the corner of the box, a little smirk on his face. That smirk means a lot to me since I’ve never seen him so much as smile when I’m treating my patients.

We get our patients transferred over and give our report to the ED staff. Once he’s on that bed he shakes my hand and nods. I just smile at him and head on out once we get our CPAP controller back.
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I think all of us dread that first bad call. We never know how we’re going to do, if we’re going to do the right thing. We can have all the training in the world, and freeze when we should be doing our thing and treating the human being in front of us.

That call is when all the treatment came together for me. But there’s something else that a lot of new medics have to work at. And that’s realizing that we don’t always save lives. We don’t always win.

I learned this at a pediatric code I helped with during my clinical hours. I wrote about it a while back. We did everything we could. We did everything we were supposed to. But the kid we were dealing with still died.

After those two experiences, it just clicked for me. I realized that every patient I have, critical or not, is important. Yes, it gives me a chance to practice our art of medicine, but that’s not the only reason it’s important.

Every one of those people who call on us are having an emergency, one of the worst days of their life. What makes them all so important is that we come in to help them. No matter if all we’re doing is holding their hand and talking them through what’s going on with them, or sticking a tube down their throat and breathing for them; it’s all to help alleviate their suffering and try to keep them alive.

We don’t always save lives. But even when we lose, we are still helping someone. That someone is the family the patient might be leaving behind. Someone who might get some comfort in knowing that everything was done that was possible.

Until that all clicked, I had always thought of medics as the ones who always get saves, who always do the ‘cool’ interventions. But now that it has all come together for me, I realize these things. It’s made me a better EMT, and a better person overall for it, because I know even when I lose, I’m still trying to help.

My entry for EMS week 2010 'I was there'

After reading ADs blog tonight, I got inspired to write this. It’s a shorter version, since I’m not even halfway done with the long version and it’s over 700 words 😛 This night is one of the times working as a transport jockey that I felt like I made a difference. It made it worth it to be working Christmas Eve night, with miserable weather. I hope you enjoy it.
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My partner grumbles as she brings us into the ER bay. Time to get another patient to take home. On this very cold and snowy, very unusual for us in New Mexico, Christmas Eve. “Why are we doing this again?”

I shake my head as we go inside and get our patient for the call, a very nice lady I’ve taken on several occasions for radiation appointments. But now we are called for something different. Something that, while part of my job, can be some of the hardest calls I go on. We are taking her for home hospice. This might very well be the last time I see her. So I am determined to give her as smooth a trip as I can in this horrid weather.

She is out of it for most of the trip, her mental status having slowly degraded over the months, her husband tells me from the front. I remember it’s been at least 3 months since I’ve seen her, and when I last did, she looked nothing like the tiny woman who seems to have wasted away.

It’s slow going, as a lot of the roads are icy coated. We try our very best to minimize bumps and jostles as my patient moans in pain on my stretcher. I just talk to her, reassuring her, as her husband looks back at us from the walkthrough.

“All she wanted was to get home and be with her family this one last Christmas. She wouldn’t let them admit her upstairs,” he tells me while smiling at his wife sadly. “She just wants to see her grandchildren smile as they open presents.”

“Is the whole family going to be there?” I ask, knowing that all of their children and grandchildren live nearby.

“Almost. We have one son flying in from Iraq now. He should be here late tomorrow. She’s hoping to hold on until then,” I notice a few tears roll down his face as he says this.

We eventually get to their gorgeous home, and intact no less, and get my patient covered with a blanket so she doesn’t get we or cold as we wheel her inside. As we walk in I notice a hospital bed, looking quite obscene, to one side of the Christmas tree. I also notice the whole family is awake, now at 11pm, to greet the family matriarch as she gets home. They just watch as we gently move her over to the bed and get her tucked in and as comfortable as possible.

As we start to step back the family circles around our patient, and you can feel the love flowing in the room. We get our gurney organized and the required signatures for the transport from the husband. I go to her bedside to tell her Merry Christmas when she looks at me and utters her first coherent sentence in the entire time she’s been with me tonight.

“Thank you, TJ.”

With just those words, and a last look around, we head back out to the bus. I feel a tear roll down my face now. I look at my partner and say, “This is why we do it, no matter when or what it’s like outside. Sometimes we do make a difference, even if it’s just taking someone home.”

You know it's an ambulance orientation…

When you’ve got 300 pages of protocols and procedures to look over before you go back to work in the morning…

Caffeine.

The day is here!

There’s only one reason I would be up before the buttcrack of dawn and actually be happy… er… tolerant of it.
I have orientation for ambulance today starting at 0800! And an hour commute each way :(. So time for an eight hours of watching videos we’ve all watched before and trying to stay awake.
Now to go get some more coffee.

Thank god I traded my truck for a slightly smaller one that’s better on gas.