Wait… Already planning again?

I’ve been here in BFE, TX for about two months, yet I’m already looking at planning my next move. Actually my next two at least. Maybe being single actually a good thing… Since I apparently have a problem settling down and staying in one place for very long.

I plan on staying here in BFE for at least 2.5 years or so. Long enough to get my AAS in Paramedicine and my Paramedic License (not cert) here in TX. Plus it’ll give me good experience working in a 911 system, and prove to myself that I can handle being definitive care for a long transport until I can actually get them to a hospital. That means a lot to me since I’ll actually have time to see my interventions make a difference or not, instead of dropping off the patient after only being with them for 10 minutes or so.

It’s ok living here, but it kinda sucks to have to drive at least 70 miles to do anything. I guess while I like living in a small town, there’s a limit on just how small. The town in NM that I lived in HS was just barely larger than here, but it had a college and a few things to do at least.

After I finish up my AAS and get some experience, I’m looking at moving back to NM and going to the University there and going for my Bachelors of Science in EMS on the Critical Care track. There are a few services I can work for down there that I am pretty familiar with, plus my old service down there if I really wanted to.

Some people have asked why I would make a move in the middle of going to where I really want to work at just to go to school for another two years, especially since I’ll already be a paramedic. Well… because I believe that more education is essential in this field. I want to have as much education as I can so I can better serve the patients who trust me with their care. The fact that they don’t get to pick and choose who responds to their calls makes me want to work that much harder to make sure I’m the best provider I can be and see if I can help change the system from the inside out.

I figure I’ll stay there for a few years (as short a time as I can manage while getting my degree) and then get ready to move again. I really don’t want to do career EMS in Albuquerque, just not that fond of the system there. I’ve been looking at various systems that I would love to spend my career working in and I’ve come up with three of them. One is Austin/Travis County, of course. A great third service in a good system. I’ve heard only good things about them, but heard they might be going to a P/B or P/I truck instead of the P/P trucks like I’ve heard they run.

My second option is Wake County EMS. This one appeals to me due to the fact that they have a community paramedicine program. That type of work really makes me happy to think about. I’d love to do it.

And the last option I’ve thought of so far is back to Denver to work for Denver Health Paramedics. Primarily a Paramedic agency with very few BLS trucks. I love the area up there and the agency didn’t seem too bad when I was there.

So those are my rough plans for the next 6 years or so of my life. Lets see how much life will throw at me and force me to change those plans. :)

Well, I’m on shift now as well, so it’s time to watch some more TV unless I find something else to ramble on about! Ya’ll stay safe out there.

Burnout

A lot of us in this field have dealt with the issue of burnout. For a stressful job it’s pretty common to deal with. I’ve gone through it once, even though I’ve not been in this field too long yet. When I was dealing with it I was actually even newer. It was in my first year as an EMT.

I was working for an IFT company, had just gotten engaged, and going to school full time to get my pre-reqs out of the way for Paramedic school. I thought I was superman and I could handle everything that got thrown at me, but I was very wrong.

I was working all the shifts I could get on, sometimes working 16 hours or more at a stretch, 6 days a week plus going to class when I wasn’t working. I also had to try to make time to see my fiance, who worked for the same company and my normal schedule was actually opposite her schedule, which made it even harder to see her. I was working all those hours since I had a wedding to help pay for plus school to pay for.

It all came to a head one day when  I woke up and really just didn’t care about anything. I was more cynical than I ever had been (which is actually saying something), I was tired and irritable all the time, and I seemed to be not doing as well at work or in classes as I knew I could.

My head instructor actually called me into his office and sat me down. We must have talked for hours, and he told me that I needed to find something to do that wasn’t EMS related at all so I could help keep my sanity (or, as he put it, what little sanity someone who wanted to be a paramedic had to begin with). He told me he had been in a similar boat when he was going for his degree and he wouldn’t even see home for days at a time.

It made me think about things. I had gone from one extreme to the other. When I was at my first college as an engineering major, I did nothing but mess around and have fun. It hurt my GPA, but I was happy. Now I was in a field that I loved, but I hated my job and life and wasn’t happy. I thought about all the things I’ve put on hold since I started work and school. I didn’t offroad, or shoot, or take photos, or play paintball. I was lucky if I played a video game once a month or so.

It made me realize that I needed some balance in my life if I wanted to make it in this field. No matter how much you enjoy doing this work, if you don’t have some kind of a stress relief you aren’t going to make it. Since then I’ve made sure I take time to do something that is not related to EMS at all. I’ll go flying down a dirt road in my old truck (which reminds me I need to get another one and get rid of my little car), spend the day out in the wilderness just wandering around and taking photos, or going out with some friends and firing off a few hundred rounds of ammo.

So to any new providers out there, take the advice of people who’ve been in your shoes before and make sure you don’t focus so heavily on one thing that you start hating the thing that you loved. Remember why you got into EMS in the first place, not the drunks or the system abusers, but actually helping people. Take time for yourself too.

In my example, the burn out led to horrible relations with my fiance, which led us to break up a while later, a delay on my entry into medic school due to bad grades, and just general pissing off of the people I was around day in and day out. Don’t follow my mistakes :)

It’s Thanksgiving

First off, Happy Thanksgiving to everyone! Take the day and try to relax and enjoy time with your family. If you’re on duty, like me today, stay safe out there and I hope you can get a chance to stop and sit down for a meal today. Thank you for giving up your holiday to serve your community.

This is a hard Thanksgiving for me. It’s the first one where I’m out of the state that the majority of my family lives in, and since I’m on duty today I am not able to go home for the holiday. And to top it off, the one I was hoping would be moving with me when I came here has pretty much cut me out of her life. But oh well. I’m here, and I still have things that I’m thankful for.

One of the biggest things I’m thankful for this year is my family. They’ve stood by me and have been willing to help me in any way that I’ve needed this past year. And I’ve definitely needed the help too. When I was getting frustrated on the job search, they were there to talk to, when someone I truly cared about disappeared from my life suddenly they put up with my moodiness and moping and pushed me to try and put it behind me. They gave me hugs when I needed them, encouragement when I needed it, and kicks in the ass when I needed the motivation.

And by family, I don’t just mean blood family. I also mean the people who have become like family to me on Twitter and in the #CoEMS/#EMS2point0 movements. @msenginemedic @shell1972 @EMTGoose @EMTDani @MsParamedic @enginemedic @emtmikey, and lots of others I’m forgetting,  plus people like Linuss and Lucid from over at my favorite EMT forum. Ya’ll really mean a lot to me and thank you for being here when I need someone.

I’m also so incredibly thankful to be working again in the field that I love and being given another chance to get my life turned to where I want it to go. This job has opened up several doors to me, including a chance to go back to school and try again for my medic cert. Working out here will be incredible experience, and when I move on to continue my education I’ll always look at it fondly for the chances it gave me. And this service has done it’s best to invite me into their little family with open arms, and it helped since I was a stranger moving here with no idea about anything in the area.

I’m grateful for all the lessons I’ve learned this year, even when at the time they seemed like they were the end of my dreams. I kept getting told everything works out the way it does for a reason, and I’m hoping they’re right. I’ve learned a lot this year, and I’m not the same person I was back in January. We’ll see if these lessons keep me from making the same mistakes I have in the past.

And lastly… Little one, despite everything, I’m happy that you were in my life. I wish you the best of luck with everything and everyone. You showed me what I want in life, talked to me in my darkest times over the summer, held my hand when I needed it when I visited you. You are still the one I think of the absolute most of anyone, and you probably will be for some time. I still love you and wish things were different. Good bye.

Well, that’s enough for now. I’m sitting in the station for now doing nothing, my partner is upstairs still asleep from last night (He’s on a 24, as am I, but I switch off partners at 1800 and he gets off). Later today we’re going to one of our medics house for dinner, and it’s going to be pretty much the whole department there. Should be kinda fun.

Stay safe everyone, and enjoy today.

They should know better

“But if I come in by ambulance, I’ll get seen faster!”

I’ve heard that phrase by many a patient, both here and working other areas… but last night I heard this from a place I figured was a little smarter than that.

I heard it from a bloody hospital! Rural County Hospital told us that when we were transferring a patient to Big City Medical Center. It was for a patient that would have gone to the waiting room under most circumstances, and they though that us taking him by ambulance would mean he’d get straight to the back… Guess where he went? The waiting room.

I told my chief that I’d be willing to give them an education on what exactly it means to transfer someone by ambulance, and it looks like I’ll be giving a presentation to their ED director. Should be an interesting time.

The Handover is still going…

But it needs your help!

It seems like with so many people out there trying to save the world and make a difference in EMS, no one has any time to pound out a short post for the Handover. I’ve always loved it since it’s a great way to find new blogs and see multiple peoples viewpoints on one topic. But the participation lately has been lacking.

I’d love to see it if it can get back up to a couple dozen bloggers all coming together for one topic. I know there’s tons of us out there, and we all like attracting new readers. Well, this is one way to do it.

This month it’s being hosted over at my fellow primate’s blog, the Rescue Monkey, and the topic is one all of us can relate to. Burnout. It’s something that a lot of us have had to deal with at one point or another, me included even though I’ve only been doing this for 3 years or so.

I’ve asked to host the January edition, and the wonderful @JustmyBlog is hosting the December edition, so lets see if we can drum  up some more posts for the next three months :) After all, who doesn’t like to get new readers and talk EMS with all of our wonderful EMS bloggers?

My post for this edition of the Handover is coming soon, so keep an eye out for it. And I hope to see ya’ll put up some good posts as well.

Just a quick note… I was told I am provisionally accepted to the City College Paramedic Program starting January 11 :) If all goes well I’ll get official notice the middle of December and be graduating at the end of December 2011 😀 Then I’ll be continuing to get my AAS in Paramedicine so I can get my Texas Licensed Paramedic ticket 😀

http://transportjockey.com/2010/11/16/173/

I am one very tired TransportMonkey. It’s been… well, it’s been a week.

 

Some very good calls, and one that left me with a horrible feeling afterwards. And several transfers that really had no business being sent up to the City Medical Center. All in all, not a bad week, really. Even with that one call hitting home in a bad way.

 

One thing I’m finding out about working in this rural area… For the most part, the 911 calls are usually legitimate calls. I’ve seen more people actually drive themselves to the ED for minor things than have called us to take them to the ED. I have run one call that would usually be considered BS. Compared to when I pulled medic internship in NM I could run a twelve hour shift with 8 or 9 calls and they’d all be BS.

 

Our transfers on the other hand… If Rural County Hospital even think it might be a patient they can’t handle, they will transfer them out. Some high acuity, legitimate transfers get flown out on either fixed or rotors. But they will usually turf some calls to us that leave us scratching out heads. For example, these are some of the type of calls I’ve seen, personally, come out of that hospital:

Finger that needs sutures

Chest pain, non-cardiac in origin

Pt needing a lapcholy

Any cardiac chest pain.

Abcessed tooth.

 

In fact one of the medics I ran with joked that the criteria for transferring chest pain patients to Big City Medical Center is… Chest pain. They have yet to keep a single CP patient in the last 9 months.

 

One of our transfers runs an average of 3 hours of time from start to finish. That is if we run into no delays picking up or dropping off the patient, run into bad weather, or stop to eat while we’re there. When you wind up doing three of them back to back with patients that a Lvl4 trauma center should be able to handle, it gets old quick. Especially when the patient gets back to Small Town before my bus does cause the ED in Big City discharges them right away.

 

Add onto this that my department now thinks I’m a gigantic black cloud. In the last two weeks I’ve seen… 5 dead bodies, plus the two I’m gonna tell you about later. Only one of them was a viable code. That’s more DOAs than the agency has seen in the last two months put together. Between that and the fact that we ran a 5 pt rollover along with 7 other calls last night on the 1800 to 0600 shift (that I wasn’t even on duty, just on call for… although I was on duty for 10 of those 12 hours), it just seems like the call volume has gone up steadily as I’m there.

 

Now… onto the call that made me just question even if I want to do this job forever. Don’t get me wrong, I love my job and couldn’t imagine doing anything else, but when I see things like this I question things.

“Son of a…!” I curse quietly to myself as I shocked myself on the battery terminal on my car. One of the advantages of this job is I can try to get my car fixed once station chores are done and no calls are dispatched for us. And since I have gotten stuck at the station during my oncall shift cause it wouldn’t start, I wanna get it fixed so I can got to my apartment and sleep.

 

“DEEEEEEEEEEEEEEEEEE-BOOOOOOOOOOOOP!” I hear the radio on my belt signal the EMS tones. “All EMS Personnel, please respond to neighboring county, rural route highway, marker 20, for reports of several patients with GSW.”

I quickly sprint from the driveway back into the station to slip on my uniform shirt and grab my stethoscope from where it was hanging by our little closet. My partner passes me as I head out to the rescue we’re taking out there. He hops in the driver seat while I pull out our map book.

 

“Rescue 1, leaving quarters, en route code three to call location,” I say quickly into the radio, letting dispatch know that the station was empty. We flip on our beacons and siren to clear the road so we can get out.

 

“How far out are we?” I ask my partner, since I’m not familiar with the area we’re headed to.

 

“Not too far, about 8 miles out.” He replies as he scans the intersections to his side.

 

I return the favor and scan mine. There are only a few intersections before we’re out onto the rural route and don’t have to worry about cross traffic. “You’re clear on this side. Glad to hear it’s not too far out.”

 

“Rescue 1, Dispatch. New update from deputy on scene. Looks like two codes. LEOs are investigating looking for shooter.” Our radio squawks at us, I pick up the mic and answer in return. “Copy dispatch. Advise of any further updates.”

 

We spend the rest of the time running out to the scene in almost silence, punctuated only by conversation when we need to clear intersections or my partner is telling me what he wants me to haul into the scene. As we get closer we can clearly see the area of the shooting, since there are many emergency lights strobing the air. We turn into the street and just see a deputy shake his head at us.

 

I keep my head on a swivel as we pull onto the scene, trying to take everything in at once. I see what looks like two bodies in a heap beside a vehicle. There appears to be family all around the bodies, and PD is doing next to nothing to control the scene. I think to myself that this is not a good looking scene.

 

I hop out as soon as we stop and reach into the cabinet on the outside of the box behind the cab to get the first in bag. I’ve already gloved up just prior to us getting on scene, so that’s one less thing I need to worry about. I walk over to the patients and just from looking from 10 feet away I can tell this is not going to be a workable situation.

 

I look over the patients as I get close. The male patient is lying on top of our other patient, blood spilling out of his mouth with gray matter in a pattern behind his head. Yep, that’s an injury that definitely is not compatible with life.

 

I turn my attentions to our other patient. She is lying in a pool of blood. I get in quick to check a pulse and feel nothing. When I look for where the injury is, it looks like a grouping of 4 rounds right in the area of the heart. I turn the patient slightly looking for exit wounds and see three. My medic makes the call not to work the patient, and I have to agree, since it looks like the rounds most likely took out the heart and pretty much her entire blood volume is in a puddle under her.

 

We get up without opening our bags, being careful not to contaminate what is now a crime scene more than we have already. When the family sees this they let out that sound. That god-awful sound that I have only heard a time or two in the past. A sound that I could go the rest of my life without hearing again it it would still be the worst sound I’ve ever heard. It’s the sound of realizing that someone they love isn’t going to be getting up off the ground. I’ve heard it most commonly called by other EMS providers as ‘The Wail’. It’s probably the most disturbing sound that you can hear while doing this job.

As we get up the family that is surrounding the scene starts to surge in towards us. They are upset that we aren’t doing anything. They feel like we’re not doing our job. Then I see something that just breaks my heart. The victims two small children (both elementary age) kneel down in front of their parent and just cry. It’s not a sight I don’t think I’ll ever get out of my mind.

 

There are some days that this job really sucks

 

 

So… yea. It’s been one hell of a week. The last two weeks I’ve racked up over 100 hours of time on duty, plus 80 or so of on call hours. And tomorrow I have to head up to the city to turn in my application for medic school that starts in January. I need to find something to do to distract myself from work. That’s the only downside to working in a small town.

 

Ya’ll stay safe out there.

 

 

 

 

http://transportjockey.com/2010/11/16/165/

Quick update, not about work at all

Just got back into town from going home for my birthday. I now have a place to live. Electricity will be turned on Friday (since I work most of the day tomorrow I’m not picky). Gas will be turned on tomorrow.
Heading to up to the City today to drop off transcripts and see what else I need to do to be able to start medic school in January. Also need to order several department t-shirts that I can wear for on call shifts, sicne I haven’t gotten my official uniforms yet.
Now to just get what I can setup at the new place, then on my next days off go home and bring back my parents van with a full load of my belongings.

Rural EMS can really suck sometimes

“Dispatch will be changing frequency to dispatch ambulance.”

As I hear those words I grab my boots and quickly slip into them and start running, carefully, down the stairs. I know from experience, quite painfully actually, that if I don’t pay attention while going down these stairs, I’ll wind up head first heading towards the floor. I quickly grab my steth and hat off the table where they lay after we got back from our last call.

“EMS, EMS, Ambulance requested in tiny south-county town. Called in as a difficulty breathing. Deputy is responding to scene,” The radio on my belt squawks. I stop and think about where exactly they’re sending us. I can’t recall that little town being on any of our response maps.

“EMS to PD Dispatch, copy call, clear page,” I say into my radio as I pull it from my belt. I head into the bay and hop into our rig. The senior medic I’m riding with is right behind me. We start the rig up and he flips the lights and siren on as well pull out of the parking bay.

“Hey, OldMan, where the hell are they sending us?” I yell over at my partner, while flipping through the map book trying to see where we’re headed to.

“It’s just north of SmallerTown. Usually their vollies will cover that area, guess they can’t raise anyone again, so we’re covering the county,” He tells me as he scans the road ahead and to his left as we blow through town. He gets on the radio to ask dispatch if the volunteers are responding at all.

“Negative on that, EMS. Volunteers are out of service today due to insufficient crew available. SO is sending a deputy out to assess the scene for you. He should be there in ten minutes.”

“Copy that. We have an ETA of 45 minutes to the scene,” my partner tells them, shaking his head in frustration.

The South Town Volunteers might only be BLS capable, but they could still make a difference in this call if it’s anywhere near serious. But since they are unstaffed, a common occurrence lately from what I’ve been told, the patient has to wait for our EMS service to show up. Since we are a paid department, and the only other EMS agency in the county, we are always staffed. Luckily.

We hit the highway once we’re out of town and OldMan gets on the gas for all he’s worth, trying to get there in time. It’s a long trip there, even running flat out with lights and sirens. Luckily it’s pretty much all flat and straight till we get into Tiny South-County Town.

“Dispatch to EMS, SO reports that the patient is not breathing and has no pulse. He is starting CPR.”

“Shit!” My partner curses in the radio’s general direction before picking up the mic. “Copy that dispatch, get EMS2 rolling once they get into station.”

“EMS2 to EMS1, copy direct,” The voice of the OldMans son comes back, since he is the on call lead today. “We’re rolling now.”

Thirty minutes still till we get to scene. No telling of how long the patient has been down. This could wind up not being fun at all. I just hang on and watch the terrain fly by to either side of us, keeping alert for cross streets so I can tell my partner if something looks like it’s gonna come out in front of us. I know what to do if we have to work a code, so I try to relax and just be ready.

As we pull up on scene I notice it’s a single family dwelling, with a slew of vehicles parked in front of it. This gives me a little hope that maybe we got called the minute something started to go wrong. There’s also a deputies truck parked in the driveway with it’s lights still twirling. I quickly glove up and grab the first-in bag from the side compartment behind me. I see my partner grab the cot first thing.

“There’s that working a moving code mentality again.” I think to myself.

We rush inside the residence and take a look. The deputy is in the middle of the floor of the living room with an AED attached to the victim, while performing CPR. I see a face mask there too, so it looks like he’s been doing everything right. Judging his compressions I see that they are good, solid, and deep. Perfect.

The OldMan has him stop and he does his quick assessment. By the way the body moves when we roll it, this person has been down a hell of a lot longer than 45 minutes. As we look at their back we notice lividity present as well. We both look at each other and shake our heads. As he talks to the family to get the story, he motions me to talk to the deputy to get his viewpoint since he got there.

The family is of course not happy with us when we do not continue CPR. They are mad at everyone, especially us, for how long it took their call to go through. It sounds like they tried calling the Small Town Volunteers station to try and get response from them for about a half hour before calling 911. They told the dispatcher that she wasn’t breathing. So why did we get paged out for difficulty breathing? Ya’ll know dispatchers as well as I do. Guess.

Apparently the family thought that calling the vollie station was just as good as calling 911. And they couldn’t figure how the station could be unstaffed in the middle of a weekday. They apparently weren’t happy finding out that the vollies have real jobs and don’t have the staff to maintain a crew 24/7. They were blaming us for taking so long to get there from town, even though it’s impossible to get there faster than we did.

The deputy said he got there and started CPR as soon as he checked for a pulse and got none. He never thought to look for rigor or lividity, but then again that’s not his job. I get some more information from the deputy for our report and watch as he goes to call the JP and make arrangements.

I meet up with my partner again after I finish loading the cot into our rig and put the bag back in the side compartment. As he sees I’m done putting things away he asks, “Still so happy to work in a system like this?”

———————————————————————————————————

This is the first time working here in Rural Town, TX that I wanted to pull my hair out. I wonder if this will be the call that gets the county and my town to decide that our service needs to spread to cover the entire county and needs a station down south in Small Town. In a situation like this it might have made all the difference.

Code? Code!

 

So I’ve now worked two codes for my new service. I’ve discovered a major difference in the way my training for codes was and how this service runs codes. In fact it’s a difference that to me seems backwards to how I would have expected it, coming from an urbanish area.

First code I worked was a nasty one where an ILS provider was the highest level of care on the scene, with no backup coming. I worked it like I was taught and did ok, even though we didn’t get ROSC. I got a tube, drilled the pt for an IO, ran through my asystole algorithm, and worked it for 30 minutes on scene.

The problem arose when my basic partner made multiple comments that we needed to get this guy to the hospital.

Wait? Transport a dead guy to the hospital? What the hell. Granted I’m not a medic, so I wouldn’t be able to pronounce on scene, but our chief was finishing up with his call by this point and could have come by to do that for us. I was thus informed of the procedure that all working  codes, regardless of who’s working it, get transported to the ED.

This was a large shock coming from a system where you were expected to work codes on scene, even though the hospital was maybe 10 minutes away at max. This seems to be backwards in my thinking, if transporting a working code was actually a good idea.

Out here, I could be upwards of an hour from a hospital with a working code out in the county, yet procedures say that I drive the patient to the hospital code 3 while me or my partner are in the back doing CPR the whole time? I’m not a big fan of that, and I’ve already let my new boss know this. In my opinion it’s too dangerous for too little gain.

You’d figure that being so far away, they’d want to work the code on scene, since in most cases there is very little an ED can do that an ALS ambulance can do for a working code. Hell, even as an EMT-I I’m allowed to shock, drug, and tube during a code.

The second code I worked a couple days ago when I was the on call crew was the first code I’ve ever worked that the whole purpose was the get the patient to the hospital within 20 minutes of getting on scene. We did it, and it was an odd experience. We had 2 crews plus the chief helping out with it. I did compressions (where I managed to give the pt a BP of 160/80-ish according to the monitor NIBP cuff :) ) the entire time, except for where the basic took over so I could push my Epi and Atropine.

Seems to me that doing compressions in a moving vehicle is counterproductive. You just can’t give good compressions when you’re being flung around in the back on the way to the ED. I tried. I failed. I can give great compressions to a pt while I’m standing still, but there’s just no way to steady yourself in that big old monster of a rig that we have to give adequate compressions.

So yea, there’s another thing that is different to me since coming here. And, like I said, it’s something that I figured would be the other way around versus what I’m used to in the city with 7 hospitals within a couple miles and a half dozen medics showing up to most calls.

I do think, however I might research trying to get a grant to get something like the Autopulse to make our crews a little safer if they intend on sticking with this asinine procedure of moving codes.