It’s like a roller coaster.

The last two and a half weeks have been both the best weeks and the worst weeks of my life professionally and personally.

It all started on what was supposed to be a 36 hour shift over New Years Eve and New Years day. Great time to work EMS right? Good calls, fun times.

Well it didn’t quite work like that. First few calls of the shift were all routine. A drunk or two, a minor MVC or two, a drunk doing CPR on a fully alive drunk person (“Sir, if the patient is saying ‘OW!’ every time you compress his chest, he DOESNT need CPR!”), and then it started to get interesting.

We worked a nasty tractor trailer rollover about 15 miles from town. We get on scene and see a pretty much demolished tanker truck laying on it’s side. The roof of the cab had been peeled back by the wreck and the patient was laying about 10 yards from the truck. He was laying on the ground moaning but not really responsive to us at all.

We quickly get him collared, boarded, stipped, and strapped and then haul into the bus. Just a quick look at him showed what looked like a grossly deformed femur, shattered left arm, distended neck veins, and no breath sounds on the right. Left pupil was sitting pretty at about 4mm and slow to respond while the right was about 2mm and non-responsive.

Our second bus pulled up on scene as me and my medic were getting him situated in the back. We pull the medic from the second truck to come with us while her basic drove. A PD officer drove our second truck back into town. It was decided by my medic that we would call the local fixed wing transfer service to get them ready and just meet them at the airport to get the guy to the Lvl 1 200 miles away from us, since the rotor would take at least a half hour to get to us, and the airport was in town.

We took off towards town and started our thing. Pads and electrodes on, 1 14g in the good AC, an EZ IO in the good leg. Started giving him a fluid bolus cause his pressure was in the dumps. My medic darted his chest and got a little air out, but not much, which led us to believe maybe a hemo. I cleared his airway with suction and tossed in an NPA, then tried positioning and tossed in an OPA.

I noticed his breathing was getting more and more ragged and irregular, so I double checked with the medics and grabbed a scope and ET tubes. Snap on a Mac 3 and grab a 7.5 w/ stylet. Go in and take a look and I can’t see crap. I suction him out some more and still can’t see anything. Ask for cricoid pressure and finally see that white winking of the cords. I sink the tube, pull the stylet.

Grab the slipstream, hook it up and start bagging. Listen to lung sounds? Yep they’re there. ETCo2 looks good too. I look over the patient, who is looking more like a train wreck every minute. His femur that’s deformed looks like it’s quickly collecting tons of fluid, which between that and the chest would very easily explain his low BP. We get about to the airport when I notice that I can’t feel a pulse in his neck anymore. I look quickly to the monitor and notice flatline (like the monitor making all sorts of noise doesn’t clue us in). My medic starts CPR just as the back doors to our bus open up and the flight team hops in.

Since we’re not sending him by flight we beat feat to the ED and get him in there as soon as we can. They work him for another twenty minutes but never get any organized rhythym, let alone pulses, back.

We take our time cleaning up from that call and get paged out to an 911 hangup call that PD went to and then called us out on. The PD officer sounded frantic which made us wonder what was really going on. We get on scene and find something that goes down as the worst call in my career so far.

“PD, Medic 4, we’re pulling up now, does the officer have an update for us?” I casually ask into the mic, wanting to make sure the scene is still safe for us to enter and see what we might need.

“Medic 4, PD 214, get in here quick, young child unresponsive, trauma related!” This PD officer used to be one of our EMTs back when we were a volunteer agency, or so I’m told, so we know we can usually trust his judgement. Hearing him that upset rattles us a little bit though.

We bail from the unit, grabbing our pedi-board, collar, first in bag and toss it all on the cot. As we get inside we get the story from the officer.

“The husband and wife were apparently having an argument, and the kiddo dropped and broke something. So because the father was upset and the kid broke something he beat the kid until the kid was quiet. Wife called 911 then hung up after she thought better of it,” The officer tells us. We take a look at the kid and my vision goes red.

He is completely unresponsive to us as we get in there. He has bruises already forming on his face and neck, along with old bruises that we reveal when we start cutting into his clothes. He has several lacerations to his face, along with several to his forearms that look like they are defensive injuries. His face appears to have several fractures, but we can’t tell just how bad.

My medic and I work quickly and silently as we get the little boy packaged up onto our board and call our local fixed-wing service to get the boy transferred up to the childrens Lvl 1 250 miles+ away from us. I drive the bus so the medic can be in the back with the kiddo but we wind up staying in the ED to help prep the kid for the flight out. During transport my medic had intubated the kiddo because he had stopped spontaneous respirations, and reported that the kids’ pupil was blown.

The kid was transferred to the flight crew without any more problems and flown to Big City Hospital Lvl 1. I’m still waiting to hear more, I would love to hear that the kiddo would be ok, but I don’t know if he is. He is still on my mind and I can’t get him out of there. It’s just… I don’t know…

Seeing that just shook me to the core. I don’t like kids, but I want them eventually. My ex-fiance and me were supposed to have one, but working in the field made her miscarry, at least that’s what the docs said. There’s another little girl that I would help take care of in a heartbeat if the mother decided she wants to come out here with me. I love them both more than anything and I haven’t even met the little one yet.

What makes this even more like a roller coaster is the fact that the call that I term as the best call of my career. I had my first delivery in the field as a lead EMS provider. It was the most amazing experience I’ve ever had. I helped deliver a healthy little girl into this world without any problems for her or mom. I.. I can’t even begin to put into words how this felt. It felt like it made up for all the bad calls I’ve had since I moved here, all the bad stuff I’ve seen since I became an EMT 3 years ago (BTW, I realized that earlier this month marked my third year anniversary as a certified EMT). It has given me the energy and drive I need to push me forward, to continue on and keep going. To keep on riding hte bus day after day.

Then again, life is like a roller coaster to begin with, and EMS just exemplifies this.

Yay… new year… new challenges

Well, another year is over. I’ve noticed a lot of bloggers looking back on the last year, and figured I might join in. But, take note, that I hated 2010 for hte most part, so there will be very few good things I can say about it.

Last year:

My ex-fiance got married to my ex-partner,

I quit my job and moved to CO on the promise of a job (which never materialized),

found a job at a private IFT ambulance, then promptly got fired for doing something stupid.

Fell BACK in love with a girl who had been out of my life for years, had my heart stomped on in front of me, set on fire, and then the ashes scattered by said girl.

Moved back in with my parents,

Spent a lot of the rest of my money that I had saved applying for state certs in bordering states and going to places for interviews.

Got a job in BFE TX on a 911 truck (probably the highlight of my year)

Applied for, and get accepted to, paramedic school in the City.

Strengthened a lot of ties with #CoEMS friends and other great friends I’ve made on Twitter. I’ve found out who really will be around when I need a friendly avatar to talk to.

———————————–

Yea, that’s my list of 2010. This next year will hopefully be easier to make better. I’ll have new challenges. Like working FT, PRN, and being a full-time paramedic student. But I know I can make it through everything that gets thrown at me. I’m used to being on my own, and I’ll prove that I can make it all on my own.

Although the year is off to a rough start with us here in BFE. I pulled what was supposed to be a 36 hour shift over NYE and NYD. It wound up being a 24 since we had a busy day and 1 really bad call. We worked 3 major MVCs and one of those turned into a trauma arrest while we were transporting to the airport to meet a fixed wing to get him to a Lvl1 Trauma in Big City 250 miles up the road.

Curiously I didn’t really feel anything with any of those patients. Sure it was sad they got into accidents over a holiday weekend, but I just did my job and walked away with no questions in my mind or doubts about why stuff like that happened.

For the most part, calls that day had been routine calls. Headache, dizziness, drunk, the usual for a holiday weekend. No suicide attempts or people doing grossly stupid things… Until we got the call that got me sent home early.

We got dispatched out secondary to PD for a 911 hangup call. They got on scene and sounded pretty damned flustered when they were calling us, so we got there relatively quickly.

Now, keep in mind, I hate kids. With one very large exception I don’t want them. And the person that I would have helped them raise their daughter… well, long story. Longer than I wanna go into. That and kids on calls scare me, since I don’t deal with them well.

Anyways, we get on scene and find a kiddo that has been beat to within an inch of her life. Why? Because her low life dad was a fuckign drunk and apparently she had dropped something that broke. His solution? To wail on the kid until she was quiet. The mom called, then apparently ‘thought better’ about it and hung up.

I don’t wanna talk too much abotu that call, since I know it’s already going to give me nightmares. But yea, this year is not off to a good start.

So anyways… new year, new challenges. Let’s hope things go well. School, work, work, school. That will be my life this next year, and I can’t say I mind. Keeping busy is good. Keeps me from thinking too much. As I’ve found out this past year, thinking hurts in more ways than one.

Oh and I decided to not give up caffeine like I was planning this year. That would be suicidal I think. So I decided to just give up carbonated beverages (like my Monster  O_O), with maybe the exception of a beer a week if I ever am off duty long enough to have one. So, the drinks and losing weight are my only new years resolutions other than rocking the paramedic course and earning my disco patch by the end of the year.

98% sheer boredom, 2%…

I’m starting to think that down here my most used sentence on calls is “Does anyone here speak English?” Makes me realize that for the communication portion of my AAS I’ll definitely be taking Spanish to at least get some basic conversational skills to help me out in the field.

We had a call the other night that highlighted the fact that there is a large percentage of our population here in BFE that has never bothered to learn to speak English. We get called out for a simple fall out of bed. Should be nothing major, right? Well, we get waved down at the address (Ah the infamous Bystanders Sign language) and start to head in. We leave the cot in the bus for a bit, and just take the first in bag with us.

I walk into the door, still pulling on my gloves, and just about stop in my tracks as I see the patient. Something just doesn’t look right.”Hey there,” I say to the husband, “What seems to be the problem tonight?” As if I can’t see that his wife is sitting on the floor after falling out of bed. Never hurts to ask anyways.

“Umm… No English,” Were the only words that he said. Great… I think to myself, this is going to be an interesting call, since the old man doesn’t speak Spanish either. I kneel down beside the woman on the ground. She’s pale, diaphoretic, and just seems to be flailing around. She can’t focus on me at all, and just withdraws a little when I give the webbing between her thumb and index finger a pinch. I do a quick trauma sweep and don’t see anything that could cause too many problems.

“Lets get her on the bed so we can take a look at her.” I tell my partner, who technically is the senior of us two since he’s a medic, plus the senior medic at the service. But he seems to be letting me run the calls more and more and just getting involved when something needs done that I can’t do. I don’t really mind that too much since I need the contact hours since I’m starting medic school in a month or so.

He just comes around to grab her under the arms while I grab her legs, and we heave her up onto her bed. With her on the bed, she’s in a little bit better light, and I can take a quick look at her. She looks even more pale with full light hitting her, so I look at my partner and ask him to bring the cot in.

I break open our first in bag and quickly pull out a pulseox, BP cuff, and the glucometer. I look at the husband and, knowing it might be useless, ask, “Does she have any medicines? Umm… Pills, shots… Medicinos?” I fall back on the old joke in NM of adding ‘o’ to the end of every word to make it Spanish. Amazingly enough this time, it works. He gets a big smile on his face and goes into the kitchen and starts rummaging around like he’s looking for something.

That never works, I think to myself, shaking my head. Oh well, maybe I’ll have some good luck on this one. I quickly inflate the BP cuff to my usual 150, and slip my stethoscope in and listen. I immediately hear the heartbeat in my ears, so I keep inflating until I hear nothing.

Uh oh, 190. Not good. I think as I slowly let air out and listen for the change in sound to let me know I’ve got a full blood pressure measurement. 190 over 110… This doesn’t look too good for her right now. Look down at the sat, it doesn’t look too bad. 96% on room air, pulse showing as 95, and a quick grab at her wrist confirms it to be in about that area.

I hear the husband still looking for whatever he thought I asked for, hopefully it’ll be the medications she’s on, so I can have some idea of her medical history. Right now I’m wondering if she might have a history of hypertension or heart troubles, since right now my number one concern based on her presentation is a stroke. I hear my partner get the cot in the front door and we quickly move her over to the cot. I let him know what I’ve got, and he agrees with me about my concern. Looking her over again it almost looks like she has some facial drooping on one side, but since we can’t get her to do the other parts of the stroke scale, it’s kind of hard to say for sure if that’s what we’re dealing with.

The husband finally comes out of the kitchen clutching a little soft sided cooler, like the ones I brought my lunch in every day for my first try at medic school. He smiles as he hands it to me, and I open it up in a rush to see just what conditions she might be dealing with. As I look into the bag, I feel like an idiot. A bottle of Metformin and a Novalog pen are staring up at me from the very top.

I snag the CBG kit from where my partner had left it, without getting a sugar I guess, and quickly grabbed a sugar level from the patient. Yea, 20… That might explain some of these signs.

Digging again into the jump bag yields a little white box, which I toss onto the bed, along with a syringe and a couple of needles, and an alcohol prep. I drag the vial of sterile water up into the syringe and inject it into the vial of powdered Glucagon. The old man sees what I am doing and grabs out a bag of NS and a line set and gets it set up and looking for a vein on his side.

I get the newly reconstituted Glucagon all ready to go and as I’m switching needles so I can give it to the patient I notice my partner has gotten a line and is taping it down. Once I stab the syringe of medication into her arm, I toss him a box of D50 and he goes to work pushing it.

Within 30 seconds of the start of the D50 being pushed, she starts to come around. She has that very confused look on her face that a lot of people experiencing hypoglycemic incidents get when they wake up to several strange men standing around their living room. As we’re trying to explain what happened, our other truck shows up, with one of the crew able to speak Spanish.

Great timing, why couldn’t you have been here ten minutes ago?! Oh well, at least now we know she’s telling us she doesn’t want to go with us. After all, kidnapping is highly frowned upon by the authorities.

————————————-_____—————————-

And by the way, the high BP was cause by non-compliance with HTN meds… and for the record, don’t take your AM dose of insulin at night with your nightly dose because you forgot it in the morning. Do that and pretty good chance you’ll be waking up to strange people staring over you when you wake up.

All in all the last week has been a good week. I’ve had good calls, including one ROSC code, that have helped me remember why I love my job. I love the challenge of figuring out why someone is down and out, of trying to get someone out of a car without hurting them too much and get them to the hospital safely, of helping family understand what we are doing to their loved one and why. The days of constant waiting, of cleaning trucks and stations with nothing to break the boredom, I can put up with those kinds of days because of days like this. Good calls that get me thinking and working hard. Calls that make me put the knowledge I have to the test, and look up more after calls to double check that I know the latest on treatment modalities. And of course, calls like I’ve had, where I can’t do what I know is needed to be done because I’m not a paramedic… They just spur me on more to keep going and get more education. And I’m counting down the days until I can be back into that classroom and start on the #questforthediscopatch.

Huh… What do I with that?

I had a rude awakening during a call today (my first call after being cleared to run lead in fact). We got dispatched out to a psych call. Basically to do a medical clearance so she could be committed. PD was already on scene when we got there, so we jsut took some vitals and did a quick once over. Problem… According to PD we had to wait for the case worker to show up with the paperwork we needed to transport against the patient’s will.

This call, just sitting there and trying to keep a patient who is very agitated calm, showed me that I have a lot to learn when it comes to dealing with psych patients. If she had been a medical patient I would have felt very comfortable treating her, same to a lesser degree for trauma. But since there was nothing physically wrong with her, I was at a loss on waht to do.

Guess it goes to show that you are never done learning.

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/

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.

Part 2 of comparisons

So, as I’m sitting here in the station and just waking up I’ve been thinking of some more differences in this system versus other, more urban, systems I’ve worked in.

The fact that I have spent a third of this shift asleep, and another third reading and studying and still have a third to go. I’m serious, that in itself is a big difference.

I’ve been told I have something of a white cloud over me when I’m doing EMS. My preceptors for medic school v1.0 noticed it when I would be on their buses or in their station, we would go longer than they had ever seen without a call. And when we did get a call usually it was something that was BLS and not much of a challenge.

But even when I worked for an IFT service (being a Transport Monkey :P), I would usually run at least 2-3 calls in a 12 hour night shift, and normally have upwards of 10 calls in a shift.

It’s something that concerns me about working here when I become a medic, or even now as an ILS/ALS provider. If our call volume is this low, how am I going to maintain my skills and keep in practice? This service runs approx 1200 calls/year. I think my truck in Urban NM ran that in 6 months.

 

Well, it’s the day after I wrote the above. Wouldn’t you figure it that right after I finished typing it, we got hit with three back to back calls and wound up staying over by almost two hours.

Guess it goes to show that tempting the EMS Gods is never a good idea.

And after runnign calls yesterday it seems like while our call volume might not be the best, a lot of the calls that we get are actual emergency calls. People around here tend to drive themselves to the ED when it is not something major, or go to their family doctor. The majority of our BS calls actually come from the little bandaid stand hospital to transfer the patient to the Big City Medical Center.

But I’ll keep in mind from now on. No antagonizing the EMS Gods.

Reflections on my first week

So I made it through my first week. It wasn’t bad (Except monday, but I’ll get to that), and actually kinda fun.

Monday was the easiest day of my week. I went to the station at 0800 and filled out a little paperwork. Then I went to City Hall (right behind the station) and wound up in Hell. The city orientation is basically locking you in a room with someone from HR, and you have to read, out loud, the city employee handbook. All 60 pages of it. Then sign some more paperwork. It only took about 4 hours, but it felt like it lasted forever.

Tuesday through Friday I ran on the 0600-1800 shift as third man on the trucks. Trying to get my feet wet and learn the protocols. I Found out just how different this system is than any other system I’ve ever worked in though.

One of the big things was when we were toned out to a MVC. It was out in the county and we wound up scrambling a bird to meet us on scene due to how far out it was. Our local VFD was also paged on an all-call, with no telling how long it would take them to get in the rescue truck and get to the scene, since it was the middle of the day and no one is on duty at the station, ever.

My medic unit got on scene first, and with a crew of three plus the cops on scene we split up and each took a pt. We also called in to dispatch and had them send medic 2 out when the on call crew got to the station. We had a 2 vehicle MVC, with one car being T-boned by the other. The car that was t-boned had two people in it, while the car that hit the first had one. I went to the side impacted vehicle and started assessing. The lead EMT-I on the truck (it was me, a basic, and another EMT-I as the crew that day) brought me a couple of c-collars and told me that I would be on my own as him and the basic got the first patient into our rig.

I looked around and noticed that the only people around me were LEOs. This in itself was very unusual for me. Back in ABQ or Denver, by this point, we would have at least an engine company on scene, and maybe a FD rescue as well. If not a truck and engine company. I got in and got collars on both patients and had PD hold stabilization for me while I assessed both patients. The driver seemed a little dazed but denied LOC, and only had a couple lacs on her forhead from glass from the passenger window breaking. She was belted in, with no damage to the steering wheel or starring of the windshield. I looked over at her passenger and decided she was stable enough to wait.

The passenger wasn’t so lucky. His side of the car had been hit, shattering the window and causing about a foot of intrusion into the passenger compartment. His seat also apparently broke and was reclined the entire way, with no sign of the seatbelt being worn. He was less than alert and moaning that his right ankle hurt (with the intrusion that was no surprise), and so did his back. We couldn’t get into the car from his door due to the damage. The crew of Medic 2 comes up to me while I’m assessing my second patient and getting a line in him, and asks me what I need. Imagine my surprise that my chief is on the crew of Medic 2! Talk about nervous.

I tell them that we need to get my guy out, but we can’t until the FD gets here with Jaws. So I tell them to extricate my female patient and get her to the rig. When that happens we finally get some FD showing up (about 15 minutes into the call) and they come over to me to see if I need anything. It’s at this point I find out that a couple are trained to the ECA (First Responder) level, and there’s only one EMT on the FD, who happens to be the basic on my truck today. Most don’t even know how to board and collar someone. Great.

While they’re setting up the jaws I see that his foot isn’t trapped on the door, just hung up. So I figure out a way to pull him out without cutting into the car. We get him out and on a board much quicker than we could have if they cut the car apart. This also pisses the FD off and makes them mad at me since I took away their reason for cutting apart a car.

To finish the story we get him loaded into my rig and run code to the ED with him, then wound up transferring him to the trauma center later. We cancelled the bird when we saw the scene and realized we didn’t need it.

This call woke me up to what a rural provider has to do. As the EMT-I on a truck with a basic partner (which will be my arrangement once I’m done with mentorship) I will have to be in charge of patient care, maybe of several patients, just the two of us. With no real backup except maybe our on call truck or a bird coming in. FD response can be very slow, and PD doesn’t like getting their hands dirty, at least that part doesn’t change.

I don’t know how many of the medics I worked with in ABQ would be willing to, or do well at, working in a system like this. They got way too used to have 3-5 medics plus a slew of EMTs standing around on scene just waiting to be told what to do. Working in my new system means I’ve got to handle everything that comes at me, and be able to do it fast and efficiently. Not to mention long transport and response times.

But to tell you the truth I don’t think I’d trade it for anything. I’m very excited to go to work tomorrow morning (well, except for the whole having to be there at 0600 thing 😛 I much prefer nights), and continue to work here.

There’s a few more things about this system that shocked me, but I’ll get to that later. For now I’m gonna crash out pretty soon.

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.
—————————————————————————–
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.
————————————————————–

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.