New adventures, Familiar Place

So I have alluded to a new job several times in the past few months on here. And I figured it’s past time to talk about it. As you can tell from the new banner, I have TX and NM represented in that star of life. That’s because I’m now, once again, workin in the state of Texas.

Some of you might remember that three years ago I worked in a small rural TX community as an EMT-I. Well, now I’m back in the same community working as a Paramedic :). I work 7 days on/7 days off. It actually works out well for me. I’ll go into some detail as to what it’s like down here too. But suffice to say, it’s one of my dream jobs. And I’m having a lot of fun overall.

When I worked here before, it was a city run, third service, with pretty typical protocols for this area of Texas. Now, I’m working under flight protocols on a frontier 911 truck. We have some of the broadest sets of guidelines outside of my good friends to the south in Presidio. As a Paramedic I have free reign to use clinical judgement and best practice to deviate from our guidlines, and out critical care medics (more on that in a bit) can perform CVC placements, pericardiocentesis, chest tube insertion, and several other things. The running train of thought is that we can do more in the short term than our little community hospital can, and that they only do scans and give blood (the two things we can’t do at this point).

We regularly transport straight to the airport from scene to meet up with one of our company’s fixed wings for transport of hte patient to a tertiary facility or trauma center (nearest major hospital is a level 2. Closest Level 1 is over 200 miles in any direction). The flight team runs under our same protocols, so in this instance, the flight team doesn’t bring any additional tools (except they carry an ultrasound, ours are coming for ground) or skills to the patient. We use them strictly because we are so far from definitive care.

We also fly out quite a few by rotor. Part of this is that we cover 3000 sq mi of territory, a lot of it is pretty rugged desert. We also have one major interstate running through our county. One of our most common reasons for flying people out by rotor is that we just can’t get safely back down the road the patient is on with any sort of speed, like an oil rig lease road. We have one of the highest numbers of oil rigs in the state of texas here in my county. And with all this, I haven’t seen much abuse of air medical, it’s pretty typical for frontier Texas.

One of hte nice things about our company is that they want all medics to be certified as critical care. And we are 90% paramedic agency (we only have a handful of EMT-I and EMT-B providers. Once myself and four others go through the critical care class, we will be at 100% of paramedics certified as critical care. And I’m in that weird spot because I’m currently an FP-C, which is generally considered critical care level. And the best part is the company will pay for the critical care training. And with the schedules we work, an extra class (like UMBCs 2 weeks course) are easy enough to do trades togo to.

All-in-all I’m excited to be back here. It’s a great place to learn, and I get to play sometimes as a flight medic on our fixed wings. It’s already making me a better provider and it is my favorite type of EMS, rural with great protocols. Plus we have a great crew here. I can’t wait to see what my future holds down here.

We lost a good man yesterday

NM EMS suffered a terrific blow yesterday. We lost one of our best educators, Cy Stockhoff. I met Cy close to seven years ago when he helped proctor one of my first practical exams for EMT-B. Then I got to have him when I attempted my EMT-I cert for the first time. The man knew what he was talking about, and always pushed for us students to question the norm and push to make our profession better.

Cy taught a good portion of my first try through paramedic school, and was my biggest supporter when I withdrew from the program and took my EMT-I exam instead. He told me that life will never let you follow your plans exactly, and that sometimes things happen and you have to make do as best you can.

The last time I saw him, it was a fun little reunion when I came by his office to ask about starting their degree program with my current paramedic cert. He remembers nearly all his students, it seems, and I was no exception. He asked me how it was going, and congratulated me on my paramedic cert and asked how I was liking my rural 911 service (I  was in uniform at the time, so it was an easy jump).

Even then, he asked if I had thought about doing any further training and education, including getting my instructor certs. After those years away from being his student he still wanted me to do better than the status quo.

Cy, you’ve helped mentor me, helped me learn how this EMS thing works. You’ve made me question the ‘why’ about why we do things. I’m grateful to have been one of your students, and I will keep striving to be better, and to make our chosen profession better. Thank you for everything you’ve done for us. You’ve helped teach a state full of providers who will fight to the last, with what little we have to work with.

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Keeping Promises

I’m big on keeping any promises I make. In my eyes, if I tell you I’m going to do something, I wouldn’t consider myself much of a person if I didn’t do it. And to that extent, one of my promises to someone is getting closer to fruition.

I took my classroom Paramedic Final Exam… 196 questions, all multiple choice, with parts from every section of that giantass purple book. I finished it in just under an hour… I’ve spent the last two weeks going over every page of notes, every review and exam online. I’ve looked at books that aren’t required reading, some that I’ve been told are way above what I need to know (which of course makes me even happier to read them). All to be ready for this exam. When I finished, I was tempted to go over all the questions, just to double check. Then I remembered that I am much better at trusting my gut instinct than to question what I do.

To that end, when I finished, I made sure the Scantron was ready to go, and then damn near flung it at my instructor and walked out. I was so freaking nervous when I walked out. I spend time pacing outside and I think my first twitter was… wait, let me pull it up.

“Oh dear god oh dear god… 196 questions in just under an hour… Either I suck or I kicked ass… One of the two. Freaking out now!”

I was so freakign worried about it… I just don’t like tests, I get almost physically sick… and I almost puked afterwards. Oh? What’s that? What did I get on it? Well… my intructor that was testing us came outside to get me, and told me he needed to talk to me. He told me I didn’t do nearly as well as he’d hoped I would, and then showed me a score of 47. I swear my heart sunk in my chest and I felt like looking for the nearest cliff to jump off of. Then I noticed it said ‘Section Grade’. And I thought “Wait… there were 4, 50 question sections to that test” and I think he saw my face so he just started laughing at me.

Turns out…. 87% on the written final! I was so freaking happy I couldn’t get words out. Turns out I was also the highest written grade on the test :) Now I start the long process of clinical and internship shifts. Which my first 14 hour shift is in TX Saturday starting at 0800 or so. I plan on being done, tested, and raped by the state of NM and NREMT and be a TX, NM, and NR certified paramedic by the middle of Feb. Let’s do this shit :) Now it’s the fun part.

But first, tonight I get to have fun. I get to go to this beautiful girls graduation party tonight. She is graduating with her BS from a local university, and I figure I wanna spend time with her, plus it’s a chance to relax. I’m just glad I passed the final or this party would be a little less fun :p

Oh, and in other news…. Ya’ll know this yea has not been the best for me. And this holiday season feels rather empty for me as well. I was asked by a friend of mine, a medical professional that used to be quite active on Twitter under an older name, to help her and do a guest post on suicide prevention and recognition. I was flattered that Dani would ask me, and I said yes. It was a hard post to write, but it’s one that needed to be written. And in writing it, I think it helped me a little bit too. Ya’ll can go take a look here (click the image):

My guest post

For Some, Its NOT the Most Wonderful Time of the Year – Part One

 

Alright, well I’m out for now. I need a nap before tonight :p That drive to and from TX sucks lately :p Ya’ll stay safe

Intense

Whoa… I really meant to update this thing earlier than this. The last few weeks have been intense. Right now I’m sitting in Santa Fe NM covering a 22 hour shift on an IFT ambulance. I’m about to take a break from everything and try to take a nap. I’m so short on sleep right now it’s probably almost dangerous.

So, how’s everything going? Not too bad overall. I finally saw the inside of my apartment on the way back from class early this morning. Was nice to sleep in my own bed, if only for about 3 hours. The past few weeks have shown me it’s gonna be a long few months, but it will be so worth it to get pinned as a medic.

Speaking of class. I’m almost all the way caught up finally. I started 3 weeks late and have been doing both the work assigned as we go and all the stuff I missed. Luckily it’s a lot of review for me. Right now my average is hovering at about 92% and I am regularly getting told to shut up in class so someone else can answer. I’ve finally decided that I’ll just keep my mouth shut unless I have a question or am called upon.

We are working on airway right now, and we actually had a former flight nurse teach our class last night. She was probably the best instructor we’ve had so far in this program. But then again, she went into much more depth than most instructors think we ‘need’, and since airway and cardiac are my two favorite subjects I’m not going to complain.

We also go to play around with IVs for the first time for some people in our class. I was 3/3 live sticks, and 0/3 for anyone actually getting a stick on me. I told them I was a harder stick, but no one believed me. I did get asked to help with showing people proper techniques for IV insertion. IT actually is showing me that I like instructing. I’m seriously wondering about when I finish my BSN, going for a secondary BS in education.

But pretty much the class is going well. We were given some bad news that we can’t start any form of clinicals or internship rides until almost the first of the year. IT’s gonna be rather annoying because of the long commute, but I’m thinking about volunteering for a VFD district in Las Cruces area just so I can have a place to crash for free and get some more run volume. Yep, my life is revolving around EMS until I get my medic, there’s just no other way to work it and still have money. Hell, my schedule this last week has had me sleeping in my 911 coverage area at one of the spare bases instead of having to drive back to the city and sleep, then turn around 6 hours later and drive down to Ops to pick up my classmate and make the drive to TX.

So… yea, that’s just a quick update. There’s more I wanted to write about but for now I think I’m gonna go take a nap. I’ve got more homework to do still.

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.

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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.

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.

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.