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.

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.

 

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.

Another chapter begins

Over 10,000 miles, travel through ten states, and three long months. All of it to get to this point.

Tomorrow I start my new job :) First day is of course paperwork and going over the handbook. I also have a meeting with my new medical director. I start ride-outs on Tuesday :)

It’s been a long, disheartening process to get here, but I keep getting told that everything happens for a reason. Let’s hope that’s right.

Now it’s time to sleep. I hate long drives lately, and although my drive today wasn’t too bad, it still tired me out. Tomorrow will be a busy day, especially since I still have to find a place to rent in this small town.

Tomorrow is the start of a new chapter for both work and school. Let’s make the best of it.

Are those shears in your pocket…? My Handover post

“So this is it, guess it’s time to head in,” I got out of my Jeep, made sure I had my pack and binders, and walked in the front doors of IFT Hell. This would be my first night ever being on an ambulance, and I wanted to make sure I was early and had everything I needed.

I checked in with dispatch, let them know who I was, and who I was riding with. They told me that my preceptor and his partner would be in shortly and that I should wait for them in the break room. I get there and put down all my stuff and decide I should go through it one more time.

“Lets see… shears, check, on my right leg, protocol book… there it is, let me just put it in my backpack. Penlight… Yep, right next to my shears… along with several pens… oh hey there’s a sharpie there too. iTouch w/ Epocrates… Yep it’s in my left side ankle pocket. Cell phone in my left thigh pocket. Wallet… crap. I need that to drive!” I scramble frantically and pat every single pocket I have, till I notice it sitting on the table right by my backpack. “Right, that goes in my right thigh pocket. I’ll put some gloves in my right ankle pocket.”

Now, lets see what I put on my belt,” was my next thought. “Leatherman, flashlight, rescue hook, and radio loop. Got all of that where I can get it.” Well, it looks like I’ve got all my stuff.

I waited there, looking at my PHTLS book and protocol book waiting for my preceptor to show up. I must have waited there for a half hour before the dispatcher came rushing in.

“Good you’re still here! I kinda forgot to tell the crew you’re riding with that you were in here and they left without you. Just get your stuff and wait out front.” She blurts out as she’s almost literally pushing me out the building’s front doors. “Sorry!” Was her final words as she rushed back into her little den of evil.

Great… first day and I’m already late… At least it’s not really my fault this time.” I think to myself as I fidget nervously with all my crap I’m carrying. The ambulance comes to get my quickly as I get introduced to the crew I’m riding with. The medic takes one look at me and laughs at me, as he asks, “This your first EMT job?”

—————————————————————————————-

A lot has changed since that night two and a half years ago. As I’m getting stuff packed up to get ready to go to TX on Monday I take stock in what I have for uniform items and compare it to what I carried then.

First boots. That’s one thing that’s stayed the same. I’ve worn the Converse side zip tac boots for years and love them. Comfortable from day one and they seem to last a while. I might switch it up and try Magnum boots when I need to buy another pair, but we’ll see.

Next is pants… I used to just wear the cheapest pair of EMT pants I could find (usually the original Propper EMT pants) but now I’ve mainly switched to 5.11 EMS pants. Heavy enough for NM winters, but not too bad for our summers, once the knee pads get taken out anyways. I love the shear loops on both sides, since I’m left handed, and I prefer my shears on that side. I’ve got a pair of the new CuttingEdge Propper pants coming in so I can test out a pair at my new job.

Uniform shirts have definately changed. My first service gave us gray polos that, while they were really comfortable, didn’t look the best or the most professional. My service I worked for in Denver issued white Class A shirts… I hated those. Now, my new service, is issuing me two short sleeve black ‘button down’ shirts, and one long sleeve. Complete with service and certification patches. Now I say ‘button down’ because they look like they have buttons, but really have a zipper. Should make it easier to toss it on when we get a call at 0300 and I go from asleep to truck in 60 seconds.

Hat… well, I’ve always worn hats. And this is the first time I don’t get a service issued hat, so I went and bought just a generic EMT hat, since all my other hats are service or agency hats… Or a Farleys hat that says FU in really big letters on it :p

Now for what I carry.. Here’s where the biggest change it. On my left leg I carry shears and pens, and keep my wallet in that pocket as well, along with a pen in my shirt pocket. Right leg pocket has my phone in it, along with a pen light in one of the pen sleeves on the outside. My phone that has replaced carrying a PDA and music player. I have a few hours worth of music, plus Pandora, on it, along with Epocrates, the Infor-Med ALS field guide app, and Skyscape medical calculators on it. Gloves still get put in my right ankle pocket though. I also carry a knife in my left front pocket. And of course, on the bottom of my right wrist is a watch. Can’t do my job without at least a watch.

Speaking of phone, what I’m carrying for that now is the Sprint HTC Hero, running the newest Android 2.2 build. Great phone and Android is an awesome alternative to the iOS. It’s a great reference device, entertainment device (aforementioned music, plus Twitter, FB, and games), and also, ya know, calls people.

Flashlight, rescue hook, all that other stuff either doesn’t get carried or it gets tossed into my backpack, along with a netbook and a Kindle. A shift’s worth of amusements all in a neat little package :)

Now to just find my work backpack so I can actually get it packed for next week! I might have mentioned in previous posts… but I HATE PACKING! 😛

It's gonna be an interesting few years

After doing a lot of talking with my new boss and others members of the service, I’ve come to the conclusion that my first year or two working for this service might be interesting.

First, what I really don’t like. This agency was an all-volunteer agency until about a year ago, and it shows. Now, I’m not trying to put down volunteers, as sometimes they are very professional and great to work with. But we all know some volunteer agencies who are only there because it looks cool and don’t want to do anything more than bare minimum. Or they’re there because it’s a family thing.

This service seems to be a little bit of both. Only 3 medics on the staffing list, mostly EMT-Is and EMT-Bs. A lot of them related in one way or another, and think that it will only help that they are. I’m ok with that, though, since they are willing to hire from out of the area and, hey, they’re giving me a job :D.

What I can’t stand though, is how little they care about education. They are excited to get the newest toys and gadgets, but don’t really like to look at the newest research to see why or why not they should be doing something. Tradition plays a very big role in how they think. The old “We’ve always done it this way”. Luckily they have a medical director who doesn’t like that and wants to keep pushing the protocols to be more progressive.

But things still fall through the cracks and are done just like always. One of them is working a code on scene. I’ve always been taught that you only transport a working code once you get ROSC. They are a big fan of stopping CPR to get the patient into the bus, then running hell-bent towards the nearest hospital with only one provider in the back working the code, in a moving rig, running L/S, and getting thrown around. I’m not a fan of that. Hopefully it’s one thing I can help change their mind on. But we’ll see.

I’ve talked to the chief about going back to school, since I want to finish up and get my medic soon. He’s all for it, but the minute I said I wanted to go for the AAS as a minimum, his eyes kinda glazed over. HE doesn’t understand why anyone would think that a medic isn’t quite educated enough. I love the fact that TX recognizes the extra education and issues a license, not a cert in this case, of Paramedic.

I’ve talked to a couple of the people at teh station about the EMS 2.0 movement and things like #CoEMS (I wore my EMS 2.0 pin on my dress shirt for my ‘interview’, so it was kinda obvious), and one of the on duty crew said she was all in favor of it (she was a part timer who also works as a flight medic). The other just kinda shrugged and said she had her basic, which was more than enough education for her. Not quite what I was hoping to hear. But the chief said he’s ok with me continuing to blog, as well as being active in the EMS social media aspect, which is what I wanted.

Now the service isn’t all bad. Like I said earlier, they have a very progressive medical director. I was told by the chief that if I came up with any research, that the medical director’s door was always open to improvements in the system. Also if there were any new toys that he was more than ok with me learning how to write grants to try and get money for them, pending MD approval. One of those devices is the Zoll Autopulse or the Physio equivalent. I figure if they want to risk everyone by running codes in a moving bus, I’ll see if I can get a device to make it safer and easier for all involved.

Their medical director wants them to get serious about hiring good ALS providers, and according to the chief, the MD would eventually like to see the system move to an all ALS approach. I’m more than ok with that, since it sounds like they want to try to model if after ATcEMS, which seems to be a great system. I have an official interview with the medical director already requested so I can talk to him and get a feel for how he like his ALS providers to function and talk to him about a few questions I have over just how long a leash he gives to EMT-Intermediates in his system, so hopefully I can get a good rapport with him started.

The other good news about the area… I went to the nearest big city on Wednesday morning to talk to their community college’s medic coordinator. He seemed to be a great guy, and seemed interested in me entering their program. They do offer the EMT-P AAS, which I want to take advantage of. He did tell me, though, that I can start their certificate program as early as January if I get paperwork in in time, and then finish the gen-ed courses for the AAS after I get my #discopatch. Not a bad idea. The downside is a 75 mile commute one way for classes. And clinicals. I do, however, get to do half my ride time in my small-town agency. So it is not as bad as it could be. And my new boss said he would be willing to put me on 1 24 and 1 12 a week of first out, and 1 12 every other week as second out (on call), or 2 24s a week and 1 12 of second out every other week, whichever I wanted. He is not a fan of 24s, but he said in my case it might make things easier.

I think I’ll get my medic and try to stay here for another 4 years or so at least once I get it. Then I’m seriously debating trying to transfer to ATcEMS and trying to get on with their system to finish out a career if I decide to stay a medic. but I’m not sure.

Either way, it’s going to be one hell of a ride. Maybe I can make my own little #thunder out there.

Huh

The last two days have been interesting. Right after I make my decision that I’d be more than happy to stay here in NM and finish up my BS-EMS, I get an email. From the EMS Chief at a small, west TX municipal EMS agency. I had emailed them a few weeks back to inquire if they had any openings for EMT-Is. I didn’t get any response and had kinda just put it out of my mind.

Fast forward to yesterday. I get an email asking if I am still interested in coming to work for their service, and then he give me an idea of the area and their coverage area, etc. They cover roughly 3000 square miles of their county, plus provide mutual aid and ALS intercepts for neighboring counties. They run primarily 911, but do occasional IFTs to the trauma centers about 70-100 miles away. Their calls can be anywhere from 5-40 minute response times, long transports to definitive care, extensive air-medical use, an aggressive medical director w/ progressive protocols.

It sounds like heaven to me, so I told him I was still interested. I get an email back asking me to please fill out an application (I had previously only attached my resume and copies of all my certs) and fax it to him as soon as possible, so  I did. He then emailed me saying that he figures I would want to come out and see the area, and he offered to give me a tour himself, as well as talk with me about coming to work in the area. From what everyone has told me, this seems like a very good thing.

Today I sent an email to the Chief and told him I was trying to plan on leaving my parents on Tuesday morning and getting into his area early afternoon. The next thing I know I get an email from the town’s HR office asking me to fill out the official forms for a background check and fax it to her ASAP, and to also bring the original with me for my visit.. I wasn’t aware I was going to be talking to HR when I went east to visit.

To be honest I’ve never had to do this much paperwork for anything short of an interview. So we’ll see how it goes. Since I’m not sure what it’s going to be like, I figure I’ll dress in business casual, just in case. Fingers crossed, because working for this muni third-service sounds perfect. And it’s within 75 miles of a good AAS Paramedic program.

And since this service is desperate for ALS providers (which in TX I fall under ALS instead of ILS like in NM) they might be willing to help me out to get my TX LP (Licensed Paramedic) ticket.

Just thought I’d share the last few days :)

I'm frustrated and have a decision to make… I need help making it!

I’m frustrated right now. I’ve had two phone interviews in as many days. They’ve gone great! But at the end of the interview they have told me that they don’t have any FT positions and that they can’t pay me enough for PT positions to warrant me moving out there. And I’ve gotten four more rejections in the last week, plus well over a dozen services that I haven’t heard from except for them asking for a copy of this or that. Frustrating, yep it’s a good word for it.

I’ve been debating finding any job (probably a job waiting tables again) and staying in Albuquerque. If I do that, I can hopefully start UNM’s BS-EMS/EMT-P degree program in August, and I’d be getting my full NM EMT-I cert in December, so I could start working on a bus for LCAS after that. I know the school, it’s got a good reputation, and would set me up by being a great educational background for moving on later.

I’m just getting frustrated and am wondering if moving states really is such a good idea. On one hand I paid the money to TX DSHS EMS for my EMT-I cert, but so far it doesn’t seem to be paying off. I’m sick of living with my parents and just want to get back out on my own, get my life back on track. I want to go back to school and get my medic cert ASAP. I just can’t figure out what the best thing to do would be.