Another night in the ER

Week two of orientation. I swear every time I come in for work it’s a much different experience. Working in a hospital again is something I swore I would never do, but it’s been kind of fun. And the pay is a whole lot better.

I also get to interact with docs a lot more than I have in the past. Which is a good thing. They respect our input as medics, and will ask us for our opinions about what they are ordering for our patients. It’s kind of a nice feeling that we are treated as healthcare professionals by them as well.

I’m not sure why so many people badmouth nurses at this hospital, but I also haven’t seen the attitude towards EMS crews that many complain about. I have heard very little comments of “ambulance drivers,” other than to crews that pretty much only deserve that title. For the most part, the RNs here are very considerate towards the crews and will actually listen to them. Same with the treatment they get in the Trauma Room from the docs and the trauma team. It’s actually kind of cool to see how everything plays out from this side.

But on the other hand, I can’t wait to get back on a truck. I haven’t worked an EMS shift in coming on two weeks at this point, and I miss it. I’m gonna probably go back to that little rural service I used to work at in the next week or so and start to pick up some shifts. I have been informed that my services at the Evil Empire are no longer needed, so that’s one less thing I have to deal with.

Anyways, ya’ll stay safe and I’ll update later. I’m actually getting rather busy tonight lol

BTW, these night twelves are killing me. I miss my bunk for shifts

This is weird…

So… it’s my first night as an ER Paramedic at the state’s trauma center… So far all I can say is;
This is weird… Very weird. It’s kinda fun though, since there are only two of us (counting my trainer) here on the floor, and we are responsible for not only primary patient care on up to 6 patients at once, but also we are the go-to people to help in the rest of the unit and the trauma bays.
I honestly never thought I wanted to go back to working in a hospital again, but this could be fun. Plus there’s the amazing benefits and the option of free education on a pretty consistent basis. I’m still going to be working the truck at least a few shifts a month (or one a week I hope) but this will become my primary job. It’s also easy to transition to a flight team job after I’ve been here a while, since the hospital runs a fixed wing program.
But this is also my first night shift in a long time that going to bed when I’m not doing anything isn’t an option. THAT I don’t like. But here we go. Another chapter opened, another door taken. Let’s see what kind of trouble I can get myself in.
-TJ

Also, please be sure to check out my facebook photography page, or look on my Tumblr page for more of my photos. Links are attached to my about me page.

 

And as an aside, I’m not sure why comments are being disabled on certain posts. If you have a comment or concern, post it to either my facebook page for the blog (Life of a Transport Jockey) or email to me at transportjockey@gmail.com

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.

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/

The shift from hell

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

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

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

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

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

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

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

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

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

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

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

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

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

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