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.

Code Blue, Code Stroke,… Code Green?

Recently, a group of EMS providers and First Responders have come together to make something that is near and dear to me. I present to you, the Code Green Campaign! There has been much talk recently on social media about suicided in first responder circles. Including a medic who committed suicide at his station and his partner attempted to work him. And there has been talk about the stigma that surrounds our profession and others like it about asking for help.

The Code Green Campaign is trying to break those stigmas. Please everyone, check it out. I don’t want to lose any other brothers or sisters, no matter what patches or uniforms you wear. I have lost someone very close to me once before and don’t want to go through that before. Mourning bands are not something I want to break out on a regular basis.

On the site, there is a list of resources geared just to us, the first responder community. There’s stories from other providers about their own issues and problems and how they took it on. There’s even one from yours truly that has been submitted. It’s a great idea, backed by a great group of people.

Even if we can just save one brother or sister from taking their own life, it would be worth it. But please spread this around, give it as much publicity as you can. We need to cut out the stigma that comes with asking for help. After all, we are all taught that our safety comes first. That includes unsafe scenes and unsafe mental states. Take care of yourselves people!

-TJ

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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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

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

Ow

I’m still alive, I promise. Although with how I spent last night I was wishing I wasn’t. Have you ever noticed that medical providers are the worst patients? Well, I know I was last night until they could get me to stop throwing up and ease my pain a little bit. Fast forward to about 6 this morning and I’m told that I have an even bigger gallstone than they’d seen the last time. Guess one of the things on my list to do is try to eat better and eat more regularly.

So… because of that I missed class this evening. I’m still feeling like crap. But I’m getting better. I’m gonna try to make that long drive down to TX tomorrow to make it to Friday’s class. I hate missing time in class for stupid stuff like this. But I have gotten some homework done today. It’s trauma sessions in class this week and next week, then we have a weekend PHTLS course which sounds like a lot of fun 😀

But I also keep getting distracted by CoEMS (FRN.tv) Seat at the Table which does me no good getting things done :p But hey, I’m still expanding my education. Just not quite in the way my instructors even think in. Or the majority of my classmates for that matter.

All of you CoEMS/EMS2.0 types out there reading this, any tips on how to get instructors to acknowledge that newer information than our text books is out there?

Well anyways, I’m gonna go read again. I’ve got about 3 quizzes to get done before tomorrow. And I’m really hoping I’ll even make it down there tomorrow for class. At least the new car is fun to drive.

Ya’ll have a good one. Class then 36 on a bus 😀

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.

And so it begins… Again.

So now that the tough post is out of the way, let’s move on to something happier shall we?

Today was the first day of medic school, mk 2 :) As with any other first day it was interesting, to say the least. One of the most telling things about the program is that there were four of us out of 20 that were not members of the City FireDept, and one of the 4 has been trying to get on with them for years. It does sound like CFD tends to use them as a medic mill, but it is an 11 month program, so it’s better than most mills.

This first semester will be Intro to Advance Practice for the first 8 weeks and Airway/Patient Assessment for the second eight weeks. And for about 14 of the 16 weeks we will be doing clinicals both in the hospital and on the bus. And I was told that I can do up to 50% of my 80 hours down here in BFE. Which is nice considering that just driving to class twice a week will rack up 300 miles at least on my car per week.

We also will do 2 4-hour OR rotations for ETI. I like this a lot, since my program in NM couldn’t secure any OR time for medic students due to the increasing popularity of LMAs and the asses some of the medic students made of themselves in the OR. I’ve got an advantage in that since moving out here I’ve gotten several field tubes, so I know I know how to do it.

And on the subject of skills, I’m apparently the only EMT-I in the entire program. All other 19 students are EMT-Bs. So I was told I’ll be held to a higher standard for skills that I have more practice with than the other students. Not that I mind that. It also means I don’t have to check out in class on IVs I get to go to clinicals a little earlier than the other students in the program.

So far the staff seems good to us. The only thing that struck me that I hate is… well, it’s something I’m not getting away from since the college is an accredited school now. And that’s FISDAP. FISDAP is something I used a little bit in NM and I swear it is just like dispatchers, minions of satan. But win some lose some I guess.

And one of the better parts of medic class is I might have someone that I can car pool with and study with here in BFE. A Vollie for Tiny Town Vollies is in my medic class. And she’s very very cute. It’ll be nice to have someone to drive with, if she agrees to it (we’ve already brought it up once) anyways. The only downside to her incredible cuteness though… her father is a TX DPS Sgt… I rather like my body parts intact and she’s just barely 21 so I’m a little scared off.

Anyways, that’s just first impressions of this medic program. Next class day is monday and I’ve got a ton of extra paperwork to fill out for them, not to mention finish reading the first 5 chapters of volume 1 of our Paramedic text. Not to mention get on Blackboard and register for Med Terminology and A&P (which I’m not dreading at all since they’re both online courses). Ya’ll have a good night, I need to try to get some rest. I go in for a thirty-six in 6 hours.

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.

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

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

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

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

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

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

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

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

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

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

98% sheer boredom, 2%…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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.