Wait… Already planning again?

I’ve been here in BFE, TX for about two months, yet I’m already looking at planning my next move. Actually my next two at least. Maybe being single actually a good thing… Since I apparently have a problem settling down and staying in one place for very long.

I plan on staying here in BFE for at least 2.5 years or so. Long enough to get my AAS in Paramedicine and my Paramedic License (not cert) here in TX. Plus it’ll give me good experience working in a 911 system, and prove to myself that I can handle being definitive care for a long transport until I can actually get them to a hospital. That means a lot to me since I’ll actually have time to see my interventions make a difference or not, instead of dropping off the patient after only being with them for 10 minutes or so.

It’s ok living here, but it kinda sucks to have to drive at least 70 miles to do anything. I guess while I like living in a small town, there’s a limit on just how small. The town in NM that I lived in HS was just barely larger than here, but it had a college and a few things to do at least.

After I finish up my AAS and get some experience, I’m looking at moving back to NM and going to the University there and going for my Bachelors of Science in EMS on the Critical Care track. There are a few services I can work for down there that I am pretty familiar with, plus my old service down there if I really wanted to.

Some people have asked why I would make a move in the middle of going to where I really want to work at just to go to school for another two years, especially since I’ll already be a paramedic. Well… because I believe that more education is essential in this field. I want to have as much education as I can so I can better serve the patients who trust me with their care. The fact that they don’t get to pick and choose who responds to their calls makes me want to work that much harder to make sure I’m the best provider I can be and see if I can help change the system from the inside out.

I figure I’ll stay there for a few years (as short a time as I can manage while getting my degree) and then get ready to move again. I really don’t want to do career EMS in Albuquerque, just not that fond of the system there. I’ve been looking at various systems that I would love to spend my career working in and I’ve come up with three of them. One is Austin/Travis County, of course. A great third service in a good system. I’ve heard only good things about them, but heard they might be going to a P/B or P/I truck instead of the P/P trucks like I’ve heard they run.

My second option is Wake County EMS. This one appeals to me due to the fact that they have a community paramedicine program. That type of work really makes me happy to think about. I’d love to do it.

And the last option I’ve thought of so far is back to Denver to work for Denver Health Paramedics. Primarily a Paramedic agency with very few BLS trucks. I love the area up there and the agency didn’t seem too bad when I was there.

So those are my rough plans for the next 6 years or so of my life. Lets see how much life will throw at me and force me to change those plans. :)

Well, I’m on shift now as well, so it’s time to watch some more TV unless I find something else to ramble on about! Ya’ll stay safe out there.

Just a quick note… I was told I am provisionally accepted to the City College Paramedic Program starting January 11 :) If all goes well I’ll get official notice the middle of December and be graduating at the end of December 2011 😀 Then I’ll be continuing to get my AAS in Paramedicine so I can get my Texas Licensed Paramedic ticket 😀

http://transportjockey.com/2010/11/16/173/

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.

Why am I doing this?

“3027, we’ve got a code 3 two blocks from you,” a radio crackles from the cab.

I look up from my paperwork and sit bolt straight. Time to stop being the box troll and actually get to do something.

“27, responding to address,” my preceptor calls in as the MDT shows the location. “Any info on type of call?”

With this I perk up, picking up the handset in the back to listen better to what is going on.

“Working code. PD states scene is secure, officer performing CPR. Fire is five out, Engine and Rescue 12 responding with you,” the usually demonic box blurts out.

Hearing this I start piling the gurney with our bags and monitor. I look up and see us pulling up to the address stated on the monitor. Jumping out of the module, I notice a chaotic scene already. Multiple police units on scene blocking off traffic. We get to the wreck of a vehicle, or what had once been a vehicle and take in the area.

A blue Land Rover, brand new from the paper plates on the back end, somehow wrapped itself around a light pole in a residential community. Usually a quiet section of town, everyone seems to be out rubbernecking. The front end of this SUV seems to be pushed all the way into the passenger compartment, with the engine no where in sight. No glass anywhere in the vehicle, the rear end shatter with wheels pointing in opposite directions.

We rush over to where the cops are all gathered in a huddle and ask what is going on.

“Kid was racing some friends down this road, lost control and then over-corrected, looks like he rolled it once or twice and then smacked right hard into that pole. We found the kid laying right here,” the shift Sgt tells us as I look at the distance between the wreck and the body on the road. A good 20 yards or so.

I look at the mangled form lying before us. He doesn’t look a day older than 16, wearing the colors of a local high school. Blood coming from his nose and one ear, a leg that is bending in a way it shouldn’t, bone coming out of his left wrist… This kid is not doing good. The cops have him hooked to their AED and are doing CPR, for once good quality, and bagging the kid. I quickly remember that being the box troll means I’m in charge of the scene.

“Get our monitor on him, grab the airway kit and O2 tank. Lets get him exposed,” I start barking out orders as I get set into motion. “We need someone to hold him C-Spine and then get IV access. Two large bores if we can get them.”

As I’m saying this the engine and the rescue pull up onto scene. I yell at the oncoming crews to being a board, block, and straps. Quickly looking at the monitor I see a flat line where we should be seeing beats. It turns into a mess of jumbles when the cops finish their bagged breaths into the kids and start compressions again. I look at the fire medic and tell him to get me some lines.

With that I grab the intubation gear and move to the head. 7.0 tube, stylet, 10cc syringe, laryngoscope, and tube tamer all in my hands as I get set up. I look up as I get ready and see two lines in place from the fire crews.

“Push a mg of Epi now!” I shout out towards the other medic. Then I turn my attention back towards the head. They have just finished bagging him again. I lay on my stomach with the scope and tube in my hands. Feeling the gravel cut into my chest, I go in and take a look. I ask for suction and start to clear away some of the bloody secretions I’m seeing. I think I’m seeing the white lined hole of the vocal cords. I push the tube through and pull the scope out. Pulling the stylet out and inflating the syringe I hold the tube steady. I quickly attach the inline capno and the bag to it and tell the firefighter to give it a few good squeezes.

Grabbing the stethoscope from it’s place in my right left pocket, I take a listen. It’s hard to make out, but I hear air movement in the left and very little in the right. A quick glance at the capnography shows that we’re in. Thinking quickly I reach over to the airway kit and bring out some iodine and a very large fourteen gauge catheter. Swab the betadine and stab the cath into the right side of the chest. We get a large rush of air and the firefighter tells me that the bag is easier to squeeze now.

“Squeeze that bag about 15 times a minute and tell me if it gets harder to squeeze again. Don’t stop while he’s doing compressions!”

I go to the med box and start handing my fire medic drugs as I want him to push them. A mg of Atropine, then another mg of Epi. We alternate until we have all three of Atropine on board. Then it’s just straight Epi. Amp after amp of the drug is pushed into this kids body. We don’t seem to be making a difference. I decide on a Hail-Mary and toss the other medic an amp of bicarb. We push it in along with another 500cc’s of fluid. Still nothing. I tell everyone to stop what they’re doing. Looking at the monitor reveals no change. They resume.

I ask for the hand-held from my preceptor, about to call the hospital for orders to terminate efforts when we stop and I see a lot of random squiggles on the monitor. V-Fib!

I reach over and crank the monitor to 200J, and yell out to everyone to clear.

“Everyone clear! Shocking!” The monitor hums as it builds energy. When it stops and the button flashes I hit the button, kindly marked with a lightning bolt for those firefighters who can’t read (I kid I kid, but we do call it firefighter proof). And then the sound. The sound that only a defibrillator can make. The patient gets a good jolt as 200 Joules of electricity get pumped into his body. The person doing compressions, now my units driver who happens to be an EMT-Intermediate, starts up as soon as the shock is delivered. I take the bag and start squeezing, trying not to go so fast, and knowing I’m failing at it.

When we end our set of compression I look again. This time it’s a more regular set of squiggly up and down waves. Ventricular Tachycardia. I reach towards the neck and am rewarded with a weak and thready pulse. But it’s a pulse!

I give the bag to another firefighter and reach back to the med box. I draw up 1.5mg/kg of Lidocaine to try and get his heart under control. No more compressions and he seems to pink up a little. The Lido is in. We quickly get him boarded and in my truck. The rhythm is still V-Tach, still has a weak pulse. I flip the monitor to sync cardiovert as I feel us get moving.

“Code return!” I shout up to the front. Grabbing the radio I give a quick report, “Male, late teens, was pulseless and apneic on scene. Tubed on scene. Worked him for twenty. 3 of Atro, 3 of Epi on board. 1 of bicarb. Went into V-fib, shocked once at 200 then into V-Tach with a pulse. 1.5 of Lido on board as well. Running hot to ya’ll, be there in five, see ya in the trauma room. BP is 70 palp. Getting ready to sync him.” I try my best to keep it short and give them all the info they need.

I charge the monitor to 150 and ensure it’s still on sync. It is, marking the peak of each QRS. “Everyone clear!” I yell out.

I let it charge and listen to the whining sound it makes. Then I press the shock button. The patient jolts again. I quickly look at the monitor and feel for a pulse. Monitor is showing a sinus rhythm with multiple PVCs. Pulse is now
stronger.

We get to the hospital and have a team of techs and nurses waiting for us in the bay. We get the gurney out and rush him into the trauma room. “Late teens male, was pulseless and apneic on scene. 7.0 22 at the teeth, good waveforms on the monitor. Apparently ejected from vehicle. 3 Atro, 3 Epi, 1 of bicarb, and 1.5 Lido on board. Converted to VF, one shock at 200, converted to VT with a pulse. Low BP. Sync’d at 150 converted to Sinus with multiple PVCs. A liter and a half in so far.” I watch with fascination as the trauma team takes over from here. An art line, blood hung on one of our lines, ABG drawn, fractures assessed.

We get the kids wallet out of his tattered pants and give the unit coordinator the info. I look at the date of birth… The kid is seventeen a couple of days ago. Seeing that I walk out to the bus, and look inside. It’s a mess. Almost like a tornado hit it. I suddenly feel dizzy and sit heavily on the back bumper. I feel my breakfast coming up and the next thing I know I’m staring at it in a puddle on the sidewalk.

I feel arms help me up and someone putting a mask to my face. I see my preceptor smiling and telling me that I did great for my first code. I’m not really hearing it. I just keep seeing that kids birthdate floating in my head.

—————————————————————

I have been asked, since this is my extension, why I want to do this. Why I want to be a paramedic. To run the streets and help people. I’ve never been able to come up with a good reason. It really boils down to the fact that nursing school was full and had a long wait list. Now it’s become something else.

I can’t imagine doing anything else. The street has an allure that is not easily turned down. And when you have that good call it energizes you. Calls like the one above. My first code this internship. My first field tube. My first shock. My first save. I can’t get the memories of that call out of my head even now, a week later.

I’ve been told that I have all the knowledge I need, but now I just need to show I can use it in the field. Calls like this help with that. It shows I can think on my feet. I know what needs to be done so I do it.

And for anyone wondering what happened to us after this call… We were out of service for almost an hour, and I was sucking down O2 for a good half hour trying to calm down. It feels good to get it on paper though.