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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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.

 

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.