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.

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?”

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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! 😛

EMS for the Cure

My one or two readers may have noticed a new little image up in the upper right side of my blog. It’s to show my support for EMS for the Cure. It’s something that this year I can only support by trying to let more people know about it, unfortunately, but I’ll do what I can.

We all know someone, either directly or indirectly, who has been affected by breast cancer. For me it was my mother. She was diagnosed with a rare form of skin cancer that had metastasized to the breast tissue. This was during my Jr year of high school. For the next two years she battled the cancer and went through horrendous chemo treatments, two surgeries, and lots of poking and prodding. She was really the strongest person I have ever known as she went through all of that. She wasn’t going to let anything stop her from seeing me and my brother walk across the stage at graduation, and it didn’t. Two weeks before we graduated she had an appointment and was told that the cancer was in remission. That was the best graduation present I could have ever gotten.

She was there in the stands as her boys walked across the stage to get their diplomas. She was there with us at our graduation party, and she was there when we moved out to start our college careers. Since then she has been cancer free, but I know not everyone is so lucky.

And it’s for those people, and the ones who did beat cancer, that I ask everyone who can to give just a little, or a lot, to help fight this disease. Those of you who are fellow bloggers, go pink for the next few weeks, in honor of national Breat Cancer month. For all of you that already have, thank you.

My entry for EMS week 2010 'I was there'

After reading ADs blog tonight, I got inspired to write this. It’s a shorter version, since I’m not even halfway done with the long version and it’s over 700 words 😛 This night is one of the times working as a transport jockey that I felt like I made a difference. It made it worth it to be working Christmas Eve night, with miserable weather. I hope you enjoy it.
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My partner grumbles as she brings us into the ER bay. Time to get another patient to take home. On this very cold and snowy, very unusual for us in New Mexico, Christmas Eve. “Why are we doing this again?”

I shake my head as we go inside and get our patient for the call, a very nice lady I’ve taken on several occasions for radiation appointments. But now we are called for something different. Something that, while part of my job, can be some of the hardest calls I go on. We are taking her for home hospice. This might very well be the last time I see her. So I am determined to give her as smooth a trip as I can in this horrid weather.

She is out of it for most of the trip, her mental status having slowly degraded over the months, her husband tells me from the front. I remember it’s been at least 3 months since I’ve seen her, and when I last did, she looked nothing like the tiny woman who seems to have wasted away.

It’s slow going, as a lot of the roads are icy coated. We try our very best to minimize bumps and jostles as my patient moans in pain on my stretcher. I just talk to her, reassuring her, as her husband looks back at us from the walkthrough.

“All she wanted was to get home and be with her family this one last Christmas. She wouldn’t let them admit her upstairs,” he tells me while smiling at his wife sadly. “She just wants to see her grandchildren smile as they open presents.”

“Is the whole family going to be there?” I ask, knowing that all of their children and grandchildren live nearby.

“Almost. We have one son flying in from Iraq now. He should be here late tomorrow. She’s hoping to hold on until then,” I notice a few tears roll down his face as he says this.

We eventually get to their gorgeous home, and intact no less, and get my patient covered with a blanket so she doesn’t get we or cold as we wheel her inside. As we walk in I notice a hospital bed, looking quite obscene, to one side of the Christmas tree. I also notice the whole family is awake, now at 11pm, to greet the family matriarch as she gets home. They just watch as we gently move her over to the bed and get her tucked in and as comfortable as possible.

As we start to step back the family circles around our patient, and you can feel the love flowing in the room. We get our gurney organized and the required signatures for the transport from the husband. I go to her bedside to tell her Merry Christmas when she looks at me and utters her first coherent sentence in the entire time she’s been with me tonight.

“Thank you, TJ.”

With just those words, and a last look around, we head back out to the bus. I feel a tear roll down my face now. I look at my partner and say, “This is why we do it, no matter when or what it’s like outside. Sometimes we do make a difference, even if it’s just taking someone home.”