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Truth

Truth
Bleeding

Disclaimer:

Everything you read here should be considered fiction. Patient rights will always be respected. Any resemblance to persons living or not is purely coincidental.

Tuesday, December 27, 2011

Home again - back to work and ambulances!

Well, back to reality.
Eight days in Arizona was a decent break, even if I did have to spend it with my family ;)

Still very little snow, and no calls as far as I know.

Just went to check on the ambulances, and only Effie is in the bay.  New ambulance is nowhere to be found - need to check in with The Pit Boss on that one. (Guess they managed to borrow the garage next door to get the new rig under cover - will check that out later).

Effie went in for warranty work a couple weeks ago, so it's good to have her back.  Did a quick check of supplies, popped a fresh bag of saline in the IV warmer, but other than that she looks good to go!

The search for a duffel bag for the c-spine supplies continues (goes with each backboard: adult & peds c-collar, head blocks, back raft, duct tape).  The bags we had were not great as I ripped the zipper off one the first time I opened it.  Also just a wee bit too small.  So I looked around and found what I thought would be the ideal bag.  Metal zips, heavy-duty cordura, but still at a decent price.  We bought one as a test, thankfully, as it was HUGE.  Chagrined by my lack of measuring skills, I went back to the old bag and found one that was just a bit bigger.  Arrived while I was on vacation, so I just got the chance to test load it.  Looks like a winner!
Heavy duty and the right size.  I'll offer a plug here for the folks at duffelbags.com - they have EXCELLENT customer service and listened to my requirements and offered great suggestions.  I highly recommend them.

Still have hefty to-do lists.  We are back to EMT class on Monday with General Pharmacology, so I need to make the most of this week to get some tasks done.  Mr. Medic is back from vacation later this week, so will likely have his help.  Taylor is around as well, but pretty much everyone else is on vacation.



NEW AMBULANCE:

  • Wash
  • Apply striping and decals (just a big white box right now)
  • set up strap system for backboards
  • set up strap system for stair chair
  • mount wall holders for protocol books
  • mount glove holders (waiting on shipment)
  • draw supplies from stock
  • organize supplies
  • set up bins for supplies (when they are delivered)
  • label bins (about halfway done)
  • label ambulance (informational labels for radio, etc.)
  • set up 2 spare portable O2 bags
  • install trash can
  • set up spare portable suction (ambo manufacturer forgot to send the new one)
  • arrange forward compartment (waiting on extra shelf hardware from manufacturer)
  • set up manual BP
  • order duffel bags for c-spine supplies
  • measure bins we have for next order
  • measure backboard retention strap system to replicate for Effie

EFFIE:

  • Wash
  • Wax
  • remove paint scratch (um, I'll tell that story later)
  • sew and install new backboard retention straps
  • Full inventory
  • White Board for the ambulance bay
THE BEAST (New Volunteer Ambulance):
  • Contact Tess at the volunteer squad to find out what's needed (still a lot of work to do, last I heard)
So off I go!
8 hour days at work, plus trying to get the house in order for the nephew & sister who return Friday, get work done on at least two of the ambulances, and try to get further ahead in EMS reading.

Another relaxing week.

Thursday, December 15, 2011

No calls, lots of ambulance work, and something of a personal life

Yep.  No calls. Been weeks now.
HOWEVER our winter season just 'officially' started, so you never know.

We are still working on kitting out the new ambulance.  It surprises me how much minutiae is required to get it right!  Have had tons of help, but true to fashion Mr. Medic is securely working his tush off on it.  Here's the "to do" list (in no particular order):
  • Wash
  • Apply striping and decals (just a big white box right now)
  • set up strap system for backboards
  • set up strap system for stair chair
  • mount wall holders for protocol books
  • mount glove holders (waiting on shipment)
  • draw supplies from stock
  • organize supplies
  • set up bins for supplies (when they are delivered)
  • label bins
  • label ambulance (informational labels for radio, etc.)
  • set up 2 spare portable O2 bags
  • install trash can
  • set up spare portable suction (ambo manufacturer forgot to send the new one)
  • arrange forward compartment (waiting on extra shelf hardware from manufacturer)
  • set up manual BP
  • order duffel bags for c-spine supplies
one very dirty, very white ambulance

coolest backboard retention strap system EVER (designed and sewed by A. Ranger herself)

closeup of the strap system - holds each backboard separately
 so they don't all fall out when the first strap is released

To make matters more interesting, Effie goes in for warranty work today, so we need to get the new rig set up for us to use on runs.  Going to be a busy night.

Headed off toward Arizona for a week over the holidays.  Not sure how many EMS books I can fit in my carry-on luggage, but the blessed Kindle Fire grants me access to my course books at least.

And I'm sort-of dating again.
Just trying to stay sane.
:-)

Thursday, December 8, 2011

EMT Class week 9 part 2 - Exam & Break

Woot!
Scored a 93% on the patient assessment written exam.  Well, everyone did well, but I'm feeling pretty good about it.  Some controversial questions & answers as always, but not too bad all things considered.
We all passed, and now we get a break for the holidays.
Maybe I'll finally get my reading caught up...

Tuesday, December 6, 2011

EMT Class week 9 - feeling a bit better about assessment

OK, I feel like less of an idiot this week than I did last week.

We had skills lab last night and I did fine.  Didn't miss any critical criteria, and correctly surmised our medical patient needed to go to the hospital and convinced her to do so as the in-charge.  I got a sinking feeling when she  described the transient headache, pain in her thoracic spine.  I thought to myself, "this day is going to end with an EMS incident report, and all of us will be taking antibiotics."  I made the decision to transport, let the patient know I was worried about meningitis so she needed to seek more treatment, and as we were wrapping up I asked, "so what did you have?"  She got a little smirk and said, "meningococcal meningitis."
Lucky guess? Nah.
What can I say?  I'm that good.
(Taylor will disagree with me here and just say that I watch too much House, ER, and MASH...)

Actually, I was just discussing this with an old friend over the weekend.  His son contracted meningitis which progressed into septicemia.  His son's blood vessels were breaking down and letting blood leak out into his tissues.  He was two years old.  It happened twenty years ago he should have died.  I cannot imagine living through something like that with one of my boys.  He's a damn strong dad, with a damn strong kid, for sure.

Trauma assessment went OK, but I still need to drill it into my brain.
Got smacked down AGAIN by the same instructor as last week.  I'm taking too long to get the oxygen going.  I mumble and he can't hear me verbalize.  Blergh.

Other than that, a very successful night's work.  I'm way more comfortable with assessment and might get through this section.  Written exam tomorrow night over all 8 chapters of section 3 (Patient Assessment).
So, still need to:
Finish flash cards for vocabulary
Finish flash cards for patient assessment steps
Memorize pediatric vital signs
Write out and answer chapter objectives (thanks EMS Newbie, for that suggestion)
...and probably a million or so other things I'm forgetting.

Wish me luck.

Wednesday, November 30, 2011

EMT Class week 8 - I should know SOMETHING by now!

Really.  I've gone on a few calls, felt like I was being helpful, but all that pales when I try to do an assessment in front of an instructor.  I forget things.  Bounce around.  Things that seem like trivialities in the textbook are the things we get tested on for the written tests.  Nothing is making sense right now.

I got smacked down on Monday night for not following the state approved list.  Rightly so, but still it stung.  I'm not the smartest kid in class for sure.  Poor leadership skills (surely if I talk louder, then they will listen...)  Little in the way of practical experience...

...but I just KNOW I'm going to be a good EMT.  One of the best.  I have to be.  That's what I want, where I'm led.
It's only this large amount of work in front of me that's the problem.

Class Monday night, make-up class Tuesday night, Class tonight.  I'm behind in readings, behind in making flash cards, behind in DRILLING the state practical list into my head.  I'm treading water and it's up to my larynx.  I need time.  Time carved out to study, absorb, perfuse my tissues with this necessary knowledge.  I need to get past this.

Monday, November 28, 2011

Thanksgiving Break, still no calls :(

Spent my precious four days off hunting - well three of them anyway.  Saw plenty of deer but they were all on private land behind "no hunting" signs.

Sigh.

So the freezer remains empty of game, plenty of fish from the summer but little in the way of meat.  I'm going to look into buying some more bison or maybe going in on a beef.  We will see.

Little in the way of EMS going on around here either.  One call in the past few weeks and the volunteers took that one.  "The Beast" has not yet been on a run - came back from the big city with repairs done and is waiting to be kitted out for calls.  So there's that to do.

Looks like we will be getting a new rig as well up in the park!  Another Type I made it through the ranks and is being delivered.  So the shuffle begins.  With a total of 9 ambulances we need to look at mileage versus age.  The northern station needs a newer ambulance, so they are getting south's.  The new ambulance was delivered last week and needs to be outfitted completely - radio, antennas, striping, gear, you name it.  Since south's mileage is about half ours, they will might be getting Effie and we will kit out the new rig for either us or south station.

We need to get to work - fast.  The roads will close soon and we need to get the rig down to south ASAP.  I see long evenings ahead working on the new ambulance!

That said, we have class tonight, I have a make-up class tomorrow night, then class again Wednesday night.  We are studying for patient assessment practical & written exams (next week) so the stress level is ramping up once again.

Guess it's a good thing we don't have many calls.  I would be crazed.

More on pt assessment later...

Monday, November 21, 2011

EMT Class week 7 - Medical Patient Assessment and a Break

We only have one class this week - last night's patient assessment (medical) went pretty well.  No PowerPoint paralysis, rather we spent tons of time doing practical assessments.  Very nice.

The afternoon started off a bit chaotic - call from Mr. Medic at 1435 to go grab the ambulance and head up to the residential area for a 50 yo male with chest pain.  No problem.  My office is just 50 meters or so from the ambulance bay.

Let me paint a picture.  Our ambulance bay is a single garage about halfway down a long row building.  I think it used to be horse stables back in the day.  Another row building sits across from the bay about a meter higher.  There's enough room to pull the ambulance out and make a hard right turn to go up about a meter to the "main road."  So the ambulance bay sits in a hole.

We have had a fair bit of snow over the past few days, maybe 10 centimeters or so.  Last I checked the plow crew had plowed us out of the snow at least marginally.  Not so yesterday afternoon.  Effie can trudge through 10 cm of snow without problems on most days, but when the plow driver leaves a meter of crusty berm at the top of the hill, she just can't make it.

So here I am, made the turn fine, now trying to get enough momentum to climb up onto the road.  First try in 2wd was miserable.  Not only was I sliding back, I was sliding right as well - toward the building.  Back up, put the rig in 4wd low and take another run - hit the berm and stopped.  Cursing, back up again for another run.  No luck.  Switch to 4wd high and think maybe if I back up far enough I can make it.  Hit the berm again.  Crap.  Get on the radio.

"Dispatch, I'm having trouble getting the ambulance out of the bay.  Could you send a plow truck over here at their earliest convenience?" (Under breath, f***ing idiots didn't just NOT plow the bay, they plowed us in here!")
"Copy that, ambulance, break, maintenance crew we need a plow at the ambulance bay immediately."

Sigh.  OK, I'll give it another try.  Back the ambulance up as far as it will go.  Stomp on the gas.  Tires spin a bit, but momentum is established.  Have we achieved escape velocity?  Slowly, slowly, crunch!  Through the berm!  The front tires spin on ice, then grab, then pull - we have liftoff!

Make it to the call just fine (HR a bit high, but oh well)  get our patient loaded, relief arrives as Sid and her temporary partner jump in for the ride to the hospital.

And I'm off to class.

Funny and, well, really funny

AD does it well, no lie.

http://ambulancedriverfiles.com/2007/09/06/sumdoods-army/

You will laugh, cry, and likely hurl.

Thursday, November 17, 2011

Currently Reading...

The Burned Out Medic
http://burnedoutmedic.com/
I like the writing style on this one.  Should be a fun read.

Also reading:
Emergency Care, 12th ed. Chapters 10-17
(getting ready for the big exam the first week of December)


Rescue: a novel
by Shreve, Anita.
I don't read novels much, but this one was quite good.  Paramedic and alcoholic wife have daughter after one-night-stand.  Enjoyable.

The flame trees of Thika : memories of an African childhood  
by Huxley, Elspeth Joscelin Grant, 1907-1997.
Huxley's imagery takes me right back to East Africa.  I need to read more of her work.

Scent of the missing : love and partnership with a search-and-rescue dog  
by Charleson, Susannah.
Just started this one - maybe will sate my desire to train working dogs (or fuel it further?).  Alas, I'm stuck with a doorstop of a bulldog at this time...


...and in my continuing quest to work my way through King's The Dark Tower series:
The Waste Lands
Probably my favorite book in the series.  Jake loses his mind, returns, gets snatched in Lud, and the Ka-Tet meets with a psychotic monorail.
Really, does it get better than that?

Sounds like I'm reading a bunch, but hey, it's early winter, the weather is crappy, I've been home sick a few days, and call volume is low.

Stay safe out there.

Wednesday, November 16, 2011

EMT Class week 6 - Patient Assessment

Ugh.
That's really all I can say at the moment.
The nephew and I have both been sick for a few days - just had to go pick him up from school due to his level of exhaustion (although he seemed to perk up when I mentioned that his copy of Modern Warfare 3 had just been delivered.  Figure that one out.)
I was so ill on Monday that I missed class.  Didn't make it to CPR instructor class on Tuesday either.  Managed to drag my sorry butt into work today to wade through emails and get caught up.  Just a total failure of a week.
So I missed out on Initial Assessment, Baseline Vitals, and SAMPLE.  Blergh.  Will have to have Taylor get me caught up tonight if possible.  We have just enough hours to get our class done (plus some extra study hours on weekends) so I have to make up the 2.5 hours I missed on Monday.  Somehow.

Still need to review chapters 10-13, study (I prefer the British term "swatting" for some reason), and practice, practice, practice.

Thursday, November 10, 2011

On survival, and a new rig for the volunteers

I made it.  I survived.
Made it through another exam, helped teach the safety course, and collapsed after EMT class last night.  Got a 92% on the airway exam (again, couple stupid mistakes) so I think I can live with that.  

Should have learned by now that when I'm really exhausted I should just keep my mouth shut - 
Instructor: "What do you do when you have an unconscious trauma patient, unknown MOI or NOI, nothing you can find wrong?"  
Group: C-spine precautions.  
Instructor: "Yes, but what do you do?"
My brain: "Jaw thrust"
My mouth: "Head-tilt chin-lift"
Silence.
Shut up, A. Ranger...

Moving on to patient assessment is a bit nerve-wracking.  My mind seems to blank out at all the wrong points.  I'm going to work on visualizing the process and I think that may help.  I cannot just sit and read a list or flow chart and pound that into my thick skull.  I have a bit of time this weekend so I will give that a go.


On to more exciting news, the village volunteers FINALLY got their new ambulance!  Given that it was supposed to be done over a year ago (that's not a typo) let's just say everyone was anxiously awaiting it's arrival.  In my truly weird style of giving autos their own moniker, I've nicknamed it "The Beast"
Rides to the local ED will be infinitely more comfortable than in their old ride (the van).  Unfortunately problems with the air ride and back-up cam have delayed launch of this new beauty.  Can't wait for the first run!

Monday, November 7, 2011

EMT Class week #5 - Second Exam and Beginning Patient Assessment

EMT Class is harder than I thought.  I say that because I have met people who have been through it (the watch saleswoman at Walmart who said she 'used to be an EMT' etc.)
Call me pompous, but I figured I could handle it with ease.  I'm a GIS Specialist with 2.9 Bachelor's degrees, Masters candidate, I figure I'm pretty smart, so EMT class should be a breeze, right?

Wrong.

Time is my enemy.

These next two weeks, for instance, I'm doing the following: taking care of my 12 year old nephew (attending a parent-teacher conference, not to mention keeping a snarly pre-teen alive for 14 days), reading and studying for airway practical and theoretical exams (tonight), prepping to teach two modules of a safety course on Wednesday, spending 8 hours watching a video for my instructor-level CPR class next Tuesday, reading and studying patient assessment, finishing my term paper in advanced GIS, trying to sneak in a few hours to hunt for deer and elk, work 8 hours a day, and try not to lose my mind.

Yep, I'm whining.

OK.  Gotta bust this up and try to manage my time.

Van is opening the lab at 4 so we can practice airway practicals.  Gotta get my work done and jump out of here early if possible to feed the kid, study, and practice.
Do the test tonight, read the safety materials I need to teach after class.
Put the CPR DVD away until Friday.
Deal with tomorrow, tomorrow...

Wednesday, November 2, 2011

EMT Class, Week 4 - First exam down

Holy crap.
At first I wrote "week 3" above, but it's actually week #4 folks.  Hard to believe time has flown by so fast.
Our class meets twice a week, on Monday and Wednesday nights from 1800-2030.  We meet 15 minutes early (optional) to study the government protocol book.  Since I will be working for 2 services (government and village volunteer) I get to bone up on two sets of protocols.  Eventually.  Can't bring myself to even crack open the state protocol book yet.

At this point I'm studying for my life.  I feel woefully unprepared for class and never seem to have enough time to absorb one chapter before reading the next.  How the hell can I feel like this when we're only 9 chapters and 240 pages in?

The first test was bad.  Really bad.  After taking the EMR class last winter I thought I was prepared for the insane wording and trickiness of the exams.  Not so much.  In my defense, I set aside three hours on Monday to study before the test (took the day off).  Went to town in the morning, got my snow tires mounted, bought myself a new bike, and drove the almost 2 hours home.  (Yep, long drive to the big box stores from my house).  Grabbed a shower, got dressed, decided to spend an hour at the house doing the test questions on the web, then spend 2 hours in the classroom re-reading the chapters...

BEEEEEEEEEEEEEEEP

No way.

"Paging ALS, paging ALS.  Crew requested for ALS transfer of 64 year old male from the Clinic, complaining of chest pain."

Shit.
So much for my study plans.

Mr. Medic and Floyd call in.  I pull on socks, shove on shoes, and call en route to the clinic.  Van (EMT and our course director) grabs the ambulance and brings another EMR along (Sam from the village volunteer service).  Good thing we had the help.  Took 5 of us to raise the stretcher.

Uneventful call, really.  Mr. Medic and Floyd attended, I drove, and Van & Sam headed off for class.  The fastest I've ever turned around a call (clinic to community hospital and back) was three hours.  We hit that mark.  Mr. Medic drove on the return trip so Floyd and I could study.  (Not having any of my books, this was difficult.)  We hit the classroom 15 minutes late for the exam, which I'm sure didn't help my score.

50 questions and I missed 9.  Two of them were sheer stupidity on my part - not reading the questions carefully enough - and the rest I don't know.  Mixed up sympathetic and parasympathetic nervous systems for sure...we will be going through the test tonight.  I'm bummed, but I guess I'll just have to settle for 82% on this one.

Only 32 chapters and 1,000 pages to go...

Tuesday, November 1, 2011

Thou shalt read the EMT laws, lest ye be smoted by them

I laughed, I cried, I blushed, I wanted to share.
This one is the reason the whole thing got re-re-posted:
(thanks EpiJunkie)

The First Rule of Bystanders: Any bystander who offers you help will give you none.
The Second Rule of Bystanders: Always assume that any Physician found at the scene of an emergency is a Gynecologist, until proven otherwise.
Corollary 1:Never turn your back on a Proctologist.


EMT Laws

(Shamelessly stolen from someone who stole it from someone who stole it from someone…)

Air goes in and out, blood goes round and round, any variation on this is bad.

Try not to discuss “your day” at the family dinner table.

You may not install a “car catcher” on the front of the ambulance.

The more equipment you see on a EMT’s belt, the newer they are.

Examine all chest clutchers first, bleeders next, then the rest of the whiners.

When dealing with citizens, if it felt good saying it, it was wrong.

All bleeding stops… eventually.

You can’t cure stupid.

If it’s wet and sticky and not yours — LEAVE IT ALONE!!!

“Riding shotgun” does not mean you shoot the tires of non-yielding vehicles.

If at all possible, avoid any edible item that fire fighters prepare.

EMS is extended periods of boredom, interrupted by moments of sheer terror.

Every emergency has three phases: PANIC… FEAR… REMORSE.

A good tape job will fix almost anything.

Yuppies involved in accidents complain how bumpy the ambulance ride is.

It’s not a compliment when Policemen say you’re crude, crass & cynical.

The severity of the injury is directly proportional to the weight of the patient.

Turret mounted machine guns usually work better than lights and sirens.

Schedule your days off to avoid working during full phases of the Moon.

There is no such thing as a “textbook case”.

Automatically multiply by 3 the number of drinks they claim to have had.

Your social skills will be lacking, if all your anecdotes deal with blood.

Assume every female between 6 and 106 is pregnant until proven otherwise.

Get very, very scared when a child is too quiet.

Don’t place bets on the glucose level of an unresponsive patient.

You cannot institute a surcharge for unruly or surly patients.

It is not necessary to have a pet name for your cardiac monitor. (Sparky?)

As long as stupidity remains epidemic in the US, you have job security.

Don’t worry about the gunshot wound as much as dealing with the family.

All emergency calls will wait until you begin to eat, regardless of the time.

Corollary 1: Fewer accidents would occur if EMS personnel would never eat.
Corollary 2: Always order food “to go”.

The Paramedical Laws of Time: There is absolutely no relationship between the time at which you are supposed to get off shift and the time at which you will get off shift. Given the following equation: T 1 Minute = Relief Time, “T” will always be the time of the last call of your shift. E.g., If you are supposed to get off shift at 08:00, your last run will come in at 07:59. (Or if you have early relief coming in you will see you relief sitting at the first stop light from the station, waving!)

The Paramedical Law of Gravity: Any instrument, when dropped, will always come to rest in the least accessible place possible.

The Paramedical Law of Time And Distance: The distance of the call from the Hospital increases as the time to shift change decreases.
Corollary 1: The shortest distance between the station and the scene is under construction.

The Paramedical Rule of Random Synchronicity: Emergency calls will randomly come in all at once.

The Rule of Respiratory Arrest: All patients who are vomiting and must be intubated will have just completed a large meal of Barbecue and Onions, Garlic Pizza, and Pickled Herring, all of which was washed down with at least three cans of Beer.

The Basic Principle For Dispatchers: Assume that all field personnel are idiots until their actions prove your assumption.

The Basic Principle For Field Personnel: Assume that all dispatchers are idiots until their actions prove your assumption.

The Axiom of Late-Night Runs: If you respond to any Motor Vehicle Accident call after Midnight and do not find a drunk on the scene, keep looking: somebody is still missing.

The Law of Options: Any patient, when given the option of either going to Jail or going to the Hospital by a Police Officer, will always be inside the Ambulance before you are.
Corollary 1: Any patient who chooses to go to Jail instead of the Hospital has probably been in my rig in the past.

The First Rule of Equipment: Any piece of Life-saving Equipment will never malfunction or fail until:
a)You need it to save a life, or
b)The salesman leaves.

The Second Rule of Equipment:Interchangeable parts don’t, leak proof seals will, and self-starters won’t.

The First Law of Ambulance Operation: No matter how fast you drive the Ambulance when responding to a call, it will never be fast enough, until you pass a Police Cruiser, at which point it will be entirely too fast. Unless you are responding to an “Officer Down” call then it is physically impossible to be traveling fast enough!

Paramedical Rules of The Bathroom: If a call is received between 0500 and 0700, the location of the call will always be in a Bathroom. If you have just gone to the Bathroom, no call will be received. If you have not just gone to the Bathroom, you will soon regret it. The probability of receiving a run increases proportionally to the time elapsed since last going to the Bathroom.

Basic Assumption About Dispatchers:Given the opportunity, any Dispatcher will be only too happy to tell you where to go, regardless of whether or not (s)he actually knows where that may be.
Corollary 1: The existence or non-existence of any given location is of only minor importance to a Dispatcher.
Corollary 2: Any street designated as a “Cross-street” by a Dispatcher probably isn’t.
Corollary 3: If a street name can be mispronounced, a Dispatcher will mispronounce it.
Corollary 4: If a street name cannot be mispronounced, a Dispatcher will mispronounce it.
Corollary 5: A Dispatcher will always refer to a given location in the most obscure manner as possible. E.g., “Stumpy Brown’s Cabbage Field” is now covered by a shopping center.

The First Principle of Triage: In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient.

The Gross Injury Rule: Any injury, the sight of which makes you want to puke, should immediately be covered by 4×4′s and Kerlix.

The First Law of EMS Supervisors: Given the equation: X – Y = Quality of Care where “X” is the care that you render and “Y” is the assistance supplied by any Supervisor. If you can eliminate “Y” from the equation, the Quality of Care will improve by “X”.
Corollary 1: Generally, Field Supervisors have no business in the Field.
Corollary 2: The level of technical competence is inversely proportional to the level of management.
Corollary 3: Technology is dominated by those who manage what they do not understand.

The Law of Protocol Directives: The simplest Protocol Directive will be worded in the most obscure and complicated manner possible. Speeds, for example, will be expressed as “Furlongs per Fortnight” and flow rates as “Hogsheads per Hour”.
Corollary 1: If you don’t understand it, it must be intuitively obvious.
Corollary 2: If you can understand it, you probably don’t.

The Paramedical Law of Light: As the seriousness of any given injury increases, the availability of light to examine that injury decreases.

The Paramedical Law of Space: The amount of space which is needed to work on a patient varies inversely with the amount of space which is available to work on that patient.

The Paramedical Theory of Relativity: The number of distraught and uncooperative relatives surrounding any given patient varies exponentially with the seriousness of the patient’s illness or injury.

The Paramedical Theory of Weight: The weight of the patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of floors which must be descended while carrying the patient.
Corollary 1: Very heavy patients tend to gravitate toward locations which are furthest from mean sea level.
Corollary 2: If the patient is heavy, the elevator is broken, and the lights in the stairwell are out.

The Rules of Non-Transport: A Life-or-Death situation will immediately be created by driving away from the home of patient who has just thrown you out of their house. The seriousness of this situation will increase as the date of your trial approaches. By the time your ex-patient reaches the witness stand, the Jury will wonder how patient in such terrible condition could have possibly walked to the door and greeted you with a large suitcase in each hand.

The First Rule of Bystanders: Any bystander who offers you help will give you none.
The Second Rule of Bystanders: Always assume that any Physician found at the scene of an emergency is a Gynecologist, until proven otherwise.
Corollary 1:Never turn your back on a Proctologist.

The Rule of Warning Devices: Any Ambulance, whether it is responding to a call or traveling to a Hospital, with Lights and Siren, will be totally ignored by all motorists, pedestrians, and dogs which may be found in or near the roads along its route.
Corollary 1: Ambulance Sirens can cause acute and total, but transient, deafness.
Corollary 2: Ambulance Lights can cause acute and total, but transient, blindness.
Note: This Rule does not apply in California, where all pedestrians and motorists are apparently oblivious to any and all traffic laws.

The Law of Show-And-Tell: A virtually infinite number of wide-eyed and inquisitive school-aged children can climb into the back of any Ambulance, and, given the opportunity, invariably will.
Corollary 1: No emergency run will come in until they are all inside the Ambulance and playing with the equipment.
Corollary 2: It will take at least four times as long to get them all out as it took to get them in.
Corollary 3: A vital piece of equipment will be missing.

The Rule of Rookies: The true value of any rookie EMT, when expressed numerically, will always be a negative number. The value of this number may be found by simply having the rookie grade his or her ability on a scale from 1 to 10.For rookie EMT’s medical skill: 1 = Certified Health Hazard, 10 = Jonny or Roy.
For rookie EMT’s behind the wheel: 1 = Obstruction to Navigation, 10 = Mario Andretti.
The true value of the rookie is then found by simply negating the rookie’s self-assigned value.
Corollary 1: Treat any rookie assigned to your Unit as you would a Bystander. (See The First Rule of Bystanders, above.)

The Rule of Rules: As soon as an EMS Rule is accepted as absolute, an exception to that Rule will immediately occur.

Wednesday, October 26, 2011

Tired. I'm so very tired.

I shouldn't be, though.
Been getting a decent amount of sleep.
Sitting at a computer 8 hours a day doesn't help.
Trying to write a term paper for grad school doesn't either.
Attempting to stay caught up on my EMT class reading is going, well, not so well.

3 cokes and a half gallon of tea today.  Nothing is perking me up.

So.  In half an hour I go over to the ambulance bay to grab our rig, head for the classroom for 2.5 hours more of  work fun.

God, I'm tired.

Monday, October 24, 2011

currently reading...

Pink Warm and Dry
http://pinkwarmdry.com

Nice to read another chica's story every once in a while.

Also reading:

Emergency Care (12th Edition) by Daniel Limmer, Michael F. O'Keefe, Harvey T. Grant and Bob Murray
(Obviously, for EMT class)


The Only EKG Book You'll Ever Need (Thaler, Only EKG Book You'll Ever Need)
Malcolm S. Thaler
(Haven't made it through this one yet)


And one for fun, like a chat with an old friend:
The Drawing of the Three (The Dark Tower, Book 2) by Stephen King)

Friday, October 21, 2011

Busy

Saturday morning.  Been a week since we had a call, either in the local village or in our still-busy tourist trap.  A WEEK with no calls, sigh.
Football game starts at 1000 and the nephew's playing, so I get to sleep relatively early, around 0300...

BEEEEEEEEEEEEEEEEEEEEEEEEEEPP

Tones go off at 0745 for a female with chest pain outside the gym.  Just happens there's a paramedic there as well.  So with the dearth of calls, we end up with 3 paramedics, an EMT-I, two EMT-B's, and the lone EMR (me).  12 lead shows nothing suspicious, but our ambulance heads north to the hospital for the tearing left chest pain.  Thad takes the ambulance, since I want to watch the football game.

Back in bed at 0810, set the alarm for 0940 so I can make it to the game in time for kickoff.

BEEEEEEEEEEEEEEEEEEEEEEEEEEPP

I slap my palm down on the alarm, but it's the pager.  70 yo male with syncope in the village.  I call throw the action adventure pants on and call in as on my way, 15 mins out.  Village ambulance is on the way, a couple of volunteer EMTs and EMRs have called in as on scene.

BEEEEEEEEEEEEEEEEEEEEEEEEEEPP

Football player down on the field.  Possible spinal injury.  5 blocks from the guy with syncope.  My nephew's playing in that game...sounds like plenty on hand for the old man.  Call in and request to divert.  Diverted to football field.  First on scene.  Not my boy's number (phew) grab my bag and walk on the field like I know what I'm doing.  I don't.

12 yo female (yup, the girls get to play too) point tenderness to mid-back (just below the pads) following a pretty hard helmet hit.  She's laying on her right side, pads and helmet still on.  First responder on scene has hooked up 2 liters by NC, but the kid's crying and pretty snotty, so the cannula is in her mouth.  Not what they taught us in class, but OK I guess.  ABC's, CSM intact.  Start getting the jersey cut off to do a full exam when the cavalry arrives.  A couple of the village crew grabbed the quick response vehicle (QRV) which is a crew-cab pickup containing extrication and packaging gear.  The boys take over, get the pads off, and strap the poor kid to a board with her helmet on.  (Note - pads off = helmet off too, or a bunch of padding).  We move her off the field to the QRV to await an ambulance.  Thad shows up with the Type 1, they load, and are off.

Not bad for a rag-tag bunch on a Saturday morning.

What really surprised scared the crap out of me, was how blank my mind went when I arrived on scene.  I mean, it's a responder's dream, right?

Wednesday, October 12, 2011

I'm in - on to the next step

All the work by my colleagues has paid off.  We are going to have an EMT-B (or just 'EMT' in the new standard scope of practice) course.  It starts next week.  Runs 2.5 hours twice a week, some Saturday skills days.  October through April.
We all had to write a letter of intent in order to be considered for the class, so here it is:

******************************************************************
Why do I want to be an EMT-B?
Do you want the real, full story about how an aging GIS professional falls in love with EMS after years of dabbling in WFA, WFR, and CPR courses?  I didn’t think so.
The truth of the matter is, I don’t know if I will be a good EMT. 
There.  I said it.
I am struggling as a First Responder/EMR to provide solid patient care.  After every run I find something I could have done better or differently.  My lack of knowledge frustrates me.  I am constantly looking up terminology or reviewing protocols to try and fill in the gaps. 
If I’m having this much trouble as an EMR, why go on to EMT?
It is because I’m struggling that I want to continue with my EMS education.  I want to be able to do more, to help more, both with the Government EMS crew and with the volunteer Village EMS.  To do that, I need more education and experience and I believe the course offered this winter/spring will help.
So, take a chance on this wannabe-EMT/mapping geek.
Thank you for considering my application

-A. Ranger
******************************************************************


Who would accept that letter?
Apparently our EMS director would.
Me and 13 others will be working together for the next 7 months to become better practicioners and frankly, well, I'm freaking out a bit.
I guess you will all have to get used to those type posts for the next 7 months.

Monday, October 3, 2011

Loss

My paternal grandfather died last night.  He was 94. He had a stroke 6 weeks ago and was under hospice care at home, but somehow you are never prepared for the end.  My dad is trying to hold up, but his voice is shaky on the phone.  Dad lost his mother almost 40 years ago to lung cancer (she used to send him to the store to pick up her packs of unfiltered Pall Malls...).  So my dad no longer has his parents.

People are passing out of my life, both personally and in EMS and I don't know how to handle it.  Sometimes I cry, mostly I feel the loss, but then I try to get on with my life.  I'm not sure if that's a good thing or not.  Am I just storing those bodies away in a locked cupboard in the back of my mind?  Will one day the door burst open and overwhelm with emotion?

Wednesday, September 28, 2011

More on ambulances - a change for EMS 2.0?

Boxes strapped to the back of a truck/van drive me nuts.
As our recent search for a Type 3 for over-snow use showed me, we don't have many options.
Ambulance design and safety are intriguing, and I spent a large amount of time being thoroughly unimpressed by the selection out there.

Look!  It's a bigger truck with a bigger box...

Just watching a 67 minute presentation called "Ambulance Construction 101"
http://www.jems.com/webinar/vehicle-ops/ambulance-construction-101-glo
(Slides stolen from this presentation)
This is a recorded presentation, and I think you should all go check it out.

The presenter, Wayne Zygowicz, attended the RETTmobil (mobile rescue) conference in Germany - I need to go to this, I think.  I am extremely impressed by the European EMS programs.  They employ safety experts, ergonomics experts (gasp!), engineers, solid statistics, and more to produce safer rigs and equipment for EMS providers.

DID YOU KNOW?
THE US AS A WHOLE DOES NOT MAINTAIN DATA ON EMS ACCIDENTS, FATALITIES, OR EVEN THE NUMBER OF AMBULANCES ON THE ROAD.
What does this cost us?  Glad you asked.

In contrast, there has been a European standard since the 1800's.  Standards.  Across multiple countries.  Really?  Can the US be this backward?  How long is it going to take before we make changes?

"I wonder, Is there an acceptable rate of mortality in any industry before an industry decides to take action and look at all the variables that can kill people?"  Good question, Wayne.



This webcast also goes through the construction process, chassis selection, and on to "Extreme Ambulance Makeovers" and spends a lot of time on the "Ambulance of the Future"


This Swedish rig complies with the European standard, and all the consumables are in ONE BAG.  Don't know how our folks would deal with this!  One patient, one ambulance = rig of the future.  Would definitely take a culture change in the US for sure, but a slim ambulance with just what the patient needs?  Crash tested? Comfortable to drive and ride in?  I think that's worth a culture change.

Monday, September 26, 2011

The Loaner

We have a nice ambulance.  It's a Type 1 Ford 4wd powerhouse.  She was brand new last year.  A beautiful white truck with a big box on the back.  I call her Efee.

Following our last service at the garage, I noticed oil drips on the bay floor.  No worries.  Sometimes oil gets on the frame and drips off for a while.  I checked the oil and kept an eye on it.  Every time I swept the bay there was fresh oil.  Also, the brake release handle mysteriously broke off.  Couldn't really see why it lasted as long as it did, considering the tiny chunk of plastic used as a hinge.  So the next service date came up - an oil change and fluid check.  Thad took the rig up to our garage in the morning.  Then the text message came.  The oil leak looked like an engine problem, and the rig was pulled out of service due to the brake release lever being a safety hazard.  Oy!

What to do? Apparently the powers that be decided our area needed only one ambulance, so our "spare" was taken away at the same time we got our new rig.  (Somehow, though, the fire crew managed to get all brand new F-350's for each of their upteen volunteers.  This during a "fleet reduction" year?)  Besides, they reasoned, the volunteer village department is just 5 miles down the road, so we have another backup even if one of the other 8 rigs in our department can't respond.  Sounds fine, I guess, but the volunteer rig is a tiny Type 2, about 50,000 kilometers past it's prime.  The closest relief rig to us is a 1990's era Type 3 is 30 minutes away.

Our EMS director grabbed us a loaner rig.  One of the entrance areas over an hour away had a low call volume, so they had to sacrifice.  The other Type 3 in our system (also a 1990's vintage) arrived.  I went to check it out after work.  And was shocked.

The rig is old, yes.  It's seen a lot of action, yes (over 200,000 km).  The shelves were not organized to my exacting standards, sure.  But it was filthy.  Not dirty, FILTHY!

Dirt and I are good friends.  I can deal with dirt.  But ground-in gunk consisting of sweat, vomit, pee, gore, blood, spit, you name it?  Nope.  To be fair, the rails and action area were in decent shape.  But I could see mouse droppings in one of the cabinets.  The bench should have been blue, but was instead a brownish color.  The white vinyl padding was grey.  I grabbed disinfectant and got to work.  Ms. Medic was on duty and stopped by.  We scrubbed hard for over an hour and got the rig in semi-clean shape.  Mr. Medic dropped in and we ran the inventory list.  Expired meds, expired equipment, etc. piled outside the back doors.  I ran up to the wash bay and pressure washed the outside clean.  Together we put in about 8 man hours just to get the newly dubbed "Mini Winnie" in decent enough condition to go on a run.

And run we did.  We were taking a rule-out cardiac to the community hospital and were about 5 miles out of town when I smelled the exhaust fumes.  Mr. Medic told me this was a known problem.  I thought about setting up welfare checks, but instead opened the side window and turned on the air.  It didn't smell as bad for the rest of the ride, but I checked Mr. Medic's LOC several times just in case.

After every run I do my cleaning, and find more filth to scrape away.

I now feel spoiled with our shiny Type 1.  I just hope we get it back soon.

Monday, September 19, 2011

Currently reading...

Too Old to Work, Too Young to Retire http://tooldtowork.com/
Another gun-totin' hard livin' redneck EMS provider.
Think I'm going to like this one...

(Starting at the beginning, ahem, with page #115)

Also just finished reading "An Elegy for Easterly" by Petina Gappah, meh, it was OK but a grippingly stark view of lives in Zimbabwe and I just wasn't in the mood for reality.

Finally finished the book "MASH: A Novel About Three Army Doctors" by Richard Hooker.  I can recite every episode of the sitcom from memory, like the movie, so I figured I should read the book.  Nice, easy read.  Goes into the medicine more than the TV series - altogether a decent book.

Monday, September 12, 2011

"Advice for a new Paramedic" (HappyMedic)


This is blatantly ripped off from The Happy Medic http://thehappymedic.com/
but it bears repeating. Just as relevant to a First Responder, EMT-B, or EMT-I. My comments are in italics.

Advice for a new Paramedic
Over the years I’ve been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.
I can never stress enough the first and most important tip I have:

It’s not your emergency
No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.
This one is difficult to follow. Adrenaline is pumping, you want to help, but the people I am learning to admire on scene are the ones who are un-ruffled, calm, and quiet. I need to work on this.  A lot.

You will never know enough
There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.
Don't need any help understanding this concept. The more I read, listen, and learn, the less I feel I know...

Don’t tune your patients out
Many folks don’t know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don’t get stuck in the SAMPLE questions, but use them as a starting point.
This is another good one - I like talking with patients and am getting more comfortable asking the probing and leading questions. I try to listen to the more experienced folks, and am feeling more comfortable speaking up for myself. I need to stop interrupting people, though...one of my big faults.

The most important person in the room is you
Scene safety is paramount. It’s not as easy as simply saying, “We’ll wait for PD” like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.
Love the last line.

Don’t leave the hospital so fast
Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it’s pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You’d be amazed how many times I’ve seen a Doc spot something the machine misses.
This is a problem for me. I always feel like I'm in the way in the ED. Easier just to grab the cot and leave, but I need to spend more time in the room when we get there.  Hoping my EMT-B course hours at the ED will help on this.

Buy Dubin’s
Dubin’s Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.
Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.
Ordered it, got it, and started to read. Also bought Thaler's"The Only EKG Book You'll Ever Need" and Phalen/Aehlert "The 12-Lead ECG in Acute Coronary Syndromes."  All are so far over my head it's sickening. EKG reading is still an intriguing mystery to me, but by sheer repetition some of it may be sinking in.

Find your comfort zone and avoid it
If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don’t know the answer to.
Ha! I don't have a comfort zone in ANYTHING yet, so no worries. Actually, this has reared its ugly head already.  I am a fine driver.  Patient contacts - well, I still feel nervous and out of my element.  It's too easy to say, "I can drive."  So these days I try to jump in when someone gives me the option to ride in back.  Patient assessment skills are still weak - have that moment of panic when I'm first on scene and forget everything I've learned.  I need to nail myself down somehow...

Practice humility
People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn’t suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a “war story” but as an addition to a lecture, lesson or discussion.
Again, great advice. I've been lucky so far with mostly grateful patients. The follow-up is awkward and mostly third-hand (through the medic)

Warm lunch, warm dinner, go home safe
Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn’t matter.
Sounds like a good plan to me.

Thanks Happy Medic!
(btw, if you don't read his blog, you should)

Also from the Happy Medic:


My favorite term from his glossary:
Jedi Vitals – When you know the patient is fine, but still need to record something, you pass your hand in front of them just like Obi Wan Kenobi and poof! the vitals come into your mind.

Sunday, September 11, 2011

11 September, thinking about the day

Strange.  That's how I feel.
Ten years ago today I was midway through my summer internship with the government.  My first federal job.  By the time I got to work that day there was a distinct buzz going around.  Radios were tuned to the news (no streaming internet for us, no!)  No decent TV reception up here either, without a costly satellite dish - back when those were a spendy extravagance.  Just listening.  Listening to the news in disbelief.  Mental flashes of "War of the Worlds" as surely, this must be a joke, right?

I'm such a newcomer to the EMS brotherhood that I don't really know how to feel half the time.  It's like I'm peering into someone else's agony and I feel like an intruder.

The truth is, we all lost something that day.  Not just EMS, Fire, LE - we lost a feeling of security.  That certainty that we are infallible, those of us on the North American continent.  We all look at things through new eyes - good or bad.  Is that guy in a turban a threat?  What about the person over there?  Is that baggage unattended?  The "Patriot" Act.  The wars against terror our soldiers are fighting.  We all lost a lot.

That's what I think of when I think back to that awful time in the last few months of 2001.

No, I won't forget.
But I've moved on.
I can't live with that day always on my mind, sorry to disappoint.

I'm living my life - a single woman travelling the streets without a male chaperone.   Travelling to other states, provinces, and countries on my own.  Working daily at an office job.  Moonlighting in the EMS world. Writing blog posts for anyone in the world to read (if they have that right).  Gathering with friends when and where I please.

That's my revenge, my way of coping.  To live in this great country and do those things that I couldn't were I born elsewhere.  And I am desperately thankful for that.

- the ambulance ranger -

Tuesday, September 6, 2011

EMSWorld Expo - Photos

Finally got my photos off the iPod Touch - and most of them were crappy.  Guess I need a primer on how to take decent photos with it.  But here we go!

Long walk into the Las Vegas Convention Center

Nice for organization!  Look how shiny!

What our ambulance would look like if we had any money.

MCI - two cars and a bus - ground level view


Mass Casualty Incident - seen from the monorail

Friday, September 2, 2011

Friday 2 September - Conference Day Three - the roundup


Fewer folks today, which was nice.  Not such long lines to get into sessions.  The end of conferences are quite often like the end of camp - new and old friends hug, promise to keep in touch.  This one was a bit different for me.  As a GIS professional at a GIS conference, I am 100% integrated.  I know most of the stuff that's going on and can really get into it.
This was very different.  I am very new to the EMS camp and pretty much everything is a mystery to me.  As an EMR, I'm probably the least qualified and least experienced person here.  That's a strange feeling for me.  I didn't integrate well into this group.  Now that I think about it, I suppose it was the same for me in GIS.  The first few conferences I felt out of sync - like everyone else knew each other and had some sort of inside track.  They were meeting for drinks, chatting, having intellectual debates over dinner, the whole social aspect.  Once Taylor left I really didn't have anyone to talk to.  Our guys are great, but they are guys and this is Vegas.  I didn't feel too bad for missing dinner with them since they spent the whole time checking out chicks, attempting to get Floyd to talk to a hostess.  To say I would have been out of place is an understatement.
The guys left this morning, so I am the only one still at the conference.  Guess thats a weird feeling as well.  Hundreds of people I don't know who are at least acquainted, or speak the same language, and I don't fit in.
I don't know, maybe I'm just feeling melancholy because this whole EMS thing is a strange new group for me.  Or maybe because I'm such a late-comer to this field.  I'm 37 years old for crying out loud.  I'm great at making maps, doing spatial data analysis, so why do I do this EMS thing?  It's certainly not for the money.
So I have a few hours until my flight leaves.  My grandfather died so I changed my ticket this week to fly back to my ancestral homeland in Washington State.  It will be nice to visit with my family for the day.  Maybe that's having an effect on my mood as well.  Who knows?
Hard to believe, but I'm at a loss for what to do at this point.  My bags are back at the hotel bell desk, I'm checked out of my room, and I still have 6 hours to kill before my flight.  Not interested in gambling away more money, or sitting at the airport for hours in an uncomfortable spot.  But I'm ready to leave Vegas now.  Seriously ready.
Left my ECG and A&P books (ahem, and my nintendo) in my bags, have no internet here, and it's emptying out.  Guess I will bust out of the convention center and head south.  Pick up my bags, give away my monorail pass, and get a taxi to the airport.  Hopefully I can find a semi-comfortable spot to settle in, plug in, and waste a few hours.  Wish me luck.

Gambled some more? Check
Picked up bags? Check
Gave away monorail pass with 2 more days on it? Check
Taxi to airport? Check
Lost my mini leatherman to McCarran security? (with scissors & tweezers in it) Check
Still 3.5 hours early for my flight? Yup

Sigh

Can't wait to get out of this town.

Thursday, September 1, 2011

Thursday 1 Sept - EMSWorld Expo Day 2!


Day Two - Whew!
Spent the morning in sessions - then met Mr. Medic and the Pit Boss for some ambulance shopping.Two guys and a gal out shopping for a couple Type 1's and a very special Type 2 - one that is light enough to have tracks attached in place of the wheels to travel over groomed snow.  Of the four salesmen who we spoke with, two basically ignored me (one called me "hun") and only one seemed to realize that I had input into our agency's decision with which ambulance to go for.  I hate that crap.  I am not an idiot who is scared away from the modern conmbustion engine and distracted by pink, sparkly items.   Please just treat me the same as another potential customer.  Okay?
I am sold on the Sprinter (which I just found out Dodge is no longer a part of - just Mercedes and Freightliner now)  I love the way it looks, drives, feels after hard hours in the seat.  It's thoughtfully designed and a great rig.  One small problem.  Apparently, they don't have an all-wheel drive version for sale here in North America.  Europe?  You betcha.  They've got them going on over there.  But apparently they are not certified for the US and Canada.  Lame.
Regardless, I have a lot to say about ambulances.  I detest smarmy salespeople who treat the ladies like morons.  STOP IT!
OK, I'm done ranting now.

I have a few knocks for this place (Las Vegas Covention Center) - a few technical difficulties in sessions, bad internet (either extremely expensive or low quality), and no nap rooms :)
Can you tell I'm tired?

Wednesday - conference day 2 - Part 3


Not many folks at the podcast - probably 'cause everyone was jockying for position at the mass casualty.  All good though.  Got to meet the kilted twins - Ron & Kelly and was on the front row for their intro of the EMS Newbie essay contest winner.
The mass casualty went well, for what I could see from the ground level.  They really needed more bleachers so more of us could get up high to see the action.
Dinner was lovely - went to The Sea at Bally's - the Thai was excellent and I enjoyed myself despite the price.  Floyd, Taylor, and I ordered an appetizer and entree each.  They were awesome.  Mr. Medic and the Pit Boss joined us late and we had a great re-hash of the day.  Apparently I need to visit the SAM splint booth as well as the Stryker booth tomorrow.  And we're going ambulance shopping.  Lots of difficult choices as far as sessions go, but I'll probably use the same logic as today - go to one of the ones I'm interested in, but go for the shortest line.
Not even midnight and I'm back in the room.  Dang I'm being a good person this week!
Taylor is leaving in the morning 'cause she's gotta work on Friday, so I'm losing my 'wing man' and I'm bummed. Oh well.  Still have a couple days of conference to enjoy!

Wednesday, August 31, 2011

Wednesday - conference day 1 - Part 2


Finally found a chair in the Social Media Lounge - standing next to the EMS Newbie and AD.  Pretty kewl stuff.  Podcast is running a bit late, but have no idea where the rest of our crew is (she says just as everyone walks up behind us) and we became the ersatz audience for the "Confessions" micro podcast - weird.

Wednesday - EMS World Expo - day 1


I slept thru the alarm this morning - I blame it on last night's awesome sushi.  And no, we were good and made it to bed relatively early.  Taylor and I are sitting in the food court area and I'm attempting to touch-type on this tiny keyboard, so please forgive the typos.  The place is awash in EMS peeps - it's awesome!  We're attempting to connect to any wireless network that doesn't charge $5 per hour for access and we are just hoping the social network lounge will be free.  Could not for the life of me find my stupid air card before I left home, so we're at the mercy of public networks...
Keeping an eye out for our bloggers in kilts - HappyMedic, AD, EMS Newbie, etc. but with the bagpipers floating around there's a lot of sporrin action on the convention floor.
The rest of our guys (Mr. Medic, the Pit Boss, and Floyd) are at the keynote - the place was so packed we couldn't even approach.  Bummer.
So we're holding down a table and doing some serious people-watching.  Strange just being in such a large group of folks, not really knowing any of them.  The social network revolution, or evolution has made us more friendly but also more anonymous.  Its hard for me to not want to go talk to some of my favorite bloggers - I feel I know some of them pretty dang well, but we've never met!  So forgive me if you get a heartfelt handshake from a gal you dont know!
Just ten more minutes until the vendor area opens - I have definite goals (check out a ton of ambulances, meet with the Pearson textbook rep, spend a ton of time in the social media lounge, find the person selling "RipShears", play with a lot of equipment, gather the swag...) that AND I actually have somewhat of a schedule for this afternon triage, ECG's, Trauma and emergency driving.  It's gonna be a great afternoon.
Bryan Bledsoe's talk is starting off well.  Supposed to be pretty controversial, but loving it so far.  OK, a bit dry with the statistical analyses, but hey - evidence-based EMS is where we are, right?
Tried to get into another class but settled on the one on my list with the least line (yup, you get to line up for each session and get your badge scanned.)  Stupidly slow, really.
Anyway, I'm in EKG's Made Easy by Larry Macy (from Rock Springs, WY) and scored my good seat with a table from the last session, so I'm OK.  Apparently we "become" the heart in this session...and it was great!  Kept hte energy and interest level of the audience up really well and gave us a great visual cue for 12+ of the rythms.  Really nice.
Dang netbook battery is down to 30% so I will have to charge up soon - somewhere.
Confessions of an EMS Newbie podcast live in 20 mins, so I'm literally blogging from the floor of the conference at the Pysio Control Social Media Lounge (there's power here)
Mass Casualty Incident at 1815, so I should have a few minutes to hit the vendor area again.  Glad I get to stay through the entire conference (Friday). I think it will be much less busy then. (?)

vegas day one


After a LONG day of travel (our flight was 5.5 hours late) we finally arrived in the sparkly city in the desert - the one that really shouldn't be here.  I love it. I love Vegas BECAUSE it's so wrong.Maybe it's the geographer in me, but this place is just too much to absorb.
Anyway, just spent the evening (ahem...morning...) with fruity drinks, too much tequila, slot machines, and chatting with a guy named Bill from Wenatchee. Long story short, I got to sleep around 0500 and up around 0900 for breakfast - still a bit tipsy.  God I luv Vegas.
Our EMS director met us for breakfast and we decided to go check out the conference site. one monorail stop later we emerged into the heat and walked to the convention center.  The site is huge.  We got a quick peek into the vendor area - we could spend the entire three days there, I think.
We toured around a bit more - mostly along the monorail line - and saw the MGM lions sleeping, a baby lion being burped, poked around NY NY a bit, and split up for the afternoon.  Floyd and Taylor went to a Cirque show, the "Pit Boss" (our EMS director) and Mr. Medic went to meet up with an old friend who works down here, and I headed back to the hotel - ostensibly for a nap.  Instead I spent the afternoon and evening going through the conference schedule and watching some network TV.  Sushi for dinner, lost some cash on the craps table, and now hitting the hay - 0815 start tomorrow!
I'm getting stoked.  It's just after midnight and I can't wait to see the action.  Funny, I've never been as excited about a GIS conference...

Monday, August 29, 2011

Off to Vegas!

http://emsworldexpo.com/

One more hour of work, then it's in the car to the airport!

I will hopefully be blogging from the site (if I can find my dang air card...)

Too much to see and do in 3 days, but I'm gonna try!

Friday, August 26, 2011

Another Stupidity

Call to the clinic - they need a paramedic.  PA and nurse practicioners only on duty this Sunday afternoon.  Mr. Medic in in the helicopter on a call.  Ms. Medic is off duty and out of the area.  Nothing but EMT-I's around for help.  Sid takes charge and I offer to be a third in the back.

Patient is a female in her late 60's.  Clara.  She's been traveling by car with her husband and son for over a week now.  Insulin-dependant diabetic.  Blood sugar is reading "HI" on every meter (>444).  Hypertensive at 200/100.  Cardiac changes (sorry, can't read them that well yet).  Clinic does not want to give insulin without more info.  Medical control concurs.  Our protocol is for saline on hypoglycemic patients.  500mL saline in, 2L O2 nc when she is transferred to our cot.  Clara is babbling.  Has been for hours now.  Saying things in German, her native language, but not one she speaks to her family.  She needs to go to the hospital now.  Sick with a capital "S".

Thunderstorms are closing in on us, no helicopter transport.  Gotta go by ground to the community hospital about an hour away, more or less, depending on traffic and weather.  Husband grabs a few things out of her purse, then digs through her wallet - leaving the medical cards and ID, I'm assuming.  He hands the wallet to me in the clinic room.  "We will take care of it.  We do this all the time"  She's been incontinent so I tuck the wallet between her calves on the cot.

The ride was one of the hardest I've done so far.  Sitting on the bench, taking bp, pulse, counting resps, pulse ox is on the fritz - change of batteries doesn't help.  Feel like an elephant lunging around the back of the ambulance.  All the while trying to listen attentively.  She's trying to communicate.  How her husband is wonderful.  How she is a burden and doesn't want to be.  How great her family is.  She seems a bit more lucid than she was in the clinic, but not much.  I keep scanning the scenery, willing the ambulance to move faster.  No facial droop, no slurred speech, no weakness...

Arrive at the ED.  Push the cot into one of the two emergency rooms (plus three more for observation).  Nurse asks if she can move herself over.  She does with lurching difficulty.  Big Don (our driver today - not an  EMS guy, but drives for us) leaves pulling our cot so fast I let go of the head.  He seems mad about something and does not talk to me at all.  He's a pro bed changer, though, and gathers up all the linen with the blue bottom sheet as an envelope.  I glove up and grab the package from him, depositing it in the utility room linen bag.  I can still see the circular dark blue wet spot on the sheet.  We clean up the cot, put on fresh linen, and load it back in the rig.

I check the "miscellaneous area" for any gear with our name on it.  There's a backboard and bag of straps there from the North District, so I load that in our rig for the ride back.

I want to go check on Clara once more before we go.  I told her husband I would look for him when he arrived.  But Sid and Big Don are at the rig, Sid pushing past me to jump in the passenger seat and Big Don getting in as driver.  Very brusque.  No comradeship, no witty banter as I get with Mr. Medic or Ms. Medic. I jump in back and tidy up.  Ask if we can stop for something to eat.  Sid and Big Don sigh and stop at McD's.  (I have become addicted to their pineapple mango smoothies)  They talk freely of country life among themselves (horses, hay, antelope sausage), but basically ignore me.  Whatever.  I eat and close my eyes.  Trying not to get too motion sick in the back of our Type 1.

Sid's phone rings.  She asks "Do you guys know what happened to Clara's wallet?"
Shit.
My responsibility.
"I put it between her legs, between her calves, but I don't know where it went..."
Big Don broke in "Musta gotten wrapped up in the sheets or somethin."
I brightened. "Yep, I put the dirty linen in the bag in the utility room..."
"Nope, in the first room."
"No, Don, you handed the linen to me and I put it in the utility room."
"Nope, Sid, tell 'em to look in the first room."
My turn to sigh.  Whatever.  Has to be in there.  Not in the ambulance.  Didn't see it on the ground in the bay.

I fueled and cleaned up the rig, listened as Mr. Medic stopped by to swap stories, and went home.  Tones went off again around midnight, but I clicked off the radio and eased back into bed as I heard Floyd and several others take the call.

Totally forgot about the wallet until the next day.  Until the medical director called my cell.  I repeated my version of the story and now feel like I'm being accused of stealing.  I take full responsibility for not taking proper care, but now I feel like a criminal accused.

This sucks.

Monday, August 22, 2011

Amen

http://rescuingprovidence.com/2011/02/twenty/

Code 3 for the boo-boo...

There's one good thing about being so dang far from a real hospital.  We don't get many of the fluffy calls of the big cities.  When people call 911 here, they are looking at spending about 2 hours in the company of a Law Enforcement Officer - Paramedic.  This seems to dissuade most of the crackpot callers.

Until last night, that is.  The Village Volunteers get called out at 10 pm on a "lower arm laceration" call at one of the local motels.  This motel has seen a few stabbings in the past, so we are on top of things.  A crew of 5 volunteers rush to the station, grab the ambulance, and move quickly.  Sam even backs up the rig to the entrance for an easy load.  By the time I got on scene (I'm 15 minutes out of town on a good day), Sam is in the back of the rig, looking at the band-aids.  "I don't think we have a small enough bandage for her boo-boo."  Seriously?  Russian female in her 60's bumped her arm in the room, family called 911.  Really?  Yup.

Turns out the family has been a headache to the motel - trying to get them to comp rooms, etc.  Don't know if this is another ploy, but you just dragged six great people out of bed and their homes, put them on the road in the dark, all so you could get a band-aid.  Congratulations.


Read the Welsh Viking's commentary here, if you have time:
http://thewelshviking.wordpress.com/2011/01/17/what-is-an-emergency/

Thursday, August 18, 2011

Currently reading...

Rescuing Providence blog (the book was great) http://rescuingprovidence.com

As was noted before, I am unable to read a blog without going back to the beginning.  Currently I am on page 75 of Morse's blog.  Just this girl's opinion, but I think it's a fantastic piece of work.

Am, in addition, re-reading my favorite books of all time - Stephen King's Dark Tower series.
I can still recall reading the first one - The Gunslinger.  Had the book for over a year and couldn't seem to get into it.  After a few false starts, the stars aligned one rainy Saturday afternoon and I devoured it.  And read the next two books as well.  Waited months for the next volume, and many years for those after that.

I blame my failing memory, but in reality there is satisfying pleasure in opening the pages of an old friend and re-reading the same story again.  Like snuggling under that faded down comforter you cannot bear to get rid of.

Somehow I've never been able to get into King's full novels (Tommyknockers, The Stand, Cujo, etc.)  The novellas and short stories (and Roland's world), though, I read those with relish.  Seems they meld quite well with my life in EMS.
Ka is a f**king wheel, say true.

Tuesday, August 16, 2011

Very little traffic

We have a very strange service.  That's putting it mildly.

Let me explain.  Most of our pre-hospital providers, from Paramedic down to EMT-B, are law enforcement officers.  Yup.  Somebody decided that we would staff structural fire, wildland fire, and law enforcement, but all of the EMS calls would be handled by LE.  Now we do have people, including myself, who are not LEOs, but we are the minority.  Every LEO is trained and most of the permanent, year-round employees are either Paramedics or EMT-I level practitioners.  We do hire in temporary duty paramedics to cover the area in the summer - usually a 12-24 week gig, but for the most part it's just the LEOs and the other rag-tag EMS folks.

We are more akin to volunteer EMS most days than we are a paid service.  (Yep, If a deer bites off your hand, you are getting charged for the ride).  It's a bizarre situation.  As a sparky noob, here I was jumping at every call.  I had my radio on at all times to take the pulse of the daily vibe - if there was a call and Mr. Medic was on, I would likely text him before the page to see if he needed a hand.  In the process, I managed to unintentionally piss a bunch of people off.  Take my buddy Van.  He's a temporary LEO here for the summer.  He makes less than I do and consequently would like a bunch of overtime.  If he drives or they need  a third in the rig he gets his OT.

In steps me.  I typically will drive (and get paid for it) but I also volunteer to be in the back as an unpaid third just so I can get some patient contacts.  The higher ups saw this as a way to get a free bonus - I do vitals and such, the medic gets their paperwork finished on the drive, and we turn 2 paid people around at the hospital faster = less OT.  See where I'm going?

It's a slippery tightrope I'm walking - get some patient experience while our call volume is relatively high (read: more than 3 calls a week) but try not to alienate the rest of the crew.  Ho hum.

Meanwhile, it's been 3 days with no calls.
Very little traffic.

Saturday, August 6, 2011

You get what you get

Are these stories real?  Mostly...

Unlike most of the big time EMS bloggers, I don't have a great pool of cases to pull from.

So I make stuff up.  Seriously.
I don't want to invade anyone's rights legally or ethically.  That's just not going to happen.

This is just a spot for me to get it all out.  The good and the bad.  I think social media is a great resource for a fast-moving field.  I want to be involved with the future of EMS.  I will likely blog on just that subject following the Vegas EMSWorld Expo, but for now you are stuck with just me.

You'll get my gut reactions, fears, mistakes, and successes.  I'm not censoring that.

Hopefully you'll get some entertaining stories as well.

- A. Ranger

Friday, August 5, 2011

My first live chest compressions...on a dead woman

If there's one thing we spent tons of time working on in EMR (First Responder) class, it was CPR.  Not only did we take our requisite AHA CPR&AED for Healthcare Providers course (for which I have a spiffy little card in my wallet) but we also touched on it every week, no matter what the subject matter.

So I should have been better prepared.

I was driving the agency ambulance toward our community hospital - couldn't tell you what was wrong with our patient - I can't remember, but it was a BLS transport so no medics aboard. Just one EMT-B and an EMT-I in the back.  I was driving along the river, swollen to near-flood height by the melting snow and off-and-on drizzle we'd had throughout the day.  The water was mocha brown from the runoff and fully-grown pine trees, roots intact, were a common sight floating down the river.  Just a couple miles outside town sat a gray van on the side of the road.  People were climbing over the guardrail on the river side and waiting until we passed to cross to the van.  They were all wearing wetsuits, pfd's, and some had on helmets.  A typical rafting party.  I slowed down to pass between them and the normally-clad older man next to the van managed a weak wave.

The scene puzzled me, and I forgot about avoiding the bumps in the road for the next few miles.  What was going on there?  It was near a put-in/take-out point on the river, but why didn't the van drive down to pick up the passengers?  "Ah, the raft must have flipped or something, and they were all getting out and ending the trip early - it is so cold and rainy out..."

The radio crackled to life.  Tones I had never heard.

"Volunteer fire, volunteer ambulance, volunteer search and rescue, respond to report of rafter ejected from raft near the 20 mile point.  Female, 40-50, last seen being swept away from raft guides."  Then not a minute later, "Agency fire, agency ambulance, agency search and rescue, inter-agency request from volunteer service to join in search."

We were miles down the road and down stream.  I turned to the EMT-I and asked what we should do.  "Keep driving."

So I drove.  My mind wasn't on the road.  With another 45 minutes to the community hospital, I had only a few minutes of time to listen to the radio traffic before the mountains got in the way.  Ms. Medic was on her way.  ICS was up and running.  Cars were racing downriver to viewpoints for spotting.  Volunteers were rushing in to help.   Then nothing but static as we exceeded radio range.  I wondered, pondered.

We arrived at the small ED and unloaded our patient.  I cleared the cot back to the ambulance and pulled it out of the way.  ED nurses let us in on the news - they found her.  The volunteer ambulance was right behind us - hypothermic, unresponsive patient with active CPR going on in the back.  My heart pounded and mind raced - hypothermic - you're not dead until you're warm and dead.  Could be they would get this one back!  Cool!  Get to see my first real save!

I was at the back doors when the ambulance arrived.  The volunteer ambulance is a Type II, just a glorified Chevy van, and 5 people jumped down out of the back.  It was like clowns exiting a VW bug at the circus.  The urge to laugh bubbled up in my throat, but sunk back down as they jumped out, sweat dripping and hair hanging limp.  They had been doing chest compressions for over an hour in the back of that cramped van.  I got the hell out of their way.

We all followed the cot as my EMT-B buddy, Van, continued chest compressions into the emergency room.  The screen was pulled around her limp body as the ED staff took over.  I turned and busied myself with getting fresh linen for our ambulance.  I worked on the ambulance, cleaning, tidying up, changing linen, when Van came out to find me.  "You should go do chest compressions for a while."  Dang, not a bad idea.

I ran into the ED and into the small emergency room area which is closed in by 3 walls and the fourth is a sliding glass door/curtain arrangement.  There were at least 10 people in this small space, with all manner of EMT's and medics switching out for compressions.  I stepped in on the opposite side of the patient from the person that was doing compressions.  I took over.

And my mind went blank.

I couldn't get high enough to do them correctly (there was a step stool on the patient's left, I was on the right).  I forgot to count out loud.  Everyone on staff in our EMS area was there - including the supervisors.  I started to sweat.  The nurse on the BVM told me to count out loud.  I was trying to stay up on my toes so I could get in proper position and give good compressions.  I was failing.  Van stepped in across from me and took over.  That's when the world started to spin.  I couldn't hear, then there was a ringing in my ears.  I was now crunched back in the corner of the room, seemingly miles from the door.  I've felt this way before, but where?

Holy crap.  I'm going to faint right here.

I must have been ashen, because Lonnie (one of the EMS supervisors) took one look at me and said, "Are you alright?"
I thought about lying and playing tough for a millisecond, but instead responded, "Nope.  I'm going to pass out."
Lonnie grabbed me by the arm and pushed through the crowd. "Get some air."

But the air didn't help.  It wasn't the blood, the gore, or the whole situation.  It was the exertion.  I'd been going all day and hadn't eaten.  After the adrenaline rush and exertion of compressions, I was probably ready to go down.  I staggered out to the truck and grabbed a bottle of gatorade.  Five minutes later I was fine, sweaty, and chagrined, sitting on the back step of our ambulance.  Van came out and tried to say something nice about my compressions, but I knew they were crappy and everyone thought I was going to pass out from the blood.  Great impression I made.

Then I saw them.  Two of them sitting on the ground outside the loading bay.  Both still wearing wetsuits, one even had a spray skirt on.  They were in shock - just sitting on the asphalt on this cold day and trying to come to terms with what had happened.  Turns out they pronounced her during my little hypoglycemic episode.

I stopped caring about the bad impression I made.  I admit, I stared at their grief.  The guy on the left looked up and saw me watching.  He managed a brief smile.  A smile of thanks, I guess.  Every one of us had worked on her, but it made no difference.

"You own the treatment, not the outcome."  Mr. Medic's words ring in my ears.  I know he's right.

But it was still a long drive home.