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...

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!

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.

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/

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.

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.

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

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.

The Anchors and the Light

Big surprise, I'm an incredibly sparky newbie.  So I'm having to catch up on my blog reading - I cannot just go to a blog like Happy Medic's and read from today on.  I have to start at the beginning and work my way to the present.  Hence, you will likely see links to a bunch of old posts in my blog, but believe me they are worth the read.
So come on, gentle reader, you and I might just dig up some good things here.

You need to read: The EMS Anchors by Happy Medic

Finished? OK.

I haven't been around much.  Been making runs with the 'old crew' for just a few months now, but I have run into these people.  Frankly, they scare me.  (And I piss them off, I'm pretty sure.)  We are a relatively small group out here, managing a constantly fluctuating population that sees 2+ million guests per year.  But we're rural, and most visitation arrives in the summer.  But with that many potential patients we cannot afford to be lax in our continuing education and quality of care.

Most of our anchors are not paramedics, but EMT-I level practitioners.  They can be in charge of complicated scenes, though, and should be better at what they do.  They should, for instance, not sling and swath a collarbone fracture then proceed to walk that patient out on a trail to the ambulance over a mile away.  That's just not right.  They should not take C-spine precautions by placing a collar on someone, but then attach that person to a backboard in a position of comfort.  That's not right, either.  The anchors need to follow protocol, not flaunt it because of their ignorance.  They need to learn to use the incident command system on a regular basis, not just when the incident gets "too big."  These are not difficult things, are they?

This small group (thankfully small) sets a bad example for us First Responders and EMT-B's.  We are their grunts.  They know better than us and we need to just shut up and do what they say.  We are there to drive them in comfort to the hospital and get the ambulance shiny and stocked for the next run.  We make mistakes and are reprimanded for them on-the-spot, in front of the patient or our co-workers.  Are the EMS Anchors also the ones Ambulance Driver is talking about here?  Sure sounds like it to me.

Thankfully, I work with a great group of EMT-B's and 2 excellent paramedics, Mr. Medic and Ms. Medic.  They are what a preceptor should be.  Mr. Medic has been around.  He's been doing this job since before I graduated high school and is not only excellent at his job, but cares about the teaching as well.  He leads weekly classes for continuing education.  Ms. Medic is similar, although only a few years in this paramedic thing.  They are both working to get an EMT-B course put together for our area.  How cool is that?

So you will see a great difference in those runs I get to go on, depending on who is on shift at the time.  Just the way things are done here.  I'm going to take Happy's article and leave copies in conspicuous places.  Just in case.