EMT Class week 13 (part 1) - Poisoning/Overdose and Environmental Emergencies

Busy week.
There was certainly something in the air in class this week, don't know if it was the subject matter, the class, or the folks there for continuing ed.  Probably all of the above.

The Pit Boss was engaged as instructor du jour on Monday night and did a fabulous job of teaching.  Then there was the table.  You see, we have a teaching facility that was once a small elementary school (6 classrooms, library, gym - with tiny kitchen attached so used for lunchroom, and I envy those kids for the fabulous playground they had!).  So EMS gets one of the rooms for training.  It's your typical classroom, even still has the alphabet tacked up to the walls.  (Handily enough, it's also got a long counter down one side with a sink - nice for making coffee and cleaning up!)  Due to storage space issues, two walls of the room are covered with cabinets that hold training materials and the equipment stock for all the ambulances and personnel.  We've got plastic tables and folding chairs for training arranged generally in a big "U" shape around the room.  15 students, 7 tables, so one table gets 3 people.

Now we've got personalities, all of us.  Floyd and I are usually the ones to be counted on to pipe up out of turn with a dry witty comment now and then (and Mr. Medic and/or Van often get in on the act as well).  This week was different.  Larry, Moe, and Curly at table #1 were in fine form this week.  I just sat back and laughed.
Of the three, Morgan is the most vocal.  Morgan is taking the class, from what I understand, for the second time.  Or at least she took some version of EMT-B in the past.  Doesn't seem that she ever practiced, though.
 
"In my last class they had this guy who came in and talked about all the current methods people are using to overdose.  Are we going to have that?"

Pit Boss goes on to explain that things change so rapidly, we would cover some of that as we went along, read EMS journals, etc.

"Well, like this 'Leroy Jenkems' thing..."

Huh?

[Now if you've ever played the online game World of Warcraft, you know what Leroy Jenkins is about - 25 people plotting to get through a long raid dungeon, well 24 actually 'cause Leroy is off cooking chicken while the raid is being discussed.  He comes back on, shouts "LEEEEEEROYYY JEHHHNKINS!" and runs in, scattering the plan and getting everyone killed.  Great video on YouTube.]

Now back to Morgan and 'Leroy Jenkems'
"So, you take a bottle, fill it up with poo and pee, put a balloon over the top and let it ferment for like a week.  Then they inhale it and get high.  Supposed to be better than weed."

silence

then the laughter begins

"No, seriously!  They see visions!"

I'm crying at this point.
I'm not doubting her story, but we are losing it.

So apparently jenkems hit the world through a documentary on Zambian street children who scraped waste from sewer pipes and huffed the fermentation gasses.  (Likely methane with some hydrogen sulfide?)  Anyway, when it hit the American scene, the term jekems got mashed up with the WoW Leroy Jenkins reference, and 'Leroy Jenkems' was born.

And following this, the class discussion descended into talk of bath salts, spice, and excrement.  What a wonderful EMT class it was.

More on Wednesday night's class later.

Who is next?

I caught up on CCC fairly quickly, and finally finished Nee Naw (pages take a long time to load).

So who is next?  Which blogger will I delve into and read from the beginning?  Who will make it onto the "Regular Reads" board when I'm finally up-to-date with their musings?

Choices, choices...

I love the bloggers.

EMT Class week 12 - Diabetic Emergencies, Altered Mental Status, and Allergies

It was a short week, in the sense that it was only a 4-day work week and we only had 1 EMT class on Wednesday, but it honestly felt like one of the longest weeks ever.

Spent over ten hours working on ambulances this week - Mr. Medic is continuing to add the striping to the new rig (yep, we have to do our own decals, folks, can't be paying someone else to do it!)  I did a full inventory check on the new rig to see what else we need to order, and emailed the list to the Pit Boss (our EMS Director).  Seems I was a bit premature with my list since our new portable suction, glove box holders, and utility bins arrived on Tuesday!
Man, set me loose with a label maker and bins and you got yourself a party!
We had cannibalized the ambulance bay to outfit the new rig with bins, so I got to work re-organizing the stock.  Mr. Medic worked on the glove boxes, some more striping (I seem to get in the way with the striping, so I try not to "help" too much), and we installed the new backboard straps I had sewn.  The original ones were a sad first try, and once I'd finished the nice ones for the new rig I decided to sew fresh ones for our rig as well.  They look pretty nice.

Wednesday night class was classic fun - lecture, playing with trainer epi-pens, joshing around by the usual crowd.  Got to stab & bleed Taylor for a blood glucose and she got to stab me right back.  We both took way too much pleasure in that lol.  A ton of material to get through in 2.5 hours, but a great set of lectures by our local husband & wife EMT team, Mr. & Mrs. Stone.

Thursday was fine until the afternoon.  Had a meeting with the Chief of our division about safety, did some real work, did an avalanche safety session over lunch, got back in the office and sat back down to work.  Fine, right?  Well, fine until I did "something" to my neck.  Just sitting at the computer, wanted to crack the window so I swung right with my head and arm rather quickly.  Heard a "pop" and felt the pain.  Oh the pain.  Couldn't raise my chin up high enough to see the computer screen.  Couldn't stretch out my right hand to hold the mouse.  Popped a couple of Ibuprofen and hoped that would ease things.  Not so much.  Ended up going home and sleeping it off with the aid of western medicine.  (And no, no numbness, tingling, or parethesia).  Going to see the doc this week so hopefully they can check it out.  Can't wait to see what I've done to myself this time.

Anyway, on to week 13.  Four chapters this week: Poisoning/Overdose, Environmental Emergencies, Behavioral Emergencies, and Abdominal/Renal Emergencies.  Busy week and a lot to cover.  Next week we have skills lab and test, so lots of studying to do this weekend!

EMT Class week 11 - Cardiac Emergencies

So Mr. Medic led us through a week of cardiac fun - it really makes a difference when the instructor is engaged and excited about what they do.  And on that subject, I was reminded of how lucky we are to have such a great EMT class.  Instructors from throughout the park who are offering up their time to teach us this subject matter.  They patiently answer our newbie questions and correct our form.  This class (and working on ambulances) is keeping me going right now.

My "real" job is less than satisfying and I'm wondering why the hell I continue doing it.  I'm awesome at what I do, but there's no joy in maintaining spatial databases.  Seems empty.  Topic for another day.

Back to cardiac emergencies - Mr. Medic commented that his EMT class did not go into any of the rhythm disturbances or really into anything cardiac at all besides basic CPR [the smart ass I am, I blurted out "Did they have EKG's back then?"  Yep.  I'm going to hell...]
I loved every minute of it.
I'm focused on getting through EMT class and getting more time on the street right now, but the possibility of going to medic school is out there.  Like a bright pinpoint of light floating on the edge of my peripheral vision.  It's there.

And on to week 12!  What's coming up?  Diabetes, Altered Mental Status, and Allergies. Wahoo!

Currently reading...

http://captainchairconfessions.com
In my eminently anal-retentive way, I am starting this one from the beginning.  Thankfully CCC has not been posting long!  I am enjoying the writing and content, so I'm sure this will become a daily read for me.


Raw Art Journaling [Kindle Edition]
This is my first Kindle book purchase for my new-ish Kindle Fire.  So far not too impressed.  By saving $6 over the paper book I have gotten: bad formatting (lists are all garbled) and the inability to re-sell or give away the book when I'm done with it.  E-books and e-readers are handy, but I likes my paper!

Taking a break from The Dark Tower as of late, and trying to focus on EMT class.  Good thing is, I know Roland and the rest of the ka-tet will always wait for me...

We have moved on to section 4-Medical Emergencies (chapters 18-26) of Emergency Care (12th Edition) [Paperback].  Guess I didn't really think that EMT class was going to be so much material, since I have met some people who qualify as EMT's that I wouldn't want touching me.  Guess there's a difference between a good EMT and one who squeaked by...

And with that in mind, I am currently reading through and attempting to digest The Only EKG Book You'll Ever Need (Thaler) [Paperback].  This has been the best EKG book I have found.  Easy for me to work through and reference.

And in case this looks like an Amazon ad, it's not.  That's just where I do most of my shopping.

Michael Morse's new book Responding is next on my purchase list (next payday for sure!).  I enjoyed Rescuing Providence so much, love his blog, and can't wait to dig in for a read!

A Murder at Paradise

Online opinion from The New York Times
http://opinionator.blogs.nytimes.com/
January 12, 2012, 9:00 pm

A Murder at Paradise
By TIMOTHY EGAN

PARKLAND, Wa. — The next time somebody mindlessly bashes a “federal bureaucrat,” as if the term itself were a parasitic disease, remember the bright young woman we said goodbye to here a few days ago: Margaret Anderson, a park ranger in a flag-draped casket.

In the West, most people live in sprawling urban centers not far from the public-land playgrounds that shape so many lives on the sunset side of the United States. When the worst of our world spills over into that other one, it is people like Anderson  who hold the line.

She was asked to do so on New Year’s day, which dawned Technicolor bright on Mount Rainier, the 14,411-foot volcano that can get more snow in some years than any other place on earth. The biggest draw is Paradise, more than a mile above sea level at the high point of the main park road, named by an early visitor who gushed, “This must be what Paradise is like.”

On that first day of this year, an Iraq war veteran named Benjamin C. Barnes was steaming toward Paradise after a night of gunfire and partying. He blew past an initial stop where drivers were told to put chains on their tires. No one knows for sure what his intentions were, but it’s not unreasonable to speculate, as many in law enforcement have, that he might have fired on people enjoying the snow at Paradise.

Anderson was the daughter of a Lutheran minister, 34 years old, a mother of two little girls. She was the kind of park ranger familiar, by necessity, with flora, fauna and firearms. Just below Paradise, Anderson set up a road block.
“She put herself between the evil coming up the mountain,” said her father, the Rev. Paul Kritsch, “and the people at the other end.” The gunman opened fire on the ranger. At least two shots, one to Anderson’s head, the other to her torso, were enough to kill her. Barnes plunged into waist-deep snow. The next day he was found, dead of exposure and drowning, in the icy creek that drops quickly into a waterfall, the subject of countless pictures.

“Margaret Anderson is a hero not because she died,” said Jon Jarvis, director of the Park Service, “but because of why she died.”

You could not help asking that question — the why — as the horse at the center of the funeral procession passed by on a winter day, boots reversed in the stirrups of an empty saddle, in the military tradition. On both sides of the street were cops and park rangers, hundreds of them from all over the West and Canada, uniforms crisp, faces downcast.

It’s a terrible thing whenever anyone pays with her life while protecting the rest of us. But in the case of a park ranger, it’s exceedingly rare. In the nearly century-old history of the National Park Service, Anderson was only the ninth ranger to be killed in the line of duty. But five of those killings have occurred in the last 20 years.

This is a consequence, in part, of how the surging population has pushed toward the parks, making them more a reflection of society’s ills, clutter and excesses. When Rainier was established in 1899 as the nation’s fifth national park, this suburb where Anderson’s service was held, about 35 miles from Seattle, was mostly farms and forests. Now nearly three million people crowd the Puget Sound metro area. The park is an island of the natural world, a fragile 368 square miles surrounded by everything from strip malls to military bases.

The other point worth noting is about how selfless and valuable so many public employees are — especially those who work the parks, forests, deserts and wildlife refuges owned by every citizen. The hours are torturous, and the rewards inconsistent. Meth labs loom deep inside any number of national forests. A park ranger, at peak season, can have a workload that rivals that of New York City cop. And when the government shuts down because politicians don’t have the courage to find middle ground, it’s these public servants who are kept from the jobs they love.

“They don’t punch a clock,” said Pastor Kritsch of his daughter’s work and that of his son-in-law as well, for Margaret married another park ranger, Eric Anderson.

Rainier is a sanctuary, a living museum of the land without much of a human imprint. On most days, the big mountain is the embodiment of why national parks are called America’s best idea. You don’t expect a park to go on lockdown, as Rainier did briefly, with helicopters dropping coffee cups with handwritten warnings to hikers.

At the start of Margaret Anderson’s memorial service, the mountain was in hiding, as it is on so many winter days. By the time taps was played inside an auditorium packed with nearly 3,000 people, the mountain had come out, in all its glory — a fresh reminder of why rangers young and old are so passionate in defense of Paradise, and us.

Editors note: Mourning bands are authorized for uniformed employees to honor the life and service of Ranger Anderson until sunset on January 31, 2012.

EMT Class week 10 - Pharmacology and Respiratory Emergencies

Don't get me wrong, the book we are using is great [Emergency Care (12th Edition)] but to spend one chapter on pharmacology?  Really?
Don't feel like I know anything about the plethora of drugs out there.  I mean, we have the ability to administer only very few of them - oxygen, aspirin, oral glucose, charcoal, nitro, epinephrine auto-injector, and rescue inhaler.  No one around here carries charcoal anymore and most of the others require us to first contact medical control before using them.
Guess I won't be on too many BLS only runs anyway.
The real goal I have is to be able to assist ALS with medication information on the drugs the patient is already taking.  Should I delve into this and study the most commonly used meds?  My instinct is to say yes.  I just need to find a good list somewhere and start memorizing (and always make sure my iPod apps are updated!)

We talked about respiratory emergencies a bit, but again I feel like I'm just scratching the surface.  I want to know WHY pregnant women can get a pulmonary embolism, WHY epiglottitis is so dangerous (and why does it spike in men >40 getting over a cold?).  Guess I either need to do a ton of reading, get through my EMT, and go to medic school or just give up now. :)
For now I have to be content as a technician.  It's bad enough as an Emergency Medical Responder in EMT class, knowing I can do more but my scope of practice doesn't allow more.  When I'm an EMT I think it will be worse.  Unless I can be content as an assistant to ALS...

...but I'm never content.

The end is (too) near!

So I had a minor panic attack yesterday.

I was setting up my 2012 calendar.

Now, for as much of a tech-junkie as I am (the kit I take EVERYWHERE contains: Kindle Fire tablet, iPod Touch with med apps & podcasts, iPod Classic for music, Bose headphones, wifi hotspot, solar power pack, iPod external battery, and all chargers/cables for said devices)
BUT I am a Luddite when it comes to calendars.

There's something very visceral about writing down a task then crossing it off.  I love that.  I'm a constant list-maker.

So when the new year arrives, I'm off to the nearest office supply store to find the perfect calendar.  Must be indexed by month, prefer spiral bound, not a ton of extra pages I will need to rip out, and at least letter sized so I can slip important papers in it.  These usually run around $20.

Then the fun begins.  I go through the calendar and mark out the holidays, pay days, and birthdays.  I use different color pens and pencils for this.  Then I go through last year's calendar to make sure nothing slips through.  It's total overkill and I enjoy it.  I get to review last year and see what this year is going to look like.  When are the holidays - oooh!  should I book a vacation for that long weekend?  See?  Fun!

But then I started adding in our remaining EMT classes.  That's where the panic set in.
Total?
24 weeks of class
41 night classes
1 extrication day
7 written exams
1 class written final
1 class practical final
1 NREMT practical
1 NREMT written
Clinicals @ ED and another Ambulance Service

Completed?
9 weeks of class
16 night classes
3 written exams

I start to add all of the EMT classes, study sessions, reviews, and tests to my new calendar.
BP rises.  Flushed.  Tachycardic.
Maybe it was the fact that we had a few weeks' break and now it's just class, class, and more class until the final?  I don't know.  We are just over one-third of the way done and I feel sick.
I have do do this, and do it well.  I want to be a good EMT.  Hell, I want to be one of the best.
I know I can do this well.
So why am I so freaked out?

Rest in Peace, Ranger Anderson

It is a sad time for all park rangers.  My heart goes out to her family.

Ranger Margaret Anderson, 34, was shot and killed on the road to Paradise at Mount Rainier National Park on New Year’s Day morning. The body of her assailant, Benjamin Barnes, who fled into the backcountry, was found by searchers yesterday afternoon.

The intensive manhunt for Barnes came to an end when searchers in an aircraft spotted a body lying face down and partially submerged in the Paradise River in the vicinity of Narada Falls. Searchers on the ground traversed challenging terrain to reach the spot and confirmed that it was Barnes and that he was dead.

An investigation into the incident is being led by the Federal Bureau of Investigation with park rangers and Pierce County Sheriff’s Department officers assisting. The Western Incident Management Team (Denny Ziemann, IC) is en route to the park to assist with planning a memorial service for Anderson and with ongoing park needs. Information on the service will be posted on InsideNPS once it becomes available.

The park will remain closed to the public through today to let staff begin to work through their grief.

On the morning of January 1st, Anderson set up a traffic block to intercept a vehicle that had failed to stop at a chain-up checkpoint. The driver, Benjamin Barnes, opened fire on Anderson, killing her, and then fled on foot into the woods. Anderson had worked at Mount Rainier for three years. She is survived by her husband, Eric, also a ranger in the park, and by two young children.

Mount Rainier National Park closed during the hunt for the gunman, with the park evacuating park visitors to get them out of potential danger. There were 125 visitors in lockdown at the Paradise Visitor Center from Sunday noon until 3:30 a.m. on Monday. They were escorted out of the park in small groups of five vehicles, accompanied by law enforcement officers. There were also 25 visitors at the National Park Inn at Longmire who were evacuated out of the park. Visitors had been held at these locations for their own safety.

Approximately 200 personnel were involved in search operations on Monday, January 2nd. Agencies participating in the search effort included the National Park Service, Pierce County Sheriff’s Department, Federal Bureau of Investigation, Tacoma Police Department, Washington State Patrol, Customs & Border Patrol, Department of Homeland Security, U.S. Forest Service, Pierce County Fire Districts, Lewis County Sheriff’s Department, Enumclaw PD, Portland PD, Seattle PD, Snohomish PD, and law enforcement officers from other jurisdictions as well. Resources included K-9 units, armored vehicles, helicopters and fixed-wing aircraft.

Director Jarvis issued this statement early on Monday morning:

“Yesterday morning, Park Ranger Margaret Anderson was shot and killed while making a traffic stop at Mount Rainier National Park. As I write this late Sunday night, the murderer is still at large in the park, which has been closed. We are working closely with the FBI and local law enforcement to protect visitors and staff and to track down Margaret’s killer and bring him to justice.

“This is a heartbreaking, senseless tragedy. Margaret was just 34 years old. She and her husband Eric, who is also a park ranger at Mount Rainier, have two young children. Margaret was killed while doing her job – protecting the visiting public on one of the park’s busiest days of the year.

“Last week, we mourned the death of U.S. Park Police Officer Mike Boehm, who suffered a heart attack while responding to a serious incident in Washington, DC. Mike left behind a wife and a son.

“Our hearts go out to both families, and I ask you to keep them in your thoughts and prayers in the hard days ahead.

“As updates from Rainier are available we will share them with all employees through InsideNPS. These losses are painful reminders of the risks faced by National Park Service employees every day. Please be careful out there and watch out for each other.”