Extrication Day!

Ingredients:
(1) impounded GMC blazer [covered in Jesus stickers]
(1) fire engine
(3) firefighters
(13) EMT students
(2) ambulances
(1) instructor [as all the others called in sick]

Instructions:
Mix ingredients copiously with a portable generator, hand tools, and several C-collars.  Add 3 inches of fresh, blowing snow and simmer for 5 hours.

Result:
One fun-filled day where I felt entirely inadequate and pissed off multiple people.  Hooray!

Before:  One moderately crumpled practice vehicle, complete with no less than 3 Jesus stickers (my fave: it's the 10 commandments, not the 10 suggestions), plus one engine, one ambulance.

 Doors coming off:  Chief & Deputy had some fun getting the doors to pop.  Apparently when it's a cheaper car it's tougher.  The screams from the three under the tarp were priceless, though.  Fire Dept. probie got to punch all the windows and it scared the crap out of them.

We practiced spinal restriction & extrication with doors on, doors off, and roof off.  This was toward the end of the day when the snow finally stopped.

Had a good debrief with the fire crew on site, then did EMS debrief back at the classroom.  I learned a lot of things about myself, I think.  I have a hard time being a support person - I tend to take over when things aren't going the way I think they should.  I talk too much, and too loud (happens when I'm under stress, so this is tough for me to break).  When I'm not the in-charge, I need to zip my mouth unless I see something unsafe.
There is a line somewhere between being a good leader and being a pain in the rear.  I firmly jumped over that line with both feet.  Not good.

In retrospect, I would have done some things differently.  And I will do things differently in class from now on.  My first priority is the patient.  That will not change.

Coming next: TB Tests, Trauma written test, and beginning special populations.

EMT Class week 17 - make-up class, end of trauma, and extrication day

For being a 'short' week due to the holiday, it sure seems long.

Monday Van held an extra class for those who needed to make up hours.  Ended up being the same old folks - Taylor, Floyd, me, and Ben the structural firefighter.  We did some chatting about recent runs, as it's been a busy few weeks for us, and then ran through trauma scenarios.  Taylor and I failed.  Miserably.

Don't really want to go into it, but basically I screwed up a couple of times - manually holding C-Spine (should have made the imaginary bystander do it), securing the head to the backboard before the torso, and a couple other issues.  Ugh.  Really thought I was going to be good at this but I'm sucking wind right now and it pisses me off.

Last night was the last night of the trauma section - Chest & Abdominal Trauma, and Multi-system Trauma.  We sped through it pretty fast and had some good discussion.  Upon arrival at the EMS Classroom/Storage room, it was surprisingly packed with people organizing.  Van, Mr. Medic, Mrs. Medic, the Pit Boss, and Fred were all sorting equipment, checking stock, etc.  I showed up an hour early to study - never seems to work out when I do that - and ended up helping a bit, and getting in the way more.  Everyone was tense.  The atmosphere fairly crackled with stress.  Found out later that one of our crews had been working a scene and was taking WAY too long.  This has been a recurring theme lately.  I'll hash that out in another post sometime.

Anyway, they all cleared out for class and Mr. Medic & Van tag-team taught.  We got a load of 'official' paperwork - TB testing next week, state paperwork for clinicals, etc.  We also discussed our Saturday extrication day schedule.  Structural fire is helping out and we will be cutting up a Chevy Blazer SUV.  Supposed to be snowing and cold, so looking forward to a very realistic training day!

Sparked by AD's article on EMS1.com, we will be practicing assisting with advanced airways in our weekly training (after EMT class finishes in April).  So lots going on here in our little world.

I'll try to remember to take lots of good pics on extrication day - wish us luck!

EMT Class Week 16 - More Trauma

So this week we took on musculoskeletal, head, neck, and spine trauma.  Another week of OUCH!

Minimal lectures this week, though, and got to spend more time splinting and bandaging.  Spent most of this week in a safety class, so I wasn't able to attend any of the cool lectures going on in the local ALS refresher.  I still couldn't pick our medical director out of a line-up if I had to.

So with so much training going on and even a few runs (cardiac rule-outs, broken bones), there hasn't been much time for ambulance work.  Taylor finally got to go on her first ambulance run!  I got to help out and drive, and it was cool seeing her work.  I'm generally a giant pain in the rear, barking orders, etc., and she actually will call me on it :)

Another of my classmates got to take his first run last night, and he was so excited talking about it I thought he would burst.  Pretty dang cool.

We all need a minimum of 5 patient contacts and 10 hours experience before we pass the class and can go on to the national register exams.  Been a pretty dry winter as far as calls go, so I suppose I won't be helping out much until everyone else gets their hours in.  I plan on spending a few shifts in the 'local' emergency departments (1 hour and 1.5 hours away) so I should get my hours without issue.  I just hate to see our ambulance drive away without me in it!  The many, many hours I've spent working on that rig, alone and with help, have been a bonding experience.  It takes a lot to keep our ambulances in service and I've learned to take care of ours pretty well.

That said, I guess it's time to own up.  I bruised Effie.  A 15-inch or so bright orange scratch across one of the back doors.  When we first noticed the paint transfer, we all wondered what the heck could have caused it.  Surely "I" couldn't have done that to poor Effie!  Alas, contemplation provided the answer.  Backing into a driveway, basketball hoop hung too close to the road, SCREEETCH = big orange scratch.
Mr. Medic nearly ripped his arms off trying to remove it with a big eraser-type wheel attached to a drill, but there was still a faint orange line in the white paint.  It was my badge of shame.
Ended up picking the brain of a master car painter (my uncle) who directed me to the correct buffing compounds.  A mere 3 hours of elbow grease has caused the scratch to fade even more.  I'm spending another session on it this weekend before a final coat of wax.  Should be OK by then.

On to next week - optional class on Monday (I will be making up for the day I missed a couple weeks back).  Van said we could work on trauma & medical assessment so I'm ready to drill that into my thick head.  Should get into the clinic for my TB test if I can.  Then Abdominal and multi-system trauma.  Test the week after!

This is going way too fast!  I'm not ready!  EEEEEK!

EMT Class week 15 - Trauma Time!

So we've moved (too quickly, imho) through medical emergencies and have pulled in to trauma world.  Let the gross pictures begin!

This week we worked through Bleeding & Shock, and Soft-Tissue trauma.  Most of Bleeding/Shock was review from the First Responder course, albeit in more detail.  We went into a bit more than just the simple "pressure, elevate, more pressure" scenarios - looking at vessels in more detail, tourniquets, splinting, application of cold, and the ever-favorite pneumatic anti-shock garment (PASG).  Needless to say, it seems silly to be studying and potentially tested on something that has been all but removed from EMS.  (Yes, I realized the book is 5 years older than it's publication date, but NREMT may still have it in there on the test) That said, we just removed it from our protocols this year, so whatever.  PASG is more interesting to me in a historical sense anyhow, in that it was touted for so many years until studies were done that essentially disproved any good outcome.  Except of course in postpartum hemorrhage in rural South Africa...
(Detractors/believers can argue in comments - I'm not an expert by any stretch, but was tasked to do a literature search for the Pit Boss and was able to read twenty or so articles on the subject.  He presented his view to our Medical Director who then authorized removing MAST pants from our protocols.)

Then on to soft-tissue trauma.  Can sum this up pretty simply.  Gory.  Gross. Nauseating.
I mean, some great pictures out there...really.  For some reason soft-tissue trauma grosses me out pretty badly.  Maybe I just need to look at more pics and video to desensitize myself.  They only showed male genital trauma, but the internet is an easy place to search for this.  Does take you to some dodgy websites, though, and I doubt I will be doing any of these searches at work!  Thanks to AD for his electric fence penis burn.  OUCH!

The degloved arm still haunts me,  the avulsed penis, the crush injury to the hand, ugh.  Does one just need to be exposed to this?  Desensitized?  I'm really worried that I'll keel over at a patient's injury.  This would not be a good thing.  I'm generally decent with vomit, blood, poo, urine.  But there's some things I just need to be able to deal with.  Is this a skill that can be learned, or will I always feel like passing out?

On to week 16 - Musculoskeletal Trauma, and Trauma to the Head, Neck, and Spine.  Hope I survive this section.

Just let this week be over, please

I've had enough.  I'm saying when.
I mean, there have been busy weeks, but I've managed.
This week was brutal on a mental level, in the way for which finals and last minute deadlines have not prepared me.

 I'm an introvert and proud of it.  I get along with people, generally get along with groups, I have little problem with public speaking, it's just that I gather my personal strength by spending time alone.  Groups drain me.

I'm exhausted.  (Trauma is going OK so far, and I'm caught up on EMT reading.)  But I'm helping teach this class in employee-driven safety and one of the instructors had to bag out at the last minute.  I had to prepare a decent presentation and go through material I wasn't intimate with.  In not enough time.  That was yesterday.  Then EMT class, attempting to prep for today's lessons but falling asleep in the book.  Then I spent this morning (6-8 am) reviewing the sections I usually teach, and spent from 8-12 teaching it.  This is not my strong suit (neither is getting up early in the morning). I believe in this safety program, but there is just so much information you have to cram down people's throats that it's hard to make it all entertaining.  I feel like I failed today.

And since I was woken up by a sick dog at 2 am and did not get back to sleep, I know start doing my "regular" job without a break for 12 hours.  I'm so useless right now it's ridiculous.  And I didn't do any good today.

Quite the feeling.

Currently reading...

Siren Voices
http://sirenvoices.blogspot.com

Spence's writing is ethereal.  Each post like a short story, but not necessarily neatly tied up in a bow.
And so wonderfully British.
Loving this.
And, as always, reading it from the beginning.  Finally up through 2008, and starting 2009.

A new section in the ever-favorite Emergency Care, 12th ed. - TRAUMA EMERGENCIES.  The trauma junkies in class are puffing out their chests at this one.  I, however, feel like I need to go back and repeat medical emergencies again.  And again.  Then maybe study more A&P.  Only 7 chapters in this section and we did one of those during medical (environmental emergencies) so fairly short.

Time is also getting short - TB tests for everyone the last week of February, then we're cleared for clinicals.

And for fun reading?  I'm digesting Australian paramedic Katherine Howell's books, beginning with "Frantic".
Liking it so far.

And just to draw out the epic Dark Tower series, I devoured Wizard & Glass once again.  At this point, my memory fades.  I've only read the last three books one time each.  I've lost count of the number of times I read the first four.  So on to Wolves of the Calla!

EMT Class Week 14 - Skills Lab & Exam #4

Busy week.  Came down with the creeping crud over the weekend and had to miss Monday's skills lab (and a couple days' work) so I was really playing catch-up on Wednesday.

First order of business? Exam.

I should have studied harder.  That's all I can say at this point.  100 questions, and on the first page "hmm, I'll come back to that one, and that one, and that one..."  In all I starred 26 questions, meaning I wasn't sure I got the right answer.  I missed 17 (mostly by over-thinking the answer - I changed all but 4 of those from the correct answer to a wrong one).  So, note to self - go with your first instinct!

I was chatting extensively with Taylor and Floyd about this, as we all were disappointed in our scores.
"I do all the reading, the online content, the workbooks, practice quizzes, and I still barely pass!"
"I just don't get this question - it's stupid!"
"Either of these answers could be correct!"

That's pretty much how the conversations went.

Oh well, we passed.  Better on the next one for sure.
I spent hours this weekend reviewing the 200 page section just to make sure I feel comfortable with Medical Emergencies.  I still don't.

Best part of the week was the extrication/assessment challenge!  Since we have 2 ambulances right now (Effie and the new rig) we brought both down, set a patient in the driver seat, another in the passenger, split the class into 2 teams and saw who could do the job faster.  My team "officially" won, though an issue was raised that our overseer (Mr. Medic) was giving our team much more assistance than Van was giving his.

Even though I know our ambulance so well I could probably find most everything in the dark, getting the cot all the way down proved to be too much of a struggle.  Maybe it was panic, or the excitement, but I kept trying to kick it down and continually locked the dang thing up.  Mr. Medic had to jump in with a suggestion (tilt up first, then unlock, then depress lever...) and I finally got it.

The whole scene was so cool - watching my classmates put into action all the stuff we've been learning.  It was great.  At one point, I probably should have been in the ambulance (but there were 4 in back already) I was stowing gear, looked through the side window, and smiled at Mr. Medic, "look at them!  This is so cool! They are really doing this!"  First time I really felt like the whole team could handle a scene.

With supervision.
:)

Off to week 15 we go - Section 5 and Trauma!

EMT Class week 13 (part 2) Behavioral Emergencies, Abdominal & Renal

Tess from the Village Ambulance service popped in to teach this session.  As usual, did a wonderful job.  Tough subject matter to teach, for sure.

Behavioral Emergencies was highlighted by videos of some really poor responders reacting to a meth addict call.  [click here for video]  She was obviously wired up and had either scratched her neck raw or burned it then scratched.  Several off-camera responders talked about her and treated her like garbage.  Here she is, a person who is MOST in need of medical services, being laughed at and treated like trash.  Made me sick to see this.

I realize 'regulars' can be a pain in the butt.  Problem is, EMS providers and other responders are often the only access these folks have to medical care.  For better or worse.  If you are that burned out of the job, seek another avenue of release.  Don't treat your patients like that.

Easy for me, a total noob, to say, right?
I guess time will tell whether I manage to avoid the burn.

Abdominal & renal (no big surprise) - assess, transport.  That pretty much sums it up.

Week 14 brings us to skills labs, and written test on Section 4 - Medical Emergencies.
EEK!!!
I had better go study...