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.

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...

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.

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.

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.

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!

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...

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...

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.