EMT

It's official.  Six months of class, new friends made, new skills learned.  Got my patch, card, and certificate in the mail yesterday.  Funny how I feel like I know less now - maybe it's just that I know how much I don't know...

Currently reading...

EMT Protocols (what else?)

Also, for you Dark Tower fans out there, King's latest "The Wind through the Keyhole" aka The Dark Tower 4.5 is out.  I just got my copy today, so protocols may have to wait a little while!

In the EMS blog world, I am still getting caught up on Siren Voices.  If you're not reading it, you are really missing some fantastic writing.

NREMT

It was not simple.  The questions were harder than I thought they would be.

It went too fast.  About 35 minutes.

It didn't seem like enough questions - I last looked on #55.

Then it ended.  Abruptly.  It was done.

I had plenty of time to ponder as I drove the hour and a half home.  Did I fail that miserably?  I didn't think so, but it didn't feel like a slam-dunk either.  By mile 50 I was convinced I'd failed and would have to pay, schedule another test, take another day off work, and drive another 150 mile round-trip to the testing center.  I had told a few people it was my test day, they would be surprised if I tanked it.  Mr. Medic knew, Taylor knew.  Crap.

With the EMR class last year, it took a couple of days to post.  How could I wait that long?
[And yes, I have heard the stories about "Back when I took my test we had to wait by the mailbox for weeks.  Walked to it three times a day in 6 feet of snow, uphill, both ways..."]
It doesn't make the waiting any easier, folks.

So, fingers trembling, I logged in on the off chance it had posted.

Examination Scored
Congratulations on passing the NREMT National EMS Certification cognitive examination


And there it is.  I passed.
Still waiting for the pshychomotor exam results to make it through the bureaucracy, but for now I'm done testing.

Time to start studying protocols.

:-)

EMT Class week 24 - The final chapter...and the beginning

We passed.  We all passed.

Class practicals, class written, and NREMT practical.  Done.
Clinicals? Done.

NREMT written?  Scheduled for one week from today.

Funny, I feel less capable now than I did when I finished my EMR.  Maybe it's just that there's so much more to learn.  Two sets of protocols, master all the equipment for both ambulance services.  Wanting to learn more, know more.  I'm a bit lost at the moment, really.  I need some direction.  Set new goals.  Learn to be the best care provider I can...

EMT Class week 23 - Van departs, practice, and written test

First big shocker - Van our class coordinator got a nice job offer and had to leave earlier than anticipated.   We are all stoked for him, but none of us got to say good-bye :(

So Tess and Mr. Medic are back in the hot seat to get us through these last few weeks.

I don't think any of us really took too much to heart that we should have been studying for practicals all along.  This was a known entity, and we should have been preparing.  Really.  We all have our excuses.  Family, job, life, ahem, graduate school, all the usual suspects.  It's a good thing we built in a couple of practice sessions.

On to the test.  I would like to say I breezed through it, but 270 questions (!) is a lot for anyone to 'breeze  through'.  Floyd kicked my ass by a couple points and I will never live that down.  I did well.  Missed a few stupid points, but overall I'm good with it.  Everyone passed.

Since Van wasn't around, Tess decided to start class practicals right after the written.  I was done early so I got through Medical Assessment, C-Spine immobilization, and Cardiac Arrest.  Was nice to have those done and focus on getting through Trauma Assessment, BVM Apneic Patient, and "choose your own adventure" AKA long bone, joint, traction splint, OPA/Suction/NPA, bleeding/shock, O2 administration, or mouth to mask.

I miss Van, but it feels good nonetheless to be toward the end of EMT book work.  Time to get out into the real world, deal with protocols, and get the job done.  I hope!

We lost one of our own yesterday

I didn't know him very well.

Of the 150 or so providers in our family, I'm just getting to know some of them.
And there are those I will never know.

We lost a good man, too young, too soon.

Rest in peace, Ranger Nelson.  Your jump kit will be here if you need it.

EMT Class week 22 - Practice and Clinicals

Not much to report from class last week, we are running through stations to get ready for our practical exams.  Given that our first written exam is on Wednesday, I would rather do more prep for that!

Taylor and I hit the "big city" for our ED shift yesterday.  All I can say is - whew!  I'm glad we're done!

Nothing like being in a place where you really have no idea where (or if) you fit in, what to do, and where to find things.  We started our 10 hour shift at 0900 with a quick orientation by the the ER Tech.  Here are the rooms, the board, no you don't write anything down on the chart - just jot vitals on a piece of paper, etc.  And here's your vomit bucket filled with thermometer, BP cuff, PulseOx, and stethoscope.  When you're not needed, stand here.  Simple enough.

Yep, not so much.

Mr. Medic's suggestion rang in my ears, "You will be in the way.  Leave the docs alone.  Nurses you will just have to see how they react.  ER Tech is probably your best bet.  Try to shadow/emulate them.  And keep an eye out for that little old lady/man who comes in without any family or friends.  Spend some time with them.  Ask them SAMPLE and OPQRST.  The nurses will be happy someone is spending time with them and you will get a good history taken."

So Taylor and I are plugging along, grabbing vitals as asked.  The first room goes empty and the ER Tech starts to clean and make it up for the next patient.  "How can we help?"  Irene gives us the scoop - "Grab the disinfectant, wipe down the bed, pillow cover, counters, tray, floor if needed, coil up any cables, any sterile, unopened equipment goes back, opened goes in the trash.  New sheet on the bed, new pillow cases on the pillows. Trash taken out as needed."

Boom.  We've got an assignment.

Any patient gets discharged, we are on that room like white on rice.  Cleaning with passion.  Not much different from working on the ambulance, really.  Running to catch vitals when asked.  Grabbing coffee, water, sodas, sandwiches for patients when asked.  Otherwise just standing in our assigned space, waiting.  Sunday is not a very busy day, apparently.  There were almost always 4 rooms empty at any time out of the 20 total.  Seemed pretty busy to me compared with our regular receiving hospital which has 5 beds!  Taylor and I chatted quietly when we had the chance.  The hours passed.

Abner arrived.  82 years old, shortness of breath.  History of asthma and pneumonia, coughing, can't catch his breath.  All alone.  Dan was his nurse, and had a bunch of patients.  "Can you give me a hand?"  We were trying to get him to the loo.  When Abner stood, I noticed the watery mess on the sheet.  Then the smell.  I mouth "I think he had a BM" to Dan, behind Abner's head.  Oh boy.  Short, slow walk to the toilet.  We strip him down and begin to clean.  Caught myself gagging and started breathing through my mouth, and trying to keep a smile on my face (apparently the smiling counteracts the gagging reflex...)  Abner is embarrassed.  "I'm so sorry.  This is humiliating."  I assure him that there are no apologies necessary and we are happy to help.  Dan keeps rushing out for more supplies - wipes, a clean gown, an adult diaper.  I'm looking around for an exhaust fan switch - there is no fan.  He keeps talking.  Never stops.  His devoted family (none of whom are inclined to get off work to come care for him in the ER) his deep faith.  Getting old.  Living with a broken body.

We get him cleaned up, put together, and into another room.  I check in on him.  He asks for a blanket, something to drink, something to eat, a phone to call his daughter.  I help.  I listen.  I sit with him while the ER doc goes over the instructions.  Probably not over the pneumonia, here's some more antibiotics.  Daughter can't come pick him up for two hours.  Nurses move him to the hall 'cause we're running out of beds.  A roll-over accident is coming in by ambulance.  I make sure he has all his stuff and is comfortable.  I check in every few minutes and go chat whenever his eyes are open, just so Abner's not under the impression he's been forgotten, shoved into this back hallway.
"You have sown so many seeds of kindness today.  You will reap a bushel."
"I need all the help I can get." I replied "But being a heathen all my life tends to keep one out of God's graces. Well, maybe not a complete heathen, really a rebellious ex-mormon"
"I don't believe that.  You've sown your seeds of kindness today."
"That's probably the nicest thing anyone has ever said to me.  Thank you."  And I meant it.

Abner's daughter showed up after work.  We got him into the wheelchair with all his belongings.  The daughter looks exhausted.  Guess I can't just judge her too harshly - we all have lives to live and our own issues to deal with.  She wheels Abner out the door.

We're on to the next patient.

EMT Class week 21 - Testing and review

We had our last regular written test on module 7 - ambulance operations.  I passed.  That's all I'm going to say.  I'm not the top person in the class by any means, but most of the questions drive me insane anyway so I'm just going to live with that for now.
After the test, on to stations.  We're practicing for practical exams now and I have to say that the first night panicked me a bit.  I'd been so focused on the written exams I had not been studying the practicals.  Blergh.  We have 4 tests to take.  Written class exam, practical class exam, practical NREMT exam, then written NREMT.  I don't have much stress about the written.  I'm re-reading the book, around 100 pages each night, so some of the old stuff will freshen up my mind.  Practicals are another story.

To pass the class, we need to get checked off on all of them.  On NREMT practical day, there are six stations.

We need to do all of these:
Trauma Assessment
Medical Assessment
CPR with AED
BVM apneic patient
Spinal Restriction (supine or seated - aka long board or KED)

Then we pick a card to get one of the following:
Splinting - Long Bone
Splinting - Joint
Splinting - Traction
OPA-Suction-NPA
Mouth-to-mask ventilation
Supplemental O2
Bleeding & Shock

I can do this.  I can do this.  I will not freak myself out about it.  I will be a good EMT dammit.

Van is holding extra review sessions this week and I think I'm going to partake.

Taylor and I are spending the day in the ED on Sunday.  From others' who have already gone, it's pretty tough.  Basically a day spent doing vitals.  Nobody wants you there.  They see you as an annoyance.  Super!

EMT Class week 20 - Operations

We are winding up with the book work with the last 4 chapters: Ambulance Operations, Gaining Access & Highway Safety, Hazardous Materials, and Terrorism.

A lot to cover.  We hit another milestone as well when someone in class asked, "What page was that on?"  "One thousand forty-nine."  Holy frijoles.  End of The Book.  I will be extremely excited when I no longer have to lug that brick of a book around any longer.  Terrorism chapter was crazy long, and a load of new acronyms like CBRNE, TRACEM-P, OTTO, SLUDGEM, etc.  But the chapter was informative and had a ton more info on biological agents like Anthrax, Q Fever, Tularemia, Plague, and more.  Disease has always interested me, in fact I was looking at doing my Masters thesis in Spatial Epidemiology...

Great guest lecturers - the Deputy Fire Chief, an EMT/EMD, Tess, and Mr. Medic.  Some good discussion as well.  Test on Monday, then 4 more classes of review to prep for our finals.  Final class written comes next, then final class practical.  Then we do the NREMT practical.  Provided we pass all that, we schedule our NREMT written at the university testing center.  All this in the next 4 weeks.  (Not to mention I just began a new semester of graduate classes...)  EEEK!

Better news: clinicals are booked.  Taylor and I are headed for the "big city" ED for a ten hour shift on April Fool's day.  Should be an interesting day.

So, tons of study, revision, practice over the next four weeks.
I cannot wait!

ePCR Pains

We are finally jumping into the digital age (and compliance) - we bought into an ePCR system.

Having done a few software implementation projects in my day, this one has gone about as poorly as it possibly could.  You take several dozen law enforcement officer - EMS providers and tell them they are switching to an ePCR system.  In an area that rarely has cell coverage and more rarely has internet.  No printers on the ambulances.  Transferring to 5 different county EMS and a couple helicopter services (in different states).  Throw this project on the back of an already over-stressed EMS director.

We went live a few weeks ago.
Chaos.

We were nowhere near ready to go live.

At the very least, we went live when our call volume is at its lowest.
And we had to jump off the bridge at some point.

So here we are.  Still filling out paper charts on a run, then entering data back at the office.  Naturally our run sheets are not set up like the ePCR, so there's a ton of jumping around to find correct fields.  Thankfully (for us) computer nerd/LE officer/AEMT George is on light duty for a leg strain.  He's desk-bound and has torn into the database and forms with enthusiasm.  In a couple weeks we have moved away from out-of-the-box horrible, to, um...less horrible.

George and I decided that maybe taking a few of the courses offered by the ePCR folks would be a good idea.  We are learning.  Slowly.

This is the continuing tale of our organization.  "We need you to moonlight this project," or "It falls in the category of 'other duties as assigned'."  Trouble is, the original duties don't just go away.  I don't know how the Pit Boss makes it all work, really.  At the very least he needs an assistant.  Instead, he's stuck with a rag-tag handful of willing volunteers who also have day jobs.  We're doing the best we can to patch the canoe, bail out the bottom, and simultaneously paddle.  Upstream.

Help!

EMT Class week 19 - TB tests and OB/Gyn-Peds-Geriatrics Exam

Too much going on.  Seems like class has sped up once again and we are racing to the end.  Hundreds of pages of reading to get through - all quite dense.

TB tests were uneventful - we all got poked by a nice nurse from the clinic Monday tests were read Wednesday, and our paperwork was signed.  Now Van can get us signed up at the hospital ED for clinicals.

We once again just scraped the surface of caring for emergencies with special populations.  I need to know more.  At this point, though, I've just resigned myself to getting through the testing.  There is so much in the book I disagree with and even our instructors have changed from the fun real-world enthusiasm to saying things like "Well, the written exams will want you to know what the book says, so..."

I'm making a conscious effort in class to keep my mouth shut.  Not speak up and give answers.  Apparently my forward attitude and inability to shut up is detrimental to the rest of the class.  They won't speak up or take control - call me arrogant, but is that really my problem?
So I'm playing nice.  Trouble is, I'm just not interested when I'm not engaged.  I end up looking up medical info on my tablet, or playing the Speed Anatomy app (which, btw, is incredibly fun).  So class is no longer that fun for me.  It used to be the highlight of my week.  Now, I'm just getting through it. I read my chapters, dutifully study the objectives, and try to feign interest even though I'm not participating.

Guess maybe I'm just down this week.

EMT Class week 18 - Trauma exam and OB-Gyn

Well, after extrication day we were all pretty wasted, but excited to keep moving forward.  Seems like class is speeding up at this point.  Just two very short modules left - Special Populations & Operations - so two exams, three nights of practice, then final written, final practical, NREMT written, and clinicals.  Too much, too fast!

We started off the week with our Trauma section exam.  It went fine.  I didn't fail, but didn't do as well as I wanted either.  I think I scored an 88%.  At this point I just want to get through the "book learning" and move on to studying our protocols.  The real way we work and not the 5-year old textbook interpretation. To learn how to assist with intubation, IV starts, and generally be a better EMT.
We spent the rest of the night taking vitals - just working on getting better at it.  We have a matrix of every person in the class and have to get their vitals at least once.  This way everyone is forced to practice at least a dozen times throughout the class.

We got a much more graphic look at childbirth in EMT class than we did in EMR class - more photos and fewer drawings.  Nothing like skimming through the chapter to find an explosive wave of amniotic fluid!  Anyway, we had the same instructor (nurse from the local clinic) and he did an excellent job.

Up next: Geriatrics, skills lab on special populations, and exam!