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Monday, November 29 2004
Less Filling Strobe Light

Well, on 11/23 I pondered whether 'twas me black-clouding the evenings, or my partner.

'Sme. Partner worked several days last week while I attended classes, took off Thanksgiving and the Friday afterwards, etc, etc, no problems. I returned to work today.

And there we go, innocently off to a patient pickup when we crest a hill and find a 30-second-old accident involving three vehicles - lots of glass and plastic on the road. Personae dramatis include Driver 1,Driver 2, and Driver Mom with her two kids bringing up the rear vehicle. No airbags deployed, no windshield breaks, no steering column or dashboard deformities for anyone.

Kids, ages 2 and 3 by their size, are still in their car seats and seem fine. Middle guy and Mom both have neck and back pain (although both were out of their cars, amblin' about) so we sit both down and take C-spine until the County guys could get there.

I think I'm prepared for this - I rather expected something based on my black-cloud theory - and so I have this here nifty orange vest with reflective yellow tape and "OWL VFD" in big letters. So I get to lean in to Car the Last and hold Mom's C-Spine. Can't get all the way as Kid 1 is buckled into his car seat directly behind mom, which means my legs are sticking out the door while cars whizz by. All I needed was for some dumbass to rear-end the car, make it jolt forward, slam the door shut, and break both my legs.

Fortunately, PD showed up and blocked the lane for us and shortly thereafter the County's engine and medic arrived.

Guess I gotta start carrying flares and stuff too, now.


Friday, November 26 2004
Pungi Stick Talking Points

Wednesday night was the Eve of Refusals; we had one (1) patient transport to the hospital, and all the rest wanted refusals - the guy who hadn't eaten solid food in 3 weeks (vs stable, glucose 140's, A&Ox3); the guy who had was in an mvc with deployment who now had right-side pain, which "went away" after a four-lead...

It wasn't that each of these folks had family in town or anything - many of them were living alone. And they called 911. And their problems were not immediately life-threatening. So they stayed home. Very strange.

And of course, Thanksgiving. That time of year you gather with the extended family and Explain What You Do.

Why is it that everyone waits until you have a table so weighted down with food that it sounds like a too-deep submarine (groans and rivet popping ala Das Boot), why is it then that people want to know about the goriest mvc, or the "worst burn you ever saw"?

Sure, we can eat and talk about that stuff all day long - honestly, how many times have we come off a code and gone straight out to KFC, pass the coleslaw? - but poor Aunt Minnie is gettin' pale over there, by gum, so we tend not to discuss that stuff unless we're with our EMS Brethren.

And we all have the relative who gauges folks by how much money they make. The inevitable question comes, "So, how much do you make a year doing that?" and I explain that at this point, two months shy of Paramedic, I am a volunteer. I was actually asked if I volunteered for FREE, or if I got paid to volunteer... sigh.


Wednesday, November 24 2004
Non Compost Mentis

Huzzah! ACLS has been vanquished until 2006! Now the AHA owes me another card. I still haven't received my CPR Instructor's card. If we get to the point where they owe me five or more, gonna have to have Bumpy and Rocko go talk to 'em.

Daughter and nephew both made it safely in last night, Thanks. Although she's only been gone a couple of months, she's me firstborn and first off to college; good to have her back.

And now on this foggy, rainy night in Northern Virginia it is time to go rescue Grandma-bound motorists and stuffing-tasting-induced coronaries. Love these little acronym tags - I'm probably overusing, but, eh - saw them over at Far from Perfect's website and had to give them a try.

Happy Thanksgiving to All.


Tuesday, November 23 2004
Small Calibre Rage Going Post-It-Notal

Another car wreck in front of us last night, this one a single vehicle which went straight instead of turning with the exit ramp from I-95, plowing through part of a barrier and onto a grassy shoulder. No injuries, and I swear it happened right in front of us - there's no way I could have caused it. Not even to liven up an otherwise uninteresting evening. And anyway it was PDO (we did stop and make sure no one was hurt. Even though it wasn't our fault.)

Sheesh. I think that makes it three or four times something of that nature has happened, where we Transport People get to stop and play 911 Guys for a few minutes. Am I black-clouding this or is it my partner? We'll see. I have the second half of my ACLS class tomorrow, during which time he runs with someone else, so we'll see if anything interesting happens.

Although I do tend to think I'm somewhat of an off-duty black cloud. Years ago before I even considered the EMS field I got a pedestrian-vs-auto, a pickup-truck rollover with double ejection, a 4-door sedan rollover with mom and baby ejection (baby ejected car seat and all, and miraculously unharmed), a couple of others which don't immediately come to mind...

Anyway, our daughter is due home from college this evening at 23:00, and a nephew is arriving by 19:00 or so... much to do.


Friday, November 19 2004
Pieces of 8-Tracks for Music Pirates

Last night I Learned Stuff. I always enjoy it when that happens, and especially when the things I learn are not textbook things. Medic show-me's are always good, but People Lessons, such as those I got last night, are always appreciated.

Especially when those People Lessons are Me.

I do not think, especially, that (God, Ghod, Roscoe, "The Ceiling") is necessarily providing lessons - methinks one gets 'em if attention's paid, and a little thought and alternate perspective applied.

At OWL we're issued pagers on which our call information is displayed - this helps gobs when you can't hear the dispatcher properly. You can read the address from the text page, refer to it whenever you wish without seeming a fool on the radio ("Uh, Dispatch, what was that address again? I dropped my notebook...")

We were dispatched at 02:30 in the morning to respond to a second-due area for "gum pain". Somebody had a toothache and called 911. Go FRICKIN figure, I thought to myself. Once again, I was "lead" and would have to deal with... but here we were.

The medic (!) arrived thirty seconds ahead of us. They exited the house as I instructed one of my thirds to remain with the driver and help her move the vehicle off the unlit, curvy two-lane road. As my remaining third and I approached, our patient stumbled out of the home and collapsed onto the front porch. He was clutching what looked like a sweatshirt to his face and sobbing. The medics looked at me, I at them.

"Well, what've we got here?".


"You guys want us to transport?"

Palpable relief. "Yeah - if you're comfortable with it."

Hmmm. Just thought of that - was this some sort of dig? Well, anyway, transport we did.

This is where A Lesson came in. Normally, one thinks: "Toothache. Okay, dude - either do not call 911 and use your personal vehicle; if you do not own or cannot drive a personal vehicle, a Friend will do nicely (there was an SO, Friend, or Other Person Type in the house, so that would have been an option). A Taxi can be Appointed For You. Especially at this hour!".

I admit to thinking these sorts of things all the way from the bunkroom to the unit, once I'd read the page; all the way from the station to the scene; and while helping the patient from his home to my unit, too.

But then here's my patient, who began to violently strike their own head with closed fist, such was the pain. Right then and there it occurred to me. Whoa, hang on here...

If you are a professional in EMS, you don't give a damn about what the person was doing, or why, when they were injured - you treat 'em. I remember reading some time ago of an off-duty medic in Israel who was driving home, came on a sniper picking off people from a hilltop. He pulled his personal weapon, snuck up behind the sniper, and put a few rounds in him. Then ran back to his car, got his aid bag, and ran back to treat the guy...

I had here my patient. Did what I could, stopped bitching (it was never more than internally, but it was there) about whether the timing was convenient, about whether I thought the problem was too small to activate 911...

And you know, the receiving hospital knew the guy, a frequent flyer - but for some reason that didn't bother me. I didn't get the "Oh yea? Shit." I believe I normally would have. I have no idea what, but Something clicked with this patient. Maybe beneath all the hoopla I sensed that what we really were transporting was some kind of psych... much more difficult to treat.

Anyway, I suppose I can add "No Job Too Small" to the logo on the bus.


Exercise Caution

Be careful:

Authorities have closed the westbound lanes of Interstate 70 in Ellicott City due to multiple crashes involving a tractor-trailer, an ambulance and a truck. State police said the crash involves three vehicles.

Investigators say it happened when an ambulance carrying a pregnant woman eastbound on I-70 crossed over into the westbound lane and smashed head-on into a tractor trailer. The two vehicles were then struck by a flatbed truck carrying cardboard boxes.

The driver of the ambulance was killed. Three other persons in the emergency vehicle -- including the pregnant woman -- were taken to various hospitals. 

This unit was not responding, or dodging traffic.

More information here, and here, with overall crash statistics and information here.

Yes, this sort of thing happens all the time. Remember, folks:

  • There's always a minute or so to run a seatbelt strap through the Lifepak or the carry strap of the portable O2 (unsecured objects wind up smacking us...)
  • You can get your lines and assess your patient while strapped in; if you can't, do your "can't do it while strapped in" stuff, as much as possible, before you go en route or respond to the hospital


Tuesday, November 16 2004
Pasty White Icing Substitute

Sometimes it feels... empty. As if ambulance transport is to EMS what the Stop/Slow guys are to law enforcement. We shall consider this.

Actually, today was Work day, not Run 911 Calls day. Still, it had its moments.

Okay, one really long moment that had lots of plot twists. At PTS the tradition is that you drive a call, then tech a call, then drive a call... and due to circumstances my driver yesterday done went and bust' a mirror off a competitor services ambulance, quite accidentally and no facetiousness intended. Exuent personae dramatis...

Today my (different person) partner and I pull into a local hospital. Two fine young ladies from aforementioned service are there - one of whom was for a long time a classmate of mine, one of whom runs with my volunteer service and was on my crew before redistribution. Festive and joyous reunion, "fancy meeting you here" all around. I note their mirror is intact. "That was you?" they ask. Curtain falls.

Curtain rises on DTs and partner inside the hospital, for their patient pickup. And who might this patient be? A very close relative of DTs, that's who - purely by the laws of Chance and Probability (a Janus-like god if e'er there was, singly claiming a false duality!) And DTs turn to tech, too.

As Dramma (as it's pronounced) it's thin and poorly entertaining - we takes what we can gets, Precious. Aw, who're we kidding? It's boring. But still, that's my day and I'm sticking to it.


Saturday, November 13 2004
Panting By Numbers

Got to run the second-worst call of the shift this morning. Dispatched for an "unconscious", we found our patient seizing behind the wheel of his automobile. All the windows were down, the engine was off and cold, and it was 2am. We were told the patient was expected home at 10pm, but nobody thought anything of it that he wasn't. End result, patient probably did arrive at ten and had been seizing in the driveway for four hours. Hypothermic, tonic-clonic, incontinent, a very difficult stick - ugh.

But, as stated, this was the second-worst call. The details of the worst call can only be inferred from the CAD - 22 yo patient "out drinking" found by Mom this am with head stuck in the bathroom trash can (who knows how long she'd been there), not breathing and cyanotic; next entry CPR in progress, and the medic who did get the call spent a long, long time at the receiving hospital.

Kind of a theme here, I suppose, folks. Be the kind of over-protective, butt-inskyish, embarrassing parent that waits up for the kids when they're out.


Thursday, November 11 2004
Tide(tm) In The Tidal Pool

Mucho boring rant begins. I've been giving some consideration to changing hours at PTS. Consider that working a 12-hour shift effectively blows your entire day - why not just finish the job by staying on another 12? Currently I am spending three days (Mon-Wed) from 09:00 to 21:00 there, for a total of 36 hours worked, three days blown. Since I'm used to doing the budget thing for my ex-company I can add that this includes six meals purchased and three round trips in the personal vehicle. After travel time, I get home just in time, usually, to tell my kids goodnight and head off to bed myself.

Compare and contrast to spending two days (Whatever) from 06:00 to 06:00, total of 48 hours worked, two days blown, four meals purchased and four round-trips in the personal vehicle. Switching to 24-hour shifts seems therefore to make sense - fewer expenses, eight hours overtime EVERY time, and best of all only missing my kids two days a week versus three. The downside, of course, is that currently I am able to run every sixth night at OWL, even though I am arriving late (OWL evening duty begins at 18:00). And that occurs three duties in a row (Wed-Tue-Mon). Whereas I would be completely missing duty, but only twice every six weeks as the duty falls on a workday, and those wouldn't be back-to-back duties (e.g. Wed-Tue) because I would not be running back-to-back 24 hour shifts.

Eh. Told you it was boring. Obviously much to consider...


Sunday, November 07 2004
Rice Served With Lemon Wedgies

Ah, Country Buffet! For those who don't have one available, think of an All-You-Can-Eat Denny's. The food is good if not fancy. We responded to a 2nd-due call for adult dizziness, but the medic decided to transport. Finding ourselves famished, and conveniently located to the aforementioned establishment, we decided on a good breakfast.

Our dining was interrupted by a call. Both the Lead for a Day and I had pagers, and we both read the same thing - at Total Rental Care, an elderly pt c/o a bleeding chest. We grabbed our receipts from the restaurant and mounted up, only to spend six whole minutes traveling around looking for this rental place. I imagined it was some sort of car wash/detailing spot for Hertz types, or a place to rent home-care tools like floor waxers. We soon found it - Total RENAL Care. We had each read the extra "T" into our pages. It was your ordinary dialysis center with nary a New Car Smell Dispenser in sight. Our patient had jiggled a central line and lost perhaps 50cc of blood, which looked worse than it was. We transported, cleaned and restocked, then receipts in hand returned to Country Buffet, whose fare had by this time transmogrified to an all-you-can-eat Lunch place. Perfect! These folks kindly (and not for the first time!) honored our receipts and we were able to scarf sufficient lunch to fuel our continuing life saving efforts. If there's such a restaurant in your due and you've not yet been, it is heartily recommended.

Alas, the day slowed. Until, that is, one of our Thirds exited class, bringing a classmate tagalong. Since the additions to the family brought our crew count up to five, either me or my lead needed to head off to another venue, such as running with Station 14's medic crew and garnering lead ALS calls for the Registry. I declined, so off went my Lead.

I became Lead for Station 2, therefore, but our departing member's white cloud didn't dissipate until 23:30 and a possible CVA; after that, a 2yoF difficulty breathing, an MVC with one neck-and-back pain, and a possible sudden-onset A-Fib with dizziness (transport declined) to round out the duty. Since our rotations are every six days, my next scheduled duty night is Friday from 18:00 to 08:00 Saturday.


Friday, November 05 2004
Mindsocks In The Dryer

Having finished my clinical requirements, my only out-of-class "to-do's" are the lead-seat calls. I still have Lab, however, as my one remaining class. In theory this class is to provide us with practice for the upcoming (Jan 29) NREMT-P test. For most of us in the class it does.

Lab is on Thursdays.

Like Arthur Dent, "I could never quite get the hang of Thursdays". I go into class and it's like a hood drops over my face, or the Stupid Pills take effect. I'm like a sock puppet - one half my brain went missing in the dryer, never to return. And yet, I'll leave class and return to the parking garage, get into my car, and presto! Full functionality. "I am the very model of a modern Major-General, I've information vegetable, animal, and mineral..."

I've experimented. I set up the experiment in advance by pinning instructions to the front of my own shirt. Enter Lab, Experience Shutdown. Do whatever Lab requires that day - ECG interpretations, megacodes, IV arms, etc. Do them stupidly. Breaktime. Examine paper pinned to shirt. "Go To Car". Car? Why? Why not? Leave Lab, go to car. Information floods in. My name, stuff like that. Aha! Break is over, return to Lab and the numbness, a prelude to Alzheimers - taste of the future.

What's the problem? Is it the lighting? Something in the air? Am I the only one affected/afflicted? Is this Burnout, maybe Lab Burnout? I don't know - I came to EMS from the computing field (28 years or so) and never burned out there, so I have nothing to compare.

If it is burnout, should it not have been ameliorated to some degree this yester-Thursday? I was out from Lab last week with illness; the week prior with PALS class at another facility. Two-week break. So yesterday should not have been a problem, or should have to some extent been less acute.

A most curious phenomenon. All I know is my teeth hurt on Fridays, because I make the conscious effort Thursdays, before entering Lab, of shutting my mouth tightly to (hopefully) reduce the slack-jawed, drooling Look that I may not sport on the outside, but sure seems to be there on the inside.


Wednesday, November 03 2004
The Pitter-Patter of Little Feat

My usual partner was out Sunday, giving me the opportunity to run BLS with my two thirds, neither of whom is yet an EMT-B (although one is a driver). Of course, Sunday turned into The Day The Airbags Deployed. No fewer than three back-to-back MVAs with airbag deployment, and here we are toting but two long boards. The third guy therefore got KED'd out. Things were hopping at PoH such that they hadn't a chance to clean the boards they had on hand. I found some unused in the hose room of Station 12 while we refueled before returning to Station 2.

Evidently, someone didn't much care for that, though, for I received a call from the rescue chief asking me if I'd absconded with boards from other units. "Tell me, where did those boards come from?" "Hose room." "Not from other units?" "Nope." "Good answer." Sheesh. Some whiny motherfucker didn't have the balls to walk up to me there at Station 12 and ask about them, but rather ran sobbing to the rescue chief. Boo hoo.

SO, to top off that Fun Day, a middle-aged gentleman decided to code in the wee hours as a finale to our little weekend adventure. My two Thirds each got some BVM time and chest time both on scene, and tagging along with the medic, who transported. Their First Code, and although we found out where some extra training is going to come in handy next duty night, they did well!

Ah yes, I also found out today that some, ah, indelicate handling of the transport situation from several days back, from PoH to Fairfax, has resulted in the Lieutenant who was Lead during that call actually quitting OWL.


Posted Thursday, December 02 2004 12:21