On the Way to Paramedic in Northern VA

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Sunday, February 27 2005
On the Language Thing

The EMS field was to me completely unexplored territory when first I entered in mid-2002. I didn't even have a CPR certification. Since then there have been classrooms, labs, books, books books. From where I sit at the computer I see no fewer than 39 EMS textbooks and 8 scribble-filled notebooks. I have in the course of time read all of them, some several times over. Some I am still studying from. In this, DTs is no different from his EMS Brethren - everybody who graduated from my Paramedic class had to do the same.

In order to do the Job more effectively, though, we all had to augment these books with "outside references" - EKG interpretation, for instance, is one field where you can never study enough. So to those 39 add in well over three dozen "outside" reference books, and Pocket References Galore. Although the classes are over, the books continue to accumulate.

So it's no wonder, when all is said and done, that those folk who have to their own satisfaction "made it" to their level of choice (Basic, Intermediate, or Paramedic) are usually quite finished with book larnin' and very glad to throw down stuff by Brady and, if they are of what passes for firehouse literary persuasion, pick up something by Koontz or Steele.

Those in the House who are not of literary persuasion - by far the majority - Look At You Sideways when spotting you with a book in hand. But everyone in the House is always doing some sort of training, some sort of recertification. In the Station, then, not so much reaction. DTs with a Book: Acknowledged.

In the Private Sector, however, from the Sideways Look there are three typical follow-up actions:

If said book is merely an EMS "fun" book, such as Manhattan Medics or Into the Breach, no words, or a grunt. Also expect this reaction if you are reading, say, Garfield's Word Search or Highlights. As long as it's not a Textbook. (DO read the two italicized books if ever you get the chance - they're both excellent!)

If said book is a textbook, one is usually asked if a test or recertification or "upgrade" is in the works - typical banter.

If, as has lately been the case with DTs, the book is Medical Spanish or Spanish for Law Enforcement or an English-Spanish Dictionary - prepare for incredulity. Your EMS brothers are much too polite to roll their eyes, circle their ears with a forefinger, laugh outright, or... what else is it they always do, lemme think...

Books, books and more books. Away with our books, then! Especially language books, because:

"They're in America - let 'em learn English."

"Their kids probably speak English - let them translate."

"Let the hospital deal with it - normal saline never hurt nobody and a splint's a splint"

"The detailed history can wait until the ER."

"They Point and You Patch."

"If they were unconscious you wouldn't get verbal info, so just pretend..."

All, to my way of thinking, baloney. We don't tell obese patients, "Lose the weight, then we'll talk about getting you onto the stretcher". Rather, we in EMS work out. I see no difference between accommodating a patient with my muscle and accommodating them with some added study. Either way, I'm investing time in myself.

It all distills into What Makes Us Better At Our Job? And one never knows when the extra bits will come into play.

For example, I had to leave my driver at the scene of a wreck last duty. Her Spanish was better than mine, and the medic needed her help with a patient who was a fly out. My patient was a "load and go" as well, due solely to mechanism - both patients were ejected from the car, mine straight into the arms of angels - not a scratch or broken bone anywhere.Better safe than sorry and my X-Ray Glasses have yet to arrive from DC Comics.

Here too, Spanish was it. No Spanish = No communication.

Nobody needed to speak to the third occupant.

Thursday, February 24 2005
Folie Deux For One, Please.

I apologize to all for the lack of recent posts - I know that while BC and BE continue to expose you to 30 seconds of this site, the least I could do is change the view from time to time. However, if this were the Bible, the past week would be a big "begat" list - very boring.

With the exception of a non-911 call ran earlier this week. The patient was an 80 yoF nursing home resident 2xBKA, extensive other medical hx, requiring routine dialysis. We were told prior to transport that she had extreme dementia (A&Ox0) and was "noisy but harmless".

I looked in on my patient on the way to the nurses station to do paperwork. She was supine in bed and had removed all her clothes, and was busily trying to remove the diaper she wore. She was quite loud and chattering away to herself; the words were difficult to make out because they were of the "veryquicklywithouttakingabreath" variety.

Paperwork was taken care of while the nurses dressed the patient for her trip. We loaded her (strangely subdued) onto our cot and into the ambulance for her 15-or-so minute ride. My turn to tech, so I'm in the back when she starts writhing around on the cot and the fast talking starts up again.

In French, I'm sure of it. Very very fast French.

Now folks, DTs hasn't spoken French since 1978. Even when I worked near Embassy Row in DC one could have expected at least one encounter with a French-speaking person. No such luck. I am told by reliable visitors to that country that the French would rather speak English than hear your poor efforts mangle their language. My source tells me you can construct a perfect sentence but say "le" instead of "la", both of which mean "the", and they'll cock their heads and discard the entire sentence as unintelligible. My source usually finished this observation with, "So f* the French."

But I try anyway, stuttering out "n'est ce pas tres vit, s'il vous plait" which think I remember meaning, "Not so fast, please". It must be close enough. My patient repeated slowly and clearly, "Mon dieu! Ma derriere blesse!" - "My god! My ass hurts!".

I can't help it, I'm a bad person. I laughed, big time. "Je me regret! Je me regret, mais nous sommes ici, la maison dialysis, dans cinque minutes, je, um, dit le doctor" and while the French is poor, my meaning of "I'm sorry, I'm sorry, but we're here, at the dialysis place, in five minutes, I'll tell the doctor" seems to get through and she calms down. I get the word "dormez" or "dorm-" something as she closes her eyes - she wants to sleep.

Suddenly she doesn't seem as demented.

Both the folks at dialysis, and the nursing home, knew that she was indeed speaking French; she still had dementia, it turns out. She just had a fleeting moment of lucidity with me when I seemed to "get it" and she calmed down.

Which was a nice thing to happen, to me at any rate, and led me to consider the whole language thing. A subject for a later post, methinks.

Thursday, February 17 2005
I Didnt Spend Six Years At Evil Medical School...

"As one of seven children, I was delighted to receive a bike for my birthday - until the other six kids each got a pony for theirs."

No, this isn't me, but as an analogy it works well. I decided for the last week or two, and continuing on, that I'll no longer have my pager on when I'm not on duty. That way, I don't get worked up about the calls I've missed. Works well. Reduces stress, I've found.

And we got five calls last duty! This effectively doubled the number of calls I've done so far in 2005. While all of the last batch of calls were medical (no traumas), and four were unremarkable, still, I have no cause whatsoever to complain. Either statistics, or the gods of EMS, are catching up to me, which is just fine.

Then, there was that fifth call...

I think most folks in EMS have some sort of self-image, a persona we adopt during patient care or an avatar we assume when arriving on-scene. Kindly, wise, gentle but firm in our dedication to providing care ("Yes, it'll hurt, but you need this IV"), our personas do not necessarily reflect any aspect we may present to the world off-scene. "At home", most EMS folk are a loud opinionated lot who laugh at fart jokes. Our dream TV station runs Southpark, ER, and Third Watch over and over.

It is my belief that such self-imagery is practiced by the medical side more than by the fire guys. Fire guys seem more to want to use axes to chop down non-burning stuff to get to burning stuff, which they then hose. If a non-burning person is in the way, they will firmly move them aside to continue with Plan A. I have not observed them to become Gentle or Kindly in the process. Fire waits for no man, I suppose.

We speak, however, of Bambulance Folk. Now, naturally, by assuming this persona your typical Bambulance Person will expect the patient to react in a certain way. It throws us when a patient reacts differently from our expectations, because sometimes these personas are all we have to control patients. Most of us pack another, spare persona - Stern Medical Professional - to fall back on in case the patient is, well, different.

It is not unheard of to be called out to a domestic disturbance because Husband is bleeding from where Wife walloped him upside his cheatin' haidbone with his very own golf clubs. It helps to have Wife a little calmed down for The Nice Medics. Usually, domestics bring PD with them before we ever enter such a scene, but there are other situations.

Patients with low blood sugar, or drunks, or people on Bad Drugs. Combative from head injuries. Senility and dementia. New Mom freaking out because Baby Bunting went a-bouncing. We smile and soothe, they relax and cooperate. Good avatar.

When we smile and soothe and they do not relax and cooperate, it literally disarms us. Johnny Law may reach for the 'cuffs, or place a meaningful hand on gun-butt; EMS folk can switch to Stern Medic, but that sometimes backfires as well. Mr. Drunk goes from uncooperative to "you wanna piece of me?" and there you are. Back up, back out, call for PD. The patient has called our bluff.

So that fifth call. Typical day in Trailer Virginia; 50 yoM possible seizures; caller is not at the residence. No further information. Lights and sirens, whee!

ATF a 50 yoM c/o intoxication; AOB; very uncooperative. No seizures. Patient was drinking heavily, got on the phone to a friend who became alarmed and called us. I have seen this call many times. As usual, the patient finally agrees to be transported to the ER for evaluation.

In my Mind's Eye my avatar-self is being Kindly and Gentle, trying to get information from this patient. Smiling Benevolent Figure.

However, to the patient - who didn't call us, remember, the friend did - I am Evil Incarnate, whisking him away to Fate Worse than Death. He agreed because he felt outnumbered by a Medic crew, a BLS crew, and an Engine crew.

I am Snidely Whiplash. I am every character ever played by Rutger Hauer. I am worse than Hitler. And so, I get no patient information, no medication list, no allergies, no history, no verbal response. I do get a teensy bit peeved and might just remember once thinking that a 14-gauge in a hand vein might do the patient some good, but cannot under our protocols start one as an EMT-B. Still, Snidely Whiplash Hauer Hitler is tempted.

I have yet to decide if my EMS Mental Toolbox needs space for more avatars, or if I should accept as fact that some folks just want to be left alone.

Anybody know?

Thursday, February 10 2005
"Look now how mortals are blaming the gods" - Homer

Magic, or "magick", is a big subject, but parts of it can be defined as Ritual for Effect. The whole premise is that certain rituals will result in certain outcomes. Recipes. Say the secret word and win $100.

"If Ye Practikal ParaMedick bee desirous of an Call and wouldst maek Tones Drop, or if an comely ER nurse wouldst forsaek all Rest, then spaek thus: "Wow, it sure is slow around here. Things are so quiet. I think I'll take a nap."

Whether medicine in general, and EMS in particular, is rife with Magic or simply the belief in magic is debatable, but a large percentage of docs, nurses, medics, EMTs and fire fighters believe in certain rituals. In our society, belief this fervent is called Faith when it involves God. If it does not involve God, or involves the "wrong" gods, it is Superstition. Most people are of the opinion that we, puny mortals, are not very effective at pushing around and controlling the behavior of the One True Creator of the Universe, and so let us defend their sensibilities and place Medical Magic in the "superstition" category.

The superstitions in EMS are many, and vary from region to region, I understand. Certain beliefs are pernicious and wide-encompassing, however, and fall into two categories: Conjuration (causing something to appear) and Dissipation (keeping something from happening).

Rituals concerning these two abound in medicine, but if we further narrow our attention to prehospital and ER staff, then of these Conjuration is by far the most developed. There are things we can do to Make Calls Happen, but avoiding these rituals does not guarantee fewer casualties. For instance, anyone in their kitchen can perform the Ritual of Brownies - follow the recipe, voila, you have brownies. Not baking brownies does not guarantee you won't have any - someone might bring some to you. Our EMS Spigot can be turned on "Full" but we don't know how (or have no rituals) to turn it completely "Off".

Conjuration itself can be broken down into two categories: Verbal (spoken word) and Somatic (actions). I've seen evidence that beliefs are pretty evenly divided between these two, but the Verbal components, especially by ER staff, are the most strongly held - and the most efficacious. Certain words in the ER are Big JuJu, and strictly forbidden.

Now, this power is not ours by any means. We don't get the power to make "slow quiet" work when we're EMT, and it gets stronger as we rise through the ranks of EMT-I, Paramedic, Nurse, PA, etc. until Doctor Kildare can read a Robert Frost poem and cause a mass casualty. It's not like Nun powers. Anyone can say "Slow" or "Quiet" and cause chaos. Redhats and ridealongs are cautioned at the outset - and some even say their naive utterances are the most powerful.

It is rather the use of these words which bring the attention of the EMS gods to you, and cause you trouble. This by the way is not a new concept. Homer used it circa 750 BCE:

Ulysses: "Hey, look, there's Ithaca! Sure looks quiet. Slow the oars and we'll sail right in!"
Aeolus (God of the Winds): "Wassat? Slow? Quiet? Oh, hey. *PUFF*. There ya go, li'l fellers - safe and sound again in the wine-dark sea."
Ulysses: "shit."

Everyone in EMS agrees on the Slow Quiet Curse. The somatic components are much more varied. Every field has its somatic superstitions. Sports, for instance - the quarterback who doesn't wash his jockstrap, thus keeping his mojo while at the same time lending new, brown meaning to "winning streak". EMS somatic superstitions are largely less disgusting.

To Conjure a Call, we must simply:

  • try to sleep;
  • cook an elaborate meal in the station kitchen, tones guaranteed at the critical burn-everything stage;
  • enjoy a really good episode of [insert TV show];
  • study for tomorrow's Big Test;
  • walk to the corner store two blocks away;
  • get in the shower;
  • sit on the can and mean business;
  • take off our boots...

... etc.

Or, when performing an innocent task, doing it the wrong way will cause the tones to drop. For instance, in getting ready for bed, if the EMT doesn't align his shoes properly (which according to various sources can be one of Toes Facing Door, Toes Under Bed, Unlaced, Laced, Upside Down, or Still On Feet) then the tones drop. Not leaving the doors open on the ambulance, for quick entry, will make tones. Not refilling the fuel tank when it reaches the 3/4 mark is a guarantee of tone-out and a call which lasts several hours. Not peeing when you have the chance. Not...

Folks, I am here to tell you: none of that stuff works. I tried it. Total calls for last duty: Zero. At this rate, people in my first due will begin spontaneously healing when I have duty. It's enough to test one's faith.

Good golly, if we can't believe in the stuff we ourselves make up, what can we believe in?

Sunday, February 06 2005
Bringing Out The Bic Guns

At the end of last week's duty I was approached by my new Captain.

"DTs", he said, "We need your help. Can you be here Saturday to run the bambulance? Everybody who would normally be here is going to a Burn. Actually, this Burn has been planned for a long time, so I'm sorry about the short notice. Can you do it?"

I assured him that I would ask She Who Must Be Obeyed.

"A Burn?" asked SWMBO. "What's that?"

"I have no idea. It's a Burn, they said. It's been planned, they said. But they didn't have anyone doing the ambulance thing while they were gone. So they asked me."

Permission was granted, so off Saturday morning I went, wondering about this Burn thing.

I understood that they've planned to burn something for a long time, the Captain practically admitted it. He was particularly vague about what it was they were burning, though. Could it be that the Fire Guys had said, "On February 5th we're gonna light something up, boys. Come that day, put on your gear and mount up and we'll ride around in the fire trucks and find something sweet. Bring hot dogs."

Couldn't they just? I have seen these guys at play. I decided that I wouldn't rat them out when the PD arrived at my station.

"DTs, we caught these guys Burning stuff - what did you know about that?"

"These guys? They was here all along. We was playin' cards - see all the cards? The forty of 'em just went to the bat'room a minnit ago."

Indeed, one must cover one's EMS bruthaz.

At 07:30 I arrived at the station, where parking for POVs was at a premium. The previous shift's bambulance crew was still there - in theory they'd get off shift at 08:00. I checked out my equipment bags while noticing the fire guys excitedly getting their stuff together - filling air tanks, tightening straps, testing masks. My sincere offer of latex gloves to the younger fire guys, whose whole lives were yet before them, was met by blank stares. Fools. Go ahead and leave your fingerprints at the Burn, then.

Into the vehicle bay strode two gallant figures, incongruously dressed. Dressed much as I was - no fire gear marred their crisp blue uniforms. We exchanged wassups, when I was dealt a shocking surprise: These two were going to be the Bambulance Crew.

I tried to explain. "No, see, the captain wanted me here today while the guys, you know, went out (wink) on this thing (wink) they're doing..." It was for naught. This crew was manning the rig at the station.

I was going to The Burn.

So this is it, then. Perhaps my silence on the subject thus far had been misinterpreted, or too few of the fire guys knew me well enough. The only way to keep DTs from spilling his guts to the authorities is to Bring Him In. Get soot on his hands - then he's guilty as the rest of us. As added insurance, the two young ladies from the previous crew were accompanying me - pulling a back-to-back duty. The capstone? DTs will drive. Yes, this not only keeps his hands in plain sight at all times but eliminates any "I was in the back and didn't know..." or "I was a helpless passenger..." pleas I might have tried.

We were off. I tried to keep the conversation light.

"So, this Burn. Neat thing to do, is it? Good wholesome fun, yes?"

The young lady in the passenger ("lead technician") seat appraised my best "innocent" look.

"You've never been to a Burn before, then?"

"No, no, no, not me, no, never burned up anything, really, never lit a fire, well, in the fireplace, but - my own fireplace, in winter - but no, not to a Burn, as such, no."

Well. Boy was I wrong about all that, then. Turns out they have an entire building made of concrete block and steel, three stories, into which they toss old shipment palettes and scrap lumber from lumber yards and stuff, and light it up, and run in and put it out. The Fire Guys practice laying hose lines, hooking things up, searching smoke-filled rooms for victims (mannequins, in this case) and rescuing them, knocking down the blaze, etc.

All above-board, all great practice, skill-building and good clean fun. Each time they start a fire in the building they choose a different location (basement, "kitchen", attic, whatever) and the fire trucks have to come swooping in from down the street. They put the fire out while Higher Ups watch 'em, keep 'em safe, praise their skills and critique them later on how they could improve.

Each fire is called an "evolution", and they did five or six before calling it a day. We bambulance folk were invited to go in and try it. Yours truly declined - "I know's me place, guv'nor, and it's hon the outside wif' the patients, it is."

Fact is, our presence was for safety reasons only, in case (let it never happen) one of our guys got hurt, which fortunately was not the case.

Some might conclude that all that good paranoia of mine was wasted, but it gave me a chance to see where my ultimate loyalties lie - which is, unsurprisingly to me, where I knew it would, with my fire guys.

Thursday, February 03 2005
Neptune is Off the Hook

This week, the evening duty followed a familiar theme. The gods of EMS looked at their watch and said, "Hurry up and hurt everybody before DTs gets here!". Really, I don't know what they're afraid of - for gossakes, I'm still BLS.

Between 18:00 and 21:30, again, there was:

  • a hit and run, car vs. pedestrian - who was flown out by helicopter to a trauma center;
  • a BLS car accident, one occupant c/o back pain;
  • a BLS home accident (fall down a flight of stairs);
  • a call for an unconscious (no further information);
  • an adult female c/o abdominal pain;

My crew got a "fall from a standing position" - somebody tripped - which was a patient refusal, and a lot of sleep - thus the insane rush to update this, the chronicle of the mundane.

I thought, given the "feast or famine" nature of the call situation, that I had once and for all identified the malicious Force behind EMS as Neptune. Superficially, our situation resembled fishing - and we weren't getting any bites. However, on further reflection the similarities between when the tones drop and when the fish bite were few and limited. And it's not as if we actually bait anything to get trauma, a subject I could go into in detail because we do sometimes joke about it, but I don't want to give any Evildoer ideas. Besides, I do not fish, and one can only analogize that which is familiar.

I am familiar with sleep - becoming more so as I run with the rescue squad - and so the obvious reciprocal question arose. Not, "Who benefits by getting these calls out of the way before I arrive?" but rather, "Who benefits when my crew and I sleep all night?", but to suggest that Morpheus controls EMS Tones would be the height of absurdity and paranoia. I am so glad I never suggested it.


Good EMS Reads:
Maddog Medic
The Mac Medic
Subaqua Sternal Rubs
You Can't Cure Stupid

Posted Saturday, March 05 2005 21:52, Site Meter