On the Way to Paramedic in Northern VA

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Saturday, March 26 2005
The Right Stuff

Sometimes I get the feeling I'm not as "into" EMS as are others. At least, not the stuff.

To illustrate: When one encounters a group of fire guys talking about their work, one will hear something like this:

FF1: "Did you hear Station 99 got a Fireblaster 3000?"

FF2: "I hear that has a OptiFoam Regurgitator - that must be sweet!"

FF1: "Yeah - at 66 million RPF it beats hell of the Piddlemeister!"

FF2: "Say DTs, what do you think of the Deluge Deluxe?"

DTs: "Um, it's yellow?"

After a minute of silence, DTs realizes his coffee has cooled .5 degrees and must be recharged. He wanders off, to the great relief of all.

But I think I've figured it out. Fire is a young man's game, that was my first clue.

This is their baseball cards.

In my not-misspent youth one had to maintain a familiarization with cars in order to join a conversation. Horsepower, colors, how many wheels, that sort of thing, whether Ford is better than Chevy or is in fact Found On Road Dead. If they are fast. Other minutia, I am sure.

Guessing that DTs often realized his Coke had warmed .5 degrees and needed more ice means you're a good guesser, that's all.

Or, okay, football teams - the names of the players, heated speculation as to whether they would, in fact, throw the ball at some point in the game, and what that might mean to the Scheme of Things.

Guy1: "Do you think the Wombats have a chance this year?"

Guy2: "Yes, if they score many points. If others score more, then, no."

DTs: "Succinctly done - every game commentary ever, distilled into Essence."

DTs is adept at reading The Look which means, "You're ruining it. Go away. Perhaps your tea is cold."

But all this is all right - whatever entertains, says I.

In the meantime, I am simply delighted that I can wander into my station and they'll hand me the keys to my Monster Medic, a half a million dollars worth of stuff, and say, "Do as thou wilt." - knowing, of course, that I "wilt" eagerly anticipate the tones and do the EMS thing.

Of course, I hear good things about the Lifepack 20...

Saturday, March 19 2005
To Tell the Truth

I have learned, in my short time in EMS, to listen to the patient - but never, ever to blindly believe them.

Because sometimes they can't tell the truth...

As I was driving southwards one evening a pickup truck ran through an intersection in front of me, attempted to turn northbound, at speed, and instead rolled over a half dozen times. I called 911 and pulled off the road, then went over to the wreck. Still a civilian, this was many years ago.

The woman and her husband were both ejected. Husband was tossed farther, the woman had landed in brambles at the base of a railway embankment. Both conscious.

As I approached the woman her husband half-stumbled, half-crawled over to her. The most I could do at the time was cover the woman with my coat and try to keep the distraught man from moving her while we waited for EMS.

I asked them, "Was there anyone else in the car?" Both said, "No." But it turns out they were going into shock and not thinking clearly - their 12-year old son was still in the car. As far as I know, they all made it, but still - I didn't check the car because "there was nobody inside."

Because sometimes they won't tell the truth...

On the scene we can ask, "Do you have any medical history?". "No."

As we load the patient, we ask, "Ever been hospitalized for anything?" "No."

En route we inquire, "Have you ever seen a doctor for anything serious?" "No."

Arrived in the ER, we turn the patient over to the nurse and give our report.

The nurse will turn to the patient and say, "So, Mr. X, any medical history?"

"Why yes. I had a heart bypass operation last year - this was after a dual lung transplant - but before my hip replacement..."

The nurse will look at us as if to ask, "Why didn't you mention this?"

We stare wide-eyed at the patient, pointing ineffectually and whispering "He never said that. We asked but he never, he didn't..."

Briefly, the patient's eyes flare red as he smiles, but the nurse doesn't catch that either.

One of my instructors called it addonis tidbitis, defined as "The relevant information that the patient suddenly remembers only once he or she is discussing it with the ED physician, making you look like an ass"

And finally because sometimes they do tell the truth...

My patient was having a tough time. Every time his eyes uncrossed and focused on me, his head would drift forwards or back and I'd be out of focus again.

"Quantas cervezas?" I asked again. "How many beers?"


"My friend, you have had more than four beers."

"No, no, cuatro cervezas!"

"I'm not the police - I'm trying to help you. Any drugs, drogas?"

"No drogas", he giggled.

"Cuatro cervezas, eh? Cuan grande, how big?"

His smile slowly grew wider, and wider. Held his hands waaay apart. "Cuarenta!" he shouted, and laughed as he fell back onto the bench seat. Four forty-ounce beers.

Okay, that I believe.

Thursday, March 17 2005
Parsley in the Butter, Watson

In order to take the tests in EMS "they" require one to ride along with people already doing the job. To test for EMT-B one must first ride with Basics; to test for Intermediate or Paramedic level one must ride with medics, and so on.

Not only that - after a bit of ride along, when the working crew gets to know you, they are expected to let you "lead" the team - pretend you are at their level - to see how you do. They are there, naturally, to catch and correct any mistakes you might make in patient care, but for the most part step back and see what you've got. As a matter of fact, they all put on their poker faces and do what they're told - no clues at all to help you out, no raised eyebrows, no "Really? You really want to do that?".

But sometimes, just sometimes, they need to step in.

My Best Stoopid Story begins with the career medics being toned out for a "difficulty breathing" call. I'd been riding with these particular medics for several days a week, the past four or five weeks. They decided to "give me" the call and let me act as lead. Oh boy!

We get to the residence - permanent trailer-type home with a zigzag wooden ramp leading to the front door.

Difficulty breathing, let's see, what do we need? I ask that someone bring an aid bag (for the stethoscope, pulse oximeter, glucometer, bp cuff), O2 bag (for the oxygen, masks, cannulas) and Lifepak (cardiac monitoring, backup pulse ox, backup automated bp cuff).

"Okay", says the medic.

The fire crew has arrived - they generally show up for these things. They immediately ask the medic what he wants them to do. The medic points to DTs.

"Ask him. He's in charge."

We enter to find an elderly female patient sitting in a laz-e-boy type chair, complaining of a tightness in her chest. She's alert and oriented times 3, speaking in full sentences, non-cyanotic, good impression. Her SaO2 is 93%. Nervously, DTs asks one of the medics to put her on O2 at 4lpm nc.

"Okay", says the medic.

Diffidently, DTs asks the other medic to apply a four-lead EKG and run me a strip, to see if she's having any cardiac problems.

"Okay", says the medic.

"My compliments to the fire officer, and can he please get me some vital signs?" - at least, it felt like that coming out. Big confidence.

"Okay", says the officer.

I begin questioning the patient. When did this begin? Sudden or gradual onset? What makes it better, or worse? Ever happen before? Medical history?

In the meantime, DTs with supreme confidence asks the remaining fire guys to bring the cot to the front door.

"Okay", say the fire guys.

I'm convinced we do not need to whisk her away but can proceed leisurely to the hospital for a checkup. Her cardiac function looks perfect - sinus rhythm, no PVCs, no tachy- or bradycardia, good P waves followed by good QRS, no T waves. Her SaO2 is up to 100%, her tightness is diminished or gone.

Damn, DTs is getting cocky.

I fish around for a line I've heard these medics use before, when all is seemingly well with the patient: "Ma'am, if we assist you, do you think you could take five steps to our cot over there?"

Dead silence from the medics. Dead silence from the fire guys. Oh shit, thinks DTs. I've done something wrong, but what...

"No," says the patient.

"Why not?" asks DTs, confused. Muffled grunt from the fire guys, who flee the room en masse. DTs notices eyes widening on his medics.

"Because I only got one leg," says the patient, pointing.

Well, fuck me, thinks DTs. Sure enough, she's missing one leg from the knee down. I noticed her knee when first we arrived, but thought she was sitting with her foot tucked under her - I used to have a similar recliner and found that position comfortable myself. No, no, she only had one full leg. In a flash DTs recalled the ramp leading up to the house.

Gosh, it sure is getting hot in here all of a sudden, thinks Our Hero.

"Um, well, um. Uh, in that case..." DTs' brain went to his Happy Place, where Care Bears played pattycake with unicorns. The medics, sensing Mental Breakdown, assisted the patient to the unit and smoothly allowed DTs to slide into a "third" role without so much as a word between them, God bless 'em.

What I really liked about this crew was their sense of humor. We returned to the station after transferring patient care to the ER. As we backed the unit into the station, there lined up were all the fire guys in a row - each standing on one leg, holding their left leg up behind them with their left hands and saluting DTs with their right.


Saturday, March 12 2005
Momma always said...

Try to guess the biggest fear of Bambulance Folk.

Is it a fear of getting shot during a domestic? It is not, try again.

Aha! Is it contracting a Deathly Disease from the verminous patients we sometimes run? Hardly.

Is it the Fear of Killing Someone? We'd have to try, literally try, very hard, to do that. Mostly. But no, that is not generally a fear bambulancers harbor.

The biggest fear is the Fear of Looking Stoopid.

Stoopid is different from Stupid. Stupid happens, and is immortalized in a phrase one hears quite often at the firehouse - "Huh. Look what I just did. It must be Stupid O'clock." A nap makes Stupid O'clock go away, and the world is good and right-side-up again.

Stoopid is something entirely different. Collaring a patient with the collar on upside-down. Wrapping the BP cuff backwards so it unravels from the patient's arm each time it inflates. Unloading a patient at the hospital only to find, as the cot gets almost to the end of the rig, that they're still hooked up by their nose to the onboard O2. Sproing! Eager thirds cutting the clothes off a medical patient. Stoopid has endless permutations.

So, here is DTs' second-best personal Stoopid story - so little has there been otherwise to write of.

Envision January 2003. The City of Woodbridge, VA is gripped in the clutches of six whole inches of snow. It is one of DTs' first ride-alongs - somewhere in the first five, anyway. Supply your own adjectives to describe his value.

The call comes in - injury from an assault, PD are on the way. The scene is a small apartment, where an extended family consisting of about twelve people is snowbound. Tempers flared, and one gentleman is punched in the nose. PD is on scene when we are, and the one Spanish-speaking officer attempts to restore calm.

The patient does not want to go to the hospital, but our Lead EMT tells DTs, the third, to "get the guy a cold pack". Cold packs are chemical ice packs - chemicals in a vinyl bag, water in an inner pouch. To use, break the inner pouch, the water mixes with the chemical, voila - it gets cold.

DTs gingerly squeezes the bag, then hands it to the Lead EMT. She is not pleased and tosses it back, "You have to squeeze it harder to break the inner pouch". DTs squeezes harder, still nothing.

"Hit it", she says.

Hit it. Right. DTs holds the bag in his right palm and karate chops the sum'bitch with his left hand. The inner pouch breaks. The outer pouch explodes. By curious coincidence it is a shape charge, aimed precisely at the backs of the two police officers between DTs and the family. At 6 foot 4, DTs is slightly taller than the PD. Ballistics assure that the mixed, cold chemical goes straight onto their necks.

I do not know how Law Enforcement is trained, but the training is damned good. I'd have shot my Stoopid Third Ass if I had had a gun. They of course did not. Hell, they didn't even use bad language.

The Bambulance Driver disappears behind a closet door - so PD cannot see him laughing. The Lead EMT exclaims "Shit!" or some such, then begins fishing gauze and padding from the aid bag, handing same to the PD for their cleaning needs.

DTs is paralyzed - except his mouth. "OhshitohdearohfuckohImsosorryjeezusshitohgod"

By some curious coincidence, this slapstick display seems to be just what the family needed. I'm sure the family tells the tale to this day. Hope so. Anyway, we all traipse out in short order. PD assures me there are No Hard Feelings - after asking the Lead EMT how long I've been around.

Because to be that Stoopid I had to be very, very new.

Sunday, March 06 2005
Treading Silently Through Mimefields

In the last post I may have given the impression that, once on site, EMS providers zoom in, lock on, and descend onto "target" patients ala Ahnold-as-Terminator. "Owah mission is to protect John Cahtah - Theah he is." (This, if one is charitable; persons unkind will liken us to George Romero's zombies as we stagger, arms outstretched, towards the patient, the while groaning, "Spliiiinnt!")

If this was the impression, forgive me. My fault entirely.

As every Good EMT knows, Scene Size Up is one of the first orders of business we take care of on-scene. The fire guys have RedHats, and we have Thirds - "Third person on the bambulance." Also known as Canaries, from the old West Virginia coal mining days.

"Say, DTs, there's our patient pinned beneath that chemical truck!"

"I see him. It looks danger... ah, serious. Quickly then, Bandage Boy, wade through the liquid spilling from within to his rescue! I will watch from afar to, uh, direct your progress."

This would be a Bad Thing. DTs would get into so much trouble. I mention this (redhat/third) = canary myth, which some may have heard, to dispel it as the scandalous slander it is. What we do instead, at a spill, is stop at a safe distance (rule of thumb - cover the spill with your outstretched thumb - if you can't, you're too close) and figure it out through binoculars while Hazmat guys suit up.

Scene size-up should occur in every situation, and not just MVAs.

Called out to an "injury from an assault"? Is the assaulter still around, perhaps taking exception to your plugging up the nice bullet holes he made?

Gladys Kravitz delivers a pie and sees, through the window, Samantha and Darrin sprawled on the carpet. Rush in, O EMT, 'cuz a bad guy bopped them on the head, or suspect a gas leak?

Size up the scene, man.

Personal safety is not the only reason. It helps the docs plan their treatment when they know what went on Out There. Did the airbag deploy? Was the car T-boned, and if so, was the door dented in? By how many inches? Was the patient driver's side, passenger side, front or rear seat? Seat belt? Steering column deformed?

We once ran a bicyclist who was standing with his bike, about 50 feet from the roadside. Asked what happened, he replied, "Well, I was following a car, and they stopped, and I didn't and hit them." We walked with him back to the road and took him to the hospital for a look-see.

No biggy, yes? Indeed not! Bad DTs, bad! No cookie!

It would have been a Good Thing To Know that yes, he hit the car - doing 40 or 50mph - and his bike stopped but he continued on like a rocket sled over the trunk, turning the back window of the car into musical dust and stopping with his torso between two back-seat passengers. All he needed were sparklers in each hand to produce that genuine Vegas effect.

Being 50 feet from the roadside, though, did DTs go and check the car? He did not, because in EMT class we learn Scene Size Up... then some stuff... then do Patient Stuff. DTs was already doing Patient Stuff, so that other junk was skipped over and dispensed with.

Live and learn. Size up that scene, baby.

Saturday, March 05 2005
The Big Dark Picture

I think most people who are not associated with emergency medicine get the impression that it's Exciting. A good many of the folk working EMS do so for an adrenaline rush, I'm told. Alas, for DTs, this is not the case. Are we sure? Let's look:

Here is DTs, riding in his first bambulance ride-along. Note the periodic muscular twitches! Observe the dilated pupils! Marvel at the slow, stuttering speech! Yes folks, this is a trained professional in the making!

But it ain't excitement, per se. It's more Fear of F*ing Up. Which he does, by the way - someday he may tell the tale.

Next slide, please.

Here is DTs, driving the bambulance after EVOC [emergency vehicle operators course]. Behold his teenager-like driving skills as he wrestles with driving and all the extra buttons and switches!

And here, running his first call... and here, running his first code... and here: Is this his first dead person? How tentative he is to presume death! And here... but need we see the rest? We do not. Suffice it to say that, every time it looked like Excitement was rearing its head, it was instead Excitement's uninspired cousin, Nervousness. And Nervousness went that-a-way, slowly sanded off by repetition and confidence.

One of the aspects of Excitement which laymen suspect exists in EMS comes, I'm convinced, from TV shows which give the viewer The Big Picture. We don't get that on the bambulance. At least not while it's happening, anyway.

In TV-Land, the happy amigos are driving down the highway, fooling perhaps with the radio, when sudden catastrophe! The car swerves, the highway divider beckons, a montage of shots - mostly with the passengers crossing their arms over their faces as they scream in wide-eyed fear. Crash! Flip! Smoke and smouldering ruin! A Saintly Driverby peels the cell phone from his yap - "Call you back" - and dials 911.

Long-shot of the wreckage, and cresting the hill are Our Heroes, lights flashing. Reaction shots as their steely gaze encompasses the hideous carnage. Medium shot as they approach the thing; close-up over the shoulder of the muscular, mustachioed patient as he focuses on his rescuers' approach. Zoom on the trapped leg with a "My leg! My Leg! And I am (gasp) a ballerina!"

Blah blah blah.

In Reality-Land, we come on the accident. It's a mess. We pull over and are mostly concerned with not getting hit ourselves as we exit the ambulance. Motorists who slow to see what happened to them there in the wreck have seen enough. Satisfied, they whizz past us.

Careful going down the bank - the grass is slippery, you don't want to slide into a sepuku situation on the protruding steel. Pay attention to your footing.

Five seconds per patient to decide who's worse off - we see here Bad, Worse, and Dead. Being BLS, DTs and crew can give no drugs, fluids... we'll take Bad, who was ejected. Here's the medic to take Worse, and besides, Worse needs to be cut out of the car.

Put Bad on a backboard, collar and cot. Your entire crew is doing this and you trust each to do their role as you concentrate on your part. Look up, everyone's done at the same time. Let's go.

Roll him to the ambulance and load. It's too cold to stay out, we can always unload. Quick check - severe trauma will not go to the closest hospital but instead need to fly to the trauma center. This guy's injured, yeah - after all, there was enough force to make one occupant Dead - but Airway is good, breathing on his own, no real bleeding and no major bone breaks. We can take him, so Go!

We do not see the extrication of Worse, or all the other stuff you see on TV. The Overall. The Wow. That which makes it all so exciting.

That's your typical load-and-go situation; you gotta talk to the fire guys when you get back from the hospital to even find out what kind of car it was.

Not exciting, but somehow satisfying.

Posted Sunday, April 03 2005 14:14  Site Meter