On the Way to Paramedic in Northern VA
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Thursday, April 28 2005
Which way did they go?

In TV-Land the EMS crew wheel you in through the big "Emergency!" doors, and the DOCTORS run over to meet them, (hahaha) and THEN, (hehhaha) the doctors (hmmph ha) listen as report is given (ahHAHA) AND THEN get right to work on that patient! (HAHAHA, oh jeez, stop it!) The Drama Unfolds as the patient is heroically worked...

Well, okay, it could happen that way, somewhere. Say it does, doesn't matter, as that sidesteps the important questions.

What, you must be wondering, happens to the Ambulance Guys? Let's see.

Your ambulance crew consisted of at least two people, the driver (rather self-explanatory) and the Lead. Lest I offend my own sensibilities let me point out that the driver is almost always trained to the same level as the Lead, and usually puts on the Lead hat on alternate duty nights, alternate calls, or special situations (burliest EMT might take the violent patient, female EMT the rape patient, etc., regardless of "whose turn" it is to drive.)

To differentiate on-scene, know that the Lead EMT or Paramedic is the person who does most if not all of the talking and note-taking while the driver is taking vitals.

Some situations require more than two hands in "the box". CPR, for instance, works better with at least two people, in which case a third person is needed to drive. In such a situation a driver is pulled off another piece, e.g. the fire apparatus or second unit which also came to the call.

In Reality Land both the lead EMT and his driver wheel you into the ER room or curtained alcove and help move you from the cot (that gurney thing on wheels) to the ER bed. The driver takes the cot out while the lead remains with the patient to give report to the nurse. Once report is given (and in some jurisdictions a signature must be obtained), the patient is officially "turned over" to the hospital and the lead EMT may leave the patient.

While the patient and lead EMT are in the room, the driver meanwhile has taken the cot out and cleaned it, replaced the linen and restocked any items used in transport. The back of the ambulance has been cleaned, equipment has been cleaned and put away. A conscientious partner will also clean the door handles (both inside and out), steering wheel, gear shift, emergency brake handle, lights-and-sirens switches - anything a bloody glove might have contaminated. Seat belts and buckles. The Whole Shmear.

The nurse arrives, the report is given, the lead EMT bids farewell and buena suerte to the patient.

"But DTs," you protest, "The work is complete! Yon driver has striven mightily to be-sparkle the bambulance!"

Ah, the work is not yet finished.

In most hospitals, usually just inside the ER, you will if you look find a small room designated the EMT Room, Report Room, EMS Personnel Only - the name doesn't matter.

Devoid of fancy equipment, lacking airtight doors, rarely equipped with any window or observation port, these rooms are still really decompression chambers. This is the place to which bambulance folk disappear once they've given report to the nurse or doctor and placed the patient into the hospitals hands.

These rooms usually boast some form of non-tallow-burning artificial lighting, a relatively flat horizontal surface, and a bewildering variety of second-hand butt slings into which your weary EMT may plop.

A factual report must now be written, in which no turn of flowery phrase is tolerated. "Arrived to find 52 year old male complaining of chest pain 8/10..." is demanded. "It was a dark and stormy night. My medic-sense began to tingle just before the tones dropped..." is frowned upon. Leave out nothing, but include no speculation or diagnosis - "the patient had Quagmire's Disease" - 'cuz you don't know that for sure.

Signatures from all hands on board the bambulance, a copy dropped off with the ER, and your crew is now back in service for the next call.

As Paul Harvey says, "Now you know the rest of the story."


Sunday, April 24 2005
Louder, Steve

This is just annoying, from folks who should know better. So who, we wonders, ordered it?

I suppose I should just get over it - I am sure that the sign was not ordered by the Pill Pushers or Bedpan Changers who work in that facility. And while a Rent-a-Cop came over to ask what I was photographing, I'm sure they didn't get the sign made either.

The Mop Jockeys aren't usually in charge of stuff like that, either. I'm stumped as to who it could have been - but that's just DTs for you, head fulla' puddin' as he smiles and drives his ambulance.

Steve Berry, please report to the front desk. Bring a megaphone.


Friday, April 22 2005
Profaning the Semi-Sacred

There was a TV commercial some years ago for, I think, shampoo, in which a sultry actress breathed, "If you want someone's attention... whisper."

If you want the undivided attention of an EMT, borrow his pen. We'll watch you like a hawk.

Pens are semi-sacred to EMTs. Since "semi-sacred" is a strange status indeed, let's differentiate and define it by comparing it to, say, something sacred: the stethoscope

Stethoscopes are sacred, but since absolutely everyone knows this, there is never a problem with stethoscopes. Run calls with someone for a few months, day in and day out, and they may, if you ask, let you borrow their stethoscope, for a moment, to look at. Don't put your fingers on the bell end of it. Don't touch the nubbins which go in their ears. Do wipe off any fingerprints you leave. Use it? I've known husband-wife medics who take exception to swapping stethoscopes.

Put your stethoscope on a chair and in even the most crowded report room that chair is "reserved". You will certainly get dirty looks when you return from wherever to claim your chair, if the Paramedics find they've been standing for a mere EMT – but they won't have moved your 'scope.

Note to newbies: This applies to EMS Report Rooms, a later subject. Leaving your ‘scope unattended anywhere else does not indicate "reserved". It indicates "free stethoscope", and yes, the culprit will if caught be treated much as a horse thief in the Old West, but still – they've done unspeakable things to it in the meantime, like, using it or something. Ewww.

It is an emergency indeed if someone calls out for a stethoscope and a medic will give you the one 'round his neck. We’ll look through a bag or two first, for a spare stethoscope to toss to you, or yell, "Forget it – we’ll do lung sounds in the unit", meaning, "I, who have a ‘scope, will do it then, or you, when you find your own damn ‘scope, may do it."

So that's sacred. Here's semi-sacred.

It must be remembered that most of our equipment is issued. There is very little room for individual expression. DTs tried wearing a bandanna with skull-and-crossbones once, but it was frowned upon. And while TV tells us that doctors in Korea wore monkey suits and bathrobes, we, alas, must stay in uniform and wear sensible shoes.

We can't choose which brand of BP cuff to use and anyway that's just plain dumb – who cares about BP cuff brands? Which brand of expensive item, like, say a Zoll or a Lifepak? Not our call. We use what we got.

Ah, but They Don't Issue Pens, Do They?

Now, here's a piece of equipment we can express opinions about, because we're in a position to do something about it. And opinionate we do!

A pen whose clip holds it point-down is frowned upon by some – leakage into shirt pocket – but others in EMS say, no – leakage is minimal, while the point-up position means the ink runs to the back of the pen and it's not ready to use. And why use shirt-clips at all when you can clip it to your belt? Some say that since shirt-clips keep it next to the body, in cold weather the ink stays loose, and what's the freezing point of a Gel pen anyway?... it goes on.

You can find an EMT in the CVS or Office Depot comparing pens in the aisle. Next time you see someone peering at each and every pen, while avoiding the mechanical pencils and wincing at the Bic Value Pack (!50! Non-Retractable Pens!), that person is probably in EMS.

By the way, the Papermate FlexGrip has a rubberized exterior which not only allows it to snug into your scissors-penlight-pen holder, keeping it from falling out while you're upside-down in an auto wreck, but the rubber is antibacterial too. Just thought I'd share.

So, what are the odds that someone who puts that much into choosing a pen will simply hand it over? And why, if an EMT is wearing socks and underwear, do they not also have a pen? What kind of a health provider are they, anyway? No pen!

Prepare, O Penless One, for scornful looks from your colleagues. And give it back when you're done.


Friday, April 15 2005
The Policeman Is Your Friend

One of the minor annoyances of running 911 calls in a city you don't live in is your relative unfamiliarity with the streets.

This, by the way, is merely an annoyance to those of us who must pilot; it in no way affects the 911 Caller In Peril, for each of the units has several huge, honkin' mapbooks with detailed directions to each and every alphabetically-listed street, with each address on that street carefully drawn in. We may not be local, but we're not lost either.

What these books lack, however, is how far away the street is. An example is in order.

Tones drop in the station, all conversations halt. The dispatcher speaks. "Box Zero Two-"

We're Station 2 - immediately, we know this is for us. Start moving towards the units...

"- Sixteen, on Five Adam, for Injuries from an Assault-"

The Fire Guys relax - it's not a fire, lockout, water hazard, power lines down, car accident, entrapment, trench rescue... fire guy stuff. They wave buh-bye. Bambulance folk away!

"-Fourteen thousand five hundred Wombat Circle, Apartment 107. Ambulance 502 at 23:16."

Neat. Climb into the unit, put away A-Q and fish out the R-Z book. Look up Wombat Circle. The directions assume you're in the station. They read:

. Left on Your Ave

. Right on Aussie Way

. Left on Didjeridu Lane

. Left on Wombat Circle

The accompanying hand-drawn topo view shows that 14500 is the third apartment building on the left. So far so good. Turn on the lights and woo-woos and go.

What these books fail to mention is that there are fourteen stop-lights until your Right on Aussie Way comes up. Six stop signs until the left turn, then an IMMEDIATE left with no stop sign or light...

Now, what does all this have to do with Our Friends, PD?

It so happened that not too long ago we had a call for an assault. Neither my driver nor I happened to live around them thar' parts, so off we went - and got real close to the address before we knew it. Like, right in front of the address. All lit up and noisy we were, too.

Since the caller indicated he'd been shot (or stabbed - dispatch was getting conflicting information from him) we, Unarmed Healers, were in a particularly exposed position for Mayhem Upon Our Selves.

Calls like that, we "stage" two blocks away from the address, until the Poh Leece get there with special tools - Skills, Guns, Sprays, Cuffs, Sticks, and Muscle - to make sure that the bad guys who caused bodily harm are through harming bodies. They secure the scene, then call us in. This time we beat 'em there.

Double-plus ungood.

"Shit, we're here," laughs DTs.

"Oh Shit," laughs his Trusty Driver. "Where's the good guys?"

"Dunno, but go Stealth, real quick," says DTs. Sirens quiet, lights slow and stop. The red light in the cab is extinguished. Run silent, run deep.

"Dispatch, is, uh, PD coming on this one? Cuz, we're here..."

"502, you are on scene? Affirmative on PD, 502. We'll advise."

Silence.

Driver: "You hear anything?"

DTs: "What, like gunshots, the schluuck of a stiletto into a body...?"

Driver: "Ha ha. No, dimwit. Cops. Sirens. The cavalry."

Listen.

DTs: "Uh-uh."

Driver: "Me neither. Lock the doors."

DTs: "Why're you looking at me like that?"

Driver: "I'm looking for a laser dot. You don't have one." Laughter.

DTs: "Neither do you. Yet. God, I hope the bad guy could afford laser sights. Just our luck this is some poor, moneyless bastard."

Driver: "Yeah, just a cheap-ass gun and lots of bullets."

DTs: "Let's keep looking anyway."

FWOOM. The rig rocks as something blue streaks past, leaving a vacuum behind it.

Driver: "What the f* was that? Was that them?"

DTs: "What, did you see a big "S" and a cape anywhere?"

FWOOM. FWOOM. Two more. PD begins showing up, streaking past us like meteors. Must have been six or seven of them. We cheer them on, feeling like ground troops waving in air support.

Scene secure.

Good times.

What brought this call to mind, though, were the youths who ran into the station last shift. Teenagers, out pretty late at night. "Just going to the convenience store," they said, when "guys with baseball bats" jumped into an SUV and started chasing them. We shut the bay doors and called 911 for PD assistance as the "bad guys" car took off.

Talking to the Misunderstood Youth, looking at the clock. Where were PD? A whole two minutes had passed and they still weren't anywhere in sight!

Turns out, there were DOZENS of squad cars, ringed around the station. Man, we were SECURE.

Thanks again, guys.


Friday, April 08 2005
Theatre of the Mind

Ever notice how you can tell if someone is smiling on the other end of the phone? You can form a mental picture of exactly what is going on there, at the other end of the cell tower or phone lines, just by the tone of voice. From the other person's volume, how loudly they speak, we conjure the brightness of their room. We can tell if they've just finished hearing a joke before turning to answer the phone, or if they've discovered a mess made by the dog and the ringing phone is simply One More Thing.

Our mental picture shifts constantly during the conversation, filling in gaps and changing details. We can tell if they're happier at the end of the call, or if we've simply added to their daily burden.

Which is why I sometimes dread calling in to the ER when I'm on the way with a patient. Some days, the nurses act as though we're some kind of FTD Florists from Hell who deliver only skunkweed and old cabbage.

Sorry! It's not like it was our idea to pop out of bed at 2:30am and go get this guy. Being human, however, the mental images form...

The Conversation The Mental Image
" Hello! This is (facility) ER, Nurse Happydance speaking, how may I help you?" Perky, fresh-faced Cheerleader for Healthcare, yay! No frownie-wownies allowed!
"Hi there! This is ambulance (mine)..."  
"Oh. What do you need?" A cigarette dangles listlessly from the overpainted lips, her last drag flares, illuminating her thick makeup. The ash falls onto the beer-soaked wood of the nurses station
"Well. We're en route to you with a 36 year old male..."  
"What're his vitals?" It's $20 for straight, you pay for the room. Show me the money up front and if you wanna be called Daddy it's an extra five.
"Um, okay, pulse is this, reps that, bp the other. His complaint..."  
"Is he stable?" The DA stomps from the witness box to the bench. "Your honor, the witness is hostile. I demand a yes or no answer only!"
"Yes, he's stable, and..."  
"Triage." Click. Forget GOMER, don't even come in to my ER!

Ah, well. Next time, we shall test the Healing Power of Chocolate and see if we can't dislodge whatever it is crawled up their butt.


Sunday, April 03 2005
On Patient Abuse

Unfortunately, patient abuse exists. It happens all the time, and mostly goes unreported. There is no specific age bracket. The elderly. Average adults. Children as young as six years of age.

Seldom are the police, or any other authorities notified. When you ask the victims they will most often try to shrug it off as being "the way things are". Resignation. After all, they theorize - I probably won't see them again. Why cause trouble? And who would I tell, they think - the nurse? The doctor? They don't care. My friends? What are they going to do about it?

It has been suggested, many times, that video cameras be installed in the ambulance. But how is HIPAA satisfied when a video record exists? There are deep privacy concerns which must be addressed here. Not every transport involves patient abuse.

But those transports which do make some funny stories sometimes.

"Que es su nombre?" What is your name?

"Mi nombre es Senhor Rodriguez," comes the reply. "SU nombre es... bendecho! Ha ha ha!"

"Yeah, okay, thanks. Been drinking tonight, Mr. Rodriguez?"

"Like I'll tell you, Mr. Bendechho. Ha ha ha! That's funny. Mr. Bendecho!"

"Ooookay. I'm going to borrow your arm here for a minute-"

"No bendecho is going to borrow my arm!"

 

Patient last run, adult female who had a 5" head lac and possible dislocation from a fall.

"I don't need no collar!"

"Well, you know, we kind of need to be careful about that..."

"I know medicine. I work in a pharmacy!"

"Then I'm sure you understand why I need to-"

"I know medicine. This is unnecessary! This is brutality!"

"Because you've been drinking you might not feel any pain even if-"

"There is no cause for this thing on my neck. I know this and who told you to put it on me?"

"Ma'am, I sure would hate to ask the police to come here to help me with this."

"Police? Police! In my house! Who the hell do you think..."

Later, during the transport:

"I need this thing off my forehead."

"The tape?"

"It's choking me."

"The tape. On your forehead."

"It's chokin' me, I tell you. I can't breathe. I can't breathe at all. Why can't you understand when I tell you the thing you got here across my face is chokin' the life out of me and makin' it so I can't breathe at all and you sit there and you ain't goin' to do nuthin' about that I call that brutality!"

Via con Dios, Johnny Cochran. You know you are most sorely missed.



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