On the Way to Paramedic in Northern VA
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Wednesday, October 26 2005
Laughing At You or With You (or Without You)

"DTs," I am told, "Your riveting tales of ambulancious adventure sometimes paint you the Fool. Why is this?"

Truthfully, I suspect that in every EMS career one does Stoopid Stuff. Now, a lot of people who enter into this line take it Very Seriously - we are, after all, talking about people's lives here. And the work is indeed very serious, but that doesn't mean we must always take ourselves seriously.

I would hate for some ambitious para-wannabe to Make a Mistake and flee the field forever, blushing in shame when recalling the Horrid Day When...

Things happen. Laugh about it, fix it, go on to the next thing.

For example: In your typical bambulance one finds, always, a Driver and a Lead. The driver, appropriately, is tasked with taking the unit hither and yon, while the Lead is in charge of the whole shebang. Occasionally, or more often, there will be sundry personnel in the "box", the back of the unit. Since we have two people up front, these extra personnel are referred to as "thirds". Thirds may be subdivided into those who can have patient contact, because they're EMT-B or better, and those who can't touch the patient due to lack of certification and training - these latter are called, simply, Observers.

Today, the tones drop, and we board the unit. Ours is equipped with "FireComs", headset-microphone combinations which enable us to better hear over the din of our own passing. We in front put ours on.

"Everybody ready?" asks DTs.

"Yeah" and "Okay" from the two Thirds in the box.

"Are you ready?" asks DTs again.

"Ready!" they chorus.

This is not the prelude to a football-coach team-spirit building exercise. "It's a stroke, boys! We hate strokes, don't we? Whadda we do to strokes?"

"Oxygen and thrombolytics, sir!"

"I can't hear you!"

"OXYGEN AND THROMBOLYTICS SIR! GRRRR!"

No. This is rather the Way DTs Does It. One must reply with the word "ready", and only "ready", and there's a reason behind it which, one might guess, involves a Stoopid DTs story.

It was a pleasant summer day, long ago, when DTs was first released as a driver. The FireCom system was not installed in the ambulance, so we tended to shout at each other through the narrow square window between the box and the front cab. Such a pleasant day, we had opened the windows in the box to let some fresh air in.

The tones dropped, and DTs climbs aboard and starts the engine. His Lead plops into the cab.

"Everybody ready?" yells DTs.

"Go! Just GO!" he hears from the back.

"Jeez, okay fine," thinks DTs. Just go? You wanna see just go? How about we get to the scene in under two minutes!

As we flash around the corner of the station, sirens wailing, DTs notices from the corner of his eye two figures running full-tilt towards the ambulance, on a pathetically inadequate intercept course. They are, of course, the two Thirds. Perplexed, he stops and waits for them to catch up and board the unit before proceeding to the call.

Turns out, Third #1 was heading to a table in the vehicle bay to grab her stethoscope. Third #2, seeing the unit ready to depart, tells her to forget it and "Just Go", pointing to the door of the ambulance. DTs hears the "Go" order through the box's open window and speeds away, leaving his wide-eyed Thirds choking on diesel exhaust and indignation.

So for those folks starting in EMS who do something dumb, just remember: "At least I'm not DTs" is a good mantra until you get over it.


Saturday, October 15 2005
Monkey See...

DTs is still precepting as a medic for the transport company. The rescue organization with which I run lacks the personnel to precept medics; when and if things change I suppose I'll precept with them as well. In the meantime, the transport precept gives me some needed experience, but it is experience of a different flavor.

"Flavor?" Well, yes. Consider these two calls (with patient-confidentiality changes, of course):

A 40 year-old male with diabetic neuropathy (where the diabetes has adversely affected nerve conduction, especially in the extremities) has accidentally spilled onto himself industrial-strength oven cleaner, used in his workplace. He cleans it off his pants, thinks nothing of it. This occurs around lunchtime.

He leaves work at 17:00, goes to his child's soccer game and cheers him on, goes home, eats dinner. Then he settles in to a relaxing evening around 19:30. He removes his work boots.

A good deal of the oven cleaner had, unbeknownst to him, spilled into one of his boots. His neuropathy ensured that there was no pain. Even so, oven cleaner + skin = bone. Most of the flesh of his foot was dissolved away. A tough guy, he has his wife saddle up the car and bring him into the ER, rather than call 911. Our transport company picked him up, stabilized and bandaged, for transport to a burn center.

A thirty year-old male is helping his neighbor work on a classic car. I'm not sure what they were attempting, but at one point the neighbor was pumping the gas pedal while the patient was directed to slowly pour gasoline straight into the carburetor. The car backfires, and the carburetor shoots flaming gasoline over the patient's arm, resulting in extensive second-degree burns. Again, we're called to the ER to transport once the patient has been bandaged and stabilized.

Now, had DTs been first on-scene to either of these calls, that would be one thing. I've noticed that we in EMS like to hear about calls like this not because we enjoy suffering, but rather to ask ourselves, "Would I have handled that the same way? Would I have started two lines on the oven-cleaner guy, instead of the one line he had? Run lactated ringers instead of normal saline? He's not in pain, but this has got to be freaking him out somewhat, could he benefit from a teensy bit of sedation, and if so, how will that affect the "weeping" of his wound?".

Or, "What if the gasoline burn guy needed another line for fluids? His other arm is shot. Where would be the best place for a second line, here? Could his arm have been bandaged differently, better?"

On the transport side, then, DTs gets a good chance to see how others are handling such emergencies, rather than being on the rescue side and having to figure it out himself. One would suppose that playing such second-guessing games now will help to save time on scene as a first responder, when something like this comes along.

So in that respect, it's all good. All too soon, I know, it'll be Monkey Do...


Tuesday, October 04 2005
Darned Socks

Next posts will probably deal with The Inadvisability of Dumping Gasoline Into A Running Carbeurator, and How To Pour Your Foot from a Boot. Today, however, it's time to take a stroll over to Low Pay Corner for some helpful tips.

It's the boots. Steel-toed boots just have a thing for socks. No matter how closely one trims his toenails, even down to the nail bed, even a brand-spanking new steel-toed boot is going to put a hole in the socks. This means we replace a lot of socks.

"Woe!" we cry, "Our pay is insufficient for such lavish weekly outlay!" Be of good cheer - for $5.00 or so in material one may keep a flotilla of footwear comfortably repaired. In about three minutes (per sock).

What you'll need: A thingy of yarn (a skein? I don't know the terminology, see the picture); a tapestry needle or a needle from a kid's rug craft kit; the needle should be pointy but not sharp; something called a "darning egg", which is just a rounded wooden block. These three things can be bought at Total Crafts, or Michaels, or whatever your local hobby/crafts store is called, for less than five bucks. Scissors are probably lying around the house, but you need those too. The thingy of yarn pictured is one I've been chipping away at for over eight months, repairing many a sock, so this isn't going to be a $5/week expense.

And a sock with a hole in it.

Okay, so here's the stuff:

stuff

This works best, by the way, if you do not launder the sock first - take it off, air it out, fix the hole, and then launder it - we'll get to why that is at the end. If your feet are that bad, put on some gloves first.

Slip your hand into the sock and find the hole. Notice the thin, dark horizontal seam below the hole? We're gonna use that.

a sock - with a hole.

Grab the darning egg, wooden block, top of the bedpost, whatever you're using, with the sock hand and turn the sock inside-out around it:

Now, the needle and yarn. Pass the yarn through the needle, about six inches, and leave it hanging. Do not tie the yarn to the needle, nor tie it to itself, nor double it up as one would thread. Just leave six inches or so hanging from the end so it doesn't slide back out from the needle's eye. Pull about a yard of yarn from the ball (or skein, or whatever it's called) and snip it.

DTs is left-handed so reverse these instructions if that makes it more comfortable.

Start above the hole, and about half an inch to the left of the hole. Jab needle. Pass it along the egg and out just below the sock seam line:

Pull the yarn through but leave enough sticking out the top so you can fold it over the top of the hole, thus:

Now, back: The needle should enter just to the right of where it came out, at the bottom, but above the seam - that seam is going to keep the loop from pulling through. Pass the needle between the sock and the egg, as before, and come out above the folded-over yarn bit:

That's it. Loop over the foldy bit, into the sock, and back down below the seam; above the seam and above the foldy bit, back and forth, keep the ins and outs close together. About sixty seconds of this and you'll be halfway done:

halfway there

No special tricks at this point - just keep going. When you've gone past the edge of the hole, just go a bit further. You can end up with the needle sticking past the seam or the foldy bit, it doesn't matter. Snip off the yarn and leave about an inch or so:

all done, too soon to be therapeutic

Turn right-side out and remove the stinky egg, put all the junk away until next sock.

"DTs, you moron!" you sneer. "What keeps my Biggest Piggy from poking through this flabby fence of yarn, like a neighbor sticking his head through Venetian blinds?"

Aha! This is why we fixed a sock in need of washing. In the washer, and dryer, the yarn frays microscopically and each line attaches to the next - a process they call "felting". While it doesn't form a continuous cloth from your yarny zigzags, it does bind them together. Trust me.

If you really need to, you can match the yarn to the sock, and buy a bunch of different-colored yarns. I purposely clashed the colors to show the process better.



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Posted Wednesday, November 02 2005 11:59  Site Meter