On the Way to Paramedic in Northern VA

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Wednesday, November 29 2006
Yah gee-ay chah-joo ohmneeka?

Think I'll say something here about languages, since that is what I'm primarily working on at the moment. Well, languages and numbers.

The reason upwardly-mobile parents push their kids into becoming dentists and doctors is that everyone has teeth, at some point, and everyone has medical problems of some sort, and if everyone is coming to you for treatment you make lots of money. Then of course there are lawyers, who realize that not everyone will be happy with their root canals and surgery, but let's not talk about them.

So everybody gets sick, everybody FDGB. This means of course that everyone, or a representative sampling thereof, may at some point be our patient. And representative sampling is just what census data is all about.

Flipping through that, we find that most of the sort of people who fill out census forms in Northern Virginia are of European descent, second generation or more, and English-speaking. All well and good, and because that's just what I happen to be I should have no problem communicating with about 80% of the population.

It's that other 20% who present a little problem then.

While pointing and gesturing are all well and good - "I am having chest pain" comes across quite clearly no matter what language you speak - our treatments may vary based on little specifics that gesturing can't quite convey. Take that chest pain: When did it start? Was it sudden or gradual? Does it go away when you rest? On a 1/10 scale what number would you give the pain? Have you ever had this before? Do you take heart medicines? Any medicines? Are you allergic to anything? And so on.

Try getting that information in pantomime.

Now, there's a little trick they teach you which allows you to treat anybody, anywhere, male or female, young or old, no matter what language they speak, even English. The little trick is called Pretend They're Unconscious, and it works like this: Pretend the patient is unconscious.

Unconscious is the penultimate barrier to communication. Here's the patient, what you see with your eyes, ears, and tools is what you get, treat accordingly. The ultimate barrier to communication, death, we don't much treat - toss that in with the lawyers we discarded at the beginning.

One problem with PTU is that it greatly narrows your treatment options. For instance, here's our heart monitor, showing atrial fibrillation. Our treatment of a brand-new a-fib is very very different from a pre-existing a-fib that the patient's had for a few weeks. Which is it? If you can't ask, you have to default to the most restrictive treatment option. And if I am about to inject someone with medicine, it would be extremely nice to first make sure they're not allergic to it.

Okay, so to recap: 80% of everybody (in NoVA) we can treat just fine, the other 20% we can treat but in a slap-dash fashion, and even if all 20% do really, really badly 80% is a "B-" which if it were a report card ain't too shabby.

Problem is of course that it's not a report card, it's people. So what do we do? Well, I said at the beginning we'd look at language, and numbers. For NoVA, that 20% non-English speaking population breaks down further. 17% speak Spanish, which makes Spanish the next-best thing to learn. Korean seems next in line, a few percentage points. Finally one may pick a less-encountered language as a backstop. We're not talking about becoming fluent, necessarily, just a few words ("Relax" is a good one!) can make a difference. As bambulance folk we only have patient contact for half an hour or so anyway.

"They're in America!" some shout. "They should learn English!" Yeah, they should, I agree. But do you come to an accident scene, see that the driver wasn't wearing a seatbelt, and leave? "He should have been wearing his seatbelt!" "She shouldn't have drank booze after taking those pills!" "He shouldn't have been up on that ladder!"...

Lump all those observations into the "If I Ran The World" pile, realize you don't, and do your best around it. Sometimes "doing your best" means "learning something new".

The title? Korean, gets a little laugh in the ER sometimes if you say "Nohng-dahm eem-needah" after that. It means, "Do you come here often? Just joking."

Wednesday, November 15 2006
The Slows

Slow to post - glacier slow, as I have been otherwise engaged, in part by running with Arlington County Fire and EMS.

These folks are different.

On my first day there, I happened to hear a story being told about a crew who were recently called to an injury from a fall. An elderly lady had fallen and broken her hip - while exiting a car at the funeral for her husband of 60 or so years. The ALS crew extensively screened the widow and verified there were no immediate life-threats, stabilized the fracture and loaded her onto their cot, then trundled her to the gravesite. I'm not sure if a line was started, but the storyteller insisted that no pain meds were given - the patient declined them as she wanted to be "all there" during the funeral. The crew stayed with her during the entire service, and only when she was ready did they take her to the hospital.

Hearing this story, several thoughts popped into my head, a sort of "which of these reasons would I be called to the carpet for" game, conditioning from the time spent running in Woodbridge: "unit out of service for over an hour!"; "on-scene time way, way above normal!"; "withholding pain medication!"; "withholding definitive medical treatment!" - why, any one of these is reason to be sued, Sued, SUED! Certain of my Lieutenants would have "killed me, eaten my flesh, worn the rest, and if I was very, very lucky, in that order."

"Man!" exclaimed one listener, in all sincerity, "I hope somebody put them in for a commendation!"


"Yeah, well I'm going to check with the Captain. If nobody else has beat us to it, maybe we could be the ones to put them up for a commendation!"

"Well, somebody has got to, that was righteous!"

These folks are fantastic.

And What, you may be wondering, was that scalawag DTs doing in this fine and gallant company?

As detailed elsewhere in this bloggy-thing, all clinical and classroom work has been long, long completed for Paramedic. Excepting my lead-seat rides, of which I had only enough (30) to test for Intermediate, rather than the (50) required to test for NREMT-P. This shortcoming was being corrected. My initial thought, "Oh, I'll get NREMT-I, then everything I do every day will automatically count towards my NREMT-P requirements" was woefully naive.

And truthfully, it was very nice to be back in a 911 system, even if only as a ridealong. DTs has been off the volunteer clock for some time now (various and sundry reasons) and the only EMS getting done is on the transport side.

A Different Beast, more "MS" than "EMS". A Typical Transport:

Receive a page from dispatch: Pickup time is 45 minutes from now, at X facility going to Y facility, Joe Patient, c/c chest pain, weight 200#. Yawn - it takes 15 minutes to get to X facility, giving one 30 minutes to...

Arrive at facility, get detailed history and report from a nurse, who also by the way hands over a thick package with blood analyses, urinalysis results, toxicology reports, CT, MRI, X-Rays, several comparative 12-leads, retinal scans, three full sets of vital signs and the script for the upcoming episode of House. The patient has two or more patent IVs already started, fluids running (if indicated) and at least two rounds of stabilizing medications on board.

Compare and contrast to the usual 911 call of "situation unknown" and a "likely" address. Arrive, assess, treat and go!

Man, did DTs have a bad case of "the slows" on his first few calls! Shaming, it was, and a fine indicator that once the P test is done, it's back into the 911 system for me.

I wonder if I can get my armor shiny enough to join the... wishful thinking!

Good EMS Reads:

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Posted Saturday, December 23 2006 21:25  Site Meter