Expecting is different than Experiencing

Lot going on trying to get a paper out by a 4/1 deadline, registration for next semester (my 8:20 stats class is full at 24 with 24 on the waitlist - Are these kids insane?), EMT class etc.



That all said, what has been consuming my thoughts this week is the difference between expecting something and experiencing something. Our neighbor and friend lost her father to cancer last night. She new it was coming, but it clearly has hit hear hard.



Today, less than 24 hours after finding out about our friend's father, my wife got a call saying her father had been taken to the ER by ambulance for difficulty breathing. The reason? Stage 4 lung cancer. I still have not heard a prognosis from an M.D., but the little reading I have done suggests he will not have a lot of time left.



My father-in-law is almost 70 and has smoked almost all of his life. He is a recovering alcoholic who lost his leg due to his two addictions. We expected that he might be the first parent we'd lose. That expectation was an abstract idea always pushed to the back of our minds. It is not so abstract anymore.



I regret he won't watch my kids grow, see their graduations or attend their weddings. My daughter will likely not even remember him. I know we all have to die, and as a parent, I selfishly hope my kids have to deal with my death because I don't know how I'd deal with theirs. This hope, of course, means that the price we pay for the normal order of things is that we have to watch our parents die. This sucks.

Acute EtOH Abuse

I did some of my required emergency room time from Friday at 2000 to Saturday 0200. I got so see:

A drunk student (and patient).

A friend of the drunk student who was in one of my classes. This person became drunk patient #2 when I wondered why in the hell she was in the bathroom for so long. She had, of course, passed out on the floor in a puddle of puke.

A colleague of mine who was rushed in by her husband. She was PALE and looked freaked out. She ran up to me, tossed her arms around me, and said in a barely audible voice "D.. Help me". She is a calm, wonderful woman and I was scared at this point because I knew if she is freaked she must be in real trouble. Her throat was closing from an allergic reaction. Some EPI and she was doing much better.

I had an ambulance call at 1730 (I was driving) that came in as a difficulty breathing. This patient was still in ER when I started my ER time at 2000 and remembered me. I went down to CT with him and got to see his scans, including his heart. Really great experience.

Saw some stitches go into this small but deep gash in a knuckle. Cool.

Several "I don't feel good and probably should have gone to my GP today but I was busy and I knew you guys would be here tonight so what the..."

I took lots of vitals (the real way, not with those stupid machines :-) ). Ok, Ok, so I wished we had the cool machines on the back of the rig.

A lot of people complain about the ER time. I had fun and learned some stuff. Worth a few hours of sleep deprivation.

DJ

Busy Week

Been super busy last few days:

Stuff that's been going on:

-Registration for next semester is coming up and since I'll be back in action then I've been dealing with students with questions about classes, etc. I forgot how crazy things are when I leave the door open, and it is worse when you are on leave as everyone sees it as their one chance to stop in to talk.

-Finished a review for a journal. Easiest review I've ever written as the paper was good

-Working on submitting a paper to a peer-reviewed journal with two of my students. Should go out on Tuesday.

-EMT class - just did cardiac emergencies. The heart is really an interesting organ and I want to learn more. I wonder if there is a cardiology for dummies book?

-Found out the family and I are going to Australia on the employer's dime in the spring of '06 (I'll write more later but this is great news as it is a strongly sought after opportunity and I am honored to be given the chance)!

-Attending a MCI drill this Sunday which will involved several fire departments, ambulance corps and hospitals. Exact scenario isn't known but it will be at an electronics manufacturing facility about 25 miles from here so I guess Haz-Mat.

-I've gone to the dark site and ordered a gas grill (I've been a charcoal guy for all my life). I hope to get it set up and ready to cook in time for Sunday dinner.

DJ

First Chance to "Run" a Call

Went to go to lunch today and the pager went off. I wasn't on call but I knew the board was thin so I thought I'd drive down and see if they needed any help. Given the call was on campus, and I was on campus when it came in, it was weird to drive away from where I knew help was needed. With no official EMS status ("Hi, I am an EMT student and can't treat most things - How can I help?") and no equipment I figured I couldn't help much on the scene without a crew and a rig.

Call came in as 80 year old male who collapsed in a lecture hall.

I get to the station and there is a driver and EMT-B. No ALS anywhere to be found (unless you count the hospital 3 min away). EMT asks me if I want to "run" the call. I figure she'll keep me from hurting anyone and I need the practice.

Short version of things is this really interesting speaker (he told me about his research on the way) had just finished his presentation, got dizzy, and was helped to the ground. No difficulty breathing or chest pain. Did not want O2. Vitals all normal. I got to do everything but call into "resource". Even got to write the Prehospital Care Report (PCR).

A subset of lessons learned today:

1) Either go through your questions in a rigid order or have a LOT of practice doing it conversationally (I tried to just work them in and it was too hard for me given the lack of experience).

2) If I obtain the skills and stay with this EMS stuff I will try to remember how nice it was to have someone guide me without interfering. The EMT gave me a great treat by giving me the freedom and trust she did and I need to remember to do the same when(if) the tables get turned.

3) Learn how to spell syncope.

4) I still have way more to learn.

DJ

My MCI will come, but not tonight...

MCI - Mass Casualty Incident. I'm certain that what constitutes a MCI varies from region to region, but around here if you have more than 3 patients needing advanced life support it is a MCI.

You don't want MCIs to happen, but if they happen...

I took tonight off. I have spent 72 hours on call in one capacity or another this week and wanted to enjoy a nice meal and a DVD with my wife. My pager off. Boots somewhere. Coat? I don't know. Car face in. Steaks ready for the love that is garlic and pepper. I'm relaxed with no worries.

Scanner is in background downstairs (my wife has become addicted) while I'm watching my 2 year-old daughter take a bath. Wife calls upstairs claiming my corps may have a call. I say hmmm. She says it sounds like an MVA. I say HMMMMM. She says "Want to go"? I go AHHHH. We usually send two rigs on MVAs but only have one crew on the board so the second rig is composed of those who make it down. I figured they might be able to use the extra hands so out I go. Because I'm not on the board I don't have my stuff laid out and it takes me 60 seconds longer to get out the door. These are a precious 60 seconds.

I live a bit out of the village and my response time is on the longer end. I hear our first rig call out of service BLS (basic life support) and ask for ALS (a medic or paramedic) to meet them at the scene. I hear our chief ask control for more rigs through mutual aid (nearby agencies will send a unit to help us just as we often do for them). I am no more than 500 yards from the station when I hear the second rig call out of service and see them fly past me lights and siren. I cursed out loud. I know better than to go to the scene so I defeat my strong urge. Last thing they need is someone who is an EMT in training taking his private vehicle to a scene with 4 patients.

I'm glad we got two rigs out so fast. Very impressed with how quickly our neighbors got out to help us and how a paramedic and medic appeared out of the woodwork. I just wish I could have been there.

As the fire chief clears the scene he asks control to get a sander truck out as the roads are icy. We had such a crappy winter with so few accidents and now three in one week. I think spring has suckered people into thinking they can drive fast again and when the roads ice over they are caught by surprise.

I know I'll get to go on a "real" trauma call soon enough and I certainly would be happier if no one ever needed us. But, if they ARE going to need us, maybe they can wait until I'm on call?

DJ

Rollover Season?

Just got back from a Sat EMT class (CPR certification). Long but very interesting. I really like the hands on stuff better if it is prefaced with the logic behind the procedures. A lot of this stuff is just following a bunch of "IF X THEN Y" logic trees. I find it much easier to think about (and do) if I think about the purpose. I know I am a pain in the ass in class sometimes due to the questions I ask as it makes class a little longer than it could be...

"B" was on call last night and caught a rollover with a head injury. Our second rollover for the week. "B" has now been on two calls total, one the smoker on O2 who lit himself on fire and now this one. Both calls went to hospitals away from our local one (first went to a burn center about an hour away and the second to a trauma center about 40 min away) so he has yet to go to our hospital while I have yet to go anywhere else.

Wife and kids out of town so I can eat crappy food and sleep when I want (minding the fact that I need to remember to feed and walk the dogs). I am afraid to say that I like having them around better than not, but I try not to let them know for fear they'll get big heads :-).

DJ

Action (well, for us)

With the students gone on spring break this week I have had more ride time (both as driver and, more importantly, riding in back). Going into this week the plan was to put 60 hours of "on the board" time in with the hopes of seeing some calls. Mon and Tues did not work out that way, but last night and this morning at least got some action.

Last night (11:30 pm-ish): seizures in a male with a history of seizures. Nothing interesting for those of you who run these calls all the time, but this was my first seizure call. Uneventful but I got some patient contact and the call was 45 seconds from our station so it was over quick.

This morning (4:01 AM): Single car rollover MVA. I roll out of bed, slam some clothing on, empty my bladder and start driving to the station. Quickly realize that if I do not slow down I'll be the second call. It has been snowing and the roads went from wet with snow to frozen surface covered in snow. SLICK. As we leave the station we hear them toning out the rescue truck again with no response. We manage to make it first on the scene to find the patient has extricated himself and gotten into his wife's car. She's an RN and claims he is fine. As I'm looking around I want the fire folks here quick as we have NO traffic control and the road is a nasty two-lane with a 55 mph limit. Our medic asks the driver to step out of his wife's car so we can check him out. I hold C-Spine stabilization as the medic works. Thinking of everything I have read I'm mentally going over what I would do and ask the patient and this is sharply different from how things actually go. "By the book" if I was there with just BLS folks I would have collared this guy and done a standing takedown onto a backboard. He was traveling north and ended up with his car in the ditch next to the southbound lane, pointed south, resting on the driver's side door. Damage to front, both sides and rear of vehicle. I figure this counts as "significant mechanism of injury". The medic, who is also an RN, does a mini-neuro exam on the guy and asks him if he lost consciousness. He then asks if he wants treatment. Guy says no. Wife is OK with this call on husbands part (my wife would have HELPED them tie me down :-) ). Looks like real world ALS is very different from BLS by-the-book (which I suppose is the point of ride time). Fire/Rescue arrived 5 min after us and REALLY helped as they shut the road down which made me feel much safer. Law enforcement wasn't there by the time we left. This is rural life...

I'm on until 0600 and then go from 0900 to 0000.

Given the time I can't decide whether to try and sleep some more or fire up the caffeine machine...

DJ

I could go for a cigarette...

Note to smokers with COPD on O2 therapy:

"They" really mean it when "they" say you should keep flames away from oxygen. Hence the following call:

"... ambulance monitors - A call for your ambulance for a 74 year-old male with burns to his nose, face and neck...".

Really.

When Communicating with “Control” Details Matter

This fall I was driving the ambulance for standby duty for a NCAA playoff sporting event associated with the college at which I work. Let’s call the school “ABC”. Let’s call my ambulance “999”. When ending a standby around here the typical communication with control would go like this:

999: “Control, 999”

Control: “Control is on for 999”

999: “999 back in service from the ABC game”

Control: “Affirmative 999, I have you back in service at ”


Well, at the particular game I was at our team won unexpectedly. We were very pleased. Instead of the third line above, I decided to say:

999: “999 back in service from the ABC victory”

I figured it was the name number of words and I wasn’t wasting any bandwidth, and I figured anyone with a scanner on would want to know the outcome of the game since everyone assumed we would lose.

Fast forward to last night. We are at home listening to the scanner as I am about to be on call, and my wife (I was reading a book to my son who was going to bed) hears our second rig call back in service from a playoff event for a different sport:

998: “Control, 998”

Control: “Control is on for 998”

998: “998 back in service from the ABC game”

Control: “Affirmative 998, I have you back in service at ”

998: “Received”

Control: “Control to 998”

998: “998”

Control: “WELL, DID YOU WIN?”

998: “AFFIRMATIVE!”

Lesson learned: When communicating with 911 control you need to convey all of the important information.

The Good, Bad and Ugly

Just returned from EMT class and hanging out at the station. I have not had a call in a week and am on the board as a driver now (from 0000 to 0600). Lots of midterms for students this week and they leave for spring break tomorrow. The college students in my EMT class looked BEATEN down (pale, sickly and tired – just the way one would hope to feel before jetting off to a warm island for boozing and…). The non-college students (33 of the 39 left in the class) are looking forward to a break from the EMT class for a week as we get a break as well.

The Good: The written test was (almost) fun and the practical stations (one trauma and one medical) were run smoothly and were well designed as they needed to test our assessment skills while avoiding giving us things to treat ( well, we know how to open an airway and give O2, but that’s about it). I did well on the written and 2 practicals. I stuck around while they were scored – 95% on the written and I “passed” both practicals (they are scored pass/fail). I still need to work on these stations, but I was pleased as I only missed a couple of points and they were for things I did but did not verbalize and were not caught by the examiner.

The Bad: I don’t know how other people did on the written, but for many the practical stations were a disaster given the statements I heard examiners make to each other (one guy claimed he had 8 people through his station and only 1 passed).

The Ugly: We have a post-mortem at the end of practicals and tonight I felt like I was in the wrestling room in junior high with the coach ripping us a new one for losing a meet we should have won. You know the drill: “Do you guys want to be here? ‘Cause if you do, I can’t tell. There is the door. Leave now if you don’t want to be here and all will be fine. However, if you stay, you best change your ways or next time…”. A good 15 min session of yelling aimed at getting us to work harder and/or take things more seriously. Comments like “you come to MY house to treat my family with skills like you showed tonight I’ll sue you until you have nothing left”. It was hard to judge people’s reaction to the “speech” but I assure you there were no smiles. I’m curious to see how he starts class off a week from Monday.

Thanks for taking the time to read!

DJ

Stars Aligned Tonight?

We saw the "lawn" for the first time in months last week. It is now covered in snow again, but at least spring threatens an appearance. I don't know the exact count, but we've had over 10 feet of snow this year and I am anxious for the sun to come out and take it all away for good. When I lived in the Washington, DC area the cherry blossoms signaled the official start of spring. I think that DC sees spring 6 weeks before we do up here!

Studying for our second major test in EMT class (the test is Thursday - Written section and practical stations on trauma and medical). I am not nervous but I do need to prepare more.

Took a break from studying this morning to pretend like I have a day job. Department had a meeting to discuss curriculum revision and my presence was requested (demanded). What this means is that they expected a miserable time and felt the need to share the pain :-). What I cannot for the life of me understand is how our meeting was educational, enjoyable and productive with no points of lasting contention. Days like today remind me that I love my job and that I have a great set of colleagues. That said, given how today's meeting went, it is the day to buy a lottery ticket, that is for sure!

Sitting by the phone waiting for a call...

If I don't spew this out now my health will be at risk, so please excuse the sarcastic and grumpy rant...

For the third time in three months all of the squads in our dispatch area have been asked to keep a full crew at the station for several hours. These squads are composed of volunteers with jobs. Why is this needed? Because the county knows they are going to have to shut the radio system down for repairs and have no backup. Today from 1200 to 1700 (they hope it will only last this long), and for a similar amount of time tomorrow, calls to 911 will be dispatched by telephone. That's right - By phone! No beeping pagers, no radio communication with dispatch from the rig, etc.

If our second rig is needed this afternoon it could well be a LONG time before people get out as we won't be able to keep two crews at the station.

These planned outages are to try and maintain a radio system that is over 30 years old and in horrible condition. A new system is something the police, fire and EMS people have been asking for for more than 10 years. Even when it works there are dead spots all over the county (can you imagine being a police officer and having to use a PHONE to ask for backup?). We are not asking for fancy new turn-out gear, or a generator for our station so we can have heat and lights when the power goes out (which it does at least once a winter), but instead we are asking to have the equipment we need to safely and efficiently do the VOLUNTEER job we signed up to do. Someday the system is going to go down unscheduled and this is going to cost someone their life (or alternatively, it will be down in a planned manner but EMS personnel will end up on a scene where they need police presence and can't get it due to lack of radio communications).

My county is, based on median family income, one of the poorest in the state. I don't see a new system happening anytime soon without state or federal help. Should your tax dollars go to pay for a radio system in my county? While I certainly understand why you may say no to this question ( *I* may even say no to this question), the result is that our country is destined to have the quality of EMS available to our citizens be a function of where you are and how much money the people there make (keep in mind we provide EMS to people traveling through our area so it could be YOUR husband, wife or children that do not get a response when the radio system craps out).

No doubt that wherever you live you roll the dice when you call 911 (how busy is it? what are the traffic patterns now? who is on call? etc.). I do hope, though, that when you call 911 the providers can know you called, be able to respond, and have access to needed resources (by radio!) when required.

Lastly, what KILLS me is that I live in one of the most highly taxed states in the U.S.! I sure as #$!! hope that they are spending all of that money wisely.

I feel better now - Thanks :-)

Blah blah blah update

Home / Work / EMT Class / Ambulance Call

Home: ANOTHER stinking virus going through the house. College students go all over the world to collect new strains and then come into my office and cough, sneeze and touch my stuff. By the time I'm 50 I should have one heck of an immune system.

Work: External review team to give feedback on our "general education program". By being on sabbatical I have the right to avoid this mess, but I will be taking a three-year term as a director of one component of this program in July and wanted to see where the team was going with their questions as this often gives a good feel for the suggestions they will make. I took the director position with the knowledge that the next three years will involve change and the hope that I could help guide the program to be even better than it is now. This review was very interesting and I learned a lot, but I was also reminded how nice sabbatical is as I have not had to sit through hours of meetings in a long time.

EMT Class: C-Spine, backboards, lifting and moving, etc. We had class today (Sat.) to do more lifting and moving. Monday will be documentation and ambulance operations. Thursday is the second main written exam along with testing of the trauma and medical practicals.

Ambulance calls I drove for since I last checked in: One "difficulty breathing call". I swear 65% of our calls must come in this way. This patient wasn't kidding. I have read about cyanosis, but to actually see that shade of blue on a human being is an experience. The guy wouldn't let the medic start a line, stating "don't worry boy, if I die you can start your IV and cover your ass". I'm not kidding. The "boy" comment comes from our medic being 23 and looking like he is 17.

Decisions, Decisions

The instructor of my EMT class is pushing for a friend and I to jump right into the “medic” course a couple of months after this EMT-B class finishes. The state I am in recognizes something between paramedics and basics called AEMT-CC, or “medics” around these parts. It has been described to me as something similar to the national registry version of EMT-I. Medics can intubate most patients (down to a certain age – I don’t know how young), start IVs, and administer a variety of drugs (not as many as a paramedic but considerably many more than a basic). Why is this a quandary? Because I think there are very good reasons not to go this route and very good reasons I should consider it.

Reasons AGAINST:

Who knows what my clinical skills are really going to be like out in the field? The instructor and some of the more experienced people in my service say I will be fine, but I really can’t believe they have enough data to be so sure as I have not really been tested under fire yet.

Shouldn’t I have considerable BLS experience before going ALS?

Who knows if I will really even like the EMS setting once I really get into the practice side of things?

Do I really have the time to take more classes, considerably more clinical and ride time, and return to teaching a full load and the resumption of my administrative duties at the college? Will this time come out of my professional life, family life, or social life?

Reasons FOR:

Right now we have three medics that cover about 85% of our ALS calls, and one is retiring this summer. These medics are tired and stressed as they have day jobs (one in EMS at a paid service, one as a nurse and one as a teacher’s aid in my son’s kindergarten class). These medics spend most of their “free” time listening in for ALS calls. Not only do they cover our service, but our service is often asked to do ALS link-ups with nearby services that are only able to get out BLS. There is clearly a need in the community for more ALS providers, and it looks like the choice isn’t between me (and my friend “B”) and someone better qualified, but instead it is between us and no one.

I HATE listening to the scanner and hearing a call that should be handled ALS but isn’t due to lack of coverage. A few weeks ago a call came in during the middle of the day (when it is hardest for all-volunteer services to get out) for a 50-something year old man with chest pains and difficulty breathing. When the second page came through the dispatcher added that the man had a history of three prior heart attacks. The first responders on the scene were from the local fire department (my ambulance corps overlaps with something like three fire districts), and they found a responsive patient complaining of severe chest pains radiating down his left arm. They had oxygen with them on their rescue truck but could not administer it because no one who made the call was a certified first responder or EMT (they were certified in CPR so they could bang away on the guy once his heart stopped). Our service went out BLS with a desperate plea for ALS support. On route to the scene ALS was requested again along with a mutual aid request for ALS. Again ALS was requested from the scene, and again while on the way to the hospital. ALS never materialized. These types of calls make may stomach churn and really wish I could help. Yes, I KNOW that even if I was a medic there would be times when this still would happen, but if I can make a difference in just ONE instance, what is that worth to me? My community? The patient and his/her family?


I mentioned it before - This is not an ideal EMS system. It is, however, what my community has. I KNOW that a younger, fulltime medic with a lot of BLS experience would be better than me. That is not, however, what I am being compared against. The question is, then, would I be a good enough medic to do no harm and make a positive impact on pre-hospital care? How can I make this judgment?

I have a couple of months to decide. I honestly don’t know what I am going to do.

DJ

Quiz Me Tender

Work: Made comments on a student paper (she's doing research in my lab and is presenting at a conference in April). Nice work :-)

Ambulance: Rode along for an ALS link-up with another corps but turned out to not be much.

EMT Class: Practiced the trauma station today before class and aced it. I'm sure I'll screw it up at some point, but I now have a conceptual grasp of the station (and trauma calls in general) so things are moving along.

Quiz tonight. 10 points and I got a 10 (though I had to argue for the 10th). Mid-class break and the instructor comes back grumpy. Class mean is a 67.7. He claims this is due to people not studying. Maybe. The material is difficult and I think it takes time to acquire. We were supposed to spend today on the "medical" patient, but instead spend 3 more hours doing scene safety and extrication. Ouch.

It is so strange to read the blogs of people who do EMS for a living. Many of these individuals have busy stretches where they are handling a call an hour or so. Things are SO different here it is like a different world.