Saturday, July 31

Sorry – EMS is on vacation...

I was on duty last night from 1800 to 0000. Of course, all of the activity happened after midnight, and there was a pattern...

On one call, which came in as a 20 y/o unconcious at a bar, control calls our chief and tells us that rescue won’t be getting out as they have no medical personnel. Rescue needs at least an EMT-Basic to roll, and they couldn’t get even one to show up for a medical call.

Then it was our turn. Control hits our tones asking for a medic to help out another Corps (“mutual aid”) that is on the scene with a severe difficulty-breathing patient and would like one of our medics to meet them enroute to the hospital. The agency that was asking for mutual aid from us is an ALS agency, as is at least one between them and us. In the end that patient traveled 20 minutes with BLS only coverage, as there were no medics around.

Our board where people sign up for shifts is getting REALLY empty. I am on for at least one shift, and many times two, for six nights a week through most of August. When the students get back it will be hard to find even one shift, but for now, I could basically provide BLS coverage 24 hours a day if I wanted.

In short, this is a bad time of the year around here if you are looking for emergency medical coverage.

Friday, July 30

Missed The Bus

The few students who have been around are slowing trickling out of town to get their last respite before classes start. This means I’ll be taking a lot of shifts the next couple of weeks and then many fewer once Sept. hits.

Last night my pager went off at 2022 for an “unknown medical” on the side of the road. Our chief calls in and says he’ll meet the rig at the scene and that he has an EMT with him. At this point I was 60 seconds out from the station our rig quickly called out of service ALS and took off. Given I was “on the board” I was pissed. I would have used my radio to tell the ambulance I was close but I knew my friend “B” was on the board with me and he knows how long it takes me to get to the station.

Instead of going back home and going to sleep I waited for them to come back so I could beat the hell out of them :-). The first words out of the medic’s mouth were “Don’t be mad!”. Too late dude. I’m on the board, I block that time with my family, I get up and risk the drive to the station, rescue is rolling and so is the chief... Take the time to see who is on the board and WAIT THE 60 F’n seconds for me to get there before you go!

Good news: The patient was puking all over and I didn’t have to deal with it.

Monday, July 26

Differential Diagnosis – Slob or Slob with hormonal issues?

Three years ago I was in great shape cardiovascularly and weight wise. I was racing my bike, had a resting pulse in the low 50’s, and weighed less than 180 pounds with a body fat of around 8% (I know, sounds heavy, but at 6’2” with my frame, people were asking me if I had cancer – anything under 200 and people call me thin).

Then my daughter was born, we oversaw the building of a new house, and I started picking up more administrative duties at work. I stopped working out altogether, and my eating habits did not change much (you can chow on a lot of calories if you are riding your bike 12 hours a week). I am out of shape. By a LOT. I knew things had to change in February when I had to have a physical to take my EMT class. My labs came back less than stellar, and a 50 pound weight gain was right on the doctor’s computerized charts for all to see.

So I vowed to start working out again and eating better.

I didn’t.

In fact, since February I have gained weight and my labs have gotten WORSE (in total I have gained almost 80 pounds!) , as evidenced by my trip to the MD today. Between February and now I have been lethargic, needing a nap to get through most days, and generally down about things. I assumed the weird sleep patterns associated with my volunteer ambulance work, with perhaps some sub-clinical depression, was the cause. However, my labs this time pointed out another issue that is playing a partial role: My TSH level was over 18. TSH stands for Thyroid Stimulating Hormone, which is produced by the pituitary to get the thyroid to produce more of its hormones. For those of us with intact pituitary glands and crappy thyroids, TSH is used as a measure of how well the artificial thyroid hormone (Synthroid in my case) we are taking is fulfilling our bodies’ needs (with the pituitary being the judge). Any TSH value over 5 is a problem. I am clearly hypothyroid (AGAIN – I have been treated for this for a long time and we can’t seem to find one dose that continually works) to the extent that I am experiencing symptoms (which include most all of what you read above).

You’d think I’d have been though this enough times to know that if I feel depressed and want to eat carbs and fats all day between sleeping then I should get my TSH checked. Instead I assume I’m just being a slob and need to just “get over it”. I may be a slob, and I do need to “get over it”, but my newly increased dose of Synthroid should help.

Saturday, July 24

"Extremely Intoxicated" sign-off

My pager went off the other morning sometime after 0200 – “Extremely intoxicated 20 y/o called in by campus safety”.

When I got down to the station the crew included our chief (who was driving) and two students I know well (both EMTs). In the absence of a medic, the EMT on the board is usually “crew chief”, and in this case she asked me if I wanted to run the call. I said “sure”.

Being new at this it was harder for me than I thought. I was a little torn regarding what to do with the patient and not 100% comfortable with the decision. When we arrived she was standing talking with campus safety (who, in this case, are also local police). She was alert and oriented to time, place and self. CMSx4, PEARL, HEENT clear. Smooth pursuit eye-movements were fine. Seemingly nothing wrong with her (though she did smell of EtOH). Her chief complaint was that she was embarrassed and wanted to go home. She also wondered if this would end up on her “permanent record”. Our chief told us “check her out and sign her off”.

The problem, from my perspective, was that this young lady was found on the ground under some bushes. Since I didn’t find her, it is hard to say whether she was sleeping or had some sort of loss of consciousness from another cause. If it had been my call with no other input I would have taken her to the hospital to get checked out. My chief made it clear, however, that we should let her go, and that if we took her to the ED we’d catch hell given she was walking, talking and seemingly fine. Given campus safety was going to transport her and make sure someone was there to watch over her, it wasn’t like we were letting her walk off into the night, but I still felt strange about it as there was a small but non-zero chance there was something else going on with her.

From my chiefs perspective she was a “safe bet”. That is, the odds were high she’d be fine. I guess I just need to learn that it is ok to “bet” on these things, as my gut reaction is still “better safe than sorry”. Of course, our local ED would be overrun if we brought in every college student who had a few beers, so some balance needs to be struck. I need to learn how to strike that balance and feel ok about it.

Tuesday, July 20

Meal of Champions?

My daughter (who is two and a half) and I were at the store yesterday evening. As I was pushing the cart around, loading it up with food, she was following behind me pushing a little play cart with a teddy bear in it. She was (and is) cute beyond words and I felt a special kind of happiness that only parents know.

Then I saw something that turned my mood around. A student athlete I had met while fulfilling one of my administrative duties was in front of us in the checkout lane. I remember thinking when I met her that she was awfully thin for an athlete. As the student checked out I could not help but notice her purchase: Three bags of baby carrots and three enemas. Not the proper dinner for a Division 1 athlete whose body fat is currently so low there is no way she menstruates. Having only met this person once I certainly do not feel comfortable addressing this issue with her, yet clearly she needs help. There is no way her coaches and friends don’t know she is in trouble. I hope they are helping her find the treatment she needs.

I have dealt with eating disordered individuals before. If you have a lot of contact with college students you either have to deal with it or actively ignore it. Last night was the first time, however, I looked at someone and thought about them as someone’s daughter. I looked at my own happy and beautiful child and realized that her demographics put her at high risk for this problem. It must be very difficult having an adult child out of the house knowing she is being destructive to herself and not having any control over the situation.

Other stuff:

EMS: One call – MS patient dehydrated and feverish. Easy call with no problems.

Tour: The tour hits the Alps and OLN coverage starts in one hour! Lance will be in yellow at the end of the day our I’ll shave my head.

Thursday, July 15

What Will Happen in the Pyrénées?

Yeah, yeah – This isn’t really a blog about cycling. I can’t help bring it up again as it is where my thoughts are right now…

Tomorrow the Tour DAY France (thanks Bob Roll) should see the major players animating the action for the first time. Up until this point poor decisions or bad luck could have lost the tour for anyone (i.e., Mayo getting caught behind and losing 3+ minutes on his General Classification rivals), but little could have been done to win it. Will the tour be won tomorrow? I doubt it. But it should allow for an excellent demonstration of who is on form and a legitimate contender, and may well allow someone to put everyone else on the defensive. The last hour should be pure excitement as all of the big guns will be ready for a fight and watching each other closely. For anyone interested in cycling in general, or Lance Armstrong in particular, tomorrow marks the beginning of a special week and a half.

My guess is that many US cycling fans will be “sick” tomorrow and have to stay home and watch live coverage on OLN. I’ll be glued to the TV myself but have a *&$#(*(%&^ dentist appointment at 1100 EST which should be just when things heat up. Yell at the TV for me, will ya?


PS – Anyone speculating that Hamilton will be thrown off his race by the death of his dog Tugboat is mental. I’m not saying he won’t be upset, but certainly a professional bike racer who has raced hundreds of grand tour miles with broken bones will be able to suck it up and win one for the “Tugger”.

Wednesday, July 14

Radio Check

Most people in our agency have one-way “pagers” which receive voice transmissions and “beep” when pre-programmed tones are played. The pagers let you know when you are needed, the nature of the call, etc. Very handy and all that is needed for most of us.

I now have a new (both to me and the agency) scanning two-way radio that allows me to transmit (on three different frequencies that serve different purposes) as well as receive. Our chief bought a few new radios and now a little fewer than 10% of our members have a radio. I guess that the scarcity makes them valuable as for some reason people are really concerned about who has one. I can’t say for sure why the chief gave me one, but it is clear that for some the possession of one of these is some sort of status symbol. Humans have an amazing ability to turn even the most trivial of things into a contest or statement of perceived value. Weird. That said, the radio is cool :-).

Two calls since my last entry:

First came in as a cardiac arrest. Turned out to be an anxiety attack by a guy in is early 80’s who had a recent spike in his PSA and was due to have his prostate removed this week. Given the potential side effects of that surgery I’d be having anxiety attacks as well. Something to be said about attaining and maintaining an erection and deciding when and how often you’ll urinate. Maybe that’s just me.

Second was a non-emergency transport to a hospital an hour away. My agency does not do many non-emergency transports as we leave them for the paid folks. However, in this instance the patient has had a long history of volunteering for a local fire station, and his son is a current chief, so our chief wanted to do the patient and is family the favor. The patient and his wife were really nice and the ride would have been fine but for three things. First, my glasses broke that morning and I was without them, which leaves me a tad dizzy. Second, the trip was considerably longer than I’ve ever spent in the back of an ambulance and was over rolling and winding roads, starting a bit of motion sickness in, well, motion. Third, the patient puked sending the aroma of fresh vomit throughout the patient compartment. The combination got my gag reflex going and I almost managed to vomit myself. The patient’s wife, who also has volunteered in EMS during her time, was cracking up and full of advice (breath through your mouth, stick your head out the window, etc.). I am glad someone saw the humor in the situation.

Work stuff: Calm before the storm. Things are nice and quiet and I know that means August is right around the corner. I have a bunch of paper work to fill out for my trip to Australia in ’06. Seems I actually have to do some WORK in order for them to send me over there. Who knew?

Saturday, July 10


Yesterday afternoon I had been talking with a student (who is also an EMT) about some research we plan to do this coming year. When we finished we went outside to head our separate ways when the pager crackled something about a two car MVA with injuries. We both jumped into our cars and headed down to the station.

I was on the first rig out. Rescue was on the scene and had the roadway secured by thetime we got there. The scene was on a busy state highway (one lane each direction). Cars #1 and #2 were headed south when Car #1 decided to stop to avoid hitting a farmer and his cows, some dozen plus of which were in the middle of the road. Car #2 drove into the back of Car #1.

I got the driver of Car #2 who was up and around saying she was fine, despite a nose bleed and a significantly banged up car. I had two CFRs (certified first responders) helping me, and it was weird to have someone looking at me for direction. I successfully pretended to know what I was doing and we did a “standing takedown” on her getting her collared and boarded. The whole time she was laughing uncontrollably claiming that being collared and boarded was FUN. She was a hoot. By the time we were rolling toward the hospital my student was on board and she did the trauma assessment. I much prefer having a same-sex assessment if possible. In this case, our patient was again laughing claiming the assessment tickled. I was glad I was not touching her at that point… No real injures besides some expected soreness.

At the hospital, after the police spoke to everyone, one of the passengers in Car #1, who had been a sign-off, suddenly experienced neck and back pain. I find the timing curious as her pain began right around the time the officer made it clear that the accident was the fault of the driver of Car #2. Delayed onset neck pain or $$$?

Anyway, it was good to have a patient all my own but that wasn’t seriously injured as it helped build my confidence.

PS - No cows were injured.

Friday, July 9

14 + 14 = Pain and Disfigurement

I haven’t been able to get myself to write the long version of this (despite what it looks like below), but wanted to get something down. I write these in the present tense for reasons I still don’t undestand…

Chatter on the fire channel at 0445 – Scene Command: “Has {my agency name} been alerted yet”? Control: “No”…

I awake at the sound of our agency name. Confusion on the radios. Seems two 911 controls (for different counties) can’t quite communicate and have managed to not dispatch us to a scene of a one-car MVA. While they got an agency out, it meant a longer response time and someone working outside of their district.

Scene command is clear that they want us there and that we should be alerted that there are two patients with one difficult extrication. I’m getting dressed as our pagers go off. We get 2 rigs out ALS. We arrive on scene to see rescue working in the middle of a field with dozens of people all around. The sounds are a mix of generators running lights and machines designed to tear vehicles into pieces, radios with lots of traffic, and the screaming of someone who is experiencing more pain than a human should have to endure.

One ambulance (from another agency) already left the scene with the passenger. Another (again, not us) is providing care to the driver of an SUV. There is nothing for us to do but survey the scene, feel sick to our stomachs, and be backup. This is OK by me as I can learn a lot being able to watch various aspects of the situation whereas if I was providing care I would have been too focused to notice things like the setting up of a landing zone for the helicopter, coordination between the rescue and ambulance people, etc.

The SUV is 100 ft off the road in a pasture. A trail of parts, an odd mix of suspension components and plastic, lead from the side of the road to the car. Part of a telephone pole is between the road and the SUV, the other is in front of it. The SUV hit the pole head-on on driver’s side. Foot well on driver’s side is now the size of a bread box. Distance between the steering wheel and the seat cant be more than 6 inches.

The entrapped driver vacillates from screaming in pain to silence. It took almost 90 minutes to get her out of the car. I have no idea how long she was in the field before 911 was called. The helicopter was waiting for her and when they got her out things went from crazy to silent within a minute.

The driver and the passenger were both 14 y/o girls having a sleepover. Still unclear how they got access to a $35k SUV or why they were driving 80 mph at 0300. For those reading from outside the US, minimum driving age in my state is 16. There is no way this story has a happy set-up, and I can only hope it has a non-lethal ending.

Tuesday, July 6

Classism All Around

My chief and assistant chief keep subtly suggesting I work to get more faculty members involved in our ambulance corps. Their thinking is that professors have time (particularly in the summer when they most need help), are smart, hardworking and responsible. With 200+ faculty, a good chunk of our corps could be made up of faculty members, right?

Well, there are problems. First of all, temporary faculty and assistant professors are very unlikely to give their time to any pursuits besides scholarship, teaching and service. Why? Being tenure track is like playing baseball in the minors trying to play well enough to get the call up to the show. You are either about to make the jump or your baseball career is over. It is a scary feeling to think you could end up in your mid-30’s and looking for a new career after 4 years of college, 4-8 years of graduate school, 0-4 years of post-doc or temporary work, and 6 years of working at an institution. Searching for a new job at a different institution would be one thing, but a new career altogether? Ouch. The opportunity costs that go into preparing for an academic career are HUGE and one must ensure that a tenure decision is made based on a best effort. So, let’s limit this discussion to full-time, tenured faculty.

Of the tenured faculty, some are old enough that they are going to think they are too old too learn new tricks. Many are so burdened with other volunteer or administrative duties that they can legitimately say they don’t have time. Others just won’t find EMS interesting. Others are book smart but couldn’t coordinate their hands to put a regulator on an O2 tank to save their lives, or be emotionally stable enough to calmly triage patients at a car accident as patients and bystanders are screaming.

Still, two (“B” and I are the only two)? Certainly more than 2 out of 200 will have the time, inclination and physical and mental talents needed? There is one last issue, one that I think few would admit to but that would make their working in volunteer EMS a serious issue. Academics like freedom. Freedom of time, freedom to make their own decisions, etc. Of course everyone values these things, but we can tell from behavior what people really value in a relative sense. Take freedom of time, for instance. Even when I am working 60 hour weeks, I have a LOT of control over what I do when. Sure, a lawyer at a NYC big-time firm might value this type of freedom, but the fact that they chose a path of 80+ billable hour weeks, scheduled by someone else, tells us they value other things over freedom of schedule. We know how much academics value intellectual and temporal freedom over other things (like money) based on their chosen career path (if they were willing to trade freedom for money they would have been in business, law or medicine which all pay considerably more). So, here we have people who as a group (obviously I’m making gross generalizations) like freedom to act when and how they want.. You can imagine that a lot of these people might find it hard to take orders. The average academic has no real boss and takes orders from themselves. Obviously, in EMS there are situations where someone else tells you what to do and there isn’t much time to have a cup of tea and chat about alternatives (or, more likely in academia, form a committee to draft alternatives that will be voted upon).

But it isn’t just the issue of taking orders, as I fear something uglier. Classism. Despite a lot of rhetoric to the contrary, I get the feeling many of my colleagues consider themselves “special” in some way that is hard for me to put my finger on, but very much based on their idea that they have chosen a more noble path, like their value system is superior than others. My gut feel is that many would have an especially hard time taking orders from people with considerably less formal education. In volunteer EMS experience and success in the field are the currency that builds a command structure. Our chief is in his early 30’s, has a high school education and is a landscaper. By his own estimation his skills as an EMT basic are ok. Why is a basic EMT with admitted “OK” skills the chief of an advanced life support (ALS) agency? The guy knows what he is doing on scene. He knows how to judge resources and when and how to ask for more. He can triage, talk to the fire and police, and direct medical personnel while staying calm and collected. He can talk a psych patient out of her house when moments before the police were going to get her out using pepper spray and cuffs, convince someone having a heart attack who hates needles to let the medic start a line, etc., etc., etc. His education has come from being in the corps for a LONG time, paying attention and learning from past experience, and using his obvious intelligence to his best advantage. His being a landscaper with a high school education is irrelevant. Period.

Volunteer EMS is a type of “melting pot” were people with very different educational and socio-economic backgrounds work together as a team. Things are fairly egalitarian until the crap hits the fan, at which point people TELL others what to do. If they are good, they tell you clearly, and the task is something they know you can do, but even when they “ask”, they are telling you (i.e., “can you bag the patient?” is not really a question when there are two of you on a full code and the person “asking” is starting compressions). I take orders from people who are twenty years my junior, are students in my classes or people working jobs earning 20% of the salary I do, and in many cases have at least a decade’s less formal education. I don’t have a problem with this. I know in this arena they know more than I do and have something to teach me. I also know that in the end, it isn’t about ME, but about the patient. I am embarrassed to say that I think for many of my colleagues this would be difficult if not impossible. I hope I am wrong and being too cynical, but my past experience with some of my peers suggests a smugness and self-importance that would seriously complicate their ability to take direction from, for example, a 25-year old car wash attendant.

What I find most disturbing about this is that my chief and assistant chief seem to have classist attitudes as well. In talking to “B” and I about bringing in faculty, they use phrases like “we want to bring {insert agency name} up to the next level” or “we want to bring in people who will be reliable”, etc. You’d think if the high school educated landscaper could be chief they would figure out that we shouldn’t be selecting people for our corps based on anything other than whether they can do the job. In EMS, that is a complicated job description and, in my opinion, including or excluding people based on occupation or education level is a mistake. Assumptions often are.

Quiet 4th of July

The lack of entries here correlates with things being uneventful in my life.

EMS: I was on for 40+ hours between last Friday and the weekend. NO CALLs. None. The parade was a lot of fun and we hung around downtown until the crowds cleared. I have not had a call in forever and a day…

Home: In-laws in town for the weekend. Lots of BBQ and hanging out. The kids (mine and their cousins) had a great time playing on the play set I built earlier this summer. Another 1000 sessions like that and the work will have been worth it :-).

Work: Things are very quiet. I need to crank some stuff out before mid-August as that is when the $&!) will hit the fan for the fall semester.

Hope everyone reading who celebrates had a safe and happy fourth.