Monday, August 30

Taking the Next Step in EMS Education

I have signed up to take a “medic” class which starts in September and runs through May. It will be interesting to see if I can balance the class while I perform my “real” job at full tilt.

The decision to take the medic class was difficult as it will put a strain on my family and me. I also know that if the world were a perfect place my community would have full time paramedics who have extensive BLS backgrounds and who run dozens of calls a day. Our system is not even close to perfect. Our agency is woefully short of ALS providers, as are most of the surrounding agencies, and by performing my clinical and ride time in a nearby urban area I hope to continue gaining valuable BLS experience as I gain ALS skills. All of the ALS providers in my agency, as well as my chief, have told me that I will make a good medic and that I am ready to take the class.

In many parts of the country, “medic” means Paramedic. Around here, there is middle ground between EMT Basics and Paramedics, and these middle ground providers are called medics. This system allows volunteers to bring ALS into communities where without this level there would be BLS only care as paramedic training is difficult for many of us to obtain while working a professional job. The differences between “medics” and paramedics primarily have to do with medical direction, invasive procedures, and the age of patients they can treat. “Medics” need to get medical control permission to perform actions that paramedics often can do at their discretion, “Medics” can not put in chest tubes or perform other types of emergency surgery or facilitated intubation, and lastly, they cannot intubate anyone younger than 8 years of age. In my area, the drugs medics can push include acetylsalicylic acid (aspirin), adenosine, atropine, bronchodilators, 50% dextrose, diazepam, epinephrine (1:1,000), epinephrine (1:10,000), furosemide, lidocaine HCL 2%, morphine sulfate, naloxone, and nitroglycerin (this list varies by agency and region). Given most of our ALS calls are adult traumas or cardiac related events, you can imagine how having medics around would help the community.

I am taking the medic class in a small city thirty minutes away from my home. There is a class closer to me, but given my lack of EMS experience I wanted to take the class where I could get considerable clinical and field experience. If I took the class locally, I would ride with an agency that gets, on average, a little over a call a day. The agency I’ll ride with for my field time gets at least a call per hour for each ambulance they have on duty. In addition, they routinely see patients and emergencies that we rarely see in my area (e.g., patients that do not speak English, shootings, etc.). It should be an education.

The state curriculum for medic classes requires between 175 and 225 Hours of classroom and pratical lab time, between 50 and 75 hours clinical time, and between 75 and 100 hours field time under a preceptor. I should be a busy man over the next academic year!

Sunday, August 29

They are back!

I’ve been busy this week with trying to get everything set for tomorrow, which is the first day of classes for our students. My medic class starts on 9/8, and I’ll blog about my decision to take the class before then. In the meantime…

In the last two days, lots of D-R-U-N-K college kids. None of them first years, so my guess is that will be this coming weekend. For me personally, this is not about ethanol consumption. I admit I think the 21 drinking age is stupid, particularly when it means college students will be split between those legally allowed to drink and those who can’t. What this is about is drinking so much that you put yourself at significant risk and that you can no longer, by any reasonable person’s definition, be having fun.

Other things to vent on: I just got back from drop/add, where I reminded myself of a few things that I can’t understand…

“LOOK AT ME” – Why do intelligent people wear clothes to drop/add, which is populated with professors from every department and program, wearing clothing their parents don’t even know they wear in public and certainly would not approve of? Examples: Women wearing x-small, see-through ribbed tank tops with no bra on underneath, or a “mini-skirt” made by cutting the crotch out of a pair of sweat pants and cutting the legs off, wearing a thong underneath, and bending over a table to talk someone knowing there are people behind them. Men wearing pants with the waistband at mid-thigh level with their ripped and holey boxers showing. The list goes on and on. I understand wanting your peers to look at you, but when you are going to class or somewhere else where old farts like me congregate, what the hell are you thinking?

“We are on the same team” – Athletes sometimes bitch that they are typecast in a negative way. Hmmm. So do: Greek letter organization members, science majors, and homosexuals. Do you, as a football player, think you help your cause by walking around with 3 other 6’6”, 296lb guys all trying to take the same classes together?

“What time is it at?” – You need a course in “X”. I say there is one open. You say great, sign me up. I do. You then say “WOAH, dude, that’s at 8:30”. Yes it is. “I don’t get up that early”. You come here to learn or sleep?

The above said, I had a GREAT time at drop/add. Lots of “old” students coming by pretending like they are happy to see me, etc. 90% of the students are not like the above, but I’ll tell ya, the few that are sure stand out.

The students are back. I am happy they are and look forward to a fun semester!

Tuesday, August 24

Don't Forget to Call Your Mom

So yesterday I’m at work trying to get a statistics syllabus ready and failing miserably as I actually spent the whole morning on administrative crap. Around lunchtime I slip out to go home with hopes of spending time with my kids so my wife, who has just returned from a stressful trip visiting her terminally ill father, can get a nap. I climb in the car and my pager goes…

{blank} rescue, {blank} ambulance, EMS call, xxxx something road, elderly female, general illness.

“General Illness”? I guess that’s better than “unknown medical”, but not by a lot. I know the board is light so I head down to the station. There is a driver, an “S/O”, and no qualified medical personnel (besides me, I guess). I ask them to wait a minute in hopes a medic or more experienced EMT will show up, as the location of this call puts us a ways from the hospital and I have NO idea whether this general illness is the flu or a cardiac arrest. While the rescue associated with my village won’t roll without an EMT, the rescue that serves the location our call is at will go with just a CFR (certified first responder), and they have no medics or paramedics, so I know I’ll be the senior medical person on the scene. You can bet that I’m not that excited about the idea of running a BLS full arrest with no other EMTs around. The whole way to the scene the pucker factor is rising, aided by the fact that there is road construction between us and the patient (and the patient and the hospital), with only one lane open. My imagination is going wild as I try to plan a strategy for working a code with no other EMT, etc.

Boy did I get worked up over nothing. My patient is sitting in a chair with a trashcan in front of her, “vomiting”. “Vomiting” is in quotes because that’s what the patient said she was doing. Actually, she was spitting. Clear, clean, lovely saliva. There was maybe a half-cup of spit in the trashcan. She wasn’t swallowing, which at first made me wonder about an allergic reaction, but her breathing was fine. Nice clear lung sounds. Warm, dry and pink skin. And then I noticed that when I asked a question that required more than a one or two word answer, she did manage to swallow while forming her sentences.


Me: How long has this been going on.
Patient: Three hours.
Caregiver: Note that three hours ago her daughter was to call and didn’t.
Me: Any chest pain, difficulty breathing, nausea?
Patient: Nope.
Me: What is bothering you the most right now?
Patient: I keep vomiting.
Me: Is your stomach upset?
Patient: No.
Me: Does your vomit taste like vomit or like spit.
Patient: Spit.
Me: Can you swallow?
Patient: Yes, but I don’t want to.
Me: Do you think you need to go to the hospital?
Caregiver: She called her doc and the doc said to bring her into the emergency room and she’d see her there.
Me: Do you want to go to the hospital?
Patient: Well…
Caregiver: Yes, she does.

The lady is 94, but she is not mentally challenged. Obviously I’m going to transport her, but I am interested in whether SHE thinks she needs to go, as I think even she knows she is putting on a show. I never did get an answer from her. What I am sure of is that her daughter will learn not to call three hours late…

Friday, August 20

The fan is spinning, and the "stuff" is about to hit it...

Been crazy busy and not updating the blog enough...

EMS: I was on every night, from 1800 to 0600, for something like 12 out of the last 14 days. Nothing really worth writing about (a few difficulty breathings, one "can't feel anything on my left side" psychosomatic nightmare, and a few basic BLS calls).

I decided to take a "medic" class to become an ALS provider. More later. Class starts 9/8 and runs through May.

Home: My parents just left, wife's mom is here to help with the kids as wife goes to visit father (hope to get a better feel for how much time he has left).

Work: YOW! Meetings, requests for ME to decide whether things are worthy of funding/approval, etc. Class start 8/30 and I'm not ready.

I need to remember to blog about our new neighbor the freshly minted M.D. who is having a hard time adjusting to a rural setting. By writing this here I hope I won't forget...

Friday, August 13

Would There Be Something Wrong About Retiring Happy?

The phone rang last night around dinner time and it was A.W., someone I knew from my post-doc days at NIH. A.W. is part of a crew of guys who used to play poker together and pal around, and then we all got married and went our separate ways. We still see each other at weddings and rare gatherings, but we don’t see each other often enough. A.W. wanted me to know he was applying for a security clearance and that the FBI might be ringing me up to ask some questions about him. After the requisite teasing I admitted that I would tell the FBI the truth about him (who in their right mind would mess with the FBI?) and the conversation moved on to other things. At some point A.W. asked me if I planed on moving on professionally or if I was going to retire happy where I am now. The question gave me pause for a moment, as I realized where I am now compared to where I was in 1996.

From 1987 to 1996 I lived in the Baltimore/DC area (first in graduate school and then doing a post-doctoral fellowship). The last few years in the area my wife and I owed a townhouse that was a cookie-cutter copy of several hundred others in our neighborhood in Gaithersburg, MD. I drove to work each day on highway 270, leaving an hour before my first meeting as you never knew when the 15 minute drive would turn into 60 (or more) because of an accident or the sun coming up brightly over the beltway interchange (I’m not making this up – the SUNLIGHT could cause traffic delays!). We didn’t know our neighbors (nor did they know each other), and by the time we got done working and commuting each day we were too tired (or lazy) to brave a trip downtown to go to a play, the zoo or a museum. The first thing people wanted to talk about at a party was what you did for a living or whom you knew. My wife and I both realized early on that the environment was not for us and that we needed to grow ourselves as professionals to be marketable and then get the hell out of there.

A.W. is like a lot of people I met while in the region. He’s a transplant who ostensibly came for a few years and ended up staying. He changes jobs every one to three years, each time making more money but also guaranteeing that he’ll be away from home more and have a heart attack by the time he is 55. His question struck me as odd. Maybe I misunderstood the tone in his voice, but it seemed like the question was suggesting that staying at this same job for 30+ years and retiring happy would be a sign that I had no ambition. I got defensive, and began to reel off how my responsibilities have been growing, and basically explaining how there is plenty for me to do here that will allow me to grow as a person.

It wasn’t until I got off the phone that several things struck me. A.W., and several of my friends down in the D.C. area, tolerate their jobs, but they don’t really like them. Their professional advancement is important to them, but mostly it is because they want the monetary compensation that comes with moving up. On the other hand, I really enjoy my job. Of course there are things about it I don’t like, but driving into work I feel good about what I am doing and feel lucky I get paid for it (and frankly I get paid very well). I live in a very nice house, on 6.5 acres, within 5 minutes of my office. I CAN’T get stuck in traffic as there are no traffic lights between work and me. A.W. called me at 5:40 pm. I don’t know how late he was going to stay, but he was at work and still had a 75 minute drive ahead of him, and it would not be a pleasant 75 minutes. I was at home having dinner with my family.

This town of 2500 people, and my job, are not for everyone. If I wanted to be a world famous researcher I picked the wrong place to be. We have no Gap, Outback Steakhouse or Best Buy next to a Circuit City. There is little chance of looking across to the treadmill at the gym and seeing a senator (or someone who sleeps with one). If you spend $350,000 on a house here you are shopping for homes in the top 3% (I’m afraid to know what houses are going for in suburban Maryland these days). My hope is that my DC friends are happy in total (that is, their family, working and living environments, taken as a package, let them be happy and fulfilled). I can understand how they could be and have no questions for them other than are you fulfilled. That life wasn’t for me.

In 1996 I wasn’t in a place that made me happy. Now I am. And while I can’t predict the future, in 30 years I may well retire happy. I’m OK with that.


P.S. Baylor, the super-sweet Bernese Mountain Dog, died in his sleep the night before we were going to take him in to the vet to be put down. RIP Baylor. Love ya man (not that he reads this blog from the doggy afterlife).

Tuesday, August 10

I Don’t Work Wednesdays / Over Stimulated

Some people are so amazingly bold it blows my mind. As academics we have a lot of freedom of time. Some of us forget, however, that when you take a job you have obligations. The further you go up the administrative side of the ladder, the fewer degrees of freedom you have. This coming year a group of five people, one of whom is me, have to meet regularly to discuss issues related to the administration of a program. Four of us direct separate pieces of the program and one person runs the whole show. How hard can it be to find a meeting time? Not hard, you might say, given there is a time during the work week where none of us has a university commitment (classes, office hours, other administrative meetings, etc.). Done deal? Not for Person X. You see, Person X lives 40 minutes away from campus and likes to work from home on Wednesdays. The only other times available are well outside of reasonable working hours. I have no problem making those kinds of meetings, but I see no reason to schedule one when we have a perfectly viable time during the work week. People choose to live where they live. If you choose to live 40 minutes from Campus that’s your decision and I have no problem with it. However, if you think that your preference to work from home should rule out 20% of our possible meeting times, and in this case the only time we all are free, you’ve gone off the deep end. At my institution we are paid a “9 month salary”, which means from September through May we are expected to be able to be at work during the work week. How tough is that? Imagine, someone expecting you to be at work when you said you would be in exchange for compensation! Thankfully the person in charge of scheduling had the ovaries to tell Person X to sober up and smell the coffee.

EMS Stuff – Whole bunch of helping people off the ground who can’t stand up on their own. One was a middle aged male with a seizure disorder who had a vagus nerve stimulator implanted in his chest with a wire going under his skin up to his neck. The stimulator is supposed to minimize the number of seizures the guy has, and can be kicked into overdrive by a caregiver (by waving a magnet over it) when needed. The thing was acting goofy and was keeping his blood pressure so low he couldn’t stand up. May be the only guy in the county who has his blood pressure DROP when he gets over stimulated…

Friday, August 6

Not the way anyone wanted to find out + Sidewalk Monster

Our tones went off for a two car MVA with personal injury. When I got down to the station the chief points me to the second rig, I climb in, and both rigs are out of service in a flash. My rig has me, another EMT (who has lots of experience, is an RN, and is the chief’s wife), and a driver. Neither rig has a medic. The chief’s wife says to me “this one is yours – you just tell us what to do and we’ll do it”. Cool.

We arrive to find a mess. Traffic snarled, fluids all over the road, mangled cars and people everywhere. I jump out and rescue points me to a young woman sitting on the curb. She was the driver of a car that SMACKED a car pulling out of a parking lot. My patient's car had at least 20 inches of deformity in the front and both airbags deployed. As I approach her she looks shaken but has all of her body parts attached and isn’t actively bleeding. ABC's OK. A few quick questions to figure out what happened as my partner holds head stabilization. Collar, board, and into the rig away from prying eyes (a small crowd is forming). Chief complaint is pain in her left arm and upper-left quadrant of her abdomen. Both of these areas show abrasions. Quick trauma evaluation shows no DCAP-BTLS except for the pain and abbrasions on the abdomen, arm and an abrasion on her chin (from the airbag...). CMSx4 both before and after spinal immobilization. Ask about medical history…. She’s 8 weeks pregnant and was on her way to the OB when the accident happened. As she tells us this she starts to freak out. Her family doesn’t know, the father doesn’t know, and she is clearly upset that they are going to find out this way. I try to keep her as calm as possible as we make the 3 minute ride to the hospital.

At the hospital I transferred care, wrote the PCR, got our collar and board back, and we were set to go. As we are driving back to the station our tones get spanked again. 78 y/o f with injuries from a fall. Arrive to find just what was dispatched, with a nice head lac from making contact with the ground. No LOC, no dizziness, blood pressure or cardiac issues (that we can tell…) and no hip or leg injuries. Two chances to collar and board someone in one day. Luckey me. Why, exactly did she fall? She claims she tripped, but I am certain the sidewalk monster grabbed her. So, if you are going to be walking on the sidewalk today, please watch out for the sidewalk monster. That dude can do some damage.

From now until a week from Sunday I am the only EMT on the board from 1800 to 0600 (and most of the days are empty too). Holy cow will I be glad when people return from vacation and the students get back.

Monday, August 2

Tumor Ridden Pooch, Padded Room, Tractor Fun and Helplessness

Crazy Day. Short version follows…

Took one of my dogs to the vet as he has been loosing weight. X-rays show mass in lungs/liver. They’ll do an ultrasound soon but it doesn’t look good. He is the sweetest dog I’ve ever known (and I’ve known a lot of great ones!) and I hope this can all end without too much pain for him.

EMS Call – Psych evaluation for a resident of a group home. She had been making homicidal and suicidal gestures. When we get to the group home she is being restrained in a “time-out” room that is effectively a lockable padded cell. Spooky room – You would NOT want to be locked alone in this hellhole. Made the 70 minute drive to the psych hospital and things were relatively uneventful on the way there. While we are there a guy with some lacerations walks past me wearing an inside-out shirt and hospital bracelet. Note we are in the “city” now, and this country bumpkin (me) figures that if this guy wants to leave he can leave (and besides, he walks past at least four security guards on the way out). Two minutes later I am looking for my crew when the cops start asking for someone who fits the description of the guy I saw leaving. When I describe him and his behavior to them they give me a “you’ve go to be shitting me” and run out of the hospital. Hmmm.

EMS call – Tractor incident, unknown injuries. Rescue beats us to the scene and has all the patient information and a full set of vitals to hand me (LOVE THEM!). It’s just me and a driver. The patient has some real damage to his foot/ankle but everything else is fine. This guy was TOUGH. Talking to me, showing no sign of pain, and when asked, gives his pain an 8 on a 1-10 scale. Given his age (71) and experiences, this guy knows pain, and yet he doesn’t show it. I’d have been crying like a baby. Soft-splint, ice and a quick trip to our local ED which has the best orthopods for 500 miles.

Home. My wife is making plans to make another trip down to see her father. It is clear that his impending death is weighing heavier on her family as the outcome is undeniable. The doctors have given him his last chemo and radiation treatments, and I think this has triggered the realization that the medical care will be moving from treatment of the cancer to pain management to make his last days easier. I hate seeing my wife in pain and knowing I cannot make it better.

I’m on from 0000-0600 so off for a few hours (hopefully many more) of sleep. I have a meeting tommorrow that pretty much proves that August is here and my "real" job is heating up. I'm not ready for summer to be over!