04/27/04

Well, my 12 hours as ambulance driver from 1800 Sat to 0600 Sun went without a hitch and with no calls. Campus safety transported over 20 intoxicated students to the ED over the weekend but we were thankfully without another call after our MVA on Fri/Sat. At some point I’ll blog on Campus Safety and their transporting patients. They WILL get sued some day.

I was on the board for 12 hours Monday as medical personnel but still no calls. Things do tend to run hot-and-cold.

My EMT class is ending with a flurry:

Thursday 4/29: Kids, Older folks and Obstetrics.
Saturday 5/1: Cutting up cars and extricating people.
Monday 5/3: Fourth Exam + Review of Class
Thursday 5/6: Final Exam for the class
Friday 5/7: Practice for the state practical exam.
Sat 5/8: State practical exam
Thursday 5/20: State written exam

Waiting for the state written exam date will be OK, but the state then takes 4 to 6 weeks to grade the tests (though they are scantrons) and get the cards out. That wait will be annoying.

Am I ready to be an EMT? Probably not without someone more knowledgeable around, though in a pinch I’d be able to pull it off. I think the more experienced EMTs can walk in on a scene and know what is going on, and how the call should be handled, MUCH sooner than me. And I am sure I miss some details they see as I still have to focus on the basics. I do look forward to getting more experience.

One week of classes (at the college) left, meaning I am one week away from effectively being done with my sabbatical. Yech.

Next fall I’ll likely have more posts related to academia. I realize the few of you who read this mess now are EMS folks and hope you’ll be willing to wade through the academic crap as there will still be EMS-related content (for all I know I’ll be in the medic class in the fall).



DJ

What a night/morning

In my last post (last night!) I mentioned it is “Spring Party Weekend”. A lot of ethanol, music, and general rowdiness. As I went to bed I put my pager on “alert” mode which means it only makes noise if my ambulance corps has a call. I had a hard time falling asleep as the music from a band playing outdoors made it from a fraternity downtown to my house (I live outside of town on a hill so there is a straight line-of-sight between me and campus). The last time I saw on the clock before I fell asleep was 2350.

At approximately 0130 my pager went off. MVA rollover right in town. Can’t be an accurate call given the location as the speed limit there is 30 MPH. I figure this will be a bogus run, but that with everything else going on in town I might as well head down to the station as we like to take two rigs to an MVA and there could always be a second call as the first is being dealt with.

As I approach downtown I yield to some fire trucks turning left at the main intersection. I see a bunch of clearly intoxicated students jumping up and down and cheering the trucks. If these idiots knew where they were going I certainly hope they would have managed to be somber. My chief gets on the EMS channel and asks control to tone out for more manpower. I hear our first rig go out. Hmm. In retrospect, I should have known that the request for more manpower was a horrible sign of what was to come, but at the time I just assumed he wanted to make sure the second rig got out.

It is worth mentioning at this point that my pager does not get the fire/rescue frequencies and that some of the ambulance corps in my area come out of fire departments. If I had brought my handheld scanner with me I would have known a lot more about what was going on and could have had time to get the pucker factor dialed up. As it was I still figured this had to be, at worse, a car-pole minor incident.

Pulling into the station there are cars everywhere. I open the door to the back of our second rig and see 4 (FOUR!) people in the back. This is in addition to the two in front. I start to back out and tell them to be careful when they look at me like I am crazy and tell me to get into the rig. As soon as the door closes we are off. This made me realize they knew something I didn’t and that something bad was going on.

Station to scene in 90 seconds. A late-model smaller SUV (like a Chevy Blazer) is in the middle of the road, near an intersection, and is in BAD shape. On its side is the vehicle our students call the “drunk bus”. This is a commercial bus that is contracted by the school to shuttle students around downtown and campus locations. It was put in place after a fatal MVA involving alcohol a few years ago. The “drunk bus” probably holds 30 people or so, and is large enough that a small SUV should not be able to knock it over unless there was a lot of speed. There was.

The good news: No one on the bus was hurt despite the fact it was flipped over.

The bad news: The smaller SUV contained 3 unrestrained people in their 20s. Our chief had called out mutual-aid for a third ALS rig (this went out over the fire freq so I didn’t hear it), and good thing. When I jumped out of our rig I heard the fire chief (who is a paramedic) yell “the driver is going next, get ready to board him”. I grabbed a backboard and set of collars. I got involved in getting the guy out of the car and boarded when I realized my ambulances were driving away! I didn’t realize the other two passengers had already been extricated and were packaged waiting to leave. Here I sat, with a boarded patient and these firefighters are looking at me like “what next”? Thankfully the mutual-aid rig pulls up and we load the driver (who has a wicked mid-shaft femur fracture). The mutual-aid guys tell me to jump in and off we go to the trauma center that is 20 minutes away. Patient is alert and oriented x 3, complaining of extreme pain in his mid-thigh, and incredibly has normal vital signs. Much to the patients benefit I learned how to use a Hare traction splint THURSDAY. The second time I put one on is for a real femur fracture. Wow.

All of them made it to the trauma center alive. The police took a BAC on our patient before we left. I don’t know what it was, but given the nature of his fracture and the limited amount of complaining, it must have been high. Enroute he admits to having consumed alcohol and says that he never lost conciousness. When asked how the accident happened he complains that the bus turned left without a signal. He was going in the same diretion as the bus. The road is two lanes, in town, with a 30 mph speed limit. When our patient saw the bus slow down he decided to pass it. He was going 55 mph when he struck the bus (by his report).

I’m going to go back to sleep (or try). I will try hard NOT to think of the fact that this guy was driving on the roads I drive on. Or that someone’s son or daughter could have been killed by him. Or, if the story someone at the trauma center is true, that IF he was DWI this would give him his 4th conviction.

Instead, I’ll think about this morning being the first day of soccer for my son. I plan to watch some 6 year olds play some soccer, plant 100 tree seedlings on our property, take a nap, and get ready for tonight (I’m on call as a driver from 1800 to 0600 Sunday).

I hope the students talk about this accident enough that it will tame them some tonight. I know better.

DJ

Spring, '04

Spring is really starting. The trees are budding out. Crocus and daffodils are in bloom. And, just when you thought things were quiet, here comes “Spring Party Weekend” where the students blow off a whole lot of steam during their rite of spring. Alcohol sales in our county must be up 400%. Fireworks are going off downtown, bands are playing, and my ambulance corps just got toned out for a “Man Down”, which, given the location, will be an intoxicated student.

For things to start, things must end. I am watching things end with bittersweet feelings. My EMT class is in its final two weeks, with the state test set for the 20th of May. I finished the hospital time required for my ambulance course (perversely I had a great time hanging out in the ER). I have learned so much and on the whole it has been fun. The senior I have been working closely with is finishing her honors project and will be defending in the next 10 days. As usual, a student I have formed a close bond with will spend increasingly intense and frequent periods of time with me (as she prepares to defend her thesis) and then we won’t see each other for months or years. My sabbatical will end SOON, and I’ll be back to doing too much work (back on the disciplinary board, faculty rep to the NCAA, Director of the Scientific Perspectives Program [along with the new title “University Professor of the Liberal Arts”], athletic committee meetings, blah, blah, blah), teaching like a madman, etc.

I am psyched. One of the things I love about my job is that there are radical changes of pace and clear demarcations of time. Semesters to start and end. Winter, spring and summer break. 50 to 80 hour weeks and then weeks when I can work 25 to 40 hours on MY schedule. New students just waiting for someone to capture their attention and help them fall in love with learning, who in four years will be the students to whom it hurts to say goodbye. New challenges in the lab, classroom and administratively.

The final sign of spring came today. “Roger” came and took the snow-blower off my tractor and put the mower deck on. By tradition, we will have one more snow that is light enough that it will melt away without having to be cleared. From that point on, clear skies, warm days and cool nights, and SUNLIGHT! There is no denying it: Spring is here!

Ah, yes.

DJ

Trial by Fire (well, car crash actually)

My family and I left our home Friday to drive down to Philly to have some more in-law time. At least this time the purported purpose was to celebrate the birthdays of my son and his cousin.

About an hour away from home we are headed south, still on two lane highway (one lane north, one south), when a pleasant sunny drive gets really interesting. The second car in front of us (i.e., there is a car between us and the car in question) crosses the double yellow lines. It crosses again, this time forcing some cars coming north to go onto the shoulder. As we approach a bridge I am about to ask my wife to grab the cell phone and call 911 when it happens. The car swerves right, hits the guardrail on the southbound side (our side), crosses both lanes of traffic, and SLAMS into the other guardrail. Seeing this about to happen the car in front of us slows, as do we. After the crash, the car in front moves around the crash (I figure the guy is just moving on) and I decide I’ve got to help but I can’t leave my family as the first car to be hit by someone coming from behind, so I too pull around the crashed car and park on the shoulder about 50 feet beyond the wrecked car. The person who was in front of me pulls over and we both get out at about the same time, waving our arms trying to get traffic to slow around us.

I start running towards the wrecked car, which is now on the shoulder and in the southbound lane, sitting at a 90 degree angle to the road. The guy who also got out starts yelling at me not to touch anything. I run around the car to the driver’s side and look in. The driver is supine, across both seats with his head resting on the passenger door. There is a star shaped pattern in the windshield on the passenger side, along with a huge dent in the dash. The car was older with a two-part seat belt system (the shoulder strap connects to the door frame and is on a motorized track and the lap belt is separate). The driver is unresponsive and isn’t moving. Thankfully his door is unlocked. As I open it, the shoulder belt moves with the door, and I have to unhook it to get into the car (the driver was not wearing his lap belt). I switch the ignition off (the car was not running – there was coolant and oil everywhere on the ground). At first he is breathing, but he suddenly begins snoring respirations and then stops breathing altogether. I realize that I can’t help him from the driver’s side of the car (as I am effectively at his feet), and if I open the passenger door to get to him his head will move a LOT. So, I reach across the car and his broken and bleeding body, roll down the passenger side window, and then get out and run around the car to the passenger side. Reaching down to stabilize his head (and C-Spine), I perform a modified jaw thrust. BIG GASP. He hyperventilates for 20 seconds or so and then settles into a reasonable reparatory rate. During this time I have to tell the guy who was in front of me, who has been yelling “DON’T TOUCH HIM, YOU’LL PARALIZE HIM!”, that if I don’t touch him he is going to die right in front of us. This pretty much shuts the guy up and he (to his credit) thankfully focuses on keeping traffic under control. As I was maintaining the patient’s C-spine and airway a woman CPR certified showed up and parked her car in the southbound lane such that it would get smacked instead of us. The first words out of her mouth when she saw me (I was wearing a t-shirt, shorts, open-toed shoes and NO gloves) were “Shit, I left my gloves and first aid kit in my other car”. Perhaps obviously the injured driver is bleeding all over my ungloved hands and I begin to replay in my mind our instructor’s admonition that we keep gloves in all of our cars. I ask the woman to check the guys radial pulse – it is there. The patient begins to moan, and takes a few swipes at my hands on his head. I tell him what I am doing, and ask him to hold still. He does. I ask him to wiggle his fingers without moving anything else – fingers on both hands begin to wiggle. I can’t see his feet, and he has shoes on anyway. I tell him I know it hurts a lot, but he needs to hold still until the ambulance comes, and that they will be here soon. He complies.
We were, of course, in the middle of nowhere. With two people calling 911 (my wife and the wife of the driver who was directly in front of us) 911 dispatch got the message and the ambulance showed up about 8 minutes after I opened the guys airway.

The ambulance shows up before rescue. A women wheels a stretcher to the car, looks at me, and begins to open the passenger’s side door to the car. What was missing here? A) I could not have held C-spine as the door opened, so SOMEONE should have been there to take-over head stabilization. B) I’m bare handed, in shorts and t-shirt. I should be nowhere near an extrication. C) Don’t you want a backboard and neck brace? D) Wouldn’t you like to ask me what has been done, what the guy’s mental status has been, ABCs, etc?

I’ll admit that I got a little snippy at this point. I asked the lady if she realized that opening the door would prevent me from maintaining head stabilization and the open airway I had established. She looked at me like a deer in headlights. I asked if she might rather maintain head stabilization and wait for rescue. She did, and I went and drowned my hands in sanitizer and then got my family out of there (there where 10 rescue vehicles on the scene when we left). I never did have anyone ask me who I was, what I saw or did, or how the patient was doing when I found him.




Lessons learned:

-Keep BSI in both cars.

-Spend the $8 and get a window hammer (if this guys door had been locked I would have been screwed)

-The cell phone is worth every penny we pay for it.

-This is just a prediction, but it seems to me that it is easier to deal with an emergency if you are the senior person there, you have no duty to act, and you don’t have time to worry about what you’ll do. I am sure that if I had come on this scene with an ambulance it would have freaked me out. Things happened so fast I had no time to stress, worry or even think. I just DID. If this were a situation where I had been paged to a one-car MVA with personal injury, I would have had the whole trip to the station, and then from the station to the scene, to worry about what I should be doing. When we got there, being so inexperienced, I likely would have stood around and waited for orders. In this case, it was ME or this guy would have been without O2 to his brain for 8 minutes. I did a scene size-up and initial assessment without even thinking about it. It made me feel like all the time I put into the EMT class has already paid for itself.

-When you arrive at a scene with people already giving some kind of care, introduce who you are, what agency you are with, and what level of training you have. Then, politely ask the person who they are, what their credentials are, and what has happened so far. In this instance the responding ambulance could have learned a lot from this exercise (never mind the fact that I have no idea who you are when you have no clothing on to identify yourself).

The rest of my weekend was relatively uneventful.

DJ

Making Quads 3/4 of the way into the course?

Been busy:

Father-in-law holding stable. If this continues they’ll let him go home to rest and maybe start Chemo which may add months to his life.

Work: Curriculum revision. Nothing like having 12 people in the room trying to make a decision.

Ambulance Corp: Several shifts with no calls. “Call jumped” (went down to the station for a call when I wasn’t on the board) on Easter as I was worried few people would be around. 6 people showed up for the call LOL. They let me go for the experience. Guy calls in with difficulty breathing and chest pain after being released that day from the hospital having been in for treatment for AMI (heart attack). We wasted no time getting out to his trailer in the boonies and I got a bit motion sick riding in the back of the rig. Driving is a lot easier on my stomach. When we showed up rescue had done a good job prepping the guy and we loaded and went (we could only get out BLS). I got some great experience taking vitals in the back of a moving rig going lights and siren. Patient delivered alive and well. Hope he stays that way.

EMT Class

Test last night: Written and three practical stations. The stations were automated external deliberator (AED), spinal stabilization of a supine patient on a long board and spinal stabilization of a sitting patient using a Kendric Extrication Device (KED). I didn’t feel that good about the written test having missed two classes and being distracted, with a lot of questions seemingly coming out of left field (i.e., I certainly didn’t read the answers to them). Must have been an OLD and recycled test as several other people were complaining about this issue as well. After the exam we all got yelled at as most of the class failed the long-board and KED stations, causing lots of “quads”. Getting yelled at before you see your score sheets is a pain as it makes you think you did poorly. I hung around while things were being scored and did better than expected given all else that has been going on: I was high score on the written (93 out of 100) and passed all three stations without missing a single point on any of them. I understand that the performance on the written exams is a factor of many variables and may not predict how I’ll do in the field. That said, my classmates who are not doing well on the written exams are the same ones who forgot to use a rigid collar, or secure the head, or did secure the head but not the rest of the body. How can you make this kind of mistake and claim you want to be an EMT? The long-board and KED stations are not rocket science, they depend on PRACTICE and an understanding of a few basic ideas. If these people are not practicing now, what are the odds that they’ll keep up their skills once they are out in the field?

I'm Back

We (my wife, two kids and myself) went to North Carolina (Wilmington) to visit my father-in-law. We timed things well as he was alert for most of our visit and he really got to enjoy the kids (and us I presume).

He is still alive, but I fear we have seen him alive for the last time. His cardiac issues will likely kill him before the cancer does, and each time the phone rings my wife and I wince.

Our trip was a study in contrasts:

The joy of seeing family vs the reason for our meeting.

The look on my son's face when he sees (and plays in) the ocean for the first time vs. when he sees his grandfather in a CCU.

Wilmington is in full spring mode with flowers everywhere. We are still shades of gray with some green just starting to show.

Them: restaurants galore (REAL Mexican, Thai, etc.). Us: Pizza.

Smokers everywhere.

2 Wheel drive pickups. No such beast around here!

Clean cars.

Low riders.

Tans.

You get the picture. My job is great, but the fact is that in my business you move to the job as there are VERY few in a given year. Why ANYONE would decide to start a village in a place that can go 21 days without sunlight is beyond me.

EMT class rolled along without me. I read while I was away and caught up on the quizzes when I returned. The one question I missed dealt with the difference between Stridor and Crowing. If anyone can explain it to me I would appreciate it as I still don't understand (if you can provide a mechanistic explanation that might help!). Big test on Monday.

I'm digging out and my guess is I'll be posting sporatically until things return to semi-normalcy. Sorry for the delay between posts. I have been negligent in reading ya'lls blogs during this period and need to catch up on what you all are up to.

DJ