Tuesday, April 12

Ride Time is Over!

EMS Update:

Our last module exam was tough and killed off two more people. I really feel bad for them, as we've been going at this for over seven months now. I have a system down now such that without worrying about things much I score between 91 and 95 (I got a 93 on this one). I have given up trying to score in the high 90s as there are always a few strange questions that I'll never anticipate.

Ride Time
Ride time is over! My last call came Sunday late-afternoon. I rode from 0600 to 1800 on Sunday, so it was a long day. The call came in as difficulty breathing. To make a long story medium, my patient had some adventitious lung sounds, but based on her presentation I thought her problem was not acute pulmonary edema (which is what the nursing home staff claimed it was). My preceptor twice asked me what drugs I was going to push. The first time I told him I needed to finish my assessment and see how she responded to the improved positioning and O2 (when we got there, she was flat on her back and on 2 liters of O2 via simple face mask!). The second time he asked, which was right after I finished my assessment, I told him that if I was by myself I would not push anything, to which he said "You're running the call". After the call was over he said "Well, thats it, we're done. You are ready. I knew you knew what drugs to push on most calls, but this call let me know that you know when to NOT push them, and this is very important. Combined, I've seen enough to know you are ready to go out there on your own. Just remember that it is always OK to ask for help from medical control, and you can always call me on my cell if you have a question. Nice job."

My preceptor is a great street paramedic, and in many ways a great mentor and teacher, but he is very quiet. His positive words meant a lot to me. Someone else told me that he was saying (when I wasn't around) that I have a special combination of street skills and book learning, which was nice to hear. I certainly have a lot to learn, but this experience with a higher volume agency, with very experienced providers, was great. I suppose the fact that they asked me if I wanted to work there part time is a sign that they think I can do ALS in a tough environment.

Things I noticed during my ride time (note that I rode in a small urban and suburban environment while my home agency is very rural):

* Many nursing homes are staffed by people who either don't know or don't care how to treat potential medical emergencies like difficulty breathing. I can't count the number of DB calls I went on where the patient was flat on their back and not receiving sufficient oxygen therapy. Truly frightening.

* Some people un-intentionally commit suicide by being stubborn. There are a subset of patients who refuse to allow that they are having a heart attack and will refuse medical treatment against medical advice.

* Compared to my area, the area I rode has a large number of psychologically disturbed patients who are not compliant with their meds. These people are known BY NAME by entire EMS agencies. This is a problem for the patient, the agencies and the hospitals.

* It really sucks that we have a system where some people receive their only medical care by calling 911. This is a REALLY expensive way to do socialized medicine (someone is paying for the ambulance and the emergency department, and it isn't some of these patients).

* Professional EMS providers, on the whole, care about their work, are well trained, provide a vital function to society, and are horribly underpaid. I saw VERY few EMS workers in their 30s. Most were in their teens or 20s OR in the 40s. There seems to be a large burnout factor.

Getting closer yet - State practical exam on 5/14 and State written 5/19.