The following post is not about EMS, but rather about my local community. The following is my analysis of a bit of patent absurdity put out by none other than the master, Bill O'reilly. The video in question can be found on his own website, misleadingly titled "Global warming vs. christmas.":
In my opinion, there is no higher form of praise than to be directly vilified by Bill O'reilly. Our town - Great Barrington - has recently received this highest of accolades by becoming the newest front on his "war on christmas" - by limiting the town's holiday lights, which consist of two or three marquee-style banner lights stretched across downtown main street, from being lit all night. Not, mind you, from being put up at all, or lit period, but from being lit after 10:00 pm. Normally, they would run until midnight, but the town selectmen decided to turn them off for an additional two hours in order to save power. Now, O'reilly's points fell into three categories:
1. The lights are a traditional part of the "small town" asthetic of GB, which is being ruined by "rich secular elitists" from New York and elsewhere.
2. The selectmen refused to call the lights "christmas lights," instead referring to them only as "holiday lights," and
3. The lights attract people to downtown main street and are therefore good for business, and turning them off hurts these folksy, religious local shopkeepers.
4. Small attempts to save power like this are pointless and have no effect at all on global warming.
Now, point by point, these are ridiculous claims. First off,
1. The decision was made by the locally-elected selectmen and not by rich NYC insurgents. I've spoken directly to these people, and certainly believe that they adequately represent both interests. Additionally, I would say that it is in fact the rich elitists that would prefer they stay on in order to make their tourist nest that much more resemble santa's little village.
2. The selectmen preside over a town that consists of a large and growing jewish population, among others. The lights in question are festive and attractive in my opinion, and contain no religious symbols of any kind- they look like banners and snowflakes. As far as I know, Christ didn't say anything regarding snowflakes only representing his birthday. In fact, if we want to get technical, the idea of a white christmas is a distinctly non-bethlehem tradition, global warming or no.
3. We're talking about turning them off AFTER 10 PM. As anyone who has visited Great Barrington after 10 pm knows, you are not impacting the number of people shopping by dimming the lights at this point. The number is reduced from 0 to 0. All of the stores are closed, and the only places open are bar/restaurants that will get their customers lights or not. Also, this is only on downtown main street, and other parts of town are not affected at all.
4. Small attempts like this spread across multiple communities have a cumulative effect, and every step counts. Plus, it saves town money, and I'd rather have better plowed streets than festively lit ones when no one is there to see them anyhow.
The interview was full of clearly out-of-context quotes from people on the street and direct attacks on our selectmen. You can view it here and have a good laugh at the theater of it all.
http://www.foxnews.com/oreilly/#
That link may not display the story as current for too long, but for now it's easy to find.
Happy Holidays!
Simon's Rock College grad, local resident & voter, and Great Barrington volunteer EMT,
Peter Tiso
EDIT: After reading a few people's reactions to the fox news segment, including people who e-mailed the town saying that they have chosen a different holiday destination because of the fox news segment, it seems that O'reilly did more to hurt local shopkeepers than a two-hour period in which an empty downtown turns off its holiday lights ever could.
Thursday, December 20, 2007
Thursday, November 29, 2007
N&V
Last night was what I would call a perfect night of EMS. It's a hard concept to come to grips with, but as an EMT, there is a certain part of you that wants to work - you want calls, even though you know that a call means that someone else is sick or injured. You don't wish for the accident, you wish for the chance to help, and more often than not, you get it.
Last night was such a night. I came on in a good mood, although I had been tired and feeling sick all day. Dinner improved my spirits, and afterwards, we settled in for a quiet night. A little after 9 pm, we received a call, and luckily I was still dressed; an elderly individual at a local restaurant, unresponsive and projectile vomiting. We hop in the rigs quickly, the call is upgraded to code 1, the lights go on, and we page for assistance.
We arrive on scene to find a person in truly serious condition. They aren't speaking, but seem to be able to obey vocal commands; they are able to squeeze our hand, they're breathing, and they have a good pulse. So far so good. However, there are clear signs of a neurological problem of some kind; the eyes are unresponsive, and one is pointing in the wrong direction. We attempt and fail a quick on-site blood pressure reading, and decide not to wait any longer. We load the patient (with some difficulty) and move to the ambulance.
Doors close and we move right away. On route, I set to taking a blood sugar reading, which came up normal. I grab a gauze pad to cover the finger, and look up at the patient, who coughs twice before proceeding to vomit a surprising amount of barely-digested expensive dinner, a sizable portion of which ends up on my legs. I ignore this, towel the patient off a bit, and we continue to be bounced around the ambulance, suctioning the vomit from the patient and starting him on high-flow oxygen via nonrebreather mask. We arrive at the hospital, move him in quickly, transfer him to a bed, and the nurses set to him immediately. I stand back and watch it all happen, never having experienced this level of emergency before, and find that everyone's motions are practiced and smooth, while I hardly know where to stand this time; I just take it all in, remembering what to do for the next patient.
Afterwards, we begin on the lengthy cleanup process. Every tool we used gets wiped down thoroughly, and I change into a set of scrubs, feeling for all the world that although I've been an EMT for a year now, this was my first real call.
Last night was such a night. I came on in a good mood, although I had been tired and feeling sick all day. Dinner improved my spirits, and afterwards, we settled in for a quiet night. A little after 9 pm, we received a call, and luckily I was still dressed; an elderly individual at a local restaurant, unresponsive and projectile vomiting. We hop in the rigs quickly, the call is upgraded to code 1, the lights go on, and we page for assistance.
We arrive on scene to find a person in truly serious condition. They aren't speaking, but seem to be able to obey vocal commands; they are able to squeeze our hand, they're breathing, and they have a good pulse. So far so good. However, there are clear signs of a neurological problem of some kind; the eyes are unresponsive, and one is pointing in the wrong direction. We attempt and fail a quick on-site blood pressure reading, and decide not to wait any longer. We load the patient (with some difficulty) and move to the ambulance.
Doors close and we move right away. On route, I set to taking a blood sugar reading, which came up normal. I grab a gauze pad to cover the finger, and look up at the patient, who coughs twice before proceeding to vomit a surprising amount of barely-digested expensive dinner, a sizable portion of which ends up on my legs. I ignore this, towel the patient off a bit, and we continue to be bounced around the ambulance, suctioning the vomit from the patient and starting him on high-flow oxygen via nonrebreather mask. We arrive at the hospital, move him in quickly, transfer him to a bed, and the nurses set to him immediately. I stand back and watch it all happen, never having experienced this level of emergency before, and find that everyone's motions are practiced and smooth, while I hardly know where to stand this time; I just take it all in, remembering what to do for the next patient.
Afterwards, we begin on the lengthy cleanup process. Every tool we used gets wiped down thoroughly, and I change into a set of scrubs, feeling for all the world that although I've been an EMT for a year now, this was my first real call.
Thursday, November 1, 2007
Happy Halloween
I went as an emergency services worker for halloween last night, and definitely got to go out trick-or-treating. A number of bizarre incidents, some of which directly related to the holiday, kept my team and I running around all evening. Sadly, I treated two patients who had very minor injuries as the result of violence perpetrated by themselves and others, and one patient with a more serious injury caused by her desire to not let the unfinished state of her front steps stop her from giving out candy to local kids.
The first and most notable incident was well in progress when my shift started. An assault took place at the local convenience store, and the guy proceeded to run off into the woods, where he "tripped on some bittersweet vines and twisted his knees and ankles." He then proceeded to climb onto the roof of the bowling alley, which is perhaps the most exposed yet least escapable location I can think of in town. Following a brief scuffle with officers (which I believe caused the laceration to his forehead) he was arrested. He seemed to be much calmer when we took him to the hospital later, and this leads me to wonder what he may have been thinking (or on) when he committed the crime. Witnesses say he "threw the clerk five feet through the air," but that scarcely seems possible from looking at him.
The second incident was a simple fight victim found in a parking lot. 19, a shiner, and drunk enough to write his date of birth on the "today's date" line beside the signature on his refusal form (the form that says we think you should go to the hospital but you don't want to and it's your choice.)
Third was a woman whose house was under construction who broke one ankle and sprained the other while running out to give candy to local kids. It was good to deal with a patient not handcuffed to something, but the downside was that her house was like an obstacle course. we had to traverse around a hanging wire, through a muddy dirt front yard, over a very steep makeshift step and through a doorway that didn't allow the stretcher to turn through without lifting it a couple feet over the stairway. Generally, having a hydraulic stretcher (the Power Pro on this list) is a huge advantage, but when you have to carry the whole thing, patient included, the extra weight is not helpful.
Long story short? Halloween is one of my favorite holidays. It's an incredible cultural event, and it was interesting to see it from this perspective. However, there's no question that any emergency department is going to be spread thin with unfortunate incidents when there's a combination of children in the streets and drinking, all while the spirits are free for the evening to walk the earth.
The first and most notable incident was well in progress when my shift started. An assault took place at the local convenience store, and the guy proceeded to run off into the woods, where he "tripped on some bittersweet vines and twisted his knees and ankles." He then proceeded to climb onto the roof of the bowling alley, which is perhaps the most exposed yet least escapable location I can think of in town. Following a brief scuffle with officers (which I believe caused the laceration to his forehead) he was arrested. He seemed to be much calmer when we took him to the hospital later, and this leads me to wonder what he may have been thinking (or on) when he committed the crime. Witnesses say he "threw the clerk five feet through the air," but that scarcely seems possible from looking at him.
The second incident was a simple fight victim found in a parking lot. 19, a shiner, and drunk enough to write his date of birth on the "today's date" line beside the signature on his refusal form (the form that says we think you should go to the hospital but you don't want to and it's your choice.)
Third was a woman whose house was under construction who broke one ankle and sprained the other while running out to give candy to local kids. It was good to deal with a patient not handcuffed to something, but the downside was that her house was like an obstacle course. we had to traverse around a hanging wire, through a muddy dirt front yard, over a very steep makeshift step and through a doorway that didn't allow the stretcher to turn through without lifting it a couple feet over the stairway. Generally, having a hydraulic stretcher (the Power Pro on this list) is a huge advantage, but when you have to carry the whole thing, patient included, the extra weight is not helpful.
Long story short? Halloween is one of my favorite holidays. It's an incredible cultural event, and it was interesting to see it from this perspective. However, there's no question that any emergency department is going to be spread thin with unfortunate incidents when there's a combination of children in the streets and drinking, all while the spirits are free for the evening to walk the earth.
Sunday, October 28, 2007
A Sense of Urgency
It's been a relatively quiet night. My usual partner has switched off, dinner is long past, and all that remains is to read a bit and try to fall asleep, always a difficult task while on call. However, it's a nice, cool night, and I'm tired, so I manage it relatively quickly tonight.
At exactly 0300, I'm awoken by the familiar sound of the pager buzzing angrily on the desk beside my head. The dispatcher chimes in with a common, and uniformly unhelpful, "please respond to [one of the local nursing facilities], 66 year old male patient." No further information. This is a relatively common call, and with the usual lethargy I haul myself out of bed and into my boots. My partner for the night similarly takes his time; we know that at the nursing home, nurses are on hand, and conditions are generally good. We weren't given a code 1 or other information that would lead us to hurry.
However, upon arrival we find nurses that look unusually concerned. Our patient, an elderly man, was breathing at an unbelievable 60-80 times per minute, and was shockingly unresponsive. I had taken this man back to this facility the week before, and found him to be a good patient. Now, he was breathing fast, loud, and with a rough noise that made me think of the training I've recieved concerning agonal respirations , which of course these were not. Our sense of urgency increased. A weak, thready pulse, low blood oxygen saturation , and a complete inability to control his muscles in any way didn't make me feel any better. We got him started on Oxygen, and started driving.
Things went uphill from there - his breathing normalized a bit, his sweating relaxed, and while he didn't regain what I'd exactly call consciousness his vitals approached normal again. How he fared in the long term I don't know, but from the episode I've certainly come to know that a call to the nursing home can be as much of an emergency as a call anywhere else, no matter how little the dispatcher tells you.
At exactly 0300, I'm awoken by the familiar sound of the pager buzzing angrily on the desk beside my head. The dispatcher chimes in with a common, and uniformly unhelpful, "please respond to [one of the local nursing facilities], 66 year old male patient." No further information. This is a relatively common call, and with the usual lethargy I haul myself out of bed and into my boots. My partner for the night similarly takes his time; we know that at the nursing home, nurses are on hand, and conditions are generally good. We weren't given a code 1 or other information that would lead us to hurry.
However, upon arrival we find nurses that look unusually concerned. Our patient, an elderly man, was breathing at an unbelievable 60-80 times per minute, and was shockingly unresponsive. I had taken this man back to this facility the week before, and found him to be a good patient. Now, he was breathing fast, loud, and with a rough noise that made me think of the training I've recieved concerning agonal respirations , which of course these were not. Our sense of urgency increased. A weak, thready pulse, low blood oxygen saturation , and a complete inability to control his muscles in any way didn't make me feel any better. We got him started on Oxygen, and started driving.
Things went uphill from there - his breathing normalized a bit, his sweating relaxed, and while he didn't regain what I'd exactly call consciousness his vitals approached normal again. How he fared in the long term I don't know, but from the episode I've certainly come to know that a call to the nursing home can be as much of an emergency as a call anywhere else, no matter how little the dispatcher tells you.
Wednesday, July 25, 2007
I'll only be looking 40% of the time
I've just finished a job application for a private Ambulance service.
The job description itemized by use of my senses by percentage of time worked.
I will be using my sense of touch 15% of the time.
My Touch ability must be "high."
I do not believe I will pursue this particular position much further.
The job description itemized by use of my senses by percentage of time worked.
I will be using my sense of touch 15% of the time.
My Touch ability must be "high."
I do not believe I will pursue this particular position much further.
Monday, July 23, 2007
Busy Night
I apologize for a long lack of posts, but to put it simply, nothing much has happened that I would consider blogworthy. This changed last Wednesday, however.
I arrived at the garage about an hour early for my shift in order to do some work on the company's website. However, right after I settled in and got my uniform out of the car, the on-call team's pagers went off for a car accident with four passengers involved. I immediately went ahead and put on my uniform as well, since it was probable that a backup team would be called. It was called a moment later, and by luck my team Capitan that night (who is a Paramedic, another good thing) walked in, and I told her that we may as well head straight over to a rig.
The ride over was fast, and I barely had time to lace up my boots and gather equipment before we got on-scene. The scene was well organized, and maneuvering the ambulance in didn't prove difficult. The cars were badly damaged - it had been a head-on collision at about forty miles an hour - and at least one of the passengers was badly enough injured to require a fast ride to a better trauma center than we have locally.
My own involvement was very specific. Passengers had been triaged and tended to when I arrived, and I simply helped to apply straps to a patient on a backboard and get her into our ambulance. We then staged for a moment in order to get vital signs and prepare for the trip, and headed off for the ER.
This was perhaps the most intense part of the experience for me. It was my first time driving an ambulance with a trauma patient in it with all the lights on. It's a little surreal - you can never be sure what other drivers are going to do - but I quickly became comfortable with maneuvering traffic and was incredibly focused throughout the experience. I also remembered to communicate with my partner, and slowed down through turns and helped to make sure the ride was smooth while she attempted to start IV's on the patient.
This case was a remarkable demonstration for me in vehicle safety features. Three patients wearing seatbelts in a minivan suffered little worse than bruising, while one patient, unrestrained, driving a Jeep suffered life-threatening head injuries from the same incident. The rest of the night proved trying - we had calls almost back-to-back until three A.M., and I had to drive to Pittsfield (about 45 minutes each way) twice, in heavy rain and thick fog.
On the other hand, I'm getting to know my squad better and increasingly feel competent in the day-to-day running of an Ambulance. This is what I'm here for, isn't it?
I arrived at the garage about an hour early for my shift in order to do some work on the company's website. However, right after I settled in and got my uniform out of the car, the on-call team's pagers went off for a car accident with four passengers involved. I immediately went ahead and put on my uniform as well, since it was probable that a backup team would be called. It was called a moment later, and by luck my team Capitan that night (who is a Paramedic, another good thing) walked in, and I told her that we may as well head straight over to a rig.
The ride over was fast, and I barely had time to lace up my boots and gather equipment before we got on-scene. The scene was well organized, and maneuvering the ambulance in didn't prove difficult. The cars were badly damaged - it had been a head-on collision at about forty miles an hour - and at least one of the passengers was badly enough injured to require a fast ride to a better trauma center than we have locally.
My own involvement was very specific. Passengers had been triaged and tended to when I arrived, and I simply helped to apply straps to a patient on a backboard and get her into our ambulance. We then staged for a moment in order to get vital signs and prepare for the trip, and headed off for the ER.
This was perhaps the most intense part of the experience for me. It was my first time driving an ambulance with a trauma patient in it with all the lights on. It's a little surreal - you can never be sure what other drivers are going to do - but I quickly became comfortable with maneuvering traffic and was incredibly focused throughout the experience. I also remembered to communicate with my partner, and slowed down through turns and helped to make sure the ride was smooth while she attempted to start IV's on the patient.
This case was a remarkable demonstration for me in vehicle safety features. Three patients wearing seatbelts in a minivan suffered little worse than bruising, while one patient, unrestrained, driving a Jeep suffered life-threatening head injuries from the same incident. The rest of the night proved trying - we had calls almost back-to-back until three A.M., and I had to drive to Pittsfield (about 45 minutes each way) twice, in heavy rain and thick fog.
On the other hand, I'm getting to know my squad better and increasingly feel competent in the day-to-day running of an Ambulance. This is what I'm here for, isn't it?
Friday, May 4, 2007
Recognition
When I started this blog, it was with the intent of letting others in on the absolutely surreal quality that my first foray into Emergency Medicine had been taking on. Lately, as I've been working nights that have taken on a more familiar quality, this has been perhaps subsiding a bit, but yesterday the feeling came back in full force.
I was out at dinner and saw someone on the street. I did a double take, as they looked very familiar, and after a minute it dawned on me that it was a patient that I had transported, and that was where I had seen them. It completely knocked me off my feet for a few minutes, as this was the first time it had happened. I don't know if they saw or recognized me, and I wouldn't have been able to communicate at the time if they had - it was too odd seeing them in such a wildly different context.
I'd better get used to it.
I was out at dinner and saw someone on the street. I did a double take, as they looked very familiar, and after a minute it dawned on me that it was a patient that I had transported, and that was where I had seen them. It completely knocked me off my feet for a few minutes, as this was the first time it had happened. I don't know if they saw or recognized me, and I wouldn't have been able to communicate at the time if they had - it was too odd seeing them in such a wildly different context.
I'd better get used to it.
Saturday, April 28, 2007
Contact - Part 2
While we're in the process of returning the 96-year-old female from the previous post to her home, we receive a call for a "possible section 12." (Possible psychiatric emergency.) We call other services, but none are available to assist, and we've got the only ambulance, as the other is out of service for the night. It's just us. We finish the call we're on, and move to the next.
As we approach the scene, it becomes clear that no one on this call is particularly well-informed. We find police waiting at the front of the road in question - protocol for a section 12 - and after a brief conversation we move to the house.
At this point, there are three state police cars present, including a higher-up. Always a good sign.
They go to the house, which is obscured by a curving drive and woods. Lights turn on and off, and my partner remarks, "No gunfire. That's a good sign."
We wait around 20 minutes, at which point we see a female, appears to be in her 20s, walk towards the ambulance, flanked - but not restrained by - the officers. She hops into the back of the ambulance where I am with some paperwork and sits on the bench.
Silence.
I don't see anything major wrong with her. A cut hand, which doesn't seem to be bleeding much, but she has an airway, is breathing, and her skin looks normal. She's very stressed out, though, that much is clear - she looks around the ambulance with eyes that definitely reveal some sort of problem. She's looking for a way out, sizing up the space. I glance to the back doors, wondering if I should lock them. But, mostly, I sit there, hand on a clipboard, not knowing precisely how to handle the situation.
Abruptly, she yells at me in an accusing, angry voice, "Don't you have questions to ask me?"
"Errm... not just yet, ma'am."
A few more minutes of silence.
"Are we going to *freaking go already? I don't want to be here all night."
"We're going as soon as we can."
"Can I smoke a cigarette?"
"Not in here, there's oxygen."
We start to move, a development I'm very happy with. My partner hops in the back with me, and it becomes apparent quickly that small talk will not be possible. The patient won't let us near her to treat her hand or take vitals. We observe her, move to the hospital, and wonder why we were called in the first place - the information we got on this call was sparse.
In the previous post I mentioned how odd the inside of an ambulance can look, at for this patient, that was apparent. Not in her proper frame of mind, stressed out from the police pulling her from her home, and angry, she looked around the ambulance like it was an alien laboratory, for lack of a better image. The radio was making a variety of sounds, from static to bits of voices, and we were sitting in profound silence. To her, this wasn't a caring space where humans help other humans through their worst moments. This was an extension of the state, the state that was currently depriving her of her freedom to be left alone, for better or for worse.
We were all glad (except her, I think) to arrive at the hospital. We waited for a police officer, and walked her inside. My heart rate dropped from hummingbird to approximately human, and my partner did the hospital hand-off and dispatched me to go collect our cold, neglected dinner.
I couldn't help feeling like I should have done more to diffuse the tension. As a person about her age, I should have empathized with her more - I know how people of my generation perceive police officers, and it may have helped her to know that despite my uniform I was not a police officer, I was here to be an advocate for her rights and her well-being. As it happened, though, I just sat, silent, nervous, and looking at my first psychiatric call.
It's going to be a long time until I'm good at this.
As we approach the scene, it becomes clear that no one on this call is particularly well-informed. We find police waiting at the front of the road in question - protocol for a section 12 - and after a brief conversation we move to the house.
At this point, there are three state police cars present, including a higher-up. Always a good sign.
They go to the house, which is obscured by a curving drive and woods. Lights turn on and off, and my partner remarks, "No gunfire. That's a good sign."
We wait around 20 minutes, at which point we see a female, appears to be in her 20s, walk towards the ambulance, flanked - but not restrained by - the officers. She hops into the back of the ambulance where I am with some paperwork and sits on the bench.
Silence.
I don't see anything major wrong with her. A cut hand, which doesn't seem to be bleeding much, but she has an airway, is breathing, and her skin looks normal. She's very stressed out, though, that much is clear - she looks around the ambulance with eyes that definitely reveal some sort of problem. She's looking for a way out, sizing up the space. I glance to the back doors, wondering if I should lock them. But, mostly, I sit there, hand on a clipboard, not knowing precisely how to handle the situation.
Abruptly, she yells at me in an accusing, angry voice, "Don't you have questions to ask me?"
"Errm... not just yet, ma'am."
A few more minutes of silence.
"Are we going to *freaking go already? I don't want to be here all night."
"We're going as soon as we can."
"Can I smoke a cigarette?"
"Not in here, there's oxygen."
We start to move, a development I'm very happy with. My partner hops in the back with me, and it becomes apparent quickly that small talk will not be possible. The patient won't let us near her to treat her hand or take vitals. We observe her, move to the hospital, and wonder why we were called in the first place - the information we got on this call was sparse.
In the previous post I mentioned how odd the inside of an ambulance can look, at for this patient, that was apparent. Not in her proper frame of mind, stressed out from the police pulling her from her home, and angry, she looked around the ambulance like it was an alien laboratory, for lack of a better image. The radio was making a variety of sounds, from static to bits of voices, and we were sitting in profound silence. To her, this wasn't a caring space where humans help other humans through their worst moments. This was an extension of the state, the state that was currently depriving her of her freedom to be left alone, for better or for worse.
We were all glad (except her, I think) to arrive at the hospital. We waited for a police officer, and walked her inside. My heart rate dropped from hummingbird to approximately human, and my partner did the hospital hand-off and dispatched me to go collect our cold, neglected dinner.
I couldn't help feeling like I should have done more to diffuse the tension. As a person about her age, I should have empathized with her more - I know how people of my generation perceive police officers, and it may have helped her to know that despite my uniform I was not a police officer, I was here to be an advocate for her rights and her well-being. As it happened, though, I just sat, silent, nervous, and looking at my first psychiatric call.
It's going to be a long time until I'm good at this.
Contact
The night began about as oddly as any I've had yet. I show up with my overnight gear at 6 p.m. to be greeted by two of the EMTs who were outside the garage, smoking a cigarette.
"If the last two hours are any indication, you're in for a fun night."
"Well, I'm just glad they all got it out of their system early tonight."
Grins all around, and I walk inside to find my team for the night has all traded off, and I'm with two experienced EMTs I haven't worked with before. We order chinese, and before it's ready, the phone rings. Transfer from the Hospital to a patient's home - not something we do often, but should be pretty simple. After one false start - the patient wasn't quite ready yet - we're ready to move her.
It's a 96-year-old woman. We approach her in her hospital bed, and as is fairly common, she's distressed at first, and understandably so. Three uniformed men are here to take her away; but she's happy to hear that she's going home, and once we let her know what's going on, she's not worried. She does, however, look at me, and say, "He's too small for me!" causing laughs all around. As we move her, though, a pained, terrified look comes over her face; it wasn't a very clean move. Her legs are clearly in pain, and we do everything we can to make her comfortable.
We move her out to the ambulance, and I turn on the lights and get the heat on. The first major mistake I made, that I only realized too late, was that we loaded this poor woman into the back of the ambulance without turning the lights on inside first, which I imagine must have distressed her. I'll touch again on this in my next post, where it comes up, but the inside of the Ambulance - which I find very comforting, because it's clean, orderly, and full of options for interventions that feel very empowering to me - can be very unsettling to someone who isn't used to it.
"Where are you taking me?"
"We're taking you home, ma'am." A smile. She's alert and understands what we say to her, but she asks the same question over and over again, which is very convenient - I like to be able to make someone happy with the same answer six times in a row.
I take vitals. Her arms are completely devoid of muscle - they're completely soft. I worry that the BP cuff will squeeze too hard, and she says it's cold, so I move her sleeve down and put the cuff over it. Her vitals are textbook perfect - 120/80 BP, pulse very strong (a little irregular), and good skin condition. I place my stethoscope on her chest to take breath sounds, and notice that they're strong, but very shallow.
Try an experiment to get an idea of what this is like. Spend a couple minutes taking breaths that only last at most half a second in, and see how little you can do breathing like that.
I pull my scope out of my ears, and I move to withdraw my hand from under her blankets, but I stop. A few moments pass, and my partner looks over. He sees I'm not listening, but my hand is still near the patient. "What're you doing?" He asks, bemused.
I don't know whether it was for warmth, comfort, or just human contact, but I replied, "She's holding my hand."
"If the last two hours are any indication, you're in for a fun night."
"Well, I'm just glad they all got it out of their system early tonight."
Grins all around, and I walk inside to find my team for the night has all traded off, and I'm with two experienced EMTs I haven't worked with before. We order chinese, and before it's ready, the phone rings. Transfer from the Hospital to a patient's home - not something we do often, but should be pretty simple. After one false start - the patient wasn't quite ready yet - we're ready to move her.
It's a 96-year-old woman. We approach her in her hospital bed, and as is fairly common, she's distressed at first, and understandably so. Three uniformed men are here to take her away; but she's happy to hear that she's going home, and once we let her know what's going on, she's not worried. She does, however, look at me, and say, "He's too small for me!" causing laughs all around. As we move her, though, a pained, terrified look comes over her face; it wasn't a very clean move. Her legs are clearly in pain, and we do everything we can to make her comfortable.
We move her out to the ambulance, and I turn on the lights and get the heat on. The first major mistake I made, that I only realized too late, was that we loaded this poor woman into the back of the ambulance without turning the lights on inside first, which I imagine must have distressed her. I'll touch again on this in my next post, where it comes up, but the inside of the Ambulance - which I find very comforting, because it's clean, orderly, and full of options for interventions that feel very empowering to me - can be very unsettling to someone who isn't used to it.
"Where are you taking me?"
"We're taking you home, ma'am." A smile. She's alert and understands what we say to her, but she asks the same question over and over again, which is very convenient - I like to be able to make someone happy with the same answer six times in a row.
I take vitals. Her arms are completely devoid of muscle - they're completely soft. I worry that the BP cuff will squeeze too hard, and she says it's cold, so I move her sleeve down and put the cuff over it. Her vitals are textbook perfect - 120/80 BP, pulse very strong (a little irregular), and good skin condition. I place my stethoscope on her chest to take breath sounds, and notice that they're strong, but very shallow.
Try an experiment to get an idea of what this is like. Spend a couple minutes taking breaths that only last at most half a second in, and see how little you can do breathing like that.
I pull my scope out of my ears, and I move to withdraw my hand from under her blankets, but I stop. A few moments pass, and my partner looks over. He sees I'm not listening, but my hand is still near the patient. "What're you doing?" He asks, bemused.
I don't know whether it was for warmth, comfort, or just human contact, but I replied, "She's holding my hand."
Tuesday, April 17, 2007
Definition
Embarrassing:
Walking into a patient's home with everything you need to solve a diabetic crisis only to find you haven't brought a band-aid for his finger.
Unprepared:
Being asked to take a pulse only to answer your captain with "Errm... might I use your watch?"
Learning:
Two mistakes I won't make again, at least.
Walking into a patient's home with everything you need to solve a diabetic crisis only to find you haven't brought a band-aid for his finger.
Unprepared:
Being asked to take a pulse only to answer your captain with "Errm... might I use your watch?"
Learning:
Two mistakes I won't make again, at least.
Wednesday, March 21, 2007
The Long Haul
Tonight was my first long-distance transport; a patient with cardiac instability headed out to Albany. It was a fairly complex call; two nurses were escorting, which took the pressure of medical care off of us, but there was more paperwork than normal and it was my first experience with how tangled the ambulance can become when you have an IV setup and an ECG going at the same time.
Time begins to do funny things when you're on a call. At the beginning, it seemed to drag on forever - casually documenting while working through the logistics of the ride. We got underway, and things seemed simple enough - the nurses would take vitals, and I would write them down. About forty minutes in, however, the patient began complaining of left arm pain - a possible sign of cardiac trouble - and the patient began to become paler and diaphoretic. At the same time, our directions to the hospital, with which we were unfamiliar, began to fail us. At this point, ambulance time sped up considerably, and I was stuck in the middle trying to help out the driver while keeping an eye on what was going on in back.
At the end of it all, we came into the hospital lights and sirens ablaze, a firefighter ahead of us to show us the way. Ambulance time had worked out in our favor - the patient wasn't as good as when he left, but stable - and we were able to find our way through the busy city hospital.
Total time? About 3 hours, all of which passed in a moment.
Time begins to do funny things when you're on a call. At the beginning, it seemed to drag on forever - casually documenting while working through the logistics of the ride. We got underway, and things seemed simple enough - the nurses would take vitals, and I would write them down. About forty minutes in, however, the patient began complaining of left arm pain - a possible sign of cardiac trouble - and the patient began to become paler and diaphoretic. At the same time, our directions to the hospital, with which we were unfamiliar, began to fail us. At this point, ambulance time sped up considerably, and I was stuck in the middle trying to help out the driver while keeping an eye on what was going on in back.
At the end of it all, we came into the hospital lights and sirens ablaze, a firefighter ahead of us to show us the way. Ambulance time had worked out in our favor - the patient wasn't as good as when he left, but stable - and we were able to find our way through the busy city hospital.
Total time? About 3 hours, all of which passed in a moment.
Saturday, March 17, 2007
Too Legit to Quit
As of today, the testing process is finally over and I'm a fully certified MA EMT-Basic!
Now, the fun really begins...
Now, the fun really begins...
Wednesday, March 14, 2007
Perfect Timing
Tonight held an event familiar to anyone who wears a pager: we drove to a restaurant, ordered, and the moment the food came, the pager goes off: a nursing home transfer. We get up, ask the wait staff to hold our food, and head over.
The call was fairly routine - from the nursing home to the hospital. Had a little trouble with the blood pressure, but worked it out. The patient was visibly frightened - I always feel bad for folks that feel lost and insecure about the three of us coming in to take them off to the hospital, but we're as gentle as possible and the nursing staff was very good in this case.
The only catch came at the end, when my partner comes up to me and says, "Wash your hands extra well. The patient had MRSA."
Just what I've always wanted.
The call was fairly routine - from the nursing home to the hospital. Had a little trouble with the blood pressure, but worked it out. The patient was visibly frightened - I always feel bad for folks that feel lost and insecure about the three of us coming in to take them off to the hospital, but we're as gentle as possible and the nursing staff was very good in this case.
The only catch came at the end, when my partner comes up to me and says, "Wash your hands extra well. The patient had MRSA."
Just what I've always wanted.
Friday, March 9, 2007
The best part of waking up
Sorry for weeks without posting. That's what happens when you work Wednesday nights in a small town - two weeks, literally no calls.
This Wednesday was similarly uneventful up until 5 a.m. when I awoke to the pager out of an otherwise good night's sleep. It was a nursing home call; possible fractured hip. Jumped out of bed, hopped in the Ambulance, and off we went.
One of my favorite part of calls when I'm not the driver is the pre-scene prep work: holding on to the handles on the roof of the ambulance with one hand while it bounces over the rough back roads and shuffling through compartments and cabinets with the other, looking for all the things that might come in handy on the call. I used to feel a little seasick when this happened first thing in the morning, but this particular day I was feeling very awake.
We arrived on scene to find an elderly person on the floor of the nursing home, clearly uncomfortable. After a brief on-scene assessment, we moved him up onto a backboard and from there to the stretcher. I love (some) nursing home calls since very often the patients there, even when they're quite ill, will have the best sense of humor about everything. This was one of those times: as I put the shoulder straps of the stretcher over the patient, he makes a rasping, choking noise. I look over at him like a deer in the headlights, worried that I had done something boneheaded, like tighten one over his neck, only to find him grinning at me mischievously. I smile, and we finish getting him up, covered thoroughly as it was about -2 out, and into the hallway. I'm maneuvering the stretcher and listening to the medical history given by the nurses, and in a minute we're out the door.
In the ambulance, heat is up, patient is shivering. Start oxygen, this helps, warms up, time for vitals. I take out my stethoscope - I use my own for the first time, knowing how poorly I can hear on the rig scopes, especially on older folks - and am surprised that the pulse is loud and clear the moment I touch the scope to the arm. Usually, even on a young, healthy person, I find I can't hear the pulse very well until the cuff is slightly inflated. I take the BP, don't believe the results, take it again, turn to my partner, and ask if he has high blood pressure or if the sweater is interfering. I was right, though; it's up around 175, whereas you and I are probably near 12o.
On the short ride to the hospital, you'd be amazed at how quickly you come to like or dislike a patient. Unless they're totally silent, they're usually very endearing or very troublesome, and this one was one of the best I'd seen. He asked my partner if she was a Signora or a Signorina,
and we all had a laugh. He then turned up and said, "If you can't have fun at this job..." and drew his fingers across his throat, making that same rasping sound as before.
That ride was excellent - I got to radio in to the hospital patient information for the first time, fill out a complete run report, and, best of all, actually feel like I helped someone. There's no better way to wake up than to jump out of bed without laying around procrastinating, get your things together, and go do something exciting right away. Now if only I could feel that way about my day job...
This Wednesday was similarly uneventful up until 5 a.m. when I awoke to the pager out of an otherwise good night's sleep. It was a nursing home call; possible fractured hip. Jumped out of bed, hopped in the Ambulance, and off we went.
One of my favorite part of calls when I'm not the driver is the pre-scene prep work: holding on to the handles on the roof of the ambulance with one hand while it bounces over the rough back roads and shuffling through compartments and cabinets with the other, looking for all the things that might come in handy on the call. I used to feel a little seasick when this happened first thing in the morning, but this particular day I was feeling very awake.
We arrived on scene to find an elderly person on the floor of the nursing home, clearly uncomfortable. After a brief on-scene assessment, we moved him up onto a backboard and from there to the stretcher. I love (some) nursing home calls since very often the patients there, even when they're quite ill, will have the best sense of humor about everything. This was one of those times: as I put the shoulder straps of the stretcher over the patient, he makes a rasping, choking noise. I look over at him like a deer in the headlights, worried that I had done something boneheaded, like tighten one over his neck, only to find him grinning at me mischievously. I smile, and we finish getting him up, covered thoroughly as it was about -2 out, and into the hallway. I'm maneuvering the stretcher and listening to the medical history given by the nurses, and in a minute we're out the door.
In the ambulance, heat is up, patient is shivering. Start oxygen, this helps, warms up, time for vitals. I take out my stethoscope - I use my own for the first time, knowing how poorly I can hear on the rig scopes, especially on older folks - and am surprised that the pulse is loud and clear the moment I touch the scope to the arm. Usually, even on a young, healthy person, I find I can't hear the pulse very well until the cuff is slightly inflated. I take the BP, don't believe the results, take it again, turn to my partner, and ask if he has high blood pressure or if the sweater is interfering. I was right, though; it's up around 175, whereas you and I are probably near 12o.
On the short ride to the hospital, you'd be amazed at how quickly you come to like or dislike a patient. Unless they're totally silent, they're usually very endearing or very troublesome, and this one was one of the best I'd seen. He asked my partner if she was a Signora or a Signorina,
and we all had a laugh. He then turned up and said, "If you can't have fun at this job..." and drew his fingers across his throat, making that same rasping sound as before.
That ride was excellent - I got to radio in to the hospital patient information for the first time, fill out a complete run report, and, best of all, actually feel like I helped someone. There's no better way to wake up than to jump out of bed without laying around procrastinating, get your things together, and go do something exciting right away. Now if only I could feel that way about my day job...
Saturday, February 24, 2007
Testing purposes only
Today was the state practical exam for EMT-B, which means I'm up at 4:00 a.m. and on the road. The test went well; it was a lot less intimidating to do than it was to think about. The way the test works is fairly straightforward; you have four stations, each with one or two sections. If you fail more than two stations or pass all stations, you are sent home without word; if you fail only one, they keep you and have you re-take that station. I was sent home directly, which means I either failed miserably or passed, and since I don't believe I screwed anything up in a major way, I'm guardedly optimistic. I won't know for sure for a few weeks, at which point I'll either be able to re-test or schedule my written exam.
My shift last week was uneventful - no calls. Just a test prep session. I did manage, however, to completely destroy my transmission first thing in the morning to the point where I have to find a new car.
Sorry for a pretty weak post, but I've been up for 12 intense hours. You'd think I'd be used to that kind of thing by now.
My shift last week was uneventful - no calls. Just a test prep session. I did manage, however, to completely destroy my transmission first thing in the morning to the point where I have to find a new car.
Sorry for a pretty weak post, but I've been up for 12 intense hours. You'd think I'd be used to that kind of thing by now.
Sunday, February 18, 2007
White knuckle excitement
For the people who have known me longest, the statement "Oh, I drive an ambulance now" never fails to elicit a laugh. This isn't because anyone thinks I'd be bad at it per se, but because those who know me know that, generally speaking, driving is my least favorite part of modern life by far. When I do drive somewhere, I sit with my seat all the way up, tense on the wheel, and I tend to drive slow enough to guarantee someone will always be tailgating.
While this has kept my record clean as a whistle thus far, these are generally not traits associated with ambulance driving, although we are encouraged not to speed, even with the lights on. It doesn't pay for itself; you'll get there a minute or two faster at best and at worst you flip a top-heavy, incredibly expensive ambulance.
I got my first taste of driving a couple weeks ago. I would liken it to driving a u-Haul full of your stuff. It's incredibly heavy, slow around turns, and very wide. Backing up is an exercise in prayer, since you can't see behind it at all without someone spotting you.
And what's the first call I drive to? The ski resort parking lot on a very, very busy day. There are kids running in all directions, the lot is pure ice, and of course no one is getting out of my way. To top it off, I have to back into a space that is approximately exactly the size of the ambulance and has a wooden fence on either side. I manage to do it with the help of a spotter, knuckles white and nerves shot. I'm glad I'm not this nervous around patients.
It's an odd feeling, sitting behind the wheel of an ambulance. Think of how you feel when you see a set of flashing lights behind you; there's a moment of shock and panic, no matter how calmly you deal with it afterwards. The way in which drivers react can be erratic, and that, coupled with a truck you can't see behind, comes with giant blind spots, and costs about $100,000 without the equipment in it is why I don't think I can pull this job off in a major city.
Thursday, February 15, 2007
12:01 a.m. - Finish setting up blog. Turn on radio, go to bed.
4:00 a.m. - I wake up to radio noises. Put on clothing as fast as possible, but not fast enough - I see the ambulance pulling out of the garage as I run in. It was a simple run to the nursing home, and the others were considerate and let me rest. I usually use a pager at night, which makes a loud beeping sound before switching to radio, but they're out of comission, so I used a radio, which apparently doesn't wake me up fast enough. They were called back by dispatch before they even got on scene, though, so I missed absolutely nothing except a coffee run.
6:00 a.m. - Come home and everything's snowed in. Shovel for a couple hours.
Coffee. Tired. 8:00 a.m.
4:00 a.m. - I wake up to radio noises. Put on clothing as fast as possible, but not fast enough - I see the ambulance pulling out of the garage as I run in. It was a simple run to the nursing home, and the others were considerate and let me rest. I usually use a pager at night, which makes a loud beeping sound before switching to radio, but they're out of comission, so I used a radio, which apparently doesn't wake me up fast enough. They were called back by dispatch before they even got on scene, though, so I missed absolutely nothing except a coffee run.
6:00 a.m. - Come home and everything's snowed in. Shovel for a couple hours.
Coffee. Tired. 8:00 a.m.
Wednesday, February 14, 2007
Man in uniform
After a snowstorm, it's always likely that we'll get an increased number of calls for motor vehicle accidents, which is actually a call that so far I haven't seen. However (knock on wood) that hasn't happened yet tonight, even though we've just experienced the worst snow of the season and getting here at all tonight was pretty rough. So far, I've made myself a cup of sleepy time tea and ate a number of delicious cupcakes that our squad president baked.
But as I'm sitting here listening to radio chatter and playing with my penlight, I'm reminded of the times lately that one of the most fundamental things associated with medics - the uniform - has come up. I definitely didn't realize exactly what it meant until I was in one, but uniforms are tricky things. For example, everyone in the squad knows exactly what each patch means and how to tell something like an EMT's level of training with a glance. However, that's not general knowledge among the people who call us, or even necessarily among other members of emergency services. When people see a uniform, they immediately and understandably associate it with all of their concepts of the skills and secret knowledge members of that profession are supposed to have. In our case, that means that by glancing at us, someone will probably assume that we all can do CPR well, shock a person out of cardiac arrest, put in a breathing tube, and perform other procedures. While this may or may not be true in a lot of cases, the important thing is that people don't look at me in the field and see someone who may never have dealt with a broken leg before; they see a trained professional who is there to make everything better, and when you're faced with that, it's a staggering feeling.
For example, I responded to a call for a possible concussion at a sporting event a couple weeks back that, when we arrived on scene, was clearly a minor injury but still definitely worth a trip to the hospital, to be on the safe side. However, the coach wanted us to bring the patient to a hospital much closer to the patient's home, which would have put us out of service for at least an extra hour, as this hospital was much further away from our garage. The coach approached me about this and started asking questions, and I froze up - I didn't know protocols concerning where to bring patients and couldn't answer even a simple question like "what are her options on where to go for treatment?" Luckily, a more experienced EMT with me quickly fielded this, and she ended up going to the hospital closest to us.
Another time, more recently, I was asked by a very worried mother if she could ride with her daughter to the hospital. I managed to think through that one, and immediately answered yes, since I knew this was something we did allow. That was an occasion where the entire family was around one downed member, and they would have all liked to crowd into the back with us. These are the situations where no amount of technical knowledge will answer for even a little bit of experience.
People drowning will latch on to anything they can to pull themselves out - even friends who try to help them. People in emergency situations probably feel and act in much the same way, and they look to a uniform as something they can hold on to for security. Being placed in that role and being able to act responsibly, which means being honest and not just saying that everything is going to be fine, is going to take a while to get used to.
First things first
This blog is about my recent love affair with Emergency Medical Services, or EMS. It's written from the perspective of a student fresh out of an EMT - Basic course hitting the real world for the first time. To give you a further idea of my own perspective, I've just finished school at a tiny liberal arts college, and half of the challenge so far is moving from the well-known comfort of academia, where ideas and actions can be toyed with indefinitely without consequence, to the back of an ambulance, where ideas only matter if they lead to direct, real action, which is anything but inconsequential.
I'm not writing this with the intent of staying anonymous, since I realize how pointless that would be in the modern day. I am, however, compelled to point out that all of the viewpoints expressed here are my own and reflect in no way the views of the EMS profession or my ambulance company. Patient confidentiality is also very important to me, so I will make it a point not to release details that I believe will allow someone to be identified. If you read a post and find something that you think violates this confidentiality, please let me know and I'll immediately remove it.
Finally, I'll try to keep things as understandable as possible for the lay-reader, but a knowledge of the basics of the EMS system is probably necessary to figure out what I'm talking about half the time. For the basics, check out these articles on Wikipedia: EMS, for an overview of the system as a whole, and EMT for a description of EMTs themselves.
I'm not writing this with the intent of staying anonymous, since I realize how pointless that would be in the modern day. I am, however, compelled to point out that all of the viewpoints expressed here are my own and reflect in no way the views of the EMS profession or my ambulance company. Patient confidentiality is also very important to me, so I will make it a point not to release details that I believe will allow someone to be identified. If you read a post and find something that you think violates this confidentiality, please let me know and I'll immediately remove it.
Finally, I'll try to keep things as understandable as possible for the lay-reader, but a knowledge of the basics of the EMS system is probably necessary to figure out what I'm talking about half the time. For the basics, check out these articles on Wikipedia: EMS, for an overview of the system as a whole, and EMT for a description of EMTs themselves.
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