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.
Sunday, October 28, 2007
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.
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