What Would I teach Lizzie?

-The Handover-EMS Blog Carnival Aug. Submission-

So your proficient in your skills, able to back board with the best of them. Fully capable of putting on a traction splint, vacuum splint and can sling and swath a shoulder. You've studied all the acronyms needed, DCAP-BTLS, PERRL, SAMPLE, and have a solid understanding of their use as it pertains to the patient.

You have a sound understanding that majority of calls will fall in the "grey realm". You'll have some black & white calls laid before you, but over all you'll have an unproportional amount of grey calls. Understanding that once on the streets the clinical decision making is in your hands. You do not solely rely on your initial education, rather the trends in EMS you have been continually researching and the Con Ed classes participated in.

When all else fails Lizzie, you know when to call for help. People become afraid to show weakness in this line of work, but don't be. The simple fact is the nature of the beast that is medicine is ever changing and progressing. It is impossible to be on the cutting edge of every single change in EMS, but hopefully some one else may have the knowledge where you haven't gotten to yet. We must never forget that we are serving for one single reason, and that is to do whats best by the patient. Sometimes that means to ask for help, but you know that already.

Solid fundamentals, capable clinical decision making skills, and the ability to admit to one's self that you need help. That pretty much covers the whole lot of attributes a newly carded EMT will need for the field, and you have them.

So what do I hope I've taught Lizzie? Keep your sense of humor girl! This Career/Stepping stone/Hobby/Calling surrounds us with people having the worst day of their life potentially. We are always in the thick of their crisis, and are the ones they have summoned to help. That is a lot of pressure on an individual, to be the sole saver of life, the Grand Puba of help. the Sultan of Assistance. In order to maintain our sanity we have to be able to keep our sense of humor. Humor is really just a matter of perspective after all. When in the appropriate times it lightens our moods and gives us that little extra to make it another call.

But I'm sure you already knew that Lizzie, you were always a great student.

Be Safe
Ambulance Junkie

The Girl

She has walked this side walk hundreds of times before, but never quite like this. She is a young girl, only six years of age, a cute girl, innocent and sweet. She walks this sidewalk gazing upon it as though she's never seen it before. She feels lost and alone as she walks this side walk she has hundreds of times before.

She walks with a small suitcase beside her then she waits to cross the street. She seems to be alone, as she carries her suit case next to her in the cross walk. She disappears from view as she passes in front of my rig. She reappears pulling her Hello Kitty luggage, she walks with her small suitcase beside her.

She's not alone, for she holds her teddy by its arm. She stops on the curb and sets her luggage down. She tucks her teddy into her arm and looks around her, unsure of what to do next. She looks infront of her but does not know where to go or who to ask. She's not alone, she has her Teddy she holds tucked in her arm.

I know she's run away from home, but I dont know her reason why. I can't sit by and wait to understand her reason. I have an obligation to help this child, even if she doesn't know she needs help. There is some one missing their child. I know she's run away from home, doesn't matter the reason why.

A wake up and a wasp

I wake up and stretch, glancing over my shoulder peering at the bed side stand looking for the clock. Rubbing my eyes I can barely believe the red numbers laid out in front of me. 16:10 I read, "Crap!" I exclaim "I got half an hour before I need to leave for work." Throwing the covers off and swinging my legs over the edge of the bed I sit up. "Hi moo moo, Hi A-bay" I rattle off to my dogs on a maddened dash to the the shower. Five minutes flat I'm out and then I get changed in my uniform. Stumbling down stairs I head for the sliding door out to the back yard still tightening my belt. I let my dogs out and off I am to preparing the pup's evening food bowls.

I then wonder what on earth I'm going to fix for dinner. Grabbing a corn muffin out of the microwave to munch on it while throwing a few south western style egg rolls in the oven and also grabbing a few cucumbers to cut up. Eureka, PB&J I determine as I'm sliding the back door open to let the pups in for grub. Glancing at the clock I realize its only 16:25.

I jet over to the radio to turn on some classic rock while I begin to unload the dishwasher, placing all the cleaned items on the counter top. Being spastic I begin to peel and cut the cucumbers and toss them in a Tupperware bowl with seasoning of salt and pepper and a tablespoon of Mayo. Closing the lid I give it a few gentle flips and place it in my lunch box. Grabbing bread and jelly from the fridge and peanut butter from the cabinet I slather together two PB&J sandwiches and put them in zip lock baggies. Back to the dishes I finish putting them away, and grab my egg rolls from the oven. Toss it all in my lunch box and throw my boots on in the living room, Time check 16:35.

Rushing back in the kitchen I wash the dishes I created and place them on the drying rack. Running up stairs I call for my boxer Gracie to go in her kennel. In she goes and I stumble back down to pick up my lunch box and grab the kitchen garbage bag to take it to the curb. Head to the front door I grab Jeep keys and pull the door shut behind me. I grab two garbage cans and take them to the curb, jump in my Jeep and off I go. Time 16:40

Right on time I think, now I can enjoy my two and a half mile ride into work. Windows down, music jamming I am physically and mentally prepared for the night ahead. Suddenly a ticklish and unexpected sensation on my arm. Startled I look over and see a Wasp has landed on my forearm braced against the passenger head rest. Shivers run down my spine and I flail my arm violently in hopes to dislodge this creature of nature.

Unaware of my surroundings I have begun drifting towards a row of parked cars. Screaming like a school girl because of the wasp I notice my course and make a quick  yet over-corrective action. Realizing the Wasp has fallen from my arm I look frantically over my body for it. Glancing back on the road I swerve correcting my course yet again. Coming to a red light I have time to gain my composure. I catch my breath and notice the Wasp fly out the window, good rid dens I think and turn my attention back to the road.

No sooner have I regained my composure do I notice a spider drop down in my field of view. "Odd, what is a spider dangling from outside my wind shield?" I mutter to my self when I realize this nasty horrific beast of a spider is actually between me and my wind shield.

Surprisingly I made it to work on time that day, though there was one less spider living in the world upon my arrival. Time check 16:46

Be Safe
Ambulance Junkie

The story of a Druggie

She enters the room seeing the site before her. The curtains pulled shut with only the slightest streak of sun light comeing through. A man lays before her in his own filth, no doubt over dosed on today's black bag special. Shes not afraid, she just goes to work. On the table bag sits emptied and the spoon covered in the residue of the druggies fix. The smoldering wick of a tea lite candle sits ideally by. She prepares the site, cleaning it in a circular motion working out from the center. She has her supplies laid out in front of her, at an easy reachable distance. She wraps the rubber tournique around the arm, ties off the tourniquet in the middle of the bicep and quickly slaps the AC vein a few times in hopes it pops up. Its tiny and tattered, but it'll have to do even though its been used several times before. She picks up her needle and syringe her partner had already prepared. Flicking the syringe to make sure the air is out, she places the setup in her teeth and caressed the vein with her index finger. She hopes that it wont roll or vanish when she sticks it, for she needs this site to be usable. Placing the needle up against the skin, she is ready for it all to come together. Steady and with slight pressure the needle advances tearing a hole in the skin, piercing through with a familiar pain. In the vein unnaturally sits a cold and lifeless piece of manufactured metal, its as though she can taste her sucess. A thumb overs the end of the syringe she begins to push slowly, forcing the fix through the body, a mental escape from the hell in which she lives. Trying to kill the pain she slips away, to a place she feels free. The drug rushes through her veins, coursing through her body leaving her numb. The needle drops to the floor, the tourniquet still attached, she feels nothing. She stumbles from the table completely strung out, she experiences the world in her to familar way. She crashes to the floor just like the one before. Her future is unknown.

Be Safe

Ambulance Junkie

The Glorious Life

EMS is not the highest paid career choice there is by any means. I mean Children aren't lining up on career day to see the Paramedic thinking "Wow, I bet he drives a Lexus and has a twelve bedroom mansion." No the thought of saving lives and being involved in the Emergency is what brings the kids, that and the lights and sirens. We make sacrifices in life constantly, though it seems EMS is a bit more often.

My Wife and I have done alright for ourselves, both in under paid professions, we own rather than rent and are able to provide for our son. That being said, I have made changes in these economic times to be more fiscally responsible. Packing my dinner rather than buying out, drinking from the stations water cooler, and enjoying being home bodies for entertainment. Its not ideal but it makes life easier on us, and reduces our stress.

Now I'm not blogging for sympathy, or bragging rights, that's not my style. So there is comedic twist to this blog...dun, dun, dun...foreshadowing? But I digress.

 I am not afraid to be, as my wife would say, cheap; though I think of it as Fiscally responsible. I go through the couch cushions at the station to find loose change in attempts to scrounge up enough to purchase the item of my desire. After a few weeks I use this said change to treat myself on day four to a soda. Which today was that day, That day where my hard earned work of flipping cushions and combating the creatures of the couch paid off. Three weeks to find enough change to buy an ice cold, thirst quenching, caffeine enthralling Mountain Dew. What a brilliant, magnificent, splendid, resplendent, splendiferous, illustrious, redoubtable day this was going to be!

Much as I enjoy cake and fried foods, I love my Dew. The day I get to purchase my Dew from the vending machine is what I can only relate to as Christmas when I was younger. I wasn't even going to wait for a while before the purchasing and inevitable consumption began. As soon as I clocked in, I headed straight for the back of the ambulance bays, my eyes locked on the light emanating through the stiff plastic logo of the soda incubator. Oh sweet luscious mana of heaven, I thought upon reaching the towering machine. I glance over my shoulders to make sure we're alone and stretch out my arms embracing it in a long, yet surprisingly satisfying hug. Getting lost in the moment I realize I have the correct amount of currency to release this locked liquid crack. Digging through my pockets, I throw unneeded items aside, gloves, spare pens, my junk drive all just to grab the loose change sitting with in its depths.

In my palm sits the key to happiness, I begin to slide my change in the slot of the machine. A quarter followed by another, followed by a few dimes. All was going great until this stationary bipolar vending machine turned on me. Clank I hear as a dime falls down the return shoot. I grab and reinsert. Clank I hear as it falls again. Temperamental piece of crap I think as I try a nickel. Clank, Clank, Clank as it spits out Sixty of the dollar ten it had already been given. The tiny LED marquee reading, Balance: 0.00, "What the hell" I exclaimed "Worthless piece of...Rotten, no good son of a....." Locked within the belly of this beast sits my hard earned, some one else's misplaced, change.

The fit of rage that ensued is not appropriate for all readers. I ended up losing to an inanimate object, out smarted at a game I obviously had no idea we were playing, by a soda machine.

Like the title implies, Ain't this The Glorious Life.

                                                           Be Safe

Ambulance Junkie

A Black and White or a Grey Affair??

"Everyone thinks when they get out of the academy, everything is black and white.  Well you know what? It isn't.  We live in the gray." Southland. 

There is no amount of training or schooling that will prepare you for the gritty realization of life on the streets. There is the obvious right thing to do and the obvious wrong thing to do, but that only covers the extreme polar ends. What do you do the rest of the time? What would you do in the moment when none of your training and none of your schooling seems applicable? The moment you enter the Grey Zone?

Your presented with a Frequent Flyer drunk, we all know the one, you pull up on scene and know his Name, DOB, SSN, Medical Hx, his wife's name, and their pet cat named Fluffy. He's a block away from his apartment, and is shit faced. He left the bar the block back and has been fighting the ever ominous force known as gravity the entire time. A good Samaritan saw him fall while driving and called 911, though never felt the need to stop and help him.

So Black and White would say a male Intoxicated fallen is a transport to the ER, right? He has consumed alcohol and thus not allowed to refuse medical aide and transport because he has a mind altering drug on board. He is adamant in not going to the ER, and it will be a struggle the entire ride in to keep him relaxed and on your stretcher.

Grey would say that he was heading home, He's a block away, and he needs to sleep this off. Yes he is drunk but if he shows no signs of trauma after a full assessment and is capable of appropriately answering person, place, time and thing than he has the right to refuse Medical aide and transport. You can't take a man against his will and you know his non driving wife is home awaiting his eventual arrival.

So what do we do? In this exact situation it comes down to your way of thinking, which I have done both:

Black&White- You get your Malnourished Morgan Freeman look alike patient and sit him on the stretcher. He banters on about being taken against his will as you put his lap and leg belts on. He emanates enough booze out of his pores for you to inhale a contact buzz. You wrestle to keep him on the stretcher and avoid his misguided attempts at a punch. You use all EMS Mind tricks to distract him and take his attention off his disgruntlement.

Grey- I've signed off my local drunk and given him a courtesy ride home. Walking him to his door and helping him to his front door where he lets himself in. Seeing his worn and weathered wife looking with shame and embarrassment of the spectacle he must have caused from with in the house. We bid our patient ado, and reassure the wife that bringing him home was no problem and it'd save them some money from the ER bill. No doubt leaving the patient to crash on his couch and sleeping off his alcoholic induced life style.

No one prepares us for the split second decisions having to be made on the streets. No one prepares you for the second guessing you'll do the moment the call is over. EMS is Black and White except for when its grey. EMS is truly a conundrum.

No matter your decision, use you clinical assessments and sound medical judgment and stick by it; but always be able to learn from your mistakes.

Be Safe
Ambulance Junkie

My Promise to my Son

The first time you smiled, I was Working.

The first time you Laughed, I was Working.

The first time you learned to sit up, I was Working.

The first time you crawled, I was Working.

Your mother will tell me of your wonderful accomplishments, I am proud!

Though I am saddened, I will never let you know.

I will never let your mother know.

This is my burden to bare, and no one else's.

Please don't think this is how your life will be.

I'll be there for you my son.

I won't miss your games, I won't miss your awards, I won't miss your growing up.

I know what that was like and I won't make the same mistake.

That is my Promise to my Son

Dry Chem + Ambulance Cab = A Day Off

It had all the story lines of a comedy plot with the classic punch lines and gags of a Charlie Chaplin movie. The scene is set, the parking lot of a busy service station, the afternoon of a mild winter's day. Our heroes sit in the front seat of their ambulance...and action:

My partner and I have the same routine once on post, the every day chatter entails in the rig over what we did this weekend. The music playing in the back ground we joke and laugh amusing our selves over various happenings at work and hear say about the unionizing neighboring department. We head inside to grab an early morning coffee and discuss whether its to early to grab a cup of Wendy's chilly or not. Exiting from the service station we tromp through the slush and gusty wind and hunker back in our warm ambulance. All the time never thinking about the mischievous happenings that are effectively occurring at that very moment.

Unknown to us the plastic seal on the fire extinguisher is to the point of total failure. It at any moment has enough disintegration through its plastic being to break apart setting in motion the days events. The continuous  vibration of the old 98 Ford will ultimately bounce the broken seal tag off the extinguisher and onto the ground. The said vibrations will rattle enough to dance the pin out of the dry chem, and set up this devilish plot.

We continue to chatter to each other and a few hours have passed. The Pin now on the verge of falling out and clanking will no doubt alert us to the unsafe extinguisher standing between us. As the pin falls it lands on the only towel in a five foot radius thus not making a noise, and not warning us.

Reaching back to his bag my medic goes to grab his novel to read. the bag having shifted just enough out of reach during the mornings drive. He has to stretch and with his finger tips grabbing at his bag just out of reach. in order to get a little extra leverage my Medic has rested his opposite elbow on the handle of the extinguisher. The same said extinguisher that we unknowingly possessed with a faulty seal tag. The planets have aligned in favor of the events about to happen, and set in motion to a point of no return.

With the slightest of pressure on the handle he is able to stick his finger on the bag with the tiniest of traction, pulling towards him he shifts his weight. The transfer of weight from his reaching grasp to his steadying arm creates enough energy to drive the handle down on the extinguisher releasing dry chem agent into the air. With out missing a beat my partners shifting weight triggers him to become off balanced and falling between the seats. Kicking up the dry chem on the rigs floor. As he falls his legs stretching out shoving his boots towards any solid mass in attempts of bracing him in his new stance strikes the the GPS unit mounted on the dash dislodging it. In his follow through with his boot he strikes the speed dial of the heat vent kicking it to high. The vent intakes near the dog house floor suck the low lying dry chem in allowing it to vanish from site momentarily.

Laughing at each other we do not realize what is about to happen. The vent sounding as if its clogged draws our attention to the outlets. We stop laughing just in time for the evil twist of Karma, *PUFF* as it fills the entire cab with dry chem. My medic laying on the floor no less than two feet from me vanishes in a fine white cloud within our rig, the air becomes thick and unbearable. Coughing ensues with intermittently laughing over our situation. We stumble out of our rig coughing and dry heaving from the dust that has no doubt filled out lungs. Suppressing the cough we assure each other of our safety. Then burst out in laughter which begins the cycle of coughing once more.

We call OOS and proceed to drive back with windows open and our heads hanging out. At the station we explain to the D.O the events of the day while uncontrollably shivering and coughing. We are told to head to be medically cleared at the ER. Once doing so we return to be advised the truck will be in need of a interior servicing and vent work cleaning. With no other trucks available for use that day, we are given the rest of the day off with pay.

It seems as though Karma had its intentions all along.

Be Safe
Ambulance Junkie