Coach Now

He is a frail, weak and sickly old man.

Some time has passed, but he still looks the same to me.

He lays in front of me on his hospital bed in the living room

Face sunken in around his eyes and cheeks

Wife holding his hand, daughter at the foot of the bed

Hospice nurse giving us his paperwork and a run down.

Its funny how for years I rode on his bus to places with the rest of his team

Now he rides on my bus with my team

This time instead of to the football field we travel to the hospital

We talk about the years past

We talk about my life

Lastly we talk about football

Coach was a good man

I'm glad I had the chance to tell him how he influenced me

For Coach was in the final minutes of his final game.

He knew he was losing, and wouldn't tie up the score

That night the Ref's blow the final whistle

Game over

 Good Game Couch, Good Game.

Be Safe
Ambulance Junkie

Trauma note taking

We all have different techniques for keeping track of pertinant assessments. Many people have these Tricks of the trade they do with out second thought. I'd like to share one that I find most useful for the trauma call.

I typically scribe on my left glove all my findings from assessments, so I have the info readily available for a patch report to the ER or nurse report. I found scribing this way inauspicious during a trauma call because of all the dirt, grime, blood and various other substances that typically get on gloves. Also during a trauma I am more likely to change gloves and then lose any info I have scribed.

This Scenario is assuming that your rapid initial assessment has determined that the best course of action allows you to remain on scene with your patient. Let me repeat myself, this is not the proverbial "load and go" yet rather you can "Stay and Play" we are talking about. This technique is rather helpful when remembering all those injuries for later on in the call or after all said and done.

Once the Pt is in the rig and you can focus on your primary detailed physical assessment take a roll of 3 inch tape over lapped vertically 2-3 times. Sectioning it into three areas and place on the cabinets along the patient or the wall/ cabinets behind you. The three sections represent the three sections of the body to focus on in a trauma. Head/Neck, Chest/Arms/ABD and Pelvis/Legs. Now every time you find a injury during  your primary assessment you write the findings on the tape, allowing you to re-evaluate systematically on secondary assessments. This technique also lets you take the findings on these sections into the ER for the staff to see and use.

This is an easy skill to get a young provider to do while you preform the assessments. In the case you are with a driver only, you can use them to scribe for you to help out.

By breaking down a trauma assessment from head to toe you have a record of all the DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling) for all the Non EMS'ers. This will alleviate forgetting any injuries when documenting or when sharing during a report to a nurse.

Now not to say this couldn't be done during a "load and go" depending on various factors, such as transport times, Multiple providers in the back Ect. During those times more important life saving interventions of course  take presidence.

I'm glad to pass this off to my readers for I was passed onto me from a great mentor. She's no longer on the streets but misses it greatly. I hope this bit of info helps, I know it has for me.

Be Safe
Ambulance Junkie

A Knife called Envy

As we turned the corner the cop cruiser whipped around in front of us and flashed his directional bar light as if to say follow me. We knew it was going to be a legitimate trauma, as the cruiser turned the corner and pulled up on scene we were fifty yards behind rolling up to the cruiser when he jet further down as if to say there he is boys do your thing. My door opened as I called out on scene fighting through radio traffic, throwing my glasses on the dash I approach the screams and agony through a driving rain. In front of me stands a burdened woman in complete suffering. Drenched either from rain or her sorrowful tears the young woman weeps in misery. This early twenty's white female stands unable to control her frantic shaking. At my feet lays her man, my patient, with his legs over a guard rail and a bystander holding a towel on his shirtless torso. He's Limp and becoming ashen in front of my eyes, he's my age and laying in a puddle. Turning his head ever so slightly with his last gasp for air. Its as though I feel every drop of rain falling as time slows down. I remove the towel and see a non sucking chest wound just left of the sternum and one just under his left arm pit. The on lookers circling like vultures with their beady eyes gazing on my crew. A Sergeant from the Police approaches me and asks what I need, I gaze up through the driving rain and yell over the approaching sirens that I need these scavengers roosting on the railings and side walks gone. I stand to see my medic rounding the corner of the rig with his monitor in hand and the newbie in tow with the drug bag. I jump back to the rig and inform my medic in passing the locations of wounds. Grabbing the radio with my wet gloved hands I call out in an apathetic tone, "County and Control from Medic Two; Advise Trauma Two we have a traumatic arrest with two to three stab wounds to the chest; will advise once in route." I walk to the rear compartment of the rig to grab out the back board and collar bag, throwing them closer to the patient. Its no lie to say I felt no sorrow for this gang banger, though I still had a job to do. I grab the intabation kit from the inside cabinet and proceed back towards my medic. Opening the intabation kit and drug bag I prepare for a quick and systematic approach to the call.

Various other units have been arriving on scene from the Fire medics to the detectives. The street looking like a block party with rave lights bouncing off the buildings. The officers stringing the DO NOT ENTER yellow tape around the scene and various people receiving shiny linked bracelets There is no blood exiting the wounds, even if there were the driving rain would have washed it off his cold limp body. We are joined by two of the Fire Medics I would trust with my child's life, One an RN and the other an EMS instructor. The two of them and my medic use a tag team approach. My Medic Intabating, squatting in the puddle as to not get his pants soaked. The Nurse Medic throwing a large bore IV in the left AC, and the instructor Medic preparing the IO gun in the rig. I toss the prefilled Epi and Atropine to the RN medic and take the drug bag to the rig where I hang another thousand bag. I know only first round med's will be given before they move out of this rain, its cold dark and damp on the street. They secure to the body to the back board and throw it on the stretcher, wheeling it to the rig. Inside five providers pile and I close them in. Jumping in the drivers seat I put the rig in drive, kick the emergency lights on and head to Trauma Two. Just twelve minutes have elapsed since the initial dispatch.

I realize five additional occupants may seem like a little much but I wasn't wasting time to weed any out. We were only a few blocks from the highway on ramp which we jump on to head a village over. Slow and steady I proceed only topping out at 60mph. I have precious cargo, a back full of standing providers working there ass's off to save this man. Regardless of his social or economic background he is our patient and he will have every chance to survive we can give him. Slowing for the exit I hear the boys in the back quickly consult each other over the diminishing lung sounds. A Chest decompression is in order, preformed and quickly realize a shock is to follow. Pulling the rig over to a shoulder, I hear "3,2,1, Clear" and accelerate the rig back up to speed we are minutes away from Trauma two.

Arriving we hand off to the ER. having gotten him back momentarily we were hopeful. Only for all that hard work to come up short. Later we find out this was all over a girl...Not a good reason to loose a young life.

Be Safe
Ambulance Junkie

Gone Hunting

The early morning fog begins to burn off as the groups anticipation dies down. Settled into the weeds and shadows they sit and wait. The echoing of quacks from down around the bend travel up to the waiting ambush. The sun begins to break over the horizon and the group knows that the gaggle would soon be on the move. The calling between the members of the gaggle can be heard clearly now as the flock moves up along the river. Hands shaking with jitters as the unsuspecting victim approaches from the north. With target in site, the order is given.

Take Them!  

Guns drawn from along side

Target in the cross hair

Bang

Bang

Bang

And with down feathers floating though the air, the success of the ambush is known. 

The flock scatters through the side yards and the hunters head for their cars and dart away. 

The injured Goose brushing its self off takes flight only grazed in the opposite direction. 

Near the river in the middle of the street lays an unintended target. A young Duck fatally wounded, only 16 years of age on his way home from choir practice. Still dressed in his slacks and dress shirt wearing his down feather winter coat.

Only now with a 9mm hole left in it and no future thanks to an early morning ambush.

Be Safe

Ambulance Junkie

A Mid Fall's Night

The sun has set some time ago,

The night before last,
And all through county not a call was being placed, not even an "I've fallen" 

Ambulance plugged in, wheels ready to roll, hopes of a stroke emergency will soon be here.
EMS providers comfy are all snug in their seats.

Thoughts of diabetics and traumas of past were dancing through medics heads. 

Suddenly with out much warning, came a tap tap tap at the window. 

Waking the snoring dispatcher in such a startle. 

Getting up from my desk, eyes filled with joy, I head to dispatch to see what was the matter.

The glow from the neon light shows us what the noise had been.
Could it be, A patient in need?

A call for help? maybe it is an assault? 

Or maybe a chest pain

But no, it is none of these
Twas a drunk cold urban nomad slurring as he speech.
"Its Nisss un.....warmth and conthy."
Looking for a warm place to stay no doubt on this chilly fall night.
The aroma of booze lingered off his breath
Before we had a moment to think the door opened again
In came the officer to escort our late night visitor away to his sleigh
"I'll take him" he said with a jolly chuckle
With a spring in his step, and away with his catch
"Sorry to disturb you and have a good night"

Be Safe
Ambulance Junkie

The Boy Next Door

You would think that one of the safest places on earth would be living next door to the ambulance station.  I don't mean in the rhetorical sense of next door either, literally twenty feet away, building to building. No matter how close the help was, it wouldn't have made the difference. He never reached out, He must have known we were here. He saw the ambulance's parked in the lot underneath his window. I'm Sure he saw the glow of the lights at night as we backed in the garage. Surely he heard the echoing of the sirens while he watched television. 

Did he not know that there is always some one here? Did he not know that we are well versed in assisting people in need? Depression is a disease like any other. Why did he not reach out to ask for help? It is not his fault that he felt this way, its not something to be blamed for. Was he under that much stress that it blurred his vision of reality? He left this world in a cold and dismal way, in hope to escape the social confines of this world. 
With the last words he uttered to his mother


I'm Sorry

Be Safe 

Ambulance Junkie

Vegas Series: Meet Mr. Hero

Hanging out in the Centrifuge Bar at MGM in Las Vegas we are enjoying a night out. A bar filled to the brim with people enjoying them selves. Drinks in hand, Fly boy, Nerf Herder, and myself are comfortably set up against the wall people watching, life is good. Our other two former comrades, use to the crowded bar scene, work their way to the bar strategically near an unsuspecting group of ladies. M.S and Fidney anti up to the bar and buy two shots, enjoying them selves Fidney sets his eyes on his target.

Now maybe as outside observers, we could see the pack mentality, the configuration of these woman and the devotion to one in particular. A Petite blonde, the center of attention and the inevitable item of affection to Fidney. Making eye contact he strikes up a conversation, and buys the young lass a drink, on account of celebrating. Though he never really knows what the celebration is all about, and doesn't bother asking.

The rounds of drinks pass and we take notice of M.S with a shit eating grin on his face. We see the ladies look on in disbelief which quickly turns to horror. Fidney continues to ramble on in an animated fashion, arms flailing, head weaving side to side. Quickly M.S leaves his post as wing man and heads to us as to disassociate him self with Fidney. M.S weaves a tale of Fidney's feeble attempt to impress the ladies he was surrounded by. Mr. Hero's, as M.S renamed him, exploits of life as a medic in the big apple, include tales of dying baby's, being shot at, and saving those sworn to protect the people of NY. These are all in a days work for this man. By the looks of the ladies, what went from a casual interest, irrefutably changes to disbelief. With the bar tenders jumping on the bar to do a dance grabbing Fidney's attention in mid sentence these opportunistic ladies simultaneously finish their Cosmo's and beat feet.

Slightly dismayed Fidney heads to the rest of us and talks a big game. We let him chat on and on ever knowing the glorious ball of fire he was shot down in. We continue our adventures of the night and to this day we know Fidney as the man to drive an entire Bachelorette party from a bar, in Sin City.

Moral of this story guys: Never over play the hero card.

Be Safe

Ambulance Junkie

An EMT's take on not Needing more Medics.

Recently fellow bloggers have put forth a topic of discussion that I feel I would weigh in on. Medic 999 posed the question of  "Do we really need Paramedics on ambulances?", which caused a well thought out response,   "We don't need more Medics"  from 510 Medic.

Both Bloggers are Paramedics and offer, in my opinion, a surprising response. They both seem to say that more medics is not the solution to an overwhelming problem in EMS. There is no need to have a Paramedic on every single ambulance let alone two. In fact I am willing to argue that the common place of having Medics on every single rig has lead to a decline in patient care and a Medic's overall ability. 

Now don't get on your soap box and assume I'm saying that Medics abilities are poor, or we don't need medics. One the contrary my dear reader, I am merely making reference to my comment on 510 Medic's blog, which was:

"I agree totally, I feel it is leading to a downward spiral of our providers. EMT’s who may not get the experience from the BLS truck, may not be as experienced with the “basics”. EMT’s only riding on ALS trucks then feel the need to advance them selves in order to get more patient contact and more experience. Thus becoming Paramedics, and with declining con-ed budget’s, are still not being as experienced as their predecessors. These newly carded Paramedics who have a lack of the “basics” typically turn out to be poorer providers. "

By this I refer to the idea that EMT's are rushing them selves into a Medic class before having confidence in their own ability or exposure to really bad patients. EMT's see Medics doing more skills, being paid more, and being the "life saver". They do not get a sound fundamental skill set that they can rely on through their career in EMS by rushing their advancement. These providers are then welcomed into a world of diminishing providers by being thrown into the captains chair by being cleared. The expectation of a systematic transition to gain and hone the much needed street skills is pushed aside to the need for a warm body to fill a schedule hole. The response to the negligence of clearing a provider before they are ready? They can make up needed skills in the continuous education training that is expected of all providers and catch up on their need. Sounds great, and almost reasonable right? Except we enter the new age of declining education budgets and fewer instructors. Now the much needed continuous education isn't being offered or being set aside for a later date. Now the new medics have to rely on their experience and their fundamental skill set. When all else fails they can rely on the basics after all right?

So if you have followed along, you may have picked up on the criticism systematic failure that faces EMS. 

"I’m not saying we need to triple the BLS trucks on the road but rather put weight on the experience gained for our EMT’s in a BLS setting. As with any performance overhaul its typically a good idea to start at the bottom/beginning."

I think we need to understand and credit that there is an enormous amount of applicable skills that can be learned in the Basic ambulance arena. By putting weight on this experience, EMS will only benefit with strengthening our base structuring and ultimately our future Medics.

Be Safe
Ambulance Junkie

What does OH, NC & MD have in common?

Ohio, North Carolina, and Maryland  all had crashes involving ambulance's this month thus far. With all of these being in the news lately and it has caused me to do some reflection on my own driving. Whether its due to youth, our inexperience, the inability to handle the adrenaline, or other motorist faults, we are at risk. A constant risk of Motor Vehicle Crashes, some of which have ended with fatalities of civilians and EMS providers.

Emergency Medical Services unfortunately involves the use of Ambulances. Ambulance's which are on every city street, rural road, state route and interstate highway. Roadways which are occupied by various other forms of vehicles. Vehicles have a molecular attraction to each other, much like moths to a flame. Being in the ambulance is possibly the most dangerous yet consistent part of our jobs. Yet I dare say that it is the most overlooked when it comes to safety, not necessarily by the industry but by the providers.

There are new safety features and innovations when it comes to patient compartment restraints, new ideology for paint schemes including the American's introduction (and acceptance) to the chevron. Emergency vehicles are being equipped with the same safety features many new age passenger vehicles have. Along with the addition of Opticom's to give us the right of way at intersections, are all valiant attempts for safety. This way of thinking excludes what I'd argue is the biggest factor of the accidents, the Human Factor.

As the articles have shown, some times EMS is the human factor, sometimes the populous is the human factor and sometimes in the case of training an inexperienced individual its multiple human factors. Now there is little we can do to fix the populous other than public service announcements and the hope it sinks in. On the other hand we can strive for better self control and a stronger diligence towards the inexperienced while training them. The need for repetitive assessments of current practices and skills would go a long way. A strong need to re-mediate any and all practices we may not have a full remembrance about. This is not a supervisory or managerial assessment but rather the responsibility of each individual to protect each other. Self assessments and continual application of safety concepts would go a long way

A few remediation points hopefully to spark self awareness: 
1. Never drive above the posted speed limits going to or returning from an incident. 
Now this by far is the hardest for me to do. Though I understand the thought behind it. There are posted speed limits set forth by the state as to the operator of a vehicle to know at which speed he can safely operate at. Safe operation includes such factors as population, road size and road conditions.  I find it hard to travel the speed limit because I rarely do in my personal vehicle.


2. Wear a Seat Belt.
This goes for both while in the front of the vehicle or passenger compartment while vehicle is in motion. Though not directly related to the concept of this piece a good point to make anyway. 


3. Stop and Clear all traffic controlled intersections.
If being in the ambulance is potentially the most dangerous part of the job, it being in emergency transit and entering an intersection is death defying! The factors involved in a safe intersection transition are numerous and readily relies on others. Stopping and making sure all traffic is stopped before you enter the intersection is imperative to life.


Now in no way is this a fix all to this months crashes. Nor do I intend to place any form of blame, rather I hope I get you to think of how to make yourself safer on the next run you make. After all, Your life and others depend on it. 


Be Safe
Ambulance Junkie

Addition to my Digital Imprint

I'm sure it has already been coined but I haven't yet found an actually definition. So, I have to go by my opinion of the meaning and concept. So here we go, 


Digital Imprint: Your individual and distinctive influence of self or brand though the various outlets available on the internet. For Example Web Page's, Social Media outlets (Facebook, Twitter, LinkedIn) and/or Blogs. 


Like the term? Yes? No? 
It is fashioned after the idea of a Carbon footprint.


Anyway's I have added to my Digital Imprint in hopes to extend my slight influence and input on this ever changing world.


You may have noticed the Like button on the upper right hand column of the blog. Which I hope, is linked to the new Facebook Fan page for the Blog. It will soon also be added to the Digital Imprint page of the blog. 


I hope you find time to click the Like button and share the Fan page and ultimately the Blog with your various EMS networks and friends.


If not its OK, Because the true trason behind this Blog is so my son knows the kind of Father he has.


Be Safe
Ambulance Junkie

Vegas Series: The Prologue

"Vegas?" I jokingly pondered.

"Yeah it'd be fun" says Fly Boy. "think of it as a Man'cation"
"Wait...Vegas? like Las Vegas? Sin City?"
"Ya!! End of this month" Fly Boy burst out in excitement.
"Vegas" I say with confidence

 I hadn't really consider the proposition as usual, it was more the off the wall idea we entertained. This time was different though, it felt right. Why not? I thought, and as simple as that, we began to get excited. A trip away from the grind of work, away from this east coast existence. Fly Boy, Nerf Herder, and myself meeting up in NYC with Fidney and flying out to Sin City to hook up with M.S who now lived in Henderson. The five of us reuniting for the first time in a couple of years. We weren't age old friends, but we had all developed and honed our EMS skills together for a time. While we were traveling so far we'd of course take the time to head to Yosemite through Death Valley to flex our need for the out doors. See some sites, place some bets, and Fly Boy could even see his Grizzly bear he was so obsessed with.

It was a trip of a life time, and in all honesty it was the best thing to ever happen to me besides my bride and my son. It was just one of those moments that I was fully capable of letting go of control and decided to just go with the flow. The last time I truly did that was when I began dating the girl that became the love of my life, who is now the Mrs. Who, by the way was the ultimate decision

The antics we are known for carried over into our Man'cation and lead to some rather precarious moments. Whether in the NYC, aboard the air plane, in Las Vegas or Yosemite National Park we were never far from a laugh.

I hope you enjoy this sliver into my life outside of EMS.

Be Safe
Ambulance Junkie

A chance encounter

He sits waiting but for who he doesn't know.

I sit finishing up my chart from the last run.

He looks at the passing faces with confusion and concern.

I look at my fellow workers and strike up a conversation.

He wants to call out for help but is afraid.

I get the call for help and head for the scene.

He meets an officer and he answers "I cant move along" wiith an embarassed feeling.

I meet the officer who admits he thought he was just another vagrant.

He tries to stand but he can not.

I tell him not to stand, though he still attempts.

He doesn't know what to make of me

I don't know what to make of him.

He says he can do it on his own.

I say let us help.

He feels young at heart, he looks old and aged. The sun has blemished his skin, the wind has hardened his face. His wrinkles chissled in his face's granite fasade, His eyes blueish grey screaming out in pain and anguish. Time has washed all the color from his hair and beard leaving it white. His hands, rough as sand paper and cold as ice, his fingers jaggedly contorting inwards with lose of dexterity. This urban nomads right foot externally rotated from years of abuse to his body, his left leg bent.

He wears layers of clothes because he has no place to keep them, his boots tied up with rope. He has spent years on the street. Made it through heat waves and blizzards, droughts and floods, and has received hand outs and has been made a fool of. He is an old weathered man to stubborn to know when to give in to the help that surrounds him. Or maybe He feels to much pride to accept from those who offer assistance.

Not knowing what its like to be him, He knows not what it is to be me. There is something that connects us on this day, we are both fighting to keep him safe.

Be Safe

Ambulance Junkie

Off on Vacation

Realizing I have never spent more than 4 days off in a row with my son since he's been born, I am going to spend 11 days with him and the Mrs of course.

I am off to the area know as New England.

I shall return,

after a much needed family vacation.

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

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

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

Chuck & Ralph

"County to Medic Four recieving reports of multiple patients reporting Vomiting and other general illness symptoms we are starting additional units and the Fire Department for a possible CO2 condition in the residence" "Medic Four copies, we are two blocks away we'll advise additional upon arrival" my partner chatters.

We see patients from 200 yards away, arriving on scene Patient One & Two are at curb side puking their metaphorical brains out. We call out "Medic Four on scene, will advise the situation" over the radio as I step out and avoid pools of stomach content all over the side walk. The first two patients in agony but breathing we quickly survey for additional bodies. My eyes sweeping the area I catch movement inside the front door, I advance as the faint sounds in the distance of help can be heard. I bend down unsure of the nature of the environment and upon arrival to the door way I am presented with patients three, four, five, and six. They are all inside the front door in what appears to be a common living quarters. All of them also spewing out every last bit of stomach contents they had, though these chaps were all civilized and using various forms of buckets. "If your able to exit this building and come outside" I yell over the sound of the arriving cavalry. All four stand and walk towards the door. "Are there any others in the house other than the four?" I over hear my partner asking patient one and two. They point to the fenced in side yard where I now turn and head, getting to the gate I go to unlatch hearing:

"I think the Clams were bad Charles!" 

"Oh my! Don't even say that word, it'll make me sick again Raphael"

"Why did you have to cheap out on the seafood of all things Charles"

"County from Medic Four, Be advise we have eight patients all out of the residence this appears it could be food related. You can down grade all remaining medic's response to non" I chatter as I direct the two remaining patients out front. The Fire department pack's up as I tell the lieutenant of the possible food illness of all the patients. My partner has all but the last two triage'd and handing them off to various rigs. I direct Charles and Raphael to our rig and sit them down. Assessing them and listenting to the story I hear of a fun get together amoungst friends and them sharing steamed clams and telling of days past. All only to be strickened by food poisoning a few hours later.

Only as I return to service do I realize that This would be a humorous story realizing my Patients names were Chuck and Ralph!

Be Safe

Ambulance Junkie