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

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

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

Down Time

We have all been there, sitting around in our bus at 200 hours waiting for the hand of the clock to click a second closer to the end of our shift. Surrounded by the darkness of the night, our partner snoring away and the soft gentle glow of a street light far off in the distance. We spend countless moments Stumbling through the vast emotional emptiness of the Internet, grinning at the occasional viral video of a hit in the junk while listening to the chirp of the occasional radio transmission. Watching urban nomads settle in for the night on their park bench bed's and the ladies of the night turning tricks a corner away. Maybe we sit in the confines of a station, flipping channels because we have seen the oxyclean infomercial enough to recite it by heart. Listening as the Fire Ambulance signs off yet another assault victim, we pace to the vending machines to tame a late night hunger. The hum of the air conditioner like a lullaby we fight the need to sleep some of us give in to this desire while others review yet another pile of charts.
When we are left to our own devises and are feeling rather creative we can truly come up with some great and memorable time killers. An impromptu snow ball fight employees V.S Supervisor (which I was on the receiving end of) or sledding down a hill with the backboards at the park. In the summer months we kick back and cast our lines in the river and wait for the bass to bite, or maybe work on our drive with a bucket of balls on the range. Grab a Ball and head down to the courts to play a quick two-on-two game of basketball or even a game of horse. Creating a dance atmosphere with the rigs lights and a radio station. Creating an ambulance dance which much like it sounds reenacts the unloading and reloading of the stretcher.
When it comes to the best down time I have ever had; it is hands down the simplest yet most gratifying moments of sitting around the kitchen table in the station late at night telling stories and rolling off each others jokes. Standing in the kitchen reenacting the story of "The Ambulance Chaser" or chuckling over our Brit and his love of Quiche and meat pie's. Laughing at NH's cat book page only to have NH unable to sarcastically defend his love of cats/ Reminiscing about old school toys like lawn darts, Pogs, and intellivision and than having to explain to the nineteen and twenty somethings what they are. Explaining how it really was a lady on a horse we got directions from, and how much better things really are on this side of the river.
The kitchen table talks have to be the greatest time to bond amongst the crews in the station. Interweaving our personal humors and sarcasms into a gut wrenching conversations. Only to be interrupted by the inevitable squawk of the radio...County: "Have a rig for the city"....Dispatch: "That's affirmative"....County: "stand by one"
Be Safe
Ambulance Junkie