Holiday "Break"

From my family to yours

Merry Christmas

I shall return after the New Year, as I will be spending it with
family and celebrating my Lil Mans 1st Birthday.

Please enjoy every thing that is the holiday season
 And thank you for all your support from the bottom of my heart

As Always

Be Safe
Ambulance Junkie

Over Simplified?

While fueling the rig I saw the sign above, which raised a thought. Doesn't the use of a Credit or Debit card negate the "payer" as Cash Customers? So is this sigh really necessary than? Frankly should this over simplification of a concept have to be this redundant within such a small space?

Obviously if we have to have such a sign even exist, which obviously we do, it really needs to be quite large. The individuals it is intended for aren't going to see this misplaced signpost plastered to the steel support beam of the gas station. Rather they need an enormous neon sign on top of the building that asks a simple question and then will answer it for them (No thinking involved): USING CASH? PREPAY. Maybe add additional blinking lights, flashing arrows to point at the glowing neon light pollution. That way Joe Public is drawn to the sigh much like bugs to a light, they'll ask them selves "Am I using cash?...Hmmm...Yes I will have to use cash to buy my gas today, what of it? Oh I understand, I must Prepay"

So that got me thinking about some of the people I've had the pleasure of training over the years. The ones who didn't see the giant neon sign above the stations which read's "You don't know it all, apply within, we teach"  The fresh out of Basic class, who already working their way through the Medic Class with out an ounce of real exposure, new hire. By the time they are getting out of the Medic class they are so full of them selves and how well they have the book knowledge down that a little basic, such as myself, is nothing more than the proverbial "Ambulance Driver"or the "Bitch" to do all the crap calls.

Granted, I may not almost be done with the eighteen months (or less) of schooling that you have under your belt that has taught you how to read cardiac rhythms, given you the "skills" to push drugs, start IV's, or intubate a patient, and given you the ability to read protocols. But I do have a couple of years of experience and more calls under my belt than some agencies have in a year.

So it may be advisable to listen to what I have to say, and don't automatically answer "Ya, I know". If I've picked up on something you're doing incorrect or am attempting to refine your hop-scotch assessments, your incoherent patch reports its because its apparent you don't "know"...Ya Know?

So do not brush off the guy who's "just" a Basic that could be the one to save your ass if you ever get cleared as a Medic. Our Basic's are the best assest you could ever have in your bag of tools. Though you are the one with the eighteen months of education, so you tell me; what should our basic's neon signs say?

Be Safe
Ambulance Junkie

Twelve days of EMS

*On the First day of EMS my dispatcher sent me to
A Smelly Necropolis Rectal Bleed

*On the Second Day of EMS my dispatcher sent me to
Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Third Day of EMS my dispatcher sent me to
Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Fourth Day of EMS my dispatcher sent me to
Four Frequent Flyers, Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Fifth Day of EMS my dispatcher sent me to
Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Sixth Day of EMS my dispatcher sent me to
Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Seventh Day of EMS my dispatcher sent me to
Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Eighth Day of EMS my dispatcher sent me to
Eight Swinging Drunks, Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures,  Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Ninth Day of EMS my dispatcher sent me to
Nine Needing Narcan, Eight Swinging Drunks, Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures, Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Tenth day of EMS my dispatcher sent me to
Ten Tooth Aches, Nine Needing Narcan, Eight Swinging Drunks, Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures, Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*On the Eleventh day of EMS my dispatcher sent me to
Eleven Esophageal Varices, Ten Tooth Aches, Nine Needing Narcan, Eight Swinging Drunks, Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures, Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

*And on the Twelfth day of EMS my dispatcher sent me to
Twelve Febrile Kids! Eleven Esophageal Varices, Ten Tooth Aches, Nine Needing Narcan, Eight Swinging Drunks, Seven CHF'ers, Six Month's of Chest Pain's, Five Trauma Codes, Four Frequent Flyers, Three Faking Seizures, Two Stubbed Toes & A Smelly Necropolis Rectal Bleed

Tis The Season

Dispatch: "Caller advises it's the house on the corner and stated he left the lights on"

I have nothing against holiday cheer, in fact my house is beautifully decorated both in and out. I begin to listen to Christmas music the first work shift after Thanksgiving. I'm not devote about it, it just seems that its only played a short time out of the year so I should enjoy it. I'm not fanatical about Christmas in any way, its not my favorite holiday but I do enjoy it.

It perplexes me though about human nature and how they can put the time and effort into creating the "master piece" as seen above. They then use it to their advantage when having a medical emergency, great! Very creative in fact, I applaud your effort and out of the box thinking. Any other time of the year though they can never turn on a porch light, Shovel thier sidewalks or make sure house numbers are visible (if they even have them). I cant begin to count the number of times that I have had to back down a road with scene lights on just to guess which house is probably the correct scene because you've obviously passed it. Its like a game show half the time, the prize? The Patient!

As long as I am on the subject, know what your address is. If I have to roll up to a 23 Made-up St. one more time this year and its an empty lot, I'm going to think about calling out No Pt found. Rather I take the time to call up to county dispatch advising of the current situation and asking for them to recontact the caller to find out the call is at 32 made-up St. and then I get grief because the Pt's "Dyslexic".

I really do enjoy rolling up with all the flashing lights though, the blinking candy canes, the dancing Santa Claus, The moving deer statues, the twinkling the brightness and the rest of the festive display but can we carry this courtesy through the rest of the year?

Be Safe
Ambulance Junkie

The Boo-Boo Bunny

Thanks to my great mate over at Scaredy Fish 

I'd like to share this helpful trick with you.

All credit is due to Scaredy Fish for bringing this into my everyday skill set.

Now its not original to him but he taught it to me so I give him credit

A matter of fact this Posting is dedicated to him for teaching me it.

(I kinda asked/stole its Blog use prior to his return to Blogging)

The ambulance is a scary and unfamiliar place for people especially children,

so if there was a way to ease their anxiety while preforming simple treatment and care

should we not strive to accomplish it?

There is the natural psychological first aid effect for children towards stuffed characters,

  Kids typically cling to them for comfort during times of distress.

This can typically be used to our advantage

as a great tool to disguise an intervention such as an Ice pack, or Blow by Oxygen.

"Hold the bunny on the boo boo." 

"Make sure you hug the bunny"

Items needed: Standard Hospital Towel

2 or 3inch Tape

a Sharpie or marker.

Ice Pack/ Oxygen Mask

The instructions are simple.

1. Lay the towel out

2. Fold the corners in 

 3. Roll tightly

4. Tape the edge

5. Bend into a U shape

6. Twist the ends to form ears

7. Tape around the base of the ears 

This creates the face and keeps the ears formed

8. Draw your best cute bunny face, remember triangle noses

Smiles are nice, no teeth.

You can put an ice pack in the hole in the belly 

and wrap the body in another towel to create a cold pack they will hold on the injury

Works wonders for holding O2 masks, 

just insert from the bottom of the belly out the back and its instant blow by oxygen.

Be Safe

Ambulance Junkie

One Award I'm Glad I Didn't Win!

 With the ever approaching New Year

I thinks its safe to say

My Wife and I are not in the running

for Worst Parenting Decision 2010

But I'd like you to meet a front runner...

MCKEES ROCKs, Pa. (AP) - Authorities say a 2-year-old girl spent 15 minutes stuck inside a toy crane vending machine in a Pittsburgh-area mall. The girl apparently climbed up the chute into which the coin-operated crane drops prizes. Moon Run Fire Chief Paul Kashmer tells WPXI-TV that the girl didn't seem upset by the ordeal Wednesday night in the food court at the Mall of Robinson, in Robinson Township. 

She was extricated from the machine unharmed

Though it took nearly $9.00 in quarters to get the girl out. 

(yes I stole that from SNL but its funny)

Be Safe

Ambulance Junkie

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

Coach Then

He was a rough, rugged and rotten old man.

Bathed in booze and Cigar smoke

Skin tough as leather

Face wrinkled and weathered from battles in the elements

Eyes cold and grey

A formidable opponent to a high school kid

Making us Bleed, though never laying a hand on us.

Making us sweat until we ran out

Making us suffer at his mere delight

Always on his hill, watching over us

Criticising our every move, our every formation

His voice screaming to get it right

Wrong route; Run The HILL!

Missed the block; Run The HILL!

Fumbled the ball; Run The HILL!

As hard as he was though, he was our Coach

Year after year we returned in early August

To be tortured under his rule.

To young to understand the lessons he was entrusting us with

If I only knew then what I would have learned

Thanks to Coach

Be Safe
Ambulance Junkie

The Handover: Burn out

So after participating in only a few of these Handover's I just realized I've never allowed

those who dont follow other EMS Blogs to get a taste of whats out

there on the Blog-o-sphere.

I hope you'll take a moment to head over the this months Host

and see what the others in the world of EMS 

have to say.

The Handover EMS Blog Carnival

Burn out

Hosted this month by:
Rescue Monkey

Scaredy Fish

I would love to introduce to you the blog of 

Scaredy Fish

A coworker of mine who I can gladly has become a friend.

Which is hard to say in this business.

In this world of Zombie Apocalypse

He'd be in my fox hole.

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

The Night Terrors

The Handover- Episode 21 "Burnout"
Hosted by Rescue Monkey

I swing my legs out of bed and sit on the edge, taking a deep breath as I sit in the calm of my bedroom at night. I wipe the bead of cold damp sweat from my brow, I have no intention of going back to sleep, so I lay in bed with eyes wide open, glancing into the pitch dark and wonder if its all worth it in the end. 






Is reliving these experiences worth the time and effort of this job? Is being haunted in my sleep worth the pride I get?  Are the choices I've made actually making a difference?  


My first infant death, a result of SIDS, was thanksgiving night. Only a month after being cleared from the New Employee Orientation and forty five minutes till the end of my shift. We got the call from county, a two month old down not breathing, Echo priority. The actual events have become a blur after reliving it so many times but the feeling and sensation is forever imprinted in me.

The guilt lasted a few months, always second guessing what I did, and if I did it well enough. Constantly judging every call I did, second guessing myself after any run I had. Though I was not prepared for the relentless mental bombardment experienced in the silence of sleep. Night after night after night, a restless sleep in which I felt stuck in the call and even more helpless than during the call. The night terrors have never really went away though. Reliving the calls over and over again feeling that there should have been more I could have done. Feeling that young innocent life slip through my fingers again. I thought the terrors were just going to last for a few days, which became weeks, then months later and now years later. Tonight was a repeat my first terror ever experienced, not surprised seeing it was on this night that it happened. It's the call that now makes me get up in the middle of the night to check on my son six years later, just to make sure.

Pulling up on scene my medic tells me not to run, always walk because there is no time to treat me too. I'm frozen in time. Before we even get to the front door, a fire medic comes out holding what looks like a baby doll in his arms. Small, lifeless and grey, a peanut of an infant, limp on his forearm. I turn to return to the rig and suddenly I'm in the back of the rig. My Medic yells to get us to Trauma One as fast, but safe, as I could. The rig begins to roll but I feel as if still in the back and I'm supposed to be driving. Terror fills my heart, I feel cold and all my training I can not recall.

Now no matter how fast you get to the hospital it wont feel fast enough. No matter how much your told you did all you could, it doesn't sink in. No matter how much time passes I still think of the identical twin who will never know their sibling. Never able to keep secrets with, never able to stay up late at night, never able to celebrate the holiday season.

If I'm lucky I wont have another terror for a week maybe two. Unfortunately its usually not the case, typically they are only days apart. My only relief is that the terrors rarely repeat them selves on consecutive occurrences.

Tomorrow begins like any other day, with me putting my boots on one at a time. The terrors wont get the best of me, I can't let it. Not everyone has the ability to take that step towards a limp child being carried your way, and because I can, I'm needed. Because of this fortunate or unfortunate ability to burden the life and death challenges I have no other solution than to continue, I just hope that maybe next time it will be different.

I have felt the pain of Burnout, I have felt the darkness and utter frustration which has chained me down into a deep depression. The constant self doubt, the constant questioning, the constant fear. The only way to over come it? The only way I've gotten back to the job I love? Taken that first step. Whether that step is debriefing, talking with crew mates, or time to over come it just needs to be taken. The first step is of most importance, and is for the individual to decide.

For me the First step was literally putting my boots on and taking that step back into the station.

I hope this will help someone Take that first step.

Be Safe
Ambulance Junkie

Happy Thanksgiving!!

To all sacrificing their Thanksgiving to serve the community

Thank you!

The Thanksgiving song!

By Adam Sandler

Any Questions?

It's not a hard concept, but maybe I'm wrong. After all it's not nice to assume these days.

It was however, spelled out right in front of you.

With at least five printed signs, 

posted in an area no bigger than two square feet

at all different height levels.

you even had to 

MOVE A SIGN OFF THE BOTTLE TO USE IT

......but

maybe the system that was enacted failed you

and 

maybe we didn't do enough to 

explain what it was about.

So

The Oxygen Bottles..........Do Not Use

Questions feel free to ask, I'd be happy to explain it to you some more.

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