31 December 2006


The last few weeks have been a blur of almost continuous residence on an ambulance. I can tell you for sure I worked every day between 12/24 and 12/30, and I don't really remember anything before that. I'm sure there were good interesting calls in there somewhere, but I've been running on autopilot so nothing really sticks.

I had one call where I had to ask my partner at the hospital whether he'd started an IV because I'd been away from the patient for 10 minutes and honestly couldn't remember. Normally, I write all that sort of information down because it is important for the run form, important to tell the hospital and just generally good to know, but somehow I'd just lost it. I had a hard enough time writing the report because I was trying to explain what happened to the patient because we were the second ambulance on-scene and I got a lot of conflicting reports from the other ambulance, the firefighters and the patient.

I've actually had two days off in a row now because I took this weekend away for K's birthday today. We're having a low-key celebration and he's making prime rib for dinner since we didn't really do Xmas dinner this year (I don't think the mac and cheese counts). Next month is lighter duty on the ambulance according to the current schedule and K has asked that we try and schedule things a little differently to make sure someone's around for the hound so hopefully I won't be quite so insane and with any luck I'll actually get a med school interview sometime...

Have a happy New Year!

25 December 2006


On the overnight for 911 tonight, crazy busy so far. Day crews said it wasn't too busy for them, but apparently everyone was holding out for the overnight.

Checked my email tonight, got my first med school rejection - not even an interview for them.

22 December 2006


911 from 0700-1700 on 12/20, ALS transfers from 1700-0700, BLS transfers from 1000-1800 on 12/21. Comatose on couch at 2030 on 12/21 while K is out playing bball and I'm on call for the FD - who thankfully don't get any calls. The overnight wasn't actually that bad, I slept from 2a to 5a and got a nap during the break between ALS and BLS transfers, so I'm not complaining about the schedule. I do have to say that I find my patience runs thin when I'm tired though, so here's two transfer stories. I do have a 911 story I'll try and share tomorrow.

0130 transfer patient from west-side hopsital ER to psych/detox center next to the east-side hospital. 23 yo female, depressed, not suicidal. Fine, fine, hop on board the sad bus and let's go. She's got an extensive list of meds and medical hx with her but nursing report indicates she's fine, normal vitals, so on and so on. Less than a mile from our destination, she looks at me and says, "I don't feel so good. My chest hurts and my jaw hurts." My internal BS sensor is screaming, but she does have a history of cardiac dysrhythmias, so I reassess vitals to find a slight elevation but still within normal limits, pulse strong and regular. She also has a history of anxiety, but denies that has anything to do with her current feelings.

When we arrive, medic is a little surprised that I head inside for a few minutes because we normally drop them off at the door. An aide and a social worker greet us, I hand over the paperwork and get the you're dismissed look just as I start to explain that she's developed chest pain and get their attention again. I try to accurately explain the situation and my assessment of her condition when the social worker looks at me and says, "Did you do an EKG?" Nope. "Do you want to?" I didn't answer that question because clearly, if I wanted to, I would've done it. The social worker finally turns her attention to the patient and eventually they agree to admit her for her fourth trip through their system. I left and had to explain the situation to the medic, who backed up my actions and assessment since she'd heard the nursing report and read the history documents. I worry that I wasn't being patient enough, caring enough, but everyone I talk with agrees that I was at least 10x nicer to the patient than they would've been. Just the fact that the medic didn't know there was an issue speaks to how nicely I treated her. I don't know how to feel about that, but I truly believe that there was no current cardiac issue with the patient.

1630 transfer patient from a nursing home to an emergency department, issued as a "go now" call from dispatch. Limited patient info enroute indicates 80's female with fever. Even though I'm on a BLS transfer truck, there happens to be a medic working with me so we treat this as a 910 (get it, 1 less than 911) call. When we get there, we head to the nursing station and are pointed down the hall to the patient's room - I leave them a parting shot asking about paperwork to go with the patient since they seem to be fairly ignoring us while continuing their social conversation.

In the room is the patient (and her roommate), her son and her husband. No staff. We start getting ready to move the patient to the stretcher and start asking questions of the family since they are the only ones there. An aide shows up and thrusts paperwork in my direction and is three steps toward the door before I look up. I ask her if she knows anything about the patient. Of course not. In a tone tinged with both annoyance and sarcasm, I ask if she could please send us someone who does know something about this patient. The family is looking at me somewhat slack-jawed at this point, so I apologize to them and explain that it would really be more realistic to have the nursing staff explain why they called us and what the patient's situation is than for us to continue to give the family the 3rd degree. They are in complete agreement and the son explains he's just surprised to see someone sticking up for his mom who has never even met her before.

I don't get into it further because the medic is working with the patient and I want to make sure I'm on top of what is going on and what he needs from me, but ultimately I just want to make sure that our patient gets our best help which means knowing what the heck is going on. Things clear up a little after getting some more information and we have an uneventful trip to the hospital. The ER is packed and they don't have a room for our patient, so we wait in the hallway with her for more than a half hour and I continue to chat with her and keep her occupied. I actually don't mind the wait because the ER staff is attentive to our patient even though they don't have a room for her, and the doctor who had seen her earlier in the day came down from the floor to take care of her specifically since the ER was so busy. That is the kind of care I can deal with and I will be patient all day if you can show me that you give a care and that I'm leaving my patient in a good place.

19 December 2006

In need of body work

I was called a grandma the other day by one of the young punks on the ambulance. I turned up my hearing aid, shook my cane at him and threatened him with boxing his ears if he came over close enough to the couch. Everyone continued to mock the "old lady" truck, because I was riding with a partner who was 32. Ancient, I know.

While there are physical demands to being on the ambulance, I don't particularly find this job to be that bad for my body yet. I have more lingering issues from previous problems that ache and pain me on any given day. Knee surgery, ankle injury, wrist surgery, that weird pain that runs the length of my left fibula, the list goes on.

My tendency to fall down stairs only adds to my problems though. Three weeks ago, I slipped down the last 4-5 stairs in my house. I was, of course, carrying two bags and a lunch box so I didn't have a hand to grip the railing to try and stop my fall. Thankfully, one of the bags had my linens and pillow for staying overnight at the station so at least I hit my head on that and not the stair. But that didn't save my back or shoulder blade from bouncing down the stairs. It took less than a day for my back to give a loud snap and have my shoulder pain disappear. The lower back pain has been a whole other issue.

The spot I hit was just to the spinal side of my hip bone. Thankfully, not a place with a lot of muscular attachments needed for lifting patients, so I've been able to continue doing my job. But, it is a place that causes a fair amount of pain - when I sit, when I lie, or just when I reach the end of the day. No, I haven't been doing the appropriate ice and ibuprofen because I keep telling myself this is going to go away. That the large lunp is nothing, maybe just a knotted muscle. I've been to have my back adjusted twice, to no improvement. I had a routine physical last week and kept mum about the pain, although I did comment to the doc about having fallen down the stairs. Really, it will go away, I think.

I think what I need is one of those "Overhaulin'" type shows where someone hauls me away for a week, scrubs off the rust, lubes all the joints, fixes all the squeaks, and slaps on a bright, shiny coat of new paint. Anybody know someone?

15 December 2006

10 hours of 911

0700: Truck check. Allow OCD tendencies to take over until truck is pretty on the inside. No time to clean the outside as the rotation of 911 ambulances has put us out next.

0830: Dispatched to chest pain. Transport high stress/anxiety patient with no cardiac history, unremarkable EKG. Medic takes 2 tries to get IV with patient screaming about how much it hurts.

1000: Dispatched to heart problem. Transport patient with confusion, mild chest pain, dehydration, extensive cardiac history, unremarkable EKG. I miss the IV, medic hits one.

1115: Dispatched to fall with head injury. Find patient who fell getting out of wheelchair and wants help to stand up and get back in chair. Find three adults and 4-5 kids in house not helping patient, wife hollering "I told you the next time you fell I was going to call the ambulance!!" Help patient up, quick assessment, no transport.

1200: Lunch.

1230: Finally get chance to wash outside of truck. Medic finds me just as I'm finishing up and complains I didn't ask for help. Unenthusiastic response to earlier request for truck washing made me fairly sure asking for help was going to cause ill will. We are again next out before I can finish washing, but the EMS gods are good to me and I finish before our call.

1300: Dispatched to medical clinic for heart problem. Ask if medic is bad luck for cardiac calls today. Find tachycardic patient (155 bpm) with "palpitations". FD assists moving and loading. In truck, medic asks for patient to be hooked to defibrillator pads and gives adenosine. Patient's heart rate slows to below 30, before running back up to 130. Drive lights and sirens through city. Patient's heart settles down to 108 before we clear the hospital.

1415: Fuel truck. Settle in to couch to watch TV, read, play on internet as we are still 3rd in line for calls.

1630: Dispatched for motor vehicle accident. Find 2 cars in front-end collision, one car with woman and baby, other car with no driver. Police say driver went to get her purse from building. Medic assesses woman and baby, no injuries and no transport. Other driver reappears, I assess, no injuries and no transport. Clear the scene, head back to station for paperwork.

1720: Finish paperwork after begging times from dispatch. Get lecture on how we're supposed to wait for them on the computer, but the call wasn't over because the fire engine was waiting for a second tow truck. Out only 20 minutes late.

So there it is, a reasonable day - not too many calls, not too few, and really only one patient that needed an ambulance, others that just needed the reassurance that comes with being evaluated by trained professionals.

12 December 2006


So, yeah, I've been slacking off again with writing. It seems to come hand in hand with either being crazy busy or entirely asleep. If I'm busy, there's stuff going on and no time to write. If I'm not busy, there's time to write and nothing going on to write about. Only when I hit that sweet spot in the middle do you hear anything here. Nothing too exciting lately, no word back yet on the cardiac patient, so just a reflection here on my changing role as an intermediate...

I worked a 24 at the ambulance co. recently and ended up doing calls with three different medics. Two of those were "stay and play" medics as opposed to "load and go" medics. The stay and play medics are those who want to do nearly everything on-scene, or at least in the ambulance at the scene, so they have everything together and organized by the time we're rolling. I can understand it because a lot of the transport times in the city are short so if you want to have time to double-check yourself, you have to finish most of it before you roll.

Before this shift, I've been mostly with load and go medics - ones that want the patient in the truck and on the road as quickly as possible, with everything accomplished en route and if we don't get time to do something, well that just leaves the hospital something to do. These have also been the medics of the mindset that if you aren't going to use an IV for something specific, then don't start one. Goes back to efficiency because if you don't have to wait to start an IV, then you are that much faster to transporting.

I'm not yet falling in support of one side or the other, just noticing the distinct dichotomy first-hand and the difference it makes in the turn-over time between calls and the pacing of the day. Stay and play medics spend longer with each call making the break between calls shorter, but you really do feel busier all day. Load and go usually falls in line with getting the patient to definitive hospital care quickly when they need it, and getting them out of the truck quickly when they don't need it. I think both methods can be appropriate for specific patients, and I've seen people who tend towards one type utilize the other when a specific situation calls for it. I'm learning how to cooperate with both methods and how that changes my role on scene, so hopefully I'll be able to blend smoothly with anyone I work with.

06 December 2006

Witnessed arrest

FD Dispatch: "Truck A, Ambulance X respond to [address] for a fall. Caller was hysterical and hung up on 911."

That's gotta be some fall for someone to be that hysterical. Enroute I hear the truck and ambulance sign out on scene with no further update. Scene was less than 3 minutes from the station, but more like 8-9 from my house.

Arriving on scene, I walk in to the kitchen to find a average-sized middle-age woman on the floor, shirt cut off, one medic intubating, one FF doing chest compressions, and the other medic adjusting leads and preparing to defibrillate again, calling out meds and rhythms for the other medic to discuss. I wait for an opportune moment to see what I can do because everything looks like it is being done, and get assigned to bring in the drug box, then the backboard (already in the house) and prep the stretcher outside. On my return, I find her boyfriend standing very close to everyone, crying and freaking out (understandably). I gently move him away a bit and start pumping him for information on the patient, name, DOB, meds, allergies, history.

After he's able to calm down a little because he's got something to help with, he fills me in, 43 years old, negative history, negative meds, just engaged 2 months ago, they were working on the garage and she went into the house to get something they forgot. Patient was in the house with her daughter, reported feeling dizzy and went down like a ton of bricks. Bystander CPR started before FD arrival. At this point, he is crying again and asks me if she's alive, does she have a pulse? I take a quick look over and see active chest compressions, electrical activity on the heart monitor (when they stop compressions), and see the seriousness with which they are continuing to work and not prepping to leave and tell him that she does not currently have a pulse but they are still aggressively working and we'll do everything we can for her.

The medic decides he's ready to roll, so out we go, compressions in progress, into the ambulance and the additional meds. They keep working on her in the truck, including starting her second IV in the external jugular (a great big neck vein). I'm sent back in to clean up the mess - wrappers, paper, saline, plastic, all the debris of a working code. I finish up quickly and find the ambulance still outside, so I'm back in, and get handed the BVM to maintain ventilations. Second medic is out and we're off.

I'm ventilating, chest compressions are going every time we can't find a pulse because she's back and forth as to whether her heart is beating hard enough to create a pulse, and drugs are going through the IV or on a drip. The medic exhausts the supply of 2 of the 3 drugs he's been pushing and eventually there's nothing left to do but keep ventilating, watching the monitor, and checking for a pulse. We see a little V-tach, some V-fib, something nobody recognizes, and even a few sinus beats from time to time. Patch to the hospital goes by phone instead of radio to prepare them for what we're rolling in with, but there's no way to summarize the massive amount of work that has gone on, so the medic hits the highlights - her current state, the meds in and the shocks delivered. Another ambulance at the hospital sends out crew to help us get inside with the assortment of attachments and the doctor starts checking for the all-important pulse. He gets no radial pulse. Possible faint but intermittent carotid pulse, he isn't convinced. He listens to her heart - and hears it, we haven't lost her yet.

I don't know right now how she fared. I wasn't feeling optimistic when we left the hospital because they had the lights off in her room and were looking for her finacee. I may find out tomorrow because that crew is on duty again. This was the first working cardiac arrest I've ever been a part of, and I have to say that it was pretty near how I imagined it. Heart-wrenching to interact with the family, but otherwise too busy to have emotion in the way of getting the job done. The ambulance was on scene for half an hour, which was much longer than I would've expected. My role was minor, and I expect the scene would've affected me a lot more if I'd been ultimately responsible for her care rather than following the medic's lead.

05 December 2006

Transfer of care

I had a discussion last night with K about something that has been bothering me for some time - I promise, he brought it on himself, I didn't offer to talk about it. The problem is especially highlighted in a combination professional/volunteer department like the FD where not everyone arrives on scene at the same time because the volunteers respond POV rather than from the station. When everyone arrives at the same time, the process is basically this:
  1. Gather information about what happened from what you can see,
  2. Initiate patient contact, begin to set up rapport and patient trust,
  3. Gather information from patient and/or bystanders,
  4. Provide patient care and/or transport,
  5. Transfer patient care to hospital by radio patch and then verbal report to the nurse/doctor.
Seems reasonable enough, yes? Where the problem occurs is when steps 1-3 are completed by somebody else before I arrive and I'm expected to take over at step 4 with little to no information. (It isn't just me, I'm just going to speak to my own experience.) Patients are confused by this sudden "abandonment" of their providers and why they have to re-answer questions, and frequently, answer questions that didn't need to be asked initially because people could see what was happening.

I do NOT think that anyone should delay patient care to wait for everyone to arrive on scene. I DO think that treating a transfer of care between FD personnel on scene with the seriousness and detail that transfer of care to the hospital is treated would be valuable. Why is anyone detailed with the hospital? Because they can't see what happened and they lose all that information unless EMS or the patient provides it to them.

I would like to think that even if a medic on scene has decided that a patient isn't critical, it would be good experience for whomever is taking over patient care to have enough information to understand how he reached that decision. Here's the incident that sparked this conversation with K:
Dispatched to a SNF for a patient who had fallen and was bleeding from a head injury. I arrive on scene and find the patient sitting on the stretcher with bandaging just being finished on her head. I help carry equipment back to the ambulance and get in to help with whatever else needs to happen before we transport. Everyone else stays outside, the medic on scene hands me the demographics and medication list from the facility and tells me the patient is all mine - simple "fall down, go boom". I catch him before he closes the door and ask a couple of questions (including whether they took vital signs inside), which are grudgingly answered and he hops up front to drive before the other volunteer even arrives on scene. I start talking to my patient, taking vitals, history and so on and I discover that I'm not sure she's as okay as everyone makes out. I start her on O2, hook her up to the heart monitor and see something that looks like maybe atrial fibrillation or flutter - which she has NO history of. We get to the hospital without any issues and I'm trying to talk to the nurse about what I saw and the medic interrupts with, "Yeah, she's 80, who doesn't have atrial fib?" When I'm trying to write my report, I have to chase him all over the emergency department to get answers about what happened before I got there. Very frustrating.

03 December 2006


As always, it was nice to see K's family - not the circumstances, but the time spent with them. The funeral related time was difficult, it is hard to see people you care about in pain. I'm not a big fan of viewings and there was seven hours straight on Wednesday with a lot of crying and mourning. K's grandfather didn't look much like I remembered, but several people who had seen him last week said the same thing, so I think it was a matter of the missing glasses and the makeup that masked all the age lines that make such a characteristic part of his face. K seemed to hold up fairly well, he had done a lot of his mourning after his last trip out there.

The service was fairly short, but it was hard to hear him eulogized by church people who had only known him the last four years and only really interacted in that one facet of his life. He had rediscovered faith in his last decade or so and many of the stories I had heard over the years did not quite jive with sermon we heard at the service, but if the spiel brought comfort to someone there, then I suppose it was worth it.

As a family, we relived a lot of memories, K's grandparents coming as Raggedy Ann and Andy to K and my halloween wedding, fishing trips and times in Florida, compassion and friendliness - this is a man who didn't really have any strangers in his life, only people he hadn't met yet. The first time he met my parents, he reassured them about my moving to Michigan because no matter what happened with K and I, they would be there for me. We will all miss him greatly, but are relieved to know that he no longer has to struggle with the pain and confusion that have marked his last time with us.