24 April 2008


I'm a bit lacking in focus right now. Again, I'm questioning my path, mostly by trying to answer the questions everyone else has for me. To medical school? To a foreign country? Maybe D.O? What would make me happy?

Right now, just studying for my class (see fun photo from lab with my new camera), working on the ambulance, and being crazy enough to take on a small amount of work at the office job again. So, maybe people could ask me questions I'm ready to answer. Like the enzymes of glycolysis or energy production from the citric acid cycle.

19 April 2008


The ambulance company has been having morale problems for quite some time now and the peon grumbling was finally loud enough for management to notice. Constantly changing paperwork requirements leading to crews being threatened for incomplete paperwork, government fines, being promised and trained for new equipment that never arrives on the trucks, and generic job dissatisfaction all pop up.

So what is management to do? Well, if you're a fan of Dilbert, observant of management in general, or just pessimistic, you're probably guessing that they implemented something which does not actually address any of the problems. I'll just call it the "Superstar!" program (envision SNL's Molly Shannon in classic cheerleader lunge wiggling fingers at you). We are to nominate employees who go above and beyond the call of duty; said employees are entered into a monthly drawing to win a prize to be named later, usually a gift certificate or something reasonable at least. My issue isn't with the desire to recognize good employees - the point is that it doesn't actually address the problem and, at least at the north station, has become an object of ridicule.

Yesterday was another ambulance day where we mostly drove around helping people rather than transporting them or providing much medical assistance. We spent an hour with a diabetic, went for a medical alarm activation, a couple of accidents, someone with pancreatitis. On several of these calls, The Asian did things that were truly above and beyond, including cooking lunch and calling a utility company. These are not things he does for recognition, but things he considers part of his duty as a patient advocate. But that doesn't mean that I don't get to spend most of the afternoon telling him he was a "Superstar!" and I was going to send my nomination immediately and others in the station coming up with all sorts of things he's done which could potentially nominate him. He actually already got nominated one month, but I didn't have anything to do with that one. I guess it helps morale because it gives us a common object of ridicule, but really, we don't need help with that.

What would actually help?
  • Employees being held to the recognized job standards. If you're not doing something you're supposed to do, or doing a shitty job of it, something should happen. Not necessarily being immediately fired, but some sort of discipline where you understand that this is not acceptable.
  • Understanding that sending paperwork back to crews for errors made by discharging staff is ridiculous, without having to listen to 4 weeks of crew complaints before they figure it out.
  • Hold off on training about equipment to come until said equipment actually arrives. Many of us have already lost our passwords for the new electronic patient care reports and nobody even knows when the computers will officially go live.
  • Pay equity.
  • Supervisors responding to problems in the station sometime before they become critical, quick examples: a toilet that leaks so long that the hallway 8 feet away smells like pee, a water leak inside that covers two beds in mold.
These are concrete things that could've been done instead of the token popularity contest, but they are also things which would cost time or money. I will at least give credit that things are improving slowly (the two problems above are being addressed) and I'm not sure where the motivation finally came from, but I'll take what I can get.

10 April 2008


I'm struggling to keep my chin up right now. Affirmations all around, "I'm good enough. I'm smart enough." But how do I convince people who sit in judgment without even knowing me?

Dear Applicant,
We're sure that you're very wonderful and everything you claim to be, but you're not going to be that here at our school. We've found dozens of more interesting and more qualified people to fill our class. Good luck in your career! (you're going to need it!)
The School You Wanted to Attend

Okay, the last letter I received over the weekend was actually a wait list letter and not a rejection letter, but after my experience on this very same wait list last year, I'm not getting my hopes up. I'm damn tired of waiting.

Two suggestions that are starting to sound more and more realistic, go to school in the Caribbean and hope I can score a residency, or target the schools in the least desirable locations with the worst reputations. Another more plausible suggestion was looking into D.O. programs instead of M.D. programs, but I'm not sure that I'm open-minded enough for the other students (it isn't the general philosophy/teaching that worries me). The thing that keeps running through my mind, maybe they're right and I don't belong as a doctor at all.

03 April 2008

Incident command

At every level of EMT training, you learn about incident command. Specifically, the fire department senior officer is in charge. Emphasis on period, regardless of the type of "incident". Most departments use the National Incident Management System because the government has decided that is the training required to get a hold of the all important $$$. This system is really intended for large incidents where you need a staging area, different operational groups and levels of command. But, working with fire departments I encounter officers with varying interpretations of their responsibility.

The vast majority of the fire officers are EMT-Basics and are happy to be involved in coordinating their firefighters with the ambulance folk, telling us where to park, how we're going to extricate the patient and helping carry them, performing the complicated and technical extrications that can be required, breaking whatever necessary to get us to the patient's side, even providing patient condition updates en route since they arrive before us, and generally being reasonably helpful and not too obtrusive. As far as actual medical care, most defer to the paramedic on scene, recognizing that the additional education and training usually allow them to make good patient care decisions. All is happy smiles in the world of intra-agency cooperation.

Then there are the other officers, and sometimes firefighters, who want to be in "command" of everything on scene. One particular officer in the city has been an on-going problem for me. Now, he is a paramedic himself, with a number of years of patient care experience prior to the FD becoming a non-transport agency and no longer working elsewhere as a transporting medic, so the issue is not one of education and training. He is in charge when he is on scene unless there is a captain or chief of some rank there, which is rare for EMS calls. He likes to directly "command" every aspect of a scene, including all decisions on patient care, to the point of actively interfering when something is not being done per his assumed course (even if he hasn't told anybody what that is). Where the difficulty lies is that he is not the medic whose ass gets chewed by the doctors if something is not to their satisfaction.

Just one quick example: The Asian and I arrive on scene for an overdose patient, unresponsive in a parking lot at night, maybe 40-45 degrees outside. When we get to the patient, the firefighters are searching the man's pockets for ID to give the police, the officer is talking to PD with the friend who found the patient trying to get noticed. I don't know what to make of this at first, is he dead? is he fine? why isn't anybody treating the patient?

I start assessing the patient, who has a pulse, is breathing adequately and protecting his airway, but is distinctly unresponsive. He is laying next to a car which is blocking all ambient light. I've got baseline vitals and tell The Asian I'm heading for the stretcher so we can move the patient into the truck where it is 1. warm, 2. safe, 3. light. As we get the patient onto the stretcher, the officer decides that we are not allowed to move the patient until we drop an OPA (oropharyngeal airway) to protect his airway. The Asian and I both pretty much ignore him and continue to the ambulance because, since we actually assessed the patient, we're not that immediately worried. When we are nearly ready to leave, The Asian asks if I can go find the pt's friend to try and get some additional information on the overdosed drug. The officer blocks my path and refuses to help locate the friend, instead demanding repeatedly, "What do you want to know?" He never offers any information, and I'm not sure what exactly the question was. Finally, I find the friend the question gets answered and off we go.

This officer follows us to the hospital and demands all sorts of attention and action, eventually keeping his crew out of service at the hospital for over an hour waiting for our supervisor to come address the issue. Which boiled down to respect. He felt we did not respect his command of the scene. Well, I couldn't really argue with that point. The problem is that you lost your opportunity for respect when the crew that you really should be in command of was not caring for the patient and you did NOTHING.

I followed up with some of the management folks on this and was told that I am to do whatever this officer says, when he says it, regardless of what I think about it. He is in charge of the scene and paramedic, or basic, or first-grade nosepicker is irrelevant because the officer on scene will always be the first one on the legal hook. I find this both ridiculous and unbelievable and struggle with it every time we encounter said officer. I don't even want to go on calls with that engine because I always wonder if he's going to be there.