21 September 2008


The weather is running circles around me. Today, no forecasted rain, just "possible drizzle" in the afternoon. Just as I'm getting ready to run, I have to double check the time of day because it is now VERY black outside, followed by thunder and a downpour. WTF? I check the local radar and the only storm anywhere on the doppler 8 million in the entire state is immediately over my house. Well, I can take a hint, but I still have to run today. I'm leaving to give it a try, wish I had a lightning deflector of some sort.

16 September 2008

Main event

Ladies and gentlemen, guys and dolls, welcome to tonight's main event. Sponsored by the ambulance co., the police department and a lovely drinking establishment that refuses to say when if there is more beer to be sold.

In this corner, we have The Asian, wearing the blue uniform and hailing from the southern U.S. A record of 5-3-1 and a reputation for being brutally honest.

In the other corner, we have Drunky, wearing the latest in trashy bar fashion and hailing from our great city. A record of 0-0-0 and a reputation for flapping her gums at every passerby.

Let's get ready to r-r-r-r-r-u-u-u-u-u-umble!

The Asian is out of his corner quickly with a sneaky patient steal maneuver, getting the assault victim into the ambulance with no regard for Drunky. He sways a little to avoid her hand on his arm and closes the door. Well folks, this one might be over in the first round as he settles in to treat his patient.

Wait! Wait! Drunky isn't going to take this lying down - she's on her feet and heading for the door. Oooh, that is a triple door slam followed by a shout to the open slider window ("Hey! I'm covered in her blood and need something to clean up with!") and another triple slam for good measure. He can't ignore this auditory onslaught.

Sure enough, here it comes! A quick verbal tap to the forehead followed by the cold shoulder, he should patent this one and charge admission. She's still full of bluster but has to turn back to the crowd to find her courage, this medic isn't going to fold as easily as she thought. Where's the respect and adoration? Where's the gratitude for helping that victim? She stopped that girl's nosebleed all by herself. She's gotten herself back into full rage mode and refuses to be ignored.

Back with the old standby, two triple door slams in quick succession. But hold on to your hats, now the patient jumps up and starts defending the Asian. Nobody agreed to a tag team match, one at a time, save the rest for the pay-per-view rematch! There it is folks, the knockout punch directly to her pride. The killer dismissal ("Whatever, princess.") and this match is over! The Asian has the last word, a happy patient and leaves the scene with no regard for Drunky who is set on slow boil.

Stay tuned folks. See who steps up to take on the medics next week.

15 September 2008

I think she missed the point

Dispatched for an assault, person choked by their neighbor.

On scene, find three little girls running around the sidewalk, one of them flagging us down, and a trashy-looking woman coming out of the door at the address. I walk to the woman, the medic to the girls. "What's going on today?" "That little brat was fighting with the neighbors." "Who are you to her?" "Her mother. Not that she listens." "And she got choked?" This is followed by a string of profanity about her daughter and fighting all the time with the neighbor kids and a whole lot of nothing useful.

"Do you want us to take her to the hospital to get checked out?" "Hell no. There's nothing wrong with her. (At least we agree about that!!) She called 911, ask her what she wants." "Ma'am, you're her legal guardian, so if you don't want us to take her to the hospital, I need some information from you and your signature." "You know, someone should teach these kids that 911 is serious business." "Yes ma'am, somebody should."

Amen sister, somebody should teach this kid a whole lotta things she doesn't seem to know before she gets any older and a not-so-gentle man teaches her some of the other things she should've learned at home.

11 September 2008

I remember

I remember sitting in a conference room watching smoke pour from the buildings, seeing one fall and asking out loud "Did that building just fall down?" because the TV person hadn't acknowledged it. I remember being horrified at the thought of the fire and police at the base of the building. I remember getting the scariest phone call of my married life from K, telling me the volunteer department he was with was sending people and equipment and he was going. I don't know how it is appropriate to "memorialize", but I remember.

10 September 2008

Paperwork in a paperless system

We finally transitioned to electronic patient reports earlier this year, the so-called "paperless" system. The old system involved a single, legal-sized sheet, with 3 carbon copies attached. Patients and facility staff signed the back of the top sheet for all the legal and billing junk. We left a carbon in the patient chart, a carbon in a mysterious box that was supposed to go to the state, and one carbon and the original back to the station for billing and whatnot. Transitioning to the computers was not a challenge though dislike the software because I think it is a disorganized muddle of patient information. Somehow the printed version of it which is faxed to the hospital seems reasonable, but trying to figure out which window had which aspect of patient information was an annoying hurdle when it could have been an intuitive breeze.

The Asian and I have a system that makes us very efficient in turning over emergency calls. The person in the passenger seat starts the computer form with the dispatch information like address, dispatched complaint, which fire engine is responding, etc. while we are rolling to the call. (This takes second seat to helping the driver navigate, if needed, but usually the driver is fine until we're pretty close to the call and the computer work is done by then.) On arrival, one of us starts entering info like patient medications, medical history, date of birth, vital signs from the firefighters, basically as much as we can get and still deliver efficient patient care. Anything that doesn't get entered on scene usually gets entered on the way to the hospital, leaving only the billing information, signatures and narrative to write at the hospital.

Transfers are a slightly different beast. We use the same software, but not everything can go into the computer. There is a separate form for EVERY transfer that involves somebody from the hospital certifying that it is medically necessary for this patient to transfer by ambulance. This form has been the source of a massive number of headaches since just before the transition to the computers. Now we are being told that the crews have to make sure everything is accurate on the form, which we are not allowed to write on and not allowed to make changes to. Rarely, this form is filled out by the MD which saw the patient and is never available for questions/changes at the time of transfer. More often, this form is filled out by a "discharge planner" who may or may not be an RN and may or may not actually read the form prior to randomly checking boxes and signing the bottom and is rarely available for questions/changes at the time of transfer.

First, the crews were the ones taking the brunt of staff resentment at having to fill out this stupid, unclear form and having to tell them either they fill it out or we're not taking the patient. Finally, enough issues were addressed that staff just accepted our form as another hurdle to getting the patient out the door. Crews were told that we just needed to accurately document the patient's condition in our narrative and billing would address the inconsistencies. Now, the crews are the ones who are going to have to point out that to the staff any inaccuracies in documenting the condition of the patient. "So the patient is bed confined?" "Yes." "Then why is he sitting in a chair having lunch?" "!*@#$%, I didn't fill out the form and I'm not going to fix it."

Good to know everything poo-related still rolls downhill to the crews. It isn't enough to be polite to facility staff, kind and caring to your patients, take appropriate medical care of them, and document observations and treatments accurately. Now, we have to find the political savvy to point out that their paperwork is wrong without causing any offense. This will certainly be easier for some crews and with some staff than others.

09 September 2008

Bath day

Apparently, I didn't need to travel too far to enjoy the benefits of mother nature. On Saturday, New Hampshire experienced the remnants of Hannah. During the day shift, we had some seriously sick people, air quality was bad for several days prior and difficulty breathing was the call of the day. After a shift change nap, I spent all night picking up soaking wet crazy and or homeless people. We started with an elderly man who ignored the "don't drive through water" maxim and found out half way through that his little sedan wasn't going to get through 4 feet of water, the FD actually broke out the boat to get him and evacuated several houses near by that were flooded. Amazingly, by 3 or 4 am the vast majority of the standing water was gone and all we were left with were soaking wet patients.

05 September 2008


At the ambulance co, the inmates are running the asylum. The morale at the north station has gotten so bad that there are days I don't even want to go to work. From the rumor mill, apparently the south station is fine because there are more "established" employees there who just don't give two figs for anyone other than themselves. But here, we are agitated. We are tired of seeing good people leave, tired of seeing people get screwed, tired of having no leadership, tired of bitchy phone calls trying to fill shifts.

I've tried to be a reasonable influence, complain when things are beyond unreasonable, let some things roll off, talk calmly and logically to folks about the issues. I don't know that it has had much effect, but I've tried to keep a positive attitude when I'm at work (at home I let some of the negativity out). So I took a big step, a training position came open and I applied for it. Given the state of things, I don't have high expectations of being hired for it, but that isn't the point. The position allows me to keep working my shift with my partner, but adds the responsibility of helping orient new employees to the company and work with anyone they send for "extra" education. I'm hoping that if I get the spot, maybe, just maybe, I can make a dent on the attitude of new hires. I've given up on the old hacks, but if new people understand that there are folks here who care about the standards we're supposed to be held to and that it is reasonable to try and live to them, maybe that will help.

Or maybe you can just sign me up for the neat white coat and padded room right now.

01 September 2008


I read a fair number of other blogs, some regularly, some when a comment catches my eye, some just because I'm avoiding real work (like now). There is a dichotomy between people who write about their spouse/relationship and people who do not. I have mostly been in the do not crowd, you see mentions of K from time to time, but not too often. He knows I write, he's decided that he doesn't need to read it because it is all "old news" anyway. I suppose he's right because I tend to tell him stories from my day after I've had some time to think and frame the story more like how I would write about it than how it actually happened, you know, HIPPA and all. Anyway, after that brief journey into left field...

A few years back we had come to a point where neither of us was happy and there was much time spent arguing, yelling, crying, stomping, door slamming, the works. We pushed through for a while and eventually decided maybe a third party opinion was needed. After some discussion with the professional, we came to "I" statements. When we argue, we're supposed to stop accusing one another with "you do X" or "you need to stop doing Y" and instead frame the problem differently, "I feel attacked and belittled when you do Y". Very difficult advice, especially when you're mad enough to be yelling as we don't have a lot of arguments that involve calm, rational thought. The problem is, we both heard this advice and we both know that what I'm really saying is "Stop that" not some sort of squishy, namby-pamby, you need to respect my feelings statement, and vice versa. The one big benefit has been to realize we don't have to resolve a fight at that moment. Sure, we have to stop fighting, back off to neutral corners and take a little time, but nobody has to be declared the winner.

Recently, I've been working on negotiation tactics, give a little, get a little, find a compromise. I like to do this out loud, as a conversation between us. K has apparently been doing this on his own, behind the scenes. No, I don't know why, just his deal I guess. The problem with this disconnect is that I don't necessarily know what the heck he's up to. The current scenario involves him constantly being up in my grill. "Where you going?" "What are you doing?" and on and on. When I can answer these questions politely, they are usually followed by some sort of "advice". Which annoys me as I wear big girl panties and can manage for myself, and I know where to find him if I want his opinion. During the discussion/negotiation phase, I've learned that many of these questions are not actually the ones he wants to ask. Instead of "Where are you going?", he really wants to know "Are you hanging around long enough that we can watch that movie we rented?". Instead of "Do you know where you're running?", he really wants to know "Can you tell me where you're going so I know where to look for you if you're not home soon?". Very different questions. For the record, there have been elements of compromise on both sides, but we're still stuck.

So here's the part I'm struggling with...is it unreasonable to expect him to ask the questions he really wants answered instead of the annoying ones? He says that it isn't the questions which are annoying, just my perception of his intention. I need to stop attributing "ridiculous" motives to his questions and just answer him so he can expand on what it is he wants. I think that if I was asking something that was being misinterpreted, it would be my responsibility to clarify, not the listener's responsibility to change their thinking. And around and around we go.