So how do I, as an ambulance worker, end up on the evening news? The two most recent cases were a car accident where one patient was severely injured and trapped in the vehicle for an extended period of time (giving the news crews time to get there) and a fire that sounded bigger than it was where the news crew happened to be in the right (or wrong) place at the appropriate time. For whatever reason, our local news LOVES to have footage of EMS or fire departments in action. Maybe it is the sense of importance and tragedy, but I tend to think it is because they don't show the patients and they want to have something interesting which makes the whole event seem exciting. Mostly, we avoid the cameras by being as quick to get the patients off scene as possible. No faster than is appropriate for the patient, but hopefully faster than the cameras show up.
The crews at my station hate being on the news. Firstly, it makes everybody harass you because they never fail to use that 3 seconds of footage where you scratched your butt or stood there looking stunned and ridiculous. Secondly, it gives your supervisors and higher management the chance to see you on scene in a way you may not have been expecting. Not a big deal for me as I wear my ugly neon green reflective coat and non-latex gloves all the time and I try to abide by safety regulations, but there are always folks who assume that nobody is going to see them on scene and that they will get away with doing something they shouldn't be doing. Seeing yourself on the nightly news quickly cures you of that illusion. Heck, in a state as small as NH, just talking to people should cure you of that illusion because there is always somebody around who saw you at XYZ place or with Mrs. So-and-so on your stretcher and wants to know all the dirty details.
28 January 2008
21 January 2008
Life
After running two pregnancy calls in two days where it looked very likely that The Asian was going to be cleaning and warming newborns, I was prepared for our truck to be ushering new life into the world. I was not prepared for what we got instead.
Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."
At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.
I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.
After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.
Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."
At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.
I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.
After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.
12 January 2008
Downside
EMS routinely puts patients on long spinal immobilization boards to prevent further spinal injury. And when we do, the goal is complete immobilization, no movement at all. Which is great, until they need to vomit.
Standard protocol for people vomiting when immobilized is to roll them on their side. But once you've secured the backboard to the stretcher, there isn't enough slack in the seat belts to easily roll the patient. If you're in the ambulance, you can reach over and open the belts and roll the board. But if you're walking the stretcher into the hospital room and then the patient starts to vomit, you aren't really in a good position to loosen everything. And if you're at the head of the stretcher, you are in the wrong spot.
Speaking from experience, this results in a vomit-covered EMT. The only entertaining part was that this guy had such force to his vomit that it was everywhere. I guess in the end it was good that I was the one covered in the vomit because I was the only one not dry-heaving or actually vomiting at the sight/smell. Glad I could be of service.
p.s. my camera just came back, good as new, so the pics of the kitchen are better now.
Standard protocol for people vomiting when immobilized is to roll them on their side. But once you've secured the backboard to the stretcher, there isn't enough slack in the seat belts to easily roll the patient. If you're in the ambulance, you can reach over and open the belts and roll the board. But if you're walking the stretcher into the hospital room and then the patient starts to vomit, you aren't really in a good position to loosen everything. And if you're at the head of the stretcher, you are in the wrong spot.
Speaking from experience, this results in a vomit-covered EMT. The only entertaining part was that this guy had such force to his vomit that it was everywhere. I guess in the end it was good that I was the one covered in the vomit because I was the only one not dry-heaving or actually vomiting at the sight/smell. Glad I could be of service.
p.s. my camera just came back, good as new, so the pics of the kitchen are better now.
06 January 2008
Non-writing holiday
Okay, so I haven't been posting. Honestly, we've been working on the kitchen and I've been rocking out to Guitar Hero. I got kinda bummed about my camera, so I haven't been keeping up with photos of all the kitchen work either. K and I put together some camera phone pictures so we could post something at least, check out the recent work on the right.
Today we worked 6 hours on the kitchen and got a bunch of the backerboard for the ceramic tile done, should have the rest finished tomorrow. Tile itself will probably have to wait until Wednesday when we're both around because I don't know how to run the wet saw and it is on loan from someone.
Work has been going okay, there's been a lot of little annoying stuff going on with management, but nothing I feel reasonable writing about. The Asian and I made the evening news twice in three days (damn, two station lunches!), once for a doozy of a MVA and once when we hauled off the only smoke inhalation patient from a fire.
Living in NH during a campaign season is extremely annoying. Large mobs of political supporters on many corners, freezing, shouting, and swinging signs. Thankfully, no ambulance calls for political-related assaults or injuries yet.
I'll try to be better about posting. Biochemistry class starts on 1/23 and yes, the plan is to be done with the kitchen by then so I have time to study. Later!
Today we worked 6 hours on the kitchen and got a bunch of the backerboard for the ceramic tile done, should have the rest finished tomorrow. Tile itself will probably have to wait until Wednesday when we're both around because I don't know how to run the wet saw and it is on loan from someone.
Work has been going okay, there's been a lot of little annoying stuff going on with management, but nothing I feel reasonable writing about. The Asian and I made the evening news twice in three days (damn, two station lunches!), once for a doozy of a MVA and once when we hauled off the only smoke inhalation patient from a fire.
Living in NH during a campaign season is extremely annoying. Large mobs of political supporters on many corners, freezing, shouting, and swinging signs. Thankfully, no ambulance calls for political-related assaults or injuries yet.
I'll try to be better about posting. Biochemistry class starts on 1/23 and yes, the plan is to be done with the kitchen by then so I have time to study. Later!
26 December 2007
He has a what?!?
He had a pulse folks. Un-freaking-believable. I was beginning to think that the whole "CPR saves" mantra was solely effective marketing by the AHA. Blah-blah-early CPR-blah-blah. I was finally on a call with a patient who went from asystole back to a perfusing rhythm.
The Asian, the stu' and myself were dispatched for a cardiac arrest. Nothing like that dispatch to put a spring in the step of a stu; he nearly ran to the truck. Workable arrests are highly prized for paramedic students because it gives them the opportunity to practice a number of skills and have procedures checked off their list all in one fell swoop. The usual review of what equipment to take in and our division of responsibilities happened on the ride over. Update enroute with CPR in progress.
On arrival, we find out CPR had been in progress from pretty much the moment the arrest happened because there was an off-duty city FF on scene. The engine crew took over when they got there, no shock advised on the AED and they had a good combitube airway, so this patient was getting everything he should be and mighty fast. Our stu dropped an ETT, I got the IV and the first round of drugs into the patient, patient on to a backboard, onto the stretcher and out to the truck. Transport initiated within 10 minutes. More drugs and an IO enroute and just as we're pulling into the hospital parking lot, he has a pulse.
I get to the back doors to help pull the stretcher out and am surprised to hear the good news. We roll the patient inside and The Asian starts giving report as the rest of us are working on moving the patient into the hospital bed. I look up and see a nurse doing chest compressions and loudly state that our patient has a pulse because clearly she missed that part. Thankfully she only got in 3 or 4 before I stopped her, CPR on a living person is not so good for them. Doc gave us the thumbs up for the good work. Update before the end of shift (6 hours) was that patient was in the ICU and had actually opened his eyes at one point. I haven't been able to check in again to find out whether he had any brain injury from the arrest, but as far as I know, he's still alive.
The Asian, the stu' and myself were dispatched for a cardiac arrest. Nothing like that dispatch to put a spring in the step of a stu; he nearly ran to the truck. Workable arrests are highly prized for paramedic students because it gives them the opportunity to practice a number of skills and have procedures checked off their list all in one fell swoop. The usual review of what equipment to take in and our division of responsibilities happened on the ride over. Update enroute with CPR in progress.
On arrival, we find out CPR had been in progress from pretty much the moment the arrest happened because there was an off-duty city FF on scene. The engine crew took over when they got there, no shock advised on the AED and they had a good combitube airway, so this patient was getting everything he should be and mighty fast. Our stu dropped an ETT, I got the IV and the first round of drugs into the patient, patient on to a backboard, onto the stretcher and out to the truck. Transport initiated within 10 minutes. More drugs and an IO enroute and just as we're pulling into the hospital parking lot, he has a pulse.
I get to the back doors to help pull the stretcher out and am surprised to hear the good news. We roll the patient inside and The Asian starts giving report as the rest of us are working on moving the patient into the hospital bed. I look up and see a nurse doing chest compressions and loudly state that our patient has a pulse because clearly she missed that part. Thankfully she only got in 3 or 4 before I stopped her, CPR on a living person is not so good for them. Doc gave us the thumbs up for the good work. Update before the end of shift (6 hours) was that patient was in the ICU and had actually opened his eyes at one point. I haven't been able to check in again to find out whether he had any brain injury from the arrest, but as far as I know, he's still alive.
24 December 2007
Open letter
Dear admissions offices,
I recognize that crushing people's hopes and dreams is just part of the daily routine for your office, but I request that you have a little bit more consideration as to when it happens. Applicants all want quick decisions so they know what to plan and prepare for. I would just like to ask that you please not send rejection letters on Christmas Eve.
I'm not a particularly religious person and I don't always get to spend the holidays with my family, but that doesn't mean that I would like my Christmas celebration ruined (two years in a row) by feeling worthless and depressed about not being accepted to your program. Obviously, I think you have a good program that would be worth going hundreds of thousands of dollars in debt to attend. Please just wait to destroy my self-worth until after the holidays. I propose that you not send rejections between December 23 and 27.
Thank you for your consideration.
Jen
I recognize that crushing people's hopes and dreams is just part of the daily routine for your office, but I request that you have a little bit more consideration as to when it happens. Applicants all want quick decisions so they know what to plan and prepare for. I would just like to ask that you please not send rejection letters on Christmas Eve.
I'm not a particularly religious person and I don't always get to spend the holidays with my family, but that doesn't mean that I would like my Christmas celebration ruined (two years in a row) by feeling worthless and depressed about not being accepted to your program. Obviously, I think you have a good program that would be worth going hundreds of thousands of dollars in debt to attend. Please just wait to destroy my self-worth until after the holidays. I propose that you not send rejections between December 23 and 27.
Thank you for your consideration.
Jen
19 December 2007
Kitchen update
Okay, I was going to post some more pictures, but if you get to the end of the slide show, you see where the camera gave out. Good news is that it is a known problem for Cannon and they are going to fix my camera, no charge! (M&D - if yours is still hanging around, they'd fix it too.) Bad news is that now you have to wait to see pics, although I may try a few with the camera on my phone and see if they look reasonable enough.
Verbal update, all the cabinets are out, sink is out. All drywall will be finished hanging tomorrow (needs two of us to lift some remaining pieces). Plan is for first coat of mud/tape finished Saturday, hopefully second coat on Sunday/Monday. After that, primer + texture + paint ceiling, replace the rotted piece of subfloor which was under the sink, and on to tile! No timeline yet for finishing, too much left to do and too many variables for work that will take two of us vs. work that can be accomplished with only one home and all the conflicting schedules.
Re: feedback on the format not lining up properly in IE - I tried changing some of the widths and nothing seems to make Exploder happy. Try Firefox.
Verbal update, all the cabinets are out, sink is out. All drywall will be finished hanging tomorrow (needs two of us to lift some remaining pieces). Plan is for first coat of mud/tape finished Saturday, hopefully second coat on Sunday/Monday. After that, primer + texture + paint ceiling, replace the rotted piece of subfloor which was under the sink, and on to tile! No timeline yet for finishing, too much left to do and too many variables for work that will take two of us vs. work that can be accomplished with only one home and all the conflicting schedules.
Re: feedback on the format not lining up properly in IE - I tried changing some of the widths and nothing seems to make Exploder happy. Try Firefox.
18 December 2007
Quotable
Sometimes patients say hilarious things. Sometimes the entertainment comes from somebody else on scene. The Asian had the misfortune to be the source of this story, and I will now tell it to anyone in the station who hasn't heard it - every time he gets on my case for something. Dirt is good.
On scene with PD and an extremely intoxicated "psych problem". Eventually we get the patient heading down the stairs, The Asian in front and me behind. On the way down, The Asian asks how much the patient has had to drink. Patient replies (every one in the field knows this answer!), "Two." "Two what? Beers? Cases?" PD comments that the patient prefers vodka. Patient answers, "Fifths."
Asian decides to be funny, "Two fifths?! Why didn't you just drink the whole thing?"
Upon realizing that he honestly doesn't realize that two fifths means two whole containers of vodka (The Asian doesn't drink), I try to contain my giggling while explaining what the patient meant. PD wasn't quite so polite at containing the guffaws. Later, I find myself additionally amused that my partner really thought the patient could do math in that intoxicated condition.
On scene with PD and an extremely intoxicated "psych problem". Eventually we get the patient heading down the stairs, The Asian in front and me behind. On the way down, The Asian asks how much the patient has had to drink. Patient replies (every one in the field knows this answer!), "Two." "Two what? Beers? Cases?" PD comments that the patient prefers vodka. Patient answers, "Fifths."
Asian decides to be funny, "Two fifths?! Why didn't you just drink the whole thing?"
Upon realizing that he honestly doesn't realize that two fifths means two whole containers of vodka (The Asian doesn't drink), I try to contain my giggling while explaining what the patient meant. PD wasn't quite so polite at containing the guffaws. Later, I find myself additionally amused that my partner really thought the patient could do math in that intoxicated condition.