To train or not to train...

You would think this would be a simple and straight forward answer, but it really isn't. I am an EMT-IV Tech, one step above being EMT-Basic, and I am the training officer for our department. You may be thinking 'Yeah? So what?' as I am, but there are others on my department that are having a fit over it. See, I am not the highest level of care on our department. We have one in class for I-99, two paramedics and one RN/EMT-P. The thought is that these people have more to offer as a training officer than I. While I don't dispute the fact that they do in fact have more knowledge and training than I, I don't think it disqualifies me for the position I hold. There is nothing that says that I can't call in other resources to do a training that is beyond my skill/knowledge level and trust me I intend to do just that.

I'm not really sure what I'm trying to get at here so please feel free to chime in and either school my sorry behind or jump on the bandwagon. I'll even scootch over a bit to make room for ya.

Happy Holidays

Seeing as it has been a few weeks since anyone has posted, just thought I'd wish everyone Happy Holidays and a safe New Year.

Lessons learned...

Some people love to train rookies, others hate to do it. My station decided to make me training officer since I always seemed to inherit the rookies so I spend a lot of my rotations training new members or members that just got their EMT certification. Last week's lesson was that even experienced people can make mistakes. Actually it was a two part lesson, the second part is titled "THIS is why I always yell at you to wear your seat belt!" While responding to a call in one of our response cars we had a little mishap that was almost a big mishap and would have turned our crew into our very own mass casualty incident. Everyone was okay and there was no major damage but it really showed them that mistakes happen and the best thing you can do is learn from them and move on. And always wear your seat belt! I joked with the member who was at the station and witnessed the incident that I had planned it all out as a training exercise...for some reason he didn't believe me.

The kicker is this incident happened a few days before the 4Th anniversary of our heavy rescue being involved in an accident while responding to a call. The driver, who is my brother, and the passenger were both injured but thankfully survived. One witness of the accident ran up to help and said "oh my God, you ARE alive. I don't know how." I'm sure that was very comforting for the crew to hear but then again, you don't expect to see a fire truck rolling down the interstate. No charges were pressed as it was caused by black ice but that was a heck of a reminder to our local departments that while we're here to help others we have to remember that we aren't invincible. That's the reason for my post today, we all get complacent and sometimes just have to be reminded that our safety comes first.

Only A Matter Of Time

Answered a first aid call a little while ago, and people just amaze me. Here's a woman that abuses the 9-1-1 system. I've had her as a patient twice in the past week. The first time, she wasn't too bad. But this time.. she was a different person. Bitching and complaining the ENTIRE length of the call. Didn't want to sit on the stair chair, didn't want to climb one small step, didn't want to do this.. Christ. It's challenging trying to be polite and kind to someone who is being nothing but disrespectful and ungrateful, but luckily I managed. It's sad when you go to give report to the RN and she looks at the report and recognizes the name. Long story short, she's at the hospital getting help for whatever her complaint is this time. Probably only a matter of time before she picks up the phone and dials 9-1-1 again though.

Battle for the ERs

"The funniest thing I ever heard a nurse say was that Paramedics don't belong in triage. "

I am not anti-nurse, but I would like to explore the subject of Paramedics in the ER. Why do nurses run the ER? What is an ER? Emergency Rooms are used to assess newly arriving patients and determine if they need to be admitted to the hospital, or can be treated and sent home. Emergency Room Doctors are equipped to handle a myriad of diseases and trauma, temporarily, until proper long term care can be established. An ER is not meant to be a long term care facility. The idea is get them in and get them out, or admit them. Everybody knows the saying, "Greet them, Treat them, Street them." What is a nurse? The very definition of nursing is to care for in a long term manner, as in to nurse back to health. That is why you see nurses in Hospice and NURSING HOMES!!! What is a Paramedic? A paramedic was created to provide short term care to sick and injured people until they could be cared for, long term, by a doctor or nurse. They specialize in triage and transport. So I ask again, why are nurses running the ERs?

Paramedics have taken over the role of the house-calling doctor. No, I'm not calling us doctors, but we do go to people's houses and treat what we can while we transport to the hospital. We work under an extension of a Medical Directors license as put forth by the Medical Control Office's Protocols. Where I am from, we do not need to call online medical direction for anything, unless we just need advice. I am seeing more and more Paramedics being utilized in the ERs around here, but only under the descretion of the nurses. They are treated as techs. Nurses cannot intubate, do surgical airways, or many other things that Paramedics can do, so why are we taking a role that limits our abilities? Wouldn't it make more sense to place Paramedics in the nurses place, to work alongside of the ER doctors and actually help them treat and care for the patients seen in the ER? I know nurses do that same thing, but not like a Paramedic would be able to. Regardless of how you feel about Paramedics and nurses, the end result should be to the patients benefit, and by having a person who can intubate and do many other things that a nurse cannot, the patient would definately benefit. I'm not saying that nurses need to leave the hospital, but they should have a bigger role on the floors, where long term care is needed. There is a nursing shortage ater all, that would help alleviate the nursing shortage, as well as the Paramedic shortage. Paramedics working in the ERs would get paid much more than street medics (they traditionally have), which would lure more people to the field. It would be a trickle efect.

So why isn't this going to happen? Nursing Union! They have been here longer, took control of the ER long ago, and won't give it up, even if it means that the patient doesn't get the benefit. I'm not saying there aren't nurses out there that cannot intubate, do sugical airways, and whatever else, but they aren't trained that way. They have to take extra classes and whatnot to get the experience. Paramedics are trained that way from the go, and we specialize in short term medical care, like TRIAGE!! When was the last time a nurse intubated as opposed to a Paramedic? When was the last time nurses were put in charge of Triage at a mass casualty incident? I am sure there will be nurses that say, I have, or I do, or I do all the time. They are the exceptions, not the norm. The only way Paramedics will start to win the Battle for the Ers is with higher education. Everything with us starts with more education. I advise all the medics out there to look into higher education and go get your Baccalaureate.

Paramedics need to look into the ERs and explore what could be.

I mean no malice or harm to any nurses reading this. I am not against nursing, I just don't understand this trend we have going in the ERs. This is just the tip of the ice-burg and I could go on, but I don't want to monopolize the blog. PLease let me know what you think. Thank you

-JZ

Happy Thanksgiving

Happy Thanksgiving everyone!

You did what?? And why??

In following up on the sentiment expressed in the previous post about EMS' "taxi runs," here's one of my stories. I spent a while looking for the PERFECT one, but after realizing I had SO MANY (unfortunately), I decided to just close my eyes, point my finger, and pick THAT one...



We were en route back to the station from the hospital when EOC dispatched us TO OUR STATION for a “walk-in” having an “unknown problem.” If you’re not versed in this, a “walk-in” is just what it says- someone who “walks-in” or “drives up” to the station for “help.” This particular station I was at for that shift seems to have more than it’s fair share of “walk-ins” for some reason. We were only about a mile away when we got the call.

So we get there and find the fire department sitting in the truck bay with this woman in her 30s. According to her, she had been at home sitting at her computer when she spun around in the chair to get up and became dizzy. Then she threw up…ONE TIME. Now she wants to go to the hospital. Her husband rides in the front of the ambulance with us to the hospital. Know what I did? I took her blood pressure. I took her pulse. I got her O2 sat. I asked her about her medications and allergies. I called the hospital. That was IT. It took me about 3 minutes.

Alright first of all, why do you “need” to go to the hospital because you’ve thrown up ONCE? I’ve spent all day throwing up and feeling lousy, and I didn’t call 911. Never even THOUGHT about doing it. Second of all, if you drove- well actually your husband drove you- from your home to the fire station, WHY couldn’t you just keep on driving to the hospital yourself? I didn’t do anything life-saving for you in the ambulance. I didn’t do ANYTHING for you. A “ride” to the hospital is $400 via our ambulance. Then we charge $8.50 per mile from wherever we pick you up. It’s 15 miles from the fire station we were at to the hospital. You do the math.

The other thing I don’t get- which I didn’t actually think about until later- is what was the point in this woman’s husband riding WITH US? Now someone has to waste the time and gas to come get you both then take you back to get your car and…I just can’t see any point in all this.

Biggest Pet Peeve

No doubt, my biggest pet peeve in EMS is the taxi runs we do. It has been on my mind a lot lately, between the Men's Health article, and some issues we are having at the firehouse. Go to any state in this great union, to any firehouse, and any medic can give you ten examples in the last year of such runs. Why is this such a problem? Ask any child: When do you call for an ambulance? Most likely they will answer: When there is an emergency. Yet, the parents of those kids call for some extremely stupid reasons. If 7-year-olds can figure it out, why not 30-year-olds?

We see abuse of EMS from all walks of life, regardless of race or socio-economic class. Regardless of insurance status. Even regardless of transportation status, and by that I mean the patient is completely ambulatory, stable, not a damn thing wrong, and six family members all with cars are home and able to drive.Over the last few years I have heard many excuses as to why the ambulance was called.
-Going by ambulance will get me seen faster (not true, not true)
-I don't have insurance (this ride isn't free)
-I don't have any other way to get there (OK, I can kind of see that)
-I don't have a regular doctor (huh?)
-Because I want pain meds (I don't think so)
-Because I wanted to (can't argue with that logic)

I have transported stubbed toes, hurt pinkies, and fevers of 99 degrees. I have also transported a 22-year-old who drank one beer and the parents freaked out, a scratched knuckle, and someone who needed inner reflection. I am sure all of you reading have similar stories. I even had a chronic caller, 3 times a day from the same pay phone. He would call and say he was dizzy and he needed to go to the hospital. 3 times a day. I would think that would be an abuse of 911, punishable by law, but PD told us there was nothing they could do. Once, when we were with him, a 3-year-old girl was hit by a car in our district. She had to wait 5 minutes longer for help to arrive. When we explained this to him, his reply was "Oh well. When I call, you have to come." I had no response to that. He had me there.

We educate the public on fire prevention. We educate the public on fire safety. We educate elementary students on E.D.I.T.H., stop, drop, and roll, and stay low and go. We educate on everything fire related. Thanks to all of this public education, fires are down. What about EMS? EMS makes up 85% of FD calls (depending where you live). Why do we not educate on EMS? Sure, we put on CPR and AED classes. But why is it so taboo for us to educate on what is an emergency? When it's OK to use an ambulance? There has to be a solution to this problem. Unfortunately I don't see it coming anytime soon.

Just another day at the office

I've worked in the ER long enough to feel confident in what I do. I can do that 12 lead ECG with my eyes closed, I can get the IV first time and draw blood without bruising my poor unsuspecting patient. I *can* do it. I do do it... and most of all, I enjoy it. Well, at least until the end of last week. I think the universe decided I was getting too big for my boots and knocked me clean out of them.

Without going in to enormous amounts of detail, towards the end of my shift, we had a 30 something year old lady come to us with chest pain. She had a significant family history (both parents died of MIs before 40) and her ECG showed huge ST elevation. Oh and before I forget - she was 38 weeks pregnant... and she coded.

So, skipping over the gory bits (for my sanity as well as yours), there was a very quick and dirty c-section in the ER, not an OR with dad watching. Mom didn't make it but the baby is going to leave the NICU tomorrow morning.

I didn't know that pregnancy increases the risk of the patient aspirating and that I needed to apply cricoid pressure. I didn't know that my hand position for chest compressions should be moved up the sternum or that the uterus needed to be displaced. I didn't know, I didn't know, I didn't know...

I've learned a lot from it and in that respect, I'm grateful for the experience. I just wish I hadn't been left feeling like I've failed... but I guess thats the price you pay for for all the great stuff being in medicine gives you the chance to take part in.

Party Paramedics

Just got my JEMS email, and in there was this fascinating article about "party medics" and the concept of having EMS staff on hand at college parties.

Party Paramedics

One has to wonder, though, what kind of message it sends.

Does it simply accept that "college kids will be college kids" and offer a measure of protection for that mentality or does it show a level of acceptance for potentially illegal behavior?

Working part time for a small university's Public Safety department, I've seen the best and the worst of college students, and their choices. We very recently created our own EMS club, and are in the tentative stages of trying to figure out what roles they can play on our campus, without major liability on the university's part.

Does this university's insurance policy cover the "party medics"? Are they affiliated with the school itself? How are they funded?

And does anyone else see this as a lawsuit waiting to happen?

Advice Anyone?

Hello everyone. I was recently laid off from my job due to a budget cut. There, I was a Security Guard/EMT, but if you ask me, I was more of a secretary than anything else lol. I thankfully found a new job, but this time as a paid EMT. I'm a member of a volunteer first aid squad in my town but to go from volunteer to paid, well that's just a HUGE jump, at least in my eyes.

I joined the squad in my town a couple of years ago for reasons I'm not even sure of. Our squad, along with many other volunteer squads were struggling and dying for EMT's, so taking the EMT course was just kind of the next step. I wish I had some meaningful reason as to why I became an EMT but sorry guys, I don't.

Although I did well in the class and passed everything with flying colors, to this day I swear up and down that I shouldn't have even passed any of the tests and even the state test. My new job obviously will entail answering emergency calls and I feel like I'm no where near ready. I try to answer as many calls with my squad and even sign up for more than one duty crew night a week. Sometimes up to four. I feel like the effort is defiantly there but the lack of call volume and certainly the lack of confidence defiantly doesn't help my situation.

I will hopefully be starting at my new job next month and will have to either get over my fears and suck it up or be jobless. I know this blog was originally started has a place for EMS workers to tell their stories but I come to this blog looking for advice. With that.. advice anyone?

(Yes, I did do a similar post a month or so ago.. but did I mention I REALLY need advice?)

Meltdown

Protecting its citizens from harm is the noblest of government functions, the very core of a successful republic. Providing that protection is the purpose of organizing and maintaining our government. But who do we turn to when our fellow citizens turn against us?

A pregnant female with a toothache called 911 from a housing project at six AM. She had been up all night, unable to sleep. An advanced life support vehicle was sent to her home and took her to the emergency room. Innocent enough, one of hundreds of EMS calls fielded by the Providence Fire Department every day. Most rational persons would have a difficult time defining the majority of these calls “emergencies.” Had the Emergency Medical Technicians refused to transport her, instead of being commended for using common sense and reason, would be reprimanded for failing to address the needs of the patient. It matters not that an entire section of the city was left unprotected during the time this patient was transported; time when true emergencies could, and often do happen. The patient was catered to, no complaint filed, and the department’s goal of “covering your ass” was met.

Our EMS System is in chaos, patients are allowed to call and request transportation to the hospital for any reason whatsoever and an advanced life support vehicle will be sent, damn the cost to the taxpayer. Most responsible people wouldn’t dream of tying up a valuable resource because they needed a ride or wanted to get into the emergency room faster. Responsible citizens are being bullied by the minority who think government is at their beck and call.

Is this society’s problem? Is there a law that protects the rest of us from such unscrupulous drains on our resources? No, there is not. Perhaps it is time to consider the possibility. We pay for a service. That service is rendered useless when it is unavailable. The CYA policy is an insult to those providing EMS service, and those who founded this country and the generations who fought and died for our independence. The time has come for us to learn how to say no!

For years the 911 system has been overburdened with calls for non-emergency reasons. Because of fear of litigation anybody who calls for assistance for any reason will get help at their door within minutes; unless all resources are otherwise utilized. In that event, the people requesting transportation will have to wait a little longer. Some people die waiting, and that is the result of ineffective leadership. It happens. It could happen to any one of us.

In Providence, there is a severe shortage of advanced life support vehicles. Or is there? Six rescue units handle approximately thirty-thousand calls for emergency medical aid each year, and the number is growing. The need for additional resources is well known, and blatantly ignored by the Mayor’s office and the Fire Department administration. But is this crisis truly a crisis? Or is it merely the personification of a much larger problem plaguing our society, the insistence of many Americans to have government cater to their every whim? When will we have had enough, and simply say, NO MORE!

Because of the very real fear that a responsible person may not call for help in time of crisis we as a society are catering to an unscrupulous bunch who will exploit any option that is available. A mentality exists where government services represent an unlimited pie waiting be devoured, and only a fool would hesitate to get their piece. Our generosity can only be exploited if we allow it. We need to close the drain before the pool is empty! It is time for responsible citizens take our country back. As long as people are willing to give, the long line of takers begins to form. It is our nature to lend a helping hand to those truly in need. There is a limit. It is only natural to have the giving spirit replaced with bitterness.
Going along to get along is no longer an option. It is time to take a long, hard look at our policies and recognize that one of our greatest strengths, our generosity, is also our biggest weakness.

Some Days Are Good

As with life, in this job you have to take the bad with the good. The first call we had this morning was routine. Man fell down, woman gets scared and calls 911 thinking he's having a CVA (Stroke). We arrive and find that he just tripped and all is well but still want to go to the ER just in case.

About an hour after that, we get a call for the unknown medical call. Now nine times out of 10 these calls turn out to be nothing. Just a tag that the dispatcher gives a run when they don't know what the complaint is. We arrived on scene and was greeted by the PD officer who reported that our patient was in bed and breathing shallow. As we proceeded towards the bedroom, I asked the daughter when the last time anyone saw her was. She replied that the checked on her a few times last night but didn't see her until about 30 minutes ago. At that point she wasn't responding to anyone.

Hearing that, we increased our pace to the bedroom. We soon found our patient. We found her doing very little actually. No shallow breathing, no heartbeat, no response to pain. Her lifeless body cold to the touch. Giving my partner a look, we asked the family to leave and informed dispatch to send an ALS intercept our way.

Once the family left the room the CPR began. I have always thought that the most effective scene for a heart disease commercial would be to show an actual CPR scene. The indignity, the blood, the sound of cracking sternums not to mention the far off stare that the patient has. Yes, all of this would definitely open a few eyes because it wasn't like it seemed on TV.

With ALS enroute, the patient packaged and the D-fib advising no shock, we carried our patient outside. Passed the waiting family, passed the eyes of the curious onlookers who had begun to congregate. Out onto the stretcher and into the bus.

After ALS set up and was ready to go, we proceeded to the ER. But during the trip, something happened. Something that very rarely happened. After the third Epi was on board, a heartbeat could be felt! No that can't be right?! Her age, the history of heart disease and the fact that she was just in the ER yesterday for chest pain all pointed to her not making it.

Yet here is was, a pulse! Soon the monitor confirmed it, she had a rhythm! The rest of the trip was spent maintaining her airway and respiratory rate. Turning her over to the ER staff with a heartbeat was really a great feeling.

Now in this game, CPR saves are a few and far between. Some days you get them and some you don't. It's yet another cold hard lesson of life. But today we actually did it! We actually saved a life. It wasn't a drunk frequent flier or a BS taxi ride to the hospital. We actually made a difference in someone's life!

Yes, these moments are truly a few and far between. So when they come, enjoy them, learn from them, for they won't last forever.

Wait

She stripped off the non-rebreather, reached deep, turned her head my way and coughed. Not a polite little clear your throat cough, rather a full on clean out the lungs job. I looked out the rear window of the rescue and focused on the car that was tailing us. Her boyfriend.

"Cover your mouth!"

Years of training and experience reduced to scolding a petulant patient with the audacity to call 911 for a free ride to the hospital. What possesses people to call? Do they think they will "get in faster?"

I walked her past the ambulance triage, through the treatment area and into the waiting room.

Cough in my truck? Not today.

It's Nice to Hear Thank You

Well, it's been some time since I have posted. After doing some reflecting today I have realized that I'm slowly getting the confidence needed to be an EMT. I will never ever have total confidence in what I do, but that is how I am. I think what is most important is I'm learning things everyday and no longer afraid to jump in that passenger seat on the rig. There are times where I'll beg another EMT to take the call, but if you were to ask members at my squad, I think they'd say I'm not as bad as I used to be. It's going to take time, but I'm glad that I'm slowly making the changes needed.

The other night, we took an elderly female to the hospital. She had fallen a couple days prior to calling, but the pain finally got to the point that she thought it was wise to go to the hospital. I have taken her to the hospital before, but she did not remember me. To make a long story short, we got her to the ER. Just waiting on the ER RN to give us a bed for her, I stood next to the cot just talking to her. She grabbed my hand and told me I was a sweet girl and she gave me credit for doing what I do. I just smiled and said thank you. I think if more patient's were like this sweet old lady the world would be a better place. Some people don't understand how hard things are, especially for Volunteer Squads. Every now and than it's nice to be thanked for what we do.

A tiny bit late for Halloween, but here's an EMS Spooky Story for you!

The patient is a well known man. So is his wife. If I told you what they were well known as, you would know who they were, and that would violate HIPPA. So I won't tell you. But suffice it to say, it involves events of the supernatural kind.

I'm home responding, and the rest of the crew comes from headquarters. It's dark as all get out, and a very weird feeling washes over me. My "spidey sense" is tingling. "Very bad!!!!!" vibes slam me as I walk down the dark driveway. Something is very wrong in this house. The feelings make me turn around, head back to my car, and wait for PD or the rest of my crew. I'm not going in there alone.

He's at a GSC of 8, post CVA a number of years ago. She's been taking care of him at home since then. Diaphoretic, pale, and obviously not well, we begin to load him onto the stretcher. I run out for a blanket, and the cop says to me "You know who these people are, right?"

Nope. No idea. Never heard of them. But in fear of looking totally clueless, I say "oh yeah, but I treat all my patients the same" and carry on.

Still with the bad feeling in my chest. There is a mist that night, and it comes in waves...is there someone over there???...I'm spooked, and run back inside very quickly, glancing over my shoulder a few times. But no one follows me. There is no one there.

We load him up, and start transporting. He begins seizing, and we meet up with our intercepting medic just in time. His fever is raging, he's very ill....we aren't sure if he's going to make it through the night.

As we head to the hospital, the bad feeling is gone, I decide I'm just sleep deprived or something.

We go immediately inside, we've been assigned a room already during our patch. But the wife needs to register him.

She registers him under a pseudonym, and the desk clerk doesn't bat an eye. He must have been here before.

She is done, she has requested a priest from the clerk, who is calling one for her. She wants to get to her husband, and the rest of my crew is still moving him from the stretcher to his bed. I've gone to write the run form. There's a digital lock on the door to the main ED area. All the local EMT's have the code, and the staff can hit a buzzer to release the lock to allow people in and out as needed. She is standing at the door, and no one is there to let her in. She glances around surreptitiously, checking to see if anyone is watching her. I'm getting up, to go help her out and wondering what she is doing. Suddenly she waves her hand in front of the lock, the light changes, and she opens the door.

She didn't put in a code, and there were no staff members at the desk to let her in. I don't know what she did to that lock, but somehow she made it open.

FREAKY!!!!!

And that bad feeling at the house? Apparently they keep a collection of their work in the house. All I'm going to say about that is, after this call, I believe in ghosts. And I'm not walking into that house alone ever.

Hope you had a Happy Halloween!!!!

Doctor...Doctor!!

My first run this morning reminded me of how different things are in other parts of the world. Which is good that I'm reminded of this because I'm trapped here in the "Garden State".

We're dispatched to a local hotel, on the other side of town, for the 55 year old female who fell down seven steps. As we approached the facility, I made a jocular comment to my partner about the hotel sign advertising their "Fall Special". Sorry EMS humor.

I directed the rig to the rear of the building and as I turned the wheel to round the corner, we were greeted by several tour buses and a sea of tourists from the Orient. PD walked over to us and reported that our patient was a male and upstairs. He had apparently fallen, incurring a bump on his forehead and a possibly broken wrist. I said that dispatch informed us we had a female patient. To that the officer just laughed and said, "I don't think so."

Climbing the stairs, we soon walked into the hotel's welcome area that was populated with about the same amount of tourists that were waiting outside. We then found our patient, a 76 year old, sitting in a chair, arm resting on a table propped up by a towel. A small golf ball sized bump was beginning to form on his forehead. As I knelt down, the only member of their party that spoke the King's English approached. He informed me that SHE had fallen, hurting her arm and head. After asking the patient the usual questions, through my newly found translator, I surmised that her wrist would need an x-ray for a complete diagnosis. I offered to split the appendage and then transport her to the ER.

The group then exploded into a sea of chatter, I guess it was a group decision. Rising to my feet as the think tank processed the data that I had just given them, I bumped into a new fellow that was standing way too close to me. As I turned to greet him, he began pointing at his eyes and mumbling "fix, fix."

Having a three year old, I could notice conjunctivitis from a mile away. I turned to the translator and pointed to my new patient. He told me not to worry about him, that he had been complaining about his eyes for the last two days. I explained that he would need to see a doctor before the whole group came down with it. The translator than asked me why I didn't just give him the medication he needed. Taking a second to respond, Mr Pinkeye rubbed his eyes, and walked out of the room.

Turning my attention back the my original male/female patient, the translator informed me that the patient really wanted to go to Washington DC and if we could, set the arm and then splint it. Now once helping an orthopedic doc set a wrist once, I smiled a bit, running through the steps that I remembered. But then remembering my lack of x-rays and knowledge, I informed them that we would splint the wrist and transport the patient to the ER. The group began to shake their heads in a negative fashion and I was informed again that she really wanted to see DC.

Taking a deep breath and explaining one last time that we could only splint and transport because an x-ray would be needed for a proper diagnoses.

"But you don't understand, we are here to see Washington DC."

At this rate, I was ready to note that as her chief complaint. The translator then asked if we could just splint the arm and leave her be. To that I said if we treat we have to transport. By now, we had been joined by a curious by standard, who had begun fashioning a makeshift splint for our patient.

I asked the translator what was going on and he informed me, you guessed it, that she really wanted to go to DC and this guy was some kind of doctor where they were from. He was going to build a splint and get her ready to travel. Shaking my head, my partner began getting the appropriate information so that our patient could sign off on our release for treatment and transport.

I began packing up our equipment when the officer approached. He told me that I was to walk out the door first because I had gloves on and Mr Pinkeye grabbed the handle after rubbing his eyes. Laughing a bit, I pulled out an alcohol prep pad and cleaned the handle down before we all left.

What can I say, you can't make this stuff up.

Why Don't I Get Paid What I'm Worth?

I wanted to get started with a question that plagues EMS folk all across the country. Why don't we get paid what we are worth? It's an easy answer, but a complicated fix. If your employer is anything like mine, they will tell you tales of Medicare reimbursements and inability for people to pay for the services, but the answer is much less complex than that. I will agree that Medicare keeps tightening the noose around reimbursements and there is no good way to ensure payments from people when they cannot afford, but need an ambulance, and I could argue those points. The real reason Paramedics/EMTs don't get paid what they are worth is pure and simple, education.

If most Medics are like me they obtained their education from a technical school. Technical school education is one of the main reasons why our profession is lacking in monetary compensation. I have nothing against technical schools, I believe they serve a valuable purpose with professional trade training. My problem is that I view a Paramedic's profession as collegiate, not technical. In my state all you need to be a medic is to be 18 years old and have a high school diploma or GED. That is it, no college foundation courses or anything. Granted I believe it's changing a little to where anatomy and physiology are now a pre-requisite, but in my opinion, that is not enough. We think we are on the same level or better than nurses, but we aren't required to have the same education as they? How can we be better or even comparable? We cannot! Granted, nurses have a choice of just an RN or BSN, but I think you would find that most are BSN or attempting to get their BSN. Paramedics do not have anything like that. If we are to be taken serious about wages, or even professional, we need to up the ante on our education. Not only would it start to secure better wages for our brothers and sisters, but we would start to see better quality medics out in the field, instead of the cookie-cutter, get them out as fast as you can medics.

There is a problem with the idea of better wages for higher education. No employer in their right mind would hire a medic with a BS at $30-40k a year (starting) when they can get a technical school medic for only $20k a year. The only way to bypass that obstacle would be to make it mandatory for all medics to have a BS. Only then would employers find that they can no longer hire medics at ridiculously low wages, there would be a shortage, and wages would increase to lure people into the field. I know it is more complex than that, but it's a start. Educational requirements could be similar to nursing requirements, but with emphasis on Emergency Medicine and Triage. With this kind of educational background, medics can start taking over the ERs like we need to be doing, instead of leaving it to the nurses. I am not anti-nurse, but I do believe that Medics belong in the ER, not nurses.

Hopefully in the coming years as the need for more medics increase so will the educational requirements at obtaining a Paramedic license. Only by increasing educational requirements will our pay be increased as well. We need to take control of our profession and make it clear that minimal pay is not acceptable anymore. I have left a lot of my arguments out because of the length of this blog already. There is so much more reasoning and many more complex issues that need to be ironed out, I just want to start people thinking about it. Have any questions or criticisms please feel free to ask.

Be Safe,
JZ

We'll leave the light on for ya!

No, my name isn't Tom Bodett but sometimes I feel like my ambulance could double as a Motel 6. This is my first EMS Taxi post so let me take a moment to introduce myself. I've been a volunteer EMT-B for about 8 years, I'm currently studying to become an EMT-Enhanced which just means I'll get to start IVs and give a few more medications. I volunteer in a small town next to a big interstate.

The interstate is where I ended up yesterday during my shift. Things have been really quiet in our county lately so when I heard the printer start whirring I couldn't help but jump up from the couch in excitement. This excitement left my rookie very confused because he hadn't heard the printer and I'm pretty sure he thought I had finally gone around the bend. I grabbed the "rip and tear" and headed out to where my driver was already sitting in the ambulance. A medical call on the interstate, the patient is having stomach pain, is sweating and is shakey.

Our first due area on the interstate is about a 12 mile stretch and the patient was just on the edge, almost into the next county so it took us a few minutes to get there. Upon arrival I note that the patient has vomited a few times, is very pale, sweaty and says he is having a hard time breathing. Due to our location on the shoulder I had the engine company shut down a lane so that we could get him into the ambulance quickly. As soon as we are in the unit I asked my driver to get a baseline set of vitals because dispatch wanted to know if ALS was needed. The first set looked good so I told them no, we would just go ahead and transport. (At that time we would have had to wait approximately 20 minutes to get an ALS unit there, about the time it would take us to get to the ER.) The patient said he was having no trouble breathing at all, his stomach was fine and he just didn't feel well.

The rookie hopped up in the back with me as we began making our way to the ER, he has only been on a few EMS calls so he is still getting the hang of it all. I asked the patient a question to which I received no reply. I asked my question again and the patient didn't move. Just as I am about to switch from "easy ride" to "get me there!" mode I noticed him pushing his pulse ox off of his finger very slowly. I asked him another question, this time even louder, and he opened one eye, looked at me and said "I am very sensitive to noise, would you shut up?"

The rookie looks at me with "WTF?" written across his face. I tell the patient I will talk quietly to him but that I need him to answer my questions. I ask medical history and I am told he is "sensitive to light, noise, smells temperature and people in general." He asked me to turn off the light, he told me the oxygen smelled horrible (we'll look past the fact that he probably hadn't showered in a few days...) he told me I talked way too loud, even when I whispered, and that the ambulance was too bumpy. Then he fell asleep and started to snore. In our 20 minute ride he woke up every few minutes to complain about the light, the smell, the bumps, the weather, the color of my hair (yes the color of my hair), the Redskins game, the fact that we wouldn't go an extra 20 minutes to his favorite hospital, and the equipment I had on him. If I asked him a question he would tell me that talking required too much effort but if I said nothing he would complain about one of the above. He would remove the cord from the blood pressure cuff that was hooked to our Lifepak 12, then he would remove his pulse ox every time I put it back on and he would do this without ever opening his eyes.

When we transferred him into the hospital bed he curled up into the fetal position, told the nurse to go away and then asked her to bring him water first. When the nurse asked him what exactly was wrong he said "my back hurts and I'm tired. I just need sleep. Can't I just sleep and you come back in a few hours?" He never told me his back hurt (even after I asked specifically) and told her he never had nausea/vomiting and that I was just rude. The nurse and I smiled at each other, you know the smile of "I'm sorry, I can't help who calls 911 and isn't he a fun patient?" I went back in to his room about 10 minutes later to drop off the cigarettes he had left in our ambulance, there he was snoring loudly. The nurse told me he said he just needed a place to sleep. The worst part? He was only 3 miles from home when he called 911.

Motel 6, we'll leave the light on for ya!

My First Call....

I searched my closet for a light blue shirt, and dark pair of pants. Until I finished my required training period, I wouldn't be assigned a uniform, but still needed to look the part. Wincing at the bright orange of the "trainee" coat, that screamed FNG from a mile away, I packed the pockets with pens, paper, gloves, my wallet, my cell phone, more pens just in case, tissues, trauma sheers....anything I thought I could possibly need during the 6 hour shift.

Totally gung ho, ready to "save lives" and "do good in my community," I bounced my chipper bubbly self into the firehouse all full of smiles, agreeableness, and interest. I was secretly trying to hide the fact that I was terrified of what I might see, and that I would kill someone.

5 hours later, all I had done was spend an hour and a half inventorying the rig, and gone out to dinner. The perkiness was starting to falter. The nerves were starting to win. The rest of the crew sat in the day room, and watched TV as calmly as you please. Outwardly I was watching with them, but inwardly I was having self doubt. Is this all you do on a volunteer ambulance?? Watch TV and go out to dinner?? What have I gotten myself into?

Beeeeeeeeep-BEEEEEEEEEEP-beepitdy beepitdy BEEEEEEP....the tones dropped 15 minutes before the shift was supposed to end. The sound echoed off the walls of the bay, and reverberated in my stomach. This was it. My very first call on an ambulance. All fatigue cleared away, my adrenaline started racing. I was holding my breath in anticipation, just waiting for the dispatch to come back with details on the call.

My crewmates slowly disengaged themselves from the couch, muttering under their breath, since it was so close to time to leave. Most calls in this town average about 2 hours, between the ride to the hospital and back, and scene time. They wouldn't see their beds for a few hours, and weren't happy about it.

"Dispatch to MVEMS, respond Priority 1 to 15 All American Street for the cardiac arrest, possible DOA"

17 words that made my heart almost stop, and my stomach find it's way to my throat.

Wait. It's my first call EVER. Can't we start with something easy, like a broken arm or like, a kid falling off a skateboard?

The drive to the house goes by in a blur. The driver is talking to me, calmly, and gently. He can sense my fear. I'm trying to hide it by acting totally calm and natural...asking what size gloves everyone would like, what did they want me to carry, making idle conversation. But my hands are shaking.

When we arrive, PD has confirmed the DOA, and just wants someone from the service to come in and pronounce. We cancel the medic, one EMT goes in with PD to do the dirty work, and PD asks the rest of us to hang tight, to not mess up their crime scene.

Then a family member runs out another door: "My mom just fainted!!! You have to help her! The shock was too much for her!"

The rest of us go inside, where a very nice family has just received the news. Their brother or their son was found dead in his own bed in the apartment off the family's house. His brother went out to the apartment tonight to ask him something, and found him. His family is overcome with guilt and mourning.

The mom of the deceased sits on a couch. She is supported by her daughter-in-law. The trainer tells me to get vitals. I step up, and gently ask her if I can take her pulse and blood pressure. She looks at me with sad eyes, and agrees. She begins to cry again, as I try to talk gently to her. My hands shake again, trying to take her blood pressure. The trainer becomes inpatient with me, telling me I'm taking too long. She grabs my arm, and drags me back, and takes over.

The trainer turns her back to me, effectively cutting me out of the entire evaluation. I have been dismissed. I stand there, and try to send comforting smiles to the family, completely unsure of what I should do now. I feel like a fool.

I'm worried. I'm thinking that I've failed at EMS, since the trainer snapped at me.

We leave the main house, and the trainer tells me that I need to see the DOA, so that she can review the steps for DOA's. I'm dragging my feet. At this point, I shook during a blood pressure. She must think the worst of me. It's not that I don't think I can handle a DOA, its that she is making my nerves freak out, because I think she's thinking I'm a moron.

She brings me over to a cop, tells them in a brusque voice "She's never seen a dead guy before, so I'm bringing her in" The cop looks startled. OK, so maybe it isn't just me that she's short with.

The gentleman is lying on his bed, sprawled out, face down in a pile of vomit. The smell of booze fills the air, as we see bottles of beer laying around the room. At least the alcohol is kind of masking the other smells. It's a summer night, and the air conditioner doesn't appear to be on in the place.

He's been gone for a while. The family reported that the last time they saw him was on Friday. It's Sunday...whoops, technically Monday now. He very well could have been gone all weekend. The trainer walks right up, grabs my gloved hand, and forces me to touch him. "That's what rigor feels like, and see that? That's lividity" and she begins to cover our DOA protocols.

My first call taught me a lot of lessons. The biggest one was that I will never ever be that kind of trainer. I will never ridicule my students, or make them feel humiliated for being scared. I understand the lessons she was trying to teach me, but I will never repeat them in the same way for anyone else.

Since that day, I hold a special place in my heart for the newbies. You can spot them a mile away, in their hideous orange coats, and from the nerves written on their face. We've all been brand new at this at one point or another. Remember your first call?

Too Drunk To...

Circa mid-1990's

The tones knifed through the quiet air of the squad building. It was the beginning of summer and I was enjoying the warm night air with my a few of my compatriots, when the call came in.

"It's been quiet all day." Jake replied, walking to the dispatch phone to acquire the info for the call.

"Too quiet for a Friday night in fact," I replied, "I hope you didn't just start something when you said that."

Pausing for a second to note the sarcasm in my voice, Jake wrote the call information on the board and made his way over to the rig.

"So are you going to tell us what and where, or do we have to guess?" Bill questioned, some agitation behind his voice.

"Sorry, MVA, lower main. Car into pole." Jake responded, now picking up his pace. It was as the seriousness of the call now dawned on him as he heard his own voice.

"What?!" I blurted, falling in behind the two senior members as they made their way to the rig.

It was my second year as a member. And even though we were a small town rescue squad, I had been apart of some serious and heartbreaking. Even with a year of calls under my belt, I could still feel the rush as I climbed in the back before the old gas powered battle wagon, pulled out. The once quiet small town night now disrupted by the whine of the siren.

"PD is backed up so they'll be a little late getting there." Jake said, grabbing the portable radio and the jump bag.

No one thought this unusual. A large portion of our calls went with PD back up. Even when the officers assistance was needed.

The trip was short. Two lights and several blocks later, we arrived on the scene of lower Main Street. Unlike upper Main, littered with its well lit houses and stores, lower Main was dedicated more to industry and had no real illumination. Hosting a sand and cement company, this road was always full of large trucks speeding by. Making work on this part of Main Street, very dangerous.

Jake called on scene and the wreck came into sight. There was indeed a car into a pole. Smoke gushed from the now mangled hood and the telephone pole leaned precariously to one side, taking the full force of the impact.

"2 is out. Requesting PD and fire for the assist. Will advise further." Jake relayed over the radio.

Soon the air was filled with the sounds of the fire department overheads. Signaling the membership of the need for their services.

Jake reached over and began to open the door when the driver of the car fell out of his door and ran over to the ambulance!

"Here we go!" Bill shouted, jumping out from behind the wheel to intercept this bloody mess of a man.

By the time I reached the group, they were walking back to the rig. Jake gave me the, "this is a wast of time", look as he passed. Followed by the strong smell of alcohol.

Sitting the man down on the stretcher, the senior members began the usual assessment of the patient. After a minute of sluridly answering their questions, the patient sat bolt upright and began to scream!

"Oh My God!!!! I hit someone!!" Blood now pouring from his open wound on his forehead.

Jake and Bill looked at each other before Bill asked, "You hit someone? Where?!"

"They were standing right in front of the pole! It might have been a child! They seemed close to the ground!"

Without another word, the three of us ran from the back of the rig to the smoking mass of metal!

"Chris, shine the light here." Jake ordered, trying to look under the front of the hood.

After a minute of looking, Jake emerged with a red rage that was pinned between the car and the pole.

"That's not a shirt from some kid is it?" I asked, a lump in my throat beginning to form.

After a second, Jake began to laugh. I must admit I was dumbfounded as to what part of this situation was funny.

"Aaa, I take it that's a no?" I asked, not sure whether to follow along or prepare myself for something gruesome. Or perhaps Jake was getting burnt out.

"Chris, this rage has been hanging here for as long as I've been a member." Jake relieved.

Relief now passing through my body, I was able to take a deep breath once again. "You think he's just so drunk he thought it was a shirt?"

"That sounds about right to me."

The senior guys continued to laugh and made they way back to the truck. I stood up, careful to make sure that my shaking knees would still support me.

Jake and Bill returned to the back of the truck and the now sleeping patient on the cot. After seeing that they were back, the driver sat up again and, in a concerned voice, continued to ask how the kid was.

"Sir, Jake began, with obvious trouble attempting to contain his laugh, "it wasn't a kid. You hit a pole with a rage hanging from it."

After a second of silent thought, the driver began to cry.

"Oh my God, I can't believe I killed a kid!!!"

Stunned the three of us exchanged bewildered glances, not sure how to respond.

"I guess he's too drunk to understand." Bill said, voice full of conjecture.

"Services him right. Shouldn't be drinking and driving anyway," Jake spat.

"Maybe, he'll learn his lesson." I said, shrugging my shoulders.

**************************************************************************************
Other than me, the names of this memory have been changed to protect the innocent, lol.

The Proposal

"Sir! Sir, can you hear me. Open your eyes for me." I have to shout for my voice to carry over the roaring of the generator.

"Leavesss me alone! I'mmmm ffffine."

The overpowering smell of alcohol pours out of his mouth and assaults my nostrils. I have to turn my head to gasp for a fresh breath of air before I heave. After a few deep breaths, I lean down to fit my head, helmet and flashlight under the bed of the truck.

"Sir, you just flipped your truck like a pancake and now you are pinned underneath. Does anything hurt?"

"Hellll no. I'mm sdrunk asss, assssss... you know. Datsss amnimal."

"Right. I can tell. We are going to get you out of here as soon as we can? What's your name?

"Isssss... itsssss, Shawn."

"Okay Shawn. I'm Bernice. I'm going to put some oxygen on you until we can get you out of there." I am praying it will cut down on the amount of toxic waste coming out of his mouth as well.

"Bernische!"

"Yes, Shawn. What's wrong? Does anything hurt now? Are you feeling nauseated or light-headed?"

"No."

"Okay. Are you sure? Do you need something? Are you cold?"

"No. I wantss sto know ifff youssis marry me. Yous is perty,"

I hear Eddie cough in a vain attempt to cover his laughter.

"No Shawn. I can't. I'm already married. In fact, my husband is the one cutting apart your truck."

My polite decline is rewarded with a string of profanity that would make my Marine brother blush. His tirade also brings forth another cloud of staink. I gasp for another breath of air only to find diesel fumes have permeated my clean air. Great, which is better diesel, or alcoholic gingivitis face?

I spend the next ten minutes asking all the pertinent questions and getting nowhere. I feel like a dog when chasing it's own tail - it is fun, but pointless. I get the nod from the firefighters that we are ready to slide him out. Thankfully, Shawn has decided to put a belt on this morning. At least he has done something to make this easier for me. Greg grabs hold of c-spine and Eddie grabs his shoulders. We rhythmically count and anticipate a smooth transition to the back board. On three we all pull, but nothing happens. I look under the truck to find his hands neatly folded together on his chest.

"What is he stuck on?"

Three men in black and reflective tape army crawl under the bed of the truck to find me an answer.

"Nothing. He's free. Go ahead."

We count again and again are met with resistance.

"What the hell?" Now I'm getting pissed. "Jeremy, get under there and tell me what he is stuck on."

"He's not stuck on anything Bernice. You are clear."

This time we don't count out loud. And low and behold, he moves. That is until he gets a hold of the bed of the overturned truck.

You dirty little rat! "Shawn! Let go!"

"I ain't goinnng to no hoschpitalll."

"You really don't have any choice Shawn. We can do this my way, or the hard way. And trust me, you don't want to do it the hard way."

"Itscch okay. I like itsch rou-tough. Rough? Tough? Yeschh, pleasche hurt me."

By this time, Eddie is in a full blown laughing fit. And so it half the department.

Thankfully, Shawn was far too amused with himself to remember he was trying to stay under his broken Dodge as long as possible and with one swift motion he was removed from the twisted metal. He decided to behave himself for the remainder of the call thanks to the man with the shiny star on his chest looming over him.


Sometimes being an EMT is scary but this has put a whole new deinition to the term. But hey, at least I know I make turnout gear look good, even if it is through beer goggles.

House of Horrors

The house was ready for Halloween. A graveyard decorated the front yard, a mummy hid in the bushes, a scary black cat waited for us on the porch, next to a zombie locked in a cage. The side door was open, the house dark. The door creaked when I pushed it. There was some commotion coming from the upper floor, I started toward the stairs. My old partner, Renato appeared at the landing, a forty year old woman dressed in pajamas at his side.

"She ate Dominican Rat poison," said Renato. "Her kids are upstairs."
"Get her to the truck," I said, Renato and my new partner, Rob walked her out of the house. I went upstairs. Two kids were there, with Miles, the officer of Engine Co. 11who had been called to assist and had arrived on scene a few moments before Rescue 1.

"I'm on the phone with her husband," said Miles. "Trying to get the package. Take Renato if you need him, we'll meet you at the hospital." The kids father had been with friends a few streets away. The woman went there, and there she ingested the poison, then drove home to her children. Oliver, the third firefighter from Engine 11was with the kids, a boy about twelve and his ten year old sister. They tried to be brave but tears flowed freely down their faces. Their parents have been "having problems," their mom said she's had enough and decided to "end it."

I walked out of the home, school papers stuck to the refrigerator with cheerful magnets, family pictures on the walls, certificates of achievement framed and displayed. Dinner dishes sat in the sink, waiting to be cleaned and put away. Everything here looked to be in order, but something was terribly wrong.

In the truck, Renato and Rob had the patient on oxygen, an IV established and were running an EKG. Although her vitals were stable, 128/72, HR 70, sp02 98%, the poison was starting to take hold. She was diaphoretic, foaming from the mouth and started convulsing. Her breath smelled like insecticide.

Rob drove to Rhode Island Hospital, Renato comforted the patient as best he could and I contacted the ER. A room waited for her when we arrived. The ER doctor "Googled" Dominican rat poison and came up with a treatment plan, Atropine and a lot of it.

We did all we could, then left her in the ER. Her prognosis is not good. She may be gone in twenty-four hours. I drive by her home on the corner often. I hope I don't have to add it to all the others I avoid. After seventeen years on the Providence Fire Department, I'm running out of happy places.

*Update, 2300 hrs., Wednesday.

I just talked to the RN and doctor who treated our patient. The poison she ingested is called Tres Pasitos ("Three Little Steps.") Shortly after we transported her to the ER her convulsions and abdominal pain increased, she was unconscious, incontinent and eventually went asystolic. 40 units of Atropine were administered in the ER. She is now stable in the MICU.

My old partner, Renato, who is actually doing quite well as a firefighter on Engine 11 helped considerably with his Spanish language skills. Had the patient been treated for "normal" rat poisoning, which are anticoagulants such as coumadin and their long acting derivatives, she in all likelihood would have died.

I love a happy ending and hope the patient gets all of the help she needs.

Song

Hi, I'm Sheri, and I run with a tiny volunteer agency in Southwest Virginia. We average about 700 calls a year, and the majority of those are "I stubbed my toe, take me to the ER". I wish I had the funny, crazy stories that I love to read, but the reality is, the last month of night calls for me have been nothing but a great nights sleep.

So why am I posting today? Because last night at our building we got the best laugh out of the new song released by Brad Paisley. Now, whether or not you're a country music fan, if you're in EMS, you have to be a fan of at least the title. Oh, what is it you ask?

Cluster Pluck. 'Nuff said.

Alone

After a really long 12 hour sift yesterday. I had some time to sit and reflect on some of the calls that we responded to. At first glance, they weren't anything out of the norm for an EMS crew to respond to. First was the DOA (Dead On Arrival), followed by several refusals, two MVCs and then one poor gentleman with leg pain. It was this gentleman that tied it all together for me. Now the following description might make some people sick to their stomachs, so you might want to skip ahead.

We were dispatched for leg pain and we walking into an elderly man living with his developmentally challenged older son and his neighbor who was just there to help clean him up out of the goodness of her heart. The sad fact of the situation was that this man should really be under supervised care. He is bed ridden and covered in sores.

As we walked in, we discovered that he was unable to speak so the only way he would get people's attending was to demonstrate what he needed. At the time of us walking in, he needed to be changed and to get everyone's attention he decided to throw his feces at everyone in the room. Now barring the cleanup before we packaged him up for transport to the hospital, the rest of the trip went smooth.

After the shift was over and all things settled down, I began to think about how alone these people must be. My DOA was found in a field, face down against a fence in the cold. Covered in blood and not a soul around. My elderly gentleman was in a warm bed and still alone in a room full of people.

Most days are like this, seeing people at some of the worse moments of their lives. And some days it just reminds you that in the end, we all die alone.

Am I The Only One?

I had to take a vacation from work. Life on the ambulance was overtaking every other aspect of my life. I was thinking about work constantly. Being woken up in the middle of the night, heart racing, sweating, because I was dreaming about work. It's my full-time job that does it to me, though. I only have nightmares about that place. I only act like a raging lunatic when I'm at that place. I'm calm, collected, and almost zen-like at my part time job. Am I crazy, or is the environment where I work that toxic?

Sometimes there are no words

Hi, I'm Katie and I'm a medical junkie. I'm an EMT, ER tech, phlebotomist and occasionally, just for kicks, I teach first aid. Its not a mental illness I'm just in to all things medical... and it helps me pay for important things, you know, like shoes.

I've been teaching for a while but nothing could have prepared me for one overexcited student the other night. I spent the first half of the evening teaching leaving the second half free to set up some practice scenarios.

I had half the group leave the room while I told the remaining students they were going to play unconscious casualties. I explained that I wanted them to lie on the floor, close their eyes and let the medic roll them. I made it clear they were not to prompt their partner unless they were going to roll them in a way that would injure them.

I let the medics back in and play dumb. I don't know what happened, I just found them like this. No, I don't know who they are or how long they've been here. Are they okay? The room echoes with "Hello, can you hear me? Open your eyes!" and the occasional giggle.

I turned to one student and asked him what he'd found while he was checking his patients breathing. He took a second before telling me that he had "an unconscious casualty who isn't breathing." Hold on a second, did he just say he isn't breathing? I can see him breathing. I mean, he must be breathing, he's sniffing!

Before I could question him, the student turned back to his "patient" and jumped on his chest. He gave him a chest compression. A real chest compression.

There really are no words...

A Good Question

I have a question that needs to be answered.. and seeing as it's EMS related, I figured this would be the place to go. My question is, do you think that some people are meant to be great EMT's? Like it just runs in their blood? Something I have lacked my whole life is self confidence. And whether everyone agrees with me or not, confidence is something you need when you're on the rig. I guess that's why I am my own worst enemy.

No matter how many times I try and convince myself that I can get on the rig, and get the job done, it never works. I love being on the rig. Love having the ability to help someone and feel like I have made a difference, no matter how small it is. But lately I find myself avoiding getting on the rig, and avoiding sitting in the dreaded passenger seat.

Recently, I opened up the good old EMT book I got while I was going through class. I flipped to many sections, reading many paragraphs until I realized something. What do you do when you are weak in virtually every aspect of being an EMT. How can you study and try and improve on that? Believe me, I ask questions on the rig when I have them. But sometimes the answers are ones I hate hearing... "it depends". Every single call is different, which means you handle things different. Sometimes I just wish there was always one clear cut answer. One clear cut solution to every call.

Right of Way

One of the more interesting questions that I have heard asked over the years, and have certainly asked myself, was what happens when two emergency vehicles transporting "code 3" both attempt to enter the same intersection. In this scenario, who has the right of way? In eighteen years, sixteen of those driving, I have never come across this first hand until recently.

While transporting an ALS patient to an out of the way hospital, I was approaching a major intersection only a block away. Having the red signal, I sounded the appropriate amount of sirens and air horns to notify the oncoming traffic that my rig and the ALS intercept unit were calling for the right of way. Seeing that traffic had yielded, I proceeded forward but then out of the corner of my eye I saw it. The bright flash of a Type V heading into the same intersection!

Depressing the brake and now waiting to see what their next move would be, I was relieved to see that he stopped and let me continue. As both of our rigs, backed into the ambulance bay, I leaned over and told my compatriot from the other rig that I had a life long question answered just then. He gave me a look and asked what I was talking about. I said, what would happen when two rigs both came into the same intersection. He laughed and said he wasn't sure either, but that in his book the rig with ALS always had the right of way.

Never Wear White Shoes

Last night I was signed up for duty crew at the squad. Call goes in, and we get to the house. I begin walking up the outside steps and I look down and see the concrete is wet.. I thought it was water. I walk into the house only to find out it was blood. And it was everywhere! I have never been on this bad of a bloody call. And amazingly the guy was fine.. I still think it was because adrenaline was pumping and he just didn't realize how bad his arm was cut. And I of course was kicking myself in the ass for wearing my brand new WHITE shoes on this call. Should have realized the first call I would wear them on would be a bloody one.

While waiting at the hospital the police officer who came to the hospital with us needed the crew's names and birthdays. Why? Oh just the fact we were in a crime scene and it needed to go in the file. That's defiantly a first... walking around in a crime scene. It's true what they say, the world of EMS is crazy and you really can't make this stuff up!

Although I'm still a new EMT I wish I was more into getting on the rig and learning all I can. When I do get on the rig, I'm learning to ask questions on why certain things were done. I asked some questions last night and now if I'm ever in a similar situation I'll know what should be done. And what's sad is the fact that these crazy calls happen. Like last night's stabbing. You really have to wonder what goes through people's minds. I guess logic and knowing right from wrong go right out the window when your mad enough. Seems last night's victim experienced that first hand.

Tonight I'm signed up for another night of duty crew. Wonder what it will bring me..

Quick Rundown

Let me start off by saying Hello to everyone. In this post I will be giving you all a little info about me, and a quick rundown of what I will be blogging about. So lets see first of all I am a 24 year old male from ft lauderdale, florida. I am a huge yankees fan cause thats the baseball that I grew up with. Some of my hobbies include any sport, poker, anything to do with Disneyworld, Madden and Fifa for XBOX 360, and fantasy baseball and football.


So what will I be blogging about. I will take everyone thru the state/national EMT Exam, job hiring process, and continue on with all the other exciting stuff I encounter related to this wonderful job of helping people. I will be a third generation FF/Medic so I have some cool stories that have been passed on. If you have any questions about getting into the service or the hiring process you can send them to me at firemanxxx900@gmail.com and I will help you out when I have an answer.

Goodluck and stay safe all,
Joe T.

Traffic Law & Safety

Even though I have a number of stories to tell, I've been resisting the urge to dive into my war chest. For this blog, I'm trying to limit myself to things that have just happened to me during my recent shifts. This means it'll probably be a rant, but then there isn't much about that I can do.

For today's anecdote, I have chosen the topic of family members following emergency vehicles. From a traffic law stand point, just because someone that you are related to is in back of a rig, this doesn't give you this right to blow through traffic control devices and cut people off. You would think that this would be obvious but I can't tell you how many times I'll look in the side view mirror and see a car with its four ways on, tailing me and cutting through lights. Hell, last month I had a family cut between my trailing ALS intercept unit, almost hitting them!

I know that you need to be by your family member but really, this is unsafe and just stupid. There is nothing more that you can do for them. Any information that the hospital needs will either be obtained by us or can be acquired after you get there. Not to mention that after you arrive all you'll be doing is sitting in the waiting room until they come to get your insurance information.

Driving emergency vehicles for as long as I have, I can tell you that it's hard enough having people see us with all of the lights on and the sirens blaring. Try getting cut off by a little black car with its four ways on. And I wouldn't even mention what will happen if the cops catch you.

In the end, just use your head and take your time. I know your first reaction is to be near your loved one. If that's the case leave the car and take a ride with us.

My First Call

Seeing as this blog is starting to take off, I'd thought I would contribute another post. This one will actually be about a call, my first call I officered to be exact. The squad I belong to has duty crew nights. You sign up and have to be on the rig for any call that goes from 10:00pm - 5am. I was signed up with another EMT and a driver.. which meant that I wouldn't have to officer and I could just help where it was needed.

The alarm went in and I wasn't really nervous.. probably because I knew I had my ass covered and wouldn't have to officer. As I got into the rig with the other two guys I was signed up with, a second call goes in. Of course, just my luck! My heart dropped. I knew I would have to officer. I started flipping out, and I do mean flipping out. I dropped the f bomb so many times. lol. Luckily the other EMT I was signed up with was also a driver so I took the call with him. We called in service and made our way to the location. It came in as difficulty breathing. We pulled up in front of the house and I recognized the house because we just had this lady a week prior for the same thing.

I won't bore you with the details of the call, because it honestly wasn't anything exciting. I do remember that the medic was very mean but I was grateful for having her there because she did all the work and I didn't have to give the report to the ED Nurse upon arrival.

Sorry everyone, my posts aren't anything exciting or bragging worthy. Like I have said in my very first post, I'm a new EMT and don't have many calls under my belt.

My Introduction

I can honestly say I was rather flattered to be asked to contribute to a project like this. I see what I do as just that - what I do, it's my job. I don't take it well when called a hero, I get uncomfortable when people tell me how awesome my job is or ask me if it's exciting or tell me how amazing it is I get to save lives. I love what I do, don't get me wrong...it's way more than a pay check. I can't imagine myself anywhere but on an ambulance. I just don't see it as something so special like the "outsiders" do.

I took an EMT class at the suggestion of a friend. Every other job I tried just left me bored and uninspired. The class was $75 and gave me something to do for a summer. Even if I hated it, it was no huge loss. I started running on trucks as a student once I got my CPR card, even though the program I went through didn't require it. I have a fear of failure and I didn't want to be a gung-ho EMT, fresh out of school, who freaked out on my first call. Before even carrying a state EMT card, I had been on all types of calls - psych emergencies, cardiac emergencies, strokes, traumas, pediatrics, and even a cardiac arrest one Sunday morning in church. The more I ran on the truck, the more I got comfortable, the more I liked it, and the more it became my life.

Two years later, I'm on the payroll with 3 different ambulance providers. Corporate EMS, and two municipal EMS agencies. Both have their pros and cons, and some people are better suited for one as opposed to the other. There will always be little things that irritate me, be it management decisions, stupid policies, or useless partners. However, I can say that every day when I come home from work, I feel like I accomplished something and maybe made someone's bad day a little better. My father tells me all the time that he wishes he had a job where he truly got to help people every day, and how proud he is of me for committing myself to something and truly enjoying it, and in the process, learning that money isn't everything.

I don't have many great war stories. Funny ones, sure...but few that everyone hasn't already heard before. I'm just doing my thing out there on the trucks, getting my ducks in a row so I can move on and be a paramedic, and making the choice to make a career out of this crazy little job.

The Influence of an Instructor

Jennifer's post made me think about my new EMT class starting in just one week. I've lost count, but, in 25 years, I've trained a lot of people and sent them into the EMS world as EMTs. I enjoy teaching EMTs even more than paramedics. They're a clean sheet of paper and are ready to learn, then, go out and save the world.

I'm proud of the way our class is run. When we started 12 years ago there was also a fire and police academy which held a rigid posture and high standards. We adopted it and still maintain it which is a departure from how most EMT classes are managed.

Kids right out of high school have a hard time wearing uniforms and realizing they will get locked out of a quiz if they're late from a break or don't have thier ID badge. Only when they leave do they understand why we do what we do to prepare them for the world of EMS. Some have become lifelong friends, and many I see again in the recert classes in subsequent years. They send me
e-mails to tell me they're at the top of their fire academy class and felt it was the discipline we gave them that got them there. I had a student who went to a disaster assignment during hurricane Katrina and was thrown into an experience that was way over his head. He told me later that the constant memorization we made them do on ABCs, CMSTP, AVPU, OPQRST, SAMPLE etc. came back to him when he needed it. I've watched my students become RNs, PAs, public health administators and ambulance company executives. One is a medical writer for a hospital system.

One of my most profound memories was walking into my class on September 12, 2001 to 50 wide-eyed and confused people. I realized most of them were too young to have ever had any threat to their basic sense of security. The age range was 18-62 and their reactions were all over the map. I had to wonder how the death of 300+ firefighters in New York was going to affect their career goals. Some left, most stayed. My critical incident stress management training kicked in and that day was about sharing our feelings of fear, and violation, and anger. Six weeks later my Disaster Medical Assistance Team was deployed there. Myself and one other student, a police officer, were gone for two weeks. It was years later before I realized the huge impact that had on my students. They were proud that we made that contribution and it gave them even more incentive to become one of the special ones who are part of the solution rather than part of the problem.

Do I get tired sometimes. Yeah. The "deer in the headlights" first night, the "high maintenance" individuals; the ones that have a tired excuse for always being late; the "minimalists"; the ones that always seem to know more of my lecture material than I do ... Out of each class, though, there are always a few shining stars. They are the ones I feel good about, the ones I know will make a difference. There are also the ones I watch struggling through the semester, but want it badly enough to fight for it. They have perservence and motivation. They come back 2 or 3 times, but are ready for the world when they eventually succeed.

Sometimes I'm lucky enough to learn where my students have gone with their lives, or that they were the ones to step up when a child was drowning, an old man went into cardiac arrest, or they need to triage a fatal head-on collision on Vasco Road. I can take pride in thier accomplishments. That makes it worth doing all over again.

Learning About Beginnings and Ends in the ER

Hello everyone, my name is Jen and I'm a new EMT. When I was approached and asked if i would contribute a post or two about the world of EMS and the craziness involved, I was excited about telling my stories. But than I remember that I don't have many stories at all. Seeing as I'm new and don't have many calls under my belt, I began thinking about the calls I have been on, and none of them are "bragging" worthy. Lol.

The only time I can remember like it was yesterday was the first time I did chest compressions. I wasn't even an EMT at the time. In fact I was doing my required hospital hours when a code was brought through the hospital doors. All the nurses just threw me in the trauma room and pushed me towards the poor guy who wasn't breathing. I stepped up (just a tad bit nervous). I began chest compressions and the trauma room that was filled with doctors and nurses all broke out into cheering and applause. I couldn't help but smile until I looked down and realized this man was dead and probably wasn't coming back.

Sadly the guy didn't make it. I talked to the nurses and a medic who was doing hospital time as well and they both drilled me with tons of questions. Than I was asked who would go to the morgue and with some hesitation I decided to go. Never having been to a morgue before, I was filled with trepidation! In the end though, one thing I did learn was you can't lock someone in the freezer. Lol.

Well I hope everyone enjoys this little post. And I look forward to reading other posts!

When to Call 911

A few years ago, after responding to a series of "Taxi" calls in the dead of night, I generated this list and posted it on my MySpace page and my personal blog. I recieved some rave reviews and thought it would fit in good here.

When to call 911:

1. When you or someone you know stops breathing, moving, or a combination of both.
2. When you or someone you know gets hit by a truck, car, or something that is moving fast enough that the kinetic energy transfer will cause bodily harm.
3. You or someone you know has taken an over abundance of an illegal substance and it has caused you to fall into number 1’s category.
4. You or someone you know fallen from a great height and one of your appendages is now angled funny and you can’t move it.
5. You or someone you know is bleeding uncontrollably.
6. The law states that anything that is a perceived threat is cause to activate the emergency system.

Although number 6 covers a broad range of situations, here are some helpful hints as to what shouldn’t be perceived threats.

1. You’ve dropped a sofa on you big toe three weeks ago. It’s 3 in the morning and you just noticed your nail turned black.
2. You can’t sleep and you think the ambulance or hospital will help.
3. You’ve had a fight with you significant other and you find solace in laying on an active railroad crossing. Though this is more of a cry for help, skip the dramatics and just call a shrink or couples counselor.
4. You’ve just had sex a few hours ago then realize your partner is “coyote ugly” so you fake passing out.
5. You feel nervous because your internet connection went down.
6. You feel nervous because your car is low on gas.
7. During the course of your suicide attempt, you choke on the very pills that were going to kill you an hour from now.
8. You feel nervous because your cell phone bill is too high.
9. You can’t sleep and you have a toothache. I know I already mentioned can’t sleep, but even with the toothache added, it’s still not a threat.
10. You feel nervous because the rent is due.
11. You noticed that the toe nail from number 1 has fallen off.
12. You feel nervous that the toe nail fell off.
13. You fell nervous that your beer is empty.
14. You are out of beer.

The Declaimer:

The above stated shouldn’t be perceived or construed as an actual list of accurate information of what to do in an emergency situation. It simply depicts a jovial rant that because of the mood I’m in this morning, felt the need to post. If you or someone you know feels that they need assistance, please call for help!

Humor in EMS

After my update post this morning, I began to think about some funny calls that I have responded to over the years. After smiling and laughing to myself for a second, I was then reminded that our humor in emergency services is a singular one. One that can often be construed by the general public as being crass or uncaring.

It's easy for us to forget that the rest of the world doesn't experience things the way we do. And in that capacity, we have a habit of developing an "interesting" humor about things. The easiest way I've found to describe this to people who are not in the field is this. We have very few options when it comes to our feelings about the things that we see out there. After all, for the most part we're seeing people during probably the hardest moments in their lives, how could we joke about that. Well, either we joke about it or keep it all inside and take everything to heart. Those that have followed the second option are doomed to burn out or drive themselves, their loved ones or their partners up a wall.

When this topic comes up, I am reminded of a sign the use to be posted in one of the inner city ER's I use to frequent. I love to quote it because it breaks the issue down succinctly.

"Please excuse us if we are laughing or appearing to be having a good time. This may cause you to think that we are uncaring but please understand, it's how we deal with things."

Need I say more? I just wanted to explain for those that may visit here, so that they won't come away with a bad taste in their mouth because some of the humor might be misunderstood.

Update...

Good morning. Just a quick update, as I have to get ready for work and a little girl to prep for daycare. I'm excited to report that I've gotten a lot of feedback from other interested emergency service providers around the globe. That means that this blog will be filled with all sorts of stories from far off places that I'll probably never visit!

I do just want everyone to keep in mind that you can never make this stuff up. After eighteen years, I've seen some strange, disturbing and "funny" things. But in my wildest dream I'd never be able to think any of this stuff up if I had to! Actually, I think I think I have an interesting idea for my next post.

The Ambulance Chaser

Though this term is usually associated with lawyers looking for clients, in this post I will be using this term to describe those people who, for whatever reason, feel the need to follow ambulances around and try to help the personnel.

Now the truth is I haven't thought about this topic for years, since my last "stalker" finally stopped showing up to our CPR scenes. But last week during not one but two different shifts, spread out between three different townships, we had an admirer following us.

Now there will be some out there that will scratch their heads and wonder what the issue is. I mean isn't more hands on a scene always better. In fact, depending on the scene, this may very be true. But the world of public safely has been know to attract some strange people to its bright lights. Stopping once at an accident scene to help the ambulance crew lift a heavy patient is one thing, but to purchase a scanner and listen for your favorite crew to receive a call is something totally different.

As emergency responders, we're always taught about scene safety. Whether it's from the dangers of on coming traffic, a power line falling or some nut job following us around all day, it's all the same thing. We don't know what your intentions are now do we? Not to mention the weird feeling you get when you look out your driver-side window and see the toothy grin of someone who you just saw the day before, several towns over, waving a scanner at you asking if you need help.

The long and the short of it is, please just understand that while we appreciate the help, we have to be concerned with the safety of not only ourselves but our patients and their families.

In The Beginning...

Salutations, my name is Chris. Welcome to my little corner of this thing that we call the internet. So what is this blog all about you ask? Well I've had this idea knocking around for awhile and finally decided that even though I'm not to sure how this idea will exactly take shape, the only way to find out is just to do it. The general idea is to express ideas and experiences in my life as I travel in through the Emergency Medical Services in New Jersey. Though I don't consider myself an authority in this field by any stretch of the imagination, after 18 years on a truck you do learn a thing or two.

My EMS career started in 1990 when I joined my local volunteer first aid squad. For those of you that don't understand what this is, think of an ambulance company but staffed with people who don't get paid. The training is the same as if they were receiving compensation though between the paid and volly services there is always animosity.

As for myself, in the last eighteen years I've been on both sides of the fence. Either running emergency calls for my volly squad, doing non emergency transports for various transport companies or my current position as a paid EMT. So if anyone ever starts up the argument about who is better, I always maintain the truth, there are flakes on both side of the fence.

So the reason for this blog is kind of a simple one. Anyone who has been in this field long enough knows that getting burned out is just a matter of time and mind set. There are things that we as emergency providers can do, but serving the public is never easy. I could use the old adage about the guy standing in front of the damn with his finger plugging a hole. Every time a new hole appears, he sticks in another finger. Before he knows it, he's out of fingers and the holes still keep coming. This is the same in any field of public service. The call for help is never ending. Night or day it will always be there.

To off set the things that we see, humor and venting needs to take place. If you hold it all inside, you'll go insane. As a wise man once said, you can't change what's out there, only how you're coming at it. So I guess that's the easiest way to explain this blog.

If it's one thing there will always be enough of in this field, it's something to complain about, especially in this great state of ours. Either from volunteer squads that can't do the job anymore but won't take steps to change, to the state shutting down hospitals where they are needed the most. Yes, I'm sure there will always be something that I'll be commenting on with my unique, warped humor.

I should mention that anything I say here is not the views or feelings of any agency that I currently am or in the past have been affiliated with. These views are mine and mine alone. Unlike my main blog or Twitter, the posts here will be strictly about my life in EMS.

EMS Taxi, what's that about? Well the name is just a reflection of my humor. Yes, believe it or not there is a whole legion
of people out there who call 911 not for emergencies, but because they're too lazy to call for a cab. They are under the mistaken impression that they'll be seen quicker if they arrive at the Emergency Department by ambulance. This is a huge misconception, one that in the long run can cost time and lives.

In any event, I'm excited to see how this developers. Please bare with me as I work on the site to make it better and more attractive as the months go by. I am a very busy boy and will do my best. Please feel free to leave comments on anything that gets posted here. And if anyone is interested, in the future I would love to have guest authors every now and then to post their experiences far away from my little corner of the world.