The Call For Help

The radio screams, the phone rings or the pager beeps. No matter how the call for help is received, it will always be answered. Let's face it, this is what we do. We pull ourselves out of bed, chairs, meals, out of our lives to respond to this never ending call for help. They are the nameless, faceless masses that drive passed your rig on the street without a second look, until they need you. At best, we are considered a utility, something to be used when needed then forgotten about.

This is one of the harsh realities we face day to day on this job. We throw out our backs, break bones, dislocate joints and may never, ever be asked if we are okay by the community that we service. How do we get by? How do we get back on the truck one more time? We depend on each other. Sure you can talk to family or friends about these things. But do they really understand what it's like? How we feel when a mother throws her dead child in your arms then spits in your face and curses you off because you were unable to save her child. That very child that she, just a few hours ago, threw down a flight of stairs because he wouldn't stop crying. How could they understand that?

It is in that spirit of helping each other, for being there when one of us fall that has led me to this post. I won't dive into the whole story, there are smarter people that have used better words to discuss this. I will just say that a dear friend of mine, a guest author to this blog and a decent human being has fallen on some hard times. The greatest thing is that, in the age of blogs, Twitter and FaceBook, we are able to connect and help each other even when we're countless miles away.

Please click this link if you are interested in helping one of EMS's brightest members.

Call It As I See It

What a good idea!!

So in Bangkok, they were finding that a large percentage of expectant mothers weren't making it to the hospital in time, due to horrible traffic conditions. So they formed a special division of the traffic police to deliver babies!!! That's actually a really great idea!!!

What a neat thing to do! (OK, neat...maybe not so much....cool might be a better word)


Special police unit delivers babies in Bangkok traffic jams (video news report)

Enjoy!

I posted this on my tumblr but I thought y'all might appreciate it too.


Dear Drunk

My name is Katie and I’m a healthcare worker. I take care of people when they’re sick or hurt, I hold their hands when they’re scared, take the extra corners out of their arms when they fall and put band-aids on boo-boos. Sometimes, when someone is really sick, I’ll even breathe for them or keep their heart pumping by pushing on their chest. I’m good like that, see.

While you’re out “enjoying” yourself on a Friday night, I can be found in your local Accident and Emergency department kindly giving up my sleep to look after sick people. In case you were wondering, by the end of my shift last night, I’d been up for 24 hours straight… and the reason, dear drunk, is this.

Before losers like you decided that a good night out ended with lying semi-conscious on the sidewalk with your eyes rolling back in your head, A&E would empty out in the early hours of the morning leaving just the sickest of sick patients in the department. This allowed us poor healthcare workers to have a break, a cup of tea and occasionally a nap. Now, because you’re selfish and stupid, this is not the case.

On a Friday and Saturday night, the majority of patients I see are:

so drunk/high on drugs they collapse in the street and inevitably, someone calls 999. If a person is intoxicated and unable to get home, the ambulance crew must take them to the hospital.
so drunk/high on drugs they walk in front of a car/spaceship/bike/train or fall down. Alcohol masks pain and so ambulance crews, unable to assess the patient properly, bring them to A&E just to be safe.
so drunk/high on drugs they get in to a fight with someone else who is equally intoxicated. Someone hits/stabs/shoots someone else and lo and behold, we have visitors. Its also worth noting that when we try and help them by stitching up their wounds, we’re met with abuse and violence.
If you weren’t so stupid and childish, you wouldn’t drink quite so much. You’d be able to walk out of the club with your shoes and knickers still in place, get a taxi/bus/train home and disappear in to the night. But, piss-head, the concept of moderation is far too advanced for you and your tiny pickled brain so listen up.

When you show up in my A&E, know that you are not my priority. You are not sick or dying, you’re drunk because you chose to be and I’m not interested. Please take a vomit bowl and find a seat out in the waiting room and be quiet. If you don’t want to wait, you’re more than welcome to go home, I don’t want to see you anyway.

When I do finally see you, its only because I have to. Please keep your hands to yourself at all times, I know I’m gorgeous and I’m very flattered but I’m not interested. Do not try and spit at me, swear at me or threaten me either, you’ll just end up thrown out of our nice warm establishment (or even arrested).

I’ll stick a big needle in your arm and dilute the alcohol in your blood just enough to make you sober enough to go home but not enough to relieve that enormous hangover you’ll have tomorrow… or in three days when your body gets done processing the booze.

When you wet yourself or throw up in your hair, don’t expect me to change you or clean you up. You’re a grown up and this is what you chose… If you have to get the tube home at 9am covered in piss and vomit, so be it. Now you know how I feel after a Friday night shift.

If nothing else, when you read about the 8 year old boy who almost died because there were no ambulances to send to him last night, know that it is your fault. The ambulance he so desperately needed was tied up scraping you, the piss soaked drunk, off the street.

Yours

Katie

Manual VS Automatic B/P

I came across this article on JEMS where a study was done on the differences between a manual and an automatic B/P reading and it reminded me of a conversation I had recently with a paramedic. In my county we use the Lifepak 12, ours are set up to be a BLS and an ALS tool as we can use it for pulse ox, B/P, capnography, Congreve, ECG and 12 lead ECG and as our AED. The paramedic and I were discussing the fact that most providers rely only on the information they obtain through their Lifepak now. We have both witnessed the look of panic on the newer members faces when the Lifepak beeps, alerting them that the pulse ox is not found because they put that on the same arm as the B/P cuff. When I first started I remember working with medics who insisted on at least one manual B/P, when going through my Enhanced class last year I had a few teachers who still felt the same way. Most people in my class rolled their eyes at the thought of taking a manual B/P, including myself, but after reading this article it definitely makes me take a step back.

Since the contributors and readers of this blog cover many states and protocols I figured we could get a good mix of opinions on this subject. So tell us, do you prefer only manual, only automatic, or a mixture of both?

P.S., When doing spell check on EMS related blogs you receive some interesting "suggestions." Instead of "capnography" spell check suggested that I use "pornography." Our Lifepak doesn't provide that, maybe it's an upgrade option?

Getting a little quiet around here!

Ok, so no one has posted in a while. We need something fun to get it started again!

Here's a quiz from facebook that someone just sent me:

1. Do you believe people sometimes activate the 911 system just so they have a story to tell thier friends and family?

a) Heavens no! Why would someone do that.

b) Sometimes, but then again it gives me a good story.

c) Absolutely!

2. Have you ever wiped your feet "after coming out of someones home"?

a) Oh yeah! I have even thrown them away before getting in the truck. Used their trash can as a matter of fact.

b) Sometimes, but that is just the way it goes.

c) I would never do something as insulting as that. I am sure they were getting ready to clean up before we got there.

3. Have you ever deliberately called a patient the wrong name just for enjoyment?

a) Golly gee, no! How disrespectful!

b) Only once, and I was sorry.

c) No, that would me to inquire what their real name is so I could call them by a different name. Too much effort!

4. Have you ever just opened the door to the ambulance, pointed to the cot, said "Sit", and drove to the hospital without saying another word?

a) Seriously, people do that? That is an atrocity.

b) Every run!

c) Only if they have trouble hearing or language impaired.

5. Have you ever provoked a patient to antagonize the police just so you can watch them get tazed?

a) You are kidding, right?

b) No, I render care to enough peole who have been tazed. I don't need to create more work.

c) Hell yes! I don't care who you are that's some funny shit!

6. Have you ever prompted a faking trauma patient into saying their different parts of their body hurt just so you can cut their $100.00 jeans, $300.00 coat, and $75.00 shirt off their lying ass body?

a) Who prompts? Just start cutting! Hold them down if necessary. Lying pieces of sh*t!

b) OMG! Who does this? That is horrible.

c) No, why make more work for yourself.

7. Do you think EMS should be able to issue cab vouchers?

a) No! Obviously if they called 911, they need help.

b) In some cases this would be appropriate.

c) Why can't dispatchers just fax them out and save me the trouble?

8. Have you ever told a patient the voices in their head actually would prefer they stay home and not call again?

a) Yes, yes I have and I will not apoligize for it.

b) No, easier to haul them in than to come back in two hours.

c) I would never knownly mess with a person's psychosis.

9. Have you ever "accidently/deliberately" broke something each time you go to a frequent flyer's house?

a) Too much paperwork.

b) I am not even going to dignify this question with an answer!

c) Judge & Punish, baby! Lets get it on!

10. Have you ever made a patient cry from a well deserved EMS-Come-To-Jesus talk?

a) No, easier to just haul them to the ER.

b) I hate this test! You people are horrible!

c) I have tears on the fender of the squad where most dweebs put storks

wow.....some of these questions are pretty far out there. Deliberatly breaking something in a house? Egging on psych calls? And what exactly is a EMS-Come to Jesus talk??

dealing with the drama

As with any group of people you always have a certain level of drama or politics going on, I've always believed that I could go to any fire department or rescue squad in the country and find basically the same kinds of people. There are roles to be filled and while the names and faces may change deep down it's all the same. You can always find the know it all, the rookies, the ones who have been there done that, the ones that haven't been there or done that but feel that they know it all, the overachiever, the one who overextends them self and the ones who majored in trouble stirring in college.

Over the years of moving up the ranks from the "wet behind the ears rookie" to "in charge of more things than I can even remember on a good day" I have learned the two step shuffle that is required to survive. It's a tough step to learn, you have to know how to talk to this person and that person without upsetting them or sometimes, stooping to their level. Sometimes it is exhausting. Scratch that, most of the time it is exhausting. You can only please so many people per day and my quota sometimes fills up by 9am. (and believe me, I am NOT a morning person) For the past few years my two stepping hasn't been all that bad but we had a major shift in operational officers a few months ago and I feel like I am stuck in one of those horrible techno dance clubs where the songs supposedly change but you can't tell where one ends and the next one begins. (and you can only chant "only 9 more months, only 9 more months, only 9 more months" so many times before your significant other starts to look at you funny)

What I have never understood is why some of the trouble stirrers spend so much time upsetting people. I am in a volunteer organization, we're not collecting a paycheck to be here every day so WHY do they come by, normally at the worst times, to spread lies and rumors? Why not find something that truly interests them? I am told that obviously stirring up trouble IS what interests them but I can't wrap my mind around that. Maybe the problem is I can't shove my head that far up my butt?

Tell me your department has these people and please tell me I am not crazy since I can't understand their game.

EMS at the scene of Jett Travolta's death

Did anyone else see this article?
An EMT from the scene tells all....

The fact that this EMT was exploiting this family and their grief was bad enough. I don't know the HIPPA laws in the Bahamas, but morally, trying to make yourself famous by talking about a 16 year old's death is just repugnant. I don't care who the family is.

But I let it slip from my memory, only to read this today:
A paramedic from the scene of Jett Travolta's death is being charged with extortion

If you read the articles, it's two different folks from the crew. Which means at least two people from the crew that day were just ready and eager to tell their tale, and grab their 15 minutes of fame.

Any decent EMT or paramedic would never seek to exploit their patients or their pain, even if it isn't against the law to talk about what you saw or did.

It's just wrong...and it's got me bugged about it.

Anyone else?

You're Very Welcome.

It's a rule in EMS... It's a self preservation kind of rule.

Eat when you get the opportunity. You don't know when you'll get your next chance.

So it was with that in mind that I was quickly consuming some very cold Chinese food. Chinese that I had stupidly ordered three hours prior thinking that it might be a slow night.

Hey, I was new.

Two bites into my meal the phone rang. I shoved the styrofoam takeout container aside and picked up the phone sitting a few feet away, "26's," I answered, looking longingly towards my shrimp lo mein.

I really need to look into a cooler and cold meals.

The bright and intelligent although occasionally directionally challenged dispatcher answered, "Code three run for the county at the Local Marina."

The local marina. 12 miles and four stations separated us.

"Okay we're heading out." I shoved my dinner into the dorm fridge and we made our way to the truck.

A quick phone call to a Medic who worked in the station that should have been responding to this run revealed that there was a major regatta going on at the marina. Hundreds of people were out on the water drinking and partying.

I got the distinct feeling one or both of us were going to get puked on.

**********

The ride over was uneventful... Well, as uneventful as a Code three response through 12 miles of city traffic could be. PD was driving, I was the look out. He would roll up to an intersection, and we would both scan the roads to make sure that it was clear before proceeding. I didn't know what the nature of the call was that we were speeding across town for, in Toledo they don't give us that information. It could be a popped pimple, it could be a femur fx. As a BLS truck, dispatch was typically pretty good at not sending us to ALS runs, but the truth is, you never know.

We pulled into the park that lead to the marina. Assorted revelers were stumbling along the narrow road we were driving on. The sun was setting fast, we were losing light, and there was scant street lighting provided along the road we were on. We continued creeping along the path until we saw the flashing red lights of the BRT (Big Red Truck, typically the engine TFD sends to the scene). I jumped out of the truck and met my partner at the back doors. Our patient was nowhere to be found. TFD was there, FF's sat on the bumper of the truck. The Medics were presumably with the patient. No one knew where anyone was. It was like the hand wasn't communicating with the brain. Nothing new there, sadly.

We radio'd the County in an attempt to locate someone, anyone, who could tell us why we just put our lives and the lives of the people on the roads we drove on for 20 minutes for a patient and Medics who couldn't be found.

Before the County could give us an answer, we found them. Two TPD officers, two TFD Medics, and our patient. It was a brawl, folks. Four vs. one very unhappy (and vocal about it) boater. It's never good when it's four versus one and you can't tell who's winning.

And of course he would be my patient.

PD began to sprint over to help the LEO's and the Medics. The patient was a pretty imposing guy, towering over most of the guys trying to take him down. PD was as equally imposing. I followed him for a few feet before he yelled at me, "Epi, stay back. Stay back!"

I stopped where I was. PD had been around the block more than a few times, and I trusted him. He hadn't let me down yet, and until he did... well, I wasn't going to argue with him. I watched from twenty feet away while the now five men wrestled him into submission.

Good God.

The patient was screaming to anyone who would listen that he did not "want to go to jail or to the hospital". He was just fine, thank you very much. The fact that he was bleeding from the head and nose didn't mean much to him. Nor did the fact that according to bystanders, he had fallen face first on to a dock after tripping over some anchor line on his boat.

Now that they had him under control, I approached the group. He was my patient, after all. I thought that maybe a female might be a calming influence after having just fought with several men. Drunks can be weird like that.

"Hey there, I'm Epi with Itty Bitty Private Service EMS. Let's take care of your bloody nose there. Okay?"

Our Patient, who I'll call James, was looking tired from all the commotion. He nodded his head.

PD glared at me. "I'll take him, Epi." His voice was pretty firm, something I wasn't used to. I backed off for a moment.

But only for a moment. One of the LEO's was a bit of an instigator. "Dude, I remember the first time I had a beer. I think I handled it better than you...." It wasn't the worst thing I've ever heard someone say to a patient, especially someone behaving like an idiot. It frustrated me because it wasn't helping the situation.

I stepped back up to James and put it all out there for him. "James. You can chill the hell out and let me take care of you.... or you can continue to fight with these guys, get handcuffed to my stretcher, and still go to the ER. Your options are kind of limited at this point. Dude, you're bleeding. Let me take care of you."

For a moment we locked eyes and I thought he got what I was saying. He climbed into the back of the truck with a little bit of effort and sat down on the stretcher. It was about the time that Pseudo Dad ordered me to stand down yet again and tried to force him into a collar and board situation that he flipped out. Fantastic. Here we go again. More fighting. More yelling. I stood on the step at the back of the truck while five grown men fought with James. This time it was seconds before he found himself handcuffed to the stretcher.

Hey, I warned him...

He was restrained. Finally. I have very little tolerance for stupidity, and getting hammered and then fighting with MY PARTNER AND THE POLICE definitely qualifies as stupid. That being said... Antagonizing him isn't going to help. Particularly when he's my patient. Our patient.

**********

"You realize that now you have to ride with us." I'm staring down the baby faced Officer who was picking a fight with our patient.

"I know." He kicked an imaginary rock, or piece of lint, or EMT. He wasn't happy about it, but rules are rules, he was going.

I climbed in back and started to talk to the patient. I'm a mother, a wife, and a woman. Sometimes having these things in your favor can help calm folks down. Sometimes it doesn't. In this case it worked miracles. James was reduced from the insane fighting drunk he was to a crying depressed drunk. At least he wasn’t throwing punches anymore. It's amazing what a stern word from a maternal figure can do.

Pseudo Dad seemed to have a problem with me handling patient care because he was worried about me. While I appreciated his concern I told him that we (myself and my patient) were both fine. I knew where he was coming from, he saw his daughters in me.

The transport to the hospital was truly uneventful. My patient had a broken heart, which is unfortunately not something I could fix. He was refusing a collar and board, which caused some problems with the receiving ER Doc. He would have problems bigger than his broken heart once he sobered up. TPD ended up arresting him a few hours later.

It took a few hours to get our patient off of the stretcher thanks to the handcuff situation; apparently the ER weren't allowed to use restraints.

We donated our leathers. The ER Nurses had no problem with that.

**********

The following afternoon:

Mr. Epi, myself and the kids were at a local festival. Mr. Epi tugged on my sleeve.

"Hey... That dude is staring you down. He looks pretty ticked off. Do you know him?" He motioned towards a gentleman in a flannel shirt and jeans that I didn't recognize.

I couldn't tell who he was pointing at, but it didn't matter. The gentleman emerged from the crowd and introduced himself. He definitely had a surly look on his face. I stepped forward, instinctively putting my kids between us. Mr. Epi pushed the stroller holding SWR and took FC by the hand. He took them out of the equasion.

My heart raced.

"You're a Paramedic, right?" The guy's speech was slurred. He was holding a Busch Light can in his hand.

Did I mention the fact that I was a little nervous?

"I'm an EMT, yes." Over his shoulder I could see who I could only assume was his wife or girlfriend approaching. She looked significantly less upset.

Who the hell was this guy?

I surveyed the area for my escape route.

"You're the one who took care of my Buddy last night. I was with him at the Marina. I just wanted to shake your hand."

I exhaled.

"Thank you," he started, putting his palm out there for me to grasp. "He was acting like a complete moron. I'm glad you were there to take care of him."

I shook his hand, instantly relieved.

"You're very welcome." I replied.

Update

Wow, haven't posted anything in some time. I think the last time I had posted, I was scared because of my new job. Well, here I am almost two months later and I LOVE it! I defiantly should have listened to everyone when they said "You'll be just fine."

Today I had another long 12 hour shift. I woke up just feeling like it was going to be a fun day (note the sarcasm). My first 4 hours were uneventful. Got the rig check done as well as the daily chores around our building. Than around noonish, that damn call phone went off. We were sent to a house only a couple of blocks away for an asthma attack. En route, that asthma attack got upgraded to unresponsive. Instead of my heart dropping, like it always had done on calls, I just started to use my brain and think about everything that could go wrong on the call, and what I would need to make sure it didn't go wrong. So I grabbed our big green bag, full of airways, gauze, stethoscope, bp cuff's, cravats etc. I also grabbed the defib, you know.. just in case.

My partner had to move the ambulance closer to the house, so I ventured into the house with the police officer who must have hauled ass to the scene when he heard "unresponsive." Of course little me had to walk up to the second level of the house with our heavy green bag as well as the defib. Instantly I heard a little girl screaming her head off and other kids and 2 adults running crazy around the VERY messy house. They yelled for me to hurry up that he wasn't breathing.

If its one thing I remembered, always look cool calm and collected, even if deep down your not. The second you show fear or uncertainty in your face, your pt's family members will instantly freak. I saw our pt laying on the ground. Of course he was a very big guy so I had a feeling getting him to our ambulance would not be an easy task.

I asked, or rather demanded all the family leave the room. I felt bad, but the room was a mess. Mattresses everywhere, as well as other random crap. I checked for a carotid pulse and to be honest, my heart was pounding and I couldn't tell if it was me or the pt lol. My parter felt a pulse so we held off on the AED. I took out our BVM, hooked it up to the 02 and began to bag our pt.

To make a very long story short, it took 3 other squad members as well as two police officers to carry this man to our ambulance. ALS were in the rig waiting for us and the guy went into cardiac arrest shortly after. I ended up being the one to do chest compressions as we took our pt to the ER. ALS put on their AED, and today was the very first time I heard the AED say, "Shock advised." It was an awesome experience, although my pt probably doesn't agree.

With all the HIPPA laws now, EMS workers can't call the hospital to check up on a pt. I know that when you bring a code into the hospital, you defiantly wish you could see if the pt lived or died. Sometimes all you need to know is your pt survived. It's good to know your hard work paid off.

A new Facebook Cause you gotta check out.

I just got sucked into the vortex that is Facebook, and today got invited to join the cause "Did you seriously dial 911 for this"

In less than a week, there are over 3,000 members, and more every minute!!!!

With all our posts about how frustrated folks are about these kinds of calls, I thought some of you all would be interested. If you want a laugh, and you have a Facebook account, go check out the cause. Some of the stories are so ridiculous that you can't stop laughing!!!!

New Year, New Job(s)?

Well, I found out on December 1 that I'd be laid off from my full time job. The joy of working for a corporate EMS provider. They decided we weren't going to be profitable in 2009. The swooped in and shut down our operation. December 31 was the last day. December 30 into December 31 was my last shift. I spent the morning of the 31 at the bar with coworkers who also worked night turn. We figured it was a fitting end.

So, as it stands now, I only work 12 days for the rest of the month of January. My part time jobs are all I have, while I sit and also collect severance from the big giant. I'm getting paid more to do less, currently. Sounds like a win-win to me!