Patience with Patients

Fair Maiden is dispatched by the university's Public Safety department. Given this, you can understand that we don't always get the best or most reliable dispatches in the business. No times of transmissions, no detailed information, and no chance for updated reports., though PS is usually pretty good about sending an officer (read: security guard) to meet us at the job. We got toned out for a 'possible intoxication' at a student's dorm room around 3AM towards the tail end of the Friday night shift. Of course, this was the one time PS doesn't send an officer when we might actually need one.

We step off the elevator and walk into the suite... "EMS!" Note that PS wasn't able to obtain a specific room number, and so there we were: standing in the suite, everything quiet as a dormouse on Christmas Day. I was about to start knocking on random doors, when out pops a tall, slender, rather flamboyant looking kid, ~20 y/o...

"Oh hey guys! Heh heh, sorry about that. False alarm..." Note: this kid wasn't even close to needing an ambulance, so course that makes him only the supporting character, i.e., the friend trying to cover up for his pal who's currently in the room either puking or high. This is going to be pleasant, thought I...

"Well, can you tell me what's going on?"

"Oh, my friend had a little too much to drink, but she's alright, she's sleeping now. I just got off the phone with her mom, and she said to just let her be."

"Do you mind if I have a look?"

"Ummm, well, gee..." You could almost see the wheels turning in his head -- trying to figure out a way to prevent me from entering the room. Finally, "Alright, but she's sleeping."

I walk into the room to see exactly what he said, a female (wearing all her clothes), laying in bed, apparently sleeping. 'Great!' thinks I -- quick, easy RMA. Back to the friend, "What's her name?"

"Oh, Monique," says he. (Names changed, of course, to protect the guilty, and cover me from big bad HIPAA.)

Shaking the poor soul, "Hey Monique, how are you feeling? Monique... Monique..." Nothing. I can see she's breathing, and she feels warm and dry, and I'd be a monkey's uncle if she was actually asleep, but I'm not too concerned... "Monique, honey, what's wrong?" Suddenly...

"Will you just leave me alone! And stop calling me Monique! My name's Sandra!" Hmmm. The plot thickens. She's too drunk to realize her friend was trying to cover for her. Being drunk in a dry dorm won't get you in a lot of trouble, but it will earn you a call to your mother in the morning. I look back at the friend, giving him my best, "Monique...?" look.

"Oh, it's just a nickname...." Yeah, suuuurrrre.

As my partner tries to talk to the friend to get some real info and start the PCR, I try to talk to our patient, and ask her about the night's events.


Things quickly get out of hand.


I hear the friend shout, "I don't see why you need her phone number!" why the patient starts throwing a tantrum, flailing and screaming, "Leave me alone! Leave me alone! Leave me alone!"Now there were a lot of other people in the room, who started getting agitated as well.

Seeing as we run crews of three, a lead, a driver, a third, and this go we had a probie, for a grand total of four, there were just enough ruffians in the room so my crew could have just gotten away with a man-to-man defense. Seeing as that setup only seems to work for the Jets, I needed to turn the tables in our favor. "Medic to Base, can we get a PS officer up here?" "10-4, he's on his way."

As the arguing escalated, I tried to deal with the patient and the rest of my crew dealt with everyone else. My partner taps me, "Want me to ask for a 10-50?" He's from Jersey. "A what?" I say. "911." replies he. Let's give me another thirty seconds. It seemed like hours before it happened,

In walks, like the shining figure of authority the square badge on his chest might imply, the Public Safety officer. My trusty partner starts explaining the situation to him. Everyone looks expectantly... unfortunately, it seems the HE doesn't speak English, oddly enough. So what does he do...? Picks up the phone, dials, and says, "Yeah, it's XXXXX, can you give me a sgt? Alright, bye."

Oy!

At this point, I'm thinking, 'OK, if we just grab the patient and go, we may get away with it. AMS is great. Under the protocols, that's not kidnapping. If she slugs me, great. I'll slug her back. If the friends get involved, it's a felony...' Happily, I put my brain in before I got out of bed this morning.


---And here I end the story--- Quick finish: The sarge walks in with a complement of five more officers and clears the room (finally!). So all that was left in the room was my half my crew (I sent the other half outside to wait with some of the officers) the sarge, another officer, and the patient. First the sarge talks to her. Then my partner, then the sarge, then me. Finally after a FIFTY-FIVE MINUTE on scene time, the poor soul jumps from her bed to our stretcher and we make boogie faster than mice on ice. Good times.



The upside: No one got hurt, no one got arrested, and no one got sued.
The downside: Looong on scene time, and people could have gotten hurt. Oh, and no one got arrested.


Brings up the questions, when do you handle the situation by yourself, when do you call for backup, when do you call for PD, and when do you run?

The way it was, I could have called for Public Safety the moment I walked off the elevator and started getting sass from the pt's friend. I could have called for an RMP as soon as the sassing friend got out of control. I probably should have gotten my crew out of that room rather than waiting for Public Safety to show up. But where would that have left us? The patient would have been restrained and probably booked, possibly her friends as well. I wouldn't want to do that to someone if I didn't have to, though it would have meant I would have initiated transport a LOT sooner.

I suppose I liked the way I handled this situation the most, but then I'm biased. I know a lot of people who would have liked to get in & get out, and wouldn't have the patience to talk a patient into coming with us. And in the event that this had been a real emergency, and not just a drunk, I would have probably liked to do the same. I know when I was working under someone else, we had a person O/D on an unknown medication (a story for a later day), and I was starting to request RMPs and the cavalry to force this person to the hospital when my partner (and the lead) told them to cancel. Boy that pissed me off. We were on scene there for about thirty minutes, all the while, I'm waiting for this person to collapse, seize, or go crazy while my partner tries to talk her down.

I suppose it's just a judgement call, as like any other, but remember what they teach you: First the safety of your self, then the safety of your partner(s), then the safety of the patient, and finally the safety of others.

Training

$1100 - Cost of average EMT class in NYC, including books, crappy stethoscope and BP cuff.
$550 - Cost of average EMT-B Refresher class.
Opening the envelope with a brand new certification card: Priceless.

Here in New York State, you're required to take the class- over 180 hours of medical knowledge compressed and condensed int0 lectures several times a week, or practice sessions to apply what you learn. All this culminates into a few very panicky days of the oh-so-dreaded State Exam. 6 Practical Stations where we demonstrate our ability to care for a person. Medical, trauma, splinting, boarding, KEDing, AED, CPR, the whole shabang... and you get one thing wrong and you fail. All you have to do is forget to say "...and regular" and it could mean the end: months of wasted effort. Yours truly, however passed the practical with flying colors. That is, I did two years ago. Unfortunately, EMT certifications last only three years... so I'm stuck taking a Refresher course. My opportunity to retake the State Exam for recertifications lies only 12 days away. But I'm not worried... too much.

My point is this: Earning and maintaining an EMT certification is a time-consuming (and expensive -- though in New York State, the Health Department will reimburse volunteer corps for their fees incured paying for their certifications) commitment. One needs to be dedicated. What I don't understand is why there exists people who go through the whole process of obtaining their EMT card, but then don't want to spend any time actually working as an EMT.

When I first got certified, I could not wait to get out there and save some lives... or at least take someone's BP (A real-live sick person!) I got involved with a fire department, a crew supporting a concert venue (You won't believe the one about the two girls at a Dave Matthews concert who, on their own, decided to find out what it feels like to take roofies), and of course, Fair Maiden herself, my university ambulance (name changed to protect the guilty). FM is a funny organization. It's the only place I know where they have so many EMTs they're coming out of our ears. Their solution of course: offer applications and conduct interviews. Of the fifty-some EMTs that apply every semester to join, the squad only invites 10-15 to become Probies. It took me two semesters before I was invited. My friend applied five semesters in a row -- a record as far as I know.

So why are there people around who just don't get it? I was at a general body meeting the other day; there were only maybe twenty-five of us there. A corps with nearly 60 members, and less than 50% in attendence at a MANDATORY meeting. More than that, in the final portion of the night (that is, the last five minutes of a total half-hour romp), we schedule crews for the coming two weekends (weekday/weeknight shifts are staffed by permenent crews the entire semester). I saw more than three guys slinking away and sneaking out of the room without volunteering to take a 12-hour shift, more who simply sat in their chairs keeping their yaps shut. Then it dawned on me, they weren't having fun!

In a job like EMS, there are two ways to do it: Either you become cynical and dejected -- barely going through the motions, I've been like that before -- or you can take the light-hearted approach, where you can be enjoying yourself even while a drunk, coked-up, more-than-spoiled rich girl swats at you (with those long sharp nails), yelling obscenities enough to make a grown man cry. But what causes the difference? I suppose if I knew, every corporate executive would be vying for me, trying to get me to inspire their suicidal cubical dwellers. I do know one thing though, The people at the top make a big difference. It's funny about growing-up. Coming out of high-school, wouldn't most people you knew rather throw themselves into an icy river before giving you responsibility? Now however, responsibility has (gradually) been piled upon our shoulders. Hell, we're even in charge of some people. I mean, I run an EMS crew and three other guys follow my orders and take my lead, not to mention the patient. Sometimes, if we're in a bad mood, we don't realize how that affects the other people around us. Sure, we'd all like to kill the dork who called us out and all he's got is a finger lac sustained by cutting carrots, but he doesn't have to know that. There is more than one way to let a guy know that by calling 911 for a Band-Aid, he's preventing our unit from responding elsewhere. You don't have to make him feel like an idiot. And the Probie.... just because she handed you a ring cutter when you asked for a collar, doesn't mean you need to berate her until she breaks down and quits. EMS is a funny playground. Perfection is required. But even if you have to get through the teeter-totter, the swing set, the monkey bars, and the tire swing without flaw, you can still have fun. And better yet, you don't have to be the bully that the recess lady will later need to take to the principal's office, you can simply be the kid that plays nicely with the other kid. Why? Because when you have fun, it makes it easy for the other kids to have fun as well.

"Insert title of first post here"

Putting off my schoolwork... as usual... at 4AM ... as usual... I stumbled across an amazing blog about a hobby of mine: EMS. For reference that blog titled 'DTs EMT' can be found at http://mysite.verizon.net/vze25hnc. From there I linked to 'Flatline NYC' at flatlinenyc.com. Half way through reading a post about an 300lb. combative autistic asthmatic, I revelated: I could write something like this. Better yet, I wanted to, and more to the point: here it is.

I am an Emergency Medical Technician, aka an EMT. The lay public calls us ambulance drivers, medics, EMS, heroes, assholes, and on occasion, firemen. I like plain-old "EMT" -- the name is shrouded in layers of professionalism and ideas of experience and sagacity, it doesn't make any claims to things we're not, and doesn't leave us sounding like livery cabbies. The job is hard. Physically, mentally, and emotionally. My fire and PD brethren will have you believe that their profession is more difficult. They would be correct. In general, EMS is the only of the BIG 3 emergency services where you don't line up to risk your life, but it's also the only one where injury, misery, grief and death is the most routine... a part of the job description.

Luckily for me, this is only a part-time gig. I dwell most days as a lowly college student. Engineering school is a reliable existence, albeit the UWS of the borough of Manhattan bleeds just enough caffeine to keep me on my toes. But its when I don my uniform for the University ambulance that I start to really come alive.

I don't remember why I decided to sit the training to become an EMT. Maybe it was the promise of truly, genuinely saving someone's life on every second Tuesday. Or maybe I like flashing lights and sirens. As a kid, I remember calling 911 for my sick grandfather and having the Paramedics arriving seconds later, perform their witchcraft, and save the day. OK, that last statement isn't true, but it would fit the profile wouldn't it? Truth is, I've been doing this for a long time ("how long?" you ask, but if I told you, You'd have to call 911) and love it. Oftentimes we get toned out for silly, inconsequential things: Sprained ankles, cut fingers, and I've waded through more foul, drunken vomit that you could ever imagine (Collegiate EMS remember). But there are more than enough legit calls as well.

And that brings me to the grand bullet of the presentation. I have stories to tell, and ideas to express (which I suppose is the point of all blogs -- cut me some slack, this is my first one ever). I've run EMS in urban and suburban (my home away from home(school) is a little town in Upstate NY) settings. I've been the probie, the chief, and the administrator. I've been in thick as much as thin, sun as much as snow, and day as much as night, and grown right along with the green, green grass. So I write -- not for you, but for me. I'll try to make it interesting, but no guarantees. I like adrenaline, but I like whimsical humor just as much. Anyhow, we'll see how it goes. This is my first post and it's Tuesday. I leave you now, there are people to see.