Blue Lights & Car Horns

My First Kill

2009-10-20T13:55:00.003-04:00

They always said that sooner or later, at some point in your medical career, you'd be responsible for causing the death of a patient. Thankfully, my most recent experience doesn't fall into that heading, but perhaps that's up to interpretation.

This past Saturday was an unseasonably cool and rainy day. The first snow of the year had just fallen in the higher elevations, and autumn seemed to have skipped us by in the Northeastern part of the United States completely. It was summer two weeks ago, and now here I am, bundled up in a thick jacket and cradling hot chocolate while sitting in the ambulance, waiting for a call. My partner that day was a nurse/paramedic with about 15 years experience on me, and when we're not doing 911 jobs, we serve as the critical care inter-facility transport unit. I myself have 6 years total EMS experience, with just about a year as a paramedic.

About three hours into the shift that started at 6AM, we're off to a call for new onset seizures. Our system is multi-tiered, and in addition to the Paramedic unit I'm working, every Priority 1 assignment gets a BLS ambulance and the firefighters as first-responders as well. Fire is already in the house when we pull up on scene, but a few moments after the BLS had arrived. When we get upstairs, we find a 62 y/o women tended to by her tall, panicky son, who in my opinion anyway, seemed tweaked up on something. The women is conscious and breathing just fine. My partner starts asking her some questions which she answers without difficulty. She doesn't seem like she had any seizures at all. By talking to some of the family members, it seems that she has a history of asthma and diabetes. She vital signs all check out fine (EKG: ST at 110 bpm, BP: 128/82, Respiration clear at 14-16, BGL: 224 mg/dL). She tells us that she has no pain, but "doesn't feel well." Her son says that she threw up this a couple hours ago this morning, and was in the hospital and discharged for something similar a week or two ago. Other than this, everything else checks out.

In our system, if a patient doesn't need ALS, we routinely release the patient into the care of the BLS and allow them to transport to the hospital. This is what we did in this case. Finding no life-threatening medical problems, or issues that we could care for, we allowed the BLS to take her to the hospital, an eight minute ride away - three minutes farther than the closest hospital. Our field diagnosis was that of either a stomach bug or perhaps the flu.

We return to the station to pick up some supplies and about fifteen minutes from the time we left the patient's home, I get a phone call from the BLS crew.

"Dude! Our patient just arrested in the ER!"

"No!!" I yell into the phone, "That's not possible!"

"Yeah man, they're doing CPR on her right now!"

Out patient died not 30 minutes after I last spoke to her.

I don't know for sure the cause of death, but after we raced up to the ER to find out what was going on, the nurse said she likely had a heart attack. This is something we could have detected. Perhaps not in time to prevent her from going into cardiac arrest, but something we should have known about. We have drugs that could have helped, and we certainly could have treated her.

For the past few days, images from the scene have been replaying themselves in my head. My mind is looped on the assessment we performed on this patient, trying to determine if there was something, anything, that presented itself that would have indicated to us to go a little further and spending more time with this patient - something that would have indicated that we should do an additional test, or look deeper in the patient's situation. I keep coming up dry. Aside from throwing every test we have available to us and looking for an abnormal finding, we performed a prudent exam based on the presentation of the patient. That exam lead us the the field diagnosis that we arrived at.

It's easy to Monday night quarterback these types of calls, and some colleagues of mine have indicated that they would have handled this patient differently, but several others have indicated that they would have probably done the same. It's easy to think about how things would have gone another route, but I continue to arrive at the same conclusion time after time: we didn't miss anything, obvious or subtle.

I'm waiting for the Quality Assurance director to review this call, but I've already approached our medical director and spoken to him about this one. He said that it probably would have been prudent to do a 12-lead EKG or orthostatic vital signs, and I agree, but he seemed sympathetic at least. In the mean time, the images continue to roll around in my head.

Essay

2009-03-13T16:37:00.003-04:00

So I decided to try to go back to college, and eventually medical school. Here is the essay I wrote for the admissions folks about my decision (some information redacted!):

The decision to change careers was not an easy choice to make, yet in a way, it was the easiest one I’ve ever made. During my undergraduate work at [some NYC school], I had one main goal: obtain my engineering degree then find a solid and stable position to begin my professional career. I succeeded in achieving that goal and for the past two years, I’ve been happily engaged as an engineer working for the government [doing stuff] in the City and State of New York. My work is secure and interesting. It is challenging and often rewarding. However, I feel that my career is just a job and I quickly realized that I could never, truly be passionate about engineering.
In retrospect, it probably should have been easy for me to listen to my passion from the beginning and set goals that were worthier than simply trudging down a career path that lead only to job security, but no zeal about my future or my work. In fact, all along I’ve been walking down two paths simultaneously. These paths led side-by-side for a long, long time, but when they finally diverged, I realized I was stuck on the path that led to the place I find myself now, a comfortable but unfulfilling existence.
It wouldn’t be accurate to say that I “suddenly realized” the path that I wanted to follow, or that I had a “revelation,” because I really knew the truth all along. I knew that I wanted to enter the field of medicine, go to medical school, and become a physician for a long time. Starting from the first semester of my first year in college, I have been involved with EMS, the Emergency Medical Service. By the end of the term, after taking the class on campus, I was certified as an EMT. My involvement with EMS has been a large and constant part of my life ever since. I started as the low man on the totem pole at my college’s volunteer ambulance, and upon graduation, I had achieved the highest rank there was in the Corps: Crew Chief. But it went beyond that – during my summers off, I worked as a volunteer from my parent’s house in Upstate New York with the local fire department. I also became involved as the [big-wig? no thatr's not right] for a non-profit organization: the [some EMS organization].
After I earned my degree, one of the first things I did was to enroll in Paramedic school, an intense 12-month educational experience. The process of becoming a Paramedic was eye-opening. I learned to practice a new level of clinical medicine and I loved it! I did observations in nearly every department in the hospital, and learned skills like starting IVs, intubation, reading and interpreting EKGs, treating heart attacks, and giving medications in response to a patient’s distress. It was also during this year in Paramedic school, through interacting with doctors on a regular basis that I finally knew that I could never work as an engineer for the rest of my life.
My current place in life has me again walking two paths. I now work full-time in my regular and non-changing engineering job. I am also working part-time in [hem, ahem!] in the dynamic setting of a Paramedic. I enjoy being a Paramedic, but I am eager to learn and do even more. There are now people alive on this earth that would not be here today if I hadn’t been beside them. There are also people who have died because I wasn’t able to intervene, because the training of a Paramedic is limited and the skills and procedures that we perform do not address every situation.
Becoming an engineer was difficult, and an arduous journey itself. It was difficult deciding to turn my back on a promising career. I am aware of the challenges that await me. I know that a high-level of academic achievement is required. However, I will succeed. I have never felt more determined and eager for the future. It is time for me to leave the path that is warm, comfortable, and smooth all the way to retirement, and return to the path full of potholes, challenges, and excitement – the correct and true path. I know that every obstacle I overcome is a step in the right direction.

Happy Birthday!

2009-03-06T16:56:00.001-05:00

My Dad turned 58 yesterday. He’s an engineer and currently works apart from the family in Saudi Arabia. I remember when I was a lot smaller we were all sitting down one weekend afternoon for a nice lunch of hot dogs. I started choking. My Dad called 911, started the Heimlich Maneuver (abdominal thrusts!), and a minute or so later, out popped the chunk of meat that had been plugging my trachea.

So, Thanks Dad: Not just for giving me life, saving my life, and raising me into a man, but thanks for just being here. Happy Birthday!

'THE' EMS Convention. No, not that one.

2009-03-03T00:00:00.003-05:00

This weekend I had the opportunity to participate in the National Collegiate EMS Foundation's annual conference. As one of the mid-level volunteer administrators for the Foundation, I had an very interesting and very unique view of the event.

NCEMSF is a group formed nearly 20 years ago to address the specific needs of an under-served part of the EMS community: the scores of volunteer first-response and ambulance corps that operate on our country's college campuses. This year, nearly 900 participants traveled to our nation's Capital to attend lectures, participate in discussions, and learn how to advance each individual group's missions.

The college-based EMS group is unique. There are very few ALS providers, and the majority of providers are new to the field. Almost all are volunteers, and for many, participation on a college EMS squad is their first exposure to the field of EMS.

Campus squads also face many unique challenges: money is certainly an issue. Very few receive federal or state grants. Training is another concern: with the high level of turnover associated with graduating students, experienced providers often barely reach an level of excellence before leaving the scene. Also associated with this transient group are issues of recruitment, retention, and motivation. Myriad other challenges also stand in the way of the success of a campus EMS group.

Yet, this past weekend was inspiring. As facilitator of the skills competition, I saw providers struggle with some very challenging scenarios. Some failed miserably, others were competent, but many rose to the occasion, and probably provided care that would be unmatched elsewhere. In the ten minute time window, I was groups recognize immediately a case of possible bacterial meningitis; something I myself probably would not have done, even with my ALS qualifications and six years of experience. On the ALS competition, the rare and tricky beta-blocker overdose provided a challenge, but many treated the patient successfully.

Collegiate EMS is not really an end in itself. It is really just a beginning. A nation of healthcare providers and leaders grow out of this one-of-a-kind community. Being a part of this community and helping nurture it was a rewarding and significant personal experience. I received my start in EMS as a freshman in college back in 2003. The ability to begin to serve not just my patients, but now the next generation of EMS providers is truly special.

PS, Congratulations to my alma mater for winning this year's Collegiate EMS Organization of the Year Award!

We've all been there

2009-02-24T18:09:00.003-05:00

The job is for an 'altered mental status' at a local nursing home. The BLS gets there first and radios us to set up in the back of their bus. As they're coming down the elevator, they again radio us that this "could be cardiac related."

Relaxed, my partner throws a few new stickies onto the 12-Lead wires, and I continue scribbling the location details on the chart. As if by magic, the EMTs appear when they throw open the rear doors. "Nursing home staff found her this morning at 10AM, but they thought she just wasn't speaking because she was in a sullen mood, I couldn't feel a radial pulse or get a blood pressure" the quite petite and quite cute, young EMT tells me: Mr. Medic.

I glance at my watch: 4PM.

My partner puts the EKG leads on, and we both look at the monitor at the same time -- idioventricular beats only, at a rate of 20 bpm. Not good. In case you haven't guessed yet, this patient is completely unresponsive. Here we have the 85 y/o female who waited six hours for medical attention, and all of a sudden, now we are all springing into action. My partner and I move with the certain speed and grace that only a life hanging in the balance can instill in a man.

Oxygen. Intubation. Intraosseous Access. Assisted Ventilations. Fluids. Atropine. Pacing.

Our first line medical treatments... not a dent, not a change. We've run out of Standing Orders.

We call the doc and and let him know what he's about to get hit with. By this time we're racing away with every light and every siren blinking and yelping at full bore. "DOPAMINE!" the doc yells over the din. Barely time to look at the drug and we're pulling into the ER. A flock of nurses, a young, quiet Attending, us - the medics, a mass of people. More medical procedures the do, more hands flying around in a blur. Then calm. Order sets in. The routine kicks in again...
A nice stable blood pressure gradually sets in. The ventilator is hooked up, blood work gets sent, the medics go on their next job.

The following day I speak with the quiet young Attending physican. " A Save!" says he, but to what end? Only a stopgap in death. A crumbling levee against the tide of the inevitable. The doctors, can't wean our patient off the dopamine. Physically, she's probably moderately strong, but too long a hypoxic brain. Too much injury. The family makes their grandmother DNR. Six hours.

Green Medic

2008-11-02T22:08:00.003-05:00

This just in! New medic in town! Oh baby, going to hit the streets!

After a year of classroom study and clinical rotations, I am a fully certified and rip-roaring, ready to go, brand-new Paramedic. The new gig is a very busy urban EMS system in the most densely populated county of the most densely populated state (New Jersey). I started last week and tomorrow is the last day of orientation. Since I'm a per diem, my first official tour of duty will be six days from today.

Now, you may ask, "Why cross the mighty Hudson River from your beloved City of New York for a job? You have five years experience as an EMT in your fair city, and trained as a medic in the same?" The most honest answer is "Uhhhh...?" So, with that affirmation in the hopes that I know what I'm doing, I embark to work in the Garden State twice a week; and for twelve hours on each of those days, 'County of 1,000,000 people': I will be one of the only six paramedics here to come at your call (assuming the dispatcher decides you need ALS attention!). Good luck crazy county, to the both of us!

Ho, crap!

2008-10-26T04:09:00.004-04:00

Wow, what happened!

Paramedic school really beat the piss out of me. But at least I can now call myself Polarbear, NREMT-P!

With medic school over and done with, I think it's time to get back to this blog. New posts coming soon!

Old and Crusty

2008-02-19T15:44:00.002-05:00

Anyone who's anyone in this game has seen "Bringing Out The Dead," starring Nick cage and directed by Scorsese. The movie is based on the book by Joe Connelly.

I found out when starting my medic class that one of the characters in the book is based on someone who currently works as a Medic at one of the places where we do ambulance rotations. There are lots of stories about this man, who we all know only as Marcus. Most recently, I heard him described as a "curmudgeon." I had spoken to him in the past about non-EMS related things and had thought that this was a fair description of his personality. We just didn't see eye-to-eye on things.

This past weekend I worked my first ever tour with this man, and was delightfully surprised. He was a pleasant enough individual, and true to the movie, some of the qualities portrayed shone through quite clearly. For instance: he drives sllloooowwww. Case in point: On our response to the Unconscious, I'm pretty sure we didn't exceed 7 mph.... with a clear path ahead of us... and our lights and sirens going.........! I just have to say... I understand being cautious,... but why stop at the green lights?

All in all, we only did one job, so I reserve whatever judgment I have on his performance as a Medic and a teacher... though I'm sure of this now: whatever criticisms I may have of him, he will never find out. There's only so much you can disagree about with a person who's been working the streets since 1978.

A real Paramedic?

2008-02-09T13:01:00.000-05:00

It's funny, isn't it? At this point in time, I'm just about nearing the halfway point in Medic school. An odd accomplishment. The novelty of going to class and working the rotations has pretty much worn off. We've lost a number of students, so that the room where we have lectures is only half as full as on Day One. I've been the the NYC Morgue, the Operating Room, NYPD's Central Booking, and a number of other places where I didn't think I belonged a mere five and a half months ago.

I've learned a load of skills that I had only dreamed about performing, once upon a time, and actually done them on real people without any real harm (at least, no permanent harm). I've now started countless IVs, taken EKGs, and finger sticks. I've intubated people, paced and defibrillated people. I've carefully carted my City's poor, homeless, and hunger, to a safe place off the streets, where they could get a warm meal (and put up with the derogatory banter from everyone they came in contact with).

And yet, though we've studied Anatomy, physiology, pathophysiology, patient assessment, pharmacology, airway management, trauma, and pulmonology, we still sit on the cusp of cardiology and still have another six months of class to go.

One of my friends, who I know from school and from a volunteer ambulance corps, is a BLS provider. He asked me the other day, whether I was starting to feel like a real Paramedic? The truthful answer to this question is: No. I don't. I feel like an EMT who now can start IVs and intubate, etc.

A few weeks into class, one of my classmates came to lecture wearing a borrowed paramedic job shirt. He had just got puked on during a rotation and didn't have any extra clothes. Our instructor riped into him. "Do you really think you're ready to wear a white patch! Do you?!" he yelled. At first I thought this uproar was about paramedic pride. An elite group of few who protect their rank with indignant honor. Yet now, I think differently. I realize that the white patch is as much an journey of self, as of just completing the Paramedic course. The thinking is different from a paramedic as from an EMT, just as thinking is different from an EMT to a lay person. I can only assume that sooner or later my thinking will shift from BLS provider to ALS provider. But, until that time, I'm still just an EMT.

Sorry Boys.....

2008-02-09T12:57:00.001-05:00

Note to self: Do not try to drive ambulance down steps in Central Park!

68

2008-01-07T00:06:00.001-05:00

I wonder what it's like to wake up on a normal, beautiful, sunny and crisp winter day, go to a restaurant with friends for a bit of lunch, step outside, trip on a grating on the street, then fall into a coma and die?

As a paramedic student, I've been spending an awful long time in the Emergency Room lately. Mostly I'm there to help out -- you know, start IVs, do EKGs, take vital signs, etc., but also to observe. Thus I find myself observing a late-afternoon scamper as a notification from an ambulance comes in for a person falling from standing height, unconscious, being manually ventilated.

Doctors are literally pouring out of the woodwork. "Notify the trauma team!" screeches one MD, "Call neurosurgery!" yells another, "Does respiratory know?" asks a third. These people haven't even seen the patient yet, but already beepers and pagers are going off all over that block in Greenwich Village.

Finally, red and yellow flickering lights can be seen through the opaque doors of the ER as we all watch from the trauma room down the hall. Thirty seconds passes, then a minute. A doctor starts to walk towards the entrance, when... swoosh!... it slides open. Two medics are calmly and carefully pulling their stretcher towards the sea of green scrubs. The one at the head gently squeezing the bag at the patient's head every few seconds. They wheel him into the room and transfer this man onto on the hospital bed. A whirl of activity ensues.

Clothes are cut off. The medics are grilled by one doctor. Another nurse starts an IV and draws blood. Another doctor makes the decision to RSI (Rapid Sequence Intubation) the patient, a portable X-ray machine is suddenly in view. One doctor gets a brainwave: "This doesn't look like a trauma! There's no sign of external injury! Someone call the stroke team!" Ten doctors all working on one patient. Some independently of the others. How they know what another is doing, I don't know. Maybe they don't....

The decision is made to transfer the patient off the longboard and take off the collar protecting his cervical spine. I've moved outside the trauma room to talk to one of the medics who brought this unfortunate soul in. He asks me, "What do you think?" I shrug. The he asks me the question that's really bugging him: "Do you know why they're taking him off the board?" Again, I shrug -- they don't think it's a trauma I tell him; but I agree with him, if this were my patient I would leave him on the backboard. Both of us are powerless to stop the mass of doctors.

The process has finally reached an end. The patient is carted out for a CT of his head and any other body area they can think to irradiate. The show is over.

About an hour later I notice that the patient has returned. He's now in the main treating area, lying in bed, next to another patient, looking just like the rest of them, only this patient is on a ventilator. I ask the attending physician if I could look at his imaging. The CT isn't good. I massive bleed on the left side of his brain with midline shifting. On of the ventricles on the right side is empty. Essentially his whole brain is being squeesed through the only place where it can go: down through the hole which the spinal cord passes. I start to form a question, but the attending already knows what I'm going to ask.

"This was probably caused by his fall," he says, "There's nothing we can do. It's only a matter of time."

68 years old on a beautiful, sunny, crisp winter day.

New Year's Eve on 7W

2008-01-03T01:21:00.001-05:00

After completing the first phase of our clinical time December 1st, I took a few weeks off to rest and prepare for the Holidays. Unfortunately, when I looked more carefully at the work I need to finish by April 1st for the second phase, I realized I was starting to fall behind. Thus finds our brave hero walking into the Medic room at ten minutes to 4PM on December 31st for the eight hour tour leading into 2008.

I would have preferred not to be working, but this is medic school after all, and sacrifices have to be made. I should be counting my blessings since I was able to at least get up to see my grandparents and family over Christmas. I know at least one person who was doing tours over that holiday.

Prepared for the worst, I knew an ALS tour in Greenwich Village on New Year's Eve could turn into hours of responding to the "Unconscious," aka people who indulged on too much Champagne. Also, the possibility existed that we would spend the entire tour in the throng of partygoers chasing ghosts in the crowds at Times Square, a mere 30 blocks north from our assigned station.

Lady Luck seemed to be with us however and by 7PM, we were just starting to head to our first job for the "Internal Bleeding" of a 95 y/o women. Pretty uneventful call. It wasn't even too stinky considering her chief complaint was a GI bleed. I couldn't get the IV on my one attempt (also my first attempt in the field), but I think that was more luck (and not so great veins) than lack of skill on my part. In fact, after doing about fifty or so in the ER, I'm starting to feel more confident with sticking people. Her B.P. was pretty low and one of my preceptors got the line in the pt's other hand to start administering fluids on the way to the hospital.

Hours passed until we got our second job. This one was for the unconscious, but on arrival, the pt has already disappeared. Seems like there were some ghosts haunting the City after all. I actually don't mind chasing after phantom patients. I prefer to be working than idle (or as it was, studying my trauma textbook in the back of the rig), but it amazes me how many resources go into this one 911 call. For example, this was a street job, and more than likely, someone walked passed someone lying on the sidewalk. They then flipped out their cell phone, hit the magic buttons, and next thing you know, I'm on my way, along with another BLS ambulance, a FDNY engine company, and a police car going to another scene where everyone is gone by the time we get there. Oh well, this is the age we live in. Cell phones are everywhere and people have just enough scruples to call this an emergency, but not enough to walk over the person lying on the concrete, shake their shoulder, and find out if their alright.

Returning to the medic station, we find the street we're traveling down blocked by a fire engine. We weren't assigned to this job, but the firefighters wave us in. We call ourselves flagged down to dispatch and enter the nice, quiet restaurant. At least it was quiet until six firefighters, two Paramedics, one medic student, and two cops barge in.

The patient is a middle aged women. Cool, pale, diaphoretic. History of MIs and COPD. Appears weak, and slightly AMS. Bystanders report a near syncope as she was eating her dinner. FD has her on O2, so we make our quick, ninja-like exit with the stairchair to the back of our bus. I've noticed that the medics are staring to trust us students a little more, so I have the responsibility of hooking her up to the 12-Lead, and getting IV access. Both completed successfully (22-guage in the right AC! -- Woo hoo -- first line in the field!). Her rhythms look good and the field diagnosis is vasovagal near-syncope. we dish her off to the hospital without any problems and it's 11:00 PM.

No more jobs for the rest of the night, but a couple minutes to midnight we all start to gather on the sidewalk outside the ER. Nurses, doctors, staff, medics, and students stand at 7th Ave and 11th St. in Manhattan. We can just barely see the ball, but when the fireworks go off, we all cheer and hug each other. A few quick minutes of celebration and everyone soon returns to care for their patients.

What a great way to bring in 2008!

National Politics of EMS

2007-12-08T15:01:00.000-05:00

Fortunately, this is not a political blog, and the last thing I'm going to do is write a politics post. However: with all the presidential nonsuch beginning in just a few short weeks, I thought I would start looking into a few things...

Namely, I was surfing around looking at the different candidate's webpages and came across one that mentioned firefighters. Hmmm, I thought. Interesting. The next logical progression was to start looking for candidates that stated on their website that they were supporting EMTs and Paramedics. Unfortunately, if you were to do the same thing that I did, you'd be quickly disappointed.

So I systematically went through the websites of all the presidential candidates from the two major parties (as listed on washingtonpost.com) and checked to see what the candidates stood for:

The following candidates explicitly mention standing for Firefighters and Police Officers:

Joe Biden (D)
Chris Dodd (D)
Bill Richardson (D)

The following candidates had no mention of firefighters, police officers, or EMS:

Hillary Clinton (D)
John Edwards (D)
Mike Gravel (D)
Dennis Kucinich (D)
Barack Obama (D)
Rudy Guiliani (R)
Mike Huckabee (R)
Duncan Hunter (R)
Alan Keyes (R)
John McCain (R)
Ron Paul (R)
Mitt Romney (R)
Tom Tancredo (R)
Fred Thompson (R)

Now, as a member of the EMS community, the fact that no presidential candidate mentions anything about EMTs or Paramedics explicitly on their website (some say 'other first responders' -- but come on, what does that mean?) is troublesome to me.

This was just an observation I made that I thought I would share with you.

And by the way, if I made a mistake in looking at one of the candidate's websites, tell me about it in a comment or shoot me an email and I'll fix this post.

OK, this will be the last post I make on politics in a long, long time.

ER

2007-11-18T02:37:00.000-05:00

In the ER today... 16 hours in the ER.

The good news: we were cleared on IV sticks this past Monday so I was able to get a lot of practice today.

The bad news: missed my first eight IV starts on real people before I got one patent line in.

(Good news again: I got five in a row after that... I'm on a streak!!)

Things were good and the nurses I was working with were very nice and very helpful. Entirely willing to teach... That is, until the end of the day, at 11:30PM when I went to get all my skills and attendance verification sheets signed by the Charge nurse... who said, "Who are you? I've never seen you before!"

Let me tell you -- If you want to beat your head against the f---ing wall, work 16 straight; performing skills and walking past someone all day and have them say that to you. I was about to deck her. She actually refused to sign any of my sheets! (I was able to get the nurse I was working with to sign me off, but technically, the charge nurse is the one who supposed to take care of that.) I really don't understand... it seems only in nursing that you find so many wonderful people doing a job, and yet... just as many bitches doing the exact same job.

I apologize for my use of profanity, but it's hard to convey my frustration to be on the receiving end of undeserved treatment like that after I spend so many hours of my Saturday (unpaid!) working my hardest to learn, doing my best to treat the patients and staff as respectfully as I can, and just generally being helpful... And all for what would have amounted to 15 seconds signing my forms.

A terrible end to an otherwise decent day.

I just hope that a good night's sleep and a day off will cure my newly instilled despair.

Something completely completely different

2007-11-07T01:21:00.000-05:00

Found this today and thought it was an interesting read. Thanks to the original author at: http://www.math.canterbury.ac.nz/~m.steel/life.pdf

Advanced Provider

2007-11-02T01:53:00.001-04:00

Oh my God! Oh my God! Oh my God! Oh my God!

I finally feel like a real-live advanced provider!

Tonight in class, I did my first IV stick!!!!!!!! Woohoo!!! (OK, OK, it was only on the plastic arm thingy.)

Yeah, yeah. I know all you Paramedics out there are rolling your eyes, and you nurses have already surfed away -- but to me, a lowly EMT for years on years, it seems like Neil Armstrong's 'One Small Step.' And albeit I have no idea when an IV is actually required. And I realize I have no idea what to do with it once it's in place. I also realize that there are still months and months left before I even think about considering myself a Paramedic. BUT GIVE ME A BREAK because I CAN START IVS!!!!

Pharmacology 101

2007-10-18T23:59:00.001-04:00

Did I mention how my Medic school instructor is pretty cool. JB (as we'll call him) started the basic Intro to Pharmacology unit with us tonight (not where you memorize all the drugs, but where we figure how how drugs function).

Now if you were an instructor and decided to use a clip from a movie to show the exciting world of medication administration what would you pick?

The scene OD scene from Pulp Fiction of course!

What a great way to kill twenty minutes in class.

PS: Got a 90% on my A&P exam. Not as good as I would have liked (5 questions wrong), but who can complain?!

Tired

2007-10-08T22:59:00.000-04:00

Whew! This was a tough weekend.

The guys at my volunteer squad back at school needed a hand with shifts on Friday night and they came to me. Since I'd been MIA for awhile, and like an idiot, I decided to help them out. Overall not a bad time, however, when it came to Saturday, I knew it was going to be trying to finish the day.

I decided I wanted some experience doing the overnight shift in Lower Manhattan, so to kill a couple birds, I took a double starting 3PM and ending 7AM Sunday morning, on a BLS truck for my clinical time. We were hopping all through day and into the wee hours. Some new experiences:

-Getting left on scene by the crew
-Sleeping in the back of the ambulance (max 35 min. at 5:15AM between calls)
-Picking up an inmate from a police precinct
-Having said inmate cry all over me
-Sort out the victims of a massive fight, including our patient, who, when asked "Would you rather go to jail with everyone else, or not go to jail?" picked "Go to jail."
-Sixth Floor walkup (is there a maximum number of floors in a walkup?)
-10 jobs in 8 hours, 16 jobs total.

Let's put it this way: when I finally walked into my apartment at 8AM, I was beat, and hit the sack. I also banged out of some tours I was supposed to do today.

Back to the day job tomorrow, and the Anatomy & Physiology exam is Wednesday night.

Let's hope I make it through the week....

Push

2007-10-01T23:35:00.000-04:00

Finally... after nearly 5 years as an EMT, I get to push some drugs!

Doing some ride time for the clinical component of my Paramedic class, we get an Altered Mental Status (read: probably drunk), in a homeless shelter. And while after only two and a half weeks in class, I still don't really know squat, I saw the ALS AMS algorithm being worked. More importantly, the Medics I was riding with let me push the meds. OK OK, so I didn't have to think about anything and all I was doing was pushing plungers on the stuff that the Medics were handing me, but it was still a learning experience.

Here's what we did:

25 mg Dextrose (D50W, 50 mL)

followed by

Thiamine, 100 mg (100mg/ml)

and finally,

Naloxone 0.5 mg

After all was said and done, we talked about what we pushed and why. I also looked up the protocols, and sure enough, that was exactly what it said to do. One of the Medics, who is a 25-year veteran and usually based in the South Bronx (read: YIPES!) drilled in the Six Rights of medication administration, and scolded me for initially not checking what I was pushing.

Right Patient

Right Route

Right Dose

Right Time

Right Medication

Right Documentation

Overall, a great learning experience... and I'M EAGER FOR MORE!!!

Week 1 Done, and walking in my apartment door at midnight

2007-09-18T23:46:00.000-04:00

Completing tonight's lecture marks 1 week and 1 day of Paramedic class over. Tonight was the first night where we stayed almost all four hours and got out at 10:15 PM. Previously we've been released between 8:30 and 9:00 PM.

We only covered Medical-Legal issues tonight and while the review was useful, it seemed really repetitive from EMT-Basic class. Though this time, instead of the instructor throwing out scenarios that we, the students, might encounter in the field, we instead asked the instructor if the actions we took while encountering those scenarios were legal. A few highlights from tonight's discussion:

"I'm a volunteer and we took a patient to the hospital on our rig. The ER was packed and we were waiting forever in triage. Since I had to get to my real job, I hopped a ride with another truck from my agency and left my partner at the hospital with the patient. Is that abandonment?"

"Our medical control physician works 8AM-4PM, so we don't have online medical direction outside those hours. Can I administer a med that usually requires online control and let the doc know the next day?"

"We got in a fight with the police, and after they Tazed my patient, they refused to allow us to take her to the hospital. The police threatened to arrest us. Do we have liability if the police take her away and she has a heart attack?"

"Can parents consent for their children over the phone? How do we get them to sign the form?"

"I can't believe how hard it is to RMA someone in New York, back in Jersey if the patient can move the pen, he can RMA. Is that cool?"

The Road of 1000 Miles Begins with the First... Day

2007-09-12T00:24:00.000-04:00

The first day of Paramedic school is over. Things were pretty low key. We talked about course policies and procedures, expectations... and the insane amount of work: clinical and didactic coming up in the next year. I can't say I didn't expect it though.

We had today off in memory of 9/11 (this class takes place in Manhattan after all), and Day 2 starts at 7PM Wednesday!

Can't wait to actually start learning stuff!

If case you're wondering, you can see exactly which program I'm a part of here.

The Long Road Ahead...

2007-09-05T19:11:00.000-04:00

Good Lord! PARAMEDIC School starts this Monday!!!! Whoa! Aaahh! Help!

Another Map

2007-06-03T02:11:00.000-04:00

While existing as a bored, empty shell in my present state of insomnia, I created yet another map. This time, Google gets all the credit for the software and instead of charting all the Manhattan Hospitals, I have plotted the only the trauma centers for the Five Boroughs.

The map is available for your perusal here.

A short hiatus...

2007-06-01T02:27:00.000-04:00

The past several weeks were hectic. During this time I took a break from writing here, but also had final exams and GRADUATED COLLEGE!!! You didn't miss much since EMS-wise it's been pretty laid back -- sans the job where I found out 'mostly but not completely - unconscious' patients don't like having NPAs applied.

However, I'm out of NYC for a short while and back in my little town in Upstate New York. One of the more interesting happenings in this suburban locale was the 80+ y/o female, driving her car along one fo the town's roads and managed to wedge it nicely between a hill and the utility pole she cracked. My FD was called for an extrication, but essentially all we had to do was open the passenger door and yank her out, easier said than done since the car was pointed downhill at about 70 degrees. Not so bad, the pt wasn't injured but after she told us she was "trying to avoid all the mud all over the road..." (I turned my head and not only was there no mud on the road, but it was dry and clean as a whistle), we decided to ship her off to the ER. No harm done and the power company replaced the damaged pole. The next day (I KID YOU NOT!), we're toned out for a PIAA (personal injury auto accident) on the same road. Turns out it's the same pole struck. Let's just say the power company wasn't too happy. No injuries noted, but this 80+ y/o woman is c/o back pain, so she gets boarded and shipped out.

I hear new telephone poles are going for $1500 these days. I wonder if Medicare covers...?

2007-04-20T00:17:00.000-04:00

Reaching to our friends at Tech Rescue. Your response makes us proud. We're with you in the mourning.

This is unbelieveable!!

2007-04-14T23:56:00.000-04:00

Check out this video of a news broadcast from a Fox station in St. Louis.

I couldn't believe it when I saw it.

Governor Corzine Follow Up

2007-04-14T20:18:00.000-04:00

Here is a follow-up story from the New York Times, printed today, to the story I posted earlier.

April 14, 2007

In the Spotlight, the Politics of Buckling Up

By LISA W. FODERARO and KEN BELSON

As constituents and public officials wished Gov. Jon S. Corzine of New Jersey a full recovery from his injuries in a car accident, many were shaking their heads that someone who is so smart, and has so much to lose, would put himself at risk by apparently not wearing a seat belt.

Such was the surprise that the issue became an instant corollary to the main news that Mr. Corzine had been so seriously injured, with multiple broken bones, that he needs help breathing from a ventilator and faces months of rehabilitation.

In interviews and on the Web, people in New Jersey and from around the country expressed incredulity over the state police superintendent’s statement that the governor routinely refused to wear a seat belt. Some accused the Democratic governor of hypocrisy, even arrogance. A few called for his resignation.

Many said that if it turns out that Mr. Corzine was not wearing a seat belt when the crash occurred, he should receive a citation for violating the state’s mandatory seat belt law. The fines are $20 and court costs are $26 per violation. Others wondered why the state trooper driving the car did not insist that he wear one.

“What is he thinking?” asked Marsha McMillan, 22, a worker at a store in the Hamilton Mall in Mays Landing, N.J., several miles from the crash site. “It’s almost bizarre. I bet even the strangest of rappers and punk rockers wear seat belts.”

Comments in a similar vein appeared on popular political blogs and local Web sites, like Baristanet.com in Montclair, N.J., as well as the reader forums of several local newspapers.

Jon Rantzman, 67, of Walnut Creek, Calif., who posted a critical comment on the Empire Zone blog of The New York Times Web site, said in a phone interview: “A governor, any governor, should be a role model, not a scofflaw. How can we pass a law and fine the citizens of New Jersey for not doing something” that the governor “gets away with”?

Safety organizations, in the meantime, cited the severity of Mr. Corzine’s injuries as further evidence of the importance of seat belts.

“It’s unfortunate and tragic and another very high-profile reminder that we still have a ways to go to convince some people to wear their belts,” said John Ulczycki, executive director of transportation safety at the National Safety Council.

Even though New Jersey may be perceived as a dangerous place to drive, traffic statistics tell a different story.

According to figures from the National Highway Traffic Safety Administration, the number of traffic fatalities in New Jersey is well below the national average. And a record-high 90 percent of drivers and front-seat passengers in New Jersey wore seat belts in 2006, the eighth-highest rate in the country. (The state of Washington is No. 1, at 96 percent.)

Statistics show that 46 percent of passenger vehicle deaths in New Jersey in 2005 involved people who were not wearing seat belts, according to state police records.

While mandatory seat belt laws were strenuously opposed in many quarters when states first started enacting them in the mid-1980s, they are now so much a part of the culture that even toddlers know to buckle up before a car starts moving.

So what might cause Governor Corzine and the others to break the law in such a risky way?

“Even the worst nervous Nellie in the world has some glimmer of a sense of invulnerability, and all of us have some of that,” said Dr. Tony Stern, a psychiatrist in Westchester County, who admits he does not wear a seat belt “100 percent of the time” himself. “And someone who is a doer and an alpha male and a multimillionaire is going to have more than the average sense of invincibility.”

The former governor of New York, Mario M. Cuomo, said in a phone interview yesterday that he, like Mr. Corzine, preferred to sit in the front seat. And while he initially found seat belts somewhat uncomfortable, he said he wore them out of a sense of duty, given the fact that he had signed the nation’s first mandatory seat belt law in 1984.

“I remember the violent opposition it received,” Mr. Cuomo said. “People didn’t like the idea of being forced to strap themselves in. When we adopted the seat belt law, it was the most unpopular thing I had done as governor.”

In New Jersey, which passed its own law shortly afterward, the use of seat belts has been on the rise. The rate was 74 percent in 2000, when New Jersey made the law stricter, allowing police officers to pull over vehicles to issue seat belt citations. Previously, they could issue such citations only if the car had been pulled over for a separate offense.

About half the states now have the stricter form of the law, and organizations like Mothers Against Drunk Driving, a nonprofit group, are pushing for the rest to follow suit.

It is not clear whether the governor will get ticketed. New Jersey State Police officers have the discretion not to issue citations for seat-belt violations.

New Jersey’s Seat Belt Law applies to drivers, all passengers between 8 and 18, and all front-seat passengers. The law makes the driver responsible for proper seat belt use only by those younger than 18.

Few people interviewed suggested that Governor Corzine would suffer any lasting political consequences.

“Whenever there is a tragedy like this, I think whether it hurts or helps in the long run has a lot to do with how the victim handles it,” said Peter J. Woolley, a professor of political science at Fairleigh Dickinson University. “Corzine could become an apologist and a spokesman for traffic safety and seat belt use.”

Robert Strauss contributed reporting.

NJ Governor Injured

2007-04-14T13:12:00.000-04:00

The following story has been in the news these past couple days in the Tri-State area. Thoughts and prayers go out to Mr. Corzine. Reposted from the New York Times.

April 13, 2007

New Jersey Governor Is Injured in Car Crash

By DAVID KOCIENIEWSKI and DAVID W. CHEN

CAMDEN, N.J., April 12 — Gov. Jon S. Corzine underwent surgery on Thursday night after a car accident in which he broke his left leg, sternum, collarbone, six ribs on each side and a lower vertebra, state police and other government officials said. He was in critical but stable condition at midnight, sedated and on a breathing tube.

Mr. Corzine was in the front passenger seat when his state police vehicle swerved to avoid an apparently out-of-control driver on the Garden State Parkway and hit a guardrail. He was flown by helicopter to Cooper University Hospital in Camden, where he received seven units of blood and a metal rod in his leg during a two-hour operation that ended about 11:30 p.m.

“He has what we call multisystemic injuries,” Robert F. Ostrum, Cooper’s director of orthopedic trauma, who led the surgical team, said in a midnight briefing for reporters here. “Injuries to his chest, lungs, to his legs, and he lost a significant amount of blood.” Asked whether Mr. Corzine was lucky to be alive, Dr. Ostrum said: “Yes.”

Mr. Corzine is scheduled for two more operations, Saturday and Monday, to clean up the wounds, Dr. Ostrum said, adding that it would be “days to weeks” until he was lucid enough to conduct state business, and three to six months before he could get around fairly well. Though the governor sustained a cut on his forehead, Dr. Ostrum said a CAT scan showed no brain injury.

Richard J. Codey, the State Senate president and a Democrat like Mr. Corzine, stepped in as acting governor during the surgery, and is expected to remain in charge as long as Mr. Corzine is hospitalized.

The state trooper who was driving the Chevrolet Tahoe that was carrying Mr. Corzine was flown separately to Cooper, and asked that no information about his condition be released. Samantha Gordon, an assistant to the governor who often travels with him, was also hurt in the accident but walked into the Camden hospital unassisted shortly before 8 p.m.

After delivering a speech to the New Jersey Conference of Mayors at the Trump Taj Mahal casino in Atlantic City, Mr. Corzine was on his way to Drumthwacket, the governor’s mansion in Princeton, for a meeting between the Rutgers women’s basketball team and Don Imus, the talk-show host who was fired on Thursday for making a racist and sexist remark about the players.

In a 9 p.m. news conference at the hospital here, Col. Joseph R. Fuentes, superintendent of the New Jersey State Police, said that a red pickup truck entered the highway “erratically from the shoulder,” causing a white Dodge Ram pickup truck to swerve left. The governor’s driver, State Trooper Robert Rasinski, swerved to avoid the white truck, but hit it, and then slid into the guardrail, with the impact on the passenger side.

Colonel Fuentes said neither weather nor speed appeared to be a factor. He said Trooper Rasinski did “an excellent job handling the situation, considering that a car swerved into his path.”

The driver of the white truck stopped, he said, but the red truck did not, adding that state police will be examining cameras on the highway in hopes of identifying the red truck.

Governor Corzine was traveling, as he normally does, in a two-car caravan. Officials said the two troopers in the car following Mr. Corzine stopped to care for him rather than chase the red truck.

Mr. Fuentes said he was unsure whether Mr. Corzine was wearing a seatbelt; he often does not.

James Freund, a volunteer emergency medical technician, said he happened upon the scene and saw Governor Corzine, his glasses off, pulled from the car head first on an board used to immobilize the spine. “The only thing you could verbally hear from him was that he was moaning,” Mr. Freund said. “It looked like the car made a direct impact on the left guard rail and kind of hopped over it.”

Mr. Freund said that he saw the injured trooper give the thumbs-up sign to a fellow trooper, and that a swarm of firefighters and some 30 law enforcement officers, “looking like C.I.A. agents, dressed in black, with earpieces coming out,” surrounded the scene. He said the helicopter arrived at 6:25 p.m.

“It was obviously someone important,” he added. “I was assuming there was a fatality.”

New Jersey faces a $2 billion budget deficit that Mr. Corzine must close by July 1, and questions have been raised about the fiscal and legal soundness of the state’s accounting of its troubled pension system. He has been criticized by Republicans and others for failing to disclose the extent of his financial gifts to a former companion who is also the head of the state’s largest union. And all of this is taking place at a time when federal prosecutors have subpoenaed records from the governor’s office, and legislative offices, as part of a broad inquiry into Trenton’s often-murky budgetary practices.

More immediately, he was scheduled to leave Saturday for a five-day trade mission to Israel, his second international trip since becoming governor last year.

Dr. Ostrum, the surgeon, said the governor’s most severe injury was an open femur fracture, in two places, that pierced the skin. Surgeons used the longest rod and longest screws they had to repair the bone, and it still was not quite long enough for the 6-foot-3 governor. “Governor Corzine has a very long leg,” he said. “He’s got a significant rehab ahead of him,” he added,” but “there is no risk that he will lose his leg.”

Despite the seriousness of the injuries, Mr. Corzine’s pulse and blood pressure remained stable, Dr. Ostrum said, adding that he was lucid and talking to doctors when he arrived at the hospital. The doctor described the broken vertebra as “a nothing fracture,” and said he would give the governor a sling “for comfort” to heal the collarbone. The broken ribs and sternum were what necessitated the breathing tube.

The accident occurred at Mile Marker 44.5 in Galloway Township on the parkway’s northbound lanes, about five miles north of the Atlantic City Expressway. At Drumthwacket, the Rutgers team, which made it to the N.C.A.A. championship game but lost to Tennessee, arrived at 7:45 p.m. expecting to see the governor. Mr. Imus had arrived earlier by limousine. Half a dozen news reporters and photographers waited outside, and a news helicopter flew overhead.

They spent three hours in Drumthwacket’s library, departing shortly before 11 p.m., without commenting on their meeting.

David W. Chen reported from Trenton and David Kocieniewski from Camden, N.J. Lawrence K. Altman contributed reporting from New York, and Tina Kelley from Princeton.

National Registry

2007-04-13T20:01:00.000-04:00

Aside from DTs National Registry woes, I don't have to jump through nearly as many hoops to get my certification. In fact, I don't have to jump through any at all. As a New York State provider, we are a "Non-Registry" state, which is great because it means my certification lasts for three years instead of two, and I don't have to deal with an external bureaucracy (NYS DOH is actually pretty good). Unfortunately, it also means that should I want to work in another state, I'm pretty much screwed. So I finally bit the bullet and (having done a recert class in the past year) decided to do the paperwork and pay the fees to get registered. Thus... today I had the fun (really!) experience of taking the computerized written exam, and hopefully, in a few days I'll know if I'll be allowed to prepend the letters "NR" to the front of my "EMT-B."

The Future Lies at Your Feet

2007-04-12T02:48:00.000-04:00

I accepted a job working for the government of the State of New York... the paperwork should be arriving in the mail any day now. All those lovely I-9s and W-2s and Health Insurance Enrollment forms. Not to mention a union membership in PEF.

Meanwhile, I already know where my office will be. Here's a photo courtesy of the Wired NY website:

Yes... that's Ground Zero in the foreground...

Spoke too soon!

2007-04-12T01:12:00.000-04:00

About my post about Spring in New York.... I guess I can't say as much about Spring in Maryland. Looks like fellow blogger Maddog is having a fine old time!

Spring in New York!

2007-04-11T15:01:00.000-04:00

The best part about Spring in New York, aside from the warm weather, sunny skies, and overall more pleasant aura: flu season is over! At last a hiatus from running calls for runny noses and general malaise!

Of course, Spring also means the start of allergy season, bringing.... calls for runny noses and general malaise.

Woe is me!

Paramedic

2007-04-10T17:20:00.000-04:00

So I've resolved to enroll myself in a paramedic class, or as they say here in New York: AEMT-P. (One step above AEMT-CCT, followed by EMT-I, EMT-B, and CFR).

I got a job working for the State of New York as a Junior Engineer when I graduate in about a month, so hopefully, starting September, I'll be going to school at St. Vincent's Catholic Medical Center in Downtown Manhattan doing the evening -P class.

Wish me luck, and I'll keep you updated!

All ALS all the time?

2007-03-30T19:58:00.000-04:00

There are those who believe that the idea of "all ALS all the time" is the best policy for providing EMS to the masses, and believe it or not, I'm not here to debate that fact even though I am a BLS provider myself. There are also those ALS providers out there who believe that BLS providers should not be able to make a determination about whether a patient needs ALS care. Surprisingly, I'm not here to talk about that either. Rather, let me tell you a story:

We're called for a 27 y/o female having an asthma attack. Our crew is fast today, and everyone is assembled and we're off in the ambulance in record time: 4 minutes after the initial call marks our arrival on scene. Walking into the lobby of the building, I find the patient sitting in a chair, barely moving any air; she states (barely) that she has a previously diagnosed case of childhood asthma, but doesn't have an albuterol inhaler. A quick listen to the lungs, and she has wheezes on the exhale; also a tinge of cyanosis to her lips. This is not a healthy person. My partner starts a more detailed workup, and I get on the phone to medical control for a request to administer nebulized albuterol, which we carry on board. The request is approved and we begin administration of the medication and start prepping her for transport.

My next call is for ALS backup. Stair chairing and getting her out the door has already run us through a couple minutes and the 1st dose of albuterol is almost already run dry to no relief to the patient. I'm back on the phone to Med Control and get an order for "continuous albuterol administration -- no dosage maximum," which is technically not in protocol, but I'll worry about my two unit dose maximum when I get there. Move onto the stretcher and loading into the back of the ambulance, I see a FDNY rig quickly approaching from down the street, "Good," I think, my ALS has arrived. The two guys from the FDNY rig get out and walk up. Judging from the confused look on their faces, I know the question to ask them.

"You guys ALS?"

"No.... what's up?"

"Asthma.... bad. You guys know if they have ALS en route?"

"I don't think so."

I hesitate a second, thinking, and my thoughts reach the same conclusion as the FDNY EMT's who urges: "you guys just go, don't wait."

My thoughts exactly. Already a third of the way through the second dose of albuterol, and no change in the patient's status. She's still struggling valiantly for breath. 'This is probably my second worst asthma case I've ever done,' I think. The worst one ended with the patient intubated... luckily for the patient, I suppose, she won't, and can't be subjected to that today... at least not in the field.

I'm driving so I hop into the cab of the bus. I take a second to bring up the hospital notification number on the phone, hit the SEND button, hit the sirens, put the truck into DRIVE and we're off. I tell the ER what we're bringing them. Conveniently, we're only three minutes out. Arrival in the ER brings our rush into the trauma room and the "Green team" descends on our patient. Finally, quickly, she gets some advanced treatment and interventions. A happy ending to a frantic twenty-minute procedure of getting the struggling patient to the hospital, quickly and alive.

By the way, at the end of it, when my crew of three were bringing in another patient a little while later, a now freely-breathing young women in hospital gown gave us all hugs and thanks. Guess BLS isn't so bad after all. But the conclusion of the story is, this is the second time in a month when I thought I needed ALS and didn't get it. All ALS all the time is well and good, but how about all ALS when you need it, all the time? In a city like New York, you'd think that ALS would be available when needed. The facts of the matter are that FDNY*EMS does not use EMD dispatch, and does not work with the voluntary and volunteer organizations operating in the City limits. How many lives have been lost because advanced care was not sent where it was needed? How many patients received ALS for whom an accurate determination of need was not established by the dispatcher? How does the public allow shabby, poorly-run systems to continue to exist?

In the Navy

2007-03-28T17:41:00.000-04:00

When I first started working as an EMT, I had just got certified and was working for my local volly fire department during a summer home from college. We got called to the "Better Spaces" home, an 'assisted living' community for people suffering with Alzheimer's. I think most of you remember your time in this position, you didn't really know what you were doing: you had your training to guide your actions, but no experience.

I'm running lead on this call for a 86 y/o male with a fever. I've got the Chief, who is decidedly hands-off for this one, and another college-aged firefighter, not trained in EMS, except that he picked up the art of taking vitals somewhere along the line. We do first-response, and the Hudson ambulance service reports a delay in the time of arrival of their rig. In fact, when I start talking with the guy, he's appears fairly healthy and we find him in the dining room (how the staff found out he had a fever in the middle of dinner, I will never know) sitting calmly at a table.

I introduce myself and start the routine I was taught in class.

"Hi, I'm a EMT with the fire department, how're you doin'?" I ask.

"Oh, I'm good! I'm feeling pretty well, and I'm just sitting here eating dinner.... what do you want?"

"Well, we were called here for you because you have a fever."

"Ah. I see," A puzzled look on his face, "I really feel fine. All of this is probably not necessary."

"Well, my partner here is going to check you blood pressure and pulse if you don't mind."

"..."

"You alright?" I ask as he seems to have momentarily blanked out. He blinks and I ask about the vitals again.

"What...... oh. Yeah, sure, whatever you need. Why're you guys here?"

I feel like I may have answered this question already, but.... seeing as we're in a home for Alzheimer's patients.... "Well, the staff called us because you have a fever, apparently. I'm going to take your temperature now, OK?"

"Sure," he replies, and I stick a probe in his ear: 100.2 F. Geez, I don't know what all the hubbub is about. Well, with baseline vitals unremarkable, EMT-Basic training states to begin OPQRST, and obtain a SAMPLE history.

"When did your fever start?"

"I have a fever?"

"Ummm, yeah." A staff member fills in the blank that they routinely take temperatures every evening before bed. I see. "And when did you take his temperature?" I ask the staff member. Blank stare answers that question. Right then, so proceeding right along...

"Does anything make it better or worse?"

"Make what better or worse?" asks my patient.

"Your fever."

"What fever?"

'Oh, Lord' I think. I look over at my Chief, who is happily engaged in conversation with a young blond nurse in a flowery frock. Firefighter partner has started wandering around looking at the artwork in the dining room.

"Have you felt sick recently?"

"Nope, I'm healthy as a horse!"

Skipping the rest of the history of the illness, I remember I need SAMPLE and AVPU.

"Do you know your name?"

"Sure, I'm Jim."

"Do you know where you are?"

"I'm at home."

"Do you know the day of the week?"

"Yeah, today is Sunday."

'Well, that's not right,' thinks I, seeing as it was Wednesday.

"What's the date?"

"Oh, It's October 14th, 1943. Speaking of dates, I had a cute, little one last night...." he smiles and winks, "yep, got me some shore leave for the weekend and had a little hook-up, if you know what I mean!"

I'm speechless for a moment... I start to open my mouth and I shut it. "What do you do?" I ask, stalling.... somehow I know asking for his allergies and past oral intake, etc., won't get me too far.

"I'm a hand on an ocean going tug," he replies, "we're in port for a week, so I thought I'd look up some gals that I know."

The grin on his face is contagious and tragic all at the same time. I can't even begin to relate to the patient. Here is a man who has lived his whole life, and now, nearing the end, the doors of his memories for the past 70 years are shut. The only memories accessible to him at this moment places him the morning after a one-night-stand he once had, with a person who now probably has grandchildren of her own, and yet, it seems like it was just yesterday. In a sense, the reality he's living at this moment is almost better than the reality that actually exists. The triumphant attitude of a virile young man facing the adventures of youth has to be far superior to that of a frail, elderly gentleman, stuck confined to four thin walls with locks to keep you inside - the smell of urine and sponge baths always prevalent. Is this the way the brain keeps us sane, in response to conditions that would surely drive us insane? Is this the way a body, barely able to respond to the demands of life, much less the enjoyment and full expectations of it, cope with the disappointment of a machine worn well beyond the limits of its construction? Alzheimer's is a terrible disease, I've been told, robbing its sufferers from their faculties. And yet, this smiling, talkative soul in front of me, older than my own grandparents, is enjoying life just as fondly as he ever could.

We chat a little more about things and wait for the ambulance to show up. When they arrive, the medic doesn't bother asking for a report from me. In and out. Jim is loaded onto the stretcher for another unnecessary ride to the hospital that Medicare or his insurance company will have to pay for. The assisted-living community I learn later has no medical resources, so for any ailment, no matter how small, 911 is dialed and EMS is summoned to transport its residents to the ER.

I've seen enough of this home to know that most of those who live here aren't nearly as active as my patient today was. Many go through the day barely aware of their surroundings. I've taken calls here where the patient, after falling down in their room, with copious bleeding from certainly painful injury to their arm or to a leg, can barely comprehend the simplest questions, or even tell us if there's any pain at all.... the only indicator yelling or screaming when a site is touched or pressed upon, or maybe not. Yet.... what is happening in their minds? As the world progresses and time continues around them, what reality and what present are they interacting with? Is it possible that they're in a better place? As a patient is picked up, bandaged, and carried to the ambulance, are they vividly reliving their time on shore leave?...smiling, winking, laughing, and enjoying the art of living.

Cool! A nifty map!

2007-03-26T08:23:00.000-04:00

With the help of a great site created by Phillip Holmstrand, I was able to plot and map the locations of every 911 receiving hospital in Manhattan, as well as specify the trauma centers (in orange). This is a screenshot of the map created and an interactive version can be found by clicking the image. Enjoy!

Ooooooh...pretty....

2007-03-26T01:51:00.000-04:00

I just wanted to put this up. Good ole Fair Lady. Excuse the unskillful removal of license plate numbers and name. It is a nice truck though, isn't it?

The Maze Known as a College Campus

2007-03-25T12:23:00.000-04:00

As a New Yorker, I'm fairly accustomed to finding my way around the city easily enough. And while I'll admit to the small difficulties every once in a while, like where exactly do I get off on the Canarsie line to transfer to the Crosstown Local (and by crosstown I mean Brooklyn/Queens); in Manhattan north of Houston is easy enough to find: The numbered streets go East/West, the numbered avenues go north/south.

I bring this up because a most amazing phenomena occurs every third or fourth day as I look out the 9th Floor window of my apartment onto Amsterdam Ave, and my college campus beyond it.

"So what is this strange occurrence?" You ask.

"Why, it's an FDNY ambulance traveling north on Amsterdam Ave., slowing as they approach the intersection and the gates to the main entrance to campus, then gradually stopping. In fact, they look....lost! You can see into their vehicle as their poor heads search the area, turning left, right, up, down. The the driver takes his foot off the break pedal and the FDNY rig pulls a U-Turn in the intersection, slowly, and starts heading back south."

Three minutes later they're back again. Same routine. They know that they're not in the right place, but probably close. They travel north this time, past the wrought iron gates, but once again, back they return, fruitlessly traveling north and south, pulling U-Turns while, I can only assume, their patient waits -- panic slowly setting in, until a campus Public Safety officer walks up to them, listens, gives directions, and off they zoom to save the day. This is where my ambulance service comes in. Our ability to excel in our service to our community of 50,000 students, faculty, visitors, and staff lies very much in the fact that we can respond directly to a location much faster than ye standard Citywide ambulance.

For example, this is a photo of a building on campus:

When yada-yada person calls into the 911 system and says, "Hi, I'm whoopie-wheepie, and I'm having a heart attack, and I'm in Shapiro Hall at The University." Citywide EMS dispatch will send all sorts of folks over, who will promptly not know where to go for several minutes at least. On the other hand, when same person calls x99 and contacts campus' Public Safety, we get the call, and we know exactly where Shapiro Hall is. In fact, we even know to ask for a clarification since there are actually TWO Shapiro Halls in existence. Thus, we hop in our truck, off and away, and establish patient contact in a much more efficient fashion than would otherwise be attainable through the municipal system.

Though this efficiency does not come easily. We require of our new Drivers that they memorize almost every location for each named building on campus, a list of about 100 places, each with it's own physical address, and some buildings with multiple addresses, as well as multiple buildings with a single address! What fun!

I've been working on a document for several months now, and tonight we are presenting it to the rest of the corps. It is essentially a standardized route listing for each possible location on campus. Here is an excerpt:

Schapiro Center
PRIMARY - Access through Peters Hall entrance on X St. Take your first left and walk past loading dock to the giant Freight Elevator. When returning to vehicle, remember that only the freight elevator reaches this level, and not the regular passenger elevators.

(2) – Access through entrance to Schapiro building on X St. requires changing elevators at Campus level. Beware, the first set of elevators are very slow.

(3) If responding to a call above the above the 7^th floor in Shapiro, try going through Mensche Hall Sky Bridge. Access is given by the 10^th floor of Mensche Hall. Use this is you like parking in the grove.

As you can see, there is a Primary route of access, and two alternatives. This may not make any sense to you, but by referencing other landmarks on the campus, this allows for a more streamlined approach to access to locations. The next steps will be distilling this down to something that anybody can use, especially for FDNY fire and EMS, NYPD, and anyone else who may be conducting emergency responses to our campus. Hopefully, in providing the municipal agencies with a listing of buildings with their corresponding physical addresses, and the best way to get into them, we can make this maze of a campus much safer (even if it means loss of business to my volunteer ambulance service)! Now, anyone know how to get FDNY to listen?

Why send an Engine company anyway?

2007-03-24T17:52:00.000-04:00

Dispatched to a call for a "22 y/o female fell down the stairs with a head injury," I think first "Woohoo!" as the tones go off, then "Hmmm, this might be interesting," as the dispatch comes across. Little did I know how interesting.

The FDNY*EMS system is an entirely separate entity from the FDNY Fire system (and entirely separate from Fair Lady). They have different radio systems, different dispatch networks with different computer systems, different chains of command, and they don't even talk to each other. In fact, surprisingly, they also have different 10-Codes, which despite NIMS, both organizations are completely married to, and I would be surprised if "10-84" changes to "Arriving" anytime in the next 25 years (Nevermind that arriving is easier to say with one less syllable than 10-84).

Despite this, when the Citywide EMS system gets swamped, like it did last night, FDNY*EMS starts sending Engine companies to the serious medical calls. Since we're unaffiliated with FDNY completely, there is also the possibility of a dual dispatch if someone calls the University's Public Safety emergency line directly, and also calls 911, this also occurred last night. We arrived on scene to find the engine company, with their crew of CFRs, already tending to the patient. I dropped my partner and a Probie off at the front door, and went to stage the ambulance a little farther down the street. NYPD and Public Safety were also already on scene. After parking, I grab a stair chair and head into the building about 30 seconds after my partner entered. After I enter the foyer, I pass a firefighter who says, "You're going to need a backboard." I drop the stair chair, do the twirl, and head back to the the rig. Things progress nicely from there. My partner and the Probie do a nice job stabilizing C-Spine at the foot of the staircase, and we secure to a backboard.

I got the full story eventually from a friend who told me that the patient tripped at the landing on the top of the stairs and rolled all the way down to the bottom, head over heels. About 20 feet. Technically this is major trauma criteria, so even though the pt was negative for AMS, and PE revealed over some abrasions to her head and bruising to her arm, I called a notification to the trauma center, and we hustled to the hospital.

After we clear from the call, my crew sits together for a quick post mortem review. This is when my partner tells me that when she first arrived on scene, the FDNY firefighters had a 4x4 out and were pressing it against the pt's head. No manual stabilization of C-Spine, no collar out, no backboard. This suddenly struck me as odd since it was an FDNY firefighter that had originally told me that the pt would need backboarding to begin with. So, basically, the FDNY crew knew what needed to be done, but didn't bother doing it.

New Engine

2007-03-24T17:22:00.000-04:00

As promised, I now go into the details of the new engine that I discussed in the last post. It's funny, I joined my local volunteer fire department so I could do EMS, but I found that I also began liking the fire services as well. Crazy world, who would have thunk it?

This engine is a brand-spanking-new, Pierce pumper with a 500 gallon tank outfitted with a Waterous fire 1250 GPM fire pump, and all the bells and whistles.... I mean that literally, the department actually ordered the truck with bells and whistles, which can be seen mounted on the front fender in the picture below. We tried out these bells and whistles, but you actually can hear them over the mechanical or electrical siren or the air horn. It's a full foot taller than our other, older Pierce Quantum, a 1999 model. This new truck replaces our trusty, well-used Pierce Dash, circa 1980, and is now designated E-411, and is also our FAST truck.

I spent an afternoon over break, helping get the new engine into service. Basically there were five guys there, the three college students, and the two chiefs. We transfered hundreds of feet of hose: hand lines, supply lines, and everything else from the 1980 Dash to the 1999 Quantum, and from the 1999 Quantum to the 2007 Quantum. Fun times, eh?

After moving the hose, we moved the tools, radios, and everything else, and finally, we were good to go. as mentioned, I got to ride in it that very evening towards an MVA, on it's very first call. It's a nice piece of equipment, and hopefully, it will provide several decades of service. The pictures included here are from the Pierce plant in Wisconsin, just before the decal work was put on, (and saving me the trouble of re-anonymizing the images through Photoshop) right before it took its trip to its new home in Upstate New York.
(click to enlarge images)

Hometown Happenings

2007-03-18T00:22:00.000-04:00

Well I've been back home this past week for Spring Break, and had the chance to run about again with my local Fire Department. First though, I should mention that I coulda/shoulda posted about an event that happened two weeks ago, but due to some of the implications legal and whatnot, I'll refrain from doing so for now. However, I'll give you a keyword: RUM RABBITS! When I mention this keyword again, refer back to this post to give yourself a timeframe when I do write about the events that occurred.

It's been a busy week here at home. My town of about 20,000 is essentially a suburb in Upstate New York. Not unexpectedly, the type of calls we get here are different from the calls down at school in Manhattan. For example: no substance abuse calls. However, this was a three wreck week with three MVAs (together with a structure fire last week, a car fire this week, and a variety of medical calls: including the ever-joyful recurring trip to the local home for persons suffering with Alzheimer's.)

The first MVA occurred on a clear, sunny, morning with dry roads. A 79 y/o female lost control of her car on a winding road by the river and drove across the lane of oncoming traffic (thankfully missing everyone) and into the grass, trees, and shrubbery on the opposite side of the street. Tones went out on the pagers and I responded from home. I live almost exactly a five-minute drive from the fire house, so after hopping out of bed, into my clothes, driving to the station, donning my turnout gear, I had missed the first-out rescue truck. Luckily (or unluckily, depending on your point of view) many of the department's members work during the day and therefore can't respond, so I was the second person into the first-due engine and got to play officer. We left the station on that piece with a crew of two. Arriving, I see a mostly unharmed vehicle, I'm asked by the Chief, as one of the few EMT members of the department to help with the medical aspect. I walk up and see that the crew of the rescue rig are already maintaining C-Spine, with a member in back of the sedan holding stabilization of the driver. There is only one patient. Another EMT is conducting the PE and so I start the paperwork. Overall, she's not badly injured, but due to the MOI (and the fact that he car's no longer drivable), we ship her out via the commercial Hudson Ambulance company (the fire department is strictly first response, name changed) to the local hospital. Since I had arrived on the engine, the rescue packed up and left, and I got to stay and now play Fire Police, directing traffic around PD and the tow as the vehicle was removed. 20-30 minutes on scene and we're done. Not a difficult call at all.

Number two didn't actually happen in our fire protection district -- The town is split into three such districts: District #1 (clever name), District #2, my territory (equally clever name), and Magical Heights (name changed, except the 'Heights' part). This one was a more interesting call. Initially, my pager announced the dispatch, which it shouldn't have since it was alerting District #1. I was just about to reset the pager, when I hear "...two car collision with multiple injuries, multiple calls coming in. Repeating for District #1..." "Uh oh," I think, "could be bad." As apparatus start to arrive on scene, it sounds even worse. I decide that the we're probably going to get called for mutual aid on this one and I change out of my PJs, and head to my car. As I'm leaving my home for the station, I hear: "OK. We've got four patients. Send out tones for addition manpower from District #1 to the scene, put Medflight in the air, tone out District #2 for assistance in extrication, call Hudson Ambulance and give me two additional ambulance on scene, ALS if they have them, but we'll take a BLS, and put Magical Heights on standby in their station to cover the town for fire and medical." I hear first the call go out for the additional District #1 manpower, then my tones drop, then the call goes out for Magical Heights. Aside: note that District #1 is a paid, professional department, while we're volunteer, and that their paramedics already had two district-owned ambulances on scene (and all their on-duty personnel). It's now about 9 PM, and I'm the second person in the station. I start the rescue rig and run to don my turnout gear. I'm riding in back, and we're out the door about 3-5 minutes later. It's a relatively long drive, ~8 minutes, since we have to go across town. We also sent one engine to establish a landing zone for the 'Bird' at this time, but my truck goes to the scene. By the time we arrive, some District #1 medics have already rapid extricated and sent an ambulance off to the hospital for a trauma-arrest. This patient is the first and only death of the evening. The scene is pretty bad: A full-size pickup had ignored a stopsign at an intersection and is T-boned by an oncoming small compact car. Due to the velocities of the vehicles and the circumstances, the compact acted as a wedge and slid under the pickup, causing the truck to roll and adding to its momentum. The truck, however, never completely rolled over since a three-foot wide metal utility pole impeded its rotation when it was at about a 45 degree angle, causing the cab to collapse in on itself and "squishing" the passenger's head between the truck body and the pole, ultimately causing her death. I couldn't believe the status of the pickup when I saw it: The entire bady and frame were actually visibly and uniformly bent in the middle, to the tune of a good 15-30 degrees, such that the floor of the truck was almost touching the surface of the road when it was set back straight, regardless of the height of the wheels and axles; this being a large truck whose strongest characteristic is supposed to be the frame itself. Unreal. The two passengers of the compact were relatively unharmed and that vehicle did not require extrication. Extracting the driver of the pickup was fairly easy since that side of the truck was largely intact. The door was popped off, and the patient was fairly OK, though in the end he was flown to the Regional Trauma Center, because of the MOI and because the chopper was already on scene. Once again, the crew of our rescue truck did some Fire Police: closing down the roads surrounding the scene while the site was cleaned up and PD conducted their investigations. We returned to quarters after about an hour after initial arrival.

MVA #3 happened last night during the blizzard that swept through Upstate, leaving behind about 18" of snow in my town. One of our department's members actually was driving behind the vehicle involved in this one and told us the complete story. Through my town, runs a fairly large state highway, two lanes of traffic in each direction and a center turn lane. People were traveling at reduced speed due to the snow, but apparently not slow enough. My comrade-in-arms stated that she was watching this car slowly lose track of the lane markings in the road, and watches as the driver gradually drifts over to the left. At the time of the accident, he was actually driving almost exactly in the middle of the turning lane. Cresting a small rise in the road, the car collides with an oncoming snow plow approaching in the opposing direction, one of the big mothers owned by the state. The blade of the plow hits the left side of the car, spinning it and destroying almost all of the front end. We're toned out and due to the snow and the distance of the station, I proceed slowly to the fire house, actually displaying my blue light, which I rarely do (irregardless of the title of this blog!). Ironically, I have to pass the scene of the accident on the way to the house, but such are the rules of the department. Expectedly, I miss the first out rescue, but again, I am the second person in the first due engine (a different one from MVA#1, and a brand new one that arrived in the past week, post on that to come). I again get to play truck officer. We make it off the apron, when the Chief radios us to remain in quarters. Not an easy thing to do: turning this new beast around, and not wanting to take a chance, we do the great circle routing of going three right turns through a development to get us back home. Second bit of irony for the night, we come within about 300 feet of the accident scene before we hit the street that will allow us to start heading the right direction. Nonetheless, we sit back for the ride and enjoy the comfort of this new piece of apparatus, basking in the knowledge that I got to take it out on its first call as a fully equipped piece of fire suppression goodness. The patient was able to RMA and this was a close call that could have easily been a whole lot worse.

Not a good week for E(me)rgency Services

2007-03-01T21:37:00.000-05:00

The results came back from the Accident Review Board and I've been suspended from driving for a two-week period. The worst part was the 'serious talk' from Lucy McGillicuddy who, I remind you, is *rum-pum-pum!* years younger than myself. Could have been worse, could have been better. I guess the moral of the story is that everyone makes mistakes (yes, even me!) and there are consequences to those mistakes. At least my mistake caused no permanent damage to Fair Lady's vehicle and no one was hurt.

Can't say as much for FDNY's Engine 123. This happened yesterday. Again, good thing no one was hurt. We will all learn from our mistakes.

Read This!

2007-03-01T14:49:00.001-05:00

http://www.neenaw.co.uk/index.php/ambulances/174/weeding-out-the-snifflers/

Ho Boy! I'm in trouble...!

2007-02-28T20:20:00.000-05:00

Responding to a call of a "head injury" today, I was driving the ambulance to the scene and proceeding blinkies and woowoos down a narrow side street intersecting Broadway. The time is about 11:45 AM. Traveling about 10 miles per hour, there was a backhoe off the right hand side of the street. Just as we're passing the construction crew: Pop! and a jolt. I glance in the mirror and don't notice anything out of the ordinary so we continue on our way to the scene, just the next block over.

My partner is teching the call, so I take a quick look at my rear axle. Verdict? Slashed tire. Still drivable, but definitely not pretty. I pop into the lobby of the building, where the patient is sitting on a bench. A small cut to his forehead, and he's not complaining of any other ailments. We RMA and now the fun can begin. I need to place a call to the Director (Lucy McGillicuddy), and the Operations officer. They ain't happy. Not one small bit.

I call us out of service, and the cogs start turning to get the vehicle serviced. It's too far for us to drive to the truck shop, so they have to come to us. I usually meet another Crew Chief at 3:00 and she covers me for a couple hours as I attend to some business about this time every Wednesday. I'm informed by her that she would be keeping the keys and radio until shift change today.

"Huh?" I think. Another crew chief (we're just having a big ole party today!) walks up.

"Nice job on the rig, polarbear," she quips.

"Yeah, great. That backhoe just walked into me, I swear! There was nothing I could do!"

Next thing I know the Director walks up to the three of us.

"So, I guess you suspended me for the rest of the day, huh?"

"What? No. Where'd you get that idea?" he says.

"Well, you took me off call. That's a pretty good indicator."

"You're off call. You just got into an accident, common sense would say that you can't be on call for the remainder of this shift. There's just too many liability issues. There'll also be an Accident Review Board soon."

"You realize I'm scheduled for two shifts this weekend," I remind him.

"Oh, yes. I know."

Ooops. How bad did I screw up!?

My first code...

2007-02-28T02:33:00.000-05:00

It's finally time for me to tell this story.

My first code happened when I was home from school for break about nine months ago, though it seems like longer than that. At first, as I was trying to remember the exact details, so that I could write them here, I had difficulty recalling the time of year, and the order of events. However, as I dwell on them, I now surprise myself by just how much I do remember. I know it was the summer since it was a warm sunny day, it must have been between 3 and 5PM. Those were the hours that I would consistently hang out at my volunteer fire department after my internship at the chemical plant. The call came out as an elderly person having fallen. I remember because I was chatting with the Asst. Chief, Jose we'll call him, and the tones dropped, and we both took the ten steps into the bays and got into our truck. He drove even though he's the ranking officer, so I sat in the officer seat. Our truck for routine medical calls is an older E-One box mounted on a newer 1997 Chevy 2500 frame, with a duramax diesel. The cab seats five, and the box holds all manner of small rescue tools, including a jump bag, heavy-duty first aid kit, suction, AED, etc, etc. It's got a nifty (and broken) stem light, cribbing, high-angle rescue gear, fire police equipment, and more. R-410. We took off with just the two of us.

Our system works such that the local volunteer FD (us) provides first response BLS service to about half my town. The other half is serviced by the paid fire district. We contract out to a commercial ambulance company who does our transports and ALS. The nice thing about this arrangement is that we always have ALS coming to us. The downside, of course, is that we don't transport, though that can sometimes be a nice thing. Depending on how busy the service is, they can run a little slow. Today was a mediocre day. They certainly didn't beat us to the scene, which when that rare event happens they rub in our faces, but they weren't the 30 minutes they've been known to pull (extraordinary for a mostly suburban part of the state).

As we're driving down the highway, it wasn't especially congested, about forty-five seconds after our departure from our house -- maybe two minutes after the call came out, our Fire Police Lieutenant gets on the horn (as I would find out later, he lived next door to the patient) and informs us "410-C to Fire Control, be advised that this is a full arrest. Full arrest! Put an expedite on [Generic Ambulance Service]!"

Fire Control: "7-5. Full Arrest acknowledged."

410 (us): "410 redirects." Suddenly I find myself propelled against the rear of my seat as I watch my Chief floor the gas pedal. I look up from the PCR I was starting and stare out the window.

Jose asks me, "Polarbear, did you hear that?"

"Yeah," I reply meekly.

Out of nowhere a police car approaching from the opposite direction turns across the highway in front of us. Blinkies and woowoos. We follow with a right hand turn ourselves. I now realize that that was a very nice coordinated and skillful piece of driving by the officer and my Chief for neither of our vehicles to slow down as we took that turn. Of course, Chief cut the turn short several feet so that we sliced out a nice portion of lawn.

We followed PD all the way to the scene, the Chief barely able to manhandle our larger truck and maintain sight of the far more agile police cruiser. We end up parking on the lawn of the neighbor across the street from the patient's house. I open the door just as I spot the police officer starting to race into the house, AED in hand. The medical equipment is on the passenger side compartments of our truck, so I yank open the cabinet's metal doors and grab the suction, AED, and jump and airway bags. Chief rounds the corner of the truck and we both run up the slight hill into the patients house. Elapsed time is probably no more than five minutes from the time of the initial call. At this point, I seem to be moving without thought. Acting but not comprehending.

The patient has fallen in the kitchen and I am greeted by the sight of our Fire Police Lieutenant, who is also the only advanced provider in the department (EMT-I, New York 'I', not NREMT, so like NREMT-I/85 or whatever they're called). His name will be Red. Red and PD (whose name I actually don't know) have just finished cutting the patient's shirt and applying PD's AED pads. PD hits analyze. Beep beep beep. Analyzing rhythm. Beep beep beep. Analyzing rhythm. Don't touch patient. Stand-by. Beep beep beep..... Enough already! Just let me hit the shock button. Beep beep beep. No shock advised. @%#$!!

We start to resume CPR. The BVM and O2 are broken out. My Chief points out that we need to take PD's pads off the patient since they're incompatible with Generic Ambulance Service's Lifepak 12. I rip off the pads, and apply new Medtronic pads, and power up our trusty old Lifepak 500 (Which I neither know whether it is trusty or old). We run through the routine again. I know, I know. Should have done a couple minutes of CPR, but hey, what's the harm. I hit analyze. waiting waiting waiting. "No shock advised. Start CPR." @%#$!! Again!

As Chief starts pounding and Red handles the ventilations, I find myself without a job. I will soon learn that Jose likes chest pounding, and as this story will play out, he was probably the one pounding away all the way until the MD called time of death at the hospital 30 minutes from now. Oh yes, this story doesn't have a happy ending. I remember a few days later after Jose has downloaded the AED traces into the computer, the nice steady rhythm he was producing all on his own. Anyway, I was without a job for a moment and just as I was thinking that someone should have thought of three-man CPR, I notice a nice steady distention of the abdomen. I look a little closer and see Red pumping the BVM at a rate close to 40 breathes per minute, full bag, and over the course of about a quarter of a second. Sweet! I'll play airway coach.

"Nice and easy" I say to red.

Immediately you can see the anxiety and tension come off his face (remember, he was on scene by himself for several minutes doing one-man CPR) as his training kicks in again. He immediately slows down the breathing. We all take a second to expel the air out of pt's abdomen, and resume once again. I think, what can I do to stop this form happening again. We reposition the head, I slide in an OPA, and Red vents. At this point, a couple more members of the FD have arrived, some in their personal vehicles and a couple in the department flycar. One member picks up the PCR I have long abandoned. I apply cricoid pressure. Someone asks, "Anything I can do." Jose pounds away. Where the @&!$% is ALS?!?

Turns out ALS is another 3-5 minutes. Must not have gotten the message that this was a true MEDICAL EMERGENCY! The first man from the Generic Ambulance Service rig is a kid, a EMT-B, definitely younger than me, and the look on his face was priceless. I can still remember it today: Stunned silence. He literally stopped moving. Someone had to grab the drug box and tube kit he was carrying and out of his hands and place them on the table. He basically stood off to the side for the rest of the call. ALS provided from GAS was slightly better, walking in to the room and starting patient care, but certainly not taking control. Someone suggests hooking up that nifty Lifepak that she bothered bringing into the room. Good idea! All this time we haven't have a shockable rhythm. The Lifepak-12 goes into AED mode (I really know nothing about these things. I didn't even know that was a choice). No shock advised. @$%%@&! What's the point of these bricks if they're not going to deliver 300 Joules of life-saving electricity when you expect (and want) them to? CPR is resumed. The medic, an AEMT-CCT (that's NREMT-I/99, I think), begins attempts to start a line. This provides me with ten minutes of amusement.

About 4-5 minutes into this attempt one of our kindly volunteers inquires as to whether he could be of assistance in tubing the patient. Medic, surprised, nods and points to the tube kit. Our heroic volunteer, whose day job is work as the head respiratory therapist at a local hospital (and an expired paramedic, that's right, full NREMT-P), works his stylet and plastic tube magic, and a tube is in place. Ventilating begins. Jose still pounds away. Tube guy begins ventilations. I once again am obsolete. Red and I run out and grab the stretcher and backboard. The cot won't go up the front steps into the house. The board is brought in. Resp. guy suggests some meds down the tube. Medic lady, still trying to start a line nods and atropine is produced. Jose pounds away. Lifepak, neglected for so long (probably only four analysis provided since we've been on scene, nearing, if not over twenty minutes now) suggests a shock. Wonderful! ZAP! Shocks no longer advised. CPR resumes. Patient is transferred to the board and carried outside and set on the cot. I lift one end of the stretcher along with Jose who has the other end. Medic grabs her stuff. Where is that Generic Ambulance Service kid? The bed is wheeled down to the bus and Jose immediately hops in back and begins to pound away... again.

Off they go. Blinkies and woos. I inhale. I look up. I'm outside.

My head turns a couple times. There are now three police cars. The fire truck I rode in on. A FD flycar, and the FD pickup, and two personal vehicles. Lights blinking. I exhale. I look at the front of the house. Bystanders are around now. Neighbors are milling around. People have heard what's going on. Red comes out of the house, along with the other members of the department. I need to call Fire Control and let them know the situation. Technically, I'm now in charge of the scene, since I rode Officer on the first responding apparatus and there are no real line officers around (Jose off to the hospital, and Red doesn't really count). I realize I don't have a portable and actually turn in my place a few times as if one will magically appear. I see a blue uniform and some stripes, the PD sergeant. I call to her to ask her to radio dispatch and update them (Fire Control and PD dispatch is all one person on different frequencies). Red yells to me and tells me that he still has his portable. He calls in the conditions report. Equipment is put away. I'm the one who has to drive the truck back to the station. I get in an argument with the neighbor whose lawn I'm parked on. I want to back up while he wants me to pull forward. Whatever. I make sure everyone has a ride and call us back in service. Drive. Stop. Reverse into the bay. Close the door. I sit around a little and drink a couple sodas. Jose calls from the hospital and says he has a ride back and we're all dismissed. Good. I get in my car and go home.

Life's Ambitions

2007-02-27T23:16:00.000-05:00

I need a place to put this list. Somewhere where it won't be lost, so I can refer back to it, change it, and add to it. Don't mind that it is not strictly (or at all!) EMS related. We'll file it under 'personal' for now.

Things to accomplish in life

-Get my Rescue Diver
-Become a SCUBA Instructor
-Get my Class A CDL
-Get my Private Pilot license
-Graduate medical school
-Take Firefighter I

Things that have been on above list and ACCOMPLISHED!

Things that used to be on the above list that I've resolved will never happen

House MD

2007-02-27T19:06:00.000-05:00

I'm not a griper, but I was watching an episode of House, MD, my all-time favorite show on the "Idiot Box" and found the opportunity to bring up an issue.

The main character is quoted in one episode as saying:

"Dr. Gregory House: [to EMT guy who has just tried to give directions] If you wanted to be a doctor, maybe you should have buckled down a little more in high school."

this quote coming as EMS is wheeling a patient into the ED and saying something to the order of "he lost three units of blood en route, he needs a transfusion stat." Not that I would never say something as canned as that, but the response is still slightly off, don't you think?

Another episode has an EMT announcing to a crowded restaurant,"someone call for a wagon to Princeton-Plainsboro [Hospital]?" (Anyone ever arrive on scene and ask if someone requested a [meat]wagon, or even use our EMS slang: bus, truck, rig...?) The actor saying that last line is listed in the credits as the ever-dreaded: "Ambulance Driver."

This line of thought brings about the age-old topics of debate: (1) How do we rid ourselves of the title "Ambulance Driver" and (2) How do we cope with our profession (applicable to the professionals*) and care (applicable to the volunteers, professionals, and everyone else) being portrayed in such a manner, in such public view. We are all highly trained, and albeit paramedics much more so than us simple EMTs, but we all take great pride in our work, and I think we all take just a little offense when we see ourselves placed in a lesser role in life, given less respect than we deserve.

The term 'ambulance driver' probably, and you old timers would know better than I would, came from the point in history when the people who worked on ambulances were just that, 'ambulance drivers.' That casting can easily be seen when one watches such classic TV shows as 'Emergency!'. Those proud L.A. paramedics Johnny and Roy (who, Lord only knows how and why, can perform a trench rescue in nothing but their station blues and not get the slightest speck of dirt on them) would hop into the back of the ambulance just as it was about to be driven off by the... driver. Need I remind anyone that this was 1972. When was the EMT program established? Answer: 1973 with the federal EMS Systems Act. By the way, who was given authority for the development of the EMS curricula and development: why of course, the Department of Health and Human Services! Wait, but then why does it say Department of Transportation on the third page of your EMT-Basic text? Oh, now I remember.

According the Wikipedia, the first organized police department occured in 1667, the first organized fire department happened in Rome (that's Italy! not New York!) in the Year AD 6! EMS, the third branch of the emergency services could not even begin to be considered until the advent of CPR in the 1950's and 1960's. Being more than three hundred years older than the other 'uniformed' services, has its disadvantages: No NFPA, no PBA. I attended a lecture this past weekend about the safety of ambulances by Nadine Levick at the National Collegiate EMS Foundation's Annual Conference (I'll post about the conference itself.... later). Did you know that ambulances are only one of two types of vehicles on the road today that are exempt from federal safety standards. This ain't a good thing. If you dig around her website there are some spectacular images of what happens when an ambulance gets into an accident.

Essentially, no one is looking out for us prehospital care professionals, us EMTs, paramedics, etc. We have no strong unions (my friend works for a commercial outfit: their union, the teamsters. Another transportation related group). No lobbyists. The NFPA exists solely for the protection of firefighters. When they come out with a new regulation regarding building construction, it almost automatically becomes part of a municipality's local codes. How about a similar organization for EMS? Nope. Nonexistant. If you work here in New York City for FDNY as an EMT or paramedic, you are allowed to take the test and then accept a promotion to become a firefighter (No more EMS work). That's right, the career ladder clearly shows that firefighter is above EMS. Frustrating huh?

So all of this brings us around to our initial question. (1) How do we rid ourselves of the 'ambulance driver' stigma? and (2) how do we appear more professional than we are often portrayed?

The answer to both questions, I believe, are simple and obvious. We work hard. We provide excellent patient care, and we act as the professionals that we are. Through this, we as an industry, and as individuals working as EMTs and paramedics can open the eyes of the public as we touch them through our care every day and earn the respect that we deserve.

Griping fine. (My entire Italian lexicon put to good use)

*Professionals - Do ye volunteers consider yourselves as professionals or merely as workers? Or is professional applicable only to the career guys? Another side issue that could turn into a post, but probably never will.

Leadership

2007-02-16T04:23:00.000-05:00

I've got this friend who's goal in life is to become a neurosurgeon. Let's call him Lucy McGillicuddy. Thing is, he could actually do it. He's one of those EMS protégés, you know, the best EMT on the corps. The guy who knows every protocol and every nuance. The guy who could recite 10 NYCRR 800.20:08-ii from memory [interim testing requirements and pass/fail criteria], if only you could somehow trick him to do so -- as you can guess his ego is pretty big (our fault). Not that that's a bad thing, he's absolutely friendly, and he really is an awesome EMT. Smart, funny, clever, etc. He has earned respect and he's dished it out where it's warranted. In a nutshell: you can get engaged in a conversation with him, but often there's a certain point when he says something, and you just have to go, "I no longer have the intelligence to participate constructively in this discussion." He's that good.

Trouble is, he's 19, and he was just elected to be the Director (Chief, for you non-PC folk out there) of our corps. His two-year reign begins.

Being *ahem!* years older than him, I've been trying to, subtlety, show him the administrative shortcuts I've discovered over the years (and get things I want done, done through him!). That is, the back doors that exist to procure the difficult to obtain, and the efficient ways to avoid red tape. He's learning: he's delegating, and he's dealing swiftly with the administration, he's making friends with those who can give. He's also making some good, if small, changes in the way our organization is run.

However, as I'm just beginning to realize, his overall leadership skills are not yet fully developed. He's not a bad leader, just someone who still has rough edges. Small things: like he'll crack jokes when he supposed to be serious, and not conduct meetings efficiently, etc. People have been commenting to me about him, which has triggered this line of thought. Reflecting on my friend's situation has sparked a debate in my head: what makes a good leader? Is it the ability to 'lead the troops'? The ability to recruit and retain? The man who's a friend to all? The one who gets the job done? The one you confide in when you have a problem? The regular guy who has the best skill set? The guy who makes good speeches? Runs good meetings? Doesn't hold meetings at all?

I view myself as a good leader, but I definitely have my flaws. I also realize that it took me at least a year in my first serious leadership post to develop the skills I needed to handle that job. I don't know if the skills I have would allow me to be competent in a different position, or a leader in a different situation.

I feel like the quintessential leader is thought of as the strong-willed person who have gained those he leads' trust. But that's not even close to being complete, is it? I know Lucy will, with time, become a good leader himself, but in this train of thought, I know that no matter who you are, you can also improve your leadership skills (by the by, this sentence you're reading has six (!) commas -- I've got to learn to be more concise!). I've resolved to reflect on the people who I believe to be good leaders, and think about which qualities in particular make those people the leaders they are. In identifying those traits, I hope I can absorb some of them and become someone better than I am.

Icy Day in the City

2007-02-14T23:44:00.000-05:00

I had my first ever burn-out, apathetic feeling today. It just crept up on me, and as it was happening, not only did I not try to shake it off, I just didn't care. I let my partner run the call, and when we got to the ER, I basically stood in one corner all through triage, signing the pt off, and completing the documentation.

It was our fourth call of the day on this very icy, very treacherous day in New York. While Upstate got the fluffy white stuff (and feet of it, according to the first-hand report from my mother), down here we got gray, wet, heavy sleet and ice. The tones drop around 6:30 PM for "severe headache" and we arrive on scene to find a 42 y/o female c/o falling 11 hours prior (on her "butt," quoting my partner's PCR), with some dull achy pain in her head and sinuses, no recent hx of illness. Pt is prescribed two type of antidepressants, and denies SOB, LOC, neck/back pn, nausea, vomiting, dizziness, or cx pn. Pt is ambulatory and answering questions without difficulty, A&Ox3.

While this hx is being obtained, I'm mindlessly walking around the room looking at the furniture, peering into the office adjacent, and generally not paying attention. We go through the motions, and before I know it, I'm reading over my partner's documentation and signing off, we get in the truck, and head home.

It took me a while to realize why that call was such a blur, and it shocked me even more to realize my state of mind during it. As a person, I always pride myself on the excellence of my patient care. I follow the protocols to a T, and never take shortcuts. I try to make the patient feel comfortable, and strive to be the best EMT on the corps (and in the city!). I am ashamed and disappointed by my behavior, and worse still, I don't know what brought it on. When I say this is the first time I've felt like this, it is the truth. I've been a volunteer EMT for nearly five years now ("nearly a fossil" jokes the triage nurse whenever we get to chatting about my youth), and I'd never expected to hit a point I hit today.

In analyzing myself, I think today was an especially hard day. The first three calls sapped a lot of my energy, and the continual maintenance of the bus during the storm today added to the burden on my shoulders. I think I just need to put this behind me, and refocus on why I love EMS in the first place. Not just because I'm an admitted adrenaline junkie, but always because I love caring for people, being able to help them through the worst times of their lives. It is also fun, and the challenge of constantly improving on myself in a goal truly worthy of achieving.

I hope I won't see the demon that poked his head out today for a long time, and I won't be remiss if he never shows up again. One can only hope.

To put it all in perspective, I found this cartoon online today. Drawn by Steve Berry, that omnipresent force in EMS humor (JEMS):

Template Change!

2007-02-09T02:37:00.000-05:00

So blogger's new blogging system has a new template tool that I decided to give a whirl. While I was doing that, I lost a few of my customizations, so in restoring them, I kinda changed the look of the whole blog and added an important new feature: my email address!!

Let me know what you think of the new look, by commenting or via.... email!... and we'll see if this iteration stays. After all, it's now wicked easy to change templates. Thanks Google, I think.

Achilles

2007-02-07T11:58:00.000-05:00

Call comes out as a "Male in the Fitness Center with a torn Achilles Tendon," which is an unusual dispatch for all the same reasons why you think it's an unusual dispatch, compounded by the fact that about 75% of our dispatches have us responding to an "Aided." (Yeah, someone needs to take an EMD class).

We arrive on scene to the University's basketball courts and find a 35 y/o male sitting on the floor by the sidelines, unrmk except that he's extraordinarily sweaty.

"What's up?" I ask.

"I tore my Achilles," the kindly athlete replies.

'Interesting diagnoses,' I think to myself. I also note that he did not say: "I hurt my foot/ankle/leg" or "I can't walk" or "I think I may have hurt my Achilles," but rather a affirmative statement about an injury that occurred less than five minutes ago.

Easy way to find out the truth about this. I palpate the back of his foot/leg/ankle. Well, let's just say, there certainly weren't no tendon where it's supposed to be. And there was instead a nice squishy hole where there ain't supposed to be one.

Pt --> Stretcher --> Ambulance --> ER.

I always find it amazing when the dispatches turn out to be correct.

Can one man really activate every EMS unit in the city?

2007-02-01T22:17:00.000-05:00

It's a cool, sunny day in New York. The first snow flurries of the season (occurring in January!) had fallen the night before, leaving the streets wet, but just the fainted hint of white under the trees. The time is just past 1PM.

BEEP BEEP BEEP BEEP!!!!!

"Fair Lady, Fair Lady! Respond to the School of Social Work for a woman passed out!"

"Ummm, Medic 1 to Base, is the patient breathing?"

"Stand-by Medic 1!"

...two minutes later...

"Medic 1: Patient is breathing!"

"Ummm, thanks. 10-4. Fair Lady arriving."

By the way, in case you haven't yet figured it out, it is going to be one of those calls.

We arrive on scene to find our patient, a 63 y/o female, who was reported to us as passed out and in the lobby, already gotten up and traveled to the 7th Floor. Sooooo.... off we go! My crew and myself get off the elevator, through a couple glass doors to find the patient smiling and yelling:

"Oh you guys! No. No. No. Enough. I'm fine. Go away!"

Definitely one of those calls. My partner (and CCiT -- that is, Crew Chief in Training) approaches the patient. He quickly makes no headway. Intervening slightly, I steer the patient and my crew into a conveniently empty conference room. My partner directs the Probie (did I mention my crew comprises of FOUR people!) to start getting vitals. The patient puts up some fight, but quickly sees reason and lets us check her BP, etc. as my partner persuades her.

"Come on, I don't need this! You guys were here two years ago! I feel fine now," she says.

"Huh?" I think. "What happened two years ago?"

"Oh, I passed out, right over there," she points. "I went to the hospital and they told me I was having 'mini-strokes.' I'm also diabetic."

"Great."

My partner gets the rest of her history. Unfortunately, our patient has gotten even more vocal, and worse, when my partner suggests she takes a ride over to the hospital, she refuses, adamantly. I take the opportunity to pull my partner off to the side and remind him of the presenting problem's link to her Hx. Now, at this point in the game (Warning! Rant alert!) I would normally do a quick finger stick (and so would every other EMT on the planet) and check her blood sugar. After all, she did say she missed lunch today. Too bad. New York City BLS units aren't allowed to carry glucometers.

So instead I tell my partner to call Med Control and ask for a recommendation. Since the patient is under 65, Med Control physicians don't have authority to force the patient to be transported, but I figure what's the harm. I want to take her, but I don't want to get in a fight with the patient. I figure with a doctor's recommendation and the moral authority to pursuade the patient to spend a $50 co-pay, she'd be more willing to go. Little do I know. The Medical Control Doc orders us to transport the patient. Unwittingly, I have now entered a very, very, gray zone.

At this point, the Patrol Captain of the University's Public Safety Department strides in the room.

"Virginia," he begins (Name changed to protect Pt. con.) "you realize that you're on private property. If the Medics" (by the way, that's just the street name for Fair Lady personnel. We're all just EMT-Bs) "want you to go to the hospital, I can..."

I cut him off. I know where that statement is going, and the last thing I want is to force the patient to the hospital. I want her to want to go to the hospital. Besides, I can always call PD. I have a valid order saying I need to take her, I think. It also becomes increasing evident that my chances of convincing my patient to take a ride with us are becoming less than nil faster and faster.

"What do I do!" I think at myself... and in a moment of EMS competency I remember my protocols: "...care can only be transferred to a medical authority with a higher level of care."

Aha! This is what ALS was designed for. Sorta. Well, it'll do the trick regardless. While, I no longer have the authority to RMA, and ALS rig still does. So I get on the horn and call MARS and request an ALS bus to our location. I decide the patient is in the good hands of my partner. I go downstairs and await our backup. 10 minutes later, a BLS rig pulls up. @&%#! I approach. I speak. They speak. I call MARS again, reinstating my request for ALS. I am informed that since I already have a BLS bus on scene, they are the ones who need to request ALS. I remind the nice man on the other end of the phone that I am a BLS bus. The nice man tells me to pound salt. I look at 16-E and tell them what MARS told me. We both roll our eyes. 16-E decides he wants to make contact with my patient. We go upstairs. 16-E talks with the patient. He asks me, "Do you want me to call the Conditions Boss?" Me, never ever having heard of an entity known as the Conditions Supervisor says, "Huh." I seem to be doing that more than usual today.

The Conditions Boss, 16-E informs me, is an FDNY dude who solves situations just like ours. Awesome. I grant him permission to proceed.

"16-E to Central. Request Conditions Boss at this location."

"16-E! No Conditions available in the vicinity. Will you take an ALS unit instead?"

Mon dieu! 16-E looks at me. I nod.

"16-E. Go ahead. We'll take an ALS unit here."

"10-4. 24-U respond to....."

Let's go over the cast currently on stage:

-1 patient, hereknown as Virginia.
-1 concerned friend, female.
-2 crew members, BLS unit 16-E
-1 Public Safety Patrol Captain
-3 random extras, assorted genders, looking through the window into the conference room
-4 Fair Lady crew members

Basically, we're all looking at each other.

Final Act

"16-E! 16-E! Pick it up!"

"16-E."

"Conditions Boss is now available. I've sent him to your location."

Enter 24-U, the ALS unit. We fill them in. We also simultaneously hear the Conditions Supervisor pulling up to the front of the building. I take a quick peek out the window and see:

-Public Safety Patrol Car
-Fair Lady Ambulance (Type III)
-Conditions Car (Ford Excursion)
-16-E Ambulance (Type II)
-24-U Ambulance (Type I)

All blinkies going strong.

The Paramedic goes, "What's your blood sugar?" Patient sticks herself with a meter that I have now determined she has had on her person all along.

Patient: 132

Paramedic: Right. Good! Well, finish your lunch, sign here, and we'll all leave.

Patient: Great!

Handshakes all around.

We all pack up and take the elevator down. As we're leaving, I'm not quite convinced the paramedics did everything they should have, especially since on the way out the door I'm stopped by a coworker of Virginia's. He states that the present incident is actually the second in a row. An earlier episode having occurred an hour before we started this call. I'm concerned, but I shrug, and head back to the vehicle. I've already passed care to a higher level.

What are your thoughts? What would you have done?

Wow!

2007-01-23T00:50:00.000-05:00

Hey! it works! My "new" website: clickthrough

Nifty Internet Stuff

2007-01-23T00:26:00.000-05:00

So being an Internet "Have-Not," I envy the ease and finesse of the Internet "Have." Which is why I'm trying to add new features at this page, but seem to be failing miserably. Anywho, tried to register a new domain name for this: www.flashingbluelights.org and have it automatically forward (and step 2: mask) to my nice little Blogger address. So far, no pie.

We'll see what happens in a day or so.

Try it!

Vehicle (and Mental) Disfunction (or rather, Malfunction)

2007-01-11T22:50:00.000-05:00

We had our ambulance malfunction today. I mean, the vehicle that shouldn't be malfunctioning was malfunctioning, as opposed to our other vehicle which is in a state of constant, perpetual malfunction. The latter will, sooner or later, end up in the scrap heap. This former will too, but hopefully not for many more years to come.

No, the problem was that we park our ambulance in a nice, convenient location on a usually pedestrian only street which is suited just as much for display purposes as accessibility. Free advertising you see. The other reason we park it there is that being in Manhattan, no one wanted to buy us a building with a garage. Unfortunately, when it gets cold out, our ambulance gets cold too. And while the fine first responders on our corps. can bundle up, our ambulance can't. So cold ambulance + diesel engine = vehicle that does not start.

This is all fine and well until one tries to respond in said ambulance, and instead of sailing away with blinkies and woowoos to the rescue. Said first responders, call the Fire Department for assistance, and hoof it on foot to the scene with trauma and O2 bags slung across our fine, broad shoulders. Luckily campus is not all that big, so we can walk to just about any scene in a few minutes. (Insert comment on how FDNY arrived on scene 15 whole minutes after we did, a sum total of 25 minutes after the call initially went out.)

But I stray...

How, you may ask, does this occur when modern block heaters and shore-powered space heaters, and magic heaters of thine heart, and all the rest are there to there to prevent such occurrence? Answer: I have no clue. All I can say is that hopefully, we'll get the rig checked out top to bottom, and maybe a problem will be caught. Something along the lines of, "oh, there is no engine block heater after all...!" (When this happens, I'll be the one going "Thwack!" followed by our Operations Officer going "Owwww!").

In the meantime, we were able to jump the engine (and the battery was cranking just fine, which is odd) and get her started after the call was completed. For the past day or so, at three hour intervals, I'm also going out and starting the bus and letting it run for 15-20 minutes. So far so good, but I'm just waiting for the moment at the next call when I realize she's not going run this time either.

All I can do, I suppose, is turn up the heat of mine heart, and hopefully, prayerfully, there'll be enough warmth to light a fire of fuel injected diesel and metered amounts of air in a cast iron block to keep the public safe and happy.

P.S. I realize there hasn't been a simple medical related post in a while (or ever?), so the next one will be. I promise, I swear. I's gots me some good idears. I's swears. I's promises.

Driver Training, part Deux

2007-01-08T16:46:00.000-05:00

As a solution to the lack of an EVOC course, or even a large parking lot nearby where I can set up pylons, I've been taking willing guinea pigs to the famed Fairway supermarket near 125th St. on the Hudson River here in Manhattan. This is the only place within twenty miles that I know of that has a clear stretch of pavement that will hold more than five cars. In fact, in itself, it's like a pre-built obstacle course just waiting to be used by college aged EMTs learning to drive the rig for the first time.

Of course, a few weekends before the Christmas break, I was having my pro tempore preceptee doing the serpentine in reverse around the thick steel columns that held the West Side Highway fifty feet above our heads when a friendly RMP from the local 26th Precinct pulls up as I'm walking alongside the vehicle, spotting the driver.

"Good Lord, what the Hell are you guys doing now?!?" says over-caffeinated patrolman.

"Driver Training," replies Yours Truly.

"Wow, you guys train a lot."

"Name of the game."

"You know, we were following you guys the other day, you were doing CPR in the back of your bus..." the Officer says.

'Uh-oh' I think, I know where this is going...

"Yeah, but we got a little confused when you guys drove past the hospital. Guess you guys were training, huh?" Officer says with a smirk.

"Yep, had to show the newbies what it felt like to be chest-pounding in the back of a moving vehicle," I respond.

'Great,' methinks, 'At least I know we getting talked about the the Precinct house, but you gotta make do with what you have.'

Louisiana?!

2006-12-14T12:42:00.000-05:00

So I accepted a job drilling for oil in offshore in Louisiana (details not so relevant), which I may or may not report to come June, but anyway, I was browsing for apartments and the like in the towns around Lafayette. Interestingly around, this is my first major move in around four years, which is a little more than the total time I've been involved with EMS. So I was surprised when I discovered myself looking first for towns that had volunteer EMS squads and fire departments as the primary criteria of where I might want to go live. Oddly enough, I found out that many towns (in fact all of them) are serviced by a single commercial ambulance company. Investigating further, I discovered that much of the entire STATE of Louisiana's EMS system is this single outfit.

Now, there are many volley fire gigs, but most of the fire gigs don't do EMS, as evidenced by the online lists of members with only one or two members at most being certified as EMT-Bs. I'm a little disconcerted about this situation, and as much as I like working the fire service, EMS was always (and I hope forever will be) my primary emergency gig. This is quite a conundrum since I swore that I work never work commercial EMS. This quandary turns out to be the principle misgiving of moving from New York City to Louisiana. Anyway, two concerns: (1) I hope the single commercial ambulance outfit that runs everything down there has good QA/QI because they own the business, and no one has a choice to the EMS they get. (2) I wonder if they hire per diem Basics who spend 3 weeks a month offshore?

Bite Nails and say, "Driver Training!"

2006-10-20T03:55:00.000-04:00

New found duties as Crew Chief: (1) Driver Training (2) Crew Chief Training (3) Probie Training... I'm sensing a theme here. Regardless, it is issue #1 that scares the bejeezes out of me. Now, to refresh your memory, recall that Our Fair Lady is a COLLEGE ambulance service in MANHATTAN! Driver Training just isn't so easy.

Our squad is jointly run by the college Health Service and the Department of Public Safety. The Health Service's job is to give us as little money as possible and reduce that amount every time we screw up. Public Safety's job is to let us do whatever we want and not ask questions.... until recently. Apparently their vehicle insurance rates are increasing, which means questions are coming down from the TOP. Specifically, questions phrased as commandments: i.e., STOP GETTING IN ACCIDENTS! Not an unreasonable request.

In Manhattan you're bound to get in minor fender benders here and there. But some drivers new to the art of Emergency Vehicle Operations don't seem to realize that one needs to be a more conservative driver when going blinkies and woowoos (sorry DTs -- such a great phrase), rather than blowing through every intersection without looking and twice on Sundays.

Don't get us wrong, we train our new vehicle operators. First we give them CEVO (the cheaper, textbook only version of EVOC), then they hook up with the wayyyyy overprotective CCs (of which, may I add, I have recently joined the club) and start driving.... slowly.... around the streets of Manhattan. Going Cold, aka, no blinkies. No woowoos. This phase (DiT 1 -- Driver in Training 1) lasts until the trainee gets used to driving an ambulance, that is, a vehicle with a big ole butt (We have Type IIIs) and no rear-view mirrors. This phase sometimes lasts months. However, when a DiT 1 has proved himself, they get promoted to DiT 2. Eligibility to drive HOT! (Fun Fun). Believe you me, if a DiT 1 EVER got in an accident while driving, they would NEVER make it to DiT 2. Oddly enought, not many DiT 1s get into accidents.

Now another note: We have a relatively small campus. It's only 3 blocks wide and 10 blocks long. Response times are not very long at all. So why is it, that after that certain moment when the Captain grants a certain person the privledge to drive HOT and forever after, that the drivers just can't stop banging into EVERYTHING!?!?!

While I was still a Driver, the rank directly below Crew Chief, responding to a call, my crew chief was driving. We were HOT -- full blinkies, full woowoos. We enter an intersection. We need to make a left hand turn. We stop behind a car waiting to make the same turn. The (I assume) nervous driver in front of us panics a bit. He pulls his car forward a few feet. My crew chief sees him starting to move and starts to move as well. Two seconds later: BAM! We've rear-ended the car in front of us.

Now both vehicles could not have been traveling faster than 0.5 mph. Yet somehow, we've just got in an accident. Luckily it was late at night, and there was no other traffic. We sustained a dented quarterpanel, the other driver was unscathed. No one was hurt.

These incidents happen all the time. The most common one is that a driver will, while reversing, back the ambulance directly up into one of the giant yellow concrete posts that sits on either side of the bays at the hospital. (Almost as bad as reversing directly into the side of the fire house -- but a story for another day.) How can we improve? We have a fairly rigorous and conservative training program. But unfortunately, the nature of our personnel is that they are all young, inexperienced drivers, who have never driven an emergency vehicle before coming to us.

We have even considered hiring out and getting an instructor to teach the Corps. the full EVOC class, practical and everything. Trouble is, our budget isn't very big, and it would require us to take our one main ambulance out of service, drive one hour (each way) to the Northern Bronx, just to find a parking lot big enough to set up an obstacle course. We also have a second ambulance, which we don't run since we don't have the required call volume to justify keeping two crews fully staffed 24/7. It is, fortunately older, and unfortunately, smaller, than our main 2003 Horton Type III. Upside: No one cares that we ding it, Downside: it is not a good training platform. It seems to be asking for trouble requiring our new drivers to learn on a smaller ambulance. I can just hear it now: "Well, he got into the accident because he didn't realize that his vehicle is actually 2 feet longer than he thought it was."

The conclusion that everyone seems to draw at the end is that we're just going to have to do the best with what we've got, and accept the fact that we won't ever cure our problem. We will always get into the minor accidents, and perhaps, even small dings and scratches to the paint job are OK, just so long as we never get into a major accident, no laws are broken, and we NEVER hurt someone because of poor driver training.

The End.

...Now where did I put my Probie Whipping Stick?

Crew Chief -- At Last!!!

2006-10-10T23:16:00.000-04:00

As of tonight, Yours Truly has finally been promoted to Crew Chief! Ahhh, three long years...

MARS: "Mutual Aid Response System"

2006-09-23T01:23:00.000-04:00

There once was a little pig called MARS. He was the system set up by the FDNY administrators to send jobs to and recieve requests from EMS agencies not affiliated with the Fire Department, or field requests from agencies for additional resources, including ALS, Fire, PD, HazMat, and more. Unfortunately this little pig is dead, and we're not talking about freshly killed. No, we're talking carcass hit by a bus years ago, and all that remains is a clean little skeleton that the flies have long since left.

You see, as one of two volunteer ambulance agencies headquartered in Manhattan, and the only one in service 24/7, we are relatively small. We have a group of eagar college students by day / EMT by night that staff our single ambulance. Mainly, we serve the campus: but since the university is the third largest landholder in the city, that area is relatively large. We crank a good 700 calls a year.

OK, enough shameless self-promotion -- The real problem is Big Red has a very long history of not paying attention to or establishing links with other agencies in the city. While many agencies outside of the Manhattan proper seem to have more success, within the city, there is not much support. Here are the problems with MARS:

1.) No Training -- Us college kids have never been trained in using MARS by the Fire Department. What we know is limited to what gets passed from the Seniors to the Freshmeat.

Solution: One FDNY rep could spend an hour talking about how to and when to inplement the radio system*

2.) VHF -- The Fire Department is on VHF. We're on UHF. MARS is essentially a radio based system. There is a work around where we use our cell phone to call the MARS number, but that's just ridiculous! Can you imagine calling a dispatcher on the phone only to tell them that you're 10-XX.

3.) 10-Codes. They're all different. 'Nuf Said.

4.) It's easier to call 911 -- Yes, that's right. Our current system for when a drunken 250lb. football player starts wailing on my crew. Step 1: Run! Step 2: Dial 911. Step 3: Dispatcher sends an RMP (Radio Motor Patrol -- The guys with guns!) AND another BLS unit.

5.) BLS arriveth -- #1 reason to call for help: Request ALS. #1 response from FDNY after requesting ALS for our patient through 911: BLS car.

6.) Computer Assisted Dispatch -- Yeah, we don't have it. Do you know what it costs to put one of those systems in your truck!?! Unlike the Voluntary units (for-profits), the Fire Department (the professionals), the volunteers don't make money (we don't do cost-recovery), hence we can't afford toys.

7.) CPMU has NYPD -- The other volunteer EMS unit in Manhattan is dispatched by NYPD. Their radio system works just fine: it the police system! (Might I mention how odd it seems for every other agency in the five boroughs to talk with Fire, but the Central Park Medical Unit talks with Police -- even if it is the Central Park Precinct.)

8.) Disaster Strikes! -- Please don't, hopefully it won't happen again, but the way things are going, it's bound to sooner or later. Then what?

Someone help!

*PS: Any fire folk out there: Could we borrow your training academy? We've looking for a place to do EVOC.

Back on Campus

2006-09-06T22:44:00.000-04:00

As promised, here is the down low on EMS in a chemical plant. A little background info to start with:

I worked over the summer in a small-to-medium sized chemical plant in Upstate NY. Located in Rotterdam Junction there were two side to the plant, the "Chemical" division, and the Performance Resins Division (PRD). I worked mostly with PRD, but also spent some time on the ChemDiv side, and also at the Waste Water Treatment Plant (WWTP). The ChemDiv manufacturtures alkylphenols from phenol raw material. A decidedly boring process, but extremely dangerous. Phenol (and alkylphenol) will kill you in under a minute if you get exposed to a 3"x3" splash of it on your skin. PRD uses the alkylphenol produced in ChemDiv, reacts it with formaldehyde and produces resin. The resin is sold to company who use it in many different products, but the most prominent customer is Goodyear which puts loads of it in their tires.

I've been holding off on writing this entry for a while because I wanted to see some EMS in action. The plant has a First Response Team that could respond to any medical emergencies, and they also took care of fire, confined space rescue, and incident command.

The biggest hazard in the plant is response to phenol spills. As mentioned above, it's nasty stuff if it gets on you. Luckily, there is a treatment. Polyethylene Gylcol, or PEG, is effective in stopping the action of the phenol, and application to an area of exposure alternating the PEG with water is essential. PEG stations are located throughout the plant. Initial response is straightfoward and usually a person exposed is able to start treatment on his own, and with the assistance of a coworker, can do an effective job. The FRT will be contacted by radio, and an ambulance will be called as well.

Here is where things could get hairy, I believe. All the workers in the plant are trained to the precautions to take when handling and being around the material. The FRT members are EMTs who can provide more initial care. However, the personnel staffing the ambulance, assumedly from an outside municiple or commercial agency would not have the training necessary to avoid accidents or becoming contaminated themselves through contact with the patient. Many EMTs (and hospital staff, as well) are trained in use of PPE to avoid bloodborne pathogens, but I know of very few who are trained in chemical precautions. For example, many solvents will easily penetrate or even dissolve latex gloves. With nitrile gloves you're a lot safer, but they still won't protect you from fuming chemicals or agents.

The plant I worked for had a visitor's video that was shown to all guests, but in an emergency situation where transport to a hospital is critical, ambulance personnel may very well be quickly shoved into a situation where they were not trained and are not prepared for. Here are the lessons learned: (1) Scene Safety!!!! -- more important than ever in an industrial setting. (2) Proper PPE -- Most hazards can be mitigated by protecting yourself. (3) Advanced Preparation and Knowledge -- If you know that there is an industrial facility in your jurisdiction, ask them to bring someone to your agency to give a presentation on the risks, hazards, and precautions they should take when they respond. You can also simply try going up to the front gate and asking for a quick overview yourself.

Summer Transition

2006-05-29T04:32:00.000-04:00

After an extended absence, during which I passed by practical (again), finished off the current semester at school, worked graduation, moved back home, and started my glamorous summer job working at a chemical plant.

With the transition from collegiate volunteer ambulance corps to town volunteer fire dept complete, I eagerly wait some interesting calls. My town is home to about 30,000 people, covering about 25 square miles, spanning three independent fire districts. Zoning is mostly residential, some commercial and just about no industrial. It's a mainly commuter town while much of the population traveling for work and play. We're located in the Capital Region of Upstate New York. The fire department is dispatched by the police department. PD sets off one-way radio pagers and whoever wants, responds to the station to pick up a truck (EMS, fire, or Rescue) and heads to the call. Volunteers are issued blue lights ("courtesy lights") and only lieutenants, captains, and chiefs are allowed to head directly to the scene. Only chiefs have red lights.

It's a pretty decent system, but no guarantee of a response, hence automatic mutual aid. However, I think it's been years since AMA had to be implemented for our district. Overall, I think we have some of the most dedicated volunteers I've ever worked with, who get up at all hours of the night to help strangers.

It's this reason why I love EMS so much, and it's not just my town. I plan on going to Medic school after I graduate college, but I never plan on working the system as a full-time job. True, I enjoy the medical applications and such of the job, but I enjoy the job more because of the great people I get to work with. They tend to be the most honest and selfless people in all of society.

Next time: EMS in a Chemical Plant

Patience with Patients

2006-04-30T23:26:00.000-04:00

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

2006-04-27T17:08:00.000-04:00

$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"

2006-04-26T08:24:00.000-04:00

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.