Years of academy training, wasted!

Yesterday I was able to cross something new off of my list of things to do: survive an earthquake. Of course, I thought I might be somewhere more exotic than the Mid-Atlantic to fulfil this one, but I'll take it.
To be fair, it is only amusing and exciting in hindsight. In real time, I felt, and I don't admit this often, but, scared. I hated the feelings the experience gave me. And I've come up with several reasons why. But I guess I should begin with the story.
Several things happened at once. I was in our local mall for the first time in literal years, so I entered it like a foreigner, interested to see what had changed. Secondly, I was surprised, with no offense to her, (because I certainly didn't know where we were going) that my mom immediatly escorted us to the exact place we meant to be without any fuss. Marveling at the mall and our swift arrival with the neice and nephews in tow, the third strange thing happened, in that the floor began to shake.
It is wonderous where the mind goes at such times, as the jingling of the jewelry department and the low grumble all around us increased. My nephew (9) suggested a sumo wrestler had gotten mad. My mind, though, sadly went to far more likely scenarios, and more sadly, earthquake was not among my top three. Until earthquake was suggested, it was all down to bombs and terrorism to me. In the 15-30 seconds it took to stop, a myriad of things crossed my mind; exits, whether we should exit, what exactly was going on, and how to protect my family.

One thing I really didn't like, is how out of control I felt about the whole thing. I hated that I didn't know what to do and that I looked to the other equally useless members of the public to cue me into how to react to our siuation. But everyone around us looked equally dumbfounded and confused. All of my knowledge was buried under a pile of temporary panic, and after a few tentative minutes of consideration, we continued on as usual, as if we lived in LA and this kind of thing happened all the time. This whole 'not knowing what to do' thing really bothers me on a personal level as I am an emergency planner, the paramedic, the problem solver. I bring order to chaos (on a finite scale) all the time, and yesterday, I really wasn't sure where to turn. I wasn't sure what to do when my most beloved people in the world were at risk.

Within the next ten minutes, the information came trickling in, 5.8, northern Virgina, and if people felt it while on the highway (they didn't.) Once it was confirmed as an earthquake, we were like, 'okay', made our purchase and went straight home. We managed not to panic the kiddos either. They thought it was cool right away, and were still hoping to glimpse the sumo wrestler. It wasn't until we left that we realized our phones weren't working properly and that maybe something serious could have happened.

It wasn't until I was on my way to work today, that I thought back to when I read the first few pages of the 9/11 report. It didn't take long for me to feel nauseous and stay up half the night with worry, so I stopped reading it. But. Something I do remember is that the people in the tower that wasn't initially hit (but felt shaking and swaying, etc.) did one of two things (basically.) They either immediatly left, thinking something wasn't right and they should probably get out (survived), or, carried on as usual thinking nothing of it (did not survive.) Now, this is extremely grim, but what did I do when the building I was in shook in a suspicious manner? Nothing. What a great example for an emergency planner to set! Technically, we did the right thing for an earthquake, stay put and wait it out and stay away from big stuff. But I didn't think it was an earthquake initally and I guess that makes me a pessimist, or a realist, or something.
But I guess, despite training and knowledge, I psychologically did what all other lemmings do. Seek comfort in the actions of others. I think we Americans like to say 'no big deal!' to lots of things, hence we carried on as usual. But I think next time, I might think a little more carefully.
I did think about demanding that those around me use their smart phones to figure out what had happened. I did think that if it were my doomsday scenario we were slightly safter inside. And this all has gotten me thinking of how well we are prepared as individuals.
When it comes down to it, perhaps we will not have the government or the media to tell us what to do, but will have to think and plan for ourselves. Especially when we are out and about and all we may have are the contents of our pockets to get us through. When you are in it, it is difficult to see the big picture. Could we have stepped outside and seen the mall fall down, a cloud of smoke in the distance, a plague of locusts? Who knows?
Of course, I'm not going to build an Anderson Shelter in my back yard or stock my basement with spam, but I will give it some thought. I could embody another American sterotype, that of self reliance, a bit more fully.

I think that's all I wanted to rant about, and I am sorry it got on a bit, but I think it makes sense and is worth a ponder. Yes, I've now felt an earthquake, and yes, it did scare me. And, on a side note, it did feel and sound just like that simulator at the Natural History Museum.

My house was fine, and after nearly 100 years of standing, already had cracks in the ceiling, so I'm not sure if any are new. My playmobile ambulance did roll off of it's shelf, but survived the ordeal. The greatest loss so far are the finials at the National Cathedral and the renewed loss of innocence I have when I felt for a moment that I was in the middle of something very real and very serious.


Among the millions of mnemonics one learns in paramedic class, one I still remember is "C3,4,5, keep the diaphragm alive". This refers to three of the vertebrae in the neck which if intact, keep the phrenic nerve working and telling the diaphragm to move so that breathing occurs (among other complicated things that keep you breathing). But on a physically tangible level, it is the most simple. This tidbit of information is not an extremely useful thing to know as we don't have x-ray machines and if your not breathing we'll help you out regardless.
But sometimes, it just cool to know. And it allows me to say things like "Well it wasn't C3, 4, or 5, because he was still breathing." Unfortunately, our patient wasn't able to do much other than that. It was a real lesson for me in spinal shock. This patient had well, one way or another, broken a window with his head which (I now know) broke some of his cervical vertebra and because there is no light way of putting it, paralysed him.
It was the first time in years that I saw a KED board (here's a low budget explanation) actually being used. And a more appropriate time I haven't encountered. The patient looked, for a lack of concise clinical wordage, like crap. To me, he really looked like an MI patient about to leave this world. This freaked me out and we did our best and happily flew this patient to the nearest trauma center as soon as humanly possible. After asking several colleagues, that is what spinal shock looks like: bad.
It was an interesting call and one I'd rather not repeat because it was scary on many levels.  One thing about this job that I don't like is how often it reminds us of how fragile we are. 

MI (s)

I was at my part time gig where we hang out in triage and help out in the ER (crazy, I know!). But sometimes we get to play, bandaging and starting IVs and stuff before they get to the department. The other day, a guy came in, said he had a little chest pain and thought he should be checked out. It was kind of busy so one of my colleagues took him to a spare area next to triage and hooked him up to the three lead. There it was, ST elevation in II, III and aVF. So we got him straight back, did a 12 lead, talked to the doc, sunk some IVs and he was flown to an interventional cath lab within 20 minutes. I must say, it was kind of awesome.
We got settled back in after that and about 10 minutes later another guy came in saying he just didn't feel right and thought he should be checked. The triage nurse and I put him in the monitor and low and behold: a STEMI! II, III and aVF again. It was deja-vu as I wheeled him back, we did a 12 lead, talked to the doc, sunk some IVs and he was on his way to an interventional cath lab within 30 minutes.
It was indeed strange, and though I kept trying to envoke the rule of '3's', a third MI didn't walk in.

Throat Holes

That title sounds dirty, but for some reason I like saying it. I mean throat hole literally, as in a hole in the throat. And not one that comes standard.
I went on a trouble breathing call, arrived to find a guy leaned over sitting on a bed struggling for breath. As he looked up at me, I noticed blood running down his shirt coming from his neck.
It turns out that he had a trach (a throat hole, if you will) placed a few months ago. He was attempting to change the inner catheter when he began to think that he couldn't breathe properly. He promptly panicked as any normal person would, and then pulled his entire trach out as any normal person would? Either way, it left him, not feeling much better. To add to his distress, as he leaned over, he was occluding the hole.
At a loss of what else to do, I took a regular endotracheal tube and shoved it into the hole, inflated the cuff, and he kind of felt better. By then, he needed a breathing treatment which I was happy to give and though he wasn't well by the time we got to the hospital, he was better.
It was kind of a fun call, getting to solve such a problem. Which is mostly what we do anyway.

Sorry, Blog

You've been neglected.  I've been focused on gluing photo mats together and making futile attempts at assembling an ez-up tent in my woefully too small back yard.  I've been working out a wild-ass plan with almost no mention here.  I've been going to work and going to calls, and yet, not one word to you.  I've been riding bikes.  I've even been writing, with surprising regularity, but not here.  How sad this is.  How can I stray so far from my roots?

I've stuck ET tubes in peoples throat holes (literally) treated two MI's in 10 minutes, and used a KED board, and do you know about it?  No!  How terrible.  If you were a person you'd be pale and emaciated, searching for nutrition and sustenance. 

But, fear not, blog.  You are loved.  Please do not be sad that your sister blog has been getting more attention as of late.  Hers is a specialty topic, and I'll run out of material soon enough.  Like the prodigal kayak, blog, I will get you out of the yard and into some water.  I'll make you promises that I intend to keep and soon get out of this summer lull.  After six years, I think you know that I'll always come back to you.  You are the outlet. 
I'll see you soon. 
Big Love,

Under the Same Sun

Here's a little plug, for the now, (somewhat) official photography selling biz.  I have put some wheels in motion and spent some money and am almost ready to start selling photographs at craft fairs and the like.  I am particularly excited about my business cards which will be particularly awesome and officiall looking.
There's not much to see on the site at the moment, but it's a start.  Please check back often to my sister blog and come on down to a show if you can.  (If I ever get into one!)


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