30 March 2012

Behind every great paramedic...

...is an even better EMT. This, is largely true, and my thoughts on the subject have been brought on by some opinions shared with me by an EMT. He works for another jurisdiction with a very different delivery of EMS. His is a more traditional fire-based system with ambulances staffed with an EMT and a paramedic, while I am typically a chase care medic.
Tonight he suddenly began to rant that with a good EMT, a paramedic is pretty much obsolete. After all, in his system, he sets up IVs, breathing treatments, EKGs, etc and he supposes that paramedics are only good for starting IVs and intubating people. Wait. Hold the phone. I know that in class we joked that monkeys could do intubations. But intubations alone do not a paramedic make.

Obviously, I believe in the worth of paramedics. I also believe in the worth of EMTs. And if an EMT believes that paramedics are only good for starting IVs and intubating, then I am sorry for him, and question the quality of the paramedics he works with. On the other hand, I'm sure that what he's saying is true. For the most part, he sets up stuff for his paramedic, he knows exactly how the routine call are run and what the paramedic needs.

But, in a chase car system, I work with different EMTs on every call. Most I know, some I don't. Some I trust, some I don't. Sometimes, I don't get an EMT for some time while I am on scene by myself. So, don't tell me that I am only good for IVs and intubations.

Many times, with those EMTs whom I know and trust, some real magic happens where we work together flawlessly and the call just flows and everything is great. We bounce ideas off of eachother, creat a plan, and carry it out. Other times, the EMT I get holds their clipboard, asks unconscious people what their social security numbers are and I take care of everything else.
It varies every day. Sometimes, I need a good EMT, and I am the happiest person alive when I open the back doors and see a familiar face I know I can trust. And sometimes, an EMT needs a good paramedic. I try to do my best and be that person that when the back doors opened they are as glad to see me as I am to see them.

It's great when an EMT can set stuff up for me, but that's not what they're there for. They assess and treat the patients as much as I do. I just have cooler toys.

23 March 2012

The Calm

In recent days I've had calls that tested my patience.  And not because of the patients, but because of their family.  It is important for a paramedic to be empathetic and patient, but I think that overly excited families forget that a paramedic is also an investigator and problem-solver.
I've had a rash of kids who had febrile seizures.  In these cases, the patients are largely fine. It's not an ideal situation, but, it happens.  I work hard as a non-mom to put myself in their positions of these parents.  I can see how it would be terrifying to see your kid have a seizure, but once someone arrived to help, I might think some of your stresses would be relieved.  But one mom I had to deal with recently I seriously wanted to vulcan death-grip her, just to knock her out and let her reset.  She was absolutely inconsolable, despite the fact that the baby in her arms was clearly fine by that time and left seriously wondering what it's mother was doing shouting like a crazy person.

Then I had a call where an elderly father had gone unconscious.  Two of his daughters were on scene. I arrived before the ambulance and was thusly alone there for a few minutes.  The panic had well set in by my arrival and the daughters couldn't tell me anything useful because they were too wrapped up in their own conclusions.  Berating me about what I could and couldn't do by myself, how gentle I needed to be with him and how he couldn't go even one second without oxygen wasn't helping me to fix the problem.  Calling their entire Rolodex while I was trying to figure out what was going on wasn't helping either.  I almost lost my temper with this call.  I had to ask one of them to leave as her phone call was drowning out what I needed to hear, and then I heard her complaining about it in the next room.  My requests for medical history, medications, and at the very least the story fell on deaf ears.  It was frustrating beyond belief. 

Anyway, I guess my point is that I am having trouble empathizing.  I am having trouble being patient at the times when I should be most patient.  It is easy to imagine the situation the frantic daughters were in, but it's just not in my demeanor to panic.  I worried that my calmness was actually winding them to a higher state of frenzy.  I could feel they were actually mad that I had arrived alone, didn't match their panic, and then didn't solve their problem within 60 seconds.  I've seen it in the ER quite a bit, when you don't match their level of concern, people get more mad instead of more calm. It doesn't really make sense.

On this call, my BLS partner assured me I wasn't mean, just to the point.  It didn't feel that way after I started to ignore their questions that I had already answered.  I suppose it's not bad that I was more concerned for the patient then their feelings. And frankly the patient was far more critical then appeasing their inquiries.  Despite that, I'm going to try to be the eye of the hurricane and make every attempt to convince everyone on scene to join me. 

09 March 2012

Chew, then swallow.

I am a big fan of 'I Love Lucy' it is simply...great. In one episode, in an attempt to buy time, Lucy advises her three besties to chew their food 25 times before swallowing. Her time wasting was futile, of course, but the advice wasn't half bad.

We were called to a guy who was throwing up blood. We arrived, and he was right in the front room. He looked up from a small trash can and said, "I'm throwing up blood." and before I could inquire further, he proved it by spraying bright red blood all over the interior of the can. "Well, yes you are. Can you walk outside with us?"
He followed us to the ambulance where the plot thickened. He had been eating steak when suddenly he got a sharp pain in his chest and began throwing up bright red blood. Without any other associated symptoms or history, (allegedly not a drinker) I was puzzled.
So, we did what we do best and took him to the hospital.

I got a rare follow up on this patient. In the OR, they put a really fancy cam down his esophagus and just above the stomach they were met with a big hunk of steak that had taken a little rest stop. They couldn't get it to go in any logical direction, so they actually had to cut him open to remove the meat.

Can you believe that?! As interesting as it is to find a third exit for your steak, or as clever as it seems to save some for later like a hamster, I'd avoid this situation.
Lucy was right, chew at least 25 times before swallowing. It will save you an overnight stay in the hospital and the recounting of an embarrassing story. At least, more embarrassing than buying the wrong theater tickets.

07 March 2012

Winter

I went recently on a call in the snow. The snow started around 10 pm. We got a trouble breathing call around 1130.
There was just enough snow by then to make things slippery and annoying. We parked at the end of a short but steep driveway.
I still haven’t figured out what is best in these situations: leave the cot, and fetch the patient, or take the cot and risk killing everyone on the way to the ambulance. Or, just give up completely. Either way, these calls are fraught with risk.

Anyway, we pushed the cot to the door, and even carried it into the house. There we found an incredibly sick guy, struggling for oxygen and looking within inches of death. “Oh, good god” I said aloud.
I threw a neb treatment on the guy and had already made the decision to get the hell out of there. “Sir, stand up.” I said firmly to him. He was so starved of oxygen, but he obeyed and we buckled him in.
There was cop on scene, thank God, and he and my partner took the cot and eased it out of the house. I stood at the top of the driveway and watched as they both slid half way down the with the patient on the cot between them. It was horrible to watch, but all made it down in one piece.  I then slid myself down the drive and found the patient was so hypoxic that he was in a panic.  I don't think he even realized that he was nearly dumped in the street.  He fought us as we put CPAP on his face, but after a few minutes he began to calm down and I was exponentially less nervous.
Later, I expressed my horrible feeling as they went down the driveway to my partner.
"I saw my career flash before my eyes, dude, and there was nothing I could do."
“I was sliding, but the cop had it.” he replied confidently.
“No, no he didn’t.  Nobody had it. It was the scariest moment of my life.”

If he had called an hour and a half earlier, life would have been easier for everyone, and there would have been less danger. Given the state of him, he had been feeling bad for at least an hour and a half. In inclement weather, just call! Well, call before the weather comes.

06 March 2012

Improv

For the past few weeks, I've been taking an improv class.  I took it because, well, I like to subscribe to the adage of 'do something that scares you...every once in a while'.  It goes something like that.  Thanks to this class, I have done something that scares me at least once a week.  I have no background in 'the stage' nor have I recently undertaken any public speaking challenges or anything of that sort.  Further, I am not that funny.  So, taking an improv course seemed like a great idea!
It's a small class of nine, I think, and they are all wicked smart.  And quick.  The two characteristics that are the basis of impov.  Smart and quick.
But I'm not too bad.  I think probably because we have an audience of one.  We are supposed to do a 'show' at the end of the sememster for friends and family.  I worry that with an audience of any number greater than one, I will be as good as Michael Scott.
Outside of that future terror, this is the most fun I've had in a while.  I want to stay all day and play improv games with these people.  It's all so new, I find it endlessly amusing. I also find it an amazing human thing.  In the blink of an eye, you are essentially creating a story, characters and actions with another person, and they don't know what the first line will be.  It really is amazing that anything happens at all.  But in seconds the two (or more) of you can get on the same page.  What's more, you're on the same page, and it's funny!  Perfect storm!
I'm not saying were good, in fact, collectively, we really struggle with some things.  But it is a small group of people who are really trying.  Really, really trying.  It's a really fun hour and a half, and I feel it's good for my brain and my personality.