18 February 2013

Stay and Play

There is an trend in EMS that has apparently proven to improve outcomes of cardiac arrest patients.  It is the idea that arrests should be worked where they are found. This reduces the interruptions of CPR especially those taken when getting the patient on a backboard, moving them outside, loading them into the ambulance, etc. 
If the arrest is worked in the house or wherever they're found, it will be worked well, efficiently and with out interruption of CPR.  There was a study in Maine where this technique improved patient outcome (or, at least, reuturn of spontaneous circulation).  The patient is worked until they are resuscitated, or they are definitly dead. 
The problem the Maine study found was that paramedics were not used to giving families death notifications.  We do have to do them if we are called too late and it is just not practical to resusciate.  In these cases, we have to break the news that the family already knows and in my experience these instances are rare. 
Granted, if we did this no transport resus thing, we would probably give a lot more notifications.  It's hard to do, and it would certainly be a learning curve for all of us.  Moreover, there is probably an expectation in the community that their loved on will be taken to the hospital and cared for by a doctor.  The truth is, they will get the same care from us as they will in the ER.  I would argue that despite our limited diagnostic tools as far as cardiac arrests go we can run them more efficiently than some ERs.  We tend to be good at CPR and good at running codes. 
The only problem I see concern the patients found outside or somewhere strange that render it impossible to stay and play.  Additionally, as with the case with the arrest I talked about before in the filthy hoarding house, there was no way I wanted to spend another second there if I didn't have to.  It was not only impractical to work that patient where she was found, but a hazard to responders as well as just plain gross. 
My service has recently put a Lucas into service.  This is a chest compression device that really looks brutal (as they all do) but I believe does a good job and elimnates the interruped CPR problem.  More importantly it elimates the need for dangerous CPR in the back of a moving ambulance.  I don't know if there is literature on how well these work (I think there is positive lit for zoll's auto pulse) but I like having it along.  Between this and our vent, it almost makes arrests too easy.  These tools help to keep the whole scene calm and our focus where it needs to be. 

There.  A long winded column!

17 February 2013

Location, Location, Location

"How could we have missed the house?"
"Dispatch said they don't have a porch light."
"Yeah, but do they have a driveway?"
It turned out that they didn't have a driveway.  The ambulance crew and I were on the wrong side of the road at the wrong cluster of buildings.  We did find the house after a few minutes of confusion, and I got to blaze a trail to the house with my 4x4.  It appeared as though the house had been dropped by a twister into the middle of a field.  A very muddy field.
There wasn't a porch light because there wasn't a porch to put it on.  I'm not sure how they got to the house because there was no driveway or walk, and there was no mailbox, so I don't understand how the house existed at all.
That said, someone knew where this house was because they used it as a place to put all of their trash and crap. 
Rather unfortunately, the resident of this mystery house had recently died and we were called. Muddy and confused, we found her sitting in a living room chair.  Thanks to shows about hoarders, it is easy for me to give you a visual on this house.  First, imagine a house on hoarders, and my work here is done.
Sadly, all of this stuff made resuscitation extremely difficult.  And I love and hate to recount these stories because I always feel horrible and heartless afterwards, but I also recognize that you need (want) to know. 
We had to move furniture and trash and all sorts of stuff to get her on the floor to start resuscitation.
Someone on scene tried to move the coffee table.  Pulling it backwards, it hung up on something and stopped short.  He fell forward onto it and its feeble legs gave way.  He then started to tumble onto the patient.  He caught himself, but not before all of the contents of the table poured onto the patient. 
I witnessed all of this and had one of those dreaded moments where I was almost caught in the giggle loop.  If I had made eye contact with anyone or stopped one millisecond to take this all in, I probably would have been fired.  Despite the seriousness of the situation, this struck me has hilarious.  It is probably lost in translation. 
Most importantly, if you're unaware of the giggle loop, I'm sure you've been in it.  But to be sure, here's a video for you.
https://www.youtube.com/watch?v=-iKjkPgVQcE 

There are two lessons here.  First is to never make eye contact with colleagues when something silly happens.  It is a sure step toward the giggle loop, and nobody wants that.

Secondly, location matters.  Timing can sometimes really make a significant difference in this business.  Cities like Seattle have excellent response times because the city is well organized and homes and streets are clearly marked. 
When we are dispatched to a house that barely exists it is frustrating to say the least.  We want to find you and sometimes we need a little help. Numbered mailboxes, houses, paved driveways all help.  Sending someone out to greet us is even better.  If they are shining a flashlight at us it is ideal.  Just a little PSA from your local friendly paramedic whom sometimes gets the giggles at inappropriate times.  Just like everybody else.   

15 February 2013

Oh, Blog

Before you lament  "Oh, resqellie, if only you'd get yourself together and blog again like in the old days!" don't fret.  The blog has suffered due to my apathy, work schedule, and most importantly, because of writing.  Yes, writing has gotten in the way of my writing.  I've been passively working on a non-blog writing project for some time and recently have decided to dedicate myself more to it than blogging.  It's odd that I haven't shared any snippets of it with you blog readers. 
It is a work of fiction and somehow I am far more self conscious of it than writing about myself alone.  So, I will probably continue to not share these writings with you, but at least you know the truth.  This other project does take up some time.  The other night, I had a great brainwave and set to putting it on paper.  About three hours later I had written two pages.  Two pages!  I was as shocked as you are.  But, such is the nature of writing.  It can be fun.  It can be tedious.  And I am thinking of increasing my font size.
As for the blog.  A year ago I wanted to make it into a weekly column.  But, like working out and being constantly polite, this idea lasted only a handful of weeks before I succomed to the easier option: doing nothing. 

I miss you, blog.  I miss having great ideas for you.  Something I will keep in mind is that in 10 years I will miss having something to read about in this time in my life. 
As I've said before; time will be made for the important things.  I just need to remember that the blog is one of those things.  Maybe in a few years when you've read the amazing work of fiction, you'll say "Hey, this was worth the wait and the neglect of the blog. Now, get back to blogging!"

Duly noted, readers.  Thanks for reading.  And happy anniversay, blog.  Here's to eight more.