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Monday, September 10, 2007

Some action shots...

A local firefighter and former AmCare employee, Ron Robtoy, likes to take pictures on scene when he happens to be around for good calls. He's put together quite a collection of pics. I am posting some here.

















Albuterol

Called to a man with difficulty breathing Saturday night. We arrived to find this guy on the floor, barely breathing, audible wheezes, full blown asthma attack. The patient and the only bystander were no help as to patient history. I got on the radio immediately and as I was setting up the nebulizer I was asking for albuterol. My partner is getting the stretcher and everything else ready. The radio operator from the hospital gets on asking for vitals. I told her what I knew: pulse 100, resps about 40 and very labored, bp forthcoming, "I'm more concerned with the "B" from the ABCs right now..."just then the OLMC doc jumped on and gave the order for the neb. The guy was 100% better after 30 secs. of the treatment. He says to me..."I thought I was gonna die"... A good call.

Saturday, September 8, 2007

Saturday 24

I'm on today for 24. There's just 2 crews on Saturdays and my experience has been that its either hit or miss. Either you both end up running like crazy (usually no good calls), or you get nothing. Actually, nothing on Saturdays is pretty nice, as the weekend shifts are a lot more laid back in terms of getting chores done at quarters, etc. Its usually a good day to watch movies. There, I've managed to jinx us for the day.

I hope to touch base here later with an update on the day's events.

Thursday, August 30, 2007

Dealing with the Heavy Stuff

A recent double fatality call prompted a CISD (Critical Incident Stress Debriefing) to be held for local responders involved in the call. I wasn't on that call, but fellow crew members were and from their casual discussion of it at quarters and while riding other calls, it was clear to me that it was a tough one. I attended a CISD for a call a couple years ago. I found it helpful. The team seemed professional and supportive, and structured a session that allowed an outlet for the images that stay with us after a bad call. I noticed that most of the attendees were responders that are volunteers: that is they don't see this stuff as often as a full time EMT or firefighter.

Which leads to my main point. Whether volunteer or paid, first responders see a lot of stuff that is just plain nasty. Stuff that makes you think and that can stay with you for longer than you want it to. The more calls you do, the more likely you'll experience stuff that sticks with you. What's the first part of the newspaper we go for? The obits. Why? For me, its a way of getting some closure. Its an opportunity to learn about the person whom you only got to know as a patient. Sometimes the obits is the only place you can find out if your patient survived.

We transport a lot of very elderly, very sick people. We even get to know them at some level. We see their names and life stories in the obits at a rate of three or four a week.

Critical Incidents? I guess not, but nonetheless, a part of the job.

How do you deal with this part of the EMT's life? Comments??

Across the Waves (EMS to the Rescue) Part 2

We eventually figured out that the state park people were waiting for us at the dock on the mainland with a boat, and that the Town Fire Dept. would be about 10 minutes behind us with their rescue boat, leaving from their dock (which is closer to the station). We rolled up to the small picnic area at the end of the point, being directed by bystanders toward the docks. Our second ambulance was well on the way by then, so we parked our rig as close to the dock as we could and started grabbing gear.

Knowing the general nature of a call before rolling up on scene allows us to grab the gear we might need as we exit the ambulance. Additional gear is usually just a few short steps away if it turns out we're gonna need, say a stair-chair or scoop stretcher. When you leave your ambulance behind while you race away on a boat, however, you just gotta think of everything with the first grab. Thinking Cardiac Arrest, we grabbed the jump bag (essentially a combination Code 99/trauma bag: O2, BVM, combitube, airway adjucts, suction, IV supplies, and just about everything you'd need for bleeding control), the ALS bag (meds, airway, IV stuff, pulse-ox, stethoscope, BP cuff, glucometer), a backboard, c-collar (who knows?), headblocks, extra blankets, gloves and more gloves, and last but not least our trusty Zoll (12-lead ECG, and defibrillator). The boat operator, who works for the State of Vermont Dept. of Parks, turned out to be cool under pressure, willing and able to help with gear, and an absolute pro behind the wheel of the 24' Boston Whaler he had idling there for us.

Between keeping tabs on the radio chatter, making sure the gear was in the best place to keep it dry and secure, and holding on for dear life, the ride to Burton Island went quickly. It was a warm evening, and I told Kari that "we ought to get out boating more often", to which she replied "yeah, without the 30 minutes of CPR we have to look forward to, this wouldn't be bad." As the whaler approached the small island marina, we could see a pretty good sized gathering at the dock. A green State of VT issue pickup truck was at the edge of the dock, ready to carry us on the next leg of this unusual call.

Our craft's captain maneuvered expertly around the mix of private and state-park boats, including the big ferry used to trundle campers between the island and the mainland, and stopped smoothly at the dock. A handful of park workers and bystanders helped with the gear, lugging it the 20 or so feet to the back of the waiting pickup. Kari and I jumped in the back and the truck sped off down the gravel road towards the campsites. We turned this way and that, leaving the open of the dock area and heading into the heavily wooded campground. I was surprized at the size of this island-park, thinking that this leg of the trip alone would have been tough if I had it to navigate with only a dispatcher's directions. Finally the truck ground to a stop near a small gathering of tents and leantos which looked out over a rocky beach. A woman ran up to us and started rapid-firing details about the patient and the situation, while leading the way through someone's campsite and toward the water.

EMTs develop a sense that usually tells us at the first glimpse of the patient, how serious the call is going to be. Considering it was at least 20 minutes from the time the call was dispatched to my first look at what I was expecting to be a pulseless and apneic person, I was shocked and relieved to see, supine on the beach, surrounded by a small group of family and friends, a man in his 40's with his eyes open and a look on his face that told me he was aware of what was happening! Now I often use humor (when appropriate of course) to help ease the patient's fear and apprehension they must feel when they are sick or hurt enough to need an ambulance. I may have overdid it a bit this time, however. My first words to him as I knelt down and checked his pulse were, "Man, you don't look anywhere near as dead as we thought you were gonna be!" Luckily Our guy took it very well, even producing a small smile.

Not a code, but our patient still needed immediate treatment and transport. I didn't like the look of his vitals and knew we had a way to go to get him to definitive care. Suddenly, we were joined by a small army of Town firefighters and first responders. Getting the patient backboarded and moved to the pickup truck went smoothly with the extra help.

We ended up taking the Town Fire boat back and were greatly relieved to find our back-up ambulance at the dock, complete with crew. They had everything ready, so the transfer from the boat to a stretcher, to the ambulance went smoothly. As we cruised on toward the hospital, our pager went off, notifying us of a transport to Burlington that was pending, the anti-climax to an exciting and unusual call.

Saturday, August 18, 2007

Across the Waves (EMS to the Rescue) Part 1

Just as I was fretting about a lack of decent calls recently, I got to take part in a pretty exciting and unusual call a couple weeks ago. Our service area includes quite a few miles of shoreline on Lake Champlain, and its not unusual to get a call at one of the many private camps out "at The Bay". Lake Champlain has many islands, ranging in size from Grand Isle (big enough to have several communities) to little rock outcrops that manage to stay just above the deep waters of this glacial lake. One of the islands is home to a Vermont State Park: Burton Island State Park. It is accessible by private boat or by taking a small ferry that the park service runs. It has a beach, tons of great fishing, hiking and biking trails, and many really fine campsites.

I was working a 24 and the call came in just about at the end of the regular day-shift, when the day crews go home, leaving just our crew for the overnight. The dispatch was to an unresponsive person at the campground. No other information was available. Of course only one thing came to mind: Code 99.

We jumped in our rig and headed code 3 through the rush-hour traffic. We got to the main intersection in town and had just managed to convince most of the drivers to clear the way, when our truck coughed twice and stalled. I looked at my partner (Kari) who was driving and all I got was the "oh shit" look. She tried the key and it was dead. This truck had done this a couple times in the past week and the repair shop assured us that "nothing was wrong with it, it shouldn't happen again." I grabbed the radio and called back to quarters, hoping that someone was still there. I got a quick response and was explaining the situation when Kari got the truck started and accelerated through the intersection and turned onto Lake St. "Better keep a second truck coming", she yelled over the siren, "in case this thing does it again."

On the radio with our boss, I relayed our plan: To continue towards the dock in hopes that we could make it without the truck crapping out again. If we made it that far, we'd head for the island on whatever transportation we could find, and please have a fresh rig waiting for us on the dock when we get back. If the truck did die en route, the second truck (presumably with a full crew) could leap-frog us and get to the dock to take the call. With that plan in action, we rolled on.

With the truck running better than ever, the state park ferry dock was getting closer. Dispatch had Town Fire rolling for med assist (by now we're almost dead sure its a code, even though we still have no more 43 from the scene), and they have a boat. Are we meeting them (at a different dock) to get to the island or are the park personnel on board with this situation? Between the traffic on our channel (getting the other truck with crew rolling), dispatch (getting Town Fire rolling), and all the chatter between the volunteer firefighters trying to coordinate their response, it was just about impossible to glean the info we needed from the din.

The Absent EMT-Blogger

I'm pleased to find out that quite a few people are checking out this blog. I get comments all the time, even on stuff that I may have written several months ago. This (in addition to the lack of therapeutic value I get simply from writing) is why I feel bad about not being as prolific in my entries lately.

I am going through some personal stuff that is also somehow linked to my career as an EMT, and I find it difficult to go to this space and write lately. For good or bad, one way or another, these issues should be resolved in a month, two at the most. At that time I expect that I'll be back at writing a lot more regularly. I may even be able to share with you a bit about what I'm now going through now.

Thanks to everyone who checks in to WayOutEMS...I appreciate the comments. I'm going to try to bust out at least a couple entries this weekend.

Stay safe out there ya'll!!

Saturday, July 28, 2007

Dinner at the Firehouse

I've mentioned in this blog before the relationship AmCare has with the St. Albans City Fire Dept. They respond to all of our calls in the city and are a great help on scene. Tonight my partner and I find ourselves at the firehouse sharing dinner with the FD duty crew. Some barbequed ribs and chicken along with the fixins are on the menu. Last time we did this, we were just sitting down to eat when we got a call...in the city, so we all had to leave our food. Hopefully we'll make it to the after dinner cofee before something comes up. :)

I enjoy these little get togethers, it builds team sprit among the first responders responsible for this area.

Monday, July 2, 2007

Suicide and Trauma

So he said, "May the trauma gods be with you".... Boy do we ever get what we ask for, huh? My sometime partner (out for awhile with a back injury), said those very words to me as he finished washing his car at the bay last weekend. Besides the three trauma calls we had (anaphalaxis, I know, sorta medical, but it started with a TRAUMATIC bee sting, then a fall off of a roof, and an unrestrained driver who suddenly became real up-close and personal with his steering wheel), we had to confirm a suicide death this weekend too. Something in the water or "the times they are a changin'" cause there's been like 6 too many in the past 4 weeks.

Busy freakin' weekend, followed by a busy Monday. How about this folks? Thurs 6P-6A, Fri 8A-6P, Sat 8A-Sun 8A, Sun 5P-8A, Mon, 8A-5P..and on it goes. Whining? Naw, I actually enjoy it. As my sometimes partner Clem says: "Ya gotta check the "insane" box on the application to get this job in the first place....."

Tuesday, June 26, 2007

My Brothers and Sisters

Today my partner and I had to do a long distance transport, leaving around 2PM and returning around 830PM. It was HOT here today, like 95 and muggy like the northeast can be in the summer. Even with AC in the truck it was a long trip: We returned, just a while ago actually, pretty worn out.

We looked at the log when we got in and saw that the crews that were on duty while we were gone stayed busy too, running a whole stretch of calls throughout the rest of the afternoon and early evening. Plus they had to do chores at quarters for the end of shift, etc. When we walked into quarters there was a note in our mailbox that they had gotten ice-cream sandwiches at the end of the day and had left some for us in the freezer.

Here they busted their butts all afternoon and they thought of us. Now there's no doubt that we can get on each other's nerves around here sometimes, but all in all, the ice cream story is the way we treat each other here. And non EMS people wonder why our fellow crewmembers are called "partners" and why we act like a big family.

Thanks guys!

Testing and Re-Certing

A bunch of us had to re-cert recently. Vermont has 2-year re-certs and this would have been my first. The day of the test I happened to be on the state EMS website and noticed that if you maintained your National Registry cert (through a whole bunch of CE stuff!), that that will satisfy the state for recerting. I also had to submit the required CE credits at the Intermediate level to maintain my VT EMT-I03 cert, but it worked out. I think I was the only one that bothered to keep my NREMT-B cert, so I was the only one (besides a couple crew members that had recerted at an earlier time) that didn't have to test that night! I ended up jumping on a truck and running E-calls throughout the entire evening anyway, so I missed just about everything (except the fabulous supper provided by our testing host). :) Later.

Serendipity?

If you've been in EMS for awhile, you've probably been to car-wreck calls where either you couldn't believe how freaking lucky the occupant(s) were, or you couldn't get over the small detail that led someone to a particularly poor outcome.


For example, I can remember a crash last year. My partner and I were called last fall at about 01:00 to a single-car 10-50. The town's Fire Department and their 1st responders headed there, as well as the State Police. When we got on scene, the FD and PD were searching the tall grass and woods adjacent to a smoking heap that used to be a car. A discussion with the State Trooper nearest the scene revealed that there were no occupants in the car, and so far, no one had been found injured or deceased anywhere near the vehicle. My partner and I examined the vehicle to see for ourselves if anyone was in it, and to get an idea of mechanism of injury should a patient be located.



From what we could piece together, the driver was going at a very high rate of speed down a paved country road, lost control, veered off the road just at a spot where a ledge dipped down to road level. The car rode up the ledge as if climbing a ramp, continued on for a couple hundred feet, taking out sections of barbed wire fence and several small trees before careening off the ledge and ending up in a ditch adjacent to the road, on its roof, flat as a pancake.



We convinced ourselves after a pretty thorough inspection that there was no one in the vehicle, and if someone had survived the wild ride, they probably wouldn't have had the space to crawl out and take off. That left only one reasonable explanation: The occupant(s) was/were ejected during the crash and were lieing dead or injured somewhere, or were uninjured enough to run.
No sign of anyone was ever found, though I'm sure that the police investigation eventually led to someone who was likely involved.

So, that brings to mind another 10-50 we responded to. A car left the highway on a dry, warm night, slid down an embankment and rolled several times. We found the driver, deceased, still in the vehicle. Looking at the skid marks and talking to the investigators leads me to believe to this day that a momentary lapse at the wheel, maybe reaching for a CD or seeing a deer at the side of the road, coupled with the steep embankment (and just plain old bad luck or whatever), caused the car to swerve just enough, and that was it. I still have a hard time getting my head around that.

Tim McGraw's song, Live Like You Were Dying talks about living every day like it might be your last. So hard to fully put into practice, but do any of us really know?

Stay safe out there.

Tuesday, June 12, 2007

I'm still here

Been way busy lately. EMS has been kickin my butt: Lots of calls and lots of late calls = sleep deprivation for this EMT. I'm getting recharged though, so I hope to be back to some more regular blogging soon.

Just an observation. In the past 10 days or so I have run probably 25 "E" calls. Of those 25 I would guess that we had PD (police) on scene for 15 of them. Is it the moon or something in the water? Who knows? One call had 3 County Sheriffs, 4 State Troopers, 2 Border Patrol Officers, and a couple of police dogs tossed in for good measure. You know what a scene looks like with 10 vehicles running their lights?

Stay safe, I'll be back soon, barring any crazy unforeseens!!

Sunday, June 3, 2007

Busy Weekend

Just wrapping up a pretty busy weekend. I worked the overnight shift at AmCare last night. We ended up with three calls after midnight, so we got little sleep. A couple calls were decent, not fantastic by any stretch, but we did get to use our skills.

On with Enosburgh today, doing a 24. This is Dairy Festival weekend, very similar to Maple Fest in St. Albans a while back I guess. We were on standby for the 10k road race, and ended up transporting a patient with heat exhaustion. It was nice to be able to really make a difference (like lowering his temperature about 5 degrees from on-scene to at the hospital, and getting some IV fluids into him). I wish I had my camera to take a pic of the back of the ambulance after the call: We had IV set-up bags, tape, 4x4s, cold packs, chux, open med bags, monitor leads, etc., etc. all over the place. Funny how you don't realize the mess you're making when you're really working the call until you get ready to get the rig cleaned up. :)

We went from that call to a seizure call. The transport time was a good half-hour, and it was just my partner and I. He struggled just about the entire way to maintain the airway with suction and positioning, while I drove like heck. No IV access due to the tonic-clonic activity. No benzos because we are not allowed and our medical director isn't convinced that paramedicine would be valuable in our district. Ok.

Just got back from a call that involved the State Police (seen those guys several times this weekend). Great to have the "Super-Troopers" go in and make sure the scene is safe for us, thanks guys!!

Thursday, May 31, 2007

Arizona

I wrote briefly a few days ago about my trip to Arizona. I did get a chance to talk to some EMS providers and also got a tour of Southwest Ambulance's headquarters in Mesa, Arizona. The tour of Southwest was a real eye-opener for an EMT that runs in rural New England.

The crew pictured above were nice enough to talk to me about what they do. They are an RN and EMT-P and they run together as a Critical Care team. They had just finished their rig-check and were checking and signing for their drug box when I first met them. Their ALS box was a whole lot bigger than what I carry as an EMT-I here in VT! We talked about our respective scopes of practice; they were shocked that we have no paramedics in my VT district. Thank you to everyone I met at Southwest, especially Ms. Sandy Nygaard who took over an hour out of her busy day to show me around.

I also got to talk to a crew from another ambulance company, PMT. I saw their ambulance parked outside of one of their satellite headquarters, and just walked in. The crew was made up of a paramedic and an EMT-B. We talked about their service area and I was a little surprised to find that EMS in the definitely urban City of Scottsdale, AZ has a lot of similarities to what we do here in rural VT. They have multiple nursing homes in their area and are called to them frequently. One of them even made a comment about not having a highway in their service area (it is served by another service), and thus they got to go to relatively few 10-50s. Sounds familiar!


I tried to stay aware to what was happening around me as I spent several days touring the area. I did see several working scenes that I would have loved to be a part of. The opportunities for a career EMT are plentiful, and the weather....hot and sunny everyday. Hmm......


Saturday, May 26, 2007

Saturday at EAS

Made it through Friday night without a "Memorial-Day-based" EMS call, though I was not on duty last nite. I left the house to take the kids fishing at 20:15 last evening and clipped the pager to my belt. My wife asked if I was on call and all I could say was, "no, but I just have an uneasy feeling about this weekend." She said I couldn't respond with the kids in tow anyway, but hey, don't we all want to stay connected? I mean if The Big One were to come up, I suppose I could drop them off at a friend's house between the fishing spot and quarters, right??

Friday, May 25, 2007

22:45 Friday Night

My prediction for th weekend is trauma. Freakin-A, warm weather, end of the school year, maybe just a bit of "bored-EMT who knows what-the F is gonna happen this weekend" premonition. But for God's sake, hand the keys off, OK?

Today was a real opportunity for us to explore the retail opportunities, (as well as take care of a few personal financial obligations) in our service area, as well as being fully aware of the first best weather weekend, combined with the traditional party weekend of the year. Bottom line, Jeezum-Crow if the planets ever lined up better for bad-mojo, I cannot remember when. Good luck to all crews out there this weekend!!!!!

Memorial Day Weekend

Besides the obvious connection that EMS has to Memorial Day, the vastly increased number of PD cruisers on the roads today remind me that this is a big trauma weekend.

As a matter of fact, for some reason things are getting off to a hot start a little early, though they really haven't been trauma calls. I ran a possible broken hip call followed to a suicide attempt yesterday, and the other squads in the area have been running staight out as well. This AM shift is only a couple hours old and we've run 4 or 5 calls with AmCare already. As the weekend unfolds, who knows what else is in store.

Goes without saying, but lets be careful out there. Memorial Day means alcohol in increased quantities for those members of the public that wish to go there, and with that comes the potential for violence. Don't get caught between a drunk and the police that are there to secure the scene before you start to render aid.

As well, let's take a few extra seconds to stay aware on the highways if responding to an MVA. Keep an eye out for rubberneckers, and stay safe so you and your partner can do your jobs!

Tuesday, May 22, 2007

The Artist in the Ambulance

One of my favorite movies of all time is "Saving Private Ryan". Near the end of the movie, after Capt. Miller and his squad have finished the battle by the bridge, Miller (Tom Hanks) lies dieing and tells Ryan (Matt Damon) "Earn This." It appears that Ryan doesn't quite understand at first what is meant (neither did I at first as a viewer), but comes to realize that the sacrifice of others has allowed him to have a full and free life, and he ought to always strive to really earn the gift he's been given, to live a good and worthy life. As the scene in the war fast forwards to Ryan as an old man at the foot of Miller's grave in Normandy, he asks his wife (with tears in his eyes) if he's been a good man, because he had obviously tried hard to live up to Miller's dieing advice. What a powerful scene.

I came upon a song recently by a band called Thrice. I interpret the lyrics as carrying the same theme as above: The gift of life ought to be repaid by living out the rest of your life with respect and caring, to never forget the gift you've received.

Anyway, here's the lyrics, the song is great too. I'm sure its available for download at many of the music sites, I can't link to it without permission of course. I'm gonna try to get permission to link to it because I think the song is good enough to be the EMS theme song. Meanwhile here's a link where a sample of the song is available for listen, and the song can be downloaded for a fee: http://www.mp3.com/albums/593044/summary.html


"The Artist In The Ambulance"

Late night, brakes lock, hear the tires squeal
Red light, can't stop so I spin the wheel
My world goes black before I feel an angel lift me up
And I open bloodshot eyes into fluorescent white
They flip the siren, hit the lights, close the doors and I am gone

Now I lay here owing my life to a stranger
And I realize that empty words are not enough
I'm left here with the question of just
What have I to show except the promises I never kept?
I lie here shaking on this bed, under the weight of my regrets

I hope that I will never let you down
I know that this can be more than just flashing lights and sound

Look around and you'll see that at times it feels like no one really cares.
It gets me down but I'm still gonna try to do what's right, I know that there's
A difference between slight of hand, and giving everything you have
There's a line drawn in the sand, I'm working up the will to cross it and

I hope that I will never let you down
I know that this can be more than just flashing lights and sound

Rhetoric can't raise the dead
I'm sick of always talking when there's no change
Rhetoric can't raise the dead
I'm sick of empty words, let's lead and not follow

Late night, brakes lock, hear the tires squeal
Red light, can't stop so I spin the wheel
My world goes black before I feel an angel steal me from the
Greedy jaws of death and chance, and pull me in with steady hands
They've given me a second chance, the artist in the ambulance

I hope that I will never let you down
I know that this can be more than just flashing lights and sound

Can we pick you off the ground, more than flashing lights and sound

Friday, May 11, 2007

Urban EMS from a Rural Provider's Viewpoint: My upcoming trip to Phoenix, Arizona

A few years ago, before I was involved in EMS, my parents sold their home in northern Vermont and retired to Arizona. They live in the greater Phoenix area, and from all reports, they love it there. Considering they come from families that have generations of roots here in Vermont, it was quite a change for them. While leaving family and grandkids back here must have been incredibly difficult, they were able to admit that the long, cold, messy winters, inflated cost of living, and sameness of it all here was enough to spend their retirement years where the could actually live a little, not just struggle to get through another winter.

Anyway, I am here in Arizona on a brief visit. The weather is warm and sunny and just about what I would design if I could have a "build-your-own-ideal-weather" genie. I hope to do a little research while here into the EMS scene. I've seen a few ambulances running around, but haven't gotten a chance to talk to anybody yet. I hope to get out an talk to a few medics today about what EMS is like here where the population of the metro area is over 4 million people!

Thursday, May 10, 2007

Prom-Week Mock Crash Exercise

I mentioned in the last post that I had the opportunity to take part in a mock-crash exercise for the local high school. This was a fun project and from our perspective was another opportunity to work with others within the community. Involved besides AmCare EMS was St. Albans City PD, St. Albans City FD, and St. Albans Town Heavy Rescue. Many other individuals and organizations donated time and materials. Did we make a positive impact on our target audience? It's hard to know for sure, but the reaction seemed positive.

This was the first time I have participated in something like this. I have been involved in a couple very large scale MCI drills/trainings, but their focus was more on learning to work with multiple agencies at a large scale event. The mock-crash we did on Tuesday was not really training-based at all. The goal was to accurately simulate the look and feel of a bad car wreck involving kids, alcohol, and fatality. Knowing this going in I was unprepared to find out that it felt almost exactly like working a real call. A lot was going on and we had only choreographed this thing to a very general point. Kinda cool to see that with very little guidance, all these 1st Responders managed to work together to make it seem like the real thing.





We are up close and personal at bad wrecks as a part of our jobs. We have seen the consequences up close and personally, whereas the general public may only pass a scene on the road or read about it in the paper. I hope this event helped at least some of these young adults realize that their actions can and often do have a large impact on others.

Special thanks to Ronnie Robtoy for the photos. Ron also shot video of the event, and I hope to have time soon to create a short movie that interested readers of WayOutEMS can access from this site.

Tuesday, May 8, 2007

Back at Long Last

It has been way too long since I've written anything here. I guess the reason is that I've been pretty busy at work but have really had nothing worth writing about call-wise. Today is really no exception, though we were extremely busy. This is the first time I've had to sit down for more than a minute or two since my shift started at 08:00. I'm on a "24" today at AmCare, though I signed up for an extra shift tomorrow, and by the time I get off at 17:00 I will have worked a "33".

I am in another slump as far as "good" calls go, having run my ass off today, driving for all the e-calls and riding all the BLS transports. I suppose it's not that bad, though it gets frustrating when just about every crew and squad in the area ran some good ones today. Last time I griped about this I ended up running an extremely messy code. I guess I should have learned the "be careful what you ask for" lesson. Besides, just because I'm driving a call doesn't mean I am not taking part: The way my partners and I generally work, we share the assessment duties, each of us asking questions and trying to form a diagnosis, playing off of each other to better nail down a treatment plan that makes the best sense.

We did have some fun today, and perhaps made a difference. We took part in a "mock-crash" for prom week at the local high school. I'll follow up this post with more about this, along with some pics as soon as I can get a hold of them. I also have some stuff to write about an upcoming trip to Phoenix, Arizona.

Later!

Tuesday, May 1, 2007

Maple Fest 2007 - Part 2

The Maple Fest turned out good despite typical Maple Fest weekend weather: a steady drizzly rain and mid 50s. I have been on this "promote EMS" kick recently and was disappointed to find out that our staged ambulance was parked quite a ways from the main center of the event. My hope was that we could get a chance to talk to some people about what we do.

As it turned out on Sunday, the final day of the festival, we got to do some promotional things. There was a giant parade and we had an (off-duty)ambulance, preceded by a lot of AmCare's EMTs kids walking with an AmCare balloon-laden wagon, throwing candy to the crowd. My daughter April, who is six, had the time of her life, even though later she told me that the bad part of being in a parade is that you don't get candy!

While the crowd was waiting for the parade to start, we got an e-call and had to disrupt things temporarily to zing through town running code-3. The call turned out to be nothing (false medical alarm), but nobody there knew that, so it looked as though we were doing something other than just sitting there.

After the parade, we moved our duty ambulance much closer to the event's center, next to St. Albans City Fire Department's main truck (311). The two vehicles and crew parked together generated a lot of interest, especially from the kids. The fire truck was a big hit with parents, who took snapshots of their little-ones sitting up in the cab. Meanwhile, I gave several tours of the ambulance, and I was happy to explain to people that we are a mobile treatment center, not just a ride to the hospital. A lot of people didn't know that, and seemed pleasantly surprised to learn a little more about what we do. I also got to walk around with the crowd and talk to a lot of the local people. All in all, the 2007 Vt. Maple Festival was a good time and a success. I hope to be posting some pics here soon.

Friday, April 27, 2007

If You See Seven Moons, You'd Better Finish Your Broccoli Pizza and Get Out of Town!

A patient actually told my partner and I this very thing tonight. Funny, yeah actually hilarious, but sad too, as this person was in serious psychiatric trouble. I've seen a lot of drunks and a lot of fakers, but this person was 100% out there. I hope they can find someway to help this person. All we could do was try to keep this person from hurting them self, even going so far as discussing restraints with medical control (CYA baby!).

Really got me thinking (actually ironically I was thinking of this very thing earlier today and this call reinforces it). What training do we as EMTs get for patients with behavioral or psychiatric problems? I don't remember getting much if anything in my B class, a bit in one chapter of the book, and my Intermediate class touched on it, but not really. How about a training or a class or something that we can get a foothold on better managing these types of calls. I mean, if its not some fancy new ALS thing are we not interested? Holding a hand and listening is sometimes all we can do, and really the best care for the patient. I mean a lot of us are pretty good at this sort of thing naturally, I think it contributed to our initial interest in becoming EMTs in the first place. But I'd like to learn more. I know I do my share of calls that have a "behavioral issue" component.

Overworked and understaffed - Revisited

I received an e-mail recently from a close acquaintance describing a situation they experienced regarding nursing home care. The problem seems to lie in under staffing; perhaps its about making money for the facility, perhaps there's just not enough qualified help available. Either way, the result is not good. I have changed the names of locations (in italics) in the original e-mail to protect the anonymity of the author and the location of the facility.

I heartily agree with your assessment of the nursing homes. I work at a retirement home here in Somewhereville sometimes and had a job this winter with a 300 apartment facility in SomeUrbanplace, Somestate. About half were in the assisted living part, but attendance of qualified personnel was limited there and in the rest of the facility - nonexistent.At the end of my employment there, I agreed to fill in at the reception desk in the independent living section for two weekends - all night 12 hour shifts. To my surprise, I was it - the only employee on duty - solely responsible for hundreds of people - most infirm, with walkers or wheelchairs - on three floors, in two buildings with several entrances to the various sections. It was so huge that I constantly got lost in the labyrinth of floors and corridors.The nurse on duty in the assisted living section was not allowed to attend to any residents in the other sections, so it was up to me to decide what to do when residents called for help. While I did assist several, I never called 911, though I think I probably should have is some cases. The poor residences were terrified that they would be reassessed and be required to move if it was determined that they did not have the capacity to care for themselves. One night, a lower level hall filled with the smell of smoke that smelled like someone burned from food. The chef (who's job topped mine) hadn't left by then, and decided it was not necsesary to call the fire dept, but I worried about it for hours, until the smell disipated, and still think I should have called 911.I could go on and on about the deficiencies in that place.

This seems like an extreme case, but it is happening everywhere that I've seen.

Thursday, April 26, 2007

Maple Fest 2007 - Part 1

Well, it's that time of year again. St. Alban's biggest public to-do is the Vermont Maple Festival, celebrating Franklin County's and Vermont's strong maple syrup-making heritage. As far as EMS goes, it mean three days of available overtime, an ambulance ride in the parade, and at least one crew on stand-by at the site during the daytime events.

It all starts tomorrow. Last year was my first and it was pretty cool. I'm told that it was a completely uncharacteristic day, as the weather was sunny and mild. Traditionally it is cool and rainy for the entire three-day weekend. Forecast for the weekend this year: Showers with highs in the 50's all weekend. Let's hope we can squeak out a bit of sunshine here and there.

Of course our job is to be on site to assist with medical emergencies. It is also a great opportunity to familiarize the public with what we do, and I hope to take the initiative tomorrow if I end up there. I likely will. I am working on the primary crew on Sunday, so I know I'll be there that day.

More info on the Maple-Fest can be found at: http://www.vtmaplefestival.org/ Check it out, maybe I'll see you there!

Monday, April 23, 2007

Vermont Bill Addresses Assault on EMS Personnel

H.142, introduced by Reps. Masland of Thetford, Botzow of Pownel, McCullough of Williston, and Shand of Weathersfield, seeks to enhance the penalties for acts related to assaults on PD, PD, or EMS members. I include the bill as introduced below:
:
Subject: Crimes; assault on emergency medical personnel
Statement of purpose: This bill proposes to provide enhanced criminal penalties for assaulting emergency medical personnel.
AN ACT RELATING TO ASSAULTS ON EMERGENCY MEDICAL PERSONNEL
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1.
13 V.S.A. § 1028 is amended to read:
§ 1028. ASSAULT OF LAW ENFORCEMENT OFFICER, FIREFIGHTER,
OR EMERGENCY MEDICAL PERSONNEL member
A person convicted of a simple or aggravated assault against a law enforcement officer or, firefighter, or member of emergency services personnel as defined in subdivision 2651(6) of Title 24 while the officer or, firefighter, or emergency medical personnel member is performing a lawful duty, in addition to any other penalties imposed under sections 1023 and 1024 of this title, shall:
(1) For the first offense, be imprisoned not more than one year;
(2) For the second offense and subsequent offenses, be imprisoned not more than ten years.


How do I feel about this? Obviously I am against getting assaulted, but I'm not sure that increasing the penalty will make much of a difference. It can't hurt. I think that those that are going to fight police and or firefighters are likely to take a swing at me or my colleagues even as we attempt to render aid. I will be writing my legislatures in support of this, anyone else feel like writing theirs?

Friday, April 20, 2007

Overworked and understaffed

Recent calls to local nursing homes have brought to light an issue that concerns me, and should be of concern to anyone with even the basic level of compassion for those in need. It is not uncommon for our crew to arrive at a facility and not be met at the main nurses station with information as to where the patient is located. Additionally, once we are pointed in the right direction, it is not uncommon to have the patient attended by (if attended at all) by an inexperienced LNA that has no knowledge whatsoever of the patient's baseline condition, emergent condition, or past medical history. It is at times like pulling teeth to get a clear picture of what is going on. We are given a copy of the patient's face sheet and a list of meds and ongoing medical issues, usually 3-4 pages long. By the time we have done our rapid assessment and loaded the patient, we barely have time to review the patient's [written] history before we are out at the ED.

The problem, as I see it, is that many of the nursing facilities have a tough time attracting and keeping good staff, and are constantly understaffed. Especially at night. It is a special person who not only commits to working with the elderly (and often times demented), but does so at a pay scale far below what they are worth. I'm not talking about RN's, cause I imagine they get paid a decent salary. They do have to have the commitment though, as they could pretty much have their choice as to where they want to work. LNAs and LPNs have it rough though. I imagine that the rewards of the job are similar to what they are in EMS: Just knowing that we've made a difference in some one's life is a pretty valuable fringe benefit.

So how do we as EMS providers work through the situation at these nursing homes? I've found that it is invaluable to get to know the providers there, and let them know (without sounding critical or condescending) how they can be most helpful to the EMTs (and ultimately the patients) when we arrive for an E-call. In addition, one of the things I found as a resource for the upcoming EMS Week is a pdf file that deals with how to better work together with nursing homes to increase the quality of the care we as EMS providers are able to give the patient's when we are called to the facility. I'll try to follow up with this in a future post.

Thursday, April 19, 2007

A Visit With Angels - Revisited

In my Tuesday, April 3rd post to this blog, I quoted from a private ad placed in our local paper by a grateful patient who was the recipient of a successful cardiac resuscitation in the ambulance. The newspaper followed up recently with a full article, and I include the link below.

www.samessenger.com/index.php?option=com_content&task=view&id=861&Itemid=75

Pretty cool.

Wednesday, April 18, 2007

Short transport distances/times

I was reading a thread on an EMS forum the other day that had to do with the amount of time spent with the patient on calls. A forum member said something to the effect that we are aware that one of the challenges of rural EMS is that transport times are often comparatively long, but wondered about the challenge of the very short transport time in an urban EMS system. Even though I consider just about everything about Vermont to be rural, I feel I have the two extremes with the two services I run with. In Enosburgh, we often have 30 minutes in the back of the truck with the patient. That's plenty of time to run through every assessment and intervention available and/or appropriate. Obviously the flip side of the coin is that definitive care is also 30 minutes away. In St. Albans, the opposite is often true, with drive-time to NMC frequently in the under-five minute range.

I ran with AmCare in St. Albans for nearly a year before starting to do some shifts at Enosburgh, and I think I understand the meaning of the phrase "trial by fire". Depending on the priority of the patient's illness or injury, we often have to move from a very focused assessment to a treatment plan, and right into treatment within minutes. With very few standing orders, communicating with OLMC can also tie up a minute or two. Don't misunderstand: We learn to do it efficiently, but never at the cost of good patient care.

I find it easier on Enosburgh calls to do IVs, simply because I learned to get them done in a minute or two. I sometimes think that the hardest part about an in-ambulance IV isn't finding the vein, but making sure everything is ready beforehand (flush, lock, catheter, tape, etc.) because there is not an extra set of hands back there to hand you stuff.

Monday, April 16, 2007

Podcasts

Nope, they are not something a doctor puts on you after you've broken your pod.

I'm suddenly coming aware of much of what is available through the web and with technology in general. Maybe this dates me, but when I was a teenager if someone had told me that in the future we would have these little devices that hold like 3000 minutes of music, cost less than 100 bucks, are small enough to hide in your closed hand, and can be filled up with music by hooking them up to a computer, I would have thought someone has been reading too many science-fiction novels. Top it off by being able to cruise around the web and find an unlimited supply of information in audio format, free for the taking, and that anyone with a computer and modem could essentially broadcast to the entire planet....phew, man o man, here we are in the future.

I have found an excellent site called MedicCast, where informational podcasts are available. These are mp3 files that I can listen to on my little mp3 player. They contain lots of great tips and information about EMS related topics. MedicCast's host is Jamie Davis, a medic in Maryland, and his website also contains a lot of other great information. There are other EMS podcasts available as well, two noteworthy ones are at Jems and 1st Responder News.

I think these are an excellent way to spread information, and seem to be one way of making our rural world a little closer-knit. What do you want to tell the world?

Sunday, April 15, 2007

Advancement of Pre-hospital Medicine

I posted a note of frustration on the EMT City Rural EMS forum yesterday about my frustration with local EMS, particularly having to do with scope of practice issues that I have addressed here many times. I received a message from one of the founders of an organization that is trying to wake up the people of this country to the fact the EMS is in trouble. EMS providers are paid significantly less on average than firefighters, prompting one columnist I read recently to say that that proves that as a society we value material possessions over human life. I'm not sure I'd go that far, and I certainly don't want to discount the incredibly difficult and challenging job of firefighting. It is true, however, that EMS in general comes in last amongst the three entities of the public safety triad (PD, FD, EMS) when it comes to funding, organization, recognition, and public awareness.

EMS is the youngest of the three, having only become more than a way to get people to the hospital for care in the past 30-40 years. It is clear that the public's impression of what EMS is and does is flawed. We as providers need to help change this. What can we do?

One thing that is being done is the creation of CAPEM or the Council for the Advancement of Pre-hospital Medicine. This organization is trying to get out the message. Check out their website.

Saturday, April 14, 2007

What have you done today to make you feel proud?

Proud
by Heather Small

I look into the window of my mind
Reflections of the fears I know I've left behind
I step out of the ordinary
I can feel my soul ascending
I am on my way
Can't stop me now
And you can do the same
What have you done today to make you feel proud?
It's never too late to try
What have you done today to make you feel proud?
You could be so many people
If you make that break for freedom
What have you done today to make you feel proud?
Still so many answers I don't know
Realise that to question is how we grow
So I step out of the ordinary
I can feel my soul ascending
I am on my way
Can't stop me now
And you can do the same
What have you done today to make you feel proud?
It's never too late to try
What have you done today to make you feel proud?
You could be so many people
If you make that break for freedom
What have you done today to make you feel proud?
We need a change
Do it todayI can feel my spirit rising
We need a change
So do it today
'Cause I can see a clear horizon
What have you done today to make you feel proud?
So what have you done today to make you feel proud?
'Cause you could be so many people
If you make that break for freedom
So what have you done today to make you feel proud?
What have you done today to make you feel proud?
What have you done today?
You could be so many people
Just make that break for freedom
So what have you done today to make you feel proud?

EMS Chaplain?

There is an EMT in our service area who is also the pastor at a local Baptist Church. He is an EMT-B (soon to be an Intermediate!) with a first response squad that goes to our calls. He's one of the very active members of that squad, and has responded to some pretty rough calls. I remember one call in particular. In a blinding snow-squall, we were 10+ minutes out with the ambulance when the call came in for a person unresponsive, not breathing. Code 99. When we got there, here's our 1st responder on his knees in the patient's bathroom performing CPR. He'd been at it (stopping only to run the AED) for about 10 minutes. I've run my share of codes, but it had to be tough doing it by himself with the family freaking out 10 steps away.

Anyway, he's also on the local fire department and is the official department Chaplain. He stops by our crew room often just to chat. There are always good natured "I don't think I saw you at Church on Sunday" jabs, and we all enjoy his friendship. In EMS it seems that we all have some demons that need excising, especially after a bad call. CISDs (Critical Incident Stress Debriefings) are good, but it really helps to have a friend that has a strong spiritual read on things. And its not just stressful calls I personally like to discuss with him. He's a great ear (with some solid advice) for those everyday things that make me feel I need some divine help. Thanks Charlie, you are needed and appreciated.

Seatbelt Law Revisited

Just a brief update. I received am e-mail from one of my legislators, Avis Gervais, regarding the seatbelt primary enforcement law. She said that it looks like the bill will be sent to the Governor, and that he has stated that while he doesn't support it, he would likely not veto it. So she thinks it will be made into law. That's great news!

The video that I referred to in the last post got booted by YouTube for an infraction of their TOS. You're not allowed to post clips of graphic violence or injury, which is certainly what the clip showed (but it showed pretty realistically what is likely to happen in a high-speed rollover if the occupant is unbelted). Funny, I got the original clip from YouTube...I just didn't put a disclaimer at the beginning like the other one had. Perhaps I'll edit it later and try to re post it.

Thursday, April 12, 2007

Primary Seat-Belt Enforcement Law

I just found out that Vermont's legislature is working on a bill that would allow police to ticket people who are not buckled up. The difference between this law and what we have now is that now they can only ticket if they stop the vehicle for another reason. This new bill would allow officers to ticket for non-use if they see someone not wearing their seat belt.

So I did something I have never done. I wrote to my legislators and even the Governor about this.

OK, I know. Civil Liberties, Live Free or Die (wait, that's New Hampshire, not Vermont.) How many more am I gonna have to scrape off the pavement? No way of knowing. I think this law will increase seat belt use at least a little bit. And every little bit helps.

Check out the video I made to support the bill. Its in the sidebar to the right somewhere on this page. It might take a little while to be visible as I just uploaded it. BTW, it's VERY graphic, so be forewarned before you watch it.

Front Page News?

The local paper, the St. Albans Messenger ran a small piece on the front page today about the helicopter transport we assisted with on Tuesday. It was a good story, just a brief description of the call (and a pretty cheesy (my opinion!!) self-serving quote from NMC's Community Relations Specialist). The fact that it made the front page highlights the rarity of an air ambulance making an appearance in our district.

The story was accompanied by a very nice picture (my partner and I and our ambulance can be clearly seen in the background). I couldn't help showing the paper around to my family this afternoon. But jeez, do any of us do this for the praise and acknowledgement? I don't. But it makes me feel proud to see myself on the front page of the paper. Is that wrong? Just tellin' it like it is. :)

Tuesday, April 10, 2007

Transfer to Dhart

We had a cool call today. Working in conjunction with a helicopter ambulance is an everyday event for many EMTs, especially in the urban setting or deep rural such as in the western states. Here in our district, it's as rare an event as can be. We don't have a service anywhere near by, and for whatever reason, it just doesn't happen here. It's not uncommon for choppers to fly in and out of Fletcher Allen, but at NMC, never.

A local squad brought in a patient with CO poisoning and the ED doc determined that he needed a hyperbaric chamber for treatment. The nearest available was at Mass General, a good 5 hours away by ground ambulance, and less than 90 minutes by air. We were called to transfer the patient from the ED to the Landing Zone.

The patient was intubated and attended by a nurse and an RT. My partner Jodi and I assisted the transfer in the ED, with Jodi assisting with ventilations during the transfer of the ventilator. One we got going, I rode in the back, assisting ventilations and monitoring the ECG. We arrived about 5 minutes before Dhart (The Dartmouth Hitchcock Hospital Air Rescue Team). Once on the ground, care was transferred to their flight nurse and paramedic. The FD assisted us in transferring the patient to the chopper stretcher. It was pretty cool. It was also neat to see once again the cross-service cooperation.



Saturday, April 7, 2007

Jumpin' from a "B" to an "I" to a "P"??

Funny how there are times when I just get so complacent with things as they are. It usually happens when I do a stretch without any "good" calls. I'll just kinda roll with things, and not really care to change much.

Then there are times when I just get so fired up about this EMS stuff. I want to do more! This usually comes off in my mind as "I WANNA INCREASE MY CERT LEVEL!"

I was chatting with Alex the other day about this and he made a good point. We started as EMT-B's and it wasn't long before we jumped into an "I" class to earn our EMT-Intermediate certification. It doesn't take too many calls spiking bags and doing vitals while someone else gets IV access and is talking to the Doc on the radio about meds before you start to think that being an I-tech would be cool. So Alex's point was that the jump from a B to an I was not that big. The class wasn't easy- a lot of study and a lot of time doing practicals. But running full time with other I's really helped, and 5 months later, boom, we're I-techs.

So the next logical step is to take the next level of training, which is Paramedic. But whoa there Nelly. First of all, if you've been following along with this journal, you know that there are no paramedics in our district. There's no medics in the next district near here, District 3 which encompasses Burlington and our only Level 1 Trauma Center, Fletcher Allen. So, you take a 1200 hour class, spend months at hospitals getting your clinicals in, spend 8 or 9 grand$$, work your ass off without letting the ball drop even once, lest you get too far behind to catch up, and then if you pass the exams, you can be a medic.

So, the big question is...Become a medic and then what?? I have this vision of a year of no sleep and complete focus on this training only to come to work and continue to do routine BLS transports.

The answer of course is once you taste paramedic level runs, (which you would because the training would likely take place in conjunction with an urban hospital/EMS system), it would be damn near impossible to stay where you can't legally use your cert level. Even if medic level were to come to the district, the amount of time you actually used it would be pretty slim, and now you're nationally certified as an EMT-Paramedic and you look in the back of JEMS and see that there are lots of big EMS businesses aching for medics. Paying real decent wages, paying relocation bonuses, offering very liberal standing orders and a great working relationship with the hospitals, located where it's sunny and warm, where there are LOTS of E-calls.....

Not sure where this ramble leads to, it just sort of spilled out. I'd love to hear some comments from anyone out there. Have a safe night everyone.

Tuesday, April 3, 2007

A Visit with Angels

Recently a couple of my colleagues were responsible for saving a man's life. While many of us can claim having saved lives, we rarely get the recognition we deserve. Now it's not about the recognition of course. But when you make a difference in some one's life and you do get recognized, it makes it that much sweeter.

Fellow AmCare EMTs Heather and Jen were recently recognized for their efforts. During a transport to FAHC with a patient having an active MI, the patient coded and was revived. Afterwards, the patient actually paid for a 1/6th page spot in the local paper to thank them and local nurse Pam Scott (also an EMT with Enosburgh) for their efforts. I quote directly from the spot entitled "A Visit With Angels":

This is my story about a visit with angels. On March 8th, 2007 while shopping ..in St. Albans, VT, I suffered a heart attack and the emergency response team was called. As I remember it, they were at my side in just a few minutes. I believe I was lucky to be conscious long enough to observe these ladies in action.

Knowing how to do this work is not all it takes. Their determination and heroic action saved my life. My wife was in the ambulance with me as we sped to Burlington and she recounted most of the ride to me a few days afterward....

The main focus of this story is to praise the three angels, Jennifer Mucha, Heather Wright (EMT's) and Nurse Pamela Scott and the emergency medical team at Fletcher Allen for their effort. This kind of experience has to take a toll on them both mentally and physically. They should be treated with the highest regard. There is no way that I know of to put a monetary value on the saving of the life of someone you don't even know. I will be indebted to them for as long as I live.

May God bless you all that you inherit the reward you deserve.

Larry Hetrick Sr.


Nice job girls, and thank you Mr. Hetrick for taking the time to publicly acknowledge these dedicated professionals. We all too often see the worst side of humanity...the pain and suffering, the despair and sorrow. Your story in the newspaper makes doing our job even more rewarding.

Saturday, March 31, 2007

48 Straight at EAS??

I'm into hour 9 of a 48 at EAS. Not sure how I got sheduled for 48, but it is what it is. I think my director didn't notice that I was on for 24 on Saturday, the last day of the month, and scheduled me for a 24 on Sunday, which happens to be the first of the month. So far no calls. I've spent my time here re-stocking and organizing my ALS jump bag and searching the web for rural EMS resources (of which there are plenty...the links section on this blog has a couple at the top.) My partner for the day shift lives just a quarter mile or so away from the station, so he responds from home. My night partner, Sarah, is due in at 1800. Sarah, by the way, is Miss Vermont for 2006-2007. Kinda interesting to be running with someone who was in the Miss America Pageant. Check out what she's been up to at: http://www.missvermont.org/

I have said that I run for 2 squads: AmCare in St. Albans and Enosburgh Ambulance. I also am a 1st responder for Berkshire 1st Response, the squad in my town. We are linked to Enosburgh Ambulance, the squad that responds with a crew and truck for calls in Berkshire. I've only been on a couple of calls with Berkshire. I'm either working at the other places or have my pager turned off otherwise. Berkshire doesn't get that many calls anyway, less than 50 a year I suspect.

Wednesday, March 28, 2007

City Fire Dept. Responding with AmCare EMS

Now that Joe B. is Interim Chief at SACFD, he's having the FD crews respond with AmCare to certain calls, and we can call on them for other calls that aren't automatic "sends". Chest pain, unresponsive, seizures, and Code 99 are the automatics. Its been great to have the extra manpower on scene for the times we've needed them so far. Kudos to the SACFD. I only hope that when budget time or whatever comes that the powers that be see the value in it.

We are planning on setting up a series of workshops between AmCare and SACFD to review the use of some of the basic equipment. Most of the FD staff is familiar with just about everything, but we use it everyday and they don't. Better to have everyone on the same page when we really need to.

Just for the hell of it, I'm pasting in a favorite picture of mine: Fireman Joe (or should I say "Chief" Joe) and I at the Maple Fest last year.
That's all for now...later!

ALS Intercept

A cool call yesterday. As I've mentioned in here before, we run in a pretty rural district. Most of the more outlying squads run with volunteers and it is sometimes a challenge to get a crew together for a call. People are at work or whatever. And then there may not be an ALS provider available. Simple fact is that there are a lot more EMT'B's and First Responders than there are I-Techs.

We (AmCare) were called to intercept a Franklin Rescue ambulance for a call for a patient with a severe asthma attack. Difficulty breathing is one chief complaint that calls for ALS care if available. Franklin's call was in the farthest reaches of that town, nearly to Enosburgh, about 20 miles from AmCare. Enosburgh's crew was out on a call and their unit 2 is out of service, so while their service is much closer, they couldn't take the call. We were the closest, so with Alex driving (The A-Team!), we went code-3 about 20 miles to meet their truck. It was my call, so when we did meet up with the other ambulance, I jumped in (with our monitor/AED and our jump bag). A quick review from the two B's in the back got us up to speed as the Franklin ambulance high-tailed it code-3 to NMC. The patient had a very tachy rhythm and though apparently well oxygenated, would have these periods of stridor like breathing and slip into seizure. I felt the heart rate contraindicated additional bronchodialators (the pt. had 3 neb treatments at home), so we mostly monitored her airway, got IV access and kept the BVM ready in case she arrested. We made it in and last I knew she was doing well.

The cool thing about the call to me was that even though I usually work with the same people all the time, jumping into a strange ambulance with 2 EMTs I'd never met, and picking up the case in the middle, we all worked together as a team, and it worked out well. I think that says a lot for the way that EMS is standardized, everyone learns it the same way, and thus, like interchangeable parts in a machine, we are able to work together in a pinch. That analogy is of course an oversimplification, but I think it works here. Come to think of it, when we find ourselves in an MCI, alot of squads are going to have to work together, so all the better that it went smoothly on this single-patient call.

After the call it was kinda neat to feel a new camaraderie with some other EMS people from our district.

Got some more stuff to talk about, I'll be back later.

Thursday, March 22, 2007

March Training

We had our monthly training for AmCare last night. The topic was Shock, Fluids, and Electrolytes. Good topics to brush up on, especially as they contain significant elements of both BLS and ALS care. I can never hear enough of the message that my colleague and Sat. nite partner Clem is often reminding us of: All the ALS stuff in the world is worthless if you forget the basics. Makes sense and seems so obvious, but I don't ever want to realize too late that I forgot to keep my shocky patient warm while I was worrying about IV access. Gotta thank Curt (AmCare's Training Officer) for bringing that up in training last night. I feel grateful that we have so many good teachers to learn from.

Our ICO (Infection Control Officer) gave a talk on BSI and some new policies being implemented to try to minimize our risk of an exposure. She is establishing alot of new procedures, but thankfully everyone seems to be on board with them. Change doesn't always come easy, especially if you were originally trained a certain way and have been doing it the same way for a long time. I think everyone is realizing though that without a very formal and regimented system for handling issues as they relate to staying safe on the job, that it would be all too easy to get lax. I want to be always as well prepared as possible.

Tuesday, March 20, 2007

Busy, Crazy, WayOut 24 at AmCare

I had been on an extended slump lately. My best estimate is that I ran for the past six weeks with a 9:1 ratio of transports to emergencies. On the few E-calls I did end up on during this period, I was either driving (as the rotation goes) or the calls were minor. (Now there's a whole discussion to be had when it comes to EMTs wanting a "major" call. I suppose from someone on the outside it would appear as though we are wishing ill health, bad luck, and/or pain on others. Nothing could be further from the truth. The fact is, people are going to get sick and hurt, at least let me have my fair share of the opportunities to help them.) Anyway, I suppose the old adage "be careful what you wish for...you just might get it", could apply to today.

I am going to spare everyone the details because they were none too pleasant. However, the call did involve all three public safety branches (Police, Fire, EMS) working together. St. Albans City PD officers were there because the call came in as an unresponsive person and they respond with EMS to those calls by protocol (I suppose because these calls have at least the potential to involve foul-play), St. Albans City FD was there as a part of the new Interim Fire Chief's policy of sending a crew to major EMS calls. The call came in to us from Central Dispatch as a 911 emergency.

If you've read some of this blog, you'll recall that I am eager (as are many in this district) to increase our level of care; to learn more and to be able to put more skills and tools to work when needed. But even with a bigger toolkit at our disposal, this call likely would have gone exactly the same way. We used alot of the basics: airway adjuncts, suctioning, patient positioning to ensure a patent airway, scene safety concerns, infection control concerns, communicating and working effectively cross-agency, evaluating the scene for clues to the events leading up to the call, and safely extricating and lifting the patient. The ALS tools involved IV- access, blood-glucose monitoring, and administration of meds and fluids(naloxone and Ringers Lactate) via IV. Advanced airway management was considered (in the form of a Combitube), but the patient's jaws were clenched. Having a good professional rapport with Online Medical Control, and the manpower available to leave one EMT free to handle to communications and to assist in coordinating crew assignments really helped.

Two of my fellow EMTs with 15+years experience both said that in many ways it was the worst they had ever seen. (I'm dying to toss out the details here, but even if I wasn't bound by HIPPA and the possible loss of my cert if I break confidentiality, I do this job to render aid and I would not be assisting this person in any way if I were to make details public).

Let me end this brief entry by stating that: 1) I did need to change my uniform afterwards 2) It took us nearly 3 hours to decon, re-inventory, and restock our ambulance, and most of all 3) I am extremely proud to be associated with the EMTs, Firefighters, Police Officers, and hospital staff (MDs, RNs, RTs, and Techs) who worked this most difficult of calls.

Friday, March 16, 2007

Non-Paramedic increased Scope??

What if (as my today's-partner Gabe so aptly put) we have an increase in scope of practice that doesn't go as far as medics? What about allowing pain mgmt., intubation, a handful of drugs like anti siezure meds, a few cardiac meds, manual de-fib, and pacing? What if?? How about Lasix for CHF patients?

Medical Director and expanded scope of practice

As I wrote yesterday, our medical director gave a lecture on trauma at the EMT class at EAS last night. It was a good talk; he expanded on a lot of topics and I found it very informative.

The subject of expanding our scope of practice, even going to a paramedic level (gasp!) was discussed ( brought up by me and a couple of other ALS EMTs in attendence). His take on things is that we really don't need to go there at this point, but he sounds like he would be very willing to entertain ideas if he can be convinced of their value to the patients. Paraphrasing, his words were: "Paramedics? Convince me." So, I guess that's a bit clearer, at least in my mind, where he stands.

I'm not sure if I'm 100% on board with the idea of going medic anyway. I mean as it stands, the training is lengthy, expensive, and intensive. A degree in nursing can be earned with less time and expense. And the financial payback is considerably better, at least in the present health-care climate.

I am going to do a bit of research on pre-hospital pain management and bring it to his attention though. Convince him? I'll try, at least a little at a time.

Thursday, March 15, 2007

Stuff

Back again. I'm at Enosburgh tonight for the overnite shift. No big deal, it's usually easy.

They hold an EMT-B class here at quarters on Thursday nights and tonight they are having a guest speaker. Dr. John Minadeo is our district's medical director and he will be here to speak on pre-hospital trauma care. I'm pretty psyched to hear him. I have set up my video camera hoping to get the lecture on tape, and then convert it to a DVD that I can share with my co-workers.

The other night at AmCare (my last entry) turned out to be a no-sleeper. Alex and I first got called out at midnight and ended up getting not more than an hour of sleep. None of the calls were anything worth writing about in the Journal of Emergency Medicine or anything. We did have an interesting call at about 0600. A 17 y/o girl crashed her car, and while she wasn't injured in the wreck, the police noticed that she wasn't acting right. We were called to the PD station to take a look at her. She was pretty loopy and refused to go to the hospital. I wasn't sure if she had taken enough of what she had taken to get worse if we didn't get her to the ED. She seemed like a sweet girl, and from what I saw and heard, and from what the PD said, seems like she has an iffy home situtation. It's sad. Maybe she'll end up getting help from this incident. It finally came down to the PD telling her that she was either going with us in a nice warm ambulance or with them in handcuffs. She went with us.

Tuesday, March 13, 2007

24 at AmCare

Doing the A-Team shift today. A-Team is what my favorite partner and I call ourselves every other Tuesday. Sounds a bit self-important I know, but it's all meant in good fun. The fact is that our styles and abilities match pretty well, so much so that we rarely communicate verbally while on a call, we just "do". I suppose that's a good thing, to be in tune with each other enough to get the job done efficiently and effecitvely, so as best to serve the patient's needs.

Very slow so far today. We've run one e-call. A hemorraging patient from a nursing home. We have an EMT-B running with us today, being precepted, "field-training", for her EMT-I. She's a good EMT and will make a great EMT-I when she gets there later this year.

It's all A-Team for the overnight, after 1700. Maybe I'll catch up later.

Monday, March 12, 2007

Gripes and More Gripes

One of my gripes about working in this district is that we are not allowed much of a scope of practice. There are NO paramedics in this district, despite there being at least 10 EMTs who are eager and willing to undergo the training. I mean c’mon, transport times for some patients approach 45 mins., if there’s no extrication or bad roads. Even short transport patients could benefit from advanced care at times. No intubation, no intra-osseous access, no needle decompressions, no cardiac or anti-seizure drugs, and perhaps the biggest travesty…no pain management options beyond the BLS level. I had a guy a little while back that was pinned by a boulder at a construction site and fractured his pelvis and his femur. There was a 45-minute extrication followed by a 20-minute transport. This big, rugged guy cried for 30 minutes. Tell me that it is good patient care to let this go on. And before anyone says: What about helicopter transport?, the nearest service is DHART out of Dartmouth Hitchcock in New Hampshire, a minimum of one hour response time, if the weather allows flying in the first place.

I don't know what the problem is. My guess is that the district's medical director is not on board with making this level of advanced care available, for whatever reason. Assistance from the hospital is unlikely, they seem to be stuck in the stone age at times. And the ego problem looms large too: "We can't let lowly EMTs or Medics do what our nurses can do."

Why is Vermont often at the forefront of advancement for this state and its people (Civil Unions, Dr. Dynasaur, Act 250, etc.) and lags so far behind the rest of the Northeast and most of the country when it comes to an EMS system??

Respiratory, man o man

I finally made it in here to AmCare. Still trying to deal with a broken truck. To make things worse, my wife’s van is broken too so we are relying on a (very expensive) rental car to serve the both of us. Luckily and thankfully, a co-worker asked his wife to drive me to work, no small favor considering the nearly 50 miles round trip.
So EAS was a breeze. We did just a single call, an elderly woman with difficulty breathing. I think that at least 75% of my calls in the past month have been for this. Either there’s a respiratory bug going around or its just that time of year.

Sunday, March 11, 2007

A New Host

Sitting here completing a 12-hour shift at EAS after an overnight at AmCare. No big deal except I didn't get much sleep last night. My own fault I guess: I stayed up too late reading and then we got called out at 01:45. The change to Daylight Savings Time cost me an hour, then we got called out again at 05:00, and I never got back to sleep. The slow, usually easy pace here at EAS helps though. I did take a nap :).

Anyway, the purpose of this post is to talk about the move to Blogger. I had my stuff on thediary.com, but nobody really goes there and I figured that this Google-based blog might actually get somebody to tune in occassionally. Anyway, I am going to figure out how to move the content from the other place to here, even if I have to cut and paste.

Later.

Dan

Cell Phone Samaritans



Since just about everyone carries a cell phone these days, it's not uncommon to get sent to a "car off the road, no further information available." People driving by see something and call it in. I guess that's really a good thing, cause there could be someone in real trouble and unable to summon help. Unfortunately, what often happens is several people make the call, and (especially if it's snowing hard) there are different descriptions of what they see. This results in the dispatch center thinking there is more than one incident and dispatching multiple ambulances and fire trucks to what in reality is a single event. I don't know if there's a solution to this.

Just awhile ago, we were sent to a car off the road about 5 miles from quarters. The location was a dirt road, and with the weather in the past few days, the dirt roads are a mess. We got a little more than halfway there when a first responder on the scene called in to advise that it was just someone who had gotten stuck in a ditch...no real MVA and no injuries. That's good, but it is frustrating to have the ambulance and heavy rescue and fire responding to nothing. That's the nature of EMS though. You have to treat every call as if it is a serious situation.

So, back in quarters just achillin.


Posted: 18h56, March 3, 2007

Saturday 24 at EAS



Haven't written in awhile. Haven't had any really decent calls in a while either. I should know better than to put that out there as I usually end up with a bad call after I complain about getting no decent E-calls.

Speaking of a bad call... I got a phone call from a woman while I was working at EAS the other night. She called to let the service know that she wasn't blowing us off as far as her bill goes, its just that she has been unable to get things together enough to make a payment. I was confused as I don't do the billing end of things, and insurance covers this anyway. I let her know that she needn't worry, that we aren't gonna make a big deal out of things, as long as she makes an effort, etc. Besides, it takes a while for Medicaid to pay etc.

After I got off the phone with her, I suddenly realized why her name was familiar. My worst call ever came last fall when we were dispatched to a MVA. Arriving on scene I found a patient laying in the road amidst the debris and the remains of a small sedan. Fire and heavy got there just ahead of us, PD was there and the officer on the scene said there was a DOA in the car. I approached the patient in the road, finding out it was a 15 y/o boy. He'd been ejected and had severe injuries to his head and upper body. Bottom line is we had a 25 min. transport time, with the kid coding on us when we were still about 10 mins out. I only had free hands enough to do one large bore IV and maintain the airway and do CPR. There were just 2 of us in the back, (my partner being certified at the BLS level) while a firefirghter drove. The patient had a brain injury that precluded his ultimate recovery, but we managed to get a heartbeat back in the ED (we meaning the doctors, RTs, nurses, and me as I continued the CPR). He was rushed into surgury, but died later in the day. He was an organ donor and there are people living longer and better lives today because of him. My partner and I recieved an accomodation from the hospital and the medical director for our efforts, which was I guess helped ease the hangover from the call. I still see that kid's face just about every day though.




Posted: 11h27, March 3, 2007

Transports and More Transports

We do alot of transports at AmCare, it's a big part of why our call volume is comparitively high, and frankly probably why I have the luxury of getting paid to do what I love to do. Transports help support the company. We have several nursing facilities in our area, and patients are always needing to either get to one of them or get to the hospital from one of them. Also, just about every major illness or injury eventually goes to FAHC in Burlington, and we usually take them.

It's late so I have little time to write tonight. Just let it suffice to say that my partner Jen and I did our share of transports today.

I also talked to Jen about some of my ideas for bringing some positive, progressive changes to our district. I believe that for starters what we really need is someone with passion, drive, and an ability to bring the issue(s) onto the public's radar. She was very supportive.

More on that later, gotta go!


Posted: 01h10, February 24, 2007