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:

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 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


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, 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.



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 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

Back To it Tomorrow (Maybe)

After a couple of days off, I am back at it tomorrow, that is if I can get to work. The power steering pump seized up on my truck today, and Sherry's van is in the shop as well. Man oh man.

Kinda hard to write about EMS when I haven't done it for a couple days. I could have worked tonight's shift at Enosburgh (EAS). The director, Robert, called me today to see if I could. EAS runs just 1 ambulance during nights and weekends, and one and a half during weekdays. Well, its not really one and a half, I mean you can't have half an ambulance, now can you? They have 3 EMTs on duty during weekdays and on the odd chance that there are 2 calls at the same time during the day, they only need to find one other member to fill the spot for the call. Call volumes are comparitively low at EAS, so it's rarely a problem. There are about 20 members and someone usually hears the tone for an additional member to respond to quarters if we get a "Unit 2" call. Anyway, because of the vehicle problems my wife and I are having, I had to pass on the extra shift.

In hindsight it's a good thing. I usually end up signing up for extra or open shifts without thinking about how it will impact my family and I if the shift is a busy one. It's a no-brainer sometimes to grab a day's pay simply for being available if needed, but if you end up running a couple of middle-of-the-night calls, your ass is draggin the next day. EAS calls are generally much more time consuming than AmCare calls, simply because AmCare is based about 2 miles from the hospital and EAS is about 20 miles out. A call at EAS usually lasts about 2 hours. Then if the next day is busy too, you can get pretty out of whack in a hurry.

OK, gonna wrap this up for today.

Posted: 22h20, February 22, 2007

Home Again

Back home after my 24 at AmCare. It was a relatively quiet night, though I stayed up too late last night writing in my blog and we ended up getting called out at 0400. It was an easy-to-manage SOB (Shortness Of Breath) call with a 2-minute transport time. I am once again reminded that oxygen is a good thing. Another easy call at 0730 (CC: weakness, the all encompassing protocol) ended up the shift. I now have 48 hrs off, if you don't count monthy training tonight at 1600.

Posted: 11h00, February 21, 2007

Another Tuesday 24

Just read online of a line-of-duty death of a Pennsylvania EMT. He was responding to quarters at 3AM for a call to assist a pregnant woman. They talk of the brotherhood amongst firefighters or police officers, but I feel a strong connection to other EMTs and medics out there. Let's all pray that our brother's family, fellow EMTs, and the community find some peace in the days to come.

A shitty way to start a blog I suppose. Maybe its cause I'm trying to do this as a stream of consciousness thing, lest I never get around to writing it. I currently have a dismally slow and unreliable freaking dial-up connection at home, therefore I don't foresee spending any time online while at home updating this thing. Luckily the two squads I run with both allow free access to the web (gotta wait in line when its quiet to use it though ), so hopefully I can update when I'm on duty.

Shifts vary here at AmCare (, but generally start at 0800 and run till 1700 or from 1800 to 0800 the next day. 24s are always 0800-0800. Been slow today (sorry, I guess I just jinxed myself): My partner Kari and I ran 2 calls during the day shift that both ended up being cancelled, and just completed the return leg of a sick nursing home patient "sent to the ED and back to the nursing home with a prescription" pair of runs. Kari's sleeping now, or at least trying to, trying to get into REM before I start snoring.

I'm hoping to make this a diary of sorts with EMS as the main topic, but also a way to flesh out ideas, feelings, gripes, and praises for the way the State of Vermont in general and our district (District 1) runs things. I'll likely toss in a pinch of bitch about the local hospital, though I suppose they deserve a pinch of praise regularly as well.

A little background is in order I suppose, assuming that at some point someone other than myself will read at least some of this. You should know at least a little bit about who you're dealing with here. I am a relative newcomer to EMS. Though I'd been interested for years, I took no courses or training (not even basic first aid) until I started my EMT-B class in the spring of 2005. I began ride-alongs with Enosburg Ambulance (the 2nd service I run with) a couple months prior to my B class starting up, but never witnessesed anything but a few routine calls. Heck, I didn't even know if I could handle the stress and demands of the work. But the second I stepped into the back of the ambulance on my first ride-along, I could feel an intense sense of belonging. Maybe other EMTs feel the same way, but it was almost as if (to steal a line from the Blues Brothers movie) I was "on a mission from God."

My B class was an intensive course that took place over seven weeks starting in June of 05. We did (if I remember correctly) Monday and Wednesday nites for 3-4 hours and every other weekend, Sat. and Sun. from 0800 to 1600. I was blessed with a fantastic teacher, Pat Malone of the University of Vermont. His dynamic and challenging teaching style really forced us to think, not just learn techniques. His best lesson was (and is to this day something I incorporate into nearly every call) that a good EMT "gets it done." Having a can-do attitude (not cockiness) on calls has resulted in some really great patient care (and that's what it's all about folks.)

Once I realized that EMS could be a career and not just a very part time neighbor-helping-neighbor deal, I decided that I would make it my career. I was a consulting forester for nearly 10 years prior to becoming an EMT, and had found myself in a career and job that I couldn't freaking stand anymore. Going from that to something I absolutely love is just amazing. I was offered a full-time position with AmCare the very day I received word that I had passed the National Registry B exam. My boss (Walter Krul, also the owner and director of Amcare) told me during the interview that he really hoped to have as close to an all-ALS staff as possible, and wanted me to persue my Intermediate training when I felt ready. I think I ran with Amcare for a full 3 days before finding an I class and signing up. I earned my I in December of '05, just 7 months after I got my CPR card (which was my first instruction in 1st aid.)

Having written that I suppose the argument could be made that I jumped in too soon. However I've always been a quick study, and have been blessed with a great group of EMTs here who teach through example on nearly every call.

Amcare is located in St. Albans, VT, which is the largest city in our county (Franklin), and in our district. We cover 911 calls for St. Albans City and the towns of St. Albans, Georgia, and Fairfield, and also provide transport service throughout northern New England (though I'd say 90% of our transports are from our local hospital (Northwestern Medical Center, hereto referred to as NMC, web site at ) to FAHC (Fletcher Allen Health Center, Vermont's largest hospital, , in Burlington, nearly 30 miles south of St. Albans.) For anyone not familiar with Vermont, it will likely come as a surprize to learn that the total population (2000 census data) of Franklin County is just over 45,000. Our service area is rural by just about any standards, but decidedly urban when compared to the rest of the district.

VT EMS District 1 is made up of 15 towns and one city which are served by 13 EMS services: Eight ambulance squads and five 1st Responder squads. While AmCare's territory is located essentially adjacent to NMC and thus our total time spent per E-call is relatively short, it is not uncommon, due to the rural nature of this area, for some squads to have transport times upwards of 45 minutes, and that's if the roads are not snowy, icy, or otherwise messed up.

OK, its now past 0034 and while I have tomorrow off, I suppose I should try to grab some sleep in the likely event that we run some calls tonight.

Posted: 00h32, February 21, 2007