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: 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.
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1.
13 V.S.A. § 1028 is amended to read:
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.

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


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?

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 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.