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!!