Hi, my name is Grace and I have a problem.

Two problems, actually.  The first being my name isn't Grace. The second is if you were one of the people that saw me fall and bust my ass in the ambulance on Saturday you would know that balance isn't my strong point.  At least I saved the Lifepak! It did NOT go rolling out in to the street! This is the second week in a row I have managed to fall while on a call, I figure if I fall this upcoming weekend then I have a good chance of breaking something. Third time is the charm and all. 

Let's not spend all day talking about my lack of ability to ever be on So You Think You Can Dance  let's move on to why I had an AWESOME weekend.  Our weekend wasn't overly busy call wise but two of the calls we had, including the one where I performed my twinkle toes moment, were great calls.  I'm still figuring out where I stand with this whole Enhanced certification as I either always work with Basics or Paramedics. I'm not ashamed to say that the Protocols book and I have been spending more time together lately to make sure what I think I need to do is right but so far I've been right on track.  Our first of the two awesome calls was a possible heart attack.  Cardiac is not something I can do. I can give Aspirin and Nitro off the ambulance instead of only if it's the patients like a Basic can, but I can't run an ECG or a 12 lead. (Well I CAN, I know where to put the leads and what buttons to hit but no one would be impressed with my "flat line bad, squiggly line at least somewhat good" interpretation skills) We had a medic continue in from another town about 12 miles away while my crew and I dealt with removing the patient from the bar and getting them in to the ambulance.  I initiated a beautiful IV, beautiful because it was successful and I didn't get blood everywhere, and we hurried on over to meet the medic. At this point they were only 2 miles away so before I could say "Aspirin" the medic was hopping on and I gave my report, the medic was happy with what we had done up to that point so life was good.

That call was just after midnight so by the time we got back to the station it was around 1:30 am and we quickly hopped in bed.  2 hours later we get the next call. Back on the road we go not looking quite as bright eyed and bushy tailed as we had on the first call.  This one is a pediatric call, possibly croup, and no one else but us responding even though it wasn't our call. (Dual Dispatch) We arrived and found our patient easily by the sound of wheezing that greeted us at the door.  Prompt treatment and prompt transport got us on our way to the ER and no more wheezing unless you used a stethoscope.  That is until we made the turn in to the hospital, I swear as soon as we started up that road the wheezing started again.  Have you ever had that happen? No changes until you hit the one mile radius of the hospital then BAM, back to square one.  We moved the patient inside quickly where they gave another treatment right away.  I stopped by to say goodbye before we left and the patient was much improved. Very cute kid, listened to everything we asked and in general followed directions better than most adult patients I have.

After the calls my partner and I went back to bed, well not together we had separate beds.  Nothing like trying to go to sleep when the sun is coming up! Later on my partner said it was amazing how even though we had two serious calls neither one of us were stressed.  I sat there for a moment then realized he was right, I didn't have to worry about what my crew members were doing or where they were wandering around to, I didn't have to worry that my "experienced emt" that runs a shift with me each week was freaking out like normal, I didn't have to explain myself 3 times, all I had to say was "I need..." and it happened. I need vitals, I need the patient out of here, I need an IV set up, I need the drug bag, let's go ahead and get on the road. All of it was done, no fuss, no running in circles, just done. At any given time right now I am precepting three basics trying to be released and a junior in EMT class. I enjoy teaching and helping them learn, I'm always available to answer their questions and will pick up an extra call or two so they can get experience, but sometimes it's nice to just run a call and not have to make it a teaching moment.  Not have to have them count off to make sure I have every one. There are times when I have at least 5 people on scene from my station and they all want to be in the ambulance at once. Then I feel like we're playing duck, duck, goose to decide who goes where and there are times when one of them tries to override my decisions.  While the patient care is never affected sometimes it makes me a bit frazzled.

Now let's hope I don't break anything this upcoming weekend!

Pocket Guide #10: Signs You Need A Break

1. Someone asks you a question, on election day, about the state elections and you start spouting off by laws about your department's elections.
2. You go to pull up a web site for work and instead pull up your PPCR web site out of habit. Then you start reviewing new charts.
   
3. You ask your significant other to rate things on a scale of 1-10, including how hungry they are.
   
4. When you shaking hands you are always on the look out for an easy vein to hit.
5. You go to hit the air horn pedal in your personal vehicle when someone cuts you off.
6. You sign everything with your name and rank, whether it's a credit card slip or a thank you card. 
7. In the middle of the night you sit up and say "Ambulance xxx responding!" much to your significant other's confusion. 
   

PS these are all things that have happened to me within the past few weeks.  Vacation? Is that you I hear calling?

Trauma has NOTHING on me

You think you're so big and bad, Trauma? Just because you have helicopters and cool patients who get hurt in totally awesome ways doesn't mean anything! I just transported a patient with constipation! So stick THAT in your juice box and suck it! Wait. What's that? You mean no one wants to watch an hour long show about a constipated person? Oh. Well that's okay, I heard Trauma was cancelled anyway.

Want some real drama? Picture this: it's 00:45 and you're laying in a nice, warm bed, about to fall asleep.  The tones drop for an illness near your residence, in fact it's 3 doors down. (Not the band) The internal struggle begins! Well, I could get up and see if they need help. But they have a staffed crew. But they know I live here. And they know my minitor is always on. So I guess I should get up. But it's cold outside and I think it's raining. I just got comfortable. I guess I should go, though, since it doesn't look good for me not to. They know I'm not sick or have any other good excuse. *sigh*  I decided to go and was proud of myself for remembering my keys, wallet, minitor and crackberry. It only took me 5 minutes of talking to the patient and the paramedic from another station that came to assist to realize that even if I did want to start an IV, I didn't have my glasses on or my contacts in.

I've run 3 calls this weekend after being released and haven't started an IV on one of them. There wasn't a need for an IV on any patient but I'm still kind of excitedly waiting for my first call where I start an IV and don't have to be supervised.  At least we started to get calls, after my Friday crew where I jumped at every tone drop I was starting to think I'd be a Nervous Nelly all weekend.

200th Post!

And for this post I am going to give you random facts about me because what's more interesting to talk about than me?

• I got in to this business because my older brother became an EMT and always had the coolest stories. Anything he did I wanted to do so as soon as I turned 16 I took EMT as a class in high school.


• I decided to take my Enhanced (aka Shock Trauma aka equivalent to IV Tech in some states I believe) because I watched medics start IVs and give medications for 7 years and always thought "I bet I could do that..." I'd like to bridge to Intermediate/Paramedic but this was a good place to start with my schedule.
  


• I'm allergic to medical tape. I can't touch it without gloves and if I leave it on I get horrible welts. This does not stop my rookies from trying to stick medical tape on me to "see me light up like a Christmas tree." I hate my rookies.


• I actually love my rookies and most of the guys and gals I volunteer with. Some I am closer to than others, but they're all my family. Even the ones I fight with have been there for me in a time of need and vice verse.
  


• People can puke on me, I can see decomposition in various stages, other bodily functions are okay, not my favorite but okay, but let there be a spider within 50 feet of me and I'm climbing up the nearest person.
  


• My all time hero has been with my station for 25 years. We threw him a surprise party earlier this year and he loved it. I'm kind of sad it's over and would love to throw another one just to try and show him how appreciated he is. No amount of parties can really show him that, though.


• I'm officially released now as an Enhanced. 13 months from the beginning of class until the release date. Phew. This means I can randomly start IVs and give medications without having to wait for a medic to arrive to oversee me. This also means I will be reading my protocols every second of my shift.
  

Pocket Guide #9: Dealing With Your Members

1. Not everyone responds the same way to the same training. Some people require constant praise, some people want tough love. Some people are just as smart as a rock and there isn't a thing you can do about it.
2. If you are going to be in charge it's a good idea to perfect "the look." This look should communicate a few things; stop what you are doing, start behaving, start thinking like an intelligent person and if you don't I am going to rip your spinal column out through your left nostril. Got it? My crew is so afraid of this look that sometimes they will do things and purposely avoid looking at me, though they do admit that they normally feel the glare.
3. Communication is so very important. With all of the technology available to us today there is absolutely no excuse for not communicating important information with your members. Taking a specialty piece out of service for a week and not telling anyone is a bad idea. Buying a new kind of toilet paper is good but doesn't require an email to everyone.
4. Happy Members are members that run calls. As a leader you should be doing what you can to make sure members are happy, not going out of your way to cause hate and discontent.
   
5. During downtime members are either hungry or bored. Snack and soda machines do wonders and you can normally buy favors with baked goods. Our Wii, pool table and basketball hoop keep people entertained and at the station. They've also caused us to consider putting in a swear jar so we can buy another ambulance with all the cussing at the Wii we have.
6. The men's rooms are normally the dirtier than the ambulance after a trauma call. Seriously, how do they achieve this? Is there a handbook on how to do this?
   
7. Kids these days...They probably said the same thing about you when you were younger. Remember they need guidance, a strong leader and sometimes a strong backhand. Just kidding. Sort of.
8. The classic rule of "if it felt good to say it, you probably shouldn't have" is in effect here.

And PS, I opened up a copy of Jems Magazine yesterday and found that I basically quoted them on the obesity post. My apologies I hadn't had the chance to read it yet and imagine my surprise when I see a blurb about it!

Where do we draw the line?

After reading this blog on slate.com about ambulance services charging more for obese patients I had to ask; where do we draw the line? America is getting larger and in response to this some ambulance companies are purchasing bariatric stretchers, lifts, and other specialized equipment. These items are expensive and I understand the need to pass the expense on to the "consumer" but then I wonder, what about the frequent flyer patients, or non emergency 911 calls?

If we charge extra because a patient weighs 500+ pounds can we charge extra for the patient that calls 911 for mild symptoms that don't even begin to require an emergency room visit, let alone an ambulance transport? What about the patient that calls every other day for things they can control and choose not to (ie a non complianet diabetic), sure they're getting charged every time they get transported but can we add on a Special Service charge of "been here too many damn times this week?" These patients may not require a special stretcher but they tax our system in other ways, for example; we lose the availability of that ambulance during the transport and calls like these often contribute to burnout in our personnel.

Just some food for thought on a quiet, Sunday afternoon.

Parlez vous Francais?

Remember high school? I do. I took my EMT class in high school. I also took French class in high school all those years ago. Well, 8 years ago actually. I do remember my EMT skills because obviously it's something I use quite often. I do not, however, remember enough French to get me by. I especially do not remember enough French to communicate with people that speak only French. I either told them "My name is.... and I only speak a little bit of French" or "I have a porcupine in my nose." Normally I can translate some simple things but my brain instantly froze and I couldn't think of anything French to save my butt.

What didn't help my situation was my little "oops" on the radio. Instead of announcing that my unit had arrived on scene, x number of vehicles involved, I announce that we're involved. I set down the radio, looked at my partner and said "OH $(#( did I just say we were involved?" My worst fears were confirmed when dispatch comes back and says "ummm...just to be sure, you were NOT involved but you are on scene correct?"

Oh yes, I can't even tell you all of the text messages, facebook notices and everything else I've received since the "Involved" heard 'round the world.