The Handover - "Respect" - March 2010 Edition

The Handover "Respect Edition" hosted over at Life Under the Lights

This may have been where I started reading EMS blogs and I love it when it comes out every month. Its a great snapshot of providers from across many a different EMS system.

Go! Read! Enjoy!

Snow Hills

I swear, this is the second to last Winter 09/10 post!

After most of the fire department had been trapped at a fire house for going on two days without relief, I decided to pull an extra shift to help out since I could still get from point A to point B unlike many people.

Just as I walk in from the bay, the tones go off. Well, that was lucky!

I dash out to the ambulance, catching the Captain and the officer I am replacing in the bay and doing a quick personnel transfer. The directions are easy and our driver seems to be doing well despite the poor plowing conditions.

We approach the location, a school, and are greeted by someone who is trying to wave us up a heavily snowed in driveway. No way the ambulance is getting up that. We stay on the street by move closer down to the entrance to the patient.

Its dusk as the friend leads us past the school to the back field and down a very steep hill. I am eternally grateful that instinct my told me to grab the Reeve’s stretcher when we found out this was outside. We start a quick assessment and discover that the man got his foot stuck under the inter-tube he was sliding down on, leaving him with significant pain in his ankle. I can’t see much since he has rain boots on, but its very painful to movement.

Our driver has to tell the surrounding sledder to NOT sled down by us, seeing as if one wears reflective clothing, one will have people draw to the reflective tape.

A quick transfer later, me, the driver, and my partner are trying to get this man up the sledding hill. The driver is a good sized fire fighter. My partner is barely larger than me and I am pretty small when it comes to hauling people up snow hills. Halfway up we finally get the attention of some bystanders who are willing to help, thus filling the handles from three people to six. Much better. The girlfriend is ahead carrying the tablet that is making an amazingly good flashlight.

Once in the ambulance, my partner gets vitals as I cut open the boot and socks to find his foot completely flopped over to the side and a grapefruit sized swelling an inch or two above the ankle joint. Yes, that would be broken. Feet simply do not flop to the side like that with the knee strait up and facing the ceiling.

I wished I had been able to give the man painkillers in the ambulance, but I am just a Basic. We did try to avoid as many bumps as humanly possible on the way to the hospital, but it was rather difficult with the poorly plowed roads.

Not the way one wants to end the day on a snow hill.

Drunk or sick, do you really have to?

Case One:

Its late in the evening, even past midnight maybe, and my pager goes off. “Campus safety requesting EMS transport to the hospital from stair well in Any Dorm.” While this might be interesting, it probably means that I have again acquired a drunk. Its policy that if campus safety encounters a drunk student who vomits, its automatically an EMS transport so that the patient’s airway will be protected, even if it would be shorter to transport by campus safety.

After clambering to the top of the staircase, we find one very drunk kid, a distressed friend, a few campus safety officers, and a pool of vomit. I quickly start an assessment as I send a fellow crew member down for the stair chair. Looks like the guy nearly got to his room on the fourth floor before alcohol won, no trauma and he wasn’t passed out yet so I at least had an airway.

With a bit of struggling with the rather limp patient, we get him into the stair chair, where he promptly vomits again. Judging by the volume of vomit everywhere, that probably was the last of his stomach. We got lucky though, he missed the chair. Four flights later, we have him transferred to the stretcher and he begins to perk up just enough to half answer our questions and start swearing us out. All the short way to the hospital.

Case Two:

Evening again, (seeing the theme of night shifts yet?), and we get a call at the Local Apartment Complex for a sick person. Okay, cool, not unheard of in our district as we all hop in the ambulance. I read through the dispatch report. Patient age: 27. Oooookay, that one is a bit odd. Not in College Town anymore and my demographic is predominately much older.

We get to the apartment door, knock, and give the customary “Fire Department, did someone call 911?” to be greeted in under five seconds with the door opening, young man walking out and nearly sitting on the cot without us taking off the bag.

“S*** man! I’ve been throwing up and I need to go to the hospital NOW!”

My quick scan of the patient lets me know he is not faking it, pale, sweaty, and generally looks sick. I promptly get the guy strapped into the stretcher and we get back towards the ambulance with history questions bouncing around as we go. My guess is food poisoning or stomach virus with how suddenly it sounds like it hit.

In the back of the ambulance, I let our newest recruit take the vitals as he needs the practice and while this patient is sick, he isn’t urgent yet. The recruit tries once, not rolling up the sweat shirt sleeve the patient is wearing. Our patient is doing his best not to vomit and failing, half screaming as he does vomit. The recruit misses and tries again, sleeve up, as I call in the patient to the hospital. He misses again.

“F***! I just want to go to the hospital!”

My older partner turns to him promptly and in a surprisingly calm manner responds. “Hey man, we are working as fast as we can. I am sorry we can’t give you anything but we are going to get you to the hospital.”

~~~~~~~~~~~~~~~~

I have always wondered why when someone is sick, the need to swear comes up. Drunk I can almost excuse because the patient may not be in full control of themselves, but the sick? You called us, we are trying to help you.

In both cases, swearing continued to the E.R., which promptly ended up with a swift reprimand from the nurses, which works. Now, this may be in part because I am female and don’t get overly demanding of my patients, but then again, our food poisoning patient didn’t even listen to my older, male partner. Patient seem to respond better to the nurses in the E.R. than to those of us in the ambulance. The lack of respect for those working on an ambulance is rather sad, as we are the ones coming to take care of you. I may not be a medic, a nurse, or a doctor, but I am the one getting you to the care you need. A thank you would be nice once in a while but in the mean time, I’ll take solace in the fact that I know I did the best that I can for you.

Lab Zen

There are two basic kinds of lab work, wait, no, make that four, and some are more desirable more than others.

There is the tedious work, such as analyzing samples. If I am running flow cytometry, all I do is take my prepared samples, hook them up to the machine, and hit start. I get maybe two to five minutes of run time before enough is collected and then I repeat with the next tube. I can’t do anything but stare at a computer screen and wait. Even the down time between samples is not enough to do anything significant. It get, well, boring.

There is the work that takes just enough brain power that I have to pay attention to what I am doing but the work itself is repetitive and stressful. When I have to hold a mouse with one hand in a scruff while treating or measuring a tumor. The mouse squirms and I really have to focus on not letting that mouse move to get everything just right. Or I am pipetting samples into a 96-well plate where each well has something different in it and I cannot cross contaminate anything or I will lose the whole experiment. This work is taxing and stressful; it doesn’t tease the curious brain cells, but does require focus whether or not it is interesting.

Then there is the work that requires massive amounts of brain power. I have to set up an experiment, calculate cells and titrate dyes while making sure nothing gets cross contaminated. Or I am trying to understand results that are just not making sense and all the possible why’s are running through my brain.

Finally, there is the work that is repetitive but not stressful. I get into a rhythm as just enough of my brain stays around to make sure I do not cross contaminate anything but otherwise it gets to wonder. There is usually a phase of random thoughts, which leads into a battle with my inner demons, which can be fairly stressful and self-destructive, but once that passes my brain finally relaxes and is blissfully peaceful. No stray thoughts, no what ifs, no doubt, just simple peace.

That is my favorite kind of work, the work that leads to lab zen.

From the Other Side of the Stretcher

I was visiting my sister, I had come up with my mother and we three were all going back to her house. It was late, dark, and the streets were virtually empty. We weren’t going fast, there was no hurry, just everyone getting home since we all had to be up early the next day.

I remember our lights suddenly reflecting off of a very solid car in front of us. The glow was rather eerie as I remember not even having enough time to say anything as they pulled out and kept pulling out in front of us from their stop sign like we weren’t there. It was a T intersection and we had the right of way. It still is mind boggling to me that they just kept pulling out as if we weren’t there.

The crash, the noise, the smell, the silence. I know I closed my eyes before we hit but after that all I remember was that my sternum hurt. It really, really hurt. Now, I can handle a lot of pain, but the sudden shock of this pain compounded with the fact that it now really hurt to breath scared me. I couldn’t take a deep breath.

The acrid smell of air bag is something I will never forget as my mother tried to get me out of the car, thinking it was on fire. I refused to move. I hurt and I didn’t know why, all of which screamed to me to hold still.

I really had been holding a plate of cupcakes and to this day I don’t know if the plate landed perfectly on the folded up seat next to me or if I had put it there in the first moments after the crash, I really don’t remember.

The police officer checked my pupils, making sure I was conscious, talking, and without the immediate signs of a head injury. Fire was next on the scene, apparently they had just gotten off of a call on the campus and were very close. The irony was that I had just watched that company hang lights on their fire house earlier that night from my hotel. They were really nice, though I do think the guy who took C-spine really did kneel in a cupcake. We found them all over the car the next day.

The medic was very nice, quickly assessing I was probably not as injured as dispatch had told him, though I don’t know what it was dispatched as, just that I had told my mother to tell dispatch that I had midline sternal pain. The EMT and the fire fighters got a good practice at a KED and backboard extrication thought while I learned that lowering the backs of seats can be very handy if they will move.

I felt so bad that I was shaking uncontrollably not because I was cold, perhaps something closer to the simple shock of being in an accident. The 12-lead must have looked horrendous, though somehow he was able to tell it was normal sinus. We really did have a good talk in the back and it helped in getting my nerves and adrenaline down enough to feel slightly more coherent. I wish I had gotten his name before he had handed me off so I could send him a thank you.

The hospital must have been having a slow night with the relatively short amount of time it took to get me off the board, out of the KED, and out of the collar. Surprisingly the thing that hurt the most was the KED against the back of my head.

Numerous questions, an X-ray, and a CAT scan later, it was determined that I had in fact not cracked my sternum like the X-ray was alluding to and I did not have a pneumo in the top left part of my chest. Though both would have been possible seeing as my lack of other seatbelt bruises indicate I took the full force of that crash across my sternum and only across my sternum. Also, I do remember holding my breath right before we hit, which is a paper bag lung in the making.

I count my lucky blessing that I was not hurt worse, that my family was fine, particularly my sister on her birthday, and that the other driver was surprisingly unscathed. My mother’s car may have been totaled, but no one was seriously injured.

Saratoga Springs Fire and EMS services, thank you for all that you did that night. It may not have required extrication and cutting up cars, but you made me feel well cared for and in good hands during a very rattling experience.

Cupcakes

Its 2300, maybe closer to 0000 on a dark but clear night in early December. Call goes out for a motor vehicle accident with one injured. Its back in NY so ambulance and engine are separate but everyone is going lights and sirens to the scene.

Its behind the college, two cars involved, a CRV T-boned a sedan. It doesn’t look bad, though the radiator has sprung on the CRV. The engine and PD are already on scene with one guy in the back of the CRV holding C-spine on our patient. Its a bit odd that its the passenger in the back of the CRV, not the driver of the sedan who got hit, that is our patient. Everyone else is out of the cars, looking a little dazed and the mother rather worried about her daughter now held in C-spine. The police officer and fire department are checking on the driver of the T-boned car and mother who had been driving the CRV who hit the sedan.

“I think I am kneeling on a cupcake,” comes the voice of the fireman in the back as the medic starts talking to the patient. And indeed, there is an empty plate sitting perfectly on the raised and folded seat that is the other side of the CRV. The smell of deployed airbag is strong as I can hear a bit of conversation from the passenger, saying how they didn’t know how the plate got there, just that they had been holding it before the crash, and yes they had a seat belt on. It seems that it was hard for them to breath because their chest hurt so much but they otherwise looked stable. No blood, no broken bones, no distressed breathing.

We get a collar and a KED on her before getting her on a backboard. There is back pain in addition to the chest pain, though its not midline or spinal, probably just muscle injury from whiplash or the likes. Its cold out but the patient is quickly moved to the ambulance so that the medic can finish his assessment. We quickly get a 12-lead on because of the chest pain and he listens to her heart. He doesn’t hear anything unusual though the 12-lead is virtually unreadable because she is shaking so much. Mom is in the front as we head to the hospital.

The medic strikes a friendly conversation up with the patient as we go, quickly establishing that the patient is okay mentally, rather shaken up and still has pain in their chest. They are sorry because in the end they are probably just freaking out over the chest pain but they are an EMT too and had just taken ITLS and of course the first thing through their brain after the accident was injuring their heart.

The patient is an EMT.

The patient is me.

In the Cloudy Future

You will have to pardon the lack of posts thanks to the lovely rainstorm that romped across the East Coast, knocking out phone and internet at my house. I will spare the detailed gripes about how if someone doesn't have a cell phone how on earth are they supposed to call for help since you are not fixing this till Thursday of next week at best. Thus the only internet I have is the firehouse or occasionally at work.

Anyways, my life is currently consumed by applications. After another fruitless round of medical school applications (though a very productive month in lab), I am doing applications again. Not just for medical school, though that will be happening come May, but for master's programs of various sorts. I have to have something to do in the fall, and as much as I would love to go to paramedic school, it may make getting into medical school harder (unless I can get a nice master's packed into it too), not to mention most of the schools around me require anatomy, which I have oddly not taken yet.

I honestly don't know what I would like a master's in other than molecular biology and immunology are currently on the top of the list. Not having GRE's is becoming frustration, as many programs require this, though the ones that accept MCATs are becoming my saving grace.

I have also come to the unfortunate but probably for my own good decision that I need to take the MCATs again. Not because my score is bad, but because I know it can be better and so that if I end up in a two year master's program I will still have a valid/active MCAT score for medical schools.

This is not where I wanted to be in my life but it is were I am, so much better at anything practical than book work, but determined to not give up yet.