It's 5am do you know where your ambulance drivers are?

Ambulance driver. This simple term sets me on fire. I do more than drive an ambulance folks.

To enlighten a few of our readers that do not know what EMS really does please observe the following:

First Aid: You can learn it anywhere, some classes are better than others.

First Aid/CPR: Now your doing something useful, but still, some classes are better than others.

First Responder: This is the entry level of professional rescue, about 2 months of school.

Basic EMT: Step 2 in professional rescue. Some drugs and medications about 6 months of school.

Advanced EMT: (some states call them specialists) Step 3 in a 4 step process. More meds, more proceedures. 6 months school to get your basic then 4-5 more months to get your advanced.

Paramedic: The last step in most pre-hospital care. Advanced Cardiac Care, even more meds and proceedures. At LEAST 12 months of school with many classes being 18 months.

From first responder to paramedic we all drive the freaking ambulance from time to time, but dont call us ambulance drivers.

Z

Emails

I'm still here guys, thanks for all the emails... Give me a few days, I'll be back at the writing...

Real Life Bites You In The Ass

**ALL NAMES AND PLACES CHANGED TO PROTECT PRIVACY**

A week ago Saturday I'm at home with my children, the girl is at work. It's about 1pm and I'm settling down for some television while the children are taking their afternoon nap.

My buddy Rick walks into my house and says he needs me to come over to his house with him, someone has locked themselves in his garage and he hears music blaring. Immediately I tell him to call 911 and we'll sort the issue out from there. He calls 911 and they inform him that there are no local police officers on duty he would need to wait 15 minutes or so for the sheriff to arrive. Rick heads home and sends his son over to watch my kids so I can leave. I arrive at Rick's house just as the first Deputy does. The garage windows are all blocked off, you cant see in it anywhere.

The deputy says he is waiting on another deputy before he enters; being a tactical medic I understand fully, but Rick is very upset. He wants to get to the bottom of this, and generally feels a little freaked out. I guess I don't blame him, if it were my garage I would be a bit freaked out too.

While we are waiting for the other deputy to arrive I try to brace Rick for the two possibilities I foresee. I know he and his ex-girlfriend have been on the outs for the better part of 2 years. I know that there is some concern over his visitation of their child, and I know he sought the advice of a lawyer to try and rectify the problem.

Knowing his Ex only two things were possible in my mind; either she was waiting in the garage to kill him or she has killed herself. I relay this information the the deputy, but Rick clearly doesn't want to hear any of this and walks away kind of in a daze.

The other deputy arrives and they discuss how they are going to enter the garage. Eventually they break out the glass in the man door and open it. With guns drawn they yell "SHERIFF'S DEPARTMENT!!" Then one deputy stumbles backwards and yells: "Get EMS!"

From behind the truck where I was standing I reply: "I am EMS". The deputy yells: "She's in the car!" I ask: "Is the scene safe?" The deputy replies "Yes, hurry, she's in the car"

Rick starts for the garage and I quickly yell at him to go across the street and I'll talk to him in a second. He caught a glance of her in the car... I wish he hadn't.

As I rush to the garage I notice the car still running with a garden hose from the exhaust pipe to the drivers window, one of the deputys breaks out the passenger side window and unlocks the door, he leans over and cuts the ignition. As he jumps out of the way I'm yelling for him to open the garage door or we are all gonna be in trouble. I jump in the car and grab her, prepared to pull her out onto the garage floor and work her. As I touched her arm I knew. She had been gone for several hours. Lividity has set in and she was very ridged. No pulse, no respirations.

I exit the garage just as the local squad is pulling up. They go to the patient with a monitor and confirmed what I told them on arrival.

Now, I have been on several calls like this. I would like to believe that I knew what to expect. The truth of the matter though... It's all very different when you know the people involved. It's very hard to maintain a professional distance when the people grieving are your friends.

The first question on everyone's mind was "Where was the little girl?" The deputys checked every inch of the vehicle and were confident in saying that she was not in the car. Rick called the family, informed them of the situation and found out his daughter was with them.

As the sheriff's department was processing the scene they had a lot of questions for everyone. It felt like we were there 100 hours. Rick was still across the street and he had been joined by a friend of ours and eventually my girl-friend showed up there too. They were all doing what they could do to try and keep him calm during the investigation.

The scene was elaborately set up. She had went to great lengths to make sure no one would be able to enter that garage. The windows were blocked, the garage doors were unplugged and she had secured the dead-bolt, which Rick never had a key to.

There was much more, but to tell you the truth I really don't want to have to relive it. I might add more to this post later, but right now it's all still very vivid.

Some times when you think you have seen it all, the EMS gods look down and say: "What about this Mr. Confident?... Deal with this"

Z

Overtime

Sorry I haven't been real current with the writing lately. We are slammed with OT at work. We have several people on vacation and as it stands we were already down 2 medics and a basic. So basically we are down 5 people. That means one HELL OF A LOT OF OT for the rest of us.

Now, don't get me wrong. In emergency services, most of us like to hover around the 70 hour mark, but 90-100 hours a week is a bit draining.

I put a pool up for the kidos today. Me and a couple buddies spent the better part of 4 hours leveling the ground where it sits. Put the pool up to find out it leans. Crap. Time to drain 2000 gallons of water out and re-level. Poor children might be able to swim by the middle of August.

Playing very little paintball lately, I either cant find the time to play or I can't find the players. So much for shooting your buddy.

Been screwing around with Sony Vegas and Micro(shaft) Movie Maker. I'm toying with the idea of making a realistic video clip about EMS.. Only problem is I have to find enough footage that doesn't infringe on any copyright. If anyone out there has a stock of pics or vids that they wouldn't mind seeing in a video lemme know.

Been teaching a bit lately. Just got done doing a 2 day WMD class for the IAFF. It went ok, could have been better. I just don't understand people sometimes, you give them FREE training and they want to bitch. I got several complaints that the class was too long, then I got several complaints that there was too much information for a class so short. Geees.

Oh well, back to the back yard. I got a pool to wrestle with and kids that at least appreciate me.

Z

A Modern Day Hero is Gone.

He was never afraid to call it like it was. He was never afraid to get right in your face. He was never afraid to take it to "the man".

You will be missed AcidMan

Z

Private EMS

Got our ass beat today. Back to back all day.

I start up blogger to bitch, complain and scream about my job in private EMS. However, when I got here and started writing this it occurs to me that I could be in a factory punching out car parts for more money. I could be screaming "Would you like frys with that?" and proabably be making more money... BUT.. what i couldnt do is: Write a blog, read a book, watch television, play video games, eat a sandwich, take a nap, sit in a lawn chair, web surf, or take a lengthly crap. All the while being paid to do it.

My job aint that bad. Sometimes you get the bull, but sometimes you get the horns.

Z

Realisticly Speaking

If you look at EMS realisticly it's pretty simple. The whole process of Emergency Medicine is simple: You see a problem and you correct it. I like to relate it back to the old BASIC programming days of the TRS-80 and the Commodore C=64.

IF THEN

IF the patient cant breath THEN we check the airway.

Almost every single problem in any given circumstance can be over come with simple logic, remember it is not the EMT's job to "cure" the patient. It's the EMT's job to get them to the doctor alive and as stable as we can. Long term care is left up to the doctors and nurses. It simply is not our problem. The reason I bring this up is because I'm tired of the following:

You arrive to a patients house, they cant breath. The have a history of COPD. A breathing treatment later and some high flow O2 and your on your way to the hospital. Yes I know all about the respitory drive of COPDers, I don't care. It's not my job to worry about the long term care of these patients. At the hospital you are met by a nurse that receives your report and then snatches the non-rebreather off your patient lightning fast. I don't have a problem with them doing this, but I do have a problem with them assuming they know my job and glaring at me as if I have done something wrong.

Sir/ma'am It is your job function to give this patient continuous care, and get them to a point that they can return back to their residence, it was my job to get them to you alive. If their respirtory drive would have magicaly dropped out in the 15 minutes I had the patient, I would have tubed them. I would be doing my job maintaining this patients life and once again you would have to provide for their continuing care.

I WILL NOT deny my patient the O2 they need to sustain their life, because of a "maybe". If I don't give this patient O2 they will die. If I give the patient O2 nd it knocks out their respirtory drive the I will tube them and breath for them, but they wont die.

All I ask is respect the part we EMTs play in the grand scheme of things and we will respect yours. Don't assume because a rule is steadfast for you it's the same for us. Most of the time it's not.

Documentation Evils

Paper work, paperwork, paperwork, if you didn't write it down, it didn't happen.

They have been preaching this to you since you were in school for your basic card.

I have noticed a few things in my years as an EMT and I think this is a good time to talk to you about a couple of my pet peeves. The "by the book report writer" and the "forecast report writer".

By the book report writer:

This is the guy that can have 40 thousand things go wrong on his scene and when you read his report it's as if he was teaching a class on the proper way to do things. They are marched out step by step in his report perfectly, just as you would see them in the EMS book. Everyone that was on the scene knows it didn't happen the way he wrote it, but none the less it looks pristine.

Come On! We are not stupid, everyone knows that the scene NEVER goes the way the book states, and to make your report look like it did only undermines EMTs everywhere. Tell the truth! A doc would always choose an accurate report of the actions at the scene over a "pretty" fabricated one. Sure you might have done everything you wrote in your report, but it sure as hell didn't happen the way you wrote it.

The Forecast Report:

This type of report writing is very common with non-emergency transport and I have heard of it being utilized a lot. This is the guy who will sit and write his entire report (usually minus the vitals) before he even sees the patient or will write it in the first 10 minutes of patient contact and then just sit in the truck for the rest of the trip. It could be a 1-2 hour trip and his paperwork will be done in the first 10 minutes.

Come On! You cant possibly tell me that there was absolutely no change in the patients status in 1-2 hours, further more you're "guessing" about the patients continued condition during your trip. What if the patient starts complaining of pain that they didn't have when you started transport? What if the patients becomes incontinet or vomits? What if the patient makes comments that you need to document. If your report is already done, I doubt very seriously that anything but a full arrest will get you to rip up your old report and start a new one!

Now that I have vented, lets hear what you have to say!

Z

EMT's the other NOMADS

Have you ever noticed how EMT's seem to switch job locations frequently? Sure, you have a few lifers that stay in one place, but as a general rule, EMT's of all levels are very nomadic.

They move from place to place and town to town. They have stories that start off like : "When I was a medic in (random town) we did..."

Or

"Back in (Some place else) we..."

I have made many good friends in this business and I've had many good friends leave to persue other oppertunities. Some of the people that they left behind feel deserted or "cheated" on, but I never have. I always figured they did what was best for them and still considered them a friend. Nothing has changed in my eyes except I don't see them often anymore.

As health care providers we have a responsibility to our patients and above that we have greater responsibility to ourselves and our peers. If we let each other down there is no way we can be the professional we need to be for our patients.

My friends are my friends, no matter who they work for. I understand you have your life, all I ask is that you understand I have mine. We are each doing what we need to do, or what we feel is best for us and our families.

Z

HUGE FIRE

Yesterday we had a huge fire at a manufacturing plant. Our SOG (Special Operations Group) was called in to provide decon of patients and rescue personnel. Our EMS division was called to transport many patients to the area hospitals.

It was our big chance to shine! We have been training and practicing, and practicing and training for 3 years and finally a full scale activation of our SOG.

I'm not going to get into too many details of the disaster, but there is a couple things I wanted to express. First off, we worked exactly as we had trained. Training pays off BIG TIME in the long run. Even members that had never been to any HazMat scene before and only had book work to rely on operated to their specification perfectly. There was no arguing among the team members or with other other departments and there was no ego trips. We were there for the support of the local community under the authorization on the county EMA, and it went beautifully.

It was long though. The activation lasted about 10 hours and during that time we decontaminated many people and even 1 dog. I got to see the EPA in action and those guys are pretty impressive too.

One more note. Our company president was there, and when he first arrived I figured he would go on over to the administration area and chat it up with the other people way out of my pay grade, but then he asked "Where do you need me?" To tell you the truth it blew my doors. He suited up and worked a decon pool for over 5 hours with other crew members. Say what you want about big wigs, but some of them put their money where their mouth is. This guy earned MAJOR respect points with the team. They were talking about it for hours after he had to leave and head back to the office. To tell the truth, I was talking about it too. We all knew he was trained to the operations level, but it was damn impressive to see him voluntarily suit up and join the other guys in the trenches.

For our first major call out I could not have been happier.

Oh Orderly

I've mentioned before that I work for a private EMS system. We do 911 calls just the same as the city guys, however we also do a lot of medical transports.

For those of you unfamiliar with medical transport it generally involves taking someone who requires medical supervision to the hospital for x-rays or to a doctors appointment, then returning them to their place of residence; whether it be home or a nursing facility.

Today I felt less like an EMT doing a medical transport and more like a hospital orderly. We arrived with our patient who was due for a bone scan, we were told there would be a 10-15 minute wait and could we sit with our patient in the hall. The nurse told us that after our wait we would only be there 15 minutes "tops" she said. Well, we were pretty sure our dispatcher wouldn't want to send us away only to have to call us back in 3o minutes so we waited. And we waited some more.

During this waiting time either myself or my partner were summoned 2-3 times to come into the x-ray room and help move a patient. For the greater good of company PR we happily obliged.

Finally was our patients turn and just like she said "15 minutes tops" BUT, when he was done magically he needed some standard x-rays as well and could we wait in the hall. Now we are getting concerned. It's approaching a hour we have been here and we are sure our dispatcher is getting a bit on the concerned side. Not for our safety, but someone probably has to go somewhere else and we are tied up here.

We receive a page to check in. My partner relays the information to the dispatcher and we sit to wait with our patient again. During this waiting time we were asked to relocated our patient more than 6 times and summoned 2-3 more times to help with other patients. Over an hour passes and FINALLY we get in. The films are taken and we are on our way 2.75 hours after we got there for a 15 minute "tops" appointment.

I guess I'm a little frustrated with the entire health care spectrum. If they really need more help to process patients quicker, maybe they should hire more people. I'm an EMT, not an orderly.

Z

I See You.

Would it kill you to leave a comment from time to time? Ya you! You reading this... That comment thing at the bottom... I know your there.. I can see you and my hit counter keeps growing, so I know your there. Your lack of comment posting unfortunately means only 2 things to me. #1 You agree with 100% everything I have to say, Zer0 your a genius and I have nothing to add.. Or #2 You think the blog is horrible and would not lower your standards to the point of actually replying to my blather... Come on, I can take it.. I got broad shoulders

Z

National Health Care

Ok I was playing WoW (World of Warcraft) today and chatting with a few of my online buddies and the topic of National Health Care came up. I know this is hot topic for a lot of people so I'm going to try and approach it delicately. Ok, who am I kidding I never approach anything delicately.

Question: Why doesn't the USA have National Health Care? Answer: Greed.

that's right folks, the people on the upper end of the health care spectrum make way too much money to ever consider endorsing a National system. While the people on the lower end of the spectrum i.e. ME, make very little money and would welcome a standard wage across the board.

National Health Care also does some pretty drastic things like (gasp) makes sure everyone gets equal treatment regardless of income bracket, provides medications to those who can't afford it. Ya, that's right Granny can get her blood pressure meds and not have to eat cat food for a month to afford it! If you need a transplant you get it... Even if you cant pay for a single penny of the procedure or follow up care. Sure you may be on a list for awhile, but you'll get the same shot everyone else gets. You'll get the same meds, not ones dumbed down or generics.. The SAME.

National Health Care also generally runs the ambulance services. Do you think that any owner of a private ambulance service wants to turn over control to the government? Let me think a second . . . Uh, no. There is way too much money in private health care, whether it is ambulance service or privately owned hospitals. Doctors in most areas of the US are private contractors. Look on the walls of most any ER! The doctors don't work for the hospital you are being treated at. The hospitals hire these contractors or contractor groups. National Health Care would put all of these people under one banner. It would regulate pay across the board for quality of service. If you were a year 1 doctor with XX certification you would make the exact same coin as another year 1 doctor with the same certification.

As it stands now hospitals are set up very differerntly by the JACO standard. Then you have Trauma hospitals, level 1,2,3. Wouldn't it be easier and better for the patients if the doctors with the greatest expertise were placed in the hospitals where they were needed most... Regardless of where they were located?

wouldn't it be nice to know that if you called for an ambulance in a "bad" part of town that you would get an ambulance in a timely manner?

Sound off guys, I wanna know your input.

Z

The Amazing Mouth Mime

It's funny how you never really think about things until you are in the back of an ambulance. Today I had a patient that appeared to say or "mouth" my words as I was saying them. It almost appeared as if he were trying to complete my sentences for me under his breath.

I don't know if I found this act to be rude or slightly un-nerving. I certainly don't think he was doing it on purpose. He didn't appear to be hard of hearing.

As I sit and reflect on it, this isn't the first time I have noticed this behavior, which leads me to believe that it might be some sort of illness not defined by age or ailment. Thinking back I can recall at least 4 other times that has happened. Two males and two females, ages range from mid 20's to mid 60's.

Anyone have any information on this?

Z

Secondary Drowning

Now, I have been an EMT for a good many years, this makes me feel very ignorant.

You ever hear of a condition called Secondary Drowning? No? Me either. Leave it up to my English counterpart Tom at Random Acts of Reality to point it out.

Those damn Brits know their business I'll tell ya!

Z

'Tis the season for severe weather. Don't worry though, no matter what mother nature brings you, rest assured that you will be in the squad 50 miles from the station. You will be rocking back and forth like crazy and fearing that you will die in a pile of wreckage that used to be an ambulance.


Returning a patient to an ECF (nursing home) today I noticed nurses scrambling through halls squawking about a "tornado watch". They had every aide go into patient rooms and inform them of the situation and close the patients window drapes. I found this very interesting and being the person that I am, I stopped an aide I the hall and asked what was up. The aide replied to me in a very un-concerned voice... "Nurses have been informed that there is a tornado watch for the next few hours" I said: "Ya, so what's the business with closing the drapes?" He looks down the hall to be sure he wouldn't be over heard by said nurses. "I have no idea man, we used to have to cloths pin them together too, but someone stole the cloths pins. I guess they think the drapes will protect the residents from breaking glass and stuff " I found his remarks interesting to say the least and when were we're comfortably outside of the facility and back in the truck I looked to my partner and told her that they probably close the drapes so the old folks don't stare outside at the impending doom in the form of a funnel cloud. If all it takes are a few yards of fabric and some cloths pins to protect a person from a tornado, sign me up for home economics.


For those of you that may not be as familiar with emergency language during severe weather season I have broke it down barney style for you. I'm sure everyone can relate to a fart.


I'm eating all the wrong foods at all the wrong times, I don't exercise as much as I should and I'm stressed to the maximum load allowable without medication. This is Fart Season.

I'm sitting in the truck and we are on our third run. I haven't been able to take my morning constitutional this AM and I'm not very happy about it. I'm awake earlier than I want to be awake and all this bouncing around has got me a bit on the uncomfortable side. I know that it will be at least 30 minutes before I get back to the station. This is a Fart Watch. Conditions are right for massive gas, but nothing noticed yet.

The 4th run comes in and it's a doosey. I have to crawl under a car and try and extricate a 16 year old kid from some wreckage that used to be his car. I have the family screaming at me, the police would like information on the patient, my partner is pressing me like crazy to get this kid out so we can scream to the hospital. I get back to the station, sit down on the couch and take off my boots. The next thing you should be concerned about is.... This is a FART WARNING. Some mild soiling of the pants has already happened and there is sure to be more.


Z

Boom.... KA-BOOM

Well, as many of you know I'm the commander for a special division of where I work and from time to time we get the opportunity to attend new and interesting classes.

One of those classes is IRTB or "Incident response to Terrorist Bombing". Un fortunately for me I wont be able to attend this one due to scheduling conflicts and the fact that I still have a 2 day class to teach for about 20 of our employees on WMD and I haven't gotten that totally prepared yet. BUT, BUT, B U T.. If you get the chance to take this class please drop me a line and fill me in on all the particulars. It is held in New Mexico at New Mexico Tech.

The government pays for most of your expenses, including travel, food, lodging and rental car, all you would really have to provide would be some free time and willingness to learn about bombs. According the the paperwork I received you will be building and detonating explosives and studying the effect they have on different materials.

Keep in mind though, to a dog, you will smell like Osama after this class. Take pictures of the class, bring your paperwork as a carry on, have your certificate handy... These things might make your wait in security a little less stressing and keep good 'ol Johnny from cramming a finger up your butt and digging for C-4.

Z

Protocol VS. Scope of Practice

Here is something for you to wrap your head around.

You are called to transport Joe a 67 year old cancer pt to his radiation appointment.
The skinny on Joe is.

Throat Cancer
120 lbs
6' 3"
BP 110/70
Pulse 100
SP02 93% with trach o2 mask set at 4 lpm.
Non-communicative, has trach, requires frequent suctioning.

The catch to this senerio is your a basic crew and according to your company protocol you are not allowed to trach suction. Your "state" guidelines say you can, but your company protocol does not have a provision for it.

You are 20 minutes into your transport and Joe starts to grab at his trach site and he appears to be turning blue. You immediately contact your dispatcher and ask for an ALS intercept and head for the closest facility that can handle Joe.

Joe is breathing on his own, but it's very noisy and you can hear obvious obstructions with his airway. A yankur suction device is not doing the trick. Joe's SPO2 drops into the 80's, you are 15 minutes out of a hospital and your intercept is at least 10 minutes away.

The question I have for you is. Do you suction Joe as you have been trained by your state? This would go completely against your companies policy. Do you wait for your intercept and hope for the best?

You decide.

Z

New Look

I revamped the look of the blog today. Kind of an "Out with the old, in with the new" type of thing. I'm even considering adding another author or two to the writing so that the content wil be fresher than it has been lately. Give me a few days and I'll have the page counter back and all my links restored to their former glory.

Z

Comment Spam

It's late and rarely do I ever make more than 1 post in a 24 hour period but this is pissing me off.

You know, we blog as a sort of diary. It lets us get things off our chest and share with others who might be able to help with a kind word or a well deserved atta boy.

This business of spamming a bloggers comment box is complete horseshit. I spent the better part of 2 hours de-turding all the bogus comments on my board by people trying to sell me viagra or an online degree I can get in as little as 6 weeks with 900 dollars.

A blogger's face lights up when they see that they have a new board comment. To log in and see that it's just some bogus spam really brings me down.

I have turned on word verification on my comments... Sorry to everyone who wants to post a comment, because of a few asshats you now have to type the little word in the box to post.

Z

Grown Men Dont Cry

Ya! Sorry!

I know I havent written in forever. I honestly intend to write about once a week, something just comes up and I dont have the time or more pressing issues are before me.

I was talking to friend online about EMS today and it inspired me to fire up blogger and give it a whirl.

Things are much the same here, kids, job, bills, more bills... did I mention bills?

I got to thinking today about how desensitized we EMS providers get to violence and death. We like to laugh and joke, but seriously, have you ever taken the time to really reflect on the amount of suffering you see on a daily basis?

My father passed away about a month ago and it never hit me. I was sad, and I wanted to cry for my sons who were without a grandpa, but I never even thought about crying for myself... after all, GROWN MEN DONT CRY. I stayed strong for my boys, and I stayed strong for all the family that was there. Every one hugged me and said how sorry they were. Some were crying, some were not. I never even considered it, at least not in the sense a child would cry for the loss of a father.

We see death and violence on a daily basis.. we come back to the station and turn on the television and watch more while the crew fires up the BBQ and cooks lunch... we never give it a second thought. Sure a child hurt will rattle our cage, and the senseless death of a teenager by their own hand will disturb us, but when someone of "adult" age dies.. no matter what the cause, it's all in a days work. I'm thinking maybe this is wrong.

Maybe we dont push CISD enough (Critical Incident Strees Debriefing). Maybe because GROWN MEN DONT CRY, we dont press the issue of much needed mind flushing.

I think next week, when things calm dawn a bit with the kids and job and home life I might find a quiet place to cry for my dad, maybe in the garage where we used to work together so often. I dont want to go much longer without mourning the loss of a loved one. Come to think of it maybe I'll find time to cry the next time anyone loses a loved one, maybe that will remind me that even though it's all in a days work for me...lives are still shattered and some grown men cry.

Z