Monday, August 25, 2008

Ambulance Ass

I have a reader who asks about physical fitness in EMS. She is inquiring about what type of work-out we do and how to be able to pass some PT tests.

I think she said she needed to be able to lift 85 pounds 48 inches. I can only assume that would roughly be the weight of the cot while loading it into an ambulance.

Ok, to start at the beginning. If you work in EMS and you don't follow some sort of diet and/or exercise routine you will gain weight. Simple as that. No one escapes it forever. We affectionately call this "Ambulance Ass".

I'm about 5'10" tall and I weigh in at a chubby 216lbs. I was at 240 when I knew I had to do something before my penis disappeared. I gave up Pepsi. Yep, 24 pounds shed in 4 months just by giving up the Pepsi. I also started drinking my coffee black. No cream, no sugar. I mean, COME ON, what do you drink coffee for? It sure ain't the taste.

The biggest problem I saw with my rapid weight gain was the fact that I was eating all the wrong foods at all the wrong times. This is still pretty hard to control given the nature of our work but if you make simple corrections like NEVER EVER eating after 7pm and watching your portion size you can at least hold back the progression while you work out a way to lose some of the extra baggage.

We have one guy at our station that has went completely nuts and lost over 60 pounds in 6 months. He has given up almost everything that tastes good. I think I lack the courage of that convection though. I mean...No Cheese? No Way! Whey protein shakes...water all day and a sensible dinner? I guess I'm just not a sensible guy.

As far as our reader's question goes. "Just Do It" if you are having trouble lifting 85lbs 48 inches...Just do it. Go to one of your volunteer departments and load the cot with a person on it over and over. Do it as many times as you can, remembering to put the stress on your legs and not your back. We have had PLENTY of smaller people build themselves up this way. It would also not hurt to go out to your local Walmart and buy some 2-6lb dumb bells. It doesn't seem like much weight but if you work out with them every day you will see an improvement in your arms and chest.

Everyone who wants to do this job can, it's just a matter of how much effort you want to put into reaching your goal. You'll get there.

As for me. Well I have lost 14 pounds and I'm losing more. I told you earlier how I cut out pop and sugar in my coffee...Well I also started dating a girl quite a bit younger than me. Keeping up with her is aerobic in it's self. I find more time to run around with my children and I try to stay active in the garage and away from the computer. If you sit and do nothing all day, don't be surprised when you develop ambulance ass.

Friday, August 22, 2008

OMG It Changed!

Yes, we are working with a new look here. The reason is 2 fold really.

#1 I really got tired of looking at the old format. It was boring and not very friendly on the readers eyes.

#2 There are a lot of cool new features that can only be used with a template upgrade, so I figured... Why not?

So far I have added a little tool that tells you important things that happened today in history and a way to search youtube and watch videos right from the sidebar. Type in paramedic in the little box. Some funny stuff there.

If you have any suggestions please drop me a line!


Tuesday, August 19, 2008

The Pain Of Living.

In the course of doing our job we see plenty of horrible things. Some things you literally wish you could "Un-See". It's all part of that sacrifice we make to try and force a difference in the outcome of people's lives. The general public should never have to see these things.

An old paramedic once told me "Son, God made EMTs to give him a chance to change his mind but you have to remember that he does not always change his mind". It's those words that help me through the rough calls. What solace does the layperson have in those troubling moments?

I was thinking of this my last shift when we had probably the most horrible motorcycle accident I have ever witnessed.

We were posted across town on a special event when the alarm dropped. Our other unit was about 2 minutes away from the accident and they had an extra crew member so it was not likely myself and my partner would be called. Well, at least that's what I thought as I sat in my lawn chair sipping a cold cola and nibbling on fair food.

They had to have been on scene for about 30 seconds when the second alarm dropped and my partner and I packed up our chairs and raced to the scene.

On arrival I was pretty astounded by the lack of scene control. The road was sufficiently blocked off and there damn sure were plenty of cops there but no one seemed to have a handle on all the gawkers. It was very hard for me to determine who was involved in the accident and who was just standing around.

I send my partner to help the crew working on the motorcycle driver and I proceed to beat the bushes, so to speak, to find any other patients. I turn up empty, the driver of the car was uninjured and in police custody.

Making my way back to the trauma patient I see at least 2 maybe 3 people weeping so hard they can barely stand. As I survey the motorcycle driver I see he is being aggressively worked by my guys so I think I would be most useful trying to calm the bystanders. With the assistance of a couple police officers we get all of them off the road and over to the grass where I can try and answer any questions to the best of my ability.

They were screaming "He's dead, I know he's dead" I replied with the standard: "Everything that can be done is being done" they were not buying it. I knew he was a trauma arrest and his chances were very slim, but how do you tell that to people? You just kind of bite your lip and hope for the best.

Someone had used a whole roll of paper towels trying to stop the blood pouring from this guys face and head. What had been going through their mind when they were doing that? What horrible visions are they having today every time they close their eyes? They pile more and more paper towels on and the blood never stops. Finally EMS arrives and things are moving very quickly for them. It must seem like a nightmare, a painful visage that can not shake even with all of the light of a noon day.

I think I was most concerned with the driver of the car. How would he live with the knowledge of taking a life? The police would not let us near him, but I was worried that he was in shock so I went and talked to the Sargent. He made a few wild hand gestures and I was allowed access to the driver. He was literally destroyed with guilt. He wanted to know if the guy was going to make it. I'm sure you know how I replied: "Everything that can be done is being done".

It was a traumatic arrest and all of us know the odds are greater than 1 in 100,000. The guys worked and worked securing an airway, then stabilized his spine and neck. Into the truck he went and they left. My partner and I were left to collect the equipment from the scene and bag up all the biomass for disposal.

We were told later that he regained his heart beat after a couple rounds of Epi and Atropine in the truck. He was delivered to the ER with a pulse. I was very proud that, the guys were on cloud nine!

6 hours later, when his heart stopped and he was pronounced dead at the trauma center we were all in shock. It's not fair we said. He beat the odds! HE BEAT THE ODDS! How could he die after surviving such a horrible accident? How could God let this happen?

Son, God does not always change his mind.


Friday, August 15, 2008

New plan!

After going back through all of my posts on the blog I realized that there are a lot of really interesting people that have left comments over they years. I feel kind of crappy only posting once a month or so. I feel like I'm letting people down.

So here is the new plan. I'm going to start posting at least once a week. Every week there will be new content. It's not like I don't have something to say, I just forget. I have made myself a little sign and stuck it above my desk that reads:

"Have you had your blogger therapy this week?"

I encourage all readers to send in comments or things they would like covered. If there is anything on your mind, drop me a line and we'll work through it together. I will supply an email address and put it in the links to the right of the content.

Take Care


Friday, August 01, 2008

To AMA or Not to AMA. This is the question.

Ok, we have all got those calls at 4am that you just know are bull-shit. You arrive on scene and find lots more drama than trauma. You know they don't have any serious problem... or do you?

Today I had one that was kind of strange as far as possible AMA's go. You see, I don't talk a patient out of going to the hospital ever. I always felt it was my job to talk them into going to the hospital. After all, they did call 911; I would like to think I was there for a reason.

50is woman in a praying position on the floor with arms holding her up against the side of a night table. I stated "Mam, I'm here with EMS, can you tell me if you hurt anywhere?" She replied very slowly: "No I don't hurt but my legs and feet are asleep, I've been down here 3 hours."

After a brief assessment myself, my partner and the FNG helped her to her feet and she could not bear any weight (This lady was 400lbs +). We sat her down on the edge of the bed and began to sort through the laundry list of medications and diagnoses she had. All of which are not really important at this time.

After assessing her again sitting this time I noticed that she was answering everything correctly but it was taking her forever + 1 day to do it. She was incontinent as well... So I'm thinking seizure or stroke right? She is flat out refusing to go to the ER. She states they wont do anything for her. We run baselines and check a sugar... 320. Ouch, that sucks... now I'm thinking DKA or Hyperosmolar NKA (Medic school taught me big words).

The only person there to help her is her 75 year old mother, and there is NO WAY IN HELL she would be able to help her to the bathroom or to get a shower. I call the doctor hoping he will mandate her. No Dice. He told me that if the patient was A&O he wasn't going to mandate her to be brought in.

So here I am with this problem. I know she needs to go, my partner knows she needs to go...hell even the FNG knows she needs to go, but she refuses to go.

Finally I leveled with her. I told her that I was not comfortable with her being by herself and I knew that her mother could not get her cleaned up or even up to go to the bathroom. She nodded. Then I gave her the option of agreeing to go to the hospital with me or I was going to be forced to call the social services officer to place her in protective custody.

After a few minutes of word wrestling and a couple unflattering comments made under her breath she agreed to go.

There really is no moral to this story, but consider what could have happened to her if I would have just happily had her sign the AMA form and left. What would have my responsibility been then?

Food for thought: Have you ever signed off someone only to have it come back and bite you in the ass? Let me know.