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!

Z

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.

Z

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

Z

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.

Z

It's a TRAP!!!

What kind of friend would I be if I did not keep all of my avid readers apprised of every single thing I find to be utter bullshit or a blatant attempt to deceive me?

No friend at all that's what kind. So, even though this does not pertain to emergency medicine or emergency services in any way at all; I still feel the need to vent a little and let all of you single guys out there know about the great many traps I've either fell into, or almost fell into over the last 18 months.

It has only been the last month or so that I have started to notice feeling lonely. With that said I dabbled a bit over the last 18 months, but I really started examining the situation over the last 2 weeks or so. I think I have managed to piece it all back together again in my mind; or whats left of it since medic school. CT would show Swiss cheese, I'm sure.

#1 Never date for the sake of dating. You will only end up miserable WITH someone rather than the preferred "Miserable Alone"

#2 Never suggest to your 2 sons that you haven't dated seriously in over a year and a half.

I woke up to my phone ringing. The female on the end said she saw my oldest son at the supermarket with his mother (my ex of course) he said to her "Mam, your very pretty and not wearing a ring.. My dad hasn't dated seriously in over a year. I'm sure he is lonely" The lady who we will call "Lacie" wanted to call me (after getting my number from MY son) and say it was the sweetest way anyone has ever asked her out. I promptly told her that I had not asked her out. After a few seconds of conversation she obviously thought the guy standing behind my ex and my son was ME... it wasn't. I was laughing too hard when I hung up the phone to call the boy and be stern. I waited until he returned from his mothers house the next day and told him if he were to ever set me up again to offer a picture and then call and warn me. He promptly agreed.

#3 Stay away from online dating sites.

Ya they seem "Fun" and "Harmless" but they are not. I tried out Yahoo's service for about 6 months. They were running some special for 60 bucks or so, I figured I'd spend way more than that in a single night at the bar so why not give it a shot.

The first one I got was amazing. She sent a picture and I sent mine. We talked for hours and hours for the first few weeks on Yahoo Instant Messenger. Then one day she offers her phone number and we start talking on the phone. We had so much in common, we had the same likes and dislikes. We had the same view on politics, children, world events etc... This all carried on for about 3 months. Then we decide to meet. On the day before the meeting she calls me and tells me she has a confession. The picture wasn't her. She is 10 years older than me and 17 years older than she told me she was. She is married and has 3 children. Well I have to admit, I was a little stunned. I had never done the online things before and I thought "Gee, I get the real deal right out of the gate...this is AWESOME" Now I know better.

The next few were pretty bad. A few dates, a few disappointments. I had one that was sort of promising but then I realized that she really didn't care for children. Every time I would mention my boys and the fact that they are with me a lot she would say things like "Well you don't ALWAYS have them do you?" It only took 3 times for it to sink into my thick skull and I never returned any of her phone calls after that. My sons are the biggest part of my life. I love them more than anything, they are my best friends. We are a package deal.

#4 Avoid all MOB agent sites! (Mail Order Brides)

Ya so I was feeling a bit lonely one evening and I decided to myself "Self, if you can't meet the right kind of women here... go abroad!" So I start researching meeting women from different countries. All of the websites pitch a good game but when you start peeking under their skirt (so to speak) you get to the hairy mess of it. 99.5% of them are blatant scams. There is no easy or efficient way to sort out the reputable from the scammers anymore. Some sites have BOTH on their pages according to a few articles I read. I spent the better part of 6 hours reading horror stories of men scammed out of THOUSANDS of dollars in the search for love abroad. It was enough to deter me from ever trying to navigate those narrow streets.

#5 Kill all who offer you a blind date.

The phone rings, it's my buddy Chris. First question out of his mouth. "Dude, your still single right?" I affirm reluctently. "Dude, you have got to help a brother out here.. I have this date tonight but she is shy. She will only go out if her BF can come with us" I asked Chris if he could remember ANY of highschool and why I should be forced to play some stupid ass games with his date prospect and her "BF". I further informed him that I was 35 damn years old and he was 36! "Why are you even considering this" I asked. Well, he sent pictures and like the weak bastard I am... I went.

The lady I was set up with was attractive, 5' 5" about 135lbs and brunette. She was a considerable bit younger than me but I could adapt. I'm 35 not 65. She had a wonderful smile and I was starting to feel a little more at ease about this blind date.... Until she spoke.

"Hi man, I'm.... like..... Amber. Whats your name?" "Oh thats right Shelly told me you like.... are an ambulance driver or sumptin right?"

I felt like asking her if I could answer her first question before I addressed the "ambulance driver" question but then I quickly realized it would be to no avail. I start scanning the room for the exits then a brilliant plan comes to me. I excuse myself to the bathroom, call a buddy and cash in a favor.

I got back to the table and sat down. She was babbling on about some idiot on MTV's "The Real World" and how much she lusted over him. I was smiling and nodding. Trying to bide my time.

***Pager Alert*** (Show pager to Amber)

I'm sorry Amber, there has been an industrial accident. I need to get my team mobilized. We will have to do this again. She smiles and looks at me "Can I go?" I told her I was afraid not and got the hell out of there.

She actually called twice. I was unavailable twice as well.

So here I am. At work, praying for a call to come in so I can occupy my mind a little. I'm sitting up in the office typing this while the other guys are down stairs watching reruns of old movies. Most times being alone doesn't bother me. When my boys are home or when I'm busy I hardly ever think about it..... but sometimes, just sometimes I wish I could remember the scent of a woman's hair, or the way she smiles at you when she likes you, or the way you can just be close and not have to say a word.

Sex once in every 12 months wouldn't kill me either. Given my options and my misadventures I think I'll stick with the bar, at least then you know what your getting...or you at least know what the presentation looks like. I don't need a double cheeseburger from Micky D's every night... but just once in awhile I'd at least like to be able to lick the cheese off the wrapper.

night.

I Let Her Die.

The call comes in early in the morning around 12:30am to take a elderly female back to the nursing home after treatment at the ER for dyspena.

My partner and I arrive to find a 88 year old female with a GCS of about 4 working hard to breathe on 15 lpm by mask. Rate was about 32, SPO2 91%.

We ask the ER doc what O2 he wants her to go back on as the nursing home can only provide 6 lpm by concentrator. The doc then informs us she is hospice care and hands us a newly minted DNR.

We switch her over to a cannula at 6 lpm per the doc and begin the transport.

She makes it about 10 minutes and codes.

As we arrive at the nursing home I leave my partner in the back so I can run in and talk to the charge nurse and try to explain the situation. The charge was just as confused as I was. I guess what we were both wondering is why the ER didn't put her on the cannula and let the dying process happen there?

There are specific protocols for letting a patient die in the ER and there are also protocols for letting them die in a nursing facility under the care of hospice. There are NO DEFINED protocols for allowing them to die in the squad.

It all was very alien to me. My mind knew I had to follow the direction of medical control but my soul was screaming to do something... ANYTHING!

We knew she was going to go. I just didn't want her to go without her family around. I had offered to let them ride in the squad but they chose not to for one reason or another.

I feel sad.
Rest in Peace.

Frustrated!

I'm still settling into this whole "Paramedic" thing. Trying to find my place in the grand scheme of things. I have made a few very painful realizations over the last few weeks. I'll share a few with you.

#1 Your never as smart as you think you are.

You might have gotten perfect grades in school and you could have been a damn good basic or intermediate but thats no indication of how you will be as a paramedic. You see, you have always been able to secretly think "I'm not the medic, it's not my final decision" When you get that medic card guess what? Yep.. it is your final decision and that scares the bejubus out of you. Take a few deep breaths and let your training and field experience kick in. It's likely you know the solution, you just need to give yourself time to access it.

#2 It's 50/50 now buddy!

I used to get such a kick out of screwing with my medic partners on BLS runs. We would go to a nursing facility for a seemingly routine transport and of course I would be expected to take it since the medic was normally in the back. I would get in and ask a question like "Good afternoon Mam, do you feel like you have any difficulty breathing?" 95% of them would say something to the affirmative and WHAMO.. I would call my partner to take the patient, they are the medic! After getting my card most of the medics I work with now are quick to remind me that it's all 50/50 now unless they feel like getting even for my past shenanigans and stick me with all of them.

#3 Even if it hasn't happened in 10 years, it will now.

Since I have recieved my card I have observed some crazy runs. Stuff you only see once every 5-6 years. Yep, I got the majority of it in my first week. I think it ranked about a 8 on the pucker factor when I was in the back with my first AAA. Prepare for the worst, it's coming.


All of that and the lingering thought that I should probably start dating again at some point. I mean, I'm ok with being single and all but every once in awhile I would like to have some sort of female companionship. No, it's not about sex (although that would be cool too) it more just about the connection to a female that allures me. Plus, women are soft and smell nice. The problem is, I have no idea where to start! I have been so self absorbed for the past 3 years I have kind of lost touch with all the things I SHOULD be doing to put me on the right track to romance. Plus the fact that romance in it's self bores the shit out of me. I prefer REAL conversation with rational people, all the romantic drivel just seems to mask what people are truly thinking.

So I post a couple personals on a couple obscure sites (I shy away from the popular ones) and I get half a dozen or so replies and I notice a trend of BIG women. I have to sit and ask myself "Self, are you only capable of attracting women at 190+ lbs? or is it that those are the only women looking at the personal ads. I certainly hope the latter is true or I'll be single forever. I know I'm a bigger guy, but I'm not obese. I do tend to gravitate toward smaller women but I have nothing against ones with a little meat on their bones either.

So ya, all in all... I'm FRUSTRATED.

Rant off.

Extra Time

Ok for the last year I've had my life pretty well mapped out for me. Work, School, Study, Rinse and repeat.

My work schedule changed like crazy due to people covering my class time. I never really knew when I was expected to work unless I looked at the schedule the day before. Now that things are back to quasi normal I hardly know what to do. I woke up this morning before my kids did, that was kind of cool. I walked downstairs WITHOUT a textbook and had some coffee WITHOUT looking over notes or drug flashcards, I stumbled out to the back porch to survey the damage of the last storm WITHOUT stressing over an upcoming test.

It only took me about 45 minutes to realize that I needed to fill some time now or I was going to go stark raving bat shit crazy. You just get so used to a mid to high stress level that when it's gone you ALMOST miss it. Note the use of the word almost.

I have to teach at a Basic EMT class tomorrow. I'm pretty excited about that and Wednesday I go back to work but today... Hmmmm.

I think I'll run a new electrical line for my family room AC today so I can watch TV and stay cool at the same time without blowing a breaker.

I think I'll investigate my eve spouts and find out why I'm getting water in my basement.

I think I'll work on the go-cart and get it running.

I think I'll clean up the fire ring and get it ready for a few BBQ's

I think I'll replace the window in the mud room that the storm took out.

I think I'll service the boys' motorcycles and have them ready to ride when they get home.

or.

Maybe I'll just sit and and try to talk myself out of grinning like an idiot. It's really over and I actually pulled it off. At 35 years old I went back to school and became a paramedic.

Still amazes me.

Big Fight!

I wake up in the morning at 5am. I don't shave. I didn't shave on Saturday and I managed to pass my practicals. So shaving is out for today. My nerves are killing me. I can't eat, just the thought of it makes me want to vomit. Since I didn't shave, getting puke in my beard would be bad.

I go in and kiss my boys. They have sacrificed so much over the last year. Daddy has been gone almost everyday and many events were missed. They miss their Daddy.

I stumble down stairs and turn off the AC, too cold in the house. I grab a Rock Star Energy drink, I know it will make me crash, but the test is only 2.5 hours so I should be done before the big crash happens.

I drive to the shop. The director is kind enough to drive us the 50 miles to our test. He wants to give us every opportunity to be as rested as we can.

The 3 of us don't say a word on the hour drive, we are too consumed with our own thoughts, ambitions, and fears.

As we arrive at the testing center the paranoia kicks in and my stomach starts to tumble. I feel like I'm here to do battle. They WANT to fail me and I will need to fight like hell to even have a chance. I know it's irrational, but thats what I think. I'm a fighter by nature so bring it on, lets get to it. It's either you or me NREMT.

125 questions later I walk out the door wondering how long it will be before I can reschedule. It was a good fight but I think they got me. A cheap shot indeed, but I think they got me. No matter, we'll fight again and things will be very different.

Quiet on the ride home too, I know it will be at least 6 hours before I will know the results of the fight. I was bloody, bruised and tired but I thought I got a few good shots in too. I might not have won, but that bastard would know he was in a fight tomorrow.

Pull into the drive and stumble in the house. Too hot, the AC comes back on. I crawl upstairs exhausted and fall into a coma.

Phone rings. Results are in.

THAT BASTARD GAVE UP! He rolled over and showed me his belly! I may be broken up and bruised but he couldn't continue!

I'm a Paramedic

Medic School Is Over

Medic School is complete and now the real stress begins. National Registry.

5 Days from today I will find out if I'm a brand new paramedic or if I have fallen short of my goal and need to study up and re-test.

Lord knows I would like to accomplish this on the first time around, but I know many fine paramedics that had to take the test several times.

Then again... I know many crappy paramedics that only took it once.

I don't know how to feel really. One the one hand I'm EXTREMELY happy to be done with school. I have let a lot slide in the last year. On the other hand, I'm about crazy with nerves about this test.

Wish me luck.