EMTs, the OTHER health care professionals

EMS is the lowest paid of all health care professionals, but before you go to your boss and complain lets look at why this is the case.

1) Personal appearance: Although some of you take great pride in how you look, others look like they have just rolled out of bed 24/7. Stains on their un-tucked shirts, grossly overweight with a 5 O' Clock shadow at 8am. I don't care if your full time or a volunteer you can always take the time to look your best. A simple jumpsuit, hat and can of deodorant by your bed will solve almost all of these issues.

2) Attitude: I can't tell you the number of times I have ran across EMTs who are bad mouthing either the company they work for or the patient they just had because it was inconveniencing them in some way at that particular moment. Shape up, suck it up and do your job. There is always McDonalds if this line of work is too rough on ya.

3) Conduct: If you want to go out on a Friday night and raise hell DONT WEAR AN EMS SHIRT. No one care about your macho ass! Your making all of us look bad when you swill liquor and boast about how many lives you saved today. Grow up. People judge the entire profession on the things they see. Perception is everything.

4) Reimbursement: You are getting a lower wage because the reimbursement rate by the feds or state (Medicare, Medicaid) is garbage. We need a better lobby in Congress and State Departments to get things improved.

5) DOT: Department of Transportation. This is a joke, there is no way in this day and age that EMS should be under anything but the State Board of Nursing. There has to be a department more qualified to oversee us than the DOT. These is a huge disconnect between EMS and other health care professionals and until we bring all of them together on the same issues there will always be problems.

Ya, it's early in the AM and I just got back from a run...I am ranting a bit, deal with it.
It is EMS week, you can be happy about that. The one time during the year that people feel they are obligated to show us even the smallest amount of respect and graditude. We get a trinket from the local hospital and a free meal. They pass out some awards and pat you on the back and tell you GREAT JOB!

Wouldn't you rather have it that way year round? Wouldn't you rather have a living wage and the respect of all of your healthcare peers daily?

Stand up for yourself. Demand change both within yourself, your peers and the system!
Show respect and you will receive respect.

They presented me with the award for "Provider of the Year" today. I was proud and sad at the same time. We all deserve that award, not everyone can do what we do, but until every single one of us is willing to stand up for what we believe in and force a change in ourselves and our situations we will always be "other health care professionals"

G'night

My Boys.

Few things in this world come even close to the joy I feel when I look into the eyes of my sons. They are the whole reason I do what I do, and the driving force behind my absolute need to succeed. I want them to have the things I never did. I want them to feel secure and know that no matter what life throws at them Daddy will be a constant and home is safe.

Last night someone took part of that innocence from them. Someone violated their home and stole their property.

3 motorcycles, 1 quad and a go-cart all stolen under the cover of darkness by a coward.

Sounds like a lot but it really isn't. My bike was the only thing of real value. A 2003 V-Star that was 2 months from being paid off. It's insured so I'm not really mad at all about that. They found it about a mile away wrecked in a ditch. The sheriff has it now trying to get prints I presume.

What infuriates me is the things that belong to my sons. They were second-hand and pieced together with duct tape and coat hangers in places but they were one of the true joys of their summertime. We spent many hours in the shop welding and tacking broken parts back together. We searched Ebay for parts and rummaged through junkyards for repairs. The time spent with my sons on these projects were as good as gold to me.

I had to work overtime for 6 months to pay for those motorcycles. I gave them to them on their birthdays. They were so excited they could hardly stand still. Some bastard or group of bastards has taken that away from them. They robbed them of the joy of being a child. They robbed me of the satisfaction of seeing them zoom around the yard smiling like crazy.

As a medic we are supposed to preserve life. We are supposed to help those in need no matter the circumstances. Right now I don't feel like the helping type. My sole wish is that I could find those responsible for this just about 20 minutes before the Sheriff does. I wouldn't ever condone killing anyone, but I'd like to give them a taste of the pain my sons feel before they get the pain of a pounding in the ass in prison. I'd like a little "Dad Justice" first.

I was trying to explain to my oldest child (10 years old) what had happened. He looked down sad and simply replied "Well at least they found yours dad, it was the most expensive"

I almost cried. When had he grown up? How did I manage to raise such a good kid? God-bless him for thinking of others before himself... But it's not good enough for me. When I get mine back I'm selling it and buying my boys 2 brand new ones, because I'm a daddy and thats what daddy's do.

To the cowards who stole them. I was ok with you stealing from me, but I'm not ok with you stealing from my children. You are lower than snake shit. You don't rate in anyone's book. Not even your mother loves you, kill yourself and do the world a favor.

Pray to whatever god you worship that I never find you.

Stop, just stop it already!

Ok. For the last few months I have been hearing a lot of crap about the world coming to an end in 2012 because the Myans stopped making their calendar there.

I think it's bullshit and here is my rational as to why.

The Myans lived from 300-900 AD. They built housing so they had contractors and engineers. They ate so they had farmers etc. They basically had most of the professions we have today right?

So it stands to reason they had teachers and scribes too.

Some poor sap got placed in a hut around 315AD and it was his job to make calendars. As he got older it was further his job to pass off the calendar making to some other non-athletic Myan. Given the average life span of a Myan of lets say, 70 years, that means that from the time they winked into existence around 300AD until the time they winked out of existence around 900 AD we have a span of 600 years.

That means if only 1 Myan was making calendars it took almost 9 of them to do nothing but make calendars for that 600 year period. (Of course you can multiply that number by a factor of 1000 easily as there were probably plenty of calendars)

It is my belief that somewhere down the line they just got tired of adding years. I mean, COME ON! If it were your job to make calendars what year would you say.. "Ok, to hell with it. We don't need to go any further than this!"

Some wrinkly old Myan got to 2012 and said "That looks good, here it is 898AD... Who the FUCK is going to live 1114 more years to even appreciate my work?" "If we happen to make it that far we will just start making calendars again, but this is good enough for now."

Lighten up people.. We are not going to wink out of existence in 2012 just because some Myan got tired of making calendars.

The only thing this serves is to remind ourselves that in EMS there will always be some nutter with a reason to be going crazy. Load up on your Haldol and Versed and start your day guys. There are plenty of nuts out there for all of us.

CCFCCP

Now that takes balls!

One morning I was called to the emergency room by the head ER nurse. She directed me to a patient who had refused to describe his problem other then to say that he "needed a doctor who took care of men's troubles." The patient, about 40, was pale, febrile, and obviously uncomfortable, and had little to say as he gingerly opened his trousers to expose a bit of angry red and black-and-blue scrotal skin.

After I asked the nurse to leave us, the patient permitted me to remove his trousers, shorts, and two or three yards of foul-smelling, stained gauze wrapped about his scrotum, which was swollen to twice the size of a grapefruit and extremely tender. A jagged zig-zag laceration, oozing pus and blood, extended down the left scrotum.

Amid the matted hair, edematous skin, and various exudates, I saw some half-buried dark linear objects and asked the patient what they were. Several days earlier, he replied, he had injured himself in the machine shop where he worked, and had closed the laceration himself with a heavy-duty stapling gun. The dark objects were one-inch staples of the type used in putting up wallboard.

We x-rayed the patients scrotum to locate the staples; admitting him to the hospital; and gave him tetanus antitoxin, a broad-spectrum antibacterial therapy, and hexachlorophene sitz baths prior to surgery the next morning.

The procedure consisted of exploration and debridement of the left side of the scrotal pouch. Eight rusty staples were retrieved, and the skin edges were trimmed and freshened. The left testis had been avulsed and was missing. The stump of the spermatic cord was recovered at the inguinal canal, debrided, and the vessels ligated properly, though not much of a hematoma was present. Through-and through Penrose drains were sutured loosely in site, and the skin was loosely closed.

Convalescence was uneventful, and before his release from the hospital less then a week later, the patient confided the rest of his story to me.

An unmarried loner, he usually didn't leave the machine shop at lunchtime with his co-workers. Finding himself alone, he had begun the regular practice of masturbating by holding his penis against the canvas drive-belt of a large floor-based piece of running machinery. One day, as he approached orgasm, he lost his concentration and leaned too close to the belt. When his scrotum suddenly became caught between the pulley-wheel and the drive-belt, he was thrown into the air and landed a few feet away. Unaware that he had lost his left testis, and perhaps too stunned to feel much pain, he stapled the wound closed and resumed work.

I can only assume he abandoned this method of self-gratification.

By Dr. William A. Morton, Jr. MD, a retired urologist residing in West Chester, Pennsylvania.

There are angels all around us.

My truck is back together and so are the other two. I'm tired, I have a laceration to the top of my head and my back hurts like a son of a bitch... but he will live.

As we arrived on scene I saw 4 semi's jack-knifed and about 8 cars piled into them. The snow was pouring down and my partner had a concerned look on his face that I rarely see.

The police approached us and said there was one trapped in the wreckage of a semi. Every one else was just fine. We set off toward this huge pile of twisted metal that looked like a scrap yard and I peered inside the window. I could see the top half of a body in there and my stomach fell. The wreckage was one of the worst I have seen in 15 years and I was just about positive no one could have survived.

There was still a side window intact and I thought I could make entry there, so after we did a quick check for safety hazards I removed the window and started to crawl inside. I heard "Hello, hello... I'm stuck!" By God he was alive... I asked him his name and told him mine and we went to work trying to get him our of the carnage.

Both of his legs were crushed under the engine compartment and the steering wheel was pressed into his belly but he was A&O x 3 hanging upside down by his seat belt.

Within the next few minutes we had a couple firetrucks join us in the extrication and 2 more of my units as well. We took turns holding him up to keep the pressure of his body away from the steering wheel and seat belt. I didn't want to cut the belt yet since it was the only thing holding his upper half in place. If I released the seat belt all of his weight would strain against his lower extremities and I was positive they were in some nasty shape.

Gave him O2 and covered as much of him as we could with blankets. About 30 minutes into it we started placing hot packs in axial areas to keep his temp up. He remained awake and talking most of the time. At one point I told him he was not allowed to pass out without my permission. He laughed a little but I knew he was in some serious pain.

We all took turns holding him up and talking to him. When we were not squished into the cab with him we were outside running the jaws or the sawsall cutting away at the truck and the engine compartment trying to free his legs. He was in there very tight and from what I could see of his legs he was going to need a trauma center.

I called to request a bird, but they were not flying due to the weather, so I called the ER and told them the story and to have a MICU ready to take him to a trauma center after he was stabilized. Our little hospital is damn good, but this guy was going to need a specialist, of this I was sure.

I asked about his family and told him about mine. He has 6 kids.. I said "Buddy, how do you have time to make six babies when you drive truck?" He replied to me "That's all I got time to do man". We laughed about that a little but I could see that it was getting harder and harder to keep him awake. I kept reminding him he did not have my permission to pass out. He would say ok man, ok.

Almost 90 minutes into the extrication we were able to free his legs and pull him out onto a long board. We did the standard immobilization and got him into one of the units. As we were pulling him out his legs were hurting so much he almost passed out. I yelled his name and he promptly replied "I know, I don't have your permission." He then started thanking us. I told him there was still much to do and for him to be strong we would walk this road together.

In the squad we gave him a through once over and controlled the bleeding from his legs. He was in pretty bad shape but there were two legs there and we intended to deliver him to the ER with a good BP and perfusion to those legs.

Started an IV and gave him some morphine for the pain. Worked to realign and get pulses back to those feet with pretty decent results.

On arrival to the ER their trauma team was ready to stabilize and the mobile life was there ready to transport to a level 1 trauma center just as soon as the local guys could get everything under control.

Looking back on it I have to say: Today an angel was riding shotgun with that guy, I have never in 15 years seen an accident that bad have such a positive outcome. This guy will need surgery sure..probably lots of it, but he's alive and doing well when everything there said he should be dead.

Greetings Mr. President.

We traveled the 500 miles in just over 7 hours. 15 ALS units en route to provide medical support during the 2009 inauguration of President Obama.

The security was very tight and we ended up having several forms of identification we had to carry with us plus FEMA and USSS tags in the windshields of our units. FEMA had also lo-jacked all of our trucks and provided us with 2 cell phones in addition to the 2 phone we were already carrying and 2 radios per truck. It was obvious to everyone that they wanted to maintain contact with us at all times. It was further obvious that they wanted to know where the trucks were.

We started out staging about 12 miles from the DC area, we were not there long before they moved us to a park about 3 miles outside the capitol. The thing is though, in DC during any big public event, it can take you over an hour to travel 2 miles.

We sat at the park for about an hour and then FEMA assigned a DC firefighter to every unit as a spotter. These guys were supposed to know which roads were closed and the quickest ways to get around the capitol area. If you ask the crews, the firefighters were little to no help at all.

Eventually they broke our strike teams up and started assigning our units to DC fire stations. We could hear the traffic on the DC radios and there were literally hundreds of cold related calls within the first couple hours. I heard a couple full arrests come across too. With a crown of over 2.9 million people you had to expect that a few of them would die.

Reports were coming in of ambulances stuck in mobs. They could not respond, as the crowds completely over-took them and surrounded them on all sides. They were using small ATV type carts to get around inside of the venue area with just slightly better results. Some of them would not start and other times the medics on board would have to leave them to go off on foot. When they tried to return to them they couldn't find them. They either were moved of the crowd had just swelled so much they they got disoriented and couldn't find their way back.

My unit got staged at 14th Street and Congress Ave. It was quite a happening place there. I have never in my life seen so many tactical operators in one area. There were officers as far as the eye could see. As far as I could tell there was only 1 more unit in our area and they were sleeping in their truck. Fortunate for them, they were not part of my team, I think I would have had something to say to them.

My team performed exactly as they had been trained, no one missed a beat and everyone was very professional. We even decided that there was not going to be a debrief after this activation because there was really nothing that could have been improved upon. I was very proud of them.

When we got home I got quite a few calls saying things like "Good Job Chief, another activation down with no problems" I was quick to remind them that if not for the ENTIRE team things would have been very different. We have a fantastic group of operators, each one of them makes the team is as good as it is. All I do is gently (well sometimes not gently) steer them in the right direction.

It's good to be home, but now I'm up to my ass in snow...

A New Era

I didn't vote for him, but I'm willing to give him a chance to excel. I guess only time will tell if this proposed CHANGE is what is best for the country.

We have 15 trucks sitting here in DC as part of a FEMA response team. It's unlikely that we will be utilized but it was a huge honor to be asked to come. Our special operations team made the 8 hour trip and stayed in a hotel a couple nights while all of this was being put together.

We held down a parking lot yesterday, and today we are waiting in the wings. As it gets closer to noon we can hear all of the EMS traffic picking up. Lots of cold related emergencies, a few serious patients but all in all it doesn't seem too busy yet for the amount of people that were here. Just turn on a television and you'll see what I'm talking about.

I'll write more tomorrow, right now were just waiting to be pressed into service and I'm happily surfing the Internet and listening to the traffic.

Cold Weather Musings

My God is it cold outside today!

My truck is saying 9 degrees and thats not figuring in the 30mph winds that have take the power out all over town. Wind chill -20 or so.

We ran on a few slip and falls yesterday and a couple domestics. Nothing says "Seasons Greetings" like kicking the shit out of your spouse.

My other crew did 2 DOAs in the first 10 hours of the shift and then some various BS runs the rest of it. I hate it when people die near the holidays. You know their family will never look at the seasons the same anymore. They will always equate Christmas with death. Fitting? Maybe, I don't know.

My babies wont be home until Christmas morning. I miss them like hell already, but it's good that they get to spend some time with their mother. I'm a firm believer that little boys should be raised by their fathers (if the father is able) but I'm also a firm believer that no one coddles and preens over a child like their mother. My sons have me all the time to keep their butt in line, and they know I love them but around the holiday season I guess it's ok for them to be pampered by mommy a bit.

The girl and I are getting along very well. This in it's self is news because never before in my 35 years on this planet have I had such an easy going relationship. We both respect each others space and personal differences. We even go so far as to accept each other for who we are. I KNOW, WEIRD HUH??!!??! Now if I could just get her to tell me what she wants for Christmas I'd be all set!

Got a call from one of my guys thats also on a volunteer department, he had a pretty bad run involving a whole family. One of the children died. A parent lifeflighted to a trauma center. He was pretty shook up about it. he would never admit it but I could hear it n his voice.

He asked about the usefulness of CISD meetings. I encouraged him to go, and told him if it wasn't enough to come and see me and we'd talk some more. I've been there, and it sucks. I hope he pulls through without being too screwed up. It's hard to get past those calls.

I'm holed up by the computer trying to keep my hands warm. I have the heat jacked up and Oscar (The bird...The Grouch) is singing his damn fool head off. I can imagine him saying "Hey dumbass, if you cold I'm down right frozen here...help a brother out"

Stay warm guys... hats and gloves on every call. You never know when you'll have to play in this shit for 30 minutes or so.

Seeking Acceptance

Lately we have been getting a lot of riders on the squads; some are students, others are members of the community who just want to see what EMS is all about.

I wonder about them sometime, what makes them tick? What do they think about our job? Do they respect us?

We have this kid Ben who has been riding with us for a couple weeks. He just finished up basic school and took his NR practicals. Having found out that he passed them he was on cloud nine. I felt happy for him, remembering how I felt years ago when I conquered that obstacle. I told him that the only thing standing in his way now was a few words on a computer screen. He then asked me if I thought he would make a good EMT. I told him the truth "Time will tell Ben, time will tell". I know it's not the answer he wanted but I thought it best not to sugar coat anything for him.

All of that got me thinking about acceptance and how people crave it. I have been overheard saying "I don't give a shit what anyone thinks as long as my patients are taken care of" I know now that is untrue. I do seek acceptance, as much as it displeases me.

At 35 years old I have done more and saw more than most men in their 70's. I have had jobs in every branch of emergency services and finally settled down to be a full time paramedic. I have owned 4 companies, sold 2 of them, lost 1 in a divorce and went belly up with the other. I worked in the family business for years and I even bar tended for awhile.

Through every job and everything I ever did I think I was seeking acceptance in some form or the other. In the beginning I was trying to redeem myself for being such an awful kid. My father would tell me he was proud of me, but I knew he couldn't care less what I did as long as I didn't embarrass him. I worked for his acceptance for 27 years, and he died without ever giving it to me. I'm not sure I will ever be able to come to terms with that.

When my children were born things seemed to switch for me. I'm not sure anymore if I ever wanted anything more than to make my boys proud of their father and what he does. I see children every day in the course of my job who have deadbeat fathers. Fathers who not only don't help support their kids, but are never around either. I never want to be that kind of father. I want my children to say "That is my Dad, he helps people, he's a paramedic"

We all have to have a driving force behind us and in the end I guess it is a matter of seeking acceptance. Whether you are a new EMT looking for acceptance from your peers or a son looking for acceptance from a father it hurts when you don't get that acceptance. It stings like a bitch and there is really nothing that fills that. If your a strong person you will work harder to get that acceptance if you are easily disheartened it will hurt you for quite awhile. Push on, push on and stay your course. In the end you have to accept yourself first.

So I vow today to be more accepting. I will accept people unconditionally and I will reassure them where I can, but make no mistake... I'll still tell them their an idiot when they deserve that too.

Did you expect any less?

An Old Friend.

If you are in this profession for any length of time you will make some strong bonds with other like minded people. You will learn from them and they will learn from you. You will influence each others lives and never know it happened. We rub off on one another. It's not until years later you realize what an impact they had on your life.

Today I got done with my truck check and wandered upstairs to start the daily paperwork and order supplies for the week when I saw a piece of paper with my name on it tucked under my keyboard. I opened it to find a message from a long lost friend. It listed his name and number and where he was living now with a small note that said "Call Me".

I just sat there for a moment rubbing my head. I thought "No shit, the old guys is still alive!"
I couldn't bring myself to call immediately. I had to basically talk myself into the process. Not because I didn't want to talk to him, not because I was afraid... Because what do you say to someone who unconsciously and unknowingly shaped the clinician you are? How do you tell someone that if not for them, you would be in a very different place right now?

So I sipped on my coffee and tried to rehearse my words before I placed the call. That took all of about 15 minutes and I muttered "Fuck It". I'll just call him.

The phone rang about 4 times and his wife answered it sleepily "Hello?" Shit, it is 8am what the hell was I thinking... Oh well I'm committed now.. "Is Leroy there?"

She heard it was me and her voice changed for a second when she got him on the phone, she remembered me too it would seem.

The first thing out of the old guys mouth was "Hey man, I heard you went to the dark side!" He was referring to me becoming an officer for the company and it brought a smile to my face.

The laughter started then as if it had only been 24 hours since we worked together. We talked about how he was doing and the changes in his life while he inquired about what I was doing now and that he was glad too see I had progressed so far with the company.

We caught up on the children and how they have grown, we discussed dating/being married to younger women and I promptly blamed him for instilling that fancy in my head. It was a light hearted and warm conversation and I enjoyed it very much.

You see, Leroy and I worked together years ago. When he came to work for the company he was at the end of his career and I was at the beginning of mine. He was widely regarded as one of the best paramedics that ever started a line and I was regarded as one of the loudest most obnoxious basic EMTs to ever drive a squad. He was a paramedic instructor and I was defiantly NOT the teachers pet.

I resented him those first few weeks. He was so laid back and mellow, nothing ever got to him and nothing was ever urgent. He would slowly and methodically assess our patients and then make a plan for their treatment. It was far too slow for me.. I wanted the LIGHTS, SIRENS, DRIVE FAST GO GO GO treatment. He was slowing me down.

I don't think I could have been more wrong about anyone. Leroy knew what he was doing, years of experience had proved to him "It's their emergency, not yours". That's just one of the things I learned from him. As I look back through my writing all of these years I realize that Leroy was one of my strongest influences. He taught me a great many things, even if I didn't want to learn them at the time. He was always a reassuring voice in the back of my head when I didn't think I could go any further. Always pushing me forward and forcing me to see the other side of the problem. He forced me to look at things from the patients eyes and not focus on what the book said.

I remember a run we went on in the county once with a 83 year old male that was dizzy and lightheaded. We arrived on scene and the man was flat out refusing to go to the hospital. Leroy hooked him up to the monitor and continued to try and persuade the man to seek medical attention. The man threw us out of the house.

When we got outside we told the fire department to go ahead and leave, we would not be requiring their assistance as the man was refusing care. The patients son was there outside and begging us to do something. Leroy looked at the son and said the following: "Alright sir, I'm going to have to go back in there and tell him like it is. It might sound a little rude but it's the only way I know how to convince him". The Son agreed and Leroy and I went back in. Leroy told the man "Listen buddy, your heart is in trouble. Your going to get up and walk that 4 feet to go poop, your going to sit down, push and die" This convinced the man and we started to load him on the cot when he went into full arrest. We did everything we could to try and bring him back but in the end they pronounced him at the hospital 25 minutes later. I was stunned. Here we did everything by the book. We ran a textbook code and the guy still died. This is where Leroy took me aside and said: "God made paramedics to give him a chance to change his mind" I looked at him in disbelief and he followed it with: "You gotta remember though, he don't always change his mind"

Those words would ring true with me for years following that code and they still are just as true today. I have counseled many new EMTs with the words Leroy said to me that day, and I'm sure I will in the future. Nothing more true has ever been said about why we lose patients in the field. "Your damn right it's not fair" Leroy would say. "If you wanted fair you should have found another job."

I'm glad I reconnected with Leroy, there are still so many things I can learn from him. Now that I see things a bit differently maybe I can take his lessons to heart and use them sooner than later.

In the course of you doing your job and meeting other EMS providers, pay attention. Everyone has something they can teach you if your willing to listen.

Thanks Leroy!