Partners

It's been awhile. I'm not sure if I have returned to vent or to actually try and express some of the frustration I have been feeling lately. No matter I guess; I'm here now.

You ever stop to notice that it's not just the patients that you make a difference (or indifference) with in your day to day dealings? I mean, we like to think that we are in this job to preserve life but in the end we also leave a considerable mark on those around us. Some of them are patients, some are not.

Partners

One way or the other if you work with someone long enough there is a transference of both attitude and personality (not to mention skill level) between you and your partner. I have written many a blog post about grizzled old paramedics that I have learned a trick or two from. It wasn't until a few months ago that my wife pointed out to me that I WAS in fact a grizzled old paramedic now.

I guess it just crept up on me. I never saw it coming, then one day WHAMO....shit.... you've been doing this a long time. What stories are people telling about you? How did you affect the lives of the people around you? What did someone learn from you? What legacy are you leaving to the NEW group of practitioners?

One person comes to mind when I think about how I might have influenced a younger, less experienced EMT. You know me I never name names, just not polite.

I got this guy as a partner straight from his basic program, he was young, eager to learn and a cracker jack basic. Many times I had to reel him back in on things, but at the end of the day we saw pretty much eye-to-eye on most calls. He would ask questions when he needed answers and I'd do my best to answer them or at least point him in the right direction for answers. It wasn't long before he decided to go to intermediate school, it seemed almost effortless for him. He had a question or two from time to time but in the end he did very well and his experience on the truck gave him a good foundation to build upon his basic education.

After he got his intermediate card he immediately stepped up his game. There was very little coaching from me. He did very well under his scope and knew most of my scope as well. We were able to work seamlessly in the back of the truck. People would often comment about that fact that we would almost never speak to each other during a critical call. Talking to the patient was important to us, but getting the job done didn't require any delays. We had worked together for almost 2 years and we KNEW what each of us were going to do. Conversation with anyone but the patient was unnecessary.

I could see his mind growing past his scope though and it wasn't long before he was in medic school. This time around his training was more difficult for him, but he always asked questions when he didn't know and he pushed right along to graduation day. I was so proud of him when he walked in and passed registry. 3 years had passed and I watched this young EMT really refine his art. It almost like a father watching his son graduate college. I suppose I felt just as much a sense of accomplishment as he did. It wasn't just that HE made it... It felt more like WE made it.

A couple months later staffing changes forced us on to different trucks. A month after that he never showed up for work again. 30 days later he went to work for another company. I felt betrayed. I felt like I had invested so much to have him just walk away without even so much as saying goodbye (not to mention 2 weeks notice). The rumor mill was spreading that he didn't like the people he was reassigned with and he wanted his own truck. Well, I guess he got it.

So I fumed over this for 4 months. I was always polite when I saw him out with the other company but I never stopped to have much of a word with him. I don't know if I was more angry about the switch to another company or just the fact that he left at all.

I ran across his profile on Facebook. Just for old times sake I start poking through some of his pictures then I noticed his favorite quotation.... It was something I had told him over and over during his time riding with me.

I made an impact on him, and in the end I guess thats all that matters. We all move on in one way or the other, it sucks, but it's life.

Death a collection of scars.

It's a fact of life, that life ends. From the moment we are born we begin the process of dying, it's not a mystery and it is not avoidable. You are born, you live, and you die and along the way you give and get a few scars.

I can run on a DOA of a senior and not even batt an eyelash. It's so common place that you have to remember to be sullen and mournful while in the presence of the family. I guess my brain justifies it as "They had a good long life." To tell you the truth I'd be hard pressed to remember the name or even location of the call. I'd have to read my report to refresh my memory, but it leaves a small scar on me.

With that said, while you're all thinking I'm some cold heartless bastard, I can remember the name, age and face of every person I ever came across DOA or worked in vain that was under 70. I don't know why 70 is the magic number for me, it just seems to work out that way. It's not like someone dying at 71 is any less a tragedy, but my brain just doesn't process it the same way.

The others haunt me sometimes. I'll dream of them and wake up in a cold sweat. I'll close my eyes and vividly recall every single action I took on the scene. I'll hear and feel the screams and sorrow of the family. My heart will start racing again just as if it were that day. I can't escape them and honestly I don't think I want to. They keep me centered, oddly enough. The ones that we lose can teach us much more about ourselves than the ones we save. Can you remember the last 20 patients you "saved" (treated, etc..)? I can't, but I can remember all the ones I lost. I know what I did, how I felt, how the patient presented. I can recall all of my treatment and could probably tell you pretty close to 100 percent on how I wrote the report. The same goes for the DOA's. I can tell you how the house looked, how we determined death, who I called, who was there from the family and who arrived later and pretty much what time they got there. The scars from these calls run deeper.

Then there is my personal nemesis, the 30 somethings. I'm a 30something and when one of them buys the farm I can't shake it for months. Probably some sense of self preservation or something but it scares the hell out of me when someone my age punches their ticket. I have shit to do, I'm not ready to check out, but whenever a 30 something dies I always think "That could have been me". So then my brain goes into "justification mode". I try to find a reason that person died: drug use, poor driver, no seat-belt, alcohol, bad genetics, non-compliance with prescribed meds. Really, anything I can try to explain why this person died. It's all just a ploy though, when your number is up....your number is up. These scars are noticeable.

Kids are the worst. I imagine they are for everyone in this profession. Let me be clear, it's not the absence of life in the child that damages me the most. It's the sound of a parents weeping, like their soul is being ripped from their chest. There is no worse sound in the world than a mother or father crying over the loss of a child. It will burn it's self into your consciousness and sub-consciousness and you will never remove it. No amount of therapy or booze will help, don't bother with it. Maybe you would have to be a parent to understand. These are deep vicious scars that are ragged and ugly.

Death scars us all, no matter how tough you are.

Paramedics are a collection of scars. Cherish them all, they once were a life and will continue to live on through you.

Where to start...?

Sorry, it's been awhile since I have posted. Things have become crazy in my life and I was also introduced to facebook.

In June I got married to a wonderful gal and was promoted to station captain. Things took a bit to smooth out around the station but we are running like a well oiled machine now. Private EMS is still private EMS.. it has it's ups and downs, you just hold on for the ride and make the best of every situation and every call.

A few months ago they restructured the emergency room. They replaced all the ER technicians with paramedics and I picked up a part-time job there too. I must say that I find that very enjoyable. On the squad you get to be a paramedic 5-6 times a day; but in the ER you get to function as a paramedic for 12 hours in a row. It's a great way to keep your skills polished and learn a lot of new tricks from the ER docs.

I'm still teaching EMS too, so some weeks I work over 120 hours. I feel it's worth it. I'm trying to save as much money as I can now so I can relax later.

Balancing work time with family time is always challenging but I'm doing the best I can.

Stay safe out there guys!

It shouldn't be easy...

My next few comments may be a bit sensitive. I apologize in advance for them, but they are my true feelings and in the spirit of open discussion I will post them now. They are not pointing fingers at anyone. They are general remarks.

Do not be a "Bare Minimum" provider. Do not be a "Fast Food" provider. Do not be a "Good Enough EMT"
We have already dumbed the system down quite a bit from what it was 10 years ago. Many of my friends who have been medics much longer than I spoke of a text for Paramedics titled "You the ER Physician". We made it easier so more people would do it. I think that was a mistake.

We have cut too much already, we have made the system and the testing easier for people to pass and as a result of this we have some pretty crappy providers on the road. This is also one of the reasons we cant get better reimbursement as a health care profession. It's also a reason why we are not taken as seriously as we should be.

Not everyone should be an EMT. Volunteer or not, some people just do not have the aptitude for the work, they don't work well under pressure etc. All we accomplish by making the system easier is a type of EMT that you wouldn't want attending to your loved one. You can teach ANYONE to pass registry, but the cold hard truth of the matter is not everyone should. There is a big difference between book knowledge and actual working knowledge.

I don't care what your level is. A solid understanding of the human body and how it works is essential to being a good provider. Yes, there are areas you can stress and areas you can gloss over but all of these areas are very important to the rounded knowledge of a "Good" clinician. You can skate with "Just Enough" to pass the class and still get your card; but honestly, is that the type of EMT you want treating you?

*My Disclaimer*

The preceding post was not a reply to anyone. If you take offense to it your most likely one of the people I'm talking about. If you skin is actually that thin, find new work.

Ass Whoopin' Needed

YOU HAVE GOT TO SEE THIS http://www.youtube.com/watch?v=Gkaq9o_qe1M

By Carlos Miller
An Oklahoma State Trooper pulled over an ambulance on its way to the hospital Sunday, resulting in the police officer placing a chokehold on a paramedic as a patient lingered in the back.

It was all caught on video by the patient’s son, who was following in another car.
The officer was apparently upset that the ambulance did not yield for him.
However, it is evident that the ambulance had a real emergency on its hands, unlike the cop, who had been speeding towards some incident he was able to resolve in minutes, enabling him to refocus his attention on the ambulance.

The incident marks the second time this year that a police officer pulled a vehicle over as it was clearly on its way to a hospital for an emergency.
Paramedics say they were rushing a woman to the hospital who had suffered heat exhaustion when they noticed the trooper traveling at a high rate of speed behind them. They say the trooper had its emergency lights on but had its sirens off.
The driver of the ambulance did not notice the trooper until it got right behind him. He pulled over allowing it to pass. Through his microphone, the officer allegedly said, “You should consider checking your rearview mirrors.” The driver of the ambulance said he responded by lifting his hands in bewilderment.

Three blocks later, the trooper was seen pulling out of a side street - apparently having addressed his emergency or having picked up a female passenger - and pulled the ambulance over.

At first, paramedics thought the woman in the passenger side was having an emergency.
According to the paramedic’s transport incident report: The officer got out of his vehicle in a state of rage. He approached my partner and yelled, “Get your ass back here. I am giving you a ticket for failure to yield.” He also added, “What do you mean flipping me off?”

The trooper wanted to cite the driver of the ambulance but the other paramedic insisted on driving the patient to the hospital first, then allowing the driver to be cited.
The trooper then told the second paramedic that he was under arrest for obstruction and attempted to grab the paramedic’s arm. But the paramedic reminded him that it was a felony to assault a paramedic in the line of duty, especially when he needs to transport a patient to the hospital. They struggled briefly before the paramedic was able to hop in the back of the ambulance to tend to the patient.

By that time, another trooper had pulled up and started banging on the side of the ambulance, telling the paramedic that he was under arrest for assault. The paramedic stepped out of the vehicle and another struggle ensued - this one caught on tape - which resulted in a cop grabbing the paramedic in a vise-like-grip around his neck.

The officers finally allowed the paramedics to transport the patient to the hospital where they planned to arrest the paramedic. But then they finally got smart and contacted the district attorney, who insisted on reviewing the evidence before filing charges.
Police say they have their own version of the truth that was recorded by their dashboard cam. Of course they are refusing to release it.

At one point in the hospital, the trooper told the paramedic that he was so enraged about the perceived “flipping off” gesture that he considered pulling his gun out and using deadly force, according to the paramedic’s transport report.


Clearly this cop was WAAAAAYYYY over the line here and needs to evaluate his position within the scope of things. He would be better suited serveing fries at McDonalds.

I can tell you one thing for sure, he and I would be meeting off duty to "discuss" how he treated me.

If your in this business....

I started catching up on the comments of this blog today. Lots of people I never got a chance to respond to over the years. In the course of doing that I re-read a lot of my old posts and noticed that I used the phrase: "If your in this business any length of time" quite a few times. It struck me as odd at first that those were he only words repeated often. Then I came to the following conclusion. IT FITS.

If your in this business for any length of time you will...
notice that your call volume increases sharply and proportionately to the las time you took a piss.

If your in the business for any length of time you will...
get screamed at for taking too long to get there, even though no one moved out of your way.

If your in this business for any length of time you will...
know what it feels like to wear the same underwear for 48 or more hours.

If your in this business for any length of time you will...
know the pain of a complete stranger crying on your shoulder.

If your in this business for any length of time you will...
feel wracked with sadness over telling a parent their child is dead

If your in this business for any length of time you will...
eat from every single fast food restaurant in your area.

If your in this business for any length of time you will...
miss your children's plays and sporting events, not to mention special evenings with your spouse. You will cancel and re-schedule appoints almost monthly.

If your in this business for any length of time you will...
respond to find a friend or family member seriously injured or deceased and your the only truck available.

If your in this business for any length of time you will...
see a near complete turnover at your station, leaving you feeling alone and with strangers.

If your in this business for any length of time you will...
see new EMTs burn out and fade away even before their carrer starts, due to one bad run.

If your in this business for any length of time you will...
witness the miracle of life and the sadness of death all within 24 hours.

If your in this business for any length of time you will...
find your boots fit differently at the end of the day because your feet are swollen from all the walking.

If your in this business for any length of time you will...
learn to eat when you can and never miss a chance to take a leak.

If your in this business for any length of time you will...
know the difference between: mostly dead, almost dead and dead.

If your in this business for any length of time you will...
opt to work when your sick and save your PTO for "Important" things.

If your in this business for any length of time you will...
learn from someone everyday and teach others without knowing you did it.

If your in this business for any length of time you will...
be constantly reminded to lift correctly, but still lift incorrectly and suffer back bain almost 50% of the time.

If your in this business for any length of time you will...
ruin at least 2-3 perfectly good relationships, but replace them with stronger bonds than you ever thought possible.

If your in this business for any length of time you will...
notice that most nurses don't even listen to your report.

If your in this business for any length of time you will...
see at least 10 patients more than 10 times each per year. They will start calling you "friend"

If your in this business for any length of time you will...
stare blankly when someone approaches you in the mall rattling off a call you were on that helped them. You will struggle to remember the details.

If your in this business for any length of time you will...
measure your payment in the smiles you recieve from little old ladies, they know someone cares. (JS)

If your in this business for any length of time you will...
sit behind your computer and write lists of shit that occured to you...

There are literally hundreds more I think of day to day but forget to add here. Please leave a comment and I'll keep editing this post until we have covered as many as we can think of. I need to start carrying a tape recorder, lol.

Take care guys, stay safe out there.

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.