Moral Support

I came across a wreck on the way home from medic school today. I pulled over and checked everyone out. No major injuries, just a mother and grandmother worried about the safety of their newborn. They were understandably nervous, but thank God that they actually had the little guy properly restrained. The grandmother was thanking me and gave me a hug before I had her sit down and keep still. Once local EMS arrived, I helped secure everyone and load ‘em onto the rig.

When I got home I started thinking, I always hear people talk about looking for the “big one.” That one crazy wreck or event when all hell breaks loose. I admit I have been guilty of hoping to see some bad stuff at times, but I realized today that I was even more happy just to be a guy there for what amounted to emotional support and reassurance. I know that time will do its best to strip this empathy from me as I have seen it do to others, and I hope it is not naïve to think I can avoid it.

Too often we see medics and EMTs render physical aide but withhold emotional support. I find that weird because a majority of calls are not major, and emotional support is probably the only thing the patient really needs. People are not used to being in/seeing the things we see, so it is understandably jarring to be involved in a wreck or have chest pain, etc. We know that it is minor, and far too often we do a poor job at relaying that information.

I know that there are many EMTs and medics that are supportive in a human way, but I also see those on the edge of burnout that are just plain mean. I guess what I am trying to say is that I hope I never become one.

P.S. My arms look like I have been shooting drugs for the last week from IV practice. My veins are seriously praying that my classmates and I get proficient enough to stop practicing on one another. =)

Almost...

Well, I went to paramedic orientation the other day, and it was a world away from basic orientation. Everyone that was there seemed much more...professional. No one was browsing porno on their cell, asking the instructor if guns are allowed, or brushing their teeth while instructors spoke (seriously, we had a guy do this on a daily basis before being removed from basic school). I met a few of my fellow classmates and they seem like a great bunch, I am excited. At this point I feel as though I have been blessed, seriously, what are the chances of getting zero douches in your class?

Then he walked in… I have only met him on one day prior to this, and that was enough. He is the type that feels as though he is qualified to stop the instructors and interject his own opinion and must always question why it was not done as he would have done it. This particular trait is annoying enough, but the first kicker is that he feels the need to stand up and practically yell, the second kicker is that the 2 times I have seen him do this, his question had already been answered a few short sentences earlier, clownshoes.

I am not all that upset by him, I just have nothing else at the moment to write about.

Anat and Phys

I tried to sign up for anat and phys in college a few years ago, but it was already full. I took chemistry instead, which is also pretty cool stuff. I figure I would just take it in a community college summer course prior to the start of the paramedic academy. Holy shite, they want $800 for it plus lab plus books! The problem is that I live (by a few streets) out of district, which just about doubles my tuition. Scratch that idea...

I decided that I would just buy some books and do some reading on my own. Sure, it is not as good as a class, but at least it would be helpful. The first one I could find that seemed okay was one of those "idiots guides for anat and phys." Four chapters in, and the only thing the book had accomplished was giving me criteria for youtube searches to better understand concepts that were poorly explained in the book i.e. cellular respiration, cell structures, tissues, etc. Okay, scratch number 2...

Then by an act of god, I found a post somewhere that informed me that the entire semester of anat and phys class had been posted by University of CA Berkeley. SCORE!! I just play one or two 45min classes each night and take notes like I was actually in class. It has been a tremendous help!

For anyone interested, here is the link.

Round 2 of 3

I cant wait!

The Fear is Getting Real Now

I have received my license to work in Texas. I have written a new resume and begun to turn in applications. My preceptor from my clinical rides has helped me obtain an interview at her service, and I am starting to feel a pressure that is unlike the pressure and anxiety I experienced going through basic school. If I screwed up in school, I did not get fired. Not only that, I think people expect less from the students. The truth of the matter is: I am not trained any more than I was when I was doing clinicals. Sure, I passed my exams and national registry test, but I have had no more time on the street.

I find myself worrying about patient care, assessment, driving, skills, reputation, attitude, etc. The mistakes I make are real now. I know that I am not expected to be perfect, but I am starting to get nervous and wondering if I can even reach acceptable in a new employers eyes. At a minimum, I don’t wont to hurt anyone any worse than when I found them. My gut tells me yes, I can excel, but I think it is just human to have that voice in the back of my head saying “what if?”

Now I am just reviewing basic material, preparing myself for the next semester, and attempting to be positive. Why is it that when we learn more, we only have more questions, and things become increasingly uncertain? It is totally counter intuitive…

My First MVA - Part 2

Continued from My First MVA - Part 1

At one point, no one can intubate the guy and the decision is made to place a surgical airway. He is now flatline on the monitor, and I can actually see my preceptor get a little nervous when she says “I have never done one.” They reassure her as they unpack a scalpel and hand it to her. She slices into the guys neck, and gets a tube in him. They start bagging him, and I can see his stomach grow like there is baby developing in timelapse. They re-position the tube and now his chest is rising appropriately.

They ask me to start CPR. I feel blessed, nervous, and excited all at once. I remember hearing instructors say “if you don’t feel like you are breaking ribs, you probably aint pushing hard enough.” So I place my hands on his sternum and compress the hell out of his chest, all the while I am singing (in my head) ah, ah, ah, ah, stayin alive, staying alive, because I remember that the song’s tempo is 100bpm, which also happens to be the rate of compressions per minute for adult CPR. They start pushing the epi and other cardiac drugs and get a decent cardiac rhythm out of the guy, and ask if I want to help put him in the chopper. Umm, hell yes I want to help put him in, that is freakin sweet. (I grew up with a dad heavily involved with helicopters, but they just haven’t lost their awesome factor yet)

After he is loaded up, I am asked to ride with a medic I have never met to the hospital. I get in the back of his rig and see that he has two patients. One is a 5 year old boy who appears to be okay, the other is the zombie that asked me for help earlier in the call, his mental status has deteriorated somewhat. My impromptu preceptor introduces himself, lets me know we have about a 25 minute transport time to the closest trauma center, and then asked if I would do an assessment of the little boy.

Up until this point in my life, I have been generally indifferent to children. I never really knew how to handle them aside from the lame high five maneuver. I introduced myself to the little guy and got to work. Did my head to toe on him (he had actually been declared stable by a medic prior to my arrival, I was just being given practice, I think.) He had a bump on his head, so I just made sure that he stayed awake by talking with him. He didn’t cry or complain, he was a trooper. He asked me how his dad was, and it was at that moment I realized that I had done CPR on and watched his father flatline not five minutes earlier. His dad was my patient that had been airlifted. My heart sank, I had no idea what to tell him, and the only thing I could do was ask him what his favorite cereal was. It was fruity pebbles.

We dropped him off, and I was taken back to my home station. My preceptors had not arrived yet, and everyone else that had been on the call was now playing x-box.

My preceptors returned and ran down the call with me. I was able to ask some questions, and she said I had done well, and the other medic I worked with said I had done well in his rig too. I was beaming, I know it is lame, but I felt like I had met the situation head on, and felt I did well.

My awe of paramedics at this point was off the chart. The accountability they have with peoples lives is nothing short of incredible. I get a sense of the responsibility they have when I read about them, and I thought I understood. Then, I saw them in action and realized that if I want to join them, I really need to prepare my mind and my body, because CPR is much more of a workout than I thought!

I am hooked…

My First MVA - Part 1

Disclaimer: If my postings seem naive and unseasoned, it is because I am indeed naive and unseasoned when concerned with the world of emergency medicine. I think everyone has “first real call” story, the following account is my first real call. It is a lengthy read, but I think you may find it enjoyable, or at least familiar.

It was my second day of basic clinicals, and I was riding with a rural county EMS service. I was incredibly nervous, but my preceptor had been sent from God. She was very empathetic to my situation, and greeted me with the comforting words of “We were all in your position at one point, just stick close, ask questions, and if you get queasy, feel free to head back to the rig.” Nervousness fading, now I am just trying to not get too excited and blurt out questions in front of patients.

By the second half of my second day, I was comfortable with the crew I was working with, I had figured out most of my boundaries, and was on my way to what I hope was a decent impression. The last thing in the world I wanted was to be a run of the mill, brainless, lazy, nuisance that I am sure basic students can be.

We get toned out for a MVA. Cool. I am thinking maybe this will be an interesting call and I can get a chance to see about what we learn in the classroom, and watch seasoned medics do their thing.

As the student, I sit in the back of the ambulance facing backward as we approach the scene. I see a fire engine, then another that have parked and are already on scene. My heart sinks a tad as I realize that I may not have an opportunity to help because these guys know what they are doing and will probably step in. I try and clear my mind and prepare to stay out of the way and do what I am told. I hear the intermediate up front say “oooh, looks like a good one.”

I step out of the back of the ambulance and my general reaction is summed up by “holy shit!” There is a deformed truck shooting flames about 6 feet high about 30 feet in front of me. The gas tank explodes. Jokingly, I say to my intermediate preceptor “scene is not safe.” He laughs then says “get the trauma bag, and meet me over there.” He then points to where firemen have extricated the driver and passenger of the burning truck.

I jump in to the back of the ambulance and grab the trauma bag, and as I am leaving some guy who looks, walks, and talks like a zombie appeared at the back door and says “my friend needs help.” I am thinking, okay shit, this guy needs help of a medic, I can’t find my medic preceptor, and my intermediate preceptor is with another patient. I have him sit down, look him over for any obvious life threats, and then ask where his buddy is as I wave over the approaching ambulance. He points to the other vehicle in the crash, another truck that has obviously hit head on with the burning one. A medic takes charge of this particular guy, and I race off with the bag to find my intermediate preceptor.

As I am running past the non-flaming vehicle I hear my name shouted out. My medic preceptor needs the bag I was taking to the intermediate. I think to myself, she is the in-charge, do what she says and explain it to the other guy later. I get to her and she has me pull out the BVM, then asks me if I am comfortable jumping through the shattered back window of the truck and stabilizing the spine of the man entrapped inside. The window was not quite big enough for the firefighter in full turnout gear, so I jumped in and was immediately surprised by what I saw. Lots of blood, open facial fractures, serious lacerations to the head, obvious mid-femur fracture, and agonal respirations. I hear my medic tell the patient’s friend to talk to him, try and get him to respond. He has a wide eyed look, and she tells him that his buddy might die, and he needs all the help he can get. Surreal.

The smell. This was something I had not thought about before. In school we are focused on pictures in books, and our eyes are somewhat prepared for scenes like this. Never had I thought to myself “hrmm, I wonder what a multi-system trauma victim smells like?” Well, now I know…it was kind of like a really musky sweaty iron scent intermixed with occasional whiffs of the dudes cologne.

Okay, now I am holding a very bloody c-spine, I have manipulated a collar onto him, and am trying to get through to him and get him to respond somehow. They always tell you in class about holding c-spine, don’t let go, etc, and it seems pretty basic. What they neglect to tell you is that in some cases you will be holding c-spine in some god-awful contorted position, balancing your lack of movement with his head so that medics can breathe for him, all the while trying to avoid having your leg pinched by the jaws-of-life. I would say that I was having “fun” by this point, but the harsh reality was that this man was circling the drain. So, fun is not the right word, I was focused and excited.

They get him extracted and we get him in the back of the ambulance. It was at this point that I noticed not one, but two helicopters had landed. How the hell did I miss that?? There are now 5 people in the back of our ambulance and I am in a seat handing out whatever people are asking for, and I am really nervous at this point because I don’t know where/what everything is. There are some points where I have to swallow my pride and just say “I don’t know what/where that is.” It is embarrassing, and I make a mental note to go through the ambulance top to bottom and try to memorize locations and names later. (This probably should have been obvious, but it is only my second day on one.)

I am in absolute awe watching these medics go to work on this guy all the while casually greeting each other. I actually realize the gravity of what it means to be a paramedic, and for the first time I am really wondering if I have what it takes. It was a symphony, and I felt like the uncultured looky-lou, a tourist.

To be Continued…