We were running scenarios in my EMT class yesterday. I was playing patient: my "husband" and I had a nasty case of food poisoning from some bad crab cakes. We were sitting at a table when the guy who was running the scenario came in... let's call him Jimbo.
I fake-puked on his feet and apologized profusely.
My "husband" said "I gotta warn you man... I'm explosive outta both ends."
Jimbo put his hands up and immediately walked out of the door and told the instructor: "I'm calling Hazmat. This is CO."
The instructor, the other students and I all got that furrow in our brows.
Instructor: "Hold on a second. You think this is carbon monoxide poisoning?"
Jimbo: "Yes. There's two people sick with flu-like symptoms in the same place. The book says that's carbon monoxide poisoning and that you can't enter."
Me: "We were awake and talking... you could've asked us what was going on you know. Explosive vomiting and diarrhea aren't really signs of CO poisioning."
Jimbo: "Well the book and [main instructors name] says flu-like symptoms... yadayadayadayada... blah blah..." he continued to defend his diagnosis.
The room was silent for a second as the instructor tried to find what to say. She kinda ripped into him. Just a little bit.
They went back and forth for a while. Jimbo's the type of guy that gets ultra-defensive when he gets called on an error, regardless of how minor it is. He won't admit to being wrong without a fight, and when he does admit it he blames it on circumstance or someone else.
We restarted the scenario, but Jimbo was butt-hurt and tried to pass the scenario onto another student. The instructor insisted that Jimbo continue to lead. They went back and forth for a while before he finally agreed to continue.
He started back on the right path... asking questions and surveying the patients and scene. My "husband" excused himself to go to the bathroom to poop.
Jimbo to instructor: "Ok. So I'm going to want him to poop in a bucket so I can take it to the ER."
I couldn't take it. I burst out laughing.
Instructor, with a look of pure disgust: "Why? Why would you want a bucket of poop in your ambulance?"
Me: "Jimbo, can you imagine what the nurse would say if you handed her a bucket of shit? Can you imagine the look on her face?"
Again, a squabble arose, with Jimbo defiantly defending his shit-collecting and the instructor and I raising the points of only needing a tiny tiny bit for hemoccult tests, that the man has explosive diarrhea... he's probably going to give 'em a massive stool sample at the ER eventually, and that bringing in poop will give you the reputation in the ER as "that crazy guy who brought in a bucket of diarrhea."
Oooooh brother.
3.28.2008
From zero to hectic in fifty seconds
So that clinical... the spring-break-grave-trauma... it started off horribly slow.
Like... "no-ambulances-for-four-hours" slow.... like "Everyone-including-the-security-guards-remarks-on-how-strangely-slow-it-is" slow.
For the first 7 hours of my 8 hour shift, I mostly stood around the nurses station. I shot the breeze with a few patients, including an absolutely amazing WWII Marines vet who was at Iwo Jima, among many other battles.
Then magically in that last hour of my rotation, all hell broke loose.
First came a pt that hardcore intentionally ODed on EtOH and benzos. I dropped my first NPA in her, but had to pull it right back out because she became pretty combative. Her BP was insanely low... like 86 / 44 last I checked.
Then came a man whose wife awoke to him seizing... she called 911 and the man became extremely combative with the paramedics who brought him in. Luckily by the time he landed in the ED he was out of the "beat-your-ass" postictal phase and into the "sleepy-drunkish" postictal state.
Then came a boy slumped over in a wheelchair, rushed in by the triage nurse. He was about 15 and drunker then all hell. An acquaintance had driven him from some house party to the front doors of the ED. He's a John Doe, because he's completely unresponsive and the guy who brought him in didn't even know his first name.
Man, that poor kid is going to have a hell of a time when he wakes up. He kept slumping over and moving around.. banging his head on the side rails, he's got a foley, he probably aspirated some vomit, he's going to have the mother of all hangovers, and his parents are going to be mega-pissed. That's a bad spring break right there.
And then at exactly 3:30 AM, the time my rotation was supposed to be over, the first trauma team activation of the night came in. Drunk dude was leading cops on a chase when he crashed his pickup and was ejected. He was banged up but there were no obvious major injuries that I could see.
Poor guy, he was completely alert giving his information to the registrar, when they started placing a foley. I had to hold his legs down. Man, that would suck. I hope if I ever need a foley, I'm as out of it as that OD lady was. When they placed a foley in her she didn't even twitch. Mr. Police Chase, however, definitely felt it.
I bet he learned his lesson. The next time he gets shit-faced and runs from the cops, he'll wear his seatbelt.
Like... "no-ambulances-for-four-hours" slow.... like "Everyone-including-the-security-guards-remarks-on-how-strangely-slow-it-is" slow.
For the first 7 hours of my 8 hour shift, I mostly stood around the nurses station. I shot the breeze with a few patients, including an absolutely amazing WWII Marines vet who was at Iwo Jima, among many other battles.
Then magically in that last hour of my rotation, all hell broke loose.
First came a pt that hardcore intentionally ODed on EtOH and benzos. I dropped my first NPA in her, but had to pull it right back out because she became pretty combative. Her BP was insanely low... like 86 / 44 last I checked.
Then came a man whose wife awoke to him seizing... she called 911 and the man became extremely combative with the paramedics who brought him in. Luckily by the time he landed in the ED he was out of the "beat-your-ass" postictal phase and into the "sleepy-drunkish" postictal state.
Then came a boy slumped over in a wheelchair, rushed in by the triage nurse. He was about 15 and drunker then all hell. An acquaintance had driven him from some house party to the front doors of the ED. He's a John Doe, because he's completely unresponsive and the guy who brought him in didn't even know his first name.
Man, that poor kid is going to have a hell of a time when he wakes up. He kept slumping over and moving around.. banging his head on the side rails, he's got a foley, he probably aspirated some vomit, he's going to have the mother of all hangovers, and his parents are going to be mega-pissed. That's a bad spring break right there.
And then at exactly 3:30 AM, the time my rotation was supposed to be over, the first trauma team activation of the night came in. Drunk dude was leading cops on a chase when he crashed his pickup and was ejected. He was banged up but there were no obvious major injuries that I could see.
Poor guy, he was completely alert giving his information to the registrar, when they started placing a foley. I had to hold his legs down. Man, that would suck. I hope if I ever need a foley, I'm as out of it as that OD lady was. When they placed a foley in her she didn't even twitch. Mr. Police Chase, however, definitely felt it.
I bet he learned his lesson. The next time he gets shit-faced and runs from the cops, he'll wear his seatbelt.
3.26.2008
Spring break grave at a trauma 1
Tomorrow I work a graveyard shift clinical at a busy trauma 1: 7:30 p -3:30 a. Seems like a good shift to catch some MVAs, considering it's spring break and I'll be there while the bars are closing. I have yet to see serious trauma while on a clinical, so I'm pretty excited. Not that I want anyone to get hurt, I just want to be there when it inevitably happens.
I'll let you know how it goes. Don't expect too much, though. You know how fickle the Trauma Gods are. It may just be another shift of endless piles of old men with pneumonia.
I'll let you know how it goes. Don't expect too much, though. You know how fickle the Trauma Gods are. It may just be another shift of endless piles of old men with pneumonia.
3.23.2008
The best pieces of advice I have received so far
1. It is not your emergency.
2. Always look ahead of you, behind you, above you, around you and below you.
3. If its warm, wet, sticky and someone else's, don't touch it.
4. Never forget that you are first and foremost a provider of care.
5. Check your gear religiously and thoroughly.
6. Sleep, pee and eat at any given opportunity, because it may be hours before you have that opportunity again.
7. Don't recap needles, get in the firing path of an airbag, piss anyone off, or put water on burning magnesium.
8. Anyone can be combative. Even your sweet lil' grandma can rip through kerlix and beat your ass given the right conditions.
9. Your status as an officer is secondary to your status as a regular member.
10. People do not always go missing during normal business hours; in fact they usually go missing at 2 am.
11. Don't drink and drive. Don't drive tired. Don't use lights and sirens unless you absolutely have to. Everyone else on the road is a complete moron that will hit you given the chance.
12. Learn Spanish.
13. 5% of EMS is about saving lives. The other 95% is about frequent fliers, paperwork, drunk idiots, drugged-up idiots, sober idiots, toothaches, headaches, pneumonia, cleaning up poop/vomit/urine/etc, and anything else boring, disgusting, and/or ridiculous you can imagine.
14. Document everything.
15. Sick kids should always scare the shit out of you, no matter how "okay" they look at the moment.
16. Priorities, greatest to lowest: yourself, your partner/team, the patient, family, bystanders.
17. Always have at least one way out of any location.
18. You will have to save the lives of people who probably don't deserve to live.
19. Always prepare for the worst case scenario.
20. This is the hardest job you will ever love.
2. Always look ahead of you, behind you, above you, around you and below you.
3. If its warm, wet, sticky and someone else's, don't touch it.
4. Never forget that you are first and foremost a provider of care.
5. Check your gear religiously and thoroughly.
6. Sleep, pee and eat at any given opportunity, because it may be hours before you have that opportunity again.
7. Don't recap needles, get in the firing path of an airbag, piss anyone off, or put water on burning magnesium.
8. Anyone can be combative. Even your sweet lil' grandma can rip through kerlix and beat your ass given the right conditions.
9. Your status as an officer is secondary to your status as a regular member.
10. People do not always go missing during normal business hours; in fact they usually go missing at 2 am.
11. Don't drink and drive. Don't drive tired. Don't use lights and sirens unless you absolutely have to. Everyone else on the road is a complete moron that will hit you given the chance.
12. Learn Spanish.
13. 5% of EMS is about saving lives. The other 95% is about frequent fliers, paperwork, drunk idiots, drugged-up idiots, sober idiots, toothaches, headaches, pneumonia, cleaning up poop/vomit/urine/etc, and anything else boring, disgusting, and/or ridiculous you can imagine.
14. Document everything.
15. Sick kids should always scare the shit out of you, no matter how "okay" they look at the moment.
16. Priorities, greatest to lowest: yourself, your partner/team, the patient, family, bystanders.
17. Always have at least one way out of any location.
18. You will have to save the lives of people who probably don't deserve to live.
19. Always prepare for the worst case scenario.
20. This is the hardest job you will ever love.
3.20.2008
50 years and still searching... What a half century of SAR looks like.
Our SAR team was founded in 1957... the second team in the state. Here's some then vs. now for you. Notice the addition of girls to the team... that happened in the early 90's. Now half of the Officer Staff is female, including the Captain and myself. Some of these pictures may be from as early as 1957.
By the way, notice those ugly white helmets? It seems that at one point they were required for like... everything. Going on a line search? Wear a helmet. Treating a victim? Wear a helmet. Securing the perimeter at a crime scene? Better wear your helmet!
On second thought, it may not be a bad idea for us to re-implement that rule, considering the completely freakish number of concussions a particular member has acquired in a short amount of time doing relatively non-dangerous activities.
By the way, notice those ugly white helmets? It seems that at one point they were required for like... everything. Going on a line search? Wear a helmet. Treating a victim? Wear a helmet. Securing the perimeter at a crime scene? Better wear your helmet!
On second thought, it may not be a bad idea for us to re-implement that rule, considering the completely freakish number of concussions a particular member has acquired in a short amount of time doing relatively non-dangerous activities.
3.18.2008
Speaking of pediatrics...
Here's my accomplishment of the year, and a reminder to CHECK YOUR GEAR:
I'm in charge of medical inventory for my search and rescue team. My first run-through of our 3 gigantic emergency care backpacks was pitiful. Broken 02 regulators, missing c-collars, and the worst find: the single BVM in one of the packs was completely broken and non-functional.
Imagine sitting beside an apneic patient on the side of a mountain 6 hours from civilization and desperately trying to assemble a broken BVM.
Anyways, I noticed that we were only carrying 1 pediatric c-collar and 1 pediatric non-rebreather in each pack, although we had plenty of infant and pediatric-sized equipment stored away. I also noticed that one of our packs would be impossible to bring back up to par... for adults.
Inspiration struck; let's turn the crappy e-care pack into the team's first pediatric pack. And so it was born: a pack filled with pediatric and infant c-collars, NRBs, BVMs, BP cuffs, etc, etc. Now I feel I can treat a kid with our supplies with confidence.
(By the way, that BVM looked totally fine, until I tried to assemble it. This just illustrates how important it is to check your equipment thoroughly instead of just giving it a glance-over)
I'm in charge of medical inventory for my search and rescue team. My first run-through of our 3 gigantic emergency care backpacks was pitiful. Broken 02 regulators, missing c-collars, and the worst find: the single BVM in one of the packs was completely broken and non-functional.
Imagine sitting beside an apneic patient on the side of a mountain 6 hours from civilization and desperately trying to assemble a broken BVM.
Anyways, I noticed that we were only carrying 1 pediatric c-collar and 1 pediatric non-rebreather in each pack, although we had plenty of infant and pediatric-sized equipment stored away. I also noticed that one of our packs would be impossible to bring back up to par... for adults.
Inspiration struck; let's turn the crappy e-care pack into the team's first pediatric pack. And so it was born: a pack filled with pediatric and infant c-collars, NRBs, BVMs, BP cuffs, etc, etc. Now I feel I can treat a kid with our supplies with confidence.
(By the way, that BVM looked totally fine, until I tried to assemble it. This just illustrates how important it is to check your equipment thoroughly instead of just giving it a glance-over)
To peds or not to peds?... that is the question.
I love kids. Naturally, the thought of specializing in pediatric EMS/trauma has crossed my mind many, many times.
I wonder if I could deal with it, though. Could I really wake up every morning for work, knowing that the day will bring abused and neglected children, dead babies, and innocent kids in horrific pain? How could I ever tell anxious, desperate parents that their child is just not going to make it? How could I look into the empty eyes of a child whose short life has already been shattered by a traumatic brain injury?
I don't know. It sure as hell wouldn't be easy. But all of the reasons that make me unsure if I could handle the emotional gore also make me want to dive in and try to make a little difference.
I wonder if I could deal with it, though. Could I really wake up every morning for work, knowing that the day will bring abused and neglected children, dead babies, and innocent kids in horrific pain? How could I ever tell anxious, desperate parents that their child is just not going to make it? How could I look into the empty eyes of a child whose short life has already been shattered by a traumatic brain injury?
I don't know. It sure as hell wouldn't be easy. But all of the reasons that make me unsure if I could handle the emotional gore also make me want to dive in and try to make a little difference.
3.14.2008
Stupid answers
I was using the workbook for my EMT class when I couldn't help but notice how stupid some of the potential answers for multiple choice questions are. Here are some gems, stated as a complete sentence, with the answer portion bolded. Comments in parentheses.
When a patient begins to vomit, it is essential that you have a blood pressure cuff ready to go at the patient's side.
To determine a patient's skin temperature, the EMT-B should listen carefully with a stethoscope.
During the assessment of an infant or child patient avoid eye contact at all times.
(that's how they consume your soul)
If a patient stands in a corner of the room with fists clenched and screaming obscenities, you should challenge the patient in an attempt to calm him.
When suctioning a newborn insert the syringe about 22 inches into the baby's mouth.
(You'll know you've done it correctly once you penetrate the skull and see it coming out the back of the head.)
When a patient begins to vomit, it is essential that you have a blood pressure cuff ready to go at the patient's side.
To determine a patient's skin temperature, the EMT-B should listen carefully with a stethoscope.
During the assessment of an infant or child patient avoid eye contact at all times.
(that's how they consume your soul)
If a patient stands in a corner of the room with fists clenched and screaming obscenities, you should challenge the patient in an attempt to calm him.
When suctioning a newborn insert the syringe about 22 inches into the baby's mouth.
(You'll know you've done it correctly once you penetrate the skull and see it coming out the back of the head.)
3.09.2008
A lovely day of SWAT training
The Cap'n and I headed out to the boonies today to play in SWAT trainings. This was my second SWAT training experience, but last time we were working with the new guys and no TEMS (tactical EMS) medics. This time we were playing with the seasoned SWAT officers and three TEMS medics.
So this is how their trainings work for us... we show up at some strange location and basically play paintball with the SWAT team. It pretty much rocks. Today we were in a big field and I played the daughter of a crazy man screwing up the DNC by wielding a knife and parking in the middle of the road with his two kids in the back, the getaway driver for a pair of bank robbers, and a hooded hostage.
I was hoping to get shot by one of their special paintball/bullet things because on Tue. I'm playing patient for a paramedic class and I wanted them to freak out if I was a trauma pt. and they had to strip me down and see huge welts... I figured it would add to the realism. Unfortunately I was only shot once in the back by one of the bank robbers and I was wearing a bullet proof vest at the time so I didn't even feel it.
So this is how their trainings work for us... we show up at some strange location and basically play paintball with the SWAT team. It pretty much rocks. Today we were in a big field and I played the daughter of a crazy man screwing up the DNC by wielding a knife and parking in the middle of the road with his two kids in the back, the getaway driver for a pair of bank robbers, and a hooded hostage.
I was hoping to get shot by one of their special paintball/bullet things because on Tue. I'm playing patient for a paramedic class and I wanted them to freak out if I was a trauma pt. and they had to strip me down and see huge welts... I figured it would add to the realism. Unfortunately I was only shot once in the back by one of the bank robbers and I was wearing a bullet proof vest at the time so I didn't even feel it.
3.03.2008
Oh my god.
I was adopted at birth. My birth mother was 16, and my birth father was 18. My birth father worked with a man whose wife was rendered infertile by some investigative IUD. So an arrangement for an open adoption was made. I was adopted at birth, and my parents were always extremely honest about the adoption. There was never a point in my life that I did not know I was adopted, and I coped with it extremely well.
Fast forward to now. On Friday I was on the 6 pm news because the DMV is screwing me over. My entire birth family, including my birth mother, saw me. Her parents called my dad while I was at work. They were elated. They want to meet me. My birth mother wants to meet me.
Here's the kicker....
My birth mom is a nurse.
Can you believe it?
Fast forward to now. On Friday I was on the 6 pm news because the DMV is screwing me over. My entire birth family, including my birth mother, saw me. Her parents called my dad while I was at work. They were elated. They want to meet me. My birth mother wants to meet me.
Here's the kicker....
My birth mom is a nurse.
Can you believe it?
3.01.2008
The Most Dangerous Thing I've Seen Someone Do.
One time I was at a house party. We were in the backyard and the homeowner noticed that some of his trees' branches were resting on a power line, and he commented that he should cut the branches soon.
"No problem! I'll do it right now! I'm an arborist," replies random extremely stoned and wasted hippie.
So the wasted/stoned arborist gets a chainsaw, climbs the tree about 20- 30 ft., and starts cutting the branches.
Hmm... a very intoxicated man climbing a significant height and operating a chainsaw within close proximity to a power line.
He was fine.
"No problem! I'll do it right now! I'm an arborist," replies random extremely stoned and wasted hippie.
So the wasted/stoned arborist gets a chainsaw, climbs the tree about 20- 30 ft., and starts cutting the branches.
Hmm... a very intoxicated man climbing a significant height and operating a chainsaw within close proximity to a power line.
He was fine.
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