6.28.2008

The real heroes.

After a while, he got used to me dropping everything and leaving the restaurant/store/party/etc whenever my pager went off calling me to the last seen point of a missing person.

Although he has a weak stomach, he learned to deal with my gory stories, which I recited in vivid detail.

Once he held me and wiped away tears as I cried for nearly 2 hours after hearing the news that hunters had discovered the body of a man we had searched for without success, and that he was likely alive while I was searching.

He grew accustomed to my routine disappearances to the backcountry, which often lasted days with no contact.

He let me practice my assessments and vitals on him.

Although a music industry studies major with absolutely no interest in science or medicine, he pretended to be interested when I selfishly recounted my passionate interest in the pathophysiology of hypertrophic cardiomyopathy and commotio cordis.

He understood that I couldn't always make time for him while I was taking a 30+ credit hour course load, working a part-time job, and on call for SAR 24/7/365.

Even though he was the jealous type and my line of work often put me in close quarters with several men, he tried his best to grin and bear it.

He tried his best to respect the completely unique, incredibly close bonds I formed with others on the team, mostly with guys.

But most importantly, he believed in my dreams as much as I did, sometimes even more so.

It's hard to say exactly why this 3-year relationship came to an end. There's a lot of reasons. I'm sure that the stress my work placed on both of us played a part.

But here's to those folks who love an EMSer and put up with all of the pressure. Here's to those who try to make it work the best they can. Here's to those who have stayed up late night worrying about their loved one while they're out fighting fires or crime or trauma or terror. Here's to the husbands, wives, boyfriends, girlfriends, moms, dads, sisters, brothers, daughters, sons and friends who know that they will never really get "it", but respect "it" anyways.

Thank you.



This post is a part of Normal Sinus Rhythm, a collaborative writing project in which awesome EMS bloggers from all over the country share their experiences/misadventures/whatnot.

6.27.2008

6.24.2008

My Captain's Fall

I follow their swift motions with a wide-eyed gaze, my trembling hand gripping the bloody portable suction unit.

As they package her on the backboard and place her into a litter my radio buzzes with talk of ALS and landing zones and sucking chest wounds.

"Ger her out of here, don't let her out of your sight and don't let her get on that litter," the Chief says as he hands me over to a new babysitter, The Other Lt.

I drop the suction on the ground near the crushed and bloody branches and shuffle past the probationary members who avoid my lost stare. The Other Lt. grabs my arm and guides me down the slope. We walk through the people who have already been set for relief - to rotate people off of the litter carry-out. I shiver and mutter "we should have worn helmets" to myself as we pass, but I do not cry.

A few people who know me well hug me and provide words of comfort that I cannot remember as I pass. I know we have made it to the road when I am blinded by arrays of flashing lights. With short, simple reassuring sentences I am guided into the passenger seat of the Deputy Chief's truck... I feel like a small child.

I am driven back to the mobile command post where a member of the BOD who is also a shrink takes me under her wing and tells me things like "she's in good hands now," "it wasn't your fault," "I'm glad you were there to help her," and "they're going to do everything they can." She wraps a sweater around me and Sgt. V brings me water.

They tell me that she's on the helicopter now, en route to the trauma center. A bonfire has been burning since before the incident and I am huddled around it as members trickle back from the carry-out. I finally start to cry, quietly.

The Chief updates the team on their Captain. Many of the members, even the new ones, are sobbing. He asks me about what happened.

"We were... scouting for scree... scree-evac and she fell." I mutter.

"How far?"

"I... I don't know... I just... 30 feet?"

"Were you wearing helmets?"

I fail to respond because everyone knows that we weren't. I start truly bawling and the new members look on with pity. The Chief gives a little speech about safety. He walks away for a little.

"We have another update on the Captain, but I think it's best that she gives it to you herself..."

The Captain, dirty and "bloody" but grinning from ear to ear comes out from behind a large rock. I run up and give her a high five. She never fell, I just carefully moulaged her and in the dark it's easy to fake bagging someone. The probationary members look bewildered. Some look angry. Some laugh.

For decades my SAR team has done this tradition. Call it cruel, but it has this tendency to bolster the team fast. I went through it last year... it makes you realize how quickly you begin to care for people working with you in this field.

6.18.2008

Scrubbing

She's at least 60... I'll say she's 67 or so. She's chubby and her skin is mottled with years gone by and her wrinkles seem like notches for all of the experiences she's had. Her eyes are simply jovial... curved and sparkling, while her mouth holds onto this constant little smirk. She has that starchy, curly white hair that most old women have, but little bits of it are singed.

She burned down her kitchen today, unfortunately. She left something on the stove and when she came back it was all ablaze. She lives alone, and she tried to fight the fire alone. A neighbor called 911, and the firefighters found her struggling to breath throwing buckets of sink water on the flames.

When they took her to the hospital, they managed her smoke inhalation pretty easily. By the time I met her, she was breathing with ease. Now the concern is her hands. Somehow they got burned pretty badly... and she is diabetic so wounds are more of a problem. I've been called into to scrub the burns.

My preceptor, an ER tech, helps me set up a little sterile field with gauze and a little sponge and a solution of sterile saline and johnson's baby shampoo in a little dish. I dip the sponge in the solution and prepare to scrub the first area... it's 2nd degree on her palm. I am so nervous about causing her pain. I imagine how bad it would hurt and wince. Finally I just start, gently at first, monitoring her facial expressions and voice... but she doesn't make any hint of pain. I realize that they've medicated the hell out her. Thank god. She has this lovely British accent and as I'm scrubbing away little flecks of black, burnt skin she tells me about her hometown.. Liverpool.

It takes over half an hour for me to scrub her burns. I'm meticulous, though. The whole time she is stoic and lively, chatting up a storm and staying cheery. I admire her for that. I bandage up her hands and tell her: "no more fire-fighting, okay?" before I leave.

6.17.2008

Surgeon?

Maybe I could be a trauma surgeon?

I've been damn steadfast about this nursing thing... maybe I decided too fast. I've been warned away from medical school from several friends who have been there, done that... but there is a certain appeal to cutting people open and actually fighting death rather than prolonging it as EMS does (which is of course a noble goal).

I'm the type that finds beauty in the biscuspid, awe in the alveoli, and joy in the jejunum. Anatomy is my God and physiology is my religion. At the cadaver lab, I was right up there... the first one to get my hands dirty... as others stood motionless in the back with a look of shock or left the lab dry-heaving. I'd probably make a good surgeon. I think on my feet and absolutely flourish under pressure. I am detail-oriented and catch things that others don't.

I like the idea of trauma surgery because they so often operate on cardiothoracic and abdominal trauma, which are my FAVORITES. Oh my God, it sounds so weird but I freaking love cardiothoracic injuries. They fascinate me. I think I have scared off more than a few people because I started excitedly discussing stuff like commotio cordis and tension pneumothorax like most women talk about the "Sex and the City" movie or chocolate or shoes. Just the mechanisms and physiological undoings are so intriguing.

Disadvantages... well I'm not so much into the whole medicine philosophy as the nursing philosophy, but from what I've seen trauma surgeons become much more involved in the long-term care of patients than surgeons of other specialties do. They also seem to be more involved in the health care team, working side-by-side with nurses and techs and the likes. But still. Also, most trauma surgeons do general surgery as well, which is like... meh to me. I'd probably enjoy it but yeah, I'm a trauma junkie. I guess I wouldn't mind doing Little Susy's urgent appendectomy at midnight, but you know...

Big advantage: putting in chest tubes. I know, I'm a nerd. I just want to stick a tube in between someone's ribs so they can breathe. Really bad. This is a such a big deal to me that guys from the SAR team call me "Chubs", short for "chubby for chest tubes".

6.16.2008

My First Trauma

I know this is long overdue... it happened about a month ago on an ambulance ride-along.

The day had been busy with fairly routine calls. Take Mr. Jones from hospital A to hospital B. Take Little Susy from the urgent care facility to the real hospital because she has appendicitis. Yada yada yada.

After all of that stuff, I was relaxing on their ridiculously comfy couch watching some stupid movie when we overheard on the radio the local fire department getting called out to a 2 car, 2 motorcycle MVA about 2 miles from the station we were at. The EMT told me to prepare to go on the call. The company I was riding with is private and does a lot of non-emergent transport, but they have a contract with the local fire department to essentially take all the 911 shit that they don't want or can't handle alone.

Within a few minutes, we're called out to the crash. I'm elated. This was the last hour of my last ride-along I had yet to see any MVAs or real trauma. On the short drive over I glove up and slip eye protection into my pocket. My heart is pounding. As we're pulling up I can't see anything because I'm in the captain's chair in the back. The paramedic hands me a traffic vest so large that at least 4 of me could fit into it.

We come to a stop, the back doors open to reveal sunshine and road, and I scurry out. The scene is the typical well-organized chaos... police and firefighters and cones and flashy lights abound, but they're all in order. There's 2 motorcycles laid out in the road... one of them is barely recognizable as a bike.

It's a fairly busy and large intersection but now it's almost completely shut down. Bystanders are gathering in the grass and on the sidewalk, talking loudly and bonding with strangers over their communal witnessing of someone else's tragedy. As the medic, EMT and I walk up they all fall silent and stare. I try to pull the humongous traffic vest back onto my shoulders, but it keeps trying to fall off of me.

My eyes finally locate our patient. The firefighters are all standing around him... one is holding c-spine. By his clothing it is clear to me that he was on a motorcycle, and I'm happy to see that there is a helmet lying next to him and that he has gnarly helmet hair. From a distance I can tell that he is not bleeding, grossly deformed or screaming in pain. Based on the mood and activity of the firefighters I can tell that he is probably not critical.

A firefighter gives us a rundown of what happened. 2 buddies were out riding motorcycles. A car pulled out in front of them and they each hit her. Biker #1 was not wearing a helmet, hit her first at full speed - about 45 MPH -, is in bad shape, and has already been transported by the fire department. Biker #2, our patient, was right behind Biker #1, was wearing a helmet, had time to react and slow down a bit. According to the firefighter he's pretty much okay... just has some crepitus over the clavicle with shoulder/clavicular pain.

The EMT calls me over to help with packaging as the medic and firefighter continue to chat. He hands me a c-collar as I look over the pt. He is middle-aged and looks great for his age... strong features, clean-cut, in good shape. He is exposed from the waist up and I can tell that he is shaking from a distance. A wave of... what it is... mercy? pity? sympathy? Well, whatever it is, it socks me in the stomach and resonates throughout my body. I cannot know exactly how he is feeling, but I do know that he has experienced something awful.

That image... of an injured, trembling half-naked man lying in the grass with firefighters and bystanders gathered around... will never leave me. It's amazing how quickly a moment of impact can steal someone's dignity. It's hard to explain, but that image captures so many reasons why I want to go into this field.

The EMT introduces me.

"This is Lucid. She's a student but she knows what she's doing. She's going to put this uncomfortable collar around your neck to remind you not to move it, okay?"

Moving only his eyes he glances over at me.

"Okay." He half-smiles at me, but I can tell he's in pain.

I size up the collar and place it on him. The firefighters roll him onto the board and strap him down. I secure his head down and they move him into the ambulance.

The hospital is only about a mile away. I ride in the back with the medic and talk to the patient, let's call him Jim, as the medic starts an IV. I ask a few questions about his pain and the accident and his history... I decide not to palpate his clavicle because he says it hurts and it's clearly deformed.

Out of the blue he says... "Rick is in pretty bad shape, isn't he?" It's more of a statement than a question. He knows. He watched his friend crash.

"I didn't get to see Rick. I know he's hurt, but I don't know how bad. He's at the same hospital we're going to, so we'll probably find out more when we get there," I tell him.

Jim registers my answer and stares silently at the ceiling, through his eyes I can see his mind tugging around thoughts. We pull into the ambulance bay and roll him out of the ambulance into a trauma room. The trauma room 2 doors down where I assume Rick is, is buzzing with activity and humming with noise.

The customary information swap amongst the medic and the doctor and the nurses and the registrar and the patient begins as I switch Jim to the hospital's oxygen and make sure he's comfortable. After the doctor does his own assessment, begins his orders and has Jim log-rolled off of the backboard, Jim finally receives some information after giving so much. The doctor tells him that it looks like he simply broke his collarbone so they're going to get x-rays of that and his spine just to make sure everything's okay. Jim doesn't seem to care much. He just asks about his friend.

"Jim, your friend has a pretty bad head injury. We're doing some tests to look at his brain right now and we're doing everything we can, but at this point we don't know what his condition is going to be. Do you have any questions?"

"No."

The doctor and nurses leave the room. I ask Jim if he wants anything.

"Yeah... my cellphone... it's in my pocket. Can you get it out for me and help me call someone?"

I slip the phone out of his pocket. He has me look for a man's name in the cell's phonebook so I scroll through all these people to find it... dial it... and hold the phone to his ear for him because it hurts too much to raise his arm up. They don't pick up so he leaves a message... who was it? His son? Brother? Then we call a woman... I think it was his sister... she picks up and starts heading for the hospital once he tells her what's going on. We call one last person who doesn't pick up. Based on the somber message he left, I think it was someone from Rick's family.

The EMT calls me out of the room, it's time to go. I wish Jim the best for his recovery and Rick's. It's really hard to find the right words. I squeeze his hand as I leave.

As the medic finishes up paperwork in the EMS lounge he tells me what he learned about Rick's condition from the fire medics who transported him and the nurses.

"It doesn't look good... he didn't know his name or anything and apparently he was very combative in the back of the bus. Now he's unresponsive. His pupils were normal on scene but now one of them is blown."



I don't know what happened with Rick or Jim. I'd like to imagine that they both recovered just fine and right now they're back on their bikes, this time both wearing helmets.

6.15.2008

NREMT-B Practical

Yay! I passed my NREMT practical yesterday on the first try for everything. Now I just have to pass the written/computer-based test.

I honestly thought I was going to fail the long spine board station... it was a disaster. It's a skill I'm definitely comfortable with (last week I taught it to 30 probationary members!) but I'm more accustomed to working with a particular type of board with spider straps. In the exam I had to use a particular type of board that I despise and seatbelt straps which I really, really despise. They get stuck under the board and malfunction and get in the way and get stuck up patients butts and are generally a pain in the ass (figuratively for me, literally for the pt).

So I get started on the long spine board exam with one of the more intimidating proctors watching my every move. CSMs go well. I start applying the c-collar but I'm struggling because my "patient" is wearing a massive hoodie and the hood is getting in the way of the collar at every turn. Finally I get it on and it's sized wrong. So I take it off and start over, again struggling with that damn hood. This time I get it right.

Finally he's collared and I'm ready to place him on the board. The proctor and I log roll him and I pull the board up to his back and we roll him back down. He's barely on the board. Okay, let's try it again. We roll him again and I try to get the board up against him but it's really stupidly-shaped so when we roll him on to the board, he's barely on it. At this point I'm sweating, humiliated, and getting into that nervous death-spin cycle, but I know that I just need to do it again until I get it right. So we log roll him one more time, and this time his body and the board cooperate and he is neatly centered on the board.

I immobilize his thorax, pelvis and legs with no trouble, and then I get to the head. I place the head blocks and start trying to tape his head down but the damn tape sticks to my gloves like crazy. Now I'm really frustrated. So I spend all this time fumbling with the tape as it rips my gloves and turns itself into a twisted mass of worthlessness.

Finally I figure it out and place the forehead strip, folding it to be nice to my "patient". As I start taping the chin down I look up and notice that the forehead strap has slipped down conveniently right over my "patient's" eyes. At this point, I want to cower out of the room and sit in a corner for a while, but I don't. I move the tape out of his eyes and apologize and finish the job. I leave the room confident that I had failed and really angry that everything seemed to go wrong and I couldn't seem to get anything right.

The other stations went smoothly but that experience in the long spine board station definitely dropped my confidence a little. I was shocked when I learned that I passed that station, although my instructor did comment that I had stepped over my "patient", which I don't remember doing at all but probably did.

At first I was pissed that all of the equipment "malfunctioned" and all of the circumstances seemed to be stacked against me, but then I realized, hey... that's EMS for you. It's rarely pretty and perfect and things are not always going to go the way they should. Equipment is going to break. Partners are going to be stupid. Patients are going to be difficult.

Anyone can backboard someone in a nice clean little room with plenty of light and a calm patient and all this perfect equipment and a bunch of hands, but EMS will ask you to backboard a screaming, bloody patient who is upside down surrounded by a crumpled vehicle in a ditch while it's raining at night after you have gone without sleep for 2 days and you really, really need to pee.

That stuff cannot be taught in a classroom and while it's intimidating it's also something I'm anticipating. It's a challenge that I want to match my resourcefulness and stubbornness against. I hope I can stand up to it.

6.12.2008

Homicide files

Today I did some undercover work with the investigations unit of the local sheriff's office (sounds much cooler than it is). Things didn't work out exactly as planned so we're going to try again in a couple of weeks.

We (we being my Captain and I) went back to their headquarters to eat afterwards and an investigator gave us a bit of a tour. He showed us where they keep all of their major case files... most of them homicides. He had to return to his desk to work on some stuff but he told us we could look through the files for a little if we wanted.

These files are amazing. They are gigantic binders, often 2-3 for each case, filled to the brim with crime scene photos, autopsy photos, dialogs, test results, comprehensive personal histories of suspects and victims, and much more. They really capture and tell the story of a murder from many different angles.

There was the elderly woman who lived in the ghetto, but was a grandmother figure to many. She had no children but had lived with and taken under her wing an autistic adult for 10 years. She was willing to help anyone who came to her needing it.

One day a neighborhood crackhead came to her and asked for $20. She refused, and the crackhead got angry and bludgeoned the poor innocent old woman to death with a hammer. The autistic adult, who was basically this woman's child, was found sitting next to the old woman's battered body.

Yes, they did track down the crackhead, who confessed and is now serving a life sentence, thank God. I can't comprehend senseless violence, really. Some violence I can understand, but I guess this is the type of act only a crackhead could wrap his head around.

There was also the strange case of the husband, wife and daughter who entered a suicide pact together one day and all took a bunch of pills. The daughter died first, and then the husband and wife entered a semi-coma. When the husband came to and realized his wife was still alive, he shot and killed her.

Such a strange concept. Suicide pacts are nothing new... but with your own wife and daughter? So sad.

I wouldn't mind being a cop if I could put creeps like this behind bars on a regular basis.

6.11.2008

Ponderings about c-collars


Excuse me, but does Laerdal StifNeck (a company that makes adjustable cervical collars) employ giraffes exclusively? According to them we are all a bunch of fat short freaks with no necks. I'm sure many of you EMS'ers have picked up on this and have had a chuckle or two over it, but I'll explain this for everyone else.

Laerdal StifNeck Select collars have 4 neck height settings, from tallest to shortest: Tall, Regular, Short and NoNeck (a size name they have trademarked). The ironic thing is, almost everyone is a short or a "NoNeck". Excuse me Laerdal, I have a fucking neck thank you very much. Is it me or is that kind of insulting? Those smug bastards at Laerdal are calling us all freaks.

I have probably collared at least 30-50 individuals with StifNeck collars in the past year, and only one was a regular and I have yet to meet a "tall". So here's my open letter to the folks at Laerdal StifNeck.

Dear Laerdal StifNeck,

This is not a "regular" neck length:


So until you start manufacturing cervical collars exclusively for the lovely Kayan people of Burma, please stop being a bunch of assholes and referring to the rest of us as no-necked turtle-freaks. Every time someone applies a cervical collar on me and adjusts the collar to your trademark size of "NoNeck", I think I die a little on the inside.

Please, revise the size categories of your cervical collars to make an inch of sense.

Love,

Lucid.

adventure time

So a couple of guys from the team have welcomed me into a tradition for the past couple of weeks. I dubbed it adventure time.

The first time they taught me how to rappel at night in death fog.

The second time I was supposed to rappel - it was again the middle of the night- but 3 0f them went over the edge first only to discover that only one of their ropes hit bottom... and bottom was a gigantic crevasse. So I didn't get to rappel but we did have a good time and found an epic set of rocks.

Apparently next time we are going to create a completely gigantic slip and slide with several tarps and copious amounts of dish soap. I can't wait. (Location? I voted for the Sand Dunes)

On a side note, I always assumed that one day I would be an EMS educator. I figured that I would love to one day teach people all about emergency medical care. But today I gave the entire probationary class a crash course in topics such as medical direction, confidentiality, scope of practice, negligence, BSI, etc and skills such as c-spine immob., back boarding, bleeding control, basic shock treatment, and splinting.

It was hard. I got so freakin' bored of explaining the same simple concept over and over again to people who weren't paying attention. And I got sick of supervising their patient packaging and correcting all of them... I think I will have to shoot myself if I ever have to say "this strap needs to be tighter" ever again. Man I have much more respect for my EMS intstructors now.

6.10.2008

Balancing act

I am learning more and more that being an officer is a huge balancing act. On one hand, I need to build camaraderie, trust, and rapport with my underlings. On the other, I need to lay down the law and command respect. It's not an easy thing to do. They need to feel like they can come to me with everything from a great dirty joke to a very serious issue.

I had to lay down the law today on a probationary member. I may have scared him off a little bit, but sometimes I just have to take care of business. You see, this probie's uniform looked like utter shit. You would think that by now he would've learned how to tuck in a freaking shirt. Hell, before I joined the team I had never tucked in a shirt and I learned pretty fast how to do so all by myself just like a big girl. But no, this kid has his pants sagging down his ass and his shirt all muffin-topped spilling out over his belt.

I told him over the weekend... pull up your pants and tuck in your shirt. Others told him the same thing over the weekend. Today, before I snapped, at least 3 different people had told him politely on different occasions to fix his uniform, to no avail. So after I told him for the fourth time today and he rolled his eyes and ignored me as he walked out the door, I lost it.

"SMITH. Stop," I said in my I-mean-business-voice. He paused in the doorway and looked a little scared.

I pushed my own pants down to the delinquent-teenager-sag position and pulled my shirt out all funny so my uniform looked as crappy as his did, "This is not how you wear a uniform Smith." His fellow probie buddies watched on, wide-eyed.

I grabbed him by the waist band of his pants, pulled them up over his hips to the proper position, and tucked his shirt in bit by bit as I turned him in a circle. "This is how you wear a uniform. Understood?" I said firmly as I fixed my own uniform.

"Yes Lieutenant," he said before cowering all the way out the door.

You know what though? His uniform looked good the rest of the day. Maybe I sound anal about the whole thing, but I'm really concerned about professionalism. I sure as hell wouldn't want a bunch of punk-ass looking kids that look like they just rolled out of bed trying to save my life. It does make a difference, I don't care what anyone says.

We have 2 more days of intensive training for probationary members. We'll have to see if that probie will revert back to his sloppy uniform ways. I'll let you know.

6.09.2008

Basic 1

This weekend's Basic Training was excellent.

There are several standouts among the probationary members that totally blew me away with their enthusiasm, work ethic and endurance. There are others that clearly will not last much longer. But in general, I have to give this probationary class mad props for the way they encourage each other and pass on an infective positive attitude to each other. We asked them push their physical and mental limits VERY hard, and when it comes down to it, attitude matters almost as much as physical ability.

This training was also a triumph for me. Last year at Basic 1 I was sick. Out of shape. Tired. Unprepared. I totally sucked and even missed a few evolutions because I was so messed up. Nobody thought I would make it through the weekend, never mind through the second weekend of basic training. Nobody thought I'd be on the team for much longer.

This year I was ready... in better shape, prepared, healthy, and excited. I did much better and totally confirmed to myself that yes, I can do it. It's amazing what a difference a year makes.

Now I'm counting down the days til Basic 2!!

6.05.2008

It's that time of year again: Basic Training

Tomorrow the team and our large class of probationary members will embark on a journey they will never forget: basic training.

Basic training (AKA Basics) is essentially search and rescue boot camp. They are the most awful, painful, and difficult 2 weekends I will ever love and fondly remember.

After returning from Basics, everyone will be blowing black shit out of their noses for days. Muscles that we didn't even know existed will ache. Not only will our feet be blistered, but our palms will be too. We'll all be so dirty that when we shower, the water will turn opaque brown and we'll leave behind sediment on the floor. We will all have gained a second family and realized how far we can go when we push our limits. Most importantly, we will be a search and rescue team.

The first day of the first Basic weekend is pure hell. We wake up with the sun, eat a quick breakfast, and do a mock search. We find the person code 1 (alive, uninjured, no assistance needed) about 1.5-2 miles away and hike back. The next scenario is a search with a code 2 find (injured or ill, needs rescue/assistance) and so the probies get their first taste of a carry-out. This is a carry-out:


The victim is loaded into a stokes litter and carried by 6 people (ideally). People are rotated on and off the litter periodically but it is hard work. You're carrying significant weight with one hand while wearing a hot, uncomfortable uniform and a pack that weighs 15-40 pounds while hiking over rough terrain at altitude for miles. During Basics, we purposely make the carry-outs more difficult than normal by choosing long, difficult routes and not using the wheel (a wheel that can be attached under the litter to help support the weight) or scree-evac rope systems (a way of making carrying the litter on slopes easier).

We repeat this cycle of search...find...carry-out...brief rest...search....find...carry-out...brief rest... all day. That night the exhausted members lick their wounds and pass out in their tents early. They sleep like babies. Until we wake them up in the middle of the night to do 2 more carry-outs.

It is the most physically strenuous work most people on the team have ever done and will ever do. Last year, when I was a probationary member I thought I was pretty much going to die. You just can't anticipate how difficult it is going to be without going through it firsthand. This year will be better because I'm prepared.

It's a beautiful experience though. I love everyone on my team like family and we have a great time toughing it out together.

I can't waaaaaaaaaaaaait. I'll let you all know how this year goes.

NREMT-B exams, oh how I will destroy you.

So this is what I have left to complete before I become a brand spanking new NREMT-B:

-mock practical
-real practical exam
-final NREMT written exam

I am so glad to be done. 6 months of class, every Sat., 8-5. Can you imagine the liberty of having my lovely Saturdays back? It will be glorious.

So I'm feeling pretty damn confident about the exams. I've been so immersed in EMS for the past year that I would be ashamed if I screwed up. I've heard that the written can be a bitch because the questions are funky, but I think I'll be fine. I'm a little worried that I'll go into this whole thing overly confident and fall on my ass but my gut is telling me otherwise.

An instructor told me that you're ready for the practicals when you can do all the skills while barely paying attention and complaining about something else. I think I'm at that mindless regurgitation phase:

"BSI-my-scene-safe?-it-appears-I-have-1-patient-high-MOI-it's-a-
rollover-I'll-get-someone-on-c-spine-and-consider-ALS...." and so forth.

Anyone who's taken a CNA, NREMT, etc exam knows the drill. It's pretty damn ridiculous.