a pocket guide to being thankful

Most conversations had in the world of fire and rescue center around complaining.  We got that call right in the middle of dinner! We transported soandso for the hundredth time!  We never have _____ when we need it!  Most days any conversation you have with me can center around complaining. I like to share my thoughts and feelings! Today I decided to share what my department can be thankful for so here we go...

• We have 3 ambulances total, two of them brand new.  The third one is only 5 years old and for some stations this is ancient but for most rural volunteer stations this is considered brand new.
• We have 3 support vehicles, one is brand new. The other two...eh not so much but they run. When they stop running we will cut them up so they double as a training bonus!
  
• Our heavy rescue is relatively new.  This is another item that in some stations would be considered old but in most stations is brand new.  Especially since our neighbors have a fire truck that is older than I am.
• Up until this year we had the nicest station in the county.  A few stations were able to secure funding to build desperately needed brand new buildings.  We've had plenty of space, rooms, and fun stuff ( like a Wii!) for awhile now.
• We really don't have a lot of personnel issues and any ones that we do have are minor.  Our members get along well both on calls and outside of our department.  A lot of us talk to each other almost daily and are there when we need them.
• With the exception of one vehicle we basically have no debt.  It's rare for a volunteer station to be able to say that. The building is paid for and was mainly built by members.
  
• and last, but not least, they have me. I'm pretty awesome.  (JUST KIDDING!)
  

Kids these days... teenagers and EMT class

Many states have a minimum age for becoming an EMT-B of 16, including my state.  When I was 16 I enrolled in EMT-B through my high school and for one semester it was my second block class.  We won't get in to the constant nagging of my mother for "grades as good as you got in EMT and history!" for my other classes that semester of math and science. (Have I mentioned that math is not my strong point? Seriously, it isn't.) When I took the class we were one of the leading high school programs in my state, we had a very high passing rate for the state test and most students, it not all some semesters, at least attempted the state test.

Enter the current program.  Kids these days...it's all I hear.  Students are being told to take EMT-B as an "easy elective" because they don't have to take the state test.  Due to No Child Left Behind they are placing students in the class that aren't able to test.  A lot of time and money is going in to teaching students that will never use their education for anything because they just want an easy grade.  So that puts us at a cross roads of what we need to do.  Continue the program? Find a different program? Let the teenagers take the adult evening classes?

I'm not in favor of dropping the program entirely, I'd like to see some changes made so our instructors feel more like they are accomplishing something and less like they are babysitting kids that don't want to listen.  I am not for teenagers in the night class because the classes run from 7-10 and we are in a rural area so most kids live at least 20-40 minutes from where the classes are held and where their high school is located. That means teenagers driving home late at night and having to get up at 5am in order to get to school the next day.  There has to be a solution, this program is working in other places. 

If your state has an age of 16 do you know how your local schools and departments handle educating them? I'm all ears.

Experts in the Field

Sometimes you will be on a call and either the patient or a bystander is an expert in your field. They normally have absolutely no experience at all but still know more about medical care than you do.  Twice this weekend I had calls where the bystanders were giving me lessons on how to care for my patient and I had to remember the cardinal rule of "if it felt good to say, you probably shouldn't have said it."

The first call involved a drunk bystander that I've actually transported to the ER before.  As I am asking the current patient questions the ex patient tells me that current patient has CHF.  I ask the patient if they have a history of CHF and am told no, they do not have it.  Ex patient INSISTS that CHF is the reason this patient is having an episode.  I continue to ask questions, do my assessment, get vitals, etc as the Ex patient repeats "It's Congestive Heart Failure! WHY WON'T YOU LISTEN TO ME?!?!"  I thanked ex patient for their analysis, explained that we were doing everything we could for current patient and no, I really can't "force current patient to go to the ER." Current patient did not want to go, they really needed medical treatment and I tried my different angles of trying to talk them in to going.  Ex patient grabs my arm and insists that I take current patient to the ER right this instant.  Thankfully law enforcement was already on scene... The patient did end up going, thankfully, and I'm pretty confident that it was a case of pneumonia and not CHF.

The second call involved being told exactly how we should get the patient out of the house. The patient that they tell me is having seizures. The patient that is very obviously not having seizures.  Then as one of my crew members is getting patient history their response to "Are they allergic to any medications" is "Well, not really."  My head pops up from where I am talking and treating the patient. I say "Not really isn't the answer we need. Yes or no?" After 10 minutes of being told they know better for the patient than we do, though they don't know what medications the patient takes, we were thankfully able to get the patient in to the ambulance and on the way.

Hi, my name is Grace and I have a problem.

Two problems, actually.  The first being my name isn't Grace. The second is if you were one of the people that saw me fall and bust my ass in the ambulance on Saturday you would know that balance isn't my strong point.  At least I saved the Lifepak! It did NOT go rolling out in to the street! This is the second week in a row I have managed to fall while on a call, I figure if I fall this upcoming weekend then I have a good chance of breaking something. Third time is the charm and all. 

Let's not spend all day talking about my lack of ability to ever be on So You Think You Can Dance  let's move on to why I had an AWESOME weekend.  Our weekend wasn't overly busy call wise but two of the calls we had, including the one where I performed my twinkle toes moment, were great calls.  I'm still figuring out where I stand with this whole Enhanced certification as I either always work with Basics or Paramedics. I'm not ashamed to say that the Protocols book and I have been spending more time together lately to make sure what I think I need to do is right but so far I've been right on track.  Our first of the two awesome calls was a possible heart attack.  Cardiac is not something I can do. I can give Aspirin and Nitro off the ambulance instead of only if it's the patients like a Basic can, but I can't run an ECG or a 12 lead. (Well I CAN, I know where to put the leads and what buttons to hit but no one would be impressed with my "flat line bad, squiggly line at least somewhat good" interpretation skills) We had a medic continue in from another town about 12 miles away while my crew and I dealt with removing the patient from the bar and getting them in to the ambulance.  I initiated a beautiful IV, beautiful because it was successful and I didn't get blood everywhere, and we hurried on over to meet the medic. At this point they were only 2 miles away so before I could say "Aspirin" the medic was hopping on and I gave my report, the medic was happy with what we had done up to that point so life was good.

That call was just after midnight so by the time we got back to the station it was around 1:30 am and we quickly hopped in bed.  2 hours later we get the next call. Back on the road we go not looking quite as bright eyed and bushy tailed as we had on the first call.  This one is a pediatric call, possibly croup, and no one else but us responding even though it wasn't our call. (Dual Dispatch) We arrived and found our patient easily by the sound of wheezing that greeted us at the door.  Prompt treatment and prompt transport got us on our way to the ER and no more wheezing unless you used a stethoscope.  That is until we made the turn in to the hospital, I swear as soon as we started up that road the wheezing started again.  Have you ever had that happen? No changes until you hit the one mile radius of the hospital then BAM, back to square one.  We moved the patient inside quickly where they gave another treatment right away.  I stopped by to say goodbye before we left and the patient was much improved. Very cute kid, listened to everything we asked and in general followed directions better than most adult patients I have.

After the calls my partner and I went back to bed, well not together we had separate beds.  Nothing like trying to go to sleep when the sun is coming up! Later on my partner said it was amazing how even though we had two serious calls neither one of us were stressed.  I sat there for a moment then realized he was right, I didn't have to worry about what my crew members were doing or where they were wandering around to, I didn't have to worry that my "experienced emt" that runs a shift with me each week was freaking out like normal, I didn't have to explain myself 3 times, all I had to say was "I need..." and it happened. I need vitals, I need the patient out of here, I need an IV set up, I need the drug bag, let's go ahead and get on the road. All of it was done, no fuss, no running in circles, just done. At any given time right now I am precepting three basics trying to be released and a junior in EMT class. I enjoy teaching and helping them learn, I'm always available to answer their questions and will pick up an extra call or two so they can get experience, but sometimes it's nice to just run a call and not have to make it a teaching moment.  Not have to have them count off to make sure I have every one. There are times when I have at least 5 people on scene from my station and they all want to be in the ambulance at once. Then I feel like we're playing duck, duck, goose to decide who goes where and there are times when one of them tries to override my decisions.  While the patient care is never affected sometimes it makes me a bit frazzled.

Now let's hope I don't break anything this upcoming weekend!

Pocket Guide #10: Signs You Need A Break

1. Someone asks you a question, on election day, about the state elections and you start spouting off by laws about your department's elections.
2. You go to pull up a web site for work and instead pull up your PPCR web site out of habit. Then you start reviewing new charts.
   
3. You ask your significant other to rate things on a scale of 1-10, including how hungry they are.
   
4. When you shaking hands you are always on the look out for an easy vein to hit.
5. You go to hit the air horn pedal in your personal vehicle when someone cuts you off.
6. You sign everything with your name and rank, whether it's a credit card slip or a thank you card. 
7. In the middle of the night you sit up and say "Ambulance xxx responding!" much to your significant other's confusion. 
   

PS these are all things that have happened to me within the past few weeks.  Vacation? Is that you I hear calling?

Trauma has NOTHING on me

You think you're so big and bad, Trauma? Just because you have helicopters and cool patients who get hurt in totally awesome ways doesn't mean anything! I just transported a patient with constipation! So stick THAT in your juice box and suck it! Wait. What's that? You mean no one wants to watch an hour long show about a constipated person? Oh. Well that's okay, I heard Trauma was cancelled anyway.

Want some real drama? Picture this: it's 00:45 and you're laying in a nice, warm bed, about to fall asleep.  The tones drop for an illness near your residence, in fact it's 3 doors down. (Not the band) The internal struggle begins! Well, I could get up and see if they need help. But they have a staffed crew. But they know I live here. And they know my minitor is always on. So I guess I should get up. But it's cold outside and I think it's raining. I just got comfortable. I guess I should go, though, since it doesn't look good for me not to. They know I'm not sick or have any other good excuse. *sigh*  I decided to go and was proud of myself for remembering my keys, wallet, minitor and crackberry. It only took me 5 minutes of talking to the patient and the paramedic from another station that came to assist to realize that even if I did want to start an IV, I didn't have my glasses on or my contacts in.

I've run 3 calls this weekend after being released and haven't started an IV on one of them. There wasn't a need for an IV on any patient but I'm still kind of excitedly waiting for my first call where I start an IV and don't have to be supervised.  At least we started to get calls, after my Friday crew where I jumped at every tone drop I was starting to think I'd be a Nervous Nelly all weekend.

200th Post!

And for this post I am going to give you random facts about me because what's more interesting to talk about than me?

• I got in to this business because my older brother became an EMT and always had the coolest stories. Anything he did I wanted to do so as soon as I turned 16 I took EMT as a class in high school.


• I decided to take my Enhanced (aka Shock Trauma aka equivalent to IV Tech in some states I believe) because I watched medics start IVs and give medications for 7 years and always thought "I bet I could do that..." I'd like to bridge to Intermediate/Paramedic but this was a good place to start with my schedule.
  


• I'm allergic to medical tape. I can't touch it without gloves and if I leave it on I get horrible welts. This does not stop my rookies from trying to stick medical tape on me to "see me light up like a Christmas tree." I hate my rookies.


• I actually love my rookies and most of the guys and gals I volunteer with. Some I am closer to than others, but they're all my family. Even the ones I fight with have been there for me in a time of need and vice verse.
  


• People can puke on me, I can see decomposition in various stages, other bodily functions are okay, not my favorite but okay, but let there be a spider within 50 feet of me and I'm climbing up the nearest person.
  


• My all time hero has been with my station for 25 years. We threw him a surprise party earlier this year and he loved it. I'm kind of sad it's over and would love to throw another one just to try and show him how appreciated he is. No amount of parties can really show him that, though.


• I'm officially released now as an Enhanced. 13 months from the beginning of class until the release date. Phew. This means I can randomly start IVs and give medications without having to wait for a medic to arrive to oversee me. This also means I will be reading my protocols every second of my shift.