The Misery of Labor Negotiations

This past week has been all about union contract negotiations. I don't know if any of you out there are familiar with this boring and tedious aspect of the fire service, but it is truly the shittier side of a rather fullfilling job.

We are in the midst of a rather nasty fight with the city regarding personnel policy and wages (to name a few of the complaints). Most of these issues stem from other city departments. We are too small to be in the IAFF (International Association of Fire Fighters) so we are part of the union that all city employees belong to. This causes a lot of problems because most people don't really understand how unique the staffing and scheduling is in fire departments.

To make me feel how appreciated our paramedics (and would-be paramedics) are, we are offered a whopping extra $25.00 per month for the sparkly paramedic badge. Twenty-five measly dollars. It would only take about 35 years to pay off the college tuition it took to get that badge. Needless to say, that was a little slap in the face to say the least.

Hopefully things will work out soon, we still get a raise, but we were hoping for a little RESPECT from the City Council... just can't get no love.

Aside from all of that school started this last week. Geez. You know, I really did have a nice summer so I shouldn't complain, but we just jumped right back into it. We have a test on our Cardiac Rhythm Interpretation Rules next week (16 of them) and ACLS protocols the week next. He just hands us blank sheets of paper, and tell us to start writing. Everything is rote memorization and it all makes my head hurt. I am sure I will survive, but it was nice not having to worry about anything. I'll write more on school in the next few.

The Last of a Long Weekend

Saturday morning came on with the constant roar of Harley Davidson motorcycles cruising past the station. They are beautiful machines, but they do get tiresome when you are trying to sleep. The night had been quiet and the morning would not be the same.

Around 10:30 we get a call for a motorcycle accident with injuries, multiple patients. On arrival we found on pretty banged up dude and a not-so-banged-up wife of said dude. The guy reeked of alcohol. He ended up with a sprain and a few other bumps and bruises, all the while screaming in pain. It always cracks me up; the big huge tattooed and ass kicking motorcycle guy just screaming to end all, then you get the tiny little frail men and women who don't seem to be bothered by anything.

At about noon tones sounded once again for a motorcycle accident with injuries, multiple patients. Bystanders on the scene had decided to load up the patients and take them towards the hopital. This is not uncommon around here (as evidenced by the post covering Friday), in fact it was the second motorcylce MVC of the day with bystanders deciding to transport. Well, on arrival (or rondezvous) we find a mom and daughter who had dumped their bike at low speed. Mom had one of the most horrifying cases of road rash I have ever seen. Daughter was fine, just scared to death and banged up a little. Again no helmets; again very lucky. I can't imagine what it would feel like to have a vegetable for a daughter because you didn't make her wear a helmet. Lucky people, er well, lucky and stupid people.

We come to the end of Saturday with yet another motorcylcle accident in the exact same area as the previous. On arrival the patient had a GCS of 3 and snoring respirations. Load and go. I was particularly happy with myself on this one because I nailed bilateral 16g IV (both on the first attempt). Manic medic had a tough time with the airway, but did eventually get the patient tubed, with a little chemical assistance. We use a rough version of rapid sequence intubation here, better known as "pharmacoligically assisted intubation." A little etomidate and valium usually does the trick. It's kinda new around here, but works with the old TBI clamp down. Anyway, we did what we could, again lamenting the under-use of helmets. Our patient died the next day when it was decided to remove life support.

Saturday night brought a few more BLS calls, old people, drunk people, but generally pretty slow. Sunday we were skunked. All in all it was a busy weekend with 17 transports between Thursday and Saturday.

From a learning perspective (which is where I seem to see everything from since starting paramedic school) it was a great review of trauma. I got to do it over and over again on real patients. Usually trauma call are pretty few and far between around here, at least serious trauma calls. It was a good trial run for me, and Manic Medic is cool about letting me do whatever I am comfortable with. Next semester, I won't have a choice, but this early in the game it's great to work on the skills I know and to get better and better at them.

Oh, by the way...

I forgot, I just started wondering when school started up again... I looked it up. It's just a few weeks away. That sucks, summer has been good to me this year. Oh well, just two more semesters left to NREMT-P.

A Further Review of Trauma

So Friday continued on with one more (yes, it's true) motorcycle accident. This one wasn't so bad. On arrival the patient was sort of concious with a GCS of 12 or so, in a lot of pain, had a nasty fractured wrist, but for the most part ok; just a good bell ringing really. This particular victim barely missed launching off a 750 foot cliff, so I guess luck was the order of the day for this one.

As evening came on the aforementioned motorcycle enthusiasts gave up riding (thank God) for drinking (no thanks). The tiny little town I call home offers many renowned drinking establishments and all of them were full to capacity this night. The call came through pretty early, about 11pm or so, and was for a, "Woman down, possibly intoxicated, fell off the bar." Oddly enough, this is not an unusual call for us, particularly at this location.

The bar was totally packed (way beyond fire code occupancy by the way - mental note to self) and it was extremely difficult to make our way to the patient. Enter the ever popular injury for drunken idiots: Traumatic Brain Injury. Unbelievable. She ended up getting intubated and flighted due to her rapidly declining mental status. The more I think about it the more I wonder how ever survived my partying years. I would be interested to hear what became of her. I sometimes get the feeling that drunk people are totally over treated here... but I don't know. There is a lot of reluctance to let drunks "sleep it off" anymore. Maybe a topic for another day.

I think I need to take a little break here and fill ya'll in on information about the fire department I work for. We don't see too many 911 calls (probably about 350 EMS and about 140 fire) per year, but we also don't have a definitive care type hospital. So all these people that we see, at least 75% of them end up going to a hospital a little higher up the billing chain (he he). So, when we transport to the hospital, we usually end up transporting again to the nearest trauma center. That gives a grand total of a little over 500 total EMS calls. So even though our little service doesn't see much of busy day like above, these people all technically get transported twice, so it takes a lot of man power to get these people out of our system and into the next one.

I got a comment about being bored, and sometimes we are. But when it rains it pours. The weekend will conitinue later...

A Review Of Trauma

Every year about this time, the small hamlet in which I am semi-gainfully employed swells from the wee size of 2000 to the not so wee size of 10,000. Most of these people are tourists or part time residents who enjoy the nice country summers we are famous for. There is one weekend however that brings thousands (yes, literally thousands) of motorcycle enthusiasts. Particularly Harley Davidson types, but some BMW types and even fewer Ninja types.

The lovely aforementioned hamlet lies in a state that currently does not require helmets. Need I say more? Those of you out there (if in fact there is anyone out there) who are involved with the EMS world probably know where I am going with this. But nonetheless, I feel I must continue my story.

I work weekends typically, thus it was my fate to be on duty the weekend of the infamous Harley Rally. The weekend started out nicely. I came on shift at 0600 Friday morning and by 0800 we had our first motorcycle vs. deer call (not uncommon around here). This got everyone's blood going as the last motorcycle vs. deer ended badly for the deer and the motorcyclist. Alas, this call was to end differently as the victim decided to be transported in the rear of a pick up truck.

At 1300 we were dispatch to a multi-vehicle motorcycle accident with injuries. As we arrived in the ambulance with the first due engine company, we noticed two twisted motorcycles along with two twisted bodies laying alongside the road. My boss (hereafter known as ManicMedic) went to one patient as he directed me to check out the other and report back to him. My patient was alert, oriented, quite friendly, and resting in the arms of a beautiful young woman. I asked him how he was doing while trying not to grimace at the horribly angulated lower half of his left leg. He reported that he was fine, no trouble breathing, no pain, no nothing, but... he did think that maybe his knee was dislocated (actually he had a most hideous closed spiral fracture of his distal femur). I put some o's on him, left him in the care of another EMT who came on the engine, and went to report to the ManicMedic.

As I walked over to the location of the other patient I detected that certain tone of voice in the ManicMedic that always means trouble. You may know people that are similar. Manic's voice always hits new octaves when things are going poorly (for him or his patient). I looked at the paitent, noticed his slightly greyish blue tint and asked if there was anything I could do. He asked me for the cardiac monitor and the ET intubation kit and asked how my patient was. I informed him of my findings and he directed me to intiate chest compressions while a friendly fireman was monitoring the patient's airway. I did as ordered, watched the not-so-encouraging flat line move across the monitor after it was connected and paid close attention as Manic handily intubated the young man below me.

Suddenly little blips started appearing and shortly our patient was no longer in asystole, but in a normal sinus rhythm. This was encouraging. A small army of newly arrived EMS personnel and firemen arrived and I was directed back to mister busted leg. I packaged my patient, splinted his leg in a position of comfort, initiated an IV, and off we went. Nearly text book, and I must admit, this was the first major trauma call I have worked mostly by myself, and I was very happy.

The young man who went into arrest on us ended up dying. He suffered massive internal brain injury coupled with a nasty skull fracture and several other broken things, I don't really remember all of them. I can only hope that he was made a donor, he couldn't have been more than 25. I also hope his friends and his family think about wearing helmets the next time they get on a motorcycle.

I will continue later with the rest of the weekend. Remember, above was just Friday morning.