Life in the Slow Lane

Pre-Season Warm Up

2008-04-26T21:36:00.000-07:00

I have been thinking about global warming a lot lately. I have recently been attending several conferences on the wildland fire problem is the United States, paticularly in the wild west, where I reside and fight fire. I sometimes find these conferences and meetings a little tedious just because they require me to be away from home more, but the last few I have attended have actually been great. Here is a picture of me working at the fire and a few things that I have learned over the last few weeks:

The "wildland fire season" has grown by 79 days in the last 20 years

Global temperatures are rising

Most forests in the US are overgrown and unhealthy

There are forests in my region with fuel loads up to 8000 btu/ft2

Those are some scary statistics. There were much more. It seems like scary things are becoming more and more common these days.

On that note, I went on my first large wildland fire of the season the last week of March. The last large fire I went on last season was just before Thanksgiving. I missed a big one in January due to me having to also be a paramedic. Doing the math, I only got about 4 months off from wildfire this season. Pretty amazing.

This fire I went on was pretty large for March, about 4000 acres total. That number includes the four other fires in the complex, the particular one I was on was about 2000 acres. As sad as the whole wildland fire and mismanaged forest situation is, it was nice to get out and put some red stuff on the red stuff.

As much as I enjoy firefighting, I fear it may be a long summer. Apparently La Nina is coming. Over the last two decades, La Nina weather patterns have been responsible for some of the most catastrophic wildland fires in history. Yikes.

Oh How Time Flies...

2008-03-29T13:03:00.000-07:00

Well, I was cruising through this rabble today and realized it has been nearly a year since I graduated and got my shiny disco patch and since I last posted. I sat and stared at the screen, thinking of something interesting to write and can't seem to come up with anything good. However, I will give a brief overview of the last year and then leave with the promise to chronicle some good stuff soon.

I finished up school last spring and tested in June. The test was odd; for those of you out there studiously cramming for the National Registry I have only this advice: Know everything and know it well. The test leaves you feeling confused and disoriented as well as convinced that you have failed. The new computer based testing supposedly gauges your abilities and quits asking questions if you are too smart or too stupid. No one seems to know what it does if you are teetering on the edge of both. It kicked me off at 80 questions, and I passed.

Soon after becoming a bonafide paramedic I was lent out to our state firefighting agency and mostly fought wildland fire all season. As some of you may know, we had a record year out here in the west and burned a lot of land and spent a lot of money. It was a blast, I love wildland fire and the whole monstrous machine that it has created.

As fall came on I took my first ever trip to the renowned event Burning Man. I tagged along with my wife and her sister who have both been several times. What a blast. I have signed up to volunteer as a fire / EMS person this next fall and am looking forward to working the event. I met some the fire and EMS folks out there and they seem like an awesome crew. Medics and firefighters from all over the country volunteer, so it seemed like a place where I could learn a lot and make some great friends.

As winter is coming to an end, I am again looking forward to a busy summer. We are hiring some new folks, so things should be interesting around here for a bit. I will do my best to post some new stories. Much to my surprise, I actually have a reader or two out there.

I just wanted to throw a question out there to see if anyone knows the answer. What ever happened to flatlinenyc? Perhaps the greatest EMS blog ever has been idle for nearly two years! Let me know if you know.

The End Of The Misery

2007-06-23T21:11:00.000-07:00

Well, I did it. I passed the national registry this last Tuesday. I am happy to say that it was a little underwhelming. I guess my class prepared me well. The majority of my nervousness came from the fact that I didn't feel like I was nervous enough. Does that make sense?

I should have my state license here in a few days, I already got confirmation from the National Registry. I will be a practicing (well, field interning) paramedic in a week. Needless to say I am really excited.

Things are picking up here in the Sleepy City. Summer has arrived, the tourists are wrecking their cars and motorcycles again, old people in motor homes are having chest pain and syncopal episodes in the high temperatures and elevations, and life is good.

I think I am suffering from some sort of post-traumatic stress disorder after paramedic school. I am so used to having to pick up an 800 pound book every night that I don't quite know what to do with myself now that I am done. One benefit is that I should have a little more time to post, another is that I have more time to spend with my wife and dog, both of whom hardly seem to know me as I have essentially been out of the house for the last two years. I actually brought my '68 Chevelle to work today so I could wax it tonight.

With my new found time I hoping to post more now. Calls are coming in all the time, even in my quiet little town, and wild land fire season isn't even here.

What About The Dog?

2007-02-24T12:44:00.000-08:00

The call came across as a “possible ETOH party, patient stated to the call taker that he didn’t know his name, he needed an ambulance, and you will find him in the back yard.” This seemed like an odd call to me, but my preceptor and his EMT partner didn’t seem too alarmed.

“Probably a drunk, maybe drunk and crazy, who knows,” he said. This seemed to be the running theme of the evening tonight, as we had transported a few psych patients and more than a few drunks already. It was nearing the end of our shift, about 4 am, and we were all tired and running out of patience.

The calm and emotionless voice of the dispatcher once again came over the radio advising us that police was responding and that we should stage in the area with the fire department. This is routine for any crazy person, as you never know who might be wielding a gun and shoot you as soon as you walk in the door. This type of apprehension and precaution is a little unfamiliar to me. My small town EMS and fire experience have been pleasantly free of gun-toting psychos for the most part. Aside from the occasional bar fight I have been fairly shielded from the more outrageous crazy people of the big city.

We arrived on scene at the same time as police and fire, all of us rolling up into this sleepy suburban area of town, probably drawing attention from neighbors within three blocks. We watched the officer go up to the door, knock and walk in, hand on his holster. He disappeared for few minutes then waved us in from the upstairs window. We grabbed our mountain of stuff; the monitor, red bag, blue bag, and cot and walked up the driveway with the firemen. It always strikes me as funny when we all arrive together, seven people total (four firemen and the three of us on the ambulance). It just seems like overkill sometimes.

We all squeeze up the stairs. I was expecting to hear some drunken asshole screaming from the back yard but it was quiet. We were immediately greeted by the cutest dog I had seen in a long time; a very light yellow lab, wagging his tail. He was looking for a good pat on the head and scratch behind the ears. He ran up to me to say hello and immediately struck me as a good dog, friendly and well trained; obviously well cared for. It eased my mind a little, as I fall under the school of thought that your pet is a reflection of you; that if your pet is friendly, smart, and well cared for then you probably are as well.

The dog was running from fireman to fireman getting petted and loved by each one. We had still not seen a patient. As usual, being the student, I was pushed up front to take control of the scene. I asked the officer what was going on. “Well, come on out back and take a look,” he said with that same sarcastic smirk that I seem to get from everyone as a student. More experienced emergency response types seem to delight in toying with students for some reason. I walked out the back door onto the deck which overlooked the back yard and “made patient contact” so to speak.

Laying in the back yard was our patient, shotgun by his side. What was left of his head was, to say the least, not anatomically correct. There was a significant amount of skull fragment and brain matter scattered throughout the back yard. I found the whole scene surreal and disturbing. My preceptor came out on the deck along with the firemen and his partner. “Is that what I think it is? Oh, yup it is.”

This was not my first exposure to what the textbooks call “obvious signs of death” but it shook me a little. It must have done the same to everyone else because the firemen all said they didn’t need to see that and went back inside. Since this was now a crime scene, we all went back inside so as not disturb the scene. The officer and the fire lieutenant went down to make sure the guy was dead, as expected he was.

Back inside was the dog, still looking for some attention. My first thought was why would this guy do this if he had such a great dog? Perhaps his problems outweighed the love his dog had for him or vice-versa. I was concerned for the dog, so I asked what would happen to him. The firemen had obviously been thinking the same thing and one of them said, “We’ve been talking, and if there is no family, we’ll have the officer bring it by the station, one of our guys will take him home. He’s too cool to go to the pound.” I felt relieved.

Suicide is sad, but it doesn’t really bother me. At least the guy did a thorough job and didn’t botch it, leaving himself permanently disabled and a drain on his family. I was genuinely more concerned about the dog. You would think that if I was going to be bothered by something, it would be the missing half of this guy’s head that was all over the yard, but instead it was the welfare of the dog. Is it wrong to be more worried about the dog? I don’t think so. The patient removed the need to worry about him quite effectively.

Madness In The Big City

2007-02-23T21:00:00.000-08:00

The apartment was in a shitty part of town, was small, and smelled funny. As we approached the living room where our patient was to be found my preceptor encountered "the room mate."

"I don't know what's wrong with him, he's acting funny and talking crazy," said the room mate as he sucked the life out of a cheap cigarette and blew the smoke in our general direction.

We walked in the living room and found two largish police men with annoyed smirks on their faces. As I am the student, I was pushed forward by my preceptor; I approached the patient while taking on my slowly developing compassionate yet authoritative stance and asked, "What's going on tonight?"

He nervously looked up at the cop that was nearest him and asked, "Should I tell them the whole story?"

"Sure, I think you should," said the cop as he gave me a knowing look and tried not to snicker. I immediately suspected that he was attempting to make me work harder than I should have to.

"The long version or the short version?" The patient was obviously nervous and had some sort of altered mental status. I was thinking some sort of amphetamine or other stimulant like cocaine or crack or all of the above. This was bound to be interesting.

"These are medical professionals, I would definitely go for the long version. My preceptor looked and me and rolled her eyes. It was now obvious that the cops were infinitely amused by our patient and felt it was important for us to participate in this amusement.

"Well, you see," our patient nervously continued, "when I was in high school, I was good looking, blond hair and blue eyes you know... I had all the girls, girlfriends all the time you see... I was pretty popular." I immediately began to wonder what any of this had to do with what was going on tonight. I tried to steer him into talking about what was going on right now but met with little success. "Let me tell you my story and you will see," the patient continued. I could see that he probably was in fact a pretty good looking guy at one point, but these good looks had left him long ago with hard living and excessive drug use.

"I had all the girls you see, but I always had this deep secret, this fantasy. I have always wanted to have sex with two large black... I mean, you know, African-American men. Always had this fantasy. It made me crazy with sexual feelings this fantasy you see. So, I did cocaine. Cocaine makes you crazy sexual you see, intense and crazy. I used cocaine to fulfill this fantasy, it's wrong to have sex with men like that but I always wanted it." My preceptor now had the funniest expression on her face. She is seven months pregnant, it just seemed funny that she had this quizzical expression on her face. Moms-to-be shouldn't have to listen to some coked up dude open up like this.

"So I would smoke it, shoot it, snort it, whatever. Well, I have been clean for 90 days now, but I just couldn't take it anymore, the longing, the sex. I had to do some meth tonight to get away from the feelings, but I am fine, really, I don't have any problems, I don't want any trouble." His pupils were huge and sharp. The guy couldn't hold still, he was obviously tuned up to the max, but he seemed fairly ok. Other than his burning desire to open up to total strangers, I wasn't exactly sure what his problem was.

The rest of the call went smoothly. He was actually a pretty nice guy. My preceptor let me handle the whole call, I am pretty sure she was laughing inside by the looks she kept giving. I guess it takes all kinds... but really.

Back In The Fast Lane

2007-02-18T11:40:00.000-08:00

So here I am again, back in the big city getting ready to begin the last phase of my field clinicals. I am excited and apprehensive at the same time, but I feel I am ready. Mostly I am ready to be done with this paramedic program, but also I am ready to see and do some really cool stuff.

The city itself is a little crazy. I didn't mention this after my last visit down here, but I have to say that the city is no longer the place for me. I have lived in big cities, small cities, totally huge cities... I am done with them. I think I am from now on at most a town kinda guy. Towns are small, often they are cute, and usually you know everyone from the post man to the police man.

I actually get a bit of anxiety being in a city now. I feel like I need to be wary for some reason. I guess it is just a function of being around so many people again, but I don't know. I was never wary when I lived in New York City, nor was I wary when I lived in San Francisco (well, I was wary one time but that is another story). Now, from lack of exposure I suppose, I have become wary.

Hopefully the big city will prove my wariness to be unfounded. Just may take a little time to get used to people, traffic, fast food, and all that stuff again.

The First Round

2007-02-10T10:28:00.000-08:00

Geez, I just realized how long it has been since I last posted. As you may have guessed, I have been mucho busy. I passed all my last exams, finished my hospital internship, and have just returned from my first foray into my field internship (FI).

Intimidated, unprepared, downright flustered at times; these words only nick the surface of my first 120 hours of FI. Sitting in class and passing tests, playing on dummies for practice... these things hardly prepare you for the real patient in the field with an experienced paramedic or two looking over your shoulder. It is difficult, but I learned more in the first 120 hours of my FI than I think I did in 2 years of class time and 600 hours of hospital internship. It was good, it was exciting, and boy howdy was it challenging.

My next 120 hours will undoubtedly be more challenging as I am supposed to move into the team leader role full time and actually be 100% in charge of the patient and the care they recieve. I am anxious, but I am ready; I think I will do well.

I will try to post here throughout, but I can't make any promises as I usually have to read constantly when not on the ambulance. There are about a million little tidbits of information jammed somewhere in my brain that I just don't know well enough to provide for total recall, so I read and read and read and read. Hopefully I haven't lost any of my two or three loyal readers. Hang in there, I promise to be back soon!

The Year's End

2006-12-31T16:30:00.000-08:00

There is at last a bright light at the end of the tunnel. I am so happy that the school phase of my education is over; I am ready to move on the the practical phase. I have just 30 shifts of 12 hours standing between me and the national registry. Lucky for me, I have four months to complete those 30 shifts, so it wont be quite as miserable as the last year and a half.

It's been a pretty big year, going through paramedic school, studying all the time, working full time. I am a little sad to see it go. Now that things have slowed down so much with the semester ending, I find myself actually not busy sometimes. It has been a long time since I have felt like that. Perhaps this spring some fishing will actually get done.

I think I have all the information I need to move on to the next phase of my program. I am nervous; I am going to big and bad ass system for my field internship. I am sure they will bust my chops, but I want to put on a good show. I am representing not only my department, but my program as well. Our program director never hesitates to tell us that we are representing our school out there so we need to look good.

I will try to post as often as I can throughout, but it will be hard. I am working straight 12 hour shifts; that leaves little time for me to get anything done other than eating and sleeping. Wish me well and stay tuned...

The Home Stretch... Finally

2006-12-02T20:42:00.000-08:00

Alas, there is light at the end of the tunnel. I am sitting here at work, it is late, and I am reading about the joys of incontinence in the geriatric patient. I am nearing the home stretch and cannot wait to be done with school.

I have about 12 days left of class. After a short break filled with a bunch of ER and Labor/Delivery clinicals I will begin precepting as a paramedic student on an ambulance. Once that starts I will only be 360 hours and one big ass test away from my shiny NREMT-P badge.

I have to apologize for not posting much lately. Though I am skeptical that I have too many readers (aside from my pal Carmelo), I do feel like I need to keep plugging along with this thing. I have been deep in the books and the clinicals lately. We have also all had to get NRP (neonatal resuscitation), ACLS (advanced cardiac life support), and PALS (pediatric advanced life support) aside from the usual studies. I have been busy, and tired, but things are finally starting to make sense.

It happened suddenly. I was practicing assessments with a bunch of nurses and doctors during out PALS class when all of the sudden I was able to "visualize" a clear clinical picture of my patient. I don't know how else to explain it. It was like suddenly the 2000 pages of my text book, all the reading, videos, practice, everything came together and I understood how it all worked together. It was an awesome feeling. For the first time I had a solid and confident feeling that I was going to be good at this.

That feels good, really good.

Moving Along Nicely

2006-10-22T16:29:00.000-07:00

A quick review of the last stretch of my third semester:

Most gruesome test ever - Cardiac Box Test COMPLETE
Fairly annoying but not too awful - Neurology COMPLETE
Pretty mellow but annoying - Endocrinology COMPLETE
Easy all things considered - Allergies and Anaphylaxis COMPLETE
Tougher than I thought - Toxicology COMPLETE

I am at the phase where I can not only see, but feel the end of the tunnel. As discouraging and difficult as school is sometimes, I am still loving. Things are starting to make sense; the job is coming together. My shifts in the hospital are a little less gruelling because I can now see a patient and get a better picture of what is going on. That is a cool feeling.

We have only 8 more weeks of actual class time left. I am looking forward to starting the last clinical phase. Mostly just because I am getting tired of class work; I want to get out there and see some stuff. Eight weeks of class, 360 hours on an ambulance, then we're off to the National Registry Exam. I should be licensed in less than 9 months from now!

Things have been real slow here in Rural America. Hunting season is at hand, so we will probably see a few environmental emergencies and maybe a search and rescue or two. Who knows. Busy season is right around the corner though, and this ski season is looking to be awesome. We already have more snow than we have had in years. Of course, this is the first time I haven't bought a season pass in a long time...

Its All Down Hill From Here

2006-10-09T15:46:00.000-07:00

I passed. Unbelievably so, but ture. I passed the cursed "Cardiac Box Test." It was by far and away the most miserable test I have ever taken, but it is now behind me. Let me summarize the misery for you:

285 multiple choice questions done one page at a time (you can't go back and change answers or look ahead, you must turn in the pages as you complete them).
67 EKG Strip Interpretations
86 questions pertaining to ACLS protocols
38 questions pertaining to EKG rhythm interpretation rules

As I was deep in the middle of the 6 hours it took to take the test, I was impressed with the amount of stuff that has been crammed into my head over the last year. I actually know some of this stuff; even more impressive is that I comprehend most of this stuff.

The post-test beer drinking was well deserved and appreciated by all of us. We had a great time and all surived with few scars. The stress relief was nice. About half way through the test all I could think about was how nice it will feel to be done with the test, and boy did it feel nice.

No good news on my poor friend. After surgery, he did get some better function in his hands. We are all holding out for his legs. It doesn't look good. He is in good spirits though, and his family is with him and supportive. I am sure that no matter what the outcome, things will work out for him. They will because they have to I guess.

A Shitty Day In Paradise

2006-10-02T12:57:00.000-07:00

I just returned from a friend's wedding. It was beautiful. The ceremony was held at a secluded ranch far out in the middle of nowhere. The trees were all golden yellow and orange, it truly was a spectacular setting for the wonderful act of marriage. I had been tasked with cooking the meal, which was an ordeal worthy of it's own blog, but all turned out well.

The thing about weddings is that afterward, when all the tears are dried and anxiety has subsided, people tend to want to drink, and (with this particular group of friends) drink a lot. Sometime throughout the revelry, the idea was put forth that a good midnight swim in the pond would be a grand idea. I am famously known as a party pooper but this time kept my dissent and reservation to myself. By this time I was on the downward trend of revelling, and was beginning to think about going to bed. I had long quit drinking was enjoying the associated people watching that sober people find themselves doing when surrounded by partiers.

Off the boys went with a trail of whooping girls behind them. Camera in hand, my wife marched along as well to get the great action shots of our drunken and naked friends hitting the ice cold water. I ducked off to refil my water bottle and then headed down to the pond. I heard a few splashes and then I heard some screams. I stopped and thought to myself, "Aw, there just drunk and somebody is fooling around."

Just then my wife came running up the road, "Grab your bag! Allen is hurt, hurry!" On a whim I had decided to bring my back country jump kit. I knew there would be drinking, and I knew we were a long way from any kind of help, so I threw it in not thinking I would actually need it. I headed back, grabbed the bag, and ran towards the pond. I saw a guy staggering up the road and asked him what happened, "Oh, they're just fucking around. He's ok." I felt a little better.

As I approached the pond I noticed a naked guy laying beside the pond with about twenty or so partyers crouched around. I got closer and wedged my way up to Allen. He looked a little freaked out but fairly fine. I asked what happened and about twenty or so partyers began to tell me not just what happened, but that he was fine, he was just drunk, and that we just get him up and take to the camp fire to warm up.

I looked at Allen and asked him what happened. "I can't feel my legs."

"What happened? Do you remember?" I asked.

"I don't know, I can't feel my legs." I looked him in the eyes and saw that he was scared. The chatter around me was pissing me off and yelled out loud for everyone to shut the fuck up and be quiet.

"You in pain anywhere?" I asked. It hit me just as I asked. I was looking him in the eyes and I just knew. There are times when you just know. I have been on many trauma calls and medical calls and there have been times when I had no idea what was going on with a patient or why they called us. But as I looked at Allen, I knew we were in serious trouble here. I knew he was hurt.

"No, I am kinda cold. My hands tingle, I can't feel my legs."

I ordered a couple people to go fetch a folding table or a door or something to use as a backboard and I sent someone else to get a bunch of sleeping bags. I did a quick trauma assessment on him. Nothing remarkable, small laceration on the top of the head, no sensation or movement below the middle of his sternum. He was breathing fine, but his chest was "a little tight." He could move his arms, but he couldn't squeeze my hands. My stomach dropped as I realized that being drunk was no excuse for this. My heart sank when I realized that getting him to a hospital was going to be at least a three hour adventure. The nearest rendevous with EMS was ten miles on a really horrible two-track four wheel drive road. The nearest regional hospital was another 50 miles and it was unlikely that they even had a CT scanner.

I looked up and saw my best friend (the groom) standing there and I knew that his wedding was effectively ruined forever. No one would ever talk about their wedding without thinking about Allen and his broken back (or neck). He saw in my eyes that the situation was serious and he walked away. I could see him starting to freak out as he walked toward his new wife. The midnight swimming adventure was his idea.

I rounded up the three or four sober people I could find. We got him duct taped to a folding table, loaded in the back of a truck, called 911, and headed for the hiway. I gave him to a group of volunteer EMS people in a brand new ambulance after a gruelling 35 minute drive. They had a little attitude at first, but I think the tone in my voice let them know that not only did I know what I was doing, but that the situation was serious. He was flown to a trauma center over 500 miles away. I haven't heard what the outcome was. My gut says he will never walk again, my heart hopes for something else.

I haven't prayed in a very long time. I prayed for Allen today. I can't stop thinking about him, his wife and new baby, the look on my wife's face when she told me to hurry. It was a real life lesson (and career lesson) in what it feels like to be the loved one at an emergency instead of the rescuer. I got to be both; I don't like being the loved one.

Clinical Depression

2006-09-23T20:26:00.000-07:00

I was looking over the titles from the last few posts and noted a depressing theme. I decided to stick with it as I have just finished signing up for this semester's clinical shifts. I officially have only eight days off from now until Christmas Eve. That sucks, but it is better than last semester where I went for almost four months with two days off.

I am looking forward to clinicals a little bit. We get to cooler stuff this semester; two shifts with the air ambulance, more cardiac stuff, pediatrics, and OB. It should be fun. Just a lot of work.

Things have quieted down a bit here. Tourist season is ending and mud season has began. It has rained for days and there is mud everywhere. Fall is certainly here. There is actually snow on the mountains already. That is excellent for September.

Hopefully with clinicals around the corner I will have some interesting medical stuff to relate. Calls have been pretty mellow around here. It seems like this is the time of year when the older population gets sick and need transporting. Structure fire season is at hand though, as people fire up there clogged up fireplaces and old stoves. No matter what, things are bound to get more interesting around here as I get busier and busier.

ACLS Blues

2006-09-21T21:11:00.000-07:00

It's fall now, and raining out. I was looking back over this blog and noticed that I started writing last spring during a rain storm. That's funny I thought. Then I was looking forward to a summer off and now I am gearing up for another semester.

Big test tomorrow. ACLS stuff, you know the stuff I have bitching about for the last few posts. I just want the cardiac section to be over with. I have everything memorized, and I have taken the practice test six times today. I think I am going to make it, and I am fairly certain that some beer drinking will be in order tomorrow nite. Wish me luck.

The Tortuous Death of a Paramedic Student

2006-09-17T17:09:00.000-07:00

Perhaps it is just me being a big baby, I don't know. I need the input of other recently graduated or currently enrolled paramedic students out there. Is paramedic school this hard for everyone?Christ, I have never had to memorize so much shit in my life. I am down to line 46 of my 86 line long ACLS protocols. Everyone I know just looks that stuff up in the manual. An example of the fine reading and memorizing I am undertaking:

15. Provide CPR for 5 cycles without rhythm check. Establish advanced airway then chest compressions should be delivered at a rate of 100 / min with ventilations of 8-10 / min.
16. Check rhythm every two minutes.
17. Administer one antiarrythmic drug:
18. Amiodorone 300 mg IV/IO push (may repeat once 150 mg in 3-5 minutes)
19. Lidocaine 1 to 1.5 mg/kg IV/IO push then 0.5 mg to 0.75 mg Q 3-5 max dose 3 mg/kg.

Argh! It goes on and on... but hey, at least I busted that out from memory. It is slowly settling in. At least I am at the point where the shit I am being made to memorize makes sense to me and I can actually envision a long term goal here. Last year during pharmacology all we did was memorize drug information without knowing exactly what the point was... it is better now.

I should not bitch, but this program is slowly sucking the life out of me. At least the world at large can be sure I will know what the hell I am doing when I get out of school.

I seem to be holding my own at school, at least for being the old guy. I am ready to hit the streets and use some of this stuff though. I am not sure where I will be going for the bulk of my clinicals. I want to go out of state. I asked my professor about it and said that he doesn't make a habit of discussing clinicals until he sure that the subject he is talking to will be passing, and no is ever sure of passing until after cardiology. I don't think he needed to say it so bluntly, but hey, cardiology is hard. I have a wager on a few of the guys in my class. We shall see. I know I will be passing... ergh, at least I hope.

Aside from all that EMS stuff, I did a drive through on a recent large wild land fire that I was on. All the houses we were able to save had signs on them thanking the firefighters for helping. That made me feel good. I only wish we could have saved all of them. There was quite a few homes lost in this last round of fires.

Trading a Life for an Education

2006-09-11T08:25:00.000-07:00

So there is a saying in paramedic school... something to the effect of, "You either get divorced or get married in Paramedic School." Something like that. Well, not true for me, at least not yet, but for two of my close friends the divorce part is true. I can understand, certainly my wife can understand. Never before have I felt the pressure, stress, overwhelming sense of ingorance, and sheer helplessness that I have the last year (particularly the last week) of school. Now my friends have to deal with a divorce and school.

Summer was a cruel taste of life away from school. I have been in school for three years now, first finishing my Fire Science degree, and now half way through AAS Paramedic. I have also worked full time and tried to be a good husband, work on my house, pay bills on time, mow the lawn... It is taking a toll on me, I just want to be done.

But alas, I should not complain too much. I did manage to get the job I wanted in the middle of all that, and I have kept up good grades, and even seem to find time to plod away at blogging a bit. The first week of school just has me down in the dumps. Our merciless instructor has us memorizing ACLS protocols, reading like 200 pages, and we are being tested on cardiac rhythm rules with no compassion whatsoever. It takes the life out of a guy, you know? I am sure that most of you out there do...

The reward is great though. Yesterday I got to run my first ALS call. Of course I had a paramedic standing over my shoulder, but I did get to call the shots on this one. A standard diabetic emergency, altered mental status, BG of 34. Got an awesome line and gave D50. Problem saved, life saved, everyone was happy. I was thrilled. It is cool to pull from all that knowledge that has been memorized and stomped into my mind and come up with a field diagnosis that is correct and then take the steps to treat the underlying problem. It was truly awesome.

I think I need to think of those moments when I get down about cramming shit into my summer-atrophied mind. One day I will diagnose multi-focal atrial tachycardia or Wolff-Parkinson-White syndrome and think this was all worth it.

The Misery of Labor Negotiations

2006-08-26T12:49:00.000-07:00

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

2006-08-19T08:52:00.000-07:00

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...

2006-08-11T21:15:00.000-07:00

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

2006-08-11T15:50:00.000-07:00

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

2006-08-05T20:50:00.000-07:00

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.

In the Midst of the Dying and the Healing

2006-07-04T17:05:00.000-07:00

I spent my first whole day in the intensive care unit (ICU) this week. I was doing a respiratory therapy shift, something that most paramedic students that are in a program that is worth a shit are required to do. We have to listen to lung sounds, extubate people, suction airways, that kind of stuff. The ICU is an odd place, stuck in between hope and despair. The people that work there are something to be admired, I don't think its for me.

Patients there are in one of three states it seems; dying, healing, or in limbo. I am sure all of us here have dealt with the dying kind, either with loved ones or acquaintences. Many of us may have been the healing kind, or had direct contact with those that have been in the ICU for a time. It's the limbo kind that not too many people are familiar with. They are the ones that bother me.

The patients that are in limbo have some "untreatable," or "inoperable" condition. Their families hurt, they hurt, the people that work with them even hurt a little. They have no recourse, and their outcomes are usually very sad. These people are the topic of many a medical ethics conversation (that usually turns into an argument). I took a class in school called Death, Dying, and Medical Ethics and we talked about that kinda stuff a lot. I can tell you this, it is fairly difficult to find two people that share the same opinion on medical ethics and morality/mortality.

I am tired tonight. I am on shift again, this will make my third 24 hour shift here. The last two I haven't been able to sleep. Strange bed, strange sounds, plus the underlying feeling that you may have to jump up out of bed at any time and go do something. They say you get used to it. I hope so. I think I am getting too old to go without sleep completely.

Rain

2006-07-03T14:26:00.000-07:00

It's raining outside. Not the nice spring rain that comes and goes, leaving everything all clean and fresh. It's the spring rain that lasts for a few days and causes mud slides, floods, and various other crappy spring disasters.

I was looking forward to a day of working outside. We were planning to flow test some fire hydrants today, maybe paint a few, look dashing in our fire engine; get out in the public and do something that doesn't involve cleaning, washing, or organizing. Alas, mother nature has confined us to quarters.

Few people know this, but firemen only rarely do really cool exciting shit, like save kittens, babies, puppies, grandmas, and other desireable cute things like that. Most of the time we wash trucks, sweep floors, organize and re-organize various things, and do routine boring shit like fire inspections. Fire departments (especially those involved in EMS) have mountains of paperwork that lead to even larger mountains of statistical information that must be compiled and shared with the governement at various levels; city, county, state, federal. At times the amount of paperwork can reach storybook proportions (I can't off hand think of any stories that involve mountains of paperwork, but surely Monty Python has done something of the sort).

I think it's good that most people don't know that. Otherwise, people wouldn't think it was nearly as cool to be a fireman as they do. Larger departments have secretaries and assistants to assist with all this stuff. We here in the middlst of nowhere do not. We answer phones, file, sweep (see aforementioned list).

Anyway, this boring spring day is undoubtedly going to lead me into the dark task of cleaning out 100 years worth of out dated fire code books, training manuals, worthless army surplus shit from great wildland fires of days past, petrified mice, and other useless shit from our massive storage room.

I hope I don't catch the haunta virus or something awful like that.

Waiting

2006-07-01T18:01:00.000-07:00

While we wait, how about some background...

Tonight is my first overnight shift at the fire station. I have everything I need to entertain myself (well, most everything). I suppose I should clarify that and limit everything to worldly things such as TV, high speed internet, books, magazines, telephone.

What I really need (or want) is a good fire or EMS call. This always pisses my wife off when I say things like that. For me to have "fun" with a fire truck or an ambulance, someone undoubtedly has to have a really shitty day. That is the sad truth about my new job. Keeping me and my fellow firefighters busy means ruining someone else's day. A lot of being a firefighter or a paramedic involves waiting, at least out here in the middle of nowhere. I am sure there are departments out there where you can't get any sleep ever... I don't know that I would like that (at least not in the long term, but for a short stint it would be way fun.)

So anyway, back to my first evening at the fire station. It kinda feels like moving in to a new apartment. I will be living here for two (sometimes three) days a week, so I wanted to make myself comfortable. Set up the computer, install some hooks for my clothes, fan out some nice nerdy Firehouse or Fire Chief magazines, you know, move in. The sleeping quarters are brand new, so they kinda have this awful carpet glue smell about them. That has been teasing a slowly developing headache I have been working on all day.

Our department is unique in a sense. There is only one paid person on at night. That means I have the whole creepy and dark fire station to myself. In my younger days that could have meant a hell of a party. The station has great acoustics and all the light show equipment is very impressive. This is a new thing for our department, well sorta. There used to be an overnight person all the time, but budget cuts eliminated that long ago; we are now in a huge growth spurt so things are going the other direction now. In the event of a fire call, I hop up, get the engine started and become part of the engine crew along with volunteers. In the even of an EMS call, I either respond in an ALS quick response vehicle or hop on the ambulance with volunteers.

We run about 500 EMS calls and 100 fire calls (some of those overlap) a year with ALS coverage 24 hours a day. Even though I have not yet finished school, I am considered ALS because I run as an EMT-I-85. When I am finished I will be a paramedic. I have been a volunteer on the department for two years and was hired full time last year. Technically, I have been around a bit, but officially I am still a probie, thus I stay over night a lot and do a lot of sweeping, mopping, and washing.

I think that's enough rambling. Howdy to all my pals out there. Wish you were here to enjoy the light show. The music sucks, just some whiny dispatcher rambling on about drunk and disorderly people. Maybe one of them will need an ambulance ride...

Test Taking

2006-06-30T19:40:00.000-07:00

Bored...

Sitting at school waiting to take my trauma / pulmonary practical final. This is my last test of the semester. I can't wait to be done. I am forecasting large amounts of beer drinking tonight at the nearest establishment that sells anything even remotely alcohol-like. Wish I didn't have to work tomorrow.

Paramedic school has given me some gray hairs. Everyone here that is sitting around waiting their turn to take the last test looks like they haven't slept in weeks. I am the oldest guy in my class of 15 by about 3 years, and I am only 32. Sometimes I think I have an advantage over them. Looking at us now, all sitting here wringing our knuckles, hoping that we pass, knowing that if we don't we all have to take the entire semester over... we look like shit; like we are dying.

I didn't think that paramedic school would be so hard. Fire Science was way easy. It was even an AS... sort of an actual degree. Paramedic AAS... it sounded easy. It is by far and away the most difficult thing I have undertaken. I kinda wish it was a four year degree... there's just too much information to absorb in two years.

It's almost over though... I am next. The practical takes all of 10 minutes. The longest 10 minutes of the semester. God I hope I don't screw up my drug dosages...