Thursday, October 7, 2010

"Medication Seeking," he mouthed...

I finished my last ride outs which were, again, pretty uneventful.

The one that stood out the most was a woman who was complaining of a severe headache and her husband said she was shaking. Upon entering the house, you could hear her moaning and making unintelligible noises from another room. The look on the EMT-Basic's face as he looked into the room was priceless. Just by that look, I knew he was either seeing something totally serious, or something that had him wondering why we were even there.

The woman was in bed, having what appeared to be seizures. I've never personally seen someone have seizures before, but this seems to be what she was going for. Her eyes were darting in many different directions, her speech as cut off as she jolted in all sorts of directions. Amazingly, her husband was able to assist her to walk to the stretcher as she had her fit, before our guys could do anything.

Turns out the husband is familiar with the EMS line of work. We loaded her up, my preceptor and myself in the back. The basic and the husband up front. Her BP was fine, her HR was fine, her pulse-ox was fine. But she said she was in horrible pain. The husband shouts through the window, "She needs atropine, or maybe morphine." (or something to that effect). When I heard "morphine" coming out of a guy's mouth who doesn't look like I'd trust on the street, I felt something was up. Nevertheless, I watched as my preceptor did his thing.

My preceptor yelled back to him, "I cant give her morphine if she's not in pain". Now, from the time we picked the lady up, she couldn't speak a single word clearly. But "I AM IN PAIN" came out clear as a bell. At which point the paramedic said that he could not give her morphine for a headache.

As we settled in for the ride, I looked over where he was sitting behind the head of the patient. "Medication seeking," he mouthed.

It all made sense to me now. This was my first "frequent flyer". Turns out this couple calls fairly frequently for absurd injuries to try and get to the hospital for meds. I had read about this in blogs, books, forums, but I kind of never thought about how I would ever know if a patient was trying to scam me out of medication. I'm not a paramedic, so I really don't know the indications or contraindications of morphine, atropine, etc.

But everything started to fall together. From what I had learned, I was kinda of under the assumption that someone who was having seizures. Unless these were some severe seizures, I never noticed a tonic clonic phase, or any sort of break in the convulsing. Her convulsing, also, was just that; It seemed to me like she needed a priest to perform an exorcism more than she needed a pair of EMTs.

In the long run she got to the hospital, it looked as if they were starting an IV line on her as we did our paperwork. Whether she got what she wanted or not, I don't know.

What I do know is that I do not want to be to quick to judge someone for medication seeking. Not at least until I know what I am doing. However, it sickens me that people do this. This was a code 3 call. We rushed to get there, ran red lights, and the works to make sure we got to this lady in time. All because she wanted some morphine.

On a lighter note, I am done with class. I got my class certificate today. I have applied for my national exam and I'll be waiting to take that soon, then play the waiting game before my state certification comes in. Wish me luck on my test!

Saturday, October 2, 2010

Thinking Ahead

So I've started to think about my future in EMS. That means I have a lot more questions that need to be answered.

The current program that I have been going through for my EMT-Basic may be offering a 10 month paramedic course sometime next year.

However, I have been reading, listening, and learning that many colleges may have better education standards than the program that I am currently going to. Also, here in Texas you must have a two year college degree to be a "Licensed Paramedic" versus an EMT-Paramedic. They both do the same jobs, and from what I have researched, they get paid the same. I think it is just Texas' way of promoting higher education within the EMS system.

Paramedic title aside, it still comes down to quality of education. Perhaps a local college could have given me a better EMT-Basic education. To be honest, EMT-Basic knowledge and practice is so simple that monkeys could be doing the job. I am fully confident that I learned what I needed to learn and I can perform my duties.

However, the local colleges here have had classes for some time now. Compared to a new program, they may have higher standards. Then again, perhaps the new course that they are setting up will be a good one. It doesn't have a reputation yet.

I just want to make sure that I get a good education. I don't want to be a victim of an EMT mill. (Not saying that my program is one)

The thing about going to an associates degree in emergency medicine is that I would probably have to take the full course. That means I will have to repeat the EMT-Basic curriculum. I'll need to talk to the campus on that, but if it means I will be a better paramedic in the future, then so be it.

I will also explore the program that may be coming available. If it is comparable to the local associates degree in experience, education, high quality curriculum, and plenty of clinical hours, then I may give it a try.

If you're looking to become an EMT or a Paramedic, I strongly suggest you research your local programs. Ask your EMT friends about their opinions. If you don't have any EMT friends, call or visit some local stations and ask. Initial education as well as on-going education is very important in this career field. It is your responsibility to make sure that you can be the best that you can be.


Apparently there is some form of miscommunication on the student ride-along scheduling. I arrived at the station to find out that all of the four available rigs had students on them, and another student was waiting on station to take turns with what rigs came back from calls.

Instead of waiting around all day, trying to take turns, I opted to go in on Monday, when it is supposed to be busy and 7 trucks will be available.

Not too happy about the wasted gas but what can ya do. I'm going to go in next week and arrive an hour early.

I did get some information about companies that are hiring and I might have an opportunity to get hired as soon as I am certified. So that is good news.

Friday, October 1, 2010

My Little Medic

Little Rylan is here!

My son was born on September 14th at 9:04pm. He weighed 9lbs 6oz, measured 23 inches long. What a behemoth. Veronica did awesome and made a brave choice is having a VBAC (Vaginal Birth After Cesarean) because she wanted to have the experience of regular birth.

So, if you have read my recent posts and wondered why I am behind, or why I have not been posting, this is part of the reason. This guy is a handful, however, I am SO close to being done with school and we are getting a bit more used to him being around that I feel like I can be gone for 12 hours to finish my last ride-along and be done.

My final exam went well, so the only thing holding me back from completing my class is this last ride-along. After that I will have to take the NREMT Basic exam and I should be in business! My ride along is tomorrow, I will update afterwards!

My First Ride Along

I completed my first ride along at Valley EMS a few weeks back.

It was a 12 hour shift from 8am to 8pm. Aside from the fact that every call we got was a code 3, lights and sirens, speeding down the road, adrenaline filled experience; the day was quite boring.

After I got to the station, met with the medics I would be riding with, and got settled in, everyone went to a local restaurant to have some breakfast. About halfway through the meal, our unit gets its first call. Code 3, lady in a local supermarket "fell". We're out the door, don't even pay, and on our way down the road lights and sirens. The adrenaline rush was great.

I was so excited to be going on my first call, and nervous about what I would expect and if I knew what I should do when we get there. The two medics worked great as a team as they approached intersections and navigated through morning traffic on the main streets. I felt like I was on a carnival ride as I sat on the jump seat in the back.

Then it got quiet. The rig slowed down and I leaned forward in the cab to hear the medics griping. The call was canceled and we were on our way back to pay for our breakfast.

I'm not sure what I got into but back at the station I had an overwhelming urge to "do my morning poo". You know that feeling you get when you're some where new and you need to go #2? You're nervous about your surroundings, you don't know the people, nor if the bathroom that you're looking at is even the one that you're allowed to use. Now add the fact that at any time while you're trying to "make it happen" on the pot, a call could come in and then you've REALLY got to go.

This was my predicament. I waited about an hour or so, nervous that I would sit down and get comfy on that porcelain throne, then get a call midway through. I finally came to the conclusion that the shift was at a slow point, and I had the time, so I went... And sure enough, it happened. Murphy's Law.

"STUDENT! STUDENT!" I guess they hadn't learned my name yet. I yelled from the bathroom, wiping frantically, telling them that I was coming. I ran out the door to the rig, just as they were ready to drive away.

It was another code 3 call. Difficulty breathing. We started rolling, I just buckled in when we stopped and they started to get out. I jumped out the back of the rig, looking at the station we just left (which sat just across the street). Our code 3 was waiting for us at a local doctors office, yes, right across the street from the station. The poor old man had some short, labored breathing, probably had a mild state of dementia, and was contracted to the shape of his wheel chair.

I helped the medics lift him from his chair on to the gurney and we left. In the rig I took what vitals I could. I was really there for observation, but I wanted to get that experience. I found that it was much harder to listen for breath sounds, and to get the blood pressure in a moving vehicle.

After that call we sat around the station for a good few hours. The guys joked around with eachother. I got to get a little insight to "intra-facility politics" and the like, but I found it mostly humorous. Most of the guys seem pretty cool.

We finally got another call. Code 3, lights and sirens, waaaay out in the boonies, lady having difficulty breathing. Turns out that she had congestive heart disease and was probably in the midst of having treatment for it. No obvious vital signs out of whack or anything but a mean case of pedal edema, which I got to check out first hand. It ended up being a typical BLS call.

Call 4. I'm not sure what the call was, but it was cancelled.

Then at last, an adrenaline call. Motor vehicle collision, we were off again. We get to the scene, it really is a minor collision. They probably hit each other going about 20mph. By the time I get the bag down and join the medics, the people involved have already refused transport. Another busted call. Strike two.

(Let me stop for a minute... Some of you might be reading and thinking, "This guy is twisted. Wanting stuff to happen to people?" That isn't the case. The fact is, things are going to happen, no matter what. I know this career isn't all adrenaline, blood and guts, and saving lives. But I have to experience 5 successful emergencies calls this day, and the day was going rather slow. I was also ready to get some experience in. So please don't think that I wish harm upon other people. I really just want to be able to learn so that when I am out there on my own as an EMT, I will have better knowledge of how to do my job.)

After spending more endless hours at the station, we get another emergency call. A child has fallen out of a grocery cart right on his head. This really was a basic call. The poor kid had a good knot on his head, and normally we would have immobilized his spine, but considering that he was intent on grasping onto his mother, we felt that placing them both on the stretcher would suffice.

Everything I read about head injuries in my text book pointed to c spine immobilization! c spine immobilization! c spine immobilization! But if we would have tried to immobilize this young child, who was already shy as hell and wondering what was going on, he would have made any spinal injury, if any, much worse. I hope he just got away with that bump and nothing else. He seemed to be doing alright.

I have one more shift of ride alongs to do, which I will be doing tomorrow. You can be sure that I will post those stories here as well. Hopefully I will get more hands-on experience as it is a Saturday...


It has been quite a long time since my last post and unfortunately, so much has happened that I will not be able to outline every aspect of class for those who might be interested. So I'll just outline the major events up until now to get everyone caught up.

Some time in July my Grandfather fall, broke his arm, and had a bout with a blood infection. My grandmother has multiple sclerosis and she relies heavily on my grandfather to do daily chores around the house. So, I took a flight out of town to help out with the family for a week or so. During that time, I got behind in school.

When I got back, I was a little down that I had fell behind. It took a few weeks to get myself into gear about getting caught up. It ended up being a week long study marathon to get me caught up (or so I thought). I was sure that the class was nearly over.

However, when I got to class I found that I was now 15 chapters ahead. I had completed all of my online exams and read every chapter in the book. All I had left to do was my ride-alongs, and my final exams...
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