Drinking and Driving: A Public Service Announcement

Its 5:30am and I am nearing the end of a 24 hour shift but I'm wide awake.

Today was pretty slow due to the fact that our unit was out of service after I inspected the tires to find the majority of them slick with no tread and one front tire with some cuts and a 1/2 inch chunk missing from it.

We didn't get into service until about 1:30 this afternoon. The calls consisted of a pretty minor MVC, some general body weakness calls, and a hospital to residence transfer, with the calls starting to slow about 11:30pm, when I decided that it was a good time to get some sleep.

The call that I want to talk about came in at about 3:00am dispatched as a major MVC with two patients located about 15 minutes away.

In route we met up with two engines from local fire department who were in route to the scene also. It looked like this one was going to be a doozy.

Arriving on scene, we found the vehicle on fire, but the fire department was starting to handle it. The first thing that went through our minds was "Oh geez, is the patient still in that vehicle?". We were lucky to see that a few of the firefighters were kneeling with our patient holding c-spine next to a ditch a good distance from the wreck.

It turned out that we would only have one patient. No one else was involved. As soon as I got the SMR gear and took a knee next to her, I could smell the alcohol, the most likely cause of the MVC.

We got her SMRd, assessed, loaded, and started setting up the monitor on her as well as her IV. All went well. The patient didn't appear to have obvious life threatening injuries. A few lacerations here and there, severe pain on the whole left side of her body to include her shoulder, ribs, and hip.

We were ready to take off code 1 to the local trauma hospital. Before taking off, I walked up to the vehicle to talk to the firefighters just to see if there might have been another patient and to see the damage to the vehicle, the fire of which was already put out by this time.

After confirming no more patients, I turned my attention to the vehicle. I couldn't help but notice that the engine was missing. As I looked closer, I found the engine inside the vehicle. It turns out that along with her intoxication, she said she started to get tired and may have fell asleep at the wheel. She impacted her car head on into a traffic signal pole (a very big one mind you). No airbag deployment, but she was restrained.

I felt that this was important information that might lead to injuries that we had not been able to see. I let the medic know and we changed our transport to code 3.

Now, I like lights and sirens, I like the adrenaline rush that I still get out of rushing to the patient. However, I don't have a hardon for it especially when I am driving lights and sirens with a patient in the back who is strapped to a backboard. I kept my speed just at 10mph above posted speed limits and did my best to give her a comfortable, yet hasty ride.

If you don't read anything else in this post, at least read this...

What I would like to say here for my friends or even people that I do not know that may be reading this is: Don't drink and drive.

I know you've heard it before, since before you could drink and before you could drive. This young lady was lucky. Even more fortunate was that fact that it happened on a rural road at 3am with no on around to be injured by her lack of judgment. Please don't put your life or other people's lives at risk. I hate calls like this. They could easily be prevented by crashing at the person's house, calling someone, or simply having the common sense to know that you have to drive home alone.

By the way, the young lady said she only had five beers. It doesn't matter. The next thing you know, you might be laying in a ditch with your life on the line. Even worse, you may not have your wreck in front of someone's house and be trapped in that burning vehicle.

Be smart and stay safe out there.

Redemption

I feel better about things now. After my bad day, I was worried that maybe I wasn't up to par to be working with a 911 company just yet.

This shift (48 hours) was fairly busy. Some attempted suicides, the regular respiratory complications, general body weakness calls, etc. I did everything right this shift.

I got in, did my vitals, spiked ivs, got the iv equipment ready before the medic told me, o2 and all that. I actually felt good when my partner praised me and said I was on top of things. It wasn't the same medic that I was with when I screwed up on my last shift but at least I know that if I work with him again, I'll be more confident.

The most interesting call of the day came in about an hour before my shift ended. We were dispatched to an MVC on the highway which turned out to be a hit and run involving a motorcycle who was going about 65. This was my first MVC with a good deal of trauma involved.

The patient was an older guy, possible dislocated shoulder, lacerations to the head, distended abdomen, with back and neck pain. All in all, I think he got off pretty lucky considering the mechanism of injury.

We got to him, assessed, SMRd, and transported code 3 to the local trauma hospital pretty damn quick. I'm not sure how the guy turned out afterwards, but I felt like he would make it through.

The guy was alert and said that the other vehicle got to close to him, probably a distracted driver, and sideswiped him and fled the scene without even stopping. It sure makes me think twice about ever wanting to own a motorcycle. They're just too dangerous.

Rookie Moves

Well, today was a rough day for me mentally. I was paired up with a medic, a good medic mind you, who seems to be strict and straight forward. He's not an ass, he's not out to get me, but he lets me know when I make mistakes and that I need to correct things.

I made a few good rookie mistakes in two calls. A big problem for me is that I have not had to do any EMT-Basic related skills since I finished class in September. Other than studying for my NREMT and reading up to refresh myself a bit, I've done nothing EMS related. I knew, coming into this job, that there would be things that I may have forgotten, or simply missed out on due to some time missed out at school.

The first thing that happened was on a call with an asthmatic patient. In the back of the unit, the medic asked me to set up an albuterol treatment. I'm sure we were taught this in class, but I'm pretty sure I missed out on it due to being out of class because of a family emergency. It was embarrassing when I had to tell him that I didn't know how. So I let the medic down by not knowing how to do a basic skill and he let me know. At that point, I was useless since he had to do that, plus set up the patient's IV.

From that point, maybe I was flustered and off of my game. On another call, the same day I made two mistakes. One being that I put the damn BP cuff on upside down and I put the EKG leads on incorrectly.

The professionalism of my partner is something that stands out to me. Instead of letting me know right away, in front of the patient and while I am driving, and instead of telling me in front the ER staff, and instead of telling me in front of the rest of the medics, he waited until we were in route back to station to let me know of my mistakes and that the mistakes that I made through the day are important basic knowledge and that I need to make sure that I know my job.

Mentally, I was bummed out. Like I said, I knew there would be things that I would need to refresh on and skills that need to be brushed up. I didn't want to come into this job with guys having years of experience and myself doing stupid stuff like this. I don't want to be "that guy".

I've talked to my instructor, who also works here, and I also went back and researched these skills and others to make sure that I don't make the same mistakes again. I know I'm not stupid. I'm a fast learner, but I am a hands on learner. I'm sure I'll make mistakes again in the future and I hope that whoever is there with me will give me constructive criticism.

I just don't want to be "that guy".

Bwak Bwak Bwak!

I was thinking about some other calls that happened on my 48 hour shift the other day and I thought this one was a little funny.

We get dispatched to an MVC involving two vehicles.

Two of the four patients in one of the vehicles opt to go to the hospital due to a head laceration and neck/back pain. However, they're both standing, so we need to SMR and take them down on the backboard.

First of all, they were on their way to a party or something. They had a cake in the truck which must have exploded when they were hit because there was pink icing`everywhere. The patients had pink icing on them, we had pink icing on us, the unit had pink icing in it. It was all over the place.

The other basic and I were just about to take down one of the patients on a backboard and the medic was having a look at the other patient when, out of nowhere we hear "BWAK BWAK BWAK BWAK!" and this chicken leaps out of the truck and takes off down the road. The reaction of the medic was priceless. He wasn't sure what it was at first, but he did a little dance. The police, the patience, and ourselves were all laughing about it.

I'm guessing the chicken wanted to refuse transport.

First Shift

I just got finished working my first shift, a 48 hour weekend shift.

During this shift, I was supposed to be taking a crash course orientation in my responsibilities as a basic with the company. What I ended up doing was observing on a three man truck for the first half of my first shift, then driving on another truck with the medic attending and an experienced basic observing me.

On my second shift, I was let go on a truck with a supervisory medic.

Since then, just about everyone I talk to wants to let me know the proper ways to drive and what I need to be doing. A lot of it gets repetitive but I understand why. I'm making a point to be very cautions when driving calls, especially code 3 calls due to the high risk of being in a wreck. I already feel comfortable with the rig to be honest, but I don't mind getting more advice as it comes.

My very first call was something else. We were dispatched to a residence for a man with a "laceration to the head". I'm in the back of the unit on the way to the scene thinking, "I wonder if he was in a fight. Perhaps he was playing baseball and got knocked in the noggin. Maybe its an old man that tripped and fell". I was wrong.

Once we arrived, we were led through the house to the back yard where the patient was lying on the pavement with a good deal of blood around him and a towel covering his head.

It turns out the man was painting his house using some sort of scaffold stand and fell off, landed on the pavement, and the scaffold followed his lead, landing on him.

All in all he had a compressed skull fracture in the back of his head, every bone in his face was fractured, fractured right radius, fractured right ulna, fractured left wrist, shattered left elbow, distended abdomen (possible internal bleeding), and possible broken ribs (according to his complaint of rib pain). Oh yeah, and a laceration to the head.

Because of the fractured occipital bone at the rear of his skull, our medic opted to call in a helicopter to have him air lifted to the local trauma hospital. I think the risks of him bouncing on that fracture and driving at a slow pace to keep that from happening called for this option. I think it was a good call. It sure was interesting to witness also.

Due to the fact that both of his arms were splinted, they medics tried to find a vein in his feet to no avail. One IV was attempted in his neck shortly after arriving to the landing zone a short distance from his residence, but it didn't work out.

The flight medics jumped in the unit and made the decision to give him an intraosseous IV using the EZ IO drill. I had studied about it in school but I never got to see it performed, of course. Its an experience that I hope I never have to feel for myself. It sure looked painful.

I don't want to say that it was an "exciting" experience. But I sure was wondering how I would react to a real trauma call. I had been nervous as hell. I feel like I handled it well. I fumbled a bit with things just because I was nervous, but I wasn't disturbed by the injuries or the situation. It made me feel confident about future emergencies.

I found out later that night that this patient was air lifted out to a major city for better treatment. I hope he pulls through.

All in all, I think everything went well on this day. We had other calls, but this one was my first, and I'm sure I'll always remember it.

My First Day

Today was rather mundane. It was just orientation consisting of myself and a new paramedic learning how to fill out their paperwork, watching a powerpoint presentation on safe ambulance driving practices, and a few other equipment tutorials.

I start work tomorrow, Saturday and I will be pulling a 48 hour shift for my first shift.

From what I've gathered, I'll be riding along with another crew and observing mainly for driving reasons.

The company seems to be hard up for drivers at the moment and it sounds like I'll be doing an accelerated field training to get me on a truck with a medic as soon as possible.

I'm a little nervous because I haven't really done anything related to EMS since studying for my NREMT exam in November.

I'm Working!

Well, the day finally came. I'm hired. I spoke with a friend who works at the company as a supervisory medic and he forwarded my application on to the operations director.

I had my interview today and everything went well. I'm basically in. I'll be taking a quick trip out of town to visit my family for two days, then come back and start work.

I will be working for a 911 company that is contracted to a city of about 75,000 plus surrounding towns.

I'll be working a 24 on, 48 off rotating shift. That will give me 72 hours one week, and 48 hours the next week, rotating. There are tons of hours available and I should be able to pick up any shifts on my 48 hour weeks.

I'm looking forward to getting some emergency experience in and moving ahead with my career.

If anything interesting happens, I'll be sure to write.

Sitting, Waiting, Wishing

There have been no updates because... well... There have been no updates! :D

I am patiently waiting to hear from the EMS company that I have applied to. I have people that work there that have allowed me to use them as references and right now it is just a matter of being patient. This is a 911 company and it is what I am interested in doing, versus an all-interfacility company.

Hopefully I will hear from them soon and get my career on the road.

In the meantime, I am brushing up on my EMT knowledge that I have not been able to practice yet. I don't want to start working, almost 3 months after finishing school and not remember all that I had learned.

If anything happens, I will update it here ASAP.

Stay safe!

Still Waiting

I passed my NREMT-B exam back on November 26th. Yay!

As of now, I am just playing the waiting game to get approved for my state certification. I guess they have paperwork to do and all that stuff.

I've been checking online about 10 times a day to see if my certification has gone through yet. I cannot wait to get to work.

There isn't much to update. If anyone is curious how the NREMT-B exam was, all I have to say is read over the chapters in your book that pertain to the subjects on the test, Trauma, Bleeding, Medical Emergencies, Airway and Breathing, Pediatrics, Obstetrics... And I think that may be it.

Just refresh your memory in general. Don't put off taking the test too far after you've completed your class. Also, try to sign up for some online practice tests.

Don't use JBCourse.com It was alright and it did help me on more than one of the real questions on the test, but after taking about 2-3 practice tests, you begin to get the same questions over and over. So, their "improvement" system is flawed. Yes, you get better scores, but it is because you already have their questions memorized.

Just take practice tests, read the rationale for the answer, and understand it.

I'll update when I receive my certification.

"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!