May 2004 Archives

So even after spending an extra 3 and a half hours at work I was not all that tired and if the tightness in my neck and shoulders was any indication I was pretty uptight and not going to be able to sleep. As I drove home I decided on the spur of the moment that I would talk a walk in the woods to try and bleed off some stress and relax so that I might be able to sleep when I got home.

Always prepared to Geocache, I knew there was a new cache in one of the state forests that I would pass if I took just a small detour on my way home and that sounded like it would fit the bill quite nicely. I was still in uniform and didn't have any spare clothes but it would just have to do.

I found the cache after walking about a mile and a quarter into the woods. On my way out I ran into a family searching for the same cache. They must have thought it to be pretty strange to see a uniformed paramedic deep in the woods but they didn't show it.

I got back to the car about a hour later with a three mile hike under my belt and feeling less uptight and ready to head home to go to sleep. That was just what I needed.

The night started out a bit busy with four calls in quick succession but once again things started to slow down after midnight. I spent a few hours catching up on paperwork and then waited for the shift to end.

A little after 0630 I heard the state police dispatched to a one car accident on the highway just over the border to Medic 1's district and I had a brief nagging feeling that I was not going to like the result. 15 minutes later the phone rang and it was Medic 1 calling. He wanted to let me know that my relief had been in a car crash on his way to work and his arrival was going to be delayed if he came in at all. He was uninjured but his car was totaled. I was glad he was OK and although I had no interest in staying longer I wasn't upset about it. End of shift plan changes are a hazard of the job. It did mean that I was going to head out and grab some breakfast and a Diet Coke so I could stay awake. Our department policies allow me to work up to 16 hours at a time and if I was going to be there for another 6 hours I was going to need some caffeine.

I never made it. Shortly after I signed on the air as available the dispatch came over for a call on the far eastern border of my district, literally a stone throw from Medic 11's district, for a 60 year old male with chest pain, no past history. I had been in the neighbourhood a few nights before for a GI bleed so I didn't even need to pull out the map. The dispatch enter relayed more information to me after a few minutes. A 60 year old male with a sudden onset of crushing 10 out of 10 chest pain after moderate exertion. Patient had no significant history but was in extreme discomfort, nauseous, and short of breath. This was going to be ALS no matter how you look at it so I called for a cover assignment before I even arrived on scene.

The ambulance arrived a couple of minutes before I did but I was still met by the wife in the driveway. She was frantic and I did what I could to assure her that we were going to do everything we could for her husband.

The patient was in bed on the second floor. The room was pretty dark, I had forgotten to take my sunglasses off before I went in, but even in the reduced light of closed shade and sunglasses I could see that he looked horrible, grey, sweaty, ragged breathing. The ambulance was on the ball and had already started him on oxygen and was setting up the stair chair to get him down to the ambulance rapidly. We weren't going to wait around long and I had a chance to get a 12 lead done before they were ready to head downstairs. The 12 lead looked frightening, No doubt he was having an MI, in the anterior (back of the heart) lateral (left side of the heart) AND septal (the all between the right and left halves of the heart).

About three minutes later we were loading the stretcher and I told the technician driving to head for the ED at the hospital as fast as he could while still giving me a smooth ride. His vitals signs were reasonably stable so I started pushing lots of nitroglycerin, sublingual (under the tongue) every 3 minutes along with some nitropaste (an ointment that would be absorbed through the skin) while I started the first IV and ran another 12 lead. No better, if anything it looked a little worse. His pain was decreasing a but with the nitroglycerin but not as much as I would like to see. He had already gotten aspirin from the BLS ambulance and I was breaking open the narcotics kit to get the morphine out and during the transport I continued to push the nitro and added morphine to the mix. His pain diminished from 10 out of 10 to 5 out of 10 while we were enroute. Inbetween doses of medication I managed to get a total of three IV's started, blood drawn, a thrombolytic screening done and several serial 12 leads including a set of right sided chest leads (not required but they would help show if his infarct was spreading to the other side of the heart as well.

We arrived at the ED about 23 minutes after I had arrived on the scene. Very good time on the part of the driver and during that time the BLS crew and I had gotten everything done that we needed to. We made the turnover to the ED staff smoothly and I gave report to the doc. It turned out that I had worked for the doctor when he was the EMS medical director in on of the larger cities I had worked in in the mid 1990's and he remembered me so I found that the usual skepticism on the part of the staff was avoided.

The patients heart attack was still evolving and his pain could not be totally relieved. When I left they were talking about flying him to a larger hospital for emergency surgery or a cardiac cath. Either way his outcome was far from certain and with the new privacy laws I might never know what the end result of his care was going to be.

By 1030 when I returned to my station my relief had arrived and I made a quick report to him, finished the paperwork on the last call and got ready to head home.

Total calls for the night: 8
3 ALS transports
3 BLS downgrades
2 Cover assignments

Total milage: 104 miles

CD for the night: "Cracked Rear View" by Hootie and the Blowfish

I fell alseep quickly this morning and slept fitfully for a couple of hours. After waking up a couple of times I finally settled down for a good nights, er, days sleep.

I am looking for ward to tonight being over. It's not often that I get to spend a day with my wife and kids for any extended time but tomorrow is one of those days and after a short nap in the monring we'll have to take the girls out and do something fun. I don't know what yet but we'll ask the kids when the time comes.

In the meantime I need to get through the night first.

I had really great intentions this morning when I got home. Since everyone was still asleep I figured I would stay awake and have breakfast with the whole family for a change. I should have expected that I would fall asleep pretty quickly. By the time I woke up my wife and kids were out of the house and on their way to her parents house in New York. So much for that. Obviously, I rolled over and went back to sleep. Sleep is good.

When I woke up I had a message on my answering machine asking me to come for another interview on Tuesday morning to meet with the department chairman and the HR people. I'm hopeful that this is what I think it is.

I got in to work early so I could talk to the paramedic working days. He's one of the paramedics who's opinion that I value and I wanted to run a few things by him. It was a very productive talk that we will finish in the morning when he relieves me again.

For the beginning of a holiday weekend the night was pretty slow. I went out on a number of calls but all of them were medical and none of them were all that impressive. It wasn't just me either, the fire department and police departments were very slow too. Very unusual.

The most interesting thing that happened during the shift was that I found out that the fire chief and his deputy in the city we are based in is being, well not exactly, fired. The city has elected not to renew his contract. I found that a little disturbing since he was, in my opinion, a good chief, good administrator, and all around good guy. I've known him since he was a firefighter in the department and worked with him on various calls for a long time. He understood EMS and he understood how to dovetail non-fire service EMS into a rapidly advancing department and keep all parties relatively happy. I'm sorry to see him go. I had forgotten that at a certain level in the fire service you cross a line and go from civil servant to political appointee. After talkng with the platoon on last night it almost sounds like crossing that line is akin to selling your soul to the devil.

Total calls for the night: 10
1 ALS turned over to the ALS ambulance
3 BLS transports
5 Cover assignments
1 Unable to intercept

Total milage: 67 miles

CD for the night: "Off Kilter" by Off Kilter

I'm still paying for my late call this morning. I slept for about 5 hours which was delightful but it just wasn't long enough. I'm not feeling sleepy but I am feeling worn out. It will be really nice to get home in the morning and head right back to bed again.

Tonight I found myself in a slight predicament. One of the problems with shift work and primarily working nights is that it is very easy to become temporally disoriented. It never occurred to me until tonight when I was in the shower that this was a holiday weekend and almost everything will be closed on Monday. That makes things a little interesting. I need a haircut before my meeting on Tuesday morning but with the place that normally cuts what's left of my hair closed for the long weekend I'm likely to have to scramble to find someone else to do it. That is unless my wife convinces me to just use my clippers and cut my hair myself just going a bit shorter than I usually do. Tempting, I've even given some thought to just a clean sweep of my scalp too. Not that I would be taking off all that much hair.

I'm hoping to be in a little early so I can finish the paperwork that I didn't finish this morning.

The shift ended up being not so short. I did nothing from around 2330 until 0430 other than socialize with the ED staff and a couple of the medical residents. At 0430 I was bounced out to cover for Medic 2 & Medic 3 but before I could get to that I was put on an assignment with an engine company and an ALS ambulance a few blocks from the hospital for chest pain. Nothing spectacular, actually better described as chest wall pain that increased on palpation. Because of the patients age and history the ALS ambulance was going to do some routine ALS and a 12 lead during transport, if they had time, and I cleared to go back to covering the world.

Medic 2 became available first and I relocated to better cover Medic 3 and was there in time for the ambulance returning Medic 3 to his vehicle to drive by and honk. Very good, another 10 or 15 minutes and I would be heading back to the ED, or so I thought. A couple of minutes later I was dispatched to a call fairly deep in Medic 3's area and in a different town that the one who's ambulance he was on board.

I arrived on scene first and was led to the patient who was a gentleman in his mid 80's complaining of the worst headache of his life and a general throbbing sensation in his head and neck. No other complaints or symptoms. He was hypertensive but his blood pressure was significantly higher on one side when compared to the other. Overall, I just didn't like the whole situation and I helped the ambulance load and we began transport to one of the nearest ED's, about 40 minutes away.

The transport was pretty uneventful and after getting through heavy traffic we arrived at the hospital just in time to stand in the queue at triage for 25 minutes before we got a bed assignment and then wait another 20 minutes for the nursing staff to finish getting report at their shift change before I was able to really turn over care.

By the time I had turned over the patient to the nursing staff I had been at the ED for almost an hour and still had to go back to the scene for my vehicle and return to the hospital. For some reason the trip back to the scene took 20 minutes longer than the trip in did even with the rush hour traffic going into the city and us traveling out.

I finally made it back to the ED at 0900 and turned over to my relief. I still had some paperwork to do but was just barely hanging on to consciousness. I did a baaaaaad thing. I left my paperwork in the log book to complete when I came in tonight. That is not my normal mode of operation but I was so tired and no matter what would still be getting up at 1530 to get my kids off the bus and really needed to sleep some so I could be back in at 1900 I just had to go.

Total calls for the night: 4
1 ALS transport
1 ALS turned over to the ALS ambulance
2 Cover assignments

Total milage for the night: 68

CD for the night: "The Girl in the Other Room" by Diana Krall

I agreed to work a partial shift tonight so one of the other medics could leave on vacation early. The shift is from midnight to 0700 at Medic 1. I don't mind taking partial shifts as long as I don't have to spend more time traveling than I do working.

I spent today alternating napping and getting work done around the house. I probably should have taken my Ambien and gotten a good days sleep but I had too much that needed to get done. I got more done than I expected to and still got a few hours of sleep in as well.

I am debating what I want to do while I'm at work tonight. I have some new project work that I haven't started yet, some reading I want to do, and I would love some time to just search the internet for a nice kayak to build. At this point I don't know which will win and take my attention.

This morning I found myself watching a incredibly interesting show on The History Channel on car crashes. Normally this kind of show is not very interesting to me but for some reason this one grabbed my attention early on and I was hooked for the hour.

I don't normally search out pictures of crashes, I see enough in the course of my work to satisfy that need(?) and that wasn't what grabbed me. What grabbed my attention was the teaser on the engineering research that has been done over the past half century to make cars and roads safer. In the mid-1960's the average annual death toll from car crashes was in the order of 55,000 people. A mind bending thought when you try to put it into local perspective. I thought about it from the perspective that 55,000 people would be the equivalent of killing off the population of the largest city in my service area (granted not all that large) and throwing in a neighbouring town to make up the difference. In that context the number becomes almost staggering.

Since the 60's the number of vehicles on the roads has more than doubled and the number of deaths has decreased by almost a third. That is still a pretty high number.

The show spent several minutes talking about the development and deployment of seat belts and other restraining devices and the engineers they interviewed estimated that the amount of car crash related fatalities on our roads could be dropped by another third if seat belt use were closer to 100%. Anecdotally I agree with that. In my 24 years in EMS I have rarely seen fatalities in restrained occupants. Sure there are some but they would have been killed either way just looking at the severity of the crash. There always will be some crashes that are just too severe to survive.

A long segment was spent on crash testing which I found fascinating. Watching films of crash testing going back into the 40's and 50's and seeing the difference in survivability was amazing. As one with engineering training I could understand completely why the number of fatalities and serious injuries was able to be reduced so much. It was very cool to see that the engineering advances were not just in the design of the automobile but also in the design of the roadway and things like signposts and guardrails and barriers, to name a few, that have been able to reduce the number of fatalities and the severity of injuries.

Very thought provoking and it explained quite nicely the trends I have seen in crashes during my career.

After the show had ended I extrapolated some of what they had said to my day to day life and found that there is still an area where we have advanced very little. That is in the area of crash safety for EMS vehicles. Major strides have been made in passenger vehicles and trucks of all types and almost no significant advances have been made in the area of crash safety in the patient compartment of ambulances. Essentially we are no better off than we were when EMS was in it's infancy in the 60's and 70's. Sharp corners, lack of effective restraint systems for patient and EMT, general instability of ambulances design, loose equipment all have shown only marginal improvement in the past 40 years. Very depressing.

A CDC report from 2003 didn't make me feel much better. It pointed out some of the deficiencies of current ambulances but doesn't do much toward proposing effective solutions. We have come so far and have so far yet to go.

There are some patients that you look at and have to ask "what were they thinking?". I started the shift with one of those last night. No matter how hard I try I just can't follow his thought process.

I was dispatched to the interstate for a possible overdose, meet the state police on scene. When I pulled up I found that they had a young man, early 20's at most, handcuffed and lying on the ground. The sergeant gave me the run down. A trooper on patrol came upon a vehicle on the shoulder of the road with it's hazard lights flashing. Thinking it to be a disable vehicle he turned on his lights and pulled off the highway behind it. As he approached the vehicle he saw a single occupant who seemed unaware of his presence. He knocked on the window intending to ask if the occupant needed help. When he did that the young man looked up with a surprised look on his face, locked the doors, opened his glove compartment and after pulling a plastic bag out started to eat the white powdery contents. Understandably the trooper found this to be bizarre behavior and tried to convince him to open the doors. When he refused the trooper, being concerned for the safety of the occupant broke a side window and gained access so he could stop the occupant from eating anymore of the powder. He pulled the occupant out of the vehicle and forced him onto the ground. In the process the occupant started threatening the trooper and his backup units and ended up being handcuffed. After a search of the vehicle what little remained of the powdery substance was determined to be cocaine and EMS was called.

The patient presented with a rapid heart rate and some diaphoresis but otherwise looked pretty normal. Until he opened his mouth and started to talk about the 40 troopers that had been following him all day and the helicopters, and the spy satellites. Riiiiight, a little paranoid are we? As I tried to interview him he dropped into a diatribe about how he was a black belt and he would take us all on and put us all in the hospital. Clearly I was not making any friends here. We loaded him onto the ambulance and started a cold transport to the ED with him alternating between threatening us and changing his story as to how he got there and what was happening.

By the time we got to the ED and turned him over he was starting to quiet down and stopped threatening everyone. He still got restrained and a trooper still stayed with him. After a few hours and a lot of tests it was determined that he had a fairly significant alcohol level and tested positive for cocaine, cannabis, and opiates. Eventually he was released to the trooper for transport to the barracks for processing.

On the way out the trooper was telling the patient to remember that sometimes the simplest answer is the best answer. The patient asked what he meant by that and the trooper replied that had he simply said that he had run out of gas (which was the truth) a wrecker would have been called to bring some gas and he would have been on his way. Instead he was going to the lockup for processing on drug related charges, violation of probation, resisting arrest, assault, and threatening charges. The patient didn't say a thing.

To me this just went to prove that given the choice of doing something smart and doing something stupid there is a significant group of humanity that will choose the stupid answer. I don't feel sorry for this guy, in the grand scheme of things he is getting what he deserved, but you can't help wondering, even just for a few moments, what his thought process was. Then again, no, I am sure that any answer I get would make no sense and keep me up most of the day trying to figure it out.

Total calls for the night: 3
2 ALS transports
1 BLS downgrade

Milage for the night: 73

CD for the night: "Beach House on the Moon" by Jimmy Buffett

I've been listening for the past couple of hours and the day medics have been getting absolutely pounded with calls. I'm hoping they save some for the night shift.

I slept pretty well for a change and woke up feeling better than I have for several days. Not exactly energetic and full of vigor but at least not as dark and gloomy as I have been. It's about time.

As I got out of the shower one of my daughters was beating on the door telling me I had telephone call. It was a call regarding interview I had a couple of weeks ago. I am to come back sometime on the next 7-10 days and meet with some additional people to, hopefully, finalize everything. I am hopefull that things will go well and I that a new challenge will give my mood a boost.

We just got back from the family wedding in New York City that we went to. I actually have to say that I learned quite a bit about myself in a short period of time. I learned that I am certainly not a Gen Y party all night in a very cool NYC loft kind of guy anymore (if I ever was). The party was still going strong at about 0100 when my wife and I left. The wedding was at 1900 and they didn't server desert until 0000.

My wife's cousin was the one getting married and I have never felt such a generational gap before. She and her husband and all their friends partied at the reception until 0230, then took the subway back to the hotel to change clothes and went out and parties further until almost 0600. There was no way I was even go to attempt it. No way, no how. I'm just too old.

In the morning after a perfectly dreadful nights sleep my wife talked me into going shopping with her and her sister to buy shoes. I must have been asleep when she asked since while I dislike shopping, I totally detest shopping for shoes and in New York, put the two together and I can't even imagine that I would agree to it with a gun to my head. But, I went, and I smiled, and my wife and her sister had a good time.

I also learned that I just am not comfortable in New York City. The city is too big for me, the lifestyle too chaotic, the noise too loud, and the city just plain too dirty. It was rather disappointing to realize this because I have always thought that I might enjoy living in a large city having so many things to do and virtually limitless options for food, entertainment, recreation. I wonder if it isn't New York? I didn't have the same feeling when I was in Boston, Philadelphia, Montreal, or even Houston.

The night was one of those where things just kept going with lots of going on. It seemed a lot busier than it was probably due to the heavy rain we had for a while and the unfortunate encounter that Medic 3 had with a deer while responding to call which put us down a unit for a few hours.

The early part of the shift was a couple of cancelations and some BLS calls. The night got a little more interesting after midnight while I was returning from a cover assignment. The city dispatched 2 engine companies two ambulances and Medic 1 & Medic 3 all to a small side street for a motor vehicle accident. I was kind of skeptical as I responded as for the need for all those units to such a small street. My skepticism went away when I was still a couple of blocks away and could see a column of smoke and flame over the rooftops. I arrived to find a compact car head on into a tree fully involved in fire. Not being something you see everyday I was impressed. One of the engine companies made a quick knockdown on the fire while the other was attending to two patients lying in the street about 30 meters from the car. The first patient was tearful and bordering on hysterical but appearing to be relatively uninjured except for a laceration on her foot.

The other patient was prone on the ground complaining of "pain everywhere" although he was not acting like he was in all that much discomfort. He was also quite intoxicated. My initial exam found only some obvious soft tissue injuries but since he couldn't tell me who was driving, if he had a seat belt on or how he got out of the car I just felt uneasy about the whole thing even though some of the other responders felt comfortable and had suggested a routine transport to the nearby ED. I wasn't sure yet.

We rolled the patient supine onto the backboard and all it took was a quick glance to see that we would be headed to a trauma center. Once the patient was on his back and still trying to move around the angulation at his right hip and midshaft thigh were both very evident. The leg was shortened and rotated outward as well and he was complaining of additional pain as well. Enroute to the trauma center we got an IV started and the patient got some morphine for pain relief. Because of his mental status and severe state of intoxication I didn't want to give him too much pain medication, he mental status was altered enough already but we were able to reduce his pain from a 7 out of 10 to a 3 out of 10 and at least make it so he would stop moving.

The staff at the trauma center was their usual cranky mood and stopped us at triage for several minutes to decide where he should go. Eventually we moved into the trauma room although the trauma team was not activated, only a few members. Our happy go lucky patient stop being very happy when he started getting the trauma workup. Femoral stick for blood gases and blood samples, rectal exam, foley catheter, routine stuff for a trauma patient but not what he wanted or expected.

Before we cleared we got a chance to see his films and I was very impressed with his hip. He had dislocated his right hip and fractured his femur pretty high up, almost at the ball of the hip joint. Ouch!

I couldn't help but think about the whole situation. They had been on a first date and at a semi-formal dance before the crash and while it was not exactly the most professional thought I have ever had I wondered of there would be a second date.

The last patient of the night was one that was amusing and frustrating at the same time. I was dispatched to a SNF for an elderly woman with an altered mental status around 0330. When I arrived I was shown to the room of a 97 year old woman who the staff felt was not acting right because she had not called for the bedpan as often as she usually did and was exhibiting some slight difficulty speaking. While I was there waiting for the ambulance to arrive her speech was clearing up and she was more oriented than I was. I asked her if she knew what the date was and she replied with month, day, year, and day of week. I was embarrassed that I had to look at my watch to see of she was correct. She further volunteered that she didn't want to go to the hospital.

The situation got a little murkier since when I asked the staff if she had someone who was able to make healthcare decisions for her and they replied that she made all her own decisions. A little tension developed when I explained to the staff that I couldn't just take her against her will. After trying to explain things to the nursing supervisor I got the doctor at the ED involved and ended up working out a compromise with the patient and the staff. The patient would agree to BLS transport as long as her favorite aide from the SNF were to accompany her to the ED. It was clear that she was very unhappy with the situation but this seemed like the only solution that was going to satisfy the staff without getting the patient too upset. As we rolled the stretcher out one of the staff members told the patient "We were worried, you were so disoriented.". Without missing a beat the patient shot back with "I'm 97 and it's the middle of the night, I'm allowed to be disoriented". The crew and I just smiled at each other and choked back our laughter. The way I figured it that was a point for the 97 year old patient. She was treated and released as a probable TIA and happily went back to the SNF with the intention of giving the staff a piece of her mind. I don't doubt that she did either.

Total calls for the night: 8
2 ALS transports
2 BLS downgrades
1 Cancelled on arrival
3 Cover assignments

Milage for the night: 167

CD for the night: "Audio" by Blue Man Group

I definitely could have slept better today but have a much better outlook on going to work tonight. This is my last night before heading to New York for tomorrow nights wedding. To a certain extent I think I may just be looking forward to being with adults for a while and doing the things that grown ups do. I would like to think that we would have some time to go and do the "touristy" things in New York but we really won't. It's just drive down Friday afternoon and back Saturday morning, no time to hang around and see the sights or even visit friends and other relatives.

This week has been terribly slow and I haven't really done much that was either interesting or significant and it would be nice to have that change. Well, nice for me, not for the patient, but that is the way the job works.

A number of people have asked over the past several months why I call myself "The MacMedic". I wish I could say that it's an interesting story, it's not, at least I don't think so.

I have been a fan of Macintosh computers since they were introduced. Before that I had used a number of computer at school most of the being of the Apple II or III vintage and later on running some kind of rudimentary Unix. I got my first Mac and I had to know what made it tick. Not just the operating system but the hardware as well. With the help of a good friend I learned as much as I could about taking them apart, fixing problems, putting them together again, and even canniblizing several dead computers to make one or two working ones. Didn't matter who I was doing it for, hardware or software problems I was very happy to dig in and figure it out. I even started writing software (badly) as relaxation.

After several years of this I was asked to donate some of my time to a charity auction and a friend of the family bought 4 hours of my time to help her with her Mac problems. She knew that I was a paramedic and that I loved both my medic job and hacking around with computers. After spending much more of than the 4 hours she had purchased with her getting everything just so and teaching her how to use it she declared that I was "the paramedic for her Mac".

After I started a side business as a Mac consultant she would call when she needed help and I would find messages on my answering machine starting "Hey MacMedic!". After a while the name just stuck. 10 years later that friend has passed away from cancer, and my business passed away from the lousy economy and the bursting of the tech bubble but the name still stuck.

When I first started to think about blogging I tried to think about a title for my blog. A friend had suggested that I find a title that described me and what I do. Outside of my family my two biggest passions were my Macs and my life as a paramedic. Hey, somebody else had already selected the name for me. It fit and I used it.

My Mac hacking is pretty limited now with much of my time being taken up by my job and being a dad but when I have some free time I still enjoy trying to force my Macs to do what I want them to do.

There it is, not very exciting but true.

Posted by themacmedic at May 20, 2004 5:57 PM

The night was blissfully slow. So slow that after midnight no patients came into the ED for almost 6 hours and the staff spent their time watching "The West Wing" on DVD. I did a little reading and a lot of thinking.

My only call of the shift came in at 0650 and ended up being a BLS downgrade. I ended up getting out late but not tremendously so.

Total Calls for the night: 1 BLS downgrade

Total milage: 36

CD for the night: "Cracked Rear View" by Hootie and the Blowfish

The night started out slow with only one call early in the shift. By 0200 the ED had pretty much cleared out, none of the medics had anything going on and everyone in the department had settled in to read, knit, or just occupy their time. I had settle in with my book and was enjoying it while I listened to some music as well.

A little before 0400 Medic 3 was dispatched to cover a call for Medic 31 and a few minutes after that Medic 1 went out for a call his his district. As I expected it wasn't too long before I was sent on a cover assignment because both of them were out and committed on calls. I had barely gotten the truck out of the garage when the dispatcher called and changed my assignment. The cover assignment was on hold and I would be responding to back up Medic 1 for a motor vehicle rollover with patients entrapped. The crash was about 25 miles from my station and it was going to take me a while.

As I responded I kept an ear on the radio traffic and heard the incident commander order another rescue/engine company for another set of heavy tools. Then he requested an EMS helicopter and shortly thereafter a second EMS helicopter and another engine to establish the landing zone. In the meantime, on another frequency the commercial service that covers the city was sending a second and third ambulance and their supervisor fly car. An ambulance to the scene, the other and the supervisor to the landing zone to shuttle the flight crews to the scene about 3/4 of a mile away.

When I arrived on scene I found Medic 1 and 2 of the ambulances and got the rundown and my first good look at the crash. The car was a compact car, a Saturn coupe that had rolled onto it's side and struck a telephone pole at what had to have been high speed. The roof had been crushed down to below the level of the dashboard and the driver was clearly visible (and audible) through the shattered rear windshield that was now about 3 feet forward of where it was supposed to be. The passenger was another story, she was barely visible in the wreckage and was either screaming uncontrollably or totally flaccid. Our access to her was extremely limited so our assessment of her was difficult.

Things were further complicated by the fact that they had fractured the telephone pole about 6 feet above ground level and the top of the pole along with the still energized wires was still lying across the vehicle. All we could do was wait for the power company to come and de-energize the lines so we could get to work.

While we waited the fire department was planning how they were going to get in. It was an extrication I was glad that I wasn't in charge of because it was going to be extremely complex and if not done correctly probably pretty dangerous.

It took the power company about 40 minutes from the original time of dispatch to get a crew out to the scene but they made quick work of de-energizing the lines and the rescue company went to work cribbing the car and stabilizing it with a come-along so that the heavy tools to could get to work. The operation was difficult just due to the extremely heavy damage and deformity to the vehicle as well as the fact that both patients were compressed between their seats and the telephone pole, separated only by the skin of the roof. In an ideal world they would have simply folded the roof down to give us access to the patients. With the telephone pole enveloped by the car that was not going to work. One crew cut off the telephone pole to about 3 feet above the ground. I have to admit I was uncomfortable with the chain saw being used that close to the patients with nothing but the roof and a blanket between the saw and where we thought the patients were. The sawing was done gingerly and with a lot of care and the pole was shortened by half allowing them to get at the roof to work on getting the driver out.

It ended up being a long and tedious process. The roof was so crushed and deformed and in places mashed into other parts of the car that they could not simply make a few cuts and pull it down. It was made more frustrating by the fact that whatever they did to try and disentangle the driver caused increased pressure on the passenger. It took 38 minutes for them to cut, pull, and pry the patient out. Half the roof, much of the dashboard and drivers door had been removed in small pieces 2-3 feet across. The driver came out onto a backboard with relative ease once he was freed and looked surprisingly good considering the crash he had just been in.

Medic 1 went with this patient accompanied by one of the flight crews to the landing zone while the firefighters went back to trying to get the passenger out.

This was a much more difficult job since the telephone pole was knocked out of plumb by the force of the collision and the amount of pressure on her was much greater than that on the driver. It was also more complicated because while we could reach her head and one arm her legs and her other arm were not fully visible so our options were limited. Some of the rescue crew wanted to use the chain saw to cut the pole down to about 4 or 5 inches above the ground. I saw what they wanted to do but voice my opposition to the plan since we had no idea exactly where the hidden parts of the patient were, the risk was too great.

An alternate plan was formulated where one crew would continue to work on the roof piece by piece while another crew would start working on gaining access through the floor of the vehicle to see if they could disentangle her legs and a third crew was starting to hook the rear of the car up to a winch both to stabilize it and to relieve some of the pressure on the roof so that it could be worked on easier.

While this was happening I felt like a caged animal just pacing the perimeter of the action and occasionally darting closer to to confer with the guys working the tools. I was pretty happy with the way the extrication was going. I didn't always agree with the plan that they had made but my opinion was asked for and listened too on several occasions and I felt like we were working well together.

During this whole time the patient was still alternately screaming and being unresponsive. We had been able to get to the point where we could find her right arm which was across her midsection with her obviously fractured wrist pinned between the door frame and her chest. Her feet were found by the crew coming in through the floor and they worked to disentangle them. I was able to get a look and reach in to feel them. They were pulseless, pale and cold. Not a good sign. It was pretty obvious from the angle that her lower legs were placed that she had some significant fractures higher up in her legs. Slowly progress was being made in getting her freed. By this time the vehicle itself was starting to loss integrity at the base of the front seats and once the crews in the front were ready to extricate the patient we were able to use the winch and the come-along to take advantage of this instability and almost open the car like a book. It gave us the few inches we needed and the final part of the roof was removed with a saw and the passenger was able to be lifted out onto a backboard. Total time to disentangle and extricate her was 76 minutes. It was a long time but I thought that, all things considered, it was a job that was pretty well done.

The damage to her lower extremities was significant, both femurs were obviously fractured and both ankles were either fractured or severely dislocated. She had no pulses in her legs all the way up to her pelvis which was also unstable. Her belly was firm and tender to the touch making us suspicious of an abdominal injury. To be on the safe side while the flight crew worked on paralyzing her and intubating her other EMS personnel worked on getting the MAST on her (for the non-medical reader MAST, Medical Anti-Shock Trousers, are a set of essentially inflatable pants that, in theory at least, will help to keep a patients blood pressure up, at least thats why we carry them). This is a piece of equipment that we use very seldom mostly because the science to back up the theory of why they work just isn't there and some people don't think they work. In this case we were putting them on for two reasons. First, by applying them and inflating them a little bit they would become somewhat rigid and act as a splint to keep her legs and pelvis from moving around any more than they already had. Secondly if she ended up having a bleed of some kind in her abdomen they trousers could be fully inflated to, hopefully, slow or stop the bleeding by putting pressure on the damaged blood vessel or organ.

The second helicopter took her and headed for the trauma center.

Her prognosis was not looking all that good. The injuries to her legs were extreme and they had no blood flow for close to 2 hours. Her pelvis was probably shattered and her right arm was broken with no blood flow to her hand for the same time frame. I don't know what other injuries she may have had that I couldn't see but I know that they were others.

One of the questions that kept coming up during this operation was the events leading up to the collision and as we treated both patients we were able to get some insight into maybe not the how but at least the why. As the driver was being removed from the vehicle and his clothes cut off his crack pipe fell from his pocket. As we were cutting the clothes off of the passenger we found that she had a rather large baggie of marijuana stuffed in her bra. It sort of figured that drugs and/or alcohol were involved.

As I headed back to my station to write one of the poorest constructed run forms of my career I kept thinking about this call. What went right, what went wrong, what we had no control over, and what the patients were going to be going through. One thing was for sure, if the passenger survives this accident her life will never be the same. The driver will survive and his life will go on. I hope he can live with the knowledge that he maimed ( and possibly killed, we don't know yet) his friend. I know that I would have a very hard time with those facts.

I also thought about how calls like this one change the lives of those who respond to them. Looking at many of the men and women on scene lots of us have kids, some younger, some older than the patients here, but I am sure that each one of us breathed a small sigh of relief that the patients were not our children and choked up a little thinking about what the parents of these kids would be feeling like. As EMS, fire and law enforcement professionals this may have been just another call, as parents and people none of us walked away from that scene unscathed. I know that when I got home all I wanted to do was hold my kids and tell them how much I loved them.

Total calls for the night: 3
1 ALS transport
1 ALS turned over to the helicopter
1 very short cover assignment

Milage for the night: 83

CD for the night: "Mirrorball" by Sarah McLaughlin until around 0400 and then nothing, I needed the quiet.

I slept for most of the day after being up a good portion of the night. I wish I could say that I got a lot of stuff done last night but I didn't. I started lots of things but just couldn't see anything through to the end. My mother came and watched my youngest daughter while my wife was in surgery for the morning and taking my oldest daughter to the pediatric GI doctor at the Children's Hospital. She has to go back to be examined and be tested for Celiac Disease.

From all the reading I have done and her preliminary lab tests my wife and I have no doubt what the results will be and not a little trepidation about what it means and what happens next. What happens next is my 9 year old daughter has to undergo a procedure to biopsy her small bowel. She has to have an endoscopy. I don't even like the sound of it and knowing what I have read neither will she. If the biopsy were simply to confirm the diagnosis we would be comfortable just bypassing it and going with the lab results and the symptoms that she has been having. Unfortunately it is not just diagnostic, Celiac can result in damage to the small intestine.

The only bright spot in this is that provided there is no damage to her intestine the treatment is largely the removal of gluten from her diet. She has been on a gluten free diet for several months but we will need to become even more vigilant about looking for hidden gluten in her diet. Beyond that we will just need to be mindful of some of the other conditions that are frequently associated with Celiac Disease, some of them quite unpleasant.

Yet another thing to worry me and keep me off kilter. I just want her to be a healthy child and develop into a healthy young woman. I know she will never be normal and that causes me so much pain and distress, but I pray for her to be healthy.

The recent car bombing in Iraq that killed a member of the provisional government and the train bombing in Madrid have made me think. Not about Spain or Iraq in particular, that is a whole other conversation, but about terrorism and our level of preparedness and focus. The past few years have seen tremendous focus on weapons of mass destruction in the form of nuclear, biological, and chemical agents. I know the training and educational materials that have been made available to me have been exclusively related to NBC attacks. Professionally I find this very unsettling. The obvious reason to be unsettled by it is the simple fact that these type of incidents can easily scare the daylights out of me but also because we seem to be preparing for them to the exclusion of the far more widespread (I don't dare say popular or common) terrorist actions using so called "conventional" weapons.

If one were to look at terrorist incidents for the past 30 years, even if you limit them to those that occurred in the US to date have all been almost exclusively with "conventional" weapons. Even the attacks of 9-11 would be considered a conventional attack because of the type of agent used no matter how unorthodox the method of deployment used.

I have been looking at various Standard Operating Guidelines, training materials, resource guides, and other documentation from my place of work and from places where my friends and colleagues work and I have to say that I am disturbed to say the least. Almost all of them have very detailed plans (not all of them realistic) on how to deal with NBC incidents, many have stockpiles of chemical suits, respirators, decontamination supplies, and chemical/radiation/biologic agent detection equipment. While I think it is a good thing that agencies have thought about these incidents ahead of time and are (somewhat) prepared for them should they occur I am disturbed by the sparse preparation for terrorist incidents using conventional agents.

Looking at these plans I saw mass casualty plans that have not been updated in years, operational guidelines that offer no guidance in how personnel should respond to possible terrorist incidents, very few had any plan for an effective general callback of personnel, even fewer had information in the hands of their field personnel and communications personnel as to what resources would be available to them, how long it would take mobilize them, and what their capacity and capabilities are. Even rough guesstimates on regional hospitals capacities and capabilities are frequently unavailable. I fully realize that much of this cannot be fully qualified or quantified before hand but it is more than possible to maintain very basic estimates of capacity, up to date lists of capabilities, and resource listings as to where needed personnel and vehicles for treatment and transport can be obtained.

Most disturbing to me was the almost total lack of procedures on responder safety. Anyone who has read some of my previous writings knows that one of my main goals each day when I go to work is to come home again in the morning and I am appropriately conservative with that in mind. Not all of my colleagues have the same conservative mindset or healthy fear of death or injury, and sense of self preservation (or is it common sense) that I like to believe that I have.

I know from conversations with colleagues in Israel, Central America, and the UK that for many of them they have extensive education and drilling in their SOGs on responding to terrorist incidents. Things situational awareness, maintaining a high index of suspicion, specific training on blast injuries, operating in an unsecured area, joint operations with tactical military and/or law enforcement units. These guidelines and educational opportunities do not exist in mostEMS systems in the US. Many of them have related specialized units based in their service or geographic area to handle some of these tasks. This is a good thing, no doubt.

That being said it is imperative that we reevaluate our ability and preparedness for conventional incidents and retool our thinking. As usual, the American mindset lags behind the reality of the rest of the world. We have finally changed our thinking from the "it won't happen here" mindset which flew in the face of the reality we had been experiencing (i.e. LaGuardia Airport in the 70's, Oklahoma CIty, the first WTC attack, the bombing during the Atlanta Olympics to name a few) to "it has happened here". But somewhere along the way we lost our focus. We got hung up on the NBC incident and have ignored the fact that the vast majority of terrorist attacks worldwide have been of a conventional nature. The mindset that we have not been able to change is the one that requires us in America to start with a blank sheet of paper when it comes to developing our response to any type of incident.

We have failed to take heed of more experienced members of the international community who have been dealing with terror for decades such Israel, the UK, Spain, and France just as examples. We Americans know best, we have the all the right answers, we can use our wealth and technology to solve all problems. Except that others have been working on solutions related to terrorism for decades and we cannot ignore their experience and expertise. I, for one, would love to be able to call on my colleagues who have been dealing with the aftermath of Palestinian suicide bombers, Basque separatists, the IRA, and numerous other agents of terror for help, to draw on their experience and use that information as a strong foundation to base our response to terrorism on. Then, as true friends do, reciprocate with our ideas and developments to help them as well. We are not omnipotent, we do not have all the answers, but we stand a better chance of having the right answers when the time comes if we draw from all sources, not just we invent here.

There was a sick call for Medic 1 tonight and after watching numerous pages come over the pager looking for coverage they started calling people at home. I so badly wanted to say yes and make sure that they didn't go down a unit tonight but I just couldn't. I have been home all day with one of my kids, I haven't slept more than an hour or two, I am getting over a sleep depravation induce migraine, and I just need to be selfish. I have an important meeting in the morning that I really need to be in top form for. Tired and less than sharp just won't do.

Still, I feel a little guilty saying no.

My backside hurts. I spent almost the entire shift in my unit moving from place to place racking up lots of miles but accomplishing little. I had hoped for some calls to take my mind off of things but that was not to be. Once again Medic 3 was the hotspot doing several calls, most of which were ALS. I am not complaining about the calls, this is just the way things go sometimes. There are nights where I am doing most of the ALS and in the long run it all balances out.

Now I am just very tired and looking forward to some sleep and a chance to do some work around the house when I wake up. My grad school application remains 95% finished and I need to get it done if I have any hope of entering the program in the fall. I have a multitude of appointments that need to be made. Items I have been auctioning off need to be shipped and more items listed. The kids will have homework that they will need to be helped with and I am hoping that things will work out the way I want and I will, at least, have dinner started by the time my wife gets home.

Total calls for the night: 14
2 BLS downgrades
1 Unable to intercept
2 Cancelled upon arrival
9 Cover assignments

Milage for the night: 237

CD for the Night: "Far Side of the World" by Jimmy Buffett

In for overtime tonight as Medic 1. With the weekend I had I almost wish I could have just said "I changed my mind" but that wouldn't be fair to anyone and we sure could use the extra money. When I had originally taken the shift it was at Medic 3 but I swapped locations because I had my doubts that I would be able to get to Medic 3's station by 1900 unless my wife got out of work early and since she took the morning off for our meeting at the school I knew my chances of that would be slim.

Monday nights are usually fairly slow and the weather is supposed to be foggy and rainy after midnight so I am hoping that it is and will be slow.

The meeting this morning was difficult for me in so many different ways that I am not surprised that I didn't sleep well today. The meeting went as well as it could considering how awful I felt about it. It was a pretty crowded room with her teacher from this year, her teacher for next year, her paraprofessional aide, special education teacher, occupational therapist, social worker, speech and language therapist, principal, school psychologist, school nurse, and, oh yeah, my wife and me. I know that everybody that was there was there for a reason but it felt like everyone was involved except the custodian and her bus driver. It's not fair for me to say that.

Almost all of the comments were positive and telling us how much progress she had made this year and that felt good. I was glad I had a little feeling good because the rest of it was just one depressing thing after another. As goals like shoe tying, socialization skills, limiting emotional outbursts, following directions and such all just drove home how far she has to go. When they started talking about teaching her to play and converse with other children I just had to take my glasses off, close my eyes, and stop listening or I was going to cry.

I know, all of this is important and will help her to develop into as normal a child and eventually adult as she can but all I can wonder is what the future holds for her. As hard as I try to look at the positives and believe that she will be equipped to begin dealing with life as a member of the community I am always left with the overwhelming fear that, when her mother and I are no longer around to guide her and protect her, her future will be pretty bleak. As much as I know that it is not fair to any of us for me to allow my fears to get the best of me but I can't help it.

I had hoped that what little sleep I was going to get would make things look at least a little better but it has done nothing to take the edge off of my fear.

Sleep never came last night even though there wasn't much going on. Too much on my mind about the weekend and I am facing this morning with trepidation. At 0900 we have a meeting at my oldest daughters school to map out her educational plan for next year. We meet like this a couple of times a year and it is always a struggle. Mostly for me. Each time we meet I face the reality that my daughter is autistic, even though she is high functioning she is still in the autistic spectrum. She will never have a normal life. These meetings always seem to highlight her weaknesses, I guess they are supposed to, and that never fails to make me frequently somber, often morose, and sometimes on the verge of tears. I want so much for her and these meetings drive home how much of what I want for her will never happen and how powerless I am to change it. I would give anything for her to have the childhood, life, and future of a normal kid.

I can't imagine why I couldn't sleep.

The mini-van is dead so we have been operating out of one of the spare ambulances as our response unit. It's better than the mini-van but not by much. The unit we have been assigned is the oldest in the fleet, rattles to beat the band, runs terribly, has no air conditioning and is generally very uncomfortable. But still, it could always be worse.

Just a pair of calls last night and nothing of any significance. A fall victim who refused treatment and then an intoxicated person who fell on the side of the street. Neither were anything that needed my skills. The PD put us on standby while they and the fire department searched for two missing teenagers but left us in quarters so I can't even consider that a call. It ended up being nothing as both were found unharmed and at home a while later.

Total calls for the night: 2
1 Refusal
1 BLS downgrade

Total milage for the night: 16

No music tonight, no CD player and I wasn't in the mood anyway.

It has been a really rough day and a half. My oldest daughter has been very difficult to deal with. Her anxiety, her impulsiveness, her inability to cope with situations that are not what she wants, all have made my level of stress so high that I am just beside myself. I am feeling so angry and upset that I want to cry. The fact that I am angry and upset only makes me feel worse. I know she can't help it. I want to make everything right for her but am so frustrated that I can't. I wish I had the patience to not get upset by the manifestations of her illness. I don't always and I should, I need to. Someday I wish I could be the father that she needs.

Not much of a night. Most of my time was spent on cover assignments for Medic 3 who was getting pummeled.

Total calls for the night: 8
1 ALS transport
1 ALS turned over to the ALS ambulance
1 Cancelled enroute
5 Cover assignments

Total Milage: 97

CD for the night: May 2004 Issue of Jazz Times

I slept like a rock today and was not happy to be getting up when I did. I wasn't tired, I just was not interested in getting moving. It's Friday so that means that I am working again.It seems that I am always working on Fridays and this has meant that I don't get to go to the synagogue for sabbath services on Friday night much anymore. It's not something that is essential for me but it is nice to be able to remain connected with the rest of the community.

My daughter and wife are in a dance competition this weekend and will be at rehearsal starting around 1800 so I won't even get to have dinner with my family. It amazes me how busy life can be and how much busier it will get.

I spoke with an acquantaince from one of the ambulances we cover who happens to be a very serious radio geek (in a good way). I was describing the new radios we are getting in our new units to replace the antiques that we have been using. Some people just aren't happy if they have nothing to complain about. As much as the radios we are getting are not "top of the line" and "cutting edge" they are new, modern, and better than what we are using. Sure, I would love to have the kind of radio system he described, but we don't have an unlimited budget and there needed to be a balancing between features and price. Next time I'll know better.

Thge weather is supposed to start out nice tonight and then get foggy and humid. I don't have any idea what the night is going to be like but whatever it is I'm still looking forward to it.

It was a pretty laid back night with only the chaos of some ongoing renovations to stir things up. The weather was great and I pulled the truck outside of the garage to check it and enjoy the breeze and fresh air. This is the only station we have with a garage for our vehicles and except in the winter or the rain I find that I am just as happy with the vehicle outside. During the summer there are times that I will just leave the vehicle parked in front of the ED in the middle of the night.

The calls last night were pretty light with the most significant call being an elderly gentleman who was 6 hours post angiogram now having chest pain. He was scheduled to go to one of the nearby tertiary care hospitals for open heart surgery next week. Even in the midst of his chest pain the patient was extremely pleasant and talkative. He was transported to the ED I was based out of and after getting some significant reduction (but not elimination) of his chest pain was transfered to get his CABG on an accelerated basis. On his way out he shook my hand and thank me profusely for my help. It felt pretty nice to get thanked like that.

Nothing else was all that taxing, except living the night without the soda machine that had been removed for renovation of the waiting and registration area. I was caffiene depleted off and on throughout the night.

I took the opportunity to read some of the articles in the latest issue of JEMS (Journal of Emergency Medical Services) and found some of them very thought provoking and interesting. I've been working on some comments on a couple of them to post later (unless you caught the draft version that was accidently posted here yesterday for a couple of hours).

I'll be Medic 1 tonight and off on Saturday so my wife can be on call.

Total calls for the night: 4
2 ALS transports
1 BLS downgrade
1 Cancelled enroute

Total Milage for the night: 68

CD for the night: "The Best of the U.S. Army Air Corp Band" by Glen Miller (yes, it's old but I still love it)

I was up for a good portion of the night doing various projects and chores that needed to be done while trying to stay up and prep for a day of sleep. I made it until about 0500 when I crashed hard.

I felt pretty good when I woke up in a good mode, happy with what I had accomplished last night, the way that my days off had gone, and the fact that I would be going back to work tonight. For a change I had nothing really pressing that needed my attention and I spent the time between waking up and my kids arriving home reading a magazine on the front porch. Quite a delightful half hour, even if it was a trade journal.

I'll be Medic 2 tonight and have to pressing work that needs to be done. My next time I need to teach won't be until early June and the lesson plans are already complete and ready to go. I managed to catch up on my projects while I was working last week, at least all of them except one where I am still waiting for replacement parts to arrive.

Tonight can be whatever kind of night comes and I will be pretty happy with it. The weather is supposed to be nice through the night, I'm well rested, fairly nonstressed, and feeling downright energetic.

Last week I found an open WiFi node on Main Street in one of the nearby cities. It was there for a day, then two, the coverage kept getting better and better extending for several blocks and then even more. I was totally amazed and felt like I was doing something almost illicit sitting at a table next to the police station answering my email in the sunny warm weather. It felt like I was living on the edge and just outside of the law (in more ways than one).

This mornings paper told me that I was not on the wrong side of the law, I was not flirting with the dark side, I was simply a week or so ahead of the curve.

Some of the local businesses have joined together to provide wireless internet access along almost the entire length of Main St, for free.

Up until recently there were areas of the city that didn't even have access to braodband. I maintained for years that when it came to internet access this part of the state was as backward and backwater as you could get. Now we have a 19 block wireless hotspot? Well, well, well, maybe this isn't such a backwards place after all.

Yes, I dropped off the face of the earth for a while. I needed to think and try to destress. Yesterdays meeting went so much better than I expected that I couldn't help but get to the end and think "OK, when is the other shoe going to drop?". It hasn't. nothing says that it won't later on but for now I am pretty happy with the way things went.

I'm pretty surprised about that too. I went into this meeting thinking that I was only mildly interested in the project that was being described and left being excited about the details that I learned and the scope that was outlined. It took me a while to finally hit the point where I was able to look objectively on what we discussed. I needed to take the time to step back and look at the project after I had a chance to let my excitement bleed off. Frequently I have the problem of being dramatically effected by the excitement (or lack thereof) that something was presented to me with. I need a chance to mull things over and try to place things in context. Obviously, if I don't get the chance to put things into the proper context and make a rushed decision it is frequently wrong (Q.E.D? my first marriage, one of my first jobs as a paramedic, my wardrobe).

If this works out the way that it sounds like it will all my fretting about doing what is safe or expanding my horizons will be for nothing as it will prove that, for a while at least, I can do both. Nothing is decided yet so the other shoe may yet drop, but, not yet.

I was right, it was a pretty busy night and not much of what I wanted to get done got done. I did manage to talk with the ED Doc that I needed to speak with. He's was my Medical Director at another job and I both value his opinion and know that other value what he says as well. It's very nice to have people like this to turn to.

The night started shortly after I got in with a cover assignment for Medic 1 and went on from there. No really significant calls though. All of them were pretty routine, cancellations, or BLS downgrades. Oh, and lots of cover assignments.

I was right when I thought the new procedures would delay things a little as I adjusted to a new alarm system and new lock down procedures for when I left the building after closing. I kept having to pull out my cheat sheet with the alarm instructions to make sure that I was arming and disarming it the right way. I didn't have any phone calls from security and the police didn't show up so I have to assume that I didn;t trip the alarm by accident any of the times I left or came back in.

Our new digs are pretty nice, although I didn't spend much time in there. I was impressed, after so many years in the basement not only have we been moved upstairs to the ground floor, but we actually have a window in the office! No more sensory depravation chamber. Certainly not as spacious as some of the medic quarters I have seen at other places but then again, there is only one of us here and we don;t spend much time in the office anyway. The office isn't complete yet, some of the cabinets are not finished, one nagging plumbing problem in the shower needs to be taken care of, and, for some reason, the alarm clock seemed to get lost in the move. I guess it doesn't really matter since Medic 3 doesn't sleep much now anyway but I always used to set it anyway just on the off chance I dozed.

Total calls for the night: 11
2 ALS transports
1 Presumption
1 No medical emergency
1 Cancelled
6 Cover assignments

Total milage for the night: 218

CD for the night: "Etched in Stone" by Off Kilter

Off to Medic 3 tonight. I don;t work there very often because it is the furthest station from my house and other medics live much closer. Tonight, however, it was equally inconvenient for anyone else to work there either.

It should be interesting. The new facility opened and it will be an adjustment to get used to the new procedures and layout. Not much else has changed for us at that station except we have been moved out of the basement and into an office near the ambulance office. It's closer to our vehicles but I suspect it will delay us for a little while longer until we get used to the new procedures to set the alarm and secure the building after the ED closes at 2300.

I know it's going to be a bad night because I have work that I need to get done and I need to talk to one of the ED docs before he goes home at 2300. I am pretty much betting that I will not get everythng done that I need or want to.

It's Mothers Day and she is having such a lousy day. There isn't even much I can do about it. Two kids sick, the third misbehaving, I have to work tonight an nap during the afternoon. It's just not going her way. I need to find a day to make it up to her and show her what an exceptional mom and woman she is.

As bad as the day is for her she is taking it all in stride and not upset. She's amazing.

A very nice night. A couple of good and significant interventions left me feeling really good about the night when I left this morning.

When I got in the day medic was already on his way to the trauma center with a motorcycle crash. I missed him by almost 20 minutes. No way I could even meet him on the highway and finish the transport for him since they were already passed the station. He didn't get back until over an hour after his shift was over and almost as soon as we had signed over the narcotics I was off to a SNF for a patient with difficulty breathing. As the ambulance was bringing me back to my unit we came upon a three car crash on the highway and ended up stopping to render assistance and do some initial care until the assigned transport ambulance could arrive. Unfortunately we still have some pretty backward ways of doing things. It's all about who is assigned the area, not who is closest. I truly would have been faster for us to put the two patients in the back of the ambulance and transport rather than waiting but the ambulance I was in was from the next town over and, well, somebody, somewhere would have gotten cranky about it. By the time the transport ambulance arrived the engine had obtained refusals from 2 of the drivers and we had boarded and collared both of the patients who needed BLS transport.

A couple other calls came in before midnight but they were all cancelled enroute or cancelled as I pulled up. As I was returning from the last of the cancelled calls 4 engine companies and 3 ladder companies were sent to an elderly housing complex for a heavy smoke condition on all floors. EMS was not requested on the initial alarm but since I would be going pretty close to the scene I cut over two blocks and parked across the street. I had vision of all the residents all coming out into the hallways, being exposed to the smoke, and exacerbating their COPD/asthma/other health problems. It's always better to be where you might be needed before you are actually needed, just in case.

The initial size up from the first in engine was food on the stove with a heavy smoke condition on the first floor. Subsequently arriving units checked the floors above and reported fairly heavy smoke on the three floors above as well. 2 of the truck companies were setting up to try and vent the smoke and several other firefighters were patrolling up and down the hallways telling residents to stay in their apartments out of the smoke. Good thinking on the OIC's part to delegate manpower for this, it probably prevented a number of medical calls.

So, I'm just sitting there doing the paperwork from the previous calls when the IC asks for a team with medical equipment to one of the stairwells for a possible smoke inhalation victim. A BLS ambulance was requested but I was not. Even so, I figured I was there, I could see if I could be of any assistance without committing to the scene so I grabbed my gear and walked up to the IC asking of I could be of any help. He directed me to the "C" stairwell with one of the engine companies. I let my dispatch know what was happening and that I was just assisting and not officially on the call yet and went in.

Seated on the bottom step of the stairs was an older gentleman who I was reasonably familiar with and knew to have a heart problem as well as high blood pressure. He was on oxygen and was extremely pale and very, very sweaty. He really looked pretty awful. When we checked his blood pressure we found him to be about 80/30 which explained why he looked so bad. During his exam we found that he had some first degree burns on his torso, hands, and face, singed hair and mustache and a palm sized second degree burn on his chest. One of the firefighters was preparing a sterile dressing for his chest when he suddenly went totally limp and became unresponsive. Fortunately nobody was really thrown too badly by this and he was immediately laid out on the floor and someone started bagging him. I had slapped the defib pads on him and was looking at the monitor seeing a textbook sinus bardadycardia at 60 beats per minute. After a minute of so he became responsive again. I had already called the dispatcher to commit myself to the call, request a cover assignment, and an ETA on the ambulance. Witht he other hand I was dialing the cell phone to get the ED attending on the line and see if he felt we should be looking for a different destination. He said no, the patient should probably get an initial evaluation and intervention before he was shipped out.

The ambulance was on scene a couple of minutes later and the patient was transfered to the stretcher and we started transport to the ED. We were only a few blocks away so there was not an incredibly large amount of time to get stuff done but we were able to get one large bore line started and some bloods drawn. The patient had remained quite alert for the entire transport and complained of no real pain, only a tight feeling across his face and legs. In the dark and even in the ambulance lights he still didn't look too bad but when we arrived in the ED and got him into the really good lights it was clear to see that his face had a leathery quality to it and more of his chest and abdomen had started to blister. He had soot around his mouth and nose and had even burnt the hair inside his nose.

20 minutes later he was swelling to alarming proportions on his face and chest and an ALS ambulance was in the ED to transport him the 60 minutes to the nearest burn center.

As always happens it seems, someone was bent out of shape over the whole thing. When I called my dispatcher he mentioned that the dispatcher for the ambulance had called and gave him grief because they had not been advised that I was there. I figured that they couldn't be too upset since they only had sent a BLS ambulance and the patient got the right treatment. That is what is important. Besides, when we were headed for the ambulance with the patient the IC gave me atta boy, complimented me on my foresight and hustle, and said he was glad that I had been there.

I still don't know the circumstances of the whole incident but I am very glad that I decided to go and lurk at the edge of the scene.

After that I only had one more call, a patient with a bowel resection 4 weeks ago who had a pretty nasty infection at the surgical site. All his doctors were at an academic hospital some distance from where his home was but it seemed to me to be the best thing for him to go where his surgeon was. I suppose I could have sent him in BLS but he was so uncomfortable with his 104 degree fever and so dehydrated and thirsty that I just wasn't comfortable downgrading toBLS even though he looked good otherwise. After a 500cc bolus of saline he started to look better, he looked a little better, and felt much better. Good enough to give the driver grief about the route he used to get to the ED.

I felt great driving home, it was a good shift and I was pretty sure that I would sleep really well.

Total calls for the night: 10
3 ALS transports
1 ALS turned over to the ALS ambulance
2 BLS downgrades
2 Cancelled
2 Cover assignments

Total milage for the night: 87

CD for the night: "The Girl in the Other Room" by Diana Krall and
"The Best of Monk" by Thelonius Monk

As I suspected I slept pretty poorly today. No, no nightmares just very uneasy and restless. Someday I really hope this goes away. Things were kind of interesting when I got up as I had a telephone message waiting for me saying that an ED Director at a nearby hospital wanted to meet with me on Tuesday morning regarding the possibility of a part time position as EMS Coordinator. I don;t recall ever applying for that position but I figure I have nothing to lose by talking to him. The position had recently been held by an RN who had been there for several years who was one of the instructors at my paramedic course back in 1985. It's an interesting prospect although because of their service area I have some questions as to just how much there would be for me to do. Well, like I said, no harm in talking.

The weather sounds like it is going to be exceptionally nice for the night tonight and I am really looking forward to that. Friday night at our busy station with nice weather, it doesn't get much better than that. The guy working days had paged me while I was asleep asking if I could come in early for him. It's too bad that I didn't look at the pager until I was getting dressed for work already. I'll be in 30 minutes early for him but not the hour he had wanted. That's the way things go sometimes.

I have been cleaning again today. A lot. Enough that, once again, the refuse collection people are going to be unhappy. I have managed to empty one of my bookcases, listing over 100 books for sale on Amazon.com, cleaned the closet, found the file cabinet and my desktop, and listed about 25 items on eBay. I've run into stuff in the past several hours that I didn't even know I had. What's worse, I have run into things that I can't, for the life of me, figure out why I have. No matter I guess, they're here and among the many jobs on my "Honey Do" list is to get rid of as much stuff as possible.

Some of the stuff is left over from my computer consulting. Lots of Not For Resale (NFR) software that companies sent me to demo for my clients to convince them to buy it (much of it still sealed in the boxes), excess inventory that was written off when I closed the business, and my much larger than I expected collection of spare obsolete and not so obsolete computer parts. All of it will be out of here one way or another. If I can make some moeny in the process that will be great, if not, well, I'll find something constructive to do with it.

I have come across some stuff that I would have prefered not to find as well. I found several folders in the file cabinet containing documents I have accumulated over the past 20 years or so of work. Copies of old incident reports and run forms, protocol books from the mid 1980's, pictures, letters, and newspaper clippings. A lot of the clippings were just pictures from magazines and newspapers that either had me in it or incidents that I had responded to. It was kind of amusing to look at some of them. Awful haircuts, awful uniforms, antique equipment, lots of memories.

In the process of looking through all of this I came upon a large sealed envelope. I couldn't even think of what was in there before I opened it and after I did I wished I had burned it long ago. Inside were more newspaper clippings, copies of my reports, legal paperwork, and a copy of my return to work authorization from 14 years ago. No, I didn't get injured, I was out of work with PTSD for a short while after a call involving the crash of an engine company from my district. This whole thing has been the source of most of my nightmares for a long, long time. I really did not want to look at any of this again but I couldn't help myself. Like bystanders at a crash or a shooting, I wanted to see but I didn't want to see.

So now I sit here leaning back in my chair thinking about what had happened and how it has effected me over the past 14 years. It was far from the most horrific accident I have ever been to, it was not the highest death count not the most gruesome. I have known other fatalities better. I thought I had given up asking "why?" many years ago. Not why did the crash happen, that was pretty clear even in the beginning, bad brakes on an old piece of apparatus. I guess I am still searching for the other "why". Why did it bother me so much then, why does it still bother me, and will it ever go away?

I thought everything was looking great for me to start grad school in a couple of weeks for the summer term. That was until we took a good look at the finances and realized that other things had to get done before I can think about going back to school. I need to do some serious overtime so that we can make some of the improvements we need to make to our house and pay down some debt.

Things look better for the fall term and I guess I am OK with that. I am disappointed but on the brighter side it does take some of the pressure off, I no longer have the time pressure I had to complete the application and all the ancillary paperwork that goes with it in the next 4 days. It's not much, but it is somewhat a bright side.

In the meantime I'll be sucking up as much OT as possible and redoubling my efforts to find a day or two a week at a part time job.

It was a pretty good night. My uneasiness didn't go away but I ended up being to busy for it to bother me too much. The ED was hopping most of the night and so was I. I really miss having the extra medic on evenings but I think the chances of getting that back is pretty much nonexistent.

One bit of craziness that happened last night was just inexplicable as far as I was concerned. The local commercial service went out to a SNF for a patient who was diaphoretic (sweaty). Generally I only go to nursing facilities if they are sending a BLS or Intermediate unit or if the SNF calls 911 so the fact that I didn't get sent was a nonissue. A while later they rolled in with the patient who was a seriously demented woman who had no particular complaints. I started a saline lock when I went in to draw her blood and a couple of hours later she was discharged. I pulled her lock before the BLS unit put her on the stretcher. The whole thing seemed pretty routine to me.

About 30 minutes later I was sent out to intercept with a BLS unit from the commercial service for a patient with an allergic reaction. Through some miscommunication the ambulance and I ended up taking different routes to the hospital and it delayed our intercept by a few minutes. We were less than 2 minutes from the hospital when we finally met up. I grabbed my gear and hopped into the back...and was shocked to find the same patient that had just been sent back to the SNF there looking quite the same as when she had left.

The crew related that they had gotten to the SNF and the staff had refused to accept the patient back because she was hypertensive. Indeed, she was 12 points higher than she had been upon discharge, but even so I had a hard time saying that this was a hypertensive emergency. The crew, assuming that the staff knew something that they didn't loaded the patient back into their rig and headed out running hot to the ED and called for an ALS intercept.

The one thing I was sure about was that this was not an allergic reaction. The patient was pink, dry, mentating to her norm and clearly not suffering from an allergic reaction. While her BP was on the high side, 186/88, it was just not something that needed immediate intervention. I asked the crew if they were comfortable transporting the patient the last 2 minutes without me and when they said yes I cleared up and made myself available again. As I closed the rear hatch to my truck the ambulance took off heading for the ED running hot again. Hey, I didn't think it was a hot run but I didn't know what their company policy was and I wasn't going to make a big deal over it.

I cleared with the commercial services dispatcher and she started questioning why I cleared, why the ambulance was running hot to the ED, wanting my name, badge number and such. I told her that I was not going to discuss this over the air and that I would call her on the phone. I called on the phone and told her that I cleared because the patient was not having an allergic reaction, at best she was mildly hypertensive, I had no idea why the crew was running hot to the ED, gave her my name, badge number, and just to make sure she had all the information she needed, I included my department heads name and telephone number. I don't know what the problem was but I wasn't too worried about it. The parting shot from the dispatcher? "Well, our policy is that hypertension is always an ALS call." Right, OK, I'm not going to argue about this. If someone is going to make an issue out of this it will be resolved at a higher level than me.

Oh, and the kicker? The patient sat in a nonacute bed for four hours, got her evening dose of antihypertensive medication and was sent back to the SNF with nothing else found and no further intervention.

The other strange disposition I had was on the last call of the day. I was sent to an unresponsive patient with an ALS ambulance from the same commercial service. I had just cleared a cover assignment for Medic 2 and was still a considerable distance away. I knew it would be 15 to 20 minutes before I could get to that section of the city and I had the responding units informed of my location and extended response time. I heard the engine and the rescue sign off on scene, then the ambulance arrived a few minutes after that. For the next 15 minutes I heard absolutely nothing from the scene. Kind of unusual but who knows what the situation is.

Finally I heard the rescue requesting to know what my ETA was. By that time I was pulling into the condo complex and a moment later pulled up. The ambulance crew and first responders had the patient, an unresponsive diabetic with a very high glucose reading (I don't know what it actually was, the meter only started flashing "HIGH"). The paramedic on the ambulance had already done everything that needed to be done except he was unable to get an IVstarted which I managed to do on my second attempt. At this point I sat back and evaluated where we were. The patient was maintaining her own airway, would open her eyes and follow directions if you spoke loudly to her, all the expected care was being rendered, everything seemed to be in pretty good shape. I looked at the paramedic on the ambulance and asked him if he was comfortable riding in without me and he said he was. Not seeing any need for two paramedics on this call I turned the patient over to him and cleared the scene. Nobody questioned it but it just felt weird. I responded for 23 minutes, did nothing more than start an IV and then turned the patient back over to the paramedic who had turned the patient over to me when I arrived. Weird.

Total calls for the night: 11
1 ALS transport
2 ALS turned over to the ALS ambulance
1 BLS downgrade
1 Cancelled upon arrival
1 Cancelled enroute
1 No medical emergency
1 Unable to intercept
3 Cover assignments

Total milage for the night: 187

CD for the night: "I Feel Love" by Blue Man Group

I'm not feeling very well tonight, I have a sense of uneasiness that I just can't shake. Not about anything in particular, just something.

It's been a while since I worked Medic 1 and I am happy to going back to that station. Not only is it the station closest to home but it is the station that tends to be busiest. Yeah, Medic 1 does a lot of cover assignments as well, but thats just part of the job.

The other thing I am interested in doing tonight, aside from being busy, is checking out our new vehicle. The stock vehicle arrived, it hasn't been sent out for modification and installation of all our equipment yet but I am interested in seeing what changes have been made by both GM and what the hospital purchased. There is a nasty rumor floating around that these trucks will have the base model (vinyl) seats. I really hope not. With the amount of time we spend in the truck now a little consideration for our comfort would be in order. We'll see.

One of the services that borders our service area took delivery of a new ambulance recently. Clearly I am missing something. When was it decided that ambulances all had to be enormous? The first time I saw this ambulance it was parked beside an engine company. I was totally astounded that both the ambulance and the pumper appeared to be built on the same chassis.

Then I transported in it. It swayed and bounced. The ride was just as bad as every other monster ambulance I have ever ridden in. What was the icing on the cake though was when both the EMT and I complained about the roughness of the ride and the driver calls back "Rides great up here!". Yeah, it'd feel pretty good back here too....if I were riding in a $2000 air ride seat with a six point harness. All this time I thought it was the ride in the back that mattered. Silly me.

I love Macs, and since the release of Mac OS X the stability of the system has been incredible and working with it (in a support sense) is a dream, most of the time.

It's been almost a year since I have officially worked as a Mac consultant and I can't really say that I miss the hassles of running my own business. I am very happy not to be at the beck and call of each and every client, each thinking that their problem was the most important disaster that could ever happen and that I owed them instantaneous (or faster) response. Heh, sounds like being a paramedic.

When I closed down my clients were referred to other colleagues to provide them services. My friends knew that they could still call me and I would do my best for them and that is what happened tonight. A call from the rabbi saying that his computer was not starting up properly. He rattled off the cryptic Unix error message which I quickly looked up and found a couple of possible solutions. He was worried about the data on his hard drive and I can't say that I blamed him. I agreed to head on down to his house and see what I could do. Not exactly what I had planned.

Four hours later we had managed to get almost all of his documents of his failing hard drive and I was heading home. I came into a quiet house and four sleeping women. *Sigh* so much for an evening with the family. At least I was able to help a friend, that makes it worth it.

Only 2 calls, one at the beginning of the shift and one at the end of the shift. Two calls, well, certainly better than the last few nights. Both calls were pretty basic, routine ALS only but it was refreshing to be back out on the road. I didn't even mind that it was raining for most of the night either. That is certainly unusual for me.

I'm glad the last several days are over. For the past several nights I have either been working or my wife has been on call. A little time to catch up on stuff around the house and see my wife and kids for a while will be welcome.

Total calls for the night: 2 ALS transports

Total milage for the night: 84 miles

CD for the night: "I Feel Love" by Blue Man Group

Today was not a good day so far. It rained most of the day so my kids were cranky and loud. I didn't sleep well and woke up early. When my wife and I sat down to finish paying the bills we ran out of money before we ran out of bills. Just a lousy way to start the night.

After the last 2 nights with no calls I really need to do something tonight just for my own sanity.

This morning when I got home from work I sat down and took off my boots as soon as I got inside. My three year old promptly stepped into them and started clomping around the living room in them. I don't know why but I was on the verge of being furious with her. It wasn't until I read Tom Reynolds post about his boots that I realized why.

My kids see these boots as something that daddy wears to work and it's fun to wear them (or anything I wear to work) and pretend. I see the boots, the uniform, coats, and equipment as reminders of where I have had to do and what I have had to witness. I so much want to keep my children away from those memories.

I know it's silly but I still have the idea that if I can keep my kids unaware of what I really have to do at work the longer it will be before they have to confront some of the ungliness that is in our world. Someday they will learn but I don't want that to be any earlier than it has to be.

I want to publicly thank Tom for finding the right words to help me understand.

Last night was my second shift in a row with no calls. These kind of shifts can be more tiring than those when I am busy. At least when I am busy I come home tired but with a sense that I accomplished something during the night. No such luck last night. Even the work that I brought to do didn't get done as I was always missing one thing or another that would have allowed me to complete the job. I came home this morning with more of a sense of frustration than anything else.

Total calls for the night: 0

Milage for the night: 24

CD for the night: "The Girl in the Other Room" by Diana Krall (still)

I was right, I crashed pretty soon after I finished writing last night and slept deeply and soundly until I awoke to the sounds of my darling "thundering herd" of daughters arguing about which TV show to watch. All three wanted to watch "Power Rangers" but each one wanted somethig different. I stayed out of it, it was just something that they need to work out on their own.

They seemed to have done that. 20 minutes later when I headed out to do some yard work they were all watching TV quite nicely, no obvious damage or missing parts.

We spread another 3 yards of mulch in my wifes garden by noon and I was ready to head back to bed to try to get a nap in before I had to go in for Medic 2.

I don't know what the night is going to be like, the temperatures are supposed to be mild all night which means that I may park the truck outside to do the usual beginning of the month chores. Unseal the backup gear, check it all, and reseal it. Looked for expired or expiring medications in the packs, change out the succinylcholine in our RSI kits with a fresh batch from pharmacy and make sure the end of month paperwork is done.

One of the local ambulance services is having their annual banquet tonight and the paramedics are invited to attend. I am hoping that there will be an official representative and then I won't feel compelled to go. I won't know until I get in so I suppose it doesn't matter.