April 2010 Archives
A very busy day with not so many calls but lots of other work that needed to be done. I started the morning early at 0800 to do some training with a half dozen people looking for promotion. With that training completed our IV pumps were placed in service and the drip medications that had been removed under state guidelines due to the lack of these pumps were returned. The remainder of the day was spent working on various administrative tasks that are the mundane but seemingly prevalent part of my reality.
The evening portion of the shift was a bit more interesting from an operational standpoint. One of the student organizations was sponsoring a concert with several thousand people expected. I spent a couple of hours meeting with the Assistant Fire Chief working to coordinate our operational plan for what was expected to be a busier than normal night. I would be the in our officer in charge for the evening, would be staying on duty until the concert was over and the primary interface for our personnel with the fire department incident commander. We worked out what seemed like it would be an effective plan and at 1900 I briefed our personnel on it. It's always better to be well prepared ahead of time.
We watched as the clock advanced, doors open, warm up act takes the stage, main act takes the stage, 1st ambulance goes out for an intoxicated student at the concert venue, and...and...and...nothing else happens and by 2330 we are told we can stand down. I turned the shift over to the duty officer for the night shift and headed home, staying on call as the back up paramedic. The crews handled two additional medical calls early in the night shift but nothing after 0130. Lots of preparation and no need for most of it.
It's better to be well prepared and have nothing happen than to be poorly prepared and have all hell break loose. Besides, we can use the same plan for future events of similar size, like next week when the who process repeats itself for a similar concert at the same venue.
Another boring day. A single call for the ambulance to the campus health center for what was called in as an allergic reaction but ended up being a hyperventilating student. Nothing for me to do.
I really miss being busy.
Total calls for the evening: 1 BLS downgrade
Milage for the evening: 16 miles
Slow, slow, slow was the word of the day. No calls for me and only one dispatch for the ambulance. With the training program for our new equipment ready to go I spent most of the day working on installation and storage of the new equipment. Drilling holes in the cabinets so that we can access plugs to charge the IV pumps when not in use. As I progressed I found a few quirks in the construction of our older ambulances that had me going to the hardware store for different drill bits so that I could do the job. I got most of it done, hopefully I'll be able to finish everything Thursday evening.
I'll be the duty paramedic tonight and, as much as I like to be busy, the cold rain that's falling is making me think that it will be a night on the slow side.
I was afraid that Friday night would be as bad as Thursday night was. Fortunately it was not but it was busy enough that I didn't actually get to bed until almost 0300.
Only two calls of note tonight, both within a quarter mile of each other and both resulted in the crew wrestling with patients in the back of the ambulance.
The first call came in just before midnight, I'd been asleep for about 20 minutes when the tone for the unresponsive party came in. I arrived on scene shortly after the ambulance and the rescue and found them in a small apartment with a male in his early twenties with alcohol on his breath who was awake but not responding verbally. The people in the apartment with him, of course, had no idea of he had just been drinking or if there were any other substances involved. We brought him out to the ambulance and started to transport. My partner put an IV in. We checked his glucose, 128 mg/Dl, so that wasn't the problem. After a few minutes he started with making circles with his feet and then his head, and finally started reaching out and grabbing us with his hands. We tried verbally coaching him to stop for a couple minutes but after he latched on and it took two of us to pry his hands off we decided it was time to restrain him. Problem was, both of us were using all our hands to hold him in place and nobody could reach the restraints. Since by this time we were three minutes out from the ED we shouted up to the driver to have her radio ahead and have security waiting because the patient was uncooperative and would require restraints fairly soon after arrival. I was quite pleased to find security waiting on the ambulance pad when we arrived and even more pleased to find one of the ED nurses there as well. He hopped on and immediately gave the patient some a Haldol and Ativan. Between the three of us on the crew and the guards we were able to get the patient inside and onto the stretcher where they restrained him quickly.
I have no idea what was going on with him. I spoke with the ED doctor after his initial evaluation. He had no obvious sign of a head injury (they were going to get a CT scan anyway). He was acting a little like he was taking GHB but not the usual presentation. He acted a little like he was on Illy, a drug combination from the mid 1990's (marijuana cigarettes laced with embalming fluid) but not completely. A mystery that I guess the toxicology screens will make more sense of.
The second call was for a fall with facial abrasions, check a patient for the police. Usually these don't require a paramedic but I was two blocks away. I arrived in front of a downtown bar to find several police officers in the area along with a prisoner transport van from the Sheriff's Department. I was informed that the patient has tripped getting into the van and "just needed to be checked". Now before any gets the wrong idea, I really do believe that he tripped as opposed to "tripped". The police in this town are very used to dealing with intoxicated students and by and large find them approach them with amusement more than frustration.
The Deputy Sheriff opened the back door to the van and I had the patient sit down on the floor and scoot over to the door. Even though he was cuffed with flex-cuffs I am not going to get into an enclosed space with an intoxicated prisoner. My safety comes first. The patient was a male in his late teens, crying, and repeatedly saying that he wanted to go home. An quick evaluation later revealed a couple of small abrasions to the side of his face where he struck the door of the van while he tried to climb in. Nothing big, the bleeding had already stopped. I tried to talk to him quietly to calm him down and get a better history and it was working pretty well until the Deputy told us that he had to go to the hospital to be medically cleared before the county jail would accept him for booking.
The patient then began crying hard, becoming more and more upset as time went on. BY the time the ambulance crew brought the stretcher he was starting to get belligerent. As we stood him up off the step of the van to put him on the stretcher he tried to kick one of the EMS crew. He was told in no uncertain terms that this would be unacceptable behavior and he should stop it by the police. This only resulted him him starting to shout obscenities at us.
The stretcher was secured into the back of the ambulance and I was getting ready to clear, no ALS was necessary, when he started to spit at the crew and tried to kick them. I came in the back door and beside the stretcher, pushing the patients head towards the wall to prevent him from spitting on my crew while kneeling on his upper legs to prevent him from kicking any more. The police sergeant decided that enough was enough and detailed an officer to accompany the crew to the ED. I asked the crew if they wanted me to accompany them and they declined, feeling that the police officer should give them more than enough hands to deal with any problems from a handcuffed patient. They closed the doors to the back and pulled away from the curb. I realized that I wasn't completely comfortable with the situation and decided to follow them as far as the highway (4 minutes from the hospital) just to make sure that they would be OK. They were and when the crew returned from the ED they told me that the patient had been reasonably calm for the trip in only to become more belligerent at the ED and end up in 4 point restraints and sedated.
The bars closed at 0200 just like every night and the sidewalks were streaming intoxicated students heading back to their dorms and apartments. Chances were pretty good that there would be another call and I didn't want to get dragged out of bed again. I waited until the pedestrian traffic slowed to a trickle, around 0245, and at that point I felt it was worth the risk to head back to bed.
I slept like a rock and actually overslept making me over an hour late getting the truck back. With the next shift on duty I am still giving serious consideration to going back to bed.
Total calls for the night: 2
1 ALS transport
1 BLS downgrade
Milage for the night: 22
After the busy night last night and less than 2 hours of sleep it was a pretty rough day. I tried very hard to actually be productive with limited success. With only 1 canceled call during the day shift I was bobbing and weaving at my desk and finally gave up at 1530 or so and crashed for a little more than an hours nap. I'm allowed to do that under our rules if I was up on department business during the night shift but I really try not to nap unless absolutely necessary. Today it was.
As tired as I was I did make some progress on some projects and hope to wrap up the first stage of the training project I am working on Monday or Tuesday.
At this point I have 8 hours as the on call paramedic left before I am off for the weekend. As hard as the crews that are on tonight are praying for a busy night I am praying for a slow night. If I were a betting man I would bet against me though, it's a Friday night, with reasonably good weather, and the campus already appears to be hopping.
Total calls for today: 1 cancelled upon arrival
Milage for today: 24
Well, that was certainly an eventful night. Only three calls but all told I only got about 40 minutes of sleep.
We started the night responding to a 69 year old female complaining of 10 days of off and on chest pain that tonight radiated to her jaw. Tonight was the worst she ever experienced and her husband, a retired ED physician, felt that it was time to go to the hospital. Her pain was waning when we got there and after some aspirin and oxygen she was complaining only of some mild nausea. Her 12 lead and vital signs were totally unremarkable. We carried her downstairs to the ambulance and had a relatively uneventful trip to the hospital after I established an IV and gave her an anti-emetic to calm her nausea.
It truly was an uneventful call. The eventful part of it didn't start until after the ambulance dropped me off at my truck and I was headed back home. As I was driving up one of the main roads in town I approached a curve and suddenly found headlights traveling at high speed traveling in my lane. I began some evasive maneuvers to avoid a collision and so did the other driver, his car crossed back into his lane onto the shoulder of his side of the road, turned sharply back towards my lane and onto the shoulder on my side of the road, spun out, avoiding striking my paramedic unit by less than 6 feet and struck a tree with the passenger side rear corner of his vehicle.
I called the dispatcher and asked for PD to be dispatched as I just witness a crash and turned around to go check for injuries. As I pulled up to the vehicle it was spinning it's tires trying to get disentangled from the tree and rocks it had hit. I put my truck in park just as the other vehicle shot away from the tree and continued on down the road in the same direction it had been traveling prior to hitting the tree. I figured I probably should see if I could at least get a license plate number from the vehicle just to pass on to the police and I followed. We turned onto a side street and then an even smaller street off of that. I got close enough to see the plate and called it in just as the car pulled into a residential driveway.
The young driver got out and approached me and I inquired as to if he was injured. I suppose I shouldn't have been surprised when he responded "What are you talking about? I'm fine.". He had alcohol on his breath and widely dilated pupils with nystagmus even when looking straight ahead. I explained to him that I he almost hit me head on and I witness him hitting a tree and he replied that I "must be mistaken". I pointed out the damage to the back of his car and he told me that it had been like that for a few months and that there was no new damage. Curious, I figure of he had been driving with the back bumper dragging on the ground for a few months someone might have stopped him and told him about it. At this point three other young men exited the vehicle, one sprinting for the trees, the other just standing at the back end of the care and the fourth disappearing into the dark. About this time the first of 4 police cruisers arrived.
The driver still denied having any type of accident even though one of the later arriving cruisers actually brought a shorn off part that matched his vehicle. After a short discussion with the sergeant the driver was given a shiny pair of stainless steel bracelets and a trip to the police station to be processed.
I sate down in my truck to fill out a statement for the police. Several minutes later the passenger that hadn't bolted (who had also been handcuffed) seemed to realize that he was probably under arrest began complaining of dizziness. I called the dispatcher and had the fire department and an ambulance dispatched and began assessing him. His assessment was totally normal. Unfortunately he kept slipping up with his story and let slip that he had been in an accident, that he was underage, had been drinking, that none of the people in the car lived at the house where they pulled in, and that the driver was lying through his teeth (we knew this already). The ambulance arrived shortly and we boarded and collared him and he was transported by the ambulance BLS to the hospital.
At this point I went and finished my statement and checked with the sergeant to make sure they didn't need anything else from me before I left the scene. He said no and I headed back home with the idea of getting some sleep.
That was not to be. I got home and found that I was still a bit hyped up from my near miss and couldn't sleep. I took another 20 minutes and jotted down some notes on what happened since I had a feeling that I might need to refer to them at some point in the future. Nothing specific, just a feeling. After I finished my notes I had relaxed a bit and tried to sleep some more.
I think I may have actually slept for 10 minutes before my cell phone rang. It was the crew chief from one of the two crews on duty telling me that one of the fire departments had just struck a second alarm and that they were getting ready to go for the fire standby. I glanced at my watch, 0314, ugh. Normally we should have been dispatched on the first alarm, as soon as it was reported as a working fire but for some reason it took the dispatcher another 6 minutes to actually dispatch us and do an "all hands" call for EMS personnel to report to the station.
The two on duty ambulances and I responded to what was described as a "three story wood frame fully involved". This was going to be a long night if that was indeed the case. When I arrived I deployed our EMS resources with one ambulance crew and some extra personnel setting up a rehab area and the second ambulance staging just outside the fireground to be available if we needed to transport or had another call in our response area before the third ambulance could be retrieved and staffed.
The fire department knocked down the fire fairly quickly, it was not fully involved, just heavy fire on the first floor, and overhaul took a while. All told we were on scene for three more hours, performed rehab, and dealt with no injuries. While a lot of my colleagues here like fire standbys I find them to be dreadfully boring once the suppression phase is done and they move into the overhaul phase. Come to think of it thats the way I felt when i was a firefighter too.
We were finally released just before 0630 and I gave orders for the third ambulance to stand down and retuned to the station to hand off to my relief.
I'm home now, winding down for a few minutes so I can try to get , at best, 90 minutes of sleep before I have to be up again and getting ready to go back to work at 0900.
It's going to be a long day.
Total calls for the night: 3
1 ALS transport
1 BLS downgrade
1 Fire standby
Milage for the might: 44
A very slow day, only one call that technically didn't need me but I tagged along anyway just for something to do. The ambulance got called for a 19 year old syncopal episode on campus. They got there just before the rescue and a couple minutes before I did. Totally uninteresting, the patient had a history of doing the same when she stood up too quickly for some time now and was completely awake and alert. She did have some back and neck pain from when she fell so I helped the crew board and collar her before I headed back to the station.
Over the next few hours I checked the reserve ambulance at the other station, ran some errands, got fuel and headed back to do some paperwork. I managed to make some serious progress on the training program I have been working on, discussed some personnel issues with the personnel officer, and went over some equipment with one of our probationary members.
I wish I could say that I would have the rest of the night off but tonight is one of my nights on call and while I can take the truck home I will still be the duty paramedic for "thirsty Thursday". It's starting to rain though so I may luck out have that keep the call volume lower since I'm back for my usual long Friday shift and another night as the duty paramedic tomorrow.
Wednesday is my regular day off and with my family on vacation we wanted to do something special. Well, it didn't quite work out the way we had planned it. My wife and I agreed that we had some chores to complete around the house before we did anything and that in the afternoon we would take the kids to the planetarium. So, we spent the morning mowing the lawn and filling in the holes the dog dug (me) and weeding the garden and planting some of the new plants she had purchased (her).
As it ended up we didn't finish our respective chores until almost 1400. After showers, lunch, and an hour drive we would have arrived at the planetarium less than 2 hours from closing. That just didn't seem like it made a lot of sense. We decided that we would instead go out for lunch and do something close to home.
My oldest daughter and I both have celiac disease, which means that we can't eat gluten (wheat, oats, barley, rye) or anything that has been exposed to it. This makes finding restaurants a bit more challenging as we need to make sure that the menu has food that the two of us can eat. One of the restaurants that does this pretty well is P.F. Changs, a chain of chinese restaurants. As we were driving out to find lunch I asked if anyone would mind driving far 45 minutes and having a late lunch/early dinner at the nearest location. The kids didn't care and my wife was up for the adventure and we headed off with the kids trying to decide if we were having "linner" or "dunch" (they never did decide).
The restaurant is next door to a fairly large mall and after we located it and found a parking place it was clear that I was going to have to go along with one of my wife and kids favorite activities after lunch, shopping.
Lunch was fantastic, Changs Spicy Chicken, their gluten free version of General Tso's Chicken, the service was mediocre, but we all had a pretty good meal and were glad that we came.
After our meal we headed over to the mall. As luck would have it there was an Apple Store in the mall and the kids and I were able to hang out there playing with Apples new iPad while my wife perused the shops. I couldn't think of a better way to handle it.
I have to say that I was pretty impressed with the iPad and, although lots of people are having a hard time seeing it as a new type of technology with a unique use I was able to see it for what it is, an awesome content consumption device. It's not going to replace my laptop for content creation, nor is it likely to replace my iPhone where I consume content and manage my life. Do I want one? Yes. Do I want one right now? Probably not for a few months. As much as I like cutting edge technology I no longer have a job that requires me to be that close to the bleeding edge that I have to have the latest and greatest device as soon as it is available. I expect that I will get an iPad sometime in the next 4-6 months and that the platform will mature as the unavoidable bugs are squashed and new software and accessories are released.
We headed home well after the end of rush hour and stopped on the way at Trader Joe's to see what gluten free goodies they had in stock.
When all was said and done our jaunt out to find something for lunch had us getting home at almost 2000. everybody had a good time and we are chalking it up as a successful day for the MacMedic family.
A pretty boring day today. No calls for me and most of my time was spent putting together a training program for our new IV pumps. A much smaller amount of time was spent running around doing operational tasks but not much. I was pretty much married to my desk. Not exciting by any stretch of the imagination.
Total calls: 0
Milage for the day: 12
One of the things that my wife and I said we had to get done while the kids and she were on vacation was complete passport applications. The kids have never had them, my wife's had expired a few years ago and mine would expire next year. The US Department of State had a very nice set of web pages that fill out the applications for you and print out the final application ready for delivery to the Post Office with pictures and accompanying documents for processing.
The applications were complete and we had what we thought was all the supporting documentation. Off we went to the pharmacy to get pictures taken. The pharmacy tool the pictures but refused to cut them into the 2"x2" size required because the post office had been rejecting the ones that they had been doing as being incorrectly formatted. No big deal I guess.
When we arrived at the post office and got to the front of the line we splayed out the documents in front of the clerk only to be told that we needed pictures of both sides of the adults drivers licenses to prove citizenship. I went quickly back through the directions that printed with the passport applications and showed the clerk where it said that a current or expired passport could also be used. "They're wrong" was the reply. Realizing that we were going to get nowhere we cut our losses and headed to my office where we made the multiple copies of both of our drivers licenses that would be required and headed back to the post office.
Different clerk this time, the first one seemed to slow down his processing of the package he was shipping. Same paperwork plus the copies of the drivers licenses put down. This time the problem was that the pictures hadn't been cropped to the appropriate size. Wait, can't you trim them here at the post office? Well, yes, but it should have been done by the photographer. A little back and forth and the clerk disappeared to trim the photos herself. OK, this is promising. 10 minutes later she is back at the counter ready to process the paperwork. One at a time the applications changed from our stack of paper to hers. Birth certificates for each of the girls, copies of my drivers license, copies of my wife's drivers license, the now trimmed pictures, and a separate check for each application.
30 minutes later we are on our way out to the car. The applications have been sent off priority mail with a return receipt. My wife is just amazed at how difficult the process had to be. Easier to get into the country illegally than to get out as a law abiding citizen was what she complained about. I have to say, she has a point.
A fairly typical day shift for me. I really only work one day a week and my remaining 3 scheduled shifts are evenings. I started the day doing the daily vehicle checks, all three ambulances and the paramedic intercept unit, narcotic counts on all, fuel for the intercept unit, and picking up some equipment at our off-site storage area. Then it was on to paperwork and other tasks. Nothing heavy duty and nothing complicated today.
Only one call today, responding to one of our towns for a teenager who took an "accidental" overdose of her anxiety medication. She was acting fine when we got there and complaining only of feeling "weird". Not surprising.
One thing I'm doing different now on my overdoses, intentional or not is calling the Poison Control Center. I realized a while ago that they have much more expertise in toxicology than I ever will and they can give me really useful information that can help me make treatment decisions. In this case the Nurse on the other end of the phone was able to tell me that with the amount of medication this patient ingested she might have dizziness and upset stomach but little else. The EMT-I on the ambulance agreed with me and I downgraded the call to him for transport to the hospital.
I know that in the past I had viewed Poison Control as a resource for exotic or industrial ingestions or exposures and felt that paramedics and EMTs shouldn't need to consult them for information but after a CME session with a representative from the local Center I have completely changed my tune. They have been extremely helpful and my interactions have always been professional. A valuable resource that can be reached almost everywhere in the US by calling 1-800-222-1222.
Total Calls for the Day:
1 Patient turned over to the Intermediate ambulance
Milage for the day: 35
I listened to the latest Mediccast Podcast while in the truck today.
I left work at 2200 on Friday and turned my pager off. It felt strange but my wife was on call and I would be unavailable to matter what disaster befell the community. I was asleep pretty quickly and when I woke up Saturday morning I didn't think about work all that much. Nice. My wife was having an unusually quiet weekend and we decided to risk taking the kids to the movies with the neighbours to see "How to Train Your Dragon". It was surprisingly enjoyable and we all had a good time. Our neighbour and her kids went on their way and we went out to dinner before heading home.
Sunday was a day of shopping for my wife and kids and work around the house for me. She took the kids out shipping individually during the morning and early afternoon to buy spring clothes while I entertained and cajoled the remaining kids into helping me do laundry and straighten up around the house. We all met for lunch and a quick trip to the bookstore so my middle daughter would have a new book to read on her trip later this week, she'll be going away with a friend and her family for 5 days and wanted something to read.
For me the weekend ended with my wife and I renting Up In The Air on TV. Another good movie although one with a less happy ending. I always hate movies that end with the main character finding that everything they believed in wasn't what it seemed and that they were left with less of a life than they had thought they had. I suppose that I worry that I would end up finding the same thing.
On Fridays I work a long shift, 0900-2200, almost a double shift. I spent a good part of the day doing paperwork, operational errands, and working on a powerpoint for the training program for our new IV pumps. Not very exciting.
The only ALS call today was to the local urgent care center for what started out as a BLS transport to the ED for an elderly man who amputated two fingertips with a table saw. I decided to head out that way anyway just on the off chance that the call turned into an ALS call. I figured the worst thing that happened would be that I would head back to the station if I wasn't needed. When we arrived we found the staff giving the patient Morphine through the IV that they had started (so apparently it wasn't a BLS transport after all). The patient was complaining of 8/10 pain in his left 2nd and 3rd digits. He looked pretty uncomfortable and the 2mg of morphine that the staff had given him didn't really touch his pain. I hopped in the back with the crew and we headed to the hospital. On the way I gave him an additional 8mg of morphine which was just starting to control his pain.
He was a nice guy and very appreciative of what we were doing for him. I felt pretty good that we were able to help him feel a little better. The big disappointment is that the hospital does not have a hand surgeon so, even though the fingertips were recovered, there was almost no chance of his having them re-implanted. I hope that the plastic surgeon they called would be able to do the job but I honestly think that his chances of not losing those two fingertips is pretty small.
An afternoon call for a two car MVA that ended up being a pair of refusals and an evening call for an intoxicated, elderly fall victim who was somewhat combative rounded out the day.
Total runs for the shift: 3
1 ALS transport
1 BLS downgrade
Milage for the shift: 46
What was I listening to? The Mac Jury Podcast
Hi, I'm the MacMedic. Some of you might remember me as a paramedic and blogger from 2003 to 2008 or so. For the past few years I have been missing in action. Why? Well, that's an interesting question. Well, no, not really, it's probably only interesting to me but I'll tell you anyway. I went missing during 2008 for two reasons, one good and the other total crap. I'll leave it to the reader to decide which is which.
First reason, my job found out about my blog and demanded that I delete it, right now, while they watched, or I could pack my things and go home. At that point I had stopped running my own server and had about a years worth of entries on Wordpress.com. They're gone forever and I am sad because I had written some good stuff that meant a lot to me. My own stupidity, I guess, for not keeping a backup copy of everything. Suffice it to say that I won't be making that mistake again.
The second reason was that I was starting to write things primarily for my readers and not for myself. I was forgetting why I started to write in the first place and it was rapidly becoming something I did not enjoy. In the beginning I wrote to relieve my stress, keep some of my friends up to date on what I was doing, and to just exercise what stood in for my creativity. When I started writing to attract readers and keep them interested it started to feel like a chore and became stressful in and of itself. In short it wasn't making me happy.
The reality though, is that I missed it. I missed using my blog as an outlet for my stress and a way to express myself. I tried writing other stuff, short form fiction, non-fiction and the like but it never satisfied me like my blog did, like writing about my life as I saw it, being able to see where I had come from, and to a lesser degree, where I was going.
I need that outlet and finally, two days ago, I decided that it was time to try again. This weblog represents my attempt to come back to blogging. I had backups of all my entries in my old blog up until August of 2007 and I will be reposting them as time permits, a few at a time. Unfortunately the comments will most likely be lost which disappoints me to no end as I found a great deal of support from them. I hope that some of the friends that I made come back and start to read me again but I understand if they don't.
This site will be in flux over the several weeks as I repost almost 2000 entries and work to personalize the stylesheets and templates to what I want them to be. I'll be out on the web looking for some of my other blogging colleagues to put together a list of some of the quality weblogs that I read in the past and read currently.
I want this weblog to turn into something that I enjoy, something that helps me relieve my stress, and something that helps me keep in touch the reality that is my life. If others read it and get something useful from it thats great. If they don't, thats OK too
To quote my very first blog post:
That leads me right back to the original question, why am I doing this? I'm doing this because I need to put my thoughts down on paper, real or virtual, so I can look at them, mull them over, consider them, and make the best decisions I can. I need to tell the tale of my search for happiness and balance in my life. If others can glean some useful thoughts from my tale I am happy to tell it.
That is why I am doing this...again.