Archives for August 2010

Defending My Castle…

First of all, this is not much of an EMS post, more of a rant…so bear with me.

It’s 0439 right now, and I’m awake, been this way since 0221 this morning.  Not because of some call, no, but because at exactly 0221 this morning, someone kicked my front door.  Not just a little kick either, a big, trying to break the door in kind of kick…something we would do if we saw someone lying on the floor unresponsive and we had a locked door in front of us.  The White Puppy immediately reacted.  He jumped up and ran to the front door, sounding the alarm the whole way.  I was on the phone with 911 the whole time.  As I get to the door, I see it’s opened a bit, and The White Puppy charges past my legs and out the (opened) front door.  He runs amok for a few minutes, sniffing the deer tracks and peeing on anything he can find before coming back inside to watch his Mistress from the front window.

The cop who arrived yelled at me for my dog getting out and asked me how I would feel if my kid was being mischevious and played ding-dong-ditch and got bitten by a dog.

My response:

“Good on the dog for protecting his owners and property.  After I was done beating my childs’ ass for doing such at 2am when s/he’s supposed to be in bed, I would take him to the ER where he’d have to explain that, while tresspassing on private property at 2am, he was bitten by the family dog.  Then the next day, when I was sure people were home, I’d take him to the houses that he hit and make him apologize for terrifying a family or multiple families.  S/He would then work to repair the damages inflicted on the home and/or do labor for the family, cutting grass, raking leaves, ect until such time as we feel he’s learned his lesson.  This would all be concurrent with having to face the legal aspect of having criminal tresspassing/attempted burglary/whatever statute the law decided to tack on…and I would NOT fight to get them out of trouble.”

Mind you, this is the 5th time in 3 weeks my house has been “hit”.  The door to my garage was busted open, my doorbell has been ripped off, and now the lock on my door is loose.  They weren’t just trying to make noise and run, I honestly feel that someone is trying to break into my home, or at least scare us bad enough that we leave.  The cops keep saying that it has to be a bunch of juveniles just trying to be funny.

I think not.

Funny would be at 1600 them knocking on my window just to rile the dogs up and running.  Funny would be ringing the doorbell and hiding in the bushes, playing that game a few times.  Funny would be leaving flaming bags of dog shit on my porch for me to stomp out.

Kicking my front door so hard the vanity windows on either side crack is not funny.  Kicking my side door so hard they busted the frame is not funny.  The cop asked if I had a gun.  I explained to the cop that, due to my serious lack of firearms training, I do not own a gun and will not until I’ve had training on how to use it properly.  My father taught me that, if I plan on leveling the buisness end of a gun at someone, I better plan on killing them.  The officers’ response:

“Not my problem you don’t have a gun.  Keep the dog locked up or we’ll take the dog.  The dog isn’t even allowed to bark viciously at someone who may be an intruder until they are in your home and in your personal space.”

So, since I need to (effectively) defend my castle, and I can’t use something that probably wouldn’t cause mortal wounds, I guess I need to upgrade and look at purchasing a home defense weapon so that, instead of giving a criminal tresspasser (my front door is almost 30 ft if not more from the sidewalk, it’s not like I have 6 inches of grass and then my front door.  You actually have to make the effort to come to my front door, so yes, they are tresspassing in a serious way) the opportunity to run the hell away, I need something that, if needed, can effectively stop someone once they are in my home.

If someone makes it through the front or side door, it will be the third time they have made unlawful entry into my home.  If I wanted people in my home whenever the hell they felt like it, I’d leave my front door unlocked, the silver on the table, and diamonds hanging from the key hooks.  Signs would be posted, “Please, come on in! I won’t do anything!”  So, anyone out there in EMS blogger land has any good ideas of a home defense weapon, that’d be great.  I’m looking for classes on how to shoot anything, but I’m leaning towards a shotgun.  I figure the loud click-clack of the gun being racked should be enough to deter someone, but who knows…I may get sued for making someone who, I feel, was threatening my home by kicking on/trying to kick in the front foor, scared for their life because I’m bearing down on them with a shotgun…

Defending my Castle,

~M. Trommashere~

Blogs, Blogging, and Aeromedical Transport.

Hello!

Just wanted to put out a vaugely EMS post here.  First of all, I am having a blast in this new format if no one has figured this out yet.  Anywho, I’m adding more and more to my blog-roll here, and I want to give everyone a day in the spot-light.  Today I am turning the scene-lights on to: The Happy Medic, Life Under the Lights, and Mark Zanghetti at Student Paramedic.  Mark is an up and coming blogger who is new to Paramedicine.  He’s in a spot we all were in at one time; Medic Class.  Some of the revalations he is making now are things that some Medics are learning 5, 10, 15+ years into their career.  I see big things coming down the pipes for him.

Life Under the Lights: An awesome blog showcasing the mind of the man that writes the blog.  His posts are educational without sounding like you are reading from a text book, fun without feeling like it’s all fiction.  It’s like listening to the crewmember at work who has been around the bay once or twice and you know he isn’t full of it.  He’s the type of medic you aspire to be when you grow up.

The Happy Medic: Cooler than the cool side of your pillow.  He delivers information in a gentle way; half the time you don’t realize you learned anything until later on in the day, you find yourself thinking back to one of his articles.  Each post brings his unique perspective of EMS, never once leaving us wanting. (Except for his next post that is…)

Welcome to the Blogroll, gentlemen!

Now for the nitty gritty of my post.  I want to touch back on the discussion of Aeromedical Transport, specifically the use of Helicopters.  I am not, nor will I ever bash on Flight Medics and Nurses; Critical Care Medics and Nurses are a very specialized person, having a skillset that those of us Hubcap and Spokes Medics can only dream about.  The issue plauging the Helio-EMS field is the LODD rate they have.  I don’t believe any other Pre-Hospital entity other than Combat Medics in active war zones have such a high mortality rate.  The question comes to; are they being over-used for “non-emergent” situations?

There are many locations that need Helio-EMS; very rural areas that don’t even have a Doc-In-A-Shed.  Those locations where the local ER consists of maybe 4-10 beds that can get over-run very quickly with one or two critical patients.  I’m not saying that the medical treatment provided by the medical professionals is sub-par or that they lack the ingenuity to do what needs to be done, but they lack the resources for critical interventions, (CT Machine, CAT Scanner, MRI, Thrombolytics for clot-busting in CVA’s and STEMIs, Cath Labs, ect…)  Where the distance to the nearest Level 1 Trauma Center is measured in hours, not minutes or miles.  These places need the helicopters to get their residents from either the ER where they drove themselves after having chest pain, or the side of the road after an accident.

What needs to be examined is the use of Helio-EMS in more suburban and urban settings.  There is very little reason for someone to call for a helicopter if definitive care can be reached within a reasonable amount of time.  Even if the local hospital is just that; a local hospital that has an emergency room that may not be the gleaming trauma center, they still have doctors who can do more than what can be done sitting at a landing zone waiting for the Helio to arrive.  We ground-pounders need to examine our trauma patients more intently and we need to fully understand the capabilities of our local hospitals.  With national standards as Door-2-Balloon Times for STEMI’s, or the 1-3 hours depending on local protocol needed to infuse TPA on CVA’s, we are trying to get the patient to the Cath Labs quicker, and to the Neurosurgeons quicker at the expense of our fellow providers.

Smaller hospitals are now doing telemetry where they can start Thrombolytics on Stroke patients under the watchful eye of a Neuro-surgeon from a Stroke Center, the same with STEMI’s.  Once stabilized, it is possible for ground transport with a Doctor, or an RN, (Critical Care or not depending on local protocol), or even a Critical Care Paramedic.  Some regions have Chase vehicles for their Flight Providers; outfitted SUVs with lots of lights and sirens, jam packed full of the same toys that were used in the air.  They are able to meet up with Ground Medics and transport when the weather or location is inclimate from flight.

When I started in EMS, flying someone out was the gold standard and to some, it still is.  I remember hearing from instructors and co-workers alike; it’s not a good Trauma unless someone gets flown.  At one point in time, in the early days of Pre-Hospital and Trauma care, locals hospitals were used to dealing with the baad accidents.  With mostly basic providers who had little if no true training, the axiom was to get them off your hands as quickly as possible to the people who are trained better than we are.  The only time you flew them was if you had access to a Helio and if you knew that it was too baad for even the local hospital to play with. 

We need to start re-examining ourselves.  The gold standard is definitive care, not just strictly Trauma care.  Definitive care is getting them to an Emergency Room Physician as quickly as possible, not just handing them off to someone who, and forgive me for seemingly minimizing the job role of Flight Medics and Nurses, but someone who can only do one or two more procedures than we can, but who still can’t do what a sterile, stable, muli-provider environment can do.

I am not saying that they do not have their place in the EMS world.  They do and always will, but their use, no, abuse, needs to be examined, or we’re going to lose more great providers…

Have fun and be safe out there,

Trying to Meet My Maker

Trying to Meet My Maker

 Today started out great. Everything was going great. I was in the zone. When I got to work, I found myself working with who else, Jon. Now, though, I had time on my side. I have been around for over 3 months, everyone had given me glowing reports, so now, no one could say that I can’t ride. Jon stayed to himself, as I caught a quick shower; track practice had run long after class, and hopping in the shower would’ve made me late. The water cascaded down my face as I kept my eyes closed, trying to center myself. I only had to be there until midnight, only seven hours, fifteen minutes, and thirty seconds. I slowly washed up, the warm water keeping my blood pressure down. Noises wafted in from the crew room; I could hear Jon entertaining one of his Medic Bunnies. She was a creepy broad who had more tattoos than teeth. When she introduced herself as “Tiffany” and said it was nice to see someone else who was under 25, I wanted to ask her how many times over had she passed 25. In those days, sex at the station was common-place. Whether it was the appropriate significant other was a different story. I can’t count how many times I had to be on the look-out for a wife/babys’ mamma while my partners were otherwise entertaining.

I loudly announced my emergence from the bathroom; by flinging the door open. I wanted to interrupt Jon in the worst way. He gave me a dirty look as he zipped his fly. “Tiffany” straightened her top.

“Sorry guys, didn’t mean to interrupt..” I said with a cheeky smile.

“Whatever…” The two got up and retired to the supply room turned axillary crew room; it was too small to even hold a bed, all it held was an old, reclining chair and an old rolling hospital table that substituted as a night table. The tube tamer rapped on the old wood door as it was hung on the doorknob, and the loud roar was dimmed down to a small whisper of noise. Every so often, we’d hear a thump, but that was the worst. As I dried my hair, I looked at the bay. I saw a brown head of hair passing back and forth in front of the door, and I didn’t recognize the person. Sauntering out into the bay, I put on my best smile, using the best voice I could.

“Hey there, ya lost?” He turned around, and I went weak in the knees. His dark green eyes gazed at me, and he laughed slightly as he closed the ambulance doors.

“No, ma’am…” He pulled a cigarette from his pocket and went to hand me one. I shook my head and he shrugged, then lit it, pulling the butt to his lip. Never had I ever wanted to be a cigarette more in my life than that moment. “What’s your name, darlin’?”

With the sweetest southern drawl I had ever heard, he made it even harder to stand up straight. I found the back step of one of the other ambulances, and I sat down, pretending to tighten the laces on my boots.

“Shao, Shao Trommashere…”

“Pretty. I’m Keith, pleasure is mine…” He deftly tipped his hat as he took my hand. It was gentle, not the hard shake I had become accustomed to. He held my hand as if it would break if he held it any harder. He tipped his hat, a black cowboy hat, and I just had to laugh.

“I’m guessing you aren’t from around here…”

“Nope, moved here about six weeks ago from Dallas, what gave it away…?” I looked at his hat, listened to his voice, and just smiled, “Your personality…” Keith and I walked around the trucks, getting to know each other. We did the dinner run for the evening, and we kept talking with no end in sight. I looked up at the clock, noting that it was after ten, I was to be going home soon and we had no calls. As we cleaned from dinner, we heard the police get dispatched for a motor vehicle accident. We went quicker, knowing where they called the accident at was known for fatalities. That stretch of road was known for accidents that left bodies broken and no lives to save. In the log book, when you looked for the road name, all you saw was “DOA” written after it. We went to the truck, making sure there were enough electrodes and c-collars. Multiple calls were being dispatched for the same location; two vehicles, three people laying on the road, one big car, one little car. Each phone-call seemed worse than the last. We heard the cops get on scene, and we waited. Even Jon, who never seemed to get excited about any EMS call, had come out to the truck and the look in his eye even showed a bit of an excited twinkle.

Then, the radio silence was shattered.

“County! Send me everything! We got two cars, SUV versus Sports car, we have six victims, two have self extricated, two have been thrown, and two are still entrapped. Get me as many birds as possible!”

We didn’t even wait for the dispatch. Several other local crew-members heard the initial dispatch, and had come out just in case. We had three, fully stocked ambulances ready to lock and load, and my truck was the first out. Jon hopped up in the front seat, the door barely closed before we zoomed from the garage. Quickly, we cleared the small city, and we bounced along the back roads. Jon handed me a Fire Fighting helmet.

“Put this on…”

“Why…?”

“You’re the smallest one here…if I need you to, you’ll have to get in the car…they taught you that, right?”

I nodded quickly, strapping the helmet on. I spiked bags, clipped electrodes onto the leads. The plastic IV bags swung like pendulums from the ceiling, one filled with Normal Saline, one filled with Lactated Ringers. I tore one inch wide pieces of tape into half inch wide strips, hanging them off the ‘Oh Shit’ bar on the ceiling. Facing backwards, I couldn’t see the scene coming up, but I heard Keith as we screeched to a sudden stop.

“Oh Fuck…” He didn’t excuse himself like he had earlier, so I looked out the windshield. No one moved. The scene was eerily lit by flashing red, white, and blue lights. Something that, not even generously could be called a car, laid off to the side of the road. A big gas-guzzling car was feet in front of us, the front end demolished. The engine block looked as if it had been shoved backwards at least six inches, if not more. We got out, surveying the damage. Nothing could’ve prepared me for this. Car parts, body parts, everything was just chaotic. The silence was eerie. Vehicles that normally made a lot of noise were silenced. Keith grabbed me by the arm, snapping me out of my haze.

“Come on, we got patients…” He lead me around a pile of fabric, a large beach towel laying haphazardly on top. I saw a hand sticking out from under.

“Hey! We got something!”

“Shao, don’t…” But before he could stop me, I whipped the towel off and receded back, my hand over my mouth. The pile was a broken body, the legs bent at mid thigh. An arm was missing, the head deflated. A river of crimson moved lazily from the body. I moved back, my back pressing up against Keith’s’ chest. The silence was broken by the groan of generators starting up.

“I’m…sorry, kid. Wish you didn’t have to see that…” Jon came running up, shoving medical equipment into my hands, “Come on, they’re about ready to tear the car apart, we have two kids in there. You need to put collars on them and put them on oxygen. You’re the only one who can fit, even past the shoulders.” He looked down at the ground and he winced. It was obvious even he was affected.

“Come on, we gotta job we hafta do…” We hurridly moved to the red car, the sports car. It was destroyed. I could barely tell what was the front and what was the back. From the police report, we found out it was a two-door late model Mustang. The engine was pushed back almost into the drivers’ compartment. I noticed that, everything where the hood was supposed to be was smoking. Everyone seemed more concerned about those in the car than about the smoke, so I left it alone. As I walked past it, I got a good whiff, and I started to cough. The smoke tasted like rubber, but no one else seemed to care about it. I looked into the car; two kids, not much older than myself were twisted in the wreck. I wasn’t even sure if they were sitting in the front seat or back. I looked around as a Fire Fighter draped a salvage blanket over the broken windshield and he gestured to the opening.

“Ready?” I nodded, and with a little help, they got me in the windshield. I started coughing immediately. Even with the windows busted out, the smoke still wafted in and hung around. I clipped a lifeline to my belt, the large carabiner a reassuring weight on my back. I gave the lifeline a tug; it was tugged back. All I knew was, if I pulled and pulled hard on the rope, they would pull me back out.

In the car, the one kid cried weakly. I put each one in a collar. A firefighter reached his hand through the other “window” to hold C-Spine on the crying kid. I held onto the other kid, talking to him softly. All the while, I felt an…ugly sensation in my chest. As an asthmatic from what felt like birth, I felt the closing up sensation. I tried to arch myself forward as best as I could, my body naturally sinking into the tripod position. I started coughing and wheezing, coughing up weird tasting phlegm.

The air had an odd taste to it as I moved around, a fine, white dust settled on every surface. As I moved about, tending to the victims, the dust kept being kicked up. Every breath was filled with this crap. It tasted odd in the back of my throat, and after a good breath, my lungs and throat felt like they were closing even tighter. I didn’t want to get out though; all I could hear was Jon telling me I was the only one who could do it, who could really climb in the car and help the kids. My throat closed even tighter, it was getting almost impossible to breathe. The air was remarkably clear, aside from the dust, but my chest continued to tighten. I glanced at my watch, I had been in for almost ten minutes.

“How are you doing, kid!?” I heard Keith scream over the hydraulic equipment.

“F…f..f..fine!” I wasn’t going to let them pull me out of that car. I was surrounded by men, and I didn’t want to look weak.

“You don’t sound good! Let’s get you out of there!”

“No! I…I’m 10-4!”

Without warning, the entire car shifted. Black, acrid smoke filled the car. At the same time, the roof peeled back. I saw the stars, and inhaled the first clear air I had had in what seemed like years. I climbed out of the car, watching the patients being loaded onto flight stretchers. Looking out, I saw a field full of helicopters and ambulances. The patients I cared for were being loaded into the helicopters. I stood on what was left of the trunk of the car, and Keith held out his hand. I took his hand and jumped down, my knees going out from under me. I could barely breathe. My head was spinning in circles. I couldn’t even focus on Keith.

“You okay?”

I nodded. I stood up, my hands shaking. I started breathing faster, trying to suck in air. The smoke was still wafting my way, so I tried to shift out of its reach. I waved at Keith, making my lips form words. With the generators still buzzing, I wanted him to think he may have just not heard me. I gestured to the truck, and I stumbled my way there.

I never reached the truck.

I felt myself collapse into a heap on the ground. I could barely draw in a breath. Every cough brought up more phlegm. My mouth felt gritty and full of chalk. Keith made it to me first. He took one listen with a stethoscope and he started yelling for Jon.

Oh God…he’s not gonna treat me…he hates me…

 “Jon! Jon! Get over here! Jon!!”

Oh God, I’m gonna die. God help me, I don’t want to die…

 I started fighting, I didn’t want Jon to touch me. After our first shift together, I didn’t want him near me. Keith picked me up, throwing me into the truck. I bounced on the stretcher, and I tried sitting up, but I had no energy to do so. My uniform shirt was ripped off, and I had a small moment of modesty where I tried to weakly cover up. Keith whipped out the Trauma Shears, cutting my sleeves off. He stuck the electrodes to my chest, and I heard the machine beating wildly. I rolled my head towards it…

140?

 My eyes started to close; I was tired. I just figured a quick nap would make this go away. I felt my cheeks being slapped. I opened my eyes, trying to lift my hand to move the hand away.

“No, come on, Shao, stay awake…” I shook my head, then I realized something was on my face. I reached up, feeling the mask of a BVM enshrouding my mouth and nose. I saw the bright red semi-circle of a nasal trumpet sticking out of my nose. I suddenly realized; I was screwed. Nasal Trumpets and BVM’s were tools that were only used on very sick people, people who couldn’t breathe. I felt my arm start to burn, and I started to cry. Jon grabbed my hand, looking in my face. I could see his eyes, the furrows on his brows deep with worry, dripping with sweat. His other hand cupped my cheek, his voice ringing above the din of the noise.

“Shao, listen to me, focus on my voice. Take slow, deep breaths. You’re going to be fine, I promise. Just breathe with me, in and out, that’s a good girl…”

With that, I breathed with him. The man I hated, the man who, months before, told me of his loathing of me, how he couldn’t stand me, and now, he was going above and beyond the call of Paramedic by literally coaching me to breathe.

“We’re here!” I heard a voice call out. Jon looked over at Keith, “Last vitals?”

“BP 88/40, pulse 130, pulse ox, 72 percent.” I felt the stretcher being pulled from the truck, and watched the stars in the sky go by. The ER docs, along with several other Medics and EMTs were waiting; news had gotten around that they were bringing in an EMT, and everyone wanted to help. I heard my mum call out to me, but she was quickly lead away by someone else in a robins’ egg blue shirt. Hands flew over my body, cords were tugged and pulled. I felt myself lift in the air, then I felt myself land. I let my head drift off to the left, and I saw my IV tubing. My last memory was of hearing a Doctor talking to a nurse.

“This isn’t good…”

Suddenly, my body felt warm and tingly. I no sooner received the Versed before I was asleep.

 I’m watching the clouds go by as I am being driven back to work. The hospital released me after three days. I still have a bad cough, but I could be worse. I looked at the little puncture marks on my arm; my forearm still sore from the doses of Epinephrine. For some reason, I had a reaction to the effluent from the airbags; my throat started closing and I was having a severe asthma attack at the same time. I didn’t want to go back to the station, but I had to sign all the paperwork for the incident, and everyone just wanted to see me. I was still tired; the Prednisone was kicking my ass along with everything else.

As we got to the station, I saw people outside cleaning the trucks, scrubbing them tenderly as if they were their children. I slowly climbed from the car as people came up to me, hugging me happily, glad I was okay. Keith came over, tipping his hat to me, then he wrapped me up in his long arms, kissing me on the forehead.

“You gave me a scare, darlin’, glad to see you on both hooves.” I smiled at him, thankful for his presence. I went to saw something when I saw the sea of people part behind him. Keith turned and moved to the side. There stood Jon. He looked me over slowly while no one said a word. Everyone had, by then, heard of the drama going on between us. He took a step closer, smiling at me.

“Good to see you up, kid. You scared the shit outta me…” He wrapped me up in a bear hug, and I hugged him back.

         It took me nearly dying for me to see the big picture; it wasn’t that he didn’t like me. Yes, he was an ass, but at the same time, he had seen more in his career than I could’ve ever thought to have seen. Car accidents were no longer the fun, trauma filled, exciting moments, but moments of terror; lives shattered in an instant. The more interventions he did, the worse off they were. He wanted the days of peace and quiet, and it took me seeing it for myself before I got the picture. Nine years later, I hear a car accident go out, and no longer do I run to the truck, excited to see broken limbs and to do fun treatments. I go and pray it’s nothing more than someone with a seat-belt bruise and someone who is covered in dust, coughing from the effluent.

Big Plans…

Hey All!

I’m working on something…interesting…I have started pulling together a mess of my stories from the last 9 years and I’m trying to make heads or tails of this.  Always being the one who thinks I suck at writing anything but random blog posts, I will leave it up to my fellow readers to be my source for peer review.  Every so often, I’ll post up a story.  I’d love to see feedback, good or bad, makes no difference to me.  I’m working on my writing style, and it’s been a while since I’ve actually thrown something together to actually tell a decent story.

Have fun and be safe!

~M. Trommashere~

The Move is Done!

Hello All!

I am sorry I haven’t posted recently, but I was concerned that, in the move, I would lose a post or something crazy would happen.  As you saw from the home page of EMSBlogs.com, I have moved, and I have arrived.

As the proprieter of the site, Dave, wrote, I am the illustrious Medic Trommashere.  I hail from some state somewhere in the US, and I have been playing Paramedic for a while.  I have to admit, I am really liking to be the first Female to blog with this network.  I have the pleasure of being the ‘only’ female at many EMS companies, but never the first. 

I hope to bring a new voice to EMS and everything around it.  I have always loved this profession, since I was a little girl watching Rescue 911.  I have seen things happen in this profession that has disgusted me, and things have happened that have thrilled me.  We are saving more lives than ever; cardiac arrest saves have improved dramatically as well as trauma saves.  We have moved far beyond picking up our patients and chucking them into the back of a herse, we have moved beyond doping people up with morphine and telling them they can never work again.

We have also regressed.  Fellow members of our profession are lying about taking the mandatory classes (as you can read about in my blog post, Outrage) , not upholding the basic oath of, “First, do no harm…” by physically and sexually assaulting patients in their care,   imbibing in alcohol, then getting behind the wheel of an ambulance, or behind the IV needle.  We have sunk to new lows, back-stabbing our partners, verbally assaulting our brothers and sisters across the globe as noted blogger  “Ambulance Driver” commented about in an article of his titled Think before you post.  What happened to the days of working well with each other, striving to make this job, this calling the best it could be.

I am here to help herald that change in, as Ambulance Driver, Too Old To Work, Too Young To Retire, Rogue Medic, and many many other EMS bloggers are.  Chronicles of EMS is helping that, bridging the gap of services across the globe.  We need to band together, form ideas, create change. 

The Revolution is here, folks, are you in?

~M. Trommashere~

Quick Ramblings

Hello everyone!

I am pleased to announce that over the next couple of days, or weeks, I will be moving to a new blog site! I will be moving to EMSBlogs.com. I am moving for one reason.

I am moving because I am trying to continue providing the best reader experience I can, and the most informative experience I can. Nothing will change except the blog address. I started blogging because I wanted to help change the face of EMS as a whole. I want to be one of the many voices in the chorus of change that is sweeping the EMS world. I am surrounded by many very talented bloggers such as Ambulance Driver, TOTWTYTR, Rogue Medic and Lizzie just to name a few.

So, over the next few days and even some weeks, my blog will be moved. I believe I will be able to have a link or page that will direct you to the new site. If not, just check on EMSBlogs.com every few days and I’m sure you will find my new link up there soon.

Thanks so much, and have a wonderful evening

~M. Trommashere~

Failure is an option.

Today I had a bad day. I was taking a physical fitness test for my new job and I failed…badly at it. Back spasms have plagued me since I got between a 300lb man and a Stryker stretcher. He was trying to jump off, and some how I thought I was going to stop him. In the middle of the sit-up portion, my back locked up tighter than a virgins’ legs and I couldn’t sit back up. I tried, but my body betrayed me at the worst time. My emotions got the better of me, and I stormed off, being followed by Medic Dolphine.

I lived by the creed: “Failure is not an option.” Ask any one of my friends and they’ll tell you that I don’t take failure well…at all. It is not in my genetic structure to fail. I sat and stared at the running track that I was supposed to be running on after doing the sit-ups, and I realized that, failure had become an option in my life.

I knew that failure sucks big eggrolls, and it’s not something I like to do on a regular basis, but because of EMS, failure was an option. It just depends on how we look at it. The sit-ups: There was nothing I could’ve done. My back locked up on me, my feet went numb, and I couldn’t see through the white hot pain. I’ve trained for this day for months, almost six now. I had done countless more push-ups, sit ups, and running than I had to do today, but it was not ment to be.

Years ago, I would’ve fought, argued, and whined my way to never trying again. My mentality was, it’s not me, it’s them. After losing several patients over the years though has taught me that, no matter how hard you try, if it’s not supposed to work, it’s not going to work. I was not supposed to get in today for whatever reason, who knows why.

We as Medics and EMTs put a lot of blame on ourselves when things don’t go right and our co-workers help that process by reminding us of our failures. What we don’t remember are the times the shit went right. Yeah, my back may have spasmed today, but thank my lucky stars it didn’t when I had help get a kid out of a mangled car and I was contorted into a position I hadn’t seen since my Cheerleading days. I stayed in the same spot for almost an hour, yet my back didn’t betray me until I bent to pick up a piece of plastic on the ambulance floor during clean up after the call.

I remember all the large bore IV’s I missed and I think about them constantly, but I don’t pull up the fond memories of sinking 22’s and 24’s on little old ladies who would be poked and prodded into the night because of people rushing to get the line.

I’ve “failed” many arrests, hell, I speak of one in one of my posts. I remember dates, times, places, faces, what have you of the “failed” arrests, but I can’t even remember the name of my very last arrest. While she wasn’t a techincal save (walking out of the hospital), we “saved” her to the point that she was perfusing so her hand was warm when her husband of over 50 years was able to hold her hand and say good-bye while she was “alive” in her husbands’ mind.

I walked to my car, feeling dejected, but at the same time relieved. The spasm abated not too long after it started, keeping me from hours, if not days of bed rest and medication. I was given permission to retest; the instructors figured that I wasn’t lying about the back spasm because of the look of sheer pain on my face. They saw me trying, so they gave me information to reschedule.

I also think my mental shift came from reading. I had been voraciously reading a book by A.J. Jacobs called The Guinea Pig Diaries. In it, he does various experiments about his life. Outsourcing EVERYTHING he did during the day, even reading to his kids, to doing everything his wife asked him to do…no matter what. One section that caught my interest was when he spoke about how he makes a note every time he’s in a fast moving line at the store or at airport security. He’s right; we only notice the bad shit. Sure, for this particular section he researched a Harvard Psychologist (Daniel Gilbert and his book Stumbling on Happiness, but the take home point in all of it was that, we remember the bad stuff well, but never the really good stuff.

So, as I doff my cap to Mr. Jacobs, here is my “mental list” of everything that went right today:

I woke up and the Earth was still here.

I felt great considering my nervousness.

The drive to the hotel we stayed at and even to the test was uneventful and we found the place with lots of time to spare.

I was able to help motivate the girl who was before me into punching out her last few sit-ups; she made it.

I don’t have to get a prescription filled for a steroid because of my back; the spasm went away on its own and I just feel stiff, but nothing too bad.

I didn’t have to run in the extreme humidity which would’ve set off an asthma attack which would’ve been worse than the spasm.

I now know what I’m looking at and I’ll do better next time.

Now I’m going to lay down, get a few hours of rest, and start my process over again.

Have fun and Be safe!
~M. Trommashere~

Get Flown or Die Trying….

So another fun debate looming over the EMS Blog-o-sphere is the great flying debate. I have lost count over the last few months of just how many great men and women have died during an Aeromedical Crash…and not the fixed wings either, the helicopters are going down. Many in the blogsphere and on other EMS websites like EMS1.com and JEMS.com all have articles relating to the necessity of flying patients. Questions are raised like, Is flying needed? How much time is really saved? Is it worth the risk? What can they do that we can’t?

Oddly enough, my career path is going into being a Flight Medic. I wanted to be a flight medic before it was cool. (Okay, it’s always been cool, but go with me on this one.) I have always respected them to the highest, and not because of their awesome flight suits, but because of what they did. They go in to major accident scenes and rescue those who can’t be helped due to the lack of adequately trained ground personell.

Or so I thought…

When I did my flight time that was required by Paramedic Program, I got to see up close and personal just what they did. I never flew once, the weather was horrible on each day that I went. I chatted with many flight medics, nurses, and even pilots. I asked the same question, Is Flight Medicine really that important? Do you need to come out on EVERY car accident scene that has a bent in door, or car fluids leaking, or for every patient that is more than twenty minutes from a “specialty resource center?” Is it worth risking your life every day?

The answers I got were amazing. From the expected, “Everyone working with me is awesome and we can fly through anything ’cause our pilots are awesome.” to the unexpected, “I like going on scene runs, but constantly going out on calls that Basics could handle, just because they are more than twenty minutes from (insert trauma center here) gets a little on the crazy side.”

I had to agree with them. I know I don’t have any good scientific facts like RogueMedic or as witty as Ambulance Driver, buthere are my direct obsversations.

I came from a county where, we had at least a Level 2 Trauma Center within 20 minutes of anywhere. As much crap as I gave the outlying hospitals, I had to give them their credit when it was due for stabilizing truly bad accidents when no one could get them into the city for the Trauma Centers. On the other side of things, in XYZ county where I came from, we had 4, not one or two, but FOUR Level One Trauma Centers within 10 miles of each other and on any side of the county, were no more than twenty minutes from one of these centers.

I have personally witnessed the rampant abuse of Aeromedical. We had a bad traffic problem, and we’d notice the use of helicopters would go up during rush hour traffic and when there was a sporting event in town. Even though there were thirty different ways to get to each center, because the main (and shortest by mere seconds) route was full, the bird would go up.

What most people don’t realize is, the ETA for the helicopter is just flight time. They don’t include the 10-20 minutes for everyone to wake up, answer the call to nature, check the radar to make sure there isn’t going to be a severe weather event where you are headed. Then you have to do the pre-flight check, get the blades turning fast enough, then get to the scene.

So, if there is an ETA of twenty minutes, the true ETA can be almost fourty minutes for the bird to even get to you. Then you have the transfer of care, the changing over of equipment, changing from one stretcher to another, then the patient is loaded into the helicopter and they take off. We’re talking about almost an hour of someone sitting with their thumbs up their asses waiting for the almighty helicopter to land and whisk their patient away.

I am not calling for the immediate halt of flight services. There are many places that need helicopters to come in. I live in a place now that they fly ANY critical patient where the trauma center is. Now, it’s a ninety minute, if not longer depending on traffic drive in, so I can understand, but where is the fun in that? Most of the people I work with have not handled a severe trauma patient. There are always helicopters near by, so the patient has barely been taken from the wreck before they are loaded into a helicopter.

I believe that a change needs to come though, but it has to come from everwhere. We have to stop teaching EMT’s and Medics how to manipulate Medical Command Doctors into allowing the bird to come in. We need to start teaching that, it’s okay that your patient has a Femur fracture…that’s why the Hare Traction Splint was invented. Slap that puppy on and head for the nearest hospital if they are that bad, or to your local trauma center.

Doctors at the outlying hospitals need to pull up their big boy/girl panties and actually do what they were trained to do: play doctor. No more telling ambulance crews that you don’t take “That kind” of patient. No more freaking out when someone comes to you with more than a scraped knee. No more screaming at ambulance crews for not taking them to a “better hospital”, and no meeting them in the ambulance bay when they come in with a patient who is trying to die (and doing a helluva job at it) and telling them that you’re going to pull their numbers if they don’t take their critically ill patient somewhere else (true story).

We as EMT’s and Medics need to start taking pride in our work. We wonder why they take things away from us like Intubation and agressive Trauma Protocols. They do that because a majority of us act like we can’t do it! On the outside, those medics (outside of extremely rural areas, or places that have drive times of two hours or more), who call for birds constantly name key phrases such as, Extended transport time/distance to specialty resource center. Possible Airway Compromise that cannot be handled in the field. Or my favorite one, The patient has an Altered Mental Status that may continue to decline and make ground transport risky.

We all know that most of these medics just don’t want to deal with it. They have something to do right after they get off of work, and the ground transport will cause them to miss their event, so they call a bird. Too Tired after running all night? Call a bird. Don’t want to deal with a drunken, crazy patient that you can’t sedate and tube because of protocol? Call a bird! We bitch, moan, and complain when we are dragged out in poor weather, citing that, because we’re in an ambulance, we may wreck and get injured or killed. What about those who are up in the air thousands of feet? They don’t have that 50/50 chance, or even a 40/60 chance. Their chances of dying if that hunk of metal and fiberglass decides to fall from the sky is over 70%! We have seatbelts and airbags…they don’t.

Across the board, we need to change. We have to stop calling the birds in for “questionable” situations. If you have to think whether calling the bird in or not is a good idea, then you can probably drive the patient to the closest hospital and let them treat/stabilize, or drive them to the trauma center yourself. Other than giving blood products and doing RSI, we can do the same thing they do! Nothing they do is going to make a world of difference (except for blood) in our patients.

Medics! Start taking pride in your work. If we spend our time flying every patient, it dumbs us down, making us look as if we can’t handle ANYTHING, location issues aside.

Before I close this out, I just want to say that, I love my Flight Medics and Flight Nurses. I have had the pleasure of being able to work with them going through Medic Class, and even outside of medic class in other areas. For locations that need them, they are a Godsend, and I pray that they go up in the air safely and come back down just as safe. At the same time, I am very proud to say I’ve not broken my Flight Cherry. I love my Trauma Patients too much to let someone else take them in.

Not saying that I won’t use them here, especially since drive times to a Trauma Center are horrific, but I believe I’ll be very limited in my use of them. I believe (read: hope and pray) that the local hospital can stabilize Trauma’s, STEMI’s and CVA’s (Heart Attacks and Strokes for those who aren’t used to the nomenclature). If not, then I guess I’ll be flying more people than I’m used to.

In my next post, I’ll give you a call I had when I worked in the Land of Many Specialty Resource Centers, tell you how it played out, and my other thoughts on if Air Transport Services are being used and abused like a two dollar whore on half off night.

Until then, Have fun and Be safe, My friends!

~M. Trommashere~

Confessions…

Okay, I figured I just needed to come out with this and confess this before things become too hectic.

The move that I made was for a job. I am looking to become an Aeromedical Paramedic, also known as a Flight Medic. While my former state has a phenominal, and I mean, phenominal program (that I never used, which is another post in itself), but the training program where I’m from is very…exclusive. You have to work with certain companies, know certain people, and get your EMT/Paramedic from a certain school before you are “allowed” to get through their class (another post in itself).

I moved to a place where I can (hopefully) get on with another well known Flight program…I’ll explain more maybe after I (hopefully) pass my entrance exams on Monday.

Have fun, and be Safe!
~M. Trommashere~

Round Stretcher Discussion…Finally!

So here it is, the first Round Stretcher Discussion. Topic for this one was discussed a week or two ago. For your refresher, the topic was: “Should EMS/Fire Personell be allowed to carry some sort of weapon to defend themselves including but not limited to: Guns/Knives/Mace/Tasers/Ect…”

Participants:
Medic Trommashere: Myself

Medic Dolphine: My partner for over five years. We have worked together from before we were both medics. We went to Paramedic School together and even managed to work in the same service before moving to pursue a new career. He has worked in all areas; urban, suburban, and rural. We share similar war stories, but he has many of his own.

EMT Doodle: Another partner. She spoiled me, being one of the better EMT’s I have had the pleasure of working with. With an energy that can vibrate her surroundings, she’s awesome!

********************************************

Medic Trommashere: Thanks you guys for being willing to sit down and chat with me about this. The three of us have worked together in probably one of the most dangerous areas in our county at that time, and we also have worked separately in various areas, so hopefully this will be fun. So the question I am posing to the two of you is this: Should we be allowed to have something in the ambulance or on scene to protect us, things like a gun, or mace, or a taser, or something that is considered a ‘weapon’ under our EMS Weapons’ Rule.

EMT Doodle: A gun? Seriously? Think of all the people we worked with, do you want to see any of them with a gun?

Medic Dolphine: We already look enough like cops, do we want to make it even worse?

MT: Point taken…so we’ll pretend that we’re not even considering fire arms anymore. So, what do you think about any other type of weapon?

ED: There needs to be some sort of training to help us defend ourselves. I’m trained in the Martial Arts, just like the both of you are, so we can defend ourselves if needed, but most haven’t had much if any formal training. I’d be afraid that, for something as simple as a drunk getting a little aggressive, someone would pull out a Taser or a can of Bear Mace, or a Baton to beat them and possibly kill them.

MD: Yeah, most people who play on the ambulance or on the fire engine would take it too far, and the first time someone got killed, we’d have everything taken away. For a parallel example, look at Lasix. We got it, we used it like water, but after a major screw up, Lasix got bumped so far down the list it wasn’t funny.

MT: But the question is, should we have a mechanical device to defend ourselves? (Shows a print out of Mark Zanghettis’ comment on the original post) Also, how do you feel about this comment?

ED: He’s right. We used to talk about it when we worked together, and even when we worked separately, that we didn’t like looking similar to the cops. We’re there to help, not hurt, if it can be avoided. I have to disagree with the non use of Mechanical Restraints like softs, leathers, and what not. Some times you just have to have them tied down. All that sometimes separates us from getting our ass kicked are seatbelts that we all know how to buckle and unbuckle. As a woman, I don’t feel comfortable with the big behemoth patients who could kick my ass if they looked at me the wrong way to be without restraints if they even start getting aggressive.

MD: True. Mind sets are also important, but we can’t smooth talk every patient. Someone gorked out on PCP who feels no pain and feels that they can take on the world can’t pay attention to the calm talking of an EMS provider because of the psychosis that are raging. I wouldn’t want to carry around a taser or a gun, but to be allowed to carry a can of mace would be great. The last time I had a severely psychotic patient, the patient tried to attack a cop and got tased…yet he still kept coming. The mace was the only thing that even had him pause long enough, because he was so disoriented from lack of sight, for us to retreat to safety. Now, I consider myself a big guy, but sometimes even I worry about my safety. (Authors’ note; Yeah, he is. 6’2″, 275, built like a brick shit house. Most see him coming and they back down from the fight, but I digress)

ED: I don’t think I could work for a company that didn’t have restraints. Sometimes just the threat of restraints to the patient can get them to calm down. Verbal assaults are one thing, but I do like the idea of going home every morning.

MT: I agree with both of you. I have played enough over the years with violent patients, each time the attacks have gotten worse. There’s nothing like having that feeling of, ‘I’m not going home today’coursing through your system to give you a wake-up call. Even with the cops around, anything can happen. I got grabbed by a patients’ family memeber with three or four cops standing around because they were angry at the death of their family member. Now, nothing resulted from it except for frayed nerves, but it could’ve been worse.

MT: What would I have done if it were just myself and my partner surrounded by multiple family members? I take full blame for the incident; I should’ve been paying attention, but with an emotionally charged scene like a homicide, suicide, or overdose, there’s only so much we can do. We can leave the scene if it becomes dangerous, but at some point, we have to go back, and now we’ve just pissed everyone off by re-involving the cops. It may not be that day they take their revenge, but we can’t call the cops out on EVERY call, medical or otherwise. Two or three weeks down the line, that may be the day that the little brother of your shooting homicide patient that you pronounced decides to take it out on you.

ED: You brought up a point that wraps back into Scene Safety. I went through EMT school only a few years ago, and we had the quick, “If it doesn’t feel safe, it’s not” lecture, but past that, I learned on the fly. We didn’t know which side of the door to stand on when knocking on a door of a house (Hinge side, btw), how to approach a vehicle so that they can’t see you, but you can still see them, or anything like that. We need to have better training before we get out on the road. I’m not talking about a Master Belt in Brazilian Jiu-Jitsu or anything like that, but just some way to defend ourselves past, “Call the cops and run away quickly.”

MD: True. I took my EMT class over eight years ago, and the best defensive technique I learned was throwing my jump bag at someone and running away, but that only works if you see them coming. Best thing I was taught on how to defend myself in the truck was to climb through the birth cannal…but I can’t fit through there on a skinny day, let alone any other day of the week. Something needs to be changed in the teaching of how to keep yourself safe on scene and in the ambulances. Hours for Medic class and EMT classes have been lenghtened to cover more medical things, but we’re started to skimp out on the important things; how to keep yourself safe.

MT: True. So to summarize so far; Guns and Tasers have no place on an ambulance, I agree. Things like self defense techniques should be taught, but we should be allowed to carry mace with us as a last resort,

ED: Pretty much. I don’t think that guns and tasers could be used properly on the ambulance, number one, and number two, I don’t trust anyone to be able to adequately defend themselves to keep an enraged person from taking the gun or taser and using it on us. The downside to mace is that, unfortunately, everyone is going to get a piece of it, but at the same time, I’d rather get a face full of mace like everyone else instead of a fist, bullet, or taser prong.

MD: Same here. I’ve caught the back blow of mace several times, hell, I think we’ve all walked into a jail-cell or an enclosed area where we’ve walked right into the lingering cloud of mace. I agree with everyone though that, facing a face full of mace is more desirable than getting my ass kicked.

MT: So I believe we have reached a consensus: While some would say that the only way to defend themselves would be to arm themselves with something that can cause fatal lead poisoning or low flow electrial therapy, the thought is that teaching of proper self-defense techniques, both passive and aggressive, would be beneficial to all. Not enough time is spent on diffusing hostile situations, or recognizing them, or getting us out of them safely.

MT: All they focus on is if we get in trouble, we call the cops and try to run. With people arming themselves more and more these days with guns, a metal clipboard, a heavy house bag, or an oxygen tank isn’t going to serve us well when a 12-gauge shotgun is leveled at us. With more and more violent crimes happening across the country, we’re going to find ourselves on more and more scenes with angrier and angrier patients and their families.

MT: With the addition of companies making their crews wear bullet proof vests with trauma (aka: Stab Plates as I’ve been told they’re called), people have that bit of ‘security’ going into these bad scenes. Unfortunately, most companies cannot afford to buy them for even the on-duty crews, especially since crews have varying body sizes. The companies that do have them, have them in a ‘one-size-fits-all’ size, and none of them fit anyone well; not even close to how they should be worn to keep us safe, and they are usually well out of the range of when they were supposed to be replaced.

MT: While many say that the one through three thousand dollars that it would cost per vest is a drop in the bucket when it comes to trying to save someones’ life, most companies are concerned with the almighty dollar; Bullet Proof/Stab Proof vests are not as important as making payroll or keeping the ambulances up and running.

MT: Other methods need to be taught on how to deal with agressive patients when in the ambulance. This is where it seems to be that most attacks happen. While we can’t restrain every patient who looks at us cross-eyed, we need to teach the skills to those who follow in our footsteps on how to keep themselves safe; where to sit, how to seat belt them down to the stretcher, and overall communication between crewmembers to keep everyone aware of what is going on. With that, I am closing out the first ‘Round Stretcher Discussion’. Have fun and be safe out there, everyone.