Saturday, June 30, 2007

Learning Curve

So this Crew Cheif thing is tough. The whole decision making process is tough. The being in charge part is tough. The working with brand new EMTs is tough. Not that I mind any of the things I have listed, just two weeks without a day off makes for very long shifts. I had a few calls that tested me, like the syncope I went to who done fell out in the middle of the street. When we got her in the back of the unit and hooked up to the monitor, she was in an accelerated Junctional, then her heart just stopped for like 3 seconds, then one complex, the another 3 second pause then converted to just a regular junctional. Mind you she was CAOx3, vitals better than mine, and compleatly pain free. Her only complaint "I'm just dizzy" So we took a ride down to the ER where she never had an episode like that again. I did nothing for the woman other than IV and O2. She was more stable than I, so why fuck with something if it's fine, right? Thats how I justified it. Plus we were litterlly 3 mins from the ER. Had we been further I might have put the TCP pads ON her, you know, just in case Then there was the status seizure who I tried IV lorazapam, line infiltrated and I sat for the rest of the transport trying to figure out how to get the drug out of the vile to give it IM. It was one of those things that you don;t think about until you are sitting there going "I know there is a way to get this out, why didn't I ask my FTO. Damnit" Well, the pt still breathing, and thats what matters, a breathing, circulating patient is just fine. Its when the air quits going in and out and blood stops going round and round do I really worry. From what I understand this man spends most of his life in one long continuous Seizure.

So it's all a learning experience, every call prepares you for the next. We work unsavable full arrests so that when that one savable one comes along we are confident in our treatments. Everyday we learn something new, even if it is something as simple as figuring out how to draw out the lorazapam into a syringe, or something as complex as figuring out a dopamine drip or RSI algorhythm. We practice so that with the next one we can go without pause. Everyday I figure out something else that makes my job easier, makes me even treat with thinking, just doing, and doing it correctly and quickly. Makes it easier to save that one. To be able to go, he's alive because of what I did.

Monday, June 25, 2007

Moving on and moving forward

It has been a rough week. Well two weeks for me, this was day 14 of a 14 day stretch. But this past week especially bad. Driving past all the Fire Stations, seeing the bouquets, the signs, the letters. It make my choke up every time. I even feel bad calling for Fire for man power, or for a driver. I just want to leave them be to grieve. But alas, life must go on. It must move forward. Their will still be fires, paramedics that need help, and patients and citizens that need them. So we grieve this week and start to move on slowly the next week. We can't be sad forever, we must think, they lived and died doing what they love, what was in thier blood to do. You don;t become a firefighter because the money is good or because you like how you look in the bunker gear. You do it because you are made to do it you bleed fire.

Alright enough about that. I was promoted this week also. They handed me the narc keys and told me to go forth and pretend I know what I'm doing. 80 percent of this job is making educated guesses and making it look good. You could have NO idea what is wrong with you patient, but if you make it look good and keep your cool ( and know when to ask for, or call for, help) nobody will ever know, right? I learned how to deal with a difficult partner on a multi patient, multi trauma, very bad MVA (and patients that don;t speak any english on top of it all). Apparently, you threaten to take away said partner's walkie, as they continuiosly kept screaming on the radio before you (as Crew Cheif) could even get a bairing on how many patients, what Category the are and how many more units you need. (The answer is 3 patients, 2 CAT2, 1 CAT3, and two more units.) The following two day were better, as yesterday I had a very green, but very competent EMT, who is so set on doing the right thing, asks permission to do everything. A nice change from the day before. Not that Im on a power trip or anything, I just need to keep control. It's my scene, it anything happens, it's my fault. I'm the grown up.

Tuesday, June 19, 2007

Moment of Silence

Please take a moment today in remeberance of the nine City of Charleston firefighters who lost their lives in the line of duty tonight. Thank you.

Sunday, June 17, 2007

Okay...not a Failure

Okay Okay Okay...I'm not a failure. I passed. I actully passed. They are now putting me in charge of an ambualnce for a shift. And I passed with an 80 freaking 7.5. Who knew? Damnit. I happy I guess, scared outta my mind. What the hell am I supposed to do now? Someones life could very well be in my hands. Oh and I'm moving to 12 hour DAYS. Sunlight makes me melt, I say! My brain can't work when it's light outside. Son of a bitch!. Oh well, I'll take a good partner on a bad truck over a bad partner on a good truck anyday. So this is quick a sweet, but I have to go. I have a 48 hour shift ahead of me.

Wednesday, June 13, 2007

I'm a Failure

Well, I did it. I finally took my Acting Crew Cheif test today. And to be quite honest, I probally failed. Not because I'm an idiot, but because the questions were off the wall policies and procedures that I don;t know off the top of my head. I know where to find them if I ever need them, like the 10 contraindications for thrombolic therapy in a acute Myocardial Infarction patient. I personally don't need to know what they are. We don't give tPA in the field here. But I would have to know them by the time I encode the hospital, which gives me plenty of time to look them up in my field guide. Same goes for the pediatric dose for an epinepherine drip in a bradycardic pedi or if and when we are supposed to ever transport a DOA (they ain't getting any deader, so again I would look it up in our field guide, or just call a supervisor and go "Can we transport this DOA?) I know the doses for all the drugs in our RSI protocol (1.5mg/kg for Lidocaine and the Succs. .3mg/kg for the etomidate) I know that we need online med control for Dopamine and our controls. Athough, Ativan we can give up to 4mgs on standing order if the patient is activly Seizing. I know that any patient complaining of Chest pain, regardless what the 12 lead EKG shows, gets Oxygen, Nitro, and Asprin. And possibly Morphine if the Doc will let you. I know that CPAP has to stay on the patient so you don't cause flash edema. I know that D50 in administered in a patent IV line as to not cause necrosis. I do get slightly confused mixing D12.5, but help is just a radio click away really.

I also know the proceduere if we break or lose a vial of Morphine...or if we wreck the truck...or what to do if a monitor, drug/ airway combo bag, 4 nasal canulas, a laryngoscope handle (why just the handle?) and 3 D-tanks of oxygen gets stolen from the back of a unit while on a respiratory call in the ghetto. The answer to all three of those questions is "Call a Supervisor"

But, still as ready as I think I am to be putin charge of a truck, I still have to pass the test. Which I don;t think I did this go 'round. Damnit.

Oyst P R


Oyst P R
Originally uploaded by artist in the ambulance 190.

Ark Drive In


Ark Drive In
Originally uploaded by artist in the ambulance 190.

Sunday, June 10, 2007

It's too damn hot for me to care

I didn't relize how long it had been since my last post...So here goes. Alright, so I've been moved YET AGAIN. This time to the opposite end of the county. To a fucking hell hole of a truck. I hate this truck. Its busy, the station's too small for the FD and EMS that live there, it's way to busy in the summer, loud, the people in the area are pretentious snobs, oh and it's fucking busy. We ran call after call after call. And because I'm on the truck for my Acting Crew Cheif training it means that little ol me gets to run all the ALS calls. Which is 90% of the call volume. We had 12 calls yesterday, 10 of which I ran. 9 of which were because it was 112 degrees outside and people think drinking several cans of PBR is a perfectly good and healthy way to stay hydrated while mowing the lawn at noon. Everyone was passing out and had a systolic of 70. Oh and apperently it was also moving day for the whole goddamn county, which people also kept hydrated with Budwiezer. I felt like I was working on the surface of the goddamn sun. I lost 10 lbs just sweating. I was a pretty sight when I got off an hour ago. And the smell, oh my, ripe. But I have since had a shower and am about to go to bed. Fucking people.

Then there was the crazy ass woman who passed out, who hit my partner, who grabbed my ass while yelling at me to "Don't you fuck up my wig! This is my good wig!" The mid sentance passess out only to wake up again and finish her thought. She told me about riding along with the narc team with the local PD. "We busted up some college kids selling dope" Jesus help me.

Well thats all I got, going to sleep. night.