an EMT made me look good

Ok, we all know the saying Paramedics save lives, EMTs save Paramedics. Well, I always tell my EMT, you job is to make Me, your Parmedic, Look Good. Ok, well my EMT, who I had been having problems with for 4 months, did both on our last shift together. We aren't gonna go into why I had problems with them, thats not the story. The story involves a patient that presented with totally random symptoms that turned out to be a big ol' bad CAT 2. So he we go...

Get called to a "sick party" Now this could be anything, this anything turned out to be inconsolable crying. Really. Pt in a mentally handicapped pt, non verbal, who's family calls this the pt's "pain cry". Pt not eating. HX of bowel obstruction. Fever. Ear infection. Tachy at 130. Hypotensive at 90/60s, but pt is also 80lbs soaking wet. BGL at 200. But Pt is compleatly stable. skin is warm/ dry. Pt will focus on you when you speak. I felt perfectly fine putting this pt in the back with an EMT who is also a paramedic student. But then the family wanted the pt trasported to a hospital who is notorious for asking for an IV for even the most mundane of symptoms and this was a borderline BLS/ALS pt. so I said to my EMT partner "I'll ride this in, but I want you to continue to assess as if this was your pt, do a BGL, put pt on monitor, everything but the IV, oh an get a manual BP the monitor been fucking up" SO he does what I say. and as he put pt on monitor I glance up for my seat as I type my report and I see little Normal sinis complexes marching across the screen. little funning looking, but I'mm get up in a minute when we get going and really look at it when i go the start the IV. from where I'm sitting there's a P wave and an upright QRS so we are golden. I go back to typing. Just then my EMT shoves a strip in my face..."Hey!!B!! is that ST elevation?!?"

"Noooo..Thats just a funny lookin...Well fuck me...
I get up and start flipping through the leads on the monitor and get to Lead I and goddamnit if there ain't huge ST Elevation. Well...get em on the 12 lead...we have elveation in leads I, II, aVL, V2, V3,V4. And BIG elevation. And pt had pressure of 90 and can't swallow, so no Nitro, or aspirin so I just placed em on high flow O2 and high flow disel and off we went. Pt didn't like me neither I had to stick em like 6 time for an IV because {the pt} kept trying to bite me.

That just goes to show you paramedics sometimes need them lowly basics.

So I yelled again.

People never stop amazing me. I know it's human nature to gawk at an accident scene. To stare at it from the car window as you dive past and imagine the carnage that may or may not be unfolding. To be mezmerized my the flashing lights of the emergency vehicles. To watch as the Paramedics, Firefighers and Police Officers run around on scene in seemingly aimless patterns, with equiptment and notepads and oxygen tanks and stretchers. To even watch as a helicopter lands in the middle of the highway blocking traffic. I can only imagine what this looks like from the outside looking in. As opposed to being right smack in the middle of it.

So as we pull up to the scene there is a small truck, roof caved in. Looked to have rolled several times. Firefighters at the side two criticals laying in the grass. Another across the highway at the side of a family of three sitting up in the grass, not bleeding. They will be care for in a few minutes. I need to see the two laying supine bleeding all over the place first. Just as we were about to pull up a man with a Nikon around his neck leaps in front of the ambulance and snaps off a few shots. I look up and see where he came from. A goddamn fucking tour bus had stopped in the middle of my fucking accident scene. So not only did I have 5 patients (two of which who were critical) but I had a bus full of fucking tourists snapping pictures. Oh and ONE COP. Who sends ONE COP to a multi car MVA? So ever the professional, I get out of the truck and begin my triage. I go to the first patient. Severe SOB and pain on inspiration, bilat, yet dimin breath sounds, several head Lacs, crushed hand. Place him on High Flow O2, Got a trauma RN on scene to hold Manual CSpine while I go see my next patient. CAT 2, trauma center criteria. Run into some tourist who goes, "You just gonna leave him with that fireman?"
I give the stank eye and go "You gonna tell me how to do my job? Or you gonna move so I can triage all my patients? MOVE!"
Next patient...Partner's got him...Altered Mental, repeating questions, weird looking pupils, neck/back/chest pain. Also CAT 2. CSpine. High Flow 02. Trauma Center Critera. Move him to unit.
GO across highway to triage family...All CAT3 facial pain 2nd to airbag deploy. Can wait on 2nd unit. Firefighter stays with family until 2nd unit arrives.

Thats the run down. Now I walk back over to where my criticals are. Where now ALL the tourists from the bus are now off the bus and all have their cameras out and snapping pictures. I have now had it. This is not a show. This is real life. This is not entertianment. There are two people laying in the grass actually bleeding, actual blood from a actual car accident and these people are treating as if it's an episode of "Grey's Anatomy" So as I walk up, I start yelling. "ANYONE WHO IS NOT PART OF MY ACCIDENT, BACK THE HELL UP AND GET THE HELL OFF MY ACCIDENT SCENE." I then think to myself I'm gonna have to call a supervisor later. I'm gonna get complaints. But right now I don't give a damn. And I got back to my original patient. He looks up at me and says "You tell 'em girl" Then the man with the nikon that jumped in front of the ambulance as we pulled up tried to get up close to me and my patient. "If you don't get that camera out of here...you see that cop over there...I will have him cofiscate that lovely little memory card from you lovely camera because you breaking all kinds of HIPPA laws right now, BACK OFF!" I was pissed. This guy felt he had the right to barge in on the lives of my injured and bleeding patients... and on mine for that matter. But I could fight him off. My patients could not. They lay there exposed to the world, both physically and emotionally. So I was angry and I expressed it and not just at this one man, but at the whole bus load of people who treated the whole thing as entertainment. So what if I end up with several tourist complaints in my file. They acted more inapproriatly than I did.
And so we load both our critcals in the back of our unit and too off.

Our patients made it to the trauma center alive and in one peice. And I only pissed off a bus load of tourists. Welcome to our fair city.

phew glads thats over

Holy mother of god I'm tired. 48 hours on an ambulance will do that to a person. 48 hours and 22 calls later and suprisingly an Angel of Death, such as myself didn't kill any one. (Refer back to a an earlier post for how I earned that nickname) In fact, I might have very well saved one. Woman having the tingling of an Inferior MI. Just the beginings, ever so slight ST elevations in the right Leads (which are ??? my Paramedic students out there) Bradycardic and slightly hypotensive. II did have to laugh at myslef for just a second as I go "I gonna give you a spray of...wait no I'm NOT going to give you nitro, I'm going to turn you fluids up a bit more my hypotensive friend" Its so ingrained, so banged into our heads that EVERY CHEST PAIN GETS NITRO that sometimes we forget that not ALL chest pain pts should get a spray of Nitro.

I do also forget how much fun it is working when you work with someone you get along with and work well together. My partner last night, we have very diffrent styles. Very diffrent. Both of us are laid back type of medics, but I tend to be, well... very sweetly southern. He's from a whole diffrent side of the country and well isn't. He's a no bullshit do you want to do the fucking hospital get in the truck now lets go quit bleeding on my fucking boots type A, but in a way that you like. He lets me be sweet, all while pushing them out to the truck. So it works. Its gets the job done. I get to be sweet and he well...covers me when the shit hits the fan. Plus, he's a good medic with strong medicine. And doesn't look at me funny when I yell at the crackheads who complain of chest pain at 4am (QUIT FUCKING SMOKING CRACK AND YOUR CHEST WILL QUIT HURTING DUMBASS!)

But now I'm going to bed. Sleep is good. And then The Shins concert. I love The Shins. The make me happy.

Keeper of Keys

Back to nights I go. Its time for our 6 month switch, and I get my nights back. Thank god. I'm getting frustrated on these 24 hour shifts. I'm getting downright mean. Not to my patients, but to my partners. I did have a difficult partner this time around, which is why I haven't been writing as much as I used to. I am afraid of what I might type and to be quite honset I haven't been enjoying the job enough to really write. The frustration had taken over and made it difficult to find the interest to sit in front of my laptop and tap out a post. I hate the managing part of my new position. Sometimes on my 12 mile bike rides I think of ways to get demoted back down to crew member. The best solution I came up with was to look up porn while on duty. It's not hurting anyone, nobody dies and after a while everybody forgets about it. As long as you don't do it again. and you let you friends in on the secret (I'm not really a dirty girl, I'm just tired of being bitched at at 0130 because I put the patient on 12LPM as opposed to 15LPM via NRB masK, does 3 LPM really make that big a fucking diffrerance really?) Or maybe making out with that cute City officer in the back of the unit while on duty. Again...not hurting anyone, not killing anyone. But still against policy. I just want to come to work, pratice medicine and go home. I don't want to have to worry if my EMT partner is going to try and push Narcan on MY patient if I wasn;t there to stop them or writing evals or having to sit my paramedic crew member down and tell them that this is not how we write our reports here when they have been doing EMS since before I was born. But here I am in charge. Keeper of the keys, overseerer of medic units.

Put my Penis in my Pocket

I yelled at a fireman yesterday. I went all bitch mode on his ass. But it was for a good reason. I was fighing for my patient. I had a bad call. An MVA on a back road. Car wrapped around a tree the only access I had to my patient... the only part I could even see was a wrist. A wrist with no radial pulse. Now the way the car was crushed, mangled around the tree I knew in the pit of my stomach that the person was no longer of this earth. But there was no way I was going to call someone based on just a pulseless wrist. So I wanted the car off the tree. I wanted access to my patient. And I wanted it ten minutes ago. So when the fireman came up to me and goes "She's dead...you got no pulse in the arm. you calling it now? I need to know now before we start pulling on that car and tree" I went off..."I most certianly am not calling based on a pulseless wrist...GET THAT GODDAMN CAR OFF THAT GODDAMN TREE...I need access to my patient, then we can talk about calling...not sooner" I paced a three foot radius around that car for 25 mins while they cut and pulled and yanked the vehicle off the tree. I do not do well with being inactive, with not helping. I'm a paramedic. I am trained to help. I don't watch very well. So I paced, waiting my turn, every so often going "Capt! You got Any activity from the patient?"
"No Baby, Nothing. But I'm still cutting"
"Thats good Capt, keep cutting!"
Then they got it off the tree. A mangled peice of metal. I got access. I was able to pronounce properly. To put my hands on the patient. To see that there was nothing I could do for her.

I broke down later. I couldn't get to her for almost 30 mins. Then I didn't want to leave her.

My supervisor came by after the call to chat. I needed it. I felt bad for getting all bitchy with the fireman. My supervisor told me that being a female paramedic in charge sometime you have to. You have to "Put your Penis in your pocket and fight like hell for the best of your patient, which you did...now you can go away knowing that you did everything you could for her...even if there is nothing you could do for her"

Lessons learned today
You can't save them all.
sometimes you have to put you penis in you pocket...and be a bitch...if it's best for your patient.

I'm being a very slack medic recently

So I have been productive in some aspects of my job and so slacking in others. To be quite honest, my day to day responsibilities, like washing the truck and making sure that we have all six tires I'm slacking. Because who really care how many transfer needles there are in the IV tray. All I really care about is if there is plenty of oxygen tanks to get my through a shift and if the narcotics and RSI drugs are safely under lock and key and tucked away in the fridge. Is the CPAP machine sitting on the actionary and the laptop plugged in in the back...then I'm going to go take a nap. Those 15 reports sitting in my EMSpro box can sit for a few more hours. I haven't worn civilan clothes in a month and a half. I haven't put on lipstick and masacara for two. I Pay rent for an aparentment I haven't slept at since I moved in three months ago. So forgive me if I don't count the 4x4s(If I you are grabbing more than say 6 4x4 for one wound, you need something other than a 4x4 I might add) nor I'm I going to polish my boots...so there.

But what I have been productive in is reasearching Versed as an alternative for Ativan for contolling Seizures. I recently got an order of IM versed for a 3 year old Status Seizure. This is an order I cannot follow becausse per our state I cannot giver Versed to Pediatric patients. After the call I spoke to the doc, some RNs and other medics and most will agree that Versed is becoming the drug of choice for seizures management. Works faster, higher serum levels for longer (meaning it's longer lasting) and ICU admissions post arrival to hospital are shorter. So if it works better, lets change it. I wouldn't mind hearing from fellow medics who use Versed as first line...what are your thoughts...are the studies true? or are they just blowing smoke up my ass.

Doh!

In the immortal words of Homer Simpson, all I have to say for myself is DOH!. Yep that was the statement of the night. we were called to an assault, ended up with a non transport which was good because as we were trying to manuver the ambualnce through the maze of police cars that lined the narrow winding street we made contact. Actually, let me back up a bit. To when I hopped out of the truck and started toward one of the officers to go "Hey lets move either this car or this car a bit either this way or that way so we have room to get by" Now keep in mind there are like 9 crusiers on this street all with the blue lights flashing and a large group of people all around...and no street lights. So our mirrors are useless...we can't see shit. While I'm talking to one officer another is guiding my partner from the front of the unit through the maze. He forgets that we are much bigger than a Crown Vic. Wider. With a very large box. So I turn around just in time to see the back corner of the box crack the headlight of a police car. What's even better is that the cop that was spotting us, that was HIS cruiser. My partner didn't find the humor in it. I, however, thought it was hilarious. I mean if you can't laugh at something like this, what can you laugh at. he guided an ambulance into his own police car. Comeon! That's funny. EMS comedy.

So there we sat for about two hours waiting on the sheriff's office to come to do the traffic report. No big deal. Kept us from running sick and stupid calls for a while. I could use the down time.

What have I told you people about lying to the medics?

I've been getting these weird calls in the middle of the night. Last shift was the assault that we thought was bullshit drunk guy that turned out to be bleeding internally going into shock guy. This shift was it was running from the cops got tased refused to sit up and talk to us guy, but not because he was that beligerant, but because he had a blood pressure of 70/squat and was tachy at 120. What the hell? He was intermitently responsive. The type of resposive that you had to fuck with all the way to the hospital to keep awake, but as long as you kept fucking with him, giving him a good sternal rub or hollar at him when his O2 sats dropped he came right back up to 100%. I did feel kinda bad when I first got him in the truck and kept yelling at him to talk to me "If you can run from the cops, you can sit up and talk to me, quit fucking around" then his pressure was 70. SON OF A BITCH! "What the fuck did you take?"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"No really, what the fuck did you take!"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"How much you been drinking?"
"I ain't been drinking man?"
"yes you have I can smell it, what esle you been doing"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
well knock me over I got a fucking angel in my possesion. So he bought himself a ride to the hospital with bilateral 16 gauge IVs a liter of fluid, some Narcan, and was going to get to meet a bunch of very nice nurses with a very large foley catheter at the ER. I also found out that I am getting very good at sliding in 16 gauges into handcuffed patients. Its a strange angle but it can be done.

With it being so hot here are some tips from your friendly paramedic. Because I don't want to pick your ass up.
1.Stay in the AC
2.Stay in the AC
3.Stay in the AC
There's plenty of Law and Order reruns on to enjoy, there is no reason to go outside in this heat, to run, play tennis, mow the grass or really do a damn thing
4. if you must go outside, you crazy bastards. Drink water. not Budweizer, not PBR, not vodka, WATER. or gatorade is fine too or my personal favorite, Revive VitaminWater.
5. Wear light cothing, both in weight and color. This does inclued the lowcountry favorite of searsucker. I didn't say it had to be flattering.

If you becaome unresponsive, stop sweating and your temp gets above 103 you are offically in need of my assistance. And I will be glad to come and get you but I do reserve the right to fuss at you if you do not follow the simple steps listed above. Because it's your own damn fault.

Balmy nights makes for miserable Medics

Hot, humid nights brings out two things here in the south. CHF and assaults. It was 93 degrees last night with 110% humidity. The air was also very still, nights like this are more bearable with a sea breeze, but last night there was none. So the sweat just sat on your skin. It made all who worked last night move a little bit slower, almost as if the air was so thick held us back. It also make people more mean I think. We got called to a stabbing. No when we got there, it was not a stabbing, well...it was, but it wasn't. He got cut with a knife and had an avulsion on his finger. Now it didn't raise flags when we saw him and he was all sweaty, we were all sweaty. It didn't raise a flag when he was slightly altered, he reeked of ETOH, it didn't raise flags when he kept saying he was thirsty, it was hot, he reeked of ETOH, and to be honest I was wicked thirsty myself. It even didn't raise flags when the blood pressure on the monitor said his blood pressure was 60/30. That damn thing had read a correct blood pressure all night. But when niether me nor my partner could find a radial pulse nor ausultate a blood pressure for ourselves was when we both looked at each other and then at the cops that were standing outside of the back of the truck and say at the same time "Fucker's actually sick!" I put in a 16 ga IV and threw him on a high flow oxygen my partner gets an 18 ga IV and gets him on the EKG (tachy as hell at 130) and We haul ass to the trauma center. He kept saying he was beat with a board in the abdomen (again no flags raised because ADB was soft, flat, non distended) But sure enough, according to the FAST scan at the Trauma Center he had a large amount of blood in his abdomen. I don't know how it works in some systems, but in mine we can, if they don't meet transport criteria, choose not to transport. The finger injury alone does not meet transport criteria. But the altered sensorium 2nd to what We initally thought was ETOH (which did in fact turn out to be shock) did. So you can say, being drunk saved his life.

The other thing we look fotward to on these balmy nights is CHF. This weather really exacerbates it. We gave over the night, 200 mg of Lasix, CPAPed just about everyone who got into the back of our ambulance, and gave more Nitro that even we of that bitter/ sweet orange nitro smell that all medics should be very familar with. I also went through the supply reqs for the night when I restocked after my last CHFer, and every single sheet listed the same thing Lasix and CPAP circuits. Every single one. Thats was all we did last night. But at least it is easy one you get it under control. It's just CPAP, NTG, and Lasix...CPAP, NTG, and Lasix...lather rinse repeat...

I'm afriad of horses

I'm afraid of horses. Really afraid of them. I never thought this would be a problem until last night when we had a potentially violent psych patient who was being taken care of by two mounted police officers. As we pull up my partner says to me, "Hey, look B, the horse cops are here. I didn't know they came this far up into the ghetto" Neither did I. I just looked at him and said what I thought to myself was "Okay, you can do this, just get out of the truck." Apparently, it wasn't to myself. "You are afriad of horses?!?"
"Uh..No...Yes...well..."
"Jesus, sit here, I got this"
"No..No. I'm not gonna leave you hanging, I'll be alright. I'm just gonna stand over here behind these other police officers across the street from the big scary animals. I got your back if you need it."

Then my partner and the other officers started cracking up. Glad I could be more entertaining than the crazy person who thought he was God.

Promotion

Well it's offical now. I am no longer an "acting" crew cheif. I have offically earned my Sargent stripe, whicch means I have gottan a pay raise, my own truck and the ability to say to pateints that don't meet our transport criteria that they can get the hellout of the back of my ambulance because there is no way I'm taken their dumb ass to the hospital for a broken toe. It also means that I have to keep up with the keys to the controled meds (I can barely keep up with my car keys what the hell are they thinking giving my the keys to the narcs), make sure my very sweet, but very green partner doen't get himself killed because he keeps getting out of the truck on the interstate without a traffic vest, and figure out how the hell I am supposed to get the 400lb inablilty to ambulate down from the third floorto my awaiting truck in the driveway. (How did you get up here, you're on the third floor?!? Why didn't you stay on the sofa in the huge open living room right by the front door?) Actually, it's not a bad gig. I learning to like being in charge. As a crew member, you can't really say much. You just take it. But as a crew cheif, if your CM gets out of line, you can take thier radio from them. Only letting them speak on the radio when you tell them they can. And when working with ParaGods, you can put them in their place if need be. Teach them they don;t know everything and when to ask for help is not a sign of weakness or stupidity. It's just smart sometimes.

HAHAHHAAHA!

This is...well listen...
http://gprime.net/flash.php/llamasong

had to share, welcome to earworm hell

Angel of Death

Angel of Death. Dr. Death. Double Oh Seven. These are just a few of the names I have earned because of yesterday. You know when you are on your third uniform, you have had a bad shift. When you come home wearing you bunker boots because your work boots are soaked through with blood you have had a bad shift. When the Fire Dept keeps a tally on how many full arrests you have worked you have a had a bad shift. Two full Arrests, One traumatic Arrest (GSW who bleed 2 units of blood all over my boots), and six DOAs (one Nursing home and 5 from a massive 4 vehicle MVA that burned up) is the offical death count. Tweleve calls in 24 hours. The AutoPulse batteries didn't even have a chance to charge back up. The Monitor batteries also didn't have a chance to charge. And of course the AC goes out in the box and of course its 122 degrees in the shade and OF COURSE it was 100% humitiy. Oh and the memory card from the monitor was lost along with my cell phone. Its been a bad day. Fucking Friday the 13th.

But I'm home now, with three days off. I have a big glass of wine. And I'm going to bed.

Babies and Social Work

So our EMS family got an addition last night. A Baby Girl. Pretty Little thing, (5lbs 9oz) with a pretty name of a southern belle, Grace. Now most day old newborns, I must say are pretty funny looking, all wrinkled and weird shaped heads. But Grace..Little Grace is beautiful. She had a whole paparazzi waiting on her. Kid's gonna have to get used to flash bulbs, being that this paramedic "aunt" is a photographer in her other life.

Today was Social Worker day. I was more of that than a Medic today. No life saving, just getting the gears in motion so that my patients today could get the help they so desperatly need. Terminal Cancer patients shouldn't have to spend the last few months on earth in dirty squalor. Geriatric couples should live out the rest of thier days not having to worry about what to do when they fall down and can't help each other get up because they live alone. So I played Social Worker today. It's time consuming, spending all shift on the phone with the people who help us take care of these particular type of problems.

But, I'm laerning my place in my new role. And these types of calls are some of the most difficult. I can fix Congestive Heart Failure, I can take pain away using Morphine, but these people need more than a paramedic. But we are the ones that start the ball rolling.

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.

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.

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.

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.

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.