Life and Times of a Paramedic Firefighter

This left feels right......

2012-02-14T07:19:00.000-08:00

   I've been back at work for two days now and things feel familiar but different at the same time.....if that makes any sense.

   Sunday I was on the Engine for a day shift. As I went through my gear and logged into my SCBA I realized that I hadn't been on the engine since that big fire back in November. November 25th 2011 to be exact, that's not a date I'm likely to forget any time soon. After two months off the engine I was feeling understandably rusty. I had brand new gear to replace my charred stuff from the fire and just seeing my name on my stuff, all shiny and brand new was enough to get me reflective for a moment. As I checked the truck I couldn't help but allowing my mind to drift. When I checked my mask I remembered how melted my mask was back in that fire. When I stuffed my balaclava into my pocket I remembered how painfully hot my face was during the explosion. When I put my shiny new helmet on the floor next to my boots I remembered how black and melted my old helmet had been as I stumbled out of the fire in a daze.

   I was having flashbacks no doubt about it, but I got through it. No point worrying about something that could quiet possibly happen to any firefighter on any floor of any department in the world. Its just one of the risks we have to accept and overcome.

   My first engine shift back was unremarkable. The pump didn't move a wheel for ten hours but I did get to take our co-response unit out and help with a few medical calls.

   Day two (yesterday) I was on the ambulance for the first time in nearly six weeks. No flashbacks noted but I was nervous as hell seeing how I had been off car for so long. Anyone who works with me will tell you that I never get nervous, well they're only half right. On calls I'm calm as can be, but returning to work from an absence tends to get me pretty jacked up.

   Our first call right out of the gate was for a lady with "weakness". She ended up being transported by her daughter cuz we were "too damn expensive" for the patient.

   Next up was a elderly guy with CP/SOB. Things came back to me pretty quick as we got our lines, 12 leads etc etc. Hell I even nailed my first IV in six weeks, although I've always thought IV's were one of those skills that don't really go away. The guy turned out to be a severe pneumonia and was admitted.

   Final call was for an attempted suicide/overdose. Our patient had called his sister saying he overdosed on pills and then hung up the phone. He wasn't answering the door when we showed up so we ended up having to knock out a window and boost a cop through. Our guy was lying on the couch with vomit all over his face, gurgling away, spitting puke with every exhale.

   Initial VS: HR 122 BP 80/44 RR 6-8 Sp02 85% GCS 10. We could hardly make out his pupils they were so damn miosed. There was a tupperware bowl on the counter with probably a hundred random unmarked pills in it, no signs of booze or paraphernalia anywhere.

   We got a line, started a bolus and I gave 0.5mg of Narcan IV. The guy didn't exactly spring back to life but within minutes he was walking (with assistance) and talking. Claimed to not know anything about pills or an overdose, hmmm, maybe he thought they were tic tacs?

   I finished up my first ambulance shift with an hour of intense ping pong back at the hall. We've hired a couple new guys who I swear have never seen or heard of the game before. Its nice because finally I'm not the crappiest pong player in the hall anymore!

   Anyways, my return seems to be going well, I'm doing calls, hanging with the guys, enjoying myself and smiling again. Cant complain about that.

Back to work a whole new me.....

2012-02-11T08:19:00.000-08:00

   I've been gone for a little over a month now. After many trials and tribulations I am very happy to report that I am going back to work tomorrow, day shift February 12th 2012!

   Its been a crazy month off that's for sure. I'm not going to get into it much here, grievances and confidentiality issues prevent me from doing so, but I will say that I am extremely excited to get back on that ambulance/engine and do what I do best.

   I saw a few coworkers at the gym yesterday, the first 'brothers' I've seen in over a month. It was awkward for all of about five seconds. It was soon business as usual as we were laughing and griping just like old times. I'm not going to lie, I'm still very concerned about my return to work and how it will be handled by the guys on the floor. Someone returning from a lengthy enforced stress leave isn't exactly a subject to be taken lightly. If my experience with the guys at the gym is any indication, I have nothing to worry about, my brothers just want me to be back and want me to be happy.

   Lots has happened to me recently, both work related and personal. Some of the changes and experiences I'll get around to blogging about, some I wont. Rest assured this blog will take on a slightly different tone as my very reason for blogging has changed from informative to therapeutic.

   Despite all the ups and downs over the last four weeks, all the meetings and appointments, all the papers and signatures, I finally go back to work tomorrow so for the moment, I couldn't be happier.

I'll be back...........

2012-01-14T08:53:00.000-08:00

Well due to some unforseen circumstances, I'm not going to be able to blog for a bit, three weeks to be exact. I'm heading off and wont be able to access a computer for almost a whole month.

Everyone stay safe out there, back to blogging in Febuary!

2012-01-07T16:43:00.000-08:00

Friday and Saturday night shifts in EMS are alwaysentertaining. Whether you work in a tinyrural town or downtown metro there is always some sort of shenanigans happeningin the wee hours of the weekend.

Last night was no exception.

We were called to the downtown bus transfer station for a “midtwenties female, unconscious not breathing”.

We arrived on scene to find a VERY intoxicated twenty fiveyear old girl lying on her back on the pavement. It was pretty cold out and she was scantilyclad and had her shoes off her feet and instead clutched them in her hands….weird.

When we roused her for assessment she immediately opened hereyes, tore off her pants and underwear and began screaming at the top of herlungs.

“F%^K you!”

“Miss calm down, were the paramedics”

“THEY TOOK MY PANTS OFF, THEY TOOK MY PANTS OFF! HELP!!!!”

Now, I’m not very superficial and being the exact oppositeof Brad Pitt in appearance I very rarely pass judgement on others physicalappearance. This fine specimen of apatient happened to be at least 250 pounds and at least 175 of those pounds hadto be localized to her abdominal region. Not too surprisingly, the sight of a screaming and bare assed 250 poundwoman drew a fair amount of attention at the bus stop. I’m pretty sure I heard a fair share of

“What the Fu%ks!!”

And

“Oh my GODS”

From innocent bus patrons who were walking behind me andhappened to catch a glimpse at our pants-less patient.

We put blankets on her, she kicked them off.

We asked her to calm down, she screamed in our faces.

We asked her to stop flailing her arms, she rubbed hernether regions and tried to grab our faces, gross.

Long story short we had to tie her down on the cot and put aspit sock on her. After hocking loogiesinto her own face for 20 minutes she finally got the point and settled down.

Very next call,

Sent to the local country bar for a “mid 30’s male patient,unconscious, ETOH”.

It was our guy’s birthday and I guess he decided to spend itgetting blitzed at the bar and then passing out in his friends pickup. His initial GCS was pathetic but his vitalswere ok. We started a line, did a 12lead, started fluids and transported. AsI was reporting to triage our patient starting having periods of apnea withsignifigant snoring respirations. Mystudent lube’d up a NPA and stuck it into the guy’s nose without a problem.

Five minutes later however, there was a problem. The patient all of a sudden snapped from aGCS of 6 to a 15 and was screaming and VERY combative, it was all my partnerand my student could do to hold him down as I called security. He ripped his large bore IV out and was nowpouring blood all over the place as well as spewing spit with every F word hesent our way.

With five security guards piled on him, plus my student andmy partner, I crept up to him with a syringe full of Versed. While our guy was mid scream I IM’d him with10mg of Midazolam and five minutes later it was nighty night.

My partner thought our guy was on PCP, the nurses said GHBand me, I placed my guess on good old alcohol. Twenty minutes and some toxicology results later and wouldn’t you knowit, I was right!

Our patient was a smaller guy and just had the look of a guywith “small guy syndrome” if ya know what I mean. I figured he was just small, drunk, passedout and then woke up in the hospital and didn’t like what he saw. He chose to freak out and swing at everyonewithin arm-shot and fling blood at everyone. When security restrained him he did what most guys with a bit of acomplex would do, he freaked out more and started yelling about how dead wewould all be in a one on one fight…..sure buddy.

Anyways, the night was long and I’m bagged, thankfully I’mon days off now, back at it on Wednesday.

So long 2011.....Moving on.....

2011-12-31T07:13:00.000-08:00

   Another year gone.

   What did I do? Where did the time go?

   To be honest it was all a bit of a blur, just like any busy EMS shift worker will tell you.

   When your a EMS worker with few family nearby and few friends outside the industry, day of the week doesn't matter, time of the day doesn't matter, hell even what month it is doesn't matter. I'm always in either one of two modes, on shift or off shift.

   A lot happened in my life in 2011. Good and bad, great and horrible, I experienced it all. Without getting too personal and deep, here's a bit of a recap.

- I stuck with my current job. I didn't get fired and I didn't quit. To date I've held the same job for almost 19 months which is the longest I've spent with a single service in EMS.

- I passed my re-class examinations to get off probation. I worried for months and studied my ass off. Not only did I pass but I did pretty well, 3rd in my hiring class with an 85% average.

- A bunch of coworkers and I formed a team and joined a relay race, running from Banff Alberta to Jasper Alberta. My leg was 25km and although I was pretty slow I still managed to finish. 25km is no easy feat when your 220lbs.

- My marriage ran into some problems. My wife and I separated and for the first time in six years I found myself alone. I was faced with dealing with one of life's greatest stresses all the while trying to maintain composure at work.

- I started taking online university courses. Thinking about the future really motivated me to learn more and about things other than hoses and fans and SCBA's.

- I took a couple trips to one of my most favorite places, Invermere British Columbia. Just me, my wife and our dog nestled up in a cabin or in our tent. Late nights with a pint on the beach and early morning's on the deck with a coffee and a good book.

- I did Vegas for the first time.......that's all I have to say about that!

  Reading that recap you would probably think,

"hmmm, this guy had a kinda boring year"

and you know what?   your right.

I did have kind of a boring year. Boring in the topical sense at least. I didn't climb a mountain, I didn't lie on any exotic beaches and I didn't party on any roof-top penthouses.

I did experience a lot though.

Confliction, reflection, anger, frustration and feeling as if my sanity was being stretched to its limits.

I thought a lot, like A LOT. I've thought about my career, my wife, my friends, my problems, my stresses, my happiness and my future.

I thought a lot about what brings my joy in life and what brings me sadness.

I've kind of come to the realization that what matters in life isn't my job, how many fires I've been in, how many codes I've got back, how much I can bench press or how many pints I can hoist.

What matters most is my own personal happiness, searching for it, obtaining it and then maintaining it.

2011 wasn't a very happy year for me. I was conflicted and stressed and fragile for the majority of the year and it wasn't a good feeling.

The year wasn't a waste, all the shit I've been through has only helped to shape and mold me into the person I currently am and will become in the future, but enough with the negativity, its time to be happy!

What is happy for me?

   For me, happy is loving my job, going to the hall, putting in a solid shift, hanging with the guys, doing calls and then going home with a smile.

Happy is having a Redbull and then meeting the guys at the gym.

Happy is putting three tables together at the pub and laughing my ass off over beers with the guys.

Happy is expanding my mind, reading, writing, blogging, even if my creations seem boring and are viewed by three people a week.

Happy is traveling the world, seeing new things, doing new things, meeting new people.

Happy is doing whatever it is that feels good to me, physically mentally and spiritually.

Happy is feeling like I'm improving, growing, expanding and accomplishing.

Those are mine, what are yours? Maybe you don't have a list like that because your already happy, maybe you need to do a list like that because your not.

Take it from a guy who spent the last twelve months in a very weird state, conflicted with himself and his choices in life, were not getting any younger. If you feel like your wasting time and potential.....you probably are.

Like Ozzy Osbourne said,

"Life wont wait for you my friend"

Tonight, 1201, its like a reset button for all of us who are thinking that there is more out there, that were capable of greater things, that we can make more do more and BE more.

Don't waste it, don't blow it off.

I know I wont.

The sunset of 2011 is fading while the sunrise of 2012 begins.

Bring it on..............

Holiday Post.........

2011-12-27T05:48:00.000-08:00

   Have I really not posted in a couple weeks? Hmm, time flies when work is hectic!

   I have been pretty busy lately, but its the holidays and everyone is busy so that's not a really good excuse.

   I guess I haven't been posting much because things have been kind of depressing at work as of late. After the fire (see posts "I shouldnt be here" parts 1 and 2) I was sent to see our department physician as well as a psychologist. The physiologist deemed me to be "unfit for regular duties" due to PTSD as well as stress related to my personal life. With a quick phone call and a few faxed documents it was good bye regular ambulance/fire duties, hello modified work program (ugh).

   I've been on modified work or "light duties" before for a back injury and I think I blogged about how much I hated it. Light duties take a sick or injured firefighter off his/her regular rotation and puts them on a Mon-Fri schedule. They are assigned tasks or assignments that accommodate their disability and are then required to work a set number of hours per week. Sounds ok right? Well I guess the program is coming from a good place and all, keeping people working when sickness or injury prevent them from doing their regular work, but when a member is neither sick or hurt, issues arise.

   I'm not going to get into things any deeper. There is a lot of BS going on at work right now what with myself, the Chief, the City and the union. You never know who reads what on the internet or who talks to who so for right now Ill leave it at this, I am currently BACK on the floor, doing calls, working with the guys and it feels friggin great! No matter what sort of drama or conflict or BS comes my way from the higher ups I still absolutely love my job and nothing makes me happier than getting the call and helping someone.

Anyways, here is the rundown from today's shift.

   Call 1 - Called to McDonalds for an intox. Patient was a gentlemen who is well know by the police and the ambulance. He was passed out at the table inside and absolutely REEKED of mouthwash. Kind of cracked me up how all the elderly people 2ft away went about their morning coffee as if they couldn't smell or see the incredibly drunk guy. The patient turned out to be fine, I saw him standing outside the ER doors later in the day having a smoke.

   Call 2 - Sent for an elderly lady having some SOB. Sounds like she took a fall out of bed and smacked her ribs on her night table. She had a bit of bruising and some pain with inspiration. She did fine during transport, no follow up available.

   Call 3 - Sent to the mall for a elderly fall. The mall was absolutely PACKED but its December 27th so what can you really expect. We got the patient out to the unit and checked her vitals which all seemed fine. ECG and 12 lead were both normal and she really didn't want to go to the ER so we formed her. "Forming" is just what I call not transporting patients to the hospital. I've heard it called "refusals" "code X" "PRS" and a dozen others but I like "forming" the best.

   Call 4 - Hot response to the local police jail for an overdose. I could hear our 20yr male patient screaming his head off the second I walked through the door. I peeked through the cell window and sure enough there was our guy, buck ass naked, screaming and swinging his blanket above his head like he was about to rope a calf. Turned out he had swallowed 4grams of cocaine earlier in the day and now felt like he was going to die (no way!). His vitals were actually pretty good, heart rate in the 90's. He was kinda tough to handle what with his naked screaming outbursts and all but I chose not to sedate him. No follow up available.

   Call 5 - House fire about an hour before shift change. My unit was sent along with two engines, an aerial unit and our command vehicle. Sounded like a small stove top fire. The guys ventilated and my partner and I assessed three people for smoke inhalation but no one was transported. We made it back to the hall just before 1800.

   That's it, all in all not a bad day. Time to whip up some dinner and then hit the sack. I work nights tomorrow for two and then start days off over New years.

I shouldnt be here....part 2

2011-12-06T19:03:00.001-08:00

Well its been a few days. Some time has passed since the fire that changed everything. The last week has been a blur of meetings, debriefings, sleepless nights, ambulance calls, fire calls, guys shaking my hand, high fives and hoisted pints. It's a strange feeling, seeing your life flash before your eyes. I've watched it in movies, even heard about it from some acquaintances, but until you actually experience it for yourself its pretty hard to grasp.

Going to work after the fire was surreal. I wasn't exactly scared, not nervous, or even anxious. In the days after I felt as if I was floating, all numb and tingly in my arms and legs. I don't know if that's normal or not but its what I felt. The sensation has since faded but I can bring it back quickly if I replay the event in my mind.

For days I had a goofy grin on my face, I laughed at weird times and coworkers kept telling me that I was acting different. I didn't have an answer for them. All I said was that everything changed after the fire, whatever that means.

Like I said, if I try I can replay that explosion vividly in my mind. The heat on my face, the gut feeling I was ignoring, the smoke blacking out my sight. I can still hear myself turning and saying "I gotta get outta here" to whomever was behind me in the dark. The heat, the smoke, the panic and then the fire. The huge wall of flame that in slow motion crept around the corner at the base of the stairs and then crawled oh so slowly up towards me. Me turning, putting my hand up to cover my face and then being pushed backwards. Opening my eyes, on my back, and seeing nothing but flame, red flame that was so bright it hurt my eyes. Worse than the sight and the feeling was the sound. The blasting, ripping, tearing sound that made me think my ears were bleeding.

Its probably not healthy to replay those details so explicitly, so I'll stop.

Work has been good since the fire. The department is taking the near miss incident very seriously and I commend them for that. There is a lot to be learned from that fire and it would be great if the whole department can benefit from the experience of the five guys who were inside. There's even been talk of us five guys speaking to every recruit class during their flashover/backdraft training.

Its tough. Its not something I can just walk away from. That fire changed me big time. Everything I thought I wanted in life, everything I thought mattered, the person I thought I was, all have changed. Sorry to sound dramatic, but I guess you had to of been there to understand. The four guys inside with me agree.

Gossip, partying, drinking buddies, work drama, personal conflicts, all that shit is meaningless. When I was on fire, burning, convinced I was going to die, I wasn't thinking about any of those.

When I was convinced my life was over all I could think of was,

"I've wasted twenty six years......what a waste......"

Its pathetic that it took a wake up call like that to open my eyes, but its happened and there is nothing I can do about it.

Anyone that is reading this, be happy, do what you love, be with those you love, focus on what really matters. If you don't know what really matters, I'll give you a hint, its not the car you drive, the money you make or clothes you wear, what matters most is the people that love you no matter what and the things that bring a smile to your face every single time.

This will be my last 'preachy' post. I don't want this blog to go off on a strange life altering epiphany tangent. A lot has happened but I'm still the same old me. Days off at the moment, back at it on Saturday for day shift.

I shouldnt be here..............

2011-11-29T10:37:00.000-08:00

The call came about an hour before shift change, 1700 or so on my second day shift.

"Engine 3 respond for reports of smoke showing at XXXX-XXth street"

My heart didn't jump, my adrenalin didn't surge, I've been on a fair amount of alarms ringing calls and smoke showing calls and they never turn out to be much. I just rhythmically put on my gear and belted in.

As we roared towards the residence I didn't even bother putting my mask on. I noticed my partner sitting back looking relaxed with no mask hanging, so I did the same. Then we heard our Captain report to dispatch as we pulled on scene,

"Dispatch we've arrived on scene and we have smoke showing appears to be a working structure fire"

We put our masks on.

Orders came in to enter through the back door on side C for a primary search and to initiate fire attack. I sprayed down the door, turned on my TIC camera, gave a nod to my partner and then entered the structure.

Conditions were volatile from the get go. There was a lot of smoke and a lot of heat. Visibility was basically zero and the thermal layer was down to the floor. I got on my knees and proceeded with the search. We couldn't find anything. We couldn't hear anything. We just kept our hand on the wall and kept moving forward. After 10 or 15 feet (or so I think) I felt a door knob on my left side. I opened it and expected to crawl into a furnace room or something but instead I grabbed some steps which apparently led down into the basement. Heat and very very black smoke was billowing up the staircase and was hitting me right in my face. It was obvious there was some serious fire involvement down there, so after my partner updated command we attempted to get down there and hit the fire head on.

We didn't make it far, maybe four or five steps until the heat was too intense, painfully intense.

We backed off to the top of the stairs and radioed for backup.

While the other attack team was being assembled I remained crouched on top of the stairs, occasionally spraying water blindly downwards, occasionally spraying water into the gas layer above me. My partner was crouched behind me and for the most part we were quiet, somber. As I crouched there staring down into this dark hot space I couldn't help but think how crazy the situation was. I couldn't see anything, I couldn't do anything, but the heat coming from the basement was just SO intense, what was I supposed to do? I hoped the more experienced backup guys coming in would have a clue, because I sure as hell didn't.

No more than ten minutes had passed from the moment we first entered the house untill I felt someone pat me on the back,

"backup's here Matty, lets do this!"

I couldn't see who it was of course, but I recognized the voice, two good buddies from Engine 2 were now behind me, ready to fight this fire.

"ok" was all I could say.

We advanced as a four man team, me on the nozzle. We made it only two or three steps down this time before the heat was unbearable on the lead man (me). We retreated to the top of the stairs again, frustrated and pissed off.

I sat crouched, grasping the nozzle, while the guys behind me talked out a plan of attack. This is where the details of the story start to get fuzzy, for reasons you'll soon read about.

I remember the heat all of a sudden became unbearable at the top of the stairs. My face felt like it was burning. My hands, my ears, my shoulders all felt on fire instantly. My gut instinct was screaming at me "something's not right, somethings NOT right" and I chose to listen to it. I thought I was a wuss, a rookie wuss and that I was not cut out for this career if I couldn't even handle a little house fire. I turned to the closest guy behind me, whom I couldn't see but could hear shouting orders and told him I was leaving,

"I'm too hot, I gotta go, I'm fucking burning" I said.

Had he told me I wasn't going anywhere, I was prepared to lie and say that I was out of air, luckily he said no such thing.

"Ok Matty, put down the nozzle, turn around, and head outside".

I remember turning back towards the stairs, putting down the nozzle and then looking downstairs one last time. Then it happened Everything went beyond bright. A wall of flame burst from around the basement corner and came up the stairs in slow motion. It consumed everything, not just the layer of gas above us, but everything. The flame exploded up the stair case and when it hit us it brought with it the most intense heat I've ever felt in my life. I turned to the side in an attempt to shield myself somehow but it was no use. I remember feeling like someone pushed me in the chest hard. I flew back maybe 5ft, maybe 10, then things blacked out.

I don't know if I was knocked out or not, but the next time I opened my eyes I was on my back and I was on fire.

It was surreal. I couldn't make out any features of the room. No roof, no walls, nothing, it was just all fire, ripping and tearing and making the most horrible noise I've ever heard. It sounded like I was inside a meat grinder, tearing and tearing and tearing and tearing. I put my arms out in front of me for some reason but they were engulfed in the flame, I couldn't see anything but flame. Unfortunately, I also couldn't feel anything but flame. I felt like my entire body was on fire.

This period of explosive heat and flame probably only lasted for five seconds, but it felt like five minutes. I thought I was going to die, slowly and horribly, I was convinced that I was going to burn to death in my first house fire.

I didn't die, but things were far from over.

After a few seconds the flame suddenly vanished, sucked backed down into the basement. Thick black smoke now blanketed the room and the heat which was now slightly less intense, lingered all around us. This was the moment I got really scared.

I could hear the guys screaming. Not yelling, not doing maydays, but screaming. Screaming for help, screaming obscenities, screaming incoherently. I was silent, due to shock not to composure. I could see absolutely nothing, but I could hear the screams crystal clear. They sounded far off in the distance,

"go go go get the fuck outta here!!!"

"FUCK FUCK FUCK Im burned, Im lost, FUCK"

"its gonna blow again move move MOVE!!!!"

"where's the door, wheres the fucking DOOR!!!!"

I was terrified. So were the guys, I could hear it in their voices. It sounded like they were moving away from me, fast, and I was terrified. I had NO clue where I was. Self orientation was gone, blown up in the explosion that should've killed me. I started crawling on my hands and knees, feeling for something, anything that would give me some clue as to where an exit was. I made it to a wall and started kicking with all my might.

I made it only a second or two before someone grabbed my tank and pulled me,

"lets go lets go, are you lost?" the person in the dark asked.

"of course I'm fucking lost!" I screamed.

We started crawling as partners and just by pure luck we came across the hose. We followed it but were going in the wrong direction and ended up at the nozzle. Being back in my original position before the blast, I looked downstairs. The entire stairway was burning freely, fully engulfed in flame and it was damn hot. We spun around and started following the line in the other direction. After 15ft or so we made it to the door we entered in through but the explosion had blown it shut, latching it tight and pinching off our two hand lines in the frame.

We punched and pushed and kicked and screamed but the door wouldn't move. Behind me I could feel the heat rising, hear the fire getting louder, feel my instincts panicking. It was gonna blow again, it was just a matter of time.

Outside the door two guys were hammering on it with everything they had. It took about a minute before they finally burst through and we had an exit. I was the last to exit the structure and was too disoriented to even realize I was outside. I was walking on the house's back patio, totally in shock, with my back to the building, when it blew again.

BOOM!!!!!!!!!!!

I felt the force push me forward onto my hands and knees and could feel the flame shoot over top my shoulders. The heat and smoke were intense but because I was now outside the forces were less then when I was head on inside the structure. All around me guys were running, fleeing, trying to escape the black smoke and the heat. A lot of the guys weren't even mask'd up because why the hell would they be? Once I was out of range of the heat I tore my mask and helmet off in one quick movement and rubbed snow all over my face and head.

I wasn't able to comprehend how lucky I was, I was still in shock, I still felt on fire, I still felt terrified, but I was alive.

I don't really know how to continue with this post. Just writing about what occurred has been tough for me. Maybe I'll make this post into a two parter and next time I will get into why things went the way they did, what happened afterwords, and whats happening now in terms of PTSD and debriefing.

All Ill say is this. Friday November 25th 2011 I almost died. Myself and four coworkers were inside a structure when conditions went volatile and a severe explosion occurred. The blast and the associated heat should have killed us but for some reason be it luck or divine intervention it didn't. I am alive today after being within inches and seconds of a horrible firefighter death. I was 100% convinced that I was going to burn, that I was going to hurt and that my life was going to end at 26years.

To all of you out there, be thankfull and be safe. To all you firefighters out there, respect the conditions, loose the old school attitude and remember your training. Each and everyday when you get home be sure to kiss your spouse, hug your kids and truly appreciate what's important to you because it can all be taken away from you in a few horribly terrifying and painfull seconds.

This will have to be a two part post because Im rambling and because there is so much more to say.

Stay safe.

Raging Inferno!

2011-11-19T05:59:00.000-08:00

The heat was insane.

The flames leapt in all directions.

Visibility was zero.

I could feel my helmet melting and my mask sucking to my face.

Umm....Ok maybe not, but it was a dumpster fire with several mattresses involved.

The call came in around 0100 and even after a year and a half on the job the "Engine 1, reports of a dumpster fire" tones still never fail to get my blood pumping.

Going through the motions of gearing up, throwing on an SCBA, handing in my tags and grabing a nozzle was a welcome refresher aswell.

Afterwards I couldnt help but think about my first dumpster fire a little over 10 months ago. I didnt know where to put my accountability tags, which line to grab or where to put the water (seems obvious). I remember traveling to the scene and completley dumfounding my partner in the back by not knowing where to put my accountability tags, "you've been here how long?" he asked.

Im not saying Im an old vet, not by any means, but this time around I sure as heck knew where to hang those tags, which line to grab and where to put the water. I also didnt get pathetically tangled up in my SCBA, which only seems to happen when an officer is watching.

Its been awhile since my last fire call. I get so caught up in EMS and training and precepting that its easy to forget that yes I am in fact a fire fighter as well. Pretty cool stuff if you ask me.

Oh and also, winter has officially arrived in central Alberta. -32 degrees celcius today with the windchill which is as terrible as it sounds. To anyone out there who works in a warm climate year round....enjoy it! I hate hate HATE working in a climate that causes your gloves to freeze as your walking up to a pt's residence, or makes you cough if you were to take a deep breath in, or so cold that all you can think of even as your standing over a critical MVC patient is, "holy crap its friggin cold!!".

Back again tonight for 14hrs, then off for four.

Train kept a rolling.....

2011-11-11T06:15:00.001-08:00

Just hanging out with the guys in the kitchen after our first of two night-shifts. They started talking about hockey with bores the hell out of me so I thought I could sneak a quick blog in before shift change.

My Paramedic student started this tour. Its his first of two practicums, meaning he's able to do a fair amount but hasn't had any cardiac or respiratory training whatsoever. He was at the station early and looked the part so my first impression was good.

Day 1

Call 1 - 78yr female patient had a syncopal while making breakfast. Everything seemed more or less in order and our exam was unremarkable minus the brief LOC. Vitals, 02, 12 Lead and IV.

Call 2 - 56yr female patient complaining of crippling back pain. Sounds like she was mid step at her office and was suddenly paralyzed with "electric" pain down her ass cheek. She was screaming at the top of her lungs and had tears streaming down her face, so basically ya she looked in pain. We couldn't even get her to move an inch to sit down so we did the next best thing, started a line and gave her Morphine while she stood upright crying. All in all I gave her 20mg Morphine and then 150mcg Fentanyl, finally getting some break through relief as we pulled into the ER.

Call 3 - 93yr male patient had weeping sores on his legs. Right foot was gone via diabetes several years ago and lefty looked like its time was basically up as well. Bs'd with the guy about his love of exotic cars on the way to the ER.

My student did well on his first day, very well actually. I have no real concerns minus a couple bad habits from his years as an EMT. He seems like a nice guy and his goal is to eventually get on with my service so hopefully things go well for him.

Day 2

Call 1 - 50yr male patient c/o sudden onset chest pain. He was supine on the living room floor when we arrived and really didnt look all that great. The engine was on scene with me as well so I had a ton of help which I utilized. Pain was sharp and sternal, non radiating, and felt like his ribs were breaking. ECG was totally normal and his VS were decent. ASA and NTG started to decrease his pain but I maxed out on my sprays quick and couldn't give Morphine because of a pre-existing allergy. I slapped a 0.8mg/hr patch on and the guy was pain free by the time we got to the ER. No follow up done.

Call 2 - 55yr male patient who had been vomiting blood, urinating blood and having bloody diarrhea for 12 hours, no prior hx of ulcers/bleeds/varicies. How much blood did he puke/piss/shit you ask? Well.......lots. He had at his bedside a garbage pail filled approx halfway which he claimed he had filled and emptied three times. Total approx fluid loss (provided he was telling us the truth) 3.5-4 litres in 12 hours. The guy looked horrible and his VS weren't all that great. He was tough to get a line on and the best I ended up getting was a 20g in the tiniest hand vein I've ever cannulated. He did ok during transport, all I heard later from his nurse was that he was doing "not good".

Call 3 - 88yr female patient c/o SOB. Sounded like an anxiety related thing with a long proven track record of ER visits with similar presentations. Assessment and treatment were unremarkable.

All in all my day-shifts weren't too bad. My first night was kinda crappy but I'm too tired to talk about that at the moment. Back at 1800 for 14hrs then off for 4 days.

Bring it on November!

2011-11-02T20:01:00.001-07:00

Well September and October were hectic and stressful months filled with many changes both wanted and unwanted. I haven't been posting much lately but hopefully that changes with the coming of a new month and new possibilities.

Maybe I'll start off my November posting by recapping what I've been up to and whats been going on in my world.

For starters, my re class examinations to move up from probationary status to the rank of "third class firefighter" have come and gone and Im glad to say that I was successful in both the written and practical tests. My written was tough, but I did well as I usually do on most written tests. My practical examinations however were a whole different story. I was anxious for weeks leading up to my testing date and was a literal wreck the morning of. For the practical side of things I had to complete the following,

- Timed turnout gear and SCBA donning, first outside the unit and then in the back of a moving apparatus.

- Establish a water supply from a hydrant using 6 inch high volume hose.

- Advance a preconnect attack line from the truck bed to a structure door.

- Call a MAYDAY before breeching a wall and escaping to safety.

- Ladder a window with an extension ladder for rescue purposes.

To the established and experienced firefighter these tasks probably don't sound like much, but to a proby like myself they are quiet daunting (were quiet daunting I should say) however I made it through everything with an 84% total average and am now officialy OFF probation and working as a 3rd class firefighter.

With the coming of fall I've also been busy doing some teaching within the department. CPR renewals are coming up and being one of only two instructors on my platoon I share the responsibility of retraining about forty members in BLS CPR. I actually did a class tonight at work, putting twelve guys through with another 12 scheduled for tomorrow night.

Also, I have a final year Paramedic student starting his precepting next tour. He's been assigned to me for 8 tours which will be just over two months. I haven't had a student for awhile and cant wait to get back to focusing on EMS after many months cramming for my fire re class exams. Maybe I'm just gloating here, but as far as I know the department rarely gives students to junior medics such as myself. People were very very surprised when I got an EMT student after being on the floor for only nine months and here I am now getting a Paramedic student after being here only 15 months. Anyways it should be a good time and I'm really looking forward to putting my teachers hat back on for a bit.

Night shift tonight has been slow so far (knock on wood). My two day shifts prior were super busy with some actually pretty interesting calls including,

- A hypotensive vaginal bleed who ended up being severely anemic. She was given 6 units whole blood in the ER.

- A NSTEMI that I gave a whole whack of Morphine and Nitro too.

And

-A syncopal lady who's heart rate was in the high 30's.

All in all things have been busy but good. I'm learning more and more than while I may not be able to control all the things that happen in my life both at and away from work, I do have total control over how I respond to the inevitable changes.

Nights tomorrow night and then four days off,

Ill keep ya posted.

Come on Reclass, be over already!!............

2011-10-14T12:25:00.000-07:00

If it seem like I haven't been posting very often these days, well lets just say things at work have been a little stressed.

October 17th and 24th are big days for me, those are the official dates of my departmental re class examinations. I cant remember if I've blogged about re class in the past, so Ill explain it a little.

At my department, all junior members must undergo annual examinations both written and practical in order to move up to the next designation level. Right now, I am designated a "probationary firefighter", if I am successful in my exams I will move up to the level of "3rd class fire fighter", next year will be my "2nd class" exams and the year after that "1st class". Once a firefighter reaches first class they no longer undergo annual exams, instead they work in a fully functional role as a firefighter/paramedic and accumulate seniority, once a certain level of seniority is attained and spots open up, a member becomes eligible for officer status, first as a "qualified for officer or QFO" and then eventually as a entry level lieutenant or "L4".

The 17th of October I will write my written exam. What will I be tested on? Well....lots, the firefighter essentials textbook for starters, from cover to cover. Department SOP's are also testable and trust me there is a boat load of those! Provincial medical protocols, traffic management and our union contract are all guaranteed to be on the test as well.

The 24th of October I will do my practical evaluations, which can include any or all of the following fire-ground tasks,

- forcible entry

- ventilation

- advancing an attack line

- laddering

- Turnout gear donning (timed)

- SCBA donning (timed)

- connecting to a hydrant

- hoisting

- interior fire attack/knockdown

The material for my 3rd class exams is vast to say the least but on the bright side its nothing compared to the guys I know who are doing their 1st class. My exams involve NO pumping, NO aerial operations and NO driving, so I guess I get a bit of a break there.

I've been studying about an hour a day for the last six weeks, but these last few days have been just a blur of study sessions, online review and coffee induced late night crams. In addition to studying I've also been keeping up with busy shifts at work, primarily on the ambulance which makes it tough to focus on fire based testing. I cannot WAIT to be done re class for this year and give my brain a well deserved rest.

Crap, the twenty minutes I took to blog this could've been spent studying, better get back at it!!

Bring it on......

2011-10-09T07:07:00.000-07:00

Well I've been busy for a while, too busy to post I guess but now its my split and I've got nothing but time before I go to nights.

My first two day shifts were as so.......

Day 1

I was sent from my usual downtown hall to an outlying hall that has a HUGE coverage area, mostly residential and seniors residences. As much as a love my downtown hall its always nice to get out every now and then to work with other guys and do calls in other parts of town.

Call 1 - Sent for an elderly syncopal pt. Multiple falls in the morning, the last of which left him bloody and confused on the kitchen floor. 02, IV, ECG, transport, mostly unremarkable call.

Call 2 - Sent for another elderly patient at an assisted living place for syncope and general weakness. The guy's BGL was pretty high and apparently he hadn't been taking any of his meds (including insulin) for several days for some reason. IV, 02, ECG, transport. I didn't get a follow up on this guy.

Call 3 - Sent out to a VERY fancy rural part of town for a single vehicle rollover. Our patent was a 19 year old girl who had self extricated prior to our arrival. She was complaining of neck pain and shoulder pain so we immobilized her. I always find it funny how people can complain about how bad their pain is but when I offer them medicine they always refuse, usually saying something like "I dont want any needles....they hurt!"

Day 2 -

Day two was the departments big annual open house, held downtown at my usual hall. Extra guys and units were being pulled downtown for display purposes as well as to help make burgers, tour people around, piggyback kids and give people rides in our ladder units. I was at the outlying hall again, on the ambulance, so I was mostly too busy doing calls to spend too much time at the open house.

Call 1 - Called for a severe SOB. Arrived to find the lady on her back in the bathroom, looking horrible, wheezing all throughout, not moving a while lot of air. Initial spo2 was in the low 70's but weather or not that was accurate I don't know. I gave her a neb of Salbutamol/Atrovent and we quickly loaded in to the unit. I hung some Magnesium Sulfate en route and her condition and SOB had definitely improved. She was saying she felt 99% better by the time we put her on the 12 lead and holy smokes wouldn't you know it.....ST elevation, lots of it...V3V4V5V6. No chest pain or associated symptoms whatsoever at that point, SOB was totally gone. Feedback at the end of the day= pt's troponin was up and was diagnosed anterior/lateral STEMI. She wasnt thrombolized for a reason I didnt hear but she was started on a nitro drip for some pain she developed in the ER and was admitted to our ICU.

Call 2 - Sent to the local hospice for a lady c/o hip pain after a ground level fall. I always hate going to the hospice, just the vibe and atmosphere makes me creeped out and sad. Our patient was 71 and was totally surrounded by family by the time we arrived. We didn't do a whole lot really, just cranked up the bedside manner, moved her to the cot very very gently, and drove to the hospital very very slowly. Long wait for a bed but we cleared up uneventfully.

Call 3 - Sent to a natural gas line burst with two engine's, our hazmat unit and our Platoon Chief's unit. Sounds like some guy was digging holes in his back yard for a fence and hit a big gas line. The whole block smelled like gas and when we were up close talking to command briefly you could almost see wavy lines in the air. We quickly retreated back to our 'medical staging area' and waited for any patients that might arise from the situation. Calls like this are always such a hurry up and wait deal. We ripped to the scene as fast as we could and then sat a block away in the ambulance for 2+ hours watching the engine crews work. No patients were brought over to us. Just as the utility guys showed up to crimp the line we were pulled off the call for a nearby cardiac arrest...........

Call 4 - Caller said that he hadn't heard from his mother (who lived in his basement suite) for over a day and was getting concerned. He smelled a funky smell but just attributed it to his many cats in the building. Eventually he got curious and went too peek into his mothers room. When I walked in to her room I nearly fainted the smell was so bad. She had only been there dead for a day or so (my best guess) but the smell was just overwhelming. I guess I'm a mouth breather because I got used to it quick while my partner ran out to the unit for a mask and that stuff you put under your nose. The woman was at least 350 pounds and lets just say she didn't die in the most dignified position or setting. We confirmed absence of a pulse, did our paper work, and handed off the scene to the police.

Thats it for my day shifts. I go to nights tonight and as far as I know I'm on the engine tonight and the ambulance tomorrow night, but who knows that could change at any time.......

The maintenance of sanity............

2011-09-28T05:35:00.000-07:00

EMS is a crazy business.

I think most people, both in the biz and not, would agree with that statement.

There sure is a lot of talk about stress management and coping mechanisms in the workplace but do you ever notice how a lot of the occupational health and safety posters you see on the walls or the pamphlets you see on the rack at the doctors clinic are geared towards non EMS folks?

I saw one the other day that advocated "getting away from your desk for five minutes every 1 hour" to both "rejuvenate the mind and rest your eyes from the computer glare". Well I don't know about you but I don't sit at a desk. Not that there's anything wrong with that, but the last desk I sat at was a principles desk in high school.

A lot of the aforementioned literature also preaches the importance of appropriately winding down after a stressful day on the job. Again, how can you compare the stress of answering emails, sending memo's, crunching numbers and getting the copying machine to work with the stress of holding your bladder while paralyzing someone and trying to place a tube in their airway?

If you have a desk job, great, I'm not knocking it for a second, I'm just saying that EMS is in a league of its own when it comes to stress and therefore needs to be dealt with separately when it comes to mental health, well being, and stress management.

If your a medic, EMT, firefighter, police officer etc, what do you do to stay sane? There must be something, if you say "nothing" then the thing that keeps you from going off the deep end is probably something so common and subtle you hardly recognize it, like kissing your kids on the forehead in the mornings for example.

I'll tell you what a lot of folks do, they drink..... a lot! But that is a whole other subject that could easily fill two separate post's.

Others fish, hunt, camp, ride motorcycles, whatever. The activity or act itself isn't so important as is the effect it has on the persons well being. Something as simple as walking home from work can possibly be that one thing that soothes a medics nerves and makes them functional in normal society until their next shift.

Me, I never used to have a "thing" that kept me sane. It was just all EMS all the time and eventually it caught up to me. Now, I have many "things",

- I read, almost excessively, Stephen King, Harry Turtledove and JRR Tolkien being my favorites.

- I write, almost excessively, I have this blog, my own personal daily journal, as well as a private note book where I write almost daily letters to my wife which she reads consistently.

- I exercise, nothing crazy, but hitting the treadmill for 30 minutes or lifting some weights is one of the easiest endorphin rushes you'll ever get.

I have buddies who travel, everydays off somewhere new and different.

I know others who work a second job on days off to keep themselves occupied, take their mind off work AND make some extra cash at the same time.

Heck I even know of a guy who bar tends at the biggest nightclub in town as often as he can and he seems to be one of the most calm level headed guys I know.

What I'm trying to get across is that whatever you do before and after work, make sure its healthy and productive. You deserve it. Your out there everyday doing a job that not just anyone could do. You owe it to yourself to sooth and heal your mind and body.

After 12 hours of helping others, doesn't it make sense to put yourself first for a bit?

Been a few days.......

2011-09-17T06:23:00.000-07:00

Well it looks like once again I've forgotten to post during my tour, now I have to retrace my steps too see if I can remember all the calls over the last four days, here it goes.......

Day 1

I was sent up to another hall to cover for a guy who was off sick. I was put on the ambulance with another junior level guy whom I work with often. One of our calls was for an elderly syncope that presented as very stable during the call but while we were switching her into her hospital bed she jumped from a NSR to a SVT. No complaints of pain or drops in pressure or anything like that, but her rate was up in the 180's. I wasn't that worked up, I mean come on I've done several SVT's before, but boy oh boy were the nurses ever freaking out!

Day 2

Same station, but placed on the engine instead of the ambulance. Engine shifts are notoriously slow in my town and this shift was exactly that. We backed up the ambulance on a couple EMS calls, nothing too crazy and ended up doing a ton of training for my up coming re class exams to loose my 'proby' status. I did things like ladder a building, deploy a handline, timed SCBA donning and of course various knot tying drills (my least favorite).

Day 3

Ummmm ok now I really need to think because this shift was busy and its all kind of vague. Call 1 was a medical alarm that turned out to be a false call. The house we were sent too was way out in the boonies in a VERY classy gated community and we later learned that the owners were out of town of vacation. We also learned that nothing attracts attention in a gated community like a big tattooed guy (me) circling a multi million dollar house trying to pry the windows open. Call 2 was for a ped vs car, a teenage guy was skateboarding on the sidewalk and was struck at low speeds by a car. No obvious injuries were found but he had a lot of back pain. We boarded him and gave him some gas which seemed to work. Call 3 was for a drunk guy in the park who was sleeping one off in the bushes, no transport. Call 4 was a syncope/possible seizure at the rec center. The call was uneventful minus our 2hour+ wait time at the ER. Call 5 was for a stat ALS transfer to the nearby neuro center. Our patient was a gal in her 70's with a massive stroke. Her pressure was over 200 and all our orders specified was PRN bolus doses of Labetalol. She did pretty good all things considering and we dropped her off around 0100, putting us back in our hall around 0300. Just a quick note, the first four calls of this shift were all done in the first 4 hours, ugh!

Day 4

I'm actually still on my 4th shift as I type this, 30 minutes to go to be exact, but I'll give you a rundown nonetheless. I was put on the engine and told I was being given a break from EMS calls, meaning that I wasn't going to be on the EMS back up unit (junior guys are commonly put on the engine and the ambulance back up unit together). Ummmmm lets see here, oh ya I remember, we were sent to a car fire that turned out to be very small and totally burned out by the time we arrived. All we did was direct traffic and push the vehicle off the major roadway. We hung around until the inspector showed up and were back in quarters by 2200 or so. During the night I heard my hall's brush truck go out to a small grass fire in the park, as well as our ambulance being sent to two or three medical calls. For myself however my night was pretty slow, just that one engine call.

Days off are busy busy coming up. I'm out of town for most of them so they will probably fly by in no time. Oh, I guess I should mention that I recently got a casual job with a local oilfield EMS company. They pay well and are willing to work with me and my crazy Fire Department schedule so I couldn't really pass the job up. I've been doing a lot of orientation and training with them for the last couple days before my nightshifts at the FD which means I could be out in the field within the next couple of weeks.

Anyways, days off in 19 minutes......18 minutes.....17 minutes, but who's counting?

Hey I forgot about my 200th post!

2011-09-09T07:44:00.000-07:00

I've been away for awhile, seems like weeks but I guess its only been four or five days. I just finished a tour of two days and two nights and now I'm kicking back with a coffee looking ahead to my four days off.

I really shouldn't wait until the end of a tour to blog because my memory is absolutely pathetic. If I post right after a shift I can usually remember what I did but trying to recal all the calls I did during the last four days is going to be tough....I'll give it a try though.

Day 1

I was on the engine for my first day shift. I got a good workout in and as I was in the shower the tones went off for a structure fire in my area, Crap!!

Getting calls when your in the shower always sucks, but when your head to toe suds'd up and the call is for a structure fire...it really sucks. I threw on my sweaty gym clothes, squeaked down the pole and was in my gear in a matter of seconds. As I was getting my BA on we were downgraded from a structure fire to a dumpster fire, my heart rate slowed a bit, but just a bit.

Arrived on scene at a large construction site where a massive debris bin had caught fire. My partner and I deployed the bumper line and had it out in five minutes or so. We were only on scene for a half hour, all in all a pretty cool call for a rookie firefighter like myself.

Later on in the day, around 1600 or so I was pulled off the engine and sent with another halls medic crew who were doing a stat transfer to another city. They needed another set of hands not to run the ventilator (as is usually the case) but to apply hands on direct pressure to a bleed on the patients abdomen. Sounds weird I know, but apparently the patient had a huge scar on his belly from an old AAA surgery that he happened to snag on something as he was moving around his apartment. The scar ripped off and the subsequent bleeding was bad enough to warrant an urgent trip to the nearby vascular surgeon. Whatever, I didn't ask any questions, I was told to drive so drive I did, I got a bit of OT, getting home around two hours after shift change.

Day 2

Time for a shift on the ambulance. I'm struggling to remember much about this day which obviously means there wasn't anything incredibly interesting going on. I remember a patent with chest pain that we gave ASA/NTG too, as well as a elderly lady with general weakness. Oh wait now I remember, day two was the day with insane hospital wait times. We only had two calls but each call had a minimum two hour wait time. I remember we had to wait with our general weakness lady for just over three hours before getting a bed.

Day 3

Engine shift again. We had an alarms ringing call at the beginning of the shift which turned into nothing. I did some training for my exams coming up in October, mostly knots and hoisting as well as some book review. I backed up the ambulance on one call around 2300 but besides bringing in the stretcher for the crew I basically just stood around. I got a few hours of good sleep, got off shift on time and was home lying on my deck in the sun by 0900.

Day 4

This shift I actually remember because it just happened. I was on the ambulance and pulled a major fluke as our unit didn't turn a wheel in 14 hours! The engine on the other hand was busy all night. The guys were dumbfounded as call after call came in for the engine crew and my medic partner and I sat around drinking coffee. If I remember correctly the calls were for a dumpster fire, alarms ringing, minor hazmat, another alarms, and then an elevator rescue around 0600. I couldn't help but notice a few resentful glares from the engine guys this morning as I sipped my coffee all smiles and sunshine after a full night of sleep. Hey, that's the way it goes sometimes boys, not my problem!

So ya this is my 202nd post I believe, crazy eh? I remember starting this blog as a requirement years ago in medic school and thinking what a lame assignment it was.

"Could these instructors BE any lamer giving us a assignment like this" I remember thinking, or maybe I said it out loud.

Time sure flies, this blog has been with me through medic school, urban EMS, rural EMS, my time up north as a flight medic and now as I forge my path as a firefighter/paramedic. I'm not gonna lie sometimes (a lot of times) the last thing I want to do is blog, especially when I see the laughably low viewership numbers I have (does anyone besides my parents read this site?) but raving and ranting about my day is very therapeutic and I don't see any end to this blog in the near future.

Anyways, days off now, back in four!

Nights wrap up.............

2011-09-02T08:37:00.000-07:00

I'm on days off at the moment. My two night shifts last tour were pretty decent, here's a quick wrap up.

Night 1

I was on the engine my first night which was kind of surprising. Engine shifts are usually unofficially reserved for higher seniority guys although probies do occasionally luck out. As I've mentioned before, I don't particularly like shifts on the pump just because its all new and foreign to me and I feel like a fish out of water, like a Paramedic in Firefighter gear sort of.

Anyways the shift was pretty slow, there was a small kitchen fire in another hall's area around midnight so we went and covered downtown while another engine dealt with the fire. We got back to our hall around 0100.

Around 0630 the tones went off for an EMS call. We backed up our halls ambulance for a two year old who was seizing. The kid was postictal when we arrived and wasn't looking to good. The attending medic asked me to come to the hospital with him as part of a three man transport, meaning a single EMT driver and two ALS medics in the back. We managed his airway and had some Versed drawn up and ready but never had to use it.

Night 2

For my 2nd night I was put back on the ambulance...ahhhhhh familiar territory, good ol comfortable ambulance calls.

Call 1 - Sent cold to a lady in a rural community who had fallen sixteen hours previous and had been unable to get up do to hip pain. She was only fifty years old but had leukemia and was already very weak prior to the fall. She was in a lot of pain so she got some Gravol/Fentanyl during the transport. I didn't get a chance to see her X rays so I don't really know what her issue was.

Call 2 - Sent to the province's big fancy (and expensive) center for mental health and brain injury with a middle aged lady who was suicidal. My partner attended and I honestly didn't get a whole lot of info about the pt. On calls like this we are literally used as nothing more than a taxi as the patients meet us out in the ambulance bay with their suitcase packed. Most people we take are crazy to the point they refuse vitals or to answer any of our questions. The fifty minute drive to the center was uneventful, we got back to the hall around 0200.

At this point I was thinking about going to sleep but decided to see the end of a movie we had been watching before call 2 came in. I ended up falling asleep around 0330.

Call 3 - Ten minutes before shift change (hello OT!) sent hot for chest pain. Turned out to be a elderly guy who spoke zero english and communicated with us through his daughter who's english was basically as limited as his. His pain was abdominal not cardiac and he was pretty nauseated and dehydrated. IV, anti-emetic, fluid and a bit of analgesia en route made for an unremarkable transport.

Anyways, days off now, back on Monday for another tour of fun and games.

Delays delays.....and more delays

2011-08-30T07:07:00.000-07:00

Dayshift yesterday. I was working on the ambulance and our day was pretty steady. Add to that ridiculous hospital wait times (upwards of two hours per patient) and you've got one heck of a day.

Call 1 - Sent cold to a nearby seniors home for abdominal pain. A 94 year old lady hadn't taken a bowel movement in over a week and her belly was "sore and hard", shocking yes I know. Transport was unremarkable. We arrived at the ER to find five or six other units delayed in the hallway, some having been there for hours already. Our own delay turned out to be around 90 minutes.

Call 2 - Two "Echo" calls came in at the same time around 1030, the radio chaos was pathetic as my partner and I sped off to one of the two cardiac arrest calls.

Arrived on scene to find a patient who was alive, but barely. Apparently the 68 year old guy walked into a hotel lobby and collapsed on the ground shaking. A hotel staff member couldn't find a pulse so 45 seconds of CPR was performed prior to our arrival. We did find a pulse, but the patient was breathing fast and shallow around 40 breaths per minute, hardly moving any air at all. His BP and HR were steady, but his SPO2 was horrible, around 86% on 15litres oxygen. We assisted ventilation's while starting lines and preparing the guy for transport. On scene GCS was 3.

In the back of the ambulance I literally had a ET tube in my hand when all of a sudden the guy started to improve. GCS increased slightly, and his resps slowed and deepened. The right side of his chest was caved in due to the compressions (assumably) and he was still moving little air on that side. I set up for intubation but held off while we started driving.

The guy made it fine, by the time we got to the ER the patient was a GCS of 13 with relatively stable vitals considering his condition. We were wheeling past all the other delayed units in the hall towards the trauma room when a triage nurse told me that the trauma room was unavailable. I plead my case, that my patient was post code and unstable with ECG changes and a possible right pneumothorax, but it was useless. We were sent to the hallway and waited over 45 minutes with our patient! The entire wait time the guy understandably complained that his chest was sore. He couldnt remember anything about the incident, except that he was going to the hotel restaurant for breakfast like he does everyday. The only follow up I could get later on in the day was when I glanced at his blood work and saw a potassium level of 6.5. The last time I peeked in the guys room he was eating toast and reading the newspaper.

Call 3 - Seizure. 48 year old female patient with cerebral palsy in a care home. Staff state she had been "twitching and shaking" for about 30 minutes prior to our arrival. Staff also stated that she was most definitely NOT have a seizure, that she was just shaking. Call me crazy but her appearance sure looked like one hell of a seizure to me. We started a line, gave Midazolam and the activity stopped. Total hospital wait time with this patient was 90 minutes.

Call 4 - Just before shift change we were toned out for a two vehicle MVA. The accident was at a very busy intersection and traffic was lined up for half a kilometer when we arrived on scene. Very low speeds were involved and injuries were minor if anything. We assessed two patients on scene and both refused transport. We cleared up and made it back to the hall just as the tones for shift change went off, perfect timing!

Only four calls but with hospital wait times the day flew by. On to nightshift tonight.....

It's the hottest day of the year, lets get wasted!

2011-08-22T06:01:00.000-07:00

Yesterday was one of the hottest days of the year so far in my city and luck had it I was working instead of lying on the beach. It was so hot that even training at the hall was limited to stuff we could do indoors. The city was slow in terms of fire calls, but EMS was business as usual.

Call 1 - Sent cold to an apartment building for a 40 year old female "unknown problem". We circled the building looking for the door with a buzzer when all of a sudden a disheveled looking woman half naked wrapped up in a starwars blanket burst out of the building screaming her head off.

My partner and I crossed our fingers, "please don't be our patient please don't be our patient".

She was. Turned out our patient had been on a three week cocaine bender and was experiencing chest pain. Ill tell you right now that our patient was darn lucky I was working that day, not because I'm the best medic in the city, but because I treat drug abusers and alcoholics with a level of respect they aren't used too.

Vitals were ok given her history. HR was up around 140, BP about 160/100. She was VERY irritable and jittery, totally unable to sit still and had to try twice to form a coherent sentence. We started a line and I gave her some IV Midazolam which seemed to calm her down and stop her CP. She was doing ok by the time we got to the ER. Just like I expected her nurse was some biased judgemental old crank who muttered "fu$king druggies" as I was giving her my report. Uggggh, I wont get into my stance on nurses who judge junkies in this post, I'll save that for another day.

Call 2 - Returned a 90 year old lady home after an overnight stay in the ER. I think she had fallen or something and was brought to the hospital earlier in the day by the night shift guys. No injuries, nothing remarkable anyways. She had severe dementia and just sat there on the stretcher staring into space.

Call 3 - Sent downtown for a "40 year old female, unconscious". Our patient was stumbling around outside the salvation army looking out of it so some teenagers called 911. We arrived to find our gal slumped up against a bus stop bench, looking very drunk and VERY sunburned. Like I said it was ridiculously hot yesterday and this woman had obviously been out in the sun unprotected for many hours. She admitted she was drunk, from out of town and was looking for the Detox center. My partner and I both chuckled a bit seeing how she was as far from the detox place as a person could possibly be. We checked her out, started a line and gave her a bit of fluid. Transport was unremarkable.

Call 4 - Sent to an alley behind a bingo hall (those of you in EMS are already rolling your eyes) for an unknown problem. Police were on scene with a woman in her fourties who had been drinking out in the sun all day with her buddies. She was absolutely hammered and stated that her boyfriend had kicked her in the chest "and bruised my lung, ouch ouch!" Her vitals were fine and we couldn't find any obvious injuries on her, she was insisting however that we take her to the hospital. Transport was unremarkable

That was it for the day. Im on nights tonight so we'll see how it goes!

Propane Propane......

2011-08-20T19:12:00.000-07:00

First day back after days off, today I was pulled off the ambulance and put as first line on the engine. Seeing how the hall was low on guys, I was also driving the tanker and the brush truck, as well as our rescue truck that goes on all "charlie/delta" EMS calls to back up the ambulance.

Call 1 - The engine responded to a local apartment building for "alarms ringing". Turns out some frat boys were moving a new couch into their place when they accidentally banged a smoke detector on the roof. The 'test alarm' button ended up being smashed in causing the alarms to ring throughout the whole complex. We shut off the power and repaired the detector. The guys were very apologetic and very worked up about the whole situation (drunk or high maybe, hard to tell) so we thought we'de joke around and told them that breaking a smoke detector is a criminal offence and that the police were on their way. They bought our story and we all had a good laugh before coming clean and clearing the scene.

Call 2 - While we were training at a nearby parking lot a EMS call came in at the city's local drug/alcohol detox center. The patient was lying outside in a pile of urine and vomit, cussing at us the second we pulled up. We assessed him and took his vitals but he didn't need to go to the ER. He got himself a nice comfy overnight stay at the local drunk tank instead.

Call 3 - Sent hot to the scene of a "propane explosion" along with another engine, a ladder truck, an ambulance and our platoon chiefs unit. We staged back, fully geared up and ready to go, just waiting for the call to move in. Turns out it was just a small barbq tank with minimal damage and no injuries. We cleared up without ever seeing the scene.

That's it, not too busy but a nice change of pace from doing ambulance calls all day. After work I met a buddy from another hall to play basketball in the sun for an hour and then we called it a day. Time to hit the sack and then do it all over again tomorrow........

A loss of freedom? Or a gain of unity?......

2011-08-19T05:53:00.000-07:00

December 1st 2010 was the day that Emergency Health care changed significantly in the province which I work. December 1st 2010 was the day management and deployment of EMS was changed from the health regions, municipalities and private service owners and given to the newly created provincial health care system.

The switch has understandably brought about a lot of change, some good and some bad. The transition has been smooth in some areas and abrasive in others. Is the provision of emergency medicine better under a provincial model? I don't know, I don't have the figures and stat's available to me and even if I did I probably couldn't understand them. What I do have is front line experience under both models of service and my formed opinion on them.

Under the old model of delivery, municipalities and private services were scored contracts to provide EMS to a set area, be it a city, town, county etc. The individual service created their own protocols with the assistance and approval of a local medical director and the employees practised according to their local directives. Some services would have more aggressive protocols while others would be more "tame" but all protocols would be within the practitioners scope of practise for the province and country. For example, when I first came to this province, the service I worked for had fairly proactive and aggressive protocols. I was given free range to practise how I best saw fit and had lots of flexibility with my drug selection and dosing. Just a few kilometeres down the road at the next town however, the adjacent service had fairly "tame" protocols, requiring their medics to consult medical control often. This freedom in creating medical protocols meant that certain practitioners gravitated towards certain services. If you were a "cowboy" medic wanting to have freedom on car, you applied to service "A". If you were a tame medic wanting lots of delegation and set guidelines, you applied to service "B".

With the switch to a provincial model the differences in practise from service to service within the province have been eliminated. Whether you work for the largest city in the province or the tiniest village, all services have the same equipment, same drugs, same doses, same protocols, same everything. Is this a bad thing? Not inherently no. I think its great that a "roaming medic" (common type of medic in this province whom makes a living roaming between several services as a casual employee) can now use the same pieces of equipment and same protocols wherever he may be.

The freedom of practise however, is gone. In my experiences with provincial services (which is considerable) the medical protocols and guidelines need to be catered to a wider array of employees. Some of these employees may be weak, un practised, under educated or just under utilized in small rural areas. Not wanting to risk malpractice suits and standards of care issues, the provincial system simply lowers the content of a protocol guideline and takes away the requirement of critical thinking. The bell curve for the body of practitioners is lowered, so to speak.

For example, prior to December 1 2010, a municipalities Pain Management protocol may be a page or so long. Within that page are numerous indications for pain management, drugs available on car, dosing guidelines and medical control contact numbers for special cases like pediatric patients, refractory pain, and patient with other associated conditions. The protocol is strict were it needs to be, but loose in certain areas to allow the practitioner to use their education and skill set to treat the patient accordingly.

After December 1 2010, the provinces pain management protocol supersedes all previous protocols and is fairly strict. The guideline lists exact indications for pain management, as well as drugs available to the paramedic. Dosing guidelines have been changed to exact doses to be given at exact intervals. In the past the dose of Fentanyl for a trauma patient varied according to several factors, paramedic experience, patient weight, type of injury, pain level, etc etc. Now that same trauma patient will get the exact specified dose (say 2.5mg of Morphine q10 minutes with VS done pre and post admin to a total of 20mg).

Do you see what I mean? There is no room for flexibility. No longer can the protocol be flexed to fit the patient appropriately. If my patient just had some Fentanyl and is still having pain before we load them onto a board and carry them 250 meters out of the ditch, sorry buddy but I need to wait another 7 minutes before I give you another dose.

Is this change in delivery a bad thing? I don't know, its too early to say I think. I do know that nowadays, guys are scared of screwing up. Now for the first time in my career I see guys flipping through protocol books to double check exact doses and to make sure their patients blood pressure is in the indicated range prior to giving a drug. Since the change I am noticing two things happen,

1. Practitioners are being very timid with their treatments. They are bringing their protocol books with them into every call and literally reading right from the book, for example "whats his spo2? 92%? hmmmm ok let me check the book"

Or

2. Practitioners are continuing to do things the way they've always done them, basically ignoring protocol and using their own knowledge and judgement and then cross referencing the protocol book while they write their patient care reports. Ive seen guys do some crazy (but totally patient appropriate) treatments on car and then copy the protocol word for word into the treatment section of their paperwork to avoid dealing with negative audits and any protocol compliance backlash.

Whats the answer? Whats the solution? I honestly don't know, but its an interesting time for EMS in my province right now. Everyday things change for the better and for the worse and its going to be very interesting to see the direction EMS takes in the near future......

What a day......

2011-08-14T06:19:00.000-07:00

Worked days yesterday, shift went like this.......

Call 1 - Sent to a small rural town for a 70 year old guy complaining of back pain. We were met outside a trailer by a 350lb retired farmer who was complaining of back and groin pain. He was kind of presenting as a renal colic patient with pain radiating into his left chest, however when we put him on the monitor he was in a bradycardia with non perfusing bigeminey, yikes! High flow oxygen and two large bore IV's were started en route. His pressure held up fine and by the time we got to emerg his ectopics had slowed down considerably. I peeked into his room hours later in my shift and he was sitting upright eating dinner and reading the paper, so I guess he wasn't in that bad of shape.

Call 2 - Went hot to a soccer field for a "11 year old obvious fracture". Sure enough we got on scene and found a kid lying in the middle of the field with his wrist bent at an ungodly angle. We gave him entonox while we splinted it and the gas seemed to be working great so I said screw it to the Morph/Gravol route. The kid did fine en route, no follow up.

Lunch - Got back to the hall just long enough to scarff down some eggs and toast and maybe a few hash browns before the tones went off again.....

Call 3 - Sent to a residence I was just at yesterday for a lift assist. A 400lb woman who I've dealt with before had fallen out of her chair and needed help up. She's called the ambulance probably ten times in the last week for this sort of problem so hopefully she can get into an assisted living facility soon because she's just not managing well alone.

Call 4 - Pick up at the hospital to return an elderly lady to her home at the city's newest and largest nursing home. Very unremarkable call, pick up, transport, drop off, paperwork.

Call 5 - Sent to an MVA on the highway, single vehicle non rollover. The one patient involved was standing by his mangled truck with a cigarette, insisting that he was fine and didn't need to be seen. His story was really weird and didn't make sense at all. Sounds like he took a bunch of Zopiclone and was speeding home trying to make it before the pills kicked in, then he told me that he was looking for a cigarette on the truck's floor and that's why he crashed, THEN the people tailing this guy tell me that he was swerving all over the place and that when they went to pass him he was straight up asleep at the wheel going over 120km/hr! Whatever the truth was this guy didn't feel like telling me but he did cooperate with our treatment and ended up being boarded and transported. No follow up.

Shift change - Back at the hall for the first time since lunch, sitting at the computer trying to get caught up on paperwork when ten minutes before shift change a call comes in. DAMN! Off we went.

Call 6 - Sent to a rural address way out in the middle of no where for a "hunting accident". Hmmmmm interesting way to end the shift I guess. Arrived to find a guy sitting in the front seat of his buddies truck with a towel wrapped around his bicep. Ill try to explain what happened but its kind of confusing. You know those tree stand thingy's that hunters use (I'm no hunter obviously), well our patient was climbing up to his tree stand when after two steps he fell, only about three feet or so and he landed on his feet but unfortunately his arm snagged on one of the pointy metal things that was hammered into the tree as a makeshift step ladder. The metal step tore a HUGE hole in his arm all the way from his shoulder to his elbow. When we peeled the towel off to have a look it was pretty nasty, bone visible, muscle hanging, and fat and blood vessels dangling like confetti. The guy was pretty damn lucky he didn't hit an artery!

Anyways he was doing OK but diaphoretic and in a ton of pain. I gave him a bit of a bolus and a whack load of morphine. Bleeding was minimal and he was actually doing fine by the time we got to ER. Funny moment as were driving and I'm in the back giving him morphine, he turns to me and says "do you think I'll need stitches?" I remember all the insides of his arm being on the outside and could only chuckle, "ya you'll prolly get some stitches......... after your surgery!"

We both laughed.

Long day, on to nights at 1800 tonite.....

Maybe one day, someday.....

2011-08-11T07:45:00.000-07:00

Pipe dreams, we all have em. Life fantasies we day dream about, usually while we're sitting at our desk or standing in line for coffee during our break. They are the 'shoulda, woulda, coulda's' of life, the possibilities past that we convince ourselves are still possible, that we will still someday achieve. As content as I am with my career, I cant help but think about what could've been, what things might've been like, where life may have taken me. I have lots of pipe dreams, both EMS related and non. Some of them are more feasible than others, but all of them serve the purpose of a quick little harmless escape from my reality, even if only for a few minutes.

My pipe dreams:

- Learning a second language and then moving to another country to practise EMS. This one would be difficult but not impossible. Rosetta stone, some practise, a work visa and I'm set.

- Going back to school, but not for a second career. I'd love to take night classes or online courses in subjects that interest me, even if they add nothing to my "official" education like a degree or diploma. This one is real easy what with the abundance of online learning opportunities available.

- Teaching English overseas. I have tons of buddies who started doing this after high school with the intention of having fun for a few years, not a single one of them has come back to Canada after they set out five or six years ago.

- Going back to school, full time, obtaining my Bachelors in Nursing, and then traveling the world as an RN. EMS is great, integrated Fire/EMS is great as well but they cant hold a candle to nursing in terms of world wide transferability. I know of a few girls I went to high school with who have worked as RN's in some of the worlds most exotic locations. The money is good and the life experience is even better.

- Saving up my vacation time for a couple years and then taking an extended leave. Nothing crazy, maybe a month a year for the next few years. Whats to stop me from banking the time, taking six weeks and renting a condo in Vegas? Or renting a condo in Cancun for half a year and commuting back to work every now and then when needed.

Some of those ideas are pretty silly, I realize that, but just because an idea is silly doesn't mean its not worth pursuing. My greatest fear in life is complacency, becoming an obedient little worker bee, going about his life doing what he thinks he should to fit in and conform. In EMS especially I think it is important to break the mold a bit and really seize life. Each day we see and do things that 95% of the population cant even comprehend. Working 9-5, 40 hours a week for 30-40 years, all the while raising kids and supporting a soccer mom wife......doesn't sound like fun, it sounds horrible actually. If that describes you and your life then all the power to you, I'm not knocking your style, I'm just saying its not for me.

There's lots out there to be seen, heard, felt, done and its all just waiting to be experienced. Our biggest obstacle is ourselves and the pre conceived notion that we shouldn't.

My year as a proby, Part 2

2011-08-09T07:38:00.000-07:00

Being a proby firefighter/paramedic at my new job has been....interesting to say the least. Prior to this job, I worked as a Paramedic in a rural service where medics were treated like they could do no wrong. I never had to cook, clean, or take orders, I simply did whatever I wanted and as long as I did good calls, the brass stayed out of my way. Prior to my rural job, I worked in a very busy urban service, splitting my time between on car shifts and night-shifts in the ER at the provinces trauma center. Again, my only responsibilities were too show up on time and do calls, that's it. Prior to coming to the fire/EMS world I was rarely called 'rookie', rarely made to clean the hall and hardly ever scrutinized for my work ethic.

Life in a integrated Fire/EMS service is a complete change from pure EMS, at least for me. I've learned a lot in my proby year, most through trial and error, which I touched on in my post "My year as a proby part 1". Today I thought I'd just expand on my previous post and maybe add a few pointers that skipped my mind last time.

- As a proby, especially in the first few months, guy want you to be seen and not heard. By not heard I don't mean you voice your opinion only occasionally, I mean you voice NO opinion at all.

Guys and gals at the hall who have put in there time do NOT want to hear what the proby thinks about a subject. If they do, they will ask. I'm a pretty quiet guy by nature so I never had any issues with this but there are a few guys I was hired with who were well known within a couple weeks of hitting the floor as being loudmouthed. Being well know early on for being a hard worker is ok......for being a loudmouth....not so much.

- I learned that little things like buying coffee and bringing donuts in may seem lame and cliched but go a long ways with the guys

This really really bugged me early on because I cant stand acting like a stereotypical wimpy proby. I hardly ever do things like this because I feel its way too cliched and everyone knows the proby is doing it just to suck up. I did buy donuts and coffee my first shift but never again since then. If they guys want donuts they can buy them themselves, that's my opinion.

-Call absolutely every guy you run into "sir". Continue to do so until they tell you to stop. Seems stupid but there was a guy senior to me who I knew was a couple years younger and I still called them "sir", luckily I only had to say it once before he laughed and told me to stop.

This was another tough one for me. Throughout my career I've prided myself on not giving others respect until they've proved to me that they deserve it. I dont consider the ability to hold a job at a fire servie for X amount of years is a big accomplishment. As you can imagine, that philosophy wouldn't go over well in the fire service. I knew ahead of time that guys would want to be called "sir" by the new guy so I swallowed my pride and did it. In the long run, that was a very small personal sacrifice to pay. I still call my officers "sir" and it doesn't feel weird anymore like it did for the first few weeks.

-Do the crappy jobs that everyone hates, like changing the garbage's and cleaning the toilets

I didn't have a problem doing this. Since day 1 I've made an effort to keep the bathrooms at my hall (specifically the toilets) sparkling clean at all times. Anyone who's been in a fire hall for more than five minutes knows that this is no easy feat. Cleaning the toilets (or shitters as they're commonly called) takes two minutes out of my day but is something that the guys notice.

- Don't skip on your workouts. If everyone is in the gym pumping iron I should be too. Even if I'm tired and busy and backed up with paperwork I cant be known as the lazy proby, we have a gym and we should use it.

I've always been in good physical shape so this was no big deal to me. Yes it sucks when I'm in the middle of a set of squats and a ambulance call comes in, but its part of the job. The guys notice when someone comes into the gym and just sits on the bosu ball yacking about their night out to the bar.

-A sense of humour is a must. Guys notice when someone cant take a joke and as soon as they know what pushes your buttons they will exploit it mercilessly!

The guys at the hall WILL play pranks on one another, this is a given. Some of them are crude and some of them are borderline inappropriate but they are all usually pretty funny. I'm lucky that I didn't get it too bad my proby year, but whenever I did I just laughed it off and played along. I learned that its a good thing to have the guys goof on you, its when they ignore you and your excluded from the funny stuff that there is a problem.

- Watch your behaviour at all times. Everyone is watching you both at work and at the pub after shift. In a lot of ways, your behaviour at the bar with the guy is watched even closer than when your on shift. You can still have fun (lots of it) but next time your doing something that you know the guys will find out about ask yourself "is this what I want the whole department to be talking about for the next week?"

This is one of the biggest points I've had to pay attention too. When your a firemen in a relatively small town like I am, you have to be on good behaviour at all times. Not that I was a hard partying jackass before, but prior to coming to the fire service I never really cared about how I acted off shift. If someone saw me pounding beers at the pub on my days off as a rural medic......who cares? I was just a Paramedic blowing off steam and having fun. If someone saw me in that same position as a fireman however, I would be seen as a 'drunk asshole fireman' and you can be assured that word would somehow get back to my officers, coworkers, admin staff, chief etc that I was acting inappropriately. I don't agree that my behaviour off shift should be scrutinized, but it is, so I behave my self.

Its been a good year all in all. I've had good calls, bad calls, clueless calls and everything in between. I've met some great people, some not so great and some straight up assholes. Is the fire service the greatest job ever? No, but what is? Its a good job and I love it so thats all that matters.

For the first time in my career I feel as if my employer and my co workers actually care about me and my longetivity. Its a pretty cool feeling to know that you are appreciated and supported in your job. Those of you in EMS will agree that a strong, supportive and protective employer is a bit of a rarity in our world.

Slow Saturdays......

2011-08-07T07:32:00.000-07:00

I just realized I haven't posted in a few days. Looks like my 30 day blog challenge is turning out to be a bit of a bust. I went from wanting to post everyday for a month straight, to just posting more often than usual. Oh well, better to post when I feel motivated.

Just got off a night shift, went as follows,

Staff level at my hall was low due to lots of guys being off sick and the max allowable number of guys off on vacation. Our captain actually had to go home sick just after shift change and we had to call another off duty guy in because all our platoon's lieutenants were out as acting captains at other halls. Craziness!

Call 1 - Sent on the Engine as part of a five man crew. Call came in "two vehicle MVC with injuries". Units that responded included the engine I was on, our heavy rescue truck, our platoon chief and an ambulance. We arrived on scene to find two pick up trucks with fairly extensive damage. Total of three patients involved, all of whom had minor injuries and refused transport to hospital. I was assigned as triage en route so my partners in the back ended up doing the traffic management. I did get to help out with the rescue truck and disable the batteries which was new for me. We hung around until the tow trucks were gone and then headed back to the hall to let our gear dry out from the brutal rain.

Call 2 - Dead of night, 0430 the call came in for a medical alarm. I hate doing calls around this hour because it seems that my brain is foggiest from 0300-0500. Arrived on scene to find our 300lb female patient lying on the floor with her 300lb lesbian partner trying to pick her up. I mention this not because I'm rude or homophobic, I've just never seen two 300lb lesbians before. Anyways our patient was fine, just had a fall but EMS had been to her place like five times in the last few days to pick her up after a fall so this time she wanted to go into the ER, probably a good idea.

That's it, slow night eh! Not too shabby for a Saturday night in the city. I wonder where all the bars calls went? I know the bar crowd was out because we could see the swarms of drunks moving about bar central from our station balcony. I guess it was too rainy for bar fights and overdoses....oh well, always time for more of those.....

Working in the heat......good times.....

2011-08-04T18:18:00.001-07:00

Today was my first day shift back after days off. Staffing levels were low again (like always in the summer) so I was on the ambulance, partnered with an EMT whom I work with fairly often. Our day went like this.....

Call 1 - Sent to a very upscale fancy dancy nursing home for "90 year old male patient with leg edema". Hmmm, not the most exciting way to start the day that's for sure. Sure enough the guy had huge edematous legs that were more swollen than usual. Uneventfull call.

Call 2 - Sent to a private residence for a 60 year old lady "unknown problem" which as lots of us know can mean anything from 'stubbed toe' to 'amputated leg'. On scene was a lady in her 60's who appeared to have had a syncopal episode and was now very dizzy with extreme nausea and vomiting. Some IV Gravol didn't help her much so I went with some Zofran which seemed to do the trick. Her vitals and ECG were all fine and she was feeling a lot better by the time we handed off to ER staff.

Call 3 - Sent to the same nursing home as in Call 1 for a elderly male patient with abdominal pain. Turned out that the patient had severe Alzheimer's disease and had been increasingly combative and aggressive for several days. I've blogged many times in the past about how much Alzheimer's scares me and I just don't like doing calls involving the disease. Loosing your memory and cognition to the point of not being able to recognize your own fifty year old son, like this patient couldn't, just seems beyond sad and scary to me. The old guy was cussing and fussing and didn't stop fidgeting the whole trip but we got him to the hospital uneventfully.

That's it, three calls. I know it doesn't sound like much but our first two calls had long off load delays in Emerg due to other EMS units coming in from out of town. Busy busy day at the hospital that's for sure.

Anyways, time to have dinner, back at it tomorrow.....

A new challenge come September.....

2011-08-02T05:43:00.000-07:00

A few weeks ago my Captain sent out an email looking to see if any Paramedics were interested in taking on a student this fall. I applied and wouldn't ya know it, I got it! My Paramedic student starts in early September and will be on car with me until early December, good times!!

It's been a few months since I had an EMT student and over a year since my last Paramedic. I really enjoy having Paramedic students for a variety of reasons. I wouldn't say that I'm "hard" on them, but I definitely do have a whole different set of expectations.

In my own personal opinion, for an EMT student to be successfull, they need to do the following,

- Show up on time, clean cut, fresh uniform, ready to go.

- Gain confidence and eventually show mastery of the Primary and Secondary assessments.

- Show me as many of their BLS treatments and skills as our calls permit.

- Bring a great attitude and be willing to learn and accept feedback.

And that's pretty much it. With enough time and positive reinforcement I believe 'most' students can be successfull at the BLS level which only requires (at least at the rookie level) one dimensional planes of thinking.

From a Paramedic student, I expect the following,

- All the above EMT expectations

- Extreme knowledge of the contents of their entire drug bag. We carry a lot of drugs as medics and I think people need to give medications the respect they deserve, if we are injecting something directly into a streanger's blood we better know it inside and out!

- Smooth, clear and concise interaction with medics, nurses, doctors, police officers etc etc. Medic students (usually) have worked the street a bit before, so preceptors shouldn't have to worry about their student stuttering his/her way through a hand-off report.

- Professionalism, this is a big one for me. The whole stereotype of EMS workers being chain smoking, coffee chugging, adrenalin junkies like in the movies (circa Nic Cage in 'Bringing out the Dead') is definitely true a lot of the time. I however firmly believe that when were on car, being paid (and being watched) we have to be professional. This means I wont put up with students cracking dumb jokes in front of patients, smoking where they can be seen, texting while on calls (yes this has happened) or showing up for work sloppy and disheveled.

- A little extra 'something'. The best example I can give of this is an experience I had with a preceptor in my old urban service I worked for. He was young, around my age, but had been a medic for several years. His big thing with medic students was messiness in the ambulance. Starting lines, doing ECG's, and drawing up drugs produces tons of garbage and he wouldn't allow his student to simply throw the trash wherever, EVERYTHING went directly into the garbage. I've since adopted his theory and to this day I can run a code and still have my unit be clean and tidy.

- And finally the most important, the ability to think in the abstract or three dimensionally. If a medic student is giving nitro for pulmonary edema, thinking about alveoli and pressures and SOB and dosing isn't enough. A medic needs to be thinking systemically at all times. What is this respiratory drug going to do to the patients LOC? Should I treat this overdose with Narcan or support respirations and transport? Does this patient need a saline lock or two large bore IV's? CPAP seems to be working now, but could I need to intubate soon? If so what drugs will I RSI with? The patient is an asthmatic, whats my ketamine dose? Etc Etc Etc. A good way to test this is by asking abstract questions while the student is treating the obvious. A student performing a chest decompression in a blunt trauma scene could be asked about intrathoracic pressures and narrowing pulse pressure, for example.

Anyways, like I said I'm not "hard" on medic students I just expect more. I know Im a good preceptor and I know that students like me. Like I've mentioned in this blog many many times, I've had some HORRIBLE experiences when I was a student and I've put up with a TON of crap from bad preceptors. My experiences were so bad that I mad a vow to myself to never treat my students poorly if I was ever in a position of leadership, which I guess I sort of am today......

Nights in the city....

2011-07-31T11:56:00.001-07:00

I was on the ambulance last night for my last shift before days off.

Call 1 - Sent to local bingo hall (those of you in EMS are already rolling your eyes) for two "unconscious males". Arrived to find a man and woman sleeping under a huge tree with twelve empty listerine bottles (no lie). The couple turned out to man and wife and they woke up easily enough. They freely admitted to being smashed on mouthwash and refused any assessment and treatment. The drug/alcohol detox center was literally right next door and our party animals decided to waltz over for a few hours sleep.

Call 2 - Sent to a nursing home for a "elderly female, fall". The home we were going to is actually located on the city college campus and is a sort of training facility for the college's nursing and care aide students. The lady had horrible dementia and wasn't talking much but it was pretty obvious she had a hip fracture. She was in a ton of pain and was pulling away harshly at my IV attempts. I eventually got a line and we gave a fair amount of Fentanyl for her pain.

Call 3 - Sent with the Police for a "suicidal female patient, knife still on scene". I know from previous experience that cops don't mess around when they hear "knife still on scene". The three officers burst into the patients tiny apartment with guns drawn which is something you don't see very often in this country. Anyways our patient was a 36 year old lady with a ton of emotional and psychological problems, she took an exacto knife to the back of her hand and had a HUGE gash that was bleeding badly. As my partner was dressing it I noticed that literally every square inch of her arms were covered in burn and cutting scars. I felt really bad for this woman, she was crying softly and was very polite and civil with us. I'm not the greatest with dealing with emotional female patients but I did my best. Our patient was going through so many issues in her life it was horrible to sit there and try to comfort her, sad stuff.

She confided in me that the hospital staff hated her and treated her badly and that doctors and nurses in the city don't give a hoot about her and her problem. She had a HUGE gash with sutures below her eye that she had inflicted with a steak knife three days earlier and she said the staff were horrible to her, giggling about her behind the curtains and being very rude and insensitive. I don't doubt she was embellishing a bit but at the same time it made me angry to hear her story of mal treatment.

She told me that she was worried about the nurses treating her badly when I dropped her off in ER, I informed her that I would be very serious with them when giving my report. Sure enough I got two sentences into my hand off report and the nurses cut me off rudely,

" ya ya ya, we know her, whats the problem her knife wasn't sharp enough?"

God its hard to bite my tongue at work sometime, thank god I have this blog to rant afterwords!

Newsflash Miss "I'm a nurse and my time is too valuable for this looser cutter woman", you ARE a educated professional who has a job to perform. You get paid very well to render your services which include providing care to patients. Ridiculing, insulting and judging people is NOT part of your job description so do me a favor, next time you have some snarky ass comment about a drunk/homeless/suicidal/depressed patient that I bring you, think about the hundreds of dollars you are being paid for your shift and then shut your conceited face and do your job. OK? Thanks......

Days off now, back at it in four!

Quick post before work.....

2011-07-29T14:51:00.000-07:00

Tonight and tomorrow have the potential to be very, VERY rough shifts. Its Friday and Saturday night, which is always interesting, its a long weekend which sometimes amp's up the bar scene and due to our staff levels I will be on the ambulance both nights. I'm downtown at my usual hall which is great because it feels like home but not so great on the weekends because it is right in the middle of the city's bar district. We are so close to all the bars that when I stand out by the barb-q flipping steaks I can see people lining up to three different nightclubs.

Not much to really report at the moment, but give that a few hours, something tells me that by 0801 tomorrow morning I'll have lots to talk about....

Bronto Operator......

2011-07-28T18:31:00.000-07:00

Another day shift today. Our staff levels worked out so that I was off the ambulance for the day. Usually when I'm not on the medic I will be put on the rescue truck that backs up the medic on "Charlie" or "Delta" calls, or I'll be riding in the back of the engine as one of two mask firefighters. Today was a little different however, as I was told I would be riding in the back of our aerial "bronto" unit for the morning and operating the unit for the afternoon.

Yikes!!

For anyone who doesn't know, the bronto unit is the biggest unit in our fleet and last I heard it cost just under a million buckss to purchase.

The morning was uneventfull, I was put in charge of lunch which I managed to screw up by buying WAY too much salad for the guys, thus inflating the cost of lunch to 7 bucks per guy. I've tried and I've tried but I still suck at making lunch, which is actually a pretty big deal for a proby at a fire hall.

In the mid afternoon we went down to a large vacant parking lot and ran some more training evolutions. Things like drafting, relay pumping, and deck gun operation. All the other guys seemed to think the training was no big deal but I was clueless and overwhelmed as usual. I've said it once and Ill say it again, put me on an ambulance with a complex EMS call and I'll do just fine. Put me on a fire truck and tell me to advance a 65mm line with a gated wye up a 35ft extension ladder into a high rise and I'll act very much like the proby that I am. Oh well, that's what training is for I guess and as much as I self degrade myself I AM actually improving my fire ground skill and knowledge.

Anyways, tonight is my split so tomorrow I head to nights, more to come....

Dayshift, CVA's, TIA's, DVT's and other abreviations.....

2011-07-27T18:02:00.000-07:00

Busy day-shift today, here the rundown.

Call 1 - Tones went off as I was elbow deep in the captains toilet with a scrubber and bleach. Sent cold to a elderly lady with "leg pain". She had a 1hr history of sudden onset pain and numbness/tingling, seemed like a possible blood clot. Transport was unremarkable, I never got a chance for a follow up or to glance at her blood work.

Call 2 - We took another elderly lady from the extendicare wing of the hospital to her new home at an assisted living facility. Talk about a small world, the lady was actually a patient of mine from waaaay back in January. I picked her up with critical heart failure and she spent the next SIX months in the hospital. She smiled when she saw my tattooed arms and immediately recognized me, who says tattoo's and EMS don't go together??

Call 3 - Sent for an elderly lady "hip pain". The 94 year old patient was laying on her side in her kitchen after a ground level fall with no LOC. She felt fine minus some hip pain. We were joking about her bratty great grand kids when her LOC suddenly dropped and she went flaccid on her left side, uh oh! We transported hot to the trauma room, CT showed what we all already knew, a massive stroke. When I left the doctor was talking to the family about writing up a Do-Not-Resuscitate order ASAP.

Post lunch was training time. The ambulance, engine, rescue truck and bronto unit from my hall all went down to the training grounds to run some evolutions. It was actually pretty fun, I got to catch some hydrants, hook into standpipes, and even run the pump and flow some water. How many probies at other departments can say they get semi-regular pump practise??

Call 4 - Late afternoon sent to the detox unit in town for a intoxicated guy "overdose". Showed up and the guy immediately went off on us swearing a mile a minute. Police showed up on scene and after the guy refused to have his blood pressure taken or sign any paper work he got a one way ride to the drunk tank, have a nice sleep man! Hopefully your hangover tomorrow smartens you up a bit!

At home now getting ready for some dinner and a cold beer, day shift again tomorrow......

Day 5 - Days off recap.....

2011-07-26T17:14:00.000-07:00

I was going to elaborate on my recent post summarizing what I learned in my rookie year with the FD, but that's not really a post I want to rush, so it'll have to come later.

I head back to work tomorrow for 2 days and 2 nights, I believe I'm down at my usual hall for the whole tour but that could change by the time I show up to work. That's the thing with summertime at the FD, guys are always booking off sick, taking vacation days, or taking last minute 'lieu' days to enjoy the season. Being the rookie on the crew I often get shipped out last minute to outlying halls to fill the gaps in the schedule. I don't mind really, those last minute hall changes keep things exciting and get me familiar with all the crews and all the captains.

I'd like to tell you that my days off were busy and productive but they were just the opposite. My first two days were spent hitting the gym and then lounging in the sun on my deck. Say what you want about the downfalls of shift work, but there is nothing I love more than laying on my deck with a beer at 5pm on a Tuesday, smiling like a jackass at my 9-5 Monday-Friday neighbours as they come home from the rat races with their brief cases. Good times!

Re-class is coming up soon, October to be precise. Re-class is the annual competency testing that the FD does in order to reinforce new skills and promote employees. Its a progressive way for firefighters to move up the ranks so to speak and gain official titles. Right now I am a proby, but if I pass my exams in October I'll move up to Firefighter 3rd class, next October I'll do my 2nd class, the October after that will be my 1st class. Once I'm first class my seniority level and the amount of retirements will dictate the length of time until I am qualified to undertake officer training.

Officer training?! What am I talking about? Maybe getting ahead of myself a bit here, all those fancy titles are still a loooooong ways away and I've got a lot on my plate for the time being.

Anyways, back at er tomorrow..........

Day 4, My year as a proby Part 1....

2011-07-25T16:47:00.000-07:00

As of a few weeks ago I have officially been at my new job as a firefighter/paramedic for one year. I know that doesn't sound like much but in the fast paced cut throat world of EMS a year at any job is actually a pretty decent accomplishment.

So what did I learn in my proby year?

Anything?

Nothing?

Well I've picked up a few things over the last 365 days that's for sure. In part 1 of my year review post I'm going to quickly go over what I've learned in point form, in part 2 I will elaborate on the points specifically.

So here we go, without further delay, what I've learned out on the road during my proby hear at the FD.....

- As a proby, especially in the first few months, guy want you to be seen and not heard. By not heard I don't mean you voice your opinion only occasionally, I mean you voice NO opinion at all.

- I learned that little things like buying coffee and bringing donuts in may seem lame and cliched but go a long ways with the guys.

- Call absolutely every guy you run into "sir". Continue to do so until they tell you to stop. Seems stupid but there was a guy senior to me who I knew was a couple years younger and I still called them "sir", luckily I only had to say it once before he laughed and told me to stop.

- Don't let someone senior to you be the first one to answer the phone. This dumbfounded me when I started and still pisses me off to this day. At the fire hall, if the phone rings, the proby is expected to drop his lunch and leap across the table to answer it even when another guy is standing right next to it.

- Do the crappy jobs that everyone hates, like changing the garbage's and cleaning the toilets.

- Don't skip on your workouts. If everyone is in the gym pumping iron I should be too. Even if I'm tired and busy and backed up with paperwork I cant be known as the lazy proby, we have a gym and we should use it.

- I learned that no one gives a crap about my prior EMS experience. Guys want to know how many fires I've been in and that's it. For the record, I've been in ZERO fires and couldn't care less about that number.

- Making an effort to attend social functions is important. I'm not talking about charity events and stuff like that, I'm talking about going for beers after work with the guys, yes sometimes I'm tired and yes sometimes I just don't feel like a beer (rarely) but guys notice when the proby is out with the guys or not, it matters.

- A sense of humour is a must. Guys notice when someone cant take a joke and as soon as they know what pushes your buttons they will exploit it mercilessly!

- Watch your behaviour at all times. Everyone is watching you both at work and at the pub after shift. In a lot of ways, your behaviour at the bar with the guy is watched even closer than when your on shift. You can still have fun (lots of it) but next time your doing something that you know the guys will find out about ask yourself "is this what I want the whole department to be talking about for the next week?"

- Everyone gets on the radar occasionally. Its impossible to be the perfect employee, eventually everyone will screw something up, sometimes big screw ups, sometimes small. When I messed up, I was on the bosses radar for a week or two, but then someone else screwed up and my mistakes were forgotten, so I did like my officers did...moved on.

- Most importantly, don't be "that" proby. Don't be the rookie that everyone else talks about behind his/her back. If your lazy/loudmouthed/disrespectfull/a bad drunk or whatever, the guys can and will label you and judging from a few of the guys I know, its hard to shake that label.

Day 3....

2011-07-24T10:57:00.000-07:00

Oh crap I forgot to blog yesterday! My month long blog challenge made it a whole two days!

Oh well, I'll pick up where I left off.

My most recent night shift was as follows:

Call 1, 1930 - Sent for a "male patient, post seizure", arrived on scene to find a postictal guy in his forties laying on the floor. His medical history was brutal and included a freak stroke at age 38 and brain damage from recent encephalitis. Despite his poor health he was actually a really well spirited funny guy. When we found him on the floor the first this he said was "I've never been so happy to see people so ugly!", we all laughed our asses off. IV, monitor, o2, transport.

Call 2, 0200 - Bar call! Pulled on scene outside a local nightclub (a cowboy club, the worst!) to find a HUGE brawl taking place. A few bouncers were doing their best to break things up but weren't having much luck. The police were no where to be seen so we decided to sit tight in the unit for a bit. A few minutes later the bars manager drug a beaten and bloody guy over to us. Allegedly the guy was sucker punched while completely minding his own business and now had a broken nose and two incredibly swollen eyes, call me crazy but I think just maybe his side of the story implied more innocence than he really deserved. The patient was pretty decent with us and the transport was unremarkable.

Call 3, 0400 - Sent to a local hotel for a "23 year old female patient, overdose". Arrived to find a very intoxicated girl lying on the floor of her room with a full barf bucket at her side. The patient was actually very nice and co-operative with us which was the exact opposite of her "sober" friend. I say "sober" in quotations because I don't know of many sober people who absolutely reek of beer and cigarettes. It was hard to keep a straight face when the "sober" friend was literally shrieking at the top of her lungs for her friend to "stay calm, STAY CALM!!!!". The patient claimed she was drugged at the bar, her vitals were normal and her exam unremarkable. We popped in a line and she got a litre or so of fluid as we waited in the ER for a bed. She slept like a baby for two hours until we finally got a room.

That's it, pretty easy for a Friday night in the city eh?

Day 2 of the blog-a-thon

2011-07-22T08:16:00.000-07:00

Just got home from a pretty decent night shift.

Played basketball with my partner to start the night off, our first call didn't even come in until just before midnight.

Call 1 - Sent to hospital to pickup a suicidal psych patient. The guy had been admitted to a nearby psychiatric hospital in a town about thirty minutes away. He was bipolar/schizo/depressed/suicidal and had attempted to kill himself a couple weeks ago by overdosing on his seroquil and clonazepam. He wasn't violent or agitated with us and the trip was unremarkable. After we dropped him off (around 0100) my partner and I took the ambulance and drove around back of the massive psych facility to the 'old' part of the hospital that has been around since world war 1. Rumor has it that crazy stuff like lobotomies and shock therapy used to be performed there but now the buildings are just used for storage. We went up to one of the closed brick buildings and peeked in through the dusty windows and holy crap was it ever creepy! My partner wimped out when I recommended exploring a bit further so back to our city we went.

Call 2 - Sent to a private residence around 0600 for 'palpitation'. The patient was a woman in her thirties with a history of SVT with recent ablation. She was asymptomatic when we arrived and her vitals and ECG were fine. She refused transport but just as we were filling out the paperwork she burst in to hysterical tears and claimed to be suicidal. Where the heck did that come from! She said she was going to hurt herself as soon as we left so of course we convinced her to come to the hospital. She was actually a really nice lady who was obviously a little messed up so hopefully she gets the help she needs.

That's it, two calls, not too bad for a 14 hour night shift, especially given that we were the designated transfer car for the city. Tonight I'm back downtown at my usuall station and I'm most likely going to be on the ambulance again so hopefully the night is either incredibly slow or incredibly (I don't like the in-betweens).

A new inspiration....

2011-07-21T06:12:00.000-07:00

I was recently reading a blog written by a young ultra-marathoner who challenged himself to blog every day for a year. It was interesting to see how his posts changed and fluctuated over the weeks and months and his feat (which he achieved) has inspired me in my writing.

I don't think I can do a year straight, I'm too lazy to make that happen, plus I think my life is just to boring to be worth writing about every single day for 365 days, I do however think I can make it a month.

Yes yes I know it is July 21st and that this is a weird place to start a month long blogging challenge, but I may as well start while the desire is here.

I worked days yesterday and the shift when a little like this,

Arrived at the hall to find our ambulance was right out of oxygen and our fuel at a half tank, UGH! I understand that the night crew was busy and tired but come on guys! My partner and I skipped our workouts to head downtown to restock and get our unit back in order.

Call 1 - Called to a local bank where an employee was having a severe vag bleed. She miscarried a few weeks back and had been bleeding and cramping everyday since. IV, O2, monitor and a quick trip to the ER.

Call 2 - Five car pile up on a major bridge in town. No major injuries. My partner assessed a full term 19year old mom to be who was sore from her seat belt but was refusing transport to hospital. My patient was a woman with neck pain who we boarded and loaded into the unit along with her 12 year old daughter and 10 month old baby boy. Poor mom had to lay on the board for almost two hours until we got her a bed in the ER.

Call 3 - Right before shift change, sent to a local group home for homeless people and drug addicts. A local alcoholic in his forties (VERY well know to police and EMS) was postictal after a brief witnessed seizure. Patient had been drinking whiskey all day and hadn't taken his epilepsy medication in a few days. The patient as well as the home staff refused transport to the ER. We explained the risk and possibility of him having another seizure but they were adamant. We left with the paperwork and to our surprise we DIDNT get called back ten minutes later for the same guy seizing.

We made it back to the hall just as the shift change tones were going off and just like that another day shift was in the books.

Night shift tonight and I'm not sure if I'm going to be on the engine or the ambulance, either way you'll hear about it, same time tomorrow.

Two nights to go......

2011-07-07T13:08:00.000-07:00

Man oh man it sure is hard to blog in the summer time! I have to admit that when it is sunny and hot on days off, sitting at the computer and typing is the last thing I want to do.

Thankfully, today is not that nice out so I have time to play a little catch up.

I just finished another tour at work and tonite I head back in for the first of two extra night-shifts I picked up. Picking up extra shifts always sounds like a great idea the week or two before but when it comes to actually working the shift it doesn't seem so great! I'm pretty tired from the previous four days but oh well, my wife is out of town working and the weather isn't that great so why not go in and work?

What's new lately?

I taught my first two day first aid class a couple weeks ago. A buddy from the FD hooked me up with a two day contract to teach first aid to a small group of workers waaaaaay out in the sticks at a sawmill. I was nervous as hell but once I actually got into the swing of things everything went pretty well. I'm still having a hard time making any actual money from my teaching, but its been a great experience so far and I'm sure things will become more lucrative eventually.

I had my road test for my class 3 license the other day (passed). All firemedics at the department are required to obtain their license within one year of employment. The class 3 enables me to drive all the engines as well as the tri-axle 'bronto' aerial units.

Oh ya I almost forgot, as of Tuesday this week I have officially been working at the FD for one whole year! I cant remember the last time I had a job in EMS for a whole year. Next post I think I'll do a year wrap up/review type blog, too much to talk about here.

My most recent tour was fairly grueling, lots of training during the days and long nights with lots of EMS calls. I worked my first code in over a year but unfortunately it didn't turn out well. It was actually the first code in my career where I ceased resuscitation efforts without transporting.

Anyways, time to grab a Redbull (shift workers life saver) from the fridge and head into work!

The drunk driving debate......

2011-06-23T16:06:00.000-07:00

My wife and I were talking last night and somehow the conversation was steered towards drinking and drunk driving. There's been a lot drunk driving deaths in the news lately, most recently a guy from the "Jackass" movies was killed while driving his car at speeds of close to 130mph while intoxicated.

Alcohol has been a part of society for a long long long time and it isnt going anywhere any time soon (not that I think it should), however the issue of drunk driving is one that I think needs to be addressed immediately and drastically.

In most places in North America the legal alcohol limit while driving is 0.08. That number doesn't sound like much and really its just a number, the actual physical state of a person with a .08 BAC is what really matters.

What is .08 to you? Two drinks? Three drinks with a heavy meal? One drink if you skipped dinner?

In my opinion there is too much discrepancy, too many variables, too many "what ifs" to place an EXACT numerical value to something as important as drinking and driving.

How many times have you yourself been out with friends and watched a member of the group have a few drinks and then drive off into the distance? Did you say anything? Your friend only had two or three beers, he/she was OK to drive right? Who knows!

I believe zero tolerance and extremely stiff penalties are the only answer.

If you have even a single drink, you are unable to legally drive.....that's it.

If you have a single drink and then decide to risk driving, you may make it home fine without running into any police officers, but then again you may not. If you get stopped and blow anything more than a 0.0, bye bye license, hello big fat fine.

My reasoning is this, people are ALWAYS going to push the boundaries of the rules. You give them an inch and they'll take a mile, its human nature. There is no wiggle room with a zero tolerance policy however. I honestly think a 0.0 alcohol rule would drastically reduce the number of drunk drivers and injuries/deaths due to drunk driving.

That's just my opinion however, whats yours?

EMS practitioner or not, we all have our own stances on drunk driving and we all have been or WILL be affected by it at some point in some capacity. For the record I am not a preachy anti-alcohol prophet, I actually enjoy alcohol as much (even sometimes more than) the next person, I do however see the results of drunk driving on a daily basis, I've seen teenagers dead and hardly recognizable in mangled vehicles, I've been there when a drunk driver kills an innocent bystander and he was too intoxicated to even realize he'd just taken a life, hell I've even seen a young kid of 21 years crying incoherently as the doctor explained to him that he would never use his arms or legs ever again, all due to alcohol and the false belief that "one or two drinks don't matter".

Something needs to be done, asap.

Just my two cents.

Apologies, negative rant ahead, when will people learn?

2011-06-13T19:37:00.000-07:00

I hate to do it again, but I just cant bite my tongue any longer.

I don't enjoy turning my blog into a raving ranting soap box, but every now and then I have an experience at work that just pushes me past the metaphorical line in the sand.

At around 0230 on my last night shift, my partner and I were sent to a local nightclub for a
"27 year old female patient, possible overdose".

Now anyone who's been involved in EMS for longer than 15 minutes knows what that dispatch info can possibly mean, anything from a drunk girl who had one sourpuss shot too many, to a party gal who has been drugged and sexually assaulted, driving to the call I had my pre-conceived notions but I kept them to myself like I always do.

We arrived to find a young girl slumped over against the wall outside the bar. The police were on scene as were hundreds of party animals in various stages of alcohol induced debauchery. I walked up to the girl and asked her what was going on, she promptly puked all over her self and then told me she thought she had been drugged.

A quick primary assessment revealed a drunk girl with an slightly altered LOC and no obvious signs of trauma or injury. The girl was literally covered in emesis and her clothes were all askew providing myself and anyone within a quarter mile a view of way too much skin. I asked my partner (first time working with this particular guy) to grab the stretcher and he said something that literally made the hairs on the back of my neck stand up with anger.

"Hey, HEY!! Can you walk? Stand up and walk to our ambulance"

Where do I start?

I have lots of things that drive me nuts in this business, but making patients walk to the ambulance when they are unable to safely do so is right up near the top of my list.

How hard is it to just grab the stretcher? Its right there, it takes ten seconds, and that's what its designed for so why not use it?

I had a brief little "professional discussion" with my partner about the issue, with him ultimately "pulling rank" and forcing my patient to stand up and stumble to the ambulance.

What happened next? You guessed it, the patient fell to her knees several times, vomited again, and then fell stepping into the ambulance causing herself to become sufficiently wedged between the stretcher mount and the adjacent wall. As I crouched there with my partner, straining and stretching trying to free this drunk pukey woman from her confines, I couldn't help but fume as drunk after drunk after drunk walked by our unit and stared/laughed/heckled.

It was wrong. We looked like idiots and our patients dignity was compromised.

Please please please, use your stretchers.

If a patient meets you at their door with a lacerated hand....ok they can probably walk to the unit, but with my aforementioned case, walking the patient is unprofessional, rude and incompetent.

Yes yes I've heard the excuses before,

"I'm not using my back and lifting a patient unless I absolutely have to".

How about this, if your THAT concerned about your back, get in the gym, drop some weight, do some core exercises, improve your health and conditioning to the point that your obvious physical limitations DONT affect patient care. If your too old/fat/stubborn to do something proactive, how about you go find a nice relaxing 9-5 job that's not going to stress your back too much.

Go ahead, have a seat at your desk and grab a coffee, all the other healthy medics and I are going to go get the stretcher for our patient.....

A small victory....

2011-06-01T19:38:00.001-07:00

A few shifts ago I had a bit of a disagreement with a nurse in the ER, by 'disagreement' I actually mean 'huge conflict that irritated me to the extreme'. Here is the short version.....

I brought in a middle aged guy complaining of weakness with stable vitals and what appeared to be a new onset LBBB on the ECG, the nurse thought it was V-Tach, fingers were pointed (at me), accusations were made (towards me) and competence (mine) was brought into attention.

Anyways, the whole things resulted in myself being written up in a formal complaint by the nurse and the rumour that I cant read ECG's being spread through the ER like wild fire. I kept my mouth shut, made a report of my own and waited to see what would happen.

Today at work I had a nurse come up to me and apologize personally for the rude and inappropriate behaviour of her coworker. The original ECG was reviewed by a panel of doctors including a local cardiologist and the determination was made that MY original ECG interpretation was correct, NOT that of the ticked off nurse.

I don't mind being questioned, not at all, I actually enjoy it and take it as a challenge and a way of constantly being kept on my toes. However, after an episode like this where I was viciously attacked by a fellow health care worker, I cant help but sit back and smile at the resolved conflict. The nurse that filed the complaint was very very rude and immature towards me and I could have stooped to her level but did I? No, not at all, I kept my mouth shut, put everything down on paper, and put my faith in the higher ups that would be reviewing the incident.

Nice guys don't always finish last....

and they're also really good at ECG's.

No end in sight.....oh wait nevermind I see it!

2011-05-19T08:23:00.000-07:00

Sitting at the computer, sipping a coffee, unwinding after yet another shift.

My night shift coming up tonight will be the last in my stretch of seven straight shifts. I don't want to sound like a whiner, but I am really really feeling the last few days beginning to weigh on me, all the days and especially all the calls are starting to blend into one big EMS blur. Ill do my best to summarize the last few days....

- My student continues to progress well. Tonight will actually be her last shift with me before she is signed off and goes to write the provincial college's examinations. Her three weeks with me have been surprisingly pleasant and productive, I really enjoyed helping her learn and develop and I think I proved to her that not all EMS workers are burnt out chain smoking coffee addicts.

- I did a ton of fire training my last few shifts. The days sure to whiz by when one minute I'm on an ambulance call starting an IV, the next I'm in my fire gear doing training searches in a smoked out house and then next thing you know I'm out on the river with a Lieutenant learning how to operate the water rescue boat. I even got to drive one of the departments aerial units for some training (the truck has a price tag just under a million bucks BTW).

- For the first time ever I was put in 100% control of making lunch for the crew. Up until recently I've only ever helped out, typically the most responsibility I am given is "iced tea maker", the other day however during my workout the Captain told me I would be the chef for the day. I managed to whip up some pretty tasty soft tacos and kept the price at five bucks a pop, not too shabby!

- My first aid instructor certificate arrived in the mail recently! I've already arranged through a coworker of mine to teach a two day course in the next couple weeks to a large group of oil and gas workers at a plant outside of town. Hopefully this first class will evolve into a semi-regular thing that I can do on my days off.

- I was accepted onto the departments "Fire Fit" team that competes in fire combat challenges. My training has been a little slow to start but I'll pick it up soon seeing how the first event is coming up in mid June.

I would write more but I'm too tired and honestly I cant remember much else about the last few days.

My 200km running relay with the guys from work takes place in just a couple weeks, hopefully I wont be too exhausted to snap a few pics!

May is here (and spring possibly??)

2011-05-05T06:30:00.000-07:00

Ahhhhh days off! Is their any greater feeling than walking out of a busy fire hall after a busy night shift knowing you have the next four days all to yourself?

My most recent tour wasn't actually that busy or exciting, but I always look forward to days off regardless of how my tour went.

When I checked in for 1st day shift on Saturday I was greeted by my EMT student who was starting her four week practicum with me. I've blogged in the past about how much I enjoy being a preceptor and so far this student has been a lot of fun. On her first shift ever she got to start two IV's, give a hip fracture Entonox and even give an unconscious diabetic IV dextrose. Not too bad for day one!

Nights were a little bit slower. A few drunk calls, a few medicals, one fairly serious overdose, she took all the calls in stride and did a excellent job given her previous experience. As we sat in the hall's kitchen around 0300 going over ECG interpretation after a call, I couldn't help but notice how much I missed having a student (its been almost a year).

Also during my last tour I was sent down to the training grounds with a group of guys on my platoon to practise self rescue techniques, meaning ladder bailouts, hose slides and the NANCE drill. Personally I find hose slides to be the most fun to do in training. For those who don't know, hose slides are a method of rescue when a FF is needing IMMEDIATE extrication from a burning building to avoid flashover or other dangers. The technique involves throwing your charged hose line out of a window, lowering it until all the slack is out, and then exiting the window and sliding down the hose like a fire pole. If the hose reaches the ground then great, if it doesn't we practised standing on the nozzle and dangling in mid-air until a ladder or an aerial unit could be deployed, fun stuff!! The attached pic is of my buddy Jon doing a hose bailout back when we got hired nearly 10 months ago, go Jon!

In non EMS related news, I've been forced to drop out of my two marathons that were scheduled for the end of May. My shins have just been killing me and I've been unable to run for longer than five minutes without considerable pain. I guess I'll have to rehab a bit and put my focus into the FD 125km relay that I am a part of, that is coming up fast as well, June 4th.

Anyways, days off mean coffee in the morning, errands during the day, and relaxation at night time, so time for me to get at er!!

Carefull what you wish for......

2011-04-27T14:36:00.000-07:00

Holy smokes! Just when I was starting to think that my streak of non critical calls was never going to end, BAM! I get hit with a series of several complex medical patients.

When it comes to EMS calls, they can basically be divided into either trauma or medical, yes yes I realize that this is a very crude division that leaves out a lot of variables, but for the most part every patient can fit somewhat into column A or column B.

I find trauma calls fairly straight forward and I think most Paramedics would agree with me. With trauma, you can "see" alot of what your dealing with. Broken bones, blood, evisceration's, angulation, deformity, bruising, swelling, amputations etc etc are all pretty hard to miss. Also, a lot of the treatments for trauma injuries are fairly simple when you think about it, bone sticking out? cover it up, gash in skin is bleeding? stop the bleeding, legs severely burned? cover up and treat the pain, absent air entry on one side with hx of blunt trauma and unstable SOB? needle decompress. Another plus of trauma treatments is that your interventions have almost immediate feedback as to their efficiency. A bleed with either stop or soak through the dressing, a splint will either stabilize a fracture properly or it wont, a realignment will either bring a pulse back or it wont, and a decompression will either help a pneumothorax or it wont.

Medical calls are a whole different ball game. A complex medical patient requires complex assessment and strategically selected interventions. This is NOT to say that all trauma patients are straight forward cases, but in my experience at least, a complex medical is much more challenging.

For example, last tour I had two challenging calls.

Call 1 - Called to a private residence for a 50 year old male "acting inappropriately". Arrived to find out that our patient was a quadriplegic who suffered a spinal injury as a result of a MVA around 30 years ago. The pt's wife stated that her husband is normally alert and outspoken and usually jokes around with the medics whenever they come for various bedsores, UTI's etc.

Upon examination, the patient was semi conscious with a GCS of 12, following basic head nod's only occasionally and rambling incoherently. ABC's were stable and the physical exam was largely unremarkable minus the anticipated pressure sores. The wife stated that her husband had been started on Gabapentin several days ago for abnormal sensations below his paralysis line, as well as Cipro for another severe urinary infection. The patients altered LOC began two days after he began his new medications.

VS were as follows,

HR: 122
BP:140/90
SPO2:93% Room Air
RR:18
GCS:12
BGL:5.0
Temp: 38.6 Celsius

What are your initial thoughts? Possible sepsis from an under treated UTI? Reaction to the Gabapentin? Like I stated earlier, this complex medical patient wasn't as easy to assess or treat as say a basic roll over MVA patient. What was going on with his immune system? Has he ever had Gabapentin before? Has he had a fever for a while? Has he had any blood work done lately?

Call 2 - Sent hot to a 77 year old female patient at a care home, "acting inappropriately" Hey whaddya know dejavu!

Arrived to find our patient supine on her bed, with her head hanging back over her pillow and her mouth wide open with her tongue hanging out. Staff stated that the patient was acting funny last night but was still able to walk with her walker, in the morning however she was unable to get out of bed and after a 40 minutes "eyes rolled back in head" episode, she had been unable to move or speak.

VS as below:

HR:133
BP:110/96
SPO2:96% Room Air
RR:38 (mouth breathing)
GCS: 12
BGL: 9.0
Temp: 39.8 Celsius

Hmmmm, time last seen normal was 1.5hrs prior to our arrival, so immediately we are running with a possible CVA diagnosis. Did she have all the classic stroke sign's? of course not, but she DID have an altered LOC with deficits (although they were bilateral) in the last 3 hours. Are her vitals indicative of sepsis? possibly, but which course of action is more appropriate, treating as a stoke with a secondary dx of sepsis, or vice versa? Or was it a bleed?, I forgot to mention that her pupils were unequal and sluggish.

I don't have follow ups on either of these patients and again, I'm not saying "trauma's are easy and medicals are hard". As practitioners it's up to each of us to ensure that all patients get the proper diligence and care that they need, whether they have broken bones or heart failure.

Like a movie fight scene.....with high heels!

2011-04-13T15:27:00.000-07:00

Around 0100 on my last night shift we were toned out for a "21 year female patent, assault".

I was driving my partner and I and the engine with four more guys was only a few blocks behind me. We pulled around a corner and slowly approached a fairly major intersection in town.

"Think this is it?" my partner laughed.

A stretch hummer limo was pulled over to the side of the road and a couple of college dudes were leaning against it smoking cigarettes and drinking beer. Around a dozen girls, all in their twenties, all drunk, all screaming and all in various stages of undress were in the middle of a HUGE street brawl.

I'm not talking about some stereotypical hair pulling and "bitch!" accusing, these girls were punching and kicking like trained MMA fighters! My partner and I were questioning even getting out of the ambulance for safety reasons when all of a sudden three police cruisers pulled on scene. Within seconds the cops were pulling apart intoxicated party girls and lining them up against the limo for questioning. One girl had her shirt off, wearing only a bra and was covered head to toe in black mud after wresting with someone in the ditch, another arguing with the cops was wearing only one of her knee high boots, there was even a girl sitting on the hood of one of the police cruisers drinking a beer and spitting gobs of coagulated blood out of her mouth.

"Hey ambulance man! She's over here, come on come on follow meeeeee!" a very intoxicated girl screamed while banging on our units window. I started to follow her with the kits and quickly realized that our navigator wasn't wearing any pants, just a tube top, thong, a purse with a broken strap and a whole lot of disheveled hair. When she turned over to yell at us again I could clearly see blood and scratches all over her face.

The bottomless brawler led us to a small group of people who were crowded around a young girl on the ground. My 6'6 260lb partner had no trouble clearing the gawkers before we squatted down to see the patient.

The girl was drunk, very drunk, and was only muttering softly and spitting blood after every sentence. Her nose bent off to a direction that noses don't usually bend and both her eyes were beginning to swell.

My partner and I were both on our knees helping the girl when one of her friends came up and began giving us the story in a very loud and high pitched manner. Halfway through her story she crouched down between my partner and I. We both glanced at her passingly and then had to quickly do a double take. The patient's friend was like all the other girls, bloody, drunk, emotional and of course half naked.

While trying to be as professional as possible in such a weird situation AND properly treat an injured patient, the friend continued her story. Turns out that all the girls were from the same college class and had rented the limo to help them celebrate their recent graduation. After many drinks however, some friends of friends on the limo turned the mood sour over one girl forgetting her ID while they were on their way to the club. Obscenities were shouted, drinks were thrown, faces were punched, and mayhem ensued.

We got our patient into the ambulance amidst many heckles and cat calls from the women, some nice, some not so nice,

"Ohhhh, big tough ambulance man saving the day, F$ck You!!!"

"Hey Mr Ambulance driver, have you seen my pants?!!"

"Hey can you check my blood pressure, no not YOU, your partner!"

As I pulled out of the scene towards the hospital I had to admit, never before had I been so happy to escape a swarm of half naked intoxicated college girls!

A therapeutic rant................

2011-04-09T08:42:00.000-07:00

I'm warning you right now that this post is going to be angry, REAL angry. If you don't want to read a hate filled rant based on some recent events then please avert your eyes.

My wife has been working as a Paramedic at a nearby rural service for about two months now. She took the job as a way to escape the grueling schedule of northern camp work and also to get back in an ambulance and help people.

Recently, she had a shift with another medic who has the reputation of being "tough to work with", "a pain in the ass", and "difficult". Being the open minded professional that she is, my wife approached the shift just like any other, not willing to make up her mind about someone without actually meeting them.

Fast forward 24 hours and she is at home, nearly in tears over her shift with the eccentric partner we'll call "Ham".

As it turns out, "Ham" isnt just difficult to work with, he is a straight up sexist and misogynistic old man. My wife reported that while having coffee before unit checks, "Ham" openly talked aloud to the other staff about how women have no place in EMS and that he hates working with them. Shocked and stunned, the other staff (my wife and two other women) stared on in dissbelief that someone could be so verbal about their prejudices.

While driving to a call in the middle of the night, my wife slowed down slightly to read the street signs and find the right address, she was quickly screamed at by Ham "hurry up! what are you doing? get there!! cant you drive??!!".

On another call, my wife asked Ham for a small pad to place under a patients hand as she started an IV. "We don't do that here!!" big shot Ham hissed at her, "your not in Saskatchewan anymore, your in ALBERTA now!!"

Basically, anything my wife (who is a complete equal to Ham in terms of qualifications and position) did while on shift was thoroughly critiqued and micro-managed, often with brutal insults that surpassed good natured ribbing and entered the realm of verbal assault.

Excuse the language, but shit like this drives me NUTS!!

My wife and I have dealt like loosers like Ham all throughout our careers in EMS. Ive always wondered what drives people to be just so downright mean to their coworkers but now I think I finally get it.......fear.

Practitioners like Ham are weak and incompetent in every sense of the word. They are old, tired, burned out and should have retired or switched careers years ago.

Ham may have been a somebody when he first started on car, that's fine, great, good for him. But he must soon realize that this isn't the 60's or 70's when he first started in EMS. Welcome to 2011 grandpa, the new age of EMS is here, the age of thorough education, gender equality, continuing competence and of course genuine compassion for the job. The day of the burned out, pissed off, sexist, grumpy, coffee and cigarette old school geezer practitioner has passed, deal with it.

Fear, it drives these Paramedics to behave the way they do. Think about it, they are towards the ends of their careers and all of a sudden they are working with fresh faced youngsters who have the zeal for the job that they lost a looooong time ago. These new kids coming onto the streets have a significant amount of training behind them, sometimes as much as a four year EMS degree, they are healthy, fit, energetic and not yet ravaged by the strains of the job. The old medics feel intimidated, jealous and dare I say it, scared, so they react the way they see most fit, buy being complete and utter pricks.

Day by day, more and more of these bitter dinosaurs retire and I say good riddance. Will I be in their shoes one day? Possibly, but that's not for 20-30 years and I would hope by then that I will have learned enough from all the disastrous examples I've seen to actually embrace the young and energetic.

Is this post biased? Probably, I am a pissed off husband, but at the same time I'm a Paramedic husband of another Paramedic. Together, my wife and I have seen and done a LOT of things in the EMS world. We've worked with many people, treated thousands of patients and have seen things that other medics can only gossip about. I'm lucky to work in a department that embraces my various experiences and treats me with respect. My wife on the other hand is stuck dealing with yet another burned out grandpa with a chip on his shoulder.

This is a major problem in our industry. Why why WHY does EMS eat its young?

To clarify, I dont mean to group all senior and veteran practitioners into the same group. I've worked with TONS of great veterans who have been great and have years of knowledge and experience to pass along. The good ones are out there, most definitley, but unfortunatley guys like Ham draw attention away from the positives in this business.

Thats my rant, time to hit the sack, back to work tonite.

Time for a change.....

2011-04-05T06:46:00.000-07:00

Apologies for the delay in posts recently, I've been out of the province with my wife for almost a week and just got back to town yesterday.

I worked day shift on Wednesday last week which was officially my last shift at my old station. As of tomorrow, I move downtown to the city's "Hall 1" which is the biggest and busiest hall in the department. I'm actually pretty nervous about the move seeing how I am going from the slowest hall in the city to the busiest. To put things into perspective, my old hall had four members on shift, a Captain, two first class guys, and a proby (me), at my new hall however, there are up to eleven staff on per shift, one Captain, four Lieutenants, two qualified officers and four or five firemedics. Oh and also adding to the anxiety, my new station has two fire poles from the living quarters into the apparatus floor whereas my old station had none, guess I better sneak in a few practise runs my first day!

I just got word from my new Captain that I will be receiving a EMT student at the end of the month. This was welcome news seeing how I haven't had a student in almost a year. As I've said before I really really enjoy being a preceptor and doing my best to give my students the most productive experience possible. I also like how students keep me on my toes with their constant bombardments of questions, its pretty hard to become idle and complacent when you are being asked things you haven't even thought about since medic school.

I want to finish with a bit of a hot topic issue that occurred in British Columbia a couple weeks ago. A news station in BC recently reported on a story involving a Paramedic who allegedly assaulted a patient. While at a downtown mall for a different story, the camera crew accidentally stumbled across a Paramedic sitting with a intoxicated patient who was in a wheel chair. With the camera's rolling, an altercation between the two men started. The Paramedic is seen grabbing the mans jacket while the patient attempts to kick him away with his feet. The struggle ends with the Paramedic using his size and momentum to firmly fling the other man to the pavement. Once on the ground the medic kneeled on the patients back and detained him until the footage ended.

Hmmmm, it was a very peculiar piece of video footage to say the least. I wish I had the link but everywhere the video used to be has since pulled the footage. I don't doubt for a second that the video was cropped/cut/edited to create the scene of a violent power driven Paramedic abusing his authority, however there is a big point here that cant be avoided or canceled by saying "they altered the footage!".

The scene took place on a street corner, not a small confined space like the back of an ambulance. There was nothing but wide open spaces in all directions. Now in my personal opinion, whatever that patient said, did, or intended to do may have warranted some sort of response from the attending Medic, but physical response must always be a last resort. If the medic would have just taken two steps back from his very drunk patient he would have been out of range of any assault attempts of bodily fluid projectiles.

Did the patient spit on him? If so what is more appropriate, throwing the patient to the ground or stepping back ten feet and calling for back up?

Did the patient say something offensive to him? If so did he have the authority or the right to toss a drunk guy onto the ground?

Did the patient physically assault him? If so does it seem justified to get in even closer to the patient and then throw him down and detain him? Wouldn't it make more sense to take the non violent route and just walk away?

My point is this, when we as medics are in the back on a small confined moving ambulance, we are vulnerable. If we are spat at, threatened or assaulted, physical response is often the only choice we have due to our location. When we are out in the open and our patient is a person so drunk they must be placed in a wheelchair, are the same responses justified?

I've had patients assault me in the back of a unit, they quickly found out that when they have me caged up and corned in an ambulance I will do whatever I need to do to protect myself because 'walking away' simply isn't an option. I've also had patients assault me in houses, at parties, in bars, in police cells etc etc and never once did I respond with physical force, why not? simple, because there was another option, walk away.

As EMS workers we need to remember that we don't really have any authority over our patients. Throwing people around and kneeling on them and holding their hands behind their backs is to me a last ditch resort to avoid further injury if all other means have failed.

Just my two cents, I'm sure the Paramedic involved (and his co workers) would disagree.

Funny? Gross? Sad? Or all three.........

2011-03-25T08:22:00.000-07:00

The ER was beyond busy the other day so myself and about twenty other medics were lined up in the hallways outside triage waiting for a bed. After about an hour or so a crew from another station in the city came barging into the hallway with a bariatric patient complaining of shortness of breath.

How heavy you ask?

Try a hair under six hundred pounds, my back hurt just typing that sentence.

The crew didn't have our bariatric stretcher for whatever reason, so the patient was teetering on top of one of our normal stretchers which I'm pretty sure is only rated to 550lbs.

Triage came out and within minutes we had a 'lift team' respond to help us move the lady from our cot onto a bariatric hospital bed. The patient was already on her lifting sling that was underneath her at her care home, so everything seemed pretty straightforward......seemed.

As the team started lifting the patient with her sling and the hospitals lift machine, the patient began to slide down on her sling, just a little at first, but more and more the higher she went. When the lift was finally in the top position, the patient was just off our cot while her massive lower body girth hovered a couple inches above the floor.

Because she had slid down in the sling, she was sort of folded in half at the chest, which made her breathing slightly laboured and caused her to have an anxiety attack of sorts,

"Hurry, HURRY, I'm gonna fall, I wanna see a doctor, HURRY!!!!" she began screaming.

We moved as fast as we could but she was just too heavy and hanging in just too awkward of a spot. To help you visualize, the patients knees were up near her chest in the sling while what we all thought was her abdomen hung down grazing the floor, nearly three feet below.

Turns out it wasn't just her abdomen that was hanging down.

" Hurry, I don't feel good, Hurry!!" she screamed a final time.

She grunted loudly and we all heard a audible 'plop' and 'slap'.

It took a few seconds before someone looked down and we all realized what had happened.

The bariatric lady just pooped herself and because her butt was hanging out of the sling, she pooped directly onto the floor.

We did eventually get her over to the hospital bed without further incident, but I must say it was very difficult to move a 600 pound woman all the while holding in laughter and trying not to step in poop.

Busy spring.....

2011-03-20T15:43:00.000-07:00

Well thanks to some physio, some rest, and a whole lot of stretching my back is healed up and I've been back at work for the last week or so. I was a little hesitant of lifting my first shift back at work but it was no big deal, I found out that engaging your core when lifting the stretcher really does go a long ways.

I've been on days off for the last four days and I've been trying to make good use of the time. Today and yesterday I was busy in a instructors program down at the local Red Cross branch. After being involved in CPR instructing for the last year or so, I thought it would be new and exciting to expand to First Aid instructing as well.

Having completed the two day theory course, I now have to arrange a 'co teach' class, meaning that I will need to instruct a standard first aid course under the guidance of a experienced instructor. I had to do something similar to this when I got my CPR instructors credential and I found it very VERY nerve wracking to teach something your brand new at while being watched and critiqued. Oh well, just another one of those hurdles to jump I guess.

Springtime has arrived here in Alberta and with the new season comes a big list of things I have to do or would like to do, including the following:

- quick weekend trip with the wife to lounge on the beach in Miami Florida
- Two day hiking trip with the guys from work near Banff Alberta
- Get going with some First Aid Instructor experience
- Look into a Wilderness First Aid course that I've been researching a bit
- Two marathons that I am signed up for, they are on back to back weekends to boot
- A fire department running relay from Banff Alberta to Jasper Alberta in June
- A annual half marathon I do every August in Invermere British Columbia

So ya, busy little while coming up. Of course in addition to all the extra stuff I'm trying on the side, there is always the never ending supply of calls and patients that my job at the FD provides!

A reminition.......

2011-03-13T12:34:00.000-07:00

I've been around for a bit now, not too long, but a bit and in my career thus far I've seen a lot of things and met a lot of people. I started my career working for a massive provincial ambulance service, dabbled a bit in a privately owned municipal service and recently made the move to an integrated municipal Fire/EMS service. I've been a Paramedic in a lot of places for a lot of employers, but have I learned anything? Well yes (and no), each type of service has provided me with a unique and interesting view on EMS and life in general.

When I worked for a big provincial service, I was fresh out of EMT school and was blown away by something as basic as taking someones blood pressure. I remember being so proud of my new job I wouldn't even take my uniform off to sleep on night shifts, I just sat in bed wide awake, fully dressed, heart beating a mile a minute in anticipation of the calls to come. I quickly learned that my co-workers and I were part of a much bigger picture.

The service I worked for had over 2300 employees throughout the province and I was just one of many. Within a brief period of time, I learned that big business politics and government funding/regulations seemed to matter more than how much I wanted to help people. Day after day I would sit around the coffee table listening to ten, twenty, even thirty year veterans of the service complain about how much their employer has been screwing them their entire careers, education, pay, vacation time, benefits, schedules etc etc etc was all blamed on the higher ups with fancy titles before and after their names. At first I sympathized, but eventually I grew tired of the grumping and groaning. I knew the service wasn't great, but I couldn't comprehend how people could be so discontent with their job and yet still come to work day after day with a poor attitude and a poor outlook. Finally, after almost two years of low pay, marathon shifts, no benefits and NO job satisfaction, I did what no one else seemed willing to do, I quit.

Private municipal EMS was fresh and exciting when I first hit the streets of my new city in my new province. All of a sudden I not only knew who my bosses were, I saw them on a daily basis, in the halls before a shift and in the company gym afterwords. I felt a new sense of satisfaction when after a long day the actual owner of the company would chit chat with me in between sets of bench presses in the private gym. I went from a service of over 2000 faceless employees to a service of just under 200 individuals, each and every one of whom I knew by their first and last name, that's quiet a change! After about a year or so however, I began to notice things. Small time interoffice politics, childish teasing, and high school like cliques began to appear. Because everyone knew everyone else, everyone loved to talk about everyone else. It felt like I was fifteen years old and in high school all over again. Focus was taken off the patients and our actual jobs and placed on social status and what "group" an employee was part of. Having no time for head games and raging emotions, I left.

Integrated Fire/EMS was very intimidating at first (hell it still is). All my career I had gotten by on my skills and my education. I never called people sir, never cleaned toilets, and never worried about what anyone else thought of me because in my mind, none of that mattered, I was a Paramedic and I wanted to help people, not kiss other peoples asses.

I learned quickly that being able to intubate someone while upside down in a mangled car wasn't going to impress anyone on the Fire Department. I love doing ambulance calls and still get excited when the tones go off, most of the guys here couldn't care less about that sort of stuff, to most of the people on the department, ambulance calls are nothing more than a nuisance that they must endure untill they gain enough seniority to be on the engine's full time. Ok ok of course I am exaggerating, I am sure there are others on the department that have the same passion for EMS that I do, so I guess it would be more correct to say that 'some' not 'most' of the guys here find ambulance calls nothing more than a nuisance.

I also learned quickly that no one here cares that I've been around and experienced a whole array of EMS services. No one cares that I've been in choppers racing over the Atlantic ocean to pick up a patient, or that I've worked in emergency room trauma centers caring for multiple critical patients at once, no one cares that I've worked in greasy downtown gutters doing twelve calls a shift, or that I once had a patient left for dead in the woods for three days make a full recovery and call me crying six months later to tell me that he can finally walk again, no one cares about any of that stuff, what do they care about then? I commonly get asked stuff like this,

"where did you go to fire school?" I didn't...
"how many fires have you been in?" Zero.......
"Bet you cant WAIT to get off the ambulance eh?" Don't talk to me......

Integrated Fire/EMS has been an eye opener that is for sure. I hope I'm not making it sound too negative, because it really isn't, its just so different from anything I've ever done. EMS has always been the focus of my career and its just a little 'different' to work in an area where EMS takes a back seat to fire fighting.

I've swallowed some pride lately, but that's ok. I've had some eye openers lately, but that's ok. I've felt like a complete idiot at times lately, but that's ok too, because in the end I have a job that is constantly challenging me. I have stability, satisfaction, excitement, and comrades as opposed to coworkers.

Things have definitely changed, but change....is a good thing.

Ouch!!

2011-03-07T17:03:00.001-08:00

Yesterday my partner and I got sent to the other side of the city for a syncope at a church (yes it was a Sunday and yes the patient was old). The ALS engine was already on scene when we arrived so we walked into the church with just our radios.

Sure enough a seventy year old gentlemen was lying supine on the floor being attended too by the guys on the engine. It always amazes me how the church service NEVER stops when one of the congregation collapses. Anyways the patient was doing fine by the time I took a knee beside him and started going through my assessment. We started a line and moved the guy over to the cot.

My partner and eye made eye contact and counted to three out loud. When 'Three!' came we both lifted just like we have done 1000 times before. The difference this time was that halfway through the lift I felt an immediate and excruciating pain in my lower back.

I was frozen. NEVER before in my entire career had I ever felt pain like that. It felt like a knife was plunged into my lower back, it screamed at me and it seemed as if I was being strangled every time I took an inspiration.

We made it through the call however, I had the guys from the engine do all the lifting for me and myself and the patient made it to the hospital uneventfully. For a brief second in the back of the unit I thought I would be able to just shrug the injury off like I have in the past, when I bent over to catch the wheels of the stretcher when unloading however, I knew something was hopelessly wrong.

I booked off shift the minute I was done my report. I went and saw the Dr and he deemed it a "moderate muscle tear" in my lower back. He said my anterior and posterior flexion/extension is severely limited and that time off and physio would be needed.

I felt like the biggest wuss in the world.

I'm a fireman for Pete's sake, I can run like the wind, haul hoses like they are feathers, swing an axe like it is a spaghetti noodle and I can lift weights in the gym that most others only dream about one day lifting. I'm a fit and healthy and STRONG guy, and here I sit, off work, in pain, sidelined by an injury I sustained from lifting a 150lb grandpa on the stretcher.

All throughout my career, Ive thought guys who missed work from "back injuries" were wimps. Being young and fit as I was, I couldn't comprehend how people could hurt their backs simply by lifting a stretcher or carrying a kit or heaving something out of a ditch. Yet here I sit, twenty six years old and unable to bend over to put on my socks.

Eye opener? You bet your ass it is.

I go to physio tomorrow where they will determine how much time off I need. In the meantime, I urge you all, young and old, to strengthen your back and increase your fitness, trust me, back injuries suck...........

Cold, Cold Day

2011-03-03T17:22:00.000-08:00

Just a quick picture of the thermometer in my car a few mornings ago as I drove to work. Can't beat this balmy Canadian March weather!

(Cetain) drugs make you sleepy.......

2011-03-02T21:00:00.000-08:00

Had a good call the other day,

1820 on a night shift, I was in the gym with my co workers, right in the middle of a heavy bench press when the tones went off for a "delta" call. I racked the weight in a panic and threw on my gear at light speed.

Dispatch info was as follow,
"40 year old male patient, unconscious, not breathing"

Turns out the residence was literally three houses down from the fire hall, so within 45 seconds or so of the tones going off, we were on scene.

Arrived to find a 40-ish year old guy supine on the kitchen floor. He WAS breathing, but not very well, and he was most definitely unconscious. The place was actually a sober living half way house, so staff on scene were able to give us a bit of history. As they described, the patient was slurring his words around dinner time and all of a sudden just collapsed. He was a new resident to the facility, and had a major history of crack/cocaine abuse.

Initial VS were as follows,

HR 60, regular
BP 90/56
RR 8, very shallow
SPO2 95%
BGL 5.5
GCS 3

It was actually quite bizarre, the patient was basically comatose and barely breathing, but he looked great! To the untrained eye it looked like he was just taking one hell of a nap. His VS and his drug history however painted an entirely different picture. There was a few empty bottles up in the guy's room, seroquil, clonazepam, and morphine specifically.

IV's were a bit of a challenge but I managed to find a couple good veins hidden within the numerous trac marks tracing the patients arms like bizzare tattoo's. After inserting an OPA and ventilating with a BVM we moved the fella outside and went to work.

I started drawing up Narcan, a drug that usually brings certain OD's screaming back to life, and told my partner to get us rolling.

To my surprise, the Narcan didn't do a whole lot. The patients RR went up to maybe 12 or so, but other than that everything was unchanged.

"Must be more than the morphine" I thought to myself as I sat staring at the patient waiting for the Narcan to wake him up.

The hospital kept going on the Opioid OD theory as I was unloading and giving my report to a room full of doctors and nurses. After 5mg of direct IV push Narcan the patient began to mumble, hardly loud enough to hear, that he wanted to kill himself.

Everyone in the room breathed a soft sigh of relief. No breathing tube for this guy, no rush brain CT or stat transfer to another facility. The nurses started an IV Narcan infusion while the doctor paged psychology.

By the time I finished my paperwork the lucky (or unlucky if you ask him) patient was sitting up, mumbling about how he should've taken even more pills.

Shoulda....woulda.....coulda..... either way he lived to face another day.

Four down, Six to go.....

2011-02-19T07:50:00.000-08:00

I agreed to work two extra shifts for a coworker recently, so right now I am switching over to night shift after working four straight day shifts, two of which were on a different platoon and at a different hall. Things have been fairly busy, lots of interesting calls with different partners, here's the highlights of the past few days,

- Called to the ghetto part of town for a 30 year female, "intentional overdose". Arrived to find a groggy but coherent woman on the couch, states she ingested a full bottle of her anti depressant pills. Citalopram was the medication and yes in deed the bottle had been refilled two days prior and was now empty, almost 40 pills, total ingestion was just over 2000mg. For those who don't know, Citalopram is a class of anti depressant called "SSRI's" or 'Selective Serotonin Re uptake Inhibitors". SSRI's can really mess with a persons neurotransmitter levels when abused and cause all sorts of adverse effects. By the time we got to the hospital the pt was trembling, vomiting, sweating profusely and her heart rate was shooting up to the 120's. No follow up available but I'm sure she was lavaged.

- Called for a "unconscious, not breathing" elderly female patient. Arrived on scene to a 88 year old lady lying semi conscious on her bedroom floor. Her roommate stated that she was last seen normal last night, approximately 14 hours previous. Pt was a GCS of about 10 initially, no obvious injuries, VS unstable with a HR around 80, RR around 10, SPO2 of 85 on RA, and a BP of 240/160. We didn't have to take her airway en route, she actually held up pretty good for transport but the second we moved her onto her hospital bed she seized and then went unconscious. She was tubed and sent up to CT, after which she was diagnosed with a massive bleed. Last I had heard she was being admitted to our ICU.

- Called for a female "breathing problems" arrived to find a 30 year old obese woman, sitting on her couch looking VERY anxious and VERY strung out. She admitted to just coming off a five day crack/cocaine binge and was complaining of shortness of breath. She screamed at us when we tried to do a blood pressure and was constantly picking at her skin, twitching, and smacking her lips loudly. After being howled at again we backed off and invited her to walk to the ambulance. My partner and our student were in the back trying to get more of a story when all of a sudden the patient snapped and lunged at the student. He managed to duck out of the way and just missed a loogie the patient had sent at him. Still driving at this point, I could hear my partner yelling at the patient that if she screamed or spat one more time we would have to give her a shot and call the cops. The patient didn't take too kindly to that, she spat again and caught my partner right in his open mouth. I saw what happened in my mirror and immediately pulled over and called the cops. We pounced on the patient and restrained her until police arrived. We got to the hospital and the patient went to the padded room and my partner to the lab for blood work. No follow up from the patient, my partner is doing fine, although very stressed as he awaits blood test results.

- Right at the start of shift, called for a "17 year old female, allergic reaction, unconscious". Arrived to an SUV pulled over on the side of a busy highway and found a teenage girl slumped over in the front seat with her hysterical mother shaking her. Mom stated that the pt was allergic to peanuts and had just drank a soy protien shake from some drive through place. Withing seconds she was then wheezing and her face started swelling. We got the pt into the unit and immediately got to work. Initial Vitals were poor, BP 70/30, HR weak and thready at 88bpm, SP02 82% on room air, GCS 13. For treatment we gave a Neb of Ventolin/Atrovent, IM Epinephrine, IV Benadryl, IM Dexamethasone, and a fluid bolus as well. Within minutes the patients facial swelling started going doing and her LOC had improved. By the time we got to the hospital she was sitting up, talking, and all her VS had stabilized. No follow up available.

Like I said, tonight I start my normally scheduled two night shifts, lets see what they can throw at me.....

Another eye opener....

2011-02-11T10:25:00.000-08:00

I'm on my split right now, meaning I'm sitting around drinking coffee waiting to go start my night shift tonight.

Yesterday was an alright day. One call in the morning for an "obvious death". It wasn't exactly obvious, but the person was cool with the beginnings of rigor. He looked like he went peacefully.

In the afternoon I was sent down to the training grounds with a few of the other newer guys on the department for some RIT training.

For anyone who is unfamiliar, RIT stands for 'Rapid Intervention Team'. A RIT team is a group of firefighters on a fire ground who are responsible for finding and rescuing downed/lost/injured/unconscious firefighters. When activated, a team of two RIT members will enter a structure and attempt to locate a downed firefighter using special equipment and techniques.

I've done a little bit of RIT training during my orientation when I started back in July, but since then I've done mostly ambulance calls. My fire gear is as clean now as it was the day I got it which is a little pathetic but what can I do, my current station has the lowest number of fire calls in the city.

Our training grounds for the day were in an old abandoned city utility warehouse. To paint a bit of a visual, the building was old, vacant, concrete, high ceilings, very dark and with dilapidated equipment scattered everywhere. The two lieutenants who were running the scenarios had used a smoke machine to render visibility next to nothing.

Despite knowing that it was only training, I was still nervous. I don't get very much fire exposure or fire training at my current hall so my basic skills were a little bit rusty for sure.

I was assigned a partner and told that we would be going in first.

The scenario was that a 'downed firefighter' had called a mayday, saying that he was somewhere on the first floor, lost and low on air. My partner and I threw our gear on, went on air, and entered the smoky abyss.

In addition to our basic tools (thermal camera, halligan, axe) we also utilized a 'RIT bag' to specialize our operation. Our RIT bag was about the size of a large duffel, with a spare air bottle inside, as well as a spare face mask, regulator, air hose, and transfill hose. In the very bottom of the bag is a smaller rope bag with 200ft of rope. One end of the rope is tied off outside the structure before the bag is dragged in with the RIT members. Knots in the rope every 25ft help the RIT members track their distance traveled.

The 'downed firefighters' last transmission revealed that he had been conducting a left hand search prior to getting lost. Using that information, we got down on our hands and knees and began a left hand search, all the while dragging the RIT bag with us and keeping track of the knots in our rope.

The noise from the downed firefighters PASS alarm was getting louder and louder, but still no sign of him after 50 feet. Finally, after our 3rd knot, we located him, 'him' being a 200lb mannequin with a SCBA on.

As we began a quick assessment of the victim, one of the Lieutenants conducting the exercise came over the radio and instructed us to perform a transfill of the victims bottle, and then get him the hell out of there.

A transfill requires using a special air hose to transfer air from the full RIT bottle to the low 'downed firefighters' bottle. Totally blind, I took the hose from the RIT bag, attached it to the RIT bottle, and then after some fumbling, attached it to the empty victims bottle. I knew I had it when I could hear the rushing of air from one tank to another.

Next up, we had to get the victim out of there. My partner removed the smaller rope bag from the RIT bag, and secured it to some pipes against the wall, this would allow us to follow our initial rope line out of the area.

While my partner positioned himself at the victims legs and converted his SCBA harness into a rescue harness (bringing one of the victims legs up and underneath the waist belt) I utilized my web sling to create a dragging harness.

A web sling is a one inch wide piece of webbing that is about 10 feet long. It is typically tied together at its ends and then stored in a fire fighters turnout gear. Using my webbing, I was able to create a dragging harness by looping it through the victims SCBA shoulder straps and then around my shoulder.

Working together with my partner, we pushed/pulled the downed firefighter out of the smoke filled area to safety.

I titled this post 'eye opener' for two reasons.

1. Cardiovascular fitness is of the uttermost importance with my job. Being able to bench press a lot and having big arms is all fine and dandy for the ego, but all that means nothing if you are too winded to be of use in a fire. I'm not in bad cardio shape now, but this exercise made me realize that there is definitely room for improvement.

2. RIT operations are extremely important and should be practised more than they are. My department is pretty good at getting us through some sort of RIT training every few months, but really every few weeks would be ideal. When RIT is deployed, it is because another firefighter, a brother or sister, is lost, hurt, or trapped. A life is truly on the line and seconds matter. RIT is lifesaving and every firefighter should be knowledgeable and well trained in its operation.

Night shift tonight, more eye openers perhaps??

Busy Busy Busy

2011-01-30T14:36:00.000-08:00

Holy smokes, has it really been two weeks since my last post? Time really flies when your having fun, being beyond busy helps things along as well.

Work has been good. I've taken a lot of time off lately to deal with some things at home. My wife and I just purchased our first home so we've had plenty to occupy our time with. To make things just a little more complicated, my wife has been up north working for the last two weeks so I've had to deal with all the lawyers, bankers, realtors, inspectors, plumbers, etc etc all by myself. Before taking possession of the new place, my cell was vibrating every thirty seconds with calls from an assortment of people all demanding papers, documents, signatures and of course many many payments.

I had a few good calls last tour.

One was a guy in his forties who fell off his snowmobile trailer and landed hard on his hip. He was face down in the snow when we showed up and appeared to be unconscious until we tried to move him, one little touch on his hip and he screamed like his hair was on fire. It took a lot of morphine, be we eventually got him comfortable. Transport was unremarkable, my partner and I kind of got into it with the receiving doctor in emerg. We tried to give our patient another dose of Morphine before moving him to the bed but the doctor was rather insistent that we move him NOW. No follow up.

Another guy we had slipped on some ice at work and landed hard. He had wicked neck and shoulder pain which earned him some Morphine and a trip to the ER on a backboard. Physically he was doing OK and the transport was medically unremarkable. He was however a hell of a interesting guy to talk to. The guy was my age and was a single father who had moved to my neck of the woods from Nova Scotia several years ago. I had a great conversation with him about work, kids, marriage, just basically life in general. He was a overall good guy and I hope he turned out ok.

Also, we had a psych patient who needed to be transported to our area's mental health center. The guy was actually being medivac'd to the facility but the plane had to detour due to extreme snow conditions. We met the guy at the airport and as with most psych's in my experience, he was pretty calm. He needed a couple Ativan's en route but was more or less pretty stable. I was just starting to think he was a pretty normal guy when during registration at the psych center, I looked over to see him digging cigarettes out of his luggage and eating them like candy.

" Fu$k I needed a smoke" he sneered at me as he chewed up another Export A.

In addition to all the work involved in buying/moving into our new home, I've been teaching CPR/First Aid on my days off. Things have been going well in that department, so well in fact that last class I was on my own, teaching the entire course myself to twelve students. I had a brief moment of panic in the parking lot beforehand, but I have found that once I actually get up in front of people and start talking, I really do enjoy myself. I don't really know what's going to come of these classes, for now I'm just taking them for what they are, a little extra money and a little extra experience.

Back to work on Tuesday.

16 days off, ohya!!

2011-01-15T17:06:00.001-08:00

I haven't been posting much these last couple weeks and I do apologize for that. My last shift at the department was the 6th or 7th of January and I've had 12 days off since then. Holidays in January aren't really the most desirable, but being the proby I have to take whatever holidays I can get.

I wish I could say I went to some tropical location and laid around drinking beer on the beach for two weeks, but in all reality I never left town. The wife and I just purchased our first home so we have been incredibly busy running around dealing with lawyers, bankers and realtors. My wife left for 2 weeks work up north on the 11th, which leaves me all by myself to finalize the paperwork, find a moving company, pack up, and move.

I go back to work at the hall tomorrow, but today I was busy teaching first aid/CPR with a co worker. The class was at a local pig slaughtering factory and the students were all employees off "the killing floor" as they called it. I haven't taught in a while, so my nerves were definitely racked for the first few minutes. I soon enough got into the swing of things and all in all I think the class went pretty well. I am scheduled to teach the same course at the same location each Saturday of the next three weeks. I still get nervous before teaching but at the same time it feels good to be gaining experience as a instructor, and hey the extra money doesn't hurt what with the new house and all.

Ill end on a sad note. That patient I blogged about in my last post "the transfer from hell", I got word today that he died two days after we transported him. He never left ICU.

Back at the hall tomorrow.......

The transfer from hell......

2011-01-04T17:31:00.000-08:00

Last night shift, 1930, we were just sitting down to dinner at the hall when the tones came in for a long distance transfer into the city.

Transfers are as much a part of the job as Tim Hortens and IV's, I've long since come to grips with the feeling of being sent on a transfer when you are tired and wanting to sleep, but this one was tough to accept, I just had a deep down wrong feeling as soon as the tones went off.

We arrived to the upstairs recovery ward, unit 22, which is usually a pretty low key uninteresting place where patients recover from surgery. As we came around the corner with our stretcher, five or six nurses with panicked faces came into view.

"Thank God your here" the designated speaker of the group piped up. "This guys is REALLY sick, he's been sick for a day and a half now"

I try not to roll my eyes too obviously, "well why wasn't he sent out a day and a half ago?" I ask.

No answer.

The story was this, patient was male, 73 years old, came into Emerg two days ago with a week history of shortness of breath and weakness. Diagnosed NSTEMI in ER with troponin's in the 40's. Patient was admitted to the ward where his troponin levels dropped, he was subsequently worked up as a possible myo/endo carditis (temp 39 degress). Up on the ward, the patient complained of shortness of breath with worsening diaphoresis for a day and a half. He was being accepted into a cardiac ward up north and it was our job to get him there. No big deal right?

HHmmmmmmm

I went in with some paperwork to have a quick look at the patient. His room was packed with about ten crying family members huddled around his bed. I said excuse me about fifty times as I worked my way into the room.

Lying on the bed, was my patient, I'll name him 'Buddy' for blogger purposes.

Buddy was pale as a ghost, very very diaphoretic, and breathing in small little gasps at about 40 a minute. He denied any pain or shortness of breath, he insisted that he felt 'pretty good' and didn't really understand why he was being sent to a bigger hospital.

His initial vitals were as follows:
HR- 122
RR- 40
BP- 90/44
Spo2- 89 on 4l Nasal

I made up my mind right there that if we were going to be taking this patient by road for over an hour, we would need some help. We radioed down to Station 1 for an EMT driver to be sent over to our location.

The patients blood work was as poor as his vital signs. His metabolic acidosis was being compensated for, but for how much longer would his respiratory system be able to keep up?

"He's also febrile at 39.5 C, and his Glucose was 20mmol this morning" his nurse told me in a panicy voice.

"ummm, ok what else do you have to tell me?" I replied

"Well, he's been diaphoretic with an spo2 like that for the last day and a half, he says he's always like that!" the nurse quipped.

"He always looks that horrible? I doubt it" I tried not to sound mean.

I told the nurse to get the attending Dr down to the floor ASAP, we weren't going anywhere until I spoke with him.

Now, this was kind of a big deal for me, I'm a confident medic, but I'm also pretty timid, I NEVER question Dr's to their face but this patient was just too poorly managed for me to let slide.

Two minutes after being paged, the patients attending doctor appeared at the nursing desk, and he wasn't too happy.

"This patients condition hasn't changed in over 24 hours, what is the problem? he is TOTALLY acceptable for road transportation" He barked.

I chose my words carefully, if I sounded over confident, he'd take that as a challenge, if I sounded too low brow, he would dismiss my opinion as that of an immature 'ambulance driver'.

"Sir, I understand his condition has not changed since his admission, it is my opinion that he has been clinically unstable since he first came to the ward"

No reply, so I continued.....

"This patient will not make the trip without needing intubation and interventions for his blood pressure, the back of an ambulance is NOT the place for a crash intubation. My partner and I are not refusing the transport nor to we mean to criticize the patients treatment. Intubate the patient here, treat his blood pressure, and we will gladly get him to the city safe and sound"

He glared at me, stared at me, eyes throwing lasers my way for what seemed like a minute. I guess my little speech was good enough for him, because he finally broke his glare,

"Ok, page RT, intubate him, get dobutamine going"

I raised my eyebrow at the orders for dobutamine what with the guys HR, but after my luck with my little speech I decided not to push things.

The guy was a tough tube, Respiratory needed four or five attempt before a tube was successfully placed. We placed 'Buddy' on our ventilator and did our best to organize all the wires, leads, IV's, ventilator circuits, foley's etc etc. Eventually, we were good to go, so down to the ambulance bay we went.

From the time we arrived on the ward, until the time we were ready to go with the patient stabilized and intubated, was almost 2+ hours. I know I know I know, that's a long time, no need to tell me. During those two hours, we had alot more to straighten out than the intubation however, the pts BP was unstable, his exact destination was still up in the air, the possibility of an insulin infusion was discussed, as was the availability of helicopter response. Once the decision was made that we would transfer by road if the patients airway was secured, he was intubated and on our stretcher in less than ten minutes.

Initial VS in the ambulance were as follows:

HR- 120
RR-12 on the vent
BP- 96/55
Sp02- 95 on 100% 02

'Buddy' was quiet a large man and was fairly tough to maintain sedation on. I didn't want to have to paralyze and affect the intrinsic respiratory muscles, so we were fairly generous with the Midazolam and Fentanyl which worked nicely after a few doses. The patients blood pressure however was still sitting around the 90 systolic mark even with Dobutamine running at 5mcg's. I quickly scanned through the in/out nursing notes to see how much fluid the guy had been giving over the last day and a half, the answer shocked me, zero!

Maybe it was a charting error, or maybe it was a legitimate number, but according to the paper work, the extremely SOB, diaphoretic, borderline hypotensive, possibly septic patient had been given ZERO fluid during his hospital stay.

The guy had two IV's, one with the dobutamine running, the other with heparin, so I started another peripheral and gave two Saline boluses. Almost instantly, 'Buddy's' HR slowed to 90, his diaphoresis stopped, and his BP increased to 100 systolic. I couldn't believe that a litre of saline could resolve so many issues, heck we even got some renal output in the bag after I was told his output had been zero and his kidneys were possibly failing!

Our patient did well the remainder of the trip, he didn't fight the vent, his BP stabilized, his oxygenation improved, and his kidneys started making urine. We got into the city just before midnight and had an uneventful hand-off.

As stressful as it was at times, this call was my 100% exact favorite type of call to do. Lots of medics love doing codes, some like nasty trauma calls, Me? I live for the crazy unorganized poorly managed calls where my partner and I can show up on scene and calmly, systematically resolve each problem. Stabilizing a patient and maintaining a certain level of calmness and level headedness during transport is very gratifying to me. I enjoy setting up ventilators, running infusions, untangling central lines and art lines. Lots of medics HATE calls like the above mentioned, they see them as unnecessary and not their job. I see calls like these as the ultimate challenge, not only must I care for a critical patient, but I must always project a level of professionalism and competence.

It's easy to let your professional guard down when you are picking up your fifth drunk patient of the night, but when you are up on a ward, with a critical patient that is crashing, its all eyes on you and although it may sound lame to say......a calm, confident, professional demeanour, gets results.

And 2011 begins....

2011-01-01T12:38:00.001-08:00

I haven't done any really interesting calls lately, hence my temporary lapse in blog post's.

The holidays have kept me busy as I'm sure they have everyone else. Unlike others though, I wont trouble you with the stories of my Christmass/boxing day/New years etc etc etc.

Ok I guess I will, its a short story, just one sentence sums up my entire 2010 Holiday season,

"I worked"

That's pretty much it, my birthday was just a few days before Christmass, I worked it, Christmass day and Boxing day, I worked, and New years Eve and day, I worked.

Makes for great pay cheques but not the most exciting blog posts!

I am working at the moment however, and who knows what the next four days will bring.

Buddy just didnt get it......

2010-12-21T12:09:00.000-08:00

Well my last tour was one of the most brutal that I can remember, specifically my last night shift when I was out from midnight untill 10AM doing calls, highlights include:

- Does anyone remember that girl I picked up a few weeks ago who had taken a bunch of pills and wrote a suicide note? She was the one whole named just about every STD in existence as her medical history, well our paths crossed again. Around 0100 we were sent to a local nightclub parking lot for a 21 year old female "unconscious not breathing". There lying on the ground with bouncers holding C Spine was a young girl with vomit all over her face. "She's shit faced dude, she hit the ground and has been out for like 15 minutes" the bouncer said to me.

We put her on the back board and got her inside the unit. Once she was out of the gongshow that was the bar parking lot I was able to get a decent look at her. She looked vaguely familiar but I couldn't quiet put my finger on where I knew her from. She started to wake up while I started her IV and was eventually talking well enough to answer my questions. I was listening to her tell me how much she had drank while I was looking at her drivers license. The picture and name were both familiar but I still couldn't put two and two together.

"What sort of medical problems to you have miss?" A brief pause, before she goes on to list about ten different STD's.

AHHHH HAH! Now I remember you!

- A couple hours later, around 0300, we went to a local Denny's restaurant for a pepper spraying. For those of you who don't know what a Denny's is, it is a greasy diner type place that is open 24 hours and offers all types of greasy deep fried huge portions at cheap prices, basically, it is a drunk persons mecca at 3AM on a Saturday night.

There was already a couple ambulances on scene treating the three or four people who had been sprayed. A couple guys from the engine on scene led a red faced drunk guy over to us. Turns out he was in the bathroom in the restaurant when some random person opened the door and let loose with the pepper spray. Our guy got it pretty bad in the face so we wasted no time lying him down and flushing his eyes profusely. It was kind of funny, he had a t shirt on with a life sized picture of a baby in a front harness and he kept yelling at us "is the kid alright? I'm babysitting, is the baby gonna be ok?!!". It was pretty hilarious at the time and all of us including him had a good laugh, maybe you had to be there.

- Our last call of the night came at about 0600, two hours before shift change. We were sent on a transfer to take a guy with spinal deficits to the urban trauma center two hours away by road. I dont want to complain, but my heart sank when this call came in. Getting a transfer like that, at that time, basically guarantee's that you will be working 3-4 hours past your scheduled shifts end.

Anyways, the patient was a 25 year old guy who had been on a three day crystal meth and cocaine bender (party on!). The guy was partying out on a buddies farm and after getting loaded on drugs, decided to drive his buddies snow mobile. Mr Party animal hit a ditch at high speeds and was thrown from the sled. Another unit brought him in and CT scans at our hospital confirmed that he had a burst fracture of his 1st Lumbar Vertebrae (uh oh). When we picked him up, he had priaprism, paresthesia of the lower legs, and paralysis from the navel down. He was still a little high and was a complete prick to everyone that was taking care of him. Here is a sample of what transcribed between us,

"Hi there bud, my partner and I are here to take you to the city for some more help ok, how are you feeling right now?"

"Well hi there FU@K head, I'm here to tell you that I'm not going anywhere before I get a smoke and a glass of water!!"

"Umm, well its like this, were in a hospital, so you cant smoke, and your probably gonna need surgery so you cant drink, its that simple"

"FU#K you man!! I have rights and I want a smoke, get that FU@KIN doctor in here so I can tell him myself"

Ugghhh.

So we get the guy into the ambulance and we start the drive and he starts screaming about an assortment of things, the temperature, the bumps, his pain, but primarily, he screams about the cigarettes and water that we are denying him.

"Pull over at a gas station and get me some FU#KIN water NOWWWW!!!!!"

I inhale slowly, count to ten, swallow hard, and lean over his head so he can see the look on my face (he was still boarded).

"Look buddy, I understand you want a smoke and some water, I understand that because you have been saying it every ten seconds for the last hour, now listen to me ok....you are in an ambulance, not a taxi, we are going to the hospital, NOT to 7-11. You are very hurt ok, your legs aren't working at all, now lie still and start thinking more about the possibility of ever walking again and less about smokes and water ok?"

He didn't even skip a beat,

"FU#K you a##hole!! I want water, I know you have some, your not a doctor, I want a SMOKE!" blah blah blah blah blah.

Long story short, we made it to the hospital without any smoke or water breaks. I was long since past feeling sorry for this guy and just wanted to drop him off in Emerg. A brief moment of pitty came when I saw the Dr insert his finger into the guys rectum and say "squeeze my finger", there was a pause before the patient snapped back "I don't know where your FU#KIN finger is you retard!!" Not a good sign.

I always give drunk/high/twigging/twitching/addicted patients the benefit of the doubt. I've been a lot of places and seen a lot of things both before and after getting into EMS and I know that behind a lot of the tough junkie exteriors there are sad, depressed, lost souls who are just waiting for someone to treat them like people and not like druggie losers. Sometimes, my approach works, when it does I can turn to my burnt out partner or whoever it was that doubted me and say to them "see! I told you! There people too and all you gotta do is be civil to everyone!". Sometime however, my approach fails horribly, this above mentioned spinal patient was definitely an example of that. Maybe he was still high and didn't comprehend what was going on, maybe he was withdrawing and was beyond irritable, maybe he had been burned by authority figure his whole life and was sternly jaded, or maybe, just maybe, he was one of the select type of people who just don't care and never will.

He was just in an accident that could have easily killed him but did he care?

No

He will most likely spend the rest of his life in a wheelchair but did he care?

No

He had Doctors and Nurses working like crazy to give him the best medical care available, did he care?

No

He had a Paramedic try to reach out and try to treat him like a normal person, did he care?

No

Maybe he didn't comprehend things, maybe he's just a prick, either way its sad.

Whats new and exciting? Well.......new at least...

2010-12-13T07:20:00.000-08:00

I'm on days off now following another brutally slow tour at work. In three shifts we did three calls, one of which was a stable transfer into a nearby city's ER. Still, even after a slow tour there is always some small things to report.

First up, hall moves! I've gotten confirmation that in April 2011 I will be moving downtown to our central hall which happens to be the busiest station with the biggest crew. Right now at my current hall, we have four firefighters (including the captain) to man one ambulance and one engine, downtown there is upwards of ten to twelve guys to man one ambulance, a back up ambulance, an engine, a bronto unit, a rescue truck, a tactical ops trucks, and a brush truck. Of course all those pieces of equipment aren't manned at all times, but depending on what type of call comes in, the downtown guys will respond on the appropriate piece of apparatus. My only worry about my new hall is that it has the highest pole out of all the halls in the city. Seeing how my current hall has no pole, I am definitely unskilled in its use, I will have to be sure to get some practise in when no one is watching!

Next up, a patient update. Some of you may remember a patient I talked about a while ago that I transported into the closest level 1 trauma center. He was the mid 40's male pt who was found unconscious at home, EMS transported into the local ER and once intubated the local doc's were thinking a possible brain hemorrhage (which CT confirmed). It was a few posts back if you feel inclined to read about the call. I got word the other day that the patient died a few hours after we dropped him off at the trauma center. The news really surprised and saddened me. Yes the patient was sick, but he did so well during the transport that I really thought he might have a chance. I guess recovery just wasn't in the cards for him which is unfortunately the way it goes sometimes.......

Today is a bit of a big day for me and my wife. A few weeks ago my wife started a small business offering contracted ALS standby service at remote oil and gas locations as well as CPR instruction. She made a little website and went through all the paperwork to make things official. Well, a few days ago a client got in touch with us through the website regarding CPR instruction and just like that, she is coming over to the house today for a private CPR renewal course! I've done a bit of teaching since obtaining my certification a while ago, but this is a whole new type of nervousness! It's going to feel quiet surreal I think when we get a cheque with our companies name signed on it!

Friday night was our work platoon's Christmass party which was everything you can imagine a bunch of spirited firefighters would be. Being at the hall that I am, with the very small call volume that I have, I don't get to see the other thirty guys on my platoon very often so this occasion was very welcomed.

Lastly, we just hired four new firefigher/paramedics onto the department who are scheduled to hit the floor sometime late January. This is great news because finally there will be someone below me on the seniority list, yay! I still feel incredibly new to the whole integrated Fire/EMS thing but regardless of how I feel, time goes on and things move forward, the last six months are living proof of that.

I'm still around.....

2010-12-07T13:39:00.001-08:00

I haven't posted in a while, partly because I've been busy with non EMS stuff, but mostly because things have been pathetically slow at work.

How slow you ask??

Try a single EMS call in three straight shifts, ugh!

Slow stretches are sometimes a welcome thing, but for a new firefighter/paramedic like me who is used to busy urban EMS, they are torture.

So ya, as far as work goes I have literally nothing to report, oh wait, as of December 1st the province I work in has switched over to a provincial medical control protocol system, meaning we have brand new medications, procedures, equipment, doses, etc etc etc. Its pretty big news around work seeing how for ages and ages the province has been ran by private employers who more or less made the policies and protocols however they saw fit.

I'm on my last day off right now. I took my last night shift of last tour off as well as my first day shift of my upcoming tour, that gave me six straight days off which the wife and I used to travel to British Columbia. We spent two nights in the mountains at a very secluded 'eco-lodge' where we snowshoed, snapped pictures, and even attempted to cross country ski (don't ask). Below is just a picture of me relaxing outside our cabin after a three hour snowshoe excursion.

Anyways, I'm back at work tomorrow for days, who knows I just may get a chance to try out some of our fancy new protocols!

Car Fires and STD's.........

2010-11-25T11:06:00.000-08:00

I just finished my last tour which wasnt super exciting but did provide a few memorable experiences.

During my second day shift we received a late transfer from our ER into the city's Neuro ICU. Patient was a 50 year old guy who had been boozing it pretty hard for the last couple months and apparently fell at home while drunk and hit his head. Our EMS guys from downtown picked him up and we were almost instantly called for the stat transfer (my hall is the slowest, so we do ALL the transfers out of our area).

Patient was intubated when we arrived which meant that for the first time ever I would be able to set up our ventilator! I know that probably doesn't sound very exciting, but I really enjoy taking a patient who is critical (and in some cases being poorly managed by the hospital staff) and then breaking things down and rearranging them in a calm, collected, organized manner. I cant STAND things like sloppy ER paperwork, tangled ECG leads, unsecured IV sites, unlabeled infusion pumps etc etc. Within 15 minutes or so we had our guy on our stretcher, monitored, ventilated, and with all this infusion pumps nice and silent (other people can just ignore the alarms, I cant).

Turns out our guy was a intracranial hemorrhage with a fair amount of coagulated blood in his frontal lobe. He started showing unequal pupils just as we got into ICU. No real follow up available.

Last night shift was pretty cool as well.

Call 1 - 13 year old kid who was pushed into a swimming pool by his buddy. The kid's lower body landed in the water while his upper body landed on the deck. He had a ton of pain between his shoulder blades but no spinal deficits. As we were immobilizing on the pool deck I looked up from holding C spine to see probably a hundred kids standing around watching us, it was kind of creepy. I guess they shut down the pool for us to do our thing, the kids weren't looking at us in interest, their eyes just screamed "hurry the heck up so we can get back in the water!".

Call 2 - Tones woke us from a deep sleep around 0130 for......a vehicle fire!! My first fire!! Yes yes I know its not a structure fire but still, it was a fire nonetheless and it was in my halls area and for once I was on the engine when the call came in!

We arrived on scene to find a minivan in a deserted parking lot and yup it sure was on fire alright, fully involved with TONS of flame and smoke. My partner and I grabbed the bumper line and we had knockdown within five minutes or so. I must've been really excited or really out of shape because just before knockdown I noticed my air was already down to almost 1500! I didn't want to look like an air hog, so I basically held my breath for the last two minutes on the line to prevent my low air alarm from going off!

The investigations officer arrived on scene within a few minutes and we were back at the hall by 0330, first fire in the books!

Call 3- 0500, sent to a neighbourhood basement suite for a 21 year old female, attempted suicide. She was asleep in her bed and would rouse decently after enough verbal stimuli. Her room was littered with beer cans and pill bottles, none of which were empty, ativan and anti-depressants mostly.

When our patient was finally sitting up and talking, she wasn't too pleased to see the firefighters and police officers in her room, and she wasn't shy about voicing her displeasure, talk about expletives! She sat on the edge of her bed, completely naked (refused to put anything on or be covered up) and make a few pathetic attempts to punch my partner while he was getting vitals. At this point my partner turned to me with a look of utter frustration.

"She's all yours Matty, maybe she'll reason with you" He said without enthusiasm.

I didn't expect much co-operation, but I did have a secret weapon up my sleeve, or on my sleeve, or it is a sleeve I guess I should say. I noticed that the patient was covered in many tattoo's all over her body (naked remember). I'm pretty heavily tattooed myself and figured maybe, just maybe we could find some common ground and get her the hell in the ambulance.

"Hi there, I'm Matt, don't worry about my partner anymore ok, you just talk with me and that's it, were gonna take you to the hospital"

"Cool tat's man! Where did you get em? Sleeves are sooooo cool, I wanna get sleeves one day, did you see this one on my hip? blah blah blah blah blah blah" Success!! Instant co-operation.

My ace in the hole worked and within minutes we were bumping down the road towards the ER.

The rest of the trip wasn't very remarkable except when it got to her medical history,

"So, do you have any health problems?"

She stared at me for a few seconds, obviously deciding if she should be honest with me or not, in the end I guess our tattoo's sealed the deal, she went on to list damn near every single STD I had ever heard of as her medical history.

Hhmm, gross, but thanks for the honesty.

I'm on days off now for four in a row. Excited to see what next tour can bring, fire call number 2 perhaps??

Flattery of a differnt sort....

2010-11-20T06:56:00.000-08:00

Today, I would like to talk about sex.

Hmmm, that sounds bad, let me re-word.

Today, I would like to talk about homosexuals.

Hmmm, ok that still sounds bad, I guess there is no way to tip toe around the subject, oh well, here goes.

Today I want to talk about my experiences with homosexuals on car, yes I've had enough gay patients to justify a whole post about them, and yes some of my experiences have been memorable for an assortment of reasons.

I'de like to start by saying that I have absolutely ZERO, literally less than zero issues with homosexuals and the gay community, my motto has always been to each his own and as long as people are happy and not harming others they should be free to do as they please. This post is meant to be humerous (I hope) and definitely NOT to stereotype or pigeonhole.

Anyways, on my last night shift, my partner and I were up at another station doing cross coverage because all of the city's other units were busy (very common situation these days). About 5 minutes before another unit cleared up, we were sent hot to a downtown bar.

"Medic 5 Delta response for a 30 year old male, intoxicated, fall down stairs, unconscious"

The downtown Engine company was already on scene by the time we showed up, they met me in the back alley and gave me the rundown as we took the back entrance into a trendy little cocktail bar.

As I walked down 20 or so steps I couldn't help but notice the blood all over each step. HHMMMM....

Sure enough at the bottom of the stairs, sitting up right in a bar chair, holding a bloody rag to his face was a very intoxicated male patient. We immobilized and got him into the back of the unit, at which point we cleared the engine company and it was just my partner and I in the back.

Now that things had slowed down a bit, I got a better look at my patient and took notice of a few things that I hadn't inside the bar. He looked like a normal everyday dude for the most part, there wasn't a thing about him that made him stand out, time for the assessment......

"So how do you feel now sir? Any different than when you were inside?"

"Ohh you know me, I'm doing A OK"

I leaned over the immobilized gentlemen so he could speak to a face and not just a voice.

"How is that pain in your head, worse? better?"

The patient stared at me in silence for a good long time, probably 15 seconds before finally answering...

"Your sexy"

"Umm, that must be the booze talking sir, how do YOU feel?"

"I feel that your sexy"

Ugghhh.

I looked over at my partner with a look of frustration and embarrassment on my face, he was all smiles...

"Whats the plan sexy, do you want me to get some vital signs for you??" He said before laughing out loud.

"Ok sir, we are going to check your blood pressure and then take you to the hospital, you had a nasty fall tonite, do you go to that bar often? how much have you had to drink tonite"

"I go there lots, you should stop by one time, don't bring your partner" He said as he pointed a drunken finger towards my now hysterical partner.

I tried being a little more authoritative, standing directly over the patient, with my arms above my head gripping the ceiling bars,

"Sir!, I need you to be serious when I ask you these questions OK, there are things I need to know and do before we go to the hospital"

"I am serious, I seriously loooooove your tattoo's" He replies,

I glance at my forearms which are obviously in his view and then quickly tuck them behind my back.

By then I was getting frustrated, the assessment was going no where because the patient was more interested in throwing me sexual innuendo's than answering my questions honestly.

I hope I haven't been offensive thus far in my post, I really don't mean to, the only reason I'm bringing up this particular patient is because he is just the most recent in a looooooong history of gay patients who have been "taken back" or whatever the phrase is, with me. I don't know what it is, but at the risk of sounding self centered, gay guys love me for some reason.

I remember one time back at my old urban job in another province, a young female partner and I picked up a guy at a phone booth, said he was suicidal. We got him into the back of the unit and almost instantly he started with the flattery. Normally this wouldn't be a big deal, but my partner just happened to be a very good looking female in her twenties, and the flattery wasn't directed at her...

At first I was just shrugging off the compliments and innuendo's, but eventually things got more than a little awkward. How awkward you ask? Well I'll leave it at this, the guy came right out and started asking me detailed questions regarding my male anatomy, questions vulgar enough to make me and my female partner blush.....and I don't blush easy!

Looking back, Ill bet I've had close to a dozen gay patients who have fit the above descriptions to a T. Really, it doesn't bother me, how can it? I have no problem whatsoever with the gay culture and its not like they are being disrespect full, as soon as I mention my wife they stop with the provocative stuff. I guess the reason I don't like these situations is because they catch me off guard, they fluster me. I can deal with suicidal teenagers without breaking a sweat, cracked out drug addicts? no problem, scared family members who's father is having a heart attack? I'll have them calm as a kitten in two sentences.

Now, put me in the back of an ambulance with a gay guy who is fascinated with me and has NO quips about saying so........awkward, and its not any less awkward even after a dozen or so similar patients.

Friday Gongshow

2010-11-13T08:59:00.000-08:00

I worked a day shift yesterday at a different hall and wouldn't you know....it was a gong show.

I cant really remember everything, but I'll do my best.

Call 1 - Granny from Emerg needed to be returned to the brand new seniors complex that just opened like two days ago. This new complex is absolutley HUGE and it is accepting all the residents of three smaller complexes that have recently closed.

Call 2 - Called to a downtown walk in clinic for a 50 year old guy with Chest Pain. Vitals were stable, 12 Lead unremarkable, ASA, NTG, IV, Diesel, unremarkable call with no follow up available.

Call 3 - "Delta" response to the same new seniors complex for an elderly lady who suffered a syncopal episode and fell out of her wheelchair. The lady had a long CVA history as well as severe dementia so she was hell to access. Vitals were fine, she was on thinners and had a huge hematoma on her forehead from the fall (presumably).

Call 4 - Went to another (different) downtown walk in clinic for an elderly lady complaining of one sided weakness. She looked fine and dandy when we showed up and talked more about all the "cutie firemen fretting over her" than her actual medical issues. No follow up.

Call 5 - After we just dropped off the flirty granny in Emerg, we were dispatched on a transfer for another elderly lady from the ward back to the SAME nursing home that we had been going too all day. The patient was young (only 55) but had severe MS that rendered her unable to speak or move much. As we pulled into the senior home we were greeted by another one of our crews wheeling an elderly guy out. (total EMS calls to the seniors home by all crews that day....10 trips in 12 hours). Anyways, it was kind of sad when we got up to our MS patient's room. We learned that our patient's neighbours down the hall at the new facility were no other that her mother and father (both in their 90's). We moved the patient into her bed and her mother and father came over in their wheelchairs to hold their daughters hand and welcome her "to our new home". Sad stuff.

Call 6 - About 10 minutes before shift change, sent out to the highway for an MVA. Everyone responded to this one, by everyone I mean us, an engine, the rescue truck, our Platoon Chief's unit, as well as two police cars. The MVA wasn't too bad, looks like an 18 year old girl was texting while driving and had a head on with an on-coming vehicle while she made her turn. The vehicle she hit wasn't just any old motorist though, it was an undercover Police suburban carrying four officers and two police dogs. No one was hurt and no one wanted to be transported to the hospital. The dogs sure were pissed though! I was standing kind of close to the suburban while they were getting ready to let the dogs out and the one cop came and grabbed my shoulder and pulled me away,

"Whats up?" I asked,

"Oh not much" he replied, "you just probably don't want to be standing close to those dogs when they are all jacked up"

Hhmm, point taken.

I think that was it, I'm back at my usual hall right now which is kind of nice seeing how we are the farthest station from that new seniors center!

Greener than green.....

2010-11-06T12:37:00.000-07:00

Today I want to talk about an issue in EMS that is really important to me, precepting (or teaching, training, mentoring, whatever your area calls it). I'll do my best not to go off on a very angry and expletive filled rant here, but this is an issue I have very strong feelings about, so no promises.

It is my own personal opinion that all new students and employees need to be nurtured and carefully guided. A new student needs to be made to feel comfortable and respected so that they may truly have the best possible opportunity to learn and grow. I'm not talking about hand holding here, I'm talking about setting the student up for success, not certain failure.

I'm not the greatest teacher around, hell I wasn't the best student and I'm certainly not the best Paramedic around, but I have been just that....around. I've been a student at all sorts of license levels and in all sorts of EMS systems, provincial, rural, urban, flight, Emergency Room, I've stood in all those areas as a bright eyed bushy tailed student or rookie, just waiting for the opportunity to learn or show what I knew. Some of my experiences were awesome and I will remember them for the rest of my career, others.....I don't want to talk about it, just kidding, that's the subject of this post so you bet I'm going to talk about it.

I remember being a Medic student in a busy urban area about three years ago. I was green, nervous, impressionable, and scared out of my mind. I met my preceptor (who was great) and her EMT partner (who was a prick). I hit it off great with my medic preceptor and tried my best during calls, but my progress was continuously hindered by the EMT who for whatever reason (I can think of several, jealously being the number 1) went out of his way to demoralize and intimidate me. I was on car with them for about 8 weeks and I can honestly say that I hated every minute of every shift. Yes of course I learned things, it would've been impossible not too, but I never truly had the learning experience that I should have had, all thanks to that burned out, bitter, prick of an EMT.

I'm sure EMS workers around the country and maybe even the world have heard of the whole "eat your young" mentality that is really prominent in certain parts of the industry. The idea is that young people coming into EMS need to "pay your dues" or "suck it up" until they have gained enough experience and seniority to then turn around and belittle the new guys that are coming up underneath them. Does this make any sense to you? I didn't to me the first time I heard some old burned-out idiot say it and it still doesn't make sense to me now. Oh, I forgot the classic line that really raises my eyebrow, "that's the way I was treated when I was new, what goes around comes around"

The minute I have some jaded old fart tell me that in defense of his treatment of a student or rookie is not coincidentally the same minute I classify them as useless.

"Well Matty its like this, when I first started, my preceptor would scream at me on calls until I'd just about piss my pants, that's just the way it was, what goes around comes around eh?!"

"Umm OK, now that your done talking why don't you go over to the other side of the room and think about the mistakes you've made in your career to to lead you to this pathetic stage, oh and by the way, don't talk to me anymore.....ever"

Am I bitter? You bet, I had some horrible experiences as both a student and a rookie paramedic, but I will never, NEVER take it out on another student or rookie, the worst I'll ever do is rant about it online on my blog (very therapeutic).

The bottom line is this, were all in it together. We all got into the business for more or less the same reasons, we thought being a Paramedic would be cool and we wanted to help people. Yes times have changed but that's inevitable. Education, training, teaching methods, experience levels, backgrounds, desires, goals, ambitions, these things will always be changing as time ticks by but every student or rookie that walks through that door has those two previously mentioned things in common, they think being a Paramedic will be cool, and they want to help people, how can they possible be faulted for that???

Also, the students and rookies of today, are the teachers and mentors and experienced providers of the future. I still have a long time left in this business (at least I think so) but what about you?? Ya YOU, the guy who treats new people like garbage for whatever reason, your not going to be around forever, actually, your probably not going to be around for a whole lot longer, do you really want the people that are going to continue on in your image to be miserable, angry and bitter? Well maybe you do, because your a looser, but I sure as hell don't want the EMS professionals of the future to be like you. But really, its not about you, and its not about me, its about the patients, they deserve the best and we should all strive to give it to them.

Students, rookies, greenhorns, whatever you call them, they all deserve a chance to prove what they know and what they can do.

Does screaming, yelling, belittling, intimidating, discouraging etc etc really set them up for success?

No.

Does it matter that that's how they did things back in YOUR day?

No.

Do today's students deserve to be treated the same way a lot of students were years and years ago?

No.

Does this post constitute a rant?

Maybe.......

Gas spills, babies, car wrecks and late calls....

2010-10-30T07:51:00.000-07:00

Yesterday's Day-shift went a little like this,

0830 - Engine call for a 'minor hazmat incident'. We arrived on scene, which was a deserted outlying gravel road where a truck was parked half in the ditch. Police were already on scene and they told us that the truck was stolen, trashed, and then deserted. The vehicle had leaked a bit of gas all over the road so we took care of the spill and were off scene fairly quickly. This call wasn't really that exciting but I was still pretty jacked seeing how it was only my second call on the engine!

1130 - We were sent to the local ER to pick up the NICU team and their islet. We transported the team to a nearby small town hospital where an 18 hour old baby was not doing well. The little girl's heart rate was dropping down into the 90's and she was having brief periods of apnea. The NICU team started a line and put on oxygen. Within half an hour or so we were cruising down the highway with the baby snuggled in the islet, at this point things got weird.

The monitor suddenly showed the babies heart rate to be in the 60's. The nurses attempted to palpate and count a pulse but of course couldn't because we were in the back of a moving ambulance. At this point the lead nurse began doing compressions. This caused me to put down my clip board and get involved.

I asked if they were able to palpate a pulse and I was quickly told "NO!!"

I looked at baby, who was squirming vigorously with skin pink as pink could be.

"Umm, do you want us to pull over for a few seconds so we can get an accurate heart rate?" I asked

"Absolutely not, GO GO GO GO!!!" she snapped back.

At this point my own personal defense mechanism against panicky rude people kicked in, I kick back and do my thing and leave them to wallow in the bad situation that they have put themselves in.

"Okee dokee" I said as I crossed my legs and went back to my paperwork.

Sure enough they stopped CPR after a few seconds due to the baby squirming and crying too much,

"ok ok, I guess her heart rate has stabilized" the lead nurse said.

Anyways we got to the NICU safe and sound and baby was doing fine (so I thought atleast) when we arrived.

1530 - Sent hot to a three vehicle MVA at the city's busiest intersection. A smaller car had been sandwiched between two much larger oil field pick up trucks, all moving at low speeds. Three patients were assessed and all three refused service.

1745 - 15 minutes before shift change, we were back at the hall catching up on paper work and of course....the tones went off and for what else than a stat transfer to the big trauma center 140km's away. Ugh, not to sound like a complainer, but nothing takes the wind out of your sails quiet like a five hour call that comes in with 15 minutes left in your shift.

The patient was on a spine board in our local ER when we arrived. The story goes he was involved in a high speed T Bone MVA, in which he was unrestrained and his vehicle rolled once. The poor guy had a sub arachnoid bleed that wasn't yet producing neuro compromise, as well as blood accumulating around both kidneys. His renal output was basically zero and what dripping into the foley was bloody and full of clots. His vitals were stable. The patient did well the whole transport and was actually quiet chatty, turned out he was an old medic that used to work in the very city we were transporting him too. We had an uneventful drop off at the trauma center and were back at our station by 2300, five hours after our scheduled shift's end.

I was supposed to go to a big Halloween party last night but truth be told I was pretty exhausted by the time I got home. I head to nights tonite for two before an anxiously anticipated four days off.

Time to sleep, back at it in six hours..............

Big Day

2010-10-28T18:18:00.000-07:00

Well today was a fairly big and important day in my career. After a month-long firefighting crash course and almost three months out on the floor, today was the day I did my level 1 Fire Fighter exams.

The written exam was first and it was surprisingly similar to my time in medic school, it was almost dejavu as I sat down and started thumbing through an exam that I hoped I had prepared enough for. The content was no where near what I thought it would be. The majority of the questions focused on sprinkler systems, apparatus safety, valves and fire theory, all chapters that I probably could've read threw another time or two (GULP) oh well, I'm sure I did fine, I didn't leave the room with a sense of impending doom so I guess that's a good thing.

The practical consisted of five separate evolutions.

- Donning bunker gear in under 60 seconds
- Donning SCBA in under 60 seconds
- Forcible entry using steel door prop
- Confined space egress
- Hydraulic ventilation

Overall things went pretty well I think. Seeing how I haven't had a chance to practise any of these skills since orientation three months ago, the evolutions today required me to 'shake the cobwebs' so to speak. My only disappointment about the practical evolutions is that we didn't do any hoisting or knot tying, just my luck, the two skills that I had practised excessively and could do in my sleep weren't even tested! Oh well, regardless of the skills that were tested, my fellow proby's and I all walked off the training grounds as full fledged Fire Fighter 1's!

The testing was over by 1400 or so and I was sent up to a hall in a fancier residential part of town to finish off my shift. Things were pretty slow until 1730 when an 'alarms ringing' call came in. We donned our gear and SCBA's and withing seconds were bouncing down the road to the call. Things weren't too serious in the end though, just a carbon monoxide alarm going off. We vented the garage, watched the gas levels return to zero, the captain had a quick chat with the home's residents who showed up on scene just after us and then just as fast as we showed up, we left.

Back at er tomorrow, I'm back at my usual hall and am scheduled to be on the ambulance for the day. Oh and we also have another fire safety presentation to a group of third graders tomorrow, how could I forget that!

The most terrifying moment of my career........kind of......

2010-10-21T16:02:00.001-07:00

Had an interesting experience at work today, it was an experience that had me sweating bullets before, during, and after. An experience that will go down as a milestone in my Firefighting/Paramedic career. An experience that I will never, ever, EVER forget.

Today,

At exactly 1330,

I went to a local elementary school to give a presentation on fire safety to a bunch of third graders.

Exaggerating much? Maybe, maybe not.

Like many others, I am not particularly comfortable with public speaking. I can do it, and do it fairly well in my opinion, but it always rattles my nerves like nothing else can.

I was informed almost a month ago that my station would be giving the presentation on the set date and I would wager that 90% of my time since the announcement has been spent worrying about it.

"Whats the big deal?" You ask, "Their just kids" You say, well yes that is true but for a guy who has no kids of his own, no friends with kids of their own, and no family with kids that age, being tasked with entertaining forty 3rd graders for forty five minutes is kind of a big deal.

To further add to my stress during the last month, my fellow firefighters have been heckling and taunting me non stop,

"You'd better be funny Matty, If your not funny their not gonna listen"

"We usually split the presentation up Matty, but this time I think you can do it all and we'll sit down with the kids and listen"

And of course this one which got me really worked up,

"Since your the proby, YOUR the one putting on the sparky the dog costume and talking about matches"

What? Sparky the dog? Are you serious??

Turns out my coworkers weren't serious (as I suspected). Prior to the presentation, we divided up the forty minute talk into equal parts and then spent some time practising and rehearsing.

Finally the big moment came. I stood at the front of the classroom (the other FF's off to the side) while the little rascals filed in quickly. Some gave me high-fives, some shouted "HI!" and some just stared. I was still nervous, but as I looked out at a room full of smiling kids, I realized that I was 'good nervous'.

I was blown away but how great the kids were. Yes some of them talked out of turn, yes some of them had some weird awkward questions, and yes trying to keep the attention of a room full of eight year olds was challenging, but getting up in front of the kids and speaking wasn't nearly as hard as I thought it was. I talked about house escape routes during a fire, another member talked about matches and lighters, and another did a little smoke alarm demonstration. At the end of the speeches, we played a little cartoon video that the kids seemed to love more than anything and then bam, next thing I knew the kids were filing out of the room waving and high-fiving.

Overall things went great. The kids learned a little, I learned a little, and we walked out of the school having just done something cool for our community.

On a parting note, the funniest moment of the presentation (at least I thought so) was during the part about smoke detectors. I asked the kids if they knew what a smoke detector was used for and of course they all put their hands up. I pointed to a kid in the front row,

"Go ahead big guy, what's a smoke detector used for?"

He looked at me stone faced,

"At my house, when supper is ready, my mom yells for us to come downstairs but if we don't come, my dad will press the smoke alarm on until we come down....its loud!"

And no, I didn't manage to keep a straight face after that one.

The writings on the wall......

2010-10-17T04:05:00.000-07:00

2nd day-shift last tour, around 0900, just as I finished my morning workout to start the day,

"Medic 5 Engine 5, respond Charlie to Hotel located at XXX-XXXXX St for a 28 year old female, bug bite, short of breath"

Ah the possibilities, could it be legit? An allergic reaction? Someone over-reacting? True Anaphylaxis? Only one way to find out........

We arrived on scene to quite possibly the greasiest hotel I have ever seen (and I've seen a few), the hotel manager greeted us in the parking lot and told us that the lady in room XYZ has been screaming all morning and needed help. She was apparently too hurt or sick to get to the door to let us in, so the manager ran back to the front desk to get his master key.

While he was gone, I started to talk to the woman through the door,

"Miss, we are just outside, were the Paramedics and were going to help, whats going on?" I said calmly.

"AAAHHHHHH it hurts it hurts it FU%KING HURTS!!!!" the woman replied not so calmly.

"Miss, the door is locked and the manager is on his way to let us in, slow your breathing down, nice and calm, and we will be able to help you in a few seconds ok"

Not surprisingly, my calm baritone did nothing to calm the patient down.

The manager was mumbling angrily under his breath as he trudged up the stairs to the door.

"She's been here for a few weeks now, always yelling, always making racket, I want her gone!" he said as he swiped the card to unlock the door, not having a witty remark for him, his statement was ignored.

I entered the room and couldn't help but take note of the surroundings. Pizza boxes everywhere?, yup, Empty beer bottles scattered around? you betcha, dirty stinkin soiled clothes covering the floor? of course, ashtray overflowing with cigarette butts and empty smoke packs everywhere? Check and check. Yes all those things were present and accounted for but they weren't what caught my attention, the writings on the wall however, did.

The walls, the mirrors, the coffee table, the bathroom counter, the bedside table, even the ceiling were all covered with incoherent ramblings in a mixture of black felt marker and red lipstick. It looked alot like that scene from 'The Shining' when Jack Nicholson's wife finds him in that room with his typewriter and all the walls are scribbled over, although I'm sure that particular movie set didn't smell so bad.

In the back room where the bed was located, I found the source of the screams and howls.

Lying on the bed, was a female patient in her late 20's.

"Morning Miss, whats the problem?"

Her blood shot eyes found mine and locked on,

"Ah, mister, m-m-m-mister, a bug bit me, it fu%kin bit me!"

As she spoke her entire body seemed to twitch and tremble, she picked at her face every three seconds and was constantly poking at a sore on her lip with her tongue.

"Ok ok, calm down, we'll take care of it, where did the bug bite you?" I asked.

The patient, we'll call her "Suzy" proceeded to pull down the blankets that were covering her lower body. Luckily for me I think she was too messed up to see the surprise on my face. Her entire right thigh was red and swollen. Red streaks raced away from her thigh and spiraled all the way down her leg to her toes. About halfway between her hip and knee, was a red, raised, nasty looking sore about an inch in diameter, even from where I was standing I could see (and smell) red and yellow pus oozing from it.

Suzy began to tell me the story. Apparently she rents the hotel room by the week with her boyfriend who was currently out of town. She was laying on the couch two nights ago when she felt a sudden pain on her leg. She didn't actually see a bug on her, but she immediately saw what looked like a bug bite. She said the next morning her leg was sore and numb with an angry looking sore on it. For the next 24 hours she did nothing but lay in bed and smoke cigarettes, hoping the sore would clear up.

I asked her if she had been picking at it or squeezing it, as she was telling me "no no of course not" I noticed all the crumpled up balls of blood and pus covered tissue all over the floor.

We got Suzy loaded up into the unit and as I was taking some vitals she confessed to smoking crack cocaine for the last seven days.

If I was skeptical of her denying any wound picking before, I was REALLY skeptical now.

"Suzy, you can be honest with me, you wont get in any trouble ok, have you been picking at your leg?"

She locked eyes with me again,

"Well, maybe a little" she admitted, sounding like a kid confessing to something she'd long denied.

Taking advantage of Suzi's sudden bout of honesty, I asked her about the scribbles all over her walls. She told me that whenever her or her boyfriend would leave the room, they would leave little notes to each other about where they were going and when they would be home. She told me that sometimes she leaves in the middle of the night and wants him to know where she went without having to wake him.

"Where are you going in the middle of the night?" I almost asked but decided not to, what do I care? I can only imagine where Suzy goes in the middle of the night.

"I used to live with my family" Suzy tells me, "a few months ago I met my boyfriend and now were on our own, were only in the hotel room till we find an apartment"

Suzy had now gone three whole minutes without screaming and picking at her face, maybe she liked talking to me, maybe she felt like clearing her conscience, maybe it had nothing to do with me personally and she just wanted to talk....to anyone.

Suzy started to cry, not from the pain, but from her honesty, I don't think she had been so open with anyone, not even herself, for along time.

As she sobbed gently, I couldn't help but notice her face. Suzy was 28, but she looked in her 40's. Her hair was ratty and whispy, her face covered in sores, her arms frail and covered in bruises and her eyes were wide, dilated, and sunken in her gaunt face. The one thing that really stood out however, were her teeth. She had the most perfect teeth I had ever seen. They were surely expensive pearly white porcelain veneers. Her perfect teeth told me that up until recently, she had been living a very different, very normal lifestyle. Her transition to crack cocaine and hotel rooms hadn't yet affected her teeth, but it would sooner or later if she stayed on her current path.

We got her to the hospital safe and sound. As soon as we rolled into Emerg Suzy changed her screaming from vague complaints about her pain to specific demands for narcotics....Morphine specifically.

Scribbles and screams aside, it was kind of sad. Suzy obviously had issues, but when she locked eyes with me through out the call, it was like I could see threw what she had become, like I could see her before the drugs and the hotel rooms and the middle of the night errands. Not everyone chooses the same or even remotely same paths in life, all we can do is learn that every choice we make has consequences that eventually must be dealt with. I don't know whats going to happen to Suzy, but hopefully she'll make some important decisions in the near future. Who knows, maybe a nasty infected bug bite will be the catalyst she needs to make some changes..........

Bariatric Geriatric.............

2010-10-11T05:39:00.000-07:00

Around 0930 yesterday, tones went off for my hall,

"Medic 2 Engine 2 respond Delta for a 70 year old female bariatric patient with difficulty breathing"

We responded to a nearby care home where I was greeted by several care aid staff,

"We moved her to her wheel chair this morning and then she started breathing funny and turned purple" they told me.

Hmmm, my extensive medical training combined with my various experiences has taught me that people should not turn purple, this could be serious.

I got kind of focused on thinking about her breathing as I was walking down the hall towards her room, I was so focused in fact, that I totally forgot that the dispatch info said the patient was bariatric, I was reminded of the fact the second I opened the door.

Stuffed into a tiny electric motor-chair was a very short of breath woman who we soon learned weighed around 500 lbs.

I've had a few bariatric patients in my days, 300 and even 400 pounders, but this woman (no offense implied) was by and far the biggest patient I have ever dealt with.

"Um, hi there, are you having some trouble breathing this morning?" I asked, kind of a dumb question but it gets the ball rolling.

She looked up at me with eyes as big as horses eyes,

"What do YOU think!!" She barked with a voice deep and loud, sounding like Darth Vader with a mega phone.

By this point in the call we all kind of settled down and training took over. My general rule of thumb is that if a patient is well enough to give me sas or attitude, they're usually not 'peri-arrest' sick.

VS were as follows,

HR - Irregular 100-130 bpm
RR - 32
GCS - 15
SPO2 - 84% on 3 litres of home O2

An NRB brought her SPO2 up quickly to 97%, her work of breathing eased a bit and the color in her lips returned to normal. She was actually lucky that the 02 helped her so much because after I put it on, it took me and my coworkers over half an hour to figure out just how the heck we were going to get her out to the ambulance.

As I was starting an IV and putting on the cardiac monitor, I could hear my Captain and his officers talking with the staff, brainstorming possible transport options. Captain wanted to get the city's medi-bus with the platform lift down to the scene so we could transport without moving her from her chair. A quick call to the city told us that the medi-bus didnt run on Sundays, hmmmmm.

Another option was somehow getting the patient to lie flat on the floor of our ambulance while we transported. Just to clarify, YES she really was that wide, putting her on the stretcher could be done, but the top heaviness would possibly be too much.

Option number three was to use as much manpower as necessary to get her on our stretcher and KEEP her on our stretcher (using ropes, straps, whatever) and take her to the ER that way.

Throughout all our brainstorming, I should point out that the patient was in good spirits and was at no time offended by the ordeal, she had been through it before and had a good attitude about everything.

"Lookit all these cutie firemen fretting over me" She'd whisper to a care aide loud enough for everyone to hear,

" I wonder which one will give this ol'girl a hug, I haven't had a hug in a long time!"

Awkward stares, greeted that last statement, hugs are normally no big deal, lots of old ladies ask for them, but this lady was huge AND MRSA positive, I dont normally make a habit of giving hugs to MRSA positive patients, but thats just me.

Finally, Captain decided that putting her on our stretcher and securing her as best we could would be the best option. We lowered the cot as close to the floor as we dared, and the care home staff used their lift machine to raise the patient up into the air.

As the woman's weight was slowly lowered, our stretcher started making these horrible moaning and groaning sounds, basically it sounded like it was going to break at any second.

"Did we check if she's heavier than the stretchers rated for?" I asked no one in particular.

Everybody eyed each other quickly but said nothing.

"How much DOES she weigh" Captain asked the staff.

The reply? Officially 515 lbs, a whole 35 lbs less than our stretchers are rated for.

The stretcher did hold the weight, but now we were presented with the problem of retaining the woman's girth to the confines of the stretcher. Abdominal tissue was spilling over the sides of the cot so much that we were unable to put up the cots side rails. The cot straps were no where near long enough to reach around the patient, so we ended up having to use three extensions just to make a single belt long enough. To keep the patients immobile legs (which were the very definition of extreme cellulitis) on the cot at all times, we had to create a fastening device out of four lengths of triangular bandages. We pushed and pulled the stretcher out to the ambulance and required no less than six Firemedics to lift the stretcher into the unit.

The patient did fine during transport, we made it too the hospital safe and sound but the two extra guys I brought with me in the back were busy the whole transport keeping their hands on the patients sizeable belly to keep it from swaying side to side and possibly toppling over during corners.

In the ambulance bay, a RN and Doctor greeted us as soon as the doors opened just so they could get an idea of what kind of resources would be needed to accommodate the patient. In the end, we used eight people and a plastic slider board to get the patient into her hospital bed, safe and sound, to get the help she needed.

This call really wasn't very complex are far as medial presentation went. She was SOB, oxygen helped, VS stabilized, ECG + IV and that's basically it. However, the logistics of moving a patient of 500 lbs were something all together that I wasn't prepared for, but with a little teamwork, some manpower, and the occasional awkward laugh ("who's giving me a hug!?") we got through the call.

Example of a Bariatric Transport Ambulance, lifts up to 1600lbs

Palpitations Palpitations

2010-10-02T05:37:00.001-07:00

Well another tour is in the books and thank God it was fairly slow, I've got enough to do this month in addition to ambulance calls and only so much time to do it in.

My first nightshift was kinda busy however, we were basically up all night transferring out of town and then covering a nearby town who's units were busy doing calls in our town (transition to a provincial service.....don't ask!).

Nightshift #1 was like so.....

Call 1 - Right at shift start, 1800, sent to the local hospital to transfer out a younger female patient who was having runs of PSVT. To complicate things a bit, she was 32 weeks gestation, primipara.

The patient seemed ok when we arrived, vitals were stable and ECG was just a slow and steady sinus bradycardia. The story was that all through her pregnancy she had been having periodic episodes of palpitations. Finally, that day she had an episode at work that almost caused her to lose consciousness. She had a HR of 220bpm upon arrival with a BP in the 90's. She was treated with beta blockers in the ER which slowed her HR but subsequently dropped her pressure into the 60 systolic range. She was given a couple litres of fluid and her condition had somewhat stabilized by the time we showed up.

All through transport she stayed stable. This might sound kind of perverse, but for a while there I was kind of hoping she would shoot up into the 220's again, just so I could give Metoprolol for a change but then I reminded myself that she was pregnant and thought "hhmm, maybe I don't hope that happens".

Mom actually turned out to be a pretty cool person. As with most two hour transports into the city, I had a lot of opportunity to chat with my patient and get to know them a bit. It's always neat to talk to soon-to-be first time moms, some are excited, some are terrified, some more prepared than others, but almost all of them have the same sort of look on their face, the one that says "its been a long haul and I am SO ready to not be pregnant anymore".

Call 2 - On our way back from the city we were re-routed into a nearby town to provide some coverage while the local units were busy. It was pretty peaceful, 0100, sitting with a coffee in the unit down by the lake. I really like the feeling of being up 'workin' while the rest of the world sleeps. All good things come to an end however, around 0130 we got a call in a very posh residential area.

We pulled up in front of a very big and very nice looking house on the lake, we entered quickly and found a 50 year old lady lying on the couch. She was complaining of palpitations that had started an hour or so ago and seemed to be getting worse. She had no prior cardiac history and was quiet healthy are far as she knew. VS were initially stable and her ECG showed just a sinus rhythm around 90bpm.

While we were transporting in, my partner gave a small fluid bolus which slowed her HR into the low 70's. The patient then began to complain of 8/10 chest pressure which he treated with ASA/NTG. 12 was unremarkable and VS remained stable the whole way in. No follow up available.

Call 3 - After a couple hour nap on the couch, my halls ambulance and fire engine were sent to a downtown hall for coverage. This call came in around 0500, just a few minutes after the downtown hall was sent to a structure fire. I'm still pretty new to the fire side of things, but I've been around enough to know that a structure fire call can clear out a station pretty fast. Responding to the fire were two engines, a ladder unit, an ambulance, a rescue unit, and our supervisor unit. The fire was pretty small I guess, they had knockdown (fire out or control of the fire) 10 minutes after arrival on scene and by 0700 or so we were back at our hall, waiting out the last hour of our shift.

Speaking of the fire side of things, at the end of October I as well as a few fellow probys will be taking our entry fire exams or 10-1's. The testing consists of a lengthy written exam and several practical exams. I feel more than prepared for the written, I usually do well on written tests but the practical components are a whole different story.

Its not that the skills are new to me, I DID get extensive training on them in orientation, but that was almost three months ago now. Maybe its just nerves, or maybe its just nerves and a bit of rust, but I cant help but feel a little less that confident. Oh well, nothing I can do about it except keep hitting the books and keep running through the motions whenever I have down time at the hall.

Anyways, back at work on Monday morning.........

Just a tad awkward.......

2010-09-25T15:49:00.000-07:00

Well another tour has come and gone, this particular set of shifts was slow but hey, its still experience.

I did have two patients on my last night-shift that are worth mentioning, not because they were complex or challenging cases, but because they both provided my partner and I with some awkward silences........

Awkward moment #1 - "Medic 5 respond to xxxxx-xxxx for a 30yr female patient having abdominal pain". The call was actually in another stations coverage area but they always seem to be busy so we do a fair amount of work in their neighbourhood. We pulled into the 'ghetto' and approached the entrance way of a ratty apartment complex and right away we saw two people outside the building waving us over. I jumped out and started walking in their direction.

"She's hurt mister, her insides hurt really bad" A tall skinny guy with a pony tail called out as I approached.

I did a quick assessment of the guys friend who was on her feet but doubled over clutching her stomach. Seeing how we were only ten feet from the unit we walked her over and got her settled on the cot.

The patient wasnt really giving me a good story, she kept rambling aimlessly about her house, dogs, drug use, religious beliefs etc etc etc, it was almost impossible to get her to stay on the topic of her abdominal pain. Growing semi-impatient, I turned to the guy that was with her for some info.

"Sir can you tell me whats going on with your friends here tonite?"

Without missing a beat he responds,

"My name is Jessica and she's not my friend she's my girlfriend"

...........Hhmmmm.......

I stared back at him blankly for a second or two, kind of speechless. At first I thought that I screwed up someone's gender by not really looking at them before I started talking to them, its happened before and is always awkward for a second. This person was different, he/she looked NOTHING like a woman. He/she had a prominent adams apple, a jaw squarer than mine and even Clint Eastwood type stubble on his face. I had to do my best not to let out a chuckle. After a couple seconds though I remembered that there is some weird people out there and that this person was just another one of many.

'Jessica' gives me a bit of history about her his/her girlfriend and I use what I can. You want a challenge? try having a serious conversation about ectopic pregnancies with a person who basically has a beard and is looking at you stone faced telling you their name is Jessica........

Awkward moment #2 - Same night, around 2300, "Medic 5 respond to xxxxx-xxxx for an 11 year old girl having an allergic reaction" The scene wasn't far away and surprise surprise it was in the ghetto again. I grabbed the kit and monitor and started up the stairs to the third floor of a greasy apartment complex. Mom met me at the door, talking a mile a minute and looking damn close to the definition of an anxiety attack.

"Its my daughter, she's swelling up, she says she cant hardly breathe!!" she screams.

"Ok mam just try to slow yourself down, were here and were gonna help ok, now where is your daughter?"

She leads me into her apartment and there standing in the kitchen is a red headed kid, around 10 years old or so. The kid has red hair, freckles, a chubby face, and gives me a non chalant "Yo" as I enter.

"Ummm, hey there big guy, where's your sister with the allergies at?" I ask.

Mom is right behind me but doesn't say anything right away........she is waiting for me to catch my mistake I guess.

A couple seconds pass in silence, just enough time for me to think to myself,

"shit! twice in one night!"

I ask the kids name and she tells me Danielle. I ask her if she's the one I'm there to see and she says ya.

Now before you think to yourself that I'm either an idiot or blind, you have to understand that this little girl looked EXACTLY like a boy, I'm not kidding or exaggerating. If the mom and the kid wouldn't of said anything I never in a million years would of thought the kid was a girl. We got the kid into the unit (she was fine, mom was just freaked) and during transport I STILL couldn't believe that she was a girl and that I'd screwed that up, nothing to do but laugh about it afterwords I guess. The one thing that made me feel better was when the whole boy/girl thing was replayed at the ER with the triage nurse. I guess I could've given the nurse a heads up but part of me wanted to see if my judgement was really that bad. Turns out it wasn't, maybe I should have brought 'Jessica' into triage for a second opinion as well.......

Slow down Jackass!!!

2010-09-21T05:59:00.000-07:00

Today I want to talk about a subject that I believe is very very overlooked in our business, driving. More importantly I want to talk about GOOD driving, however any discussion on good driving inevitably leads to bad driving, that's OK, I'll talk about that too.

I'm going to go on a limb here and say that 80% of ambulance calls require only two things,

1 - Genuine kindness/caring

2 - A nice smooth drive to the hospital

Now, number 1 is a topic for a whole other day, but number 2 is something that I believe is even easier to do than number 1.

A smooth ride to the hospital is really the bare minimum of what we owe our patients. Not everyone who calls an ambulance needs an IV or oxygen or a fluid bolus, but EVERY patient that is transported deserves to be driven in a safe and smooth manner.

I can hear the questions coming already,

"But why??, were getting them there irregardless, ambulances are bumpy!"

Well why do you think? The way the ambulance ride 'feels' to your patient in the back is going to be the number 1 thing that they remember (providing your not doing something really memorable like poking them five times with an IV needle), especially when they tell their grand kids or family Doctor about the trip.

Imagine this scene, 70 year old granny calls the ambulance because her feet are swelled more than normal (could happen). You and your partner show up and do your thing and within 15 minutes or so you have granny all settled in the back of the unit. As she starts telling you about how she used to be an orderly at the hospital back in the 40's, you give you partner the thumbs up and he/she heads off to the hospital. During the drive your partner hits speed bumps way too fast, nails every pothole dead on, slams on the brakes at every stop, and takes corners at lightning speed. In turn, all these actions are felt in the back as various amounts of yaw, pitch, and rotational forces (that's as sciency as this talk gets don't worry). Now, the ride in the back might not be so bumpy that you cant work, but you and most importantly your patient take notice, maybe even so much so that your elderly patient says something that we've all heard probably a hundred times, "my goodness these ambulances are bumpy!".

Trust me, as soon as granny is out of your care, she will tell her story of the bumpy ambulance ride to ANYONE who will listen.
When the grand kids come to visit,
"How was the ambulance ride grandma?"
"Oh my heavens was it ever bumpy!"
Or how about when she's sitting down for tea with her friends,
"Now Ethel, how was your trip to see the Doctor dear?"
"Oh it was fine just fine, mercy was that ambulance every bumpy though, pass the sugar please"

See what I mean? Word gets around fast regarding people's ambulance rides both good and bad. So what can we as EMS workers do? IS there anything we can do, after all the roads are bumpy and most units shocks and brakes have seen better days. Well for starters, here's a list of do's and dont's when it comes to driving with a patient in the back,

Do accelerate gently,
Do brake softly,
Do obey all speed limits, remembering that the posted speed is the maximum NOT the minimum recommended speed,
Do enter corners properly, 90% of all braking should be done before entering the turn, this is a big one that lots of drivers ignore,
Do slow down for speed bumps, otherwise it feels like an earthquake in the back,
Do focus on the friggin road! Put your cellphone away and keep the music to a dull roar,
Do ease off the brakes when stopping at a light or intersection, easing off a second or two before a complete stop prevents the sudden pitch forward that is commonly felt in the back,
Do be considerate, the patient in the back is someones mother/granny/wife/brother/husband etc and they deserve the best you can give them, so do it!

Don't speed, even 10km/hr above the limit can be felt in the back, 99% of the time, the extra speed is unwarranted,
Don't slam on the brakes, the weight of the unit will continue to travel forward and then rebound backwards slightly, this feel like a surging whiplash motion in the back and isn't very pleasant,
Don't take corners too fast, this causes the people in the back to grab onto something sturdy and go "whoooah" or at least think it,
Don't talk on your cellphone, I CANT stress this enough, not only is it extremely dangerous and against the law in lots of areas, but its probably one of the worst things that your patient can remember you doing, imagine your mother telling you that during her ambulance ride the driver was on his cellphone....

And finally...

Don't be a jackass, this person called the ambulance and wants our help, whether they need it or not or whether your tired or not or whether your on OT or not is beside the point. We are in a service based business here people and the way the public perceives us and our services is a HUGE part of our future.

Oh and just a end note, Its 0745 as I write this and I would like to mention that my partners driving during the previous 13 hours was textbook perfect, good job partner, the smooth rides were very much appreciated.......see, didn't I tell you word travels fast?

Tiny little fingers and Toes.......

2010-09-15T07:17:00.000-07:00

Sunday night was my first night shift of my most recent tour, things were fairly slow all shift until the tones went off around 0530...

"Medic 5 responds Charlie to XXXXX-XXXXX street for a woman who just delivered at home, baby unresponsive"

Hmmmmm, that radio transmission sure as hell woke me up in a hurry. Thirty seconds from the tones and we were out the door, blasting down the street, heading deep into the rats nest of the city for a new born baby that apparently wasn't doing too great.

We arrived on scene the same time as the support engine from another hall. Seeing how I was in the attendants chair, I grabbed the airway bag and made a B line to the dingy apartment buildings entrance (kicking beer cans out of my way as I went).

At the front door was a young man, maybe thirty years old or so, with a cell phone in his hand and one hell of a panic stricken look on his face.

"Up stairs! Follow me!" he croaked,

"Lead the way buddy" says me, and up we went.

I stoped at the correct suite number and opened the door. Greeting me in the entrance way was a woman totally naked, with a bloody baby in her arms and the umbillical cord still dangling. The sight was a bit of a surprise to say the lease, I was prepared for a apenic or pulseless baby but not that! Mom quickly ran towards me, (cord swaying wildly as she did) and thrust the baby into my arms......

"Look, Look! isn't she beautiful!!"

I looked down into my arms and I couldn't believe it, she was beautiful. Staring back at me was a tiny, pink little baby girl, ten fingers and ten toes, breathing fine, good colour, and the biggest most curious looking eyes I've ever seen.

"She most certainly is beautiful mam" I replied, "now why don't you have a seat and we'll have a look at you and your daughter.

So the story went a little like this, mom was full term with her first baby and had just seen her doctor the previous day. She was instructed to go home and wait for her water to break and that everything would be fine. Around 0500, she felt a little pressure, kind of like she had to take a bowel movement, so she went into the bathroom and sat on the toilet. Sixty seconds and a couple small pushes later, her baby daughter was born. The husband was on the phone with our dispatchers and was instructed to clean baby up and to cut the cord with whatever he had nearby (scissors and a shoe string was what he used). By the time we showed up baby was doing great, pinky, happy, curious, healthy, I couldn't find a single thing wrong with the little girl.

Mom did good as well. We bundled her up and took some vitals, and after eight minutes or so on scene we were en route to the ER.

Even though I we didn't really need to DO much on this call, it was hard to not feel like a champ after an experience like this. It's been awhile since I've had a really fulfilling call, one that reminds me why I got into this business, one that reminds me how cool my job really is, but this was definitely that type of call. Its pretty neat to realize that I was a part of these people's life for probably one of their most memorable moments. Nothing will ever change that. Regardless of what I do or where I go in the future, for those 45 minutes or so on that early Monday morning, I held and cared for a new and innocent life that began under much less than ideal circumstances. Coworkers, bosses, mortgages, finances, bills, and other stresses all seemed to fade into the distance as I held that little baby.

That call gave me the answer to the question that I think every Paramedics asks themselves from time to time,

"Why do I do what I do?"

Answer? "Because, its what I do!"

Thank God for Fentanyl!

2010-09-12T18:27:00.000-07:00

Well we were all sitting around the hall yesterday discussing the finer points of a recent football game, when the tones went off.....

"Medic 5 bravo response for a 14yr old male, mountain bike accident at location XXXXX-XXX"

Thirty seconds later were out the door, lights on, sirens wailing, tearing down the road to a local bike park that consists of various jumps, platforms, moguls and half pipes.

Being new to the area, it was my first time at the bike park, but apparently it has quiet the reputation with local EMS. For starters, its a popular area for teenagers to hang out and smoke 'left handed cigarettes'. Due to the terrain, a bit of THC, and good old fashioned teenage male hormones, the spot produces half a dozen fairly serious ambulance calls a year.

We pulled on scene and immediately called for back-up. The bike park was located on a fairly steep slope about 300ft from top to bottom. The best way I can describe it is like a small ski hill with a bunch of sketchy looking wooden jumps, oh and instead of snow the ground was good old squishy mud, the kind that tries to pull your boots off with every step.

Not seeing anyone at the bottom of the hill, we got out and started getting geared up for a hike. As I was throwing the airway kit over my shoulder I could hear some faint yelling, I looked up and squinted hard and somewhere near the middle of the hill, just at the base of a wooden ramp, was a woman jumping up and down and waving her arms. (Side note, no one can grab a medics attention quite like a distraught mom can).

We hiked up the hill with all our equipment and tried to not act too out of breath when we got to the top. The scene looked pretty similar to what I had in my mind during the trek up.

At the base of a wooden ramp was a teenage male patient, lying on his side and moaning softly. The parents informed me that they were watching their son take jumps with his new bike and that he had missed the landing of the one jump and landed hard on the ground. He did not loose consciousness and was wearing a full face helmet.

Initial exam was like so...

LOC- Conscious and alert, GCS 15
D-No neck/head pain
Airway-Patent
Breathing-Non laboured
Circulation-Strong regular radial pulse.
Patient denied any LOC,dizziness,headache, or neck pain. Pupils were equal + reactive with no visual disturbances. Denied any CP/SOB, =Air Entry X 6 Posterior, chest wall was stable to palpation. Back appeared uninjured, pain free on palpation. Abdomen was soft non tender X 4, no bruising, nausea present but no vomiting. Hips were stable to palpation. Left leg was unremarkable. Right leg was very swollen, bruised and extremely painful to palpation, specifically in the anterior mid 3rd between the knee and hip. Skin was not opened, and crepitus was not noted although the leg was slightly deformed. Distal circulation was intact with good cap refill, skin colour and a strong post tibial pulse. Upper extrems were unremarkable with = grips and no pain voiced.

While my partner got an IV ready I took a second and stood up. I looked down the huge slippery hill and then looked up the huge slippery hill......then I looked down again.....then up again.
"uuggghhh great" I muttered, getting this poor kid off this hill and into the unit, WASN'T gonna be fun.

I tried not to worry about it too much though, backup was en route and in the meantime there wasn't much I could do except comfort the patient and treat his pain.

I started an IV in the kids hand and gave some anti-emetic. Next up was Fentanyl....good old reliable Fentanyl. 50mcg and the kids fists unclenched, 100mcg and his jaw relaxed, 150mcg and he stoped biting his lip, 200mcg and we could manipulate his leg into a splint with only minimal discomfort.

When back up arrived they came with a wheeled basket stretcher and lots of manpower, six firemedics in all, plus my partner and I. After getting the kid supine on a backboard, we used a Sager Split on his leg and then bundled him into the basket stretcher. I haven't used the basket stretcher before but I gotta admit it worked pretty slick. I'm sure most people know what a basket stretcher is and ours probably isn't any different except for the huge wheel attached to the bottom that provides the patient compartment with about 3feet of clearance from the ground. All it took was four guys to manipulate the contraption to the bottom of the hill. The ride couldn't of been that bumpy because the kid didn't mention his leg once during the five minute trip, he nodded off several times and when he did happen to wake up, he just muttered something about how much ass his new iphone kicked.

The trip to the ER was uneventful, the patient slept the whole way and all I did in the back was reassess, keep the 02 going and hang up a bag of Saline. Just as the nurses were getting the kid settled into bed the patients mom somehow tracked me down in the hallway and said thank you about a hundred times. Not being able to think of anything cleaver to say I just told her 'your welcome' and took off for the bay. I've said it many times and I will say it many times more, one of my favorite things to do as a medic is to take someone who is in pain and scared, and make them comfortable and at ease.

Anyways, I'm on nights now for tonite and tomorrow. If things are event full then you'll hear from me soon, if not I'll post sometime during my days off.

Time to go make sure the unit has plenty of Fentanyl........just in case.

Six weeks in an dual Fire/EMS service and I've learned.......

2010-09-06T07:38:00.000-07:00

Well time for a little personal reflection I guess. Just to recap for anyone who is just jumping into my blog at this point, back in July I was hired on with a dual Fire/EMS service after about four years of strictly EMS experience. For a guy like me with no fire experience and a whole bunch of preconceived notions, it was a pretty big move. I've been on the floor for six weeks now (after a month of orientation) and thought I would post some of the things I've learned, points I've noticed, and experiences I've had.

The first thing I noticed about my dual service is that the level of camaraderie and companionship is sky high. Now this is just my opinion, but in my experience EMS has a sort of 'eat your young' and 'pay you dues' mentality. Yes yes I know its not like that everywhere so please don't think I'm knocking you or your service personally, this is just MY opinion.
When I was in strictly EMS services, I was in the position of 'new guy' a few times and I always noticed how the more senior medics and EMT's seemed to have a chip of varying size on their shoulders. Some were great towards me and my inexperience, actually lots were great, but more than alot seemed to be frustrated/offended/pissed off that I was even there in the first place.
As I gained a bit of experience in EMS and started having young students of my own, the negative mentality towards newbies became even more evident (at least to me).
Older medics used to say things to me like "ya gotta pay your dues rook, I was fed shit for years and years when I started, that's just how it is" and then they would turn around and yell at the new guy for pressing the wrong button on the radio or taken a second too long on their primary survey.

Phrases like that never really registered with me. I never understood why someones one's own negative experiences absolutely HAD to dictate the way they treated people now that they were in a position of influence. If anything, wouldn't you want to break the cycle of negativity by being positive and supportive? I had TONS of horrible experiences with burned out preceptors, coordinators, supervisors, managers, partners, teachers etc but I can honestly say that I have never once treated a student or newbie anyway other than the way I would hope to be treated.

Anyways, at the Fire Hall, even from day one, I haven't experienced a shred of hazing/negativity/poor attitudes etc. I'm sure guys have them, but they don't let them ooze out into their practise. The atmosphere at the hall is just so conductive to learning and experiencing that its really quiet hard to have a bad day. I've been on the floor only six weeks and already I have dozens of coworkers that yell "Matty!" and throw out high fives whenever they see me. Only six weeks and already I feel 100% comfortable going up to anyone in the department and asking any type of question regardless of how silly it may be. Only six weeks and already I feel more comfortable than I have at ANY of my previous jobs that I held for months and even years.

Why do I feel that way? Why are things going so well and why am I having such a great experience? Well its not because the job is simple I'll tell you that, there is tons to learn and tons to do. Its not because the job is 'easier' than a straight EMS job, we are constantly busy with calls, hall duties, training, gym workouts etc. When I really think about it, the answer is actually pretty obvious......its the people that make this job what it is. The gig is pretty similar to alot of jobs I've had in the past, we do calls, clean the ambulances, make meals, etc etc, but the people are different than any I've encountered so far in my career. This service has proven to me what I've always suspected, that amazing things can be accomplished when you gather together positive, goal orientated, eager, enthusiastic people and give them a serious job to do.

Anyways, enough ranting, again this is all just my opinion based on my own personal experiences both good and bad.

In conclusion, here is a list of other things I've learned in the last six weeks:

-As a proby, there is alot expected of me, however, the guys/gals at the halls understand that I am new and need direction now and then. As long as I do what I can, as good as I can, when I can, people will acknowledge the effort.

- Firefighters drink a ton of coffee, I would wager they drink even more so than desk workers, police officers, teachers and bus drivers combined. A coffee pot at the hall will last anywhere from 10-15 minutes (even less at shift change). My job? keep it full, keep it hot, and do NOT make a weak pot.

-Appearance is very important. At the start of every shift my uniform better be clean and pressed, boots polished, hair done, face baby smooth, and I better smell nice but not TOO nice, meaning not dumping on the old spice.

- The new guy should be the first to do things. Weather its doing dishes, getting the newspaper, cleaning the floors, folding hose, checking the units, I should always be the first guy up out of his chair when something needs to be done. The guys are always a step or two behind me to help out but they definitely notice the new guys who take initiative.

- Sports are HUGE. Baseball, basketball, football, hockey, golf, NASCAR etc etc, If guys aren't talking about a game that was one last night, they're talking about the one that's on tonite.

- How to address people? This one seems easy but it caused me a bit of anxiety at first. Being new to the fire service, I didn't really know how and what to call people. Sir? Officer? General? Your highness? Sounds silly but in the paramilitary structure of things there is always a formal and informal way to address someone. My solution? If I know someones rank, its always Captain/Lieutenant/Officer and then their last name. If I don't know their rank, 'Sir' until told otherwise is always a safe bet.

- As the new guy, you have to expect some fun to be poked at your expense. Its part of the process, its harmless, and hey, its probably a good thing. Its when the guy's don't raz you that you need to worry.

That's it for me, time for some hotly anticipated days off. After 18 days up north in her camp clinic, my wife is getting home tomorrow for two weeks of relaxation (and I guess some shopping). I'm going to end this post with probably the lamest/cutest picture that I have on my computer, its my wife's massive 4 pound Chihuahua checking out my helmet after my first day.

Yes yes....pathetic I know.

New stuff comin down the pipe.....

2010-09-01T13:30:00.000-07:00

December 1st is going to be a big day for the EMS scene here in my province. That is the day that a whole bunch of new protocols, procedures, and pieces of equipment are scheduled to come into effect province wide. Now a lot of what I've heard is speculation only, and all the protocols I've read online are "drafts only" but there are a few new pieces of equipment that I am 100% certain that my service is getting in December. As a bit of a refresher (I've used most of this stuff before in other provinces) I've decided to use this post to quickly go over three new tools that will be comin down the pipe shortly.

First up is the Quicktrach.

Now, cricothyrotomy is one of those skills that no Paramedic ever wants to use (well maybe some look forward to it but I sure as hell don't). Cricothyrotomy provides a means of direct intra tracheal access when all other means of airway intervention have failed. Basically, If you have to cric someone...its do or die, its a kind of intervention that needs to be done fast and efficiently or your patient will die, not maybe die, they will for sure die, no airway = death. Cricothyrotomy is done all the time on TV and it always looks pretty badass, in reality however, cricothyrotomy is a difficult and sometimes messy intervention. The Quicktrach is a piece of equipment designed to quickly and safely capture with airway with the smallest margin for error possible.

The device utilizes a plastic cannula over top of a beveled trocar. A plastic phlange with a distal cuff is utilized to ensure secure placement of the airway cannula post insertion. The syringe you see attached to the phlange is actually connected to the metal trocar inside the cannula. As the needle is inserted through the cricothyroid membrane at a 90 degree angle, the user gently pulls back on the syringle plunger, when the needle enters the trachea, air will suddenly be aspirated which ensures intratracheal placement. Once the needle is sure to be in the trachea, the device is lowered from a 90 to 60 degree angle, and the plastic cannula is inserted over the needle much the same as an IV.

The whole device is designed to make cricothyrotomy easier, quicker, and safer. Land marking is still the same as it always has been, but now instead of using a scalpel to cut and forceps to open the incision, the whole procedure can be done in one fluid motion with one piece of equipment. I cant say I ever want to have to use the Quicktrach, but it is nice to know that this handy little device is available when things are going downhill in a hurry and rapid cricothyrotomy is needed.

Next up is the King LT Airway.

In my service the King LT Airway is coming on car to replace the long used Laryngeal Mask Airway. I personally have used both airways quite a bit and have found the King LT to be faster and easier to use (although there both really really simple).

The King LT is a single lumen, self positioning airway device that is to be used as an alternative to Endotracheal Intubation. The device is able to be inserted blindly without the use of forceps, laryngoscopes etc.

In terms of design, the device is shaped like an 'S' to facilitate its proper insertion, which is into the esophagus. The tube has two cuffs that are inflated by a single valve (no chance of screwing it up like with a combi tube). The device is inserted from the corner of the mouth, and is passed into the oropharynx until resistance is felt or the depth marker near the top is at the level of the teeth. A large volume syringe is then used to inflate both cuffs with the single valve. The proximal cuff (the big one in the picture) inflates at the base of the tongue and isolates the oropharynx from the laryngopharynx. The distal cuff (smaller one in the pic) isolates the esophagus from the laryngopharynx. The proximal cuff does most of the devices stabilization, while the distal cuff is the one that helps prevent gastric insuflation. The area of the tube between the two cuffs has several apertures (air holes, as I call em) on the anterior surface. When a ventilation is attempted, the oxygen comes out those apertures and has no where to go but the trachea due to the blockages made by the two cuffs, pretty cool eh!

I've used the King LT several times before, mostly when I couldn't get an ETT to pass or I was just too busy with other stuff and I've always had great experiences with it. You can still use ETCO2 monitoring with a King LT, as well as suctioning just as you would with an Endotracheal tube. I'm not sure what the protocol is going to be in terms of indications, contra-indications, size's, air volumes etc etc, but still I am pretty happy to have this piece of equipment on car with me.

Finally we come to the Boussignac CPAP device. Ahhhh, good old CPAP. I had CPAP (continuous positive airway pressure) devices on car with me at the last service I worked at and found it to be a lifesaver (literally) on many situations. This piece of equipment is by far the one that I am most excited about getting on car.

CPAP is an airway adjunct that can be utilized in situations such as Pulmonary Edema, Submersions, and severe bronchospasm. In a nutshell CPAP devices take a supply of oxygen, pressurize it, and then deliver it into the patients lungs every time a inspiration is taken. In a more detailed nutshell, CPAP is used to force oxygen into alveoli that have collapsed due to surfactant removal. With conditions such as pulmonary edema (due to left ventricular failure, fluid overloading, submersion's etc) the surfactant that coats the alveolar surface is washed away, without surfactant, the alveoli collapse. Now, when the alveoli collapse, they can still be utilized, but it gets tricky. For a collapsed alveoli to provide gas exchange, higher than normal inspiratory pressures must be obtained in order to 'open up' or 'splint' the alveoli open and allow oxygenation/perfusion. Simply taking a huge breath in ain't gonna cut it, that will increase your inspiratory volume but not your pressure. That is where CPAP comes in.

If you had to take a second look at the picture I don't blame you. When I first saw the boussignac CPAP device I was like "huh? its just a friggin mask with green tubing", but trust me this small simple looking device has the ability to save the lives of many a pulmonary patient.

The green tubing you see is just plain old oxygen tubing. It connects to a cylinder or a wall mount that is set at 15lpm. The mask is just a plain old mask, not shown in the picture is the straps that are placed around the patients head to keep the device in place but you can use your imagination with that.

The real key to the device is the green connection between the tubing and the mask. As oxygen flows into this 'Air Funnel' the inner contours of the connection cause the oxygen to swirl into a sort of turbine. The turbine motion causes the oxygen that enters the mask to be pressurized, "how much pressure?" you ask, well to be specific, 15lpm of 02 will provide a pressure of 5cmH20. When the patient takes a breath in, they recieve 100% pure oxygen at that 5cm water pressure, which should be enough to force open collapsed alveoli and even force fluid away from the lungs. To facilitate better patient monitoring, in-line ETCO2 devices can be used simply by attaching the unit between the mask and the air funnel. Even a nebulizer devices can be attached to the CPAP circuit if you want to add some Ventolin or Atrovent to your treatment.

CPAP does have a fair amount of contraindications and how its utilized will depend greatly on what our protocols indications look like. I personally cant wait to get CPAP on car. Severe short of breath calls are some of my least favorite and CPAP is definitely a great tool to have in your arsenal.

There are a few other devices and medications that were getting, but the three I just mentioned are the few that I know for sure are coming. This post was a good review for me, who knows maybe I even got a few points across (or maybe people starting reading and got bored). To anyone reading this post I am curious, what does your service use? Do you have CPAP? What have your experiences with any of these devices been like? Anyone done any crics? I'm just asking.

Tongue biting and head shaking......

2010-08-29T08:05:00.000-07:00

Well there is nothing like a night shift in the city to remind you that not all people in this world are honest, respectful, law abiding citizens that contribute to society (not that I really needed a reminder). Last night I met two patients who caused me to just shake my head and bite my tongue.

Model Citizen 1 - Called to a townhouse in the inner city slums (or ghetto, hood, rats nest, pick your favorite term) for a 40 year female patient, "possible overdose". I had never been to the neighbourhood before but at this point in my career they all look the same, tightly packed town homes that are nothing more than rented fire hazards, front lawns covered with kids toys and beer cans, cars with flat tires and smashed windows parked on the street, and of course, the classic torn up couch with mysterious stains sitting on the front porch.

Model citizen 1's husband met us at the front door and told us that his wife was drinking rye all day with her friend and then came home and swallowed a hand full of sleeping pills. I walked upstairs and found our patient lying supine on her bed. She roused easily to some shouting and wasted no time telling me "Fu#k off man!". Unfortunately for her I actually have a job and lo and behold its one that I care about, so I of course did not "Fu#k off". She was a pain to access but we did the best we could, vitals were stable and her only complaint was of being sleepy (no way!), however because it was a possible suicide attempt and no one knew exactly what and how much she took, she had earned herself a overnight stay in the ER.

As we were loading her into the ambulance, Model Citizen 1 happened to notice her kids out on the front yard riding their bikes, at this point she totally flipped out and went from a groggy drunk sleepy head to a berserk screaming lunatic. "Bring me my babies!! I WANT MY BABIES!!"

Me: "Mame we cant take your children in the ambulance, why don't we chat for a minute in the back and then your kids can come give you a hug before we leave for the ER"

Model Citizen 1 - "FU#K YOU!!!! I want my babies NOOOOWWW!"

Me: "Mame there is no need to shout ok, your kids are standing right by the bumper and they dont need to hear you talk like that ok"

Model Citizen 1 - "Fu#k you man, babies! Babies come see mommy, get in the ambulance now, Fu#king NOW!!!"

Finally enough was enough, doors were abruptly shut and locked and we left for the hospital. The patient was a complete hassle the whole way, refusing to answer questions, refusing to let me apply 02, tangling her self in her ECG cables, and of course ripping out her IV. I just sat there on the bench, watching this screaming, groggy, intoxicated lady working herself into a frenzy all the while calling my partner and I pricks for doing the job that love to do and do well. Patients like this don't normally bother me, I've dealt with enough of them to know how to manage, but this woman just erked me from the get go, I think it had something to do with the fact that my partner and I were SO nice to her the entire call and all she could do was call us names and refuse to co operate.

When we came back to the ER later in the night I found out that the patient had ripped off her gown, tore out her second IV, and then wet herself in her bed. When the nurse tried to clean her up and change her sheets the patient refused to move an inch until her husband and her lawyer were by her side, and of course, she wanted to see her BABIES!!! No further follow up was available, although I'm sure the lady is back at home doing what she does best, which is to serve as a model of the uncivilized, the classless, and the ungrateful for medics everywhere.

Model Citizen 2 - Around midnight or so, we were sent to an apartment complex in another stations area for a "50 year old male patient, assaulted yesterday, complaining of eye pain". The complex was in an area of the city that was previously foreign to me and after meeting this patient and getting a view of the neighbourhood, I think its safe to say the area is one that I will not frequent on my days off.

Model Citizen 2 was waiting for us by a parking lot dumpster with a smoke dangling from his mouth and the worlds greasiest denim jacket on his shoulders. I knew we were in for a real treat when he refused to put out his cigarette.
Partner - "Sir we have flammable oxygen tanks on board so you need to put the smoke out"
Model Citizen 2 - "Fu#k you then, I'll finish it first" spoken in a typical drunken slur
Partner - "Sir we aren't a taxi, if you want to go to the hospital, get in NOW"
Model Citizen 2 - "Fu#k whatever then!" flicks his cigarette away.

Apparently Model Citizen 2 was at a party by the river yesterday, and obviously pissed off someone, but not just any someone, a someone who just so happened to have a piece of firewood in their hands. Model Citizen 2 was struck in the face with the wood and was now sporting a nice sized purple bruise on the entire left side of his face. The injury was sizeable, and I don't doubt the guy was in pain and needed to see the Doctor, but he was just not in the mood to co operate with anyone, helpful well meaning Paramedics least of all.

As I drove to the ER I couldn't help but overhear my partners attempts at an exam in the back.
"Sir are you having any pain right now?"
"Fu#k off, no more questions"
"Sir I need to ask you questions in order to help you"
"I got hit with some wood, what more do you need to know"
"Sir I need to know a lot more than that, do you have any allergies?"
"A block of wood, a fu#kin block of wood"
"Sir please, do you have any allergies?"
"Fu#k you!"

Uh huh.....here's what blows my mind, why why WHY do people call the ambulance and then get utterly frustrated when the Paramedics start asking them questions? Are they anti social? shy? socially inept? What is it? If all they want is to go to the hospital in silence, why not call a cab? or take the bus? or hitchhike? Wait! I got it, if all they want is to go to the hospital and not be asked about their medical history or current medical state, why don't they just walk? If you have the ability to shout profanity, smoke cigarettes, pull out IV's, spit at medics, unbuckle your seat belt, throw blankets, and refuse to uncross your arms like a two year old, then I'm fairly certain you have the physical ability to stand at a bus stop or call a cab, that's just my thoughts though.

Anyways, Model Citizen 2 kept up his tough guy routine all the way to the ER and then started giving attitude to the triage nurse. Now, the traige nurse is a person who any one in the business will tell you is someone you DO NOT mess with. Triage has the ability to make your hospital visit sunshine and roses, or fire and brimstone, all with the flick of a pen and the placement of a chart. Model Citizen 2 didn't stand a chance, all it took was three or four "Fu#k you's" and triage had security by her side in a flash. As I walked out to the ambulance bay I saw two security guards walking outside with Model Citizen 2 by the arms, no word on weather they just had a pleasant chat with him or sent him on his way, luckily for our patient though, neither security guard had a block of wood with them.

Last night might have been frustrating, but as we all know not all patients are like that. Patients come in all shapes, sizes, colors, and personalities and as a Medic its my job to make like a chamelion and change the way I act and speak to better suit each patient I encounter. I'm pretty good at it, and everynow and then I get complacent, all it takes is a string of a dozen or so nice polite patient and I start to think that I have this Paramedic thing all figured out. Patients like last night serve to knock my ego down a few pegs and remind me that I will never be totally complacent, or atleast I shouldnt be.......

Hhmmm, lets see how fast these days off can go by..

2010-08-22T04:12:00.000-07:00

My night shifts of my most recent tour were pretty unremarkable. Now I am on days off with a million things to do before returning to work on Wednesday.

My last two shifts went like this

Night 1 - I was put on the ambulance with a guy who is newer to the department (one year in or so) who I had previously never worked before. Around 2030 we were sent out with engine support for a 80 year old lady "severe SOB". Driving to the call I was actually a little concerned for two reasons. One is that I hate "severe SOB" calls that are actually legitimate, I find patients who are that SOB are always a challenge to assess and treat appropriately. Second is that due to all the big Forrest fires raging in British Columbia, the air quality this night in the city was well....smokey, I was very concerned that the poor air atmosphere would equal many "severe SOB" calls for us.

We arrived on scene to find an elderly lady sitting on her walker outside with staff from her group home at her side. She was not SOB nor did she appear to be in any discomfort/distress at all. The patient was actually developmentally disabled and totally non verbal, which any Medic will tell you is a real challenge to access. Thankfully her care worker was by her side with a big bag of medications and a stack full of paperwork. Turns out the poor lady had been suffering from a UTI for the last little while and hadn't been given her meds properly. She was absolutely terrified of the ambulance and kept screaming and clutching at the cabinets during the transport. I kept my composure, but it was really sad to see this 80 year old lady with severe mental disabilities yelling and crying with the demeanour of a 5 year old, I'll say it again, disease and injury process that affect the brain just strike a cord with me.

That turned out to be my only call of the night. I did some studying and my Captain put me through a few knot tying and hose rolling drills before hitting the sack around 2300.

Night 2 - When I showed up to work I was surprised to find a fellow new hire ( and good buddy of mine) sitting at the table with a coffee. I guess we were short staffed or something because for the first time in a long time the department placed two probationary rookies at the same hall. I was even more surprised when the Captain told me that my rookie buddy and I were going to be on the ambulance together for the shift!

Our first and only call came during our workout at 1845. "Medic 5 Engine 5 respond to !@#$% rd for a single vehicle rollover, no other info". Withing 30 seconds (our chute times are crazy fast) my partner and I were whizzing down the road with the engine just a ways behind us.

We arrived on scene to find a sporty little car on its roof in the ditch with about a hundred feet of skid marks before it. The scene was littered with beer cans and there was no patients to be seen, neither in the vehicle or around it. As the guys on the engine began their search of the surrounding area I went to question a witness. The witness told me that she came across the wrecked vehicle and saw a younger woman on the side of the road who looked distraught. She further told me that when she offered to call for help on her cell phone, the driver became hysterical and demanded to be left alone as she had some friends coming to pick her up. Apparently about five minutes before we got there (we being us, the engine and the police) a car driven by a younger male pulled up to scene, picked up the woman driver and then took off towards town at light speed.

Seeing how the scene was clear and that our only "patient" was probably sitting at her friends place with her buzz wearing off and counting her self lucky that she got away from the accident injury and trouble free, we cleared the scene and returned to our hall.

That was it for my night shifts, pretty slow compared to how things have been lately, oh well, for every slow shift it seems we get twice as many busy ones.

Days off are going to go buy quick as nearly every single minute is spoken for. Saturday I have to go up to West Edmonton Mall to get my tattoo worked on some more (gotta love paying someone to administer pain), Sunday I have to help the wife get ready for her first day of work, Monday I have an all day Airbrakes course to do and Tuesday is filled with typical errands to tie up before returning to work on Wednesday.

Speaking of the wife, did I mention her new job? She just got hired on to work as a medic in a camp clinic in a northern part of Alberta's Oilfield. The job is a two weeks in two weeks out type of deal and the protocols and pay are pretty good. She starts her first two week stint up north on Monday so I'll have the odd update from her over the next little while as well.

Anyways, time to go see how fast these days off go by.......

Kickin off the tour...

2010-08-18T05:18:00.001-07:00

Well I was back at work yesterday, after working an extra shift at a more downtown hall on Saturday night, I was back at my usual hall in my usual spot on Tuesday morning.

After my workout my Captain informed me that I would be rotating between the ambulance and the engine this tour, one day on the ambulance, one day on the engine, and so on and so forth. Day 1 of the tour was my ambulance day and it went a little like this........

Call 1 - Sent to a busy gas station for a guy who was cruising along on his pedal bike and hit a rut or something, causing him to go ass over tea-kettle. The guy was conscious when we arrived but was showing all the signs of a head injury, repeating himself, headache, as well as nausea and vomiting. Vitals were fine and the guy held up fine during the transport. He got a bed fairly quick and no follow up was available.

Call 2 - Sent to the post office (in another stations area) for a 56yr old male patient having a seizure. The engine from station two beat us there and was providing care as we pulled up. From five feet away I could tell that this patient was not having a seizure, he was having the most obvious stroke I have ever seen in my life, MASSIVE facial droop, slurred speech, no grip strength on the left side and positive left arm drift. Time last seen normal was 1500, we arrived on scene at 1508. By 1515 we were cruising to the ER -hot- with my partner and I in the back and a medic off the engine driving for us. Our transport time was less than 5 minutes and in that time we managed to get a 12 lead ecg and 2 large bore IVs. We arrived at the ER by 1520. After a quick neuro consult in emerg, the patient was just getting thrombolized as we cleared from the ER. When we were back later in the evening, I poked my head in to see the patient sitting on the end of his bed while neurology conducted basic cognitive tests, which he seemed to be passing no problem.

Call 3 - Sent to Station 2s area again for a 25 year old asthma patient complaining of SOB. When we showed up, the guy was waiting on his front porch with all his depression and anxiety medications cradled in his arms. He didn't really look short of breath too me, seeing how he walked up to the unit with a grin on his face and absolutely reeked of cigarettes. Anyways we gave him the work up and everything looked pretty normal. His main complaint was that he was stressed out and wanted to get some new stress pills, we advised him to go see his family doctor and after some deliberating....the patient agreed. No transport.

Call 4 - Our final call of the day came in about 15 minutes before shift change, which kind of sucks but hey you cant really complain about OT. Anyways it was for a 90 year old lady at a nursing home who fell out of bed and bumped her head on the night table. She had a pretty good contusion and a bit of a lac so we bundled her up in some blankets and took her into Emerg. After lucking out and getting a bed in minor treatment (while a half dozen other units waited in the hall for an ER bed) we cleared up and were back at the station buy 1830.

All in all not a bad first day. Time to scarf down some breakfast and coffee, my engine shift starts at 0800!

Saturday night cruising

2010-08-16T07:08:00.001-07:00

Well I finished my tour on Friday morning and usually would be off for four consecutive days but I agreed to work a shift for a guy at another hall so on Saturday night I found myself back in uniform for a shift on the ambulance.

Being away from my original hall was kind of weird and kind of interesting at the same time. My permanent hall is Hall 5, but for Saturday night I would be working out of Hall 4, which is located in the far east end of the city and is definitely busier than Hall 5.

One thing that was kind of cool was the guy the hall's Captain decided to partner me up with on the ambulance, we'll call him 'J'. J and I were hired in the same pool, so we just finished going through a month of orientation together. We might both be brand spankin new to the city, but as far as EMS goes we're fairly experienced while at the same time being fresh enough to still have that little spark of energy for even the most frustrating calls. In addition to all that, J and I are roughly the same age and have a lot of similar interests, basically I knew as soon as the Captain put us together that I would have a pretty cool partner for the night.

The night went like this, all calls were completed before 0100.

Call 1 - Called to a rather nice apartment building for a 22 year old male "vomiting blood". An engine from hall 1 had beat us to the scene and were waiting at the front door to give us a little hand off report. The story was that our patient had just broken up with his girlfriend that day and that proceeded to come home and guzzle a bottle of whiskey, now his stomach hurt and he says he's vomiting blood. We couldn't find any signs of emesis anywhere and our patient didn't seem to be nauseated at all, just very drunk and belligerent. It blew my mind that he would stand up off his couch and demand that we give him water. Who calls the Paramedics to their house and then demands water? Anyways, transport was unremarkable but once we got to the hospital our lovesick patient began getting even more belligerent, yelling at other patients, climbing off the stretcher, curling up on the floor because "it feels good", hell he even got up from his wheel chair and began stumbling around the ER screaming for water. That was the deal breaker right there. Within minutes the patient was sitting in a wheel chair in front of triage with a security guard on either side. We cleared from the hospital but when we returned a couple hours later nurses told us that within five minutes of us leaving, the patient tusseled with security and then stormed out of the building with his newly reunited ex girlfriend. I guess love conquers all.

Call 2 - We were sent hot to a nearby seniors home for an elderly male patient "not acting right". We arrived to a elderly man slumped in his easy chair, surrounded by a hysterically concerned daughter and several blatantly non concerned staff members. Story is that the elderly gentleman was last seen normal at lunch time and is now not following commands or speaking, just sitting in his chair staring at people and occasionally baring his teeth. The patient had a past history of TIA's so we did what we could and started transporting. The daughter rode up front with me and during our little chat told me that her father has advanced alzheimers disease and even at the best of time's will take swings at her and call her the wrong name. Now, as I've mentioned before several times, Alzheimers disease kind of scares the crap out of me. I couldn't help but feel ten times sadder for the patient when I found out about the dementia. Just as we were finishing paperwork the patient was being peddled up to CT, no follow up available.

Call 3 - Tones went off around 2300 for a 12 year old girl "unconscious, post asthma attack" Hmmm, that doesn't sound too good. The scene was at a lakeside summer camp about 25 minutes away and throughout the whole drive my partner and I sat in near silence, thinking about the string of pediatric codes the city has had recently (not really a string, but two codes in a matter of days). When we arrived however, the girl was sitting in the camp's first aid room, clutching her teddy bear and looking more scared than anything else. Story was she was having some trouble breathing "kind of passed out" and then quickly improved after the camp medic administered two puffs off a Ventolin inhaler. Throughout our time with the little girl her breathing was fine, SPO2 was excellent, and she talked more about what she wanted to be when she grew up than what happened with her breathing earlier. We dropped her off safe and sound and cleared the hospital by 0100.

Our third call would turn out to be our last thankfully, we got back to the hall at 0200 and managed a few hours of sleep. By 0700 all the guys were up and out in the bay washing the units for the oncoming crew. 0730-0800 was pretty tense as we all basically sat around the table drinking coffee and crossing our fingers that a late call not come in. As much as everybody likes overtime, when your days off are within your reach, its really nice to walk out the door on time.

Anyways, today's my last day off so time to go run some errands and maybe even sneak in some beach time!

Tour Wrap Up

2010-08-12T15:37:00.000-07:00

Well here's how my current tour has been going so far....

Day 1 - For my first day of the tour I started on the ambulance with a partner I worked with a lot last tour. The shift started with a workout in the gym (like they all do) followed by hall duties. Just as we were settling down for lunch the tones went off for a routine call. Call 1 was for an elderly lady who needed a ride from her nursing home to the hospital for her scheduled blood transfusion. I know this probably doesn't sound like a very interesting call to be on, but seeing how I am back on ambulance after more than a month off for fire training, I was pumped to be doing anything so long as I was in the back of a unit. Call 2 came mid afternoon and was for a older guy who was complaining of back pain. I guess the guy had fallen the day before and was diagnosed with a T12 fracture in the ER before being prescribed some pain meds and quickly discharged, anyways he was in so much pain that he was unable to move up out of bed to bath,eat,use the bathroom etc. We had to use the scoop stretcher and take several pauses to maneuver him from the bedroom to the driveway of his extremely tight country home. Call 3 came just before shift change (yah overtime!) and was for a lady having chest pain in a nearby resort town clinic about a 15 minute drive away. When we arrived the lady was laying on the exam table, blushing and going on and on about how silly she felt for having had the ambulance called. She was pain free at the moment, following a 20 minute episode of squeezing pain beneath her right breast. Vitals and ECG were both normal so we popped in a IV, gave some low flow 02 and transported into town.

Day 2 - For my second day shift I was taken off the ambulance and placed on the pump, meaning that I would be on the fire engine apparatus as part of a four man crew and would only respond to fire calls or to back up the ambulance on "delta" or "echo" calls. Being brand new to the fire side of my job, when I am placed on the engine I get fairly nervous about things. When I'm on the ambulance, I feel like I am in control, like I have a good idea of what will be thrown at me, basically, I feel comfortable and even a bit cocky, but when I am on the fire engine......I feel like a bit of a jackass. I know things will come with time and exposure, but its hard not to feel like a pylon sometimes. Anyways, we spent the morning doing some training here at the station, the guys put me through drills fetching things from the truck and doing some basic ladder stuff, around 1400 the tones went of for an engine call, "Medic 5 Engine 5 respond Delta for a two vehicle MVA".

I put my turn out gear on in what felt like five minutes but in reality was only 45 seconds or so and just as I buckled myself in we were off to the races, sirens blaring. The scene was one that I've seen dozens of times before as a medic, two vehicles, both going fast, smashy smashy, lots of damage, pieces of vehicles everywhere with two dazed looking drivers pacing around on their cellphones, but for the first time in my life I wasn't walking onto the scene as a paramedic. The ambulance beat us on scene by about fifteen seconds and I immediately went over to give the other paramedics a hand, they looked at me funny but quickly put me to work holding C spine. As I crouched behind the driver of the bigger faster vehicle, holding his head and feeling pretty good about my self, one of the officers from my engine came over with a grin and told me to go put out some traffic pylon's. "But...what about the patients??, we should help them" I was thinking," ohhh ya I forgot, I'm a firefighter/paramedic now and that thing I came here on with all the hoses is a fire truck not an ambulance".

Both patients were transported to hospital by the guys on the ambulance. The rest of the engine crew and I stuck around spreading absorbent all over the road to control fluid leaks from the vehicles, once the tow trucks came and gone we packed up the pylon's and returned to the hall, my first official engine call in the books.

Night 1 - For my first night shift I was back on the ambulance. "aahhhhhh" I thought to myself, finally some familiar territory, "no looking like an ass tonite!" The night turned out to be pretty slow thankfully. One call early in the shift for a lady who complained that she was groggy. Maybe she was just tired, maybe she had some metabolic problem, or maybe it had something to do with the morphine prescription she just received two weeks ago that had been refilled already. Once we were back at the station we did some knot and rope training before calling it a night around 2300.

Night 2 - Last night of the tour and I was told to go back on the engine for some experience. I was a little nervous but not as bad as my first engine shift, after all, I already had that MVA call under my belt, surely that is an immense amount of experience right?
After hitting the gym for a bit, the engine crew and I loaded up the pumper with a bunch of 65mm line and 5inch high volume hose and went down to the nearby fire training grounds to run some training evolutions. For the nights scenarios, we practised pulling up to a burning building, catching a hydrant, and then running 65mm lines into the buildings sprinkler system to boost the systems pressure and water volume. I still felt out of place, but at least I did everything that was asked of me without needing any additional instruction, I even got a "good job Matty" from my Captain back at the station, not too shabby!

Days off now, although my scheduled four days of downtown are going to be halved this time as I picked up an extra shift on Saturday night at a different station. No rest for the wicked I suppose, despite feeling silly on fire calls and not getting the jokes the guys make at the halls (especially the ones made at my expense) I still love this job and haven't doubted this career decision for a single minute. All the dazed looks I have, all the dumb questions I ask and all the terms I don't yet understand, I know that its all part of the process, and unlike pretty much every job I've ever had before, this is a process that I am more than willing to go through......

First days off, Mission Accomplished!

2010-08-08T07:34:00.000-07:00

Well as I write this my first set of days off are coming to a close, I can't help but feel a little bit disappointed, but at the same time, my anticipation to get back to my hall and start doing calls is sky high!

I did manage to get alot done these days off, my wife and I went on a quick road trip to our favorite camping site in British Columbia, but before I talk about that I will do a quick run down of my last night shift which was last Wednesday.

1800 - I showed up to shift a little early and BS'd with the day crew for a bit, by quarter to six I was out in the bay setting up my gear and checking the ambulance. For fitness at 1800 basketball was on the agenda again, however for some reason most of the crew was tired and decided to sit it out, this left just the Captain and I too shoot hoops for a bit. By 1930 I was showered up and started my housekeeping duties (fancy way of saying that I cleaned the toilets). At 2100, just as we were sitting down to burgers and salad, our first call came in, a long distance transfer of a patient to the ICU in Calgary. It only took one look at our patient to know that we were going to need a 3rd member to come along and help out, this patient required two Paramedics in the back with her at all times. The story was something like this, 51yr female patient who was admitted several days ago with Pancreatitis, she soon developed renal failure and SOB, within hours she was sedated and intubated. First labs drawn post intubation showed HUGE troponin levels, so now she was intubated with pancreatitis, big time renal failure, and she was actively infarcting. When we showed up she had the following meds on pumps for transport, Nitro, Heparin, Propofol, TPN, and Normal Saline. We did our best to manage this very sick, very complex patient the entire 1.5 hr drive to the receiving hospital, however, complications arose like they inevitably do. First our ventilator crapped out en route, so we proceeded to use a bag valve mask, then, our oxygen levels dropped significantly from a problem with the ventilator circuit and we had to rendezvous with another service on the highway and bum a couple 02 tanks from them. Despite the hiccups along the way however, we got the patient to ICU safe and sound.

We got back to the hall around 0300 and I settled in on the couch to watch cartoons and wait for sleep to come. At 0400 the tones went off for a "alpha" call to a seniors residence in our area but because I had just done a six hour transfer, the Captain told me that I was now on the Engine and would only have to respond to fire calls for the rest of the night. I said thank you sir and then curled back up on the couch for a couple hours of rest. At 0730 we were all up washing the units before the day crew arrived and at 0800 I walked out the door to hit the road for a trip to BC.

I have lots of pictures left over from fire training so I thought I'd throw a few out here, the one below is of my hiring class on the roof of the burn tower, it was our last day and just before heading out for beers we all posed on the roof while someone went up in the ladder bucket to snap a pic.

Next up was two nights three days of camping in beautiful Radium Hot Springs in British Columbia. As I may or may not have posted on here before, Radium is my wife and I's current favorite camping destination and we have made it there every summer for the last few years. The town its self is very small but is booming with tourists from all over the world, in addition to the awesome campgrounds, hiking trails, lakes and golfing, by far the number 1 attraction is the Hot Springs themselves, which are natural springs that flow from the mountains and a very high temperature before being cooled and collected into a series of outdoor pools that are nestled deep within the mountains. The pic below is of me on the diving board in one of the smaller pools, getting ready to rock a serious cannonball.

The second pic is of the Hot Spring Pool facility itself, taken from a high peak across the highway.

Our trip was great as usual and we certainly did a fair amount of beach lounging and beer drinking. On Saturday the 7th me, my wife and my brothers girlfriend competed in the annual 10km race that is held in the nearby town of Invermere, it was our third time doing the race and it was good times all around, congratulations to Jen and Candace to finishing with great times!

We got back to town last night and still have yet to unpack from the trip. Luckily I have one whole day left to clean up and get ready for my 2nd tour tomorrow.

Well that's enough out of me, time to start doing some laundry!

One more nightshift....

2010-08-04T13:41:00.000-07:00

Well I am almost done my first tour as an urban firemedic and so far things have been great. I worked days on Monday, Nights last night, and tonight I head in at 1800 for my final nightshift of the tour. Below is just a quick recap of things so far.....

Day 1 - I went and bought some donuts (cliched but effective) and drove around the station block at least a dozen times trying to calm my nerves before my first shift. A million panicky thoughts raced through my head, things like "what have I gotten myself into??" and "I cant do this, I'm in over my head", from the minute I walked through the door however, I knew I had made the right career move. The guys at the hall were instantly great to me and I was put at eaze pretty fast. The department I work for allots 60 minutes of each shift for dedicated fitness training at each hall, which means that for the first hour of each shift I get to work out with my crew. On my first shift everyone at my hall (five firemedic's and the captain) went out back to the parking lot and played 3 on 3 basketball. After that we went through some station duties, did some city orientation and then did some engine drills to help get me familiar with where certain tools are on the trucks. The day was pretty slow call wise but still things managed to fly by very quickly, I left my first day shift with a smile on my face and a cheerfull anticipation of things to come

Day 2 - I came to work a half hour before my 1800 start time and hung out with the day crew for a bit, it still amazes me how I've met close to a hundred firefighters in the last few weeks and every single one of them has been nothing but great towards us new guys. For fitness the whole crew took the ambulance and engine over to a nearby school field and played 3 on 3 football for an hour which was great, I love how these fitness hours give us the opportunity to stay in shape and bond with our crew mates at the same time (definitely don't see that in EMS, at least not in my experiences). We went back to the station and started preparing dinner when my first call came in at around 2100. The call was for a 26 weeks gestation lady who's membranes had ruptured and was being sent to a bigger center to handle the potential complications. This was my first official call with my new service and things went great. We did the transfer and got back to the hall around 0100. I then proceeded to curl up on the couch at watch a bit of TV while everyone slept, I must of dozed off because around 0545 the tones woke me for a "delta" call to a nearby gated seniors community. The call was for an elderly lady who had a syncopal episode while in the bathroom and had suffered a fall. She was conscious but confused on our arrival with stable VS aside from a HR in the 40's. Sure enough she was just started on a beta blocker the day before and had only taken two doses of the new med. I started an IV and did a ECG while the guys from the engine helped package for transport. We got her to the hospital safe and sound and were back at the station by 0800 for shift change.

Its 1500 as I write this, just a few more hours before I head back to the hall for my last shift of the tour. Days off will be very busy as the wife and I will be leaving bright and early tomorrow morning for a few days in British Columbia. We are both registered to run a 10km race in BC on Saturday and we plan on doing some serious relaxin on the beach before then.

Anyways, time to catch a quick nap before work!!