But, the commute is a bitch and I’m blowing through gas money so quick that I feel like I should be just lighting piles of cash on fire. I have to get up earlier than normal to be to work on time. And I run very few calls (meaning I don’t get to practice many skills) and it weights my calls heavier when calculating my transportation (or non-transport) statistics.

So the plan: At the end of the month, I’m moving to a 12-hour day car. After four years working 24-hours shifts and rotating through stations, getting up in the middle of the night for calls, postings, and transfers, I’m trying something new.

My wife and I just celebrated our 5th wedding anniversary, so I think about it this way: for almost my entire marriage, I’ve been away from home, not sleeping in my own bed a third of the time. Time for a change I think.

• Box of 35 N95 Masks (Latex Free): N95 Masks are the respiratory masks that are rated the best for preventing the spread of contagions (N95 masks are also good for chemical spills, wild fire, etc.)
• Box of 100 Exam Gloves (Latex Free, Powder Free)
• Box of 50 Disposable Isolation Gowns (Latex Free)
• Box of 100 Disposable Shoe Covers (Latex Free)
• Box of 100 Bouffant Cap Disposable Hair Covers (Latex Free)
• Five Pairs of Protective Safety Glasses (Latex Free)
• Five 4-oz Bottles of Epi Clenz Hand Sanitizer Gel

All this can be conveniently yours at a special discount price to make sure that your family is pandemic flu ready.

Gack! I think I’ve just thrown up a little in my mouth…

“Medic 2 respond code 3 for a traumatic injury; female with her hand slammed in a car door.”

My partner’s response: “that’s not a traumatic injury, that’s a dramatic injury!”

Laughed we did. But a few minutes later…

“Medic 2 from 44-51–we’re on scene with a conscious female patient. Obvious deformity of the left hand, partial amputation at the wrist.”

Ouch.

Another few minutes later, after Medic 2 arrived: “MedComm from Medic 2, we’re clear with a signed patient refusal.”

It begs the question: WTF?

As I’m waiting, one of the vet techs walks out from an exam room, looks up from his paperwork and sees me: “hey, you saved my daughters life!”

My first reaction was to look around for who he was talking to. I know I had that are you talking to me? “I’m sorry?” was the only thing I could say. Usually, I can remember the ‘we saved a life’ calls.

“Yeah, it was during the snow storm this winter.” He was all smiles as he was talking to me. I felt awkward because I didn’t have clue what he was talking about and now I was holding up the line.

“I’m sorry, but are you sure it was me?” I didn’t want to be rude, but I didn’t want to be taking someone else’s credit, either.

“Yeah,” he went on. “Remember, you gave her an epinephrine shot after she had some peanuts. You saved her.”

“Oh yeah! I remember now.” And I did. We had been dispatched for an allergic reaction on top of one of the hills in town. I was concerned about making it to the scene since the roads were still snow covered and we’d already had a few instances of slipping and sliding.

But we pulled up to the house without incident, grabbed our kits, and headed up the front steps. Dad met us at the door, his little 18 month old in his arms. She was crying quietly, swollen in her faces, arms, and legs–all over really. It wasn’t a matter of hives per se, but swelling all over. She looked miserable, but still awake and afraid of me, so I heaved a sigh of relief.

Dad told us he’d fed her some peanut butter, no big deal since she’d had it before, but she quickly developed a reaction. He had given her benadryl before calling 911, but she hadn’t gotten much better in the last 45-minutes. He said he would have taken her to the ER himself, but he had a 3 year old to look after also.

I sat dad and baby down and took a quick listen to her lungs. They were tight and wheezy, so I had my partner get the epi ready while I talked to dad. A quick shot in the rump and we were ready to go. Dad sat in back with me with his other little girl in the airway seat. And within a minute or so of leaving the scene, baby was crying her little head off and sounding much better than when we first walked through the door.

I stuck out my hand for the vet tech, “how’s she doing?”

“She’s great–no more peanut butter for her, though.”

We chatted for a few moments more. “I just wanted to say thank you. You guys do such great work.”

“You’re welcome.” It was the most modest thing I could think to say. I front of an office full of people, I felt pretty humble and didn’t want to ruin it by saying something non-challant like, “just doing my job, sir.”

One of my EMT instructor used to tell us that if we were in teh job for the pay or the recognition, then we should best look somewhere else. I have to say though, it’s nice when the recognition happens.

Here’s my problem:

My partner and I took a call for back pain. We were in this closet sized apartment, packed to the breaking point with a couch, queen bed, recliner, kitchen nook, and big-ass TV with stacks of X-Box and Playstation games. All of this in the same little, tiny space. We could barely find a place to set our bags down, let alone stand.

Our patient was sitting in the recliner, moaning and with three yappy dogs circling around us. “So, what’s going on?” I ask with a smile on my face.

She was a slow talker and while I felt impatient listening to her get to the point of her story, I listened attentively, taking occasional notes on my glove. But the gist of it all: she had a whiplash injury from about a week ago, had shoulder and upper back pain, and her prescribed pain meds weren’t working. It hurt when she moved, hurt when she was lying down, hurt when she was just sitting up.

“So whiplash from a week ago, huh? What happened? Was it a car accident?” Just a curious, conversational, innocent question.

“No… I fell asleep in my recliner and pulled something.” Now trust me, given my overall impression of the patient, this was a WTF? Seriously? You called for this?

I know that my partner had the same thought because I could see it in his face across the tiny little apartment. But, I thought that I could use this as an educational moment.

“You know, I’m more than happy to take you to the ER now, but this is something that can easily be followed up with your doctor. Do you have a primary care physician?”

“No. I’m in between doctors right now.”

“Well, that’s okay. Did you know that there’s an urgent care clinic at the hospital and you can easily follow up with a physician there?”

“No. But I’m on OHP and I want to go to the emergency room. That’s where I went first, they have all my records, that’s where my caseworker knows I’m going to go.”

So there it was. I tried to reason once more, explaining that records can be shared, but she wasn’t having it.

From personal experience, I’m irritated with the mindset of the ‘average’ OHP clients that I’ve run on. They look at EMS and the ER system as their only option and in some cases, as free health care. Now, I know that there are OHP clients that use the system appropriately and I’ve run on them too, but from my experience as a prehospital care provider, they are the minority.

But the story goes on. I ask her to walk outside to the gurney because there was no way the gurney would fit into her little apartment. She used her cane and I let her hold my hand as we slowly made our way outside. She sat down with a huff, slung her legs onto the cot, and handed me her cane. Then she turned to her son, shouting over me shoulder: “I’ll call you when I’m done so you can come get me.”

I was left asking myself the question if she’s able to walk to my cot (which is next to her parked car) and junior will be coming to pick her up from the ER, how come junior couldn’t drive her up to the hospital? I could make the assumption that she just wanted pain medications, but I had already told her up front after looking at her pain medications that I had nothing stronger than what she was already taking. May she simply didn’t know better, but I find that doubtful since when I tried to educate her, she wanted nothing to do with it.

Nope, I think it all has to do with her OHP Golden Ticket and her (nearly) free access to healthcare–no matter how unnecessary the access might be.

Some would argue that that’s what we do. That’s what protocols dictate we do. Find the protocol that the patient fits into and open the appropriately colored boxes. I would argue that you’re not doing enough for your patient. After reading the article on JEMS that Peter Canning recommended (EMS 12-lead ECGs after ROSC?), I noticed a comment by an anonymous poster. I’ll paraphrase: “what’s the point? It won’t change our treatment.”

I don’t want to belabor the argument (and there was a big list of objections), but the first thing I thought of after reading the comment was: Purple Box Paramedic. 12-lead ECG didn’t fit into his/her protocol for post-arrest treatment, so why bother with it? Because, as the science is starting to show, it’s probably a good idea. And as a follow up commentator stated, “if it doesn’t change what I do within the next 5 minutes then I guess it has no value at all, right?” (the sarcasm is implied). In addition to the science of it all, we have to be willing to think past the purple box and think about he long term continuation of care.

I like to browse JEMS and other literature and try to keep up to date on how EMS is evolving. In some ways, I know that I can be a little quick to jump on the bandwagon. I’ll sometimes read an article, think that’s it’s the greatest thing since sliced bread, and want to implement it the next day, regardless of how “new” or “unproven” the concept may be. But this comes from being aware of something about myself as medic: I like to know why I’m doing something. If I’m informed about the science behind it, I’m more likely to 1) perform the assessment/intervention/whatever, 2) have greater confidence in my ability to perform it, and 3) have greater confidence in the potential outcome.

As an example, I recently helped recertify our volunteer firefighters/first responders at Seaside on their CPR cards. In addition to the standard stuff (“push hard and fast; 100 times a minute; think of ‘Stayin’ Alive’”) I also gave them a brief lecture on coronary perfusion pressure and why it’s so important that we get our rate and ratios right. I kept it simple, not because they wouldn’t have understood a long lecture, but because the concept can be kept simple. And I could tell by looking at them that they were getting it, I could see the light bulbs turning on. In fact, I had numerous firefighters tell me that it was the first time that they every really “got it.” And this is the same stuff we’ve been teaching for almost 5 years now.

I’m a strong believer in the science of it all. I went to a subpar paramedic school and came out with a less-than-stellar education. I’ve done a lot of research and studying on my own and still try to learn new things every single shift.

Here’s another example. One of the headline articles on JEMS right now is The Disappearing Endotrachael Tube. Research nationwide is beginning to show that prehospital intubation by EMTs is a poorly performed skill with a significantly high (relatively) failure rate and an alarming trend towards higher rates of mortality. I read this and I think about how I want to be able to perform the skill proficiently with an eye towards long term patient survivability. Now I couple this with everything that I’ve learned about quantitative capnography, and I begin to think of intubation from a perspective of performing the skill when appropriate with an eye towards the overall patient outcome, and in turn, I have more confidence in my decision to intubate when determined appropriate.

So much of what we do in EMS is based upon habit, anecdotal evidence, and presumption. We need to be open minded about emerging research, changing trends, and evolving treatments. If we want to be taken more seriously as a profession, then we need to be willing to get behind the science of it all. It’s also so important for us to understand that we’re part of a greater health care team and that everything we do will have an effect, whether positive or negative, on the remainder of the patient’s care in hospital.

And as the NAEMT Code of Ethics for EMTs reads: “The Emergency Medical Technician shall maintain professional competence and demonstrate concern for the competence of other members of the Emergency Medical Services health care team.”

Something to ponder the next time the question is asked, “but will it change the

We were dispatched onto the beach at 11 pm for a rollover accident with injuries. There was a fog over the beach and a heavy March chill. The accident itself was a mile or so down of the beach access and we made our bearing on the lights of the fire units near the surf line.

As we approached, we could see a battered, black Toyota pickup in the surf, being rocked by waves. The rear doors of the fire department’s rescue unit was open and we could see 2 patient’s on the bench seat, and a third on the deck on a back board. We parked, positioning our scene lights on the pickup some 100 feet away in the surf. The firemen were crashing around in the surf, working on pulling another patient onto a backboard. With each wave, the pickup would shift a little more and the tide was coming in. Each wave was lapping against the tires of our ambulance.

Six firefighters, with a backboard and patient slung between them, were fast walking up the ambulance as we opened up the rear doors of the unit. The patient was lifeless, arms limp and dangling off of the board, gray in the face and soaking wet. We hoisted him up onto the gurney, expecting to get to work on him, but when he was slid forward, head resting near the airway seat and under the fluorescent lights, it was easy to see.

“He’s got brain matter showing. Get him out of my ambulance,” my partner told the firemen. He was pulseless and apneic, a clear DBA now that we could properly assess him.

The other three—the patient’s brother and their girlfriends—we took to the hospital as mandatory trauma system entries (death of a same vehicle occupant). It turns out that all four of them were crammed into the front seats of the pickup and as the truck rolled, the patient had his head roll out the open passenger side window. The driver and the two girls were relatively uninjured in the accident and alcohol appeared to be a factor. Two ambulances took all three to the area trauma hospital.

The State Police arrived at the hospital to investigate the accident. We had to hang around the hospital to do the criminal blood draws, so we got to see this all go down. The trooper made his way from patient to patient, starting with the two women. The questions the trooper asked were all the same, “what happened?” “How much have you had to drink?” “Were you wearing your seatbelts?”

Finally, he makes his way to the driver’s room. The trooper had enough of the details before even starting his questions. He knew that the passenger had died–he’d seen the body on scene. And he knew the driver and passenger were family. The driver didn’t know. When he was asking questions about his brother on scene, we deflected. “There are lots of ambulances here, another crew is with him.” “We taking care of you right now, there are others taking care of your brother.” But we knew.

So when the trooper walked into the driver’s room and the patient saw him, the first question he asked the trooper was, “how’s my brother?”

Without a pause, the trooper answers. “Your brother’s fine, he’s at another hospital. I have some questions for you.”

Our partner and I, plus the nurses in the ED all had the same knee-jerk reaction. What the hell was this trooper doing? He was outright lying to this man. His brother was dead and the trooper knew it, but he was being told he was okay and at another hospital.

Unethical, right? The trooper thought he was going to get better answer out of the driver if he though that his brother was okay. But does that justify such a horrendous lie? I don’t think so, and neither did my partner or the nurses. And as my partner and I talked about it today, we were reminded again about how upset we were two years ago about this.

But it does beg the question, is it unethical to deflect those tough questions on the scene? Is it okay to tell a family member that there loved ones, who we know to be DBAs, that they are being looked after by other crewmembers?