Dispatching for the FD used to be a relatively simple process for the ambulances. There were four ambulances, numbered 1-4. They were dispatched in order, usually. If ambulance 2 responded to the last call, 3 would be next. Fairly simple system, easy for ambulance staff to keep track of. You could guess whether you might have time to grab some food, perform larger maintenance tasks like changing the main O2 tank, getting fuel, or whether it was even worth trying to catch a few minutes of sleep. Those days are over.
Recently, we've changed to a GPS-based system. Each call is dispatched to the closest ambulance, or if all the ambulances are in quarters, to the ambulance which has been in service the longest. This seems a reasonable theory, reducing response times by sending the nearest ambulance, or the one who finished up the last call quickly. The problem is that this produces two escapes for ambulance crews who would rather not run calls. 1) Go to an out of the way location so you aren't closest to anything. 2) Wait as long as possible to put your truck back in-service. Both of these options shift extra calls onto other crews.
Now, we never know which call is going to be ours. Even if you hear the other calls, you would have to keep in mind where they were, if and where they transported to, and so on. What was an easily trackable system has changed to a big game of tag. You're "safe" while occupied on a call, but as soon as you tell dispatch you are available, you're "it" and trying to get from the hospital back to quarters without getting "tagged" for another call.
I go to work to do ambulance calls, so it would be rare to find me complaining about doing my job. But at 1700 for shift change, this entire dispatch system can make it very difficult to get out of work on time. The Asian and I got stuck the other night, one call at 1650, cleared the hospital at 1720, next call (when we were two blocks from the station) at 1730, cleared the hospital at 1800, next call (when we were 6 blocks from the station) at 1810, cleared at 1820 and made it back to the station at 1830 to get the evening crew on the truck. I can guarantee that our 1810 patient did not get the same caring ambulance crew that patients earlier in the day saw as we're fighting to make it home.
29 November 2007
23 November 2007
Action hero?
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Which Action Hero Would You Be? v. 2.0 created with QuizFarm.com |
| You scored as Lara Croft A thrill-seeking, slightly unscrupulous, tough-as-nails archaeologist, Lara Croft travels the world in search of ancient relics perhaps better left hidden. She packs two Colt .45s and has no fear of jumping off buildings, exploring creepy tombs, or taking on evil meglomaniacs bent on world domination. |
Shopping success
Sometimes, success is a matter of knowing what you want and limiting your expectations. K and I usually go shopping together on "Black Friday", 5 or 6 am will find us waiting in line in the cold for some good deal. We do a fair amount of our gift shopping and at least as much buying for ourselves. Everywhere we went, we were early enough to get the specials. Anybody still wondering for what this year's "it" gift is going to be, I think I can pretty conclusively tell you it will be GPS navigation systems.
Today, I think we topped ourselves. I believe total spending was in excess of $1600. Of course, $999 was for the 46" LCD HD TV we waited in line at 4:30 at Sears for. Temperatures dropped last night and the wind picked up this morning, so the crowd was pretty much huddling for warmth. I didn't see any trampling, but we didn't go to ToysRUs or WalMart, both of which had some vicious crowds.
K also bought a compound miter saw, an 18v cordless drill, and a compressor with nail gun. All for the kitchen project, of course. At least that store didn't have much of a line. I think the manager there is going to know K personally before this entire project is over. So new TV and new tools = happy husband today.
Today, I think we topped ourselves. I believe total spending was in excess of $1600. Of course, $999 was for the 46" LCD HD TV we waited in line at 4:30 at Sears for. Temperatures dropped last night and the wind picked up this morning, so the crowd was pretty much huddling for warmth. I didn't see any trampling, but we didn't go to ToysRUs or WalMart, both of which had some vicious crowds.
K also bought a compound miter saw, an 18v cordless drill, and a compressor with nail gun. All for the kitchen project, of course. At least that store didn't have much of a line. I think the manager there is going to know K personally before this entire project is over. So new TV and new tools = happy husband today.
20 November 2007
Assault
Apparently, sometimes you can bring a bat to a gun fight and win.
Last night ZM and I went for an assault call. On arrival, we see our patient lying face first in the grass, handcuffed and not moving. This is not good. Normally, even if they've been arrested, patients are still moving their legs or heads and more frequently, they are still hollering and putting up a fuss. Relief washed over me when a few steps out of the ambulance I see the patient move his legs and generally look a little more alive.
When we get over to the patient, PD informs us that he had been attacked with a baseball bat after trying to break into an apartment near by. This was not a couple of timid swings to the body either. Looking over the patient, you could see multiple impacts to his head. He's still conscious and talking, being reasonably cooperative, but not really aware of what happened or what is going on now. As we are getting him secured to the backboard and moved to the truck, we hear a few more details of what the cops think happened.
Patient broke into the apartment carrying a shotgun and a pistol. Pair of brothers are home in the apartment, one downstairs, one upstairs. Brother downstairs gets a hold of the shotgun and is trying to wrestle it from the patient when brother upstairs comes down with the bat and gets a good crack at patient's head while both hands are wrestling for the gun. Patient continues to struggle, more hits with bat, brothers end up with both guns and patient runs for it. PD called in the midst of all this chaos while patient still in the apartment. Patient makes it about 5 feet out the door before collapsing and being met by PD.
Ultimately, patient gets two large IVs, O2 and assessment from us, then a quick trip to the hospital. Less than 3 minutes after arriving, patient has a seizure. Seizures after head trauma are generally a sign of a pretty severe brain injury. Patient gets medicated, intubated, and has his head scanned. Results were a depressed skull fracture, subarachnoid bleed, multiple brain contusions and a broken jaw. Too bad he'll never remember the helicopter flight to a bigger trauma center, it was a nice night for a flight.
p.s. Not relevant to the story, but we've got snow on the ground today...winter finally made it. Kitchen cabinets to be delivered the week of Dec 10th. Electrical panel to be replaced this week. I have way too much shopping to be done on Black Friday.
Last night ZM and I went for an assault call. On arrival, we see our patient lying face first in the grass, handcuffed and not moving. This is not good. Normally, even if they've been arrested, patients are still moving their legs or heads and more frequently, they are still hollering and putting up a fuss. Relief washed over me when a few steps out of the ambulance I see the patient move his legs and generally look a little more alive.
When we get over to the patient, PD informs us that he had been attacked with a baseball bat after trying to break into an apartment near by. This was not a couple of timid swings to the body either. Looking over the patient, you could see multiple impacts to his head. He's still conscious and talking, being reasonably cooperative, but not really aware of what happened or what is going on now. As we are getting him secured to the backboard and moved to the truck, we hear a few more details of what the cops think happened.
Patient broke into the apartment carrying a shotgun and a pistol. Pair of brothers are home in the apartment, one downstairs, one upstairs. Brother downstairs gets a hold of the shotgun and is trying to wrestle it from the patient when brother upstairs comes down with the bat and gets a good crack at patient's head while both hands are wrestling for the gun. Patient continues to struggle, more hits with bat, brothers end up with both guns and patient runs for it. PD called in the midst of all this chaos while patient still in the apartment. Patient makes it about 5 feet out the door before collapsing and being met by PD.
Ultimately, patient gets two large IVs, O2 and assessment from us, then a quick trip to the hospital. Less than 3 minutes after arriving, patient has a seizure. Seizures after head trauma are generally a sign of a pretty severe brain injury. Patient gets medicated, intubated, and has his head scanned. Results were a depressed skull fracture, subarachnoid bleed, multiple brain contusions and a broken jaw. Too bad he'll never remember the helicopter flight to a bigger trauma center, it was a nice night for a flight.
p.s. Not relevant to the story, but we've got snow on the ground today...winter finally made it. Kitchen cabinets to be delivered the week of Dec 10th. Electrical panel to be replaced this week. I have way too much shopping to be done on Black Friday.
19 November 2007
Day of good deeds
Recent shift consisted of:
Also, favorite diagnosis from an ED doctor recently "Acute exacerbation of chronic crazy."
- Help a half-naked man (not the socially acceptable half) back to wheelchair after falling on the floor.
- Search for a person slumped over the wheel of a parked care (not found).
- Transport the least injured person from a car accident.
- Carry an elderly woman upstairs after the FD got her out of the broken elevator.
- Bandage a kid with a head laceration, then lead his mom to the hospital so she didn't get lost.
Also, favorite diagnosis from an ED doctor recently "Acute exacerbation of chronic crazy."
09 November 2007
Lobotomized lab rats
are smarter than my last two patients today. I'll just tell you that they were passed out in somebody's front yard (at 1500!) and leave you to fill in the rest. These are the days that make me wonder why I decided to do this.
Also, we now have Ativan, Zofran, and Toradol on our trucks and the medic student even got to use one today.
Also, we now have Ativan, Zofran, and Toradol on our trucks and the medic student even got to use one today.
07 November 2007
Updates
- I addressed the salary question with HR and they "investigated" and decided to up my salary to $x+0.30/hr retroactive to April, then $x+0.92/hr after my evaluation this month. Because I'm a "valued employee". And I'm now sworn to the confidentiality of my new salary to help support morale...ha!
- K and I decided to buy the new microwave now and rig up a temporary set up to use it until we can officially install it. We aren't using the convection oven settings now because I'm not sure how the heat gets vented, but I'm guessing that 3" of space underneath probably isn't enough.
- The home equity loan isn't closing until next Wednesday, so we're trying to figure out whether we're missing out on any good sales if we wait that long.
- I've been sick for the last two days, achy and miserable. Strangely like the flu I'm not supposed to get because of my flu shot. No respiratory symptoms though, and that is usually the first thing I come down with when I get sick.
- I checked in with the school I interviewed with in September and I'm still on the no decision made list.
05 November 2007
Recipe for confusion
Ingredients:
1 dispatch, "Meet PD for psych problem"
1 caseworker outside building
1 naked patient
2 unhappy cops
3 people on the ambulance (1 student)
Apply dispatch to EMTs, stir gently for 3 minute response time while student verbalizes potential patient scenarios. On scene, add caseworker. Allow complaints of patient medication non-compliance, conditional discharge, and other caseworker jargon to saturate EMTs, eventually requiring them to be rude and ask for entrance to the building to assess patient. At apartment, add 2 cops to a separate dish, laughing at EMTs and being grumpy for getting dispatched to a medical call where they had to request an ambulance. Add sweaty, naked patient, breathing heavily, answering "yes" to all questions. Wait patiently while EMTs stick to floor, seek clothing, dress patient, continue to be mocked by PD, attempt to get non-jargon information out of caseworker, and walk patient down stairs. Place PD aside for potential use in different recipe. Place mixture in ambulance, find out patient is schizophrenic with violent hallucinations, caseworker knows nothing further about medical history, knows nothing about what medications patient takes. Continue assessment, find blood sugar reading "HIGH" on glucometer. Agitate gently for 4 minute transport to hospital. Remove from ambulance and deposit mixture into ER room. Serves 6-8.
Sounds tasty, no? This entire call left me completely confused. The patient was trying her best to do everything we asked of her, so I was fairly irritated with the caseworker complaining about "non-compliance" when there was clearly a bigger problem going on. No known diabetic history, but this patient was in DKA (diabetic ketoacidosis). We missed it initially because there were so many funny smells in the apartment and we had been focused on psychiatric issues. At the hospital, they intubated her immediately. We later found out that she was also in renal failure and had some sort of fungus in her blood.
1 dispatch, "Meet PD for psych problem"
1 caseworker outside building
1 naked patient
2 unhappy cops
3 people on the ambulance (1 student)
Apply dispatch to EMTs, stir gently for 3 minute response time while student verbalizes potential patient scenarios. On scene, add caseworker. Allow complaints of patient medication non-compliance, conditional discharge, and other caseworker jargon to saturate EMTs, eventually requiring them to be rude and ask for entrance to the building to assess patient. At apartment, add 2 cops to a separate dish, laughing at EMTs and being grumpy for getting dispatched to a medical call where they had to request an ambulance. Add sweaty, naked patient, breathing heavily, answering "yes" to all questions. Wait patiently while EMTs stick to floor, seek clothing, dress patient, continue to be mocked by PD, attempt to get non-jargon information out of caseworker, and walk patient down stairs. Place PD aside for potential use in different recipe. Place mixture in ambulance, find out patient is schizophrenic with violent hallucinations, caseworker knows nothing further about medical history, knows nothing about what medications patient takes. Continue assessment, find blood sugar reading "HIGH" on glucometer. Agitate gently for 4 minute transport to hospital. Remove from ambulance and deposit mixture into ER room. Serves 6-8.
Sounds tasty, no? This entire call left me completely confused. The patient was trying her best to do everything we asked of her, so I was fairly irritated with the caseworker complaining about "non-compliance" when there was clearly a bigger problem going on. No known diabetic history, but this patient was in DKA (diabetic ketoacidosis). We missed it initially because there were so many funny smells in the apartment and we had been focused on psychiatric issues. At the hospital, they intubated her immediately. We later found out that she was also in renal failure and had some sort of fungus in her blood.