28 January 2008

TV

So how do I, as an ambulance worker, end up on the evening news? The two most recent cases were a car accident where one patient was severely injured and trapped in the vehicle for an extended period of time (giving the news crews time to get there) and a fire that sounded bigger than it was where the news crew happened to be in the right (or wrong) place at the appropriate time. For whatever reason, our local news LOVES to have footage of EMS or fire departments in action. Maybe it is the sense of importance and tragedy, but I tend to think it is because they don't show the patients and they want to have something interesting which makes the whole event seem exciting. Mostly, we avoid the cameras by being as quick to get the patients off scene as possible. No faster than is appropriate for the patient, but hopefully faster than the cameras show up.

The crews at my station hate being on the news. Firstly, it makes everybody harass you because they never fail to use that 3 seconds of footage where you scratched your butt or stood there looking stunned and ridiculous. Secondly, it gives your supervisors and higher management the chance to see you on scene in a way you may not have been expecting. Not a big deal for me as I wear my ugly neon green reflective coat and non-latex gloves all the time and I try to abide by safety regulations, but there are always folks who assume that nobody is going to see them on scene and that they will get away with doing something they shouldn't be doing. Seeing yourself on the nightly news quickly cures you of that illusion. Heck, in a state as small as NH, just talking to people should cure you of that illusion because there is always somebody around who saw you at XYZ place or with Mrs. So-and-so on your stretcher and wants to know all the dirty details.

21 January 2008

Life

After running two pregnancy calls in two days where it looked very likely that The Asian was going to be cleaning and warming newborns, I was prepared for our truck to be ushering new life into the world. I was not prepared for what we got instead.

Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."

At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.

I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.

After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.

12 January 2008

Downside

EMS routinely puts patients on long spinal immobilization boards to prevent further spinal injury. And when we do, the goal is complete immobilization, no movement at all. Which is great, until they need to vomit.

Standard protocol for people vomiting when immobilized is to roll them on their side. But once you've secured the backboard to the stretcher, there isn't enough slack in the seat belts to easily roll the patient. If you're in the ambulance, you can reach over and open the belts and roll the board. But if you're walking the stretcher into the hospital room and then the patient starts to vomit, you aren't really in a good position to loosen everything. And if you're at the head of the stretcher, you are in the wrong spot.

Speaking from experience, this results in a vomit-covered EMT. The only entertaining part was that this guy had such force to his vomit that it was everywhere. I guess in the end it was good that I was the one covered in the vomit because I was the only one not dry-heaving or actually vomiting at the sight/smell. Glad I could be of service.

p.s. my camera just came back, good as new, so the pics of the kitchen are better now.

06 January 2008

Non-writing holiday

Okay, so I haven't been posting. Honestly, we've been working on the kitchen and I've been rocking out to Guitar Hero. I got kinda bummed about my camera, so I haven't been keeping up with photos of all the kitchen work either. K and I put together some camera phone pictures so we could post something at least, check out the recent work on the right.

Today we worked 6 hours on the kitchen and got a bunch of the backerboard for the ceramic tile done, should have the rest finished tomorrow. Tile itself will probably have to wait until Wednesday when we're both around because I don't know how to run the wet saw and it is on loan from someone.

Work has been going okay, there's been a lot of little annoying stuff going on with management, but nothing I feel reasonable writing about. The Asian and I made the evening news twice in three days (damn, two station lunches!), once for a doozy of a MVA and once when we hauled off the only smoke inhalation patient from a fire.

Living in NH during a campaign season is extremely annoying. Large mobs of political supporters on many corners, freezing, shouting, and swinging signs. Thankfully, no ambulance calls for political-related assaults or injuries yet.

I'll try to be better about posting. Biochemistry class starts on 1/23 and yes, the plan is to be done with the kitchen by then so I have time to study. Later!