Summing it Up

It was during the very last class of my EMT-Basic course, and toward the second half of that class, somewhere between eight and nine o’clock at night, the fluorescent light illuminating the sheets of 110 questions – a previous state exam from several years ago – in front of each student. The question we were working on was about a patient with a transient ischemic attack (a stroke) who suffered paralysis on one half of his body – which symptoms are associated with the paralyzed limbs?

The class was silent as the clock ticked behind the teacher’s desk, above a blank dry-erase board and next to a large, ripped, copy of the Periodic Table of Elements staring back at us.

“Well,” the teacher started. “Has anyone here worked with a patient with paralysis before?”

A single hand shot up from halfway back, from a row inhabited mostly by males in their 20′s who’d been known to be somewhat silly and talkative at times throughout the class. The student who’d raised his hand, bearded and always wearing a baseball cap, looked back at the teacher.

“So describe what the affected limbs were like,” the teacher coaxed.

The student thought for a bit, all eyes turned to him for the correct answer to the question. Well, all eyes turned to him to see what his answer would be, at any rate, since many had already read ahead and circled whatever answers they figured would most likely be correct. The student cleared his throat. “Well. One side of his body was paralyzed. The limbs were … well… they were all, like, paralyzed.”

A collective shout of laughter rung out. The instructor ducked down behind his desk, trying to stop giggling. It was much needed, though unintentional, comic relief. And yes, paralyzed limbs can usually be described as paralyzed.

Mauser*Girl, EMT-B

So, as usually, I get to start an entry with, “I haven’t blogged in a long time”. If Anne Frank had written her diary like this, we’d probably have five pages to read – one page of her family winding up in the hidden attic room, three pages of Anne’s relationship with Peter, and one page where she worries about the Nazis finding her.

Luckily for my readers, I’m not in an attic. And there’s plenty of stuff to read on the Internet for all those days I don’t blog here. Heaven knows I spend enough of time reading all those things that are out there to read on the Internet … my favorite blogs (a list of which can be found in my side bar), and lots of pages such as I Can Haz Cheezburger that just make me smile or giggle or cringe or squee for the day. How did people ever make it through the day without those things?

At any rate, between my very busy life on the Internet (hah!) I’ve been very busy in my real life as well. You see, I’ve spent the last five months going to school. To become an Emergency Medical Technician – Basic in the lovely (hah!) state of New York. Going to class here involves an awful lot of driving in really deep snow and really scary road conditions, I might add. Not to mention, uphill both ways and barefoot.

My EMT class was actually quite a bit of fun and, as intended, quite educational.

Our instructor, Don T., has been an EMT in these here parts since before the dawn of time … or at least since before the dawn of any sort of standard curriculum for EMTs. You know that old TV show, “Emergency!” Yeah, back when things were like that for EMTs is when Don started being an EMT and he hasn’t stopped since. Because he’s been an EMT since the dawn of time, Don has a great deal of stories and anecdotes to share in class, not to mention some gory pictures from calls way-way-past, and he manages to easily weave those stories and anecdotes and a great deal of humor into his classes.

Mind you, Don is one of those people you’d never, ever, ever want to get mad. You wouldn’t like him when he’s mad. He started out the very first class by giving us a long list of things he does not tolerate in class and the consequences for them. In other words, your pager had damn well better be off, or you might find yourself right out of the course. He means it, too.

EMT-Basics do an awful lot of very, very basic things – taking blood pressure, pulse rate, respiratory rate, and oxygen saturation, and giving oxygen, the occasional glucose and here and there an epi-pen or two. Compared to military combat lifesavers, who aren’t even medics but can do more advanced things, such as getting an IV started, EMT-Basics are very, very basic indeed. But I suppose everyone has to get started somewhere.

And EMT class starts with a whole heck of a lot of vocabulary. You better know not only your parts of the body (and where they are located), but also your fancy terms. EMTs, for example, do not listen to lung sounds – they auscultate lung sounds. Except one in my class, who pretty consistently pronounced it “oscillate”. We don’t look for the pulse in your wrist – we palpate the radial pulse. Same with the pulse in your foot, your pedal pulse.

Having taken 6 years of Latin, most of the new vocabulary was not terribly new to me, as most consists either of Latin words or words with Latin roots. Like the dreaded pedal pulse which is, of course, in your pedis – your foot, or the brachial artery, located in your brachium – your arm. Needless to say, I couldn’t help but smirk just a bit whenever people were having trouble remembering those difficult foreign words. (I’m also making a conscious effort not to use them with patients, because the little old lady going to the hospital with difficulty breathing has no idea what “auscultate” means, but she knows what I’m going to do when I tell her I’m going to listen to her chest.)

EMT class involves a lot more classes spent lecturing than classes spent doing hands-on work, but there is a fair deal of hands-on stuff to do and learn as well. Some of this, such as spinal immobilization and CPR is covered and practiced more than other skills, such as traction splints and simple arm slings, because we do more of the former and less of the latter. (Actually, in upstate New York, the vast majority of our calls are medical in nature – chest pain, difficulty breathing, hospital transfers, allergies, diabetic emergencies – rather than trauma in nature. Which is kind of a shame because the trauma calls are a heck of a lot more interesting.)

When we practices our hands-on skills, aptly termed our practical skills, during class, our instructor normally split us into groups of three or four, with a current EMT supervising and ensuring we were doing everything correctly. That was a good concept but caused some issues since some of the folks who have been EMTs for a while, especially those who have been Basics for a long time, tended to have their own way of doing (and teaching) things, which wasn’t always correct. Nowhere did that become more obvious than during our practice of backboarding and using the KED. There, three different EMTs supervising us, on three different occasions, taught us how to do it wrong – much to the annoyance of our teacher who yelled at them as he came through and saw them screwing it up.

Incidentally, one of the more experienced proctors told us that “weak backboarding skills” was the biggest problem she had found with recent EMT graduates. I wonder why… Well, actually, I don’t. I know why. Because these folks feel the need to teach students to do it “their way”.

One thing that has to be said about the instructor is that he is a man who loves tests. In particular, he’s a great fan of the pop quiz. For a while there, it seemed like every class was accompanied by a pop quiz, either at the beginning or at the end. Usually accompanied by much collective groaning. However, everyone seems to have done well throughout the year, as we ended the class with the exact same number of students that we started it yet – which was, the instructor told us, a first. In all his years of teaching.

Although the constant tests were on the verge of annoying, the truly annoying was two rows behind me, in the form of a very large woman with “twelve years experience working in a nursing home”, as she was quick to point out while we were teamed up for backboarding practice. Having had “twelve years experience”, she expected that she knew all, and set out to prove it by giving every answer to every question ever asked. Loudly. And, quite usually, very wrongly. Which got to be quite annoying since she sat behind me.

The kid who sat next to me, Allan, was a general source of entertainment and amusement throughout the classes. We kept up a friendly kind of competition with each other for giving correct answers and getting good grades (preferably better than the other), and traded notes and humor throughout the class. Humor is good.

Once our class progressed from learning terminology and anatomy to taking vital signs, we were ready to go out into the world and complete the ride time necessary in order to be admitted to the state exam at the end of the course. New York requires 10 hours of ride time – that is, 10 hours in the back of an ambulance, watching (and doing) actual patient care – to be admitted to the exam. Which was a bit of a problem since I didn’t actually belong to any department. Fortunately, my boss at Fort Drum gave me the POC to the department he belongs to and they let me do my ride time there. (I eventually joined them.)

Getting the necessary amount of ride time proved to be difficult at best. While, I’m sure, ambulance companies stay fairly busy in densely populated areas such as Syracuse or New York City, they don’t up here. The first couple of days I spent at the Squad, nothing happened. Nothing at all. Fortunately, the Squad has wireless internet in its building. And a flat-screen TV.

After the initial nothingness, I was able to rack up a couple of hours worth of ride time and learned quickly that trips from the nursing home to the hospital and vice-versa are the EMT’s bread and butter up here. I can’t imagine a more boring type of call if I tried. Particularly since the local nursing home literally backs up to the hospital, so we essentially load them, turn around, and then unload them. A lot of money could be saved if they simply put in a hallway connecting the two buildings.

I also quickly learned that the majority of trips from the nursing home to the hospital wouldn’t need to be taken at all, if the staff of both could remove their heads from their fourth points of contact.

The nursing home staff will see a patient that is normally doing badly and, one day, decide that they need to go to the ER or to the hospital via direct admission. Maybe they decide this based on the day of the week. Or based on whether or not they like the patient (or the ambulance duty crew). But in many cases, the nurses and doctors at the hospital get the patient and say something along the lines of, “Why are we admitting him/her? He/she is usually this bad. It’s not like there’s anything we can do to change their condition.” Or the nurses roll their eyes because they know the patient is there because the nursing home staff spoke to one of the doctors on the phone, and the doctor said, “Well, send them in for admission.” (Instead of, you know, walking across the parking lot to take a look and see whether the patient actually needs to be admitted.)

And some patients just rub the nursing home staff the wrong way … like the 78-year-old we took in (for “diarrhea” – after they’d given him three kinds of stool softener), who was telling dirty jokes to the doctors and nurses and was none too nice to the nursing home nurses. When we went to take him back to the nursing home, after he spent three hours mostly asleep at the ER, we had the following conversation with him:

Patient: “I haven’t seen you before.”
Me: “I’m new.”
Patient: “Well, it’s about time they got some good-looking nurses around here.”
Colby: *snicker*
Patient: “I told one of them (nurses) the other day, she looked as bad coming as going!”
Me & Colby: *ROFL*
Patient: “I told her, she needed to give me more meds. Maybe then she’d look better!”

So yes, we do an awful lot of that, and an awful lot of transporting patients from the smaller local hospitals to the bigger hospitals down in Syracuse, which is pretty much where anyone who’s got any serious medical condition (heart attack, stroke, etc.) or any serious trauma, goes to. By ambulance. Two-and-a-half hours, for your average transport. One-and-a-half if the driver is my boss and the patient is critical.

Occasionally, we got something more interesting, and I had a particular Thursday where I racked up most of the ride time I needed before taking the exam. Which was a good thing, because I was starting to get desperate and ready to encourage my friends to run over pedestrians in order for me to get some ride time.

That particular Thursday we headed out on a transport as soon as I walked into the building and took an elderly gentleman to Syracuse for his sixth bypass. (By all means, he assured us, he was a very lucky man. After all, his father was already dead at his age.) As we were coming back from the transport, and just outside Watertown, we heard a call on the radio for a different department for a motor vehicle accident (or collision … for some reason, we don’t call them “accidents” anymore). A few minutes later, another call went out for the same accident, multiple patients. Helicopters inbound. ALS (advanced life support) needed. We were still a ways out but had a Paramedic on board, so we turned on the lights and got going.

Of course, we made it to just a mile from the accident site when they cancelled us and cancelled the second helicopter. Instead, one patient would be airlifted, another would be going to the hospital, and we weren’t needed. We decided to head over to the landing zone instead, which is located in town, to see if any assistance was needed. No sooner had we pulled in, than we were dispatched for another call. This one actually for us. And actually within our area. Another car accident.

We arrived to find everyone and their brother already on the scene, and a four-door sedan smashed into a tree, its front bumper being somewhere near the front seat bench. The Fire Department was ripping the doors off and we got to do a KED extrication, which was actually a pretty cool thing to get to do. Our driver, Mat, was beside himself with joy. “I’ve never gotten to do one of these in the two years I’ve been here!” he said. I was primarily the Gofer, getting equipment, handing equipment. Once we had the woman in the ambulance, I did pupils, hooked up the pulse oxymeter and held her very broken ankle while CM slid a pillow underneath to make a pillow splint. And off we went to the local hospital, with a link-up with another department (and good drugs) en route.

At that linkup, I ended up being the one person with nothing to do, so I got to drive the fly car to the hospital, following the ambulance. Which was just weird. I couldn’t figure out how to adjust the seat before we headed out, and then, for the life of me, couldn’t figure out how to turn off the headlights once we got to the hospital and parked.

We’d just sat down to do the PCR (pre-hospital care report) for this call when Mat joked, “I wonder what’s gonna be next?” No sooner did he say this than we got a call on our pagers – back to the landing zone to pick up helicopter crew who’ll be taking one of the patients from the first car crash to Syracuse. Go figure. So we grabbed our gear and got going back out to the LZ.

At this point, I should probably mention our LZ. We’ve got a very nice, solid-surface, well-established LZ that serves our local hospital. The problem with it is that someone decided, for whatever reason, that the perfect place to put such a thing would be in the center of town. Between two apartment complexes. On a side road that requires the ambulance to cross railroad tracks. And it’s nowhere near the hospital … it’s about 2 miles away. The person who decided that this is where the LZ should be should be shot. In my humble opinion.

So we headed out there and eagerly awaited the helicopter, along with the most of the Fire Department and the entire neighborhood. The helicopter came in just as it was getting dark, and our driver’s side headlight went out at about the same time and resisted any efforts to be coaxed into working again. Okay. We’ve got enough lights to serve our needs until we can get back to the Squad.

Helicopter!

We picked up the crew and headed with them and all their gear to the hospital where they were, of course, not at all ready for us. So we stood and waited there. At least we stood, waited and got to observe interesting medical procedures – Dr. J, who came up here after having worked in the ER in Houston, TX, for some time, let us come in and watch him put a chest tube into the patient we were there to pick up. Which was pretty damn cool. (It was very much like watching one of those “Live from the ER” TV shows, except without all the cameras. And with way less equipment than those fancy big-city ERs they always film in.)

Eventually, we got to help package the patient and take her back to the helicopter, and with that, I’d just gotten almost 5 hours of actual with-patient ride time that counted toward my 10 hours total needed in order to graduate, and I felt pretty smug about having gotten so much of it on such a short time. Our Paramedic, too, kept me educated and entertained throughout. She told me about the time she did ride time in New York City where, apparently, they do “virtual vital signs” … which is basically a way of saying, “My patient is talking to me and sitting up, so their Bp is at least …” no matter how far it is from actual. Which is a pretty damn scary thing.

This month, May, we had our final exams. One big, long 120 question final test for the course, and then the two state exams, the practical exam and the written exam. The practical was the one I was stressing about more than the written one. Although we’d spent a fair amount of time practicing the skills required, it’s a scary thing to look at those exam sheets and see all the “critical” points that you must remember on each practical skill station – missing any of the “criticals” will fail you. Just like that. And if you fail more than two stations, that’s it right there, you won’t be allowed to take the written exam. *Faints*

Needless to say, that was a stressful, long night. But I passed. Actually, I passed most station not just with all criticals but also with full points. Ironically, the station I scored lowest one was the Patient Assessment – Medical. The very station for which I had been a patient during Monday’s first round of practical skills exams. (Our class was split, taking them on two separate days.)

After the practical skills exams, we had two more classes in which we got back the final test for the course and then went over past state exams for practice. As everyone has been pointing out, the state exams ask questions in a way that sometimes comes across very much as being designed to trip you up and ensure you’re actually reading the question very closely. Any question that includes a sentence such as, “what must the EMT do first“, usually falls into that category. They’re quite annoying, to be honest.

As it turned out, when we took the actual written exam last Thursday evening, many of the questions on the exam were the exact same questions as the ones we’d had on previous course tests or pop quizzes and as we’d just gone over during our exam review, and as such, the test turned out to be fairly easy unless you weren’t in the class or didn’t pay attention (or just got really nervous and didn’t remember any of it). I took my time, carefully reading each question, eliminating wrong answers, and, where needed, doing math and taking notes in the test booklet margins. (Yes, I suck badly enough at math that I would calculate burn percentages on paper…) I stopped a couple of times to sharpen my pencil or take a sip of my soda. 30 minutes in, I had completed the test for which we’d been allotted 2.5 hours. I looked around. I decided to go back and go over all the questions again, ensuring I hadn’t read anything wrong or done anything wrong. But there were only a few questions that I wasn’t 100% certain on. So, after 45 minutes, I raised my hand and turned in my test.

I won’t officially be an EMT-B until my card comes in the mail, but it’s a pretty sure thing to say at this point that I passed the test and did well on it. (I would be very surprised if it isn’t over 90% at least!) I did well in most of the class … my lowest test score having been 86% and my average, before our one-week Easter break having been 92%. (I won’t know my full-course average until next week.)

The question now is, what next?

One of the local colleges offers the Paramedic class, either as a degree program (Associate’s) or as a certificate program, but I don’t know yet whether I will be here for two more years to take and finish it – and I would hate to get started on it, then have to move, and find out that my credits won’t transfer. The other direction I could go in would be to continue classes for ALS – the next level for New York would be EMT-I (Intermediate) and the one after that EMT-CC (Critical Care), which, together, seem to be what most states consider “Intermediate”. But they prefer that you have at least a year experience as a Basic before going into the next class.

I guess I will wait for my card to come in the mail and get some experience running calls for a while at my Squad, and then figure out what will be next.

Maybe Brian will find out he’s going to stay at Fort Drum longer. He’s been making himself indispensable lately, providing the 10th Mountain Division with its very own professional reenactor – as I write this, he’s at the Joint Service Open House at Andrews Air Force Base, hanging out in his World War II uniforms. (If you’re going to be at the show, make sure to grab one of 10th Mountain’s very spiffy posters. I designed them.)  Next month, we’re doing the Army Birthday Ball here at Fort Drum – also as reenactors. We’ll be in the flag and streamer ceremony. And the weekend after, we’re running Fort Drum’s Ride through History. (As in running. As in, I’m signed for the facilities. Running.) It’s never dull around here.