Adventures in EMS

I think it has probably become a tradition for me to begin every single blog post by pointing out that I haven’t blogged in aaages because life has gotten in the way, and this post is no exception. Of course it isn’t. You should know what to expect from me by now. If you don’t, well, maybe you haven’t been paying very close attention.

At any rate, I don’t believe I have done any blogging at all about working as an Emergency Medical Technician (Basic) since that entry months ago about the very obvious description of paralysis one of my fellow students offered in class once. Since that entry, I’ve taken my final written and practical exams, and (if I might brag for a bit), finished with 93% on the written exam and passed with full points on my practical exams. I also received college credit – 4 hours worth – for the course which is reflected as a 4.0 on my transcripts. Please bear with me while I toot my own horn for a second.

While taking my Basic class, I was required to complete 10 hours of ride time with a local ambulance squad before I was permitted to take the final exams. Ride time is a requirement so that new EMTs, such as myself, get the necessary hands-on experience under the supervision of an experienced proctor, rather than just theoretical knowledge, before they become certified to work as an EMT in their respective states. And while many of us did a fair bit of griping about making that ten hours in time to be admitted to the final exams, it’s an important and necessary thing. While it’s certainly a requirement to have all the theoretical knowledge, it’s a different matter altogether to use it, hands-on, in the field. On a real life patient. In a stressful or rushed situation.

I was extremely lucky during my ride time in that I was paired with proctors who were paramedics with many years of experience in the field. But what’s more is the fact that these proctors didn’t just let me watch – they let me do, under their careful supervision and with their help. And I think that was possibly the best way to be introduced to working (civilian) emergency medicine in the field – being able to do it from the start, with someone to look over my shoulder to ensure I did it right.

I know that many of my fellow students were not so lucky – some were allowed only to watch. Others were paired with proctors who didn’t actively teach and explain, just sort of had the students “follow along”. And a few students figured they’d to the “smart” thing and spend their 10 hours of “ride time” in the ER instead of the back of an ambulance – where, subsequently, most of them ended up watching and making beds, rather than getting any hands-on experience at all.

After finishing classes and receiving my EMT card, I joined the squad I had done ride time at and began my training there. But wait, you say … you just became an EMT. Why are you starting training at the squad? You should already know all that an EMT needs to know!

What they don’t tell you prior to taking the EMT class or even in the EMT class is all that extra stuff you have to learn at your squad that you do not learn in class. A lot of it, such as ambulance operations or working with helicopter life flights or writing PCR’s (pre-hospital care reports) is touched on in class but it isn’t covered in-depth – that’s what your ambulance squad is for. They train you to do these things the way they’re done in that particular squad. And, as I’ve come to find out, squads have specific ways of doing things. Some, for example, now write all-electronic PCR’s. My squad does not – we write our PCR’s by hand, on the state forms, and then enter them into the computer after a run, which submits the PCR to both the state and the company that does our billing. And there are specific ways we do checks on our ambulances to ensure that everything is stocked, nothing is expired, and all is where it should be. And so on, and so forth.

It took a few months, but I finally was cleared to run on my own for both transports and emergency calls. It mostly took “a few months” because of the low call volume – while large cities such as New York or Washington, DC are hopping (in a manner of speaking) all day and night long, our upstate area tends to be relatively quiet and we often have days where we don’t get a single call at all. Naturally, that makes getting cleared difficult because you have to do so many runs with a more experienced person until everyone feels you’re ready to fly solo.

Up here, our bread-and-butter calls are to the local nursing home. And while they’re our most common type of call, they are also our most frustrating type of call, for a couple of different reasons.

One – because the nursing home is located, literally, behind the hospital. It would probably save everyone time and money if the hospital simply built a covered corridor connecting the hospital with the nursing home, and patients were simply wheeled from one location to another. The length of the corridor would be approximately equal to the length of two ambulances. I’m not even kidding. It’s that close.  In the absence of a corridor, a lot of ambulance calls could be avoided if the attending physician took five minutes out of his day and simply walked over to the nursing home to see whether a patient actually needs to be admitted, or whether the nursing staff at the home is trying to send them for no reason other than “acute evaluation syndrome” (patient must be seen now for no good reason at all).

Tw0 – because the local nursing home seems to be staffed entirely by future rocket scientists, which I mean in the nicest way possible. These are the most incompetent people I have ever met in a group, save for our elected representatives in Washington, DC. Whenever we receive a call to the nursing home, it is an absolute given that none of the nurses attempting to tell us what happened were actually there when it happened. They’ve always “just gotten there” and “have no idea” why the patient is unresponsive or bleeding.

Often, calls to the nursing home are for patients who have been in pain or unresponsive for hours and received no interventions. Sometimes we get calls for patients who are obviously deceased and have assumed room temperature by the time we arrive. But if we come and take them, there’s less paperwork for the nursing home to do. Once, we received a call for a diabetic patient who had been unresponsive “since lunch” (three hours ago) and was found to have very low blood sugar. Nursing home staff had then attempted to help the patient by administering oral glucose – for those who don’t speak “medical”, that’s glucose paste inserted in the mouth. One of the first things EMTs learn is that nothing, ever, goes into the mouth of an unresponsive patient – except an airway. Certainly not oral glucose. But those are the things we deal with at the nursing home.

Besides nursing home calls, we do a lot of local “trauma” calls to the homes of elderly patients who have fallen or who are suffering from breathing trouble, chest pain, or abdominal pain. Those are our most common “elderly” calls. Sometimes, we’re called mainly because the person wants someone to stop in and talk to them for a while.

Once, we went to a call three roads from our station – KB (a paramedic), GS (a fellow Basic), and myself – to the home of an elderly lady who had supposedly slipped and fallen. She was laying on the kitchen floor when we arrived and had no complaints of any pain, having hit anything, or having felt dizzy at all. She’d simply slipped and not hit anything on the way down, she just couldn’t get back up.

After our assessment, GB stood her up and helped her into her chair. He started asking her if she wanted to go to the hospital and she said she’d rather stay home and maybe lay down in her bed. Then she looked at me and said, “Can you straighten my bed up for me?” This was an unusual request but, sure, why not … we’re here to help. While I straightened up her bed as nicely as I could and hoped it would meet her standards, she turned to KB, the paramedic, and said, “Is she making my bed? Does it look nice? Is she doing it right?”

A very large percentage of what we do, and where we make much of our money from insurance companies, is transporting patients from our local hospitals to larger facilities in Syracuse and Utica (and, occasionally, Burlington, VT) where patients have access to specialty resources or further diagnostic resources. We’ve got a lot of good stuff up here, but we don’t have a trauma center in our immediate area. We also don’t have cardiac surgeons. For example. Which means that many of our patients are looking at a long, bumpy ride in an ambulance – or, if they’re bad enough, a short ride in a helicopter once the helicopter makes that 30 minute flight to get to us to pick them up.

Transports are not a bad thing – well, for the patient, they are uncomfortable, but they’ll eventually get them to the resources they need. For us, they can be long and tedious. Sometimes they can be quite entertaining. Sometimes they’re just plain nerve-grating. A lot of that depends on the patient. And some of it depends on traffic. But, overall, it’s generally an easy way to get paid and as long as I get paid $50 per transport (before taxes), I’m not complaining about the tediousness of doing basic vital signs on a perfectly stable patient who’d rather sleep the whole way down.

And then we’ve got the small percentage of “interesting calls” – trauma calls such as car accidents, domestic disputes, and all that sort of good and interesting stuff that keeps the days from being same old, same old.

My very first car accident was one I went to while I was still doing ride time with KC, one of our paramedics. As a result, I got to do very little but it was a good introduction to my first ever trauma call. Our patient was a middle-aged diabetic who remembers blacking out and then remembers coming to just to find that her car had gone off the road and was seconds from colliding with a tree trunk that had recently been chopped down and was laying crosswise in the yard. A baffled homeowner, in the middle of chopping down some of the trees along the roadside, had stood on his porch, wondering what in the heck had happened and watching the scene unfold.

The entire roadside was lit up by flashing red, white, blue, and amber lights as several fire trucks, police cars, and our ambulance were on scene. When we arrived, a bystander was in the rear seat of the vehicle holding her neck, a first responder had taken a set of vital signs for us, and firefighters were cutting the patient free of the vehicle. All that was left for us to do was applying a c-collar, extracting her using our KED (which was cool, because we’d literally just done this in class the previous lesson), and getting her to the hospital.

The patient was not seriously injured – she’d broken her ankle but was otherwise intact – and kept apologizing profusely for “being so stupid” to run her car off the road and “making us all come out there for her.” But she was in a fair bit of pain and we wound up linking up with a paramedic from a different squad who hopped in the ambulance to administer medications to her after meeting us by the roadside in his fly car.

I don’t know what happened then, because as I was the only one not doing anything of use after helping to splint the ankle, I was chosen to drive the other squad’s fly car to the hospital, following the ambulance. So here I was, an EMT student, driving the Chevy Blazer fly car, lights and sirens blazing, behind the ambulance all the way into town. It was pretty cool. Until I parked the vehicle and realized I had absolutely no idea in the world how to turn off any of the lights with dozens of switches staring back at me from various locations.

That same day, we also met a helicopter at the landing zone and took the crew to the local hospital to pick up their patient, another car accident victim who was going to the nearest trauma center. When we arrived at the hospital with the flight crew, Dr. J, one of our emergency room doctors, was inserting a chest tube into the patient and asked us to come in and watch. Dr. J is all about teaching and always likes having his medics come in and observe emergency room procedures.

We’re extremely blessed to have Dr. J because he is a fantastic doctor with many years of experience in both civilian and military medicine. Dr. J was a responder in New York City on 9/11. He was an emergency room doctor in San Antonio, TX. He is a fellow at the Academy of Emergency Medicine. We could not ask for a better mentor, teacher, and doctor to work with. (Nor could we ask for better Medical Control to call up when we need something!)

Aside from vehicle accidents on our local roads, we get a fair number of our more interesting calls from nearby Fort Drum, which is one of our “mutual aid” locations. If Fort Drum sees a large accident – like a HMMWV rolling over in a training area or two trucks full of troops rear-ending one another, chances are that we’ll be out there for the call and transporting patients.

It has been my misfortune to always be as far as possible from the location of the call when the most interesting calls come in. Trauma call that requires a helicopter to be called? I’ll be in Watertown, getting my shopping done when that happens. Hunting accident that ends in a fatality? I’ll be just pulling off base after getting my shopping done at the commissary. It’s really quite frustrating because calls never seem to happen when I’m at the squad or at least within a reasonable distance to respond. (Though it never fails that we’ll get a call while we’ve got training classes scheduled … our MCI class, for example, was interrupted by an MCI.)

Well … here’s to interesting calls in the future.

Advertisement