Tuesday, March 5, 2013

A Life Lesson in EMS


A few Saturdays back I was scheduled to (assist) teaching EMS students with practical skills at the local University. This is the same class I took when I trained, so I know the hours and how long the Saturdays can be.

I was put in the Standing Take-Down*/Helmet Removal station with two new instructors, who I had taught in the prior class. I love doing that practical as it's a lot of fun, but I also make sure all of the students get to experience how it feels to be the "patient" so when they need to do it out in the field, they have a good grasp of how the patient is going to feel.

Toward the end of the day, the students had grown weary of all of the stations and were somewhat trying to distract us instructors. I know the game I had been there before. Many of the new instructors aren't currently practicing EMT's, at least on a regular basis, so a lot of what happens out in the field gets asked of us returning instructors.

Our final group had just entered our class room. All day, I and the other instructors had been doing a quick demo of the Standing Take-Down and Helmet removal and then had broken off into groups for practice. After the short demo I asked if anyone had questions. One student raised his hand and asked, "You ride on an ambulance right?" I responded I do, and then he asked the question that every single student asks every single instructor, "What's the worst thing you've seen out in the field?"

I know what the student wanted to hear, he wanted to hear about the blood, the guts, the gore, the broken limbs, the intestines spilled out all over the ground, etc. But what I told him was much more sobering.

A few years ago, our state had a massive storm just before Halloween. It crippled the state, power was out for days, trees and power lines were down at least every half a block. I had been scheduled to work the day of the storm, and then literally was not able to make it home from my station. I explained to the student that several calls that night made what we did very "real" to me.


I explained that scene safety extends beyond just getting on scene. Early in the night before all the power was out, we gotten a call to assist another town as all of their ambulances were out. We had made it safely to the location of the patient, (even though we could hear the cracking and the subsequent BOOMS of the tress falling around us), gotten them packaged up and were transporting to the hospital. My partner was driving our ambulance, the local tri-town paramedic was in the back of the ambulance, and I was behind them driving the fly car to the hospital. About 3 blocks into transport there was a series of tell-tale large blue sparks that exploded right on the side of the ambulance, right where the main oxygen tank is housed... and I saw the wires fall right in front of the medic truck I was driving. I stopped and watched as the ambulance drove away trying to figure out what route I was going to take to get to the hospital. When I arrived, my partner and the paramedic were glad to see me and know I was safe. On the way back to the station, my partner and I talked about how lucky we were and how the results of the night could’ve gone much differently.

The second call that came in was for an infant who had fallen off the bed and had an actively bleeding head laceration. My partner and I got into the ambulance, our service car joined us and the paramedic was en route. We tried several routes and were not able to find an unblocked one to get to the house. Every road leading to the house had either large trees or wires or both blocking our path. Our service vehicle had broken off and tried to find other ways to get to the location of the call without any luck. We called dispatch and even though they offered to send out crews to remove the trees, it would’ve taken several hours to clear even the most accessible path.

We were advised the Paramedic (who was coming from a different location than we were) was able to make it out to the family and was taking care of the child. Our crew had no choice but to go back to the station without being able to assist the obviously frightened family.

I told the student, the next morning, when the roads were clear enough for me to make it home, and the world looked like a twisted, snow covered Dr. Seussian world, it became very real that we were not going to help every patient we are asked to. I let the students know that I went home and cried. I explained that as EMS we are trained to be able to help people, but not really trained on what happens when there is nothing we can do. It was a very humbling experience for me in many ways.

I told him the second experience I had was "real" was during my paramedic student clinical rotation at the Level 1 Hospital.  The patient had gotten in shortly before my shift started and had been complaining of numbness in their legs and some trouble breathing. I walked over to the patient and told them that we were in the process of getting some medication for them. They reached their hand over to me and said they were scared and asked me to hold their hand. I obliged. The medication that was prescribed had a side effect of making the patient drowsy, so after the medication was administered, I let go of the patients hand and tucked it into the covers. I got the story and the patient’s extensive history from the nurse and wrote up a short little note in my pad for class.

Shortly thereafter, a trauma came in, so I left the patient in care of the nurse and moved over to the incoming patient. About 30 minutes into my new patient, I hear the doctor in the other room say, "Get the EPI!" I moved back to the first room and see several people in line to perform compressions on the patient. I hear the nurse yell, "CLEAR!"  and watch everyone on the room step back and put their hands up in the air (showing they are clear of the patient). The patients’ torso raised up about an inch and then fell back, the doctor ordered to continue with compressions, and I grabbed the bag valve mask (BVM) and started to squeeze air into the patient. For a few minutes, everything around me was kind of a blur. I just remember listening to the commotion in the room as I watched the monitor to make sure I was adequately breathing for the patient. Respiratory was setting up their ventilation machine and the patient was placed on it and at the same time, CPR stopped, the patient had pulses again. I don't exactly recall all of the events, but the patient was back, at least for a while.

Sometime later, the patients’ family had come in to say their goodbyes. The patients’ child was holding their hand and said, "I'm so sorry I said I hated you." I had to choke back my tears. Just a few hours ago, this patient was holding my hand, and now their child is holding the same one begging them to hold on. Watching someone come in and say goodbye to their loved one was almost too much for me to bear. To top it off, knowing this child's last words to their parent were words of hatred and anger, made my heart ache for the guilt they will carry for the rest of their life. I don't know if the patient ever pulled through, as they went to the ICU.

The last story I told the student was about how we were called to an unknown medical, possible untimely (DOA). The DOA's adult child had called 911 after finding their parent unresponsive at home. We arrive on scene and we are assessing the patient. The paramedic turns to me, hands me his gear and asks me to bring it out to the fly car. After doing so, I go back into the apartment and the adult child stops and asks, through tears, what was going on. I advised them I'd let the paramedic come out and talk. A few moments later, the paramedic walks over to the adult child and says, "I'm sorry, but your parent is dead."

The adult child fell into the paramedic's arms and began to sob; the medic held the adult child for a moment before their neighbor grabbed the child and consoled them.

I explained to the student that watching the paramedic be so firm and compassionate at the same time was a huge eye opener for me, and something I didn't realize I wanted and could be to be until I saw it. 



I explained to the student that as EMT's while on duty we kind of get a semi-superhuman feeling. Not that we don't know that we aren't invincible, but there are many moment's I've had where I've been knocked from that "savior" peg and felt human... And that was the hardest thing, was knowing that at times there is nothing we can do. And that for each patient we touch, we will impact someone's life, for the good or for the bad.

After my stories, both the students and the other instructors were listening with full attention.  They understood there needs to be an expectation of those "human" moments. Sometimes as medical providers, we lose sight of the fact we are dealing with people, not just patients, and the refocus into the human element will either make or break them. It's the kindness, compassion, passion, understanding and empathy that make a good EMS provider.

The student thanked me and admitted he was looking for the guts and the gore stories, but said he understood why I gave him the stories that I did and why they were the "worst" calls I had done.

The students in that group that day all look at me with different, more clear and focused eyes when they come into my stations now and it makes me feel good that I was able to get through to some students and make an impact.




*A Standing Take-Down is a procedure used in the field to immobilize an ambulatory (walking/upright) patient after self-extracting from a car accident or a fall, etc.  It is used when there is the potential for a spine injury. The patient is asked to stand in the location where they are, c-spine precautions are taken, a backboard is placed behind the patient, and at least 2 responders hold the patient and the backboard and guide the backboard and the patient to the ground safely. 

Tuesday, February 19, 2013

And they let you drive a Fire Truck?



Normally Mondays are my "hell day". I start my day at 5:30 am to be up for clinical rotation at the Level 1 Trauma Center for 7 am. From there, I walk two blocks to class which lasts until 10-10:30 pm. I normally get home around 10:30-11pm. Yesterday since it was a holiday, we had no class time, but I was still scheduled to do rotation.

During my shift at the volley service on Sunday I had sent a text to my Paramedic friend (with whom I've been studying with since before Paramedic School started) and let him know I'd drop by after visiting a sick relative, for assistance in reading some ECG's. My aunt had been in another hospital recovering from surgery only a few minutes away from the hospital where I log my rotations.

After an eventful shift, I made my way over to see my aunt who was in very good health and good spirits. I ended up staying a little longer than I had planned and sent a text to my medic friend letting him know that with traffic I most likely wouldn't make it up before the end of his shift. He confirmed and let me know the following shift would suffice.

Shortly thereafter, my Aunt kicked me out so she could rest and I made my way home. The traffic was much lighter than I thought giving me a few minutes to perhaps catch my friend before the end of his shift. I made my way to the Fire Station unannounced to find a parking lot full of cars and the fly car missing from the normal parking spot. Seeing as how it was 30 minutes until the end of my friends shift, I parked in my normal spot and sent a text asking if he was on call (OC) or gassing up.

More vehicles came trickling in, one pulled in next to me and parked. I decided to move my car as I thought I may be taking a spot that some one else could use. I put my car in reverse and backed up a good 35-40 feet to the old fire-house-converted-fire-museum on the other side of the lot from the main building and parked. Even though the area was a little dark, it still had some light and was far enough out of the way for cars entering and leaving. Or so I thought.

I turned the headlights off and checked the messages on my phone. Normally if not on a call, my friend is pretty prompt about returning text messages. With a quiet phone, I slid it back into my pocket and sat quietly reflecting on all the people I had interacted with during rotations that day. After a couple of minutes I took my phone out and sent my friend a message, "Must be OC. Heading home, catch you tomorrow." Before I could hit send, I noticed the truck that had parked next to me start to back up.

Granted the way the cars were parked it was impossible to do a K turn and drive out head first, I didn't think much of it at first. But then the truck got closer and closer to my car. I put my hand on the horn and was about ready to hit it when the vehicle stopped. A little irritated that the guy waited until he was *this close* before stopping, I moved my hand from the horn.


No sooner than I had done that then WHAM!  all I heard was a crunch. He backed up again this time hitting my car. He pulls forward a few feet and gets out of his car while audibly bitching about the fact he didn't see me, which is blatantly obvious at this point. Although he kept his cool, he started demanding to know what I was doing there.

While he went to his truck to get a flash light, I explained I had been waiting for my Paramedic friend to come back so he could assist me with homework. He then asked again what I was doing in that spot because he had just parked next to me. I noted that seeing as how there was a meeting going on, it made sense for me to move out of a parking spot for someone who was attending the meeting.

Assessing the damages didn't take too long thankfully. The protective covering on the headlight was completely cracked, there was a 6x2 scratch on the front bumper of my car and the license plate (and my EMS Service plate needed for first responding in the town I volunteer in) were pretty bent up. Thankfully both headlights still worked with no issue.

After a minute or two of trying to figure out how or why he hit me, and stating some of the damage he did he didn't do, and digressing after I pointed out matching damage on his truck, he gave me his contact information. He then shook his head and said he was on his way out to respond to a fire call down the road which is why he was leaving the meeting and not really paying attention.

All I could think was, "Seriously, I hope they don't let you drive the Fire Truck."

On the plus side, if he did give me false information, I know where to find him... I just have to make sure I park where he can see me.