Wednesday, January 28, 2009


An actual traffic advisory sign in Texas. Check out the news story here.

By the way, this happens to be my one irrational fear.

Things to Come?

A spiraling economy + collapsing healthcare system = this

Is this what we'll be seeing more and more of in the next year? Everyone seems to be cutting jobs--OHSU: 1000, Starbucks: 6000, Boeing: 10,000, Circuit City: 30,000. My state of Oregon has lost nearly 9000 jobs a month since August. We have an unemployment rate of 9%.

I fear that this story of a father murdering his family and taking his own life becuase of job loss and economic depression is something that we are going to see repeated again and again. And while we all know that things will get worse before it gets better, how much worse can we expect it to get?

JEMS State of the Science 2009

The Journal of Emergency Medical Services (JEMS) has a great supplement for download on their website. Called "State of the Science 2009," the 32-page insert has great articles on CPR, the changing roles of MS, lasix, and beta-blockers, the wide spread use of field 12-leads, research into hypothermic induction in a cardiac arrest, and other topics. You can find it on the JEMS website here. Look for the Download This Supplement link near the bottom of the page.

Saturday, January 24, 2009

Vehicle Fire

Responded with my fire department to a vehicle fire last night. While I wasn't there early enough to get pictures of the pickup while it was fully involved, I did get a few good ones. Enjoy.

After the knock down

At the command post

That's my brother, Gordon, on the circular saw

Feast or Famine

I’ve learned that EMS is very feast or famine—you’re either busy, or you’re not. Recently, I haven’t been busy. Now I know that I’ve posted in the past about being too busy, but right now I’m only running (on average) one call per 24-hour shift. In some ways, I feel like I’m not pulling weight.

In some ways, it sounds great, right? Getting paid to sit around all day—yeah, not so much. First of all, it gets boring. And secondly, it makes me a little concerned.

The rumor mill in my company is always working, and right now, the rumor is that our parent company has laid off medics and EMTs at some of our sister companies. Apparently (according to the rumor), ours is the only company that is managing to keep its “numbers” up. That’s concerning because we only have so much control over our numbers. We can’t control the number of 911 calls we take or the number of transfers we send, the only thing we have any influence over is our transport rate. As a private company, we need to transport patients to pay the bills. No county subsidy for us.

It used to be that health care had job security written all over. People will always get sick and we will always need the EMTs, nurses, and doctors to take care of them. But here’s a news story that makes me shiver: the Oregon Health Sciences University in Portland may cut up to 1000 jobs of its 12,900 employees. That’s almost 8% of its total work force. My partner’s wife works at OHSU and he’s worried. Now, I’m high enough on the seniority least in my company that my job isn’t in questions, but I worry about my friends and coworkers.

Feast or famine—and right now, it is very much famine.

Thursday, January 15, 2009

In Response

While I knew that Drunks 3 could ruffle a few feathers, I didn’t know that the first comment would be from an anonymous poster only hours after the post went up. I’d like to thank them for taking the time to comment and I’d like to respond. First, here is their comment:
While I agree that you (and other medics) need to do what you need to do to protect yourself, your writing style seems to show a disturbing level of enjoyment . The fact that you "got even" with your altered patient by "knocking her out and cutting up her leather coat" shows that you may need to look at your patient care/compassion skills.
I think medics should be allowed chemical sedation when needed, but from reading your take on this event, and the other "drunks" you've dealt with, you seem a little "quick on the plunger" when it comes to the potential use of inapsine.
While I will refrain from making baseless accusations about the anonymous commentator, it does sound as if this person is not a paramedic. I would like to say that the “enjoyment” they refer to is something that any paramedic or EMT takes in any skill that they perform. As an example, is it wrong for a medic to take a certain amount of enthusiastic joy in intubating someone? The medic is practicing a life saving skill on a patient having a very, very bad day, often a cardiac arrest or multi-systems trauma. Let’s be honest with ourselves, those are calls that we consider “good” in a sense that we get to practice a variety of our skills. So, is it selfish or self serving to give ourselves a high-five, pat on the back and tell our coworkers what a great job we did, after the fact? Of course not.

I performed a necessary intervention (i.e. patient care skill) when I chemically sedated this patient. I won’t lie and say that I didn’t feel an amount of justification (and the gut feeling of “getting even”) in sedating the patient. Especially considering this person had sexually assaulted my partner and myself, and caused physical injury to me. I was honest in how I felt. I wrote about the feelings that I had at the time of the incident and it is implied that I used the appropriate interventions and patient care skills to mitigate the situation and treat the patient. To imply that I am “too quick on the plunger,” well, let me quote directly from my treatment protocols.
Always consider your safety…if patient is combative [with] no known trauma cause for AMS, consider Inapsine 5mg IV or 10mg IM.
In actuality, I gave the patient an underdose of inapsine. As a paramedic, I am also thoroughly aware and take into consideration the risk versus benefit of every medication that I administer.

Finally, to imply that I need to reevaluate my patient care/compassion skills, I say to you: how dare you think you can judge me and my skills based upon one anecdotal story. I would refer you to such posts as Screamin’ Eagle, Why We Do, or Tragic to “demonstrate” my compassion and patient care. I would also like to refer you to Force, a brief essay on use of force in restraining a patient, a topic that I feel strongly about. But even if that isn’t enough to demonstrate that patient care and compassion are always at the forefront of every call I run, I’ll refer you to the two EMS Provider of the Year awards bestowed upon me by my fire department. Or even better, I’ll refer you to the Meritorious Service Medal for EMT-Intermediate of the Year and the Medal of Valor, both bestowed upon me by the State of Oregon. Oh, and after that, would you like to ask my wife, who wants nothing more than for me to come home safely after every shift, if it was acceptable patient care?

Tuesday, January 13, 2009

Drunks 3

And now the long awaited third in the series of drunk cases. Enjoy.

It was only eight in the evening, and really, it had been a slow shift. I was working with a part-timer that night, a cop that had just certified as an EMT-Basic. The plektron on the desk sounded and we lifted ourselves out of the recliners as the dispatcher intoned “medic 4, respond for an intoxicated female, unconscious, lying in front of the Sheldon Apartments.”

At least there won’t be any surprises.

My partner, Chris, hadn’t worked much at the south end of the county so I gave him the turn by turn directions to the apartment complex. We pulled into the parking lot to see two police cruisers and another two police SUVs parked in front of one of the five buildings. All four of the cops had shit-eatin grins on their faces and just pointed down the hallway as we walked approached. Clearly, they were enjoying themselves.

Our patient was a 230 pound female in her 50s, wearing a too-short little black dress and white leather jacket. Apparently, she already had been out on the town as she was fall over drunk. Her neighbor was standing at her side, supporting her when we came up. She was droopy eyed, smelled like booze, and had an extreme slur to her words. Of course, she told us she’d only had “a couple” of drinks, but the neighbor was reporting it was at least a whole bottle of vodka.

I directed my partner to bring the gurney up since I didn’t want her walking and falling. We spun her around and sat her on the edge of the gurney and all the while she was trying to flirt with us. “You’re cute,” she would say, dragging the words out. We started to belt her in, when I noticed a large bulge in the sleeve of her coat. I straightened her arm and extracted a near empty bottle of Smirnov Vodka from her sleeve.

“Hey guys,” I hollered over to the cops. “Do you think you might have missed something?”

“Where’d you find that?” the sergeant replied.

“Up her sleeve, man. That could have done some damage.”

At first, our patient was compliant, but became restless after we took her booze away. Chris and I were having a little trouble getting the seatbelts fastened since she wouldn’t stop moving around. I was standing next to the cot, trying to get the waist belt clasped when it happened.

She reached out with her left hand, quickly and with purpose, and grabbed hold of my crotch.

Immediately, I went from irritated to full-on pissed off. I took a step back, unlatched her hand and fired off a “you keep your hands to yourself!” I was stunned and it was the only thing I could think to say. But oh, things would get worse.

She was a loud drunk, with few inhibitions, and as my partner and I tried to finish packaging her, she started yelling. “Boy, you’ve got soft balls! I want to touch your balls!”

The cops were still standing by and began laughing. “Guys, could we get some help?”

With the cops help, we finished with the seatbelts and wheeled her towards the ambulance. I was red faced with anger and she wouldn’t stop yelling, “your balls are so soft!” And when we were just about ready to load the gurney, she reached out with her right hand and got a hold of my partner.

My patience was gone. As soon as the gurney was locked into place, I told Chris to get the restraints out. He was in the CPR seat, trying to dodge her groping and get the restraints, while I was on the bench doing the same. Through continued cries of “I want your balls!” we fought to keep her hands off of us. She was kicking her legs now, loosening the leg straps and doing her best to get off of the cot. And again, while the cops were standing by and laughing, I had to ask to get them inside to help us. One of the cops sat on her knees while the other climbed into the airway seat and put her into a kind of headlock.

She was getting more and more violent. I had to pin her arm against the edge of the cot with my knee and I worried (but only slightly) that I would break it as she fought against us. She kept trying to pick her head up and bite anyone that came near. We put the restraints on, but with her fighting, couldn’t get them tight enough to do any good. Chris put an oxygen mask over her face to keep her from biting or spitting. Her writhing and fighting was getting worse and worse. She would growl, trying to move the mask with her tongue, then try to bite it out of the way. Then she’d launch into another “I want your balls! Let me touch your balls!” It honestly reminded me of something out of The Exorcist.

Enough was enough. With two previous belligerent drunks, I wasn’t going to let another get the best of me or my partner. I opened up the drug kit and pulled out the inapsine. Using my trauma shears, I cut up the sleeve of her leather coat from cuff to collar without even a second thought and jammed that needle into her arm. I gave her a 5mg dose, slamming the plunger. I told everyone to back off, that she’d relax in a minute.

Within the next ten minutes, we were rolling were rolling our patient into the ER. By that time she was well and truly unconscious. She had snoring respirations at maybe 8 per minute and was only rousable by a deep sternal rub. If we had been any further out from the hospital, I would have considered some airway adjuncts of the nasal kind. Casey, a short, blonde ER nurse with a “if you tell me I’m cute I’ll kick your ass” kind of attitude, met as in the hall. She had her hands on her hips and her eyes were a little squinted when she asked, “you gave her five of inapsine?”

Without breaking my stride, “that’s right.” You see, this hospital recently had a patient with a poor outcome after allegedly receiving too much inapsine. They didn’t want a repeat performance. Frankly, I couldn’t have given a damn.

The cops walked in behind us, still grinning from ear to ear when I began my report. They only nodded their heads up and down in verification as I relayed the events, pantomiming the “violation” when the nurses asked, “what do you mean she grabbed you?” Having heard the entirety of the events, the nurses were sympathetic and didn’t question me again about the sedation.

I took a breath and stepped back then. The nurses were at work getting her clothes off, drawing blood and placing a catheter. Still simmering with anger, I took my gloves off only to discover three deep scratches on my left wrist. “Damnit!”

“What?” Chris looked over at me.

“She fucking scratched me! Do you realize the amount of paperwork I have to fill out now? Fucking incident and exposure forms, and I’ve got to call the Sup. Damnit!”

The officers, having had their fill of fun watching the ambulance do what should have been there job, looked at me. “Do you want to file charges?”

“No. It’s not worth the trouble.” Besides, I’d got to knock her ass out and cut up her fancy leather coat. I figured we were even, in a sense.


There’s a lesson in all of these. For starters, don’t let me mislead you to think that I take pleasure in “kicking the ass” of a patient. It is my sincere hope that a call doesn’t escalate to the point where restraint of any kind is necessary. However, it is my primary responsibility to protect myself, my partner, and other responders first, sometimes to the determinant of the patient. In this particular case, it was necessary to chemically restrain the patient, to “knock her ass out,” to control the scene and maintain our safety.

The lesson here, and what I preach to my partners but took three calls to put into action, is maintaining control of the scene to maintain your safety. A drunk patient may not be acting of sound mind (we know this, of course) and may in fact want to do us harm. Do what needs to be done to protect yourself.

Stay safe.

Monday, January 12, 2009


All us paramedics were handed the monthly Compliance Report today during our crew meeting. We (my company, that is) track the percentage of transported patients versus calls dispatched to and report this as a monthly percentage. Nationally accepted "standards" are right around 20% no transport, that is, we take about 80% of our patients to the hospital. These statistics also track the calls Cancelled by Fire, the DBAs, the No Patient found, and all Patient Refusals. So, here are my numbers.
  • Sept 08: 16.2% no transport
  • Oct 08: 20.5%
  • Nov 08: 13.5%
I think those are numbers to be proud of.

We also started a new shift bidding process today and I found out that I rank 4th in overall seniority in the company (not counting the three supervisors). Kinda cool, huh?

Sunday, January 11, 2009

In Service, Available

Medix 311 is back in service, available.

It's been a rough couple weeks since Christmas. While my little car accident didn't incapacitate me, it did make me surlier than usual. My wife and I have been down to one vehicle, which isn't so fun for her when she has to drive me to and from work on my 24s. Oh, I also got the damage estimate back on my car.

Drum roll please... $8000. That's right--8-K, 8-grand, 8-Gs.

$8000 on a car worth $1100. So needless to say, Allstate is going to total my car. Right now, my twisted wreckage of an automobile is somewhere in Central Oregon awaiting an Allstate service tech to verify the damage so they can cut me a check. Looks like I'll be new car shopping at the end of the month.

Additionally, I just had to drop $1000 today for a new washer and dryer as my current washer that is 20+ years old crapped out on me. My wife and I figured that it's better to replace them both at the same time.

My water heater has been acting up. I'm hoping it's because the washer was causing it trip its breaker. But who knows...

Oh, but I do have one piece of good news. Great news, really. Last night was my fire department's annual awards banquet and guess who was awarded Firefighter of the Year. That's right--me. Really, I'm honored and pretty humbled by it. My fire chief had so many nice things to say about me that I was a little embarrassed to receive the award.

That's it for now. Again, I promise I'll be back soon with Drunks 3, and it will be well worth the wait. Take care.