Extended Leave

It'll be awhile longer than promised before I get back to regular posts. I was in a car accident on the 26th on my way to work. It wrecked my car, but thankfully I'm okay, just very, very sore.

Anyways, I'll be dealing with the insurance company, the body shop, and possibly a dealership in the next few weeks.

Until I get back to regular postings, stay safe.

Merry Christmas

Merry Christmas to everyone in blogger land (even though it's almost over). I took some time for the holidays, but I'll be back with regular posting and Drunks 3 soon.

Happy New Year everyone! Stay safe and enjoy the holidays.
- Medix 311

Drunks 2

The second in a series of 3 on drunk cases.

“Medic 2, code 3 for an unknown medical, possible psychiatric problem.”

It was 2:30 in the morning and I rolled out of bed with a groan. I looked at the address on my pager: Warrenton. Great. I knew I’d be up for an hour, at least. I pulled my pants on, then sweatshirt, and finally my boots, then trudged out to the rig. My partner already had it running and put us en route as I climbed into the passenger seat. Dispatch repeated the address and nature of the call as we pulled onto the highway, our red and white strobes casting about us in the light fog.

We made for the roundabout, then south across the bay towards Warrenton. Rescue would be responding also, so I punched the SCAN key on the radio, but all was quiet—either they were already responding, or no one was. We’ll find out when we get there I thought to myself.

Going through Warrenton, we took a left at the main light, and shortly approached the scene. The fire department’s rescue unit was parked in the driveway of the single level house, its red rotators mixing with the pulsing blue and red of the police cars parked opposite the house. Everyone had come out for the show.

My partner marked us on scene, I pulled on a pair of exam gloves, then got out of the unit. We piled our equipment on the cot and wheeled towards the open front door. A police officer met stopped us short of going inside and gave me the rundown.

“So this kid shows up at these people’s home, completely drenched and drunk. He pounds on the door until they open up, then starts rambling about how it’s his parent’s place and he wants in. He’s in the living room, but he’s tweakin’ pretty good. I think he’s on mushrooms or meth.”

Our patient, a male in his early twenties, sits in a living room recliner. He’s dressed in his work uniform from a fast-food joint, soaked to the bone, and wrapped in one of FDs wool blankets. He’s fidgety and anxious, partly because he has no clue what’s going on, partly because the firemen are crowded around him, and partly (I thought) because he was high. I made a hole through the firemen, then crouch down so that I’m was at least eye level with him.

“Where are my parents?” he starts. “I don’t know who all these people are. What’s going on? Why are you all in my house?” He’s angry with us.

“Listen, partner. This isn’t your parent’s house. You woke up some poor folks and they called us. We’re going to take you to the hospital to figure this out.”

I questioned him some, tried to figure out what he’d been up to. He thought it was only 11pm. He didn’t know how he’d gotten to this house, if he’d gotten into an accident at all, or if any one had been with him. He denied drug use and—image this—denied drinking. He still thought it was his place and we had to argue back and forth a little that the homeowners had no idea who he was. I think at some level, he finally just gave up the fight and allowed us to walk him over the cot. It was when we started to put the seatbelts on him that things start to get out of hand.

“What the fuck is going on?! Fuck you people! I want to know what’s happening!”

Now, most everyone there knew my rules and I made no hesitation to educate the patient. Forcefully and sternly I told him, “you need to watch your mouth. You need to calm down and cooperate with us, or things are going to turn out badly for you.”

He was still angry, but he apologized through clenched teeth and we continued to belt him in. During this time, he’d lost a pocket full of change and as I bent down to collect it for him, he opened his mouth again. “Look at me! You need to tell me what the fuck is going on!” When I raised my head up to look at him, he was pointing his finger at me and he was red faced with anger.

“Listen. That’s your second warning about your language. You dropped your money and I was picking it up for you. We’re taking you to the hospital because you’ve had too much to drunk and you don’t know what happened tonight. Calm down, trust me, and cooperate, or things will not go good for you.”

But it didn’t stop, his bad attitude and loud mouth persisted. We had a 15 minute transport time ahead of his, so after we loaded the patient, I told my partner to just get going, that I’d handle everything in route.

Several times during the transport, he’d go from compliant and amicable to verbally combative and verbally abusive. At one point, he took his cell phone out of his pocket and after finding the battery dead, threw it against the rear doors. This was the point that I thought that’s it. I opened up my drug kit and pulled out the ampule of inapsine and a 5cc syringe. I had one eye on the patient and the other on the drug as I drew up the sedative.

“ Whoa, hey! What are you doing! What the fuck are you going to stick in me? You’re not sticking me what that fucking needle!”

“If you don’t calm down and get your language under control, that's exactly what will happen.”

“Are you trying to threaten me?”

“Nope, just giving you fair warning.”

And warning it was. Look, this is the way I see it. When you watch Cops on TV and they bring a suspect back to their car, they tell them to put their hands on the hood and not to move. After a few seconds, the suspect will take his hands off the hood and try to reason with the cop. The cop will warn him to put his hands back on the hood. This repeats three or four times before the cop finally cuffs the suspect and sits him on the curb. The cop does this to control the scene—he does this by controlling the suspect and thereby controlling his safety. My tact with this kid was the same—I needed to control the environment to keep myself safe.

Lucky for him, he kept his mouth shut and his hands to himself for the rest of the transport and the syringe of inapsine sat next to me on the bench. We unloaded him at the ER bay, and while he looked angry as a hornet, he still kept his mouth shut. The ER nurses had prepped the psych room for him and waited for my partner and I to transfer him to the ER cot, only he wasn’t getting off of the cot.

“I’m not getting off this fucking thing until somebody tells me what’s going on!”

He had a death grip on head bar of the cot and he’d spread his legs, wrapping his feet around the frame of the Stryker. We tried doing to easy things at first, just lifting him over using the bed sheet, but he wouldn’t budge. And so my patience broke. I forcefully unwrapped his feet, roughly slamming his legs back onto the cot, then I loosed his grip, throwing his arms back onto his chest. Then we roughly tossed him to the ER cot in a kind of “1-2-3-heave!” motion.

Afterwards, I told me partner “sorry. I know I lost my cool, but guys like that really just piss me off.”

“You know, you were way too nice to him,” he replied.

Too nice, huh. I guess I’d broken my own rule. I should have used to inapsine, drawn up and sitting next to me on the bench, as it was.

ACLS Update

Today I took my ACLS update and I did my PALS update about two weeks ago. I'm now sure that a person's success at ACLS and running through the scenarios is inversely proportional to a person's pay scale. In other words, the more your get paid, the worse you do at ACLS.

To illustrate my point:

My group today for recertifications consisted of an ER physician, multiple nurses, and 3 paramedics. The worst performer of the group was the ER physician--he overlooked the BLS survey (the look, listen, and feel), didn't know drug dosages, and had to refer multiple times to his pocket guide to double check the algorhythm.

The ICU, CCU, and ER nurses in my group performed slightly better. About half remembered the BLS survey, although some would skip steps (such as not checking a pulse and jumping from giving breaths to starting compressions). Most of the nurses had trouble identifying the heart rythms, which I guess is understandable. The majority of the nurses had a firm grasp of what drugs to give when, although they seemed a little iffy on dosages.

By far, the best performers at the skill stations were the paramedics. The medics were on top of the BLS survery, made smooth transitions from assessments to treatments, knew the heart ryhtms without questions, and knew the algorithms by heart.

Now, I'm not trying to say that medics know better than nurses and physicians, but I think that with the way the ACLS course is taught, it creates an environment for medics to do better. The course starts with the BLS assessment and CPR, followed by field interventions, and skills that are performed by medics on a very regular basis. Conversely, many of the nurses in my classes had no prior training in field assessment skills, or more technical skills such as intubation or needle decompression. Many of the nurses were unsure of their roles and stated multiple times, "well, the doctor normally would do that," or "I'd call for the doctor."

Doctors, on the other hand, aren't expected to perform CPR in a clinical setting, or be the ones to start the IVs or push the drugs. They often aren't expected to be the ones to perform the BLS assessment (as an example, one of the physicians in my class was an oral surgeon).

Medics practice these skills on a daily or weekly basis, incorporating the BLS survey, ALS skills and interventions, and transportation and turnover into all of their patient contacts. Nurses and doctors don't have the beginning-to-end exposure that medics in the field do and can therefore lack the same skill set. Many of the nurses in my class talked about how the patients they see on a daily basis already have an IV or airway established, how the diagnosis and treatment has already been determined, in other words, much of the guess work is already been done for them.

So the other medic students and I spent over three hours (or our six hour day) this morning going over the CPR video (a skill that we should already come to class proficient in). We then watched corny DVD videos of nurses, doctors, and EMTs perform the cardiac arrest algorithms (all of which were done with far too much urgency and energy to seem realistic or reassuring). After this we performed basic airway adjuncts like the OPA and non-rebreather masks (skills that we learned in EMT-Basic school and should be proficient in). We spent only 1 hour of our 6 hour day practicing the "mega-code" scenarios. So I have to wonder, where is the "Advanced" in Advanced Cardiac Life Support? My partners and I wanted only to do our scenario and take our test--get in and out in an hour. Really, the science and skills hadn't changed in 2 years. These are the 2005 guidelines, right?

Ideally, I'd love it if ACLS was taught in such a way that it focused on the skill level of the providers. ACLS for paramedics would focus more on the core cardiac arrest cases. ACLS for basic level providers would focus on core CPR skills and basic science. ACLS for nurses would focus on in-hospital interventions and working as part of a team with a doctor in the lead. ACLS for doctors would focus on the more tertiary aspects of cardiac arrest management, identifying and correcting causes of cardiac arrest that can't necessarily be identified or corrected in the field.

But the AHA has their way of doing things and who are we to questions, other than the providers that render their standards of care.

Drunks

The first in a series of 3 drunk cases that have given me problems over the last few months.

There's a reason that I don't like drunks. I never get called to the happy drunk, the one that wants to buy you a pint and hang out. I don't get called to the funny drunk or even the silly drunk. No, I get called to the guys too drunk to walk, too drunk to stay conscious, too drunk to be a nice. And it's never at a convenient moment, always right before or after the bars close--in other words, past my bed time. So when I'm paged out at 0230 for an unresponsive male in the parking garage of the Ocean Inn, I'm not thinking diabetic problem, stroke, or cardiac arrest, I'm thinking--I know--it's a drunk.

We had to park on the street and hike the gurney and equipment into the garage. The cop gave us his name as we walked up, Brian, from the military dog tags around his neck. He was still sitting in his enlistment bonus when we arrived. A brand new Ford Mustang Cobra, black with the twin gray racing stripes. It was a sexy ride, aside from the douche-bag in the driver seat.

The hotel worker said he'd seen the guy earlier in the day and that he'd already had a half gallon of Captain Morgans. The cop said he'd already tried honking the car horn and doing a sternal rub, both without effect. The driver's door was open and you could smell the alcohol from 10 feet away. Brian was passed out... completely... the “I just bought myself” an intubation kind of unconscious.

So I turn to my partner. "Look, we're gonna pull him out, put him on the cot, and then we're going to put in an nasal airway. We'll see if that'll wake him up."

My partner and I pulled him out of the car, roughly setting him to the ground so we could readjust our grip. Coming up under his shoulders and knees, we hefted him to the cot, then started to strap him in. His button down shirt was open at the collar, I could see a set of dog tags resting on his chest, and a couple of tatoos. His jeans were wet at the crotch.

As we strapped him in, he woke up--wide eyed and with a scrambling of his limbs. "Easy there, partner," I started to soothe him, "we're the paramedics."

"What happened?" he asked, still wide eyed and confused.

"You had a little too much to drink tonight and the hotel called 911 when they couldn't wake you up."

"I haven't had too much to drink!" he tried sitting up and getting off the gurney and only got himself tangled in the straps.

"Easy, soldier. You had enough tonight that you're either going with me to the hospital, or going with this nice police officer here to sober up," the cop raises his hand and gave a little hello.

So Soldier Boy complies and relaxes a bit on the cot. The fire department had arrived then and I told them, "we got it guys, but thanks for coming out." My partner and I slung our kits onto our shoulders, and then rolled the patient out of the garage and into the ambulance. My partner sets up the IV bag, while I go about getting a blood pressure and setting him on the pulse ox. With the IV bag set up, I told my partner we can get going, that I'll start the line in route. My partner jumps up front and we start towards the hospital.

Brian passed out again, his head rolling onto his left shoulder. We weren’t more than fifty feet down the road. My partner is eyeing me through the rear view mirror as I put the sternal rub into Brian again. He awakes with a violent start this time, flailing his arms, kicking is legs, and getting enough momentum going that he crawled right up the head-end of the gurney and wound up wedging himself into the airway seat. Honestly, it reminded me of that scene in Signs where Joaquin Phoenix sees the alien on the news clip and backs himself into the closet out of shock.

“Park it, Shane! Get back here!” I yell up to my partner. I felt the rig lurch forward as he hit the brakes and parked it.

Brian was thoroughly freaking out right now, “what’s going on! What happened! Where am I?” Over and over he kept asking as I tried to talk him down and soothe him. My partner had crawled in back and was awaiting instructions. I was trying to calm Brian down, to get him back onto the cot, at the same time I gave instructions to my partner to get the Inapsine and a syringe.

Brian had calmed a lot and was now moving back to the cot as Shane placed the drug onto the bench next to me. I settled him onto the cot, securing the straps around him again, explaining that I wasn’t trying to restrain him, but keeping him safe. He was calm enough at that point, so I told Shane to get back up front and we’d get going again.

On the drive in, I talked with Brian trying to get a little more history out of him, the entire time the Inapsine and syringe on the bench next to me. I talked him into letting me take his blood pressure and to hook him up to the monitor. He even said it was okay to start an IV, which I wrapped copiously with coban to keep it in place.

I patched my report to the hospital and soon enough, the back-up alarm was sounding as we came into the ER bay. We unloaded the cot, Brian still resting comfortably and the Inapsine still on the bench.

The nurses met us in the ER hallway, silently pointing to bed 6. Brian had tried scratching and pulling at his IV a few times and I was glad that I’d tied it down. He’d also started to have this smoldering, angry look in his eyes and I knew he was trying to work up to something. But he transferred to the ER cot on his own and I exited the ER bay with an apologetic look to the nurses.

Just a few steps outside the room though, he started pulling at his IV line again and trying to scramble off the gurney. I turned on my heel and dashed back into the room to give the nurses a hand. Brian was getting more and more agitated and I had to use my forearm to keep his shoulder pressed into the ER cot. It took a minute or so, but an ER tech came in with a set of soft restraints that we tied Brian down with. I backed away from Brian, pulled my gloves off, apologized again to the nurses, and left the room.

Maybe I should have used the Inapsine.

Posting

At post 14. A cup of Starbucks on the dash, with my ballcap and sunglasses (didn't need those today).

Another gray, rainy day on the Oregon coast.

Why We Do

My brother’s little girl was born premature by 3 months. She had a lot of health problems in her first few years of life and today is mildly autistic. When she was born, my brother and his wife Tonya had moved to a little town outside of Portland and was working for a local utilities company. He was a volunteer firefighter in that town, the same as here in Seaside before he moved. He’s also a very proficient EMT.

One morning, Gordon’s wife was watching their little girl when she stopped breathing. It wasn’t unusual, and had happened a few times before. Tonya knew what to do and did the few stimulus activities that the NICU nurses had taught her… only this time they didn’t work. She cried for Gordon who came running into the room and saw his little girl turning blue and not breathing. He checked a pulse and not feeling one, started CPR.

***

I’ve asked myself and some of my coworkers over the years, “why do you enjoy being an EMT?” (or a firefighter, depending on who I’m asking). The answers are varied, of course. Most have some variation of “because I want to help people.” One of my fellow paramedics tells me he’s here because its less stressful than his lost job—he was cabinet maker before.

Many of my fellow EMTs tell me they’re here because its more interesting that what they did before. Whether it was surveying, delivering pizza, or drug running (seriously), they find working as an EMT more entertaining.

My supervisor was recently quoted in a local paper as saying “My favorite part is making a difference in someone’s life. Sometimes that means holding a patient’s hand and taking them to the hospital. Sometimes is means saving a life.”

For me, I’m not sure I have a simple answer to the question. I started in volunteering for the fire department my senior year of high school as my community service/graduation project. It was an easy way to get the hours and it let me spend time with my brother and dad. At the time, it was the era of the dotcom boom and all I wanted was a career in computers. Then the boom went flat and I was left looking for a new path. By the time I graduated, I enjoyed my time volunteering and moved into the fire station as a resident volunteer—but I still wasn’t sure it was what I really wanted.

I worked customer service, first as a floor manager at the local movie theatre, then as a front desk agent at a hotel before I started full time on the ambulance. But even as I became a full time, paid responder, I still wasn’t sure what I wanted. I was still testing for fire department jobs, but wasn’t thrilled about working 24-hour shifts, and neither was my wife.

This were different for my brother, though. He knew he wanted to be a fireman as soon as dad brought home his bunker boots when my brother and I were still little. Right out of high school he was applying for full time for jobs. He must have taken at least 50 in the last ten years and some times he’d get as close as the final chief’s interview before being cut. Time and again I saw him get cut down, only to get back up, dust himself off, and sign right back up for the test. If only I’d had that kind of dedication and drive.

Don’t get me wrong, I enjoy what I do. I love being a paramedic. I feel like I’m putting my skills and knowledge to use on a daily basis. I know that I’m helping people and most of the time that gets me through the shift. I’ve transported friends and family and known that I’ve made a difference for them. I have seen heartache and been on the calls that bring my family tragedy. I know that EMS is a team effort, but I know that because of my skills, there are a couple of people out there still alive and that makes me feel wonderful. Sometimes I think I’m here doing this because it’s what I’m comfortable doing—who wants to rock the boat, right? Right now, I can say for sure that I’m here because I have job security. With the economy as poor as it is, I know that I have a good paying job for my family that isn’t going to disappear. I just don’t know that I have a single, sum-it-all-up answer to “why do I do what I do?”

***

Gordon performed CPR on his little girls until the ambulance arrived. By that time, she was breathing on her own again and crying. She went in again for another stay in the NICU, my brother and his wife at her side.

Gordon once told me that if his whole purpose, his whole reason for taking all the fire classes, for becoming an EMT, for testing for all those fire jobs and getting shot down time and again, that if he was never meant to get a fire job—that his only reason for all of it was to save his daughter’s life that morning, it was all worth it.

I hope that someday I can have as noble an answer as my brother’s for why we do what we do.

Gordon is now a career firefighter/EMT for the Portland Fire Department.

The Boots We Wear

It was time to order new boots. My old pair, a very comfortable pair of Galls Atheltic style boots, was cracking at the heels and the sole was separating from the boot. I did some shopping around, specifically looking for a pair of leather, waterproof, zippered boots under $150. I settled on a pair of Bates Durashock boots; leather, zippered, and water resistant.

These boots were comfortable out of the box, but still needed a couple of days to get broken in well. They looked new from the factory, unscuffed of course, but also a little dull. So I bought a tin of boot polish and started to shine ‘em up. For the last three weeks, I’ve spent at least an hour every shift polishing my boots to a glossy shine.

*****

I believe that you can tell a lot about an EMT or a medic by the boots that they wear. I take the time to polish my boots, to put forth a professional image from head to toe. I like to think that I’m precise and polished in my skills—not perfect, mind you—but polished.

Other medics show to work with ugly boots, never once shined from the moment they left the box, or worse, shined with those awful all-in-one sponges. Their uniform shirts are wrinkled, often with more than a couple of old coffee stains. Similarly, their skills are rough and they lack that personal touch, but they’re still passable as medics.

My company SOGs state that footware shall be “black and polishable.” Note that it doesn’t state “boot” specifically, but “footware.” Many of our employees have come to exploit this as well.

While black romeos aren’t specifically against company policy, they are a poor idea. They offer very little traction and no ankle support. They are not made for hiking a trail to rescue hiker or wade into a flooded ditch. And those EMTs in my company that choose to wear the romeo would not make the effort to climb that mountain, or they’d send a fireman into the ditch for their patient. They’re lazy, unwilling to do the work of lacing up a pair of boots and unwilling to do the work of polished EMT.

I’ve seen a medic come to work in black loafers. Old man shoes (if you’ll excuse the expression, but he is an old man.) His shoes also keep him from hiking hills or crawling into ditches, but they do convey a sense of professionalism and formality. We won’t see these loafers rappelling down a cliff, but we will see them standing next to Mr. Jones and his loafers as we help him up from the floor. The loafers, and the medic they’re attached to, has a way of interacting with the elderly population and putting them at ease that isn’t reproduceable by the medics my age.

A new hire EMT is working in a pair of black danskos, a wonderful nursing clog, but a shoe for the field it is not. Her attitude is great, with a perky smile, and a cute little pony tail. Her footware betrays her inexperience. She hasn’t had to hike a mountain or crawl into a ditch yet. Likewise, she hasn’t yet rolled her ankle stepping out of the ambulance, or worse, carrying a patient down a flight of stairs. Her skills lack polish and experience, just like her clogs.

*****

The last time I was at my parent’s place, I asked my mother if she still had her dad’s shoe shine kit. It was a worn, wooden box with a shoe stand on the lid. The hinges and latch were tarnished brass. Inside, I remember he had all kinds of brushes, polishes, and rags. Mom still had the box, which she was happy to pass over to me. Inside were all of grandpa’s old horsehair brushes, used so many times they’re down soft. Old tins of Kiwi polish caked and dried, and old, oil stained rags that smell like wood and polish. The care that went into my grandfather’s old cowboy boots (and a cowboy he was) now are going into my work boots.

My boots are something I can feel proud of. I think they make me stand out a little from my coworkers, even if I’m the only one who notices how nice they look. The work that I put into them, in a very strange way, makes me feel like a better Paramedic.

Bookwormin' It

Thanks Bernice over at I Just Call It As I See It for the Bookworm Award.

Rules:Pass it on to five other bloggers, and tell them to open the nearest book to page 56. Write out the fifth sentence on that page, and also the next two to five sentences. The CLOSEST BOOK, NOT YOUR FAVORITE, OR MOST INTELLECTUAL!

My closest book is actually a stack of books that my wife and I just purchased for our Hawaii trip. So I'll go five books down into the stack... On Call In Hell: A Doctor's Iraq War Story by Cdr. Richard Jadick. "... academic year, ROTC didn't amount to a whole lot more than putting on a uniform and marching around once in awhile. The summers, however, were an entirely different situation."

I'm looking forward to the read, especially knowing that I'll be reading it on a white sandy beach many, many miles away.

Now, my five picks:

WamBamThAmbulance
Yeah, I know he doesn't post frequently, but he's near my neck of the woods.

EMT to Paramedic
Another infrequent blogger, but someone I who I think has great potential. Show him some bloggin' love.

Sam over at On the Clock
Seriously, it's Sam. How could I not pass this award on to her.

As the Pump Turns
My new, favorite nursing blog about a very good nurse in a very tough job.

Epi over at Pink, Warm, and Dry
On any given day her writing can make me laugh, smile, or cry.

The EMS Gods Must Hate Me

Today, I started my vacation. I'm not on shift again until the 26th. Friday, my wife and I leave for Hawaii. But yesterday, the EMS gods, or the vacation angels, or the demons of time-off were punishing me for taking vacation. In order of appearance:

• A psychiatric making a scene in the dining room of McDonalds at 8:30 in the morning.
• A sweet, little old lady with recurrent GI bleed needing cauterization in Portland. Of course, she wanted transport to the hospital at the other end of the county.
• An 60-something female with transient chest pain with previous episodes earlier in the week. She was getting the RV ready to go to Mexico when the pain started.
• At 1:30-ish, a man having a seizure in the lounge of a local restaurant. Turns out, he almost always has a seizure after one or two drinks. Seems like he shouldn't be drinking...
• An MVA in the pouring rain. One car rear-ended a pickup when the pickup decided to make an illegal u-turn in the middle of the highway and the car couldn't swerve to avoid. The driver of the pickup, of course, was uninsured.
• After fueling and getting back into our end of the county, we were called to an elderly diabetic. He was glassy eyed, staring at the TV, had a mouthful of oral glucose (puffed cheeks and all), and with a BGL of 25. He was an easy fix with IV D50 and a no-transport.
• A 70-something female that nearly-feinted at a grade school fundraiser. She was awake and waving us away as we walked up. i had to yell to talk to her--not because she was hard of hearing, but because the bad cover band wouldn't stop playing.
  
• A dementia patient that couldn't walk upright. She looked like Micheal Jackson in Thriller when she tried to stand up and walk.
• A 50-something female with sudden onset, middle-lower abdominal pain, no radial pulses, no BP, and very delayed capillary refill. She had a diagnosis of pneumoperitoneum in the ER (along with many, many other diagnosis--she was a sick lady).
• A 40-something male with a GI bleed the vomited blood all over his bathroom and kitchen. Turns out he'd been taking 6-8 adult aspirin a day for about two weeks because of back pain.
• A hour later (at 12:30 am), we took the above GI bleed to Portland for extended care and returned by 5 am.

Upon returning from Portland, I finally slept away the last few hours of my shift, stumbling out the of senior tech room at 7:45 am by the sounds of the relief crew. I was so tired that I couldn't even do a proper shift turnover. "Narcs are out in the ambulance... somewhere. You're low on oxygen... and other... stuff. Sorry."

I am so ready for vacation.

Storm Ready

Today, I had to bring my newly packed Storm Readiness (as in I'm probably being overly paranoid) Bag to work. A wind storm is supposed to be blowing through the north Oregon coast over the next 2 or 3 days. This morning when I left the house, it was blowing rain sideways. Today, I'm thinking about trees coming down and as I told the ER nurses this morning: "the rain tends to bring out the crazies."

As for my overly paranoid Storm Readiness Bag, I now carry on the unit with me:

• A hard hat
• Rain pants
• Leather work gloves
• Headlamp
• Flashlight
• Safety goggles

At least if I get stuck on a highway this winter, I might feel a little safer while the wind is blowing and trees are falling down around me.

Ideal Partner

A comment on my last post by Michael Morse got me thinking about who my ideal partner would be--or at least the qualities that I'd be looking for.

1. Comes to work with a positive attitude. This is of utmost importance to me. I'm 25-years-old and I've been able to identify in my self that I an easily influenced by other people's attitudes. It's a flaw, I know. But if my partner comes to work with a positive attitude and keeps that attitude no matter how bad the shift gets, then we'll have a great day together.

2. Leave the ego at home. I appreciate my partner's experience, be it 10 years or 10 days on the job, paid or volunteer. I believe everyone has a different perspective they can bring to the job. That being said, I am the senior tech and with that, I'm ultimately responsible for the station, the ambulance, us (as a crew), the firemen, the scene, and the patient. I want my partner's input on things, but if I say this is how we're going to do it, then this is how we're going to do it. Check the ego and go with the flow. You keep me from having to pull the "paramedic" card and you'll save yourself some embarrassment and headache.

3. Want to be an EMT. My company works Paramedic/Basic crews, meaning that roughly 90-95% of patients are cared for by the medic, most of the time relegating the Basic to a driver. And when the Basic has patient care, typically its for the "neck-pain" c-spine patient or the belligerent drunk we (paramedics) don't want deal with. But if you have a want to be an EMT, then you should have a want to provide patient care. EMTs that are here only to be my driver don't deserve my respect. EMTs that want to ride with patients and exercise their skills will be given more opportunities to do so.

4. Have the desire to do your job. Now this goes beyond that of patient care, this encompasses everything we do in our 24-hour shifts. All the boring stuff that we don't really want to do like house chores, inventory, equipment maintenance, training, mapping, ambulance washing, and everything else that takes away from driving around with lights and sirens. I don't like doing a lot of that stuff either and would much prefer to spend my shift on the couch sleeping or watching TV--but as my boss so bluntly puts it, "you're paid to work for 24-hours." So please, take the time to help me take care of the house work and daily chores--it makes my boss happy, which in turn keeps me happy.

5. Honesty, compassion, trustworthyness, strong morals and ethics, and all the other qualities that make up a good person.

I'm still looking for that ideal partner. Oh well.

Resolution

TJ and I had a falling out as partners some months back. He was moved to a night-car after it, but we were partnered again after his return to 24s. This were never the same between us. We used to laugh and joke, we had the same black sense of humour about our job. But when we started working together again, it was all professionalism, to the extent of cold shoulderness. He would hardly say hello to me in the mornings, wouldn't do a rig check with me, or would hardly say a word to the patients or firemen on scene.

I had a conversation with my supervisor last night, and it went something like this:

Supervisor: "I had a conversation with TJ the other night. He said something about you..."
Me: "Oh yeah. What was that?"
Supervisor: "He told me, 'I know that Jeramy and I have had our differences in the past, but at least I never had to worry about his abilities as a paramedic.'"

Not that I ever tried to impress TJ, but I always did wonder if he respected me as a paramedic. Now I know.

And you know, it's nice to have that resolution.

Profanity, too

Thanks to Sam over at On the Clock for getting me thinking about this topic.

I curse as well at midnight-thirty in the morning when I'm being dispatched to... well... whatever. It doesn't matter what I'm dispatched to. I curse.

I'm not a sailor, so I can't curse like one. But I can curse like an irritated volunteer firefighter, which is near close to a sailor, I'd wager.

My old partner would be rolling on the floor at the string of curses (including my favorite "fuckin'-fuckity-fuck-fuck") coming from my mouth. I could hear her exploding in laughter in the next room over. And the string of profanities would continue while I walked to the ambulance, got into the driver's seat, and drove to the call, pausing only to key the mic. Only when I would open the driver's door and step out, would the cursing stop and the game face go on.

You see, I value sleep. I have an early bed time at work: 2100 hours. I like to maximize my head-to-pillow time because I never know when I'll be up, or what I'll be doing. Even with this forethought, this planning, I'm still highly irritable when I'm up after midnight.

Heaven forbid we be dispatched to an abdominal pain at three-thirty in the morning. I would diagnose it as "I can't fucking poop!" before even rolling out of bed. An unconscious male at four-thirty was "a fucking drunk dumbass!" And a male with chest pain at the jail at two-fifteen was "fucking handcuff-induced chest pain because he doesn't want to spend the night in jail! Fuck!" (For those of you that keep up with my blog, the F-bomb rule only applies when there are patient's in around.)

And Ms. Dominguez, the 79-year-old female with abdominal pain that hasn't pooped in 5-days, but is now deciding it's a problem at three-thirty in the morning--we'll be medivaning her back to the raisin ranch three hours after dropping her off in the ER, with a prescription of Milk of Magnesia in hand.

So last night, shortly after my head had hit the pillow, the tones went off.

"Medic 1, respond code 1, Raisin Estates for non-emergent transport."

The profanity started low in my stomach, accompanied by this deep, ugly feeling about wanting to do serious harm to care facility nurses.

"Medic 1 responding," my partner keyed the mic after we got into the rig.

"Copy, en route Medic 1. Be advised, patient requesting Columbia hospital. Dispatch clear at 0337."

"That's another 20 god-damn miles! For fuck's sake!"

And without missing a beat, my partner turns to me, "um... can I say that on the radio?"

I still love my job.

Screamin' Eagle

On the weekends, we don't run wheelchair vans which very often means that medivans are tasked to the ambulance crews. As I sat watching a History Channel documentary about the 101st Airborne division--the Screaming Eagles--we were paged for a return medivan trip from a local nursing home. I looked over the page, seeing that we would be taking a patient home. That's a bit of a bright spot I'm thought. We don't often get to return patient's home from a nursing facility.

We arrived to find our patient, Mr. Jefferson, in his hospital bed puffing on a neb treatment with his daughter and grandson at his side. This was going to be a BLS trip so while my Basic partner began chatting up the family, I tracked down the unit nurse for a quick report and our discharge instructions. The nurse was flustered, she knew little of the patient and our paper work hadn't even been started yet. "No problem," I smiled at her, "we're in no hurry."

We situated Mr. Jefferson on our cot, made a few jokes with his daughter, and talked to Mr. Jefferson's grandson, 10-year-old Patrick. My partner wanted to know if Patrick could ride with Grandpa home. "Sure," I replied, "why not?"

After 40 minutes, we were able to fluff Mr. Jefferson's pillow, collect his discharge paperwork, and load him into the ambulance. I set little Patrick up front in the passenger seat next to me, and then off we went. Patrick told me that last year he got to ride in a firetruck with his brother, that he got to play with the siren, and the horn.

"Patrick, did you get to talk on the radio?" I ask him.

"Nope." He had a hopeful look in his eye.

"Do you want to talk on the radio?"

"Yeah!" And his face lit up. I gave him the script and had him practice it once before I held up the mic for him. He had a huge, toothy grin as a keyed up the mic.

"Medcomm, Medic 1 transporting!"

"Copy Medic 1, transporting," replied our dispatcher.

"Look at that, Patrick! Perfect!" He beemed up at me from the passenger seat. During the trip, we talked about his school sports, favorite subjects, and all 13 of his scars. We when arrived home, I let him turn on the lights and talk on the radio again.

"Medcomm, Medic 1 ending!"

We unloaded Mr. Jefferson from the ambulance and he told my partner and I what a wonderful job we were doing. "We always appreciate hearing that Mr. Jefferson, thank you."

We carried him up his front porch, then into his house. His son was there, as well as his young grand daughter. They all welcomed Grandpa home and Mr. Jefferson couldn't have been happier to see them. "This is the most comfortable I've been all day," he told us.

We rolled Mr. Jefferson into his bedroom where he had his own private hospital bed. His wife's twin bed was next to in, seperated by a small night stand in the middle. He had a homemade quilt atop his freshly made bed, and clean, comfortable looking sheets. Gently, we lowered the cot, then transfered Mr. Jefferson to his bed. Above his bed, there was a blanket hanging on the wall, like a firefighter blanket with a picture stitched into it. "You see that there?" Mr. Jefferson asked, point towards the blanket.

I inspected it then. The blanket was of a familiar white eagle head on a black shield background with the words AIRBORNE in gold letters above it. I recognized it right away. "That was my outfit," he said, "the 101st Airborne. The Screamin' Eagles." He puffed up his chest a little, obviously very proud.

And I'm sure that my jaw dropped a little. "You were a paratrooper, sir?" I asked. Mr. Jefferson nodded. "Where were you deployed?"

"Oh, Europe and Africa," he answered, almost nonchalant.

I was standing before an actual American hero and I couldn't have been more honored. If I knew how to snap off a crisp military salute, I would have right then and there. Instead, I extended my hand to him, "Mr. Jefferson, I want you to know how honored I am to have met you today, and how much respect I have for you." The look of guinine warmth and gratitude that I saw in his face was not something I will soon forget.

My partner and I spent a few more minutes on scene. Mr. Jefferson's family showed me his scrap book, with photos of Mr. Jefferson in his paratrooper uniform and journal entries and notes that he took on scraps of paper. On the wall was displayed his purple heart. We left the home that shortly after and for one of the few times in my career, I felt privalaged to be able to do my job. It left me with this thought:

Sometimes we are able to do things that make an impression on our patient's lives, sometimes are patient's do the same for us.

Minor Panic Mode

I keep all of my keys together on one carabiner. One ring for car, house, and FD keys. The second ring for my narc keys for work.

My narc keys have disappeared from the carabiner, possibly on the way home from conference. I'll begin searching a 250 mile corridor from here to Bend...

I'm in minor panic mode...

Edit:
Keys located--they're only 90 miles away...

Conference Day 2

So I started the day with a great lecture on "Dirty Little Secrets of EMS," all the little things we do that we don't want to admit to. A little expository and embarrassing, but very funny and insightful. I continued with an ECG class by Bob Page--another excellent class with lots of information I'll be able to use in the field. I spent a lot of time with my dad today (who attended the conference and awards dinners with me) taking some BLS classes.

At lunch today, a ton of door prizes were given out--about $10,000 worth. I walked away with a new Littman stethoscope. Boo ya!

We go home in the morning with a 6 hour drive back to the coast, so I'm headed to bed.

New Word of the Day

Parapup: (par-a-pup) noun - a paramedic student or one waiting to take their paramedic certification exam

Conference Day 1

First day of conference started at 0800 with a presentation by Dr Broselow (that's right, of Broselow Tape fame). He spent two one hour sessions demoing a new Color Code Kids system that is designed to provide a computer based, bedside reference for all things pediatric. He's even experimenting with syringes with color coded dose markers and bringing the color coded system to consumers (color coded car seats, OTC meds, etc.) Very interesting stuff.

I spent an hour with Bob Page in Slap the Cap! learning so many things about capnography that I didn't even know. There's an aweful lot scheduled for tomorrow that I'm looking forward to.

Tonight was our awards dinner which started with the presentation of colors, then a little-too-over-the-top rendition of the Star Spangled Banner. The food was good (much better than last years) and the program went somewhat smoothly. One of the presenters kept messing up his little speeches, skipping or changing important details about the stories. The medals weren't available as they hadn't arrived by FedEx yet. Oh, and my award plaque had me listed as an EMT-Basic. Oh well.

Long day ahead of me tomorrow, I'll be going to bed soon.

Pre-Conference

The wife and I are headed off to EMS Conference in the morning. We're headed to Bend, in eastern Oregon, which is high desert country and absolutely beautiful. I'm looking forward to the trip, lots of good lectures, and maybe some golf. We'll be back on Sunday with lots of pictures.

Eliminated

Overheard on the radio tonight while returning from a transfer...

Medic: "Medcom, Medic 1."
Dispatch: "Medic 1."
Medic: "We've eliminated our 3rd rider." (That's right, lots of emphasis on eliminated.)
Dispatch: "Copy medic 1, clear your 3rd rider."

Laughter ensued...

I Didn't Ask For A Lifeboat

I don't blog about politics because I think there is so much of that on the internet already. Really, the most political thing I've done with this blog is slap an Obama banner up. But with the passing of the financial bail out package, I feel that it's time to rant a little.

The biggest thing I have to say is that I agree with Gov. Palin:

"Let's do what our parents told us before we probably even got that first credit card. Don't live outside of our means. We need to make sure that as individuals we're taking personal responsibility through all of this."

I understand that the country is in an economic crisis, much of which as a result of a failing mortgage industry, again as a result of lenders baiting borrowers into deals that were too good to be true. The burden for this crisis rests just as much on the American public that keeps borrowing as it does the banks that keep lending.

I have to love Gov. Schwarzenegger's quote about the bail-out:

"The federal rescue package is not a bailout of Wall Street tycoons -- it is a lifeboat for millions of Americans whose life savings, businesses, retirement plans and jobs are at stake."

I don't know about you, but I didn't ask for a lifeboat. I just bought a house--responsibly. I have a 30-year fixed mortgage. I'm able to make my payments on a monthly basis and yeah, sometimes it's tight, but my wife and I made sacrifices to make it work. And if even if I wanted a lifeboat, cut me the check.

When I see stories like this, about a woman who's debt was forgiven because she shot herself twice in the chest after sheriff's attempted to evict her, I get really upset. It doesn't matter that the woman was 90, it matters that the women took out a $46,000 dollar mortgage and an $11,000 dollar line of credit in 2004, it matters that she kept missing payments, it matters than she had been served eviction notices 30 times before this incident. Don't get me wrong, I feel for anyone who's home is taken away from them, but where was this woman's sense of personal responsibility? And where was this woman's common sense (she had 90 years of it) when she refinanced and took out a line of credit. Now she's a damn national hero.

This sort of stuff upsets me. The government has rescued the banks and now those individuals that are defaulting on their mortgages, those actually in financial need, are going to want their own bail out. The average American in mortgage trouble is now going to feel entitled to money in hand, for someone else to fix their financial problems.

I think my biggest bother about the whole bail out is that we're not looking for accountability here. The banks over-stretched themselves with the amount of money they've lent and the American people have over-stretched themselves by borrowing too much. And all that we're learning from all of this is that it doesn't matter, we'll just buy your debt, forgive what you owe, or print more money (oh wait, that's our next rescue plan).

Good News

I had to stop in at headquarters on my way home from work this morning to fill out my time card and such. As I was leaving, actually pulling out of the parking lot, my boss flags me down and calls me into his office. This was unusual and he was looking pretty severe.

I stepped into his office and thankfully he didn't close the door behind me. He turned to me and said, "you remember that call in December, during the storm?"

"Yeah..." The Great Coastal Gale of 2007, not something I'll easily forget. I wrote about it here.

"Well, it sure made for a good story. I wrote it up and sent it into the state for a Meritorious Service award."

Great! I'm thinking, my partner and I are going to receive a Unit Citation.

"Turns out," my boss keeps going, "they thought it was worth a Medal of Valor."

That's right, my partner and I are receiving the highest honor for EMS uniformed service personnel in the state. According to Oregon's EMS awards handbook:

The Medal of Valor recognizes acts of personal valor or heroism in the delivery of emergency medical care, which results in the saving of a life under extreme conditions and in extraordinary circumstances.

Just as cool, the Pacific Power & Light utility worker that helped clear the highway for my partner and I will be receiving the same award. We'll all be going to the Oregon EMS Conference in October and receive our awards at a banquet dinner. I can't tell you how excited I am to be receiving this award.

What did you do tonight?

I just got home from fighting a very large, fully involved structure fire.

Lots of flames, lots of hard work. I am very tired and I think I pulled a muscle in my left shoulder.

I'll write more later.

It was a good night.

Today

... I didn't forget.

Seven years ago, I was asleep in the upstairs loft of my parents place. I had just graduated high school a few months before and was sleeping in late until I had to work my shift at the movie theatre later that day. There was a knock on the door, then it opened. "Jeramy, wake up," it was my mother.

"What is it, mom?"

"Hun, you need to turn on your TV. Planes just flew into the World Trade Center."

"Hmmph. Okay." I started to roll out of bed as my mom closed the door. What the hell is the World Trade Center? I thought.

By the end of the day, I knew.

***

That day, I saw my father cry, after the realization struck that 9-11 was 911. My dad to me is a stoic guy, I'd never seen him cry before. As my family sat around the TV that evening, watching CNN, and the estimate of FDNY firemen lost went to over 300, I couldn't hold it in anymore. I sobbed, shoulders shaking and tears streaming my face. Dad got up from his chair, set a hand on my shoulder and said to me, "son, it's okay. We've all got to be strong, okay?"

***

Today, I didn't forget. Never once have I forgotten, not the 343 firefighters, 23 NYPD officers, 37 NY Port Authority Officers, and K9 Sirius, 8 private EMS workers, and the 2,564 civilians and military personnel killed at the Towers and the Pentagon.

I have to say how proud I am of my fellow blogging community for the 9/11 tributes that I've read today, they have truly lifted my heart.

Everyone, take care today and keep those that were lost in your hearts and thoughts.

New Years Eve, 2005

It was a Saturday evening and I had only been working in the company full time for 6 months. I was partnered with a new paramedic because I was “a strong EMT,” as my boss put it, “someone who can keep an eye on her.” She was green, but so was I, and in that way we kind of balanced each other.

Around midnight, we were dispatched to a person fallen through the roof of a downtown highrise. The buildings occupied a whole city block; an old hotel, an office building, and the old city hall. Five and six story buildings, separate, but all interconnected in strange ways. There were abandoned, condemned, and used mainly by squatters and vagrants.

We pulled up to the block, police were on scene already, so were the fire guys, both the paid and volunteer boys. My partner and I grabbed our kit and a flashlight and climbed up the front steps of the reported building. We climbed up dust covered stairs, old newspapers and trash scattered about, ascending towards the roof. I pictured walking into a room and looking up, seeing a pair of legs dangling from a hold in the ceiling.

We were met by a cop on the third floor, telling us he’d met with the reporting party and that an 18 year old had fallen into some kind of pit on the roof. We hustle up the roof access, looking across rooftops towards where a teenager is waving us over. He’s on the next building over, with a roof one story lower than we’re already on. My partner and I, followed by the fireman, make our way over to the roof edge, then clamber down to the next building using the pipes and ductwork.

We followed the teen to the edge of this building, where a ten foot wide, narrow pit separated this roof from the next. He told us he and his friend were screwing around on the roof when his friend tripped into the pit. Shining our light down, we could see another teen looking up from four stories below. He was propped in the corner of the pit, sitting in stagnant water up to his waist. He was awake and alert, but said he could move his legs.

The firemen were at our side now, and we began discussing options; setting up the ladder truck and an elaborate rope rescue sounded like the most fun. But as we examined the pit, we could see the walls were lined by the windows from the hotel we had just come up. Telling the kid to hold tight, we headed back inside.

More firemen had brought up our back board and had found the hotel room closest to the pit. The small, square window in the kitchen opened into the narrow trench between these buildings, and we could see the teen at the far end. The pit stunk, full of standing rain water, trash, and the carcasses of dead birds. All of us—the firemen, cops, and my partner and I—looked at each other, asking the question who’s going out there? And while it made the most sense for the firemen with their water proof boots and bunker pants, it was my partner and I, along with two cops, who rolled up and pant legs and waded into the knee deep fetid water.

Our backboard we floated towards the teen between us as we slogged the 30 feet towards him. The water was cold and most likely very, very unhygienic. The teen, Jay, was shivering when we got to him, with back pain, and the inability to move his legs.

We had already activated the trauma system for limb paralysis, and now we were trying to be as gentle as possible as we packaged him. My partner and I talked the cops through floating the board under the teen as we picked him up, then we strapped him in well enough to half float, half carry him out to the tiny hotel room. We passed him through to the firemen still waiting in the hotel room, and continued packaging Jay in the dark.

The evening was just starting to warm up, though.

We were still packaging Jay when we were dispatched to shots fired, possible GSW in the next town over. Our other units were busy taking other calls all over the county and we had a trauma system, paralysis patient to take care of. With cops lighting our way down the creaking grand staircase of this old hotel, we hustled to our ambulance and loaded Jay inside.

He was hypothermic, having been unable to get himself out of the water for over an hour, he had no sensation or motion in his legs, and he was lethargic. I was working on base line vitals while my partner was working on IVs, when we were dispatched to our 2nd pending 911 call, a bar fight downtown with injuries. “Screw it,” my partner told me, “lets go.”

We were only 12 blocks from the hospital and it was time for just quick patient turnovers and turnarounds. Rescue was already responding to the shooting, and now the fire guys who were giving us a hand with Jay were on their way to the bar fight a few blocks away.

I’m sure that when my partner and I rolled into the ER, we looked quite comical—both of us were leaving a trail of dirty, wet boot prints, our pant legs were still rolled up to our knees, and we were making that slurp-slurp sound with each step we took.
I had taken my uniform sweatshirt off and was only in a white t-shirt with a backwards-turned company cap. I know I looked like a fool.

We tried to be as quick as we could with the turnover, letting the staff know about the pending calls and to expect more patients. Our turnaround I was proud of, phenomenally fast considering. We rolled down our pants legs and set out he door. As it turns out though, the GSW was an unable to locate and the bar fight was some guy that pissed off the wrong person and took a punch to the face. He was fine, of course—only some hurt pride. Jay, as it turns out, wasn’t paralyzed. Just really, really cold and weak.

My boots however, didn’t fare so well. They weren’t water proof and became water logged. And oh my god, the smell. Even after soaking in a tub of disinfectant and bleach for 8 hours, the smell still wouldn’t go away. My boots didn’t survive the night of New Years Eve, 2005.

So Very Excited, Again

I just found out that a third Ghostbusters movie is planned. I loved the Ghostbuster as a kid, I even dressed up as one for Halloween, complete with a jumpsuit my mom made for me and a proton pack. It was the coolest thing ever. Just thought I'd share. You can check out a short article here at SciFi.com.

iPod Woes

I got off the phone with Apple Tech support a few hours ago and I'm dealing with iPod troubles again. My iPod touch dropped the right audio channel a few weeks ago. I did all the restore stuff (as if it might be a software problem) then had to send it in for service. I got it back at the end of last week and it worked fine--for about three days.

The right audio channel is out again. So I called tech support, and now they're telling me I'll be getting a replacement. But it means I have to send my current iPod back to tech services, which means I'll be without my iPod for another week.

*heavy sigh* Oh well.

Stress and a Brick Wall

Last night I tried putting together an entry about how I'm really getting unhappy at work, how my partner stresses me out, how I work over half the shifts in a month at a station 35 miles from home (while the supervisors don't work there at all), and how I feel like I'm beating my head against a brick wall about this stuff. I was complaining about how working in Little Fishing Village was giving my nothing in the way of calls, how working in a station the supervisors didn't have to be at was bullshit, and how I was tired of getting up a 5:30 in the morning to make it to work on time. Then I deleted it because it was too negative, too whiny.

I put the laptop away, then rolled over to go to bed. Thirty minutes later, I was being dispatched to a baby just born, not breathing. I had never worked an infant code by myself before, and it was not a call that I was looking forward to.

The Fire guys were there ahead of us, upstairs in the second floor, rat-hole apartment. There was a definite air of calm as my partner and I lugged our gear up the stairs in into the apartment. The Fire Medic was right inside the door as we walked in and told me right away, "this is Sylvia and she's miscarrying."

Right then, I had a guilty surge of relief. I wasn't going to be working a newborn arrest, but I still had a very difficult call ahead of me. I'll say it right now though, thank God that the Fire Medic was there--he kept his newer EMTs calm as well as the cops, and I leaned on him an awful lot during this call. He's been a Medic for over 20 years and I have a lot of respect for the guy.

The Fire Medic gave me a few more notes about Sylvia before I entered the bathroom to talk with her. She was young, sitting on the toilet, anxious and upset. She was hispanic and her husband was next to me, kneeling on the bathroom floor mat, and holding a small basin between Sylvia's legs. She was 16 weeks, had a number of miscarriages in the past, and seemed to be holding herself together fairly well. She had a lost a lot of blood, though. The husband reported she had been bleeding for about two hours prior to the 911 call, at least a litre had been lost.

I tried to talk with Sylvia, using the husband and one of the police officers as translators. My partner was brining up the stair chair and I just wanted to get her out of that apartment and into my ambulance before I did anything. I had questions to ask, and after everyone I felt this sick, empty pause. Normally, I can small talk with patients and be comfortable with them, with the scene. This was different though. I knew that Sylvia and her husband felt helpless, and I admit I felt a little helpless as well.

We had to walk Sylvia to the stair chair, then carry her down the stairs. All the while, we did everything we could to keep her covered and comfortable. I called the radio report in the phone, no need to give out too many details be radio, I thought. She was tachycardic and pale, and little hypertensive. I started a line and gave her fluids, then we transported the short mile to the hospital.

For a few minutes, Sylvia and I were in the back of the ambulance alone. She was wimpering now, partly becuase of the pain, but more I suspect becuase of her loss. I felt horrible that I couldn't say anything to her, or do anything to comfort her. And I felt terrible for Sylvia, this incredible sense of sympathy.

My partner and I turned her over to the ER staff, who went to work on Sylvia right away. I spoke with the husband briefly before leaving, who thanked me for helping. We then returned to quarters and I wrote my chart.

When I was working so much time in Little Fishing Village, this was definatley not what I was looking for in the way of calls. I told my supervisor about the call this morning when he relieved me. He's a medic with 15 years experiencing, a very calm level headed person who doesn't let anything phase him. What he said summed it up for me: disturbing.

Intermission

It's been over two weeks since my last post; an unexpected and unwanted hiatus. I've been working too many over time shifts at our slowest station. I'm stuck in Little Fishing Village just south of Little Beach Town with World's Longest Beach (allegedly) and I don't think they've ever heard of the internet. My company is working on getting us internet access into the station, but like all things, it will take time.

I thought that I would share some good news, though. My letter from Big Valley Fire Department arrived today and I will be advancing onto the physical ability round. I've heard through the grape vine that they've narrowed the hiring list down to 200 and are looking to hire a least half. We shall see.

As I've been stuck in Little Fishing Village, I don't have many interesting stories, but I promise I'll be back soon with some fresh material. I'm about to rotate down into the county for the next couple of weeks, so I'll have more opportunity to write and more to tell.

Angry Old Man

(Or, Why I Felt It Necessary To Break Down Your Door)

Several weeks back, I responded at three in the morning to a report of smoke coming from the roof of an apartment complex. This wasn’t anything too unusual, as this apartment complex still had several wood burning fireplaces. I took my time getting out of bed, then drove lazily into the fire station. I heard the Captain getting on the air and could hear the tiredness in his voice, trying to shake the sleep out of it.

I get about a mile from the station when the Captain gets on the air again, “3105 on scene. Heavy smoke showing, call a working fire!” He was awake now.

Oh boy! I’m thinking as my foot stomps into the gas pedal. (I keep it under control; I’m not one of those volunteers that wants to wreck his care because I was doing 90 to granny fell down. But this was a fire, and there was some quickness in my driving).

The ladder (really a quint in our case) is out the door while I’m still a few blocks from the station. I arrive and see my brother and another firefighter getting into their turnouts. I sprint into the station, clamber into my gear and make my way to the officer’s seat of the truck. The Captain has reported that there is not an all clear on the building, so we roll with the three of us.

Our assignment is to supply the ladder that arrived first. As we round the corner, our strobe lights, LEDs, and wigwags bouncing off neighboring homes and business, the entire apartment complex parking lot is obscured by smoke. We pull into the thick of it, spotting on the hydrant in the parking lot. My brother gets out to take the hydrant and set the pump, while I assist the other firefighter hand stretching supply line to the ladder across from us. We’re done in less than 2 minutes.

I can hear the sirens from the mutual aid engine in the distance. Local PD had showed up, their blue lights mixing with our red. The smoke, still rolling out from under the eaves of the roof, stings my eyes a little. The pumps and diesel engines on the trucks are spun up, providing pressure on the hose lines. The complex residents are out in the parking lot in their pajamas, wrapped up in blankets, watching us go to work. It’s this whole feeling that I love about being a firefighter.

My backup firefighter and I have pulled a second line from the ladder and we’re kneeling at the bottom of the stairs leading up to the fire apartment. A resident reports that the neighbor across from the fire apartment isn’t outside yet and the Captain has told us to conduct a search. I’ve checked the nozzle on my line, and I’ve taken my helmet off to put on my SCBA mask. I’m giving instructions to my backup firefighter when I see the crew from the mutual aid engine come barreling up—and I do mean barreling up. I have never seen a group of people scream volunteer firefighter more than these six firemen that had just bumped their way up to me.

And sure enough, as my partner and I pick up the hose line to advance up the stairs, the mutual aid company barrels their way right up them. There are now six 250-pound fireman standing on a narrow apartment stairwell, blocking my access to conduct a search. While I’m frustrated at these guys, I also have a morbid desire to see the steps collapse underneath them.

I watch as one of the firemen tries the door handle to the apartment I’m supposed to search. Finding it locked, he brings up his ax to give it a blow and knock it open. But he stops short. There seems to be a conversation going on at the top of the stairs, something animated, but I can’t make it out. The ax is passed off to another firefighter, and again I see him ready to knock open the door. Again, he hesitates, stops, and conversation ensues. What the hell? I’m thinking.

“Just get the hell out of the way!” I shout up to them.

Now, all six firemen from the mutual aid company pile into the fire apartment, mind your there’s already three other firefighters operating a hoseline in there from the first in ladder company. I signal to my partner and we make our way up the stairs. Again, checking the door knob and finding it locked, I get ready to take the door. I crouch a little, bring my shoulder in, and give the door a good solid hit.

Boom! The whole door swings violently in, splinters of the doorframe scatter across the entryway. Immediately I drop to my knees as my partner comes right up behind me. “Fire department!” I shout. There’s no smoke though, so I get to my feet, only to meet the now very angry resident of the apartment.

Here I am in full fire turnouts, plugged into my SCBA, hoseline in hand, standing next to a 70 year old man in pajamas and slippers, yelling at me for breaking down his door. “What the hell do you think you’re doing?”

Oh darn. “Get your ass downstairs!” I hear from behind me, “all of you!” The Captain the followed the first hose team in, was shouting at my partner, the mutual aid company, and me.

Oh double darn. See, I had been told by command to conduct a search of the second floor apartment, that there was a report of the resident still inside. But, unbeknownst to my partner and I, the ladder company Captain had already made contact with the resident and made sure that he was okay. The resident had gone back to bed when I decided it would be a good idea to bash his door in.

I’m sure that it looked quite comical to those observing: myself looking confused and abashed, while being yelled at by an angry old man and a fire Captain.

So, angry old man, I do sincerely apologize for bashing in your door and ruining your night. But feel comforted that I did it in an effort to protect your life and property. I was just trying to do my job.

New Toys

I just spent the morning in training for a couple hours at headquarters. The result of which is that we are putting into service a couple new pieces of equipment and (finally) stepping into the 21st century of treatment.

We are adding the EZ-IO and the Boussignac CPAP system. Check em out. Most of us have heard of the EZ-IO, but the CPAP system is something amazing. No moving parts, no compressors or wall mount units. Just a mask, valve, and tubing.

I do have to give credit to my OppsChief for stepping up to the plate and allowing himself to be drilled by the EZ-IO. We have it all on video and it's great. Honestly, the paramedic operating the drill was way more nervous that the OppsChief.

Aftermath

I drove by the house this morning on the way in to work.

I’d driven by the house before, my wife and I had walked the dogs past it before, and I’d admired the landscaping before. I think I wanted a different memory than that of the house burning and those kids in the street. Scene tape is up all around and the investigation is still underway, but things are calm now. I don’t talk about that morning to people. My wife and I don’t talk about it to each other. Other people don’t understand. I took my wife to see her podiatrist yesterday. He knew we were from Gearhart and eventually he had to ask, “so that plane crash was right where you live, huh?”

“Yeah, I was there. I don’t want to talk about it.” That was it. I don’t want to be rude to people, but I don’t want to share details either.

I’ll write about it though. I think it’s because I’m doing it on my own terms, no one is asking the questions. I’m able to share the details that I want to share and no one is pressing for anything else. That’s comforting to me.

*****

There has been some criticism towards our local dispatch center following the plane crash and I want to stand up for them. Our south county dispatch center fields 911 calls for 3 police departments and 4 fire departments. At the time of the accident, only one dispatcher was on shift, as usual for that time of morning.

Several local people have had concerns about unanswered 911 calls after the crash, or calls that took too long to answer. The single dispatcher fielded 32 911 calls in 4 and a half minutes. The initial fire dispatch occurred 18 seconds after the second 911 call was received (the second call provided a rough location, the first apparently did not).

Per protocol, the dispatcher toned the fire department and dispatched the alarm before fielding the additional incoming 911 calls. During this 4 and a half minute time frame, the dispatcher also managed to contact her dispatch supervisor at home to request assistance in the dispatch center.

I think our dispatcher should be applauded and commended for handling such a difficult event so professionally and efficiently.

*****

Trauma counselors from the county and Red Cross have been in the area the last few days to counsel the firemen, family, and community members. I was invited (as all responders were) to the initial counseling session Monday afternoon and all following sessions. I’ve attended trauma counseling sessions before and they’ve helped, but I think doing what I’m doing right now, writing about how I feel, does so much more for me.

Seeing my brother firefighters that morning, the sadness and solemness in their eyes, I’m so grateful to know that they are getting the counseling they need. I left the scene before the body recovery began—I had a busy morning ahead of me on shift, they needed me in at work. I know the guys that carried those three kids out, most of them have families, young kids of their own. I can see in their faces and hear in their voices how this is hurting them right now. I’m grateful to know that we’re taking care of our own right now.

*****

After I got on shift that morning, I transported one of the survivors from the hospital to the airport to meet an air ambulance crew. She was going to the Oregon Burn Center for specialized care.

The tragic irony didn’t escape me, though. The helicopters couldn’t land at the hospital because the weather conditions were too poor. Now, this little girl whose life had been changed forever, was now going to fly to Portland in the same conditions that may have contributed to her tragedy.

I was so saddened and bothered by that notion, and I could only wonder how she felt. Or if she was even in a state to understand what had happened and what was happening to her right then.

But I felt a sense of fulfillment from being able to help her, even in the small way of transporting her from one place to another. I felt like I had done something good that morning.

*****

I wrote before how I wished I had been wearing my turnouts that morning and not my white button down. I’m not sure that’s really true. I don’t envy the firemen that were there.

I don’t envy any of us. I am exceptionally proud of every one of them though. Every fireman there (with the exception of a handful of paid chief officers) were volunteers. And every fireman that helped to carry the last three children out volunteered to do it—volunteers of the volunteers. No one deserves my respect more right now.

The house after the fire had been knocked down.

*****

As I drove by this morning, neighbors had set their trash cans and recycling out. Others were out walking their dogs, coffee cups in hand. Traffic on Marion had increased, as you would expect. The house is such a tragically awesome site and a large memorial has developed: flowers, candles, and balloons all along the long stone wall.

I guess it’s a sense of curiosity that brings people to the house, to leave their memorials, the same sense of curiosity that drives people to ask “what was it like?” Sometimes I feel guilty about how my emotions surround the accident. I was in the shower when the explosion occurred, I wasn’t even sure what had happened. I was only on scene for 45 minutes, didn’t taken part in suppression or recovery operations. I only assisted briefly in patient care, helping to get them packaged and transported.

Sometimes it feels like I didn’t do enough, like I didn’t have an opportunity to do enough.