My Relief

I live in a small town, part of a small county. I know most of the firemen and EMTs in the county by first name. I'm familiar with dozens of frequent patients, care center staff members, and nurses. Because of the closeness of it all, I've also run calls on family members and friends.

I've run on my uncle when he had a massive heart attack, I took my brother to Portland for an appendicitis, I've been on friends of my wife and parents, and just last shift, I transported my sister in law.

I was on the phone with my mom last shift while my mom and dad were driving back from Portland over highway 26. We had to cut our conversation short because cell phone reception tends to cut in and out over the pass. About 10 minutes after hanging up, my partner and I are dispatched to an MVA on highway 26 at milepost 26, a very common milepost for accidents. Now, it took a moment or two, but then I realized that milepost 26 would be right where my parents would have been.

Code 3 out to accident, I couldn't shake the terrible feeling in the pit of my stomach that I would be seeing my parent's crumpled car off the side of the road. I thought about terrible scenarios like having to intubate my own mother. I prayed the entire drive out that the size-up we'd get from fire would be a positive on. One vehicle, two injuries is all that we heard.

We rounded the last corner approaching the scene, numerous fire and police cars parked along the shoulder, next to a steep embankment. We slowed to park and I saw my parent's car parked on the shoulder between a state police cruiser and a rescue truck, but it didn't look damaged. Still, I was fearing the worst. The firemen had two patients c-spined on the shoulder of the road, but I couldn't see the patients because the firemen were crowding around them. I placed us on scene, then exited the ambulance and approached the commanding officer.

He began giving my a brief report as I surveyed the scene. There were skid marks on the highway, crossing both lanes. I saw flashlights a hundred feet down the embankment where a car had landed. Then I start looking over towards the patients and I see a familiar white haired head suddenly look up, a stethoscope draped around his neck. There was my dad, a First Responder with Seaside, directing patient care. The relief that I immediately felt took over completely and for a few moments, I wasn't even listening to the firefighter. But I recovered quickly and went to work on the patients.

Looking over to the second patient, there was my mom, no medical training whatsoever but wearing a pair of medical gloves and holding c-spine on the second patient. Relief again as I walked over, touched mom gently on the shoulder to let her know I was there, then continued to work. We transported both patients, minor injuries that had self extricated from the vehicle, back to Providence Seaside.

I talked to my dad the next day and he told me they came across the accident just minutes after it occurred, before police or fire had arrived. He always carries a small jump kit in his car and he grabbed it and went to work assessing patients. He said when he turned, my mom had a pair of gloves on and was asking how she could help. Right then, I couldn't have been more proud of my mom and dad, or more relieved that they were okay.

My second biggest fear in this job is running a call on family member or friend (my first biggest fear is not being able to find the address). I live in such a small place that there is no paramedic back-up, no one to take over when I find myself caring for a loved one. It's a difficult thing and one of the things that makes working in a small system so unique.

Paramedic Pedal Power

This Memorial Day weekend, I got to see a personal project of mine take off with a very satisfying start. Following discussions with my fire department's EMS Officer, I put together a pilot program for a EMS Bike response team.

Bike response teams are in use by multiple fire and EMS agencies nationwide and provide an alternate (and often times faster) response time in pedestrian crowded areas such as special events, large parks, and promenades. Seaside is a very tourist friendly town with a 1.5 mile promenade and downtown core area. During holiday and summer weekends, the population can increase to 20,000 or more. During certain events, the downtown area can be closed completely to vehicle traffic and turned into a pedestrian parkway. Access to 911 calls during peak summer activity is extremely difficult by ambulance and often, we have to park a block or more away before reaching the patient.

This weekend was the program's pilot weekend and I worked the first two 6 hour shifts. My partner and I staffed a pair of bike's equipped with an AED, oxygen, IV supplies, BLS equipment, and ACLS drugs and patrolled the downtown area and prom. The response from the community and visitors was astonishingly positive. It was our goal to provide EMS service but we acted more as public relations than anything else. We gave out directions, answered questions, assisted the Seaside Police, and even helped to promote a neighboring fire department's annual fund raiser.

Unfortunately, the weekend overall was slower than anticipated and the bike team was not kept very busy. However, during the single 911 call in thier response area, they did arrive ahead of both the transporting ambulance and the fire department's rescue on a chest pain call.

Support from the police department, business owners, Seaside lifeguards, and local ambulance service has been very positive and it made for a very promising and bright weekend. Our next operational event will be the June 14th Muscle Beach Cruz car show, an event where downtown is closed to vehicle traffic.

I'm looking forward to a fantastic program this summer. I'll post more on this soon, or check on the Seaside Fire Department's website in the next week for a page to go live with all the details.

My Storm Story, Part III

My Storm Story, Part I
My Storm Story, Part II

The entire drive home was like watching clips from CNN storm coverage. There were very few houses that were spared any kind of damage. The highway was clear but I could look down side roads and see them carpeted in green and brown. I would learn later that in some parts of the county, it would take over a week for some people just to get off of their property because of trees down in their driveways.

Turning onto my street and pulling up to the house, I was relieved to see there was no storm damage to my house or any of my neighbors. I was weary as I headed up the front steps and let myself in. Meghan's mom, who lives alone, had driven over before the worst of the storm to spend the evening with Meghan and keep her company while I was at work. They were both sound asleep in bed as I let myself into the bedroom. Lilly gave a slight woof when she saw me, then settled into sleep again. I changed quietly, putting on a fire department sweatshirt and jeans, then kissed Meghan on the forehead before driving down to the fire station. There was still plenty of work to be done.

Weather forecasts said we were only in a break and that more high winds were expected that evening. The city was doing its best to mitigate damage and help the community. The community center had set up a soup kitchen and shelter, which we checked in with throughout the day and resupplied. The Fire Marshall was handing out assignments to fireman as they trickled in that morning and when I reported, I was put on a debris crew and also put in charge of home oxygen needs. It was anticipated that power would be out for at least a week and numerous citizens on home oxygen would be in need in the coming days.

Before going to work that morning, I headed upstairs to the department's kitchen where a few of the firemen's wives had put together and soup kitchen for us. Breakfast was up and they were starting to set out sandwich fixings for lunch. During the week, these wives would cook, feed, and take care of the department's 40 volunteers.

My crew set out shortly after lunch to help a resident clear a tree that had partially fallen and was now threatening his house. The tree hadn't caused damage to the house yet, but if left, it would surely blow over that night into the gentleman's living room. It would be dangerous to fall the tree as the winds were picking up, but we were dealing with each tree on a case by case, risk assessment type system. Using the rescue truck's winch, we pulled the tree away from the house to direct its fall then set to work cutting. In a little less than an hour, the operation was done and we were recalled to the station. Upon returning, I began doing oxygen checks and visited one of our frequent patient's who had called into the station earlier about his oxygen.

The second night of the storm was nothing like to first. It was comparable to our normal winter storms and therefore tolerable. We wouldn't be getting up that night for down trees or lines--we figured the work could wait until morning.

All week was like this; fireman reporting to the station in the morning, receiving assignments and working all day. In the 3 day period of the storm, we responded to over 40 alarms, over 10 times our daily average. In the 5 day period of the storm and clean up, we responded to 65 alarms, enough to set a new monthly and yearly record.

As for myself, I went in to work after having only one day off as I picked up an extra shift. All day long we responded to calls and had to take alternate routes because of road closures, or wait for fireman to clear a driveway. Several elderly patient's called because of oxygen problems, others called because of general illness associated with having no electric heat in their homes. On a county wide level, several people died as a result of storm related injury or accident, including carbon monoxide poisonings due to using gas grills inside as heat.

I keep a mental note of the worst shifts I've ever worked and the winter storm of 2007 certainly takes top honors for me. In a strange way, it also made my partner and I local, strange celebrities. Everyone in town had heard of the ambulance crew that was stuck on 202 during the worst of the storm and wanted to hear our story. Really, there wasn't anything too exciting or heroic about it. It's just a story of a couple of EMTs doing their jobs.

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The History Channel show "Ax Men" just aired an episode that covered the Great Coastal Gale of 2007. Ax Men, Episode 11: "The Storm of the Century" has many great clips of how highway 202 looked the first morning after the storm hit. Darrel's property is out on 202 the the footage of driving back into Astoria is the devastation my partner and I faced that night on the highway. Ax Men can be downloaded on iTunes here.

Exposure

Sunday evening while my wife and I were catching up on Battlestar, I received a phone call from the south station crew who had just transported a patient to Providence. The crew member wanted to inform me that the hospital was putting together a contact list of all health care workers who had come into contact with a certain patient because this certain patient was positive for meningitis. Not only did I have contact with this patient, but I also spent two hours in the back of an ambulance with her on a transport to Portland.

So I paused Battlestar, got out my little contact book and started making phone calls. First I called the ER to speak with the doctor directly. Sure enough, I'd been exposed to meningococcal meningitis and they want me to come in and start cipro right away. Great I'm thinking. Next phone call is to my shift supervisor to let her know about the exposure. Third phone call is to the supervisor who was working the day of the exposure as it was an extra shift for me. The fourth phone call was to my partner for that particular shift, who would now have to drive an hour into town to the ER.

Now, I understand that paramedics (and all health care workers) run the risk of exposure and I can run down a short list of recent ones.

• A hepatitis patient had explosive, bloody vomiting in an ambulance and the ER, contaminating a number of nurses and EMTs.
  
• An ambulance crew transported a confirmed pneumonic plague to Portland.
• A fire lieutenant was recently splashed in the face by contaminated IV fluid after the catheter was pulled from the patient's arm and subsequently sprayed around the scene until it was clamped.
• An EMT Basic received a needle stick after being in the wrong place as an EMT Intermediate was handling the IV catheter.
• I was splashed in the face by potentially contaminated IV fluid after the spike was pulled from the bottom of the bag and the sprayed all over my partner and I.

All these have occurred in the last 4 months between my ambulance company and my fire department. Thankfully, there have been no confirmed cases of any hepatitis, or plague, or meningitis in any of the exposed responders. It really makes me worry about the odds though. One day, my partner, or myself, or one of my coworkers may get more than just a scare.

By the way, Sunday was my birthday. What a hell of a thing to have to deal with...

What I Get for Taking Vacation

It's been a hell of a week. I took a shift off on Tuesday to spend a few days away with my wife celebrating our 4th anniversary. I paid for it though, before and after.

The shift before my anni-vacation, my partner and I ran 5 calls before noon. One of which required cardioversion for SVT after two unsuccessful rounds of adenosine. In the middle of all this, dispatch is paging us that there are return medivans waiting at providence ER. We made three round trips to Portland that shift.

I had to paralyze and intubate a stroke patient while nervously waiting for additional personnel from rescue. We took him to Portland on a vent.

Upon returning from my anni-vacation, I had a first ever experience as a patient went from a 3rd degree block to cardiac arrest in front of me. I was setting up an oxygen mask and not looking at teh patient when a fireman said "I think he just went out on you!"

"No he didn't." I replied as I double checked the monitor leads (one of them had fallen off). It was then the patient went from pale to purple in 10 seconds. Fuck I thought.

"Code 99." My partner calls into the radio. Immediately this is followed by the FTO sitting at post "Medcom from Medic 3, does 1 need our assistance?"

In the middle of applying defib pads, setting up for the intubation, and IV, I grab the handset. "Negative 3, fire is already on scene." I don't need another medic to drive 15 minutes from post to 'assist' me on a code when I'll be off scene in less than 10. (I have a problem with second ambulances responding as "back up," something I'll rant about later.)

That shift was rounded out with a transfer for gall stones at midnight. Something I truly considered a valuable use of my emergency medical skills.

Today, it continued with a trauma system entry from the memory ward at one of the local adult care facility. The patient fell outside and was in the rain for 10-20 minutes before the caretakers found him. He had a huge hematoma on the back of his head and was supposedly altered from his normal state of dementia. Turns out he had a subdural bleed as was a trauma transfer 30 minutes after arriving at the hospital.

And this afternoon, I took my second vent transfer of the week, an acute MI with complications. I just took a vacation, but really, I need another one.

Love and Loyalty

I just finished reading Marley and Me by John Grogan, and while I'm not going to write a review like I typically do (there are already thousands out there and by the way, it's a fantastic book) I'd like to share how it's affected me.

I've written a few times before about me own lab puppy, Boomer. She's a handful, as most puppies are. Destructive, playfully rambunctious, and fully of life. I love that dog, sometimes against my better judgment. I was working the office a few days ago and Boomer was in the hall chewing on something. Now, I should know better by now that more than half the time, she's chewing on something she shouldn't be. When I got up to go downstairs, there Boomer is, happily thumping her tail against the carpet while she is shredding my uniform hat to pieces. The bill was completely shredded, the sweat band gnawed on, and the plastic snap adjuster was gone all together.

Boomer looked up at me, those puppy eyes of hers saying "hi dad! Look what I found!" I was upset, but only a little because obviously I'd left the hat someplace it shouldn't have been and she found it. But now I have to take the shredded evidence into my boss and explain to him how my dog ate my ball cap and I need a new one.

The point though, by reading Marley and Me about John Grogan's struggle with his ill behaved lab, I've come to accept that this is how Boomer is. She's a lab with tons of pent up energy and usually no place to channel it. I love that dog no matter what she does. And I see that love and loyalty reflected in her eyes every time she looks at me.

I'm a dog person, and as a whole, we have a place in our hearts for dogs in need. Several years ago, shortly after I became an EMT, I responded with my fire department to a fast moving grass fire on the beach with at least one injury. The fire itself turned out to be small and fairly slow, so I was tasked with taking care of the gentleman who had tried to put it out--and was consequently responsible for setting it in the first place.

After lighting a cigarette, the man had carelessly dropped the match into the dry beach grass, setting it ablaze instantly. Alarmed, the man tried to stamp out the fire, but the fire jumped to his denim jeans and began burning at his lower legs. Running out from the immediate area of the fire, he tried patting out the flames on his jeans with his hands and was eventually successful.

As we arrived on the scene, the patient was on the promenade, smoking another nervous cigarette, with scorched and tattered jeans and burns to his hands and lower legs. What struck me the most though, was how he tended to his 3 month old black lab puppy. There was no doubt this little pup was this man's whole world, in a very literal sense. He was a transient, without insurance, and unwilling to go to the hospital to be treated. It wasn't the inability to pay that was keeping him from going though, it was his unwillingness to leave his pup behind. This man's love and loyalty for his pup was so great that he would put up with the pain of 1st and 2nd degree burns rather than leave his pup behind. We made a rare exception for the man, transporting him and his pup to the hospital, as he was in urgent need of medical care.

For me, a dog inspires such a rare type of love and loyalty between master and pet. In reading Marley and Me, in my interactions with my other volunteers, coworkers, and patients, I've come to learn that I'm not the only one that feels this way. I love my pup for who she is and I look forward to her growing up, and her ever present love and loyalty.

My Storm Story, Part II

My Storm Story, Part I

“What?” was my immediate response. Stopping cutting operations was just not an option. “Who ordered it?”

“Chief says we get off the highway until morning. We won’t be cutting until then.” The district’s fire chief, who’d I’d seen and talked to when we picked the patient up, were ordering his men off the highway. The plan was to park us at the nearest fire station about a mile back, and wait out the worst of the storm.

The cell towers were still operational so I placed a call to my supervisor at the other end of the county and gave her a report: the fire department had stopped cutting and we were returning to their station.

My supervisor, for her part, would do her best to put together a plan for us. For me, my priority was my patient. I advised the receiving trauma hospital that we were delayed indefinitely and that they could release their trauma team until we radioed another update.

My partner turned the ambulance around and followed the fire department’s brush unit down the highway. We turned down a short gravel drive and approached the little 3-bay station. They would leave the brush unit out so we could occupy the bay. The three firemen followed us into the bay and then closed the door behind us. It was the first break we’d had from the storm since we’d pulled the patient out of the house almost an hour before.

The supervisor called shortly after and told me that a plan had come together. The paid firefighters from the west end of the highway (the other side of the downed trees) would be working with a number of Pacific Power crews to clear the road and get us home. The work would be slow as Pacific Power estimated over 50 trees down in just the few miles back into town.

So we waited. The patient was stable and resting comfortably with the morphine. The supervisor was calling every twenty minutes to give me updates, check on the patient, and try to keep our morale up.

We spent over two hours at that little station, during which time a tree came down on the brush unit that was parked outside and the battery on the ambulance died, requiring a jump. Eventually though, the bay door rolled up and there stood the Pacific Power crew and the crew sent from Astoria Fire, decked out in storm gear and helmets. While there was only one Pacific Power truck outside, I would later learn that they had diverted numerous crews from repair work to come cut us out.

My partner made the radio call to dispatch that we were continuing and I called in to the receiving hospital with another update. By this time, the storm had reached a slight lull and the trip into town, lead by Pacific Power and Astoria FD, was easy going. Power was out throughout the city and the hospital was running by generator when we pulled in. The entire trauma team had been released and we were met only by the ER physician and nurse. Uneventfully, we turned the patient over and returned to quarters.

For the rest of the shift, we listened to the wind batter the station. 911 service in the county was sketchy so we had to scan with portable radios for calls coming from our dispatch and fire dispatch. If there were other calls that night, I don’t remember them.

I was off shift on time at 0800 the next morning, relieved by a crew who had slept the whole night in their own beds. The storm had calmed, but I didn’t have to drive more than a block away from the station to see the damage.

Tree debris covered the roads, houses were missing whole sections of roof, and trees still blocked side roads. I made the usual twenty minute commute in double that time. I was concerned about my wife whom I hadn’t spoken with in 12 hours. I was worried about our house. And I was worried about the guys on my fire department and how they’d survived the night.

More to come…

A Perfect Morning

I awoke this morning to the first perfect spring morning of the year. The sun was rising over the hills, casting a wonderful pink-purple glow. It was already warming outside, 60 degrees or better at seven in the morning. The air had a fresh, warm, clean smell to it, just like my favorite summer mornings always do.

Boomer was following me through the house during my morning routine. She waited outside the bathroom door while I was in the shower, sat and gazed up at me with quizzical brown eyes as I packed my lunch, happily wagged her whole body when I took her outside, then bounded up onto the bed when I kissed my wife goodbye.

With my uniform on and day bag packed, I grabbed my Oakleys and got into my car. Driving to work this morning, the 45-minute commute to Station 1, didn’t seem so bad this morning. I had a smile on my face for the first time in months when I walked into the station to relieve the previous shift.

My Mistakes

I'm a new paramedic, still in my first year in the field. I've made mistakes, some big and some small. I misdiagnosed a failing pneumonia patient as CHF and gave lasix, further worsening the problem. I've asked stupid questions in front and patients and firemen. I've rolled into the ER with cardiac patients that aren't on oxygen.

Today, I've had a difficult shift. I can't start an IV to save a life. I forgot to check a blood sugar on a fallen diabetic. My partner and I (with the fire department) had to inadequately c-spine a 300 pound patient strictly because of his size.

I've been reflecting on my mistakes today because I've been feeling down. My favorite ER nurse told me that I'm just being too hard on myself--and maybe that's all it is. Sometimes it's easier to focus on the mistakes than the times when I "got it right."

Seaside Fire Rescues One

I'm so proud of my fire department. Yesterday morning at 0430, the Seaside Fire Department was dispatched for a structure fire with victims trapped. The first arriving truck company effected a rescue of a woman from a second floor window. Check out the full story here.