Icy Roads

I woke up this morning to mild snow fall but freezing temperatures and news reports of extremely slick roads. It’s 0600, an hour before I normally wake my kids up for school. We commute about 20 minutes north to a better school district than the one in our area. I take the highway every morning which on normal days is still chaotic due to over rushed motorists.   I debate whether the risk is worth it or not. I decide to take them anyway.

Traffic is heavy as usual and big trucks whiz by me as if they are invincible. SUV’s, vans, small cars are all over the place from sliding off the roads. There is a ditch dividing the highway all the way to our destination. From about 3 miles up I can see two headlights clearly on their side. I begin to slow, expecting the worst and preparing to stop. My heart starts pounding, I’m nervous. I think to myself, am I able to handle this on my own?  I pull up and see an explorer on its side, clearly having slid off the north bound lane. There is a young man in red walking around the wreckage. I run up to him asking if he is ok, assuming he was the driver and see no one else around. “I’m fine. There is a mother and son stuck in the vehicle.” Confused I ask him if he was inside. I see no other car stopped nearby. He says “No, my car is way up there but I did witness it.” His car is parked in the north bound lane ¼ mile away.

I look inside through the windshield and see a middle aged woman and teenage son basically hanging inside by their seat belts. I ask if they are ok. I get a thumbs up. I tell them not to move and wish I could hold their hands. The mother’s eyes are teary and the son looks frightened.

The young man in red is Steve, a police officer for our University College campus. I introduce myself and tell him I am an EMT. He tells me I am the only person who stopped despite the fact there are hundreds of passing cars around us. He looks relieved and begins telling me there is no bleeding and there are only two people in the vehicle. I’m relieved to hear they are ok.

Steve had already called for help and about 5 minutes later two fire trucks pull up on scene. They immediately pull out their stabilizing equipment, a metal rod to hold the vehicle in place so it won’t roll over. Then they pull out a hand held hatchet and tell the woman inside to cover their faces, they will be breaking the windshield. He also asks them if they are ok or if they would like to go to the hospital. The woman says they are fine.

“It might be quite a while until law arrives.” The firefighter Chief tells Steve and I. “You are ok to leave now thanks!” I shake the chiefs hand as well as Steve’s and head on my way.

Peter Canning Paramedic: On The Front Lines of Medicine Review

Peter goes back to real calls he had been on, some of which were just individuals abusing the system calling for an ambulance to act as a taxi but others were true emergencies everything from shootings to infants who had stopped breathing. This 368 page book is breath taking from start to finish aside from the very few pages in which Peter speaks of his 12 years of service spent in Washington, D.C., with Senator Lowell Weicker, which I found to be a bit slow and slightly dull, any talk of politics with me puts me to sleep. But he quickly picks it back up describing everything from drug administration to his thoughts and feelings about his partners and his own doubts in himself to make the right move. He recounts a wide variety of heart pounding calls he works, how he is feeling about them and exactly what he does during the process. He acknowledges the fact that although a paramedic, he is human. Humans make mistakes, he made mistakes with some of his patients but learns from his mistakes and goes on to better himself.

As a new EMT I found this book to help prepare me in a sesne for what I too may encounter and he has given me ideas of how to handle or not to handle a wide variety of situations.

For me personally, I found myself many times in this book. Often times I would jump off my couch saying to myself how much I could relate to him. As a new EMT all you want to do is do your best, give 100% effort yet at the same time there is at times this overwhelming fear of just being in the way of your partner or what if, God forbid, you make a mistake, which in this field could be a life threatening mistake for you, your partner, or your patient which can end your career before it even begins.

So many worries can get in the way of you learning. I experienced this while doing my ride alongs during EMT school. I was so worried I would be in the way or would make the wrong move that I look back on it now and see I missed a few opportunities to get some hands on experience. The nice thing about being a student and the lead paramedic knowing it, is yes they are watching your every move but they are doing so in order to guide you incase you do get off track.

From the Inside Flap:

"In this unforgettable, dramatic account of one man's experience as an EMT, Peter Canning relives the nerve-racking seconds that can mean the difference between a patient's death and survival, as Canning struggles to make the right call, dispense the right medication, or keep a patient's heart beating long enough to reach the hospital. As Canning tells his graphic, gripping war stories--of the lives he saved and lost; of the fear, the nightmares, and the constant adrenaline-pumping thrill of action--we come away with an unforgettable portrait of what it means to be a hero."

Biography

Peter Canning has been a full-time paramedic in the Greater Hartford area since January of 1995. His first book Paramedic: On the Front Lines of Medicine details his journey from speechwriter for the Governor of Connecticut to caregiver on the city streets. Rescue 471: A Paramedic's Stories is the sequel.

A graduate of the Iowa Writer's Workshop, Canning attended the Phillips Exeter Academy and the University of Virgina. He has worked many jobs in his life: tennis instructor, aide to United States Senator, taxi driver, meatpacker, line cook, telephone solicitor, book and movie reviewer, factory worker, health department administrator, speechwriter and political campaign director before finding his place in life as a paramedic.

Canning is currently at work revising a novel about EMS.

A lifelong fan of the Boston Red Sox, he and his family live in West Hartford, Connecticut.


His blog: Street Watch: Notes of a Paramedic
I am now going on to read Peter's following book Rescue 471: A Paramedic's Stories and this too is starting off just as heart pounding as the last.

DOA and a Bad Shot

I worked in the ER this weekend in a very busy ER department and I must say it was the best experience I have had yet. I ran IV's, drew blood, performed several EMT skills, many of which I have never done before except on a doll, and even saw something those working in the field have never and may never see!

1500-0300 was my 12 hour shift.

1645- Paramedics called the ER telling us to be ready. They were bringing in a cardiac arrest. Total down time so far was 35 minutes. He was dead. They brought him in the trauma room which was filled with doctors, nurses, a paramedic on staff and myself. I was first to perform compressions on the man. His eyes where open, he was intubated, his clothes completely removed.

The man was a referee during a football game and just dropped. Bystanders began CPR and hooked up an AED, the AED continuously told them "No shock advised." He was in asystole (flatline)  from the get go. He was DOA . As soon as he was placed on the bed in front of me I felt his arms, they were already cold. We worked him for what felt like hours performing CPR and pushing epi and atropine. Nothing worked. The doctor observing our life saving efforts said "Please stop CPR....Alright.....we will call it....4:45."

The man was a large man, which made compressions difficult,  but during our efforts we were getting some perfusion but there was no use, he was gone. With each compression I could hear him gurgling and had to remind myself a few times he was not coming alive again and gurgling but my compressions were creating the gurgling from the fluid accumulating in his airway now.

Later that night we discovered through his family he is a donor. His organs could don't be harvested due to the lack of perfusion during his down time but his corneas were eligible for donation. (This is the part I mentioned earlier that some in the field have never seen and may never see.) I watched a man from a donor bank remove this man's corneas. It was amazing how they do it and it was fascinating to see the parts of a human eye as I did. Once the corneas were removed I held them up to the light and it was an eerie feeling knowing I was seeing through this once alive man's eyes.

1752- A supposed security guard was brought to us in the ER by paramedics because he had been shot in the face. The GSW was just under his left eye and he had about a 2 inch long gash along with an exit wound. His zygomatic bone was obliterated, which was clearly observed during CT scan. Three Police officers accompanied him and kept watch over him for the several hours he was there in our care. He was conscious and vitals were stable. The bullet had barely missed his left eye. He had no vision problems what so ever...lucky man.

So what happen? No one really knows but him. He claims he and his partner were sitting in a vehicle. He was the passenger. His partner was cleaning his gun, no cleaning equipment was found in the vehicle, and the gun accidently discharged shooting him in the face. Hmmm things did not add up based on the path the bullet traveled through the man's face. He later changed his story saying he was in the driver’s seat which still didn't make sense. He stuck to his story last I had heard.

We also had a female prisoner who had second and third degree partial thickness burns from a boiling water pot being hurled at her back thanks to another inmate. The rest of the night was fairly calm, one drunk who punched a wall fracturing her hand, we splinted a few other bones, had a few chest pains, a headache, a mentally ill patient and a few other minor complaint patient’s. I finished my shift smoothly.

That was my night in the ER. 

Oh Dang it!

I had mentioned in a previous post that I was super excited for my interview with my local ambulance service....I unfortunately did not get the job. 

Here's what I experienced:

I applied online. I had been constantly watching the county ambulance website and one day noticed they had just opened the online application! I applied immediately with resume attached.

A few days later received an e-mail stating I had been chosen to begin the interview process.

The day of, I first took a 100 multiple choice questions exam. I thought the test was very easy thanks to the amount of studying I have continuously done.

There were 65 EMTs and 27 Paramedics. Only 14 would be chosen for EMTs and 14 for Paramedics to move on to interview, based off the highest test scores.

I learned everyone had done extremely well on their tests so the 14 EMTs and 14 Paramedics were chosen at random.

All is well though, I will try again next hiring season which will be next Spring! This gives me the opportunity to  continue my education such as EKG cert, medical terminology classes, etc.

I take this as a learning experience and I walk with my head held high.

“The Ceiling”

Paramedic: On The Front Lines of Medicine by Peter Canning, pages 123-124, The Ceiling. “Failure haunts me.”Says Peter Canning.

 I cannot speak for any other EMT-Basic but I can speak for myself when I say failure, too, haunts me. I can’t tell you how many nights I spent staring at the ceiling worry and thinking about what I am preparing for and things I’ve already seen and how it has affected me. 

            By the very first day of EMT school I was completely overwhelmed, as I’ve mentioned in a previous post, by the amount of information I was going to have to plug into over the next three months. Becoming an EMT is a big deal, not something one should take lightly. People’s lives will be in YOUR hands, that is a heavy responsibility…I began questioning myself if I could truly do it. I am now out of EMT school and preparing to venture into the real world as an EMT-Basic actually working for an agency. But I chose to stick it out and this is the day I told myself “failure is not an option.”

            During EMT school I had the opportunity to sit in at the dispatch center to see how they do things on their end. (I recommend taking any opportunities to observe ALL areas of emergency services such as paramedic services, fire departments, police departments, ER and dispatch observation.) I sat with dispatch on two separate occasions, as I’ve mentioned before, and on the first sit in the dispatcher beside myself and dispatcher Molly Stock* a call came in that was chilling. I was able to read on our screen what the EMTs were seeing on scene and I was also able to see what the dispatcher beside us was saying back to them while she spoke to a frantic father on the phone.

            “Pt is obviously dead.” Read across the screen three separate times, written by EMTs on scene. The only time an EMT can pronounce a death is when it is obvious such as decapitation, a severed body, rigor mortis, or signs of lividity. 

            I hear the dispatcher beside us trying to calm the frantic father down and speaking in a calm but remorseful tone in her voice. “Ok, I’m going to let you go now, go call your wife.” I continue to read the screen. “Father found daughter had shot herself in the head.” “Pt was 14 years old.” 

            This call haunted me for weeks afterward. It seemed to really hit me at night right before I went to sleep. I was having trouble falling asleep and would stare at the ceiling thinking about that call. What must have been so bad in her life for her to do such a thing? Are her parents also having trouble sleeping reliving that moment they found out their daughter had perished? I felt a sense of guilt as if I could have helped her, saved her in some way. Days after the call I was watching the obituary section just wanting to see her face and to learn a little more about her.

911 Dispatch Sit-in Experience

A little more than half way through our EMT class we were offered extra credit. Our teacher wanted us to get a real feel for all aspects of the EMS field and suggested we try to observe at the ER and/or the 911 dispatch center. At this point I had finished my ride along program with the county paramedics and two fire departments but didn’t feel like I had enough hands on patient contacts. I thought this opportunity would be great not only for the extra credit but for the extra experience.

          I tried to go into the ER to observe but had difficulty finding a time that would work for myself as well as the medical director, whom I needed to shadow. So I never had the chance to meet him or work in there. However, I did have a chance to observe at the 911 dispatcher center.

          *Mrs. Molly Stock is a dispatcher and welcomed me with open arms to sit with her for a few hours at a time, I observed with her two separate nights. 

She showed me how they navigate through the very intimidating computer system. There were 6 computer screens, three key boards, 3 mice and a foot petal hooked to the dispatch radio box. If she would move one mouse, the arrow would zoom across all 6 monitors that were connected together. I was so impressed by the level of multitasking it takes to be a dispatcher. She was able to answer a 911 call, talk to the caller while at the same time calling and talking to other emergency agencies and inputting information on the screen, simultaneously. 

          We took several calls almost constantly throughout the 4 hours each night I sat with her. Most of which were BS calls and I couldn’t believe people were calling 911 for half the stuff they were. Such as “My neighbor’s dog has been barking for three hours and I am sick of it. Send police!” Really? Do you have to call 911 to report this? Have you ever heard of the non-emergency phone numbers to your local authorities? I then realized the system can be abused sometimes and it really is sad. 

          About 2230 (10:30P) we receive several calls for a shooting. The switch board is blowing up with callers saying they heard shots in an alley and know nothing else. Several dispatchers including Molly are taking these calls. Police have been dispatched to the area, several police. 15 minutes pass and we receive a call from a frantic man cussing at Molly telling her “there were shots 15 minutes ago where are the ******* police!?” “I have several officers in the area sir.” She says in a rather annoyed tone. 

When police respond to an area for a crime that has been committed, often times they omit their siren and lights so they don’t alarm the criminal and scare him out of the area, they want to sneak up on him/her and catch them! Hence the fact this man heard no sirens and assumed police never showed up.

          I learned a great deal these two nights and was able to see how dispatchers and other emergency professionals communicate. I learned some code they use and also learned what is going through dispatcher’s minds when they receive 911 calls. 

 This leads me to my next post…..

*Name has been changed

Fire Department Ride Along Experience 2

0800 (08:00A) My second fire department ride along I was just not looking forward to. Several of my classmates had already done their ride along with *Mean City Fire Department and had nothing good to say about the crews they road with. I think to myself “I’m a pretty likeable person. I bet I can get the guys to warm up to me, I’ll fit in.” Wrong.

            I walk into the fire house hoping to see a happy face to greet me. “So are you our ride along today?” “That would be me!” “Come with me.” Hmmm ok. Fire Fighter *Mark Escobar shows me around and introduces me to the guys inside the fire house. As we enter he tells me they had, had a rough night last night and the guys are really tired today. 

            Long story short the Chief was the only nice one and only one who really talked to me throughout the entire shift. He took me under his wing and made me feel somewhat comfortable. 

            I tried to keep an open mind, the guys are tired from working all night, I would be a little grouchy too. I do my best to talk to them anyway whether they wanted to or not. I think they actually appreciated the fact that they didn’t intimidate me, well that’s what it looked like on the outside but on the inside I felt like I was walking on egg shells for the entire 8 hour shift.

            We got in the fire truck and took a trip to Wal-Mart so the guys could get some ingredients they needed for their world famous smothered burritos. I offer to chip in some cash to help pay for lunch, in hopes they would share with me…they say no it’s ok, keep your money. As we walked through the store I could feel all of these eyes following us. These fire fighters were looked at like celebrities. In my previous post I mentioned how all the eyes and the applause felt good while I was walking with the fire fighters, it felt good to feel like I was one of them for the day….however, with Mean City Fire I felt like the third wheel, it was awkward.

            0936 (09:36A) As soon as we arrived back at the fire house we received our first call of the day. An elderly woman had just experienced a seizure, full tonic-clonic seizure. Her daughter-in-law was with her during it so the woman never fell or anything. Paramedics arrived just as we did and rushed into the house. It was a small house with tons of nick nacks everywhere and in the kitchen was a visible basket full of medications and a note above saying “ATTENTION PARAMEDICS.” She must have this happen often.

            She was lying in the cramped hallway on her daughter-in-law’s lap and had two paramedics around her. “Get over there and take her blood pressure. Here’s the cuff.” One fire fighter says to me. I approach the woman on the floor and say hi to her. One of the paramedics introduces me to her and says “My friend here is going to take your blood pressure ok *Miss Wallace?” I try to slide the cuff on her, I’m pumping it up and wait to hear the first “boom” in my stethoscope. I can’t hear anything. I try again…still nothing. “I’m sorry I can’t hear anything” I tell the fire fighter. “It’s ok, good try though.” 

            1100 (11:00A) Lunch time. I was told to bring a sack lunch so I bring my chips, an apple and PB&J sandwich to the table to sit with the guys. They are all ready for those famous burritos of theirs. A huge pot of hamburger meat sits on the stove, lettuce, tomatoes, homemade green chili by the truck load, a bowl of cheese, fresh warm tortillas, everything they need and it smells amazing. They wolf them down….never once offered.  They pack up the left over’s and go on about their day. Now I’m not saying they should have provided lunch for me but wouldn’t it have been polite to offer at least one burrito?

            1326 (01:26P) I’m busy studying in the dark living room while the guys fall asleep in the recliners next to me. I wasn’t going to try to turn on a light because I understood they needed their rest. The tones sound. A fax comes from dispatch stating a pedestrian has been struck by a car in a local shopping center parking lot. I throw all my stuff in my bag and the guys casually sit upright and lace up their boots. I’m thinking let’s go! This is a call hello! I jump in the truck and the guys take their time. 

            We arrive to find a young kid sitting on the hood of his car speaking with a police officer. I fumble with the jump kit (medical bag) and catch up with the crew inside a small shop where the Pt is being questioned by paramedics already on scene. 

Fire fighter Escobar tells the paramedic to let me do the assessment. The Pt was hit while riding his bike. He is diaphoretic (probably only because he was riding his bike), smiling at me and standing. I wonder to myself “shouldn’t he be strapped to a board with a c-collar on?” He is refusing treatment stating he is fine.

I tell him I will just check his pulse and BP really quick. He allows me to do so. I have 5 fire fighters standing behind me and one paramedic beside me, I feel like their eyes are burning holes right through me and I feel the room’s temperature warming up. I place two fingers on the Pt’s radial pulse. It’s rapid and feels inconsistent. I was taught in class when I assess a pulse I should do so for a full minute, I was never taught anything different.  The man is talking to me and I am trying not to be rude to him but I am also trying to focus on his pulse. 

15 seconds go by and one of the fire fighters behind me asks “What’s the problem?” Great! Now I’ve lost my count for the 10^th time and have to start over I think to myself. The paramedic to the side of me has an impatient look on his face. Then 25 seconds have now passed, the Chief says “Just guess and move on.” I feel like a failure. I couldn’t even get the man’s pulse. I check his BP and am unable to hear it. Damn.

The man signs a refusal form and we leave. Back in the truck Escobar asks me what the problem was and why couldn’t I take his basic vitals. I told him I was taught to take a pulse for a full minute, he starts to laugh. “We usually just check it for 6 seconds and add a zero or 15 seconds and times by four.” Thanks. Now I know.

1500 (03:00P) The tones sound again for a fire alarm going off at the hospital. “It’s probably a false alarm. We get these a lot there.” They say to me. So I’m not too excited. We arrive and sure enough, false alarm. 2 hours left and I get to go home. That was the last call of the day.

So my experience wasn’t as enjoyable as the previous fire department I had road with however, Mean City Fire did teach me a valuable lesson…you can’t please them all, no matter how hard you try. It’s up to you to make the best of it though and to take advantage of making mistakes and learning from them, keeping an open mind and understanding sometimes you just have to prove yourself in order to be fully accepted. Press on and don’t let one bad day ruin your dreams.

*Names have been changed.