MaddogMedic

It's a fill-in night at the firehouse. I've asked Helga to cover for me in the past and I'm paying her back now.

There's this kid. Her mom and my Mom went to Nursing school together. Her older sister is a doctor and she's thinking the same thing.

In the interim, she's decided that being an EMT-B is a good idea as a start on her road to her MD. An application, background check and a physical exam (Ironic?) later, she's a member.

Now, she's my problem.

The only time we roll the ambulance tonight is to go get ice cream at 11:00 at night.

Exciting times, no?

She fits in so well that I feel she's been here all along. This is one of those cases where someone is well suited to be here contrary to all assumptions.

I don't have a blog-name for her yet. She plays it too close to the vest for that at this point. For now, we shall call her, "Sis." She is more like a sister to me than anyone I've ever known at the firehouse. She's beautiful, confident and capable.

I have great hopes for her.

Tonight, she joked with us, commented on bad movies with us, made a senior member blush and was first on the engine when it got toned out for a fire. I watch this person for 4 hours and realize that nothing will stop her and she will do well in all she puts her mind to.

That's some powerful stuff.

'Go, Sis, GO!'

--maddog
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It's the first beautiful day of Spring. temperatures creeping into the 80s. Lovely.

Around 11 am, he puts his favorite lawn chair in a sunny spot, grabs a cup of coffee and has a seat in the sun. He's 93 years old.

It's a beautiful day.

Nine and a half hours later, we find him. Still sitting in the char, still holding his (now empty) coffee cup. From a distance, it looks like he just rested his chin on his chest and went to sleep. Up close, I see the signs.

For him, I think this beautiful day never ended.

For us on the engine and ambulance crews, we smile quietly and look inward. Passing is sad but, somehow, this one seems to fit.

Not a bad way to go.

-maddog
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I am driving south on a major highway. An interstate, in fact.

There are smells leaking in to the confines of the vehicle I drive. They are smells like any other.

It all comes down to context.

There is a smell I call "vaporized rubber." Its the smell of locked wheels sliding across tar pavement. Some of that black tire material becomes a vapor and gets into my nose. I have smelled the remnants of this as I pull up and survey the scene of someone's bad decisions

"Diesel urgency" is a smell that exists in many areas. Chemically, it's the smell of insufficiently burned diesel fuel. This can happen when a diesel engine is accelerating excessively (Go faster! She's fading fast!)or when one is desperately trying do decelerate(Oh Crap! Oh Crap! Oh Crap! *BANG*). It is also the smell equated with spilt diesel fuel hitting a hot surface (Get 'em out now!!).

This, too, is a smell I equate with highway calamity.

I, however, am not driving an ambulance tonight. I'm merely driving home from work. These smells leach into my nose and brain via the ventilation system of my car.

Around me, the day to day catastrophe of an interstate occurs. I am just another commuter.

The smells remind me.

--maddog
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Yes, I have an iPhone. I'm testing to see how well blogger works with it. So far, I'm having a bit of difficulty getting blogger and Safari to play nice. The only way I can enter text is via the HTML only window.

Ugh!

--maddog
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Car accidents. If you run from the cops in your car. You'll be arrested. Especially after you drunkenly wreck your car into the woods. 
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I'm running again.

I've even made a blog about it. Since this one is for EMS-related stuff, I've made another blog to track my efforts to prepare for the JFK 50 Mile Ultramarathon!!

Yeah, I'm crazy.

--maddog
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Rain moves through the area, bringing a flurry of accidents. We're dispatched to one after another. Often times, perhaps due to the construction of cars these days, there are no injuries. We arrive on scene, look around at busted cars and get legal signatures from people who don't want to go to the hospital (and probably shouldn't.).

We clear one accident and are on our way back to the station when we get called back to another one not far from the first. We're in stopped traffic on a two lane road. I pop on the sirens and lights. execute a 3-point turn and we're off to the races again!! Wheeee!

To get into position, we've got to go past the accident on the opposite side of the divided highway and turn around at the next exit. Some clown, on their cellphone while driving, almost takes me out with a 3 lane swerve. I suppose he couldn't see the 16,000lb, 9 foot tall, rolling ambulance with flashing strobes, wailing sirens and an air horn that's beating out a rhythm that sounds oddly like the cowbell in the beginning of "Honky Tonk Woman" by the Rolling Stones. Yes, I'm weird like that.

I start wading our way through the traffic to find the Medic unit in front of us and a trail of bashed, wrecked cars on the shoulders as we proceed. None of them appear to have injured people and we diligently report each one to the dispatch center as we go along.

Traffic is backed up because there is an SUV in one of the travel lanes. It's surrounded by police vehicles from the nearby military base, the state and the particular federal agency that patrols this stretch of highway. (Odd, I know but that's how things go sometimes). The patient is on the shoulder, out of the car already. RT immediately dives in with the medics doing patient care so I take the opportunity have a look at the vehicle.

It's got only 3 wheels. The front, passenger side wheel has only an axle stump where the wheel should be. Somehow, this driver has lost the entirety of the front wheel assembly. Tire, rim, brake caliper, ball joint...the whole mess. Both front fenders look like crumpled aluminum foil and there's not a single piece of intact glass or plastic on the vehicle from the doors forward. The busted grill of the SUV makes it look like a hapless boxer after a bad night.

Inside the car is another story. The patient is already out of the car and on the ground. The side windows have been broken and there is glass on the seat inside. This means that something broke the side windows from the outside. Rescuer? cop? rock? Errant Bird? I don't know. File that away for later.

Both airbags have been deployed. (significant) I can't tell if the driver (who is now being wrestled by the medics and RT) was wearing her seatbelt but the windshield has been broken from the outside and there is no evidence that a head hit it from the inside (hair, blood, brains or skin embedded in the glass). The seats are still bolted to the floor there is no blood or other evidence of trauma inside the car. The dashboard, steering wheel and other interior components are not deformed. This is good. It appears that nobody bounced around too much inside this vehicle.

Our patient has been living a life that is in no way deficient in calories. I dive in to help getting her to a backboard and then to the stretcher. During all this, I notice that her collar has slipped up her face. I go in to correct it and she wiggles her head around to get it out of the collar. She's already got a pretty short neck and her "upper body development" is not making it any easier. We improvise something useful and get her immobilized to the backboard, onto the stretcher and into the waiting medic unit.

While RT and the medics wrangle with the patient, I take a moment to query all the police as to how she got here. Broken windows and a busted windshield: Did she roll over? "No we had to break out the windows to get her out of the car."

Where's the missing wheel? "About 3 miles back. After she hit the 3rd car, she kept driving, on the road and in the median, with only 3 wheels and up to about 75 miles per hour!" I look at the police car that stopped her and see that it's covered in mud on the front of the car from the bumper to the lightbar. Woooh!

How long were you chasing her? "About 3 miles. Once we stopped her, she said that she was not allowed to stop for any police as she's the daughter of the top colonel of the army." Oooookaaayy.

"We pulled her out of the car and cuffed her. She immediately started to complain that her chest hurt. I put her on her side and then she started shaking."

Right-O! I hop into the medic unit and pass all this information onto them. RT is going to drive their unit and I'll follow in mine to take RT home once we get to the hospital. We get rolling onto the nearest trauma center. Halfway there, our dispatch starts calling the medic unit asking for their status. That's when I realize they haven't called with their patient information and destination yet.

After a few calls from dispatch to no avail, I hear RT mark up on the radio and advise them that we're all en-route to a particular trauma hospital and we'll advise upon arrival. Mind you, I'm driving an empty ambulance behind the medic unit and don't have a full appreciation of what's going on inside.

We arrive. Once we do, I park in a convenient spot and pop over to help unload. The doors to the unit are still closed and RT is still up front. What's going on? I pop the back doors open to see two medics looking frazzled and each trying desperately to hold down the patient. She's thrown off her collar. and thrashed around quite a bit. In the confines of the ambulance, the medics are holding her down to keep from getting hit. The looks on their faces are pleas for help. Apparently she's been fighting them for the whole drive and has even tried to fake a seizure or two. The medics have been so busy trying to hold her down and not get hurt themselves, they haven't had time to call anyone on the radio.

"RT! Come open up and get us out of here!" I say as I hop up to the head of the patient to help out. I try to put the collar back on her. Just as she snaps at me with her teeth, one of the medics says, "Watch out! She bites!"

I jack both of my thumbs into the space behind the angle of her jaw and below her ears. This is called the infra-orbital pressure point for law enforcement types and causes a LOT of pain without any tissue damage. I look her in the eye (both of which are very open right now).

"You bite me, I'm going to knock you out!"

Her whole body relaxes enough for us to get her out of the ambulance and into the loving arms of a waiting trauma team. I don't put the collar back on her but I do hold her head to keep it from moving. I also have my fingers placed in the same spot I "zapped" her before as a reminder that if she gets frisky, she's going to pay for it.

The trauma team is ready and, really, not very impressed with her antics. If you thought I was cruel. the trauma doctor is an absolute sadist.

As we clean our gear, one of the medics says to me:

"Man, this is what it's all about!"

The stress of the call sloughs off of us and we laugh and laugh.

--maddog

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We get dispatched as the 2nd ambulance on a car accident.

On our way to the scene, the incident commander (the chief of the neighboring station) asks us if we have a problem taking 3 stable kids in car seats.

RT and I look at each other. He knows he can "tap out" and drive, leaving me in "the back" to handle things if he's over his head.

"Ambulance XXX, We're direct. No worries" I reply.

Here's the deal on scene:

Mom's driving the minivan with two 11 month-old twins and a 22 month-old son in car seats. The minivan gets rear-ended. Kids are fine (that's what car seats are for) but mom's neck and back hurt. RT and I work on mom. We get her extricated to a long board & immobilized to our stretcher. Into the ambulance we go and start doing our trauma assessment to be sure we haven't missed anything.

While we're doing this, firefighters start loading car seats and kids into our ambulance. By the time we're on the road, we have a 38 year old woman in full spinal immobilization as a precaution, 3 screaming children in car seats and RT being a stuffed-toy-laden octopus who's spending equal time entertaining toddlers and treating his patient.

At the hospital, I have to go in and get help from one of the waiting ambulance crews. We roll in. One EMT with a kid in a car seat and two others pulling a stretcher containing a woman on a backboard while holding identical boys on their hips.

At the nursing triage station, it's wait wait wait.

The oldest boy is content to play with his toy while still strapped into his car seat. No escape there. RT has one twin with a biblical name. Biblical name #2 is on my hip.

As I shift Biblical name #2 from hip to hip, I notice a particular smell.

Now, RT has a son but his ex left before the boy was born. Even though RT is very much involved in his son's life now, he's never dealt with toddler management. Mind you, we're already a spectacle in the emergency room with one patient on a cot and three little kids being wrangled and corralled by two harried-looking EMTs.

I catch a nurse's eye.

"Can u get me diapers and wipes?"

Her eyes widen in recognition. I look significantly at the toddler on my hip and nod at her with a knowing look.

"I'll be right back!" She drops what she's doing and dashes off.

Five minutes later, I've got this little man on his back on an exam table and am fighting him to get his onesie off.

Clearly he has a healthy diet! Bleah!

Another 3 minutes pass and he's clean, changed and dressed.

I walk out of the exam room and mom puts a hand out to touch her baby. Her hand finds my arm.

"Thank you."

The nurse from before comes bustling by.

"They teach you that in Paramedic school?"

I smile.

--maddog

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We get on scene to an accident after the rescue squad. I had to plow through some pretty heavy traffic to get there.

I see a car with front end damage, a spiderwebbed windshield and a knot of firefighters around someone on the shoulder of the road.

I take a moment to look over the car while my partner gets in to see the patient. There is no passenger seat. The driver's seat is there but the front passenger seat has been removed. The windshield has a spot on the passenger side where something round (most likely a head) has struck it from the inside and caused it to shatter and bulge outward. It seems to me that whoever hit that windshield came from the back seat. That's a far way to travel.

Lying on the side of the road, there's a crying kid of about 7 or 8 years of age who's bleeding profusely from his chin. The attending firefighters are as distraught as he is. He's a kid, he's bleeding and he doesn't speak a word of English. Something about hurt kids makes us all get silly. All of the crew from the rescue squad are pretty worked up. these guys are top notch and I've rarely seen them so upset. They won't let my partner get close. It's like a rugby scrum!

In short order, I get everyone to take a moment to catch their breath, slap a dressing on his cut chin, talk to the kid in Spanish and find out the following:

1. He was in the back seat.

2. He was NOT wearing a seatbelt

3. He doesn't remember much

4. The back of his neck hurts A LOT.

From the cut on his chin and his complaint of neck pain, cut chin and the shape of the windshield bulge, I surmise that this kid flew from the back seat and face-planted into the windshield causing his head to hyper-extend, or bend backwards as much as it will go, as his body kept moving forward with the force of momentum.

This is bad.

I look over to the scene commander, my Lieutenant. I point my finger in the air and spin it around a few times. I'm telling him we need a helicopter NOW. This kid is potentially really messed up and needs to get to a children's trauma center ASAP.

"Called for it when we got on scene. ETA is 3 minutes." He says as he winks at me. LT's got my back!

We get the kid packaged (cervical collar, backboard, immobilized) and moved into my ambulance where I have room to work and light to see. The bleeding on his chin, however dramatic, has stopped and appears to be superficial. Good. His pupils are normal and reactive and he's not leaking out of his ears, nose, mouth or eyes (other than the crying). Good. Skull appears intact, no problems on the front of the neck but the back of his neck is very sensitive to touch. So much that I don't have a chance to fully see if anything is out of place. He's too tender for me to probe that deep.

Lungs are clear and he's breathing without too much effort. No apparent injuries to his chest or abdomen. Pelvis stable. All his limbs are solid, intact and have pulses with appropriate sensory and motor response. His other vital signs are pretty normal considering he's in a lot of pain and scared.

Other than his neck this kid's fine! His neck, though is really troubling me.

By the time I finish my assessment, the helicopter has landed and the medic is at the door of the ambulance. He's a tall, stern cop/medic with a no-nonsense, don't-get-in-my-way look about him. His eyes are scanning and talking in the whole scene.

I run down the basics and tell him my assumption about the mechanism of injury. I also fill him in that the kid doesn't speak English. He doesn't look at me until I explain my thinking on how the kid's face hit the windshield and how that relates to his severe neck pain. His eyes dart to me, he nods once and says, "Let's do this."

less than 90 seconds later, the kid is in the helicopter that is roaring its way skyward. I hear the medic on the radio indicate they're taking the kid to the local children's hospital, Priority 1.

I take a moment to watch the flashing lights of the Bell Jet ranger in the clear night sky and then turn around to clean up my ambulance open up traffic and clear the scene.

-maddog

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Though I am still a paramedic and, from time to time, still get out and do some “paramedic-izing” my full time job is a college teacher.

This semester, I am teaching several lecture classes. One of them is a seminar for freshman who have declared my department's major as their own. It's one of those, “introduction-to-college-life-this-is-you-in-the-big-bad-world” kind of things. Each week we meet for an hour and talk about things that impact them as students and as emerging adults. We've done group problem solving exercises, we've discussed campus life and where each student is from. We've done icebreakers and “getting to know your neighbor” exercises. All in all, these kids are a really neat group of people.

Today, My assigned topic was “diversity.” On the face of it, it's a tricky and possibly onerous subject. Many have tried to teach it and have done it poorly. I did my best. I worked up a nice presentation with minimal powerpoint bullets. I referred to campus resources for student culture organizations, built in time for the students to discuss their perceptions of people and even fit in a homework assignment having to do with dissecting your own bias or prejudice (everybody has one).

Well, I walked out to the lobby and saw my students lounging around. Through the window streamed pure sunlight, dappled by the green leaves of a Bradford pear tree. Two of my students are Muslim and were pretty weak after about 5 days of fasting during Ramadan. I looked at my students, I looked at the classroom (two small windows) and I looked out the sunny lobby window again.

“Hold on.” I dashed out, printed up my lecture notes. Tossed my laptop into my office and returned to the lobby.

“Follow Me!” We all traipsed out to the sunny courtyard. I took the class outside!

I went through my notes. I delivered my lecture well. My students responded well and we had a pretty good time. I tackled some tricky issues (race, religion and sexual orientation) but a lot of discussion came out of it and it was good.

Somewhere in there, we wandered off the lesson plan. We were talking about respect. Respecting people's basic human rights, their humanity and their individuality. During our discussion, I realized that a core principle of accepting and appreciating the lovely diversity of people around us is respect.

“What is the golden rule?” I asked the students in a moment of inspiration.

“Treat others the way you wanna be treated” replied a bright-eyed enthusiastic freshman.

“Exactly! 'Do unto others as you would have them do unto you.'” I replied. Something was happening, I felt this idea coming up my brainstem into my cognitive lobes. Sparks were flying!

I looked at another student in the eye. “Do you wish to be treated with respect?”

“Yes”

“And you?” to another student

“Sure!”

“And you?”

Nods

“And you?”

More nodding, and on and on.

“Well, how do you pay for that?”

Confused looks.

“How do you ensure that you are treated with respect?”

The bright eyed student piped up, “Treat them that way!”

“YES! That is the thing!” (The idea was really boiling now!)

“We MUST treat others the way we want to be treated! And the only way to be sure we do that is to look at that person and say to yourself:”

I paused. I looked right at a student in front of me.

“You are me.”

She looked a little confused.

I waited. I knew this was a doozy.

Her eyes did that: “get wider because I suddenly get it” thing! It was awesome!!

“That's right! Each person I encounter is NO different from me in the ways that really matter. Each person I meet is another one of me and I will treat them and accept them as if they were myself!”

“This is the most important thing for you to realize. If you get this, I mean really get it, then you can have compassion, acceptance and all the other fancy words. Most of all, you start to enjoy the amazing and wonderful range of people that move through our lives. Skin color, nationality, religion, physical shape, sexual orientation or politics cannot change the fact that, fundamentally, we are reflections of each other. We are alike in the ways that really, really matter! It's so GREAT! It really is!”

“When you become medical providers, you will start to look at each patient and see them as yourself. You will start to develop compassion because you can feel how you'd want to be cared for in their place. You'll treat your older patients as your aunts, uncles, grandparents, and your younger patients as your own brothers and sisters. Once you find a way to recognize yourself in the face of everyone else, regardless of where they're from and what they look like, you will find the key to all of this. You'll find it a natural thing to respect people, accept people and take joy in the broad range of people that move through your life!”

I find myself really worked up!! I was really onto something (and I still think so!)! This is really, really it!!!

Each one of my students' faces are shining at me! I mean it they're really shining like they get it too!!!

Then they start looking past me into the rest of the courtyard. Eyes shoot off to the side to the nearby lecture hall entrance.

I turn around.

My class of 15 students has suddenly grown to about 40!

Their faces are shining too!

--maddog

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..Honestly! It isn't!

I made a promise back in an early post that I would not discuss politics. This is not about my political views but it is about how politics can affect us all.

There was a decision made by the director of NHTSA. It, basically, says that no engineer, scientist or anyone else who does research into safety standards may speak to the press or the public on record. The only person who can do that is the director. An attorney appointed by a politician.

This is BIG news for us safely people but it is not caught by the front page press. It appeared in a blog in the automotive section of the New York Times online.

It's >>>Here<<<.

To this, I posted a brief but, I think, cogent comment. While many were raging about the lack of journalistic access and how our government is becoming more and more fascist, my angle is more along the lines of safety.

Here's my comment verbatim:

"This is exceptionally disturbing even beyond the journalistic perspective.

The NHTSA was responsible for starting the entire industry of EMS in the US today. It responded to a paper called, "Accidental Death and Disability - The Neglected Disease of Modern Society" that was published by the National Academy of Sciences by establishing a set of guidelines for highway safety and driver safety.

From this came the seatbelt law, the establishment of the guidelines for emergengy medical transport and countless safety laws that were imposed upon, and fought by, the automobile manufacturers.

As a paramedic, I'm appalled that this agency seems to be suffering a "throttling" effect by a political appointee. The "conspiracy theorist" in me sees a connection between this and the influence of the automobile manufacturer's lobby. (then again, I'm sure I see a lot of things like that)

The main disturbing point is that the engineers and scientists of this agency produce data that has a direct affect on the safety and injury prevention of all of us. I can't tell you how many times I was amazed to find an unhurt driver or passenger due to an airbag, seatbelt or rollover protection.

If the straightforward, factual information produced by these men and women is filtered through a person who may be influenced by a political agenda, I fear that we, as the public, may not recieve the full benefit of their work. This is what this agency does! It actually saves a lot of lives. It should be allowed to continue to do so."

Grrrr!

--maddog

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Here's my cat in my lap. He's been out for far too long. His coat is scraggly and he's getting kind of thin. My hands move over his little bony body and I feel what's going on. I can feel the big wad of food he just ate It's a hard lump just below his ribcage. I can feel him breathing and rumbling as I pet him. As I rub his shoulders, I can feel the ropy latissimus muscles moving across his scapulae. I know all of his parts. I'm worried about his kidneys and bladder. As I feel around his ribs to where his kidneys should be and down his belly to his bladder, he complains no more than usual. Good.

Thirteen years ago, when I got this cat, he was no more than a bundle of attitude wearing fur pajamas. Today, I still have great affection for my cat but he's more than just a fuzzy beast who demands food and pets. I see him as an organism. I know his parts. I have a greater understanding for how these things work.

I do this to people too. I can see both parts of the gastrocnemii in my dad's calves as he hikes up the trail ahead of me. He's got great legs from so many years of hiking and playing soccer. When I'm sitting still, watching the world stroll by, I can spot the woman with cardiac problems from her pedal edema, the COPD patient from his barrel chest and bottle of oxygen as he walks by. I also can see the worrying signs of aging in my parents as I've never been able to see before.

My perception of people has changed since I've become a paramedic. People, for me, are more than just their outward appearances. My awareness goes deeper than that. I can see their muscles, bones, tendons. I can see where they're moving wrong. Scars tell me a story like they never did before. Yes, those railroad tracks on someone's chest? That means they've had their heart open and if they're gasping for air, bad things are happening. The intellectual part of me finds this infinitely fascinating but the human me is alarmed at times to see the frailty in those I love.

I know that everyone's got a heart, two lungs, an enteral tract, a liver, eyes, brain, blood, a lymph system, IgA and all his companions, etc.. In fact, I know it more than I ever did before. I could become alarmed and frightened by how fragile all these creatures are but I'm not. I'm in a constant state of wonder that someone so wonderful and complex as my brother, my wife, my niece my cat, my dog or my father can be so much more than a simple collection of anatomical structures.

We are so much more than the sum of our parts.

If we were just meat, there would be no place in the world for people like me.

This is why we (EMTs, paramedics and rescuers everywhere) do what we do.

--maddog

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A lot has been going on.

With my new job and new certification (yes, I'm a paramedic now), I'm still not sure of what should be posted and what should not.

There is more on the way.

---maddog

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