Only one call. Slow night again. What do I expect from a Tuesday? Of course the call came in after 11. That's why I always stick around after I'm due to go.

So the call came. 32 y/o Male, trouble breathing, BLS (us) and ALS units dispatched. We arrive on scene, a 2nd story walkup apartment, and we are greeted at the entrance to the building by someone directing us to the apartment. As we go up the stairs, the guy says something along the lines of wanting to go inside.

"Duh!" I think to myself, "That's where the patients is!"


The PATIENT met us outside the building and walked up the 2 flights of stairs to his apartment with us. Okaaaay. Trouble breathing, Hm. I ask him, "Where's the patient, sir." He looks at me confusedly. "Are you the person with the trouble breathing?" I ask, kindly. Sure enough.

He opens the door to the apartment, I let him go first. I never know what I'm going to find and I'd rather it bite him first. The place looks like a semi-sloppy bachelor pad. Ok, no dogs or crazy roommates so far. I get the patient seated and start asking a few questions. Right away he's asking us whether he's going to die and do we know about sleep apnea. Oh boy!

This guy is pink, talking up a storm (patent airway), Oriented X3 (1. Knows his name, 2. knows the date, 3. Knows where he is). Well, I always get vitals and, hell, I'm here already, I could always use the practice. At this point, I'm already thinking (a little guiltily) about my blog for the night.

Pulse 106 and strong, SO2 96% before oxygen, I get a nasal cannula and 6lpm of O2 going. The ALS unit arrives and they start chatting him up. I keep taking vitals. BP 162/110, Clear lung sounds skin warm and dry and good perfusion. This guy's a little worked up but doesn't seem to be dying.

So, the medics leave and us BLS guys are trying to figure out what to do with this guy. Every time we ask him if he wants to go to the hospital he deflects by asking if he's going to die, whether people just stop breathing in their sleep and so on. I keep telling him that we're not doctors and he really should see one. He seems to be having trouble making a decision or focusing on the idea. He just keeps asking us if various ailments can kill him and if he's going to die.

I remember my sales training when dealing with an indecisive customer. Give them only 2 choices at a time. I had found that this had also worked really well in law enforcement when talking down a passively resistant subject. OK. I ask him if he wants to see a doctor or just go back to bed. He wants to see a doctor. I tell him he can either go to a doctor tonight or go to a doctor tomorrow. I ask him which. "Doctor tonight" he says. Does he want to drive himself to the hospital or does he want us to drive him. He thinks about it and asks, "Will you guys bring me back home?" No, we tell him, we're only a one-way service. He decides to drive himself.

Great! I present him with the patient refusal form. He's got to print his name in one place and sign in another. He signs, and then asks us if we think he's going to die tonight. "Print your name here, Please, sir." He does. Once the paperwork's signed he becomes a regular guy, thanks us for coming, gets his keys and coat and gets ready to leave.

We're outta there. I felt kinda bad for the guy. After we had talked to him for a while I figured out that he had eaten a huge greasy dinner and then immediately went to bed. The reflux probably came right up his esophagus and scared him out of sleep. I've actually had that happen to me once or twice. It certainly feels like you've stopped breathing. This patient also seemed to have other problems. Depressed? Just lonely? I don't know. My heart went out to him but I didn't want to be trapped in his apartment all night while he was deciding what to do.

Poor guy.



I got a comment on my last post and my reply is too big for the comments section so I'm gonna post it.

This came from the author of Random Acts of Reality and I've added his link to my list to the right.

"Hi there, In England the fire service and the ambulance trust are completely seperate. There was a recent report that the Fire Service spen 97% of the time on station, while Ambulance workers spend 3% of the time on station. So I think EMS being 75% of your calls may be a little low...unless of course, all Americans are arsonists..."

To which I reply:

In many jurisdictions in the US, there are ambulance trusts and ambulance service providers completely separate from the fire department as well. Tulsa, OK, Kansas City, KS, Richmond, VA, just to name a few.

I spent a long time fighting shipboard fires in the Coast Guard and have seen them change their policy from "fight the fire, save the ship" to "rescue the people and let it burn." With land based fire, we have seen a reduction of fire calls with the increase fire code requirements, and better construction of homes and offices. Therefore, the vehicles leave the station on EMS calls mostly. Some areas even have a policy of sending fire apparatus on EMS calls and that distorts the statistics of need for fire service.

Unfortunately, Where I serve, EMS is crammed into the fire service and it appears it shall remain so for a long time. The protocols and standards of care come from an organization outside the fire department but in my area, Fire is King.

Yes, A big fat, gluttonous blob of a king taking all the glory and benefit of the work of it's peons.


Let me know what you think. If your comment is too long for my comments section, email me and I'll post it.



Well, it was a quiet night.

So quiet that four of us decided to go for a ride. We took the ambulance out for some area familiarization. D., who was driving, knows the area like nobody's business. I've lived nearby for 30-some years and I don't know it as well as he does. Anyway, I went with them because I'd HATE to miss a call because I didn't. I learned a lot. We cruised the neighborhood and then headed over to a few special interest places. We have a high-rise residential building in our area where the entrance canopy is too short for our apparatus. D. dropped off H. and I in the front door, as if we were running a call and told us to find the loading dock around back. We didn't take the stretcher or bag with us but we were dressed.

The doorman let us in right away and I told him we were just doing training. The worried look left his face. H. seemed a bit lost. I seem to have an innate sense of buildings and how they work. I headed in what I thought was the right direction and grabbed a door handle. H. gives me a look as if saying, "Where the hell you going?" Yep, I was right. Down the Stairs to the "T" level and there's our ambulance. H. looked at me sideways. I shrugged and said, "Never been here before!" She didn't believe me.

Well, we headed out to other interesting sites in our area and D. kept up an informative and constant chatter as he drove. H., C. and I did our best to be sponges. On a few spots, I found I did, indeed, have some local knowledge. You see, D., H., and C., like most of the young people at the Firehouse, aren't from the area. I just have the years of living here in my favor. Worked there....Had a client in that building... good sandwiches in that deli... that used to be a baseball diamond... went to the prom with a girl who lived on this street... and much more useless information.

While running around, we heard a fire developing two areas over. We started edging in that direction and, sure enough, second alarm and we got called to go in. Fire in the office building, no injuries. We sat in the EMS sector staging area for an hour or so and then went home. Yawn!

The only things I really accomplished were putting stickers on my helmet with my company number and name and getting signed up for EMS Officer Class. Unfortunately, I was only one of 3 people in my whole area that signed up and the class was cancelled. Bah!

In my jurisdiction, EMS calls account for over 75% of the calls run by the Fire/EMS department but everyone STILL thinks that EMS is the bastard child of the fire service. It seems that the EMS aspect of what we do is either a necessary evil of firefighting or is shoved to the side. Why is that?

I read MacMedic's blog almost daily along with a bunch of others (see list to the right) and one entry in particular was interesting. I, too, have been through a lot of training and schooling for another career and decided to go the paramedic route. (see."About MaddogMedic" at the top of the links list for "the epiphany")

My Sister-in-law, T., asked about my decision to become a paramedic. T. is a critical care pediatric nurse and very good at what she does. She met my brother while she was working with my Mom who's a pediatric CNP in the neonatal intensive care unit of a local hospital. Her question is why the hell do I want to be a paramedic when nurses get to do so much more, push more drugs, get more respect and go through less schooling? I can do more advanced patient care and have more responsibility as a nurse. She seemed to think that I was short changing myself by "only" being a paramedic.

I said, "T., when was the last time you intubated a patient while sprawled across the hood of their car?"
"How many times have you gone into someone's home to save their life, and done it?"
"How often do you get the chance to extract a patient from a destroyed automobile, and push drugs, intubate, etc.?"

I grew up in a family of nurses and I have a lot of respect for good nurses. It seems that each specialty in patient care comes into play in a different phase of the patient's cycle. From trauma/illness onset, to rehabilitation and release and all the parts in between. Some people I've met in different parts of the process seem ignorant or disparaging of the workers in the other phases.

The nurses can't treat the patient if we medics don't bring them in treatable condition. It seemed that it didn't even cross T's mind that patients need care before they get to the hospital. That's where I want to fit in. I want to be the first or second provider of care. Thinking about it, I don't know that a hospital based caregiver has ever conducted a scene size up, or gotten clues about a patient's illness from their living conditions. There's so much more to providing medical care out in the field. We have MOIs to determine. We have our own safety to consider. Sometimes we have the opportunity to recognize a domestic violence situation and take action to protect the victim if we can. A quiet call to the PD can do wonders.

I feel there's so much MORE to medicine in the field. I'm with you MacMedic. EMS is a career choice. I don't think you are having trouble seeing what other see clearly. I discovered that my place in the world is in the field providing care to people that need it. That's all. Just because my Sister-in-law's place is on the ICU floor, that doesn't mean mine is too. Just because other people use EMS as a stepping stone to go to nursing or physician's assistant doesn't demean or belittle those who choose to remain and become outstanding medics. EMS is something that requires a lot of people who practice it and it's certainly not for everyone. Those who find that it is for them are a special sort, indeed.

Every military service has an "elite." The Army has Airborne, Marines: Recon, Navy: Seals, Air Force: Parajumpers, Coast Guard, well, I guess we're all "Elite" in the USCG ;). The point is, in EMS, I've always viewed the Paramedics to be the elite corps. They're the ones riding helicopters, performing heroic interventions in the middle of a highway, doing the things that gross everyone out but save tons of lives. They constantly train to hone the skills they have and add skills they don't. Just like the elite of any dangerous service.

The day my NREMT-P card comes, I'll be walking tall!



Running 3rd on the Ambulance tonight. Hope to see some calls.

I still have some paperwork for my EMT reciprocity. I have to prove to the state that I'm affiliated and then take a test on the state protocols on patient treatment. That happens on the 22nd. Ok, study, study, study. I've also found out that my jurisdiction is having an EMS officer class in Feb. I have to do some running around and signature gathering to get on the list for that class too. It might be all in vain. I hear there's only 1 other person signed up and they might cancel the class. Bleah.

So, not much in the past week as I've been away from the "Clubhouse" as i call the Fire Station sometimes. I have been reading a lot of other medical blogs, including the ones to the right there. Thanks to those of you who've come by, read and even commented. I'm delighted and surprised that people are reading my stuff.

Ok, off to the "Clubhouse." Wish me luck!




Well, my thanks to croliver for pointing out that I had identifying marks in my picture. Using iPhoto (I have a Mac), I rubbed out the letters on my jacket sleeve and cut out the state flag in the background.

I'm not ashamed of where I am or anything, I'd just like to keep this as anonymous as possible. I'd hate for someone I know to come across this blog and get offended or cranked off. Sometimes I get a little cranky with people and I vent on the blog.

Anyway, thanks for reading and commenting!

Last night's duty was busy and eventful. No time to watch the Idiot Box (what I call the TV) and I like that just fine.

I showed up early and got signed in. New General Orders are out and we were going to have a drill to go over them in the training room. Cool. Helped set up the training room. There were a couple of other FF's there and they helped out (sort of).

Got a lot of crap from the other FFs in the training room while setting up. Usual new guy crap talk. Who are these punks? Yeah they're fire fighters (fire technicians, actually), but they're what, 19? 20? The ideal they work for is the "saving a child from a burning building while the mother looks on with grateful tears" scenario. Everything else is a boring waste of time. Including treating patients....

I'm 32, seen a lot of dead people. Saved a lot of live ones. I'm a federal officer and a defensive tactics instructor. I've been around the world, arrested and beat up a few people, been beaten up myself a few times, exchanged gunfire, cried in the boat or ambulance after a dead kid, danced for days after an awesome rescue, fought fires on ships, and lived a lot more. I've met a lot more people from all over the world and learned to get past my own pride and insecurities and get along with anyone. I mean ANYONE.

I'm used to a more military setting, too, where some punk mouthing off to me is easily shut up with a barked order, snarl and instructions to go clean the underside of something nasty. I have a great NCO voice and a whole catalog of epithets to get the message across. That's what comes from 12 years of service, 4 years of sea time and a clear sense of command.

I'm also used to camaraderie. The automatic, "we're shipmates so we're friends and that's that" attitude that comes with being in the service. At the Firehouse, I often feel that I'm not "in the club" yet and worthy of only despite. I'm too old for that crap!

The training: The new General Orders cover our jurisdiction's application of the Incident Command System. Very easy for me since my class last semester called "Disaster Management" was all about the ICS. Pretty cool to see it at a more tactical level. Most of what applied to us was how our Rescue squad, Ambo and Ladder truck fit into various incidents and structure. Neato.

First call came not long after training finished. 41y/o Male, Chest pains. We head out with Driver, officer, me riding 3rd and a brand new volunteer riding observer. We have a medium duty ambulance so, there's plenty of room. I get in, buckle up, have the new fella do the same.

On scene: 3rd story walkup apartment, we go all the way to the back bedroom, I'm scanning the whole place all the way through, listening, sniffing. My habit of "situational awareness" is too ingrained. Don't want to be surprised by a dog and the patient's environment can give a lot of clues. Daughter greeted us at the door. leads us back to bedroom.

Pt. is in bed propped up. Somewhat alert and oriented. He tracks me with both eyes as I come in. His left arm is at his side, his right is across his chest. I get right down in front of him, eye level and say, "Hello, My name is *****, I'm here to help you. Tell me what's wrong."

"My chest hurts." The left side of his face is droopy and I hear that he had a stroke months ago. Oh boy. I put my hands out in front of him, palms up and ask him to take my hands and pull on both of them equally. Good. He's got equal strength. I didn't like his arm positioning when I came in.

I get a strong pulse, Bp normal, blood O2 at 98%, skin is warm and dry. He can tell me his name, where he is, but has no idea what day it is. That slurring is bugging me. I ask him, "On a scale of 1 to 10, with 10 being the worst pain you've ever felt, how bad is the pain in your chest?"

A long pause, the mouth is moving. Working on words? "Eight." Really quiet.

"Is the pain moving around or is it staying in one place?"



"Up here." His right hand travels from his sternum up to his left shoulder. Oh boy. The driver, D. and another EMT, S. are with me. D. goes for a stair chair and I ask S. if ALS is en route. Yes. Good.

All the while the wife is in the bed too. She just had surgery on her foot and she can't get up. She's alternating between being firm and demanding with us, "What hospital are you taking him to?" and touching her husband on the arm, "Ok, Baby, Ok." The daughter hovers and looks for things to do, people to call. I know how she feels. Helpless. I focus on the Pt. This kind of family stuff touches me deep.

By the time we have him in the stair chair, ALS is on scene. I pass all my info to the medic and go get their stretcher while the rest of the crew get the Pt. down the stairs. 2 minutes later, he's in the Medic unit. The daughter's in the front seat of the unit, crying. She lost her careful composure, finally. That's her dad. That's scary for her big time.

Afterwards, S. goes into "instructor mode." He starts to critique my work. He says I talk to the patient too much. That I don't need to tell him everything I'm doing. He also says I move too fast. Ok, I sometimes do. I'm high speed. He gives me other feedback, "we don't really wear our seat belts in the back." He also questioned why I left the pulse O2 meter and the Bp Cuff on the Pt. I tell him that with this type of Patient, I'm going to take vitals frequently and leaving them on is like a reminder to do that.

I met S. at the Volunteer Recruit School 3 months ago. He had never touched a patient then. Now, he's flush with his certification as an EMT-B, and an officer on the ambulance. Ok. I don't tell him that talking with a patient develops rapport and shows compassion. I also don't tell him that engaging in a constant conversation with the patient helps me keep track of their mental status, especially in a potential stroke victim. I don't tell him that I ALWAYS wear my seat belt. In an ambulance, I like being the EMT, not the patient.

Back at the FireHouse, we go over paperwork and we're done. S. means well. There's not a bit of malice in the guy and I like him. I can't wait until I'm the medic and not the EMT-B. I don't like handing off a patient. I want to go with them. I want to see them through. I want to know the end of the story.

One of the FFs at the station, C. is a career FF in another jurisdiction. Assistant chief lined him up to give me and the new guy SCBA training. Cool! C. is competent, patient and teaches well. I learned a LOT! C. really pushed hands-on and it's good. The SCBAs are really different than the OBAs I used back in my shipboard firefighting days. We put them on, took them off and repeated the process with turnout gear on. Practiced a lot. Cool. Check me out: SCBA Pimp! Note the much disdained BLUE HELMET. That's the indicator for EMS only in my jurisdiction. Most FFs think we're just this side of useless. Ah well....

By the time we finished all this it was 11pm and time for my tired butt to go home. I log on to the laptop (wireless with DSL at the FireHouse, Nice!) to check email and read one of my favorite blogs before heading home. Sure enough! One bell, Ambo call. Yippeee!!!

25 y/o Male. Back spasms, no other complaints. Another 3rd floor apt. but only one flight of straight stairs. Ok.

Enter the apt. to find Pt. on his left side on the floor in front of the couch. Alert oriented, about 6'2", 275lbs. This guy was great. Great attitude, worked with us, though in a lot of pain. D., who drove again, had just gotten over the same thing. Back injury while weight lifting, subsequent debilitating spasms. He had a lot of sympathy for the Pt. The Pt. was so affable that we all interacted well. We told jokes and worked together to get him moved. S. called the squad to get some people to help get him down the stairs. All vitals normal.

We got a flexible backboard and he scooted himself around the floor until we got him on it. Pretty much a simple transport to the ER which was thankfully quiet so nobody had to wait. We worked with the nurses and moved him onto a bed. Everyone was in a good mood, friendly and it went very well. The Pt. was a good sport and I think that had a lot to do with it.

A nice finish to a pretty decent night. I got a lot of training, ran some calls and got to "strut my stuff" a bit. On both calls, S. stood back and let me take the lead. Got home late and slept like the dead.


I got my turnout gear today!

It's all shiny and new. I have a blue helmet. That's the designator for EMS only. I'm sure I'll look funny and get lots of snide remarks from the firefighters at the Firehouse. I had to get an older style of jacket since it's the only one they had in a long size. I'm 6'4" so, in order to get a proper length, I have to go with tall sizes. All in all, I'm pleased to be geared up and ready to run.

I also got my Personal Accountability Tag. It's a little ID with my picture on it and a clip. I feel like I've been inducted into a club!

It's about time!
Got the comments working. Please feel free to sound off.

Next is a counter.

Late...tired....must sleep.......zzzzzz...
No calls during the meeting. Bah. In fact it's so quiet, I'm trying to put a comments link on my blog site. Not having much luck. I expected there to be a lot of calls. There's a full moon. Perhaps the cold, 20degrees Farenheit, is keeping the kooks at bay.

There was a Truck vs. Car with both car passengers fatal. Adult and a child. That happened about an hour before I left my house. The street was blocked off and I had to go to the Firehouse a different way. Our rescue squad responded and some of the people are still talking about it. Decompressing. Nobody likes a dead kid. The adult was obviously dead as there was no resuscitation attempts.


The thing is, I think I know the guy who was driving the truck. It was a municipal service truck and I used to work with those guys. I saw them just yesterday as I was going to the post office. Dang! My heart goes out to them. I don't know if the car hit the truck or vice versa. The investigation is still pending but those guys in the truck must feel crappy as all get out.


I'm gonna try to get this commenting thing working.

I get my turnout gear tomorrow!!!! yay!
Monthly meeting tonight at the Fire House. It's also my duty night. Hopefully we'll get a call and I'll have to dash out of the bored-meeting. ;)

If anything interesting does happen, you'll hear it here!

Up to now:

I've been a Nationally Registered Emergency Medical Technician, Basic (NREMT-B) Since August 2001. I went through the school offered by the Coast Guard in Petaluma, CA. I didn't get much chance as a reservist to use my skills. Not as much as I'd like, anyway. I now am volunteering as an EMT with a local fire department and am working on getting a reciprocal certification from my state.

I started school in January, 2003. It's great! I'm having a blast and it has been a real treat to be a 31 year old Freshman! Alas, due to the embarrassing nature of our foreign policy, I was called to active duty in the middle of the semester. My professors were great and accommodated me with my courses. I was fortunate to be "deployed" to only 15 miles from my house. That's what I get for specializing in domestic law enforcement, eh? I spent the summer on duty and treated a grand total of ONE PATIENT!! Fell out of a boat. Got a knock on the head. Slight bleeding. Refused transport. Sigh!

Due to me being gone so much, I had been having trouble getting checked out at my firehouse. I had gone along as an observer on many an ambulance calls but I didn't get to do anything until someone signed a piece of paper saying I knew how to ride on the ambulance. Sigh! Meanwhile, I'm back off active duty (I'm a reserve yo-yo) and in school. Finished fall semester in December. I'm using my break in January to get all of my certifications done and start riding that ambulance, Dangit!

The next step will be to get checked out on the rescue squad. We have a big piece of interstate in our first due area and we do a lot of extractions. I'm looking forward to treating patients with a wide variety of trauma including those associated with auto accidents. Here's the snag:

I'm a volunteer with my county. I'm supposed to get "turnout gear" or protective clothing when I get signed up. I can't ride or respond to calls in the Squad until I have that gear. In order to get the gear, I have to go to a school that the county offers (did that) get all my vaccinations (did that) and get some signatures from my company saying I know how to tie knots and that I read the general orders. I did all this stuff but in a weird order. Suffice it to say, I have to go track down a volunteer chief who lives about 30 miles away and get him to sign my paperwork. I then have to take the paperwork to one place, 20 miles in the other direction, and get and ID tag, then go to ANOTHER place (closer this time) and get my turnout gear. PHEW! What a mess!

The biggest complicating factor has been I've known nothing about this process when I signed up. If someone had said, "Ok, New Guy, This is what you have to do..." or had at least handed me a to do list on paper, I would have been able to avoid a lot of trouble. I recently saw an email from the assistant chief at my company stating that the "Preceptor" training program has been put back in effect. I guess he did listen to me after all.

Pretty soon now, I'll have that gear and be ready to go! Ah! This waiting for someone else is KILLING me!


Getting Started

Well, This is me. I've decided after 32 years of living, 17 years of working 13 jobs and 5 career fields, that the thing I want to do is be a Paramedic. Join me for the trip. It promises to be quite a ride. First, let me tell you how I got here.

I was working on a computer as a network administrator. It was a mess and everyone wanted it to work very much. There was a lot of stress and pressure. Well, because it was running a Micro(pleasedon'tsuemeforusingyourname)soft operating system, it was giving me fits.

I got up and walked away.

I thought about something else. "If I left right now, would anyone die?"

I came back and fixed the problem.

I went out for a pint.

I had an epiphany:
1. I had been an EMT for a few years with the Reserves and it was one of the best parts of my job. Right.
2. I've seen lots of grody stuff. I've never been grossed out.
3. The last time I panicked, I was 7 and my mother scared the bejeezes out of me. I've had lots of opportunities to do so since but I have not lost my nerve. Not bragging, just a fact.
4. I really, really, really like treating hurt and sick people.
5. I really, really, really hate working in an office 9-5.

I guess I'm going to be a Paramedic.

I have since figured out how to use my veterans benefits, grants, scholarships and help from friends and family to go to a university that offers a 4 year program with a BS in Emergency Health Services and a certification as a Nationally Registered EMT - Paramedic. Yep, I'm a full time student.

I love it.

This is going to be my journal about becoming and being a paramedic. I'm currently an EMT-B and volunteer at a local firehouse/rescue squad. I'm liking it. Let me know what you think with the email link. Check in every now and then. I'm a lot older and much more experienced than most of my fellow students and EMT-Bs. I often see that I have a very different perspective on this stuff than many of my classmates and fellow EMT/Fire Fighters.