Friday night found the firehouse busy and bustling. As I mentioned earlier, we have a house we're going to burn down and this weekend is the big "Burn." There were a lot of people around getting things ready for the first burn the next day and a bunch of extra people in the station to cover for staffing. I offered to help where I could but chief was just glad to have me staff the ambulance so he wouldn't have to "punish" somebody by putting them on the ambulance assignment. Fine by me!

2 calls. Nothing as dramatic as last week but good calls in that they completed my required number of runs. I can now be an EMS officer and ride in the front seat! J was in the station this weekend and on both calls and our dinner run, she had me sit up front to get more practice with the maps and radios.

I love it when J drives. She's got the perfect balance of situational awareness and daring that makes her an excellent ambulance driver. We have a medium duty ambulance and it's like a big truck to me. When J is driving, the ambulance dances through traffic, around corners and down the street. Imagine a 350lb football player dancing ballet, and being extremely good at it! It's awesome to see from the front seat.

J had an excellent opportunity to display her driving skill on our first call. 17 month old child, vomiting, trouble breathing. BANG! we're out like a shot! I'm in the front seat and the address is buried in the apartment complex. The ambulance is swerving and flying and my job is to get into the mapbook and figure out how the hell we get there. At first, I think, "How the hell am I going to do this?" This lasted for about 15 seconds until I slipped into "underway mode." I have plotted out complicated navigational courses and fixed out position on a detailed NOAA chart, under a dim red light while riding in a small boat in 4-5 foot seas in a storm. Finding a house on a map in an ambulance is not much different.

Streetname-page reference, find the page, find the street, find the building, memorize the landmarks, give directions. We get there in 2 minutes and 20 seconds. Then we have to run about 75 yards to the entrance to the apartment building and up 3 flights of stairs. Despite her svelte appearance and the fact she quit smoking, J cannot keep up with me. Hell, I run marathons! Dashing to a 3rd floor apartment is nothing. My old buddy S, who rode 3rd on the call, came up last since he had the O2 bag and he's wearing his turnout pants and boots.

Bang on the door, Man opens it and he's holding a toddler who gives me a huge grin as soon as we walk in.

"Sir, is this the sick child you called about?" I ask. J gives the little fellow a poke in the belly for fun and he giggles and twitters.

"Yes." says the father. Mom comes out of the kitchen and I ask if there's anyone else in the house. I see no evidence of pets or dogs. I hate being surprised by pets or extra people. No pets and no other people in the apartment. Just a worried couple with a healthy kid who's gotten a little sick. We try to get vitals but the little guy's all about playing and wiggling around. As J and I check out the little one, his parents visibly de-stress a few notches. They decide not to have us take their son to the ED and we assure them that we'll come running if they call us again. The family is from Africa and I got the feeling they didn't know what to expect when they called 911. The father kept repeating his amazement at how fast we got there.

All told, we were out for 20 minutes and I think that did a lot for that young family's state of mind.

Our second call was a hurt swollen knee, can't walk. J is driving, I'm 2nd and H is in the back. This is the 2nd time this guy's knee has gone out and he remembered J from the last time. (J is pretty hard to forget.) We load him up into a position of comfort and transport him to the ED. He's in a bit of pain but H, the patient and I are joking and having a pretty relaxed time while I get his vitals. H started teasing me about my ability to get a good BP by auscultation in the noisy ambulance.

"I got the skills to pay the bills!" I say as I crank up the Schmack-talk. The patient is right on board with this and by the time we get to the hospital, the 3 of us are joking back and forth like crazy. He's a low priority patient and, of course we have to wait a while in the ED to get him a bed. We aren't the only ones. about 4 other crews arrive with low priority patients, Migrane, split lip, dizziness with good vitals and a frequent flyer, so we have quite a crowd in triage. Outside, at the ambulance dock, there is quite a crowd as well. One of the ambulances has failed to start and is being jumped, blocking all the other ones in the ambulance bay. It's a slow night so, about 10-15 of us end up hanging around, joking, teasing, smoking and just being sociable for about 20 minutes until we can all leave.

It was a good time and the camaraderie that I like so much was definitely there. Of course there was some friendly inter-station rivalry but all in all, it was very agreeable.


The Professor is learning about scene safety and when NOT to act in EMT class:

"In EMT class Monday we talked about scene safety and extrication. There was a lot of squirming in seats as the “rules” were explained to us. Few people in the room got involved in emergency medicine in order to watch from a distance as people need help or to say “that isn’t my job”. But the rules say there are times when that is exactly what we are to do. Person shot with the “actor” still around and no police presence? Wait at a safe distance until the police secure the scene. Truck turns over spilling a caustic on a minivan full of kids with the kids screaming from the burns? Wait at a safe distance until a decontamination team arrives and can deliver your patient to you in a decontaminated state. Even if that means the kids die in the interim? Yes. Really? YES!"

What Maddog has to say about that is this:

There is a certain amount of pride and even arrogance in thinking that we are going to save all of them. If a rescuer gets hurt by placing themselves at unreasonable risk, they do a disservice to the original patients. The other rescuers will place a higher priority on their injured compatriot and the initial victims will be further delayed in the treatment they recieve.

I feel that there is little place for heroics in EMS. What wed do is, by nature, heroic. If we are to consistently provide the best, most thorough care we can, that can only be done by being consistent, thoughtful, careful and intelligent. Calmly and intelligently assessing risk is one of the ways we provide that high level of care to our patients. Failing do do so puts them at risk and belies our purpose.

Go out in a blaze of glory? No, I'd rather die at an old, old age. I can save more patients that way.



OOOH! Trackbacks!

Haloscan has improved their service offerings and I now have trackbacks!

Shotgun victim update:

The patient who suffered the GSW to the abdomen, has survived and is recovering. The charming individual that shot him has been arrested, charged with attempted murder and robbery.

From the press release:

"The victim, a 42 year old [city deleted by maddog] resident, was located, suffering
from an apparent gunshot wound. The victim advised that he was getting out
of his vehicle when he was approached by three suspects, two armed. One of
the suspects demanded money. When the victim stated that he had no money,
one of the suspects shot him with what appeared to be a shotgun. The
suspects then took the victim's cellular telephone and car keys and fled the
scene. The victim was transported by ambulance to [name deleted by maddog]
Hospital for treatment. Approximately an hour later, the [Jurisdiction deleted by maddog]
Police Department were involved in a vehicle pursuit that ended in
the 6300 block of [street and city deleted by maddog] where a suspect in the
robbery/shooting was apprehended and a shotgun recovered."

..and the beat goes on...



Holy furious Medics, Batman!

There is some discussion going on in the EMS blogs that I think everyone, both in EMS and not, should. read.

The Professor and I have a lot in common. We both are relatively new to EMS and come to it late with the perspective and experiences from our "past" lives. We both have a lot of questions about the people who skate by doing the minimum in EMS, and we have our own reasons for doing everything we can. A quote from the Prof rings true with me too:

"My goal is to get the patient to the hospital with as good a prognosis as possible. The thought that I will not know or perform something that is within my scope of practice and that I cost someone the best outcome possible scares the heck out of me."

This is from an entry sparked off, he says, by a comment I made on his blog. I encourage everyone to read it. It presents the perspective of people who recognize the the powerful responsibility we have as EMS providers and gives unspoken credit to the value of all human life. I'm sure many seasoned EMS vets feel the same way. Us newbies are still awed by it enough to put it into words.

The other posting that I think is a necessary read and resonates with me is from The MacMedic. It talks about the parallels that can be drawn in EMS and in the computer-related professions. It rings in me as I come from an IT background and still remain involved in it (I just set up my first Linux server! w00t!).

The ideas I'm pulling from both of these are:

1. Some people are slacking in EMS
2. Some people are dedicated to providing the best care they can at all times.
3. Many of the people in #2 are appalled that people in #1 exist.

I keep coming back to what the head of the USCG EMS school said to my class before we graduated.

"We all hope our mothers, wives, fathers, children, brothers, sisters and friends receive care from an EMT who is at the top of their game. Therefore we are obligated to be sure anyone's mother, father, children, brother, sister or friend has the same when they receive care from us."

Personally, I feel this idea of being the best I can, now and in the future, so strongly, I can't imagine being any other way. If I ever become so jaded that I become a "cracker", it's time to get another job.

One more quote:

"Try not!
Do or do not!
There is no try!"

Wow! I'm getting slammed!

It's almost like getting slashdotted but my blogsite has not gone down! I've gotten over 100 hits this past weekend. That's pretty awesome considering I've only got a total of 412 (at the time of this writing) since January 6th! To be sure, I've been blocking my own pc and IP address from being included in the count so, they're real stats!!

WOW! It's great to know I'm being read!

Thanks, Gang!



Looking back on my call last Friday night, I'm wondering if I could have done some things better.

We loaded the patient almost right away. In retrospect, I was thinking that perhaps I should have put a good dressing on his abdominal wound and stabilized that before we moved him. As it was, his intestines were coming out bit by bit from the movement in the ambulance. Perhaps the dressing would not have prevented that but, it would have kept the bleeding under more control. It just seems to me that I should have stabilized his wound before we did the ol' "load and go."

Mind you, I was by no mean the only EMT there and certainly not the most "senior." The patient was lying between two parked cars and surrounded by a knot of people. I would have needed to be really bossy but, I keep thinking, "Patient first."

Should I have been more assertive? Should I have had the FFs who were standing around give me some lighting and then just gone ahead, cut off the clothes, assessed, dressed, gotten a baseline and then loaded? I don't think the delay would have created too much worsening of the patient's condition. Our transport time from the scene to Trauma, including rendezvous with the Medics, was only 10 minutes.

On the other hand, our not doing all that didn't seem to affect his condition much either. Trauma was ready for us and they took over the minute we got him in the door.


I suppose I should have treated him on scene a bit more. I didn't know how long we might have been delayed in transit or if there would be any further complications. If the evisceration was properly dressed, he would have been better protected from all the movement of the ambulance and if he had become even more combative, it might have prevented some further injury.

You more senior medics who read this: What do you think?

...hours of mind numbing boredom, punctuated by minutes of mind-frying excitement....

It was a beautiful Friday afternoon. I thought if I got to the Firehouse early, I would get some calls in. I need about 7 more before I can sit in the front of the ambulance as EMS officer. Let me tell you, the fine citizens of the greater Anonymousville metropolitan area had a very safety-minded healthy day. The ambulance sat in the station.


Not really. Someone donated a house that is going to be torn down to our Firehouse to train in and, eventually, burn down. The squad and Truck headed over there for some firefighter training in rescue and recovery. J and I headed along in the ambulance with the Assistant Chief giving me his blessing to ride officer to the house. J and I weren't directly involved in the exercise but we did get some training done. We went over ambulance placement at the scene, radio protocols and usage at a fire scene and the whole communication process for the jurisdiction. At one point, a team of firefighters came out of the smoky house with a "baby." It was just a child size wad of sheets and medical tape with a splint for the arms.

"We found a baby!" McV said as he lumbered out of the building. "EMS, Here you go!" and the threw the "baby" at my feet.

Ah! I got to be in the drill. Fun!

Not much notable at the drill other than some of the more senior FF's from my station and a neighboring station kept looking over at me and smirking as they talked among themselves. Must be the "EMS only" helmet or the clean turnout gear. Ah well.

So, back at the station, with NOTHING going on. 2300 comes and goes and I'm still sitting there, watching some show on cable about building custom motorcycles. One of the FFs is a mechanic and bike enthusiast. It's kind of neat to see the creative process and to hear his well informed opinions on the bikes.

So at 20 minutes after midnight, I'm contemplating heading home when the call comes for the squad and the ambulance. Shooting, right around the corner in the low income housing complex. PD on scene.


B is driving and my old pal, S, is riding officer. The Squad is out ahead of us and when we arrive on scene, they're out first. About 5 police officers are there spaced out around the area. "Is the shooter in custody?" I ask the nearest one. With his eyes still scanning the nearby apartments and cars, he shakes his head. "Ok, Maddog, keep your eyes open." I say to myself.

There's a knot of firefighters over by a car. S and I get over there with our bags and we can't see anything. Big McV is there and I tell him to shine his light on the patient. Yep, evisceration. His intestines are sticking out and he's seeping blood. He's conscious and waving his arms and crying as we get to him. Big McV says, "I'm out....I can't do this, and hurries away"

Backboard, stretcher, ambo, dressing on the bowels, fighting with the patient, "I'm going to die!", "Not, yet, mister, not yet." O2 via non-rebreather at 15Lpm, blood on his head, check for other wounds. Nicks from birdshot. Birdshot?? DAMN! WTF? I suppose he's lucky, if it had been 00 buck shot, he'd have been a lot worse off. 00 buck shot is 9 .30 caliber lead balls in a 3" shell. OW!

Medics meet en route. All business. 3 EMTs trying to control the patient (H hopped in with me and S) and get vitals, 2 Medics trying to start IVs and keep from getting pinched. One of the medics has got the patient's hand squeezed between his thighs while he starts an IV. He winces and says, "DON'T PINCH ME!" but he doesn't flinch and he get the IV started.

This guy is cool as a cucumber!

No chance of a bp, I manage a pulse via SAO2 meter but he keeps flinging it off before I can get an O2 reading. Lung sounds? Well, He's doing a lot of yelling, "I'm dying! I'm going to die! Call my wife! He shot me!"

I'm at his head and I'm trying to keep him occupied. S is by the side that's open and he's trying to keep his guts from spilling out of the dressing all over the floor of the ambulance. at one point, we shift the strap of the cot so it doesn't slice his intestine. H is holding the IV bag (for some reason we have no IV hooks in our ambulance) and between the 3 of us, we're actually managing to cut his clothes off. I get a C-collar on the patient and we strap his knees together to keep him from kicking so much. This also take a lot of pressure off his abdomen.

"I'm dying, I'm dying!"

"Not if I can help it! Look at me" He opens his eyes. "What's your name?"


"Charles, My name is [****] and my job is to keep you alive, OK?"


He settles down a bit.

In fact a bit too much. He's fading in and out so, I start asking him questions. The other medic wants to know if it really was a shotgun blast and I ask the patient, "Did you see the man who shot you?"


"Did he shoot you with a pistol or a long gun?"

"Long gun. I'm going to die!"

I look at the medic who asked the question, "He's got some birdshot in his ear, looks like a shotgun to me." She shrugs and goes to work on the dressing as best she can.

At trauma, we leave a trail of blood all the way through the ER. I suppose we could have dressed the wound better, gotten it enveloped in a neat dressing like you see in the Brady book but, it was load and go. The FFs who got there first had already started loading him before S and I had a chance to do anything. It seemed to me they were just anxious to get him out of there. He's not spurting blood, just seeping everywhere. drip, drip drip.

Trauma ER is awesome. Everyone's on the ball and the patient is in OR by the time we get to decontamination with the stretcher. WHEW!

Lots of talking and reviewing the incident while we clean blood off of everything. On the way back we stop at an all night convenience store near the university. It's full of half-drunk, rowdy college kids. They don't make eye contact with us in our uniforms.

I look at them all, collectively and individually.

Big bags of blood.


So am I.

All of a sudden, all these kids, these annoying, drunk, well-fed obnoxious kids are so precious to me. I suddenly cherish every single person I see. The feeling stays with me. It's still with me 12 hours later. On the ride back to the firehouse, I can see the pulse in H's neck as she turns to talk to S and H in the front. Keep beating, heart, keep beating. We get to the firehouse and it's full of wired Firefighters. They're playing video games and trying to eat the pizza that was warming when we left on the call. It's a room full of vibrant life. Blood, bone, muscle, guts. I can't shake this feeling of cherishing every living person I see.

It's not a crazy feeling. I don't feel fear that each person can be hurt or killed or fall ill. Nor do I feel I have to protect each one. I just feel like the life in each thing is so precious to me. It feels good.

I love this.


Shotgun wound to the abdomen. Cops standing around. Partial evisceration (guts hanging out). Firefighters getting sick. I love this stuff!

More details after I get some sleep.


More fire vs. EMS junk.

Ok, So Fairfax County, VA is losing too many Paramedics and can't keep everything staffed. There's an article here about it. The really telling part and what gets me fired up is contained in this quote from Michael Mohler, the president of the local Firefighter and Medics Union:

  'Mr. Mohler says paramedics' concerns have been ignored for a decade because the department is focused on fire suppression, even though medics respond to more calls than do firefighters.
    According to the department's Web site (www.co.fairfax.va.us/fire/general/overview.htm), firefighters responded to 21,740 fires in the past fiscal year, and emergency medical services personnel responded to 60,306 medical emergencies.
    "If you look at the upper management, the emphasis on our system has always been on the fire side. It's that mind-set that we have that's responsible for this neglect," Mr. Mohler said.'

Yet again, the FD is taking money, and attention from EMS. This is not so much a problem unless you consider that EMS provides life saving services primarily and FD provides property saving services, primarily. Sure, sure, they do rescue and recover of people and that's where I think FDs should be moving. That, in my opinion, is a more urgent need than breaking windows and throwing ladders.

Now, don't get me wrong. There is a definite need for fire suppression. There are still fires that, if left unchecked, would devastate huge areas and destroy people's lives. There's no doubt that fire continues to be a very real hazard. My point is that it is considerably less and better managed that in was 50 years ago. Yet we continue to fund FDs as if the threat was just a great. It's as if there is still this fanatical emphasis on fighting fires and all the world will end if we don't stop funding those brave men and women who brave the flames of hell to save our homes.

Why can't we see the same emphasis on the men and women who brave disease, infection, physical harm, emotional trauma and more to save our bodies and lives. Often they reverse the seemingly inevitable onset of death, they protect people from the consequences of their own stupidity and bad choices and they save people from the consequences of OTHER people's bad decisions.

Why are medics and EMTs so marginalized by the public? Is it because people don't want to think of the icky stuff of EMS? Is it our society's aversion to death? Is it because things don't blow up when we do our job? It's not as "Hollywood" as fire?

I want to know what you think. Why is EMS seen as so much less heroic than fire? Go for it. Slam my comments link!

More blogs:

I've added quite a few links to other medical or EMS-oriented blogs over there to the right. I have to say I have been surprised at the large number of the blogs. It makes me wonder about how they help people decompress. When I read blogs like MacMedic's, I see some of that happening. Especially after some of the more difficult calls. Strangely, I feel like I get to share in some of that when I read it. In the Coast Guard, Critical Incident Stress Management is widely used. After any traumatic or particularly violent action, we go through a critical incident stress debriefing where we sit with some peers and just talk it down. There's no critique, it's totally confidential and nothing is recorded. As someone who's been through the process several times, I have to say I appreciate the results. I think this post-incident blogging has a similar effect.

Aside from the emotional aspect, I really enjoy hearing about clinical cases from the perspective of the medic or EMT. This let's me see a bit of what is going on in the brain pan when all the stuff's going on. I'm kind of isolated at my FD as someone who isn't interested in Fire Fighting so much and doesn't think patients are a waste of time. It's always nice to hear from and read about others who appreciate EMS as much (if not more) as I do.

The other thing that has surprised me and most pleasantly, is the amount of communication that occurs between all these blogging EMT providers. I've been getting traffic and comments from others and I greatly, greatly appreciate it. It has kept me motivated to keep writing. Even when I should be studying (like now, eep!). Thank you all for the links, comments and support. Keep it coming. I will too.



Well, I'm now officially an EMT-B in my jurisdiction. I've been a NREMT-B (Nationally Registered Emergency Medical Technician - Basic) for about 2.5 years now but, I have to be approved by my jurisdiction in order to do my thing here.

It involved going to 24 hours of classes and then taking a 100 question test. No sweat, really except for the scheduling, getting the right signatures, driving to an office 72 miles away because they "lost" my paperwork, and on and on.

School has made it difficult for me to continue to stand duty on Tuesday nights so, I'm trying out Friday nights. My rationale is that I'm more likely to get more calls and being at the firehouse will keep me from going out and wasting my money on loose women and expensive beer. Actually, being broke keeps me from doing that but you get the idea.

So last night was my first night as an EMT-B at the station and my first Friday night. It was rainy and cold but too warm for ice. That didn't stop some people from banging their cars together, let me tell you! We have a length of a major interstate highway in our first due that is always full of traffic, especially so at rush hour. I was surprised that we didn't get any calls for there. The accident was from the next area over from us. Dispatch called for a total of 3 BLS units to respond. This was sounding to me like a lot of people that weren't severely hurt. No rescue squad called for so, no car cutting. JS was driving, MR was riding officer and little old me in the back.

I was riding 3rd on our Ambulance. I'm going to have to do that for 10 rides and learn how to use the radios, etc., before I can be designated as an EMS Officer and ride in the front seat. Now that I'm an EMT in our jurisdiction, I can start working on that.

We arrive on scene as the 2nd ambulance. A firefighter begins to give us the lowdown on the patient we're to transport: Standing with a c-collar, complaining of back pains, doesn't speak english, yada yada, when a bystander hands a 2 year old boy to the driver, JS. She comes around to the back of the ambulance. I put away the backboard and go for the child seat. Just then Dad shows up. He's got a 4X4 stuck to the side of his head where it's bleeding and he's gripping his upper right chest. He's also calm, talking and oriented. Me, I'm starting to get confused. Ok, now we have different patients. I see the one with the C-collar holding his back and talking to a police officer. Just then the 3rd BLS unit arrives and I focus on the patients I have on hand.

The 2 year old, we'll call him Jr., Is doing fine. He's quiet, alert and keeps looking at Dad. Dad, speaks English, has pain in his chest but it's not migrating and his breath is fine. Airbags deployed and he was wearing his seatbelt. He tells me it hurts to take a deep breath but the line of his pain follows the line of the shoulder harness of the driver's position.

"Were you driving, sir?"


Dad: SO2 is 98%, P 80, strong and steady, Skin dry and warm, alert and oriented X3. We get them into the ambo and start rolling. MR starts assessing Jr: No guardin (that's where a child tries to protect an area that hurts them). He was in his car seat at the time of the accident, Dad tells us. I grab a small stuffed raccoon from the store of critters we keep in the ambulance. Jr locks onto this and Dad is almost delighted. He's talking to Jr. and showing obvious affection and concern.

Both patients transfer well to the hospital. No major worries. The whole way to the hospital, they guy's alternating between talking to his son and calling people on his cellphone. His voice was soft and measured. Very calm but still concerned. We transferred him and his son to the ED pretty quickly and when we came out, the ambulance transporting his wife had arrived. The cool thing was the ambulance was met by a HUGE gaggle of family. She was walking and got out of the ambulance herself. The family quietly gathered around and helped her out. They enveloped her and brought her into the ER. The EMT's just followed with their clipboard. Oh boy!

Ok. More later. Had another patient that night but I haven't had time to write. I'd rather publish often. Keep the comments coming! I'm so delighted that I'm being read!



I dropped in an older posting that I hadn't published. It's down there with the January 21st date.

More coming soon! I had a semi-busy night last night but don't have the time yet to write it up. Also, stay tuned for thoughts on school, discussions of different health care positions, fire department rantings and much, much more!!!



Sorry about the silence. School has started again and I'm in desperate need of a root canal (OW!).
I've got a few posts that I'll put up very soon. Stay tuned, all.