Pretty Lucky Guy

His name is Ali and, according to the ER doctor, he's a pretty lucky guy. I have to agree. 

We got called to an accident down the road. About 20 minutes later, we arrive at a crest in the road, made notable in the moonless night by the collection of cars and police lights. 

About 30 to 50 meters off the road away is a bashed up compact car resting in the rocky sand. Our patient is the driver and he's secured to a backboard in a Red Crescent Society ambulance. 

Here's a wierd bit: since the patient is an employee of my parent company the Red Crescent Ambulance waited on scene for about 10 to 15 minutes for us to arrive and take the patient to our company hospital which happens to be a few kilometers from their base. 

Oh well. That's how thing are done over here. 

The Red Crescent ambulances around here are staffed and equipped at a very basic level. Some have the ability to start IVs, administer glucose checks and give nebulizer treatments but that's about as advanced as they get. The Red Crescent guys had secured my patient to a backboard but hadn't secured his head, applied a cervical collar, conducted any examination or even taken vitals. They pulled their stretcher out as we approached with ours and I had to wade through the typical crowd of well-meaning but dangerous bystanders grabbing, pulling and trying to "help."

The Red Crescent guys don't speak English and my Arabic is not much more advanced beyond "Yes, no, thanks, hello," and "Where do you have pain?" but I immediately see that they want to lift the patient off their backboard and onto ours. I use a little pantomime, make eye contact, smile and then grab each of their hands and out them where they should be for a proper logroll. They get it right away and we do it by the numbers. It's neat to see that common training show up even across such wide gaps in culture and geography. 

In short order, we get Ali transferred to my backboard and cot. I quickly move him into the ambulance so the nurse and I have room to work without being crowded by the bystanders, onlookers, police and anyone else. The nurse I'm working with this night, a strong-willed, unflappable and solidly competent Jordanian woman, makes the call to take this patient to our company clinic in the nearby city instead of our tiny "camp" clinic. I think she realizes that there is an emergency physician on duty at the city clinic and only a general practitioner on call at our "camp" clinic. 

I do my assessment en-route and find that he's got a painful left hip but no shortening or rotation of the leg. This would indicate a break in the thigh or dislocation or break in the hip where it meets the pelvis. His thighs are pain-free when I push on them and his pelvis is stable. All the rest of him is fine. No signs of head trauma, lungs are good and clear, extremities are intact and give good pulses and motor/sensory response. All his vitals are fine. The only thing is this hip pain and the fact that he doesn't remember a big chunk of the accident. I wrap a folded sheet around the upper part of his thighs and tighten it like a band. This produces immediate relief from his pain. Other than an IV and monitoring, that's about all I can do for the guy until we get to the hospital. 

From what Ali tells us, he went off the road, not wearing a seatbelt, and rolled "many, many times." During all this rolling he said he "went out the window" and landed in the sand. So, we're looking at the unbelted driver of a car involved in a multiple rollover with ejection. All he's got is a painful hip and a few cuts on his hand and thigh. 

Yep, he's a pretty lucky guy. 

--maddog

These hands

There are times when I look down and see my hands. Yes. Of course. We all see our own hands all the time, but there are times when I see them.

My fingers are pretty long. Sometimes I think they're too long to be "manly."

My fingernails grow too fast. I want short, unobtrusive nails that don't look shiny or pretty. However, they just grow that way (and fast!).

"Clip...clip...clip...,clipclipclip"

Herself tells me that my hands are big and strong and make her feel safe. When she's not there: I don't see that.

What I see is my hands being wrong for what I want them to be.

I want my hands to be strong, every time. I want my hands to do the perfect thing, every time. I want my hands to be absolutely and perfectly "right on" every moment they touch someone.

Every time I touch a patient, I question that. It doesn't matter how well I do my job. It doesn't matter how well (or poorly) my patient ends up. I will always look at my hands as if they belong to someone else.

This is the worm of doubt. 

How did I do that?

Did I do that right?

Are these my hands?

--maddog

"And so I reach out my hand, and he grabs it"

This guy is a 'medic. And this post is a clear indication that he's a GOOD medic.

"What's a good medic?" You ask?

Well, that answer is complex, nuanced and full of opinion. I ain't ready to fight that battle in the blogsphere yet.

However:

All of us paramedics get the same training, to a point. We all have to pass the same (or similar) test to be blessed as a paramedic. There are folks who will argue the contrary but, please, for the sake of my posting, let's assume my statement is true. I'm sure I'll get a bajillion comments when I finally do post on what makes a "good 'medic" but today, I want to talk about one thing that makes this guy a "good medic."

Some of the best in our profession don't try to be doctors. We don't try to be nurses. We recognize that this is what we do and we put effort into doing it better and into improving the efforts of those who come after us. There's a lot to be said for being a paramedic. There's a bit more to be said for being a good paramedic. There are volumes to be told for being a great paramedic.

What is "that thing?" What is the one thing (if we can condense it down that much) that makes the difference between a paramedic and a "good" or, even, "great" paramedic?"

The short answer for me is, "I don't know."

But I do know what I've seen in the paramedics, EMTs, Firefighters, Cops and public servants that I've met in my job.

We care.



When we do our job, no matter how busy our county/system/service/company is, we treat one patient at a time.

When we have the privilege to treat them, they are the ONLY patient we've ever seen and ever will. It's the zen, hokagare, samurai way, or whatever you choose to call it, but it's what paramedics do. We are called upon to consistently deliver the compassion, care and individual feeling that makes that difference. Everyone who needs a paramedic becomes a member of our family. Some of us want to do well. Some of us are just tired of the dying and killing and some of us, honestly, want to really, REALLY, help.

When the public (yes, you!) see us. You are at your worst. That only challenges us, further, to be at our best.

Nobody is a 'medic for the money.

Nobody is a 'medic for the groupies.

We do it (and keep doing it) because we care.

This guy? I hope someone like him comes to my house when I have to make "the call."

--maddog

Resistance is Futile!

Let's talk a little about combative patients:

A combative patient is one that fights treatment or control. This can happen for a variety of reasons. When we talk about combative patients in EMS, typically, we're talking about folks who have a brain injury or are hypoxic (brain's starving for oxygen) and they start flailing about. You see, when the brain's in trouble, i.e. starved for oxygen, the body kind of goes into "freak out" mode and starts lashing around in an attempt to somehow correct its oxygen starved state. When you're the paramedic in a small box that's moving down the bumpy road at high speed with said combative patient, this is what is sarcastically referred to as, "fun."

Now, there are patients that are combative because of a physical injury. Then there are patients who are combative due to a chemical insult (too much booze, pills, or whatever they ingested, snorted or shot up) and then there are patients who are combative just because they're ornery! Yep. The injured a**hole. Now, technically, we shouldn't refer to these patients as "combative." That term is usually reserved for folks who do not possess the ability to make an informed mental decision and we've got to fight 'em for their own good. The very reasons they are in such a combative state also usually alters their mental faculties so that they can't give or withhold their permission for treatment. That's when we get "implied consent." and proceed to do the things necessary (we hope) to save their lives, etc..

Now, let's go  back to the ornery ones:

Some folks are just a pain in the butt. They get themselves all banged up, cut up, sick or otherwise in a bad way. Not enough to alter their mental state, mind you, but enough so that someone calls for a paramedic and they actually need some treatment. But they get stubborn and it's a constant argument to get them to let us do the simplest things. For example, I had a patient a while back who had an unfortunate meeting with his lawnmower. This 80-year old gentleman got tired of waiting for, "them darn kids" to show up and cut his grass that he went out, sandals and all, to do it himself. Well, needless to say, the mower somehow rolled back and he's a bit stubbier on his left foot than his right as a result.

We arrive, find him bleeding  a bit, uncomfortable, furious, ornery and in full possession of his mental faculties. No, he doesn't want us to take him to the hospital. No, he won't let us bandage his foot. No, we can't start an IV and hook up the monitor. Who cares how many cardiac medications he takes, "I ain't goin!" All the while he's swatting at my partner and I when we get close, waving his arms around and being a pain.

In the time It took his wife, daughter, my partner and I to convince him to let us treat and transport him, I could have driven him back and forth to the hospital 4 or 5 times. Yes, I could have taken a refusal from him but I would have been back later when he finally gorks out! This happens more often than I'd like in the USA.

Now I'm over here in the Kingdom and there are a lot of differences. I don't see as many drunk, high or chemically altered patients as I did in the USA. I know they exist in the Kingdom but not where I practice, I guess. I also expected a lot more distrust and even open hostility to my white face and lack of Arabic language skill from many of my patients. However, that's just not so.

The men who have fallen under my care seem to be in one of two states: Dramatic flailing, wailing and hollering over the tragedy and pain or completely limp as if they had swooned. Usually, if they're in the first state, they quickly swoon with a melodramatic sigh as soon as a medical person shows up. I'm always so surprised at how uncomplainingly they put up with any of my treatments. A patient may cry out at an IV stick, sure, but he usually doesn't pull back, strike out or otherwise act "ornery." It seems to me that, once medical help is perceived to be on scene, the patient just gives all into Allah's hands and sighs all the way to the hospital. After fighting ornery, bloody lawn-mowing 80-year olds, It's a nice change!


I haven't had any Arabic women patients. Usually, they are brought in by their husbands to the ER directly. I'm sure if I ever do have an encounter with a female patient over here, It'll be seriously blog-worthy!

--maddog