First Call in the Kingdom

We get a call for car vs. pedestrian right near the clinic. The caller reports that the victim is dead. Since it's quiet in the ER (no patients), the attending doctor decides to jump on board. The accident has occurred in a small area right outside the compound called "the Village." It's a collection of houses and shops that evolved from a squatters camp many years ago. Some of the houses are pretty nice now and there can be seen a few expensive cars parked here and there.

As nice as some of the houses are, the side streets are still mostly sand and gravel, there's no real street lighting and the one main road that goes through is not lit at all. Some time in the past, speed bumps were put in the road to keep folks from driving their customary 160 Kph through at all times of the day or night. All this means is that most of the drivers swerve off the asphalt onto the hard sand shoulder to go around them, often without slowing down.

This is obviously what our young driver was doing when he was probably quite surprised to find an old Bedouin in his headlights. It's clear he tried to swerve: there's only impact dents on the headlight and fender, but it wasn't enough. I have to literally shove my way through the crowd of men to get to the victim.

The Bedouin is lying in the sand about a meter from his leg. There's no active bleeding from the amputation site. In the lights from the ambulance, the sand around him looks black from his blood. I don't think there's a liter of blood left in his body. His eyes are glassy and fixed, blood and clear fluid (cerebrospinal fluid) are leaking out of both of his ears and his nose. This means that his skull is fractured inside and the fluid from his brain is leaking out of his head. No pulse, no breathing and his chest feels like a bag full of loose blocks from all the broken ribs. The nearest trauma center that might have a hope of helping this guy is at least 90 minutes away and he's busted up worse than a celebrity divorce.

The Doctor looks at me with her eyebrows raised as I check for a pulse. I shake my head.

"Get me a strip." She says casually. She means and EKG showing if there is any electrical cardiac activity. She's looked at the scene and put it together herself. She's not expecting any and neither am I.

I expose his chest to put on the leads and see that he must have tumbled or been dragged. His clothes are full of rocks and sand. In fact, I have to wipe away sand from his skin to get my electrodes to stick. Just as we expected, he's in asystole (Flat line, no heart activity).

Doc and I pack up and leave our bedouin to the care of his family and friends and the driver to the care of the police.

And that, as they say, is that.

Things are very different here.

--maddog

Catching up, Part II

From my previously referenced post:

2. Why I have been radically paranoid about posting anything for the past 2-3 years:

Well, it has to do with my fear of getting in trouble with my employer or with coworkers. You see, I've tried pretty hard to keep my blog anonymous. I've changed the name of the people involved, hidden some patient information and even edited a few photos to remove identifying marks and such. So far, as a simple medic in the big pool of medics out there, it's been pretty effective.

Then I got a job teaching at a university.

The privacy laws there are pretty strong. Also, my school is pretty unique and, I imagined, it would be very easy to figure out who I was and where I was teaching if I was blogging about my experiences there. Which is too bad. There were a TON of funny stories that came out of the classroom, let me tell you. So, you can imagine that I'm already unsure whether I should blog about my experiences at the Alma Mater.  The job is time-consuming enough that I'm not getting out on an ambulance very much but I am teaching, guiding and, in some cases, precepting paramedic students who do. Lot's to write there, like I said.

Then one day, I'm walking down the hall from my office and one of my students walks by and says, "Hey there 'Maddog!'"

He doesn't use my name (Mr. So-and-so). He calls me Maddog. I don't go by that name on a regular basis and I require my students to always use title and last name when addressing anyone on the faculty and staff. Now I'm thinking, "Crap! One of my students is reading my blog!!!! ...and that means they probably are ALL reading it!!!"

This effectively shuts down any blogging I do about that job! It also tells me that I'm not nearly as clever as I think in regards to hiding my identity and such. Now I'm paranoid that everyone is reading what I've written and knows who I am and is furious with me! This paranoia extends to all areas where I'm working and has lingered with me for the past 2.5 years. Only now, with much to write about and the weight of this blog being 6 years old, am I working to overcome that and get more words out to you, my readers.

So, there you have it. I've had some sweet part time jobs in the interim, done some pretty neat calls at the volunteer house but, here again, I've been too paranoid to write about them. My intention when I started this blog was to keep the content focused around my experiences in EMS and related topics however, in the past two and a half years, I've been worried about violating privacy laws and offending people in my EMS world.

All of this leads me to the next item on my list:

3. A discussion about what I intend to do with this blog.

I still want this to be EMS related but, living in another country, there will be a bit more of the "personal crap about maddog" stuff in it. I've got a lot of content already from being here but not a lot of calls. I ran my first actual ambulance call just the other night and I've been here for almost two and a half months (yes, it's slow). Expect to see a comparisons of how EMS is delivered here vs the United States, a few stories about some cool calls and a bit of content about my travels outside work. I still need to work out how I'm going to write a lot of this and keep within the guidelines of my employer. You see, my employer is very clear about how quickly they will fire me if I break their rules of confidentiality and such. I like this job so far and I'm not keen on getting fired. We'll see how it works out.

I encourage my readers (if I have any left) to use the comments function and ask me questions. I'll write about what I think is interesting but let me know what you want to hear about. Thanks for reading!!

--maddog

Catching up...

From my earlier post:


"1. A synopsis of what the heck I've been up to for the past year or so"

In January, 2009, I had been working at the University for about 2 years and had all but made up my mind to leave. I was enjoying the academic life but I was realizing that it really wasn't for me. I didn't leave my job, sell my house and go back to school to be a college professor. I did all that to become a PARAMEDIC. Even though I was teaching students who, I hope, will become some of the best paramedics in the world, my personal practice of medicine was lacking.  Working at the University was a sweet job, however. I was left to schedule and plan my own work. I had summers off, great benefits and all that stuff. It was sweet! However, I did have a lot more administrative crap that I wanted to handle and, when it came right down to it, I wasn't being a paramedic as much as I wanted to.

So I decided to leave.

I still had the rest of the Spring semester to finish working and, thank goodness, have an income, healthcare etc.. You see, Herself and I had a small business, a Yoga studio, that took a hard hit when the US economy dived. We had to close the business and still had a substantial chunk of debt hanging over us. We had burned through much of our savings and, with our income at the current levels, could pay back the debt over time but that didn't leave much for retirement and savings. Now, we could have defaulted, bankrupted, etc.. Many businesses fail and those who invested in or lent the businesses money end up losing too. However, we felt we needed to be true to our principles, we decided to pay back every dime. (No bailout for us!!)

So I needed to make a lot of money.

One option was to get two full-time paramedic jobs. It's possible with offset schedules and a lot of people do it. However, EMS agencies were feeling the economic pinch as well and many weren't hiring new 'medics. Things were looking grim on the home front. I was picking up a lot of part-time work in addition to my time at the university but not enough to sustain us once I left my teaching job.

So I started looking overseas.

With my military background and the current state of affairs in some parts of the world, there were a LOT of opportunities overseas for me. I applied to a plethora of jobs. I had offers to go to Khandahar, Baghdad, Darfur, and other such festive locales, mostly as a paramedic supporting contractor operations. As you can imagine, they offered me a LOT of money and, if I came home alive, I'd be pretty well off.

Meanwhile, in the USA, I'm working at an EMS company that does inter-facility transfers and provides staffing for an ALS chase car in a rural county. I'm having me some fun!!! I'll blog on that later.

Herself and I are preparing ourselves to be apart for a year or more while I go out into the world to seek our fortune. Kinda scary but the money's good. Then an offer pops up that looks really, really sweet! I end up taking a job with an oil company as a paramedic. This company is so big that they own their own hospital and several clinics as well as an EMS agency. They offer me a position in the middle of the desert in a very secure, stable and safe Middle-Eastern country.

Now, pardon me if I'm vague. My employer is pretty clear about releasing specific information about the organization and such. I'm still navigating how I'm going to blog about it and keep within the rules.

I'm offered less money than the high-risk war zone jobs but, Herself gets to join me, the company moves our entire household to a lovely house in a company-owned, company-built town in the middle of the rocky desert. The benefits are AWESOME and things look good.

So, after a summer of paper shuffling, interviews and medical checks, We've sold our house and moved overseas!!! We're now living in a lovely man-made oasis and, it being January at the time of this writing, the weather is LOVELY. (we'll discuss this again in August!).

So, there's the synopsis. Things are very good here. We have a lot of chances to travel. We've bought a 4X4 for desert camping and getting around. We call it the "camel" since it's brown, has a hump on the back (1999 Land Rover Discovery) and gets us across the desert. Work for me is VERY SLOW compared to what I was doing in the U.S.A.. However, the character of the work is very different. More on that later.... I promise!


--maddog

Update in the pipe.

I'm still sorting out the content for this blog and how it has changed. My company is pretty strict about publishing information and I need to be sure I don't step on any toes (least of all, mine!).

Coming up:

1. A synopsis of what the heck I've been up to for the past year or so.

2. Why I have been radically paranoid about posting anything for the past 2-3 years

3. A discussion about what I intend to do with this blog.

4. Why the heck I haven't posted anything cool from the Middle East yet.

Stay tuned!

--maddog

Chillin'

I'm at the big corporate headquarters for training this week. Not much to blog about. If things get slow, I'll try to catch up on some cool stories from back in the USA and more info about life here in the Middle East.

Be well.

--maddog

My little patch of Desert.

Here's where I work:


It's a tiny clinic situated in a small man-made oasis, smack-dab in the middle of the desert, surrounded by pipelines, gas plants and other assorted facilities for oil production. Salt water is de-salinated and pumped in from the Arabian Gulf to provide drinking water, irrigation and such. The place is charming, green, full of songbirds and looks like a little paradise. Now, it exists as a housing and administrative facility supporting all the oil-related operations that are scattered around the desert.


in this little pocket of green is a small clinic. We have an ER of sorts. About 4 regular beds, a "trauma room" and an isolation room. Not much to it. its' staffed by 2 nurses around the clock and the doctors are there from 7 to 4 Saturday Through Wednesday. The weekend is Thursday-Friday here. Typically, we have 2 paramedics on duty at all times, along with a driver. How we deploy those resources is the subject of another post. (Got a bit more research to do on that one before I publish).


So, there we are. In the middle of nowhere. Apparently, the 'Medics average about 15 calls per month! Yah, busy, I know!! HA! The prehospital care unit (my department) exists to provide EMS to the residential community and the outlying work areas at all the various petroleum facilities. We also will respond to auto accidents and other "110" calls in the area. Though there is no national EMS service or even a guarantee of medical care in this country, my company, altruistically, offers care to anyone who calls for it. Things are pretty slow (thank goodness) but I hear that most of what they run are auto accidents. I can see why. Nobody in this country wears seatbelts. Not even for their kids. They go careening down the road, ignoring lanes, directions of traffic and the like. It's chaos! My two hour taxi ride to my new home was an amazing and somewhat harrowing experience. Craziness!.


So, I can imagine a couple of these yahoos going flying along at 160Kph each, ignoring all concepts of traffic regulation, unbelted and then, BAM! Well, you can figure the rest. Nice, eh? I've been on the job for a week and haven't run any of those yet.


I'm not on shift-work yet. They've got me on day hours so I can dash about taking care of all the various paperwork messes that need my attention. Good thing too, I've spent half of each of my workdays running from one office to another figuring out what color my ID badge should be! (that took about 5 days!). Machiavelli would weep! Unfortunately, I was on just such an errand when the ambulance went out on an accident with two patients. DRAT! Oh, well. There's more where that came from!


We've got brand now Ford F-350 ambulances with the standard box on the back along with a hydraulic lift for an isolette in case we transport a sick baby. Odd thing: they only stock ONE Backboard per unit. They also don't have a decent place to park the ambulances inside so, we don't keep any medications on the unit. If we do, the heat will destroy them. We medics have a semi-permanent trailer outside the ER for an office. It's got a couple computers in the office side and another room with a TV, couch, fridge, etc. It's not a bad place to hang out. If that's too boring, one can always go in to the ER and hang out with the nurses. They're a pretty amiable bunch. I'm sure I'll have stories about them soon.


Here's a neat thing: If we get a really sick patient or one that needs to be intubated, the staff call in the paramedics to do that! How cool is that? I write a whole other post on HOW. I kinda want this one to be about the WHERE.


The weather here is pretty nice in November. It gets up to about 90F (32C) in the midday but drops to about 60F (15C) at night. Very breezy and VERY dry! I went for a 5k run the other day and, though I sweated, I wasn't wet. Just coated in a fine film of salt. Like I said, dry! The dry air and regular breeze keeps it feeling pretty nice, even in the heat. Now, I understand it'll get up to 135 degrees Fahrenheit (57C) during the summer months of July and August. UGH! Right now, I'm enjoying the balmy fall into the winter.


More to come!


--maddog

Boots on the ground.

Herself and I have arrived in the Kingdom. We're in temporary housing (read: hotel) at headquarters until we finish orientation and they run us out to our new house in the middle of the desert!

Right now, we're at a mall (Huge!!!) shopping for new iPhones (3GS! Win!).

Stay tuned!

--maddog

Goodbye, My comrades!

I have resigned from my local, hometown, volunteer firehouse in preparation for my move to the Middle East.

Tonight, I went down there to clean out my locker and turn in my keys. My name was still on the board under "EMS Sergeant."

I was feeling cry-prone when I arrived. That pulled a tear or two out of my eye. You see, had I not resigned, tonight would have been my night for duty. I'd have been running with "Skipper," "FirePlug," "Brooklyn," "Peru," "Fester," "WMD," "Squiggy" and the rest of the crew.

Fortunately, when I got there, they were all out on the call. Nobody was there to see me stand in the empty ambulance bay and sniffle.

I get to clean out my lockers and such before anyone gets here. They arrive, having stopped for dinner on the way back from yet another auto accident and promptly settle down to eating. They're not paying too much attention to me other than an occasional "Hi."

Have I already "passed on?" Have I so quickly fallen from being one of them? I'm not sure. The banter is still there. We still bust each other's chops as if I were still a member but, there's a relaxing of authority. I'm no longer "Sarge."

Then the cake. WMD pops out of the chief's office with it and surprises me.

"We'll miss you, Sarge!" in blue frosting.

And a framed picture. Someone thought it was a good idea a few months ago to get a picture of the whole crew in front of the engine. We're all there, in our gear, trying to look proud, mean, tough or just present. It's in a frame and, because I'm the tallest, I'm in the middle. Despite the "tough look" on the faces of these men and women, it really looks to me like I'm surrounded by my family.

I manage to not cry until I get home. Still have leaky eyes as I write this.

Triple Threat, I will miss you all!!!

--maddog

Zoom-Zoom!

I've had my first day on the chase-car. I've being precepted by the lead Field Training Officer (FTO) and the former chief of the organization. No pressure, maddog.

The "chase car" concept is one that works pretty well in a sparsely populated area that doesn't have a big enough tax-base to afford a fully-staffed paramedic-equipped ambulance on every corner. How this rural county works is this: there are several "rescue squads" who provide a slightly higher level of Basic Life Support care. They can do all the things an EMT-B can but are often staffed by people who can start IVs, give fluids and check glucose. This covers at least 50-70 percent of the calls for Advanced LIfe Support (ALS or, me!).

So, you have about 10 rescue squads with a total of 10-15 BLS ambulances covering an area about the size of Manhattan but with the population of, say, one building in downtown (during the business day).

Yes, we have farms.

Yes, we have tractors.

Yes, they roll over. (more on that later)

Now, the ONLY ALS provider around is the one, the only, the maddog!!! I, and my boss, are in an SUV that was built with the oversized engine, tightened suspension and "flashy-light-thingys" that allow us to go really fast and legally break traffic laws. This vehicle is equipped with all the gear, medicines and such that we need to do our ALS job, versus the BLS job that the ambulances do. Oh, did I mention that it goes REALLY FAST??

This is a recipe for FUN!!!!

Preview:

-Trailer Parks!!!

-Diabeetus!!!!!

-Stomach ache? No, Sir, That's your heart dying!

-Jesus Juice!

-Can you breathe through your ears?



Stay tuned!

--maddog

Ch-ch-ch-chaaanges!!

I've got a new job. In 3 weeks, I move to work as a paramedic in the Middle East!

I'm going to have to figure out how to navigate the differen privacy laws and not violate my company's confidentiality policies but, I promise you: THERE WILL BE STORIES!!

--maddog

Paramedic Refresher, Day one!

Oh my!

I'm grabbing a paramedic refresher course about 7 months before my license expires. Typically, I teach in the one that runs about 6 months later but, this year, I likely won't be there. I'll post more about that later when my official offer arrives in the mail. For now, nothing is assured until it's in INK!

So, anyway, there's 18 very experienced and, in some cases, quite jaded, paramedics and me. We're jammed into a classroom and forced to sit and try to stay awake while another paramedic puts up powerpoint slides and reads them to us.

I bravely resist the urge to gouge out my eyes with my Non-Reflective Military Matte Black Cap-O-Matic Space Pen. I'm a brave man. I have control.

Lucky for me, I survive to the end of the class where, wisely, the instructors run a practical, hands-on portion, relevant to the lecture that pained us so much that morning. This is where us 'medics get to actually walk the walk. Everyone's been spouting comments about how they've seen this and they've seen that. Each medic has an opinion on how their particular employer or medical director can do a better job of providing higher quality medical car to their patients. Sure sure sure...

Now, even though we are "treating" a plastic and electronic "patient," all of us have a chance to jump in and DO something or stand back and continue to be the griping critic.

The Scenario: An 8 month old in respiratory arrest. the simulator is actually turning blue and we can actually feel a pulse, however faint. Half the "hotshot" medics in our group stand around and make comments while the other half stammer and look for gear. Someone else jumps in and starts ventilating our infant patient with 100% oxygen. They've become the "team leader" by default but aren't doing much to direct the rest of us. I'm casting about for the next thing to do while the de-facto team leader stammers.  There is an EZ-IO drill.

An IO drill is VERY similar to a cordless drill one would use to make holes in walls in their home. The big difference is this particular battery operated drill is used to put a rigid needle into a long bone like the shin or the arm, in order to quickly and VERY effectively give us medics a way to save someone's life with fluids, drugs and other goodies.  You see, a long bone is a bone such as the femur, humerus or tibia. They play an important part in generating red and white blood cells and, in the terms of a circulatory system, are very much a big, hard blood vessel.

The maddog is a fortunate medic. he's used this tool before. I quickly realize that I'm the ONLY one who's used this tool before, besides the instructor. Our scenario is set in "real time" so that means we are all working this hunk of very realistic plastic as if it were a real baby with real parents and a real life-threatening condition.

I grab the drill and, with smooth precision, choose the correct needle, attach it to the handle, direct an assistant (who has magically appeared from the few medics who are actually INTERESTED in learning something) to spike a bag of fluid and get to work. With the practice and precision that only comes with doing something OVER and OVER again, I perfectly drill a hole into the leg bone of this simulated child, with a special drill/needle that enables me to deliver drugs and fluids.

Somehow, after starting the line, I'm the only one who remembers that an 8-month old in bradycardia gets epinephrine if oxygen doesn't make their heart rate increase. I call it out, and "push" the drug.

The key part of this story is that I'm getting open-mouthed stares of amazement from men and women i've seen time and time before in the field. They know me. They've seen me do my thing yet, somehow, in the atmosphere where we're wearing jeans and performing our skills in the classroom, they fall back and let me run the show.

Now that I think about it, perhaps they've been doing that on every call.......

--maddog

Yep, That's me!

We're floating down a river. It's a bunch of close and dear friends. We're each sitting on little inner tubes and, in a calm spot, the antics ensue.

Some folks are trying to stand on their tiny tubes. at 6 feet 4 inches, and a shallow river, I see this as a dubious task, at best.

Soon, it's, "Maddog, do downward dog!" so, being the amateur yogi that I am, I do my best to execute a Downward Dog (or Adho Mukha Savasana) on my tiny river inner tube. Somehow this inspires many people to great feats of silliness. then the comments start:

"It's pretty shallow. You're going to crack your head!"

"It's OK, Maddog's here. He'll take care of us!"

Ugh! I just want to float down the river

"I'm off-Duty!" I say!

laughter ensues.

........

A few hours later, the same crowd is at dinner. Someone orders a monster steak.

"Holy crap! that's gonna kill me!"

"It's OK, Maddog will save you!"

I'm a few drinks deep. The steak-eater looks at me. I waggle my eyebrows.

"I'll save you, honey." I say.

His girlfriend immediately responds with "Woohooo!!!!"

laughter ensues.

The paramedic? Oh, Yeah, that's me!

--maddog

9/11, Of course, but...

It's good to remember the attacks on 9/11 and we should always honor our heroes who rushed in to respond to the attacks. I certainly do.

...you know, I was going to write something cranky and scathing about how EMS workers are always marginalized and shoved aside to make room for Fire and Police and how the delayed recognition and honoring of the EMS workers lost in the WTC attacks was an example of that but... I find that after 8 years, I don't have that much anger in me anymore. I've become so used to "working behind the scenes" that it doesn't even bother me anymore.

It's time to move forward. FireFighters, Paramedics and Cops. We all protect and serve. I don't need to be a hero. I don't need to be recognized. I'm just happy to have a good job doing what I love.  Eight years ago, we saw what hate, anger and ignorance did to over 3,000 people and their families. There's no room for that in my world anymore.

I know I do good. My patient outcomes speak to that. I move through this world and do my work with compassion and dedication. I know that. I don't need anyone else to tell me.

Get over it, maddog.

He stands up, stretches and looks around the blogsphere.

By the way, It's good to be back!

--maddog

R.O.S.C.

Return Of Spontaneous Circulation!

I'm not dead yet!

My non-bloggable job is at its end!! w00t!

My VERY-Bloggable job(s) are ongoing!!

More to come (I REALLY promise this time!)

--maddog