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

Blogmeet and Blog Move

The blogmeet went awesome! More to come on that.

I'm also struggling with the move from blogger to wordpress. I've successfully moved my blog entries from one platform to the next but moving the comments is a bit of a pain and Wordpress.com won't let me modify the templates at all to insert any code. I've been pretty happy with Haloscan for the comments and don't really want to change.

Fooey!

Any ideas?

Epijunky, you're hosting your own. Any guidance (I'm clueless!)?

Here's my current rundown:

Blogger:

Pros:
Control over the template
Haloscan works
Cons:
No native iPhone blogging tool
Interface is clumsy

Wordpress:

Pros:
More tools and widgets
It's Pretty!
Native iPhone blogging tool
Cons:
Have to use the native commenting tool (all require moderator approval!)
Cannot change template
may be a size limit (saw $$ for more space advertised in there)

Any input?

--maddog

Blogmeet: It's ON!!!

Ok, Kids, Here's the deal:

Let's have a blogmeet at The Nest. It's a bar right across the street from the convention center in Baltimore. They have a downstairs bar and eating area, Pool and games on the 2nd floor and a martini-bar style lounge on the 3rd floor.

I'll be there, and, depending on how many people show up, we'll be at the bar, in one of the upstairs zones. We'll do this on Saturday, March 28th at 4pm. The last conference session ends at 4pm and the exhibit hall closes at 3. We'll make it a happy-hour style event and we can move on from there as needed.

Sound good?

Here's the details in short:

WHAT: EMS Blogger Meetup!
WHEN: Saturday, March 28th at 4:00pm
WHERE: The Nest, 200 W Pratt St. Right across from the convention Center
WHO: EMS Bloggers, Faithful Readers, Groupies, YOU!!!!!
WHY: Why Not!!!???


I'll be there early. If you want to find me, I'll be wearing this hat:




Post Comments or Email me if you have questions.

--maddog

EMS Today Conference (Blogger Meetup?)

EMS Today is coming up in March.

I'll be there.

WIll anyone else?

Wanna have a Blogmeet?

Hit the commments or email me

--maddog

iPhone blogging test.

I'm not dead. Just finding Blogger to be less and less convenient. If anyone has experiences with Wordpress, specifically importing from Blogger, give me a holler!

--maddog

Little Bodies

I sit on the floor of my living room. I make a circle with my legs and my dog finds his way there. He curls up and seems contented to be surrounded by "the boy." My hands find their way from his head to his hips and I feel his story along the way.

He is young, strong and fit. I can tell this from the shape of him. He is not a big dog, however. One of my hands covers his whole head. He's a burly boy but compact. If I reach, I can place my hands all the way around his chest. My thumbs meet in the middle.

Dogs are not people but, right away, I'm taken back.

My fingers meet between the shoulder blades and my thumbs are on the top of the sternum.

No person should be this small.

I squeeze and shove with my thumbs (We call this "chest compressions")

No person should be this small.

I am simultaneously squeezing and carrying this child.

Blue.

Floppy.

We push air in. We move the blood around. We do it all perfectly.

We know.

It is still exquisitely painful....for everyone.

Nobody should be this small.

--maddog

"Big truck...big truck...there you are"

(This one is for my friends, Elvis and Koehler......)

I'm rolling down the road.

I'm not driving a 16,000 lb ambulance. I'm driving my "compact" station wagon. I'm on my way home from work, not on my way to a call.

Big truck, big truck, there you are...

I see you. I rely on you. You move the way a professional (like me) should. You see ahead by 1/2 a mile and move your lane to make your exit.

I see that.

I drop back to let you in.

I know. I'm just a "four-wheeler." I'm part of the problem.

Last week, it was a "four-wheeler" who put herself between you and safety. You put on your brakes and grabbed that wheel like it was the end of the world.

You were in the berm. Soft grass and a gentle shoulder saved you. (along with your seatbelt).

The "four wheeler" had no idea of the chaos she caused with her thoughtlessness. I'm sure she/he was on the phone/checking email/texting. It doesn't matter. The end result is the same.

You, who's income is affected by your safety record, are in a ditch. You did that to save someone's life.

The driver of the "four wheeler?" She (he) had no idea. He did not even hang up the phone.

I check you out. YOU know you're ok. But I do my job (Heart rate, Blood Pressure, Breathing effort and a good sense of "what's wrong"). Your beloved rig is on its side next to the highway and there are things broken beyond what you and I can fix.

Yeah, You're OK. Shaken, angry and ready for a loooooooonnnngggg vacation but, to me, you're OK.

48 hours later, I'm driving my little station wagon home from work....

"...Big Truck, big truck...there you are...."

Yes, you can come into my lane.

Yes, I'll slow down to let you pass.

Yes, I'm not a "big truck" driver, but, somehow...I understand.

My car has four wheels but I'll never want to be a "four-wheeler."

"big truck....big truck....there you are...."

--maddog

Alive:Improved?????

We get ANOTHER call for trouble breathing. This one is to an apartment complex that caters to people who are just barely this side of needing "assisted living."

We've gone there so much that we have a key to the front door on the ambulance as our standard equipment.

We arrive to the 3rd floor apartment to find a woman who is 84 years old, up on her feet, agitated and talking like this:

"I"
GASP
"am"
GASP
"Having"
GASP
"trouble"
GASP
"catching"
GASP
"my"
GASP
"breath"
GASP, WHEEZE GASP

Get it?

I ask her about previous medical history (Heart disease, lung disease, diabetes, hypertension,etc.) and get a "no" at every single one.

She is house proud and wants to jump up out of her seat to open every door, move every piece of furniture, show us every thing every time we move. Over and over again, I ask her to, "Ma'am, PLEASE! Sit down and be still!!" after I've given her 15 liters per minute of oxygen.

Finally, while I'm struggling to fit our large cot into her tiny apartment, She jumps out of her seat! I have to use my 'Cop Voice',

"SIDDOWN! DO NOT MOVE STAY RIGHT THERE!!!" (I'm doing my best to scowl) "You! (I actually point at her) stay right there and let me do my work, OK??"

This earns me a meek nod from my patient as she hungrily sucks on the oxygen mask as if it were water and she was 5 days in the desert.

On the cot, out the door (keys, alarm, etc) into the elevator and into the back of the ambulance. Go, go, go!

I can't really figure out how an 84-year-old woman with NO previous medical history is having this problem just out of the blue at 3:00 am on a Saturday morning.

Until someone knocks on the door of my ambulance.

Now, you must understand that I get this all the time. Curious (Nosy) neighbors who are concerned for the welfare of their friends (Morbidly curious about who's dying before them) are always ready to ask me all kinds of impertinent questions.

I'm ready for this when I find my patient's daughter with a leather-bound book that contains all her mother's medications, medical history and allergies. It turns out our 84-year-old patient has had atrial fibrillation for the past 10 years, Hypertension (high blood pressure) and a whole bunch of other problems for just as long.

"Did you take all your pills today?" I later ask "Mom".

"Pills???" She replies.

Right! Ok! She gets the full work-up. Nowhere in the history I got from the daughter do I read anything about dementia or Alzheimer's disease but I'm trained to presume the worst.

Her Blood pressure is 200/104 (WOW!) and her 12-lead shows the early signs of an inferior MI (this means that the bottom part of the heart is sick and not getting enough blood/oxygen, etc and is not doing its job).

She's NOT complaining of any chest pain but the vague inferior MI signs lead a cautious medic to go above and beyond. We perform a 15-lead (for those of you who have been to a Bob Page seminar, it's V4R, V5-V8 and V6-V9) you all know that a right-sided MI (a sickness or oxygen/blood starvation of the RIGHT side of the heart) is a bad, bad thing. Even more so because we are not regularly taught to diagnose and treat this kind of sickness as a regular part of our training.

(Simply put, the right side of the heart takes blood from the body and pumps it to the lungs so it can dump all the Carbon Dioxide it acquired from the rest of you and trade it off for Oxygen the rest of you needs to keep doing whatever it is that you do!)

The 15-lead shows a very slight deficit (infarct) there. Cardiologists look for at least 2mm of S to T wave segment elevation to tell them that the patient is really sick. I only see 1mm of S-T elevation but she's not hurting yet.

*In my head to myself: "do we have to wait until it's a FULL-ON heart attack before we decide to transport/treat them for a heart attack??*

We give her oxygen, aspirin and not much else as she's not complaining of any pain. Her trouble breathing is still there but she can now talk to us 5-8 words at a time between breaths. When I listen to her lungs, I can hear nothing but good, clean air moving back and forth. If I heard the sound of crackling cellphane or the crinkling of fine paper, that would tell me that her lungs are filling up with fluid, most likely due to congestive heart failure.

I was somewhat disappointed to hear clean/clear lung sounds. A case of pulmonary edema with congestive heart failure is one of those things we can treat really quickly and effectively if we catch it in time. However, things are never this easy!

We decide to go to a cardiac center (clearly, it's a cardiac event!) and we call 'em up by radio.

I've been spoiled. I'm used to talking to Emergency Medicine doctors. They value the opinions and judgement of Paramedics. They know when we speak of a patient who is "combative," for example, we actually mean, "She's drunk, bashed-up, possibly brain-injured but DEFINITELY beating me up and I'm ALL BY MYSELF in the back of this ambulance for the next 10-20 minutes so, PLEASE, give me permission to sedate them to a state of mutual happiness right NOW!

This time, I spoke to a cardiologist.

No fault on them. None at all. However, I think this cardiologist has become too accustomed to working in a hospital or Emergency Department where she has an unlimited number of ER techs, Phlebotomitst, Respiratory Techs, Nurses, Radiologists, Interns and other help at a moment's notice.

In the back of the box? It's me, the scared paramedic intern and the confident, capable EMT-B. And, THAT'S IT!!!

"Give your patient 0.4 to 1.2 milligrams of nitroglycerine (NTG) and monitor vitals" says the cardiologist.

I know. I know that if my patient is truly having a failure of the right side of her heart, she's deader than a doornail not 20 seconds after I give her this medication.

"Roger, [Cardiac Center], I understand your orders per [Doctor So-and-so] for 0.4 to 1.2mg of NTG, however, I must impress upon you that this Medic believes the patient may be suffering an inferior/right sided Myocardial Infarction and NTG may be detrimental to the patient outcome." is what I say over the (recorded) radio.

"understood, Medic XXX. Please administer 0.4 to 1.2mg of NTG, Sub-lingual and report any changes."

"Roger, [Cardiac Center]. 0.4 to 1.2mg NTG as per [Doctor So-and-So], please confirm spelling of doctor's name. "

"Medic XXX, [Doctor So-and-so (spelled out)] authorizes 0.4mg of NTG. Please consult and advise if any changes or if you need orders for further administration."

OK! Now the Cardiologist has had time to refer to her (his?) drug reference and brush up on the concepts of 'Pre-load' and 'After-load'. I think I covered my butt by pinning this on the doctor in question ("Pls confirm spelling...."). I have to say, with a blood pressure of 200/104, I'm not as cautious about giving her a medication that will open all her small arterioles and allow her blood pressure to drop a lot.

I'm also not so cavalier that I don't start two intravenous lines (ways to inject a blood-like fluid or medications into her bloodstream) with 1000ml bags of fluid (one of the most important things we need to revive someone) connected to each one.

We give her ONE dose of Nitroglycerine (0.4mg)

Her blood pressure DROPS!! from 200/104 to 128/60.

OH MY!!!

However, she's still awake and talking to us. All this time I have my hand around her wrist. I'm feeling the pulse of blood through her wrist. At first it was "bounding" or hitting back against my fingers pretty hard.

Unlike my compatriot, I'm not so freaked out by her drop in blood pressure. I can still feel her pulse in her wrist. My thinking is, if her heart is strong enough to push blood all the way out to her wrist, it's strong enough to push blood to her brain, into her lungs and to back-flow into the arteries of her heart. Yeah, we dropped her pressure HUGE but she's still going.

In the ER, the Cardiologist asks me if we gave her ANOTHER nitroglycerine dose.

"Hell, No!" I reply

"Why not?" She asks me with a cross look on her face.

I put my hand on her arm, "Doc, have you ever worked alone?"

She looks puzzled. This is a foreign concept to her.

Alive: Improved.

--maddog

Alive:Improved

The call goes out as "Trouble Breathing"

CC-Rider and I are together again. Our driver, SmokeyJoe, is a recent Paramedic who's still getting his ride time in. He left the USMC and started paramedic school when he was 32. (Sound familiar?)

CC-Rider says to the both of us, "This is your call! I'm driving!" She clearly has much faith in us.

The "trouble breathing" is a woman sitting on the floor in the open front door of her house when we arrive. Her face, lips and neck are about twice the size they should be and she speaks to us in a pattern like this:

"I...GASP...ate...GASP...a...GASP...pistachio...GASP..." (you get the picture).

"Ma'am, are you allergic to anything?"

"Yes...GASP..nuts...GASP!"

I look at SmokeyJoe over the top of my glasses and see his eyebrows do their best to meet his hairline.

Ooooookay! it's GO TIME!

I don't need my stethoscope to tell me that she's closing up. From a foot away I can hear a noise like "HeeeeEEEEEEP!" every time she breathes in. My stethoscope does tell me that she's not moving any air in her lungs other than the very center of her chest. Basically, this means that her allergic reaction is causing the muscles around her bronchioles (the smaller pipes that lead from your windpipe, or bronchia, to the business parts of your lungs) have all squeezed down really hard and are blocking any air from getting to the parts of her lungs that will enable her to get oxygen into her body and carbon dioxide out.

This is what we call, "bad."

Her husband hovers nervously in the foyer. SmokeyJoe and I waste no time. We practically fling her onto our cot, dash the 10 yards to the medic unit and load her up. CC-Rider is already there and bobs her eyebrows at me, asking what to do.

"Epi, IM." I tell her, indicating her to inject 0.3mg of epinephrine into my patient's arm muscle. This is a pretty cool drug. The paramedics in the UK accurately call this drug adrenaline. That's what it is. It's the thing that makes your lungs open up, heart race, blood vessels constrict and dries up any secretions in your mucous membranes. (Pseudo-ephedrine, or sinus medications is a form of this). The dose we give people having allergic reactions (anaphylaxis) is, for the human body, HUGE!

It works quickly and very well, however, it just buys us time. It'll probably wear off before she's done having an allergic reaction. SmokeyJoe tries and fails to get an IV line on twice. I tell him to start a neb of albuterol. This is a drug that acts directly on the aforementioned bronchioles and cause them to open up. We deliver it by nebulizing it so the patient breathes it directly into the lungs (quickest way to get it where it's needed).

Meanwhile, I drop the IV perfectly into the patient's left arm. This is significant in that it's my first successful IV in over a year (not a lot of chances to start one when you're a teacher) and I was nervous that I had "lost" my skills. CC-Rider jumps in the driver's seat and we roll. Our patient is breathing easily and has the hyper, nervous laugh that comes with getting jacked up with more adrenaline than your body can make in an hour.

She's not the only one breathing easier. SmokeyJoe and I are already confident in the fact we had a "save."

What I mean is, had we not arrived (or arrived late) this one would have closed up and suffocated. She'd be dead at age 33 and her husband would be a lost and confused man, having watched his young wife die before his eyes.

We turn her over to the friendly staff at the local hospital and in the part of my paperwork that says, "Condition of Patient Upon Arrival at Destination:" I gladly choose "Alive:Improved."

Life? It's good.

--maddog

Epiloge: I saw her a few hours later when we brought another patient at the same hospital. The sight of her happy (normally sized) face made up for the "died-despite-all-we-did-and-we-did-it-right" condition of my current patient.

Second Guessing.

I'm in a unique place.

One of my students is also a member at my volunteer firehouse (where I am the EMS Sergeant). She has another four months until she becomes my student (begins field clinicals) but she's still "one of mine."

She came to me with a rather prescient question today. She had been the primary provider on an accident. She was riding the ambulance and the fire engine (with our station officer on board) had been dispatched on the call too.

It was an auto accident with very minimal car damage. There was a "star" on the windshield but not in the typical place for head impact. Relevant too, was the fact that the driver (my student's patient) was seatbelted. No airbags installed on his car.

He was also "altered." This means the person driving the car was in an altered mental status, or was so out of it that he did not remember the question that was asked of him 2 minutes before.

My student said, "Off to the trauma center you go!!!" In fact, as she arrived on scene, she asked for the status of the local trauma center.

The officer, however (someone who is primarily involved in fire suppression), said, "No, you should go to XXX hospital" (the closest but NOT a Trauma center).

60 hours later, she catches me in the Chief's office and asks me if she made the right decision.

Now, understand that these "questions" are never asked. They are always prefaced by a story. She's telling me the story and when she gets to the part about "star on the windshield + altered mental status" I interrupt and say, "Trauma Center!"

She counters with, "What if it's a seizure or EToH?"

I respond with, "Look, If its a seizure, EToH or a stroke, the local trauma center can handle that. If it's an altered mental status due to a stroke or an epidural bleed, for example, then the local "community" hospital is going to transfer them to the trauma or the stroke center (both in the same place) and that will delay care.

I tell her, "I would have made the same decision. Fire donkeys and cranky nurses be damned."

She sighs her relief.

I asked her if that's where her patient went. (To the Trauma Center) Yes, but she feels bad about "second guessing" the officer on the call.

I ask her, "Who's in charge of patient care?"

Her shoulders drop and I can visibly see the stress fall away...."Me!"

"Then it's your call and you made the right one."

"Thanks, Sarge!" A flip of a wave and a spring in her step and she's gone.

She's ready for the next one.

-maddog

Please don't eat before you die!!!

Well, yes, I told you "More to Come" and here it is!

We get called to a townhouse for one having trouble breathing. Dispatch has done a great job of getting information and we know that, even though she's 42 years old, she's already had a heart attack, suffered from congestive heart failure (CHF), and has an extensive history with a LOT of drugs.

In the door & up one flight of carpeted stairs.

This place smells horrible.

There are a lot of concerned people standing around who, I assume, are family.

Another flight of stairs. (Why is this so common!???)

Into the bedroom where she's lived for the past couple years (we can tell that walking in).

She's on a big recliner. She's got all the signs of a lifetime of being unkind to her heart. I see all this and I see her chin on her chest (not natural). Right away, I can see that "trouble breathing" is now "NO breathing!"

ZIP! I slide in and check a pulse while moving her head up to open her airway.

"I got nuthin!"

This galvanizes the other two medics I'm working with. Mind you, this is my second shift with them. The last one was exciting as well.

It's game time!

CC-Rider and I quickly move our patient from the recliner to the floor. MedicToMyRight (who, strangely enough, is again to my right) dives in to help. We also have some well-meaning, enthusiastic volunteer firefighters too.

The room is suddenly crowded.

As my patient's head is wedged between the recliner and the wall, I can't immediately get a quick assessment of her airway other than getting a basic airway (OPA, or OroPharengyalAirway) in her mouth.

I roll it in and she doesn't gag. This means that the airway is "tolerated." This also means that the patient is in a bad way. The control of the gag reflex comes off the brain directly and if there is no gag reflex, that can be pretty bad.

At this point, Volunteer Firefigthers are "bagging" (pushing oxygen via a special bag) into this woman. There's a lot of gurgling. We're having a tough time getting air into her lungs versus her stomach. (Can't breath through your stomach so, that's bad.)

I check again for a pulse and find none. I start chest compressions. All my paramedic training and the most important thing I can do for this woman (Really!!!) is something I learned about 12 years ago (CPR!).

Now, let me take a moment to tell you about OPAs. They are merely a piece of plastic curved in a way to keep your tongue from falling back in your throat. The more modern ones are very much like a curve plastic stick that does the job while allowing air to move around it. The older ones, however, are more like curved TUBES that, essentially do the same thing but are a pipe going into the back of the throat.

Neither one, however, does a dang thing to keep air from going into the stomach, versus the lungs. (two pipes down there, remember!)

The OPA that I grabbed from the bag was the old style. As I started to slam down on her chest with all my might, the pressure of the air in her stomach, combined with the full meal she just ate contrived to make a geyser.

Each time I pumped on her chest, we got a bit of vomit shooting 12 to 18 inches up in the air.

The Vomit Comet rides again!!!!

It's at this point that CC-Rider and MedicToMyRight look at me. They shake their heads. Last shift we had a code and this is looking to be the same way.

Down 2 flights of narrow stairs, through the living room and into the medic unit we go.

We intubate, hook her up to a monitor and give her a TON of ACLS drugs.

All the while we're being driven by a volunteer firefighter who's wearing a full stetson hat, a torn t-shirt and his bunker pants.

He hits every bump and curve at 65MPH.

We all get puked on as we bounce around the back of the ambulance like ping-pong balls in a tornado.

...and he gets lost on his way to the hospital.

Basically, he exemplifies every un-professional characteristic of our volunteer service (keep in mind that I'm a volunteer and riding as one during this call).

What a donkey!!!!

After the call, as we're cleaning up, I pull him aside.

"Hey, man, Howareya?"

"..Um...Ok"

"Great..thanks..listen,...can I ask you a favor????"

"...Um...Ok.."

"Yeah,....great...Listen, Um...Don't ever drive a medic unit agin..Ok?"

He's gettign defensive at this point...."What?"

We've walked away, out of earshot of everyone else, by this point. I put both hands on his shoulders.

I look him right in the eye.

With the most firm and benevolent, fatherly look I can put on my face. I say:

"It would be bad."

I keep looking at him.

He's thinking this is some kind of man-fight and gives me a defiant look.

I keep looking at him.

"What?....Welll...Sh**........"

I keep looking at him.

His shoulders hunch and I can feel him getting tense. He tries again to be tough...

I keep looking at him.

"F*** you!"

I keep looking at him.

"F*** it, I hate the ambulance!" He says with a flame in his eye.

Success..

--maddog