My first bad call happened on my third shift as a new paramedic. We were called to a home of a 26 y/o female having a seizure. Now, when we arrive at most seizure calls, the patient has typically stopped seizing, which is exactly what I expected. However, not this patient. As we arrived at the house, a man greeted us at the door, and then walked upstairs. When we walked in, we called out "EMS" and we were directed up the two flights of stairs and into the bathroom of a back bedroom. There, we found the female patient on the floor of her bathroom in left lateral recumbent and the fire department surrounding her. The fire department, a BLS crew, had already placed the patient on high flow oxygen via non-rebreather, and had obtained a pulse oximetry reading and a blood glucose value - two excellent pieces of information.
As I approached the patient, I realized that she was foaming at the mouth, and actively seizing. I immediately suctioned her mouth, felt for radial pulses. She had strong/equal/regualr radial pulses, which indicated to me that she had a blood pressure of greater than 90 mmHg systolic. As such, I gave her the anti-convulsant medication that we carry. She did not stop seizing. I inserted a nasal airway, and asked for extrication ideas. The fire crew asked if I thought carrying the patient down the stairs would work. I agreed with their plan, citing that it would be too difficult to put a seizing patient in a stair chair.
When we made it down stairs and put the patient on our stretcher, I immediately reassessed the patient. She was still seizing, but now, did not have radial pulses. I knew that giving her more of the anti-convulsant medication was now contraindicated because her blood pressure could no longer handle the drug. We quickly got her into the ambulance and began transporting emergency to the closest hospital. Once in the back of the ambulance, I placed the patient on our cardiac monitor so that I could keep track of her heart rate and pulse oximetry. I put the patient in trendelenberg, and began looking to obtain IV access. She had no veins. NONE! All I could think was "oh boy, this isn't going to be pretty". Still, the patient had no radial pulses, but I had to keep her airway in mind. My patient was still breathing, irregularly, but adequately as she maintained an oxygen saturation in the mid 90's.
I continued my search for an IV and asked my rider to hang and prime a liter of saline so that I could give the patient a fluid bolus, raise her blood pressure, and give her the anti-convulsant she desperately needed. As I looked for a vein to start an IV, I was monitoring my patient's airway, and realized she as no longer breathing at an adequate rate, and that her respirations were becoming increasingly irregular. I asked my rider to switch places with me and continue looking for an IV.
I began oxygenating the patient with an Ambu bag. Her seizures continued, with only few 20-30 second intervals without seizure activity. My rider could not obtain an IV, so I asked him to insert an IO (to drill a needle into her leg which would provide me with access to give fluids or medication. At this point, I called medical control to advise them of the situation and to see if they had any better ideas. That is, I knew I could not give the patient more of the anti-convulsant because she did not have a stable blood pressure, and the medication would decrease her blood pressure further. I did not have access, so I could not give her a fluid bolus to raise her BP. The doctor agreed with me that continuing with a rapid transport was the best plan at this time.
As soon as I got off the phone, my rider advised me that he was unable to find the landmarks necessary to place the IO. I said ok, but realized that my patient was no longer breathing on her own. I inserted an oral airway, and she accepted. At this point, I've realized that the best thing for me to do for this patient is to establish a definitive airway. However, we were about two minutes away from the hospital, and establishing an airway would mean I would either (a) not complete it before I get to the hospital or (b) sacrifice valuable oxygenation time. Not to mention the fact that it is always possible that she would wake up and I'd have to pull the tube. I had my rider switch places with me yet again, and I inserted the IO as we pulled into the hospital.
I rechecked the patient's blood pressure and found that she now had a stable blood pressure. I withheld the anti-convulsant, despite the fact that she was still seizing, because I know that the blood pressure I obtained was a result of the trendelenberg position teasing her baroreceptors into believing that she had an adequate blood pressure.
My partner opened the back doors to find me bagging the patient.
Lessons learned:
1) Airway takes priority! As much as I wish I could have gotten vasculature/intraosseous access sooner so that I could have given my patient a fluid bolus, and potentially more medication, I had to take care of my patient's airway.
2) There will be times when the paramedic cannot complete every task he or she wants to complete.
3) When the hospital is unable to do the same things you're unable to accomplish, you've done all you can do for that patient.
In the hospital:
-The doctors and nurses eventaually raised the patient's blood pressure enough to give her more anti-convulsant medications. They intubated her and admitted her to the ICU.
An interesting twist:
-While exposing the unconscious patient, we noted multiple bruises on her body, all roughly the size of fingers. So was her seizure induced by head trauma/abuse, perhaps? I don't know...and that was definitely a discussion that ensued in the ER.
Tuesday, May 24, 2011
Monday, February 7, 2011
Multitasking
I would say one of the hardest, and definitely most underestimated aspects of being a good paramedic is the ability to multitask. I have seen the work of a bunch of paramedics and the inner-workings of many calls over the past year and a half, and in order for a scene to appear to be running smoothly, the entire crew on scene, including police, fire and--of course--EMS providers must work together. But how does everyone on a scene know exactly what to do and when? Well, the paramedic tells them.
According to the majority of text books written on the practice of paramedicine, the paramedic's job on scene is to stand back and make sure that all appropriate interventions are initiated by personnel on scene. However, in real life, the paramedic is an active member of the team, providing patient care while also instructing other members on what to do, how to do it and when to do it.
As an EMT, it is often difficult to recognize exactly how hard it is to "run the scene"...until you've done it.
Let me give you some examples.
1) You are the paramedic. Your partner is a brand new EMT, and today is his/her second day on the job. They have never had a job like this before, working on an ambulance. You are dispatched to a cardiac arrest, along with fire and police. Upon arrival on scene, you find your patient is, in fact, in cardiac arrest. The fire crew who shows up does not have that much experience when it comes to medicine because their passion is fire, not EMS. So now, you are the only one who really knows how things need to be done; meaning, not only do you as the paramedic have to accomplish all of the paramedic level interventions, but also, you have to provide instruction to everyone else on scene. Following is a list of things that typically must be accomplished during the above situation. * indicates a paramedic level skill that a paramedic may delegate to someone else on scene. ** indicates a paramedic skill that the paramedic must perform.
- Check ABC's (Is the airway open? Is the patient breathing, and if so, is it adequate? Does the patient have a pulse?)
- Begin CPR
- Begin oxygen therapy and positive pressure ventilation
- Attach the patient to the cardiac monitor
- Obtain IV access
- Interpret cardiac rhythm**
- Treat rhythm appropriately* (medication administration*, defibrillation**)
- Establish definitive airway (endotracheal intubation)**
- Package patient for extrication and transport
That doesn't appear to be so hard, based solely upon the words. However, put yourself in the position of paramedic. YOU are running the scene. You are asking everyone to do different tasks while, of course, making sure you do not insult anyone, and that you appear appreciative of their efforts.
As you, your partner and the fire crew approach the patient with all of your equipment, you can tell the patient is not breathing. Family is running around the house, freaking out, yelling at you to bring him/her back to life. You bend down assess the patient's ABCs. The patient is not breathing and has no pulse. You turn around to relay the information to your team, and no one knows what to do. So you need to tell them. You ask one of the firefighters to being CPR, while you take your place at the head of the patient. You ask another firefighter to please take out the monitor defibrillator pads and begin attaching them, while opening your jump bag to pull out the Ambu bag. You begin ventilating your patient at the appropriate rate, reminding the firefighter who is just standing around to swap with the firefighter performing CPR after roughly 5 cycles of CPR. Then you realize that your partner isn't doing anything. You ask your partner to start an IV, and you hook the Ambu bag to high flow oxygen. Everything seems to be running smoothly, right? Well, now the monitor is attached to the patient, and you ask the firefighter to turn it on. Upon turning on the monitor, you interpret the rhythm. During all this time, it is your responsibility to speak to the family about the patient's medical history. So...recap...you're currently ventilating a patient, keeping track of when to squeeze the bag, you're telling multiple members of your team what to do, making sure that everyone is able to complete their task, and now, you have to consider the patient's medical history to begin considering a possible explanation (perhaps one that is treatable) for why this patient is now in cardiac arrest. Additionally, you are responsible to keeping track of time so that you know exactly when to ask your partner to give appropriate medications, or when to give the medication yourself. Not only that, but you are the one who has to intubate the patient. So on top of everything else, you need to either set up your equipment on your own while monitoring the whole scene, or you need to ask someone to set up your equipment yourself. Then, you have to consider an extrication plan. Let's say the patient is in the back bedroom on the second floor of a house that has very, very narrow hallways and a very steep and narrow staircase. Once you have spent a reasonable amount of time on scene, you have to begin the extrication, making sure to reassess your patient. Now you have to load the patient into the ambulance and continue the process while your brand new EMT partner drives incredibly fast to the hospital, throwing around you and the firefighters who opted to ride in to the hospital to help you continue patient care.
Now, the above situation might not sound so difficult, but consider doing it while knowing the whole time that if you or any of your team mess up...there's potential for you to get sued or lose your license.
2) Same partner/resources set up. This time, however, you are responding to a scene where two people are shot. The fire service is on scene along with police, prior to your arrival. Most likely, even if the fire department has no interest in medicine, if there is blood and guts, they will agree to play. The first person is shot one time and laying in the back yard of the residence unable to ambulate. The second person is shot multiple times to each leg and laying in the front yard. Needless to say, he is not ambulatory.
This situation is VERY different than the other one. For this one, I will give you details of a call my partner and I ran just the other day.
We were dispatched to a call for a person shot one time to the leg. As we arrive on scene, it is obvious based on where the majority of the firefighters are standing that our patient is sitting by the front steps to the house. As we approach the patient, the firefighter who assumed scene command prior to our arrival informs us that we have a second patient, also shot. No other details are provided. I ask my partner, should I call for another unit? She says, no, let's see what we have first. (Sidenote: as a new paramedic, I might be anxious when finding out that I have two patients on scene, both shot. However, as an experienced paramedic, my partner knows that prior to calling for additional resources, we have to make sure that the situation really requires a second ambulance. Let's say that both of our patients are shot one time to the leg with a small caliber gun. We could handle that on our own, thus not stressing an already stressed EMS system.) My partner looks at me and says "ok, the patient up front is yours, I'll walk to the back of the house to see what's going on there." Umm...ok...I can handle that...I think. I get to my patient and see that he has been shot not once, but twice. Both with a VERY large caliber weapon, and both to his legs. The wounds were both approximately 3-4 inches in diameter with likely the same depth. Blood is oozing from both wounds. I have 4 firefighters, my jump bag, all of their equipment and my stretcher. I look to the firefighters for information about the patient; information that I expected they might be able to provide, being that they have clearly been on scene for greater than 30 seconds. Such information includes vital signs, complete count of wounds and anything else they might find pertient. Well, at least they were able to get the bleeding on his right leg under control. I immediately went to the head of the patient (this is a strategic location so that I can see not only the entire patient's body, but also the entire scene including available personnel and equipment in front of me. I was able to establish that my patient was pale, cool, diaphoretic, had no radial pulses and that he was alert and oriented. From that position I was also able to ask the fire department to and instruct them how to bandage his second wound. I also noticed that the fire department had not put my patient on oxygen and that they had attempted to obtain IV access. Knowing that I had a patient who was in shock and in critical condition, I needed to place my patient on high flow oxygen and begin the extrication process, even though this patient would not be transported in my ambulance. (I know he would not be transported with my because he was the more critical of the two patients and because we were the first ambulance on scene, we are the last off the scene, meaning that the more critical patient would be transported by the second unit to arrive. Oh, by the way, my partner did emerge from the back yard to update me on the other patient and to get the update on my patient). Even though I knew that we needed to get this patient to my ambulance so that he can get out of the cold weather, I continued with the firefighters' initial plan and asked one of them to obtain an IV. When he was unsuccessful, I attempted. However, because the patient was in shock, I knew the likelihood of establishing an IV was slim to none. But, I attempted nevertheless, delaying extrication. While in the long run, I did not delay this patient's transport to the hospital, I did not extricate him in the quick fashion that I should have. This is a mistake I made because of how difficult it is to manage an entire scene with multiple patients and multiple members of a team on scene.
It is important as a paramedic to be able to step back and take in the entire scene, including your personnel and the patient and his/her condition. This is something that new paramedics often struggle with. The other difficult task this scene presents to a new paramedic is two sick patients. A lot of new paramedics would have seen that this patient was VERY sick, and they would have left the scene with this patient, leaving the newly arriving unit to figure out what was going on with the second patient down the hill. This practice, while unfortunately common, defies the known protocol for a multi-casualty/patient incident.
While I know I recovered from my brief brain fart that allowed my patient to stay outside in the cold weather only a very short time longer than he should have, I also know that I made a mistake and that I learned from it. No one is perfect, but in this line of business, every little mistake a paramedic makes has the potential to come back and bite them. The patient was rushed to surgery upon arrival at the hospital and is still alive.
In my mind, as I wrote above, multitasking is probably one of the most difficult parts of being a paramedic. And the only way to get good at it is to experience it.
Thanks to my partner and all the awesome paramedics I have worked with who have left me in charge of many scenes (while of course making sure I don't screw up) so that when I am a paramedic, by myself without another paramedic on scene to tell me what to do, I will be able to do it...I will be able to multitask and get everything that needs to get done, done.
According to the majority of text books written on the practice of paramedicine, the paramedic's job on scene is to stand back and make sure that all appropriate interventions are initiated by personnel on scene. However, in real life, the paramedic is an active member of the team, providing patient care while also instructing other members on what to do, how to do it and when to do it.
As an EMT, it is often difficult to recognize exactly how hard it is to "run the scene"...until you've done it.
Let me give you some examples.
1) You are the paramedic. Your partner is a brand new EMT, and today is his/her second day on the job. They have never had a job like this before, working on an ambulance. You are dispatched to a cardiac arrest, along with fire and police. Upon arrival on scene, you find your patient is, in fact, in cardiac arrest. The fire crew who shows up does not have that much experience when it comes to medicine because their passion is fire, not EMS. So now, you are the only one who really knows how things need to be done; meaning, not only do you as the paramedic have to accomplish all of the paramedic level interventions, but also, you have to provide instruction to everyone else on scene. Following is a list of things that typically must be accomplished during the above situation. * indicates a paramedic level skill that a paramedic may delegate to someone else on scene. ** indicates a paramedic skill that the paramedic must perform.
- Check ABC's (Is the airway open? Is the patient breathing, and if so, is it adequate? Does the patient have a pulse?)
- Begin CPR
- Begin oxygen therapy and positive pressure ventilation
- Attach the patient to the cardiac monitor
- Obtain IV access
- Interpret cardiac rhythm**
- Treat rhythm appropriately* (medication administration*, defibrillation**)
- Establish definitive airway (endotracheal intubation)**
- Package patient for extrication and transport
That doesn't appear to be so hard, based solely upon the words. However, put yourself in the position of paramedic. YOU are running the scene. You are asking everyone to do different tasks while, of course, making sure you do not insult anyone, and that you appear appreciative of their efforts.
As you, your partner and the fire crew approach the patient with all of your equipment, you can tell the patient is not breathing. Family is running around the house, freaking out, yelling at you to bring him/her back to life. You bend down assess the patient's ABCs. The patient is not breathing and has no pulse. You turn around to relay the information to your team, and no one knows what to do. So you need to tell them. You ask one of the firefighters to being CPR, while you take your place at the head of the patient. You ask another firefighter to please take out the monitor defibrillator pads and begin attaching them, while opening your jump bag to pull out the Ambu bag. You begin ventilating your patient at the appropriate rate, reminding the firefighter who is just standing around to swap with the firefighter performing CPR after roughly 5 cycles of CPR. Then you realize that your partner isn't doing anything. You ask your partner to start an IV, and you hook the Ambu bag to high flow oxygen. Everything seems to be running smoothly, right? Well, now the monitor is attached to the patient, and you ask the firefighter to turn it on. Upon turning on the monitor, you interpret the rhythm. During all this time, it is your responsibility to speak to the family about the patient's medical history. So...recap...you're currently ventilating a patient, keeping track of when to squeeze the bag, you're telling multiple members of your team what to do, making sure that everyone is able to complete their task, and now, you have to consider the patient's medical history to begin considering a possible explanation (perhaps one that is treatable) for why this patient is now in cardiac arrest. Additionally, you are responsible to keeping track of time so that you know exactly when to ask your partner to give appropriate medications, or when to give the medication yourself. Not only that, but you are the one who has to intubate the patient. So on top of everything else, you need to either set up your equipment on your own while monitoring the whole scene, or you need to ask someone to set up your equipment yourself. Then, you have to consider an extrication plan. Let's say the patient is in the back bedroom on the second floor of a house that has very, very narrow hallways and a very steep and narrow staircase. Once you have spent a reasonable amount of time on scene, you have to begin the extrication, making sure to reassess your patient. Now you have to load the patient into the ambulance and continue the process while your brand new EMT partner drives incredibly fast to the hospital, throwing around you and the firefighters who opted to ride in to the hospital to help you continue patient care.
Now, the above situation might not sound so difficult, but consider doing it while knowing the whole time that if you or any of your team mess up...there's potential for you to get sued or lose your license.
2) Same partner/resources set up. This time, however, you are responding to a scene where two people are shot. The fire service is on scene along with police, prior to your arrival. Most likely, even if the fire department has no interest in medicine, if there is blood and guts, they will agree to play. The first person is shot one time and laying in the back yard of the residence unable to ambulate. The second person is shot multiple times to each leg and laying in the front yard. Needless to say, he is not ambulatory.
This situation is VERY different than the other one. For this one, I will give you details of a call my partner and I ran just the other day.
We were dispatched to a call for a person shot one time to the leg. As we arrive on scene, it is obvious based on where the majority of the firefighters are standing that our patient is sitting by the front steps to the house. As we approach the patient, the firefighter who assumed scene command prior to our arrival informs us that we have a second patient, also shot. No other details are provided. I ask my partner, should I call for another unit? She says, no, let's see what we have first. (Sidenote: as a new paramedic, I might be anxious when finding out that I have two patients on scene, both shot. However, as an experienced paramedic, my partner knows that prior to calling for additional resources, we have to make sure that the situation really requires a second ambulance. Let's say that both of our patients are shot one time to the leg with a small caliber gun. We could handle that on our own, thus not stressing an already stressed EMS system.) My partner looks at me and says "ok, the patient up front is yours, I'll walk to the back of the house to see what's going on there." Umm...ok...I can handle that...I think. I get to my patient and see that he has been shot not once, but twice. Both with a VERY large caliber weapon, and both to his legs. The wounds were both approximately 3-4 inches in diameter with likely the same depth. Blood is oozing from both wounds. I have 4 firefighters, my jump bag, all of their equipment and my stretcher. I look to the firefighters for information about the patient; information that I expected they might be able to provide, being that they have clearly been on scene for greater than 30 seconds. Such information includes vital signs, complete count of wounds and anything else they might find pertient. Well, at least they were able to get the bleeding on his right leg under control. I immediately went to the head of the patient (this is a strategic location so that I can see not only the entire patient's body, but also the entire scene including available personnel and equipment in front of me. I was able to establish that my patient was pale, cool, diaphoretic, had no radial pulses and that he was alert and oriented. From that position I was also able to ask the fire department to and instruct them how to bandage his second wound. I also noticed that the fire department had not put my patient on oxygen and that they had attempted to obtain IV access. Knowing that I had a patient who was in shock and in critical condition, I needed to place my patient on high flow oxygen and begin the extrication process, even though this patient would not be transported in my ambulance. (I know he would not be transported with my because he was the more critical of the two patients and because we were the first ambulance on scene, we are the last off the scene, meaning that the more critical patient would be transported by the second unit to arrive. Oh, by the way, my partner did emerge from the back yard to update me on the other patient and to get the update on my patient). Even though I knew that we needed to get this patient to my ambulance so that he can get out of the cold weather, I continued with the firefighters' initial plan and asked one of them to obtain an IV. When he was unsuccessful, I attempted. However, because the patient was in shock, I knew the likelihood of establishing an IV was slim to none. But, I attempted nevertheless, delaying extrication. While in the long run, I did not delay this patient's transport to the hospital, I did not extricate him in the quick fashion that I should have. This is a mistake I made because of how difficult it is to manage an entire scene with multiple patients and multiple members of a team on scene.
It is important as a paramedic to be able to step back and take in the entire scene, including your personnel and the patient and his/her condition. This is something that new paramedics often struggle with. The other difficult task this scene presents to a new paramedic is two sick patients. A lot of new paramedics would have seen that this patient was VERY sick, and they would have left the scene with this patient, leaving the newly arriving unit to figure out what was going on with the second patient down the hill. This practice, while unfortunately common, defies the known protocol for a multi-casualty/patient incident.
While I know I recovered from my brief brain fart that allowed my patient to stay outside in the cold weather only a very short time longer than he should have, I also know that I made a mistake and that I learned from it. No one is perfect, but in this line of business, every little mistake a paramedic makes has the potential to come back and bite them. The patient was rushed to surgery upon arrival at the hospital and is still alive.
In my mind, as I wrote above, multitasking is probably one of the most difficult parts of being a paramedic. And the only way to get good at it is to experience it.
Thanks to my partner and all the awesome paramedics I have worked with who have left me in charge of many scenes (while of course making sure I don't screw up) so that when I am a paramedic, by myself without another paramedic on scene to tell me what to do, I will be able to do it...I will be able to multitask and get everything that needs to get done, done.
Wednesday, February 2, 2011
Background...
For the last 19 months I have been working as an EMT-Intermediate for a high-volume, urban 911 ambulance service in Atlanta (for those of you who live in Atlanta, that gives you one option...we'll call it GEMS on this blog), and have had some of the most memorable adventures of my life. Whether or not these experiences had positive or negative patient outcomes, many of them stand out rather prominently in my mind. I should also note that for the past 13 months I have been in paramedic school, which is perhaps why even negative patient outcomes have been great for me. I have learned so much, seen so much, and felt so much.
Why today, of all days to start this blog? Well, I just took my final exam for paramedic school, and rocked that shit, so, today is the day. I am not quite a paramedic yet, but I will be as soon as I finish my national registry written and practical exams. Regardless, the job has been so meaningful to me, I just thought I would share it with you all (whoever that is...friends, family, random EMS junkies who love reading this stuff).
Anyway, for my first post, I am going to paste a couple of emails that I sent to a group of my friends earlier on in the year, and then I will explain some other fun facts about my tenure at GEMS.
Why today, of all days to start this blog? Well, I just took my final exam for paramedic school, and rocked that shit, so, today is the day. I am not quite a paramedic yet, but I will be as soon as I finish my national registry written and practical exams. Regardless, the job has been so meaningful to me, I just thought I would share it with you all (whoever that is...friends, family, random EMS junkies who love reading this stuff).
Anyway, for my first post, I am going to paste a couple of emails that I sent to a group of my friends earlier on in the year, and then I will explain some other fun facts about my tenure at GEMS.
"I haven't really written too many emails about my life because there isn't much to write; I work while most people sleep, and I sleep while most people work. My life has become mostly work and a lot of play during my time off. Just about the only serious aspect of my life are the bills I have to pay. But, with Emma's encouragement (or more accurately, her request) I am going to explain my gmail/facebook statuses into this email about my "life".
My job is a lot of fun. I deal with a lot of crazy, pregnant and actually sick, sick and injured people. I make a difference in their lives and get paid crap for it. People don't really respect my job, but I love it anyway, because I respect it. I see things that no one should ever have to see, from death to neglect to abuse. Child abuse. Child neglect. Sad, sad realities that, thankfully, we haven't had to experience, nor should we ever have to experience. My job is dangerous. I never know when I will leave my apartment for the last time. I spend my nights walking into strangers' homes, rolling up on shootings, car wrecks. I park on the side of the highway to work high-speed crashes with high-speed traffic flying by a mere 5 feet from me. I park in the middle of the most dangerous neighborhoods of Atlanta Southwest Atlanta . At any moment I could be attacked like some of my coworkers have been. At any moment I could be gunned down by people who don't want us to help the people they've shot, stabbed, beaten. I have to drive fast going to the rescue of the people in Atlanta Atlanta
After my job, I hang out with my friends, my coworkers. We drink. We party. We sit at bars until they close and then go to someone's house to drink some more. We drink A LOT. But we share a common bond which is the reason we drink: We work hard for people who need our help. We work hard for people who abuse our service. We work hard and see a lot of things that shouldn't exist in the world.
People often ask me "Why didn't you just apply to medical school?", or "When will you be taking your MCATs?", or "Why would you want to work on an ambulance?", "Why waste your time?", "Why do this job when you could make much more money doing something else?". But, I didn't "just" apply to medical school, or schedule my MCATs because I want to work on an ambulance. I want to spend my time learning more about medicine from the front lines; medicine in the field, in an uncontrolled, dangerous, scary environment. I don't do it for the money. I won't ever do anything for the money. I do it because my job is fun, dangerous, sad, gratifying, and funny and it makes me happy. I love my job. And when I'm ready, and feel that I've gained all I can gain from doing my job, I will schedule my MCATs and apply to medical school. And become a doctor. But until then, I will continue to love my job because once I'm a doctor, I'll always be a doctor...and doctors don't work on the chaotic streets."
"Nights like tonight are the reason I work so often!
Tonight I kinda delivered my first baby!!!
Buuuut...it wasn't as pretty as it was supposed to be. Basically, we got called to the jail for a woman who was supposedly 36 weeks pregnant whose water broke. We got there and the nurse in the medical ward told us that her water didn't break and that 'she just pissed and shit herself to be obnoxious'. So, my partner and I were like okay, whatever. Got her on our stretcher and into the back of the ambulance and transported her to the hospital. The woman was not complaining of contractions...or anything except pain in her vagina. I felt her stomach and it was hard, like a pregnant woman's stomach is, but not HARD like a pregnant woman's belly is while she's having contractions. So again, my partner and I were like whatever. While transporting, my partner began looking through her paperwork from the jail and saw that in half the paperwork, our patient was registered as a MALE named 'Kieth'...and the other half of the paperwork indicated that she was a female named 'KIETH'...needless to say, we were confused. My partner and I decied that it would be best to check to see if she had a penis or a vagina, so we check...and found something ridiculous hanging out of our patient's vag. Honestly, neither of us could tell what it was....so my initial guess was prolapsed uterus, my partner thought it might be a cyst of some sort. While we were figuring out what we should do for either situation, our patient decided it was a good idea to pushe...and we realized that it was a butt and the upper part of a baby's legs. For those who might not know...baby's are supposed to come out head first. So, naturally, we were both like FUCK! We gotta roll...so we continued on to the hospital and tried contacting a million different people at the hospital to let them know we were on our way and only a few minutes away...but that's a whole different story. Anyway, just as we arrived at L&D the baby came out all the way and resulted in my first pediatric resuscitation. After the NICU team worked the baby, they finally got her back, but they said she would probably have severe brain damage. That really upset my partner and I because we obviously would have been more proactive if the patient voiced that the baby started coming out...but hindsight is 20/20. Regardless, at the end of shift my partner and I walked up to the NICU to find that the baby we delivered was still alive, and moving around, and showing no signs of brain damage. In fact, she'll be taken off the ventillator tomorrow morning (which I guess, at this point, is this morning)."
Now, a brief continuation of the stuff you might see in the future.
During my year and a half as an EMT-I at GEMs, I have responded to over 1800 calls. Of those, roughtly 29 have been for cardiac arrests (hence some people at work have called me "the grim reaper"), over 100 calls have been for severe respiratory distress/CHF exacerbation/COPD exacerbations, approximately 10-15 shootings, and countless calls for homeless people who just wanted a warm place to sleep for the night. I figure, if I've had this much fun as an EMT...being a paramedic at GEMS will be a delight...and those experiences, I will definitely share.
While I don't plan on giving you a play-by-play on all the calls I have run thus far or the calls I will run in the future, I will definitely give you the highlights on some of the most dramatic situations. In this post, you saw about my first (and only) delivery. In the next few posts, I will start to write about some of the other crazy calls I've responded to.
During my year and a half as an EMT-I at GEMs, I have responded to over 1800 calls. Of those, roughtly 29 have been for cardiac arrests (hence some people at work have called me "the grim reaper"), over 100 calls have been for severe respiratory distress/CHF exacerbation/COPD exacerbations, approximately 10-15 shootings, and countless calls for homeless people who just wanted a warm place to sleep for the night. I figure, if I've had this much fun as an EMT...being a paramedic at GEMS will be a delight...and those experiences, I will definitely share.
While I don't plan on giving you a play-by-play on all the calls I have run thus far or the calls I will run in the future, I will definitely give you the highlights on some of the most dramatic situations. In this post, you saw about my first (and only) delivery. In the next few posts, I will start to write about some of the other crazy calls I've responded to.
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