Sunday, June 13, 2010

The Para-God Complex: A Return to the Basics

I have been a nationally registered EMT-Basic for a year and a half now and a licensed and practicing EMT since January. Needless to say I am not the most experienced EMT in the world but I am learning a lot. Over the past six months I have worked with a number of ALS and ACLS providers, ranging from a fully endorsed basic to a paramedic. Each one has given me a different perspective. Also in my six months working for Eagle I have run into many other health care providers in the various hospitals I've seen. Now a lot of the providers are awesome, care about the patients enough to listen to a patient report and there are those that feel inconvenienced by patients. This ranges from EMS providers to doctors.

To be fair I have worked with my fair share of folk from both of these categories. I've seen good EMTs and medics who care more in making the patient the most comfortable they can be. I've also seen those EMTs who just want to get the patient dropped off and get back to the barn. I've run into Medics who are nothing but friendly and are willing to take the time to teach us basics various tricks of the trade and I've seen some that don't even give you the time of day. It's the latter I will be focusing on for the rest of this post. Here's an example:

One night my partner and I were coming in from a 911 to a nursing home. The patient was in no means critical but in distress nonetheless. We called a patient report in to a very annoyed nurse. Apparently calls at 0300hrs just do not make anyone's morning. We get to the hospital, get the patient moved over to the hospital bed and while my partner is giving his report as he was the one who did patient care, I went to remake the cot and clean up the rig. Well I got all the sheets together saw one of the hospital paramedics walking towards me. I asked him if he would help me lift the cot as it was lowered and he just ignored me and walked by. Now he may not have heard me but ask anyone that knows me, they will tell you I am not a quiet guy and he was two feet away from me when the question was asked. I asked my partner what his deal was as my partner also works as a medic for the hospital and he explained that this particular medic felt that cot making was beneath him. He finished by telling me that this medic was a prime example of the Para-god complex: a feeling of being above people because he knows how to push drugs, knows more advanced life saving techniques and can generally do a lot more than basics can. This would not be my first run-in with this complex. Other examples include being dumped with stable patients that the hospital medics don't want to transport.

Now I understand that with all this knowledge paramedics have a lot more responsibilities with trying to save a patient and that this can go to one's head. Especially if they were to have a streak of saves in the back of an ambulance. However as one of my fire instructors taught me, they can push all the drugs they want but if they don't start with the basics, the stuff an EMT-B is fluent in, no amount of drugs pushed will help a patient. The basics include opening the airway, checking and remedying patient breathing problems, and finally checking for adequate circulation. Without these there is no point in pushing drugs on a patient. The point is, that even with all the medical training in the world at your disposal not forgetting the basics is paramount for a patient's survival.

This does not mean that I won't be going for my paramedic certification. I plan on going for it as soon as I am done with fire school. What it does mean is that feeling that certain calls, or certain duties are beneath you causes not only a disservice to your patient base but also causes you to be complacent in patient care. This complacency will cause anyone to forget the basics needed to be done in every call. Maybe not all the time, but some of the time, which is many times too many in my opinion. Remembering that we all once started out as basics, unless someone skipped that step and went straight to medic school, and remembering we were all at the bottom of the totem pole will create more humble health care providers who don't mind teaching those below us the tricks of the trade. This in turn creates a chain reaction that will snowball lower and lower creating EMS providers who are focused on the most important part of patient care. The well-being and betterment of their patient.

Blog Spring Cleaning, Long Trips, Fire Muster!

Howdy all! Well as you can see there have been some changes made to Smoke Before Fire. What can I say other than that I was really bored with the look that Smoke Before Fire had. Then I discovered the new Template Designer by Google and as you can see, my blog got hot! Literally! Then my title image Just didn't fit the template and the sizing was off, so a new title image! So yeah, blog spring cleaning has come and I like the results. I mean I don't see it much because I don't read the blog myself, because honestly who reads their own blog? But I hope you all like it.


So work hasn't been too exciting. Thursday I spent 14 hours of my 21 hour shift in an ambulance. I got very familiar with Eagle VII that day. Here's how it went down. I get to work at 1000hrs and am told we have to leave at 1030 for a patient pick up in Butte. We get to Butte to find out that the patient's appointment at the FHVA is the following day. So we went to Butte for no reason. Well we make it back to Montana City and were getting off the interstate when our boss calls us to tell us that we have a patient transfer to Missoula for St. Peters. So we get there, drop the patient off and come back. On the way back we get a call from the VA saying we need to bring a patient to St. Peters from the VA. It was a behavioral patient so I had to do patient care with him as well. Well after we drop the patient off and get back to the shop, my partner Mike gets a call from the VA and we need to go up to Missoula again for another patient. So after maybe sitting and relaxing for 10 minutes we are on the road again. We get the patient and come back and get back to the shop at 12:30am.

Luckily we didn't have any calls that night, and I got to sleep for a few hours before I got up early to call my sweetie who is Stateside bound this Wednesday! Pretty stoked. But afterwards I went home and passed out for another four hours. That next night we didn't have any calls so I was going to go to bed early but our favorite sheriff's deputy came to visit us. So we talked with him for a bit. Again after getting to bed around midnight I woke up early. I didn't get to go back to bed when I got home because I had to get ready for Fire Muster.

Fire Muster

So every year a town about five miles west of Montana City by the name of Clancy holds a series of events known as Clancy Days. Basically it's a weekend of cook outs, flea markets, music, and fun. The Clancy Volunteer Fire Department uses this weekend to host it's Firefighter Competition known as Fire Muster. Basically you have teams of four doing three events.

The Fire hose relay is the first event where you have a hydrant, three lengths of hose and a nozzle. We start behind the hydrant, run to our respected areas of the hose and couple them together. Afterwards we raise our hands and the hydrant guy lets the water flow. We shoot one target, shut the water off, then couple a different nozzle and a different hose length and shoot the second target. The team with the fastest time wins. We had the second fastest time, because the first Clancy team cheated and didn't use gloves. Well they got a second time to go and got a faster time. None of the other teams got a second round. Our time was 53 seconds which wasn't bad. We would have had faster but our first guy didn't tighten the coupling tight enough and it burst. It soaked him and that was hilarious.

The second event was the Fold-A-Tank bucket relay. We had four buckets that we had to use to take water from the fold-a-tank and fill up a oil drum. The first person with the steady stream flowing out won. Well it was a good competition because Jefferson City and Montana City tied. But they gave it to Jefferson City because they were operating with three people instead of four.

The final event was the keg chase. No, we don't have to race against frat boys in hopes of being the first to get a hold of a beer keg. Basically it was a tug-o-war with fire hoses. We have an empty keg strung up on heavy duty cable wire in the air and the point is to use our 1 1/2 inch hose-lines to push the keg towards the other team and cross the line. We were first up against Jefferson City and we had a back and forth but we were able to push it past them. Both Clancy teams faced each other and the winner of that faced us. It was Clancy two. We were deadlocked in the middle for a while before our nozzle-man accidentally turned our nozzle off and we couldn't recover. But again we got second place.

By the end of the competition, our gear was drenched, we were freezing, because we were flowing water from a run-off filled creek, and we were the runners up. We did not receive any trophy but we did show the other departments that we were pretty skilled in what we did. Even when Clancy teams cheated some. So yeah, look out Clancy, next year Montana City is going to smoke you guys!

The Smoke Alarm

We had one call the other night around midnight. It was a smoke alarm going off. Turns out that the gentleman not being able to handle the beeping ripped out his smoke alarm, exposing live wires (another fire hazard) and leaving it at that. Well even after ripping out the alarm the beeping was still going off. After some exploring it was discovered that the alarm was the gentlemans UPS computer back-up system's low power warning. Yeah, a little ridiculous.

But that is about it, I hope to write more soon, but it's going to be a busy next few weeks, what with my sweetie returning home and us going to my buddy's wedding. So stay tuned!

Wednesday, June 2, 2010

Rain, Rain Here to Stay... Or So it Seems!

So as the title states it's been rainy in Montana. Not a constant rain but the kind of rain that goes away long enough to make you think you can go outside and do things and will sneakily comeback moments later; The kind of rain that cakes your vehicle in mud; The kind of rain that turns into snow then back into rain at a moment's notice. So yes, it is officially spring in Montana. But as we enter into June we will be arriving very shortly into Summer. Montana is the kind of state where the seasons spring and fall do not stay long. You get used to it, enjoying the changing of colors that happen so rapidly. The dismal and constant white, changes to green and beautiful. Then to the brown of summer, with a rapid orange of fall back to the dismal constant white. But yeah it's raining.

It's been an interesting few weeks since I've last posted. I left off before with telling you that I had a fireman's funeral to attend. I won't go into detail, but I will say it was beautiful. They had an honor guard. We were to wear our uniforms, we saluted as the decease passed. The coolest part was the mile and a half parade of ambulances, fire trucks, cop cars, from all of the state coming to pay their respects for a fallen firefighter. These two pictures I have posted show just a fraction of the fire trucks that were in tow. I was in Engine two from MCVFD and we were the second fire truck in line. The most amazing part was the brotherhood of firemen that came to honor this firefighter they didn't even know. We did a military farewell at the Fort Harrison here in Helena and that was it. Afterwards we went up to our station one and had food and just spent time with everyone that knew the firefighter. Laughs were had, tears were shed but overall people just came together to honor one of our fallen. The weather was just a constant day of rain, which seemed fitting.

That evening I had stopped by my ambulance shop to pick up some stuff I left at work in my haste to go home and get ready for the funeral that morning. Well good thing that I was there because we had a page go out for a MVA (motor vehicle accident) with three patients, one ejected. I wasn't going to go with Eagle but the Fire Department got paged too so I went as a firefighter but did my EMT gig. We get there and the ejected patient was out. Not only out of the car, but unresponsive. So the ALS folk went to deal with her and they put me in charge of the other two patients that were seat belted in. Basically here is what went down. Both patients c-collared, backboarded, placed on O2. Once one of the ALS crew was done with the ejected patient they came in and did their IV thing.

The patients were stoned and hit a 35mph corner going 85mph. They were going so fast they cleared the 5ft high fence ten feet away from the road. Needless to say, they got distance. After we patched them up, got them to the hospital and dropped them off it was time to go home and relax. Well after we got the ambulance put back together. As you can see from the pictures... It was a disaster and these were taken after cleaning up the IV stuff. The rains I mentioned earlier, caused the roads to be muddy, wet and disgusting. But oh well. It can't be sunshiny and awesome all the time.

Speaking of doing IV stuff, sometime this month I will be starting the classes for the rest of my endorsements. Which I am pretty excited for. Out of all the people hired in February from our class (5) I'm the only one so far they have felt has stepped up to the plate and proven that they are ready to learn the endorsements. Not to toot my own horn, but it was definitely a yay me moment. So when I get those started I will write here on everything I'm doing.

That's about it in terms of EMS/Fire happenings. I'm working as much as I can preparing for my sweetie to come back from Japan and for us to go on our trip south to Bozeman for a wedding. I will be posting here more on a few things I've noticed in the EMS field. So stay tuned!