Archive for January, 2010

29
Jan
10

Author Interview With Steve Whitehead

By Jeramedic 4 Comments
Categories: Interviews and Guests
Tags: , , , , , , , , , , ,

I’m finishing off this week of Best Practices with an Interview of Paramedic and author of the new E-Book  The Nonconformists Guide To EMS Success, Steve Whitehead.

This is a follow up to My review of  Steve’s book, which you can read Here.

It was wonderful speaking with Steve earlier this week. He is very knowledgeable, friendly and approachable. And  has two decades of experience in EMS, both as a field provider and an educator.

Steve very graciously made time for this interview and was supportive of the project. And I thank him for that.  So Lets begin.

Jer:   In the beginning of the book, you tell us that you were once very  irritated
and unfulfilled with your work. what made you decide to change your
attitude?

Steve:   It may have been one call specifically. I was working in a very high
crime and economically impoverished community in California. I was angry at
my job. Upset that it wasn’t what I expected it to be. I felt that nobody
understood what we were supposed to be doing as EMS professionals. I was
upset at the low pay, the bad working conditions, the long hours, all of
it. I was young and immature. Probably too immature to be a paramedic yet.

We worked 24 hour shifts and we were usually up all night dealing with
very sick respiratory patients (most of the community smoked), people who
were drunk, and people who abused methamphetamine. Most of are calls at
night were for the meth users.

We ran a call for a meth overdose and our patient was a combative,
out-of-control female. She injured my partner while we were restraining
her. By the time we had her in full restraints (We couldn’t sedate people
back then.) my adrenaline was in overload. My treatment of her after she
was restrained was totally inappropriate. It was what we might refer to as
“punitive medicine.”

Nothing I did was to really help her. I used my medical skills to punish
her. This wasn’t unusual for our service. Lot’s of the paramedics I knew
used their medicine to take out their aggression on their patients. But it
wasn’t normal for me. After the call I felt horrible. I wanted to quit. I
realized that nothing I was doing had anything to do with why I chose EMS
as my profession.

I decided to stay in EMS, but I had to ask myself some serious questions
about why I was doing this job and what I wanted to stand for as a
caregiver. Since that call I made the decision that I needed to always be
an advocate for the patient. Regardless of whom the patient is. Regardless
of whether or not we like them. Regardless of whether or not they like us.
We exist to serve the patient. If you’re not willing to serve people, you
have no business being in EMS.

My journey of success in EMS began the morning after that call.

Jer:   I can see how that must have been a very difficult time for you. I think it’s obvious by now that we are grateful you chose to stay in EMS.

You tell us about three types of people to watch out for. The critics,
the old guard and the bottom feeders. It’s possible that some of your
readers are these people, and it may be very difficult for them to apply
your principles. Can you offer any advice for them?

Steve:  Great question. I secretly hoped many of the readers would identify with
one or more of the archetypes. (To one degree or another.) I used to be
one for these people too. I used to be a critic. I defined everything by
what was wrong with it. It’s a very unhappy way to look at life.

You can’t talk people into changing. Changing the way you see the world is
phenomenally hard and it takes years of effort. When people decide they
want to be something fundamentally different than they are, they will. You
can’t make that happen for them. Hopefully, if they make that choice,
they’ll find my book useful.

Jer:  Yes they will.

But some may argue that conformism breeds uniformity. And that uniformity
is something we are lacking in EMS. how do you defend you point of
non-conformism?

Steve:   In my own selfish view, I’d like to see people be uniform in all the
things I advocate for and non-conformist in everything I advocate against.
That’s probably an unrealistic goal, but it’s a goal none-the-less.

It’s important to consider that the term non-conformity implies that I’m
rallying against something. I’m really not. I’m rallying for something.
Actually lots of things. I’m rallying for competence, personal
accountability, a servants heart, a willingness to contribute, and a
desire to make EMS better for the next guy or gal.

If we’re going to seek uniformity, we have to decide what we’re going to
unify around. I like my list. …And I think it would serve our profession
well.

Jer:   I agree very much with you Steve.

You also encourage readers to find a mentor. Who was your mentor, and how
did you meet?

I’ve had many mentors. from my first paramedic preceptor (Phil Rigardo)to
many members of my current leadership team and fellow paramedics and
firefighters.

I’d say some of the folks who most served to shape my career and who I
wanted to be were my father Ed Whitehead, Thom Dick, Jeff Forster, Twink
Dalton, Billy Kraft and Mike Taigman. All of them helped me decide who I
wanted to be in EMS and helped me on the path (In their own way.)

It’s impossible to relate how many people influenced me over the past two
decades. But it’s important to note that we never really know when and how
we are going to influence the people around us, for better or worse, but
it’s worth considering when we decide who we want to be each day.

Jer:   You say that for us to change and grow, we must  be willing to have
difficult conversations. What was a difficult conversion you have had,
and needed to overcome your fear about?

Steve:   As a supervisor, I needed to have difficult conversations all the time. I
had to tell some poor dude that his hygiene wasn’t up to par. That was a
tough one. All his coworkers talked about it, but nobody, I mean nobody,
was willing to talk to him about how bad he smelled. That’s a pretty
extreme example.

Every day we run into those conversations. The dude who always leaves the
ambulance understocked, the gal who’s always complaining even though
everyone’s tired of hearing it. If you come from a place of caring and
respect, those conversations can be powerful opportunities.

Jer:   Well said Steve, I have just one more question.  Many reader of your book and your website are New Providers.     if you could only give them one ideal to live up to in their new career, what
would it be?

Steve:   Be kind.

Jer:   Thank you Steve.

Weather you are a student or a seasoned veteran, an educator or administrator. I highly encourage you to go and download your FREE copy of  Steve’s E-B00k, The Nonconformists Guide To EMS Success.

28
Jan
10

Book Review: The Nonconformists Guide to EMS Success, By Steve Whitehead.

By Jeramedic 2 Comments
Categories: Book Reviews
Tags: , , , , , , , , ,

This is the first in a seires of book reviews that will be featured here at Jeramedic. And I thought what better choice then to start things off with a  new and great E-book.

The Nonconformists Guide to EMS Success . By Steve Whitehead.

Steve is a Paramedic/Firefighter and EMS Educator. He has authored several articles for EMS Magazine, Advanced Rescue Technology and JEMS, and can often be heard on the EMS Garage and EMS educast pod cast’s .

The E-book is a first for Steve, but he writes and posts frequently on his website The EMT Spot .

The Nonconformists Guide to EMS Success could be considered a blue print to a foundation on which to build a rewarding and successful career. Or a renovation project on your current career, depending on where you stand.

The book revolves around three points. Growth, Leadership, and Connection. Steve believes that by focusing on these three elements. And having a clearly defined goal for yourself personally and professionally, that  success is well within reach.  Steve asks us to “Tear up the old social contract of conformity and move in the direction of what matters to you.”

And what does matter to you? For me what matters is to be happy of course. To feel that my work and effort really mean something. To be valued and respected. To be treated fairly and honestly. And to help make positive changes. Not just for my patients, but for my industry and for myself. But how do we achieve that?  Where do we look?

“Your Leadership Doesn’t Have What You Need.” Steve explains that they are not responsible for your happiness and success. At least not in the ways you might believe.

That if you want something, Or  feel that a change is needed then “stop waiting for permission.” There is no S.O.P that restricts you from having a conversation with the boss or finding fulfillment.

Steve goes into detail on these subjects and many others, and speaks from years of experience from being on both sides of the table. He also shows us an exercise for personal review and goal setting, and explains why we should be “Remarkable” and to “recognize that the value of your work is directly and irrevocably attached to the value of the patient being served”

My Thoughts.

I enjoyed this book very much. It delighted me to see that another professional held the same or similar values as I do about this career. This not to say that did not get anything out of it. far from it. There were many concepts and principles that were new and useful to me. I think a provider of any level and experience would find it to be a valuable resource.  I also love how the information is presented. Not just in Steve’s writing, but also the format. As an E-book, it is easily obtained. If you can wait 30 seconds for it to download, it’s yours.  Being that it comes as a PDF file makes it easy to store and transport amongst your devices of choice.

It is easily printed and can be shared with crew mates, or given as a hand out during a class. I’d go so far as to say that it should be required reading for EMT and Paramedic programs.

In my experience, I find myself to be very happy with my work and my contributions to the industry. And it shows. My colleagues would ask “how come things don’t bother you?” and “you’re always in a good mood, what’s with that?”  I would try to explain and give advice, but talking about it at hospitals or between runs just doesn’t cut it. Just one read of Steve’s book could do more for a troubled EMT then five straight shifts of an in ambulance lecture ever could.

Normally when someone starts to offer up some “free advice”, you may find yourself more confused or upset then when you started. Steve and his book are the exception.  And did I say FREE advice? Yes.The Nonconformists Guide to EMS Success is available  for free download at his website.

I highly recommend that you download and read this book, and share it with your co-workers, with your class mates or your students. You’ll be glad you did.

****Coming up on Saturday the 30th. I’ll be posting an interview I had with Steve Whitehead. He’ll be talking about the book and it’s lessons, as well as what inspired him to change and find success in EMS.****

26
Jan
10

Good Enough, Is Not Enough

By Jeramedic 7 Comments
Categories: Good Medicine
Tags: , , , , , , ,

when you think of a good EMT or Paramedic what comes to mind?

when you remember back on someone who influenced and inspired you, who do you remember?

I want to introduce you to two EMS providers.  we will call them “John” and “Jane”. Now John and Jane share many things in common with one another, but they are also very different.

They both work  for the same EMS service. They both went to the same school, and they both have been working in the field for  six years.  But this is where the similarities stop.

Lets meet John.

John arrives at work for all of his shifts on time, every time.  He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He has good patient care skills and treats them appropriately for their illness or injury. At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. And at the end of his shift, he leaves work at work. And knows how to relax on his days off.

Now lets meet Jane.

Jane is usually on time, but has been late on more than a few occasions.  She also attends the training classes and keeps up her certs. She has good patient care skills too, but has had meetings with her supervisors  about mistakes and breaking company policies and procedures. At the hospital she chats with the staff and tends to take a bit longer to clear. She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work.

Now who do you wish to emulate? who would you rather be known as?…… If  you said John, hold that for a minute. And lets look a little deeper.

John arrives at work for all of his shifts on time, every time. His shift starts at 0700, he gets to the station at 0658. 

He attends his company’s mandatory CE trainings without a fuss and always keeps his certs and licenses current. He is required to do 48 hours of CE, he does 48 hours.

He has good patient care skills and treats them appropriately for their illness or injury. He has too. Otherwise he’d be injuring and killing patients, have multiple  lawsuits against him and he’d lose his job. 

At the hospital he is the model of efficiency. He gets his patients in a bed, gives report and is back in service in record time. He hates being out of the station and wants to get back to the football game and then take a nap.

He is also a training officer and preceptor. He promoted to the positions after only 2 years at the company. He Trains new employees and has students any chance he gets. FTO’s get a 10% raise and preceptors get $1,000 for every student they have. He wants a new boat by next summer and thought he could make some extra cash.

And at the end of the shift, he leaves work at work. And know how to relax on his days off. He spends his weeks call bonus as beer money and gets drunk on the weekends, drinks when he can’t sleep and drinks when the bad calls come back to haunt.

Still thinking you want to be like John?

Jane is usually on time, but has been late on more than a few occasions. She’s on time because she gets to the station early to make sure the ambulance is stocked, fueled, and clean.  When she is unexpectedly  late she informs her supervisor and dispatch before her shift.  And  also attempts  to find someone to hold over until she gets there.

She also attends the training classes and keeps up her certs. As well as her required 48 hours, she also takes classes that interest and challenge her. And she teaches CPR and First Aid three times a month. 

She has good patient care skills too, but has had meeting with her supervisors  about mistakes and breaking company policies and procedures. She admits to her mistakes and learns from them. When she broke policy and procedure, she had a justifiable cause and did it in benefit of the patient. 

At the hospital she chats with the staff and tends to take a bit longer to clear. She consults with the doctors and nurses about the patients she brings in. She asks for others opinions and suggestions on the care she gives. 

She is a training officer and preceptor as well, But she doesn’t see as many new hires or students as John does. And she is very picky about who she rides with. She loves to teach. When there are new hires or a fresh crop of students, she take her time and chooses the ones that are struggling or needs extra attention.

She bounces around the company, and has worked at every station. She doesn’t stay in one place with one partner for very long. She has been able to experience a much wider variety of calls then John, because she has worked all over the city. She know everyone at the company and has many friends.

When she goes home, she often thinks about  tough calls she had the shift before. And even on her vacation, it’s hard to get her mind off work. She remembers the tough calls and reviews her text books, does research and thinks of way she can do better next time. One of her favorite times of the year is when she goes to EMS Expo

When you look at John, and realize that as skilled and accomplished as he is. He is doing the bare minimum that is required by law to keep his certs and not be fired or sued. That’s it…. the bare minimum.  The sad part is that in my experience, I have met many Johns. and I’m sure you have too. You could be reading this and realize “wait a sec, I am John!”  If you are John, I hope this is a wake up call. A kick in the pants to get you in charge of your life and your chosen profession.

I encourage you to get out there and be the change, be the example. Find someone more experienced then you and learn something from them. Find some less experienced than you and teach them something. Read a text book, read a medical journal, read a blog, READ ANYTHING. Go to conferences, take a class or two. Be proud of who you are and what you do. And do it well.

It’s easier than you might think.

21
Jan
10

I’d Die For You

By Jeramedic Leave a Comment
Categories: Memories
Tags: , , , , , , ,

It was early summer on a  Saturday night. A call came out and we were next up. “Later guys, keep my bed warm for me yeah?” I jokingly said to the other crew as I walked through the front room. My pager went off before I got to the ambulance, I silenced it on my belt without reading the text. “802 on air” I said over the radio. “chhhh 802, Firewood ave cross of State Street on a stabbing with multiple victims, PD en route you’ll be responding with 202 and Engine 36.” “802 copies Firewood and State” I said.

The call was north of us, almost at the boarder of the next neighboring city. The other ambulance out of station 2 was closer and would get there first. For almost the last two years I had been working in some of the more “less then desirable communities” of the city. Unfortunately, violent crimes were common here. However they also often turned out to be less severe once all the smoke had cleared. Gun shot wounds would end up as shots fired but no injuries. Stabbings would end up as minor lacerations or threats with a knife. Tonight would be different.

Five minutes in to our response and less then a mile away I could see the Police helicopter with it’s spotlight over the scene, 202 came on the radio and said they were on scene with PD. We arrived a minute or so later and were met with several unattended police cars that were blocking our entrance. “what the hell is this!” my partner said as he brought the ambulance to a slow stop. One officer saw us and ran over to start moving the cars but it was taking too long. “I’ll see ya in there” I said as I got out of the ambulance.

I grabbed the jump bag and a backboard and started making my way through the maze of police cars. I saw the crew from 202 about 40 ft ahead on the side walk, they were getting a young man on to a backboard as a firefighter did CPR. “Ray what do you need?” I yelled as I ran closer, “I got this!” he said, “there’s another kid with a bad Lac on the wall over there!” I turned and saw a teenage male sitting on a low cinder block wall, the police helicopters spotlight shined over him for a moment and I could see his shirt was soaked with blood and he was holding his right arm.

I got up to him and saw he had a long laceration from his wrist to his elbow, and a through and through puncture to his bicep . “what’s your name?, are you hurt any where else?” I asked as I cut his shirt off. I ran my hands over his chest and back looking for other wounds, he looked clear. I started to wrap his arm in kerlix, Speaking as a worked “you’re gona be alright, what’s your name?.” No answer. I heard the familiar rumble of my ambulances diesel engine behind me, I looked over my shoulder to see my partner pulling up to the sidewalk. I also realized that 202′s  rescue was in full view of my patient. “um, is my friend ok?” he asked. “I don’t know, we are doing all we can. I want to just worry about you right now.” His arm was wrapped and I wanted him in the ambulance where there was more light and I could do a better assessment.

202 left Code 3 (lights and sirens) as we loaded our patient.  “is my friend going to be ok?” he asked again. “we are doing our best for him, he’ll be at the hospital soon and there will be a lot of people waiting for him.” Now after a more detailed assessment  I could see that his injuries were isolated only to his right arm. The Kerlix was holding up so I wasn’t to concerned about an arterial bleed.  I finished the rest of my assessment and interview on the way to the hospital. We transported Code 2 (without lights and sirens) so we had some time to talk.

On the way he told me the story of what had happened.  They were walking home from a high school football game. A black 1960′s chevy impala pulled up and four older men got out. I say “men” but they probably were not much older the my patient, who was barely 17y/o. One man started harassing the boys ” where you from punk? who you with?”  “we don’t bang man, we cool ok” my patient said. Then the “alpha male” of the group and lead antagonist pulled a knife and rushed closer. “whacha think I’m playin wich you!, dis ain’t no game.” He attacked, cutting my patients arm. His friend pushed him out of the way and got between the two, there was a short struggle and the boy fell to the ground bleeding and gasping for air. The four got back in the car and were gone.

*                             *                              *

We arrived at the Hospital. We unloaded our patient and I saw 202′s ambulance parked with it’s back doors still open. As we walked down the hallway I made it a point to push the gurney a bit faster as we past the trauma room. Thankfully the curtain was drawn. In the main ER there were two runs waiting in front of us, A transfer and a BLS Patient with flu symptoms.

I walked up to the triage nurse and gave a quick report. I told her that our patient was part of the same incident as the trauma that had come  in.  “is he stable?” she asked. “yes but he needs a work up.” “ok, well it might be awhile” she said. “I understand”  I walked back . “is my friend alright? Where is he?” “He’s in another part of the hospital, the doctors are working on him. He may even be in surgery now, I’m sorry I just don’t know.” My partner came over and started taking a new set of vital signs, I took this opportunity to go back down the hall.

I saw 202 standing out side the trauma room, the curtain was half open now and nurses and techs were slowly walking out and throwing away their plastic gowns in a red bio-hazard  trash can outside the door. Ray caught my eye and shook his head. I looked down and slowly walked back to the main ER.

Now the triage nurse was talking and getting basic information from my patient. when she was finished he turned to me. “Do you know anything about my friend yet? when can I see him?” My stomach ached and I felt my heart beat harder. “I don’t know, he’s still with the doctors. We are just going to have to see what they say.”

That hurt. I knew.  I knew his best friend was dead, I knew he was still warm and less the 50ft away. I knew….  I never lie to patients. But I did today. I don’t know why I couldn’t tell him. Perhaps I felt it wasn’t my job, or maybe I didn’t feel like I was old enough to give that kind of news. Yes I was older then him but, not by much. I’m not proud that I lied. I don’t think it was right, but I’m not sure it was wrong either.

Just than a Police officer and a homicide detective showed up . They asked if they could talk  to the boy, I said yes and stepped back to give them room. As the interview went on I watched as he had to relive and tell the tragic story again. With each passing minute he looked younger and younger.

I thought about what I was like at 17y/o. If my friend and I were just walking down the street and then were suddenly attacked. what if I were killed?, what if  my friend was killed? This boy was hurt and scared, but he was also calm and brave.  A room opened up and we helped the boy get on to the hospital bed. “you’ll be alright” I told him. “thanks” he said. Just then his friends parents came in the room and ran to comfort the boy, they hadn’t been told yet. The police followed close behind and started to ask more questions. I left the room.

My partner was already outside with the gurney, and on my way back down the hall I ran into the trauma surgeon. I asked about the boy. He said that he had been stabbed four times in the chest. One went through his left ventricle. when ever a patient dies you ask your self if there was something I could have done better or different. In this case there was nothing that would have helped, he bled out in less then a minute. If he hadn’t tried to protect his friend then he might still be alive. But then again things may have just ended up the other way around.

I thought I’d make it outside before the inevitable but I wasn’t fast enough. There it was, the worst and most haunting sound you can hear. The scream of a mother who has lost her child. It first echos off the cold tile floors and then rattles in your head, then you feel it in your chest before your mind rewinds and plays it all back for you.

Back at station the other crew asked “hey how was that stabbing?” “It Sucked” I told them.  I watched the news that night and they never mentioned the murder. The next morning I checked the internet and still couldn’t find any details. A week later I heard that three of the four suspects had been caught, and that they were wanted for other crimes.  I suppose some justice was served. But that won’t change what happened on that early summers night.

17
Jan
10

Do These Gloves Make Me Look Fat?

By Jeramedic 4 Comments
Categories: Rants
Tags: , , , , , ,

A Nurse puts on a pair of exam gloves and then rips the fingers off. Then cleans an IV site, then touches the vein to be punctured with ungloved fingers.

A Doctor (not wearing face or eye protection) sutures a lacerated lip of an intoxicated man who spits bloody saliva into the air. The Doctor shouts at the patient “don’t spit I’m trying to help you!” The patient spits again, this time hitting the Doctor in the face.

A EMT puts on gloves while en route to a call. He runs the entire call in that same pair of gloves, Then he  drives half way to the hospital in the same dirty, contaminated, sweaty, had on for the last twenty minutes gloves.

What do these three scenarios have in common? They are all incorrect uses ass backwards uses of protective equipment that I have witnessed.

In a study preformed at the Hospital of Kaunas University of Medicine from January to June of 2006, they found that of the workers surveyed ( the number of participants are not given ) 62.1% reported exposure to biological fluids. Exposure of healthy skin and eyes to biological fluids occurred in 63%. 60% of the exposures were due to “blood splashes”. And it was found that No personal protective equipment was used by 14.5% of the respondents during sharps injuries and 5% during exposures. This study was preformed only on surgical staff, but it reinforces the fact that the world of medicine is a filthy dangerous place. I know that most of you (I hope) take BSI very seriously. I would not be bringing all this up just to state the obvious, but something happened to me recently.

There was this patient. Mid 30′s, male,  and he was trouble. When I got to him he was very altered and very combative. He was restrained to the gurney and was covered in sweat and blood. He caused one paramedic to be exposed by spiting and getting blood on his arms and chest after fighting and pulling out three IV’s. The patient had received 2mg of Ativan IM and was ever so slightly starting to calming down. I was to take over care, and before I approached the patient I pulled out of my pocket a pair of very well fitted and good looking 3M goggles and put them on. I was Laughed at by the others on scene. “Dude are those goggles? are you actually going to wear those?” I don’t believe it. Are you serious? Do I actually need to defend the fact that I Don’t Want Sh*t in my eye?………yes.  Since when did it become a party foul to be safe? When did being smart go out of fashion? Did I miss something? I have had colleagues both in and out of hospital say that with “intact skin and proper hand washing you should be fine” and yes that is sort of  true to a point, but come on. Really? Is that how you want to play?

Look folks, “BSI Scene Safety” doesn’t just pass tests, it also increases the odds of you coming home at the end of your shift. It increases the odds of you having a long healthy career. It keeps your family healthy. And BSI isn’t just for us, it helps keep our patients healthy too. In the beginning, education can do better to teach new providers. Along the way preceptors, FTO’s and crew mates can help to reinforce good habits. But at the end of the day, personal safety falls on you.

Be good.  Play nice.  And stay safe out there.

12
Jan
10

Tragedy, Beauty, Denial and “The hot girl”

By Jeramedic 3 Comments
Categories: Memories
Tags: , , , , ,

The shift started like any other. I showed up to work  a bit earlier then most and went about preparing the ambulance. At this time I was working 12hr shifts and the ambulances that were assigned to the 12hr crews wore 99% of the time understocked, out of oxygen and usually needed a wash. Also being on a “day car” as they wore called, you wore rarely in the same ambulance twice. So, you could spend three hours pimping out your rig for the day and then next shift be back where you started with a understocked, unwashed, mysterious flashing light on the dashboard  beauty. After I got the ambulance back up to just above acceptable standards I went inside the station to wait for my partner to show up.

A few minutes later she walked through the door, powder pink jansport backpack in one hand, cell phone in the other. “You working 1116?” she asked, “Yeah” I replied. “Cool! I’m driving” she said. “Handle it” I told her, “it’s all you”.

This was Megan, she was not my regular partner which didn’t really mater because I hadn’t had a regular partner for the last month. The last several shifts had been a slew of blind dates consisting of over timers, new people and one time nobody.

Megan and I had never worked together or even really formally met, but I knew who she was. She normally worked out of station 17, about 12 miles south east of where we wore today on the industrial side of town. She also had the reputation of being one of  “the hot girls” at the company. I wouldn’t have gone so far as to say hot, she presented herself more feminine then some of the other female employees but I guess that’s all it takes. We were quickly acquainted and off on the road.

*                              *                              *

The day was going pretty smoothly. our conversation was lite but pleasant, no real critical calls had come our way and now it was lunch time. Once Megan found out I was Vegetarian I went into my scripted and very well rehearsed set of answers and explanations. “No it’s not religious”, “yes I’m green conscious”, “no I’m not a hippie”, “yes its ok if you eat meat”. I have been a Vegetarian my entire life so I have gotten pretty good at answering most questions on the subject. I’m also “a foodie” so I appreciate good meat even if I don’t want to eat it. She told me a story of how one of her friends tried going veg so she could lose weight. I appreciated her effort in the conversation and that was that.

After lunch we got dispatched to the local hospital for a transfer going from the ER to a private residence. The additional info read “male, 58y/0, history of cancer, room#3″. We parked in the ambulance bay next to another crew who was bringing in a woman with shortness of breath.

We followed them into the ER as I double check the room number on My pager. Normally I like to get a report from the nurse and have all the paperwork straightened out before seeing the patient. But like most days the ER was packed, and the only nurse I could see was with the other crew trying to figure out where to put their patient. Just then a third crew came in, and so today I ended up in the patients room first. Mainly to just get out of the way.

Megan and I walked in, “hello, ambulance” I called as I knocked on a tray table next to the closed curtain. “Come in” a woman’s voice answered. I drew back the curtain and found the woman sitting in a chair with her purse in her lap and a uncomfortable smile on her face. Next to her in the bed was our patient. He looked awful. It was plainly obvious that he was trying very hard to die, and from the looks of things was getting pretty close. His skin was ashen and grey, cold sagging and dry. His breathing was labored and he was  very lethargic.

On the bed was a basin half full of dark coffee grounds vomit which is a sign of gastrointestinal bleeding. The latest blood pressure on the monitor read 80/52. “I’m sorry for the mess” the woman said. “My husband was sick earlier”. I excused myself and left Megan with the couple. I left to go find the nurse or somebody and before I could get into the hallway I was handed a thick envelope.

” Here you go” a nurse said. “Room 3 right?”,  “uh yes” I said, “wait This man is in no shape to be leaving the hosp” I was interrupted. “He is leaving AMA” ( against medical advice) “his wife has all his things”. “Oh”,   “whats wrong with him?” I asked. “stomach cancer, it’s metastasized to everything…oh and he’s a full code”.  The nurse turned and was gone as quickly as she appeared.

I briefed Megan about the situation and we moved the patient over from the hospital bed onto our gurney. He groaned as we pulled him across on the sheet. We made him as comfortable as we could, buckled down the belts and headed out. With his wife following close behind I looked back and said “you’ll be riding up front with Megan if that’s alright?”. “Oh that’s just fine, do you need directions to our house?” she asked. ”We have you address” Megan said, “but directions would be great”.

*                              *                              *

On the way to their house I could overhear the woman telling Megan about all of the things she has planned for her and her husband “once he recovers”. Between directions there was a new story. “-and this year we are going to Ohio to spend Christmas with my sister”. “-make a left at the next light”. “-and he will be retiring in a few years and you know that might the time we finally make it to the Caribbeans”.  I looked over at this sick dieing man and wondered if he would even make it home, never mind Jamaica.

We arrived at their house, there were still four of  us. We parked on the street at the bottom of a long driveway. We unloaded the man, and once at the top of the driveway realised that the stairs to his front door wore too narrow for the gurney to be brought up safely. “We’ll have to carry him in” I said.  The wife went in front and unlocked the door. We picked the man up off the gurney, Me holding his legs and Megan at his back and under his arms. We followed the woman, and the usually easy task of carrying a man up three stairs proved to be much more difficult then it should have.

Once inside she lead us to a bedroom, we set him down on the bed and drew back the covers. He rolled over and groaned, I suppose that meant he was comfortable. Megan walked out of the room “I’m going to clean up the gurney, see ya outside”, “ok” I said. I walked back through the house and found the mans wife in the kitchen. She was cooking up a storm and had three pots on the stove.

“Ok  ma’am, he’s resting in bed, Is there anything I can do for you before I leave?”.  She turned away from the stove and with that same uncomfortable smile said “Oh no, I’ll be fine” ”And thank you both very much, You know this is my mothers recipe and he’ll be glad to have it because he just” She stopped herself. There was a pause. “He’ll be alright…wont he?” There was another short pause.

“I can see that you love your husband very much, and I’m sure he knows that”, “You should be proud of the life the two of you have had together”, “maybe turn the stove down and go spend some time with him”. “Thank you” she said. She signed my paperwork, we said good bye and I left.

On My walk back down the long driveway I wondered if in 20 minutes I’d back in their bedroom doing CPR. I got back to the ambulance, opened the passenger side door and tossed my clipboard up on the dash. Megan was fixing her hair in the rear view mirror and barely noticed me. I climbed in side, “so what do you think of all that?” I said. With out looking away from the mirror Megan replied “he was kinda heaving wasn’t he?”   ”yeah” I said, “he was kinda heavy”.

10
Jan
10

Can I Get You A Blanket?

By Jeramedic 2 Comments
Categories: Good Medicine
Tags: , , , , , , , , ,

Today I read I great article by Greg Friese about cold weather response tips.  Greg writes that provider safety is number one, and of course I agree. Personal safety always comes first on any response, no mater what the weather. Ok, so we made it safely to the call. We are  wearing the appropriate gear for the weather and the type of call, and we have a safe and secure work area. Now what? Now we must try keep the patient as warm and safe as us. At the end of Greg’s post, he also has a short video showing how to keep a patient warm using sleeping bags and a plastic tarp. This is a great technique, but is better suited for wilderness medicine or extended rescue or extrication times.

Here’s  the deal. It doesn’t have to be -20 and actively snowing before you should  start thinking about keeping your patients warm. when our patients are ill or  traumatically injured, their ability to maintain an appropriate temperature is compromised. To compound that problem we remove their clothes, put them on a cold backboard or gurney, start to fill them with IV fluids that may as well have  come from a refrigerator and then take them outside into cold  ( unless of course the above was all performed on the cold ground and outside to begin with )  This is bad patient care plane and simple. Consider this: When  someone is cold, they shiver. Shivering yields poor EKG’s, it changes respiratory patterns,  and it increases oxygen demand. When someone is cold they will have peripheral vasoconstriction which makes it more difficult to start IV’s, it changes skin signs, it gives inaccurate SpO2 readings and above all when someone is cold, they are uncomfortable. There are some simple things you can do on your next call that can keep your patients warm and happy.

  • First, if your service has a linen exchange with your local hospital then use it. Stock up on extra blankets and keep two or three on the back of your gurney.
  • Use yourself as a thermometer. If you are cold, so is your patient.
  • Pad the backboard. this is something we should be doing anyway.
  • Only expose the patient as needed, and once you are finished with the exam or treatment  cover them back up.
  • If time and you patients condition allows, encourage and help them to dress warmly before leaving their house.
  • When you arrive on scene turn on the heat in the ambulance. After ten minutes it should be nice and toasty.

These practices are simple and effective.  It’s about taking care of our patients.  Not just clinically but as people. “Can I get you a blanket?” and “are you comfortable?” go a long way.

What are some ways you look after your patients in the colder months? Does your service have special protocols for cold weather operations? speak up! and stay warm out there.

Twitter Updates

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 44 other followers

Follow

Get every new post delivered to your Inbox.

Join 44 other followers