Author Archive for Jeremiah Bush

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06
Oct
10

The Community of Paramedicine: Pt 1

By Jeramedic 4 Comments
Categories: Events, Good Medicine and Rants
Tags: , , , , , , , , , , , , , ,

Last week I spent my time in Dallas at this years EMS Expo. It was a wonderful experience of both personal and professional growth, and something a recommend everyone attend at least once. But this post is not about the event, or the speakers, or the podcasts, blogger meetups, or even the “shhhh, super secret high-viz, bluetooth  enabled airway adjunct/C-Spine translator backpack gurney, that is going revolutionize the way we…”

This is more of an observational post about what happens at events like EMS Expo, and in the online communities. Something that I am seeing more of, but not as much as I’d like. Our friends in Fire Suppression and Law Enforcement have had a “brotherhood” for nearly a century. That unspoken bond that removes the illusion of rank and department and simply says “we are.”

Granted, Fire and Law have had about a century’s head start. And when it comes to the method and delivery of Fire protection and Law enforcement, a  near uniformity exists from one department or city to the next. But when it comes to EMS, there can be near poller opposite within the same county. Private, Public, Volunteer, Hospital based, Progressive protocols, and antiquated equipment, BLS, ILS, ALS, all sharing boarders. And any combination of the above could respond in teams from one on up to six plus. They could be in a car, ambulance, fire engine, or a private vehicle.

No wonder we struggle to find an identity, let alone a brotherhood. In many ways we are our own oppressors. Thanks to the “popularity” of privatized/for profit ambulances, we are treated like numbers, and view other providers from other services as competitors rather than colleagues. This is a an unfortunate and foolish mistake. We are all EMTs and Paramedics. We went through the same testing, we have same card(s) in wallets, we take care of the same people. So can we just be done with this whole tribal nonsense already?

The funny thing about all this, is that it only happens in the field. What is it about driving around in different colored ambulances that makes many of us act this way? You see, I don’t believe that this is our true nature. I don’t act this way, and I know many other who don’t either. But for some reason only at EMS conferences and on social sites like twitter and facebook do these  walls come down on a large scale.

There, out of uniform,  we stand as equals. Its in this space, in person and online where a student from Ohio can be mentored from Louisiana. Where providers from opposite coasts can feel like old friends, when in fact they just met. And where Medics from around the world can come together and create something bigger then themselves, and give back to the community that helped create it.

This community is what strengthens us as a profession, and as individuals. Its this community that wanted EMS 2.0 when its was just called “I wish things were better.” And its this community thats going to gets its wish. We all agree that it take a special kind of person to do this work. Well, what kind of person is it who will take time off of work, and spend money to go be surrounded by work? This is EMS Expo, and this is the community of paramedicine.

This kind of community is what we need when the boots hit the ground. I wear a blue shirt, you a white shirt, and others red and green, But we are all on the same team, and until we start playing like a team, none of us will win.

More to  in part 2.

08
Aug
10

What’s The Blood Pressure?

By Jeramedic 12 Comments
Categories: Rants

Recently I have been taking 90% of my blood pressures with an automated cuff off of a LifePak 12. Cool, right ? Not really. You see up until now, all my blood pressures have been done manually with a cuff and stethoscope. Now some would argue that the “convenience” and “accuracy” of this technology is an asset to modern Pre-Hospital care. And that I should get with the times. (I’m young and only 4 1/2 years in… I’m with the times)

To be honest, I don’t like it. And I don’t like what its training our Paramedics and EMT’s to do. And that is to play the monitor like a penny slot in Reno. Before I get into that, I’ll highlight the pros of an auto BP cuff, to which there are some.

First: Yes, it is convenient. And who could argue with data storage, and the ability to transmit that data to the ER or an e-PCR… That’s about it. What I see are providers doing their assessments, and when the auto PB pops up its reading, their is a moment of contemplation. The questions is do i like this Blood Pressure? Or, Do these numbers make sense? sometimes there is even an exchange among care givers that goes something like: “you ok with that?… sure” or “you like that one?… nah, try it again”.

So what happens if you don’t like the first BP? take it again. How about the second? No? well we’ll try it one more time. So now after 3-5 minutes, you have 3 different BPs and what?

There are many factors that can interfere with an Auto Cuffs reading. Things like: A moving ambulance. A moving patient. An incorrectly sized cuff. A patient that is especially Hypo or Hypertensive, and so on. Yes, movement of the patient and the ambulance can disturb the process of taking a manual BP, but by holding the patients arm, it allows you to support and stabilize the arm, while also discouraging the patient from moving it.

The deal is, when I take a manual BP, and its 230/110, I know it is because I heard the pulse at 230, saw the needle bounce at 230, and followed it down to 110. Same goes for 88/60. I saw it, heard it, felt it. I find another advantage to manual BPs, is that you can assess skin signs, respiratory effort, and you can hear and feel the strength and rhythm of the pulse. If you allow it, a manual BP can tell you a lot about the cardiovascular status of your patient.

Now I’m not calming that my ears, or anyone else are the best in the world. And  of course there are times when you just cant hear anything, and a few other situations when an Auto BP cuff can help, but generally, I prefer a manual. In the end it all comes down to a good assessment , and an accurate Blood Pressure  is a major piece of that assessment.

Do good, and treat well.

18
Jul
10

Vistsing My Roots.

By Jeramedic 2 Comments
Categories: Memories
Tags: , , , , , , , ,

Last Sunday, the day before I left Los Angeles to go to Louisiana for my internship and the Mutual Aid project, I took a little trip with my family.  Before my farewell dinner, we all drove out to a small community in the Angeles National Forrest. This is where I spent the first eight years of my life, and on that day where I would reflect back on my past.

I lived there with my mother and father for eight years, and then on the seventh year my sister joined us. It was a small rural community of only about 40 houses, but at the same time we were only a 15 minutes drive from the L.A city boarder. Law enforcement was through L.A Count Sheriff with a 30+ minute ETA. No EMS, and little fire fighting capabilities. All we had was a U.S Forrest Service station, with so so staffing.  The only time my family called 911, my mom and brother were transported in a L.A County Fire Helicopter. That is another story for another day.

We lived down the road from my cousin (on my dads side), who is  a Paramedic with Austin-Travis County EMS. Our Grandfather, was also an L.A City battalion chief, so I guess this whole EMS thing is somewhat familiar to me. It was in this little place where I had my first experiences in public safety.

One breezy summers evening  when I was five years old, I was on a bike ride with my dad. We passed by an empty camp ground, and saw flames and embers being blown out of a public barbecue. Obviously left by a less then considerate day tripper. We road a short distance to the USFS ranger station looking for help. (this was 1990, so cell phones weren’t really an option)  After waiting at the door for some time, it was clear there was no help to be had. So we quickly road home and came up with a plan.

After filling several containers with water, we returned to the scene in my dad’s truck. And for a short moment, and on a very small scale, I was a Firefighter. For the next two summers almost every evening was spent with my dad and I patrolling the camps, protecting our home and community, and bonding.

I moved to the suburbs when I was eight, and the fire patrols stopped. In the summer of 2009, while I was away at Paramedic school in the San Francisco Bay. There was a fire. A big fire. The Station Wildfire was the largest wildfire in the history of Los Angeles County. It burned 160,577 acres (251 sq mi) destroying 209 structures , including 89 homes and killing two firefighters. One of the structures destroyed was my old house.

On the day before I  left for Louisiana, I visited my first home, or what was left of it. It had been sixteen years since I stood on that ground, and in some ways I never left.

You cant really explain the feeling you get when standing in the ruins of your childhood home. But it felt very fitting to be there, to remember the past, and then dive head first into the future.

09
Jul
10

Project Reveal! Mutual Aid

By Jeramedic 3 Comments
Categories: Events and Uncategorized

So here it is, the big reveal! Or big to me at least. In Three days, I will be boarding a plane, and leaving my home in Los Angeles, to work and intern in rural Louisiana. With much support from our friends, Ted, Justin, and Mark from The Chronicles Of EMS, Natalie Quebodaux (MsParamedic) and my self will be documenting my experiences in a series fittingly titled Mutual Aid. After all, 1800 miles away is pretty far out of district.

I’ve worked in a major metropolitan EMS system since 2006, so going to rural Louisiana, with 20 plus minute response times, and hospitals sometimes 45 minutes away, Plus the possibility of hurricanes, and the lack of field support (mainly the fire departments) it is going to be one crazy adventure.

Once or Twice a week, there will be videos posted on the Chronicles Of EMS “Ning” site, and on the show’s YouTube Channel. There will also be a live weekly Ustream show, where you can log in to the chat, and ask question, give comments and suggestions, and really help and participate in the show.

I am really excited about this, and I hope all of you  are too. The first video will be posted at the beginning of next week.

Where can you find it? What can you?

Watch it either at YouTube, or on the CoEMS site

Get involved in the weekly Ustream.

Talk about it on Twitter with the hash tag #MutualAid

And get in contact with us at mutualaidtv@gmail.com

See you soon :)

03
Jul
10

Shock Pt 2: Cardiogenic Shock

By Jeramedic 2 Comments
Categories: Clinical
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In Pt 1, I reviewed anatomy, physiology, and the basic pathophysiology of shock. If you have not read that already, I recommend you do so first. With that, lets talk about a form of  shock: Cardiogenic Shock.

In a nut shell, cardiogenic shock is an inability of the heart to pump enough blood to supply the tissues with oxygen. And is defined as insufficient forward cardiac output.  Cardiogenic shock is usually the result of a significant bradycardia (heart rate that is too slow) or heart block, or a significant tachycardia (heart rate that is too fast) resulting in low cardiac output and hypoperfusion. Cardiogenic shock can also be caused by severe left ventricular failure secondary to acute myocardial infarction, congestive heart failure, chronic untreated hypertension, cardiomyopathy, or long term habitual use of stimulant drugs like cocaine.

The heart can be divided into two halves,. the left, and the right. The left side is responsible for receiving oxygenated blood from the lungs ( via the left atrium) and pumping it to the rest of the body (via the left ventricle). If the left sides ability to pump blood  is compromised, then back pressure will build up in the system. Because the left ventricle is responsible for pumping blood to the systemic circulation, SVR, or systemic vesicular resistance plays a large part in the process. If the stroke volume and cardiac out put is not enough to overcome the SVR, (as in untreated hypertension) or the ventricle is weakened (as in a myocardial infarction or cardiomyopathy) then pressure will back up into the left ventricle. The hearts pumping ability can also be diminished by a cardiac tamponade, or a tension pneumo/hemothorax.



If the heart is not pumping blood into the systemic circulation effectively, then the body becomes hypoperfused. As the pressure builds in the left ventricle, the myocardium (heart muscle) will stretch to accommodate the larger volume of blood. The muscle can stretch, but only to a point before it weakens and fails, causing even less efficient contractions. The pressure will then spread to the left atrium. The left atrial pressure rises and is subsequently transmitted to the pulmonary veins and capillaries. When pulmonary capillary pressure is too high, it forces blood plasma across the alveoli-capillary membrane and to the lungs, causing pulmonary edema (fluid in the lungs).


The hypoperfusion is compounded by the fact that most cardiogenc shock due to left ventricular failure is accompanied by pulmonary edema, which dramatically reduces the ability of oxygen and carbon dioxide to diffuse across the alveoli-capillary membrane. Also, since left ventricular failure is often caused by an AMI (acute myocardial infarction) be awhere that your patient experiencing cardiogenic shock, may also be having an AMI.

Right ventricular failure by it self, will not likely result in hypoperfusen in the same way as left ventricular failure. But, right sided failure is interestingly often caused by left ventricular failure. Right sided failure can also be caused be chronic obstructive lung diseases like COPD. As the back pressure spreads to the right side of the heart, peripheral edema in the dependent parts of the body, and JVD (Jugular vein detention) often occur. These are both key signs to look for during your assessment.


The patient in cardiogenic shock may present tachycardic or bradycardic. Will likely be short of breath with possible chest pain. Possible JVD (right side failure). Lung sounds may be clear, diminished, wheezes, crackles, rales or absent depending on the severity of pulmonary edema. White or pink frothy sputum may be present. The patient will likely have fast labored respirations. Level of consciousness may be diminished due to hypoxia. Skins may be cyanotic and or diaphoretic. Spo2 reading will be low. Blood pressure will likely be normal or hypertensive (in exacerbated congestive heart failure) or  low in decompensating shock.

Treatment is aimed at airway and cardiac support. The patient should be placed in a position of comfort. If pulmonary edema is present, the patient well likely prefer to be sitting upright in a high fowler’s position, with their legs hanging off the gurney. Although the patient may present in a state of shock, treatment should also consist of treating the underlying cause (AMI, CHF) which if managed effectively, can relieve the hypoperfusion.

When available, a 12 lead EKG should always be obtained. Support the airway and breathing with High flow O2 via non rebreather mask, you may need to assist ventilations via BVM (bag valve mask), CPAP, or intubation. Nitroglycerin (if blood pressure is acceptable) will reduce cardiac work load and oxygen demand through vasodilatation, and relieve pulmonary hypertension and edema. Morphine may also be useful. Furosemide 40-80mg IV will relieve pulmonary edema through diuresis. IV fluid administration should be minimal so as not to exacerbate the pulmonary edema.

Cardiac support with Dopamine at 2-10mcg/kg/minute, or Dobutamine at 2-20 mcd/kg/minute will increase the force of cardiac contractions, increasing systemic perfusion and reducing pulmonary hypertension.  If the patient is bradycardic, than 0.5mg of Atropine IV, or trans-cutaneous pacing to increase the heart rate to a perfusing level is appropriate. Always be cautious of AMI in a badycardic patient, because bradycardia can be a protection response of an ischemic heart. Tachycardias (depending on the type, and severity) can be treated with 6-12mg of Adenosine, and other antiarrhythmics like Amiodarone and Lidocaine. Also Synchronized cardioversion if available, and in some systoms a Beta blocker may be indicated.

The patient may have additional cardiac compromise such as AMI which will require appropriate treatment, and transport destination.

*** Always treat your patients according to your local protocols and scope of practice. And use medical control as needed. ***

In part 3 we’ll leave medical, and deal with trauma, burns, and Hypovolemic Shock.

30
Jun
10

Shock Pt 1: Anatomy, Physiology, and Pathophysiology Review

By Jeramedic 8 Comments
Categories: Clinical
Tags: , , , , , , , , , ,

This is the first in a series of posts, that will go over the five types of shock. Covering the basics of pathophysiology, presenting signs and symptoms, and the course of treatment. Before we can understand the various types of shock, we must first have a foundation on which to build.  What follows is a review of  anatomy, physiology, and the general pathophysiology of shock.

Shock is a serious life threatening medical emergency, and can be caused by several conditions.No mater what the cause , the end result will be Hypoperfusion of the cells (Shock) and if uncorrected, death. The cells of the body require a constant supply of Oxygen and other nutrients, as well as a content removal of Carbon dioxide, and other waist products in order to functions efficiently and maintain Homeostasis. For normal perfusion to occur, three systems must be intact: The pump (the heart) The pipes (the blood vessels) and The fluid ( the blood ).

The pump is what “pushes” the oxygenated blood from the lungs, and circulates it to the cells, tissues and organs of the body, where oxygen and other nutrients are exchanged for carbon dioxide and other waist products, which are then carried back to the lungs and other organ systems (such as the liver and kidneys) to be removed. If the pump is too slow, as in Bradycardia, or pumps too fast or inefficiently as in Supra-ventricular tachycardia or other arrhythmias, or if the pump is not strong enough to circulate the blood effectively, hypoperfusion may occur.

The pipes are what carries the blood to the cells and tissues of the body. If there is a obstruction in the pipe as in a Thrombus or Embolism. Blood flow and thus perfusion beyond the point of occlusion will decrease.  If the integrity of the pipe is lost either through Trauma, a ruptured Aneurysm or increased vascular permeability resulting in a decrease of circulating volume, there will be less blood available to transport nutrients and waist. Also, excessive vasodilatation can lower blood pressure resulting in hypoperfusion.

The fluid is what holds and transports the nutrients and waist products. The blood contains erythrocytes (Red blood cells) which have a protein called Hemoglobin. Oxygen molecules attach them selfs to the hemoglobin so that they may be carried throughout the body. In the lungs deoxygenated blood travels through the capillaries surrounding the alveoli. Through the proses of diffusion, oxygen which is at a higher concentration in the alveoli, crosses the alveoli-capillary membrane into the blood where there is a lesser concentration of oxygen. At the same time, carbon dioxide which is at a higher concentration in the blood, crosses the capillary-alveoli membrane into the alveoli, where it is removed during exhalation. The oxygen molecules bind to the hemoglobin and is transported throughout the body. The blood enters capillaries within the tissue where again through diffusion oxygen is exchanged from the blood to the tissue, and carbon dioxide form the tissue to the blood. The blood, now deoxygnated returns the the lungs where the process repeats it self.

If there is a decrease in circulating volume as with blood loss and or dehydration, there will be less blood to transport nutrients and waist products. Also conditions effecting the red blood cell and its hemoglobin such as anemia and carbon monoxide poisoning can decrease the amount of oxygen that can be transported to the tissues, resulting in hypoperfusion. As you can see, a malfunction in any one of the systems can result in shock.

During hypoferfusion the cells become ischemic and switch from a Aerobic metabolism ( with oxygen ) to a Anaerobic metabolism ( without oxygen ). The primary energy source for the cell is glucose. In a Aerobic metabolism glucose is broken down ( Glycolysis ) which produces pyruvic acid which is further broken down into carbon dioxide, water, and energy (ATP). However during hypoperfusion the cell switches to an Anaerobic metabolism (without oxygen) where only the first stage of glycolysis is possible. This produces very little energy and with out oxygen pyruvic acid can not be broken down, and instead is converted into lactic acid which accumulates in the cell, lowering the cellular pH. The acidosis reduces the ability of hemoglobin to transport oxygen which compounds the problem. The lower intracellular pH causes the membranes of the lysosomes and other organelles to rupture releasing enzymes that damage the Sodium-Potassium pump which causes an influx of sodium and fluid, which causes cellular edema, which causes the cell to rupture releasing the lysosomal enzymes, lactic acid, hydrogen and other cellular contents into the interstitial and intravenous space causing further acidosis.

The body has various ways of compensating during shock. However if the cause of the shock is not corrected the compensatory mechanisms will become overwhelmed and fail, causing death. A decrease in blood pressure is detected by the Baroreceptors which activates systems to reestablish normal blood pressure. The sympathetic nervous system stimulates the adrenal glands to secrete epinephrine and nor-epinephrine which causes an increase in heart rate and contractile strength, as well as  vasoconstiction all of which increase blood pressure.

In the kidneys, the detection of low blood pressure stimulates the Renin-Angiotensin-Aldosterone system. The enzyme renin is released by the kidneys. Renin acts on a plasma protein called angiotensin, which is converted into angiotensin I. Angiotensin I is converted into angiotensin II in the lungs by angiotensin converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor which increases peripheral vascular resistants which increases blood pressure. Angiotensin II also stimulates the sympathetic response, and stimulates the pituitary glands  secretion of antidiuretic hormone (ADH) which causes the kidneys to retain electrolytes and fluid. The hormone Aldosterone which is secreted by the adrenal cortex also stimulates the kidneys to reabsorb sodium potassium and water, increases the intravascular volume. As the blood pressure slowly decreases, so does the intravascular osmotic pressure, which causes fluid to shift from the interstitial space and the intracellular space, into the intravascular space to increase the circulating volume.

Respirations increase both in rate and depth. This increases the amount of oxygen available, and attempts to eliminate the build up of toxins from the anaerobic metabolism. If there is blood loss due to hemorrhage, the damaged blood vessels constrict slowing the amount of blood flow and the clotting and coagulation cascade begins. If the conditions causing shock are too serious, or progress too rapidly, the body will be unable to keep up with the demands and move into a state of decompensation.

The heart rate and respirations will increase dramatically. The skin will be very pale cool and diaphoretic. Peripheral pulses will be weak or absent. Urine out put will low or almost none. Level of conciseness will decease from agitated to unresponsive, and the body moves into irreversible shock. At this point the blood pressure is so low the heart and brain become hypoperfused. The hypoxic heart will tire quickly, possibly becoming arrhythmical before failing. The Vasomotor, cardiac, and respiratory centers of the brain will become ischemic and die causing the cessation of compensatory efforts. The blood will begin to pool and coagulate in the capillaries. Because of the loss of vasomotor control from the brain and the low blood pH, capillaries become permeable and the pre and post capillary sphincters relax causing wash out sending microemboli and toxins into the tissues and systemic circulation, and the body dies. Once the body moves into the late stages of decompensation and irreversible shock, resuscitation and survivability are extremely low.

Now that we have all that taken care of, we can move in to the various types of shock, and what to do about them. Remember that for a patient experiencing shock, the best treatment is always safe and efficient transport to an appropriate facility.

In part two, the basic pathophysiology, signs and symptoms, and treatment of  Cardiogenic Shock. <—- Read Here

29
Jun
10

GenMed Show, and FIRESTOME Premiere

By Jeramedic Leave a Comment
Categories: Events and PodCasts
Tags: , , , , , , , , , , , , , , ,

Natalie and and myself welcome special guest Sam Bradley to the show, and talk about our experience in San Francisco at the FIRESTORM Movie premiere.

Every minute in the United States, an ambulance gets turned away from an emergency room because hospitals are simply too full. In Los Angeles, where the wait time in some ERs is as long as 48 hours, the entire 911 system is being challenged in ways that are alarming.

It was a really great experience going back to San Francisco for this event. I was able to spend some time with some friends from the Chronicles Of EMS event. Something very special about this trip, was being able to share it with my mom and sister. The week before we were visiting family in beautiful Lake County California, about 2 1/2 hours north of San Francisco.  After the visit, we all drove down to the city. Before the premiere, we had breakfast with Chief Seb Wong of the SFFD. After breakfast, we were given a tour of the SFFD EMS station 49. Then it was off to a late lunch with Sam Bradley, and then the to the premiere and meet up. After the premiere, the very hospitably Seb gave us all  a private tour of China Town. Truly priceless.

You can Listen to the show —–> HERE

Also, My Good friend Scott Kier Wrote a great review of the film on his blog

27
Jun
10

Downtime

By Jeramedic 3 Comments
Categories: Uncategorized

If you asked the average person what they thought about the time emergency responders  spend between calls, you would generally get one of two opinions. One being: “Man I know you guys never get no breaks. 911, 24/7  baby, wooo.”  Or the other: “You are so lucky, I wish I could get paid to just sleep and watch T.V all day.”

These are both examples of unfortunately true public misconceptions. There is some truth in those statements though. There are some places that well go weeks without a call, while others average over twenty runs a shift. As you know, call volume is dependent on a lot of factors. Location, Population, Time of day, Time of year, Weather, Resources, the list goes on. And even when you try to calculate all of the above, sometimes it still doesn’t make sense.

But no matter where you work, there is still downtime at some point. There is however a time when having a break, can becomes a burden. The time when you don’t want to workout, You’re not tired enough to sleep, You’ve had  it with  Mythbusters and UFC, and you have even considered  (dare I say ) asking dispatch for a transfer just so you could do something.

This is a list of some of the more creative  things I have done when reaching this moment.

  • I have made two wallets out of cloth tape.
  • I scrubbed the shower and toilets. (twice in the same day)
  • I wrote a comic book staring my station mates.
  • I made a superhero costume out of disposable sheets.
  • I once made a cheesecake from things I found in the station’s kitchen.
  • I have worked on cars.
  • Attempted to learn how to ride a unicycle.
  • Assisted in the arrest of a drunk driver.
  • Did yoga in the park.
  • Played in Toys R Us.
  • Initiated an impromptu in service training.
  • With the help of three other people, stared at a light switch, and tried to move it with our minds.
  • Went to the beach.
  • And even massaged my station mates. ( I was a certified massage therapist for two years before I went to EMT school )

This a just a slice of some of the things that have kept me entertained while the city is safe.  To be honest,  I’m not proud if everything I have done when left to fend for myself. Nothing was illegal, and nobody was hurt, It just wasn’t the most professional I’ve been. This job affords you many freedoms, and they are easily abused.  Down time is nice. But like most things in life, use in moderation.

23
Jun
10

I Little Privacy Please

By Jeramedic 2 Comments
Categories: Uncategorized
Tags: , , , ,

So I think this all started with a post by a blogger named Lissa. Now the theme of this post is not very EMS, but we’ll go with it. Lissa posted about finding odd reading material  in her bathroom while she was cleaning up for some weekend house guests. She then passed on the Blog chain to the blog “To old to work, to young to retire“.

The tail of bathroom reading was told, and then passed to “Rescuing Providence“, who tagged “The Happy Medic“, who tagged “Ms Paramedic“, who then tagged me. So here we go.

Really there is not much in the way of paper reading in my bathroom. There have been times when I’ll bring in a copy of JEMS or something, but that’s not often. You see thanks to the magic of 3G, I, like most of you reading this, carry the internet around in my pocket. So, I’ll read a Blog, check emails, creep around twitter (which I guess makes me a shweeter) and will even watch some YouTube.

Now here is the kinda weird part, (if shweeting wasn’t weird enough) if I don’t have my phone, I like to read the packaging of products. So, shampoo and conditioner for instance: I think its interesting to read the claims these products make. I like to see what the ingredients are. I even think it kinda funny to read the instructions and see what “they” believe is the best way I should  wash my hair.

This is not just limited to hair care, no sir. I’ll read about toothpaste, shaving cream, lotion, cleaning agents, even the toilet paper packaging.

Hmmmm, you know after putting it all out there, it does sound a bit odd. Hopefully you all haven’t judged me too hard, and we can all go about our “business” so to speak. But now I must pass the confessions on.

So,

Insomniac Medic

Medic Madness

EMS in the New Decade

Consider yourselves tagged.

22
Jun
10

Believe Me

By Jeramedic 2 Comments
Categories: Rants
Tags: , , , , , , , , , , , , ,

In this day of computer aided dispatch (CAD) systems, GPS locators, and EMD (Emergency medical dispatch) algorithms, one could argue that the process of getting the closest and most appropriate resources to the scene of an emergency, has been greatly stream lined. There is however two things these technologies are lacking: Eyes, and judgment.

You see no matter how much tech we load into a response vehicle and or dispatch center, there are still humans that need to operate the system, update the information, and make treatment and transport decisions. Field providers, dispatchers, and hospital staff need to be able to communicate effectively with each other, and most of all, believe each other.

What follows are two examples of a break in the communication trust.

Example 1:

30min before the end of my shift, and I am en route back to the station. My partner and I notice a large cloud of black smoke rising up a few blocks away. It was 12:30am, and radio chatter was lite. We did not hear anything relating to a fire go out, and so we thought we would go investigate. What we found was a two story house, fully involved in flames, and no one was around. No crowd of neighbors, no police, and no fire engines. Me: “Base, 1116”. Dispatch: “go ahead 1116”. Me: “1116, who do you have responding to the structure fire on 132nd street?”. Dispatch: “ummmm, no response. There is no fire on 132nd street”. Me: “yes there is, I’m looking at it” Dispatch : “umm, ok? Well we don’t show any fire calls in your area. Where are you?” Me: “At 123 132nd street, and there is a house that is VERY much on fire”. Dispatch: “……. Oh! There it is… ok, well show you on scene”. Me: “Thank you”

Example 2:

At a red light, a car pulls up behind the ambulance, and two men exit the car. “this is when we get robed” I jokingly said to my partner, Bobby. The two men begin pounding on the window, they did not speak english, but it was obvious that they were asking for help, and not for our wallets and cell phones. I flipped on the amber secondaries as Bobby followed the men back to their car. As I stepped out of the ambulance I saw Bobby’s eyes get wide. “Its a GSW” (Gun Shot Wound) he shouted. I met him with the gurney at the back of a blood soaked SUV. The patient was quickly loaded into the ambulance, and I was on the radio. Me: “802, were at the corner of Any street and Somewhere Blvd, With a still alarm GSW, we need PD!”. Dispatch: “can you repeat?”. I repeated. While I waited for a reply, I helped Bobby assess and and start treatments. The patient was a male in his late teens. He was pale and moist with labored respirations and diminished lung sounds on the left. He had a a 2cm entrance wound to his left upper chest, mid clavicle. And a 3-4cm exit wound just below his left scapula. Dispatch: “whats the gender of the patent?” Me: “Male! Is PD en route?” I handed Bobby an occlusive dressing and asked if he was ready to go, “yeah, lets get moving” he said. I got into the drivers seat just as a county sheriff pulled up. I gave him a 10 sec report and left. Me: “dispatch 802, we are transporting code 3 to Saint F’s “. Dispatch: “do you need fire to respond”. Me: “No thank you”.

I understand that dispatching is not always the easiest job, and that there are protocols and procedures that must be followed. But when I ask for help, believe me. I promise I don’t make things up just to complicate things.

We are a team. And if we cant communicate and trust one anothers information, we loose points on the field. I am not ragging on dispatchers, I’m just promoting better professional trust. I encourage you to get to know your colleagues in the little dark room, offer a ride along, and play nice.

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