Archive for the ‘Ambulance Ride-Alongs’ Category
White Cloud No More
Filed under: Ambulance Ride-Alongs, EMS | Tags: black cloud, EMS, EMT, EMT newbie, first day, white cloud
Leave a Comment So, after only 2 days on the ambulance, they’re already calling me “Black Cloud.” How the heck did that happen so fast?!
Well, from my perspective, I’ve been a white cloud for way too long and I think it’s about time something changed. (I mean seriously, I’ve done a total of 3 ambulance ride-alongs before even going to EMT school and only had ONE call per shift. My 2 clinical ride-alongs during EMT school weren’t terribly exciting either. Even at my other job in the psych hospital I have this uncanny ability to avoid codes.) But seriously, I didn’t expect my white cloud to turn black on my FIRST call on my FIRST day on the ambulance!
Here’s what happened: As I’m pulling into the station parking lot, I see the garage door going up and the ambulance pulling out. They pull up behind me and shout “Get in! We’re going on a call!” I grab my stuff as fast as I can and hop in the side door of the ambulance. Now I have no idea what kind of call we’re going to since I had just arrived for my first day and hadn’t been assigned my pager yet. We arrive on scene and the EMT-I leans in and solemnly tells me, “This probably won’t be a good thing.” And sure enough, we get inside and the family stated, “We just found him like this.” I’m thinking, Oh no…he’s dead.
Yes, indeed. My first call as an EMT was a full code! Not a very exciting one, mind you–I knew from the get-go that our efforts were futile. The guy had been down at least 20 minutes before we got there. It had probably been much longer than that, but since there was no rigor or lividity present and he was still warm, we had to run it as a code rather than a DOA. But it was asystole on the monitor from the beginning, so we delivered no shocks. Just CPR and some medications for about 20 minutes before medical control told us to stop.
I’m told I set a record. Most new EMTs have to wait weeks or months before they see their first code. I got mine before I was even technically on duty! Then we got a transfer from the local hospital to a specialized heart hospital in the city with a completely unstable patient. She was not ready to go when we got there (in fact, she was saying that she wanted to die) and it took an hour to get everything sorted out with her. I seriously thought she was going to code in the back of the ambulance in the middle of the freeway (thank god she didn’t because some doctor who was nowhere to be found had her chart with the DNR in it). Then, as 20:00 is rolling around and my shift coming to a close, a call comes in for chest pain. I decide to go even though it will add another hour or so to my shift that I won’t get paid for. (What? I couldn’t pass up a good chest pain!) It was one of those load-and-go situations—we got on scene and the gentleman was complaining his chest pain was 10 on a scale of 1-10—so it didn’t last very long, but I got to help with a 12-lead ECG and administer nitro. I really wish I knew what came of this guy. I can’t believe that I may have actually witnessed a heart attack in a 25-year old, but that’s certainly what it looked like…
So this former white cloud can certainly scratch a few items off her newbie EMT checklist after only one day. My second day wasn’t too bad either. We got a call for a woman who cut her foot after her domestic partner threw himself through the glass door in an angry rage, I spent some time in dispatch which was pretty interesting and informative, a call for an unresponsive resident in a nursing home, and when we were in the ER dropping that one off, another call came in for an elderly woman “not acting right.”
In my two days on the truck so far, I’ve gotten exposure to a good variety of calls, learned some new skills, and am learning to work well as a team with the wonderful medics and EMTs at this service. I may not be Mz. Erudite EMT Extraordinaire just yet, but I’m getting there. And if this whole black cloud thing keeps up, I may get there sooner than I would’ve thought!
For You EMS Newbies, Pre-Newbies, and Wannabes
Filed under: Ambulance Ride-Alongs, EMS, EMT Training | Tags: ambulance, ambulance ride along, EMT school, ride-alongs
Leave a Comment There are plenty of you out there who stumble on my blog looking for answers to the same questions that I had when I was first considering a career in EMS. (Don’t worry, I don’t know who you are…but I can see what you googled to get here. To those of you who type things like “nervous about my first ambulance ride-along” or “is ems right for me,” this post is for you. To those of you who search things like “pet sex” and “do you have to pass a drug test to be an emt”: I worry about you.)
I’m still a newbie myself (or a pre-newbie, depending on your definition—as far as I’m aware, the Department of Transportation does not define the different levels of “pre-EMT” so you can define it however you like!), so I still remember pretty clearly what it was like to be in your shoes: uncertain of whether this was right for me, ready to shit my pants at the thought of my first ambulance ride, etc. So, if you’re uncertain, press (or skip to) 1. If you’re nervous about your first ride-along, press 2. And if you’re wondering what it’s like to be an EMT, press 3.
1. If you’re contemplating going to EMT school, my only advice is GO FOR IT! You’ve got nothing to lose by giving it a try. It’s usually a one semester program, so even if you end up hating it, you haven’t wasted too much of your life (now if you’re contemplating entering a 7 year Ph.d program in clinical psychology on the other hand…). It’s fun and shockingly easy (you do have to do the reading, show up to class, and practice your skills regularly at minimum; if you’re not quite the natural nerd like I am, a lot more studying may be required. The point is, it’s definitely doable and you’ll get out of the class what you put into it.). All things being equal, I can’t think of any reason not to go for it. If you think you’ll like it, you probably will. If you put your mind to it, you can do it. And if you don’t, then do something else.
2. Nervous about your first ride-along? Don’t know what to expect? Worried you won’t know what to do and your preceptors will think you’re a worthless, brainless nincompoop who has no business stepping foot in an ambulance ever again? Yeah me too. I fret and fret over my first ride-along. It’s scary when you’ve never been in that situation before and don’t know what to do or what’s expected of you. I get it. But don’t worry too much. It’s really not as bad as you’re making it out to be. Just pay attention during the truck check so that if they ask you to get something, you’ll know where it is. Communicate with your preceptors so that you know what’s expected of you (don’t worry, they know you don’t know what you’re doing…they’ll generally tell you what to do, where to sit, and what equipment to grab). And finally, show some initiative so that they know you’re willing to learn all you can and are not just along for the ride. Offer to help with chores and ask questions. That’s all you really need to know. I know that all the reassurance in the world won’t prevent you from feeling nervous, but just go with it and you’ll be fine. Oh yeah, and bring your own lunch in case your crew brings their own, bring money for lunch in case your crew likes to stop for food, and bring plenty of snacks as well (it’s going to be a long day and this is perhaps the LAST situation in which you want to be suffering the effects of hypoglycemia, something I learned the hard way).
3. If you want to know what it’s like to be an EMT, I can’t help you much there (I’m still in school as of the writing of this post). Check out my “Recommended Reads” page for some good books to get you started and take a gander at the blogroll to the right as well. Many of those people are responsible for why I am here myself. So thanks for reading my blog. I hope you found what you were looking for. If not, I’ll be a real EMT soon so stay tuned. And until then, check out that blogroll!
Oh yeah, and don’t be a stranger! I love hearing from y’all so if something on this blog spoke to you or if you have questions or something to add, please comment or email me!
Clinicals: Things I Learned on the Amberlamps
Filed under: Ambulance Ride-Alongs, EMS, EMT Training, Scenarios | Tags: ambulance, ambulance ride-alongs, blood pressure, clinicals, EMS, EMT student, patient care, spinal immobilization, vital signs
Comments (1) So I had my clinical ambulance ride time on the ambulance last weekend. I did two 12-hour shifts on two trucks in two cities near where I live. I didn’t get to see anything crazy (no major trauma or medical calls, no combative psych patients, or anything like that), but I had a blast and I would say that I still learned lots.
First of all, I’m STILL a bad omen for car trouble. The first day, we were in three different trucks because we kept having problems! We operated most of the shift in the most ghetto ambulance I’ve ever seen, complete with wood paneling lining the walls and dim, flickering lights overhead. The second day, on our first call (a transfer to New Orleans), the family (who was following behind) informed us that one of our inner tires in the back was flat. Sure enough when we got to the hospital we discovered it was completely shredded and had to go to the nearest station to have it changed. So yeah, that was pretty exciting.
This particular ambulance company has ambulances designed so that the front cabin and patient compartments are separate, with only a tiny window for communication between the two. This is not what I was used to from when I did my ride alongs in Minnesota, so needless to say I was a little lonely sitting back there all by myself! I didn’t get to talk with my preceptors as much as I would have wanted to and certainly didn’t get to have all of my questions answered. Hmm…maybe that’s why they created the ambulances that way! Aha! They told me it was so that an out-of-control patient couldn’t make it to the driver and cause an accident, but I bet the real reason is to keep the students from aggravating them too much! Touche.
We do not spinal immobilize, or provide oxygen to, nearly as many patients as we’re taught to in school. I had 10 patients in those 2 days and the only one that had oxygen was a man with a broken hip who we were transferring between hospitals. Granted, none of the patients we had were critical and didn’t really need oxygen. It was just weird because it’s one of those things that’s done drastically different in the field than you’re taught in the classroom. Same with spinal immobilization. My instructor pushes this “cover your ass” medicine and advocates that any type of trauma patient “bought themselves a ticket to the spine board.” But thankfully, I learned that this service’s policy is that you don’t have to immobilize if the patient denies back or neck pain. Also, we had a patient that fell and was throwing up—I’m pretty sure if this scenario appeared on a test, the answer would be to spinal immobilize and “be prepared for vomiting” by turning the spine board on the side when the patient vomits and having the suction ready nearby. But in this real life scenario, the medic decided against immobilizing her because of the vomiting…and I’m so glad he did! That just wouldn’t have been a good situation to have to deal with had we immobilized her—for anyone. It’s difficult (and messy) to simply turn the spine board over when they start to vomit. (Now, you may have to do that when your unresponsive patient begins vomiting on you, but when the patient is responsive, alert, and oriented, why make things 10 times more difficult just because the patient might—and probably doesn’t—have a spinal injury?) And imagine if you were a nauseated patient and the EMTs forced you to lie supine and strapped to a board for the 20 minute ride to the hospital. How much would that suck? Anyway, the point of this rather longish semi-rant is that I think as EMT students, we’re taught so much to “cover our asses” that we forget that our jobs require us to, first and foremost, care for and comfort our patients. I’m so thankful that I was able to learn early on (thanks to other bloggers sharing their stories) that the best treatment according to the textbook may not actually be what’s best for the patient. And I’m really glad that the service I will (probably) be working for allows for some freedom in making these judgments.
Hmm let’s see. I also learned that I really suck at taking blood pressures in ambulances. Well actually, my first shift, my preceptors didn’t have me take ANY manual vital signs, for some reason. I really don’t know why, but for every patient we had they told me “We’ll just get an electronic blood pressure for this one.” So I’m really good at putting the non-invasive blood pressure cuff on people, but not as good at getting a manual. The second shift, they had me do it on every patient, and my first two I couldn’t get at all. The first time we were rolling along a bumpy road. It was hard enough to hear as it was but then the needle jumped every time we hit a bump! I missed the first one completely and the second time I was able to get a systolic of 118 but couldn’t hear when it stopped. The next patient was a really old lady who had bat wings hanging down from her arms. I’m guessing that was the problem that time rather than the noise. But I’m telling you I wanted to cry when I deflated the cuff and had to look up and tell my preceptor that I couldn’t get it. I swore that he looked so disappointed and was going to give me “below average” ratings and tell my instructor that I sucked. But he tried and couldn’t really get it either and after we got to the hospital he said their machines were having trouble getting it as well. So I felt a little better that I couldn’t get it not because I sucked but because it was just one of those difficult patients. I was able to get all the rest of them (And am SO thankful when I’m able to get one on scene before we get in the ambulance! It’s so much easier!).
GI bleeds are just as nasty and smelly as I have always heard. Lovely.
Finally, I learned that I’m really gonna have to learn my way around A LOT better. In just those two shifts, I was in at least 10 different cities all across south Louisiana. And the thing is, it’s not just running transfers to all of these unfamiliar cities no, no, no. You see, when you’re in a certain area, this company considers it fair game for you to run 911 calls if you happen to be there when they come in. I didn’t complain about it for my clinicals because the most interesting call we got all day was when that happened right after we dropped off a transfer. But I’ve never been to many of these cities and even the ones I’ve been to (like New Orleans) I don’t go to often and certainly don’t know my way around without precise instructions from google or mapquest (and god help me if those directions are wrong due to construction or something like that because I would not be able to figure my way around!). I know that ambulances are equipped with GPS nowadays but I was just reading a blog post the other day about how we can’t totally rely on them because they only work 90% of the time. I hope I am able to learn my way around very quickly. Otherwise I am so screwed.
All in all I had a good time and can’t wait to be a real, live, certified, working EMT! Shouldn’t be but a couple of months now…
Nerd Status: Attained
Week 2 of EMT school is complete…and I’m officially the nerd of the class!
Monday was occupied by our first exam (which I beasted) followed by our first skills day. Long spine boarding was a hoot, let me tell you. I already knew this skill from my days in first responder school and there was a guy in my group that day who had been through the EMT course already, so we were both doing our best to correct what people were doing and all that. Well when it came time for me to be the “patient,” they did a pretty good job of going through all of the steps (there are certain things that you have to do in a certain order or you fail the skill). However, when they were done, I demonstrated to them how loose some of the straps were by wiggling on the board like a worm. I told them it might be better if they put the top strap one notch higher on the board so that I would be more immobilized like I was supposed to be…….there was hesitation…..there was an awkward silence……I asked what the problem was…….it seemed the problem was that none of them felt comfortable putting the strap up higher because they would have to get too close to my boob area. Have you ever met a group of guys that were so afraid of boobs? It took a bit of prodding from me and the other experienced guy to get them to do it and the whole time they’re mumbling in little squeaky voices “I’m sorry…I’m sorry…” It was hilarious. I don’t know why they’re so afraid of my boobs, but they better get over it. Do you think I’m gonna be shy about getting ALL UP IN THEIR KOOL AID to attach those groin straps on the KED?! And if they don’t like boobs now, just wait until we get to trauma assessment! We’re gonna be feeling each other up from head to toe in a few weeks—I can’t wait to see how they deal with that! Ha ha it’s gonna be so great…
Speaking of the KED, even though I was already trained in long spine board as a first responder, KED (Kendrick Extrication Device) was new to me. I had heard of it and knew what it was, but I had never gotten to actually play with one, so that was kinda fun. However, they can tell us whatever they want in class (and they have to because it is still a National Registry skill), but I pretty much know for a fact that the KED is rarely used in real life. I was told as much by my first responder instructor plus I’ve done ride-alongs before and witnessed rapid extrication performed on a noncritical patient. But I’m sure that’s just because paramedics in Minnesota are lazy and reckless. I bet the Borg medics ALWAYS use the KED when they’re supposed to. 
But then again, that opens up a whole new discussion on immobilization techniques and whether any of them actually work anyway….we can talk about that another time, perhaps.
We spent the entire rest of the week on anatomy and physiology, which was super fun! A lot of it I already knew from past experience (combination of high school, college courses, and first responder training), but I definitely learned some new things too. I’m actually amazed at how detailed it is and how much we’re required to know. I didn’t think that EMTs were taught so much A&P, and it turns out I was right. As of now, according to my instructor, A&P isn’t really emphasized that much in most EMT courses because it isn’t required to be. However, beginning in January of 2012 that will change and EMTs will be held responsible for knowing a lot more A&P. But he bragged that this school has been teaching the new curriculum since January of 2011, so we’re a bit ahead of the game. This is a very good thing and it makes me happy.
Next week we do airway and I get to learn another new skill: combitube!!
As happy as I am to be learning a lot of useful A&P, I’ve still got a lot of studying to do before my exam on Monday, so I’ll end it here and go get started on that! I’ve got to make a good grade…I’ve got a reputation to maintain, after all!
P.S. I am still working on some more pet peeves so look out for those! I’ve just got to find a better balance for all of the things I’m trying to juggle! Bear with me! And follow me on twitter @EruditeEMT!
Observation WIN?
So I did my final observational ride-along yesterday…..and well….it didn’t go quite as I wanted it to. However, I’m slightly less angry today than I was yesterday so hopefully I can manage to share a couple of things that I got out of it and leave the bitterness aside…..
1. Stretchers are fucking heavy (and so are people)!
On the one call that we went on (elderly man not feeling well), I helped Joe get the stretcher into the house, which required lifting it a little over the steps to get inside. Let me tell you, lifting the stretcher with no patient on it required a bit of muscle! I mentioned this to them after the call and they said that the stretcher by itself weighs about 90 lbs. I was stunned. I mean, I am already working on getting into better shape so that I will be able to lift people as my job will require, but I guess that really gave me an idea of just how far I need to go! Of the three patients I’ve seen so far, none of them were overweight…but most people are. I could have lifted them if I needed to, but I’m guessing that these types of patients are in the minority.
Goal: BUILD SOME FREAKING MUSCLE. (Well, it’d be great if Americans would just get lighter….but I’m guessing I don’t have a whole lot of control over that……damn.)
2. Making people feel better/more comfortable really is what this job is all about.
That one I already knew, but I got to experience it first hand yesterday. Like I said, the one call that we had was for an old man who wasn’t feeling well. His wife said that he had gotten sick a few days ago with what she thought was an upper respiratory infection. Then he woke up that day and was shaking so badly that she was scared something was seriously wrong with him, so she called for an ambulance. This old man probably has the flu (he had a fever of 103 yet was freezing, and an unproductive cough), so there wasn’t really a whole lot that could be done for him by the medics, except to make him as comfortable as possible for the bumpy ride to the hospital. I put a warm blanket over him, plus a two or three more on top of that and could visibly see him shaking less and less until almost not at all when we got to the ER. Mission: Accomplished. That was seriously the most exciting part of my day. Lame? Maybe. But it was still pretty cool to me. (Of course, at the time I was expecting that that would be one of several more calls we were going to get that day….boy what an optimist I am!)
3. I can do this.
You know, I get really nervous before every ride-along. Part of it is excitement, sure. But I think a lot of it is because I’m afraid that my observations would only confirm all of the fears that I have about going into this profession (it’s not for me, I’m too emotional, I can’t handle it, etc.), but it actually does the opposite. As I was sitting in the back of the ambulance yesterday next to that old man, I felt….in place. For the first time, I truly felt that this is what I want to do instead of just trying to convince myself mentally. It’s true that I’ve never experienced a really exciting call or a difficult patient yet, but I’m not really worried about that anymore. Instead of filling me with more anxiety and doubt about all the parts of the job I have yet to experience, I’m filled with more certainty that this is indeed what I want to do and more confidence that I will be able to handle the less pleasant aspects of the job too.
I’m still mad that I gave up another full Saturday just to go on one call, yes. I already know how to sit on my ass all day doing homework. I believe that I was ready to face something a little more intense than that. But it was not so. But while I may be a little upset about that, I’d be a dang fool if I said that I didn’t learn anything from yesterday. I’m grateful for that one call that we did have and for the opportunity to ride with awesome preceptors (thanks Joe and Mel!). And I even got to see Nicholas again (my preceptor last time)!
So yeah, I guess it wasn’t the terrible, horrible, no good, very bad day that I maybe made it out to be at first. *sigh* There I said it. Happy?
*****
69 days until graduation
134 days until EMT school
