Liberal Artist in the Ambulance

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…