E-fun-ephrine

So the family went to King’s Dominion the other weekend.  As a teen, between 1975 and 1979  my friends and I went once or ten times every summer.  Roller coasters, flume rides, hideously overpriced food (we thought at the time – how little we knew).  It was fun.  But that was before EMS.

Now-me arrives with the family, and the first ride I get on is the Drop Tower.  Sit in your chair, which raises you to almost 300 feet.  Nice view.  Then it drops you.

During the second or two I fell, I thought, “Well, this is fun.”  But afterwards?  Meh.

The roller coasters teen-me had loved were worse.  Whether it started with a slow climb or shot like a bullet down a barrel, the initial “Whee!” was followed immediately by a feeling of inconvenience as the coaster turned, swiveled, looped and banked.  Each bump, jerk, twist, and abrupt change in direction, which used to elicit a “Wow!’, now annoyed me.  Like a scene in a movie where the main character is not enjoying a show, but is being constantly prodded and bumped by the popcorn eating fat man beside him who points and laughs and can’t get enough.  No, I’m not enjoying it, and you can’t make me.  When will it be over?

I reacted thus to every ride, when suddenly I had the terrifying suspicion that I might be getting old.  Isn’t this how old people react to these rides?  This is terrible.  I don’t want to get old.  Old people take cruises, and leave the ship to visit shoreline gift shops.

The more I considered this dire prospect, however, the more it became clear to me that while my body might be aging, it was not “getting old” that did in these rides for me.  It was physics, law, and mostly EMS.

Physics:

In my uninformed teen years, when I last enjoyed this sort of thing, it was because I suspected there was an element of danger.  After all, the TV ads played up the speed, the screaming, the terror.  That’s dangerous, right?  Dangerous and exciting, and fun.  One expected reporters and cameramen at the end of each ride. “My God, he made it!”  “Welcome back!”  “How did it feel?”  “Were you ever afraid?”  A teenage male steps from a roller coaster as a warrior steps from a longboat to the shores of a conquered nation.  Plant that flag and on to the next.

The truth was always there, but we chose to ignore it or, more correctly, were in ignorance of it – it’s all physics.  This weight going this fast exerts this force in this direction, plan accordingly.

This visit there was a particular roller coaster which was completely indoors, and mostly dark. Flight of Fear.  Just ahead of me, a determined ride attendant was bravely trying to secure a lap bar onto a woman who hasn’t had a lap in probably 20 years.  While the occupants of the cars around her ratcheted down their restraints with a satisfying tick-tick-tick-tick-tick-tick, the attendant grunted and shifted and struggled.  Finally, a single “tick” was produced, and he pronounced her good to go.

It occurred to me that the system *must* be designed so that the weight of the cars made the additional weight of the passengers negligible in the calculations.  The only way to make a ride safe is to factor in, say, a 10% margin of error and make sure that a 500 lb person is only 5% of the car weight – or whatever numbers the engineers used.  That, or these poor fools were doomed.  (They made it).

Law:

I vaguely recall that as a teen, the signs around a ride did nothing more than identify it:  “Rebel Yell”, for instance. Oh boy, here’s the roller coaster, Rebel Yell.

Now, there are multiple signs at each ride, giving one something to read while waiting in line.  Some of these signs I think are there for marketing purposes – there’s some sort of rating system such as ski trails use, the “black diamond” marking this as an Advanced Level Ride or some such.  Following this is another sign warning the usual suspects – the pregnant, heart patients and such – about possible injury.  “May cause dizziness”.

Standard fare, and I’ll be very surprised if sometime soon there isn’t a touch-screen with a camera that requires one to tap “I agree” and takes your photo doing so, to eliminate all liability to the park.  While you’re at it add a little note to the bottom showing calories burned on the ride, and remember to send me my royalty check for the ideas.

Still, where every convenience store aisle is now marked with a “Piso mojado” pylon, or else lawsuit, it is actually the lack of signs which nail home the lack of danger.  Everyone is quick to put up “Caution!”, “Warning!”, “Do Not Enter!” signs for the most trivial reasons.  Non-trivial, but let’s be realistic here, hospitals put “Caution!” signs on the doors of patients who have minor coughs.  It’s a hospital, I expect there to be sick people here, but thank you.

Now, to be scary all one has to do is remind people of their mortality.  I have heard that in the early days of air travel the larger airports had notary-publics available to sell you life insurance and notarize a quick last will and testament before boarding.  Add that, and I’ll take it seriously again.

Or not.  When the carnival comes to town, we have a team of inspectors trained to verify the safety of the rides – ferris wheels and teacup rides for the most part – but considering they’re assembled and disassembled every couple of weeks, I appreciate this.  How much safer a standing attraction?

EMS:

The price of my adrenaline seems to have gone up.  A roller coaster used to afford me a big vicious jolt of epi that had me grinning and shaking for the next twenty minutes.  That same coaster now only buys a moment’s worth of anxiety – is my cell phone safe in its case, or will it go flying off? – before seeing me back to my natural, mellow state.

What I saw as a teen:  Accept the Challenge, Traverse the Danger, Exit Victorious and Immortal.

What I see now:  Wait in Line, Get Tossed About, Get Out.

I explained this to She Who Must Be Obeyed.  “I get tossed around in rides every day, but there’s no guarantee that it’s safe.  I guess my adrenaline has a higher standard now.”  Come to think of it, when I was being tossed around on the first roller coaster of the day, my absolute first instinct was to turn to the right and tell the driver to take it easy – which would have been the correct orientation for a medic on the bench seat.

To underscore this, on returning home, I checked the news as I sometimes do and found that Rescue responded to another park that very day.  Even in failure the ride went from an entertainment to a mere inconvenience.  Every one of those passengers owes a debt to the engineers who designed that ride so well that it could completely fail and STILL not kill them.

In contrast, only a couple of days later we had a unit totalled as it was t-boned, responding through an intersection.  The AIC was injured (we would classify it as minor, but tell that to her) and the driver and patient were for the most part uninjured, thanks in great part to engineering.

That is the sort of ride that might get a little adrenaline flowing, certainly.

I suppose what I learned, at the theme park that day, was that for me, now, Adrenaline =/= Fun.  It’s something I suppress so it doesn’t get in the way of my thinking, and of my job.

Fortunately for me I don’t need to get amped up to have fun.  

Parcheesi anyone?

Did I tell you about the time…?

Our patient, c/c “chest pain”, was sinus tach and sprinkling PVCs like confetti.

We’re applying oxygen, he’s got some morphine on board, and we’re just opening the nitro when he codes, just as we get to the hospital.

We hit the ED doors running, pushing, bagging.

“Code! We need a room!”

“Room 4!” The charge is right on top of things.

We roll into room four. “On Three! onetwothree!”

Our patient is onto the bed, CPR resumes, bagging resumes.

The attending physician is a new guy, I’ve never seen him before.

“What’s the story?”

“68 year old male, chest pain for 1 day, took two aspirin 325 at home and called 911, sinus tach with PVCs on the way in, coded three minutes ago.”

“DNR?”

“Full code” Really? Didn’t he see us working the guy? But okay.

The attending says to the nurse, “Get RT down here, let’s tube this guy,”

To us: “Stop CPR. Let’s get a rhythm check.”

We stop CPR. The monitor shows little tremors, minor quakes on the surface of the heart. Some life left, it seems.

“Fine VFib,” the attending says. “Charge and shock”

A nurse grabs paddles, puts her hand on the dial. “What do you want to charge to?” she asks.

The attending seems to consider it.

“Oh, I think he just need about tree-fiddy.”

“I’m sorry?” the nurse said.

“He need about tree-fiddy.”

Well, it was about then that we noticed the attending was a six-story tall crustacean from the Paleolithic era.

“Dammit, monster!” I said. “We ain’t chargin’ to no tree-fiddy! In this ED we *work* our patients! Ain’t no protocol for tree-fiddy! Monophasic, bi-phasic, ain’t none of them call for tree-fiddy!”

Sorry…

New App

… in the Google Play store.  DTsEMT Menu allows you to remove any shortcuts you might have to other DTs (Medics of Anarchy) titles and replace them with a single shortcut to the Menu app, freeing up screen space.

The app scans your device on launch and creates a menu of all DTsEMT titles – building, well, a menu.

It does NOT check the Play store for new DTsEMT titles.

Absolutely free, like all MoA apps.

who is… The Most Interesting Medic In The World…?

To him, anything less than a 14 gauge in the Circle of Willis is a peripheral line;

 
When he marks “transporting”,  the hospital pages a “Code Awesome, ETA 5 minutes”;
 
When he brings in a patient, the ED docs gather around – to learn;
 
When he was dispatched to the wrong address, the occupant faked illness to become his patient;
 
Just sitting at his table at lunch is worth one hour CE credit
 
 He needs no siren; he just smiles at the rear view mirrors of the cars in front of him
 
Any more?

Apropos Veterans Day

In the past month – a normal month for DTs, by the way – I have met:

a Cold War submarine commander;

an original  Tuskegee airman;

a soldier/POW from the Battle of the Bulge;

a tanker from Patton’s Third Army;

at least three infantrymen who saw France – beginning D-Day;  a couple more who toured Europe via the scenic Italian route;

an Air Force officer who served in Vietnam;

a young man on leave who is still serving our country…

Folks are right, there are heroes to be found when one is in the Fire/EMS gig, and it’s our privilege to serve them.

In Which We Contemplate Speech Patterns

I’ve been observing “us” for a while now – we EMS folk – and to non-ems folk it may seem, based on our speech patterns,  that we don’t transport patients at all.

I do not mean that we disavow the people we’ve cared for; that is, we don’t deny picking people up from Bad Situation, and taking them to hospital.  Nor do we in Transport Gig deny that we also take them from standalone EDs to definitive care, or from definitive care to rehab, or from rehab to home… or wherever.

Instead, what I find in our speech patterns is that we seem to transport chief complaints.

“I had this chest pain,” one might begin.  “We ran this auto accident.”  “They toned us out for an arm pain, but it was really a hip fracture.”

It isn’t usual for us to begin “I had a guy with chest pain,” or “I had a lady with leg pain.”  Indeed, unless there is a need for this kind of knowledge, differential diagnosis information inherent in the patient themselves, we don’t mention it.  For instance, “I had a lady with abdominal pain” WILL be stated.  Women have much more that can be going on, abdominally.

And that in itself I find interesting.  We will, in telling our stories to each other, include any and all information which will allow our audience, other Bambulance Folk, to follow along at home down the diagnostic path.  “So, at 02:30 we found a 69-year old male prone, unresponsive, in the kitchen wearing slippers” – this we toss in because stocking feet tend to slip and slide – “with a bottle of orange juice on the floor near his hand” – this we include because OJ is, (as ever), a clue.

“Aha!” our audience exclaims.  “What was his glucose?”  And yes, they got it.  The stories, you see, are never really about People.  Rather, they seem like stories about Problems, And How We Solved Them.

I’ve been thinking about this, and I believe it’s because we’re all about The Data.  Give me What I Need To Take Care of My Patient.

You will not, at the station, hear this:

“I transported a young new mother, flaxen haired.  Her blue eyes: now distant with worries of tomorrow, now sparkling with merriment at the thought of today. Her smile flashed brightly, in joyous competition with those eyes, and…”

Nah.  Our stories to each other don’t work that way.  They follow the cut-and-dried approach of a patient care report. Although I have been tempted to begin a PCR with the immortal, “It was a dark and stormy night,” or, “Lounging at the station, my Medic Sense began tingling moments before the tones dropped.  We leapt into action.”

BUT – and this is the whole point of this – we seem only to tell our stories to each other to Find Things Out.  “This is what I saw, this is what I found,” and the unspoken, Did I miss something?  Or, What could I have done better?  Or, what else should I have checked?  We constantly seek feedback.

Not for every call.  Just once in a while, there IS a call where one’s Medic Sense tingled, and we want to know, Why?

Listening to us talk, I find we never bring up the calls where our Medic Sense didn’t tingle – we don’t tend to brag about the calls where we did everything right, and know it.  We constantly seek peer review and aren’t afraid to draw it out.

Which I find to be uber-cool.  Regardless of how well the patient contact turned out, and even if everything went fine, the fact is that we through these stories turn to each other and, in essence, say, “Help me to be better for next time.”

Poor Impulse Control?

Watch it, folks, these things tend to repeat:

From the Chicago Sun-Times, http://www.suntimes.com/news/24-7/2787746,ambulance-taken-100910.article

“October 10, 2010

BY ROSEMARY SOBOL Staff Reporter/rsobol@suntimes.com

A man who “thought he could get to the hospital quicker” jumped behind the wheel of an ambulance and took off Saturday while his ailing family member and two paramedics were inside, authorities said.

Jimmy McCoy, 27, of the 4800 block of West Superior, “probably thought he was helping” when he took the wheel as a relative was being treated for a diabetic episode, Fire Department spokesman Larry Langford said.

Jimmy McCoy
McCoy was arrested and charged with felony unlawful possession of a stolen motor vehicle.

Ambulance No. 23 was stopped in the 4300 block of West Wilcox at 11:30 a.m. while paramedics were treating the relative in the back, Langford said.

The male and female paramedics immediately radioed in, saying: “This is ambulance 23. Our ambulance has been stolen, and we are in the back with a patient,” according to Langford.

The paramedics were “somewhat agitated” but handled the situation professionally, he said.

McCoy allegedly began driving northbound on Kostner.

Fire Truck No. 26, which had gone on the medical run with ambulance No. 23, stopped the ambulance about three blocks away, Langford said.

Truck No. 26 “made a U-turn and made it to the intersection of Madison and Kostner, where it blocked the ambulance,” Langford said.

Police surrounded the ambulance and arrested McCoy.

Police said McCoy, who has been arrested 32 times before, allegedly told officers he “thought he could get to the hospital quicker” than the paramedics.

The patient was taken by another ambulance to the hospital, fire officials said.

No one was injured, officials said.”

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