Key of Fear

All systems support pretty much the same level of provider care for EMT-Basic (EMT-B): trauma care, splinting, bleeding control, that sort of thing, and for drugs the Basic is allowed oxygen, activated charcoal, oral glucose, and perhaps ipecac by order of the Poison Control Center. It doesn’t sound like much, but really those interventions do take care of many of the patients we see.

In many systems, the EMT-Intermediate (EMT-I) can add “options” such as IV access and endotracheal intubation. Virginia is it seems a little different from the other EMS systems around the country. One of the differences is that here, an EMT-I is functionally equivalent to an EMT-Paramedic (EMT-P).

This means that here, in good ol’ VA, the really heavy stuff is available to both EMT-I and EMT-P: epinephrine, lidocaine, morphine, demerol, ativan, mag sulfate, dopamine, dobutamine, nitro, vecuronium, all the drugs. But it gets even better.

Each “system” (county, city, or private service) has its own online medical director (OMD). Depending on one’s OMD the options available to field medics may either expand, or contract. I’ve mentioned before that some OMD’s simply want the patient brought to the ER with minimal interventions. Other OMDs are comfortable with their providers to the point where everything short of field surgery, it would seem, is permissible.

It is under such an understanding OMD that DTs is now, wearing his Transport uniform, a released Medic. Yay DTs! Yay, ice cream!

Yes, after several months of precepting, DTs has been “blessed” by the Powers and Dominions, and given a bright and shiny Key, even though he is still only an EMT-I (patience, patience, “P” be comin’).

The Key, however, has come with a price. No longer is DTs a “third” on his transport rig. When the downward-spiralling patient is snatched from the outlying urgent care center for a time-critical ride to surgery at the Big Hospital, it is DTs and he alone who must keep the patient alive. No more “Do you think we should-” or “In my opinion we ought to-” stuff. No more may he pull off an EKG tracing and say, “This looks to me like X, what do you think?” – there is only the patient, and DTs.

Gone is the comfort of a second opinion, from wiser and more experienced providers, replaced by the imprint from a Vibram-soled boot on DTs’ tender backside, the last remnant of having been kicked out of the nest.

To be sure, the precepting was not a timed event. “Well, it’s been a couple of months – toss DTs into the fray.” No, many tests and interviews and scenarios and real-time trials were overcome before the Key was relinquished to DTs’ latex-free hand. In the opinions of Those Above, then, he is ready.

But it is a heady and frightening experience, I do not mind saying. Probably all newly-minted medics do this, but I find myself looking at the thing every now and again.

It is a small key, not like a Key to the City, but infinitely more useful – and daunting.

“You’ll be picking up terribly ill patients, DTs”, says he to himself. “You’ll watch loved ones planting kisses on the recumbent form of your patient. From the family’s perspective, the rig doors close and off they go, with you and you alone in back to keep ’em alive. You better know what you’re doing here, man.”

Indeed.

The strongest impulse I felt on receiving it was, “Here – take this back, just for a little while. There’s a couple of things I’d really like to brush up on, re-study, you know, a refresher course or two might not hurt. Maybe next week is good. Yeah, next week definitely better, I’ll know more by then…”

The Powers and Dominions must have read it in my face. “Good,” said They. “Keep that attitude, and get out. Oh, and don’t lose it.”

Not sure if they meant the Key, the Fear, or my composure. Guess I’ll just have to hang on to all three.

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