Friday, December 16, 2011

Testing the Waters

I just got finished reading this post by The Lonely EMT and she raises some good points, as is her custom. I was going to leave her a comment with some other things of the same ilk which I have learned or developed over the years, but I realized it would get kind of long (for a comment anyway) so I am going to break my 'fast' and have my first EMS/Fire related post in a very long time here.
 Linda writes at length about things we volleys do to maitain a level of 'combat readiness' in order to answer the call and we all have some sort of 'system' we each use. Some systems don't work all that well, but they keep getting used anyway. I know one EMT who will not run a call unless she brushes her teeth, but this same EMT never grabs her wallet (with her credentials) when she runs out in the middle of the night.
 I have my 'things' that I always do or never ever do, as applicable. I do many of the quick response tricks that Linda mentions such as considering what I am doing at the moment and what I will have to do if the tones drop. I often make "Go/No-Go" decisions in advance. If it is at a time when most would expect me to respond (holiday weekend when they know I'm in town) and I need to take myself out of service, I usually call someone and make sure they know I'm unavailable for the next hour and get them to cover the initial response minutes. We (my crews) are in the habit of casually sharing our personal schedules, so that others know if we are in town, having a family party, or otherwise unavailable. If any of us have had a drink, it takes us out of the game, so we let others know that in advance.
 Then I have my 'habits".
 During snowstorms or heavy rainstorms I bring my tunrouts in the house and have them ready to don, so that I don't have to do it in the Engine bay or on a roadside. During the winter months I keep all the temperature sensitive EMS stuff like NPA lube, Oral Glucose, and a few other odds & ends in a small zip lock bag inside my EMS coat which hangs by the door in the house. That way they are all ready to go, and warm. Ditto my steth.
 I have one of those rechargeable LED drop lights that hangs on the book case next to my bed. For late night calls I turn that on and it does not disturb the wife when the pager goes off and I flip it on. I carry that light through the house so I don't need any other lights on and it gets me out to my truck safely. It gets REALLY dark here too, just like at Linda's place. Oh and I ALWAYS have a flashlight in my pants pocket, 24/7/365, as well as in every coat pocket, especially in winter.
 My pants are always laid on the floor next to the bed, my shirt is underneath the pants, and my fresh socks are laid out flat across the tops of my boots. I could always find them in the dark and get them on correctly before I had that drop light. (Ironically I did not get this habit from the fire service, I learned it from all my back country hiking and camping. You need to locate all your gear and operate it in the dark in case he weather blows up in the middle of the night, especially in the winter.)
 I always have at least one bottle of water in the truck that I can sip from to clear my mouth and help hydrate on the way to a call, especially in the middle of the night. In the summer I keep a six-pack in the back seat, and in the dead of winter I keep a bottle by the light switch of the door I leave the house from.
 Some folks sleep with their socks on. I have trouble with this even when it's really cold in the house, but if I KNOW we are going out that night, I will do it on rare occasions. Yes, there are indeed nights when I KNOW we are going out, mostly due to weather.
 I keep on open type satchel in my truck that was given to me as a business promo. It was useless for business, but great for the Fire work. It has two outside pockets that are perfectly sized for my hi-band and low-band portable radios. the main pocket holds my EMS hip pack that has the basics (B/P cuff, stop-clot, steth, a couple of 4x4's, some band-aids, shears, Pulse-Ox, Glasses, pad, pen, etc), a pair of work (mechanics) gloves, small camera, ERG book, a stretch hat, and yet another flashlight. The other pockets have similar odds and ends like a multi-tip screw driver, some extra pens, and things of that sort. I call this my 'officers bag' and it's nice because when I respond, I climb in the truck and can turn on the radios without removing them. When I get to the station, I grab my turnout bag and this thing, which sits on the floor next to the seat. Everything I need is in there and it has worked perfectly for me for several years now.
 I also keep an old scanner in my truck that is always on. This scanner has our EMS, Fire and police 911 frequencies ( check your state, federal, and local regulations on this one). For me this is a HUGE safety tool. While on the way I can hear what dispatch is getting and giving all the involved agencies. This can either speed up my response, slow down my response, or completely change the manner in which I respond. I have two Fire Houses (out of 3 in my department) that I can get apparatus from. The details of the call will often dictate which way I turn, and what I get. We all know that the "Rollover with entrapment and fire" can very often be reduced to a 'property damage only' call after the first cop arrives on scene and gives an update. I like to know whats going on. I am not going to risk my life for an overheated car that somebody driving by called in as a car fire with entrapment because he/she saws steam and people sitting in the car. Knowledge is power. Conversely, if the dispatch was for 'chest pains' and I hear an update form PD that includes "CPR in progress' then yes, I am going to step it up. The scanner allows me to make intelligent decisions and act in a safer manner, based on the risk.
 Let me finish up by pointing out something that Linda alluded to, but I'll be more blunt. You have to think about your responses and analyze what you have done in the past in order to find ways to do things better, faster, and safer in the future. For instance, I almost never answer a call in the middle of the night without peeing before I leave (I'm getting old and the bladder does not work like it used to). I have also conditioned myself that on a late night call when I can't seem to clear my head and wake the hell up, I drive intentionally slower, much slower in fact. Being groggy makes me a hazard to myself and others. There is no sense in getting there quickly only to find yourself confused. So I slow down and give my brain time to wake up.
 Although this doesn't apply to most folks, it will for some. I respond for some special type calls outside my district where I work with other teams like Swiftwater rescue or Wildland Search. Obviously in the warmer months my swiftwater gear bag is in the truck, but not the winter months. Likewise, I seldom have my wildland gear in the truck because I own a room full of equipment and the gear is all specific to seasons and other requirements. So seasonally I have a couple of specialty bags or backpacks already loaded and sitting in my den near the back door. One bag is configured with the most likely general use, the other bag has the additional stuff I might need in that season. When I get to the staging area I pull from one pack to tailor what I need in the other pack. This could be maps, clothing, sleeping bag, ice axes, snowshoes, crampons, stoves, food, climbing aids, and a whole bunch of other things. The point here is, all this gear is in packs, ready to throw in the truck and in clean, working order. When I get a call for the rare search, I don't have to spend a lot of time finding gear or risk forgetting a key item (like a flashlight or GPS unit). I also have EMS kits configured for all occasions. For back-country wok I have a small carefully packed kit that includes a lot of stuff I would NEVER have or use on the street like over the counter meds, moleskin, a suture kit and such like. I have a small EMS back pack configured for what I might need to assist a wild land firefighter.
 Lastly, for the 'once every two years' long running incidents where I know I will be living at the firehouse for several days I have yet another gym type bag that I keep in my bedroom closet. It has my spare EMS pants, a second pair of boots, and it ready to have my toilet kit and the other odds and ends thrown into it. We generally have warning for these events like floods and hurricanes, so I just keep it handy and ready to fill while I am doing my other storm prep work. It acts as a trigger or reminder that I should get that stuff together in a bag as part of my preparation.
 Thinking about what could (or will) happen, and preparing for it is the name of the game. So do yourself a favor and think about it a little more than you already have. I bet you come up with some time savers that also make you a better and safer responder.

Friday, December 9, 2011

Long Time Coming

Father forgive me, for I have sinned, it's been 2 months and a day since my last post....

Yeah, long time. I guess you all thought I was gone, and I guess I was. I was a-wandering out there looking for my soul, direction, and some other stuff. I buried myself in my music lessons trying to get away from the stuff we see. The PTSD had built up and I knew it was eating me up. I had nothing to write that was good or worthwhile. It was a dark place.
 No, I am not "back" and "healed". I am still working on that. Music therapy is helping (anybody wanna donate ticket money?) but I had my first really positive experience in a long time this week and I thought I might share it. It occurred to me that when we suffer a loss, a patient that does not survive, I mourn my shortcomings for anywhere between a day and a week, depending on the circumstances. But if we 'suffer' a win, I generally don't celebrate it for more than a day. That's not right.
 Several days ago we had a 'nasty'. 2 car MVA head-on, 110 MPH closing speed. As luck would have it, I wasa the 2nd EMS person in the car of the serious patient (the other driver RMA'd if you can believe). I took the head of a patient with a serious head injury, depressed skull fracture, snoring respirations, multiple lacerations, and very combative. Extrication was around 10 minutes (great crew), but we had difficulty getting her out because she was flailing. The flight medic was on scene in less than 10 minutes from dispatch of the original call because the were returning form a previous call. The first Trooper on scene was also a Paramedic and an RN. He got the main torso and assessment, while I took the head and did observations and support. Lots of blood in the car but no serious bleeds were evident when I got there.
 Once set up in the rig, we had 4 medics and 2 EMT's working the patient. It was like poetry even though none of us had much, if any time, working together before. We all held the same thought "This patient probably won't survive the flight to the trauma center".
 With all the critical calls I've done, this was my first 'squirter'. When the pressure in her head injury finally overcame the ability of the skin to hold it back, she blew a stream across the rig and shot a medic in the belly. I surprised myself because it didn't really mean much, I just moved my index finger over the hole and closed it off. We dressed it up when time allowed a few minutes later. It appeared she had a deviated trac and one medic placed his fingers to hold the trac in line while the other slid the tube in. Good hit on the first try. Good breath sounds, bilateral. The monitor showed good vitals considering and we all took 3 seconds to celebrate, as we kept working.
 This was also my first hot load. Normally the flight protocols call for shutting the bird down during the load operation, but in tis case the flight medic called the pilot while enroute and told him to 'wind it up and be ready to go" (this saves 2-4 minutes). So we loaded hot and had to maneuver the patient right past the tail rotor. Not a comfortable situation for me, having the handle end of the stretcher, but what the hell.
Off they went, and I collapsed on the tailboard of my rig, while the other guys started clean up. I was shot and began to sink into that depression that comes with the realization that even with all the effort and care, she probably won't make it.
 18 hours later there was a blurb on the local paper's web site about the accident and that she was in the trauma center in 'serious' condition". I was walking on air, she survived the night. "WOO HOO!" I thought. Then as the hours and days passed, pieces of information began to trickle back, either through medical channels, or the small town network, that she was conscious, knew her name, could wiggle her toes, etc. This gal is gonna make it, I thought. FINALLY, I get to work a bad one that doesn't turn out bad! This is, I kid you not, a first for me.
 Now I know, it's not about me, and the calls and jobs I am dealt, it is about the patient. However, I have gotten the feeling that if you are a patient in critical condition, you really don't want me showing up. It's my personal perception of a back cloud. I have never had a CPR save. I have been on some calls where I didn't expect the patient to survive and they made a full recovery, but this is the first time I have had a critical trauma patient survive. It's a very good feeling.
 About 0300 this morning we had an automatic alarm call that turned out to be false, but while on scene I ran into a friend of the family of this gal who gave me a update about the surgeries that had taken place in the past 12 hours. She said that the mother of this gal wanted to find out who had taken care of the girl's head during the incident, because the Doctors told her that this was probably what saved her life.
 I don't know what the physiology of the trauma is for this gal, but I have to tell you that as far as C-spine precautions go, this was probably the worst job I have ever done at stabilization. She was flailing and thrashing all over. I actually had my left arm across her upper chest, and had wrapped her hair in the fingers of my right hand the try and control the head. I felt like I was trying to restrain a prisoner. I was not happy with my methods. It was nothing that they ever taught me in class, and I don't recommend it. The mental picture of doing this had me awake that entire night, I felt like a failure at treating this patient in a controlled and proper way. Hindsight tells me that I got lucky. Next time I have to do better.
 At any rate, it's nice to have a winner. From what I can see now, it appears this gal will recover with most functions in tact.  I don;'t think she'll be the same as she was before the accident, but she will be alive and functional, and that's a lot more than any of us who were there could expect. I'll take that as a "win".
 With all the ugly and negative stuff I have posted here, I thought it was only fair to take an evening out and share this piece of positive news. Probably there is nobody out there reading this anymore, but on the chance that one or two of you have stuck around, I put this up for you.