Thursday, May 31, 2012

wow..apparently it has been a while..

Hello Loyal Readers!

I have neglected you, left you in the corner to starve like small pitiful creatures, and I apologize for that.

I have been incredibly busy for the last few weeks. Between working my full time Big City Trauma Center job on nights, picking up a few shifts at my contingent squad gig, working Big Rock Concert, and getting rolling with the Oompa Loompa EMS Co, I have had very little free time.

At the Big City job, the warm weather event type patients have been coming in with more regularity. More patients are coming in with extra perforations that they were not born with, whether formed by sharp pointy objects, really fast and small lead ones, or using their own motor vehicles to unleash Mayhem on themselves, people have been leaking out more fluids than they intended when they left their humble abodes. Granted, true Summer has not arrived yet, so there is MUCH more to come. Since I have such fantastic staff that I work with, I look forward to the challenge. Between the nurses, respiratory therapists, residents, attending doc's, and my fellow medics, I think we got this.

Big Rock Concert was a blast as always. One of the best things about working in EMS are those rare occasions we get paid to do something fun. Big Rock Concert is definitely one of those things. Saturday kinda sucked, as I was stuck on a transporting unit, in a city that I was not familiar with, with a partner (ambulance driver) who also was NOT from the area. Granted, we pulled through and rocked the job, but definitely not as much fun as getting paid to watch the shows and the crowd. Had several critical patients we took in, including a nasty trauma-alert head injury that was not discovered until well into the transport. Was pleased to receive several compliments on my assessment and field treatment, which I chalk up to my new experience from Big City Trauma. Sunday was amazing, as I was up at the main stage almost all day. In short, for being some people who are getting to be some Old Farts, Marilyn Manson and Rob Zombie F#$%ING rocked! They put on such impressive shows that we had many less injuries than during headliner shows in the last few years...I attribute this entirely to people too busy actually enjoying the show than thrashing and dropping each other.

Picked up a rare shift on the road for what I guess is now Big Aquamarine EMS..worked with someone I truly enjoy spending time with, and had a blast. Got to pick up one of our regular dialysis patients that I had not seen in almost a year, and happily attended. Got to drive out to BFE and do a ridiculously short tote to a doctor's appointment and back...approx 1/40th of the mileage for that trip consisted of the transport....

Got hired on with the Oompa Loompa EMS Squad, which consisted mostly of "You are a paramedic? *insert drooling and fawning here*." Gotta say, the only reason I went over to this agency was at the request of Epijunky..apparently she would like to work a shift or two with me. Orientation was a disorganized mess, at least to someone who has worked at several different agencies over the last 10 years. Had my "training" shift today, which consisted of getting quizzed over drug dosages (have I mentioned I have not seen the protocol book yet??) and writing all the reports. Oh, and I drove back to the station to prove I won't recklessly play bumper cars while being supervised...yeah. All of my patients today were neck bubblers. For those of you who have not had the joyous experience of deep tracheal suctioning, I think there is no way to put across in words what a nausea inducing experience it is..Between the sounds of the thick mucus and sputum, to the vibrations of the suction tubing..UGH..grooooosssss. Yes, I understand it is part of the job. Yes, I understand it is NOT the patient's fault that they have a trach. No, it does not make it any less hideous and disgusting to me.

On a separate note, Oompa Loompa EMS is not as bad as I thought it was going to be, based off of what I was told by many people. They are a small start up company in the already flooded EMS market here in Big City. They have issues as does any EMS agency, be it private, fire dept, or some other system. However, they are trying, and by all accounts things are improving. Plus, they have several contracts for special events in the area, AND they pay an extra $1/hr for working them. I like the sounds of that.

For now though, it is time for this Nocturnal Medic to head to bed. I have my princess this weekend, and have to drive to pick her up tomorrow, and then work tomorrow night.  Sleep well, be safe, and as always, until next time!

TS&T

Thursday, May 10, 2012

Overdue Update

Welcome back Loyal Readers!

I know, I know, it has been a while, and you were actually beginning to forget I ever existed!!! I have had a busy start to the week already, after another fantastic weekend with Little One.  At the request/urging/begging of a friend, I applied for a 2nd part time job, bringing me up to 3 total.  Interview was cake/a joke, and I have my orientation next Monday.  I work full time in a big city Trauma Center on nights as a medic, I am extremely contingent at my former employer still as a road medic, and I am now a proud member of the Oompa Loompa EMS squad. If you had ever seen the uniforms, you would understand...

At my full time job, we use a 2 step triage system. The first step just covers vitals, a very brief narrative, and is designed to get the patient into the computer system and able to be placed in a room. The second step is much more thorough, covering full medical, surgical, psychiatric, and social history, along with review of meds, allergies, and "What does very good care mean to you." I worked a short lil 8 hour shift today, and spent the first half of it, dodging from room to room doing the second step triage. Needless to say, I got more practice at it than I would have preferred. On the other hand, I learned how to do full visual acuity checks, found out how fast a pregnancy test can come up positive (about 10 seconds!) and figured out how to put in orders for the radiology department.

The second half of my shift was spent out in the Land of Unicorns and Rainbows, or as more commonly known, Triage.  As usual, I worked my non-sunny magic on the waiting room, and turned it from a steady but consistent flow of patients into a morass of huge numbers registering, and then waiting for a room. Of course, that is not nearly enough fun, I had to throw my usual Winged Simian Minion into the mix, and come up with several rather acute patients for the nursing staff in the back to untangle. Among those, just hitting the highlights of course, was a wee one with some impressive respiratory distress, and a younger lady with a history of cerebral aneurysm who felt like she was having another one. Always a good time when you deliver a patient from triage and head directly to the Attending physician to make sure they are aware of the happy happy good times you have just blessed them with.

Now, it is home, and time to curl up with SWMBO, who has long since headed to the land of Nod.  Tomorrow brings a regular 12 hour shift of fun and excitement, plus trying to make sure I am conscious in time to see The Family before I go to work.

On a better note, next weekend will be spent with 50,000 of my closest friends working EMS for that there Former Employer, working Rock On The Range..to those who are at least somewhat familiar with modern Rock Music, take a gander at this and I am sure you can see exactly how I will earn money doing nothing but listening to great music (*insert eye roll here*). Just looking at the headliners for both Saturday and Sunday night, we gone be biiiiiizzzzy.

Till next time kids!

TS&T

Sunday, May 6, 2012

Weekend with the Kiddo

Well, I have been enjoying a fantastic weekend, both because I am off work on the combination Cinco De Mayo, College graduation, prom, and Full Moon weekend, and because it is my weekend with my daughter.

Since it was rainy and nasty out yesterday there was not much that we did other than hang out inside and play, although it did get nicer enough in the evening that Little One got to go outside and play while I grilled some steaks up. Today has been a nice lazy day..Went grocery shopping and restocked the rather bare shelves in the fridge and the shelves, then just hung out for the afternoon. This evening SWMBO and I took Little One to one of SWMBO's friends weddings. Nice ceremony, not too churchy. Outdoors at a nice park with an attached reception hall.

Both Little One and I enjoyed the reception, and "danced" several dances together. I say "danced" because there is not much in the way of coordination and cooperation from a 3 year old lol. SWMBO even took LO out and danced the Cupid Shuffle. LO caught on pretty quickly, and it was quite entertaining watching the two of them out there having a blast. SWMBO sat out for most of the dancing, as apparently being 31 weeks preggo takes a bit out of ya.

Tomorrow is the last day for LO being here until she returns to purgatory for 2 more weeks. SWMBO's sister is coming over with her two kiddo's to hang out and play with LO. Should be lots of loud, raucous fun for all!

The only thing that has really brought the weekend down was a letter I received in the mail today from the lawyer..Apparently The Ex called MY lawyer, complaining that I was actually exercising my rights to vacation time this summer. Since she infuriated her own lawyer to the point of dropping her as a client, she has made the oh so logical choice to complain to the lawyer who was working against her..yeah, that's the kind of logic I am forced to deal with when it comes to LO. She apparently made the brilliant move of threatening my lawyer and me on voicemail to him that if I continued to pursue my court appointed (and agreed upon by HER as well) vacation time this summer that she would stop allowing me to see LO, claiming that I am "disregarding the court order." Understandably, I must be, since I am following the exact language of it (roll of the old eyes here...).

She then goes on to claim that I am nothing but "basically a part time father". Umm yeah, that is the unfortunate truth, since I am limited to 3 phone calls per 2 week period, and seeing her every other weekend, by her refusal to allow me to play a more significant part of her life..

Sorry to vent to all y'all...just gets a bit frustrating at times. Wish the court system around here was not such a "mother rule" system and would allow a father who does EVERYTHING in his power to be there for his daughter a little bit more leniency when the mother is being unreasonable.

Hope everyone has a safe and happy weekend..it's back to the grind again next week...which is probably better for the paycheck anyways!

TS&T

Wednesday, May 2, 2012

Back after a few day's off...

Well, since there seems to be a small but steady following here, it appears that I am overdue for a new post!

Tonight is day 4 in a row of working, hence the lack of updates. Before you get too sympathetic, tonight and Monday were my only full 12 hour shifts. The other two were shortened due to shift trades!

For lack of a better topic at the moment, I guess this will be another about me post.  As I mentioned before, I work full time as a paramedic in a busy Trauma Center. I have only been here for a little over 6 months, but I love it! One of the common questions I get from both patients and other EMS providers who aren't familiar with us, is what exactly does a medic do in the ER? Well, here we go!

Triage, lots and lots of triage..Pretty much at any point, you will find at least one of us out front, manning the triage desk. After registration enters the patient into the computer, they either come straight to the triage area, or go to the waiting room, depending on how busy we are. From there, we snag patients, check vitals, obtain a quick history of current complaint and related medical history, meds, and allergies. We determine (if we are busy) the severity of their complaint and whether they need a room immediately or if they can wait a bit. If we are not swamped, they go straight back to a bed regardless.  Busy nights it is a very stressful place to be, with people coming up every few minutes demanding to know when they will be getting a room.

In the ER itself, we assist with getting patients into gowns, getting them hooked up to the monitors, and obtaining full medical history, confirming medications and allergies, surgical history, social indicators, etc.

IV's and 12 lead EKG's are a big part of what we do, bouncing from room to room helping the nurses out.

"Bedside Testing" such as glucometers, urinalysis, and blood chemistry's using the I-Stat machines.

Since drawing Blood Culture's takes a bit of time, on night's that we don't have a phlebotomist in the department we are usually responsible for these. On nights that we do have a Phleb, we still usually end up helping out.

When we have a trauma come in, we are responsible for establishing the IV's and/or IO lines, getting the patient on the monitor, and any other assistance as required.

In general, we function as nurse extender's, functioning fully to the scope of our practice, with the exception of medications. We also place foley catheters, as well as Orogastric and Nasogastric tubes. We also do a whole lot of patient transpots, be they taking someone in a wheelchair up to the observation units, or taking a cardiac patient on a monitor and med drips over to the Cardiac unit.

Being in the ER has a ton of new learning opportunities and a nice variety of patients that I get to encounter. We are a training hospital as well, so new changes to healthcare as they come out are regularly being brought up and utilized. All in all, I really enjoy my job.

When I feel the need, I can still go get my "squad fix" as I still work (very)contingent at one of the private EMS companies in town. Later on this month in fact, I am working back to back days at one of the premier Rock Concert/festivals around for said company..should be a blast!

Till next time, be safe, and have fun!

TS&T

Saturday, April 28, 2012

Welcome back, you wonderfully deranged individuals who take time out of your day to read my ramblings! As I sit here sipping on a frosty cold beverage, I am reminded that Prom season is approaching. Obviously, prom is a pivotal moment in the formative years of the youth crowd, in both negative and positive ways. I know I enjoyed prom from the having a fun night with friends and classmates aspect, and never felt the need to drink. Too many times however, be it with or without parental consent and support, the idea of consuming large amounts of alcohol seems to be a fantastic idea. Coupled with both the emotions and hormones of the night, the addition of alcohol to a lack of driving skills is a potentially tragic combination. Every year there are stories of the horrible accidents caused by this fateful decision.

I have participated in a few Operation Prom events in the past, all of which got mixed reactions. While a number of students always just blew it off as an excuse to get out of class for a bit, there was usually a group that it struck home to. The sight of their friends being pulled from destroyed vehicles, either "dead" or "injured" shook them. The arrest and detainment of one of their peers being handcuffed, Mirandized, and placed into a cruiser. The extrication from the wreck. The landing of LifeFlight. Add in well done moulage to make it all nice and bloody for the full visual effect.  The moans and screams from the victims. Add in a few parents acting out what is a not impossible scenario, and it makes for an eerie, disturbing scene. It may not get through to all the students, but it is hoped to get through to those who are paying any attention, and with any luck will pop up in their minds when they debate whether or not to take a drink.

East Baton Rouge Parish DA office video

Fantastic video done by the East Baton Rouge Parish DA's office for their Prom Safety efforts. Great editing, and just an overall wonderful job. Worth watching, and definitely worth sharing!

On a different note, thank you to everyone who has been reading! I hope to continue with regular updates and postings. Please, feel free to post comments, questions ,etc. Share the blog on your facebook if it so suits you and you feel it is worthy. There is nothing on here that is limited to just my friends and family.

Till next time kids-
TS&T

Thursday, April 26, 2012

Me, As A True Hero...

Welcome back Loyal Readers..

A lesson, if you will, for the EMS Newbies.  Listen to your patients. Engage them, actually talk to them, not over them or around them. They called you, because they needed help. They did NOT call you for you to spend your time seated in the back conversing with your partner who is driving. Talk to them and find out what is really wrong. Listening to them, and interacting with them can make a world of difference in how a call turns out.

A while ago, I got called to a private residence for leg pain, non emergency..Showed up, walked inside, and found an older gentleman sitting in his front room. He explained that he has gout and arthritis, and the pain had become unbearable. Using the super fantastic pain score, he rated his pain at a 9/10, and I believed him. He could barely stand up, let alone walk around at home. He was widowed, and family only came to visit once in a while. He was obviously a bit lonely, which was understandable. We loaded the patient onto a stair chair, and then lifted him as gently as we could onto the stretcher, and took him to the squad. I got my initial set of vitals, finding nothing remarkable.  He wanted to go to a hospital across town, and before we began the transport, I apologized about the roads and the bumps that we would encounter along the way. While talking with him I found out he was actually a Physician, who had lived in Barbados for many years. We got to talking about his experiences and what life on the Island was like. He told me a bit about a prominent point on the Island that is named after some of my somewhat distant family. We joked, laughed, and just enjoyed talking. I was rather disappointed when it came time to call in my report to the receiving facility, and asked him his pain score to give them an update while I re-assessed his vitals. He looked surprised for a minute, and told me he didn't even notice the pain anymore.

Was a life saved or heroic's preformed? No. Simple, basic humanity was shown, along with a little bit of humor as medicine. A patient who initially was near the point of tears was actively engaged in conversation and joking banter, and became pain free, off of something that simple.

That is what patient care is about...


Till next time kids..

TS&T...

Tuesday, April 24, 2012

A little more about me, and some thoughts on the night life.

Welcome back..Surprised to see I had several other people actually read the first post, so why not continue on some more, eh?

As I said before, I have been a medic now for almost 10 years, and have worked in a variety of systems. I have done the BLS first response side of things, moving to ALS once the squad was on scene as needed, worked as both a basic and a medic on the truck, worked on the fire department, and was even a supervisor at one EMS agency. I am still learning, and probably always will be, given that healthcare is a continuously evolving career field. Anyone new to the job who happens to be reading this, keep that in mind! I have a few years experience under my belt, but am by no means one of the "old timers" who have been doing this job for as long as I have been alive.

When I became a medic, it was in a system that had, and still has, a GREAT field precepting program. Just because you have a pulse and a P, does NOT mean that you got thrown onto a truck and told to go save lives. There was an extensive training period where you could ONLY work as a medic if you were with a Field Training Officer, who was a seasoned medic. After most of a year, and having a number of high acuity patients, both medical and trauma, you could go test out with the Medical Director. He would quiz you on anything and everything that he wanted to out of the protocols, and expected you to know and understand not just what was written, but the rationale behind it. The Good Doctor used to work in EMS, and would show up at random on scene's where he might be of assistance, so he was an involved director, who knew his crews and what they were going through. Once you became a proud new Level 1 paramedic, you still were not going to be working with anyone other than other paramedics. After another year or so as a level 1, you could once again go back to the Director and test out again on protocols, with harder questions and a higher standard of care, to become a Level 2 medic. Again, still working with other medics until you tested out to the Level 2 Platinum status, which would allow you to work with a basic. After some time at the Platinum level if interested you could pursue becoming a PFI, Paramedic Field instructor. Only once one had reached that level could you be training new medic's on the truck.

I was privileged to start my career in a system such as this. It developed me as a strong, well rounded medic. It allowed me to work with a number of different PFI's, taking advantage of their experience to add to my "toolkit" of skills, tips, and tricks to make me a better provider. I feel so bad for those that are thrown to the sharks, and expected to function proficiently as an Advanced provider without that guiding hand their to help them. I also was lucky enough to do a large chunk of my training time as a probie on nights. I soon discovered that much like Dear Old Mom, I was a night person. I despise mornings. The sun is evil, and exists to make it uncomfortably warm, and to hurt one's eyes. Maybe that isn't the case for you weird daytime folks, but to us Nightwalkers, it is. I quickly learned that night people are a whole different type of animal altogether. From the gas station clerks we hung out with, drinking coffee and pop, to the staff at the hospitals, there is an entirely different attitude than the day shift. Yes, most of us have our quirks, but overall I think the night crew was much friendlier and entertaining.

I had to convert to evil daytime existence when I began working a 24 hour shift, which I did for about 3 years. Back in October, I got lucky enough to find a new full time job, working nights, 7pm to 7am. I quickly adjusted back to my nocturnal routine, and have been living every minute of it.  Since those day's of starting in EMS 10 years ago, many changes in my own life have come about. I have a daughter now, who is 3. I have a fiancee, who has a 4 year old son, and is going through her own Paramedic program currently. We also have a new little one on the way. Unfortunately, at least in my case, the rest of my family are those weird "normal" folks who are awake while the sun is up. That leads to creative sleeping arrangements so that I can still see those that I love. Most of the time, I just keep to a mostly nocturnal schedule, but every other weekend, when my daughter is here, I have to switch back to days. Man, that is rough! It is even worse when I happen to have a scheduled shift on that weekend..trying to juggle spending time with her vs being well rested enough to safely and efficiently perform my job duties. So far what seems to work best is for me just to get up in the morning with the kids, hang out until noon or so, then take a few hour nap. I wake up feeling rested, get to eat dinner with the family, and then go to work.

Alright..I just noticed how much I have been rambling..I blame the Burning Ball of Hydrogen...

Till next time folks! Be safe, and have fun!