Street Medicine in the ED

Aside from the fire department, some of the most professional fun I ever had was working for Caritas Norwood Hospital. So, since the commute to Quincy was killing me I applied to St Vincent's Hospital in Worcester in order to work as a critical care technician in the emergency room. I figgured it would be a good time and a nice way to occupy myself until I tested for paramedic.
I took my old job at New England back, it was nice to go back. New England is my version of Cheers. Everyone knows me there, I know everyone and I'm comfortable with virtually all of the partners I work with there. While I am no longer full time there, I still manage to pick up a decent amount of hours in order to supplement my time at St. Vinny's.
Eleven am to eleven pm, three days a week with benifits is not a bad deal at all. I basically do everything I do in the back of my ambulance with just a bit more oversight. In the back of my truck, I'm the doctor, the nurse and the respitory therapist. At the hospital I still do my own thing but now I have physians looking over my shoulder and nurses stealing my IVs.
Thinking St. Vs would be fun is just about the biggest understatement there is. I love working there and I am already learning a lot. Paramedics and EMTs work under a scope of practice in the field, we can only do so much without having to ask permission which usually means calling via radio or cellphone to talk to a doctor or if the shit is really hitting the fan, doing the procedure and hoping that the doctor will back you up afterwards.
But in the emergency room, the doctor is right there, in the two weeks that I have been at SV, I've simply had to stick my head out the door and say "Hey I'm gonna do this...." and the doctor just nods. In the back of an ambulance you have one patient for about a half hour or so, that patient is your soul concern and your life for those thirty minutes. I love being on the street, working on the bus but at the same time I want to be able help more people so the hospital gives me the oppourtunity to use more of the long term care (upwards of ten hours) that being on a transporting unit does not allow.
Normally my job consists of starting IVs, taking vitals, EKG monitoring and rapid transport to the closest facility at which time I say "Good luck, have a nice night....where can I find a soda?" Now I am part of a team of three nurses and two techs, assigned six to eight patients for a 12 hour shift in which time I am responsible for everything from emergency cardiac care to toileting. I start IVs, read EKGs and do all of my ambulance stuff but now I can perform blood tests, urine tests, culture for pathogens that help me diagnose and treat ailments that I would be unaware of in the truck. I insert Foley catheters that allow me to siphon urine dirrectly out of the bladder and thus test it. I can draw blood and order labs and have the results so as to provide a higher, more long term level of care.
But I still have my habits from the street, hell I still work the street down in Rhode Island and I probably will until a fire department takes me on again. I love being in the back of an ambulance and it spills over into my tech time.
Two days ago Worcester EMS brought in a 50 year old HIV positive, Hep ABC junkie who ODed on coke, crack and heroin. The narcan they gave in the back of the bus knocked out the heroin so when he shows up in my trauma room, he's going absolutely bullshit, screaming in Spanish and trying to hit anythign that moves.
I grab his arm and struggle to hold him still while calming him down while a nurse blows his AC with a 20 gauge needle. He was jumping so its not really her fault but he needs an IV badly. So I switch places with another tech and get down on my knees, time it just right and pop a 16 into his left hand.
When he starts coughing up pus we decide to knock his ass down and tube him, he's decomping quickly and as long as he's fighting, theres nothign we can do. So we hit him with versed, etomidate and prophonol, making him a zombie hooked up to our ventilators. I start bagging him with a BVM while singing:
"I'm Nick Nick the ED Tech. I got arms like Popeye cuz I bags me patients. Woot Woot." I'm a bit tapped but thats okay, it helps me do my job. Any sane person probably couldn't do this and probably shouldn't either. The doctor gives me a sideways glance before laughing and calling the CCU for an admission.
Once we finally get our junkie squared away, we need to rush him out of the room for an incoming STEMI from way down in North Brookfield. The medics bring him in and I pop a Foley cath him before we ship him up to the Cath Lab. Our door to balloon time, the time it takes for a patient to walk into the ED to the time it takes him to get on the table is supposed to be a half hour. We had him shipped upstairs in five minutes, a new record for SV. They gave us all free coffee.