Mad Irishman

2010-02-27T16:40:00.003-05:00

For those of you that followed this blog I apoligize for taking so long with this post. A lot has happened since this summer and I will be making one more career move come the spring time that will afford me and the family I hope to have more stability. It will also get me out of the rural systems I currently work in and into a busy urban setting where I belong. Once I get settled I will be starting on a new blog but for now I think this project has run its course.....thank you and good night

MVA Update

2009-07-14T11:13:00.002-04:00

Unfournately the little old lady in my last post did not make it. We received word yesterday when the medical examiner called looking for information about the car accident itself. It was not the best news to hear, but we really did the best we could for her and I like to think that I was kind and caring to her durring her last moments of lucidity before she couldn't fight anymore.

Minor MVA?

2009-07-12T17:18:00.002-04:00

A private ambulance was on scene already, they had been transfering a non emergent patient somewhere when they came across a car off the roa, slammed into a tree down in the ditch, a good six foot drop from the pavement. The airbag had been deployed and the white shirted EMT is standing there with a pair of bloodied gloves on when we arrive.
"Okay, so I'm transfering the scene to you." She says, very officially and I try not to laugh, she must be new as this is something left unspoken except for major incidents with multiple jursdictions.
"Whats up?" I ask her as the captain gets the cot and the board. The patient is still in the car, a C Collar in place and the EMT tells me she was complaining of lower neck pain, she's concious and oriented and when I talk to her she appears to have no major issues. She has strong and equal grips, her pupils are equal and reactive, she says the base of her neck hurts a little bit but its nothing major.
When I ask her how she ended up off the road she says that she thinks she fell asleep, a relative of hers is very ill and she was traveling to go and see her, she'd been driving a lot over the past few weeks and it must have caught up with her.
We eventually extricate her, carefully slidding the backboard under her and securing her because of the neck pain. She has a minor laceration to her face which at some point stopped bleeding. When I was if she has any medical history she tells me that she has A fib and that she's on a blood thinner called Comudin. In medic school they always teach us that Comudin makes a trauma patient very dangerous. They can have internal bleeding at the littlest trauma. But she seems fine and requests that we take her to a smaller hospital because its closer to her home and all of her doctors are there. Our assessments reveal nothing freightening so we agree and transport her to H.
On the transport in, she's talkative, answering all of my questions with no problems, her vitals remain rock stable and she shows no neurological signs.
When we drop her off in their trauma room she tanks us for our care and signs our paperwork. We leave and return to quarters.
Within an hour we are back at H, a walk in medical had requested a ride to that hospital. He's not critical so we transport him there with no real issues or treatments. An IV, a cardiac strip and a history, vitals. We place him in one of the rooms and I sit down to write my report.
One of the nurses comes in and says "I hope you don't want your back board back. Its on its way to Maine."
Apparently our first patient was still on the board, an MRI revealed fractures to the C 3 C4 and C5 vertbrae. A bleed had also developed in her brain. When I went in the trauma room to check in, her face was swollen and she had no idea where she was or what was going on.
I felt horrible but none of my assessments or tests had showed any reason not to take her to the hospital she requested. I am still trying to acquire follow up information on her but I am suspecting it will not end well.

NASCAR Detail

2009-07-02T08:29:00.004-04:00

Last weekend I made the last minute deceision to extend my 34 hour shift to 52 by picking up a detail at the New Hampshire International Speedway in Loudon, for those that don't know its a NASCAR track and they held the Lennox 301 there last Sunday. I figgured it would be a helluva show watching all the drunks and rednecks mingle through the stadium and that I could probably BS my way out into the infield of the track to see the cars go by.
My wife's father worked for a now defunct auto parts company and her childhood was spent going from track to track meeting different race car drivers and such. Because of that, we meet almost weekly at the inlaws to have homemade onion rings and beers and other goodies while we watch NASCAR. At first I wasn't interested in anything but the food but the more I watched and the more I drank the more interesting it became with the drafting and the bumping and what not.
So when my shift at the firehouse ended I put on my uniform shirt, I usually just wear a class C t shirt or poloshirt, and drove over to the racetrack to staff one of the private ambulances that had been rented to provide ALS care to the racegoers and, if need be, the drivers themselves.
I ended up being assigned to Grand Stand Aid with a bunch of medics from somewhere down in Connecticut. Its always interesting working with career private ambulance guys or even career EMS guys for that matter. But the career private people are usually a bit interesting and these guys from CT were no exception, they all wore police style belts with pouches for trauma shears and gloves and window punches, they wore huge MagLite flashlights even though we were in a well lit clinic type aid station.
I wore my Leatherman, a tool I wear whether I am working or not.
The day went pretty well despite the strangeness from Connecticut. We had several walk in patients. A guy in Home Depot racing team sweatpants and an AutoPalace sweatshirt comes in and asks us to rebandage his finger, the top of which is missing from some redneck racing related accident three days earlier. Its clearly infected but he refuses to be transported to the hospital claiming he has no insurance. Despite assurances that it won't matter, he still refuses. A few drunks wander in after falling over. We patch them up, hydrate them and sent them off.
For most of the day I sit outside the clinic on a golf cart and watch the parade of drunk and drunker people stagger by. Because of my badge a few of them think I am a cop and try to act sober when they stumble by which is even more entertaining. My official reason for being there was to staff one of the transporting ambulances at the paramedic level with an EMT from further up in the Lakes Region.
At about noon a call comes in from the middle of the track, because of severe mismanagement of the call by those in a position of power (private ambulances, not fire department or municipal personel) I end up being sent to the infield and spend a good portion of the race there until we are recalled to grandstand aid. I snap a few pictures with my cellphone of the cars whipping by and stand at attention for the cameras while they sing the national anthem and fly F 16 fighter jets over the stadium. Richard Petty zipps by on a tiny motorized scooter and thanks us for our service.
At one point I see a bunch of people in Lennox Tools Team t shirts and remember a friend from college who works for them, her father is Hackman, a guy who cuts apart cars with a Sawzall to demonstrate the reliablity of Lennox blades. I ask them if shes here and they tell me she's up in the suite. I call and leave a message telling her to come down and slum it with the rescue guys.
When we end up back in GSA we see a bunch of patients strewn accross the beds. The three CT guys are trying to start a line on a 15 year old girl with virtually no symptoms other than a headache while a 50 something year old guy sits unattended on a cot with his very nervous daughter. She's nervous for good reason, her father has been complaining of chest pain and nausea. His IV is infiltrated and he's shivering like crazy in the 80 degree weather.
I go over and pop another IV in him, discontinuing the 22 they had running and replacing it with a 16 guage in his Left AC. His daughter tells me he doesn't travel much and that he might have over done it.
I tell the CT guys to get a monitor and do a 12 lead, which takes them several minutes of wide eyed scariness to do. When they finally do, the monitor has no paper in it and the guy assures me "The 12 lead's fine." I take the patient and shoot off to Concord Hospital.
When we get back we are, thankfully, told to stage with the Loudon Fire guys at the TV entrance and I end up sitting there as the rain starts to fall. We get sent to meet Hillsborough County sheriffs deputies with a head injury at the other end of the stadium
On arrival we find several guys in Mass State Police sweatshirts trying to convince their intoxicated buddy that his 4 inch gash that goes to the skull over his left eye is worthy of going to the hospital.
Eventually we convince him, again another uninsured race goer, to seek help. On the way in his pressure drops and he starts projectile vommiting. Zofran calms that down and he becomes rousable only to sternal rubs, and even then minimally. All because he'd been horsing around with his buddies and fell, hitting a rock.
All in all it was a good day, despite dealing with whackers. And come September, I'll probably put in for the detail again.

ALS Skills

2009-07-01T14:51:00.004-04:00

http://www.youtube.com/watch?v=3pZxOqfB3YA

I recently read a post on FlyingVan, a blog by a San Diego Fire Rescue helicopter paramedic. Apparently his coverage area approved the EZ IO drill for use in prehospital care. We've had it in New England for a little while now and in fact have just approved it for use by New Hampshire EMT Intermediates in adult patients.
The EZ IO itself is something I have used on several patients, basically its a power drill that inserts a needle dirrectly into the bone for vascular access. While it sounds fairly barbaric it is a lot better than the old IntraOseous system which was pretty much an awl that used the brute strength of the medic to drive the hollow needle into the bone.
There's been some debate in New Hampshire as to whether or not the Intermediates should have been given access to the IO but my theory is that with the right training and propper guidance they can use this new tool effectively as paramedics.
The IO drill or bone gun as we call it in my service area, is particularly useful for dead and dying patients with poor blood pressure or compromised vascular access due to drug use or just plain "bad veins". When you absolutely, positively must have a line, the IO is there to bail you out with its easy Black and Decker style usage.
Its also not something to be taken lightly, like a lot of the paramedic toys. I recently had a student riding third on the ambulance, he's one of our volunteers, and I told him "A good call is when the ALS boxes stay closed." And its true, I am not a lazy medic but every ALS skill has consequences and reprecussions. BLS comes before ALS for a reason.
Having said that, some patients trully need ALS interventions for either life saving or life quality preservation.
Such as last night, I was working out of Station 1 when we were toned to a pizza dough manufacturing plant for a worker who had got his hand wrapped up in the dough hook of a mixer. He'd luckily self extricated before our arrival but his right hand was clearly deformed, starting at the wrist and swelling to about four times the size. His fingers were cool and clammy to the touch and his hand was continuing to swell.
He complained of 7 out of ten pain, stating that he felt fine otherwise. We propped his hand on pillows and towels in an effort to make him as comfortable as possible. His blood pressure was around 160/palp so I decided to push 4mg of morphine. All that did was lower his pressure slightly and did very little to touch the pain, but he asked me not to push anymore because it "Made me feel like when I used to use, I don't need that shit."
Fair enough, I pushed Toridol in an effort try and relieve some of the pain, the combination of both dropped his pain level to a more barable 5 out of ten.
ALS interventions do have their place and its not always for "lifesaving" purposes.
I also find it rather surprising that it has taken a California system this long to have brought out the IOs, it was always my impression they were far more advanced than us on the east coast.

Another Attempt

2009-06-15T11:18:00.004-04:00

I'm rotating through my time out of Station One, the station that houses our other ambulance and nothing else. At Station One, the two firefighters are on the ambulance, no cross manning an engine so when you go there, you know you're pretty much on the bus for your whole shift.

I'm on a thirty six hour shift which will then become a forty eight when we can't find coverage. The tones come through for a "Signal 21" which is dispatch's code for an attempted suicide. Had it been a sucessfull suicide, it would have been a "Signal 22". JT and I respond and take a student with us, the student is a 50 something year old woman who'd worked as an RN for a while and now was going to work as an EMT, supposedly.
The chief and several volunteers are already on scene including one of my favorite vollies of all time. We'll call her Sal but shes a cesspool truck driver who has been volunteering at the fire department for years. She was there when it was two seperate fire departments, two different districts. But Sal is one of those women who just exudes competence, she's calm no matter what and pretty much everything is met with the same attitude "Okay, yeah we can get this taken care of."
Sal is with the patient, a 60ish year old female who had taken 20 sleeping pills and some booze. While M, another volunteer who I like, is taking vitals and the chief is trying to figgure out how to get the patient out of the house, Sal gives me a quick run down in that no nonense, no bullshit this-reallydoesn't-impress-me tone of hers. The patient is pretty much fine, she's in and out of conciousness and this is one of many many suicide attempts.
My student is fumbling around with the O2 and puts a non rebreather on the bottle, cranking it all the way up.
"Woah, woah, she don't need that. Use a cannula." Just to be an ass I pronounce it "canoola" and the nurse turned EMT fumbles the cannula out. We end up carrying the patient down the front steps in a stairchair and I slip on a patch of wet cement, its raining like a bastard, the chief grabs my shoulders and forces me back to my feet before any damage is done.
In the truck I have the student take all the vitals and I try unsucessfully for an IV more times than I care to mention here. The woman's pressure is in the toilet so she goes into Trendelenberg with her feet raised and her head lowered to try and boost her pressure. Because I really have no idea whether she took more than just the sleeping pills I hit her with .4 of Narcan to see if it'll improve her at all. It doesn't and we end up BLSing her to Concord. She's sinus brady at 50 or so on the monitor and I really wish I had a line so I start looking at her neck for an EJ.
Even in Trendelenberg her jugular's refuse to dialate enough for me to see them and I'm not really in the mood to do it by palp (nor do I feel confident enough to get the stick if I try it) so we just screw to the hospital.
Once there we dump her in one of the rooms and the nurses do their thing. I still haven't found out about the outcome.

Growing Up

2009-06-09T18:44:00.004-04:00

I've had a lot of different dreams and aspirations as to where and how I should proceed with my career. One of the highest aspirations I have is to be able to go out on a fire crew to fight the big fires in the Western United States, in Canada and up in Alaska.

On June 6th I was supposed to take my pack test, a forty five minute hike with a forty five pound pack for a distance of three miles. Practice had become a way of life with both a fifty pound pack and a forty five pound weight vest. As I said before my White's SmokeJumpers are perfectly broken in from Walt's saddle soap idea and simply wearing them for hours on end.

Unfournatley, a lengthy discussion with my wife about our current financhial situation and all of the work that needs to be done to the Vermont house convinced me that seeking a position on a wildland crew this year would be impractical. The deceision was ultimately mine to make as my wife would have supported me even if it meant she'd need to take overtime shifts or get a second job. Her schedule is three overnights a week, 36 hours but since she works as a vet tech, she's not able to sleep like I can on my overnights. So her internal clock and cyrcadian rthyms are all out of whack.

It came down to "Do I go on the wildland crew and maybe make enough money, because of a deployment, to move out of Manchester and into our dream house? Or do I do the safe thing and stay, work my regular shifts at the fire department and get a third job?" I had already spoken with my uncle, a house painter in Exeter, and he said that he could give me extra work this summer. A town run ambulance was also looking for paramedics. So it looks like I'll be home with these three goobers.

When I sat there and thought about it, practicality won out. I need to be in New England in order to do work on the house, it needs to be ready by January. Being out in the greater wilderness of America, while tempting and certainly a lifelong dream, would not really be benificial to moving out of an apartment complex that is basically a baby step above the projects.
So this summer I will be painting houses, hopefully bolstering my income further by working for a small town's ambulance and, of course, working for the fire department.

My wife knows that I have always wanted to do the wildland fire thing, I almost left college my freshman year in order to move to Truckee California for a job that would have had me working as a firefighter/paramedic doing structural firefighting as well as wildland. At the time I had stayed because of a girl, who in the end was not worth it or the four years of my life I had given her. But if I had left I never would have met my wife. So everything happens for a reason.

By staying in New Hampshire for the summer I can get all the work done on our house, I can work extra jobs and I can hopefully start putting some money away. Next April I will take the pack test, nice and early so as to not have to worry about getting things together at the last minute.

Just for the hell of it I had put on my forty five pound vest and boots and timed myself on a three mile course similar to that of the Forest and Lands crew. At 40 minutes and 12 seconds I had finished the course.

Tatters and Onyums

2009-06-09T08:26:00.003-04:00

Everything seems to burn when I'm not on shift, it burns just enough to give the duty crew and the call company something to do but not enough for me to get a call back out of it.....

We'd been going to his house since before I'd gotten hired. He was an old, stubborn man who had been taking Lasix for his heart failure for years and refused home oxygen, prefering to call 911 when he woke up most mornings with trouble breathing. The fire department would show up, give him a few hits of O2 then he'd tell us to leave and sign a refusal.
After DC and I had put the ambulance back together after a car accident, we were finishing our paperwork up at Concord Hospital. The tones come through for a cardiac arrest at the address we have all been to at least once. Since we're twenty minutes away, we start the next town, we know they have a medic on today as they were at the MVA. For good measure, the chief of a second town takes several of his fire department's live in students and signs on to the scene. Five people to work a code should be sufficient but since it is our town we hit the lights and scream toward the scene, I curse the fact that I am still wearing bunker pants from the MVA.
En route the chief confirms a working code, the cops had been on scene first doing CPR and using their AED with no shocks advised. When we finally end up there, I find that there is blissfully nothing for me to do except hold an IV bag. The medic from next door has the patient tubed and is pushing her ACLS front lines.
"Hold compressions," I tell the student and watch as the CPR ripples on the monitor flatten into asystole. "Okay, continue." The kid goes back to pushing on the old man's chest and the line wiggles again.
We push two rounds of Epi, two rounds of atropine and continue to work the code for 25 minutes.
The cops tell us that the man had forgotten his Lasix up at his camp site somewhere in Maine. His wife had driven up to get it and come home to find him laying motionless in the chair. When the police got there, she'd been attempting to perform CPR with her husband still sitting upright. The cops hustled her out of the way and dumped him unceromoniously on the floor in order to try and get his heart going again.
In the end we determined that he wasn't coming back. He'd been down for an unknown period of time and our efforts had produced nothing to indicate he was capable of beating his own heart or taking a breath again. We took a sheet from the ambulance, draped it over him and told the family there was nothing more we could do.
I snagged an envelope marked "Publisher's Clearing House" and used the information on it to fill out my report. The table I rested the ambulance lap top on was really a cupboard that someone, presumably the dead man or his wife had handmade and carved "Tatters and Onyums" into the top of. For some reason, despite not knowing the man, I see this and want to cry.

Upside Down...For A Bit Anyway

2009-06-04T19:43:00.003-04:00

The past week has been fairly crazy. We bought my wife a Volvo from a guy her parents know in Southern Mass. Nice guy, trustable and reliable according to her parents and he was. Is. So with the new car we go and gather a bunch of plants to transfer to the house we'll be moving to in January. The plan was to get some brush cleared off and plant some rasberry bushes and some blueberries.

All that goes fairly well except for me falling on my ass and nearly sliding into the woodshed.

But on the drive back, the house is in Vermont. The Volvo starts to sputter. Not good. After two minutes of sputtering, the car dies in the middle of New Hampshire 101 in Peterborough. We push the car off into the shoulder and pull out the two totes we had used to transfer the plants to Vermont and sit down. We go through the motions of calling the inlaws to tell them the car died. Mandy's mother in a stroke of sheer genious (no sarcasm, really) signs us up for AAA on the spot and gives us the activation number and all that.

We end up waiting about an hour for a tow truck to come pick us up. Three people stop and ask if we are okay, well one drove by and just yelled "YouguysokayorshouldIstop." At 70 miles an hour. The ambulance I used to work for in Manchester goes flying by and I assume the crew is headed to Monadnock for some sort of an "emergent" transfer.

Eventually the tow truck guy shows up, stinking of weed with eyes as red as Christmas decorations. The two of us manage to get the Volvo onto his bed truck and secure it. He thanks me profusely, saying "Its hard to do this alone..." and stoned. Its getting dark when he drops us off at a closed auto body shop in Temple. We end up calling my wife's aunt, who lives an hour away in Brattleboro, actually the former owner of the house we will be living in, and asking if she can come pick us up.

She drives out as its getting dark. When she arrives its pitch black and I have taken to annoying my wife by pulling out my Zippo, firing it and saying "Look, I'm a politically correct lawn jockey."

We drive back out to Vermont and stay at her apartment, I fall asleep shortly after the Wendy's Baconator burger and fries with a shake that she was nice enough to buy me. Keep in mind by this point I am filthy from brushing clearing and planting, covered in grease from helping the tow guy and probably smell like something out of Satan's asshole because it was close to 80 degrees all day.

The next morning I get a hold of the guy who sold us the Volvo and he agrees to have one of his guys come up and tow it back to Mass and fix it, all at his expense. See, I told you he's a nice guy.

By this point my Jeep is still in the shop with a bad seal on the gas tank setting the engine light off so we rent a tiny Mazada or some Asian something or other and drive back to Manchester. Luck was on my side as my cell phone rang telling me the Jeep was ready. So we picked that up and ditched the rental.

Originally the point of this article was to show a few pictures of the house so as to document the progress of our renovations. But I figgured this story was just too good not to share.

O and by the way, the Volvo is fixed, it was just a bad spark plug. We are probably going to pick it up on Saturday. Just in time for me to go back to the firehouse......

Pack and Safety

2009-05-27T10:08:00.002-04:00

My boots are broken in and I've been hiking and pack training in order to meet the requirements for arduous duty set out by the feds for wildland fire work. On June 6th I'll be taking the test itself and a required yearly in service safety refresher. On June 13th I head down to Douglas Massachusetts to do some crew specific training in order to work on the Massachusetts Wildland Crew. After that I should be eligible to respond to wildland events nationwide and in Canada. Hopefully the rain will stop so I can get an after work hike in tomorrow morning.....

Drama Queen

2009-05-26T11:22:00.002-04:00

"Shes a drama queen." The mother warns me as we approach her screaming nine year old daughter.
"Well what happened?" I ask. The girl is laying under the monkey bars with a sweater rolled up under her head, covered in a blanket litterally screaming her head off.
The mother hikes her baby up on her hip and says "She fell off the monkey bars and she could have hurt herself but shes such a drama queen I can't tell." Five minutes earlier a woman in an orange shirt had come running into the fire station to tell us that we needed to go for a "child down" up at the school.
I finally get over to the girl and her screaming doesn't stop. I try to ask her what happened and she yelps "Will I be able to go to school, what if I broke my arm?"
I try, unsucessfully, to get a meaningful history out of her before simply deciding to put her on a backboard. BT grabs a spine board kit and we get her immobilized as the deputy chief pulls up and I learn the girl's right arm hurts. When I cut her sweatshirt I see no swelling or deformity but I slide a pillow and a rolled towel under it for comfor.
The screaming continues nonstop along with questions about whether or not she will be able to go to school and "Ohmygodwhatifitsbroken!!!!!" repeated at near ear splitting decibels.
The woman in the orange shirt shows up and yells "You shouldn't move her, what if she hurt her neck."
I just turn to look at her, at a loss for words before finding a response. The chief chimes in "Well we can't do X Rays here."
At the mention of X Rays the girl starts screaming about radiation poisioning and I wonder briefly what kind of childhood she has.
She and her family are from about an hour north of my town so we have to transport to the hospital they prefer which is way out on 126, Huggins Hospital. On the ride in she screams and yells about every bump but often gets mad enough to forget the pain in her arm because of the velcro on her forehead due to the backboard straps.
I just calmly talk to her and try to soothe her by making my voice the audible imbodiement of a Hindu cow. It doesnt work.
When we finally get her to the hospital and turn her over to the staff I get the "Oh, gee thanks so much"-- look from the receiving RN. The girl complains that the light in the room is too bright and she wants to be off the board. Again she asks if she can still go to school because she has important projects to do.
I refrain the urge to tell her she is nine years old, nothing is important. Instead I leave to do my paperwork.
Not even to the door, an SUV pulls into the ambulance bay. Out pops a guy in a suit covered in blood and his wife. They wrestle open the backdoor and pull out a frail old woman wearing no pants with blood pouring out of her rectum.
Instantly the man's wife is in my face. "She's lost about two pints of blood and I think she's arresting." The old woman is calm, smiling even, as her son carries her in and plops her into a wheelchair. BT and I help get her into Huggins' trauma room and then finally find our way out of there.
On the way back we watch the sky darken and rain begin to pelt the windshield of the ambulance.

And The Point of It All Is?

2009-05-22T12:11:00.003-04:00

Jonny began the journey back to Iraq today.
Last night over dinner he talked about the country and the mission of the military and the whole shebang. He said that the vast majority of the people there are ignorant, uneducated with no real chance to ever do better than eek out a subsistence living. Because of their ignorance their views are closed minded and difficult to change. Everything is tribal and patriarchal, women are treated horrendously and pretty much everyone has a hidden agenda.
In short, the whole country is stuck in the middle ages.
Which got me thinking (yep I'm gonna vent but my next posts will be about pretty flashing lights, fires and blood and gore, don't worry) what the hell are we doing over there? Our last president couldn't find Osama Bin Ladden, the guy responsible for the 9/11 attacks so he did what any good politician would do, he strapped on his Texas Six Shooter, put on a flight suit and flew a fighter jet onto a carrier and beat the shit out of a fifth world nation under the banner of "human rights" well for the years since the end of the first Gulf War we really could have cared less about the human rights problem in Iraq. But then magically we have the right to commit a war crime (yes invading a sovereign nation without provocation is a UN war crime for which Bush will never be tried) when public oppion dwindles on the hunt for bin Ladden.
So now countless friends and family members are trying to change thousands of years worth of culture in order to place a barely functioning form of government in effect in a place where Church and State are one. The theocratic regime that rules the Mid East knows no boarders just as the Papacy knew no boarders in the Middle Ages. American troops with sophisiticated weaponary and equipment are not going to change the way of thinking in that area just like armed Middle East troops invading America would not change our way of thinking.
When American troops leave Iraq, and in my oppinion it can't come soon enough, the puppet government we set up over there WILL crumble. They will go right back to slitting each others throats because they don't fear God the same way and they always will.
America was founded on relgious tolerance yet we force our own ideals on other nations because their standards of decency don't measure up to ours. We have no real right to go to Iraq and say "You know how you've lived for the past thousand years, well its wrong. Do it like this."
I often piss my wife off because I call myself a liberal and she feels that views such as I am expressing now are closed minded and very conservative because I am basically preaching isolationism. And maybe this is a new form of isolationism but I really don't see how we can look at a culture that has sustained itself for thousands of years and think we can change it in any amount of time with any amount of firepower. If armed troops came here and told us how to live we would fight tooth and nail to send them packing and we would never submit to their ideals. Why should we expect anything less from a far more violent culture with litterally nothing to loose.
Religion is so imbued into the politics of the Mid East that we can never sepperate the two. So what is the point of sending people like my brother in law to an area that will never change?

Be Back Soon

2009-05-20T10:56:00.000-04:00

Jonny heads back to the desert this coming Friday. I'll have more posts up and available for readers in a few days. Today I'm off for some deep sea fishing.....

Home for a bit

2009-05-08T08:24:00.001-04:00

Two days ago, my brother in law Jonny Priestly came home on furlough. He's out of Iraq for two weeks.....Let the party begin

Sempor Memorium

2009-04-20T19:02:00.003-04:00

On Friday a man with more dedication and a love of the fire/EMS service than myself and many others decided whatever personal problems he had were too much for him to bear. He spent a good portion of his 20 some odd years helping others and for whatever ironic reason was unable to find the help and solace he gave so many others.

Greg Castillo worked as an EMT Intermediate for three different New Hampshire services. He worked long, long hours often being away from his home for days at a time in order to practice his skills and no doubt tough out a living on the wages we make. He loved what he did so much that he involved himself in the Muddy Angels EMS Memorial Cycling Program and did the Boston to Roanoke Virgina ride at least once. He Traveled to Ireland in order to participate in their bike ride for rememberance.

We called him "Two Phones" because before I worked with him he sold cell phones and had his personal cell phone and his work cellphone on his belt all the time....we're not that inventive. He was a quirky strange guy but one who wouldn't hesitate to help anyone in any way he could. More than once I forgot my lunch or money and he'd unquestioningly buy me a burger. He had his little nuances that could drive you crazy but his quick sense of humor and his willingness do anything for anyone usually made you forget what little thing he did to piss you off.

He was known for consuming vast quantities of food at a sitting, littlerally measuring the first plate in servings. Putting away an entire basket of chicken fingers, french fries and a milk shake followed by a tray of the ubiquitious Sunday Night Brownies was not uncommon. Left overs on the verge of being thrown out from the fridge for sitting in there for too long never found the garbage can because of Greg.

After I left Rockingham I ran into Greg back in the winter at Concord Hospital. He was dropping of a patient for some procedure or another and as usual he had that big smile, the kind the lit up the room because you could just tell "Here is a guy who loves what he does." He shook my hand and we bull shited about peopel we knew and what the ambulance higher ups were up to, how Manch 911 was going and how he was excited for another bike ride. We talked about his Ireland trip and he how much he loved going over there.

Years ago I dealt with a patient who commited suicide. My partner at the time was a Lieutenant by the name of Mike Rosen, a big guy with a heart of gold. I can remember being totally speachless as the father of the patient just sobbed and Mike consoled him saying "Whatever pain he felt made him seek a permanent solution to a temporary problem. People often think they can't talk about whats bothering them. I have no doubt if he came to you you'd have listened and talked and helped him through it. It's not your fault."

Greg could have gone to anyone he worked with, theres not a single EMT or medic at any of the three services he worked for who would not have jumped at the chance to litterally through aside whatever they were doing and dealing with to help their brother. Unfournately whatever pain or problems Greg suffered from warped his mind into thinking that this was the only way out.

Countless co workers and friends are looking at the incident and wondering if they could have been able to help. They wonder if they could only have spoken with him or found out about his personal troubles maybe they could have gotten him help. And the answer is yes, if you knew you could have helped. If you had found out that Greg was suffering in such away as to even consider this action you would have helped. But Greg kept his personal problems personal and did not seek the help anyone would have readily given. The kind of pain that drives someone to shun his brothers and sisters is too great to even imagine, but if he had sought help I know that whoever he went to would have listened patiently and talked with him, helped him through his problems or found him someone who could.

The Fire/Rescue service is such that its members tend to be very closed off. We talk about the brotherhood and the familial atmosphere of the firehouse but lets look at the issues and the feelings we keep from our biological families. Humans are a strange creature in that we seek out companionship and relationships in order to share our feelings and our troubles yet we don't share those troubles for fear of burdening our companions. The shock wave that Greg's death sent through the emergency community is similar to that felt by a biological family, perhaps its even stronger because unlike a family his coworkers have been with him when he did what he loves, they've shared the back of the ambulance and the back step of the truck with him.

I was in the middle of a 48 hour shift when I found out Greg had passed. As is apparently the custom of our society I put up an away message on Facebook. "5-5-5-5 TP, May the wind always be at your back...." THe 5-5-5-5 signfies 4 sets of 5 tones dropped to mourn the passing of a firefighter, it means he has responded to his final alarm and he has returned to quarters for the last time. The latter of the message is the begining of an ancient Gaelic blessing which, unbeknownst to me, Greg put up on his EMS World page as his final post, his final message to the world.

Greg someday we will all meet again. Itl'' be a big firehouse dinner with enough food to sate even your appetite. At that meal the dispatch gods will be kind and we'll all get together and talk, laugh and have a grand time. The tones will be quiet and we won't roll untill all the catching up is done. And when the tones finally sound it will be for light, respectful patients and fully involved buidlings. But untill that day you watch over us, my friend, you keep us safe and you laugh when we have that annoying fat patient stuck on the toilet. Laugh when we get toned for a clearly bullshit call at 5 minutes to shift change. Enjoying knowing that everytime we get on that truck you are with us. But above all please find the peace and solace that you gave so many others through the practcing of your trade.

Parenting?

2009-04-09T18:11:00.003-04:00

As I'm half asleep in the recliner I can hear the police band talking about a high school party in which a girl had her foot run over and now her drunk mother was running her mouth off. At the time the problem was two towns over and despite being the only medic on for three towns, I assumed it would not be a problem. A foot injury does not warrant a call out for a medic especially when I didn't get toned for a diff breather in the town next door. If they need a medic, I will be sent.
Sleep.
The tones do drop, unceromoninously for a foot injury at the Alpha level, the least severe and jokingly called "Taxi Level." Lakes Region Dispatch notifies us that the girl had previously been in the town of Allendale playing football and had her foot run over about two hours ago. We are instructed to wait for PD.
"Sonofabitch!" I cough and fumble the sleep out of my eyes as I hulk down stairs and take a piss. GD, my partner is waking up. We work together infrequently but when we do its usually a good time as he is laid back and has a good sense of humor.
I hear the bus starting up and grab my radio strap and hop in as we pull out.
"I thought this was in Allendale." He mutters.
The ride is fairly quick and when we arrive two cop cars are parked outside with a state trooper truck pulling in behind us.
Officer K. comes out and waves us over. The whole property is dark so I turn on a flashlight and grab the first in bag as we walk up into the house. Its not a bad little house, it looks to be clean aside from all the shoes and a few sweaters clogging the front entrance way. As feared the mother and her five friends are very drunk and very annoying, alternatly crying and yelling that they are going to kill "the motherfucker that ran over her foot."
"I thought this shit was in Allendale." I say to K.
"Yeah but she lives here and drove herself home, mom found out and now her foot is numb."
The patient is a 16 year old girl laying on a bed in a backroom. An enormous tiger cat is sniffing her and just for the hell of it I pick him up and pet him while I talk. He's cool with it so I conduct my interview holding him and scratching his ears like the Godfather.
"What happened?"
When the girl answers its in that overly sylabic almost spitting monotone of the trully ignorant who were raised and will remain that way.
"Well we was playin' footballs and mah friend droved up so I went to his cah and and when ah stuck my head in da winder he droved ova mah foot. And mah friends was like 'Youse on her foot, backup.' Now mah foot hurts."
"How long ago was this?"
"Bout two hours but I droved home on it."
Before I can answer more questions, mom appears in a flurry of curses and covered in sweat. "I got Medicaid, she goin to da hospital. It gonna pay so you don't gotta worry bout me payin."
The cat scoots out of my hands and I just smile.
"This is a crime. Seriosuly," mom continues. "She just dere and he runned ova her foot. And dat bitch lied to me and told me she hurt it playin' football. Mothafucka lyed at me to my face on the phone."
"She looked you in the eye, thats a shame." K remarks and its clearly over the woman's head.
We carry the girl out to the bus and somehow mom ends up in the front seat.
Her vitals are fine and I put a pillow under her foot. If mom was sober she could have taken her daughter to the hospital herself. Parenting at its finest.
Durring the transport the girl's mother is bitching at GD and he ends up putting up his hand and saying : "Listen, I don't care. All I am doing is taking your daughter to the hospital. You are no longer allowed to talk to me. Sit there quietly so I can concentrate on driving." Surprisingly it works.
My paperwork is finished when we pull into the hospital.
Alerted by my patch, a security guard hangs out at the ambulance bay and the mother instantly accosts him and tells him in vivid livid detail the whole story.
While we transfer the girl to the hospital bed I remember I still have 32 hours left in my shift.

Heres to the boys who feared no noise

2009-04-01T19:59:00.001-04:00

http://www.youtube.com/watch?v=9UmtJ30Rl5o

Breakfast Delayed

2009-04-01T19:00:00.003-04:00

He died when I was driving into work.
I can imagine the scene fairly easily, he'd been asleep in his nice warm water bed and just stopped being alive. He'd had throat cancer for years and still smoked. His wife slept in the other room and got up at around eight or so.
Back at the firehouse we were trying to decide on breakfast. Just as we settled on pancakes with fried egg in the middle--- some weird Canadian thing---- the tones go off for a cardiac arrest at the echo level.
I take a piss and we jump in the bus for the quick jog up the street.
She drags her husband off the bed, his already stiff body flops to the floor and she listens as 911 tells her how to pump his heart for him. The sweat beads on her forehead as she works to save a man who'd already been dead for a while.
We pull around a slow moving car and finally end up in front of the house. BT grabs the monitor and I take the first in bag. A guy in a trucker cap and a ratty t shirt holds the door open.
"WhereamIgoin'bud?" I ask like I always do on codes. He points me to a bedroom at the end of a cramped hallway. I hustle into see an overweight woman pressing on her emaciated husband's chest. The phone is cradled in her ear.
"Rescue's here now. Do you want to talk to them?" She asks 911. I hand her off to another firefighter who showed up and feel for a pulse.
Time of death 0835. Officially anyway, the poor guy had probably been dead for several hours as he was gray and stiff.

When I started in this line of work I used to get excited for codes, the CPR the monitor, the intubations and the drugs we push in order to try and bring the person back. Maybe I'm jaded or getting a bit burnt or maybe I'm realizing what my job trully is after nearly 7 years of doing it. Codes no longer excite me. Instead I think of the family members, the friends and the vacations untaken. The home projects unfinished. The mail unopened.
As a rule I don't like to bother the family members after I've decided not to comence efforts to resucitate their loved one. I usuaully snag a piece of mail and copy the address and such from that. Today it was an unopened letter from New Mexico.
Don't get me wrong, my job is great. I really couldn't do anything else but I think I'm getting a deeper understanding of where I fit into things and people's lives. Those people today will always remember me as the guy with his shirt untucked and a radio stuffed into his backpocket who felt their relative's neck and shook his head.
The medical examiner for our area is a frail guy so we went in service on scene and waited for him to show up. I zipped a vinyl body bag around someone's father and grunted and huffed as me and my partner tried to wrestle him out of the house. When we put him on the stretcher his lifeless head made a soft, dull thud as it touched the unpaded bed.

We abandon our plans for a Frog breakfast and settle on left over Creole chili from the shift before.

Now I sit here with Dropkick blaring.

2009-03-28T20:18:00.002-04:00

I just finished reading an article about how everyone is all upset about the changing of the name of the "Freedom Tower" in New York City. For those that don't know the Freedom Tower project was supposed to be a tower that was deliberately set at 1,776 feet as a tribute to American freedom and all of the chest thumping and patriotic hoohah that could possibly be wrapped up in a massive skyscraper on the site of what is essentially a common mass grave for the thousands of friends and family members of countless Americans.
I understand that Ground Zero could not be made into a park, a sort of oasis in the hustle and bustle of a massive megalopolis in order to honor the memory of innocent souls. Come on, we can't possibly lose that real estate. So what it if its holy ground because of the blood that went into the soil. We bulldozed and built on Indian burial grounds for years. A hundred years from now there will be horror stories written about how the walls of the tower bleed and ghosts of the dead killed in the attacks haunt silicone injected botox bimbos while they have sex with their bosses for corporate advancement.
If I sound bitter, I am.
The biggest controversy surrounding this abomination is the name of it. Nearly three thousand people were killed on this site and we build an office complex. People will argue that if we don't rebuild the terrorists have won. Well heres a bit of news for you. I take my shoes off at the airport and I can't bring shaving gel in my carry on any more....... you figgure out whose really afraid of who and remember Tzu Sun's definition of terrorism next time a guy with a turban on sits next to you on a plane.
Ground Zero should be made into a park. Put a nice wall up with all the names of the dead so that we trully will "Never Forget." All that Lee Greenwood country music proud to be an American bullshit won't mean anything when the kids born in this generation are walking through Lower Manhattan, point to the ungodly monument to American avarice and tell their children. "See that big office building? We built that after some Arabs blew up the other ones. I'll show you the Nicolas Cage movie when we get home."
Everyone says they will remember, they have the FDNY 343 stickers and the T shirts and the I heart NY shirts. But if they actually remembered the pain, the suffering and the fear, the terrbile fear that day caused they wouldn't dream of putting up another building there. I can clearly remember calling my father from school that day. As we were talking the plane hit the Pentagon. My father, the man I've always thought had no fear broke into tears over the phone and said "God, they just hit the Pentagon. Its the end of the world." Remember that fear, that pain next time you send your credit card bills to grave of your friends and relatives.
Shit, Gettysburgh is open, lets put an office complex in there.
Aushwitz is prime real estate, bull doze those ovens and put in a KFC.
Pearl Harbor is clogged with sunken ships, dredge that fucker and put in a resort.
Why is it that the site of the biggest mass murder in the history of the world is being turned into an office park? Does my cousin deserve to have the only grave that inters her remains turned into an office building.
If the site of the World Trade Center attacks is not considered holy enough ground not to build on then the debate about whether to call it "the Freedom Tower" or "One World Trade Center" is totally pointless. The tragedy is not that we're being unpatriotic in not calling it the Freedom Tower, instead a mortal and irrevocable sin is being commited in building an office building on the grave of close to three thousand people.
If I lost you as a reader after this article then so be it. I'm so disgusted right now I can't stomach to even write any more about this travesty. I can't even title the damn thing.

Repeat or Sequel in a Trilogy?

2009-03-23T11:21:00.003-04:00

Things happen in cycles.
Its around half past midnight when we finally get to bed after bringing a diff breather who, in reality, just needed to calm down, to the hospital. I drift off to sleep in the recliner as the beds are not very comfortable.
Little more than an hour latter the phone starts ringing and I can hear my partner, Jay, in one of the bunk rooms fumbling around for the handset. I hear him answer it and then it starts ringing again. Apparently the caller keeps hanging up.
We go down stairs to try and catch the caller ID so we can have the cops check it out. It wouldn't be the first time some one called the firestation instead of 911 and needed help.
I don't think too much of the extra car in our parking lot untill the tones go off for a delta level chest pain in the parking lot. Still clearing the sleep from my brain I grab my flashlight and head outside while Jay pulls the bus out.
The woman's husband is smoking a cigarette, seemingly unconcerned that his morbidly obesse wife is vomitting in the parking lot and complaining of severe chest pain going into her left arm and her jaw.
"Wanna just go?" Jay asks and I nod, hastily spit out a "Yep" and we bundle her into the back.
"Hon, you have any cardiac history?" I ask as her husband starts climbing into the back with his butt still lit. "No, dude you can't ride back here." I tell him, more because his wife is so big I have barely any room to move than because of his cigarette. He shrugs and drives off in his car without saying goodbye or even telling us if he's going to the hospital.
"All I have is diabetes." We're moving now and Jay tells me he'll pull over when I want a 12 lead. The woman is pale, cool to the touch and covered in sweat. She's also dry heaving into a bucket and complaining of severe pain. I tell him to go as fast as he can safely go.
The monitor shows a sinus complex with severely elevated T waves right on the three lead, for those non medical people the whole squiggle is supposed to be fairly uniform. If it goes up at a right angle it usually means something very bad is either happening or had in the past. These elevations are more apt to show up on the 12 lead than the four lead, seeing them in the four lead is a bad sign.
She gets asprin and her blood pressure is at about 90/palp. She had told me she had a history of high blood pressure and with all the chest pain she should have been through the roof. I ask how long the pain has been going on for.
"Two hours, it just keeps getting worse."
Shit.
She's in the end stages of her MI, a piece of soemthing has occluded an artery in her heart and now she is about to die. Initialy the blood pressure will be very high, as they start to decline they are slipping closer and closer to cardiac arrest. The heart is no longer injured but dying. Despite the low blood pressure I give her a nitro which knocks her pain down to a six but unfournately her pressure drops to 80. I start running fluids because I want to get that nitro in her to drop the workload on the heart and buy some more time.
But her pressure stays low. Shes getting less and less coherent. I call her in as a status two and tell Concord to have a full team waiting for me.
When a person is having a heart attack, its a race from the onset of the pain to the cath lab. The cath lab is the only difintive treatment as they have to go in and unblock the artery in order to restore oxygenated blood flow.
The woman who showed up in the firehouse parking lot had already waited dangerously too long before seeking treatment.
I sigh with relief when we back into the ambulance bay at Concord. By now I have exhausted all I can do. She had her baby asprin and her nitro. Her pressure was too soft for more nitro and morphine was out because it too would drop the pressure. She was barely coherent now and I didn't want to totally snow her with Fentanyl.
Dr. Carter was waiting just inside the ambulane bay doors, he'd gotten to know me since I started at Northern and realized it was me coming in with a potential problem. I don't make it a point to call for a team for everything so he rightly assumed they should assemble.
I give a quick handover report telling him all that I did and showing him the 12 leads. His eyes go wide and he mouths "Oooo, shit." As we transfer her over to the hospital bed, the cath lab guys are showing up.
Then she slumps into full unconciousness, stops breathing and the monitor shows V Fib. Her heart stopped beating and was basically quivering.
We shove her over onto the hospital gurney, dropping the head of the bed and calling everyone to clear. She gets defribilated and the electricity shocks her heart back into beating, it also causes her a lot of pain because she screams. "Don't fuckin' do that again."
They end up shocking her twice more before she went up to the cath lab. I lost track of her after that and I haven't been back to the hospital since so I'm not sure how she made out.
On the ride back I remember what my father always said about strange events or deaths. "They happen in threes."
I could really do with him being wrong on walk in medicals.

Rude Awakening

2009-03-17T17:59:00.002-04:00

I wake up nearly every morning at around 0500. Whether I get out of bed or not is debatable but come Five AM I am awake. If I'm not due in at the firehouse I usually get up, hit the bathroom, check the weather report and go back to bed. If I have to work I shower and start my day.
When I'm at work, I wake up at about the same time and hit the laterine. Sometimes I'll check the weather or work out just to be up for the day. Occasionally I'll be really ambitious and start cleaning the ambulance and getting breakfast ready for the on coming crew.
My last tour I woke up, like clockwork with no pun intended and pulled on my boots to go downstairs and take a whiz. I'd been laying in bed for about fifteen minutes or so when I'd decided to give into the call of nature. It was one of those rare tours where we had a three man crew covering the house, myself, BT (station 1's lieutenant) and DG, a firefighter EMT. Downstairs there was a clattering sound like one of the screens on the outter windows had been torn loose and was swinging in the wind, so I pulled on my sweatshirt and didn't bother with a pair of socks, leaving my boots unzipped.
To get to the restroom, you need to walk through the front foyer, past the main entrance.
A guy in a denim work uniform emblazoned with a plumbing company logo was pounding for all he was worth on the front door, his brow damp with sweat and a grimace on his face.
"Shit," I muttered. At five in the morning his pounding on the door could herald nothing good.
When I let him in he blurted out. "My chest really hurts. I don't have my nitro. You guys have some, right?"
As I ushered him into the back of the ambulance he tells me he's had three heart attacks and this feels worse than his other ones. I pull a nitro out of the drug box and place it under his tongue. Then I hop upstairs to wake my crewmates up to get me some help.
We do a 12 lead and find elevations in V 3 and V 4. A 16 guage IV goes into his left AC and he gets another nitro tab before we pull out of the bay. He states his doctor's found a 75 to 80 per cent blockage on the right side of his heart and I catch a memory of the V 4 R technique my medic instructor beat into us in school.
I move the V 4 lead to his right side but find inconclusive evidence of a right side involvment. He gets another nitro with no relief so I move onto morphine and end up giving him the full 4mg before the pain lessens.
We transmit both EKGs to the hospital, surprsing them with the V 4 R.
From the time he banged on the door at the station to the time he was on the table in the cath lab was exactly forty one minutes. I should also point out that is with a brief pee break before starting transport.

Younger

2009-03-13T22:55:00.002-04:00

One of my most vivid memories from childhood focuses on a family trip to Florida. My parents were young, just starting a family, I was only about five years old. My brother was an infant or thereabouts. We didn't have a lot of money, not poor but in the conservative boat that my wife and I now find ourselves in.
My parents wanted to take their kids down to Disneyland, or World, whichever one is down in Flordia. Flying would have been too expensive so they decided to drive the family down in a 1988 Izzu Trooper. I still remember that car, it was an early SUV with a wimpy little four cylinder engine and a stick shift that would later burn out on a family trip to Canada to see Niagra Falls. But the Disney trip started early in the morning, before the sun came up on a March vacation. It was still cold out and my parents had set up a sort of bed for me and Doug to sleep on in the back of the Trooper, the seats were folded down and there were pillows and blankets. It was chilly but the blankets were warm and it felt like a little cocoon against the world. I remember the night before my dad had let me stay up and watch a Roy Scheider movie about a police helicopter pilot who is in control of a super gunship....and of course that morning, the back of the Trooper became that gunship and I was too excited to sleep. I was up imagining little adventures, imaging being grown up and wearing a uniform and a badge and saving peoples lives. My head was far away from the car and the many miles my father was going to put in driving down to Florida. All I knew was that in three days we would be swimming and going to the Magic Kingdom and the big silver golfball.....I couldn't remember what it was called back then and I still can't think of the name.
Twenty years later I found myself wrapped up in the back of another vehicle, in the chilly dark living out a different adventure. I was bundled into turnout gear, ear plugs to keep the din of the open cab Ladder truck's engine out of my brain, a knit cap pulled low over my head to keep as much heat in as possible. I stunk of smoke, my shoulders and back ached from the weighted chain I had spent four hours dragging up and down a fifteen foot chimney.
Exhausted I leaned back against the jumpseat, the dim glow from the firefighter in the seat next to me texting her husband gave an errie comic book light to the whole situation. Twinkling farmhouse windows zipped past the truck, as we chugged back to the firehouse.
I'd seen at least 12 feet of active burning chimney, so hot the bricks were cracking and the slate cover was disentegrating. Steam had billowed from the top of the flu when crews inside started spraying the flames with water cans, nearly enveloping us had it not been for the operator's quick manuvering. Bricks had exploded from the heat, pelting my helmet and the air mask I almost didn't put on, thinking "It's just a chimney fire, not like we're making entry or anything."
But on the ride back my mind was 20 years removed from the night's activities. After we'd cleaned up and left the scene, I was in the back of that car awed by the possibilities before a five year old. Imaging what my life would be like, 20 years in the future.
That's what amazed me most, I think. When I was younger I'd dream about being older, being a "grown up" and being able to stay up past nine PM. Last night at quarter to 10, true, past 9 PM, I was drifting off to sleep, dreaming of what it was like to be younger.

Helping Someone

2009-03-02T16:04:00.003-05:00

The first med call I ran at Northern was a 56 year old man who had been arguing with his wife about buying paper towels. He started to feel light headed and dizzy, he broke out in a cold sweat and felt like his heart was pounding out of his chest. We ended up taking him into Concord Hospital with nitro, morphine, two large bore IVs and several 12 leads along the way.
Last night as I was cleaning up after dinner, with a movie playing on the TV, I was pretty much convinced that this shift would go the way of the rest with another 24 hours devoid of calls. I should add that because of my previous shift's lack of calls I was able to find a great recipe for shrimp scampi that was a fairly big hit.
When the tones came through it was just starting to snow fliggy out, nothing really earth shattering but just enough to let us know that the storm was in fact coming. The ride in the ambulance was totally different in the dark. I knew the address sounded familar but I wasn't sure why. Out front one of the vollies had parked his F350 with his red light bar going, as good a roadsign as any.
The patient was inside sitting on the couch, feet up on the coffee table with a strained look on his face. My Captain, MR, was working with me out of station 2 just as she was on my first shift. I start looking around and admiring the very nice wood stove they have blasting heat into their nice little home.
"What's up, bud? I'm Nick."
"I know, we met back in August. You missed an IV in my hand." He smiles good naturedly and explains that his heart is bothering him again though not as bad as before. Sure enough the monitor shows a sinus rthym with complex dropping here and there and a few PVCs. Denying pain he tells us his chest feels tight and that he doesn't know if he should go to the hospital. His skin seems a bit pale but the only light in the room is from the stove so I don't really let it set off any bells.
The vollies end up bringing him out to the truck while I spike a bag and get my drug box ready. A quick 12 lead shows nothing scary and he states that he feels a lot better. My only real concern is that the guy was an Air Force drill instructor for 25 years who still runs and swims religously, and his blood pressure is 190s over 100s. The first IV poke into his left AC drops him down to a more resonable 150 over 90, still not great but I really don't want to give nitro to someone denying any cardiac symptoms.
We transport him to Concord again, his blood pressure going down to 130s over 80s. Another line goes in his right AC just to be safe and I do another 12 lead, again finding nothing. His anxiety seems to have abated and he asks me how I like working in town. I tell him I'm very happy because its a nice town with nice people who, for the most part, behave themselves. I bust his chops a bit by saying "Except this one AirForce guy with a heart problem...he's a real asshole." He laughes and punches me playfully in the leg and tells me he feels silly going into the hospital for what he thinks of as being tired.
"My mom had a couple of heart attacks a year or two ago," I tell him. "Once in a while she gets a chest cold or something and she gets nervous and does the same thing. I'd rather come and pick you up for a cold then have you wait too long and have to do some real work on you."
We drive through the night with him telling me that he and his wife have since split up, they're still close but "It just didn't work. You know, no hard feelings or nothing. She's living here at my house until the spring. Then we'll sell it and go our seperate ways." She's sitting up front telling the same story to my captain.
I tell Concord Hospital what I'm coming in with and they give us a room. When we drop him off, I give my report and tell him "Look, no offense but I really don't ever want to see you again." He laughes and says its a mutual thing.
Most of the time, my career has brought me into contact with frequent flyers-- people who use the ambulance enough that you get to know who they are, they're families and they're problems-- and most of the time those frequent flyers are drunks and system abusers. Every now and again its nice to get a frequent flyer who is amicable and doesn't smell of urine and booze. My guy last night is a nice guy and the drunks and druggies I've taken might be the nicest people in the world but I never see it. Last night I saw a geuniely nice guy who needed some help and because of all the different stuff I've forced myself to go through, I was able to give him that help.
It wasn't a really dramatic or even overly interesting call but it was nice to know that I was helping someone.

Cooking , Cleaning and Pumping

2009-02-24T09:34:00.002-05:00

My job makes me feel like a janitor sometimes. When theres no fire or medical calls, the station needs to be cleaned. Toilets need to be scrubbed, floors mopped, dishes washed. My last 96 hours of work have been devoid of calls. The preceeding shifts often quiping that they have done all the calls for us as their shift had nine or ten calls.
I have become intimately familar with Comet.
My dreams are haunted by mildewed dish racks and greasy pans.
Fournately my cooking prowess has improved. I've baked chicken with lemon peppercorn dressing (made from scratch), portobello mushroom burgers with pesto mayonaise and spicy pico de gaullo.
While the shifts have been devoid of calls I did start my driver operator training. Last night was spent learning the ins and outs of centrifugal fire pumps as presented by New Hampshire Fire Academy instructors on an overhead projector.
Theres a good deal of abstraction in the whole pumping process. Different pressures are acheived at various levels by cycling the water threw the pump a certain amount of times. As we serve a town with no pressurized hydrants, we need to create all the pressure ourselves through drafting. Pumps need to be set at certain pressures on the pump end so the guys on the nozzle have a consistent pressure high enough to knock down the fire.
The pump is basically another gear on the transmission of the engine. You put the truck into neutral and set the pump brake, and wait for the truck to idle down and then flip the switch to push the drive shaft up into the pump. It should catch with minimal grinding of gears. Then you get out and place wheel chocks and set your suction. Handlines or feeder lines are run off the truck or it is attatched to anothe engine or a tanker. Then you get to follow a bunch of gauges and listen for noises, monitor pressures and flow water for the guys in the fire actually enjoying themselves.
I chose to get involved in the driver operator program because, one I wanted to be able to drive the engines (what kid big or small doesn't want to drive the engine and toot the big airhorn?) but I also want to get a broader understanding of all the roles involved in the fire service. I worked for a while as a firefighter/EMT down in Mass. and I always had someone else driving the truck and running the pump. I spent a lot of time honing my rescue skills through the MFA's Rescue Technician program and eventually I went to paramedic school. I studied rural and urban search and rescue. Basically I spent alot of time learning all of the specialty skills of the fire service and I decided to take the driver operator program as a sort of return to the basics. I have found, however, that the intricacies of running a pump efficently are not all that basic, in fact its pretty challenging as there are a lot of numbers to keep track of.
Once we start the practicals, I'm told, everything will make a lot more sense. And I believe it, I always learn best by having the machine or equipment infront of me and playing with it until I figgure it out. Its just that Engine 2 is very expensive and I'm afraid my learning process will damage it.
And pumps are only half of the fun, next I get to learn to drive E 2 in all sorts of weather and conditions.
While all this is going on, I'm still working on getting myself in the best possible shape for the Wildland Academy. My body is constantly stiff from pack hikes, woodspliting, weightlifting, snow shoveling and stair climbing. A persistant ache in my left ankle has me smelling of IcyHot for most of the time.
But the pain is very focusing. Its like when I used to wear a fire academy ball cap at the gym so that everytime I passed the mirror I had a reminder of my goal. Eevrytime my ankle aches I have brief fantasies about carrying a Stihl with a 24 inch bar on a long hike into the backwoods. A crew of tired, aching firefighters treks behind me lugging shovels and axes, rakes and saws.
For years I did landscaping work with my father and it was great to be outside, working with my hands and, in all honesty, wearing a set of ear phones to drone out the din of the machines and the nagging customers requesting we "leave the lawn a bit shaggy" or "weed the garden and plant my turnups" or any one of a million other tasks that eighty something year old Italian men feel absolutely must be accomplished at noon in 90 some odd degree weather. While I love working as a fire/medic, people can sometimes get to me. 911 calls at 0400 for a toothache lasting six months try my patience.
But trees won't complain if the ride is bumpy, wildlife will be smart enough to flee once they smell smoke. Doing seasonal work in the wildland arena will recharge my batteries, so to speak.

Red Card

2009-02-12T14:33:00.002-05:00

I was having flashbacks to my days in college when I decided it was a good idea to throw a forty five pound plate into my backpack and run a mile. In short it was not a good idea back then or really now either

Today the weight was a little over half of what it was in college but the distance was three times the above. I walked a mile and a half a way from my apartment complex in a light misting rain and turned around and walked back with the weighted pack.

No, I am not going stir crazy, well yes I am but thats not why I did it. As I mentioned before I am starting training to do seasonal wildland fire work. A spot on the state, and federal or private, crew is closely guarded. In addition to completing my up coming wildland firefighter and fire behavior class, I need three letters of recomendation and I need to pass "The Pack Test"-- a three mile hike in forty five minutes or less with forty five pounds on your back.

I plan on alternating with running and pack hiking for cardio on four out of seven days a week. I will still be following the mass building program that I picked up about a month ago involving kettlebells.

The pack test itself needs to be completed in the boots you will be wearing should you be accepted to the crew. I need a pair of boots anywhere for the class so I have invested in a pair of White's SmokeJumper boots. They're all leather 10 inch boots which will need a good deal of breaking in so as to be comfortable for my purposes. Once the weather gets better I plan on wearing the boots for my recreation hikes as well as my training. Antecdotes on how to cure the leather and break in the boots include filling them with boiling water or wearing them in the tub. Most guys I've talked to say you just need to keep wearing them and applying shoe grease or mink oil.

My current routine brings me back to my college days and, a bit sadly, it reminds me that those were a little while ago. Today's hike was not a killer but I felt it when I was done. My knees tend to pop and crack when I do my kettlebell front squats. And I'm still sore from four hours of spliting wood for my father in law.

The State fire crew is exceedingly competitive so I have also started making contacts with people in various federal organizations. As I am only part time (though I do get a decent amount of hours allowing me to live my lavish lifestyle) at Northern Fire Rescue, I could conceivably be a seasonal bum. In other words I could work out west on a handcrew or a helitack unit durring fire season and come back to New Hampshire for the off season.

As of right now, my wife says she would be okay with me doing the seasonal thing. Most guys don't even work on their off time as the money made from a season is padded generously with overtime. I think doing both would certainly be a nice balance. But I am trying not to get ahead of myself. I need to take one thing at a time and not get too excited because the reality is that I might not be accepted to the crew despite jumping through the hoops.

Red Sky at Morning....

2009-02-07T11:18:00.002-05:00

I grew up on Narragansett Bay in Warwick Rhode Island. My uncle is a lobster boat fishermen and my father used to work with him on occasion before starting his own buisness. Kayacking and fishing from the breakwall were main sources of childhood, and later adulthood play. Along the way you pick up little superstitions. One is the saying "Red sky at night, sailor's delight. Red sky at morning, sailor take warning."
That little adage was playing through my head yesterday on the drive into Northern Fire Rescue as I saw the cherry red sky litterally over the station.
Day shift of my tour, 0700 to 1700 was acutally not all that bad. At around 0900 a sweet little old lady living with her sweet little old sister called 911. It seems that the sister was suffering severe hip pain and did not want to get up off the couch. We take the ambulance and find the woman sitting there on the couch with a can of ginger ale (with a bendable sippy straw) and a small plate of potatoe chips. She says she was vacuuming the day before and now it just aches.
Her grandson is "supposed to go to work and I don't want to bother him.." She doesn't realize that since he is her next door neighbor, he will see the big lights on the big green ambulance and drop what he's doing to come over and see if his eighty something year old grandmother and her ninety something year old sister (sitting quietly knitting in a chair) are okay. She wants us to take her to her doctor in the next town over.
While my partner BT explains that we can't do that and that we would have to take her to an emergency department, her grandson comes bursting in.
"Whats going on? Is everything okay."
I turn to him and say "Yeah, its cool. Hey, aren't you suposed to be going to work?" He smiles and we tell him his grandmother needs a ride to her doctor for a possible muscle pull. All of my exams showed gooseegg so I had no problem signing her off and releasing her to his care.
We go back to the station and inventory the EMS equipment until the tones come through at around 1800 (told you day shift was slow) for an elderly male who had fallen. But its the address that gives us pause, on a previous call a member of the service was assualted by the elderly man's meth head son. PD arrives before us and we end up signing the guy off as well.
Then we settle in for the night and I acutally get to watch the TV show that I wait all week for, following a fictional Toronto Police tactical team in their activities.
At four minutes after ten PM the tones come through for a structure fire. We scramble into bunker gear and jump on Engine 2, following the deputy chief out the shoot and down to what we think is the house. A simple two story ballon frame with nothing showing. Then we see a cop coming running down a long, long driveway waving his flashlight.
"You guys got heavy smoke conditions in a two story woodframe structure." He yells as we back the engine up and go up the driveway.
As advertised smoke is billowing out the door way of a pretty cool looking farm house. We pack up as BT charges an inch and three quarter and I take two vollies inside. Smoke conditions are pretty thick indeed, dark tarry smoke cascades through the front door as I push boxes of god only knows what out of the way. We can hear dogs yelping and barking and the report comes over the radio of at least ten dogs known to be in the house. Both human occupants, an invalid and a mentally retarded girl are clear of the dwelling and sitting in the chief's SUV.
The fire was reported on the second floor and thats where it seems to be as we drag the hose through a maze of stacked newspapers, old furniture and other pack rat odds and ends. I can feel things crunching under my knees so I start duck walking for fear of needles or other badness sticking through and getting me. On the stairs we start breaking long sets of windows to vent the smoke and I let a vollie take the nozzle while I get up behind him approaching the backroom where the fire is cooking.
A pretty decent little blaze is going, fueled by electrical entertainment equipment as my buddy cracks the line and starts to douse it. We break a few more windows and let the place air out. In all we maybe used 50 gallons of water, not wanting to reall damage the place. Little yappy dogs are skittering around everywhere along with a huge German Shepherd who refuses to leave his little corner of the room. Once we get the fire knocked down and the smoke clears I realize that the crunchy things I was crawling through was dog shit, about ankle deep and its all over my bunker gear.
We mop up and get out of there after midnight. Clean up back at the station has us hanging hose on the drying tower and repacking the four inch feeders we'd laid up the driveway. We scrub all the masks and refill the air pack bottles we used.
I have no sooner laid down in my bunk then the entire station goes pitch black and the phone rings.
"This is Brenda from Home Security, who am I speaking with?
"Nick from Norther Fire, what's going on?"
"Sir, this is important. How is the weather?"
"What? Its fuckin' cold. Wheres my power?"
"Sir is there an intruder in the building, if there is just say 'My aunt is ill."
I realize she wants some sort of password so I give my badge number and tell her the power went out and to leave us alone until later. While I hang up the phone the tones are dropping for an activated fire alarm at town hall and a medical service call at a frequent flyer's house. We try to call in on the radio as the phone rings again.
I get the phone while BT tells dispatch we're responding to the fire alarm. On the phone its the frequent flyer telling us not to rush, she just needs her oxygen bottle turned on because her home condenser unit is offline with the power outtage. We go next door to town hall, disable the alarm and then shoot over to the frequent flyer's house to take care of her O2.
Once we get back we begin the process of setting up the generator for the station and responding to numerous more service calls.
In short, my tour ends at 0700. I got out at 0900 and drove home, went to bed and woke up just now. Now its time for more sleep I think.

Survior Man Can Play

2009-02-05T00:10:00.003-05:00

I started reading Survive by Les Stroud, the creator, writer, producer and host of the widley aclaimed Survivor Man. Through the course of learning how to make lean to shelters and catch scorpions, I found out he is also a singer song writer. Follow the links below as his music is really catchy and funky in that Canadian bluesy kind of way.

http://www.lesstroudonline.com/music/les_and_the_pikes/player/les_pikes_player.php

http://www.lesstroudonline.com/music/les_les_stroud/player/les_les_stroud.php

Escape, for a bit

2009-01-31T15:06:00.003-05:00

Staying inside has never been one of my strong points.

Outlet or Cabin Fever Ramblings

2009-01-27T18:16:00.004-05:00

Jonny has been released from the hospital at Balad. Army doctors are insisting that he live in a tent next to the hospital itself as they want to be able to monitor him for the next seven to ten days. He will need to have fairly regular MRIs.
I haven't had the chance to talk with him yet. He called his father and they spoke for a little while about how he feels upset that he wasn't able to help his buddy. JD called shortly after and the conversation touched on how they want to get out there and find the insurgents who did it and take care of them.
But for at least a week, Jonny is in the relative safety of the Balad area.
JD called my father in law as well. Apparently the mood in their area is that they want to get out and "take care of" the insurgents responsible for the attacks. When asked if it was "a revenge thing" JD stated that it was a safety thing. This group of guys has been lauching little commando raids on American troops for a while. Unfournately the death of Jonny's buddy is just one of the many lives they have taken. So for the safety of everyone in that area, they do need to be dealt with.
I'll try not to get all intellectual about the whole thing, this really isn't a political blog.
Instead I could talk about how excited I am to be using the crock pot to make BBQ pulled beef. (In case you can't tell the FD has been exceedingly slow lately) or about how I interviewed for a side job this morning at a certain Catholic run hospital in the city I live in.
The God is Great and You are Not Hospital staffs paramedics to work in their emergency department. Medics work side by side with the nurses and doctors at close to the level of field work. The only differences being that medics are not allowed to intubate or start EJ (external jugular) IVs in the emergency room itself. Since the program is in its infancy, there are still some pretty large loopholes. The medic functions as a member of the in house crtical response team, basically 911 for the hospital. When the medic leaves the ED, he or she is allowed to perform those skills not allowed on the ED floor. In addition to that, there is some more in depth training involving psychological emergencies and a few new medications and procedures to learn.
I'm not really sure if I'll get the job. Its rumored to be very competive, but we'll see. Its right down the street from where I live and the pay is supposed to be really good. Certainly would be nice to suppliment my meager public servant wages.
But thats not the real purpose of this post, I've come to realize that I need this blog, probably more than any of my readers do. In high school and well into college I wanted to be a writer. My family seemed convinced I had a talent for it but I never really thought it would go anywhere. When I started college I was a journalism major but I sooned realized that all that degree would really get me was four years of debt. Unfournately a degree in English/Education produced the same result.
I started this blog because I needed an outlet for what was going on in my life. My girlfriend of the time was not someone I could talk to about what I did for a living, she was convinced that I was going to be safely behind a desk teaching Acne incrusted youths about a dead homosexual who may or may not have written plays in the 16th century. She had thought that being a firefighter was a "phase" and that I would grow out of it.
If any of you have followed this blog or at least leafed back through the entries, you'll see that I'm not really one to grow up so things with the first girl didn't work out all that well. But I had this blog as an outlet for my feelings on what I do at work. Occasionally some of my insanely left wing political views will creep in, some times I'll discuss my work out routines or my undying love of Kettlebells. But its the one place I can put all of my ideas and thoughts and people can either take them or leave them.
I met a girl off the internet when I was doing my ride time for medic school. At the time she worked as a vet tech in an emergency center down on the Cape. We had dinner at a TexMex place in Plymouth and ended up walking along the jetty and out onto the breakwall in Plymouth Harbor. A week later I was at work at Fallon in Quincy, actually sitting on post outside the Faulkner when my cellphone rang. It was Mandy inviting me over for dinner.
When I drove down to her parents house I found her outside, barefoot, in the garden picking grapes off of a vine in order to make jam. I wasn't really even out my Jeep when this thing in my head made me aware that she was the girl I was going to marry.
And now we live together in Manchester, she commutes to a vet clinic in northern Mass and I go north to my fire department.
This blog has been a part of my life through the uncertain years of college when I was finding my way and realizing that maybe the easy path isn't the best one. It was there when I graduated college and realized I had to find something to do with my life that I wanted to do. I've always had the outlet of being able to put all of my conflicting ideas and desired out there. And occasionally my readers will give me comments that make me stop and think. Sometimes all I get is porno ads but hey, the little "1 Comment" makes me feel pretty good.
I was watching some reality TV thing the other day and it showed a San Diego Fire helicopter plucking some guy from the beach. They zoomed in on the flight medic and it was a guy who comented on my blog. He's the author of http://flyingvan.blogspot.com/ So I got a kick out of being able to recognize someone on the other side of the country I've never met.
This blog has cronicled my reinventing of myself from teacher to EMT to firefighter to fire medic. Its watched me work in Holden and Providence, Worcester, and Boston. Manchester was briefly touched on. Come spring time it will document my quest for a spot on the New Hampshire or Massachussetts Wildland Fire Crew. (The class starts in April).
The point is that this blog has become a part of my life. If nothing else its a record of what I've done and whats to come.
Maybe I'm getting melodramatic but this blog has been one of the few constants in my life until just recently.
I am at the early twenties, well lets be honest its mid twenties now, phase where I am trying to find where I'm going to spend the rest of my life. One things for sure its not going to be in this city, probably a nice out of the way cabin in Vermont. Hell of a commute but it'll be worth it. I found my wife, a hell of a feat because I'm sure if I didn't someone else would have.
When it hit, the realization that I crossed into adulthood, it hit hard. I have a wife, we're talking about trying to get her a new car, and a house where we can start a family. I've got a little under a year (when the lease runs out) to figgure out how to get all of our stuff to a house in Vermont, a house that will see some serious renovations this summer (her family owns it, so we'll be moving there barring some unmentionable tragedy, like her realizing that I am in fact a big kid and will always be)
And the blog will be there to capture it all. For those of you that read it, keep up the comments and tell your friends, the more the merrier.

Candles

2009-01-23T13:07:00.003-05:00

We keep two candles in the window of our apartment. They're the electrical kind that people put up for Christmas. Ours represent my brother in law Jonny and his buddy JD.

Early this morning my father in law got a phone call. Jonny had been medievaced by helicopter to Balad Military Hospital in Iraq afther an attack that happened within the past forty eight hours. From what he told his dad, they were on a patrol in an MRAP, a kind of armored truck that was somehow flipped over. The gunner, was apparently unconcious but had a pulse, When they got out to try and right it, a Herculean feat, they came under small arms and RPG fire forcing them to take cover. In the insuing gun fight, the gunner died.

The team commander was the most serious and as such was flown from Iraq to Germany and the massive trauma center that serves the US military, presumably in Ramstein. Jonny and the driver are being evaluated in Balad. Doctors are trying to determine if Jon suffered any brain trauma and if there is any swelling. The driver's injuries are unknown to us at this point.

From the Email I received from my father in law this morning, I heard that Jon is beside himself over not being able to save his buddy. Its understandable, he is a very capable medic, very well trained and sure of his skills. He's used them on the streets of Boston and now, over seas he's been caring for his fellow soiliders. Its not the same impersonal medicine of EMS where we treat somebody for, at the most, 45 minutes and turn them over to the ED. Jon was alone, underfire trying to keep his friend from dying and unfournately the efforts and technology available in the field were not enough.

I had received an Email from Jon two days ago. On a whim I had noticed he had activity on Facebook so, in the hopes of contacting him I had sent a quick message. His reponse stated that he had "gotten his bell rung a couple of times." and that "Iraq smells like crap, everyone is really poor and they bombard the base with rockets at night." His father told me that kids were throwing rocks at the Hummers as they cruised out on patrol.

So Jon is in an inhospitable place, in a field hospital bearing the grief of losing a friend in a country that is basically hell on earth. I could go on about how much I detest this war and the Aemrican foreign policy that has lead to the injury of another one of my good friends. But if I do that I'll no doubt get Emails from gung ho "Patriots" who think these are necessary sacrifices in order to better the world. And I could say somethings that I'm sure would sound pretty racist about the Iraqis and the Middle East in general, but I won't because I'll get the other side of the fence complaining that I am not compassionate to their feelings and their culture. And again I think of what I would do if a bunch of people I'd never seen before came to my country and told me "This is how its going to be, assimilate." Chances are I'd find Klashnikovs and RPGs too.

And thats what my mind is doing. I feel for Jon, I worry about him. I know I won't ever trully know the grief of the gunner's family. (Out of respect for his family, I'm withholding his name.) I can understand military personell feel a need to finish what was started in Iraq, even if I don't understand why it was started (and please no comments trying to educate me on why we had to invade a sovereign nation, they will be deleted). The scary part is I can even understand the feelings of the guys with the guns that tried to kill him. They didn't see him as my brother in law, my wife's brother. They didn't see him as the guy who wants to be a firefighter and watches idiotic movies with scrotum jokes. Instead they saw him as a symbol of the evil they feel is being pushed on them by a foreign power, threatening what they feel is a just way of life. I don't condone what they did, but I understand it. A lot of conflicting emotions are bouncing around right now. Mostly, I want him and all of them to be home.

When my wife came home this morning at around 0830, East Coast Time, I was just waking up. I hadn't checked the Email yet so we were not aware of the drama affecting our brother in the desert. I heard Mandy fumbling around in the room where the candles sit in the window. She was changing the bulb on the one that I had always thought of as Jon. (It's one of those oddly childish things I do, "This candle is for Jon, that one is for JD.") Apparently this morning the bulb had been flickering, on the verge of going out.

Massachusetts Firefighting Academy Group

2009-01-11T15:36:00.001-05:00

I decided to put together a group on face book for alumni of the Mass Firefighting Academy. It's a nice way to find people you might have lost touch with. Always nice to find others who have carried the rope and water bottle. Link is below and I have to preface this by saying it is in no way endorsed, funded or probably even to the knowlege of the MFA itself.

http://www.facebook.com/profile.php?id=41201390&v=info&viewas=41201390#/group.php?gid=67507037624

The Other Side of EMS

2009-01-03T10:04:00.004-05:00

I tried rewriting this four times. I didn't like the way any of it sounded and whether or not I post this is really up in the air.
Initially I wanted to write about the car accident we had coming back from the woman with broken ribs. Both were fairly non eventful calls although I debated a chest decompression on the broken rib lady (didn't do it as positioning her alleveated the problem) and got to break a window to gain access to a minimally responsive head injury victim.
But when I got back to the firehouse I decided it was a good idea to feel dizzy and almost pass out for no apparent reason. My partner, BC, an intermediate put me on the monitor to reveal SVT at around 150, my 12 lead showed a bit of non specific T wave flattening. A 16 guage went into my Left AC and against my strenous objections I was transported to Concord Hospital by my partner and an off duty firefighter called back on rapid recall....to deal with me.
Now for those of you that follow my blog, all two of you :) You will remember that I have been suffering from kidney stones off and on for the past several years. A little gift, shall we say, from my mother. You will also remember when my mother became a patient of mine in the middle of one of her two STEMIs. So with a family history of kidney stones, which I now have, my partner was worried that I also inheritted mommy's heart problems.
I had been drinking water all morning in an effort to speed the passing of my little friend so its possible that the frequent urination may have altered my electrolytes to a level that caused me to slip into SVT. Its not that uncommon but younger people don't usually have the issue. Its also possible that I had a low grade kidney/bladder/urinary tract infection that could have played with other levels and threw me into a funky beat.
So all in all on the ride into the hospital, in my own ambulance, I was not that concerned that it could be a real cardiac event. Instead I thought that they would do some tests and tell me that my electrolytes were off and give me a bag or two of Ringers to make up for it. Instead all of the tests came back clean.
Now don't get me wrong having tests come back as negative for a heart attack, negative for issues of any kind is very nice. I like being healthy and I'm glad that I'm staying that way. I would like to know why I almost passed out and why I started vommitting. I want to know why my T waves are flat. Itd be nice to know what the hell happened.
But after laying in the hospital for eight hours, and being called a horrible patient by the nursing staff.....no one would show me my EKG strips and they took the monitor out of my room so I wouldn't look at it. I did however take my pulse a few times to see that at rest I was hitting 130. A couple of times when I got up to urinate my pulse would bounce back up to 150. The doctor, a cool guy who reminds me of the medical examiner on CSI New York, (he's got those awesome glasses that split at the nose bridge) has no idea why I had my issue. I'm cleared to go back to work, which is awesome because if I had to sit around I'd probably go insane. I just hope it doesn't happen again.
Their only real though on what could have happened involves possible swelling of my inner ear cannals. Or a foreign body such as a pebble or a piece of glass (from the car accdient) that some how lodged its way in there. They put me on Anti-Vert, a medicine that counteracts the effects of vertigo and so far has worked fairly well. Because of the sensation of vertigo, i.e. falling off of a high elevation, the body can sometimes be kicked into strange activity. But there is no real way to test for vertigo other than telling a doctor "I feel like I have vertigo."
The sensation was, in fact, so strange that I didn't even know what to call it. I can only describe it as feeling about six inches behind myself as though everything is rushing past me. It didn't affect my driving or my job performance as it hasn't happened behind the wheel or on a call.
Knowing its not a cardiac issue is nice but not knowing what it is, well thats a bit irksome. It's not that I'm annoyed at a lack of diagnosis, but would have preffered one in order to treat it and prevent reoccurence.

Jonny

2008-12-27T15:20:00.002-05:00

For the next ten months, my brother in law is going to be in Iraq, serving as a combat medic for the 772nd Military Police Company. He's 20 years old and has worked for a few years as an EMT at Fallon Ambulance in Boston, MA.

This Christmas was our chance to was the last pre deployment visit home he had before shipping out. Jonny is a good kid and a good brother in law. He got me an ice luge at my wedding, so we're close. In all seriousness though, Jonny is being shipped to one of the worst and most inhospitable places in the world in order to practice emergency medicine on our troops under the worst conditions.

A few times in my career I've been scared for my life, a roof would come down on top of us or a car would almost hit the truck. But for the most part when I put on my uniform it was always with complete conviction that in 24 hours it would come off again and I would be home. I've worked in some less than pleasant locales where violence was a real problem but never a warzone.

The next ten months will undoubtably be very trying for Jonny. He's worked hard to master all of the training thrown at him in boot camp and combat medic school. He has some experience in trauma from his job in Boston. He's leaving behind his girlfriend, a medic assigned to another company that he met durring his training. She has dreams of becoming a nurse after her enlistment is up. Jonny wants to work as a firefighter like his grandfather. The military will greatly increase his chances of hire at just about any department. His EMS experience won't hurt either.

It hit me while we were sitting around the dinner table on Christmas that Jonny was leaving. My in laws are devout born again Christians and they pray....a lot. But their prayers are always toward something, not the hollow words I knew from my Catholic upbrining. Hearing the prayers of Jonny and my father in law really hit home the fact that he is going to be leaving and is going to be placed in real danger. There were some tears, okay more than some and more than a lot because we love him and we're going to be very worried about him.

We ended up watching Stepbrothers, quite possibly one of the funniest but stupidest movies every made. And for those two hours, Jonny wasn't going to Iraq. He was laughing, joking and enjoying himself, like the burden of the coming months wasn't there.

When I met my wife we ended up marrying fairly quickly. The wedding was a beautiful one but it was one that was under the gun of Jonny's leaving. A few times the topic of Jonny's recruiter, a Sergeant from the MA National Guard, being invited brought my wife to anger. Both of us are dead set against the war. I don't think we should be in Iraq for a myriad of geo political, socio economic and legal reasons. But that doesn't change the fact that someone we love is going over there. I can be against the war all I want its still going to happen. And Jonny is still going to be there.

I don't want to pretend that our family is the only one going through the nervous experience of a loved one going into a combat zone. Thousands of families across America get to experience this with us. They have their own loved ones in ther service doing their thing in Iraq and Afghanistan. Unfournately that thought just makes it worse for me. How many people are feeling the pain of the unknown in regards to their loved ones? And how many more will have to feel that pain?

This isn't a political blog and it never will be. My views are so liberal that I don't think a party would ever accept me, my wife tells me I'm a step above an anarchist but lets be honest, they really have too many rules. I don't believe in the war that we are in right now and I never will but I know that people we love are "over there" and risking their lives for something they believe in. Jonny is going to be one of the ones taking care of them, providing life saving care for them should something happen. I may not support the war but I support them.

While I'm not religious I will have Jonny and our friend JD, an MP he serves with on my mind constantly for the next ten months. Both are young men who for their own reasons decided that the army was the correct path for them. My thoughts will be with them, my positive energy stored and sent for them. I ask that any of you that read this blog keep them in mind and if you pray, pray for them and all of our brothers and sisters, sons, daughters, mothers, fathers and friends in uniform. Like me, you can be dead set against the war, but know that the people over there are all someone's loved ones and deserve the hope that we can hold for them.

At the end of my father in law's two page prayer for Jonny, he said simply "Jonny, Godspeed."

Godspeed Jonny, come home safe.

House Interupted

2008-12-21T10:27:00.003-05:00

The prisoner had just started hemoraging from all orifices when the guards were about to take him back to deathrow. They'd been trying to figgure out what had been giving him seizures and all of sudden he started to suffer severe abdominal pain. He was bein rushed to surgery
Then the tones drop "Lakes Region dispatching Ambulance 2, abdominal pain with constipation, Alpha Level at XXXX."
I sigh, I'll never know how House solves the case of the deathrow inmate with a rectal bleed.
Its snowing like crazy and another one of our frequent flyers has decided that at 10 of 2200 she needs to be seen in the emergency room. Because her last bowel movement was unsatisfying.
The four wheel drive ambulance slides and sputters all over the untreated roads as we respond to her house. Her son's very nice, very new four wheel drive diseal F 350, devoid of plow, sits in her driveway. I restrain the urge to yell. "make him take you!"
Shes waiting at the door in her coat with an overnight bag packed.
Our ride to the hospital is uneventful aside from the fact that it took twice as long because of the snow. The nurses laugh at me because I have my bunker pants on, but I'm not getting my feet soaked and cold.
As soon as we are pulling back into the firehouse we get banged out for a chimney fire on automatic response two towns over. We beat the second due vollie company on scene and their "district chief" tells us to stay with Engine 2, our truck, while his companies "assess the situation". No smoke, no fire, we go back to the house without leaving the truck and I sleep until 20 minutes after shift change.
Not all that bad for a massive snow storm but what in God's name was wrong with LL Cool Jay that made his character so sick.....?

Done Waiting

2008-12-19T19:23:00.004-05:00

The snow finally started to fall about fifteen minutes into the only call I've done thus far.
We got toned out for a headache, charlie level, which basically means that the headache could be a symptom of something much worse, like a stroke.
It was cold when we pulled the bus out, happy to get away from the firehouse after spending most of the day trying to fix computer issues that cropped up durring the ice storm. Needless to say I was out at the work bench in the apparatus bay trying to do anything but fix computers. Instead I spent the time making various inexpensive forcible entry tools and drinking coffee ( we wonder why I have kidney stones.....)
A huge Shar Pei was pacing on the upper lawn of the woman's massive farm house. I of course instantly wanted to go play but my partner and the shift captain kept me in line so into the house for some EMS we went.
Fifty something years old and otherwise in good health a fairly decent looking woman with a paige boy haircut was sitting on a barstool and shaking at the kitchen table. The captain starts taking a history as my partner gets the back of the truck read. I go through a quick assessment and find her vitals are within the normal limits. She starts wretching so we give her a hand getting to her sink. Bile comes out but its nothing special. She sits back down and then we end up carrying her down to the truck. I feel a few flakes here and there but its not to bad.
Once I'm in the back she goes on the monitor and I see a normal pattern. A 16 goes in her left AC followed by ketrolac for pain and Compazine for vomiting. '
As soon as we hit the main highway, the snow opens up like a blizzard and the normally 20 minute drive to Concord stretches to a little over an hour. We end up turning the lights off because all they do is freak out other drivers. Besides, the patient is asleep now that her headache has been fixed.
And now its out to shovel the baydoors.

Waiting

2008-12-19T08:32:00.003-05:00

The snow is set to start falling in another few hours, we're supposed to get hit pretty hard too. The last storm after the ice debacle dumped about six inches on the town prompting us to get called out for everything from a doctor's appointment to several roll overs.
Today I'm sitting at Station 2, my usual assigned house and waiting for the fun to start. It's bitterly cold out, just around 10 degrees and the sky was bright red on my drive in this morning. I grew up on the water down in Rhode Island so the old adage "Red sky at night, sailor's delight, red sky in morning, sailor taking warning" is never far from my mind.
And whenever it does snow, people tend to panic, 911 is dialed more frequently and what people would normally consider no big deal becomes a life threatening event. I don't mind though, I am paid to respond to calls and thankfully everything I have had to deal with since the ice storm came through has been fairly minor.
A frequent flyer with advanced end stage global cancer needed to be taken into the emergency room because he was too weak to stand and his muscles were sore.
A snow plow operator rolled his personal vehicle and suffered no injury, the car was even in such good shape that he wanted to drive it off once it was righted.
A seventeen year old girl somehow lost control of her car and slammed into a teacher's vehicle. Both cars were totaled but the drivers were seatbelted so both claimed no injuries. The longest part of the call was waiting around with the state troopers for the tow trucks to clear the road.
But now we wait, already a few residents have stopped into request that we check up on their neighbors should we lose power again. A good deal of people have just flat out left the town and went to hotels in the city so as to be away from the area when the storm hits.
On another note I did polish my boots, I've yet to try Mike's remedy of baking soda but tomorrow begins my five off so who knows?

Stones and Ice

2008-12-16T05:40:00.003-05:00

I'm usually only up at 0545 when I have to go to work. The town I work for is just about an hour away from Manchester so I'm up at 0530 in order to get there by the start of my 0700 to 0700 tour. And today is one of my off days.
So why am I up this early?
Was there some great and wonderful surprise that roused me from slumber that was just too incredible not to blog about right this minute? Was there a recall at the firehouse? Did my pager for the hospital go off?
Nope, the kidney stone I have been carrying around for a little over a month decided this morning was the perfect time to send my right side into blistering pain and force me to take the dreaded Hydrocodone. I really don't like taking narcotic pain relievers because they make me loopy and a bit out of it.
Ketrolac, a marvelous NSAID usually works wonders buy my doctors refuse to perscribe it because of the frequency with which I am blessed with stonage. Long term use of Toridol (another name for Ketrolac) can lead to kidney dysfunction, which makes me wonder if they have missed the past three years of my life.....aren't the kidneys already dysfunctional?

But thats enough of my problems.
As I'm sure most people have seen, New Hampshire was hit by a massive ice storm over the past week. The night that it hit I was home in Manchester with my cats and not due into work for another two days. My wife was at her overnight shift at the animal clinic. I was in the middle of my Kelley Week and as such I was sitting up late after having finished watching a scary movie. I had decided to have a cup of tea and play a little bit of a Nintendo game with Navy SEAL frogmen that my brother in law, a combat medic for the 772 Military Police Company in Taunton MA let me borrow telling me "its the balls, its really fun." I had just brewed a nice cup and figgured out how to make my sniper rifle zoom in when I noticed the lights flickering.
This should have been a sign of impending fun not involving digital commandos.
Instead the entire city of Manchester and a good portion of surronding Goffstown and Bedford were plunged into darkness. My cats were immediately terrified enough to dart over and snuggle into my lap.
Because of the pension for the power to go out in NH and the fact that I learned a lot from my brief four month stint in CubScouts, I keep a MagLite by my easy chair and I grabbed it and turned it on. Everything seemed fine so I turned it back off and took a little nap, thinking the power would come on again fairly quickly. About an hour later it did and I went into the bedroom and went to sleep.
I woke the next morning at around 0730 or so to my cellphone ringing.
"Hello?"
"Nick?"
"Yeah."
"It's Captain XXXX. Come on in for a rapid recall. I know you live in Manch so drive careful. The roads suck and the entire town is without power. We also need a medic. So does Pittsfield. "
I told her I would be right in and took a quick shower and shaved. I threw on my uniform and grabbed a warm fleece to wear over my sweater and under my bunkers, layers are always good in 6 degree temperatures.
To say the roads "sucked" was an understatement. Untreated tarmac stretched from Manchester north. I joined a convoy of utility trucks with Rhode Island and Connecticut license plates and followed them up through a now dark Concord (state capitol without power is never fun.)
The scene at the firehouse was one of barely controlled chaos. A disel engine chugged in the back giving the building power and cars were parked litterally everywhere. Inside the chief and a groupd of select men designated the "emergency service committee" had taken over our kitchen table and the chiefs from several surrounding towns were there chiefing and trying to coordinate evacuations. Dry erase boards were set up with notes about road conditions and the status of various elderly residents scribbled on them.
I grabbed a cup of coffee and found the on duty LT. He gave us a briefing about what was going to occur. Apparently a lot of department members from our department and surrounding departments were out of state on vacation (it is the end of the year and all that earned time adds up) so I would be the only paramedic for three towns. We ended up staffing our ambulance, Ambulance 2, with me and a single role EMT from the town next door. I took all my bunker gear and tossed it in a back compartment. If need be I could meet the engine and ladder companies on the fireground.
For most of the morning we stayed at the station fielding phone calls from concerned residents and helping to fill water jugs with our garden hose. Most people in town have electric pumped wells and found themselves with no clean drinking water. I spent a good portion of time trying to find military cots at the local boy scout camp for a neighboring town's emergency shelter being set up in their high school.
We got toned out for a chimney fire and ended up taking care of it fairly quickly. A few elderly residents needed to be removed from their dark and cold homes. We ended up taking a chain saw from the forestry shed and I was dispatched with the Pittsfield guy, a kid named Kyle, to cut downed branches from vital roadways with highway department crews. We went to a house being run off of a generator for flu like symptoms, the people living there thinking they had CO poisioning, forgetting that they had the symptoms before they started their generator.
At about 1900 I made it back to the station long enough to have a chicken salad sandwich and a cup of stale Red Cross coffee. We spent a good portion of the night knocking on doors and helping residents get their cars out of branch choked driveways.
Come morning I got a partner from my own town and we were promptly banged out for a difficulty breathing in a house that I could see from the pad at the firehouse. When we got there a thin version of Grizzly Adams was sitting in an overstuffed chair surrounded by a pride house cats and several small yappy dogs. His gurgling and bubbling airway was clearly audible from the front door.
With the help of the engine company we scooped him out of the house and brought him to the back of the ambulance. I grabbed a girl from the engine and we took him into Concord. Thanks to Lasix, Nitro and Morphine along with poor man's CPAP (basically bagging the patient in order to blow the fluid back out of his lungs) because I always forget we actually have CPAP, he was pink and happy by the time we got to the hospital prompting the nurse to ask "And he was status two on your patch....why?"
On the way back into town we stopped for breakfast at a Dunkin Doughnuts, grabbing bagel sandwiches and iced coffee because it was now a down right balmy 8 degrees outside.
Back in town we were sent out on ground and pound, knocking on doors and talking to residents.
An elderly couple living in a really cool German ski lodge style house complete with the gingerbread looking outside and a wood stove upstairs waved us down. I went to check on them while my partner went next door to tell the neighbors that the propane heater they were running in doors needed to not be run in doors.
The old man was sitting in a highbacked chair in a World War 2 era field coat with a combat engineer badge on the sleeve. He had a multi colored fleece stocking cap with bells on the tassels on his head and a Beagle sitting on his feet.
"I was trying to clear some ice off the roof and I felt like I was going to pass out so I came inside." A glass of milk and a shot of whiskey sit on the table next to him. "I figgured whiskey with a milk back would fix me up but the first one wouldn't work so I'm doin' another one."
I run through a quick exam and advise the man he should go to the hospital. He refuses and downs his shot and then takes a long pull from the milk. The dog licks my hand and his wife offers me a sandwich in thickly German accented English. I tell them to call back if anything changes or if he feels worse, they agree to do that much and I am back out in the cold.
After eight more hours of door to door the chief relieves us and sends the ambulance back out with another crew. My bunker gear is set up next to Engine 2 and the monitor, medic drug box and a first in bag from the out of service Ambulance 1 are thrown in the behind the cab tool box of Utility 1, a pick up truck with four wheel drive but no heat, I will be on intercept duty so long as we don't get a fire. I spedn the next 12 hours answering phones reassuring residents that all is being done to get them power, giving them dirrections to the multiple emergency shelters that are set up, and explaining that they cannot have fire department generators for their houses. Basements flood when pipes burst and they call for us to pump their basements. Years ago the fire department would do that but now they have gotten wise and refuse because the trash that accumulates in basements is murder on pumps.
I intercept with the town to our north on a chest pain. IV, O2, monitor, Nitro and Morphine. Transport to LRGH and head back to town.
Eventually I am recalled again and I spend the next day knocking on more doors, talking on more phones. In one phone call that brought the entire station into roaring laughter I had to use the phrase "No, ma'm, diahrea is not traditionally a symptom of CO poisioning." I jump on the engine for a tree on wires call. We stand around and watch the energized wires jump and dance until the power company shuts them off. The branch smolders and smokes and as soon as the lines or powered down we hit it with a water can. No sooner do we clear from that call than we need to meet the ambulance for an evacuation of a bed ridden morbidly obese woman.
Downed branches are covering her driveway so the chain saws come out and we clear a path. My turn out boots stick to her floor as we help the two intermediates covering Ambulance 2 while I'm on the Engine, wrestle her onto the cot. They transfer her to a shelter and are soon back in service.
I finally make it home to find that my wife has bought a pot roast the size of a small dog. I fall asleep without even taking my boots off in my recliner. When I wake up to my wife shaking my arm, the roast beef is warm and pink in the center, the stick of butter with a little bit of mashed potatoes around it is sitting in the meat's juices and a generous dollop of beraise sauce is waiting for me on a a plate. A very cold Sam Adams, the box is living out on our balcony, is forming condesation next to it. I wolf down the first plate and follow it with a second, cleaning both with crusty Portugese rolls. My wife's a good Irish girl who grew up on the South Coast of Mass so she knows the value of Portugese bakeries. She had also been thoughtful enough to bake up some gluten free brownies complete with chocolate chips and rum filling. After two of those I am promplty asleep again while she knits and watches Jon and Kate Plus 8 reruns.

So that was my ice storm experience. A weather alert was just issued for a severe snow storm to hit within the next 48 hours. By this time tommorrow I will be on my way to start my 24 hour tour. The snow will probably fall and cause more havoc. I might even get rapid recalled again. But at the end of it I can come home, have a nice dinner and a beer. I can sit in my chair, I can see my wife and know that I work hard but I love what I do and I can provide a good life for her and our pets.
Now I really must be going because the pain relievers have kicked in and its getting harder to type coherent sentances without typos.......

The Trouble and The Stinky

2008-12-15T15:30:00.002-05:00

My wife calls this picture "The Trouble and the Stinky", a very adequate description based on the fact that the cat, Keeley (ancient Celtic for little warrior) is currently trying to climb out our third story window and the boots are fermenting by our credenza. She's younger than the boots by about five years.

When I was in the fire academy I was told I needed to get steel toed boots or I would be ejected. So for Christmas my family bought me a pair of side zippered steel toe and shank boots that I have worn ever since.

Over the years those boots have been through a lot. I have kicked them off haphazardly in an effort to get into bunker pants more times than I can count. They have trouped through the blood of the dead and dying, they have been vomited on, pissed on. Their steel toes have saved my flesh ones from certain destruction at the hands of countless falling objects ( I drop a lot of stuff).

They've rarely been polished, in fact the only time they were polished was for my academy graduation. Rarely I zip the sides of them, although while evacuating residents from the town I work for they were zipped tight for warmth. They have taken me into grungy disease infested houses for overdose victims and into cushy mansions for the same. They have taken me into the backrooms of people's apartments and buisness for stroke victims. I have rapelled off of buildings in them and climbed into pipes barely large enough for my shoulders to pass through. They have kicked in doors and stood as a brace for the stretcher on an incline. And everytime I start an IV, the stillete falls to the floor of the ambulance only to be covered by the right boot, waiting for me to pick it up to get a sugar from the blood in the flashback chamber.

These boots have been filled with shaving cream by fellow firefighters, glued to the floor and when I worked in Manchester tossed into the ambulane bay by a fellow EMT because they smelled so bad. No amount of odor eaters will ever cut six years worth of sweat but these boots will stay on my feet until they fall apart....which reminds me that Righty (he likes when I call him that) needs a new insert.

I used to get threatened with demotions in the academy because they were never shined. Now as I look at them I wonder if I should break out one of the countless torn shirts I make my wife keep as rags and buy a tin of boot black......

Stupidity and Boredom

2008-12-03T12:14:00.002-05:00

"People just don't understand that about 99 per cent of this job is bullshit." When I was in paramedic school one of my fellow students uttered those words. And to this day I have not found a better description for the feeling that grips me occasionally.
I first picked her up on Thanksgiving night at around 11 pm. Her "home healthcare worker" was nervously on the phone talking to a 911 operator while the patient, a 71 year old woman sat in bed in no apparent distress.
"She can't breathe!" Amy Alarmist yells as she hangs up with 911.
I look at the patient and see that she is breathing just fine with a nasal canula in place. "Hi, hon, I'm Nick. What seems to be going on tonight?"
"She can't breathe," the woman says again.
"Can you step out for a minute please?" I ask the caregiver, getting a bit annoyed as the patient is obviously breathing. She's pink, shes warm, shes happy.
"No, take her blood pressure."
"Be quiet and let me do things my way. " She simmers down.
The woman on the bed tells me she has had Parkinson's for over 20 years, shakes wrack her body fairly regularly. She asks for more oxygen so a I put a non rebreather on her at 10lpm despite her O2 sat being at 99 on the canula. I ask the woman what she would like to do and she says she doesn't want to go to the hospital. When I move to take the non rebreather she tells me to leave it in place, she needs it.
"Then I have to take you to the hospital."
"Why?"
"Because I can't stay here all night and give you oxygen. "
She gets a bit pissy and asks "Why not? Shouldn't you be here to take care of me?"
I start to try and tell her that I cannot stay and then decide its better not to try and explain the inner workings of emergency service to an asshole.
We transport her to a different hospital than my fire service favors because the people at Concord Hospital are "not very nice and they don't take care of her there." the home healthcare woker states.
On the way into the hospital the woman refuses a 12 lead, tells me not to give her an IV and allows me to take only one blood pressure because "it is uncomfortable."

I saw her again yesterday at about three in the afternoon. The CNA from Hell was on the phone with 911 again, all up in arms because the patient was having trouble breathing. Dispatched at Delta level, the Lakes Region Fire Dispatch code that means an imminant life threat, the only higher is Echo and that means that life has stopped.
When I walk in the CNA tells me. "She can't breathe and her chest hurts. She devloped a rash two minutes ago."
I nod and ask the patient whats going on. She states that her Parkinson's is acting up and she doesn't want to go to the hospital. She tells me she's had the rash for two days. I do an assessment and find that all of her vitals are not only within normal limits but they are also in the healthy end of the spectrum. Her rash seems to be heat related as the room is close to 95 degrees and when we open the window she does a lot better. She vehemently refuses an ambulance ride stating that she will be at her doctor's the next day.
Her CNA demands to know what is different about the oxygen condenser on the floor and our oxygen bottles, telling us that if ours are better than we need to leave one. I repress the urge to tell her to fuck off and describe how both of them provide the same amount of oxygen while the patient signs a refusal.

Five hours later I am back in the woman's bedroom. The CNA, who apparently never leaves, is just hanging up with 911 tells me that the woman can't breathe. Again she is breathing just fine and states she doesn't want to go to the hospital. "Her chest hurts in here." The woman pushes on the patient's abdomen and the patient says "No it doesn't."
This time she's going to the hospital. I'm not playing the press three buttons and watch the circus show up game. She refuses to be carried down the stairs and insists we put her in her electric wheelchair which she promply destroys a section of the moulding of her wall with. After piloting the craft for five feet, she springs up and walks outside, sitting on our stretcher. She refuses IVs, 12 leads and won't let me do a blood pressure because it hurts.
Her CNA follows us to the hospital in the patient's van, driving with four way flashers going as we instructed her not to do. Again we have to go to a hospital well outside of our area because the "people at the other one don't do anything for me."
In an effort to find out just why I need to take this woman to the hospital I ask her what is going on and she states that she feels "Like my whole body is a board." When I aks her what that means she states she doesn't know and when I ask how long its been going on she tells me that she's felt like this for 20 years. I ask her why she called 911 and she tells me that the hospital won't help her and I shoudln't take her there.
Too late, we're about fifteen minutes away now.
She gets mad that I put the pulse ox monitor on her finger and takes it off, telling me to leave her alone that she doesn't even want to be here. When I ask her if there is anything I can do she tells me that she has no problems other than the Parkinson's and that she wants them to fix her medication. She asks me why I didn't just stay at her house and give her the "good oxygen that my caretaker (the asshole in the van) tells me is better than mine."
The caretaker is waiting at the hospital and follows us in. I pull the nurse aside and tell her the whole story. At some point a social worker will sort this whole mess out.

911 is set up for use by people with emergencies. But what constitutes an emergency is up for debate. Some people only call 911 if they are on death's door and even then they don't want to. I once went for a med call on a guy who had been sliced from naval to neck by a shard of glass, he worked as a glazer and had droped the piece he was trying to fit into a window pain, he ended up being LifeFlighted to Boston, from the scene, for extensive trauma surgery. He stated he was going to drive himself to the ER but his boss wouldn't let him-- the guy seemed annoyed that he wasn't allowed to drive himself. My dad cut his finger off and drove himself to the hospital where it was sewn back on.
Thats the glamorous part of my job that shows like Third Watch and Rescue 911 (old school but you know you love the "Shat") publicize. What they don't show you is that the vast majority of people who dial 911 do so because they are bored. Pushing buttons on your phone will magically make a group of people appear with red lights flashing and all sorts of interesting questions to entertain you for an hour or so. People with nothing better to do have made a habit out of dialing 911 and stating they have a horrendous complaint and in reality they are healthy enough not to need emergency care. But when they call for "help" a bunch of cool things happen, even their neighbors get in on it, coming out and poking around, standing around and watching, some even walk up in the house prompting me to ask "And who are you.....? What's your purpose.....?"
Then they are the stupid people. CNAs who call for non emergency non events go into that catagory. 911 stands as a great shining hope for anyone who can't figgure out how to turn off their TV (an actual three AM Charlie level call I was sent on for a person "with difficulties.") people who took a dump four hours ago and saw that it was blue, people who have an itchy tongue for three days and my personal favorite a patient who had her appendix out in 1975 and states that it hurts again.
Emergency service workers, myself included, love their jobs because they allow us to make a real and immediate difference in people's lives. And that's the draw to this line of work. Deep down all of us have ADD and being a teacher or a preacher or a social worker or whatever is just not immediate enough for us. I know that when I push D50 on a diabetic with a sugar reading LO on the gluc they will become concious again, when I open up an Inch and Three Quarter on a roaring stove fire, it'll knock it down. So the reason I do my job is that I like to fix things but society has too many problems that can't be fixed quickly. Stupidity and boredom leading to misuse of the emergency system is one of those problems that unfournately will not be fixed.
But despite the fact that 99 per cent of my job is bullshit, I have that one percent that makes it all worthwile. Like the chimney fire in Strafford that got me back into the red stuff after five years off of Holden. Theres very little better than crawling through a smokey house with your buddies on a hoseline and tearing the place apart in an effort to put out a fire. The smoke smell stays in your gear and when you've got that coat on at three am for a person who stubbed their toe, the smell registers in your mind and even through the annoyance at being woken up for nothing, you think "Eh, its not so bad."

Thanksgiving

2008-11-27T10:57:00.000-05:00

I got married on August 23rd and my incredibly patient wife is off gathering left overs and making excuses as to why her new husband is not at Thanksgiving dinner.
Instead I'm halfway through a forty eight hour tour puncuated briefly by an activated fire alarm where I got to drive the engine literally around the block to a self storage facility and then stand around for fifteen minutes while we tried to disable the alarm that was being tested. Then we had a call to intercept the next town over for a possible CO poisoning.
When we get there we find an aging biker couple covered in Harley Davidson and swastika tattoos cramped into the back of a volunteer rescue squad ambulance. The vollie EMT states that she wanted a medic to look over her patients because she was worried.
I do a quick assessment and find that the man was a One percenter for thirty years and now he's retired. His wife is a former biker babe with a list of health problems the size of a phonebook.
They are both teary eyed over the loss of they six parakeets. I have three cats, two rabbits and a rat so I know the love of animals and their pain is a real thing for me. We talk for twenty minutes or so about animals and pets and the mountains behind their house, we talk about how they used to ride free all over the country in a roving band of leather clad non compliants and how they have settled down.
Neither one wants to be transported, their headaches and nausea have ceased. I wish them good luck and tell them their cat is still running around as I saw him outside stalking a pile of leaves.
While I can't be with my own family this Thanksgiving, if need be I can be with someone elses. Even if all they need is a shoulder to cry on.
I really do like my job.

I'm Back

2008-10-21T18:57:00.003-04:00

I got married, started a new job and got a side job. Hopefully I can write more soon.

And now its off to 48 straight hours.

Change of Pace

2008-08-09T23:45:00.002-04:00

Unlike Holden my new fire department utilizes a transporting ambulance stocked at the paramedic level. On my shifts I cross man the ambulance and a Type III 4x4 engine. I spent my in station day tearing the trucks apart memorizing where everything was. And then I did again.

And again.

Earlier in the week I had driven the department owned suburban with my training captain to the various hospitals around the area. I was issued uniforms, ID cards, bunker gear, narcotic codes to be able to work as a medic on the ambulance. I was placed in the Pixis system at our resource hospital. In short we got everything done in order to allow me to work as a fire medic.

The town that hired me has a two lane highway that bisects it. Its six or seven lakes are spread out through out the community, ringed by multi million dollar homes. Mountains on either side form a valley in which the lot of it lays. The moutains also funnel the rain or snowstorms that tend to assault New Hampshire with ever increasing ferocity. In the winter its not uncomon for the town to be shut off from the outside world by record snow falls, transportation possible only in heavy duty four wheel drive vehicles such as the Engine or the Ambulance. In the summer tinder dry conditions and frequent moutain effect lightening can cause massive wildland fires. Conversely, torrential rains can bring flash flodding so bad the department has its own swiftwater rescue team (virtually every firefighter and firemedic, myself included, is trained in swiftwater.) The long flat highway devoid of any real turns or obstacles ensures that when a crash occurs it will most likely be very bad.
I had wanted to work for Truckee Fire District in northern California for a very long time. Because of the rugged mountain terrain and weather patterns it seemed to be the best place for me to get a lot of experience in different types of situations. After I had broken up with my ex, I had traveled down to the DC area in an effort to get on various county wide fire services. Then I met my now fiance (to be married in exactly 13 days but, shit, whose counting?). She established herself in New England as a Vet Technician, a nurse/paramedic for animals and I knew that trying to ask her to accompany me across the country away from our families wouldn't cut it. So instead Iwent to the most progressive New England state I could find. New Hampshire's EMS protocols rival those of California in their scope of practice for field paramedics. Firefighters in New Hampshire are able to afford some of the best equipment in the nation due to national funding and grants. So in lieu of California I moved north and ended up working in downtown Manchester. An application filed a while back with my current fire department totally forgotten by me but not by those who matter.
I've had a lot of false starts. I thought that things in the little town next to Manchester would take off and I could work as a firefighter/paramedic there. Though they did meet with me once or twice for training, it was impossible to make things happen there. I"ve been up and down the east coast, applied to various California fire services and hadn't gotten anywhere. And then I got a call asking me to come in for an interview.
Then things seemed to fall into place.
As soon as my inhouse training is done, familarization with department equipment and procedures, the layout of the town and those I work with have seen me perform as a firemedic, they will sign me off and I will be one of two people covering the town for 24 hours at a time. The department relies heavily on part time and call members to provide coverage, should the duty crew be away on a call.
While its a dramatic change of pace from the overdoses and busy shifts of Manchester I think that my new job will be a perfect fit in my life, allowing me to fully utilize all of my fire rescue and medical training.

Circus

2008-08-01T09:16:00.003-04:00

"Think its a pit bull bite?" Rich asks as we blare the horn at a slow moving Cadilac.
"Its not always pit bulls, I've met some wicked nice pit bulls. I love pit bulls." A really thug looking guy in Manchester actually breeds them and they are the nicest dogs I've ever met. He lives in the projects but he doesn't fight the dogs and he has AKC registry rights.
We weren't dispatched with an engine so it can't be that bad. We ask the student in the back what his first priority will be once we get on scene.
"I'd wanna stop any bleeding, get a set of vitals, dress the wound and get a good history."
"Wrong" Rich makes a buzzer noise and the kid looks perplexed.
"Make sure the dog isn't there." Animal lover or not I don't want to get bit while I'm working....or ever for that mater.
When we get there I don't see any police cars, in fact I don't see anything. We stay in the truck for a minute or so taking it in and looking for anything that might be a problem. Calls in the projects are difficult because the denizens of this area look at anyone in a badge as a representation of evil.
Rich sees movement from the backyard as a girl of about fifteen or sixteen in a tube top comes running out. "He's in the back, come on!" She's pissed that we are just sitting there.
"Wheres the dog?" I ask through the open window.
"The backyard."
"Well make him go away." I tell her and roll the window back up.
Rich laughes and just goes "Poof!"
When we finally get in the back yard, there is litterally a sea of little black children ranging in age from 3 to 18. All of them are yelling at us to help a little boy sitting in a chair. I crouch down and ask him whats wrong and he points to a scar on his leg.
In broken English a matronly woman who refuses to introduce herself tells me that he says he was bit by a dog. Theres no blood and the kid doesn't seem to be in any pain. The mark on his leg looks like a scar from way before this.
I have him walk around as the kids continue to yell at us. He walks with no limp. Some of the elder kids start getting in our faces and yelling obsenities about how we took forever to get here and now we're making the kid walk around.
A particularly bold youth gets in my face and says "You a cop?"
"I'm a medic."
"Shit, you got a badge like a cop....must be a cop."
I roll my eyes and say "You a sailor?"
"Fuck nigga, I ain't no sailor."
"Got a mouth like one, you belong here or you just making my life that much more fun."
"I live around the block."
I nod, "Maybe thats where you should be then." I turn my attention to the oldest woman and ask "We taking him to the hospital? He's not hurt." The crowd starts to yell that he is and that we don't want to treat him because he's black.
Rich is just ignoring them but I turn and motion for everyone to quiet down as the cops are pulling up. Then I just cross my arms and smile as the "popo" walk up. The old woman's English is about as good as my Swahilli and she calls the kid's mother on the phone. They click and whistle at each other for five minutes and she says to me.
"He go to hospital."
"Gimme the phone." I take the phone and say "This is Nick from Manchester ALS, I'm with your son. He's fine, he's not hurt and the trip to the hospital really isn't necessary."
"But he needs to go by ambulance or we can't sue....."
In the end the kid walks to the ambulance and the older woman rides in the front. We leave them in Triage for the nurses to figgure it out.

Sucess

2008-07-27T13:03:00.002-04:00

He'd laid out towels. Filled the cat food bowl to the brim and put out a few extra bowls filled with water. The heavy duty bottle of bleach was still in its CostCo bag as was the bucket and sponges. Old threadbare sheets, the kind his wife was probably about to throw out, were drapped over the airconditioner. The hose was right next to him so that those who had to clean it up afterwards wouldn't have to go searching for it.

"ALS 3, Engine 8 respond to XXXX for a Gunshot wound. Stage for PD. Operate TAC 3."
The ride takes about 4 minutes. We park around the corner with the engine, and wait for the all clear from PD. When we get word that the scene is safe we pull around the corner and stop infront of the correct house. Its a nice little hamlet at the other end of town from where I live. Bright sunshine streams through the trees that make the street a dead end. Residents in shorts and flip flops mill about.
The Lt from the engine calls over to us. "Guys, leave your first in in the bus." Telling us we don't need our first in bag, the big blue bag stuffed with medical gear.
"Ten?" I ask, meaning Code Ten, the Manchester Fire designation for a dead on arrival.
"Not officially yet, go do your thing." The Lt. tells me.
I walk into the backyard and notice that a neighbor is watching us from his porch next door. Two or three cops are standing around and I find the patient leaning against the airconditioning unit, a rifle with a scope in his lap and things that should be inside of him sprayed all over the place, caught mostly by the towels and blankets. A quarter size hole is right between his eyes, the rifle with its stock down by his feet, one shoe off. The blood and grey mater have dried forming a film over him, his eyes half open.
"I gotta check his pulse for paperwork." I tell one of the cops and he motions that its okay if I do.
"Just don't touch the rifle, might still be a round in the chamber."
"Okay, " I say and press my fingers to the man's neck. Nothing
I see a cat move among the bushes in the backyard and tell the cop. "Hey, not to be a freak or anything but if no one claims that cat, call Fire Alarm and they'll get a hold of me. I'll take him."
The cop laughes and I smile. "No reason for the cat to suffer."
As we're leaving I hear the nextdoor neighbor tell one of the cops. "I thought it was a balloon popping, just a litle 'pop' and I didn't think anything of it. Then I took the dog out to pee, I don't like to leave him out in the heat, and I saw him lying there. That was like forty five minutes ago or so. You don't think if I came out right away...." His voice trails off and the cop tells him that there was nothing anyone could have done.
I wonder if there is something wrong with me as I climb into the truck, punching in the number of a sandwich place so that my order will be ready by the time we get there.

Attempt

2008-06-19T09:50:00.003-04:00

ALS 4 from 5 p to 7 am on overtime. It had been one of those horrendous nights where we left at around five pm and didnt make it back until about 4 am. Almost every patient was an ALS call. But the one that came in at quarter of five in the morning was the worst. I had been asleep for a little over forty five minutes when the tones dropped for an overdose on the other end of town.
"Engine Five, ALS 4 respond to XXXX for an overdose."
Groggily, realizing I still have to work a transfer truck for 12 hours, begining in less than six hours, I key the mike. "Four's responding. Is PD enroute?" Overdoses, especially ones that come in at this early in the morning usually end up being Code 10s, dead on arrival with obvious signs of being dead for several hours. In other words, long gone.
"Negative, patient is a 48 year old woman, shallow respirations. Shes known to us, possible suicide attempt."
Maggie, my chaufer for the shift gets in the driver's seat and states. "I know right where this is." She hits the lights and I drift back to sleep on the ride over to the apartment complex.
I wake up from my little nap when the radio chirps. "ALS 4 from Engine 5, just back right in up to the steps and bring in all of your stuff. We'll get the stair chair but bring in all of your stuff." I sigh and reply that we will, when they say that, the patient is usually very critical.
And she was.
Forty eight years old, snoring respirations at four to five times a minute. Her right eye is pinpoint and her left one totally blown. One of the firefighters gives me a quick report. "Breathing like four times a minute, pressure is at 70/palp. Pulse around 110. Jaw is wicked clenched, I can't even get an OPA in." The small piece of plastic used to hold open an airway when a tube is not possible.
We bundle her into the chair, take her down the stairs and drop her on the cot. Once in the back of the truck I cut off her nightgown and throw on cardiac leads. Shes in a sinus tach with occasional PVCs. We drop a nasal trumpet and I steal a firefighter to bag. The lieutenant hands me an empty bottle of psych meds. It was filled with 60 pills two days ago and now its empty.
We try for two IVs and get little more than flash before the lines blow. Her sugar comes back at 102, normal and not the problem. I pop an IO into her right leg and it flows fine. We transport, a quick little jog down to the Elliot. My patch was simple but it got the job done.
"Elliot Hospital, Elliot Hospital. Status One traffic, five minutes out on Med 1"
"Elliot, go ahead and please identify."
"Good morning, ALS4. I'm about five from your facility with a forty something year old female. Took a full bottle of at least 60 psych pills. Vitals unstable full report on arrival, I'm busy now. Have a team standing by."
I push 2mg of Narcan and nothing happens. Big shock, I didn't expect it to but on the off chance there's narcs in there I wanted to try. Her teeth are still clenched but we're pulling into the Elliot.
Once inside I help them work her up, I bag her while they push RSI meds to parlyze her and then help the doc get the tube. She was really anterior and I had to force her trachea down for him to see it.
They bring in a ventilator as the cops show up and tell us the rest of the story.
Apparently the woman is very well known, numerous suicide attempts with an extensive depression and bi polar history. Her husband had come home at around seven the night before and found her sitting in the chair much like we did in the morning and thought she was sleeping so he left her alone. When he woke up to take a piss int he morning he found her still sitting there and tried to wake her up, then he found the bottle of pills with nothing but dust in it and called 911.
Manchester is one of those typical New England urban centers, the largest city north of Boston. As such it attracts the typical urban problems of drug abuse, assaults, homeless people and the mentally ill who gravitate toward large urban areas. The over taxed healthcare system tries to do a treat and release that relies on people who want to kill themselves being trusted to take home quantities of meds capable of producing that goal and then following the propper dosage plan.
The city has four ALS trucks in 911 rotation. We basically serve as the reset button for a population that bounces in and out of care facilities. When the inevitable happens, we are there to pick up the pieces.

Long Shift

2008-06-05T22:37:00.003-04:00

When I got on at 7 I knew it was going to be a long day. It was chilly and raining which in my experience usually ends up leading to a lot of bullshit.
Our first call comes in as difficulty breathing way out on the Londonderry line. When we get there, a little old lady is wearing a fishing style boonie cap and complaining that her abdomen hurts. The firefighters are grinning and I know this isn't a good sign.
"Ma'am whats going on?" I ask in a normal tone of voice.
"You need to talk softer, my sense of hearing is very acute."
I lower my voice and ask. "Why'd we call 911 today?"
"I'm sorry you'll have to speak up."
Without further questions I tell Josh to go get the stair chair and once we put her on it she tells us she hasn't pooped in a week and now her stomach hurts.
We ride to Elliot with lights and sirens because she complains about everything.
Once we finish up some paperwork and get back in service I grab a muffin and a coffee. Pulling out of the Dunkin Doughnuts parking lot we get banged out for another difficulty breathing, this one around the corner from CMC. As we're responding the fire alarm dispatcher comes over the radio with one simple transmission.
"Fire Alarm to ALS 3, be advised 911 states bystander is performing CPR."
The engine is on scene about a minute before us and all they have managed to do is find the apartment. A large black man is laying on his back between the bed and the wall with his eyes open, his fiance is running around crying as I feel for a pulse.
"No pulse, get on compressions." I cut off the guy's shirt as one of the firefighter places his AED next to me. "Wanna put that on him?" Josh comes running in with the drug box and the monitor. The AED tells us not to shock him and on our monitor I see he's in total aystole. "Okay, continue compressions." We pop an oral airway in as Josh runs out to get a board, in a few minutes we have him on the board and the engine crew and I muscle him out the door, Josh grabbing all of our shit and hustling it out to the truck. Once in the back we get him back on the monitor and see he's still in asystole. I consider a standard IV.
" O fuck it, I'm doin' an IO." The intraoseous needle, a drill that basically places a 15 gauge needle dirrectly into the bone marrow for drug and IV fluid administration. I pop it in and it flows great, two rounds of Epi and atropine and he's on the table at CMC.
Forty minutes later he's officially dead.
We're dispatched from CMC to a "sick person", Manchester Fire Alarm's ubiquitious definition of anyone who can't figgure out why they need an ambulance. When we arrive on scene, a little old man is outside waving franticly. Josh jumps outs and I grab the bag, when we get to the old man he tells us his wife cannot stop going to the bathroom. We find her inside sitting on a hospital chux on the couch wearing a fishing hat. She has the air of someone who will make my life difficult.
"Hi, hon, I'm Nick, I'm a paramedic. What'd we call 911 for today?" I ask in a normal speaking tone.
"Theres no need to shout, infact, talk softly, my hearing is very acute." Her nasally voice commands and I drop mine a few decibles.
"So what can we do for you today?"
"What? I can't hear you."
We transport her to Elliot with no icident.
Another sick person, this one on the North Side. We go lights and siren through traffic that would prefer not to move.
On the way Fire Alarm updates us again. "ALS 3 be advised on scene nurse states possible stroke. Engine 8 will meet you there." They tone the engine and we pull into the parking lot of a moderate income apartment complex. A morbidly obese man sits on the steps with a crowd of onlookers tending to him.
"Gentlemen," He addresses us in a slightly effiminate tone that I know all to well. "I am not going to the hospital. The only problem is that my right hand doesn't work correctly." Strokes make guys sound like they are a bit light in the loafers, the slurring of the speach and the overly cautious word choice indicative of a brain event.
"Did your right hand work before?" I ask as the "nurse" on scene begins to describe how the patient needs a swallow evaluation. Josh tells her that they will take care of all of that as he scoots her out of the way. The egine pulls in and four firefighters join us.
"Well I was having trouble writing, you know, words?"
"Yeah, I'm familar with language," I reply and ask him to give me a nice big smile and squeeze my hands with both of his. The right side of his face droops, his right grip is weak. "Sir, you gotta go to the hospital."
"No, I'm going inside to take a nap." He tries to get up and finds his right leg isn't working. "What the fuck is wrong with my leg?"
The captain from Engine 8 says, "Why don't you let them take you to the hospital and they can find out there." The patient complains and protests as soon as we stair chair him to the truck and plop him on the stretcher. Once in the truck he gets even more nervous. He's tachy on the monitor with a pressure in the 90s, we pop a sixteen in his left wrist and I run a 12 lead. By the time we get to the hospital his tongue is hanging out of the left side of his mouth and he can't speak. I have the BVM ready as we wheel him into the Trauma Room.
After grabbing some ice water and attempting to write up my report the tones go off and we respond from Elliot to a psych problem in the South Side of the city. Lonely, bored and mentally ill people have found that when their prescribitions run out, 911 will send a truck to pick them up and take them into the hospital. Since they don't have insurance or have some form of state provided insurance they don't pay a co pay so its cheaper to dial 911 than to call MTDS cab.
Fire Alarm states simply "ALS3, respond to XXXX street for a psych problem. New England Fire Alarm for details." New England refers to the now defunct phone company that used to service Manchester. It's slang for call on a landline.
When I call FA on my cellphone the dispatcher starts by saying. "I'm sorry." Never a good sign. She proceeds to say. "These are two regulars, 58 year old female and her 35 year old son both have BiPolar with psychotic tendancies. PD should be enroute but they have a suspect with a gun in the West Side so you might be on your own." I thank her, hang up the phone and swear.
When we get on scene, a home oxygen delivery guy is sitting out front looking at the open front door of the house.
"You call 911?" Josh asks him.
"Yeah, they're pretty bad off in there."
"How?" I ask as I pull the large MagLite I keep in my door out and slip it into my belt at the rear for a quick draw, usually the sight of a large pipe type object is enough to calm down assholes.
"Man, they're just screaming and sitting around, its weird."
"Lovely,"I mutter and we walk up the steps.
Each of us stand to the sides of the door to avoid any gunfire and I yell out. "EMS, can we come in?"
A voice calls back that we can and we walk in to find a woman with a nasal canula and thousands of feet of tubing smoking cigarettes at the bar with a half empty bottle of bourbon. Her son sits in an easy chair rocking back and forth.
Josh goes and talks to the woman and I talk to the son. He tells me that hes in a lot of mental pain and he needs morphine. He goes on and on about how hard it is to be in this much pain and he needs pain meds because he is having an anxiety attack. His vitals disagree with his complaint and he denies physical pain but tells me I don't know what its like. "My mind hurts, I need narcotics." He snarls.
I ask one question, perhaps the most important question. "Can you walk?" He walks with me out to the truck, sits on the bench seat and continues to half heartedly request morphine as Josh carries his 98 pound mother out and plops her unceromoniously on the cot. Vitals on both of them are fine as we drive into CMC. The mother tells me her son could use some morphine.
We clear CMC and head back to the station for shift change. I bounce a few more psychs and then my night partner Rob and I head to an address around the block from where I live. A 10 month old baby fell on a concrete floor and is not acting right. We get there and he's lethargic with his pupils sluggish. I scoop him up and we run out to the truck, lights and sirens to Elliot, the Trauma Center. Two blocks from the hospital he starts to wretch and almost loses conciousness.
The night goes on with us getting dispatched to a sick person at the bus station. A little Indian guy with vomit all over his shirt and hospital ID bracelets from Los Angeles County General Hospital sits barely responsive on the bench near an idling bus.
The bus driver says "He's sick, dude, I got him off the bus and called you guys. I gotta get to New Haven by 8 am , can I leave now?"
I tell him to take off and we pull the guy onto our stretcher. He stinks of booze as we wheel him into the truck. We're down the street from CMC. I throw him on the monitor to find a Sinus Arrest rthym at about 75, not to concerning. An 18 goes in his left AC and we find his sugar is reading as Low on the glucometer, once it stops giving numbers thats a bad thing. His pupils are equal and reactive so I push D50 and watch him go from low blood sugar and drunk to just plain drunk. He tells me he loves me and I reply. "I know."
At CMC we are finishing paper work up when Fire Alarm comes through. "ALS3, are you in service for a call at CMC?"
"ALS 3 to Fire Alarm, we're sitting at CMC now, what do you need?"
"Phone-A-Nurse states you have a suicidal patient in front of the emergency room."
Phone-A-Nurse is basically a line that people call when they have medical problems but don't want to go to the hospital. Nine times out of ten, phone a nurse sends an ambulance anyway.
"ALS3 responding and on scene, show us out and investigating." We find a 30 something year old male walking around and ask him whats going on. He states he was on the phone telling them that his wife, a woman in the Cardiac Room was trying to kill herself with sleeping pills and he wants to know if she will be okay. Hospital security had kicked him out when he asked a nurse for fentanyl because of a car accident injury. The police show up, find he has a warrant for unpaid something or other in Northern Bumfuck County and arrest him.
When we finally get back to the station the tones go off yet again. "ALS 2, 3, Engines Six and 8 respond to XXXX Street Apartment XXX for a stabbing. Stage for police, be advised multiple calls and victims."
The apartment is two doors down on the same floor as my own and when we get there I see ten marked police cars and a three or four unmarked, a few police mountain bikes an unmarked van that usually carries the SWAT team.
Walt and Maggie, the ALS 2 crew are grabbed by a cop who blurts out, "The guy upstairs is fucked up. I think he's dead." He's not but close to it, a pneumo thorax and a punctured lung will do that. The guy that stabbed him is on the pavement covered in blood with a nasty laceration to his head. I get to work on him, patching him up with 4x4s and cling wrap, mvoing his clothes and asking if his neck hurts.
He looks at me blankly after denying pain and says. "Man, don't I know you? You look familar."
"People tell me I look like Russel Crowe and George Clooney only better looking. Thats probably it."
"No, I've seen you before."
I shake my head. "No you haven't. Can you walk?"
He shuffles over to the truck wrapped in one of our blankets as ALS 4 is dispatched to check on the pregnant woman they were fighting over.
Once we drop him off at CMC I write my report and fall asleep in the truck on the way back to quarters for shift changes. When I hand Eric the radio for ALS3 and thus pass the torch he says. "You look like shit, go home."
I reply, "Dude I was just there, I wanna go somewhere else."

Other Interesting Blogs

2008-05-23T12:03:00.002-04:00

I've decided to put up a few blogs that I read and find interesting. They give other perspectives on EMS. Rescuing Providence follows an ambulance lieutenant in Providence RI and is a good representation of a fire department based EMS system. Brick City Blues chronicles the exploits of a paramedic in Newark New Jersey, working for a hospital based system. Both of them are very good and make for interesting reading.

http://brickcityblues.blogspot.com/

http://rescuing-providence.blogspot.com/

Bad Batch

2008-05-02T14:31:00.002-04:00

You can watch it move through the area almost like a weather front. It starts down in Worcester or Providence and moves on up through the shitty backwater slums around Boston, up into Lowell and then Lynn. It jumps the border into Nashua first. A tubed junkie here, a cardiac arrest with the needle in his arm there. Medics from jumpsuit land (a few people in Nash still where the old school Rescue 77 style jumpsuits) tell stories of having to give astronomical amounts of Narcan in order to snap a heroin addict out of his stupor, or they just get pissed off and tube him, letting him wake up in the ICU on a vent in St Joe's or Southern. The little towns in between get it too, Merrimack had a junkie with snoring respirations and minimal effect on Narcan. Amherst had a guy with pinpoint pupils and three respirations a minute.
And then it hits Manchester. In the past two days, Manchester ALS, the division of Rockingham that I work for has worked more overdoses than ever since I've been here. My first off of this batch came on Tuesday at about two in the afternoon. He was laying in a bed in a shabby rundown apartment in the West Side. Covered up to his chin in comforters and blankets while the firefighters and I are sweating our asses off.
I try yelling at him. "Hey! Wake up, come on eyes open." Nothing, I grate my knuckles on his breastbone, which if you've never done it to yourself hurts like a bastard. He kind of rouses a bit and I ask his sister, a skimpy little twenty something whose first language died with the Soviet Republics what he took. She says he didn't do drugs but his pupils are pinpoint. His skin is burning hot and he's covered in sweat and apparently no deodorant because he smells like a Tibetan whorehouse in the middle of August.
Josh, my intermediate, shows up with the stair chair and we try to move him off the bed, he's naked and lathered in urine so we have his brother throw a pair of sweat pants on him and we strap him down. The firefighters carry him out of the apartment and I jump in the bus to set up. The guy is sinus tach on the monitor at around 125 or so, pressure is in the toilet, hovering around 80 palp, O2 Sat is 98 but his tongue flaps back over his esophogaus and he starts to do the snoring thing.
We drop a sixteen in his left hand and I push in a miligram of Narcan. His eyes widen and his breathing jumps to 10 a minute and I ask him what he took. His only response is to laugh and call me a dirty word. By the time we're pulling into CMC he's lolling back again and I give more Narcan with the same response.
The sister is already there and shes virulently denying that her brother took anything. I give the nurse my remport as they start working him up, more Narcan, less effects. I leave as they debate tubing him
Last night Mark and I get toned out for an unconcious person infront of one of Manchester's low income high rises. When we get there the crew from the engine is trying to rouse a man who is hunched over and barely breathing while the lieutenant takes some crap from the brother about his "attitude toward the people with problems."
I get annoyed and tell Mark to grab the stretcher, our student, affectionately refered to as Stu is standing there dumbly as I flick the man's nose as hard as I can. "Wake up!" I turn to the brother. "What'd he take?"
"Nothin' man he don't do that shit."
"So he's always like this? Look you called 911 we won't arrest you, what'd he take?"
"Booze and some H."
I tell the firefighters to grab him and we extremity carry him to bus, dump him on the stretcher and hop inside. Again, sinus tac in the 120s on the monitor, respirations and pressure in the toilet. He starts to make a snoring noise and Stu says. "I don't think thats good."
"No, it aint. Get me aline." Stu grabs a 20 and I tell him. "Dude he's got fuckin' pipes, bigger." But he's already pricking into the vein. He advances the cath and stops halfway through.
"I think its gonna blow."
"Mark, fix that." I am getting a bit irritated as I draw up Narcan, I already have the tube roll out in case Vitamin N doesn't do it.
Mark pushes the cath in and flushes the line, spikes a bag and hangs it. I get the Narcan on board and the respirations pop up to around 15 and our new friend becomes combative.
"What the fuck's going on? Where am I?" He takes a wild swing at Stu and I jump on him while Mark starts toward the Elliot.
"Listen, youre in an amubulance, we're taking you to the hospital. Youre brother was worried about you and called 911." I try and keep my voice as gentle and soothing as I can, telling him not to worry, he's not in trouble and won't be but that we need to get him looked at by doctors. He cries a bit and eventually as the Narcan wears off, drifts back into sleepy land. I give a bit more to keep him breathing as we pull into the Elliot.
They bitch at us for not tubing him, knowing that when he wakes up he'll be a pain in the ass again. And sure enough he is, they give him more Narcan and he starts calling the nurses the C word.
I grab and ice water and try to figgure out our new computers while security four points him to the bed.

He's a Doctor

2008-04-09T20:05:00.002-04:00

We get sent for a difficulty breathing to the rectory at St Michael's Church in Manchester. The fire alarm dispatchers have a series of questions they need to ask callers in order to prioritize responses and apparently the denizens of the city have learned that difficulty breathing means that the big red truck and the ER on wheels will get there faster.
A homeless guy with a ZZ Top beard and glasses two sizes two small is waving frantically for us when we show up, one of the rare occasions when we actually beat the engine to the scene. I hop on and grab the jump bag, following a growing crowd of people who really don't need to be there in to a half frozen swamp behind the drop off for a St Vincent De Paul society clothing donation kiosk.
"He's comin' off a bad drunk." The first homeless guy points to his friend, a severely emaciated and clearly unwashed man with an equally long beard laying half out of a small tent fashioned from tarps and tree branches. Beast ice bear cans litter the area and it smells like a cheap0 brewery
One look at the patient tells us we are in trouble, his eyes are glazed, mouth crusted shut as he refuses to answer any of our questions. The firefighter end up trouping down through the muck and the captain starts telling the man to get out of his tent. Eventually we end up cutting the ropes and dismantling the damn thing around him, slipping and slidding in beer cans. I help a Manchester jake toss him onto the cot and we get him in the back of the truck. He stinks of beer and age old piss.
When I try for vitals he tries to bite me, I feel his skin is ice cold. Dead bodies have been warmer than this guy. I start piling on blankets and patch into CMC in order to let them know we are on the way in.
"CMC, CMC, Rockingham ALS 3 about five from your facility, status three traffic."
"CMC online."
"Good afternoon, Rock 3 about five out. I have an approximately 45, four five, year old male found living in a hovel behind the church. Patient is cold to the touch and combative to vital signs. Have a room ready for me, might wanna have security on standby."
When we get there we put him on room five, a common exam room with no real facilities for emergency procedures. I sit in the EMS room and write up my report. When I go to get a signature from the staff, I find he has been moved to Trauma One and that they are about to intubate him. His core temperature was 81 degrees, far lower than the 98.6 that most of us our. The doctor asks me why I didn't have an IV.
"He tried to bite me, I only have two hands, I really counldn't hold him down and do one." I piled blankets on the guy, hoping for the best.
We get called from the hospital for a stroke at a local adult daycare, it turns out to be a diabetic semi emergency and we do our little thing, bringing her to the Elliot. I still have to finish paperwork so we head back to CMC. Once there we find the Trauma team in full swing doing their central lines and suction and such. I find a nurse I kind of know and ask her to sign some paperwork. She tells me to go see the guy in the waiting room wearing a red polo shirt.
He's old, a bit on the chubby side but looks like he can still play a pretty decent game of touch football.
"You wanted to see me?" I ask.
"I'm Father McNally." He extends his hand, I shake it, feeling uncomfortable as me and Catholicism have always had a bad relationship. "The man you took in, from the woods behind my church, I know him well. I let him and his friend sleep on the property back there, a bit of charity. It's sad really, did you know he's a doctor?"
I snort through my nose in surprise. "Sure that isnt just an urban legend?"
"Quite sure."
I restrain the urge to ask him how charitable it is to let a homeless drunk nearly freeze to death on his property and make some half assed excuse about needing to clean my ambulance.

Sons

2008-03-07T12:45:00.003-05:00

We're pulling into the parking lot of Dunkin' Doghnuts when the tone drops. Its the long, drawn out almost dramatic buzz of the county dispatch system and we instantly know we are in for a ride.
"ALS 9 Respond to Nursing Home, report of a high fever with slow respirations from staff. Staff reports patient is stable."
"ALS 9 to County Ops, enroute."
We drive with lights and siren for about twenty minutes before arriving at a dumpy little nursing home in the middle of nowhere, just south of Mt Monadnock. Once inside we find a fat sweaty man with a combover standing nervously with a CNA whose first language is some sort of clicking dialect.
"She has been hot since about four this morning, breathing around 6 times a minute." It is now 11 in the morning.
"Why did you call the County and not the local 911?"
"All of the fire department trucks are busy."
The patient is a small, ancient woman with sunken, unseeing eyes and skin the color of concrete, the staff had thrown a simple facemask on her and left the oxygen flow at about 4lpm, too low for such a device. I pull the mask off and plop a non rebreather on her at 15lpm as the CNA tells me that the fat guy is her son.
"She was a DNR but he revoked it when he arrived here earlier." The woman had paperwork in place that said, essentially, If I die, let me go. At 95 years old its probably not a bad idea but the son, being her son and loving his mother decided to revoke the orders and allow me and Josh to give her the full work up should we need to.
"Sir I need to ask you a very tough question. Please don't be offended." He nodded and I continued. "If your mother stops breathing, if her heart stops do you want me to breath for her and pump her heart." He nods vigorously and whispers an affirmative.
We transfer his mom to the cot and Josh tells him he can follow us to the hospital. "Sir," I interject. "Its best if you drive at your own pace they can give you dirrections to Concord here, its dangerous to follow a bus with all the bells and whistles going."
And with that we are off. In the back of the truck, my intemediate Josh gets an IV, a nice 18 in the left AC. I start assisting the woman's breathing with a BVM, a device used to push oxygen into people's lungs. She gags and fights it but soon we both find a rthym and I am able to breathe for her. The monitor has her in a wide complex sinus brady and her vitals are in the toilet with A pulse of 40,BP of 60/20 and unassisted respirations at 3 to 4 a minute. I tell Josh to fly as I pop a small curve of plastic into the unresponsive woman's mouth to keep her tongue from falling over her airway.
As we race toward Concord I try to intubate, her gag reflex bucks the tube but not the laryngoscope. I bag more, feeling for a pulse every few minutes and fully expecting not to find one. I try for the tube one more time on the twenty minute transport, this time getting it all the way to the chords before she starts to reject it.
"Concord Hospital, Concord Hospital, Rockingham ALS 9 inbound with Status One Notification"
I patch through to the hospital and when they respond I rattle off. "Good morning, Concord, Red Team activation on a 95, Nine Five, year old female. Patient was found with a high temp this morning and low respirations, wide complex sinus brady, vitals as follows BP 70/30, pulse 30, respirations assisted at 14 with no intubation, patient has intact gag reflex. Sugar is 99, 18 in the left AC. Five minutes from your door. Questions, comments concerns?"
"Red 1 on arrival, Concord out.
"Red 1, Rock 9 out, thank you."
We push her through the hall to the trauma room where the doc and his team are waiting, I give essentially the same report all over again and he looks at my EKG strips. "I thought she was a DNR?" I nod.
"Yeah, she was but the son revoked it this morning." As I say that, the son is ushered in by a nurse. He hugs me, hugs Josh and starts to sob. I make some lame execuse about paperwork and bolt from the room as the doctor tells him his mother will likely not make it and be on a respirator for the rest of her life.
The last thing I hear as I am leaveing is the doctor saying. "We'll make her comfortable with morphine and bring in a chair for you."

Punch and Judy

2008-01-26T10:09:00.000-05:00

We get called for a routine psych transfer. A suicidal woman named Judy had swallowed a handful of pipecleaners earlier in the day and been sent to RIH for evaluation. She has a nurse with her and stinks of urine and unwashed skin, making me wonder about the hygiene situation in the Butler Institute.
Shes docile, cooperative even as we ask her to slide over to our stretcher, she complies easily enough and we follow the usual procedure for psych patients, wrapping the blankets as a burrito around her to immobilize her should she decide to become a pain in the ass.When we get her secured and Ryan and I lift the stretcher i realize she weighs somewhere around three hundred pounds.
Until about Thayer Street she is dead silent, not moving or making a word so I quietly fill out paperwork and watch her from the airway seat. I ask if she needs a blanket because she starts shivering and then shes up.
In one motion she pulled off the straps of the stretcher and sat up, clawing at the backdoor.
"No, no. Judy, don't do that." I jump next to her in the back of the bus and try to push her back down onto the stretcher. Her right hand balls into a fist and connects solidly with my left eye and cheek bone. I groan an expletive and drive a knee onto her pelvis and lock her hands behind her head with my own.
"I WANNA DIE!" She wails and thrashes as the nurse jumps through the divider and helps hold her hands down. I weigh close to two hundred pounds and spend a good deal of time in the gym and her legs are easily moving me while I try to pin her down.
"Are you good?" My partner Ryan asks from the driver seat.
"Get back here!" I snarl back and he says something about pulling over. "Fuck that, hit the lights and get back here." He fumlbes with the emergency board and then jumps out. The backdoor opens and he gingerly starts to try and control her feet while i struggle with her arms. Finally I get pissed off and tell him to call for the police.
Another ambulance arrives before the cops show up. With the help of Craig and a new EMT we manage to keep her still long enough for me to twirl a handcuff knot into a backboard strap.
"She hit him." Ryan tells them.
"Hit you?" Craig asks.
I laugh, "Yeah she clocked me when I asked her to play nice." The backboard strap tightens itself while she struggles against it, wildly kicking and bucking even udner the combined weight of Craig and I.
Providence PD shows up and all is just about under control so we tell them to clear. I tell the new guy to beach his truck under the overpass and drive our truck to Butler. He agrees and jumps out but Ryan is already in the driver's seat. The truck starts moving and the other bus follows us to the hospital.
Ryan is screwing, hitting bumps like crazy so I yell up front. "Calm down! You hit anymore bumps and I'm gonna get a headache." He complies, sheepishly saying he's sorry.
I shake my head and turn to Craig. "This is my last night, too. I start the fire department orientation on Monday."
"Oh yeah, good for you man. Where abouts?" I tell him about the small town just outside of Manchester New Hampshire and he tells me to enjoy it. The girl underneath us starts a mantra of "Iwannadies."
Once at Butler, two security guards come to the backdoors of our truck. The fourth EMT shows up and we try to pull out the stretcher while keeping our patient from going apeshit. Some how one of the discarded straps wraps around the nurse's leg and when we pull it out she yelps in pain, struggling not to fall on her ass. Craig yells to push the stretcher back in and we disentangle her. When we finally get inside, the nurse asks us not to leave without giving her back her coach bag. I tell her I can trade it for crack or a blowjob on Veasie street and she just laughes.
Polo shirted college kids doing volunteer time to meet this or that requirement descend on our little circus, offering to help hold the bucking woman down but all we need is to get her in the safe room, a rubber padded cell that she will probably smear her feces all over as soon as we leave.
The elevator ride upstairs is uneventful aside from her screams about death. A nurse approaches her with an Ativan pill and asks her to take it but she just snarls the C word at her. I laugh and say an injection might be better off. After some typical hemming and hawing they stick her in the thigh and a total of ten people lift her off the stretcher, dump her on her belly and cut her clothes off in the rubber room. They evacuate the room and I watch the heavy door close behind them.
"You guys got a men's room?" I ask a security guard.
"Yeah, are you the one she hit."
"Yep, its my last night too."
"You okay, you want some ice?"
"Nah, just a men's room please. My stomach's bothering me."
"She get you in the stomach too?" Craig asks.
"No, I gotta take a dump. Can someone point me in the right direction here?" Toilet humor is always a good way to lighten the mood.

Waterview

2008-01-19T12:42:00.001-05:00

"Squad 22, from a phone in. Respond to Waterview Villa, patient with abnormal labs."
My partner, Ant, a guy I went through EMT school with keys the mike and tells our dispatcher we are responding.
"Abnormal labs, thats the most blanket fucking statement in the world. What were the abnormal labs? Is it a high white count with a fever? What the fuck, if its triponin thats even worse but they never fucking tell us.." Ant bitches as we skid and slide on the fresh black ice left behind by a fast moving front.
I knod, telling him I agree as I try to enjoy an Italian grinder I bought up on Federal Hill. Venda, a great little Italian shop threw about four tons of prosciutto, provolone, capicola, salami and some other Italian cold cuts on to a loaf of bread and covered the whole thing in oil and vinegar along with peppers, tomatoes and some huge palm trees of romaine lettuce.
There is some kind of sing along play the piano and dance thing going on when we get to the nursing home. Little blue haireds sit in their wheelchairs and sway while a few ancient Greek guys do a glacially slow oompa dance.
We push through the throng and go to a small but well kept apartment in the back of the living center. Her daughter and son are there making nervous jokes and small talk with her as we turn on the monitor and do a quick peripheral look (leads on the wrists and ankles.) She's tachy at about 135 or so. Vitals are unremarkable with a corresponding pulse, though weak and thready, her BP is at 130/80, not bad considering the heartrate and her respirations are at 18 with clear and equal lung sounds.
"Can you stand up?" Ant asks and shes tells him that when she does her BP drops and she feels faint. Orthostatic vital signs, usually indicative of something potentially bad. So we scoop her by knees and armpits, depositing her easily on the stretcher and leaving quietly.
Since she is doing fine we start to drive toward RIH with no lights or sirens. She's yammering away with Ant in the back and stayed pink warm and happy the whole time I drove us in.
Wedging the truck between two Providence rescue ambulances, I hop out and bring the stretcher out. As soon as the wheels kiss the ground she starts to look worse, she starts to gray up a bit, her eyes seem to go in and out of focus as she mutters something about her arm and back.
At that we start to run toward the ED doors. I find that they have been diasbled because of the cold weather, RNs wanting to keep warm. So I pry them apart and shout.
"Got a cardiac room open?"
A nurse looks startled as a Providence firefighter pulls his stretchered drunk out of the way and we come careening in. On the way to the room the overhead sounds with a medical/trauma team to room four on a stat priority. We give our report about negative and non diagnostic findings and about how the patient shit the bed in the ambulance bay. The doctors and nurses take over and start their own procedures, bloods and 12 EKGs, an aterial blood gas and so forth. I stick around long enough to spike a few IV bags for them and then get out of the way so as to let a CNA orientie get some experience.
While finishing up paperwork in the EMS room, we watch another NEA truck come in, this one with lights going. I finish off my ice water and go out to help them unload the stretcher. In the back a new EMT is trying to calm a man who is missing half his hand. The vetran Cardiac in the back with him looks up at me and says simply:
"Snowblower."
We unload the now fingerless man, the new guy carrying a bag of blood soaked ice and snow almost at arms length. Again the overhead chimes for a trauma team. I go and wash my hands while my partner finishes his paperwork.

At Last

2008-01-05T15:15:00.000-05:00

My whole life I have wanted to be a firefighter/paramedic. On the 3rd I took a giant step closer to my goal. For the past year I have been in contact with a town in southern New Hampshire attempting to secure employment with the fire department. Last Thursday I sat for the oral boards, before three lieutenants and a captain. For forty five minutes I was grilled on how I would respond to certain emergencies and what I would do in different situations.
While it was a relaxed atmosphere, no class A uniforms, just sweatshirts and unzipped boots, I was somewhat nervous. Never one for a suit, I opted to wear the shirt my mom got me for Christmas and a pair of khaki pants. I had been in constant contact with the deputy chief for nearly a year, so he had removed himself from the process but the guys on the board were very nice and even laughing and joking with me.
It started fairly simple, the captain asked me to introduce myself and give a brief history of my experience and my life. So I started telling them about how I worked for four years as a firefighter/EMT in Holden. I told them about how for the past six years I have traveled all over New England taking specialized tech rescue classes, diving and salvage courses, I told them about how I dedicated a year of my life to becoming a paramedic. Over the course of my little ramblage they learned that I love to go camping and kayacking, that heaven for me is a full tank of air and murky black waters. They learned I have a bull mastiff named Gus and that I have plans to become a certified sky diver and that I want a Harley.
Next one of the lieutenants threw me a six foot length of rope and told me I had two minutes to tie a figure eight follow through. I almost jumped for joy as this is one of my favorite knots to tie. Not only is it very strong but it looks beautiful when all dressed up and tightened. Within thirty seconds I had the knot twirled into the rope and dressed with two safety hitches and found myself holding it at arms length for inspection like back in the academy.
"Good job." He said simply and lead me to a table covered in various hand tools. Hefting a Halligan tool he asks me what it is and how to use it. Back in Holden I always took the irons, a Halligan and a flathead axe. So I took it from him told the assembled board that it was a Halligan bar and that it could be used for prying, picking, wedging and jamming. I told them that it is usually married with a flat head axe but that law enforcement prefers a sledgehammer as do some specialized rescue units particularly in industrial settings. Somewhat impressed, the officer took his tool back and told me to explain the rest of the table.
Ceiling hook, used for pulling ceilings, brute force is all, jam it through and pull it down just don't dump it on your head. Bambam tool, a pry bar with a free floating weight on the leading end. Instead of using a flat head, you use the weight to seat the tool and fit the working end into wherever you want it. Spanner wrench, adjust couplings and in a pinch a small pry bar....just don't hit it.
After running through the various implements of a trade I have learned, the captain unzipped a small duffel bag and pulled out a baby doll.
"I'm a father, you just arrived on scene and I come running up to you. This baby is pulse less and apenic. Do your thing." I run through a quick round of CPR, BLSing the baby to the ambulance while trying to get a history from the father. I verbalize dropping a tube in the back of the truck. Instead of an IV I tell them that I will use an intra osseous needle in order to secure drug and fluid access through the baby's tibia. The baby is placed on the monitor and I tell them that I will follow PALS protocols and notify the nearest children's center that I am en route with a pedi code.
The rest of the interview moves fairly quickly. They show me a picture of a three story wood frame building with fire blowing out of the bottom floor. I give a mock radio report of the building and conditions. I request police for crowd control.
We discuss building inspections and how I would deal with buisness owners offering me free things despite not passing inspections.
I tell them how a friend of mine is getting me in on a class to be certified in Neonatal Resuscitation by the American College of Pediatrics.(To be chronicled)
Finally its over and the deputy chief meets me at the door, tells me I did a good job and that he looks forward to working with me. I learn that I will be assigned to that very station, cross manning the ambulance and the first due engine for that sector of the town. He tells me that the chief likes my idea of a paramedic level technical rescue team capable of rope, confined space and water/ice operations with the possibility of a dive element. As soon as New Hampshire recognizes my NREMT Paramedic card, he tells me I will be hired.
After I finish up at the fire department I sit for a second interview. This one with the Rockingham County Ambulance Service. A countywide EMS agency that provides EMS for Nashua, Manchester and Candia with paramedic intercept for the numerous Intermediate level towns that pepper the county.
With a firefighter schedule. Two nights, two days, four days off, I will be able to have a second job. Hopefully Rockingham will see fit to take me on but if not I was offered whatever schedule i want at 20 dollars an hour with New England.
Within the next month, paperwork willing, I should be working A-2 and Engine 4 out of Pinardville.

Indian Guy

2007-12-12T16:17:00.000-05:00

They had given us box lunches so I ate mine at the nursing station in between patients. Our first was a forty three year old Indian man complaining of chest pain. His EKG was all but non diagnostic but his symptoms were dramatically similar to an ST elevation MI. The doc and I stood there and puzzled over his EKG, me saying. "Looks fine but look at him." Her saying. "Where are the elevations, his presentation mirrors a STEMI."
Amed, the man sits up on th bed, clearly uncomfortable. "My wife will need to know." He says in perfectly Oxford clipped English. "May I please use my celluar telephone to ring her about this development?"
"Yeah, go ahead." I tell him as I'm slapping two sets of monitor leads on him. The room monitor to record all of the goings on in his heart and a Lifepack 12 for the inevitable trip to the cath lab.
"Ganesh? Hello darling, its me. Yes I know its odd of me to call you at this hour, but I have to let you know something. I needed to call an ambulance at work because of chest pains. They drove me to St. Vincent's Hospital in Worcester. I'm not sure, please hold my dear." He looks up at me. "Sir are we across from the Centrum?"
I shake my head. "Nah, DCU center. Tell her exit 16 off of 290, its got a sign."
"The gentleman says we are across from the DCU Center. Exit 16 off of 290 he has told me."
The doctor had been on the phone with the cath lab and she whilred around. "Let's get him upstairs."
"Darling, I must be going. Yes, I am quite sure I will not be home for dinner. Okay, I would like that but please drive carefully. I love you too."
The elevator ride upstairs is uneventful. He sits calmly asking questions about the procedure and how long recovery will be. Can we give him a note for work? Will he need specialized recovery classes? When can he see his wife?
Once in the Cath Lab suite we roll through the recovery room. The nurse at the foot of the bed looks up into the office and then back at the patient. "Sir how do you feel?" She asks.
I glance monitor as I hear him say. "I am not feeling so very we...." His EKG rthym collapses into asystole. Muttering an obscenity I push him the bed into the cath lab in order to give us more room to work. A nurse starts compressions while I cut off his pants with my trauma shears.
The man's whole body lurches, his hands grabbing the wrists of the nurse doing compressions.
"Who shocked him?" She's pissed.
"No one, theres no pads on him."
"Felt like he was shocked, does he have an eternal defib?"
"No." He is shaking and the monitor shows a sinus brady with a weird complex.
"What happened please?" Small and childlike his voice shows his fear.
"Just relax, let them do their thing. Good luck, bro." I tell him as I hustle our stuff out of the room in order to give them space for the procedure.
Two hours later a phone call from the cath lab tells us that the catherization was totally clean, no clots to be found.

Tunnel Vision

2007-12-05T14:09:00.000-05:00

ACLS protocols are the product of thousands of man hours on the part of cardiologists, physians, paramedics, nurses and other medical professionals. They represent the thoughts, ideas and the decisions of the best and brightest of the medical field. As such, they are seen as the Bible for paramedics, offering algorithms and standards of care for a good deal of common, lethal, acute heart conditions.
On Monday I watched a woman in V Tach, an arrhythmia that when not treated in the aggressive style advocated by Advanced Cardiac Life Support guidelines, often progresses to V Fib (a previsouly mentioned death rhtyhm that does not circulate blood or do pretty much anything but look really nasty on the monitor) receive care that flew dirrectly in the face of ACLS guidelines. Unstable patients are supposed to be cardioverted immediately, a syncronized burst of electricity is passed through the body and breaks the arrthymia, allowing the heart to resume a normal healthy beat. Stable patients are usually treated with a concoction of drugs and chemicals in order to produce the same effects as the shock. But unstable patients need to be treated as aggressively as possible.
A woman was brought in by AMR for not feeling well. I had seen her before, a morbidly obesse but usually very friendly, animated woman who gave me awarm feeling just to be around. On Monday she was nearly unresponsive, skin graying and clearly miserable from the pain. Tombstones of V Tach were arching in creepy progressions across the monitor. She'd go through a ten to fifteen second run of V Tach followed by bijeminy, pairs of PVCs kicking off as the heart is basically dying. Her blood pressure was just barely palpable at around 80ish. Thinking that it was obvious I had already slapped pads on the woman and called everyone clear. She needed to be whacked, hit her with a syncronized blast that AMR didn't bother with because her apartment was within sight of the hospital. Load and screw in the shortest order possible.
"Let's hold off on the cardioversion for now, I think this is electrolyte related." The doctor tells me as I watch the patient kick off another run of V Tach. V Fib certainly isn't far away now.
So at the doctor's orders, we run K wide open through a central line (aparently two patent 14s weren't good enough). All the K suceeds in doing is lowering her pulse to around 30. I call to the other nurses on my team. "We need a code room, like now, shes shittin' out here. And can we please cardiovert?"
The doc comes back, telling us to run Amiodarone. Another non agressive treatment that should be saved for stable patients or those refractory to shock. We run it, despite telling her that the patient is low, circling the train.
Once in the code room I watch the monitor and see our patient fall into V Fib. "V Fib, " I call out calmly as I feel her carotid for a pulse. She snaps herself from it and into the V Tach once more. I'm pissed now and I turn to the doctor one more time, barely controlling my anger. "She needs to be whacked here. Please, can we shock her? Its what she needs." Again, refusal. No, let's run some calicum. Her electrolytes are off.
Calcium does nothing. She bounces in and out of V Tach for a while. I call her son and her husband from their jobs telling them it might be a good idea to get down to the hospital. Theres a flurry of activity and I run into the room to see a cardiologist bitching that the nurse hung up on him. More V Tach.
"Cardioversion? Anyone? Bueler?" My pleas fall on deaf ears as the woman continues to decline. For a horrifying moment I see her kick a really nasty form of V Fib known as Torsades des Pointes. It's a sure harbinger of death that means the electrical tissues located in different areas of her heart are firing, trying to regain some sort of order.
The doc watches her crash back into a perfusing, though poorly, V Tach and orders Mag Sulfate in order to prevent further Torsades. Another run of V Fib, this one a bit longer around 30 seconds. Still no shock.
Finally the cardiology department has me and a crash team rush her upstairs. As soon as she is switched to their bed the lead doc says. "Was she ever cardioverted?"
The ED doc tells him that she thought it was all electrolyte based and that she was treating that avenue. Without hesitation the cardiologist turns, juices her at 200 joules and she flops into a normal sinus rythym for the first time in the two hours she has been in the hospitals care.
"'Bout fucking time." I snarl miserably and take the stairs back to the ED.
Despite years of training, or maybe because of it, some doctors like to think they know better than the knowledge contained in medical protocols, they think they can make deceisions and follow their own path even when its clearly not the right one. Blinders go on and they refuse to accept other views. Its not just docotors, nurse, EMTs, medics, anyone can fall into the trap of thinking their treatment plan is the one true path. Unfournately keeping one's pride intact and being the one who came up with the life saving treatment plan often shortchanges the only person who really matters.....the patient.
I hope that if I fuck up, if I come up with a sour treatment plan that my partner or someone else on my team will point out that mistake. I hope that I will be coherent enough to push aside my convictions about what I think the problem is and take the in put of my fellow providers. I've worked EMS for a while and I know I don't know everything. I can't stand people that have more letters after their name that don't know that basic rule of medicine. You can miss things, you can have a bad day but you always have a team to bounce ideas off of. I hope that I will be enough of a medic to be able to take into account other people's ideas on treatment and combine them with mine (or throw mine out completely) in order to provide optimum care for my patient. Because in the end, after all is said and done, after the truck is cleaned and restocked it doesn't matter who said. "Hey, shock 'em." Just that it gets done.

College Girl

2007-11-30T10:48:00.000-05:00

She'd be cute, attractive even, if she wasn't sitting in a pool of her own urine. Her mouth is crusted with blood and we can see that a few of her teeth have snapped off at the gums.
"This is Kelly," A JWU cop tells my partner and I.
I squat down to get at eye level in the dark little hallway of an aging residence hall,Ryan (my partner for the evening) starts to get our bag opened and I wave him off. This girl is clearly in rough shape and I dont want to be playing around in the hallway. "Kelly, we're going to get you on the stretcher. Can you stand?" She makes some kind of a noise and I gesture to Ryan to get her other arm and we bodily lift her and unceremoniously plop her back down onto the sled.
"Her friends say she drank vodka and took a bunch of percosets." Another JWU cop tells us. I ask if he has the bottles and he says. "No, you need em?"
"It'd be nice."
He gets on his radio and sends two other officers to make entry into her apartment and grab all the pill bottles, hers or her roommates that they find.
We take a rickety elevator down to the first floor where our bus is parked and hustle her inside. I get a set of baseline vitals. BP 100/Palp, pulse 100 and thready, pupils like saucers , resperations erratic anywhere from 12 to 26 over the course of several minutes. On the monitor shes in a weird sinus arrhtymia, occasional PVCs but the pulse matches the monitor rate. Ryan's going for a 20guage in her right hand, for some reason he's shaking. As a Cardiac Rescue Tech, he's technically higher than me, even though I am waiting for my paper work that says I am officially a medic.
He goes in and gets flash with ease but then he starts to withdraw the needle before he's got the cath seated, the small teflon tube on the end of the hub starts kinking and her hand starts to swell up.
"The fuck you doin?" I whisper.
"I'll get it," he sounds upset.
"Dude, pull it out, heres some gauze." He pops the line out and I tell him to move over. Right next to his little hari kari of her hand I find a vein big enough to support a 16 and drop one in. We start running in some fluid which seems to perk her up a bit. We debate Narcan but with all the facial trauma, the inside of her lip was slashed by her teeth and the possibility of one or more teeth being loose and becoming an airway obstruction requiring intubation we decide to forgo it. Too much narcan on board would make it difficult to knock her down and kepp her that way should the need arise.
Before I head up front to drive I ask her. "What'd you take?"
Shes a bit more coherent now and manages to spit out the words. "Bottle and a half of Vodka and a handfull of perks."
I ask the standard question. "Were you trying to hurt yourself?"
She becomes indignant and glares at me while slurring. "NO! I was trying to get fucked up!"
I nod. "It worked."

Burning Flight

2007-11-19T18:18:00.000-05:00

"What's coming in?" I ask the charge nurse, an older guy named Paul.
"Hrmm? Pediatric burn victim. Face and hands." He's clearly preoccupied as we rush to clear out the trauma room and set up a burn dressing kit.
Confused I ask. "They couldn't get through over C Med?" Paul had just gotten off the phone.
"Not an ambulance, kid's father's bringing him in."
I nod as I prep a laryngoscope and a few pedi tubes. Burns are tough to intubate as is but if it should close up the airway is gone and you have to cut your patient. Cutting is never the preferred option and its especially unpopular when the patient is a burn victim because of all of the scarring and partially charred flesh that could always flake off and occlude an airway.
We break out tubs of sterile water, sterile dressings cool packs and a ton of fluids for IV infusion. Luckily one of the docs, Rifino is a former flight physician for Worcester's UMASS Lifeflight, a sort of flying ambulance staffed by a doc, a nurse and usually an EMT or paramedic in addition to a pilot. He's on his personal cell phone running around the code room talking to the Lifeflight dispatcher, pulling ranking and calling in favors to get us a bird. As it stands the on duty crew is about an hour out, doing a critical care transfer from Metheun Hospital to the Brigham in Boston.
As I spike a bag of Lactated Ringers I listen to him cajole and work his magic. "Look, Charlene its Jimmy. Yeah the doc from the bird way back in the day. Listen, you know me, I don't wanna tie up a bird with bullshit. I need a crew here, we have a pedi burn coming in......I know he's not here yet but I'm not gonna play games and.....No, I want to stabilize him here and fly him to Shriners...........Face and head thats why. Yeah, two hours? Not gonna cut it. I got no problem calling Boston Medflight and I mean, shit, we're nice and close to Hartford. Well put a rush on this. I appreciate it....thanks." And like that we have a bird in bound after it's transfer run.
When the father finally got to the ED it was thankfully, anti climactic. The kid was in a bad way, eight years old and his entire face is covered in blisters but he can breath with no difficulty and his lungs are clear and equal. His scalp is pretty singed and as I am applying sterile dressings I take to kidding with him, telling about Kojack.
For the rest of the night he is known as Kojack. Once we establish that his airway is infact patent, remarkably its devoid of burns, he's allowed to suck on ice chips. Starting an IV on him was a bitch, his arms were all moosh from the flames. We ended up starting an IO, a needle litterally drilled into his tibia.
While I am cutting off his charred close, I catch a wicked whiff of gasoline. "Hey Kojack," I ask while Paul the trauma nurse rolls his eyes and Rifino kicks all non essentials out of the room. "How did all this happen?"
His voice is clear, another good sign as any kind of hoarseness would be indicative of airway burns. "We were having a bonfire. I threw a can of gas on it and it exploded."
"Oh, shit man thats awful." I say and continue. "You're too young but when my father and I burn stuff in the back yard we like to have some beers. Tell ya what," I pop another bag of ringers into the now empty line. "When you're old enough you come by my father's place, we'll all have a few and I'll show you the right way to have a fire." He laughes and I have an unsettling flashback to the pedi code I worked earlier, silently hoping that he stays as stable as he is.
Burn patients, especially pediatrics, can decompensate really fast. The body can lose a lot of fluid through the wounds, they can go hypothermic and thus sour very quickly. While its important to cool the burns, the body temperature can be dropped as well which can lead to very untoward consequences.
The radio in my back pocket, a cheapo little two way that all in house paramedic techs have to wear, starts to come to life. "Be advised we have lights in the sky." Its one of the hospital police officers out in the parking lot referring to the incoming bird.
I snort through my nose and turn to Rifino. "That was quick." He grins and says its nice to have connections.
Kojack starts to get nervous so I ask. "Whats up, bud?"
He says hes never been in a helicopter before and that hes scared. "O don't worry, these guys are pros. They fly all over the place. Hey, doc," I call over to Rifino. "Our little buddy here is nervous, come over and tell him about how you used to fly and all that." Rifino comes over and starts telling the kid all about the chopper and about what to expect while I explain to the father that because of the burns and the potential for badness, we are going to medevac his son to Boston. Numbly, clearly drained, he agrees and asks if he can fly too. "Dunno, gonna have to ask the flight crew." I tell him as my radio chirps out that the bird has landed.
Two guys in flight suits and an incredibly tiny woman end up coming into the trauma room. The flight nurse is a guy with a graying beard and a MiniMaglite with the LED replacement bulb that I had wanted to buy but had been to cheap to. They check the kid out, take report and tell the father that he can fly with them.
The cool night air, tinged with moist fog feels good as we push our little patient out to the helicopter. The pilot who moonlights as a firefighter paramedic shows me how they revamped the back end of the chopper to allow us to go closer to the tail rotor than before. I jokingly hand the father a plastic bag and tell him. "If you feel the urge to purge, there's two very important places not to do it. One is on your son because he is very suseptible to infection." On cue the pilot chimes in "And the second is on me because I will kick your ass out of my bird regardless of height." The father stares dumbly for a minute then laughes and tells us we are a bunch of clowns.
We retreat to a comfortable distance as the bird takes off and I see a Worcester medic truck with lights going screaming down the boulevard. My radio blares, vibrating against my ass. "Available tech on the air?" Rolling my eyes I key the unit and tell them I am available. "Good, get in here and prep for a possible MI."
A myocardial infarction, our goal is to get any MI patients upstairs to the cath lab within thrity minutes. My personal goal is under ten. Soon after a foley, a 12 lead and a couple of nitros, some morphine and an elevator ride Worcester's enormously fat patient who was indeed having an MI is on the table at the cath lab.
"No mas," I tell the charge nurse. "I'm going on break, I need a sandwich."

Coping?

2007-11-03T13:40:00.000-04:00

On the back of my ID for the ambulance is a small sticker with the name, date of birth and date of treatment for a three month old girl named Gwen. Worcester EMS brought her in asystolic on the monitor, two Worcester firefighters doing CPR on her tiny body. A tube smaller in diameter than a drinking straw had been gingerally inserted down her trachea and a tiny bag valve unit was being used to pump breaths of air into her lungs.
I had two pairs of gloves on, I always do when I work a code or any "real" emergency for that matter. I remember watching the lights from the Worcester medic truck as it backed up into the ambulance bay, throwing flashes of red and yellow about the code room. Vaguely the voice of Dr. Diaz telling us not to get excited and that this was like any other code comes back to me.
Her eyes were the worst part, tiny pale blue orbs that looked up at me while I used my thumbs to do compressions. Trying to block out the fact that she's a cute little baby (really a beautiful little child) I stare at the wink and wiggle my compressions are making on the monitor. A resident, blond hair and strangely eyes of the same color takes a laryngoscope and opens the young patient's mouth to make sure tube placement was correct.
At the back of the room a WEMS medic says. "We gave her an amp in the truck, we did the whole algo with her....." His voice trails off and I feel wetness on my face. The respitory tech took over bagging from a Worcester fireman, he stands dumbly off to the side, unable to move until a nurse gently guides him a way to the back of the room.
"Can you close her eyes." My voice doesnt sound like my own, coming from somewhere else. I keep pressing my thumbs, hands almost cramping. "Please close her eyes," I ask the respitory lady again.
Her voice is small, shaking. "I tried, they won't stay closed." I feel my head nodding vigorously as my cheeks burn. The monitor still shows that weird unnatural EKG that CPR produces. Biting my lip I keep staring at that monitor, trying not to do what I'm doing.
"Nick," one of the nurses, a normally fun woman with cute little square glasses asks me "are you okay? Need to switch?" I can't talk so I just shake my head. I'm fine, I can take it.
Diaz comes back into the room and asks the Worcester crew to leave. Reluctantly they leave, a firefighter coming over one last time to look down at the little victim of whatever ended her life so early.
"All right guys," Tavi, Diaz's nickname, starts off. "Family's here. Keep doing compressions and make it look like we're doing something. It'll help them cope. Worcester says that shes been down for 25 minutes now." I bite my lip harder, pinch my eyes shut for a minute and then force them open to check the monitor.
When I hear her voice its quiet, tinged with the weight of whats going on. "Nick, you should leave the room."
"Why, what'd I do wrong?"
"No, honey, nothing. You didn't do anything wrong. You're crying." Shes pretty close to crying too and indeed a minute after I leave, she does too. When I strip off my gloves I just barely choke out an apology to the code team, a team that has already dwindled as people had to leave the room from the pain. "Don't be sorry." Tavi calls out, "Don't ever be sorry for your actions here today." Nodding I leave the room, feeling the tears streaming down my face as I scramble through the packed ED, practically running out in to the EMS bays.
The Worcester crew is still there and a medic wordlessly hands me a cigarette as the five of us sit there in silence. Its freezing out, one of those Worcester fall nights where it feels like it could snow but I dont realize how cold it is until another tech comes out and hugs me, tears coming down her face too.
"Em, I'm sorry I left you in there....." Her grip is like a vice, too strong for a girl her size.
"Don't be sorry. It means you have a heart, thats why you do your job. Its why we do this." One of the Worcester guys, I couldn't tell if it was a medic or a fireman is sobbing too, his budy propping him up.
I go off to the other side of the bays, behind the big decon trailer that we keep there and make a few phone calls. I call my girlfriend, a vet tech at a 24 hour emergency center out on the Cape and leave a message asking if I can see her the next day. I call my dad and tell him what happened, leaving out the details about how the baby looked.
The next day my phone rings at nine am. Its the employee services office asking me to come into a voluntary stress debriefing later in the day. Groggily I promise to think about it then promptly turn off the phone and think about how the little bundle seemed so heavy on the walk down to the morgue the night before. I think about the detective who came in, how for some odd reason all I could think upon meeting him was "God I want that fleece." He had a really nice black Northface fleece.
When Mandy comes down, we sit on the back porch as she smokes one of her cigarettes, I tell her about how I couldn't sleep without seeing that little girl's face the night before. I show her the little sticker on the back of my ID that I don't remember putting there. Then we go down to O'Rourke's, a local Irish pub where I have my own seat and the bartender proudly proclaims that her establishment is the "Future owner of Nick's pension and liver." I'm kind of a regular there and when we sit down the digital TVs, brand new additions to the Irish eatery, fizzle out and die.
"This would never happen at Applebees." I tell Cora, the Irish lilting bartender. We laugh and I start in on my steak and cheese, Mandy enjoying her first Sam Adams Winter Lager ever. And for those two hours, a trip to O'Rourke's is never less than two hours, I forget about Gwen and the hell of the night before.
But now, almost a week later, I can't sleep or even close my eyes without seeing her own, tiny and oddly beautiful as they stared up at me. It was like she could see us, her little curious eyes watching everymove we made like a living baby, with that "everything is new" glaze of discovery still hauntingly there. I hope the new place where she is now, where ever it is that she went, is better than where she left.

Street Medicine in the ED

2007-10-19T18:22:00.000-04:00

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.

Football Sunday

2007-10-07T21:01:00.000-04:00

"X Ray up," the radio crackles to life as I'm just starting to doze off. "I need an X Ray." Quincy PD is calling for an ambulance. With a groan i grope for the portable laying on the table behind me.
"X Ray, you on the air?"
"X Ray Three on, go ahead Control."
"Respond with PD for a well being check." She gives an address as I pull on my boots and tuck in my uniform shirt, coffee. My cup of stale java is the next thing I grab on my way down to the bus. Its around ten am but still, I was napping.
My partner's name is Tex, an old school Italian guy who is perpetually hung over. We make it to the address, a dinky high rise on the South end of Quincy and find a police car sitting out front.
The first four rings on the buzzer give us no response so I just start pushing buttons waiting for someone to let us in. Finally someone unlocks the door and we find our way in.
A very very tall police officer meets us at the door and says: "I didn't know what else to do with her." I nod and ask if he wants to tell me why she needs something done with her. "O just wait, I don't want to rob you of the experience."
Tex rolls his eyes and we go into the spartan but well kept apartment to find a cute little old lady dressed in her Sunday best perched on the couch. I use the same opening line with old women on virtually every call. "What's up, dear?"
Her face goes stoney and she practically spits the words at me. "You don't know?" I shake my head and her face turns warm and serene. "O well then, I'll tell you. Nine years ago they came and they stole my money. One hundred thousand dollars."
"O I'm sorry, dear, thats terrible."
"Now they're back, they live upstairs." Shes on the top floor. "They keep coming down in the middle of the night. They want my blood, they have a procedure to use my blood to find out where I keep the rest of my money. I hope they didn't get any of my blood."
I nod, "Yeah, me too. But hey, we can go to the hospital and they can check to see if any of your blood was taken."
She looks like a kid on Christmas morning. "They can do that?"
"Mmmmhmmmm. Come on, hun lets go down to the truck, shit I'll even use the sirens and we can get you there really fast to find out if all your blood's there."
A devilish grin cuts across her face. "Ooooh lets do that." I guide her down stairs and ten minutes later we're at the QMC. After getting her situated I hear her screaming and yelling about the nurse coming to do a blood draw.
"No fucking needles! Thats how they steal my blood!"
I stick my head in the room and say "Maddie, how do you think they check to make sure its still there? They're not stealing anything. I told you they're gonna help ya."
As if this makes perfect sense, and to her it probably does, she stops braying and calms down telling the nurse a story about her son and some sort of recipe for a jelly.
Now the game is set to start, Pats and Browns.
"X Ray up?"
Mothafucka! "X Ray on the air, go for Control."
"Unknown medical, China District. No English."
"X Ray has it."
In the China District of Quincy, virtually every house is three floors or more, none of them have elevators, just windy staircases that seem to climb into infinity. Despite the fact that the room is four hundred some odd degrees and there is a grey skinned woman vommiting violently into a bucket, it smells great. Some sort of rice and chicken meal sits untouched on the table.
"Okay, whats this all about?" I ask the son of the woman. In broken English he tells me that she's been vommiting all night. I can tell looking at her she can't walk.
"All right, bud, hang on." I reach over and key my microphone. "X Ray Three for Control. Roll an Engine, we're gonna need a lift assist here." Two guys and a stair chair is all well and good but three flights of winding stairs is just asking to fall and hurt yourself without a spotter.
I go over and feel the woman's head, even through my glove I can feel her burning up. Tex took a quick pulse and said: "Fuck the engine, we gotta go. Shes tacing away, weak and thready." And here I am working a BLS bus.
We get to the first landing when Engine Five pulls up outside. Three guys come up and meet us. We were in such a hurry we didn't bother with a stair chair. "Hi guys" Tex is overly cheerful. "This is yours" we plop the woman in their arms and help guide them down. A fourth guy had the good sense to get the stretcher out so they just drop her in it secure her and I call out. "Hey, Cap, gimme one of your guys as a driver."
The son is trying to rub oil on his mother's face when Tex just pushes him to the front of the bus. "Not now, man, get in front." The kid takes the hint and climbs in as a Quincy Jake gets in the driver's seat.
More violent vommiting and her eyes roll back in her head. "No, no honey!" I yell. "Eyes open," nothing. "Hey open your eyes." Tex reaches over and flicks her nose, her eyes snap open and I take a quick set of vitals. 90/70, pulse 120, resperations at 36. When I check the eyes I find pupils fixed at one milimeter. My partner starts hooking her up to the oxygen as i check between her toes, fingers, up and down both arms and down by the groin for track marks. Nothing.
We make it to the Quincy as I'm going for another set of vitals, cursing BLS because I would have loved to pop in a line and get her on the monitor.
Once in the ED, I'm helping transfer her to a bed when Tex says. "Ah shit, do people with SARS vommit?" The nurse laughes and tells him not to worry. She starts to decomp really fast, bradying down to around fifty for a pulse. The physian and a few critical care nurses are already there so I ask, noone in particular.
"Somebody wanna tell me the score?"

Quincy

2007-10-01T10:41:00.000-04:00

An engine crew is already on scene when I jump out the back of the truck with two medics I litterally just met. I've got the first in bag slung over my shoulder and the monitor in my right hand, mentally noting that I have two pairs of gloves in my rightside pocket.
As codes go, this one was easy. A 93 year old male with an unknown down time, litterally right in the front door as we walk in. Despite the two sets of winding staircases, his age emaciated 110 pound frame will pose no problem strapped to a backboard, especially with a group of eager engine boys to help us out.
Laurie, a thickly built bulldog of a woman drops to her knees at the now purpling man's head. Vommit chokes the man's airway so she passes off to Pete and notices me already setting up her IV bag and tubing.
"I'm bleeding it now," I tell her. "Get a venipuncture and gimme the sharp, I'll get ya a sugar. Op site's on my knee." I had stuck the side of a small clear occlusive dressing that old school guys refer to as "an opsite" on my knee for easy access, as she was on her knees it was right within reach.
"What's on ya knee?" She hasn't heard that term in years.
"An opsite....shit what do you Boston guys call em? A teg, I got a teg on my knee."
"O ok, are you a student or something?"
"Just waiting to test for medic and I been an RI intermediate for a while."
She nods, happy that I'm not some fresh out of school bumpkin like most of the other EMTs she needs to deal with.
The lieutenant of the engine company, a 5o something year old guy with a bushy white mustache has been pounding on the guy's chest for the fifteen or so minutes we've been there. "You guys gonna shock em?" He's got that almost childlike anticipation in his voice, clearly someone who loves his job. Laurie and Pete just smile and I get a blood sugar off the sharp she pulled out.
"Gluc's at 117. Sharp OUT! Sharp in the box." I gather up all of the wrappers, gauze and discarded non sharp refuse and stash it next to the O2 bottle. "All waste accounted for, next to the O2 bottle. No sharps."
The lieutnant is turning red, sweat soaking through his gray officer's polo shirt. "Hey Lou, " I ask. "You want me to spell ya over there?" He shakes his head but he's clearly beat. "Lou, I don't wanna be doin' that on you, how bout you let me take over?" He looks up, nods and says something about me being younger and gladly pushes aside.
As usual I feel the ribs breaking under my compressions, a weird kind of snapping and popping that feels almost like twigs breaking. The guy's wife, another 90 something is watching and sobbing so a female cop who showed up with us takes her in the other room. Another eager firefighter pushes in to take over compressions, fine by me.
"Pete, you want a board?"
"Yeah, lets blow this popsicle stand."
I jog down to the bus and grab a backboard in order to transport our guy down to the rig. Once we get him packaged we cart him down two windy sets of stairs two the street level and the stretcher, I'm bagging him and one of the Quincy Jakes is riding the rails like something out of ER while we hustle it to the truck.
Out of the corner of my eye I see a red car slowing down, rubbernecking at what's going on. The woman driving has her windows rolled down and I see her carseated daughter in the back, wide eyed at what we are doing.
I'm about to tell her to get out of here when the sweat soaked liutenant snarls. "You enjoyin' the show? Piss off, ya want ya kid to see this?"
In the back of the truck its me and Laurie, I'm bagging and compressing, one with each hand while she starts pushing more of her meds. She maxed out on Atropine in the house so now it's just epi until we hit the QMC.
"Tube's dislodged." I'm watching the belly blow up with air so I hand off the bag to the medic and fish out my stethoscope. I listen as she pumps in breaths and I listen for breath sounds and hear nothing over the lungs. Whoshing greets me in the stomach.
She turns to tell Pete to pull the bus over but I've already weasled the tube back into place by pulling it up a bit. Again we have breath sounds and I ask if she wants to decompress the belly, an old school procedure thats hardly ever done anymore but still, it makes bagging even with a tube a helluva lot easier.
Laurie laughes, "Who are you?"
When we get to the QMC, we bring our guy in and the doc calls it after a mere minute or two of CPR. The poor old man was practically in rigor when we got there and he's ice cold now. His confused ancient wife said she had talked to him fifteen minutes earlier but unfournatley who knows how long her age addled brain had taken to process the fact that her husband was down.
Overall as codes go, it was easy to work but wondering how long she puttered around the house with her dead husband lying there kinda gives me the shivers.
The rest of the evening went by uneventfully enough. I had been stuck on a transfer truck all day and after my crew left, I saw the medics leaving for this call. Not even knowing what it was I asked if they needed a third and managed to get a bit of excitement to start an otherwise uneventful evening.

A Fitting End

2007-09-08T10:14:00.000-04:00

My first night at New England Ambulance was nearly two years ago. I worked a 2000 to 0800 and never set foot in headquarters because it was so busy. We ran all night doing emotional disturbed person removals, difficulty breathing out of the projects, chest pain calls from a dinky little private residence in Cranston and finally several trip and falls at local nursing homes.
Lately my over nights (all I work at NEA) were not so bad, there were some nights where we got our asses handed to us but overall they weren't horrible. I worked with some great people, made a lot of good friends and, despite being on a private in RI, got to use my skills for something other than non emergent dialysis related paperwork.
But Thursday's 2000 to 0800 tour was the last I will work at New England, I've taken a position with Fallon EMS up in Boston and once my medic ticket comes through I will be moving up there. Fallon provides 911 for six communities as well as tactical medical support for the Law Enforcement Consortium and serves as the Incident Response Group for the Boston Metro area.
And so my tenure at New England has come to a close. New England got me my first code, way up in the rafters high above the ice at Disney on Ice. I had countless memorable experiences such as when the psych patient tried to jump out the back door of my bus on 95 and when I watched a coherent, non emergent patient slump into unconciousness and had to figgure out what the hell was going on.
So its around 1130 and I'm sweating my ass off. Its humid as hell and I'm holding a 17 year old girl's head in my hands.
"Wake up, open your eyes." I yell in her face as foam bubbles up from her lips. "Jesus, what did you people take tonight?" I ask her wide eyed girl friends, scantilly clad teenagers out for a night at the clubs. They nervously tell us that she didn't have anything more than a few drinks.
"Open your eyes, ah shit." She starts convulsing and my partner, a four foot something girl who looks about 18 but is really 37 says: "Fuck it, lets go."
And so, with a Johnson and Wales University cop helping us push the stretcher, we run through throngs of college students who simply refuse to move so I start shouting. "Move it, get the fuck outta the way." Because I'm classy like that.
In the back of the truck she's bouncing and shaking so I just let her do her thing while I get an IV set up, bleed the line and everything. My partner is already drawing up the Narcan, a narcotic antagonist that litterally acts as instant detox. The girl is seizing so hard I have to climb on the stretcher and use my knee to keep her arm still so I can pop an IV in her hand. Despite her jittering movements and the foam spewing from her mouth, I manage to weasel an 18, smaller than I would have liked but o well, into her left hand. We hit her with .4 of Narcan and the goofy little dance stops, she spits a massive gob of phlegm all over the back window of the truck before letting go a torrent of vommit.
Then, very lucidly she asks. "What happened?"
I give the vommit covering my truck a disdainful look as my partner says. "What did you take tonight?"
Confused, the girl sputters. "Two rum and cokes but then we left because I didn't feel good, one of the drinks made me feel funny so we got going."
Instantly the over protective old fashion Irishman in my starts getting ornery and acting up. "Listen dear, did you go anywhere alone with any guys tonight?" I can feel myself getting pissed off. She's a good looking girl, young and you can tell some creepy show lounge lizzard with a pit of Special K or whatever would love to get in her pants.
"No, my friends were really good when I got sick we just left." I let out a sigh as she starts to decomp again, head lolling back into another seizure as the Narcan wears off.
"Look, I'm gonna get us to Trauma," I tell Kyle, my partner. "Push another four or so in route, but slowly, I already gotta clean this shit up."
RIH is the usual shit show of drunks and stabbing victims. We drop off little Miss Almost Date Rape and I set about cleaning my truck.
The rest of the night has us pulling fat old people in various states of extremis out of nursing homes, we took one Mexican lady out of the projects for a diabetic emergency. At around three o clock I finally fall into bed only to be woken up for a call to Kenedy Plaza in downton Providence. Johnson and Wales cops are on scene with a white rapper gangsta wannabe who is covered in blood and had all the meat on his left arm torn off. He's also drunk off his ass and threatening to hurt us.
I tell him to sit down and shut up and I bandage his arm while the JWU cops just take off. He smears his blood all over the walls of my truck while telling me that I am a blue collar stiff and he doesn't have to listen to me. Its too early in the morning for me to be nice so I counter with. "Listen fuckface, your mom and dad are paying ungodly amounts of money for you to go to school and you're wasting their time and money. In short, you suck. Now shut the hell up before I stick you with a big ass needle."
He bitches, he moans, he refuses to give us any information so I strap him down and BLS his dumbass to Trauma. Once there, I give him to the nurses, clean his nasty blood out of my truck and fall asleep in the EMS refreshment room.
All in all, a fitting end to my tenure at NEA. I worked with my favorite partner of all time there and I had some fun little calls where I got to play with IVs and drunk people. IVs and drunk people are always a good time.

George

2007-08-25T22:20:00.000-04:00

Some aspiring paramedics have to ride for well over a hundred hours to get a code in which they tube or shock a patient. Mine came yesterday at around 45 hours. His name was George and he weighed well over three hundred pounds, kitty cornered into a little room that was simmering at 90 some odd degrees.
When I got out of the bus, grabbed the monitor and started running toward the house with a police car infront of it, I didn't realize I was running to the wrong house. A woman in the door way started pointing across the street so I shot a quick look to find several other police cars and a pretty 20 something girl in an ankle length denim skirt and skin tight shirt with tears streaming down her face. A little sheepishly I turn and bolt up to her front steps, sloping my feet through dog shit on the way up to her house, the monitor banging against the door fram and taking a chunk out of the cheapo wood while I ask.
"Where are we, dear?" She points and makes some uncontrollable wailing noise while a stoner looking kid in a rasta cap with the dreads attached says. "Our dad's in the back. I don't know what happened, help him!"
I push through the house, hearing a dog going apeshit somewhere in one of the backrooms. We find George on the floor, his head purple while two sweat soaked cops bang out some impressive CPR. In Swansea, the Medic Rescue service is paid, so are the cops but the fire department is volunteer, so the police are all EMTs and respond as though they were firefighters, basically doing whatever we tell them to. They have their AED, a defibrilator that does all the thinking for you on the patient and the sergeant, still doggedly doing compressions despite the intense heat calls out.
"AED gave us a shock advisory so we zapped him but nothing happened." For the first time I smell the vommit that is bubbling out of the guy's mouth.
"Aw, fuck." I mutter and call out to another cop. "Go get the porto-suction, officer's side third compartment." The guy takes off like a shot while I turn the patient's head to the side, my gloved fingers trying to clear chunky puke from his blue lips, spearing deeper to try and evacuate the goo from his trachea. My partner takes over and i strip of the dirty pair of gloves, a new fresh pair already on underneath and I put our monitor on.
"Stop compressions!" I call out and the cop holds off for a few seconds. A lazy blip bounces along of its own accord on the monitor so I feel the neck and crotch for a pulse. Nothing, PEA or pulseless electrical acitvity. "All right, keep going we got a PEA. " I dig through the bag for some Epi and drop a big ass sixteen gauge IV into George's left AC, the huge pipe of a vein in the crook of the elbow. Thick, almost black blood spews out of the vein as I punch in the IV line and I realize my knee is in a pool of vommit. The cop shows up with the suction and Shawn, a medic with over twenty years of experience is pulling the guy's airway open with a laryngoscope and syphoning out refuse with the battery operated unit.
Joe, the third medic on the truck is setting up the Auto Pulse, a band that fits over the patient's chest and performs compressions so we don't have to. Its nice because it frees up another set of hands.
I push the epi.
"Oh, Jesus.....dad" I look up to see the girl who was out front standing in the door way and I manage to calm myself enough to say. "Look, hon, go in the other room, you can't help your dad there. Please go in the other room." An awful gargling noise emits from the man's mouth and Shawn calls out.
"Ok, looks like hes breathing, find me a pulse." I find and just as quickly loose the pulse in the man's neck as we switch off the autopulse long enough to find another slow PEA.
I push Atropine and we key up the machine again.
"What the fuck is that?" The rasta hat kid is in the doorway.
"Go take care of your sister!" I yell. "She needs you right now, you go be with her," I manage to say a bit calmer. I don't want their last memories of their father to be a vommit soaked ghoul show with us slamming all sorts of needles and tubes into his body.
It takes four of us to lift him, once we get him in the hallway we realize that its going to be a bitch to get him out into the kitchen. Rather than carry him we put the back board on the floor and slip and slide through his ever fountaing vommit to the kitchen door and try to slip him through the door way so we can load him onto the stretcher and get the hell out of there.
The police sergeant takes the lead and tries to cram the massive dead guy through the door while I bag him and push with my knees. "Come on you, please" the cop mutters to the lifeless body as we struggle.
Shawn gets pissed off and kicks through one of those little baby fences people put up to keep dogs out of certain areas and disappears around the corner. "We got a bay window, I'm gonna pop it." He wants to break out the bay window and drag the guy out through it so we can get to the hospital.
"Don't bother," I call back as we finally finagle our guy through.
When we load him up, I hear the unearthly sobbing of his daughter, I see her wrapped in her brother's arms as we plop her dead father unceromoniously onto the strecther, strap him down and screw from the house.
A police escort gets us to Charlon Hospital in a little under 8 minutes, an incredible feat for the time of day and the area in Swansea in which we were. On the way I max out on Atropine, pushing two more and I push another seven miligrams of Epi, bringing the grand total of drugs on board to 10 epi and three atropine.
"Nick, what now?" Shawn, ever the competent teacher wants to know what I would like to push.
"Bi...bicarb" I manage to spit out as I'm starting a third IV, one of ours got torn out in the hall way.
"Thats right, what dose?"
"An AMP." Already I have the pre filled syringe assembled when Joe tells me to put it aside, we're at the hospital.
A Fall River paramedic has the doors open on the back of our truck, our CMED report lightening up the ED and spurring everyone to get ready to help us. He helps pull the stretcher our and calls.
"V-Fib on the monitor." Joe tells me to get down there and shock him, giving me the requirements I need to full fill all of the points for my ride time.
"Clear the patient, charging." My voice is suprisingly calm as I realize that I am soaked as though from standing under a shower. Right there in the ambulance bay a crew of four paramedics, three nurses and a doctor put their hands up showing me they are clear and I call again. "All clear, shocking." The body does a hideous little jolt as 200 joules do litterally nothing to the rhthym.
The ED team works the patient for about twenty minutes before calling him and noting the time of death.
While I'm cleaning up the horrendous mess we made of the truck and all of our equipment, I see the family being brought in. The girl from the door had changed into a pair of jeans, the kid didn't have his rasta hat and they had somehow managed to bring the dog, a little shitzu into the ED. For the briefest of seconds, her eyes met mine and I knew what that look was. In one second she had nothing but hatred for me, the man who helped lose her father. She was confused, she wondered if I felt her loss the same way she did, if I was going to go home and it was going to effect me as bad as it did her. In one second she hated me yet loved me for trying and working as hard as I did.
I broke off eye contact as quickly as I could, going back to scrubbing a bit of vommit from the screen of my monitor, a device that most likely cost more than my first car and second car combined. From my time at the hospital I know that they are going to go in and see their father covered with a sheet up to his neck, the tube will still be in his mouth but he will be as cleaned as possible. At the worst it will look like he's smoking a clear plastic cigar.
Codes are nothing new to me, I worked them on the fire department, worked them on the ambulance, worked them in the ED. But this is the first time I did so as a paramedic in the field. Before it was "Hey firefighter, do compressions." Now its "Ok, Nick, what do you want to do?"
While I hose out the back of the bus, a job fit for the low man on the totem pole (and they rightly don't get much lower than the medic intern) I try to figgure out how I feel. I'm glad I got my points so early, overjoyed really. I have heard horror stories of people riding for well over four hundred hours before catching their codes. At the same time I feel horrible for the family. They lost a loved one, but they lost a love one in a brutal display of medicine at its most primal. We did everything we could and we did it correctly but EMS is not pretty and I feel terrible that they caught even glimpses of the barbaric things we needed to do to their father. I also feel exhausted, seven bottles of Poland Spring do very little to replinish all of the energy expended in trying to save George.
With the back of our truck finally cleaned and restocked we head back to quarters in order to clock out and go home. Once I get home I take a long, hot shower with a bottle of Sam Adams Black Lager and then join my father at the fire pit for more beers and a cigar. We're not celebrating my code, its just what we do, we burn things and drink outback when the weather is nice. He asks me to tell him about the code, what I did, how it felt and if I was scared. My father always wanted to do what I do, he took all the tests but because of the politics of Rhode Island fire departments he was never hired. So he has me tell him everything about what I do. He loves to hear the stories and know that I am doing what he wanted to do.
Eventually I stop talking, I've told the story and in the process analyzed everything I did to make sure I did it right. After it gets dark we bring a small TV out to the fire pit and watch Brady lead the Pats on a 24 point rampage over Carolina. We cheer and annoy our neighbors with shouts of joy and explitives at the lack of Corey Dillon to temper the talented but green Maroney. And for a little while I mange to forget that I couldn't save one today.

Shit Magnet

2007-07-23T09:19:00.000-04:00

Every now and then you go through phases in your career. When I worked for the fire department I was a car accident and dead body magnet. I would work and we'd either get a dead body or a car accident. Or a car accident with a dead body.
Now I am a cardiac shit magnet. Maybe its because of my mother but I can't go through a single shift without at least one cardiac call. Or a call that becomes cardiac.
Last night at about quarter of 8 we get a call for a woman having severe abdominal pain in the right lower quadrant. Blood in the urine, vommitting and sweating. Kidney stones, I mean the walk in we took her out of even saw them on her X Rays. So we run her down to RIH for a work up. She's in a lot of pain but in the back of my bus her pressure is fine, 130/70, pulse of 65, good sats and a decent sugar.
Once at the triage station at RIH we find her BP skyrocketing. Shooting through the roof, pulse dropping. Shes clutching her shoulder so I ask her in Spanish what's going on and she complains that her shoulder is "killing" her and she can hardly breath. "Hey hon," I call all the nurses 'hon' except for Amy, a spicy little vixen over the psych ward who delights in giving me violent EDPs for removal to Butler. "Hey, hon. She just started complaining of CP and SOB, wanna do a 12 lead or you want me to, I don't mind, if you're busy." I wasn't being an ass, RIH was getting slammed but she was cool and said she would do the EKG and I give her a hand because I'm pretty curious.
Once we get a decent read on our little kidney queen we see elevations climbing off the page and punching people in the face, right there in the ER. East Providence had a drunk complaining about how hot it was as our woman couldn't breath. A cop told him to "Shut the fuck up, you tool." As I grab a transport tech and help two nurses start a second, large bore IV. As they run her up to the cath lab I have to explain to her 15 year old son what is going on and where his mom is going.
I bring him over to the EMS room and explain that she's having a heart attack and that they are going to help her. As we were sticking her she told me to tell her son everything so my ass is covered via HIPPA and all that don't talk about the patient stuff.
On the ride to RIH I let him play with the sirens and showed him how everything worked. I let him look through our trauma bag once we get his mother into the ED. Now I have to tell him his mother is having the big one. In broken Spanglish I explain his mom his upstairs, going into to get her heart fixed. He asked what happened so I give him a simplified version of what happened and he asks me to explain what "The wiggles on the page mean." He had came in just as me and the nurse were going "Hot damn" over her EKG. So I explain that each of the different markings represents a different part of the heart and that right now the front and the side of her heart are not doing too well. In my language thats an anterior lateral MI. To him it means that his mother is taken away from him while she gets all sorts of procedures that he doesn't really understand. I grab him a soda and a pastry from the EMS room and wish him luck. I hand him over to the family conselor and try to figgure out where I should go for dinner. Then I realize i already ate and that I should be a good little doobie and go back to satelite and try to lay down for a bit.
But once I get back I get sucked into an episode of Law and Order and a book I just took out from the library on pirates. At least until we get a call for a woman with severe back pain. It turns out to be osteoporsis, but with her in the back we have to by pass a car accident with noone on scene. I radio to dispatch to get a 911 truck to the area before little miss back pain starts screaming. Apparently a nerve got even more pinched and she was in excruciating pain.
Once we get to Miriam, yes Miriam from some little address in Cranston (a long ass ride no matter what) the nurse gives her enough morphine to kill a horse and I try and steal several boxes of large gloves.
Another nurse catches me so I just start humming the Mission Impossible theme very loudly as I spin around her like a master thief. She laughes, calls me an idiot and walks away but I got some nice, textured ribbed for my gripping pleasure Nitrile larges in stylish purple.

Rainy Sundays

2007-07-16T09:36:00.000-04:00

Usually my Sunday overnights are fairly quiet. A difficulty breathing here, a trauma or nursing home fall there. Occasionally I get a decent call but usaully, well its Sunday ......
Last night had to go and be the exception to the usually easy shift. Last night started with a diffculty breathing that turned out to be dramatic new onset Congestive Heart Failure. (Fluid backing up into the lungs and therefore causing difficulty breathing) Mr. CHF had ankles the size of basketballs, a sure sign of poor fluid movement. His lungs sounded like a water park and his skin was ashen.
Time to go.
Rain slicked roads made the normally easy shot from Warwick to RIH in Providence a massive pain in the ass. As did an 18 wheeler that decided flashing red lights meant jack on the breaks in the middle of 95. In front of said flashing lights.
We pushed Lasix, a diuretic that should pull the fluid out of the lungs and help our boy breathe. It did but he pissed all over my stretcher and the back of my bus. After transfering him to a critical care room I set about cleaning the peepee from the back of my truck with a spray bottle of bleach and a towel that was last washed several days before Nixon resigned the presidency.
After ensuring that my truck was urine free and smelled somewhat better, we drove back to satelite and tried to get a few hours sleep.
My partner, Dave, starts hacking and coughing due to the humidity and agrees to sleep in the day room on a couch instead of the bunkroom. Five minutes after he leaves, he comes back telling me we have a guy in Kent who needs to go to the cath lab at Miriam. A twenty to thirty minute drive sans rain and tonight its like Noah's Ark.
Our guy is upstairs in Kent's Critical Care floor hooked up to so many pumps we have to pin them to the stretcher and cary the extras. Kent has yet to unlock the magic of the pocket pump, a glorious device the size of a CD man. This guy has a thick accent so his words make very little sense to my sleep deprived brain, along with the fact that he can barely breath because of chest pain.....his skin is steel gray. Not good at all. As we rush him down to the bus with a nurse, he decides to pull out an IV and covers himself in Heparin thinned pinkish blood. Tearing through the emergency room we pass a 2o something covered in blood and vommit projectiling his expectorant across the room. Despite having a guy who has that "code smell" of too much triponin, I manage to slap a firefighter I went through EMT school with on the back and call him a fag.
We get our guy in the bus and beat feet to Miriam. Our guy goes into VFib, a useless death rhthym that means the heart is basically quivering. My partner grabs the paddles to shock him and has them jellied before sighing "O thank god....." For some reason our patient snapped back into a blood circulating beat.
Finally after litterally running this guy to the cath lab we clean up the mess made in the back of the bus. Again I am playing Martha Stewart with a bottle of bleach and a newer, cleaner and whiter towel. The rain still comes down in humid, choking sheets as we try to figgure out where to get more electrodes.
Once we get back at satelite I decide to lay down and no sooner do I have my boots off then I have to go back to Kent for a man with a massive skull fracture.
Upon arrival we find Warwick's drunk shaking and bucking violently as a nurse screams "We need to tube him!" repeatedly, in his drunk, drugged out state he is lashing out at whatever moves so I jump on him and hold him down while they push Ativan and shove a tube down his throat. We board him, collar him because if he broke his skull, he could have broken something in his spine too. His dope wears off and he starts spazing again. I get upset and just mutter "Oh, fuck this!" and use an abandoned backboard strap to loop his hands down with a California love knot, all while trying to soothe him by telling him to relax and give over to the tube, let us do the work for him.
Half way to the trauma center he goes into full on repitory arrest, pulse skyrocketing as a brand knew respitory tech doggedly bags him. On arrival, the RT is in awe of RIH and as we wheel our guy in I noticed her hands have stopped squeezing the bag.
"I've never been here before.....its huge."
"Squeeze" I tell her, politely to no avail. "Squeeze" I repeat, politely again but to no avail. "Honey, squeeze the fucking bag."
"O right, " she continues the breaths, her little lapse not long enough to cause any issue. And again we get a critical care code room. Finally it stops raining and cools off to some degree. Although how long our semi decent weather will last is really anyone's guess.

2007-07-09T09:40:00.000-04:00

The funny thing about hospitals is that not all of them do the same things. Some of them are what is known as Level I Trauma Centers, that means that at any given time you can take the victim of a car accident or other "event of badness", as my medic instructor would say, for immediate surgical treatment. Still others have 24 hour cath labs. Others specialize in certain infectious diseases.
When I worked in Holden I didn't have to transport. AMR would provide a paramedic ambulance to come and whisk away the sick and injured. Sometimes I would have to drive or in really bad calls get in the back and either do CPR or help the medics do their medic things. All of the hospitals in Worcester were Level One, they all had cath labs. It was great because there was very little thought involved and you could focus on patient care. Wherever you end up based on diversion, traffic patterns or being pissed off at a nurse because she wouldn't give you fresh linens , you would get what you need and your patient could receive optimum care.
In Rhode Island (as most things related to the emergency service system are) its a bit different. Kent Hosptial, the one I usually transport to out of proximity and just plain easiness is not a Level One nor is it a cath lab. Usually thats fine because grandma drippy butt with pneumonia and a fever of 103 does not need surgery or catherization. She needs drugs, lots of them very quickly and Kent is good at that. Kent excells at little old lady fall down and go boom calls. Kent works very well on cardiac arrest calls so long as no cath lab is needed. Kent even has a barriatric pressure chamber for injured divers. In short, usually Kent gets the job done and there is no need to get on 95 and shoot up to RIH.
Rhode Island Hospital is the only Level One Trauma Center in RI. It is one of two 24 hour cath labs, the other being in the ass end of nowhere or as Rhode Islanders call it "Pawtucket". So last night when Warwick Rescue brought a lady into Kent for chest pain, they were doing right by her. There was no problem bringing a chest pain patient to Kent, shit, I do it all the time. But when that lady started having severe ST elevations and her once high blood pressure went down to 70/30 she was in a bit of trouble. Intially the blood pressure will sky rocket then as the person starst to circle the drain it will fall through the floor, all the while as the pulse drops. At one point Li'l Miss Chest Pain had a pulse of 27. Not good.
So Kent decides to ship her to RIH, a trully necessary and brilliant deceision on the part of the staff. I say this in all seriousness because it is hard to say "We can't handle this, you need to go somwhere else" and make the patient suffer through another transport. I had to do it twice at the Norwood, calling for a bird to take very critical patients into the BW and Mass General. Its difficult to admit defeat and call for help. So what the staff at Kent did last night was commendable.
I get dispatched for the transfer, a critical care run because of the amount of pumps, monitors and drugs running, around 10 last night. We pick up the lady complete with a little Indian man who is a transport nurse. He tells us that he is studying to be a paramedic and wants to get more experience.
All in all he did a good job. He was nervous as hell, couldn't get a decent blood pressure but when you are used to working in a hospital, where its quiet and controlled, I can imagine the back of a movin ambulance with sirens going would be pretty difficult. Jokingly I told him to wait until he tries to get a BP in the back of a mangled car when the boys have the Hurst kit going. He turned bone white and asked if we could take a pressure for him. 70/20. no real change of note, but he got nervous as her heart rate fell from the atropine induced 65 back to 50 again. He begged us to go faster as he pushed another half miligram of the heart rate increasing Atropine. She perked up and asked us to call her daughter and have her take in the meatballs she left on the counter.
I asked her the recipe and she went on and on about garlic and peppers, onions, tomato paste before even getting to how to prepare the meatballs. "The secret is in the gravy." Only a Rhode Islander will call the thick, delicious tomato sauce "gravy".
When we get to RIH or as I call it on the radio "Trauma" we rush right through the emergency room, passing drunks and stabbing victims. The triage nurse says "Hey what the..... O you called for the cath lab, go on up." As if we were going to stop but she has her hands full with a 17 year old who thought it was a good idea to get drunk and try to fly off of his father's tool shed and a regular named Bernie who I have jokingly threatened, to his face, to "shit the beat out of him." Not to mention countless other ED dwellers and a trio of Providence rescues (again a fancy name for an ambulance, not the heavy rescue stuff I did when on the job) whose crews are trying to figgure out where they can get new equipment because the supply closet is quite litterally bare.
So we bring our lady upstairs, watching as she occasionally blacks out and we have to yell at her to wake up. I start demanding to know more about her meatballs and sausage recipes as we run through the halls. The male nurse frantically looks for the BVM thinking our lady will code and I simply and calmly tell him. "Knock that shit off, you wanna tempt God here?" He manages a nervous laugh and I ask if Miss CP knows any good ways to make garlic bread.
We finally end up depositing the woman in the cath lab, rushing her into a kind of holding area where we can slide her to a special bed festooned with even more pumps and gizmos. Its much bigger than the Norwood's Cath Lab and for a second I miss working with my old friends like Kerri and Terri and the ancient, brillian ED guru Janet. I miss Nick G, the former special forces soilider turned nurse, I miss Karren, the X Ray tech who was almost bitten by one of the ubiquitous Dedham drunks. I even miss Dave, the psych nurse who once got mad at me for using an uninhabited psych room to store a body when the morgue was full.
But then I snap out of it, give my report and pack all of my stuff up and prepare to bring the unnamed nurse back to Kent to finnish his shift and study up on EKG recognition as in the back of a bouncing truck everything looks the same. On the way out I steal an O2 key because I have never had one and the hospital had an extra just sitting there....tempting me. Now its looped to my shears with a hospital ID bracelet and I wear it tucked into my belt at the lower back as opposed to in the back of my Leatherman sheath. I like it better that way.

Mom

2007-06-16T20:55:00.000-04:00

My last paramedic class was May 18th, everybody in my class was going out to a local dive known as Curly's which has since burned down. I had to work that night, a detail at a Rick Springfiled concert so I decline knowing it would be a long night of drunken fortysomethings who still think they are college kids.
I had about an hour before I had to report to work so i took my uniform out of the dryer and hung it up, if you take stuff out right a way it won't wrinkle. Ironing is not my thing so I learned little tricks. But with my uniform hanging off the bench in my basement I decided I'd lay down. My fan was going and my head was on the pillow.
"Nick..." her voice was drawn out making my name a multi syallable shrill. My mother calling upstairs from her bedroom. "Nick..... I don't feel good."
Reluctantly I climbed out of bed and went up to my mother's room. She had always been strong, not really wanting to cause problems or annoy anyone so this was decidedly out of character.
I've seen it more times than I can count. Shes doubled over on the bed, pale as a sheet and wretching from nausea. She feels like shes going to vomit. When someone has a heart attack, a lot of things happen. Their blood pressure will climb, their pulse will drop. They'll get sweaty and might even puke from the nausea. My job has taken me into millions of bedrooms, bathrooms and on one occasion the back of a city bus for this exact scene.
Now when I do my job, I don't get nervous, after all its not my emergency. But this was different, my mother is lying on her bed clearly having a massive heart attack. I keep a jump bag in my car, an old habit from Holden when I would frequently get callbacks and have to respond in my car right to the scene.
Her blood pressure starts off at 170/90, pulse 36. Not good, her BP has always been low. Next it jumps to 180/100. Really not good, sweat pouring down her face, now shes bargaining. She says she won't go to the hospital until after my younger brother leaves for his prom. In her quest to avoid the ED she tells me I'm taking her blood pressure wrong.
190/110. "Mom, fuck this, you have to go to the hospital"
"What if its just heartburn?"
"Chew this asprin." I don't have any nitro so I give her double the dose knowing her stubborn ass won't go to the hospital yet.
"I feel like I'm going to vomit"
"Mo," my dad pleads, "y0u need to go to the hospital"
"What if he's doing this wrong?"
"Its his job. You need to go to the hospital." His voice raises because he's getting nervous, terrified of losing his wife. Again, seen it all before.
"Ma, you have to go."
"NO!"
"Aw fuck you, I'm calling 911." I'm pissed because I know she's going to die. Waiting around in a heart attack will kill you. So will not listening to a paramedic who says "You're going to die."
Eventually we end up convincing her to go to the hospital, my father ends up driving her to RIH because she refuses 911. Not the brightest move as 911 can give all sorts of lovely little drugs in order to ease the strain on the heart and buy the muscle time.
And I go to work. Rick Springfield kills, busty chunky forty year old platinum blondes are flashing him all night long. Panties fly on stage and one woman tries, unsucessfully to climb on stage while security gently removes her.
At about mid night I drive myself to the RIH ED and because of my uniform I just saunter right on through into the chest pain unit. The nurse tells me there are no critical care transfers and that I must be in the wrong place. I tell her that my mother was admitted for chest pain and that I'm here to visit. I ask to see her 12 leads and EKG strips but they tell me I can't see them. Of course being the classy guy that I am I reply with "Oh, bullshit. Come on, let me see 'em." The nurse knows me, I've been taking people to the chest pain unit for two years and she just nicely tells me that my mother doesn't want me to see them.
I go to visit her in her little room, turn on her monitor and find flipped T waves. Something definitly happened. Ok, she wakes up so I sit and talk to her for a while, holding her hand and nearly crying realizing that I could have lost my mother for the first time.
That was a Friday night.
Sunday I get a phone call from the Cardiac Care Unit up on the top floor of RIH. Its from a doctor who puts on his best dealing-with-the-family voice and says "Son, listen your mother is having a bit of a problem. Her heart seems to have a bit of an issue with the veins---"
"Listen, I'm a paramedic. Speak my language"
" Your mother has 9 out of 10 chest pain. Significant elevation in all leads. It looks like a global. We gave all our front lines and shes on the way to the cath lab again. Might want to get down here."
"Thanks, pal. We're on the way."
We rush over there with my uncle Danny, a goofy forty some odd year old man who will eventually turn 18. For one of the longest nights of my life, we all sit around in the waiting room watching Family Guy and waiting for the team to finish placing stents in my mom's heart. From the top floor we can see the lights of most of Rhode Island. Between laughing at Quagmire saying "I'm a vagiterian." and trying to figgure out if the long pearly strands in the distance are the Newport or Jamestown bridges, we wait. We drink bad coffee and eat decent pastries.
Then we can go visit my mother.
Shes home now and recovering as well as can be expected after two massive MIs. An MI is a bit like a stroke in the heart. A piece of plaque or debris of some kind gets lodged in one of the coronary arteries and the tissue is deprived of oxygenated blood. If it goes on too long, the patient can die. Most who wait do. My mother was lucky.
I love being an emergency responder. I like to think I am good at it, I like to think that I have been trained well and that I can handle pretty much anything. Between all of my fire rescue training and my medical stuff, I have a lot of experience.
My whole career, all of my training was for only one reason. I sat through countless lectures, worked in the hospital and spent a lot of blood, sweat, tears and a failed relationship for one reason. To be able to look at my mother on May 18th and say. "You need to go to the hospital," and have my father believe me.

Tube Time

2007-03-04T19:21:00.000-05:00

Endotracheal intubation is one of those skills that you can practice all day on a dummy. In order to successfully intubate, you take a lighted blade called a laryngoscope, insert it into the mouth and displace the tongue while pulling up in order to see the vocal chords. Once you see them, you pass a plastic tube through them, effectively isolating them and providing an unparalleled airway.
Like I said, you can do that all day on a dummy, the anatomy will never change. In a real person, things are all discombobulated. The trachea can be much more forward than the on the manequin. Teeth can be oversized and the tongue can be a floppy mess. A real person is much more difficult than a plastic one because of the intricacies of the human body.
So in order to practice the entubation technique on real people, paramedic interns are required to pass ten tubes in the OR, the operating room. This, of course means dealing with the surgeons. Now, doctors are on thing, they know they know their stuff but they are usually not too stuck up and some of the time, they are nice. Surgeons have an unrivaled god complex and a massive stick up their asses about everything. Despite the fact that all the surgeries in which paramedics intubate are elective and nonemergent, the surgeons act as though they are curing cancer on a daily basis. Apparently tummy tucks and removal of unsightly warts is a crucial and life perserving procedure.
But I digress. Each person has their own unique anatomy, their airway will be different just based on who they are. Perfect, unreplicatable snowflakes if you will. Their are two types of blades that one can use to displace the tongue. The Mac blade is curved and is widely reguarded as the easier of the two. It takes less finesse to use and it offers a wider surface area with which to move the tongue. Needless to say I tried this one first, its easier on the dummy so I figgured it wouldn't be too hard on humans.
Enter Jack.
Jack is a CRNA, a nurse who does anesthesia. He was a paramedic for 20 years and by first impression a total prick but once I got to know him, I realized he was doing everything he could to make my OR experience as close to being in the field as possible.
So anyway, I spent most of two weeks struggling with a curved Mac Blade because it is supposed to be the easiest to use. The straight Miller was the evil bastard child that I'm not allowed to play with because he kicks puppies and pees on old ladies. After becoming increaslingly frustrated with the "easy" blade, I asked Jack for advice and he said to try the Miller, his favorite because of its simplicity.
With nothing to loose I gave the Miller a shot and listened as Jack told me: "Stick it in as far as it'll go, when it won't go any further, pull up and you should see the chords. None of that sissy footing like with the Mac, stick and pull." Just like that the vocal chords, those beautiful pearly gates to Paramedicdom dropped into view. Again and again.
I had been trying to get my ten tubes for close to six months, each attempt was met with either a failure or a problem, such as a massive fountain of blood and mucus (another story I'll have to write). But the straight blade's alarming simplicity proved to be a Godsend. Without the rotation and jerky movements of the Mac, I was able to successfully entubate all of my subsequent attempts. Just for the hell of it, I tried the Mac several more times, each time surprisingly I managed to hit my mark and entubate my patients.
Tubes are what makes a paramedic a paramedic, we need to be proficient in entubations because, as those who have been following these articles know, airway is the key to everything. A patient's leg can have a beautiful splint, he can have fantastic IV access but if hes blue, who cares?

Sneakers

2007-02-19T15:57:00.000-05:00

I wrote my last dispatch from Caritas Norwood Hospital. In order to become a paramedic you have to do 400 clincal hours. Right now, I'm in the ICU. An hour ago the overhead PA system called for a "Code Six" in the ER. A code six is a dead person, its a code. I took off from my little desk in the ICU just in time to perform CPR while we tried to establish more IVs in a 43 year old man who was covered from head to toe in his own blood.
Now, I have been a firefighter for two years, I work as an EMT, gore and blood is nothing new to me. It almost never bothers me and for the most part, today is no different. I feel bad that I could not save him for his and his family's sake. My professional job ends when I hand the patient over to the ED staff. For the past few months, though, I have been the ED staff. Out in the field everything is different, being in the hospital is a big change. In the field I could take comfort in the fact that I would be at the hospital soon. Once at the hospital, theres nowhere to go.
Today was one of those bizzare days, the ICU is not exactly busy, I mean we had some interesting stuff but I love working down in the Emergency Department. So when I heard that code come in I ran to help out.
The guy was bald, strapped to a bright orange back board and covered in blood that had, presumably, hemorhaged from varices in his canercous lungs. Paramedics were unable to entubate him in the field because of the copious amounts of blood pouring from his airway so they shoved a CombiTube (a dual lumen device that is inserted blindly to at least open an airway) down his throat and kept the suction going strong. A Norwood firefighter was doggedly pumping the patient's chest when a nurse told me to relieve him. I had already double gloved, a habit from the field, when I started compressions. A respitory technician as suctioning the man while another worked the bag valve mask. I fell into a rib-cracking rhytm and watch the monitor periodically to make sure my compressions are making the man's heart contract and thus pump blood.
I don't notice the blood spraying onto my shirt untill its too late, luckily none of it is in contact with my skin so I'm in the clear, not that this guy had anything contagious anyway. I work the rest of the code, alternating CPR with another medic intern. In addition to a certain number of hours, paramedic students have to perform a certain number of skills. So as I'm doing CPR I ask Kerri, a trully gifted ER nurse, if I can push the required drugs. She's one of my favorite nurses as we work really well together, like my old partner at the fire department we don't need to say "I'm doign this...." or "Watch it, I got an IV here." On some level we know what the other is doing. Its weird but at the same time reassuring. So Kerri lets me push a miligram of Epi and an AMP of BiCarb in the hopes to get this guy's heart pumping again.
In a code, certain drugs are pushed. You push a miligram of Epinepherine every three minutes, alternated with a drug called Atropine at the same dose and timeframe. You do this untill you push three megs of Atropine and then you keep going with the Epi until the doctor tells you to stop or you run out. After an extended period of time, relative when it comes to a code, usually about fifteen to twenty minutes, the human body will become acidic because it can't offload the CO2 that has built up. So you need to push Sodium BiCarb to try and fix the Ph, sort of like a pool guy.
Every two minutes you stop CPR just long enough to see if the little green line on the monitor starts wiggling on its own. If it doesn't you keep going and keep checking.
Unfournately, the man we had today did not make it. He died despite our best efforts and now I am sitting here drinking a black coffee, writting this article. Like I said before, death does not bother me, its an inevitable part of my profession, indeed just in medic training I have had six codes that ended in death. We got one back. Then theres the bodies I saw with the fire department, so its not new to me. But this guy, dressed in a Red Sox hoodie and brand new sneakers kind of fucked me up. Just something about seeing the new sneakers really bothered me.
When someone dies in the ER its standard procedure to strip them down to their underwear and put them in a johnie, to make them look more presentable to the family. As this guy was covered in blood we had to bathe him too. When I was taking his shoes off, I noticed they were brand new. All be it covered in blood but they were straight off the shelf and out of the box. Thats when I did something I should never have done. Without realizing what I was doing I imagined this guy alive, picking out those shoes. He must have seen them on the shelf and liked them, thought they were cool. Then he tried them on and they were comfy so he bought them.
Now they are wrapped in a bag marked patient belongings.
I do what I do because I want to help people and I couldn't help this guy. No one really could, but his family is still alive. Because his family is still alive I took a warm washclothe, warm because for some reason unbeknownst to me I thought it would be more comfortable for him, and I washed the blood from his face, his hands. I cleaned him up so his family wouldn't have to see what we had seen.
I'm not going to end up all depressed and distraught over the man's passing. I'm not cold about it either but I can accept it and move on with my life. I can do that because its part of my job, I can do it because I didn't know him, I can do it because we did all we could but mostly I can do it because I have to. Writting it down in this article makes me feel more human, I can share this experience with everyone else so its not just my own. Someone said that "A man's death is the death of us all." Don't ask me who, as I think we have established I am a firefighter not an English major. That might not even be the correct quote but its something like that. So with that in mind, I wrote this article. This article isn't for you the reader. Its not so that you can see what I do at the hospital. This article was typed with shaky hands and the fabricated memory of a man picking out shoes and the fun I imagined him having doing it.
As ghoulish as I can admit that sounds, I can't help it. Like I said earlier, I am not going to go into a deep depression, or even a mild one, over this episode in my career, but I am going to remember it. A man died today, I don't know him and you don't either but he was someone and his family loved him. S0mething as nromal and carefree as a pair of new sneakers drove that painfully home to me today. In writting this I have exorcised any of the thoughts and feelings that probably would have festered if I didn't get them out.

Stoned

2007-02-19T14:26:00.000-05:00

A small deposit of calcium can build up in your kidneys. Most of the time its too small for you to notice and you just viod it along with your urine or in the best case the calcium never builds up. If it does build up and then refuses to pass you are blessed with what is known as a renal calculi, a kidney stone in laymans terms. Picture trying to pass a three milimeter razor blade while urinating and you get a glimpse at the last month of my life.
I was driving to paramedic school when I noticed a slight twinge of pain in my back, just to the left of my spine. Within five minutes I was pulled over to the side of the road, vomitting and shivering from pain in the freezing January mist. Me, being the hard ass (or is it hard head?) that I am, I drove to school and tried to stay for class. My instructor, a Boston EMS paramedic with centuries of experience told me either my buddies could take me to the emergecny room or Taunton's 911 AMR truck would do the honors. Grudgingly I agreed and after a battery of tests and several pwerful doses of dialutid, a narcotic analgesic I was released and sat for the rest of our cardiology lecture.
And so began the month from hell. Cardiology is when everything in paramedic comes together. All of the drugs we had learned about were starting to make sense because we were able to understand what they are doign and why the are doing it. Needless to say this is a very important section of medic, certainly not one an aspiring medic should miss. So one can understand why I was less than thrilled to hear that I would need to see a urologist and even more pissed off when said urologist told me he wanted to wait a month before doing anything with my stone.
A month of god awful pain passed before I decided to admit myself to Rhode Island Hospital and have the specialists go in and scoop out my little diamond.
As soon as I was discharged I had to take my paramedic mid term. I had to take a test based on an entire semester's worth of knowlege, while still under the effects of painkillers as my urinary tract was totally and painfully inflamed. Despite all that I managed to start IVs on dummies, entubate the dummies and recognize the squiggly lines of EKGs for emergency treatment. I scored a 97.5 on my mid term practical and a 90 on the written which to me was astounding.
I had been at about a level four out of ten pain consistently for a month, durring that time I developed an understanding of how prisoners of war can be tortured into insanity.
Now comes the recovery, I have started going back to the gym, my previous gym addiction ahd to be placed on hold as the pain was so bad. I am in the home stretch of paramedic with the end date of May 18 in sight and my clincal hours (400 total) are being whittled away with militaristic discpline to a 30 hour a week schedule composed of ten hour days.
Overall I miss being a firefighter very much, while I certainly enjoy the medical aspect of my job, I long to be sweating my ass off, crawling along the floor under a pall of heavy, oily smoke. To that end I have various applications in with multiple departments and I am trying to secure part time work at my ala matta Holden Fire Rescue in Holden, MA. Untill then I work as a paramedic intern and an EMT Intermediate for an ambulance. Soon has gone from the abstract future of college days to a tangible reality within sight.

Drugs of Badness

2006-12-09T21:55:00.000-05:00

The main thing that makes a paramedic a paramedic is the ability to push drugs in the field. Based on preestablished protocols and medical training, paramedics can make deceisions on what drugs to give in a vaireity of situations. A paramedic is basically making the same decisions as a doctor and inacting them in the way an ER nurse would.
As one would imagine, such responsibility is both humbling and something to take pride in. By the end of my training, I will be responsible for forty drugs, most of which if used improperly can kill my patients. Needless to say I have been busting my ass to memorize correct dosages and infusion rates. Countless multicolored lie in neat little stacks in my massive binder and After about twenty five times through the carefully arranged stacks I am able to spit out dossages, indications on when the drugs will be used, how and why they work. I can tell you that you shouldn't use dopamine in patients that have a tumor on the Adrenal gland, a condition known as pheochromocytoma. I can just as easily tell you that you give Morphine sulfate in incriments of 1 to 3 miligrams every five minutes untill the patient either feels better or their Ischemic Chest pain disipates due to Morphine's vasodilating properties.
All of this and I got a C in high school chemistry.
In order to get the drugs into a patient, you need to be able to either inject them like the dreaded nurses at the peditrician's office or flow them through an IV line.
To that end I have spent many hours sticking rubber arms complete with fake blood and veins in order to learn how to catheter a line and adminster fluids and drugs. Sometimes the patients only need a little bit of fluid, they could be dehydrated or in shock and a little shot of saline will make things all better. Just because I can "push the poison" doesn't mean I always have to.
I have a small key chain for St. Joseph's School of Nursing. Years ago at a college fair in high school I scooped it up off of a table because I thought that I might due well in the healthcare field. But I went to school for teaching. I guess I finally have it figgured out now, or maybe I always did and I just didn't realize it. I know a lot of people who have tried to become paramedics and had to drop out because it was too much work or too much memorization or they just got sick of it. After all, most guys my age become paramedics to become firefighters. Knowing that cells have a bilipid membrane layer that sepereates them from the cytoplasm in which they dwell is a huge pain the ass when all you want to do is cut holes in a roof and spray shit with a hose. But for some reason I am really enjoying learning all about this stuff. I like the whole medical aspect of my job as a firefighter because it allows me to help people in yet another way.

The Gold Standard

2006-10-30T20:12:00.000-05:00

Without an airway, a patient is dead, plain and simple. All of the splinting and backboarding in the world won't mean anything if he's blue because he can't breath. As an EMT I have been able to manage the airway with small cruved devices known as orophrangeal airways, I could drop small rubber tubes down the nose of a patient in order to facilitate forced resperations.
The basic airway adjuncts are all well and good, they have their place and they are usefull when they are all that is available. The only problem is that they do not prevent the person from inhaling vomitus or blood, not to mention any other lovelies that happen to be hanging out in the mouth of the unfournate. Even blindly inserted devices such as the CombiTube or Rhode Island's woefully outdated EOA do not totally isolate and therefore protect the airway.
In order to segregate and seal the airway, paramedics are trained and authorized to perform Endotracheal Intubation. Basically what this means is taking a lighted blade attached to a handle known as a Laryngscope and using it to open a patient's mouth by lifting the tongue and epiglottis out of the way of the trachea. By doing this, the paramedic is able to see the person's vocal chords. The vocal chords are jokingly refered to as the "pearly gates" as they are two white bands in a sea of pink flesh. After visualizing these chords, the medic takes a tube and passes it through the chords, dirrectly into the trachea. A plastic cuff on the tube is inflated inorder to seal the airway and a regular bag valve is fitted to the tube to provide ventilations.
While the procedure sounds fairly involved, it isn't the hardest part is forming the tube to the propper angle in order to pass into the trache and not the esophagus. The entire intubation procedure should take no longer than thirty seconds as that is about the limit an unconcious, unresponsive patient should be apenic.
Endotracheal intubation in the field is one of the most challenging and nerve wracking duties of a paramedic. In the textbook and the dummie lab the chords are always clearly visible, the dummy has not decided to end it all with a shotgun or plowed into the side of a mountain at a 100 miles an hour. The chords are pristine and visible quite readily. In real life they can be obscured by blood or foreign material. Sometimes all that is visible is a bubbling and the medic has to aim for that and hope for the best.
If the paramedic can not get the tube down because of severe trauma or something as simple as a poorly chewed lump of grandma's meat loaf, the medic has two options. The first is to find the crycoid cartilage, comonly known as the Adam's Apple and find the delicate membrane that lies just over the trachea. A fourteen gauge needle is inserted and the patient can be ventilated through the new opening. But a 14 guage needle, while huge as needles go, is still a very small airway. Another option is to make a surgical incision into the neck, insert a tube and ventilate in that manner. We praticed both options on extremely expensive dummies while hopping the turds would never hit that much of the turbine in the field.
EMS providers encounter people in various forms of distress, a person with altered mental status or a head injury may have their jaws clamped so tightly that normal intubation is impossible. Or they may still have a gag reflex but their ability to protect their airway is crumbling. In situations like that, paramedics can adminster paralytic drugs and essentially kill the person and breath for them.
The proceudre is known as Rapid Sequence Intubation and it was taken from the hospital setting and as is customary to fire/EMS bastardized to fit our needs. The patient is paralyzed so that they cannot breath on their own with the use of a parlytic known as succucolyne. Since this drug only parlyzes the person the amenisiac Versed is adminstered to make them forget the whole experience. Once the person is "knocked down" the tube is passed as normal. Well, hopefully. For some reason, the heart is untouched and continues its constant beat durring the entire procedure.
With just about seven months left in paramedic, there is alot more to learn and even more to do. Five hundred hours in a various hospital departments loom on the horrizon and countless more hours still remain.

It should hold

2006-09-24T20:08:00.000-04:00

The stress of paramedic training finally reached a head. Its not that its hard, its just that there is so much of it. I have to memorize so many different things that my brain feels as thought it will leak out of my ears.
So I did what anybody would do. I took a vacation.
But my vacations are a little bit different. While I did go to Block Island with my long time girlfriend Colleen, I also took the advanced rope rescue class offered by the Mass Firefighting Academy.
Four three days I hung off of buildings on ropes that I anchored to various structures and outcroppings. I rescued fellow classmates and hauled other rescuers with the help of a pulley system.
My basic rope class served as a foundation for this class. While in the basic class, one rapelled down to the victim, the advanced class had a a complex lowering system designed to completly package an injured or unconcious patient. With the use of a Stokes basket, one can immobilize and transfer a patient to stable ground so as to continue care.
We practiced a seemingly simple yet delicate technique called slope evacuation. As the name emplies, the victim is at the bottom or on the slope itself and rescuers must secure themselves and him in order to safely traverse that slope. Through the use of a pulley and haul system, Stokes basket and a good deal of personel, the victim can be safely moved.
For three days I worked upwards of three stories above the ground, practicing these techniques and working to broaden my understanding of technical rescue. As it stands I am two classes away from acheiveing the rank of Rescue Technician, a certification I have coveted since starting in the fire service.
Instructors at the MFA have a running joke before starting each day's training. The go through a rigorous safety screening of the entire rigging system and then turn to the students and say "It should hold," and nothing more.
At the conclusion of my rope course, my girlfriend and I spent the long weekend on Block Island. It was the perfect capstone to a well needed stress relieve.
But now I am back to the grind, after spending nearly five hours memorizing anatomy and physiology, loving refered to as "That fuckin' A&P stuff again." I am going to collapse into bed.

Street Doctors

2006-09-11T19:11:00.000-04:00

When basic life support is not enough, EMTs call for paramedics. A patient in the field still needs the same kind of care given in hospitals, so paramedics need to be able to provide that type of care.
Having said that, it is easy to see why I have to memorize eight books in order to become a medic. By May I will be able to push over forty drugs into the bloodstream of a dying man, I'll be able to push a tube down his throat (through either his mouth or a surgical incision that I cut in his Adam's Apple)shock his heart and do anyone of seemingly countless other things which will hopefully prolong a patient's life.
A paramedic basically does what doctors do in the first twenty minutes of treatment. While I have only completed one day of medic school, I can already tell it is going to be dramatically different than working as an EMT. I'll still be responding to emergencies but now I'll be the one that is in charge. My decisions will have a direct and dramatic impact on the outcome of a patient's future. As an EMT I worked under paramedics, I made independent decisions before the arrival of paramedics but I was still working under a paramedic. As a paramedic I can decide exactly how to treat a patient and what to do for that patient. Drugs and electrical treatments can do a whole hell of a lot more that CPR.
Paramedic will eventually take more than five hundred hours to complete. By the end of it I will not only have completed one of the most rigorus and demanding emergency service programs but I will have a new role. No longer will I be simply following a cook book type recipe for keeping people alive, I will be baking from scratch. As an EMT I followed a set path based on the work and thoughts of people with a lot more training than me. Now I will be able to think like them and hopefully perform like them.
Our lead instructor is a night shift paramedic on one of Boston EMS' busiest trucks, Medic Five in Roxbury. He has seen just about everything and performed just about every paramedic intervention there is in his seventeen years. He tells us that his wife tells those who ask that her husband is a street doctor.

Lives

2006-08-03T18:14:00.000-04:00

Sometimes I tend to think of my patients just as their ailment or where they're going. It sounds heartless but, in my new non emergent job, I sit back and just try and forget where I am. Nothing is happening to the patient, they just need me to take them somewhere. Most of the time they don't talk and they don't want you to talk. The fact that I was a firefighter is not interesting to them, all they want to is to get to their treatment.
But then, you get a guy like Bob. Bob was a firefighter for the navy for thirty years. He worked on aircraft carriers durring just about every major conflict of the twentieth century. He saw his friends burned to death when planes crashed, he fought fires in all seven seas and forty nine different countries.
One of his most compelling stories takes place in the Meditereanean. He was a young guy, about 24, working on a carrier. One of his friends was refueling a plane and as a firefighter, Bob had to supervise to make sure no sparks could set off an explosion. As it happened, the friend forgot to hook up a static line in order to prevent static electricity from igniting the fuel.
The fuel blew up right in front the gas man, covering him and turning him into a human torch. Bob jumped from his wing onto the other and kicked his friend onto the back of a waiting firefighter and prepared to jump off himself.
Because of the way airplanes fuel tanks are set up, the fire was sucked dirrectly into the fuel resovoir. A massive fireball erupted under Bob launching him fifty feet into the air and 200 feet down the runway.
For eighteen months, Bob lay in a vat of olive oil, nine of those months he was unconcious with trach tube allowing him to breathe. Now his body bears no trace of his injuries.
When Bob left the navy, he became an EMT Cardiac and worked in the district of Tiogue Rhode Island. He pulled people from burning cars, from underneath buses and stuck his fingers in a man's neck to prevent him from bleeding to death. He joined the State dive team and searched for drowning victims off the coast Narragansett. At one point his partner, decked out in a canvas deep sea suit with an old fashioned brass helmet was working under two hundreed feet of water, trying to salvage a crashed airplane. A jagged piece of metal tore open the diver's sleave and the resulting pressure blew the man's entire body into his helmet.
Bob and the other divers brought up the man's helmet and brought it to his wife. The helmet was buried in a funeral several days later.
Bob had an amazing life, he's been and done things that most people will only hear about in an adventure novel. Now he spends four hours a day hooked up to an electric kidney and suffers through the agonies of Chemo. He can't walk more than fifty or so feet at a time and even when he does his pace is slow and his gait stunted.
His only complaint is, "They don't let me drink any beer anymore. I just want a cold Miller, you know? With the ice still on the bottle." His forearm still has the anchor and now unintelligble words from his navy days.
I once told Bob that listening to his stories make me feel lazy. He looked at me for a minute and then said, "Everyone has to start somewhere. You were a firefighter in Worcester, right? Well, you'll get on again and then you'll have stories of your own. You won't be doing these bullshit granny runs forever." Then he starts to talk about the latest Harry Potter book.
As I have told many people, Bob is the man.
Bob is one of my inspirations, as I work to make money for the life I want. I know that I will get hired again and that I will have a great life with Colleen, my other inspiration.

Changes

2006-06-25T16:37:00.000-04:00

Upon graduating from Assumption with my degree in English, which is subsequently gathering dust and preventing beer cans from leaving unsightly rings on my dresser, I had to move back down to Rhode Island. While I am still on the books as a firefigther/EMT in Holden, the cutting of part time hours has made it necessary to seek membership at a new department, this one in Rhode Island.
Unfournately, most departments in Rhode Island that offer membership require the applicant to complete all of their training, regardless of prior experience. Hopkins Hill Fire Rescue District is no exception, despite having gone through the Mass Firefighting Academy, I now have to complete a series of tests to show that I know what I'm doing. Don't get me wrong, I love beinga firefighter and I am more than happy to go through their process but it can be a bit annoying testing with people who have never even seen a fire before, let alone fought one.
But the department itself has state of the art equipment and a staff of top notch professionals. The guys are nice and happy to have a new member and after completing my rescue test, I am now eligible to work off of Rescue 6, the district's ambulance that is not an ambulance but a rescue. The difference comes from the fact that this particular truck carries both life support/transport gear and rescue equipment such as jaws and forcible entry tools.
While fire rescue is a good time, it can't pay the bills untill I get a full time job as a firefighter. To that end I secured employment as an EMT with an ambulance, so named for lack of its rescue equipment. MedCare Ambulance is a small start up company a mere three miles from my house in Warwick which allows me to save on gas. We specialize in non emergent medical transport which is a serious shift in gears for someone like me who cut his teeth running 911 responses. We carry all of the gear necessary to support life, should a patient suddenly deterioate in the back of the bus, but most of the time we are simply moving patients from hospital to hospital or private residences. Occasionally we go to the children's hospital and watch as doctors pile into the back of the rig with a massive icubator to keep a premature baby alive while we race to Boston for specialized treatment. While its different from the carreer I want, it pays the bills and I really have come to enjoy it.
I have also come to the realization that being an EMT-Basic, while a lot of fun, is simply not enough. Upon much deliberation I have decided to pursue a paramedic license, the highest level of pre-hospital medical care available. The medical aspect of fire rescue has always appealed to me and I have always wanted to do as much as possible for my patients, paramedic will allow me to perform procedures that nurses are trained for, I will be able to adminster hospital drugs in order to ward off death even if only long enough for doctors to take over. So, hopefull starting in September, I will begin my paramedic training at Safety Program Consultants Inc located in Taunton Mass.
College graduation brought a lot of changes, I live and work in Rhode Island while my girlfriend lives in Mass. We see each other on weekends, each hopping to scrape together enough for an apartment. I have applied to the Providence Fire Department, I am nearly through with the process, having completed a written exam, physical fitness test and now waiting on the interview and academy appointment that I know may never come.
For now, I wait for acceptance into paramedic school or the PFD, either one would be great. I save every penny so that I can someday live with the woman I love. The most bizzare part of my new life is that my current employment is not subject to end in August. For the first time in my life, I have a job that will not have to end so that I can return to school. The surreal feeling of being a college graduate is wearing off as I simply try to enjoy my life, doing the jobs I am trained for and planning a future with the woman I love.

One Of Those Guys

2006-04-22T20:32:00.000-04:00

When I was a kid my father and I used to go to watch firefighters, police or National Guard units do their specialized training. We'd sit on the sidelines and watch as SWAT officers practiced their movements, as divers surfaced from some underwater adventure. When sirens screamed into our neighborhood, he'd take me to watch as firefighters put out the flames in someone's house, or in one incident I'll always remember, rescue a dog who had skewered his paw on a fence.
I'd always sit back in awe and think of how much fun it must be to climb a hundred some odd foot ladder and then rappel down on a thin piece of rope. I always wanted to be "one of those guys."
Last week I took a special rope rescue course in Franklin, my girlfriend's hometown. Instructors from the Mass Firefighting Academy showed us how to tie advanced knots and rig up anchor systems so that we could abseil down to the rescue. We took thin pieces of nylon webbing and rope, each rated for up to 9,000 lbs, and twisted them into contraptions meant to hold our weight. All of this was well and good on the ground, when our lives are not at risk.
The following day we were up on the roof of a three story office building. The instructors had rigged up a series of lines for us to rappel down in order to get us acquainted with the basics of rope rescue. This particular course was the gateway course to the MFA's technical rescue school, a program of study that teaches everything from ice and water rescue to confined space and trench rescue. As such, we needed to get comfortable with heights-- fast. So after a brief lesson, the instructor, a rescue tech for the Urban Search and Rescue team, showed us how to thread our A plates for rappeling and told us to walk off over the side of the building, backwards.
That first backward step will be with me forever, a mix of fear, exhilaration and "what the fuck am I doing?" Learning to trust a 10mm thick rope was not easy, but it was an amazing experience. Wind whips gently at your face three stories up, looking down produces a cold feeling in the stomach. And then you realize, I have to turn around and walk off that ledge .
After pushing myself over the edge three times, we call it a day. I've grown pretty comfortable with the technique and realize that I can do it one handed which will certainly help in a rescue situation.
The third and final day we practice climbing back up the rope using a trio of devices known as ascenders. The principle is quite simple, you basically just shimmy and muscle your way up the rope with brute strength. After reaching the required height, a belayer lowers you back to terra firma and you go back up to the roof for a self rescue and then a victim rescue drill. The self rescue is meant to take the stress off of your A plate, the rappeling device. This would be needed if the line became fouled or comprimised in anyway. You tie off to the rope with a 6mm chord known as a prusiks and pull yourself out of the way to take your weight off of the device, allowing you to manipulate the line.
Finally we come to the rescue, a victim sits on a ladder two stories down and the objective is for the student to rappel down and "pick" him off with a strap and then lower safely to the ground.
When my turn to rescue a classmate rolls around, I check my gear and look down to figgure out where I'm going. My victim is a firefighter from Hopedale in a bright yellow helmet. But then something else catches my eye. A father and his young son are standing on the opposite side of the safety tape we used to cordon off our training area. The father looks up, a hand over his eyes against the glaring sun and the boy points, I can tell by his head movements that he's talking. Smiling, I prepare to finish my assignment and wonder if the boy is telling his dad "I wanna be one of those guys."

Graduation

2006-04-05T23:50:00.000-04:00

I went to college to study English Education, I was originally going to teach high school English. When I got out of high school I really didn't have a dirrection, I just took English as a major because I got pretty decent grades. I never really had a passion for it. So the thought of teaching stuff that I really don't care about to kids who don't want to learn didn't really blow my skirt up.
I had a vague idea that I wanted to do something that really mattered, something that I could be proud of and also something that I would enjoy. Nothing against teaching, in fact I think its one of the most noble professions, its just not for me.
I graduated from the fire academy on a rainy night in March. We took over the auditorium of a junior high school way out in the sticks of western Mass in a little town called Sterling. My parents, my little brother and my girlfriend made a two hour drive to listen to the fire marshal talk about how the fire service has changed since he became a firefighter nearly forty years ago. They watched a slideshow of us in class, saw the flames arching over our heads and watched us struggle to tie knots with our bulky gloves on. Then, they watched as my fellow students and I were presented our certificates. Mostly the chiefs of our departments presented, a few guys' fathers or relatives gave them their papers.
I was going to write about the pomp and ceromony of my fire academy graduation and tell you that the whole ceremony made it worth while to have spent well over two hundred hours, spaced out over countless weekends and Thursdary nights, (and don't get me wrong, being able to show my family and the woman I love that it was all worth it, and including them in my role as a firefighter really was spectacular) but today I came to a rather interesting conclusion.
I'm still in college, I have six weeks left and I graduate. I was sitting in class today watching a film version of a Samuel Beckett play, a strange piece that followed several clay encased talking heads who would randomly yell for no reason what so ever. It wasn't doing anything for me, actually I was getting very mad that I was wasting my time watching it when I could be out doing something, but then I looked over at my professor. The man's eyes were lit up, he was basking in this movie that I could draw nothing from, loving every minute that left me baffled. I realized then that I am on the right path.
Had I become a teacher, generations of students would be screwed. Like I said earlier, I never had a passion for English, I majored in it because I was moderately good at it and I was going to be a teacher because I would get summers off. But when I looked at my professor today, I was scared that I almost went into that field. He has such a burning passion for the subject that he emerses himself in it daily, he does it because he loves it. And I didn't have that. I'm glad that he is a teacher, his love for the subject makes him perfect for the role. But me.....no way in hell.
When I shook hands with the fire marshall he told me how I was going to be doing a very brave and noble duty, all I could think was "God I love this profession." I have this inside of me, I need to do this because its the only time in my working life that I have ever not only enjoyed my work but have actually been good at it.
My father owns a landscaping buisness and I've been working with him since I've been old enough to push a lawn mower and I love that job, its great, its outside, I get to work with my hands and I can see that what I'm doing has impact. Once you cut a lawn or clean out a yard, you can tell that you were there and it looks great. My father is a real pro, he pours himself into it and his work is fantastic. He loves the work and he's good at it. Sometimes I sheer a chunk of turf when I turn the mower too quick, or I chew up a sapling with weedwacker. My father has a knack for that work, I'm good at it but I'm not like him.
When I get on a rig for a call, I know what I'm doing. Everything is automatic. I can eat on the way to calls, cupcakes, sticky Asian food, whatever because I know what I'm doing. I'm not bragging and I don't know everything but I know that this is what I'm supposed to do. I know this because when I took a 24 hour class on how to read signs on trailers to discern the chemicals they contain, I was riveted. I know this because when someone explained the pressures and rating systems for the pumping equipment at my station, I was enthralled. I also know because when I watched what my professor dubbed "The greatest modern play ever penned," I left class for ten minutes to go for a walk, lest I fall asleep.
The moment I graduated from the fire academy was one of the proudest and most emotional moments of my life. It meant the world to me that my loved ones were there to share it with me. Conversly, my coming college graduation could not mean less. I have loved my time in college, the friends I've made, the social ties and the great times I've had but academically its been simply rewriting the same paper and reading Cliff's Notes. I worked my ass of in the fire academy, studying and drilling to make sure I knew what I was doing; for college, I showed up. I haven't read an assigned reading book for school since the second semester of my freshman year, yet for the fire academy and EMT I read both books twice.
I graduated from the school that matters for my carreer path. All I have to do is sit through a four hour ceromony, listen to the Bulgarian ambassidor (that's my school's comencement speaker, should be a blast) and receive a piece of paper that will sit in the top drawer of my dresser.
But in the end, it was worth it. I met the girl of my dreams, found out what I really want to do with my life and grew one hell of a mustache.

Flashover

2006-03-04T22:34:00.000-05:00

Fire doesn't burn things, it burns the gases that super heated things give off. Through a process known as pyrolosis, things give off gases which catch on fire. Most of those gases do not reach their ignition point and end up floating around in the atmosphere of the fire room. If the oxygen that feeds that fire is somehow cut off, the fire will try to suck in more. It will begin sucking the smoke back toward itself in search of the oxygen it craves. The smoke will actually run backwards.
And you are in trouble.
The room gets very hot, almost blindingly hot because the fire is smoldering and searching for oxygen to allow it to burn. The smoke roils and bubbles like a turbulent sea. Even with turnout gear you can feel the heat, smothering you. Its only a matter of time before the fire finds oxygen and flares up enough to ignite one of the gases trapped below the ceiling.
When that happens, theres a brilliant flash, so hot and so powerful that everything bursts into flames. Anyone in a room when it flashes will not survive, turnout gear will burn readily, tissue paper would be just as usefull in that situation.
In order to be able to recognize the signs of a coming flashover, a Swedish fire safety company developed a trailer that simulates the flashober. Well, simulates is the wrong word, because it actually is a flashover. The only reason that its survivable is because the firefighters are placed three feet below the floor of the room that is flashing over. The trailer is two levels, with two doors and a vent hole, an instructor mans a charged hoseline to control the flashover.
The effect is absolutely mind blowing. Snakes of fire, jellyfish like explosions of flames and smoke expolode over my head as I repeat "Holy shit," again and again. Smoke boils so thick you can take handfuls of it and play with it like a sort of black mercury. The heat goes down through your body, cooking you. When I got out my hands, arms and chest were covered in red, sunburn like splotches, the result of radiant heat burns. I was litterally getting cooked like a hot dog in the microwave.
And thats with turn out gear and an SCBA on. My whole body was drenched in sweat, my eyes burned as I watched hell explode six inches above my facepiece.
To allow the flashover to occur again and again, the instructor would spray short stacatto bursts of a hoseline into the ceiling of the trailer. The water, close to freezing from being pumped through icy hoselines, converted to steam instaneously. All the while, the gases above our heads burst into flames from the intense heat, an occurence know as auto ignition.
A pre flashover produces dark yellowish brown smoke in breath like puffs that give the appearance of breathing. The smoke tries to escape and gets sucked back, the fire dampens to a fierce orange glow as it sucks futily for oxygen. Then someone opens the door and it explodes again, flames ripple the length of the trailer and lick the top of my tin foil covered helmet. Its not really tin foil, but a silver shield that reflects radiant heat. At least its supposed to, but with that much heat, some warmth is bound to get through. But thats what aloe vera burn lotion is for.
Now, I just enjoy the show and try to remember everything I see. In a real fire, I won't be able to sit back and watch, I'll have to get out before my facepiece explodes and I inhale superheated gases. Its something to think about as the world around me burns.

The Things You Can Never Forget

2006-01-27T23:23:00.000-05:00

The other night I saw something I'm never going to forget.
It started not three minutes into my shift on the Squad. My partner Mike, an EMT Intermediate with years of experience, and I were dispatched to a residence for an elderly woman vomiting blood. Internal bleeding for sure, and our regular truck was out of service. We didn't have a suction unit on the Ford Explorer that we were responding in, just a manual powered turkey baster type device.
When we pull up the whole house is dark, but thats nothing new. We grab our truama and O2 gear and hike up a steep set of icy stairs to the front door of a decript old cottage. I briefly think that its gonna be a bitch wrestling this woman down to the coming ambulance.
A gastro intestinal bleed has a smell quite unlike any other imaginable. Its kind of a mix between rotting dead skin and shit mixed with blood, which is exactly what it is. As soon as we get in the front door, that awful order assualts our noses and we become mouth breathers for the remainder of the time in the house.
The woman is a fragile, her skin so alabaster its nearly transulucent and from the look of her shes already dead. Sitting on the toilet, covered in her own black blood in a most undignified pose.
We waste no time, Mike gets her under the armpits and we drag her into the kitchen, propping her up in a time worn chair just as the ambulance arrives outside. Her blood pressure is about 60, way too low for her to be concious but in order to make a liar out of the medical books, she babbles about how the dinner she made is going to burn. Her husband just watches as I try to get a pulse and lung sounds.
The medics show up and tell us we should probably get her in the bus.
No shit.
We wrap her in sheets and white towels in order to protect her from the twenty something degree night. As I'm carrying her down in a stair chair with an AMR medic, she closes her eyes and her face took on the most peaceful and serene look I have ever seen. When we transfer her to the gurney to load her into back of the ambulance her eyes flutter a bit and the smile remains, gingerly her frail old wax hands pull a towel up around her head like a nun and she lays back in the gurney.
I thought for sure I had watched her die, we all did. That peacefull look was just too strangely calm not to be staring into the face of angel. When we went back to the station I kept catching whiffs of that horrible smell, the GI blood. I found a splotch on my pants and went after it with alcohol wipes, trying to wash out the scent of death.
The next day my cell phone rang. Mike had talked to one of the doctors and found out that the woman hadn't only lived but was doing remarkably well for someone who lost nearly a third of their blood.
Maybe we got there just in time to get her to the hospital for a blood transfusion, by all laws and medical rules, she should have been dead. But for some reason the eighty some odd year old lady was thriving the last I heard.
That look, the look of utter peace and serenity is something that I will always remember. I'm certain she was looking down the tunnel, into the light. They say you often see the faces of loved ones and hear their voices when looking into that tunnel. Maybe some long lost relative of hers was smiling down on her soothingly, his voice gently telling her: "Not yet."

The Talker

2006-01-27T19:48:00.000-05:00

It became painfully clear to me after one car ride that the guy I car pool with to the academy every week loves to here the sound of his own voice. At nineteen years old, he tells stories of saving the water supply for all of Western Mass, having blood and brains run through his gloved fingers and saving numerous colleagues from burning to death as a product of their own stupidity durring training burns.
His stories have the cocky air of a B grade movie hero recounting tales of derring do to a new commer in the field of heroism. Every word is carefully chosen in order to sound self assured and confident of his abilities as a firefighter.
In reality, this guy is as green as freshcut grass in the middle of July. His stories of gore and heroism are just stories because he mistakenly views firefighting as a job where personal glory is the goal. Anyone in the class will say that they have heard his stories and that they silently wish for him to shut up but feel it would be rude to tell him off. After all, we're all brothers.
The point is that he is trying too hard. Theres no shame in the fact that he's never done half of the stuff that he claims to do. Hollywood scriptwritters haven't even dreamed up some of his outlandish creations. His fabrications hurt the emergency service community because when lay people hear someone babbling on and on about brains and gore they think we're sick people who do it for the glory of telling our stories to starry eyed girls at the bar.
People who have actually seen that stuff, dealt with human suffering and death, don't take it lightly. They don't talk about it flippantly with their co workers. Theres the occasional dark joke or sick remark but they don't constantly regale each other with tales of terrible car accidents and dead children.
All of the bad things that we see (if we actually see them) go in to a sort of mental vault. We know they are there and we remember them vividly-- the sights, smells, our own almost parlyzing fear that we won't be able to do what we were trained to do-- but we don't boast about them. In a way those moments when we see people in pain, dying or dead are like praying. On the most basic and primal level, you are witness to the effects of a power much greater than yourself. Call it God, fate or whatever but you are present durring something so powerful that telling stories of it afterwards cheapens the whole experience. When it becomes about you "I did this.....I did that.....My first move was to....." the point of why you are doing your job in the first place is totally lost.
I'm not saying he's a bad guy, far from it, he's actually kind of funny sometimes, but he's too caught up in the image of the hero tough guy. Listening to country music and strutting around talking about your achievements is just going to get you laughed at. Because anyone who actually does emergency work looks on those experiences as their own, if people outside the job want to know about them, then they can ask. Most of the time, the answer will be "I don't wanna talk about it." Because its something that you don't show off, its your own private experience and to put it out as a boast makes it less than what it was.
Theres a big difference between bragging and keeping a record for your own sanity. When trying to deal with the disturbing events of emergency service, it is often recomened that the rescue worker keep a journal or a diary. Many of those journals are later published as a sort of tribute to the patients and people who the rescuer encountered. I like to think that my articles are a tribute to the people I have met and come into contact with.
The job I do is not about me, its about everyone else. I do what I to help people, not to make myself look cool. Emegency work is not about glory, its fullfillment comes not from having people listen to your stories but self knowlege you had experiences that few are privilaged to have. My job takes me to some very interesting places, I see some very disturbing (and some very uplifting) scenes but you don't have to hear about all that.
When I'm working on a patient, its me, my partner, the patient and God. My partner and I can work as hard as we want but in the end God decides whether our efforts are enough. When one of my patients lives, its because of God's blessing. I'm not overly religious, I went to a Catholic high school and the whole thing pretty much turned me off to organized religion, but I do believe that there is a deity. I wouldn't do this job if I didn't. So when I am blessed enough to help someone live through their ailment of the hour, I see it less as my victory and more as the will of a higher power.
People don't get that. Some people involved in this line of work don't even get that. The ones who know what the work is about tend to be quiet about their jobs. Those who don't understand that their work is not about them, they talk.

Code

2006-01-04T21:55:00.000-05:00

When you work for an EMS provider, its only a matter of time before someone you are treating clinically dies in your care. In EMT jargon, this is known as a code, short for Code Blue, in other words, your patient will be turning blue because he's not breathing.
My first code, well the first code I worked as a primary care giver, occured last Wednessday. I was working a medical detail at Disney On Ice, a sort of icecapades meets every Disney movie ever made. From our little medical room in the basement of the Providence Civic Center, or the Dunkin' Donuts Center, whatever they call it now, we can hear an assortment of music that makes your fillings rattle and your eyes water.
I was working with two other basics, one a North Providence firefighter, the other an out of work actor who had appeared as "Irish Dockworker Number 2" in several episodes of The Sopranos and an EMT Cardiac. Cardiacs are a Rhode Island creation that spend only 140 more hours in class than Basics but can perform more procedures and adminster more drugs than paramedics in some states.
While some announcer told the kids in the audience that they were going to watch a hundred years of Disney play out before them, a doctor in the audience was pointing out the spotlights in the rafters to his kids. By some strange twist of fate, the man pointed to a light run by an 85 year old man with an internal defribulator in his chest. At the precise moment the doctor looked up, the man collapsed, clutching his chest like something out of an old episode of Rescue 911, you could almost hear William Shatner's voice giving a cheesy dialogue.
The doctor flagged down security who for some reason did not radio us in the EMS room. Instead, several rigging workers came sprinting down to our little bunker and told us. "One of our guys went down, we need help." I grabbed a jump bag, a small medical bag with bandages, vital signs equipment and an airway kit. Bill, the Cardiac grabbed his own jump bag and we tore off after the riggers for an elevator.
"So," I ask while we're waiting for the car. "This guy got a history"
"Oh, yeah, a big one," is my only response.
"You wanna elaborate on that?" I ask and the guys tell me he's 85 years old, has an internal defribilator and will tell us "Oh I'm fine."
When the elevator doors open, I'm looking at a spiral staircase that seems to climb to the heavens. My partner and I take off running, two, three steps at a time as Disney music blares from the stage several stories underneath us. Its then I realize that our patient might already be dead and all we have with us is two bags of bandaids and blood pressure cuffs.
The man is hunched over on yet another set of stairs, several coworkers are around him, trying to calm him since he is still concious. His skin is the color of old newspapers, and covered in a film of greasy sweat.
"Sir," my partner asks him as I get my vitals kit out and ready. "Can you tell me what happened?"
"I'm fine," the guy mutters. Suddenly he stiffens and his eyes roll back in his head, his internal defribilator picking up an irregular heart rhythm and shocking him. His head rockets back toward the steps."
"Shit," Bill curses realizing he's working his first code too. "Shit."
I drop my bag and we pull him to the floor, getting him on a hard service and ready for the seemingly inevitable CPR. Bill's cutting away his shirt as I go for a pulse on his wrist.
"No pulse, I can't get a radial, " I go for his jugular. His blood pressure might be too low for a distal pulse but his heart might still be beating. No pulse in his neck. "Fuck, nothing there either."
I get on my radio to call for our defribilator/monitor. "EMT-7 to Detail Command. We got a guy going to code, bring the monitor and stretcher." An affirmative reply crackles back and I realize that we're going to have to rush this guy all the way to the other end of the building. "EMT-7 to EMT-8," the Irish dockworker. "Bring 21 around to Eborne street so we can load and go for a dirrect shot to the Rog." We were going to transport him to the same hospital I took my EMT class at several months prior.
Bill's getting the guy's teeth out and I'm pulling an oral airway so we can start CPR when he stiffens again. The whole body bounces and miraclously the man's eyes pop open. Bill starts trying to talk to him when another rigging guy starts tries to push past us.
"I need to get to his spotlight." The rigger was taking the show must go on a bit too far, kicking our bags out of his way. "Move guys, I need to get to that spotlight."
Just then the patient starts convulsing again and the rigger complains further. I rage as I prep the guy for a blood pressure, as he sputters back to life.
"Fuck off, we're busy," I tell the over ansy rigger as he climbs over the railings to get around us.
"Shit," Bill curses again as we loose our guy.
Arthur, the North Providence firefighter arrives with our monitor and we hook the guy up, trying to figgure out how much juice his own defribilator has left. No blips, just a flat line. Arthur and Bill get the guy between them and the three of us rush down the stairs. While they get him on the stretcher, his defib goes off and he comes to. "I'm fine, I just don't feel well." He tells us.
I'm hooking up his oxygen mask and spinning the dial to full when he codes again.
"We gotta go." Arthur announces calmly as I throw the monitor between the guy's legs and we hustle him out a door to the crowded front entrance of the Civic Center. A trio of security gaurds, one with dread locks like the Predator, flank us and we push out to the ambulance. Bill's getting ready to start with ches compressions and I've got the bag for ventalation when the guy's eyes pop open.
"I don't feel well. Where are we?"
"Sir, we're taking you to the hospital. You ran into a bit of heart trouble. We're going to Roger Williams."
"Oh, I like them, my doctors...." He codes again and his defib shcoks back. "...are there." He died, shocked back and remembered where he was in midsentance.
Arthur tosses me the keyes to the medical room and tells me to get back down there with the other basic, he'll dirve and we need two people at the Civic Center to man the other ambulance. Bill muscles the stretcher through the front entrance and I calmly collect all of spent medical rubbish we left strewn all over the main lobby.
A guy in a button down shirt with a little girl looks down at me on my knees in the middle of a circle of people. "Is that guy gonna be okay?" His voice has an almost childlike innocence and on my knees in a sea of used electrode patches and spittle soaked 4x4s I see that no less than fifty parents and children are staring at me. They want me to tell them they didn't just see someone die on their big day out with the kids. They want me to tell them its all okay.
"He's going to a good hospital and those two guys are gonna take real good care of him on the way there."
I hope thats true as I stuff whats left of the ordeal into a bright red biohazard bag.
Two hours later a security guard and the head of the rigger's union come down to our little medical bunker. One has tears in his eyes and can barelly choke out what he tells us.
"You saved our guy....he just called from the hospital, told us to get back to work. You guys...." his voice trails off and I can only nod in response. The joy and the relieve come later, right then I could only sit and quiver as the adrenaline faded and the sweat on my forehead crystalized.

Never Turn Your Back On Her

2005-12-28T14:18:00.000-05:00

Firefighters are taught never to turn away from a fire. If you are forced to retreat from flames, you never turn around, always keep an eye on the fire and back out of the room. Because of the unpredictable nature of fire, it must always be watched so as to see what its doing. Flames can snake up over your head, bank down behind you and block your exit. A much simpler way for fire to kill you is to explode, blasting through your turn out gear.
It is important to realize that in such a profession, they are few normal days. Things never go as they are planned because we respond to emergencies. Our job is to bring order to the madness that we see everyday.
Something as simple as a locked door can turn into a real problem when attempting to reach a fire or a patient who needs treatment. Sometimes simply bashing on the door would take too long to break it open. In instances like that, you need to understand how the door is constructed and attack it at its weakest point. With just a flat head axe and a Haligan tool, two devices married together and called "The Irons", a well trained firefighter should be able to force his way into pretty much anywhere.
For our lesson in legal breaking and entering, we had one of the best, a lieutenant and technical rescue specialist from Springfiled Mass. For two days, he showed us how to tear out locks and manipulate the tumblers in order to gain access. We learned how to use a shoveknife, a small, thin piece of metal used to catch doorlocks and allow the door to slide open. Hinges were disassembled in order to open doors with stubborn locks.
In addition to forcing regular doors, we learned how to break padlocks and chains with simple tools like vice grips and monkey wrenches. But in the end, some locks can't be forced, some doors are too strong to be popped. At that point, you need to use one of the myriad of power saws, spreaders, hydraulic jacks or chain saws that we carry on our trucks. In extreme cases, oxyacetlyne torches, a seperate class altogehter, need to be used to slice open doors.
People find more ingenious and sometimes downright stupid ways to hurt or endanger themselves everyday. Firefighters and emergency repsonse personnel need to be ready for anything, they need to be able to gain access to people who have pretzled themselves into different situations.
When my time in the basic firefighting academy has finished, I will be taking specialized rescue courses. I'll be learning how to pluck people from the bottom of wells and other confined spaces, how to perform rescue rappeling (dramatically different from the basic rappelling I already know) how to scoot myself out onto thin ice to grab someone who fell in, how to rig ropes and swim out into rapids to secure drowning people and countless other skills.
But it goes far beyound rescue, over my Christmas break from school, I'm certifying as a weapons of mass destruction specialist. The course is designed for front line personnel such as myself, the first guys on scene. It will teach us how to recognize a terrorist bombing, formulate our plans and search for secondary devices. The second half of the course teaches us how to disarm bombs strapped to either dead or unconcious suicide bombers.
A firefighter is one of the last true "Jack Of All Trades" professions. On any given day we can be called upon to fight a blaze, rescue a someone who has trapped themselves in some sort of precarious situation, render medical aid, deal with a haz mat incident, cut apart a car or any of a million and one other possiblities. Its amazing to see the real life applications of all the stuff I am learning as I already work as a firefighter/EMT. In order to deal with the many challenges faced by firefighters everyday, you need to have a broad knowledge of almost all fields because you are the guys who get called when the shit hits the fan.
Just like you can never turn your back on a fire, you can never turn your back on learning. Something new comes out everyday, and if you don't stay on top of it all the changes in the world around you, you'll get burned.

Really Getting In There

2005-12-09T17:41:00.000-05:00

In the winter months, people tend to have a lot more accidents. Ice makes surfaces slick which doesn't go to well for people walking and driving. The volume of calls for my department has gone up considerably since the snow fell.
Just the other night, I was the only one working a 6-11 tour durring a training exercise on electrical hazards. A call came through for an elderly male who had fallen on ice and was bleeding profusely from the head. My deputy chief offered to ride with me and the two of us arrived on scene in a little under seven minutes. The whole houese was dark, the lights from our truck illuminated patches of eerie black looking blood stained snow. Of course, the interior of the house, when we finally did get in, was cramped and dimly lit. A man was sitting on the toilet in the bathroom of the darkened house, a once white towel was now purplish black from the blood it was stemming.
His wife was nearly in tears when I asked her to leave the restroom to give me room to work. I immediately removed the towel to reveal about an inch long gash oozing a steady flow of dark blood. I slapped on a trauma dressing and held it in place while my chief found a kling bandage to wrap it off with. Soon my fingers felt something warm and I realized he was bleeding through about an inch of gauze so my chief tossed me another one to slap on top of it. By that time the paramedics arrived in their ambulance and were hauling a backboard into the tiny hallway. Since the guy fell down there was the possiblity of a spine injury and he needed to be immobilized, plus it would be easier to carry him out than to have him stumble and limp out on his own.
When we finally got him packaged, bandaged and boarded, we had the pleasure of carrying all 270 some odd pounds of him back out of the house and down a flight of icy stairs. At one point the medic helping me carry him slipped and i was forced to catch the boarded patient on my thigh, leaving a swollen red line.
After getting the injurded man squared away, we headed back to the station and were just sitting down for some videos of "stuff getting fried" when the tones came through for a CO exposure. It was in an area known as the maze, for its twisted and tangled street paterns. Our response for a CO call includes two engines, the tower and my unit for the night, the Squad. Upon responding, we found the entire family complaining of flu like symptoms and exhuastion, they had been suffering from the flu for a week and had seen a commercial for a CO detector so they immediately thought they were dying.
Performing a patient exam on an austic 18 year old boy is not an experience I had been looking forward to. Thankfully, the boy was only mildly autistic and did not recoild when we performed our initial exams. After running CO meters through the entire house, we confirmed our original thoughts, that the family was still under the grasp of the flu.
In an attempt to build up my experience as much as possible, I have secured employment with New England Ambulance Service, an EMS unit down in Rhode Island. I'll be working 24 hour shifts with the ambulance and random shifts with Holden. All I have to do is graduate and I'll be able to do the job I love fulltime.

Put the Wet Stuff on the Red Stuf

2005-11-20T16:56:00.000-05:00

The most basic and well known piece of fire equipment is a hoseline, ask little kids what they think of when you say firefighter and they usually say something about a hose or any an axe. Unlike a regular garden hose, a fire hose packs one hell of a punch, around a hundred or more pounds per square inch, you have to know how to control it and know you can trust your crew.
And fighting a fire is not just about spraying the water on the fire, you can do that but that will screw up thermal layering, the way the heat and toxic gases have stratified in the room on fire. Disrupting that is a good way to get yourself killed. Instead, you need to know how to use the cooling and changing properties of water to your advantage.
Water turns to steam, easily, steam burns even worse than dry heat because it can get under your gear, in your mask, cook you like a lobster. Firefighters need to be aware that the stream they are using is important to the water's ability to turn to steam. Fog and straight streams have their own unique uses and if misused, can lead to serious injury or even death.
With all of this running through my mind, I listened as an instructor showed us how to set up a Chicago loop. In order to make a two inch line easier to handle, you lay it out for fifty feet and loop it over the top then sit on it. With the nozzle between your legs, sitting Indian style, you have more control over a large bore stream. While this is good whe you dont have to move, it persents problems when you have to work a smaller line and be a bit more mobile.
Another tactic is to create whats known as a Lazy S, forming the hose into an S and bracing it with your arms and shoulders. Body mechanics, when used propperly allow you to control the hose with as little effort as possible.
Sometimes water is not as effective as one would think. Just think of the old adage, water and oil don't mix. Its true, try to fight an oil fire with awater and the flaming oil will simply float on top of the water. You need to be able to apply a substance that will both smother and cool the conflagration. This is where foam comes into play, foam makes it possible to cut to the seat of the flame and sucessfully douse the fire.
Plus it looks pretty damn cool.
Running a foam system is fairly simple, small amounts of foam concentrate can blow up to incredible porportions. After half a day of running a foam system, we had six feet of shaving cream blanketing the entire gas yard. One of the oldest foams, a prtoein mixture came out a dingy brownish color and smelled like the animals it once was.
While the day was not particularly taxing, it left me exhausted. I've been running myself a bit too hard. Every morning and every other afternoon I find myself at the gym, I work my ass off in an effort to be in the best shape I possibly can, I've been on a new exercise plan modeled after an old Bulgarian powerlifting routine from the earl 1930s.
With Thanksgiving coming up, I have a great oppurtunity to go home and spend some time with my family. A day of skeet shooting and over eating should be a nice way to relax.

Greatest Job

2005-10-30T21:37:00.000-05:00

Ladders are one of the most well recognized pieces of equipment in the fire service. Much like contractors, we have to be able to reach different parts of buildings, parts not normally accesible to regular people. Ladders come in handy, but you need to know how to set them up properly, how to foot them and keep them stable while you work off of them.
In an effort to practice with this vital pice of equipment, my class met at the Mass Firefighting Academy's facility in Stow. the facility has a large, three story burn and smoke building in the center of the drill yard. We set up ladders to each floor and spent the day climbing in and out of the windows and practicing weaving a leg through the rungs so as to hold ourselves in place when our hands are busy.
It was a particularly cold day for late October and snow was falling as we scrambled up and down ladders. When a firefighter climbs a ladder, he has to check that the pawls, locks that keep the fly section of the lader extended. Upon checking that, the firefighter has to yell "Pawls locked!"
The day was long, running around with ladders weighing upwards of 450 pounds on our shoulders, scaling buildings and raising and lowering our tools. Exhaustion set in on the way home, with hopes of the next day be relaxing as there was no academy class scheduled.
Waking up to sound of my pager, I rushed to the station. Apparently, a car had struck a bicyclist, killing him instantly. To his luck, the driver of the car was a former EMT, he performed CPR on the body until our Squad arrived and shocked him back to life with an AED. He died again and the AED brought him back to life, is blood pressure soaring over two hundred. A LifeFlight helicopter was flown in to transport him to a trauma center in downtown Boston. Helicopters carry alot of fuel and therefore require an engine on standby should they crash or burst into flames.
The LifeFlight pilot, a Nam vet called Rat, dove the chopper in like he was back in the paddies of Southeast Asia. The two flight doctors onboard and the EMT they take with them bailed out and spent a good twenty minutes trying to establish an airway on the patient. Once again, no airway, no patient. Eventually they managed to get an OPA into his throat and treat him with drugs available in hospitals.
Upon returning to the station, the tones went off again for a chimney fire. We rushed right back out and I realized I have the greatest job on the face of the earth.

Trusting Yourself

2005-10-16T23:01:00.000-04:00

In order to complete the Mass Firefighting Academy's I/II program, you need to sucessfully complete a three level maze made of chicken wire, in pitch black, full turn out gear and ScottPack. While you're crawling around in total darkness, the instructors are watching you from infrared cameras.
The purpose of the maze is to build confidence in your ability to move around in your equipment. Small round holes, covered by manhole like lidsare scattered on the ceiling and floor throughout the maze. You need to go up three levels and find your way out before your air runs out. In order to complete the evolution, you need to safely navigate through holes designed to trip up your airpack. I never want to remove my pack in a hostile environment. I've never wanted to, I don't even like to loosen the straps to fit through obstacles. So I tried to force myself through the first. In the rim of the opening so I tried to drop my shoulder, hoping that I'd reduce my profile without taking off any gear. I managed to squeeze through and got my butt up on the next floor.
Total darkness has a way of making you feel either claustrophobic or absolutly at peace. Some people get all wigged out in the dark, start to see things or get nervous about what they can't see. I tend to like the darkness. My hands are my eyes and I can pick my way around by feeling my surroundings. Its kind of like a game, find your way out of the darkness in a bulky suit.
Its fun.
Firefighting, when done correctly, is fun. The maze is one of those fun activities. You have to rely on yourself and your abilities. No second guessing, just insticnt because anything else is unrealiable. When you're crawling around in the dark, trying to figgure out where the hell you are and whats going on, you can't be wondering if what you're doing is right. You have to know its right and trust your self. Trusting your ability is what will make you suceed in the maze and in a fire.
Any kind of doubt can get you in a bad place, if you start doubting what you're doing, you're not doing what your supposed to be. If your in the middle of darknes and start to wonder if you have what it takes, you're setting yourself up for failure. Training is what builds your ability to save lives and keep yourself safe. Its imprtant to realize that you have had the bes training possible and that yourtrust in that training will be paramount in your safety.
After I stumble my way through that maze, six minutes that felt like six hours, I have a new found respect for my training. I was able to find my way through three floors of total darkness. I managed to get through holes designed to trap me. I passed one evolution and look forward to a myriad more.

You Want My Job

2005-10-04T12:36:00.000-04:00

The large framed instructor at the front of the room grabbed someone's fire/rescue service training manual. He held it up for all to see and asked, "Do you want my job?" We all answered in unison, "Yes sir." His reply was to slap the book loudly with his hand. "Everything you need to know to get my job is right in here. I know this book cover to cover, and if you want my job you'll have to know the same." He threw the book down on the table and told us we had two minutes to get upstairs and in full gear for a day of practical exercises.
We spent the morning relearning our ScottAirPacks, self contained breathing apparatus that firefighters use to survive in the harsh conditions of a burning building or hazardous materials incident. An instructor with a thick mustache told us we were doing horrible and that we had to relearn the basics. Under his tutelage we practiced donning and doffing the gear until we could barely move.
Next we had to learn how to save ourselves incase we get disoriented and lost in a building. Our first priority is to find the hoseline, we follow along it until we come to a coupling. Couplings have lugs on them used for identifying them in this type of situation. We were locked in a dark, cramped stockroom with a hose strewn randomly about the floor. It looped back on itself, went under cans and all sorts of clutter.
Finding a hoseline, especially an uncharged one, while trying to keep a foot against the wall so as not to become further disoriented, is a trying task. You claw at anything that feels remotely like an inch and three quater line. Its time consuming, nerve wracking because you realize that hoseline is your only hope. You try to hold your breath, make that tank on your back last as long as possible.
But finding the hose is only half of the work of the Long Lug Out drill. In order to navigate out of the area, you need to locate a coupling and feel, through your thick firefighting gloves. You need to find the long lugs to know which way is out, then you follow the hose, hopefully to freedom.
The next drill was a victim search, we put on a blacked out face mask and crawled around in a sheet metal trailer with various obstacles thrown in. Our objective was to find a dummy, meant to be a victim. We were given a tool to extend our reach into the middle of the "room".
Sheets of ply wood were set up to represent the confined spaces we could routinely encounter in a building fire.
I scramble around, poking and sweeping with my tool. Having done search drills before, I tucked my tool between my knees when I encounterd what I thought was the victim. An instructor stealithly snuck over and relieved me of my Haligan. I had lost my extra reach and I didn't even have the victim. After realigning myself with the wall, I inch along, kicking out my feet into the center of the "room". My feet thud against something squishy. Jacknifing myself so my feet go back against the wall, I feel the object. Its a dummy! In one motion I drag the body back to the wall and start to finish my round of the building. My arms strain and my lungs burn when my low air bell starts ringing. A deep breath, hold it, move. With low air, you're reduced to basic functions. I shuffle and drag, holding breath and taking little sips of breath to conserve my air. My mask brightens, i push toward the light, dragging my burden.
But thats just two drills, countless more will follow because, I want his job.

Everyone Goes Home

2005-09-20T12:41:00.000-04:00

Whenever you get on a truck in the fire department, you take a small tag off of your gear and clip it to a ring kept by the officer of the rig. Thats so he knows where you are at all times. When you go in a building for a fire or a rescue area, you give a second tag to be placed on a second ring. So that way, people know you're in the danger zone.
Its a simple concept but it makes all the difference, the tags say it all. A tag left on a ring at the end of the night means that someone is not going home and that's not acceptable. Everyone goes home.
The fire academy stresses accountability. When I leave the room to hit the head or to refill my water bottle, I take a tag, when I arrive at a skill station I tag in so they know I'm there. The drill instructors perform subtle tests on us, telling us to go move something and counting how many of us tag back out again. If we forget to tag, we hear about it, a lot about it.
But being able to know where everyone is at all times, is essential. You need to know where members of your crew are in order to keep track of personel and make sure everyone goes home.
So after tagging up, I set out to re-learn the fundementals of rope and knot work. Ropes are a huge element of the fire service, perhaps the most versital piece of equipment carried on any rig.
With a rope, you can perform rescues, secure things, haul things, the possibilities are endless. So a knowlege of ropes is key for a firefighter. Our knots have to be strong yet easily untied. We have to be able to tie them with bulky golve on.
Two days of tieing and retying knots in full kit had me beat, but after spending so much time with the rope, I feel confident in my ability to use knots effectively and safely. One of the most important elements of the fire service, one frequently overlooked, has been beaten into my brain, as I struggled to make my knots hold tools a mere three feet off the ground.
So now a piece of eight foot long kernmantle life safety rope hangs on a peg behind my door, when I leave my room, I practice a knot. When I watch TV or a movie, I twirl it into a bow line, a figgure eight or several others.

In Omnia Paratus (Through Training We Are Prepared)

2005-09-09T09:38:00.000-04:00

My goatee has been shaved, all I have left is my mustache, making me look lot more like my father than I thought possible. Mass Firefighting Academy regulations state that recruits are not allowed facial hair, so yesterday I shaved all but the mustache. Then I put on my Holden Fire/Rescue uniform, navy blue trousers, navy blue shirt with a Holden patch (and soon to hold an EMT patch as well) my badge and firefighter lapel pins.
The uniform is mandatory for every class of the fire academy and is subject to a military style inspection at the begining of every secession.
Knowing all this made the drive to Berlin Mass, more than a little nerve wracking. With my buddy, and fellow class mate Mike Braley behind the wheel, our bunker gear on the back seat, we set out for our first night of Firefighter I/II Plus class.
A row of white shirted instructors greeted us at the street infront of the fire station at which our class was to be held. We pulled over and told them who were and they immediately began yelling for us to pull around back. At the back another instructor yelled for us to park between the cones, get our gear and assemble inside for a pre class inspection.
Under the orders of yelling, roving, instructors we set out our bunker gear for a full inspection and then run into the classroom to find our seats. No sooner had we sat down then the instructor came into the room and yelled for us to stand at attention. A military style role call was conducted in which we each replied "Present, sir"and then we all sat down for the rules and regulations.
Everyone was issued an MFA water bottle with our number written on it, and an accountability tag that we have to wear on our right side every time we leave the room, even if its just to step into the hallway. In the fire service, everyone needs to know where you are at all times.
After going through a mountain of paperwork, we're given a break in which we were "strongly encouraged" to reassemble our gear. Basically we put our gear back into working order while the instructors gave constructive criticism---they weren't just yelling but giving tips on how to make donning and doffing our gear easier by putting it together a certain way.
After one class at the firefighting academy, I am ready for more. It promises to be a challenging and nerve wracking experience but it serves one purpose, to make me a better and more proficient firefighter. To suceed in emergency service I need not only the certifications offered by this class (Firefighter I/II and HazMat First Responder Operations) but also the lessons born of the experience of my instructors.

Finally

2005-08-28T20:24:00.000-04:00

One hundred and eighty hours of class have come to a close. After an all day practical/senario exam in which we tested all of our EMT skills and reasoning abilities, we were awarded our class completion certificates. While we still have to pass a national exam for licensure, the hard part is over. Out of forty candidates for EMT, only seventeen of us were able to complete the class, two actually failed out on the day of the practical exams.
Even though I'm very glad to see the end of what was quite possibly the most difficult class I have ever taken, I am saddened by the fact that I will not be able to spend as much time with the friends I made. Going through such a stressfull experience creates very strong bonds. Having spend every Monday and Wednessday and more Saturdays than I care to count, going over the meat and potatoes of emergency care has left me weary yet eager to put my skills to use in the field. I find myself getting restless, waiting for my pager to go off with the big one that will allow me to go out and do all of the new things that I learned.
I decided to become a full time firefighter, despite going to college for a degree in English/Education. I have nothing against teaching, I've just come to the conclusion that it is not for me. My whole life, I've been trying to repress the fact that deep down, I wanted to be a public safety professional.
It wasn't until becoming a fulltime firefighter actually appeared doable that I decided that it was what I trully wanted to do. The plan had always been to be a teacher and a part time firefighter. But when I thought about it, the summers I would have had off would have been spent working as a firefighter. I came to the realization that that I was meant to be a firefighter, I'm meant to be an emergency responder, not just because I enjoy it but because I find it so fullfilling. Not only do I want to do it, I need to. I just wouldn't be happy or satisified doing anything else.
With EMT class finally over, I am ready to begin using my new skills. But with my new training comes new responsibility. On Holden, part time firefighters are only required to keep a First Responder licensce, the certification I used to hold. Now, as an EMT, I am the second highest level of care that a patient can receive in the field. My new training allows me to do a good deal more than First Responders, it will also make finding full time employment that much easier as prospective departments will not have to give me training I already had.
Finally, things are on their way to going as they always should have.

Seeing is Believing

2005-08-19T15:33:00.000-04:00

With a hundred and eighty hours of EMT training nearly behind me, all I have left in the course is the final practical and written final exam. That is, over course, after I go through the extrication training and go through countless more drills to become as close to perfect in my desired field as possible.
Every Monday and Wednessday night I have gone to the same auditorium and learned a myriad of skills that will allow me to help people who have expereienced some sort of of trauma or illness. I've read over a thousand pages, been tested with exams, any one of which could have been my ticket out of the class had I scored less than a seventy.
But now the end is in sight. In ten days I will take my classroom final and practical final. If I pass both I am eligible to take the state final at sometime in the future. The stress is certainly a potent factor at this point. I take self exams and study skill sheets nearly everyday. Obsecure facts about anatomy and physiology that elude me are looked up and drilled into my memory along with appropriate pulses, breathing rates, blood pressures and capillary refill rates. Everyday I'm studying something in order to pass my final exam.
Alot of it fits together so its not terribly bad but the amount of hours I sink into studying go well beyound the 180 of academy time.
In order to alleviate the stress of EMT studies, I upped my workout routine to punish my body as much as I'm punishing my brain with facts, figgures, procedures and interventions. My routine ressembles that of the Russian Cossacks in its simplicity and intensity. Despite the stress of my medical class, I've seen a dramatic increse in my bench press with a current maximum of 195 pounds. My deadlift has gone up to 235, and will increse as soon as I return to school and have the benfit of more plates.
While the EMS academy has been a challenging experience, made even more intense by scuba diving training and search and rescue training, I feel that this summer has allowed me to grow and become better at my carreer in emergency service. With the end of EMT deliciously in sight, I'm confident in my abilities. Countless hours of study and training are leading up to the end of a course I have enjoyed very much---but will enjoy even more after its finished.
All of the stress and hours of training have been more than worth it. I accomplished more than I would have ever thought possible this summer. The Roger Williams EMS Acadmey mantra is "Envision yourself in the career you want, if you can't than you won't finish this course." The dirrector of the academy told us that countless times, and now I can honestly say that I can see myself as a firefighter EMT.