Balance

 December 8, 2018: This weekend, I am in Worcester, Massachusetts at the New England Short Course Meters Masters Swimming Championships as a member of the Connecticut (CONN) team. Last year, we shocked many of the other teams by taking first place. Points are awarded based on place finish in individual and relay events. Each swimmer is only allowed to swim a maximum of six events a day or 13 for the entire meet. Friday evening is distance day (800 Free), Saturday and Sunday are for the relays and the main swimming events. Last year I scored 119 points swimming 12 events despite having a pretty severe chest cold. I also swam in three of the four relays. I came in second in the men’s 55-59 200 Meter Butterfly and earned 15 points for it. I was second out of 2 swimmers. Last year I finished 25th in the nation in that event in my age group. 25 out of 25. Still I was proud as it is a difficult event, particularly for someone who did not know how to swim the stroke five years ago. I am swimming it again this year, and if all scheduled swimmers swim, I will likely finish 5 out of 5, but maybe some of them will scratch (drop out) as it is the last individual event. Last year I swam the full 200 meters without stopping. This year I may hang on the wall and catch my breath at some point along the way. I have not trained as much this year as last. My best event is the 50 free, but I will not come close to my best time of two years ago. Again, lack of training time and intensity. Plus Father Time sapping some of my strength.

Joe Frazier used to say. “If you cheated on that (your roadwork) in the dark of morning, you’re going to get found out now, under the bright lights.” I have no cold this year, but I am a year older, and not in the shape I used to be. That lack of training is likely to be apparent. Still I am here as part of a thirty person contingent of people who I have come to call my friends over the years. No matter how fast or slow I swim, i always get high fives and good jobs. I doubt we will win this year. Charles River Masters, who we upset last year, showed up loaded with more swimmers. My goal is to score more points for my team than last year, which will be a little easier as I am swimming one additional event and I have moved up in age to the 60-64 division.

Here’s why I writing all this on my EMS blog.

I was talking the other day with a new medic trainee and we were talking about a number of the old career medics who were around when I started, and I told her of how many of them ended up broken. Here’s a roll call. Overweight, fired for poor behavior, dead of a heart attack. Fired for violating policy, seen a few years later in a nursing home with jaundice, dead not long after. Retired unceremoniously, dead within months of lung cancer, obit posted on the operation’s wall. Fired for undisclosed reasons, shot dead by police in a standoff -- suicide by PD. Left for undisclosed reasons, found dead in bed a few years later, obese, uncertain of heart attack or overdose. Not a lot of happy stories. Many say that the job will leave you bitter in the end.

I used to say that I wanted to stay at this until I am 72 when my youngest daughter is targeted to graduate from college. I don’t know if I can make it make it that long. I am hoping to at least stay full time until my middle daughter who is a freshman at college graduates. My goal is to get her through without any debt. In addition to my medic job, I also work as an ems coordinator at a local hospital. Between the two I am scheduled for 64 hours a week, but I often work longer. I try to keep Saturdays as a day for my youngest daughter and I to do things together.

My youngest is very into sports, and unfortunately, tomorrow, she has her first basketball game of the season, and I will miss it because I am here at the meet. She is playing in two leagues this winter, one with Saturday games and one with Sunday. Other than today, I will be at all her Saturday games, but because I work Sundays, I will only be able to see the Sunday games if I take off work. A part of me wants to go part-time on the ambulance so I can be free to see all her games, but with the middle daughter in college, I can’t really afford that yet. I debated not going to this meet, but last year I skipped several meets to see her games. The fewer meets I do it seems the less I train. This is the one big meet of the year, so I expected if I skipped it, my identity as a masters swimmer would pretty much slip away, and I am not yet ready to give that up. I need athletic competition to keep me healthy and maintain my image of myself as an athlete and a man still in prime health.

All these conflicts.

I used to never miss an ambulance shift. I prided myself on always being on time and always being there if my name was on the books. In twenty-five years I have only had to go home sick twice, and only called out sick about the same number. I have only been late three times, twice due to a time change and once due to my alarm not going off. I take days off fairly freely now. With my seniority, I get a ton of PTO, so I use it. I took off for Zoey’s soccer championships and I will certainly take off for her basketball championships if she makes those. My next swim meet is Superbowl Sunday and I am planning to take off for that, but only if it doesn’t conflict with one of her games. I’ll take that game over the local meet. Hopefully, I’ll be able to do both.

I enjoy my swimming friends, as I enjoy my EMS friends. And of course, I enjoy my family most of all. Between the three I hope to be able to maintain a balance that I have not always had. I don’t need to be on the ambulance everyday or at every swim meet or at every single one of my daughter's games. I just have to do my best to be there whenever I can, and ensure that I am healthy, and happy. I want to be there for the long run.

Postscript:

We came in 3rd in the meet. I had the eighth most points of any male in the competition, points mainly accumulated because I was one of a few who swam 13 individual events. I finished the 200 Butterfly only a few seconds slower than last year, and captured 3rd place. Out of 4.

My daughter won her game and scored 8 of her team’s 14 points. Hearing her recap of the game wasn’t as good as being there, but it was still great. Nothing much of interest happened on the ambulance that day, according to the guy who filled in for me, nothing unusual. I didn’t miss out on anything exciting.

The meet renewed my enthusiasm for swimming, so I have been hitting the pool hard this week. I saw my daughter’s game yesterday and it was great. They won and she played well, scoring 10 or 12 points in the win, including making both her free throws. Not bad for 10 years old.

I am at work now, posted on a street corner in the December rain, drinking hot tea with honey.  I am hoping the next call will be an interesting one.  I hope that I get out on time so I can swim at the pool.  I hope that when I get home, I will sit in my armchair and have a cold glass of water, while my wife sits on the couch and laughs at Will Ferrell in the Wedding Crashers in a way that brings warmth to my heart.  I hope that my daughter will be dribbling her basketball back and forth between her legs.  I hope that she looks up at me and says “Dad-Catch!”

 

 

Napping in EMS

 

Do you nap on your EMS job?

While many EMS organizations prohibit sleeping on the job and others allow it only in designated areas, a safety panel empowered by the National Association of State EMS Officials recently issued recommendations that included encouraging napping as a way to mitigate the adverse effects of fatigue.

Recommendation 4: Recommend that EMS personnel have the opportunity to nap while on duty to mitigate fatigue.

The panel determined that current evidence supports the use of naps while on duty as an effective strategy to positively impact fatigue-related outcomes. Naps improve alertness, reduce sleepiness, and improve personnel performance (e.g., reaction time).

I recently posted about a picture put up on our employees only Facebook site where a crew was blasted for being photographed while sitting in their ambulance, the driver with eyes closed, and the passenger slouching in his seat.  I found some links to fatigue on the job, but did not get around to reading them in their entirety until later. I was surprised and pleased to find the pro-napping recommendations. In the document they directly address the issue of public misunderstanding of sleeping EMTs.

The general public may perceive EMS personnel napping on duty as unacceptable. The panel concluded that the benefits of improved alertness on duty, and ultimately improved patient and personnel safety, are a commonsense justification to this anticipated undesirable effect. Additionally, it is common knowledge that many EMS personnel and other first responders work long duration shifts requiring nighttime sleep when not on a response. Policies and protocols that clearly describe the appropriate use, structure, and benefits of naps on duty may be useful toward educating the public and reducing potential negative opinion.

I have been working EMS for almost 30 years, and have worked all types of shifts, overnights, 24s, 16s, 12s, and have never had a shift, where I did not occasionally on some days catch some rest with my eyes shut.  It could be in a designated bed with my cheek on a pillow and the blanket pulled up to my neck, in a comfy armchair with my feet up, on the stretcher or bench seat with my legs stretched out, or simply in the front seat with my head against the window and my mouth, hopefully closed.

I have always found the power nap restorative.  The only issue I have ever had with sleeping on the job was when I did overnights in places where you could sleep in a bed, and I would get a call in between the hours of 3:00 AM and 4:30 when I would wake and find myself driving down the road having no idea where I was or where I was going.

EMS conditions most responders to listen for their number and hear it even in a sound sleep.  I have never failed to respond to a call for my number when I was dozing on the job. I have had partners however who have fallen asleep so deeply that they needed a shake.

Many, many years ago when I was on overnights (and EMS was still the wild west), I did a call for a patient on a street corner who wanted to go to detox.  While my partner slept soundly in the back (he was logging 100 hour plus weeks), I had the man sit in the front seat and we drove the half mile down the road to the detox facility.  My partner was still asleep when I came back out.

It has been years since I have done an overnight.  Today I work 12 hour day city shifts and my only napping is of the head against the window power variety (or the head nodding forward and jerking me awake as just happened while writing).

The safety panel recommends for those services that use dynamic deployment that napping should only be done in the front passenger seat or the patient compartment, that the sleeper be seat belted, and the driver never engage to prevent him from waking up with sleep inertia, leading to impaired driving.

Makes sense to me.  It’s nice to know napping has the sanction of the experts.

Read the full report here.

Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services