We are sent for a man with lung cancer difficulty breathing. Visiting nurse on scene. We’ve been going to this house a lot recently. Small one story house in a lower middle class neighborhood. The grass in the yard is mostly dead, the driveway cracked. The house needs painting.
The stink hits you from the door. It is one of the commonest EMS smells. It is the smell of the unbathed. Not the BO smell of a high school locker room, but the smell of people for whom washing and cleaning themselves has become an impossible task when just getting up to go to the kitchen brings on shortness of breath. The smell is in the carpets, in the walls. Some day an out-of-state family member or relator will have to tear out the carpets, strip the walls, and give the house a professional cleaning and airing out if they ever hope to sell it, after its decades old occupants are passed on.
But for now, the husband sits in the old armchair, an oxygen cannula in his nose. From his build he looks like he was once a large powerful man. Now speaking more than a few words at a time leaves him weak. His tee-shirt is stained yellow. I can see fungus growing on his feet.
The visiting nurse sits at the kitchen table looking at her lap top computer. She is on the phone talking to the ER, telling them how she is sending the patient in because he has become increasingly short of breath. She tries to tell the person on the other end of the phone the names of the patient’s medications, but the person on the other end of the phone has other patients to attend to, and has probably just scrawled "74 year old male, cancer, dsypnea" on a pad, and that suffices.
I want my partner to hurry up and get the stretcher set, so we can get this man on it, and out into the fresh air. We get the clean white sheet spread out, and while the man wants to stand and take a step to the stretcher, I say no. I remember how short of breath he became the last time. I tell my partner we have to lift him. I reach in from behind, giving him a bear hug, my arms under his, grasping him by the crossed forearms, while my partner, with now gloved hands, picks up from under the knees, and we lift him over. Both of us trying not to breathe more than we can help for fear we will gag.
The man’s wife, using her walker, comes over and kisses him goodbye. She is crying.
"I'm not dead yet," he jokes.
We switch the cannula to an oxygen mask.
On the TV the newscaster reports another 60 people are found dead in Bagdad.
Monday, October 09, 2006
Thursday, October 05, 2006
Ambulance Driver
With apologies to Steve Berry’s "I am Not an Ambulance Driver," here’s a story from Las Vegas.
It’s Friday, my friend and I go down to the pool to have a few beers and take in some sun before going out to the Jeff Beck concert, and then heading home the next day. I bring my backpack with me, and place my wallet in the backpack rather than leave it in the room. I was at the pool the day before and was able to secure a lounge chair in the first row along the pool so I could always see my backpack when I was in the water or over at the bar line. But when we get down there all the chairs in the first line are taken, so we have to grab two from the second line. The problem is of course, I won’t be able to see my backpack if I go in the water. It will be ripe for getting lifted. So while my friend watches the backpack, I go and get us some beers, and then we sit back and get some sun. Then I see two people get up from some front line chairs and leave, so we grab our stuff and quickly claim the chairs. To our right are two women vacationing we soon learn from from Green Bay. They each have two drinks in large coconut shaped souvenir holders, that are reminiscent from a scene from Austin Powers. They immediately notice our presence and perhaps believing we have been scooping them out, turn their attention to us. My friend, who is very personable, immediately gets involved in a discussion with them, and soon they are chatting away about the great weather, the shows in town, the best buffets, the night life. The women mention their desire to going to a club called Tabbo that night. Now my friend is happily married and I am in a committed relationship. But I am getting the strong sense these two women, each a definite candidate for the bariatric ambulance, are in to the “What Happens in Vegas Stays in Vegas” scene. Then they ask us what we are doing in town. My friend mentions the EMS convention. Really? Emergency Medical Services? Are you doctors?
“No,” I say. “He’s an EMT and I’m an Ambulance Driver. He does all the blood and guts and gore stuff, and me I drive like wind. I hit those sirens on and the traffic parts like the Red Sea. Like I'm Moses himself. Yee-Haw! It’s the life for me!”
Two minutes later they excuse themselves. Nice talking to you.
“Well, you blew it with those chicks,” my friend jokes. “Should have told them we were trauma surgeons.”
Ahh, no.
**
As I mentioned the Jeff Beck concert that night was great. I found this video clip of Beck playing a “Day in the Life” which was the highlight of the show for me.
Jeff Beck: A Day in the Life
It’s Friday, my friend and I go down to the pool to have a few beers and take in some sun before going out to the Jeff Beck concert, and then heading home the next day. I bring my backpack with me, and place my wallet in the backpack rather than leave it in the room. I was at the pool the day before and was able to secure a lounge chair in the first row along the pool so I could always see my backpack when I was in the water or over at the bar line. But when we get down there all the chairs in the first line are taken, so we have to grab two from the second line. The problem is of course, I won’t be able to see my backpack if I go in the water. It will be ripe for getting lifted. So while my friend watches the backpack, I go and get us some beers, and then we sit back and get some sun. Then I see two people get up from some front line chairs and leave, so we grab our stuff and quickly claim the chairs. To our right are two women vacationing we soon learn from from Green Bay. They each have two drinks in large coconut shaped souvenir holders, that are reminiscent from a scene from Austin Powers. They immediately notice our presence and perhaps believing we have been scooping them out, turn their attention to us. My friend, who is very personable, immediately gets involved in a discussion with them, and soon they are chatting away about the great weather, the shows in town, the best buffets, the night life. The women mention their desire to going to a club called Tabbo that night. Now my friend is happily married and I am in a committed relationship. But I am getting the strong sense these two women, each a definite candidate for the bariatric ambulance, are in to the “What Happens in Vegas Stays in Vegas” scene. Then they ask us what we are doing in town. My friend mentions the EMS convention. Really? Emergency Medical Services? Are you doctors?
“No,” I say. “He’s an EMT and I’m an Ambulance Driver. He does all the blood and guts and gore stuff, and me I drive like wind. I hit those sirens on and the traffic parts like the Red Sea. Like I'm Moses himself. Yee-Haw! It’s the life for me!”
Two minutes later they excuse themselves. Nice talking to you.
“Well, you blew it with those chicks,” my friend jokes. “Should have told them we were trauma surgeons.”
Ahh, no.
**
As I mentioned the Jeff Beck concert that night was great. I found this video clip of Beck playing a “Day in the Life” which was the highlight of the show for me.
Jeff Beck: A Day in the Life
Wednesday, October 04, 2006
Go Ahead
Morphine for undifferentiated abdominal pain. I’ve written about it. I’ve advocated for it. But until yesterday, I hadn’t ever given it. At our last regional council meeting we approved the use of .05 mg/kg for undifferentiated abdominal pain on standing orders. .05 mg/kg is half the regular morphine for pain dose. It is a “judicious amount” in the new terminology that advocates relief of suffering. The literature on the issue is clear. Morphine does not hinder the diagnosis of abdominal pain. To quote the conclusion of the most recent study:
“Although administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our findings are most consistent with the inference that morphine safely provides analgesia without eroding clinically important diagnostic accuracy. These data are congruent with the aggregate weight of evidence accumulated from previous studies examining this question during the past 20 years.”
-Randomized Clinical Trial of Morphine in Acute Abdominal Pain
Gallagher, Esses, Lee, Lahn, Bijur
Annals of Emergency Medicine
August 2006
When I read that at the MAC meeting, it was a slam dunk. Who can speak against such a statement?
Still, the old ways are hard to change. It was grilled in us 15 years ago. NEVER give Morphine for abdominal pain, unless you can make a clear case that the pain is caused by kidney stones. Never. Every now and then you would hear of someone calling in and asking to give it. Such a beating they received. People would talk behind their backs for years. There’s the moron who tried to give a patient morphine for abdominal pain.
For months I have been anticipating giving it. Until our protocols are rolled out, I am required to call for orders if I want to give it for abdominal pain. I have played out the scenario in my head. I call and am denied. The doctor says on the radio. See me when you get here. He says it in the way a principle says "To my office." To my office back in the days of corporal punishment. I imagine everyone staring at me when I come in. People looking at me in amazement. All this time they all thought I knew what I was doing and here I have gone and asked for morphine for abdominal pain. Scandal. Gossip. But in my imagination I am prepared. I go toe to toe with the MD. You need to read the literature, I say. I start spouting. Annals of Emergency Medicine. Latest edition of Cope’s Early Diagnosis of the Acute Abdominal. Aggregate evidence of the last twenty years. Get with the program. I slap down the studies on the tray by the bedside. The doctor is flustered. The staff looks at me. Well, all right then. A new sheriff in town.
So here’s what happened. 86 year old male, pale as a sheet, comes walking out the front door, holding his stomach. While we spread a clean sheet on the stretcher; he says he has had the pain for four hours. He has vomited twice. There is in fact dried vomit on his shirt. No diarrhea. Once we get him on the stretcher I examine his abdomen. Soft, non-tender. No pulsing masses. His pressure is 200/100. Heart rate in the 80’s inching up to the nineties. I put in a line and hang a bag of fluid. He looks really uncomfortable. He is irritated at me when I ask questions. The pain is dull and diffusive and goes into the back. No, it is not tearing. He says he has never had pain like this before.
I’m not certain what is going on. Maybe an ischemic bowel? I don't know. I think about morphine, but I also think, maybe I don’t want to mask the diagnosis. I know, I know. I’ve read the studies. Everything for the last twenty years. Still. It is deeply ingrained. We are enroute now. My partner is taking the long way – a way he thinks is the shortest, but I know to be at least ten minutes linger, particularly at this time of day – afternoon rush hour. We aren’t going lights and sirens. The patient looks really, really uncomfortable. I am thinking this is no normal belly ache. We are at least twenty minutes from the hospital. I ask him how bad his pain is. He is annoyed by the question. He finally snaps, “I’ve never had pain this bad.” "That would be a ten then, “I say. “Ten,” he says through gritting teeth.
He is in pain. He is suffering. He needs something. Okay. I pump out my chest, run my hand through my hair. Here goes. I make the call. I give as detailed a patch as I have given for years, and then I say, “I’d like to give a judicious amount of morphine for pain relief – 3 mg IV.” I say.
“Go ahead, 3 mg MS IV,” the doctor says. Since the radio is scratchy I can’t pick up the tone, but it clear. I got the go ahead. They said yes.
Easy enough. I give the patient the morphine, and while it only makes the pain go down to an 8, he seems much more comfortable. His heart rate goes down to the 60’s.
At the ED, they put him in a medical alert room so he gets immediate treatment by two doctors. They order a stat ultrasound. I ask the doctor to sign my narcotics sheet. He does so without a problem. “Excellent job,” he says.
All right then.
“Although administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our findings are most consistent with the inference that morphine safely provides analgesia without eroding clinically important diagnostic accuracy. These data are congruent with the aggregate weight of evidence accumulated from previous studies examining this question during the past 20 years.”
-Randomized Clinical Trial of Morphine in Acute Abdominal Pain
Gallagher, Esses, Lee, Lahn, Bijur
Annals of Emergency Medicine
August 2006
When I read that at the MAC meeting, it was a slam dunk. Who can speak against such a statement?
Still, the old ways are hard to change. It was grilled in us 15 years ago. NEVER give Morphine for abdominal pain, unless you can make a clear case that the pain is caused by kidney stones. Never. Every now and then you would hear of someone calling in and asking to give it. Such a beating they received. People would talk behind their backs for years. There’s the moron who tried to give a patient morphine for abdominal pain.
For months I have been anticipating giving it. Until our protocols are rolled out, I am required to call for orders if I want to give it for abdominal pain. I have played out the scenario in my head. I call and am denied. The doctor says on the radio. See me when you get here. He says it in the way a principle says "To my office." To my office back in the days of corporal punishment. I imagine everyone staring at me when I come in. People looking at me in amazement. All this time they all thought I knew what I was doing and here I have gone and asked for morphine for abdominal pain. Scandal. Gossip. But in my imagination I am prepared. I go toe to toe with the MD. You need to read the literature, I say. I start spouting. Annals of Emergency Medicine. Latest edition of Cope’s Early Diagnosis of the Acute Abdominal. Aggregate evidence of the last twenty years. Get with the program. I slap down the studies on the tray by the bedside. The doctor is flustered. The staff looks at me. Well, all right then. A new sheriff in town.
So here’s what happened. 86 year old male, pale as a sheet, comes walking out the front door, holding his stomach. While we spread a clean sheet on the stretcher; he says he has had the pain for four hours. He has vomited twice. There is in fact dried vomit on his shirt. No diarrhea. Once we get him on the stretcher I examine his abdomen. Soft, non-tender. No pulsing masses. His pressure is 200/100. Heart rate in the 80’s inching up to the nineties. I put in a line and hang a bag of fluid. He looks really uncomfortable. He is irritated at me when I ask questions. The pain is dull and diffusive and goes into the back. No, it is not tearing. He says he has never had pain like this before.
I’m not certain what is going on. Maybe an ischemic bowel? I don't know. I think about morphine, but I also think, maybe I don’t want to mask the diagnosis. I know, I know. I’ve read the studies. Everything for the last twenty years. Still. It is deeply ingrained. We are enroute now. My partner is taking the long way – a way he thinks is the shortest, but I know to be at least ten minutes linger, particularly at this time of day – afternoon rush hour. We aren’t going lights and sirens. The patient looks really, really uncomfortable. I am thinking this is no normal belly ache. We are at least twenty minutes from the hospital. I ask him how bad his pain is. He is annoyed by the question. He finally snaps, “I’ve never had pain this bad.” "That would be a ten then, “I say. “Ten,” he says through gritting teeth.
He is in pain. He is suffering. He needs something. Okay. I pump out my chest, run my hand through my hair. Here goes. I make the call. I give as detailed a patch as I have given for years, and then I say, “I’d like to give a judicious amount of morphine for pain relief – 3 mg IV.” I say.
“Go ahead, 3 mg MS IV,” the doctor says. Since the radio is scratchy I can’t pick up the tone, but it clear. I got the go ahead. They said yes.
Easy enough. I give the patient the morphine, and while it only makes the pain go down to an 8, he seems much more comfortable. His heart rate goes down to the 60’s.
At the ED, they put him in a medical alert room so he gets immediate treatment by two doctors. They order a stat ultrasound. I ask the doctor to sign my narcotics sheet. He does so without a problem. “Excellent job,” he says.
All right then.
Tuesday, October 03, 2006
Too Busy
Writing about the daily life of EMS always creates a tension for me. On one hand I want to write about the nobler aspects of the job, on the other, much of the job is so frustrating you just want to scream. I try to avoid whining so most of the time I ignore it. I just came back from the EMS EXPO -- all fired up as always to go out and do great calls -- and as always happens instead of coming back to use your new skills in airway management or cardiac arrests, you get crapped on.
Yesterday was abuse EMS day. Most of the time when we think about EMS abusers it is the poor people who call for an ambulance because they have no primary care doctor and no ride to the hospital. Yesterday was two different, but in my opinion, worse offenders.
Call number one was for "high blood pressure." An ambulatory, working patient with mental retardation, who takes his blood pressure twice a day with one of those drug store home automatic BP cuffs, had a pressure of 150/100 while at his job. Since this exceeds his parameters -- 140/90, his case worker's "protocol" is to have him transported to the ED, and of course that means calling 911. She said to my partner, the ambulance and the hospital seem to always get upset when she calls, but "I'm are just following our protocol." My partner said maybe your need a new protocol.
The other call ticked me off even more. A doctor's office calls 911 for "heart failure." The patient at the office for a scheduled stress test has been gaining fluid in recent days. Her respiratory rate is 20, her SAT on room air is 95%, her end tidal is 35, her heart rate is 60, her pressure is 150/90. She is a direct admit to one of the floors. The office says they will fax her info to the floor and they get upset when I ask for a report. Why do I need her information when I am just taking her to a floor where they have already talked to the people who will be taking care of her? I ask them why they called 911 for a direct admit, they said when they call the commercial ambulance it takes an hour and they are "too bust to wait that long" at their office. It takes an hour of course because for direct admits the ambulance company has to get the patient's insurance company to approve the transport since it is not an "emergency." I am supposed to call the commercial ambulance to come and take the direct admits because as the town 911 ambulance, we don't do direct admits, which often take a great deal of time because the hospital is not ready for the patient - we only go to the ER. What I end up doing is taking the patient to the ER anyway, and then telling the triage nurse the patient may be a direct admit, and if the room is ready, then I take them up to the floor. If the room isn't ready, I leave the patient in the ER. That way, my run form shows I took them to the ER, which means their insurance will likely pay for the ride, instead of jobbing them with a $300 plus unapproved bill. I just resent the attitude we're too busy to wait for a commercial ambulance. We get better service with 911. On the one hand, you want to say to the office, we're not taking her. You're going to have to call the commercial. On the other hand, you have an innocent old woman sitting there and you don't want to put her in the middle.
And we also did a bunch of fender bender MVAs my neck hurts.
The only good thing about the day was we had an unresponsive diabetic at a nursing home. I brought her around with some D50, had them call her doctor back. The patient had been given insulin that morning, but had not eaten and the home's glucometer was off. They had a reading of 78. Ours was less than 20. The doctor canceled the transport.
Yesterday was abuse EMS day. Most of the time when we think about EMS abusers it is the poor people who call for an ambulance because they have no primary care doctor and no ride to the hospital. Yesterday was two different, but in my opinion, worse offenders.
Call number one was for "high blood pressure." An ambulatory, working patient with mental retardation, who takes his blood pressure twice a day with one of those drug store home automatic BP cuffs, had a pressure of 150/100 while at his job. Since this exceeds his parameters -- 140/90, his case worker's "protocol" is to have him transported to the ED, and of course that means calling 911. She said to my partner, the ambulance and the hospital seem to always get upset when she calls, but "I'm are just following our protocol." My partner said maybe your need a new protocol.
The other call ticked me off even more. A doctor's office calls 911 for "heart failure." The patient at the office for a scheduled stress test has been gaining fluid in recent days. Her respiratory rate is 20, her SAT on room air is 95%, her end tidal is 35, her heart rate is 60, her pressure is 150/90. She is a direct admit to one of the floors. The office says they will fax her info to the floor and they get upset when I ask for a report. Why do I need her information when I am just taking her to a floor where they have already talked to the people who will be taking care of her? I ask them why they called 911 for a direct admit, they said when they call the commercial ambulance it takes an hour and they are "too bust to wait that long" at their office. It takes an hour of course because for direct admits the ambulance company has to get the patient's insurance company to approve the transport since it is not an "emergency." I am supposed to call the commercial ambulance to come and take the direct admits because as the town 911 ambulance, we don't do direct admits, which often take a great deal of time because the hospital is not ready for the patient - we only go to the ER. What I end up doing is taking the patient to the ER anyway, and then telling the triage nurse the patient may be a direct admit, and if the room is ready, then I take them up to the floor. If the room isn't ready, I leave the patient in the ER. That way, my run form shows I took them to the ER, which means their insurance will likely pay for the ride, instead of jobbing them with a $300 plus unapproved bill. I just resent the attitude we're too busy to wait for a commercial ambulance. We get better service with 911. On the one hand, you want to say to the office, we're not taking her. You're going to have to call the commercial. On the other hand, you have an innocent old woman sitting there and you don't want to put her in the middle.
And we also did a bunch of fender bender MVAs my neck hurts.
The only good thing about the day was we had an unresponsive diabetic at a nursing home. I brought her around with some D50, had them call her doctor back. The patient had been given insulin that morning, but had not eaten and the home's glucometer was off. They had a reading of 78. Ours was less than 20. The doctor canceled the transport.
Sunday, October 01, 2006
EMS EXPO Report
I returned last night from the EMS EXPO in Las Vegas. I love going to these EMS conventions. The classes are great. You meet new friends and get reacquainted with old ones. You get to hear the best speakers and get updated on all the latest research and ideas, and you can wander the convention floor and see all the new products. Also, as far as convention cities, Las Vegas obviously doesn’t lack for diversions.
Here are some of my trip highlights:
1. Dinner with Thom Dick. I was able to have dinner with one of my heroes, Thom Dick, the author of Street Talk and People Care. As I wrote about in this blog several months ago, Thom Dick's writings have been very influential in my career, particularly as a new EMT. He set the example of the need to focus on the person.
2. Capnography Classes with Baruch Krauss and Bob Page. This was why I went out to Vegas. Baruch Krauss, a physician from Harvard, is the leading proponent of capnography in EMS. He has conducted research, written articles and given lectures on the subject. His class was packed to capacity, and was very informative.
Bob Page is a paramedic from Missouri, and one of the best lecturers I’ve seen. Many years ago I took a great 12 lead class from him. I wasn’t expecting to hear him, but one afternoon while wandering through the convention hall, I went by the Zoll booth and saw him as he was getting ready to give a 30 minute mini-class on capnography. I was one of five people who sat in on the class.
Both lecturers were excellent. I spoke to each of them very briefly after their talks and discovered they are both writing textbooks on capnography. Finally! I will be posting my notes on the lectures on my blog, Capnography for Paramedics. If you ever get a chance to hear either of these fine teachers, don’t miss the opportunity.
3. Drinking beers by the pool on the last day and then going to the Jeff Beck concert at the House of Blues. I stayed with an old friend of mine, who has worked in EMS at all levels from paramedic to clinical coordinator to state administrator. It was good hanging out with him – he introduced me to Thom Dick and some other interesting EMS people who I had read about but never met, and he got the best seats for the show. Jeff Beck is an enigmatic guitarist, who instead of pursuing fame, although he has plenty, has always chosen to play just what he wants regardless of commercial success. A peer of Clapton and Hendrix, a former member of the Yardbirds and The Jeff Beck group featuring Rod Stewart, he barely said a word to the crowd, just played his blazing guitar. He did an amazing version of the Beatles “A Day in the Life.” I always admire people, who do what they love, who pursue their own excellence regardless of what others think they should do.
Other notes:
I took a class called "What’s New in EMS," which was a review of the latest research: According to the lecturer, capnography, pain relief, particularly fentanyl, CPAP and nitro for pulmonary edema, permissive hypotension for trauma, 12 lead ECGs, are all proving their worth. On the downside, lasix and Morphine for pulmonary edema, intubation for head injured patients, and amiodarone are not faring well in research.
As I mentioned the EXPO floor was akin to a Tijuana market with so many vendors competing for your attention.
There were a multitude of ambulances and rescue vehicles, hundreds of different mannequins, including a dog mannequin for animal CPR, training and data software vendors, all kinds of monitors and other gizmos. Here were my non-commercial favorites:
1. Safety Ambulance – a prototype with ideas from EMTs and medics on how to make the ambulance safer.
2. The National Association of Emergency Medical Technicians (NAEMT) booth. – I’ve been in EMS for 18 years now and have never joined a national association. They signed me up and I am now a member.
3. The National EMS Museum – I gave them the requested $5 donation. The museum is just an idea now, but a needed one. I’m posting their web site, although it is still under construction. They plan to start with a virtual museum, and maybe one day get to the brick and mortal.
The next EMS EXPO is scheduled for Orlando in 2007. The next JEMS EMS Todayconference will be in Baltimore on March 6-10, 2007.
Here are some of my trip highlights:
1. Dinner with Thom Dick. I was able to have dinner with one of my heroes, Thom Dick, the author of Street Talk and People Care. As I wrote about in this blog several months ago, Thom Dick's writings have been very influential in my career, particularly as a new EMT. He set the example of the need to focus on the person.
2. Capnography Classes with Baruch Krauss and Bob Page. This was why I went out to Vegas. Baruch Krauss, a physician from Harvard, is the leading proponent of capnography in EMS. He has conducted research, written articles and given lectures on the subject. His class was packed to capacity, and was very informative.
Bob Page is a paramedic from Missouri, and one of the best lecturers I’ve seen. Many years ago I took a great 12 lead class from him. I wasn’t expecting to hear him, but one afternoon while wandering through the convention hall, I went by the Zoll booth and saw him as he was getting ready to give a 30 minute mini-class on capnography. I was one of five people who sat in on the class.
Both lecturers were excellent. I spoke to each of them very briefly after their talks and discovered they are both writing textbooks on capnography. Finally! I will be posting my notes on the lectures on my blog, Capnography for Paramedics. If you ever get a chance to hear either of these fine teachers, don’t miss the opportunity.
3. Drinking beers by the pool on the last day and then going to the Jeff Beck concert at the House of Blues. I stayed with an old friend of mine, who has worked in EMS at all levels from paramedic to clinical coordinator to state administrator. It was good hanging out with him – he introduced me to Thom Dick and some other interesting EMS people who I had read about but never met, and he got the best seats for the show. Jeff Beck is an enigmatic guitarist, who instead of pursuing fame, although he has plenty, has always chosen to play just what he wants regardless of commercial success. A peer of Clapton and Hendrix, a former member of the Yardbirds and The Jeff Beck group featuring Rod Stewart, he barely said a word to the crowd, just played his blazing guitar. He did an amazing version of the Beatles “A Day in the Life.” I always admire people, who do what they love, who pursue their own excellence regardless of what others think they should do.
Other notes:
I took a class called "What’s New in EMS," which was a review of the latest research: According to the lecturer, capnography, pain relief, particularly fentanyl, CPAP and nitro for pulmonary edema, permissive hypotension for trauma, 12 lead ECGs, are all proving their worth. On the downside, lasix and Morphine for pulmonary edema, intubation for head injured patients, and amiodarone are not faring well in research.
As I mentioned the EXPO floor was akin to a Tijuana market with so many vendors competing for your attention.
There were a multitude of ambulances and rescue vehicles, hundreds of different mannequins, including a dog mannequin for animal CPR, training and data software vendors, all kinds of monitors and other gizmos. Here were my non-commercial favorites:
1. Safety Ambulance – a prototype with ideas from EMTs and medics on how to make the ambulance safer.
2. The National Association of Emergency Medical Technicians (NAEMT) booth. – I’ve been in EMS for 18 years now and have never joined a national association. They signed me up and I am now a member.
3. The National EMS Museum – I gave them the requested $5 donation. The museum is just an idea now, but a needed one. I’m posting their web site, although it is still under construction. They plan to start with a virtual museum, and maybe one day get to the brick and mortal.
The next EMS EXPO is scheduled for Orlando in 2007. The next JEMS EMS Todayconference will be in Baltimore on March 6-10, 2007.
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