A rainy day at work. I'm sitting at the computer and trying to get caught up on email, bills, scheduling, and maybe even this blog.
Here's a couple of recent tidbits.
This morning a first occurred. I occasionally hit my head at work -- most often on the overhanging bright lights above ER beds, and sometimes on a door when I turn suddenly. Today while walking into a house hallway, I ducked to avoid hitting my head and when I raised my head back up, I hit a light-fixture, knocking it from the ceiling, into the arms of a cop, who fumbled it. The glass fixture hit the floor smashing into a 100 pieces. Fortunately, I was working with the boss of our service who was cool about it and the family was very cool about it as well. So no big deal. We gave the unresponsive diabetic some D50, got some slippers on her bare feet, and walked the now awake patient to our stretcher and took them in to the hospital.
***
The last two weeks were big meeting weeks for me, and some of the issues I found were very frustrating. The roadblocks ranged from obstinate obstructionists to people who criticize, but never read the material beforehand, to numbing bureaucracy, to problems too complex for our little committees to be able to solve to the inevitable personal and political agendas (we all have them) behind every best effort to improve patient care. My back was getting a little stiff so I stood for a moment, and then feeling better standing, began to pace a few strides back and forth from my chair. I suddenly felt quite happy and empowered. Could I perhaps attend all meeting and instead of having to sit in a chair, could I just pace while I talked? I had a vision of Robert DeNiro in The Untouchables. I pictured myself carrying a baseball bat...
***
A number of years ago when I full time city medic working nights, I turned down a chanced to be a suburban medic like I am now. I loved the street and wanted to be right in the middle of all the lights and sirens glory, the shootings and stabbings, etc now to mention the sheer craziness of the city at night. I eventually accepted the suburban position when it was offered againa couple years later -- I took it due to changes I saw coming in the way things were happening. While I continued to work quite a bit in the city (on what was then unlimited overtime), I was glad for the change. Now years later, I am equally glad.
I was talking with one of the city medics and the issue became intubations, and while it has been quite awhile since I have done a traumatic arrest, my intubation numbers are much higher than most of the city medics (due to the proliferation of city medics now along with the fact that medics do transfers much more than they used to, which when I started was never unless it was an ALS transfer. We have a number of nursing homes in the town. Two of them, it seems all the patients are DNRs. The other three, it seems most of the patients are full codes. And they keep us busy. I do enjoy intubating.
I know there is a lot of literature out there about how intubations may not in fact benefit the patients and the ET tube may be completely replaced by the LMA, Combitube or other airway device, but I read an interesting presentation (see below) that pointed out most of the literature studying intubation was done before capnography. There is reason to believe that prior to continuous wave form capnography there was quite a high rate of unrecognized misplaced intubations (mainly tubes that had become dislodged)(possibly as high as 1-4) and that this may account for the poor science backing intubation. With wave form capnography, the misplaced tube should be nonexistent, and outcomes should improve.
Check out this powerpoint:
Making Waves Continuously in the Big Apple
***
The above powerpoint comes from the annual Gathering of Eagles Conference. The Eagles are a group of big city EMS Medical Directors, who are pretty cutting edge. Check out their site. There are many more powerpoints available there on many, many interesting EMS topics.
***
So anyway, back to my suburban job. I am the contact paramedic on a busy suburban volunteer ambulance. But not so busy that I didn't have the opportunity to ride my bike around our industrial circle (0.7 miles)for 12 miles on Sunday and another 12 today. Yesterday, I watched the Boston Marathon on the big screen HD TV, but unfortunately I only got to see miles 1-22. Duty calls. I was back in time to watch the end of the Red Sox 12-1 win. 4 in a row!
Tonight I am hoping to be able to watch all of American Idol. This year on the Tuesdays I have worked (I work till 10:00 P.M.) we have seemed to get a call every time at the stroke of 8 just when the show is starting. I do have it taped for me at home, but I like watching it live. For those idol heads out there, I am rooting for Allison, but am also a big fan of Adam (I likely won't buy his records, but he is entertaining and has a voice from outer space).
***
Anyway, the best part of being out here in the suburbs in our new stretcher. Now, when I started in EMS we had the two man stretcher. You basically deadlifted your patient (one EMT on each side) into the ambulance. I resisted the one man stretcher when it debuted for about a week. So with the past, all I had to do was watch the video for the new power stretcher to be sold. There are some drawbacks -- it is heavier and harder to maneuver by yourself, lugging it into a house, but you just push a button and it raises and lowers itself. It adjusts to just the right level for sliding patients on and off the bed. It is a levitation machine. I love it!
Tuesday, April 21, 2009
Monday, April 13, 2009
Paramedic Block
I have had trouble posting lately. I go through phases with the job and with the blog and am in one now.
The reason I started writing about EMS in the first place was to capture the human side -- the view of life and people the job provides.
To a lessor extent I like writing about the medicine or the systems issues.
I am still working 40 hours a week and doing calls, but I just don't feel as close to the people as I did.
Part of this may be because I am precepting again, and the nature of precepting, standing back somewhat keeps me from fully engaging the patient. (I am also struggling with precepting because I feel so far removed from being a new paramedic that I have trouble seeing the job through a new medic's eyes anymore. I may assume they know what they don't or assume they don't know what they do. I don't think I am doing as good a job at it as I once did. It was a pride of mine.)
Another reason may be that I am so busy with the two jobs and other obligations (like family where in my 15-month-old daughter I have true happiness) that I don't have the time to just write and see what develops. Some of my favorite stories have come from just writing and as I write about the call, the lessons of it start to come out in a way they would not if I weren't examining it closely and the best way for me to examine a call is to write about it.
A third reason is I don't want to repeat myself, to write the same story over and over again. I could argue that every story, every patient is different if you look closely, but since I am not looking closely, they seem the same.
As far as the systems and medicine, I do have some interesting subjects yet to write about. One is cardiocerebral resuscitation - the variation on the new CPR where instead of ventilating, medics put a nonrebreather on the patient, who is then passively ventilated by the CPR. Very interesting and promising.
What is holding me back about writing about systems issues right now is there seem to be so many in which politics plays a bigger factor than patient care. I know it is naive of me to think that patients should come first ahead of various groups self-interest even when that self interest has the best intentions, but that is how is has always been in all fields. I am all in favor of the new evidenced based medicine, but I am seeing too much research that has its own agenda. Studies funded by drug companies or studies that advance the preexisting ideas of the authors. And too many policies promulgated or blocked based on reasons other than outcome.
I am at one of these crossroads where I want to write truthful things, but am finding myself uncertain of what to believe in.
I want this job and this field to matter, and I want to write about why it matters.
The only real truth I know is to try to do my job as well as I can and treat my patients as best as I can, but I have written multiple versions of this over the years to the point it seems repetitive. That should just be a given. It shouldn't have to be written or held up as a standard. It should just be the standard.
I have overcome these periods in the past, and hope to again write and work with inspiration.
But in the meantime I (as a paramedic and a writer) struggle to find meaning between silence and noise.
Thanks for listening.
The reason I started writing about EMS in the first place was to capture the human side -- the view of life and people the job provides.
To a lessor extent I like writing about the medicine or the systems issues.
I am still working 40 hours a week and doing calls, but I just don't feel as close to the people as I did.
Part of this may be because I am precepting again, and the nature of precepting, standing back somewhat keeps me from fully engaging the patient. (I am also struggling with precepting because I feel so far removed from being a new paramedic that I have trouble seeing the job through a new medic's eyes anymore. I may assume they know what they don't or assume they don't know what they do. I don't think I am doing as good a job at it as I once did. It was a pride of mine.)
Another reason may be that I am so busy with the two jobs and other obligations (like family where in my 15-month-old daughter I have true happiness) that I don't have the time to just write and see what develops. Some of my favorite stories have come from just writing and as I write about the call, the lessons of it start to come out in a way they would not if I weren't examining it closely and the best way for me to examine a call is to write about it.
A third reason is I don't want to repeat myself, to write the same story over and over again. I could argue that every story, every patient is different if you look closely, but since I am not looking closely, they seem the same.
As far as the systems and medicine, I do have some interesting subjects yet to write about. One is cardiocerebral resuscitation - the variation on the new CPR where instead of ventilating, medics put a nonrebreather on the patient, who is then passively ventilated by the CPR. Very interesting and promising.
What is holding me back about writing about systems issues right now is there seem to be so many in which politics plays a bigger factor than patient care. I know it is naive of me to think that patients should come first ahead of various groups self-interest even when that self interest has the best intentions, but that is how is has always been in all fields. I am all in favor of the new evidenced based medicine, but I am seeing too much research that has its own agenda. Studies funded by drug companies or studies that advance the preexisting ideas of the authors. And too many policies promulgated or blocked based on reasons other than outcome.
I am at one of these crossroads where I want to write truthful things, but am finding myself uncertain of what to believe in.
I want this job and this field to matter, and I want to write about why it matters.
The only real truth I know is to try to do my job as well as I can and treat my patients as best as I can, but I have written multiple versions of this over the years to the point it seems repetitive. That should just be a given. It shouldn't have to be written or held up as a standard. It should just be the standard.
I have overcome these periods in the past, and hope to again write and work with inspiration.
But in the meantime I (as a paramedic and a writer) struggle to find meaning between silence and noise.
Thanks for listening.
Thursday, April 09, 2009
A Profession
Over the past year we had pretty prolonged and at times nasty debate over whether to change unions, which we ended up doing. While I wasn't happy with the previous union's representation( they in fact screwed me on the one issue I needed them to grieve for me), having sat in on the last contract negotiations I had to give them and the negotiating committee serious props for being hard-asses and fighting for a decent contract. Based on that, I supported the old union, as did most of the senior people. We lost. That's life.
Over the past year there was a lot of tough talk about striking if we had to, and how we were going to win a decent contract, particularly after an incident where the company was accused of possibly bugging our negotiations.
Of course, as everyone knows the economy has taken a nose dive, unions are giving back all over the country and many people are losing their jobs. While our company appears to be recession proof, who is to say? I don't know their finances. I wasn't in on the negotiations, and I give credit to anyone who spends their time fighting for their union brothers and sisters.
That said the contract that was finally agreed to, without getting into any of the dollar figures -- and dollar figures aside -- screwed the senior medics and screwed future employees. Not that the people in the middle got a gold mine, but they apparently got something to vote for. All the senior people I talked to said they were voting no (and from the results they did). At the same time many of the people who had done tough-talking about getting a new union to get a better contract were now counseling others to vote for the contract because the public would not be on our side if we voted to strike. A contract vote is either to approve the contract or authorize a strike. It doesn't mean there will be a strike. Last go around we voted the contract down, voting to authorize a strike, went back to the table, and won a fair contract. Many don't like the idea of public safety personnel going on strike, but the right to strike is one of the few bargaining chips unions have to win fair contracts. Everyone has to have their line in the sand. Once a contract is signed, the contract forbids work-actions during the course of the contract. In the end this contract was approved with something like a 70-50 vote. I guess people were scared or else they thought they were getting a good enough deal for their situations, considering everything.
Now it doesn't impact me directly all that much as I am extremely fortunate now to have a second job with better health insurance (I didn't even mention the insurance changes in the new contract), and don't have to compete for what has become nonexistent overtime.
Nevertheless, the episode has left me saddened. I heard one younger medic saying if we went on strike, her kids would starve, and I felt like saying, if we approve this contract, which destroys the concept of increased pay for seniority and lowers what future medics can expect to make, you eventually will need to find another job(another profession), so you might as well start looking now.
I almost didn't take my new second job as a clinical coordinator because I love being a paramedic. Even working as a medic three days (40 hours) a week, I miss being out there on the other days (back when overtime was plentiful). I feel like a half-medic. I feel bad for my long-time coworkers with families who can't live on a 40 hour week salary and who can't get the overtime they relied on because in this economy there is a seemingly endless stream of new and part-time EMTs to take those shifts. Some of them -- good medics- are going to have to quit the jobs they love.
Its just got me down. I thought for awhile we were getting ahead as a profession.
Over the past year there was a lot of tough talk about striking if we had to, and how we were going to win a decent contract, particularly after an incident where the company was accused of possibly bugging our negotiations.
Of course, as everyone knows the economy has taken a nose dive, unions are giving back all over the country and many people are losing their jobs. While our company appears to be recession proof, who is to say? I don't know their finances. I wasn't in on the negotiations, and I give credit to anyone who spends their time fighting for their union brothers and sisters.
That said the contract that was finally agreed to, without getting into any of the dollar figures -- and dollar figures aside -- screwed the senior medics and screwed future employees. Not that the people in the middle got a gold mine, but they apparently got something to vote for. All the senior people I talked to said they were voting no (and from the results they did). At the same time many of the people who had done tough-talking about getting a new union to get a better contract were now counseling others to vote for the contract because the public would not be on our side if we voted to strike. A contract vote is either to approve the contract or authorize a strike. It doesn't mean there will be a strike. Last go around we voted the contract down, voting to authorize a strike, went back to the table, and won a fair contract. Many don't like the idea of public safety personnel going on strike, but the right to strike is one of the few bargaining chips unions have to win fair contracts. Everyone has to have their line in the sand. Once a contract is signed, the contract forbids work-actions during the course of the contract. In the end this contract was approved with something like a 70-50 vote. I guess people were scared or else they thought they were getting a good enough deal for their situations, considering everything.
Now it doesn't impact me directly all that much as I am extremely fortunate now to have a second job with better health insurance (I didn't even mention the insurance changes in the new contract), and don't have to compete for what has become nonexistent overtime.
Nevertheless, the episode has left me saddened. I heard one younger medic saying if we went on strike, her kids would starve, and I felt like saying, if we approve this contract, which destroys the concept of increased pay for seniority and lowers what future medics can expect to make, you eventually will need to find another job(another profession), so you might as well start looking now.
I almost didn't take my new second job as a clinical coordinator because I love being a paramedic. Even working as a medic three days (40 hours) a week, I miss being out there on the other days (back when overtime was plentiful). I feel like a half-medic. I feel bad for my long-time coworkers with families who can't live on a 40 hour week salary and who can't get the overtime they relied on because in this economy there is a seemingly endless stream of new and part-time EMTs to take those shifts. Some of them -- good medics- are going to have to quit the jobs they love.
Its just got me down. I thought for awhile we were getting ahead as a profession.
Tuesday, March 24, 2009
Florida
My brother and I went to Florida for this past weekend to see our father. I left on Friday and came back on Monday. My father had a back operation in December, and while he didn't want us to come see him then, he finally agreed, now that he is up and walking around, to have us visit in March.
Since last July I have been working basically two full-time jobs. Forty hours a week as a medic and then fifty-six hours every two weeks as a clinical coordinator -- a routine that leaves me with one day off every fourteen. I like both jobs (particularly in this economy), but I really did need some time off.
I hadn't flown for several years so the tube of Suntan lotion I bought the night before I had to pitch at the entrance to the security gate because it was an 8 ounce tube and not the smaller permissible size. And then since they went to e-ticketing, it seems they no longer save the exit rows for tall people to request at the gate so I was stuck with my legs pressed up against the seat in front of me.
For food, there was no TV-type dinner, just a tiny bag of peanuts. The stewardess actually gave me two bags and a foil wrapped cookie. I also got half a Diet Coke from the other stewardess. I guess they are called flight attendants now or uniformed flight crew.
At least I had several newspapers and magazines to pass the time. I buy Men's Health, Time, Entertainment Weekly and Rolling Stone when I fly along with USA Today, the New York Times and the local paper. On a three hour flight I get a good sense of what is going on in the county. I learned what "twittering" was. I had never heard of it before, but it was mentioned in nearly every publication. I did get a little depressed in reading the cover story of the Rolling Stone about the cast of a TV show called Gossip Girl, and how the cast members were complaining of lack of anonymity. Well, I am out of touch, I could have been sitting next to one of them on the plane and not know it. But that wasn't nearly as depressing as reading about the AIG scandal. I don't even want to go there.
It was good flight, and I was glad to see my Dad and my brother. We went out to eat twice (I had two beers on the first night, two beers on the second and then three and a half with dinner on the last night when we went to a sports bar(the half was finishing my brother's third). I love drinking beer, but working everyday I just don't anymore. I would have gladly had more, but the occasion wasn't right).
We went to a spring training game where it rained steadily for three hours before they started the game. We left after two hours. Just going to the ballpark and having a hot dog was good enough. I managed to go running twice -- it was more humid than Connecticut, but I managed to do four miles on my last run. I am slowly getting back into shape after a long chest cold this winter.
On the last day, we went to the beach where there was crazy surf. There were 100 surfboarders and no swimmers -- at least until I arrived. One of my few talents is that of a body surfer (due mainly to my thin 6'8" frame). I did hesitate before entering the water. It was rough out there, and since it had been a few years since I had been in the ocean, I wondered if maybe my bones were now to frail for the onslaught of the waves, if I would get caught up in a rip tide and carried out to see. But I ventured forth anyway and did battle with the waves, crashing through them, or diving under them, or jumping over them, and when just the right wave came, I'd dive in front of it, my arms outstretched, my head tucked down, and caught up in the powerful wave, I'd ride in to the beach till the wave stranded me on the sand, and then I'd turn and run back out. I caught quite a few good rides, and felt refreshed and alive.
We watched a lot of basketball on TV and talked about the stock market. The market has been rough on people with fixed incomes. My father was a cautious investor and seems to have protected himself okay with more bonds and declining amount of stocks as he has gotten older. He had some stories to tell about heavily invested neighbors looking for work in their seventies. Me, I don't think I'll have to worry about retiring too soon and living off my portfolio. I expect to be working into my seventies even with a good stock market if we have one again (which I expect we will as all things are cyclical). I don't see much other choice. I do not play the lottery.
It was a nice trip. We laughed over old times and promised that next time we would bring our girls down. While my father enjoys Florida and his wife clearly loves her golf and bridge groups, I think he misses the grandchildren and going to kid's soccer and baseball games. I definitely need to make some time to get down there and bring the grandchildren to him.
The flight back was a little rough on the landing and left me a little queasy, but the 28 degree air snapped me out of that. I was tired when I got home, but there was no better sight than being met at the top of the stairs by my fourteen month old, who was jumping up and down and saying Dada. Later when we read books, I was delighted to see that she had added a monkey imitation to her already prodigious collection of animal impersonations (cow, tiger, snake, wolf.)
So here I am today back at work. It was good to get away. I feel like a better paramedic than I was when I left.
Since last July I have been working basically two full-time jobs. Forty hours a week as a medic and then fifty-six hours every two weeks as a clinical coordinator -- a routine that leaves me with one day off every fourteen. I like both jobs (particularly in this economy), but I really did need some time off.
I hadn't flown for several years so the tube of Suntan lotion I bought the night before I had to pitch at the entrance to the security gate because it was an 8 ounce tube and not the smaller permissible size. And then since they went to e-ticketing, it seems they no longer save the exit rows for tall people to request at the gate so I was stuck with my legs pressed up against the seat in front of me.
For food, there was no TV-type dinner, just a tiny bag of peanuts. The stewardess actually gave me two bags and a foil wrapped cookie. I also got half a Diet Coke from the other stewardess. I guess they are called flight attendants now or uniformed flight crew.
At least I had several newspapers and magazines to pass the time. I buy Men's Health, Time, Entertainment Weekly and Rolling Stone when I fly along with USA Today, the New York Times and the local paper. On a three hour flight I get a good sense of what is going on in the county. I learned what "twittering" was. I had never heard of it before, but it was mentioned in nearly every publication. I did get a little depressed in reading the cover story of the Rolling Stone about the cast of a TV show called Gossip Girl, and how the cast members were complaining of lack of anonymity. Well, I am out of touch, I could have been sitting next to one of them on the plane and not know it. But that wasn't nearly as depressing as reading about the AIG scandal. I don't even want to go there.
It was good flight, and I was glad to see my Dad and my brother. We went out to eat twice (I had two beers on the first night, two beers on the second and then three and a half with dinner on the last night when we went to a sports bar(the half was finishing my brother's third). I love drinking beer, but working everyday I just don't anymore. I would have gladly had more, but the occasion wasn't right).
We went to a spring training game where it rained steadily for three hours before they started the game. We left after two hours. Just going to the ballpark and having a hot dog was good enough. I managed to go running twice -- it was more humid than Connecticut, but I managed to do four miles on my last run. I am slowly getting back into shape after a long chest cold this winter.
On the last day, we went to the beach where there was crazy surf. There were 100 surfboarders and no swimmers -- at least until I arrived. One of my few talents is that of a body surfer (due mainly to my thin 6'8" frame). I did hesitate before entering the water. It was rough out there, and since it had been a few years since I had been in the ocean, I wondered if maybe my bones were now to frail for the onslaught of the waves, if I would get caught up in a rip tide and carried out to see. But I ventured forth anyway and did battle with the waves, crashing through them, or diving under them, or jumping over them, and when just the right wave came, I'd dive in front of it, my arms outstretched, my head tucked down, and caught up in the powerful wave, I'd ride in to the beach till the wave stranded me on the sand, and then I'd turn and run back out. I caught quite a few good rides, and felt refreshed and alive.
We watched a lot of basketball on TV and talked about the stock market. The market has been rough on people with fixed incomes. My father was a cautious investor and seems to have protected himself okay with more bonds and declining amount of stocks as he has gotten older. He had some stories to tell about heavily invested neighbors looking for work in their seventies. Me, I don't think I'll have to worry about retiring too soon and living off my portfolio. I expect to be working into my seventies even with a good stock market if we have one again (which I expect we will as all things are cyclical). I don't see much other choice. I do not play the lottery.
It was a nice trip. We laughed over old times and promised that next time we would bring our girls down. While my father enjoys Florida and his wife clearly loves her golf and bridge groups, I think he misses the grandchildren and going to kid's soccer and baseball games. I definitely need to make some time to get down there and bring the grandchildren to him.
The flight back was a little rough on the landing and left me a little queasy, but the 28 degree air snapped me out of that. I was tired when I got home, but there was no better sight than being met at the top of the stairs by my fourteen month old, who was jumping up and down and saying Dada. Later when we read books, I was delighted to see that she had added a monkey imitation to her already prodigious collection of animal impersonations (cow, tiger, snake, wolf.)
So here I am today back at work. It was good to get away. I feel like a better paramedic than I was when I left.
Sunday, March 15, 2009
An EMS Mark Twain
Stephen "Kelley" Grayson's book "Life, Death and Everything in Between" has been rewritten and published in hardcover by Kaplan Books as "En Route: A Paramedic's Stories of Life, Death, and Everything in Between."
The book covers Grayson's long career from day one EMT rookie to established paramedic. It is told in short chapters that are stand alone stories in themselves. On one hand, you want to read the book right to the end, on the other, you want to take it slowly, a chapter a day to make the enjoyment (and often laughter) last.
Grayson is an EMS Mark Twain -- a gifted humorist who packs a serious punch. He does a great job of describing what it is like to be in EMS -- the good and the bad, the high points and the lows.
It is absolutely one of the best books about EMS I have read. Highly recommended.
Grayson is also the author of the popular blog: A Day in the Life of an Ambulance Driver.
For those who live in New England, Grayson will be delivering the opening lecture at the Connecticut EMS Conference this Friday, March 20.
The book covers Grayson's long career from day one EMT rookie to established paramedic. It is told in short chapters that are stand alone stories in themselves. On one hand, you want to read the book right to the end, on the other, you want to take it slowly, a chapter a day to make the enjoyment (and often laughter) last.
Grayson is an EMS Mark Twain -- a gifted humorist who packs a serious punch. He does a great job of describing what it is like to be in EMS -- the good and the bad, the high points and the lows.
It is absolutely one of the best books about EMS I have read. Highly recommended.
Grayson is also the author of the popular blog: A Day in the Life of an Ambulance Driver.
For those who live in New England, Grayson will be delivering the opening lecture at the Connecticut EMS Conference this Friday, March 20.
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