the doctors out, but i know something!

My sweet summer is gone...

2018-09-07T20:06:00.001-04:00

Okay, so let's go over some things.

1) Summer flew by in a flash.
2) Working is hard.
3) Balancing a social life, multiple relationships, and work is even harder.
4) “Nothing worth having comes easy.” ~Theodore Roosevelt

I went to GNEW for the second time and formally joined the SCA. I started working to become an Archery marshall and I'm getting into archery, rapier combat, thrown weapons, and homebrewing! What better "art" to learn than making alcohol. My first homebrew was set up for failure from the beginning. I told a coworker I was interested and they gave me a Mr. beer kit and some outdated ingredients... by about 4 years. What do you do with expired malt extract? Make your first beer! It sucked. Hence, Jake the dog.

I brewed my second batch with seemingly more success. I got a True Brew kit from my local health food store, I chose an Irish Stout. Brewed it with my Dad, and finally bottled it today! Our 5-gallon batch earned us 27, 12oz bottles and 12, 16 oz bottles. My Dad took on the struggle of drinking more beer while I expedited the process and just bought the nice swing-top bottles. I appreciated these bottle caps because that's what has gotten me into homebrewing. I don't think full kits and plastic buckets are in the SCA period, but I do approve of the social connection with brewing and drinking beer!
I've also collected over 15Lbs of Honey to start making mead and with apple season now around the corner I can see a large number of Cysters and hard ciders being brewed!

Done is better than perfect

2018-01-31T14:33:00.002-05:00

Does it make sense to write a blog post about every video I make? No. Why wouldn't I just put it in the video? Well, I'm learning. I'm always learning. One of the first quotes I can think of came from a high school writing class. Bethany was teaching it and she always told us to write a shitty first draft. I have always had difficulty with this. More often than not I will choose to walk away from a project that seems "bigger then I can handle" because I don't want to look stupid. Now the jokes on me, I regularly look stupid (it's mostly my hair)... That isn't the point.

Perfectionism is the voice of the oppressor, the enemy of the people. It will keep you cramped and insane your whole life, and it is the main obstacle between you and a shitty first draft. -Anne Lamott

Even this silly Tide PODS video. I was almost done and I shut down the program because it wasn't good enough. My ridiculous acting was excessively ridiculous. The lighting was wrong. The video quality wasn't perfect. I almost walked away. Then today I watched a video by Peter McKinnon. He showed how bad his old stuff was. He wasn't born a fantastic photographer and cinematographer! He's been making videos and shooting photos for over a decade... Nothing should make me think that I will be anywhere near as skilled or make content as good as he does. At the end of the say, Jake says it best.

“Dude, suckin’ at something is the first step to being sorta good at something.” ― Jake the Dog

My videos and photos are not "good" yet, but that doesn't mean they won't be. I'm a paramedic. I'm not a YouTuber. I don't need to make money on YouTube. I mean, I probably shouldn't make money on YouTube. I need to make content because I love doing it. Not hoping for a paycheck I'll never see.

Anyways, watch these two videos and appreciate that it's the mistakes we make that we learn from. It's the combination of a million lessons learned from a million mistakes that make real change.

And if you appreciate all that... Here's my video! It's my video!.. That's all I have going for me... Everyone has to start somewhere....

CollegeLyfe: A photo hunt

2016-11-07T09:50:00.002-05:00

1. A spontaneous moment
2. A compelling place
3. An other
4. Something on a different scale
5. Lush green growth
6. Something sinister
7. Something foreign
8. A map
9. Something tricky
10. Something burning up
11. Something content
12. A system

Connect on Social Media!

Behance

CollegeLyfe: Photography - Light

2016-10-05T12:00:00.000-04:00

Week 5 is based on light. I tried to modify my position to get a lot of different lighting conditions. I found "DPS: 9 Lighting Types to Harness & Improve Your Photography" really useful for ideas. I am hoping to do some more shooting in the future and add more to this.

The lighting conditions I had to work with were fairly direct, I was very happy with the lens flares I got and especially the lantern shots!

Don't forget to see my other stuff on social media!

Behance: https://goo.gl/PPU6f2

Instagram: https://goo.gl/rAdlqL

Twitter: https://goo.gl/8JV2Dv

SnapChat: https://goo.gl/gsE416

Thanks,
Nicholas.

How-to, a festival.

2016-10-04T14:00:00.000-04:00

How-To Festival and Block Party

This was the 3rd annual How-To Festival.

I've never been to a "How-To" festival before, It was very interesting! From writing prompts to 3D printing, a large variety of arts were present. My personal favorite were tech related of course. I learned that the Maine State Library UP room is a thing! While I haven't had the opportunity to work on projects, I hope to in the very near future!

I entirely understand that this video is not a production miracle. My goals are just to create. I've spent months watching videos on how to make videos... Yet I haven't been making them... So, I have to start somewhere. I am hoping to do a weekly Adventure log to be posted on Mondays. I just found my school has an open computer lab on Mondays! I am really excited to start working on a decent computer! I will be making more content as time goes on! My current interest are photography, Youtube videos, and Podcasting. I am working to build out those interest and start producing and sharing them more regularly! If you want to see more of those than make sure to follow my social media profiles!

Google+: https://goo.gl/7iPVR2

Instagram: https://goo.gl/rAdlqL

Twitter: https://goo.gl/8JV2Dv

SnapChat: https://goo.gl/gsE416

Thanks,
Nicholas!

CollegeLyfe: Photography - Depth of field

2016-10-03T12:00:00.000-04:00

Week 4... Which was 2 weeks ago...

Week 4 was based on Depth of Field. I got woefully behind due to some poor life choices (Yes, I do want to work a 60 hour work week! Great idea!) but I'm back on track and moving forward! I have got Adobe Lightroom working, which is what is running the lovely slide show you see above!

I did most of my work this week in Aperture mode, The Canon 80D has a touch screen... which made focusing a little bit of a cheat, but I also did some manual focusing. If some pictures appear out of focus... that's why.

Thanks,
Nicholas.

CollegeLyfe: Laboratory.

2016-09-28T12:00:00.000-04:00

The verb of science.

As a rule, I love science. I especially love doing Labs. Lectures are theoretical. Most of the time you just sit and listen, maybe take notes, but unless you have prior experience you don't challenge the information. You just accept with as a possible theory. Then you go to the lab. In the lab (I say lab, but I mean any place you can apply theory to the world around you) is where science goes from something you read, something you're told, to something you experience. The laboratory, In whatever form it maybe, Is the verb of science.

How would you describe the colony morphology?

I have the great opportunity to be taking Microbiology and Biology I this semester. Both require a lab book. AFTER I write and sign off on each report I am going to publish them here. NOTE: Plagiarism is illegal, unethical, and grounds for dismissal from an academic institute! Don't be dumb and just copy my work intro your lab book and expect it to fly... Not that I think anyone is looking at this blog to copy my work... It's worth saying.

So here's a glimpse of some of the little buggers you're going to see in the future. I am going to try and get microscope camera adapter so I can share some of the images that are a million times better than my terrible drawings!

My goal is the more I share about my experience, the more involved I have to be to properly share it. A modified "see one, do one, teach(share) one" if you will.

Until then! Thanks for reading,

Nicholas.

CollegeLyfe: Capturing motion

2016-09-20T12:01:00.000-04:00

closest thing I got to panning...

It's kind of weird to be start blogging 3 weeks into a semester, but I felt I wanted to share my college experiences and what I'm learning. So this post focuses on photography. This weeks assignments was to capture motion. I should go back and document what all the different shutter speeds were.... but that's a lot of work. Instead, just enjoy the motion captured! I tried capturing some panning, but It proved difficult, especially with a spastic kid as my subject... I finally did capture the first picture of his face mostly in focus.

I then tried to capture him in motion while keeping the rest of the scene clear. Some of the technical aspects of this photo aren't great. The sky is rather blown out, I'm still learning to work with color corrections...

To capture a good motion blur I meant to go to an overpass and get a great shot, but that opportunity didn't come. The motion blur of this picture is the beast I could capture. It certainly didn't help that my windshield needs washing...

Circus Maine is an amateur and professional level circus school in Portland, Me. Every third Saturday they have in house performances. They bring in instructors and entertainers from all to shows off their skill. This ring acrobatics set was by far my favorite. I love how smooth her movements were and you can really get a feel with the long exposures just how smooth the arcs are. The performances are great and at $16/Person for a 2 hour show, absolutely worth it.

If you've read this far, thank you! I look forward to sharing more of my college experience. I am looking for a good way to share my Biology I and Microbiology without creating an issue... Cellphones are pretty good vectors for microbes and I don't believe my who class wants to be recorded...

Nicholas.

Workplace and Academia: Who Teaches You to Wear Pants?

2016-02-10T10:06:00.000-05:00

This statement, in general, is ridiculous. No one needs to teach you to wear pants in college or the workplace. You and I learned how to put on pants as kids. Our guardians taught us cultural norms about the expectations of wearing pants... So why are we having trouble with it now?

Let's preface this with humans are naturally lazy energy-conscious; we know and accept that. Unfortunately, humans have done more “work” than any known species, we also have to continue doing work to keep our value. Work meaning “exertion or effort directed to produce or accomplish something; labor; toil” From a scientific standpoint work is only produced IF result are produced. I can lean against the empire state building for days and have done zero work. I feel like I’ve looked at algebra problems for days… and done zero work. As an EMT I am expected to show up to work a certain way:

A half hour before my shift starts.
Wearing a clean appropriate uniform
Having good personal hygiene
Positive attitude
Prepared to show the attributes

Compassion
Excellence
Leadership

I 100% accept that I am not perfect. I can show up with mud on my boots from the last ditch I was pulling someone out of. I can have a stain on my shirt from the snack I wolfed down between calls. I can work for 24 hours and not get a shower or brush my teeth. I can have a bad day.

That doesn’t change the expectation. It means I’m slacking.

I was lucky enough to have been raised by two parents who wanted to raise adults. I’ve been reminded of this often from the time I was very young. It generally meant that I had, again, done something wrong and had to fix the issue. They did this on purpose, as much as I was sure that it was just to make me miserable. They did this because they didn't want me to end up on YouTube. I doubt I would have acted out a "greatest freakout 2" but the statement stands. Unfortunately, a lot of my generation the "Millennials" immediately get tagged as such. Every day I see people posting on social media about another "Millennial" wanting free stuff, not having to work, and just accepting their physiologic bias to laziness.

While I would never say no to free stuff I also understand the burden of having to work full-time and go to school full-time. What does that have to do with pants? The three domains of learning basically show how we learn and think. The Domain that is becoming the problem is the affective or feeling domain. I can make you read a textbook and practice a skill a thousand times but I can't make you give a fuck about it. At work, I wear a uniform. When I put on my uniform I am expected to act a different way. I'm treated a different way. We know this and we use this. Doctor wear a white coat so you know they are important. Police officers wear uniforms so you know they are important. I wear a uniform so you know I'm important. We all wear different uniforms and we all act differently with them on. We take advantage of this internally by believing in the uniform, and externally by people believing in us.

A lot of things changed in my paramedic program to try and get people to care. To make us good students that can easily become good employees. To make the work we did in class, become the work we do as a career. Unfortunately, some people still believe in the school they went to as children. They believe that freedom of speech means they can curse and complain. They believe that self-expression means wearing their pajamas. In crisis, we sink to the level of our training. This is important if you trained like a sailor in their pajamas.

I was always homeschooled. The only thing I knew about public school was that 99% of the kids there were dicks. I went from being homeschooled to working as an EMT. I was still a kid, so I was watched very closely. If my boots weren't clean I heard about it. So when the fact that we were going to wear uniforms in class dropped I didn't even flinch. We wore that uniform for everything we did outside the classroom, we're doing the same stuff inside the classroom, why wouldn't we? "Train how you play" right?

So pants. Does wearing pants effect the Thinking Domain? maybe? most likely not. Does it effect Kinesthetic Domain? Well... depends on what you're trying to do, but probably not. Does it effect the Affective Domain? Yes. I believe that if you show up in your pajamas you aren't truly punched in. You may sit in class, take notes, and answer questions. This isn't that kind of class. We aren't here to simply get a degree. We're here with a purpose, that purpose is to learn how to take care of the sick and injured, to live a life full of compassion, excellence, and leadership. To show up to your job as excited to be there on the first day as you are the hundredth and thousandth because you get to make a positive impact in someone's life.

The thing about the affective domain is that it follows you everywhere. Shockingly enough if you're a jerk in a classroom, you'll be a jerk in the workplace. If you're lazy in class, you'll be lazy at work. If you talk to your professors like their idiots... You'll probably get fired. You don't get to pick and choose who you work with. Being able to adapt and be in control of your affective domain is essential to being a good paramedic, good medical provider, and a good human. Anyone can train you to be good at starting IVs or remembering drugs. Only you can make yourself care.

Thanks for reading.

"Why Ultrasound Belongs in EMS"

2015-12-20T14:39:00.000-05:00

While perusing the the twitter sphere I found this tweet...

Ultrasound in every service.My #ECCU2015 pick with Drew Harrell MD @tingles005 @paramedic_al https://t.co/CUAHCNagaI pic.twitter.com/mQs1Tj6eZc
— Word on the Street (@wotsukrobl) December 11, 2015

It really caught my eye thanks to the paper I just wrote and shared here. Point of Care Ultrasound (POCUS) has great utility in acute care and it will probably be the only imaging modality that could reasonably be put in an ambulance. Sonosite and Philips just released pocket/tablet form US devices that could easily be kept next to a cardiac monitor. If Philips is listening they will realize they make EMS cardiac monitors and US probes that could be added together... just an idea.

Prehospital Ultrasound in Undifferentiated shock, Cardiac Arrest, and the End of Resuscitation.

2015-12-08T23:40:00.003-05:00

Please feel free to comment, on the topic or my grammar! This paper has already been graded. ;-)

Prehospital Ultrasound in Undifferentiated shock, Cardiac Arrest, and the End of Resuscitation.

Nicholas Jackson

Southern Maine Community College

For years ultrasound was an imaging modality for sonography technicians who acquired them and the radiologist who reviewed them. With the rapid rate technology has evolved and developed we now have point of care ultrasound. Point of care ultrasound allows physicians in the emergency department and office setting to acquire diagnostic quality imaging at the bedside. While physicians have a vast array of transducers, protocols, and views The question remains, Can paramedics perform the same feats to help our patients? In this paper we will review the “Focused echocardiographic evaluation in life support (FEEL)” protocol, the “Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS)” protocol, and assessment of non shockable rhythms under ultrasound.

Beets BLU heart rate monitor review.

2015-07-10T17:45:00.001-04:00

I was given this Beets BLU to review by my Papi, Chris from FaithHack. He had received them as a sample to test/review for BeetsBLU.

First impression:

When I first got it i though it was decent looking, it's small and unobtrusive. Wearing it the first time was different and it took a couple tries to get it sized just right. On the inside of the chest band are the two electrodes to pick up the hearts electrical signals. I've found placing it just below the breast line in the 5th rib space sits well and gets good pickup.

Set up:

BeetsBlu uses Bluetooth smart which means it doesn't connect through the traditional Bluetooth functions. You must connect it from one of their approved apps (I use RunKeeper and the BeetsBLU app), as soon as you figure out you have to use the app first it is easy to setup.

Running:

Running with BLU was easy. It took maybe another 20 seconds to get it turned on and set up. While running I found it was relatively accurate. When I went full blast and was up in the 180-200bpm range it really wasn't that happy... but nether was I. When I did my normal running pace it was niceto be able to just peek and check if I was in the right range. I stopped a couple times and checked it compared to my radial pulses and they marched out with about a 5 second delay from pulse to app. My only complaint is after about 2 miles of pounding pavement the monitor had slipped down my chest a little. It was still picking up a signal and worked appropriately but I was more concerned it would fall down later. I did have to adjust it after getting my hands over my head for a little air break.

Yoga:

After my running experience I was concerned that moving in any way other than a gentle run would displace the device. So I tried a half hour yoga session with it on. It actually stayed better than I thought it would. I never had to adjust it even after major twist and turns. With the Bluetooth smart I was able to keep my phone on the table and out of my way. It is rated for a stable connection up to 10 meters (33 ft).

Would I buy it?

If I wasn't a poor college student, yes. I found the device worked well, it's low profile and light weight make it reasonable to keep on while running. I liked being able to track how well I was doing and keeping my heart rate controlled. I could also see using it for meditation exercise to see if your getting the biologic responses you're looking for. Anyways, at $39.95 it's not a bad deal at all.

Hold your ground during the charge!

2015-03-09T21:56:00.001-04:00

#AAEM15 Winters: 18% Inc in mortality per 5 seconds of pause during CPR. http://t.co/QpVVdvYx7F
— San Antonio EM (@SanAntonioEM) March 2, 2015

Excuse me? you said what?

"In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses." (Cheskes et all., 2013)

Decreasing peri-shock pauses is a good thing.

Fig. 2. Cheskes et all., 2013

The less time we are squeezing the chest, the less time the victim is perfusing and the less their chances of survival. To maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions. Expert consensus is that a Chest Compression Fraction (CCF) of 80% is achievable in a variety of settings. (Meaney et all., 2013) A viable method to decrease compression pauses is to perform compressions as shocks are charged and delivered*. The purpose of CPR is to compensate for the failure of the heart to adequately pump blood throughout the body. We're trying to perfuse the heart (and brain) well enough to get the heart excitable (Ventricular fibrillation/Tachycardia) and restartable (Shock/defibrillation).

From RebelEM

*While some evidence suggest CPR during defibrillation is safe and has benefit (Neumann et all., 2012) the AHA does NOT recommend it. Rescuer safety is the highest priority in any scenario and should stay that way!

However, as technology evolves and research continues we may find a way to safely keep hands on during the entire incident. With the increasing frequency of CPR quality monitoring devices (or CPR pucks as I've called them so far) we may have a viable barrier to protect providers from electrical shocks, with the risk of redirecting high voltage electricity into monitors worth thousands of dollars.

Until that day, remember an 80% CCF and rate of 100-120. feel free to use this excellent reference material for a rate.

Bibliography:

Cheskes, S., Schmicker, R. H., Verbeek, P. R., Salcido, D. D., Brown, S. P., Brooks, S., … Christenson, J. (2014). The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation, 85(3), 336–42. doi:10.1016/j.resuscitation.2013.10.014

Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., … Leary, M. (2013). Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128(4), 417–35. doi:10.1161/CIR.0b013e31829d8654

Neumann, T., Gruenewald, M., Lauenstein, C., Drews, T., Iden, T., & Meybohm, P. (2012). Hands-on defibrillation has the potential to improve the quality of cardiopulmonary resuscitation and is safe for rescuers-a preclinical study. Journal of the American Heart Association, 1(5), e001313. doi:10.1161/JAHA.112.001313

No TV week? Keep calm and read #FOAM!

2015-01-29T22:16:00.001-05:00

Have you just started at a service that doesn't have cable? Did your service rip the carpet out from under the feet of Abby and Gibbs? Don't know where to go without DiNozzo? Is your service trying to shield you from the Illuminati grasp on cable media? Well here's some advise for you. Keep Calm and read FOAM.

But what is FOAM?

Well it's Free Open Access Meducation says the amazing folks over at Life in the Fastlane. It's a fantastic tool to learn, teach, and grow as a person who providers medical care. It isn't just residents or doctors who use it. Nurses, respiratory therapist, medical assistants, paramedics, and ALL Allied health providers can benefit. FOAM has been facilitating collaboration across the world. In my little services we find it hard to talk to our neighbors, much less work with people in other countries. With social media connecting people on opposite sides of the world, it amazing to see development happening. So how do you access it? That's the fun part!

How do I join?

You're already a part of the #FOAM community if you want to be! So here are the tools used by most.

Twitter: Twitter is an excellent tool to share links, articles, and small comments. It's rather limiting with 140 characters and use may be frowned upon by your service while on shift.
Podcast: meaning Ipod broadcast is an audio feed. listening to things like FOAMcast and EMCrit is an excellent use of your time. I promise.
Google+:
- The EMCrit community is strong there! as are many other very smart people. You're service should have any problem. 1) It's Google. 2) none of your friends use it.
- I've also been involved with a EMS based community called Quality Box Time with a medic (he runs the Facebook version, I hope G+ is more popular!) for FOAM relevant to EMS/Prehospital providers.
- FOAMcc is an excellent community! Moderated by Chris Nickson, John Greenwood, Minh Le Cong and Scott Weingart. It has a fairly comprehensive affiliate list. I am slowly getting into more and more of this list as time goes on.
Finally! Go look at EMCrits Favorites, you don't have to take it from me!

Does it need a card to be educational?

The overwhelming answer to this is no. Unfortunately most of our educational budgets are consumed by keeping people competent. So it lands with the individual providers to learn more. Yes, that means you. The good news is you aren't alone, everyone else can use to learn more. Every day I learn something new that changes what I was taught before. I was told that we can not differentiate between a MI and a LBBB. Well we can with Sgarbossa Criteria, "A total score of ≥ 3 has a specificity of 90% for diagnosing myocardial infarction." (1,2), Go check out LITFL for more on that.

So who wants to have a four hour refresher on ACLS with information from 2010? FYI, the "Proven fact" that cooling our patients to 33°c has mortality benefit was debunked in 2013(3,4). I do not, but I must, because I need to keep a current card. I've learned the information and at this point, "refreshing" dosages and algorithms seems like something I could do more easily while sitting around base on my own or with coworkers as a full simulation. Without TV being a major barrier to get by I would hope people would be more then willing to "play".

As good medical professionals we are responsible for keeping ourselves up to date and well trained. With the excellent resources presented to us as FOAM it is very hard to cling to ignorance any longer! Hopefully this will spur a movement make learning a daily adventure and not an annual or monthly drag.

References:

Sgarbossa Criteria. Mike Cadogan. Life in the Fastlane
Sgarbossa, E. B., Pinski, S. L., Barbagelata, A., Underwood, D. A., Gates, K. B., Topol, E. J., … Wagner, G. S. (1996). Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. The New England Journal of Medicine, 334(8), 481–7. doi:10.1056/NEJM199602223340801
Kim F, Nichol G, Maynard C, et al. Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2014;311(1):45-52. doi:10.1001/jama.2013.282173.
Nielsen N,Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med 2013; 369:2197-2206December 5, 2013DOI: 10.1056/NEJMoa1310519

Cranial nerves and hard ons, oh my...

2014-12-06T15:57:00.000-05:00

"Ooh, Ooh, Ooh, to touch a female vagina, gives Victor a hardon."

Patrick J. Lynch, medical illustrator

See, I said it. Vagina, hard on, and I'll just go ahead and add penis to this sentence. However, It worked for it's purpose. Remembering the 12 Cranial nerves.

I – Olfactory

II – Optic

III – Oculomotor

IV – Trochlear

V (1,2,3) – Trigeminal

VI – Abducens

VII – Facial

VIII – Vestibulocochlear

IX – Glossopharyngeal

X – Vagus

XI – Accessory

XII – Hypoglossal - (Via Wikipedia)

(Yes, I'm using Wikipedia as a source. No this isn't a scholarly or even very intelligent post, it's okay.)

Sooo, I was suppose to memorize the 12 cranial nerves and their function (sensory, motor, or both) for a test this semester. I didn't, the test didn't go well. this is the point of test (or is how I use them at least). They are to show you what you need to learn! Within hours of that class ending, the tale of Victors sexual adventure was being repeated in my head over, and over, and over. The names of each nerve sticking out to me as much as the same nerves in my head. With the names cemented I needed a way to remember the function, and in came Victors brother.

"Some say marry money but my brother says big brains(and/or boobs) matter more" ~Dr Tim Luijkx and Dr Frank Gaillard et al

Sensory, Motor, or Both? That is the question... So we take our list of cranial nerves and line them up like so.

Some – Olfactory

Say– Optic

Marry – Oculomotor

Money– Trochlear

But – (1,2,3) – Trigeminal

My– Abducens

Brother– Facial

Says– Vestibulocochlear

Big– Glossopharyngeal

Brains/Boobs– Vagus

Matter– Accessory

More– Hypoglossal

That gives us the basic breakdown. Which is all I need for now. I hope someone finds this as helpful as I did! I wonder if anyone has done a study to see if the more inappropriate the mnemonic is the more effective it is to help people remember. Or maybe I'm just a little extra goofy and dirty minded... uh oh...

Medic school paper - Appropriate Utilization of Helicopter EMS - Draft

2014-11-14T17:13:00.000-05:00

(Please comment! If you want to comment on the paper in Google docs then I will happily share the link! Thank you!)

Helicopter based emergency medical services (HEMS) are an essential part to any EMS system. The first benefit noted with HEMS is that it gives prehospital providers access to rapid transport without the difficulties of traffic or terrain. HEMS utilizes staff ranging from a critical care paramedic to a physician led team. Working under an expanded scope of practice compared to the traditional ground ambulance. However, HEMS can be misused and abused like the rest of the EMS and emergency response system. According to Taylor, C. B. (2010) annual cost range from $115,777 to $5,571,578. The LifeFlight Foundation annual report states that in 2013 alone Maine’s very own “Green Angels” had expenses equalling $9,109,732 (2013, p. 22). That cost can be placed with the patients and insurance or absorbed by the government and citizens. No matter where the funding comes from, it is associated with significant cost. The question is are we, as ground based field providers, properly utilizing HEMS as the valuable and equally expensive resource it is? To decide that we are going to look at HEMS response, skills provided by HEMS, and issues or risks associated with HEMS.

The first decision we need to make is when the proper time is to activate HEMS, and when is air transport beneficial over ground transport. The first thought is almost always trauma. From my first day learning the management of trauma as an EMT, I was taught that “bright lights, cold steel” are what save the lives of trauma patients, and that getting them to a trauma center as quickly as possible is the best way to help that patient. It’s easy to assume that calling a helicopter will decrease that time. Helicopters fly faster than we can drive and don’t deal with rush hour traffic; unfortunately life is never that simple. Shepherd, Trethewy, Kennedy, and Davis performed a retrospective study. “To profile a helicopter emergency medical service in rural Australia. To assess patient injury severities and outcomes. To compare missions involving ambulance officers with physicians. To determine any time advantage of the aircraft over ground transfer.” (2008, p. 1). While Maine may not be as interesting as Australia it does have many places that fit into the rural category.

When comparing air transport to the computer calculated ground transport by local ems, Shepard, Trethewy, Kennedy and Davis found that in transports under 50Km (31 Miles) road transport calculated to a mean of 29.44 minutes, while air transport had a mean of 48.11 minutes. This is due partially to pre-flight preparation and increased response distance compared to local ground EMS. It was noted between 50 Km and 100 Km that times were very close with a mean time of 56.34 minutes for ground and 62.63 minutes for air. When looking beyond 100 Km (62 Miles) a significant difference is found; the mean transport time of the helicopter being 93 minutes while ground transport reached a mean of 141 minutes (2008, p. 496-497). Shepherd, Trethewy, Kennedy, and Davis concluded, “we believe that in comparable environments and in the absence of special circumstances, a helicopter response within 100 km from base does not improve time to definitive care” (2008, p. 498).

Take a map of Maine, and draw circles of a 30 mile radius of every trauma center. If your service falls in this circle, than even in trauma without special circumstances (e.g. patient entrapment or airway interventions beyond paramedic scope of practice) strongly consider transporting directly to the trauma center. On the other side of the equation, if your service covers an area 60 plus miles from a trauma center or the call requires prolonged extrications, or advance airway interventions outside of the paramedic scope of practice, then strongly consider HEMS in severe trauma.

LifeFlight has access to multiple tools that are either prohibited by cost or law to ground transport. Tools like rapid sequence intubation protocols, mechanical ventilators, portable lab equipment, invasive blood pressure monitoring, and blood products. Utilizing a paramedic and nurse team gives them the ability to provide the appropriate care to the most critical patients quickly and rapidly transport to the appropriate facility. While HEMS can use more tools than most ground based EMS and possibly use them better due to higher frequency skill use and proficiency.

“...prehospital intubation in patients with severe head injury was associated with worse survival and functional outcome in their overall population, but was associated with improved outcomes when performed by helicopter crews”. (Brown, 2013, p. 282)

It was noted in the article that in a separate study, HEMS crews had a much higher intubation frequency (80%) as compared to their grounded EMS counterparts (10%), and had a lower mortality rate in head trauma patients of 34% (Brown, 2013, p. 282). we have evidence that attributes lower mortality to a specific injury process and we should strongly consider it.

Currently, LifeFlight uses two helicopters. One is located at Central Maine Medical Center in Lewiston and the other is, located at Eastern Maine Medical Center in Bangor. These two HEMS units cover the entire state of Maine which leaves some obvious access limitations. I personally have called for LifeFlight for a severe trauma and was told that the closest unit was over an hour away in New Hampshire. The reason? Both helicopters were transporting critically ill patients from smaller, community hospitals to large, tertiary hospitals. LifeFlight provides critical care interfacility transport to all the hospitals of Maine, taking an already limited resource and stretching it further. However, this is an essential task to providing good care to the population of Maine. Unfortunately, HEMS units may be available but unable to fly as well.

In EMS we have the difficult job of actually finding and retrieving the patient, no matter where they are. When the EMS system is activated we are obligated to respond in worse conditions than the Mailman. Rain, snow, and ice are all too frequent response conditions in Maine. I do not have the option of saying no to a 911 call. When winter comes and I have to respond to one of the many crashes, caused by snow and poor decisions, I will slowly and safely respond.

Most HEMS on the other hand can refuse a call for any reason, due to the increased dangers of flight and helicopters. The most common one being weather. With the dangers of operating a helicopter in inclement weather it is reasonable for a crew of three people to refuse a dangerous mission. They are not only responsible for their own safety like every EMS provider on the ground, but they also have to think of the patient and the risk over benefits of air transport in poor flight conditions.

It is not only the HEMS medical team that has to consider risk and benefits to the patient, the ground system requesting HEMS also has to consider it. Cost should never be a major factor in directing patient care, but we should always advocate for our patients. With air transport cost being substantially higher than ground, we have to use good critical thinking and medical decision making in deciding “should this patients be flown”? Does the benefit outweigh the cost and risk? Is it reasonable to saddle the patient with transport bill in the tens of thousands of dollars range for injuries or illness that is affecting them? As an EMS provider it is very easy to be afraid for your patient and want to give them the best possible chance by flying them. With any high index of suspicion due to apparent injury, clinical presentation, or mechanism of injury it is reasonable to activate HEMS. It is a different story if do not want to sit with the patient. If you are afraid of treating a patient for the time it will take to get to a trauma center then consider additional help in the back the ambulance instead of having HEMS transport. If for some reason a provider did not feel like giving the effort or the time to treat and transport a sick or injured patient this would be an obvious misuse of resources. It would be unethical for a provider to hand off a patient to a valuable resource as HEMS for personal convenience.

As much as I wish we had a scanner like “The Doctor” has in Star Trek: Voyager, we do not. We have to rely on a solid clinical assessment and factors like the mechanism of injury when it comes to requesting HEMS transport. The choice should never be made lightly, but if a provider has a strong feeling that the patient would benefit from HEMS for any of the reasons that have been discussed, like trauma with distances over 100Km, prolonged extrication, head injury with or without need of airway management. Patients who would benefit from medication assisted intubation, blood products, or invasive monitoring. It is important to recognize however, that HEMS is not always available or could have a significant response time. HEMS crews can refuse to respond for their own and the patients safety. In the critically injured or ill patient we as prehospital providers should always advocate for our patients and consider the risk and benefits of all of our interventions, that includes “calling the bird”.

References

Mommsen, P., Bradt, N., Zeckey, C., Andruszkow, H., Petri, M., Frink, M., & ... Probst, C. (2012). Comparison of helicopter and ground Emergency Medical Service: A retrospective analysis of a German rescue helicopter base. Technology & Health Care, 20(1), 49-56.

Shepherd, M., Trethewy, C., Kennedy, J., & Davis, L. (2008). Helicopter use in rural trauma. Emergency Medicine Australasia, 20(6), 494-499. doi:10.1111/j.1742-6723.2008.01135.x

Brown, J., & Gestring, M. (2013). Does helicopter transport impact outcome following trauma?. Trauma, 15(4), 279-288. doi:10.1177/1460408613497153

Taylor, C. B., Stevenson, M., Jan, S., Middleton, P. M., Fitzharris, M., & Myburgh, J. A. (2010). A systematic review of the costs and benefits of helicopter emergency medical services. Injury, 41(1), 10-20. doi:10.1016/j.injury.2009.09.030

LifeFlight Foundation. (2013). Annual reports [PDF]. Retrieved from http://www.lifeflightmaine.org/getattachment/About-Us/Publications/ Annual-Reports/Annual-Report-FY13-FINAL.pdf.aspx

Medic School Presentations: Tetanus, Infectious disease process

2014-10-08T13:00:00.000-04:00

What type of organism is involved in spreading this pathogen (bacteria, virus, etc.)? Identify the name of the organism (if any). If you have been provided with an organism/pathogen what disease does it cause?

Clostridium tetani spores

Anaerobic gram-positive, spore-forming bacteria
Spores found in soil, animal feces; may persist for months to years
They can survive autoclaving at 249.8°F (121°C) for 10–15 minutes.
The spores are also relatively resistant to phenol and other chemical agents.
Tetanospasmin estimated human lethal dose = 2.5 ng/kg
Causes Tetanus (Centers for Disease Control and Prevention, 2012, p. 291).

What is the common route of infection (air, blood, etc.)? Identify what would be the most likely way a paramedic would be exposed.

Spores usually enters the body through a wound or breach in the skin. Toxins are produced and disseminated via bloodstream and lymphatic system (Centers for Disease Control and Prevention, 2012, p. 292).
Paramedic could be susceptible in any environment that could cause a minor or major penetration injury.

During vehicle extrication. IE: Cutting hand or arm on severed vehicle post.
Removal of Pt from environment to Ambulance. IE: removal via stairchair and getting cut on rusty nail or removal from woods and getting cut from the undergrowth.

What personal protective equipment will limit the exposure of healthcare providers to the pathogen?

wear full length heavy pants, ankle covering leather boots, slash resistant work/turn out gloves, full sleeve shirt/forearm guards, and most importantly, get and maintain vaccination!

What is the incubation time for the infection?

The incubation period ranges from 3 to 21 days, usually about 10 days.

In general, the further the injury site is from the central nervous system, the longer the incubation period.
A shorter incubation period is associated with more severe disease, complications, and a higher chance of death.
In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days (Centers for Disease Control and Prevention, 2012, p. 292).

What are common signs and symptoms seen in a patient with an active infection? What will occur (signs/symptoms) if the disease is untreated? Provide stages if applicable.

The first sign is trismus or lockjaw. followed by stiffness of the neck

difficulty in swallowing
and rigidity of abdominal muscles.
Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate.
Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks.
Complete recovery may take months.
Tetanus is often fatal if left untreated.- (Centers for Disease Control and Prevention, 2012, p. 292).

How is this disease treated once a host has become infected? What medications/treatments are utilized?

Treatment for Tetanus consist of:

Antibiotics (primarily Metronidazole or Penicillin G) to eliminate the bacteria
Tetanus immune globulin (TIG) to neutralize the unbound Toxins.
This should be immediately followed by a Tetanus Toxoid containing vaccine (Hinfey, 2014).

Is there a vaccination for this disease? What is the vaccination (provide the name (s) of the vaccination(s))? How is the vaccine administered? How long does it last?

Tetanus vaccination comes in a couple different forms based on the age you receive it. -(Centers for Disease Control and Prevention, 2012, p. 297-298).

DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the vaccine of choice for children 6 weeks through 6 years of age.
If a child has a valid contraindication to pertussis vaccine, pediatric DT should be used to complete the vaccination series.
Td is the vaccine of choice for children 7 years and older and for adults.
A booster dose of Td should be given every 10 years.
Contracting the illness WILL NOT provide immunity due to the incredibly small amount of the toxin required to cause illness.

references

Centers for Disease Control and Prevention. (2012). Tetanus. In W. Atkinson, C.

Wolfe, & J. Hamborsky (Eds.), Epidemiology and prevention of

vaccine-preventable diseases (12th ed., pp. 291-300). Aurthor.

Hinfey, P. B. (2014, March 26). Tetanus medication. Retrieved October 2, 2014,

from Medscape website: http://emedicine.medscape.com/article/

229594-medication#8

Medic school Response: Into the water

2014-09-26T15:00:00.000-04:00

Into the Water — The Clinical Clerkships — NEJM

Something that I have a hard time with and work equally hard at is understanding that I think, I make the world around me. I get so focused on trying to be "the best I can be" and all the silly ideas that come with that. I focus on the best I can be, which turns into just focusing on me, which turns into not thinking outside my own head. So it's good to hear I'm not alone in that thought. It's better to know that I can change it. I hope that as my education and understanding of the world around me gets better I'll remember to think more. Now I've been in EMS for 2 years, which is a small chunk of time in the scheme of things but I do understand how the clinical clerkship can affect providers. Tuesday night I had an elderly lady with chest pain. A man in his 50s who was having a STEMI. 98% occlusions of the circumflex was the cath lab report when we got back. A post arrest, vented Pt who was bucking the tube but the receiving facility denied the request for sedation. A young girl who had a concussion from a car crash and was like a record repeating the same loop of confusion, tears, and questions. I gave each of them the compassionate, empathetic voice they all needed when they were sick but I could help but think when I was going to get my next coffee. Six months ago even i would have been overwhelmed to deal with just talking to these people in a single night. Now it's much easier to just smile, answer what questions I can, and try to treat them the best I know how. Now I'm not totally heartless or disconnected ether. "Occasionally, however, there were moments that evoked a twinge of my old discomfort, some inchoate sense that what had just transpired mattered more deeply than I recognized at the time." - Neal Chatterjee. I don't think I'll ever forget the screams of anguish from the father of the 16 year old boy I did compression on for far longer than we should have. I have aspirations of being a paramedic, I have aspirations of getting to that third year. I want to be a paramedic to try and get use to the water. I'm hoping by learning what water is and how to tread in it I will be more equipped to take the dive when the time comes.

Medic school discussions: VARK and JUNG

2014-09-18T02:00:00.000-04:00

Vark Learning tool

Visual: 4

Aural: 12

Read/Write: 4

Kinesthetic: 14

The VARK very accurately describes my personal learning style. I have always learned best by doing. I have to actually manipulate and try things to do them to the best of my abilities. I also enjoy and do well with lecturing. I enjoy listening and talking to people. I am indifferent to visual aid and power points, I see them more as a reminder of what a good lecturer should be talking about. I also dislike just reading text. I understand it’s importance and do it willingly, but it’s a slow process for me and I often get distracted multiple times a page.

With lecturing I am going to use my visual, aural, and more than likely reading/writing. Luckily my Aural skills are better and that makes me a good student for listening to lecture.

Hands on learning happens to be my forte. I do very well working with people and practicing skills, I learn by doing very quickly and have a much higher retention rate.

Jung Typology test

Please post your answers to the following questions: ENFJ - Extravert(67%) iNtuitive(38%) Feeling(12%) Judging(33%)

Do you feel that the Jung Typology Test is an accurate description of you? Why or Why not, please be specific.

I think this is a very good example of my personality. I've always been drawn to helping people. People find me likable, passionate, and charismatic. I feel like I could be a good leader. I always have been among friends and in social groups. I’m always a “glass half full” type of person and I think people like that about me and let me speak my mind because of it.

Do you think your personality type will make you a better paramedic? Why or Why not, please be specific.

I think it will help my career as a paramedic, EMS is a team sport but at the same time every team needs a leader. The most important thing that will help me lead an EMS team would be my faith in my team. ENFJ has a strong desire to believe and expect the best out of other people. We also are excellent communicators which is essential in any good medical care, much more EMS.

Do you think your personality type will make you a better educator? Why or Why not, please be specific.

I think I could be a good educator. I enjoy helping people figure out problems. At work I’m often asked questions about using the computers, mainly because I’m a geek, but also because I’m more then willing to sit down and explain things to people. I think anyone can learn anything given the time and good, quality direction.

Medic School Discussions: Roles & Responsibilities of the paramedic

2014-09-15T14:00:00.000-04:00

Please comment and let me know your thoughts, if I'm wrong I want to learn why and how to be better

Roles & Responsibilities

My three good qualities are preparation, response, and return to service. The only one I would say I’m strong in is Preparation. My thought process is that every call is critical until proven otherwise. I know this isn’t entirely true, but It’s much easier to motivate myself to check every nook and cranny of the truck and house bag if I think I’m going to work a code. I always find question to ask the medics I work with about calls I’ve done or stories I’ve heard. I read and listen to people like EMCrit to try and learn more about medicine and hope I get something I can use in my daily assessments and treatments of my patients. I feel my response is good, I’m almost always in the truck first. I drive to every call as quickly as I safely can with regard to traffic, road conditions, and weather. At the end of every call I work hard to get my truck to a better condition than it was before the call. I restock a little more than I used. I clean a little more than got dirty. I always want the truck to be in better condition when I leave then when I got there.

My weaknesses I would label as Scene management, Patient assessment and care, and Patient transfer and report. I think all of my weaknesses are experience or confidence related. I’m a lot better at helping to manage the scene, I think about how to best get to the patient and how to best and safely get them to the truck. I’m constantly looking for potential hazard in homes, especially in elderly population and with fall victims. I know I still need to work on it a lot more though. I always think of and utilize gloves as PPE but I rarely even consider the need for goggles, gowns, or mask. I believe my assessments are too disorganized, I try to figure out what is going on before I’ve established a solid baseline for my patient. That leads to the issues with Patient transfer. I don’t always have some of the information the ED wants to know because I focused my exam and assessment on what I thought the issue was from talking to the patient. Then I feel like I’ve done something in error and it throws off the rest of my report because I’m desperately trying to figure out what I missed.

My plan to resolve my weak areas should be mostly resolved as I move through this course. As I learn more about scene management from the medics prospective I’ll be able to assist better as a BLS provider and know what information is pertinent to tell my partner when I’m a medic. I fully plan on utilizing everything I learn, as I learn it to my nightly work. As for my patient assessment I will have an excellent opportunity to learn and refine my technique into an orderly, concise, and accurate assessment with this class and paramedic procedures I. As I strengthen my assessment abilities I will be able to confidently give a quality, concise report to any ER nurse because I will have done a broad spectrum assessment and a focus exam of the issues.

Medic School Discussions: What Does Professional Mean to you?

2014-09-12T10:27:00.001-04:00

**Please comment and let me know your thoughts, if I'm wrong I want to learn why and how to be better**

What Does Professional Mean to you?

professionalism: Possessing the required abilities, knowledge, and self-discipline to effectively perform a specialized action or work. As a paramedic I have to be able to quickly and accurately assess and treat a Patient. Not only do I need the knowledge and physical ability to do the work, but I need to have the self-discipline to do it appropriately, effectively, and compassionately. Because our work is so publicly available it is essential that we show ourselves in a confident, competent manner. If my patient doesn't think I’m competent because I lacked the self-discipline to tuck my shirt in and fix my hair at O’dark thirty they won’t be as receptive to my assessment or treatments.

As someone who doesn't have a lot of volunteer experience I have mixed thoughts of “professional” volunteers. On the first day of orientation at a 24/7 paramedic license service i was told never to laugh at the volunteers. No matter what they do wrong. That’s been extremely hard for me at some points. I am always extremely thankful we have volunteer EMTs that first respond in our communities. However, I think it is very hard for anyone to keep up a “professional” level of competency doing this on their off time. I have also been on scene where at O’dark thirty a volunteer jumped out of bed to meet us at a call but looks terrible. I’ve seen patients and family visibly settle when the “real” Paramedic/EMTs show up in uniform and looking semi-awake. I think a volunteer could be an EMS professional, but the majority simply can not afford the time, energy, and experience it takes to be an EMS professional.

As a full time, paid, employee of an ambulance company this is how I put food on my table. This is all I have to know how to do. I spend a minimum of 36 hours a week on a truck. During those hours I am getting paid to provide professional quality emergency medical care. I don’t have any other jobs other than being a student. Then I’m learning how to be a better, more professional EMS provider. Is every paid EMS provider a professional? I don’t believe so. Should they be? absolutely. We are the one who must take the call when a volunteer doesn’t want to. Our time is focused on keeping competent, and maintaining the abilities, knowledge, and self-discipline required to be EMS professionals.

Personally, I am always looking for means of improving myself. I am young, and still fairly inexperienced. So for me I feel my major weak spots in my professionalism are confidence, self-motivation, and time management. I am still a young provider. When I first started I was terrified to be left in the back or perform skills on a patient for fear of messing up or possibly harming a patient. Now that I’ve been doing it for a couple years I still doubt myself and my abilities at times; I know I can manage some sick and injured to my license level. Motivating myself and managing my time will be a critical skill I’m going to learn quickly from this class. I’m very motivated to do very well in this class, My only weakness is my squirrel quality attention span. my main effort will be to overcoming those and sitting down and fully completing assignments in a high quality, timely fashion.

Hours of boredom; Minutes of terror.

2014-08-20T17:00:00.000-04:00

"Shut up! you don't really work! you played borderlands for eight hours!" He spat. I had complained I was never home. I wanted him to get off his ass and stop playing games and help me clean up after I had worked 48 hours in three days.

I had to bite my tongue. He wouldn't get it. He was right in a sense. I had spent a whole 8 hours playing borderlands. Once. The last 24 hours hadn't been like that. Had not been like that at all. The area I cover is fairly quiet most days, most days being a key component in that statement. My favorite saying at work, to the point I would call it a mantra is "No rest for the wicked". Assuming I'm a wicked person, it's about as true as they come. Like some dispatcher somewhere was watching me, as soon as I kicked my boots off the tones dropped for another call. I was running on fumes by the time I got home.

I wanted to tell him to go pound sand. I had worked for the last 24 hours. I had slept a full hour. That was it. That's my job though. I personally love it, but that doesn't mean I don't get tired. That definitely doesn't mean I spend hours on hours a day playing games at work, It can happen. I wish I could get paid for playing games every day.

EMS is known to some as "Earn Money Sleeping." I will happily admit that I have actually earned money while sleeping at work. At some time and in some places that is normal. However, At my work it isn't. One that is normal to me is something I was told to expect in my EMT-Basic school.

Hours of Boredom; Minutes of terror.

No one really plans on having an emergency. No one jumps in a car debating how best to roll it or where to hit a pedestrian. That's my job. I sit and wait for the tones to drop. I train and read about the most current treatments of trauma, CVA/strokes, cardiac, and all other medical complaints. I could wait and read for hours. When the tones drop I have to be out that door in a minute or less. The hardest calls for me are the ones we can't do anything for but treat them with diesel. I can stop blood from getting out, but I can't do anything when it's dumping into your stomach but drive faster. We don't have the tools to see if you're having a hemorrhagic or ischemic stroke. A CT scanner doesn't fit well in the back of our truck(Some do). We can recognize a true heart attack or STEMI in the field but we don't carry the clot busting medications to hopefully stop or at least slow the damage to the heart.

So we're stuck. Watching the clock, waiting. Planning for the worst and hoping for the best. Living through hours of boredom for the sick twisted thrill of minutes of terror. EMS is a beautifully terrible place.

“Oh, you can't help that,' said the cat. 'We're all mad here.” ― Lewis Caroll, Alice in Wonderland

Critical incidents: it's not heartless, at least I hope not.

2014-08-08T12:29:00.001-04:00

Terrible things happen to good and/or undeserving people. The drunk driver walks away from heaps of scrapped metal. Parents do the exact opposite of take care of their children. One persons stupidity leads to another persons demise. Sometimes people just die because of unintended side effects.

I had the misfortune to help with one of these cases the other day. A young female, no medical history. Only medication was oral contraceptives (Now I'm hoping as I write this that it doesn't turn into the catholic churches next stand against contraceptives). Started complaining of not feeling well a few days ago and had fainted earlier on the day I met her. When I met her she was already intubated and waiting to go to a major hospitals. She had coded a half dozen times already.

In EMS we have this silly notion of an "EMS code save" which means very little for people we treat. It just means that we got them to the hospital with a chemically induced pulse. Their heart was beating when we got to the hospital so we're now heroes in our own mind. This is unsurprisingly a fantasy we design to make ourselves feel better about why we're here. It doesn't matter that our patient may be nothing more then a organ donor; if that.

So this young girl had coded, and coded, and coded. Epi, two minutes of CPR and we would be back with a pulse. So in my foolish EMS head she was good! Epi plus CPR equals an alive person! we just have to get to major hospital and we'll give her the fighting chance she deserves. We gave her the chance. We got her where she needed to be. In a perfect world we would call it a day and pat ourselves on the back. I wish I could get away with being that ignorant! Sadly she wasn't in the perfect shape the EMS brain told me she was in.

On the way back my partner got a call. The service that brought her in wanted to know if we were going to join the CISD they were hosting. I had my first critical incident over a month ago. To me this felt nothing like that. I still did CPR on a girl with her parents crying and cheering her on next to me but it worked. She came back, at that time I didn't know for how long, but she did come back. We both politely declined our invitation.

"Maybe I'm heartless, but we got her there. It's just another call at that point."

I couldn't help but agree to a certain point. I'm still not sure if it's heartless or not. I think I'm just a little more callused now. If we everyone broke down or quit every time someone bad happened then our professional wouldn't last long. I enjoy EMS and Emergency medicine as a whole. I just have come to accept it takes a special kind of twisted person to do well in it.

I wish the girls family all the best. Parents aren't meant to bury their children. I commend them on their strength during a terrible time.

Critical Incident Stress Debriefing: Rule 1, It's confidential, respect the other attendees.

2014-08-05T17:07:00.000-04:00

The first thing I have to say about a Critical Incident Stress Debriefing(CISD) is that they are like civil fight clubs. They have a very sensitive, confidential nature about them, so like fight club it has 2 rules.

You don't talk about the CISD.
You DO NOT talk about the CISD. Jk...

THAT unknown medical.

2014-04-21T11:37:00.002-04:00

You're called to residence for an unknown medical. Short response time to scene.

Once you arrive you gain access by unlocked door and find patient slumped to the right in a kitchen chair and moaning "oh my head, it hurts" over and over. Patient responds to speech by only continued moans. Patients medications suggest significant cardiac history. Patient rapidly moved to stair chair and moved to ambulance. While moving patient from the house he stops moaning and is no longer responding to voice, only painful stimulus.