Burn out my A##

Alright over at 9-Echo-1 there's a thread about a couple of FDNY EMTs that supposedly refused to help a pregnant mother who later died and her baby died, because they were on a coffee break. First I sure hope that this did not play out the way it sounds and my condolences go out to the family.

Ok so now that I got that out of the way lets address this "burn out" garbage. Apparently we EMTs and Medics get too tired, overworked, underpaid, etc. Well not to sound nasty about it but we all knew that was the scenario before we left EMT class so get over it. All of us chose this job and understood the sacrifices we would have to make. Burn out is an excuse to use when one is feeling overwhelmed. I've found myself feeling tired and all that before but you know what I tell myself, AT LEAST I HAVE A FRIGGEN JOB. I may get sick of the nonsense that goes on but I chose this job and I applied at my current employer because I WANTED TO. So basically its time for all the EMTs and Paramedics to MAN THE HELL UP ALREADY. This job isn't for everyone. You either suck it up and continue doing the job you were trained to do or go find something else to do. Either way quit making the rest of us look bad because you can't handle the stress of the job.

Good grief its like having a bunch of kids. I'm not your momma and no I don't want you to whine to me about how bad it is. Either do something about it or shut the hell up about it. I can't stand whiners, excuse makers, laziness or dumbass. If you're that unhappy then quit and go do something else but stop making excuses for this kind of behavior. The more of us that find this to be unacceptable then the better chance we have at changing the mindset.

1 year later

December 4, 2008 is a day I will never forget. AJ was still in the hospital and we were all hoping and praying that he would recover only to receive that horrible phone call. This morning I got up and thought of AJ. I thought of all the tears and hugs shared last year. I felt so helpless, so numb.

This morning another Raleigh FF was hurt in an off duty accident. I find myself reliving all those terrible emotions that I felt last year.

Stay strong Flip. You have a wife, 2 daughters and a whole family of emergency services personnel thinking of you and praying for you. Fight like you've never fought before. Dig deep and find the strength to return to your family so that they may tell you just how important you are to them.

I don't pray much but here goes:

God please help Flip and his family through this difficult time. Please surround them with your love and grace. Please send him back to his family to fulfill his job as husband and father. He needs you now more than ever.

Everyone please pray hard for Flip and his family. This is such an awful event for any family to experience and I sure hope that this story has a happy ending.

Grade Reports

Well this school year has been off to a rocky start. My nephew was struggling so much to get decent grades but he managed to get a decent grade card. He was missing some assignments in 1 class in which he ended up with a D but he got Bs in all of his other classes. Considering he failed last year its a huge step in the right direction and I couldn't be any prouder of him.

My son has also done great this time. He got all As and 2 Bs this quarter. Not to bad but school seems to come easy to him. Now if we can just get his behavior to match up with his academics...but then again I'd probably have a stroke if that happened.

As a reward we took the boys out to Andy's. I was hoping for Lonestar but we told them they could pick. They were so proud of themselves and it makes me so happy to see them succeeding. I'm still deciding on an end of the year reward for them. Of course it will involve good grades all year long but I'm not sure what to do for them. Any suggestions are welcome.

My Response to Anonymous' Comment

Well kiddies if you think that I'm some precious little fragile thing you've obviously never met me. I jumped into an Airway discussion on Rouge Medic and some person, who wishes to remain nameless, had his 2 cents to throw in. For those who know me, I am not going to just let it go. Anyway if you want to read the initial topic go to Rouge Medic and look for Teaching Airway-Part I. There is also a link from Rouge on my comment and his take. So here's what I had to say to Anonymous:

Let’s respond to some of Anonymous’ comments”

"Yes, you do need more practice and it's your fault for not banging on the door of your higher ups demanding more training and why do you need an MD to confirm your tube. Your training should allow you to know that way before."

First let me say this before you go judging have your house in order and know your job. With that said, I do the initial confirmation of my tubes but in my system it is not considered a "successful" tube until verified by a MD at the ER. As for training, the places that are best suited for this according to my medical director and training officer do NOT want medics there so aside from going to the college on a regular basis and tubing a simulator, my hands are sort of tied.

“The person I want treating my family is the person trained appropriately, assesses and performs appropriate skills when necessary, recognizes change better or worse to take appropriate steps to correct, and deliver them to the appropriate next level of care. They may need you to do that skill, I hope you know how.”

If my patient needs me to do a skill then it gets done. I never withhold a treatment that I know how to do when that treatment is indicated. I however am not a cookbook medic. I was taught to think without needing a script for every patient. Sounds like maybe you should try it sometime.

“You've never worked in a teaching hospital have you. Hold on to that dream.”

I have. UNC Chapel Hill and Duke University and you worked where for your training?

“An IV can be placed by most medic's without thought but we all still miss occasionally. Is that a reason to stop the skill? Do we need more practice? Or was it because that patient was a little more difficult then others? In an arrest do we not give medications because we blew the IV or do we try an IO next or vice versa?”

Ok so now if you fail to successfully obtain a skill it’s the patient’s fault? I’ll remember that next time I am unable to get my IV. That is probably the single most moronic statement I’ve heard and why are you even bothering with an IV in an arrest situation? IO is quicker and the quicker you can get medications to the patient, along with continuous chest compression, the better outcome potential for the patient or did you miss that part at the last ACLS class?

Is it so hard for you to imagine that you may not be the best provider to do a skill for your patient or does your ego get in the way of treating your patients?

Newbies in EMS

Alright so its been a couple of months since my last post. During this time I have started to help out teaching at the community college I got my degree at. Tonight I was there helping with patient assessment, vital signs and history taking. I must say that most of the students were ready to learn and listen to what I had to say but there were a few that felt as if they knew it all. Well those met their match tonight. I may not be super knowledgeable about things in EMS but I do know how to assess a patient. I noticed a couple of students rolling their eyes and so I posed the "ok you've been dispatched to an injured person" and I sat there. Smartie pants said well how did the pt hurt themselves. I said well are you sure this pt is hurt, did you make sure your scene was safe, oh yeah and how about you ask your 16 y/o patient the questions". Ok so you get the idea I was not all that nice. Reality is that if you are at week 2 of EMT class, don't act like you know everything that's going on and that this is all too basic for you. I've been in EMS for 4 years and I ALWAYS learn something from every call I go to and from every partner I have. I really like riding with seasoned EMTs and Medics because sometimes they ask a question I never would have thought to ask.

My advice to all the newbies out there is this: humble yourself before you make a big mistake and always try to learn from those who have more experience. You will NEVER know it all and the sooner you come to terms with that the better provider you will be.

Celebration and Mourning

On Friday my family and I drove to Toledo, OH for a wedding. The wedding was on Saturday and it was a nice service. I am always happy when two people find love in each other and decide to spend life's journey together. After the reception we went out to a local bar and the bride and groom came out with us and they were still in their wedding clothes. I had mentioned to the bride that I couldn't wait to get out of my dress because I was so uncomfortable. Oh well different strokes for different folks.

On Sunday I got up and went to brush my teeth. While standing there I heard what sounded like Bev (the mother-in-law) crying. I came downstairs and she along with Brad and Chris (the brother-in-law) were standing hugging each other. I asked what was wrong and Chris took my hand as Bev was telling me that her 19 year old nephew was killed in a car accident at 0600. Throughout the day we got more and more information. Jacob was on his way to work when he ran off the road, over corrected, crossed the center lines and hit passenger side into a tree. The crash was so loud that it woke up the people that lived right in front of the tree. They said that the car was on fire when they rushed out to help. At 0624, the fire had been extinguished and Jacob was extricated from the car and pronounced dead.

I can't help but wonder why my family and I felt it so important to be here for this wedding. I never wanted anything like this to happen but I must say I am glad that we were here when it did. We went over to Jacob's parents house (Amy and Rex) to grieve with them. I can relate to Amy and Rex as parents. We are not supposed to bury our babies. They are supposed to bury us. They have had an enormous out pouring of support from the community, family and friends. Its never easy to say goodbye to a loved one especially when that loved one is your child. When I told Aaron (my son) what had happened, he stood up and leaned into me crying. Its not everyday that true emotion is coming through for him. One of my traits he got I suppose. He and Jacob would play together when we were around for family functions.

I find myself feeling guilty now. Thank God we didn't receive such horrible news. I get to tuck my kids in at night still and kiss and hug them.

Anyway I have a few pieces of advice for all of us. WEAR YOUR SEAT BELT!!!!!! Jacob did not have his seat belt on. If he did would that have changed his outcome? We'll never know but it could have.

Tell your family that you love them. Be there for them always. Even when they make crap decisions always let them know what they mean to you. You never know that could be the last time you talk to them.

Proud Momma

Well today is the last day of school and my son, Aaron, has made the A/B Honor Roll for all 4 quarters. Brad and I have spent many hours working with him and many nights fighting with him to finally get to this point. He has worked very hard and passed his EOGs on the 1st try getting high 3s on both tests. We decided to do something special for him and so we bought him a Netbook for all his hard work. I sure hope he likes it. This year has ended on a high note and I hope that next year goes well for him. He's very proud of himself as well and it makes me so happy to see that he has high self esteem. I sure hope that as the years go on, challenges become greater and peer pressure reigns that he can do the right things knowing that we will always be here for him, to support him and love him through it all.

Congratulations Aaron on a job well done. You've worked so hard and it has paid off. We love you baby and are so very proud of you.

Remembering A Friend And Collegue

Today was the 5k run in memory of Andrew "AJ" Johnson. My brother-in-law went and did the run and said he had a good time. I have found myself remembering AJ today. I remember the last time we ran a call together and the banter back and forth once I got back. He always had a good sense of humor. He was probably the nicest and most helpful guy I had met in a long time. You always knew where you stood with him. I remember AJ walking into the local FD after a call and he asked me "Who's the new guy?" I could tell by his tone that he was not impressed. We talked a little while and then of course I had to go. Had I known then that would be the last time we would speak I would have told him how much I appreciate what he does not only for me on scene but for his community.

Its been a little over 6 months since his accident and the emotion of losing a co-worker is still very strong. I've been told that the more collegues you bury, the easier it gets and I just don't see how. Frankly I don't want to attend one more funeral of a collegue. Its still hard to go into the firehouse for me. His picture is still taped to the door. It was placed there when AJ was in the hospital while we sat helpless and praying for a good outcome. I didn't have the heart to say what I knew deep down, he wasn't going to make it but if he did, the AJ we knew would be gone. Instead I cried with the firefighters, brought some food and left myself available for anything day or night. His turnout gear is in a memorial box in their training room. I was able to read the plaques inside only once. I barely made it through that without totally breaking down. I still get teary eyed going in there but I have my memories and that will just have to be good enough. We never know what the master plan will be, but I NEVER thought it would have involved the loss of a quality person.

Too often we criticize how our FD and first responders are on scene and it has created a HUGE divide between some departments. Its not right and we all can do better. I decided after AJ had passed on, that I would try my hardest to teach the first responders that I see how to help out in a better way or how to do more. I spent about 30 minutes or so about a month ago, showing some newbies how to spike a bag, general layout of an ambulance, our splinting equipment location and the like. I feel that its my responsibility to educate them on what to do to be the most effective instead of complaining how its not right. AJ was very passionate about teaching the new guys and so in his memory I am going to do the same.

Patient Assessment......The Lost Art

I've been reading some blogs of my mentors lately and they both have the same complaint. I figured that since I'm still relatively new to EMS I'd share some with them.

Patient assessment is one of those "skills" that develops over time. No amount of class time can help a student put the pieces together. We are taught signs and symptoms to look for but its very hard to visualize your fine looking mannequin with chest pain, sweating and pale. A good student looks for the things they have been taught and then also looks at what the preceptor picks up on and tries to put it together. Too often many new students say "We were taught this way" and I say so what. You can teach a monkey how to do skills but you cannot teach them how to interact with people. I don't care you were taught how to push a medication. If you can't tell me why you want to give that drug or you pick the wrong drug then you're not pushing the drug. End of discussion. You need to know what to expect once the medication is given and better yet that its the RIGHT medication.

I have learned a lot from JT and DJ over the past few years and I totally agree that the machines should be used to confirm what you suspect. For instance, I had a patient last year that when I took one look at him I knew he was having a MI. Everything fit: sweating, slightly altered mental status, look of impending doom on his face, complaints of pain in his chest. We moved him from his location to a bedroom to access him better and when I hooked him up I saw the STEMI criteria that I need to call it. We went ahead and got him loaded up and went to the appropriate facility. This was supposed to be the patient that I could help and make him better. Unfortunately when the higher authority calls on you, its time to go. Once in the ER the doctor had said that he had a heart blowout. I'm not exactly sure what that is but the doc said there was nothing anyone could have done to help this man. I felt horrible.

It was after that call that I began a very hard nosed approach to my students. No you cannot check a blood sugar just because your patient is a diabetic and is mentating normally. I really believe that just because you can do a skill does not mean you HAVE to do that skill. Your patient does not need an IV because they have vomited twice. If they are actively vomiting then yes get your IV and please do me a favor and give them an anti-emetic. I'm a symapthy puker so I'd really appreciate it if you can stop it.

Too often I hear of my collegues agressively treating patients that I wonder why not just sit on your hands? I had a CHF lady that had relatively clear lung sounds. Initial pulse oximetry was in the low 80s and improved to 96% with a little oxygen. I did not go any further down the CHF protocol because I felt it was not indicated. All the research that I've read has said keep the pulse ox level above 94%. Now my newer collegues questioned why I did not start an IV, give neb treatments, Lasix and the like. My answer was simply sometimes the most basic intervention is all that is needed. When I talked about this patient with those that have been practicing for a long time they agreed with what I did.

Unfortunately newcomers to EMS are ready to sink tubes, start IVs, give drugs and such. I pride myself on my caring and compassion with my patients. I want to understand what they are experiencing so I can better judge what I need to do next. The patient with kidney stones and renal failure needs some morphine but she's got 1 vein and if I miss it, the hospital may have to do a major procedure to give her medication. She asked me not to start the IV so I didn't. Instead I held her hand and tried to calm her through her ordeal. And the best part, she thanked me repeatedly during the ride and once at the hospital.

Bottom line is, if you cannot figure out what is going on then you DO NOT get any "skills". I make all my students no matter what level they are at, start a patient assessment and give the radio report and talk to the ER staff. I had a preceptor early on in my education that said "someday you're gonna be back here by yourself and you're gonna have to do it". She handed me the radio and I did it. It was a horrible call in but that's the push I needed to start doing them.

Remember as I've said before sometimes the most BASIC intervention is all that is needed.

Venting

Someone once told me that to keep things bottled up, is to throw fuel on the fire. Thanks Dad you're absolutely right. I'm a Paramedic of 3 years and lately I've been feeling very stressed out all the time. I began having stomach problems, that my doc attributes to stress, about 2 months ago. My sleeping habits are all over the place, I've been withdrawn from my family so I've decided that I will try writing all my thoughts down to hopefully get it out of my head and maybe restore my soul to some sense of normal.

Today I'm working and its raining and cool outside. The weather station is calling for tornadoes and the like tonight so I'm hoping that my friend at the 911 center doesn't have to set my tones off tonight. I've been feeling very conflicted in recent months with my desire to watch my kids grow up and my desire to maybe make a difference in 1 person's life. My husband reminds me quite frequently that we have financial obligations to take care of and I really do like my job. Today for instance I have a good partner and we've been having a good time. We just finished cooking dinner and it was just what the doc ordered. We've been passing the time surfing the Internet, running errands and just chatting. I remember when I was new to EMS and so full of energy and excitement. I see that same fire in my partner that I used to have and I wonder where it went. I like interacting with different people and doing what I can to help when I am needed. Lately that's just not been enough.

I've been re-evaluating what my career goals are and I'm still so conflicted. On one hand I want to continue what I'm doing but at the same time I really miss being home at night with my family. Its very difficult for me to find a good balance since I give 100% to everything I do. Unfortunately I cannot be everywhere and everyone all at the same time. My family says I need to just relax and let things go but I just can't do that. I don't quite understand why common sense is not used in every day life. Sometimes the smallest things are made so difficult it just boggles my mind.

My posts won't always be this personal. I intend to keep a diary of my growth as a Paramedic, mom and person so we'll see.