Wednesday, June 10, 2009

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.

Saturday, June 6, 2009

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.

Friday, June 5, 2009

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.