Insights and experiences from over the past 6 months on a full-time 911/ALS ambulance:
Chinatown
Call to corner of Willie "Woo Woo" Wong playground in Chinatown for the unknown medical aid. Wind up transporting the patient to Chinese Hospital in North Beach/Chinatown, which is the hospital where Bruce Lee was born. Turns out Willie "Woo Woo" Wong was a star basketball player in the 40's despite only being 5'5". I got a kick out of the weird mix of histories all rolled up in one call.
Psychic Paramedic
Somehow in conversation the medic I was working with says that he hadn't had a true seizure patient in a really long time, and he was thinking that we might get one soon. Not 3 minutes later we get dispatched to a vintage clothing store for a woman who had a witnessed seizure. Couple hours later the medic says that he hadn't had a pediatric call in like forever. Five minutes go by, then bang, dispatched for the 1 year old, fever and fainting. Later I say to the medic that he is just about calling the calls before we get them. I tell him that if he calls the next one, he is %100 certified psychic. "Alright" he says, "next call will be a...DOA." Ten minutes or so go by and the we get dispatched to the "man down" south of Market area. We get there and as we're pulling up, the fire department who was on scene a few minutes before us come out and say "Don't worry about it guys. Pt is GOA (trans. Gone On Arrival)." We almost pooped ourselves because GOA sounded so close to DOA. I told him that he was 2 thirds psychic which is really psychic.
Pride Parade
Worked at the parade/afterparty where something like 250,000 people fill into about a 5 by 5 block area where they physically and emotionally destroy themselves with substances, controlled and otherwise. About half that number are of legal drinking age, and about 5-10% of the total party population are displaying at least some level of nudity. After the parade part of the day goes by and the messages of tolerance, love, and equality are championed, the party turns into a sort of Caligula themed rave in the streets surrounding City Hall and the Civic Center plaza. There's sexual orientations displayed that don't really have classifiable terms yet; drunk 16 year old's sharing vodka and Red Bulls with homeless men; urine, vomit, sweat, and blood; NC-17 PDA; violence and theft; friends are stranded by friends; unknowable numbers of druggings, sexual assaults, and STD transmissions; but to not seem like a total downer, there are also thousands of people who look like they are falling in love and having the time of their lives. Working at an event like this, I am allowed to observe all this craziness, but stay completely detached from it all. All my calls that day where basically the same kind of patient: 19 year old female, alcohol poisoning, transported to the hospital where it comes out that they are really 17.
Again, I did some crazy, dangerous driving, learned a whole lot, made some good and bad decisions probably in equal proportions, had some fun, helped some people, and generally tried my best.
PS, the last 6 months was actually 3.5 months because in April I broke my leg playing soccer and spent 2.5 months on the couch high on a painkiller-stool softener speedball. I'm better now, thanks for asking, and I have 6 pins and a plate in my leg so now I feel like Tony Starks.
Wednesday, July 27, 2011
Saturday, June 11, 2011
Friday, February 18, 2011
First month in the bag
First month down working on a 911/ALS shift. Some highs, some lows.
Assault
Got an assault call for a kid who was beat up by some enemies. Call started ALS but was given to me to run as a BLS code 2. Nothing special, but I got to do my first complete physical assessment, entirely by myself. That was after 2 years working as an EMT. Pretty run of the mill, but it felt good to use a skill I am trained for. Kid was fine, a couple lacerations and bruises.
Transsexual with ear pain (dispatched as uncontrolled head bleed)
Two Male-to-female's hanging out in their SRO, doing a routine amount of crystal meth, one playing John Madden on the XBOX, the other felt an itch in her right ear so she started scratching it and eventually got a couple spots of blood on her finger, called 911, and by the time we got there the scratches had scabbed up and looked no bigger than an M&M. All other vital signs normal, no pain anymore. Declined transport to a hospital. Weirdest part was there was a life size leather ET sitting at a table pointed at the TV like it was watching, or maybe even playing XBOX.
DOA's
One guy dead for less than 12 hours maybe, found in a hotel room, appeared to have died comfortably in bed. Black humor moment: police officer says something like "looks like it was check out time."
Another one dead for maybe one day, maybe four. Patient was the caretaker for her severely handicapped daughter who still thought that her Mom was just sleeping. Creepy because there was no way to really know how long Mom was down and how long Daughter had been living with the deceased.
Seizures
Had a couple cool post-seizure patients. One who couldn't get past answering "San Francisco" to every question.
Heart Attack
90+ year old, dizziness and near-fainting episode dispatched as a non 911 call. Our unit was sent from really far away but we made our minimum response time anyway. My paramedic had the foresight to request additional personnel (fire engine). Patient was having an active heart attack, her first (at 90 years old!). Heart monitor findings were inconclusive but she had very low blood pressures and an extremely low heart rate, along with left side pain radiating down her side and back. Patient's MD requested the nearest hospital - which was not a cadiac specialty center - and my paramedic made the decision to take her to a slightly farther one, but one that did have a Cardiac Catheterization Lab. Brought the patient in code 3, made it to a room for triage, 5 minutes later Acute STEMI heart attack confirmed, patient brought to Cath Lab table. As the patient was being catheterized the cardiologist asked us if we wanted to watch the procedure. We took seats behind an XRAY proof glass and watched as the cardiac team inserted a catheter throuh her femoral artery, up through her aorta and into her coronary arteries. The pictureof her heart on a monitor showed very slow, irregular beats. After the catheter, balloon, and stent were inserted and placed, the remaining coronary arteries filled up and her heart began beating regularly at about a rate of 70 bpm. Door to balloon time under 50 minutes. One of the most dramatic things I have ever seen.
I'll leave it there for now. The job is amazing, the challenges - big and small - happen every day. Also I have been given the good fortune of getting to drive a brand new ambulance, 2010, 1600 miles on it, which is incredible. And I drive it through a ton of red lights - legally - and turn on the lights and sirens a whole bunch. I'm still trying to stay humble and keep from becoming too big an asshole because when I feel like I am the coolest thing since whatever, I tend to start acting like an asshole.
Assault
Got an assault call for a kid who was beat up by some enemies. Call started ALS but was given to me to run as a BLS code 2. Nothing special, but I got to do my first complete physical assessment, entirely by myself. That was after 2 years working as an EMT. Pretty run of the mill, but it felt good to use a skill I am trained for. Kid was fine, a couple lacerations and bruises.
Transsexual with ear pain (dispatched as uncontrolled head bleed)
Two Male-to-female's hanging out in their SRO, doing a routine amount of crystal meth, one playing John Madden on the XBOX, the other felt an itch in her right ear so she started scratching it and eventually got a couple spots of blood on her finger, called 911, and by the time we got there the scratches had scabbed up and looked no bigger than an M&M. All other vital signs normal, no pain anymore. Declined transport to a hospital. Weirdest part was there was a life size leather ET sitting at a table pointed at the TV like it was watching, or maybe even playing XBOX.
DOA's
One guy dead for less than 12 hours maybe, found in a hotel room, appeared to have died comfortably in bed. Black humor moment: police officer says something like "looks like it was check out time."
Another one dead for maybe one day, maybe four. Patient was the caretaker for her severely handicapped daughter who still thought that her Mom was just sleeping. Creepy because there was no way to really know how long Mom was down and how long Daughter had been living with the deceased.
Seizures
Had a couple cool post-seizure patients. One who couldn't get past answering "San Francisco" to every question.
Heart Attack
90+ year old, dizziness and near-fainting episode dispatched as a non 911 call. Our unit was sent from really far away but we made our minimum response time anyway. My paramedic had the foresight to request additional personnel (fire engine). Patient was having an active heart attack, her first (at 90 years old!). Heart monitor findings were inconclusive but she had very low blood pressures and an extremely low heart rate, along with left side pain radiating down her side and back. Patient's MD requested the nearest hospital - which was not a cadiac specialty center - and my paramedic made the decision to take her to a slightly farther one, but one that did have a Cardiac Catheterization Lab. Brought the patient in code 3, made it to a room for triage, 5 minutes later Acute STEMI heart attack confirmed, patient brought to Cath Lab table. As the patient was being catheterized the cardiologist asked us if we wanted to watch the procedure. We took seats behind an XRAY proof glass and watched as the cardiac team inserted a catheter throuh her femoral artery, up through her aorta and into her coronary arteries. The pictureof her heart on a monitor showed very slow, irregular beats. After the catheter, balloon, and stent were inserted and placed, the remaining coronary arteries filled up and her heart began beating regularly at about a rate of 70 bpm. Door to balloon time under 50 minutes. One of the most dramatic things I have ever seen.
I'll leave it there for now. The job is amazing, the challenges - big and small - happen every day. Also I have been given the good fortune of getting to drive a brand new ambulance, 2010, 1600 miles on it, which is incredible. And I drive it through a ton of red lights - legally - and turn on the lights and sirens a whole bunch. I'm still trying to stay humble and keep from becoming too big an asshole because when I feel like I am the coolest thing since whatever, I tend to start acting like an asshole.
Sunday, January 16, 2011
First week working (almost) exclusively in a 911 system, and some reactions
Had a pretty cool call to the 20th floor of the SF federal building, where we had a patient in the middle of an unknown drug OD. We ran the call with an armed federal Marshall who was super cool and kept saying to the patient: "Hold on buddy! You're gonna make it! You're gonna be alright!", even though the dude was actually totally stable.
Couple of other cool medical calls, including what turned out to be a stroke caused by suspected meth abuse. Got to take the patient straight to CT, where the MD said no obvious bleeding. Weird part was that the patient was way over Medicare age, and very LARGE, which I guess are rare findings in meth abusers. Seems like if you're gonna find all different types of meth users, you'll probably be in SF.
Transported a patient who stated they had "Springles", probably meaning shingles.
Had some good and bad interactions with SFFD firefighters and medics, drove through a shit-ton of red lights, kept my cool mostly, remembered some stuff, forgot some stuff, and basically had a good week.
Working 1 and 1 on an ALS car is a ton more interesting, and I have to attempt to keep any exaggerated feelings of self-importance in check.
Couple of other cool medical calls, including what turned out to be a stroke caused by suspected meth abuse. Got to take the patient straight to CT, where the MD said no obvious bleeding. Weird part was that the patient was way over Medicare age, and very LARGE, which I guess are rare findings in meth abusers. Seems like if you're gonna find all different types of meth users, you'll probably be in SF.
Transported a patient who stated they had "Springles", probably meaning shingles.
Had some good and bad interactions with SFFD firefighters and medics, drove through a shit-ton of red lights, kept my cool mostly, remembered some stuff, forgot some stuff, and basically had a good week.
Working 1 and 1 on an ALS car is a ton more interesting, and I have to attempt to keep any exaggerated feelings of self-importance in check.
Monday, July 6, 2009
My first ER clinical
In Chicago, where I was certified, we were required to do two 5-hour ER clinicals instead of ambulance ride-alongs. This was at the end of the 5 month class, and I was going to Northwestern Memorial, right downtown.
My clinical started at 8am and I got there at around 7:45am just to look good. I walked in to the ER and met my contact there who quickly dismissed me by passing me off to an ER tech. He told me to wait right there behind the registration desk and he'd come by and get me when he wasn't so busy. I said sure and just hung out for a second. This was all by about 8:05am.
In class the instructor told us that there was a possibility we'd see something interesting, but most likely not. He said there would probably be some drunks, a homeless guy or two, an old lady with a hip fracture maybe, but probably nothing great. Five hours was just not enough time, especially on a Tuesday morning at 8:00. So, while I was hanging behind the registration desk, basically just picking my nose, thinking that I was just going to wind up getting put somewhere out of everybody's way, a Code 3 ring down from Chicago FD came in for "70 y/o female, pulseless and apneic for unknown period, CPR in progress, defibrillation not advised, ..." Immediately, the MD who was on duty pointed at me and said "EMT student, come on over and get ready to start compressions when she gets in".
So about 2 -3 minutes later, paramedics brought her in and they were already giving her compressions. When they got her into the ER they had me get on a little foot stool for leverage right above her, and start compressions. Since I was nervous as all hell, and my sympathetic nervous system was really kicking out that adrenaline, I was yelling out my compressions like a quaterback. "Twenty-one!!! Twenty-two!!! Twenty-three!..." The MD in the ER told me to count to myself and that I didn't even really have to count if I didn't want to, he would just tell me when to stop. I said yessir like he was a drill sergeant and just kept pumping away. It was at this point that I noticed that our patient had pooped her self. And that she was naked.
I overheard the medics tell the MD that they were not sure how long she had been down because it was unwitnessed. Whoever called 911 heard a thump or a scream or something and Chicago FD had to kick her door in. Then, straight out of the Hypothermia and Enviornmental Emergencies chapter of my EMT book, the doc said "Well, she's not dead until she's warm and dead. EMT student, stop CPR." I did and peeled the back of my glove off to touch her cheek with the back of my hand. They took a temp, it was normal, and they pronounced her. I was dripping with sweat and shaking. The doc told me, "good work" and I nodded. My ER tech contact was there the whole time bagging, or getting supplies or whatever. He gave me a look that said "Wow, you are lucky."
So within 15 mins of my first experience in healthcare, I saw and touched my first dead body, I did CPR on a real person, I was really, really close to some poop that didn't belong to me or my dog, and I was part of a team that was providing emegency care that we were trained to give.
It took me a couple of minutes to calm down. The ER tech told me that I could step out if I needed to. There were a couple of nurses cleaning and wrapping up the patient. I was watching them sort of wipe the poor lady's backside while they were talking to each other like they were at Starbuck's. One was saying to the other "Yeah, we just finished the deck and it's beautiful. You and Rob should come up..."
I went outside and smoked 3 cigarettes in 3 minutes.
My clinical started at 8am and I got there at around 7:45am just to look good. I walked in to the ER and met my contact there who quickly dismissed me by passing me off to an ER tech. He told me to wait right there behind the registration desk and he'd come by and get me when he wasn't so busy. I said sure and just hung out for a second. This was all by about 8:05am.
In class the instructor told us that there was a possibility we'd see something interesting, but most likely not. He said there would probably be some drunks, a homeless guy or two, an old lady with a hip fracture maybe, but probably nothing great. Five hours was just not enough time, especially on a Tuesday morning at 8:00. So, while I was hanging behind the registration desk, basically just picking my nose, thinking that I was just going to wind up getting put somewhere out of everybody's way, a Code 3 ring down from Chicago FD came in for "70 y/o female, pulseless and apneic for unknown period, CPR in progress, defibrillation not advised, ..." Immediately, the MD who was on duty pointed at me and said "EMT student, come on over and get ready to start compressions when she gets in".
So about 2 -3 minutes later, paramedics brought her in and they were already giving her compressions. When they got her into the ER they had me get on a little foot stool for leverage right above her, and start compressions. Since I was nervous as all hell, and my sympathetic nervous system was really kicking out that adrenaline, I was yelling out my compressions like a quaterback. "Twenty-one!!! Twenty-two!!! Twenty-three!..." The MD in the ER told me to count to myself and that I didn't even really have to count if I didn't want to, he would just tell me when to stop. I said yessir like he was a drill sergeant and just kept pumping away. It was at this point that I noticed that our patient had pooped her self. And that she was naked.
I overheard the medics tell the MD that they were not sure how long she had been down because it was unwitnessed. Whoever called 911 heard a thump or a scream or something and Chicago FD had to kick her door in. Then, straight out of the Hypothermia and Enviornmental Emergencies chapter of my EMT book, the doc said "Well, she's not dead until she's warm and dead. EMT student, stop CPR." I did and peeled the back of my glove off to touch her cheek with the back of my hand. They took a temp, it was normal, and they pronounced her. I was dripping with sweat and shaking. The doc told me, "good work" and I nodded. My ER tech contact was there the whole time bagging, or getting supplies or whatever. He gave me a look that said "Wow, you are lucky."
So within 15 mins of my first experience in healthcare, I saw and touched my first dead body, I did CPR on a real person, I was really, really close to some poop that didn't belong to me or my dog, and I was part of a team that was providing emegency care that we were trained to give.
It took me a couple of minutes to calm down. The ER tech told me that I could step out if I needed to. There were a couple of nurses cleaning and wrapping up the patient. I was watching them sort of wipe the poor lady's backside while they were talking to each other like they were at Starbuck's. One was saying to the other "Yeah, we just finished the deck and it's beautiful. You and Rob should come up..."
I went outside and smoked 3 cigarettes in 3 minutes.
EMS Firsts (and other stuff too)
Hi.
I'm an EMT working in San Francisco for a large private ambulance company. I love my work and find myself surprised by the co-workers and patients that I get to deal with everyday.
This blog is meant for fellow EMS workers to read and write about their "first times", and to share some experiences of exciting, stressful, rewarding, and crazy situations that they've encountered for the first time during their careers.
Posts can be about anything, like the first time you did a resuscitation, or the first time you worked 72 hours in a row, or the first time you got pooped on, or your very first day on the job. Whatever. Feel free to write about anything that you felt strongly about, whether good or bad. Chances are there is someone out there who has seen something similar, and someone who has seen something worse.
Lucas
I'm an EMT working in San Francisco for a large private ambulance company. I love my work and find myself surprised by the co-workers and patients that I get to deal with everyday.
This blog is meant for fellow EMS workers to read and write about their "first times", and to share some experiences of exciting, stressful, rewarding, and crazy situations that they've encountered for the first time during their careers.
Posts can be about anything, like the first time you did a resuscitation, or the first time you worked 72 hours in a row, or the first time you got pooped on, or your very first day on the job. Whatever. Feel free to write about anything that you felt strongly about, whether good or bad. Chances are there is someone out there who has seen something similar, and someone who has seen something worse.
Lucas
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