Prep(aration) H? . . .

[NickD]

Hi All,

My Paramedic Prep course at Daniel Freeman (UCLA) begins in a few days. Over the past year I've been working as an EMT and have taken several classes to raise my "points" average for the Paramedic School selection process. These included becoming Phlebotomy licensed in California. The class will mostly be fire guys, but they do set aside a half dozen slots for non-sponsored civilians like me. But the competition for those are high.

After the Prep course (if I'm successful) I'll also need to sit the Hobet exam. And like a lot of people say, the math is an issue. I've been out of high school close to 35 years. My Julia is helping me out. But I find the problems confusing so we found tailoring the practice questions to my limited understanding really helps out a lot.

For instance:

If Dust can drink a case of beer in 4 hours, and Nick can drink a case of beer in 6 hours, how long will it take for both of them to drink a case of beer together?

Easypeasy - 2.4 hours and it's time to get more beer . . .

The below is a bit I wrote up for a skydiving forum I frequent to explain why I wouldn't be around for a while. Please excuse the small over-explanations as this was written for non-EMS types.

NickD

Wish Me Luck . . .

I probably won't be around here much for awhile as I'm starting Paramedic Prep classes in October, and hopefully shortly after that I'll be accepted to Paramedic School. I officially left my job as an EMT here in a So Cal coastal city and I've been thinking over my time there and things I've learned, things I'll miss, and things I won't miss.

When I started as an EMT I was lucky to get on with a private ambulance company that ran 911 calls in support of the local fire department. We did some interfacilty transfers but it was mostly fire calls. I started by working 12 hour day shifts and then went to nights. My very first partner was a jovial Mexican fellow assigned to break me in. On my first morning out we stage the ambulance in our assigned sector of the city. And his first lesson to me is, "Hey man, ya know what EMS really means, right?"

"No what?" I say.

"Earning Money Sleeping!"

And he goes into the back of the ambulance and curls up on the bench, "listen for our call number on the radio," he says and promptly starts snoring.

We have three radios in the rig. One is tuned to our dispatch. Another is on fire's frequency, and the last is a hand held we take with us on scene. But it all sounds like noise to me. I pick out words here and there but I'm absolutely terrified they are going to call us and I'll miss it.

The city has five different fire stations and they are numbered. I study the plastic covered street map we have trying to figure out where we are in relation to what fire station. If I can pick out the fire station we are covering, and then hear them being called out, I'll know to expect a call from our own dispatch on the other radio. Problem is I'd never been in this city in my life, the map is printed for 20, not 54 year old eyes, and I haven't even figured out what microphone is connected to what radio.

I don't want to make it sound like I didn't get any training or orientation from the ambulance company when I started. But I'll just leave it like this. If their instructors taught skydiving we'd all have been shut down by the FAA long before now.

I'm anxious for my first real call, of course, I feel more than ready to make the jump from school to the real world. But at the same time I'm like the kid in right field who's just praying the ball isn't hit towards him.

This goes on for about a half hour and I gotta pee. They never covered that in my training. I hear fire stations being called out and I hear the corresponding ambulance being called out too. I pay particular attention to how they answer as that part is my job. I knew I wouldn't have mic fright. I've talked down thousands of skydiving students, took flying lessons and talked to ATC, and BASE jumped a lot talking to my ground crew all via radio. The last one being mostly about how's the wind and is the coast clear.

Suddenly I hear, "Engine 24, Rescue 24, difficult breather, 123 E. 3rd street." And just as suddenly the snoring in the back stops and my partner says, "That's going to be us."

Things are happening fast now. I'm frantically scribbling down the address on my pad when our dispatch radio calls us. "54, non-emergency."

I pick up the mic hoping to god it's the right one and say, "54," in my best fighter pilot voice.

"54, non-emergency," they come back, "respond with Engine 24, Rescue 24, 123 E. 3rd street, 123 E. 3rd street, Code 2."

"Tell 'em two to four minutes," my partner says while he's still in the back yawing and putting his boots on.

I click the mic and say, "54 copies 123 E. 3rd street, with Engine 24, Rescue 24, give us two to four minutes."

I thought it went well. So far so good. But my partner got behind the wheel and laughed. "You sounded a little squeaky there." I found out he could be sound asleep and still hear the radio just fine.

This was my first call. The one they say you never forget. I thought how the tables were turned now. I was the excited and scared first jump student, and next to me was my non-nonchalant, even bored looking, first jump instructor.

We rolled out onto the Blvd as I fumbled with the map trying to find the address. "Don't worry," my partner said, "I know where it is." But I kept looking just for the practice. Code 2 isn't lights and sirens but you still have to make time getting there. My partner, I'll start calling him Ricky, so I don't have to keep writing "my partner," skillfully and efficiently weaves us around the morning traffic. "Put your seat belt on," Ricky says. Man, in all the excitement I totally forgot.

Ricky reaches into the plastic bin that sits between us and grabs a pair of rubber gloves and puts them on. I do the same. "You can start the paperwork now if you want," he says. I reach again into the bin and pull out the metal case with our run sheets in them. I start filling in what I know, the date, our unit number, the address we are dispatched to. I realize it's hard to write in a moving vehicle. The traffic is bad, and even though Ricky knows the best streets to use, they are all clogged with people still driving to work.

"In another minute," Ricky says, "you'll have to call fire and tell them we need an additional two minutes." And just as I'm figuring out how I'm going to do that, they call us. "54, what's your ETA?"

"Tell' em two more minutes" Ricky advises and I do so.

And fire comes back with, "54, bump it up to Code 3."

"Copy," I say, "bump to Code 3."

"Rock and roll!" Ricky says as he puts up the windows and hits the switches on the emergency lights and sirens. The traffic ahead magically parts as I call out, "Clear right," at every intersection. I don't want to sound like a whacker. A whacker is someone in EMS, usually a newbie, that wears too much equipment on their belt, and gets off way too much on the lights and sirens bit. But damn! This is very exciting!

While I'm watching the road ahead I'm trying to run through my protocals for SOB (shortness of breath) but I'm drawing a big fat blank. We turn another corner and I see a fire engine and the smaller paramedic vehicle in the middle of the block. We park in front of them and I go around the back and pull the gurney out. "Got the hand held?" Ricky asks. No, I forgot that, so I walk around and grab it out of the cab. And I grab the metal case with the run sheets too. Calm down I tell myself, you're not thinking.

"Critical thinking!" It's my EMT school instructor. I can hear his booming voice in my head right now. "No, no, no," he'd scream. "Your patient is presenting with this, this, and that, but not this. What does that tell you!" I loved that guy.

We roll the gurney up to the front steps of a nice, but modest house. "Go inside," Ricky says, "see what's going on." I thought to ask if he was coming with me, but instead I just went. The door was ajar and I opened it. There was no one in the living room, but I could hear voices further back in the house. I walked down a short hallway and looked into the first bedroom I came to. She was in her eighties and laying supine (face up) on her bed. She was talking with the two fire paramedics. It was obvious she was having trouble breathing, and she seemed confused. They had her on O2 and also hooked up to their portable heart monitor. One paramedic looked up at me and said, "Bring in the gurney, if you can't fit, bring in the stair chair."

I went out and relayed the info to Ricky. "We'll get the gurney in there," he said, "I've been here before." I came to learn Ricky would say that a lot on the calls we ran.

As I stood in the woman's bedroom again I took a minute to look around. There was a picture of her on the wall. In the photo she's about twenty and beautiful in that way all woman were back in the 1940s. On the table next to her bed was a photo of a man in a WWII military uniform. He was also about twenty. Put him in a jumpsuit and he'd look like any other young dude on the drop zone. It was the beginning of my realizing these were real people. People with lives full of hopes and dreams. "Her husband died about ten years ago," Ricky mentions in my ear. But there's his photo, I notice, still on the night stand, right by the bed they spent a lifetime in.

The paramedics stood back while Ricky and I placed the woman on the gurney. We were the grunts after all. There are very specific techniques for lifting and moving patients but it went well and we buckled her in and covered her with a blanket. Ricky got my attention with a look and motioned to the O2 tank on the end of the gurney. I didn't get it at first, but then caught on he wanted me to switch out the O2 hose from the paramedic's tank to that one. We rolled the woman out and lifted her down the stairs. I was concentrating hard as the worst thing is dropping a patient.

We put her into the ambulance and one of the paramedics got into the back with me. This was an ALS (advanced life saving) call. What made it that was the woman was altered. Her level of consciousness wasn't normal for her. Some other things that make some calls ALS are trauma, strokes, heart attacks, etc. For the lessor things we'd have taken her in alone. Those are BLS (basic life saving) calls. And a paramedic doesn't need be aboard to transport.

I sat on the left side and the fire paramedic was on the right side of the gurney. I saw he was preparing to run an IV line. "Get me a blood pressure." He directed.

I grabbed the blood pressure cuff off the shelf and the stethoscope out of my pocket. I'd done this a hundred times in school and another hundred times on my poor Julia at home. The paramedic told Ricky up front to, "Go easy three." He meant use the lights and sirens on the way to hospital but don't kill us getting there.

I put the cuff on upside down the first time, but quickly fixed it. I found her brachial pulse in the crook of her arm and pumped up the cuff. But then we started moving and I couldn't hear a thing under the siren. I kept trying but it just wasn't there. The paramedic noticed I having trouble and said, "over palp," is good enough." I knew he was telling me to get her pulse at the wrist and do it by feel.

"110 over palp." I told him.

"Okay, strip out this bag for me." He tossed me a bag filled with saline that he was going to hook into the IV. I'd done this few times but he noticed me fumble dicking around with it. "First day?" He said.

"First call," I replied.

He smiled at me and said, "Okay, look, here's the easy way to do it."

He was a cool guy. He let me do the blood sugar stick on her finger and he explained everything he was doing to me. I got lucky again. I later found not all the fire paramedics were as easy going. In fact some of them were down right pricks.

"Your a bit older than most of the new EMTs I see." he added. But instead of giving him my life story, I just shot him a "that's the way it is" look.

"Change that O2 hose over to your house tank." He told me. "Those small gurney tanks don't last long."

We rolled into the emergency bay at the hospital and wheeled her into the ER. The paramedic gave his report to the nurse while I listened. I'd have to do this myself on the BLS runs. We were given a room after a bit of a wait and transferred the woman to the hospital bed. I removed the EKG leads from her chest while trying not to notice her bare breasts. You do, I found out later, get very used to that sort of thing.

When I came out of the room the paramedic was already gone. Ricky was off getting some new sheets and blankets. Then he would make up the gurney and clean up the back of the ambulance. In the meantime my job now was to get the woman's medical insurance information and finish up the run and billing sheets. Besides the basic info the run sheet must include a full narrative of the entire call. Every intervention we made, and the outcome, must be included. I think of myself as a fairly good writer, but it's hard to be too creative using all those medical abbreviations and terminologies. "Are you still working on that," It's Ricky. "What are you doing, writing a book?"

Back in the ambulance Ricky told me to clear us on the radio and I did. "That's ice cream," he said.

What's ice cream," I asked.

"Any first," he explained to me, "like your first run, your first cardiac arrest, it means you gotta buy ice cream!"

I couldn't help laughing out loud. After a lifetime of "beer firsts" on the drop zone now it was ice cream.

"Whata ya laughing at, I'm serious, man."

"Nothing, Ricky," I said, "I ain't laughing at nothing.

So the time passed. Almost a year's worth of calls, some routine, some not. Overdoses, gun shot wounds, stabbings, beatings, drunks, car accidents, and just plain sick people. Sometimes only lonely people and often those who simply abused the system. But we took care of them all.

The best part? I found I have a soft spot for elderly people. Rolling them into a nursing home, sometimes knowing they'd never roll out again, I'd stop outside and watch a sunset with them. Or grab a flower off a bush on the way in and lay it on their bed stand. Sometimes I'd just sit and listen to their stories of how no one comes to see them anymore. Other times I'd just let them hold my hand for a little while.

When ever I got back into the ambulance Ricky was always going, "What took so long, what the heck were you doing in there?"

"Nothing," I'd say, trying hard not to let him see the tears in my eyes, "I wasn't doing nothing, man."

Wish me luck, everyone, with my Paramedic ambitions!

NickD

[Dustdevil]

Damn, I so wish I could be there to be your partner! And I wish we could have had you in EMS thirty years ago too. You're going to be much more than a great medic. You're going to be a great example to others. I really hope that, since you won't be spending as much time on the jump forum, you'll have more time to share your journey with us here. It's something that I will very much be looking forward to following.

Best of luck, Bro!

[P_Instructor]

Likewise, good luck. You'll do fine. Therapeutic Communication is one skill that should be taught more intensively. Just talking to a patient may be the best thing you can do for them.