March 2004

A presenter at the EMS conference used this clip to illustrate a session on “10 Things I Was Never Taught in EMT Class”. It’s about 3.1 MB, so wait ’til you get to work to look at it. Make sure you turn up the sound.


I attended the Vermont state EMS convention over the weekend. It was an interesting time, to be sure.

Friday night I got toned out to a motor vehicle accident. The dispatcher had bad information and a bit of keystone cops comedy followed with firetrucks and private EMT vehicles crisscrossing the town looking for the accident. The cars involved had no visible damage and several people actually drove by the accident scene before the confusion passed.

The driver of one vehicle was complaining of some back pain so we extracted her from the car and boarded and collared her with the help of some fire fighters. The ambulance squad lady was there and suggested that I could ride to the hospital in the ambulance if I wanted. I got into the rig with one of our FRs (first responder, the entry-level EMS qualification) and the two EMT-Is from the transporting ambulance squad.

The ambulance squad lady is the coordinator of my squad. She has been an EMT for a long time and is very calm and knowledgeable. I consider myself quite lucky to be a member of my squad for many reasons; my ability to interact with the ambulance squad lady is among the prime reasons. She is very interested in growing EMTs and is very supportive and nurturing. She also gives excellent care; I have heard more than one person say that if they needed care, they would want her providing it.

In any event, she sent the FR and me along in the ambulance to observe. It was interesting although the two EMT-I people did all of the work. The highlight of the transport was that the ambulance had to slam on the brakes to avoid hitting three deer in the road. The four unbelted EMS people in the back avoided falling on the backboarded patient, which was good.

I got up early on Saturday and drove the two hours to Burlington with another member of my first responder squad. We had to be there by 8:30 and made it without problems.

I attended several interesting sessions on Saturday; one on psychiatric disorders, one on difficult case assessments.

Q: You receive a call to 911. You arrive on the scene to find your patient sitting in a chair complaining of chest pain. The pain started abruptly three hours ago while the pt was watching television. He describes it as stabbing and substernal. The pt has a somewhat altered level of consciousness with anxiety. The pt has tachycardia with a pulse of 140 and is hypotensive with a bp of 90/70. The pt presents nonsymmetric cyanosis. Further investigation shows decreased pulse and capillary refill on the left side. There is no history of cardiac or stroke activity. Lung sounds are normal except for some gurgling on the left side. Heart sounds are normal. The pt reports no recent weight gain. What do you do next?

A: Call for Advanced Life Support (ALS) intercept if available. Start high-flow oxygen and carefully move the pt to the rig. Drive slowly and carefully to the hospital or intercept point avoiding potholes and frost heaves and cross your fingers that your pt’s aortic aneurysm doesn’t burst before you turn him over to the emergency department.

I found this case pertinent as this time of year always reminds me of aortic aneurisms.

The last session I attended on Saturday was on a search and rescue that took place on Mount Washington in 1982. I attended this session primarily because the presenter, Bill Kane, was my original wilderness first responder instructor and subsequently my wilderness EMT instructor. He’s been a mountaineer and into EMS forever. He’s a fascinating person and I have boundless respect for him. He’s another person that I am grateful to have had the opportunity to meet and learn from.

The presentation itself was very interesting. I had read narratives of the search before but the presentation cleared up a lot of confusion I had about how things had happened; usually the people writing media stories about things like this have little actual experience, don’t understand the details themselves, and so put things together so that they make sense to the writer. This often has the effect of obscuring the actual facts. In this case, the chain of events leading to the avalanche death of Albert Dow (a rescuer) had never made sense to me but Bill was able to tell us what had happened and why the SAR people had come to be in the wrong place at the wrong time. I also hadn’t realized that Bill had actually been one of the key decision makers on the SAR, so his perspective from that role was very enlightening.

I spoke with Bill after the session and was gratified that he remembered my name; given the number of people he interacts with, I would not have been offended if he had forgotten me despite having had me in class for a total of a month over five years. I tend to think he remembers me primarily due to the problems my stress level posed in the EMT class, though, rather than any positive qualities on my part. Rabid Kitten discovered the kids had been exposed to lead while I was away at EMT school and it was touch and go if I would complete the class at all; as it was, my stress level made it very difficult to concentrate. Bill, the school (SOLO in Conway, NH), and my classmates were very concerned and supportive and helped me make up for the several absences from the full-time class.

Anyway, I spoke with Bill for a few minutes and thanked him for the support during the class. I told him how much I felt that he and SOLO had benefited me in numerous ways, and I told him how impressed I was by his reach and impact on the EMS community at large, and that I considered myself lucky to have trained at SOLO. He was happy to hear that I had joined a squad and am planning to continue to EMT-I.

Then I did some shopping at the exhibition hall. I bought some crazy hard-to-find items; one of the bad things about EMS is that the online vendors want you to outfit your entire department and so charge whopping shipping minimums. If you want, say, one spring-loaded center punch, you’ll pay $5 for the punch and $20 for shipping. So I bought a punch (useful for breaking car windows), a set of extrication gloves, a keychain dealie that holds gloves and CPR mask to replace the deteriorating one I’ve been carrying for the last five years, and a set of EMT pants (BDUs with handy pockets for gloves and shears). I managed to resist the excellent fluid-impervious EMT jacket with zip-out fleece liner for $300, so that was good.

Later on Saturday I went out to dinner with a number of people from my squad and our transporting squad. A number of us ended up partying into the early hours and finally were sent to bed by Burlington cops. We weren’t being loud, particularly, but I think we were annoying the hotel staff by hanging out in the lobby. They eventually called the cops without ever asking us to go to bed or otherwise giving us the slightest notion they were unhappy with us. The nice part was that our district’s EMS board chairperson, a paramedic, was with us so there won’t be any inconvenient issues within the district.

On Sunday I attended one session on Intelligent Transportation Systems within EMS. I’ve been thinking about ITS for about fifteen years and am angling my consulting business towards ITS contracts, so this session was pretty much the crux of the event for me. It was pretty interesting; discussions of automatic crash notification (‘help! My airbags have deployed and my front bumper has been depressed at least eight inches. I’m on my roof! Heat sensors do not indicate any fire. My gas tank level is 3/4 full. My GPS indicates that I am on route 106 north of the intersection with 131. I think I have two front seat occupants; probably one or both of them are Suzy and John Public. If one of them is Suzy, watch out, she’s pregnant according to the information she’s loaded into the emergency data. Both of them have type AB blood. John’s doctor is Dr. Able, Suzy’s is Dr. Baker. I don’t think there’s anyone in the back seat. Watch out, though; I have side-impact curtains that have not deployed!’), ‘smart routing’, and some other things.

The staggeringly useful thing about the session was that I met the directors of operation for two large (4000 calls/year) services who are very interested in ITS and other data processing. I spoke with them for a while (they invited me to have lunch with them) and I think I opened their eyes to many possibilities for not only ITS but also data flow through EMS in general. They suggested I should speak with the head Vermont ITS person as well as the state EMS director. I did not get a chance to do so at the conference but will call them soon. The directors I spoke with said they felt I had a lot to offer the state in terms of the various ITS efforts (which are being heavily supported by the federal government) as well as EMS data processing.

I left the conference very excited about the future. I’ve been working on getting contracts for my consulting firm for several months… I don’t have any contracts in hand yet, but I’m getting the impression that I’m going to reach critical mass soon on several fronts.

I went to bed earlyish, around 10:30. My pager went off at 12:30 for an elderly woman who had fallen out of bed and possibly broken her arm. I went over to the station (I had no idea where the address was) and rode to the scene in Engine 1 with another firefighter… We were the only two who responded (certain calls are not popular, it seems). The woman was still on the floor, more or less under a night table and between the bed and the wall; the daughter in law had prudently not moved the woman but had made her comfortable with blankets and pillows. The lady didn’t know where she was and was concerned that she had been in a car accident. I had just started my assessment when the ambulance showed up (Yes! The cavalry!). Given the altered mental status, we protected her spine and carried her downstairs on a backboard. I felt really bad for the lady as she was not in much pain until we rolled her onto the backboard. We had no option but to roll her over the possibly broken arm, which caused her a lot of discomfort. It was hard to hear this kindly grandmother type moaning in pain, but we did it as quickly as we could and the discomfort seemed to subside once the roll was done.

After the ambulance left, we drove back to the station and filled out the paperwork, chatted for a few minutes about nothing in particular, then went our separate ways. I was back in bed by 1:45.

I’ve already spent way too much time today thinking about digital nasopharyngial decompaction.

Yes, nose picking.

First, I saw this article on Annanova.

I sent mail to a few friends about it. replied with a link to some Ani lyrics where she proudly admits to nose picking.

While I was reading the lyrics, I was reminded of a former acquaintance of mine, Petty Officer Humphry. Humphry was a classmate in Electronics Technician Class ‘A’ school. Although I served with PO Humphry for eight or nine months and socialized with him frequently, I never did learn his first name. That’s sort of the nature of the armed forces, I guess; last names only.

I met a host of interesting people in the Navy. I knew a guy who could vomit on demand (although, in truth, it took him about a minute to actually make it happen). I knew a guy who could inhale one end of his dog-tag chain through his nostril and pull it out through his mouth and clip it back together, leaving him with a chain loop through his face (I have a photograph of this someplace). I knew a guy who could accurately predict the number of ounces of urine he needed to expel (and claimed he could predict the weight of his next bowel movement… The so-called ‘one pound constitutional’… Though I never actually saw him perform that particular skill).

Humphry did not have a sideshow talent like these, but was uniquely revolting in his own way. Humphry was in touch with bodily functions.

Among other things, Humphry was an unabashed nose picker. He would eat the products from time to time as he swore they were healthy and good for you (clearly he was ahead of his time in this respect). He didn’t always eat them, though; he said that a little went a long way. When he did not ingest them, he would wipe them off on his pants in his crotch, where (he claimed) they would dry out and drop off. This saved him from having to carry a hankie or kleenex.

Humphry would periodically lecture us on the merits of nose picking. He would also help us with our hygiene in various other ways.

The last time I saw PO Humphry was in our company administrative office building at Naval Training Center Great Lakes. We were both transferring out to different commands and were individually completing the laborious signing-out process consisting of gathering about fifteen signatures from far-flung locations across base. This process had to be performed in dress uniform as many of the locations contained officers who might be offended by the sight of a sailor in dungarees (I vacuumed the driveways of some of these fastidious officers on more than one occasion).

I ran into Humphry, as I said, at the admin office… I was going out as he was coming in. We chatted for a minute and made the typical trite remarks that one sailor would make to another sailor as their life-paths diverged, realizing that this was the last time that friends would ever see each other.

At the end of our conversation as I prepared to take my leave, Humphry pointed out that I had a massive zit on my chin and could he please pick it? I said yes, of course. He did so, taking no more than a second; Humphry was a real pro at this. He showed me the big wad of pus on his finger, then started to wipe it on my uniform. He realized that I had my dress blues on, so he stopped and started to wipe it on his own uniform. Then he realized that he had on his dress blues, as well.

I left. My last sight of PO Humphry was of him standing in the foyer of the admin office with my pus on his finger, wondering what to do with it.

I hope Humphry’s doing well. At least I can be assured that his immune system is strong.

I heard that Larry LaPrise passed away recently. He was the guy that wrote the Hokey Pokey. Among my earliest memories are dancing the Hokey Pokey.

Apparently his passing was really difficult for his family. The worst of it was getting him into the coffin.

They put his left leg in… Then the trouble started.

Monday morning, my FD pager went off regarding a car off the road nearby. As I got my clothes on, the pager reported no injuries. I drove over to the firehouse. It was snowy and very slippery.

As a probationary member, I have to leave my turnout gear at the firehouse. They also really like the firefighters to go to the firehouse rather than direct to an incident for various reasons; to make sure the apparatus gets picked up, to reduce traffic and parking congestion at the scene, to enable the chief to understand the number and skills of personnel responding early in the process so that they can make deployment decisions, blah, blah.

On medical calls, I have been asked to stop by the firehouse to get the AED, and that seems to make good sense… I may be two or three minutes later on scene, but if I show up with the AED, the presence of the AED may be more important than the few minutes required to get it. If another FF (all are non-EMT) arrive first, they know how to perform immediate basic life support as well as I do. I’m told that the ambulance squad is going to get me an AED for the car, in which case I’ll suggest to the fire department that I should just go direct on medical calls.

I was first at the firehouse. By the time I wiggled into my stiff gear, two of the officers had arrived. One of them (who I think of as ‘Fire Department Lady’) told me to go in the engine with the other officer. So I rode to the accident scene in the fire engine. It was heady.

The accident was quite minor; the roads were slick and a car had spun and slid off the road on a sharp corner of a main road, coming to rest against a tree above a forty foot drop. If the tree had not been there, the car would have gone over the edge.

The local fire and police chiefs were there. Our chief waved us to a spot and we parked.

I directed traffic for about a half an hour. It was a pleasant way to spend the time. My turnout gear is warm and comfortable… Ask me again in August, right? The only problem I had was an inability to key the radio (to communicate with the other traffic director at the other end of the accident scene area) with my fire fighting gloves, so I had to keep taking one of them off and putting it on again.

After the undamaged car had been pulled back onto the road, we cleared the scene and went back to the firehouse.

The police chief stopped by and spoke with us for a while. He said that the town constable, a nice name for dog-catcher, would not be ‘running’ again this year and would anyone be interested in doing the job? He looked at me. I played dumb. I guess he thinks I’m okay, though. I had dealt with him several times regarding our idiot ex-tenant stealing the dishwasher and I had gotten the impression he thought I was a thorn in his side. Lately, though, he’s seen me at three accidents and one medical call for two departments, and I was providing care at three of them. He did yell at me at the first fire department incident I was at, but he seems to have gotten over that.

I responded to a medical call just before I went to California, and before I had discussed what I should do on medical calls with the officers.

I went over to the firehouse like a good probationary member and waited for someone to show up to tell me what to do (okay, I know what I should do, but in any organized response you need to function within your protocols and subject to direction from your incident command structure… Skate your lane, no freelancing).

After a few minutes, I realized no one was coming (it was during the day, and from the page one could tell it was non-critical). I knew an officer was going direct and that the paid service was on its way. I drove over to the patient’s house. A pickup belonging to the deputy fire department chief was there. I grabbed my jump kit and went in.

The patient was sitting in a chair. My immediate impression was that this patient was not critical. There were two relatives there in addition to the deputy chief and the patient. The four of them were discussing family current events. Based on my visual assessment, I decided not to take vital signs (although, in retrospect, I should have). One of the relatives was finishing up a patient’s medication list (very helpful). I took some history from her.

The police chief showed up after a while, then ambulance. The deputy chief and I went out and got the cot, then wheeled the patient out. I knocked a few things over with my innate clumsiness, and frightened the patient by accidently pressing the cot back-support release while we were moving him. Everyone else seemed pretty patient with me, though. Heh, patient.

The police chief held traffic while the ambulance left, then he thanked me and the deputy chief and we variously drove off.

Several days later at the firehouse, I was told that I would get to know the address as this patient was one of our frequent flyers.

Last night I missed the ambulance squad business meeting. The time has changed from following the training at the rich squad’s depot to preceeding the training, starting at 5:30. I was not present at the last meeting, either; it had been rescheduled to a time I was in California. In my absence, I was elected to squad assistant coordinator.

The training was pretty interesting; it was given by a cop/EMT and covered drugs; drugs that form the EMT-Intermediate pharmacology, common prescription medications we might see in our patients, and illicit drugs that we are likely to see on our calls. I was surprised at the frank ignorance of drug culture knowlege among the trainees and the misconceptions in the apparent police institutional knowledge… I refrained from pointing these out. The trainer recommended Trainspotting for its depiction of heroin usage and symptoms. He said that most cops that are killed or injured are dealing with methamphetamine.

It was a very nice weekend. I’m in not-so-sunny California. Heather came out on Friday, leaving the boys at her mum and da’s. I took Friday afternoon off. I picked Heather up at the airport (changed into my kilt in the parking lot; I was going to change at work but lost my nerve at the last moment), then we went off to Target to buy a pillow (I don’t sleep with one left to myself, but Heather requires one.) We went home and met my roommates; after two years of sharing a house with me, I think they were starting to think Heather was imaginary. She’s not, of course. We walked through the Castro and up into the Haight (not exactly direct). We had tapas at the Haight Street Cha Cha Cha – I prefer the Mission one, myself. No Boddington’s on tap at Haight. Then we took the bus to Mission and fourth and saw ‘Big Fish’. Interesting. Some hip young inner-city kids of today called me faggot, apparently in honor of my kilt. I smiled. Then we went home by way of a coffeeshop and got into bed early with takeout dessert.

On Saturday we got up and went to one of my usual places, Liberties, for brunch. Liberties is an Irish pub and we were able to have a lovely if filling meal. Unfortunately, the Boddington’s was flat and I had to make do with some other Irish dark thing on tap. After brunch we drove down to Santa Cruz and rode a bunch of rides; it was the first time we had ever been to the boardwalk together without children. We ate all make and manner of junk food. Then we drove up past our old house (still a nice place, but we agreed it looked better when we lived there). We got back to the city, ate yet more, then went to bed.

Yesterday we got up, got coffee, and drove over to Coit tower. The parking lot of Coit tower is one of my favorite places and one of my usual stops when out gopedding, however, I’d never been up in the tower. Heather and I went up and enjoyed the view. It was lovely. Surprisingly, there was parking available. Next we went to the mall and did a bit of shopping. Among other things, we each got shoes and Heather got this really cute short pleated green skirt. I managed to talk her into changing into it in the car. We went home, then off to the movies where we saw ‘Lost in Translation’. A late dinner at the Mission Cha Cha Cha (I finally got my Boddington’s), a spot of coffee on the way home, and off to bed.

Today Heather is on her own; I think she is planning to go to SFMOMA. Later she will take the train down and we will go to dinner at Srinivas’ house. Tomorrow morning she is back to the east coast.

It’s been a fun weekend together.