July 2005


Right.

So, after reading about Burger King’s new ad campaign aimed at 12 yo boys (a band called COQ ROQ, with the slogan ‘Chicks love the COQ’), I went over and looked at an ad site mentioned in the same article.

This is somewhat interesting.

http://subservientchicken.com/

There seems to be a loop here that plays while you aren’t typing anything; there is a chain on the floor that changes and the lighting changes. Asking a question causes different actions to occur. I’ve been trying to figure out if this other action stuff is real-time or Eliza-style expert-system harrumphosity.

I had the chicken stand on one foot, stand on its head, do the funky chicken. I couldn’t get it to change anything in the background.

I’d be interested to know other people’s opinion on if any of this is real-time.

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Harrumpf.

Since last time, I sent off my form for New Hampshire and got my NH EMT-I card in the mail. I am now certified to provide intermediate-level care if I happen to be on that side of the river; that might conceivably happen on my paid squad.

I’ve got half the signatures I need for the VT application. I spoke to the state office today; they were maddening. They have no idea when an I-03 exam may be scheduled. They will review my credentials and decide if further training will be required before the exam, would only be a few days if at all. Just a few days.

The annoying thing is that the NH medical protocols are just as complex as the VT I-03 protocols, only that the VT protocols are subject to online medical control for most meds. Online medical control is what Johnny and Roy get when they call into Rampart for instructions. So, in other words, for a specific problem with given indications and contraindications, NH expects you to administer a specific medication while VT expects you to call in with the story and have a doctor tell you ‘online’ to give the meds. In practice, certain protocols may be executed due to inability to communicate with medical control, but it seems that VT trusts the EMT less than NH does.

I attended the EMS district board meeting tonight. I found out that there are other people on several other services with I-03s in the pipeline and so there may be a test upstate in the next month or two. So that was good. Not surprising but still worrisome that the state people I spoke to earlier had no clue.

I was asked about my service’s progress; the service that I coordinate lost its transport license two or so years ago and has been working back from a first responder service into an ambulance squad. I am planning to file the license for transport this winter. We have been working, slowly, on recruitment and are able to have two people on just about every call. We are getting a new radio repeater that will go up on a mountain nearby that should solve some communications issues; people in my town can’t currently hear calls from over there.

At a meeting with me last weeek, the town manager of my primary squad’s town sugggested the idea of having a mass casualty drill. He is concerned with the number of tour buses that come through the town and the response if something should happen. We came up with two possible places that an accident would be likely to occur. I told the town manager that I would be delighted to put an MCI drill together. He told me that I would have the support of the town in any way that I needed. When I got home, I called a guy from the fire department who I knew had some interest in planning an MCI and he readily agreed to help plan it.

I was unsure how the board would react. I suggested the drill and everyone was pretty excited. Every major EMS resource including the hospital expressed support and enthusiasm. Someone knew where we could get a bus. I described the two scenarios that the town manager and I came up with. The first idea was a bus collision with a truck on a particular long descent of curvy main road where accidents happen constantly. It was generally agreed that the state police would not permit that particular stretch of road to be shut down for several hours. The second suggestion was a bus into the river along the curvy main road. Everyone liked that one.

“Ooh, river!”

Everyone was supportive of having it in my town. I’m thinking forty or fifty victims; that would be twenty or so ambulances tied up for several hours, several fire departments, and a bunch of hospitals in on the game. There has not been a big drill nearby for a long time so this would be well needed. The hard part, though, is plannning the policy. It’s easy to flip a bus into the brook and set out a bunch of participants in moulage; planning and agreeing on procedures with all of the stakeholders will be difficult. When I discussed needing procedures first to practice in the drill, the board became vague.

Some new weirdness surfaced regarding EMS in the town I live in; some woman has been anonymously stirring up trouble, incorrectly suggesting regulatory or functional defects in the way EMS is provided in my town. There have been three occasions that the board knows of that the woman has done so. In any event, it was suggested that a first responder service should be set up in my town for appearance’s sake. I disagreed and argued that there are no problems with the way EMS is provided through the fire service with
an affiliation between the fire department EMTs and the ambulance service. It seems to me that the current system works fine and limits the red-tape crap.

I was able to defend all of the issues that anyone else had with the way service was being provided; certain influential board members seemed to really want to look into it further for ‘public perception’ reasons so I volunteered to explore the issue with the town and state. If my town is going to have an EMS unit, I want to be in on the ground floor, I guess.

Work is work.

The Red Menace continues to be a source of Dilbertian annoyment. Lately, we’ve been having yearly performance appraisals on a quarterly basis. I don’t get it, either. In any event, my boss said ‘Your technical credibility within the engineering team is excellent. This is one of your key strengths.’ Which was nice of him. He’d like me to care about my projects more, though. Which is also nice; he’s finally starting to notice.

My main client keeps going. They need more of my time. They have some cool projects that need to be done, but I don’t have time to get to them; RFID timekeeping, document revision management, production-worker touchscreen workstations.

I need to hire.

I need to get a car for the TTBD (Tech To Be Determined). I’ve found a place in New Jersey that will wrap the car. It’s going to be checkered on top, I think, Bxiie-blue and vanilla. I have some vague ideas for the sides; handwritten flow charts superimposed over computer-generated ones with a pithy slogan. Unfortunately, the perfect 800 number is taken.

I’m hoping to go over and put in a few ride-along hours at the paid squad tomorrow or Friday night. We’ll see. Unfortunately, I’m not going to have much time for them until Labor Day. I’d really like to be working more calls; I need the experience.

I can’t remember my last call… It’s been at least a week and a half.

Damned healthy people.

NREMT Card

I went to my new job today for some ride-along time.

First I went to a prospective client’s place; a seafood distributor twenty miles away. They want me to set up their system so that when they get an order, the shipping label immediately prints in the warehouse. A simple enough thing; maybe ten hours, but it means my foot in the door at a different place and a possible reference.

I got to the warehouse and the person I was supposed to talk to wasn’t there. Big drag. I wasn’t too upset, though; I didn’t sleep well last night and really didn’t feel my best. I got the impression that they were embarrassed and sorry, so we’ll give it another go. The first consultation is free for my clients; I guess I’ll spot them a second visit, too.

So then I went to the municipal fire/ambulance place. It turned out to be fairly exciting in several different ways.

About ten minutes after we got there, we went out to the local hospital for a helicopter landing drill. The li’l hospital has to shut down a parking lot to land the chopper so the fire department has to go out to set up and secure the landing zone. I didn’t do much; rode to the hospital in the back of the ambulance, stood around, watched the chopper land, stood around, watched it take off. I did talk to two EMTs that I will be working with. One of them I had worked a scene with last winter, the ‘ex-member’. She reminded me of the scene and asked if the compliments from the patient’s family had been relayed. Cool. I had worked another scene with the other EMT; she also knows someone from my EMT-I class and is related to a distant consulting business associate. Small pond, I guess.

Riding in the back of the ambulance, I noticed a fire extinguisher pin on the floor. I didn’t think much of it.

After we got back, I started working through my ‘3rd-rider sheet’. This form guides my learning the location of items on the ambulance and procedures of the department. I watched a ten-minute video on how to use the ambulance stretchers. I learned how to use the nifty stair chair (a stair chair is a chair used to take people down stairs. This one has rubber tracks and the thing runs itself down the stairs. The harder the EMT in back pushes *down* on the thing, the slower it goes).

I started going through one of the ambulances (A-1) with the ‘ex-member’ EMT. We looked at a bunch of stuff; I figured out where things were and how they worked. At one point, though, sitting in the back of the rig, I turned to get something out of a compartment and hit the fire extinguisher handle with my leg. The pin on the floor, it turns out, was from this unit; it discharged, spraying yellow dry-chem agent all over the back of the ambulance.

I grabbed the extinguisher and jumped out. The other EMT jumped out as well. Yellow dry-chem dust hung in the air, drifting out of the ambulance.

I was mortified. The other EMT laughed and laughed.

We discussed how to clean the rig. We finally decided to ask the EMT captain, the person in charge of the EMTs, his opinion. Luckily, the department chief had already left for the day.

We went into the office. The EMT captain was in the office, entering run sheet information into a computer.

The EMT who had been helping me asked the captain how he would clean fire extinguisher agent out of the back of the ambulance.

The captain stopped typing and sat motionless for a few seconds. Then he turned to the EMT and fixed her with a baleful stare.

“You set off an extinguisher in the back of A-1?”

“Yes,” she said.

It was nice of her to take the heat, but I couldn’t let her do that.

“Actually,” I said, “It was me.” I didn’t bother to point out that someone else had knocked the pin out.

He looked at me as though I were something distasteful. The FNG. The FNG just loaded loose dry chem into the back of the primary ambulance.

“Try to sweep it up.”

I suggested maybe we should wet it down first so that it wouldn’t become airborne again and spread further.

The captain looked at me as though I were a talking moose; amazingly able to speak but still not welcome in the fire station.

“Yes, maybe that would help.”

As the other EMT and I left the office, I said something humorous to the captain about him being sorry he’d hired me. He agreed without mirth.

The other EMT and I cleaned up the mess in about twenty minutes. We went back to going through gear.

After a while, we went back into the office and started looking at paperwork. By this time, only the captain and the other EMT were left; the last two day staff waiting for the night staff to arrive. Ten minutes before quitting time, the tones went off.

Both the captain and the other EMT swore in unison. Tones ten minutes before quitting time means working at least a half hour late. Probably more.

Dispatch informed us that an 89-year-old male had fallen and hit his head at a hospice where he lived.

I ran out to the ambulance and ran around the outside, closing the open compartments and pulling out the ‘shore power’ plug. I jumped into the back.

The captain (an EMT-I) and the other EMT (a Basic) got in front. The captain drove.

It was only a few blocks to the hospice. When we got there, I got out and grabbed the jump kit. I went into the building, expecting the other EMTs to be right behind me.

All of the other ambulance services I work with leave the stretcher in the rig and go in with just the jump bag. I guess this one is different; I got inside and the primary EMTs were still at the back of the ambulance. I knew what to do, though, so I went in and found the patient.

The man had fallen out of bed, gashing his head and ripping open the back of his hand. The side of his head had a 1 ½ inch laceration and significant bruising; there was blood on his neck, his shirt, the sheets. He had a larger laceration on the back of his hand, although the hospice staff had already patched it with tegaderm; a clear film.

I introduced myself.

“Hello, I’m , an EMT with the fire department.”

Convenient that I can use the same salutation as I use in my own town.

The hospice nurse filled me in on the details. I palpated the patient’s skull for softness or crepitus. There was none. I unzipped the jump bag looking for gauze to patch the patient’s head laceration.

About this time, the other EMTs came in with the stretcher. I deferred to them.

After some time, we decided not to collar and board the patient. We helped him onto the stretcher and took him outside, then put him into the ambulance.

The other EMT-B asked me if I wanted to ride in back with the I-tech; the captain. Sure, I said. I hopped in; the other EMT-B got in front to drive.

The captain hopped in and rattled off a list of things we needed to do; take a set of vitals, start oxygen, put on a cold pack. I took a pulse while the captain got out the cardiac monitor; the monitor would take a blood pressure and measure SPO2 as well as confirm my pulse reading.

I gave the captain my measured pulse rate, 64, and got to work on the cold pack. I went for a wash cloth to wrap the cold pack in; the captain suggested a pillow case. I grabbed the pillow case, wrapped up the cold pack, and put it on the patient while the captain started oxygen. The monitor started to report readings; my pulse was spot on.

I talked to the patient. I asked the captain if the spine had been palpated; it had not. He had checked the patient’s circulation, sensation, and motion in extremities on scene, but no spinal. I ran my fingers up and down the patient’s spine feeling for deformity while asking the patient if he had any pain. He did not; his spine seemed clear.

I held the patient’s head and the ice pack until we arrived at the hospital. A few minutes before arrival, the captain called the hospital on the radio and delivered ‘the patch’; the description of the arriving patient and the care provided so far. I provided a correction and a clarification to the Intermediate captain while he was on the radio that he relayed to the hospital.

We got to the hospital, took the patient inside, and turned over care to the emergency room staff. I changed the stretcher linens with the help of the other Basic then took the stretcher outside to the ambulance. I put the back of the ambulance back in order, then got out. The captain was standing near the rig, completing the patient care report, writing on top of a trash can.

He looked up and spoke to me.

“You’re an Intermediate, aren’t you?”

“I just passed the National Registry. I still need to get state certification.”

“Good. We need more people who can work in back.”

He went back to his paperwork.

I know I’m going to take a lot of grief over the fire extinguisher for months to come… I think I acquitted myself well on my first call, though.

Results are finally in. I took the exam on June 12. Today I got my results; I passed. Now I’m a nationally registered EMT-I. “Woot, woot!”, as they say. I will get my New Hampshire certification by sending in a copy of the NREMT card; I will have to take yet another exam to get my Vermont cert. I have no idea when I will be able to take the Vermont exam; one has to be offered in order for me to take it and there aren’t that many ‘I’ courses given in the state. I’m going to give the state office a call tomorrow and see what I can find out.

I had an interesting call last night.

I was just getting ready to go to bed around 2:30 when my pager went off for an unresponsive 63-year-old male. I drove over and was the first on scene. The old guy was lying on the floor with his eyes open. I determined that he was unresponsive to verbal and painful stimuli and then took a set of vitals. He had a history of COPD and was on home oxygen; I replaced his 2 liters/minute oxygen via nasal cannula with 10 l/m via non-rebreather. The guy’s roommates stated that he had been okay about 45 minutes earlier, then had taken oxycodone and hydrocodone and ambien (his normal meds). Later, they heard some thumping in the guy’s room and found him unresponsive.

The ambulance showed up about the time I ran out of things to do. We got the patient onto a backboard and took him downstairs and outside. Once outside, we put him on the stretcher and threw him in the truck. The lead EMT asked me to come along for the ride. I got in back. We rolled the guy off of the back board onto the stretcher.

The guy’s breathing got worse so the EMT called to start assisting breathing. I pulled out a bag valve mask, hooked it up to oxygen, filled the reservoir, and started breathing with the guy, augmenting his insufficient respirations. The EMT couldn’t get an IV started in the guy due to poor veins; he did give the patient 2 milligrams of narcan intramuscularly. In two minutes’ time, the guy was breathing on his own and coming around.

I’ve come to the conclusion that I like working in the ambulance. Once the patient is loaded, it is a controlled environment. The tech has a number of tools and techniques and has a certain amount of time during which time s/he must support the patient before arrival at the hospital. It’s very different than the chaos at the scene. I wonder how much my perspective will change after teching a few difficult calls all by myself in the back of the bus with the patient.

Tonight I spent three hours at my new job. I am a municipal employee in the town of Windsor, Vermont; a part time firefighter/EMT, emphasis on EMT. I have to put in some ride-along time before I can run as part of an ambulance team. So far I have put in six hours without a single call… The curse of the third-rider.

I did three hours several days ago. My first task as a professional EMT? I delivered ten rolls of toilet paper to the police department.

“On September 11 I told my sons that the day they wrap my daughters in burkas every single male member of our family had better be dead. I stand by that today. They can grieve later.”

— A comment from a Londoner on David Frum’s Diary at National Review.

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