Ah, Fall.

Apparently nothing worth blogging about happened over the summer. I can't say that with any certainty, but I don't (though I should) force myself to blog. It happens when it happens.

The newest news as of late is that I am dipping my toe into the educational and mentoring portion of paramedicine. Recently our rig has had two paramedic students, the most recent staying with us until mid-December. It has been very interesting being in a teaching position in the field, especially when many times I feel like I am still learning the ropes myself. The idea of teaching has always appealed to me. I've been told I'm good at explaining things and that "I'd make a great teacher."

That is not, however, how I feel.

I realized (not surprisingly) that I have high standards for street performance. I want people I work with to be at that standard right away, and it is a bit of a shock to see a student below that (duh, they're a student) and wondering how I'm going to get them from where they are to where I want them to be. Fortunately, my partner on the ambulance is an experienced field instructor and I've been able to pick up some good tips from him. As he put it, mentoring a student is a fine art of putting them on the line between uncomfortable and dangerous to practice. Apparently this zone is the best place to learn. 

Unavoidably, I've also compared both our paramedic students. I've come to the same conclusion I always have--this is a job field built largely on field experience. Most of our job, at the basic or advanced level, centers around being able to talk to people. If you can go up to a stranger and establish a rapport with them, as well as extract pertinent information in a concise and timely manner, you'll make a great pre-hospital provider. This comes to some naturally, while in the rest of us it takes many repetitions. I'm covering all this because I'm unhappy with the way paramedic education seems to be going in my state. Now, paramedic school started out as a two year deal. With the advent of fire-based EMS, programs were pressured to shorten their academies to accomodate agencies that needed more advanced providers in the field quickly. As a result, paramedic schools everywhere are cranking out paramedics in as little as six months. 

Experience also used to be a prerequisite to a paramedic program. EMTs with a couple years street experience on an ALS rig were considered the minimum when applying to a program. Now, however, there are too many "zero to hero" programs, where someone can become an EMT and then paramedic all in the same program with no street experience in between! Even worse, many fire departments (including my own), send inexperienced EMTs to school, EMTs who got their certification only so they could apply to the fire department. Does this product sound like someone you want treating your family?

Ah, I can see I've rambled again. Anyway. I'm sort-of precepting now and it's interesting.

EMS: A Primer

Ok, judging by the recent news story I feel it's again time to discuss the basics of my job. The news story I'm referring to is about the high cost of ambulance bills, and can be found here:

http://www.thedenverchannel.com/news/23557782/detail.html

EMS stands for Emergency Medical Services. Most commonly, this translates into ambulances. There are a number of different ways of providing ambulances to the public. One way is through a private company. This may be a for-profit or a not-for-profit endeavor. Alternatively, the service may be hospital-based, and the profit standpoint depends on the hospital. As an aside, these hospital-based systems don't "only" transport to their own hospital. The most common solution to providing ambulances in Colorado is in fire-based EMS. In this system, the fire department cross-trains its firefighters in EMS and run ambulances as well as engines and trucks. At our department, there is no difference beween who works where--I may work on an engine one day and the ambulance the next. It is a non-profit endeavor.

Now, onto who works on an ambulance. There are three levels of certification. EMT (Emergency Medical Technician)-Basic, EMT-Intermediate, and EMT-Paramedic. EMT-Intermediates are found mostly in rural areas, so I will focus on EMT-Bs and Paramedics. EMTs provide BLS (Basic Life Support). They take vitals, perform exams, provide oxygen, and perform techniques ranging from CPR to IV cannulation to artificial ventilation.

Paramedics are the most advanced form of pre-hospital EMS. They have all the skills of an EMT plus some. They go to school for a longer period of time, and perform more detailed exams. They have a number of drugs they can administer to treat respiratory problems, allergic reactions and cardiac dysrhythmias. They can intubate, perform synchronized cardioversion and defibrillate, among other things.

At our department, an ambulance consists of an EMT and a paramedic, or two paramedics. Some things we can't do: kidnap people against their will, diagnose diseases, make your decisions for you, provide parenting advice or parent your children.

Now, what happens when 911 is called? For a medical emergency, the nearest fire engine and ambulance are dispatched to your location. Why two rigs? There are more engines than ambulances, so an engine will usually reach you first to provide care (remember, EMTs and paramedics are on all the engines). Also, on a seriously ill patient, more hands can help the call run more smoothly. We aim for a response time of under five minutes, and have to be out of the station in under a minute after receiving tones. Want to try it out? Here are two fun ways at home. First, get into the shower. Lather up. Relax. Then start the stop watch and make it out of the shower, dressed and sitting in your car. Don't want to soak your seats? Get into bed. Fall asleep. Deeply asleep. Have your alarm go off at 0230, in the dark. Again, get dressed, out to your car. One minute.

So, we've arrived where you are. A number of things can happen. Usually, you describe your complaint, we evaluate you, and off we go to the hospital. However, there are times where the "patient" isn't the one who called 911. They may not wish to go with us to the hospital, preferring to have someone take them, or they may not wish to go at all. Sometimes this is reasonable, sometimes they are making a poor health decision. Either way, we can't kidnap them. They can refuse, against medical advice and after consultation with our base physician at the emergency department. What we can't do is "paramedic initiated refusals;" that is, refusing to take you to the hospital. If it is a minor injury, we can explain that it may be a better decision to seek care at an urgent care, your personal physician, or have someone drive you to the emergency department. But if you want to go to the ED, we'll take you.

This brings up the question of cost. Yes, it does cost for us to take you to the hospital. Sometimes a lot. No, I don't know how much it will cost. Administration won't tell us. And we've been told that if we do know, we can't tell you. So someone gave you an estimate? Well, it's not based on anything. Your bill is higher? Sorry--it was uninformed. Here's the deal though. When you call 911, you get the jurisdiction covering your area. It's not a "shop around" type of deal. The services that respond are paid by your tax dollars.

So, you ask, if I pay taxes for these services, why isn't my ambulance ride free? Good question. It turns out taxes pay for the stations, salaries, rigs, rig maintenance, keeping our training up to date, etc. It doesn't cover the wear and tear on ambulances, fuel costs, drug costs or other supplies. So we have to charge. Again, we're not making a profit. Additionally, there are health insurance companies to deal with. Some reimburse us only pennies on the dollar. The last average ambulance reimbursement figure I heard thrown around was 30%. This is why fire-based EMS is popular in Colorado. The fire department is supported by a consistant tax base, not by ambulance fees. This is also why so many private ambulance companies go out of business. Imagine running a business where you took up to a 70% loss on every transaction.

Abuse of the 911 system adds to these costs. Think of the number of people, with or without insurance, that take the ambulance frivolously (yeah, there's a lot of them). There's the ones with a cold for three weeks that call at 3am for an ambulance ride. The drunk on the street who we will transport twice in one night. The minor cuts and scrapes, not to mention the "neck pain" patients from car wrecks hoping for an insurance payout. There's people that are "frequent flyers," known to EMS crews and ED staff by name. These aren't unusually sick people, just drunks or those with imaginary illnesses.

These patients spill over into overcrowding in the emergency department. In a place that is supposed to be reserved for life threatening illnesses, nowadays you find a majority of patients that should be seen instead by their primary care doctor. This brings us to another problem--many people lack health insurance to have a primary doctor, and thus use the emergency medical system as their primary care.

As you can see, this is a problem that quickly grows in size and complexity as it is unwrapped. I don't foresee a simple solution--my goal is to educate you to the issues at hand.

Please, just remember a few points.

-We're not "ambulance drivers."
-We're not gunning for a profit. We are healthcare workers concerned about your health.
-Please use common sense before dialing 911. If you have no common sense, please consult someone with some.
-For those of you against healthcare for everyone, remember that next time you or a loved one is waiting for hours in an overcrowded emergency department waiting to be seen.
-If you insist on calling 911 from your cell phone for a car wreck or a person "passed out" in the grass/bus stop/alley and you DON'T stop to render aid or wait for us to show up...I will hunt you down and you will lose phone privileges.

Thanks for reading.

Reentry

TJ and I are on the final leg of our journey home. PAP-MIA-JFK-MIN-DEN. It's been a log, hard, heartbreaking and rewarding week. We are both a bit run into the ground, and on top of it TJ has contracted some sort of respiratory gunk.

We feel as though we've been on the ground for a lot longer than a week. It seems weak to say that...I look around at other healthcare providers with a thousand-yard stare, and realize they've only been on the ground for twice our time.

After virgin bloody mary's on one leg of the flight, we suck it up and have a morning commemorative shot of whiskey in Minnesota. It burns in a good way after spending the night at JFK.  On the final leg home we recount the highs and lows of the trip. Most are recounted here. Most. Writing this blog, in the past/present tense, I realized that there are some stories that just aren't to be told. I've taken you for the most part day by day through our experience, and I hope this gives you an idea of what it was like. TJ and I agree though, that some stories we carry with us, though seldom share.

I feel as though we've seen humanity at its best and worst this trip. We've seen those operating on the most primitive survival instincts, and those whose compassion only grows in the face of adversity. There have been those that have become adoptive parents to children orphaned by the earthquake. There have been those that have split their families in hopes of self-preservation and a better life for their children. This is a country where adults rarely smile, and never complain. Children innocent to their situation keep smiles alive.

I worry about the mental health component of all this. Everyone we met has some sort of PTSD. It appears that no one sleeps. Some weep silently. Others speak of night terrors and loved ones screaming in their sleep. Our translators speak of even further horrors in outlying refugee camps that have seen little aid.

Coming back, it is odd to take up the life I left here. It is easy to feel guilty for the situation I find myself in. I remind myself often, that I should feel grateful rather than guilty. And a duty to help others. I know that Haiti will remain in my heart and my mind, a place that remains in need long after the media has left.  Thanks for reading.

ED

As the sun rises in Port au Prince, rays pierce the otherwise dim field hospital tent and make me squint as I survey the scene. A little boy lies in the exhaustion that follows a seizure, while a young man breathes quietly through a tube in his throat. His mother stands beside him, keeping the flies off his head. It's been an eventful evening.

TJ and I got the night shift at the ED (emergency department) after talking to an Indian doctor serving there, and hearing that they were understaffed at night. Our team leader ok'd it, but only if we'd work the day before and after--a 36 hour shift. Upon hearing our plans, our pediatric ED MD decided to join us.

We arrive at the ED just before shift change. It's located in the compound behind the presidential palace, set up by a medical non-profit. It is comprised of two MASH-style tents set up on the asphalt, without floors. There is no ventilation or A/C. Beds are green mesh collapsable cots, with buckets under them as commodes.  Storage boxes and an old desk outside the first tent comprise a rough triage area. Inside, medications and supplies are strewn between a couple of folding tables and some rolling shelves. The dimly lit interior smells of old urine and dried blood.

The staff for the night is seven strong. There is an emergency physician from California, an ACNP from New York, two nurses, the peds ER doc (Dr. M), TJ and me. There are no labs available, and X-rays are hit and miss. The most valuable staff member in the ED is the portable ultrasound machine.

The night starts off slow. There are a few patients with relatively easy dispositions. One patient had three liters of fluid drained from his bladder. Another father was concerned because his soon was pooping crayons. To quote Dr. M, "As we speak, kids all over the world are eating crayons." A couple of minor wounds come to be patched up and are on their way. I'm wondering where this chaos is that people mentioned.

Soon, a lone man comes staggering up to triage. He is soaking wet, wearing only a baggy t-shirt and smelling of feces and urine. And booze. It turns out he was riding his motorcycle and wrecked it, then walked an untold distance to the ED. No one knows if he lost his pants or if he ever had them. He gets paper scrubs and is bundled off to X-ray. My initial thought was, "ah, now it feels like an ED!" but in reality, we see very few inebriated patients.

In the midst of caring for a few minor patients, we hear the squeal of tires outside. I walk out the front to see a dusty pickup out front, with a couple of people sitting in the back staring at us. In the bed of the truck lays an unconscious man. At first glance I thought he was dead. The NP and I grabbed a stretcher (think MASH) and manhandled the patient on to it, who was guppy breathing (really, think of how a guppy breathes out of water). Once inside, he was found to have a severely low blood pressure and blood sugar--hypovolemia and hypoglycemia. Obtaining a peripheral IV was a near impossible task, and an internal jugular line was finally established with the assistance of the ultrasound. Fluids and sugar were started, while the MD worked on a diagnosis. Our patient looked like a cast member of Outbreak--red, sunken eyes and flaking skin.

From there, we treated a patient with catatonic schizophrenia, two minor asthmatics, a UTI and an elbow relocation. Most disturbing was the woman with metastasized breast cancer--our only possible treatment were to give comfort analgesics and release her.

A father rushes in, carrying his limp infant son. They came from a nearby clinic, unable to care of the child. He's been having trouble breathing, and quickly draws the attention of all of us. We grab the ED's only oxygen tank and start the child on a nebulizer. At almost the same time another pickup rolls up out front. Another unconscious male. Another double take to make sure he's not dead.

It's an asthmatic this time. His lungs are so tight he's not moving any air. He is intubated on the floor of the ED, among the flies and buckets serving as toilets. As he is moved to a bed we are alternately bagging him (breathing for him) and squirting an asthma rescue inhaler down his tube--we're out of other asthma medications. He does get steroids through an IV line. He's been sedated, and still can't breath on his own. There's no ventilator in the ED either, and there is the sick infant still. The nurses give the family instructions on how to use the bag valve mask to breath for their loved one.

Amidst the infant, now seizing, and the family bagging the asthmatic, another patient arrives. A boy of no more than fifteen comes in heavily bandaged and accompanied by his father. He has been beaten by a crowd, and treated at an outlying clinic. The lacerations covering his face and head were rudimentarily sutured. Slowly, we remove the bandages covering his eye. Under it is a bloody mess. It looks like hamburger--I'm not even sure the eyeball is intact. He has lacerations to his upper and lower eyelids, such that they split apart and overlap each other. The doc brainstorms at the best way to repair his eye.

Meanwhile, the infant boy continues to struggle. It is lucky that we have the pediatric ED doc with us tonight. He watches over us as we work on stopping his seizures, and improving his breathing. There is only one oxygen tank for the now two patients that need it. TJ disappears, and returns sometime later lugging another oxygen tank that he "liberated" from the ICU. The infant has stopped seizing, for now, but we still need to get an IV in him for medications.

The family of the asthmatic isn't doing an adequate job bagging him. We move him next to the infant, and will take turns the rest of the evening breathing for him. Keeping him alive. I take the first shift.

In another stroke of luck, an ophthalmological surgeon arrived in our camp that morning. Technology helps us to save the boys eye. An iphone picture to the camp gives the surgeon an idea of what we have. He relays back that he can fix it. From there, he wakes up the head doctor of the clinic, who in turn rouses the chief of the special forces for an escort--the streets of Port au Prince aren't safe after dark. Soon, the surgeon arrives at our ED. I help sedate the patient while we scrounge up a suture kit. We assisted and watched as this amazing surgeon pieced an eyelid back together. It turns out the eyeball is intact, and the damage is to the tissue around it. Stitch by stitch, a perfect pair of eyelids reappear. Soon, the boy is resting quietly. Hopefully, he'll have few scars and full eyesight.

The infant boy, on the other hand, was getting worse. He was in status seizure now--a seizure that doesn't stop. His brain was slowly cooking. No one was able to get an IV in him--EJ, peripheral, femoral, nothing was working. His legs were blistered from a previous clinics IM administration, and our ED was out of rectal benzos.  With much resignation, the decision for an IO--a needle directly into the boen--was made. The concern was of osteomyelitis, a bone infection. For now, that was secondary to the seizures. There were only two realistic places on this patient for an IO--the tibial plateau of each leg. Too low and the bone may crack. Too high, and the risk is run of fracturing the growth plate. The doctor made his drill....and missed it. The drill was passed to TJ, with one chance left to get an IV in order to stop the seizures in this infant. I'm proud and happy to say that TJ got the IO in successfully. Medication was given, and the seizures were stopped. He needed more definitive care, but the only NICU in the region wasn't accepting patients.

The asthmatic patient is still not breathing on his own. Worse yet, he is exhibiting deceberate posturing--a sign of serious brain injury. The MD and NP discuss discontinuing ventilation and providing palliative care--allowing the patient to die. They are worried that the lack of oxygen injured the brain beyond repair. For the moment, we continue bagging him.

Around 3 AM, the infant was resting somewhat quietly. The sickly patient with the low blood sugar was starting to come around after three liters of fluid and 3 administrations of sugar. Suddenly, gunshots shatter the silence outside, reminding us of where we are. Surprisingly, no trauma comes of it.

As the first rays of sunshine begin to penetrate the plaza, amazing things begin to happen with the asthmatic. His lungs continue to clear. His posturing stops. As his sedation wears off, he even begins to fight the tube. As he wakes up, he is even able to follow basic commands! This is a patient we feared was brain dead. As a further test, we give him the chance to breath on his own, albiet through the tube.

Our drunk wanders through the sleepy ED, having slept through the night's chaos on a cot on the floor. He smiles at us, clutching the X-ray of his bruised, but unbroken arm. X-ray in hand, he wanders out the front door and into the sun.

The shift is coming to an end, and it is full of mixed feelings. The asthmatic is breathing on his own, and should be discharged soon. The first comatose patient will likely remain in the hospital for observation, but is now up and taking the first shaking steps on his own. His suspected diagnosis is end-stage AIDS. The boy with the eye laceration has gone home with his father. Our only loose end is the infant. It remains to seen if his seizures will continue to be controlled. His lungs are clearing at least. He will remain in the ED, outcome unknown.

For us, it is time for us to rejoin the sunshine. Clinic starts soon, and there are many patients to see.

Mer-MAN

The engine was on scene for report of a gas leak. Soon after their arrival, they called for a medic unit for an "unconscious patient" in a bedroom. We responded.

I'm not sure if the "unconscious patient" regained consciousness prior to our arrival, or was conscious the whole time. Suffice to say, when we arrived the "unconscious patient" was transformed into naked-guy-covered-in-poo.

Now, this gentleman was laying on a bare mattress in his room. It was cold out, so he had the oven on and the door open to heat the place. He was yelling at the engine crew and trying unsuccessfully to maintain a seated position. The man may have had a *bit* to drink today.

Our conversation went nowhere.

"Sir, why are you naked?"
"Who are you?!"
"I'm a paramedic. How are you feeling tonight?"
"Where are my pants?"
"What color are they?"
"Who are you?"
"Are we playing the question game?"

It turns out we weren't. Our patient had to come with us (he clearly couldn't take care of himself on his own) and so someone found a black pair of sweatpants for him.

His efforts to put them on were less than successful. He'd line himself up with the pants, bit his lip in concentration.....and in one quick motion shove both legs into one leg of the sweatpants. From there, he'd fall back on the bed and flop for a moment like a merman from the sea of poo. Repeat twice.

We finally intervened, only to realize the pants were as covered in poo as he was. One hospital gown and some awkward assisted steps later, he was on the pram.

The gentleman had only one request before we left for the hospital--his Louis L'Amour novel, so he'd have something to read.

Rubbing shoulders

Practicing medicine, on any level, means that you press up against mortality. Invariably your own mortality. What we do often merely staves off death. Sometimes in the long term. Sometimes in the very short term. I've heard people mention this before, but it's only recently that I'm beginning to understand it on a personal level.

An attempt to save a life, to care for another, is to acknowledge the brevity of that life. And the ultimate fragility. No matter what "salty dogs" may say, this...is....hard! It is perhaps easier for those of us in prehospital care. We see our patients for a brief window of time, often don't get to know them on a personal level, and their care is passed off to someone else. The tragedy comes from circumstance, the sadness of a situation. For those healthcare providers who spend more time with patients, I believe the cut of death becomes deeper. It is an emotional connection being lost as well. 

It's not just a patient that one is connected to dying that is hard though. That event forces us to acknowledge that no matter what we do, it is a temporary extension of the inevitable. 

Recently, I've moved further in probing these feelings. It's hard, it sucks....and it's also a great honor to be in that position. As with many things, polar opposites highlight each other. Exposure to death gives me more beauty in my personal life. It is an opportunity to slow down, and appreciate all the things around me that I love and enjoy. That I believe is one of the great gifts of medicine. We see the unfair suffering, sudden and chaotic passings and the slow fadings away. But in exchange we are forever reminded of how beautiful each breath we take is, and how important it is to savor the life around us.

Day 4

Today is a full, hard and fulfilling day at the clinic. There are three of us in station one, a primary tent. It is a pop-up shelter, like the one you'd find at a wedding or catered outdoor event. There's canvas walls and roof, and it seems fairly well anchored. The floor is dirt, as we're in the courtyard of the police compound. There are old, rubber and steel patio lounges that serve as patient beds. We sit on old home depot buckets. At the rear of the tent is the "pharmacy": two folding tables covered in medications (majority labeled in Spanish) that we try futilely to organize each morning. There is a rapidly dwindling supply of oral-rehydration electrolytes, cough syrup, Ibuprofun, antibiotics, antifungal/antibacterial creams, and antihypertensives. It seems we are always out of what we need most.

Joining me in the tent is TJ, and our hero of the week, Dr. C. Dr. C is a primary doc....a really really smart doc. He leads station one, and is more than patient with TJ and I as we get his input on patients.

The patients...well, there's a seemingly endless stream. They line up outside the gates hours before the sun rises. There, Haitian volunteers "triage" the patients, but they really just provide them with slips of paper with their name on it that shows their place in line. Once outside our tent, there is a second line, with a few chairs to sit in. This is were TJ and I try to scan, and pick out the sick kids. I mean, the really sick, comatose in their mother's arms sick. There's usually 3-4 of those a day.

With the help of translators, we see patients as fast as we can. There is minimal paperwork, which is nice and means we can see more people quickly--around 500 a day.

There are a few complaints that seem to permeate the entire populace. Everyone has diarrhea. A headache. A stomachache. Worms. Scabies. Especially the kids. The adults are stoic, smiling a polite smile that doesn't crack the pain in their eyes. Kids are....kids. To a point. The young ones are wonderful. They laugh, smile, or are shy and hide away in their mother's breast. Some of the older children sense what is happened, and the shock reads more clearly on their faces. One girl of about 12 starts crying when I ask her how she is today. Everyone is grateful to be seen. No one complains about the wait in line.

I find that I can't get enough of these kids, which is good because our patient population is probably 75% pediatric. Even though most people live in tents or tarp shelters, every child somehow has clean clothes. The girls wear ribbons in their hair and fathers fret over sons who have dirty hands.

As we see more and more people, the complaints through the language barrier begin to make sense. A headache, a stomachache....it's stress. Lots of stress. I don't think mental health is something that is stressed in Haiti. So it presents as these complaints. Many adults state they can't sleep. Or have nightmares. All we can do is give Benadryl, and a reassuring smile.

The kids would all be healthier if we could just make their environment cleaner. Diarrhea runs rampant due to the food. Skin infections because of the sanitation issues. Open sores and crusted, itching blisters abound. Our creams disappear quickly. Others have upper respiratory infections, sinus infections, or ear infections. We are all on edge to catch fevers in our history--everyone is worried about malaria. Many single mothers come with three or four children, all sick. They leave with armfuls of medications, and my hope that they don't get mixed up.

I know I'm rambling. I'm trying to give a sense of the day. Of the kids. I'll talk about adults tomorrow. It became my goal to see who I could pull a smile out of. Kids became easy--parents were the challenge. Sometimes, I feel like it was the best thing we did. The toughest part was knowing this was all a temporary fix to a larger problem.

I'll leave with this picture. This adorable girl blew kisses throughout her interaction with TJ.

Day 3

Smoke billows over the city nightly. Our guess is that it's trash burning, and it gives the skyline a war-zone aura. It's trash now...it was buildings. And bodies.

I'm learning that Haiti is a country of dichotomies. Every morning, a marching band raises the Haitian flag on the grounds of the presidential palace as the many people in the nearby tent city watch. Though there is no sewage system or electricity in the tent cities, last night I watched a lone garbage truck making its rounds through the streets.

We transported two patients today. One went to the ED with a rigid abdomen while another patient needed transport to University of Miami for an ortho consult on an ankle fracture. CIMO drives the ambulance for us, and we run emergent everywhere. With the heavy congestion on the roads however, it does little to help.

Working in the clinic, we've gotten a crash course on antibiotics and common infections from our peds ER doc. The patient population we are seeing is about 75% pediatric, so it's a helpful session.

The strength and compassion of the Haitians we work with continues to impress, and in an effort to equal them, TJ and I are going to try and work a 36 hour shift tomorrow, covering the night shift at the emergency department (we hear they are understaffed at night).

On a side note, our tent really stinks. I think we really stink. As hot as it is on the roof, Evans says it's too cold for him to sleep up there. I guess our living arrangements are for the best.

Day 2

Our clinical days are idyllic, compared to how it must have been right after the earthquake. The stream of patients is still unending, but there is much less trauma now. The clinic's surgical room has seen little surgery as of late. The clinic is split into three stations, sometimes four. Station one is for general treatment, housed in one of those pop-up tent shelters in the compound. Station two is primarily wound care, though also general treatment. It is in one of the buildings in the barracks. There is also a pediatric station inside the barracks, and some days there is an OB/GYN room. TJ and I spent most of our time in station one, rotating as needed through the other sites.

It's easy to lose count of how many patients we see. I saw kid after kid after kid--lots of pediatric exposure. Lots of diarrhea, malnutrition, respiratory infections, skin infections....These kiddos just can't stay healthy with the conditions they are living in. A lot of kids are showing signs of stress from the earthquake, sometimes silently crying as they sit. Perhaps the most difficult thing is knowing we are providing temporary solutions to chronic problems. Still, we treat with pedialyte, Ibuprofen, antibiotics, and anything else pertinent from the pharmacy. It is a new challenge, since most of the medications are in Spanish.

Three to four times a day TJ or I catch a nearly comatose child in line, limp in their mother's arms. These go straight to our peds ED doc.

TJ and I transport one patient via the ambulance CIMO has to the OB ward. There aren't any doctors there, and we're not sure we improved her situation. Later that night I helped the ped's doc extract chipped teeth from a three year old who fell.

My translator is Jacklin, a Haitian medical student. He's smart and compassionate--I would love to see him back in school soon, as he is the type of person Haiti needs so much right now. TJ is working with a CIMO guy named Evans. He has the interest and aptitude to be a medic, and we are trying to teach him as we go along. Really, we couldn't have done anything without these two during the week. They translated, helped us wade through situations, and gave us something to shoot for in integrity. Both have been working almost non-stop since the earthquake. Jacklin has worked with different medical teams as a translator. He always pushes for the teams to go further into IDP (internally displaced people) camps to reach those who can not reach us. Evans was in the presidential palace when it collapsed, but his sense of duty has kept him on the job through it all. He and his sisters even adopted an orphaned 15-month old after the earthquake. Evans is so proud of his new son.

The only crack in their armor is their eyes. You can see the sadness, especially when we see patients. There is the woman with her newly adopted son, trying to take care of him though she has no food or shelter to offer. The family of four, a single mother, still without shelter. The twelve year old with no one.

That night was unbearably hot in our tents, pouring sweat inside as the rains pounded outside. A few questions on my mind as I try to sleep: What is the end game in Haiti? Who rebuilds? Where has the government been? How do houses get  rebuilt? It is so important to ensure your donation money makes it to the ground here. How does this situation become something other than the status quo?

JFK-MIA-PAP

We stay the night before our departure at the Howard Johnson in Jamaica, just outside JFK. It is one of the more...colorful...hotels I've stayed in. Nonetheless, we know it will be better than the conditions coming up.

I say we, meaning my travel partner and I. Let's call him TJ. He is a close friend and paramedic as well, and has been a long-time mentor of mine. To cop a cliché, he taught me everything I know.  I'm glad to have him on the trip.

The team meets in the lobby at 0245. A freezing rain has started outside, as two shuttle vans load us and our luggage. Thirteen team members and forty bags. TJ and I alone have 200 pounds of gear among six bags and two stretchers. Even then we'll end up short on supplies.

Our team consists of a pediatric ER doc, a primary care doc, a few nurses, and TJ and myself. The docs are phenomenal, and we'll learn a lot from them.

.......................................................

Wheels down in Port au Prince at a little bit after noon. My initial impression is that of a functioning country. There is little visible damage at the airport, although roving humvees and the University of Miami field hospital in the distance are reminders to what brings us here.To my surprise, our flight is positively packed with aid workers. We are hustled into a hanger, where chaos ensues as massive amounts of baggage are unloaded.

After some orderly jostling, our bags are collected and we are herded through a cursory customs check. Outside, in the blinding sunlight, Haiti hits me. A gate separates the airport from the road, and crowded there are people looking for work, looking for people off the plane, and looking to hustle. Our driver meets us, and we begin a caravan towards the vans.

At the vans is a lesson in situational awareness. Men looking for work started arguing with the people our agency had already hired. They thronged around our team leader, a timid women with no medical background. As the team milled about, the crowd got larger and larger. People started pushing and shoving, and voices were being raised. This whole time, TJ and I were on edge, circling the crowd and listening to that fuzzy gut feeling. Some internal tipping point was reached, and we plucked our team "leader" from the crowd, shoved half the team into one van and hustled ourselves and the rest into the other. Welcome to Haiti.

As we drove into the heart of Port au Prince, the scale of destructive began to come into perspective. All around us, there are piles of rubble that used to be buildings. Those that are still standing are missing facades, or floors, or leaning dangerously. A burnt out car flashes past my view. Blocks upon blocks of tents zip by, as rhythmically as utility poles. The tents nearer the airport are bigger, and nicer--the result of USAID and the Red Cross. Nearer in the city, tents become scarce and anyone with more than one tarp has a mansion. Every yard of every house we pass has a tent. No one goes inside.

Our destination is a clinic set up inside what is left of the barracks for the Haitian special forces. The tiny compound is divided from the presidential palace by a tent city covering what used to be a lush, green park. Inside the compound, the soldiers have set up their own tent city in the courtyard. Here is were most of them live with their families. I find out that we are to camp out on the roof of the barracks--apparently it is still structurally safe...comparably. The view from the roof is devastatingly awesome. It overlooks the tent city, and the collapsing presidential palace. Destruction can be found down every street, and the view we have from one side was previously obstructed by a four story building housing the legislature. That building collapsed with many inside.

We set up tents on the flat, concrete roof. The space is shared with other groups, from Columbia, Argentina, and the US. I'm told to keep my tent zipped shut, as there are "rats the size of cats" Turns out not to be an exaggeration.

Our team is thrown into the fire immediately, as the clinic is short-staffed. TJ and I take our first patient when we intercept a doctor who is about to send a pre-ecclamptic patient to a nearby hospital. We throw here on one of the stretchers we brought and load her into a surprisingly modern ambulance owned by the special forces unit we are staying with. Inside is an old Ferno pram, the only supplies being a few angios and some old IV bags. Several translators and a police escort are tossed into the ambulance with us, and off we go.

It will become apparent during the week that anytime the ambulance goes out, it goes lights and sirens. To and from our destination. It seems silly at first, but we roll with it and soon realize it is the only way we have any hope of getting anywhere in a reasonable amount of time, considering the insane traffic congestion on the streets.

Thankfully, the patient remains stable, as our biggest challenge is just finding the hospital. It turns out the hospital is little more than some old MASH-style field tents in the area behind the presidential palace. We are directed straight to the OB ward, where we search for someone in charge. The ward is a few cots in a tent, with no staff in sight. With much translation difficulty, we discern there is no bed for our patient, or a doctor, among somnolent babies and fatigued mothers. With the help of some friendly GIs, we are directed to the ED.

The ED is, again, two field tents together with a few cots. An MD and NP, visibly burnt out, accept our patient. We transfer her over to a bloody green mesh cot that is hastily washed off as we arrive.

Leaving the ED, the smell of heat, people, and concrete fills the air. Evening has set in, and somewhere something is burning. Our work is cut out for us.

We return to the compound, as a curfew is set at dark for all aid workers in the city. Tents are pitched, and as sirens wail across the city, we settle in to our first night in Haiti.

The Return

I'm back, safe and sound from Haiti.

It was an incredible, intense week. Heartwarming moments and heartbreaking moments. Some of it was easier than I expected, while other parts were harder. Ultimately, I know that our team helped a lot of people in Port au Prince. I really couldn't have done this without everyone's generous support--thank you again.

Over the next few days/weeks I will be posting my experiences there, as I had written them on that day. So take a trip back to the recent past with me, and I will share with you my experiences on the ground in Haiti.

As I Take My Leave

*Note: I wrote this at work, and am posting at home. Now I am T-12 to NYC, although it will be a bit longer before we are on the ground in Port au Prince. *

I'm at work, though my mind is several thousand miles away. It's my last set before my journey begins, and I'm antsy. There's been so much planning, fundraising (thank you, again), packing and re-packing. Now I'm anxious to have everything begin. It's similar to hoping for a serious call or a fire at work--there's so much preparation on the back-end that we are all itching to put it to use.

In a recent interview (calm down, it was my alma mater's online publication) I was asked what I hoped to accomplish in Haiti. My answer is a little selfish, and that's to see the difference I can make in someone's life. To bring calm where there is chaos. Stability where there is uncertainty. Partially, that's what draws me to medicine. Sometimes, just sometimes, I'm able to see someone's life improved because of what I was able to do. And so I hope this trip goes. From what the other teams have reported, they have been treating somewhere in the range of 500 people a day in the clinics, so at least the odds will be on my side of succeeding!

Here are a couple tangible pictures of what you guys helped bring about. We're maxing out the airline's restrictions on what we are bringing with us weight-wise. Yes, apparently baggage restrictions still apply on humanitarian missions. We have airway kits, wound care supplies, stretchers, first-aid kits to hand out, antifungals, antibacterials, Ibuprofen, a variety of drugs for allergic reactions and chronic illnesses, syringes for oral IM medication administration and oral rehydration powders. On one hand, my heart sinks when I think that this is but a drop in the bucket as far as need goes. And to pull the cheesy charity line, on the other hand it is something. We are doing something and that will make a difference. You guys made this happen.

This is my last post until I return. I'll take lots of pictures, and lots of notes. And I'll report back. Most of all, I will attempt to convey the generosity and open-hearted kindness that I have felt from so many people. 

So that even one life breathes easier because you have lived….this is to have succeeded.

Thank You

I can't tell you how much it means to me that you all gave so generously to my cause. I should say our cause. I've been overwhelmed by the outpouring of support, and I feel lucky to have so many good-hearted people in my life.

These past few weeks have been a whirlwind of fundraising, planning and packing. The medical team I am deploying with is composed of medical professionals from across the country. I don't know a whole lot about everyone yet, but I'll keep you updated. So far we've had regular conference calls with updates about the conditions in Haiti as well as planning our trip.

The flight plans have changed the most. Initially we were slated to go from Miami to Port au Prince, which change to New York to Port au Prince, then New York to the Dominican Republic to Port au Prince by car, and most recently it is New York to Miami to Port au Prince. As we have been reminded over and over, it helps to realize the fluid nature of the situation.

As for the situation on the ground, it is into a new phase of the disaster effort. The emergent search and rescue phase is over, and most of those injured in the earthquake have been treated. That being said, there are still patients being seen with wounds that have not been seen since the earthquake weeks ago. At any rate, it sounds like some aid teams are beginning to pull out, which makes the patient load on those still on the ground even more intense. The current plan is to start out at the University of Miami field hospital, helping there as needed, and fanning out from that point to clinics across the area. We will be caring for post-operative patients, as well as those seeking basic or routine medical care in a country without infrastructure.

There is still a large hazard from the enormous amount of rubble on the ground, and unstable buildings. Injuries related to this are common. Due to the loss of buildings as well as a general fear to go indoors, there are still large tent cities of internally displaced people (IDPs). These cities are anywhere from 500 to 10,000 people. From these camps are arising malaria, dysentery and sepsis, especially with the beginning rainy season. We expect to have no shortage of patients to treat.

As for gear, we are told to be almost completely self-sufficient. We have tents, sleeping bags, food, water purifiers, and as much medical supplies that we can take. In addition to wound care items, we will be taking down basic items such as Neosporin and min first-aid kits, in the hopes that people can care for themselves after aid teams such as ours are gone.

Now, it is a waiting game. There are a few loose ends to tie up, and a few pieces of gear to grab. After that, I wait with anticipation for March.

Haiti

I've just received word to today that I'll be heading to Haiti.

I'll be deploying as a paramedic attached to a team from International Medical Relief. Every time a disaster strikes, I feel moved to try and do something. Until now, apart from donating, I haven't found the proper outlet. I'm excited for the challenge, and to make a difference on the ground for a change.

The team is supposed to leave March 2, 2010, returning on the 9th. Between now and then I'll be fundraising, getting immunizations, collecting equipment, etc etc. If you'd like to donate, please visit Fong to Haiti.

This should be a new, challenging, and stressful experience. As much as possible, I will make updates regarding the trip on this blog. I'm not sure I will be able to update once on the ground, but I promise an after-action brief. Thanks in advance for everyone's help and support.

Change of pace

I imagine my post here will change a bit, for a while. I'm rotating off the ambulance for the first time in almost two years. We have a student coming to our station who is assigned to the medic unit for 1-2 months. This means I'll be "riding backwards" on the engine. Thinking about this, I decided to clarify some terms.

First of all, our fire department provides emergency medical services. This means the ambulances are run by the fire department, and the same people working on the ambulance one day might be working on the engine the next. That means I am a firefighter and a paramedic, on every day. There is no delineation of duties, other than only those guys on the ambulance transport to the hospital and the ambulance doesn't respond to fire alarms. Firefighter do medicine and paramedics fight fires. One and the same on our department.

When you call 911 for a medical emergency, you usually get a fire engine and a medic unit. This is because there are more engines than medics, so chances are the guys on the engine will get there sooner. It also provides more bodies, when needed, to provide the best care.

The day to day difference to me is that I provide more of a supportive role to the attending paramedic. I may start the call, but the attending paramedic will be transporting to the hospital. I'll "ride in" as an extra pair of hands on critical calls. Meanwhile, I'll start responding to fire alarms (quite possibly the bane of my existence), CO alarms, and gas leaks. Hopefully, I'll still have some interesting stuff to post here.

Wow. Thus endeth the PSA/educational brief on engines and ambulances.

Why so serious?

Ask just about anyone who works in the fire service or EMS, and they will tell you one of our major coping mechanisms is humor. Not every emergency can be an emotional investment that leaves you feeling drained at the end. It would never work like that. It's no place to wear your heart on your sleeve.

As a result, lots of things become funny. Perhaps some things that normally wouldn't be funny. Now I'm not saying that we laugh in faces, usually at situations. And usually back at the firehouse. But sometimes...life is life.

The cops called us out the other day to assess an elderly man that they thought needed medical attention. He had originally called 911 stating that there was "someone in the house." There wasn't, and the more the officers talked to him, the more confused he appeared. That's when we stepped in.

His house was neat, and seemingly unchanged since the 60s--I could have been on the set of Madmen. A small and very Italian man sat in front of me. He was very upset that the neighborhood was out to get him, and that someone had been stealing his pills. I then asked him a serious of standard questions aimed at determining an individual's mental status: where are you, what date is it, who is the president, etc. Here's how our conversation went:

Patient: They're stealing my medications!
Me: I understand, that is concerning. Now, I have some silly questions for you. What month is it?
Patient: March!
Me: Are you sure?
Patient: Well, March comes after February, doesn't it?!
Me: Okaaay...well, who's the president:
Patient: You know who it is.
Me: I know. But could you tell me please?
Patient: Oh, its....Um. Well, it's Mr. Obbaajee Goobajee Schmoobly.
Me: Come again?
Patient: You know, Mr. Wheegee Agits Wharaa.

At this point, the man's clock behind me chimed the hour: "Cuckoo! Cuckoo! Cuckoo!"
Suddenly there was stifled laughter from around me, and in the next moment I was alone in the room as the rest of the crew was outside collecting themselves.

We never did find out if someone was stealing his medications. I think not. I would have gone for the clock first.

Leaving

Death in the field is a curious thing. I know it's something I've explored once before in my short list of posts. People die, obviously, everyday outside the hospital. Apart from a hospice situation, this usually means that we are called. We are called both to verify death and on the outside chance that perhaps this person can be resuscitated.

To be toned as a DOA, however, means the dispatcher has information that points to no resuscitation. Cold. Blue. Stiff.

Some situations are sad. The man alone in a cheap motel room, takeout dinner on the bed next to him, french fries his only company. The husband of fifty years whose wife "just hasn't been able to wake him." Anyone young. Others are merciful. Cancer patients come most often to mind, their bodies ravaged by pain and disease.

The thing of it is, it isn't the ones that have died that bother me. The situations can be painful, or awkward, or scary. But at the end of the day it isn't a load that I bear.

It's the ones that are dying that are imprinted on my mind. There is one in particular, the first of my career, that I think will always stick with me. Here is that memory.

************

It's a cool fall afternoon, and I was brand new on the ambulance. My uniform still had creases in it, and my boots were shiny and unscuffed. The call came in as a "core." In EMS-speak, this is someone who has gone into cardiac arrest. It can be a very dramatic call, but usually one with the same outcome. The national cardiac arrest "save" percentage (that is, the patient leaves the hospital breathing) is 2%. It is often an exercise in futility, a last ditch effort to safe a life.

I don't really remember the house coming into the call. I was a swirl of nerves, wanting to well both in front of my peers and for the patient. We find him upstairs in the bathtub. He looks young. Too young to have this happen. It appears he may have suffered a significant cardiac event and slipped under the water. A limp, wet body is not easy to heave out of the tub. Once out, we start a sort of odd dance. CPR is started, the cardiac monitor hooked up. A tube is pushed down his through to breathe for him, while an IV is started and drugs are pushed in the hopes of restarting his heart.

As the new guy, I was on CPR. It's harder than it appears in class. Instructors aren't kidding when they say you tire quickly doing compressions. I pressed hard and fast, feeling a stomach-turning crunch under my hands as I pumped. Sweat poured from my face as I looked at others working smoothly and seemingly without stress.

The lead paramedic makes the decision to transport. Still doing compressions, we load the patient on a backboard and begin to carry him out to the ambulance.

Leaving the house, my tunnel vision lifted. We walked out of a master bedroom, down a hallway. From a doorway, a girl of no more than six stands, phone held limply at her side. She must have called 911. We move as quickly as we can down the stairs. My lungs heave with the effort, and I notice the smell of fresh chocolate cookies permeating the house. Downstairs, we quick-step through the kitchen through which I can see the back door and the ambulance. Time stops as shadows darken the back door. Through it appear a teen boy and a woman who appears the same age as the patient. Their faces showed a raw human emotion I don't think I can put into words. His family.

Time started again, and we moved to the ambulance. I believe a police officer comforted the family. The rest of the call is again a blur--lights flashing and sirens blaring to the hospital, my compressions continuing the whole way. Our patient became one of the 98% that day.

It stays with me as motivation. It moves me to strive to find that 2% patient I can help. To do what I can so no family loses a loved one early. Because I still remember the smell of chocolate chip cookies.

Close to Home

I think it's tough to write a post about what I do without sounding cliché. To me, that is. I read other paramedic blogs, or books, and see TV. So sometimes it's hard to write about a topic that has been elsewhere covered and not say what everyone has already said. BUT....I guess most everyone else doesn't know what is said, or what happens. And I remind myself I write this for me anyway. It's a way of processing.

So often in the field we deal with death. Yes, every once in a great while we deal with new life, but more often it is the end of life that we come in contact with. And, for the most part, I'm ok with it. It's not that it doesn't affect me, but I'm able to keep most of it at arms length. It's someone else's emergency. I don't think I'd be very good at what I do if I wasn't able to do this. EMS is not somewhere to wear one's heart on their shirtsleeve.

But death close to home. That's something else. Something I don't do well with. Something I compartmentalize and shut away, to deal with another day. There have been passings in the family recently. People my parents were closer to than I. But that made me take stock of my reality more than I care to. A friend's mother is passing. This too, hits close to home and makes me think of my parents. It's draining, these emotions. I'm not sure what to do or where to put them. I suppose that will come with time. The silver lining? At a memorial service reading recently, a few lines of prose were read that gave meaning to what I do, what I want to do. It's incorrectly attributed to Emerson--it's author is unknown, perhaps Betty Stanley. The part that meant something to me was this:

"To know that even one life has breathed easier because you have lived
This is to have succeeded."

Drowning

The ambulance's siren wails ahead of us as my partner navigates through suburban traffic. I adjust the elastic strap that holds my safety glasses tight against my head. I only use the strap when I think I'll really need to keep them on. An "unconscious party" is one of those times. I'm prepared for the absolute worst--a "core," or someone in cardiac arrest. The thought is, if you're prepared to pull out the big guns for the worst case scenario, then there is less of a chance of being surprised on scene. In my mind, I run through drug dosages and ACLS algorithms.

I grab the airway bag, leaving the rest of the gear for my crew to grab as I navigate through the ranch home that stinks of cigarettes.

I can hear my patient before I can see her. It's the oddest sound. Her breathing--it sounds like someone blowing bubbles underwater. An obese, elderly woman lies semi-upright against a mountain of pillows in a dirty bed. She makes no acknowledgement of my presence, her entire existence focused on her next breath. An oxygen cannula hangs crookedly from her nose, her son awkwardly fiddling with it as he explains no one knows how long she has been like this. The family, as is often the unfortunate case, is of little help. Either from an ignorance of her condition or the stress of the situation, they offer little in the way of a medical history, and barely a name. I take a quick listen to her lungs, redundant in retrospect as it merely confirms the gurgling that I can hear across the room.

For all purposes, she is unconscious. On demand, she opens her eyes to me. But there is no fear, or panic. Just defeat. Her congestive heart failure has filled her lungs with fluid, and she is drowning.

This is a patient to move quickly with. My crewmates struggle and place the patient in a chair they've found in the next room--more expedient than returning outside to grab the ambulance's specialized chair. A circus of oxygen tubing, bags and people, we make our way down the hallway to the stretcher. An oxygen mask is placed on the patient and as the stretcher makes its way to the ambulance I formulate my plan of care.

Through my direction, a bag of saline is spiked for an IV, the patient is loaded, a second paramedic is assigned to the back with me for the ride in and vitals are taken. But not taken. My FI reminds me we can do this on the way to the hospital, and in the interest of time I belay the last. No matter though, as a minute ticks by as my lieutenant shows up with the proverbial wrench in the monkey works: the patient is in hospice care with a DNR. This means that the patient is in end of life care, and in the event of cardiac arrest does not wish to be resuscitated. This, for the moment, does not change my care. The patient still deserves and wishes care and comfort for her condition. But it puts in a brief question in mind of how to proceed: is this a priority patient to rush to the hospital? Though there was some debate, the answer in my mind was clear: yes. This patient deserved to be made as comfortable as quickly as possible, and if nothing else this young paramedic did not want her dying in the back of HIS ambulance.

The doors slam shut and our new guy takes off lights and sirens to drive us to the hospital. As is always the admonishment, we caution him to take it "nice and easy" and to "mind the bumps." Either way, an emergent return to the hospital is usually like trying to do patient care inside a paint mixer.

While my partner obtains vital signs and looks for an IV, my first order of business is her airway. I pull out CPAP, a positive pressure airway mask. It is a slightly medieval looking device that straps to a patient's head, but the oxygen forced into their lungs can push enough fluid out of the way to drastically improve breathing. My patient submits to the mask easily, and the audible sound of gurgling goes away.

Cardiac monitor on. Vitals taken. IV attempted, unsuccessful. Again, this time successful. Nitro given, lasix pushed, all to try and relieve some of the fluid on her lungs. All the while, I look from the patient to the airway kit I have laid out beside me. Mentally, I figure that I'll try a 7.5 tube to intubate the patient if she becomes unconscious.

Through this the ambulance siren wails, cars whiz by, and every bump is amplified.

After what seems like an eternity, we arrive at the hospital. In we go, a tangle of wires and tubes. A quick report to the ED doc and my job is done. It is, technically, a success for us: our patient was still breathing on her own when we arrived.

While we clean up and I write my report, my self-critique of the call begins. We could have moved faster. Got her on CPAP faster. I think that I probably should have tried to nasally intubate this patient. I think she was borderline in our protocols for CPAP. But intubation wouldn't have pushed that fluid out of the way. Perhaps CPAP was the right choice. My FI says I did fine. But I still question. As I write my report I calm down. My FI joins me in the EMS break room and says he saw our patient go into V-fib in the room, briefly. What? I'm nervous again, thinking that I somehow missed the patient doing that on our monitor. A careful review of the strips, and my worries are assuaged. Report done, pram clean. Our unit clears, ready for the next call, but my mind lingers on the what if.

First Overdose

We are called to a small, one level apartment complex. A low rent, 10 unit place, with a blandness that blends it into the surroundings were you not looking for it. As we pull up, two men peer out from under an old gold Cadillac up on blocks while two children look up curiously from where they were playing in the broken asphalt of the parking lot. Our customer lives in the corner unit. His daughters, who can't be more than 16 and 12, found him. Tears paint the younger girls face, while the older girl, still on the phone with our dispatchers, points us to the bathroom with an exasperated expression. He took a bunch of these pills, she says, thrusting empty bottles of Oxycodone at me.

I walk in to find a middle-aged man slumped in the bathtub, legs hanging over and head on his chest, barely breathing. A syringe and burnt spoon stick out of his pocket. The syringe has been recapped, and I appreciate his thoughtfulness. He doesn't respond to me, nor the sharp sternal rub. The engine medic and I pull him out of the tub and into the hallway, onto the scoop board there. Our customer is covered in sweat, and slides too easily as we adjust him on the board and his head runs into the top with a dull thud. I decide it's the least of my worries. I'm wrapped up in what I need to do for this man, to bring him back from what he's done to himself. My crew knows what to do, but waits patiently for me to delegate tasks. They want to be sure I know what to do. Almost before I ask for it, the engine medic packages the patient onto the stretcher, while I insert an airway and begin to breath for our customer, while another crew member pushes Narcan into his nose. Narcan reverses the effects of narcotics, such as Oxycodone and heroin.

Still squeezing the BVM to force air into his lungs, we move the customer to our ambulance. My FI asks me what I'd like to do. I decide that we will get a full set of vitals in the ambulance, start an IV and obtain a sugar reading, to make sure our customer isn't diabetic as well. If the Narcan hasn't woken him up by then, I plan to place an advanced airway in his throat, to protect him from getting emesis into his lungs if he vomits.

In the ambulance, the man still doesn't move, even as crew carries out my tasks. I ready the airway kit, and am excited. I've never had a "field tube" before. But just as I am ready to go, my FI rubs the mans chest sharply again, and this time he groans and opens his eyes. Damn. Good for him, bad for me. No field tube this time. I put my equipment away, and announce that we're ready to go to the hospital. As we bump down the road, the customer slowly regains consciousness. We remove the nasal airway and he is able to talk with us.

What did you take? Heroin. It was my first time. What about these pills? Oh yeah, those too. Any alcohol? A pint. Were you trying to kill yourself? Nah, nah. I'm ok.

These are the questions I ask, but the unasked ones float in my head. Why are you lying? This isn't your first time. What kind of role model are you to your daughters? But we aren't there to fix his social problems. Just keep him alive till his next fix.

New Beginnings

I first got involved in EMS when I was in high school, on the grounds that it "looked cool." Having been bit by the bug, I went on to volunteer for a fire department and work for a couple of different private ambulance services throughout college. Although I have a collegiate business background, I was compelled to pursue this new passion of emergency services after college. I now work as a paramedic/firefighter for a busy urban/suburban fire department. 

At one point, I believed that the fire service held all things present and future for my life. After experiencing a drop of medicine in paramedic school, however, I find myself longing for more involvement in medicine. As a result, I am perhaps working my way towards a career as a physician associate. 

These posts are a result of my time on the street. They are a chronicle of real calls and the reflections stemming from them. I will attempt, at first, to backtrack a bit. I want to start from the end of paramedic school--with my first days as a medic on the street.