E[mergency] M[edical] S[ervices]

So, I did my EMS ambulance ride time today. Although I knew it would be unpredictable, I figured it would be somewhat similar to my Life Line ride time with the helicopter – a lot of waiting around and a few calls…hopefully without the motion sickness. I was assigned to ride from 10am-8pm with two female paramedics. At the beginning of the day, I mentioned I knew nothing, so everything would be new. Even if we didn’t have an "interesting" day, I would still know more about how things worked than I did before. First off, learn the lingo. Every area in medicine (and in every profession, I’d venture) has their own way of talking and definitions of unfamiliar words.

With that being said, I'll give you the DL on the lingo I heard used most commonly today.

First, codes. Now when I hear codes, I think code blue as in CPR, start chest compressions stat. Or code orange, seal off area because of dangerous chemical spills. Or even code silver, shooter in hospital. But in EMS lingo, a code is the way one leaves a scene to head to the hospital. Code one is not as emergent. Code three is lights, siren, and speed because the patient should have been at the hospital, like, yesterday. There is no code two. Don’t ask me – they didn’t think it made sense either.

Next, priorities. There’s a graduated level of priorities based on the information dispatch was given in a 911 call. If there is possibility that the patient has no airway maintained, can’t breathe, or the heart has stopped beating (or dispatch is unable to ascertain the nature of the patient’s condition via the call), then the truck responds priority one.  Again, this indicates lights and siren since it’s the highest priority. The priorities become less severe the closer you count to five. There are five levels of priority total. The paramedics explained that codes and priorities seem opposite at first. You may respond to an urgent priority one patient, but leave the scene code three (most urgent). However, a non-urgent call takes, say, a priority four status and, therefore, they would leave the scene code one. Got it? Good. Moving on.

Third, districts. Springfield has two privately owned EMS operations – Cox and Mercy – and each responds to calls made in certain districts. For instance, Cox covers anything Battlefield and south plus everything between Division and Kearney. Mercy covers calls made from Battlefield to Division and everything North of Kearney to the surrounding areas. They split the calls on Battlefield depending on if the location is on the north or south side of the street. I asked specifically since I live on Battlefield. Even though they respond to patients in these areas, they can take patients to any hospital within reasonable distance, so patients in those districts aren’t forced to use the hospital of the EMS providers who respond.

Fourth, posts. When an ambulance isn’t on call, the paramedics report to dispatch and indicate they are free to take an assignment. Dispatch then gives them a call or a location at which to post – a.k.a. hang out until needed. To my knowledge, there are three (if not more) posts in Springfield for Mercy medics. Post one is the ER ambulance bay at the hospital, post two is a clinic near Kearney and Glenstone, and post three is headquarters located on St. Louis Street. Posts two and three are nicer accommodations, with leather couches and television. When there isn’t a truck stationed at post three (HQ), then they pull a “free” truck from another post to cover the entire city from that location. Then when another truck becomes available again, the truck that was pulled is usually sent back to the post from which they just came. At least that was the case today. It seemed like there was no rhyme or reason at first to why we were constantly going back and forth between posts two and three, so I asked, and that was the explanation they gave to me.

After getting some of the lingo down, I was able to follow the conversion and assignment reports more easily. I hate being lost in the lingo, so I definitely didn’t hesitate to ask questions right away. Besides the terminology, there were several other things I learned which really enlightened me to the way EMS functions.

Organization. The first thing I observed as I walked into the ambulance bay at headquarters was one of the paramedics with which I was riding (let’s call her A.) cleaning out the truck. The other paramedic (let’s call her B.) commented that A. was a neat freak, so the truck would be spotless on their shift. (Which was fine with me since I’m a tad of a neat freak myself and can appreciate a fellow kindred spirit.) B. pointed out how the truck was arranged. Everything they needed they could keep on their stretcher – monitor/defibrillator, airway bag, and med bag. The truck was stocked with meds, IV supplies, oxygen, gloves, and all the materials of the medical trade that may come in handy. Like alcohol wipes and emesis buckets. There’s a pilot chair in the back as well as a bench seat/makeshift 2^nd patient bed and a side seat. There is also a driver and passenger seat up front.

In the back of the ambulance at the beginning of the shift.

Shifts. I happened to catch a ride-along on a 10-hour shift. However, most shifts are typically 12 hours.  (County EMS shifts are 24- or 48-hour shifts.) Four shifts run all the time starting at 6, 6:30, 7, and 7:30 (morning and evenings). Then there are 9AM-9PM and 10AM-8PM shifts. There are two partners to a truck: either a paramedic/EMT or paramedic/paramedic. Usually, the teams are consistent…so they are not constantly switching partners. As B. pointed out, this makes it great if you work well with your partner or miserable if you can’t stand each other. I loved how she mentioned that her EMS co-workers were like her family – some closer than family. But there is also some discord at times when working styles, personality, or personal preferences clash – like which radio station to listen to or how to treat family members of patients on scene.

Cost. I’ve always been told – even before I started working in the ER – that it’s expensive to call for an ambulance ride. So, I specifically asked how much it would cost if I was self-pay. Apparently, people weren’t lying when they said it would be expensive. First, there’s a base BLS (basic life saving) charge – $600-something per a certain amount of time. Then if the paramedic interacts with you at all, there’s an ACLS (advanced cardiac life support) charge of $900-something per certain amount of time. If you need intubated or any airway assistance, the cost goes up significantly because an ACLS II charge is added. And on top of all that, there’s a dollar per mile charge. For Mercy, it’s $16/mile – at least initially. I’m not sure if it goes up if the distance increases or not. The BLS and ACLS charges also go up exponentially if the distance is large – like from here to Kansas City instead of across town. All that to say, ambulance rides are expensive. So, unless you are truly dying or need the assistance of sedation, find another ride to the hospital and back home.

Challenges and Advice. Being an EMS responder is tough work. There’s a huge range of emotional extremes. Among handling horrific traumas, feeling threatened by psychotic patients, and taking non-urgent transfers back home, it’s easy to face emotional whiplash or burnout. After responding to calls involving kids or working a death, most people will need to take a step back, breathe, and regroup in order to move on to the next call. The responders never know if the next call could be the best call of their professional life or the worst one that changes how they function for the rest of their career. The shifts are unpredictable – crazy busy, boring monotony, exhilarating, frustrating procedures of changing post to post or transporting patients who abuse the system. Patients can be super sweet or incredibly ungrateful. In addition to the emotional difficulties, the nature of the work is physically exhausting. Throughout their day, paramedics and EMTS are constantly lifting patients – and not always bed to stretcher. They often receive calls for morbidly obese patients (400-600lb range) who have fallen and EMS is sent to help them get up or come to the hospital for their injuries to be treated because no one else can lift them. Not to mention the exhaustion working 12-hour shifts can create.

These are some of the challenges of the job. The advice B. offered is to come into the position with some street smarts. Many times you have to be able to read your patient before you put them with yourself in an enclosed area. If law enforcement felt threatened enough to use handcuffs, by golly, the patient needs to stay handcuffed or be transported in the back of a police car. If a patient is strung out on K2/bath salts and the police can’t handle them, pre-medicate the patient before loading them in the back of your truck. If you feel threatened as a paramedic, don’t hesitate to brace yourself, yell “brake!”, and let the patient go sliding out the back. Better they be hurt than you dead. Her other advice: take a break when you’re too overwhelmed or emotionally paralyzed to function safely. Sometimes you need to take a step back before you can continue. That’s ok. Sometimes it’s hardest to recognize your own limitations – but even paramedics and EMTs are people. They’re not super-human or deity. Sometimes there’s not a thing they can do to save someone’s life and they know it.

So, that’s what I learned.

Here’s what I Experienced: two hospital-to-nursing-home transfers, a nursing home to Cox South ER transfer, and one home-based call from residence to Mercy ER, as well as quite a bit of down time at the posts, watching the US Figure Skating Championships on T.V., and a trip to Subway. Our routes included Springfield and two other cities in the surrounding area. By 7:30PM, they were “EOS” (end of shift), we headed back to fuel up and log miles, and then returned to headquarters – ending where I had started that morning.

Conclusion. The daily life of EMS responders is completely unpredictable. They have been puked on, physically and verbally abused, thanked for saving someone’s life,  and responsible for delivering babies on the side of the highway and extricating patients from car crashes; all of these situations with minimal support, supplies, and often in an enclosed space. And yet, they keep coming back to work. What I learned today: just as is true for other medical positions, EMS responders deserve our gratitude and respect. Perhaps, more so than others do. 

Truths from the Emergency Room: Part 2

Sometimes I feel like all I relate lately revolves around work, but honestly that’s where I’ve spent most of my time recently. Therefore, I think it’s appropriate to share a little about what I’ve been learning there. Keep reading to find out…

1. Complaining is not productive. You can complain and gripe and rant about the injustices of the system and you can still not achieve anything productive. This view comes from an employee/fellow co-worker stance. I work with some people who always talk as if they are the victim when it comes to what patients they see, when they see them, the time constraints, etc. However, I’ve observed much more gets accomplished when less talking and more acting occurs. At times, it’s difficult to remain positive and optimistic when surrounded by Johnny Raincloud and Debbie Downer, but I continue to try to keep a bright outlook on the situation.

2. People lie. No duh! That's a no brainer, right? Well, this one has been more difficult for me to embrace and I believe I know the reason. My entire life I’ve been surrounded by my Christian family, friends, school, etc. where principles and values such as honesty and integrity are upheld and assumed. My reality thus far has proven that people have good and decent intentions and are telling the truth. But the more I’m at the ER, the more I’ve had to come to grips with the fact that people are sinners, manipulative, addicted, and violent. They come seeking relief from pain and consequences and will do whatever they deem necessary to obtain it. It’s difficult for me to change my mindset to constantly consider that someone is trying to deceive me. I’m still not incredibly successful in this area, but I’m sure I will continue to improve as I work.

3. Having initials behind your name (M.D., D.O., P.A., N.P., etc.) does not exempt you from common courtesy. Now that I’ve been at the ER for several months, I’m beginning to be able to evaluate which practioners I admire and respect and which ones I don’t want to model my career after. There is one particular doctor who is always kind to those “beneath” him. He lets you pass before him instead of running you over; he says thank you when you do something for him EVERY time instead of not even acknowledging your presence; he laughs with his patients; he comforts those who are grieving; he gracefully handles fellow co-workers’ and his own frustrations; and he doesn’t (at least publicly) indulge in the gossip circle so prevalent in any work setting.

4. Never assume anything. I’ve learned the hard way that this lesson should be taken to heart. Just when I think it’s safe to assume something, I end up wishing I hadn’t. For example, assuming that surgery knows you’re coming since the nurse just called up with a report and therefore not calling…but being directed to the wrong surgery waiting area and causing a whole lot of unnecessary chaos, panic, and stress. Or that the computer tells the truth – a room is marked clean so we move a patient there…only to find out it’s not just dirty but trashed. Or thinking someone was just correcting the pronunciation of their name when you call them back…only to learn that the wrong patient answered and was mistakenly roomed. All of the tedious, detailed protocol that we have to follow saves us from making these careless mistakes. There are no corners to cut when it comes to emergency medicine. And this unit only functions well when everyone works together this way.

So, there you have it: my latest revelations about life. There are so many things that I’m learning. Although, at times, it seems like I’m so far away from what I actually enjoy (the medicine part), I am learning highly valuable interpersonal skills such as teamwork, communication, conflict resolution, effective resource utilization, and good patient interaction. And, on that note, I’m going to wrap this post up. I have one more day at work before having a much needed break, so I must catch some sleep.

Truths from the Emergency Room

It’s been nearly three weeks since I’ve finished my training and been on my own in the ER. These last three weeks have taught me many things – things my trainers could not teach me but only experience could. When people find out I work in the ER, the first question they ask is if I like it. And I do. Although it’s physically challenging, I love the variety and fast pace the department embodies. Each day I have no idea what I’ll encounter, which makes it interesting.

A few truths I’ve come to see since my time in the ER are as follow:

1. Don’t take it personally. I received this advice the first night I had orientation in the ER. My education supervisor let us know that this department was stressful and sometimes didn’t allow for niceties when it came to communication. I’ve found that most of my co-workers are quite pleasant, but if I had not been warned beforehand, it would not have been good. You see, I’m a people-pleaser by nature. I’m also a type-A perfectionist. I don’t like to disappoint. When I make mistakes and get called out on them, I just have to remember not to take it personally. Learn from it and move on. Also, when nurses have had awful encounters with patients, doctors are frazzled and overwhelmed, and patients and their families are the furthest things from saints, I have to let it roll off my back.

2. Every person is human. It doesn’t matter what your age, gender, career, family situation, location of residence, or education level, every person is mortal. We don’t live forever in our earthly bodies, and we all can be placed in a situation of dependence. When I was little, I remember the president of the United States placing temporary power into the VP’s hands while he underwent a colonoscopy…and I remember thinking it strange that such a private medical concern should be public knowledge. It just goes to prove, though, that it doesn’t matter who you are, medical concerns affect us all. Keeping this in mind helps me be able to relate to everyone on an equal plane; each person is worthy of the best care possible and I am able to respect each patient as a person by not having my perspective clouded with pre-conceived notions. Usually I show up to a room not even aware of the reason the patient is in the ER. I’m just there to serve in whatever way I can.

3. Small things matter. In a world where a one-digit difference on a code pulls up Suzy instead of Johnny, little aspects make it or break it. I’ve found that it’s important to check the O2 tanks under the beds so as not to run out on a transport, include a middle initial on an EKG, clean under the bed so as not to leave trash or objects that could hurt someone if the bed is placed in a psychiatric room, change the battery in my phone at the beginning of the shift, and let people know when I’m going to lunch. I’ve found that by doing my tasks well and to the best of my ability, my co-workers are beginning to trust me. I know that no one else will have to pick up the slack because of my inattention.

4. I love the field of medicine. In the midst of all the messiness and complexities of our patients’ lives, there lies one common thing: they have a problem. Sometimes the problem is the body, sometimes the mind, and sometimes the spirit – or a combination of these. Although St. John's is better than other hospitals about acknowledging the spirit due to its Catholic heritage, the other two receive more attention. I love that there are the few brave, dedicated men and women who have pursued the study necessary to understand the body. They can look at a situation with an underlying medical problem, recognize that problem, and know how to treat it. Some of the interesting procedures I’ve been able to watch include lumbar punctures, stapling head wounds, cath lab procedures, splinting, CPR (code blues), CTs, X-rays, and ultrasounds. I’m continually learning new things about the body, it thrills my soul, and I know I’m in the right place at this point in my life.

So, that’s what I’ve been up to these last few weeks. I’m hoping as time goes by to earn the doctors’ friendship and be able to take on more of a student-mentor relationship with them. For now, I will continue to be faithful in the small things at work, respect my patients and co-workers, and strive to be a light for my Savior. There are so many opportunities to do so.

With that being said, I’ll leave you with the verse I’ve taken to heart recently. Psalms 118:14 – The Lord is my strength and my song; he has become my salvation (NIV). Truly, he is what keeps me going in this physically challenging job. He is the joy of my heart and the One my soul worships with both audible and inaudible singing. And he is redeeming me day by day; a sinner in need of mercy and grace being transformed into the image of Jesus and his righteousness.