Archive | August, 2009

Break Out Your Sex Wax

26 Aug
Tropical Storm Danny

Tropical Storm Danny

 

 

And guess who doesn’t have to play EMT until Sunday?!?!  So guess what I’m doing this weekend?!  Yup – I’m going  SURFING!  WOOHOO!!!!!!!!

Also, before anyone misinterpets – this is Sex Wax…and it’s totally PG Rated. 

 

Sex Wax

Sex Wax

Geeking Out

25 Aug

I’m an EMT-B.  I’m in school to get my Paramedic.  And I’ll get it….eventually.

Right now, I work on my EMT-B skills, I try and do my best to give my patient the best care that I know how and teach my trainees how to be competent AND confident in their patient care.

But I still ‘geek out’ when I get a compliment from the paramedics in my city – even if they aren’t verbalized as compliments.

The first one happened two Saturday’s ago – on the 15th.  We went for a guy in SVT – with some other cardiac terms relating to his p-waves and QRS complex and other stuff.  Enough that the paramedics pushed Adenosine.  Anyways – the reason I’m saying this is that the Paramedic looked at me and looked at my partner, told my partner to drive and that he’d prefer that I stay in the back with him. 

The second time was just on Sunday.  We went for a guy in A-Fib and the paramedic asked who was going to drive the zone car (our version of a paramedic sprint car) – I volunteered to.  The paramedic told me that she’d be more comfortable and prefer that I stay in the back with her, my partner drive the ambulance and the trainee take the zone car.  While I felt bad for the trainee (though there wasn’t much for us to do in the 3-5 minute transport), I was still jazzed that my reputation is such that the higher level providers in the area want me to stay with them.

Hell, I was even stoked that the paramedic took time (once we were at the hospital) to explain to me the EKG rhythm – not that I know what I’m looking at – I don’t start classes to interpret them until October…but I asked if she’d show me what she saw when she interpreted A-Fib.  I wasn’t trying to act like I was questioning her call, but rather, ‘hey, I’m learning, can you show me?’ and she let me keep the strip so that I could have it for my classes. 

I know – sounds like I’m grasping for compliments or making a big deal out of nothing, but I work really hard to be a good BLS provider and since we (the EMS providers) are usually busting hump to go from one call to another, that the senior field providers recognize who I am (by name…) and that I have good skills…well, that’s so cool in my book.

The other thing I was geeking out out about was being able to teach my trainee something (how to take a BP off of the leg) while managing patient care, not tripping out (got diverted from the hospital-around-the-corner to a trauma hospital for a patient potentially having a stroke with no ALS available) and running the call well.  My trainee thought I was so cool for keeping my composure and teaching her a new skill that she may have never learned.  I also taught her the importance of taking pedial pulses because that will give you a ‘BP is at LEAST this because they have pedial pulses’ that will help the hospital.  While the hospital would prefer you to have a full systolic / diastolic set of numbers – good numbers (those that are taken accurately, even if somewhat incomplete) are better than NO numbers.

In the ‘No Shit Sherlock’ file, this from CNN:

24 Aug

911 abuse: Calling with the sniffles

Chronic abuse of 911 for non-emergency issues is wasting billions of dollars every year and overwhelming the safety net of health care. And taxpayers are left with the tab.

By Parija B. Kavilanz, CNNMoney.com senior writer
Last Updated: August 24, 2009: 7:14 AM ET

NEW YORK (CNNMoney.com) — People struggling with headaches, toothaches, and even feelings of loneliness are calling 911 — often several times a day.

This chronic abuse is overwhelming what industry experts call the 911 “safety net” system. It’s also wasting what could add up to billions of dollars every year, paid ultimately through higher taxes and medical fees.

This costly problem has gone unnoticed in the current debate on health care reform.

“Everyone’s talking about the billions of dollars wasted when people misuse the emergency room in hospitals,” said Jerry Johnston, outgoing president of the National Association of Emergency Medical Technicians (NAEMT). “How about the misuse of emergency services even before they reach the hospital? That’s not been on anyone’s radar.”

$400 taxi to the hospital

The 911 system has become a sort of stop-gap primary care for many individuals, said Connie Meyer, president-elect of the National Association of Emergency Medical Technicians.

Meyer, who is an EMS captain in Johnson County, Kan., said 50% of the 35,000 911 medical calls in her county are not really emergencies. And for each 911 call, it costs between $400 to $500 to transport a person via ambulance to a hospital, she said.

“If you don’t really need it, it becomes a $400 taxi to the hospital,” Meyer said.

That’s only the base fee for every ambulance that goes out on a call. If a person is also given treatment or medication in the ambulance or at the hospital, the cost quickly rises to $1,000, and can hit as much as $5,000.

For uninsured patients, Meyer said it’s the taxpayers in her county who eventually bear the burden. They pay a $30 annual assessment for 911, and it goes toward these non-emergency treatments, rather than improvements.

Some of those who use 911 for non-life threatening reasons do so multiple times a week — or even a day. Medics refer to them as “frequent flyers.”

“For some, 911 is a necessity,” Johnston said. “These people don’t have [private] insurance or Medicare and 911 is their only access to health care.” He said many of these people are immigrants who don’t how to navigate the system.

Others, he said, should know better. “These people have the ability to pay for care but still want to exploit the system,” he said. “They know EMTs have an obligation to respond to 911 calls. People want this immediate treatment instead of having to wait in a doctor’s office.”

The National Fire Protection Association, which tracks 911 call volume annually, said fire departments nationwide responded to about 15.7 million total medical aid calls in 2008. Using that data, the National Academies of Emergency Dispatch, said about 20% of the calls are classified as non life-threatening and don’t require a paramedic.

Norman Salas, a lieutenant and paramedic with a South Florida fire department, said more than 80% of the 911 calls he answers are routine health calls better handled by a physician or nurse.

But Salas said it’s the ethical duty of a paramedic to respond to every call without judgment. “Whatever the call may be, even for a rash, we have a duty to respond,” he said.

People treated by 911 responders often don’t have to pay for treatment on the scene, according to emergency technicians.

Charges kick in once an individual is treated in an ambulance while they’re being transported to the hospital.

“So these frequent flyers refuse transportation after we treat them, even though we always recommend that they see a doctor,” Salas said.

Manipulation and solution

Others are manipulating the system differently, according to Dr. Denis Pauze, an emergency room doctor at the Inova Fairfax Hospital in Falls Church, Va.

Pauze said one big misconception many people have is that coming to the hospital in an ambulance will get them faster access to a doctor.

“There are cases of people so frustrated waiting to see a doctor that they have left the ER to call 911,” Pauze said. “They think they can jump the line if they’re brought in by a paramedic.”

In reality, Pauze said anyone with a non-emergency situation who is brought into ER will be asked to wait anyway while emergency cases are first evaluated.

Shreveport, La., fire department chief Brian Crawford, whose EMS crews responded to 26,300 medical calls last year, said departments around the country are working to find a solution to the problem.

He said public education is key to curbing abuse of 911. Also, his department and others across the country are testing a “nurse triage” system, in which a nurse will evaluate 911 calls and decide the appropriate level of emergency response.

“We’ve found that the cost savings offset the cost of employing a full-time nurse,” he said.

“This is a delicate issue,” said NAEMT’s Johnston. “We don’t want to come across as insensitive, but as EMS costs increase, it’s leading to closures of ambulance services around the United States.”

Talkback: Have you or a doctor that you know left the medical profession mid-career to start a new career outside of the health care industry? E-mail realstories@cnnmoney.com you could be part of an upcoming story. To top of page

First Published: August 24, 2009: 4:24 AM ET

I’m in love with a man named Bill

21 Aug

Isn’t he gorgeous?!

Hurricane Bill

Hurricane Bill

 

I know, my ankle is effed up six ways to Sunday.  I know, I am on the ambulance ALL WEEKEND LONG.  All day Saturday and All day Sunday.  I know that there will be bariatric patients who will fall over and not be able to get up and need my partner and I to come get them and pick them up.  I know I’ll be getting into and out of the ambulance hundreds of times. 

HOWEVER! Good surf only comes to Virginia Beach when hurricanes / tropical storms / nor’easters (in the winter) hit or come up the coastline.

 This storm is doing EXACTLY what I prayed for it to do – get big, get nasty and don’t come ashore.  No loss of life or property. 

So, this afternoon, as soon as I can get out of work, I’m heading out to go surf / bodyboard with my sister. 

And I might do the same after EMS on Saturday…and Sunday. 

 

Besides, my mother always said ‘salt water cures what ails you’…

A White Coat does not make you a doctor

20 Aug

Any more so than a monkey throwing a football makes him a quarterback.

I had probably one of the worst visits to the doctor yesterday for my ankle. It’s still bothering me, point tenderness, pain upon palpation.  The left lateral distal side of my ankle hurts like a motherfucker.  Point tenderness between the ankle and the top of the foot in that squishy/vascular/small bones space.

Upon palpation, shooting pain goes up the lateral side of my shin.  At rest pain is 4-5/10, upon palpation 8/10.  No swelling, deformity, contusion or abrasion noted.  No LOC at time of fall.  Fell from standing position to gravel/grass/concrete.  ETOH NOT involved.  Did not hit head, negative to pain in head/neck/back, negative abdominal pain and negative cardiac problems.  Currently taking 800mg Ibuprofin taken 3x/day as needed for pain.

I knew all of the above and was taking the meds BEFORE I went to the doctor. 

Here’s how this went down –

I went to a Doc in a Box because my insurance was accepted there.  I made an appointment.  Hobbled in, explained what I did, had my vitals taken (BP 112/80, pulse 65) and went (WALKED) to the exam room.  In walked the good Doctor.  Doesn’t introduce herself, rather she opened her laptop and proceeded to take the most obscure history I’ve ever heard of all the while trying to convince me to have blood work done.  When I asked why she wanted the blood work done she said it was because I am 28.  She never asked have I ever had blood work done or anything – as a matter of point, I did have blood work done back in May.  And I would have gladly told her that had she asked OR given me an opportunity to share that with her.

Instead, she tells me that my cholesterol could be high, I might be diabetic, I could have all these other problems. And you’re right, I could have any of those, but let’s see if there’s any family history of any of those and / if I exercise…and if my weight is normal.  She asked me at one point if I ever had gestational diabetes!  Hmm, if I’ve never been pregnant, how the fuck would I have gestational diabetes????

She’s yet to ask me why I’m here, establish my chief complaint or examine the site of my injury. 

She does the most BS physical assessment EVER to include using her hand like a stick and forcibly poking me in my abdomen in the 4 quadrants…She listened for lung sounds at the base of my neck – ON MY SPINE.  She said she couldn’t hear lung sounds unless I removed my shirt (I was wearing a tank top…and a really thin one at that!). 

It was at this point that she asked me why I was here.  I repeated that my left ankle hurt, I told her where it hurt and I pointed out where the pain was.  SHE REACHED OUT AND GRABBED MY ANKLE!  AND APPLIED PRESSURE!  I jumped.  She asked ‘did that hurt?’ No you friggin’ moron, it felt fucking fantastic – that’s why I keep using words like OW! and HURT! and WHAT THE FUCK ARE YOU DOING?!

She told me I needed an x-ray.  No shit sherlock.  So she had me walk to radiology. And ‘hop up on’ the table.  The tech took the pictures and I walked back to the exam room. 

She comes back in and tells me that she cannot read the films because she’s not a radiologist and that the radiologist won’t have an opportunity to read the film until Friday…or Monday.  But that I should stay off my foot and not apply pressure.  I asked ‘then why did I walk to radiology?’ because I was fed up and pissy. 

She asked me if I wanted crutches or for her to wrap my ankle in a tone that was asking for a negative reply. 

So today, on my way to work, I bought a brace.  And I’m wearing it…and my ankle still hurts like a motherfucker.  I could have saved my $20 and 2hrs of my life. 

In my oh-so-humble opinion, what she did was not what a doctor does.  A doctor asks questions, listens, doesn’t insult, humiliate or bewilder the patient.  Isn’t the first tenet of medicine ‘to do no harm’ – then don’t forcibly grab an aching appendage until you figure out what the hell is going on!

I’ve had better phyiscal exams done by EMT Trainees…and I’ve never asked someone to remove their shirt so I could listen to lung sounds – and I listen to lung sounds in the back of a running  ambulance!

So picture time…

 

I fell off the damn deck, OR ‘how I sprained my ankle’

18 Aug

So…I’m usually on top of things and while I do dumb shit on occassion, what I did last night set the bar for ‘doing dumb shit with no reason’. 

I went for a run yesterday afternoon with my dogs.  Did 2.75 miles in 24 minutes in 92 degree heat.  Not too shabby, huh?  After Jersey, Stanley and I get back to the house, we all go out on the back deck and into the back yard.  I’m on the phone at this point just chatting and not paying all that close attention to where I am or what I’m doing…when I fell off of the deck.  Well, the concrete thing at the bottom of the steps of the deck.  I dropped the phone and kind of caught myself.  But not before I twisted my ankle pretty good and I scraped my knee and my shin. 

The poor person I was talking to was all like ‘Hello?  What’s going on?  Are you ok??’ because the steady stream of explatives that came gushing out of my mouth was probably a little disconcerting.  After assuring them that I’m fine except that my ankle feels like I wrenched it pretty good and the scrapes have stoppped bleeding all was well with the world.

Then Jersey smacked me in the face with her head. 

 

And then this morning, I capped off my dumbness and shaved my legs.  Scrapes included. 

 

Saturday’s calls…aka “Are You Kidding Me?”

17 Aug

My first “day shift” (6am-6pm) was this past Saturday, 15 August 2009.  It’s been a couple of months since a ran a day shift (April 3rd to be exact).  So it took a little bit to realize I would be awake for the entire shift…

First, let me put this out there, we were at minimum manning.  We are required to have 8 ambulances on at all times.  Usually on the weekends we are upwards of 13-14 ambulances.  So to be at minimum manning was stunning.  But here’ s how the day went:

Call 1: 53yo male, who tripped and fell 12hrs earlier.  Cause of this injury from a fall?  Alcohol.  Raise your hand if you were surprised….anyone?  Anyone?  No?  me neither.  What made this call somewhat interesting was the fact that this patient had had a stroke 18 months earlier, he didn’t have mobility on his left side.  So the fact that he was walking with his walker/cane AND he was drunk when this occurred made me go ‘duh but why’d you wait 12hrs?’.  So anyways, because of his injury (ankle and knee on his paralyzed side), I had to call for an engine for manpower.  After that, it was a pretty ordinary call until the very end, when I’m pulling him out of the back of the ambulance when he says ‘while your down there, suck on my toes’.  WTF? Who says that?  He’s damn lucky I didn’t drop him.

Call 2:  80yo female, fell from a standing position YESTERDAY (as in Friday, 14 August) but today her daughter and son-in-law want her checked out.  (aside: what’s with people falling 12+hrs earlier and only calling rescue now???).  Because neither she nor her family knew if she lost conciousness, we c-collared, backboarded, straps  – the whole nine yards…which is when we noticed the fecal matter on the sheets.  And then the family said that she’d recently been in the hospital for cleanliness issues.  Say it with me people…’ewww’.  So take her the hospital and away we go.

Call 3:   Dispatched for a woman who drove into a bar.  Literally.  Cancelled by the engine when the patient signed a refusal and she had no injuries.

Call 4: Dispatched immediately TO THE OTHER SIDE OF THE TOWN for a 90+ year old male who fell.  Cancelled by the crew in that area as they were leaving the hospital and would be closed.

Call 5:  ‘Diabetic’ with no history of diabetes, who was really an alcoholic going through the DTs.  The monitor showed him in SVT and he was sweating and twitching like crazy.  Patient also weighed in at 320lbs.  When the medic on the engine said ‘we need to go and we need to go now!’ I took the head of the stretcher, the fire captain took the feet and we lifted.  Remember, the patient weighs 320lbs and I’m 150lbs.  But I managed to get the lift!  WOOHOO!  (and that would be the sound of my back crying out in pain….).  We get him into the back of the ambulance, the two medics push one of Adenosine to no relief.  So we take him to the hospital…

Call 6: 11 month old choking on apples.  In the car.  We get sent to a car that has pulled off the side of the road because the 11mos old female was eating APPLES WITH THE RIND STILL ON and choked, vomited twice and in the vomit was blood.  Commence the part where the parents freak the freak out.  (Stupid question from me:  isn’t 11mos old a little young to be munching on apples?)  Child is AOx3, smiling, playing, vitals normal in the field, smells like vomit, visible residue of blood, parents want her checked out.  So we go to the hospital 5 minutes away.  No sooner had I secured a bed for the patient, then dispatch clears us (without us knowing we were clear and sends us to another call…)

Call 7:  MVA at the Oceanfront.  We’re coming from 15 miles away – ish.  We get a late start because we didn’t know we had a call and the devil-spawn of a dispatcher got snippy with me. Never mind that my rescue squad number and that of another squad (who’s first due the MVA was in) often sound similar over the air.  AND WE WERE NOT CLEAR FROM OUR LAST CALL! So we start flying…only to be cancelled by the engine that was on-scene with patient refusals.  But that was good so we could go get fuel – and we ran into the shift captain who told us that he knew we weren’t clear when we were shipped the call and he’d talk to the devil-spawn about it. 

Call 8: CAME OUT AT 15minutes till shift change!  UGH!  For a guy who’d been moving furniture and had his dresser ‘kind of rock on his back’ 4hrs EARLIER! But not stopping at having a sore back, he moved his bed and the rest of his furniture.  And then called us.  But did I mention the schizophrenia, the meds – to include percocet – and the fact that he’d recently been released from the psych ward?  He had the gall – he who WALKED OUT OF THE HOUSE AND TO THE AMBULANCE to get mad that I didn’t put him on the stretcher and lift him into the back of the ambulance.  Ugh.  And when we got to the hospital, he told me that I look like ‘Ms. Vanilla Ice’.  UGH AGAIN. 

This upcoming weekend I work all day Saturday AND all day Sunday with Hurricane Bill heading my way.  Could get interesting….