I finished my half marathon on Saturday, limping across the finish line in 2:34:14. Part of the run went through streets and neighborhoods in Hartford where I have responded over the years to motor vehicles, drunks, cardiacs, asthmas, shootings, diabetics and general illness. When I started as a paramedic in Hartford, I did most of…
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The Golden Hour
R. Adams Cowley, the founder of Maryland’s well-known Shock Trauma hospital in downtown Baltimore, famously said: “There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but…
Incredibly Nimble
We were sent today for a lady too dizzy to get out of bed. There were elaborate instructions given about where the key was in the garage. We searched for about fifteen minutes with no luck. It was dark in there and dusty and there were mouse traps everywhere. We saw two neighbors come over…
Learn Something Every Day
50-year-old woman recent heart surgery to replace a valve. Visiting nurse says the patient is bradycardic. The officer tells me the patient doesn’t look very good. I find the woman laying on the couch with a nonrebreather on. She says she doesn’t have any pain, but doesn’t feel well, and vomited a couple hours ago….
Work
I came into work yesterday morning and as I always do, switched ambulances. We have three rigs here, and each of the four regular medics are assigned their own (two share one). Every six months or so we switch assignments. Right now I have my own ambulance, but it is the oldest one. Very rough…
Till I One Day Vanish
I work in a diabetic town. There is one particular section of lower middle class homes along the avenue that runs north out of the city that seems to be diabetic central. Many of the older residents came to the United States from Jamaica, and while they continue to enjoy their home cuisine — jerk…
Beach Ball Bellies
Woman collapsed on the roadside CPR in progress. We arrive and when I get out of the ambulance, I can barely see the woman’s face her stomach is so large — it looks like a beach ball and getting bigger with each squeeze by the first responder of the bag valve mask. “I think the…
Micellaneous
A rainy day at work. I’m sitting at the computer and trying to get caught up on email, bills, scheduling, and maybe even this blog. Here’s a couple of recent tidbits. This morning a first occurred. I occasionally hit my head at work — most often on the overhanging bright lights above ER beds, and…
Paramedic Block
I have had trouble posting lately. I go through phases with the job and with the blog and am in one now. The reason I started writing about EMS in the first place was to capture the human side — the view of life and people the job provides. To a lessor extent I like…
A Profession
Over the past year we had pretty prolonged and at times nasty debate over whether to change unions, which we ended up doing. While I wasn’t happy with the previous union’s representation( they in fact screwed me on the one issue I needed them to grieve for me), having sat in on the last contract…
Florida
My brother and I went to Florida for this past weekend to see our father. I left on Friday and came back on Monday. My father had a back operation in December, and while he didn’t want us to come see him then, he finally agreed, now that he is up and walking around, to…
Empty Shoe
“How much morphine?!” the nurse asks. I see across the room in the faces of the ten staff gathered around looks ranging from shock to disbelief to not certain they heard right. “Seventeen,” my preceptee says. Again some looks, understandably. 17 milligrams of morphine is a lot, but after all we are in the trauma…
An EMS Mark Twain
Stephen “Kelley” Grayson’s book “Life, Death and Everything in Between” has been rewritten and published in hardcover by Kaplan Books as “En Route: A Paramedic’s Stories of Life, Death, and Everything in Between.” The book covers Grayson’s long career from day one EMT rookie to established paramedic. It is told in short chapters that are…
12-Lead ECG in ROSC
The other day I heard a story of an ED doctor geting angry at the paramedics who had brought in a cardiac arrest who the medics had had gotten pulses back on in the field. The doctor was angry because after he had done a 12-lead on the patient in the ED, he’d discovered the…
Dust
Cardiac arrest. Old frail man in his 80’s in a hospital bed. Wife was talking to him, and then after awhile noticed he had stopped talking back, not that he ever said much in the first place. We put him down on the floor. He was warm and limber, but asystole in three leads. I…
"Funky Troubling Looking" — Right Bundle Branch Block and MI
As I mentioned in a recent post, we have a process for instituting a STEMI alert to, in consultation with an ED doctor, activate the cath lab prehospitally based on clinical assessment and a 12-Lead ECG. The coordinator at the hospital that I transport most of my patients to told me so far EMS is…
Nursing Home Codes
I did another nursing home code this weekend. We have five nursing homes in our town. Two are very nice and are the final stop in larger retirement communities where residents start off in the own cottages or apartments, move to their own rooms and then go to skilled care before they pass on. The…
My Hall of Fame
Every now and then I marvel at how far EMS has come, I did three calls on Sunday that had they happened fifteen years ago would have gone quite differently. The first was a CHFer. Obese woman, filled up with rales, felt like she was suffocating with the nonrebreather on her. I strapped on the…
Hip Fractures (2) and Dr. Welby
So I have been talking to many people about this hip fracture issue and it is quite a dilemma. I want to change the dispatch protocols to send ALS to fall with hip pain. They don’t have to go lights and sirens. They can go “cold,” but they should at least be on the way….
Hip Fractures
A hip fracture is not a prehospital emergency. Let me repeat that. A hip fracture is not a prehospital emergency. I couldn’t believe it. But there is was written in bold. Not just a stray sentence by listed as “an axiom.” A hip fracture is not a prehospital emergency. For those who know this or…