Gripe

Posted on May 29, 2013 by maddogmedic

I usually don’t complain (out loud). It really doesn’t serve to do so as an expatriate, living away from all that you grew to know as familiar. When I do voice complaints, it typically concerns something difficult about living abroad and delivered for the sake of humor.

This time, my gripe is with my home country (and the texbook-publishing mega-business).

You see, I’ve gotten my company to agree to send me back to the US for CCEMT-P course. I’m delighted to have the chance to do some more learning. I’m also a bit nervous about the degree of difficulty and amount of material I have to absorb in such a short time. I’m not going to walk into the class unprepared.

At least I’m trying not to.

You see, there are some great textbooks and an extensive suggested reading list for the course. Were I living in the USA, I’d poke around and find new and used copies of the books and get to it. In fact, I would have done that back in April. However, I live abroad. Shipping here is ridiculously expensive. I can pay $150.00 for a textbook and then pay an additional $200.00 to have it shipped and it’ll take about a month or more. Also, religious-based restrictions on book sales prevent this book from being readily available in this part of the world.

"Gee, maddog, you’re such a prodigious reader. How do you get all those other books you read?"

Well, I have a lovely e-book reader and I download them from the interwebz. It’s all very convenient and easy!

"Gee, maddog, why don’t you download the book you’re looking for?"

I’d love to but it’s not available in e-book form. I’d pay full textbook price for the thing in e-book form, just to save on shipping but the publisher seems too afraid of electronic piracy to put it out. Sigh! Think of the printing costs they’d save. I’m sure it would more than make up for any loss of revenue due to copying and illegal distribution. Get with the times!

"Gee, maddog, why such a tizzy? Aren’t you smart enough to pass the course based on the lectures and material delivered by the excellent instructors?"

No. Simply put, I’m not. The CCEMT-P course is way more difficult than anything I’ve studied to date. Furthermore, there is a financial incentive. You see, my employer is spending a lot of money to fly me thousands of miles, put me up in a hotel, pay for my food, car rental, the course etc. etc.. Basically, the are paying for everything (except book shipping, FFS). Pretty nice, no?

That’s if I pass the course and exam.

If I fail to gain my CCEMT-P certification, I have to pay it all back. All of it, the course fee, airfare, lodging, everything. 

That’s incentive!

–maddog

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What have I learned?

Posted on April 15, 2013 by maddogmedic

One of my favorite blogging folks, ResqEllie, has written a funny post about what she’s learned in our profession. She finishes by asking the rest of us what we’ve learned in ours. I thought I’d answer with a list of a few of the things I’ve learned since coming to work in the Middle East 3 1/2 years ago: 

  • We all bleed red. It doesn’t matter where you’re from, how you pray, how much money you have or what your last name is. When too much of what’s on the inside gets on the outside, you die.
  • Drink lots of water. All the time.
  • Physics always wins. Driving at over 100mph without a seatbelt and hitting a sand-drift on the highway will teach you that lesson so you’ll remember it for the rest of your life (all 30 seconds of it).
  • If it really is all "God’s will" then he’s got one hell of a sense of humor.
  • Wear sunscreen & a hat. Wear sunscreen & a hat. Wear sunscreen & a hat.
  • Grief is universal.
  • No matter where they’re from or what language they speak, everyone understands the F-Bomb.
  • Being white and male can get you almost anything in this part of the world.
  • Fun is found wherever you choose to make it.
  • Asking an Arab ambulance driver to "Slow down" somehow gets translated to "Go faster and brake harder" by the time it hits his brain.
  • Wishing someone peace (Salaam) over here will always elicit a response in kind.
  • When people ask me, "What’s the worst thing you’ve seen in your job?" They really don’t want me to answer honestly. … Really.
  • Camels smell horrible on the inside as well as the outside.
  • There is a cure for stupid. Most folks call it death.
  • Wear your seatbelt.

I’m still learning.

–maddog

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This call is the most important call of your career, each and every time.

Posted on March 12, 2013 by maddogmedic

Every year, I return to the USA at least once to attend an EMS conference. In 2013, I attended EMSToday in Washington, DC. As I usually do, I make time to meet up with some of my friends and blogging associates. This year, I got a chance to sit down with my friend Tom Bouthillet. My intention was to interview him as I have with other bloggers. We sat down in the lobby of his hotel, I clicked on the recorder and we started talking.

Tom is one of the most genuine people you can ever meet. He invests himself completely in every conversation and when Tom talks with you, you feel like you are the most important person he’s ever encountered. It’s a fantastic feeling. I am fortunate to count him as one of my good friends. Our conversation started as an interview but quickly turned into just a pair of friends catching up, drinking some good wine and talking about things that each of us found important. We covered subjects ranging from his work as a paramedic, my life in the Middle East, the importance of discipline, the connectedness of all humans, the Dalai Lama and electrical pathways in the heart.

If you haven’t been to the EMS12lead.com, go there now. Bookmark it and visit every day. It’s a master-class in 12-lead EKGs and a fantastic resource for paramedics, nurses, doctors and anyone else. Go ahead. I’ll wait …

Another project Tom has been working on is the CodeSTEMI web series. He and Ted Setla have been visiting with EMS systems that are putting passion, effort and money into improving outcomes of patient who suffer an S-T elevation myocardial infarction (STEMI for you EMS types or "heart attack" for non-EMS folks).

Click on that link up there. Watch the episodes. I’ll still be here … Go ahead! It’s worth watching.

Tom Bouthillet is one of those people who does the extraordinary as an ordinary chore. He commits himself completely to what has to be done and brings compassion and drive to the effort. Much of his work involves connecting people, from the collaborative nature of 12-lead EKG interpretation on his blog to the human stories that he tells in the CodeSTEMI series. What Tom and Ted did was exactly the sort of thing that ResqEllie was talking about in her interview with me. They tell a compelling narrative that EMS needs.

I did ask Tom a few questions about his work with the latest CodeSTEMI episode in the London Ambulance Service (LAS). He and Ted traveled to London and were given access to the LAS, one of the busiest EMS system in the world.

How did you feel about your access to the "real" LAS? Did you feel you were placed with the "cream of the crop?"

On one hand, I feel the sample size was small and hand-picked but on the other hand, and this is critical: in doing this web series, Ted and I have never hesitated to say, "That sounds amazing! Show me the data."

So, when we were at one health system in the USA being told, "Oh yeah. Our door to balloon times are 35 minutes." our reply was, "Extraordinary claims require extraordinary evidence. Show us." In the end, they couldn’t. The best the could show us was that 98% of the time, their door to balloon time was less than 90 minutes. In other words, I do believe they’ve had some door-to-balloon times of 35 minutes. I do not believe that their routine door-to-balloon time is 35 minutes. I think that’s something for the six o’clock evening news when so-and-so and his cameraman show up and they don’t know a thing.

We crunched these numbers for our system. We understand what an extraordinary claim that was. I was putting my credibility on the line, Physio-Control’s credibility on the line and First Responders Network’s credibility on the line for an educated, sophisticated audience. I’m not going to accept that without proof.

So it did not make it to production. You have to back it up if you’re going to make that claim. I’m not going to be your mouthpiece in a web series for something you can’t back up.

The CodeSTEMI web series is not a six o’clock evening news fluff piece nor is it a no-holds-barred documentary. It is a balance between documentary filmmaking, marketing and storytelling that is scientifically compelling. It is its own unique animal. It has to navigate a slender path to avoid bumpers that, on one hand, can cause it to lose credibility and, on the other, cause it to damage relationships.

Tell me a little bit about where you went in London, from the perspective of the patient care continuum. A patient with chest pain calls 999 in London, who does this patient reach?

That patient reaches a call taker in what is called their "control room."

And you were there?

Yeah. The control room, which holds the call handlers and is separate from the area holding the dispatchers. It’s a giant area. The 999 call comes into the call-handlers. They confirm your address and they confirm your phone number, the location and the call-back number. They use EMS ProQA, just like my fire department does, just like Seattle does. It’s a type of emergency medical dispatch program where, depending on what your complaint is, they have very specific directions and pre-arrival instructions. It’s highly regimented. They determine your emergency and then it’s coded. They then determine the appropriate response and it goes to the appropriate dispatcher.

It sounds like a whole lot is happening before the call gets passed off to a dispatcher. People who call 999 or 911 don’t see that. What did you observe when you were in the control room while these calls were coming in?

What I observed were some astoundingly competent call-handlers because of what they’re put through before they are ever allowed to be in that position in the first place. They have been carefully selected and carefully trained before they can sit there.

There was a woman named Jules Lockett, one of their head trainers that I sat down with and had a brilliant hour long interview. In my opinion, everyone should watch that interview just to understand how profound the process is to train a dispatcher. It was fascinating for me to hear her talk about the process. She’s involved in the hiring and selection as well as training of the call takers. This isn’t a process where they ask, "Do you have a pulse? Ok. Let’s put you in the chair, train you for two shifts and you’re on your own." No, it’s an exhaustive process for you to be qualified to sit down in that chair. They take time with you to make sure you’re competent to handle this responsibility.

Jules trains them to immerse themselves in the EMS call, just as she does in her work. In the CodeSTEMI episode she says:

"I tell people about an actual cardiac arrest that I dealt with personally on a phone call … I could picture the whole scene. I could tell you what kind of flooring they had in this kitchen. I could tell you what was cooking in the kitchen. I could tell you what the son and the daughter was wearing. I could tell you absolutely everything around that scene. And I think if you can’t picture the scene, if you can’t almost step into that call or that situation, then it’s very difficult to, probably, handle that call in the most appropriate way.

So, I actually have the best job, probably I would say, than even the chief executive. I get that opportunity to deliver exactly what the chief executive instructs and what the [National Health] Trust wants. We get to teach that and I get to mentor my staff into being able to deliver that and to make sure the staff in the control room do the very best job for patient care."

Wow! What is it about Jules that impressed you so much?

I think it’s a 100% commitment to doing whatever has to be done to help this patient on this 999 call. The last call doesn’t count and the next one doesn’t matter. In a nutshell, that was it. This call is the most important call of your career, each and every time.

Did you feel different walking away from your experience with the LAS?

I felt validated in a way, by the LAS. They showed me that it is possible for there to be an EMS system that is guided by impeccable integrity and caring for patients. There are probably a thousand paramedics from the LAS who would cringe to hear this. I don’t share their baggage with their supervisor and their battles between labor and management or whatever daily concerns get in the way of comprehending what they have over there, which is something they need to cherish.  What I saw, in each and every aspect of their operations, from call-handling to dispatch to operations to the street-level ‘medic to the nurses to the people inside the cath lab: caring competence, caring competence caring competence. It was overwhelming! I saw it everywhere I went: caring and competence!

After days of it, I was like, "Ok, this must be a veneer." I thought I was in a "Potemkin Village" or something. We had a handler from their PR department but Ted and I weren’t born yesterday. We got to ride around with these ‘medic by ourselves.

From talking with you and Ted, it sounds like you both used your professionalism and "street cred," to borrow an American term, to quickly pierce the veil and talk to people in the LAS honestly. How quickly did that happen?

It happened by the end of the first day.

Did you feel like you could run any call any time with any of the ‘medics you met in the LAS?

Absolutely. In a heartbeat. Suzy Fish and Craig Birkin were the crew we were placed with. Top notch crew. They way they handled their business was not just competent and caring but street-wise. And you would be as a full-time ‘medic in London. 60,000 calls for chest pain last year! 5,000 active resuscitations in one of the busiest metropolitan areas!

One hundred percent commitment. Reading over my notes and editing this entry, I remember how I felt after talking with Tom. I was fired up about what I do. I was (and am) reminded about how much I really feel for my profession and the value of my work. As such, I’m driven again to look at each patient interaction and each encounter anew.

 This call is the most important call of your career, each and every time.

Thanks, Tom Bouthillet. It’s always a pleasure to talk to you.

–maddog

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An EMS Today Sit-down with Scott Kier

Posted on March 12, 2013 by maddogmedic

I sat down with a lot of folks, turned on my recorder and had some amazing conversations. One of them is a fellow FRN affiliate blogger, Scott Kier. He and I have collaborated on a few projects and I hope to continue to do so in the future.

Scott writes EMS In the New Decade and it’s another worthy read. He addresses misconceptions about the EMS industry and speaks with experience and candor on a lot of issues that are bouncing around our profession.

I managed to drag him away from his million commitments at EMS Today and steal 30 minutes of his time.

When did you start your blog?

I started blogging about 3 years ago: February of 2010.

Why did you start it?

I always had an affinity for writing. I worked for American Medical Response at the time and they flew me out to the west coast to do some training. I got an inside look at the EMS system in the city of  Oakland, California.: jumping from ambulance to ambulance, riding with crews. I got talking to them about a movie I had seen online called "Level Zero." I started asking the guys what they thought about it and one guy said, "Well, if you like ‘Level Zero,’ you’re going to want to check out ‘Chronicles of EMS‘ that’s coming out."

So I started following the community and reading the Happy Medic and a lot of those blogs. Like I said, I always had an affinity for writing so I decided to start sharing my opinion again. I had tried blogging years ago but it just never really took off. So I said, "What the hell. Let’s do it."

What has changed over the 3 years you’ve had this blog?

I guess I’ve evolved as a provider as a result of reading a lot of blogs and also writing one. A lot of what I write is geared towards either systemic issues, national issues or, from the provider standpoint, being a better provider of care, which I feel is different from being a clinician. It means dealing with the person you are taking care of rather than the medical condition you are taking care of. That has swung my priorities in my patient care as well. I’ve started to have a "practice what I preach" kind of attitude. While I’ve always had a strong bedside manner, I try to set a good example for the other people that I work with.

How does reading and writing blogs feed into that?

Some if it is sharing on joint issues but really what it is is a global reflection on me, from what I read and what I write. I don’t write for an audience. I write for myself. If people choose to read it and they enjoy what they read then that’s awesome.

How does it feel to have an audience?

There is certainly a narcissistic quality to blogging and I don’t think there’s anybody who does blog where that doesn’t exist.

Not for me. Certainly not for me. Not at all. (laughter)

I am flattered to have an audience. It’s humbling for me to have an audience and it’s a reminder to me that what we say and what we do and how we project ourselves on every level in this community and in this field has an impact on somebody. Whether you’re in the street, whether you writing something online, whether you’re posting something to Twitter or Facebook, it’s a constant reminder to me that we need to uphold our own values to promote our field and move the community in a forward direction.

What role does your blog play in your work as a paramedic?

I don’t look at myself as a much of a clinical blogger. It does have some impact into my bedside manner but the stuff that I do away from the field, whether it be being involved in conferences, being involved in advocacy through NAEMT and promoting those kind of agendas, that’s where the blog really takes shape and is part of my career.

How does it do that?

It’s a soapbox. Gives me the means to share the agendas I feel are important to me as a paramedic. It’s more geared towards global things such taking EMS from being a job, that most people perceive it as, and moving to being a sustainable career. Advocacy for change.

And public education as well. Just last week I wrote a response to an article. They talked about response times and response times and response times. And the government talks about response times and response times and response times and they hit that stopwatch and as long as it’s under that magic ten minutes, or eight minutes and fifty nine seconds, or whatever they say it is, they say, "Ok!" (Dusts off hands) " We have a good EMS system!"

I took some of the facts that they put in the article and addressed them. For example, not only was the company named in the article compliant with their 911 contract, they were almost three percent over compliance.

So they were doing really well?

Uh-huh. 97.5% compliance on a 95% contract with 30,000 to 40,000 calls per year. That’s not bad at all. And they were making an issue with 350 calls that they found out of 35,000 calls last year. Yeah, one percent. I took issue with those facts. They were buried in the story when I felt those facts should have been highlighted in the story.

I felt that the real, true story here should have been, "Well, you know, it might take the ambulance nine minutes to get there or it might take twelve minutes to get there but here’s why you want a paramedic walking up to your door."

What perspective do you think you are providing with your blog?

I feel I’m providing a perspective that many people in the industry and many services are afraid to show because they are terrified of HIPAA for no reason. I feel that, as an industry, we are very, very poor at public relations and promoting ourselves and, more importantly, proactive public relations. When you see leadership from any ambulance service talking to the media, it’s in response to something. That service should be reaching out consistently to the newspapers, the television stations and the rest of the media and saying, "Hey! You know what? We got this brand new ambulance. State of the art safety vehicle and we want you to come in and film and we’ll give you a tour of it and show you why our patients will be safer riding in it."

So, you think that the public information officer (PIO) should be more "busy."

Exactly. Or even exist! Too many ambulance services don’t even have a PIO or reach out to the media. If they did, then when issues are reported to them, such as the article I discussed, then the first thing the reporter would do is call up and say, "Hey, you know what? We’ve been in your service a bunch of times. We’ve talked to you a bunch of times. We’ve got these claims, here. Tell us what you think of them." You build the relationship with the media before instead of being reactive.

We are blaming the media for their own ignorance but the they’re ignorant because we’re not telling them the whole story.

What other social medial tools do you use?

My primary one is Twitter. I have a Facebook page for my blog. My personal one (Facbook page) is my personal one. Of course I "like" my blog Facebook page from my personal one because I want one more "like." (laughter)

 There’s already a lot of discussion on how the industry as a whole should or should not be using social media. How does social media fit into your personal paramedic practice, you, Scott the Paramedic?

I use it as a resource. I’ve been a paramedic for twelve years. Back when I was in paramedic school, I hauled around this huge Mosby textbook. There was no social media, no Internet or, at least not accessible to me. But now there are so many resources out there that you can tap into and the gateway to them is often social media. The other thing is just a generalized promotion of the field. Have you heard of a Twitter hashtag called #MyEMSDay ?

Hah! You’ll see it on my twitter feed all the time, along with #MyEMSNight .  Didn’t you start that?

I started that and it’s taken off! For the most part, people have been good at using them. They post about the bad runs but they also post the good ones. "Just caught a ROSC (return of spontaneous circulation)" or "Just got a save." So you’re getting that positive stuff in there too. It creates some affirmation and positive perspective on our work.

Why did you become a paramedic?

It’s what I wanted to do since I was 15 years old, from the first time I got on an ambulance.

What got you on an ambulance when you were 15?

Both my mom and dad were EMTs. I’d sit around and watch them go out. My mom rode days, which were very busy, and when I got a little older I said, "You know. I want to try it." I tried it and I really enjoyed it.

We had intercept ‘medics out of the hospitals who told me, "You are going to want to get a degree. Don’t just go to the community college and get your certificate, get a bachelor’s degree." So I went and spent 4 years at Springfield College, got my paramedic certification, my BS in emergency management and a minor in business management, graduated and walked right into a full-time job in a very busy EMS agency.

What keeps you on the ambulance now, 12 years later?

Well, I just got back on the ambulance. I was a supervisor for 7 years and I just got back in the field.

And how do you like it?

I was a supervisor at a private ambulance company. The problem I had was toeing that fine line between effective patient care and profitability of the company. I now work for a prominent municipal service. It has a static staffing structure and is the most patient-care-driven service I’ve ever been a part of. It feels great! I’m perfectly fine with having to step back on the road. It took a little while to get my feet back under me and I still am, in a lot of ways, but it feels really, really good to be taking care of people again.

Do you think you’ll move into management again?

I think so. My employer invests a lot into their people, from what I’ve seen so, I feel I can invest a lot of myself in return.

You’ve said a lot of great things about your employer. Will you talk about them in your blog?

My employer knows I have a blog I prefer to use my blog for personal reasons. When I come to these things (EMS Today), I come on my own two feet. You see on my badge, it says, "Writer/editor, EMS in the New Decade" not "Paramedic for such-and-such agency."

Right! Mine doesn’t even have my real name!

The people here who know me here, know me as, "Oh. That guy I heard on EMS Garage." or, "That blogger who wrote that really crappy piece that pissed me off" (laughs). You know what I mean? That’s how they know me. They don’t know me as a street medic. I try to keep a division between my employer and my blog.

Would you name your employer in your blog?

No. Not yet.

That’s called a, "career-saving move," son! (laughter)

Exactly! I stress on my blog that my viewpoints are my own and do not reflect the views of my employer. I make that abundantly clear

Anything else you want to tell my readers about you, Scott Kier, the blogger.

The main reason above everything else, that I write is for myself. It’s like cheap therapy.

At first, I was not on Facebook with my blog. I didn’t share anything on Facebook about my blog. There were a few very close colleagues who knew about it but, for the most part, I kept it very quiet for probably the first year and a half. Then, one day, I just decided to make a Facebook page, promote it, put it out there and let the people that saw me every single day start reading it. The feedback I got from those people was remarkable.

People were coming in from shifts and saying, "Hey, I saw what you wrote a few nights ago." and identifying with it, relating to it, asking questions about it. It sparked interest. I was able to use my blog as a springboard to generate conversations about the fields, about why we need to be better providers.

Does working with people who read your blog force you to "walk the walk?"

Absolutely. Practice what you preach, man. Gotta do it.

Scott, thank you very much for taking the time to talk to me today.

Sure thing!

Stay tuned for more great conversations with bloggers, paramedics, EMS Chiefs and other folks who continue to elevate our profession.

–maddog

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A Sit-Down with Resqellie, the Value of a Good Narrative

Posted on March 7, 2013 by maddogmedic

Resqellie is a blogger who’s been writing since February of 2005. She’s a dear friend of mine and a fabulous writer. I had a chance to catch up with her at EMSToday 2013 and, after plying her with good food and booze and Busboys and Poets in DC, she agreed to an interview.

Ellie is warm, engaging and witty, much like she comes across in her blog. She had scheduled herself for 8-12 hours of classes per day of the conference was was looking for ways to get herself into more. She said that since her employer was paying for her to be at EMS Today, she wanted them to get their money’s worth.

As we sat down in a booth, she looked both frazzled by and excited about the things she was learning at the conference.  Even with the enthusiasm she was obviously feeling, she couldn’t hide the wry humor that colors everything she says and does. She is passionate about what excites her and comes across as exactly the person you want showing up when you call for help.

Check out her blog here. In fact, bookmark it and return again and again. It’s worthy.

Read on for the interview.

You were a student when you started blogging in 2005 and it seems like you were doing it to see what was going on. Why did you start blogging?

Appease the parents so they could see what was going on.

Did your blog change while you went through school?

Everything was still new and shiny, you know? A lot of "first times." It changed after I was in school. It began, eventually, to encompass my whole life.

When did you first notice you had an audience and how?

Well, Gosh, I don’t know. I remember when I got spammed with comments. Like, I got spam comments. I had to put on the captcha thing to confirm that people were human.

People that I didn’t know would comment sometimes. It was always nice. A little self-gratifying. Maybe it was only you.

It wasn’t just me.

What type of interaction did you develop with your audience?

Not real good interaction, I guess, in the sense of saying something nice. I learned that I could get more people to read it if I put comments on other EMS blogs but that waxed and waned as I read TONS of other blogs. I got tired of reading them all!

Then I became personal friends with one person who was a stranger who was an EMS blogger in Edinburgh. He’d had some rough things happen but he’s got some beautiful writing. I actually met up with him. I went to Edinburgh. He showed me his ambulance and spent a lot of time showing me around. It was really nice. That was like how social media can bring people together, in a weird way.

So, now, eight years later, you’re still writing and you claim you’re not writing a whole lot. Do you still feel you have an audience?

Certainly a familiar audience. My mother still reads it. (laughs) And my cousins read it on occasion; you read it on occasion.

All the time!

But I would not say I have a huge following at all.

How does it make you feel to know you have an audience?

My mother always said it was brave of me to blog about a job like this where she thought I would be judged a lot by my colleagues or my contemporaries. It never even occurred to me that I would be like, "Oh, this is my first time intubating someone." and they would be like, "Oh you stupid noob." or whatever. But I never had that feeling of judgment. It was more like a supportive community, you know? For a while it was important for me to have an audience because I want to be justified in what I’m doing.

Did you feel your audience is mostly EMS professionals?

Yes and no. There are definitely a few lay people who read my blog.

You started commenting on other blogs. You started talking to other people.

Here and there. I liked to read other’s stuff. It’s like free con-ed. The blog became therapy for me. I had a string of mad suicides and things you take home with you. Then I’d write about it and some other people write about similar things and I’d say, "Oh, I’m not crazy." or "I’m not going to lose my mind. I’m going to get through this. It’s going to be OK."

You have a very human and accessible style of writing. When you write about the technical aspects of your job you don’t get mired down in the terminology and technical speak. You don’t write your blog as if you are writing to other EMS providers nor do you dumb it down too much for lay people. Who do you imagine your audience is?

(laughter)

Besides your mom.

People who are like my mother? (laughter) She does complain when I use big words but she likes when I use them because she feels she paid for them. If I say "Super-ventricular tachycardia." she’s all like, "Yeah! That college education was totally worth it."

(Laughter)

I don’t like to get bogged down in the technical mojo because that’s not what it’s about. It’s what the job is about sometimes but I like the social aspects. I like people to find it readable so I imagine it’s lay people or people who have just a little know-how.

When I got my first real job and I was working there for a little while, one of my colleagues, who I didn’t really know yet, came to me and said, "Are you Resqellie?"  I said, "No!" I didn’t know what to do! I was all, "Uhhhhh I don’t’ know you!" It freaked me out! At the same time, I thought it was kinda cool. All I had on my blog was a picture of the top of my head as I was starting an IV. It wasn’t even my face. I didn’t realize how easy it was to figure me out.That was an interesting experience but it did make me more cautious about easy it is to figure me out.

Why did you become a paramedic?

Ask my eight-year-old-self. That’s what I declared I would do when I was eight. I wanted to be a firefighter but I realized I was afraid of hot things. And heights. I’m afraid of taking hot things out of the oven so the thought of me being in a burning building is ludicrous. Paramedic? It’s all I wanted to do, ever.

Ummm…To help people? It’s really trite, I know but it’s also really cool.

How long have you been a paramedic now?

Um, about seven years.

And how do you feel about it?

Pretty good. I feel like I’m hitting my stride. I’m feeling pretty confident. I work at a single-provider, chase car 911 service and that can either make you really bad or really good. If you’re really bad then you can get away with being really bad because nobody really sees you. Whatever portrait you paint on your paperwork is what you really did.

But I think it has made me better: a better clinician and even a better EMT. Forget being a paramedic. Often times you arrive first and you have to do it all. You’re waiting for your loyal volunteer crew to back you up and they may not have done whatever you need them to do in months or even years. Then you gotta do it yourself!

Its still a good decision. Except the pay, you know.

You’ve continued to write. You started as a student, you wrote as you became a paramedic and you continue as you hit your stride. Do you think you’ll write and publish in your blog as you move forward?

Yeah. Definitely. Even if it’s less medicine now. I spent a full year abroad and there was a lot of travel but I think travel writing is boring unless you’ve already been there. I’m kind of selfish and don’t like to read about a place unless I’ve been there. "Yeah! I was there! That’s cool!’

My writing has evolved and I’m moving away from the first person and focusing more on narrative and building characters. I’ve been doing some other writing but I feel very self-conscious about putting it on the blog. I’ve been doing this writing because I feel compelled. Every time I buy or read a book that has evolved from EMS blogging, it’s been very disappointing to me. It’s like, "Title: entry. Title: entry. Title: entry." No continuity. No character development. No beginning-middle-end. It’s boring and I’m like, "I could have gotten this for free right off your blog!’"

EMS deserves a good narrative, good characters. It’s a funny career. It’s a touching career. It’s a weird career. You have strange shared experiences with strangers. You know, Andy [former partner] and I went on a call. It was a stabbing. A few hours later, as a joke,  I threatened to stab Andy and he’s all like, ‘Too soon! Too soon!’ It’s these weird situations you get into that, no one normal would ever get into. I like that.”

Even if the narrative you intend to write takes off, do you think you’ll continue to write in and share your blog?

Yeah, No doubt. I’m loyal to the blog. I buy it an anniversary gift every year. (laughter) I always write an anniversary post and I always apologize for not writing more. I feel like the blog is this entity and I’m like, “I’m so sorry I didn’t write in you very much last year!” Even though it’s ridiculous because now it’s for me and not really for an audience.

I really love, love, love having a slice of your life forever digitally preserved. “What was I doing in March of 2006?” I can just go into the archives and be like, “Oh my god!” and see things I totally forgot I did and things that shaped me but I didn’t realize it! I have this resource that I can go back into and reminisce about myself.

Do you have any fans that you know about? Besides Mom?

(laughter) I won’t mention her any more!

Yeah, there’s this lady who commented a few times who I don’t know. Even one person that’s interesting to me who bothers. That’s all it takes: if one person’s interested. If I wrote a book and I sold one copy to a stranger, I’d be pretty frikkin’ thrilled! Not self-actualized but.. (laughs).

That’s up to you, Kid!

Working on it! (laughs)

Is there anything else you think would be cool for people to know about you, Resqellie the blogger or you, Ellie the paramedic?

I don’t think so. I’ve always thought it was boring and not very interesting. I don’t know. I like that the blog is no longer just EMS. I’m trying to be more comedic and write about my online dating experiences and travel and improv and that kind of thing so, yeah. I don’t know. It’s all in the blog. That’s why my blog description is, “The blog pretty much covers it.” If you’ve been reading it, you’ll know everything. So I don’t want my boyfriends to read it because then we’ll have nothing to talk about! (laughs)

Thank you very much!

Any time!

–maddog

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Posted in #CoEMS, #EMS2.0, #WhatMakesMeHuman, Funny | 1 Comment

EMS Today 2013

Posted on March 6, 2013 by maddogmedic

I’m sitting in a lovely apartment I’ve rented through Air Bnb and getting ready to head over to the conference center and dive into EMSToday 2013. I’ve always enjoyed this conference and I’ve especially enjoyed meeting a few of my fellow EMS bloggers.

I’ve been thinking a lot about the role of blogging, twitter and other social media in our profession and how it has affected me. I’m going to talk to other people about this too. In fact, I’m going to informally interview a few folks I encounter at EMS Today and put our discussions up here.

I’ll be regularly updating my location via twitter and Facebook. I’m on twitter at @themaddogmedic, I’ve just started a Google+ account and you can find my Facebook page here.

If you see me at the conference step over and say hi. Introduce yourself if you haven’t already (or if I look like I’ve forgotten your name) and we’ll see what happens!

–maddog

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Can You Hear Me Now? (Part 3)

Posted on March 5, 2013 by maddogmedic

A reader asked me if my patient from "Can You Hear Me Now (Part 2)" ever recovered. Here’s what I got from the cardiologist (who called our patient a "miracle") the next day:

Melvin’s right coronary artery (RCA, or the main blood pipe that feeds the muscle of the right side of the heart) had been building up plaque for some time and was about 75% blocked. What gave him chest pain and brought him to us was a recent clot that blocked 99% of his left anterior descending artery (LAD). This kind of blockage, when it’s close to the beginning point of the LAD, is called, "The widowmaker" as it often kills the patient right away (and makes a widow of the wife).

The left side of the heart is the larger and harder working side. The clot in main branch of Melvin’s LAD kept blood from getting to the muscle of the heart. The blood flow from the right side (which can sometimes travel around to the left via the circumflex artery) was insufficient due to the old buildup of plaque in his RCA.

In the OR, the cardiologist had put a stent in Melvin’s LAD, pushing the clot out of the way and allowing blood to flow to the left side of his heart. Even so, the muscle was so damaged and, in some places dead, that he needed a mechanical device inserted into his aorta called a "balloon pump" to help his heart get enough blood out to the rest of his body.

Melvin made it to the cardiac operating room and he got some good treatment from some good people but his heart was too damaged by all the blockages. Twelve hours after surgery, he died in the intensive care unit. He stayed dead this time.

Looking back, could I have done anything different? No. I feel good about everything I did. The team I was working with was spot-on as well. Perhaps Melvin could have taken better care of himself but that’s moot now. So, what good did I do?

Melvin’s wife saw the whole thing. She was upset but present. She saw all of us doing everything we could to keep Melvin from dying, including talking to him. She rode the roller coaster of dire prognoses and moments of hope ("He’s grabbing my hand!") but she wore a face of resolve and acceptance as we wheeled Melvin to the OR.

I’ve posted recently about one we didn’t save, yet I felt we gave him every chance. I feel the same about Melvin. I’m sorry that he’s dead. I’m sorry that his wife was made a widow. I gave him every opportunity in my power to live. Often, despite my best efforts, Death wins. I’m here to make that victory a difficult one and, when needed, to lose gracefully.

–maddog

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EMSToday 2013

Posted on March 2, 2013 by maddogmedic

I’m going to EMSToday 2013 this year. I’ll be arriving in Washington DC on the 4th and will certainly be looking for trouble. Anyone else going to be around?

–maddog

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Can You Hear Me Now? (Part 2)

Posted on February 27, 2013 by maddogmedic

I posed a question in my previous post. I asked, "Do the dead hear us?"

I asked this because I had a very strange interaction with a "dead" person who couldn’t seem to decide whether he was going to be dead or not. There was some talking.

Not many people are calling for ambulances on this particular night. As I’ve mentioned before, I’m based out of an emergency room and frequently jump in to help the nurses when I see a need. Tonight Melvin had been having chest pain for a few hours and finally drove himself to the hospital at his wife’s insistence. He’s an overweight Filipino in his early 50s. He walks in under his own power looking slightly uncomfortable. I don’t see where I can contribute anything valuable and wander back to my little corner of the ER.

Five minutes later, Melvin is lying in the bed in the resuscitation cubicle (it’s the space in the ER with all the cool toys you need to stop someone from dying right away). I find my place doing chest compressions while Dr. "B" gets ready to intubate. The monitor shows persistent ventricular fibrillation (the heart is just wiggling instead of pumping blood) and in between trying to shock it back to function and dose it with medicine to make it wake up and work right, I’m beating him up to make his heart pump.

Things go well with the emergency physicians and nurses (and paramedics). Dr. B can’t intubate the patient. Melvin is intermittently clenching his jaw and once we get him paralyzed and sedated (RSI), Dr. B goes in with a laryngoscope (A metal "shovel" to push the jaw & tongue out of the way, enabling Dr. B to put a tube into Melvin’s trachea.) but discovers that Melvin’s obesity and odd mouth shape (short jaw) make it impossible to see where he’s going.

Maddog is a smart ‘medic sometimes.

I had noted Melvin’s odd jaw and such when he walked in. When I heard the code get called, I ran into the trauma room and grabbed our brand-spankin’-new GlideScope.

Tools in the toolbox, I’m all about tools in the toolbox.

The GlideScope is, basically, a camera on the end of a laryngoscope ("mouth shovel") that let’s me see around corners and intubate patients that we can’t intubate by looking directly. It’s pretty dang cool.

I’m doing chest compressions and I point with my chin at the GlideScope I had placed by the oxygen tree. "Used it before?" I ask Dr. B.

"No. I even missed the training." He tells me.

 A Lebanese nurse relieves me on chest compressions while I do my paramedic thing! Using the GlideScope, I promptly intubate Melvin and we now have much better control of how much oxygen we can get into his body. We even have the chance to suction out his stomach (which had filled with air before we intubated him) thereby allowing his lungs to expand further and take in more oxygen-rich air.

Once the breathing tube is in place and secured, I go back to my preferred role performing chest compressions. The nurses here have pre-assigned roles for a code. My job is not assigned so I help out where I can. By taking over the chest compressions, I have freed up a skilled nurse to get supplies, pull drugs from the pharmacy (I don’t have an access code) and otherwise benefit the patient further.

And so I pound away while drugs are given, cardiologists mutter and Melvin’s wife sits across the room looking stunned. I get short breaks while Melvin’s heart rhythm is analyzed and he occasionally gets zapped with therapeutic electricity.

Time passes. We all do our thing with aplomb and grace. Melvin shows little signs of improvement. One of the cardiologists notes that we have been performing CPR for over 40 minutes and he doesn’t think it would be worth it to transfer the patient to the cardiac operating room.

I and all the staff have been working really hard to save Melvin. His wife has been watching the entire process. None of us are ready to give up yet but the facts are the facts. I look down at Melvin as I’m pushing on his chest and I say, "C’mon, buddy! give me something to work with!"

Suddenly, the Irish nurse to my right yells, "He’s grabbing my hand! He’s grabbing my hand!" Sure enough, Melvin has got a solid grip on her first two fingers. Then he’s squeezing her hand in response to questions! Holy crap! This guy’s alive! We pause chest compressions to check his heart rhythm and he stops responding. The rhythm we see on the monitor is still V-fib. He stops squeezing or otherwise responding.

Back to the compressions and ventilations and drugs and shocks and all the rest. He comes back a few times like before but each time we let off the CPR, he slides back to unconsciousness. Things don’t look too good. The cardiologists start muttering again.

Once more, I find myself looking at him and not wanting to give up. Half hoping and half joking, I say, "Hey, Melvin. No slacking on the job, buddy. We’re all working hard over here. This ain’t no time for lying around."

And then he does it again!

This time, we get his heart beating in an organized manner but it’s too slow. I step off of chest compressions to start "pacing." This is a process of delivering rhythmic shocks across his chest to make his heart beat faster. I’m always amazed at how much we can "take over" for an organism. The cardiac pacing works and his blood pressure comes up. He also starts biting down on his endotracheal tube. The drug we gave to paralyze him has worn off and he’s starting to fight back.

Melvin gets re-sedated, re-paralyzed we transfer him up to the cardiac operating room. As the cardiologist scrubs up for surgery, he expresses his admiration for the team in the ER and calls this patient, "nothing short of a miracle."

We did it. We delivered a viable and (mostly) living heart attack patient to the cardiac surgery. After the hand-off, I clean up and start thinking about what happened. I realize I wasn’t thinking about it as it happened. Everything that happened and what I did about it seemed a normal, natural part of what I do. When I was talking to Melvin, I wasn’t thinking that he could hear me. I don’t necessarily believe in spirits, souls afterlife and all that. I was just talking as a way of expressing myself. I wanted to feel like all of our effort meant something.

I certainly didn’t expect a response.

One of the comments to my previous post mentions effective CPR perfusing the brain sufficiently to generate a neurological response even if the heart’s underlying rhythm is ventricular fibrillation. Looking back, I’m sure that’s what was going on with Melvin. We had a good airway and we were working his heart to good effect. Once or twice during CPR, a doctor thought Melvin had converted to ventriular tachycardia (where the heart actually has a regular rhythm) because my chest compressions were creating a consistent and regular waveform on the EKG.

So, yeah. Melvin heard and responded to us, not because of some mystical, spiritual connection. I didn’t pull his soul back down into his body by calling out to him; I just pushed enough oxygenated blood to his brain that it kept working. It was a surprise to get a response like that. 

–maddog

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Can you hear me now?

Posted on February 17, 2013 by maddogmedic

Do the dead hear us?

Does talking to your patient while performing CPR have any effect? Can the patient hear you even though his heart is not beating (and you’re doing it for him)?

If the (dead) patient can hear you, does it help all?

I ask this because I had a patient that the cardiologist called a, "miracle." There was some talking.

Discuss….

I want to hear what you think before I tell my story.

–maddog

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