Tuesday, April 29

Paramedics Make the Worst Patients

We're experts at assessment, treatment and disposition of life threatening emergencies.  We're also good at that stuff for all the other reasons people call 911, but when it comes to more complex medical issues we are lousy at assessment and can muddy the waters for the rest of the medical community.

But don't worry fellow medics, there is a solution I have discovered after almost 2 decades of falling into this trap:

Play dumb.

Luckily it's a skill I know for sure you possess.  Use simple lay person terms when speaking to the doctor.  "Adverse Lung Sounds" becomes "Funny breathing noises" for example.  Leave your education at the door and use the simplest terms to describe your condition.  Over simplify it if you have to.  At a recent visit I told my MD that I thought I heard a kind of clicking or bubbling in my throat at night and it always happened if I didn't use both pillows and even then I could still hear it.  Had I tried to describe to him that I was sure I was experiencing pneumonia symptoms all he would have heard was "Hi, Antibiotics please."

Instead he explained the difference between a bacteria and a virus and I let him.  I pointed out that I only had 2 of the 5 signs of a viral infection and 4 of the 5 for bacterial bronchitis or pneumonia.  I then mentioned my daughter was recently given (Not prescribed) medicine for her pneumonia and she got better almost overnight.

He pondered my statement and I looked at him and said "Doc, drugs or no I just need to be able to sleep so I can get back to work."

Prescription in hand and meds on board I can tell you that right now (18 hrs post loading dose) I awoke after almost 4 hours uninterrupted sleep after having done about the same time at least once more in the night.  HUGE improvement.

Had I gone in as a medic and explained my self assessment I keep him from doing his full assessment and he may not reach the same conclusions we do.  Had my kid not been sick with the same thing last week I'd be in the weeds.

After all, isn't your least favorite patient the one that calls you and then proceeds to tell you their assessment findings?

Play dumb!

 

Monday, April 14

Celebrating the Voices

I hear voices.

At least I used to hear voices, before I took this desk job at Headquarters, but before that, in the field, I heard voices.

The voices woke me from my sleep and interrupted meals more often than not and always seemed to know someone was ill or injured.  Most of the time anyway.

For all my griping about MPDS, dispatchers and call takers, they still show up everyday to do a job I would fake a seizure to not have to do.

They take the confused, rambling mumblings of someone, code it, send it and away I go to deal with the problem.  So what if it's not always what they say it is, all they're doing is telling us what someone told them.

And many times, after listening to some of these calls for QA purposes, "told" isn't exactly the right word.

A man is shouting to please hurry! please hurry! but won't say why or what is wrong.  He simply says please hurry.

The woman holding the lifeless baby can't get a word through her screaming but the voice still tries to talk her through CPR.

The whispers of the young boy hiding in the closet while someone assaults his older brother in another room are barely discernible because the call taker next to them is dealing with the screaming mother from before.

The voices belong to a group of folks who aim to bring a few moments of sanity to an insane world, and all over the phone and the radio.

Call them dispatchers, broadcasters, call takers, whatever, they still always answer the phone and will always answer the radio when you need them to.



So call up your local dispatch center and see if they have an event planned.  If not, step up and put something together.

Sunday, April 13

Now at Uniform Stories

Your pal Happy is proud to be included as a guest blogger over at Uniform Stories.



Uniform Stories allows you to upload a video about your experiences in uniform, no matter the type, and you know I'll tell you that is a powerful medium.

Head on over and take a look at the site and watch a few videos and I invite you to upload your own.

If your uniform could tell 1 story, what would it be?

See you there.

Thursday, April 10

Suicide: Know when to ask for help

Pussy.  Wimp.  Lightweight.

 

All things you think people will call you when you ask for help.

They went to the same call you did, they're fine.  They're not.

They went through a divorce just like you did and they're fine.  They're not.

I failed and they didn't because they're better than me.  They're not.

 

"They" are going through the exact same mental roller coaster you are.  I've been there to a certain extent.  When I got hurt I went through every emotion I've ever known from thrilling excitement getting back on the Engine to crushing depression that I was one call away from being killed in a fire.  I've been confused, conflicted, felt like screaming.  Screamed (it helps) and even cried like a baby.

Dealing with depression can be hard, is hard, will be hard.  Regardless of what people want to tell you, things aren't always going to be better.  One day you'll look back on today and be willing to swap feelings for anything.  The trick is going to be what you do about it today.

 

No one controls you but you.  The feelings you feel, the things you think, the situations you run out over and over and over in your head until they get so loud it feels like they're going to come bursting out of your forehead will only get worse unless you let them out.  Only you have the power to release them.

Start a journal, write your feelings on a single piece of paper.  Get out all the negativity, anger, hate and everything else Yoda warns us about the dark side and look at it.  It's outside your head and nothing is wrong with that.  Now destroy it.  Destroy all the hurt.  It feels good.  Then take a deep breath and feel the emptiness the hate has left.

 

What will you do with it?

This is the part no one tells you about PTSD, that you can address and overcome your fears rather easily, but even scarier is what might take their place.  If your thoughts were that dark before, what will happen now?  Now there is room for worse!

And for better.

Some fill that void with faith, companionship, adventure, music or art.

Others fill the void with solitude, smoke and the bottle.

 

What you do with the space you make is up to you, but I can tell you from experience that looking for a new challenge every day will lead you to places your old self never imagined.

Some departments offer Critical Incident Stress Debriefing (CISD) but others do not.  It is important to have an understanding of what to expect from your healing process.

I did a brief series on CISD using the band OKGO:

Part I   Part II  Part III  Part IV  Part V

The hardest part is knowing when to ask for help and realizing that anyone and everyone that tells you some bullshit line about having to have thick skin in this business is falling apart inside just like you and may actually want YOU to help THEM, but they're afraid to ask.

They're afraid you'll call them a pussy or wimp or lightweight, laugh at their sorrow because they can't take it while you're fine.

Asking for help early can break the cycle of depression not only for you, but for your coworkers, friends and family.

 

I don't understand suicide and I never will.  It's a coward's move and no one can convince me otherwise.  Besides, why not ask for help and avoid the whole mess to begin with?

There are a number of ways to find help, one of which is by following the Code Green Campaign on Facebook.  Click the green star and follow, talk, heal.

Sunday, April 6

Open, Pending

As the default Risk Management guy for my agency (until the new gig kicks in that is) I get routed all manner of citizen complaint that has anything to do with the Ambulances.

As a result I often have the opportunity to do some public relations work right there on the phone.

Did the mean Paramedics stab you with a needle?  Let me just take a look at your chart here...oh.  It says here you're a known diabetic and had a blood sugar of 21.  Yes, Sir.  Yes I understand you have trouble remembering to take you medicine.  Yes I do think they should have woken you up first before stabbing you with the needle.  But here's the thing...

Problem solved.

Most complaints seem to come in about 2-4 weeks following the date of service.

Our billing turn around is about 2-4 weeks.

Total coincidence I'm sure, but every now and again I get a phone call that brightens my day.  Often it has to do with someone most certainly under the influence of a central nervous system depressant and their attempt to recover said intoxicant from the Paramedics that took it.

Take Eddie Dean(Not his real name, but think of Eddie from the Dark Tower series).  Eddie called me doing his best Tommy Chong impression, right down to forgetting to answer some of my questions until after I ask "are you still there Eddie?" "Wha?"

Boils down to this:  Eddie is refusing to pay the ambulance bill because the Paramedics stole his marijuana.  Tough part on this one is that Eddie seriously needed some aggressive ALS care a few weeks back and I've got a gold star chart to prove it.  He mixed up a few prescriptions for a few diagnosed ailments and...BAM...altered, parastesias, the whole 9.  Most complaints revolve around fizzled attempts at a Lawsuit Chart, which still has to be paid prior to their surely losing case being heard.

Eddie is worried the Paramedics thought he was high at the time, which he claims he was not and I believe him...until he starts to try to explain how high he is right now.  While on the phone with me.  "Like...like right now, I'm able to smoke some and feel good, but I didn't smoke a lot that night."

He swears his girlfriend can corroborate that the Paramedics took his weed so I ask for her number to call her.  Eddie didn't think that all the way through and is asking that I not call her right away, that he needs to call her first to tell her what to say.

Smooth move, Eddie.

On the answering machine at my office is a message that ends with "If this is a pressing clinical matter, please call (my cell phone number)."

Eddie left me three messages yesterday (Saturday) moderately sober and begging me to call him immediately so I can talk to his girlfriend who "can tell you more about what happened because I talked to her already."

So now I get to hang onto an open file about how while in the midst of a code 3 scene time of less than 11 minutes  at an 8th floor apartment, my crew somehow had time to grab a few little green bags.

Marked:Open, Pending

 

Friday, April 4

C-Spine Policy Rooted in Science

Friend of the blog Nick Williams sent this on from a Reddit feed.

VMtHUmF

The future is here folks. Long spine boards are no longer the standard of care.

Speaking of the future, I posted all this from my phone. In my pajamas. While drinking wine. #micdrop

Wednesday, April 2

Overheard in the CQI Office

*Department issued cell phone ringing with hip electronic themed tone*

HM (Our hero): "Good afternoon, EMS CQI, Captain Schorr"

SM (Southern Ma'am-Caller with an almost comical southern accent): "This is Janine from General Freight we have a driver trying to deliver and your gates are locked. Can you send someone to the North Field gates?"

HM: "I'm sorry, I think you have the wrong number.  Who are you trying to reach?"

SM: "Sweetie, I doubt it, just get someone out to the gate for me...m'kay?"

HM: "Ma'am you called the San Francisco Fire Department.  Is your driver in San Francisco?"

SM: "Sweetie if he is he sure is lost.  How 'bout you just get someone out to the north gate and let us in OK?"

HM: "I believe someone gave you the wrong number Ma'am, I'm in a little office in San Francisco.  Can you read the number back to me?"

SM: "I need to speak to your supervisor unless you get someone to...oh...oh my...sorrybye"*click

Yup...never a dull moment in CQI.