No one.  Skilled nursing facilities have always fascinated me.  I’m not entirely sure why.  It has nothing to do with the first two words though, they’re nowhere to be seen.

THE EMERGENCY

A nurse has called asking for a code 2 transfer from the facility to the local ER for a possible bowel obstruction.

THE ACTION

We’re out the door code 2 after stopping for a quick piece of bread at the now completely set dinner table.  The salad is about to be served.  No wonder we caught a job.

Wandering through the streets we wonder why a skilled nurse at the skilled nursing facility can’t remove an impaction, but assume they know something we don’t.  Stop laughing, this is a serious story.

Arriving on scene a middle aged woman is in the street doing the parking valet dance.  Both arms over her head waving, then pointing us to park where we always do.  Does she not know we’re here so often we could classify as residents?

“What floor?” I ask, expecting a response with a number.  Instead she gives me letters.

“They’re doing CPR!”

Grabbing the red bag while my partner grabs the O2 and monitor I key up the radio and ask if they have a second call at this address.  They do not, just our code 2 bowel impaction.  It appears to have worsened.  “Send me an engine” is my report and I hear the dispatch come out while we climb the stairs.

Upstairs in the cafeteria is a man in his late 80s being physically assaulted by two young Asian women.  Sitting somewhat upright in a wheelchair, his chin is down against his chest almost as if trying to hide.  He may have been since they were doing the most bizarre chest compressions I have ever seen.  On a man seated in a chair.  Go ahead, think about it.  It’s weird.  A third woman is nearby holding a cup of water just in case, I’m assuming, he bursts into flames.

“What happened?” I ask while pushing myself through the throngs of robe wearing elderly who have come to see something new for once.

“He stopped breathing!” One of the women shouts.

“Give him more water!” Suggests the one with the glass and she hands it over.  Like a good EMT partner should the glass has been intercepted and he’s along the patient’s other side ready to move him to the ground.

As we do the water is pouring out of his mouth like a babbling desktop water feature and it is now readily apparent that he has cleared the bowel impaction without our help.  Amazing what the body can do when stressed.

The sirens outside have stopped and I hear familiar voices coming up the stairs, they must have been nearby.

He is log rolled and suction begins to gather the fluids forced on him by his skilled nurses.  To say his airway was compromised was putting it lightly.  The decision was made to transport him on his side, feet elevated to try to keep as much of the water out of his lungs as possible.

Down in the ambulance I’ve got the medic from the engine and my EMT with the EMT from the engine driving us the short 8 blocks to Saint Closest.

My radio report was short and we had just filled our only spare suction canister.

After transferring care I approached the woman who so kindly showed us where to park and asked her what had led to her father being nearly drowned.

“I think he choked” she sobbed “and they were trying to wash it down.”

Skilled my ass.

I’ve been posting some of Sean Eddy’s paramedic memes recently, having a few laughs when I posted one about a TV Paramedic only being in EMS until he gets into medical school.  I thought is was pretty self explanatory.

This morning I see 23 comments.  How can there be 23 comments about a silly picture?

Here is the first one:

“sad…yet why true? we do more thanmost nurses in poor conditions, more than many allied health care providers, yet who wants education and a true unified body to be compensated at a higher wage?? sad when mileage is reimbursed at higher rate tan our evals and treatments, oh yeah, that we diagnose.”

I liked the comment and went on.  After all medics do do more in worse conditions than nurses.  Fact.  Mileage seems more important than our treatments. Fact.  I agree.  This seems to be a running argument between the bed pan washers and the knuckle dragging ambulance drivers: “Who is better?”

Then there was this comment:

“Nurses think they are better than medics. I hear it all the time when im working in the ED, but I enjoy what I do. We are more hands on then they will ever be.”

And from there it just goes downhill. My comments are a general response to the debate, not a direct response to those who posted on the page.

The medics found an unconscious person in a hallway. They assessed, treated, extricated and transported to local ER. At local ER the nurses turn up their noses at the medics’ “diagnosis’ of DKA and remind the ambulance drivers that they haven’t completed a lick of medical school or nursing school.  Time is wasted gathering information instead of continuing care, care started by the medics in the field without direct medical oversight.

Am I right so far?

Nurse monitoring 11 patients due to short staffing has orders for 3 of them requiring him to re-assess, draw, administer and reassess the meds making sure they do not go against possible future interventions on another floor or in another ward.  Making sure room 6 doesn’t sneak in a sandwich before surgery, room 8 needs a wound irrigated and the woman in the hallway is asking for details on her newly prescribed medication.  Dr Johnson’s hand writing is still illegible and his 3cc should actually be 3mg, confirm and administer.  Ambulance patient arrives and will need his full attention.  But first he needs to make sure the rest of his patients are cared for.

Am I right so far?

People, please.  I hate nurses as much as they hate me.  Meaning likely not at all.

Paramedics get upset for not being recognized as a profession while they’re out there breaking hearts and saving lives.  Nursing has curious roots and took a long time to reach where they are in the medical hierarchy.  We in EMS have just as curious a birth (less prostitutes but more dead people) and are well on the way to being a recognized profession within EMS.  You want it tomorrow?  I hate to break it to you, but most of the EMS professionals reading this are not educated, trained or qualified to reach the Profession status in the eyes of the medical community.

Raise the education guidelines, licensing requirements, hiring standards and maybe, just maybe we’ll be on our way.

Many medics are upset at nurses because they get the salary, benefits and opportunities for advancement that EMS lacks.  OK, hate the fact you didn’t go to nursing school, not that they did.  The pay sucked in EMS when you got in.  The opportunity for advancement in EMS was nonexistent when you got in.  It isn’t the nurse that did that, it’s us.

If the nurses don’t give you the respect you demand, try earning it.  You’d expect nothing less from them, right?

Those words used to make me run.  That is the pre-empt our dispatch gives us when one of their call taker colleagues shouts across the dispatch center “Box going out!”

It means there’s a fire.

In my new staff role I haven’t answered a 911 call, EMS or fire in months.  I’ll be honest, it’s weird.

But today I was in the Chief’s Secretary’s office getting ready for a hospital meeting and heard those words I used to dream of, “Units on the air stand by for the box…”

And I almost didn’t notice.

The light duty firefighters nearby huddled around the radio as the first in engine reported heavy fire from the third floor.  I was more focused on the dozen cases being presented at my meeting and how I would defend the actions of my Paramedics if questioned.

I think I’ve made a turn.

We can all agree my life has been more patient focused than fire, but I never realized how little I would miss the engine.  It kind of makes me wonder if I just accepted the engine work because it meant more patients.  Engine work is pretty straight forward when you boil it down, especially for a layout guy like I was.  Not easy, just straight forward.

“Standby for the box” was what I heard the morning a ceiling fell on me.  “Stand by for the box” is what Vince and Tony heard on the way to the fire that claimed their lives.  And at this moment, when all my brothers and sisters were hearing those same words and stepping up to answer the call, my mind was elsewhere.

It was a powerful moment for me, difficult to describe, even reading this short explanation leaves so much emotion out I wonder if posting this is even worth it.

The drive to the meeting took me near the fire, but not close enough to get caught up in the chaos.  On the way I thought about what I should write about on the blog and nothing came to mind.  All I wanted to do was get to that meeting and remind the doctors and nurses that the reason they can have a meeting about patients who are still alive is because my guys and gals did their jobs.

I can still throw a 24′ aluminum and take a pole on the 50′, advance a 1 3/4″ up a stairwell or re-position the aerial, but my main focus, my passion and my drive is that little room on the third floor where I get to stand up for good patient care.

Call me crazy, but I’m happy.  Stressed, confused, scattered and unsure, but happy.

Standby for the box…You guys get this one.  Let me know if anyone’s hurt.

My EMS career has been just over 12 years.

It has been a fantastic time and has changed me in ways that I would never have thought possible.

And it all ends in a little over 9 hours time.

Justin has kindly offered to let me have some space on his blog so that I can say my farewell to EMS and share why I feel so privileged to have spent time in this most amazing of careers.

It seems a fitting place to say my goodbyes. Justin and Ted Setla have been a constant part of my life for the past few years and the opportunity that presents itself to me, that allows me to take my future in a different direction can be traced back to Justins and my ‘Project’ which later became the Chronicles of EMS after Ted found us and brought his vision to the screen.

One person who was watching along was Mathias Duschl, a paramedic from Switzerland who also shared our vision of trying to make EMS better for all of those that we care for. Just over a year ago, Matt and I met in Newcastle, where he showed me this rather cool medical device called the RhinoChill. I was hooked, and our relationship developed until he invited me to become part of the Benechill family. That has led to now, and my new career in research across Europe.

Im not quite done for with EMS yet though, I have this last shift left.

One shift left to enjoy the feeling of being an operational paramedic…
One shift left to maybe make a difference….
One shift left to try not to show my frustration with some of the people who will be calling 999…..
One shift left to avoid the one job on my ‘tick list’ that I still haven’t had to deal with and one that I don’t ever want to see.

But most importantly, one shift left to work with my wife!

We haven’t worked together for about 6 years. It didn’t seem to work once we were well into our relationship and on the way to getting married. I am her boss at work….She is my boss 24hrs a day! I think you can see the conflict.

Tonight will be different, because this is the last chance we will get to work together for a very long time, maybe forever. Tonight is going to be great.

I think that my leaving the ambulance service is harder for her than me at the moment. EMS has been ‘our thing’. We met over a decapitated head (only a medic would find that amusing!), and most of our conversations revolve around the job and the patients that we meet.

She needn’t worry though, she is now my insight into paramedicine on the front line. I will live through her and the stories that she tells me when she gets home.
Whatever control, or the world wants to throw at us, we will enjoy working together and seeing out my last shift at North East Ambulance Service.

But, what about me?

Sandra (my wife) keeps asking me if I am upset to be leaving and I keep saying, no not really. I am excited about the prospects ahead and the work that I can do and contribute to, that may well go on to save thousands of lives around the world. But then I am here, sitting alone in my response car and I realize that I am upset to be leaving. This is who I am.

That’s a simple sentence to write. Five words.

This is who I am.

I am a paramedic.

I am incredibly proud of that title. It is who I am.

The situations that I have experienced, the patients I have cared for, the good times and the bad.

The memories that I have, both happy and sad.
The pieces of my soul that have taken on indelible imprints of people I will never ever forget and who still touch my heart to this day…..

I see them all now, I hear the cries and screams; the blood and the devastation.

The lifeless baby and the hanging body. The man whose hand I held while he looked me in the eye to tell me that he was going to die, and he didn’t want to, he wasn’t ready yet. The grief and the despair.

Its all there….and it wont go.

But…

There is also the joy, satisfaction and happy times.

Laughing so hard with Dominic, that I had to sneak out of patient’s houses so that they wouldn’t see my hysterical laughter.

The caressed hand that brought so much comfort.

The sound of a baby’s first cry and the thank you from the grateful parents.

The visits to the intensive care units to see those that we have saved on their way back to their families.

The times when you come home so tired that its difficult to keep your eyes open, but you know you have made a difference.

The first time I worked with Sandra, when I knew…..she was the one.

There is so much that I could write, but I guess that’s what the 450,000 words were about from my blog.

EMS is not just a job. It cant possibly be. It changes who you are and how you view the world. It can make you hard, but it can also reduce you to tears when you least expect it.

I have been in the ambulance service 12 years. That may not be long to some of you, but it has seemed like a lifetime to me. I can’t imagine that I was ever happy doing anything else.

In my very first year,  a paramedic came up to me and said

“ if they were to cut you in half, you would have green and white checks through the middle of you “ (they were our service colours at the time)

I feel the same now.

I may be leaving the ambulance service tomorrow, but it will never, ever leave me.

-Mark Glencorse, Paramedic

The first recorded EMS Bromance was in the late 17th century when two stretcher carriers began to hang out together off the battlefield.

Centuries later a Geordie Paramedic and a Yankee Fireman who spent most of his time providing EMS began reading each others blogs on the interwebs.

Reading led to commenting, commenting led to cross posting, cross posting led to extensive discussions, discussions led to podcasts and podcasts led to a TV pilot.

There was a little more to it, but that’s the gist of mine and Mark Glencorse’s friendship.  It started with curiosity about each other’s systems and led to what will surely be a lifelong friendship.  Mark made a huge impact in my life and my career.  While this therapy experiment called the Happy Medic was helping me heal, learning from Mark and the community that I discovered has helped me grow, both personally and professionally.  I think we can all agree that when I first noticed a visitor to the blog was from outside the US, telling me that years later I would be watching videos of us goofing off around San Francisco and England would have brought a chuckle.

But watching the videos reminds me of how passionate about EMS Mark and I were and how we wanted to share our unique experience with as many people as possible.  That passion remains.  A passion not just for running calls and treating patients, but also looking outside the ambulance for solutions.

I chose a staff job at HQ.

Mark is heading into the private sector.

Although his blog 999Medic was shuttered awhile ago, Mark is still active in the online EMS Communities on Facebook and Twitter.  This week Mark will be working his last shift in EMS.

I have accepted the honor of hosting a message from Mark about the experience very soon.

I hope that when it is up you will read it and share it with your friends, readers and co-workers.

Stay safe,

HM

Greg Friese issued a challenge of sorts to some bloggers the other day:

“Take Sean Eddy’s excellent series about famous people as Paramedics and let’s all do a Tim Tebow one.”

I imagine the idea was to see how different bloggers interpret the pop culture figure and perhaps learn more about them in the process.

So here goes:

If Tim Tebow was a Paramedic…

I would still not know who he is, nor care too much.

People get upset when he prays at the scene of a call.  That’s his right, surely, but there is a time and a place and at the scene ain’t it.

From recent accounts he would be useless at the scene of the call but wrap up the tube, the vent and the Dopamine piggyback in the time it takes to get the rig from the street to the ED entrance.  Then he’d take all the credit and point upwards.

But on the ones we lose he won’t point up.

Tim Tebow as a Paramedic would last about 3 weeks in any EMS system.  Especially when the “Roxies” get to him.  More on that soon.

I love watching a show called Renovation Realities on DIY Network.  It usually shows a couple who want to remodel their house on their own to save a few bucks and it usually ends in a half done job.  I’m not sure if I like it because I do a pretty good job at finishing my projects at home or because it’s just a train wreck when they make mistakes like not knowing how to use a saw or not measuring the cabinets properly.

One guy was in the lower floor of a duplex and wanted to remodel his kitchen.  He had wanted to for a long time.  The kitchen was working OK, but the appliances weren’t laid out in the most efficient manner and a lot needed to be updated.

For years he had been told by the homeowner’s association that remodeling the kitchen the way he wanted wouldn’t work.  One day he got a chance to remodel it and put his plan into action.

Bright and early one morning he was ready to start demolition.  Little bits went well, adjusting certain things to get ready for the big remodel.

The cabinet makers came by to measure exactly what he needed.  The flooring rep was in constant contact about his needs, even the folks that make the appliances were on site to help in any way they could.

Then the demo started.

And stopped as soon as the first hammer hit the wall where the stove was to go.

Behind the drywall was brick.  It didn’t show on the plans, but there it was.  A wall.  A thick one.  Initially he blamed the homeowner’s association, but he slowly realized it wasn’t them who put the wall there, but the folks that built the house in the first place.  Curious to learn more he listened carefully to the HOA describe why the wall was there and shook his head.  The wall was built so that the two units could share supplies easily in case of a disaster.  It seemed easy enough to just close it off, put in some beams and keep going, but then he looked around the brick structure and noticed that all the eletcrical, gas and HVAC conduits came into the duplex through the bricks and taking it down would mean completely restructuring both units, something the upstairs neighbors would never consider.

So he sat down in the kitchen, single hole in the wall, and all the appliance and flooring folks asking when he plans to have the new kitchen ready.

He refers all their calls to the HOA now, even though they’ve been through this with the HOA numerous times.  The kitchen is still working, they don’t love it, but they were able to make a few adjustments and that will have to do for now.

He just wished the units were completely split.

Neat show.

One of these:

Flashlight with video recorder AND night vision?  Hells yes, MC needs this!

Alt Kilt, official kilt of Kilted to Kick Cancer and the definition of a small American business, has announced their Spring Model Contest.

You have until January 12th to email the needed information and a photo of you to them to be considered.

The thing I like about this contest is that it’s not a cattle call for beefcakes and swimsuit models, although said categories are not being excluded.  Alt Kilt is looking for everyday people of all colors, shapes and sizes.  Even amputees are being encouraged to enter, the entire point being that ANYONE looks better and feels more confident in a kilt.

I entered, mainly because the chosen few will get a free custom made kilt to model for photographers in their own area, then the photos used to promote Alt Kilt around the world.  In addition, Motorcop and I, along with interwebs coding ace Alex from Unkilted.com, have been toying with the idea of a Kilted to Kick Cancer Calendar to raise money in September.  If you have a blog, please share the contest with your readers, on twitter and facebook.  I want Alt kilt FLOODED with a wide variety of folk to chose from.

So keep an eye out for details on the calendar soon after the new launch of the improved KTKC website.

Get over to Alt Kilt, read the rules and enter!

Stay Kilted, my friends.

Remember the discussions we’ve had in the past about pain?

And when I shared what my 10/10 was? (Photograph removed by request)

I’m updating my 10.

On Monday afternoon I was enjoying a day off after the holidays and tidying up around the house.  Cleaning up Christmas decorations, washing out the keg, you know, usual post holiday stuff.  As I walked back into the garage and began to close the door I noticed the sprinkler bin outside still had the lid open.  I had gotten it out to assemble a keg washer from old PVC pipe and a sprinkler.  Very clever I thought.  Half a step from the bin it felt as though my left foot had gone into a hole.

A bright light flashed in the back of my head and a bolt of lightening struck my lower back.  At least, that’s how it felt.

I collapsed to the ground faster than you could say “WTF?”

The pain caused me to begin to writhe on the cold concrete not 3 feet from the house.  As I writhed in pain, my back continued to burn and tingle, which was causing me to contort in small jerky motions.  Each time I did my back sent lightening up to my shoulders and down my legs.  Even the wind blowing by seemed to make it worse.

“h…elp” was all I could get past my clenched teeth.  For a brief moment I thought back to my burns and wished I could have them back instead.

Slowly my eyes opened and I was able to look for the hole I surely stepped in, but there was none.  I needed help, but couldn’t move.  The clothes dryer had just started and the vent was nearby.  that combined with the sounds of my girls playing loudly in a nearby bedroom meant that no one was going to hear me for some time.  I had to move.

Each and every motion except blinking sent shock waves out from the searing pain in my lower back.  After 3-4 minutes of grunting, crying and twisting, I was able to get on my hands and knees and start crawling back to the house.  Those 3 feet felt like miles.

Crawling is not as easy as you remember it.  It is very easy to lose your balance when you’re not in shape, which I apparently was not.  Each hand movement became a slide instead of a lift and my knees also never left the ground.  The movements were telegraphed from the pain in my back and I could have traced the entire nerve system through my body had you needed to know it.

An unknown time later, the 2″ tall metal door threshold behind me, I was in the garage and able to raise my voice.

“help”

“KIM!”

She came running and found me in tears, on all fours and trying to explain what happened.

A few moments later she had a cushion, ice pack and ibuprofen ready and the decision was made to move me onto my back.  A decision I would curse until supine.

Unable to stand, Kim got under my left arm and helped me shuffle into the house and onto the couch.  I would spend the rest of the day there, eventually able to get up and shuffle around the house and head for bed.

The next morning my alarm went off and I sat up to get out of bed for work.  Well, not exactly.  More like I started to sit up and the lightening struck again.  Back to sleep, no way I can go to work like that.  Awaking at 830 to a busy household, I decide a shower sounds nice and the family is off to their regular weekday routine.  As the water is turned off and I feel 100% better my hand instinctively reach to dry off my feet.

Flap!

And I’m on the floor again in worse pain than the initial injury.  Nowhere near a phone, the family gone for at least another hour and naked, and I’m wondering how long I’ll be lying there.

No way.  I have to get moving.  Crawling is worse that yesterday but I make it to the dresser and somehow am able to manage getting some clothes on, then look down the hall towards the phones.  It was a good idea yesterday to leave all the phones I need on the couch.  Now I’m wishing I had brought at least one into the bathroom with me.  Now we know why the fancy hotels put phones in the bathrooms at least.

A long crawl down the hallway and I make it to the office where my cellphone is.  On top of the desk.  Barely able to reach up and pull it down I dial the wife’s cell phone on speaker while collapsing onto my side.

Then I hear her phone ring.  She forgot to take it with her.

As I hung up I saw the number I should call and sighed.  Did I really need an ambulance?  It sure would be nice to not have to crawl anywhere anymore.  One more try first.  Able to reach the wife at one of the places she told me she was going, she advised a 15 minute ETA and I decided to call my insurance company to see about a handicap van or other transport to an urgent care.

It was there on the office floor, alone, that I realized that even though I was willing to jump off a cruise ship to get pain management for my chemical burns, I was willing to hurt someone for muscle relaxers.  For pain management I would have done more.  Thinking back to the floor of the bathroom, it clearly became my “10″ on the 1-10 pain scale, pushing the burns to a close 2nd.

When we discovered the clinic was by appointment only and no openings for 4 hours we chose to get me to the ER for an assessment and some medication.

After an excruciating walk to the car we arrived at the ER and got me in a wheelchair.  The ER Doc came in and saw my knuckles white from holding onto the rails of the wheelchair, splinting my body from resting on the soft chair.

“Bad back?” he asks.

“Since yesterday, yes.” I answer, now pushing my head against the extended rails behind the chair.

“Can you show me where?” His question is answered by my strange jerky repositioning, trying to create space for him to look at my back.

“That’s far enough. You need some meds.”  When he returned not 3 minutes later I was given a Zofran tablet, Valium and muscle relaxers IM and the bad news.  I was going to be useless for at least 2 more days.

After a brief wait at the pharmacy we were home and my Valium was kicking in.

That was yesterday.  Today finds me finally able to sit up enough to get on the ol’ laptop instead of holding the ipad over my face to get my social media fix.

The decision to share my tale was to remind all that we ALWAYS need to qualify a patient’s 10 out of 10 to properly dose them based on their level of discomfort.  When I checked into the ER I rated it a 3/10.  To me that meant it hurt when I hold still, but walking, standing, most anything else instantly became an 8 or 9.  Looking at the happy faces chart now used, my inability to stand or care for myself meant I was always a 10.  Hogwash.  Get a baseline, it’s the only way to know what a 10 really is for the patient, not the provider.

And make sure to exercise your core, not just your arms, legs and cardio.