Monday, August 30, 2010

New Site!

I'm sorry! I've moved sites, and I should let those who have this link have the new one! Ready? Grab your keyboard ladies and is: *drumroll* Yup! That'd be me!

Come on over! There's a great new format and an even cooler site.

Have fun and Be Safe!

~M. Trommashere~

Monday, August 16, 2010

Quick Ramblings

Hello everyone!

I am pleased to announce that over the next couple of days, or weeks, I will be moving to a new blog site! I will be moving to I am moving for one reason.

I am moving because I am trying to continue providing the best reader experience I can, and the most informative experience I can. Nothing will change except the blog address. I started blogging because I wanted to help change the face of EMS as a whole. I want to be one of the many voices in the chorus of change that is sweeping the EMS world. I am surrounded by many very talented bloggers such as Ambulance Driver, TOTWTYTR, Rogue Medic and Lizzie just to name a few.

So, over the next few days and even some weeks, my blog will be moved. I believe I will be able to have a link or page that will direct you to the new site. If not, just check on every few days and I'm sure you will find my new link up there soon.

Thanks so much, and have a wonderful evening

~M. Trommashere~

Monday, August 9, 2010

Failure is an option.

Today I had a bad day. I was taking a physical fitness test for my new job and I failed...badly at it. Back spasms have plagued me since I got between a 300lb man and a Stryker stretcher. He was trying to jump off, and some how I thought I was going to stop him. In the middle of the sit-up portion, my back locked up tighter than a virgins' legs and I couldn't sit back up. I tried, but my body betrayed me at the worst time. My emotions got the better of me, and I stormed off, being followed by Medic Dolphine.

I lived by the creed: "Failure is not an option." Ask any one of my friends and they'll tell you that I don't take failure all. It is not in my genetic structure to fail. I sat and stared at the running track that I was supposed to be running on after doing the sit-ups, and I realized that, failure had become an option in my life.

I knew that failure sucks big eggrolls, and it's not something I like to do on a regular basis, but because of EMS, failure was an option. It just depends on how we look at it. The sit-ups: There was nothing I could've done. My back locked up on me, my feet went numb, and I couldn't see through the white hot pain. I've trained for this day for months, almost six now. I had done countless more push-ups, sit ups, and running than I had to do today, but it was not ment to be.

Years ago, I would've fought, argued, and whined my way to never trying again. My mentality was, it's not me, it's them. After losing several patients over the years though has taught me that, no matter how hard you try, if it's not supposed to work, it's not going to work. I was not supposed to get in today for whatever reason, who knows why.

We as Medics and EMTs put a lot of blame on ourselves when things don't go right and our co-workers help that process by reminding us of our failures. What we don't remember are the times the shit went right. Yeah, my back may have spasmed today, but thank my lucky stars it didn't when I had help get a kid out of a mangled car and I was contorted into a position I hadn't seen since my Cheerleading days. I stayed in the same spot for almost an hour, yet my back didn't betray me until I bent to pick up a piece of plastic on the ambulance floor during clean up after the call.

I remember all the large bore IV's I missed and I think about them constantly, but I don't pull up the fond memories of sinking 22's and 24's on little old ladies who would be poked and prodded into the night because of people rushing to get the line.

I've "failed" many arrests, hell, I speak of one in one of my posts. I remember dates, times, places, faces, what have you of the "failed" arrests, but I can't even remember the name of my very last arrest. While she wasn't a techincal save (walking out of the hospital), we "saved" her to the point that she was perfusing so her hand was warm when her husband of over 50 years was able to hold her hand and say good-bye while she was "alive" in her husbands' mind.

I walked to my car, feeling dejected, but at the same time relieved. The spasm abated not too long after it started, keeping me from hours, if not days of bed rest and medication. I was given permission to retest; the instructors figured that I wasn't lying about the back spasm because of the look of sheer pain on my face. They saw me trying, so they gave me information to reschedule.

I also think my mental shift came from reading. I had been voraciously reading a book by A.J. Jacobs called The Guinea Pig Diaries. In it, he does various experiments about his life. Outsourcing EVERYTHING he did during the day, even reading to his kids, to doing everything his wife asked him to matter what. One section that caught my interest was when he spoke about how he makes a note every time he's in a fast moving line at the store or at airport security. He's right; we only notice the bad shit. Sure, for this particular section he researched a Harvard Psychologist (Daniel Gilbert and his book Stumbling on Happiness, but the take home point in all of it was that, we remember the bad stuff well, but never the really good stuff.

So, as I doff my cap to Mr. Jacobs, here is my "mental list" of everything that went right today:

I woke up and the Earth was still here.

I felt great considering my nervousness.

The drive to the hotel we stayed at and even to the test was uneventful and we found the place with lots of time to spare.

I was able to help motivate the girl who was before me into punching out her last few sit-ups; she made it.

I don't have to get a prescription filled for a steroid because of my back; the spasm went away on its own and I just feel stiff, but nothing too bad.

I didn't have to run in the extreme humidity which would've set off an asthma attack which would've been worse than the spasm.

I now know what I'm looking at and I'll do better next time.

Now I'm going to lay down, get a few hours of rest, and start my process over again.

Have fun and Be safe!
~M. Trommashere~

Saturday, August 7, 2010

Get Flown or Die Trying....

So another fun debate looming over the EMS Blog-o-sphere is the great flying debate. I have lost count over the last few months of just how many great men and women have died during an Aeromedical Crash...and not the fixed wings either, the helicopters are going down. Many in the blogsphere and on other EMS websites like and all have articles relating to the necessity of flying patients. Questions are raised like, Is flying needed? How much time is really saved? Is it worth the risk? What can they do that we can't?

Oddly enough, my career path is going into being a Flight Medic. I wanted to be a flight medic before it was cool. (Okay, it's always been cool, but go with me on this one.) I have always respected them to the highest, and not because of their awesome flight suits, but because of what they did. They go in to major accident scenes and rescue those who can't be helped due to the lack of adequately trained ground personell.

Or so I thought...

When I did my flight time that was required by Paramedic Program, I got to see up close and personal just what they did. I never flew once, the weather was horrible on each day that I went. I chatted with many flight medics, nurses, and even pilots. I asked the same question, Is Flight Medicine really that important? Do you need to come out on EVERY car accident scene that has a bent in door, or car fluids leaking, or for every patient that is more than twenty minutes from a "specialty resource center?" Is it worth risking your life every day?

The answers I got were amazing. From the expected, "Everyone working with me is awesome and we can fly through anything 'cause our pilots are awesome." to the unexpected, "I like going on scene runs, but constantly going out on calls that Basics could handle, just because they are more than twenty minutes from (insert trauma center here) gets a little on the crazy side."

I had to agree with them. I know I don't have any good scientific facts like RogueMedic or as witty as Ambulance Driver, buthere are my direct obsversations.

I came from a county where, we had at least a Level 2 Trauma Center within 20 minutes of anywhere. As much crap as I gave the outlying hospitals, I had to give them their credit when it was due for stabilizing truly bad accidents when no one could get them into the city for the Trauma Centers. On the other side of things, in XYZ county where I came from, we had 4, not one or two, but FOUR Level One Trauma Centers within 10 miles of each other and on any side of the county, were no more than twenty minutes from one of these centers.

I have personally witnessed the rampant abuse of Aeromedical. We had a bad traffic problem, and we'd notice the use of helicopters would go up during rush hour traffic and when there was a sporting event in town. Even though there were thirty different ways to get to each center, because the main (and shortest by mere seconds) route was full, the bird would go up.

What most people don't realize is, the ETA for the helicopter is just flight time. They don't include the 10-20 minutes for everyone to wake up, answer the call to nature, check the radar to make sure there isn't going to be a severe weather event where you are headed. Then you have to do the pre-flight check, get the blades turning fast enough, then get to the scene.

So, if there is an ETA of twenty minutes, the true ETA can be almost fourty minutes for the bird to even get to you. Then you have the transfer of care, the changing over of equipment, changing from one stretcher to another, then the patient is loaded into the helicopter and they take off. We're talking about almost an hour of someone sitting with their thumbs up their asses waiting for the almighty helicopter to land and whisk their patient away.

I am not calling for the immediate halt of flight services. There are many places that need helicopters to come in. I live in a place now that they fly ANY critical patient where the trauma center is. Now, it's a ninety minute, if not longer depending on traffic drive in, so I can understand, but where is the fun in that? Most of the people I work with have not handled a severe trauma patient. There are always helicopters near by, so the patient has barely been taken from the wreck before they are loaded into a helicopter.

I believe that a change needs to come though, but it has to come from everwhere. We have to stop teaching EMT's and Medics how to manipulate Medical Command Doctors into allowing the bird to come in. We need to start teaching that, it's okay that your patient has a Femur fracture...that's why the Hare Traction Splint was invented. Slap that puppy on and head for the nearest hospital if they are that bad, or to your local trauma center.

Doctors at the outlying hospitals need to pull up their big boy/girl panties and actually do what they were trained to do: play doctor. No more telling ambulance crews that you don't take "That kind" of patient. No more freaking out when someone comes to you with more than a scraped knee. No more screaming at ambulance crews for not taking them to a "better hospital", and no meeting them in the ambulance bay when they come in with a patient who is trying to die (and doing a helluva job at it) and telling them that you're going to pull their numbers if they don't take their critically ill patient somewhere else (true story).

We as EMT's and Medics need to start taking pride in our work. We wonder why they take things away from us like Intubation and agressive Trauma Protocols. They do that because a majority of us act like we can't do it! On the outside, those medics (outside of extremely rural areas, or places that have drive times of two hours or more), who call for birds constantly name key phrases such as, Extended transport time/distance to specialty resource center. Possible Airway Compromise that cannot be handled in the field. Or my favorite one, The patient has an Altered Mental Status that may continue to decline and make ground transport risky.

We all know that most of these medics just don't want to deal with it. They have something to do right after they get off of work, and the ground transport will cause them to miss their event, so they call a bird. Too Tired after running all night? Call a bird. Don't want to deal with a drunken, crazy patient that you can't sedate and tube because of protocol? Call a bird! We bitch, moan, and complain when we are dragged out in poor weather, citing that, because we're in an ambulance, we may wreck and get injured or killed. What about those who are up in the air thousands of feet? They don't have that 50/50 chance, or even a 40/60 chance. Their chances of dying if that hunk of metal and fiberglass decides to fall from the sky is over 70%! We have seatbelts and airbags...they don't.

Across the board, we need to change. We have to stop calling the birds in for "questionable" situations. If you have to think whether calling the bird in or not is a good idea, then you can probably drive the patient to the closest hospital and let them treat/stabilize, or drive them to the trauma center yourself. Other than giving blood products and doing RSI, we can do the same thing they do! Nothing they do is going to make a world of difference (except for blood) in our patients.

Medics! Start taking pride in your work. If we spend our time flying every patient, it dumbs us down, making us look as if we can't handle ANYTHING, location issues aside.

Before I close this out, I just want to say that, I love my Flight Medics and Flight Nurses. I have had the pleasure of being able to work with them going through Medic Class, and even outside of medic class in other areas. For locations that need them, they are a Godsend, and I pray that they go up in the air safely and come back down just as safe. At the same time, I am very proud to say I've not broken my Flight Cherry. I love my Trauma Patients too much to let someone else take them in.

Not saying that I won't use them here, especially since drive times to a Trauma Center are horrific, but I believe I'll be very limited in my use of them. I believe (read: hope and pray) that the local hospital can stabilize Trauma's, STEMI's and CVA's (Heart Attacks and Strokes for those who aren't used to the nomenclature). If not, then I guess I'll be flying more people than I'm used to.

In my next post, I'll give you a call I had when I worked in the Land of Many Specialty Resource Centers, tell you how it played out, and my other thoughts on if Air Transport Services are being used and abused like a two dollar whore on half off night.

Until then, Have fun and Be safe, My friends!

~M. Trommashere~

Friday, August 6, 2010


Okay, I figured I just needed to come out with this and confess this before things become too hectic.

The move that I made was for a job. I am looking to become an Aeromedical Paramedic, also known as a Flight Medic. While my former state has a phenominal, and I mean, phenominal program (that I never used, which is another post in itself), but the training program where I'm from is very...exclusive. You have to work with certain companies, know certain people, and get your EMT/Paramedic from a certain school before you are "allowed" to get through their class (another post in itself).

I moved to a place where I can (hopefully) get on with another well known Flight program...I'll explain more maybe after I (hopefully) pass my entrance exams on Monday.

Have fun, and be Safe!
~M. Trommashere~

Tuesday, August 3, 2010

Round Stretcher Discussion...Finally!

So here it is, the first Round Stretcher Discussion. Topic for this one was discussed a week or two ago. For your refresher, the topic was: "Should EMS/Fire Personell be allowed to carry some sort of weapon to defend themselves including but not limited to: Guns/Knives/Mace/Tasers/Ect..."

Medic Trommashere: Myself

Medic Dolphine: My partner for over five years. We have worked together from before we were both medics. We went to Paramedic School together and even managed to work in the same service before moving to pursue a new career. He has worked in all areas; urban, suburban, and rural. We share similar war stories, but he has many of his own.

EMT Doodle: Another partner. She spoiled me, being one of the better EMT's I have had the pleasure of working with. With an energy that can vibrate her surroundings, she's awesome!


Medic Trommashere: Thanks you guys for being willing to sit down and chat with me about this. The three of us have worked together in probably one of the most dangerous areas in our county at that time, and we also have worked separately in various areas, so hopefully this will be fun. So the question I am posing to the two of you is this: Should we be allowed to have something in the ambulance or on scene to protect us, things like a gun, or mace, or a taser, or something that is considered a 'weapon' under our EMS Weapons' Rule.

EMT Doodle: A gun? Seriously? Think of all the people we worked with, do you want to see any of them with a gun?

Medic Dolphine: We already look enough like cops, do we want to make it even worse?

MT: Point we'll pretend that we're not even considering fire arms anymore. So, what do you think about any other type of weapon?

ED: There needs to be some sort of training to help us defend ourselves. I'm trained in the Martial Arts, just like the both of you are, so we can defend ourselves if needed, but most haven't had much if any formal training. I'd be afraid that, for something as simple as a drunk getting a little aggressive, someone would pull out a Taser or a can of Bear Mace, or a Baton to beat them and possibly kill them.

MD: Yeah, most people who play on the ambulance or on the fire engine would take it too far, and the first time someone got killed, we'd have everything taken away. For a parallel example, look at Lasix. We got it, we used it like water, but after a major screw up, Lasix got bumped so far down the list it wasn't funny.

MT: But the question is, should we have a mechanical device to defend ourselves? (Shows a print out of Mark Zanghettis' comment on the original post) Also, how do you feel about this comment?

ED: He's right. We used to talk about it when we worked together, and even when we worked separately, that we didn't like looking similar to the cops. We're there to help, not hurt, if it can be avoided. I have to disagree with the non use of Mechanical Restraints like softs, leathers, and what not. Some times you just have to have them tied down. All that sometimes separates us from getting our ass kicked are seatbelts that we all know how to buckle and unbuckle. As a woman, I don't feel comfortable with the big behemoth patients who could kick my ass if they looked at me the wrong way to be without restraints if they even start getting aggressive.

MD: True. Mind sets are also important, but we can't smooth talk every patient. Someone gorked out on PCP who feels no pain and feels that they can take on the world can't pay attention to the calm talking of an EMS provider because of the psychosis that are raging. I wouldn't want to carry around a taser or a gun, but to be allowed to carry a can of mace would be great. The last time I had a severely psychotic patient, the patient tried to attack a cop and got tased...yet he still kept coming. The mace was the only thing that even had him pause long enough, because he was so disoriented from lack of sight, for us to retreat to safety. Now, I consider myself a big guy, but sometimes even I worry about my safety. (Authors' note; Yeah, he is. 6'2", 275, built like a brick shit house. Most see him coming and they back down from the fight, but I digress)

ED: I don't think I could work for a company that didn't have restraints. Sometimes just the threat of restraints to the patient can get them to calm down. Verbal assaults are one thing, but I do like the idea of going home every morning.

MT: I agree with both of you. I have played enough over the years with violent patients, each time the attacks have gotten worse. There's nothing like having that feeling of, 'I'm not going home today'coursing through your system to give you a wake-up call. Even with the cops around, anything can happen. I got grabbed by a patients' family memeber with three or four cops standing around because they were angry at the death of their family member. Now, nothing resulted from it except for frayed nerves, but it could've been worse.

MT: What would I have done if it were just myself and my partner surrounded by multiple family members? I take full blame for the incident; I should've been paying attention, but with an emotionally charged scene like a homicide, suicide, or overdose, there's only so much we can do. We can leave the scene if it becomes dangerous, but at some point, we have to go back, and now we've just pissed everyone off by re-involving the cops. It may not be that day they take their revenge, but we can't call the cops out on EVERY call, medical or otherwise. Two or three weeks down the line, that may be the day that the little brother of your shooting homicide patient that you pronounced decides to take it out on you.

ED: You brought up a point that wraps back into Scene Safety. I went through EMT school only a few years ago, and we had the quick, "If it doesn't feel safe, it's not" lecture, but past that, I learned on the fly. We didn't know which side of the door to stand on when knocking on a door of a house (Hinge side, btw), how to approach a vehicle so that they can't see you, but you can still see them, or anything like that. We need to have better training before we get out on the road. I'm not talking about a Master Belt in Brazilian Jiu-Jitsu or anything like that, but just some way to defend ourselves past, "Call the cops and run away quickly."

MD: True. I took my EMT class over eight years ago, and the best defensive technique I learned was throwing my jump bag at someone and running away, but that only works if you see them coming. Best thing I was taught on how to defend myself in the truck was to climb through the birth cannal...but I can't fit through there on a skinny day, let alone any other day of the week. Something needs to be changed in the teaching of how to keep yourself safe on scene and in the ambulances. Hours for Medic class and EMT classes have been lenghtened to cover more medical things, but we're started to skimp out on the important things; how to keep yourself safe.

MT: True. So to summarize so far; Guns and Tasers have no place on an ambulance, I agree. Things like self defense techniques should be taught, but we should be allowed to carry mace with us as a last resort,

ED: Pretty much. I don't think that guns and tasers could be used properly on the ambulance, number one, and number two, I don't trust anyone to be able to adequately defend themselves to keep an enraged person from taking the gun or taser and using it on us. The downside to mace is that, unfortunately, everyone is going to get a piece of it, but at the same time, I'd rather get a face full of mace like everyone else instead of a fist, bullet, or taser prong.

MD: Same here. I've caught the back blow of mace several times, hell, I think we've all walked into a jail-cell or an enclosed area where we've walked right into the lingering cloud of mace. I agree with everyone though that, facing a face full of mace is more desirable than getting my ass kicked.

MT: So I believe we have reached a consensus: While some would say that the only way to defend themselves would be to arm themselves with something that can cause fatal lead poisoning or low flow electrial therapy, the thought is that teaching of proper self-defense techniques, both passive and aggressive, would be beneficial to all. Not enough time is spent on diffusing hostile situations, or recognizing them, or getting us out of them safely.

MT: All they focus on is if we get in trouble, we call the cops and try to run. With people arming themselves more and more these days with guns, a metal clipboard, a heavy house bag, or an oxygen tank isn't going to serve us well when a 12-gauge shotgun is leveled at us. With more and more violent crimes happening across the country, we're going to find ourselves on more and more scenes with angrier and angrier patients and their families.

MT: With the addition of companies making their crews wear bullet proof vests with trauma (aka: Stab Plates as I've been told they're called), people have that bit of 'security' going into these bad scenes. Unfortunately, most companies cannot afford to buy them for even the on-duty crews, especially since crews have varying body sizes. The companies that do have them, have them in a 'one-size-fits-all' size, and none of them fit anyone well; not even close to how they should be worn to keep us safe, and they are usually well out of the range of when they were supposed to be replaced.

MT: While many say that the one through three thousand dollars that it would cost per vest is a drop in the bucket when it comes to trying to save someones' life, most companies are concerned with the almighty dollar; Bullet Proof/Stab Proof vests are not as important as making payroll or keeping the ambulances up and running.

MT: Other methods need to be taught on how to deal with agressive patients when in the ambulance. This is where it seems to be that most attacks happen. While we can't restrain every patient who looks at us cross-eyed, we need to teach the skills to those who follow in our footsteps on how to keep themselves safe; where to sit, how to seat belt them down to the stretcher, and overall communication between crewmembers to keep everyone aware of what is going on. With that, I am closing out the first 'Round Stretcher Discussion'. Have fun and be safe out there, everyone.

Wednesday, July 28, 2010

Lack of posting

I apologize for not posting. As a rule, I try to post constantly, but these past few weeks have made it difficult. Coupled with the anxiety of moving to a new location, I have all types of new fun diseases to find, so of course I got the fashionable head cold that is floating around. Hopefully in a Sudafed induced haze I can finally get my long awaited round stretcher discussion out for all to read.

Have fun and be safe!

Thursday, July 22, 2010

Pre-emptive Strike...sort of

Okay, so I want to put this out there before I put out the final, edited version of the "Round Stretcher Discussion." I am so not advocating fire arms in the ambulance. At the same time, I didn't want to hear someone get all pissy because I didn't include guns in my list of things a Medic/EMT/Fire Fighter be allowed to carry to help with self defense.

So, if you'd like a snippet of the very first portion of our discussion, here you go.

MT: Thank you for participating in this "Round Stretcher Discussion." Topic for this week will be, "Should we as EMS providers and Fire Fighters be allowed to carry something to defend ourselves such as a side arm, taser, pepper spray, what have you?"

Medic Dolphine (MD): If I see anyone coming towards me with a gun, I'm liable to shoot them myself.

EMT Doodle (ED): Only if they provide the bullet proof vests and make the ambulance bullet the stuff they make the black boxes on airplanes out of bullet proof...

There you have it. Guns were taken off the table in the first two minutes of conversation.

Saturday, July 17, 2010

A new EMS Debate...

Hopefully I can get people eager to read my next post series. By the way, I am currently living with two other EMS professionals. I will call them Medic Dolphine and EMT Doodle. We get together and have our own round table discussion, and they have graciously allowed me to post their comments about a given topic. This next round will be about....

"Should Paramedics, EMT's and Fire Fighters be allowed to carry a side arm/taser/mace/self defense weapon on them while they are performing their duties?"

I'm sure this will be the start of something awesome. Look for a post tomorrow regarding the conversation. I'd also like to hear from what you think about this topic.

Have Fun and Be Safe,
~Medic Trommashere~

Sunday, July 11, 2010

The Great Intubation Debate (Part 1)

First off, let me say two things. Number One: I am so excited as an EMS provider that Paramedics and EMT's alike (both ground based Medics, Flight Medics, and those who work in hospital) are concerned about something so important; Intubation. We are all well aware that there needs to be a system wide change in how Intubations are taught, handled, and "scored" in the field. Number Two: I have to say the posts on this subject that I have seen are excellent! Please don't take offense to me disagreeing with your post; if I didn't like the content and thought you were so way off base I never would've given it a second thought to even write a rebuttal.

Anywho, Rogue Medic wrote about Intubation Education. Go ahead and read it, it's very well written and has a lot of great points.

Now, RM states: We act as if the OR (Operating Room) is the only place that we can obtain good practice. There is no evidence to support this.

There is nothing to show that OR training is superior to morgue training and mannequin training, but we act as if the decreased availability of OR time is the only reason medics can't intubate competently.

The decreased availability of OR time is not the only reason medics can't intubate well, but it is a big one. When was the last time you saw a mannequin with a severe facial deformation? A trachea so anterior or posterior that no matter how hard you apply crichoid pressure or manipulate their head back to the point of turning them into a lighted Pez dispenser can you even get a glimmer of cords?

When was the last time you saw a mannequin with cords so discolored and raw from years of smoking unfiltered Marborlo 100s and the wracking emphasemic cough that has them looking more like raw pieces of hamburger, or little slivers of charcoal?

As for the morgue, I can honestly say that my state did not allow anyone below an RN into the morgue; I tried to get in. Also, yes, the Coroner may have done some sort of ER time when s/he went through med school, but what type of advice can you get from them on intubating a live patient? When was the last time they held a blade and tube in their hands and intubated something that wasn't already cold and stiff?

The OR/ER is the only place, in my opinion, to get real world intubating practice. You have someone who does nothing but makes people really sleepy, then makes them chew plastic all day long. You get the smokers, those suffering such severe kyphosis of the spine that you can't get the head and neck to go into the sniffing position, those with Mallampati scores no less than 3. You just can't get that on mannequins.

We act as if the only problem with the way we are teaching paramedic school is that the students are not learning. As if this is not a reflection on the teaching.

Teaching means providing information to students in a way that helps the students to understand. If the students do not understand, the teacher did not teach.

Unfortunately, Paramedic classes are made up of a multitude of students. You have those who have been through Medic class over a half a dozen times, if not more, those who have never been in the field...the ones who's ink isn't even dry on their EMT card before they hopped in class, the know-it-all's who have been in the field since before Christ turned water into wine and they're just doing class because they want to be just like their childhood hero's from Emergency!, and then the ones who are being medics for all the right reasons.

Now let us say that you have six of each of these students. The first six have been taught over and over again how to intubate on a mannequin, so therefore believe that they are "good" at it, and have done their required OR time to the point that the CRNA's know them by name. They're just doing whatever the good instructor/doctor/nurse tells them so they can move on and maybe pass the final this time

The Second Six: The Eager Beavers: They can barely hold the blade before they make a mess in their pants. Their whole EMS existance has revolved around this one golden moment that they tune EVERYTHING out just so they can put that blade between the plastic lips of the mannequin. They'll say "Yes! I understand!" just to put that blade in. Instructors take that as the newbie screwing up and they get some remedial training, but even then that may be taken as a grain of salt by someone who, once they get their first tube, no matter how badly they fudged it up, think that's the way to do it.

The Third Six: They've seen every Medic in the world intubate, so they claim. Most of these students will claim that they, as mere EMT's, had a blade thrust in their hands because the Medic had his hands ripped off/maimed or was incapacitated somehow, and they managed to intubate the haemophiliac great-grandmother of 30 who was on her way to church and was in an accident that turned her jaw to mush, but somehow, he intubated her perfectly. I seriously doubt they even pay attention during any of the lectures and get lucky when they sink a tube correctly.

The Fourth Six: The Baby Medics: These Medic Students may have seen an intubation, but were too busy focusing on patient care to really pay attention. They have the thought process, maybe even the mechanics, but are listening at rapt attention during the lecture, and are the ones seen staying after class to get help on how to intubate.

Also, everyone needs to remember that Medic Classes are taught by PEOPLE Usually they are Medics with years of experience who have intubated at least 3 people before they started teaching. They also have their own nuiances to make it easier for them to Intubate, but may confuse the hell out of those who are trying to learn them.

Intubation education does need to be overhauled. On scene is not the time to learn how to intubate through ecchymosis, through Le Forte Fractures, through junk in the airway, through anything else than what was given to them by the mannequins and instructors. OR/ER time is needed for the sheer fact that, live tissue responds a certain way. You can't get the same feel off a (really) dead person or a mannequin.

Pediatric Mannequins are even worse. I heard more times than not from my instructors: "If you can intubate the mannequin, you can intubate a live baby."

That's a lie. The first time I ever stuck a blade into a (deceased unfortunately) babys' mouth, I was amazed at how much it wasn't like a mannequin. Just the feel, how you had to manipulate the blade, everything. My first adult intubation was an elderly female who went into cardiac arrest. Her trachea was so screwed up from numerous throat surgeries that it didn't even look like a trachea. The vocal cords didn't look like cords; hell, there wasn't any white to be seen really. The occasional little sliver, but it looked like a brown crescent moon.

What needs to happen is EMS instructors need to try and create as many real world scenarios that they can. If that means taking an endotracheal tube, cutting it so it fits in the airway and looks like the throat is swelling. Yes, I know that they make Sim-Mans', but here is the price break down:

Sim-Man: 27,395.00$
ACLS Scenarios: 4,194.00$
The Peripheral Kit that makes it do all it does: 7,495.00$
The Compressor to make it breathe, swell, and bleed: 3,300.00$

Now, if you are a little stand alone community college, there's no way you can even pretend to pay for the Sim-Man, let alone anything else including mantience. Also, having used a Sim-Man before, it is realistic to a point. You still have the perfect Mallampati once you get through the trismus and ecchymosis. The swelling is so overdone that it doesn't even look real anymore and when the "swelling" goes down, it abates completely within moments and intubation is easy.

In closing, while the lack of OR time is not to blame for the lack of success of Intubation, the lack of "live practice patients" is. Paramedics and Paramedic Students need face time with real body parts in various states of trauma and disrepair. At the fire scene is not the time to see first hand just how bad airway burns can get.

Most of all, on scene is not the time to realize that your instructors were wrong, that intubating the baby mannequin is not like a real baby.

This goes out to the students and practicing Medics: Do what you need to do to learn how to intubate. Don't leave it up to your instructors, or feel as if you know everything there is to know. YOU are the only thing standing between a good, open airway, or a dead patient. Ask questions, find classes, whatever you have to do.

Instructors: Don't lie to your students. You may think you are making them more comfortable and easing their fears of screwing up, but in reality, you are placing bad ideas in their head. If you say it's easy, then those who screw up will give up too easily, and those who manage to get a tube will think that all tubes will be that easy. Be creative and do something to challenge your students in the airway portion of the class; you already make up fun and bizzare rhythm combinations for ACLS, and make PALS seem fun with how you mix up scenarios and present it.

Airway isn't the module to skimp on. Airway is not just about shoving things in peoples' mouths and noses and hoping for the best. It's about being competent and good at what you're doing.

Have Fun and Be Safe.


Friday, July 9, 2010

So, in my daily parusal of the various blogs, I came across Ambulance Drivers' blog, and an article he wrote for I'll wait right here, I promise.

Ready? Okay!

So, this topic has definately struck a (good) nerve with me. I will always be the first person to say that I don't have all the facts, but my opinion would be (insert opinion here). In the case of the PA Medics. I was in Pennsylvania during the snow storms, actually in Pittsburgh visiting family. We got easily 24 inches in about twelve hours, if not more in a shorter time. Heavy Snow Plow trucks and Salt trucks were stuck all across the city. I personally watched an ambulance attempt to get up a hill and continually slide down.

Now, for those Medics. First off, I do not condone leaving the scene of someone who is calling for help. In this instance though, I can see it and would've probably done the same. You have Medics who need to respond all across the city. Pittsburgh roads in many places are still made out of cobblestone and bricks, so even using drop chains won't help. Trying to extricate the victim out would've been another challenge. Sure, you could've used the Reeves stretcher like a sled, but now you could cause an even worse injury to the patient if the providers fell ontop of them. Asking the patient to meet them half way isn't irresponsible either. I would not have taken a stretcher up there...that's just asking for it to tip over.

All in all, while the comments over the radio were poor form, the medics in Pgh did the best they could in the disaster that occured.

On the other side of the coin, we don't see the good that happened. I don't think anyone heard about the other EMS crew in a Pittsburgh Suburb that, after wrecking their ambulance trying to get a patient to the hospital in the same blizzard, hopped out of the truck with their various broken bones and injuries, and carried the patient up the hill to the trauma center they were trying to go to.

Now that's dedication.

It's true, EMT's eat their own kind.

As I posted before about the death of my C-1. I was the head Medic on that call. We had several different departments from the area there trying to help out with the other patients and mine. The stuff that was said about my crew and myself after the call was abhorrent. I am trying to intubate, laying on my stomach on a completely dark bridge. The Fire Department didn't have the scene lights up yet, and all I have to see with is the little light at the end of my blade. One of the cops on scene refused to shine his MagLight in our direction for a few moments so we could get our job done, insistant on standing a few feet away smoking a cigarette.

Somehow in the confusion, the tube tamer got out of my reach, so I did what any self respecting medic would do; I held onto the tube in my bare hand while I sent someone to the truck for a new one.

The flack I heard for the months following drove two of my partners from EMS. We heard things like: It's their fault, you know. That Medic didn't have a tube tamer, and that killed 'em or That's what happens when you let a girl on the truck or my favorite one If I would've been there, I woulda saved him. Other comments about what drugs we did and didn't use, or the caliber of the training we had or didn't have, or how gender played a role in the outcome ran rampant through the EMS world.

We were all punished and admonished by our own, fellow crew members. I had to have another Medic ride with me for a few weeks afterwards because those in power weren't sure if I was "able to perform the functions of being a fully functional Paramedic." I had random members of the department show up on calls, and I even had calls jumped and taken away from me because of my "poor performance on an EMS call." When asked about my performance and what was poor, the answer given to me was, "Well, if you can't save a life, then you can't be a Medic."

Yeah, talk about a swift kick to the pretend balls.

So, long story short; Be nice to your fellow EMT's and Medics. Unless you were there, you don't know the full story. Good article, AD!

Now, I'm off to go fishing! Power Bait for everyone!

~M. Trommashere~

Wednesday, July 7, 2010

Reply to Comments!

Medic 3: First of all, thanks for joining in on a good topic. I wasn't trying to say that Rogue Medic wanted to take it away, I was speaking about a certain part in his article that sparked my interest and I wanted to write about my own experiences. I'm all for taking it away from incompetent medics, hell, I watched a flight medic intubate a womans' stomach and proceded to try and ventillate her that way for the next three minutes until someone higher trained than I that he'd listen to stepped in and told him he FUBAR'd.

You are correct. Incompetent or "bad" medics are just asked to go back through non hands' on classes, or put back to something we at home called 'Mother-May-I?' status where we'd have to call our command doc to do anything other than BLS skills. Neither one of those solves the problem though. How is it going to change how I do my IV/Intubation/whatever ALS skill I want to do? Sure, I'll be using my ALS powers responsibly because I have a doctor telling me when and when not to do something, but it's not going to change the mechanics. The doctor isn't there to hold my hand and show me what I'm doing wrong to facilitate a good intubation.

Back home they also looked at the use of an "alternate" airway as a failed intubation. Per our protocols, unless you use CPAP, the other airways are considered a last ditch effort. On the computerized trip sheets, the only way you can show that you used something other than intubation is if you state that you had an unsuccessful intubation. I know of a medic who actually got dropped back to "Mother May I" status instead of "Full Orders" because he didn't have a single intubation on the year, but because the reporting forms show a bunch of "missed" intubations, he was dropped down.

I completely agree with you, Medic 3. I had a positive tube, all my little doo-dads showed positive, I saw it go through the cords, positive lung sounds with re-checks every 3-5 minutes due to poor road conditions. We get to the ER, and I watch as they (roughly) pick up the patient and nearly drop him back onto the gurney, then they grab the tube tamer I used and switched it out, then put him on the ventillator, took X-rays, THEN and only then did they check lung sounds and lo and behold, it was right mainstem. Did they get screwed for not reassessing, no. I got dinged because I had a bad tube.

Unfortunately it seems as if there are only "bad" medics in the profession. No one, sometimes not even our own services, recognizes "good" medics. All you ever hear about is how a medic "didn't provide quality care" or "gave the wrong medication" or "didn't treat a patient well". Even Medics who did the right thing by breaking protocol because their patient didn't fit into a neat little set of rules gets railroaded because they, in the opinion of those around them, "did the wrong thing." no matter the outcome.

And yes, with multiple patients, we are nothing but a "Cabulance".

Thanks for writing. Your comments were awesome!

Have fun and Be safe

~M. Trommashere~

Sunday, July 4, 2010


I saw this, and I just had to comment on it. Read and their article on the Mass. EMT's who are upset that they got suspended.

Kim is a state emergency technician. She's been suspended for nine months for allegedly falsifying certification class attendance. She says if she broke the law, she should be punished. "But a nine-month suspension? I've lost my job and my health insurance. I don't now what I am going to do," said Kim

Are you serious?!

You should've thought about that BEFORE you lied about your recerts and possibly paid off someone to get the job done! You should've thought about that when you put patients' lives in jeopardy by not taking your recert classes. What would've happened if in your recert class, they stated that Atropine is now seen to work better if given in a 3mg dose over ten minutes, versus 1mg over 3-5 minutes. Now you go ahead and kill someone because you have no clue what you're doing. What would you say for yourself? Oh wait, you already did that for me!

Quote: She said the harsh punishment of EMTs is unfair, especially because she believes the refresher courses they're required to take have no bearing on competence and knowledge.

"The refresher course just repeats everything. We didn't put you at harm," Kim said.

You don't know if it's "all the same stuff."! Then, a part time Paramedic, who should be watching his ass even closer came in with:

Quote: Terry Urekew is a part-time paramedic who was not on the penalty list, but she believes the state has done an injustice to her colleagues.

"So if it's fraud, slap them. Give everyone a $100 fine and community service," said Urekew. "Don't take someone's livelihood away from something that has no impact on whether or not we are better EMTs," she said.

This moron is why they want to take tubes away from us! Refresher Classes don't have an impact on whether or not you're a better EMT?! I'm guessing the Queen of England came to you and while using the Gilded #4 Macintosh Blade, knighted you and made you God! You must know everything about EMS. Yes, CPR involves you pushing on someones' chest and breathing for them, but without your refresher, you wouldn't know that the compression rate changed from 15:2 to 30:2! Without your ALS refresher, you wouldn't know the new drug dosages, or if the drug had a new delivery system or not.

Both of you, Terry and Kim, need to be ashamed of yourselves! You call yourselves professionals! You call yourselves devoted to your craft, and what do you go and do? You screw the pooch so bad its' still squeeling! Did you not stop and think about what your actions could do and would do? Then you try and say that the heads of your EMS system are forcing your co-workers to work longer hours. No, YOU are the one who has forced them to do it!

"Do you want me working on your mother who is having a heart attack in hour 87 of my 90 hour week?" said Urekew. "Do you want that? That's what you are going to get. There are not enough people to fill the gaps," she said.

I'd rather you be doing it that way because you've worked your balls off all week, attended your correct classes, and had to do it this way, not well rested but as dumb as a box of fly shit.

If it were up to me, all 200 of you would be fired. Not suspended, fired! You both deserve to lose your jobs and your certs and never be allowed to play EMT/Paramedic anywhere in the world again. They should fire the whole lot of you. Doctors who forge paperwork lose their licenses, the same should happen to you.

If the whole system ends up changing for the worst, boys and girls, you know exactly who to thank.

Saturday, July 3, 2010

Reply to comments!

Lizzie: Parents do that, that's why you see more and more kiddie shoes with velcro ties instead of laces. The bigwigs will never get the clue because we as a profession don't stand up for ourselves. In the grand scheme of things, we're the kid wearing the suspenders and the pocket protector trying to try out for the All-Star football team (or Futbol for those over the pond)

New EMT's and Medics feel that they don't have to try. Things are constantly being dumbed down for us. Take the advent of the new airway adjuncts; the LMA, King LT, Combi-Tube, and so on. Their marketing ploy: "So easy a trained monkey can do it." Everything is being made idiot proof. The standard is being lowered to meet the needs of people who shouldn't have been allowed to pass medic class in the first place.

Why can't we as a profession stand up for ourselves and raise the bar. We need to quit allowing ourselves to be "dumbed down." Doctors and Nurses fight like hell the minute one of their skills are taken away no matter how little they use it. When we went through our trial separation from the ET tubes, I remember sitting in the meeting with other members of other services and my own. Everyone groaned and complained about it, but the minute they whipped out the new, shiny toys (Combi-Tubes and the King LT's) everyone was okay with it!

The premise of those adjuncts promotes irresponsibility in managing the advanced airway as well. "Oh, it's okay if you jam this tube in the esophagus, you'll still put air in their stomache and bloat it up, but this ballon here will keep them from throwing up..." We were taught that putting any tube in the esophagus outside of a gastic tube was a bad thing, now you're telling me it's okay to do that?

It's a never ending cycle, but until we stand up for ourselves, we'll just have to keep taking the hits against us.

Big Boys taking our toys

So I was reading an article/blog written by Rogue Medic. If you haven't checked him out, you should. He's incredible! Some of the things he writes about are just fantastic. He brings an interesting spin to the EMS Table. Anywho, he posted about Customer Service in the EMS application. (Here's the link:

What struck me was about the idea that intubation success was not taken seriously, and he sited various examples. I agreed with his entire article, but the comment about taking away of the tubes struck a nerve. I was from a state that tried it for a while and failed miserably, so here's my retort for that particular side of the coin:

The taking away of the "ALS" Airway like Endotracheal Intubation is a double edged sword. Yes, there are a lot of medics out there who suck at it because it's not a skill that is done often enough to gain proficiency. The problem is, there's nothing in place to allow us to get better at it.

Flight Medics, Nurses, Doctors, what have you, are given the opportunity, and in some companies, are required to go in hospital every month to obtain ten intubations. The state I used to live in required all Flight Medics and Flight Nurses to go in hospital and get 10 tubes either in the ER or the OR.

Now try to call a hospital and get in to their ER or OR to "steal" tubes away from the interns, residents, and Flight Providers, you may get shot on site.

Medics have a hard enough time while precepting getting ER/OR time in when they have to, let alone any other time.

The mentality of, if-they-don't-do-it-let's-take-it-away won't work. Think for a moment about your drug box and all the other little Para-toys we have in our scope of practice.

You know that Hare Traction splint? We hardly use it, so since we don't that means we're not proficient in it, so let's get rid of it.

OB Kits? That's what hospitals are for. Since EMT's and Medics don't deliver them on a regular basis, let's trash those as well.

Needle Decompression/Needle Crich Kits? Nope, just taking up space. Trash that.

Drug wise? Well, Dopamine, Dobuatime, those clumsy Mark 1 (or whatever addition your on) kits, Versed (for those services that carry other drugs that can stop seizures)...the list goes on and on. If our ambulances were subject to usage reviews, at the end of a year, we'd have no equipment!

You take away intubation and you add another "mindless" airway adjunct, fine. You're still going to run into the same problem; lack of usage.

Also, when the docs sit around in their Fat Cat Pow-wow and decide which toys they're going to take away because of failed usage, they just look at numbers. They don't look at Paramedic Smith who was trying to intubate a kid while upside down, in a ditch, in the dark, at 3 am while generators were going, and all he could see by was the little bulb at the end of his blade. They don't look at Paramedic Johnson who was trying to intubate a smoke inhalation victim whos' airway was swelling shut because his service took away the expensive TTJ's and needle cric. equipment for "lack of use". All they see is a missed intubation.

Where is our hands on, remedial training? I'd love to be able to go in to the ER/OR once a month, hell, once every three months and get to practice. I got kicked out of OR's while precepting for my Medic because I wasn't a nursing student/person who wears flight suits to work/person who wears a lab coat to work.

If this mentality continues, we can expect to go backwards in time, back to when we were throwing someone in back and hopping up front.

I'm not throwing a temper tantrum because they want to take *my* tubes away, I'm pissed off they want to take my ability to save lives in an effective manner away. Why don't we take something away from the IV's. Doctors turf that out to Nurses and IV Tech's and lowly Interns. When was the last time you saw a full fledged doctor do an IV on someone besides a cut down or a femeral stick? I bet if someone stood up and said they wanted to take IV's away from doctors, we'd have a herd of stampeeding white coated Angrius Doctoriis and the creation of "IV Remediation" classes would begin.

I ask all medics and other Pre-Hospital providers who can make someone chew plastic, to stand up for your right to do it. If you let them take tubes away, what else are they going to take away from you?

Friday, July 2, 2010

Why did I pay 150$ for this Part Deux.

So. As everyone knows, I am going through trying to get my state changed from one to another. After being told it was a cake-walk, it became a nightmare. Here's an update on the situation.

Before I left my former state, I had a problem. My command physician left the country for a month...the same month I had to turn in my NR renewal forms. No command physician signature ment no Renewal. I called the main office of the NR and I explained my situation; how my command physician would not be back before I was going to move to a new state and that once I left my job, I could no longer use that physician on my paperwork. The wonderful human being on the other end of the line stated that, because all my con-ed hours were done and that everything else was ready, I had two years to get a command physician signature before I would have to take the written test all over again.

That sounded too good to be true, so I asked to speak with a supervisor. They stated that, yes, I had 2 years before I could be considered inactive and lose my registry status. I told them that, by the middle of July I would have my registry paperwork in and I'd be good to go.

Flash forward two months.

I go online, log into the Registry website, and I notice that, in the corner of the sign in screen, it tells you your name, your level, and your registry number. All I saw was my name. Nothing was in my con-ed files or anything. It was blank.

I call the Registry and this is the exact conversation that was had.

"Hi, I'm M. Trommashere. I can't find my information on your website and it says to call you, what's going on?"

"Oh, can you give me your NR number."


"Okay, Ms. Trommashere. You are not a Nationally Registered Paramedic anymore."

" *long pause*...excuse me?"

"Yes ma'am. It says your registry expired on May 31st of this year, and you had a built in 15 day extension which passed, so therefore you have been dropped from the Nationally Registered Rolls."

"But your staff told me...*insert story here*"

"Correct, but you failed to get everything in by June 15th, so now you need to take a 48 hour National Registry Refresher Class, a new ACLS Class, PALS class, and CPR class. You also need to meet the other con-ed hours needed by your new state, then you must take a Practical Exam, then a written exam."

"Wait. Flag on the play. You expect me to do over one hundred con-ed hours that I have to pay for out of pocket, pay for a brand new ACLS and PALS class..."

"It has to be the actual class, not the refresher, the two day one..."

"A new CPR class which, by the way, if I can't do CPR by now, I'm giving my damn card to the dog. Then you want me to pay another 100$ plus travel expenses for a practical exam AND 150$ for a written exam. Lady, what are you smoking, because I want some."

"Well, that's why you have a job..."

I lost it. I'm sorry, God for losing my religion.

"I DON'T have a job because your bass friggin ackwards system has kept me from getting a job. I can't get a job in a Nationally Registered State until I have my NR numbers. You said I could use my numbers for two years until I got a command doc to sign it, but I can't have a command doc unless I can apply for a job, but I can't apply for a job with an expired NREMT card!"

"It's not my fault your card expired. We don't even know if you're a real Paramedic or not, so you have to take the tests."

"Why? Because I didn't hand you another grand of my money by taking the more expensive 'NR Accredited' classes?!"

"There's no reason to get upset..."

"Fine. Let me speak to your supervisor..."

" *dial tone* "

I know, first things' first, I never should've let my NREMT expire in the first place. It had taken me a while to build my refresher, and I was an hour short up until about a month before it expired, and even then, I had so much trouble TRYING to pin my command doc down to even sign the paperwork before she left that, when she skipped town I wanted to commit homicide, but back to the story.

She hung up on me. I had never been so angry at anyone before. The prospect of having to go back and do six months or more of work just to get my NR back made me physically ill. Since I live in a NR state, I have to have it to work. I sat down to a glass of wine and I went back to my phone call. I called back, and I got on with a supervisor. I calmly explained that I didn't want to play this game anymore, and that all I wanted was to be able to turn my paperwork in. The supervisor agreed that what I was dealing with was bull, and that the nerf herders in his office should've directed me to the paperwork to go inactive, which would have kept me from losing my damn mind. I now have until the end of July to get my things in order.

The fact of the matter is, the NR sucks! It's a big, money making scheme that forces hardworking EMT's and Paramedics to play FiFi the Circus Dog to keep their lively hoods. I can only imagine people in states who don't have easy access to a con-ed class, kind of like where I am now. Con-Ed is so few and far between that it's standing room only for their ACLS and PALS classes, not to mention any other "fun" classes. I think that, if I only need my NR just to get the job, and I don't need it to keep it, I'm not going to. I'm tired of feeding the beast.

I'm done.

~M. Trommashere~
@Faking Patience: Another name I love. That describes me in the back of an ambulance at 2 am with a patient with a stubbed toe who wants to go to a Trauma Center. As always, I am firmly against the senseless abuse of a corpse that is an EMT/Paramedic after dealing with the National Registry. They need to get to a trauma center fast to get their crainio-rectal inversion fixed before it becomes a permanent (read: terminal) condition. Their (physical) inadequacies will be their downfall. I am glad you have succeeded in getting everything switched over in an easy manner.

@TOTWTYTR: Thank you! I am glad someone can find a bit of humor in what I write. If he wants it, he can use and abuse it all he wants! I'm honored that I am getting such feedback from people who are such prolific EMS writers. I love you blog, I'm in love with AD's's a win win situation! I'm sure as the days continue, I'll have more to complain about when it comes to the registry, so hopefully you keep tuning in and enjoying it.

Once again, thank you everyone for your comments. I love reading them, responding to them, and just knowing that my posts are making people happy. My goal in life is to make people laugh, make them happy, and above all else, make you think.

Have Fun and Be Safe.

~M. Trommashere~

Wednesday, June 30, 2010

Confidence can kill.

Here's a life lesson I learned a year or so ago. I'm hoping everyone from a rookie to someone so seasoned they can cause hypertension just by looking at them.

I consider myself to be physically fit and damn lucky. Working in the rougher neighborhoods has toughened me up over the years. So has taking over a decades' worth of martial arts. First patient v. provider fight I got into involved me trying to calm down an irate family member after my partner had just pronounced them dead. The family member picked up a stool and went to show my partner that he was more than willing to "shove it somewhere". I reacted immediately for fear of my partners' life. I was sure that, if the guy had gotten her on the ground that it would've been over for her in a heartbeat. Why the cops left us alone; two providers versus ten freaking out family members were not odds we wanted in any situation. It was during the hasty retreat to the truck that the family decided that we were the best target to exact their anger on.

A set of bloody knuckles later, the cops were back on scene and I was checking my pulse to make sure I was still alive. I had never gotten into fights in school, so physical violence between myself and someone else was completely foreign.

After that, I felt slightly invisible. I knew I could handle myself no matter what happened. If a patient felt froggy, I'd sure as anything jump with them. I never went looking for the fight, but I was ready and willing when it came.

I was also told I had a way with psych patients. Even the most suicidal/homicidal patients were calmed and persuaded to get in the truck and calmly going to the hospital. That above anything else made me feel...well...invincible.

Jump forward a few years. I was working the late shift when a call came in for an assault at a nursing home. We arrived on scene to find out that a patient had assaulted another patient, and was now holed up in his room. The police were called, but they never showed. My partner at the time was not what someone would consider to be kind. He had an attitude the size of Kansas and the chip on his shoulder was even bigger. Top it all off with getting slammed all shift left me with one pissed off partner.

My partner swaggers into the room and within moments was running back out. The patient was getting violent and was talking about another assault if we didn't leave. Second phone call for the police were made and I then phoned in for backup. I knew that, at that moment, there were three very large men sitting at the station who were more than willing to help me make the patient more compliant. I had already gone ahead and gotten orders for chemical restraints, but if you thought I was going after the patient with a syringe full of Versed, you're crazier than you look.

In comes backup. The plan was to go in, grab the nearest body part and hold it down, while leaving me a fleshy piece of thigh in which to inject the Versed. Then, we'd all leave the room and wait for the med to kick in, then we'd put him on the stretcher and get him out of there.

Simple, right? I've seen train wrecks go better than this.

We all enter the room, trying to look non threatening. We explained to the patient that he was either going to come with us peacefully, or he was going to be given medicine that would make him come peacefully. After he verbally announced that he was unsure if both of my partners' parents were human, the guys held him down. As he was held down, he decided to question my heritage and called me more racial terms than I had the pleasure of hearing throughout my life. I nodded with him, making quips as he talked.

"Yeah, yeah, I know, you think my mother had carnal relations with a dog; No, I do know who my father is, no, my mother is not a female dog..."

And so on.

After we were done, I stood up and clicked up the sharps guard on the needle. Then I did something I had never done until then and have never done since.

I turned my back on a psychotic, violent patient.

Everyone else was filing out of the room, their backs to me. I turned around to my partners and said, "Okay, let's give it 5 minutes and we'll come back in."

Well, all I got out was, "Okay...*URGH!*"

The patient came up off his bed, grabbed me by the ponytail and dashed my head against a concrete wall so hard the paint chipped off, I was knocked out immediately, and as my partners told me afterwards that it sounded like a Watermelon had been thrown at the wall at over fifty miles an hour.

From what I was told, my body immediately seized up, then went limp. I woke up long enough to feel myself being choked by the patient as he began to bite my ear and neck while everyone else was jumping on him, trying to pull him off of me, or me out of his arms.

Being unconcious was weird. I could hear the occasional snippet of conversation, but it was distorted and off. Next thing I knew, I was lying on the floor, looking up at the lights on the ceiling. I know I got up, brushed myself off, and told everyone I was fine, but I felt off. I turned my head left, yet I felt like I was going right. I sat down, but I felt like I had stood up. I figure since I wasn't dropped off at the hospital initally, I convinced them. I remember driving back to the station in the front of the ambulance, but next thing I knew, I was laying in the back, on the stretcher, being looked over by everyone who was there.

One Trauma Room trip later, I discovered I had a severe concussion and BPV (Benign positional vertigo). The doctor believes I got my head cracked so hard that one of the calcium "stones" on the hairs in my cochlear cannals got knocked loose and are now bouncing around in my balance centers of my brain...on both sides. I am now on Antivert for the rest of my life and I don't go anywhere without a bottle of Dimenhyramine with me as well.

I screwed up that day. I was over confident in myself and I let my guard down. I preach scene safety and safe practices on the ambulance all the time. I'm the one smacking the rookie EMT upside his/her head when they charge into a violent scene without looking around and seeing their surroundings.

Please, please, PLEASE! Don't ever do this. If I was alone, say my partner went to the truck for something, or it was just the two of us, I could've been strangled to death, or had an even more severe head injury than I do now. Take this lesson from me, boys and girls; don't ever let your guard down. The one time you do may be all it takes to make it your last call.

Be safe out there, please.

Tuesday, June 29, 2010

Letter to the Engineers

Warning: One of the pictures below is NSFW (Not Safe For Work). It's a girl in a bikini. So, there you go, you were warned.

To the Designers/Engineers who have created MedTech, Wheeled Coach, International, Pierce, American LeFrance and other Ambulance/Fire Engine manufactures:

Hello! My name is Medic Trommashere. I have been riding around in your lovely vehicles for almost a decade now, and as a devoted user, I figured I could offer some friendly advice from a real life consumer.

Firstly, contrary to popular belief, your target demographic does not look like this:

Or this:

Or even this:

We come in various body sizes, especially height. Now. I am not exactly model height, hell, I still get called Munchkin, but it can get a little complicated trying to climb into the back of an Ambulance where the little tail step of the truck is nearly eye level with my chest. I am not saying there is anything wrong with your wonderful products, but a little consideration to those less fortunate with height would be a great thing. Either an extra step or some good rock climbing equipment would be great...jus' sayin'.

Also, to facilitate easier movement within the ambulance, a larger opening between the cab and the box would be great. I find that to be a good escape route when my, "he's so quiet, he wouldn't hurt a fly..." psych patient decides to rip off the arm rest on the Stryker stretcher and tries to bludgeon me with it, calling himself "The Caveman" and wants to take his bride back to the cave. Some days, my size 16 hips won't fit through the aptly named 'birth canal' with a radio, Leatherman holster, and Trauma Shears (The pink kind)strapped to my belt.

Lastly, can we get some more padding on those lovely corners of cabinets? I'm not sure how you test to see what happens when an appendage (usually the Occipital lobe or the not-so-funny end of the humerous) slam into one of those corners after a car decides to stop within three feet of the front of the ambulance while we're coding at a safe velocity (Read: So much faster than the posted speed limit that if my boss ever found out, he'd rehire me just to fire me for how fast we were going). I got a black eye so bad one time, the hospital we arrived at thought I had gotten beaten up by the patient. Those corners hurt like there's no tomorrow. So, I would like to recommend the following adjustments.


Or this:

Just because we like Traumatic Injuries doesn't mean we want to have one.

All in all, I have no complaints about your wonderful products. They get me from point A to point B REALLY fast and I get to look cool doing it. Thank you for your hard work and dedication to your craft.

M. Trommashere.

PS: gotta really work on that electrical system issue...having the entire box of the ambulance turn off including the main board suction while I'm using it really bites.

PPS: American LeFrance and Pierce; Big props for the little steps you can fold down so short people like me can get up in the hose bed or just get stuff from up high.

Have Fun and Be Safe!

Monday, June 28, 2010

Yay! Comments!

Side note: I am and will address comments in a post fashion. I want to be able to bring attention to the comments/questions, and be able to give a well thought out and appropriate answer/response. Keep the comments coming! Thank you!

Murphquake: I looked into going to NYC before I moved where I did. They do not honor the NREMT other than not making you go through your Paramedic class. I would have had to take a 3 month program, then jump through even more hoops just to possibly get a job there. The sad part is, at least the way it was described to me by your EMS council, was that after I took all those classes, I'd have to live in NY for at least 3 months before I could apply for a job. Needless to say, I wasn't going to move somewhere where, even after jumping through the hoops, I wasn't guarenteed employment. Homie don't play that game.

The Happy Medic: Tell AD I said hello and thank you for stopping by. I have to agree with you, but at the same time, the NR sucks people in by telling them that this craziness won't happen if they take the test. I probably still would have gotten my NR in any case...don't feel like going through medic class again, but I would have been better prepared if I would've known what each state requires past the NR. A lot of people in my class have experienced the same thing. In the state where I'm from, you don't need the NR; you have to take it just out of Medic School to satisfy being accredited through the NR, but you don't have to stay NR to work. Most other states, except Ohio, which is where the NR is based out of, make you take a crap ton of exams and other tests/interviews even before anything else happens.

Lizzie: As far as my research has shown, most states accept the registry, but still make you go through classes/tests before you can practice. Some locations have border state resciprocity that would allow you to transfer over just because of the state you lived in. Problem with that is, it usually comes down to the bordering counties, the ones that touch the other state directly. Ohio is one of the states that I can speak of because of direct knowledge, that transfers the NR easily. You take a simple protocol test; they have some drugs that most states don't, and that's it. West Virginia is another one. I could've moved to WV and all I had to do was sign on with a service, send in a form asking for WV numbers, and within a few days, would've been a WV Medic, few questions asked.

All in all, the system as a whole is flawed. I believe that, for a state to say they conform to the NR, they should grant licensure/certification with minimal hoops to jump through. I am understanding of a protocol exam; not knocking that from ANY state. I can even see a skills review. Coming from a state that does not allow surgical crichothyroidotomies, moving to one that does, I am understanding of sitting down with a Command Physician to show them that I am proficient in that skill.

But telling a Paramedic who has worked their ass off for a year, in upwards of three or four, that to even apply for a job, they have to jump through more hoops than Shamu at Sea World is ridiculous. If the NR is to continue, I believe they need to mandate some serious changes across the board. My thought is; if you as a state want to continue to be in the NR, then they must create a written protocol test and/or a practical exam, and that is the only test used for incomming medics and EMT's. If not, then they can do all the frivolous testing they want, but they can't require someone to be Nationally Registered if they are not going to accept it for all it's worth.

Thank you everyone for your comments! I believe that, the only way to make positive changes in our chosen profession is to have dialogues like this, to fuel ideas and create new ones. I'm glad you all have stopped by my little slice of paradise, and I can't wait to hear more from you! You guys were wonderful! Thank you to Lizzie, The Happy Medic, and Murphquake for your wonderful comments!

Have fun and Be Safe!

Why did I spend 150$ on this?

Before I became a Paramedic, I heard about this little thing called the National Registry of Emergency Medical Technicians. My state had just recently adopted their standards, and from everything I heard, it was great! If you moved, you could practice your EMT and Paramedic skills without going through another states' program, or jumping through hoops. All you had to do was show your shiny NREMT card and you were in. It was like holding the golden ticket of epic proportions.

Flash forward about eight years.

I am sitting in my new state of residence, waiting to go through a protocol class...a state exam...a con-ed update...ALS Skills Review...and a four to six week long Paramedic school.

I learned all of these drugs with their respective dosages in my Paramedic Class. I can do everything they can do...because I've been playing Paramedic for a while. I've only been out of service for a month or so...AND I have my little NREMT card! I'm in a bordering state, and I was told that resciprocity would be easy. Sign a piece of paper, flash my card like a cop badge, and I'd be legal.

They were wrong.

I spent 150$ on a test that caused considerable anxitey that I thought would be a good thing to have because I had planned on moving years ago when I took this class. The only thing it did was keep me from having to go through EMT and Paramedic school all over again. At this point, I have at least three months until I can play Paramedic again. Until then, I fortunately found a little service who was willing to take a homeless Paramedic in and let her run as a crew assistant. I get to fetch stretchers and play gopher for the other EMT's and Medics on the truck.

I was depending on the ease of transferability to get a job. I wasn't able to start the resciprocity until I was affiliated with a service, but I had to wait until I was here to start the hiring process. I was told repeatedly by the state that the whole process shouldn't take more than two weeks. The minute I get here, that's when I find out about all the hoops I have to jump through.

After doing some research, I found out that over 40 states require you to go through "refresher classes", which is code word for paramedic school, over time periods as short as 3 weeks, to as long as 14. On top of that, you have to jump through other hoops that the local heads of the EMS departments have in mind. Some require you to take multiple con-ed hours in addition to other classes.

What was the whole point of getting my NREMT if it doesn't transfer over easily. I understand doing the Hey, we want to make sure you actually know the difference between a nasal cannula and a non-rebreather mask class, but seriously...40+ hours of classes to get the job?

I'd do it no matter what...which is why I'm going through the craziness, but I'm lucky to be able to. Getting the job is hard enough, but getting to the promised land only to be told that you have to wait to pull a paycheck until you get through with three months of classes is just ridiculous.

I am so furious right now, I can't see straight. Every time I turn around, a new hurdle pops up. Part of me would rather go back through their Paramedic class than sit here and wait and pray that my resciprocity comes through soon.

Pissed off in Medic Land...

Sunday, June 27, 2010

In Honor.

Yesterday in Colorado Springs, Colorado, new names were added to the EMS Memorial. At 7 pm, there was a moment of silence that I especially partook in this year, and had a great cry about it. While I would mourn the loss of any EMS provider, Fire Fighter, or Police Officer, this year was especially hard on me.

I knew one of the people who were being added.

He was my supervisor, a great man who built a service around volunteering. Even though the service began to pay some of their employees, many there stayed as volunteers for the good of the area. The area was one that outsiders drove past quickly with their windows up, doors locked, and eyes on the road ahead without even offering a glance to the city. Other EMS services would hesitantly come in, not even wanting to get out of the truck at night because of how bad it was and had gotten.

He held "First, do no harm..." near and dear to him. He attended every con-ed class he could, and if con-ed hours rolled over like cell phone minutes, he would never have had to take another con-ed hour for the rest of his life.

His life ended suddenly while on a call. His own service and many others; the ones who couldn't be bothered to come in on any other call answered the call that night on that roadway. All in all, twenty pairs of hands touched him, waging their war against the inevitable. A set of Flight Nurses and Flight Medics were called in, and they used their quick response vehicle to arrive at the scene, trying to lend a hand.

He was taken by his own company, his own hand picked crew that he spent months, if not years getting to know. In the hospital, the efforts continued, Medics, EMT's, Nurses and Doctors fighting together. 110% was given, if not more. Drugs were pushed, chests were compressed, everything was done and then some. No one wanted to stop, but we all knew what the outcome was going to be. The doctor ended the code at 2213, after his family, both by blood and by profession had gathered. That dark night, the world slowed for a moment, then continued its lazy orbit.

That world was changed for forever in that moment. A great man had fallen.

The next days for that service were filled with anguish. The service never stopped rolling. The crew that only moments before had worked feverishly on their comrade, answered the next call in his memory. The minute the tones went off, the doors to the bay went up and the big, white box went out the door. Other services volunteered their time and staff, helping to keep the station staffed so that the crew could go to the viewings.

The community pulled together. Honor guards were present at every moment. Those who knew him barely left the funeral home. The crew who worked him held the hollow look of a survivor of something so devastating. Most of them stood guard at the casket, tears streaming down their faces as they stood at attention.

The funeral was a rainy, cold day. The four on the crew were secluded in their own corner, trying to keep their emotions in check. The funeral went on, not a dry eye in the place. The ride to the cemetary was full of ambulances, fire engines, and police cars, all with their lights on, all with their sirens on in a final salute. They rode, sending their brother to the other side in a fitting tribute to the great man that his newest ambulance carried.

The bagpipes blew at the gravesite, the twenty one gun salute piercing the ears and minds of those present. Not a dry eye was to be had the entire time. How do I know all this, you ask?

I. was. there.

I was one of those four who worked on him in the dead of night. I was the crew cheif, the supervisor of the day. I had just talked to my supervisor two hours before after he stopped up at the station to check on his "babies". We exchanged pleasentries, and as he was leaving, he thanked me for all I was doing for the company. He shook my hand and departed. The next time I saw him, I was working on him.

I couldn't function. I broke my own rule about not drinking alcohol when stuff went bad. My crew and I hit a bar that catered specifically to those in public safety, having odd hours at which they opened. We sat around a table, haunted looks on our faces. I went straight for the hard stuff, Johnnie Walker Black Label. I rolled the ice around in my glass, my eyes foggy. We didn't talk to each other, we felt as if there was nothing to say.

Other providers from all sectors of public safety including in hospital workers came trickling in. They would glance over in our direction and nod silently. News traveled fast, especially since it was all over the 5, 6, and 7am morning news. Some came over and spoke in hushed tones, others just nodded in our direction. The death was the talk of the county by that point; everyone knew about it.

The bartender, Zac, came over as the news came on, showing our faces as we walked from our station. The caption read that we were the ones who worked on our boss. Silently, he went back to the bar, pulled down the bottle of Johnnie Walker Blue Label and came over, pouring each of us around.

"On the house, guys. Looks like you had a bad night."

We all looked at our glasses and raisied them.

"To C-1. God Speed my friend." I said quietly.

"To C-1.." Came the reply.

We all drank in silence.


To C-1, God Speed my friend. You were the best boss a girl could ask for. I was honored that I had the opportunity to work side by side with you. God Speed, my frend

"His master replied, 'Well done, good and faithful servant! You have been faithful with a few things; I will put you in charge of many things. Come and share your master's happiness!'

(Matthew 25:21)

Saturday, June 26, 2010

Way back when....

Someone asked me today why I started writing a blog. I had thought about putting my experiences on paper, and maybe one day putting an EMS book out there like EMS writing hero's Peter Canning and Steven "Kelly" Grayson. Reading Graysons' work implanted the seed that maybe I could do this. I have funny stories, I have the ones that'll touch your heart, and on more than one occasion, I had brought work home to disasterous results.

To steal a phrase from the Navy, I created my blog to be sort of a "proving ground." If it works, and I get a lot of people saying, "Wow! That's awesome!" Then maybe I'll pick up my quill and actually write some of this stuff down and even put in some new stories, and see if I can get it published.

But that's a ways down the line. Right now, I just hope that you can enjoy the stories and random notes of the blog.

To Grayson and Canning: Thank you for paving the way to allow me to do this. You both have shown me and others like me that even a lowly "Ambulance Driver" can do something great in the Literary world, not just making addendums to Paramedic and EMT text books.

Have fun and Be Safe!

Friday, June 25, 2010

Wow....just wow...

So, I think I made it in this world. I opened up and found this on their blog page:

Yup. I made it!

Better post to come later.

Thursday, June 24, 2010

A sad day in EMS Bloggin History

A friend of mine called me eariler nearly screaming in the phone.


I looked at the phone in the same manner that a dog looks at you while you are discussing with him why he shouldn't be licking his balls in public.

"Before I dose you up with Narcan, slow down and tell me what's going on."

"That really hot english dude we met in B-More who did that webcast thingy and had that cool blog isn't blogging anymore."

I immediately went to his blog and found this:

Yeah. That sucks big eggrolls.

To all who don't know, Mark Glencourse is the other half to a Web Show called 'Chronicles of EMS.' I had the opportunity to chat with him for a few moments at the JEMS Convention in Baltimore. Like any other red blooded American female, I found the accent to be cute, but what I liked more was his drive to pull EMS together all across the world. Coming from an EMS arena where neighboring services want to kill one another, the idea of someone bridging the gap between services across the world was awesome to me in many ways.

To hear that he's leaving definately leaves a hole in the EMS world. As someone on the inside of EMS, I can understand his fears and concerns; with the advent of multi-media communications and the HIPPA monster, everyone has that opportunity to get burnt in many ways.

That's why, with the EMS stories I present, they are just that, stories. I have been through enough crazy shit in my nine years where I can take a cheif complaint, and meld many different scenarios together to make up a good story. I've even gotten comments from people through private e-mail asking me if the exact story happened. My response is: yes and no. I've had psych patients, multiple ones, but my initial psych patient story is a collection, melding, and blending of numerous patients.

Anywho, so to Mark; You are awesome! I am sorry that the proverbial fecal matter slammed into the rotating ocillating device. Have fun with your family, enjoy them. Hopefully one day you can begin blogging again. Until then, Cheers!

Have Fun and Be Safe!

Fun Days are here Again...

So, I got to enjoy several Non-EMS related days. Here's a little snapshot of what I got to enjoy.

Yeah, that's The White Puppy laying on what has to be the most expensive dog bed EVER. He's the same one who will wait until the humans get out of the seat, then firmly affix himself to it. Then, he'll look up at you, just like in the picture, trying to make it so I or anyone else won't harbor any thoughts of homicide.

Got to catch some deer coming through the backyard, and I had a camera on hand. They are beautiful, majestic creatures...especially when prepared in gravy and mushrooms.

Unfortunately, I didn't have my camera when we went to the Bay. I had never been to the beach before, save for a week two years prior when I got into the water, and proceded to get right the hell back out because I was being stung violently by Jelly Fish. Hopefully I'll be able to get more pictures and posts out soon; who knows what I'll get to do today!

Have Fun and Be Safe!

Tuesday, June 22, 2010

Legal Stuff

I feel as if I should get this out of the way before I go too much further. In my blogs about my calls that I have run, I have purposely changed the names of crew members, changed locations if I even mention one, names of companies, and even some of the minor facts about the story. I am not trying to receive a visit from the HIPPA monster here, so that's why it's all changed.

The basics of the story are still there; the heart wrenching moments, the hilarity, and even the more somber ones, the meat of the experience is still there, just the facts around it have changed to protect the innocent and even the not so innocent.

So please, no nasty-grams because you think that I forgot about you on a call, I just didn't say it was you for the sake of not saying it; if I'm not even going to put my name out there (for now), I'm not going to do the same to you. I say it to my EMT's all the time, "I'm not going to ask you to do something I won't or wouldn't do myself..." I still remember who was with me when, so don't think I'm not giving you the credit you deserve. In writing the stories, I feel as if I am thanking you in the highest degree; what you did was so awesome to me, that I had to tell the world about it.

In closing, please don't try to read more into the story than there is. I want to put my experiences out there to show you what I learned from them, or for you to have the most miniscule experience that I had.

Have Fun and Be safe.

You did...WHAT?

I picked up my cell phone for the one hundredth time in the last twenty minutes. I had finished with my Mother-May-I portion of getting my medic. I had to get ten good calls out of my way with a more seasoned Medic riding with me until the deities at Medic Command decided I was good enough (read: out of my bleeping mind) to play on my own. I had been called in at 6AM to fill in for a Medic who had just gotten suspended. Until I got "the" phone call, we were a BLS service, and had to get back-up from our mutual aid service...and I didn't want to do that.

The long standing feude between the companies made the Hatfields and McCoy's look like an afternoon bridge party. The two areas were night and day. While our little slice of paradise held some of the more active gangs in the county, 98 percent of the residents were being assisted by the State for all their needs, and the mean age of girls having babies was 16. I had seen them pop as young as fourteen. The neighboring city though had beautiful homes, a good school, and minimal crime...until the citizens of our city crossed the street into their neighborhood.

After waiting what seemed like hours in the quietness of the city, one of the supervisors came down to the station. All he did was walk in the door of the station, pat his pocket where he held his cigarettes, and motion for me to come out to the bay and talk. I obediantly grabbed my blue Zippo lighter and my pack of Newports and headed to the garage. Greg, my supervisor, all without saying a word leaned over and lit my smoke as the filter touched my lips. We both finished half before he spoke.

"You feel comfortable yet?" Greg was a man of few words, but excellent skill. He had precepted me during Paramedic Class, and even during my Command Precepting phase. We got along great; it wasn't uncommon for him and his wife to come and make the crew dinner, or just hang out during the summer months to help play back-up. Help was sparse during the summers, and with all the calls we ran, we needed it. Greg was was almost thirty years my senior; he had been in EMS before I was even an itch in my daddy's pants. I hung on his every word as if his medical knowledge were gospel.

"Yeah. Fortunately the protocols run the same as what they taught us in class, dose wise and med wise. I'm not too sure how I'm going to do flying solo on a major trauma though. You and Tracy helping the crew out on calls made it easier."

"But you're comfortable, right?" He stated calmly as he ground out what was left of his cigarette, which wasn't much. I always wondered how he managed to smoke it down to the filter, and then some. I instinctively handed over what was remaining of mine; no sense in him fumbling with his lighter to light his own. He had been having issues with swelling in his hands and feet as of late; he was working nearly every day of the week and was having issues keeping up with his medication. We had all noticed, and were doing our best to help keep him on the straight and narrow.

"Yeah, I guess, why?"

"Just got back from the Mother Ship..." The Mother Ship was the nickname we gave the largest hospital in our region which ran Medic Command.

"Dr. Polazzi and Dr. Ilania are signing you off with their blessing." With that, Greg did the sign of the cross over me, smiling.

"You got your Holy Hazmaticus. Don't kill anyone, kid."

I beamed with delight. I got the blessing from the Mother Ship. Dr. Polazzi and I had been having fun over the past few weeks on Consults. I had a deluge of interesting calls that didn't even pretend to fit in protocol. Even though there were hundreds of people calling in every day to Medic Command, he always knew who I was.

With that, Greg handed me the service pin with the word "Paramedic" stenciled in at the bottom. I fingered the pin, but didn't put it on my collar. I had several superstitions, and one I developed over the years was seeing brand new medics who put their service pin on before their first call by themselves seemed to be cursed with a White Cloud. I liked having the nickname of Princess Dark Cloud, and I wanted to keep it that way. Greg knew, and he didn't question when I put the pin in my pocket.

"Tracy's making dinner tonight at the house. Steak, Potato Au Gratin , Green Beans...none with almonds so you don't die. Don't want a FUBAR like last time..."

I winced, remembering back to the first time Tracy brought dinner. She made green beans amandine, but the almonds were cut so finely I didn't even notice. With my severe allergy, I looked like the Michelin Man within three bites. Thank God we rode the three blocks to their home in the truck, because I had left my Epi-Pen at the station.

"She's also making brownies and that lemonade with the rasberries in it. Dinner will hit the table at 6:30, but we'll see you guys at 10..."

I had to laugh. Every time dinner plans were made, we got a call at the exact same time we were to be eating. Tracy could throw down on some serious food, and I didn't want to miss pigging out on it. Fortunately, Greg and Tracy were good about it; they were both night owls and were usually up until the sun rose, when they went back to bed...

"Alright, see you at 10..."

Greg sent me off with a hug and a swat on the ass. I walked in, proudly showing off the pin.

"I wonder what my first call will it's something really messed up..."

Truer words had never been spoken. Twenty minutes later, the tones went off. I hurridly hosed the suds off the truck as I listened to the call. Easy enough, I figured, a sixty year old male lethargic. I fingered my pin on the way to the call, all sorts of excited. Within the hour, I'd be able to put my pin on and say I had truly made it.

When we reached the residence, we were greeted at the door by a caretaker. I smiled and went about asking general questions while my partnet went for vitals. As I was gathering information, my partner called to me, his voice shaking. Without turning around I answered him.


"Uh...he doesn't have a pulse..."

I stopped. "What do you mean he doesn't have a pulse..." My voice rose an octave as I felt my asshole go on lockdown status.

"His heart stopped going thumpety-thump and he stopped exchanging Carbon Dioxide for Oxygen..."

I finally looked around the corner to look at the patient. He was sitting up on the couch, his chin resting on his chest as if he were sleeping. Only then did I notice just how pale he was, and just how not moving he was. For the very first time in my career, I swore in front of the patients' family.

"Oh Fuck..."

With that, I moved over and helped my partner get the patient on the floor. As I tilted his head back to listen, I noticed all these little white things rattling in the patients' mouth. I hurridly did a finger sweep, sweeping what looked to be little white pebbles from his mouth...with my ungloved finger. The little pebbles scattered across the floor, and we knelt amongst them to wage our battle with death.

As we fought, I noticed I just didn't feel right. My head felt all swimmy like and I started getting a headache. Before I could figure out what was going on, I saw the care giver reach into her pocket and pull out a little. brown. bottle. My eyes focused on the bottle and my jaw fell open.

"Are those...Nitro pills?"

"You mean the explody stuff? Yeah, the doc told me that if uncle was feeling funny light headed, to put these under his tongue. We lost the box they came in, but the doc said they'd work quick to make him feel better. When he wasn't feeling better, I figured I could give him more..."

"How many was more?"

"Uhm, 'bout ten, twelve."

I proceded to swear...again. Really loud this time. Not only was the patient on Nitro, but he was getting ED pills from his roommate! All I could do was shake my head and continue with the call.

At the hospital, the patient was pronounced dead on arrival. As a rule, I always made myself available to the family to answer any questions. I've found that, some ER Doctors really suck at giving bad news, so I try to be helpful when I can, but not stepping on any toes. The family asked the standard questions to which I had the best answers I could. As I was leaving, the caregiver stopped me at the door, pulling me away from the rest of his family.

"Can I ask you something?"

"Sure, what can I do for you?"

"Did the pills help? Did I do the right thing?"

So many answers went through my mind. Of course you helped him, you moron. You helped him cross over to the other side! or Well, he's dead so you figure it out. With all decorum I could muster, I explained that, what he did was right, if he felt it was right...all the while giving myself the face palm from hell.


Have Fun, and Be Safe!