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 gentlemen...it is: *drumroll*

http://lookingthroughapairofpinkhandledtraumashears.com 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~

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 EMSBlogs.com. 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 EMSBlogs.com 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~

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 well...at 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 do...no 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~

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 EMS1.com and JEMS.com 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~

Confessions...

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~

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..."

Participants:
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 taken...so 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.

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!