Friday night I got toned out to a motor vehicle accident. The dispatcher had bad information and a bit of keystone cops comedy followed with firetrucks and private EMT vehicles crisscrossing the town looking for the accident. The cars involved had no visible damage and several people actually drove by the accident scene before the confusion passed.
The driver of one vehicle was complaining of some back pain so we extracted her from the car and boarded and collared her with the help of some fire fighters. The ambulance squad lady was there and suggested that I could ride to the hospital in the ambulance if I wanted. I got into the rig with one of our FRs (first responder, the entry-level EMS qualification) and the two EMT-Is from the transporting ambulance squad.
The ambulance squad lady is the coordinator of my squad. She has been an EMT for a long time and is very calm and knowledgeable. I consider myself quite lucky to be a member of my squad for many reasons; my ability to interact with the ambulance squad lady is among the prime reasons. She is very interested in growing EMTs and is very supportive and nurturing. She also gives excellent care; I have heard more than one person say that if they needed care, they would want her providing it.
In any event, she sent the FR and me along in the ambulance to observe. It was interesting although the two EMT-I people did all of the work. The highlight of the transport was that the ambulance had to slam on the brakes to avoid hitting three deer in the road. The four unbelted EMS people in the back avoided falling on the backboarded patient, which was good.
I got up early on Saturday and drove the two hours to Burlington with another member of my first responder squad. We had to be there by 8:30 and made it without problems.
I attended several interesting sessions on Saturday; one on psychiatric disorders, one on difficult case assessments.
Q: You receive a call to 911. You arrive on the scene to find your patient sitting in a chair complaining of chest pain. The pain started abruptly three hours ago while the pt was watching television. He describes it as stabbing and substernal. The pt has a somewhat altered level of consciousness with anxiety. The pt has tachycardia with a pulse of 140 and is hypotensive with a bp of 90/70. The pt presents nonsymmetric cyanosis. Further investigation shows decreased pulse and capillary refill on the left side. There is no history of cardiac or stroke activity. Lung sounds are normal except for some gurgling on the left side. Heart sounds are normal. The pt reports no recent weight gain. What do you do next?
A: Call for Advanced Life Support (ALS) intercept if available. Start high-flow oxygen and carefully move the pt to the rig. Drive slowly and carefully to the hospital or intercept point avoiding potholes and frost heaves and cross your fingers that your pt’s aortic aneurysm doesn’t burst before you turn him over to the emergency department.
I found this case pertinent as this time of year always reminds me of aortic aneurisms.
The last session I attended on Saturday was on a search and rescue that took place on Mount Washington in 1982. I attended this session primarily because the presenter, Bill Kane, was my original wilderness first responder instructor and subsequently my wilderness EMT instructor. He’s been a mountaineer and into EMS forever. He’s a fascinating person and I have boundless respect for him. He’s another person that I am grateful to have had the opportunity to meet and learn from.
The presentation itself was very interesting. I had read narratives of the search before but the presentation cleared up a lot of confusion I had about how things had happened; usually the people writing media stories about things like this have little actual experience, don’t understand the details themselves, and so put things together so that they make sense to the writer. This often has the effect of obscuring the actual facts. In this case, the chain of events leading to the avalanche death of Albert Dow (a rescuer) had never made sense to me but Bill was able to tell us what had happened and why the SAR people had come to be in the wrong place at the wrong time. I also hadn’t realized that Bill had actually been one of the key decision makers on the SAR, so his perspective from that role was very enlightening.
I spoke with Bill after the session and was gratified that he remembered my name; given the number of people he interacts with, I would not have been offended if he had forgotten me despite having had me in class for a total of a month over five years. I tend to think he remembers me primarily due to the problems my stress level posed in the EMT class, though, rather than any positive qualities on my part. Rabid Kitten discovered the kids had been exposed to lead while I was away at EMT school and it was touch and go if I would complete the class at all; as it was, my stress level made it very difficult to concentrate. Bill, the school (SOLO in Conway, NH), and my classmates were very concerned and supportive and helped me make up for the several absences from the full-time class.
Anyway, I spoke with Bill for a few minutes and thanked him for the support during the class. I told him how much I felt that he and SOLO had benefited me in numerous ways, and I told him how impressed I was by his reach and impact on the EMS community at large, and that I considered myself lucky to have trained at SOLO. He was happy to hear that I had joined a squad and am planning to continue to EMT-I.
Then I did some shopping at the exhibition hall. I bought some crazy hard-to-find items; one of the bad things about EMS is that the online vendors want you to outfit your entire department and so charge whopping shipping minimums. If you want, say, one spring-loaded center punch, you’ll pay $5 for the punch and $20 for shipping. So I bought a punch (useful for breaking car windows), a set of extrication gloves, a keychain dealie that holds gloves and CPR mask to replace the deteriorating one I’ve been carrying for the last five years, and a set of EMT pants (BDUs with handy pockets for gloves and shears). I managed to resist the excellent fluid-impervious EMT jacket with zip-out fleece liner for $300, so that was good.
Later on Saturday I went out to dinner with a number of people from my squad and our transporting squad. A number of us ended up partying into the early hours and finally were sent to bed by Burlington cops. We weren’t being loud, particularly, but I think we were annoying the hotel staff by hanging out in the lobby. They eventually called the cops without ever asking us to go to bed or otherwise giving us the slightest notion they were unhappy with us. The nice part was that our district’s EMS board chairperson, a paramedic, was with us so there won’t be any inconvenient issues within the district.
On Sunday I attended one session on Intelligent Transportation Systems within EMS. I’ve been thinking about ITS for about fifteen years and am angling my consulting business towards ITS contracts, so this session was pretty much the crux of the event for me. It was pretty interesting; discussions of automatic crash notification (‘help! My airbags have deployed and my front bumper has been depressed at least eight inches. I’m on my roof! Heat sensors do not indicate any fire. My gas tank level is 3/4 full. My GPS indicates that I am on route 106 north of the intersection with 131. I think I have two front seat occupants; probably one or both of them are Suzy and John Public. If one of them is Suzy, watch out, she’s pregnant according to the information she’s loaded into the emergency data. Both of them have type AB blood. John’s doctor is Dr. Able, Suzy’s is Dr. Baker. I don’t think there’s anyone in the back seat. Watch out, though; I have side-impact curtains that have not deployed!’), ‘smart routing’, and some other things.
The staggeringly useful thing about the session was that I met the directors of operation for two large (4000 calls/year) services who are very interested in ITS and other data processing. I spoke with them for a while (they invited me to have lunch with them) and I think I opened their eyes to many possibilities for not only ITS but also data flow through EMS in general. They suggested I should speak with the head Vermont ITS person as well as the state EMS director. I did not get a chance to do so at the conference but will call them soon. The directors I spoke with said they felt I had a lot to offer the state in terms of the various ITS efforts (which are being heavily supported by the federal government) as well as EMS data processing.
I left the conference very excited about the future. I’ve been working on getting contracts for my consulting firm for several months… I don’t have any contracts in hand yet, but I’m getting the impression that I’m going to reach critical mass soon on several fronts.
I went to bed earlyish, around 10:30. My pager went off at 12:30 for an elderly woman who had fallen out of bed and possibly broken her arm. I went over to the station (I had no idea where the address was) and rode to the scene in Engine 1 with another firefighter… We were the only two who responded (certain calls are not popular, it seems). The woman was still on the floor, more or less under a night table and between the bed and the wall; the daughter in law had prudently not moved the woman but had made her comfortable with blankets and pillows. The lady didn’t know where she was and was concerned that she had been in a car accident. I had just started my assessment when the ambulance showed up (Yes! The cavalry!). Given the altered mental status, we protected her spine and carried her downstairs on a backboard. I felt really bad for the lady as she was not in much pain until we rolled her onto the backboard. We had no option but to roll her over the possibly broken arm, which caused her a lot of discomfort. It was hard to hear this kindly grandmother type moaning in pain, but we did it as quickly as we could and the discomfort seemed to subside once the roll was done.
After the ambulance left, we drove back to the station and filled out the paperwork, chatted for a few minutes about nothing in particular, then went our separate ways. I was back in bed by 1:45.