Ghosts: A Tale of a Career Paramedic.

I'm Not a Cop, But I Am a Detective.

Back when I still had Facebook I fillwed a few EMS profiles. Savage Paramedics was one of them, they can thank me later for the free plug. Savage Paramedics are notorious for posting funny memes about EMS. The also post merchandise for sale from differnt websites. I saw a tee shirt that I was almost tempted to buy. It's a bit taboo for EMS professionals to buy and wear such things in our industry, esspecially medics like myself that have been in the field for so long. Those things are reserved for the rookies who are eager and ready to save the world. The longer you are in EMS the less likely you are to tell people you are in EMS. It's not hecause we don't want to help or were embarrassed, but I'm not a Dr., and no, I don't know what that mole is. But the shirt in qurstion read as follows; "We do precision guess work based on unreliable data, provided by those of questionable knowledge." As soon as I read that, I thought to myself, that might be the most accurate statement about EMS I have ever heard. It perfectly sums up our job. I am making a field diagnosis based off the i formation I am given by the patient and by what I can see. And the information I'm given is given to me by people of little to no medical knowledge. Or even worse, "WebMD'Dr's". I'll ask of they have high blood pressure and they will say no. And then I read their medications and I see two or three different medications for high blood pressure. So I ask then about it and they reply, "Yeah, I take that." "So you do have high blood pressure?" "No." But you take Lisinopril." "Yes but my blood pressure is normal." "Well now it is, because you take medication for it." "Well I used to have high blood pressure, but now I don't." Folks, if you had a medical condition at any point, it's part of your medical history. And just because you are being treated with medication and that issue is now normal, doesn't mean you don't have the problem anymore. I just means the medication is doing it's job and you are being treated for it, it doesn't just go away. My favorite is when we bring in a patient who has denied any and all medical history, and when the RN or Dr. asks about it, the list off a scrolls worth of history. I metaphorically throw my clipboard in the air and walk out of the exam room. Sometimes its not even the patients fault. A good portion of the nursing homes I go to have the same problem. From what I've gathered every LPN is either brand new to that facility or moves to a different floor every shift. "So what's going on with room 23?" "I don't know, I don't usualy work this side." My all time favorite was a less than functional nursing home. It was 3'ish in the morning. Got called for Altered Mental Status. We walked into the room and the LPN met us at the doorway. So we asked what was going on, the standard stuff. And she, swear my hand Zeus said; "I don't know, I just got here." Me and my partner simultaneously looked down at our wrist watches, I don't even wear one. "It's 3 am and you just got here?" "Well I mean I got here at 7pm, but I've been busy handing out meds." "So you mean this is the first time coming in here and checking on her?" "Yes." Then there are those times where nothing makes sense. Shits just all messed up. Parts of one illness are there but other symptoms are conflicting what the first set are saying. In those cases you have one choice. Fix what you know you can fix, and keep the critical stuff working. Fake it till you make it. Focus on what you know and piece it together as new information comes to light. And don't be affraid to pick the Dr.'s brain. You might understand everything they say, but you will have a better understanding than when you started. The biggest thing is to not panic. Work with purpose, be task oriented, but don't panic. Panic spreads like wildfire. The patient is already in some level of distress and has called you to help them because you have the medical expertise. So if you the help, the professional starys to panic, the patient in turn will panic even more. "Why is the medic panicking, whats wrong to make him so worried?" And then your partner, esspecially if they're new will ask the same question. "What the hell is wrong if this person who has been doing it for awhile is panicked?" It's contagious and spreads quickly, it's like Ebola on steroids. If you ever start to feel panicked because all hell is breaking loose and you habe no idea what the shit is going on, do the following. Take a step back either physically or mentally, and start from the beginning. Control what you can control. Go over a checklist in your head. Airways good, breathing is slightly labored but is controlled with oxygen. Perfusion is good. Blood pressure is low, but I can give fluids to help balance that out. Mental status is questionable, can't control that but it's not affecting the airway. Again, fake it till you make it. Even if you have no idea what's going on, act like you do. You will be surprised on how much more confident you will be when you realize that you still have some control over the situation. Remember, you can't fix everything. But what you can do is control enough to keep them alive until they get to more definitive care. Prime example of full panic mode. I was very new, hadn't even started Paramedic school yet. Got my first real call. Called lights and sirens to a nursing home for a woman unresponsive. Walk in the room and new right away this lady was in trouble. It doesnt take a rocket scientist to tell when someone is really sick, for me at least, it's fairly obvious. She was labored breathin and it was irregular in pattern, which is always bad. Her jaw was clenched and she was unreponsive. Quickly got her out to the truck and hauled ass to the hospital. Put her on high flow O2 as that was my only treatment I could do. It was 2 miles to the hospital, you could literally see it from the nursing home. I'm scrambling to call in the radio report before we get there. About halfway there I heard her make an unmistakable noise. Never having heard it before, you know excatly what has happened. Her last breath. She still had a pulse, but she wouldn't for long if I didn't fix her breathing. She toom her ladt breath while I was on the radio still given report. I know it's not possible now, but I would love to hear that report, esspecially the point where she stopped breathing. Man, that shit would be funny. I belive I screamed, I know I shouted "She stopped breathin!" I didn't even finish the report. I threw the mic away and reached into the cabinet for the BVM. It's in a sealed bag to keep it sterile. And I'll admit, if your in a hurry, it's almost impossible to open, and I was in a big hurry. I tried a few times to open it correctly with no success. So my last attempt I wrenched on the bag. Poof! The bag tore open. The BVM went to the right, the mask went to the left. I found the BVM on the patients legs, I couldn't find the mask. And without the mask the BVM is essentially useless in this case. Somehow I remembered there was a spare CPR mask, the same that came in the bag in the cabinet. I found it, attached it to the BVM and started pumping like I was trying to inflate a falling blimp. I later found that mask, two days later. It had landed behind the drivers seat. Which is a feat, because although the front and back are connected, it's a narrow space. And it's in the middle of the seats. How it got lodged in behind the drivers side I still haven't figured out. Looking back on that call now, other than not screaming and yelling out shes not breathing, the only thing I would have dine as a Paramedic is start an IV. There really was nothing else to do. There's no meds to give for that, her sugar wasn't the issue so no Dextrose (go go, wake em up juice). She wasn't having a seizure, so no Valium or now a days Versed. The IV really has no effect, it's more to help the ER staff, it's one less thing for them to do. I visited her in the ICU a few days later. She had had a Bi-Lateral brain bleed. Both side of her brain had bleed and caused pressure and a shift in her brainstem, she was and would be forever comatose. Never to wake up again. I told my partner recently that I wish there was a camera crew to follow us around. I explained I wanted to see what I looked like on critical calls, to see if I look or acted panicked. I asked him if I do panic or look that way. He told me that I don't and have never. He said you sometimes can looked a little strained, but never panicked. He says I get really quiet on serious calls. In my experience that is the opposite of what a lot of people do. They bark out orders and their volume increases significantly. They also become very red in the face and sweat profusely. Somtimes even more than their patient. I apparently don't. I get quiet and speak pointedly. My partner can always tell when im serious, I stop talking and look very concentrated and focused. I'm thinking about everything, piecing it all together, thinking about my options, the end game. I'm mentally taking a step back to overview the scenario. Often he will say "Everything ok? What are you thinking?" If it's not serious and just puzzling, I'll just tell him I'm just going through my rolladex and maki g sure I'm not missing something. I think it's important to remain calm. The faster and more rushed you become you forget steps. You also have a greater tendency to miss things. But if you reamin calm and focused, you are more likely to have a better grasp of the situation, and therfore no how to treat it. In summary; We do precision guess work, based off unreliable data. Given to us by those of questionable knowledge.