NickD

A fiery horse with the speed of light, a cloud of dust, and a hearty "Hi-yo, Sil . . ." Opps, wrong show. Tonight's Trauma (somehow that just sounds right) is "Stuck" (like EMS is with this show). "Tyler and Boone respond to an explosion at a Chinese restaurant; Nancy's advanced medical training is put to the test; Rabbit has a bumpy flight." Buckle up! Everyone!

In health care you seldom see (excepting many EMT jobs) the phrase, "no experience required." Saying they want prior experience is them maintaining some mythical higher standard. You see it a lot with positions like ED tech, Phlebotomist, etc. But if they need a CNV or whatever, and your timing is right, they'll give you a shot. Don't ever let the phrase, "one year of experience," stop you from applying . . .

Just some nick-pics . . . - Letting an ETOH Pt. sign a refusal and walk away. - The comment about organ transportation being, "lame." Really? - No sheet on the gurney with c-spined Pt. aboard. (Could be some "reason" I've never learned, but still seems wrong, especially if Pt. is bleeding.) - Rabbit's use of cold therapy in the spinal case so the producers could say, "Look, we are educating people to new stuff." - Medic allowing his wife to stick her bare hands into bloody GSW. (Bystanders getting involved in treatment is becoming a mainstay of the show). - Rabbit taking a large caliber round at close range wearing something like "Dragon Skin" and apparently escaping any blunt force trauma. One thing I liked: - The spinal case kid wiggling his toes on Rabbit's iPhone. (Excepting it was an iPhone advert). And the Running Blondie Bang Count now stands at 2.5. Guy in the rig, guy in the boat, and now it appears Rabbit may need Dragon Skin fitted for another body part.

What a win-win that would be! Blondie's boobs and continuing education to boot! It just shows what TV could really be . . .

>> Its just TV to me<< The power of television has been debated ad nauseum since Felix the Cat first appeared in early TV demonstrations. The bottom line however is we are so overexposed to TV it might be hard for us to realize how much it does manage our perceptions. Especially in younger people. There are several young EMTs in the Paramedic Prep class I'm attending that are all ga-ga over EMS air transport. They know little to nothing about aircrew safety statistics, the over triage, especially in pediatric cases, of many patients, and the exsisting studies that show lack of improvement in patient outcomes. What they do see is the percieved glamor, and in the case of one female student, how cool she'll look in that flightsuit. And she actually said it was the show "Trauma" that peaked her interest. She's a EMT in a small IFT company and I don't think she's even seen a helicopter up close. Skepticism, in most of us, only comes with age and experience. So to say, in effect, TV is just TV is a stretch for the general population. It's more about what information we take in, and the quaility of that information, not its source. For example "Emergency" vs "Trauma" - one good - one bad - and both from the same source, television. If viewing TV was a medical procedure we'd have to call it invasive. And if we spent more of our spare time reading peer-reviewed EMS journals instead of watching TV we'd all be better off . . . NickD

Praise from Dr. Bledsoe is praise indeed . . . I just came home from my first day of Paramedic Prep at Daniel Freeman (UCLA). And of course the two textbooks I received both have Dr. Bledsoe's name on them. It's been a big day for me! Thanks, Dust, for sending him the link. And thinking about Johnny Gage from "Emergency" looking at something I did, and maybe having a laugh, is the absolute cherry on the cake! NickD

Sorry guys, had to do it . . .

The show is being hammered so badly NBC locked the "Trauma" forum topic called "Negative Opinions spoken here..." this morning. It's now read only! Link to NBC Forum

Straight out of Compton . . . "First In" A mix of fire and EMS. What's an ambulance operator? Full Episodes here: First In NickD

Hi All, My Paramedic Prep course at Daniel Freeman (UCLA) begins in a few days. Over the past year I've been working as an EMT and have taken several classes to raise my "points" average for the Paramedic School selection process. These included becoming Phlebotomy licensed in California. The class will mostly be fire guys, but they do set aside a half dozen slots for non-sponsored civilians like me. But the competition for those are high. After the Prep course (if I'm successful) I'll also need to sit the Hobet exam. And like a lot of people say, the math is an issue. I've been out of high school close to 35 years. My Julia is helping me out. But I find the problems confusing so we found tailoring the practice questions to my limited understanding really helps out a lot. For instance: If Dust can drink a case of beer in 4 hours, and Nick can drink a case of beer in 6 hours, how long will it take for both of them to drink a case of beer together? Easypeasy - 2.4 hours and it's time to get more beer . . . The below is a bit I wrote up for a skydiving forum I frequent to explain why I wouldn't be around for a while. Please excuse the small over-explanations as this was written for non-EMS types. NickD Wish Me Luck . . . I probably won't be around here much for awhile as I'm starting Paramedic Prep classes in October, and hopefully shortly after that I'll be accepted to Paramedic School. I officially left my job as an EMT here in a So Cal coastal city and I've been thinking over my time there and things I've learned, things I'll miss, and things I won't miss. When I started as an EMT I was lucky to get on with a private ambulance company that ran 911 calls in support of the local fire department. We did some interfacilty transfers but it was mostly fire calls. I started by working 12 hour day shifts and then went to nights. My very first partner was a jovial Mexican fellow assigned to break me in. On my first morning out we stage the ambulance in our assigned sector of the city. And his first lesson to me is, "Hey man, ya know what EMS really means, right?" "No what?" I say. "Earning Money Sleeping!" And he goes into the back of the ambulance and curls up on the bench, "listen for our call number on the radio," he says and promptly starts snoring. We have three radios in the rig. One is tuned to our dispatch. Another is on fire's frequency, and the last is a hand held we take with us on scene. But it all sounds like noise to me. I pick out words here and there but I'm absolutely terrified they are going to call us and I'll miss it. The city has five different fire stations and they are numbered. I study the plastic covered street map we have trying to figure out where we are in relation to what fire station. If I can pick out the fire station we are covering, and then hear them being called out, I'll know to expect a call from our own dispatch on the other radio. Problem is I'd never been in this city in my life, the map is printed for 20, not 54 year old eyes, and I haven't even figured out what microphone is connected to what radio. I don't want to make it sound like I didn't get any training or orientation from the ambulance company when I started. But I'll just leave it like this. If their instructors taught skydiving we'd all have been shut down by the FAA long before now. I'm anxious for my first real call, of course, I feel more than ready to make the jump from school to the real world. But at the same time I'm like the kid in right field who's just praying the ball isn't hit towards him. This goes on for about a half hour and I gotta pee. They never covered that in my training. I hear fire stations being called out and I hear the corresponding ambulance being called out too. I pay particular attention to how they answer as that part is my job. I knew I wouldn't have mic fright. I've talked down thousands of skydiving students, took flying lessons and talked to ATC, and BASE jumped a lot talking to my ground crew all via radio. The last one being mostly about how's the wind and is the coast clear. Suddenly I hear, "Engine 24, Rescue 24, difficult breather, 123 E. 3rd street." And just as suddenly the snoring in the back stops and my partner says, "That's going to be us." Things are happening fast now. I'm frantically scribbling down the address on my pad when our dispatch radio calls us. "54, non-emergency." I pick up the mic hoping to god it's the right one and say, "54," in my best fighter pilot voice. "54, non-emergency," they come back, "respond with Engine 24, Rescue 24, 123 E. 3rd street, 123 E. 3rd street, Code 2." "Tell 'em two to four minutes," my partner says while he's still in the back yawing and putting his boots on. I click the mic and say, "54 copies 123 E. 3rd street, with Engine 24, Rescue 24, give us two to four minutes." I thought it went well. So far so good. But my partner got behind the wheel and laughed. "You sounded a little squeaky there." I found out he could be sound asleep and still hear the radio just fine. This was my first call. The one they say you never forget. I thought how the tables were turned now. I was the excited and scared first jump student, and next to me was my non-nonchalant, even bored looking, first jump instructor. We rolled out onto the Blvd as I fumbled with the map trying to find the address. "Don't worry," my partner said, "I know where it is." But I kept looking just for the practice. Code 2 isn't lights and sirens but you still have to make time getting there. My partner, I'll start calling him Ricky, so I don't have to keep writing "my partner," skillfully and efficiently weaves us around the morning traffic. "Put your seat belt on," Ricky says. Man, in all the excitement I totally forgot. Ricky reaches into the plastic bin that sits between us and grabs a pair of rubber gloves and puts them on. I do the same. "You can start the paperwork now if you want," he says. I reach again into the bin and pull out the metal case with our run sheets in them. I start filling in what I know, the date, our unit number, the address we are dispatched to. I realize it's hard to write in a moving vehicle. The traffic is bad, and even though Ricky knows the best streets to use, they are all clogged with people still driving to work. "In another minute," Ricky says, "you'll have to call fire and tell them we need an additional two minutes." And just as I'm figuring out how I'm going to do that, they call us. "54, what's your ETA?" "Tell' em two more minutes" Ricky advises and I do so. And fire comes back with, "54, bump it up to Code 3." "Copy," I say, "bump to Code 3." "Rock and roll!" Ricky says as he puts up the windows and hits the switches on the emergency lights and sirens. The traffic ahead magically parts as I call out, "Clear right," at every intersection. I don't want to sound like a whacker. A whacker is someone in EMS, usually a newbie, that wears too much equipment on their belt, and gets off way too much on the lights and sirens bit. But damn! This is very exciting! While I'm watching the road ahead I'm trying to run through my protocals for SOB (shortness of breath) but I'm drawing a big fat blank. We turn another corner and I see a fire engine and the smaller paramedic vehicle in the middle of the block. We park in front of them and I go around the back and pull the gurney out. "Got the hand held?" Ricky asks. No, I forgot that, so I walk around and grab it out of the cab. And I grab the metal case with the run sheets too. Calm down I tell myself, you're not thinking. "Critical thinking!" It's my EMT school instructor. I can hear his booming voice in my head right now. "No, no, no," he'd scream. "Your patient is presenting with this, this, and that, but not this. What does that tell you!" I loved that guy. We roll the gurney up to the front steps of a nice, but modest house. "Go inside," Ricky says, "see what's going on." I thought to ask if he was coming with me, but instead I just went. The door was ajar and I opened it. There was no one in the living room, but I could hear voices further back in the house. I walked down a short hallway and looked into the first bedroom I came to. She was in her eighties and laying supine (face up) on her bed. She was talking with the two fire paramedics. It was obvious she was having trouble breathing, and she seemed confused. They had her on O2 and also hooked up to their portable heart monitor. One paramedic looked up at me and said, "Bring in the gurney, if you can't fit, bring in the stair chair." I went out and relayed the info to Ricky. "We'll get the gurney in there," he said, "I've been here before." I came to learn Ricky would say that a lot on the calls we ran. As I stood in the woman's bedroom again I took a minute to look around. There was a picture of her on the wall. In the photo she's about twenty and beautiful in that way all woman were back in the 1940s. On the table next to her bed was a photo of a man in a WWII military uniform. He was also about twenty. Put him in a jumpsuit and he'd look like any other young dude on the drop zone. It was the beginning of my realizing these were real people. People with lives full of hopes and dreams. "Her husband died about ten years ago," Ricky mentions in my ear. But there's his photo, I notice, still on the night stand, right by the bed they spent a lifetime in. The paramedics stood back while Ricky and I placed the woman on the gurney. We were the grunts after all. There are very specific techniques for lifting and moving patients but it went well and we buckled her in and covered her with a blanket. Ricky got my attention with a look and motioned to the O2 tank on the end of the gurney. I didn't get it at first, but then caught on he wanted me to switch out the O2 hose from the paramedic's tank to that one. We rolled the woman out and lifted her down the stairs. I was concentrating hard as the worst thing is dropping a patient. We put her into the ambulance and one of the paramedics got into the back with me. This was an ALS (advanced life saving) call. What made it that was the woman was altered. Her level of consciousness wasn't normal for her. Some other things that make some calls ALS are trauma, strokes, heart attacks, etc. For the lessor things we'd have taken her in alone. Those are BLS (basic life saving) calls. And a paramedic doesn't need be aboard to transport. I sat on the left side and the fire paramedic was on the right side of the gurney. I saw he was preparing to run an IV line. "Get me a blood pressure." He directed. I grabbed the blood pressure cuff off the shelf and the stethoscope out of my pocket. I'd done this a hundred times in school and another hundred times on my poor Julia at home. The paramedic told Ricky up front to, "Go easy three." He meant use the lights and sirens on the way to hospital but don't kill us getting there. I put the cuff on upside down the first time, but quickly fixed it. I found her brachial pulse in the crook of her arm and pumped up the cuff. But then we started moving and I couldn't hear a thing under the siren. I kept trying but it just wasn't there. The paramedic noticed I having trouble and said, "over palp," is good enough." I knew he was telling me to get her pulse at the wrist and do it by feel. "110 over palp." I told him. "Okay, strip out this bag for me." He tossed me a bag filled with saline that he was going to hook into the IV. I'd done this few times but he noticed me fumble dicking around with it. "First day?" He said. "First call," I replied. He smiled at me and said, "Okay, look, here's the easy way to do it." He was a cool guy. He let me do the blood sugar stick on her finger and he explained everything he was doing to me. I got lucky again. I later found not all the fire paramedics were as easy going. In fact some of them were down right pricks. "Your a bit older than most of the new EMTs I see." he added. But instead of giving him my life story, I just shot him a "that's the way it is" look. "Change that O2 hose over to your house tank." He told me. "Those small gurney tanks don't last long." We rolled into the emergency bay at the hospital and wheeled her into the ER. The paramedic gave his report to the nurse while I listened. I'd have to do this myself on the BLS runs. We were given a room after a bit of a wait and transferred the woman to the hospital bed. I removed the EKG leads from her chest while trying not to notice her bare breasts. You do, I found out later, get very used to that sort of thing. When I came out of the room the paramedic was already gone. Ricky was off getting some new sheets and blankets. Then he would make up the gurney and clean up the back of the ambulance. In the meantime my job now was to get the woman's medical insurance information and finish up the run and billing sheets. Besides the basic info the run sheet must include a full narrative of the entire call. Every intervention we made, and the outcome, must be included. I think of myself as a fairly good writer, but it's hard to be too creative using all those medical abbreviations and terminologies. "Are you still working on that," It's Ricky. "What are you doing, writing a book?" Back in the ambulance Ricky told me to clear us on the radio and I did. "That's ice cream," he said. What's ice cream," I asked. "Any first," he explained to me, "like your first run, your first cardiac arrest, it means you gotta buy ice cream!" I couldn't help laughing out loud. After a lifetime of "beer firsts" on the drop zone now it was ice cream. "Whata ya laughing at, I'm serious, man." "Nothing, Ricky," I said, "I ain't laughing at nothing. So the time passed. Almost a year's worth of calls, some routine, some not. Overdoses, gun shot wounds, stabbings, beatings, drunks, car accidents, and just plain sick people. Sometimes only lonely people and often those who simply abused the system. But we took care of them all. The best part? I found I have a soft spot for elderly people. Rolling them into a nursing home, sometimes knowing they'd never roll out again, I'd stop outside and watch a sunset with them. Or grab a flower off a bush on the way in and lay it on their bed stand. Sometimes I'd just sit and listen to their stories of how no one comes to see them anymore. Other times I'd just let them hold my hand for a little while. When ever I got back into the ambulance Ricky was always going, "What took so long, what the heck were you doing in there?" "Nothing," I'd say, trying hard not to let him see the tears in my eyes, "I wasn't doing nothing, man." Wish me luck, everyone, with my Paramedic ambitions! NickD

"Smoke Eater" is a good one . . . It's about an old school Fire Captain who doesn't hold with the LAFD being involved in EMS. Also the boys work a full code that's interesting to watch. And the topper is Dr. Bracket lays out an outlaw biker! Smoke Eater NickD

Might as well ask, "Why are they responding to SOB calls," too . . .

Nobody was injured so I don't mind finding this funny . . . This Engine was responding to a water main break, and I guess they found it. Haven't posted for about two years but have been working for a private that supports Fire in Los Angeles. Most of the fire guys are all right, but there are certainly a few, "monkeys."

A nifty short film depicting ambulance operations from 1956. There's no stopping for red lights with these guys! And dig the big silver bell on the hood . . . Long Before Mother, Jugs & Speed . . . NickD EMT-B

>>Pranksters, clueless callers block lines for legitimate crises<< While the volume of "junk" 911 calls is certainly higher nowadays, it's always been an issue. I'm old enough to recall when you dialed the (0)perator to request either police, fire, or an ambulance. But in those days folks rarely called for an ambulance outright. In a medical emergency you called your doctor and he/she (mostly he) would rush right over. And yes, if you had a big test at school that day it was a lot harder to play sick-hooky. My Aunt Rose retired as a switchboard operator during the recreational drug haze of the early 1970s and she said a fairly common call was, "Hello Operator, where am I?" And, at least down to the neighborhood level, she could tell them. She'd also, if her supervisor wasn't directly plugged into her board, spend a moment or two with the lonely and the depressed. That kind of personal touch is gone now and we are the worse for it. In an early example of, "we own the world," the current three digit system was first suggested by the fire department in the late 1950s. But it took almost thirty years before it was truly in place. And what finally pushed it into existence was the government forced break-up of AT&T in the early 1980s. In addition to forming separate and smaller Baby Bells it opened the door to independent phone companies. And I knew that was a big mistake when in Arizona I stopped at a phone booth to call California. When the call wouldn't go through I dialed the operator and was stunned to hear, "I'm sorry sir, we don't go there." Today when 911 calls make news they are sometimes heartbreaking, sometimes funny, and sometimes they make me angry. I realize dispatching on the 911 level must call for the patience of Jobe and surely they need tongue tied callers to get to the point, but there is often that condescending tone that comes through. One thing we overlook is many people simply can't operate on whatever the expected level happens to be. And we (society wide) too readily write those folks off. So in reality before the 911 system implodes any further it needs some kind of buffer system. And I think the answer is simple. Bring back Aunt Rose . . . NickD EMT-B Phlebotomist

Yuck, Yuck, that's as funny as EMS joke from someone who's not in EMS . . NickD

I've found one benefit of coming to EMS late, or more specifically when older, and after having done other stuff, is when a Doctor or Nurse reams me, when I deserve it I can smile and say thanks for the lesson, and when I don't, I can smile and say thanks for the lesson too . . . Setting an age limit for entering EMS at 35 years or older would mostly solve 99% of our problems . . . except for carrying fat people down the stairs . . . and of course, therein lies the rub . . . Here's what I do when I'm not doing EMS . . . I'm a skydiving instructor . . . NickD EMT-B Phlebotomist 1

I used to watch TV to be inspired. I pretty much gave it up after "Leave it to Beaver" was canceled. I came back for Cosmos, but split again right after. As for "Reality TV" I thought the general purpose of TV was to escape reality? Watching losers bicker is not entertainment . . . NickD

I'm a newly certified Basic in both Los Angeles and Riverside Counties in California. And before deciding to go the ED route as a Tech I looked into both systems and did several ride-alongs in each. I know you didn't ask about LA County but just for the sake of comparison . . . In LA the fire department is the primary responder to 911 calls. Privates also respond to some of the same 911 incidents and seem to usually do the transport, and sometimes if it's serious, with the fire medic onboard. It seemed obvious (to my inexperienced eye) the main purpose of this is to leave the FD ambulance pristine and the privates with the mess to clean up. Riverside County works a bit differently, at least in the eastern part of the county like Perris Valley and Hemet. You benefit here from the fact California State is a county by county system. And the rule of thumb here is the more rural the agency the more fully you can practice to the limits of your scope. Also the Riverside FD is not as well funded or as all encompassing as the LA FD. And while they still send an Engine to most all 911 calls the responding ambulance will be AMR with two EMTs onboard. And they seem to work on the principal of call in ALS if it's hairy. But I also think they run some ambulances with a Paramedic and a Basic onboard too. I don't recall the pay scales, but the living is way cheaper than in LA or SD. Since I'm not an experienced street EMT, I can only go by the little things I noticed on the few ride-alongs I did. The relationship between LA Fire and the privates was a little too frosty for my taste. It was better in Riverside. Also when I applied for my initial certification in LA, even though my ducks were all lined up properly, it was a descent into bureaucratic hell. On the other hand the EMS agency in Riverside (it's located in Corona) was friendly and efficient. I think what I'm getting at is between the two counties working in Riverside might reduce your overall heartburn. Again, grain of salt here, as I'm eyeballing this all as a newbie . . . NickD EMT-B Phlebotomist 1

Warning: Fire up your sense of humor . . .

When Emergency first aired in 1972 I was in the Marine Corps so I didn't get to see much of it. But I've since purchased all the DVDs. Jack Webb directed the first episode of Emergency and his production company was involved so the show had that trademark Dragnet touch. There was the good natured banter between the boys, the appearance of many well known guest stars, and the over the top way of always making the civilians they came in contact with seem as goofy and out of control as possible. Although, now that I'm involved in EMS, the latter doesn't seem all that far fetched. There's also a line in the first show that was rather prophetic as Roy is trying to convince Johnny to sign up for the new Paramedic program. And Johnny says something like, "No way, Roy, I'm a rescue man, I don’t know from nothing about medicine." It's also always a big groan to see the boys finish working on someone as the ambulance rolls up with the white coats straight out of Mother, Juggs & Speed. In EMT school whenever we ran partnered scenarios I always introduced ourselves as Johnny and Roy. The sad part was most of my younger classmates didn't get the reference. Station 51 in the series is actually Station 127 and is still in operation in Carson, California. And many folks stop there for pictures and, if there's nothing going on, you can still get the nickel tour. It's interesting that in the series whenever the boys rolled out there was never much traffic on that street, but it's absolutely in grid lock nowadays. I've since wondered what drew me so strongly to Emergency when I was younger. And it's too easy to say it had something to do with where I am now. Maybe it was the lights and sirens, the shiny red trucks, and the adventure of it all that stirred my inner wanker before I even knew I had an inner wanker. But I've since outgrown that nonsense and realize it was much more than that. It was something more basic and something most of us still carry to the job everyday. It was plainly and simply Julie Dixon's boobs . . . NickD EMT-B

I posted about UCLA's Phlebotomy course here NickD EMT-B

Like a lot of things the answer may be found in the past. Nobody mistook the ambulance attendant of the early 20th Century with anyone else. The white shirt and pants topped off with a jaunty cap just said it all. But our own insecurity would prevent us from going there. But ask yourself - what is the real purpose of a uniform? For those working the street, at least historically, it's strictly self preservation. A medic moving down a dark inner city alleyway is less likely to be smoked by a jittery police officer if he's in uniform. So in that sense uniforms merely divide the good guys from the bad guys. For younger folks "Emergency" defined the role of medics, but for me it was "Doc" from the older "Combat" TV series. What separated Doc from the rest of his squad was the big Red Cross on his helmet. Unfortunately, that big Red Cross could also facilitate separating ole' Doc's head from the rest of his body. And medics aren't the only ones in this miss-uniformed boat. In the phlebotomy clinicals I'm doing right now we wear white coats. The joke in the lab is people become phlebotomists because they look good in a lab coat, but didn't have time for all that medical school. And as I'm older (and somewhat wiser looking) I'm continually called "Doc" by casual passers by. So street medics are stuck somewhere between something practical, something that says it's us, and something everyone can get behind. And all that will probably never happen. So I think the answer is we wear "street scrubs" together with a large and very noticeable Red Cross. It's just too much of a universal symbol to ignore and nothing says "medic" like it does. And by all means, the jaunty cap too . . . NickD EMT-B

From what I could find on the net the fines for not yielding to an emergency vehicle in California are indeed cheaper than getting a red light ticket. The first offence fine for not yielding is between $100 - $250 and the red light ticket can be as high as $370. Here's a Q&A from a California law website FAQ: Question: What if I had to run the signal, because of a tailgater, road-rager, sirens, medical emergency, etc.? Answer: This is a legitimate defense, but doesn't work very often. A lot of people tell the judge that there was a siren behind them. Because they have heard it so much, the judges won't take anyone's word for it. << It goes on to say you'd need a copy of the agencies' run report and a third party eye witness to have a hope. >>Don't the cameras take a picture of the entire lanes of traffic?<< I'm not sure, but I doubt if the emergency vehicle would show if was several car lengths (or further) behind you. This is clearly a case of the law working against itself. NickD EMT-B