Remind me why we do this

[Kaisu]

Greetings from the uncivilized part of the country. It was another one of those killer shifts. Three crews of 1 EMT and 1 medic each ran 37 calls in the first 24 of our 48. I finally got 5 hours of sleep at 9:30 the following morning when a supervisor called in a crew from the substation to get each of us some down time on the second day. The second half of the 48 was almost as bad. We went through 4 rotations after midnight.

The angel of death rode with us this shift. I personally had 2 die on me, and one (details to follow) lived despite our efforts to kill him. This is the one that bothers me this morning, a full three days later, so as is my wont, I am writing to expunge it and appreciate comments from all.

I had just returned from a call to the state prison, where a 25 year old inmate had shot himself up with a lot of heroin. CPR had been in progress. Long transport time, but this one is going to live. We get toned out for a gunshot wound in BF nowhere. This location is 40 minutes from our station down I-40, locale for desert rats and lean-tos. In this area, I have seen garbage piles that pass for residences, ran on patients with maggots infesting open wounds and 14 year olds beating up their grandmothers. Dispatch states “gunshot wound to the neck - the weapon has been secured.” That’s it - that’s all I get.

We go enroute and I launch a rotor. 15 minutes into the run, I get an update from the BLS volunteer squad on the scene. There are a couple of new EMTs out there, which is a positive development because at least they still remember what they need to do, and are green enough to want to do it. I get “he’s got no nose, no tongue, and we can’t stop the bleeding.”

I co-ordinate with DPS and BLS for landing the chopper, and it gets on scene about 10 minutes before I do. My EMT partner is tearing up the dirt road, he turns to me and says “I’m only doing this for you.” He knows I want to get there, and he is driving faster than he normally does. The dust from these dirt roads is infiltrating every nook and cranny in the cab and the patient compartment, and he is going to have hours of work to clean this thing up, if we ever get enough downtime to eat, let alone decon a rig. (Our “management”, 60 miles away, is based at a station that never runs on anything but pavement with half our call volume and 1 more rig, and writes us up when we turn over dirty rigs.)

I get on scene. The flight crew has moved the patient on a gurney into the BLS rig. The patient is a 77 year old man. He is in tripod on the gurney. I see accessory muscle use, and labored breathing. There is a seeping clot where half his face used to be. I immediately flash to that infamous picture in the Brady Paramedic text of the patient with a shotgun blast to the face and whom my esteemed instructor referred to as the walrus. I also immediately recall his first rule of wing walking: “Never let go of one thing before getting a hold of something else.” This patient cannot be bagged because it’s pretty hard to get a seal on hamburger. I also figure that if I see no identifiable external landmarks, my odds of identifying internal landmarks are pretty slim.

If it was my scene, I would hit the guy with some Versed and crice him. The flight crew is getting their RSI drugs ready. The flight crews around here are infamous for knocking down patients and then not being able to get tubes. I also note that there are no ACLS drugs in the rig (recall that it‘s a BLS rig). I turn around, go to my rig and get my drug box.

On my way back, I note the patient’s son and granddaughter standing outside the rig. When I get back to the patient, they have given up on the tube and are cricing him. They get the tube in through a very nice hole in his throat and begin ventilations. The patient arrests. He is in a brady PEA. CPR begins and the flight RN is yelling at someone to get her ACLS drugs from the chopper. I draw up epi and pass it to her. As she is pushing that, I draw up the atropine. I hand that to her and she pushes it. I take over chest compressions. I get about 50 in and ask her to verify that she is getting a pulse with the compressions. She is. After about 2 minutes, we do a rhythm check. Patient has a pulse of 135 (um.. That would be the atropine) and a BP of 220/140 - um, that would be the epi. The Hs and Ts folks - when you cause hypoxia in a patient, if you correct that, you actually have a chance for ROSC from a brady PEA.

I take over ventilations (and custody of the tube) from the flight medic. He is pumped because he just got his first field cric. My supervisor is on the scene. (He had come out in the supe vehicle) and he secures the tube. Does a fine job of it too. Patient is now stable. The EMTs and the flight medic begin organizing the move onto a spine board (why he wasn’t on it when they put him on the gurney is anybody’s guess). My supervisor grabs the yankauer and begins to suction the hole in the guys face. “leave that alone” I tell him - “it’s the clot”. He grins sheepishly and stops. A few minutes later, the RN picks up the suction and heads for the hole in the guy’s face. “leave that alone” I tell her - “it’s the clot”.

Bottom line, the patient is loaded onto the chopper and off they go. They had debated taking him into Kingman and I chime in with “no - get him into definitive care in Vegas. That’s where he will need to be anyway”. They contact med control and get the OK to take the patient to Vegas.

I am left on scene with my rig covered inside and out with dust, the BLS rig knee deep in trash and gore, and the patient’s family staring at me and my blood covered gloves, jacket and uniform. I remove the gloves and the jacket and go over to the family. “Is he gonna be OK?” I tell him the patient has done a lot of damage to himself. He wont’ be able to talk (no tongue), and I prepare them for the fact that he may lose one of his eyes and he has no nose. The son says “I wish I had known - if only… “ I stop him and say “It’s not your fault - there is nothing you could have done or not done.” The son collapses weeping into my arms.

OK - so that’s the story. Now I’m going to tell you what had me up this morning thinking about it. This patient has shit for a life. He got to the point where he put a .38 under his chin and pulled the trigger. If he makes it, and I’m pretty sure he will, now he’s got shit for a life and no face. Tell me again why we do what we do.

Thank you for listening.

[P_Instructor]

Tell me again why we do what we do.

Thank you for listening.

Sounds like you did have a sh** shift. All I can say is one can only adapt to their own 'reasoning' in what we can, should, maybe, hopefully do. Everyone has their own reasons, but as pre-hospital providers, do the job you have been trained to do. Be realistic that not all patients may survive (and it is usually the ones who shouldn't that do, and the ones that should don't).

Be realistic in your own goals and beliefs, to provide the care that everyone should get. Do your job well and be satisfied with that.

I wish I could have been of more assistance to you.

Take care.

[HERBIE1]

There is no quicker way to a loss of your sanity than to look for justifications for the actions of people- especially in our business.

Not our place to ask those "why's".

Why does it seem that too often, in a confrontation between a LEO and a bad guy, the LEO dies and the dirt bag lives?

Why does it seem that we so often "save" an elderly, contracted, nursing home patient who is in a vegetative state yet may be unable to save an infant SIDS victim?

Why would someone stab their own brother to death at the dinner table because they took the last pork chop?

Why would someone sexually abuse and then murder their own infant child?

Why would someone leave 6 children all under the age of 6 alone in an apartment so they could go out and score some dope and cigarettes, only to return after all those kids were killed in a fire?

and, more globally...

Why would someone justify killing innocent men, women, and children in the name of some religion?

In your situation, like you said, clearly someone had come to the end of their rope- and for whatever reason, they could no longer cope with their problems. Unfortunately their "solution" did not work out as they planned it and they and their family must deal with the aftermath. Suicide- a permanent solution to an almost always temporary problem.

When I first met my wife, I would relate some of the funnier events I would see, and for a long time, she would ask "why" would someone do what they did. I told her there is no "why"- it just IS. When I first started out in the business, I realized the best way to "understand" someone's rationale in insane situations was to say that there is a subset of people who look at life, morals, and right and wrong from a POV 180 degrees off mine. Their "right" was my "wrong", and nothing I could say or do would change that.

We do the best we can- regardless of how futile or crazy it may seem- and let a "higher authority" decide on the outcome.

Ultimately, there needs to be an internal drive to do our jobs to the best of our abilities- we cannot operate on immediate positive feedback or recognition, - we'd never last a week in this business.

We do this because every so often, we get a thank you. We get an appreciative nod, hug, handshake, or occasionally a note from someone who's life we have touched in some way- be it a patient or a family member.

Hang in there, Kaisu. I know it's frustrating at times.

[Chief1C]

There are so many deep things that come to mind when people ask that, but there's something inside that just can't be put into words. The only word that comes close to what I want to say is, life. Hope that doesn't sound too cheesy or cliche.

[angeleyes921]

Wow, thank you for sharing. My heart goes out to you and the patient's family. I can understand how you feel though. Unlike you I live and work in a rural area...a community where we are all "family", so I have had my share of rough calls. But the most difficult was this last spring. We were called out to a 1 vehicle rollover with 2 known patients. On the way there, I went over in my head the MOI and that we would need air support. On scene I saw the pickup on its top and my daughter's friend from school impaled on a metal fence post. I rarely am shaken-up, but this cene made even me "the ice queen" gasp. He was still alive screaming and the firemen onscene trying to clam him. He knew he was in big trouble! To make a long very painful story short, still to this day everytime I close my eyes I still see his pleading face in my dreams. As for the question at hand, "why do we do this..." well, despite all of the bad calls and tough working conditions, I feel that we were put here on this earth to help people in the worst time of their lives. In my heart that is what helps me through each shift, each call... take care of yourself and remember you are not alone in this.

Greetings from the uncivilized part of the country. It was another one of those killer shifts. Three crews of 1 EMT and 1 medic each ran 37 calls in the first 24 of our 48. I finally got 5 hours of sleep at 9:30 the following morning when a supervisor called in a crew from the substation to get each of us some down time on the second day. The second half of the 48 was almost as bad. We went through 4 rotations after midnight.

The angel of death rode with us this shift. I personally had 2 die on me, and one (details to follow) lived despite our efforts to kill him. This is the one that bothers me this morning, a full three days later, so as is my wont, I am writing to expunge it and appreciate comments from all.

I had just returned from a call to the state prison, where a 25 year old inmate had shot himself up with a lot of heroin. CPR had been in progress. Long transport time, but this one is going to live. We get toned out for a gunshot wound in BF nowhere. This location is 40 minutes from our station down I-40, locale for desert rats and lean-tos. In this area, I have seen garbage piles that pass for residences, ran on patients with maggots infesting open wounds and 14 year olds beating up their grandmothers. Dispatch states "gunshot wound to the neck - the weapon has been secured." That's it - that's all I get.

We go enroute and I launch a rotor. 15 minutes into the run, I get an update from the BLS volunteer squad on the scene. There are a couple of new EMTs out there, which is a positive development because at least they still remember what they need to do, and are green enough to want to do it. I get "he's got no nose, no tongue, and we can't stop the bleeding."

I co-ordinate with DPS and BLS for landing the chopper, and it gets on scene about 10 minutes before I do. My EMT partner is tearing up the dirt road, he turns to me and says "I'm only doing this for you." He knows I want to get there, and he is driving faster than he normally does. The dust from these dirt roads is infiltrating every nook and cranny in the cab and the patient compartment, and he is going to have hours of work to clean this thing up, if we ever get enough downtime to eat, let alone decon a rig. (Our "management", 60 miles away, is based at a station that never runs on anything but pavement with half our call volume and 1 more rig, and writes us up when we turn over dirty rigs.)

I get on scene. The flight crew has moved the patient on a gurney into the BLS rig. The patient is a 77 year old man. He is in tripod on the gurney. I see accessory muscle use, and labored breathing. There is a seeping clot where half his face used to be. I immediately flash to that infamous picture in the Brady Paramedic text of the patient with a shotgun blast to the face and whom my esteemed instructor referred to as the walrus. I also immediately recall his first rule of wing walking: "Never let go of one thing before getting a hold of something else." This patient cannot be bagged because it's pretty hard to get a seal on hamburger. I also figure that if I see no identifiable external landmarks, my odds of identifying internal landmarks are pretty slim.

If it was my scene, I would hit the guy with some Versed and crice him. The flight crew is getting their RSI drugs ready. The flight crews around here are infamous for knocking down patients and then not being able to get tubes. I also note that there are no ACLS drugs in the rig (recall that it's a BLS rig). I turn around, go to my rig and get my drug box.

On my way back, I note the patient's son and granddaughter standing outside the rig. When I get back to the patient, they have given up on the tube and are cricing him. They get the tube in through a very nice hole in his throat and begin ventilations. The patient arrests. He is in a brady PEA. CPR begins and the flight RN is yelling at someone to get her ACLS drugs from the chopper. I draw up epi and pass it to her. As she is pushing that, I draw up the atropine. I hand that to her and she pushes it. I take over chest compressions. I get about 50 in and ask her to verify that she is getting a pulse with the compressions. She is. After about 2 minutes, we do a rhythm check. Patient has a pulse of 135 (um.. That would be the atropine) and a BP of 220/140 - um, that would be the epi. The Hs and Ts folks - when you cause hypoxia in a patient, if you correct that, you actually have a chance for ROSC from a brady PEA.

I take over ventilations (and custody of the tube) from the flight medic. He is pumped because he just got his first field cric. My supervisor is on the scene. (He had come out in the supe vehicle) and he secures the tube. Does a fine job of it too. Patient is now stable. The EMTs and the flight medic begin organizing the move onto a spine board (why he wasn't on it when they put him on the gurney is anybody's guess). My supervisor grabs the yankauer and begins to suction the hole in the guys face. "leave that alone" I tell him - "it's the clot". He grins sheepishly and stops. A few minutes later, the RN picks up the suction and heads for the hole in the guy's face. "leave that alone" I tell her - "it's the clot".

Bottom line, the patient is loaded onto the chopper and off they go. They had debated taking him into Kingman and I chime in with "no - get him into definitive care in Vegas. That's where he will need to be anyway". They contact med control and get the OK to take the patient to Vegas.

I am left on scene with my rig covered inside and out with dust, the BLS rig knee deep in trash and gore, and the patient's family staring at me and my blood covered gloves, jacket and uniform. I remove the gloves and the jacket and go over to the family. "Is he gonna be OK?" I tell him the patient has done a lot of damage to himself. He wont' be able to talk (no tongue), and I prepare them for the fact that he may lose one of his eyes and he has no nose. The son says "I wish I had known - if only… " I stop him and say "It's not your fault - there is nothing you could have done or not done." The son collapses weeping into my arms.

OK - so that's the story. Now I'm going to tell you what had me up this morning thinking about it. This patient has shit for a life. He got to the point where he put a .38 under his chin and pulled the trigger. If he makes it, and I'm pretty sure he will, now he's got shit for a life and no face. Tell me again why we do what we do.

Thank you for listening.

Wow, thank you for sharing. My heart goes out to you and the patient's family. I can understand how you feel though. Unlike you I live and work in a rural area...a community where we are all "family", so I have had my share of rough calls. But the most difficult was this last spring. We were called out to a 1 vehicle rollover with 2 known patients. On the way there, I went over in my head the MOI and that we would need air support. On scene I saw the pickup on its top and my daughter's friend from school impaled on a metal fence post. I rarely am shaken-up, but this cene made even me "the ice queen" gasp. He was still alive screaming and the firemen onscene trying to clam him. He knew he was in big trouble! To make a long very painful story short, still to this day everytime I close my eyes I still see his pleading face in my dreams. As for the question at hand, "why do we do this..." well, despite all of the bad calls and tough working conditions, I feel that we were put here on this earth to help people in the worst time of their lives. In my heart that is what helps me through each shift, each call... take care of yourself and remember you are not alone in this.

Greetings from the uncivilized part of the country. It was another one of those killer shifts. Three crews of 1 EMT and 1 medic each ran 37 calls in the first 24 of our 48. I finally got 5 hours of sleep at 9:30 the following morning when a supervisor called in a crew from the substation to get each of us some down time on the second day. The second half of the 48 was almost as bad. We went through 4 rotations after midnight.

The angel of death rode with us this shift. I personally had 2 die on me, and one (details to follow) lived despite our efforts to kill him. This is the one that bothers me this morning, a full three days later, so as is my wont, I am writing to expunge it and appreciate comments from all.

I had just returned from a call to the state prison, where a 25 year old inmate had shot himself up with a lot of heroin. CPR had been in progress. Long transport time, but this one is going to live. We get toned out for a gunshot wound in BF nowhere. This location is 40 minutes from our station down I-40, locale for desert rats and lean-tos. In this area, I have seen garbage piles that pass for residences, ran on patients with maggots infesting open wounds and 14 year olds beating up their grandmothers. Dispatch states "gunshot wound to the neck - the weapon has been secured." That's it - that's all I get.

We go enroute and I launch a rotor. 15 minutes into the run, I get an update from the BLS volunteer squad on the scene. There are a couple of new EMTs out there, which is a positive development because at least they still remember what they need to do, and are green enough to want to do it. I get "he's got no nose, no tongue, and we can't stop the bleeding."

I co-ordinate with DPS and BLS for landing the chopper, and it gets on scene about 10 minutes before I do. My EMT partner is tearing up the dirt road, he turns to me and says "I'm only doing this for you." He knows I want to get there, and he is driving faster than he normally does. The dust from these dirt roads is infiltrating every nook and cranny in the cab and the patient compartment, and he is going to have hours of work to clean this thing up, if we ever get enough downtime to eat, let alone decon a rig. (Our "management", 60 miles away, is based at a station that never runs on anything but pavement with half our call volume and 1 more rig, and writes us up when we turn over dirty rigs.)

I get on scene. The flight crew has moved the patient on a gurney into the BLS rig. The patient is a 77 year old man. He is in tripod on the gurney. I see accessory muscle use, and labored breathing. There is a seeping clot where half his face used to be. I immediately flash to that infamous picture in the Brady Paramedic text of the patient with a shotgun blast to the face and whom my esteemed instructor referred to as the walrus. I also immediately recall his first rule of wing walking: "Never let go of one thing before getting a hold of something else." This patient cannot be bagged because it's pretty hard to get a seal on hamburger. I also figure that if I see no identifiable external landmarks, my odds of identifying internal landmarks are pretty slim.

If it was my scene, I would hit the guy with some Versed and crice him. The flight crew is getting their RSI drugs ready. The flight crews around here are infamous for knocking down patients and then not being able to get tubes. I also note that there are no ACLS drugs in the rig (recall that it's a BLS rig). I turn around, go to my rig and get my drug box.

On my way back, I note the patient's son and granddaughter standing outside the rig. When I get back to the patient, they have given up on the tube and are cricing him. They get the tube in through a very nice hole in his throat and begin ventilations. The patient arrests. He is in a brady PEA. CPR begins and the flight RN is yelling at someone to get her ACLS drugs from the chopper. I draw up epi and pass it to her. As she is pushing that, I draw up the atropine. I hand that to her and she pushes it. I take over chest compressions. I get about 50 in and ask her to verify that she is getting a pulse with the compressions. She is. After about 2 minutes, we do a rhythm check. Patient has a pulse of 135 (um.. That would be the atropine) and a BP of 220/140 - um, that would be the epi. The Hs and Ts folks - when you cause hypoxia in a patient, if you correct that, you actually have a chance for ROSC from a brady PEA.

I take over ventilations (and custody of the tube) from the flight medic. He is pumped because he just got his first field cric. My supervisor is on the scene. (He had come out in the supe vehicle) and he secures the tube. Does a fine job of it too. Patient is now stable. The EMTs and the flight medic begin organizing the move onto a spine board (why he wasn't on it when they put him on the gurney is anybody's guess). My supervisor grabs the yankauer and begins to suction the hole in the guys face. "leave that alone" I tell him - "it's the clot". He grins sheepishly and stops. A few minutes later, the RN picks up the suction and heads for the hole in the guy's face. "leave that alone" I tell her - "it's the clot".

Bottom line, the patient is loaded onto the chopper and off they go. They had debated taking him into Kingman and I chime in with "no - get him into definitive care in Vegas. That's where he will need to be anyway". They contact med control and get the OK to take the patient to Vegas.

I am left on scene with my rig covered inside and out with dust, the BLS rig knee deep in trash and gore, and the patient's family staring at me and my blood covered gloves, jacket and uniform. I remove the gloves and the jacket and go over to the family. "Is he gonna be OK?" I tell him the patient has done a lot of damage to himself. He wont' be able to talk (no tongue), and I prepare them for the fact that he may lose one of his eyes and he has no nose. The son says "I wish I had known - if only… " I stop him and say "It's not your fault - there is nothing you could have done or not done." The son collapses weeping into my arms.

OK - so that's the story. Now I'm going to tell you what had me up this morning thinking about it. This patient has shit for a life. He got to the point where he put a .38 under his chin and pulled the trigger. If he makes it, and I'm pretty sure he will, now he's got shit for a life and no face. Tell me again why we do what we do.

Thank you for listening.

[Happiness]

We do this because we are good at what we do no matter what level we are.

We do this because of the ending of all the ones that survive not the ones that die.

We do this for our communities because with out us they would have no body to come and help when the need help.

We do this because god or who ever you belive in knows that you can do it, and do it well.

We do this because we are naturaly good people.

And you do Kaisu because you trained hard at something that you really wanted to be, so take thought in all the good ending calls you have had and try to file away the bad.

When you have time take a nice hot bath with bubbles, and crawl into a nice warm bed and have sweet dreams

[EMS49393]

We do it because it is our job.

Very few people could or would do it.

There is no shame in counseling sessions when you're at the breaking point.

There is no shame in needing the occasional sleeping pill.

There is no shame in needing a day off.

There is no shame in asking for help.

Figure out a fast way to deal with it. The more baggage you carry the heavier you are when you're trying to do your job and the less effective you become. You'll have to put these bad calls and shifts behind you and concentrate on continuing to do the very best job you can do.

Good luck, and consider a vacation day or two to sharpen your blades.

Edited December 7, 2009 by EMS49393

[HERBIE1]

We do it because it is our job.

Very few people could or would do it.

There is no shame in counseling sessions when you're at the breaking point.

There is no shame in needing the occasional sleeping pill.

There is no shame in needing a day off.

There is no shame in asking for help.

Figure out a fast way to deal with it. The more baggage you carry the heavier you are when you're trying to do your job and the less effective you become. You'll have to put these bad calls and shifts behind you and concentrate on continuing to do the very best job you can do.

Good luck, and consider a vacation day or two to sharpen your blades.

Well said.

[crotchitymedic1986]

This will sound like a smartas* comment, but it is not intended to be one: "Please stop working 48 hour shifts" ! I know you may feel as though you have to, but it is the quickest way to burn-out that there is. I have always told newbies that if you took a job that just required you to watch porn for 100 hours per week, it would not take too long before you would be tired of porn. It is no different in our job, and the long hours are just unhealthy. Please try to cut back, as there is a future full of people who will need you to respond in their hour of need; you may not be there if you continue to work this much ?

[Kaisu]

This will sound like a smartas* comment, but it is not intended to be one: "Please stop working 48 hour shifts" ! I know you may feel as though you have to, but it is the quickest way to burn-out that there is. I have always told newbies that if you took a job that just required you to watch porn for 100 hours per week, it would not take too long before you would be tired of porn. It is no different in our job, and the long hours are just unhealthy. Please try to cut back, as there is a future full of people who will need you to respond in their hour of need; you may not be there if you continue to work this much ?

Nothing smartass about it. We do not have a choice. Our shifts are 48 on, 96 off. If we don't like it, we can find another job.

PS.. we have surreptitiously collected approx. 90% of the signatures we need to bring in a union