Monthly Archives: April 2008

>This morning, I woke up to this:

Technically, it is still April. But May is less than 24 hours away. The snowplows are scraping along on the road outside the cabin. For my part, I’m eyeing my skis and wondering if there is enough pack on the recently thawed trails for a last horrah.

>Sunday’s Fire Medic training was much improved. Our sponsoring doctor came in to discuss protocols and standing orders. We played with pigs feet, cleaning out nasty contaminated wounds with days of transport time and swelling between them and definitive care. We poked around one another’s ears and eyes with examination tools. One of the lecturers from last month’s EMS symposium came in and gave another excellent presentation on orthopedic injuries. Department folk were a little less standoffish this go round. My falafel and hummus was spectacular, and I spent lunch hanging out with another department medic’s dog Quark in the parking lot and chatting with Pete on the phone. Much better company.

One of the things I am most excited about with the Fire Medic program is that we have protocols and training that allow us to do a fair bit more care than our state EMT levels allow. The reasons are twofold. On a fire line, we are doing significant preventative treatment to keep fire crews healthy and mobile and on the fire. On the remote wildfires in Alaska and in a lot of western states (Idaho, Montana) transport times for significantly sick, burnt or otherwise wounded firefighters can be days, not hours. We have to be able to provide more significant, long term pre-hospital care to prevent complications later down the line. I think this summer will be an invaluable learning experience as an aspiring paramedic.

In other news, I passed the forestry pack test tonight with over three minutes to spare and three firefighters behind me. I was barely out of breath. I was elated. Hauling fifty pounds of sand up and down my neighborhood hills for the last several weeks has paid off. I even spent the last leg of the test chatting with a firefighter about his day-job as a 747 pilot and his dog team.

Back to the dog kennel tomorrow. Despite waking up to snow every morning for the last four days, things are clicking along towards spring.

>I woke up early this morning to attend the first of four training days for the Alaska Wildland Fire Medic program. On Monday, I will take the pack test – and endurance test that is one of two steps in earning my Red Card. In May, I will complete my Red Card requirements by passing four days of Emergency Fire Fighter training, and in doing so be given a green light to work on any wildfire line in the country. In June, when the fires start, I will hope for a call telling me that I have two hours to be at the helipad on the local army base to meet a lead medic and four hundred pounds of medical equipment. All summer, I hope to be camping in the smoldering taiga treating burns and dehydration and blisters and intestines plugged up by too many MREs. And maybe a cool chainsaw wound or two or three.

Sounds cool, right? But in order to pull this off, I have had to reign back my already dwindling kennel hours, despite the lack of training pay for the summer. I have also had to reschedule things with the Little Tour Company, where I am helping prepare a new crop of guides for their commercial driving test. I have had to do this a few too many times this week, as non-negotiable fire trainings keep getting shifted around. I am afraid that I am blowing my good will and credibility with the tour company and my friends there – especially the friend who helped me snag this training position. Also, around fire fighters at the station and medics at the training, the language and talk is loud and rough. Kayak guiding and deck handing on Resurrection Bay and working in a shelter in Chicago set me up well for this. But the corporate culture at Little Tour Company runs on a different track. I thought I was doing well going back and forth until I received a reprimand this week for using the word “freaking” in the staff room at LTC.

Then there is the reality of Fire Medic training itself. This first day consisted of fire-medics showing cool slides of flames in trees, billowing smoke and pretty vistas they have camped in while waxing on about this fire line and that fire camp and how much it rains and floods and how dark smoke is. Interspersed between these slide shows were acronym strewn arguments about the politics of helicopter procedures, ICS structure and lower 48 crews and assignments. These heated conversations meant nothing to me. I felt like Charlie Brown when the grownups talk. We only got to relevant medical stuff (debriding burns, dealing with AMS, how the pounds and pounds of gear is allocated) in the last couple of hours of a long day. Already over an hour behind schedule, it was given short shrift.

In addition, although the majority of those at the training were from my fire department, there was a clear inner circle of veterans of the program. I felt my friendly hellos rebuffed by folks I have been working and training with since January. It stung, and I got a little pissed. Although I packed a lunch to eat (peter made hummus and falafel, horrah!) I decided to cough up lunch money to eat with the group at the mess hall on base. I thought the cold shoulders of the morning were perhaps due to a lack of coffee. I was wrong. It was elementary school lunch all over again – both in food quality and cool-kid table politics. I could hardly believe what was happening. I will be eating my own pita bread tomorrow.

When I got home, I threw on my training pack and slogged around the neighborhood in the break-up mud. Peter and Nyssa came along for moral support. I have two days till the pack test and I am terrified of failing, especially in front of department captains and firefighters I’m trying to gain credibility with. By the time we got back to the house, snow had started spitting again. Is it going to be a long weekend.

>fuzzies, for the weekend. Spring is almost here, but there is still a foot of snow on the ground and frost-nipping evenings. Perfect cuddling weather. Or co-napping, at least.

>In my last five shifts at the station, I have not had a single call – not even to stand around with my hands in my pockets while the firefighters put out a dumpster blaze. As happy as I am that nobody is getting hurt (or abusing the system) in our district, I’m also a little frustrated at the rust that’s starting to build up on the edges of my brand-spanking-new skills. Also, there seem to be plenty of calls when I’m not around … so maybe I have some bad karma I need to work off.

In the mean time, I’ve been thinking about my first few calls and the steep learning curve I’m traveling towards having any sort of clue about what I’m doing back there in the box. They are things I’d like to remember when these first days of stumbling through the adrenaline and jitters of lights-and-sirens are through.

Call One, Lesson One –
Just because you could manhandle the gurney into and out of the ambulance in training does not mean you’ll remember which lever to push and which way to pull when there is a patient sitting on a stair chair in the snow waiting for it.
Homework – Spend the medic’s paperwork time in the hospital ambulance bay manhandling the gurney within an inch of its life. Then do it again at the station. And again in the bay. And again at the station. Until you can do it blindfolded.

Call One, Lesson Two –
If the troopers are there and the place has been torn to pieces, look before you kneel. Especially in the kitchen.

Call Two, Lesson One –
If the tones go off at five am for a bravo response, pee first.
Homework – The third time it happens should be the last, right?

Call Two, Lesson Two –
Have the bandaid out before you stick for glucose. Put the bandaid on while you wait for the reading. Because the reading takes just long enough for the tiny little finger stick to bleed all over the floor.

Call Three, Lesson One –
Just because you got checked off on what is where in the ambulance a month ago doesn’t mean you won’t grab the Pedi-MAST pants that live next to the O2 bag – instead of the Pedi Jump-Kit by the back doors – on your first Pedi call. Thank the EMS gods it wasn’t serious, and never, ever make that mistake again.
Homework – Get out the inventory sheet and do inventories of every ambulance, every shift until you can pinpoint everything – even ALS drugs and gear – in your sleep.

Call Three, Lesson Two –
Have extra penlights in the Pedi-kit. They make spectacular toys/distractions and you don’t have to make the kid scream my taking them back when you leave. Because the kid will scream when you take away the neat inflatable cuff.

Call Four, Lesson One –
Just because the patient ambulates himself to the ambulance doesn’t mean he won’t crash before you get to the end of the road.

Call Four, Lesson Two –
Grand Mal Seizures look scary on the cardiac monitor. Focus on the patient, not the monitor.

Call Four, Lesson Three –
If you take a pressure when the medic is sticking the patient in her other arm and the patient is screaming her head off about it, you will get a high reading.
Homework – Run Review: The elevated pressure had nothing to do with the impending seizure. Neither did the chest pain, although that’s what got her a fast pass into open heart surgery.

Call Five, Lesson One –
If you get on scene and an EMT you don’t trust is already there making an ass of themselves, a good lead medic will get them the hell away from the patient. Especially if the patient is critical. Homework – Do everything you can think of to make your lead medic happy for the rest of that shift, and the next shift, and the next shift, ad infinitum.

Call Five, Lesson Two –
If a spouse passes you a bucket of blood when you walk in the door and tells you it is the second one being worked on by your vomiting patient, expect to run hot. But watch and learn as Star Lead gets a solid history and exam before moving them, while the patient is still talking. Because two buckets means the patient won’t be talking for long.

Call Five, Lesson Three –
Contrary to what they taught you in class, if there is only blood in the bucket the ER staff doesn’t need or want to see it. Don’t bring it. It will piss off the nurse you hand it to, and it’s not worth the risk of covering the ambulance floor when the bucket tips. A good volume estimation goes a long way.

Call Five, Lesson Three –
If you focus on the skills you know and do those things fast and well, you’ll have done everything you can for the critical patient – even if you are still too jittery to take a step back mid-call and see just how critical that patient is.
Take Home – Practice what you know, and let the lead medics worry about how critical patients are. The ability to see the big picture – and act on it – in the middle of a crazy call will come.