911 - 101

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.
- 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.

No comments: