Saturday, September 15, 2007

No, I didn't get abducted by aliens.

What Up, Blogland?
Sorry it's been so long... It's been one heluva year for me.
Working like crazy, a relationship, etc.

I'm working 4.5 jobs right now.
Still working for the Wolcott Hill Express (my hometown ambulance), the city Ambulance service ( just got active again back in July. Didn't have time to diddle around with the ride-outs, nor the motivation for a while. When you get hired or advance levels, you have to ride out with a crew for 5 shifts to make sure that you meet the uber-high standards here [sense any sarcasm?] So after being on my own with the WHE for almost 10 months, I finally did my ride outs here. I've worked some shifts since, I've also done standbys at the race track that we cover.), also back driving school bus again (talk about irony... I life-long homeschooler driving a school bus), I just got hired at a local pizza place as Delivery Driver/Kitchen Bitch (straight from the kitchen manager's mouth at my impromptu interview while I was there for lunch with a friend), and still occasionally working up at the bar.

"Adam, why the hell are you working 4.5 part time jobs instead of 1 full time job?", you ask.
Well, several reasons.

#1: Not a lot of worth-while full time jobs around here. Every one that I've looked at either has bad reputations as employers with how they treat their people, or they're specialty jobs.

#2: I'm working double-full-time hours with The WHE, but the pay sucks. But I also have no gas budget since i'm right in town anyway.

#3: I'm seriously considering moving out of state next year, therefore I am going to be doing some traveling over the coming months, investigating areas that I'm considering calling my new home. It's a lot easier to get time off from 4 part time jobs than it is 1 full time job. (I know, in the big picture, it isn't too logical, but I never claimed to be completely logical all the time.)

I was originally in a toss-up between Oklahoma and Montana, but now it's leaning toward Montana or Wyoming.

I was going to stay in NY and go to either Ranger School or get some environmental degree and try to get into a Fisheries Management job, but I'm really getting sick of NY. There is not a lot here. The economy sucks, a lot of the people suck (I know you get that everywhere, but NY has a special breed), and we're taxed and regulated to the point of strangulation here.

I was originally considering OK because a few years ago I had decided that if nothing was going for me here by the time I hit 25, I was either going to go work as an OTR truck driver or move to Tornado Alley, find work, and chase storms. OK started sounding even sweeter when I was told that they are practically begging for paramedics (who get paid appreciably better than here in NY), the cost of living is 1/3 less, plus... I could be a storm chaser.
Then I started wondering if I really wanted to trade Nor'easters, lake-effect snow, and nose-hair-freezing cold for Diaphoreses-caliber heat, Rattlesnakes, Scorpions, and the chance of getting sucked into the sky by a Hoover from Hell.

I still like the thought of storm-chasing and not having to deal with the crappy weather we are famous for here, but I don't think it would be something I'd want to do forever. I don't like oppressive heat. It can be near debilitating for me. If I can barely stand a NY 95 degree day, how the hell would I be operational in OK heat?
Montana is definately more up my alley. The mountains, the woods, the wide-open spaces... I've always wanted to visit MT and I am going to, sometime this winter if I can save the money for the trip. I want to go visit to see if it's just another hair-brained idea or if it's something that I would definately enjoy. I know it has the bad winters and everything, but the way I look at it is that it's easier to warm up than it is to cool down.
I'm still gonna visit OK next spring if I can swing it. I will be going to Texas in the next few months to visit an old friend that I haven't seen in about 8 years and just regained contact with, so that'll be cool, too.
There is a lot of investigating to be done for sure. I'm not making this move on a whim. I'm gonna have a job lined up before I move. I'm also going for my National Registry certifications next time a class pops up around here.
If I do decide on MT or WY, that'd be an awesome area to work as a Forest Ranger in, or to work in fisheries. I'm already daydreaming about flyfishing for trout in MT or WY. :-D

So, there's the trailer for the next year or so of my life. I'll update the plot and script as time marches on. I can't make any moves until after August '08, since the town paid for my Paramedic tuition. They didn't make me sign any commitments, but I decided to give the town and WHE 2 years of service as a paramedic as a bit of a Thank You for paying for my tuition. It'll most likely be early '09 before I do anything... Stick around for Christmas, move shortly after that. Part of me is hesitant about moving that far away from my family, you know? I love them and I don't want to be the missing face in the family photo, nor do I want to be the one who has to race cross-country to get home if something bad happens. We shall see what happens.

In other news, I'm single again. I have been for about 2.5 months.
I had mentioned a few posts back that I finally got myself a girl. It went great for a while. We went from meeting to being a couple over the course of 2 weeks and we were inseperable from the start. We spent pretty much every moment together for the first 3 or 4 months while she lived in town. Then she moved about 20 miles away to her parents' house things still went well for a while. The last month or 2 we were together, things were getting kind of stressful. There was a lot of BS going on that I'm not gonna get into tonite because I'm not in the mood to elaborate. Basically, things were still going tolerably (from my point of view, anyway), and she went from totally in love to "I'm feeling suffocated, miserable, I love you but I'm not in love with you anymore, blah blah blah" over the course of about 2 weeks. This was late in June.

I was devastated. She was my first relationship, things looked great... i was planning on proposing in February, actually. Now I'm glad I didn't jump the gun and do it sooner. I've had a personal ground rule for a long time that states that new relationships (from meeting to engagement) require a year and a half before popping the question, to really get to know the person, etc. There are exceptions, for example if it were someone I've known and been friends with for a while, if it became a romantic relationship it might not need as much time.

Anyway, I got to see some true colors in the last month or 2 we were together that I didn't really like, plus there was other stuff that I'd been ignoring (i'm sure the same is true the other way around, too).
I actually did alright getting over it, for the most part... Aside from the part of drinking a little too much... I drank more in the month after we broke up than I had the entire previous year, possibly longer. I didn't spend the month in an alcoholic haze by any means. I had several times where I got markedly intoxicated, especially in the first 2 weeks, but after that it wasn't bad... somewhere between social drinking and a good buzz a few times a week.

I've been really good for the last month and a half or so. I can look back on it without getting misty-eyed or depressed and I can actually enjoy the memories that we'd made. We still talk from time to time, we've met up for C&C (Coffee and conversation) a few times. The first few post-breakup C&C's were rough afterwards... Seeing her made everything fresh again and would put me in a funk for a few days. The last time we had C&C though, it was good. I was good with it during and after, it didn't throw me into a funk or anything.

The first month and a half or so was definately a roller-coaster. I'd have good days and I'd have really really really bad days. Some people say that if they could go back knowing what would happen that they'd never let it happen to begin with. Not me. I learned a lot of things while we were together and after the break-up. My self-esteem shot way up and I've got a ship-load of great memories. Not only were we a couple, we were great friends. She even says that still, after the break-up. Being able to talk as friends is good. I still have my moments where I'm like "WTF, man..." Sometimes I get a little perturbed, sometimes a little wistful and "what if" and all that, but I know it's best in the long run.

Actually, the night she broke it off between us, as absolutely devastated as I was, I breathed the biggest sigh of relief through my tears on the drive home. It felt as if a huge weight was lifted from my shoulders. As I look back, I see a lot of things now that I wasn't seeing then, both in me and in her. Things that other people were seeing that I either wasn't seeing or was ignoring, stuff that I'd shrug off when it was brought to my attention... You know how it goes.

So I'm single again and I'm actually enjoying it. The alone time, the freedom to do whatever (within reason, of course), the sudden and quite relieving lack of drama in my life, all that good stuff. In the meantime, I'm just cruisin. I'm not searching for another relationship, I'm not out hooking up or dating around, nothing like that. I'm not getting serious again unless I'm pretty damn certain that there is long-term future potential. Besides, my "game" sucks, anyway. LOL

I think I've typed myself out for one night. I'm at the City ambulance, working a semi-unexpected overnighter. I'd signed up to work the races Friday and Saturday. Friday night went well, Saturday (yesterday technically) was iffy. It rained all night and into the early morning Fri-Sat, so they spent a few hours working the track to get it raceable (it's a dirt track), then they had the hot laps and the heats for qualifying, then just before the feature race (a 200 lap race), the skies opened. So we sat there doing nothing for several hours (if we leave, the race is called off because they have to have an ambulance there, so we stayed until they told us to leave). A little before 2100, they decided to call off the race and hold it Sunday morning at 1000. So we watched the fireworks and came back to quarters, after which I was planning on going home, throwing my uniform in the wash, and going out for a little while to check out my favorite local bartender. :-P
Jumping back a few days, one of the paramedics who was supposed to be on tonite had called and asked if I'd work for her when I got done with the races. She said she had another call into another one of the ALS guys, and she'd let me know if she ended up needing me to cover for her.
Well, she never called me back, so I assumed that the other guy was covering.
As I went to punch out tonite, the shift supervisor looks at me and says "Aren't you staying?"
I said "I wasn't planning on it.
He said "Amber (not her real name) said you were gonna work for her tonite."
I said, "Really? I said I'd work if she needed me and to call me to let me know for sure, but she never called back so i thought she had the shift covered."
Eyes then rolled as most of the guys on duty tonite made some comments and I said "No problem, I'll stick around, i just didn't know I needed to"
So here I am working the overnighter, then working the race, hoping someone will relieve me at 1430 if the races are still going on, because I have to work the delivery job at 1600. Fun stuff.

Ok, enough typing for one night.
Again, sorry about the absence, I hope all is well with everyone!
Be safe,

Saturday, June 02, 2007

My 1st code

Yes, it happened. I've actually had 2 so far, but we'll just talk about the first for now.
I was working on the Wolcott Hill Express one fine evening when my pager went off for a 37 y/o male in seizures in the next town north (one of the 3 towns in our first due).
I knew pretty much right away that if he was still actively seizing we were going to have to call for a link-up (still no narcs...). I got to the fire station and waited for the rest of the crew, Mike and one of our Basics. We called en route and headed north (about a 7-10 minute trip). About a minute out, FD got on the radio and told us that the pt was still actively seizing, and had been for almost half an hour. WTF. He seized for 20 minutes prior to the family calling 911. We grabbed our stuff and started heading into the house... The fire chief met us half-way across the yard, making the "Glove up" motions... Then told us that the pt had HIV and Hemophelia. Nice. No extra pressure there...

We got into the house and sure enough, this scrawny, sickly looking guy is on the floor flopping around in a grand mal seizure, eyes wide open, foaming at the mouth. We got the info on what had happened, put him on a blanket (couldn't get the stretcher in the house) and carried him out to the stretcher. Before we left the house I asked the family where they wanted to go... they said Syracuse. I said No way, not in his condition, pick something closer. They did and we headed outside. We got him in the rig, got him on the monitor, got an 18 ga to the AC on the 1st try (thank goodness). I told the driver to call for a link-up for narcs and we got moving.
I felt kind of helpless, because all we could do was monitor his airway and his condition... Breathing was adequate, sounded like he aspirated a bit... Monitored pulse, rhythm, resps, etc. He was still seizing, staring straight at the ceiling with this wide-eyed look of terror... It was chilling.

About 15 minutes into the transport, he suddenly stopped seizing. I thought "Well, this is a good thing!" Then I looked up at the ECG and said "Oh fudge, that is not a good thing at all..." A very irregular bradycardia. He had a relatively normal rhythm and pulse rate up until that point.
I jumped up for the Atropine, pushed it, flushed it.... Annnnnd he went asystolic. Dammit.
I looked back at him and i actually saw his lights go out... His body just went limp, his eyes almost closed, and his face went completely slack.

I jumped up, grabbed the box of code drugs, grabbed the airway kit, grabbed a BVM, and told my driver that we now had a code. He asked if i wanted to cancel the link-up rig and I said No way, I could use an extra set of hands.
I pushed Epi and another Atropine, I did some CPR, then handed the BVM and the compressions off to my partner while I set up the ET Tube kit.

I got everything set up, donned safety goggles and a mask, and then went for the tube. His throat was full of fluid so I suctioned him out and saw his vocal cords, dropped the tube, inflated the cuff, hooked up the BVM and verified the tube placement. In the middle of getting the tube, we met up with the other rig and their paramedic jumped on board with us just as i was dropping the tube in. He took over CPR and asked what the story was.

After a round or 2 of Epi and Atropine, the pt went into an idioventricular rhythm, but nothing more, no pulses.

We got him to the hospital, gave report, they worked him for a little while longer, then called him.

I went outside after leaving his room to have my post-code smoke, wrote my paperwork, then we headed home.

Not too bad for my first code as ALS, i thought... other than him coding in the first place, there were no major snags as far as codes go.

Thennnn, i got home. My girlfriend called me and said "You need to call Paul (a friend of ours). That was a really good friend of his and he's really broken up." Crap. Not only was I bothered a little because this call was the first time in my life that I actually watched someones lights go out, but it also had to be a very good friend of a good friend of mine.

Over the next several days, I found out that pretty much everyone that i associate with in town was friends with this guy. It was kind of hard... Seeing them so upset, wondering what was going on in their heads, if they were blaming me in any way for this guy's death... It took me a little while to get over that and not feel uncomfortable around everyone. I knew I couldn't talk about it because of the HIPPA shit... All i could and did tell them was that I did everything that I could possibly do for him.

My gf was friends with him too, so I wound up standing in a corner at the funeral... After the funeral, I got a bit of a laugh. Joanie (my gf) was talking with our friends Paul and Missy, so i went over to them and chatted with them for a few... And suddenly I smelled something peculiar. All 4 of us looked at each other and I asked "Is that what I think it is?" We looked around and saw the source of the herbal odor... A circle of people around the casket, in the funeral home, passing around a bowl.

My pt had been a dedicated stoner and usually took in loners, gave them a place to crash, befriended them... so he had a pretty tight circle of friends. And in his honor, at his funeral, they gathered around his casket and lit one up. For me, it was an interesting combination of touching, comical, and disbelief.

Friday, March 16, 2007

Hey dude, that ain't the bathroom...

That title is words of wisdom that a patient of mine should have heard before he went and made himself the first pucker-factor trauma pt of my paramedic career.

I thought my Cardizem guy got my pulse rate up a bit. pfft. I have learned over the last few months that I, unlike many EMTs and Paramedics i know, am not a trauma junkie. No sir, no how. I do not like trauma. I know it's relatively simple... Airway Airway Airway, secure the spine, large bore IV's, pump some fluid into them, do your exam, evaluate extent and possibilities of injuries, patch em up, etc etc etc. Still, I do not enjoy trauma at all. Give me a cardiac call any day of the week.

I was hanging out at my girlfriend's house by the fire station when my pager went off for an "Injuries from a fall down some stairs, bleeding from the ear." Hmm... this could be interesting.
Mike (the best damn driver in the world) and I got to the station at around the same time, but no one else was showing up. We waited for a minute, then I called home to mommy (because she just happens to be the scheduler and I wanted to see who was on with us). Well, the EMT who was supposed to be on with us no-showed so we said screw it, we gotta get going. If she decides to show, she can meet us on the scene. On the way to the call, Mike called another one of the EMT's with his cell and asked him to meet up with us. Mom also volunteered to join up with us if we needed her. So anyway, the call was just outside of the village by not even a mile so we were there quick.

Mike and I got out, grabbed our stuff, and started walking in. Near the door, one of the 3 or 4 people who were there said that he was in the basement. I walked in the door with the backboard and related equipment and followed the directions to the basement door.

I reached the top of the basement stairs, looked down, and promptly thought, "Ohh, Shit..." as my pucker factor went into overdrive.

Looking down the stairs, I see a man and a woman holding the arms of a good sized fella who is posed with one knee on the floor, one foot on the floor (like he was trying to get up), one arm on the womans shoulder, and the other hand on the stairs. Any hopes for a minor case of "Fall down, go boom" went out the window as I realized this guy was about 1.5" from FUBAR.

He was looking up at me with Bad Head Injury Eyes. You know the look. The wide-eyed, terrified, glazed over, lights-are-on-but-nobody's-home look. And he had blood all over his face/head. And shoulders that were soaked with blood.

I made my way down the stairs and asked what happened. Apparently, this guy had had 4 or 5 beers over 2 or 3 hours, needed the bathroom, and since he was at a friends house, he didn't know where the bathroom was (I'm sorry, but that's one of the first places I look for anywhere I go. That and secondary exits.) Well apparently, this guy grabbed the wrong door.
Instead of door #1 (the throne-room of the porcelain princess) he grabbed door #2 and entered without looking. And backwards, I believe. Problem with door #2? Door #2 causes your 6'2", 260 lb ass to fall down 13 rough cut wooden stairs headfirst onto a bare cement floor. Yeah. Ouch.

I took a look at this guy and the more I looked, the more my stomach dropped. A large, bright red and bleeding goose egg (ostrich, maybe) on the back of his head, copious amounts of blood coming from his ears, running down his neck, soaking his shoulders... No CSF that I could see though.
I began trying to talk to the guy, to calm him down, to get him on the backboard... Well, he didn't want none of that. He wanted to get upstairs. We were trying to calm him down, hold him back, trying to do a standing take-down. The more we tried, the more combative he got. His wife was standing in front of him with her hands on his shoulders, trying to calm him down... I realized for certain how seriously screwed this guy was when he began looking over her shoulder, yelling her name.

We finally got him on the backboard, then he really started fighting. We eventually got him strapped down, immobilized, hands secured... Then all of a sudden his LOC dropped. We got him up the stairs, out into the rig... by then, he would respond to verbal, just barely. As we were loading him into the rig, I was standing by his head when he chunked up some of the chicken noodle soup he had been eating earlier and sprayed me. Just luckin' fovely. Before we left, I called fire control and asked for a status on the trauma center. The replied that the trauma center was open. I told them we were enroute with a serious head injury and would call when we got closer to give report... We started heading for Syracuse to the trauma center and Mike asked if I wanted a helicopter, to which I promptly answered "Most definately!"

I was definately nervous. This guy was FUBAR'ed, and how. Anyway, we got him ALS'ed and were told the bird would meet us on the way there. He continued to vomit, we continued to roll and suction. Once we were settled in, it was pretty much chunk, roll, suction, monitor vitals. Pupils equal, sluggish, and dilated, by now responsive to pain only, resps were sufficient, pulse rate of 56, BP 150/P. Hmmm. Looks like we have the start of some Cushing's Reflex here...

By the time we got to the LZ (about a 15 minute ride), he was completely unresponsive. I had considered tubing him along the way as a precaution, but he was totally clenched. All we have for intubation meds is Etomidate, which I've been told is sketchy in trauma scenarios... plus Etomidate will only keep him under for a few minutes, and I had no Valium or Versed (long story there).

We were at the LZ, I turned around to do something, and the EMT said, "Hey Adam, is he breathing?"
"He was just a minute ago..." I look... Oh, fudge. He's not. Oh wait... he is... I watched for a second... Mr. Head Injury has just gone into Cheyne-Stokes Respirations. WTF. Where the hell is Mercy Flight??? I grabbed the BVM, started bagging, and a firefighter stuck his head in and said that the medivac was on final approach. Sweet. A minute later, the flight crew jumped in, saw the bagging, raised the eyebrows, and started getting all their supplies and drugs out as I gave them the report.

In goes the Lidocaine, in goes something else, in goes the Succs. Flight medic goes for the tube... Nothing. Tries again, Nothing. After the 3rd unsuccessful attempt, he breaks out the Blue Stick (not the technical name, just what I call it). Blue stick goes in and I felt it in his trachea and told the flight medic so. He pulled the stylette out of the tube, slid the tube over the blue stick, inflated the cuff... Chest rise and equal lung sounds. Sweet! Wish I could use that lil gadget...

We got him loaded into the bird and they took off. We then got the nice task of cleaning and disinfecting that comes with trauma calls.

The next day, my suspicions were confirmed. Massive Basilar Skull Fracture. One of the paramedics I work with told me the guy had pronounced Racoons Eyes and Battle's Sign the next day.
Things were iffy as to his chances for a while, then I didn't hear anything more.
I did find out recently that he is home. Not sure how much of a lasting effect he has from it, but he is home.

That call officially blew away my white cloud.

I've had several other calls worthy of writing about, but i'm just going to post this one for now... I've been pecking away at this post for way too long, a little here and a little there... I'll write more soon.

Be safe!

Monday, January 08, 2007


How come when you think you've found a good thing, sometimes it just totally lets you down, or you let yourself down, or it turns out it wasn't meant for you???
That's what has bouncing around my head for a good week now... And here I am, on the brink of letting the dispatch job go...
It started out pretty good... I started in September, working 1600-0000. The learning process was fun... going from watching to doing helped me learn a lot more. I was slowly getting the hang of it as time went on. My trainer was good, pointed me in the right direction, gave me a load of help...

Then I went to nights. Not bad, kind of tough to get used to, and usually very quiet. Which was good and bad. Good because it was a slower pace most of the time, gave me more time to learn the intricacies of the job, etc... bad because it is quieter, so you don't get the repetitive learning mechanism in motion as much... things are more spread out, but usually when something happened, it was big. One time we had 25 or 28 cars headed to one incident... Big fight at the city college, (the city that has its own dispatch center)... City PD showed up, called us, and basically screamed for every available marked car in the county... he got all but 5. 3 town cars, 1 sheriff, and 1 trooper were the only cars that did not respond due to location or being tied up on something. Every time a car arrived, we heard "KEEP EVERYBODY COMING!!!!!!!!!!!!!!!" until they finally calmed the riot down... well, near riot anyway... 300 people in a college dance who didn't wanna leave, 20-30 of whom got violent and started to brawl...
Anyway, nights went ok. I was having a few snags here and there but was going ok for the most part, my trainer was great, etc...

Thennnn, I went to days. Within a few days of being assigned to B-lines (0800-1600) I felt the beginnings of a slow downward spiral. I was convinced that my trainer was the Devil's red-headed stepchild. (Not really. She is however, one of the most venomous, bitchy, nasty, rude, condescending, unhelpful, monkey wrench-like, abrasive wenches I've ever met.)
No help from her at all. I actually went backwards. In her eyes, everything I had learned before her tutelage was wrong and she had no problem burying her claws in my ass and hissing or screeching in my ear that she thought so. I could not do anything right. And everything I was doing was the same as I had done on the other shifts without problems from anyone, even the picky perfectionists. So here I was, basically relearning the entire job because this witch was on a power trip.

This spiral of apprehension and dread continued up until about a week and a half ago when after one particularly nerve grating day, I snapped. I held it in until she left, just slowly blocking everything else out, trying to get that last 40 minutes out of the way and over with. After she left, I went to leave also, then decided to grow a set of cojones and talk to the supervisor. I called her into the hall and just unloaded everything. Told her what was going on, that I could not take this anymore, that I did not want to fail at this job, but that I couldn't take the wench's badgering anymore. The next day of work I was with the supervisor and everything was peachy keen... for a few days.

I began looking inside of me, objectively at my performance, trying to figure out what went wrong... I felt dumber. I felt more useless and clueless than I did when I first started, except now I also felt like I was sitting there cross-eyed and drooling, and I was feeling very inadequate.

Then, my feelings of inadequacy was confirmed when I was pulled into the office of our new Assistant Director ( A Sgt. with the Sheriff's Office) and informed (fairly and matter-of-factly) that I was behind the curve of where a new dispatcher with my time in so far should be and that my training was being extended a few weeks. I should be just about ready to be cut loose of trainee-hood by now and sent into the insane, confusing, and frustrating world of dispatcherland with no leash. But, I am not ready for that yet, I was told, to which I totally agreed. That conversation got my "Plan B" wheels turning hard.

What to do, what to do....????

I decided yesterday, after a solid week of deep consideration, brainstorming, and trying to work out every angle that this job was not meant for me.

Then I began to think of the last year or so of my life... Giving a year of my life to paramedic training for what? So I could sit behind a radio and send all the other paramedics to jobs and let my skills rot? So that I could say "See, I told you I could do it!" and then neglect everything that I learned? I think not!

So Today, I began the hunt. I stopped by 3 ambulance companies. I was told by 2 that they didn't think that they were hiring but it's always good to have an application on file. I also went to the ambulance Co. where I did my ride time for paramedic class. There, I was told that they "May just be hiring", filled out the app, and left. I was hoping to talk to the bosses, but one was off today and the other was out and about. I did get to say hello to my preceptor and some of the people who were on when I was going my time... hung out and chatted for a few and then left.
I've also heard of 3 other ambulances that are hiring "Within Range" (not too far of a commute).
I could be pretty much gauranteed a job in Syracuse. However, I really don't want to go there. I know a guy (works for QVA and Syracuse) who, when I spoke to him a little while ago about a lead he was looking into some time ago, went into recruit mode, telling me the 43 reasons to go to Syracuse. I'm sorry, but I don't want to work in Syracuse. I will if I have to, but i'd rather not, given a choice.

So here I am, blogging instead of searching the net for opportunities. I'll be signing off of here shortly and starting the search for paramedic employment...

This sucks though... So many doors were opened for this job, I figured this was it...
I've known for a while that this wasn't for me to retire off of though... I knew that within a month of starting my training.

On to Plan B...
Get a paramedic job full time, start working my butt into shape, go back to school for Criminal Justice, try to get into ENCON (NYS Dept of Environmental Conservation Police), then hopefully eventually go to the Ranger School and get into the NYS Forest Rangers.
That's the plan anyway...

Other than yet another job fiasco, life is great.
I have an awesome girlfriend, if I didn't mention it last time... Things are going great. She's pretty down to earth, tomboyish, likes the outdoors almost as much as I do (some of our best dates have been hikes and nature drives...) and to top it off, we can actually hold intelligent conversations with each other. It's great.

Well, time to start looking for job options in the paramedic field.
Be safe!!!

Wednesday, December 06, 2006

Still alive!

Hello all!
Sorry for the absence. Life has been pretty crazy lately. Much has changed since August! I'll be writing soon to fill in the blanks there.

The purpose of this post is to announce with pride that my Paramedic Cherry finally got popped.
I've had a fair amount of run-of-the-mill calls since i got my card in mid-August. Quite a few BLS runs, and quite a few simple ALS runs. You know what I mean; O2, IV (usually a saline lock), ECG, check blood sugar, keep em comfortable, and have a nice cruise to the hospital. I've had a few that induced a mild pucker factor, but nothing that seriously puckered me up or tested my knowledge retention.

Well, that changed the other day. I've been running a pretty stupid schedule for the last month or so... 0000-0800 at dispatch, 0900-1800 or 2000 at QVA, and just praying for peaceful days so i can sleep before I have to go back to dispatch. I've had a few days that were busy and I got diddly for sleep, but for the most part it's been ok.

Anyway, I got home from work on Monday morning, slept for a few hours. A while after I got up, I had to go into town for something. On my way back, I was coming around the corner about a block up for the fire station when I heard "QVA, EMS".
"Well, this is convenient, I'm right here already."
---QVA, Medical Emergency, 12345 Back Rd., 70 y/o male, Possible Cardiac---
*Yawn* "Yep. ECG, IV, O2, check blood sugar, maybe some Nitro and Aspirin, transport, etc etc..."

The other 2 members of my crew answered up. One of whom is one of the best Ambulance Drivers you'll ever see (Before you all gasp and start calling me names, he is actually strictly an ambulance driver. Was an EMT once upon a time, but now just drives. And boy, can he drive. It's a lot more comforting when you hear Mike answer up, especially when the weather is bad. The guy gives one heluva smooth ride and he can also whip the ponies very effectively and safely when he needs to). The other crew member was an EMT who has a history of issues. Some of these issues include agitating fragile situations, not following directions, etc. Nice woman, but has a history, ya know? So right there, a small part of me groaned and hoped for a BS call. We all got to the station and went on our merry way, over the river and through the woods, to cardiac's house we go...

On arrival, we backed into a nice snowblown driveway (we picked up some accumulation the other day... this locale had 10-12 inches.) I assigned the crew to get the Monitor, Airway bag, and stretcher while I went in and got the scoop.
I knocked on the door, heard "Come in", and went in. To my left sat an elderly gent, a little on the heavyset side, sitting on a recliner with his hands on the arms in a tripod position of sorts. He was obviously short of breath and a bit on the pale side.

This is the conversation and sequence of events that followed:
Me: "Hi, I'm Adam, I'm a Paramedic with the ambulance, what's going on today?"
Him: "Well, I'm having a hard time catching my breath, my chest feels funny, and my blood pressure is acting weird."
Me: "Define 'weird'."
Him: "Well, this was my last one, I took it with my machine here," pointing at the bottom set of numbers on a legal pad.
Me: *Looks down at legal pad and sees 72/52, eyebrows promptly raise, I reach for his wrist for a radial pulse... nada. Reposition... Nada. Hmmmm... Put on my ears and listen to his chest... clear lung sounds in all fields, heart sounds are kinda quiet and kinda fast. Couldn't tell how fast, but it sounded a little Tachy.*
Him: "Then I took it just before you walked in and my machine said 'ERROR'"
Me: "Hmm."

At this point, my crew walked in. I promptly reached for a BP cuff and directed the EMT to get the monitor set up for me. Inflate cuff to 160... 150, 140, 130, 120, 110, 100, 90... Nothin. Eyebrows start to crunch as I drop past 80, 70, 60, still nothin. I hit 50 and suddenly I heard a sound that instigated one intense pucker factor; "beepbeepbeepbeepbeepbeepbeepbeepbeep." "Please let that be a pager ," was the first thought to cross my mind. Alas, it was not to be. I looked at the cardiac monitor to my right and saw a bright green "200" over a picture perfect narrow complex tachycardia.

"Feces," I thought. "Thiiiiisss is gonna be fun."

Driver has been around long enough to know good from bad on ECGs and I see his eyebrows raised also. "You did bring your lead foot with you today, right?" I quietly ask, to which he smiles and nods. Sweet.

"Sir, which hospital would you like to go to?" *Please say RMH, please say RMH, please say RMH* (I'm not too fond of RMH, but it is the closest facility at a distance of 20 miles and pretty much a straight shot from QV to there.)
"RMH," states the patient.
"Good choice," I said to Pt. To EMT, I said, "Mike and I will load him up and get him outside, I need you to go set me up an IV start kit, a line, and get the Adenosine out." Off she went after she finished putting him on 02, Mike and I got him loaded up and carried the stretcher down the porch stairs, then wheeled him to the rig.
The EMT was still spiking the bag for me. I rechecked his radials, very weak and very fast. At least I can feel them now, I thought.

I reached across to the opposite bench, grabbed an 18 ga, a tournequet, gauze, alcohol prep, and the venigaurd (the clear sticky piece of plastic we use to secure IV sites.) On goes the tournequet and after a few seconds I started looking for an AC. (Antecubital vein. It runs under the surface in the crook of your elbow, its a good size vein.) I could just barely feel it there. I prepped the site, took a deep breath, crossed my fingers, inserted the needle... Flash! Shweeet!
This was the perfect night for a successful first stick. Got it hooked up and it flowed beautifully. I know sometimes AC's can be positional but this baby was flowin no matter how the arm moved.

Once the IV was in, I again asked for the Adenosine and was promptly handed a small brown glass vial. Phenergan. WTF. Tell me we're not setting the tone here...
"Nononono. Adenosine. White boxes, one with a red end, 2 with yellow ends."
Next I'm handed a box of Lidocaine. I start to get up to get it myself when they finally found it. They also set me up some 10 cc flushes. Come to find out, the drug shuffle was the only issue of the whole call. We really did have a good flow going among the crew and the EMT was actually keeping her head on straight today. Sweet.

I told Mike that we were good to go so he hopped up front and took off. I got the first Adenosine dose (6mg) set up and told the EMT to squeeze the IV bag hard when I told her to.
I gave the guy the Adenosine prep speech (you might feel funny, you might get dizzy, your chest might hurt for a minute, but this should make you feel better), hit 'Record', kinked off the line, slammed in the first 6mg of Adenosine, slammed in the flush, and told EMT to squeeze. Looked at the monitor.... Holding steady at 196. "Ok, not uncommon for the first 6 to be ineffective, lets go for 12." Got the next dose of 12 mg ready, record, kink, slam, slam, squeeze... Nada. Didn't even skip a beat. WTF. All of a sudden, pt says he feels a little better. BP is 118/72 with a pulse rate of 190. Nice. He also had about 400cc's of saline in by then.

Ok, 3rd dose.. Set up for the final 12 mg, record, kink, slam, slam, squeeze... Whats this? Brakes! Rate slows down to 133, plateaus, then climbes back up to 188. Dangit.
Then just to confirm what I was thinking, I pulled out my protocol book...
"For Narrow Complex Tachycardias >150 bpm, Immediate Syncronized Cardioversion is indicated. You may attempt a brief medication trial. For NCT's <150, cardioversion is usually not indicated."

Dammit, I do NOT want to have to zap this guy without Valium or Versed, but he is still haulin
ass, completely refractory to the Adenosine... Hmmmm. HEY! We just got Cardizem! And everything about this guy is stable except for his rate...

So I called Resource and asked for RMH. Once I had RMH on the phone, I gave them the scoop, told them his current vitals, told them that he was refractory to the whole series of Adenoside, that cardioversion was the next thing on the protocols but this guy was pretty stable, and I mentioned that we now have Cardizem. I was told to stand by.
A minute later, they asked if I had Amiodarone.
"Yes, I have Amiodarone..." *Why the hell do they wanna know if i have Amio?*
"Oh wait, QVA, Standby again."
"QVA, is it wide complex or narrow complex?"
"Narrow complex! *I already told you SVT-narrow complex, knucklehead*
"OK, Stand by again..... QVA, do you have Cardizem?"
"Why, Yes I do!"
"Ok, standby again...... QVA, per Dr Soandso, Give the pt 20 mg of Cardizem IV over 2 minutes."
"Copy RMH, Per Dr Soandso, 20 mg Cardizem IV over 2 minutes, we're see you in 5-7 mins."
"That's affirmative QVA, transport and advise, we'll see you when you get here."

So out comes the Cardizem. Mixed it up, shook it up, looked it over, plugged it into the line, and slowly started pushing the plunger, keeping an ear on the monitor. About 10 mg into the dose, I heard the monitor slowing down. I looked over and saw that we were at 165 and dropping. Sweet! It progressively made its way down to 100 then started bouncing between 130 and 90. Once the whole dose was in, the rate danced around for a minute and then settled down at 96 and regular. I looked at our pt and his eyes were kinda wide as he took a deep breath.
"I bet you feel better." I said.
"Wow, Do I ever! Can I go home now?" he asked with a laugh.

By this point, we were almost at the hospital and we took another set of vitals: 124/62, 96, 18. B-E-A-U-tiful! I like this Cardizem stuff! We took the guy into a room, transfered him over to their bed, gave report, then started writing, had the Doc who gave me the order for the Cardizem sign my PCR, talked to him for a few minutes, finished up, and off we went. Of course, I forgot to turn in the hospital copies of my PCR's so we had to turn around about 10 minutes away from the hospital on the way home to drop of the paperwork. I was happy thought. If forgetting to turn in my paperwork was the worst thing that happened out of that whole call, it was a damn good night. And my EMT was great for the whole call. Every time she checked his vitals she checked his lung sounds. Fantastic.

So that was my first real pucker-factor call with me in the role of lead. And I didn't even screw anything major up. I was a little nervous about my first big call, but all turned out well and I remembered just about everything I needed to, so hopefully I can continue to do alright.
No codes or other major shit calls yet *knocking hard on the desk* So far so good!
Well, I will sit down sometime in here and fill y'all in on current events soon.
Take care!

Monday, August 28, 2006

The light at the end of the tunnel!

The light is a new career and the tunnel is my less-than-impressive resume spanning the last several years. The last few years have seriously sucked, job-wise.
I worked in a convenience store on grave shift during college, quit that job to come work for QVA (which is the one thing that has been relatively steady for me) and because I was moving back home, then in '04 i got a job working at a furniture factory near here. I turned down a security/EMT position at the casino because this job was closer to home. Then I kind of kicked myself because the factory job lasted 8 months, then I got laid off due to a sales slump. Looked back into the casino, nothing open. Looked into the R.M. Syracuse, also kept looking locally for work. I got hired on at a Marina/Bait and Tackle shop, then a week before that was to start, RM called me for an interview. So I weighed my options: $8.50/hr 15 miles from home, or $8.00/hr starting pay 45 miles from home. I took the closer option.

A week after I got hired, they decided to tell me it was a seasonal job. The place is open year-round, but only 2 or 3 people, the manager included, work there during the off-season.
When the end was getting near, I looked back into the casino. I got shot down from there because they didn't like the fact that I had a fair amount of Saturday classes for paramedic class, and they told me to call back after class was done. Yeah, right. I'll get right on that.

I wound up getting hired as a Sub. Bus Driver for the school district I live in. That was relatively steady and quite interesting. So over this past winter, I worked for QVA, occasionally for VO (Just started doing my ride-outs that are required for new employees and new ALS providers. before that, I havent worked there in months... BS factor got to be too high and i felt i needed to concentrate on paramedic class more than I did being people's litter-box), and I drove Bus.

When school let out, I was stuck between a rock and a hard place. I desperately needed a job, but I had NO time available to get a full time job and still get my clinicals and ride time done. So I scraped by over the summer, working for QVA, then getting hired at the bar that I have frequented over the last year or so. That is quite entertaining, being a bartender in a redneck bar. Some of the stories I've heard and some of the people I've met... wow.
Anyway, i've been working there for a couple months, a few days a week, and it's helped. The main thing was that it is flexible.

Early this year I had to stop by the Administrative Office for the schools and on my way out, I took a glance at the bulletin board, which had a number of civil service exam postings on it. One caught my eye: Public Safety Telecommunicator. Hmm. So I looked into it, paid to take the exam, took it in March, and went on my merry way.

Then in June, I got a notice in the mail to report to the county office building on such-and-such day for the Typing and Information entry test. I went, passed it, and again went on my way

I got a canvas letter and the test results shortly thereafter. I scored a 90 on the civil service exam, which surprisingly put me in the #1 spot. I also comfortably passed the typing test. Well wouldn't you know it, I got that letter, went to MA to visit my Aunt and Uncle for a weekend, came home, and on the Tuesday after I came home, I sat down to fill out the canvass letter. As I was looking it over, my heart almost stopped. The time was 17:30 on a Tuesday. The canvass letter had to be hand delivered or postmarked THAT DAY. %$#@&
I was so mad at myself, because I had spent that whole day being a couch potato, then finally remembered the letter when it was too late.
The next day, I called the county Personnel Dept and told them what happened. They said that I was off of that canvass list, but if I sent in the canvass letter with an explaination as to why it was late, they would put me on the list for any future canvass. I did just that, then I spent about a week kicking myself over my laziness and blowing that job opportunity, then I got over it and decided to keep looking for job possibilities.

Fast-forward a few weeks. Guess who gets a phone call from the 911 Center, looking to set up an interview? That put me on Cloud 9. I went into my interview, found out that I was one of 4 candidates, and also the only one with any dispatching experience (Mom used to dispatch for one of the ambulances in an adjoining county before 911 came in, and when I was old enough I also signed on. Didn't do much dispatching because 911 came in just before I joined, but I got a few years of keeping track of the rigs, their times, getting crews together, etc etc.)
Anyway, the interview went well, the interviewer (who is also the head of 911, a county coordinator, among other things) told me all the stuff about the job, asked tons of questions... When it was over, he said they would be wrapping up the interviews that week and would be making their decision the week after that and would call to let me know.
Well, they never called. I didn't think much of it, I figured I either didn't get it, or else they were following the typical state/county hiring process (slower than molasses in February). A few weeks ago, I got a letter telling me to go to the county health office for a Visual and Hearing Acuity test. I figured that either it was just another part of the screening process prior to them making their decision, or else I had the job and they just forgot to tell me.
There was one girl there who had taken the test and we got talking. I asked if anyone had ever called her after the interview and she said that no, no one did, but she called the guy at 911 and bugged him after a week or 2 and he told her that yes, she had the job, Personnel must have forgotten to call. So right there, I got excited. She was #2 on the test, I was #1, and we were the only 2 there for the visual/hearing test.
The visual/hearing test was the day after the written exam for paramedic (So it was the 18th). Wednesday of last week, I got a call from home while I was working at the bar: There were 2 letters for me from the Dept. of Personnel. They brought them to me, i opened them, one was another canvass letter and the other was a letter saying that I passed the physical exam requirements for the job and was now eligible for appointment. SWEEET!
The next day, I called Personnel because I had a question about the canvass letter. On the front are 2 checkboxes. One says "Yes, I am interested in the position" and the other one says "No, I'm not interested". On the back are all sorts of particulars to check, and I wanted to make sure I filled it out right. I asked the woman at personnel what I needed to do on the back and she said "Nothing, just check yes or no on the front. I know for a fact that they want to appoint you to the position, and the only thing you use the back for is for future canvasses if you dont get appointed the first time around. So just check yes on the front and send it back to us, we'll get it upstairs, approved by the county board, send it to the 911 Center, and you should be hearing from them soon, it could be a few days, it could be a few weeks." I was almost dancing across the firehouse when I got off the phone with her. So I mailed it Thursday of last week.

I am really excited about this. I'm really hoping and praying that I can hack it as a dispatcher, because it is way past time for me to get into a career and get out of the dead-end-job pool.
I do have the paramedic card under my belt, so I can always fall back on that, but still. This job has county benefits, state retirement, starting pay of $23,381 a year, $30,000 at 5 years, and a really sweet vacation and scheduling setup. 8 hour days, 5 on 2 off, and each pay period the off-days back up one day. So if my first 2 weeks I have Wed-Thur off, the next pay period I get Tue-Wed off, then Mon-Tue, Sun-Mon, so on so forth. 2 weeks paid vacation per year, I get my 2 weeks the first year but I can't use them until I hit the 1-year mark, so when my 2nd year starts, I'll have 4 weeks of vacation that year. Then you have the usual earning of sick time and personal time.

From what they said in my interview, you don't get stuck on any one position, either. There are 5 spots on shift: County Law (State Police, County Sheriff, and multiple town/village police agencies) County Fire/EMS, City Fire, City PD, and Data (running VINs and licence info, backgrounds, etc.) and it rotates on a day to day basis so that each day you're on a different station.

Did I mention that i'm really excited about this? I am gonna make this work. This is too good of a shot for me to miss. I think I could definately stick with this job. It would take something pretty impressive for me to leave this job. As long as I can handle everything that goes with it, I don't see it being much of a problem. I've dealt with the on scene stuff for 7 years... I know dispatch can be just as stressful though. Probably more so, I would imagine. (What do you think, Wadical? Any advice?)

Well, it's getting late and i need to go get some coffee. Have a good night!

Friday, August 18, 2006

A case of whup-ass

I'm a paramedic, I'm a paramedic!!! We did it!
Mom, Stacey, and I all passed!!! QV's paramedic population has now doubled and now half of the paramedics for the ambulance have the same phone number. how cool is that!!! Plus from what mom said last night, we are the first mother/daughter/son combo in New York State to all get certified together.

Yesterday was pretty great overall. All but 2 of us from my class who were testing on-site met at the training center, hung out for a bit, had a beer (passengers only) then headed out to Albany.
The guys i rode with had gotten a hotel room so we just chilled there for a few, went to Applebee's, went back to the hotel, soaked in the hot tub for a few, then went to the testing site.
Near the end of the test i started getting a little edgy and had to consciously keep myself from getting lax and just whipping off answers. After 2.5 hours, went into the scoring room as a basic and stepped out as an extremely excited paramedic. I got a 94% on the BLS portion and a 90% on the ALS portion. I was just about dancing.

We went back to the hotel room afterwards, lounged in the pool and the hot tub for an hour or 2, then started making our way back.

Now I am just writing this out while waiting for the bathroom to free up so i can take a shower. I'm heading into the city to take my visual and hearing acuity test, then going to the training center for my protocol test and to get online, then going to VO and letting them know that despite their doubts and occasional mockery, I passed this thing. Actually, today is a friend of mine's shift and he and most of the ppl on this shift have been pretty supportive.

Ok, gotta hit the showers.

Thanks for the well-wishes, everybody!

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