reedmaniac.com

»Link.  How two libertarian billionaires are influencing American politics. Quite possibly the most sickening article about politics that you will read this year. Long but worth the read.

»Link.  Just signed up for this and it looks like I have roped in at least two others for the 50K and two for the 25K. Looks like a brutal, masochistic challenge. Better start putting together a training plan.

»Link.  Remember Book, the shepherd on the Firefly TV series with the mysterious past? Dark House Comics is releasing a graphic novel that finally fills in the character's backstory.

»Link.  If this salmon was able to speak, I think the most likely word out of his mouth at this point would be "fuuuuuck."

Email from Eric: I'm the guy who is going to put together a "play on the Eliot glacier" day in September. As in, ice climbing.

Paul's Reply Back: See, you said "play" and I thought we were going to do a lovely rendition of Fiddler on the Glacier.

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Can you just imagine it? Perhaps with a little guidance from William Shatner?

»Link.  

“Later that evening, a group of Sherpas appeared at our door, utterly exhausted. They had carried the injured porter on their backs for six hours through darkness over treacherous ground. He was tied into a doko (basket), set down on the floor amongst the crowd of his comrades, in dire straits— shaking from trauma and hypothermia, moaning through a clenched jaw, eyes swollen shut, his clothes soaked with blood and urine.”

This kind of remote, challenging work is exactly what I am thinking of when I consider medical school.  Wilderness medicine might just be the reason I start working on the pre-requistes this year.

»Link.  When I was off studying to be an EMT, this debate, if you can call it that, really took the nation by storm. America should be a beacon of hope for all those oppressed because of their spiritual or religious beliefs. This is the perfect opportunity for all faiths and all Americans to show that the hate and violence of terrorists will never make us stray from our ideals. I see no reason to be "sensitive" to the bigotry of others when it is so absurdly illogical.

As I expected, I never really got back to editing that last entry. I will get around to it after the course, perhaps. The end of last week was just so incredibly full of course work, practicing skills, studying, and scenarios that pretty much everything except eating and sleeping got tossed to the wind. And even those received less attention than they deserved.

Last night was my 8 hour emergency department shift, which was incredible and horrific at the same time. I am still mentally digesting it. It was a rough weekend for pretty much every student who had a clinical or ride along from what I have heard. And, I suspect there is going to be serious catharsis when we present our patient notes at the beginning of class tomorrow. Before that though, I did have a little tidbit to mention about our night time scenario last Thursday night.

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Right around 7pm on Thursday night, our group of 25 rescuers were contacted here at the hostel by an off-duty dispatcher concerning a multiple casualty incident up in the woods of Yosemite. Our gear was already organized and we knew there were at least 5 patients (ended up being seven patients total). So, we piled into five cars and headed off towards the location. For this scenario, I had requested being a patient caregiver since the rolls of Incident Commanders were already filled and I had little interest in being in charge of Search And Rescue or Litter/Supplies.

My gear was the basic caregiver backpack that included a cervical collar, a complete oxygen kit, bandages, notebook, and various other medical tools/supplies. Dusk was just starting to hit as we turned off the paved road onto the dirt road that headed towards the scene. My first vision of the scene was our vehicle coming around a bend and in the middle of the road is our Search and Rescue leader holding up a severed arm and being vomited upon by a patient screaming for help, who also has a rather visible scalp wound. Now, Jay, the SAR leader, is a solid guy and he has a fair amount of respect for my knowledge and skills. So, not knowing where I am exactly but knowing I am a patient caregiver, the first words out of his mouth after being vomited upon is "Paul!! PAUL!!!! PAAAAAUUUUUULLLLL!!!"

I jumped out of my vehicle, grabbed by gear from the truck behind us, and got to work calming my patient down and taking care of her (not an easy task since she was hysterical and quickly collapsed from her head trauma). The rest of the night went relatively smoothly as patients were found, stabilized, and littered out of the woods to the transport area. We were done with our entire scenario in under two hours. The instructors praised us immensely by saying that even a seasoned SAR team could hardly have handled it better.

So, yeah, by far, my favorite scenario memory is seeing Jay, holding a severed arm, with vomit running down his shirt, and screaming my name. I think he and I have retold the story at least a half dozen times since then and continue to crack up every single time.

(Update: Written rather late Monday night. I have a few chapters of reading to review for class tomorrow, so hopefully I can reread this tomorrow during lunch and edit any grammar/spelling mistakes then.)

(Update Again: And, here we are one week later and I finally get around to editing this.)

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This past weekend was my ambulance ride along, which is one of the requirements for passing the non-wilderness portion of my EMT class. My shift started at 4pm and our last call ended just after 4am the next morning. During our shift, we responded to 17 calls and had approximately 9 canceled calls (I don't remember the exact number). In short, it was an extremely busy Saturday night for EMS in the county of Fresno. Within five minutes of being cleared for duty after finishing a call, dispatch paged us and off we went again. The only breaks we had the entire night where when we dropped patients off at the Fresno Community Hospital and Medical Center. Thank goodness for paperwork--it allowed us the chance to snack and go bathroom on a semi-regular basis.

Way back at the beginning of the course, when being informed of our ride alongs and clinicals, we were told that our involvement in the calls and interaction with the patients would be entirely up to the ambulance crews and hospital staff. There was a chance that we would simply be observers and perform no procedures at all. This makes perfect sense since we are still uncertified EMT students. When the first students came back from their shifts two weekends ago, it was thrilling to hear that at least one student got to bag a patient with a BVM (Bag - Valve - Mask) for a few minutes on his ride along.

On my shift, I did ever so much more. My crew of Josh (EMT-I) and Scot (EMT-Paramedic) were spilling knowledge and stories from the very beginning. On our very first call, they handed me a cervical collar and told me to go ahead and place it on the patient. I then helped the firefighters with rolling the patient onto the backboard and putting him on the gurney. In the ambulance, I prepped the IV bag, assisted in taking vitals, and did the head to toe exam. Kind of an incredible step from doing mock scenarios and skills in the classroom one day and then working on ill patients the next.

Our next call was a 20-something female that was 8.5 months pregnant and having lower abdominal pains. The call was basically a transport, but on the way I got a lesson in basic OB questions and more practice taking vitals. At the hospital, Josh took me on a tour of the OB department and we just missed a chance to observe a C-section in progress.

The next call was a psych-transfer between hospitals for a patient who had essentially lost the will to live because of a series of rather heart breaking events. Reading her file was a lesson in perspective on how bad things could really become.

After that, with a bit of help from Google Maps on Scot's iPhone, we arrived at a house for a patient complaining of severe abdominal pain. 20-something female who had had a gastric bypass 2 months ago and been released from the hospital just the day before for the same complaint. Upon palpation of the abdomen we discovered a plum sized mass just left of the umbilicus. None of us could get find her radial pulse and I ended up using a stethoscope on her chest to determine her heart rate. Another lesson in the difficultly of getting vitals on a patient who was not a 20-something adult in excellent physical condition (like most of my classmates).

Next, we were the third ambulance dispatched to a two car accident on the edge of the city. There was quite a lot of chatter on the radio about it as there were seven patients, one red and one yellow, and fire was there helping with the extractions. J-P, a fellow student, was in the first ambulance to arrive on scene and assisted with triage and maintaining the ABCs of the critical patient. We passed them on the way there and upon our arrival there was no patients left for us to treat. So, instead, Josh and Scot took me on a tour of the accident scene. A medium sized passenger truck had hit an SUV laterally. The truck's entire front end was smashed up to the windshield with the driver side airbag deployed. The SUV was in terrible condition. It had rolled at least five or six times and only by examining the shell closely could you even tell which side was the top/bottom. Fuel, metal, and glass were everywhere. Definitely a lesson in scene safety. No way should an EMT be doing extrication in a situation like that.

Then, a couple of patch and release calls before we got a call to help an MS patient who had been abandoned by his in-home caregiver. We entered the home and found him in his bedroom laying on the floor and in pain. Just abandoned. Thankfully, his phone was nearby as he no longer had the ability to walk and had limited dexterity in his upper extremities. He was the nicest, most appreciative patient of the entire night and we did everything we could to position him comfortably and get him situated until his mother returned home. We stayed extra time because it was just so WRONG for a man of his friendliness, humor, and intelligence to be placed in a small bedroom alone without even a book or a TV. No neglect of any legal sort, but he deserved better. Frustrating.

The next call was the highlight of the night. A 20 year old intoxicated male had become agitated during a verbal argument and punched through a large glass window. When we arrived he was lying supine in the doorway of an apartment with over a litre of blood soaking into the carpet underneath him and flowing down the steps. He had three large lacerations in his upper right arm and a gushing severed brachial artery. Immediately above the wounds an ineffective tourniquet made from a stretchy t-shirt had been applied by his friend. Josh told me to get in there, so I applied direct pressure with a huge dressing and held the arm above the heart while Scot removed the patient's clothing and the ineffectual tourniquet, which was greatly impeding our work. All the while, the friend who had applied the tourniquet was squatting two feet away informing us that his tourniquet was fine and that we did not know what we were talking about. Buddy, the blood pulsating out of your friend's arm when we arrived would seem to indicate otherwise.

A new tourniquet was applied by Scot, and I remained on the arm as we moved the patient quickly towards the gurney. He went unconscious just a foot from the gurney (paging orthostatic vitals), requiring us to make a herculean push to get him loaded. Back in the ambulance, we put him on high flow O2 via a non-rebreather mask and got his blood pressure. A paltry 80/50 with a weak heart rate of 110 bpm. Gave him an IV of Lactated Ringer's solution and began an extremely rapid transport. He regained consciousness rather quickly with the O2 and IV, but he had quite a bit of disorientation and kept on forgetting that he was on an amublance. We got a full patient history though and another set of vitals. By the time we were at the ER, his BP was back up to a far healthier 100/60. At the hospital, we got him into the trauma operating room and prepped for surgery. By the time we had cleaned up ourselves, the gurney, and the ambulance, they had already sealed up the artery in two places and he was stable. He was unconscious, but I got to walk over and see the arm lacerations with the muscle, artery, and bone still visible. He was extremely lucky. He will likely have residual problems with nerves and circulation, but he lived.

Our next call, which we received just as we turned the key in the ignition, was for a patient complaining of chest pain. No rest for the weary. Thankfully, the patient was stable and seemed to only be suffering from a slightly more severe than usual asthma attack, which had not been relieved by his albuterol inhaler. Sharp, localized pain in the upper chest with wheezing lung sounds. A calm transport and that was it.

Our final two calls of the night were 5150s, which is an involuntary protective hold for patients, which means law enforcement is involved, which is never that much fun because you know there are likely going to be behavioral problems with the patients. And, boy, did they deliver. The first was an unstable 40-something male that was violent, abusive, swearing, and emotionally unstable. This is the only call where I took a step back and made the decision not to be involved. The EMTs and police are paid to restrain this kind of patient and put themselves at risk for verbal and physical attacks. As a ride along, it was not really a place I wanted to be. So, I got a few items from the rig and then sat in the passenger seat up front while Scot dealt with the patient in the back.

The second patient was an older teenager who was off his schizophrenia medicine, had likely been smoking marijuana, and was fearing for his life and experiencing auditory hallucinations. On some level, he was fascinating. He rapped constantly (and amazingly well) and we put Dr. Dre on the speakers during transport to help him relax. The patient was outspoken, friendly, and exaggerated all of his gestures to the point that it was rather hard to get vitals. During admittance, an entire crowd of nurses, EMTs, security, and doctors watched this guy rap his entire life story. A few of his actions were inappropriate, but he ultimately seemed not to be a threat to anyone.

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And that was our last call. We got back to the ambulance headquarters and that was our thoroughly exhausting shift. There were a few other calls that I am not going to mention, and I purposefully left out descriptive personal information above so I could discuss the patients here without violating their privacy. Ultimately, I consider this one of the best experiences of my life. So much to do and see. I desperately want to do it again. And, it would be fantastic to proceed onto studying to be an EMT-Paramedic, as they seem to be the stars of the EMS world, doing most of the work and interacting with the patients.