Disasters and Individual Readiness

January happens to be one of the "on-call" months for my DMAT. About a week before each on-call month, I go through my 72 hour pack and my main gear bag, making sure that anything I "borrowed" from it was put back in, any foods that need to be replaced are, and that everything is in good shape. I potentially have to live out of my 72 hour bag. It has food, my medical gear, first aid kit, change of clothes, stuff to keep me busy, some survival gear, etc. And my gear bag is replacement clothing, sleeping bag, sleeping pad, pillow, spare bag (Things expand while on deployment! I swear!), MREs, and more.

I had begun this process, then got hurt. On December 31, I called my unit commander to advise him I would not be deployable for 6 weeks. I think that hurt worse than the injury. I joined DMAT to provide medical care during disasters. I made the decision to join the team right after 9/11 (I had heard about them during my EMT recert class), and I've been with them ever since. I've deployed since in 2004, and 2008, with wildland fire medical and CalMAT thrown in in-between. Even when the orthopedist told me the news, I had not immediately thought it would take me out of deployment availabiltiy, but that realization hit a few moments later.

This week, as hopefully all of you are aware, a 7.0 earthquake hit in Haiti, a few miles from Port-Au-Prince. Casualty estimates are 50,000 to possibly 500,000. That's just the dead. Injured? Try 4 or 5 times that. Illness, infection, rescue/recovery/rebuilding injuries will increase that. And the hospitals and clinics are destroyed. This is a first for DMATs. We have historically worked US missions, although some teams have gone to US territories, such as Guam, and American Samoa. Teams landed in Port-Au-Prince today, along with DMORT (Disaster Mortuary Response Team), IMSuRT (International Medical Surgical Response Team), and more. My team is on standby, although not first out the door for this mission. The medical response for this mission will be prolonged. The magnitude of this disaster is almost surreal. 3 million people are homeless. Malaria, Dengue, HIV/AIDS, Hepatitis B, and TB are endemic in Haiti.

I was asked last night "how broken I was", by one of my teammates. A few want me to deploy with the team, but I can't. Part of my readiness is assessing my capability. I am an EMT. Yes, I am also the Electronic Medical Record expert on the team, but I am first and foremost an EMT. I can't do that work right now. And I need to let my elbow heal, so that I can continue to be a responder, for the team, for my company, and for my employer. This is my livelihood at stake right now. Back in July, I had to make the same decision when I had my knee worked on. Each of us has a responsibility to ensure that we are capable of performing our work. And to assess ourselves and determine that we are not putting our team or partners at risk due to illness or injury. I don't want to do something that will make my arm worse, and potentially send me to the O.R., when I can potentially avoid it by allowing my arm to heal. And I don't want to risk the safety of my team.

Besides, there will always be more deployments. And I suspect multiple deployments to Haiti.

Working EMS as a supervisor

While I am a supervisor as one of the owners of a BLS provider, I am usually a "hands on" supervisor. I am not the type to stand back and not have direct patient contact. Unfortunately, with my triceps tendon injury, and my arm in the brace at a 45 degree angle, there isn't a lot I can do, EMS-wise, except to supervise. So, I've decided to turn lemons into lemonade, and hone my supervisory skills during this time.

While I did assess one patient who has diabetes with a minor hypoglycemia issue, he self-treated while we watched him. But if he had gone to the ground, I knew I would not have been able to drop him in a controlled manner, to avoid injuring him and myself. Thankfully, the two EMTs I was supervising were right there as well and would have been in a capacity to care for this patient. After that, I stepped back and let them handle all the patient care for the duration of the shift. I need to really work on being only a supervisor for the next several weeks. And keep my hands in my pockets. :-)

On the injury front, the brace has done wonders to stop the spasms in my triceps muscle. I do have a fair amount of upper arm soreness, but I think that is due to sleeping positions and from holding my arm in a protective posture (which I am correcting and learning to relax while walking and sitting). And the soreness is in the biceps muscle, which is uninjured. The brace slips a little, so I need to re-adjust it occasionally, but it is infinitely more comfortable than a cast. The pain is down to a level that I hardly notice it any longer. Except when I bonked it a bit last night. I am going back to the gym today, but to work on my cycle time (stationary bike only - I am absolutely not allowed on my MTB), and work on lower body and core strengthening.

Uh oh... what did I do now?

I've gone back to the gym lately, more as a result of the weather not being very conducive to riding my bike lately. But I realized I was also losing muscle mass since my knee surgery in July. I just haven't needed to really USE my muscles much. The last time I really had to lift a patient was back in October. So, I needed to get back into a good muscle building regime, along with some good cardio.

I like mixed cardio/weights in a workout, not isolating to one or the other, when I am in the gym. Part of this is to break up the monotony, but I think (for me) that I get more out of my workouts when I do this. I'm not a body builder, nor am I a long distance runner. I am simply someone trying to lose weight, to build some muscle, and generally feel and look better. That said, sometimes I do just use the bike, or the elliptical, but I never just do weights.

Two days ago, I was at the gym, and had moved from the elliptical to a 30 minute weight session. Worked on the legs, and the back, and went to work on the biceps, triceps, and lats. I have a 3-way method on the lat pull-down machine for this. Standard lat pull down behind the neck, forward, and then I work the triceps using the same machine, but with my hands close to the center of the bar, elbows close to the body, and just bring the bar down so my arms are at a 90 degree angle, then up again, not moving the upper arms from my body (so the triceps are forced to work). No problem, right?

Set the machine for 40 pounds. First two exercises went off without a hitch. Then I moved to the triceps. First 4 felt good, then something went "pop!" in my elbow, and I felt a tearing sensation. I stopped right then. Checked out my arm, and moved it. Moved ok. No real pain. Dropped the weight to 30 pounds. 3 pull downs later, the pain returned. OK. I stopped the exercise altogether. This was going to be the end of my workout time anyway, so I went home, and iced my elbow.

Yesterday, I woke up, and my elbow felt ok. Pushing down hurt a bit, but not bad. I went to work, and finished out my day without a problem. Not that a keyboard really works out your arms a lot, mind you. Got home, and was pulling my backpack out of the back seat like a normally do, and went to sling it over my left shoulder, when WHAM! Sudden, searing pain in my elbow! 10 times worse that at the gym. I think they could hear me yell a few streets away from my apartment complex. I know one of my roommates did. Damn that hurt!

I closed up my car, and went immediately into my apartment, grabbed the ice pack in my freezer (A zip-loc bag full of peas - works great), and iced my elbow. This time, the pain didn't subside. And my elbow was feeling hot. Crap! After 45 minutes of icing it, I had some improvement, and could move it a bit without pain, but putting pressure, even typing, hurt. I spent most of last night before bed icing it off and on, fired off a message to one of my docs, letting him know what happened, and went to bed.

I didn't sleep much last night. Positions that didn't allow my muscles to completely rest were uncomfortable (read: painful). I am still waiting for an answer from my doc. I hope he is in this week. If not, I may have to call in and get an urgent care appointment. I don't know if I just tore some old scar tissue in my elbow (from years of bowling), if this is a new injury, or a combination of the two. I can move my elbow this morning, but it still feels warm, and pushing down on things hurts (I can type again with my left hand, as long as I rest my arm while doing it.). I've also started back on some non-steroidal meds (started those last night), hoping the combination of NSAIDs and icing will calm this down. Based on the improvement since yesterday, I am hopeful that I didn't tear anything major, but since I am dealing with ligaments and tendons that don't heal normally, I do have to be careful. EMS-wise, I am not working until Saturday, and if I had to work, I could right now. Might not be the happiest EMT around, but my arm does work.

In the meantime, I am going to work more on strength in other parts of my body, riding, and other cardio. I do have MTB season starting soon, and I plan on participating this year.

December update

Not much to report lately. I've been working my "day-job", still dealing with the governor taking almost 15% of my salary under the guise of "furlough". Yeah... what its done is to cause me and 200,000 other State of CA employees major problems financially. We don't have the money, so we don't spend it. Less spending is less sales tax money for the state... see where this is going? And he calls it a "haircut"... I call it something else. Oh well, the courts will sort it out... eventually.

Still working EMS (always!), both at events with my own company, and also for the Sacramento Rivercats. Yeah, I know it isn't baseball season. Corporate events... fantasy baseball, meetings, etc. I was supposed to go out of town tomorrow, but that event was canceled due to inclement weather. In the world of mountain bike racing, that is a rare event. Its a little wierd being on a first-name basis with some of my patients, but I treat many of them over and over... kind of a "frequent flyer" system that many working on an ambulance see. One thing I do like is the follow-up I do tend to get. My patients come back and let me know how they are doing, or they email me with updates (Facebook also!). Its nice, actually. Most people working a rig just deliver their patients, never learning about how they did.

Oh... we got snow this week! I know, those of you in areas that get snow frequently are thinking... wow... not. Well, its a rare event here. Monday morning, about 2:00am, it started snowing here in the Sacramento Valley. Most areas got a dusting. We got about 1 to 1-1/2 inches. Didn't stick long, though. The last time it snowed this much was in 2002. Mike had never seen snow falling, so at 2:00am, he was out playing in it like a little kid. I wish I could have seen that, but there are pictures to memorialize it! Here is a picture of the ambulance with snow on it. Temps have been REALLY LOW for this area most of the week. Finally, the temps have come up a bit, but only due to storms that are bringing rain, and the occasional lightning strike. I wish it would snow again. Two pictures I took:

Altamont Pass

The Fremont/Milpitas foothills

What I saw on my laptop Sunday evening... 100% chance of snow in my area.

I'm not going to be traveling anywhere for Christmas. Finances are just too tight. So, I am working on decorating my apartment a bit. Found most of my decorations. Can't seem to find the ornaments for my tree, though... They have to be somewhere... I thought they were in my green and red box, but alas... I am going to be working on Christmas cards tomorrow. So, Mike, Mary, and I will spend Christmas and Hanukkah here (Mary is Jewish, and I am learning about Hanukkah from her, and she is learning my traditions, including the lighting of the Advent candles, and the prayers I make when I light them).

I do hope that the holidays bring great things to all of you. May the Lord bless all of us this coming year, as many are still working on getting back on their feet with the economic issues still facing a lot of us. If any of you are traveling in my neck of the woods, please feel free to let me know! I'd love to have you over!

At What Point?

Note: A few things have been changed in this post, so the person I am referring to cannot be identified. But I wanted to share this with all of you. Chances are, you know someone like this.

A few nights ago, I was on the phone with a friend of mine for over 2 hours. This wasn't a bullshit session. She woke me up at 11:30 in the evening with a phone call, sobbing uncontrollably. She has had bipolar disorder since she was 15, and I could tell within a few minutes that she was clearly off her medications. This isn't the first time she's done this. We've been friends a long time. But this is a lifetime illness, and at age 43, she knows better. It wasn't a matter of affording the meds, although in the past, this had been an issue for her. She makes good money (a lot more than I do), has insurance that pays for her medications, and for her medical appointments that she needs to maintain her bipolar disorder (BPD).

We talked, and she unloaded on me. She was in the middle of a divorce (her 3rd marriage). This time, he was seeking alimony, custody of their 14 year-old daughter, and essentially most of the life she has made for herself. This is hard for most people to handle, but when you have a serious mental illness, it can be absolutely devastating. She had called and hung up on three other people before talking to me. I can't say I didn't see this coming. Some of her recent emails to me seemed, well... negative.

I've mentioned her before in some previous posts, because I have talked with her and even traveled to meet her when she was clearly suicidal. That time, I helped her to check in for what started as a 72-hour stay at a hospital, but which became nearly two weeks long. Each time, she stopped taking her medications. When she is on her meds, you can't tell her from anyone in the crowd. Those meds keep her brain chemistry in check. But, they have side effects that eventually cause her to stop taking them. That's when the problems start. She had been off her meds this time for 3 weeks. Last time, it was just over 2 weeks when she reached me. One time, it was over 4 months, and she was almost to the point of living on the streets. Each time, reality hits eventually, and she comes back. Her employer has always looked the other way, knowing that this occurs with her. She is an incredibly talented software engineer. With her BPD, the timing isn't predictable. Some people with BPD have a predictable cycle. Not her. It can be 3 times in a year, or nothing for 2 years.

Something about the way she was talking told me she had already decided to get help and get back on track again. But I wasn't sure if she had started. Mentioning meds is something approached at the right point, not right away. But, as an EMT, it is part of my thinking, and eventually I asked her if she had restarted her meds. Not yet, but she had gone and gotten them refilled again earlier that day. OK. That's good. She has them. What were her plans at this point? First, she knew she had to get back on her meds to be able to handle any legal actions, especially custodial proceedings. But the depression she was in was keeping her from opening those bottles and taking those pills. Or it could push her over the edge and make her take more than she should. A lot more. Its happened before. Which is why we talked and talked and talked. Letting her dump on me gives her an outlet that I always hope will allow her to see some things clearly and essentially go back and do what she knows she needs to do.

Its hard dealing with someone in the cycles of BPD. Even harder over and over again. But she's my friend. She's been through tough times, and she has an ability to rebound that is just unreal.

By the time our call was ending, she was less upset, but I could tell the brain demons were still working on her.

... She called me yesterday when I was driving home, and let me know she was ok, which was good to hear, and she had started back on the road to her recovery. She restarted her medication regimen, contacted her doc, and had an emergency plan in case she relapsed in this acute period for her. She hasn't spoken with her soon-to-be ex-husband yet, but was hoping to in the next week or so. She didn't do anything on Sunday except stare at pictures most of the day. Pictures of family, of friends, and of parts of her life she clearly wants back, but can't have. Her daughter is staying with her father, who moved out before I was called. I think she understands that she more than likely won't get sole custody of her daughter. We may meet up later this week or early next week, as she is thinking about a little travel while she gets back on track. Can't say its the smartest move for her, but if it works...

I am sharing this story to you, because when I was done talking with her, I realized the drain it had on me that night. I'm not giving up on a friendship, nor do I feel I have to maintain this friendship to keep her going (I'm not that unrealistic). But it made me think about all those people, including her husband, who have reached the end of their rope... at what point do they stop and say, "I can't deal with this any longer"? I'm not at that point, and I don't think I ever will be with her, but it did make me think. When I was dealing with my husband's illness, I have to admit, I felt that way sometimes. When would the rope break? It never did for me, the stresses of dealing with his medical conditions did add up, and took a heavy toll on me (some of which I still deal with to this day)... But it did come very close to breaking. I did almost walk away back in 2002. In my case, I had the realization, through my religious beliefs, that God never gives me more than I can handle. And that includes friends calling me at 11:30 at night needing someone to talk to.

Commitment

I've made a commitment to a few things...

1. To continue losing weight via exercise (mountain biking primarily, but also at the gym), and food control. BTW, I am now down 45 pounds from my all-time high weight of 280. By the first race, I want to be a lot closer to 200 than I am now (235). Hopefully less than 200.
2. To actually COMPETE in 3 mountain bike races this spring. This should keep me on track with #1.
3. To make damn sure my asthma stays under control as much as possible, so I can get #1 and #2 accomplished.
4. To get my living room and my laundry under control tonight and tomorrow. Its driving me nuts.
5. To get my paramedic back.

So, there. I've put it out for the world to see. I plan on posting regular updates on #1-3, including that lovely weight tracker up at the top of this page.

Now, for those of you asking, "Why in the WORLD do you want to race in mountain bike races? After all, you treat these guys and gals all the time. You KNOW they get hurt." True... but I trail ride already. And its fun. Its a little different when you compete. I can be a very competitive person, and having a goal of racing (i.e. finishing) is a good goal to start with. These are simple races. I am not going down a 2000' foot decent or anything here, folk. This is decent singletrack located near my home, and I am familiar with it. Both from a perspective of riding it, and from getting people out of there. I came back to trail riding partly to understand a little more of the injuries I was seeing at the races, but being out there... well, I got bit by the bug again. And since my knee surgery, I've made a decision that I WANT TO DO THIS. Yeah, I might get hurt. I've slid out just riding the trail before. But hey, I know my EMS company will be out there providing EMS at the events... I know I'll be in good hands if I do get hurt. They are "the best"!

On the last commitment, I've decided to take the pre-paramedic class at Sierra College this winter/spring. I've already registered, and am waiting to schedule the class. Its the first step for me. I've been away so long, I need to start over. This is my chance. Then, I am HOPING that the fall part-time paramedic program will be up again at ARC. If not, I will find another program. I'd do it full-time if I could find someone to support me for the year it will take... any takers?

Athletes and medical conditions

Anyone who has a significant medical condition will tell you a story or two of how they (or someone they know/knew) had an issue with their condition, and couldn't relate that to the EMS/Fire/Police/First Responder that came to their aid. In some cases, the results have been tragic.

Someone at some point created necklaces and bracelets with basic identifying information; "Penicillin Allergy", "Diabetic", "Heart Problems", etc. are all available to purchase at most local drugstores in the U.S. But it was and is for the most common health issues, and not for unusual health problems.

Then in 1956, the MedicAlert Foundation formed, and eventually had custom bracelets available.You could put basic information on it (think up to 30-40 characters total), and there was an 800 number that hospitals and other medical professionals could call to get more information. And it was a great idea. I got one for my daughter when she was an infant, as she had apnea (she would stop breathing), and other medical issues. Hers was the necklace, and we pinned it to her with a diaper pin. I also had one for years, until it came off one day out in the middle of nowhere.

As beautiful and functional as some of their products are, most of their items are, for lack of better words, bulky. And loose. Both the original bracelets/necklaces, and the MedicAlert versions are great for providing some basic information to those rendering emergency medical assistance. I look for them on my patients. And, as I stated, they come off rather easily. It was time for improvement...

Along comes ROAD ID Inc. They came up with a few designs, and began marketing them to the athletic community. These are designed to go on and stay on during exercise; something that caught my eye.Runners, bikers, and others have become their customer base. And they recently sponsored a large bike event, Levi Leipheimer's Granfondo, which I was proud to work as an EMT.

Yesterday, I received a Tweet (a message via Twitter, for those that don't know) telling me that for the next 36 hours, if I ordered a ROAD ID, 100% of the sales go to the Levi Leipheimer's Granfondo charities. I've been thinking about it, since I happen to have a severe bee sting allergy, and don't currently wear a medical bracelet (Bad EMT! I know better.), I'm playing Russian Roulette out there, working event medicine. And a bracelet designed to stay on is just what I need. Yeah, I have an Epi-Pen in my pocket, but I crashed fast the last time I was stung. And I almost lost my life.

So, I decided to order one for myself. This is what it will look like when it arrives:

So, they are taking orders through midnight tonight for the fundraiser. If you want one, go to: http://www.roadid.com/Levi/LeviCharity.aspx. Use promo code: PCLEVI if it doesn't fill it in automatically for you. You can still order one after tonight, it just won't go to this worthwhile cause.

My MedicAlert bracelet is somewhere up in the hills of Toro Park in Salinas. If anyone finds it, let me know...

Kids as Patients

When I work events that are youth oriented, such as soccer, football, and even triathlons, I always strive to remind myself that kids are not "small adults". Many people in EMS treat kids as if they were, which is not good for a variety of reasons, including:

• Their physiology is not the same as adults
• Their understanding of what is happening to them is not on the same level as an adult
• They sometimes display differing symptoms than adults for the same problem

I was never reminded more of this than on Sunday, when I treated a young man with a very probable ankle fracture. This kid was trying to act as an adult, but clearly was very scared, and in a lot of pain. His ankle was swollen, even though this injury happened mere minutes before. His pain was in a specific location above his ankle along the bone called the fibula (Technically, it isn't a broken ankle at that location), and bruising was starting right at the point of impact. When I asked the him to show me where it hurt before I touched his ankle, he drew a very defined line across the bone.

I explained to him that splinting him was going to hurt, but then it would get better. Its never easy to tell a child you are going to hurt them for them to feel better. So I set to the task at hand. I gently removing his shoe, as he was complaining of some tingling in his toes. Turns out, his shoe was causing the tingling, which went away as soon as the shoe came off. Then I splinted his very painful ankle, with his father assisting as an extra pair of hands and talking his son through this procedure. Once the splint was on, you could see the relief in this youngster's face. Was it really relief from the pain? Or relief that the splinting was completed? I think it was a combination of the two. He was still in pain, but not as much as before I splinted him.


The adults around us kept trying to offer the child support, but making statements that clearly went above him. He had a puzzled look on his face when one of the coaches told him, "Now that its splinted, we can get you back out there playing.". The child didn't see that this was humor. To him, what his coach said was serious. He looked at me, and I told him it was a joke. Then he smiled a bit.


I offered ambulance transport, primarily for pain control, but the father decided to take his son to the emergency room himself. So, I helped get this young man over to their vehicle, using the motorized cart I had. I gave the father instructions on how to get to a nearby emergency room. And then they were gone.

Surgery Update

OK. Sutures came out today. Well, it was actually one LONG suture. The P.A. that pulled it was duly impressed at how large the incision was, since most bursectomies (removal of bursa) are much smaller. The white steri-strips will fall off in the next few days. There are two areas that still need to heal in a little more, but it looks good, scar-wise.



He also noted the large amount of fluid that had accumulated. We agreed it needed aspiration (thank you!). So, he got all the stuff together, numbed up the location he was going to put the needle into (It is the same general area I used before as well, which is numb already), and went ahead and started aspirating the fluid off. This is OUTSIDE THE KNEE, everyone! He used a 30cc syringe, and pulled off one, two, three syringes full, plus another 22cc. Total 112cc removed! It was almost a record for him (115cc is his record). I had guessed yesterday that there was about 100cc, so I was close on my guess. Last Friday, when I emailed my surgeon, I told him more than 40cc, but more swelling has gone down, so the fluid was more evident. The fluid looked just like it should, no sign or smell of infection. Hopefully, the fluid wont come back, since that was why I went through this surgery in the first place. Bandaid placed over the aspiration site. The picture was taken after the sutures were out and the fluid pulled off. I am using a pad on the area where the fluid probably originated at, putting pressure on that area, to try and convince the area to not fill in again, and an ace wrap for compression.


I came home, and immediately iced my knee again. It was a bit sore from the suture removal and aspiration, so I figured it was a good idea.

 

(Comparison of my knees)

So, I am off the crutches (yes!), and am allowed to use a stationary cycle (yes! yes!), and exercise at the gym. No regular bike riding for at least 3 more weeks (sigh...). Once the skin heals a little more, I will be able to bend my knee more than 90 degrees, but not yet. I may need to wait up to 10 days. I can shower again, too! In terms of EMS work, I can supervise, and do some work, but no kneeling on that knee. So, I will stay a supervisor for a few more weeks. I really want patient contact again, and I miss my work at the ballpark, but need to let my body heal first.

Back to the grind

Well, this week, I started back to work, but from home. Worked Monday-Wednesday at home, with my leg elevated. Once the over throbbing went away, I began to keep it propped up, just not resting on the floor like normal. That worked well. Well enough, that I decided to try and work at my normal cubicle. Since there is a fair amount of walking involved to actually get to my desk, I drove to work, rather than taking light rail in as I normally do. Still using my crutches for distances, although at home I am walking around without them. I have my leg propped up on a box of all things! Tried propping it up on my desk, but it isn't very comfortable:

You can actually see my wrapped knee through the blue jeans. Might try some different things.In the meantime, my office chair broke. It had a crack in it when I acquired it over a year ago, and seems to have decided that now is the time to commit suicide. Bad timing. So now, I am scrounging to find another one. Budget woes are apparently hampering our ability to order needed things, such as something to sit on.

I have been feeling what I think is "suture pull" for the past few days. As tissue begins to heal, with sutures in place, the whole area feels like it is being tugged on. Hard to know for sure, since the feeling is not quite normal. Been doing the quad set exercises that apparently were supposed to have been included with my post-op instructions, but were not. I know them anyway, so its not a biggie for me. Even sitting at my desk I do them. I have noticed there appears to be fluid accumulation around my knee, right around the suture site, going up the medial side of my knee and over the kneecap. I sure hope it is just post-op, and not the seroma back again. I'd be "extremely disappointed" if this was all for nothing, except making it worse. So, I've been wrapping the ace wrap tighter than it was wrapped post-op, hoping to convince my body to absorb the fluid back. Hope it works...


Trying to see when I can ditch the crutches. I have to admit, when walking distances, it is more comfortable than walking without.

In the meantime, I am going back to EMS in a supervisory capacity for a few weeks. No kneeling for me for a while... got to be a compliant patient. Got several new EMTs, and I don't want them working without good supervision.

Back on the bike

Today, I got back on my bike. This is the first time since the crash on May 5th that I have ridden. I missed it so much! I didn't get to just ride. I was actually working EMS at a race in Folsom tonight, the Running of the Bullipedes. So, I loaded up the panniers with the EMS gear (An AED, diagnostic tools, cervical collars, airway management items, wound care, splints, slings, water, and more... Yeah, it all fits!), hooked them on the rack (which I had to re-install last night), strapped the oxygen tank onto the top of the rack, put on my NEW helmet (Yes, I did retire my old one after the crash), and followed the racers on the mini-marathon (1 mile) through historic Folsom. I stayed behind the racers for most of it, talking with one of the Folsom PD motorcycle officers that was also following the racers. He was really nice to talk to.

The race was over almost as quickly as it started. First team to finish took 4 minutes 30 seconds. The last team took 20 minutes. It was 100 degrees out there. Rather toasty! I stayed at the finish for a few reasons. One was that the roads were closed, but the more important was that there was a medical emergency nearby, that required them to get an ambulance in there. No, it wasn't any of the racers. Folsom Fire treatd that patient. And then there was the parade and running of the bulls. The parade was nice to watch while I guzzled water. I sweated off a LOT of fluid while out there. The bulls were walked. All of them behaved.

Afterward, I headed up the hill. Sweated off even more fluid! Got back to the Jeep, unloaded the world, and headed home. It was still over 90 when I left.

Although short and warm, it was really good to get back on my bike. I was planning on riding to work tomorrow, but I just picked up a shift at the ballpark. Maybe next week. :-)

Asthma attacks... again (Misadventures in stupidity)

Sometimes, I amaze myself at how stupid I can be. I mean, I treat people for asthma often enough, that as an asthmatic myself, I should know better about getting help when I need it. But nooooo... I, like many other EMTs and paramedics, think that we know enough to take care of ourselves when we get sick or hurt. It is an arrogant trait, one that we really shouldn't have.

On May 17th, I had an asthma attack while returning from an EMS assignment. We had gone through a big dust cloud that was created by an RV in front of us while driving down a dirt road on a mountain. I wasn't affected initially. In fact, earlier in the day, I used my albuterol preventatively due to the heat and dust that was being created from the mountain bike race I was providing EMS services at.

On a scale of mild to severe, this was a moderate asthma attack. Enough to make me cough like hell (a hallmark of my particular asthma), to wheeze, to have more problems breathing out than in (a hallmark of all asthma), and to eventually impact my ability to think clearly. It started out innocently enough. I just had a mild cough, that started about an hour and a half after the dirt road. I even joked to the EMT with me about it. Soon enough, I realized I needed to use my albuterol inhaler. I had it in my pocket; I reached in to grab it, and realized that the outer plastic case was missing. All I had in my pocket was the medication canister. Not good. But, I do keep a spare with me. The other EMT went into the back and grabbed it for me. No problem. Two puffs, and all would be good.

Except it didn't work. I took two more puffs... and two more... and two more, over the course of the next half hour or so. By the way, I was driving. The EMT with me wasn't cleared to drive the ambulance. But, I was in control, and although I was coughing a helluva lot, I was still able to breathe ok. And drive safely. We even kind of joked about it over the air.

I continued to use the inhaler (I use an inhaler with a spacer, which generally provides the same effect as a nebulizer treatment), without any success. We eventually stopped for a bathroom break, and I stayed in the ambulance. I just couldn't get out. I had no energy, and was rapidly getting short of breath. I knew I couldn't drive safely any further. So, another EMT took over driving the ambulance, while I went and became a passenger in the Jeep. This would let me concentrate on treating myself. I headed over to the Jeep, and suddenly a wave of nausea overcame me. I knew I didn't want to puke all over the Jeep, so I quickly went to the front of the Jeep, and stood in a planter area. I didn't think I had actually thrown up, but I since found out I had. My legs were like rubber, and I had to steady them with my arms extended just to stay standing. Eventually, I got into the Jeep. The EMT driving tried to get me on some O2, but I declined (stupid!). I figured I would improve (Big hint I wasn't thinking clearly... I know the progression of breathing disorders, and I was heading into big trouble.). I kept sucking on my inhaler, sipping water, and probably going in and out of consciousness. My vision tunneled, and I eventually couldn't see much. I don't remember much of what the other EMT was saying to me. I think I remember her talking on the radio to the ambulance.


Within 20 minutes, we were at the first stopping point in Sacramento, to pick up my Jeep that had been used at another event. Clearly, I still couldn't drive. But I was so short of breath that I finally said yes to some oxygen. 10 liters per minute via a non-rebreather mask. My vision came back pretty quickly. I managed to pull out my pulse ox meter (measures how well tissues are getting oxygenated - 96-100% is normal) from my fanny pack, and put it on. 84% initially. Eek. Even not thinking clearly, I knew what that meant. The numbers began to come up quickly while on the oxygen, but I had decompensated. My pulse ox stays high and then nose dives when my asthma gets bad. I know at some point, someone mentioned my going to the E.R., but I said no. I wasn't getting worse at that point. This is arrogance. Adults have a right to be stupid. Even EMTs. I should have gone.

Which is exactly what had happened. The oxygen began to make a difference. I started to breathe a bit better, allowing more oxygen into tissues, but keeping a proper mix of carbon dioxide in the body as well. "Blowing off CO2", as many of us in EMS call it, is seen frequently in people who hyperventilate. Many times, they fall unconscious due to blowing off CO2, which slows their breathing, corrects the imbalance, and wake back up. Mine was probably a combination of hypoxia and hyperventilation, since I couldn't breathe deeply, I was breathing rapidly.

The albuterol began to FINALLY open up my airways. And I started feeling better. We made it back, and all of us eventally went home (I was at home at that point, as we all met at my place to go to the events that weekend). I continued to use my albuterol that night, but the worst was clearly over. I did take a long shower to make sure I didn't have anything on my skin that would create further irritation to my lungs.

Should I have gone to an E.R.? YES. Should I have followed up with my allergist the next day? DAMN RIGHT. Did I? NO.Is this an excuse for others with asthma to avoid the E.R. NO WAY! What I did was stupid in not wanting the oxygen or the E.R. trip, pure and simple.

This story should have ended here, but it doesn't.

My lungs have remained "twitchy" since that wonderful day. But, arrogant as I am, I can handle that... I was using my albuterol a couple times a day, but it was "under control". Right. NOT. I refilled my meds, so that I had a full supply with me, and went on a trip to NYC that was planned. It was work-related, and I needed to go. I was given a piece of paper that I had not been previously given by the pharmacy, which mentioned the need to "prime" the new HFA Pro-Air inhaler that was my albuterol inhaler. Especially if it isn't used for 2 weeks. Well, up until May 17th, I had not used my inhaler for at least a month and a half. If it isn't primed, then the albuterol isn't delivered. Hmmm... thinking back on it, this may have contributed to my asthma attack. I made a decision to re-prime my inhaler weekly from then on.

I did ok most of the time out in New York City. Used my inhaler a few times each day, but stayed fairly clear. Did my work out there, and had a lot of fun in the evenings. Coming back, the last dose I needed was earlier in the day, and I didn't use any until mid-day after I got back.

This weekend, I worked EMS as usual. Saturday was in one location, Sunday in another. Twitchy lungs and all, I went out. Both locations were dusty, and I needed more albuterol on Saturday. Got home, showered, felt better, went to sleep, got up, and went to the Sunday event. Dusty and windy there, too. I took a more preventative approach that morning. I used my inhaler before I had any problems.

Well, the problems still happened. I managed to get through the day, even taking care of a patient and transferring him to EMS transport when I was feeling pretty bleh myself. On the drive back, I needed to use the albuterol more and more again. Not as bad as the 17th, but I even commented that I HAD to get in and see my doc to get this under control.

I got in to see him today, thankfully. I am grateful to his nurse who worked me into what must be a very busy schedule for this allergist. His next available appointment for routine care is August. After spirometry, which looked pretty good (I had used my albuterol two hours earlier, before I got the appointment), and a peak flow test (470 out of a norm of 550 to 600 for me), it was obvious that I needed some medication tweaking. He upped the daily inhaled steroid I use (Advair, for those of you who follow asthma meds... it is a combination of an inhaled steroid, and a longer acting version of albuterol called salmeterol to basically keep the airways as open as possible) to the max dose for the next month or two, prednisone if I felt I needed it (I do, and I did start it), more judicious use of my albuterol via inhaler and spacer or by nebulizer, and some blood work to see if we can spot the culprit, since clearly I am having issues when it is dusty and windy. Probably a mold floating in the dust. I will find out soon.

In the meantime, I am taking it easy at least today. Resting, taking my meds, and staying hydrated. I don't know if I am going into work tomorrow or not, until tomorrow. If I am still coughing and as damn tired as I am just sitting here typing while on my bed, I will take another day to get better. I HAVE to get this under control. I certainly don't want to end up in the E.R. fighting to breathe (or getting intubated... been there, done that). My work needs me for my day job, and my business needs me for EMS. And I need to be a better example to my patients.

I need to learn to be a patient patient myself. And to not be stupid.

p.s. Read http://urbanparamedic.blogspot.com/2009/06/heal-thyself.html (I'm not the only one who is guilty of this transgression. This paramedic was truly lucky.)

Crash Update

My knee bruised up, swelled up, and developed a good sized effusion (fluid under the surface of the skin in my case, but not in the joint thankfully). A good section of it is still numb (which may be really good right now, but worries me). I was hoping the numbness would have improved by now, which makes me think I may have actually damaged some of the nerves in the area that I landed on. Hope it comes back.The bruising is also tracking down my leg, a function of gravity, which unfortunately makes it look worse.

I've been able to work my EMS shifts. Worked a mountain bike event Wed, and a baseball game Thu. I inadvertantly knelt down on it Thursday night, which was a BIG mistake. I am surprised I didn't yell out loud when I did it, but since I was with a patient at the time, I am glad I didn't. Never scare the patient, right? ;-)

I am still icing it during the day. The ER doc prescribed a narcotic to help me sleep, but I haven't needed it since Wed night. Good thing, as I hate taking narcotics.

Crash

I crashed my bike today.

I was riding my bike from a light rail station to work (All of about a mile at the most), with the intention to ride my bike on the American River Bike Trail after work. I was riding down 12th Street, and got to 12th and G Streets, and the light was changing, so I was going to turn onto G street, which would get me closer to work. I started to brake, and another cyclist on G Street suddenly was in my path. I hit the brakes hard, and crashed. My right knee hit, then my face, and finally my left knee and shoulder.

My first thought was that I had crashed into the other cyclist. So I asked him if he was alright. I never even touched him! Good. Then he asked me if I was ok. I told him I wasn't sure yet, while my face was still on the ground. I turned over, and took a quick inventory. A little blood on my face, one of my teeth felt funny (but it was still there, and intact), and I felt my legs. Hurting, but intact. I looked at my right knee, which already had started bruising up. I sat for a minute, and politely waved off a lady who had gotten out of her car to help. I got up, and quickly checked my bike. It was ok.

I got on my bike, and crossed the street. I asked the other cyclist again if he was ok. He was. I pedaled to work and locked up my bike in the bike room. Wiped my face with my hand and realized it was mildly bloody. Got in the elevator and got some 4x4s, antibiotic ointment, and an ice pack from a first aid kit at work. A few minutes later, my face looked reasonably normal again after cleaning it and applying some of the antibiotic ointment. Just a small cut under my nose, and abrasions on my nose.

I then focused on my now very sore knee. I took a nice look at it. Bruising and red, with abrasions. NIIIICE. Ice pack went on it. My shoulder was beginning to ache as well. I had things to do at work, so I got to them to get my mind off my injuries. Attended a conference call, and emailed my boss telling her about the accident and that I may leave to work at home. Finished the call, packed up my work laptop, and headed home.

Tried to find someone to meet me at Watt and I-80 and get me home. No go. But I expected that, for the time of day it was. I was hoping, though... So I got on a bus that got me closer to home. But, I had to either walk or ride from where the bus left me off. I realized on my way home that cycling was mildly less painful than walking. So, I biked almost all the way home. One hill was just a bit too much today, though. Walked that. Made it home, and my roommate was waiting for me. "So, how bad is it?", he asked me. I showed him. "Ouch", was his only response at the moment. The swelling on my knee was getting worse, regardless.And my shoulder was hurting more.

My business partner, friend and fellow EMT, got back to me, and I let him know what happened, along with a nice picture of my knee. His response, "Ouch!!!!, so when are you gonna get seen?" He was right, I need to get it checked out. I wasn't planning on it, since I had good mobility, but it was numb right at the top of the tibia (the larger bone in the lower leg). In me, that can be a sign of a fracture. So, I called up Kaiser advise, let them know what I did, and what was hurting. After conferring with their doc that is in the advise center, the decision was that I needed to go to the ER, and not a clinic appointment. Bleh...

So, I went to the ER to rule out a fracture. Since I had no major injuries, and I walked in, I was sent through the "fast track" portion of the ER. Sat on the gurney and chatted with the nurse for a few minutes. A few minutes after she left, I was seeing the doctor. She checked my knee, my face, and did a cursory check of my shoulder. She didn't think I fractured anything, but authorized a knee series to rule it out. Got x-rayed, and back to the bed. After a little bit, the doctor came in and let me know there was no fracture. That was my goal, anyway. She gave me a prescription for pain meds, and discharged me. Less than an hour total time! Wow! Truly fast-track!

So, whats it look like now? Its not pretty...

Oh, I am banned from riding my bike for a week. Ugh... but I need to let this get better.

Update

Yes, I am still around! I've just been busy. Went to Dallas for the HHS Training Summit on April 3rd, and got back on April 8th. And I hit the ground running ever since! I worked my day job on the 9th, and then worked opening day for the Sacramento Rivercats (I work as an EMT there during baseball season). Worked the ballpark Friday night, worked in Salinas on Saturday, then back to the ballpark Sunday... then Monday, it was back to work at the day job again! And this week, I got to pack up my cubicle (Its amazing the crap I have accumulated at work in 2.5 years), as we are moving people around in the building. Me? I am moving 3 cubes over to the west... Along with packing, we were interviewing students this week for 3 positions. Whew!

Going back to the training summit, I think I learned more at this summit than the ones from 2004-2008. 2003 was a big learning curve for me (First National Disaster Medical Service (NDMS) conference I attended), but this one... wow! Advanced airway management, ultrasound technique, providing medical on trains during evacuations, and more. Suffice it to say I learned A LOT. This was not a "kick-back" conference by any means. It also reinforced my belief that I have chosen the right path to serve my country as well as a member of my DMAT in the NDMS. This conference allowed a lot of us to express our condolences in person to members of TX-4 DMAT, who lost their unit commander Ozro Henderson, as well as to mourn. Ozro was also in Dallas last year when we were staged for Hurricane Ike to make landfall.  He died shortly after. I wrote about him in a previous post.

Yes, I also had fun. Got to meet up with my good friend Barbara from NJ-1 DMAT, and also the ICE (Immigration, Customs, and Enforcement) folk that watched over us in Houston during Hurricane Ike. I even scored a cool coin from them. Had our usual sister team meeting/dinner with CA-6, which is also a lot of fun! But, I was glad to get back here to Sacramento, even with all the running!

Now, onto some not-so-fun stuff... my ankle appears to be getting worse. Maybe it is just "overuse", but late Sunday, it started hurting BAD. Swelled up pretty good as well. I treated it aggressively, applying the RICE formula (Rest, Ice, Compression, and Elevation). It has calmed down a lot, but today is the first day I have even dared to walk around the house, let alone working, without a support on it. It made me think that perhaps it is time to revisit my doc about it, and the possibility of surgery to reconstruct my ankle sooner than later. I just don't want to be out of commission for 4 months... I might not have much choice.

3 months down...

Wow... We've gone through 3 months of this year all ready. It seems like it should still be January to me. Time is just FLYING by.

I am still losing weight... not sure what I weigh, but the pants are looser and looser all the time. Had to go get a new duty belt today, as I was running out of holes (going in, not out!) in my current one. Donated my big belt, that was way too big now. I even tried on some EMS pants today. They fit, but a few pounds, and they will fit WELL. The pic to the left was taken about 10 pounds heavier ago, at the beginning of March. Still need to get rid of the stuff around the middle...

I am getting ready for the ESF-8 Training Summit (formerly known as the NDMS Conference/Training Summit). I fly out on April 3rd to Dallas, TX. Haven't been there since, oh, September (Hurricane Ike deployment)! Dallas is a beautiful city. I will come back on the 8th, and then work opening day for the Rivercats. Not sure if I am going to my day job that day or not. We'll see (probably will!).

Working EMS is a blessing to me. I love doing it. More than any other job I have EVER had. That's why I got back into it, even though the pay isn't quite there for survivability (Thus, why I work for the State during the day). I see people when they are having a bad day... and hopefully help make it better for them.

Speaking of which, I ran into one of my patients at an event recently. He had sustained life-threatening injuries last year at that same event. Injuries that we found out were even worse than we had observed, and later had been told. He was back doing what he had been doing that day, taking photos at the event. Only this time, he was walking, and not on a bike. I don't get a huge amount of feedback on my patients normally. His was and still is the exception. He is well known in the biking community. But to be able to talk with him at length was really, really nice. He isn't 100%, and may not ever be, but I like to think we gave him a chance to get there.

HCl + NaClO = Toxic Gas

Repeat After Me: "Mixing hydrochloric acid (aka pool chlorine) and bleach is B A D".
This will always result in a nasty chemical reaction that releases heat, and toxic vapors.

Yep, it happens every day. Except this happened on the grounds of a major Denver-area hospital. Read the article here.

Note: This hospital specializes (ironically enough) in respiratory diseases.

Good design, seat belts, airbags, and friggin' luck

The other night, as I was coming home from an EMS shift at the ballpark, I came upon a recent head-on accident between two cars. Both were smaller (but newer) sedans. One was a Toyota, the other a GM. They had hit on the left third of the front end of their vehicles and were off to the side a bit, primarily in the west bound lane, suggesting one of them veered from their lane. The damage was SIGNIFICANT. Looks like at least one of them was going the speed limit (45 at this point), if not both of them. Fire was just arriving on scene as I approached, so I didn't stop, just cruised by at a whopping 2 MPH. This is a two-lane road, so were were driving partially on the shoulder to get by.

What got my attention, aside from the overt damage these two vehicles had, was that BOTH THE DRIVERS SEEMED OK. They were driving solo, and both were out of their vehicles, standing next to them. Usually with the level of damage I saw, someone is seriously injured. But these two looked as if they had merely bumped each other. Now, without stopping, I can't be sure if they were not hurt or not, but I truthfully didn't see blood, bone, or other signs of trauma.

Why weren't they seriously hurt? Well, I did see that airbags did deploy in both vehicles. This reduces the impact of a collision. Newer cars have "crumple zones" designed into them as well, which also absorb impact. I'd be willing to bet they were wearing their seat belts also, which keeps a vehicle occupant from becoming a windshield (or hood) ornament, or being ejected from their vehicle. Another thought on this was "spin". Both vehicles, when they collided, looked like they had spun a bit, which may also have lessened their impact.

One final thought is dumb luck. I've been at accidents where one person got a scratch, and the person next to them died on impact. I've seen them walk around fine for a while, and then drop, once the adrenaline rush ends, and their systems begin to show shock from the accident. Were they hurt?...

I checked on CAD that night (the CHP Traffic Incident Information Page), and although the initial call was "Collision - Ambulance", I didn't see in the notes that anyone was actually transported. I would bet that they sure felt it the next morning, though.

Happy Racers

Standing wet
Standing cold
Waiting, waiting
Checking gear
Never knowing
When? Where?
Injury? Illness?
Assess Them
Treat Them
Happy Racers

Death Valley and (eventually) Orange County

Got back at midnight last night from what was a whirlwind tour of California...

On February 6, I took one of our ambulances, and a friend/EMT Jim, and headed toward Bakersfield. I wanted to leave at 6:00am, but due to technical difficulties (i.e... a diesel fuel leak), we had to repair it before we took her out for the drive. Ended up leaving at 9:00. Picked up my friend/EMT Anita in Bakersfield, and headed through the desert to Death Valley. Got to Furnace Creek around 9:30pm, and dropped off pretty rapidly to sleep (I had gotten up at 3:15am). It had been raining, and continued to do so all night. We had found out when we checked in that the marathon we were working was not going to be in Titus Canyon, due to snow and flooding. I really wanted to see Titus Canyon... maybe next year. So, now the race was going to be in Badwater, the lowest point in Death Valley.

We got out there, and began to set up shop. It stopped raining long enough for us to get the ATV out that I would spend the next 6 hours on, set up the gear on it, and get me going right after the racers took off. It began to rain pretty quickly after the race started. It wasn't hard rain, just constant. I got soaked and muddy pretty quickly. I had put on my polypro long underwear, which helped to keep me warm, although not dry. After 2 hours, though, my hands were numb. Got them to come back to life periodically by using the ATV engine to warm them. Jack-rabbited around, keeping an eye on the racers the entire time. These are hardy marathon runners! Death Valley can be brutal any time of the year, but add cold and rain into the mix... well, they did incredibly well! Jim and Anita kept shop up at the Start/Finish.

Toward the end of the race, I began to follow the last ones in. It also got colder, and was raining a bit harder.  Water was becoming more apparent in the low area of the race. The racers had to jump over the streaming water.

I started getting really cold, and shaking. As the last racers crossed the finish line, I hung back, to allow them their moment of glory (and a decent finish line photo, I hope). Jim began to wave wildly at me. I came in, and he told me that there was massive flooding in the valley, and that the rangers were going to close Badwater Road any minute now. I drove the ATV all the way up to the trailer, and we got it loaded quickly. I got behind the wheel and we (The three of us, all the racers still there, and the event organizers) all left Badwater. We drove through several areas of flash flooding, and made it to the Furnace Creek Ranch, where we quickly found out that all roads in and out of Death Valley were closed. Yep, we were trapped. There was mild flooding at Furnace Creek, but the folk running the resort know how to channel the water. No problem for us, except that we couldn't leave. Not that we were planning to until morning.

I ended up mildly hypothermic, and took a 30 minute shower to warm up. Even 12 hours later, I was cold. But I was functional. I made a decision that alcohol that night was not on my menu that night... Hot food was. We got dinner, and after talking with the event organizers for a few minutes, ended up back in our rooms. I let Anita and Jim know that if the road was open when we woke up, we'd leave immediately.

The next morning, I checked with the hotel front desk. They told me that 190 westbound was open, so we packed up, checked out, and took off around 8:00am. Oops! 190 west was NOT open. In fact, we found out from the rangers that we could have made it to Stovepipe Wells, but that it was physically impossible to make it farther. They call it a "hard closure". I call it washed out road. After speaking a little more with them, we found out that 190 east was open, all the way to 127. Took it down to Baker at I-15, back to 58, and up 99 to home... Long drive, but not really longer than it is over the mountain.

Dropped off Anita in Bakersfield so she could head home. Had more technical difficulties with the ambulance while heading home,but we finally made it. Got home around 10:00pm. Threw my clothes in the laundry, and got a few hours sleep. Then I got up, packed, and went to the airport. My day job took me down to Anaheim, where I was until last night, working a conference, on my own. It was a long week...

Random Acts of Reality

A paramedic in the London Ambulance Service has an excellent blog I recommend you to subscribe to: http://randomreality.blogware.com/blog

His stories, comments, and pictures give an interesting, humorous, and sometimes emotional view of EMS in the LAS.

Take a look... go ahead... nothing bloody there.

Cold and Wet Days

Winter has finally arrived. Yep. It is cold AND wet here in Northern California. How cold? Well, the low this mornig at my apartment was 37. For the Sacramento area, this is fairly cold in December. Not the coldest here, by any means, but add the rain into this mix, and the words "bone chill" come to mind. The snow level is currently around 1200 feet, which is low for this area. We have actually gotten snow in Sacramento Valley, but it doesn't look like it is going to happen this time around (Too bad, actually!). I've been in much colder temps (How's -20 in Indiana sound?). But when you are outside...

Yesterday, I worked a cyclocross bike event in Monterey. I love working these, but yesterday was just COLD. We had our small propane heater, but the poor fingers just would not get warm for more than a minute or two. The rain started around 1:00pm and really didn't let up after that. Thankfully, conditions were really good, race-wise, and we didn't have any major injuries. Not even road rash yesterday, which is really unusual for this group. Shivering bodies aside (and many were!), I am glad they all had fun!

VitalNotes

I got a chance to take a look at a new upcoming product (I got pre-production samples): VitalNotes. This product, made by ParaMed Systems, does what I do on my glove, my bare hand, my arm, whatever surface I can write on at times: Put patient vital signs, and other pertinent info in a written fashion. When we use our gloves, it is because the surface is there, and we are in a hurry to get that needed data to make decisions on care for that particular patient.

Now, along comes VitalNotes. This product, on a cloth adhesive tape, allows me to write (directly on the patient if I want) that needed info. More than once, I have had a firefighter or other EMS agency copying off my glove while I am still caring for the patient. Or I have handed them my glove or turned my hand so they can copy off the information. Now, if it is attached to the patient... wow! It goes with them! So, I use a section of it for a patient (taped to my sleeve or on a pant leg), and write those needed pieces of information.

Let me show you this product:

On one section of tape, there is space for:

• Chief complaint
• Medications taken
• Allergies
• Notes
• Time
• Pulse
• Respirations
• Blood Pressure
• Pupil Response
• Skin Color
• Glascow Coma Scale
• Capillary Refill

I think it is fantastic! They talk about using it as a general medical tape. Nah... use it for what it is designed for. Taking those needed field notes that we need for our PCRs and electronic medical records. Then tape it to the patient so it goes with them. I will post more photos of it in action from our actual use in the next few weeks. Stay tuned...

...And Back

Got back from Death Valley around 10:30 last night. I wish it could have been longer. I love that area. I know most of you don't see deserts as God's beauty, but it is. And what incredible sites!

Anyhow, the marathon went well. Had a few patients, including a rather dehydrated runner who may have probably has an infection. Bad combo. I wanted her transported out, but she refused. She has that right... .

For My Paramedic Friends Who Have Passed On

The medic stood and faced God.

Which must always come to pass.

He hoped his uniform was clean,

He'd gotten dressed kind of fast.

"Step forward now, paramedic.

How shall I deal with you?

Have you always turned the other cheek?

To my church have you been true?"

The medic squared his shoulders and said,

"No Lord I guess I ain't,

cause those of us who wade in blood,

can't always be a saint.

I've had to work most Sundays,

and at times my talk was tough.

And at times I've been violent,

cause the streets are awful rough.

But I never took a penny

that wasn't mine to keep...

although I worked a lot of overtime,

when the bills got far too steep.

And I never passed a cry for help,

though at times I shook with fear.

And sometimes, God forgive me,

I wept unmanly tears.

I know I don't deserve a place

among the people here.

They never wanted me around,

except to calm their fears.

If you have a place for me, Lord,

It needn't be so grand.

I never expected or had too much,

But if you don't I understand."

There was silence all around the throne,

where saints had often trod.

As there medic waited quietly

for the judgment of his God.

"Step forward now, paramedic.

You've borne your burdens well.

Walk peacefully on heavens streets.

You've done your time in hell."

I have posted this to honor those paramedic and EMT friends of mine who have passed away, including my original mentor, Jesse Abrams, and most recently, Ozro Henderson, Team Commander of DMAT TX-4, who passed away yesterday:

Please say a prayer for his family, friends, and for his team.

Note: I did not write this. I would love to know who the author is, to give this incredible person appropriate credit. If you know, please email me.

Not what I wanted to hear

Five weeks ago, I rolled my ankle. Not doing anything incredible; I was just reaching for something across my bed of all things. Didn't seem that bad, but it hurt. I treated it with the usual formula (RICE):

• Rest
• Ice
• Compression
• Elevation

It improved relatively quickly. However, a couple of weeks ago, it really began to ache, up into my fibula (One of the bones in the lower leg). My thought was, "maybe you have a stress fracture". So, I got in touch with my old podiatrist by email. Didn't hear back, so when I went to pick up some meds from the pharmacy, I stopped by. Talked with him briefly when he passed by me in the hallway heading somewhere else. Got an appointment, and got some x-rays taken.

Flash-forward to today. I saw him, and we chatted about my ankle, while he found the area of what we call "point tenderness" that was the worst. It wasn't in the bone. The pain I was feeling was "referred pain" (pain that starts somewhere else), probably due to the previous nerve damage in my ankle. Its that nerve damage that allows me to walk on a potentially severely injured ankle without screaming. The pain was clearly in an area of soft tissue (Non-bone). I was figuring he would offer a few options, one of which was injecting it with a cortisone drug to get it to calm down.

Nope. He dropped a bombshell on me. He told me that I need surgery AGAIN to essentially reconstruct the ligaments. Either I overstretched the repair I had in 1993 (and previously in 1992 which didn't take), or I tore it out (I had the extensor tendon from my ring toe harvested in 1993 to recreate the anterior talofibular (ATF), posterior talofibular (PTF), and calcaneal ligaments. Took months before I was allowed to put my foot to the floor after that one, and a year before it was ok to walk without support (Most of the time, I was in a "fracture walker", a removable cast that looks like a ski boot). This time around, it will take cadaveric ligament grafts to fix. Hmmm. Not real thrilled about that, but my tissue isn't usable. And two months non-weight bearing, along with another 2 months in a fracture walker. Hmmm. Thats four months directly out of commission, in terms of EMS work. Ugh.

I don't have to do it immediately, but it does need to be done. My ankle will dictate more than anything when I have to get it done, but I am thinking next summer might be a possibility. In the meantime, the doctor built up the outer edges of my boot inserts to keep me from turning my ankle while walking. He wanted me to be in a fracture walker again, but after we talked, my work boots are a good support for it (just about as rigid on side-to-side movement). I have to be able to work. At least right now.

Bike EMS

This last Sunday, I had the opportunity to be a "Bike EMT". Basically, two of us followed waves of half-marathon runners, to ensure that they stayed healthy on the course, and to treat any injuries or illnesses that might happen to them on the course. Being one of the few EMTs in our company that rides a bike on a regular basis, I volunteered to be one of them. We also had my business partner out there on an ATV, with gear attached that we may need to use to stabilize someone in the event of a more severe illness or injury.

My bike fitted EMS-style. That red bag is oxygen and airway supplies. Medical gear is in the panniers.

 

Steve on the ATV

I had ridden the course the Tuesday before, just to make sure I knew the expected problem spots (fast downhills, slip areas, etc). It was all along the American River Bike Trail, with the exception of an area at the beginning of the course, and along one of the bridges. But they would be protected by traffic controls (courtesy the local PD), and concrete and steel barricades on the bridge).

Thankfully, it was relatively uneventful out on the course. A few folk with cramps from dehydration or electrolyte imbalance, one that I kept an eye on that was doing her first half-marathon and was going to finish no matter what (She needed fluids and calories to continue), and some other issues treated at our tent at the finish line.

At one point, Steve needed to stop for gas to top off the ATV, just in case. They don't expect people to just drive up in an ATV. Probably turned a few heads!

 

Not sure who created this memorial, or why, but it is simple and beautiful.

 

Interesting sign over the Walker Bridge

Events and Rattlesnakes

I remind people all the time to watch out for wildlife when they are hiking, biking, or otherwise spending time in the back country. All manner of critters are out there... bobcats, cougars, bears, raccoons, and rattlesnakes. I tell them, so they don't have run-ins with them, resulting in a medical need.

So, imagine my surprise when, at an event at Toro Park this past Sunday, I found this guy at my feet:

Yeah, thats a Western Diamondback. Little guy, around 16 inches long. But perfectly capable of laying me out. Seems he was just moving past me. I stopped and let him continue on. Didn't seem to mind me at all...

Problem is, he decided to continue on to the race course. Just as the last mountain bike race was getting started. Although he was VERY young, I was amazed at how agile he was, avoiding getting hit and killed by the cyclists. Talk about FAST! Wow!

Then he continued on. Right toward a car next to our medical station. Someone brought me a long pole, and I "guided" the little snake into the bush, away from people.

Who Says Firefighters Don't Get Cats Out of Trees?

Take a look at this:



Way to go Sacramento City Fire Station 5!!!

A Jaw-Dropping, Hair-Raising moment

But one that was extremely satisfying.

Several months ago, my partner and I helped to save a man at an event I worked at. I won't go into details, but his injuries were quite severe. Today he surprised me by showing up at an event I was working at. One of the event staff let me know he was there, and took me over to speak with him. We had followed his hospitalization and his recovery. It was one of those calls that stay with you, and the people who know him run in a specific circle that we are also a part of. So, we were able to learn how he was doing.

I was absolutely amazed to just shake his hand, knowing how hurt he was the last time I saw him taking off by helicopter to the trauma center. He is still recovering, but is doing very well, all things considered. I hope he continues to fully recover.

EMTs and Paramedics work like he** to save people. Sometimes we can, sometimes we can't. But we often don't get to see those we do. :-)

Never Forget

It was seven years ago today that this nation was attacked by terrorists. It changed many of our lives in ways we are still discovering. We traded some of our openness and freedoms for what we hope is enhanced security against further attacks; TSA screening everything we own when we board a plane, "LiveScan" fingerprinting and increased background checks for simple things such as employment, RealID coming up, and more.

It was on September 11, 2001, after the attacks, that I made the decision to join DMAT CA-11. I had tried to join the military years and years ago, but they wouldn't take me, since I was missing a kidney. I have always felt a strong need to give back to my country. I remember filling out the application that day, and have been a member of this team since then. Interestingly enough, my application sailed through in record time (Karma?).

Today I sit in a hotel in Dallas, waiting with my team and many others for Hurricane Ike to make landfall. Whether we move before it moves in, or afterward, is up to the folk well above my level. Some teams are out there evacuating patients, others like us, are waiting for our missions, which will eventually occur.

Please take time today to honor those who died as a result of these horrid acts. And take special time for those who died trying to save so many... the firefighters, EMTs, and police. They truly died serving their country on that day. If you don't already volunteer, consider it. It doesn't need to be DMAT... local non-profits are always looking for volunteers.

Hurricane Gustav

... is making landfall as I write this entry. I am currently anticipating being deployed in the near future (24-48 hours) to the region. Depends on the amount of damage, the needs of the evacuees, and what NDMS decides to do. For those of you who are curious, there are teams that have been "pre-deployed", and are staged (waiting) in safe locations in nearby states. Others are already handling special needs populations that were evacuated to Dallas and other areas.

I just heard on the news (NBC) that the storm surge is topping one of the levees. Not good, folk. There is also a barge and a boat on the loose in one of the canals. They can actually damage the levees.

Helicopter Crash Photo Released

This photo was released today. Its amazing anyone survived.

On a brighter note, two of the firefighters were released from the hospital today. :-)

A Sad Day for Firefighters... and all of us

Last night, up to 9 firefighters were killed in a helicopter crash here in Northern California. This occurred up near the "Buckhorn" fire, in the Shasta/Trinity area. A Sikorsky helicopter was transporting the 11 firefighters (2 crew members were on board as well), when it went down. It crashed and burned.

4 survived. Three have critical burns, and one is in serious condition also with burns.

These firefighters gave their lives protecting others and property. Please pray for these heroes, and for their families.

UPDATE: Two of the firefighters may not survive. The news just reported that their conditions were getting worse. William Coultas and Jonathan Frohreich remained in critical condition in the UCD Burn Unit Wednesday. The other victim, Michael Brown was listed in fair condition in the hospital's surgical intensive care area.

Disappointment...

... doesn't even begin to describe my feelings right now. I caught word that the letters went out late last week regarding acceptance into the paramedic program. I knew I qualified, so it wasn't that I was expecting a "sorry, you didn't make the cut" letter. So, I eagerly went to my mailbox to retrieve what I thought was going to be my acceptance letter into the paramedic program.

"Thank you for submitting your application to our 2008 Part-Time Paramedic Academy. Unfortunately, the number of qualified applications did not meet the required minimum in order to provide this important course to the public."

My jaw hit the floor as I was reading it. THEY CANCELED THE PART-TIME PROGRAM! Paramedics are retiring from EMS and leaving EMS due to low pay in droves (many are firefighter-paramedics... firefighting pays a lot better than paramedicine alone... better benefits also.), and they canceled it! Why? Not enough people applied to the program... I don't know how many applied, how many were qualified, but right now, all I can think is there is at least one person who won't be a paramedic for at least another 6 months beyond the 2 years she was going to give up to do this.

Something needs to change, and change quickly. Otherwise, there won't be enough paramedics out there to provide the advanced life support that our increasing aging population needs (some of them are the very paramedics retiring).

I had already committed the next 2 years of my life to getting my paramedic license... For me, it wasn't the money. It never was. If I want a lot of money, I know how to make a lot of money. Its the love of medicine, pure and simple.

This really sucks.

Update: I decided to write a letter back urging them to reconsider. More later.

I need your help

I have helped many people and organizations over the years: financially, emotionally, spiritually. Some of you read this blog. Now, I need your help.

I need to raise about $1200 before Aug 23rd, to pay for my paramedic program (Books, tuition, malpractice insurance, uniform, etc). That is the first day of class. Until my month-to-month costs go down or my income goes up, I am barely keeping my head above water. BUT I NEED TO GET MY PARAMEDIC LICENSE. This is a part-time paramedic program through a local highly-rated community college. When I am done after 4 semesters, I will have earned another degree (An associate degree, but another degree nevertheless). But most importantly, it will enable me to provide a much higher level of care to my patients.

If you can help, I ask you to please make a donation through this link:

Can you help? Please? All donors will get recognition (unless they request otherwise) through a donors list on my main web page.

Paramedicine and its dangers

I have previously mentioned that being an EMT or paramedic can be dangerous. Inner city medics are keenly aware of this, so are some suburban and rural medics. Some medic units have been known to pack weapons in certain areas, due to the high dangers. Others are known to wear Kevlar vests (Reasonably bulletproof). Personally, I consider it unethical to carry a gun while providing medical care, although I was tempted one time when I worked on an ambulance years ago in Los Angeles.

Once in a while, an incident occurs that drives this home to us again. That such incident occured this morning in Maplewood, MO, a suburb of St. Louis. A young firefighter-paramedic, 22-year old Ryan Hummert, was shot and killed this morning while responding to a car fire. As they got out of their fire engine, they were shot at from a home across the street. Two police officers were also shot, one critically.

It is a reminder that we must always stay vigilant, no matter where I am providing care. Especially where we are providing care. It isn't unheard of for hunters to be in the same region as the races that I provide emergency care at. Not that I would think of a hunter intentionally shooting at me, but weapons fire is possible anywhere.

How NOT to keep your EMS gear

A few weekends back, I worked a motocross practice session. I was told there was gear out there for me, but since I have been burned once before, and discovered that there wasn't any gear when I got there, I brought some of our company's gear along. A trauma bag, a board, and my personal "fanny pack" (overstuffed, and is basically a small trauma bag sans oxygen).

When I got there, I was told that the gear was waiting for me. Well, it was. Here is what it looked like:

At first glance, it is dusty, but looks ok. Not a huge problem. I prefer clean gear, even when working in a dusty environment, but if the inside is clean and organized, I don't mind. However, when I opened the gear, it was a jaw dropper:


This stuff was FILTHY. As you can see on the outside of the blue trauma bag, that dirt isn't just a dust layer. IT IS CAKED ON. In the blue trauma bag, The OPAs were coated with dirt (Would you place a dirty device in someone's airway? I know I won't!), there were no NPAs, the scissors were also dirty, the white cloth tape was brown, the pocket mask was dirty, there was basic gear missing (such as 4x4s, plastic tape, saline for irrigation, triangular bandages, and other items). There were gloves in there, but they too were filthy. Some looked like they had been used. There was trash left in the bags (primarily 4x4 packaging). Some had spots of dried blood on it. I gloved up and picked most of the trash out. At this point, I realized that I didn't want to touch this bag, let alone use it on a patient. The spine board was ok, but the C-collar attached to it was really dirty (Bad place for it anyway). I decided to work out of my gear and closed it up after taking these shots with my cellphone.

The O2 bag was a little better. They had put splints in there (and apparently cut on to create a smaller splint out of a larger one), but most of the stuff was cleaner than the trauma bag. The BVMs needed to be replaced, as they had been in there for a long time, and looked like they were brittle from the heat (This is Sacramento, after all).

Keep in mind that this equipment is used by at least 2 EMTs that regularly work that venue. I was brought in on an emergency basic when neither was available. I mentioned the condition of the gear to several people. I told them that this was a danger to the patients that are being served, and that I refused to use it, as it could and most certainly would impact care, and was unprofessional.

I sure hope they clean this gear ASAP. Is it that hard to put a little pride in the gear provided to those who care for your patrons? Empty the bags and wash them. Its amazing how well these bags clean up. They may end up looking brand new again. In the meantime, I will be sure to make sure my gear is with me if I work out there again.

Wow! Attendance Topper at Rivercats game

I worked at Raley Field last night (For those who don't know, I am an EMT out there. Talk about enjoying baseball and medicine at the same time!). We had an incredibly busy night. I never got to see a single hit or play during the game. Not that I could have if we were standing by our office...

The Rivercats set a new attendance record last night. Maximum capacity of the ballpark is considered to be 14,414. Last night, it was... get this... 15850! Yeah, 1,436 more people than maximum capacity. Talk about standing room only! It actually made getting to patients more difficult, since we have to literally call out "Coming Through!" to get through the crowd. My partner had one of the "Sleep Train" whistles that they gave out at the game. He was blowing it while we were pushing through to get to patients. It actually worked, and got the guests attention!

Can't go into the gory details, but we sent 2 to the hospital, one from heat exposure, and the other from a fall. As I said, busy night at the ballpark! But I love this work!

Fire Updates

Unless you've been under a rock lately, you probably are keenly aware of the fires going on here in Northern CA. Here are some interesting statistics:

- The region's wildfires burned almost 250 square miles despite the efforts of more than 12,000 firefighters. (50 MILES X 50 MILES... imagine that... that is the size of most of L.A.)

- Fire crews from 41 states have arrived to help California firefighters battle hundreds of blazes that are darkening skies over the Central Valley and San Francisco Bay area.

- A Chinook helicopter with five Washington National Guardsmen has left Fort Lewis to help fight the wildfires. The aircraft headed to Sacramento on Friday. (That is a BIG helicopter!)

- The Sacramento Metropolitan Fire District said five fire departments in the area have sent 107 firefighters and officers, along with 20 engines, to help fight the fires.

- The smoke is everywhere. Visibility is currently less than one mile. Everyone is coughing. Those of us with asthma are doing our best not to become patients right now (Especially those of us in EMS). Current readings are PM 177 (177 parts per million parts of normal air - Thats alot of junk everyone!)

- The Governor has asked President Bush to declare many counties here in Northern CA disaster areas, allowing him to obtain extra much needed resources. That MAY include DMATs, folk! In the minimum, it means money, manpower, and machinery.

... Makes we want to huff oxygen... (Not really)

Job Security

In yet another example of how people keep EMS hopping with work, I provide you with this:

Man Emerges From Storm Drain, Hit By Car
Police: 3 Decided To Climb Into Underground Tunnels

POSTED: 1:08 pm PDT June 24, 2008
UPDATED: 1:52 pm PDT June 24, 2008

SACRAMENTO, Calif. -- A Sacramento man was badly injured after he surfaced from a city storm drain and was struck by a car.

Sacramento police said the 26-year-old man, his 19-year-old girlfriend and his 24-year-old brother had been drinking early Tuesday and decided to climb into the underground tunnels.

Lt. Mike Bray said the brothers apparently had explored the storm drains as youngsters and wanted to relive the experience.

The three walked about 200 yards in the drain and then tried to surface. When the older brother was lifting a manhole cover in the middle of a street, his head was struck by a passing car.

He suffered a skull fracture and was taken to the University of California, Davis Medical Center, where he was in critical condition.

The motorist, who got a flat tire, called police. The younger brother and girlfriend were arrested on suspicion of being drunk in public.
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I keep thinking back to this t-shirt graphic I saw (That I want!):

Yep.

Fuel Prices and Its Fallout

Everyone is aware of the absolutely wonderful gas prices today. Diesel is up there as well (Actually, considerably higher than gasoline). The fallout from that is obvious, as well as not so obvious. On the obvious side, we are becoming more careful about how we are using our vehicles: Combining trips, cancelling trips and vacations to stay close to home, using alternative modes of transportation, and even riding with friends and "co-shopping". It means that overall fuel consumption is decreasing. More on this in a moment.

On the not-so-obvious side is the financial fallout in other ways. Grocery prices are increasing (some is fairly evident, others more subtle), truckers are beginning to refuse to haul since they aren't making enough to even cover their fuel costs, and one that is noticed by the EMS community: It is costing us A LOT MORE to move our diesel ambulances. In April alone, for 2 ambulances (yeah, two), we paid out over $1,000 in diesel costs to cover events we were scheduled for. A year ago, it would have been half that. Scary? Your local EMS providers, especially the municipal fire departments, are struggling to find the money to pay for this fuel. Who will pay? You! Your taxes will have to increase to pay for the greed of others. Or you will pay directly by getting a bill for the ambulance trip you may take. Those who use these services as glorified taxicabs (Those on public assistance tend to abuse the system more than others, but this is by no means limited to them) will end up pushing the bill off onto you, again through increased taxation.

Now, back to the decreased fuel consumption. Our roads are supposed to be maintained in part by the taxes we pay on gasoline and diesel fuel for road use (Farmers don't pay it, by the way). Less fuel consumption results in less taxes collected. This results in less money for the roads (or other programs if the money is siphoned over to it from the funding). Crappier roads will be the result. Fun, huh? And another interesting side note: With less fuel consumption, allowing for the laws of demand and consumption, shouldn't the price of gas be dropping, not increasing? Are the gas companies playing the market, and manufacturing less to keep the demand high? Or are they just being overtly greedy and not lowering prices when there is less demand? Food (er, fuel) for thought...

Celebrate the First National CPR/AED Awareness Week, June 1-7

In December 2007, Congress declared the first week of June each year as National CPR/AED Awareness Week. June 1-7, 2008 will mark the first National CPR and AED Awareness Week with the goal of encourage states, cities and towns to establish organized programs that provide CPR and AED trainings and increase public access to AEDs.

Doing CPR isn't difficult. It is the one thing that anyone (including older children) can do and possibly save someones life. Witnessed cardiac arrests happen every day in the U.S. If CPR is started immediately and/or an AED (Automatic External Defibrillator) are used, the chances of survival increase dramatically. Having performed CPR myself on more than a few people over the years, I can tell you that 5% is better than 0%. At least they have a chance.

So, take time this week to find a CPR class in your area, and take it. I have embedded a video below that teaches "Hands-Only" CPR, but you really need to take a class to get the "feel" of it, so-to-speak, and to gain the confidence to be able to provide someone the necessary circulation with your hands until their heart restarts, or it is helped to start through defibrillation. The CPR class will teach you additonal information.



Remember, ANYONE can have a sudden cardiac arrest, anywhere. And you may be the difference between life and death for that person.

Road Rage

Yesterday, while I on my way to pick up more EMS supplies, I saw first-hand what road rage can be like. We all hear about it, but to be in the middle of it... that's another thing.

I was getting on Business 80 here in Sacramento, to then merge almost immediately onto US 50 on my way to Rancho Cordova. No biggee. I travel this route all the time. As I am getting on the on-ramp, a maroon Dodge Ram pickup truck pulls a U-turn from a one-way street (She had been going the WRONG WAY), right behind me. She pulls up extremely close to my bumper. Traffic was slow-go, and I found myself braking every 10 feet or so. Each time I brake, she pulls right up to my bumper. She hit her horn. Yeah, that's gonna make a difference.

At one point, I got tired of this, and pulled forward and then "Brake Tested" her. She literally pulled within an inch or two of my bumper and began the angry hand motions, and hitting her horn again. So, realizing I have something at my disposal most don't, I hit the rear flashers on my lightstick. Nice BRIGHT amber lights. She backed off a bit. So I shut them off.

As I was almost at the merge to eastbound US, she pulls suddenly to my right IN THE SHOULDER of the freeway! She pulled up right in line with me, and begins to THROW STUFF AT MY CAR! Near as I can figure, I got her Pepsi, her morning donut remains, and cigarettes. Nice... She is also yelling out her window, but I am not about to roll mine down to hear what she is saying. I got on the phone to the CHP, and let them know about this very angry, very DANGEROUS person. I gave them the description of the vehicle, and the driver, and I made them aware that she seemed either having an anger management issue, or she was under the influence. After all, she got on the on-ramp by driving the wrong way on a one-way street initially. I pulled into the next lane to my left, and got onto US 50. She was stuck where she was, and forced onto westbound US 50. Thankfully.

This whole incident sure got my adrenaline flowing! I hope they stopped her before she caused an accident... and/or killed someone.

Close Call

My EMS partner had a VERY close brush with serious injury or death yesterday. While using our ATV on a mountain bike race race course, he and the other EMT he was working with that day had a brake failure, and they were tossed off the ATV when they attempted to stop by downshifting. Unfortunately, since they were on a hill (and headed down), after they were tossed off, the ATV rolled over them. Steve took the brunt of the rollover on his hip. There were concerns by all of us that he might have a pelvic fracture, but an E.R. evaluation complete with x-rays showed no fractures... thankfully. He will need time for the very deep bruising to heal, but he will be ok.

Those of us in EMS are fully aware of the injuries that can occur with ATV use. We treat people for injuries sustained on them, usually due to excessive speed and maneuvers that should not be attempted on them. Although we are very careful with our rescue vehicles, things can happen.

Of course, we are going to investigate the cause of the brake failure fully before the unit is back in operation. Besides, it needs a little surgery itself, due to the damage it sustained. I am still so thankful that neither of them were seriously injured. They were truly being watched over yesterday.

Getting those good feelings... and the bad

Once in a while in EMS, you get to hear from those you help. And it makes a difference to hear that they are doing much better than when you saw them. After all, when we get involved, they are generally having a VERY bad day.

My EMS partner and I received just such an email today. It was nice to hear that this patient was doing well, and that the care we provided to this patient probably saved him from paralysis.

Ironically, the same day this happened, we had another patient who isn't fairing nearly as well. Not from any problem with our care. We stabilized what were major injuries, helping to save this patient's life. The head and spinal injury he suffered in his accident are critical injuries. We just hope he recovers.

NDMS Training Summit

Just got back from the NDMS Training Summit. If I hear from anyone at my work that I was "on vacation", I think I will remind them that I need a vacation from my "vacation". It wasn't by any means a vacation. This was work, pure and simple. Granted, it is work in Nashville, TN at the Gaylord Opryland (Right next to the Grand Ole Opry), but it was still work...

Day 1 - Travel to Nashville (Got up at 3:30AM to finish packing... left the house at 4:15. Went to work briefly to pick up my USB drive that I forgot, and turn in my parking pass from the day before. First flight at 6:00am. Got to the airport around 5:00am. Next flight was in Denver, CO. Got into Nashville around 2:00. Got to my hotel around 3:00. Checked in, then got over to the training summit to pick up my badge and switch some classes around.


Day 2 - Core Disaster Life Support class (4 hours). Then Electronic Medical Record training for the 3rd time (Longer story here). Butt is getting sore from sitting in hotel conference center chairs.


Day 3 - Basic Disaster Life Support class (8 hours). My butt is starting to get seriously numb.




Day 4 - Advanced Disaster Life Support class, day 1 (8 hours). Now, my legs are getting antsy too! I am drinking iced tea like it is going out of style. And my bathroom breaks have increased due to the iced tea! :-)

Day 5 - Advanced Disaster Life Support class, day 2 (8 hours). THIS IS THE FUN DAY! We had a mass casualty incident (MCI) training. Scenario was a bomb going off at a concert. And a second device went off. We found a third device on a patient. We also had training on patient simulators (These are like manikins, but they respond to what we do. Technically, you could kill them by doing something wrong, or if their injuries are too severe, they could "die". Their eyes blink, they have pupillary responses, they breathe, they have a heart rate and pulses. Its actually kind of eerie. You can push meds and they react. Really cool! Also Personal Protective Equipment (PPE) refresher (For some, it was a brand new experience suiting up). Last class was learning how to use Mark-1 kits (Atropine/Pralidoxime (PAM-2) combo), and how to give smallpox vaccine. All in all, this day made the rear-end trauma of the previous 4 days worth it.

Day 6 - Final general session at the training summit. Very informative presentation by the military on trauma care. Then, it was travel back to Sacramento. Flight left at 6:11pm CST. Next flight from Denver at 9:45. Got back in Sacramento at 11:15pm. After waiting for luggage and my ride, got home around 1:30am today. Crashed until 10:30am.

Now, you may ask, "Why would I take all of these classes?" Because I happen to be one of a group of people who see the writing on the wall. These trainings are an "All Hazards" medical training for mass casualty events. Basically, it puts all healthcare providers on the same page for dealing with MCIs. I see it coming as mandated training for healthcare personnel. And I want to teach it.

So, my next step is to take the instructor training.

Of course, I had "downtime", I went to the Grand Ole Opry and saw Carrie Underwood, Randy Travis, and Vince Gil all in the same night. I went to dinner one night with my team, DMAT CA-11, with our sister team CA-6 (All of us do this each year at the conference), and with some friends from other teams on another night. And yeah, I enjoyed a few drinks at night. But trust me, with what I learned, it was no vacation.

Padded lampposts to protect texters?

In yet another one of those, "Why are they doing this?" moments, somewhere in London, England, lampposts are being padded to PROTECT PEOPLE WHO ARE WALKING AND TEXTING USING THEIR CELLPHONES. Here is the article from ITN:

-----
Padding to protect pedestrians

People who have been injured while walking and texting on their cell phones may be in luck.

A London street is experimenting with padded lampposts to protect those not paying attention from banging into them, ITN reports.

A study conducted by 118 118, a phone directory service, found that one in 10 people has been hurt while focusing on their cell phone instead of where they were walking, ITN reports.

The test lampposts will be given a trial run in London’s East End on Brick Lane. If the trial is successful it will be rolled out in Birmingham, Manchester and Liverpool.

The survey found that almost two thirds of respondents lost peripheral vision while texting, and more than a quarter wanted lines on the pavement to create routes for texters to walk while using their phones.

The study claims that 68,000 people were injured in the U.K. last year while chatting or texting on their cell phone, Infomatics reports.

118 118 will provide the padding, and in return will be allowed to advertise on them.
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OK... Here's my take on it... Stupid people should not text and walk at the same time. Sit down and send your message!

In the neighborhood

Yesterday, I was heading home to grab some Girl Scout cookies for one of the girls in my troop, and I happened to notice a guy RUNNING down the street. What caught my eye wasn't his running, it was that he had no shoes on, and he appeared to be running in fear. In fear of what? Nothing that I could see.

A few minutes later, I am heading down our main drag here in Antelope, and I see this same guy on the side of the road, sitting down. And another man is holding him down, having grabbed the hood of his sweater and twisting it a bit to keep the other guy down. He looks around with what I refer to as "pleading eyes", so I pulled over and got out. I asked him if everything was OK.

"My brother is having schizophrenia problems", he tells me. "Can you call the police?"

I did a brief check on the man. High pulse, his respiration rate, sweating. Not 100% alert. Well, since this is clearly a medical issue, not a criminal one, I got on the phone with dispatch, requesting medical aid instead. Went through the usual yada-yada with dispatch, even after I informed them I was an EMT (They operate off of scripts), who tells me, "Don't let him eat or drink anything". OK. Right. I forgot to ask for no lights or sirens, however.

I get my gear, and get back to the man and his brother, who is still holding him down. I start up a conversation with him. He starts to talk to me a bit, which is good. He's not completely gone wherever he went. He was clearly running from someone, but we can't see them. I assure him I won't hurt him, and that the people coming to check him won't hurt him either. I don't want him bolting into traffic.

The man wants to lay down. I put my backpack under his head for a cushion. Recheck his vitals, still high pulse and respirations. Then the Fire Department arrives. Thank God, no Code 3 (Lights and sirens). I honestly think it would have wigged this guy out. I give them the run-down, and they offer to take the man to the hospital. Thankfully, he agrees and goes with them.

"Thank you, maam...", is the bulk of what I got from Fire. I toss my gear back in my Jeep.

Oh well. At least the man will get the treatment he needs. I hope.

Busy-ness

Wow! These last few weeks have been CRAZY!

Jan 28 - Went down to WestPack conference and worked there until Jan 31 for work. Had two of my co-workers with me. Worked out really well, though!

Jan 31 - 10:30pm - Got home from southern CA.

Feb 1 - 7:00am - Got in our ambulance, heading for Death Valley.

Feb 2 - Worked in Death Valley. Nobody had to get transported - YEAH!

Feb 3 - Came home

Feb 4 - Out the door at 4:00am to Southern CA again to pick up a new (well, new to us!) ambulance

Feb 5 - Home after midnight... Got up and gone by 6:00am, heading for ANOTHER conference! This one was near San Francisco. Started feeling sick on the way (scratchy throat, nose getting stuffed up.)

Feb 5-7 - Attended the CUPA Conference. Learned a lot, but I was REALLY sick. Did what I needed to, work-wise, but went to bed around 6:00pm on the 5th and 6th. Started feeling better on the 7th (Nyquil and fluids, yeah!), finished out the conference, and headed home.

Feb 10 - Out the door again, this time for Monterey for a race. Treated a few racers, sent one to the hospital. Asthma flared a bit, so I was on albuterol every 2 hours.

Yes, I am feeling better. As I said, my asthma kicked up a bit, due to that nasty cold I got, but it is under control again. Hey, I gotta breathe, right? And I don't want to end up a patient!

Of Deserts, Snow, Conferences and Updates

Well, where to start? Um...

This last month has been an absolute BLUR. I started out going to the 2008 Consumer Electronics Show in early January. Had an incredibly fun time while I was there, even though I got sick ('tis the season... see below). Got home and promptly hit the ground running, work-wise. First, I became a partner in First On Scene EMS. Yep! I am co-owner of a business! Second, my work at the St. of CA has kept me incredibly busy, with prep work for 2 conventions, plus my usual work. We are talking 16-hour work days! And not just M-F. EVERY DAY... But I love it!

So, Monday Jan 28, I boarded a plane for Orange County, and ran our booth at a packaging show. Contacted A LOT of people! It was definitely worth the cost, time, and effort. By Thursday, I was exhausted, and got home after 10:30pm, due to flight delays, even though I changed my flight to an earlier time. Threw my clothes in the washer, went to bed, and got up at 4:30am to get ready for... a trip to Death Valley! We had a marathon out in Titus Canyon, and First On Scene is the EMS provider. We took the ambulance down there, and had a good time, providing EXCELLENT medical care out there. Got back LATE Sun night, threw the clothes in the washer and dryer again, and was up and gone by 4:30am yesterday to go down to pick up another ambulance we were buying (Business is picking up!). Got stuck at the Grapevine for 1.5 hours due to snow and fog (More fog than snow), then got over the hill. Picked up the new rig (well, new to us... it is a used ambulance), and headed home. Got home after midnight this morning. Got up at 5:00am, and went to yet another convention for work! Crazy schedule, huh?

So, I am here in the SF Bay area attending a conference for the next few days. I will update more when I have a chance, and will hopefully post some pics soon.

Why Wouldn't They?

I just read that Boston EMS personnel OVERWHELMINGLY approved a new contract that included both alcohol and drug testing of personnel. I ask again, "Why wouldn't they?" I would not want to be working with an impaired partner EVER, nor would I expect them to work with me if I was impaired. Random drug and alcohol testing removes this concern for us. Are there impaired EMS, fire, and police out there? Unfortunately, the answer is yes. Not many, but they are there. I've seen them, and in one case, briefly worked with one (I turned him in after he refused to clock out and go home.). I don't drink much to begin with, but I actually REFUSE to have alcohol within 24 hours of an anticipated shift. If I have been drinking within 12 hours of a call-in, then I decline it. Why? Patient safety, and more importantly, my own safety and that of my partner. I want to go home safe at the end of the day.

Way to go, Boston EMS! Way to go!!!

To Death Valley and Back

Last weekend, I went to Death Valley (from Sacramento - long trip!) for a marathon that was being held out there. No, I didn't run in it. I was part of the EMS crew working the race. :-)

Anyhow, I thought I'd show you a pic of the ambulance I work on. The ironic thing? Even with that wild yellow color, we are invisible on the road to other drivers.

The next picture shows us up next to the rig. That's me on the left, Steve, and Amy. Steve is co-owner of the company.

We had a lot of fun working that event. They are a great crowd, and actually followed what we told them to do when they came to see us for care. I will be out there again in February for the next race.

Saving Back

Years ago, one of my EMS partners saved my life. Literally. I had a severe allergic reaction, and I was treated by my own partner (and a newbie EMT that was with us on a ride-along).

Last night, I had a chance to repay that debt. Not to the same person, but to my current friend and EMS partner/boss. He told me over the weekend his pressure was high, and that he knew he had High Blood Pressure (HBP). How high? 170/120. Thats up there. Especially the diastolic (the lower number). I had sent him a text message yesterday, trying to get my gear back that I loaned him recently. It took a while, but I got a response, including that he had a nasty headache. My first thought was to ask him what his BP was. He hadn't taken it (His wife is an EMT also, but he apparently refused to let her take it), but he was bringing my gear over, and asked me to check it.

When he arrived, it was clear he wasn't doing well. I checked his BP. It was 190/122. Eek. That is getting atmospheric, folks. And at that pressure, a stroke is a good possibility. He was a bit altered, also. Not a lot, but clearly not himself. Had periods of blurring vision, and that headache.

I advised him to get to the ER NOW. He was dealing with uncontrolled hypertension, and after pleading with him for a few minutes, reminding him that he tell his patients the same thing (He agreed), and mentioning some other things, including the fact that he would more than likely have a stroke, he finally said he would go to the ER. He left for home, a few minutes from my house. In hindsight, I should not have let him drive home.

In the meantime, I finked on him to his wife. I sent her a text message with the BP's from both arms. She met him at the door with her cell phone in hand, "188/122??? You need to see your doctor TOMORROW!", is what she told him. His reply was, "Actually, I'd like you to take me to the ER". So, off they went. It took 3 different BP meds to get him out of the stratosphere, and some narcotics for the headache. They also did a head CT, to rule out a stroke, since he was symptomatic.

UPDATE (8:45PM) - I just heard that the meds seem to be working, and his BP was now 155/94. His wife said he is acting more like himself again also. MUCH BETTER!

Home again

Got home around 2:30am on Sunday. LONG RIDE. Spent most of yesterday recovering from exhaustion. Sleep is not something to take lightly! I feel about 90% now, and went to work today. They were surprised to see me, as I had not contacted anyone to tell them I was returning (It was Saturday when we demobilized, so no one was there to read it anyway!). Coworkers have been dropping by asking a lot of questions. I figured I would answer a few here:

Q. Where were you at?
A. We were initially going to Qualcomm Stadium, but when it was discovered that they had plenty of medical help, we were sent to Del Mar Fairgrounds (and Racetrack). We were housed most of the time at the Mission Tower. We shared the space with the CA National Guard (who also were our guards as well as fullfilling other missions). Eventually, we were moved out to another warehouse, the Multipurpose Livestock Facility. None of us saw that sign until the next morning. See the guys in the yellow vests? Those things slung over their shoulders are automatic weapons. Our security was taken very seriously. I did go to some outlying evacuation centers on a strike team one day.

Q. What did you see?
A. Lots of smoke. Saw some fire also.

Q. How close to the fire did you get?
A. Within a mile (as the crow flies), when we were in Julian. Didn't get to see that, though.

Q. What kinds of things did you treat?
A. Mostly medication needs, from people that forgot theirs when evacuating. But I really didn't treat anyone out there. Did some triage, though. Listened a lot.



Q. How many people really were evacuated from the fires?
A. The jury is still out on that, but it seems around 700,000.

Q. Got pictures?
A. Yep. Gotta post them.

Q. Got video?
A. Yep. Gotta post them.

Q. Didn't your asthma flare up?
A. Surprisingly, no. Coughed a little bit on day 3 down there, but my lungs stayed clear. (Remember, prevention is the number 1 thing! I take my meds!)

... it goes on and on.

The pics in this posting show the Mission Tower, one of many road closure signs, a crashed coworker (Note the stethoscope sticking out of her pants pocket. We all crashed hard at times, getting sleep when we could.), and my fellow nightcrawler Susan and I working "Real World Medical" (Caring for our coworkers).

I felt privileged to serve my fellow Californians as a member of the California Medical Assistance Team (CalMAT). This was our first mission; we fulfilled it, and then some.

Not my idea of a San Diego vacation

Of course, it isn't. Keep in mind, I was here Oct 7-12. Its like a totally different place now. The smoke makes things look, for lack of better words, dirty. Versus the crisp clean air back then. A whole two weeks ago.

Looks like the firefighters are making progress, as long as the winds behave. If they kick up again, the fire will as well.

The sunsets caused from the smoke are incredible, however.

Firestorms

As I write this, I am preparing for possible deployment to Southern CA. I have already been contacted, and am awaiting a call saying I am going. Our mission: Provide medical care to the firefighters. There may also be other missions, as a hospital and skilled nursing facilities are also being evacuated with the other 250,000 people evac'd, but that is the primary one.

The firestorms in Southern CA provide sharp memories to a lot of us of 2003, when San Diego, Los Angeles, and San Bernadino counties had major firestorms. Our DMAT was on a deployment exercise with other CA teams, when our exercise became a "realtime" emergency. We got caught in fireborne winds that damaged equipment, and reminded us what nature can do. Team members deployed from the exercise to the fires.

The picture is a satellite image of the fires. The smoke is seen trailing off over the ocean.

Anyhow, I am tired and rambling and need to get a few hours sleep. Please pray for those affected by the fires, and for those fighting them.

(UPDATE: I was deployed at 11:45PM. I am reporting this morning, and will be gone for 3-5 days (possibly longer). So, as a result, I probably won't be updating here until I return.)

Rollover

I was heading to SF with my Girl Scouts this morning, and as we were passing from Vacaville to Fairfield (a kind of no-mans land between the two cities), noticed a vehicle that had left the freeway and landed on the frontage road. He had obviously rolled the car a few times. The girls saw it too, the prevailing comment, "Oh, my God."

I pulled over immediately as far as I could on the shoulder, told my girls to stay in the car buckled up, grabbed my jump bag, and went over to the car...

Initially, there were three people there. Took me a second to figure out who was in the car. It was a single occupant accident, and even though the guy rolled the car three times, HE WALKED AWAY FROM IT! Upset, yes. Slight injuries, yes. Major injuries? Well, aside from the potential of internal injuries due to the mechanism of the crash, he had no head, neck, back, or extremity injuries. Now, he was pumped on adrenalin, so I can't be sure, but I'd be willing to bet he got cleared at the hospital in record time.

Oh, CHP dispatch: PLEASE EDUCATE YOUR DISPATCHERS. When I tell them that a vehicle rolled over multiple times, they should not ask, "Is anyone injured?" Send the friggin' paramedics out, just to be sure, PLEASE.

I hung around until fire got there, then handed him off ASAP to get to my girls. I was really concerned about them on the freeway, and rubberneckers hitting them. We talked about the whole thing. I think a few of them are interested in emergency medicine now. :-)

A Long Day

Today I worked another triathlon, one that kept us quite busy. Right off the bat, injured people. Minor stuff, but an indication of the day, IMHO. And that was before the race started. Swim went portion went well. We kept an eye on a few swimmers, but everyone made it out of the water. Got a few more folk with minor injuries, easy to treat (bandaids and such).

Ended up with a bike crash near the beginning of the bicycle portion of the race (which was also a loop-around point). Two racers collided, with one going over a metal pipe-type gate. Based on MOI (Mechanism of Injury), we chose to C-Spine him in preparation for transport to the hospital. Fire Department got there, and before they even evaluated the patient, essentially convinced him not to go to the hospital. Argh. But, at that point, they had "control" of the patient (and legal liability if something goes wrong... we chose to be cautious). We stood back, and let them evaluate him after they got him off the board. We still think it was a bad idea, but the patient and the medics made the choice, not us.

Had some other slides/crashes, but none so serious as the one I described above.

During the run portion, we were notified of a runner down on the course at one of the aid stations. That was all we had. We kept trying to get the aid station on the radio, and finally got a garbled message, the gist of which we heard, "heart attack". Damn! We got on scene, and found a runner down with crushing chest pain, diaphoretic, low blood pressure, and thready pulse. Not good. Got the patient on O2, and began transport in our Jeep to meet up with the ambulance at a major intersection nearby (We are on-scene BLS only). Re-evaluated vitals, pain level, and pulse ox while the fire department and ambulance were en route.

The FD got there, took control of the patient, re-evaluated vitals again, and then decided to give him nitro spray under his tongue. Nitro is used to dilate blood vessels, allowing more blood flow to the heart, and reducing pain. Problem is, the FD EMT sprayed it several inches from the patient. While it did make it into his mouth, he sprayed me as well. Nitroglycerin can be (and was) absorbed by the skin and mucous membranes. While I didn't take a breath at this time, I suspect my face and eyes took a hit from the spray. As a result, I entertained a minor headache for around a half hour that ensued from the exposure. Not horrid, but he should have been a lot more careful. And hey, more medication would have gotten into the patient. He was then moved onto a gurney, and headed off to the hospital. FYI: Looked like an Left Anterior Descending MI (Aka "Widowmaker") on the ECG, according to my partner.

That pretty much wrapped up the race. While we were out with this patient, one of the other EMT's was dealing with a line of "road rash" from crashes, minor falls, etc. As I said, it was a long day. But hopefully one that everyone will be ok, including the possible MI (Heart attack).

Oh, all this occurred in around 3 hours.

What did I say about heat?

Back on 9/2/07, I wrote an entry regarding heat. And now, we see the effects of heat and lack of effective planning. The Chicago Marathon occurred on a hot day (for Chicago), that was also humid. Races happen all the time in hot and humid weather. What made this different is that it appears that the race organizers did not adequately anticipate the consequences of so many runners needing to cool down. They had the equivalent of 1.8 million cups of water. Problem is, the runners used them to douse themselves as well as to drink. The water was near the end of the race, not interspersed along the route. The heat was anticipated. Adequate "all weather" planning is a must for large events such as this.

Over 250 people were transported to area hospitals. And yes, one runner died, although the autopsy showed that it was due to mitral valve prolapse, not heat. Heat obviously had something to do with his death, but it was a heart ailment that actually caused this man to die.

Eventually, race organizers shut the race down, after 3-1/2 hours. Did the runners all stop? NO. Many continued on, partly due to what I call "runners tunnel vision". They want to keep going, no matter what. This is expected during races. I treat athletes that want to continue even when I know darn well that they should not. And yes, I override them on occasion. And for good reason.

The paramedics and EMT's out there in Chicago performed incredibly well in the face of a LARGE MCI (Mass Casualty Incident) that played out over a large area. WAY TO GO!!!

When I read this article from the Ventura County Star, I felt strongly that I had to share it with all of you. Each of us in EMS has our "nightmares", those cases that hit us especially hard. And yes, I have a few that strike me hard when I think of them even today. Some come back to haunt me when I have a similar case, or when we all talk about something. Personally, I have been a part of 3 CISD (Critical Incident Stress Debriefing) events, and one "Defusing" (A chance to just openly vent). All of these will remain confidential with all of us that participated. I can share with you that even the most hardened firefighter, policeman, and medic can break down at these very important meetings of all involved.

The last paragraph especially points out that we EMS folk are human. Keep in mind, when I first became an EMT, "suck it up" (AKA "deal with it yourself") was the common method of dealing with the unthinkable. We have learned a lot over the years; this attitude resulted in burnout and suicide among EMS, police, and fire personnel.

Saving lives sometimes trigger crises

First responders' roles to lessen suffering and save lives sometimes trigger their own crises

By Cynthia Overweg
Correspondent
Wednesday, October 3, 2007

When paramedic Brian Williams got the emergency call, he knew he was about to encounter a tragic scene.

Along with police, firefighters and others, Williams was on his way to one of the most notorious crime scenes in Ventura County history.

When his ambulance crew arrived at an apartment building in Newbury Park in August, they found 6-year-old Sev'n Molina had been brutally killed with a meat cleaver.

The first responders were not only confronted with the mutilated body of a child, but also with the boy's critically wounded mother, a seriously injured neighbor who had managed to stop the attack, and a violent suspect, who had to be restrained with a police Taser.

While first responders are specifically trained and equipped for the difficult jobs they do, the strain of repeated calls to scenes of human anguish can take an emotional, psychological and physical toll.

"The violent death of a child is the hardest call there is. There is nothing that can train you to deal with that," said Williams, who pronounced Sev'n Molina dead at the scene.

He also stabilized Sandra Ruiz, the boy's mother, who had near-fatal stab wounds, and rushed her by ambulance to Los Robles Hospital and Medical Center for emergency surgery. A second ambulance crew attended to the injuries of Diane Cox, the woman who intervened in the attack, and took her to the same hospital.

When they arrive at the site of heartbreak and danger, whether a man-made tragedy or a natural disaster, emergency responders — firefighters, police, paramedics, chaplains, and crisis intervention workers — work to alleviate suffering and save lives, sometimes at great personal risk. But their vital role as public servants can sometimes trigger a private crisis within.

"When you're on the call, there's no time to think and reflect. It's only later, sometimes much later, that incidents like these get to you," said Williams, who lives in Newbury Park and has been a paramedic for 20 years.

Senior chaplain and certified trauma responder Larry Modugno, who works for the county Fire Department, also went to the apartment where Sev'n died and said it was one of the most traumatic things he's ever seen.

"As chaplains, we make ourselves available to anyone who needs us. Often, all that is needed is a hand on the shoulder or a few words of encouragement, but more was required in this case," Modugno said. He said he stayed as long as necessary and then went to the hospital to be with the two surviving victims.

Team assists after incident

To help first responders deal with the inevitable stress created by the work they do, a critical incident stress management, or CISM, team is assembled after a traumatic incident.

CISM is a volunteer, peer-driven support network, chartered in Ventura County under the International Critical Incident Stress Foundation based in Maryland, regarded by many as the nation's leading crisis intervention program.

A CISM team consists of emergency responders, chaplains and mental health professionals who specialize in stress-related disorders. Within 48 hours of a traumatic event, emergency responders have the option to attend a "debriefing," a meeting where they discuss what happened, have the opportunity to express their feelings in a supportive setting, and get further assistance if needed.

Not inclined to seek help

"First responders deal with the trauma and grief of others every day. In so doing, they can become traumatized themselves," said Scott Barash, a licensed clinical social worker with the County of Ventura and a CISM team member.

Barash said the personality traits that make emergency responders good at their jobs can also make them less inclined to ask for help.

"These are very resilient and compassionate people who need to be able to lighten up and not carry the stress around," Barash said.

The slaying of Sev'n Molina caused a tremendous amount of sadness among responders, said Capt. Jerry Hernandez, spokesman for the sheriff's department.

"He was chased down and struck repeatedly with a meat cleaver. Along with other deputies, I saw the body of that poor child. We were all traumatized by it," said Hernandez, who added that just repeating the details of what happened can be uncomfortable.

"These are normal reactions to a very abnormal event," said Stephanie Huhn, emergency medical services coordinator for the Oxnard Fire Department and a CISM team member involved in the debriefing of responders. "Because of the horrible nature of the crime, I felt some dread prior to the debriefing, and that's normal, too. It's not easy to see co-workers in distress, but I'm there to validate how they feel because I've been in similar situations myself," said Huhn, who was an emergency room nurse for 23 years.

"We see things in our daily jobs most people never see in their entire lives, unless they've been in a war," said Capt. Barry Parker, spokesman for the county Fire Department.

He said one event that stands out in his mind involved a traffic collision on Highway 101 in Camarillo. He was first on the scene to find a man and a woman trapped in the front seat of their van.

"The woman was screaming for her baby, but I didn't see one. Then I noticed a car seat on the highway. I went over to get it and found a dead infant with massive head trauma. Images like that get glued into your brain," said Parker. He said sometimes a traumatic memory can be re-triggered by a similar event or by passing the spot on a road where something terrible happened.

"We talk about these things at the firehouse, and we help each other," Parker said.

Disturbing images or nightmares eventually go away, said Barash, but when they don't, it's a signal to ask for help.

"Emergency responders are better prepared to handle a traumatic event because of their experience and training, but they're not super-human. Like the rest of us, they can be overwhelmed and need reassurance and support," he said.

2974 and still counting - 6 years later

The official death toll from 9/11/01 now stands at 2974 after a woman who worked a block from the World Trade Center became ill and died 5 months after the towers came down. She died from lung disease not present before 9/11.

Why do I say "and still counting"? Because there are first responders (firefighters, police, EMT's, and paramedics) who are becoming ill at alarming rates, due to their response to the World Trade Center. "WTC Cough" was the start of it. Now, cancers, asthma, and other problems are surfacing.

I am not attempting to detract from this ominous anniversary. What happened still shocks me to this day. It still seems like it happened yesterday.

Please remember those who died. But also remember and pray for those who responded, risking their lives, and who may ultimately give their lives for doing what they do.

Heat

OK. I am getting up on my soapbox now.

Heat Hurts and Heat Kills... Heat Hurts and Heat Kills... And I am going to say it again. Heat Hurts and Heat Kills.

Why do I mention this? Because every day I work outside in the heat working EMS, I see people who:

1. Don't drink enough fluids
2. Don't drink enough fluids
3. Don't drink enough fluids

And I see them with heat cramps, heat exhaustion, and heat stroke. I treat them at baseball games, football games, races, triathlons, walking on the street (twice, as a bystander).

Dehydration can affect ANYONE. Once you become dehydrated, you become very vulnerable to the effects of heat. Heat cramps first. This is where you feel cramping in your muscles, and you may become nauseous due to stomach cramping. This is INTENSE, and painful. Treatment: more fluids, cooling, and working out the cramps. You'd think that would convince people to drink more fluids. Nope.

Once you pass through heat cramps, next is heat exhaustion. It feels like exhaustion. And more nausea, vomiting, fainting, and maybe a low grade fever (a degree or two high). The cause is the same. Dehydration. Treatment is fluids (sometimes intravenous, due to nausea and vomiting), quick cooling, and maybe a trip to the E.R.

Don't treat that, and you can move on to heat stroke. Red skin, hot skin, not sweating. Temperatures can go to 106 degrees or higher. Highest I have seen was 107 in someone. We checked his temp twice, and on ourselves, because we didn't believe it when we saw his temp was that high at first.

He didn't make it. Temps over 105 can cause significant brain damage, as your brain literally begins to cook and cells die. Oh, and other cells in your body, like heart muscle, liver, and kidneys. Treatment is rapid cooling, including ice packs EVERYWHERE (even the groin and around the neck), intravenous fluid therapy, supportive care such as ventilation (breathing for someone who isn't breathing on their own - or not enough). Guaranteed trip to the hospital for heat stroke. And a stay there for a while, too. If you survive. Heat stroke is LIFE THREATENING, folks. People die from heat stroke every time there is a heat wave. And maybe without the heat wave.

Some medications and conditions increase your risk of heat injury. Know what you take, and how it makes you react to heat. Keep a list of your meds on you. I've even treated someone for heat stroke in 67 degree temps. Really. She was vulnerable to heat due to a medication she took, and she ran in a triathlon. Oh. She was also dehyrated.

Why do I say this? Because it is preventable. Absolutely preventable. And yet, I see people with heat injuries just about every day I work in extreme heat.

• If you aren't acclimated to heat, start to become acclimated. It doesn't happen instantly.
• Drink plenty of fluids, well ahead of the heat. Like days ahead of time.
• Drink plenty of fluids while in the heat.
• Drink plenty of fluids after heat exposure.
• Gatorade/Powerade/Deluge by itself is not good. Alternate with water, folks. Really.
• Keep drinking fluids. Hey, don't get dehydrated in the first place.

OK, now that I have said this, how much should you drink? 8-10 8oz glasses per day is what you should drink daily (unless your doctor tells you otherwise). On hot days? Try 15-20 8oz glasses. Thats about a gallon of fluid. Yesterday, I drank approximately 2.5 GALLONS of fluid. But I know my body, and what it requires when I am working in 105 degree temps. I am moving around, sometimes bolting around on runs instantly (Yeah, even at my weight... I can run pretty fast!). I don't drink that instantly. It is in small amounts all day long.

Off the soapbox now.

BTW, yes, I have been a victim of heat cramps and heat exhaustion. Last year, even taking care of myself, I sweated more than I could take in. Why did I develop symptoms? Simple. I didn't start out well-hydrated. I felt like crap. My head hurt, I was nauseous, my muscles ached (even days later, they hurt), my pulse raced, and my temp was 102. I was tempted to ask a medic friend of mine to come over and start an I.V. on me. I hate needles. So I kept sipping fluids all night long.

And as I said, I have seen people die from heat stroke. Which is why I take heat seriously. I hope you do, too.

Back from DMAT training

Just got back from a large statewide exercise called Rough and Ready, down in Southern CA. This year's exercise was a LOT of work for everyone. We had a chance to work (albeit briefly) in one of the new mobile field hospitals that the State of CA bought. This puppy is BIG:



Its about the size of a football field, has 200 beds, and everything you'd find in your normal hospital. It takes 17 semi-trailers to haul each of these (There are 3 of them located state-wide). That blue unit in front? It is one of the generators for the hospital (There are multiple generators to run this thing). See the tan rounded units just on the left? Those are the living quarters for those of us who will end up working in the hospital. It is really something else! If you saw this on the news, or know of articles and video, let me know! We are looking for any and all articles, video, and still images!



Yes, that's me listening to the lungs of a CPR manikin! We had "real" patients (nursing students that were moulage'd up) and a few Resusci-Anne's around for good measure. Lots of press people taking out pictures, and taking video.

Of medicine, odd temperatures and exhaustion

First, I am writing this after coming off three days straight working 16+ hours. So, if I come off a bit negative, I am sorry.

As summertime has hit, things have gotten busy for me. Since I work multiple jobs (my "day" job + 3 other part-time jobs), it can get... hectic. Friday, I worked my usual 8 hours, then worked at the ballpark for a game. Got home ala 11:30pm, then was up and running at 5:30am, picking Diana up from work, going to pick up the ambulance, then have her drive home with Jonny. Got home, threw my uniform on that had been in the dryer from working the night before... then off to the soccer matches to work! Worked that from 8:00am-6:30pm, then went home, quick shower, and threw on my shorts and work shirt to work a shift at the ballpark (We had a no-show... seems to happen more this time of year). Game didn't even start until 7:30, as it was "Dusty Baker Day", and things ran late. The work at the soccer matches was BUSY. It was very hot (105 degrees), and we had kids crashing due to heat. Even sent one to the hospital, but hers really wasn't a true heat-related issue. Something else was going on there... more later.

Got home late, threw the uniform in the laundry, putting my shorts in also, since I baked that day in my long pants and enjoyed being in shorts that night at the park. Hit the pillow and that was I remember until 5:30am again yesterday. Woke up, threw everything in the dryer, got ready for work, tossed the now dry clothes on and went to pick up my partner for the day and get back to the soccer fields.

Except for one thing... I put my shorts on, since it was hot the day before. Remember what temp I said it was on Saturday? Not yesterday... the high was a whopping 75 degrees (That's a 30 degree difference!). I froze my tush off out at the field for the first 4 hours. It was cold, windy, and a little smokey from a brush fire nearby. The brush fire got knocked down quickly, so that didn't linger too much. But wow... I ducked into the rig just to stay warm! While I was in there, I made use of myself and cleaned it up. My partner helped me also (She and her husband own the ambulance). Her husband got there and I took off pretty soon after that to get ready for my shift at the ballpark. Heh... I put my pants back on instead of shorts, and dug out my jacket that I haven't seen since the first week of June. Glad I did. I got damn cold at the park last night by 7:00pm. By the time I left around 10:00pm last night, the temp was in the 50's. Wierd... I have never seen a two-day change in temp like this IN AUGUST. Normal is around 93 degrees this time of year. I honestly never thought I would be shivering in Sacramento in August.

In terms of medicine, the girl we treated at the soccer matches bothered me to no end Saturday. Her problems didn't seem like a heat issue. Usually, we cool them off, and they are doing well. She didn't really improve much. Her problems seemed more neurological (She complained of a sudden onset headache, which *can* be heat related, but most of the time is slow to onset). Crying incessently, poor grip strength, poor reflexes, couldn't follow simple commands, and overt confusion including not recognizing her mom. Mom and her coach denied any head injury, fever, anything that would explain any of this. And she really didn't seem hot. We still cooled her off just in case. Got her on high-flow oxygen. Temp slightly elevated, but nothing out of the ordinary for running around on a soccer field in 105 temps. Oxygen helped a bit. She woke up a little more, but couldn't speak at all. Completely aphasic. She seemed more post-dictal than anything (For you non-medical folk reading this, like she had a seizure). Things just didn't add up, if you know what I mean. I started considering the possibility of a hemorrhagic stroke. Yeah, it happens in kids, too. Being that she improved a bit with the O2, that was less a possibility. Got her transferred to the hospital.

Both my partner and I were just going over this in our heads constantly (and discussing it at the ballpark... he works there also.)... and for good reason. Turns out the next morning, we were told that she HAD been in a head-on collision with a goalie. Aha! Concussion and a seizure make a lot of sense now for the symptoms she had. Last I heard, she was doing ok and home. The crappy way we were treated by the fire department that showed up is enough for another blog entry... but I will leave that alone.

So, what's the take-home lesson for this? If it quacks like a duck, walks like a duck, and swims like a duck... it probably is a duck. If things don't seem right, they aren't. Trust your intuition. It will guide you well with your patients.

Last night was busy at the ballpark... slow early on, then a TON of foul ball hits, including one patient that went to the hospital (Yes, as I have said before, baseballs do hurt and can do a lot of damage). I was so busy, I didn't even realize that the game had ended for 20 minutes!

So, I am back at my "day job", and exhausted. I sure hope I don't get called to work tonight... I need the sleep tonight.

BTW, I still do love emergency medicine. Its just that I get worn down sometimes.

Does caffeine come in an I.V. form?

Jet Skis and Helicopters

Last weekend, I worked JetSki races at Camp Far West, a local reservoir and campsite. Most of the day was fairly quiet (yeah, the "Q" word... Its ok to say AFTER the event!). Toward the end of the day, some of the faster racers were out on the course. One of them wiped out solo, necessitating an ambulance trip to the hospital for further evaluation. Before we knew it, there was an air ambulance helicopter from Reach overhead, looking for a landing site! So, we ended up taking the patient via our ambulance to the landing site, and "hot loading" the patient into the helicopter. Its been a long time since I have done that. I had to keep reminding one of the volunteer firefighters that showed up to keep his head down... I don't need a fatality out there from the helicopter blades. For those who don't understand hot loading, the helicopter is still running, moving the rotors and blades. Its a gigantic guillotine if you aren't damn careful. The Reach guys were very professional, BTW. Nice working with you guys!

So, how did we end up with the helicopter? We certainly didn't request it. We felt the patient was stable enough to go by ground transport. It seems that they couldn't get a normal ambulance out to us in a reasonable time, so the dispatch center for Yuba County sent them out. This was after the ambulance was dispatched. Right after we loaded the patient, we saw the rig on its way in to Camp Far West... they turned around and left.

9 Firefighters Die In Collapse of Burning Store

Last night, 9 firefighters were caught in a collapse of a burning furniture store in Charleston, SC, and lost their lives. They are:

• Capt. William "Billy" Hutchinson
  • Age: 48
  • Years with department: 30
• Capt. Mike Benke
  • Age: 49
  • Years with department: 29 years
• Capt. Louis Mulkey
  • Age: 34
  • Years with department: 11 1/2 years
• Engineer Mark Kelsey
  • Age: 40
  • Years with department: 12 1/2 years
• Engineer Bradford "Brad" Baity, Nine years
  • Age: 37
  • Years with department: 9
• Assistant Engineer Michael French
  • Age: 27
  • Years with department: 1 1/2 years
• Firefighter James "Earl" Drayton
  • Age: 56
  • Years with department: 32 years
• Firefighter Brandon Thompson
  • Age: 27
  • Years with department: Four years
• Firefighter Melven Champaign
  • Age: 46
  • Years with department: Two years

Please pray for their families. These men lost their lives as heroes. They went BACK IN to look for other trapped in the burning store.

Time of your life

Today was a VERY busy shift at the ballpark. Lots of patients with varying problems. But, we got through it.

After the game, because it is Sunday, the kids run the bases out on the field. Because it is also Father's Day, they allowed dads and kids to play catch on the field also. It is really neat to see everyone down there! Here is a pic:








I also went and found a few more geocaches today. I found what is (for me) the smallest cache yet. It is literally the size of two watch batteries glue together. It screwed open, to reveal a small paper log that I signed and dated. Isn't that tiny?

C-Spine Humor

Something that most people outside of EMS aren't normally aware of is that each EMS agency purchases spine boards, and usually marks their agency on it. Not that they ever get it back (Some do - Raley Field got theirs back one time in the last 8 years). We even had one from the Los Angeles area at one time (400+ miles from Sacramento).

I got a little bored at work the other day, and was cleaning up the office a bit, when I noticed that our most recent board acquisition was from Vacaville F.D. They have a nice sense of humor! Their board reads "Stolen From Vacaville Fire":


BTW, if anyone finds the Sacramento Rivercats board, let me know! I'll come get it and trade you! We suspect it is a trophy on someone's wall.

I love Event Medicine!

It is days like today that I realize that my love of emergency medicine is alive and well. I worked out at Folsom Lake (a beautiful, albeit man-made lake just outside of Sacramento that provides a lot of the water for this region) for a friend of mine that runs an event medical service, First On-Scene EMS. It was a triathlon, and there were several hundred participants. This was a swim, a bicycle ride, and then a run. Its a lot of work for the participants. And sometimes a lot of work for those of us providing emergency medical care at these events. A lot of you know I also work for the Sacramento Rivercats, a AAA-affiliate Minor League baseball team. These two jobs have one thing in common. They are events. And event medicine is getting to be big.

The image that you see (on the left) is called the Star of Life. It is the multi-faceted approach to emergency care, with the ultimate goal of improving outcomes for those who are ill or injured. Notice the bottom phase, On-scene Care. This is where Event Medicine comes into play.

I started working in event medicine several years ago, and I love it! I thought I'd explain it a little more to everyone, so that you would understand what it is, and why it is important in today's society.

What is Event Medicine? Well, put simply, it is having emergency response personnel (EMT's and Paramedics) at events where large numbers of people are gathered. Rather than having someone call 911 when someone gets hurt or sick, a certain number of EMT's and/or Paramedics are on-scene to help stabilize and treat a patient and either transport them to the hospital, arrange for transport to the hospital, or release them from care (for minor injuries or illnesses that require no further treatment than provided).

Why is Event Medicine important?

Over the years, our activities have changed. Many people engage is what is considered "higher risk" activities than in the past. Soccer, baseball, football, wrestling, running, swimming, biking (including biathlons and triathlons), skating, surfing, skiing, you name it. Many people are aware of "ski-patrol". This is a form of event medicine. People who are specially trained in both emergency medicine AND skiing and its particular injuries and treatment do ski-patrol. At biathlons and triathlons, the situation is the same. People are trained in their emergency specialty, and also in the particular injuries and illnesses expected at this type of event. This is the same for baseball, and other sports. Non-sporting events include fairs (like county and state fairs), parades, etc. At almost all of these, there are event medical personnel, waiting in the background (or sometimes mingling with the crowd with their gear) to provide care as soon as it is needed. For some events, it is the people participating in the event (Triathlons). For other events, it is the crowd and employees that we are treating (The Rivercats, for example).

One of the problems with the "old system" was that many people who were injured or sick at events would have delays in obtaining emergent care. This resulted in higher death rates, and higher complications (like infection from wounds). Having EMT's and Paramedics on-scene lowers those rates dramatically. We can stabilize patients readily, providing the SAME CARE for many injuries that waiting for an ambulance would provide, just quicker. Stabilization includes splinting possible fractures, immobilizing people onto backboards for possible neck and spine injuries, providing oxygen as needed, dealing with diabetic emergencies, heart attacks, etc. We monitor breathing, blood pressure, oxygenation, everything you get on a BLS ambulance. We just do it out of a tent, small room, or even out of vehicles.

OK, I see ambulances at events. What is the difference?

There isn't really any. Except cost. For an event to keep an ambulance sitting and waiting (sometimes with no need that day) is prohibitively expensive nowadays. Hundreds of dollars per hour, just to sit and wait. But event medical services are much less expensive, and provide the SAME LEVEL OF CARE as typical BLS (Basic Life Support) ambulances that are seen all over the place. While some events (such as varsity and college football, for example) mandate a higher level of standby care (due to the much higher chance of needing Advanced Life Support services), most don't need that level to be just "sitting and waiting".

Some event medical providers also have ambulances and other support vehicles, but those are not typically used to transport patients to hospitals. Many times, they are used to help us transport a patient to another ambulance provider that takes them to the hospital. Seems odd, huh? Let me illustrate by example:

It was a busy day! Today we had that triathlon. We had a bicyclist injured on the ride. A serious injury (no, I can't go into what, but imagine taking a header off a fast moving bike on an asphalt road and you get the idea). We went out there in a Jeep Grand Cherokee (just like mine) with specialty medical equipment. We evaluated the patient, kept her neck from moving, placed her in C-spine (on a backboard, strapped in), and took her in the back of the Jeep with one of us with her in the back constantly evaluating her to near the entrance of Folsom Lake State Recreation Area, where an ambulance was pulling up. We transferred her to their care. Immediately, we were informed of another racer that had also crashed. While the first patient was being transported to the hospital, we raced back to the second patient. Similar injuries (similar mechanism). This patient was in a little better shape, but still needed stabilization. The first patient triggered a typical 911 call, so we also had a fire department engine as well as the ambulance that transported the first patient. They came out with us and assisted in stabilizing this patient. Another ambulance transported this patient. While all this was going on, other event medical personnel were starting to deal with yet another patient, this one was having trouble with temperature control following the swim portion of the race. We went back to assist them. We have an ambulance there, and it was running and pre-warmed just in case of this type of problem. It was incredibly windy today, and cool. Getting this patient into the pre-warmed ambulance, getting her out of her wet clothes, wrapped in special blankets, and warm fluids helped to stabilize her, and thus avoid further injury and hospitalization. She left us with her family, instead of by ambulance. If we had not been there, another ambulance would have been called. In that time period, she would have gotten worse, not better, while waiting for it to arrive. Of course, during all of this, other patients were seen, for blisters, sprained ankles, pulled muscles, cuts, scrapes, etc. Whew!If 911 had been called without properly trained personnel on-scene, the patients would not have been treated as quickly, and I believe firmly that the outcomes would not have been as positive as they were today.

This is the same concept at other events. Having emergency personnel on-scene improves outcomes. Thus, the need for this rapidly expanding and very useful segment of emergency medicine.

I hope you now have a greater understanding now of what it is I do during evenings and weekends. Some people bowl, some fish, some play golf. I like to assist people and save lives. :-)