Those We Carry

There are calls that you remember, calls you forget, calls you'd rather forget. Then there are those we carry forever in the back of our mind. Those that come around from time to time and pull on the heart strings. This is one of them.

It was eighteen years ago today. My partner and I were flagged down by the caller. A woman leaving work heard her cries and called 911.  I found her with a bloody towel in a plastic shopping bag near the rear tire of a parked car.  She was a newborn, maybe hours old. She was cold, wet, bloody and alone. How desperate do you have to be to do this? We took her immediately to our truck and started to dry her. She had a good cry and good tone. Ten fingers, ten toes. We turned up the heat. Ironically, her disposal garment may have saved her life.  Wrapping newborns in plastic wrap is now neonatal resuscitation protocol to prevent heat loss. Her umbilical cord had been cut but not clamped. She had lost a bit of blood but her color was good. I clamped the cord, thankful that we won’t need an umbilical line. My partner suctioned her nose and mouth making sure her airway was clear. And that was it, no intubation, no IO, no CPR, nothing fancy or sexy. The ride across town couldn’t have taken more than three or four minutes but it felt like an eternity. En-route, we wrapped her up in a dry bath blanket and delivered her in stable condition to the ER at Memorial.

   

That was the last I saw of her. Her parents were never found.

The local news must have heard us on the scanner and picked up the story. Being May first, she was dubbed Baby May by the hospital staff. They say every cloud has a silver lining. Well, because of her story, a bill was filed in 2000 called the Baby Safe Haven Bill. The bill allowed a new mother to surrender her baby to a police station, fire station or hospital without question or prosecution.  The bill was signed into law in 2004 and is credited with saving more than 25 lives, preventing ninety five percent of these tragedies in Massachusetts. I hope she knows of this law in her honor.

Happy Birthday Baby May, wherever you are.

The loss of a mentor. RIP John Lynch

I first met John Lynch back in 1989. He was the 3-11 supervisor at Worcester City Emergency Ambulance. I was a paramedic student doing my field time. John was larger than life. A big man, brown suspenders holding up his pants and his badge pinned to his suspenders. We went out to a chest pain and brought the patient back to Worcester City Hospital. As we were cleaning up the truck he handed me the ECG from the Lifepack 5 and said  ”what is this?” I handed it back to him and I said “I think it’s A-fib.” He handed it back to me and said “You better take another look” I spent the next three hours looking at that strip. No P waves, irregularly irregular, I had my calipers out. It was shift change and I gave the strip back to him and said, “It looks like A-Fib to me” And he gave me a wink and said, “it is, you need to be more confident kid”

Four months later, I was fortunate enough to be hired by WCEA. Worcester City Hospital was in it’s waning days. Sick time was viewed as use it or lose it so I had the opportunity to work tons of “Bova-time” on all shifts. Many of those shifts would be spent with John.

Anyone who has ever worked with John knows when it was time to take care of Carl. An elderly man that John looked after. You also knew that John never did an errand unless he was at work.

Time off was time off so why not make use of your down time in the city doing errands? John was a waking Worcester atlas. He knew every damn street in the city. We would be transporting a patient and he would stick his head in the window between the box and the cab asking “Where the f@#* are you going?” I often asked myself how the hell he did it. After 20 years in the city, I found out.

Occasionally, I would be assigned to dispatch. There was an old window that had been boarded up in the entrance to our quarters at City. And John took great delight in hitting that plywood, scaring the shit out of anyone unfortunate enough to be on the phones that shift. His notorious laughter immediately followed. Another favorite prank of John’s was slap you in the balls while you were waiting for someone to answer the door on a call. As you held tight, he would snicker and walk on by into the house.

It seemed like he knew everybody and everybody knew him. I joked with him that he should run for city council. I remember numerous old timers telling me about him and his brother. They were known as Red and Black Lynch. An Irish thing that I am yet to understand.

I learned a lot from him. Not the medical minutia but the more noble aspects of the job.

How it was an honor to be invited into someone’s home when they were at their worse. That you have chosen to be the one to help. To be the calm in the eye of a storm. I hope people speak as well of me when I am gone.  

Rest in peace John.

For all of you police and fire thinking about nasal Narcan:

Ride Time Survival

It's always humbling to hear what others think of you. I received this email from a former coworker who ran a medic program. Some of the students wrote down their tips for success during their ride time with us. I abbreviated the contributors names. 

Tips for riders: 

Always be early to your shift. Always. 15-30 minutes is ideal.
Make sure the beginning of your shift corresponds to the shift change of the crew you're riding with. Adjust your start time to accommodate this. Otherwise, you can expect to wait for anywhere from 40 minutes to 2 1/2 hours for your crew to have time to swing by and pick you up. It's just a call volume issue, and it's worth avoiding if you can flex your schedule.
Take time to familiarize yourself with the layout of the jumpkit and cabinets. Also familiarize yourself with their model EKG machine, if not already familiar. The more quickly you can locate equipment when asked, the more confident and competent you appear. This translates into more skills and better rapport with your crew.
Solicit feedback and debrief between calls. It's a good time to ask any questions you have, and also to find out how you're doing.
Different crews will vary in their style and attitude. Be open to learning different methods for your skills, whether it's securing an IV, selecting a laryngoscope blade, or anything else.
Volunteer to help with the mundane chores before you are asked. Better yet, once you know where the linen's kept, just start making the stretcher, cleaning the patient compartment, etc. Anything you see that needs doing...do it.
Attitude is everything. Appreciate the opportunity you've been given. This is a high-volume service staffed by skilled medics. Keep your eyes peeled, ears open, and mouth shut and you are guaranteed to learn a lot.
Have a great time!

DF



Subject: WEMS ride-time survival guide

1. Know your shit.

2. Refer to number 1.

3. Show up early (1/2 hour or so).

4. Get some sleep prior to shift (esp. night shift).

5. Refer to number 1.

6. Know your drug dosages...cold.

7. Don't second-guess yourself.

8. Listen. Listen. Listen.

9. Bring food (you'll save money) and a flashlight (esp. for night shifts).

10. Work with Ed Fowler at least once but only if you have number 1.

11. Leave the attitude at home. Remember, anything you've done, they've done at least twice that week.

12. You don't know it all (which is why you’re doing ride time).

13. If you already have your tube, you ain't gettin' another one: so deal.

14. When you have to pee, or other, let them know or you won't go.

15. Be confident and assertive, but not too assertive.

16. Help to clean the truck PRIOR to doing your paperwork.

17. Seek out criticism.

18. Remember they are street medics, not "cookbook" medics. They may not always follow the book exactly as you read it.

Optional advice

A. Learn a foreign language.

B. Only participate in personal banter if you are invited.

C. Do not tell your stories. They're boring.

D. Refer to number 1.

JK& BT



Words of Wisdom for WEMS......

As previously stated "Know your shit!"

Know everything there is to know about your drugs, when to give them, how much and when not to give them.

Don't be afraid to lift; patients, equipment, stair chair, etc. A little sweat equity goes a long way. Once you're a medic you'll need to do it, might as well start now and give them a good impression.

Learn where the linen is kept and change the cot! Clean up the back of the rigs after a call and help restock supplies.

Jump in and assist with truck check prior to the shift.

Running a mop, brush or hose is not beneath you. Help wash the trucks!

Be confident and aggressive, but don't be arrogant; know your place. Most of these medics see more in one year than you'll see in your career. Respect them, and listen to what they have to say.

IM Narcan, get ready to push a lot of it. One of the best things I got out of Worcester.....

Be safe, learn and have fun!

MP



My Advice:

----------------

- Show up early

- Carry snacks with you

- If you can find a preceptor that intimidates you, ride with that person as much as possible.

- Ride with Tim and Pete at least once when they work together.

- Do a balance of night and day shifts. If you do, you will see two different worlds of EMS (both in styles of medics and types of calls)

- Talk to each medic the first time you work with him/her and find out what they expect

- Don't be afraid to ask questions. You're a student, which is why you are there.

JC


Hey T,

I found these things important while riding at WEMS,

-Schedule as many shifts as you can, you will only get this chance once.

-Early is Key, they like to get the off going crew out on time and they make up for it at the beginning of the shift.

-Look the part, clean uniform, clean-shaven, this is a PROFESSION so look and act PROFESSIONAL!

-CHECK OUT THE TRUCK, they know the truck and you need to.

-Pay no attention to what you are dispatched to; another crew is going to jump it.

-Be prepared to work fast, walking and talking is a must.

-All skills are done on the way to the hospital, so do as much of your assessment as you can while taking the patient to the truck.

-Remember to take people to the hospital and do what you can for them along the way; the back of the truck is NOT the best place for your patient.

-KNOW YOUR DRUGS......COLD. Know what they are, when to give them, how much to give them, how to give them, the effects that are desired, when not to give them, what they interact with, know why your giving it,...........KNOW IT.

-Know why you want to do something, whatever it is and then know why you don't want to do something whatever it is.

-Answer the questions you are asked.

-If you don't know, say " I DON'T KNOW" then don't ask for the answer, look it up and report back later, you'll get more out of it that way.

-You are there to learn, they aren't there to teach you but they will if you show them you want to learn. Be sure to learn from the patient whatever they have to teach you. If you don't learn from each call you are missing something.

-Ask questions, but not about war stories.

-It's about the patient not the skill, don't worry you'll get tons of both.

-Then it's about the next patient, move quickly you are in service even if you have to clean up on the way to the next call.

-RESPECT the Profession, the Professionals you are riding with and the Patient

-Get as much sleep as you can before your shift, assuming you can sleep.

-Eat what you can when you can, hypoglycemic headaches don't make anything easier.

-Keep up with your documentation; ask for signatures at the end of you shift. Clean the truck before you ask for signatures though.

-Thank your preceptors, each of them, each time you ride with them. Show your appreciation somehow, be creative.

-This will be the only time in your career when you'll have 2 experienced paramedics working with you, try to take it all in.

-This isn't supposed to be fun, but it will be if you do it right.

Just some friendly advice from a guy who was right where you are going to be.



Thanks,

JM

Congrat's CEMLEC!

The West Hartford Police Department held it's 7th annual CT SWAT Challenge last week, 8/21-8/23. The team finished in 7th place among 37 teams. There were 6 shooting events and the grueling 5.5 mile PT Challenge with 33 stations was the toughest one yet.

Here, the team loads up for the multi-gun challenge. The tent was loaded with tear gas, a stray wind had the crowd of spectators coughing and giggling at the same time.

If an accident or injury should occur, the competitors had some of the best tac-medics going to take care of them.

Also of note, my friends with the Worcester Police SWAT came in a respectable 11th place. Very good for their second year out. 

The MA State Police STOP Team fought hard to defend their 2011 win but fell just shy to the CT State Police. 

 "It was a privilege to see the skill, precision, tactical prowess and camaraderie that we saw in these teams this year. " CSC 2012

Benchmarking Public Safety in Worcester: 2012

The news is good for WEMS and Worcester. 


EMS TRENDS
Since 1991, UMass Memorial EMS has provided emergency ambulance services in Worcester at no cost to the City.11 The all-paramedic, hospital- based service operates a fleet of six ambulances staffed by 50 full-time and 25 part-time paramedics.
Over the last ten years, the EMS workload has risen and response times have declined (Chart 812 and Chart 9). UMass Memorial responded to over 30% more incidents in 2011 than it did in 2002. During the same period, its average response time to all incidents has declined by 55 seconds. Its average response time to so-called priority one calls (life-threatening injuries or illnesses) went down 3 seconds to 5:05.

UMass staff believes that improved response times in recent years could be the result of the employment in April 2009 of new global positioning system (GPS) and CAD (computer aided dispatch) system technologies. These allow dispatchers to view the exact location of each EMS vehicle, and automatically identify street routes and calculate drive times. Also, in 2009, UMass Memorial EMS added six field supervisors to the system for purposes of better quality oversight and better integration with fire and police services, and in 2010, it added a Quality Assurance/ Performance Improvement specialist to oversee the preparation and analysis of metrics as well as monitoring the performance of paramedics. These and other recent improvements, which total millions of dollars, were undertaken and fully funded by UMass Memorial at no cost to the City of Worcester.
It should be noted that, with the exception of cases of cardiac arrest, rapid response times do not necessarily enhance a patient’s survival chances.


The whole report here:
http://www.wrrb.org/files/downloads/ongoing/benchmarking/pub_safety/2012/benchmarking-public-safety-in-worcester-2012.pdf