A Kinda' Unmerry Christmas and an Unhappy Birthday... Bah humbug... Kinda...

This Christmas season was rough to say the very least.

I knew that I would be working Christmas Eve which was fine with me as I am well aware that EMS operates 24/7/365. 

But I was promised Christmas Day off by all of my employers….

I went to check what unit I was scheduled to work and who I was working with on Christmas Eve and lo and behold….

1800-0600 12/25/2010 Unit XYZ with EMT Yadda Yadda

Management had pulled a vicious fast one.

I truly felt my heart rip from my chest and quickly fall and thud at my feet.

The adults involved in my Christmas plans would reluctantly understand…

BUT the two little girls, my nieces, who were SO excited to see me on Christmas, would not.

I had made a promise I would be with them on Christmas. 

I phoned my Mom and explained that someone had pulled a fast one and I was now working Christmas and would be unable to make the trip up North with them early Christmas morning. 

She offered to make the phone call to my nieces for me but I knew that the right thing would be for me to tell them.

I am big on saying what you mean, meaning what you say, and following through with your promises. 

My sister answered her cell phone and I explained what was going on and her reaction was pretty emotional. 

I knew that talking to my oldest niece would be even worse.

And it was.

My oldest niece cried and told me it was unfair that I told her I was coming and now I wasn’t… +1 for my niece -50 for me.

So Christmas Eve came.  I was alone.

Went to work on the most Silent Night ever…

Not call volume wise, partner wise.  Look in the picture dictionary under anti social and I am sure that my partners face would appear.

We had a steady night but were not slammed.  The hours we sat at post were torture for me because all dude did was sleep and snore, grumble, and demand we go to the convenience store to get him a meatball sub. 

Lovely *Insert eye roll here*

I got off on time on Christmas morning…  Merry Christmas to me

Christmas morning my parents decided that they had to see me and had to pull something together because they supposedly felt horrible for me but I suspect they felt even more horrible for themselves. 

I could hardly keep my eyes open because I couldn’t sleep on our down time the night before due to the snoring.  I was not really all that hungry because I was so exhausted.  It was very hard to muster excitement, gratitude, and happiness.

We opened gifts.  I got some good stuff from them but alas when I am exhausted, emotionally and physically drained, and just generally feeling screwed over and unable to do a thing about it I really stop caring. 

They left and I slept until it was time to go to work on Christmas night. 

I arrived to work and it immediately became apparent that management had done nothing for those of us on duty that evening.

Ugh.

Thank God my partner was a quality human being and a quality provider because she was the saving grace in a very difficult situation.

We proceeded to get slammed. 

It was clear dispatch was pissed that they were working Christmas night because the airwaves were about as cold as the outdoor temperature and that was pretty frigid.

Lovely

Every other patient was pretty damn sick.  Some were even critical and got diesel therapy and some pretty powerful pre-hospital interventions.

0000:  Happy Birthday to Me. 

I didn’t even realize it had come because when my birthday arrived I was literally trying to save a life.

To my patient:  Thank you so much for staying alive until we reached the ER.  I really don’t appreciate people dying on my watch on my birthday… just saying

We continued to run pretty solid.  I was hungry, exhausted, emotionally shot, and really ready to be done with the shift. 

I was officially bummed. 

As we neared the end of the shift dispatch gifted us a late run. 

Of course the call was in the far Southern end of our coverage area I now knew I would be getting off AT LEAST 45 minutes late.

Happy Freaking Birthday to Me

We arrived on scene, quickly assessed and packaged the patient and quickly got on the road.

Neither of us had ever delivered a patient to this facility nor were we familiar with the area as the truck that was supposed to be covering this far south had not been scheduled this particular shift for some odd reason. 

En route to Mystery Facility it became clear that we had been covering two coverage areas that evening. 

The entire shift now made perfect sense.

We delivered the patient to Mystery Facility.  Nice place.  Nice staff.  They made handover easy.  Karma was working in my favor. 

We cleared and it was now 0645… 45 minutes after shift was supposed to end.

The radio keys up…

ANOTHER run

We quickly got on scene as it was pretty close to the where we were.  It was a complete total BS call.  Read:  Someone doesn’t have a primary care doc and uses the ED as primary medical care.

We cleared and were finally told to fuel up and head back to the station.

At the station we restocked our truck and made sure everything was in order. 

I think I literally ran to my car, jumped in and hightailed it out of the lot.

I arrived home to my parents awaiting my arrival….

And a 32 inch LCD HDTV and a dozen roses

For about 10 minutes I was absolutely thrilled.

I then inquired as to what the time frame for the day was as it was my birthday and make up Christmas. 

I was supposed to see friends and family to celebrate. 

Supposed to… key words… supposed to….

Snow called all plans off. 

Nah I phrased that too nicely, snow crapped on the day’s plans. 

I am still unplowed and stuck in my house and it’s almost the 28th from a storm that ended VERY early this morning and began midday on the 26^th. 

Basically I would like to rewind this Christmas and my birthday and have plans work out the way they were supposed to. 

Generally I am the eternal optimist and try to find the best in each and every situation and person but the cumulative disappointment and the suckage of this whole situation is making that near impossible. 

Near being the key word…

I saved one life on Christmas and one on my birthday.  I served a higher purpose.  I allowed two human beings to live longer, two families more time with their loved one, nobody died on my watch.  For that I am thankful.

Be Safe... Please be safe.

EMS providers are really are one big, dysfunctional, worldwide family…

This past week nearing the end of one of my many shifts my partner and I were en route back to the station to restock and handover the truck

Partner and I were joking and talking about the days calls when all the sudden we see one of our trucks and a semi in the middle of the grassy median.

The mood instantly went from jovial to dead silence.

Both of us felt like we were dying inside.  He looked over at me and without words we shared the same sentiment, “This isn’t happening”

Partner was driving so he put lights on, got traffic to the right and approached the scene.  As we approached we saw the truck was not in bad shape at all. 

We both audibly breathed a sign of semi relief. 

We then saw that between our guys and the semi was a HORRIBLY crumpled sedan. 

Our guys had come upon this horrible accident and were doing their jobs… in one, safe, untouched piece. 

The lump in my throat made me feel like I was choking.  I wanted to cry tears of joy.

Our guys were okay.

We asked if they needed assistance, they both made eye contact and they thanked us and told us they had it under control.  We nodded and uttered two words that until that day I didn’t fully recognize the complete significance of:

“Be safe”

That night everyone went home.  That night there were no EMS fatalities in the US, the US contingent of the EMS family remained untouched. 

This is not always the case. 

Each and every time I hear of an EMS LODD I can’t help but try to hold back tears, sometimes I cry.

I think I have the same fear every single one of us has in the back of our minds but does not talk about:

“Will today be the day I make the ultimate sacrifice?” 

Silence

So I had dinner with a large group of EMS providers this evening and we talked about basically everything but naturally we ended up talking EMS. 

The majority talked about how they hate working multiple jobs to make ends meet, bashed our system, complained about the nursing staff at the various local and not so local facilities, and of course we shared war stories.  It was a rather typical EMS meet up. 

Not one person offered suggestions as to how we can change things.  NOT. A. ONE.

I am not feeling all that wonderful so admittedly I was not the greatest company this evening.  More importantly I was rather interested to hear what everyone else had to say so I just sat back and observed and listened for a good long while. 

Finally the EMT next to me who I have known for awhile now poked me with her elbow and said, “You are so quiet it’s scaring me.  I have worked with you and we definitely have some stories to tell!”  So I replied, “Eh not feeling all that lovely and I am not my usual chipper self and anyway it’s good to listen rather than talk sometimes.” 

Insert my fellow EMS providers blank stare here.

EMS providers are VERY skilled at running their mouths so leaving one speechless, especially this one, is an accomplishment.

They run their mouths in the station or at post, they run their mouths on scene, they run their mouths in the bay, they just talk, talk, talk….

Sometimes silence REALLY is golden.  Sometimes REALLY, truly hearing a patient out is what’s necessary as one question can elicit a response that answers every single question you would have asked the patient and then some. 

Tonight silence was NOT golden. 

Everyone got their food and while there was a lull in conversation I simply stated:

“Change begins with us.  If we don’t speak up for ourselves nobody will.”

Silence.

Stating the Not So Obvious Because Common Sense is Clearly Uncommon

At some point in each and every EMT’s career, they get asked what motivated them to become an EMS provider in the first place. As time passes, a lot of providers lose focus of their initial motivation and become complacent, jaded, sloppy, difficult to work with, etc. 

The list is endless. 

Some may think I am stating the obvious, but nonetheless, the vicious cycle continues. Clearly, what some believe is obvious really is not!  Recently I have had a revolving door of, to put it as nicely as possible, partners who are poor providers and antisocial human beings; clear illustrations of what I strive not to become as an EMS provider or for that matter a human being… ever.

I am completely aware that we all have things going on in our lives.  I certainly can attest to life never being perfect. I have my own share of current obstacles that perhaps I will write about in due time. That stated, if you walk into shift with a horrible attitude it just sets the tone for the rest of the shift. 

Additionally, if you are working with a partner you are unfamiliar with, and you walk into shift with said bad attitude, I can guarantee that you will not win favor with your new partner. 

If they’re anything like I am, one who believes that if providers got their shit together and really made the attempt to improve themselves that EMS would be the better for it, you will most certainly not gain favor with them.

And you just might end up with an Sister Mary Freakin’ Sunshine, trying to draw you out of your funk and out of your shell.

I observe my regular partners on scene. I see what their method of obtaining the patient’s pertinent history is, how they assess and provide patient care, and I try to learn from them and improve.  I also observe my partner interacting with other crews, because a lot can be learned about a person watching them in everyday interactions. 

I learn how they take their coffee. I learn what they like at the local Taco Shack and Rib Joint, the one that gives the 50% EMS discounts. I try to find out about their families and interests. 

When I am in station, I allow them to pick what we watch on TV.  Some may think, “Well damn, isn’t she just a pushover!” but doing so allows me to get to know my partner. If I know – really know – my partner,  it enables that unspoken communication that allows me to gauge whether they are comfortable on scene, or if they’re having an off day. If I see that, I’ll willingly pick up the slack because strong partnerships composed of solid EMS providers create solid patient care.

Just don’t come to expect it, because I’m not always going to be Sister Mary Freakin’ Sunshine. Sometimes, it’s your turn to pick up the slack.

I know that people only want to admit to what they are good at.  That stated, it is important to talk about what you are not comfortable doing.  Don’t lie about being able to hear when auscultating blood pressure or lung sounds.  If you legitimately don’t think you can lift a patient, speak up. 

Know your limitations as well as your strengths.  Work on improving your limitations.  I refuse to call them weaknesses because they truly are not.  They are what I like to refer to as improvement points. 

I began my career with a Sprague stethoscope and, for the life of me, could not auscultate a BP. I found myself palpating a lot of blood pressures.  In one of our local Emergency Departments one night, the paramedic on the call with me told me, “Hey, I notice you try to auscultate the patient’s BP initially, but every time you seem to give up and palpate one, and that first time, we were in a quiet room in the patient’s home.”

 He suggested investing in a decent stethoscope, and had me I try my partner’s schweeeet Littman. So, I took his advice, and Ho. Lee. Shit… what a world of difference! Suddenly I could hear lung sounds easily, and my blood pressures were very accurate. 

I may have done a Snoopy Dance right there in the ED, but I categorically deny  the rumors that I ran right outside and randomly accosted passers-by, offering free blood pressure checks.

But I was pretty stoked.

Not only did my confidence in myself as a provider improve, but so did my patient care. I mean, finally I could accurately assess my patient! I know plenty of providers who jokingly admit to using the third method of blood pressure determination – oscillation - or they fudge numbers, or just use the auto cuff on the Lifepak or whatever.

So. Very. Wrong. 

Not only are you short changing your patient, which is the paramount issue,  you are also short changing yourself.  By relying on needle bounce or fudging numbers, you are NOT being the best you can be. 

People constantly settle and slack off.  I am guilty of both at certain points in my life, and I’ve missed opportunities or been passed over for advancement as a result.

Do not settle. 

Do not slack. 

Do not allow opportunities to pass you by.  Do not set yourself up for less than your best.  That’s one mantra I have followed in both my professional and personal lives.  When I find myself slacking and settling in the field, I challenge myself. 

I set goals for myself, such as going an entire calendar month without leaving a patient care report undone before I head home. I make myself take two sets of vitals on stable patients despite having a short transport. I strive to never have a PCR flagged for quality improvement. To this day, I have yet to have one returned to me because I document adequately and correctly to begin with.

Why? Because the little things count, that’s why. Show me a provider who takes pride in doing even the little things well, and I’ll bet that provider rocks the big stuff, too. 

One thing I’m always doing is suggesting to partners that we go into the bay and practice skills and use equipment that we don’t use that often.  Maybe a quarter of the time they take me up on the offer. Who cares if it’s not a scheduled training or you seem like a loser suggesting it. 

I love having students on board or in station for this exact reason.  I can use the student as an excuse to practice.  I know that is somewhat off, but for some reason having a student in station or on the rig (if you post) helps because “seasoned” EMS providers are more willing to practice their skills in the name of educating future providers. 

I also regularly bring JEMS and EMS World to work.  Sometimes when someone sees what I am reading, after ribbing me for being a whacker, they ask what I am reading and conversation ensues regarding the topics in the publications.  Sure, sometimes the topics are old news by the time they appear in print, having already been discussed and debated in social media long before, but I am okay with that, if it provides the means to open dialogue among EMS providers. 

I’ll be blunt: I really, really, REALLY dig it when a student asks me for help with the didactic portion of EMT class. The book work was always my forte.  Skills took some work for me, but the reading, writing, and paper testing where my thing.  I excelled, and honestly did not have to read most modules more than once. I studied rarely, if ever. I am blessed in that way. 

Some are not, and I recognize that. I am willing to help anybody who asks in any way I can, and if I have no clue I tell them so.

Then I’ll go research the answer and get back to them. That’s how students make me better.   

What it comes down to, in my humble opinion, is that once the ink dries on a lot of provider’s cards and they get clearance, they begin to fly just under the radar.

They get complacent. They get jaded.

It’s only human nature, but it has no place in EMS. Complacency is dangerous to yourself as a provider and human being, your partners, your employer and most importantly the patient.   We can all improve, and during down time at work you have an ambulance full of equipment to practice and hone your skills with. You have a partner who has gone through the same schooling, so practice and discuss! Only then will you be able to develop that sixth sense that tells you exactly what your partner is thinking, and what their next move will be.

That is priceless knowledge.

 EMS is not a place for ego.  I am well aware that there are many egomaniacs out on ambulances providing patient care, but this should never be the case.  You check your ego at the door. 

The job is bigger than you, or me.

Patients care about getting quality, professionally delivered care, and if you are fudging vitals, coming to work in a dirty and un-ironed uniform, not introducing yourself to patients, doing inadequate pre-shift truck checks, throwing things back into your jump bag, etc., you’re not giving it to them.

Even worse, you’re cheating yourself.

Sure, everybody has off days and things happen.  Nobody is perfect, although Ambulance Driver comes close. But don’t tell him I said that, because his ego is already freakin’ huge.  

Perfection is unattainable, but we should always strive for it nevertheless. That’s how we become our best.

The whole point of this post is that improving EMS and improving pre-hospital patient care begins with you as the provider.  You are the first healthcare contact the public has in an emergent (or not so emergent) situation.  Make sure you represent yourself in the best way possible and in doing so you will provide the best representation of your service possible! 

It’s a very simple concept: stop accepting the excuses we make for ourselves and our fellow providers, and improved public opinion will follow. More importantly, we’ll deserve their high regard.

As far our relationship and reputation with other healthcare providers, be a consummate EMS professional, introduce yourself, smile, and give a solid report that proves that you are educated and competent.  Improving how we are perceived by other healthcare professionals begins with us. 

Seriously, I shake my head in shame when I see other EMS providers walk into  a hospital wearing disheveled uniforms, no smile, mumbling some gibberish masquerading as a handoff report to the charge nurse. Is it any wonder, then, that the nurse disrespects them?

Yet, they get righteously indignant about being disrespected, as if they deserved better. It would be funny if it weren’t so sad, and so common. I wouldn’t respect that person as a healthcare provider either, and seeing so many others like them, I’d have a pretty dim view of the profession as a whole.

To be honest, I don’t respect those EMS providers. They do nothing to improve our profession, and make it nearly impossible for those of us who are.  

Clearly, common sense is uncommon, and many EMS providers are a perfect example of that truism. It’s time for us to get together and fix things before it’s too late!  We need to strive to be our best.  We need to challenge ourselves and the public’s perception of us. 

The time is now.  Don’t hesitate or it may be too late.