I found myself sitting in the back of the squad catching my breath.

It truly did look like a bomb had gone off back there.  Countless plastic wrappers, empty med vials and much of the contents of our formerly pristine cabinets were tossed about.  Three different drug boxes were open with some of their contents missing.  Our stretcher sat outside of the ambulance, the lifepak and a mass of cables (hopelessly tangled) sat on top of our backboard on the stretcher.  All of the cabinets had broken tags.

It had been a very long day already, and we had a few more hours of work ahead of us in an attempt to piece together our truck.

**********

It was one of those days where you don’t get to do a lot of sitting.

I think that’s probably the most positive spin I can put on how I was feeling.  I was cold, tired, and getting a little cranky.  We had been running the stripes off the side of the truck… Back to back to back transfers with few and far between opportunities to learn about the new equipment I now have available to me at this service.  After almost 13 straight hours of teching all but one run (and squeezing in driving time when I wasn’t teching) and I was ready to throw in the towel.  Figuratively and literally.

We were posting in a quiet area… If there is such a place… I turned the lights in the mod off and reclined the captains chair.

Bring on the power nap, baby.

I had barely managed to close my eyes when I heard the high pitched tones go off.  OOOOEEEEOOOOOOOUUUUHHHHHHHH!!!!  Unit 427…. 2122 Blackhawk road… Cardiac arrest… Unit 427…2122—”

*Blink*

I leaned forward into the driving compartment and strained to hear the rest of the dispatch.  ”They just said Cardiac arrest, right?”

“Sure did,” My FTO replied as he threw the truck into drive and lit us up.

Airway bag.  Monitor.  Drug box. They’ll all need to go in.  What are the ACLS drugs and dosages?  Crap, I can’t remember the dosages…  Uhm… SHIT!  Where are the IO needles and pressure infusers kept? Do we have an extra roll of paper for the monitor?  ET or King?  Where’s the vent?  We’ll need a backboard too…  I tossed my field guide in the action area, just in case.

I had a good seven minutes to complete my mental checklist and load the stretcher up… My FTO had barely managed to hit the brakes before a Volunteer Firefighter was throwing open the back doors to the squad.

“It’s an ARREST!  BRING IT ALL!!!”  He sounded significantly more rattled than I did, which is an odd feeling for me.

I’m usually the shaky one.

I shook my head in an effort to clear my mind and jumped out of the back of the truck. The volunteer and I dragged the fully loaded stretcher across the gravel driveway towards the front door of the home.  Bright red, amber and blue lights from various vehicles bounced off of the houses.  It was a little disorienting… Kind of like stepping into a crazy nightclub environment and feeling dizzy from the light show going on inside.

**********

A man I recognized as being a fellow coworker from the last service I worked at was kneeling next to the AED while another pumped furiously on the patients chest.  ”Clear… CLEAR!!!”

The patients arms jerked like someone had just scared the life out of him.

Hrm.  I’ve never seen that happen before outside of TV or a movie…

The living room of the trailer was at capacity.  Three guys in turnout gear were mixed in with three others volunteers in jeans, sweat pants and shorts.  The patients wife sat stone-faced in a rocking chair while his two Sons held back his hysterical Daughter.  A curious neighbor hung out with the two Sheriff’s deputies outside.

“What do we have?”  I got a good look at our patient… He looked pretty good for a man in cardiac arrest… Diaphoretic, sure, but very pink.  Good on ya for the fantastic compressions, mate!

“VFib.  That was the second shock.  He was out doing some work in the back yard, came in the house, complained about some chest pain, and just dropped right here.  His son started CPR.”  The firefighter doing compressions on the large man was doing his best to give us a run down, it was very clear that he was running out of steam.  ”Someone switch with me,” he asked, a little deflated.  I’m sure his back and shoulders were screaming at him.

The next few minutes was filled with some organized chaos.

Switched to our monitor.

King LT placed with ResQPod.

Another shock.

Bilateral IO’s drilled in.

Epi pushed.

More compressions.

Another shock.

Epi pushed.

More compressions with a fresh set of arms.

Another shock.

Amiodarone pushed.

More compressions.

I was furiously scribbling down notes and reaching for another Epi when something caught my eye.  It looked like our patient with the previously dead eyes was now attempting to chew on his tube. Others noticed it too.  Three of us simultaneously reached towards pulse points on the patient.

Hey, that’s a strong radial.

“Stop… Stop for a minute,” someone yelled.  All of the activity in the room ceased for a few brief seconds while we held our breath.

That’s definitely a pulse.  That’s a good pulse.

“Oh my GOD, DAD?  DADDY???” The grown woman broke past her brothers and rushed us.  ”Is he going to live?  Did you get him back???”  She grabbed on to my arm and pleaded with me to make a promise that her Father was going to live.

I froze.  I was standing there holding the IV bags looking much like a deer trapped in headlights.  ”Uhm… We’ll do everything that we can, Ma’am… He has a long way to go, but his heart is beating on it’s own.”  I didn’t know what else to say.  I didn’t want to give her any false hope, I just wanted to get her Dad into the back of the truck and haul ass to the closest ER.

**********

He survived, and the last I heard he was neurologically intact.

We ended up doing a few 12-leads that revealed a massive inferior MI.  We kept his BP up and packed his groin and axilla with ice packs.  He got fentanyl and chilled saline.  When he started bucking the tube we RSI’d him.

A STEMI and ICE alert was called in with the report.  Luckily (if there is a way for an arrest patient to be considered lucky), we only had a ten minute transport to a STEMI center.   The patient was heading to the cath lab within a few minutes of arrival at the ER.

This was the first arrest that I’ve been able to take part in since becoming a paramedic, and it was a hell of a learning experience.

Here’s what I really picked up on during this run.  And this is in no order whatsoever….

I’ve learned that these runs work best when egos are left at the door.  I thank God that wasn’t an issue on this run.  Everyone worked together.  It was the best case scenario for the patient.

I’ve learned that there is no ALS without BLS.  We’re told this in school, and we know it in our heads, but when you see it in person, when you see that arrest patient with pink skin… because of good compressions, a BLS skill… Well, that kind of cements it in your head.  Make sure your basic skills are excellent before moving up in certification levels.

I learned that getting amped up on a run like this is best handled by remembering to breathe.  Seriously.  Keep breathing.

I learned that it’s a good idea to know if family is riding up front during transport. We often have a coping mechanism during stressful situations that most people don’t understand.  We make jokes, we say things that lay folk would find a little… well… inappropriate.  If positions were switched I can’t say I’d feel differently.  It’s all said in an effort to break the tension, and there’s absolutely no disrespect meant, but the average person isn’t going to realize that.  Just be conscious of who’s riding along.

I learned how important it is to keep track of your equipment. Equipment like thermometers, for instance, tend to disappear rather easily in the back of a squad with five people and a patient.

I know I’ve said this before… Multiple times, in fact, and I’m going to say it again.  Know the back of your truck. Know the back of your truck. KNOW THE BACK OF YOUR TRUCK. This was only my 4th shift with this service, and honestly, I thought I knew where everything was… Or at least what cabinet it was in.  I was wrong.  It wasn’t anything vital, and my FTO wasn’t upset over it, but damn if I wasn’t angry with myself over it.

So there it is, ya’ll.  My first code as a medic.  And he not only lived, but he’s still the same person.  I was a part in that as a member of a team that really did work well together.

It’s a feeling that can’t be beat.

One more thing… I made ya’ll a promise well over a year ago that when I finally pushed epinephrine as a medic that I’d do it with my people in mind (it was a little quirk of mine given my namesake).  For every single person who listened to me while I was in school, for every person who gave money (which I still can’t wrap my head around) so that I could actually go back to school… For every person who told me that I could do it.  For every person who told me that I had the stuff to reach this goal… For every person who let me start an IV on them.  For every person who was… There.  In any way shape or form.

I’m finally there.  I’m where I should be.  Thank you.  And that field guide… Never looked at it.  Not even once.

This coming Wednesday (July 14) at 7pm EST I’ll be a guest on the EMS Office Hours podcast.

Me.  Holy cow, ya’ll.

I’ll be talking with Jim about finishing up with Paramedic school, my experience so far, and my expectations as a new medic.

Feel free to pop on by Wednesday night and heckle me participate in the program!

I’ve always known that there was this hunk of muscle about the size of my fist in my chest.  I knew it pumped blood through my entire body, and that as long as it kept beating at a somewhat regular pace, say about 80 beats per minute, that that was a good thing.

Then I started Paramedic school.

The Cardiovascular system is one of the more challenging chapters for many.  Some dread it.  I looked forward to it like a kid being let loose in Toys R Us with a million bucks.  Or a certain medic student being let loose in a Coach purse store with 10 million bucks.

Yep.  I’m a geek.  Sue me :)

The more I learned, the more I wanted to learn.  I would seek out cardiac patients during my ER time.  I would frequently read articles from various websites and blogs written by people who have forgotten more about the heart than what I’ve learned (big shout out to Prehospital 12-lead and Paramedicine 101).  When I couldn’t quite understand something, I went to my people.  Blogdaddy Ambulance Driver,  Medic Matthew, and JB.

I learned about the atria, ventricles, conduction pathways and coronary arteries.  I learned about 3 leads, memorized rules to rhythms, and eventually began to understand what was going on in the heart to cause a certain rhythm to march across the monitor.  We learned about AMI’s, and 12-leads, and how doing something as simple as moving V4 can mean the difference between nitro and fluids.  I didn’t just memorize drugs and doses and that you push Adenosine really freaking fast, I learned the why behind it.

And that was  just scratching the surface. What I’ve just begun to learn… It’s hard to wrap my head around.

We’ve been done with the chapters for a few months now, and I’m still eating up all of the information I can get my hands on with a big ole spoon.  Today, for instance, was a very cool day.  Today I was fortunate enough to be able to spend some time in a cath lab.

The first thing I learned was that I look awful in scrubs.

(And yes, that’s a Chronicles sticker on the back of my phone :)

And wearing boots certainly didn’t help.

Wow, way to get off track.

Not five minutes after getting into my lovely ensemble I found myself donning a lead vest and skirt, a cap over my hair and a mask.  I was invited to watch someone have a dual chamber pacemaker put in.  The Doctor, I wish I had remembered his name, was fantastic. He really took the time to explain what he was doing as he did it, and inviting me to stand directly to his right.  I had a front row seat.  And it was so unbelievably cool.

Electricity.  It’s good stuff when it works.  When Sydney Sinus gets sick, however, all kinds of wickedness kicks up.  I watched the patients rate and rhythm change like the weather does in NW Ohio.  Which is to say often and unpredictably.  At one point there was a sinus arrest that lasted just long enough to make my heart race, about 15 seconds before returning to RSR.

The rest of my shift was equally as cool.  I was able to watch a few PCI’s being performed, and watched with held breath as pefusion was returned to what had been a blocked RCA.  And again, everything was explained to me as it was done, everyone went out of their way to answer any questions I had.

This is how it’s done, folks, these people were amazing.  And I am so grateful for the opportunity that I was given to learn and observe.

**********

I’m within a few short weeks of finish the course, and I couldn’t be more excited.  Right now my days are pretty much consumed by class and clinical time.  The next 30 days, for example have me doing six 15-hour third rides on a life squad, two eight hour OR shifts for intubations, two OB shifts (cross your fingers, I still need a live birth!), seven ER shifts, a major exam and of course the days of lecture and lab.

Am I complaining?  Absolutely not. Still, some days are easier than others, and I when I need a swift verbal kick to the backside, I know who to call.  Honestly, though, I’m doing well.  I knew this would be a challenge when I started, and it should be.

Take care ya’ll, and again, thank you for giving me this amazing opportunity!  I wont let you down!

For the students out there.

Courtesy of my Blogfather, Ambulance Driver.

Thanks, AD, for getting my head straight yet again :)  Now, back to studying.

P school is not easy.

And it doesn’t matter if it’s your first attempt or your third.  Nothing about constantly having your nose in a book, balancing work with school (and clinical time, and third rides) is fun or easy.

And it’s not supposed to be.

And then you hit the dreaded Cardiac chapter.  And even though you might have been through this before, you realize that you have to read the same paragraph three times to retain the information.  Information that you had down pat just a few years earlier seems to run away to the parts of your head that you can’t access at the most inopportune times.

You find yourself unable to remember what you walked into the kitchen for.  You start calling your four-year-old little girl by the wrong name.  Repeatedly.  And She’s less than impressed by this.  Then again she’s less than impressed by just about everything you do and at least it’s a name she recognizes…

The truth is that I’ve hit a brick wall.  And something has to give. Unfortunately for now that has to be my posts here.  For just a little bit.

That being said an amazing group of people have stepped forward and offered to takeover the blog for a bit. Some of them you’ll know, some you might not be as familiar with.  All of them are far better at this writing stuff than I am.

I’ll be back as soon as I’m through cardiac.

With that being said, I’m very honored to present you with our first guest blogger, Greg Friese.

**********

5 Things I learned in Paramedic School

In May of 2005 I completed a nine month paramedic program. Nearly five years later I can barely comprehend how I attended class two or three days a week, finished all my clinicals before the end of March, worked full-time, and welcomed our first child into the world eight weeks before graduation.

Along the way I learned a few things that I don’t recall seeing in the syllabus and as I look back may be the most important lessons I learned.

1. Everyone has advice, but that advice is not always for everyone. Lower the bevel angle. Who showed you to use such a low angle? Approach from the lateral edge. Plunge right in. Move real slow. Tension the skin here. That is not enough tension. That is too much tension. Start high. Start low. I could probably write a reasonably sized book with all the various IV insertion advice I received. Like most things there are many techniques, tips, and tricks. Once I focused on just doing it with confidence the cascade of advice dried up and my success rate increased.
2. I couldn’t learn it all. Not in nine months, probably not even in 24 months could I learn everything about being a paramedic. What I did get though was a foundation so I could keep learning and growing as a paramedic.
3. The people that smile a lot were always helpful. Kristen, an ER nurse, had an amazing smile. I remember pushing and pulling a recently deceased patient onto the funeral home gurney as she continued to explain and teach me about the code we had run an hour earlier. I gravitated to Kristen even though she was not my “official” preceptor because she was friendly with her patients. Her enthusiasm for being with patients and their families overflowed onto me and other students. Spend time with the people that genuinely smile the quickest when you enter the room.
4. Neonatal Advanced Life Support certification is way more information than any expecting dad should have seven days before their first child’s due date. As the Doctor explained the worrisome fetal monitor tracing, copious red vaginal bleeding, and weakening contractions I wished for ignorance. Instead my mind raced with things like placenta abruption, uterine rupture, and breach birth as the surgical team rushed into the room preparing my wife for an emergency c-section. Thankfully, less than an hour later a ten and half pound boy entered the world healthy and screaming and NALS worries drained away.
5. Priorities can change really fast when something big happens. There were several big events during my paramedic training – a large work project, a dramatic situation with a friend, and our first child. Each time something big happened I reshuffled the deck and came up with a new plan. I would love to tell you I studied as hard, listened as well, and read just as many pages in the last two months as I did in the first seven months. But there was no way I could hammer out another hour of studying when little Michael just needed to be cuddled.

Finally, stress and fatigue for me come in waves. Throughout paramedic class there were highs and lows. Then and now when I recognize I am at the peak of the stress wave I try to step out of it for a moment, reaffirm where I am going, eliminate any obvious clutter, and reenergize for the next manageable chunk of time and tasks.

Greg Friese is paramedic, educator, and online CE designer. His blog is http://everydayemstips.com and he co-hosts the http://emseducast.com podcast.